Screening for mild cognitive impairment among older Albanian patients by clinical pharmacists.

OBJECTIVES: To assess the prevalence of mild cognitive impairment (MCI) and its correlated factors among elderly Albanian patients using different screening tools applied by clinical pharmacists. METHODS: Patients aged 60 years old or more from two primary care centers located in two Albanian cities were included in the study. Two clinical pharmacists applied the MoCA/MoCA B (Montreal Cognitive Assessment/Basic) and the Mini-Cog in Albanian. A predictive multivariate logistic regression analysis and Kappa statistic were conducted. KEY FINDINGS: The prevalence of MCI using MoCA/MoCA B and Mini-Cog scales was 75.73 and 20.39%, respectively. There was a poor degree of agreement between them (Kappa 2.38). Older men had an increased risk of MCI. CONCLUSIONS: The involvement of clinical pharmacists in screening for MCI might help in selecting vulnerable individuals for more specialized examination. The MoCA/MoCA B tool is recommended for higher sensitivity.

Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment.

BACKGROUND: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country. OBJECTIVE: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI). METHODS: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population. RESULTS: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)]. CONCLUSIONS: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.

Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment

BACKGROUND: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country. OBJECTIVE: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI). METHODS: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population. RESULTS: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)]. CONCLUSIONS: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment

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Effectiveness of Electronic Guidelines (GERH®) to Improve the Clinical Use of Antibiotics in An Intensive Care Unit.

The objective of the study was to evaluate the capacity of GERH®-derived local resistance maps (LRMs) to predict antibiotic susceptibility profiles and recommend the appropriate empirical treatment for ICU patients with nosocomial infection. Data gathered between 2007 and 2016 were retrospectively studied to compare susceptibility information from antibiograms of microorganisms isolated in blood cultures, lower respiratory tract samples, and urine samples from all ICU patients meeting clinical criteria for infection with the susceptibility mapped by LRMs for these bacterial species. Susceptibility described by LRMs was concordant with in vitro study results in 73.9% of cases. The LRM-predicted outcome agreed with the antibiogram result in >90% of cases infected with the bacteria for which GERH® offers data on susceptibility to daptomycin, vancomycin, teicoplanin, linezolid, and rifampicin. Full adherence to LRM recommendations would have improved the percentage adequacy of empirical prescriptions by 2.2% for lower respiratory tract infections (p = 0.018), 3.1% for bacteremia (p = 0.07), and 5.3% for urinary tract infections (p = 0.142). LRMs may moderately improve the adequacy of empirical antibiotic therapy, especially for lower respiratory tract infections. LRMs recommend appropriate prescriptions in approximately 50% of cases but are less useful in patients with bacteremia or urinary tract infection.

Predictive Model of the Risk of In-Hospital Mortality in Colorectal Cancer Surgery, Based on the Minimum Basic Data Set.

BACKGROUND: Various models have been proposed to predict mortality rates for hospital patients undergoing colorectal cancer surgery. However, none have been developed in Spain using clinical administrative databases and none are based exclusively on the variables available upon admission. Our study aim is to detect factors associated with in-hospital mortality in patients undergoing surgery for colorectal cancer and, on this basis, to generate a predictive mortality score. METHODS: A population cohort for analysis was obtained as all hospital admissions for colorectal cancer during the period 2008-2014, according to the Spanish Minimum Basic Data Set. The main measure was actual and expected mortality after the application of the considered mathematical model. A logistic regression model and a mortality score were created, and internal validation was performed. RESULTS: 115,841 hospitalization episodes were studied. Of these, 80% were included in the training set. The variables associated with in-hospital mortality were age (OR: 1.06, 95%CI: 1.05-1.06), urgent admission (OR: 4.68, 95% CI: 4.36-5.02), pulmonary disease (OR: 1.43, 95%CI: 1.28-1.60), stroke (OR: 1.87, 95%CI: 1.53-2.29) and renal insufficiency (OR: 7.26, 95%CI: 6.65-7.94). The level of discrimination (area under the curve) was 0.83. CONCLUSIONS: This mortality model is the first to be based on administrative clinical databases and hospitalization episodes. The model achieves a moderate-high level of discrimination.

Monitoring the incidence, duration and distribution of hyperglycaemia in very-low-birth-weight newborns and identifying associated factors.

Objectives Hyperglycaemia is a common metabolic disorder in very-low-birth-weight (VLBW) infants and is associated with increased morbidity and mortality. The objective is to describe the incidence, duration, episodes and distribution of hyperglycaemia during the first 7 days of life of VLBW infants. Methods This is a prospective cohort study of 60 newborns weighing <1,500 g. Blood glucose levels were monitored with a continuous glucose monitoring system (CGMS) during the first 7 days of life. Hyperglycaemia was defined as glucose ≥180 mg/dL (≥10 mmol/L). Results Incidence of hyperglycaemia recorded with the CGMS was 36.6% (95%CI: 24.6-50.1). In almost 74.6±5.48% of these cases the duration of the episode exceeded 30 min and in 45.25% (95%CI: 2.26-57.82) it exceeded 2 h. The condition occurred most frequently during the first 72 h of life. One-fifth of cases were not detected with scheduled capillary tests and 84.6% of these had hyperglycaemic episode durations of 30 min or more. Agreement between the two techniques was very good (r=0.90, p<0.001) and the CGMS proved to be reliable, accurate and safe. Hyperglycaemia detected by a CGMS is associated with lower gestational age (OR: 0.66, p=0.002), lower birth weight (OR: 0.99, p=0.003), the use of ionotropic drugs (OR: 11.07, p=0.005) and death (OR: 10.59, p=0.03), and is more frequent in preterm infants with sepsis (OR: 2.73, p=0.1). No other association was observed. Conclusions A CGMS could be useful during the first week of life in VLBW infants due to the high incidence and significant duration of hyperglycaemia and the high proportion of cases that remain undetected. The advantage of the CGMS is that it is able to detect hyperglycaemic episodes that the capillary test does not.

Correction to: Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials.

In the original article the name of author Enrique G. Artero was misspelled.

Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials.

The combination of bariatric surgery and physical exercise has been suggested as a promising strategy to positively influence obesity, not only body weight but also all associated comorbidities. An electronic search of intervention studies was carried out in which an exercise training program was implemented after bariatric surgery. The quality of each study was assessed and the data were meta-analyzed using a random effect model. Twenty-six articles were included in the systematic review and 16 in the meta-analysis. As the main conclusion, exercise in patients who have undergone bariatric surgery does not seem to be effective in enhancing weight loss (SMD = 0.15; 95% CI = - 0.02, 0.32; p = 0.094). However, the variability in the protocols used makes it too early to reach a definite conclusion.

Insulinaemia and insulin resistance in Caucasian general paediatric population aged 2 to 10 years: Associated risk factors.

BACKGROUND: The aim of this study is to determine values of insulinaemia, homeostasis model assessment (HOMA) index and quantitative insulin sensitivity check index (QUICKI) among a population of prepubertal Caucasian children, to analyse factors associated with insulin resistance (IR), and to study its association with cardiovascular risk factors. MATERIALS AND METHODS: Population-based study conducted on a randomly selected sample of prepubescent Caucasian subjects aged 2.00 to 9.99 years old. Anthropometric measurements, blood pressure, and fasting blood samples were obtained, including fasting glucose, triglycerides, High Density Lipoprotein (HDL)-cholesterol, and insulin. In addition, QUICKI and HOMA indices were calculated. Generalised additive models for location, scale and shape (GAMLSS) was used to calculate centiles curves and multivariate logistic regression analysis to assess factors associated with IR. RESULTS: A total of 654 subjects were included. Mean values obtained for insulinaemia, HOMA index, and QUICKI were 3.74 µIU/mL, 0.73, and 0.44, respectively, in the overall population and 3.32 µIU/mL, 0.64 and 0.46, respectively, in normal weight subjects. The main factor associated with IR was abdominal obesity (odds ratio [OR] 3.38 [95% CI 1.44-7.94] in the subgroup aged 2.00-5.99 years and OR 9.14 [3.42-24.41] for those aged 6.00-9.99 years). An increased risk of hyperglycaemia (P = 0.043), hypertriglyceridaemia (P < .001), and HDL < p10 (P = 0.021) was described among children aged 2.00 to 5.99 years with IR, and among those aged 6.00 to 9.99 years, IR was associated with an increased risk of hypertriglyceridaemia (P < .001). CONCLUSION: Abdominal obesity was the main factor associated with IR. Metabolic changes associated with IR seem to be present from early stages of life, which highlights the importance of the prevention, early diagnosis and treatment of obesity.

[Effect of age on the prevalence of diabetes mellitus in Spain between 2001 and 2012]. / Efecto de la edad sobre la evolución de la prevalencia de diabetes mellitus en España entre 2001 y 2012.

OBJECTIVE: To assess the effect of age on the increase in DM prevalence in Spain between 2001 and 2012. METHODS: From the DM prevalence data of the National Health Surveys performed in Spain in 2001, 2006, and 2012 and age distribution of the population, adjusted prevalence rates by age for each year were calculated by the direct method, taking the 2006 population as the reference one. Crude and adjusted percentage increases were also calculated for the whole period and for the 2001-2006 and 2006-2012 sub-periods. RESULTS: 12.5% of the crude DM prevalence increase is attributable to the population aging during the whole period. Although the trends are different in the two sub-periods, adjusted prevalence rates also show an increasing trend. CONCLUSIONS: Aside from population aging, there exist other factors responsible for the increase in diabetes prevalence rates in Spain in 2001-2012 that should be known.

Objetivo: Valorar el efecto de la edad sobre el incremento en la prevalencia de DM en España entre 2001 y 2012. Métodos: Partiendo de las prevalencias de DM de las Encuestas Nacionales de Salud realizadas en España en 2001, 2006 y 2012 y de la distribución etaria de la población, se calcularon, mediante método directo, las prevalencias ajustadas por edad para cada año, tomando como población de referencia la de 2006. Asimismo, se calcularon los incrementos porcentuales crudos y ajustados para el periodo total y para los subperíodos 2001-2006 y 2006-2012. Resultados: El 12,5% del incremento en la prevalencia cruda de DM es atribuible al envejecimiento poblacional durante el período total. Aunque las tendencias son diferentes en los dos subperíodos considerados, las prevalencias ajustadas también muestran una tendencia creciente. Conclusiones: Además del envejecimiento poblacional, existen otros factores responsables del incremento en las tasas de diabetes en España en 2001-2012 que es preciso conocer.

Efecto de la edad sobre la evolución de la prevalencia de diabetes mellitus en España entre 2001 y 2012 / Effect of age on the prevalence of diabetes mellitus in Spain between 2001 and 2012

Objetivo: Valorar el efecto de la edad sobre el incremento en la prevalencia de DM en España entre 2001 y 2012. Métodos: Partiendo de las prevalencias de DM de las Encuestas Nacionales de Salud realizadas en España en 2001, 2006 y 2012 y de la distribución etaria de la población, se calcularon, mediante método directo, las prevalencias ajustadas por edad para cada año, tomando como población de referencia la de 2006. Asimismo, se calcularon los incrementos porcentuales crudos y ajustados para el periodo total y para los subperíodos 2001-2006 y 2006-2012. Resultados: El 12,5% del incremento en la prevalencia cruda de DM es atribuible al envejecimiento poblacional durante el período total. Aunque las tendencias son diferentes en los dos subperíodos considerados, las prevalencias ajustadas también muestran una tendencia creciente. Conclusiones: Además del envejecimiento poblacional, existen otros factores responsables del incremento en las tasas de diabetes en España en 2001-2012 que es preciso conocer (AU)

Objective: To assess the effect of age on the increase in DM prevalence in Spain between 2001 and 2012. Methods: From the DM prevalence data of the National Health Surveys performed in Spain in 2001, 2006, and 2012 and age distribution of the population, adjusted prevalence rates by age for each year were calculated by the direct method, taking the 2006 population as the reference one. Crude and adjusted percentage increases were also calculated for the whole period and for the 2001-2006 and 2006-2012 sub-periods. Results: 12.5% of the crude DM prevalence increase is attributable to the population aging during the whole period. Although the trends are different in the two sub-periods, adjusted prevalence rates also show an increasing trend. Conclusions: Aside from population aging, there exist other factors responsible for the increase in diabetes prevalence rates in Spain in 2001-2012 that should be known (AU)

[Design and validation of a questionnaire exploring risky-driving patterns in young drivers]. / Diseño y validación de un cuestionario sobre patrones de conducción de riesgo en jóvenes.

BACKGROUND: Traffic Injuries are a major public health problem, especially among young people. However, we have not found any useful questionnaire designed in our country for the epidemiological research in this field. The objective of this study was to design and validate an easy and quickly-to-fill questionnaire aimed to collect information on how frequently university car drivers report to be involved in driving circumstances theoretically related to traffic crashes. METHODS: Between 2007 and 2010, a total of 1597 young undergraduate students at the University of Granada answered a self-administered questionnaire collecting information about exposure, accidents and involvement in 28 different driving circumstances. For designing this questionnaire, an extensive literature review was carried out and the opinions of five experts in a panel were also taken into account. By applying the tetracoric correlation coefficient, we conducted a factor analysis. Internal consistency was assessed using Cronbach's alpha coefficient. Finally, we evaluated the crude and adjusted association of each identified factor with the odds for having suffered an accident. RESULTS: After excluding 8 circumstances, the remaining ones were grouped into three factors: the first one included ten high-prevalence circumstances and explained 31.9% of the total variability. Meanwhile, the other two factors included five circumstances each one which respectively explained 15.2% and 12.5% of the variability. Cronbach's alpha coefficients ranged between 0.816 and 0.553. When adjustments according age, sex, years in possession of the driving license and intensity of exposure were made, the first factor obtained the score more strongly associated with the accident rate (OR = 1.51; CI95%: 1.25-1.85). CONCLUSIONS: The final version (20 circumstances) identified three factors related to higher accident rates among the young drivers. The first one integrated, among other circumstances, the excessive speed and driving while sleepy or tired and it was the most closely associated with the accident rate in the adjusted analysis. The second factor included, among others, the commission of driving offences, and the third one included driving under the influence of alcohol, not always wearing the seat belt and distractions.

Diseño y validación de un cuestionario sobre patrones de conducción de riesgo en jóvenes / Design and validation of a questionnaire exploring risky-driving patterns in young drivers

Fundamentos: Las Lesiones por Tráfico continúan siendo un importante problema de Salud Pública en población joven. A pesar de ello, no existen en nuestro país cuestionarios idóneos para la investigación epidemiológica de este problema. El objetivo del presente trabajo fue diseñar y validar un cuestionario orientado a explorar la frecuencia de implicación en circunstancias de conducción teóricamente asociadas con la accidentalidad por tráfico en población universitaria. Métodos: Se aplicó un cuestionario autoadministrado (MATCA: movilidad, accidentalidad por tráfico y circunstancias asociadas) a 1597 jóvenes alumnos de grado de la Universidad de Granada, entre los años 2007 y 2010, que recogía información, entre otras variables, sobre la exposición, la accidentalidad y la implicación en 28 circunstancias de conducción. Para su diseño se realizó una extensa revisión de la literatura al respecto y se contó con el juicio de un panel de cinco expertos. Aplicando el coeficiente de correlación tetracórico, se realizó un análisis factorial. La consistencia interna se valoró mediante el coeficiente alfa de Crombach. Finalmente, se valoró la asociación cruda y ajustada de cada factor identificado con la odds de haber sufrido un accidente. Resultados: Tras descartar 8 circunstancias, las restantes se agruparon en tres factores: el primero incluyó diez circunstancias de elevada prevalencia y explicó el 31,9% de la variabilidad total. Los otros dos factores, incluyeron cinco circunstancias cada uno que explicaron respectivamente, el 15,2% y el 12,5% de la variabilidad. Los coeficientes alfa de Crombach oscilaron entre 0,816 y 0,553. Cuando se ajustó por la edad, el sexo, los años de antigüedad del permiso y la intensidad de exposición, la puntuación más fuertemente asociada a la accidentalidad fue la del primer factor (OR=1,51: IC95% 1,25-1,85). Conclusiones: La versión final (20 circunstancias), identificó tres factores asociados a una mayor accidentalidad entre jóvenes conductores. El primero integró, entre otras, la velocidad excesiva y conducir con sueño o cansancio, y fue el más estrechamente asociado a la accidentalidad en el análisis ajustado. El segundo agrupó las circunstancias relacionadas con la comisión de infracciones y el tercero incluyó la conducción bajo los efectos del alcohol, el no uso siempre del cinturón y las distracciones(AU)

Background: Traffic Injuries are a major public health problem, especially among young people. However, we have not found any useful questionnaire designed in our country for the epidemiological research in this field.. The objective of this study was to design and validate an easy and quickly-to-fill questionnaire aimed to collect information on how frequently university car drivers report to be involved in driving circumstances theoretically related to traffic crashes. Methods: Between 2007 and 2010, a total of 1597 young undergraduate students at the University of Granada answered a self-administered questionnaire collecting information about exposure, accidents and involvement in 28 different driving circumstances. For designing this questionnaire, an extensive literature review was carried out and the opinions of five experts in a panel were also taken into account. By applying the tetracoric correlation coefficient, we conducted a factor analysis. Internal consistency was assessed using Cronbach's alpha coefficient. Finally, we evaluated the crude and adjusted association of each identified factor with the odds for having suffered an accident. Results: After excluding 8 circumstances, the remaining ones were grouped into three factors: the first one included ten high-prevalence circumstances and explained 31.9%of the total variability.Meanwhile, the other two factors included five circumstances each one which respectively explained 15.2% and 12.5% of the variability. Cronbach's alpha coefficients ranged between 0.816 and 0.553.When adjustments according age, sex, years in possession of the driving license and intensity of exposure were made, the first factor obtained the score more strongly associated with the accident rate (OR = 1.51; CI95%: 1.25-1.85). Conclusions: The final version (20 circumstances) identified three factors related to higher accident rates among the young drivers. The first one integrated, among other circumstances, the excessive speed and driving while sleepy or tired and it was the most closely associated with the accident rate in the adjusted analysis. The second factor included, among others, the commission of driving offences, and the third one included driving under the influence of alcohol, not always wearing the seat belt and distractions(AU)