[Prevalence and associated factors in self-monitoring of blood glucose in noninsulin-treated type 2 diabetes patients in the Valencia Community, Spain]. / Prevalencia y factores asociados de la automonitorización glucémica en pacientes diabéticos tipo 2 no tratados con insulina en la Comunidad Valenciana.

BACKGROUND: Self-monitoring of blood glucose (SMBG) in noninsulin-treated type 2 diabetes patients (T2DM) is a controversial topic. We aimed to describe the SMBG prevalence in noninsulin-treated (NIT) T2DM patients in the Valencia Community (VC) and to analyze factors associated with their use. METHOD: Cross-sectional study with 573 NIT-T2DM patients from 83 primary care surgeries. Electronic medical records and patient interview were used. We examine associations among patient, doctors and organizational characteristics, and the SMBG indication. RESULTS: 289 (50.4%) of the 573 NIT-T2DM patients used SMBG. In the multivariable analysis SMBG use was associated with age (OR:2.3 for 65-84 and 6.0 for <65 years vs 85+ years old)) the length from diagnosis (OR:2.2 for 10-15 years vs 0-5 years), the number of OAAs prescribed (OR:2.5, 4.1 and 5.7 for 1, 2 or 3+ OAAs vs no treatment with OAAs) and type (with more SMBG prescribed in patients with sulfonylureas and glitazones), glycated haemoglobin figures (OR: 1.9 y 1.6 for 7-8 and >8, vs <7), sedentary behaviour (OR:1.6), obesity (OR:1.5), and housewife status, and chronic respiratory disease antecedents (OR:0.5). After controlling these factors, SMBG use was also associated with the length of doctor's professional practice and some healthcare departments. CONCLUSIONS: In the Valencia Community the SMBG use in noninsulin-treated T2DM patients is strongly associated with clinic patient' characteristics, but some non-clinical factors explain part of the variance in their utilization.

Effectiveness of safety warnings in atypical antipsychotic drugs: an interrupted time-series analysis in Spain.

BACKGROUND: Studies conducted to obtain drug authorization are often of short duration and based on small sample sizes in selected populations. Policies on drug safety rely on the validity of the methods used to achieve rapid and effective communication of new information. No formal evaluation has ever been made of the Spanish communications system, although indirect data have raised questions about its effectiveness. OBJECTIVE: To evaluate the impact of two safety warnings issued by the Spanish Drug Agency, and of a later prior authorization requirement involving the use of atypical antipsychotic drugs in the elderly. METHODS: The study was based on a time-series analysis constructed with data corresponding to monthly invoicing from 2000 to 2006 for olanzapine and risperidone in the Region of Valencia, Spain. Because the safety warnings and the prior authorization policy applied exclusively to prescriptions of these drugs for elderly patients with dementia, we investigated whether these interventions were successful and therefore changed prescription patterns for pensioners receiving low-strength formulations (the available proxy for elderly subjects with dementia), without altering patterns for those receiving the highest-strength formulations (typically used in schizophrenic patients) or for prescriptions for non-pensioners (any strength formulations). These two latter groups were therefore established as the control groups. RESULTS: Defined daily doses (DDDs) for olanzapine in low-strength pharmaceutical forms showed a clear levelling off after the first warning, while that for risperidone showed less pronounced decline. The prior authorization policy had a dramatic effect on the consumption of risperidone, but not on that of olanzapine. DDDs for low-strength formulations between the 12 months prior to the first warning and the 12 months following the prior authorization showed a substantial reduction (22% for risperidone and 33% for olanzapine). In the high-strength forms and in non-pensioners the upward trends in DDDs remained unaltered after both interventions. CONCLUSION: The safety warnings concerning atypical antipsychotic drugs were effective in reducing the prescribing of risperidone and olanzapine in low-strength doses in pensioner prescriptions, and the implementation of a prior authorization policy had a dramatic effect on the prescribing of risperidone.

[The secondary prevention of ischaemic heart disease in Spain. A systematic review of observational studies]. / Prevención secundaria de la cardiopatía isquémica en España. Una aproximación desde los estudios observacionales.

OBJECTIVE: To describe the use of ischaemic heart disease (IHD) secondary prevention measures in the Spanish National Health System. DESIGN: Systematic review of observational studies with information on the use of preventive treatment and measures in the prevention of secondary IHD. SETTING: Primary care and specialised out-patient clinics. DATA SOURCES: Medline search and complementary searches of studies published between 1995 and 2004 with a description of the use secondary prevention measures on hospital discharge or in the follow up after discharge. SELECTION OF STUDIES: A total of 125 references were found after the MEDLINE search, 13 of which were selected after an independent review by 2 researchers. The complementary sources provided 9 more studies giving a total of 22. DATA EXTRACTION: One researcher extracted information on the characteristics of the study and the results variables, which were independently verified by a second evaluator. RESULTS. In the 22 studies found, a high level of variation was shown in the different treatment rates: anti-aggregants (at discharge, 72%-97.1%; follow-up, 46.4%-93.8%); beta-blockers (at discharge, 29%-68.3%; follow-up, 22.4%-59.0%); drugs with action on the renin-angiotensin system (at discharge, 16.2%-52.2%; follow-up, 6.1%-53.1%); lipid lowering drugs (at discharge, 6.7%-88.7%; follow-up, 24.5%-89.5%). The treatment rates showed a progressive improvement over time during the period studied. CONCLUSIONS: In the period 1994-2003 treatment rates in the secondary prevention of IHD have increased, although there is still much room for improvement.

Prevención secundaria de la cardiopatía isquémica en España. Una aproximación desde los estudios observacionales / The secondary prevention of ischaemic heart disease in Spain. A review of observational studies

Objetivo. Describir la utilización de medidas de prevención secundaria de la cardiopatía isquémica (CI) en el Sistema Nacional de Salud. Diseño. Revisión sistemática de estudios observacionales con información sobre uso de tratamientos y medidas preventivas en prevención secundaria de la CI. Emplazamiento. Atención extrahospitalaria, tanto primaria como especializada. Fuentes de datos. Búsqueda en MEDLINE y búsquedas complementarias de estudios publicados entre 1995 y 2004 con descripción del uso de medidas de prevención secundaria al alta hospitalaria o en el seguimiento tras el alta. Selección de estudios. Tras la búsqueda en MEDLINE se encontraron 125 referencias, de las que en la revisión independiente realizada por 2 investigadores se seleccionaron 13. Las fuentes complementarias aportaron 9 estudios hasta totalizar los 22 incluidos. Extracción de datos. Un investigador extrajo información sobre las características del estudio y las variables de resultado, que fue verificada independientemente por un segundo evaluador. Resultados. Se hallaron 22 estudios que muestran un alto grado de variabilidad en el uso de los diversos tratamientos índice: antiagregantes (al alta, 72-97,1%; seguimiento, 46,4-93,8%); bloqueadores beta (al alta, 29-68,3%; seguimiento, 22,4-59,0%); fármacos con acción sobre el sistema renina-angiotensina (al alta, 16,2-52,2%; seguimiento, 6,1-53,1%); hipolipemiantes (al alta, 6,7-88,7%; seguimiento, 24,5-89,5%). La evolución temporal de las cifras de tratamiento muestra una importante mejora en el período. Conclusiones. En el período 1994-2003 se ha incrementado la utilización de tratamientos índice en prevención secundaria, aunque aún queda un importante espacio de mejora

Objective. To describe the use of ischaemic heart disease (IHD) secondary prevention measures in the Spanish National Health System. Design. Systematic review of observational studies with information on the use of preventive treatment and measures in the prevention of secondary IHD. Setting. Primary care and specialised out-patient clinics. Data sources. Medline search and complementary searches of studies published between 1995 and 2004 with a description of the use secondary prevention measures on hospital discharge or in the follow up after discharge. Selection of studies. A total of 125 references were found after the MEDLINE search, 13 of which were selected after an independent review by 2 researchers. The complementary sources provided 9 more studies giving a total of 22. Data extraction. One researcher extracted information on the characteristics of the study and the results variables, which were independently verified by a second evaluator. Results. In the 22 studies found, a high level of variation was shown in the different treatment rates: anti-aggregants (at discharge, 72%-97.1%; follow-up, 46.4%-93.8%); beta-blockers (at discharge, 29%-68.3%; follow-up, 22.4%-59.0%); drugs with action on the renin-angiotensin system (at discharge, 16.2%-52.2%; follow-up, 6.1%-53.1%); lipid lowering drugs (at discharge, 6.7%-88.7%; follow-up, 24.5%-89.5%). The treatment rates showed a progressive improvement over time during the period studied. Conclusions. In the period 1994-2003 treatment rates in the secondary prevention of IHD have increased, although there is still much room for improvement

El valor de la información y la información como valor / The value of information and information as a value

No disponible

Terapia antihipertensiva e insuficiencia cardíaca congestiva / Antihypertensive therapy and congestive heart failure

No disponible