Biodegradable stents for the treatment of refractory or recurrent benign esophageal stenosis.

INTRODUCTION: Esophageal stents are used for the treatment of refractory and recurrent dyphagias. In 2007, esophageal biodegradable stents (EBS) were authorised as an alternative to existing metal and plastic stents in Europe. The advantages claimed for EBS are fewer complications concerning tissue ingrowth, stent migration and stent removal. AREAS COVERED: We performed a systematic review to evaluate the efficacy and safety of EBS compared to fully-covered self-expanding metal stents, self-expanding plastic stents, and esophageal dilation for the treatment of refractory or recurrent benign esophageal stenosis. Three comparative studies (one randomized controlled trial and two cohort studies) were assessed. The studies used different inclusion criteria, had a very small (sample) size and the quality of the evidence was very low. Expert commentary: The current evidence is insufficient to determine the relative efficacy or safety of esophageal biodegradable stents. The results of this systematic review should be updated once new evidence is available.

Current situation of depression healthcare in Spain: results of a psychiatrists’ survey

No disponible

Objective: To analyze the current situation of healthcare for depression in Spain, according to psychiatrists opinion, and how it has evolved over the last 20 years, comparativily with the results reported in previous studies of our group. Methods: Throughout 2002, we recorded the opinions of 101 specialists in psychiatry after asking them to fill out structured questionnaires in which they rated care, clinical, therapeutic and care quality. Results: The presence of depressive disorders in healthcare is substantial, despite the high figures for “concealed epidemiology”, with an increase in these last 20 years of disorders comorbid with anxiety. Currently, most patients arrive at the psychiatrist having been referred by their general practitioners (GP), as there is now less reluctance in depressive patients to such referral. In the last years there has been an increase in pharmacological treatment, with adverse effects of the drugs representing the major obstacle to no adherence to such treatment. Selective serotonin reuptake inhibitors (SSRIs) constitute the pharmacological group of choice, and are the drugs most commonly used in the treatment of depression, together with venlafaxine. Areas where there is a need for improvement are time devoted to consultation, coordination between GPs and psychiatrists, waiting lists, and resources available to Mental Health Units. Conclusions: Current situation of depression healthcare in Spain has substantially changed in recent years, improving in some aspects, thanks, in part, to the attitudes of GPs with this disorder and to evolution of pharmacological treatment (AU)

Management of depression in primary care: a survey of general practitioners in Spain.

OBJECTIVE: The objective of this study was to analyze the current situation of health care for depression in Spain according to general practitioners' (GPs') opinion and how it has evolved over the last 20 years on the basis of comparisons with the results of two previous social-health studies (published in 1997 and 1982). METHOD: Throughout 2002, we recorded the opinions of 238 GPs after asking them to fill up structured questionnaires in which they rated care, clinical, therapeutic and care quality aspects. RESULTS: Only 40% of patients with depression visit a doctor, implying a very high level of "concealed epidemiology." The diagnostic instruments most commonly used are assessment of symptoms and patient interview. Pharmacological treatment is the option GPs most commonly choose once a depression diagnosis is established (80% vs. 50% in 1997; P<.001). Selective serotonin reuptake inhibitors (SSRIs), together with anxiolytics, are the drugs most commonly used in the treatment of depression. SSRIs are the first choice drugs, being preferred to tricyclic antidepressants and anxiolytics, which were the most popular options for GPs in the 1997 survey. Areas where there is a need for improvement are time devoted to consultation, coordination between GPs and psychiatrists and waiting lists. CONCLUSIONS: The quality of health care for depression has improved in recent years, thanks to changes in the attitudes of GPs and the evolution of pharmacological treatment.

Aspectos asistenciales y farmacológicos sobre la depresión en España en el ámbito de la atención primaria y especializada: situación actual y evolución en los últimos años / Healthcare and pharmacological aspects about depression in psychiatry and primary care in spain: current situation and evolution in the last years

En la primera parte de esta Tesis hemos evaluado en quesituación se encuentra la asistencia sanitaria en nuestropaís y como ha evolucionado en los últimos 20 años,según la opinión de psiquiatras y médicos de AtenciónPrimaria (AP), desde una perspectiva comparativa conlos resultados aportados en dos estudios sociosanitariospublicados previamente en nuestro país (1997 y 1982).En la segunda parte de esta Tesis Doctoral, se ha estudiadoel uso de los antidepresivos en España durante el año2002, y la evolución en su consumo desde 1997. Asimismo,se ha comparado este patrón con el de variospaíses de la Unión Europea (Francia, Italia, Alemania,Reino Unido y Suecia).Podemos concluir que la calidad de la asistencia sanitariaa la depresión ha mejorado sustancialmente en losúltimos años, gracias, en parte, a la evolución de lostratamientos farmacológicos. Son áreas de mejora el tiempode consulta, la coordinación entre AP y Psiquiatría,las listas de espera, la asistencia social y psicológica alas familias y la dotación de medios a los Centros deSalud Mental.Por otro lado, el consumo total de antidepresivos en Españase ha incrementado en un 107% durante el periodode 1997-2002, produciéndose, paralelamente, un cambioen el patrón de uso de estos fármacos

In the first part of this study, the current situation ofhealthcare for depression in Spain was analyzed, fromthe point of view of general practitioners (GPs) andpsychiatrists, and how it has evolved over the last 20years, on the basis of comparisons with the results of twoprevious social-health studies (published in 1997 and1982).In the second part of this study, the pattern of use ofantidepressant drugs in Spain through 1997-2002 wasstudied. Elsewhere, it was compared with the pattern ofuse of antidepressant drugs in some of the European Unioncountries from different geographic areas (South, Centerand North Europe): Spain, France, Italy, Germany, UnitedKingdom and Sweden.We can conclude that quality of healthcare for depressionhas improved in recent years, thanks, in part, to theevolution of pharmacological treatment. Areas where thereis a need for improvement are time devoted to consultation,coordination between GPs and psychiatrists, waiting lists,social and psychological support for families andresources available to Mental Health Units. By otherside, the total consumption of antidepressants in Spain,through 1997-2002, increased in 107%, and there wasa change in the pattern of use of these drugs

Evolution of Spanish scientific production in international obstetrics and gynecology journals during the period 1986-2002.

OBJECTIVE: The present bibliometric study analyzes Spanish scientific work published in the field of obstetrics and gynecology in the most important journals during the period 1986-2002. STUDY DESIGN: The material studied (779 original documents) was selected in accordance with the science citation index (SCI) of 2001, obstetrics and gynecology section, using the EMBASE: Obstetrics and Gynecology database. We applied the customary rules of bibliometrics: Price's Law of increase in scientific literature, Bradford's Law of scattering of scientific literature and Lotka's Law of author productivity. Furthermore, we analyzed participation index (PaI), the collaboration index and the superior (%SUP). RESULTS: The material studied is closer to an exponential adjustment (r = 0.958) than to a linear adjustment (r = 0.856). The journal with the largest number of originals is Human Reproduction (Bradford's first area), with 217 articles and that with the highest PaI is Menopause (4.07). The total number of authors is 1829, who are responsible for 3938 authorships (2.79% of the authors have a productivity index (PI) > or = 1 and 70.09% have a PI = 0). The majority of the studies were carried out in hospitals (47.62%) and universities (23.36%). CONCLUSION: Spanish productivity in the field of obstetrics and gynecology increased considerably in the period 1986-2002.

Bibliometric analysis of biomedical publications on SSRI during 1980-2000.

We performed a bibliometric study of the scientific publications referring to selective serotonin reuptake inhibitors (SSRIs). The database used was EMBASE: Psychiatry. We applied the principal bibliometric indicators: Price's and Bradford's laws on the increase or dispersion of scientific literature, Lotka's law on the productivity of authors, the participation index (PaI) of countries, the productivity index (PI) of authors, and the collaboration index. By means of manual coding, documents were classified according to type of study and to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or nonpsychiatric categories. We analysed 3,622 original documents published between 1980 and 2000. Our results show nonfulfilment of Price's law because production on SSRIs does not grow exponentially (r=0.937 vs. r = 0.946, after linear adjustment). The journal most employed is the Journal of Clinical Psychiatry (Bradford's first zone). The United States is the most productive country (PaI=41.50). The documents were distributed in four groups: experimental pharmacology (8.38%), tolerance and safety (34.94%), clinical efficacy (49.11%), and not specified (7.56%). The drug most studied was fluoxetine (1,745 articles), followed by paroxetine (659). The DSM-IV diagnostic categories most studied were depression (834), obsessive-compulsive disorder (171), and panic disorder (75). The control antidepressants most used in comparative clinical studies were amitriptyline (51) and imipramine (42). The results of the present study show that the SSRIs are not solely antidepressant drugs, but also have a wide range of uses both within the psychiatric sphere (especially in the field of anxiety) and outside it, which explains the considerable scientific production generated in relation to these drugs.