Search

Mental health care in the context of the Psychosocial Care Center – CAPS, imposes important reflections from the perspective of the performance of health professionals, where the model of interdisciplinary action emerges as a fundamental aspect for the performance. Thus, the objective of this study was to analyze the conception of health professionals at the Psychosocial Care Center about interdisciplinarity, through their analysis of this concept, as well as its applicability in their practices in professional practice. This is a study of a qualitative method, and for that, non-participant observations in technical meetings and semi-structured interviews in three different CAPS units in a metropolitan region of the city of São Paulo were used. The results point out that interdisciplinarity has been understood as a theoretical construction, being, therefore, sometimes poorly articulated and complex in terms of its applicability. It was also possible to notice a certain lack of knowledge of health professionals about the possibilities of interdisciplinary action, sometimes approaching other practices, such as multidisciplinarity, or even confused with simpler strategies of joint action. With this, the differences presented in the speeches between thinking and doing interdisciplinary go back to the difficulty of understanding, articulation and applicability of these professionals on the subject.

Objetivo: avaliar os danos atencionais em usuários de cocaína quando comparados a um grupo-controle, assim como identificar e descrever os dados sociodemográficos, o consumo abusivo e/ou a dependência de cocaína em uma amostra de universitários e de pacientes de um Centro de Apoio Psicossocial. Método: estudo descritivo com abordagem quantitativa. No total, 25 pessoas participaram da pesquisa, sendo 15 do grupo-controle e dez do grupo experimental. Foram utilizados instrumentos para medir a atenção (Bateria Psicológica para Avaliação da Atenção) e o instrumento para mensurar quais tipos de substâncias já foram utilizadas pelos sujeitos (Alcohol, Smoking and Substance Involvement Screening Test), delineando a pesquisa para que seja mais objetiva. Resultados: foram percebidos prejuízos atencionais causados pelo uso da cocaína na população de usuários em comparação com o grupo-controle. Conclusão: este estudo permite a possibilidade de refletir sobre esses danos causados pelo uso da cocaína e abrem-se novas perspectivas para a descoberta para outros prejuízos do uso da mesma droga.

Complementary and alternative medicine (CAM) has been fronted as an alternative due to its potential for holistic treatment. Many CAMs are plant-derived, including algae and mushrooms that have been used widely in many parts of the world, where they are regarded as biological response modifiers. The purpose of this article was to review the role of mushrooms as an adjuvant in conventional therapies, to reveal the therapeutic substances of mushrooms as an adjuvant in conventional therapies, to bring together the available scientific data on the medical effects of mushrooms in oncology, and verify its efficacy and safety. A literature search was conducted in September 2021 on the MEDLINE-PubMed and Cochrane databases to identify relevant randomized controlled trials or clinical trials studies addressing the use of whole mushroom formulations as complementary therapy during conventional cancer treatment.: The findings from the present study suggest that mushrooms may act as a potentiator of host defense mechanisms and decrease adverse events for patients with cancer undergoing conventional therapies. New protocols to conduct clinical trials are needed to elucidate the possible active mechanisms and clinical benefits of these fungi in various types of cancer.

The development and commercialization of genetically modified T-cell medicines using chimeric antigen receptor (CAR) T cells represents a new challenge for European Union hospital pharmacies. The aim of this article was to review the key aspects of these medicines, particularly those already available in the European Union (axicabtagene ciloleucel and tisagenlecleucel), and to describe the hospital pharmacist’s role within the multidisciplinary health team. Because CAR T-cell medicines are exclusively used at the hospital level, hospital pharmacists have a responsibility to contribute to their rational use, assuming technical responsibility for their ordering, product receipt, storage, preservation, and dispensing, as well as establishing an effective and safe system that ensures correct administration to the patient. This should also include the short- and long-term follow-up of patients treated with this type of therapy, emphasizing on the management of the main adverse effects of this therapy. CAR T-cell therapy offers hospital pharmacists the opportunity to work closely with other health professionals involved in the process, allowing their contribution to the development of procedures, clinical practice guidelines of global use, establishing starting points when facing future therapies of similar complexity, and even improving previously established basic processes in the various phases of this type of medication.

RESUMO Diversas variáveis estão implicadas no entendimento do fenômeno da dependência de substâncias psicoativas, dentre elas a personalidade. O presente estudo teve como objetivo comparar os resultados de traços de personalidade em uma amostra de vinte indivíduos do sexo masculino divididos em dois grupos compostos por dez participantes com diagnostico de dependência de substâncias psicoativas e dez participantes não dependentes a partir do modelo dos Cinco Grandes Fatores e os dados foram coletados por meio do instrumento NEO-FFI-R. Os resultados apontaram que o grupo de dependentes apresentaram escores mais altos para o fator neuroticismo quando comparados ao grupo de não dependentes e menores escores para fatores, abertura à experiência, amabilidade e conscienciosidade. Neste sentido o presente estudo visa contribuir como base para pesquisas futuras para ampliação do entendimento do papel dos fatores de personalidade na dinâmica do fenômeno de uso de substâncias psicoativas.

Immune checkpoint inhibitors are a revolution in cancer treatment, having a better toxicity profile than chemotherapy. However, many mechanisms and management of immune-related adverse events are still unknown, and guidelines are a crucial tool to take clinical decisions. However, even the most recent guidelines lack information about alternative treatments for steroid-refractory immune-related adverse events, safety in special populations, biomarkers and therapy reinstitution. The aim of this article is to review the management of immune checkpoint inhibitors immunotoxicity and analyse the possible gaps in the clinical practice guidelines. Search on PubMed, Scopus and Clarivate Analytics of articles related to immune-related adverse events’ management. The summary of product characteristics of each immune checkpoint inhibitor approved by EMA and/or FDA was also considered. Based on this general literature search, an analysis of what is included in the most cited guidelines was made. Overall, 83 records were included in the descriptive review. The least developed topics in guidelines that are important to consider in future versions of the guidelines are the conditions to reinstitute immunotherapy after adverse events, possible biomarkers useful for clinical practice, if special populations such as patients with prior autoimmune diseases and elderly are eligible for treatment and options in the management of steroid-refractory adverse events. Furthermore, the grading system used for immunotoxicity classification may underestimate toxicity, and it is not optimized for immunotherapy. Clinical practice guidelines need to be updated and include information about special populations, biomarkers, treatment reinstitution and steroid-refractory immune adverse events.

We present the first systematic feasibility study of accessing generalized parton distributions of the pion at an electron-ion collider through deeply virtual Compton scattering. Relying on state-of-the-art models for pion GPDs, we show that quarks and gluons interfere destructively, modulating the expected event rate and maximizing it when parton content is generated via radiation from valence dressed quarks. Moreover, gluons are found to induce a sign inversion for the beam-spin asymmetry in every model studied, being a clear signal for pinning down the regime of gluon superiority, We would like to thank P. Barry, H. Dutrieux, T. Meisgny, B. Pire, K. Raya, C. D. Roberts, D. Sokhan, Q.-T. Song, P. Sznajder, and J. Wagner for interesting discussions and stimulating comments. This work is supported by the University of Huelva under Grant No. EPIT-2020 (J.M.M. C.). F. S., J. R. Q., and J. S. acknowledge support from Ministerio de Ciencia e Innovación (Spain) underGrant No. PID2019–107844 GB-C22 and Junta de Andalucía, under the 2014-2020 FEDER Contracts No.UHU-1264517, No. P18-1321FR-5057 and No. PAIDI FQM-370. This project was supported by the European Union’s Horizon 2020 research and innovation program under Grant Agreement No. 824093. This work is supported in part in the framework of the GLUODYNAMICS project funded by the “P2IO LabEx” (No. ANR-10-LABX-0038) in the framework “Investissements d’Avenir” (No. ANR-11- IDEX-0003-01) managed by the Agence Nationale de la Recherche (ANR), France

Introduction Cancer is considered one of the most devastating causes of death for humanity. Innovative and targeted therapies have become urgent in the treatment of this large subset of diseases. Over the last decade, the development of PARP (poly (ADP-Ribose) polymerase) inhibitors has emerged as a new target in cancer therapy. Areas covered The authors conducted a review focusing on the clinic relevance and adverse effects of the four drugs already approved by drug regulatory agencies, namely: olaparib, rucaparib, niraparib and talazoparib. Despite the targeted action of this drug class, the adverse effects should be carefully monitored for the adequate safety of cancer patients taking them. The role of multidisciplinary cancer teams is crucial to help more and more patients to benefit from these revolutionary agents. Expert opinion PARP (poly (ADP-Ribose) polymerase) inhibitors are drugs with great potential in the treatment of several types of cancer. However, their toxicity profiles often lead to treatment interruption or early discontinuation. The daily monitoring of these cancer patients by multidisciplinary cancer teams is essential for the success of therapy and for the promotion of a better quality of life.

A pratica obrigatoria da avaliacao psicologica em motoristas e candidatos a obtencao da Carteira Nacional de Habilitacao (CNH) e a mais conhecida atribuicao do psicologo no contexto do trânsito. Compreende-se que a acao de dirigir demanda de habilidades cognitivas minimas que sao de grande relevância para o comportamento do motorista. Posto isto, este trabalho apresenta como objetivo identificar na literatura quais construtos psicologicos minimos apontados como relevantes na avaliacao psicologica de candidatos a Carteira Nacional de Habilitacao. Realizou-se uma pesquisa bibliografica narrativa do tipo qualitativa e exploratoria, para levantamento dos dados foram pesquisados artigos cientificos nacionais nas bases de dados Scielo, Pepsic, Scholar Google (Google Academico), atraves de triagens por titulos e palavras chaves: “trânsito”, “avaliacao psicologica”, “motorista”, e “construtos psicologicos”. Como resultado da pesquisa foi possivel constatar que os construtos aferidos em qualquer condutor na pericia psicologica devem ser: atencao concentrada, atencao dividida, a atencao alternada, memoria visual, inteligencia, juizo critico/comportamento e tracos de personalidade. Conclui-se entao que mesmo que com as condicoes psicologicas minimas determinadas em resolucao, ha ainda insuficiencia na sistematizacao dessas caracteristicas psicologicas dos candidatos a Carteira Nacional de Habilitacao que possa servir de parâmetro para o trabalho do psicologo.

Pion and kaon structural properties provide insights into the emergence of mass within the Standard Model and attendant modulations by the Higgs boson. Novel expressions of these effects, in impact parameter space and in mass and pressure profiles, are exposed via $\pi$ and $K$ generalised parton distributions, built using the overlap representation from light-front wave functions constrained by one-dimensional valence distribution functions that describe available data. Notably, e.g. $K$ pressure profiles are spatially more compact than $\pi$ profiles and both achieve near-core pressures of similar magnitude to that found in neutron stars., Comment: 9 pages, 6 figures, 2 tables. Accepted for publication in Phys. Lett. B

Background and importance Some medicines are described as potentially inappropriate medications (PIM) for older patients. At least one PIM is regularly prescribed in 25–56% of hospitalised elderly patients,1 and have been associated with adverse drug reactions in this population. Aim and objectives To identify what medicines classified as PIM by three different tools are present in national hospital formulary of medicines (NHFM) and to check what information, if any, is in the summary of product characteristics (SmPC) about precautions in older patients. Material and methods A search (September 2019) of the Portuguese NHFM, through the National Medicines and Health Products Authority (INFARMED) website, was made for all medicines included in the EU(7)-PIM list, in the STOPP V.2 criteria and in the 2019 Beers criteria. For each PIM found in the NHFM, the SmPC was analysed to check the recommendations made for older patients. Results There are 242 chemical substances included in the Portuguese NHFM that were classified as PIM by at least one of the three tools. It was observed that, of these 242 chemical substances, 181 were classified as PIM by the STOPP criteria, 136 by the EU(7)-PIM list and 64 by Beers criteria. About 17% of identified PIMs were present in all three tools. About 27% of all PIM in the NHFM belonged to the ATC group C (cardiovascular system), 23% to group N (nervous system) and about 15% to group A (alimentary tract and metabolism). The SmPC of about 36% of the identified PIMs did not have special recommendations or precautions for use in older patients. Conclusion and relevance Identification of PIM by hospital pharmacists, using adequate tools, is essential to contribute to the reduction in drug related problems in older patients. References and/or acknowledgements 1. Scott, et al. Using EMR-enabled computerised decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review. Ther Adv Neurol Disord 2017;23:153–156. Acknowledgements This work was financially supported by the project APIMedOlder (PTDC/MED-FAR/31598/2017), funded by FEDER/FNR, POCI-01-0145-FEDER-031598, and by national funds (OE), through FCT/MCTES. No conflict of interest.

Ethnopharmacological relevance Arbutus unedo L., the strawberry tree (Ericaceae family) is of increasing interest because of its common traditional, industrial, chemical and pharmaceutical uses. The plant is a typical evergreen plant of the Mediterranean basin, as well as of other regions with hot summers and mild rainy winters. This review covers the studies relevant to Arbutus unedo L. utilization in the current pharmacological therapy. Materials and methods The available information on traditional uses, phytochemistry and biological activities of Arbutus unedo L. was collected from scientific databases through a search using the keywords ‘Arbutus unedo L.’ and/or ‘strawberry tree’ in ‘Google Scholar’, ‘Pubmed’, ‘Sciencedirect’, ‘SpringerLink’, ‘Web of Science - Clarivate Analytics’ and ‘Wiley’. Unpublished Ph.D. and M.Sc. dissertations were also consulted for chemical composition, biological activities and traditional uses of Arbutus unedo L. and for manual search of additional references. Results The fruits of the plant have been traditionally used as antiseptics, diuretics and laxatives in folk medicine, while the leaves have been used due to their diuretic, urinary antiseptic, antidiarrheal, astringent, depurative and antihypertensive properties. According to the scientific literature survey, different extracts obtained from Arbutus unedo L. have demonstrated a high pharmacological potential due to their in vitro and preclinical antibiotic, antifungal, antiparasitic, antiaggregant, antidiabetic, antihypertensive, anti-inflammatory, antitumoral, antioxidant, and spasmolytic properties. Conclusion This review suggests that A. unedo is a promising source of phytopharmaceutical products. The potential advantages of Arbutus unedo are related with the presence of polyphenolic compounds in its composition. However, further studies are needed to ascertain some profitable effects in humans. The beneficial effects associated with this shrub suggest that Arbutus unedo can be used for the development of new drugs to treat diseases such diabetes, hypertension, among others. Nonetheless, the safety of the Arbutus unedo compounds should also be examined.

El alcohol es la sustancia cada vez mas presente en el consumo de este estudio fue describir adolescentes. O sobre el consumo de alcohol y la calidad de las relaciones sociales entre los miembros de la familia y amigos para determinar como estas influyen en el consumo de alcohol. Trata es un estudio transversal cuyos datos se recogieron con una muestra de 2423 estudiantes matriculados en la escuela secundaria. Os datos expresan la importante presencia de alcohol en las relaciones y el uso de la conexion con las relaciones tanto familiares y sociales parejas, independientemente de las relajones. El dato es relevante para pensar acerca de la efectividad de las intervenciones de politica publica, considerando los lazos familiares y sociales.

Type 2 diabetes mellitus is one of the main chronic diseases worldwide, with a significant impact on public health. Behavioral changes are an important step in disease prevention and management, so the way in which individuals adapt their lifestyle to new circumstances will undoubtedly be a predictor of the success of the treatments instituted, contributing to a reduction in the morbidity and mortality that may be associated with them. It is essential to prepare and educate all diabetic patients on the importance of changing behavioral patterns in relation to the disease, with health professionals assuming an extremely important role in this area, both from a pharmacological and non-pharmacological point of view, and also ensuring the monitoring of the progress of these measures. Diabetes is a chronic disease that requires a high self-management capacity on the part of patients in order to achieve success in treating the disease, and non-adherence to therapy or non-compliance with the previously defined plan, together with an erratic lifestyle, will contribute to failure in controlling the disease. The lower adherence to pharmacological and non-pharmacological treatment in diabetes is mainly correlated to socio-economic aspects, lower health literacy, the side effects associated with the use of antidiabetic therapy or even the concomitant use of several drugs. This article consists of a narrative review that aims to synthesize the findings published in the literature, retrieved by searching databases, manuals, previously published scientific articles and official texts, following the methodology of the Scale for Assessment of Narrative Review Articles (SANRA). We aim to address the importance of behavioral sciences in the treatment of diabetes, in order to assess behavior factors and barriers for behavior changes that have an impact on the therapeutic and non-therapeutic optimization in patients with type 2 diabetes mellitus control.

Background Allergic rhinitis represents a public health problem that is significantly prevalent in the global population and has been associated with asthma, a strong desire to sleep and a low quality of life. Objective This study aims to evaluate the prevalence, symptoms, control strategies and treatment, as well as the control of this condition and its impact on the quality of life of customers of community pharmacies with allergic rhinitis. Setting A questionnaire survey was carried out in nine community pharmacies in the city of Guarda, Portugal. Method In this cross-sectional study, data was collected by an interview between May 2014 and December 2014. The control of the illness and the impact of allergic rhinitis on the quality of life were assessed through a CARAT10 test and a WHOQOL-BREF instrument, respectively. Main outcome measure The impact of allergic rhinitis on the patient's quality of life. Results The estimated prevalence of allergic rhinitis was between 10.8% and 15.4%, from which 63 and 42 individuals were medically and symptomatically diagnosed, respectively, from a study population of 804 respondents. The majority of participants (57.1%) suffered from the symptoms more than twice a year. The symptoms, such as difficulty in falling asleep, repeated and continuous sneezing and bilateral nasal obstruction, were severe. There were patients with uncontrolled allergic rhinitis symptoms after the CARAT10 test, even when the individual's perception of the quality of life was good according to the WHOQOL-BREF score, with gender differences in the psychological domain. It should also be emphasized that there was a significant association between higher education levels with better control of the illness/quality of life. Additionally, most participants used pharmacological treatment (not alternative therapies) and the adoption of self-management measures to relieve their symptoms. Conclusions The findings of this study showed that the estimated prevalence of allergic rhinitis seems to be apparently lower in Guarda than that found in the general Portuguese population. From the data, some patients showed uncontrolled allergic rhinitis symptoms, strengthening the importance of the role of intervention by a health professional.

A presente revisao bibliografica analisou artigos publicados sobre violencia psicologica entre jovens parceiros intimos, captados por meio do gerenciador de artigos cientificos Mendeley . A partir do descritor psychology violence foi possivel acessar 1.897 artigos, em cerca de 300 bases, publicados desde o ano de 1979 ate 2018. Apos, utilizarmos criterios de exclusao e priorizamos os trabalhos entre os anos de 2015 ate 2018, chegou-se a uma base final com 15 artigos analisados, provenientes de oito paises. Podemos concluir que: as adolescentes percebem mais a violencia psicologica; ha fortes correlacoes com problemas de saude, desenvolvimento e rendimento escolar, nos individuos vitimados; a violencia sofrida no lar aumenta a probabilidade de violencia no namoro; o comportamento violento pode ser perpetuado na fase adulta, e em outros relacionamentos. O tema tem exploracao apenas incipiente em todas as areas, no Brasil e no mundo, o que serve de alerta para a producao de novos trabalhos e para a formatacao de programas de conscientizacao e prevencao da violencia psicologica entre jovens casais.

The presence of age-related comorbidities prone elderly patients to the phenomenon of polypharmacy and consequently to a higher risk of nonadherence. Thus, this paper aims to characterize the medication consumption profile and explore the relationship of beliefs and daily medication management on medication adherence by home-dwelling polymedicated elderly people. A questionnaire on adherence, managing, and beliefs of medicines was applied to polymedicated patients with &ge, 65 years old, in primary care centers of the central region of Portugal. Of the 1089 participants, 47.7% were considered nonadherent. Forgetfulness (38.8%), difficulties in managing medication (14.3%), concerns with side effects (10.7%), and the price of medication (9.2%) were pointed as relevant medication nonadherence-related factors. It was observed that patients who had difficulties managing medicines, common forgetfulness, concerns with side effects, doubting the need for the medication, considered prices expensive, and had a lack of trust for some medicines had a higher risk of being nonadherent. This study provides relevant information concerning the daily routine and management of medicines that can be useful to the development of educational strategies to promote health literacy and improve medication adherence in polymedicated home-dwelling elderly.

Este estudo consiste numa revisao de literatura sobre o uso de maconha por adolescentes e suas consequencias neuropsicologicas, os fatores de risco, a influencia e as estrategias de prevencao ao uso de drogas, bem como o tratamento dos adolescentes drogaditos. Foram selecionados 15 artigos utilizando-se de 5 bases de dados: Scielo, PsycInfo, Progust, Pepsic e Lilacs, tendo como descritores as expressoes adolescencia, cannabis, prevencao de drogas, fatores de risco na adolescencia e habilidades sociais. Os resultados deste estudo mostraram que a adolescencia e um fator de risco por si so, o que somado aos conflitos com a familia e rede social acabam aprofundando a vulnerabilidade e comportamento de risco do adolescente. O consumo do alcool, maconha e outras substâncias psicoativas (SPA) entram no contexto como forma de ameniza-las. A influencia da familia e redes sociais pode ser positiva se seus membros tem bom relacionamento com adolescentes e negativa se eles fazem uso de drogas, ja a abordagem preventiva nas escolas e uma das melhores estrategias de enfrentamento do uso das drogas pelos adolescentes. Quanto ao tratamento dos adolescentes drogaditos, o estudo mostrou que na busca por ajuda terapeutica no CAPS e comunidades terapeuticas predominou o adolescente masculino, multiusuario de SPA e reincidente. As comunidades terapeuticas oferecem tratamento baseado na abstinencia total da droga e isolamento social em franca contradicao ao modelo psicossocial preconizado pelo SUS. Ja os CAPS atuam conforme politicas de RD (reducao de riscos) que tem como objetivo reduzir os efeitos nocivos de uso de SPA.

A familia desempenha um papel fundamental no contexto do consumo de substâncias psicoativas, e o modelo comportamental dos pais pode contribuir como fator de protecao ou de risco. Sao diversos os fatores contribuintes que levam ao uso de substâncias e ha evidencias da relacao entre o consumo de SPAs e o universo familiar. Estudos apontam a importância da relacao entre pais e filhos, principalmente referindo-se as praticas utilizadas no manejo da educacao. Objetivo: A presente pesquisa teve por objetivo analisar a relacao entre estilos parentais e o consumo de drogas. Metodo: Foi realizado um estudo experimental com o objetivo de comparar os resultados obtidos por meio do Inventario de Estilos Parentais (IEP), entre sujeitos com diagnostico de dependencia em SPA e nao diagnosticados. A amostra foi composta por dez participantes com diagnostico e dez sem diagnostico. A coleta de dados ocorreu entre os meses de julho e agosto de 2019 em uma clinica de recuperacao para dependentes em SPA e um centro universitario, localizados no municipio de Curitiba-PR. Resultados: Os resultados obtidos corroboraram com a literatura e foi possivel identificar que diferentes comportamentos sociais, entre eles o consumo de substâncias psicoativas, podem ser aprendidos a partir das interacoes estabelecidas entre pais e filhos e as praticas educativas consideradas como negativas possuem grande influencia no desenvolvimento de comportamentos antissociais e a negligencia e considerada um dos principais fatores e esta intimamente associado a historia de vida de usuarios de alcool e outras drogas e as praticas educativas consideradas positivas, podem reduzir a possibilidade de engajamento em comportamentos de risco, demonstrando haver correlacao positiva entre apego familiar e comportamentos pro-sociais. Conclusoes: Os Pais que adotam um estilo de monitoria fundamentado no respeito e em relacoes de reciprocidade, constroem as condicoes de adaptacao positiva e pro-sociais atuando assim como fator protetivo ao uso de substâncias psicoativas.

Resumo: O uso de substâncias psicoativas alteracoes nas funcoes executivas. Essas funcoes possibilitam nossa interacao nas mais variadas situacoes seja na organizacao, regulacao de tempo e tomada de decisoes. Objetivos: analisar o comprometimento das funcoes executivas em usuarios de substância psicoativas fazendo uma comparacao dos resultados obtidos em um teste entre dois grupos (dependentes e outro de nao dependentes). Metodo: Foi elaborada uma pesquisa experimental, descritiva e exploratoria de natureza quantitativa e qualitativa. Os dados foram coletados por meio da Escala de Avaliacao de Disfuncoes Executivas (BDEFS), realizada entre as datas 19/08/2019 e 09/10/2019. Resultados: Foi possivel verificar as alteracoes ocasionadas pelo uso de substâncias psicoativas quando comparado ao grupo controle, destacam-se neste estudo as alteracoes nas funcoes de regulacao do tempo, autocontrole, autorregulacao de emocoes, organizacao, resolucao de problemas. Discussao: As alteracoes de funcoes encontradas neste estudo se convertem em prejuizos na organizacao regulacao do tempo e principalmente na capacidade de resolver problemas e tomar decisoes. Consideracoes finais: A avaliacao neuropsicologica pode contribuir significativamente para a elaboracao de estrategia de intervencoes efetivos ao atendimento que os sujeitos possam beneficiar, bem como maior adesao ao tratamento.

Diabetes mellitus is a major health problem that is growing rapidly worldwide. A collaborative and integrated team approach in which pharmacists can play a pivotal role should be sought when managing patients with diabetes.To identify and summarize the main outcomes of pharmacist interventions in the management of type 2 diabetes.PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials evaluating the effectiveness of any pharmacist intervention directed at patients with type 2 diabetes in comparison with usual care. Outcome measures of interest included glycosylated hemoglobin (Alc), blood glucose, blood pressure, lipid profile, body mass index (BMI), 10-year coronary heart disease (CHD) risk, medication adherence, health-related quality of life (HRQoL), and economic outcomes. The risk of bias in included studies was assessed using the Cochrane risk of bias tool.Thirty-six studies were included in this systematic review, involving 5,761 participants. The studies evaluated the effects of several pharmacist interventions carried out in various countries and in different health care facilities, such as community pharmacies, primary care clinics, and hospitals. The number of studies reporting each outcome of interest varied. Alc was evaluated in 26 studies, of which 24 reported a greater reduction in this outcome in the intervention group compared with the control group, with the difference in change between groups ranging from -0.18% to -2.1%. Eighteen studies assessed change in systolic blood pressure, of which 17 studies reported a greater improvement in this outcome in the intervention group, with the difference in change between groups varying between -3.3 mmHg and -23.05 mmHg. For diastolic blood pressure, a greater effect was also observed in the intervention group in 14 out of 15 studies, with the difference in change between groups varying between -0.21 mmHg and -9.1 mmHg. Thirteen studies described total cholesterol as an outcome measure, of which 10 reported a greater improvement in this outcome in the intervention group, with the difference in change between groups ranging from +18.95 mg dL(-1) to -32.48 mg dL(-1). With regard to low-density lipoprotein cholesterol, a greater reduction in this parameter in the intervention group was documented in 12 out of 15 studies, with the difference in change between groups varying between +7.35 mg dL(-1) and -30 mg dL(-1). Similarly, favorable data were reported on high-density lipoprotein cholesterol in the intervention group in 9 out of 12 studies that assessed this outcome, with the difference in change between groups ranging from -5.8 mg dL(-1) to +11 mg dL(-1). Data on triglycerides were also reported in 12 studies, of which 9 reported a greater reduction in triglycerides levels in the intervention group, with the difference in change between groups varying between +12 mg dL(-1) and -62 mg dL(-1). Overall, a beneficial effect on BMI was also described in the intervention group in 12 out of 14 studies. Of note, in all 6 studies that estimated the 10-year CHD risk among study patients, a greater improvement in the intervention group versus the control group was found. In addition, pharmacist interventions also had a positive impact on medication adherence and HRQoL in most studies that ascertained these outcomes. Finally, although only 3 studies conducted a cost-effectiveness analysis, pharmacist interventions proved to be cost-effective.The findings from this review clearly support the involvement of pharmacists as members of health care teams in the management of patients with type 2 diabetes.This systematic review was not funded. The authors declare that they have no conflicts of interest. Concept and study design were created by Pousinho, Morgado, and Alves. Pousinho took the lead in data collection, along with Alves, and data interpretation was performed by Pousinho, Falcão, and Alves. The manuscript was primarily written by Pousinho, along with Alves, and revised by Alves, Morgado, and Falcão.

Breast cancer (BC) is the most common cancer in women worldwide, and has an undeniable negative impact on public health. The advent of molecular biology and immunotherapy has made targeted therapeutic interventions possible, providing treatments tailored to the individual characteristics of the patient and the disease. The over-expression of human epidermal growth factor receptor (HER) 2 is implicated in the pathophysiology of BC and represents a clinically relevant biomarker for its treatment. Trastuzumab, a recombinant antibody targeting HER2, was the first biological drug approved for the treatment of HER2-positive BC. Although there are currently other anti-HER2 agents available (e.g. pertuzumab and lapatinib), trastuzumab remains the gold standard for treatment of this disease subtype. Nonetheless, concerns have been raised regarding potential cardiotoxicity and treatment resistance. Moreover, several other therapeutic issues remain unclear and have been addressed in an inconsistent way. The current literature lacks a comprehensive review of trastuzumab providing useful information for clinical practice, including pharmacokinetic and pharmacodynamic aspects, its clinical use, existing controversies and future advances. This detailed review of trastuzumab in the pharmacotherapy of BC attempts to fill this gap. info:eu-repo/semantics/publishedVersion

Introdução: O abuso sexual infantil manifesta-se em todos os países e culturas, trazendo consequências que podem permanecer até a vida adulta, repercutindo na saúde física e principalmente psicológica do sujeito. Objetivos: O presente estudo objetivou investigar na literatura quais as consequências psicológicas desenvolvidas pelos adultos abusados na infância. Método: Trata-se de uma pesquisa de natureza qualitativa, descritiva, exploratória e de revisão de literatura sistemática cujo levantamento se deu por meio da base de dados de artigos científicos denominada BIREME, no período de 2014 a 2019, utilizando como o descritor o termo “abuso sexual infantil”. Partindo de tal pesquisa, dentre os 120 artigos apresentados pela base de dados. Resultados: Após aplicar todos os critérios de inclusão e exclusão foram selecionados 9 artigos que tratavam acerca da problemática. Discussão: Este estudo permitiu observar que as consequências do abuso sexual infantil implicam em danos graves sobre a saúde mental das vítimas, e, se não tratados corretamente, podem permanecer por toda a vida. Conclusão: A proporção dos danos depende muito da idade da criança, da configuração da relação em que há entre o abusador e a vítima, do ato sexual, da frequência, e ainda, do tempo de duração do abuso sexual. Quanto mais nova a criança, mais vulnerável ela é ao trauma.

By increasing the activity of the immune system, immune checkpoint inhibitors (ICPI) can have adverse inflammatory effects, which are referred to as immune-related adverse effects (irAEs). In this review, we present the recommendations for the appropriate identification and treatment of irAEs associated with ICPI to increase the safety and effectiveness of therapy with these immuno-oncological drugs. Several guidelines to manage irAEs adopted by different American and European societies in the field of oncology were identified. A narrative review of the several strategies adopted to manage irAEs was performed. With close clinical surveillance, ICPI can be used even in patients who have mild irAEs. Moderate to severe events require early detection and appropriate treatment, particularly in patients with a history of transplantation or pre-existing autoimmune disease. In most cases, adverse reactions can be treated with the interruption of treatment and/or supportive therapy, which includes, in serious adverse reactions, the administration of immunosuppressants. The identification and treatment of irAEs in the early stages may allow patients to resume therapy with ICPI. This review is an instrument to support healthcare professionals involved in the treatment and monitoring of patients who are administered ICPI, contributing to the timely identification and management of irAEs.

A maioridade penal e um assunto nao resolvido do ponto de vista legislativo no Brasil e a discussao implica natural polemica ante a escalada dos indices de violencia. As propostas ate aqui colocadas na mesa por parlamentares nao conseguiram atingir seu objetivo, qual seja, serem levadas a efetiva votacao e implementacao, exatamente pela polarizacao que se cria sobre o tema. Tratando-se a maturidade do individuo, determinante na questao de julgamento e tomada de decisao, de um construto neuropsicologico, buscou-se descrever, no presente, as principais propostas em tramitacao no Congresso Nacional com vistas a reducao da maioridade penal, cotejando os ordenamentos juridicos brasileiro e americano, bem como conceituar as bases neuropsicologicas envolvidas no processo de maturacao do individuo. Descrever os achados mais recentes de estudos neuropsicologicos no tocante a maturidade, alem de descrever brevemente a experiencia americana no tocante a reducao da maioridade penal, por fim, constituem meio valido a compreensao das razoes pelas quais a polemica persiste. Foram pesquisadas as propostas de reducao da maioridade penal atualmente constantes do site do Congresso Nacional, bem como a legislacao penal brasileira em vigencia, alem da legislacao civil, constitucional e de protecao a crianca e ao adolescente. Procedeu-se, outrossim, a pesquisa de artigos constantes do Portal Regional da BVS e de revistas internacionais de neurociencia na Internet .

Purpose The complex combination of medicines associated with age-related physiological alterations leads older adults to experience drug-related problems (DRPs). The goal of this study was to review the frequency and type of DRPs and DRP risk factors in home-dwelling older adults. Methods A MEDLINE PubMed and EMBASE scientific databases search was performed. Articles published from January 2000 through December 2018 reporting DRPs in home-dwelling older adults were included. Findings From 668 articles screened, 13 met the inclusion criteria and were included in this study. Overall, the studies included 8935 home-dwelling patients. The mean number of DRPs per patient observed was 4.16 (1.37–10). The main causes of DRPs were “drug selection” (51.41%), “dose selection” (11.62%), and “patient related” (10.70%) problems. The drug classes more frequently associated with DRPs were “cardiovascular system,” “alimentary tract and metabolism,” and “nervous system,” and they represented 32.1%, 29.4%, and 16.5% of all drug selection problems, respectively. Respiratory system medicines accounted for 6.65% of all DRPs, of which “patient related” problems accounted for 97.28%. Implications Despite the heterogeneity of methodology of the included studies and the heterogeneity of tools used to identify DRPs, this analysis clearly shows the high prevalence of DRPs in home-dwelling older adults and highlights the need for interventions to improve medicine use in this population. This work also provides useful information for the development of strategies to improve medication use in home-dwelling older adults.

O objetivo deste estudo foi avaliar a qualidade de vida em adolescentes matriculados em escolas do Municipio de Sao Paulo, a maior cidade do pais. Para atingir este objetivo aplicou-se o instrumento de qualidade de vida SF-36 e um instrumento para verificar a classe sociodemografica de uma amostra de 2.434 adolescentes. Observou-se que varios aspectos influenciam na qualidade de vida desta populacao. Os estudantes do genero masculino declararam qualidade de vida mais alta do que as do genero feminino. Da mesma forma, os adolescentes mais novos tenderam a relatar melhor qualidade de vida que os mais velhos. Os representantes das classes socioeconomicas mais altas tambem apresentaram melhor qualidade de vida. Observou-se a necessidade de novas pesquisas e acoes que promovam tanto a qualidade de vida quanto os habitos saudaveis e auxiliem na busca de alternativas apropriadas de lazer.

Este estudo objetivou verificar a prevalencia do consumo de substâncias psicoativas em adolescentes do ensino medio da cidade de Maceio, no Estado de Alagoas. Tratou-se de um estudo descritivo transversal. A amostra foi composta por 407 estudantes de quatro escolas publicas e tres particulares. Os participantes responderam a um questionario sociodemografico e a um questionario sobre o consumo de substâncias psicoativas. O alcool foi a substância mais consumida nas cinco modalidades de uso: na vida, no ano, no mes, uso frequente e uso pesado. O consumo na vida foi prevalente nos adolescentes do sexo masculino e nos estudantes das escolas particulares. A pesquisa verificou a necessidade de realizar projetos de prevencao ao uso de drogas de promocao de saude. Palavras-chave: adolescencia; drogas; abuso de substâncias; ensino medio; prevalencia.

Current study analyzes drug consumption in undergraduates and verifies the association with stress. Methodology involves descriptive research in 373 undergraduates. Data were collected online and participants responded to TCLE, sociodemographic questionnaire, stress measuring tool (Perceived Stress Scale – EP-10) and illicit drug consumption. Logistic regression at 0.05% significance was employed to assess the association between abuse drugs and the variable under analysis. Logistic regression revealed significant association between tobacco usage, religion and living with parents. In the case of alcohol consumption and other drugs, logistic regression provided association with high stress. The more undergraduates are exposed to risk factors, such as stress, the more their possibilities in drug consumption.

Background Underuse of medication considered beneficial is particularly common in elderly patients. A new Screening Tool to Alert Doctors to the Right Treatment (START) has been published to identify potential prescribing omissions. Objective To quantify and characterize potential prescribing omissions of cardiovascular risk management therapy using START criteria. Setting This study was conducted in the Stroke Unit of the university teaching hospital of Cova da Beira Hospital Centre, Covilha, located in the Eastern Central Region of Portugal. Method During 6 months, the medical files of all elderly patients (age ≥ 65 years) admitted with acute cardiovascular disease were reviewed and the START criteria applied to the information of medication, at admission and at the time of discharge from the hospital Stroke Unit. Main outcome measure Potential prescribing omissions of cardiovascular and endocrine pharmacological therapy were identified and the difference in the potential prescribing omissions between admission and discharge from hospital Stroke Unit was also evaluated. Results At the time of admission to the Stroke Unit, 101 potential prescribing omissions were found in 68.1 % (n = 91) of elderly (average 1.11 omissions per patient), of which 84.2 % (n = 85) were corrected at the time of discharge. In 14 patients, 16 omissions found at admission were not corrected during hospitalization, and in 5 patients 5 new omissions were detected. Conclusion Prescribing omissions of beneficial drugs are highly prevalent in acutely ill admitted to a Stroke Unit. START criteria represent a simple, evidence-based and easy-to-use tool to screen underuse of cardiovascular risk management therapy in elderly patients.

A literature review and meta–analysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies., Purpose. Pharmacist interventions to enhance blood pressure (BP) control and adherence to antihypertensive therapy in adults with essential hypertension were reviewed. Methods. A literature search was conducted to identify relevant articles describing pharmacist interventions intended to improve adherence to antihypertensive medications. Studies were included if they described a pharmacist intervention to improve medication adherence and analyzed adherence to therapy and BP control as outcomes. A fixed-effects model was used to combine data from randomized controlled trials. Results. A total of 15 studies were identified, testing 16 different interventions and containing data on 3280 enrolled patients. Although 87.5% of the interventions resulted in significant improvements in treatment outcomes, only 43.8% of the interventions were associated with significant increases in medication adherence. All interventions that increased antihypertensive medication adherence also significantly reduced BP. Almost all the interventions that were effective in increasing adherence to medication were complex, including combinations of different strategies. Meta-analysis of 2619 patients in 8 studies found that pharmacist interventions significantly reduced systolic blood pressure (SBP) (p < 0.001) and diastolic blood pressure (DBP) (p = 0.002) and that the meta-analytic differences in SBP and DBP changes from baseline to endpoint in intervention and control groups were –4.9 ± 0.9 mm Hg (p < 0.001) and –2.6 ± 0.9 mm Hg (p < 0.001), respectively. Conclusion. A literature review and meta-analysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies., Supported by fellowship grant SFRH/BD/36756/2007 from the Fundação para a Ciência e a Tecnologia.

Este estudo teve como objetivo investigar o papel moderador de potência de equipes sobre as relações entre percepção de suporte social e bem-estar subjetivo, mediante delineamento longitudinal. Participaram da pesquisa 249 adolescentes escoteiros, provenientes de 53 equipes. O estudo foi realizado nas cidades de Contagem e Belo Horizonte, Minas Gerais. Os resultados demonstraram que a percepção de suporte social e a potência de equipes influenciaram positiva e significativamente o bem-estar subjetivo dos adolescentes, porém, a potência de equipes não foi capaz de moderar a relação entre percepção de suporte social e bem-estar subjetivo. Logo, os adolescentes desfrutavam de bem-estar e saúde psíquica, condição que se manteve ao longo do tempo. Tais evidências asseguram o papel promotor de bem-estar subjetivo tanto de percepção de suporte social quanto de potência de equipes na saúde mental do indivíduo.

Testosterone has rapid nongenomic vasodilator effects which could be involved in protective cardiovascular actions. Several authors suggested specific mechanisms to explain this effect, but this matter was not clarified yet. We studied the actions of testosterone and cholesterol on endothelium-denuded rat aorta and their effects on the L-typeCa2+current (ICa,L) and potassium current (IK). Testosterone (1–100 μM) totally relaxed, in a rapid and concentration-dependent way, the aortic rings contracted by KCl or by (−)-Bay K8644 (BAY). Cholesterol also fully relaxed the contractions induced by KCl. None of the potassium channel antagonists tested (glibenclamide, tetraethylammonium and 4-aminopyridine) modified significantly the relaxant effect of testosterone. The antagonist of classic testosterone receptors, flutamide, did not modify the vasorelaxant effect of testosterone. Furthermore, testosterone and cholesterol inhibited either basal and BAY-stimulatedICa,Lin A7r5 cells and they have no effects onIK. In summary, our results demonstrate that cholesterol and testosterone relax rat aorta by inhibiting LTCC. This effect of testosterone is not mediated by the classic hormone receptor or by potassium channel activation. These results suggest that the vasodilator mechanism of cholesterol and testosterone is the same.

Objectives This work aimed to evaluate the quality of non-sterile formulations compounded at Centro Hospitalar Cova da Beira (Covilha, Portugal) immediately after preparation and up to the defined ‘beyond-use date’. Methods Microbiological quality control tests were performed in accordance with monograph 5.1.4 of the European Pharmacopoeia 8.0. Samples of compounded products were collected from January to December 2014 after preparation and were analysed immediately and reanalysed after storage under the established conditions, for each preparation. Results In the test period, 392 preparations were analysed, corresponding to 24 different formulations (8 intermediate preparations, 11 oral solutions/suspensions and 5 topical preparations). All preparations were in accordance with the pharmacopoeia specifications immediately after preparation. However, for the formulations ‘prednisolone oral solution (5 mg/mL)’ and ‘nitroglycerine and cinchocaine ointment (0.25%/0.5%)’, the microbial counts of some batches exceeded the defined limits after storage up to the beyond-use date. Conclusions These results show that the compounding practices implemented at this pharmacy department are able to ensure the microbiological quality of compounded products. This microbiological quality control methodology also allowed identification of the need to replace formulations shown not to be stable throughout the storage period. On the basis of these results, a monthly routine of microbiological control of a random sample of compounded medicines was established in order to ensure their quality and safety for use.

The current study presents, in three brief topics, the development of a study and research exchange between the Health Psychology Programs of the Methodist University of Sao Paulo, Brazil and the University of Algarve in the city of Faro, Portugal. It aims at presenting the current themes in Health Psychology in the level of collaborations between Brazil and Portugal.

As relações entre grupo familiar e uso de substâncias têm sido investigadas ao longo dos anos, uma vez que a família é tida como o primeiro grupo social do ser humano, no qual seus membros projetam seus impulsos, fantasias, e é nesse grupo em que se pode encontrar tanto fatores relacionados à patologia quanto protetores da saúde psíquica de seus membros. O objetivo desse estudo foi o de levantar a produção científica a respeito da relação entre padrão de funcionamento familiar e o uso e abuso de substâncias psicoativas. A revisão abrangeu o período de 1990 a 2014, consultando-se as bases de dados Sielo, Lilacs, IndexPsi e Sof, com a utilização dos descritores: padrão familiar, uso, abuso e substâncias psicoativas. Os resultados foram agrupados e distribuídos em três grandes categorias de análise: Disfunções de vínculo familiar; Funcionamento Familiar Psicotóxico; Funcionamento e estrutura familiares rígidos. Essas categorias foram subdivididas, para melhor descrição dos achados, em mais quatro sub-categorias: Vínculo familiar disfuncional e conflitos entre gerações; Vínculo marital disfuncional; padrões educacionais rígidos e punitivos com os filhos; Famílias psicotóxicas. Os estudos revelaram que embora sob diversas perspectivas de compreensão e análise, os vínculos estabelecidos são o principal fenômeno a ser observado.

This study presents, in summary form, the actions established and practiced by the municipalities of the so-called Grande ABC (Brazil). Only the Municipality of Diadema, determined the closing of bars between 11 PM and 6AM, an act known as "Prohibition" or "Dry Law." Surveys conducted by the Secretary of Social Defense of Diadema (2000) revealed that 49.5% of homicides used to happen between 21 and 6 o’clock in the vicinity of bars. Public policies adopted in the municipalities of the region contributed decisively to the reduction of violence, especially homicides, but no data suggest that the closure of bars in Diadema, was a decisive factor for the results achieved.

Lysophospholipids and free fatty acids produced by lecithin hydrolysis are important natural compounds with high potential for application in the food, chemical, and pharmaceutical industries. In this work, the enzymatic hydrolysis of lecithin (essentially phosphatidylcholine) catalyzed by porcine pancreatic phospholipase A2 (phosphatide 2-acyl-hydrolase, EC 3.1.1.4), encapsulated in mixed reversed micelles of lecithin andbis(2-ethylhexyl) sodium sulfosuccinate (AOT) in isooctane, was carried out in a continuous reversed-micellar membrane bioreactor. A tubular ceramic membrane with a 10,000 molecular weight (MW) cutoff was installed in an ultrafiltration module to retain the phospholipase A2 (MW 14,000) and to continuously separate the products from the reaction media. Water and co-factor (Ca++)-containing reversed micelles of lecithin/AOT in isooctane were supplemented to the reactor to compensate for the permeation of reversed micelles and to continuously supply the substrate. The influence of relevant parameters, such as substrate, AOT and enzyme concentrations, water content and fluid hydrodynamics, on the performance of the ultrafiltration membrane bioreactor was investigated. Fluid axial velocity and substrate concentration were the major factors that affected the transport processes through the membrane. Permeate flow rate increased significantly with fluid axial velocity and decreased with substrate concentration; on the other hand, water and enzyme concentrations were identified as critical parameters for the final conversion of lecithin. The relationship between productivity and normalized residence time was analyzed for each set of experimental parameters tested. Operational stability of the bioreactor was tested in a long-term operation to confirm the high stability of this catalytic system.

The hydrolysis of egg yolk lecithin was studied as catalysed by porcine pancreatic phospholipase A 2 (phosphatide 2-acyl-hydrolase, EC 3.1.1.4) entrapped in reversed micelles of lecithin and sodium dioctyl sulphosuccinate (AOT) in isooctane. The influence of relevant parameters such as temperature, pH, water content, and buffer, AOT, lecithin, calcium and enzyme concentrations was investigated. The order in which the reactants were mixed showed a strong influence on catalytic activity. Higher activities were obtained if the enzyme, water and calcium were first solubilized and pre-equilibrated in plain AOT reversed micelles before the addition of the substrate. Maximum activity was obtained at 750 mmol dm -3 calcium in the water pool of the micelles, which is an extremely high concentration when compared with the values reported in the literature. This was related to the formation of divalent chelates of calcium with AOT that compete with the binding of the co-factor to the enzyme. Accordingly, the optimum concentration of calcium in the inner core of the micelles decreased from 750 to 500 mmol dm -3 when the AOT concentration was lowered from 15 to 10 mmol dm -3

Background Most topical dermatologic preparations are presented as semisolids meant to be locally active. Although the stratum corneum acts as the rate limiting barrier, variable systemic adverse effects may occur due to drug permeation through the skin. 1 Formulations often include penetration enhancers either intentionally selected for this function or as excipients with other purposes which end up by facilitating the percutaneous absorption of the active ingredients. Purpose To review the most frequently used permeation enhancers in topical preparations in view of their potential role in promoting systemic adverse effects. Material and methods Bibliographic search in PubMed, Google Scholar and Science Direct using the terms ‘permeation enhancer’, ‘skin permeation’, ‘systemic absorption of topical drugs’. Results Occlusive dosage forms, such as ointments, may promote drug permeation by increasing the hydration and temperature of the stratum corneum. Concerning excipients, several mechanisms have been identified: skin hydration increase (urea); reduction of the permeation barrier (amides, such as azone, used as solvents and that act through drug partitioning improvement); substances which pass through the stratum corneum (pyrrolidones, which affect hydrophilic and lipophilic drugs; surfactants, especially anionic or cationics, used as emulsifiers; small peptides which act by stabilising structural proteins in the skin; modifiers of the stratum corneum: essential oils, terpenes and terpenoids; fatty acid esters: isopropyl myristate, which may promote drug solubility in the skin); sulphoxides, such as DMSO; alcohols, fatty alcohols and glycols: particularly ethanol which can increase drug solubility and extract some of the lipid fraction from the stratum corneum. Conclusion The effectiveness and safety of dermatologic therapies depend on both the active drug and the properties of the vehicle. Identification of permeation enhancers included in topical preparations may be useful for hospital pharmacists in identifying and understanding their potential systemic adverse effects. References and/or Acknowledgements Chang RK, Raw A, Lionberger R, et al . Generic development of topical dermatologic products: formulation development, process development, and testing of topical dermatologic products. Aaps J 2013;15:41-52 No conflict of interest.