ABSTRACT Objective: To determine the incidence of congenital hypothyroidism (CH) over a 10-year period at the Reference Service in Neonatal Screening of the state of Rio Grande do Sul (RSNS-RS). Subjects and methods: Historical cohort study including all newborns screened for CH by the RSNS-RS from January 2008 until December 2017. Data of all newborns with neonatal TSH (neoTSH; heel prick test) values ≥ 9 mIU/L were collected. According to neoTSH values, the newborns were allocated into two groups: Group 1 (G1), comprising newborns with neoTSH ≥ 9 mIU/L and serum TSH (sTSH) < 10 mIU/L, and Group 2 (G2), comprising those with neoTSH ≥ 9 mIU/L and sTSH ≥ 10 mIU/L. Results: Of 1,043,565 newborns screened, 829 (0.08%) had neoTSH values ≥ 9 mIU/L. Of these, 284 (39.3%) had sTSH values < 10 mIU/L and were allocated to the G1 group, while 439 (60.7%) had sTSH ≥ 10 mIU/L and were allocated to the G2 group, and 106 (12.7%) were considered missing data. The overall incidence of CH was 42.1 per 100,000 newborns screened (95% confidence interval [CI] 38.5-45.7/100,000) or 1:2377 screened newborns. The sensibility and specificity of neoTSH ≥ 9 mIU/L were 97% and 11%; of neoTSH 12.6 mUI/L, 73% and 85% respectively. Conclusion: In this population, the incidence of permanent and transitory CH was 1:2377 screened newborns. The neoTSH cutoff value adopted during the study period showed excellent sensibility, which matters for a screening test.

Abstract: This cross-sectional study evaluated factors associated with toothache in 12-year-old adolescents from the state of Minas Gerais in Brazil. Secondary data were collected from the SB Minas Gerais 2012 epidemiological survey. The dependent variable was toothache in the past 6 months. The independent variables were grouped into two levels: individual (sex, ethnic group, family income, periodontal condition, dental caries, dental treatment needs, and type of service used) and contextual (allocation factor, Human Development Index, Gini coefficient, gross domestic product, unemployment, illiteracy, basic sanitation, garbage collection, family income, half or a quarter of a minimum wage, primary healthcare coverage, primary oral healthcare team coverage, oral health technician, access to individual dental care, and supervised tooth brushing). A multilevel analysis was performed using the Hierarchical Linear and Nonlinear Modeling Software Program to assess the association of individual and contextual variables with toothache in the last 6 months. The prevalence of toothache in the last six months among the adolescents of this study was 19.1%. An association was found with family income (p <0.001), dental caries (p <0.001), primary oral healthcare team coverage (p = 0.015) and oral health technician (p = 0.008). Socioeconomic conditions and the most prevalent oral diseases, such as dental caries, as well as the use of public services, were related to toothache in adolescents aged 12 years. These findings reinforce the need to develop and implement public policies to address the oral health problems of this population.

Resumen El propósito de este estudio fue identificar el tamaño de muestra ideal que representa a una familia en su potencial, identificar familias superiores y, en paralelo, determinar qué disposición espacial puede tener una mayor precisión en cuanto a la selección de nuevas variedades de caña de azúcar. Para tal fin, se evaluaron cinco familias de hermanos completos, cada una con 360 individuos, en diseño de bloques al azar, con tres repeticiones y tres distancias diferentes entre las plantas en una misma hilera (50 cm, 75 cm y 100 cm). Se mantuvieron 150 cm entre hileras. Para determinar el tamaño ideal de la muestra, así como la mejor distancia para la evaluación, se adoptó el método bootstrap. Se observó que distancias de 100 cm resultaron en el mejor valor promedio de números de tallo, diámetro del tallo y peso estimado de los tallos en las heces. La separación de 75 cm entre las plantas permitió un mejor poder de discriminación entre las familias para todos los caracteres evaluados. Con 75 cm también fue posible identificar familias superiores con una muestra de 30 plantas en cada parcela y 3 repeticiones en el ensayo.

Abstract The purpose of this study was to identify the ideal sample size to represent the potential of a sugarcane family for identification of superior families, and, at the same time, determine which spatial arrangement may provide better phenotypic expression of the progeny of the sugarcane families tested. Thus, five full-sib families, each with 360 individuals, were evaluated in a randomized block design with three replications. The plants were placed in three different spatial arrangements in the row: 50 cm, 75 cm, and 100 cm between plants; with 150 cm between the rows. The bootstrap method was adopted to determine the ideal sample size, as well as the best spacing for evaluation. The 100-cm spacing provided the best mean values for number of stalks, mean stalk diameter, and estimated weight of stalks in the stool. The 75-cm spacing between plants within the row allowed better discrimi nation among the families for all the traits evaluated. At the 75-cm plant spacing, it was also possible to identify superior families with a sample of 30 plants from each plot and 3 reps in the trial.

Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37–0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07–2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11–1.40), periodontal health (OR = 1.80; 95%CI = 1.04–3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96–12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Abstract The aim of this study was to evaluate the factors associated with toothache in the adult population of Minas Gerais, Brazil. Individual data from a population sample (age 35 to 44 years) were collected from a secondary database of the SB Minas survey. Sampling was carried out by clusters and with multiple drawing stages. The eligibility criteria were to reside in areas chosen for the research, be within the age group, and accept to participate in the research. The individual variables assessed by a questionnaire and dental exams were sex, income, race/skin color, root caries, periodontal condition, need for dental treatment, and last dental appointment. The contextual variables, assessed by municipal indexes, were Human Development Index (HDI), illiteracy, unemployment, half minimum wage, quarter minimum wage, oral health team coverage, access to individual health care, and supervised tooth brushing average. The dependent variable was toothache in the past six months. A descriptive analysis was made using the Statistical Package for the Social Sciences and Hierarchical Linear and Nonlinear Modeling Software was used to perform the multilevel analyses for individual and contextual levels. An association was found between toothache and low income (OR = 2.00; 95%CI = 1.32–3.13), dental caries (OR = 1.86; 95%CI = 1.22–2.86), periodontal condition, and living on a quarter of the minimum wage or less (OR = 1.03; 95%CI = 1.00–1.08). Clinical and social factors were associated with toothache, reinforcing the need to improve public polices in oral health focused on the adult population.

Resumo O objetivo deste artigo é investigar as morbidades relacionadas a medicamentos (MRM), os fatores e as causas detectados em pacientes que buscam o serviço de emergência de hospital universitário do sul do Brasil. A coleta de dados baseou-se na aplicação de um questionário aos pacientes com idade mínima de 18 anos, durante o período de outubro de 2013 a março de 2014, e na análise do prontuário eletrônico. Os casos foram avaliados para definir se era um caso de MRM e para estabelecer as suas possíveis causas. A evitabilidade da MRM foi verificada com base em critérios previamente estabelecidos na literatura. No total foram entrevistados 535 pacientes e a frequência de MRM foi de 14,6%. Aproximadamente, 45% das MRMs foram relacionadas com a segurança no uso de medicamentos e cerca de 50% apresentou como possível causa questões relacionadas ao usuário. Houve necessidade de internação em 44,8% dos casos de MRM; 62,7% dos casos foram considerados evitáveis. Presença de doença crônica e utilização de medicamentos potencialmente perigosos e de baixo índice terapêutico foram consideradas fatores associados ao desenvolvimento de MRM.

Abstract This article aims to investigate the morbidities related to medications, their risk factors and causes detected in patients who seek the Hospital Emergency Service of a University in the South of Brazil. Data collection was based on application of a questionnaire to patients of a minimum age of 18 years, that signing the Term of Free and Informed Consent (TFIC), during the period from October 2013 to March 2014, and analysis of electronic record charts. Cases were evaluated by pharmacists and a doctor to define whether it was a case of medication related morbidity (MRM) and to establish its possible causes. Avoidability of MRM was verified based on criteria previously established in the literature. In total 535 patients were interviewed, and the frequency of MRM was 14.6%, Approximately 45% of MRMs were related to safety in the use of medications, and approximately 50% presented user-related questions as the possible cause. Hospitalization was required in 44.8% of MRM cases; 62.7% of cases were considered avoidable. Presence of chronic disease and use of potentially dangerous medication and low therapeutic index were considered independent factors associated with development of MRM, according to statistical analysis.

Resumo O objetivo deste artigo é investigar as morbidades relacionadas a medicamentos (MRM), os fatores e as causas detectados em pacientes que buscam o serviço de emergência de hospital universitário do sul do Brasil. A coleta de dados baseou-se na aplicação de um questionário aos pacientes com idade mínima de 18 anos, durante o período de outubro de 2013 a março de 2014, e na análise do prontuário eletrônico. Os casos foram avaliados para definir se era um caso de MRM e para estabelecer as suas possíveis causas. A evitabilidade da MRM foi verificada com base em critérios previamente estabelecidos na literatura. No total foram entrevistados 535 pacientes e a frequência de MRM foi de 14,6%. Aproximadamente, 45% das MRMs foram relacionadas com a segurança no uso de medicamentos e cerca de 50% apresentou como possível causa questões relacionadas ao usuário. Houve necessidade de internação em 44,8% dos casos de MRM; 62,7% dos casos foram considerados evitáveis. Presença de doença crônica e utilização de medicamentos potencialmente perigosos e de baixo índice terapêutico foram consideradas fatores associados ao desenvolvimento de MRM.

Abstract This article aims to investigate the morbidities related to medications, their risk factors and causes detected in patients who seek the Hospital Emergency Service of a University in the South of Brazil. Data collection was based on application of a questionnaire to patients of a minimum age of 18 years, that signing the Term of Free and Informed Consent (TFIC), during the period from October 2013 to March 2014, and analysis of electronic record charts. Cases were evaluated by pharmacists and a doctor to define whether it was a case of medication related morbidity (MRM) and to establish its possible causes. Avoidability of MRM was verified based on criteria previously established in the literature. In total 535 patients were interviewed, and the frequency of MRM was 14.6%, Approximately 45% of MRMs were related to safety in the use of medications, and approximately 50% presented user-related questions as the possible cause. Hospitalization was required in 44.8% of MRM cases; 62.7% of cases were considered avoidable. Presence of chronic disease and use of potentially dangerous medication and low therapeutic index were considered independent factors associated with development of MRM, according to statistical analysis.

Objective: To assess the frequency and types of drug-related problems (DRPs) in patients seeking emergency care in a teaching hospital in southern Brazil and to identify the possible causes and drugs involved in these problems. Method: A cross-sectional study was performed, using a structured questionnaire for data collection. Multivariate logistic regression was used to control for possible confounding factors and to establish an independent association between the presence of DRPs and the amount of medication, patient's age and their educational level. Results: A total of 350 patients were interviewed. The frequency of DRPs was 31.6%. Quantitative ineffectiveness was observed in 30.9% of DRPs and the main cause of the DRP was an inadequate dosing regimen. Sixty-six DRPs (53.7%) were caused by the health system or the health professionals. Factors independently influencing the development of DRPs were educational level and the number of drugs being taken. Conclusions: Our data suggest that one-third of the patients attending the emergency room of our hospital had a drug-related problem, highlighting the importance of considering drugs as a possible cause of health problems and the need for their more rational use.

Objetivo: Evaluar la frecuencia y el tipo de problemas relacionados con medicamentos que presentan los pacientes que acuden al servicio de urgencias en un hospital universitario del sur de Brasil, e identificar las posibles causas y los fármacos involucrados. Método: La investigación siguió el modelo de estudio transversal, con una encuesta estructurada para la recogida de los datos. Se empleó el análisis de regresión logística múltiple para controlar posibles factores de confusión y establecer una asociación independiente entre la presencia de problemas relacionados con medicamentos y el número de éstos, la edad y el nivel educativo. Resultados: Se entrevistaron 350 pacientes y la frecuencia de problemas relacionados con medicamentos fue del 31,6%. La inefectividad cuantitativa se observó en el 30,9% de los casos. La principal causa de los problemas fue el régimen de dosificación inadecuado. El sistema de salud o los profesionales de la salud se identificaron como responsables en 66 casos (53,7%). El nivel educativo y el número de fármacos contribuyeron de forma independiente a la aparición de los problemas. Conclusión: Los datos sugieren que un tercio de los pacientes que buscan atención en el servicio de urgencias del hospital donde se ha realizado el estudio lo hicieron por problemas relacionados con medicamentos, lo que refuerza la importancia de considerar a los fármacos como una posible causa de problemas de salud y la necesidad de promover un uso más racional de ellos.

Objective: To assess the frequency and types of drug-related problems (DRPs) in patients seeking emergency care in a teaching hospital in southern Brazil and to identify the possible causes and drugs involved in these problems. Method: A cross-sectional study was performed, using a structured questionnaire for data collection. Multivariate logistic regression was used to control for possible confounding factors and to establish an independent association between the presence of DRPs and the amount of medication, patient's age and their educational level. Results: A total of 350 patients were interviewed. The frequency of DRPs was 31.6%. Quantitative ineffectiveness was observed in 30.9% of DRPs and the main cause of the DRP was an inadequate dosing regimen. Sixty-six DRPs (53.7%) were caused by the health system or the health professionals. Factors independently influencing the development of DRPs were educational level and the number of drugs being taken. Conclusions: Our data suggest that one-third of the patients attending the emergency room of our hospital had a drug-related problem, highlighting the importance of considering drugs as a possible cause of health problems and the need for their more rational use.

Objetivo: Evaluar la frecuencia y el tipo de problemas relacionados con medicamentos que presentan los pacientes que acuden al servicio de urgencias en un hospital universitario del sur de Brasil, e identificar las posibles causas y los fármacos involucrados. Método: La investigación siguió el modelo de estudio transversal, con una encuesta estructurada para la recogida de los datos. Se empleó el análisis de regresión logística múltiple para controlar posibles factores de confusión y establecer una asociación independiente entre la presencia de problemas relacionados con medicamentos y el número de éstos, la edad y el nivel educativo. Resultados: Se entrevistaron 350 pacientes y la frecuencia de problemas relacionados con medicamentos fue del 31,6%. La inefectividad cuantitativa se observó en el 30,9% de los casos. La principal causa de los problemas fue el régimen de dosificación inadecuado. El sistema de salud o los profesionales de la salud se identificaron como responsables en 66 casos (53,7%). El nivel educativo y el número de fármacos contribuyeron de forma independiente a la aparición de los problemas. Conclusión: Los datos sugieren que un tercio de los pacientes que buscan atención en el servicio de urgencias del hospital donde se ha realizado el estudio lo hicieron por problemas relacionados con medicamentos, lo que refuerza la importancia de considerar a los fármacos como una posible causa de problemas de salud y la necesidad de promover un uso más racional de ellos.

O objetivo deste trabalho foi avaliar a utilização de fitoterápicos a base de saw palmetto na terapia sintomática da hiperplasia benigna da próstata (HBP) por médicos urologistas da cidade de Porto Alegre. Consistiu em um estudo transversal, exploratório, por meio de entrevista semi-estruturada aplicada a urologistas de Porto Alegre. A amostra foi obtida utilizando catálogo do plano de saúde UNIMED- Porto Alegre. A randomização foi realizada através de sistemática aleatória, sendo sorteados trinta e cinco médicos, dos quais 21 foram selecionados para realização da pesquisa através de questionário. Todos os urologistas entrevistados avaliam e tratam pacientes com hiperplasia benigna da próstata. O saw palmetto não foi citado como terapia medicamentosa de 1ª ou 2ª escolhas no tratamento da HBP. O grupo farmacológico mais freqüentemente utilizado para o tratamento da HBP foi ∝-bloqueadores. Mais da metade dos médicos entrevistados relata ter conhecimento sobre a utilização do saw palmetto, principalmente através de artigos científicos. Os resultados indicam que o saw palmetto não é prescrito pelos urologistas em Porto Alegre, todavia a maior parte destes profissionais tem conhecimento sobre sua utilização.

The aim of this work was to assess the prescription of saw palmetto phytomedicines for improving symptoms of benign prostatic hyperplasia (BPH) by urologists in Porto Alegre (Brazil). The study was transversal and exploratory consisting of a semi-structured interview with urologists. The sample was obtained from the UNIMED Catalog - Porto Alegre (Brazil). The randomization was made by chance, being selected thirty-five physicians. The first twenty-one who accepted to participate were interviewed. All the interviewed urologists treat patients with benign prostatic hyperplasia. The saw palmetto was not mentioned as the first or second choice for treating BPH. The α-blockers were the most mentioned pharmacological group. However, more than half of urologists have heard about the use of saw palmetto and most of them gathered the information in scientific papers. The results indicate that saw palmetto is not prescribed for urologists in Porto Alegre, although most of them have knowledge about this phytomedicine.

Objectives: To develop and study the validity of an instrument for evaluation of Printed Education Materials (PEM); to evaluate the use of acceptability indices; to identify possible influences of professional aspects. Methods: An instrument for PEM evaluation was developed which included tree steps: domain identification, item generation and instrument design. A reading to easy PEM was developed for education of patient with systemic hypertension and its treatment with hydrochlorothiazide. Construct validity was measured based on previously established errors purposively introduced into the PEM, which served as extreme groups. An acceptability index was applied taking into account the rate of professionals who should approve each item. Participants were 10 physicians (9 men) and 5 nurses (all women). Results: Many professionals identified intentional errors of crude character. Few participants identified errors that needed more careful evaluation, and no one detected the intentional error that required literature analysis. Physicians considered as acceptable 95.8% of the items of the PEM, and nurses 29.2%. The differences between the scoring were statistically significant in 27% of the items. In the overall evaluation, 66.6% were considered as acceptable. The analysis of each item revealed a behavioral pattern for each professional group. Conclusions: The use of instruments for evaluation of printed education materials is required and may improve the quality of the PEM available for the patients. Not always are the acceptability indices totally correct or represent high quality of information. The professional experience, the practice pattern, and perhaps the gendre of the reviewers may influence their evaluation. An analysis of the PEM by professionals in communication, in drug information, and patients should be carried out to improve the quality of the proposed material.

Objetivos: Desarrollar y estudiar la validez de un instrumento para la evaluación del material educativo impreso (MEI); evaluar el uso de los índices de aceptabilidad; identificar las posibles influencias de los aspectos profesionales. Métodos: Se desarrolló un instrumento para evaluación del MEI en tres pasos: identificación de dominios, generación de ítems y diseño del instrumento. Se desarrolló un MEI fácil de leer para la educación de pacientes con hipertensión sistémica y su tratamiento con hidroclorotiazida. Se midió la validez del instrumento mediante los errores previamente introducidos a propósito en el MEI, lo que sirvió de grupo extremo. Se aplicó un índice de aceptabilidad teniendo en cuenta la tasa de profesionales que tenía que aprobar cada ítem. Participaron 10 médicos (9 hombres) y 5 enfermeras (todas mujeres). Resultados: Muchos profesionales identificaron los errores intencionales de carácter crudo. Pocos participantes identificaron los errores que necesitaban una evaluación más cuidadosa, y ninguno identificó el error intencional que requería análisis de la literatura. Los médicos consideraron aceptable el 95,8% de los ítems del MEI y las enfermeras el 29,2%. Las diferencias de puntuación fueron estadísticamente significativas en el 27% de los ítems. En la evaluación total, el 66,6% fue considerado aceptable. El análisis de cada ítem reveló un modelo de comportamiento para cada grupo de profesionales. Conclusiones: Es necesario el uso de instrumentos para la evaluación de materiales educativos impresos y puede mejorar la calidad de los MEI disponibles para los pacientes. Los índices de aceptabilidad no son siempre totalmente correctos ni representan la calida de la información. La experiencia profesional, el modelo de ejercicio, y quizás el género de los revisores puede influir en la evaluación. Debería realizarse un análisis de los MEI por profesionales de comunicación, de la información sobre medicamentos y por pacientes para mejorar la calidad del material propuesto.

OBJETIVO: Uma das principais preocupações mundiais quanto ao uso de medicamentos está relacionada à utilização de antimicrobianos. Nos países em desenvolvimento, poucos recursos são empregados na monitorização de ações sobre o uso racional de medicamentos. São, também, limitados os dados sobre o uso daqueles agentes em hospitais. Assim realizou-se estudo para determinar os padrões de uso de antimicrobianos em hospital num período de sete anos (1990 a 1996). MÉTODOS: O estudo foi realizado em um hospital universitário, terciário, com 690 leitos, localizado em Porto Alegre, RS. Os registros hospitalares foram revisados visando identificar o consumo de antimicrobianos por pacientes internados, sendo os resultados expressos em dose diária definida (DDD) por 100 leitos-dia. A análise de conglomerados foi realizada para determinar as tendências de consumo dos agentes individuais. RESULTADOS: O consumo de antimicrobianos aumentou com o correr dos anos, passando de 83,8 DDD por 100 leitos-dia, em 1990, a 124,58 DDD por 100 leitos-dia em 1996. O grupo de medicamentos mais utilizado foi de penicilinas (39,6%), seguido por cefalosporinas (15,0%), aminoglicosídeos (14,4%), sulfonamidas (12,8%), glicopeptídeos (3,6%) e lincosaminas (3,1%). Estes grupos foram responsáveis por cerca de 90% do consumo. A análise de conglomerados do uso de antimicrobianos mostrou 13 grupos principais de tendência de consumo. CONCLUSÕES: O consumo de antimicrobianos cresceu no período avaliado, sendo expressivamente mais alto em comparação com o relatado em outros estudos. Quando novas alternativas terapêuticas foram disponibilizadas no hospital, o uso de medicamentos antigos decresceu e, em alguns casos, existiu manutenção dos níveis de consumo. Quando foi realizada intervenção específica como uma campanha para o uso correto de cefoxitina, as mudanças esperadas ocorreram.

OBJECTIVE: There is a worldwide concern about rational drug use, more specifically related to antimicrobial utilization. In developing countries, few resources are intended for monitoring on rational drug use. Moreover, there are limited data on the use of antimicrobial agents in hospitals. A study was carried out to describe patterns of use of antimicrobial agents over a 7-year period (1990 to 1996). METHODS: The study was conducted in a 690-bed tertiary care university hospital in Porto Alegre, Brazil. Hospital records were reviewed to identify inpatient antibiotics use. Results were expressed in defined daily dose per 100-beds/day. Cluster analysis was performed to determine the trends in use of individual agents. RESULTS: Antimicrobials use increased year after year, from 83.8 DDD per 100 beds-day in 1990 to 124.58 DDD per 100 beds-day in 1996. Penicillins were the drug group mostly used (39.6%), followed by cephalosporins (15.0%), aminoglycosides (14.4%), sulfonamides (12.8%), glycopeptides (3.6%), and lincosamides (3.1%). These groups were responsible for around 90% of all agents used. The use of antimicrobial agents was divided into thirteen groups based on cluster analysis. CONCLUSIONS: Antimicrobial use increased dramatically in the study period, and this increase was significantly higher when compared to other studies. When newer alternative agents became available in the hospital, the use of already existing drugs decreased and in some cases remained relatively stable. After implementing specific interventions, such as an effort for the correct use of cefoxitin, the expected changes in use were observed.

OBJETIVO: Uma das principais preocupações mundiais quanto ao uso de medicamentos está relacionada à utilização de antimicrobianos. Nos países em desenvolvimento, poucos recursos são empregados na monitorização de ações sobre o uso racional de medicamentos. São, também, limitados os dados sobre o uso daqueles agentes em hospitais. Assim realizou-se estudo para determinar os padrões de uso de antimicrobianos em hospital num período de sete anos (1990 a 1996). MÉTODOS: O estudo foi realizado em um hospital universitário, terciário, com 690 leitos, localizado em Porto Alegre, RS. Os registros hospitalares foram revisados visando identificar o consumo de antimicrobianos por pacientes internados, sendo os resultados expressos em dose diária definida (DDD) por 100 leitos-dia. A análise de conglomerados foi realizada para determinar as tendências de consumo dos agentes individuais. RESULTADOS: O consumo de antimicrobianos aumentou com o correr dos anos, passando de 83,8 DDD por 100 leitos-dia, em 1990, a 124,58 DDD por 100 leitos-dia em 1996. O grupo de medicamentos mais utilizado foi de penicilinas (39,6%), seguido por cefalosporinas (15,0%), aminoglicosídeos (14,4%), sulfonamidas (12,8%), glicopeptídeos (3,6%) e lincosaminas (3,1%). Estes grupos foram responsáveis por cerca de 90% do consumo. A análise de conglomerados do uso de antimicrobianos mostrou 13 grupos principais de tendência de consumo. CONCLUSÕES: O consumo de antimicrobianos cresceu no período avaliado, sendo expressivamente mais alto em comparação com o relatado em outros estudos. Quando novas alternativas terapêuticas foram disponibilizadas no hospital, o uso de medicamentos antigos decresceu e, em alguns casos, existiu manutenção dos níveis de consumo. Quando foi realizada intervenção específica como uma campanha para o uso correto de cefoxitina, as mudanças esperadas ocorreram.

OBJECTIVE: There is a worldwide concern about rational drug use, more specifically related to antimicrobial utilization. In developing countries, few resources are intended for monitoring on rational drug use. Moreover, there are limited data on the use of antimicrobial agents in hospitals. A study was carried out to describe patterns of use of antimicrobial agents over a 7-year period (1990 to 1996). METHODS: The study was conducted in a 690-bed tertiary care university hospital in Porto Alegre, Brazil. Hospital records were reviewed to identify inpatient antibiotics use. Results were expressed in defined daily dose per 100-beds/day. Cluster analysis was performed to determine the trends in use of individual agents. RESULTS: Antimicrobials use increased year after year, from 83.8 DDD per 100 beds-day in 1990 to 124.58 DDD per 100 beds-day in 1996. Penicillins were the drug group mostly used (39.6%), followed by cephalosporins (15.0%), aminoglycosides (14.4%), sulfonamides (12.8%), glycopeptides (3.6%), and lincosamides (3.1%). These groups were responsible for around 90% of all agents used. The use of antimicrobial agents was divided into thirteen groups based on cluster analysis. CONCLUSIONS: Antimicrobial use increased dramatically in the study period, and this increase was significantly higher when compared to other studies. When newer alternative agents became available in the hospital, the use of already existing drugs decreased and in some cases remained relatively stable. After implementing specific interventions, such as an effort for the correct use of cefoxitin, the expected changes in use were observed.