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ABSTRACT Objective: to analyze the prevalence and factors associated with depressive symptoms in pregnant women attended in primary healthcare. Method: this is an epidemiological, cross-sectional and analytical study conducted in Montes Claros, in the north of the state of Minas Gerais, Brazil. The dependent variable (depressive symptoms) and independent variables (sociodemographic characteristics, social support, obstetric characteristics, sexuality and health conditions) were collected through a questionnaire and validated scales. The collection took place between October 2018 and November 2019. Descriptive, bivariate and multiple analyzes were performed through multinomial logistics regression. Results: a sample of 1,279 pregnant women was evaluated. The estimated prevalence of moderate and serious depressive symptoms was 16.2% and 25.2%, respectively. Low social support (p<0.001), low sexual performance (p = 0.002) and a high level of perceived stress (p<0.001) were factors associated with moderate depressive symptoms. First gestational trimester (p = 0.006), low social support (p<0.001), low sexual performance (p<0.001) and a high level of perceived stress (p<0.001) were factors associated with serious depressive symptoms. Conclusion: the prevalence of moderate and serious depressive symptoms in pregnant women attended in primary healthcare was considerable. Factors related to social support, gestational quarter (first quarter), sexuality and perceived stress showed association with these symptoms. Caution and the promotion of mental health is necessary for pregnant women in this scenario.

RESUMEN Objetivo: analizar la prevalencia y factores asociados a síntomas depresivos en gestantes atendidas en Atención Primaria de Salud. Método: se trata de un estudio epidemiológico, transversal y analítico, realizado en Montes Claros, norte del estado de Minas Gerais - Brasil. La variable dependiente (síntomas depresivos) y las variables independientes (características sociodemográficas, apoyo social, características obstétricas, sexualidad y condiciones de salud) se recogieron mediante un cuestionario y escalas validadas. La recolección se realizó entre octubre de 2018 y noviembre de 2019. Se realizaron análisis descriptivos, bivariados y múltiples mediante Regresión Logística Multinomial. Resultados: se evaluó una muestra de 1279 gestantes. Las prevalencias estimadas de síntomas depresivos moderados y graves fueron del 16,2% y el 25,2%, respectivamente. El bajo apoyo social (p<0,001), el bajo rendimiento sexual (p=0,002) y el alto nivel de estrés percibido (p<0,001) fueron factores asociados con síntomas depresivos moderados. El primer trimestre del embarazo (p=0,006), el bajo apoyo social (p<0,001), el bajo rendimiento sexual (p<0,001) y el alto nivel de estrés percibido (p<0,001) fueron factores asociados con síntomas depresivos severos. Conclusión: la prevalencia de síntomas depresivos moderados y graves en gestantes atendidas en Atención Primaria de Salud fue considerable. Factores relacionados con el apoyo social, el trimestre gestacional (primer trimestre), la sexualidad y el estrés percibido se asociaron con estos síntomas. En este escenario, es necesaria una mayor atención a las mujeres embarazadas y la promoción de la salud mental.

RESUMO Objetivo: analisar a prevalência e os fatores associados aos sintomas depressivos em gestantes assistidas na Atenção Primária à Saúde. Método: trata-se de um estudo epidemiológico, transversal e analítico, realizado em Montes Claros, norte do estado de Minas Gerais - Brasil. A variável dependente (sintomas depressivos) e as variáveis independentes (características sociodemográficas, apoio social, características obstétricas, sexualidade e condições de saúde) foram coletadas por meio de questionário e escalas validadas. A coleta ocorreu entre outubro de 2018 e novembro de 2019. Realizaram-se análises descritivas, bivariada e múltipla mediante Regressão Logística Multinomial. Resultados: avaliou-se amostra de 1279 gestantes. As prevalências estimadas de sintomas depressivos moderados e graves foram de 16,2% e 25,2%, respectivamente. Baixo apoio social (p<0,001), baixo desempenho sexual (p=0,002) e elevado nível de estresse percebido (p<0,001) foram fatores associados aos sintomas depressivos moderados. Primeiro trimestre gestacional (p=0,006), baixo apoio social (p<0,001), baixo desempenho sexual (p<0,001) e elevado nível de estresse percebido (p<0,001) foram fatores associados aos sintomas depressivos graves. Conclusão: as prevalências de sintomas depressivos moderados e graves em gestantes assistidas na Atenção Primária à Saúde foram consideráveis. Fatores relativos ao apoio social, ao trimestre gestacional (primeiro trimestre), à sexualidade e ao estresse percebido apresentaram associação a esses sintomas. Nesse cenário, fazem-se necessários o cuidado ampliado às gestantes e a promoção da saúde mental.

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The launch of the COVID-19 vaccination program was the largest vaccination campaign in U.S. history, with an unprecedented demand for vaccine and new vaccination providers, warranting significant education and communication efforts. NIP-INFO (nipinfo@cdc.gov) is the Centers for Disease Control and Prevention's (CDC's) immunization inquiry response service, and it receives inquiries for COVID-19 and routine non-COVID vaccines. A qualitative analysis of NIP-INFO's content was performed to better characterize and understand some of the knowledge gaps and reasons that COVID-19 vaccine administration errors occur. A total of 734 COVID-19 vaccine administration error inquiries were received between January 2021 and April 2022. The most frequent inquiries related to storage (n = 191; 26.0%), incorrect dosage or product (n = 190; 25.9%), unauthorized age group (n = 108; 14.7%), and schedule (n = 105; 14.3%). Training and communication strategies are imperative to ensure proper vaccine administration and build and maintain vaccine confidence.

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Resumo Objetivo: descrever as prevalências de fatores de risco e de proteção para doenças crônicas não transmissíveis (DCNT) e testar associações desses fatores com sexo, idade e satisfação com o trabalho entre professores da educação básica. Métodos: estudo transversal analítico realizado em Montes Claros, MG, Brasil, em 2016. Amostra probabilística por conglomerados. Utilizou-se questionário autoaplicável e avaliações físicas. Estimaram-se razões de prevalências (RP) e intervalos de confiança de 95% (IC95%) pela Regressão de Poisson. Resultados: dos 745 participantes, 83% eram mulheres, 81% tinham até 49 anos e 60% estavam insatisfeitos com o trabalho. Houve maior prevalência de fumantes entre homens (RP: 2,33; IC95%: 1,13;4,81), bem como consumo abusivo de álcool (RP: 7,24; IC95%: 2,19;23,91), excesso de peso (RP:1,48; IC95%: 1,04;2,13), menor prevalência de sintomas depressivos (RP:0,93; IC95%: 0,88;0,98) e de estresse (RP:0,88; IC95%: 0,82;0,95). Professores mais velhos apresentaram menor prevalência de Burnout (RP:0,87; IC95%: 0,81;0,94) e maior prevalência de comportamentos de proteção, apesar de terem maior comprometimento da saúde física. Professores insatisfeitos apresentaram maior prevalência de sintomas depressivos (RP:2,52; IC95%: 1,61;3,93), estresse (RP:1,76; IC95%: 1,33;2,32) e Burnout (RP:9,20; IC95%: 4,46;18,99). Conclusões: tabagismo, etilismo, excesso de peso e comprometimento da saúde mental foram fatores de risco frequentes para DCNT entre professores. Observaram-se diferenças nas prevalências de fatores de risco e de proteção para DCNT segundo sexo, idade e satisfação com o trabalho.

Abstract Objective: to describe the prevalence of risk and protective factors for noncomunicable chronic diseases (NCD) and test the association of these factors with sex, age, and job satisfaction among public primary and secondary schools teachers. Methods: analytical cross-sectional study in Montes Claros, MG, Brazil, carried out in 2016. We applied the probability cluster sampling technique. We used a self-applicable questionnaire and physical evaluations. We estimated Prevalence ratios (PR) and 95% Confidence Intervals (95%CI) using Poisson's regression. Results: of the 745 participants, 83% were women, 81% were 49 years old or younger, and 60% were unsatisfied with work. Smoking was more prevalent among men (PR: 2.33; 95%CI: 1.13;4.81), as well as alcohol abuse (PR: 7.24; 95%CI: 2.19;23.91), overweight (PR:1.48; 95%CI: 1.04;2.13), lower prevalence of depressive symptoms (PR: 0.93; 95%CI: 0.88;0.98) and stress (PR: 0.88; 95%CI: 0.82;0.95). Older teachers had a lower prevalence of burnout (PR: 0.87; 95%CI: 0.81;0.94) and a higher prevalence of protective behaviors, despite having a greater impairment of physical health. Unsatisfied teachers showed higher prevalence of depressive symptoms (PR: 2.52; 95%CI: 1.61;3.93), stress (PR: 1.76; 95%CI: 1.33;2.32), and burnout (PR: 9.20; 95%CI: 4.46;18.99). Conclusions: smoking, alcoholism, overweight, and mental health impairment were frequent risk factors for NCD among teachers. Differences were observed in the prevalence of risk and protection factors for NCD according to sex, age, and job satisfaction.

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BACKGROUND AND AIMS: Myasthenia Gravis requires expert treatment from specialized neurologists. In Germany, this treatment is mainly provided by 18 Integrated Myasthenia Centers (iMZ) accredited by the German Myasthenia Gravis Association (DMG). The DMG is a large and well-organized patient organisation that is regarded as a trusted source for disease-specific information. The aim of this study was to analyse the type of requests that each of these institutions receives in order to identify any potential unmet needs regarding the availability of advice for patients and caregivers. This data can then be used in further research to tailor modern digital communication tools to the specific needs of MG patients. METHODS: Counselling requests sent via e-mail to both institutions were extracted for defined examination periods and divided into a period 'before COVID-19 pandemic' (01.07.2019-31.12.2019) and 'during COVID-19 pandemic' (01.07.2020-31.12.2020). Requests were then analysed using four main categories: medical requests, organisational issues, COVID-19 and social legislation inquiries. RESULTS: One thousand seven hundred eleven requests for advice were addressed to DMG and iMZ Charité. Most inquiries directed to the DMG (47%; n = 750) were related to medical issues, most frequently to side effects of medications (n = 325; 20%) and questions about treatment (n = 263; 16%), followed by inquiries regarding organisational issues (26%; n = 412). About half of the inquiries (n = 69; 58%) to the iMZ Charité were related to medical issues and almost one in three inquiries concerned organisational issues (n = 37; 30%). About one in ten inquiries concerned socio-legal matters (iMZ: n = 7; 6% and DMG: n = 177; 11%). During the pandemic, COVID-19 related issues accounted for 8% (n = 6) of inquiries at iMZ, and 16% (n = 253) at DMG. CONCLUSIONS: MG sufferers have a high demand for timely advice. In the current setting, they address their requests to both iMZs and the DMG via e-mail. Our findings confirm that the DMG is highly trusted by patients and caregivers and is used to obtain second opinions. A relevant proportion of requests to the iMZ could be answered more effectively through standardized responses or improved process management. The implementation of modern digital solutions, including telemedicine, for communication between patient and specialist should be evaluated in further research.

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Objective: To show the feasibility of using combined nasopharyngeal swab auto-collection and pool testing to detect SARS-CoV-2 in epidemiological surveys. Methods: The study involved a sample of 154 students from the Universidade Federal de Minas Gerais, who performed the self-collection of the nasopharyngeal swab in individual booths without supervision. Molecular testing was performed using the pool testing technique. Results: Obtaining samples lasted about 5 minutes each. Analysis 6 was performed to detect endogenous RNA in 40 samples, and the results indicated that no failures resulted from self-collection. None of the pools detected the presence of viral RNA. The cost of performing the molecular test (RT-PCR) by pool testing with samples obtained by self-collection was about 10 times lower than with the usual methods. Conclusion: The investigated strategies showed to be economically feasible and valid for the research of SARS-CoV-2 in epidemiological surveys.

Objetivo: Demostrar la viabilidad de utilizar el uso combinado de la autocollección de swabs nasofaríngeos y pool testing para la detección del SARS-CoV2 en encuestas epidemiológicas. Métodos: El estudio involucró a una muestra de 154 estudiantes de la Universidade Federal de Minas Gerais, quienes realizaron la autocolección del hisopo nasofaríngeo en cabinas individuales sin supervision. La prueba molecular se realizó utilizando la técnica de prueba de grupo. Resultados: La obtención de muestras duró unos 5 minutos por persona. Se realizó un análisis para detectar RNA endógeno en 40 muestras y los resultados indicaron que no hubo fallas derivadas de la autocolección. Ninguno de los grupos detectó la presencia de RNA viral. El costo de realizar una prueba molecular (RT-PCR) por pool con muestras obtenidas por auto-recolección fue aproximadamente 10 veces menor que con los métodos habituales. Conclusión: Las estrategias investigadas demonstraram ser económicamente viables y válidas para la investigación del SARS-CoV-2 en encuestas epidemiológicas.

Objetivo: Demonstrar a viabilidade da utilização combinada da autocoleta de swab nasofaríngeo e pool testing para detecção do SARS-CoV-2 em inquéritos epidemiológicos. Métodos: O estudo envolveu amostra de 154 estudantes da Universidade Federal de Minas Gerais, que realizaram a autocoleta do swab nasofaríngeo em cabines individuais e sem supervisão. O teste molecular foi realizado utilizando-se a técnica de pool testing. Resultados: A obtenção de amostras durou cerca de 5 minutos por pessoa. Realizou-se análise para detecção de RNA endógeno em 40 amostras e os resultados indicaram que não houve falhas decorrentes da autocoleta. Nenhum dos pools detectou presença de RNA viral. O custo da realização do teste molecular (RT-PCR) por pool testing com amostras obtidas por autocoleta foi cerca de dez vezes menor do que nos métodos habituais. Conclusão: As estratégias investigadas mostraram-se economicamente viáveis e válidas para a pesquisa de SARS-CoV-2 em inquéritos epidemiológicos.

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Objective: Pharmacists at insurance pharmacies play an important role in the pharmaceutical care of outpatients receiving cancer chemotherapy. This study aimed to clarify the actual status of insurance pharmacies' involvement in cancer chemotherapy and associated issues, based on an analysis of prescription inquiries made to doctors by pharmacists at an insurance pharmacy.Design: This was a retrospective observational study.Methods: The data was collected in one insurance pharmacy, which received prescriptions mainly from Gunma Prefectural Cancer Center. Among 2, 258 inquiries recorded from January 2015 to May 2018, inquires related to oral anticancer drugs or supportive care medicine were extracted. The frequency of inquiries for each item, or the frequencies of factors that lead to inquiries were calculated. Inquiries considered to have potentially led to the prevention or avoidance of adverse drug reactions (ADRs), so-called “preavoidance” inquiries, were also extracted.Results: Four hundred and forty inquiries related to 20 oral anticancer drugs were included in the analysis. The prescriptions were changed after 92.7% of all prescription inquiries. Prescription inquiries for drugs with rest periods were more frequent than those for drugs without rest periods. The most common inquiries were about the medication schedules stated on the prescription, followed by inquiries about supportive care drugs. Approximately 60% of the pharmacy inquiries were related to“pre-avoidance”inquiries. Most of the pre-avoidance inquiries concerned prevention of ADRs, though these inquiries also contributed to“reduction or avoidance of mental anxiety”. The prescription inquiries were triggered by information collected by pharmacists from patient interviews and from medication histories.Conclusion: Our findings suggest that inquiries to the prescribing doctors by pharmacists at insurance pharmacies contribute significantly to the appropriate use of anticancer drugs.

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This method emphasizes the interrelation between the pedagogical mode of intervention and the resulting development in the student's way of reasoning. This is reminiscent of Heisenberg's principle of indeterminacy, according to which "there is no way to observe a particle without altering it." Our knowledge of things can only be knowledge of how they act as a result of our observation and experimentation with them. The development of the student's scientific medical thinking is defined according to how he acts when subjected to the tests and stimuli of the forms of pedagogical intervention. Therefore, if the student's medical thinking develops as a result of various pedagogical interventions, then teaching and mental development are inseparable from each other, as we see daily by being dazzled by the ability of our students to understand, learn, incorporate and act. Furthermore, if the student's cognitive performance is a function of the teacher's pedagogical performance, then we must find ways to expand the teacher's ability to challenge the student to respond. I propose here a clear defense of a curricular program that goes far beyond the power of construction attributed to the typical professor; a curricular program that constitutes a discipline dedicated to stimulating the mind and engaging it to understand what it otherwise willingly assumes.

Este método hace hincapié en la interrelación entre el modo de intervención pedagógica y el desarrollo resultante en la forma de razonar del alumno. Esto recuerda el principio de indeterminación de Heisenberg, según el cual "no existe ningún modo de observar una partícula sin alterarla." Nuestro conocimiento de las cosas sólo puede ser conocimiento de cómo actúan como resultado de nuestra observación y experimentación con ellas. El desarrollo del pensamiento médico científico del estudiante se define en función de cómo actúa cuando se somete a las pruebas y estímulos de las formas de intervención pedagógica. Por tanto, si el pensamiento médico del alumno se desarrolla como resultado de diversas intervenciones pedagógicas, entonces la enseñanza y el desarrollo mental son entre sí indisociables, como lo comprobamos a diario al deslumbrarnos con la capacidad que tienen nuestros alumnos de comprender, aprender, incorporar y actuar.   Además, si el rendimiento cognitivo del estudiante está en función del rendimiento pedagógico del profesor, entonces debemos encontrar modos de ampliar la capacidad del profesor para desafiar al alumno a que responda. Planteo aquí, una clara defensa de un programa curricular que vaya mucho más allá del poder de construcción atribuido al típico profesor de aula; un programa curricular que constituya una disciplina dedicada a azuzar la mente y a comprometerla a entender lo que de otro modo asume de manera complaciente.

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PURPOSE: This article applies the whistleblowing stages model to whistleblowing journeys as seen in British National Health Service (NHS) Inquiries. DESIGN/METHODOLOGY/APPROACH: It provides a qualitative analysis of Inquiry Reports since 2001, using Interpretive Content Analysis to allocate material to stages. FINDINGS: It is found that the Inquiry Reports show a wide variety of reporting mechanisms, but that most persons initially report internally. It seems to confirm recent suggestions that WB is often not a "one off" or simple and linear process, but a protracted process. While the simple stages model may be appropriate for individual "whistle-blowing incident" by a single whistleblower, it needs to be revised for the protracted process of raising concerns in a variety of ways by different people as shown in the Inquiry Reports. RESEARCH LIMITATIONS/IMPLICATIONS: The evidence is confined to the publicly available material that was presented in the Inquiry Reports. PRACTICAL IMPLICATIONS: It provides a template to apply to cases of whistleblowing, and provides some baseline material. ORIGINALITY/VALUE: This paper is one of the first to explore the whistleblowing stages model using qualitative material to one setting over time.

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Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of contributors was 14 (interquartile range, IQR, 5-26) per report. The most common recommendation was to increase funding to LTC to improve staffing, direct care and capacity (67% of reports). A median of 8 (IQR 3.25-18) recommendations were made per report. The total cost for all 80 reports was estimated to be $23,626,442.78. Conclusions: Problems in Canadian LTC homes and their solutions have been known for decades. Despite this, governments and non-governmental agencies continue to produce more reports at a monetary and societal cost to Canadians.

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CONTEXT: In response to the COVID-19 pandemic, the Centers for Disease Prevention and Control (CDC) clinicians provided real-time telephone consultation to healthcare providers, public health practitioners, and health department personnel. OBJECTIVE: To describe the demographic and public health characteristics of inquiries, trends, and correlation of inquiries with national COVID-19 case reports. We summarize the results of real-time CDC clinician consultation service provided during 11 March to 31 July 2020 to understand the impact and utility of this service by CDC for the COVID-19 pandemic emergency response and for future outbreak responses. DESIGN: Clinicians documented inquiries received including information about the call source, population for which guidance was sought, and a detailed description of the inquiry and resolution. Descriptive analyses were conducted, with a focus on characteristics of callers as well as public health and clinical content of inquiries. SETTING: Real-time telephone consultations with CDC Clinicians in Atlanta, GA. PARTICIPANTS: Health care providers and public health professionals who called CDC with COVID-19 related inquiries from throughout the United States. MAIN OUTCOME MEASURES: Characteristics of inquiries including topic of inquiry, inquiry population, resolution, and demographic information. RESULTS: A total of 3154 COVID-19 related telephone inquiries were answered in real-time. More than half (62.0%) of inquiries came from frontline healthcare providers and clinical sites, followed by 14.1% from state and local health departments. The majority of inquiries focused on issues involving healthcare workers (27.7%) and interpretation or application of CDC's COVID-19 guidance (44%). CONCLUSION: The COVID-19 pandemic resulted in a substantial number of inquiries to CDC, with the large majority originating from the frontline clinical and public health workforce. Analysis of inquiries suggests that the ongoing focus on refining COVID-19 guidance documents is warranted, which facilitates bidirectional feedback between the public, medical professionals, and public health authorities.

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BACKGROUND: External inquiries are carried out following adverse maternal/perinatal events, to examine the care provided and make recommendations to improve it. Clinical governance ensures that organisations promote high-quality care and are accountable for the care they provide, thus contributing to its improvement. OBJECTIVE: This study examined how Irish perinatal bereavement services and the management of perinatal deaths (including events leading up to the deaths) were affected by developments in maternity services governance as described in ten Irish enquiry reports published over 14 years (2005-18). METHODS: Two clinicians collected data from the ten enquiry reports by using a specifically designed review tool. Thematic analysis was carried out, following the steps of familiarising, coding, identifying, grouping and revising themes. FINDINGS: Seven main themes were identified: workforce, leadership, management of risk, work environment, hospital oversight, national documents, data collection. Eight reports noted shortcomings in staffing levels, with a workforce that was under-resourced, and at times carried excessive workloads. The absence of 24/7 midwifery-shift leaders in maternity units resulted in problems with care at times not being escalated appropriately. The absence of a widely-owned, understood strategic plan for the management of the maternity services was mentioned in the reports from 2013. Conclusions and implications for practice The National Bereavement Care Standards were published in 2016 to address deficiencies identified in the enquiry reports and to standardise perinatal bereavement care across Irish maternity units. Though the first Irish Maternity Strategy (2016-26) was published in 2016, its implementation is incomplete. Inconsistencies remain in the definition and collection of national perinatal data, as well as concerns regarding the lack of local audit activities on pregnancy outcomes. Greater focus on hospital oversight, implementation of national documents and reliable data collection is required. To be effective and initiate positive changes in clinical services, documents such as incident reviews, national strategies and national reports including inquiries, need to include realistic recommendations with clear timelines and responsibilities for implementation.

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Obstacles in dealing with child sexual abuse (CSA) can hinder survivors in the process of coming to terms with their experiences. The present study aims to identify and analyze factors that may pose obstacles in the long-term process of dealing with CSA. It is part of a larger research consortium "Auf-Wirkung," funded by the German Federal Ministry of Education and Research, and was conducted in cooperation with the Independent Inquiry into Child Sexual Abuse in Germany (IICSAG). The IICSAG was appointed by the Independent Commissioner for Child Sexual Abuse Issues and the German Federal Ministry for Family Affairs, Senior Citizens, Women, and Youth in 2016. To determine responsibilities, recognize injustice, and further acknowledge the survivors of CSA in the Federal Republic of Germany (FRG) and the German Democratic Republic (GDR), the Independent Inquiry has held 1,303 private sessions with survivors of CSA by Oct. 17th, 2020. The present study focuses on exploring reoccurring problematic experiences reported by survivors in private sessions regarding the long-term process of dealing with experiences of CSA. A total of 30 transcripts of private sessions, conducted by members and appointees of the IICSAG between September 2016 and June 2019, were analyzed using qualitative content analysis. Attendants of private sessions described a variety of obstacles, including negative social reactions to disclosure, institutions' unwillingness to elucidate occurrences of CSA within their midst, as well as general financial difficulties, and those linked to redress claims. Manipulative grooming by perpetrators and limited access to adequate psychotherapy were perceived as obstructive by survivors dealing with CSA. In the context of criminal proceedings, survivors reported long durations of court proceedings and negative experiences in connection to credibility assessment. Results will be discussed to better support survivors of CSA in the process of dealing with their experiences in the future.

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The #MeToo Movement has brought new attention to sexual harassment and assault. While the movement originates with activist Tarana Burke, actor Alyssa Milano used the phrase on Twitter in October 2017 in response to multiple sexual harassment allegations against Hollywood producer Harvey Weinstein. Within 24 hours, 53,000 people tweeted comments and/or shared personal experiences of sexual violence. The study objective was to measure how information seeking via Google searches for sexual harassment and assault changed following Milano's tweet and whether this change was sustained in spite of celebrity scandals. Weekly Google search inquiries in the United States were downloaded for the terms metoo, sexual assault, sexual harassment, sexual abuse, and rape for January 1, 2017 to July 15, 2018. Seven related news events about perpetrator accusations were considered. Results showed that searches for metoo increased dramatically after the Weinstein accusation and stayed high during subsequent accusations. A small decrease in searches followed, but the number remained very high relative to baseline (the period before the Weinstein accusation). Searches for sexual assault and sexual harassment increased substantially immediately following the Weinstein accusation, stayed high during subsequent accusations, and saw a decline after the accusation of Matt Lauer (talk show host; last event considered). We estimated a 40% to 70% reduction in searches 6 months after the Lauer accusation, though the increase in searches relative to baseline remained statistically significant. For sexual abuse and rape, the number of searches returned close to baseline by 6 months. It appears that the #MeToo movement sparked greater information seeking that was sustained beyond the associated events. Given its recent ubiquitous use in the media and public life, hashtag activism such as #MeToo can be used to draw further attention to the next steps in addressing sexual assault and harassment, moving public web inquiries from information seeking to action.

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BACKGROUND: Generic drugs are heavily promoted in Japan. The aim of this retrospective single-center study was to clarify whether the frequency and reason that patients request a switch from a generic drug to the original drug differ according to therapeutic category and dosage form. METHODS: This study was performed at Chiba University Hospital. Prescription inquiries about 121 generic drugs from community pharmacies over a 3-year period (from July 2014 to June 2017) were analyzed. RESULTS: Approximately 30% of the requests were related to the efficacy, safety, and comfort of the generic drug. The most cited motive was "patient's desire with no reason given" at 44.5%. According to multiple logistic regression analysis, therapeutic categories and dosage forms were associated with the requests. The median request frequency differed according to therapeutic category and dosage form. The frequency was highest for "agents affecting the central nervous system" and "tablets and capsules", respectively. Among the therapeutic categories, "agents affecting the central nervous system" had the highest median number of requests related to "decreased effectiveness"; "cardiovascular agents" had the highest median number of requests related to "physician's instruction"; and "agents for the epidermis" had the highest median number of requests related to "uncomfortable to use". Among dosage forms, the odds ratio for patients' original drug request for "liniment and patch" was about 1.5 times that for "tablets and capsules". "Liniment and patch" had the highest median frequency of requests related to "decreased effectiveness", "uncomfortable to use", and "patient's desire with no reason given". CONCLUSIONS: The request frequency and reason differed according to therapeutic category and dosage form. Pharmacists should advise each patient properly about the choice and switching of drug brands, taking into account the therapeutic category and dosage form, especially liniments and patches.

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BACKGROUND: The only non-legal reference in Lord Cullen's Review of fatal accident inquiry (FAI) Legislation in Scotland (2009) was my audit of FAIs into 97 deaths in prison custody in Scotland, 1999-2003: recommending that waiting time from prisoner death to end of FAI should be less than 1 year for 90% of FAIs, and epidemiological rules for FAIs to have a written determination versus formal findings. AIMS: Audit of FAIs into 83 deaths in Scottish prison custody in the period 2010-2013. METHOD: Assessement of waiting times from prisoner death to end of FAI; dissemination of written determinations; self-inflicted death rate per 1000 prisoner-years; cause of natural deaths; and yellow card submissions. Detailed cross-checking was nec37essary between Scottish Prison Service and courts' websites and the Scottish Fatalities Investigation Unit. RESULTS: Of 83 FAIs into deaths in Scottish prison custody, 2010-2013, 37 (45%) were long-awaited (ongoing >2 years after the prisoner's death); 16 (19%, 95% CI 11-28%) beyond 3 years. Of 37 long-awaited FAIs, 27 made written determinations but only 12 of these (44%) were published. Self-inflicted deaths numbered 36: 1.1 per 1000 prisoner-years (95% CI 0.75-1.48). Of 47 deaths from natural causes, cardiovascular disease accounted for 23 (49%, 95% CI 34-63%); liver disease was implicated in 10 of 47. To support pharmacovigilance, submissions were made to Medicines and Healthcare Regulatory Agency for eight deaths (10%, 95% CI 4-19%). CONCLUSIONS: FAIs into prisoner deaths in Scotland are too long-awaited given that four (5%) identified precautions that could have prevented death.

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BACKGROUND: Investigations may be undertaken into mental healthcare related homicides to ascertain if lessons can be learned to prevent the chance of recurrence. Families of victims are variably involved in serious incident reviews. Their perspectives on the inquiry process have rarely been studied. AIMS: To explore the experiences of investigative processes from the perspectives of family members of homicide victims killed by a mental health patient to better inform the process of conducting inquiries. METHOD: The study design was informed by interpretive description methodology. Semi-structured interviews were conducted with five families whose loved one had been killed by a mental health patient and where there had been a subsequent inquiry process in New Zealand. Data were analysed using an inductive approach. RESULTS: Families in this study felt excluded, marginalised and disempowered by mental health inquires. The data highlight these families' perspectives, particularly on the importance of a clear process of inquiry, and of actions by healthcare providers that indicate restorative intent. CONCLUSIONS: Families in this study were united in reporting that they felt excluded from mental health inquiries. We suggest that the inclusion of families' perspectives should be a key consideration in the conduct of mental health inquiries. There may be benefit from inquiries that communicate a clear process of investigation that reflects restorative intent, acknowledges victims, provides appropriate apologies and gives families opportunities to contribute.

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STATEMENT OF THE PROBLEM: Head and neck cancer treatment has provided better cure and survival rates but the patient's quality of life is still an issue. PURPOSE: To verify the correlation between the three most used instruments for evaluating the quality of life of head and neck cancer patients. MATERIALS AND METHOD: This cross-sectional study evaluated patients treated for head and neck cancer at the Mato Grosso Cancer Hospital, Cuiabá, MT, Brazil. The variables age, gender, cohabitation status, education, religion, smoking, ethnicity, tumor location and histological type and treatment modality were collected. The patients quality of life was assessed by the Functional Assessment of Cancer Therapy Quality of Life Measurement System (FACT-H&N), University of Washington Quality of Life Questionnaire (UW-QOL), and EORTC QLQ-C30/EORTC QLQ-H&N35 of the European Organization for Research and Treatment of Cancer. RESULTS: The study population consisted of 33 individuals with a mean age of 63.42±11.25 years; 69.70% were males; 54.55% had no partner; 45.45% had only elementary education; 87.9% followed a religion; 84.38% were smokers and 87.50% alcoholics. Squamous cell carcinoma responded for 78.79% of the cases and palate/oropharynx and mouth floor (21.21% each) were the most affected sites. All patients underwent radiotherapy, 90.91% chemotherapy and 63.64% surgery. On the analysis of quality of life, shoulder (UW-QOL), social performance (EORTC QLQ-C30/QLQ-H&N35) and overall well-being (FACT-H&N) had the highest scores while saliva (UW-QOL), nausea and vomiting (EORTC QLQ-C30/QLQ-H&N35) and emotional well-being (FACT-H&N) had the lowest scores. A positive correlation was found between the questionnaires for the patient's overall quality of life and the domains Pain, Appearan-ce, Activity, Deglutition, Chewing, Speech, Taste, Saliva, Mood and Anxiety. CONCLUSION: Given the correlation between the questionnaires, the selection of the instrument for future research involving head and neck cancer patients' quality of life should consider the specific aspects to be evaluated.

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BACKGROUND: Medical information departments are responsible for maintaining standard response letters to address health care providers' inquiries. Several factors, including Food and Drug Administration regulations, insufficient diversity in clinical trials, and stringent exclusion criteria, might limit the information available to respond to unsolicited requests. However, if new data becomes available for an inquiry that was previously unanswered, it is not common practice for medical information departments to provide an updated response to health care providers. Therefore, the purpose of this study is to evaluate the impact of reviewing literature to provide an updated response to health care providers. METHODS: We conducted a 1-year retrospective review of medical inquiries regarding a Bristol-Myers Squibb oncology product. We identified medical inquiry responses that were missing data via our metrics reporting software and conducted an internal and external literature search to assess if new data became available. RESULTS: Of 21,264 unsolicited global inquiries, data were unavailable for 531 (2.7%). The 3 most frequently observed inquiry topics were "use in special populations" (32%), "drug interactions" (27%), and "adverse events and safety" (23%). After performing an internal and external literature review, we developed standard response letters for 30% of medical inquiries that were previously unanswered. CONCLUSIONS: Medical information departments serve as a resource to answer product-related questions for health care providers. However, data are not always available to provide a response. On discovery of new data, if medical information departments followed up with health care providers to share new data, this could potentially increase patient safety, build stronger relationships with health care providers, and obtain insights that could influence strategies in future clinical trials and publications.

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Abstract Introduction Patient-reported outcome measures, inventory and or questionnaire, allow patients to present their perspective of the impact of their individual condition on a day-to-day basis, independent of the analysis of test results by the expert clinician. Outcome measures are recommended when there is evidence showing their reliability, validity and sensitivity. There are standardized patient-reported outcome measures for hearing in English language; however, other languages lack these instruments. Objective Adapt the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese and analyze its validation measures. Methods We conducted two studies. In Study 1, we translated and adapted the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese according to good practice guidelines; this included the pre-test stage. In Study 2, we administered the Portuguese version to adults with and without hearing loss (n = 31 and 18, respectively) and analyzed the measures of instrument validation, reliability, and reproducibility. Moreover, we calculated the correlation between pure tone thresholds and scores on the questionnaire. Results The results obtained in Study 1 demonstrated the feasibility of the translation process and the instrument's cultural adaptation, as well as its applicability, resulting in the Portuguese version of the Amsterdam inventory for auditory disability and handicap. In Study 2, the results revealed construct values for the questions and domains, as well as for the total reliable score. The intra-interviewer test-retest condition showed excellent reproducibility (ICC = 0.97). Finally, there was a strong positive correlation (r = 0.83) between the mean pure tone threshold and the hearing difficulties values, as measured by the instrument's scores. Conclusion The English version of the Amsterdam inventory for auditory disability and handicap could be translated and adapted to Brazilian Portuguese. An analyses of the validation process yielded reliable, consistent, and stable results.

Resumo Introdução Medidas de resultados relatados pelo paciente, inventários e/ou questionários, permitem que os pacientes apresentem suas perspectivas do impacto de sua condição no dia a dia, independentemente da análise dos resultados dos testes realizados pelo especialista. Esses instrumentos são recomendados quando há evidências que mostram sua confiabilidade, validade e sensibilidade. Existem medidas de resultados relatados pelo paciente padronizadas para a audição em língua inglesa; no entanto, esses instrumentos não existem em outras línguas. Objetivo Adaptar o Amsterdam inventory for auditory disability and handicap para o português brasileiro e avaliar suas medidas de validação. Método Realizamos dois estudos. No estudo 1, traduzimos e adaptamos o Amsterdam inventory for auditory disability and handicap para o português brasileiro de acordo com as diretrizes de boas práticas; inclusive a fase de pré-teste. No estudo 2, aplicamos a versão em português em adultos com e sem perda auditiva (n = 31 e 18, respectivamente) e analisamos as medidas de validação, confiabilidade e reprodutibilidade do instrumento. Além disso, calculamos a correlação entre os limiares de tons puros e os escores do questionário. Resultados Os resultados obtidos no estudo 1 demonstraram a viabilidade do processo de tradução e adaptação cultural do instrumento, assim como sua aplicabilidade, proporcionaram a versão em português da Amsterdam inventory for auditory disability and handicap. No estudo 2, os resultados revelaram valores de constructo para as questões e domínios, bem como para o escore total confiável. A condição de teste-reteste intraentrevistador mostrou excelente reprodutibilidade (CCI = 0,97). Por fim, houve forte correlação positiva (r = 0,83) entre o limiar médio de tom puro e os valores das dificuldades auditivas, medidos pelos escores do instrumento. Conclusão A versão em inglês do Amsterdam inventory for auditory disability and handicap foi traduzida e adaptada para o português brasileiro. Uma análise do processo de validação produziu resultados confiáveis, consistentes e estáveis.

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