Altamiro da Costa Pereira

Frequency of adverse drug reactions in hospitalized patients: a systematic review and meta-analysis.

To perform a comprehensive systematic review of prospective studies about frequency of adverse drug reactions (ADRs) occurring during hospitalization (ADRIn), including a thorough study quality assessment, meta‐analysis and heterogeneity evaluation.

Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study)

Objective:Guidelines for the adrenergic support of septic shock are controversial. In patients with community-acquired septic shock, we assessed the impact of the choice of vasopressor support on mortality. Design:Cohort, multiple center, observational study. Setting:Seventeen Portuguese intensive care units (ICUs). Patients:All adult patients admitted to a participating ICU between December 2004 and November 2005. Interventions:None. Measurements and Main Results:Patients were followed up during the first five ICU days, the day of discharge or death, and hospital outcome. Eight hundred ninety-seven consecutive patients with community-acquired sepsis (median age, 63 years; 577 men; and hospital mortality, 38%) were studied. Of the 458 patients with septic shock, 73% received norepinephrine and 50.5% dopamine. The norepinephrine group had a higher hospital mortality (52% vs. 38.5%, p = 0.002). A Kaplan–Meier survival curve showed diminished 28-day survival in the norepinephrine group (log-rank = 22.6, p < 0.001). A Cox proportional hazard analysis revealed that the administration of norepinephrine was associated with an increased risk of death (adjusted hazard ratio, 2.501; 95% confidence interval, 1.413–4.425; p = 0.002). In a multivariate analysis with ICU mortality as the dependent factor, Simplified Acute Physiology Score II and norepinephrine administration were independent risk factors for ICU mortality in patients with septic shock. Conclusions:In patients with community-acquired septic shock, our data suggest that norepinephrine administration could be associated with worse outcome.

Association of anxiety with asthma: subjective and objective outcome measures.

Background The relationship between anxiety and asthma is currently being intensively studied. Objective The authors examined anxiety that influences and is influenced by this complex disease. Method The authors conducted a cross-sectional study of adults with asthma at a hospital outpatient department, excluding known psychiatric patients. A sample of 195 patients, mostly middle-aged women with moderate/severe asthma, underwent pulmonary function and airway-inflammation tests and were given anxiety rating questionnaires. Results A high level of anxiety was present in 70% of the patients. Anxiety was associated with worse subjective asthma outcomes and increased use of medication/healthcare services, but with decreased airway inflammation, and was not associated with lung function. Conclusion Anxiety seems to influence patients’ perception/awareness of asthma symptoms.

Agreement studies in obstetrics and gynaecology : inappropriateness, controversies and consequences

A literature review was performed to assess how agreement has been measured in obstetrics and gynaecology. Inappropriate or controversial measures were often used. The possible consequences of these inadequacies on validity studies and randomised controlled trials are shown in case examples. The association of two measures, proportions of agreement and kappa for categorical variables, and limits of agreement and intraclass correlation coefficient for continuous variables, is encouraged in agreement studies, until new and better ways of assessing agreement are found.

Methodologies for the detection of adverse drug reactions: comparison of hospital databases, chart review and spontaneous reporting

To evaluate a methodology for adverse drug reactions (ADRs) detection through hospital databases.

Detection of adverse drug reactions using hospital databases-a nationwide study in Portugal.

This study aimed to detect and characterize adverse drug reactions (ADRs) that occurred during hospitalization (ADRIn) and ADRs associated with admission (ADRAd) in Portugal from 2000 to 2009. We also intended to compare the results of this methodology with spontaneous reporting.

Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review

BackgroundSeveral organizations and individual authors have been proposing quality indicators for the assessment of clinical care in HIV/AIDS patients. Nevertheless, the definition of a consensual core set of indicators remains controversial and its practical use is largely limited. This study aims not only to identify and characterize these indicators through a systematic literature review but also to propose a parsimonious model based on those most used.MethodsMEDLINE, SCOPUS, Cochrane databases and ISI Web of Knowledge, as well as official websites of organizations dealing with HIV/AIDS care, were searched for articles and information proposing HIV/AIDS clinical care quality indicators. The ones that are on patient’s perspective and based on services set were excluded. Data extraction, using a predefined data sheet based on Cochrane recommendations, was done by one of the authors while a second author rechecked the extracted data for any inconsistency.ResultsA total of 360 articles were identified in our search query but only 12 of them met the inclusion criteria. We also identified one relevant site. Overall, we identified 65 quality indicators for HIV/AIDS clinical care distributed as following: outcome (n=15) and process-related (n=50) indicators; generic (n=36) and HIV/AIDS disease-specific (n=29) indicators; baseline examinations (n=19), screening (n=9), immunization (n=4), prophylaxis (n=5), HIV monitoring (n=16), and therapy (=12) indicators.ConclusionsThere are several studies that set up HIV clinical care indicators, with only a part of them useful to assess the HIV clinical care. More importantly, HIV/AIDS clinical care indicators need to be valid, reliable and most of all feasible.

A survey of spontaneous reporting of adverse drug reactions in 10 years of activity in a pharmacovigilance centre in Portugal

Reporting of adverse drug reactions (ADRs) may differ between countries.

Ophthalmic adverse drug reactions to systemic drugs: a systematic review.

To perform a comprehensive and systematic review regarding ophthalmic adverse drug reactions (ADRs) to systemic drugs to: (i) systematically summarize existing evidence, (ii) identify areas, ophthalmic ADRs or drugs that lacked systematization or assessment (namely drugs with original studies characterizing specific ophthalmic ADRs but without causality assessment nor without meta‐analysis).

Análise de indicadores da saúde materno-infantil: paralelos entre Portugal e Brasil

PURPOSE To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS Births in Portugal were characterized by lower maternal mortality (12.2 x 76.2/100.000) and neonatal mortality (2.2 x 14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990 s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.