The Impact of the Magnitude of the Group of Bullies on Health-Related Quality of Life and Academic Performance Among Adolescents.

This study examines the consequences that physical and verbal/social victimization by peers and the magnitude of the groups of bullies have on academic performance and the psychological and social domains of Health-related Quality of Life (HRQoL). 1428 secondary school students in the south-east Spain completed the Spanish version of the "Adolescent Peer Relations Instrument-Bullying" and "KIDSCREEN-52" questionnaires in order to analyse, respectively, peer victimization and the psychological and social domains of HRQoL. Data on sociodemographic characteristics and academic achievement was also collected. Findings emphasise the potential of peer victimization in all its forms as risk factors explaining poor HRQoL in psychological, social and emotional domains. The number of bullies was an imponent and significant risk factor that explains a worse HRQoL in the five socio-psychological dimensions studied (Odds Ratio 4.08, Odds Ratio 9.25, Odds Ratio 4.69, Odds Ratio 2.91, Odds Ratio 11.92). Nevertheless, peer victimization rarely seems to affect academic achievement. Results suggest that much of prevention and intervention are still needed to reduce peer victimization, focusing on large bullies' groups and their harmful impact on adolescent's HRQoL.

Willingness to get vaccinated with the first-generation vaccines against SARS-CoV-2.

OBJECTIVE: To explore people's decision-making regarding whether or not to get vaccinated against COVID-19. METHODS: A purposive sample of people over the age of 18 who had not yet been vaccinated against COVID-19 was studied. Data were gathered using semi-structured interviews in focus groups and personal in-depth interviews. All interviews were conducted on the Zoom® platform and were recorded for subsequent verbatim transcription. Using a grounded theory approach, both open and axial coding of the narrative data were performed. RESULTS: Information saturation was reached after eight focus group meetings and 14 in-depth interviews (n = 55). Six principal themes emerged, with the fear of possible adverse side-effects and the worries generated by the speed of the development and commercialization of the vaccine amongst the main expressed anxieties. Social pressure to get vaccinated was a recurrent subject, as was the desire for clear and understandable information from reliable sources. CONCLUSIONS: The willingness to get vaccinated against COVID-19 is determined by a complex series of interconnected factors that define an explanatory model, which has evolved concurrently with the development of the vaccines and the progress of the vaccination campaigns. This model will be useful for deciding social scenarios aimed at tackling this or future pandemics and for designing formulas that will increase the initial acceptance of these vaccines.

The impact of resilience as a protective factor on Health-Related Quality of Life's psychological dimensions among adolescents who experience peer victimization.

Peer victimization have a negative impact on Health-Related Quality of Life (HRQoL) during adolescence, however some personal skills such a person's resilience could play a significant role in this relationship. In this context, this study aims to analyse if resilience is a moderator of the relation between peer victimization and HRQoL's psychological dimensions. Sociodemographic data, peer victimization, psychological domains of HRQoL and resilience were measures in a sample of 1428 secondary school students using the following scales: "Adolescent Peer Relations Instrument-Bullying", "KIDSCREEN-52" and "Brief Resilient Coping Scale. Different multivariate analyses were carried out using linear regression. PROCESS tool was used to examine the moderating role of resilience, with John-Neyman post-hoc approach to quantify moderation. Results suggest that resilience could moderate the association between physical (ß = - 0.0021; p = 0.025) and verbal victimization (ß = - 0.0018; p = 0.024) and the "Mood and Emotions" dimension of adolescents' HRQoL. Nevertheless, this regulating influence appears to be faint (∆R2 0.004). Resilience showed no moderating effect between social victimization and psychological dimensions of HRQoL. We concluded that resilience could function as a protective factor that weakly regulates the negative association between physical and verbal victimization and the psychological sphere of adolescents' HRQoL.

Usefulness of population pharmacokinetics to optimize the dosage regimen of infliximab in inflammatory bowel disease patients

INTRODUCTION: infliximab is used in inflammatory bowel disease, which has a great inter-individual pharmacokinetic variability. Thus, it is necessary to individualize the therapy in many cases. The main objective of our study was to compare two methods of a dose adjustment strategy using therapeutic drug monitoring: a) based on an algorithm and b) based on Bayesian prediction, to achieve an optimal infliximab trough level in patients with inflammatory bowel diseases. The secondary objective was to evaluate the predictive performance of a population pharmacokinetic model of infliximab in patients with inflammatory bowel diseases and therefore, its clinical utility. Furthermore, the factors associated with a suboptimal adjustment of the model were analyzed. METHODS: a retrospective observational cohort analysis was performed of patients with inflammatory bowel disease and available serum levels of infliximab. The relationship between trough concentration and dosing strategy was compared in both groups. The external validation of a previously published population pharmacokinetic model was performed using the NONMEM software. The mean prediction error and mean absolute prediction error were calculated to evaluate the predictive performance of the model. RESULTS: a total of 94 infliximab serum samples were obtained from 47 patients. After the adjustment, a total of 30 patients (63.8 %) achieved optimal infliximab trough levels. A dosing strategy based on Bayesian was associated with optimal infliximab trough levels that were higher than the strategy based on an algorithm (OR: 8.94 [95 % CI: 2.24 - 35.6], p = 0.001). For the individual predictions, the mean prediction error was 0.118 Mug/ml (95 % CI: -0.149-0.384) and the mean absolute prediction error was 0.935 Mug/ml (95 % CI: 0.569-1.075). CONCLUSIONS: the application of a population pharmacokinetic model based on Bayesian prediction is an important advance in the optimization of infliximab dosage in the treatment of inflammatory bowel disease

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Usefulness of population pharmacokinetics to optimize the dosage regimen of infliximab in inflammatory bowel disease patients.

INTRODUCTION: infliximab is used in inflammatory bowel disease, which has a great inter-individual pharmacokinetic variability. Thus, it is necessary to individualize the therapy in many cases. The main objective of our study was to compare two methods of a dose adjustment strategy using therapeutic drug monitoring: a) based on an algorithm and b) based on Bayesian prediction, to achieve an optimal infliximab trough level in patients with inflammatory bowel diseases. The secondary objective was to evaluate the predictive performance of a population pharmacokinetic model of infliximab in patients with inflammatory bowel diseases and therefore, its clinical utility. Furthermore, the factors associated with a suboptimal adjustment of the model were analyzed. METHODS: a retrospective observational cohort analysis was performed of patients with inflammatory bowel disease and available serum levels of infliximab. The relationship between trough concentration and dosing strategy was compared in both groups. The external validation of a previously published population pharmacokinetic model was performed using the NONMEM software. The mean prediction error and mean absolute prediction error were calculated to evaluate the predictive performance of the model. RESULTS: a total of 94 infliximab serum samples were obtained from 47 patients. After the adjustment, a total of 30 patients (63.8 %) achieved optimal infliximab trough levels. A dosing strategy based on Bayesian was associated with optimal infliximab trough levels that were higher than the strategy based on an algorithm (OR: 8.94 [95 % CI: 2.24 - 35.6], p = 0.001). For the individual predictions, the mean prediction error was 0.118 µg/ml (95 % CI: -0.149-0.384) and the mean absolute prediction error was 0.935 µg/ml (95 % CI: 0.569-1.075). CONCLUSIONS: the application of a population pharmacokinetic model based on Bayesian prediction is an important advance in the optimization of infliximab dosage in the treatment of inflammatory bowel disease.

Usefulness of therapeutic drug monitoring of infliximab during the induction period in patients with inflammatory bowel disease

INTRODUCTION: previous studies have shown that higher infliximab trough levels are associated with favorable shortterm and long-term therapeutic outcomes in inflammatory bowel disease. There is a need to determine which patients could benefit from proactive therapeutic drug monitoring in the induction phase. The aim of this study was to evaluate the pharmacokinetic variability of infliximab, determine the factors associated with achieving target infliximab trough levels in the induction phase and analyze the clinical and biochemical response at week 26 of treatment. PATIENTS AND METHODS: a retrospective observational study was performed of patients with inflammatory bowel disease and data available on serum levels of infliximab during the induction period. The percentage of patients that achieved target infliximab trough levels at week 6 was determined. Clinical remission and response and biochemical remission were evaluated at week 26. RESULTS: thirty patients were included and only 13 (43.3 %) had infliximab trough levels > 15 μg/mL at week 6. A clinical response was observed during the maintenance period in 71.4 % of patients, their infliximab levels were significantly higher than in non-responders (6.3 μg/mL [IQR: 6.7] vs 1.0 μg/mL [IQR: 5.0], respectively; p = 0.016). Likewise, 53.6 % of patients achieved biochemical remission (responders 6.2 μg/mL [IQR: 5.2] vs non-responders 3.2 μg/mL [IQR: 5.0]; p = 0.031). CONCLUSION: less than half of patients had target infliximab levels during the induction period. Therapeutic drug monitoring during this period is related to the achievement of therapeutic levels of infliximab and may lead to a better clinical response in these patients

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Usefulness of therapeutic drug monitoring of infliximab during the induction period in patients with inflammatory bowel disease.

INTRODUCTION: previous studies have shown that higher infliximab trough levels are associated with favorable short-term and long-term therapeutic outcomes in inflammatory bowel disease. There is a need to determine which patients could benefit from proactive therapeutic drug monitoring in the induction phase. The aim of this study was to evaluate the pharmacokinetic variability of infliximab, determine the factors associated with achieving target infliximab trough levels in the induction phase and analyze the clinical and biochemical response at week 26 of treatment. PATIENTS AND METHODS: a retrospective observational study was performed of patients with inflammatory bowel disease and data available on serum levels of infliximab during the induction period. The percentage of patients that achieved target infliximab trough levels at week 6 was determined. Clinical remission and response and biochemical remission were evaluated at week 26. RESULTS: thirty patients were included and only 13 (43.3 %) had infliximab trough levels > 15 µg/mL at week 6. A clinical response was observed during the maintenance period in 71.4 % of patients, their infliximab levels were significantly higher than in non-responders (6.3 µg/mL [IQR: 6.7] vs 1.0 µg/mL [IQR: 5.0], respectively; p = 0.016). Likewise, 53.6 % of patients achieved biochemical remission (responders 6.2 µg/mL [IQR: 5.2] vs non-responders 3.2 µg/mL [IQR: 5.0]; p = 0.031). CONCLUSION: less than half of patients had target infliximab levels during the induction period. Therapeutic drug monitoring during this period is related to the achievement of therapeutic levels of infliximab and may lead to a better clinical response in these patients.

Comparison of drug survival between infliximab and adalimumab in inflammatory bowel disease.

Background Conventional therapy of inflammatory bowel disease with traditional immunosuppressant medication is increasingly being replaced by biological agents. However, the response to these biological agents may be lost over time, with discontinuation being a marker of loss of effectiveness. There are few published reports on the treatment drug survival of infliximab and adalimumab in patients with inflammatory bowel disease. Objective This study compared the drug survival of infliximab versus adalimumab as first- and second-line treatments, identified factors associated with drug survival, and described reasons for treatment withdrawal. Setting A pharmacy department of a university hospital in Spain. Method A retrospective single-centre cohort study of all patients with inflammatory bowel disease treated with biological agents between 2008 and 2017 at a regional referral hospital. The primary outcome was drug survival and associated factors during a follow-up of 52 months. Main outcome measure Drug survival of infliximab versus adalimumab. Results One hundred thirty-four patients with inflammatory bowel disease (73.9% Crohn's disease and 26.1% ulcerative colitis) were treated with biological therapy. The overall mean drug survival of first-line treatment with an anti-tumour necrosis factor agent was 18.6 months (SD 14.9), with mean values of 20.2 months (SD 16.6) for adalimumab and 17.1 months (SD 13.1) for infliximab. As a second-line treatment, the drug survival of anti-tumour necrosis factor agents was 17.9 months (SD 15.6), with mean values of 22.9 months (SD 17.1) for adalimumab and 12.5 months (SD 11.7) for infliximab. The difference in time to discontinuation at 52 months of follow-up between the infliximab and adalimumab subgroups, as either first- or second-line treatment, was not statistically significant (p = 0.547 and p = 0.676, respectively). Therapeutic drug monitoring was the only factor associated with greater drug survival in first-line treatment (HR 0.27; 95% confidence interval, CI 0.15-0.50) and second-line treatment (HR 0.26; 95% CI 0.10-0.65). Secondary failure to treatment was the most frequent reason for withdrawal. Conclusion Infliximab and adalimumab showed similar drug survival as first- and second-line anti-tumour necrosis factor treatments. Therapeutic drug monitoring was associated with higher drug survival for both first- and second-line anti-tumour necrosis factor treatments.

Validity of self blood pressure measurement in the control of the hypertensive patient: factors involved.

BACKGROUND: Improving clinical practice aimed at controlling hypertension is a pending issue in health systems. One of the methods currently used for this purpose is self blood pressure measurement (SBPM) whose use increases every day. The aims of this study are to establish the optimal cut-off point for the 3-day SMBP protocol and to identify factors that could affect the precision of the 3-day SMBP protocol using 24-h ambulatory blood pressure monitoring (ABPM) as a reference. METHOD: This is a cross-sectional descriptive study to validate a diagnostic test performed by a primary care team in Murcia, Spain. A total of 153 hypertensive patients under 80 years of age who met the inclusion criteria were evaluated. ABPM was performed for 24 h. The SBPM protocol consisted of recording 2 measurements in the morning and 2 at night for 3 days. RESULTS: The cut-off point for SBP was set at 135 mmHg (sensitivity: 80.39%, specificity: 74.19%), and for DBP, it was set at 83 mmHg (sensitivity: 76.48%, specificity: 84.89%), which yielded the highest combined sensitivity and specificity. After carrying out the validation study with the new figures, we proceeded to establish which socio-demographic factors prevented a correct classification of patients. These errors were more common in male patients for the assessments of both DBP (OR = 2.4) and SBP (OR = 2.5); hypertensive patients with age < 67,5 years (OR = 1,5); having no work activity (OR = 3,6) and with concomitant chronic kidney disease (CKD) (OR = 5.0). CONCLUSION: Being male, older than 67.5 years, with CKD or with no work activity increases the probability of being misclassified for hypertension during follow-up as assessed by SBPM over 3 days. TRIAL REGISTRATION: This study was approved by the research ethics committee of the University of Murcia under registration number 1018/2015.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain.

This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain / Interações medicamentosas potenciais e clinicamente relevantes em instituições de longa permanência para idosos: um estudo multicêntrico em Murcia, Espanha

Abstract This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.

Resumo Este estudo pretende identificar a prevalência de interações medicamentosas potenciais (IMP) em idosos institucionalizados e seus fatores associados. Realizamos um estudo observacional, multicêntrico e transversal, durante o último trimestre de 2010. Selecionamos uma amostra de 275 sujeitos (≥ 65 anos) de 10 instituições para idosos de Murcia (Espanha) mediante amostragem aleatória complexa em duas etapas. As IMP foram identificadas usando a base de dados do College of Pharmacists. Estimamos a prevalência de IMP de relevância clínica e analisamos os fatores associados com análise de regressão uni e multinível. Identificamos 210 IMP, das quais 120 foram consideradas clinicamente relevantes (57,1%) e afetaram 70 idosos (25,8%). Oito grupos farmacológicos constituíram 70,2% das IMP clinicamente relevantes. A prevalência de IMP esteve associada à multimorbidade (OR = 2,3; IC 95% = 1,4-4,5) e tomar dez ou mais medicamentos diariamente (OR = 9,6; IC95% = 4,8-19,1) e uso de medicamentos anti-inflamatórios (OR = 3,9; IC 95% = 1,4-10,4). Este estudo revela que as IMP clinicamente relevantes são muito comuns em idosos institucionalizados e que os serviços devem melhorar seus processos para reduzir a prevalência deste fenômeno.

Incorporación de los anticoagulantes de acción directa al arsenal terapéutico disponible: ¿progresa adecuadamente? / Incorporation of direct-acting oral anticoagulants to available therapeutic arsenal: Progress adequately?

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[Gastrointestinal bleeding and potentially inappropriate medication by NSAIDs]. / Hemorragia digestiva y prescripción potencialmente inadecuada de AINEs en mayores de 65 años.

OBJECTIVE: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely used but they increase the risk of gastrointestinal haemorrage among other adverse effects. The objective of this study was to compare potentially inappropriate medications (PIM) by NSAIDs using the original Beers Criteria, a global reference for evaluating elderly people's prescriptions, and the Spanish adaptation of the same; and the relation between PIM of NSAIDs and gastrointestinal bleeding. METHODS: The study was a retrospective observational study carried out located in a primary care district in the province of de Murcia, south-eastern Spain. The study population (n=7.856) were citizens aged 65 and above, with at least one drug prescribed in a Spanish health district during the study period . We analized illnesses and treatments registered in the primary care's electronic medical history of patients and hospital admissions, during the 12 month study period (2012). The original Beers Criteria and their Spanish adaptation were used to evaluate PIM of NSAIDs in patients considering the medication globally and also each active substance. Gastrointestinal bleeding events recorded in the data bases studied were evaluated. RESULTS: Detection of PIM of NSAIDs was 5,6% with the original version and 7,0% (Δ=25,5%; p less than 0,001) with the adapted one. PIM of NSAIDs was related with an increased incidence of gastrointestinal bleeding without significant differences between PIM exposed and NSAID exposed patients AINE (RR=1,6; IC:0,2-14,5). CONCLUSIONS: The Spanish adaptation of the Beers criteria identified a greater degree of PIM of NSAIDs than the original version, and in both versions the detection of PIM was not related with a significant increase of gastrointestinal bleeding compared to patients exposed to NSAIDs.

OBJETIVO: Los Antiinflamatorios No Esteroideos (AINE) son un grupo de medicamentos con uso muy extendido en la población, su uso genera un mayor riesgo de hemorragia digestiva. El objetivo de este trabajo fue evaluar y comparar la prescripción potencialmente inadecuada (PPI) de AINE según los criterios de Beers en su versión original con su adaptación española y la relación de esta PPI con los eventos de sangrado gastrointestinal. METODOS: Estudio observacional longitudinal retrospectivo de 12 meses (año 2012) realizado en un área de salud de la Región de Murcia. La población estudiada fue los mayores de 65 años a los que se les había prescrito, al menos, 1 receta médica de AINE durante el periodo de estudio (7.856). Se utilizaron ambas versiones de los criterios de Beers para evaluar la PPI por AINE. Para evaluar el papel etiológico de la exposición a AINE potencialmente inadecuados, respecto a haber recibido AINE, en la hemorragia gastrointestinal se calculó la incidencia acumulada y el Riesgo Relativo. RESULTADOS: La detección de PPI por AINE pasó de 5,6% con la versión original, a 7,0% (Δ=25,5%; pmenor de 0,001) En los sujetos con prescripción de AINE la exposición a PPI por AINE presentó una mayor incidencia de sangrado gastrointestinal pero sin diferencias significativas respecto a la población que recibió AINE (RR=1,6; IC:0,2-14,5). CONCLUSIONES: El uso de la adaptación española de los criterios de Beers posibilita una mayor detección de PPI por AINE en comparación con el uso de la versión original, en ambas versiones, la PPI por AINE no genera un incremento significativo en el sangrado gastrointestinal respecto a recibir AINE.

Prescripción potencialmente inadecuada en mayores de 65 años según los criterios de Beers originales y su versión adaptada / Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation

Objetivo: Comparar la detección de prescripción potencialmente inadecuada (PPI) con el uso de los criterios de Beers, referente global en la evaluación de la farmacoterapia del paciente aciano, en su versión original y en su adaptación española. Diseño: Estudio observacional retrospectivo. Emplazamiento: Un área de salud en la Región de Murcia. Participantes: Ciudadanos mayores de 65 años que hayan recogido, al menos, una receta médica durante el periodo de estudio (n = 7.856). Método: Análisis de la información de la historia clínica informatizada de atención primaria (enfermedades y prescripciones) durante el periodo de estudio (12 meses, año 2012). Se utilizaron los criterios de Beers en su versión original de 2012 y su adaptación española para evaluar la PPI. Se estudió la proporción de pacientes con PPI a nivel global y por cada criterio concreto, y la diferencia entre ambas versiones. Resultados: La mediana de edad de la población estudiada fue de 76años, con predominio del sexo femenino (56,6%). Respecto al uso de medicamentos, la muestra presentó una mediana de 13 principios activos y 66 recetas. Respecto a la población estudiada, el porcentaje de pacientes con PPI según la versión original de los criterios de Beers es del 44,8%, ascendiendo al 49,4% cuando se utiliza la adaptación. Conclusiones: La PPI es frecuente en nuestro entorno. La aplicación directa de los criterios de Beers en su versión original, sin tener en cuenta la idiosincrasia del mercado farmacéutico local, proporciona una infraestimación del volumen de PPI en el paciente mayor de 65 años (AU)

Objective: To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. Design: Retrospective observational study Location: A Primary Care area in the province of Murcia, Spain. Participants: A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. Method: Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12 month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. Results: The median age of the patients was 76.0 years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. Conclusions: PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied (AU)

Conocimientos, creencias y actitudes de la población gitana ante el cribado del cáncer colorrectal / Knowledge, beliefs and attitudes of the Roma population regarding colorectal cancer screening

Objetivo: Identificar los factores predisponentes, inhibidores y facilitadores que pueden afectar a la participación en los programas de cribado del cáncer colorrectal en la población gitana. Método: Estudio cualitativo exploratorio mediante técnica de grupo focal. Se realizaron tres grupos focales de hombres y tres de mujeres, con un total de 16 hombres y 18 mujeres participantes de población romaní, de 50-69 años de edad, de la provincia de Alicante. Se realizó un análisis del discurso con el modelo PRECEDE como marco de análisis. Resultados: Se identificaron diversas barreras a la participación, como la aversión de la población gitana a hablar de cáncer, el rechazo a anticipar un diagnóstico que puede provocar sufrimiento de la persona y su entorno familiar, escaso conocimiento de la enfermedad y del programa preventivo, rechazo hacia la recogida y manejo de las muestras, miedo y vergüenza ante la posible colonoscopia, aceptación de la voluntad divina, dificultades de comprensión y lectura, y percepción de estar discriminados por su etnia en el ámbito sanitario. Sin embargo, se identificaron factores predisponentes a la participación en el programa de cribado, como la predisposición favorable a recibir información pertinente a través de vías más apropiadas, así como su confianza en el consejo profesional. Conclusión: La predisposición a recibir la recomendación de participar en los programas de cribado colorrectal y una información comprensible de los profesionales sanitarios permiten entrever posibles estrategias de aproximación a este colectivo. Esto podría contribuir a la mejora de la participación de la población gitana en el programa de cribado de cáncer colorrectal y abrir nuevas vías para promover conductas preventivas (AU)

Objective: To identify predisposing, inhibitory and facilitating factors that may affect participation in colorectal cancer screening programs in the Roma population. Method: Qualitative and exploratory study by focus group technique. Three focus groups of men and three groups of women were carried out, with a total of 16 men and 18 women from the Roma population, aged 50-69 years, from the province of Alicante. A discourse analysis was performed with the PRECEDE model as an analysis framework. Results: Several barriers to participation were identified, such as the aversion of the Roma population to talk about cancer, refusal to anticipate a diagnosis that can cause suffering to the person and their family, poor knowledge of the disease and the preventive programmes, refusal to collect and handle samples, fear and shame about the colonoscopy, acceptance of divine will, difficulties in understanding and reading, and the perception of being discriminated by their ethnicity in the health sector. However, predisposing factors to participate in the screening programme also were identified, for example willingness to receive relevant information through more appropriate pathways, as well as their confidence in professional counselling. Conclusion: A willingness to receive the recommendation to participate and understanding information from health professionals have been identified. This will enable us to envisage potential strategies for approaching this population group. This could contribute to improved participation of the Roma population in colorectal cancer screening programmes and to open up new ways to promote preventive behaviours (AU)

Hemorragia digestiva y prescripción potencialmente inadecuada de aines en mayores de 65 años / Gastrointestinal bleeding and potentially inappropriate medication by NSAIDs

Fundamentos: Los Antiinflamatorios No Esteroideos (AINE) son un grupo de medicamentos con uso muy extendido en la población, su uso genera un mayor riesgo de hemorragia digestiva. El objetivo de este trabajo fue evaluar y comparar la prescripción potencialmente inadecuada (PPI) de AINE según los criterios de Beers en su versión original con su adaptación española y la relación de esta PPI con los eventos de sangrado gastrointestinal. Métodos: Estudio observacional longitudinal retrospectivo de 12 meses (año 2012) realizado en un área de salud de la Región de Murcia. La población estudiada fue los mayores de 65 años a los que se les había prescrito, al menos, 1 receta médica de AINE durante el periodo de estudio (7.856). Se utilizaron ambas versiones de los criterios de Beers para evaluar la PPI por AINE. Para evaluar el papel etiológico de la exposición a AINE potencialmente inadecuados, respecto a haber recibido AINE, en la hemorragia gastrointestinal se calculó la incidencia acumulada y el Riesgo Relativo. Resultados: La detección de PPI por AINE pasó de 5,6% con la versión original, a 7,0% (DELTA=25,5%; p<0,001) En los sujetos con prescripción de AINE la exposición a PPI por AINE presentó una mayor incidencia de sangrado gastrointestinal pero sin diferencias significativas respecto a la población que recibió AINE (RR=1,6; IC:0,2-14,5). Conclusiones: El uso de la adaptación española de los criterios de Beers posibilita una mayor detección de PPI por AINE en comparación con el uso de la versión original, en ambas versiones, la PPI por AINE no genera un incremento significativo en el sangrado gastrointestinal respecto a recibir AINE

Background: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely used but they increase the risk of gastrointestinal haemorrage among other adverse effects. The objective of this study was to compare potentially inappropriate medications (PIM) by NSAIDs using the original Beers Criteria, a global reference for evaluating elderly people's prescriptions, and the Spanish adaptation of the same; and the relation between PIM of NSAIDs and gastrointestinal bleeding. Methods: The study was a retrospective observational study carried out located in a primary care district in the province of de Murcia, south-eastern Spain. The study population (n=7.856) were citizens aged 65 and above, with at least one drug prescribed in a Spanish health district during the study period . We analized illnesses and treatments registered in the primary care's electronic medical history of patients and hospital admissions, during the 12 month study period (2012). The original Beers Criteria and their Spanish adaptation were used to evaluate PIM of NSAIDs in patients considering the medication globally and also each active substance. Gastrointestinal bleeding events recorded in the data bases studied were evaluated. Results: Detection of PIM of NSAIDs was 5,6% with the original version and 7,0% (DELTA=25,5%; p<0,001) with the adapted one. PIM of NSAIDs was related with an increased incidence of gastrointestinal bleeding without significant differences between PIM exposed and NSAID exposed patients AINE (RR=1,6; IC:0,2-14,5). Conclusions: The Spanish adaptation of the Beers criteria identified a greater degree of PIM of NSAIDs than the original version, and in both versions the detection of PIM was not related with a significant increase of gastrointestinal bleeding compared to patients exposed to NSAIDs

[Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation]. / Prescripción potencialmente inadecuada en mayores de 65 años según los criterios de Beers originales y su versión adaptada.

OBJECTIVE: To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. DESIGN: Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain. PARTICIPANTS: A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. METHOD: Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. RESULTS: The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. CONCLUSIONS: PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied.

[Knowledge, beliefs and attitudes of the Roma population regarding colorectal cancer screening]. / Conocimientos, creencias y actitudes de la población gitana ante el cribado del cáncer colorrectal.

OBJECTIVE: To identify predisposing, inhibitory and facilitating factors that may affect participation in colorectal cancer screening programs in the Roma population. METHOD: Qualitative and exploratory study by focus group technique. Three focus groups of men and three groups of women were carried out, with a total of 16 men and 18 women from the Roma population, aged 50-69 years, from the province of Alicante. A discourse analysis was performed with the PRECEDE model as an analysis framework. RESULTS: Several barriers to participation were identified, such as the aversion of the Roma population to talk about cancer, refusal to anticipate a diagnosis that can cause suffering to the person and their family, poor knowledge of the disease and the preventive programmes, refusal to collect and handle samples, fear and shame about the colonoscopy, acceptance of divine will, difficulties in understanding and reading, and the perception of being discriminated by their ethnicity in the health sector. However, predisposing factors to participate in the screening programme also were identified, for example willingness to receive relevant information through more appropriate pathways, as well as their confidence in professional counselling. CONCLUSION: A willingness to receive the recommendation to participate and understanding information from health professionals have been identified. This will enable us to envisage potential strategies for approaching this population group. This could contribute to improved participation of the Roma population in colorectal cancer screening programmes and to open up new ways to promote preventive behaviours.

Components of quality of life in a sample of patients with lupus: a confirmatory factor analysis and Rasch modeling of the LupusQoL.

The objective of this study was to test different exploratory solutions to the LupusQoL scale in a sample of Spanish patients with SLE using confirmatory factor analysis (CFA) and Rasch modeling, as well as to estimate the convergent validity. The χ 2 test, RMSEA, CFI, and TLI were used to test the fit of the different exploratory structures with CFA. To estimate the parameters in the dimensions found, a rating scale Rasch multidimensional random coefficient multinomial logit model was used. The reliability of the scores was obtained with coefficient alpha and coefficient omega. The convergent validity was calculated using Spearman's rho. Four hundred and fifty patients participated but complete data were available for 223 subjects. The original version (UK) and the French version obtained the best fit, showing that the proposed original structure was the best solution for the structure of the LupusQoL scale in the Spanish sample. The multidimensional solution of eight dimensions was adequate, but item 8 in physical health, item 16 in intimate relations, and items 29 and 30 obtained mean squares >1.6. Internal consistency and coefficient omega of the scores in the eight domains were higher. The Spanish version of LupusQoL correlated strongly with the corresponding SLAQ, EQ5D analogic scale, and EQ5D domain. This analysis confirmed the structure of eight dimensions of the original version in patients with SLE.