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1.
Epidemiol Serv Saude ; 29(1): e2018414, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32074195

RESUMO

OBJECTIVE: to analyze the frequency and factors associated with coverage by health insurance in the metropolitan region of Manaus, AM, Brazil. METHOD: a cross-sectional population-based study was conducted in 2015, with data collected through household interviews; prevalence ratios (PR) and confidence intervals (95%CI) were calculated using Poisson regression with robust variance adjusted for sex and age. RESULTS: we interviewed 4,001 individuals; 13% (95%CI - 12.0;14.1%) had health insurance; greater insurance coverage was observed among military personnel (PR=3.18 - 95%CI 1.64;6.15), private sector employees (PR=1.91 - 95%CI 1.46;2.52) and public sector employees (PR=1.75 - 95%CI 1.23;2.49); health insurance was lower among poorer people (PR=0.21 - 95%CI 0.13;0.33), and those with less schooling (PR=0.66 - 95%CI 0.46;0.99). CONCLUSION: frequency of health insurance was low and was associated with better purchasing power, schooling, and employment.

2.
Epidemiol Serv Saude ; 29(1): e2019122, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32074199

RESUMO

OBJECTIVE: to estimate the prevalence of self-reported chronic kidney disease and associated factors in adults living in the Metropolitan Region of Manaus, Brazil. METHODS: this was a population-based cross-sectional study conducted in 2015, with probabilistic sampling to select adults ≥18 years to be interviewed at home; factors associated with self-reported chronic kidney disease were investigated using hierarchical Poisson regression, to calculate prevalence ratios (PR) and 95% confidence intervals (95%CI), considering the complex sampling used. RESULTS: a total of 4,001 people were interviewed - 52.8% were women, 72.2% were of brown skin color and 19.7% had hypertension; prevalence of self-reported chronic kidney disease was 2.1% (95%CI 1.6;2.5), it was positively associated with age (35-44 years old, PR=2.31, 95%CI 1.02;5.21; 45-59 years old, PR=2.52, 95%CI 1.10;5.75; ≥60 years old, PR=2.95, 95%CI 1.21;7.16) and having had strokes (PR=2.20, 95%CI 1.09;4.45). CONCLUSION: two out of every 100 Manaus metropolitan region inhabitants self-reported chronic kidney disease and it was more frequent in older adults and those who had had strokes.

3.
Rev Soc Bras Med Trop ; 53: e20190363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994666

RESUMO

INTRODUCTION: This study assessed the seroprevalence of cytomegalovirus, associated factors, and Epstein-Barr virus coinfection among adult residents of Manaus. METHODS: Using a cross-sectional study design, we collected blood samples from 136 individuals in a household survey in 2016. Prevalence ratios were calculated using Poisson regression. RESULTS: Cytomegalovirus and Epstein-Barr virus seroprevalences were 67.6% (95% CI: 9.7-75.6%) and 97.8% (95% CI: 95.3-100.0%), respectively. Coinfection was observed in 66.2% (95% CI: 58.1-74.2%) of participants. Bivariate analysis showed no statistical association. CONCLUSIONS: Seroprevalences were high among participants and approximately 7 out of 10 individuals had cytomegalovirus and Epstein-Barr virus coinfection.

4.
Front Pharmacol ; 10: 945, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31572172

RESUMO

Background: Oseltamivir and zanamivir are recommended for treating and preventing influenza A (H1N1) worldwide. In Brazil, this official recommendation lacks an economic evaluation. Our objective was to assess the efficiency of influenza A chemoprophylaxis in the Brazilian context. Methods: We assessed the cost-effectiveness of oseltamivir and zanamivir for prophylaxis of influenza for high risk population, compared to no prophylaxis, in the perspective of Brazilian public health system. Quality-adjusted life years (QALY) and effectiveness data were based on literature review and costs in Brazilian real (BRL) were estimated from official sources and micro-costing of 2016's H1N1 admissions at a university hospital. We used a decision-tree model considering prophylaxis and no prophylaxis and the probabilities of H1N1, ambulatory care, admission to hospital, intensive care, patient discharge, and death. Adherence and adverse events from prophylaxis were included. Incremental cost-effectiveness ratio was converted to 2016 United States dollar (USD). Uncertainty was assessed with univariated and probabilistic sensitivity analysis. Results: Adherence to prophylaxis was 0.70 [95% confidence interval (CI) 0.54; 0.83]; adverse events, 0.09 (95% CI 0.02; 0.18); relative risk of H1N1 infection in chemoprophylaxis, 0.43 (95% CI 0.33; 0.57); incidence of H1N1, 0.14 (95% CI 0.11; 0.16); ambulatory care, 0.67 (95% CI 0.58; 0.75); hospital admission, 0.43 (CI 95% 0.39; 0.42); hospital mortality, 0.14 (CI 95% 0.12; 0.15); intensive care unit admission, 0.23 (95% CI 0.20; 0.27); and intensive care mortality, 0.40 (95% CI 0.29; 0.52). QALY in H1N1 state was 0.50 (95% CI 0.46; 0.53); in H1N1 inpatients, 0.23 (95% CI 0.18; 0.28); healthy, 0.885 (95% CI 0.879; 0.891); death, 0. Adverse events estimated to affect QALY in -0.185 (95% CI -0.290; -0.050). Cost for chemoprophylaxis was BRL 39.42 [standard deviation (SD) 17.94]; ambulatory care, BRL 12.47 (SD 5.21); hospital admission, BRL 5,727.59 (SD 7,758.28); intensive care admission, BRL 19,217.25 (SD 7,917.33); and adverse events, BRL 292.05 (SD 724.95). Incremental cost-effectiveness ratio was BRL -4,080.63 (USD -1,263.74)/QALY and -982.39 (USD -304.24)/H1N1 prevented. Results were robust to sensitivity analysis. Conclusion: Chemoprophylaxis of influenza A (H1N1) is cost-saving in Brazilian health system context.

5.
Rev Soc Bras Med Trop ; 52: e20190232, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31508784

RESUMO

INTRODUCTION: Dengue is an endemic and epidemic disease in Brazil, with a high burden of disease. Amazonas State has a high risk of transmission. This study aimed to assess the self-reported prevalence of dengue in adults living in Manaus Metropolitan Region. METHODS: A cross-sectional study was conducted with adults living in Manaus Metropolitan Region in 2015. We performed a three-phase probabilistic sampling to collect participants' clinical and sociodemographic data. Self-reported dengue infection in the previous year was the primary outcome. Descriptive statistics and Poisson regression analysis with robust variance were used to calculate the prevalence ratio (PR) of dengue infections with 95% confidence intervals (95% CIs). Multilevel analysis including city and neighborhood variables was calculated. All analyses considered the complex sampling. RESULTS: Among the 4,001 participants, dengue in the previous year was self-reported by 7.0% (95% CI 6.3%-7.8%). Dengue was more frequent in women(PR 1.51; 95% CI 1.06-2.13), elderly participants (≥60 years old, PR 2.54; 95% CI 1.19-5.45), White and Asian participants (PR, 1.57; 95% CI, 1.11-2.23), and individuals who had not received endemic agent visits (PR, 2.28; 95% CI, 1.31-3.99). After multilevel analysis, sex was no longer a significant variable, with the remaining associations still significant. CONCLUSIONS: Seven out of 100 inhabitants of Manaus Metropolitan Region reported dengue in the previous year. Dengue was predominantly observed in women, elderly individuals, White and Asian individuals, and individuals who did not receive endemic agent visits. The setting plays an important role in dengue infections.


Assuntos
Dengue/epidemiologia , Autorrelato/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , População Urbana , Adulto Jovem
6.
Int J Health Plann Manage ; 34(4): e1846-e1853, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31515900

RESUMO

BACKGROUND: Although Brazil has a public and universal healthcare system, utilization of health services is marked by social and regional discrepancies. OBJECTIVE: To assess the prevalence and factors associated with underutilization of healthcare services in the Brazilian Amazon. METHOD: Cross-sectional, population-based study. Adults aged over 18 years old were selected through probabilistic sampling. Underutilization of healthcare services was defined as never seeing a physician or a dentist. Poisson regression with robust variance was performed to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). A complex sample design was considered. RESULTS: A total of 4001 individuals were included, of which 419 (10.4%; 95% CI, 9.5-11.4%) never visited a physician or a dentist. In the adjusted analysis, underutilization was higher among poorer people (PR = 3.32; 95% CI, 2.16-5.11), men (PR = 1.34; 95% CI, 1.10-1.65), people with brown skin color (Brazilian mixed race; PR = 1.34; 95% CI, 1.02-1.76), and people who are separated (PR = 1.40; 95% CI, 1.01-1.94) and widowed (PR = 1.55; 95% CI, 1.02-2.37), when compared with the reference categories. Individuals with informal jobs, those who are retired, students/housewives, and unemployed people were more vulnerable to underutilization than formal workers (P < .04). CONCLUSION: Underutilization of healthcare services occurs in one-tenth of adults in Manaus Metropolitan Region and is associated with social and economic inequities.

7.
Sao Paulo Med J ; 137(3): 216-222, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340252

RESUMO

BACKGROUND: Patient safety culture is part of the organizational profile of healthcare institutions and is associated with better quality of care. OBJECTIVE: To assess patient safety culture in a university hospital. DESIGN AND SETTING: Hospital-based cross-sectional study conducted in a public university hospital in São Paulo, Brazil, between September and December 2015. METHODS: We randomly selected 68 sectors of the hospital, to include up to 5 employees from each sector, regardless of length of experience. We used the validated Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPS) via an electronic interface. We calculated the percentage of positive responses for each dimension of the HSOPS and explored the differences in age, experience, occupation and educational level of respondents using the chi-square test. RESULTS: Out of 324 invited respondents, 314 (97%) accepted the invitation and were surveyed. The sample presented predominance of women (72%), nursing staff (45%) and employees with less than six years' experience at the hospital (60%). Nine out of the 12 dimensions showed percentages of positive responses below 50%. The worst results related to "nonpunitive response to errors" (16%). A better safety culture was observed among more experienced staff, nurses and employees with a lower educational level. In the previous year, no events were reported by 65% of the participants. CONCLUSIONS: The patient safety culture presented weaknesses and most of professionals had not reported any event in the previous year. A policy for improvement and cyclical assessment is needed to ensure safe care.

8.
Medicine (Baltimore) ; 98(21): e15769, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124966

RESUMO

INTRODUCTION: Health services utilization is an indirect measure of the rights and equity of a health system. A 2015 survey conducted in the Manaus metropolitan region showed that in the previous year, over 70% of adults visited the doctor and 1 in 3 had visited a dentist. Socioeconomic factors and inequality played a central role in the usage of healthcare services and health situation in this population. Since then, political and economic crisis are evolving in Brazil. This project aims to estimate the prevalence of use of health services and the health status of the adults residing in Manaus in 2019. METHODS AND ANALYSIS: This is a population-based survey of adults (≥18 years old) residing in Manaus. This survey will be conducted in the first half of 2019 with 2300 participants who will be interviewed at home, selected from a probabilistic sampling in 3 stages (census tracts, household, and dweller), and stratified by sex and age quotas based on official estimates. The participants will be interviewed using previously validated tools and questions employed in Brazilian official surveys, which will cover use of health services and supplies, health status, and lifestyle. Primary outcome will be any healthcare usage in the last 15 days. Associations between health services usage and socioeconomic data and health outcomes will be assessed using a Poisson regression with a complex sampling design correction. Results will be reported according to the strengthening the reporting of observational studies in epidemiology statement. ETHICS AND DISSEMINATION: This project was approved by the Ethics Committee of the Federal University of Amazonas, Manaus, Amazonas, Brazil. All participants will sign an informed consent before the interview. The results will be disseminated in peer-reviewed manuscripts, reports, conference presentations, and through the media.


Assuntos
Pesquisas sobre Serviços de Saúde/métodos , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Nível de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Análise de Regressão , Projetos de Pesquisa , Fatores Socioeconômicos , Adulto Jovem
9.
Säo Paulo med. j ; 137(3): 216-222, May-June 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1020966

RESUMO

ABSTRACT BACKGROUND: Patient safety culture is part of the organizational profile of healthcare institutions and is associated with better quality of care. OBJECTIVE: To assess patient safety culture in a university hospital. DESIGN AND SETTING: Hospital-based cross-sectional study conducted in a public university hospital in São Paulo, Brazil, between September and December 2015. METHODS: We randomly selected 68 sectors of the hospital, to include up to 5 employees from each sector, regardless of length of experience. We used the validated Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPS) via an electronic interface. We calculated the percentage of positive responses for each dimension of the HSOPS and explored the differences in age, experience, occupation and educational level of respondents using the chi-square test. RESULTS: Out of 324 invited respondents, 314 (97%) accepted the invitation and were surveyed. The sample presented predominance of women (72%), nursing staff (45%) and employees with less than six years' experience at the hospital (60%). Nine out of the 12 dimensions showed percentages of positive responses below 50%. The worst results related to "nonpunitive response to errors" (16%). A better safety culture was observed among more experienced staff, nurses and employees with a lower educational level. In the previous year, no events were reported by 65% of the participants. CONCLUSIONS: The patient safety culture presented weaknesses and most of professionals had not reported any event in the previous year. A policy for improvement and cyclical assessment is needed to ensure safe care.

10.
Clin Toxicol (Phila) ; 57(5): 338-342, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30449184

RESUMO

CONTEXT: Erucism, envenomation caused by dermal contact with larval forms of moths, may result in intense local pain, mainly after contact with puss caterpillars (family Megalopygidae). OBJECTIVE: To evaluate the response to different treatments for controlling severe pain in a case series of erucism in Campinas, southeastern Brazil. PATIENTS AND METHODS: Prospective cohort study. A Numeric Pain Rating Scale (NPRS 0-10) was used to assess pain intensity in the Emergency Department (ED). Pain was considered as severe upon ED admission (T0) when the NPRS was ≥8. INCLUSION CRITERIA: age ≥8 years old, severe pain at T0, with continuous assessment of pain intensity in all patients using the NPRS during the ED stay (T5, T15, T30, T60 min and at discharge). RESULTS: Fifty-five patients fulfilled the inclusion criteria and were divided into three groups according to the initial treatment at T0: local anesthesia alone with 2% lidocaine (group 1, n = 15), local anesthesia and analgesics (group 2, n = 26) and analgesics without local anesthesia (group 3, n = 14). Most patients were admitted within 2 h after dermal contact with the stinging bristles of caterpillars (median =90 min, IQR: 40-125 min). In 22 cases (40%), the caterpillar was brought for identification (Podalia spp., n = 18; Megalopyge spp., n = 4). There was a significant decrease in pain from T5 onwards with all of the treatments. When the short-term response (T5 and T15) was considered, analgesia was more effective in groups 1 and 2 compared to group 3 (p < .01). Additional analgesia (from T5 until discharge) was frequently required (n = 25/55), mainly in group 1 (n = 11/15). The median length of stay in the ED was 120 min (IQR: 80-173 min). CONCLUSIONS: The association of local anesthesia with analgesics was apparently a good combination for the rapid management of severe pain in the ED.

11.
Rev. Soc. Bras. Med. Trop ; 52: e20190232, 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1020445

RESUMO

Abstract INTRODUCTION: Dengue is an endemic and epidemic disease in Brazil, with a high burden of disease. Amazonas State has a high risk of transmission. This study aimed to assess the self-reported prevalence of dengue in adults living in Manaus Metropolitan Region. METHODS: A cross-sectional study was conducted with adults living in Manaus Metropolitan Region in 2015. We performed a three-phase probabilistic sampling to collect participants' clinical and sociodemographic data. Self-reported dengue infection in the previous year was the primary outcome. Descriptive statistics and Poisson regression analysis with robust variance were used to calculate the prevalence ratio (PR) of dengue infections with 95% confidence intervals (95% CIs). Multilevel analysis including city and neighborhood variables was calculated. All analyses considered the complex sampling. RESULTS: Among the 4,001 participants, dengue in the previous year was self-reported by 7.0% (95% CI 6.3%-7.8%). Dengue was more frequent in women(PR 1.51; 95% CI 1.06-2.13), elderly participants (≥60 years old, PR 2.54; 95% CI 1.19-5.45), White and Asian participants (PR, 1.57; 95% CI, 1.11-2.23), and individuals who had not received endemic agent visits (PR, 2.28; 95% CI, 1.31-3.99). After multilevel analysis, sex was no longer a significant variable, with the remaining associations still significant. CONCLUSIONS: Seven out of 100 inhabitants of Manaus Metropolitan Region reported dengue in the previous year. Dengue was predominantly observed in women, elderly individuals, White and Asian individuals, and individuals who did not receive endemic agent visits. The setting plays an important role in dengue infections.

12.
Medicine (Baltimore) ; 97(49): e13364, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544404

RESUMO

Research shows an instability in the way workers in the healthcare field live, and a prevalence of an unhealthy lifestyle. Exhaustion, an overload of obligations and responsibilities and dissatisfaction are all factors that may result in both physical and mental disorders. The aim of our study is to analyze the association between individual and occupational aspects of hospital workers and their job satisfaction, burnout syndrome, and depressive symptoms, as well as the relationship between these 3 factors.A transversal study was carried out from August to November 2016 in a teaching hospital that is a reference in healthcare to 13 cities in the State of São Paulo, Brazil. Workers with an employment relationship of a period of 3 months or longer were included in the study. Subjects for the study were recruited through random probability sampling. Data were collected using psychometric tools in order to analyze job satisfaction (Job Satisfaction Survey [JSS]), the presence of burnout syndrome (Maslach Burnout Inventory [MBI]) and depressive symptoms (Patient Health Questionnaire-9). Adjusted analyses were conducted and the prevalence ratio (PR) was calculated using Poisson regression. The partial least squares structural equation modeling (PLS-SEM) was used for the analyses.The final sample of this study comprised 271 professionals. Administrative workers or technical support workers from the hospital showed to be more satisfied in their jobs compared to the healthcare professionals (P = .02). Time of professional activity was also associated with job satisfaction (P = .03). Men displayed burnout syndrome approximately twice as often as women (PR = 1.98; 95% CI: 1.03-3.79; P = .04). Workers who had a low household income presented a predominance twice as high of depressive symptoms (PR = 2.84; 95% CI: 1.24-6.51; P = .01). PLS-SEM confirmed the causal and inverse relationship between burnout syndrome and job satisfaction (P < .001). Depressive symptoms were considered predictors for professional exhaustion (P < .001).Personal and occupational factors of hospital workers were associated with job satisfaction, burnout syndrome, and depressive symptoms. The absence of burnout was identified as a predictive aspect for job satisfaction, and depressive symptoms as a predictor for professional exhaustion.


Assuntos
Pessoal Administrativo/psicologia , Esgotamento Profissional/complicações , Depressão/complicações , Pessoal de Saúde/psicologia , Hospitais de Ensino , Satisfação no Emprego , Adolescente , Adulto , Brasil , Esgotamento Profissional/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Síndrome , Fatores de Tempo , Adulto Jovem
13.
Sao Paulo Med J ; 136(5): 407-413, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30570092

RESUMO

BACKGROUND: The consumption of antibiotics has been widely discussed, mainly because of antibacterial resistance, which has become a worldwide concern. In Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made under medical prescription. The aims of this study were to evaluate antibiotic use and associated factors among adults in the Metropolitan Region of Manaus, Amazonas, Brazil, and to assess the proportion of self-medication from this use. DESIGN AND SETTING: Population-based cross-sectional study conducted in the Metropolitan Region of Manaus between May and August 2015. METHODS: Adults aged ≥ 18 years were selected through probabilistic sampling in three stages. Trained interviewers collected data from the participants in their homes. Antibiotic consumption over the last 15 days was reported. Bivariate analysis was used to calculate the prevalence ratio (PR) of antibiotic usage, with 95% confidence interval (95% CI). A multivariate model adjusted according to significant variables at P ≤ 0.20 using Poisson regression with robust variance was constructed. RESULTS: The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted analysis showed that consumption was higher among women than among men (PR 1.58; 95% CI 1.11-2.24) and among people with fair health status than among those with good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was 19.0%; amoxicillin was the most self-medicated antibiotic (10/26). CONCLUSION: Antibiotic use was associated with women and individuals with fair health status. One fifth of the antibiotics were consumed through self-medication, contrary to the current Brazilian legislation.


Assuntos
Antibacterianos/uso terapêutico , Automedicação/estatística & dados numéricos , Adulto , Distribuição por Idade , Brasil , Estudos Transversais , Uso Indevido de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
14.
BMJ Open ; 8(10): e019505, 2018 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-30341109

RESUMO

INTRODUCTION: Oral mucositis is an iatrogenic condition of erythematous inflammatory changes which tends to occur on buccal and labial surfaces, the ventral surface of the tongue, the floor of the mouth and the soft palate of patients receiving chemotherapy. This protocol of ongoing randomised parallel group clinical trial aims to access the therapeutic effect of an herbal gel containing 2.5% Arrabidaea chica Verlot standardised extract on oral mucositis in patients with head and neck cancer compared with low-level laser therapy. METHODS AND ANALYSIS: Patients with head and neck cancer held at Clinics Hospital of University of Campinas, Sao Paulo, who develop early signs/symptoms of oral mucositis are eligible. Baseline characteristics of participants include oral mucositis grade and quality of life assessments. Enrolment started in November 2017 with allocation of patients to one of the study groups by means of randomisation. Patients will be treated either with Arrabidaea chica or laser until wound healing. Monitoring includes daily assessment of mucositis grade and diameter measurement by photographs and millimetre periodontal probe. Treatments will be concluded once mucositis is healed. A blinded assessor will evaluate mucositis cure after referred by the study team. At this point, the gel tube will be weighed to indirectly assess patient's compliance. At close-out, data will be analysed by a blinded researcher following the procedures described in the statistical analyses. ETHICS AND DISSEMINATION: This clinical trial was approved by the ethics committee of research in humans at the Faculty of Medical Sciences of University of Campinas (report no. 1,613,563/2016). Results from this trial will be communicated in peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER: RBR-5×4397.


Assuntos
Protocolos Antineoplásicos/normas , Bignoniaceae , Terapia com Luz de Baixa Intensidade/métodos , Extratos Vegetais/uso terapêutico , Estomatite/tratamento farmacológico , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Säo Paulo med. j ; 136(5): 407-413, Sept.-Oct. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-979384

RESUMO

ABSTRACT BACKGROUND: The consumption of antibiotics has been widely discussed, mainly because of antibacterial resistance, which has become a worldwide concern. In Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made under medical prescription. The aims of this study were to evaluate antibiotic use and associated factors among adults in the Metropolitan Region of Manaus, Amazonas, Brazil, and to assess the proportion of self-medication from this use. DESIGN AND SETTING: Population-based cross-sectional study conducted in the Metropolitan Region of Manaus between May and August 2015. METHODS: Adults aged ≥ 18 years were selected through probabilistic sampling in three stages. Trained interviewers collected data from the participants in their homes. Antibiotic consumption over the last 15 days was reported. Bivariate analysis was used to calculate the prevalence ratio (PR) of antibiotic usage, with 95% confidence interval (95% CI). A multivariate model adjusted according to significant variables at P ≤ 0.20 using Poisson regression with robust variance was constructed. RESULTS: The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted analysis showed that consumption was higher among women than among men (PR 1.58; 95% CI 1.11-2.24) and among people with fair health status than among those with good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was 19.0%; amoxicillin was the most self-medicated antibiotic (10/26). CONCLUSION: Antibiotic use was associated with women and individuals with fair health status. One fifth of the antibiotics were consumed through self-medication, contrary to the current Brazilian legislation.

16.
ScientificWorldJournal ; 2018: 9156301, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30104917

RESUMO

Objective: To assess the culture of patient safety in studies that employed the hospital survey on patient safety culture (HSOPS) in hospitals around the world. Method: We searched MEDLINE, EMBASE, SCOPUS, CINAHL, and SciELO. Two researchers selected studies and extracted the following data: year of publication, country, percentage of physicians and nurses, sample size, and results for the 12 HSOPS dimensions. For each dimension, a random effects meta-analysis with double-arcsine transformation was performed, as well as meta-regressions to investigate heterogeneity, and tests for publication bias. Results: 59 studies with 755,415 practitioners surveyed were included in the review. 29 studies were conducted in the Asian continent and 11 in the United States. On average studies scored 9 out of 10 methodological quality score. Of the 12 HSOPS dimensions, six scored under 50% of positivity, with "nonpunitive response to errors" the lowest one. In the meta-regression, three dimensions were shown to be influenced by the proportion of physicians and five by the continent where survey was held. Conclusions: The HSOPS is widely used in several countries to assess the culture of patient safety in hospital settings. The culture of culpability is the main weakness across studies. Encouraging event reporting and learning from errors should be priorities in hospitals worldwide.


Assuntos
Segurança do Paciente , Pessoal de Saúde , Humanos , Cultura Organizacional , Gestão da Segurança/métodos , Inquéritos e Questionários , Estados Unidos
17.
Pediatr Emerg Care ; 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30106866

RESUMO

OBJECTIVES: The objectives of this study were to analyze adverse drug events (ADEs) related to admissions to a pediatric emergency unit and to identify the associated risk factors. METHODS: This was a prospective study. Demographic data and details of medications were collected for each patient admitted. Case studies were performed by clinical pharmacists and the clinical team to discuss whether the admission was due to an ADE and to characterize the ADE. Multivariate logistic regression was used for statistical analysis. RESULTS: In total, 1708 pediatric patients were included in this study. Adverse drug events were the cause of hospital admission in 12.3% of the studied population. The majority of patients presenting with an ADE were in the age group of 0 to 5 years (61.6%), had a mean ± SD age of 4.9 ± 3.9 years, were female (51.2%), were Caucasian (72.0%), and had infectious disorders (49.3%). High frequencies of medication errors (68.8%), use of drugs to treat respiratory disorders (27.7%), and ADEs of mild severity (75.3%) were reported. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological (odds ratio [OR], 4.63; 95% confidence interval [CI], 2.38-8.99), dermatological (OR, 3.16; 95% CI, 1.93-5.18), and respiratory (OR, 3.02; 95% CI, 1.89-4.83) disorders. CONCLUSIONS: A high frequency of ADE-related admissions to the pediatric emergency unit was observed. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological, dermatological, and respiratory disorders. Clinical pharmacists play an important role in the identification of ADEs and the education of child caregivers and health care providers concerning pediatric medication.

18.
Rev Lat Am Enfermagem ; 26: e3014, 2018 Aug 09.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-30110092

RESUMO

OBJECTIVE: to assess patient safety culture in a university hospital. METHOD: cross-sectional study with data collection through the Hospital Survey on Patient Safety Culture applied in electronic device. A total of 381 employees were interviewed, corresponding to 46% of the sum of eligible professionals. Data were analyzed descriptively. the Cronbach's alpha was used to calculate the frequency and reliability. RESULTS: most were women (73%) from the nursing area (50%) and with direct contact with patients (82%). The composites related to "teamwork within units" (58%, α=0.68), "organizational learning - continuous improvement" (58%, α=0.63), "supervisor/manager expectations and actions promoting patient safety" (56%, α=0.73) had higher positive responses. Nine composites had low positive responses, with emphasis on "nonpunitive response to error" (18%, α=0.40). Only the item "in this unit, people treat each other with respect" had positive response above 70%. The patient safety assessment in the work unit was positive for 36% of employees, however only 22% reported events in past year. CONCLUSION: the findings revealed weaknesses in the safety culture at the hospital, with emphasis on culpability.


Assuntos
Hospitais Universitários/normas , Cultura Organizacional , Segurança do Paciente , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato
19.
Ethn Dis ; 28(1): 49-54, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29467566

RESUMO

Objectives: To assess the prevalence of, and associated factors to, self-reported chronic diseases and health care utilization by ethnicity in the Manaus Metropolitan Region. Methods: We conducted a cross-sectional, population-based survey from May through August 2015. Using probabilistic sampling in three stages, we recruited adults aged ≥18 years. Ethnicity was self-identified as White, Black, Yellow, Brown (Brazilian mixed-race), and Indigenous. We calculated adjusted prevalence ratios (PR) and 95% CI of chronic diseases and health service utilization for each ethnic minority and compared the data using Poisson regression with data from White respondents. Results: In this study, we interviewed 4,001 people. Of these, 15.9% were White, 7.5% Black, 3.4% Yellow, 72.1% Brown, and 1.0% Indigenous. Indigenous respondents had the highest prevalence of self-reported hypertension (29.4%), diabetes (12.3%) and hypercholesterolemia (17.0%) among the ethnic respondent groups. Compared with the White population, Browns had less health insurance coverage (PR=.76; 95% CI: .62-.93) and reported hypertension (PR=.84; 95% CI: .72-0.98) and diabetes (PR=.69; 95% CI: .51-.94) less frequently. Yellows visited the doctor more frequently than Whites (PR=1.13; 95% CI: 1.04-1.22), with no significant difference in prevalence of diseases. Conclusions: Indigenous respondents had higher prevalence rates of the investigated diseases. Compared with Whites, Brown respondents had lower rates of self-reported arterial hypertension and diabetes, as well as lower rates of private health insurance coverage.


Assuntos
Diabetes Mellitus/etnologia , Grupos Étnicos/estatística & dados numéricos , Hipercolesterolemia/etnologia , Hipertensão/etnologia , Grupos Minoritários/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Brasil/epidemiologia , Doença Crônica/etnologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Índios Sul-Americanos/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Autorrelato , População Urbana/estatística & dados numéricos , Adulto Jovem
20.
Rev. latinoam. enferm. (Online) ; 26: e3014, 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-961160

RESUMO

ABSTRACT Objective: to assess patient safety culture in a university hospital. Method: cross-sectional study with data collection through the Hospital Survey on Patient Safety Culture applied in electronic device. A total of 381 employees were interviewed, corresponding to 46% of the sum of eligible professionals. Data were analyzed descriptively. the Cronbach's alpha was used to calculate the frequency and reliability. Results: most were women (73%) from the nursing area (50%) and with direct contact with patients (82%). The composites related to "teamwork within units" (58%, α=0.68), "organizational learning - continuous improvement" (58%, α=0.63), "supervisor/manager expectations and actions promoting patient safety" (56%, α=0.73) had higher positive responses. Nine composites had low positive responses, with emphasis on "nonpunitive response to error" (18%, α=0.40). Only the item "in this unit, people treat each other with respect" had positive response above 70%. The patient safety assessment in the work unit was positive for 36% of employees, however only 22% reported events in past year. Conclusion: the findings revealed weaknesses in the safety culture at the hospital, with emphasis on culpability.


RESUMO Objetivo: avaliar a cultura de segurança do paciente em hospital universitário. Método: estudo transversal com coleta de dados por meio do Hospital Survey on Patient Safety Culture aplicado em dispositivo eletrônico. Entrevistaram-se 381 funcionários, correspondendo a 46% do total de profissionais elegíveis. Os dados foram analisados descritivamente, com cálculo de frequências e da confiabilidade pelo alfa de Cronbach. Resultados: a maior parte eram mulheres (73%), da área de enfermagem (50%) e com contato direto com pacientes (82%). As dimensões "trabalho em equipe no âmbito das unidades" (58%, α=0,68), "aprendizado organizacional" (58%, α=0,63), "expectativas e ações dos supervisores e gerentes para promoção da segurança do paciente" (56%, α=0,73) apresentaram maior positividade. Nove dimensões tiveram positividade baixa, com destaque para "respostas não punitivas aos erros" (18%, α=0,40). Somente o item "nesta unidade, as pessoas se tratam com respeito" obteve positividade acima de 70%. A avaliação da segurança do paciente na unidade de trabalho foi positiva para 36% dos funcionários, porém somente 22% informaram ter notificado eventos no último ano. Conclusão: os achados revelam fragilidades na cultura de segurança no hospital, com destaque à culpabilização.


RESUMEN Objetivo: evaluar la cultura de seguridad del paciente en un hospital universitario. Método: estudio transversal con recogimiento de datos por medio del Hospital Surveyon Patient Safety Culture aplicado en dispositivo electrónico. Se entrevistaron 381 funcionarios, correspondiendo a 46% del total de profesionales elegibles. Los datos fueron analizados descriptivamente; fueron calculadas las frecuencias y la confiabilidad con el alfa de Cronbach. Resultados: la mayor parte eran mujeres (73%) del área de enfermería (50%), con contacto directo con pacientes (82%). Las dimensiones "trabajando en equipo dentro de las unidades" (58%, α=0,68), "aprendizaje organizativo - mejorías continuas" (58%, α=0,63), "expectativas y acciones del supervisor para promover la seguridad de los pacientes" (56%, α=0,73), presentaron mayor positividad. Nueve dimensiones tuvieron positividad baja, con destaque para respuesta no punitivas a los errores (18%, α=0,40). Solamente el ítem "en esta unidad, el personal se trata con respeto" obtuvo positividad arriba de 70%. La evaluación de la seguridad del paciente en la unidad de trabajo fue positiva para 36% de los funcionarios; sin embargo, solamente 22% reportaran incidentes en el último año. Conclusión: los hallazgos revelan fragilidades en la cultura de seguridad en el hospital, entre los cuales se destaca la culpabilización.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Universidades/organização & administração , Gestão da Segurança/organização & administração , Segurança do Paciente/normas , Administração Hospitalar/normas , Suíça , Atitude do Pessoal de Saúde , Inquéritos e Questionários
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