Introduction Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. Methods A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine ( Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases ( Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology ( Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. Results Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. Conclusion So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

RESUMO: Introdução: O letramento em saúde é avaliado em diversos países por instrumentos adaptados ao idioma e à cultura locais. O objetivo deste trabalho foi realizar a adaptação transcultural para a língua portuguesa do Brasil e validar o Teste de Letramento em Saúde (TLS), a partir do Test of Functional Health Literacy in Adults (TOFHLA). Método: O TLS, traduzido e adaptado à realidade brasileira a partir do original em inglês, foi administrado a 302 usuários de uma clínica universitária em Santa Catarina, entre setembro e outubro de 2013. Coeficiente alfa de Cronbach, correlação de Spearman e análise de variância foram utilizados para verificar a consistência interna, a correlação entre suas partes e a associação entre as variáveis sociodemográficas e a pontuação do teste, respectivamente. Resultados: A pontuação média do teste foi de 72,2, e 54,6% dos participantes apresentaram letramento em saúde adequado, 19,2%, limitado e 26,2%, inadequado. A pontuação média do teste diminuiu com o aumento da idade e aumentou com a elevação da escolaridade. Não houve diferença significativa para as demais características sociodemográficas. O coeficiente alfa de Cronbach foi de 0,953. Para a parte numérica e para os trechos de leitura, os coeficientes apresentados foram de 0,808 e 0,951, respectivamente. Todos os trechos correlacionaram-se positiva e significativamente com o teste, e também entre si. Conclusão: A validação do TLS oferece um instrumento para a determinação do nível de letramento em adultos brasileiros.

Utilização de medicamentos entre crianças de zero a seis anos: um estudo de base populacional no sul do BrasilDrug use among children between zero and six years old: a population baseline study in the south of Brazil

To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. Methods We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. Results Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged �65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001).

Objective To evaluate the labeling preferences of medication users and characterize their perceptions of the comprehensibility and readability of medication labels. Methods We conducted a population-based cross-sectional study of medication users aged 18 years or older in 10 Brazilian capital cities. Perceptions of the comprehensibility and readability of medication labels in relation to sociodemographic characteristics were evaluated by Poisson regression models with robust variance. Labeling preferences were assessed through questions addressing possible improvements and through the use of digitally simulated packages. Results Of 6,255 medication users interviewed, more than half found it difficult or very difficult to read (50.8%) and/or understand (52.0%) medication labels. Difficulties were more pronounced for participants aged 40 years or older, with lower levels of education, and non-whites. Increasing the font size (93.7%), describing the indications for use (95.9%) and contraindications (95.6%) on the label, and highlighting the expiration date (96.3%) were the most widely accepted improvements. In the evaluation of simulated packages, users preferred factors that improved readability, such as increased font size, use of graphic elements and color to highlight the concentration of the active ingredient, and contrast between the font color and background. The new simulated package design, with increased font size, color to highlight the concentration and contrast between the font color and background, was preferred over the standard design by 77.0% of participants. Conclusion Based on users’ perceptions, increased font size and use of graphic elements and color to emphasize critical information, such as expiration date and concentration, are factors that contribute to making medication labels clearer to users. Pharmaceutical industries and policy makers should consider these items when developing labels and defining policies on this issue.

ABSTRACT:Objective: To assess the agreement between three recall periods for self-reported drug use using a 24-hour recall period as reference. Methods: Participants were allocated into three groups with different recall periods of 7, 14 and 30 days and were interviewed at two different times. A 24-hour recall questionnaire was answered during the first interview, and a questionnaire on drug use over the different recall periods tested was answered during the second interview. The agreement between the questionnaires was evaluated using percent agreement and kappa. Results: For continuous drugs, percent agreement varied between 92 and 99% and kappa varied between 0.71 and 0.97 for three periods tested. For drugs of occasional use, percent agreement varied between 63 and 81% and kappa varied between 0.27 and 0.52. The prevalence of drugs, particularly those of occasional use, increases with time. Conclusions: The high level of agreement between the three recall periods suggests that all of them are valid for the investigation of drugs of continuous use.

Introduction: The written information on medicines has been acknowledged as an important tool for health education. Objective: To analyze the use and understanding of medicine package inserts by users and assess sociodemographic and medical factors associated with their comprehension. Method: Data in this analysis are part of the PNAUM National Survey - a cross-sectional population-based study conducted in Brazil. Descriptive statistics and the Pearson χ2 tests were performed to compare proportions between sociodemographic and medical characteristics, as well as use and understanding of medicine package inserts. Results: A total of 28.427 individuals responded to questions related to medicine package inserts. From these, 59.6% (95%CI 57.7 - 61.5) said they usually read the inserts, and 98.4% (95%CI 98.0 - 98.8) considered them necessary. Among people who read the medicine package inserts, more than half indicated difficulties with legibility (57.4%; 95%CI 55,2 - 59,6) and readability (54.1%; 95%CI 52.1 - 56.1). People from a lower education level reported greater difficulty in understanding them. Conclusion: The larger portion of the population usually read medicine package inserts. Nevertheless, people have difficulty in reading and understanding them.

The aim of the study was to evaluate the effectiveness of interventions designed to reduce problems with readability and comprehensibility in drug labels.Methods: A systematic review of observational and experimental studies was conducted using MEDLINE (via PubMed), Embase, and Scopus databases. Two independent reviewers selected articles and collected data about study design, interventions, and outcomes.Results: Of 1786 studies screened, 17 were included in this systematic review. The main findings were described according to the type of intervention in the drug package or label: color-coded labels (7 studies); changes in information layout (5 studies); changes in font size (3 studies); and interventions involving look-alike/sound-alike (LASA) drugs (3 studies). Color changes were important both for healthcare professionals to improve safety in hospital practice and for medication users to differentiate between the types of insulin. Layout changes were effective and included highlighting key information, such as medication name, dose, and instructions. Increased font size yielded good results in the recognition and identification of medications mainly for the population with impaired vision. This review was limited by the heterogeneity of interventions and populations studied, as well as the small number of high-quality studies, which prevented meta-analysis across any one intervention or outcome. Conclusions:All studies reported positive results for the proposed interventions. In the case of LASA drug names, the use of resources beyond Tall Man lettering (such as color and highlighting) reduced recognition errors, which may contribute to the development of new strategies to improve safety in the use of LASA drugs.