Valoracion de la Adecuación de Medicación en población mayor de 65 años

Estudio de Prevalencia realizado en población comunitaria de edad igual o superior a 65 años perteneciente a 12 centros de salud urbanos. El tamaño muestral estimado fue de 582 pacientes. Las variables recogidas fueron: sociodemográficas, clínicas, comorbilidad (Indice de Charlson), valoración funcional (Indice de Katz y Lawton-Brody), función cognitiva (Pfeiffer o SPMSQ), estado afectivo (Escala de depresión geriátrica de Yesavage), calidad de vida relacionada con la salud (SF-12) y datos referentes al tratamiento. Fuentes de datos: historia clínica, entrevista personal y medicación aportada por los pacientes. La adecuación se valoró midiendo la tasa de polifarmacia (5 o mas medicamentos habituales), gran polifarmacia (10 o mas), medicación potencialmente inapropiada (según STOPP-START 2015 y Criterios de Beers 2015) y carga anticolinérgica (escalas ACB, ARS, DBI DURAN y ABC). Estadística: análisis descriptivo y analítico (regresión logística para las variables principales de interés). Aspectos ético-legales: estudio clasificado por la Agencia Española del Medicamento como EPA-SP (estudio posautorización), con dictamen favorable del CEI Provincial y consentimiento informado de todos los participantes. Se han analizado un total de 3626 prescripciones. El promedio de fármacos por paciente es de 6.8 (±4; 0–23), polifarmacia del 68.6%, y gran polifarmacia del 24.7%. Los grupos más prescritos fueron cardiovascular (80%), digestivo (71.6%) y nervioso (66.5%). Los factores determinantes de polifarmacia fueron la comorbilidad (OR=1.66), ser mujer (OR=2), padecer hipertensión (OR=3.93), diabetes mellitus (OR=1.93), dislipemia (=R=2.3), enfermedad respiratoria (OR=2.4), enfermedad osteoarticular (OR=1.72) y alteraciones psicológicas (OR=2.12). Conclusión: La prevalencia de polifarmacia es elevada, y muestra un incremento sobre estudios previos en Atención Primaria. Sería necesario ir desarrollando modelos de deprescripción racionales y prudentes.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

A comparison of Clinical Risk Index for babies (CRIB-II), Score for Neonatal Acute Physiology (SNAP-II) and SNAPPE-II in predicting parenteral nutrition necessity in low birth weight preterm neonates.

Advances in perinatal care have made it possible to improve survival of low birth weight neonates. Clinical risk index for babies (CRIB-II), score for neonatal acute physiology (SNAP-II), and SNAP-perinatal extension-II (SNAPPE-II) have been used as mortality predictors for preterm infants. Feeding intolerance is very frequent in preterm neonates, and the development of an early effective biomarker for its prediction could be useful for carrying out a proper feeding strategy. Our aim was to compare the ability of CRIB-II, SNAP-II and SNAPPE-II in predict the feeding intolerance and parenteral nutrition necessity in preterm neonates. Methods: A retrospective cohort study on preterm neonates’ born at Jaen Hospital Complex with low birth weight and ≤ 36 weeks of gestation was done. Epidemiological, clinical and clinical scores CRIB II, SNAP-II and SNAPPE-II were recorded. Results: 255 low birth weight preterm neonates, 131 males (51.4%), aged ≤32 weeks of gestation (71%), were enrolled at our hospital. Parenteral nutrition needed were significantly higher in preterm neonates weighed 2500-1500 g (73.3%) and ≤ 1000g (87%). CRIB-II, SNAP-II and SNAPPE-II mean values were higher in neonates group subjected to parenteral nutrition compared with oral nutrition (p<0.05). CRIB-II and SNAPPE-II scores significantly correlated with parenteral nutrition days (p<0.05). Overall mortality rate was 11%. The 78.6% of all deceased infants needed parenteral nutrition. Conclusion: Clinical Risk Index for babies (CRIB-II) better than SNAPPE-II correlated with the feeding intolerance and thus the parenteral nutrition days in preterm neonates with low birth weight.Subvencionado: Ayuda del Plan Propio de Investigación de la UMA. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Unveiling the Synergistic Interplay of Neuropeptides for Novel Therapeutic Approaches in Neurodegenerative and Depressive Disorders.

The intricate relationship between hippocampal neurogenesis dysregulation and neurodegenerative diseases such as Alzheimer's, as well as depression, has sparked an urgent call for innovative therapeutic strategies. Our groundbreaking study delves into the interaction of Neuropeptide Y (NPY) and galanin (GAL) agonists, two neuromodulatory systems with a substantial presence in the limbic system, and their potential neurogenic impact on both the dorsal and ventral hippocampus. Through meticulous examination of the subchronic e"ects of NPY Y1 (Y1R) and GAL2 (GALR2) agonists on hippocampal cell proliferation, survival, and neuroprotective factor expression, we reveal a fascinating cascade of cellular responses. These include increased cell proliferation (PCNA), enhanced hippocampal cell survival (BrdU), and induction of neuroprotective factors (BDNF). Our functional assessment showcases the resulting improvements in spatial memory performance in the object-in-place task and antidepressant-like e"ects in the forced swimming test. These outcomes are attributed to the synergistic interaction between Y1R and GALR2 receptors, which promote neuronal survival and neurite outgrowth in hippocampal cells. This pioneering research paves the way for the development of heterobivalent agonist pharmacophores that target Y1R-GALR2 heterocomplexes. By acting on neuronal precursor cells in the dentate gyrus of the dorsal hippocampus, these novel compounds hold immense promise as transformative therapies for cognitive and a"ective impairments in neurodegenerative and depressive diseases.Supported by the Proy_Excel_2021_0613 (Junta de Andalucía) and Proyecto Puente (B4-2021) (UMA), Spain to MN. Swedish Medical Research Council, Sweden (62X-00715-50-3), to KF, by Stiftelsen Olle Engkvist Byggmästare to KF, and by Hjärnfonden, Sweden (F02018-0286), Hjärnfonden, Sweden (F02019-0296) and EMERGIA2020 (Junta de Andalucía), to DOBE. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Estudio de las prescripciones farmacológicas en niños a nivel de atención primaria: evaluación de los usos off-label o fuera de ficha técnica

Objetivo: Evaluar el perfil de prescripción y los usos off-label (fuera de ficha técnica [FT]) y unlicensed (medicamentos no autorizados específicamente para niños) de medicamentos a nivel ambulatorio. Diseño: Estudio transversal. Emplazamiento: Consultas de pediatría de 2 centros de salud urbanos y sala de urgencia general del Hospital Materno-Infantil de Málaga. Participantes: Niños de 0-14 años que acudiesen a consulta y se les prescribiese al menos un medicamento. Mediciones principales: Variables sociodemográficas, motivo de consulta y medicación. Clasificación de las prescripciones según información contenida en FT. Resultados: Se incluyeron un total de 388 niños, una submuestra de 105 (27%) atendidos en urgencias, y se valoraron 462 prescripciones, que involucraron 74 principios activos diferentes. Cada niño recibió un promedio de 1,7 fármacos (IC 95%: 1,6-1,9), siendo los más prescritos ibuprofeno, paracetamol, amoxicilina-clavulánico y budesonida. El grupo terapéutico más empleado y con mayor variedad de fármacos fue el respiratorio. El 27,4% de las prescripciones (IC 95%: 23,5-31) fueron off-label, constituyéndose como causa más frecuente el uso del fármaco para una edad distinta de la autorizada (60%; IC 95%: 54,1-63), seguida de distinta dosis (21,5%; IC 95%: 18-25), diferente indicación (12%; IC 95%: 9,2-15) y el 7% por distinta vía de administración (IC 95%: 5,4-10). Conclusiones: La tasa de usos off-label presenta cifras intermedias, pudiendo recibir este tipo de prescripciones una tercera parte de los niños. Esto no significa que sean prescripciones incorrectas, pero es recomendable respaldarlas con la mejor evidencia, así como seguir las directrices de la normativa sobre medicamentos en situaciones especiales

Prevalence and Clinical Conditions Related to Sarcopaenia among Older Persons Living in the Community

(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary care and to analyse the factors associated with this age-related clinical condition; (2) Methods: A multicentre cross-sectional study was conducted of 333 community-dwelling Spanish adults aged 65 years or more. Sociodemographic, clinical, functional, anthropometric, and pharmacological data were collected. Sarcopaenia was defined following European Working Group on Sarcopaenia in Older People (EWGSOP) criteria; (3) Results: Sarcopaenia was present in 20.4% of the study sample, and to a severe degree in 6%. The intensity of the association between sarcopaenia and frailty was weak-moderate (Cramer V = 0.45). According to the multinomial logistic regression model performed, sarcopaenia was positively associated with age and with the presence of psychopathology (OR = 2.72; 95% CI = 1.30&ndash;5.70) and was inversely correlated with body mass index (OR = 0.73, 95% CI = 0.67&ndash;0.80; (4) Conclusions: Sarcopaenia commonly affects community-dwelling older persons and may be associated with age, body mass index, and psychopathology. The latter factor may be modifiable or treatable and is therefore a possible target for intervention

Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version.

Emerging and changing evidence made it necessary to update STOPP-START criteria, and version 2 was published recently. In this study the objectives were to determine the prevalence of potentially inappropriate medication prescribing (PIM) in primary care using STOPP versions 1 (v1) and 2 (v2), as well as 2012 AGS Beers criteria, and analyze the factors associated with inappropriate prescribing according to STOPP/START v2. A cross-sectional study was carried out including community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. This variable was measured using three tools: STOPP v1, 2012 AGS Beers criteria and STOPP v2. Similarly, the percentage of patients receiving at least one potential prescribing omission (PPO) was calculated using START versions 1 and 2. A total of 1,615 prescriptions were reviewed. The median number of medications per patient was 7.1 drugs (±3.8). The prevalence of elderly people exposed to polypharmacy (≥5 medications) was 72.9%, whereas 28.4% of the participants took ≥10 drugs regularly. PIM were present in 18.7%, 37.3% and 40.4% of participants, according to the STOPP v1, 2012 Beers criteria and STOPP v2, respectively. According to STOPP v2, the number of medications taken (OR: 1.14, 1.06-1.25), the presence of a psychological disorder (OR: 2.22, 1.13-4.37) and insomnia (OR: 3.35, 1.80-6.32) were risk factors for taking a PIM. The prevalence of PPOs was 34.7% and 21.8% according to version 1 and 2, respectively. In conclusion, STOPP-START criteria have been remarkably modified, which is evidenced by the different prevalence rates detected using version 2, as compared to version 1. In fact, the level of agreement between version 1 and the updated version is only moderate. Special attention should be paid on benzodiazepines, which keep being the most frequent PIM

Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis

Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient's susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried's frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7-27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10-46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy.This research was funded by the Fundación Pública Andaluza Progreso y Salud, Consejería de Salud, Junta de Andalucía, through the Programme Proyectos de Investigación Biomédica (Grant number PI 0234/14). The APC was funded by the University of Málaga. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.Ye

Factors Associated with Health-Related Quality of Life in Community-Dwelling Older Adults: A Multinomial Logistic Analysis.

The main aim of this study was to determine the association of various clinical, functional and pharmacological factors with the physical (PCS) and mental (MCS) summary components of the health-related quality of life (HRQoL) of community-dwelling older adults. Design: Cross-sectional study. Patients and setting: Sample of 573 persons aged over 65 years, recruited at 12 primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The main outcome was HRQoL assessed on the basis of the SF-12 questionnaire. A multinomial logistic regression model was constructed to study the relationship between independent variables and the HRQoL variable, divided into intervals. The average self-perceived HRQoL score was 43.2 (± 11.02) for the PCS and 48.5 (± 11.04) for the MCS. The factors associated with a poorer PCS were dependence for the instrumental activities of daily living (IADL), higher body mass index (BMI), number of medications, and presence of osteoarticular pathology. Female gender and the presence of a psychopathological disorder were associated with worse scores for the MCS. The condition that was most strongly associated with a poorer HRQoL (in both components, PCS and MCS) was that of frailty (odds ratio (OR) = 37.42, 95% confidence interval (CI) = 8.96-156.22, and OR = 20.95, 95% CI = 7.55-58.17, respectively). It is important to identify the determinant factors of a diminished HRQoL, especially if they are preventable or modifiable

Resultados de la implantación del Plan de Actuación Conjunta en el Infarto Agudo de Miocardio

Objetivos. Analizar la efectividad, fiabilidad y seguridad de la trombólisis prehospitalaria en el infarto agudo de miocardio en el Distrito Sanitario "Costa del Sol" de Málaga. Diseño. Estudio de intervención en el que se compara un periodo (fase I) en el cual aún no se realizaba trombólisis prehospitalaria, con otro posterior (fase II) en el que sí se hacía. La efectividad del proceso se midió por el porcentaje de trombólisis realizadas dentro de las dos primeras horas de evolución del infarto agudo de miocardio, la fiabilidad por el número de pacientes tratados fuera del hospital con trombólisis no indicadas, y la seguridad por el número de complicaciones relacionadas con la misma ocurridas en los tratamientos extrahospitalarios. Se realizó un ajuste mediante regresión logística en el que se tuvieron en cuenta las posibles variables de confusión relacionadas con el porcentaje de tratamientos realizados dentro de las dos primeras horas. Resultados. El porcentaje de tratamientos realizados dentro de las dos primeras horas de infarto agudo de miocardio en la fase II (49%) es significativamente mayor (p< 0,001) que en la fase I (8%). El modelo de regresión logística múltiple demostró que los pacientes que recibieron el tratamiento trombolítico extrahospitalario en la fase II tuvieron 130 veces más posibilidades de recibir dicho tratamiento dentro de las dos primeras horas del infarto agudo de miocardio que los pacientes tratados con trombolíticos en la fase I en el hospital. No se realizó ningún tratamiento prehospitalario no indicado, y no se objetivó ninguna complicación relacionada con la trombólisis prehospitalaria. Conclusiones. La trombólisis prehospitalaria en nuestro Distrito Sanitario demuestra ser una intervención efectiva, fiable y segura