[Updated report on STOPP-START criteria in Primary Care]. / Evaluación de la actualización de los criterios STOPP-START en atención primaria.

INTRODUCTION: The aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Avilés, Asturias, Spain. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. RESULTS: The study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. CONCLUSIONS: There were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP.

[Rates of surgical wound infection in hip arthroplasty (2007-2015)]. / Tasas de infección de herida quirúrgica en artroplastia de cadera (2007-2015).

OBJECTIVE: To estimate the incidence of surgical site infection in the hip replacement procedure during nine years of follow-up in a local public hospital. MATERIAL AND METHODS: A prospective study conducted between 2007 and 2015, using the Clinical Indicators of Continuous Quality Improvement (INCLIMECC) tool. All primary hip prostheses and revisions were studied. The definitions, criteria and categories for surgical site infection were those estimated for the risk index of the National Nosocomial Infections Surveillance of Centres for Disease Control and Prevention. Crude and adjusted rates were calculated by risk index. RESULTS: A total of 999 interventions were included. The overall infection rate was 1.5% (95%CI: 0.75-2.25). Surgical prophylaxis was prescribed in 98.3% of the cases, and was adequate in 70.7%, with the main cause of inadequacy being its prolonged duration in 71.3%. The infection rate was 53%, being better than the rates published for Spanish hospitals INCLIMECC in the period 1997-2012. But they were 19% higher than those published for the USA according to the National Healthcare Safety Network, and 50% higher than expected according to data published for Europe by the European Centre for Disease Prevention and Control. DISCUSSION: The infection rate in the present study is better than those described in the Spanish literature, but it is higher than those published for Europe and North America. Strategies for surveillance and control of infections associated with health care allow the evaluation of trends and the impact of prevention measures.

[Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients]. / Prescripción potencialmente inadecuada en pacientes mayores grandes polimedicados según criterios "STOPP".

INTRODUCTION: Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. PATIENTS AND METHODS: A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. RESULTS: A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]). CONCLUSIONS: PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP.

Prevalencia y duración de la lactancia materna en Asturias / Prevalence and duration of breastfeeding in Asturias, Spain

Objetivo: Estimar la prevalencia y duración de la lactancia materna en Asturias y describir los factores asociados. Métodos: Estudio transversal. La población fueron todos los niños nacidos en los hospitales públicos de Asturias que tenían entre 0 y 8 meses de edad en el momento del estudio (4.326). Se obtuvo una muestra aleatoria estratificada de 453 niños. Los datos se obtuvieron por entrevista telefónica con cuestionario a las madres, preguntando si el día del estudio el niño tomaba el pecho. Se interrogaba además sobre datos sociodemográficos y de atención prenatal y perinatal. La estimación de la curva de prevalencia de lactancia según la edad del niño se realizó mediante regresión logística univariante, y el análisis de los factores asociados mediante regresión logística múltiple. Se estimaron como indicadores de duración el índice de discontinuidad (ID) y el índice de lactancia acumulada (ILA). Resultados: Se efectuaron 418 entrevistas. La prevalencia de lactancia materna exclusiva (LME) al inicio fue del 51,4 por ciento (intervalo de confianza [IC] del 95 por ciento: 46,6-56,2) decayendo al 14,9 por ciento a los 90 días y al 8,7 por ciento a los 120 días. Los ID fueron del 28,6 por ciento a los 30 días y del 71,0 por ciento a los 90 días. La prevalencia de LME se relacionó en el ajuste multivariado con la localidad de residencia: residir en una localidad rural o semiurbana aumentaba la probabilidad de lactar ( odds ratio [OR] = 5,69 y OR = 3,55, respectivamente) respecto al medio urbano. También se encontró relación positiva con que la madre tuviera estudios universitarios (OR = 3,90; IC del 95 por ciento: 1,778,58) y el haber sido atendida por la matrona durante el embarazo (OR = 2,13; IC del 95 por ciento: 1,04-4,38); se detectó relación inversa entre la LME y que el niño hubiera recibido suplementos en las primeras horas de vida (OR = 0,43; IC del 95 por ciento: 0,20-0,95).Conclusiones: La prevalencia de lactancia materna es muy inferior a la recomendada por la Organizacion Mundial de la Salud, especialmente su duración. En el hábitat no urbano se mantienen patrones más adecuados de lactancia (AU)

[Functional ability in people above 80 years old]. / Capacidad funcional en mayores de 80 años.

OBJECTIVE: To discover the functional capacity (CF) for population over 80 years assing to an health center. DESIGN: This was an observational crossover study, using OARS questionary. SETTING: An urban health center. PATIENTS AND OTHER PARTICIPANTS: A sex and residence proportional sample of aged 80 and over was taken from 1986 census registry. MEASUREMENTS AND MAIN RESULTS: To asses functional capacity we used ADL (Activities of daily living) dimension from OARS questionry. It's composed of 14 items, seven for basic activities of daily living (AVDb) and seven for instrumental activities (AVDi). We considered severe incapacity if the aged had some difficulty in one AVDb at lest; moderate incapacity if the showed only a trouble in some AVDi, and good CF if didn't show the least difficulty in any item. The 42.2% of aged had severe incapacity, 26% of population had got good CF. The most incapacity was watched in house-works and cooking; in the AVDb were sphincters and control and cleaniless corporal. CONCLUSIONS: Functional capacity in population aged in the zone is lightly inferior to the other studies, however the ages chosen aren't comparable absolutely. We find differences in functional capacity between sex, the results are better for men. Population aged who is living in institutions have mainly CF moderate, and the married are more good functional capacity than singles or widows.