Mobbing as a Predictor of Health Risk Behaviours and Seeking Specialist Support in Non-university Teachers / [El acoso psicológico como predictor de conductas de riesgo para la salud y la búsqueda de apoyo especializado en los docentes no universitarios]

The purpose of this study was to investigate whether experiencing mobbing can predict different health risk behaviours, such as smoking, alcohol intake, increased use of medication as a consequence of psychological disorders at work, and the need to seek specialist support in non-university teachers (N = 9,350). The results of the factorial analysis confirmed the one-dimensionality of the scale and its invariance by gender and educational stage. Results for the predictive model showed that the total score on a mobbing scale predicts the increase in both alcohol intake and tobacco use, a greater use of medication as a consequence of psychological or psychosomatic health disorders at work, and the need to seek support from a specialist to overcome some personal crises related to work. Likewise, the consumption of alcohol and tobacco were positively correlated, whereas the search for specialist support was more related to the increase in the use of medication.(AU)

El objetivo del estudio fue investigar si el acoso psicológico predecía conductas de riesgo no saludables en forma de aumento del consumo de tabaco y alcohol y aumento del consumo de medicamentos por trastornos psicológicos asociados al trabajo, así como la búsqueda de apoyo de profesionales en docentes no universitarios (N = 9,350). Un análisis factorial inicial confirmó la unidimensionalidad de la escala de mobbing y su invarianza por género y etapa educativa. Los resultados del modelo predictivo mostraron que la puntuación en acoso predice el aumento de consumo de alcohol y de tabaco y mayor uso de medicamentos debido a problemas de salud psicológicos o psicosomáticos derivados del trabajo, así como la necesidad de buscar apoyo de especialistas para superar crisis personales relacionadas con el trabajo. El aumento del consumo de alcohol y de tabaco correlacionan positivamente. La búsqueda de apoyo especializado está más relacionada con el aumento del uso de medicamentos.(AU)

Evaluating population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings: A systematic review protocol.

BACKGROUND: Inappropriate antibiotic use contributes significantly to the global challenge of antimicrobial resistance. While government-initiated population-level interventions are fundamental in addressing this issue, their full potential remains to be explored. This systematic review aims to assess the effectiveness of such interventions in reducing inappropriate antibiotic use among antibiotic providers and users in healthcare and community settings. METHODS: We will conduct a systematic literature search across multiple databases and grey literature sources. We will include studies which evaluate the effectiveness of population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings in both high-income and low- and middle-income countries. This includes government-initiated measures targeting antibiotic use through education, restriction, incentivization, coercion, training, persuasion, context modification, behavior modeling, or barrier reduction. Two reviewers will independently perform screening to select eligible studies, followed by data extraction. The outcomes of interest are various measures of antibiotic prescription and consumption, such as Defined Daily Dose (DDD) or number of prescriptions per year. We anticipate including a broad range of study designs and outcome measures. Therefore, we will narratively synthesize results using the categories of the population-level policy interventions of the Behavior Change Wheel Framework. We will organize outcome data by economic contexts, target populations, and implementation settings. DISCUSSION: This review will strengthen the evidence base for the use of population-level interventions to address inappropriate antibiotic use. Drawing lessons from global experiences, the findings will provide valuable guidance to health policymakers, public health authorities, and researchers on tailoring interventions to specific economic contexts, populations, and settings, thereby enhancing their capacity to drive substantial improvement in appropriate antibiotic use.

Uso de drogas y automedicación en estudiantes de escuelas secundarias / Drug use and self-medication in secondary school students

Introducción: La adolescencia es la etapa clave en la adquisición de hábitos y conductas adictivas que perduran toda la vida. Existe un modelo de consumo juvenil de drogas, legales e ilegales, como forma de relación social, uso recreativo y realización personal. El policonsumo no debe ser visto como un rito de transición, sino como un problema de salud pública. Objetivos: Se estudió la prevalencia de consumo de sustancias adictivas y de medicamentos en 520 alumnos, entre 15 y 18 años, de Escuelas Públicas secundarias de la ciudad de Bahía Blanca. Asimismo, caracteriza el marco familiar, hábitos y costumbres de los estudiantes. Grupos estudiados: El 55% de los alumnos encuestados pertenece al sexo femenino y un 36% tiene doble escolaridad. Resultados: Los resultados indican que el 24% de los alumnos manifiesta fumar y un 85% tomar alcohol, de los cuales el 62% llegó a la borrachera. El 25% consume drogas, 96% corresponde a marihuana, 8% cocaína y 7% éxtasis. El 76% declara automedicarse y un 27% considera riesgosa esta práctica. El 84% convive con ambos padres y un 51% no posee materias desaprobadas. Un 35% de los jóvenes no realiza deporte, el 46% estudia otro idioma y un 39% tiene como hábito la lectura. El 25% de los alumnos que reconocen tener actividad sexual no utilizaron ningún método de protección. Conclusiones: Los resultados de la encuesta exponen la magnitud del problema y sumado a la baja edad de los estudiantes, derivan en múltiples consecuencias adversas. Este panorama constituye un desafío para el médico que, junto con la familia, docentes y especialistas, pueden actuar en aspectos preventivos, diagnósticos y terapéuticos.

Introduction: Adolescence is the key stage in the acquisition of habits and addictive behaviors that last a lifetime. There is a pattern of youth drug use, both legal and illegal, as a form of social interaction, recreational use and personal fulfilment. Polydrug use should not be seen as a rite of passage, but as a public health problem. Objetive: This paper studies the prevalence of substance and drug use in 520 students, aged 15-18, from public secondary schools in the city of Bahía Blanca. It also characterizes the family background, habits and customs of the students. Gropus: 55% of the students surveyed were female and 36% of them had double schooling. Results: The results indicate that 24% of the students report smoking and 85% drinking alcohol, of which 62% became drunk. 25% use drugs, 96% marijuana, 8% cocaine and 7% ecstasy. 76% declare that they self-medicate and 27% consider this practice risky. 84% live with both parents and 51% do not have failed subjects in the report card. 35% of those surveyed do not practice sport, 46% study another language and 39% have reading as a habit. 25% of students who admit to sexual activity did not use any method of protection. Conclusions: The results of the survey expose the magnitude of the pro- blem and, coupled with the low age of the students, lead to multiple adverse consequences. This panorama constitutes a challenge for the doctor who, together with the family, teachers and specialists, can act in preventive, diagnostic and therapeutic aspects.

Prevalence of suicide attempt and associations with deliberate self-harm, mental health problems, drug misuse and traumatic experiences - a cross sectional survey of the Norwegian population.

BACKGROUND: Monitoring self-reported suicide attempts (SA) with nationally representative surveys is important to initiate suicide prevention strategies. The aim of the study was to assess the prevalence of SA and compare deliberate self-harm, (DSH), mental health, drug misuse and traumas between SA and non-suicide attempters (NSA). METHODS: In this cross-sectional survey of a representative sample (N=1757) of the Norwegian population, we compared people with self-reported SA (n=54) to NSA (n=1703) regarding sociodemographic data, mental health problems, drug misuse and exposure to trauma. RESULTS: The prevalence of SA was 3.1 %. There was a higher proportion of welfare recipients and more deliberate self-harm, mental health problems, drug misuse and traumas in the SA group compared to NSA. CONCLUSION: This national study confirms the association between suicide attempt and deliberate self-harm, mental health problems, drug misuse and traumas.

Neuroimaging in Adolescents: Post-Traumatic Stress Disorder and Risk for Substance Use Disorders.

Trauma in childhood and adolescence has long-term negative consequences in brain development and behavior and increases the risk for psychiatric disorders. Among them, post-traumatic stress disorder (PTSD) during adolescence illustrates the connection between trauma and substance misuse, as adolescents may utilize substances to cope with PTSD. Drug misuse may in turn lead to neuroadaptations in learning processes that facilitate the consolidation of traumatic memories that perpetuate PTSD. This reflects, apart from common genetic and epigenetic modifications, overlapping neurocircuitry engagement triggered by stress and drug misuse that includes structural and functional changes in limbic brain regions and the salience, default-mode, and frontoparietal networks. Effective strategies to prevent PTSD are needed to limit the negative consequences associated with the later development of a substance use disorder (SUD). In this review, we will examine the link between PTSD and SUDs, along with the resulting effects on memory, focusing on the connection between the development of an SUD in individuals who struggled with PTSD in adolescence. Neuroimaging has emerged as a powerful tool to provide insight into the brain mechanisms underlying the connection of PTSD in adolescence and the development of SUDs.

Ondansetrón para el control de vómitos asociados a gastritis y gastroenteritis aguda en urgencias de Pediatría: uso, abuso y buen uso / Ondansetron for the control of vomiting associated with acute gastritis/gastroenteritis in Pediatric Emergencies: use, abuse and appropriate use

Introducción: el ondansetrón es un antiemético ampliamente utilizado en la práctica clínica para el control de vómitos asociados a gastritis y/o gastroenteritis aguda en niños. Sin embargo, la evidencia disponible es controvertida, sus indicaciones no están claramente definidas y no existe una unanimidad de uso en las guías de práctica clínica. Material y métodos: se realizó un estudio de cohortes retrospectivo en el que se incluyó un total de 825 niños entre 0 y 14 años con vómitos asociados a gastritis y/o gastroenteritis aguda que acudieron a Urgencias de Pediatría de un hospital terciario durante el año 2019. Se analizó la asociación entre el uso de ondansetrón y la necesidad de rehidratación intravenosa, las hospitalizaciones, el tiempo de permanencia en Urgencias y las nuevas consultas a Urgencias dentro de las 72 horas posteriores. Resultados: de la muestra estudiada, el 38,8% de los pacientes recibieron ondansetrón. La administración de ondansetrón redujo el riesgo de ingreso (OR 0,19; IC 95%: 0,04-0,84) y disminuyó el tiempo de permanencia en Urgencias (p = 0,000). No se encontraron diferencias significativas en la reducción de la necesidad de rehidratación intravenosa (OR 0,65; IC 95%: 0,40-1,05) ni en las nuevas visitas a Urgencias dentro de las 72 horas siguientes (OR 1,38; IC 95%: 0,82-2,31). Conclusiones: nuestros resultados sugieren que el uso de ondansetrón podría ser beneficioso en niños mayores de 6 meses con vómitos asociados a gastritis y/o gastroenteritis aguda y que presenten deshidratación de leve a moderada (AU)

Background: ondansetron is an antiemetic widely used in clinical practice for the control of vomiting associated with gastritis and/or acute gastroenteritis in children. However, the available evidence about its use is controversial, its directions for use are not clearly defined and there is no unanimity on its use in clinical practice guidelines.Methodology: we performed a retrospective cohort study which included a total of 825 children between 0 and 14 years, who presented symptoms of vomiting associated with gastritis and/or acute gastroenteritis and attended the Pediatric Emergency Department of a tertiary hospital in 2019. The association between the use of ondansetron and the need for intravenous rehydration, hospitalization, length of stay in the Pediatric Emergency Department and return visits to the emergency department within 72 hours was analysed.Results: of the sample studied, 38.7% of the patients received ondansetron. The administration of ondansetron reduced the risk of hospital admission (OR 0.19; 95% CI 0.04 to 0.84) and decreased the length of stay in the emergency department (p = 0.000). No significant differences were found in reducing the need for intravenous rehydration (OR 0.65; 95% CI 0.40 to 1.05) or in return visits to emergency department within 3 days (OR 1.38; 95% CI 0.82-2.31).Conclusions: our results suggest that the use of ondansetron could be beneficial in children older than 6 months with vomiting associated with gastritis and/or acute gastroenteritis and with mild-to-moderate dehydration. (AU)

Cefalea por abuso de medicamentos y sus marcadores clínicos / Medication overuse headache and its specific clinical markers

Resumen Introducción: Los marcadores clínicos de la cefalea por uso excesivo de medicación (CMA) se basan en la clasificación de las cefaleas desarrollada por la Sociedad Internacional de Cefaleas (IHS). Esta clasificación incluye sólo dos criterios: la frecuencia de los días de cefalea debe ser de 15 o más días al mes durante al menos tres o más meses; - y el número de días de uso excesivo de la medicación debe ser de 10 o 15 días al mes dependiendo del tipo de medicación. Sin embargo, los pacientes suelen tener otros marcadores clínicos asociados distintos, que la mayoría de los médicos pasan por alto durante la evaluación inicial. Metodología: Este estudio es un estudio prospectivo, longitudinal y observacional de 76 pacientes ingresados en la Unidad de Cefaleas del hospital DIPRECA. Todos ellos fueron diagnosticados de HMO según los criterios establecidos por su ICHD III beta.(1) Los pacientes recibieron un tratamiento estándar que incluía desintoxicación y medicación preventiva y fueron seguidos durante 6 meses. Se registraron los síntomas de interés en cada visita de seguimiento clínico y se administraron escalas de evaluación como Zung, MIDAS, HIT-6. Resultados: Los medicamentos sobreutilizados incluyeron antiinflamatorios no esteroideos (AINE), triptanes y cornezuelos. Los síntomas clínicos más significativos asociados fueron: despertar por la mañana con dolor de cabeza, despertar al paciente al amanecer por dolor de cabeza, dificultades de atención, depresión, dolor cervical y síndrome de dolor miofascial. Todos los síntomas mejoraron significativamente al iniciar el tratamiento, al igual que la calidad de vida medida por las escalas MIDAS y HIT-6. Discusión: Al evaluar a los pacientes con HMO, hay que tener en cuenta tanto los criterios diagnósticos de la ICHD III beta como los síntomas comunes y específicos que se observan en la mayoría de los casos de HMO.

Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: frequency of headache days must be 15 or more days per month for at least three or more months; - and the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often have others distinct associated clinical markers, which are overlooked by most physicians during the initial evaluation. Methodology: This study is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with, MOH according to the criteria established by the his ICHD III beta.(1) Patients were given standard treatment including detoxification and preventive medications and followed for 6 months. Symptoms of interest were recorded in at each clinical monitoring visit and assessment scales such as Zung, MIDAS, HIT-6 were administered. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant clinical symptoms associated were: awaking in the morning with headache, awaking the patient at dawn by headache, attention difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms significantly improved when treatment began, as did quality of life as measured by MIDAS and HIT-6 scales. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.

¿Conlleva la desprescripción de condroprotectores en pacientes con artrosis un incremento del consumo de analgésicos? Estudio observacional retrospectivo / Does the deprescription of chondroprotectors in patients with osteoarthritis lead to an increase in the consumption of analgesics? Observational retrospective study

Objetivo: El objetivo del estudio es evaluar si la desprescripción de medicamentos considerados de bajo valor intrínseco como los condroprotectores o SYSADOA, conlleva un empeoramiento sintomáti-co de la artrosis, incrementándose el consumo de analgésicos.Material y métodos: Siguiendo la práctica clínica habitual se retiró el tratamiento con SYSADOA a pa-cientes de un Centro de Atención Primaria (pobla-ción asignada: 34.382 habitantes, 17% mayores de 65 años) en base a la evidencia científica publicada y a la recomendación de la administración sanitaria de reducir los tratamientos con medicamentos de bajo valor intrínseco. Mediante un estudio obser-vacional post-intervención se analizaron diferen-cias de consumo de analgésicos y AINEs entre un periodo anterior a la retirada y el mismo periodo post-retirada.Resultados: Se analizaron 354 pacientes (68,4% mujeres, media de edad 66,2 años). No se encon-traron diferencias estadísticamente significativas en el consumo de analgesia total en el periodo de 6 meses post-retirada (media de 3,97 envases) com-parado con el periodo de 6 meses previo (media de 4,04 envases). Al estratificar por código ATC, edad y género, únicamente se encontraron diferencias en el consumo de otros analgésicos y antipiréticos teniendo en cuenta el sexo.Conclusión: Se concluye que, considerar con el paciente la desprescripción de SYSADOA a criterio del médico, es seguro y no conlleva un aumento del consumo de analgésicos (otros analgésicos y anti-piréticos, AINE, opioides menores, opioides mayo-res) sugiriendo que no implica un empeoramiento de la enfermedad artrósica. La desprescripción de SYSADOA, además, puede contribuir a reducir la po-limedicación sin alterar la situación clínica y evitar posibles riesgos de efectos adversos o interaccio-nes potenciales (AU)

Objective: The objective of this study is to assess if the deprescription of medications that are consid-ered low intrinsic value medications such as the chondroprotectors or SYSADOA entails a symptom-atic worsening of the arthrosis and consequently an increase of the consumption of analgesics.Material and Methods: Following the usual clinical practise, the SYSADOA treatment was withdrawn to the patients from a Primary Health Care Centre (assigned population: 34,382 inhabitants, 17% up to 65 years old) according to the published scientific proof and the recommendation of the health ad-ministration consisting of reducing the treatments with low intrinsic value medications. Differences in consumption of analgesics and AINEs between a previous period before the withdrawn and the same period post-withdrawn were studied through an observational post-intervention study.Results: 354 patients were analysed (68,4% wom-en, average age 66,2 years). There were not found significant differences from a statistical point of view in the total consumption of analgesia in the 6 months period post-withdrawn (average of 3,97 packagings) compared to the previous period of 6 months (average of 4,04 packagings). When stratifying by ATC code, age and gender, there were only found differences in the consumption of other analgesics and antipyretics taking into account the sex.Conclusion: It is concluded that considering togeth-er with the patient the deprescription of SYSADOA according to doctor’s criteria is safe and does not involve an increase of analgesics consumption (other analgesics, antipyretics, AINEs, major and minor opiods) suggesting that it does not suppose a worsening of the arthrosis disease. Besides, the deprescription of SYSADOA may contribute to re-duce polymedication without disrupting the clinical situation and avoid possible risks of adverse effects or potential interactions

Panorama de la automedicación en estudiantes de educación superior: una mirada global / Overview of self-medication in higher education students: a global view / Panorama da automedicação em estudantes do ensino superior: uma visão global

Introducción: La automedicación es una práctica que llevan a cabo especialmente los jóvenes universitarios, al percibirse inmunes a enfermedades, sin tener en cuenta los efectos sobre el uso de fármacos sin prescripción. Objetivo: Analizar los hallazgos de la literatura existente sobre la automedicación en estudiantes de educación superior. Materiales y métodos: Se em-pleó la metodología Scoping Review, utilizando los términos DeCS y MeSH en español, in-glés y portugués en cuanto a: "automedicación", "estudiantes", "educación superior", "COV-ID-19". A continuación, se articularon las ecuaciones de búsqueda empleando los operadores booleanos AND y OR, en las bases de datos: IBECS, Scielo, BVS, Google Scholar, LILACS, Science Direct y Pubmed. Al respecto se limitó el tiempo de publicación entre 2016 ­ 2021. Resultados: Se obtuvieron 23 artículos, consolidando seis núcleos temáticos: motivos para automedicarse; grupos farmacológicos que se consumen; fuentes de recomendación; factores sociodemográficos; semestres y programas académicos; y, conocimientos sobre los riesgos de la automedicación. Los analgésicos son los medicamentos que más se consumen, siendo el principal motivo de uso el dolor de cabeza. Los farmacéuticos junto con los medios de comunicación suelen ser fuentes de recomendación. Predominaron bajos niveles de cono-cimiento acerca de los riesgos de la automedicación. Conclusiones: La literatura indica que este problema de salud pública es cada vez mayor y evidencia la necesidad de abordarlo con estrategias eficaces

Introduction: Self-medication is a practice carried out especially by university students, be-cause they perceive themselves to be immune to effects on their health as a result of the use of non-prescription drugs. Objective: To analyze the findings of the existing literature on self-medication in higher education students. Materials and Methods: The Scoping Review methodology was used, using the DeCS and MeSH terms in Spanish, English and Portuguese "self-medication", "students", "higher education", "COVID-19", articulating them by creat-ing search equations using Boolean operators. AND and OR, in the databases: IBECS, Scielo, VHL, Google Scholar, LILACS, Science Direct and Pubmed, limiting the publication time between 2016 - 2021. Results: 23 articles were obtained, consolidating six thematic nuclei: reasons for self-medicate; pharmacological groups consumed; recommendation sources; so-ciodemographic factors; semesters and academic programs; and, knowledge about the risks of self-medication. Analgesics are the most consumed medications, with headaches being the main reason for use. Pharmacists along with the media are often sources of recommendation. Low levels of knowledge about the risks of self-medication prevailed. Conclusions: The literature indicates that this public health problem is increasing and evidences the need to address it with effective strategies.

Introdução: A automedicação é uma prática realizada principalmente por estudantes uni-versitários, pois se percebem imunes aos efeitos sobre sua saúde decorrentes do uso de me-dicamentos isentos de prescrição. Objetivo: Analisar os achados da literatura existente so-bre automedicação em estudantes do ensino superior. Materiais e Métodos: Foi utilizada a metodologia Scoping Review, utilizando os termos DeCS e MeSH em espanhol, inglês e português "automedicação", "alunos", "ensino superior", "COVID-19", articulando-os através da criação de equações de busca utilizando operadores booleanos AND e OR, nas bases de dados: IBECS, Scielo, BVS, Google Acadêmico, LILACS, Science Direct e Pu-bmed, limitando o tempo de publicação entre 2016 - 2021. Resultados: Obtiveram-se 23 artigos, consolidando seis núcleos temáticos: motivos para automedicação; grupos farma-cológicos consumidos; fontes de recomendação; fatores sociodemográficos; semestres e pro-gramas acadêmicos; e, conhecimento sobre os riscos da automedicação. Os analgésicos são os medicamentos mais consumidos, sendo as dores de cabeça o principal motivo de uso. Os farmacêuticos junto com a mídia são muitas vezes fontes de recomendação. Predominaram baixos níveis de conhecimento sobre os riscos da automedicação. Conclusões: A literatura in-dica que este problema de saúde pública é crescente e evidencia a necessidade de enfrentá-lo com estratégias eficazes

Hematoma subdural diagnosticado como ingesta medicamentosa en paciente con esquizofrenia / Subdural haematoma diagnosed as drug ingestion in patient with schizophrenia

Objetivo: Subrayar la importancia de una exploración exhaustiva para el diagnóstico de procesos intraparenquimatosos en pacientes con antecedentes de patología psiquiátrica. Caso clínico Varón de 56 años con antecedentes de esquizofrenia ingresado a urgencias por somnolencia, dificultad para la deambulación y temblor de miembro superior derecho. Se sospecha por medicina interna, de secundarismos neurológicos tras intento autolítico mediante ingesta farmacológica. Resultados Tras la exploración del estado mental por psiquiatría, se amplía el estudio mediante tomografía axial computarizada (TC) que revela un hematoma subdural agudo (HSA). La atrofia cortical en pacientes con esquizofrenia predispone a la acumulación de sangre intracerebral y al retardo en los síntomas y el diagnóstico de estos procesos aumentando el riesgo vital. Conclusiones Es fundamental una correcta anamnesis y la inclusión de pruebas de imagen cerebrales para el diagnóstico diferencial del HSA en pacientes con esquizofrenia. (AU)

Objective: To underline the importance of thorough examination in diagnosing intraparenchymal processes in patients with a history of psychiatric disease. Clinical case A 56-year-old male with a history of schizophrenia was taken to the emergency department with somnolence, difficulty in walking and right-arm tremor. The internal medicine department suspected to be secondary neurological symptoms after attempted to self-harm through ingestion of drugs. Results After the psychiatric department had examined the patient's mental state, a CT scan was performed that revealed an acute subdural haematoma (ASH). Cortical atrophy in patients with schizophrenia favours the accumulation of intracerebral blood and a delay in the symptoms and diagnosis of these processes, increasing the risk to life. Conclusions Accurate anamnesis and brain imaging tests are essential for the differential diagnosis of ASH in patients with schizophrenia. (AU)

Caracterización de la polifarmacia en adultos mayores de un consultorio médico urbano / Characterization of polypharmacy in older adults consulted in an urban medical office

La polifarmacia en adultos mayores es una problemática frecuente. Con el objetivo de caracterizar la polifarmacia en adultos mayores del consultorio urbano El Golfo, reparto Antonio Guiteras de Bayamo, Policlínico Jimmy Hirzel, se realizó un estudio retrospectivo, analítico, de utilización de medicamentos según clasificación del tipo de consumo con elementos de indicación-prescripción, en la cadena del medicamento, centrado en la prescripción. Muestra: 40 adultos mayores. Se emplearon métodos teóricos, empíricos y estadísticos. Los datos se analizaron con el auxilio del Programa IBM SPSS versión 22 para Windows (Estadísticos Descriptivos). Predominaron los pacientes de 60 a 64 años (50 por ciento) y del sexo femenino (60 por ciento), la hipertensión arterial (37 casos) como enfermedad crónica diagnosticada, los antihipertensivos (37 pacientes) como grupo farmacológico más empleado, la asociación de 4 a 5 medicamentos involucrados en la polifarmacia (82,5 por ciento) y el captopril (47,5 por ciento) como el medicamento más prescrito. Se concluyó que la mayoría de los adultos mayores hacían uso de la polifarmacia, por prescripción facultativa(AU)

Polipharmacy in older adults is a frequent health problem. With the objective to characterize polypharmacy in older adults consulted in El Golfo urban medical office, of Jimmy Hirzel Policlinic in Antonio Guiteras locality, Bayamo, Granma; a retrospective, analitic, of medications utilization study was carried out, according to kind of consumption classification with elements of indication-prescription; in the medication chain, this study is centered on prescription. Sample were 40 older adult patients. Theoretical, empiric and statistical methods were used. Collected data was analyzed with IBM SPSS 22 software for Windows. In the study predominated patients from 60 to 64 years old (50 percent), female gender (60 percent), hypertension (37 patients) as diagnosed chronic illness, antihypertensives (37 patients) as the most used pharmacological group, association of 4 or 5 medications involved in polypharmacy (82,5 percent), and captopril (47,5 percent) as the most prescribed medication. Conclusion was that most older adults used polypharmacy by facultatives prescription(EU)

Medication discrepancies in a hospital in Southern Brazil: the importance of medication reconciliation for patient safety

Medication discrepancies are of great concern in hospitals because they pose risks to patients and increase health care costs. The aim of this study was to estimate the prevalence of inconsistent medication prescriptions to adult patients admitted to a hospital in southern Santa Catarina, Brazil. This was a patient safety study on patients recruited between November 2015 and June 2016. The participants were interviewed and had their medical records reviewed. Discrepant medications were considered those that did not match between the list of medicines taken at home and the prescribed drugs for treatment in a hospital setting. Of the 394 patients included, 98.5% took continuous-use medications at home, with an average of 5.5 medications per patient. Discrepancies totaled 80.2%, The independent variables associated with the discrepancies were systemic arterial hypertension, hypercholesterolemia, vascular disease, number of medications taken at home, and poor documentation of the medications in the medical record. Findings from this study allowed us to conclude there was a high rate of prescription medication misuse. Medication reconciliation is crucial in reducing these errors. Pharmacists can help reduce these medication-related errors and the associated risks and complications.

Uso (y abuso) de antibióticos en la medicina perinatal / Use (and abuse) of antibiotics in perinatal medicine

INTRODUCCIÓN: El uso racional de antibióticos (ATB) implica que los pacientes reciban ATB adecuados a sus necesidades clínicas, en dosis correctas según sus condiciones individuales, durante el tiempo adecuado y al menor costo para ellos y para su comunidad. La mayor tasa de abuso de ATB ocurre durante el período perinatal, a pesar de que existe evidencia de múltiples efectos negativos a corto y a largo plazo. Además, este abuso se asocia con incrementos en los costos de la atención médica. OBJETIVO: Actualizar y reportar la evidencia sobre el uso, abuso y efectos adversos de los ATB en medicina perinatal y las posibles medidas para prevenirlos y, de este modo, mejorar la calidad de los cuidados, los resultados y los costos. Métodos Revisión y análisis: de la literatura relacionada con el uso de ATB en perinatología hasta febrero de 2020. RESULTADOS: El abuso de ATB en perinatología oscila entre el 50 y el 70%, y aún más en algunas unidades neonatales. Los efectos adversos incluyen morbilidades agudas, muerte, aumento de resistencia microbiana, alteraciones del microbioma y disbiosis asociadas a complicaciones graves a lo largo de la vida, como infecciones, alergias, trastornos autoinmunes, enfermedades gastrointestinales, artritis, asma, obesidad y tal vez cáncer. Prevenir y disminuir el uso indebido de ATB conducirá a mejorar la salud y a ahorros significativos en el sector sanitario. En solamente 4unidades de cuidados intensivos neonatales (UCIN), con 1.000 admisiones anuales, el ahorro se estima en 230.000 dólares por año. CONCLUSIÓN: La necesidad de optimizar la utilización de ATB en la medicina perinatal nunca ha sido más urgente

INTRODUCTION: The rational use of antibiotics (ATB) implies that patients receive those adequate for their clinical needs, in correct doses according to their individual conditions, during an adequate period of time, and at the lowest cost for them and their community. The highest rate of ATB abuse occurs during the perinatal period, despite the fact that there is evidence of multiple short- and long-term negative effects. Furthermore, this abuse is associated with increased costs of medical care. OBJECTIVE: To update and report the evidence on the use, abuse, and adverse effects of ATB in perinatal medicine, and possible measures to prevent them, and thus improve health care outcomes and costs. METHODS: A review and analysis was performed from the literature related to the use of ATB in perinatal medicine up to February 2020. RESULTS: ATB abuse in perinatal medicine ranges from 50% to 70%, with even higher rates in some neonatal centres. Adverse effects include death, increased microbial resistance, along with microbiome abnormalities and dysbiosis that lead to serious life-long complications such as infections, allergies, autoimmune disorders, gastrointestinal disorders, arthritis, asthma, obesity, and perhaps cancer. Preventing and reducing the abuse of ATB would lead to better health and to significant savings in the health sector. In only 4neonatal intensive care units, with 1000 admissions per year, savings are estimated at US$230,000 per year. CONCLUSION: The need to optimise the use of ATB in perinatal medicine has never been more urgent

Resistencia a los Antimicrobianos y COVID-19 [infografía]

La resistencia a los antimicrobianos ocurre cuando los fármacos que actúan contra las bacterias, los virus, los hongos o los parásitos se vuelven ineficaces y dejan de servir.

Síntomas de ansiedad y abuso de medicamentos en pacientes con migraña crónica de Trujillo, Perú / Symptoms of anxiety and medication abuse in patients with chronic migraine from Trujillo, Peru

Resumen Objetivo: Determinar la relación del abuso de medicamentos y síntomas de ansiedad en pacientes adultos ambulatorios con migraña crónica en la Clínica SANNA /Sánchez Ferrer, Trujillo-Perú. Material Y Método: Estudio transversal, con una muestra de 104 pacientes con migraña crónica con y sin abuso de medicamentos. Se reportan frecuencias absolutas, relativas, promedio y DE según el tipo de variable. En el análisis bivariado por medio del Chi2 de Homogeneidad y nivel del análisis multivariado, utilizando regresión de Modelos Lineales Generalizados, familia Poisson y Poisson con varianza robusta. Resultados: Encontramos 96 (92.3%) pacientes de sexo femenino, con una edad media y DE 37.1 ± 9.6. A nivel general, 1 de cada 3 pacientes tenían síntomas de ansiedad y 1 de cada 2 pacientes reportaron abuso de medicamentos. La proporción de pacientes con síntomas de ansiedad fue tres veces mayor en el grupo con abuso de medicamentos que aquellos sin abuso de medicamentos. Los pacientes ambulatorios con migraña crónica que abusan de medicamentos tienen 2.28 veces mayor riesgo de padecer síntomas de ansiedad, que aquellos que no abusan de medicamentos. Conclusiones: Los pacientes ambulatorios con migraña crónica que abusan de medicamentos tienen mayor riesgo de padecer síntomas de ansiedad. Por lo tanto, es necesario incorporar soporte psicológico a todos los pacientes con abuso de medicamentos y prevenir efectos secundarios de ese abuso.

Objective: To determine the relationship of medication abuse and anxiety symptoms in adult outpatients with chronic migraine in the SANNA / Sánchez Ferrer Clinic, Trujillo-Peru. Material And Method: Cross-sectional study, with a sample of 104 patients with chronic migraine with and without medication abuse. Absolute, relative, average and SD frequencies are reported according to the type of variable. In the bivariate analysis through the Chi2 of Homogeneity and level of the multivariate analysis, using regression of Generalized Linear Models, Poisson and Poisson family with robust variance. Results: We found 96 (92.3%) female patients, with a mean age and SD 37.1 ± 9.6. Overall, 1 in 3 patients had anxiety symptoms and 1 in 2 patients reported medication abuse. The proportion of patients with anxiety symptoms was three times higher in the group with medication abuse than those without medication abuse. Outpatients with chronic migraine who abuse medications are 2.28 times more at risk of anxiety symptoms than those who do not abuse medications. Conclusions: Outpatients with chronic migraine who abuse medications have a higher risk of anxiety symptoms. Therefore, it is necessary to incorporate psychological support to all patients with medication abuse and prevent side effects of that abuse.

Soledad social en ancianos hospitalizados en el servicio de Geriatría. Hospital "Comandante Faustino Pérez" / Social loneliness in elder people hospitalized in the Geriatrics service. Clinical Surgical Hospital "Comandante Faustino Pérez"

RESUMEN Introducción: la soledad social se define como la experiencia subjetiva de insatisfacción frente a la sociedad en la que se vive; en términos de estilos de vida, de valores y de uso de nuevas tecnologías, entre otros aspectos. Objetivo: caracterizar la soledad social en los adultos mayores hospitalizados. Materiales y método: se realizó un estudio observacional, descriptivo, transversal en pacientes que ingresaron en el servicio de Geriatría del Hospital Clínico Quirúrgico "Comandante Faustino Pérez", provincia Matanzas, desde octubre 2015 - 2016. El universo estuvo constituido por 212 pacientes que vivían en compañía y no padecían de demencia, confusión mental ni enfermedades graves. Para la recogida de la información se aplicó al universo de estudio la Escala ESTE II de soledad social, validada a nivel nacional e internacional para identificar el nivel de soledad social. Se utilizaron métodos de estadística descriptiva. Los resultados se presentaron en tablas. Resultados: alto nivel de soledad social en los ancianos estudiados, en el grupo atareo de 60-70 años, sin pareja, de bajo nivel de escolaridad y con enfermedades crónicas. Insuficiente percepción de apoyo y participación social, así como un limitado uso de las nuevas tecnologías. Conclusiones: predominó alto nivel de sentimiento de soledad en los ancianos, asociado a insuficiente percepción de apoyo y participación social, más un bajo acceso a las nuevas tecnologías (AU).

ABSTRACT Introduction: social loneliness is defined as the subjective experience of dissatisfaction toward society in which one lives, in terms of lifestyles, values ​​and use of new technologies among others. Objective: to characterize social loneliness in hospitalized elder adults. Material and Method: a cross-sectional, observational, descriptive, study was conducted in patients admitted to the Geriatrics Service of the Clinical Surgical Hospital "Comandante Faustino Pérez", province of Matanzas, in the period October 2015 - 2016. The universe was formed by 212 patients who lived accompanied and did not suffer from dementia, mental confusion nor serious illnesses. For collecting the information of the studied universe, the authors used the ESTE II Scale of social loneliness validated at national and international level to identify the level of social loneliness. Descriptive statistical methods were used and the results were shown in tables. Results: high level of social loneliness in studied elder people of the 60-70 years-old group, without a partner, with a low level of scholarship and with chronic diseases. They had an insufficient perception of support and social participation, as well as made a limited use of the new technologies. Conclusions: a high level of the loneliness feeling predominated in elder people, associated to an insufficient perception of support and social participation, plus a low access to the new technologies (AU).

Catastrofización ante el dolor y abuso de analgésicos en pacientes con migraña crónica / Pain catastrophizing and medication overuse in patients with chronic migraine

INTRODUCCIÓN: La migraña es una cefalea primaria frecuente y debilitante. La catastrofización ante el dolor (CAD) es un constructo mental negativo exagerado que se manifiesta durante la experiencia dolorosa real o en forma anticipada a ella. El miedo anticipatorio ante el dolor, una de sus características, se ha asociado con una mayor prescripción y utilización de analgésicos. OBJETIVO: Explorar la CAD en relación con el abuso de analgésicos y el impacto de la migraña en la calidad de vida en pacientes con migraña crónica. PACIENTES Y MÉTODOS: Se realizó un estudio analítico transversal observacional. Se incluyó a pacientes mayores de 18 años con migraña crónica, a los cuales se les administró de forma anónima la Pain Catastrophizing Scale y el Head Impact Test-6. RESULTADOS: Al comparar la incidencia de abuso de analgésicos entre pacientes con niveles clínicos de CAD y pacientes sin CAD, la probabilidad de presentar abuso de analgésicos fue 16 veces mayor en el primer grupo (odds ratio = 16,06; IC 95% = 5,91-43,61; p < 0,0001). Al comparar la presencia de un gran impacto de la migraña en pacientes con CAD y sin CAD, la probabilidad de un gran impacto de la migraña es aproximadamente ocho veces mayor en el primer grupo (odds ratio = 8,27; IC 95% = 3,19-21,42; p < 0,0001). CONCLUSIÓN: Niveles clínicos de CAD en pacientes con migraña crónica se asociarían a una mayor incidencia de abuso de analgésicos y un mayor impacto de la cefalea en la calidad de vida

INTRODUCTION: Migraine is a frequent and debilitating primary headache. Pain catastrophizing is a negative set activated in response to anticipated or actual pain. The anticipatory fear of pain, one of its characteristics, has been associated with a greater prescription and use of analgesics. AIM: To explore the pain catastrophizing in relation to analgesic overuse and the headache impact on quality of life in patients with chronic migraine. PATIENTS AND METHODS: An observational cross-sectional analytical study was performed. Patients older than 18 years with chronic migraine were included, who were given anonymously the Pain Catastrophizing Scale and the Head Impact Test-6. RESULTS: When comparing the incidence of analgesic overuse among patients with clinical pain catastrophizing levels and those without pain catastrophizing, the probability of analgesic overuse was 16 times higher in the first group (odds ratio = 16.06; 95% CI = 5.91-43.61; p < 0.0001). When comparing the presence of a severe migraine impact in patients with and without pain catastrophizing, the probability of a severe migraine impact is approximately eight times greater in the first group (odds ratio = 8.27; 95% CI = 3.19-21.42; p < 0.0001). CONCLUSION: Clinical levels of pain catastrophizing in patients with chronic migraine might be associated with a higher incidence of analgesic overuse and a greater headache impact on quality of life

Bacterias Multirresistentes. Revisión del Estado Actual / No disponible

No disponible