Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study.

BACKGROUND: Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. METHODS AND FINDINGS: We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. CONCLUSIONS: There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.

Eventos adversos a antibióticos em pacientes internados em um hospital universitário / Adverse events to antibiotics in inpatients of a university hospital / Adverse events to antibiotics in inpatients of a university hospital

OBJETIVO: Antibióticos são os medicamentos que mais causam eventos adversos, gerando problemas aos pacientes e custos adicionais ao sistema de saúde. Assim, objetivou-se analisar a ocorrência de eventos adversos a antibióticos em pacientes internados em um hospital. MÉTODOS: Realizou-se monitoramento intensivo do uso de antibióticos em pacientes adultos internados no município de Maringá, Paraná, de setembro de 2002 a fevereiro de 2003. Foram pesquisadas variáveis relativas aos medicamentos em uso, em particular aos antibióticos e aos eventos adversos. Com base em critérios para a avaliação do uso correto dos antibióticos, os eventos observados foram classificados como reações adversas, erros de medicação e "quase erros". Para relação de causalidade entre a administração do fármaco e o surgimento dos eventos utilizou-se o algoritmo de Naranjo. RESULTADOS: Foram acompanhados 87 pacientes e identificados 91 eventos adversos, sendo três deles (3,3 por cento) reações adversas a medicamentos, sete (7,7 por cento) erros de medicação, e 81 (89,0 por cento) "quase erros". As reações a medicamentos ocorreram devido ao uso de quinolonas e foram consideradas "prováveis" utilizando-se o algoritmo de Naranjo. Os sete erros de medicação ocorreram devido a quatro prescrições incorretas de dose e três interações medicamentosas. CONCLUSÕES: Os resultados sugerem que a falta de conhecimento do medicamento ou a falta de informação sobre o paciente no momento da prescrição tenham sido os principais fatores envolvidos na ocorrência das reações a medicamentos.

OBJECTIVE: Antibiotics are the most common drugs causing adverse events and they lead to problems to patients and additional costs of the health system. The aim of the study was to evaluate the occurrence of adverse events to antibiotics in inpatients of a hospital. METHODS: An extensive drug monitoring was conducted in adult inpatients taking antibiotics in the city of Maringá, Southern Brazil, from September 2002 to February 2003. Variables related to medications used, especially those related to antibiotic use and adverse events, were studied. Based on criteria for adequate antibiotic use, the observed events were classified as adverse events, medication errors and near-misses. For the analysis of causality between drug administration and event occurrence Naranjo algorithm was used. RESULTS: A total of 87 patients were studied and 91 adverse events were identified: three (3.3 percent) adverse drug reactions; seven (7.7 percent) medication errors; and 81 (89.0 percent) medication near-misses. Adverse drug reactions were related to the use of quinolones and likely according to Naranjo algorithm. The seven medication errors were associated to four inadequately prescribed doses and three drug interactions. CONCLUSIONS: The study results indicate that an inadequate knowledge on antibiotics or lack of information about the patient at the time of prescription were the major factors involved in the occurrence of adverse events.

[Adverse events to antibiotics in inpatients of a university hospital]. / Eventos adversos a antibióticos em pacientes internados em um hospital universitário.

OBJECTIVE: Antibiotics are the most common drugs causing adverse events and they lead to problems to patients and additional costs of the health system. The aim of the study was to evaluate the occurrence of adverse events to antibiotics in inpatients of a hospital. METHODS: An extensive drug monitoring was conducted in adult inpatients taking antibiotics in the city of Maringá, Southern Brazil, from September 2002 to February 2003. Variables related to medications used, especially those related to antibiotic use and adverse events, were studied. Based on criteria for adequate antibiotic use, the observed events were classified as adverse events, medication errors and near-misses. For the analysis of causality between drug administration and event occurrence Naranjo algorithm was used. RESULTS: A total of 87 patients were studied and 91 adverse events were identified: three (3.3%) adverse drug reactions; seven (7.7%) medication errors; and 81 (89.0%) medication near-misses. Adverse drug reactions were related to the use of quinolones and likely according to Naranjo algorithm. The seven medication errors were associated to four inadequately prescribed doses and three drug interactions. CONCLUSIONS: The study results indicate that an inadequate knowledge on antibiotics or lack of information about the patient at the time of prescription were the major factors involved in the occurrence of adverse events.

Eventos adversos a antibióticos em pacientes internados no setor de clínica médica do Hospital Universitário de Maringá - PR / Adverse events of antibiotics in inpatients in the clinical medicine section of the Hospital Universitário Regional de Maringá - PR

Introdução: Os eventos adversos a medicamentos (EAM) constituem um problema grave de saúde pública, causando hospitalização, aumento do tempo de internação e óbito, elevando os gastos com saúde. Os antibióticos estão entre os medicamentos mais consumidos no meio hospitalar, embora de excepcional valor, se destacam entre as classes medicamentosas que mais causam EAM. Objetivo: Pesquisar a ocorrência de eventos adversos a antibióticos em pacientes internados no setor de Clínica Médica do Hospital Universitário Regional de Maringá (HUM). Métodos: Dos 87 pacientes estudados, 62,1 por cento pertenciam ao sexo masculino e 37,9 por cento ao feminino, na sua maioria idosos (58,6 por cento). Observou-se uma média de prescrição de 1,6 antibióticos por paciente, sendo que 10,3 por cento fizeram uso de 4 ou mais antibióticos. Nas 135 prescrições de antibióticos foram encontrados 23 diferentes antimicrobianos, sendo as cefalosporinas (34,1 por cento) o grupo mais freqüente, seguido das penicilinas (20,0 por cento) e quinolonas (17,8 por cento). Quanto ao uso, considerou-se incorretas: 2 (2,3 por cento) indicações, 4 (4,6 por cento) doses, 26 (29,8 por cento) tratamentos com duração inadequada e1 (1,1 por cento) administração. A via intravenosa foi a mais utilizada (88,5 por cento). Observou-se uma freqüência de 5,5 por cento de eventos adversos preveníveis, 3,4 por cento de eventos não preveníveis e 87 eventos potenciais. Conclusões: EAM são comuns e na maior parte evitáveis. Programa de farmacovigilância hospitalar multidisciplinares, são necessários para dimensionar a realidade dos e EAMs e para propor estratégias que diminuam sua ocorrência.