Portuguese Community Pharmacists’ Attitudes to and Knowledge of Antibiotic Misuse: Questionnaire Development and Reliability.

Objective: To develop and evaluate the reliability of a self-administered questionnaire designed to assess the attitudes and knowledge of community pharmacists in Portugal about microbial resistance and the antibiotic dispensing process. Methods: This study was divided into the following three stages: (1) design of the questionnaire, which included a literature review and a qualitative study with focus-group sessions; (2) assessment of face and content validity, using a panel of experts and a pre-test of community pharmacists; and, (3) pilot study and reliability analysis, which included a test-retest study covering fifty practising pharmacists based at community pharmacies in five districts situated in Northern Portugal. Questionnaire reproducibility was quantified using the intraclass correlation coefficient (ICC; 95% confidence interval) computed by means of one-way analysis of variance (ANOVA). Internal consistency was evaluated using Cronbach’s alpha. Results: The correlation coefficients were fair to good (ICC.0.4) for all statements (scale-items) regarding knowledge of and attitudes to antibiotic resistance, and ranged from fair to good to excellent for statements about situations in which pharmacists acknowledged that antibiotics were sometimes dispensed without a medical prescription (ICC.0.8). Cronbach’s alpha for this section was 0.716. Conclusions: The questionnaire designed in this study is valid and reliable in terms of content validity, face validity and reproducibility

Educational interventions to improve prescription and dispensing of antibiotics: a systematic review.

BACKGROUND: Excessive and inappropriate antibiotic use contributes to growing antibiotic resistance, an important public-health problem. Strategies must be developed to improve antibiotic-prescribing. Our purpose is to review of educational programs aimed at improving antibiotic-prescribing by physicians and/or antibiotic-dispensing by pharmacists, in both primary-care and hospital settings. METHODS: We conducted a critical systematic search and review of the relevant literature on educational programs aimed at improving antibiotic prescribing and dispensing practice in primary-care and hospital settings, published in January 2001 through December 2011. RESULTS: We identified 78 studies for analysis, 47 in primary-care and 31 in hospital settings. The studies differed widely in design but mostly reported positive results. Outcomes measured in the reviewed studies were adherence to guidelines, total of antibiotics prescribed, or both, attitudes and behavior related to antibiotic prescribing and quality of pharmacy practice related to antibiotics. Twenty-nine studies (62%) in primary care and twenty-four (78%) in hospital setting reported positive results for all measured outcomes; fourteen studies (30%) in primary care and six (20%) in hospital setting reported positive results for some outcomes and results that were not statistically influenced by the intervention for others; only four studies in primary care and one study in hospital setting failed to report significant post-intervention improvements for all outcomes. Improvement in adherence to guidelines and decrease of total of antibiotics prescribed, after educational interventions, were observed, respectively, in 46% and 41% of all the reviewed studies. Changes in behaviour related to antibiotic-prescribing and improvement in quality of pharmacy practice was observed, respectively, in four studies and one study respectively. CONCLUSION: The results show that antibiotic use could be improved by educational interventions, being mostly used multifaceted interventions

A Powerful Tool for the Understanding and Diagnosis of Polycystic Ovary Syndrome

The Associate Laboratory Institute for Health and Bioeconomy–i4HB (project LA/P/0140/2020), which are financed by National Funds from FCT/MCTES. This work was supported by operation Centro-01-0145-FEDER-000019-C4-Centro de Competências em Cloud Computing, cofinanced by the European Regional Development Fund (ERDF) through the Programa Operacional Regional do Centro (Centro 2020), in the scope of the Sistema de Apoio à Investigação Científica e Tecnológica-Programas Integrados de IC&DT. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Polycystic ovary syndrome (PCOS) represents one of the leading causes of anovulatory infertility and affects 5% to 20% of women worldwide. Until today, both the subsequent etiology and pathophysiology of PCOS remain unclear, and patients with PCOS that undergo assisted reproductive techniques (ART) might present a poor to exaggerated response, low oocyte quality, ovarian hyperstimulation syndrome, as well as changes in the follicular fluid metabolites pattern. These abnormalities originate a decrease of Metaphase II (MII) oocytes and decreased rates for fertilization, cleavage, implantation, blastocyst conversion, poor egg to follicle ratio, and increased miscarriages. Focus on obtaining high-quality embryos has been taken into more consideration over the years. Nowadays, the use of metabolomic analysis in the quantification of proteins and peptides in biological matrices might predict, with more accuracy, the success in assisted reproductive technology. In this article, we review the use of human follicular fluid as the matrix in metabolomic analysis for diagnostic and ART predictor of success for PCOS patients.publishersversionpublishe

EurOP2E – the European Open Platform for Prescribing Education, a consensus study among clinical pharmacology and therapeutics teachers

Purpose Sharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers. Methods CPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting. Results Data from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources. Conclusion Key challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system

UV-B Filter Octylmethoxycinnamate Is a Modulator of the Serotonin and Histamine Receptors in Human Umbilical Arteries

Every day, people use personal care products containing UV filters. Although their use initially showed a protective role, toxicity is a concern for human health as several UV filters are endocrine-disrupting chemicals (EDCs). Exposure to EDCs may induce cardiovascular diseases and can affect the health of sensitive people, such as pregnant women. Currently, the world’s most widely used UV-B filter is octylmethoxycinnamate (OMC), an EDC. However, the disruptive effects on pregnant women are little known. The present work proposed to understand how long-term exposure to OMC affects vascular homeostasis. Endothelium-denuded human umbilical artery (HUA) rings were incubated in an organ bath system. Long-term effects of exposure to OMC (0.001–50 μmol/L) were evaluated on the contractile responses of HUA to the application of the contractile agents, serotonin (5-HT) and histamine (Hist). To investigate in more detail the vascular mode of action of OMC, through which it impairs the vascular homeostasis of HUA, the activity and expression of different 5-HT and Hist-receptors involved in contractility processes were studied. Our findings pointed out an increase in the reactivity of HUA to 5-HT and Hist due to OMC exposure. These alterations in reactivity may be precursors of preeclampsia development and/or gestational hypertension

UV-B Filter Octylmethoxycinnamate Alters the Vascular Contractility Patterns in Pregnant Women with Hypothyroidism

Increasing evidence relating the exposure and/or bioaccumulation of endocrine-disrupting compounds (EDCs) with cardiovascular system are arising. Octylmethoxycinnamate (OMC) is the most widely used UV-B filter and as EDC interacts with TH receptors. However, their effects on thyroid diseases during pregnancy remain unknown. The purpose of this work was to assess the short- and long-term effects of OMC on arterial tonus of pregnant women with hypothyroidism. To elucidate this, human umbilical artery (HUA) rings without endothelium were used to explore the vascular effects of OMC by arterial and cellular experiments. The binding energy and the modes of interaction of the OMC into the active center of the TSHR and THRα were analyzed by molecular docking studies. Our results indicated that OMC altered the contractility patterns of HUA contracted with serotonin, histamine and KCl, possibly due to an interference with serotonin and histamine receptors or an involvement of the Ca2+ channels. The molecular docking analysis show that OMC compete with T3 for the binding center of THRα. Taken together, these findings pointed out to alterations in HUA reactivity as result of OMC-exposure, which may be involved in the development and increased risk of cardiovascular diseases

Development and Validation of Pharmacists' and Physicians' Attitudes Instrument about Microbial Resistance and Antibiotic Use in Primary Care

Objectives To evaluate reliability and reproducibility of two questionnaires on knowledge and attitudes of pharmacists and physicians about antibiotic use and microbial resistance. Methods Two structured questionnaires, one for pharmacists and one for physicians, were constructed after review of published studies and after performed a qualitative study designed with pharmacists’ focus group sessions. Our research was developed in an area of Statistically Territorial Unity Nomenclature (NUT) II of Portugal, defined by Health Northern Regional Administration (ARS-N). ARS-N was informed about the study and questionnaires were administered to each health professional twice, at an interval of 2 to 4 weeks. Attitudes were measured using a continuous visual analogical scale, with answers scored from 0 (total disagreement) to 20 (total agreement). Statistical analyses included the determination of intraclass coefficient (ICC) and Cronbach's alpha for each questionnaire. Results A total of 43 pharmacists and 32 physicians participated in this survey. Each questionnaire evaluated 17 attitudes that were grouped in four dimensions of attitudes to antibiotic resistance: perception of the problem, attribution of responsibilities, confidence and factors associated to dispensing habits (in pharmacists questionnaire) or factors associated to prescription habits (in physicians questionnaire). Six questions, related to the first three categories mentioned are common for both questionnaires what permits to compare these attitudes between pharmacists and physicians. All evaluated attitudes demonstrated good ICC for each questionnaire and the reliability (Cronbach's alpha) was 0,624 for pharmacists’ questionnaire and 0,711 for physicians’ questionnaire. Conclusions These questionnaires proved to be a good tool for collecting data, since it allows compare some attitudes between pharmacists and physicians, and to detect differences among each professional group. Data collected from this questionnaire are important to design interventions directed to pharmacists and physicians to improve antibiotic use, tailored taking into account attitudes, knowledge and dispense or prescription habits of these health professionals

Influence of community pharmacists׳ attitudes on antibiotic dispensing behavior: a cross-sectional study in Portugal.

PURPOSE: The emergence of microbial resistance is widely associated with inappropriate antibiotic use. Self-medication with antibiotics acquired directly from pharmacies without a medical prescription has been reported by several European countries as being an important cause of such inappropriate use. The goal of this study was to identify and evaluate community pharmacists׳ attitudes toward and knowledge of antibiotics and microbial resistance and to assess what influence, if any, these attitudes might have on their propensity to dispense unprescribed antibiotics. METHODS: We conducted a cross-sectional study covering all community pharmacists registered with the Official College of Pharmacists in Portugal׳s Central Region. A self-administered questionnaire on attitudes toward microbial resistance and antibiotic use was mailed to 1197 pharmacists. Responses ranged from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to model the association between respondents׳ attitudes and their propensity to dispense antibiotics without an earlier medical prescription. FINDINGS: The overall response rate was 64.8%. Agreement with the dispensing of unprescribed antibiotics was highest in the case of dental diseases and ailments, followed by urinary tract infections. Although none of the sociodemographic data were associated with a propensity to dispense antibiotics without a medical prescription, the attitudes shown to be significantly associated with this propensity were complacency about patients, responsibility of others, and precaution or fear. IMPLICATIONS: Because the attitudes of community pharmacists can influence their readiness to dispense unprescribed antibiotics, educational interventions addressing such attitudes should be implemented to improve antibiotic use

Hospital Pharmacists’ Attitudes Concerning Antibiotic Resistance: A Pilot Study

The World Health Organization has defined antimicrobial resistance as one of the main concerns of public health for the next years. This study sought to evaluate a questionnaire’ reproducibility and internal consistency about attitudes and knowledge of pharmacists working in hospital pharmacy concerning antibiotic use and bacterial resistance

Knowledge, perceptions and attitudes of hospital pharmacists about antibiotic resistance - a pilot study in Portugal.

Introduction: Antibiotics are the most commonly used and costly drugs used in hospitals, and the inappropriate use is related with occurrence of bacterial resistances, that is one of the most important problem of public health. Pharmacists play an important role in implementation of guidelines in hospital, and their proactive attitude related to antibiotic use and bacterial resistances, could improve antibiotic use in hospitals. Aim: This study sought to evaluate reliability and reproducibility of a questionnaire on knowledge and attitudes of hospital pharmacists about antibiotic use and microbial resistance. Method: A structured questionnaire was constructed accordingly data obtained during a qualitative study, and literature review. Our research was developed with pharmacists working in 5 hospital of statistically Territorial Unity Nomenclature (NUT) II area of Portugal, defined by Health Northern Regional Administration (ARS-N).This study was approved by the Ethics Committee and Board of Directors of each hospital. Questionnaires were administered to each pharmacist twice, at an interval of 2 to 4 weeks. Attitudes were measured using a continuous visual analogue scale, with answers scored from 0 (total disagreement) to 20 (total agreement). Questionnaire reproducibility and reliability was determined by intraclass correlation coefficient (ICC) and Cronbach´s alpha calculation. Results: A total of 16 hospital pharmacists participated in this survey. Questionnaire evaluated 17 attitudes related to knowledge and perception of the problem, attribution of responsibilities, pharmacists practice behaviours and perceptions of measures that could improve antibiotic use. Attitudes related to perception of the problem demonstrated highest ICC (95%, IC), and Chronbach’s alpha is 0,8. Conclusion: Results obtained allows us to conclude that our questionnaire is valid to evaluate the attitudes and knowledge of hospital pharmacists related to antibiotic use and resistances, since it allows to detect differences among these health professionals that work in hospital pharmacies. We recommend based on these results continuity of studies including case-control studie