Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/EMCO-966NWX |
Resumo: | The focus on the biomedical model which is a central aspect of the health interventions of the contemporary times omits nuances of the therapeutic process with medicines, and of failures of that process. Therefore, the appropriate managing of the use of medicines requires a paradigm shift regarding the guarantee of effective pharmacological interventions but also safe ones, in addition to alternative strategies in the absence of these fundamental pillars. Some of the challenges to this paradigm shift are exemplified by two public health problems: the adverse drug reactions and the complex health problems. In both contexts, the pharmacologic interventions sometimes do not provide the necessary safety and sometimes not exert a therapeutic effect according to the presumed effectiveness. This thesis follows the path for the design and application of unique epidemiological methods approaching these problems and challenges focusing on an adverse drug reaction (the heparin-induced thrombocytopenia) and on a complex health problem (the low back pain). Taking this perspective in account, this scientific work structures two research lines named: Epidemiology of adverse drug reactions and Genetic epidemiology and twin study. The results are organized in five original articles, presented in the form of publication or submission. Considering the research line Epidemiology of adverse reactions we should highlight as main results: our studies showed the heterogeneity of the heparins commercialised in Brazil, a situation with potential impact in the safety profile of the drug and in the risk of heparin-induced thrombocytopenia; we were able to ascertain the lower risk of heparin-induced thrombocytopenia in patients exposed to low molecular weight heparin when compared to patients exposed to unfractionated heparin; it was demonstrated a paucity of randomized controlled trials addressing the safety aspect of the use of heparins; and we were able to generate health information for professionals and for the national and international pharmacovigilance system about safety aspects related to the use of heparins in Brazil and about the heparin-induced thrombocytopenia. Considering the research line Genetic epidemiology and twin study we should highlight as main results: we were able to study the influence of the genetic component in chronic low back pain showing its major contribution in the prevalence of this chronic condition; and our studies showed an important contribution of domestic physical workload but not leisure physical activity to chronic low back pain. These results contribute to a comprehensive understanding of the process of drug utilization and represent a positive contribution for the knowledge generation regarding the safe use of medicines and the risk assessment of complex diseases. We also believe that the knowledge behind these results may support the design of new clinical protocols and public health strategies considering the use of heparin and the low back pain problem. We also emphasize that both research lines are incipient in Brazil and, from this perspective, this thesis embodies the expectations of scientific innovation and of international partnerships as a strategy to the development of national researches with competitive calibre which may encourage the scientific advancement of the country. |
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Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombarDor lombarTrombocitopenia induzida por heparinaEstudo de gêmeosEventos adversos a medicamentosEpidemiologiaMedicamentos UtilizaçãoTrombocitopeniaDor lombarMedicamentos Efeitos colateraisEpidemiologiaThe focus on the biomedical model which is a central aspect of the health interventions of the contemporary times omits nuances of the therapeutic process with medicines, and of failures of that process. Therefore, the appropriate managing of the use of medicines requires a paradigm shift regarding the guarantee of effective pharmacological interventions but also safe ones, in addition to alternative strategies in the absence of these fundamental pillars. Some of the challenges to this paradigm shift are exemplified by two public health problems: the adverse drug reactions and the complex health problems. In both contexts, the pharmacologic interventions sometimes do not provide the necessary safety and sometimes not exert a therapeutic effect according to the presumed effectiveness. This thesis follows the path for the design and application of unique epidemiological methods approaching these problems and challenges focusing on an adverse drug reaction (the heparin-induced thrombocytopenia) and on a complex health problem (the low back pain). Taking this perspective in account, this scientific work structures two research lines named: Epidemiology of adverse drug reactions and Genetic epidemiology and twin study. The results are organized in five original articles, presented in the form of publication or submission. Considering the research line Epidemiology of adverse reactions we should highlight as main results: our studies showed the heterogeneity of the heparins commercialised in Brazil, a situation with potential impact in the safety profile of the drug and in the risk of heparin-induced thrombocytopenia; we were able to ascertain the lower risk of heparin-induced thrombocytopenia in patients exposed to low molecular weight heparin when compared to patients exposed to unfractionated heparin; it was demonstrated a paucity of randomized controlled trials addressing the safety aspect of the use of heparins; and we were able to generate health information for professionals and for the national and international pharmacovigilance system about safety aspects related to the use of heparins in Brazil and about the heparin-induced thrombocytopenia. Considering the research line Genetic epidemiology and twin study we should highlight as main results: we were able to study the influence of the genetic component in chronic low back pain showing its major contribution in the prevalence of this chronic condition; and our studies showed an important contribution of domestic physical workload but not leisure physical activity to chronic low back pain. These results contribute to a comprehensive understanding of the process of drug utilization and represent a positive contribution for the knowledge generation regarding the safe use of medicines and the risk assessment of complex diseases. We also believe that the knowledge behind these results may support the design of new clinical protocols and public health strategies considering the use of heparin and the low back pain problem. We also emphasize that both research lines are incipient in Brazil and, from this perspective, this thesis embodies the expectations of scientific innovation and of international partnerships as a strategy to the development of national researches with competitive calibre which may encourage the scientific advancement of the country.O foco do modelo biomédico predominante das intervenções em saúde dos tempos contemporâneos omite nuances do processo da terapêutica com medicamentos, e de falhas desse processo. Assim, o adequado tratamento do processo de utilização de medicamentos depende de uma mudança de paradigma no sentido de garantir intervenções farmacológicas eficazes, mas também seguras, além de estratégias alternativas na ausência desses pilares fundamentais. Alguns dos desafios para essa mudança paradigmática são exemplificados por dois problemas de saúde pública: as reações adversas a medicamentos e os problemas de saúde complexos. Em ambos os contextos, as intervenções farmacológicas ora não oferecem a segurança necessária, ora não exercem o efeito terapêutico segundo a eficácia presumida. O caminho para o delineamento e aplicação de métodos epidemiológicos diferenciados para a abordagem desses problemas e desafios são percorridos nessa tese com foco em uma reação adversa a medicamentos (a trombocitopenia induzida por heparina) e em um problema de saúde complexo (a dor lombar). Nessa perspectiva, esse trabalho estrutura duas linhas de pesquisa: Epidemiologia das reações adversas a medicamentos e Epidemiologia genética e estudo de gêmeos. Os resultados estão organizados em cinco artigos originais, apresentados no formato de publicação ou de submissão. Considerando a linha de pesquisa Epidemiologia das reações adversas, podemos realçar como principais resultados: a demonstração da heterogeneidade nas heparinas comercializadas no Brasil, situação com impacto no perfil de segurança do medicamento e no risco de trombocitopenia induzida por heparina; a comprovação do menor risco de trombocitopenia induzida por heparina em pacientes expostos à heparina de baixo peso molecular em comparação aos expostos à heparina não fracionada; demonstração da escassez de ensaios clínicos controlados e aleatorizados abordando o aspecto da segurança sobre a utilização das heparinas; e a produção de informação em saúde para profissionais e para o sistema nacional e internacional de farmacovigilância acerca dos aspectos de segurança relacionados ao uso de heparinas no Brasil e sobre a trombocitopenia induzida por heparina. Considerando a linha de pesquisa Epidemiologia genética e estudo de gêmeos, devemos realçar como principais resultados: demonstração do componente genético na dor lombar crônica, componente estimado com elevada influência na prevalência dessa condição crônica; e demonstração de uma associação exploratória entre atividades físicas leves e vigorosas com a dor lombar crônica. Os resultados contribuem para a compreensão do processo de utilização de medicamentos de forma abrangente além de representarem positiva contribuição para a produção de conhecimentos nas áreas de segurança de utilização de medicamentos e de determinantes de risco de doenças complexas. Acreditamos ainda que os conhecimentos produzidos poderão apoiar o delineamento de novos protocolos clínicos e estratégias de saúde pública com relação à utilização de heparinas e à dor lombar. Ressaltamos ainda que ambas as linhas de pesquisas são incipientes no Brasil e, nessa perspectiva, a tese materializa as expectativas de inovação científica e de colaboração internacional com vias ao desenvolvimento de pesquisas competitivas para o avanço científico do país.Universidade Federal de Minas GeraisUFMGMaria das Gracas CarvalhoEdson PeriniPaulo Henrique FerreiraMonica Rodrigues PerraciniLuci Fuscaldi Teixeira SalmelaCristiane Aparecida Menezes de PaduaDanyelle Romana Alves RiosDaniela Rezende Garcia Junqueira2019-08-12T18:46:02Z2019-08-12T18:46:02Z2012-10-25info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfhttp://hdl.handle.net/1843/EMCO-966NWXinfo:eu-repo/semantics/openAccessporreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMG2019-11-14T22:18:07Zoai:repositorio.ufmg.br:1843/EMCO-966NWXRepositório InstitucionalPUBhttps://repositorio.ufmg.br/oairepositorio@ufmg.bropendoar:2019-11-14T22:18:07Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.none.fl_str_mv |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
title |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
spellingShingle |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar Daniela Rezende Garcia Junqueira Dor lombar Trombocitopenia induzida por heparina Estudo de gêmeos Eventos adversos a medicamentos Epidemiologia Medicamentos Utilização Trombocitopenia Dor lombar Medicamentos Efeitos colaterais Epidemiologia |
title_short |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
title_full |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
title_fullStr |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
title_full_unstemmed |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
title_sort |
Desafios metodológicos em epidemiologia: uma abordagem com foco na reação adversa da trombocitopenia induzida por heparina e na condição clínica da dor lombar |
author |
Daniela Rezende Garcia Junqueira |
author_facet |
Daniela Rezende Garcia Junqueira |
author_role |
author |
dc.contributor.none.fl_str_mv |
Maria das Gracas Carvalho Edson Perini Paulo Henrique Ferreira Monica Rodrigues Perracini Luci Fuscaldi Teixeira Salmela Cristiane Aparecida Menezes de Padua Danyelle Romana Alves Rios |
dc.contributor.author.fl_str_mv |
Daniela Rezende Garcia Junqueira |
dc.subject.por.fl_str_mv |
Dor lombar Trombocitopenia induzida por heparina Estudo de gêmeos Eventos adversos a medicamentos Epidemiologia Medicamentos Utilização Trombocitopenia Dor lombar Medicamentos Efeitos colaterais Epidemiologia |
topic |
Dor lombar Trombocitopenia induzida por heparina Estudo de gêmeos Eventos adversos a medicamentos Epidemiologia Medicamentos Utilização Trombocitopenia Dor lombar Medicamentos Efeitos colaterais Epidemiologia |
description |
The focus on the biomedical model which is a central aspect of the health interventions of the contemporary times omits nuances of the therapeutic process with medicines, and of failures of that process. Therefore, the appropriate managing of the use of medicines requires a paradigm shift regarding the guarantee of effective pharmacological interventions but also safe ones, in addition to alternative strategies in the absence of these fundamental pillars. Some of the challenges to this paradigm shift are exemplified by two public health problems: the adverse drug reactions and the complex health problems. In both contexts, the pharmacologic interventions sometimes do not provide the necessary safety and sometimes not exert a therapeutic effect according to the presumed effectiveness. This thesis follows the path for the design and application of unique epidemiological methods approaching these problems and challenges focusing on an adverse drug reaction (the heparin-induced thrombocytopenia) and on a complex health problem (the low back pain). Taking this perspective in account, this scientific work structures two research lines named: Epidemiology of adverse drug reactions and Genetic epidemiology and twin study. The results are organized in five original articles, presented in the form of publication or submission. Considering the research line Epidemiology of adverse reactions we should highlight as main results: our studies showed the heterogeneity of the heparins commercialised in Brazil, a situation with potential impact in the safety profile of the drug and in the risk of heparin-induced thrombocytopenia; we were able to ascertain the lower risk of heparin-induced thrombocytopenia in patients exposed to low molecular weight heparin when compared to patients exposed to unfractionated heparin; it was demonstrated a paucity of randomized controlled trials addressing the safety aspect of the use of heparins; and we were able to generate health information for professionals and for the national and international pharmacovigilance system about safety aspects related to the use of heparins in Brazil and about the heparin-induced thrombocytopenia. Considering the research line Genetic epidemiology and twin study we should highlight as main results: we were able to study the influence of the genetic component in chronic low back pain showing its major contribution in the prevalence of this chronic condition; and our studies showed an important contribution of domestic physical workload but not leisure physical activity to chronic low back pain. These results contribute to a comprehensive understanding of the process of drug utilization and represent a positive contribution for the knowledge generation regarding the safe use of medicines and the risk assessment of complex diseases. We also believe that the knowledge behind these results may support the design of new clinical protocols and public health strategies considering the use of heparin and the low back pain problem. We also emphasize that both research lines are incipient in Brazil and, from this perspective, this thesis embodies the expectations of scientific innovation and of international partnerships as a strategy to the development of national researches with competitive calibre which may encourage the scientific advancement of the country. |
publishDate |
2012 |
dc.date.none.fl_str_mv |
2012-10-25 2019-08-12T18:46:02Z 2019-08-12T18:46:02Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
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publishedVersion |
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http://hdl.handle.net/1843/EMCO-966NWX |
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http://hdl.handle.net/1843/EMCO-966NWX |
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por |
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por |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais UFMG |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais UFMG |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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Universidade Federal de Minas Gerais (UFMG) |
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UFMG |
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UFMG |
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Repositório Institucional da UFMG |
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Repositório Institucional da UFMG |
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Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG) |
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repositorio@ufmg.br |
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1816829715115147264 |