[Sleep quality and adaptation to shift-work among ambulance staff in the Basque Country].

BACKGROUND: To explore the extent to which the shift-workers of emergency ambulances maintain an adequate sleep quality and adaptation to shift-work, and its relationship to personal, circadian rhythm, and work-related factors. METHODS: A cross-sectional study was performed on a sample of 180 technicians and nurses from the Emergency Medical Service of the Basque Country (18-60 years old) who were surveyed. The Pittsburgh Sleep Quality Index (PSQI), the Adaptation to Shift-Work Scale (ASW), the Circadian Type Questionnaire (CTQ) and the Composite Scale of Morningness (CSM) for evaluating chronotype, were administered. RESULTS: Fifty-two percent of the staff presented an intermediate adaptation and 30% reported a good adaptation. A progressive deterioration of sleep quality across the shifts (52% were bad sleepers during days-off, 63% after day-shifts and 90% after night-shifts) was related to a poorer level of adaptation to shift-work. A predictive model of adaptability was obtained based on the baseline level of sleep quality during the days-off and the V factor. The R factor moderated this interaction positively or negatively depending on sleep quality. CONCLUSIONS: There is a high presence of sleep disorders among the technicians and nurses of emergency ambulances as the main symptom of maladjustment to shift-work. Sleeping habits can cushion the impact of difficulties in resting and favor a better adaptation to shifts, introducing key-factors at the level of formation, prevention and intervention.

Effects of vibration therapy on hormone response and stress in severely disabled patients: a double-blind randomized placebo-controlled clinical trial.

PURPOSE: To assess the effects of vibration therapy (VT) on quality of life and hormone response in severely disabled patients compared with placebo. DESIGN: A longitudinal prospective, double-blind, randomized placebo-controlled trial, with pre and postintervention assessments. METHODS: A total of 20 severely disabled individuals were recruited from a National Reference Centre in Spain: 13 (65%) men and 7 (35%) women, 45.5 ± 9.32 years of age (range 41: 22-63). We evaluated their physical stress and state anxiety. RESULTS: No statistically significant changes were found in the socio-psychological variables studied, while in the experimental group state anxiety decreased significantly with p < 0.01 (Z = 2.38; one-tailed p = .009) and, among the biological variables, the level of cortisol fell (p = 0.03). CONCLUSION: Short periods of exposure to low-frequency and low-amplitude local vibration are a safe and effective mechanical stimulus that can have a positive effect in terms of hormone response. CLINICAL RELEVANCE: VT can be considered to have an anti-stress effect.

[A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)]. / Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004).

INTRODUCTION: Epilepsy and the epileptic syndromes are common neurological diseases and represent an important public health problem that has given rise to marked social and healthcare concerns. AIM: To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). MATERIALS AND METHODS: The consumption of the N03 subgroup has been studied using data from the ECOM database of the Spanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). RESULTS: A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. CONCLUSION: Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs.

[The prevalence and pharmacological cost of Parkinson's disease in Spain]. / Prevalencia y coste farmacológico de la enfermedad de Parkinson en España.

INTRODUCTION: Parkinson's disease is the second most frequent neurodegenerative disease. AIM: To analyze the dispensation of antiparkinsonian agents in Spain and to estimate the Parkinson's disease prevalence. MATERIALS AND METHODS: Dispensation of antiparkinsonian agents were studied in Spain during two years (October 1998 to September 2000). Results were expressed in defined daily dosages per 1,000 inhabitants per day (DID). Levodopa's DID was used to estimate the prevalence of the disease. The cost per 1,000 inhabitants per day (CID) and the daily treatment cost was also valued. RESULTS: The most frequently used drugs are levodopa, biperiden and selegiline. The total cost reached values of 116,346,589.30 euros during the study period. The CID was 4,14 euros. It was very high the daily treatment cost of pramipexol and entacapone. The prevalence of Parkinson's disease is considered in 1.7 per 1,000 inhabitants in Spain. There is an important geographical variability; regions as Castilla-Leon, Galicia and La Rioja have a higher prevalence than Andalucia or Murcia. The number of patients in Spain can be considered in 69,571 people. CONCLUSION: There are some differences between the autonomous communities in the antiparkinsonian drugs' utilization.

[Dispensation and cost of antimicrobials in Spain (1998-2000)]. / Dispensación y coste de antimicrobianos en España (1998-2000).

The aim of this study was to analyze the dispensation of anti-infectives for systemic use, excluding immune sera and immunoglobulins and vaccines, made in all of Spain's pharmaceutical offices in a two-year period and to analyze their pharmacological cost. A retrospective pharmacoepidemiological study was made of dispensations in Spain's pharmaceutical offices for medicines belonging to the J01, J02, J04 and J05 subgroups. The dispensations were quantified as defined daily doses per 1,000 inhabitants per day (DID). The economic cost of the dispensing was expressed in absolute terms and as CID (cost per 1,000 inhabitants per day). The total DID of anti-infective drugs was 32.11 (30.70 for antibacterials, 0.53 antimycotics, 0.73 for antimicrobacterials and 0.16 for antivirals). In the J01 subgroup the most frequently used were penicillins, macrolides, cephalosporins and quinolones. And the most frequently used drugs were amoxicillin, amoxicillin and clavulanic acid, clarithromycin, cefuroxime axetil and ciprofloxacin. The total cost was 1,403,462,770 euros, and the CID was 47.18 euros.

[Evolution of antimicrobial use during the years 1996-2000 in a general hospital. A detailed ICU study]. / Evolución de la utilización de antimicrobianos durante los años 1996-2000 en un hospital general. Estudio pormenorizado de la UCI.

PURPOSE: Antimicrobials are a mayor part of hospital pharmacy budgets and must be considered in resource planning and spending projections. This study describes the profile of antibiotic use at a medium-sized hospital (by examining the ICU separately) and analyses its evolution over the period 1996-2000. METHODS: Descriptive and retrospective study. Pharmacy records were reviewed to identify oral and parenteral antimicrobial agents administered to inpatients. Results were expressed in Daily Defined Doses (DDD) per 100 stays and day. RESULTS: During the five-year study period 176.162 DDD / 100 s-d of antibiotics were consumed in the ICU, whereas in the rest of the hospital usage was much lower (54.540 DDD / 100 s-d). Aminoglycosides, cephalosporins, penicillins, glycopeptides and carbapenems were the most commonly used groups of antimicrobials in the ICU, and penicillins, cephalosporins, trimethoprim/sulfonamide combinations, aminoglycosides and quinolones in the rest of the hospital. CONCLUSIONS: ICUs have some special features which make them different to the rest of inpatient areas. Because of that fact we consider important to study this specific patient-care area separately.