Sara Soares

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

BackgroundExcessive 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.MethodsWe 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.ResultsWe 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.ConclusionThe results show that antibiotic use could be improved by educational interventions, being mostly used multifaceted interventions.

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.

A scoping review on studies of cyberbullying prevalence among adolescents

This descriptive scoping aims to understand how the prevalence of cyberbullying has been estimated across studies. A systematic scoping review of cyberbullying empirical studies was conducted by using three bibliographic databases to search for papers published between January 2004 and August 2014. A protocol was defined to identify the relevant papers. Papers selected were included in a data sheet developed by the authors to record specific findings. In total, 159 studies were included in the scoping review. Most of the prevalence studies were conducted in the last 4 years, mainly in North America (n = 77) and in Europe (n = 65). High methodological heterogeneity was found among the studies, which may contribute to explain variability in prevalence estimates. Cyberbullying experiences were assessed through several different perspectives: focused only on victims, focused only on perpetrators, or focused on both victims and perpetrators (without differentiating between if they are victims or perpetrators). Most of the studies tend to assess cybervictimization experiences. However, even considering the same perspective, the same country, and the same recall period, a high variability in the estimates was observed. As a main conclusion, the way in which the prevalence of cyberbullying is estimated is influenced by methodological research options.

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 Cronbachs 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). Cronbachs 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.

Impact of rosiglitazone safety alerts on oral antidiabetic sales trends: a countrywide study in Portugal.

Pharmacovigilance systems are important to monitor the safety of on‐market drugs after approval. The aim of this study was to assess the impact of rosiglitazone safety alerts on trends in the sale of rosiglitazone and other oral antidiabetic drugs. An ecological study was conducted, using temporally aggregated data and linking safety alerts to countrywide sales of all oral antidiabetic drugs in Portugal from January 2002 to December 2012. Sales figures for oral antidiabetic drugs marketed in Portugal were supplied by IMS Health Portugal with a breakdown by active substance and fixed combinations. The number of defined daily doses per 1000 inhabitants per day (DIDs) of each oral antidiabetic drug sold to the estimated diabetic population using oral antidiabetic drugs in Portugal was calculated. Particular attention was paid to the case of rosiglitazone, with the results being adjusted for changes in rosiglitazone reimbursement policies. A total of four safety alerts were issued about rosiglitazone. Rosiglitazone sales registered an increase of 32.9% (0.202 DIDs; P < 0.001) after the first alert (risk of macular oedema or worsening of pre‐existent macular oedema) in January 2006. After subsequent alerts about cardiovascular risks, this trend was not, however, repeated and sales fell. Following the January 2006 and January 2008 safety alerts, rosiglitazone sales described a long‐term downward trend, with decreases of 3.75% (−0023 DIDs; P > 0.05) and 0.24% (−0.001 DIDs; P > 0.05), respectively. It is important to promote the dissemination and publication of drug safety alerts.

Health and living conditions in social housing: comparison between rehabilitated and non-rehabilitated neighbourhoods

AimOur aim is to compare how residents from two social housing neighbourhoods of Porto City, one rehabilitated and one non-rehabilitated, perceived their living conditions, health and quality of life.Subjects and methodsA cross-sectional study was conducted, selecting residents from two social housing neighbourhoods of Porto City, one rehabilitated and another one non-rehabilitated. The information was collected through quantitative (a structured questionnaire; n = 82) and qualitative face-to-face interviews administered by trained interviewers (n = 16).ResultsNo significant differences were found between populations from both neighbourhoods regarding social, behavioural and health characteristics. The major differences among neighbourhoods were found on variables such as satisfaction with house, the need of rehabilitation work, and the absence of mould and dampness in the house (p < 0.001) as well as pollution (p < 0.05). Qualitative data showed that residents from the rehabilitated houses were pleased not to have been moved to another location and were very satisfied with the rehabilitation work, which in their perception contributed to the residents’ wellbeing. Nominal and ordinal variables were described using proportions and compared using the chi-square test. Quantitative continuous variables were presented as a median (percentile 25 to percentile 75) and they were compared via the Mann-Whitney test.ConclusionPublic economic and financing resources should be redirected to social housing rehabilitation that, although in the short term does not have a direct impact on health savings for the occupants, is an important dimension of the residents’ sense of wellbeing and satisfaction.

Influence of indoor hygrothermal conditions on human quality of life in social housing

Background: Modern societies spend most of their time indoors, namely at home, and the indoor environment quality turns out to be a crucial factor to health, quality of life and well-being of the residents. The present study aims to understand how indoor environment relates with quality of life and how improving housing conditions impacts on individuals’ health. Design and Methods: This study case will rely on the following assessments in both rehabilitated and non-rehabilitated social housing: i) field measurements, in social dwellings (namely temperature, relative humidity, carbon dioxide concentration, air velocity, air change rate, level of mould spores and energy consumption); ii) residents’ questionnaires on social, demogaphic, behavioural, health characteristics and quality of life. Also, iii) qualitative interviews performed with social housing residents from the rehabilitated houses, addressing the self-perception of living conditions and their influence in health status and quality of life. All the collected information will be combined and analysed in order to achieve the main objective. Expected impact It is expected to define a Predicted Human Life Quality (PHLQ) index, that combines physical parameters describing the indoor environment measured through engineering techniques with residents’ and neighbourhood quality of life characteristics assessed by health questionnaires. Improvement in social housing should be related with better health indicators and the new index might be an important tool contributing to enhance quality of life of the residents. Significance for public health This study will contribute to understand how indoor environment relates with quality of life and how improving housing conditions impacts on individuals’ health, in social housing neighbourhoods. As so, it is important to share the undertaken methodology carried out by a multidisciplinary team, in order to allow other researchers following comparable studies to adopt a similar approach. The case study results will allow to define building rehabilitation policies, improving residents’ quality of life and adding great contribution to public health promotion.

Safety Alerts: An Observational Study in Portugal.

PURPOSE The information that is available when marketing authorizations are approved is limited. Pharmacovigilance has an important role during the postauthorization period, and alerts published by national authorities allow health care professionals to be informed about new data on safety profiles. This study therefore sought to analyze all safety alerts published by the Portuguese National Authority of Medicines and Health Products I.P. (INFARMED). METHODS We conducted an observational study of all alerts published on the INFARMED website from January 2002 through December 2014. From the data included in the alerts, the following information was abstracted: active substance name (and trade name), event that led to the alert, and the resulting safety measures. Active substances were classified according to the Anatomical Therapeutic Chemical (ATC) code. FINDINGS A total of 562 alerts were published, and 304 were eligible for inclusion. The musculoskeletal system was the ATC code with more alerts (n = 53), followed by the nervous system (n = 42). Communication of the information and recommendations to the health care professionals and the public in general was the most frequent safety measure (n = 128), followed by changes in the Summary of the Product Characteristics and package information leaflet (n = 66). During the study period, 26 marketing authorizations were temporarily suspended and 10 were revoked. IMPLICATIONS The knowledge of the alerts published during the postmarketing period is very useful to the health care professionals for improving prescription and use of medicines and to the scientific community for the development of new researches.