Improving adverse drug reaction reporting in portuguese health professional : case-control studies and cluster-randomized trial

Las reacciones adversas a medicamentos (RAM) es un importante y persistente problema de Salud Pública en términos de morbi-mortalidad y de costes. En un estudio realizado en los Estados Unidos (EE.UU.) se estimó que más de 100.000 personas mueren cada año a consecuencia de las RAM, y que más de 2 millones sufren importantes efectos secundarios, situándose entre la cuarta y la sexta causa de muerte en los EE.UU. En un estudio realizado en el Reino Unido mostró que uno de cada 16 admisiones hospitalarias son causadas por RAM. El coste exacto atribuible a las reacciones adversas no esta bien determinado, es sabido que aumentan de forma importante el tiempo de estancia y los costes sanitarios

The use of antidepressants, anxiolytics, sedatives and hypnotics in Europe: focusing on mental health care in Portugal and prescribing in older patients

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.publishe

Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies

Inappropriate prescription has been associated with mounting rates of antibiotic resistance worldwide, demanding more detailed studies into physicians’ decision-making process. Accordingly, this study sought to explore physicians’ perceptions of factors influencing antibiotic prescribing. A systematic search was performed for qualitative studies focused on understanding physicians’ perceptions of the factors, attitudes and knowledge influencing antibiotic prescription. Of the total of 35 papers selected for review purposes, 18 solely included physicians and the remaining 17 also included patients and/or other healthcare providers. Data collection was based mainly on interviews, followed by questionnaires and focus groups, and the methodologies mainly used for data analysis were grounded theory and thematic analysis. Factors cited by physicians as having an impact on antibiotic prescribing were grouped into those that were intrinsic (group 1) and those that were extrinsic (group 2) to the healthcare professional. Among the former, physicians’ attitudes, such as complacency or fear, were rated as being most influential on antibiotic prescribing, whilst patient-related factors (e.g. signs and symptoms) or healthcare system-related factors (e.g. time pressure and policies/guidelines implemented) were the most commonly reported extrinsic factors. These findings revealed that: (i) antibiotic prescribing is a complex process influenced by factors affecting all the actors involved, including physicians, other healthcare providers, healthcare system, patients and the general public; and (ii) such factors are mutually dependent. Hence, by shedding new light on the process, these findings will hopefully contribute to generating new and more effective strategies for improving antibiotic prescribing and allaying global concern about antibiotic resistance

The Role of Endocrine-Disrupting Chemicals in Male Fertility Decline

Endocrine-disrupting chemicals (EDCs) are exogenous compounds with natural or anthropogenic origin omnipresent in the environment. These compounds disrupt endocrine function through interaction with hormone receptor or alteration of hormone synthesis. Humans are environmentally exposed to EDCs through the air, water, food and occupation. During the last decades, there has been a concern that exposure to EDCs may contribute to an impairment of human reproductive function. EDCs affect male fertility at multiple levels, from sperm production and quality to the morphology and histology of the male reproductive system. It has been proposed that exposure to EDCs may contribute to an impairment of sperm motility, concentration, volume and morphology and an increase in the sperm DNA damage. Moreover, EDCs exert reproductive toxicity inducing structural damage on the testis vasculature and blood-testis barrier and cytotoxicity on Sertoli and Leydig cells. This chapter will explore the effects of EDCs in male reproductive system and in the decline of male fertility

The Impact of Lifestyle on Prostate Cancer: A Road to the Discovery of New Biomarkers

Prostate cancer (PCa) is one of the most common cancers among men, and its incidence has been rising through the years. Several risk factors have been associated with this disease and unhealthy lifestyles and inflammation were appointed as major contributors for PCa development, progression, and severity. Despite the advantages associated with the currently used diagnostic tools [prostate-specific antigen(PSA) serum levels and digital rectal examination (DRE)], the development of effective approaches for PCa diagnosis is still necessary. Finding lifestyle-associated proteins that may predict the development of PCa seems to be a promising strategy to improve PCa diagnosis. In this context, several biomarkers have been identified, including circulating biomarkers (CRP, insulin, C-peptide, TNFα-R2, adiponectin, IL-6, total PSA, free PSA, and p2PSA), urine biomarkers (PCA3, guanidine, phenylacetylglycine, and glycine), proteins expressed in exosomes (afamin, vitamin D-binding protein, and filamin A), and miRNAs expressed in prostate tissue (miRNA-21, miRNA-101, and miRNA-182). In conclusion, exploring the impact of lifestyle and inflammation on PCa development and progression may open doors to the identification of new biomarkers. The discovery of new PCa diagnostic biomarkers should contribute to reduce overdiagnosis and overtreatment

An Educational Intervention To Improve Antibiotic Use In The Center Region of Portugal

Microbial resistances are one of the most important problems of public health, and it has been associated to the misuse of antibiotics. Inadequate antibiotic prescription and self-medication (with antibiotic leftovers or by acquiring antibiotics directly in the pharmacy without a prescription), are behaviours directly related with this misuse, revealing the necessity of interventions directed to health professionals. Accordingly this, our aim is to improve the consumption of antibiotics through an educational intervention directed to community pharmacists and primary care physicians

Elderly and Polypharmacy: Physiological and Cognitive Changes

Population ageing is one of the most significant social transformations of the twenty-first century. The increase in average life expectancy was a successful challenge achieved in the modern world. However, nowadays a new challenge arises for all society: achieving a better quality of life for increasing people’s life. The comorbidities associated with ageing make elderly prone to polypharmacy. On the other hand, physiological and cognitive changes interfere with drugs’ pharmacodynamics and pharmacokinetics contributing to drug-related problems which have been reported to account for a large percentage of emergency treatment and hospitalizations of older people, increasing the costs with health in the most aged regions. In order to reduce the use of potentially inappropriate medicines in this population, strategies and tools have been developed in recent years to assess the appropriateness medication use in the elderly

Influence of Sociodemographic and Professional Characteristics on Antibiotic Prescribing: A Cross-Sectional Study In The Center Region of Portugal

Introduction Antibiotic prescribing is very complex process influenced by medical and non-medical aspects. Accordingly, our aim was to evaluate the influence of GPs’ sociodemographic and professional characteristics on the quality of antibiotic prescribing, in Portugal. Material and Methods An observational cross-sectional study was conducted (November 2011 to February 2012) in the catchment area covered by Portugal’s Centre Regional Health Administration (1094 General Practitioners (GPs) working at 84 primary care facilities). A validated, self-administered questionnaire was used to assess sociodemographic and clinical practice information. To evaluate the quality of physician antibiotic prescribing, we’ve assessed the twelve quality indicators validated by Coenen, S. et al (2007), per physician per year (2010, 2011 and 2012). Logistic regression using crude and adjusted analysis was performed. Results The response rate was 46.6%. Older GPs revealed to have better performance of antibiotic prescribing [OR (95% CI) = 2.21; 1.08 – 4.54; P < 0.05]. About GPs who also work at the emergency department, statistical significant was found on their relation with poor prescribing [OR (95% CI) = 0.29; 0.16 – 0.54; P < 0.05]. Workload also revealed to influence the quality of antibiotic prescribing: more patients seen per day [OR (95% CI) = 0.97; 0.94 – 1.00; P < 0.05] and more patients seen per week in the emergency department [OR (95% CI) = 0.98; 0.97 – 0.99; P < 0.05] were related with lower quality on antibiotic prescribing. Conclusions These findings revealed that sociodemographic and professional characteristics could influence the quality of antibiotic prescribing, which is a very important step to understand this complex process aiming to tackle a global concern: the misprescription of antibiotics

A mobile app to support clinical diagnosis of upper respiratory problems (eHealthResp): co-design approach

Background: The misuse of antibiotics is a global public health issue that fosters bacterial resistance and jeopardizes generational health. The development of validated tools such as web-based courses and mobile apps to enhance clinical decisions in upper respiratory infections is of great importance in reducing the incorrect use of antibiotics in these situations. Objective: The aim of this study was to design and prevalidate the interface of a mobile app to assist and provide clinical support in the diagnosis of upper respiratory problems. We aimed to assess the adequacy and usability of the interface of the tool in the belief that it could be beneficial to health care delivery in the clinical decision setting. Methods: Using a co-design approach that brought together professionals in interface design and experts in pharmacology and pharmacoepidemiology, the mobile app interface was evaluated through peer review sessions held by interface design professionals on a heuristic survey. The reviewers accessed a high-fidelity interactive mock-up of the interface and filled in a questionnaire to assess the dimensions of layout and visual design and navigation and tasks. The resulting feedback of this evaluation supported the redesign of the primary interface, which was assessed for the second time by 2 of the previously mentioned reviewers. Results: With 4 as the highest score, the interface scored a mean of 3.16 (SD 0.45; median of the means 3.2) for layout and visual design and a mean of 3.43 (SD 0.33; median of the means 3.51) for navigation and tasks, reflecting an overall positive evaluation. The open-ended commentaries allowed us to better understand specific recommendations of the reviewers. Throughout this section, approximately 0.98 comments per parameter were registered, reflecting a high level of effectiveness of the chosen parameters in identifying potential problems. The resultant beta version of the interface, addressing the majority of the detected problems, was further assessed by 2 of the previous reviewers, validating the new design. Future tests with physicians and pharmacists will help assess credibility and user experience dimensions. Conclusions: Our study revealed that the designed interface is easy to interpret and use. Peer reviewers raised important issues that could be easily fixed and positively reassessed. As a result, the study enabled us to produce a new tool for interface usability assessment and a set of recommendations for developing mobile interfaces for clinical decision support systems in the scope of upper respiratory problems.publishe

Improving antibiotic use through educational interventions

The growing rates of antimicrobial resistances demand the improvement of antibiotic use worldwide. The antibiotic misprescription by physicians, the antibiotic dispense without prescription by pharmacists, and the misuse by patients, are some of the most important factors underlying the increasing rates of antimicrobial resistances. Accordingly, it is of major importance to develop educational interventions targeting the different actors in the chain of antibiotic resistance, aiming to increase knowledge, understand attitudes and improve antibiotic use. In this chapter, readers can find a proposed design model which aims to improve the effectiveness of the educational interventions, presenting and developing each step that should be considered when implementing an educational intervention