RESUMO
AIM: To validate and standardize the Brazilian version of the Medication Regimen Complexity Index (MRCI) for older adults in primary healthcare. METHODS: A cross-sectional methodological study was carried out with elderly patients attending primary healthcare centers in southeastern Brazil. Convergent validity was tested by correlating MRCI scores with medication number. Divergent validity was tested by correlating MRCI scores with age, sex, cognition, and basic and instrumental activities of daily living. Reliability was assessed by interrater and test-retest reliability. Regarding standardization, percentiles were calculated for the total MRCI scores. RESULTS: A total of 227 older adults were included, with a mean age of 71.4 years (standard deviation 7.5 years) and mostly women (70.9%). There was a correlation between MRCI scores and medication number (rho = 0.890; P = 0.000). There was no correlation between MRCI scores and age (P = 0.192), sex (P = 0.052), cognition (P = 0.369), and basic (P = 0.682) and instrumental (P = 0.582) activities of daily living. High interrater (intraclass correlation coefficient = 0.98; rho = 0.991) and test-retest (intraclass correlation coefficient = 0.996; rho = 0.985) reliability was obtained. The following complexity was considered: low, MRCI ≤ 9.0 points; average 0.9 < MRCI ≤ 16.5 points; and high, MRCI > 16.5 points. CONCLUSIONS: MRCI showed satisfactory psychometric qualities for measuring regimen complexity of older adults attending the primary healthcare centers evaluated. Standardization might increase the applicability of MRCI to the health research context. Geriatr Gerontol Int 2018; 18: 853-859.
Assuntos
Conduta do Tratamento Medicamentoso , Atenção Primária à Saúde , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Conduta do Tratamento Medicamentoso/normas , Reprodutibilidade dos TestesRESUMO
Pharmaceutical care is a professional practice seeking the responsible provision of drug therapy by identifying, resolving, and preventing Drug-Related Problems (DRP). The study aims to describe and evaluate the impact of pharmaceutical care given to patients being treated for tuberculosis (TB). Study concurrent, longitudinal, prospective conducted during pharmaceutical care in the TB outpatient clinic, Clinical Hospital, Federal University of Minas Gerais during the period August 2009 to July 2012. The Pharmacotherapy Workup proposed by Cipolle et al. (2004) was used. Statistical analyses were performed by X2 or Fisher exact test, as appropriate. A total of 62 patients were followed up, and 128 drug-related problems (DRP) were identified: 69.5% related to safety, 13.3% to effectiveness, 12.5% ââto indication, and 4.7% to treatment adherence, and 62.1% of the DRP were resolved. A total of 115 pharmaceutical interventions were performed. The impact of pharmaceutical care was satisfactory for 73.9% of patients with a resolution rate of 77%. There was a greater impact on pharmaceutical care (index ≥ 0.50) for those patients who were not smokers (p <0.05). The impact of pharmaceutical care was important, so the pharmacist should work alongside the multidisciplinary team to monitor treatment and perform interventions.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antituberculosos/uso terapêutico , Atitude do Pessoal de Saúde , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Assistência Farmacêutica/estatística & dados numéricos , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Prospectivos , Fatores Socioeconômicos , Adulto JovemRESUMO
ABSTRACT Pharmaceutical care is a professional practice seeking the responsible provision of drug therapy by identifying, resolving, and preventing Drug-Related Problems (DRP). The study aims to describe and evaluate the impact of pharmaceutical care given to patients being treated for tuberculosis (TB). Study concurrent, longitudinal, prospective conducted during pharmaceutical care in the TB outpatient clinic, Clinical Hospital, Federal University of Minas Gerais during the period August 2009 to July 2012. The Pharmacotherapy Workup proposed by Cipolle et al. (2004) was used. Statistical analyses were performed by X2 or Fisher exact test, as appropriate. A total of 62 patients were followed up, and 128 drug-related problems (DRP) were identified: 69.5% related to safety, 13.3% to effectiveness, 12.5% to indication, and 4.7% to treatment adherence, and 62.1% of the DRP were resolved. A total of 115 pharmaceutical interventions were performed. The impact of pharmaceutical care was satisfactory for 73.9% of patients with a resolution rate of 77%. There was a greater impact on pharmaceutical care (index ≥ 0.50) for those patients who were not smokers (p <0.05). The impact of pharmaceutical care was important, so the pharmacist should work alongside the multidisciplinary team to monitor treatment and perform interventions.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Assistência Farmacêutica/estatística & dados numéricos , Tuberculose Pulmonar/tratamento farmacológico , Atitude do Pessoal de Saúde , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antituberculosos/uso terapêutico , Equipe de Assistência ao Paciente , Fatores Socioeconômicos , Brasil , Estudos Prospectivos , Estudos Longitudinais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controleRESUMO
The prevalence of allergic diseases such as asthma has increased markedly over the past few decades. To evaluate the possible mutual influence of helminth infection and allergy, the combined effects of experimental allergic airway inflammation and infection with Strongyloides venezuelensis on various parasitological and inflammatory indices were evaluated in the rat. A challenge of immunized rats with aerosolized ovalbumin (OVA) resulted in eosinophilic inflammation that peaked 48 h after the challenge and was accompanied by airway hyperresponsiveness (AHR) to an intravenous acetylcholine challenge. S. venezuelensis infection concomitant with an OVA challenge of immunized rats resulted in prolonged pulmonary inflammation with increased eosinophil infiltration in bronchoalveolar lavage fluid but not in the lung tissue. These rats also showed a significant parasite burden reduction, especially during parasite migration through the lungs. However, the fecundity rates of worms that reached the intestine were similar in allergic and nonallergic animals. Despite airway inflammation, the increased responsiveness of the airways in the experimental asthma model was suppressed during parasite migration through the lungs (2 days). In contrast, parasite-induced AHR was unchanged 5 days after infection in immunized and challenged rats. In conclusion, infection with S. venezuelensis interfered with the onset of AHR following an antigen challenge of immunized rats. The ability of parasites to switch off functional airway responses is therapeutically relevant because we may learn from parasites how to modulate lung function and, hence, the AHR characteristic of asthmatic patients.
Assuntos
Asma/etiologia , Pulmão/fisiopatologia , Estrongiloidíase/complicações , Animais , Hiper-Reatividade Brônquica/etiologia , Eosinófilos/fisiologia , Imunização , Imunoglobulina E/biossíntese , Interleucina-10/biossíntese , Masculino , Ovalbumina/imunologia , Ratos , Ratos Wistar , Estrongiloidíase/imunologia , Estrongiloidíase/parasitologiaRESUMO
Infection by nematode parasites with a pulmonary migration in their life cycle and allergic asthma are two highly prevalent diseases in humans; therefore, one may expect both may occur concomitantly. There is a predominant and essential role of Th2 lymphocytes in the mechanisms underlying the control of parasite elimination as well as in the pathology observed in the asthmatic lung. The consequences of such situations have been explored, with controversial results, justifying the development of experimental models in which the relationship between allergic airway inflammation and helminth infection might be evaluated. The present work describes the inflammatory, humoral, and functional changes that occur in the lung of rats after single (subcutaneous inoculation of 1,500 L3 larvae) or multiple (five weekly subcutaneous inoculations of 1,500 L3 larvae) Strongyloides venezuelensis infections. The results show that the migration of S. venezuelensis larvae through the lungs of infected rats induces a local eosinophilic inflammation process which is mostly focal and parenchymal for rats infected a single time and which is peribronchial after multiple infections. The inflammatory process is accompanied by mucus hypersecretion, thickening of bronchial epithelial and muscle layers, and local increase in immunoglobulin E concentrations that peak after 5 to 7 days and are resolved after 12 days of single or multiple infections. The peak of lung immunopathologic changes observed in infected rats coincides with lung airway hyperresponsiveness (AHR), a key functional alteration in asthma. We propose that this experimental model is ideal to carry out further studies on immunoprotection against nematode infection versus immunopathology of allergic airway inflammation.