Impacto de la atención farmacéutica en pacientes polimedicados ingresados en un servicio de Geriatría / Impact of pharmaceutical care in polymedicated patients admitted to a geriatric ward

Fundamento. Estimar la prevalencia de prescripción potencialmente inadecuada (PPI) y de problemas relacionados con los medicamentos (PRM) en pacientes ancianos polimedicados hospitalizados, y evaluar el impacto de la intervención farmacéutica sobre dicha prevalencia. Material y métodos. Estudio de intervención, cuasi-experimental, en pacientes polimedicados (≥ 6 fármacos) que ingresaron en un servicio de Geriatría en 2018-2019. Se analizaron las PPI según criterios STOPP/START 2014 y los PRM según el Tercer Consenso de Granada. Los PPI y PRM detectados, junto con posibles acciones para solucionarlos, se remitieron al geriatra responsable. Si al alta el cambio en la prevalencia de PPI y PRM fue ≥75%, se consideró aceptada la intervención. Resultados. Se realizó intervención farmacéutica en 218 pacientes, analizándose 1.837 prescripciones. Al ingreso se observaron PPI (90,8%) y PRM (99,5%). Se realizaron 1.227 intervenciones, el 57,6% sobre PRM. Se aceptó el 53,6% de las intervenciones farmacéuticas; la PPI según criterios STOPP y START se redujo un 49,7 y un 22,1%, respectivamente; los PRM disminuyeron un 60,1%. Las frecuencias y medianas de PRM y de PPI según criterios START y STOPP se redujeron significativamente al alta. Las variables más asociadas con la aceptación de la intervención farmacéutica fueron el geriatra responsable, el número de PPI START y el número de PPI STOPP. Conclusiones. Durante el ingreso hospitalario, la detección de PPI y PRM del tratamiento crónico por el farmacéutico, y en colaboración con el médico del paciente, ayuda a disminuir, la prevalencia de PPI y PRM.(AU)

Background. The aim of the study was estimate the prevalence of potentially inappropriate prescribing (PIP) and drug related problems (DRP) in an acute geriatric ward, and to evaluate the impact of pharmaceutical intervention on their prevalence. Methods. Quasi-experimental, interventional study in polymedicated patients (≥ 6 drugs) who were admitted to a Geriatric ward in 2018-2019. PIP were analyzed according to STOPP/START 2014 criteria and DRP on the Third Consensus of Granada. The PIP and DRP detected, and the possible actions to correct them, PI were sent to the physician in charge. The effect of the intervention was analyzed at hospital discharge; if the change of prevalence of PIP and DRP was ≥75%, the pharmaceutical intervention was considered to be accepted. Results. Pharmaceutical intervention was performed on 218 patients, analyzing 1,837 prescriptions. On admission, PIP (90.8%) and DRP (99.5%) were observed. We carried out 1,227 interventions, 57.6% on DRP. More than half (53.6%) of the pharmaceutical interventions were accepted; the PIP according to the STOPP and START criteria was reduced by 49.7 and 22.1%, respectively; DRP decreased by 60.1%. The frequencies and medians of PRM and PPI according to the START and STOPP criteria decreased significantly at discharge. The variables most frequently associated with acceptance of the pharmaceutical intervention were the geriatrician at charge, the number of PPI START and the number of PPI STOPP. Conclusion. The detection of PIP and DRP of chronic treatment during hospital admission by the pharmacist, and in collaboration with the patient’s doctor, helps to reduce the prevalence of PIP and DRP.(AU)

[Impact of pharmaceutical care in polymedicated patients admitted to a geriatric ward].

BACKGROUND: The aim of the study was estimate the prevalence of potentially inappropriate prescribing (PIP) and drug related problems (DRP) in an acute geriatric ward, and to evaluate the impact of pharmaceutical intervention on their prevalence. METHODS: Quasi-experimental, interventional study in polymedicated patients (= 6 drugs) who were admitted to a Geriatric ward in 2018-2019. PIP were analyzed according to STOPP/START 2014 criteria and DRP on the Third Consensus of Granada. The PIP and DRP detected, and the possible actions to correct them, were sent to the physician in charge. The effect of the intervention was analyzed at hospital discharge; if the change of prevalence of PIP and DRP was =75%, the pharmaceutical intervention was considered to be accepted. RESULTS: Pharmaceutical intervention was performed on 218 patients, analyzing 1,837 prescriptions. On admission, PIP (90.8%) and DRP (99.5%) were observed. We carried out 1,227 interventions, 57.6% on DRP. More than half (53.6%) of the pharmaceutical interventions were accepted; the PIP according to the STOPP and START criteria was reduced by 49.7 and 22.1%, respectively; DRP decreased by 60.1%. The frequencies and medians of PRM and PPI according to the START and STOPP criteria decreased significantly at discharge. The variables most frequently associated with acceptance of the pharmaceutical intervention were the geriatrician at charge, the number of PPI START and the number of PPI STOPP. CONCLUSION: The detection of PIP and DRP of chronic treatment during hospital admission by the pharmacist, and in collaboration with the patient's doctor, helps to reduce the prevalence of PIP and DRP.

Retinol-binding protein 4 (RBP4), a potential biomarker of frailty in HIV-infected people on stable antiretroviral therapy.

OBJECTIVES: A quantitative biomarker for identification of pre-frail and frail persons is still lacking. This study aimed to identify biomarker predictors of frailty in HIV-infected patients. METHODS: A cross-sectional study of HIV-infected patients who had been on antiretroviral therapy (ART) for at least 1 year and who presented an undetectable viral load (< 50 HIV-1 RNA copies/mL) at baseline was carried out. For each frail patient, up to four pre-frail and robust patients were randomly selected. The frailty status assessment was based on the five-item criteria described by Fried et al. Sociodemographic, anthropometric, biochemical and HIV-related characteristics were evaluated. Multiple potential biomarkers of frailty and a biological age biomarker were analysed. RESULTS: A total of 73 HIV-infected patients on ART for at least 1 year were evaluated. The patients were categorized as robust (n = 33), pre-frail (n = 32) and frail (n = 8) using the Fried criteria. All patients were on ART, with 100% undetectable viral load (< 50 copies/mL) at baseline. No significant differences in demographic, clinical or analytical characteristics were observed among patients in the different categories based on Fried criteria, with the exception of the veterans aging cohort study index (VACS). Similarly, no differences were observed in HIV-related characteristics, although nucleoside reverse transcriptase inhibitor (NRTI) use was less common in frail persons. The distribution of biomarker values varied according to frailty status, with frail persons having higher levels of interleukin (IL)-8, IL-18, CXC chemokine ligand 10 (CXCL10) and retinol-binding protein 4 (RBP4). In multivariable analysis, the assocation of frailty with RBP4 showed a tendency to statistical significance (odds ratio 1.0; 95% confidence interval 0.99-1.00; P < 0.05). CONCLUSIONS: Differential biomarker expression was present according to Fried status. Longitudinal studies will clarify the utility of these biomarkers as targets for diagnostic or therapeutic intervention.

Valoración de la satisfacción materna con la analgesia epidural para el control del dolor del trabajo de parto / Assessment of maternal satisfaction with epidural analgesia for pain control during labour

Objetivos. Conocer el grado de satisfacción y las características sociodemográficas de las pacientes a las que se les realiza la técnica epidural para el trabajo de parto. Material y métodos. Encuesta SERVQHOS administrada con muestreo consecutivo a 140 pacientes que habían recibido técnica anestésica epidural para el control del dolor de parto desde enero hasta junio de 2014 en el Hospital San Pedro. Resultados. Recogidas 140 encuestas. La satisfacción media global (SERVQHOS): 4,4 con desviación estándar (DE):±0,9 con mejor resultado en preguntas subjetivas: (4,3; DE: 0,8) que objetivas (4; DE: 0,9). El 84,3% se mostraron satisfechas con la analgesia epidural y 100% volverían a solicitarla. No hemos encontrados diferencias significativas en relación con la satisfacción con la epidural ni con la percepción del dolor con variables sociodemográficas (edad, nacionalidad, situación laboral, nivel de estudios o estado civil). El 85% (119) eran mujeres españolas y el 14,3%(20) pertenecían a otras nacionalidades. Una paciente no respondió. Respecto al estado civil: 79,3% (111) estaban casadas, 16,4% (23) eran solteras, 1,4% (2) eran viudas o separadas y no contestaron el 2,9% (4). La edad media fue 33,3 (DE: 4.4). Antes de administrar la analgesia epidural, el 93,2% de las españolas definieron el dolor del parto como grave frente al 95% de las mujeres extranjeras pero sin encontrarse diferencias estadísticamente significativas (p=0,279). Conclusiones. La proporción de pacientes satisfechas con la técnica fue muy elevada, siendo los aspectos subjetivos los mejor valorados (trato y confianza en profesionales) (AU)

Background. To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. Material and Methods. A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. Results. A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD):±0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again. No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status). As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4). Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279). Conclusion. The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more (AU)

[Assessment of maternal satisfaction with epidural analgesia for pain control during labour]. / Valoración de la satisfacción materna con la analgesia epidural para el control del dolor del trabajo de parto.

BACKGROUND: To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. MATERIAL AND METHODS: A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. RESULTS: A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD):±0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again. No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status). As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4). Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279). CONCLUSION: The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more.

Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis.

BACKGROUND: Rhabdomyolysis (RB) is a syndrome characterised by decomposition of skeletal muscle that could be life threatening, so the identification of biomarkers of its severity could help us in its treatment. Creatine kinase (CK) is usually taken as a reference in patients with RB in order to stratify prognosis, however that is not probably the most effective parameter. AIMS: The present study was designed to analyse the specific features and mortality of patients with RB and the relation between creatinine, CK and mortality. METHODS: Retrospective cohort analysis among patients admitted to San Pedro Hospital in Logroño (Spain) with RB (CK levels higher than 2000 U/L) diagnosed since 1 January 2009 until 31 December 2; 013 522 patients with RB patients diagnosed of RB were collected. The aetiology and the analytical feature (creatinine, CK, calcium, phosphorus, pH and bicarbonate), as well as 30-year mortality, were investigated. RESULTS: Among the 522 patients, there were 138 deaths. Four patients required renal replacement therapy. The most common cause of RB was trauma (29%). Infectious aetiology had the highest mortality (41.2%). The median CK was 3451 u/L (interquartile range 3348), and the mean creatinine at admission was 132.6 umol/L (±110.5). Initial CK levels do not have predictive ability on mortality or renal dysfunction in contrast to initial creatinine values. Each state of acute kidney injury (AKI) increased mortality compared with those who have not presented this renal dysfunction (P < 0.0001). Age, calcium, phosphorus, bicarbonate and pH are associated with AKI. CONCLUSION: Despite being a diagnostic marker for RB, initial CK levels do not predict mortality. However, creatinine initial levels are related to progression to acute renal injury and mortality at 30 days.

Evolución de la natalidad en España. Análisis de la tendencia de los nacimientos entre 1941 y 2010 / Birth rates evolution in Spain. Birth trends in Spain from 1941 to 2010

OBJETIVO: Analizar las tendencias de los nacimientos en España y sus comunidades autónomas (CC. AA.) en 70 años (1941-2010). MÉTODOS: Se calcularon las tasas brutas de natalidad por cada 1.000 personas/año por CC. AA. utilizando modelos de regresión de Joinpoint. Se identificaron los puntos de cambio en la tendencia así como sus porcentajes anuales de cambio (PAC). RESULTADOS: La distribución de los 38.160.305 nacimientos ocurridos en los 70 años transcurridos entre 1941 y 2010 representa cambios evolutivos de gran importancia, tanto a nivel nacional como entre las distintas comunidades. Existe un patrón general para el total nacional, en el que se identifican 5 puntos de inflexión, con cambios en la tendencia y en el PAC. Se identifican diferencias entre las CC. AA. CONCLUSIÓN: El análisis de las tendencias de la natalidad y los porcentajes anuales de cambio deberían permitir a las autoridades sanitarias planificar adecuadamente los recursos asistenciales pediátricos en nuestro país

OBJECTIVES: The aim of this study was to analyse trends of births in Spain and its Autonomous Communities (CCAA) over a 70 year period (1941-2010). METHODS: The crude birth rates per 1,000 inhabitants/year were calculated by CCAA using Joinpoint regression models. Change points in trend and annual percentage of change (APC) were identified. RESULTS: The distribution of 38,160,305 births between 1941 and 2010 shows important changes in trends both nationally and among the CCAA. There is a general pattern for the whole country, with 5 turning points being identified with changes in trend and annual percentage change (APC). Differences are also found among regions. CONCLUSION: The analysis of trends in birth rates and the annual rates of change should enable public health authorities to properly plan pediatric care resources in our country

[Birth rates evolution in Spain. Birth trends in Spain from 1941 to 2010]. / Evolución de la natalidad en España. Análisis de la tendencia de los nacimientos entre 1941 y 2010.

OBJECTIVES: The aim of this study was to analyse trends of births in Spain and its Autonomous Communities (CCAA) over a 70 year period (1941-2010). METHODS: The crude birth rates per 1,000 inhabitants/year were calculated by CCAA using Joinpoint regression models. Change points in trend and annual percentage of change (APC) were identified. RESULTS: The distribution of 38,160,305 births between 1941 and 2010 shows important changes in trends both nationally and among the CCAA. There is a general pattern for the whole country, with 5 turning points being identified with changes in trend and annual percentage change (APC). Differences are also found among regions. CONCLUSION: The analysis of trends in birth rates and the annual rates of change should enable public health authorities to properly plan pediatric care resources in our country.

Trends in systemic lupus erythematosus mortality in Spain from 1981 to 2010.

BACKGROUND: Incidence and mortality of systemic lupus erythematosus (SLE) seem to be increasing in the last few decades, in contrast to the survival rate that has improved over time. The objective of this study was to examine the trends in the SLE mortality in Spain over a 30-year period (1981-2010). METHODS: Data on SLE deaths were drawn from the National Statistics Institute of Spain. Crude and overall age-standardized SLE mortality rates were calculated and joinpoint regression models were used to describe trend changes. Mean age of deaths by SLE each year was also assessed. RESULTS: The overall age-standardized SLE mortality rate was 1.82 per million in 1981 and 2.24 in 2010. It was higher in women, 1.39 vs 0.43 in 1981 and 1.96 vs 0.28 in 2010. There was a statistically significant change in 1999. The overall age-standardized mortality rate increased from 1981 to 1999 and stabilized from 2000 to 2010. Only male rates decreased from 2000 to 2010. The mean age at death increased with time, from 42 years in 1981 to 61 years in 2010. CONCLUSIONS: In conclusion, a slight decrease in SLE mortality has been observed in Spain over the last decade and future studies would be needed to explain the factors contributing to the improvement in the mortality rates.

Reflux patterns and risk factors of primary varicose veins' clinical severity.

OBJECTIVES: Primarily, to determine the association between the clinical severity of primary varicose veins and different reflux patterns in an anatomic and haemodynamic clinical study using duplex ultrasonography (DU). Secondly, to analyse the association of clinical severity with other aspects, such as risk factors for chronic venous insufficiency (CVI) and other concurrent diseases. METHOD: A total of 2036 limbs were evaluated using DU. Clinical status was characterized by the CEAP (clinical, aetiological, anatomical and pathological elements) classification. The degree of clinical severity was grouped into two categories, mild to moderate CVI (C1­C3)and severe CVI, characterized by the presence of skin changes (C4­C6). We analysed the association of the different reflux patterns with CEAP status. RESULTS: Saphenofemoral junction (SFJ) reflux of the great saphenous vein (GSV) was associated with the most severe form of the disease (odds ratio [OR] » 2.96; confidence interval [CI] 95%: 2.2­3.8), whereas competent SFJ of the GSV with reflux from proximal veins (OR » 2; CI 95%: 1.4­2.7) and the pure non-saphenous reflux (OR » 4.1; CI 95%:1.8­9.0) were associated with mild to moderate CVI. Obesity increased the frequency of severe CVI 2.7 times (OR » 2.7; CI 95%: 1.6­4.6); being a woman also increased the frequency of more severe disease 1.3 times (OR » 1.3; CI 95%: 1.0­1.7). CONCLUSION: Anatomical and haemodynamic studies by DU are postulated as a useful diagnostic tool that allow, by identifying the pattern of venous reflux of varicose pathology, characterization of the probable association to CVI clinical severity.

Reflux or not reflux? Reflexiones sobre la publicación anglosajona del término en las varices primarias de los miembros inferiores en relación con nuestro entorno / Reflux or not reflux? Reflections on the term used in English language publications in relation to primary varicose veins of the lower limbs compared to that in Spanish literature

El significado práctico del término "reflux" en el estudio hemodinámico de las varices primarias publicado en la literatura varía en función del marco conceptual que se tenga de las distintas alteraciones hemodinámicas del sistema venoso. En este trabajo se exponen los fundamentos hemodinámicos y las discrepancias más interesantes entre la literatura anglosajona y "nuestro entorno"(AU)

The meaning of "reflux" in the haemodynamic study of primary varicose veins varies in the literature, according to different concepts of haemodynamic disorders of venous system. In this paper we present the haemodynamic basis and the main differences between English and Spanish literature(AU)

An outbreak of Mycobacterium fortuitum cutaneous infection associated with mesotherapy.

OBJECTIVE: We describe an outbreak of Mycobacterium fortuitum cutaneous infections associated with mesotherapy in La Rioja, Spain. DESIGN: Descriptive epidemiology. SETTING: Private practice. PATIENTS OR OTHER PARTICIPANTS: Case subjects were customers of a single beauty salon who were treated with mesotherapy injections. INTERVENTION(S): Two skin biopsies were taken from each patient. RESULTS: Over the designated period, 138 women received mesotherapy. Of these women, 39, or 28.3%, developed lesions ultimately thought to be caused by Mycobacterium fortuitum infection. The number of lesions per patient varied from 3 to 20 in the most severe case. Most of the lesions were indurated, erythematous or violaceous papules, some progressing to become fluctuant boils with suppuration, fistulization and scarring. The individual lesions varied in diameter from 0.5 to 6 cm. Two patients (5.1%) developed inguinal or axillary adenopathy. Two others presented with fever. One reported muscular pain. In 12 of the 39 cases, M. fortuitum was isolated from the wound cultures. The patients were all successfully treated with clarithromycin and levofloxacin. CONCLUSIONS: We identified a large outbreak of rapidly growing mycobacterial lesions among women who received mesotherapy injections in a single beauty salon.

[Huntington's disease mortality in Spain in the period 1981-2004]. / Mortalidad por la enfermedad de Huntington en Espana en el periodo 1981-2004.

INTRODUCTION: Huntington's disease (HD) is an autosomic dominant neurodegenerative disease characterized by neuromuscular, cognitive and psychiatric symptoms. AIM: To analyze the mortality trend for HD from 1981-2004 in Spain. PATIENTS AND METHODS: Both crude and specific rates adjusted to the European population were used to show the evolution of mortality. Rates are showed by age and gender per million of inhabitants. Joinpoint regression model was used to analyze mortality trends. RESULTS: 866 deaths under HD codes were recorded in Spain during the study period (452 males and 414 females). Adjusted rates ranged from 0.64 in 1981 to 1.65 in 2004 in males and from 0.40 in 1981 to 1.16 in 2004 in females. The trend of the mortality rates in both genders followed a slight and steady increase during the whole period and dramatic changes were not detected. The average yearly percentage of this increase was 3.76% in males and 3.67% in females. CONCLUSIONS: The study has showed a yearly age adjusted mortality rates increase close to 4%. No differences have been seen between males and females. The follow up of this trend should be monitored to test if it stabilizes or it rises.

Mortalidad por la enfermedad de Huntington en España en el período 1981-2004 / Huntington´s disease mortality in Spain in the period 1981-2004

Introducción. La enfermedad de Huntington (EH) es una enfermedad neurodegenerativa hereditaria autosómica dominante, caracterizada por síntomas motores, cognitivos y psiquiátricos. Objetivo. Analizar las tendencias en la mortalidad por EH en España en el período 1981 a 2004. Pacientes y métodos. Los datos de mortalidad proceden del Instituto Nacional de Estadística, código 333.4 de la CIE-9 para el período 1981 a 1998, y código G10 de la CIE-10 desde 1999. Se han calculado tasas brutas, tasas específicas por edad y tasas ajustadas según la población europea, según el método directo y expresadas por millón de habitantes. Para analizar la tendencia en las tasas de mortalidad se han empleado modelos de regresión de joinpoint. Resultados. En el período estudiado fallecieron 866 personas (452 varones y 414 mujeres) en España por EH. Las tasas ajustadas por millón de habitantes fueron de 0,64 (en 1981) y 1,65 (en 2004) en varones, y de 0,40 (en 1981) y 1,16 (en 2004) en mujeres. La evolución de las tasas de mortalidad ajustadas por edad ha sido monótonamente creciente, sin que se hayan identificado puntos de cambio en la tendencia. En promedio, el crecimiento estimado mediante el porcentaje anual de cambio ha sido de 3,76% en varones y de 3,67% en mujeres. Conclusiones. El estudio ha mostrado un incremento cercano al 4% anual en las tasas de mortalidad ajustadas por edad, similar en varones y en mujeres. Queda por evaluar si la tendencia creciente encontrada se mantiene en el futuro o si se estabiliza en las cifras de los últimos años

Introduction. Huntington’s disease (HD) is an autosomic dominant neurodegenerative disease characterized by neuromuscular, cognitive and psychiatric symptoms. Aim. To analyze the mortality trend for HD from 1981-2004 in Spain. Patients and methods. Both crude and specific rates adjusted to the European population were used to show the evolution of mortality. Rates are showed by age and gender per million of inhabitants. Joinpoint regression model was used to analyze mortality trends. Results. 866 deaths under HD codes were recorded in Spain during the study period (452 males and 414 females). Adjusted rates ranged from 0.64 in 1981 to 1.65 in 2004 in males and from 0.40 in 1981 to 1.16 in 2004 in females. The trend of the mortality rates in both genders followed a slight and steady increase during the whole period and dramatic changes were not detected. The average yearly percentage of this increase was 3.76% in males and 3.67% in females. Conclusions. The study has showed a yearly age adjusted mortality rates increase close to 4%. No differences have been seen between males and females. The follow up of this trend should be monitored to test if it stabilizes or it rises

A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006.

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses.

A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006.

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses.

[Effectiveness of comprehensive geriatric assessment in primary care]. / Efectividad de la valoración geriátrica comprensiva en atención primaria.

OBJECTIVE: To review and update evidence on the effectiveness of the comprehensive geriatric assessment (CGA) of the elderly in the community environment. DESIGN: Systematic review. DATA SOURCES: MEDLINE (January 1997 to November 2001) and The Cochrane Library, completed with a manual search. SELECTION OF STUDIES: Randomised clinical trials (RCT) to study the effects of a CGA in people over 64 and not in an institution. Trials that assessed mortality, institutionalisation and functional status were included. Those conducted after hospital discharge or not in a community environment were excluded. 133 summaries were reviewed and 16 articles analysed. DATA EXTRACTION: Methodological quality assessed with adapted Jadad scale. A data archive was worked out to collect information on characteristics of the population and the intervention and on the main findings. RESULTS: The quality of the trials was adequate, though they had important methodological differences. Eleven trials found no favourable effects in the result variables studied. Five of the twelve trials which assessed functional status and one of the twelve that evaluated admissions to institutions found some favourable effect. None of the nine studies with mortality data found favourable results. CONCLUSIONS: Evidence for the effectiveness of the CGA for the elderly not in institutions continues to be inconsistent and insufficient. Nevertheless, given the complexity of this intervention, it seems prudent to continue to conduct CGAs of the elderly in the PC environment until such time as further studies clarify the role of these programmes.

Efectividad de la valoración geriátrica comprensiva en atención primaria / Effectiveness of comprehensive geriatric assessment in primary care

Objetivos. Revisar y actualizar la evidencia sobre la efectividad de la valoración geriátrica comprensiva (VGC) en los ancianos realizada en el ámbito comunitario. Diseño. Revisión sistemática. Fuentes de datos. MEDLINE (enero de 1997 a noviembre de 2001) y The Cochrane Library, completada con búsqueda manual. Selección de estudios. Ensayos clínicos aleatorizados (ECA) que estudiaran los efectos de una VGC en individuos mayores de 64 años no institucionalizados. Se incluyeron los que valoraban la mortalidad, la institucionalización o el estado funcional. Se excluyeron los realizados tras el alta hospitalaria y en el ámbito no comunitario. Se revisaron 133 resúmenes y se analizaron 16 artículos. Extracción de datos. Calidad metodológica evaluada con la escala de Jadad adaptada. Se elaboró una ficha de datos para recoger información sobre las características de la población, la intervención y los principales resultados. Resultados. La calidad de los ensayos fue adecuada, aunque con importantes diferencias metodológicas. En 11 ensayos no se encontraron efectos favorables en las variables de resultado estudiadas. En 5 de los 12 ensayos que valoraban el estado funcional y en uno de los 12 que evaluaron las admisiones a instituciones se encontró algún efecto favorable. En ninguno de los 9 estudios con datos sobre mortalidad se encontraron resultados favorables. Conclusiones. La evidencia sobre la efectividad de la VGC de los ancianos no institucionalizados sigue siendo inconsistente e insuficiente. No obstante, dada la complejidad de esta intervención, parece prudente seguir realizando una VCG a los ancianos en el ámbito de la atención primaria hasta que nuevos estudios, en nuestro entorno, clarifiquen el papel de estos programas (AU)

[Appropriateness of emergency hospital admissions]. / Adecuación de los ingresos hospitalarios urgentes.

INTRODUCTION: The aim of this work is to know the proportion of inadequate urgent admissions in a general hospital. MATERIAL AND METHODS: A retrospective and descriptive study of patients admitted during 1,999 was performed. The Appropriatness Evaluation Protocol (AEP) was used in order to evaluate the appropriatness of the admissions. RESULTS: Eighteen admissions (4.5%) were inadecuated. There was a higher proportion of inappropriate admission (IA) when the physician responsible of the admission was a medical specialist (internal medicine, hematology or nephrology): odds ratio 5.3 in opposite to emergency physicians (p < 0.03). CONCLUSIONS: There was a low proportion of inadequate admissions (4.5%) and the risk of inappropriatness of the admission was major when it was ordered by a medical specialist.