Background Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). Methods LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensivecare units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. Findings Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO 2) to the fractional concentration of oxygen in inspired air (F I O 2) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of stay in the intensive-care unit were significantly shorter in patients in rWORLD-High countries than in Europe-High or Middle countries. High gross national income per person was associated with increased survival in ARDS; hospital survival was significantly lower in Middle countries than in Europe-High or rWORLD-High countries. Interpretation Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes. Income per person and outcomes in ARDS are independently associated.

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Risk perception assessment of COVID-19 among Portuguese Healthcare Professionals (HCPs) and the general population (GPop) was evaluated in a snowball sample of 3403 individuals, 54.9% of HCPs believed there was a high probability of becoming infected, in contrast with 24.0% of the GPop (P<0.001) and, in more than a quarter, that this could happen to their family. Regarding prophylactic isolation, more than 70% agreed with its effectiveness. A large proportion perceived that health services were poorly prepared (50.1% GPop vs 63.5% HCPs, P<0.001). Regarding health authorities' communication, about 60% were "moderately" satisfied. The opinion that the pandemic could be controlled in 3e6 months was held by 46.7% of the GPop and 52.8% HCPs (P¼0.01).

BackgroundMost studies on academic cheating rely on self-reported questionnaires and focus on the individual, overlooking cheating as a group activity. The aim of this study is to estimate the true prevalence of cheating/anomalies among medical students using a statistical index developed for this purpose, and to explore the existence of social networks between anomalies in students’ results.MethodsAngoff’s A index was applied to a sample of 30 written examinations, with a total of 1487 students and 7403 examinations taken, from the 2014/2015 academic year of the Faculty of Medicine of the University of Porto to detect anomaly pairs. All analyses are within the same academic year and not across years. Through simulations, the sensitivity and specificity of the statistical method was determined, and the true prevalence of anomalies/cheating was estimated. Networks of anomaly pairs were created to search for patterns and to calculate their density.ResultsThe percentage of students who cheated at least once increased with the year of medical school, being lowest in the first year (3.4%) and highest in the fifth (17.3%). The year of medical school was associated with anomalies (p < 0.05). The network’s density was also lowest in the first year (1.12E-04) and highest in the fifth (8.20E-04). The true prevalence of anomalies was estimated to be 1.85% (95%CI: 1.07–3.20%).ConclusionsThese findings suggest that some students are involved in social networks of cheating, which grow over time, resulting in an increase of anomalies/cheating in later academic years.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1299-7) contains supplementary material, which is available to authorized users.

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