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The objective was to describe the demographic and sexual characteristics of clients attending a Sexual Health Clinic for emergency contraception (EC). Information about women attending the Parramatta Sexual Health Clinic (PSHC) who received EC between January 1999 and July 2002 was derived from the clinic database. Age-matched controls were randomly selected. Univariate and logistic regression analysis was performed to establish which factors were associated with use of EC. Two hundred and sixty-seven women requesting EC, and an equal number of controls, were studied. Factors that were independently associated with EC use were being a student, (OR=1.7 [95% CI 1.02-2.69]) and having a regular sexual partner (OR=2.3 [95% CI 1.14-4.73]). Women requiring EC were significantly less likely to have had a sexually transmitted infection (STI) (OR=0.3 [95% CI 0.16-0.60]) or a previous pregnancy (OR=0.2 [95% CI 0.09-0.67]) than controls. We concluded that users of EC are at low-risk for STIs, but need counselling about safer sex. [ABSTRACT FROM AUTHOR]

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of prenatal diagnosis. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General Interest; 3 Normal Fetal Development; 4 Gametogenesis and Pre-implantation Diagnosis; 5 First Trimester Diagnosis; 6 Second Trimester Diagnosis; 7 Fetal Diagnosis by Ultrasound and Other Imaging; 8 Maternal Screening; 9 Screening for Carriers of Genetic Abnormality; 10 Technological Developments; 11 Confined Placental Mosaicism and Uniparental Disomy; 12 Molecular Cytogenetics; 13 Fetal Cells in Maternal Circulation; 14 Fetal Therapy; 15 Psychosocial Aspects; 16 Epidemiology and Environmental Factors; 17 Developmental Pathology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted [ABSTRACT FROM AUTHOR]

The Consensus Statement on Emergency Contraception recommends the collection of data within each country in order to facilitate the use of emergency contraception; this has led us to design a prospective observational study with a view to identifying the reality in Spain regarding emergency contraception. We have conducted a national observational study including 4390 cases of requests for the prescription of emergency contraception in the entire Spanish territory, collected by means of a questionnaire completed by the person prescribing the emergency contraception between April and December 2002. The mean age of the women requesting emergency contraception was 23 years, with 35.1% of these being adolescents and 71% of them under the age of 24 years. Of the applicants, 40% reported that they were students and 31.8% were working. The educational level of studies was medium or higher. Emergency contraception had previously been used by 19.8% of the women and, of these, 75% used it on a single occasion. The main reason put forward for requesting emergency contraception was condom breakage (68.7%), followed by the failure to use any contraceptive measures whatsoever (15.4%). The Spanish women requesting emergency contraception are young students and resort to this method on one occasion. [ABSTRACT FROM AUTHOR]

Despite the increasing adoption of laparoscopic donor nephrectomy, no study has examined donor perceptions following this procedure. In particular, it has been tacitly assumed that a less invasive procedure might in itself provide a more satisfactory donor experience. The present study reviews the experience of donors undergoing laparoscopic nephrectomy, and examines the extent to which contemporary management practice addresses issues relevant to consumerism. Forty-two donors participated in a structured telephone interview, and 33 (79%) returned a written questionnaire. Coming through the survey was a strong sense of commitment to donation, and most respondents were satisfied with the experience. The main criticisms related to hotel services, the duration of the preoperative investigations, the perceived quality of nursing care on the general wards, medical communication and the duration of postoperative follow up. The self-reported time to meet recovery goals was extremely broad. Considering the nature of criticisms offered by the respondents, it is concluded that the expectations of donors as health-care consumers will only be met through modification of existing protocols. [ABSTRACT FROM AUTHOR]

Background: Inverted papilloma involving the temporal bone is an extremely rare occurrence. Reports in the literature suggest a higher recurrence rate and association with squamous cell carcinoma in Schneiderian-type papillomas of the middle ear than in sinonasal Schneiderian-type papillomas. Objectives: To investigate the expression of apoptosis-related proteins, markers of cell proliferation activity, and sex hormone receptors in temporal bone inverted papillomas and to compare this entity with sinonasal papillomas. Design and Subjects: We investigated 2 rare cases of inverted papilloma of the temporal bone and a control group of 6 cases of sinonasal inverted papilloma. The expression of p53, Mib-1, p27, and progesterone and estrogen receptors was determined. Results: In the 2 cases of temporal bone inverted papilloma, p53 expression was 43.75% and 4.92%; p27 expression was higher in temporal bone inverted papilloma (82.45% and 70.53%) than in the sinonasal inverted papilloma group. One of our 2 cases of temporal bone Schneiderian-type papilloma was positive for progesterone receptor. Conclusions: The expression of progesterone receptor in 1 of our 2 cases and in the only other case reported in the literature may imply some degree of hormonal dependence of temporal bone inverted papilloma. Our analysis of the expression of apoptosis-related proteins, markers of cell proliferation activity, and sex hormone receptors does not allow us to demonstrate that temporal bone and sinonasal inverted papilloma are different pathological entities. [ABSTRACT FROM AUTHOR]

There is debate about the role of human papillomavirus in the induction of rare inverted papillomas involving the temporal bone and in the higher recurrence rates and association with squamous cell carcinoma of temporal bone inverted papillomas compared with sinonasal inverted papillomas. An exhaustive review of the literature revealed that eight cases of temporal bone inverted papilloma have been analysed for human papillomavirus. None of the cases studied with in situ hybridization proved positive. Only one case was found to be positive using the more sensitive polymerase chain reaction assay. We present the first two cases of Schneiderian-type papilloma involving the temporal bone to be analysed by type-specific polymerase chain reaction methods for human papillomavirus. [ABSTRACT FROM AUTHOR]

This review updates the evidence that the human papillomavirus (HPV) is involved in the development of benign and malignant sinonasal lesions. Since the early 1980s, when evidence was provided on the possible involvement of HPV in the aetiology of both benign respiratory papillomas and squamous cell carcinomas, a substantial number of studies have explored this issue. To date, 33.3% of sinonasal papillomas and 21.7% of sinonasal carcinomas analysed have been shown to be positive for HPV. Many elements of the data parallel the observations made in HPV lesions at other mucosal sites, such as malignant transformation and frequent recurrence after radical treatment; the fact that low risk HPV types 6 and 11 are usually confined to benign lesions, whereas the reverse is true for the oncogenic HPV types 16 and 18; and the presence of squamo-columnar junctions and squamous cell metaplasia in the sinonasal system. The discrepancies reported by several studies might result in part from technical reasons, but it is also possible that sinonasal lesions have a heterogeneous aetiology (HPV related and non-related) and/or that some novel (yet unidentified) HPV types exist in these lesions, which are detected by some studies but not by others. [ABSTRACT FROM AUTHOR]

The structures of the Somma-Vesuvius volcanic complex are modelled on the basis of the interpretation of gravity anomalies obtained from data available in the literature and acquired along a new profile along the coastline from Naples to Castellammare di Stabia. In order to highlight the contribution of shallow crustal structures, the residual anomalies were considered. A marked gravity low was recognised in the eastern sector of Vesuvius. Furthermore data interpretation was carried out along two profiles centred on the low gravity region in question: a first profile crossing the Vesuvius crater in direction WNW-ESE, and a second one in NNE-SSW direction. The 2 ½ D model obtained reveals a crustal structure characterised by sediments of 2.3 Mg/m3 density, overlying bedrock with a density of 2.6 Mg/m3. Near the volcanic system the model becomes more complex due to the presence of light sediments with a density of 2.1 Mg/m3 overlying a body with a density of 2.4 Mg/m3 which extends into depth. The latter is thought to be closely related to the zone of magma ascent developed along the volcanic axis. Along the coast the volcanic component is reduced and the model shows that the layer with a density of 2.3 Mg/m3 ranges in thickness from 0 to about 3500 m. An additional body between 1500 and 3000 m with a density of 2.4 Mg/m3 was considered in order to account for the slight rise in the residual anomaly in the area in the vicinity of Mt. Vesuvius. The analysis of the gravity anomaly pattern coincides with the complex system of faults and fractures intersecting the carbonate basement and the volcanic area in question, which developed as a consequence of extensional processes at the continental edge of the Italian Peninsula due to the opening of the Tyrrhenian basin. This extensional tectonics has created favourable conditions for the collapse of the south-western slope of Mt. Vesuvius and the development of eruptive vents and cracks on its flanks. [ABSTRACT FROM AUTHOR]

The effect of food on pharmacokinetic properties of drugs is a commonly observed occurrence affecting about 40% of orally administered drugs. Within the pharmaceutical industry, significant resources are invested to predict and characterize a clinically relevant food effect. Here, the predictive performance of physiologically based pharmacokinetic (PBPK) food effect models was assessed via de novo mechanistic absorption models for 30 compounds using controlled, pre-defined in vitro, and modeling methodology. Compounds for which absorption was known to be limited by intestinal transporters were excluded in this analysis. A decision tree for model verification and optimization was followed, leading to high, moderate, or low food effect prediction confidence. High (within 0.8- to 1.25-fold) to moderate confidence (within 0.5- to 2-fold) was achieved for most of the compounds (15 and 8, respectively). While for 7 compounds, prediction confidence was found to be low (> 2-fold). There was no clear difference in prediction success for positive or negative food effects and no clear relationship to the BCS category of tested drug molecules. However, an association could be demonstrated when the food effect was mainly related to changes in the gastrointestinal luminal fluids or physiology, including fluid volume, motility, pH, micellar entrapment, and bile salts. Considering these findings, it is recommended that appropriately verified mechanistic PBPK modeling can be leveraged with high to moderate confidence as a key approach to predicting potential food effect, especially related to mechanisms highlighted here. [ABSTRACT FROM AUTHOR]

Excipient concentrations in the gastrointestinal luminal fluids can influence the absorption of poorly water-soluble drugs when dosed orally with solubilizing excipients, and poorly permeable drugs when dosed with permeation-enhancing excipients. This report examines how dose volume, excipient dose level, volume of water chaser, and gastric fluid volume influence luminal excipient concentrations, and how these could differ from preclinical species and humans. Gastric concentrations of excipient resulting immediately after dosing typical formulations containing a solubilizing excipient are estimated in preclinical species and humans. Examples of the effects of excipient dose and dose volume on drug absorption are illustrated using cases in the literature. When estimating human absorption potential of poorly soluble drug candidates from solubility data, in vitro dissolution models, physiologically based pharmacokinetic models, or preclinical pharmacokinetic data, it may be useful to consider the dose volume and excipient dose, and it is recommended to include estimated luminal excipient concentrations as a factor. There is a need for further studies collecting data on excipient concentrations in luminal fluids and evaluating the effects on drug absorption. [ABSTRACT FROM AUTHOR]

Dissolution testing and solubility determinations in different biorelevant media have gained considerable interest in the pharmaceutical industry from early-stage development of new products to forecasting bioequivalence. Among all biorelevant fluids, the preparation of fed-state simulated gastric fluid (FeSSGF) and handling of samples from dissolution/solubility testing in FeSSGF is considered to be relatively challenging. Challenges include maintaining the stability of FeSSGF medium upon sampling, filtration, and mitigating analytical interference of excipients and milk components. To overcome these challenges, standard and uniform working practices are required that are not only helpful in preparation of stable FeSSGF but also serve as a harmonizing guide for the collection of dissolution/solubility samples and their subsequent processing (i.e., handling and assay). The optimization of sample preparation methodology is crucial to reduce method-related variance by ensuring specificity, robustness, and reproducibility with acceptable recovery of the analytes. The sample preparation methodology includes a combination of techniques including filtration, solvent treatment, and centrifugation to remove the interfering media-related components and excipients from the analyte. The analytes of interest were chromatographically separated from the interfering analytes to quantify the drug concentration using the new high-performance liquid chromatography methods with ultraviolet detection. The methods developed allow rapid sample preparation, acceptable specificity, reproducible recoveries (greater than 95% of label claim), and quantification of study drugs (ibuprofen and ketoconazole). The sample preparation technique and method considerations provided here for ibuprofen and ketoconazole can serve as a starting point for solubility and dissolution testing of other small molecules in FeSSGF. [ABSTRACT FROM AUTHOR]

The aim of this present study was to investigate the ability of different dissolution methods to predict the in vivo performance of efonidipine hydrochloride (EFH). The solid dispersions of EFH were prepared by solvent evaporation method with HPMC-AS as matrix and urea as a pH adjusting agent. The paddle method, the open-loop, and the closed-loop flow-through cell methods were studied. In the study, Weibull's model was the best fit to explain release profiles. The pharmacokinetics behaviors of two kinds of solid dispersions with different release rate were investigated in comparison to the EFH after oral administration in rats. In vivo absorption was calculated by a numerical deconvolution method. In the study, the level A in vivo and in vitro correlation (IVIVC) was utilized. The correlation coefficient was calculated and interpreted by means of linear regression analysis (Origin.Pro.8.5 software). As a result, excellent IVIVC for solid dispersions and crude drug (r2 = 0.9352–0.9916) was obtained for the dissolution rate determined with flow-through cell open-loop system in phosphate buffer solution with 0.1% (w/v) polysorbate 80 at pH 6.5, the flow-rate of 4 mL/min. In addition, the self-assembled flow cell system had good repeatability and accuracy. The dissolution rate of the solid dispersion could be slowed down by the flow-through method, and the difference caused by preparation was significantly distinguished. The study demonstrated that flow-through cell method of the open-loop, compared with paddle method, was suitable for predicting in vivo performance of EFH solid dispersions. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition in Canada and globally that a substantial proportion of health care delivered is inappropriate as evidenced by (1) harmful and/or ineffective practices being overused, (2) effective clinical practices being underused, and (3) other clinical practices being misused. Inappropriate health care leads to negative patient experiences, poor health outcomes, and inefficient use of scarce health care resources. The purpose of this study is to conduct a systematic review of inappropriate health care in Canada. Our specific objectives are to (1) systematically search and critically review published and grey literature for studies on inappropriate health care in Canada; (2) estimate the nature and magnitude of inappropriate health care in Canada and its provincial and territorial jurisdictions. Methods: We will include all quantitative study designs reporting objective or subjective measurements of inappropriate health care in Canada over the last 10 years. We will search the following online databases: MEDLINE, Cochrane Central Register of Controlled Trials, EconLit, and ISI-Web of Knowledge, which contains Web of Science Core Collection-Citation Indexes, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science & Humanities. We will also search grey literature sources to identify provincial and national audits of inappropriate health care. Two authors will independently screen, assess data quality, and extract data for synthesis. Study findings will be synthesized narratively. We will organize our data into three care categorizations: preventive care, acute care, and chronic care. We will provide a compendium of inappropriate health care for each care category for Canada and each Canadian province and territory, where sufficient data exists, by calculating (1) overall medians of underuse, overuse, and misuse of clinical practices and (2) the range of medians of underuse, overuse, and misuse for each clinical practice investigated. Discussion: This review will result in the first-ever evidence-based compendium of inappropriate health care in Canada. We will also develop detailed reports of inappropriate health care for each Canadian province and territory. Systematic review registration: PROSPERO CRD42018093495 [ABSTRACT FROM AUTHOR]

Purpose: The overall purpose of this study was to understand the impact of different biorelevant media types on solubility and crystallization from supersaturated solutions of model compounds (atazanavir, ritonavir, tacrolimus and cilnidipine). The first aim was to understand the influence of the lecithin content in FaSSIF. As the human intestinal fluids (HIFs) contain a variety of bile salts in addition to sodium taurocholate (STC), the second aim was to understand the role of these bile salts (in the presence of lecithin) on solubility and crystallization from supersaturated solutions,Methods: To study the impact of lecithin, media with 3 mM STC concentration but varying lecithin concentration were prepared. To test the impact of different bile salts, a new biorelevant medium (Composite-SIF) with a composition simulating that found in the fasted HIF was prepared. The crystalline and amorphous solubility was determined in these media. Diffusive flux measurements were performed to determine the true supersaturation ratio at the amorphous solubility of the compounds in various media. Nucleation induction times from supersaturated solutions were measured at an initial concentration equal to the amorphous solubility (equivalent supersaturation) of the compound in the given medium.Results: It was observed that, with an increase in lecithin content at constant STC concentration (3 mM), the amorphous solubility of atazanavir increased and crystallization was accelerated. However, the crystalline solubility remained fairly constant. Solubility values were higher in FaSSIF compared to Composite-SIF. Longer nucleation induction times were observed for atazanavir, ritonavir and tacrolimus in Composite-SIF compared to FaSSIF at equivalent supersaturation ratios.Conclusions: This study shows that variations in the composition of SIF can lead to differences in the solubility and crystallization tendency of drug molecules, both of which are critical when evaluating supersaturating systems. [ABSTRACT FROM AUTHOR]

The article presents as study that performed resuscitative emergency thoracotomy (ET) as a salvage manoeuvre for selected patients from European trauma centres. The study conducted a retrospective analysis of injured patients who underwent resuscitative ET in the emergency department (ED) or operating room between January 1996 and September 2008. It used logistic regression to analyze survival in the ED and to hospital discharge.

The article focuses on the importance of implementing professional and organizational safety in the health care industry. To ensure the safety for patients, the authors suggested that health facilities should have competent individuals who are able to work collectively, supported by systems that are designed to reduce the effect of medical errors.

The article examines the use of case management in dealing people with chronic diseases. Here, the authors found evidence that case management reduced hospital admissions. Five studies reported 25-50 percent reductions in admissions and three studies reported 1-10-day reductions in the lengths of stay per patient.

Discusses research being done on adverse events (AE) in hospital care. Reference to a study by G.R. Baker et al., published in the May 25, 2004 issue of the "Canadian Medical Association Journal"; Overall AE rate researched; Discussion on treatment injury as a public health issue.

Background: The promotion of safer healthcare interventions in hospitals is a relevant public health topic. This study is aimed to investigate predictors of Adverse Events (AEs) taking into consideration the Charlson Index in order to control for confounding biases related to comorbidity.Methods: The study was a retrospective cohort study based on a two-stage assessment tool which was used to identify AEs. In stage 1, two physicians reviewed a random sample of patient records from 2008 discharges. In stage 2, reviewers independently assessed each screened record to confirm the presence of AEs. A univariable and multivariable analysis was conducted to identify prognostic factors of AEs; socio-demographic and some main organizational variables were taken into consideration. Charlson comorbidity Index was calculated using the algorithm developed by Quan et al.Results: A total of 1501 records were reviewed; mean patients age was 60 (SD: 19) and 1415 (94.3%) patients were Italian. Forty-six (3.3%) AEs were registered; they most took place in medical wards (33, 71.7%), followed by surgical ones (9, 19.6%) and intensive care unit (ICU) (4, 8.7%). According to the logistic regression model and controlling for Charlson Index, the following variables were associated to AEs: type of admission (emergency vs elective: OR 3.47, 95% CI: 1.60-7.53), discharge ward (surgical and ICU vs medical wards: OR 2.29, 95% CI: 1.00-5.21 and OR 4.80, 95% CI: 1.47-15.66 respectively) and length of stay (OR 1.03, 95% CI 1.01-1.04). Among patients experiencing AEs a higher frequency of elderly (≥65 years) was shown (58.7% vs 49.3% among patients without AEs) but this difference was not statistically significant. Interestingly, a higher percentage of patients admitted through emergency department was found among patients experiencing AEs (69.7% vs 55.1% among patients without AEs).Conclusions: The incidence of AEs was associated with length of stay, type of admission and unit of discharge, independently by comorbidity. On the basis of our results, it appears that organizational characteristics, taking into account the adjustment for comorbidity, are the main factors responsible for AEs while patient vulnerability played a minor role. [ABSTRACT FROM AUTHOR]

Background: Several review studies have shown that 3.4% to 16.6% of patients in acute care hospitals experience one or more adverse events. Adverse events (AEs) in hospitals constitute a significant problem with serious consequences and a challenge for public health. The occurrence of AEs in Portuguese hospitals has not yet been systematically studied. The main purpose of this study is to estimate the incidence, impact and preventability of adverse events in Portuguese hospitals. It is also our aim to examine the feasibility of applying to Portuguese acute hospitals the methodology of detecting AEs through record review, previously used in other countries.Methods: This work is based on a retrospective cohort study and was carried out at three acute care hospitals in the Administrative Region of Lisbon. The identification of AEs and their impact was done using a two-stage structured retrospective medical records review based on the use of 18 screening criteria. A random sample of 1,669 medical records (representative of 47,783 hospital admissions) for the year 2009 was analyzed.Results: The main results found in this study were an incidence rate of 11.1% AEs, of which around 53.2% were considered preventable. The majority of AEs were associated with surgical procedures (27%), drug errors (18.3%) and hospital acquired infections (12.2%). Most AEs (61%) resulted in minimal or no physical impairment or disability, and 10.8% were associated with death. In 58.6% of the AEs' cases, the length of stay was prolonged on average 10.7 days. Additional direct costs amounted to €470,380.00.Conclusion: The magnitude of these results was critical, reinforcing the need of more detailed studies in this area. The knowledge of the incidence and nature of AEs that occur in hospitals should be seen as a first step towards the improvement of quality and safety in health care. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of postconditioning on mitochondrial dysfunction in skeletal muscle through the reduction of oxidative stress. For the study, researchers examined rats with ischemia. They observed that ischemia-reperfusion alone resulted to a significant decline of maximal oxidative capacity. They concluded that ischaemic postconditioning is capable of protecting skeletal muscle mitochondria against ischaemia-reperfusion injury via the reduction of oxidative stress.

: Background Root cause analysis is a method to examine causes of unintended events. PRISMA (Prevention and Recovery Information System for Monitoring and Analysis) is a root cause analysis tool. With PRISMA, events are described in causal trees and root causes are subsequently classified with the Eindhoven Classification Model (ECM). It is important that root cause analysis tools are reliable, because they form the basis for patient safety interventions. : Objectives Determining the inter-rater reliability of descriptions, number and classifications of root causes. : Design Totally, 300 unintended event reports were sampled from a database of 2028 events in 30 hospital units. The reports were previously analysed using PRISMA by experienced analysts and were re-analysed to compare descriptions and number of root causes (n = 150) and to determine the inter-rater reliability of classifications (n = 150). : Main outcome measures Percentage agreement and Cohens kappa (κ). : Results Agreement between descriptions of root causes was satisfactory: 54% agreement, 17% partial agreement and 29% no agreement. Inter-rater reliability of number of root causes was moderate (κ = 0.46). Inter-rater reliability of classifying root causes with the ECM was substantial from highest category level (κ = 0.71) to lowest subcategory level (κ = 0.63). Most discrepancies occurred in classifying external causes. : Conclusions Results indicate that causal tree analysis with PRISMA is reliable. Analysts formulated similar root causes and agreed considerably on classifications, but showed variation in number of root causes. More training on disclosure of all relevant root causes is recommended as well as adjustment of the model by combining all external causes into one category. [ABSTRACT FROM AUTHOR]

: Objectives To estimate the incidence, nature and consequences of adverse events and preventable adverse events in Swedish hospitals. : Design A three-stage structured retrospective medical record review based on the use of 18 screening criteria. : Setting Twenty-eight Swedish hospitals. : Population A representative sample (n = 1967) of the 1.2 million Swedish hospital admissions between October 2003 and September 2004. : Main Outcome Measures Proportion of admissions with adverse events, the proportion of preventable adverse events and the types and consequences of adverse events. : Results In total, 12.3% (n = 241) of the 1967 admissions had adverse events (95% CI, 10.8–13.7), of which 70% (n = 169) were preventable. Fifty-five percent of the preventable events led to impairment or disability, which was resolved during the admission or within 1 month from discharge, another 33% were resolved within 1 year, 9% of the preventable events led to permanent disability and 3% of the adverse events contributed to patient death. Preventable adverse events led to a mean increased length of stay of 6 days. Ten of the 18 screening criteria were sufficient to detect 90% of the preventable adverse events. When extrapolated to the 1.2 million annual admissions, the results correspond to 105 000 preventable adverse events (95% CI, 90 000–120 000) and 630 000 days of hospitalization (95% CI, 430 000–830 000). : Conclusions This study confirms that preventable adverse events were common, and that they caused extensive human suffering and consumed a significant amount of the available hospital resources. [ABSTRACT FROM AUTHOR]

: Objective To evaluate the incidence of adverse events in Brazilian hospitals. : Design Retrospective cohort study based on patient record review. : Setting Three teaching hospitals in the State of Rio de Janeiro, Brazil. : Participants Random sample (1103) of 27 350 adult patients admitted in 2003. Patients under 18 years old, psychiatric patients and patients whose length of stay was less than 24 hr were excluded, and obstetric cases were included. : Main Outcome Measure(s) Incidence of patients with adverse events; proportion of preventable adverse events; number of adverse events per 100 patients and incidence density of adverse events per 100 patient-days. : Results The incidence of patients with adverse events was 7.6% (84 of 1103 patients). The overall proportion of preventable adverse events was 66.7% (56 of 84 patients). The incidence density was 0.8 adverse events per 100 patient-days (103 of 13 563 patient-days). The patients ward was the most frequent location of adverse events (48.5%). In regard to classification, surgical adverse events were the most frequent ones (35.2%). : Conclusions The incidence of patients with adverse events at the three hospitals was similar to that in international studies. However, the proportion of preventable adverse events was much higher in the Brazilian hospitals. [ABSTRACT FROM AUTHOR]