Determination of a cutoff value for medication regimen complexity index to predict polypharmacy in HIV+ older patient.

OBJECTIVE: HIV+ patients have increased their life expectancy with a parallel increase in age-associated co-morbidities and pharmacotherapeutic complexity. The aim of this study was to determine an optimal cutoff value for Medication regimen complexity index (MRCI) to predict polypharmacy in HIV+ older patients. METHODS: A transversal observational single cohort study was conducted at a tertiary Hospital in Spain, between January 1st up to December 31st, 2014. Patients included were HIV patients over 50 years of age on active antiretroviral treatment. Prevalence of polypharmacy and it pattern were analyzed. The pharmacotherapy complexity value was calculated through the MRCI. Receiver operating characteristic curve analyses were used to calculate the area under the curve (AUC) for the MRCI value medications to determine the best cutoff value for identifying outcomes including polypharmacy. Sensitivity and specificity were also calculated. RESULTS: A total of 223 patients were included. A 56.1% of patients had polypharmacy, being extreme polypharmacy in 9.4% of cases. Regarding the pattern of polypharmacy, 78.0% had a cardio-metabolic pattern, 12.0% depressive-psychogeriatric, 8.0% mixed and 2.0% mechanical-thyroidal. The ROC curve demonstrated that a value of medication complexity index of 11.25 point was the best cutoff for predict polypharmacy (AUC=0.931; sensitivity= 77.6%; specificity=91.8%). CONCLUSIONS: A cut-off value of 11.25 for MRCI is proposed to determine if a patient reaches the criterion of polypharmacy. In conclusion, the concept of polypharmacy should include not only the number of prescribed drugs but also the complexity of them.

[Analysis of the causes and predictive factors for discontinuing treatment with tenofovir in pretreated HIV patients]. / Análisis de las causas y factores predictivos de discontinuación del tratamiento con tenofovir en pacientes VIH pretratados.

OBJECTIVE: To determine the frequency and causes for discontinuing treatment with tenofovir and analyse possible predictive factors for changing this therapy in pretreated HIV patients. METHOD: A multi-centre, observational and retrospective study of all HIV patients undergoing treatment with tenofovir between July 2002 and December 2005. Data were obtained from databases for outpatients attending the three pharmacy departments participating in the study, and by reviewing clinical histories. The main sociodemographic, clinical and analytical variables at the start of treatment with tenofovir were collected. The causes for discontinuing treatment were classified as follows: adverse effects, virological failure, death and "other causes". A survival analysis was performed using the Kaplan-Meier method to analyse the possible predictive factors for discontinuing treatment. RESULTS: A total of 733 patients were included in the study and the median treatment period was 34.7 months. A total of 23.8% of patients discontinued treatment for the following reasons: adverse effects (43.2%), death (17.7%), virological failure (14.8%) and "other causes" (24.4%). There were 99 cases of lost to follow-up. In the survival analysis an association was found between normal serum creatinine values (p = 0.0042) at the start of treatment and the statistically significant probability of discontinuing treatment. CONCLUSIONS: Almost a quarter of the patients discontinued treatment with tenofovir during the study. The main cause for this was adverse effects. No association was found between any abnormal basal analytical parameter and a greater probability of discontinuing treatment.

Análisis de las causas y factores predictivos de discontinuación del tratamiento con tenofovir en pacientes VIH pretratados / No disponible

Objetivo: Determinar la frecuencia y las causas de discontinuacióndel tratamiento con tenofovir y analizar los posibles factorespredictores de cambio de esta terapia en pacientes VIHpretratados.Método: Estudio multicéntrico, observacional y retrospectivode todos los pacientes VIH en tratamiento con tenofovir entrejulio-2002 y diciembre-2005. Los datos fueron obtenidos a travésde las bases de datos de pacientes externos de los tres servicios defarmacia participantes y de la revisión de las historias clínicas. Serecogieron las principales variables sociodemográficas, clínicas yanalíticas al inicio del tratamiento con tenofovir. Las causas de discontinuaciónse clasificaron en: efectos adversos, fracaso virológico,exitus y “otras causas”. Se realizó un análisis de supervivenciade Kaplan-Meier para analizar los posibles factores predictores dediscontinuación.Resultados: Un total de 733 pacientes se incluyeron en elestudio. La mediana de tiempo en tratamiento fue de 34,7meses. El 23,8% de los sujetos discontinuó el tratamiento. Lascausas fueron: efectos adversos: 43,2%, exitus: 17,7%, fracasovirológico: 14,8% y “otros motivos”: 24,4%. Hubo 99 casos deperdida de seguimiento. En el análisis de supervivencia, se asociótener niveles normales de creatinina sérica (p = 0,0042) alinicio del tratamiento con probabilidad estadisticamente significativade discontinuación.Conclusiones: Durante el estudio, casi una cuarta parte delos pacientes discontinuó el tratamiento con tenofovir. La principalcausa de discontinuación fueron los efectos adversos. No seasoció ningún parametro analítico basal anormal a mayor probabilidadde discontinuación de tratamiento

Objective: To determine the frequency and causes for discontinuingtreatment with tenofovir and analyse possible predictivefactors for changing this therapy in pretreated HIV patients.Method: A multi-centre, observational and retrospectivestudy of all HIV patients undergoing treatment with tenofovirbetween July 2002 and December 2005. Data were obtainedfrom databases for outpatients attending the three pharmacydepartments participating in the study, and by reviewing clinicalhistories. The main sociodemographic, clinical and analyticalvariables at the start of treatment with tenofovir were collected.The causes for discontinuing treatment were classified as follows:adverse effects, virological failure, death and “other causes”.A survival analysis was performed using the Kaplan-Meiermethod to analyse the possible predictive factors for discontinuingtreatment.Results: A total of 733 patients were included in the studyand the median treatment period was 34.7 months. A total of23.8% of patients discontinued treatment for the following reasons:adverse effects (43.2%), death (17.7%), virological failure(14.8%) and “other causes” (24.4%). There were 99 cases of lostto follow-up. In the survival analysis an association was foundbetween normal serum creatinine values (p = 0.0042) at the startof treatment and the statistically significant probability of discontinuingtreatment.Conclusions: Almost a quarter of the patients discontinuedtreatment with tenofovir during the study. The main cause for thiswas adverse effects. No association was found between anyabnormal basal analytical parameter and a greater probability ofdiscontinuing treatment

[An analisys fo causes for the discontinuation of a simplified antiretroviral regimen with abacavir, lamivudine and zidovudine]. / Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina.

OBJECTIVE: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the co-formulation of abacavir, lamivudine and zidovudine (ABC-3TC-AZT). METHOD: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients withdrawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. RESULTS: In all, 114 patients (85 males, 74.6%) received this therapy - 25.4% of them were naïve patients - and 34.2% (39/114) withdrew from this regimen, amongst them 44.8% (13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). CONCLUSIONS: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented.

Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina / An analysis of causes for the discontinuation of a simplified antiretroviral regimen with abacavir, lamivudine and zidovudine

Objetivo: Identificar y analizar las causas más frecuentes de discontinuación de la terapia antirretroviral que incluye la co-formulación: abacavir, lamivudina y zidovudina (ABC-3TC-AZT). Método: Estudio retrospectivo observacional de los pacientesen tratamiento antirretroviral con ABC-3TC-AZT, atendidos en la unidad de pacientes externos del servicio de farmacia durante el periodo comprendido entre febrero de 2002 y junio de 2004. Se analizó la causa de discontinuación en aquellos pacientes que no siguieron con esta terapia. Se evaluó la adherencia mediante los registros informáticos de dispensación. Se diseñó un análisis de supervivencia de Kaplan-Meier para identificar factores predictivos de discontinuación. Resultados: Un total de 114 pacientes (85 hombres, 74,6%) fueron tratados con esta terapia. Un 25,4% era naïve. El 34,2% (39/114) de los pacientes discontinuó el tratamiento. Entre ellos, el 44,8% (13/29) de los sujetos naïve. En el 92,3% del total de casos esto ocurrió antes de alcanzar las 48 semanas en tratamiento. Las causas de discontinuación fueron: reacciones adversas (46,1%), abandono voluntario (33,3%), decisión clínica (15,4%) y otros motivos (5,1%). Posible reacción de hipersensibilidad a ABC fue descrita en 9 pacientes. Se relacionó tener carga viral detectable al inicio del tratamiento, ser ex-ADVP, y paciente naïve, con mayor probabilidad de discontinuación (p < 0,05). Conclusiones: Se encontró un alto porcentaje de discontinuación debido a efectos adversos y abandono voluntario, principalmente al inicio del tratamiento. Es necesario identificar a aquellos pacientes a los cuales este esquema les puede aportar un beneficio terapéutico, especialmente los sujetos naïve, y realizar intervenciones para mejorar la adherencia y optimizar así los parámetros de recuperación

Objective: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the coformulation of abacavir, lamivudine and zidovudine (ABC-3TCAZT). Method: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department’s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients with drawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. Results: In all, 114 patients (85 males, 74.6%) received this therapy – 25.4% of them were naïve patients – and 34.2% (39/114) with drew from this regimen, amongst them 44.8%(13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). Conclusions: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented

[Smoking of in-patients]. / Tabaquismo en pacientes hospitalizados.

OBJECTIVE: To asses the knowledge and attitude about smoking habit of in-patients in order to detect the sanitary activities that could help to decrease the prevalence of smoking. MATERIAL AND METHODS: Cross-sectional observational study of random sample (n=395) of in-patients of University Hospital Virgen Macarean, Seville, Spain. Participation rate was 89% (n=350) and the interviewer-administered questionnaire was completed with epidemiological and clinical additional data. RESULTS: Sixty per cent of in-patients were smokers or former smokers. There were statistically significant differences in smoking distribution by age, gender, education, socio-economic level and admission diagnosis. Etiologic relationships between tobacco smoking and lung cancer or chronic lung disease were known by more than 90% of in-patients but other smokings health effects were not so well known: larynx (86%), oesophagus (86%) and oral cavity (81%) cancer, coronary heart disease (82%) and low birthweight (78%). Forty-five per cent of smokers began to smoke before the age of 15 and an additional 40% at 15-19 year. Forty-six per cent of smokers tried to leave this habit without success in spite of receiving medical advice of leaving smoking (61%) and the recommendations of family and friends (60%). CONCLUSIONS: Preventive campaigns against tobacco smoking must include pharmacological and psicological treatment for current smokers because an important proportion of them try to leave this habit without success.

Tabaquismo en pacientes hospitalizados / Smoking of in-patients

Objetivo: Este estudio investiga los conocimientos y las actitudes respecto al hábito de fumar en pacientes hospitalizados. Se pretende así identificar aquellas actuaciones sanitarias que podrían ayudarnos a reducir la prevalencia del hábito tabáquico. Material y métodos: Estudio transversal de una muestra aleatoria simple de 395 pacientes, del Hospital Universitario Virgen Macarena de Sevilla, de los que 345 (89 por ciento) aceptaron participar en esta investigación. El cuestionario sobre hábito tabáquico, administrado por un sólo encuestador, se complementó con información sobre características epidemiológicas y clínicas de los pacientes Resultados: Un 60 por ciento de pacientes son fumadores actuales ò ex-fumadores, con diferencias estadísticamente significativas en la distribución del hábito de fumar según edad, género, educación, nivel socioeconómico y diagnóstico de ingreso. Más del 90 por ciento de los pacientes conoce la relación causal entre tabaco y cáncer de pulmón o enfermedad pulmonar obstructiva crónica, pero esta proporción es menor para las localizaciones oncológicas de laringe (86 por ciento), esófago (86 por ciento) y cavidad oral (81 por ciento), cardiopatía coronaria (82 por ciento) y recién nacidos de bajo peso (78 por ciento) sin que existan diferencias significativas entre fumadores, ex fumadores y no fumadores. El 45 por ciento de los fumadores actuales tenían menos de 15 años cuando comenzaron a fumar y un 40 por ciento adicional entre 15 y 19 años. El 46 por ciento de los fumadores han intentado, sin éxito, dejar este hábito, a pesar de recibir recomendaciones, en este sentido, del personal sanitario (61 por ciento), familiares y amigos (60 por ciento). Conclusiones: La actuaciones sanitarias contra el tabaquismo deben contemplar, el apoyo farmacológico y psicoterapéutico a los fumadores actuales ya que una proporción importante de los mismos aunque desean abandonar el tabaquismo, no lo consiguen (AU)

Objective: To asses the knowledge and attitude about smoking habit of in-patients in order to detect the sanitary activities that could help to decrease the prevalence of smoking. Material and methods: Cross-sectional observational study of random sample (n=395) of in-patients of University Hospital Virgen Macarean, Seville, Spain. Participation rate was 89% (n= 350) and the interviewer-administered questionnaire was completed with epidemiological and clinical additional data. Results: Sixty per cent of in-patients were smokers or former smokers. There were statistically significant differences in smoking distribution by age, gender, education, socio-economic level and admission diagnosis. Etiologic relationships between tobacco smoking and lung cancer or chronic lung disease were known by more than 90% of in-patients but other smoking’s health effects were not so well known: larynx (86%), oesophagus (86%) and oral cavity (81%) cancer, coronary heart disease (82%) and low birthweight (78%). Forty-five per cent of smokers began to smoke before the age of 15 and an additional 40% at 15-19 year. Forty-six per cent of smokers tried to leave this habit without success in spite of receiving medical advice of leaving smoking (61%) and the recommendations of family and friends (60%). Conclusions: Preventive campaigns against tobacco smoking must include pharmacological and psicological treatment for current smokers because an important proportion of them try to leave this habit without success (AU)

[Oral health of school children in Ceuta. Influences of age, sex, ethnic background and socioeconomic level]. / Salud oral de los escolares de Ceuta. Influencias de la edad, el género, la etnia y el nivel socioeconómico.

BACKGROUND: The objective of this study is that of gauging the prevalence of dental caries, periodontal disease and malocclusion among the school-age population of Ceuta and the spread thereof by age, sex, ethnic background and father's occupation. METHODS: Prevalence survey of a multistage, stratified, random sample of schoolchildren 7, 12 and 14 years of age (n = 347) in order to calculate DMFT and dmft indexes--permanent and deciduous dentition--, CPITN and malocclusion. Assessment of the statistical significance of the differences encountered according to age, sex, ethnic background and socioeconomic status using the Chi-Square, Student T and Snedecor F tests. To calculate, among schoolchildren ages 12 and 14, the odds ratios of showing a DMFT index over 4 and their 95% confidence intervals by gender, ethnic background and the socioeconomic status. RESULTS: Dmft (decayed, filled and missing teeth) was 3.02 at 7 and DMFT was 3.91 at 12 and 4.46 at 14. Odds ratios of DMFT > 4 were 2.26 by gender (95% CI = 1.27-4.05), 2.17 by ethnic group (95% CI = 1.18-3.99) and 1.8 by SES (95% CI = 0.85-3.81). In schoolchildren of low SES--unemployed father's--OR by ethnic group was 1.37 (95% CI = 0.28-7.0). No statistically significant differences were found in the distribution of malocclusion and periodontal disease--except by age. CONCLUSIONS: Dmft and DMFT values are in Ceuta higher than the mean national values and the proposed value of the WHO for the year 2000. Risk of DMFT higher than the median is 2.3 in girls compared with boys, 2.17 in Moslem compared with non Moslem and 1.8 in low SES schoolchildren--unemployed father's--compared to other SES schoolchildren. The increased risk related to ethnic background is influenced by SES.