Multimorbidity was common in the studied population. The observed patterns may be used to generate and improve Brazilian diseases guidelines.

Background: Over-the-counter analgesic use during pregnancy, particularly acetaminophen, may be associated with negative developmental outcomes in children.Objective: Estimate associations of prenatal and early-life exposure to acetaminophen in early childhood with cognitive, motor, and language skills in two birth cohorts. Methods: The American Project Viva cohort (1217 mother-child pairs enrolled 1999-2002) assessed cognition at approximately 3 years using the Peabody Picture Vocabulary Test and the Wide Range Achievement of Visual Motor Abilities (WRAVMA). The Brazilian 2015 Pelotas Birth Cohort (3818 mother-child pairs) assessed cognition at 2 years using the INTERGROWTH-21st NeurodevelopmentAssessment. We used linear regression to estimate associations of acetaminophen use during pregnancy (Project Viva and Pelotas) and infancy (Project Viva) with children's cognitive scores adjusted for maternal age, pre-pregnancy body mass index, education, parity, race/ethnicity, smoking and alcohol use during pregnancy, depression during pregnancy, antibiotic and ibuprofen use during pregnancy, household income, and child's sex. Results:In Project Viva, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was associated with lower WRAVMA drawing scores (β −1.51, 95% CI −2.92, −0.10). However, in Pelotas, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was not associated with INTER-NDA motor scores (β 0.02; 95% CI −0.05, 0.09) and was associated with higher INTER-NDA total scores (β 0.08, 95% CI 0.01, 0.16). Other comparisons did not show evidence for any associations. Conclusions:Inconsistencies and lack of specificity of the findings did not clarify the research question considering that we still have a large variability and uncertainty to define the risk or safety in the use of acetaminophen related to cognition in early childhood. More studies using better exposure assessment and better confounding variables are needed to clarify these associations.

A non-blinded randomized controlled trial evaluated efficacy of pharmaceutical care (PC) (Dáder method) on self-reported antiretroviral adherence and undetectable plasma viral load (UPVL), compared with usual care (UC) in HIV-positive patients in Brazil. Most were male (63 %), mean age 40.3 years (SD = 10). After 12 months, 79.8 % of those receiving PC versus 73.8 % in UC were adherent (RR 1.05, 95 % CI 0.95-1.15, P = 0.35), and 50.3 versus 49.8 % (PC vs. UC, respectively) had UPVL (RR 1.08, 95 % CI 0.97-1.20, P = 0.15). Factors associated with self-reported adherence were regular employment, UPVL, no depressive symptoms, and lower pill load in the treatment regimen. Older age, education, CD4 count <200 cells/mm(3), and shorter treatment duration were associated with UPVL. Of 94 reported drug-related problems, 43 % resolved. In subgroup analyses of patients who experienced therapeutic failure and who were non-adherent at the beginning of the trial (N = 50), no differences were found in UPVL (HR 1.35, 95 % CI 0.57-3.19). Only education level (>12 years) was independently predictive of viral suppression (HR 7.47, 95 % CI 1.69-32.91). In conclusion, PC was not associated with increased self-reported adherence to ART or UPVL in patients treated at a health care facility in southern Brazil. The study suggests, however, that PC could be effective for the subgroup of patients with poor adherence.

Depressive symptoms are frequent in patients on ART, and are associated with low income.

PurposeTo track the use of medicine and self-medication from infancy to adolescence.MethodsAll newborns in the city of Pelotas, Brazil, were monitored and enrolled in the 1993 Pelotas (Brazil) Birth Cohort Study. Subsamples of the cohort were visited at 1, 3, and 6 months and at 1 and 4 years of age. At 11 and 15 years of age, all cohort members were sought. In each of these visits, information on medicine use in the 15 days before the interview was collected. Two outcomes were analyzed: prevalence of medicine use and prevalence of self-medication.ResultsPrevalence of medicine use in the first year of life ranged from 52.0% to 68.6%. From 4 to 15 years of age, the prevalence decreased, ranging from 30.9% to 37.2%. At age 15, girls presented a 33% higher prevalence of medicine use than boys. The proportion of self-medication ranged from 12.4% to 29.0% and was higher in girls aged 11 and 15 years than boys of the same age. In all follow-up periods, use of medicines was significantly higher among children who used medicines in the earlier period. Prevalence of self-medication was higher among those who were self-medicated in the previous periods.ConclusionsTracking studies are important to public health because they can predict future behavior by analyzing past behavior, thus helping in designing preventive actions. In this study, previous use of medicines predicts future use, thus creating an opportunity to plan actions that promote the rational use of medicines.

The number of sputum smear microscopies performed in Bagé increased in the past four years. In 2003 and 2004, it exceeded the goal of the National Tuberculosis Control Program. However, the number of new cases decreased, demonstrating the efficacy of the active search for tuberculosis cases in the city.

PurposeTo estimate the point prevalence of self-medication among adolescents aged 18 years and to evaluate the type of drugs used (either over-the-counter or prescription drugs) and socioeconomic, health-related, and behavioral correlates of self-medication.MethodsThis cross-sectional study used data from the 1993 Pelotas (Brazil) Birth Cohort Study. Data were obtained through the administration of a questionnaire to adolescents aged 18 years. The outcome variables were point prevalence of medicine use and self-medication collected by self-report. The independent variables studied were gender, continuous medicine use, socioeconomic status, schooling, self-rated health, body mass index, and physical activity levels. Medicines were classified into therapeutic groups according to the Anatomical Therapeutic Chemical classification system.ResultsA total of 4,106 adolescents were interviewed. The point prevalence of medicine use was 41.1% (95% confidence interval [CI] 39.6–42.6), and the proportion of self-medication among medicine users was 65.1% (95% CI 62.8–67.4). The point prevalence of self-medication was 26.7% (95% CI 25.4–28.1), and it was higher among female adolescents, those more educated, and those who rated their health as poor. Out of the drugs used for self-medication (58% of all drugs used), 1,003 (78.7%) were nonprescription drugs and 271 (21.3%) were prescription drugs. The most frequently used drugs for self-medication were analgesics (56.1%), systemic antihistamines (7.4%), and anti-inflammatory and antirheumatic products (7.1%).ConclusionsA high point prevalence of self-medication was found among adolescents, which is particularly concerning due to high use of prescription drugs for self-medication. Interventions are needed to promote rational use of medicines in this population.

Resumo: Este estudo compara a percepção, conhecimento e uso de medicamentos genéricos em adultos de Pelotas, Rio Grande do Sul, Brasil, por meio de dois estudos transversais de base populacional realizados em 2002 e 2012. Os desfechos estudados foram: (a) prevalência de utilização de medicamentos genéricos; (b) proporção de uso de medicamentos genéricos entre os demais medicamentos; (c) percepção dos usuários sobre preço e qualidade dos medicamentos genéricos; (d) conhecimento dos usuários sobre medicamentos genéricos; e (e) estratégias de aquisição de medicamentos. A prevalência de uso de medicamentos genéricos aumentou de 3,6% (IC95%: 3,0-4,3) para 26,1% (IC95%: 24,5-27,7) no período de dez anos. A percepção sobre preço e qualidade dos medicamentos genéricos se manteve estável, a identificação das características que diferenciam os medicamentos genéricos dos demais medicamentos melhorou (p < 0,001) e o erro de classificação de medicamento diminuiu (p < 0,001). Houve um aumento significativo na estratégia de aquisição de medicamentos pela substituição do medicamento prescrito pelo medicamento genérico. Entre 2002 e 2012, aumentou o conhecimento e uso de medicamentos genéricos, enquanto a percepção quanto ao menor preço e qualidade equivalente mantiveram-se elevadas.