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Abstract(s)
A presente dissertação é composta de três partes distintas. A primeira parte é o resultado de um
trabalho de investigação para avaliar a exequibilidade de um protocolo para um estudo cohort
da sensibilização alérgica numa população de estudantes universitários. A segunda e terceira
partes consistem nos meus relatórios de estágio em farmácia comunitária e farmácia hospitalar,
respetivamente.
Parte I Objetivo. Avaliar a exequibilidade de um estudo cohort na Universidade da Beira Interior
para avaliar a incidência de novos casos de sensibilização alérgica em novos alunos desta
instituição de ensino superior. Introdução. A sensibilização alérgica é um mecanismo imunológico
desencadeado em resposta a estímulos externos, ou seja, alergénios. Estes são proteínas
com propriedades pró-alergénicas ou homólogas. O processo imunológico envolve várias células
do sistema imunitário — células Th2, B, mastócitos, eosinófilos — e citocinas por si produzidas
(nomeadamente interleucinas (IL)) as quais, por mecanismos ainda em estudo, podem levar ao
desenvolvimento de doenças alérgicas específicas, tais como rinite alérgica e asma. Estas têm
um impacto negativo não só na vida dos doentes como também da sociedade em geral. Alguns
fatores têm influência nos mecanismos da sensibilização alérgica, incluindo geoclimáticos. Consoante
o clima e a geografia, a prevalência de alergénios específicos varia, pelo que se pode
colocar a hipótese da sensibilização em cada indivíduo também poder variar com a mudança
de habitação. Materiais e métodos. A amostra do estudo-piloto consistiu em estudantes voluntários
dos cursos de Ciências da Saúde com a sua primeira matrícula na Universidade da Beira
Interior. Aos voluntários foi aplicado um questionário standardizado do ISAAC, adaptado ao
projeto, e foram realizados testes cutâneos aos que os aceitaram realizar segundo a técnica
adaptada de Jack Pepys e standardizada a nível europeu, recorrendo a uma bateria de aeroalergénios
adaptada da recomendada pelo estudo GA²LEN. As respostas ao questionários foram
validadas manualmente para análise dos principais erros cometidos e o protocolo foi submetido
a uma análise SWOT. Com base nos resultados dos testes cutâneos, foi calculada a amostra
mínima necessária para um estudo tendo em conta a prevalência calculada. Resultados. De
uma população de 330 alunos, a taxa de resposta foi de 54;85% (n = 181). 71;27% dos voluntários
aceitou realizar os testes cutâneos, tendo apenas comparecido 52;21% destes. A taxa
de respostas inválidas ao questionário foi de 19;33%, a qual baixou para 14;92% após correção
por parte dos voluntários, promovida e orientada pelos investigadores. A parte relativa à rinite
alérgica e rinoconjuntivite constituiu 69;44% dos erros. A prevalência de sensibilização alérgica
a pelo menos um dos aeroalergénios testados foi de 66;15%, onde os ácaros do pó doméstico
(D. pteronyssinus e D.farinae) e Poa pratensis foram os alergénios com sensibilização mais prevalente.
Para uma população de 330 alunos, a amostra mínima necessária é de 169 voluntários.
Conclusão. Não foi possível reunir um número de respostas válidas suficiente ao questionário a fim de realizar uma análise estatisticamente significativa (nível de confiança: 95%; intervalo de
confiança: 5%) nem estabelecer as causas para o fornecimento de respostas inválidas uma vez
que o questionário proposto pelo ISAAC foi utilizado com sucesso noutros estudos de prevalência
de doenças alérgicas. A taxa de resposta foi insuficiente e a taxa de não-comparência nos testes
cutâneos foi elevada.
Parte II O farmacêutico comunitário representa a interface entre o doente e o bom uso dos
medicamentos. O seu papel é, portanto, preponderante na saúde pública. Como parte da minha
experiência profissionalizante, integrei a equipa da Farmácia São Cosme, situada na cidade da
Covilhã, num estágio curricular de 488 horas onde tive a oportunidade de viver o dia-a-dia
de uma farmácia comunitária e realizar atos farmacêuticos. O relatório de estágio percorre
o circuito do medicamento, assim como aborda a gestão da farmácia e os atos farmacêuticos
por mim levados a cabo, nomeadamente: atendimento ao público, dispensa de medicamentos,
aconselhamento farmacêutico, prestação de serviços de saúde e preparação de medicamentos
manipulados. Apesar de esta experiência profissionalizante ter fornecido uma boa visão acerca
do papel do farmacêutico comunitário, esta não foi a que esperava uma vez que não me senti
verdadeiramente parte da equipa.
Parte III Ao providenciar um serviço de saúde pública, um hospital depende da sua farmácia
para o fornecimento eficaz e eficiente de medicamentos aos vários serviços. Por conseguinte, o
farmacêutico hospitalar tem um papel fulcral. Ao integrar a equipa dos Serviços Farmacêuticos
do Centro Hospitalar da Cova da Beira, pude participar ativamente nos diversos setores que
os constituem (tais como farmacotecnia, distribuição, ambulatório, ensaios clínicos). Esta experiência
profissionalizante de 312 horas permitiu-me preparar bolsas de nutrição parentérica,
medicação citotóxica, medicamentos manipulados, assim como participar na reembalagem, distribuição
em dose unitário, dispensa em regime de ambulatório, análise farmacocinética, entre
outros atos farmacêuticos. Tendo-me sentido parte da equipa, esta experiência foi vital na
minha formação profissional enquanto farmacêutico.
This dissertation is composed of three distinct parts. The first part is the result of an investigation work in order to evaluate the practicability of a protocol for a cohort study of allergic sensibilization on a population of universitary students. The second and third parts consist of my internship reports in community pharmacy and hospital pharmacy, respectively. Part I Objective. To evaluate the practicability of a cohort study in the University of Beira Interior to evatuale the incidence of new cases of allergic sensibilization in new students of this institution. Introduction. Allergic sensibilization is an immunologic mechanism initiated in response to an external stimulus, that is, allergens. These are protein with pro-allergenic properties or that are homologous. The immunologic process implicates various cells form the immune system — Th2 and B cells, mast cells and eosinophils — and cytokines (namely interleukins) which, through mechanisms still under study, can lead to the development of specific allergic diseases, such as allergic rhinitis and asthma. These have a negative impact not only for patients but also for the society in general. Some factors have an influence on the mechanisms of allergic sensitizations, including geo-climate ones. Depending on the climate and geography, the prevalence of specific allergens may vary, so that one can hypothesize that sensibilization in each individual may vary as well with the change of location. Materials and methods. The sample of this pilot study consisted of voluntary students of the Science Health courses with their first enrollment at the University of Beira Interior. Voluntaries were submitted to a standardized questionnaire from ISAAC, adapted to the project, and to skin prick tests (SPT) on those who accepted to participate on these, according to the adapted method of Jack Papys, standardized in Europe, using a battery of allergens adapted from the recommendation from the GA²LEN study. The responses to the questionnaires were manually validated through analysis of the mistakes committed, and the protocol went through a SWOT analysis. Based on the results of the SPT, the minimum size of the sample necessary for a cohort study was calculated. Results. From a population of 330 students, a response rate was 54,85 % (n = 181). 71,27 % of the voluntaries accepted to participate on the SPT, having only attended 52,21 % of those. The invalid responses rate was 19,33 %, which fell to 14,92 % after some voluntaries corrected their responses under the investigators orientation. 69,44 % of the errors were from the questions about allergic rhinitis and rhinoconjunctivitis. 66,15 % of the voluntaries submitted to SPTs were sensitized to at least one of the tested allergens, being dust mites (D. pteronyssinus and D.farinae) and Poa pratensis the most prevalent. For a population of 330 students, the minimuz size of the sample is 169 voluntaries. Conclusion. It wasn’t possible to get a sufficient number os responses in order to make a statistically significant analysis (confidence leve: 95%; confidence level: 5%) nor establish the causes of the invalid responses given the fact that this questionnaire proposed by ISAAC was successfully used in other studies related to allergic diseases prevalence. A rate response was insufficient and the SPT no-show rate was high. Part II Being the interface between patient and the good-use of pharmaceutical drugs, the community pharmacist has a preponderant role in public health. As a part of my professional experience, I integrated the staff of São Cosme Pharmacy, Covilhã, in an internship of 488 hours where I had the opportunity to live de daily routine of a community pharmacy and do pharmaceutical acts. This report goes through the drug circuit, as well the pharmacy management and the pharmaceutical acts I did, namely: customer service, drug dispensing, pharmaceutical advisement, health services providence and preparation of manipulated medicines. Although the experience had provided a good overview about the role of the community pharmacist, this wasn’t what I was hoping for given the fact I didn’t felt a part of the team. Part III By providing a public health service, a hospital depends on its pharmacy for the effective and efficient drug supply to the various services. Consequently, tha hospital pharmacy plays a core role. By making part of the CHCB pharmacy staff, I was able to actively participate on its various sectors (such as pharmacotechnic, distribution, outpatient service, clinical trials). This 312-hour profissional experience let me prepare parenteral nutrition, cytotoxic drugs, manipulated medicine, as well to participate in the packaging, unit-dose distribution, outpatient service distribution, pharmacokinetic analysis, etc. By feeling part of the staff, this was a vital experience for my professional formation as a pharmacist.
This dissertation is composed of three distinct parts. The first part is the result of an investigation work in order to evaluate the practicability of a protocol for a cohort study of allergic sensibilization on a population of universitary students. The second and third parts consist of my internship reports in community pharmacy and hospital pharmacy, respectively. Part I Objective. To evaluate the practicability of a cohort study in the University of Beira Interior to evatuale the incidence of new cases of allergic sensibilization in new students of this institution. Introduction. Allergic sensibilization is an immunologic mechanism initiated in response to an external stimulus, that is, allergens. These are protein with pro-allergenic properties or that are homologous. The immunologic process implicates various cells form the immune system — Th2 and B cells, mast cells and eosinophils — and cytokines (namely interleukins) which, through mechanisms still under study, can lead to the development of specific allergic diseases, such as allergic rhinitis and asthma. These have a negative impact not only for patients but also for the society in general. Some factors have an influence on the mechanisms of allergic sensitizations, including geo-climate ones. Depending on the climate and geography, the prevalence of specific allergens may vary, so that one can hypothesize that sensibilization in each individual may vary as well with the change of location. Materials and methods. The sample of this pilot study consisted of voluntary students of the Science Health courses with their first enrollment at the University of Beira Interior. Voluntaries were submitted to a standardized questionnaire from ISAAC, adapted to the project, and to skin prick tests (SPT) on those who accepted to participate on these, according to the adapted method of Jack Papys, standardized in Europe, using a battery of allergens adapted from the recommendation from the GA²LEN study. The responses to the questionnaires were manually validated through analysis of the mistakes committed, and the protocol went through a SWOT analysis. Based on the results of the SPT, the minimum size of the sample necessary for a cohort study was calculated. Results. From a population of 330 students, a response rate was 54,85 % (n = 181). 71,27 % of the voluntaries accepted to participate on the SPT, having only attended 52,21 % of those. The invalid responses rate was 19,33 %, which fell to 14,92 % after some voluntaries corrected their responses under the investigators orientation. 69,44 % of the errors were from the questions about allergic rhinitis and rhinoconjunctivitis. 66,15 % of the voluntaries submitted to SPTs were sensitized to at least one of the tested allergens, being dust mites (D. pteronyssinus and D.farinae) and Poa pratensis the most prevalent. For a population of 330 students, the minimuz size of the sample is 169 voluntaries. Conclusion. It wasn’t possible to get a sufficient number os responses in order to make a statistically significant analysis (confidence leve: 95%; confidence level: 5%) nor establish the causes of the invalid responses given the fact that this questionnaire proposed by ISAAC was successfully used in other studies related to allergic diseases prevalence. A rate response was insufficient and the SPT no-show rate was high. Part II Being the interface between patient and the good-use of pharmaceutical drugs, the community pharmacist has a preponderant role in public health. As a part of my professional experience, I integrated the staff of São Cosme Pharmacy, Covilhã, in an internship of 488 hours where I had the opportunity to live de daily routine of a community pharmacy and do pharmaceutical acts. This report goes through the drug circuit, as well the pharmacy management and the pharmaceutical acts I did, namely: customer service, drug dispensing, pharmaceutical advisement, health services providence and preparation of manipulated medicines. Although the experience had provided a good overview about the role of the community pharmacist, this wasn’t what I was hoping for given the fact I didn’t felt a part of the team. Part III By providing a public health service, a hospital depends on its pharmacy for the effective and efficient drug supply to the various services. Consequently, tha hospital pharmacy plays a core role. By making part of the CHCB pharmacy staff, I was able to actively participate on its various sectors (such as pharmacotechnic, distribution, outpatient service, clinical trials). This 312-hour profissional experience let me prepare parenteral nutrition, cytotoxic drugs, manipulated medicine, as well to participate in the packaging, unit-dose distribution, outpatient service distribution, pharmacokinetic analysis, etc. By feeling part of the staff, this was a vital experience for my professional formation as a pharmacist.
Description
Keywords
Aeroalergénios Design de Estudo Estudo-Piloto Farmácia Comunitária Farmácia Hospitalar Fatores Geoclimáticos Fatores Ambientais Sensibilização Alérgica Testes Cutâneos