Adecuación y seguridad en el consumo crónico de inhibidores de la bomba de protones / Adequacy and safety in Proton Pump Inhibitors (PPIs) chronic use

Objetivo: Evaluar la adecuación del uso crónico de IBP, qué factores se asocian a ella y la presencia de posibles efectos adversos. Diseño: Estudio observacional retrospectivo. Emplazamiento: Centro de Salud urbano. Participantes: 109 de los 242 pacientes de 40 a 85 años que consumieron IBP más de 12 meses en 2013 y 2014. Mediciones Principales: Sexo, edad, principio activo, meses consumo, indicación, adecuación actual, comorbilidad, tratamientos crónicos y efectos adversos. Muestreo aleatorio en dos cupos médicos. Revisión de historias clínicas. Resultados: Edad media: 70,9 (DE: 10,1) años. Mujeres: 58,7 %. Consumió omeprazol el 83,5 %. Mediana de consumo de 96 meses (rango intercuartílico: 60-132). Se indicaron para gastroprotección (55 %), ERGE (9,2 %) y ninguna (35,8 %). El consumo actual fue adecuado en un 64,2 % (37 % en <65 años frente a 73,2 % en ≥65 años; p=0,001). Comorbilidad media de 2,3 (DE: 1,1) enfermedades, siendo la artrosis y depresión más frecuentes en mujeres y la enfermedad vascular, neumopatía y hepatopatía en hombres. El número medio de fármacos crónicos fue 5,7 (DE: 2). Neumonía (24,8 %), déficit de vitamina B12 (6,4 %) y osteoporosis (31,2 %) fueron enfermedades concomitantes durante el consumo de IBP. Los pacientes con adecuado consumo crónico de IBP se caracterizaron por tener más edad, mayor comorbilidad (principalmente enfermedad vascular y ansiedad-depresión) y tomar más fármacos (entre ellos antiagregantes, ISRS, AINEs gastrolesivos). Conclusiones: Se observó un consumo crónico de IBP superior a 5 años en el 75 % de la muestra. Más de un tercio consumían IBP sin indicación justificada, por tanto son necesarias medidas correctoras para mejorar la seguridad de los pacientes (AU)

Objective: To evaluate the adequacy of PPI chronic use, the factors associated to it and the presence of possible adverse effects. Design: Retrospective observational study. Location: Urban health centre. Participants: 109 of the 242 patients aged 40 to 85 who consumed PPIs over 12 months in 2013 and 2014. Main measures: Sex, age, active ingredient, consumption time (months), indication, current adequacy, comorbidity, chronic treatments and presence of adverse effects. Random sampling from two doctor quotas. Review of medical records. Results: Average age: 70.9 (SD: 10.1) years old. Women: 58.7 %. 83.5 % consumed omeprazole. Median consumption time: 96 months (interquartile range: 60-132). PPIs were indicated for gastroprotection (55 % ), GERD (9.2 %) and nothing (35.8 %). Current consumption was appropriate in 64.2 % (37 % in aged <65 vs 73.2 % in aged ≥65, p=0.001). Average number of comorbidities was 2.3 (SD: 1.1) diseases. Osteoarthritis and depression were more common in women while vascular disease, lung disease and liver disease were more common in men. The average number of chronic medications was 5.7 (SD: 2). Pneumonia (24.8 %), vitamin B12 deficiency (6.4 %) and osteoporosis (31.2 %) were concomitant diseases during PPI consumption. Patients with appropriate PPI chronic consumption were older, had more comorbidities (mainly vascular disease and anxiety-depression), and used more medications (among them, antiplatelet drugs, SSRIs, gastroerosive NSAIDs. Conclusions: 75 % of the sample showed a PPI chronic use of over 5 years. 35.8 % used PPIs without justified indication. Corrective measures are therefore required to improve patient safety (AU)

[Foodborne outbreak by Clostridium perfringens in a school dining room]. / Brote de toxiinfección alimentaria por Clostridium perfringens en un comedor escolar.

BACKGROUND AND OBJECTIVE: The purpose was to investigate the etiology and epidemiological characteristics of a food-borne infection outbreak in a school dining room. SUBJECTS AND METHOD: Retrospective cohort study. Information about gastrointestinal symptoms and the use of the service of the school dining room was obtained. Coprocultures and detection of Clostridium perfringens enterotoxin in stool samples by means of reverse passive latex agglutination were carried out in 7 ill persons. Relative risks (RR) at 95% confidence intervals (95% CI) were calculated. RESULTS: The attack rate was 17.5% (48/275) and the probability of becoming sick was higher in students who ate at the second shift than in those eating at the first one (RR=13.8; 95% CI: 4.4-43.1). C perfringens enterotoxin was detected in 6 stool samples from patients. A high recount of C perfringens was not observed in those food samples kept frozen after their elaboration. CONCLUSIONS: The determination of C perfringens enterotoxin in feces allowed to confirm the etiologic agent of the outbreak.

Brote de toxiinfección alimentaria por Clostridiumperfringens en un comedor escolar / Foodborne outbreak by Clostridium perfringens in a school dining room

FUNDAMENTO Y OBJETIVO: Investigar las características epidemiológicas y la etiología de un brote de origen alimentario en un comedor escolar. SUJETOS Y MÉTODO: Estudio de cohortes retrospectivo. Se recogió información sobre la utilización del servicio de comedor del colegio y la presencia de síntomas de gastroenteritis. Se realizaron coprocultivos de siete pacientes y se investigó la presencia de enterotoxina de Clostridium perfringens en heces mediante aglutinación pasiva reversa por látex. Se calcularon los riesgos relativos (RR) y sus intervalos de confianza (IC) del 95 por ciento. RESULTADOS: La tasa de ataque fue del 17,5 por ciento (48/275) y la probabilidad de enfermar resultó superior en los alumnos del segundo turno de comida con respecto a los del primero (RR = 13,8; IC del 95 por ciento, 4,4-43,1). En 6 muestras de heces de enfermos se detectó la presencia de enterotoxina de C. perfringens. En las muestras testigo de los alimentos del menú que se mantuvieron congeladas tras su elaboración no se observó un recuento elevado de C. perfringens. CONCLUSIONES: La determinación de la enterotoxina de C. perfringens en heces permitió confirmar la etiología del brote (AU)

Factores asociados a mal estado de salud percibido o a mala calidad de vida en personas mayores de 65 años / Factors Related to Perceived Poor Health Condition or Poor Quality of Life among those over Age 65

Fundamento: Hoy en día, en los países desarrollados, llegar a una edad avanzada ha dejado de ser algo excepcional, sin embargo muchas personas no logran envejecer con una buena calidad de vida. El presente trabajo tiene como objetivos, contribuir a un mejor conocimiento de los principales factores que influyen en la calidad de vida y la percepción de la salud de los mayores de 65 años, así como determinar qué ventajas y desventajas presenta cada uno de los tres instrumentos de medida de la salud y la calidad de vida frente a los otros dos instrumentos utilizados. Métodos: A partir de 911 encuestas a personas mayores de 65 años no institucionalizadas, realizadas a domicilio, se hizo un análisis multivariante mediante regresión logística, poniendo en relación los resultados obtenidos en el Perfil de Salud de Nottingham (PSN), el Euroqol y el EAS con las caracterísiticas sociodemográficas, el nivel de recursos económicos, el grado de apoyo sociofamiliar, el estado de salud física y mental y la capacidad funcional. Resultados: Los principales factores que se asocian con la percepción de un mal estado de salud y mala calidad de vida en el Euroqol y el PSN son los trastornos de ansiedad (Odd Ratios entre 1,8 (IC:1,2-2,8) para movilidad y 7,9 (IC:4,5-13,9) para perfil distinto de 11111), trastornos depresivos (OR:1,8 (IC:1,3-2,6) para dolor/malestar -3,3 (IC:2,1-5,1) para aislamiento social), falta de ejercicio (OR:1,4 (IC:1-2,1) para ansiedad/depresión -3,9 (IC:2,5-6,2) para actividades cotidianas), dependencia para las actividades básicas de la vida diaria (OR:0,5 (IC:0,3-0,9) para reacción emocional -4,8 (IC:3-7,6) para actividades cotidianas) y dependencia para las actividades instrumentales de la vida diaria (OR:1,5 (IC:1,1-2,1) para Escala Visual Analógica < 70 - 7,1 (IC:2,9-17,2) para cuidado personal). Conclusiones: La salud mental y la capacidad funcional son los factores que más influyen en la percepción del estado de salud y la calidad de vida de las personas mayores. Dado que los tres instrumentos utilizados han obtenido resultados semejantes, el Euroqol ofrece ventajas por su brevedad, incluyendo una valoración global y por dimensiones (AU)

Background: Nowadays, in the developed countries, a long lifespan is no longer the exception to the rule, however there are still many people who even today do not manage to age with a good quality of life. The objectives of this study are, first of all, to contribute to a better knowledge of the main factors which have an impact on the quality of life and the perceived health condition of those over age 65 and, secondly, to determine what advantages and disadvantages involved in each one of the tools for gauging health and quality of life as compared to the other two tools employed. Methods: Based on 911 home surveys of non-institutionalized individuals over age 65, a multivariate analysis was made using Logistic regression, relating the results obtained in the Nottingham Health Profile (NHP), the EuroQol and the Self Perceived Health Status to the socio-demographic characteristics, the level of economic resources, the degree of social-family support, the physical and mental health condition and the functional capacity. Results: The main factors related to the perception of a poor health condition and a poor quality of life in the EuroQol and the NHP are anxiety disorders (Odds Ratio ranging from 1.8(IC:1.2-2.8) for mobility and 7.9(IC:4.5-13.9) for Profile*11111), depressive disorders (OR:1.8(IC:1.3-2.6) for pain/discomfort- 3.3(IC:2.1-5.1) for social isolation), lack of exercise (OR:1.4 (IC:1-2.1) for anxiety/depression -3.9(IC:2.5-6.2) for everyday activities), dependence for basic everyday living activities (OR:0.5(IC:0.3-0.9) for emotional reaction - 4.8(IC:3-7.6) for everyday activities) and dependence for the instrumental daily living activities (OR:1.5(IC:1.1-2.1) for Analog Visual Scale c<70 - 7.1(IC:2.9-17.2) for personal care). Conclusions: Mental health and functioning capacity are the factors which have the greatest bearing on the perception of health condition and quality of life of individuals over age 65. Given that the three tools used have led to similar results, the EuroQol has advantages to offer due to its short length, including an overall evaluation by dimensions (AU)

[Factors related to perceived poor health condition or poor quality of life among those over 65 years of age]. / Factores asociados a mal estado de salud percibido o a mala calidad de vida en personas mayores de 65 años.

BACKGROUND: Nowadays, in the developed countries, a long lifespan is no longer the exception to the rule, however there are still many people who even today do not manage to age with a good quality of life. The objectives of this study are, first of all, to contribute to a better knowledge of the main factors which have an impact on the quality of life and the perceived health condition of those over age 65 and, secondly, to determine what advantages and disadvantages involved in each one of the tools for gauging health and quality of life as compared to the other two tools employed. METHODS: Based on 911 home surveys of non-institutionalized individuals over age 65, a multivariate analysis was made using Logistic regression, relating the results obtained in the Nottingham Health Profile (NHP), the EuroQol and the Self Perceived Health Status to the socio-demographic characteristics, the level of economic resources, the degree of social-family support, the physical and mental health condition and the functional capacity. RESULTS: The main factors related to the perception of a poor health condition and a poor quality of life in the EuroQol and the NHP are anxiety disorders (Odds Ratio ranging from 1.8(IC:1.2-2.8) for mobility and 7.9(IC:4.5-13.9) for Profile*11111), depressive disorders (OR:1.8(IC:1.3-2.6) for pain/discomfort-3.3(IC:2.1-5.1) for social isolation), lack of exercise (OR:1.4 (IC:1-2.1) for anxiety/depression -3.9(IC:2.5-6.2) for everyday activities), dependence for basic everyday living activities (OR:0.5(IC:0.3-0.9) for emotional reaction -4.8(IC:3-7.6) for everyday activities) and dependence for the instrumental daily living activities (OR:1.5(IC:1.1-2.1) for Analog Visual Scale c < 70-7.1(IC:2.9-17.2) for personal care). CONCLUSIONS: Mental health and functioning capacity are the factors which have the greatest bearing on the perception of health condition and quality of life of individuals over age 65. Given that the three tools used have led to similar results, the EuroQol has advantages to offer due to its short length, including an overall evaluation by dimensions.