Assessment of the implementation of pharmacist prescribing: Challenges and pathways for ambulatory practice.

BACKGROUND: Prescribing by pharmacists is an increasingly common practice worldwide. In Brazil regulation of this practice began in 2013, and the practice remains unexplored as a research topic. OBJECTIVE: We aimed to explore and gain insights into pharmacist prescribing practices in Brazil and assessing pharmacist's perceptions of their training and preparedness to prescribe medications. METHODS: A cross-sectional survey was conducted between October 2022 and March 2023 via convenience sampling. Data were collected using an online questionnaire covering sociodemographic issues, academic training, prescribing practices, and perceptions regarding the provision of pharmacist prescribing in ambulatory care. Exploratory descriptive analysis and Poisson regression were performed to estimate the associations between pharmacist characteristics and their practices in prescribing medicines. RESULTS: Among the 305 valid responses, 58.7% of the outpatient pharmacists stated that they had not prescribed any medication in the previous three years. Over-the-counter medication prescriptions were most common (42.0%). Only 4.6% of respondents had prescribed prescription-only medicines provided through collaborative agreement, with 2.6% reporting that they had adjusted doses, and 2.3% played a role in prescription renewal. Pharmacists living in Northeast regions tended to be more active prescribers (PR = 1.42; 95%CI 1.03-2.18), whereas those in primary healthcare (PR = 0.61; 95%CI 0.39-0.96) and self-declared Black pharmacists (PR = 0.30; 95%CI 0.10-0.97) prescribed less. Respondents strongly believed in the pharmacist's role as a prescriber, although they remained ambivalent regarding their responsibility for patient outcomes. Progress barriers include infrastructure gaps and strained relationships with physicians. CONCLUSIONS: This study suggests that pharmacists in Brazil predominantly prescribe over-the-counter medications, and variations in setting, region, and race can influence prescribing by pharmacist in ambulatory care.

Telemedicine for diagnosis or treatment during Covid-19: systematic review

OBJECTIVE: To describe the use of telemedicine by health professionals for diagnosis or treatment of patients during the Covid-19 pandemic. METHOD: This is a systematic literature review of observational studies. Five databases were used. The assessment of the studies methodological quality occurred individually among the revisors and the Joanna Briggs Institute (JBI) tool was used. RESULTS: The reviewers selected 22 articles from 6,180 works. The services provided through telemedicine were consultation/screening, consultation/follow-up or monitoring, test reports, medication prescriptions and case discussions. The technological resources used were platforms using video and telephone (audio and video). The use of telemedicine made it possible to reduce their exposure to Covid-19, reduce social panic and anxiety, quickly medical specialties access and the possibility of access to diagnosis and treatment of patients with chronic and acute diseases. CONCLUSION: Telemedicine can be an important tool in healthcare, keeping patients and healthcare professionals safe during the Covid-19 pandemic.

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review.

OBJECTIVE: To evaluate the influence of the ethical climate on workers' health among healthcare professionals. METHOD: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. RESULTS: Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). CONCLUSION: The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.

Prevalence of antidepressant use in Brazil: a systematic review with meta-analysis.

OBJECTIVE: To estimate the prevalence of antidepressant use in Brazil. METHODS: We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data and assessed the methodological quality. We combined the prevalence of antidepressant use using meta-analyses of proportions by Freeman-Tukey and estimated heterogeneity by I². Odds ratio (OR) meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. RESULTS: Out of 3,299 records, 23 studies published in 28 reports were included. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; I2=98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; I2=0.0%) than men (4.6%; 95%CI 3.1-6.8%; I2=0.0%), p<0.001; OR=2.82; 95%CI 1.72-4.62. Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; I2=37.6% versus men: 0.5%; 95%CI 0.2-1.0%; I2=0.0%, p<0.001; OR=4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with participants' mean age (p=0.035; residual I²=0.0%; regression coefficient=0.003). CONCLUSIONS: Four in every 100 Brazilians use antidepressants; use increased with age and was higher in women compared to men.

Prevalence of psychotropic and antidepressant use in a Brazilian Amazon city: analysis of two cross-sectional studies.

This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Prevalence of psychotropic and antidepressant use in a Brazilian Amazon city: analysis of two cross-sectional studies / Prevalência de uso de psicotrópicos e antidepressivos em uma cidade da Amazônia brasileira: análise de dois estudos transversais

Abstract This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Resumo O objetivo deste artigo é avaliar a prevalência do uso de psicotrópicos e antidepressivos e fatores associados em uma cidade da Amazônia. Dois estudos transversais foram realizados em Manaus, em 2015 e 2019, com adultos selecionados por amostragem probabilística. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson. Foram incluídos 3.479 participantes em 2015 e 2.321 em 2019; 2,0% usaram psicotrópicos em 2015 e 2,7% em 2019. Antidepressivos foram usados por 0,4% (2015) e 1,4% (2019). O uso de psicotrópicos foi menor em jovens (RP = 0,41; IC95%: 0,19-0,90), sem companheiros (RP = 0,64; IC95%: 0,44-0,93) e trabalhadores informais (RP = 0,47; IC95%: 0,25-0,86), mas maior em pessoas com saúde ruim (RP = 2,86; IC95%: 1,71-4,80), multimorbidade (RP = 3,24; IC95%: 1,87-5,60) e que visitaram médico (RP = 3,04; IC95%: 1,45-6,38) ou dentista (RP = 1,50; IC95%: 1,08-2,10). O uso de antidepressivos foi maior em 2019 (RP = 2,90; IC95%: 1,52-5,54), e pessoas com saúde ruim (RP = 2,77; IC95%: 1,16-6,62) e multimorbidade (RP = 8,72; IC95%: 2,71-28,00), mas menor em trabalhadores informais (RP = 0,33; IC95%: 0,12-0,87) e desempregados (RP = 0,26; IC95%: 0,08-0,81). O uso de psicotrópicos permaneceu estável em Manaus de 2015 a 2019, enquanto o de antidepressivos triplicou, sendo marcados por desigualdades sociais.

Trends in sales of antidepressants in Brazil from 2014 to 2020: A time trend analysis with joinpoint regression.

BACKGROUND: This study aimed to investigate the trends in antidepressants sales in Brazil. METHODS: We performed a joinpoint analysis of antidepressants sales in Brazil from 2014 to 2020, recorded in the Brazilian National Controlled Products Management System. The primary outcomes were the defined daily dose per 1000 inhabitants per day (DID) and the market shares for each antidepressant per year. We used joinpoint regression to assess the changes in antidepressant consumption in DID to obtain the average annual percent change (AAPC) and 95 % confidence intervals (95 % CI). Changes in market shares were tested by chi-square trend test (p < 0.05 as significant). RESULTS: From 2014 to 2020, 42,252,989 antidepressant sales were recorded in the system. Antidepressant sales increased from 13.7 to 33.6 DID in the period (AAPC: 15.7; 95 % CI: 13.0-18.4; p < 0.001); the largest increases were observed for serotonin reuptake inhibitors and 'other' antidepressants (including serotonin-norepinephrine reuptake inhibitors), whereas tricyclics remained steady. Escitalopram and sertraline were the most sold drugs. Market share of serotonin reuptake inhibitors decreased, particularly for paroxetine (13.1 % to 6.5 %; p = 0.016), while 'other' antidepressants' market share expanded from 21.9 % to 33.3 % (p = 0.027), especially for desvenlafaxine (2.9 % to 14.3 %; p < 0.001). LIMITATIONS: The dataset does not include antidepressants dispensed in hospitals, public services, and compounding pharmacies, neither their therapeutic indications. CONCLUSION: Sales of antidepressants significantly increased in Brazil from 2014 to 2020, which were mainly driven by higher prescriptions of serotonin reuptake inhibitors and 'other' antidepressants classes. Market share changes seem to be driven by novelty of products.

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review / Influencia del clima ético en la salud del trabajador entre los profesionales de la salud: una revisión sistemática / Influência do clima ético na saúde do trabalhador entre profissionais de saúde: revisão sistemática

ABSTRACT Objective: To evaluate the influence of the ethical climate on workers' health among healthcare professionals. Method: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. Results: Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). Conclusion: The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.

RESUMEN Objetivo: Evaluar la influencia del clima ético en la salud de los trabajadores entre los profesionales de la salud. Método: Revisión sistemática y metanálisis utilizando MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature y Web of Science. La selección, la extracción de datos y la evaluación de la calidad metodológica fueron realizadas por revisores capacitados. Se aplicó metanálisis para la síntesis de datos. Resultados: Entre 2644 estudios, 20 fueron incluidos para el análisis, en el que tres (15,0%) artículos fueron clasificados como de alta calidad (puntuación ≥ 80%), mientras que 17 (85,0%) fueron clasificados como regulares (puntuación 50-79%). Ocurrió correlación negativa y moderada entre el clima ético y el sufrimiento moral general (r=-0,45; IC95% -0,52; -0,38) y la frecuencia del sufrimiento moral (r=- 0,32; IC 95% -0,45; -0,18), así como una correlación positiva y fuerte entre el clima ético y la satisfacción laboral (r=0,71; IC 95% 0,39-0, 88). Conclusión: La percepción negativa y positiva del clima ético entre los profesionales de la salud, respectivamente, influyeron en el aumento del malestar moral y la satisfacción laboral.

RESUMO Objetivo: Avaliar a influência do clima ético na saúde do trabalhador entre os profissionais de saúde. Método: Revisão sistemática nas bases MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature e Web of Science. A seleção, a extração dos dados e a avaliação da qualidade metodológica foram realizadas por revisores capacitados. Aplicou-se a meta-análise para a síntese dos dados. Resultados: Dentre os 2644 estudos, foram incluídos 20 para análise, em que três (15,0%) artigos foram classificados como de alta qualidade (pontuação ≥ 80%), enquanto 17 (85,0%) foram classificados como regulares (pontuação 50-79%). Houve correlação negativa e moderada entre o clima ético e o sofrimento moral geral (r=-0,43; IC95% -0,50; -0,36) e a frequência de sofrimento moral (r=-0,36; IC95% -0,45; -0,25), bem como a correlação positiva e forte entre o clima ético e a satisfação no trabalho (r=0,71; IC95% 0,39-0,88). Conclusão: A percepção negativa e positiva do clima ético entre os profissionais de saúde, respectivamente, influenciou no aumento do sofrimento moral e na satisfação no trabalho.

Trough-guided Versus AUC/MIC-Guided Vancomycin Monitoring: A Cost Analysis.

PURPOSE: Recent vancomycin dosing and monitoring guidelines recommend monitoring vancomycin area under the 24-hour time-concentration curve instead of traditional trough-only monitoring. This study aimed to compare the total costs of vancomycin dosing and monitoring between trough-guided and AUC-guided approaches in a quaternary hospital from Brazil. METHODS: In this retrospective cohort study, patients were divided into 2 groups according to the monitoring method. Patients with previous renal impairment were excluded. Vancomycin AUC was estimated by using 2 steady-state serum concentrations and first-order kinetics equations. The primary outcome was total cost of vancomycin therapy and monitoring from the hospital perspective, which included costs of cumulative doses, laboratory fees, materials used in blood collection, nursing time for collection, and pharmacist time for result interpretation. FINDINGS: A total of 68 patients were included in the AUC/MIC-guided monitoring group, and 76 patients were included in the trough-guided monitoring group. There were no significant differences between groups regarding baseline serum creatinine level, duration of vancomycin therapy, and cumulative vancomycin dose. The median (interquartile range) total vancomycin drug and monitoring cost was $298.32 ($153.81-$429.85) for the AUC/MIC-guided group compared with $285.59 ($198.81-$435.57) for the trough-guided group (P = 0.9658). IMPLICATIONS: Vancomycin AUC estimation using 2 steady-state serum concentrations and first-order kinetics equations is a feasible alternative for limited-resource institutions that intend to transition from a trough approach to AUC/MIC-guided monitoring.

Prevalence and factors associated with polypharmacy and potential drug interactions in adults in Manaus, Amazonas state, Brazil: a cross-sectional population-based study, 2019. / Prevalência e fatores associados à polifarmácia e potenciais interações medicamentosas em adultos na cidade de Manaus: estudo transversal de base populacional, 2019.

OBJECTIVE: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019. METHODS: This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design. RESULTS: Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67). CONCLUSION: Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.

Beta-Lactams Therapeutic Monitoring in Septic Children-What Target Are We Aiming for? A Scoping Review.

The antimicrobial therapy of sepsis and septic shock should be individualized based on pharmacokinetic/pharmacodynamic (PK/PD) parameters to deliver effective and timely treatment of life-threatening infections. We conducted a literature scoping review to identify therapeutic targets of beta-lactam antibiotics in septic pediatric patients and the strategies that have been applied to overcome sepsis-related altered pharmacokinetics and increase target attainment against susceptible pathogens. A systematic search was conducted in the MEDLINE, EMBASE and Web of Science databases to select studies conducted since 2010 with therapeutic monitoring data of beta-lactams in septic children. Last searches were performed on 02 September 2021. Two independent authors selected the studies and extracted the data. A narrative and qualitative approach was used to summarize the findings. Out of the 118 identified articles, 21 met the eligibility criteria. Population pharmacokinetic modeling was performed in 12 studies, while nine studies reported data from bedside monitoring of beta-lactams. Most studies were conducted in the United States of America (n = 9) and France (n = 5) and reported PK/PD data of amoxicillin, ampicillin, azlocillin, aztreonam, cefazolin, cefepime, cefotaxime, ceftaroline, ceftazidime, doripenem, meropenem and piperacillin/tazobactam. Therapeutic targets ranged from to 40% fT> MIC to 100% fT> 6 × MIC. Prolonging the infusion time and frequency were most described strategies to increase target attainment. Monitoring beta-lactam serum concentrations in clinical practice may potentially maximize therapeutic target attainment. Further studies are required to define the therapeutic target associated with the best clinical outcomes.

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies.

OBJECTIVE: To investigate the use of health services among adults living in Manaus, Amazonas. METHODS: This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS: The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS: From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.

Prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence and hazardous alcohol drinking: a population-based study in the Brazilian Amazon.

BACKGROUND: The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon. METHODS: Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors. RESULTS: Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05). LIMITATIONS: Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population. CONCLUSION: Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.

Adverse events related to oral hormonal contraceptive use in undergraduate pharmacy students: a cross-sectional study

Abstract We aimed to measure the prevalence of adverse events related to oral hormonal contraceptive (OHC) use and their associated factors in undergraduate pharmacy students. A cross-sectional study was conducted by using an online questionnaire for female students of the Faculty of Pharmaceutical Sciences of the University of São Paulo from July to August 2020. A descriptive analysis of the data was carried out, which was followed by determining the prevalence ratios to identify possible factors associated with adverse events resulting from OHC. A total of 269 valid responses were obtained, among which 50.2% (n = 135) of the students reported using OHC as a contraceptive method and 21.2% (n = 57) affirmed that they had at least one adverse event related to OHC use, which corresponds to 42.2% of those who had used OHC. The most common adverse event was headache (70.2%), and a period of less than one month was the most cited (49.1%). Only migraine comorbidity was associated with the occurrence of adverse events related to OHC. These findings reinforce the high incidence of adverse events among OHC users and the low rate of discontinuation due to these events. There is a need to provide more information on contraceptive methods to users, including its risks and contraindications.

Prevalência e fatores associados à polifarmácia e potenciais interações medicamentosas em adultos na cidade de Manaus: estudo transversal de base populacional, 2019 / Prevalencia y factores asociados a la polifarmacia y posibles interacciones farmacológicas en adultos en la ciudad de Manaus, Amazonas, Brasil: estudio transversal poblacional, 2019 / Prevalence and factors associated with polypharmacy and potential drug interactions in adults in Manaus, Amazonas state, Brazil: a cross-sectional population-based study, 2019

Objetivo: Analisar a prevalência e fatores associados à polifarmácia e a presença de potenciais interações medicamentosas em Manaus, estado do Amazonas, Brasil, em 2019. Métodos: Estudo transversal de base populacional, com adultos de ≥ 18 anos. Entre pessoas em polifarmácia (≥ 5 medicamentos), pesquisou-se a presença de interações medicamentosas na base Micromedex. Razões de prevalências (RP) com intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson com variância robusta, seguindo análise hierárquica e considerando o delineamento amostral complexo. Resultados: Dos 2.321 participantes, 2,8% (IC95% 2,1;3,6) estavam em polifarmácia e, destes, 74,0% apresentaram interações, sendo mais frequentes quatro ou mais interações por pessoa (40,4%) e gravidade alta (59,5%). Polifarmácia foi maior entre idosos (RP = 3,24; IC95% 1,25;8,42), pessoas com saúde ruim (RP = 2,54; IC95% 1,14;5,67), hospitalização prévia (RP = 1,90; IC95% 1,09;3,32) e multimorbidade (RP = 3,20; IC95% 1,53;6,67). Conclusão: A polifarmácia foi mais frequente entre idosos e pessoas com problemas de saúde, que tiveram mais interações medicamentosas.

Objetivo: Analizar la prevalencia y factores asociados a la polifarmacia y la presencia de posibles interacciones farmacológicas en Manaus, estado de Amazonas, Brasil, en 2019. Métodos: Estudio poblacional transversal realizado con adultos con edad ≥ 18 años. Entre personas en polifarmacia (≥ 5 medicamentos), se investigó la presencia de interacciones farmacológicas en Micromedex. Las razones de prevalencia (RP) con intervalos de confianza de 95% (IC95%) se calcularon mediante la regresión de Poisson con varianza robusta, siguiendo análisis jerárquico y considerando el diseño de muestra complejo. Resultados: De los 2.321 participantes, 2,8% (IC95% 2,1;3,6) se encontraban en polifarmacia, de los cuales 74,0% presentaban interacciones, siendo más frecuentes cuatro o más interacciones por persona (40,4%) y de alta gravedad (59,5%). La polifarmacia fue mayor entre los ancianos (RP = 3,24; IC95% 1,25;8,42), personas con mala salud (RP = 2,54; IC95% 1,14;5,67), hospitalización previa (RP = 1,90; IC95% 1,09;3,32) y multimorbilidade (RP = 3,20; IC95% 1,53;6,67). Conclusión: La polifarmacia fue más frecuente entre los ancianos y personas con problemas de salud, que potencialmente tenían más interacciones farmacológicas.

Objective: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019. Methods: This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design. Results: Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67). Conclusion: Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.

Continuity of Primary Care in the Brazilian Amazon: A Cross-Sectional Population-Based Study.

BACKGROUND: Few studies have evaluated the continuity of primary care in universal health care systems, especially in underserved areas. METHODS: This was a cross-sectional study with 4,001 adults (≥18 years old) living in the Manaus Metropolitan Region in 2015. Interviews were conducted in households selected with probabilistic sampling. City and neighborhood variables were collected from databanks. Prevalence ratios (PR) of the continuity of care (defined as using a primary care service and having been previously registered in the Family Health Strategy program) and 95% confidence intervals (CIs) were calculated with multilevel Poisson regression analysis. RESULTS: A total of 20.6% (95%CI 19.4-21.9%) of the participants reported continuity of primary care. Women (PR = 1.38; 95%CI 1.18-1.61), nonwhite individuals (PR = 1.13; 95%CI 1.05-1.21), and poorer people (PR = 1.55; 95%CI 1.19-2.02) had higher levels of continuity, whereas health insurance holders had lower levels of continuity (PR = 0.46; 95%CI 0.34-0.62). Individuals with continuity of care had more physician consultations (PR = 1.06; 95%CI 1.02-1.10), dentist consultations (PR = 1.16; 95%CI 1.05-1.28), fewer depressive (PR = 0.59; 95%CI 0.44-0.79) and anxiety symptoms (PR = 0.64; 95%CI 0.48-0.85), and a higher quality of life (ß = 0.033; 95%CI 0.011-0.054) than those without continuity. CONCLUSIONS: Continuity of care was attained by two-tenths of the population and the level of continuity was high among socioeconomically disadvantaged people. Good outcomes and health services usage increased with continuity of care.

Diretrizes de prática clínica para o tratamento da Covid-19 no Brasil: uma revisão sistemática / Clinical practice guidelines for the treatment of Covid-19 in Brazil: A systematic review / Guías de práctica clínica para el tratamiento de la enfermedad por Covid-19 en Brasil: revisión sistemática

Resumo Introdução A Coronavirus Disease-2019 é uma doença infectocontagiosa que afeta o sistema respiratório, que surgiu na China e logo se espalhou pelo mundo. Objetivo Avaliar a qualidade metodológica e transparência das Diretrizes de Prática Clínica brasileiras para o tratamento da Coronavirus Disease-2019. Materiais e Métodos Trata-se de uma revisão sistemática realizada em 2020 nas fontes de dados: MEDLINE (via PubMed), EMBASE, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde, National Guideline Clearinghouse e Guidelines International Network, e sites do Ministério da Saúde do Brasil, Sociedades Médicas Brasileiras, Conselhos de Medicina, Conselho Federal de Enfermagem e Conselho Federal de Fisioterapia. A avaliação da qualidade metodológica e da transparência das diretrizes ocorreu por meio do instrumento Appraisal of Guidelines for Research & Evaluation, versão II, realizada por quatro autores. Resultados Foram encontradas 33 diretrizes, das quais foram incluídas 14 para análise. Somente uma diretriz apresentou pontuações acima de 60% em todos os domínios. Entre os seis domínios, três apresentaram maiores pontuações: Escopo e finalidade, Envolvimento das partes interessadas e Clareza da apresentação. Discussão Apesar da fragilidade metodológica, os autores se preocuparam em apresentar as recomendações de forma clara e concisa, através de informações-chave e opções terapêuticas que facilitam a tomada de decisão. Conclusão As diretrizes brasileiras apresentaram baixa qualidade metodológica, em que somente uma diretriz foi recomendada e classificada com alta qualidade e transparência metodológica.

Abstract Introduction Coronavirus disease (Covid-19) is an infectious disease affecting the respiratory tract, which emerged in China and spread rapidly throughout the world. Objective To evaluate the methodological quality and transparency of Brazilian clinical practice guidelines for the treatment of coronavirus disease (Covid-19). Materials and Methods A systematic review was conducted in 2020 on Medline (via PubMed), Embase, Scopus, LILACS, National Guideline Clearinghouse and Guidelines International Network databases, in addition to online searches on the Brazilian Ministry of Health, Brazilian Medical Association, Federal Council of Medicine, Federal Council of Nursing and Federal Council of Physical Therapy websites. The methodological quality and transparency of the guidelines were assessed using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument developed by four authors. Results 33 guidelines were found of which 14 were included in the analysis. There was only one guideline that scored above 60% in all domains. Among the six domains, higher scores were found in the following three domains: scope and objective, stakeholder involvement and clarity of presentation. Discussion Despite methodological weakness found, the authors were keen to provide clear and concise recommendations through key information and therapeutic options to facilitate decision making. Conclusions Brazilian clinical practice guidelines were found to be of poor methodological quality, from which only one guideline was recommended and classified as to be of high methodological quality and transparency.

Resumen Introducción La enfermedad por coronavirus (Covid-19) es una patología infecciosa que afecta al sistema respiratorio, la cual se originó en China y se extendió rápidamente por todo el mundo. Objetivo Evaluar la calidad metodológica y la transparencia de las guías de práctica clínica brasileñas para el tratamiento de la enfermedad por coronavirus (Covid-19). Materiales y métodos Se realizó una revisión sistemática en 2020 en las bases de datos Medline (vía PubMed), Embase, Scopus, LILACS, National Guideline Clearinghouse y Guidelines International Network, además de consultas en los sitios web del Ministerio de Salud de Brasil, Asociación Médicas Brasileña, Consejo Federal de Medicina, Consejo Federal de Enfermería y Consejo Federal de Fisioterapia. La evaluación de la calidad metodológica y la transparencia de las guías se realizó con el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE), segunda versión realizada por cuatro autores. Resultados Se encontraron 33 guías, de las que se incluyeron 14 en el análisis. Hubo una sola guía que obtuvo una puntuación superior al 60% en todos los dominios. Entre los seis dominios, se presentaron puntuaciones más altas en los siguientes tres dominios: alcance y objetivo, participación de las partes interesadas y claridad de la presentación. Discusión A pesar de la fragilidad metodológica, los autores se interesaron por presentar las recomendaciones de forma clara y concisa a través de información clave y opciones terapéuticas que faciliten la toma de decisiones. Conclusión Las guías de práctica clínica brasileñas mostraron tener una baja calidad metodológica, de las que solamente una guía fue recomendada y clasificada como de alta calidad y transparencia metodológica.