Indications related to antidepressant prescribing in the Nivel-PCD database and the SIDIAP database.

BACKGROUND: Antidepressant drug consumption has increased, mainly in the elderly. This trend could be explained by the use for indications other than depression. We aimed to describe the indications related to antidepressant drug new users in two primary care settings. METHODS: A longitudinal study of new antidepressant users aged ≥65 was conducted, with data from the Nivel-PCD (The Netherlands) and SIDIAP (Catalonia) databases (2010-2015). As a proxy for indication, diagnoses registered around the 3 months of antidepressant prescribing were collected. Indications were classified in seven categories and an additional one of non-selected indications. The percentage and incidence calculated over the total population registered was described. RESULTS: A total of 16,537 and 199,168 new antidepressant users were identified in the Nivel-PCD and SIDIAP databases, respectively (women aged 65-69 were the most prevalent). Depression was the most frequent indication (24.0% and 31.3%), followed by anxiety (12.5% and 19.5%) and sleep disorders (10.2% and 26.4%). Tricyclic antidepressants were the most commonly prescribed in Nivel-PCD (48.7%), mainly associated with neuropathic pain, and selective serotonin reuptake inhibitor antidepressants in SIDIAP (63.1%), associated with depression. The non-selected indications category showed an upward trend in the Nivel-PCD database while in the SIDIAP database it decreased. LIMITATIONS: It is not mandatory for physicians to register a diagnosis with each prescription. CONCLUSIONS: Depression was the most common prescribing indication in The Netherlands and Spain, followed by anxiety and sleep disorders. The most commonly prescribed antidepressant differed between the countries and is likely explained by differences in local guidelines.

Unleashing the full power of LHCb to probe stealth new physics.

In this paper, we describe the potential of the LHCb experiment to detect stealth physics. This refers to dynamics beyond the standard model that would elude searches that focus on energetic objects or precision measurements of known processes. Stealth signatures include long-lived particles and light resonances that are produced very rarely or together with overwhelming backgrounds. We will discuss why LHCb is equipped to discover this kind of physics at the Large Hadron Collider and provide examples of well-motivated theoretical models that can be probed with great detail at the experiment.

Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Cross-National Comparison in Six European Countries (2008-2015).

Aims: To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Methods: Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008-2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases. Results: The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases. Conclusion: Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH).

Study of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use?

BACKGROUND: We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007-2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants. METHODS: We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption. RESULTS: The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed "others AD". Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model. LIMITATIONS: This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance. CONCLUSIONS: AD use increased through 2007-2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.

Inappropriate prescribing in elderly people with diabetes admitted to hospital.

AIMS: To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS: In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS: Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS: Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.

Salud infantil y cooperación internacional: una aproximación pediátrica / Child health and international cooperation: A paediatric approach

La cooperación internacional al desarrollo en salud infantil despierta un especial interés en el ámbito pediátrico. En los últimos decenios se han ido revelando nuevas evidencias en torno al análisis de los factores vinculados a la morbimortalidad en las primeras etapas de la vida en los países menos adelantados. Este mayor conocimiento del origen de los problemas de salud y las posibles respuestas en forma de intervenciones con impacto determina la necesidad de su divulgación entre los profesionales de Pediatría interesados. Se hacen necesarios mayores esfuerzos para profundizar en materias relacionadas con salud global infantil y favorecer el que los pediatras conozcan y participen en estos procesos. Este artículo pretende ofrecer un acercamiento pediátrico social hacia los elementos relacionados con cooperación internacional y salud infantil

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters

[Child health and international cooperation: A paediatric approach]. / Salud infantil y cooperación internacional: una aproximación pediátrica.

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.

Epidemiology of tuberculosis in Galicia, Spain, 16 years after the launch of the Galician tuberculosis programme.

SETTING: Galicia, Spain. OBJECTIVE: To describe changes in tuberculosis (TB) epidemiology and characteristics in Galicia, Spain, during the period 1996-2011. DESIGN: Retrospective observational descriptive study of data obtained from the Tuberculosis Information System. The Galician Tuberculosis Prevention and Control Programme, created in 1994, is based in seven tuberculosis units that actively collect data on case finding and follow-up of all cases of TB in the region. RESULTS: TB incidence fell from 72.9 cases per 100,000 population in 1996 to 24.6 in 2011 (respectively 40.5 and 14.2 in patients aged <15 years). In 2011, 49.8% (n = 343) of patients were aged between 25-54 years; 62.3% (n = 429) were male; 52.1% (n = 359) had pulmonary TB (PTB) alone, of whom 33.5% (n = 144) had cavitary lesions; 50.7% (n = 218 PTB cases) were sputum smear-positive and 80.5% (346 PTB cases) were culture-positive. The median diagnostic delay was 56 days; 4.6% (n = 32) were human immunodeficiency virus positive and 5.2% (n = 36) were immigrants. The treatment success rate was close to 90%. Contacts of 86.7% of the smear-positive index cases were evaluated. CONCLUSION: TB incidence in Galicia is progressively decreasing; however, it is still higher than that of neighbouring regions. A long diagnostic delay was observed, which may have contributed to the high incidence rate in children.

Duality symmetry and Kerker conditions.

We unveil the relationship between two anomalous scattering processes known as Kerker conditions and the duality symmetry of Maxwell equations. We generalize these conditions and show that they can be applied to any particle with cylindrical symmetry, not only to spherical particles as the original Kerker conditions were derived for. We also explain the role of the optical helicity in these scattering processes. Our results find applications in the field of metamaterials, where new materials with directional scattering are being explored.

Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study.

PURPOSE: To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture. METHODS: All patients ≥ 65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients' clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out. RESULTS: Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis. CONCLUSIONS: One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.

Definición de caso sospechoso de gripe A(H1N1) 2009: razones para la discordancia / No disponible

No disponible

[Quality evaluation of a neuro-development follow-up program of very low birthweight infants]. / Valoración de la calidad de un programa de seguimiento del neurodesarrollo de prematuros de muy bajo peso al nacimiento.

INTRODUCTION: Advances in perinatology have been associated with improved survival of very low birth weight (VLBW;<1500 g) infants. These children have an increased risk of future neurological and development handicaps. A set of quality indicators have been recommended for the neurodevelopment follow-up programs in this group of patients. AIM: To analyze our neurodevelopment follow-up program according to these quality of care indicators in 5 post-discharge follow-up areas: general care; physical health; vision, hearing, speech and language; developmental and behaviour assessment; and psychosocial issues. PATIENTS AND METHODS: Fifty-one VLWB patients born in 2000 who have completed our 6-year follow-up program have been retrospectively studied. The agreement between our program and the standard of quality is evaluated. RESULTS: A copy of a discharge summary of the patient's neonatal course is present in the medical record in 92% of the cases. The inclusion of clinical data and general medical aspects in the medical summary is heterogeneous. Somatometric evaluation for the first two years of age is always present in a filled-in graphic. The international classification of the retinopathy of the preterm (RDP) is used in 100% of the patients. An ophthalmologic examination for RDP is performed in 72% (37/51) of the infants before hospital discharge; of the other 28%, only in 6 patients the date of the outpatient examination is present. Specific evaluations and interventions are performed within the recommended period of time in most of the children with suspected or neurosensory handicaps. More than ninety per cent of the patients are referred to the neurodevelopment specialist and most of them go to the visit (90.2% between 9 and 15 months and 78.4% between 21 and 30 months). Recommendations for a psycho-educational assessment are followed in the extremely premature (BW<1000 g and/or 28 weeks of gestational age) children. The number of patients who follow the program decreases with time. Psychosocial evaluation does not usually appear in the medical records of the patients. CONCLUSION: We have a good adherence to most of the recommended indicators in our follow-up program. The evaluation of these indicators is a useful tool to analyze the quality of a developmental follow-up program and to improve it.

Valoración de la calidad de un programa de seguimiento del neurodesarrollo de prematuros de muy bajo peso al nacimiento / Quality evaluation of a neuro-development follow-up program of very low birthweight infants

Introducción: Los avances en la perinatología condicionan un aumento del número de recién nacidos de muy bajo peso (RNMBP) (<1.500g) que sobreviven, con el consiguiente riesgo futuro de presentar problemas en el desarrollo. Se han propuesto unos indicadores de calidad para evaluar los programas de seguimiento en este grupo de pacientes. Objetivo: Analizar el cumplimiento de estos indicadores en el programa de seguimiento del neurodesarrollo para los RNMBP de este centro. Material y métodos: Estudio retrospectivo descriptivo de los 51 RNMBP nacidos en el 2000 e incluidos en el programa de seguimiento hasta los 6 años de edad. Se evaluó el cumplimiento de los indicadores en las siguientes áreas: inclusión de datos en la epicrítica; aspectos médicos generales; evaluación visual, auditiva, de la comunicación y del lenguaje; evaluación del desarrollo y del comportamiento; valoración psicosocial. Resultados: Se adjuntó la epicrítica a la historia clínica en el 92% de los casos; el cumplimiento de los datos médicos generales fue heterogéneo. La valoración somatométrica durante los primeros 2 años quedó reflejada en una gráfica. Se utilizó siempre la clasificación internacional de retinopatía. A 37 (72%) de los 51 pacientes se les realizó el fondo de ojo durante el ingreso; sólo en 6 de los 14 restantes se explicitó la fecha de la visita ambulatoria. Se cumplió con los plazos máximos recomendados para la valoración por los especialistas cuando se detectó algún déficit. Se envió a más del 90% de los pacientes al neuropediatra y la gran mayoría acudió a la consulta (el 90,2% entre los 9 y los 15 meses, y el 78,4% entre los 21 y los 30 meses). Se cumplió con las recomendaciones de una valoración psicológica sistemática en los prematuros extremos. La evaluación psicosocial quedó poco reflejada en la historia clínica. Conclusiones: Este programa de seguimiento para RNMBP cumple con la mayoría de los indicadores de calidad propuestos. El análisis de éstos es una herramienta muy útil para evaluar y mejorar los programas de seguimiento para este grupo de pacientes (AU)

Introduction: Advances in perinatology have been associated with improved survival of very low birth weight (VLBW;<1500g) infants. These children have an increased risk of future neurological and development handicaps. A set of quality indicators have been recommended for the neurodevelopment follow-up programs in this group of patients. Aim: To analyze our neurodevelopment follow-up program according to these quality of care indicators in 5 post-discharge follow-up areas: general care; physical health; vision, hearing, speech and language; developmental and behaviour assesment; and psychosocial issues. Patients and methods: Fifty-one VLWB patients born in 2000 who have completed our 6-year follow-up program have been retrospectively studied. The agreement between our program and the standard of quality is evaluated. Results: A copy of a discharge summary of the patient's neonatal course is present in the medical record in 92% of the cases. The inclusion of clinical data and general medical aspects in the medical summary is heterogeneous. Somatometric evaluation for the first two years of age is always present in a filled-in graphic. The international classification of the retinopathy of the preterm (RDP) is used in 100% of the patients. An ophthalmologic examination for RDP is performed in 72% (37/51) of the infants before hospital discharge; of the other 28%, only in 6 patients the date of the outpatient examination is present. Specific evaluations and interventions are performed within the recommended period of time in most of the children with suspected or neurosensory handicaps. More than ninety per cent of the patients are referred to the neurodevelopment specialist and most of them go to the visit (90.2% between 9 and 15 months and 78.4% between 21 and 30 months). Recommendations for a psycho-educational assessment are followed in the extremely premature (BW<1000g and/or 28 weeks of gestational age) children. The number of patients who follow the program decreases with time. Psychosocial evaluation does not usually appear in the medical records of the patients. Conclusion: We have a good adherence to most of the recommended indicators in our follow-up program. The evaluation of these indicators is a useful tool to analyze the quality of a developmental follow-up program and to improve it (AU)

Asfixia perinatal: relación entre afectación cardiovascular, neurológica y multisistémica / Perinatal asphyxia: relationship between cardiovascular, neurological and multisystem involvement

Objetivo: Conocer el perfil epidemiológico de los neonatos a término con asfixia perinatal; relacionarlo con la existencia y el grado de encefalopatía hipóxico-isquémica (EHI); valorar la frecuencia de afectación cardiovascular (ACV) y relacionarla con la afectación neurológica y extra neurológica; determinar la relación entre ACV y factores etiopatogénicos de la asfixia. Material y métodos: Estudio retrospectivo de los pacientes que cumplieron criterios de asfixia perinatal entre enero de2000 y diciembre de 2004. Resultados: Se incluyeron 295 pacientes. Un 39% cumplía criterios de EHI: leve 23,1%; moderada 8,8% y grave 7,1%. La afectación pulmonar se dio en un 35,9%, la renal en un 18%,presentaron hipocalcemia un 18,6%, trombopenia un 13,9% y coagulopatía un 21,4%. Un 14,2% de los pacientes presentaron ACV cierta (alteración enzimática y/o ecocardiográfica con shock y/o hipotensión arterial), y un 15,6% ACV probable (sólo hipotensión arterial y/o shock). La existencia de ACV se relaciona con la presencia de EHI y, por consiguiente, con alteraciones en el electroencefalograma y de neuroimagen. Asi mismo,la existencia de ACV aumenta la presencia de afectación extraneurológica. También se constata que los pacientes con ACV presentan más frecuentemente acidosis al ingreso y acidosis metabólica persistente durante su evolución. Conclusiones: La ACV se correlaciona con la existencia y la gravedad de las manifestaciones neurológicas y con la afectación de otros órganos y sistemas, en especial con la acidosis metabólica persistente (AU)

Objective: The aim of this study is to review epidemiological data concerning asphyxia in full-term newborn infants and the relationship between this data and the existence and severity of hypoxic-ischemic encephalopathy (HIE). The authors also evaluate the incidence of cardiovascular involvement (CVI) and the relationship between this condition and neurological and extraneurological involvement. A third objective was to determine the relationship between cardiovascular involvement and the etiological and pathological factors of asphyxia. Materials and methods: A retrospective review of all the asphyxiated term neonates born between January 2000 and December2004. Results: A total of 295 patients were included. Thirty-nine percent were diagnosed as having HIE: mild, 23.1%; moderate8.8%; and severe, 7.1%. Pulmonary involvement was detected in 35.9% of the patients, renal involvement in 18%, hypocalcemia in 18.6% of cases; thrombocytopenia in 13.9% and coagulopathy in 21.4%. Forty-two patients had “proven” CVI (abnormal enzyme levels and/or echocardiographic findings in patients with hypotension and/or shock) and 46 had “possible” CVI (only hypotension and/or shock). CVI is associated with the presence of HIE and, consequently, with abnormal electroencephalographic and neuroimaging findings. Moreover, CVI increases the prevalence of extraneurological involvement. It was also observed that, in patients with CVI, there is a higher incidence of acidosis at admission and persistent metabolic acidosis throughout the course of the disease. Conclusions: CVI correlates with the existence and severity of neurological and extraneurological involvement, and especially with persistent metabolic acidosis (AU)

[Reduced postnatal growth in very low birth weight newborns with GE < or = 32 weeks in Spain]. / Restricción posnatal del crecimiento en recién nacidos españoles de muy bajo peso con edad gestacional menor o igual a 32 semanas.

AIM: To analyze postnatal growth restriction in a cohort of very low birth weight (VLBW) infants with gestational age < or = 32 weeks in 55 Spanish neonatal units (SEN 1500 Network) during 2002 and 2003. METHODS: Weight, length and head circumference were recorded at birth, and at discharge. Weight was also recorded at 28 days postnatal, and 36 weeks of postmenstrual age. Growth restriction was measured as the shift in weight z score from birth to 28th day. RESULTS: The study included 2317 VLBW infants. Weight z score at birth, 28 days, 36 weeks of postmenstrual age and discharge were: -0.66 +/- 1.3, -2.54 +/- 1.35, -3.12 +/- 1.7, -1.56 +/- 1.1, respectively. Length z score at birth and at discharge were: -0.88 +/- 1.8, and -1.97 +/- 1.56. Head circumference z score at birth and at discharge: -0.83 +/- 1.87, and -0.60 +/- 1.96. Prenatal steroids, gestational age, place of birth, type of hospital, CRIB score, symptomatic patent ductus arteriosus and late-onset bacterial sepsis were related with the shift in weight z score at 28 days (multiple linear regression), but explained very little (14 %) of his change. Weight and length at discharge were under the 10th percentile in 77 % and 80 % of the infants, respectively. CONCLUSIONS: VLBW infants < or = 32 GA suffer postnatal growth restriction with respect to intrauterine growth pattern, which is more relevant in the first 28 days of life, in patients with more severe illnesses, and differs among neonatal units. Perinatal and neonatal items evaluated are poorly related with restriction.

Restricción posnatal del crecimiento en recién nacidos españoles de muy bajo peso con edad gestacional menor o igual a 32 semanas / Reduced postnatal growth in very low birth weight newborns with GE <= 32weeks in Spain

Objetivo: Analizar la restricción posnatal del crecimiento en una cohorte de recién nacidos de muy bajo peso (RNMBP) y de no más de 32 semanas de gestación de 55 unidades de neonatología españolas (SEN 1500). Métodos: Se estudiaron peso, longitud y perímetro craneal al nacer y en el momento del alta. El peso se registró también a los 28 días de vida y 36 semanas de edad posmenstrual. Se analizó la relación entre restricción de crecimiento y datos perinatales y neonatales. Resultados: Se incluyeron 2.317 niños. La puntuación Z de peso al nacer, a los 28 días, a las 36 semanas de edad posmenstrual y al alta fue, respectivamente, ­0,66 ± 1,3, ­2,54 ± 1,35, ­3,12 ± 1,7, ­1,56 ± 1,1. La puntuación Z de longitud al nacer y al alta fue ­0,88 ± 1,8 y ­1,97 ± 1,56, respectivamente; la puntuación Z del perímetro craneal al nacer fue ­0,83 ± 1,87 y en el momento del alta ­0,60 ± 1,96. Los factores relacionados con el grado de restricción de peso a los 28 días fueron: corticoides prenatales, edad gestacional, lugar de nacimiento, tipo de hospital, puntuación CRIB, ductus arterioso persistente sintomático y sepsis tardía. Estos factores sólo explicaron el 14 % de la variabilidad del grado de restricción. El peso y la longitud al alta fueron inferiores a P10 en el 77 % y el 80 % de los RNMBP, respectivamente. Conclusiones: Los RNMBP de no más de 32 semanas de gestación durante su estancia en las unidades de neonatología sufren una "restricción de crecimiento" respecto al patrón intrauterino. Esta restricción ocurre sobre todo en los primeros 28 días de vida y es diferente en distintas unidades españolas. Las variables estudiadas explican en escasa medida este fenómeno (AU)

Aim: To analyze postnatal growth restriction in a cohort of very low birth weight (VLBW) infants with gestational age <= 32 weeks in 55 Spanish neonatal units (SEN 1500 Network) during 2002 and 2003. Methods: Weight, length and head circumference were recorded at birth, and at discharge. Weight was also recorded at 28 days postnatal, and 36 weeks of postmenstrual age. Growth restriction was measured as the shift in weight z score from birth to 28th day. Results: The study included 2317 VLBW infants. Weight z score at birth, 28 days, 36 weeks of postmenstrual age and discharge were: ­0.66 ± 1.3, ­2.54 ± 1.35, ­3.12 ± 1.7, ­1.56 ± 1.1, respectively. Length z score at birth and at discharge were: ­0.88 ± 1.8, and ­1.97 ± 1.56. Head circumference z score at birth and at discharge: ­0.83 ± 1.87, and ­0.60 ± 1.96. Prenatal steroids, gestational age, place of birth, type of hospital, CRIB score, symptomatic patent ductus arteriosus and late-onset bacterial sepsis were related with the shift in weight z score at 28 days (multiple linear regression), but explained very little (14 %) of his change. Weight and length at discharge were under the 10th percentile in 77 % and 80 % of the infants, respectively. Conclusions: VLBW infants <= 32 GA suffer postnatal growth restriction with respect to intrauterine growth pattern, which is more relevant in the first 28 days of life, in patients with more severe illnesses, and differs among neonatal units. Perinatal and neonatal items evaluated are poorly related with restriction (AU)

Use of granulocyte colony-stimulating factor (G-CSF) and outcome in patients with non-chemotherapy agranulocytosis.

PURPOSE: The use of granulocyte colony-stimulating factor (G-CSF) in the treatment of non-chemotherapy drug- induced agranulocytosis is controversial. We aimed at assessing the effect of G-CSF on the duration of agranulocytosis. METHODS: To assess the effect of G-CSF on the duration of agranulocytosis, a Cox proportional hazard model with an estimated propensity score covariate adjusting for several prognostic factors was used. RESULTS: One hundred and forty-five episodes of agranulocytosis were prospectively collected from January 1994 to December 2000 in Barcelona (Spain). No differences were found in the case-fatality rate between treated (9 of 101, 8.9%) and not treated (5 of 44, 11.4%) patients. The median time to reach a neutrophil count > or =1.0 x 10(9)/L was 5 days (95%CI 5-6) in patients treated with G-CSF compared to 7 days (95%CI 6-8) in those not treated, with a hazard ratio of 1.58 (95% CI 1.1-2.3). CONCLUSIONS: G-CSF shortens time to recovery in patients with agranulocytosis. However, as an effect on case-fatality has not been recorded, and data on cost-effectiveness are lacking, it would be wise to restrict its use to high-risk patients.

Risk of acute liver injury associated with the use of drugs: a multicentre population survey.

BACKGROUND: Acute liver injury of uncertain aetiology is often drug related and quantitative information about the associated risk is scarce. AIM: To estimate the risk of acute liver injury associated with the use of drugs. METHODS: In a population survey study, 126 cases of acute liver injury were prospectively assembled from January 1993 to December 1999, in patients over 15 years of age, in 12 hospitals in Barcelona (Spain). We estimated the relative risk for each drug as the ratio between the incidence of acute liver injury among the exposed population to the drug and the incidence of acute liver injury among those not exposed to it. Drug consumption data were used to estimate the exposed population. RESULTS: Isoniazid, pyrazinamide, rifampicin, amoxicillin with clavulanic acid, erythromicin, chlorpromazine, nimesulide, and ticlopidine presented the highest risk (point relative risk > 25). Amoxicillin, metoclopramide, captopril and enalapril, furosemide, hydrochlorothiazide, fluoxetine, paroxetine, diazepam, alprazolam, lorazepam, metamizole, low-dose acetylsalicylic acid and salbutamol showed the lowest risk (point relative risk < 5). CONCLUSIONS: This study provides a risk estimation of serious liver disease for various drugs that will be useful in its diagnosis and management, and when comparing with the drug therapeutic benefit in each indication. Some observed associations would be worth specific studies.

Fate of the abstracts presented at three Spanish clinical pharmacology congresses and reasons for unpublished research.

OBJECTIVES: To assess the publication rate of abstracts at 5 years after their presentation at three consecutive clinical pharmacology congresses and to examine the reasons relating to the lack of publication. METHODS: Oral and poster presentations from the congresses of the Spanish Society of Clinical Pharmacology (SSCP) in 1994, 1996, and 1998 were reviewed. Authors were contacted to determine the fate of their presented studies and the reasons for not publishing them. Publications of abstracts with unknown fate were searched the in PubMed database. Determinants of publication were examined by Cox regression. RESULTS: In all, 248 abstracts were analysed. The cumulative publication rate at 5 years was 26%, and the median time for publication was 18 months (range: 2-60). The European Journal of Clinical Pharmacology was the English language medical journal where most abstracts were published. The median impact factor of the articles published was 1.96 (range: 0.29-8.32). The author survey identified a lack of time (38.2%) and a lack of interest (33.3%) as the main reasons for failure to publish. The only predictor of an abstract's publication was to be affiliated with a university department (hazard ratio: 1.98, 95% confidence interval: 1.20-3.27). CONCLUSIONS: Only one-quarter of the abstracts presented at SSCP congresses were subsequently published. A lack of time and interest were the main reasons given for not submitting these presentations for publication. Authors, scientific societies and editorial boards should enhance publications as full papers in peer-reviewed journals of the abstracts presented at meetings.