Infliximab serum concentrations in luminal Crohn's disease and its relationship with disease activity: A multicentric cross-sectional study.

OBJECTIVES: In Latin America, experience with monitoring serum Infliximab (IFX) concentrations is scarce. Our study aimed to compare IFX serum concentrations between patients with active disease or in remission. PATIENTS AND METHODS: A cross-sectional study was performed in patients with luminal Crohn's disease (CD) during maintenance treatment with IFX. Patients were classified as in remission or disease activity according to clinical scores and endoscopic, radiological, and laboratory markers. A comparison of IFX trough levels between the two groups was performed. RESULTS: 80 CD patients were included [41 (51%) in remission and 39 (49%) with active disease]. In the analysis of general disease activity, the median serum levels of IFX in patients with remission and with active CD were 5.63 [0.03-14.40] vs. 3.84 [0.03-14.40] (p=0.287). Furthermore, there was no difference in serum IFX concentrations in endoscopic, radiological, and laboratory activities. Only in the clinical evaluation there was a significant difference in the median serum IFX levels between patients in remission and disease activity, 5.63 [0.03-14.40] vs. 2.14 [0.32-10.54] (p=0.042). CONCLUSIONS: IFX serum concentrations during maintenance treatment were similar in patients with luminal CD in remission and general, endoscopic, radiological, and laboratory disease activity. Patients with clinically active disease had lower IFX concentrations than patients in remission.

Therapeutic drug monitoring in inflammatory bowel diseases. Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis. / Monitorización terapéutica de los fármacos biológicos en la enfermedad inflamatoria intestinal. Documento de Posicionamiento del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU).

The treatment of inflammatory bowel disease has undergone a significant transformation following the introduction of biologic drugs. Thanks to these drugs, treatment goals have evolved from clinical response and remission to more ambitious objectives, such as endoscopic or radiologic remission. However, even though biologics are highly effective, a significant percentage of patients will not achieve an initial response or may lose it over time. We know that there is a direct relationship between the trough concentrations of the biologic and its therapeutic efficacy, with more demanding therapeutic goals requiring higher drug levels, and inadequate exposure being common. Therapeutic drug monitoring of biologic medications, along with pharmacokinetic models, provides us with the possibility of offering a personalized approach to treatment for patients with IBD. Over the past few years, relevant information has accumulated regarding its utility during or after induction, as well as in the maintenance of biologic treatment, in reactive or proactive strategies, and prior to withdrawal or treatment de-escalation. The aim of this document is to establish recommendations regarding the utility of therapeutic drug monitoring of biologics in patients with inflammatory bowel disease, in different clinical practice scenarios, and to identify areas where its utility is evident, promising, or controversial.

[Pharmacological intervention in the medication review of institutionalised elderly patients under polypharmacy]. / Intervención farmacéutica en la revisión del tratamiento en pacientes mayores polimedicados institucionalizados.

OBJECTIVE: To describe the Drug-Related Problems (DRP) and their resolution after pharmacological review in institutionalised elderly patients under polypharmacy. DESIGN: Descriptive, retrospective cohort study from January to October of 2022. LOCATION: Twelve nursing homes at the Community of Madrid. PARTICIPANTS: 295 patients aged 65 or older taking at least 5 chronic medications prescribed prior to the treatment review. INTERVENTIONS: Medication reviews carried out by the pharmacist and agreed upon in face-to-face meetings between the primary care doctor, the nursing home doctor and the pharmacist. MAIN MEASUREMENTS: Detected DRP, types and resolution. A age, sex, and number of medications before and after the intervention. Pharmacological subgroups according to anatomical therapeutic chemical classification system (ATC) and active pharmaceutical ingredients involved in the detected DRPs. RESULTS: 1425 DRP were detected, with a mean of 4.85 (SD 3.33) DRPs/patient. The most frequent DRP was reconciliation error (32.52%), followed by pharmaceutical regimen and dosaje. Among the 1425 improvement proposals, 86.73% of them were accepted.Significant statistically differences were observed between the number of medications per patient prior to the pharmacotherapy review (12.29) and after it (10.20), obtaining an average difference of 2.09 (95%CI: 1.98-2.21; P<.001). CONCLUSIONS: It is found that the intervention of multidisciplinary team in which the pharmacist performs a revision of the medication decreased the number of prescribed medications. Therefore, it reduces polymedication and its associated risks.

Prescription of non-steroidal anti-inflammatory and antirheumatic drugs in outpatient hypertensive patients.

BACKGROUND: It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. OBJECTIVE: Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. MATERIAL AND METHODS: Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. RESULTS: Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. CONCLUSIONS: The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

ANTECEDENTES: Los antiinflamatorios y los antirreumáticos no esteroideos (AINE) disminuyen la eficacia de algunos antihipertensivos. OBJETIVO: Analizar el patrón de prescripción de AINE y las variables asociadas en pacientes ambulatorios con diagnóstico de hipertensión arterial, así como explorar algunas características de los médicos prescriptores. MATERIAL Y MÉTODOS: Estudio transversal de pacientes con hipertensión de la Unidad de Medicina Familiar 24 en Ciudad Mante, Tamaulipas. De los pacientes se registraron datos sociodemográficos, antecedentes patológicos y tratamientos farmacológicos; y de los médicos, información sociodemográfica y académica. RESULTADOS: La edad promedio de los pacientes fue de 63 ± 11 años, 31.7 % recibía AINE y al contrastarlos con quienes no los recibían, se identificó mayor proporción de obesidad, presión arterial más elevada, más casos en descontrol de la hipertensión arterial, multimorbilidad y polimedicación. Las variables asociadas a la prescripción de AINE fueron estar en descontrol de la hipertensión arterial, multimorbilidad y polimedicación; 56.7 % de los médicos prescriptores fue del sexo femenino, 83.3 % con antigüedad superior a 10 años y 33.3 % con certificación vigente. CONCLUSIONES: La prescripción inapropiada de AINE reveló la necesidad de implementar acciones para mitigar el riesgo potencial de los pacientes hipertensos de presentar una complicación.

Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Columbia. / Erupción fija por luz solar, una serie de 13 casos en Bogotá, Colombia.

Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.

Family Planning Concerns Among Women With Psoriasis: A Descriptive, Cross-Sectional, Multicenter Study. / Percepción de la mujer con psoriasis en la planificación familiar: Estudio descriptivo, transversal y multicéntrico.

BACKGROUND AND OBJECTIVE: A significant proportion of women of childbearing age have psoriasis. The aim of this study was to examine family planning concerns in this population. MATERIAL AND METHODS: Observational, descriptive, cross-sectional, multicenter study conducted between March 2020 and October 2021. We collected sociodemographic data and analyzed responses to a family planning questionnaire administered to women aged 18 to 45 years with plaque psoriasis who were candidates for systemic treatment. RESULTS: We studied 153 patients (mean [SD] age, 35.4 [8.0] years; mean disease duration, 16.7 years) being treated at 11 Spanish hospitals. Overall, 38.4% of women were considered to have moderate to severe psoriasis by their physicians; perceived severity ratings were significantly higher among women. Psoriasis affected the women's desire to become pregnant or led to their delaying pregnancy in 1 in 3 respondents. They were concerned that their condition might worsen if they had to discontinue or switch treatment or that the treatment might harm the baby. Approximately half of the women had not received family planning counseling from their physicians, and this was more likely to be the case among never-pregnant women. Women on biologic therapy (58.7%) had better psoriasis control and a better quality of life than women on other treatments. Their sexual health was also less affected. CONCLUSIONS: Women with psoriasis have numerous family planning concerns, which in some cases can lead them to delay pregnancy or affect their desire to become pregnant. Dermatologists need to receive better training regarding family planning in women with psoriasis so that they can provide their patients with more and better information.

[Translated article] Family Planning Concerns Among Women With Psoriasis: A Descriptive, Cross-Sectional, Multicenter Study.

BACKGROUND AND OBJECTIVE: A significant proportion of women of childbearing age have psoriasis. The aim of this study was to examine family planning concerns in this population. MATERIAL AND METHODS: Observational, descriptive, cross-sectional, multicenter study conducted between March 2020 and October 2021. We collected sociodemographic data and analyzed responses to a family planning questionnaire administered to women aged 18 to 45 years with plaque psoriasis who were candidates for systemic treatment. RESULTS: We studied 153 patients (mean [SD] age, 35.4 [8.0] years; mean disease duration, 16.7 years) being treated at 11 Spanish hospitals. Overall, 38.4% of women were considered to have moderate to severe psoriasis by their physicians; perceived severity ratings were significantly higher among women. Psoriasis affected the women's desire to become pregnant or led to their delaying pregnancy in 1 in 3 respondents. They were concerned that their condition might worsen if they had to discontinue or switch treatment or that the treatment might harm the baby. Approximately half of the women had not received family planning counseling from their physicians, and this was more likely to be the case among never-pregnant women. Women on biologic therapy (58.7%) had better psoriasis control and a better quality of life than women on other treatments. Their sexual health was also less affected. CONCLUSIONS: Women with psoriasis have numerous family planning concerns, which in some cases can lead them to delay pregnancy or affect their desire to become pregnant. Dermatologists need to receive better training regarding family planning in women with psoriasis so that they can provide their patients with more and better information.

New paradigms on antibiotic recommendations for community-acquired infections in Spain.

Over the last years, the susceptibility activity of the most common microorganisms causing community-acquired infections has significantly changed in Spain. Based on the susceptibility rates of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, and Klebsiella pneumoniae collected from outpatients aged 15 or older with symptoms of respiratory or urinary tract infections in several Microbiology Departments in Catalonia in 2021, penicillin V should be first choice for most respiratory tract infections, amoxicillin and clavulanate for chronic obstructive pulmonary disease exacerbations and a single dose of fosfomycin or a short-course nitrofurantoin should remain first-line treatments for uncomplicated urinary tract infections. Updated information on antimicrobial resistance for general practitioners is crucial for achieving appropriate empirical management of the most common infections by promoting more rational antibiotic use.

Work-family interface on hazardous alcohol use and increased risk for prescription drug misuse among diverse working parents in STEM.

BACKGROUND: Science, Technology, Engineering, and Mathematics (STEM) industries are competitive and can be stressful work environments leading to an increase in substance misuse. Little is known on the role of work-related risk and protective factors on substance misuse among working parents navigating multiple roles. OBJECTIVES: This study aims to examine work-life balance as a protective factor and various risk factors (emotional exhaustion, work-family, family-work conflicts) for hazardous alcohol use and increased risk for prescription drug misuse among diverse working parents in STEM. METHODS: Participants (n = 1,228) were recruited via Qualtrics from across the US and the sample was racially ethnic and gender (50% men, 50% women) diverse. An overall path analysis was conducted to explore direct and indirect effects of work-life balance on hazardous alcohol use and increased risk for prescription drug misuse. Path analyses explored the racial-ethnic and gender differences across the overall model. RESULTS: Path analysis revealed that healthy work-life balance indirectly predicts decreased hazardous alcohol use (b = -.149, p = .004) and decreased risk for prescription drug misuse (b = -.185, p < .001). Exploration of the model across racial-ethnic and gender groups revealed that higher work-life balance indirectly predicts decreased hazardous alcohol use for Black and Asian Americans, but not for Latinos and Whites; and higher work-life balance indirectly predicts decreased hazardous alcohol use for men, but not women. CONCLUSIONS: Identifying the work-family interface can help providers understand prevention, risk-reduction practices, and interventions for hazardous alcohol use and prescription drug misuse among diverse working parents in STEM.

[Perception of the safe administration of medications in primary care]. / Percepción de la administración segura de medicamentos en atención primaria.

The purpose of this study was to know the perception of nurses about safety in the preparation and administration of medications in a primary care health department of the Spanish national health system. Cross-sectional descriptive study. Carried out in the Health Department 21 (Alicante, Spain) in the months of September to November 2021. 66 nurses, with a predominance of women (88.9%). A semi-structured interview with ten questions was used. The inclusion criterion took into account nurses with more than two years of experience working in the health center. The perception of nurses about the degree of safety in the preparation and administration of medications was evaluated. 81.9% of the sample did not report adverse events. The steps for secure administration were varied. A significant association was observed in the correct time of medication (p < 0.031) and antisepsis (p < 0.026) according to the number of nurses in the basic health areas. Our results indicate the perceptions of nurses about improvements in the degree of implementation of standards or tools for the safe administration of medications, with special attention to lack of knowledge, care overload (high patient/nurse ratio) and associated dilemmas with the notification.

[Antibiotic consumption in primary care in the adult population of Asturias during 2014-2020 period]. / Consumo de antibióticos en atención primaria en población adulta de Asturias durante el periodo 2014-2020.

Trend study of the consumption of systemic antibiotics in the adult population in of Primary Care of the Health Service of the Principality of Asturias (SESPA) during the period 2014̶2020. Retrospective observational study. SESPA, Primary Care. Population from the Individual Health Card database. Data were collected on the prescription of antibiotics, carried out in the family medicine consultations, dispensed in the pharmacy offices with charge of SESPA. Antibiotic use and consumption variables were analyzed using linear regression models. Prevalence of antibiotic use (population percentage); consumption rate of systemic antibiotics (DTD), relative consumption of narrow-spectrum antibiotics (percentage DDD). The average prevalence of the use of antibiotics for the 2014̶2019 period was 32.2% and 23.9% in 2020. The rate of consumption of systemic antibiotics decreased from 21.4 DTD in 2014 to 12.7 DTD in 2020. The consumption of narrow-spectrum antibiotics remained stable (19.4% DDD in 2014 and 19.3% DDD in 2020) (CI95: -0.10, 0.26). In the period from March to December 2020, the consumption of antibiotics decreased by 28.6% compared to the same period in 2019. In 2014̶2020, the consumption of antibiotics decreased, especially since the COVID-19 pandemic, with stabilization of the consumption of narrow-spectrum antibiotics compared to the total. There is variability in consumption by therapeutic subgroups.

Effect of Drug Compounding on Quality of Life in Patients With Genodermatoses: A Cross-Sectional Study. / Formulación magistral en pacientes con genodermatosis. Impacto en la calidad de vida: un estudio transversal.

BACKGROUND: Cutaneous manifestations are complicated to treat in rare diseases. The main aim of this study was to analyze the impact of compounded drugs prepared by hospital pharmacists on the quality of life of patients with genodermatoses. MATERIAL AND METHODS: We undertook a cross-sectional study of patients with genodermatoses treated with topical medications compounded and dispensed by the pharmacy at Complejo Hospitalario Universitario in Pontevedra, Spain. We collected demographic data and answers to questionnaires examining generic and disease-specific quality of life, treatment satisfaction, and treatment adherence. RESULTS: Nine patients were included. We observed a significant improvement in health-related quality of life following treatment with compounded drugs. Satisfaction with the topical medications was 2.8 on a scale of 0 (greatest satisfaction) to 25. Treatment adherence was 59%. CONCLUSIONS: Drug compounding facilitates access to orphan drugs that are not available for many rare diseases. Few studies, however, have analyzed impact on quality of life in this setting. In this series of patients with genodermatoses, topical medications compounded and dispensed by a hospital pharmacy improved health-related quality of life. This preliminary study has given rise to a multicenter study of compounding for ichthyosis. We expect that analysis of a larger sample will confirm our findings.

[Therapeutic positioning reports: Experience in Spain during the period 2013-2019]. / Informes de posicionamiento terapéutico: experiencia en España en el periodo 2013-2019.

OBJECTIVE: Describe the characteristics of the therapeutic positioning reports (TPRs) published in Spain in the period 2013-2019. DESIGN AND DATA SOURCE: Systematic review of all TPRs published in the website of the Spanish Agency of Medicines and Health Products (AEMPS). SELECTION OF STUDIES: All TPRs published since May 2013, until March 2019 DATA EXTRACTION: The main variables collected were the therapeutic groups assessed, the number of TPRs, the time of elaboration, the existence of restrictions versus the authorized indications and the information on the efficiency of medicines. RESULTS: During the period under review, 214 TPRs were carried out, with an average production time of 8.8 months, almost three times the objective of 3-month initially set. 57% of the TPRs established restrictions of use with respect to the approved indications. 26% of TPRs referred to the existence of economic data, although none included details on the efficiency. 10% of TPRs were updated. CONCLUSIONS: For TPRs to meet their objective of improving the efficiency of the assessment process and the consistency in the decisions on price, reimbursement and financing of medicines by the SNS, the deadlines established for publication must be met, incorporating systematically information on the efficiency of the drugs and including periodic updates with the new information generated.

[Effects of changing the appearance of medications in safety and adherence in chronic patients over 65 years of age in primary care. CAMBIMED Study]. / Efectos del cambio de apariencia de medicamentos en seguridad y adherencia en pacientes crónicos mayores de 65 años en atención primaria. Estudio CAMBIMED.

OBJECTIVE: To study whether the changes in bioequivalent drugs with different appearances are associated with an increase in lack of adherence and medication use errors, in patients >65years old treated with antihypertensive and lipid-lowering medications. DESIGN: Observational longitudinal prospective cohort study with a one-year follow-up period between 1 January 2013 and 31 December 2014. LOCATION: Primary Healthcare Centres in the Community of Madrid. PARTICIPANTS: Patients ≥65years-old with a diagnosis of hypertension and/or dyslipidaemia receiving treatment with Enalapril and/or Amlodipine and/or Simvastatin. MAIN MEASUREMENTS: Variables collected during a Primary Care consultation by means of a personal interview were: sociodemographic (age, gender, level of education), clinical variables, adherence (Morisky-Green test and direct counting), medication errors (number and type), medication changes and number, analytical (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) and combined variable (error and/or adherence). There were 1 baseline and 4 quarterly visits. RESULTS: The study included 274 patients with a mean age 72 (6.6) years, of whom 47.8% were female. Some medication changes were observed in 134 patients (48.9%), with a median of 3 (IQR 1-5) and a maximum of 11 changes. The risk of presenting with a medication use error or decreased adherence was increased in patients exposed to changes in all visits with RR 1.14 (1.16-1.69) at one year of follow-up. The most frequent error was the loss of dose. For each change in medication, the probability of a combined event increases by 41%. CONCLUSIONS: The changes made in bioequivalent drugs with different appearance could increase the number of medication use errors and decrease the adherence. More studies should be carried out to assess how much this affects the control of the disease. The intervention section is not considered because it is an observational study.

Importance of the list of essential medicines in medical prescription.

The implementation of an essential medicines list in health institutions allows acquiring and administering a long list of drugs that offers treatment alternatives to physicians, as well as a collegiate academic description of indications, doses, side effects, interactions and cost-benefit analyses, thus facilitating medical prescription and administration of health products. The Committee of Ethics and Transparency in the Physician-Industry Relationship issues several recommendations for optimizing the benefits generated by essential medicines lists.La implementación en instituciones de salud de un cuadro básico permite adquirir y administrar una larga lista de medicamentos que presenta a los médicos las alternativas de tratamiento, así como la descripción académica colegiada de indicaciones, dosis, efectos secundarios, interacciones y análisis de costo-beneficio, con lo que se facilita la prescripción médica y la administración de insumos para la salud. El Comité de Ética y Transparencia en la Relación Médico-Industria emite diversas recomendaciones para la optimización de los beneficios generados por los cuadros básico de medicamentos.

Medical prescription: conditioned reflex or conscious reflection?

Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise.Extender una receta o indicar un tratamiento suele ser la última parte de la consulta médica. Este proceso crucial puede desvirtuarse debido a múltiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexión o tiempo. La información insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organización Mundial de la Salud, hace énfasis en hacer del proceso prescriptivo un ejercicio de reflexión.

Self-medication and self-prescription.

Self-medication and self-prescription are actions undertaken by patients; the former, as an element of self-care that involves over-the-counter drugs, and the latter, as a violation of the Statute of Health, since it includes drugs that can only be dispensed with a medical prescription. All the drawbacks that have been attributed to self-medication are actually associated with self-prescription.La automedicación y la autoprescripción son acciones de los pacientes; la primera como elemento del autocuidado que involucra medicamentos de venta libre y la segunda como una violación a la ley de salud, pues comprende medicamentos que solo pueden expenderse con receta. Todos los inconvenientes que se han atribuido a la automedicación en realidad lo son de la autoprescripción.

Libertad de prescripción médica.

Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.

Los médicos requieren flexibilidad para sus prescripciones. Sin embargo, algunos límites están marcados tanto por el conocimiento vigente como por las restricciones de acceso, normas y reglamentos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) propone varias sugerencias para ayudar a los pacientes, que incluyen la selección de las mejores alternativas para cada caso, la protocolización de variaciones a los estándares de prescripción (dosis, indicaciones, etcétera) por escrito en el expediente y eludir modas, novedades no probadas, argumentos simplemente publicitarios o promocionales y conflictos de interés.

Comorbidity, concomitant medication, use of resources and healthcare costs associated with chronic hepatitis C virus carriers in Spain. / Comorbilidad, medicación concomitante, uso de recursos y costes sanitarios asociados a los pacientes portadores del virus de la hepatitis C crónica en España.

OBJECTIVES: To assess the comorbidity, concomitant medications, healthcare resource use and healthcare costs of chronic hepatitis C virus patients in the Spanish population. PATIENTS AND METHODS: Retrospective, observational, non-interventional study. Patients included were≥18 years of age who accessed medical care between 2010-2013. Patients were divided into 2 groups based on the presence or absence of liver cirrhosis. The follow-up period was 12 months. Main assessment criteria included general comorbidity level (determined by the resource utilisation band score) and prevalence of specific comorbidities, concomitant medications, healthcare resource use and healthcare costs. Statistical analysis was performed using regression models and ANCOVA, P<.05. RESULTS: One thousand fifty-five patients were enrolled, the mean age was 57.9 years and 55.5% were male. A percentage of 43.5 of patients had a moderate level of comorbidity according to the resource utilisation band score. The mean time from diagnosis was 18.1 years and 7.5% of the patients died during the follow-up period. The most common comorbidities were dyslipidaemia (40.3%), hypertension (40.1%) and generalised pain (38.1%). Cirrhosis was associated with cardiovascular events (OR 3.8), organ failures (OR 2.2), alcoholism (OR 2.1), diabetes (OR 1.2) and age (OR 1.2); P<.05. The most commonly used medications were anti-infectives (67.8%) and nervous system medications (66.8%). The mean total cost per patient was 3,198€ (71.5% healthcare costs, 28.5% indirect/non-healthcare costs). In the corrected model, the total costs per patient-year were 2,211€ for those without cirrhosis and 7,641€ for patients with cirrhosis; P<.001. CONCLUSIONS: Chronic hepatitis C virus patients are associated with a high level of comorbidity and the use of concomitant medications, especially in patients with liver cirrhosis. Chronic hepatitis C virus infection represents a substantial economic burden on the Spanish National Health System.

[Impact of disabling chronic pain: results of a cross-sectional population study with face-to-face interview]. / Impacto del dolor crónico discapacitante: resultados de un estudio poblacional transversal con entrevista cara a cara.

OBJECTIVE: To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services. DESIGN: Cross-sectional population study with face-to-face interview. SETTING: Andalusian Health Survey (2011 edition). PARTICIPANTS: 6,507 people over the age of 16 (p=q=0.5; confidence level=95%; sampling error=1.49, design effect=1.52). INTERVENTIONS: Not applicable. MAIN MEASUREMENTS: Dependent variable: DCP: population limited in their activity by any of the CP specified in the survey. INDEPENDENT VARIABLES: quality of life, absence from work, consumption of medication and utilization of health services. RESULTS: Compared to a population without CP, DCP impact is 6 points less on the mental quality of life and 12 points on the physical one, medication consumption is triple, health services utilization is almost double, and long absence from work is triple. On the other hand, a population with nondisabling chronic pain (nDCP) presents similar results to a population without CP. CONCLUSIONS: We have considered DCP as another CP category because of its huge impact, as is shown in our study, on the study variables. On the contrary, the population with nDCP does not obtain significant impact differences when compared to the population without CP. Therefore, we believe that Primary Care and Public Health should lead different prevention strategies for DCP as well as for the identification of the nDCP population to decrease its possible deterioration towards DCP.