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      Possibilidades de contribuição do farmacêutico para a promoção da saúde Translated title: How pharmacists can contribute to health promotion


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          Os medicamentos são considerados a principal ferramenta terapêutica para recuperação ou manutenção das condições de saúde da população. No entanto, o simbolismo de que eles são revestidos e, conseqüentemente, o uso dos mesmos pela sociedade, tem contribuído para o surgimento de muitos eventos adversos, com elevado impacto sobre a saúde e custos dos sistemas. Assim, a promoção do uso racional dos medicamentos é uma ferramenta importante de atuação junto à sociedade, para senão eliminar, minimizar o problema. Neste sentido, o farmacêutico pode contribuir sobremaneira, já que este é assunto pertinente a seu campo de atuação. Sua participação em equipes multidisplinares acrescenta valor aos serviços e contribui para a promoção da saúde. Este artigo trata destas questões e discute as possibilidades desta contribuição.

          Translated abstract

          Medicines are considered the main therapeutical tool for the treatment or maintenance of public health conditions. However, the symbolism in wich they are cloaked and thus their use by society, has contributed to the emergence of many adverse events with high impact on health and health systems costs. Thus, rational drug use promotion is an important tool to eliminate or minimize the problem. This is where the pharmacists can play an important role because this is a pertinent subject in their field of performance. Their participation in multidisciplinary teams adds value to health services and contributes to health promotion. This article addresses these issues and how pharmacists can contribute to health promotion.

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          Most cited references41

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          25 years of the WHO essential medicines lists: progress and challenges.

          The first WHO essential drugs list, published in 1977, was described as a peaceful revolution in international public health. The list helped to establish the principle that some medicines were more useful than others and that essential medicines were often inaccessible to many populations. Since then, the essential medicines list (EML) has increased in size; defining an essential medicine has moved from an experience to an evidence-based process, including criteria such as public-health relevance, efficacy, safety, and cost-effectiveness. High priced medicines such as antiretrovirals are now included. Differences exist between the WHO model EML and national EMLs since countries face varying challenges relating to costs, drug effectiveness, morbidity patterns, and rationality of prescribing. Ensuring equitable access to and rational use of essential medicines has been promoted through WHO's revised drug strategy. This approach has required an engagement by WHO on issues such as the effect of international trade agreements on access to essential medicines and research and development to ensure availability of new essential medicines.
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            Genotoxicity of pesticides: a review of human biomonitoring studies.

            Pesticides constitute a heterogeneous category of chemicals specifically designed for the control of pests, weeds or plant diseases. Pesticides have been considered potential chemical mutagens: experimental data revealed that various agrochemical ingredients possess mutagenic properties inducing mutations, chromosomal alterations or DNA damage. Biological monitoring provides a useful tool to estimate the genetic risk deriving from an integrated exposure to a complex mixture of chemicals. Studies available in scientific literature have essentially focused on cytogenetic end-points to evaluate the potential genotoxicity of pesticides in occupationally exposed populations, including pesticide manufacturing workers, pesticide applicators, floriculturists and farm workers. A positive association between occupational exposure to complex pesticide mixtures and the presence of chromosomal aberrations (CA), sister-chromatid exchanges (SCE) and micronuclei (MN) has been detected in the majority of the studies, although a number of these failed to detect cytogenetic damage. Conflicting results from cytogenetic studies reflect the heterogeneity of the groups studied with regard to chemicals used and exposure conditions. Genetic damage associated with pesticides occurs in human populations subject to high exposure levels due to intensive use, misuse or failure of control measures. The majority of studies on cytogenetic biomarkers in pesticide-exposed workers have indicated some dose-dependent effects, with increasing duration or intensity of exposure. Chromosomal damage induced by pesticides appears to have been transient in acute or discontinuous exposure, but cumulative in continuous exposure to complex agrochemical mixtures. Data available at present on the effect of genetic polymorphism on susceptibility to pesticides does not allow any conclusion.
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              Interactions between physicians and the pharmaceutical industry: what does the literature say?

              J Lexchin (1993)
              To determine the effect of three types of interaction between physicians and the pharmaceutical industry--company-funded clinical trials, company-sponsored continuing medical education (CME) and information for physicians supplied by pharmaceutical detailers--on orientation and quality of clinical trials, content of CME courses and physicians' prescribing behaviour. MEDLINE and HEALTH searches for English-language articles published from 1978 to 1993, supplemented by material from the author's personal collection. A total of 227 papers from the MEDLINE and HEALTH searches and about 2000 items from the author's library were initially reviewed. The following selection criteria were used: studies conducted in Australia, Canada, New Zealand, Britain and the United States; studies conducted after 1977; quantitative surveys containing details of the survey methods; studies on the orientation and quality of company-funded clinical trials and on the content of CME courses giving explicit criteria used in the evaluation; and reports on the outcome of interactions stating how the outcomes were assessed. Thirty-six studies met these criteria. Information was extracted on five topics: physicians' attitudes toward drug industry interactions, frequency with which physicians participate in the interactions, orientation and quality of company-funded clinical trials, content of company-sponsored CME courses and changes in physicians' prescribing behaviour as a result of an interaction. Although most physicians participate only occasionally in company-sponsored clinical trials, most see detailers and attend company-sponsored CME courses. However, physicians do not have a very high opinion of the information from detailers or of company-sponsored CME events. Many doctors regard pharmaceutical companies as an important source of funding for clinical trials, but they also have concerns about accepting money from this source. Company funding of clinical trials may affect the quality of the trials and the types of research that physicians undertake. Company-sponsored CME courses may have a commercial bias even if conducted under guidelines designed to ensure the independence of the event. All three types of interactions affect physicians' prescribing behaviour and, in the case of obtaining information from detailers, physicians' prescribing practices are less appropriate as a result of the interaction. Physicians are affected by their interactions with the pharmaceutical industry. Further research needs to be done in most cases to determine whether such interactions lead to more or less appropriate prescribing practices. The CMA's guidelines on this topic should be evaluated to see whether they are effective in controlling physician-industry interactions. Further measures may be necessary if the guidelines fail to prevent negative effects on prescribing practices.

                Author and article information

                Role: ND
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro )
                March 2007
                : 12
                : 1
                : 213-220
                [1 ] Ministério da Saúde Brazil



                SciELO Brazil

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=1413-8123&lng=en
                Health Policy & Services

                Public health
                Rational drug use,Pharmacist,Health promotion,Pharmaceutical care,Uso racional de medicamentos,Farmacêutico,Promoção da saúde,Atenção farmacêutica


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