[Morbidity and drug consumption. Comparison of results between the National Health Survey and electronic medical records]. / Morbilidad y consumo de fármacos. Comparación de resultados entre la Encuesta Nacional de Salud y los registros electrónicos.

OBJECTIVE: To compare the prevalence of disease and drug consumption obtained by using the National Health Survey (NHS) with the information provided by the electronic medical records (EMR) in primary health care and the Pharmaceutical Consumption Registry in Aragon (Farmasalud) in the adult population in the province of Zaragoza. METHODS: A cross-sectional study was performed to compare the prevalence of diseases in the NHS-2006 and in the EMR. The prevalence of drug consumption was obtained from the NHS-2006 and Farmasalud. Estimations using each database were compared with their 95% confidence intervals (95% CI) and the results were stratified by gender and age groups. The comparability of the databases was tested. RESULTS: According to the NHS, a total of 81.8% of the adults in the province of Zaragoza visited a physician in 2006. According to the EMR, 61.4% of adults visited a primary care physician. The most prevalent disease in both databases was hypertension (NHS: 21.5%, 95% CI: 19.4-23.9; EMR: 21.6%, 95% CI: 21.3-21.8). The greatest differences between the NHS and EMR was observed in the prevalence of depression, anxiety, and other mental illnesses (NHS: 10.9%; EMR: 26.6%). The most widely consumed drugs were analgesics The prevalence of drug consumption differed in the two databases, with the greatest differences being found in pain medication (NHS: 23.3%; Farmasalud: 63.8%) and antibiotics (NHS: 3.4%; Farmasalud: 41.7%). These differences persisted after we stratified by gender and were especially important in the group aged more than 75 years. CONCLUSIONS: The prevalence of morbidity and drug consumption differed depending on the database employed. The use of different databases is recommended to estimate real prevalences.

Prescripción extrahospitalaria de antibióticos en Aragón y sus diferencias por género y edad / Outpatient antibiotic prescription in Aragón and the differences by gender and age

Introducción: El objetivo de este estudio es describir la prescripción de antibióticos en atención extrahospitalaria y su patrón de consumo por subgrupos, analizar los patrones de utilización por edad y sexo e identificar pacientes hiperconsumidores. Métodos Estudio observacional retrospectivo en el que se estimó la proporción de habitantes de Aragón que habían sido tratados con antibióticos en 2008. Los datos se obtuvieron del Sistema de Información de Consumo Farmacéutico de Aragón, que recoge las recetas dispensadas en oficinas de farmacia. Se calcularon la tasa de habitantes expuestos a tratamiento antibiótico y la dosis diaria definida (DDD) por mil habitantes/día (DHD).Resultados La tasa de prescripción de antibióticos en 2008 en Aragón fue de 339,81 por 1.000 habitantes (303,54 por 1.000 en hombres y 375,34 por 1.000 en mujeres). La prescripción extrahospitalaria de antibióticos en Aragón fue de 23,72 DHD. La frecuencia de consumo presenta diferencias importantes en función de la edad y el sexo. En los niños de 0 a 4 años se observa la mayor tasa de utilización de antibióticos, y las mujeres, en general, presentan una mayor frecuencia de consumo que los hombres. Las penicilinas son el subgrupo de antibióticos más utilizado en todos los grupos de edad, excepto en los mayores de 80 años, en quienes son desplazadas por las quinolonas. El mayor porcentaje de pacientes considerados hiperconsumidores en adultos (más de 60 DDD de antibióticos al año) tuvo lugar en el grupo entre 60 y 80 años. Conclusión Se observó una elevada prescripción de antibióticos en Aragón, siendo llamativo el elevado consumo en los niños más pequeños, y las diferencias entre mujeres y hombres (AU)

Background: The objective of the study is to describe the use of antibiotics among outpatients, the pattern of sub-group prescribing, as well as to analyse age- and gender-specific patterns of use, and to identify high users. Methods: A retrospective, observational study was designed, in which the rate of patients treated with antibiotics in Aragon (Spain) in 2008 was calculated. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions in Aragon in 2008. Defined Daily Dose (DDD) per 1000 inhabitants per day (DID) was calculated, and the number of patients who had received an antibacterial drug was analysed. Results: The antibiotic prescription rate in 2008 in Aragón was 339.81 per 1000 inhabitants (303.54and 375.34 per 1000 for men and women, respectively). The DID was 23.72. Population prevalence of antimicrobial use changed markedly between different age groups and between genders. Children (0-4 years) had the highest rate. Females, in general, used antibiotics more than males. Penicillins was the most used antibacterial group in all age groups, except for people of advanced age (>80 years), where quinolones were the most frequently used. Most of the individuals defined as high users (using more than60 DDDs/year) were in the 60-80 years age group. Conclusion: We observed a high antibiotic prescription rate in Aragon, particularly in children. There are differences between men and women in the use of antibiotics (AU)

[Outpatient antibiotic prescription in Aragón and the differences by gender and age]. / Prescripción extrahospitalaria de antibióticos en Aragón y sus diferencias por género y edad.

BACKGROUND: The objective of the study is to describe the use of antibiotics among outpatients, the pattern of sub-group prescribing, as well as to analyse age- and gender-specific patterns of use, and to identify high users. METHODS: A retrospective, observational study was designed, in which the rate of patients treated with antibiotics in Aragon (Spain) in 2008 was calculated. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions in Aragon in 2008. Defined Daily Dose (DDD) per 1000 inhabitants per day (DID) was calculated, and the number of patients who had received an antibacterial drug was analysed. RESULTS: The antibiotic prescription rate in 2008 in Aragón was 339.81 per 1000 inhabitants (303.54 and 375.34 per 1000 for men and women, respectively). The DID was 23.72. Population prevalence of antimicrobial use changed markedly between different age groups and between genders. Children (0-4 years) had the highest rate. Females, in general, used antibiotics more than males. Penicillins was the most used antibacterial group in all age groups, except for people of advanced age (>80 years), where quinolones were the most frequently used. Most of the individuals defined as high users (using more than 60 DDDs/year) were in the 60-80 years age group. CONCLUSION: We observed a high antibiotic prescription rate in Aragon, particularly in children. There are differences between men and women in the use of antibiotics.

[Variations in the prescription of antibiotics among primary care areas in the autonomous region of Aragon, Spain]. / Variabilidad de la prescripción de antibióticos en atención primaria de los sectores sanitarios de Aragón.

BACKGROUND: Resistance to antibacterial drugs can be contained by judicious utilization, so we must know about its use. The objective is to describe the prevalence of antibiotic consumption and the variability in the use of antibiotics among outpatients in the different health areas of Aragon. METHODS: Study of the prescription of antibiotics in the health areas of Aragon in 2008. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions. Prescription rates per 1000 individuals adjusted by sex and age were calculated using a direct and indirect standardization method. The subgroups utilization were calculated in Defined Daily Dose per 1000 inhabitants per day (DID). In the variation analysis were used: extremal quotient (EQ), coefficient of variation (CV), weighted coefficient of variation (CVw). RESULTS: The adjusted rate of antibiotic varied between 279,8 and 382 per 1000 inhabitants, showing a CVw=0,12. The utilization rate in women was 364.9 per 1,000 and in men 300.0 per 1,000. Cephalosporins have a EQ=2,42 and CVw=0,37; and quinolones have EQ=1,84 and CVw=0,22. CONCLUSIONS: The utilization rate was higher in women than men. The higher variability in the prescription of antibiotics among health areas in Aragon was in cephalosporins and quinolones.

Efectividad y seguridad de ranibizumab en degeneración macular neovascular asociada a la edad / Assessment of the effectiveness and safety of ranibizumab in neovascular agerelated macular degeneration

Fundamento y objetivos: La degeneración macular asociada a la edad (DMAE) neovascular es una enfermedad degenerativa y crónica. Los tratamientos actuales sólo han demostrado ralentizar la progresión de la DMAE. El objetivo del estudio es evaluar la efectividad y seguridad de ranibizumab en una serie de pacientes, así como describir sus características demográficas y clínicas. Pacientes y método: Se realizó un estudio observacional y retrospectivo, incluyendo todos los pacientes que iniciaron tratamiento desde el 1-12-2006 hasta el 31-12-2008, realizándose el seguimiento hasta el 31-03-2009. Se realizó un análisis bivariante y modelos de regresión logística para analizar la influencia de factores demográficos y clínicos en la efectividad y en la durabilidad del tratamiento. Se recogieron las reacciones adversas descritas en las historias clínicas para evaluar la seguridad.Resultados: Se incluyeron 112 pacientes con una media (DE) de edad de 77,7 (6,0) años. La media de durabilidad del tratamiento fue de 18,2 meses, siendo superior en el grupo de pacientes que iniciaron tratamiento con agudeza visual (AV) > 0,1 (p<0,001). Ranibizumab mantenía la AV por encima de los valores basales hasta los 18 meses. Ninguna de las variables estudiadas se asoció con la efectividad del tratamiento. La agudeza visual inicial influía en la duración del tratamiento, siendo superior en el grupo de pacientes con AV > 0,1.Conclusiones: Ranibizumab parece ser efectivo hasta los 18 meses. Un diagnóstico precoz de DMAE permitiría un inicio del tratamiento más temprano cuando los pacientes presentan valores superiores de AV, optimizando los beneficios del tratamiento. Ranibizumab fue bien tolerado y seguro en la mayoría de los pacientes (AU)

Background and objectives: Neovascular Age Related Macular Degeneration (ARMD) is a chronic and degenerative disease. Current treatment options are limited and have shown to slow diseaseprogression. The aim of this study was to assess Ranibizumab effectiveness and safety and to describe patients’ demographic and clinical characteristics. Patients and method: We conducted a retrospective observational study including all patients who had started treatment between 1/12/2006 and 31/12/2008, and were followed up until31/03/2009. A bivariate analysis on months 4, 12 and 18 and two logistic regression models were performed to analyze the influence of demographic and clinical factors on the effectiveness and durability of treatment. Adverse reactions were collected as described in themedical records to assess safetyResults: A total of 126 eyes of 112 patients were recruited. The mean age was 77.7 ( 6.0) years. The meandurability of treatment was 18.2 months, and it was higher in the group of patients who started treatment with visual acuity (VA) > 0.1 (p < 0.001). Ranibizumab therapy maintained AV over baseline at 18 months.None of the studied variables showed any influence on treatment effectiveness. However, baseline visual acuity influenced on reatment duration, being higher in the group of patients with AV > 0.1.Conclusions: Ranibizumab was shown to be effective until 18months. Early diagnosis of AMD could lead to an earlier treatment start, when patients present a higher AV, in order to optimize the benefits of treatment. Ranibizumab was well tolerated and safe in most patients (AU)

[Assessment of the effectiveness and safety of ranibizumab in neovascular age-related macular degeneration]. / Efectividad y seguridad de ranibizumab en degeneración macular neovascular asociada a la edad.

BACKGROUND AND OBJECTIVES: Neovascular Age Related Macular Degeneration (ARMD) is a chronic and degenerative disease. Current treatment options are limited and have shown to slow disease progression. The aim of this study was to assess Ranibizumab effectiveness and safety and to describe patients' demographic and clinical characteristics. PATIENTS AND METHOD: We conducted a retrospective observational study including all patients who had started treatment between 1/12/2006 and 31/12/2008, and were followed up until 31/03/2009. A bivariate analysis on months 4, 12 and 18 and two logistic regression models were performed to analyze the influence of demographic and clinical factors on the effectiveness and durability of treatment. Adverse reactions were collected as described in the medical records to assess safety. RESULTS: A total of 126 eyes of 112 patients were recruited. The mean age was 77.7 (± 6.0) years. The mean durability of treatment was 18.2 months, and it was higher in the group of patients who started treatment with visual acuity (VA) > 0.1 (p<0.001). Ranibizumab therapy maintained AV over baseline at 18 months. None of the studied variables showed any influence on treatment effectiveness. However, baseline visual acuity influenced on treatment duration, being higher in the group of patients with AV > 0.1. CONCLUSIONS: Ranibizumab was shown to be effective until 18 months. Early diagnosis of AMD could lead to an earlier treatment start, when patients present a higher AV, in order to optimize the benefits of treatment. Ranibizumab was well tolerated and safe in most patients.

Desigualdades geográficas en mortalidad e incidencia por cáncer de laringe en varones: factores socioeconómicos y ambientales / Geographical inequalities in mortality and incidence in larynx cancer in men: socioeconomic and environmental factors

Fundamento: Diversos estudios sugieren la relación entre menor nivel socioeconómico y factores ambientales con mayor riesgo de cáncer. El objetivo del trabajo es identificar desigualdades geográficas en mortalidad e incidencia por cáncer de laringe (CL) en varones y su asociación con factores de privación y ambientales en el marco del proyecto MEDEA. Métodos: Estudio ecológico cuya población de referencia fueron los hombres residentes en el municipio de Zaragoza. El periodo de estudio fue 1996-2003. Las defunciones fueron obtenidas del Registro de Mortalidad de Aragón, los casos incidentes del Registro Poblacional de Cáncer de Zaragoza y los datos socioeconómicos del Censo de 2001. Se utilizó la base de datos del Registro Europeo de Emisiones Contaminantes en la localización de posibles industrias contaminantes. Para cada sección censal (SC) se obtuvo un índice de privación mediante análisis de componentes principales. Se obtuvieron las Razones de Mortalidad e Incidencia Estandarizadas suavizadas aplicando metodología bayesiana. Resultados: Se analizaron 211 defunciones y 569 casos incidentes, con SC conocida, que correspondieron al 95% del total de casos registrados de mortalidad y el 97,8% de incidencia. Las SC que se encontraban en el cuartil superior, mayor índice de privación, tuvieron significativamente mayor riesgo, tanto de mortalidad (2,74 veces) como de incidencia (1,66 veces). Sin embargo no se encontró asociación estadísticamente significativa con los indicadores ambientales utilizados. Conclusiones: Las SC con menor nivel económico presentan mayor riesgo de mortalidad e incidencia por CL. La posible exposición a focos industriales contaminantes no explica la variabilidad geográfica observada(AU)

Background: Several studies suggest the relationship between lower socioeconomic status and environmental factors with increased risk of cancer. Within the framework of the MEDEA project, this work aims to identify geographic inequalities in larynx cancer (LC) mortality and incidence in men and its association with deprivation and environmental factors. Methods: Ecological study having as reference population men living in the city of Zaragoza. The study period was 1996-2003. The deaths were obtained from the Mortality Registry of Aragon, the incident cases from the Cancer Registry of Zaragoza and the socioeconomic data from the 2001 Census. We used the European Pollutant Emission Register database to locate possible polluting industries. For each census tract (CT) a deprivation index was obtained using principal components analysis. Smoothed Standardized Mortality and Incidence ratios were also calculated using Bayesian methods. Results: We analysed 211 deaths and 569 incident cases with CT, corresponding to 95% of the total registered mortality cases and 97.8% incidence. The CTs in the highest quartile, highest deprivation index, had significantly higuer risk of mortality (2.74 times) as well as incidence (1.66 times) by LC. However, the environmental indicators have not been shown a statistically significance association. Conclusions: The CTs with the lowest socioeconomic status have higher risk of LC mortality and incidence. Nevertheless, the possible exposition to the polluting industrial focus does not explain the observed geographic variability(AU)

Respuesta: Transfusión sanguínea, infección nosocomial y trombosis venosa en pacientes de edad avanzada intervenidos de fractura de cadera / Reply: Blood transfusion, nosocomial infection and venous thrombosis in aged patients with surgery of hip fracture

No disponible

No disponible

[Geographical inequalities in mortality and incidence in larynx cancer in men: socioeconomic and environmental factors]. / Desigualdades geográficas en mortalidad e incidencia por cáncer de laringe en varones: factores socioeconómicos y ambientales.

BACKGROUND: Several studies suggest the relationship between lower socioeconomic status and environmental factors with increased risk of cancer. Within the framework of the MEDEA project, this work aims to identify geographic inequalities in larynx cancer (LC) mortality and incidence in men and its association with deprivation and environmental factors. METHODS: Ecological study having as reference population men living in the city of Zaragoza. The study period was 1996-2003. The deaths were obtained from the Mortality Registry of Aragon, the incident cases from the Cancer Registry of Zaragoza and the socioeconomic data from the 2001 Census. We used the European Pollutant Emission Register database to locate possible polluting industries. For each census tract (CT) a deprivation index was obtained using principal components analysis. Smoothed Standardized Mortality and Incidence ratios were also calculated using Bayesian methods. RESULTS: We analysed 211 deaths and 569 incident cases with CT, corresponding to 95% of the total registered mortality cases and 97.8% incidence. The CTs in the highest quartile, highest deprivation index, had significantly higuer risk of mortality (2.74 times) as well as incidence (1.66 times) by LC. However, the environmental indicators have not been shown a statistically significance association. CONCLUSIONS: The CTs with the lowest socioeconomic status have higher risk of LC mortality and incidence. Nevertheless, the possible exposition to the polluting industrial focus does not explain the observed geographic variability.

Variabilidad en la utilización de nuevos medicamentos en un área de Atención Primaria / Variability in the Use of New Drugs in a Primary Care District

Fundamento: La utilización de nuevos fármacos ha aumentadode forma importante en los últimos años. El objetivo de este trabajoes conocer la utilización de novedades farmacéuticas en un área desalud de Zaragoza, describir cuales son las más utilizadas y su evoluciónen el tiempo y analizar las características de los centros que seasocian con un mayor uso de estos medicamentos.Métodos: Se trata de un estudio descriptivo en el que se analizarontodas las dispensaciones de 50 nuevos principios activos comercializadosentre el 1-1-2000 y el 31-12-2003 en un área de salud. Secalculó el porcentaje de utilización de novedades durante el primeraño de su comercialización, en cada centro de atención primaria, y seanalizaron las características de los centros que se asociaban conmayor grado de innovación.Resultados: El 76% de los 50 nuevos fármacos comercializadoseran escasamente innovadores respecto a los ya existentes. Las dieznovedades más prescritas comenzaron a utilizarse en el primer cuatrimestretras su aparición en el mercado. El porcentaje de utilizaciónde novedades respecto al total de fármacos prescritos en los centrosde salud estudiados osciló entre el 0,3% y el 1,18%. En el análisisefectuado por centros, el «gasto por paciente» y las «consultas pormédico» se correlacionaron positivamente con un mayor uso demedicamentos nuevos, mientras que el porcentaje de pensionistaspresentó una relación inversa.Conclusiones: Existe una gran variabilidad en el porcentaje deutilización de novedades farmacológicas entre los centros de atenciónprimaria. Los centros con mayor número de consultas por facultativoson los que tienden a incorporar los nuevos medicamentos conmayor facilidad

Background: The use of new drugs has undergone a majorincrease in recent years. This study is aimed at ascertaining thedegree to which pharmaceutical novelties are being used in onehealthcare district in Zaragoza, describing which are those mostused and the trend thereof over the course of time in addition toanalyzing the characteristics of those centers associated with a greateruse of these drugs.Methods: A descriptive study analyzing all of the dispensationsof fifty new active ingredients marketed within the January 1, 2000 -December 31, 2003 period in one healthcare district. The percentageof use of novelties throughout the first year these drugs were marketedat each primary care center was calculated, the characteristicsof those centers associated with a greater degree of innovationhaving been analyzed.Results: Seventy-six percent of the fifty new drugs marketedwere barely innovative in comparison to the existing ones. The tennew drugs most prescribed began being used during the first fourmonths immediately after coming out on the market. The percentageof use of new drugs as compared to all of the drugs prescribed at thehealthcare centers studied fell within the 0.3% -1.18% range. In theanalysis made by centers, the «per-patient expense» and the «consultationsper physician» are positively correlated with a greater useof new drugs, whilst the percentage of retirees showed a reverseratio.Conclusions: A high degree of variability exists in the percentageof use of pharmaceutical novelties among the primary care centers.The centers having the largest number of consultations perphysician are those tending toward more readily incorporating thesenew drugs