Perfil epidemiológico de automedicação entre acadêmicos de medicina de uma universidade pública brasileira / Epidemiological profile of self-medication among medical academics of a brazilian public university

Introdução: Automedicação é entendida como sendo a prática de ingerir substâncias de ação medicamentosa sem a indicação e/ou acompanhamento de um profissional de saúde qualificado. Objetivo: Estabelecer a porcentagem de acadêmicos de medicina da Universidade Federal de Jataí que já realizaram a compra de medicamentos sem orientação qualificada. Metodologia: Trata-se de um estudo descritivo e transversal realizado por meio de um questionário respondido pelos discentes do curso de medicina no mês de novembro de 2019. Resultado: Na análise estatística dos resultados observou-se que em todos os ciclos do curso, básico, clínico e internato, mais de 90% dos discentes já compraram medicamentos sem orientação qualificada. Conclusão: Existe uma alta prevalência de estudantes de medicina da Universidade Federal de Jataí que utilizam medicamentos sem prescrição médica. O uso de conhecimento acadêmico para se automedicar e o sentimento de aptidão para se automedicar aumentaram ao decorrer dos ciclos do curso. O ciclo básico obteve a maior porcentagem de discentes que acreditam na existência de malefícios na automedicação. Os fármacos mais automedicados foram anti-inflamatórios não esteroidais e antibióticos, ambos podem causar graves consequências se utilizados de maneira incorreta e sem a supervisão de um especialista.

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status