Evidence for deprescription in primary care through an umbrella review.

BACKGROUND: There is a high prevalence of potentially inappropriate prescriptions in primary care. This is associated with more frequent adverse events, lower quality of life and more frequent visits to hospital accident & emergency departments. The aim of the present study is to summarise available evidence on the effectiveness of deprescription interventions in primary care, and to describe the barriers and enablers of the process from the point of view of patients and healthcare professionals. METHODS: We designed an umbrella review which includes nine systematic reviews. More than 50% of included studies were performed with adults in primary care. Two reviewers independently performed data extraction and analysis. RESULTS: In considering studies of the effectiveness of interventions, it can be observed that the educational component of deprescription procedures is a key factor, whilst procedures tailored towards the patient's situation offer better results. With regards to studies involving healthcare professionals, the main explored areas were the balance between risks and benefits, and the need to improve communication with patients as well as other colleagues involved in patient care. Amongst the identified barriers we found lack of time, inability to access all information, being stuck in a routine, resistance to change and a lack of willingness to question the prescription decisions made by healthcare colleagues. With regards to patients, it is clear that they have worries and doubts. In order to overcome these issues, a good relationship with healthcare professionals and receipt of their support is required during the process. CONCLUSIONS: Optimizing medication through targeted deprescribing is an important part of managing chronic conditions, avoiding adverse effects and improving outcomes. The majority of deprescription interventions in primary care are effective. Good communication between healthcare professionals is a key element for success in the deprescription process.

["Here (in Sydney) we are lost:" An ethnographic study of life satisfaction among urban aboriginal Australians participating in a community outreach program]. / "Aquí (en Sídney) estamos perdidos": estudio etnográfico de la satisfacción vital de aborígenes urbanos australianos participantes en un programa sociocomunitario.

This ethnographic study was designed to explore living conditions among a group of aboriginal families residing in an urban context, who participated in a recreational social program. The aim of the study was to explore life satisfaction by analyzing their living conditions and cultural capital inscribed in established attitudes, perceptions, and lay knowledge. Fieldwork was carried out in two complementary phases: phase 1, between May 2008 and December 2010, began when the first listed author initiated volunteer work with the organization responsible for the program; in phase 2, which extended from January 2011 to February 2013, participant observation was intensified and semi-structured interviews were carried out. The results indicate that the process of cultural uprooting underscores the experience of social inequality, and suggest a cohort effect that continues to this day. This process of cultural (in)consonance must be taken into account as a key factor when analyzing the living conditions and well-being of ethnic minorities, as well as when developing programs and interventions.

Este estudio etnográfico fue diseñado para explorar las condiciones de vida de un grupo de familias aborígenes residentes en un contexto urbano, beneficiarias de un programa sociorecreativo en Sídney, Australia. El objetivo fue explorar la satisfacción vital mediante el análisis de sus condiciones de vida y del capital cultural inscrito en sus actitudes, percepciones y conocimientos establecidos. El trabajo de campo se estructuró en dos fases complementarias: en la fase 1, entre mayo de 2008 y diciembre de 2010, se inició con el ingreso del primer autor como voluntario en la asociación responsable del programa y, en la fase 2, entre enero de 2011 y febrero de 2013 se intensificó el proceso de observación participante y las entrevistas semiestructuradas. Los resultados muestran que el proceso de desarraigo cultural está en la base de las experiencias vitales de desigualdad social experimentadas y apunta a un efecto de cohorte que llega hasta nuestros días. Dicho proceso de (des)consonancia cultural debe ser tenido en cuenta como un factor clave a la hora de analizar las condiciones de vida y bienestar de estas minorías étnicas, así como a la hora de desarrollar programas e intervenciones.

Aquí (en Sídney) estamos perdidos: estudio etnográfico de la satisfacción vital de aborígenes urbanos australianos participantes en un programa sociocomunitario / Here (in Sydney) we are lost: An ethnographic study of life satisfaction among urban aboriginal Australians participating in a community outreach program

RESUMEN Este estudio etnográfico fue diseñado para explorar las condiciones de vida de un grupo de familias aborígenes residentes en un contexto urbano, beneficiarias de un programa sociorecreativo en Sídney, Australia. El objetivo fue explorar la satisfacción vital mediante el análisis de sus condiciones de vida y del capital cultural inscrito en sus actitudes, percepciones y conocimientos establecidos. El trabajo de campo se estructuró en dos fases complementarias: en la fase 1, entre mayo de 2008 y diciembre de 2010, se inició con el ingreso del primer autor como voluntario en la asociación responsable del programa y, en la fase 2, entre enero de 2011 y febrero de 2013 se intensificó el proceso de observación participante y las entrevistas semiestructuradas. Los resultados muestran que el proceso de desarraigo cultural está en la base de las experiencias vitales de desigualdad social experimentadas y apunta a un efecto de cohorte que llega hasta nuestros días. Dicho proceso de (des)consonancia cultural debe ser tenido en cuenta como un factor clave a la hora de analizar las condiciones de vida y bienestar de estas minorías étnicas, así como a la hora de desarrollar programas e intervenciones.

ABSTRACT This ethnographic study was designed to explore living conditions among a group of aboriginal families residing in an urban context, who participated in a recreational social program. The aim of the study was to explore life satisfaction by analyzing their living conditions and cultural capital inscribed in established attitudes, perceptions, and lay knowledge. Fieldwork was carried out in two complementary phases: phase 1, between May 2008 and December 2010, began when the first listed author initiated volunteer work with the organization responsible for the program; in phase 2, which extended from January 2011 to February 2013, participant observation was intensified and semi-structured interviews were carried out. The results indicate that the process of cultural uprooting underscores the experience of social inequality, and suggest a cohort effect that continues to this day. This process of cultural (in)consonance must be taken into account as a key factor when analyzing the living conditions and well-being of ethnic minorities, as well as when developing programs and interventions.

"Pasar el mal trago": un estudio etnográfico de jóvenes que experimentan una intoxicación etílica aguda en un servicio de urgencias / "Overcome a bad shot": an ethnographic study of young people experiencing acute alcohol intoxication in an emergency department

En la actualidad, el patrón recreativo de consumo intensivo de alcohol conlleva, en ocasiones, que los jóvenes terminen en los servicios de urgencias. El objetivo de esta investigación ha sido estudiar la experiencia y perspectiva de jóvenes tras una intoxicación etílica aguda. Se trata de un estudio etnográfico llevado a cabo en el servicio de urgencias de un hospital de la ciudad de Granada (España) mediante un muestreo intencional con 95 jóvenes. Se realizó un análisis de contenido cualitativo. Nuestros resultados muestran que los jóvenes atendidos suelen considerar su experiencia con una intoxicación etílica como un «mal trago» que hay que pasar y olvidar. Justifican dicha intoxicación con razones no relacionadas con el consumo abusivo de alcohol (no habían comido, mala suerte, padecer diabetes, etc.). El servicio de urgencias es la última medida terapéutica para revertir los efectos adversos de una intoxicación etílica aguda y no consideran, tras su experiencia, dejar de beber, aunque la mayoría de la muestra consultada puso de manifiesto la necesidad de moderar el consumo de alcohol. Los resultados se discuten proporcionando ideas para poder realizar intervenciones en los servicios de urgencias que sean adecuadas a las necesidades de las personas jóvenes y la organización de los servicios sanitarios

The current pattern of intensive recreational use of alcohol leads sometimes excesses favoring the support of young people in the emergency department. The objective of this research was to study the experience and perspective of young people after an acute alcohol intoxication. This is an ethnographic study carried out in an emergency department of a hospital in the city of Granada (Spain) by purposive sampling with 95 young people. We develop a qualitative content analysis. Our results show that youth served often consider their experience with AAI as a ‘bad shot’ that is necessary to go and forget. They justified this AAI with causes unrelated to alcohol abuse (have not eaten, bad luck, diabetes, etc.). The urgency department is the last therapeutic measure to reverse the adverse effects of AAI and do not consider stop drinking, although most of the consulted youth recognized that they need to moderate the alcohol consumption. We discuss the findings providing ideas to make interventions in the emergency departments more sensitive to the needs of young people and the organization of health services

Intensive alcohol consumption by adolescents in Southern Spain: The importance of friendship.

BACKGROUND: There has been an increase in intensive alcohol drinking by Spanish adolescents since the 1990s, especially among the females, but there has been limited exploration of this phenomenon. The objective of this study was to analyse the discourses of Spanish adolescents on their drinking behaviour at contextual, relational, and personal levels. METHODS: A qualitative study was undertaken in 96 adolescents aged between 14 and 17 years who had experienced at least one intensive drinking episode during the previous year. They lived with family members and were not offenders or at risk of social exclusion. Participants were recruited at educational centres and youth centres in two provinces in southern Spain. Ten focus groups and 30 in-depth individual interviews were conducted. A summative content analysis was performed. RESULTS: Intensive alcohol drinking was widely practiced in this study population. Consolidation of this practice was influenced by cultural, interpersonal and personal dimensions. Consumption in public spaces emerged as a key influential factor, especially the botellón, a collective space-time in which Spanish adolescents socialize and become initiated into intensive alcohol consumption. Besides the facilitating elements of the social and cultural setting, the results also evidence the effects of interpersonal relationships within the peer group, which offer a series of approaches to risk and protective practices. In these adolescents, the main reason for engaging in alcohol drinking was to enhance their social relationships, which acted as a mechanism to normalize intensive alcohol consumption. CONCLUSIONS: Policies to reduce the harm caused to adolescents by intensive alcohol drinking need to take account of the contextual, relational and personal dimensions of this practice. The discourses of these adolescents from Southern Spain point to a potential role for the peer group in harm reduction strategies.

Bebiendo como chicos: consumo compartido de alcohol y rupturas de género en poblaciones adolescentes / No disponible

La información epidemiológica en España pone en evidencia los cambios que se vienen sucediendo en los patrones de consumo de alcohol en las poblaciones adolescentes. Estos son especialmente significativos en relación a la reducción de la brecha en los consumos intensivos de alcohol por parte de las chicas. Este artículo tiene como objetivo describir algunos elementos que, imbricados al sistema de género, muestran tendencias de lo que está sucediendo en relación al consumo de alcohol en las poblaciones adolescentes. Para ello fue diseñado un estudio cualitativo en base a grupos focales con chicas y chicos de 14 a 17 años. Los discursos de los 66 adolescentes andaluces participantes en el estudio fueron tratados siguiendo un procedimiento de análisis de contenido. Los resultados ponen de manifiesto tanto aspectos diferenciados como compartidos entre chicos y chicas en relación a los procesos de inicio al consumo de alcohol, experiencias de consumo intensivo y control de riesgos. Los resultados se discuten en torno al papel del consumo de alcohol a la hora de definir y reforzar ciertos valores y significados atribuidos a lo masculino y lo femenino. Especialmente, en relación a los procesos de ruptura dentro del sistema de género provocados por las prácticas de consumo intensivo de alcohol en el espacio público por parte de chicas

Epidemiological data available in Spain highlights the changes that are occurring in patterns of alcohol consumption in adolescent populations. These are especially significant with regard to reducing the gap in intensive consumption of alcohol by girls. This article aims to describe certain aspects relating to the gender system that show what is happening in relation to alcohol consumption in adolescent populations. A qualitative study based on focus groups with girls and boys of 14-17 years was designed for this purpose. The speeches of the 66 Andalusian teenagers in the study were processed by means of a content analysis procedure. The results highlight different aspects shared between boys and girls in relation to consumption, intensive consumption experiences and risk control in alcohol consumption. The results are discussed in respect of the role of alcohol in the definition and reinforcement of certain values and meanings attributed to the masculine and the feminine identity and especially with regard to rupture processes within the gender system caused by practices of intensive alcohol consumption in public space by girls