Negative outcomes associated with medication in patients with chronic atrial fibrillation who present at the emergency department.

WHAT IS KNOWN AND OBJECTIVE: Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided. METHODS: This descriptive, cross-sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts. RESULTS AND DISCUSSION: Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood-forming organs. WHAT IS NEW AND CONCLUSION: A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.

Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study).

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). Conclusions: The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

[Knowledge about AIDS and sexually transmitted diseases among adolescents]. / Conocimientos de los adolescentes sobre el sida y las enfermedades de transmisión sexual.

OBJECTIVE: To determine knowledge about AIDS and sexually transmitted diseases (STD) among school adolescent in order to define their lacks, and those aspects to include in programs of health education. DESIGN: Cross-sectional study. SETTING: Secondary schools from Córdoba. PARTICIPANTS: 893 teen students. Stratified random sample. MAIN MEASUREMENTS: Anonymous self administered survey. Dates related with knowledge about AISD, STD and its mechanism of transmission. MAIN RESULTS: The mean age of the sample was 17.16 years (95% CI, 17.05-17.26) and 48% was men. 56.7% (95% CI, 53.46-59.94) recognize to be very informed about AIDS and STD, finding significant differences among public (58.9%) and private schools (51.6%) (P=.045). About AIDS, the mean of successes was 8.81 (95% CI, 8.69-8.92; limits 0-12), finding positive differences among men (P=.048); older students (P=.003); public schools (P=.025), and the students non believers (P=.021). About STD, the mean of successes was of 2.47 (95% CI, 2.35-2.78; limits 0-12), with significant differences among women (P=.045); older students (P=.001) and public schools (P=.001). About AIDS sexual transmission, the mean of successes was of 13 (95% CI, 12.87-13.12; limits 0-16), without differences between sex, classrooms or type of schools. CONCLUSIONS: Level of knowledge shown by adolescents for aspects related to STD is poor. Likewise, the information about AIDS can be consider as enough, being men those that to present a bigger degree of knowledge.

[Sexual behaviour among school adolescents in Córdoba]. / Comportamiento sexual de los escolares adolescentes en la ciudad de Córdoba.

OBJECTIVE: To know sexual behaviour among school teenagers and to determine different risk behaviors and groups with specific needs of health education. DESIGN: Cross-sectional study. SETTING: High-schools from Córdoba. PARTICIPANTS: 893 teenagers students selected by random sample. MAIN MEASUREMENTS: Anonymous self-rated survey about sexual behaviour and uses of contraceptives methods. MAIN RESULTS: The average age was 17.16 years (95% CI, 17.05-17.26), 48% males. 22.9% have had completed sexual relations; there were mainly girls (P=.001). The average age for the first relation was 16.64 years (95% CI, 16.45-16.82), with no difference between gender. Among girls, first sexual intercourse use to be with their regular partners (P<.001). 48% of the girls have had one or more sexual intercourse per week, that was only a 19.5% among boys (P<.001). 82% had used a contraceptive method at the first time, and the condom was the method more frequently used. CONCLUSIONS: 20% of school teenagers have had complete sexual intercourse, most of them before 18 years. Girls have more frequently sexual relations, usually with their regular partners. Condom is the contraceptive method more frequently used.

[Reliability of blood pressure measurement: the patient versus primary care workers]. / Fiabilidad en la medición de la presión arterial: paciente frente a profesionales de atención primaria.

OBJECTIVE: To evaluate the degree of inter-observer concordance in the blood pressure figures taken by a nurse and a doctor with a mercury sphygmomanometer and by the patient with a semi-automatic device. DESIGN: Observational, crossover study. SETTING: A rural health centre. PATIENTS: 318 people selected by systematic sampling. INTERVENTIONS: Pressure was taken in different ways by 3 different "observers" (0): the patient with a semi-automatic device (01), a nurse (02) and a family doctor (03). Inter-observer concordance was assessed through the Intra-class Correlation Coefficient (ICC) and the kappa index. MEASUREMENTS AND MAIN RESULTS: 42.1%, 41.8% and 44.3% of patients had high blood pressure (> or = 140/90 mmHg) according to 01, 02 and 03, respectively. 33% were known to be hypertense. The ICC for systolic pressure was 0.81 (95% CI, 0.75-0.87) between 01 and 02; 0.84 (CI, 0.78-0.90) between 01 and 03; and 0.87 (CI, 0.82-0.92) between 02 and 03. The ICC for diastolic pressure was 0.67 (CI, 0.59-0.75), 0.72 (CI, 0.64-0.79) and 0.79 (CI, 0.72-0.86) for 01-02, 01-03 and 02-03, respectively. The kappa index was 0.53 (CI, 0.43-0.62) for 01-02; 0.60 (CI, 0.51-0.68) for 01-03; and 0.67 (CI, 0.58-0.75) for 02-03. CONCLUSIONS: Inter-observer concordance was good, with no substantial differences between the measurements made by the different observers. As the figures determined by the semi-automatic device were reliable, this is a good option for the follow-up and monitoring of hypertense patients.

Comportamiento sexual de los escolares adolescentes en la ciudad de Córdoba / Sexual behaviour among school adolescents in Córdoba

Objetivos. Conocer el comportamiento sexual de los adolescentes escolarizados a fin de identificar distintas conductas de riesgo y determinar el grupo donde hacer más hincapié en los programas de educación sanitaria. Diseño. Estudio transversal. Emplazamiento. Centros escolares de secundaria de Córdoba. Participantes. Un total de 893 escolares adolescentes seleccionados por muestreo aleatorio polietápico. Mediciones principales. Mediante cuestionario anónimo autocumplimentado se recogieron datos relacionados con su actividad, sexual así como del uso de anticonceptivos en sus relaciones. Resultados. La media de edad fue de 17,16 años (intervalo de confianza [IC] del 95 por ciento, 17,05-17,26), siendo el 48 por ciento varones. El 22,9 por ciento reconoce haber mantenido relaciones sexuales completas, destacando en este sentido las mujeres respecto a los varones (p = 0,001); la media de edad al inicio de éstas fue 16,64 años (IC del 95 por ciento, 16,4516,82), sin apreciar diferencias por sexo ni tipo de centro. El inicio de las relaciones suele ser con la pareja, destacando en este sentido las mujeres (p < 0,001). El 48 por ciento de las mujeres reconoce mantener relaciones sexuales completas con una frecuencia superior a una vez a la semana, dato superior al registrado para los varones (19,5 por ciento) (p < 0,001). El 82 por ciento dice haber usado algún método anticonceptivo en su primera relación, siendo el preservativo el método más utilizado. Conclusiones. Dos de cada 10 adolescentes afirman haber mantenido relaciones sexuales completas, la gran mayoría antes de los 18 años. Las mujeres son quienes tienen con mayor frecuencia relaciones sexuales, generalmente con su pareja. El preservativo es el anticonceptivo más usado, siendo irrelevante el uso de métodos poco seguros (AU)

Fiabilidad en la medición de la presión arterial: paciente frente a profesionales de atención primaria / Reliability in blood pressure measurement: patients versus primary care professionals

Objetivo. Valorar el grado de concordancia interobservador en las cifras de presión arterial tomadas por un enfermero y un médico con esfigmomanómetro de mercurio y el paciente con un aparato semiautomático. Diseño. Observacional transversal. Emplazamiento. Un centro de salud rural. Pacientes. Trescientos dieciocho sujetos seleccionados por muestreo sistemático. Intervenciones. Se realizaron 3 tomas tensionales de forma alternativa por 3 observadores (O) distintos: el paciente con aparato semiautomático (O1), un enfermero (O2) y un médico de familia (O3). Valoración de la concordancia interobservador mediante el coeficiente de correlación intraclase (CCI) y el índice kappa. Mediciones y resultados principales. Presentaron cifras elevadas de presión arterial (>= 140/90 mmHg) un 42,1, 41,8 y 44,3 por ciento de los sujetos, según O1, O2 y O3, respectivamente; un 33 por ciento era hipertenso conocido. El CCI para la presión arterial sistólica fue de 0,81 (IC del 95 por ciento, 0,75-0,87) entre O1-O2, de 0,84 (IC del 95 por ciento, 0,78-0,90) entre O1-O3 y de 0,87 (IC del 95 por ciento, 0,82-0,92) entre O2-O3. Para la presión arterial diastólica el CCI fue de 0,67 (IC del 95 por ciento, 0,59-0,75), 0,72 (IC del 95 por ciento, 0,64-0,79) y 0,79 (IC del 95 por ciento, 0,72-0,86) para O1-O2, O1-O3 y O2-O3, respectivamente. El índice kappa fue de 0,53 (IC del 95 por ciento, 0,43-0,62) para O1-O2; 0,60 (IC del 95 por ciento, 0,51-0,68) para O1-O3 y 0,67 (IC del 95 por ciento, 0,58-0,75) para O2-O3. Conclusiones. El grado de acuerdo interobservador fue bueno, no apreciándose diferencias sustanciales entre las mediciones efectuadas por los distintos observadores. Las determinaciones obtenidas por el aparato semiautomático son fiables, constituyendo una buena opción para el seguimiento y control de los pacientes hipertensos (AU)

Conocimientos sobre embarazos y métodos anticonceptivos entre adolescentes / No disponible

Objetivos. Determinar el conocimiento sobre embarazo y métodos anticonceptivos en los adolescentes escolarizados a fin de delimitar sus carencias, y aquellas facetas a incluir en los programas de educación sanitaria. Personas y métodos. Estudio transversal. Muestreo aleatorio estratificado de los centros escolares de secundaria de Córdoba. Cuestionario anónimo autocumplimentado. Resultados. De los 893 alumnos, el 48% eran hombres. La media de edad fue de 17,16 años (IC 95%: 17,05-17,26). El 77,7% afirman estar bien informados respecto al embarazo y anticonceptivos, encontrando diferencias significativas entre centros públicos (80%) y privados (73,5%) p=0,034. Respecto al embarazo, la media de aciertos fue de 3,40 (IC 95%: 3,31-3,48; límites 0-5), encontrando diferencias a favor de las mujeres (p<0,001); en los cursos superiores (p<0,001); en los centros públicos (p=0,002) y los alumnos no creyentes (p=0,002). Para los anticonceptivos, la media fue de 5,69 (IC 95%: 5,59-5,78; limites 0-8), con diferencias significativas a favor de los cursos superiores (p<0,001) y en los centros públicos (p<0,001). Conclusiones. El nivel de conocimiento mostrado por los adolescentes para aspectos relacionados con el embarazo y los anticonceptivos se puede considerar como suficiente, siendo las mujeres las que presentan un mayor grado de conocimiento. Asimismo, la información facilitada por médicos y profesores influye de manera favorable en el resultado final (AU)

Objectives. To determine knowledge about pregnancy and contraceptive methods among school adolescent in order to define their lacks, and those aspects to include in programs of health education. Subject and methods. Cross-sectional study. Stratified random sample from Córdoba secondary schools. Anonymous self administered survey. Results. Of the 893 students, 48% was men. The mean age of the sample was 17.16 years (95% CI: 17.05-17.26). 77,7% recognize to be very informed about pregnancy and contraceptive methods, finding significant differences among public (80%) and private schools (73,5%) p=0,034. About pregnancy, the mean of successes was 3,40 (95% CI: 3.31-3.48); limits 0-5), finding differences among women (p<0,001); older students (p<0,001); public schools (p=0,002), and the students non believers (p=0.002). About contraceptive methods, the mean of successes was of 5.69 (IC95% 5,59-5.78; limits 0-8), with significant differences among older students (p<0.001) and public schools (p<0.001). Conclusions. Level of knowledge shown y adolescents for aspects related to pregnancy and contraceptive methods can be consider as enough, being women those that to present a bigger degree of knowledge. Likewise, the information facilitated by doctors and professors influences in a right way about the final result (AU)