Utilización de antidepresivos y prescripción fuera de ficha técnica en atención primaria en España (2013-2018) / Antidepressant use and off-label prescribing in primary care in Spain (2013–2018)

Introducción: Estudios recientes muestran un aumento del uso de antidepresivos en menores de 18 años, aunque pocos de ellos cuentan con indicación en este grupo de edad. El objetivo de este estudio es calcular la prevalencia anual del uso de antidepresivos en niños y adolescentes y revisar la adecuación de la prescripción a las indicaciones actuales. Métodos: Estudio de prevalencia de la utilización de antidepresivos en menores de 18 años a partir de los registros de la Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) durante el periodo 2013-2018, considerando al menos una prescripción por año para un mismo paciente. Resultados: La prevalencia de prescripción de antidepresivos entre los pacientes de la cohorte BIFAP ha aumentado de 2013 (7,97 prescripciones/1.000 pacientes) a 2018 (8,87 prescripciones/1.000 pacientes) en la mayoría de los grupos y en ambos sexos. El sexo femenino suma la mayoría de las prescripciones, superando al masculino en hasta 2,5 puntos en las tasas generales. En menores de 13 años la tendencia se invierte y los antidepresivos predominan en los chicos. La prevalencia de las prescripciones aumenta con la edad de los pacientes, igual que la proporción de tratamientos fuera de ficha técnica. El empleo de fármacos sin indicación disminuye con el transcurso del tiempo. Conclusiones: Observamos un aumento gradual en la prevalencia de prescripción de antidepresivos en menores de 18 años, preponderante en el sexo femenino. La elevada proporción de uso de estos fármacos sin indicación autorizada exige profundizar en el balance beneficio-riesgo y en alternativas de tratamiento más seguras. (AU)

Introduction: Recent studies show an increase in the use of antidepressants in minors (younger than 18 years), although few antidepressants are indicated for this age group. The aim of our study was to calculate the annual prevalence of antidepressant use in children and adolescents and to review the adherence of prescription to current indications. Methods: Study of the prevalence of antidepressant use in minors based on the records of the Electronic Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP) of Spain for the 2013–2018 period, considering at least one prescription per year for each patient. Results: The prevalence of antidepressant prescription in patients from the BIFAP cohort increased between 2013 (7.97 prescriptions per 1000 patients) and 2018 (8.87 prescriptions per 1000 patients), in most groups and in both sexes. In this period, female patients received the most prescriptions, surpassing prescriptions in male patients by up to 2.5 points in the overall rates. In patients younger than 13 years, this trend was inverted and antidepressant use was higher in male patients. The prevalence of prescription rose with increasing patient age, as did the proportion of off-label prescriptions. The use of off-label medication decreased over time. Conclusions: There was a gradual increase in the prevalence of antidepressant prescription in minors younger than 18 years, with a predominance of the female sex. The high proportion of unapproved medication use in this age group calls for more thorough investigation of the risk–benefit balance of these treatments and of safer treatment alternatives. (AU)

Antidepressant use and off-label prescribing in primary care in Spain (2013-2018).

INTRODUCTION: Recent studies show an increase in the use of antidepressants in minors (younger than 18 years), although few antidepressants are indicated for this age group. The aim of our study was to calculate the annual prevalence of antidepressant use in children and adolescents and to review the adherence of prescription to current indications. METHODS: Study of the prevalence of antidepressant use in minors based on the records of the Electronic Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP) of Spain for the 2013-2018 period, considering at least one prescription per year for each patient. RESULTS: The prevalence of antidepressant prescription in patients from the BIFAP cohort increased between 2013 (7.97 prescriptions per 1000 patients) and 2018 (8.87 prescriptions per 1000 patients), in most groups and in both sexes. In this period, female patients received the most prescriptions, surpassing prescriptions in male patients by up to 2.5 points in the overall rates. In patients younger than 13 years, this trend was inverted and antidepressant use was higher in male patients. The prevalence of prescription rose with increasing patient age, as did the proportion of off-label prescriptions. The use of off-label medication decreased over time. CONCLUSIONS: There was a gradual increase in the prevalence of antidepressant prescription in minors younger than 18 years, with a predominance of the female sex. The high proportion of unapproved medication use in this age group calls for more thorough investigation of the risk-benefit balance of these treatments and of safer treatment alternatives.

Lack of changes in preterm delivery and stillbirths during COVID-19 lockdown in a European region.

Preliminary data in Europe have suggested a reduction in prematurity rates during the COVID-19 pandemic, implying that contingency measures could have an impact on prematurity rates. We designed a population-based prevalence proportion study to explore the potential link between national lockdown measures and a change in preterm births and stillbirths. Adjusted multivariate analyses did not show any decrease in preterm proportions during the lockdown period with respect to the whole prelockdown period or to the prelockdown comparison periods (2015-2019): 6.5% (95%CI 5.6-7.4), 6.6% (95%CI 6.5-6.8), and 6.2% (95%CI 5.7-6.7), respectively. Proportions of preterm live births did not change during lockdown when different gestational age categories were analyzed, nor when birthweight categories were considered. No differences in stillbirth rates among the different study periods were found: 0.33% (95%CI 0.04-0.61) during the lockdown period vs. 0.34% (95%CI 0.22-0.46) during the prelockdown comparison period (2015-2019).Conclusion: We did not find any link between prematurity and lockdown, nor between stillbirths and lockdown. Collaborative efforts are desirable to gather more data and additional evidence on this global health issue. What is Known: • Prematurity is associated with increased risk of morbidity and mortality. • Contingency measures during the COVID-19 pandemic may have an impact on reducing prematurity rates. What is New: • Prematurity and stillbirth rates remained stable in Castilla-y-León, a Spanish region, during COVID-19 lockdown. • The role of behavioral patterns and sociocultural factors in the prevention of preterm birth as a result of lockdown measures remains a subject for debate.

Inoculation with rumen fluid in early life accelerates the rumen microbial development and favours the weaning process in goats.

BACKGROUND: Newborn ruminants possess an underdeveloped rumen which is colonized by microorganisms acquired from adult animals and the surrounding environment. This microbial transfer can be limited in dairy systems in which newborns are separated from their dams at birth. This study explores whether the direct inoculation of fresh or autoclaved rumen fluid from adult goats to newborn kids has a beneficial effect on rumen microbial development and function. RESULTS: Repetitive inoculation of young kids with fresh rumen fluid from adult goats adapted to forage (RFF) or concentrate diets (RFC) accelerated microbial colonization of the rumen during the pre-weaning period leading to high protozoal numbers, a greater diversity of bacterial (+ 234 OTUs), methanogens (+ 6 OTUs) and protozoal communities (+ 25 OTUs) than observed in control kids (CTL) without inoculation. This inoculation also increased the size of the core bacterial and methanogens community and the abundance of key rumen bacteria (Ruminococcaceae, Fibrobacteres, Veillonellaceae, Rikenellaceae, Tenericutes), methanogens (Methanobrevibacter ruminantium, Methanomicrobium mobile and Group 9), anaerobic fungi (Piromyces and Orpinomyces) and protozoal taxa (Enoploplastron, Diplodinium, Polyplastron, Ophryoscolex, Isotricha and Dasytricha) before weaning whereas CTL kids remained protozoa-free through the study. Most of these taxa were positively correlated with indicators of the rumen microbiological and physiological development (higher forage and concentrate intakes and animal growth during the post-weaning period) favoring the weaning process in RFF and RFC kids in comparison to CTL kids. Some of these microbiological differences tended to decrease during the post-weaning period, although RFF and RFC kids retained a more complex and matured rumen microbial ecosystem than CTL kids. Inoculation with autoclaved rumen fluid promoted lower development of the bacterial and protozoal communities during the pre-weaning period than using fresh inocula, but it favored a more rapid microbial development during the post-weaning than observed for CTL kids. CONCLUSIONS: This study demonstrated that inoculation of young ruminants with fresh rumen fluid from adult animals accelerated the rumen microbial colonization which was associated with an earlier rumen functional development. This strategy facilitated a smoother transition from milk to solid feed favoring the animal performance during post-weaning and minimizing stress.

Social interaction and conceptual change pave the way away from children's misconceptions about the Earth.

Throughout development, children undergo moments of abrupt conceptual transitions, often replacing intuitive knowledge with grounded scientific theories. This typically also creates a situation of social conflict, as different children may hold at the same time substantially different theories and explanations about the same phenomenon. The main objective of this work is to understand whether social interaction and exchange of arguments and reasoning may be a catalyzer for conceptual development. Dyads of 7-year-old children with different conceptual understanding of the Earth were asked to reach a consensus about its astronomic and geometric properties. Our results show that mere minutes of deliberation can result in substantial changes in children's conceptual representations, and moreover, that this transition was consistently in the direction of reasoned and scientific opinions. These results provide empirical evidence and suggest specific ways in which peer interaction can be used effectively to promote conceptual change in school settings, in a knowledge domain at the center of this era's post truth and science denial crisis.

Epidemiología del tratamiento farmacológico del trastorno por déficit de atención e hiperactividad (TDAH) en la Región de Murcia: diferencias por sexo, edad y lugar de residencia / The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in the Region of Murcia, Spain: Differences by gender, age and location of residence

INTRODUCCIÓN: El trastorno por déficit de atención e hiperactividad (TDAH) es la alteración del comportamiento más frecuente en la infancia y la adolescencia, representando un problema de salud pública. El tratamiento recomendado incluye tratamiento farmacológico y psicosocial. El objetivo de este estudio es analizar la evolución del consumo de los fármacos utilizados para el TDAH en la Región de Murcia y su variabilidad sociodemográfica. MÉTODO: Estudio observacional retrospectivo referido a la dispensación de medicamentos para el tratamiento del TDAH mediante receta en la Región de Murcia entre los años 2010 y 2014. Se calcularon las tasas de consumo expresadas en dosis diarias definidas (DDD) por 1.000 habitantes/día (DHD), estratificadas por sexo y edad y las razones de prevalencia de tratamiento por sexo comparando las tasas de consumo de hombres y de mujeres. RESULTADOS: Durante el periodo estudiado prácticamente se ha duplicado el consumo de medicamentos para el tratamiento del TDAH, pasando de tasas de 5,58 DHD y 3,39 DHD en 2010 a 9,34 DHD y 6,71 DHD en 2014, para las franjas de edad de 10 a 14 años y de 15 a 19 años, respectivamente. Los varones de entre 10 y 14 años presentan las tasas de consumo más elevadas, observándose variabilidad geográfica con menores consumos relativos en las zonas rurales. CONCLUSIÓN: Se ha producido un importante aumento del uso de los medicamentos para el TDAH en la Región de Murcia, si bien las tasas de consumo siguen siendo inferiores a los datos de otras comunidades autónomas o países de nuestro entorno. Se observa una gran variabilidad geográfica con un mayor consumo en adolescentes de zonas urbanas

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most frequent disorder in childhood and adolescence, and is seen as a public health problem. The recommended treatment includes pharmacological and psychosocial treatment. The aim of this work was to study the changes in the prescribing of the medicines used in ADHD treatment in the Region of Murcia, as well as their socio-demographic variability. METHOD: A retrospective observational study was conducted using the dispensing of medicines for ADHD treatment by means of prescription in the Region of Murcia from 2010 to 2014. The consumption rates were determined as defined daily doses (DDD) per thousand inhabitants/day (DHD), stratified by gender and age. The reasons for prevalence of treatment by gender were also determined by comparing male and female consumption rates. RESULTS: The consumption of medicines for ADHD treatment had almost doubled in the period studied, from 5.58 DHD and 3.39 DHD in 2010 to 9.34 DHD and 6.71 DHD in 2014, for the age range of 10-14 and 15-19, respectively. Boys from 10-14 showed the highest consumption rates, showing a high geographical variability with less consumption in rural areas. CONCLUSION: The results showed a large increase in the use of medicines for ADHD treatment in the Region of Murcia, although the consumption rates are still lower than in other Autonomous Communities or neighbouring countries. A wide geographical variability was found, with a higher consumption in adolescents from urban areas

[The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in the Region of Murcia, Spain: Differences by gender, age and location of residence]. / Epidemiología del tratamiento farmacológico del trastorno por déficit de atención e hiperactividad (TDAH) en la Región de Murcia: diferencias por sexo, edad y lugar de residencia.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most frequent disorder in childhood and adolescence, and is seen as a public health problem. The recommended treatment includes pharmacological and psychosocial treatment. The aim of this work was to study the changes in the prescribing of the medicines used in ADHD treatment in the Region of Murcia, as well as their socio-demographic variability. METHOD: A retrospective observational study was conducted using the dispensing of medicines for ADHD treatment by means of prescription in the Region of Murcia from 2010 to 2014. The consumption rates were determined as defined daily doses (DDD) per thousand inhabitants/day (DHD), stratified by gender and age. The reasons for prevalence of treatment by gender were also determined by comparing male and female consumption rates. RESULTS: The consumption of medicines for ADHD treatment had almost doubled in the period studied, from 5.58 DHD and 3.39 DHD in 2010 to 9.34 DHD and 6.71 DHD in 2014, for the age range of 10-14 and 15-19, respectively. Boys from 10-14 showed the highest consumption rates, showing a high geographical variability with less consumption in rural areas. CONCLUSION: The results showed a large increase in the use of medicines for ADHD treatment in the Region of Murcia, although the consumption rates are still lower than in other Autonomous Communities or neighbouring countries. A wide geographical variability was found, with a higher consumption in adolescents from urban areas.

El régimen de jornada escolar completa y la participación en el juego: una política pública en deuda con los niños y niñas / Full school day regimen and play participation: a public policy in debt with children

La investigación “El régimen de Jornada Escolar Completa y la Participación en el Juego: Una política pública en deuda con los niños y niñas” muestra el impacto de la Jornada Escolar Completa en la Participación en el Juego de escolares de segundo año básico pertenecientes a establecimientos de educación municipal de la ciudad de Temuco. Se entiende Participación en el Juego como “participar en el juego; mantener un balance entre el juego y las demás ocupaciones; y obtener, utilizar y mantener los juguetes, equipos y su ministros apropiadamente”. La metodología utilizada para este estudio es de carácter cuantitativo, descriptivo - comparativo, noexperimental y de corte transversal. La muestra se selecciona mediante un muestreo no probabilístico intencionado, participando del estudio un total de 68 estudiantes pertenecientes a la Escuela Los Trigales y a la Escuela Campos Deportivos, establecimientos que cuentan con Media Jornada Escolar y Jornada Escolar Completa respectivamente. Los hallazgos de la investigación dan cuenta de un déficit de juego de 8,6 horas semanales, proyectándose un déficit de 344 horas anuales en los niños y niñas que asisten a Jornada Escolar Completa, en relación a los escolares que asisten a Media Jornada Escolar; y de diferencias significativas en el balance entre el juego y las demás ocupaciones entre los escolares de ambos establecimientos, dejando en evidencia cómo esta política pública que configura el ambiente institucional educativo en el que se desenvuelven diariamente los escolares, determina sus horarios, ocupaciones disponibles y la distribución de las actividades en su rutina.

There search, “Full School Day regimen and Play Participation: A Public Policy in debt with children” shows the impact of Full School Day in Play Participation of schoolchildren of second grade who belong to municipal educational establishments of Temuco city; understanding Play Participation as “participating in the game, maintaining a balance of play with other occupations, and obtain, use and maintain toys, equipment and supplies appropriately”. The used methodology for this study is quantitative, descriptive - comparative, non - experimental and cross - sectional. The sample is selected by means of an intentional non - probabilistic sampling, participating in the study a total of 68 students who attend to Los Trigales and Campos Deportivos School, establishments that has Half School Day and Full School Day respectively. The research findings shown a play deficit of 8.6 hours per week, projecting a 344 hours deficit per year for children who attends to Full School Day, in relation to schoolchildren who attend to Half School Day; and significant differences in the balance between play and other occupations, between school children of both establishments, revealing how this public policy that configures the educational institutional environment in which school children develop daily, determines their schedules, available occupations and the distribution of activities in their routine.

Variabilidad del consumo de antibióticos en una región sanitaria según áreas de salud y modelo de cobertura: sistema nacional de salud vs. mutualidad de funcionarios / Variability in antibiotic consumption within a regional health service, according to health area and model of healthcare coverage: national health system vs. civil servants’ mutual insurance society

Introducción. El objetivo de este estudio es analizar el consumo de antibióticos en la Región de Murcia en el contexto nacional y europeo en el año 2011 y su patrón de consumo en las distintas áreas de salud, y entre los usuarios del servicio regional de salud y los de la mutualidad de funcionarios civiles del estado (MUFACE). Métodos. Estudio observacional retrospectivo referido a la dispensación de antibióticos mediante receta en la Región de Murcia durante el año 2011. Se calcularon las tasas de consumo expresada en dosis diarias definidas (DDD) por mil habitantes/día (DHD) y las razones de utilización estandarizadas (RUE). Resultados. La tasa de consumo de antibióticos en 2011 en la Región de Murcia fue de 30,05 DHD, muy superior a la media nacional (20,9 DHD) y a la de la Unión Europea (21,57 DHD). Las áreas de salud con mayor y menor tasa de consumo son, respectivamente Vega Alta (RUE: 124,44; IC95% 124,26 a 124,61) y Cartagena (RUE: 84,16; IC95% 84,10 a 84,22). Los usuarios mutualistas de la Región de Murcia tienen tasas de consumo superiores a las de los beneficiarios del servicio regional de salud (RUE: 105,01; IC95% 104,86 a 105,17). Conclusiones. Existe una elevada prescripción de antibióticos en la Región de Murcia, observándose además una notable variabilidad entre las distintas áreas de salud, principalmente en el caso de cefalosporinas y macrólidos, que podría estar en parte asociada al nivel de frecuentación (AU)

Introduction. The aim of this study is to describe antibiotic consumption in the Region of Murcia in 2011, within the Spanish and European context, as well as to analyze the differences within the Region, both between health areas, and between users of the regional health service and those protected by the civil servants’ mutual insurance society (MUFACE). Methods. Retrospective observational study of prescriptions dispensed by the pharmacies in the Region of Murcia during 2011. Consumption rates were expressed as defined daily doses (DDD) per 1,000 inhabitants/day and standardized consumption ratios (SCR). Results. Overall antibiotics consumption rate in the Region of Murcia in 2011 was 30.05 DDD/1000/ day (DID), which is much above the average rate for Spain (20.9 DID) and for the European Union (21.57 DID). Health areas within the Region with the highest and lowest consumption rate are, respectively, Vega Alta (SCR: 124.44; CI95% 124.26 to 124.61) and Cartagena (SCR:84.16; CI95% 84.10 to 84.22). Civil servants covered by the mutual society have higher consumption rates than users of the regional health service (SCR: 105.01; CI95% 104.86 to 105.17). Conclusions. There is a high level of antibiotic prescription in the Region of Murcia Region in relative terms. A great variability in antibiotics consumption was observed between the different health areas, which might be related to the higher rate of the frequency of visits. The highest amount of variability in antibiotics prescription was found in cephalosporins and macrolides (AU)

[Variability in antibiotic consumption within a regional health service, according to health area and model of healthcare coverage: national health system vs. civil servants' mutual insurance society]. / Variabilidad del consumo de antibióticos en una región sanitaria según áreas de salud y modelo de cobertura: sistema nacional de salud vs. mutualidad de funcionarios.

INTRODUCTION: The aim of this study is to describe antibiotic consumption in the Region of Murcia in 2011, within the Spanish and European context, as well as to analyze the differences within the Region, both between health areas, and between users of the regional health service and those protected by the civil servants' mutual insurance society (MUFACE). METHODS: Retrospective observational study of prescriptions dispensed by the pharmacies in the Region of Murcia during 2011. Consumption rates were expressed as defined daily doses (DDD) per 1,000 inhabitants/day and standardized consumption ratios (SCR). RESULTS: Overall antibiotics consumption rate in the Region of Murcia in 2011 was 30.05 DDD/1000/ day (DID), which is much above the average rate for Spain (20.9 DID) and for the European Union (21.57 DID). Health areas within the Region with the highest and lowest consumption rate are, respectively, Vega Alta (SCR: 124.44; CI95% 124.26 to 124.61) and Cartagena (SCR:84.16; CI95% 84.10 to 84.22). Civil servants covered by the mutual society have higher consumption rates than users of the regional health service (SCR: 105.01; CI95% 104.86 to 105.17). CONCLUSIONS: There is a high level of antibiotic prescription in the Region of Murcia Region in relative terms. A great variability in antibiotics consumption was observed between the different health areas, which might be related to the higher rate of the frequency of visits. The highest amount of variability in antibiotics prescription was found in cephalosporins and macrolides.

CHO cells expressing the human P5-ATPase ATP13A2 are more sensitive to the toxic effects of herbicide paraquat.

P-ATPases are membrane transporters energized by ATP. The subfamily of P5-ATPases is the least studied P-ATPases and the ion substrate specificity of the P5 subfamily is not known. Mutations of the human P5ATPase gene ATP13A2 has been shown to underlie a form of Parkinson disease (PD). We investigated the link between ATP13A2 and environmental factors related to PD development. Increasing concentrations of the synthetic polyamine analog paraquat induced a greater cytotoxic effect over CHO cells expressing ATP13A2. Paraquat-toxicity was associated with increased production of cellular reactive oxygen species and this increment was reversed by the natural polyamine spermidine. Acridine orange fluorescence intensity suggested that ATP13A2 induced the expansion of acidic vesicles that become more alkaline upon external addition of spermidine. Polyamine uptake is proposed to be initiated by a plasma membrane carrier followed by sequestration into acidic vesicles of the late endocytic compartment through an unidentified active mechanism; because ATP13A2 is located in lysosomes and late endosomes, our results open the possibility that ATP13A2 could be one of those active transporters capable of transporting polyamines like spermidine as well as its toxic analog paraquat.