Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index.

This study aimed to comparatively analyze the effect of the person-centered prescription (PCP) model on pharmacotherapeutic indicators and the costs of pharmacological treatment between a dementia-like trajectory and an end-stage organ failure trajectory, and two states of frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted to a subacute hospital and identified by the Necessity of Palliative Care test to require palliative care. Data were collected from February 2018 to February 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, and several pharmacotherapeutic indicators and the 28-day medication cost. Fifty-five patients with dementia-like trajectory and 26 with organ failure trajectory were recruited observing significant differences at hospital admission in the mean number of medications (7.6 vs. 9.7; p < 0.004), the proportion of people on more than 10 medications (20.0% vs. 53.8%; p < 0.002), the number of drug-drug interactions (2.7 vs. 5.1; p < 0.006), and the Medication Regimen Complexity Index (MRCI) (25.7 vs. 33.4; p < 0.006), respectively. Also, regarding dementia-like patients, after application of the PCP model, these patients improved significantly in the intervention group compared to the control group in the mean number of chronic medications, STOPP Frail Criteria, MRCI and the 28-day cost of regular medications (p < 0.05) between admission and discharge. As for the PCP effect on the control and the intervention group at the end-stage organ failure, we did not observe statistically significant differences. On the other hand, when the effect of the PCP model on different degrees of frailty was evaluated, no unequal behavior was observed.

Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life.

Objective: This study sought to investigate whether applying an adapted person-centered prescription (PCP) model reduces the total regular medications in older people admitted in a subacute hospital at the end of life (EOL), improving pharmacotherapeutic indicators and reducing the expense associated with pharmacological treatment. Design: Randomized controlled trial. The trial was registered with ClinicalTrials.gov (NCT05454644). Setting: A subacute hospital in Basque Country, Spain. Subjects: Adults ≥65 years (n = 114) who were admitted to a geriatric convalescence unit and required palliative care. Intervention: The adapted PCP model consisted of a systematic four-step process conducted by geriatricians and clinical pharmacists. Relative to the original model, this adapted model entails a protocol for the tools and assessments to be conducted on people identified as being at the EOL. Measurements: After applying the adapted PCP model, the mean change in the number of regular drugs, STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) criteria, drug burden index (DBI), drug-drug interactions, medication regimen complexity index (MRCI) and 28-days medication cost of chronic prescriptions between admission and discharge was analyzed. All patients were followed for 3 months after hospital discharge to measure the intervention's effectiveness over time on pharmacotherapeutic variables and the cost of chronic medical prescriptions. Results: The number of regular prescribed medications at baseline was 9.0 ± 3.2 in the intervention group and 8.2 ± 3.5 in the control group. The mean change in the number of regular prescriptions at discharge was -1.74 in the intervention group and -0.07 in the control group (mean difference = 1.67 ± 0.57; p = 0.007). Applying a PCP model reduced all measured criteria compared with pre-admission (p < 0.05). At discharge, the mean change in 28-days medication cost was significantly lower in the intervention group compared with the control group (-34.91€ vs. -0.36€; p < 0.004). Conclusion: Applying a PCP model improves pharmacotherapeutic indicators and reduces the costs associated with pharmacological treatment in hospitalized geriatric patients at the EOL, continuing for 3 months after hospital discharge. Future studies must investigate continuity in the transition between hospital care and primary care so that these new care models are offered transversally and not in isolation.

Psychotropic Drug Prescription in Nursing Homes During the COVID-19 Pandemic.

BACKGROUND: To limit the introduction of coronavirus disease 2019 (COVID-19) into nursing homes, restrictive measures and social distancing were implemented; however, these caused an increase in affective disorders such as depression and anxiety and an alteration of the behavioral and psychological symptoms of dementia. Therefore, it is expected that prescription trends of psychotropic drugs in nursing homes during the pandemic may have changed significantly. OBJECTIVE: This study aims to compare patterns of prescribing psychotropic drugs in nursing homes during the COVID-19 pandemic to those of the pre-pandemic period. METHODS: This cross-sectional multicenter study was conducted in geriatric units and psychogeriatric units in seven nursing homes in Gipuzkoa, Spain. On 1 March, 2020, data regarding 511 residents in geriatric units and 163 in psychogeriatric units were recorded. This study examined utilization percentages for psychotropic drugs before the pandemic (April 2018-March 2020) and during the pandemic (April 2020-March 2021) in light of projected usage based on previous years. Following the Anatomical, Therapeutic, Chemical Classification System, four therapeutic groups were analyzed: antipsychotics (N05A), benzodiazepines (N05B and N05C), antidepressants (N06A), and antiepileptic drugs (N03A). RESULTS: In the case of geriatric units, a downward trend of prescription was reversed for antipsychotics (-0.41; 95% confidence interval [CI] -1.41, 0.60). Benzodiazepine use also decreased less than expected (-2.00; 95% CI -3.00, -1.00). Antidepressant use increased more than predicted (0.02; 95% CI -0.97, 1.01), as did antiepileptic drug use (2.93; 95% CI 2.27, 3.60). In the psychogeriatric units, the drop in antipsychotic utilization was less than expected (-2.31; 95% CI -3.68, -0.93). Although it was expected that the prescription of benzodiazepines would decrease, usage remained roughly the same (-0.28; 95% CI -2.40, 2.34). Utilization of antidepressants (8.57; 95% CI 6.89, 10.24) and antiepileptic drugs (6.10; 95% CI 3.20, 9.00) increased significantly, which was expected, based on the forecast. CONCLUSIONS: For all categories, usage of psychotropic drugs was higher than anticipated based on the forecast; this increase might be related to the worsening of emotional and behavioral disorders caused by the restrictive measures of the COVID-19 pandemic.

Local renin angiotensin system and sperm DNA fragmentation.

The renin angiotensin system (RAS) appears to influence male fertility at multiple levels. In this work, we analyzed the relationship between the RAS and DNA integrity. Fifty male volunteers were divided into two groups (25 each): control (DNA fragmentation ≤20%) and pathological (DNA fragmentation >20%) cases. Activities of five peptidases controlling RAS were measured fluorometrically: prolyl endopeptidase (which converts angiotensin [A] I and A II to A 1-7), neutral endopeptidase (NEP/CD10: A I to A 1-7), aminopeptidase N (APN/CD13: A III to A IV), aminopeptidase A (A II to A III) and aminopeptidase B (A III to A IV). Angiotensin-converting enzyme (A I to A II), APN/CD13 and NEP/CD10 were also assessed by semiquantitative cytometry and quantitative flow cytometry assays, as were the receptors of all RAS components: A II receptor type 1 (AT1R), A II receptor type 2 (AT2R), A IV receptor (AT4R or insulin-regulated aminopeptidase [IRAP]), (pro)renin receptor (PRR) and A 1-7 receptor or Mas receptor (MasR) None of the enzymes that regulate levels of RAS components, except for APN/CD13 (decrease in fragmented cells), showed significant differences between both groups. Micrographs of RAS receptors revealed no significant differences in immunolabeling patterns between normozoospermic and fragmented cells. Labeling of AT1R (94.3% normozoospermic vs 84.1% fragmented), AT4R (96.2% vs 95.3%) and MasR (97.4% vs 87.2%) was similar between the groups. AT2R (87.4% normozoospermic vs 63.1% fragmented) and PRR (96.4% vs 48.2%) were higher in non-fragmented spermatozoa. These findings suggest that fragmented DNA spermatozoa have a lower capacity to respond to bioactive RAS peptides.

Implantación del etiquetado Nutri-Score en España: percepción de Dietistas-Nutricionistas. Protocolo de estudio transversal / Implementation of the Nutri-Score labeling in Spain: Dietitians-Nutritionist’s Perception. Cross-Sectional Study Protocol

Una de las estrategias para combatir la creciente epidemia de sobrepeso y obesidad es la complementación del etiquetado nutricional con un logotipo que facilite la selección de alimentos por parte del consumidor. El objetivo de este trabajo fue describir la percepción de los Dietistas-Nutricionistas sobre el etiquetado frontal de alimentos Nutri-Score previo a su implementación en España. Se realizó un estudio transversal, con la participación de al menos 376 titulados en Nutrición Humana y Dietética (D-N), mayores de 18 años, cualquier sexo, residentes en España. Por cuestionario electrónico se registrarán datos sociodemográficos e ítems de percepción sobre el etiquetado Nutri-Score, con un un Indice de Validez de Contenido (IVC) global de 0,90. Las variables de escala continua se presentarán como medias y error estándar o medianas y rangos intercuartílicos de acuerdo con el análisis Kolmogorov-Smirnov. Las variables categóricas como frecuencias y porcentajes. El análisis realizará en R y RStudio. Estudio aprobado por el Comité de Ética para las Investigaciones relacionadas con Seres Humanos (CEISH) de la Universidad del País Vasco UPV/EHU 10/2021/033MR1). (AU)

One of the strategies to combat the growing epidemic of overweight and obesity is the complementing of nutritional labeling with a logo that facilitates the selection of foods by the consumer. The objective of thiswork was to describe the Dietitians-Nutritionists’ perception about the Nutri-Score frontal food labeling before its implementation in Spain. Cross-sectional study, with 376 graduates in Human Nutrition and Dietetics (D-N), over 18 years of age, any sex, resident in Spain. Sociodemographic data and Nutri-Scorelabeling perception items will be recorded by online survey, with a global Content Validity Index (IVC) of 0.90.Continuous variables will be presented as means and standard error or medians and interquartile ranges according to the Kolmogorov-Smirnov analysis. Categorical variables such as frequencies and percentages. The analysis will be done in R and RStudio. The study was approved by the Ethics Committee for Research onHuman Beings (CEISH) of the University of the Basque Country UPV/EHU (M10/2021/033MR1). (AU)

[Influential factors in the quality of prescription in primary care and relation to pharmaceutical expenditure]. / Factores influyentes en la calidad de la prescripción en atención primaria y relación con el gasto farmacéutico.

OBJECTIVE: The high pharmaceutical consumption requires establishing improvement measures with the collaboration of all the agents involved. The objective of the study was to analyze the pharmaceutical expenditure generated by prescriptions made by physicians working in a primary care area and assess its relationship with the quality indicators of the prescription. METHODS: The prescriptions of 200 family physicians of the Basque Health Service Araba Countyand dispensed by the community pharmacies between 2009 and 2016 were studied. The variables evaluated retrospectively corresponded to the quality indicators of the pharmaceutical prescription included in the Contract-Program of the Basque Department Health of 2016. Prediction models were developed using linear regression and binary logistic regression analysis. RESULTS: The main factors which increased the pharmaceutical expenditure per person were: the use of novel drugs which do not offer therapeutic improvements, the proportion of pensioners, the use of statins and the use of antiulcer the proton pump inhibitors (PPI). On the contrary, the factors that reduced this expense were: the seniority in the medical position, the physician job stability and the prescription quality index. The profile of the doctor who generated the greatest expense of pharmaceutical prescription was mainly that of a professional who was responsible for a high percentage of pensioners, prescribed a high amount of inhibitors of the enzyme angiotensin converting enzyme inhibitors (ACEI), prescribed a high amount of first level non-steroidal anti-inflammatory drugs (NSAIDs) and also showed high use of antiulcer PPI. CONCLUSIONS: There is a statistically significant correlation between physicians who generate lower pharmaceutical expenditure and have a higher quality of prescription. The most influencing factors in the pharmaceutical expenditure are a high percentage of pensioners in the medical quota, the use of novel drugs that do not provide therapeutic improvements and the prescription of statins and anti-ulcer PPI drugs.

OBJETIVO: El elevado consumo farmacéutico requiere establecer medidas de mejora con la colaboración de todos los agentes implicados. El objetivo del estudio fue analizar el gasto farmacéutico generado por las recetas prescritas por los médicos que trabajan en un área de atención primaria y evaluar su relación con los indicadores de calidad de la prescripción. METODOS: Se estudiaron las prescripciones de 200 médicos de familia de la Comarca Araba de Osakidetza y dispensadas por las oficinas de farmacia entre los años 2009 y 2016. Las variables evaluadas retrospectivamente correspondieron a los indicadores de calidad de la prescripción farmacéutica recogidos en el Contrato-Programa del Departamento de Salud del 2016. Se elaboraron modelos de predicción mediante técnicas de regresión lineal y logística binaria. RESULTADOS: Los principales factores que aumentaron el gasto farmacéutico por persona fueron: el uso de medicamentos novedosos que no ofrecen mejoras terapéuticas, la proporción de pensionistas, el uso de estatinas y el uso de antiulcerosos inhibidores de la bomba de protones (IBP). Por el contrario, los factores que redujeron este gasto fueron: la antigüedad en la plaza médica, la estabilidad laboral e el índice de calidad de prescripción. El perfil del médico que generó mayor gasto de prescripción farmacéutica fue principalmente el de un profesional que tenía a su cargo un elevado porcentaje de pensionistas, recetaba una cantidad elevada de inhibidores del enzima convertidor de angiotensina (IECA), prescribía una elevada cantidad de antiinflamatorios no esteroideos (AINE) de primer nivel e igualmente tenía un elevado uso de antiulcerosos IBP. CONCLUSIONES: Existe una correlación estadísticamente significativa entre los médicos que generan un menor gasto farmacéutico y presentan mayor calidad de la prescripción. Los factores que más influyen en el gasto farmacéutico son un elevado porcentaje de pensionistas en el cupo médico, el uso de medicamentos novedosos que no aportan mejoras terapéuticas y la prescripción de estatinas y de antiulcerosos IBP.

Factores influyentes en la calidad de la prescripción en atención primaria y relación con el gasto farmacéutico / Influential factors in the quality of prescription in primary care and relation to pharmaceutical expenditure

OBJETIVO: El elevado consumo farmacéutico requiere establecer medidas de mejora con la colaboración de todos los agentes implicados. El objetivo del estudio fue analizar el gasto farmacéutico generado por las recetas prescritas por los médicos que trabajan en un área de atención primaria y evaluar su relación con los indicadores de calidad de la prescripción. MÉTODOS: Se estudiaron las prescripciones de 200 médicos de familia de la Comarca Araba de Osakidetza y dispensadas por las oficinas de farmacia entre los años 2009 y 2016. Las variables evaluadas retrospectivamente correspondieron a los indicadores de calidad de la prescripción farmacéutica recogidos en el Contrato-Programa del Departamento de Salud del 2016. Se elaboraron modelos de predicción mediante técnicas de regresión lineal y logística binaria. RESULTADOS: Los principales factores que aumentaron el gasto farmacéutico por persona fueron: el uso de medicamentos novedosos que no ofrecen mejoras terapéuticas, la proporción de pensionistas, el uso de estatinas y el uso de antiulcerosos inhibidores de la bomba de protones (IBP). Por el contrario, los factores que redujeron este gasto fueron: la antigüedad en la plaza médica, la estabilidad laboral e el índice de calidad de prescripción. El perfil del médico que generó mayor gasto de prescripción farmacéutica fue principalmente el de un profesional que tenía a su cargo un elevado porcentaje de pensionistas, recetaba una cantidad elevada de inhibidores del enzima convertidor de angiotensina (IECA), prescribía una elevada cantidad de antiinflamatorios no esteroideos (AINE) de primer nivel e igualmente tenía un elevado uso de antiulcerosos IBP. CONCLUSIONES: Existe una correlación estadísticamente significativa entre los médicos que generan un menor gasto farmacéutico y presentan mayor calidad de la prescripción. Los factores que más influyen en el gasto farmacéutico son un elevado porcentaje de pensionistas en el cupo médico, el uso de medicamentos novedosos que no aportan mejoras terapéuticas y la prescripción de estatinas y de antiulcerosos IBP

OBJECTIVE: The high pharmaceutical consumption requires establishing improvement measures with the collaboration of all the agents involved. The objective of the study was to analyze the pharmaceutical expenditure generated by prescriptions made by physicians working in a primary care area and assess its relationship with the quality indicators of the prescription. METHODS: The prescriptions of 200 family physicians of the Basque Health Service Araba Countyand dispensed by the community pharmacies between 2009 and 2016 were studied. The variables evaluated retrospectively corresponded to the quality indicators of the pharmaceutical prescription included in the Contract-Program of the Basque Department Health of 2016. Prediction models were developed using linear regression and binary logistic regression analysis. RESULTS: The main factors which increased the pharmaceutical expenditure per person were: the use of novel drugs which do not offer therapeutic improvements, the proportion of pensioners, the use of statins and the use of antiulcer the proton pump inhibitors (PPI). On the contrary, the factors that reduced this expense were: the seniority in the medical position, the physician job stability and the prescription quality index. The profile of the doctor who generated the greatest expense of pharmaceutical prescription was mainly that of a professional who was responsible for a high percentage of pensioners, prescribed a high amount of inhibitors of the enzyme angiotensin converting enzyme inhibitors (ACEI), prescribed a high amount of first level non-steroidal anti-inflammatory drugs (NSAIDs) and also showed high use of antiulcer PPI. CONCLUSIONS: There is a statistically significant correlation between physicians who generate lower pharmaceutical expenditure and have a higher quality of prescription. The most influencing factors in the pharmaceutical expenditure are a high percentage of pensioners in the medical quota, the use of novel drugs that do not provide therapeutic improvements and the prescription of statins and anti-ulcer PPI drugs

[Analysis of proton pump inhibitors anti-ulcer drugs use in the Araba district primary care area]. / Análisis de la utilización de antiulcerosos inhibidores de la bomba de protones en el área de atención primaria de la comarca Araba.

OBJECTIVE: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. METHODS: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23® statistic software. RESULTS: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. CONCLUSIONS: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole.

OBJETIVO: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacológicos más prescritos en atención primaria. El objetivo del trabajo fue conocer la prescripción de IBP en el Área de Atención Primaria de la Comarca Araba de Osakidetza para sensibilizar a los médicos de familia sobre su correcta utilización, así como fomentar la prescripción de los IBP más eficientes. METODOS: Estudio descriptivo de la prescripción de IBP de 200 médicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los años 2009-2014. Se analizó el importe del consumo y las Dosis por 1000 habitantes/día (DHD) de IBP, así como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapéutico. El análisis estadístico se realizó mediante el programa IBM SPSS v23®. RESULTADOS: La prescripción de IBP se incrementó un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilización muy superior a la de otros países europeos. En el mismo periodo, el porcentaje de prescripción relativa de omeprazol frente al resto de IBP disminuyó un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol pasó del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyó un 17,60%. CONCLUSIONES: Existe un incremento global en el número de prescripciones de IBP, aunque ha disminuido el gasto por la reducción de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripción de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevención de gastropatías aumenta el riesgo de prescripciones inadecuadas. El antiulceroso más recomendado continua siendo el omeprazol.

Análisis de la utilización de antiulcerosos inhibidores de la bomba de protones en el área de atención primaria de la comarca Araba / Analysis of proton pump inhibitors anti-ulcer drugs use in the Araba district primary care area

Fundamentos: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacológicos más prescritos en atención primaria. El objetivo del trabajo fue conocer la prescripción de IBP en el Área de Atención Primaria de la Comarca Araba de Osakidetza para sensibilizar a los médicos de familia sobre su correcta utilización, así como fomentar la prescripción de los IBP más eficientes. Métodos: Estudio descriptivo de la prescripción de IBP de 200 médicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los años 2009-2014. Se analizó el importe del consumo y las Dosis por 1000 habitantes/día (DHD) de IBP, así como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapéutico. El análisis estadístico se realizó mediante el programa IBM SPSS v23(R). Resultados: La prescripción de IBP se incrementó un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilización muy superior a la de otros países europeos. En el mismo periodo, el porcentaje de prescripción relativa de omeprazol frente al resto de IBP disminuyó un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol pasó del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyó un 17,60%. Conclusiones: Existe un incremento global en el número de prescripciones de IBP, aunque ha disminuido el gasto por la reducción de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripción de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevención de gastropatías aumenta el riesgo de prescripciones inadecuadas. El antiulceroso más recomendado continua siendo el omeprazol

Background: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. Methods: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23(R) statistic software. Results: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. Conclusions: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole

Factores asociados a la mortalidad extrahospitalaria de las paradas cardiorrespiratorias atendidas por unidades de soporte vital básico en el País Vasco / Factors associated with mortality in out-of-hospital cardiac arrests attended in basic life support units in the Basque Country (Spain)

Introducción y objetivos. Describir las características epidemiológicas de las paradas cardiorrespiratorias atendidas por las unidades de soporte vital básico del País Vasco y determinar los factores asociados al fracaso de las maniobras de reanimación. Métodos. Estudio observacional sobre el total de paradas cardiorrespiratorias asistidas por las unidades de soporte vital básico del País Vasco durante 18 meses. Se tomaron como variables independientes las definidas en el estilo Utstein y como variable dependiente la mortalidad extrahospitalaria. Se aplicó estadística descriptiva y analítica, evaluando la magnitud de asociación mediante el riesgo relativo aplicando un modelo de regresión logística. Resultados. Se atendieron en total 1.050 paradas, de las que se reanimó in situ el 15,7%. El 55,3% de las paradas fueron de etiología cardiológica y el 71,4% aconteció en el hogar. Se intentó la reanimación antes de la llegada de la ambulancia en el 22,9% de los casos y en el 18,2% el ritmo de presentación fue desfibrilable. Las variables asociadas a menor mortalidad fueron ritmo desfibrilable (riesgo relativo=0,44; p=0,003), edad del paciente<65 años (riesgo relativo=0,44; p=0,002), tiempo hasta la reanimación<8 min (riesgo relativo=0,56; p=0,039) y eventos extradomiciliarios (riesgo relativo=0,55; p=0,031). Conclusiones. La probabilidad de sobrevivir a una parada cardiorrespiratoria es baja. Se realizan pocos intentos de reanimación antes de la llegada de la ambulancia. Un ritmo desfibrilable, edades inferiores a 65 años, el inicio precoz de la reanimación y la localización fuera del domicilio se asocian a mayor supervivencia. Deben crearse estrategias dirigidas a disminuir los intervalos de respuesta e instruir a la población en reanimación básica (AU)

Introduction and objectives. To describe the epidemiological characteristics of cardiac arrests attended in basic life support units in the Basque Country (Spain) and look for factors associated with failure of cardiopulmonary resuscitation. Methods. We conducted an observational study during 18 months, including all out-of-hospital cardiopulmonary resuscitation provided by basic life support units. The variables defined in the Utstein-style were considered as independent and mortality as the dependent variable. We applied descriptive and analytical statistics and evaluated the magnitude of the association using a logistic regression model, which included variables with P<.05 in the bivariate analysis. Results. Of 1050 cardiac arrests attended, 15.7% of patients were revived in situ. The presumed etiology was cardiac in 55.3% of cases and 71.4% occurred at home. Cardiopulmonary resuscitation was started before the arrival of the ambulance in 22.9% of cases and in 18.2% the rhythm of presentation was shockable. Variables associated with lower mortality were: shockable rhythms (relative risk=0.44; P=.003), patient aged<65 years (relative risk=0.44; P=.002), time to cardiopulmonary resuscitation<8 min (relative risk=0.56; P=.039), and out-of-home events (relative risk=0.55; P=.031). Conclusions. Cardiac arrest survival was low. Cardiopulmonary resuscitation before the arrival of the ambulance was rare. A shockable rhythm, age younger than 65 years, early cardiopulmonary resuscitation efforts, and a location away from home were associated with longer survival. It is necessary to develop strategies designed to reduce ambulance response time and educate the public in basic resuscitation (AU)

Factors associated with mortality in out-of-hospital cardiac arrests attended in basic life support units in the Basque Country (Spain).

INTRODUCTION AND OBJECTIVES: To describe the epidemiological characteristics of cardiac arrests attended in basic life support units in the Basque Country (Spain) and look for factors associated with failure of cardiopulmonary resuscitation. METHODS: We conducted an observational study during 18 months, including all out-of-hospital cardiopulmonary resuscitation provided by basic life support units. The variables defined in the Utstein-style were considered as independent and mortality as the dependent variable. We applied descriptive and analytical statistics and evaluated the magnitude of the association using a logistic regression model, which included variables with P<.05 in the bivariate analysis. RESULTS: Of 1050 cardiac arrests attended, 15.7% of patients were revived in situ. The presumed etiology was cardiac in 55.3% of cases and 71.4% occurred at home. Cardiopulmonary resuscitation was started before the arrival of the ambulance in 22.9% of cases and in 18.2% the rhythm of presentation was shockable. Variables associated with lower mortality were: shockable rhythms (relative risk=0.44; P=.003), patient aged<65 years (relative risk=0.44; P=.002), time to cardiopulmonary resuscitation<8 min (relative risk=0.56; P=.039), and out-of-home events (relative risk=0.55; P=.031). CONCLUSIONS: Cardiac arrest survival was low. Cardiopulmonary resuscitation before the arrival of the ambulance was rare. A shockable rhythm, age younger than 65 years, early cardiopulmonary resuscitation efforts, and a location away from home were associated with longer survival. It is necessary to develop strategies designed to reduce ambulance response time and educate the public in basic resuscitation.

Evolución de la incidencia de migraña en Álava en el período 2004-2008 / Evolution of the incidence of migraine in Álava over the period 2004-2008

Introducción. Existen muy pocos estudios sobre la incidencia de migraña en España, y los que hay tienen alguna limitación, como carecer de base poblacional clara. Objetivo. Examinar la evolución de la incidencia de migraña a lo largo del período 2004-2008 en la provincia de Álava (País Vasco, España).Pacientes y métodos. Los datos corresponden a personas de 15 o más años de edad registrados como nuevos casos diagnosticados de migraña en la base de datos del Servicio Vasco de Salud/Osakidetza. La tendencia en la incidencia de migraña se valoró mediante regresión lineal. Resultados. La incidencia de migraña fue significativamente mayor en las mujeres que en los hombres, a cualquier edad. No se observaron cambios en la incidencia de migraña en el período 2004-2008 en el conjunto de la población de Álava (p = 0,189). Sin embargo, se ha producido un descenso en la incidencia de migraña en las mujeres mayores de 64 años (p = 0,014), y un aumento en las de 15-24 años (p = 0,052) y 35-44 años (p = 0,057). Los nuevos casos de migrañadiagnosticada tendieron a aparecer en edades más jóvenes a lo largo de este período. Conclusiones. Estos resultados indican una ausencia de cambios en la tendencia de la incidencia de migraña a lo largo del período 2004-2008, excepto un descenso en el caso de las mujeres mayores de 64 años y un aumento en las jóvenes. Esta evolución es similar a la de otras regiones europeas (AU)

Introduction. Few studies have been conducted on the incidence of migraine in Spain, and those that have been carried out have some shortcomings, such as the lack of a clear population base. Aims. To examine the evolution of the incidence of migraine over the period 2004-2008 in the province of Álava (Basque Country, Spain).Patients and methods. Data concerned persons aged 15 or over who were registered in the Basque Health Service/Osakidetza database as new cases diagnosed with migraine. The tendency of the incidence of migraine was evaluated by means oflinear regression. Results. The incidence of migraine was significantly higher in females than in males, at any age. No significant changes in the incidence of migraine were observed over the period 2004-2008 in the population of Ávala as a whole (p = 0.189). Nevertheless, there have been both a decrease in the incidence of migraine in females over the age of 64 (p = 0.014) and an increase in those aged 15-24 years (p = 0.052) and 35-44 years (p = 0.057). The new cases of migraine that arediagnosed tended to appear at younger ages over this period. Conclusions. These results suggest an absence of changes in the tendency in the incidence of migraine throughout the period 2004-2008, except for a decrease in the case of females over 64 years of age and an increase in young females.This evolution is similar to that of other regions in Europe (AU)

[Evolution of the incidence of migraine in Álava over the period 2004-2008]. / Evolución de la incidencia de migraña en Álava en el período 2004-2008.

INTRODUCTION: Few studies have been conducted on the incidence of migraine in Spain, and those that have been carried out have some shortcomings, such as the lack of a clear population base. AIMS: To examine the evolution of the incidence of migraine over the period 2004-2008 in the province of Álava (Basque Country, Spain). PATIENTS AND METHODS: Data concerned persons aged 15 or over who were registered in the Basque Health Service/Osakidetza database as new cases diagnosed with migraine. The tendency of the incidence of migraine was evaluated by means of linear regression. RESULTS: The incidence of migraine was significantly higher in females than in males, at any age. No significant changes in the incidence of migraine were observed over the period 2004-2008 in the population of Ávala as a whole (p = 0.189). Nevertheless, there have been both a decrease in the incidence of migraine in females over the age of 64 (p = 0.014) and an increase in those aged 15-24 years (p = 0.052) and 35-44 years (p = 0.057). The new cases of migraine that are diagnosed tended to appear at younger ages over this period. CONCLUSIONS: These results suggest an absence of changes in the tendency in the incidence of migraine throughout the period 2004-2008, except for a decrease in the case of females over 64 years of age and an increase in young females. This evolution is similar to that of other regions in Europe.

Patologías crónicas en trabajadores de limpieza y administrativos / Chronic Pathologies among cleaning and administrative personnel

La salud de los trabajadores resulta de vital importancia para un óptimo rendimiento laboral. La prevalencia de ciertas patologías afecta al normal funcionamiento del trabajador, provocando incapacidades y absentismo laboral. Por ello se mide la prevalencia de enfermedades de tipo crónico en dos grupos laborales, trabajadores de limpieza y administrativos, analizando las diferencias de género y valorando la influencia del trabajo desarrollado. Las patologías crónicas más prevalentes halladas en ambos colectivos son: asma, alergias, psoriasis, escoliosis, varices, trastornos músculo-esqueléticos (TME) e HTA(AU)

Workers’ health is of vital importance in order for workers to work at their utmost on their jobs. The prevalence of specific pathologies affects the normal functioning of workers, provoking incapacities and absences from work. The authors measure the prevalence of chronic type illnesses among cleaning and administrative personnel. The authors analyze differences based on gender and they evaluate its influence on the work assigned. In both labor groups, there exists a significant difference in the prevalence of varicose veins and scoliosis favorable in the feminine sex, a fact which corresponds to gender reasons and not to the type of work carried out. Arterial hypertension, on the other hand, is more prevalent among men in both groups, making them be exposed to a greater cardiovascular risk. The remaining pathologies found did not show any significant gender differences(AU)