Long-term effect of a practice-based intervention (HAPPY AUDIT) aimed at reducing antibiotic prescribing in patients with respiratory tract infections.

Objectives: Few studies have evaluated the long-term effects of educational interventions on antibiotic prescription and the results are controversial. This study was aimed at assessing the effect of a multifaceted practice-based intervention carried out 6 years earlier on current antibiotic prescription for respiratory tract infections (RTIs). Methods: The 210 general practitioners (GPs) who completed the first two registrations in 2008 and 2009 were invited to participate in a third registration. The intervention held before the second registration consisted of discussion about the first registration of results, appropriate use of antibiotics for RTIs, patient brochures, a workshop and the provision of rapid tests. As in the previous registrations, GPs were instructed to complete a template for all the patients with RTIs during 15 working days in 2015. A new group of GPs from the same areas was also invited to participate and acted as controls. A multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results: A total of 121 GPs included in the 2009 intervention (57.6%) and 117 control GPs registered 22 247 RTIs. On adjustment for covariables, compared with the antibiotic prescription observed just after the intervention, GPs assigned to intervention prescribed slightly more antibiotics 6 years later albeit without statistically significant differences (OR 1.08, 95% CI 0.89-1.31, P = 0.46), while GPs in the control group prescribed significantly more antibiotics (OR 2.74, 95% CI 2.09-3.59, P < 0.001). Conclusions: This study shows that a single multifaceted intervention continues to reduce antibiotic prescribing 6 years later.

Perception of facial esthetics by different observer groups of Class II malocclusion with mandibular retrusion.

AIM: To compare the esthetic perception of different observer groups of 14 photos of two patients with Class II, division 1 malocclusion with severe mandibular retrusion. MATERIALS AND METHODS: A sample of 441 participants, of which 191 were laypeople, was obtained through a snowball sampling method. Fourteen photos of two children with Class II, division 1 malocclusion with severe mandibular retrusion were used, before and after orthodontic treatment (OT), with advance genioplasty simulation. For the evaluation of esthetic perception, the photos were rated using a numerical scale from 0 (very unesthetic) to 10 (extremely esthetic). RESULTS: Despite a parallelism of opinions, there were statistically significant differences (P < 0.05) in the assessments made by the different observer groups. Laypeople tended to attribute higher values (statistically significant difference of P < 0.05) compared to the other observer groups, with the exception of the girl's lateral profile and smile photos before OT (P > 0.05). Although they did not agree on all the photos, the other groups expressed similar scores between them. Pretreatment photos obtained the lowest scores, and those with advance genioplasty simulation obtained the highest. CONCLUSIONS: Mandibular retrusion has a strong impact on the perception of facial attractiveness. The esthetics of the lateral profile in children with severe mandibular retrusion is improved by OT. As a rule, laypeople tend to assign higher ratings.

The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary.

INTRODUCTION: Since 2011, the Spanish Society of Family Medicine has recommended general practitioners (GPs) to ask their patients to stop taking antibiotics when they suspect a viral infection. However, this practice is seldom used because uncertainty about diagnosis, and fear of consequences of discontinuing antibiotic therapy, as well as perceived pressure to continue prescribing antibiotics and potential conflict with patients are more of a concern for GPs than antibiotic resistance. The main objective of this study is to determine whether discontinuation of antibiotic therapy when a GP no longer considers it necessary has any impact on the number of days with severe symptoms. METHODS AND ANALYSIS: This is a multicentre, open-label, randomised controlled clinical trial. The study was conducted in 10 primary care centres in Spain. We included patients from 18 to 75 years of age with uncomplicated acute respiratory tract infections-acute rhinosinusitis, acute sore throat, influenza or acute bronchitis-who had previously taken any dose of antibiotic for <3 days, which physicians no longer considered necessary. The patients were randomly assigned to the usual strategy of continuing antibiotic treatment or to discontinuing antibiotic therapy. A sample size of 240 patients per group was calculated on the basis of a reduction of 1 day in the duration of severe symptoms being a clinically relevant outcome. The primary outcome was the duration of severe symptoms, that is, symptoms scored 5 or 6 by means of validated symptom diaries. Secondary outcomes included antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. ETHICS AND DISSEMINATION: The study was approved by the Ethical Board of Fundació Jordi Gol i Gurina (reference number: 16/093). The findings of this trial will bedisseminated through research conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02900820; pre-results.

Prevalence of Chagas disease in the Bolivian population of Majorca (Spain) / Prevalencia de la enfermedad de Chagas en población boliviana de Mallorca (España)

Objective: To establish the prevalence of Trypanosoma cruzi infection in Bolivian (Spain) participants. Methods: A cross sectional study was carried out in Majorca. Bolivian residents older than 18 years assigned to the family physicians of two primary care centers were randomly selected from the health card population database. Participants were invited to attend a serology test and an interview. T. cruzi infection was confirmed after two positive ELISA tests. If the result was positive or dubious, the serological test was sent to the National Microbiology Center for confirmation. Results: A total of 251 participants were included (response rate 36.3%). The overall seroprevalence of Chagas infection was 19.1% (95% CI: 14.06-24.19). Seroprevalence was higher in participants from highly endemic provinces, those from rural areas, those who had lived in mud houses, and in those whose mother or a family member had contracted this infection. Conclusion: This study demonstrates a high prevalence of T. cruzi in Bolivian residents, which was strongly associated with established risk factors (AU)

Objetivo: Este estudio pretende estimar la seroprevalencia de la infección por Tripanosoma cruzi en sujetos bolivianos. Métodos: Estudio descriptivo transversal en Mallorca (España), en el cual sujetos bolivianos mayores de 18 años, asignados a médicos de familia de dos centros de salud, fueron seleccionados aleatoriamente de la base de Tarjeta Sanitaria Individual. Se citaron en el centro de salud para prueba serológica y entrevista. Se confirma como caso dos pruebas de ELISA positivas. Los resultados positivos o dudosos se enviaron al Centro Nacional de Microbiología para su confirmación. Resultados: Se incluyeron 251 sujetos (tasa de respuesta 36,3%). La seroprevalencia fue del 19,1% (intervalo de confianza del 95%: 14,06-24,19). La seroprevalencia fue mayor en quienes vivían en provincias endémicas, áreas rurales, casas de adobe o cuya madre o algún familiar había sufrido la infección. Conclusión: Este trabajo evidencia una alta prevalencia en personas bolivianas residentes que se asocia con los factores de riesgo ya establecidos (AU)

Prevalence of Chagas disease in the Bolivian population of Majorca (Spain).

OBJECTIVE: To establish the prevalence of Trypanosoma cruzi infection in Bolivian (Spain) participants. METHODS: A cross sectional study was carried out in Majorca. Bolivian residents older than 18 years assigned to the family physicians of two primary care centers were randomly selected from the health card population database. Participants were invited to attend a serology test and an interview. T. cruzi infection was confirmed after two positive ELISA tests. If the result was positive or dubious, the serological test was sent to the National Microbiology Center for confirmation. RESULTS: A total of 251 participants were included (response rate 36.3%). The overall seroprevalence of Chagas infection was 19.1% (95% CI: 14.06-24.19). Seroprevalence was higher in participants from highly endemic provinces, those from rural areas, those who had lived in mud houses, and in those whose mother or a family member had contracted this infection. CONCLUSION: This study demonstrates a high prevalence of T. cruzi in Bolivian residents, which was strongly associated with established risk factors.