Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018 / Morbimortalidad de las infecciones del tracto respiratorio inferior en España, 1997-2018

Background:Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. Methods:An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchio-litis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. Results:Overall, 3.5 % (IQR: 3.4-3.5 %) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p < 0.001) and increased by 65.7 % from 1997 to 2018. A 41.2 % of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p < 0,001). In 89.1 % of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8 %, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7 %; p < 0.001) and doubled from 1997 to 2018 (5,257 deaths in 1997 and 10,514 in 2018). A 75.5 % of the deaths occurred amongst people over 74 years.Conclusions:LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute towards the prevention and treatment of LRTIs need to be adopted.(AU)

Fundamento: Las infecciones del tracto respiratorio inferior (ITRI) constituyen una de las principales causas de mortalidad por enfermedades infecciosas a nivel mundial. Los objetivos del estudio consistieron en determinar la incidencia de hospitalizaciones por ITRI, y en analizar los resultados clínicos de los pacientes hospitalizados. Métodos: Se llevó a cabo un estudio observacional de las hospitalizaciones por ITRI (neumonía y bronquitis/bronquiolitis aguda) en España entre 1997-2018. Los datos se extrajeron del Registro Español de Atención Sanitaria Especializada. Resultados: El 3,5% (RIC: 3,4-3,5%) del total de hospitalizaciones se debieron a ITRI, con una incidencia mediana de 31,2 (RIC: 27,8-33,0) por cada 10.000 habitantes/año. La mediana de incidencia fue superior para las neumonías que para las bronquitis/bronquiolitis agudas (22,2; RIC: 19,1-23,5 vs. 9,0; RIC: 8,4-9,6 por 10.000 habitantes/año; p<0,001), y entre 1997-2018 aumentó un 65,7%. Un 41,2% de las hospitalizaciones por ITRI ocurrieron en mayores de 74 años. La mediana de duración de las hospitalizaciones por ITRI fue 8,9 días (RIC: 7,6-10,4), superior para neumonías (9,5 días; RIC: 8,3-10,6 vs. 5,7; RIC: 5,5-6,2; p<0,001). En un 89,1% de las hospitalizaciones por ITRI los pacientes fueron dados de alta a domicilio. La mortalidad intrahospitalaria fue 6,8%, con 9.380 fallecimientos anuales (RIC: 8,192-10,157). La mortalidad fue superior para neumonías (9,0 vs. 1,7%; p<0,001) y se duplicó entre 1997 y 2018 (5.257 fallecimientos en 1997 y 10.514 en 2018). El 75,5% de las muertes ocurrieron en mayores de 74 años. Conclusiones: Las ITRI se asocian a una elevada morbimortalidad. Se requieren medidas efectivas para su prevención y tratamiento.(AU)

Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018.

BACKGROUND: Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. METHODS: An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchiolitis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. RESULTS: Overall, 3.5% (IQR: 3.4-3.5%) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p<0.001) and increased by 65.7% from 1997 to 2018. A 41.2% of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p<0,001). In 89.1% of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8%, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7%; p

Effect of “triple whammy” combination in hospitalization due to acute kidney injury: a protocol of a nested case-control study / Efecto de la combinación «triple whammy» en la hospitalización por fallo renal agudo: protocolo del estudio de casos y controles anidado en una cohorte

Objective: Acute kidney injury (AKI) is a life-threatening condition characterized by an abrupt deterioration in kidney function. The simultaneous use of diuretics, renin-angiotensin-aldosterone system inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizol, known as «triple whammy» (TW), has been associated with an increased risk of AKI. The main objective of the study is to analyse the risk of hospitalization due to AKI with the TW combination versus non-exposure to TW. Additionally, hospitalization due to AKI according to the time and duration of the TW exposure, and depending on whether the TW includes NSAIDs or metamizol; mortality; and the requirement of renal replacement therapy will be determined.Methods: A case-control study nested in a cohort will be carried out. Data for the study will be extracted from the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP), managed by the Spanish Agency for Medicines and Medicine and Health Products (AEMPS). Adults admitted to hospital due to AKI between 2010 and 2018 (cases) will be matched with up to 10 controls per case. The exposure to TW during the 12 months prior to the index date will be determined. The association between the exposure to TW and the outcomes will be analysed using multivariate logistic regression models adjusting by potential confounding factors. A subgroup analysis will be performed to evaluate the risk of hospitalization due to AKI with the exposure to TW in patients older than 75 years. (AU)

Objetivo: El fallo renal agudo (FRA) se caracteriza por un deterioro abrupto de la función renal que puede aumentar el riesgo de mortalidad. El uso simultáneo de diuréticos, antihipertensivos inhibidores del sistema renina-angiotensina, y antiinflamatorios no esteroideos (AINE) o metamizol, conocido como “triple whammy” (TW), se ha visto asociado a un incremento del riesgo de FRA. El objetivo principal consiste en analizar el riesgo de hospitalización por FRA con la combinación TW frente a la no exposición a dicha combinación. Adicionalmente se analizará la hospitalización por FRA en función del momento de la exposición a TW y de su duración, y dependiendo de si la TW incluye AINE o metamizol; la mortalidad; y el requerimiento de terapia de reemplazo renal.Métodos: Se llevará a cabo un estudio de casos y controles anidado en una cohorte. Los datos para el estudio se extraerán de la Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), gestionada por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Los adultos con hospitalización por FRA entre 2010-2018 (casos) se emparejarán con hasta 10 controles por caso. La asociación entre la exposición a TW y las variables de resultado se analizará mediante modelos de regresión logística ajustados por potenciales factores de confusión. Se realizará un análisis de subgrupos para evaluar la variable principal en pacientes mayores de 75 años. (AU)

Transparencia, equidad y acceso a los medicamentos: a propósito de la pandemia por COVID-19 / Transparency, equity and access to medicines: talking of the COVID-19 pandemic

La pandemia por COVID-19 ha generado una crisis a todos los niveles, desde el sanitario hasta el económico, laboral y social. Los sistemas sanitarios han mostrado una enorme capacidad de adaptación a las necesidades, que han requerido de rápidas actuaciones. Realizar un análisis de la situación es esencial para redimensionar las necesidades y hacer un uso más eficiente de los recursos disponibles con vistas a futuro. Algunas de las cuestiones que nos permitirán avanzar para garantizar que el sistema siga siendo sostenible y equitativo son el disponer de investigación científica de calidad y realizar una evaluación crítica de la misma, la prudencia en la práctica médica, la transparencia y el acceso a la información, la inversión pública en I+D+I, el desarrollo de nuevos modelos de financiación de medicamentos y la cooperación internacional

The COVID-19 pandemic has generated a crisis at all levels, from health sector to the economic, working and social fields. Health systems have shown an enormous capacity to adapt to the needs, which have required rapid actions. To carry out an analysis of the situation is essential to resize needs and make a more efficient use of available resources with a view to the future. Some of the issues that will allow us to make progress in ensuring that the system remains sustainable and equitable are good quality scientific research with appropriate critical appraisal, prudence in medical practice, transparency and access to information, public investment in R+D+I, development of new drug financing models and international cooperation

Validation and incidence of community-acquired pneumonia in patients with type 2 diabetes in the BIFAP database.

Oral anti-diabetic drugs (OADs) have been associated with community-acquired pneumonia (CAP). We aimed to validate the recording of CAP in the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP) for the future evaluation of OAD-CAP association. The incidence rate (IR/1000 person-years) of CAP in type 2 diabetes mellitus (T2DM) was also determined. In total, 2966 pneumonia records (2040 listed as diagnosis and 926 as identified from comments added by physicians) were identified from 76 009 patients with T2DM after the first OAD in 2002-2013. Data around the CAP date were reviewed: 1803 (60·9%) were classified as 'probable CAP' (confirmed by X-ray/laboratory, referral letters or CAP lung site); 589 (19·8%) as 'no-case' (486 had other illness, 78 previous CAP, 25 cancer); and 574 (19·4%) as 'possible CAP' (441 without confirmatory information, 133 with uncertain diagnosis or uncertain diagnosis date). In total, 74·2% and 31·4% of pneumonia records in the diagnosis and comments, respectively, were 'probable cases' (IR: 6·04), which increased to 90·5% and 42·9%, respectively, when the 441 'possible cases' without confirmatory information were included (IR: 7·52). In summary, diagnosis had a high positive predictive value, and adding cases automatically detected from comments decreased that value significantly.

Utilización de fármacos para la osteoporosis / Drugs prescription for osteoporosis

El objetivo de este estudio es analizar la evolución del uso global y relativo de fármacos indicados en la osteoporosis durante el periodo comprendido entre 1998 y 2002 en Navarra y su adecuación a las evidencias actuales, haciendo referencia a las diferencias del perfil de prescripción en atención primaria y especializada. Para ello se explota la información de todas las recetas prescritas dentro del Sistema Nacional de Salud en las que se indica alguno de estos fármacos, dispensadas en oficinas de farmacia de Navarra y facturadas al Servicio Navarro de Salud-Osasunbidea (SNS-O).El perfil de utilización de fármacos en la osteoporosis difiere significativamente según el tipo de especialista que prescribe. Sería conveniente homogeneizar el abordaje de la prevención de fracturas óseas. En el periodo en estudio el uso de fármacos en Navarra aumentó en un 85,6 por ciento en número de dosis/1.000 habitantes/día. El uso relativo de terapia hormonal sustitutiva disminuye de forma constante, el empleo de calcitoninas es sostenido, experimentando un perfil cíclico con picos en invierno y valles en verano, mientras que los bifosfonatos y raloxifeno tienden al aumento de uso relativo. Sería deseable evaluar los resultados en salud de la utilización de estos fármacos en la práctica clínica dados los discretos resultados de eficacia que se obtienen en los ensayos clínicos. Se debería fomentar más el uso de calcio por su potencial en la prevención de fracturas de cadera frente al resto de alternativas farmacológicas. El uso relativo de raloxifeno y calcitoninas parece excesivo (AU)

[Drugs prescription for osteoporosis]. / Utilización de fármacos para la osteoporosis.

The aim of this study is to analyse the evolution of the global and relative use of medicines recommended for osteoporosis during the period between 1998 and 2002 in Navarra, and their adaptation to present evidence, making reference to the differences in the prescription profile in primary and specialised care. To this end, information is used from all the prescriptions made within the National Health System where one of these medicines is recommended, issued in pharmacies of Navarra, and billed to the Navarra Health Service-Osasunbidea. The profile of the use of medicines in osteoporosis differs significantly depending on the type of specialist who prescribes them. It would be useful to homogenise the approach to the prevention of bone fractures. In the period under study the use of medicines in Navarra rose by some 85.6% in number of dose/1,000 inhabitants/day. The relative use of hormone replacement therapy fell constantly, the employment of calcitonins remained steady, undergoing a cyclical profile of peaks in winter and valleys in summer, while the relative use of biphosphonates and raloxifen tended to increase. There is a need to evaluate the results on health of the use of these medicines in clinical practice given the discreet efficacy results obtained in clinical trials. Use of calcium should be encouraged because of its potential in the prevention of hip fractures against the rest of the medicinal alternatives. The relative use of raloxifen and calcitonins seems excessive.

[Multicenter study of prescription-indication of antacids and antiulcer agents in primary care]. / Estudio multicéntrico prescripción-indicación de antiácidos y antiulcerosos en atención primaria.

OBJECTIVES: To analyse the prevalence in primary care of use of drugs to treat acidity and ulcers, and to study how prescription of these medicines matches up with indication. DESIGN: Crossover study of 1213 clinical histories selected according to simple random sampling. SETTING: 6 health centres in Navarra. PATIENTS: 370 histories with a record of use of one of the drugs under study were chosen. MEASUREMENTS AND MAIN RESULTS: Between March and June 1997, third-year family and community medicine interns collected data based on a questionnaire designed by the Pharmaceutical Provision Service of the Navarra Health Service-Osasunbidea, where the information was subsequently processed. The prevalence of patients in treatment with the drugs being studied was 30.5%. On the use of these medicines as prophylactics (n = 206), 74.3% were indicated as gastro-protection by NSAIDs (n = 153). The risk factors recorded in these cases were described, by which at least 39.9% of the prescriptions were unjustified. In general the proton pump inhibitors were prescribed more by specialists (43.7% vs. 16.4%, p < 0.001), whereas primary care doctors used more drugs for acidity (40.8% vs 21.8%, p < 0.001) and zinc acexamate (7.7% vs. 0.7%, p = 0.002). The main differences between PC and specialists was seen in duodenal ulcer treatment and prevention with NSAIDs of gastropathy. CONCLUSION: These results suggest it would be appropriate to establish mixed protocols (primary/specialist care) in order to tackle peptic ulcers better.