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Background: Causality assessment of adverse drug reactions (ADRs) is an essential approach in pharmacovigilance. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) system has been considered one of the most adequate method for establishing causal relationship in hospitalized patients. Objective: To describe the causality of potential ADRs in hospitalized patients assessed by the WHO-UMC system and by different healthcare professionals. Methods: Three healthcare professionals, with different backgrounds, acted as judges to adjudicate the causality categories for potential ADRs according to WHO-UMC system, in a Brazilian high complexity hospital. Judges' agreement was evaluated by using Fleiss' and Cohen's kappa coefficients. Results: Ninety potential ADRs identified in 300 participants were adjudicated by each judge, comprising a total of 270 assessments. Most potential ADRs were classified as probable or possible (77.8%). Fleiss´ kappa revealed slight concordance among judges (k = 0.096;CI:95%;0.01-0.18). Conclusions: Diverse backgrounds may have influenced the results for causality assessment of ADRs by employing the WHO-UMC system. Despite the slight concordance found for the method, this result suggests potential opportunity to enrich the ADRs management by engaging multiprofessional teams in the process. Further studies should be considered to investigate the performance of methods for ADRs assessment in hospitalized patients in low- and middle-income countries.

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Worldwide, Brazil has the highest prevalence of violence and hate crimes against sexual and gender minorities (SGMs) among countries with available data. To explore the impact of this scenario, we conducted a qualitative study with 50 SGMs from Rio de Janeiro, Brazil. Among the participants, 66% screened positive for generalised anxiety disorder, 46% for major depressive disorder and 39% for PTSD. A third reported low self-esteem (32%) and one quarter low social support (26%). Experiences of interpersonal discrimination were highly prevalent (>60%), while institutional discrimination related to employment or healthcare was reported by 46% of participants. Verbal abuse is very common (80%), followed by physical assault (40%). Sexual violence is highly frequent among women. Focus groups analysis highlighted three major domains: (1) stigma and discrimination (family, friends and partners, in schools and health services, influencing social isolation); (2) violence (bullying, harassment, physical and sexual violence); and (3) mental suffering (alcohol and drug abuse, depression, suicidality, anxiety). Our findings suggest a close synergy between experiences of discrimination and violence with selected mental disorders. This complex synergy might be better addressed by longer-term individual and group-level interventions that could foster social solidarity among the different groups that comprise SGMs.

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AIMS: Adverse drug events (ADEs) can seriously compromise the safety and quality of care provided to hospitalized patients, requiring the adoption of accurate methods to monitor them. We sought to prospectively evaluate the accuracy of the triggers proposed by the Institute for Healthcare Improvement (IHI) for identifying ADEs. METHODS: A prospective study was conducted in a public university hospital in 2015 with patients over the age of 18. Triggers proposed by IHI and clinical alterations suspected to be ADEs were searched daily. The number of days in which the patient was hospitalized was considered as unit of measure to evaluate the accuracy of each trigger. RESULTS: A total of 300 patients were included in this study. Mean age was 56.3 years (standard deviation (SD) 16.0), and 154 (51.3%) were female. The frequency of patients with ADEs was 24.7% and with at least one trigger was 53.3%. From those patients who had at least one trigger, the most frequent triggers were antiemetics (57.5%) and 'abrupt medication stop' (31.8%). The sensitivity of triggers ranged from 0.3 to 11.8% and the positive predictive value ranged from 1.2 to 27.3%. Specificity and negative predictive value were greater than 86%. Most patients identified by the presence of triggers did not have ADEs (64.4%). No triggers were identified in 40 (38.5%) ADEs. CONCLUSIONS: IHI Trigger Tool did not show good accuracy in detecting ADEs in this prospective study. The adoption of combined strategies could enhance effectiveness in identifying patient safety flaws. Further discussion might contribute to improve trigger usefulness in clinical practice.

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A perda por viuvez em idade avançada é, porventura, de entre vários acontecimentos do ciclo de vida, um dos mais normativos e, simultaneamente, dos menos investigados. Com o aumento da esperança de vida, a viuvez nos adultos idosos ocorre cada vez mais tarde no ciclo de vida, é um acontecimento expectável e parece haver vantagens em conceptualizá-lo como uma importante transição psico-social que implica a reconfiguração do significado da vida e dos seus propósitos. Neste artigo abordaremos alguns dos principais modelos do processo de luto e algumas variáveis individuais e contextuais que determinam reacções associadas à perda. Faremos uma particular focalização no modelo proposto por Stroebe e Schut bem como nas suas implicações teóricas e práticas.

The loss of a spouse in old age is one of the most significant, but least investigated events in the life cycle. With increasing life expectancy, widowhood in older adults occurs increasingly later in the life cycle. It is an expectable event and may be advantageously conceptualized as a major psychosocial transition that involves the reconfiguration of the meaning of life and its purpose. The present article discusses some of the main models of the grieving process and the effect of some individual and contextual variables on reactions regarding the loss of a spouse. It focuses mainly on Stroebe and Schut dual process model as well as on its theoretical and practical implications.

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A perda por viuvez em idade avançada é, porventura, de entre vários acontecimentos do ciclo de vida, um dos mais normativos e, simultaneamente, dos menos investigados. Com o aumento da esperança de vida, a viuvez nos adultos idosos ocorre cada vez mais tarde no ciclo de vida, é um acontecimento expectável e parece haver vantagens em conceptualizá-lo como uma importante transição psico-social que implica a reconfiguração do significado da vida e dos seus propósitos. Neste artigo abordaremos alguns dos principais modelos do processo de luto e algumas variáveis individuais e contextuais que determinam reacções associadas à perda. Faremos uma particular focalização no modelo proposto por Stroebe e Schut bem como nas suas implicações teóricas e práticas.(AU)

The loss of a spouse in old age is one of the most significant, but least investigated events in the life cycle. With increasing life expectancy, widowhood in older adults occurs increasingly later in the life cycle. It is an expectable event and may be advantageously conceptualized as a major psychosocial transition that involves the reconfiguration of the meaning of life and its purpose. The present article discusses some of the main models of the grieving process and the effect of some individual and contextual variables on reactions regarding the loss of a spouse. It focuses mainly on Stroebe and Schut dual process model as well as on its theoretical and practical implications.(AU)

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OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

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OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6 percent) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4 percent) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

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Aspectos ecológicos e da biologia reprodutiva de Tropidurus oreadicus foram investigados em uma área de cerrado rupestre do Brasil Central. Foram estudados a morfometria, o uso do microhábitat, o padrão de atividade, a dieta e características da biologia reprodutiva de T. oreadicus em Cocalzinho - GO, de abril a setembro/2003. São animais sexualmente dimórficos, com os machos adultos maiores que as fêmeas. O microhábitat preferencial utilizado pela espécie foi a superfície das rochas (hábito saxícola). A espécie mostrou padrão de atividade unimodal. Foram frequentemente observados parados e expostos ao sol entre 9:00 e 10:59 horas. A alimentação desta população de T. oreadicus é baseada em formigas, larvas de inseto e besouros. Além disso, apresentaram mudanças ontogenéticas e diferenças intersexuais na dieta. Provavelmente essas diferenças estejam associadas à alocação diferenciada dos recursos para o crescimento ou produção dos gametas. A reprodução é provavelmente sazonal ocorrendo principalmente nos meses de maior pluviosidade.

Ecological aspects and of the reproductive biology of Tropidurus oreadicus was investigated in a rocky cerrado area in Central Brazil. It was studied the morphometry, the microhabitat use, the activity pattern, the diet and the characteristics of the reproductive biology of T. oreadicus in Cocalzinho-GO, from April to September/2003. They are sexually dimorphic animals, with adult males larger than females. The preferential microhabitat used by the species was the surface of the rocks (saxicolous habit). The species shows a unimodal activity pattern. It was frequently observed resting and exposed to the sun between 9:00 and 10:59 hours. This T. oreadicus population feed upon ants, larvae of insects and beetles. Besides it presented ontogenetics shift and intersexual differences in the diet. Probably these differences were associated with the differentiated allocation of the resources for the growth or production of gamete. The reproduction is probably seasonal occurring mainly during the months of higher rainfall.

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