Problemas relacionados con la medicación que causan ingresos hospitalarios

ResumenObjetivoLos problemas relacionados con los medicamentos (PRM) están vinculados al tratamiento farmacológico del paciente e interfieren o pueden interferir con los resultados esperados en su salud. El presente estudio tiene como objetivo determinar la prevalencia de los PRM en los pacientes de un centro de salud urbano que son causa de ingreso en su hospital de referencia, y su evitabilidad.DiseñoEs un estudio observacional de tipo descriptivo y retrospectivo.EmplazamientoCENTRO de Salud Les Corts, que es un centro de salud urbano y docente con una población asignada de 32.318 habitantes.ParticipantesUsuarios del CS Les Corts ingresados en el Hospital Clínico de Barcelona desde agosto de 2005 a enero de 2006.Resultados y mediciones principalesUna pareja de un farmacéutico y un médico de familia analizan las historias clínicas y determinan la presencia o no de PRM. El 13,4% de todas las altas presentan PRM, que en su mayoría están implicados en el ingreso hospitalario (12%). Un 57,3% del total de altas con un PRM como causa del ingreso hospitalario se ha considerado evitable. Los ingresos por PRM se concentran en los servicios de medicina interna, cardiología y neumología. Los problemas de salud motivo de ingreso hospitalario por PRM son mayoritariamente circulatorios (38,5%) y respiratorios (11,5%).ConclusionesEl número de ingresos debidos a problemas relacionados con la medicación es elevado y evitable.AbstractObjectiveDrug related problems (DRP) are health problems associated with the pharmacological treatment of patients and interfere or can interfere with the expected results on their health. The aim of this study is to determine the prevalence of DRP in patients from an urban health centre that lead to hospitalisation, and its prevention.DesignIt is a retrospective, observational and descriptive study.SettingLes Corts Health Centre (HC), which is an urban health and teaching centre with a reference population of 32,318 inhabitants.ParticipantsUsers of the les Corts HC admitted to the Barcelona Hospital Clinic from August 2005 to January 2006.Results and main outcome measurementsA pharmacist and a family doctor analysed the clinical histories and determined whether or not there was a DRP. A DRP was present in 13.4% of all hospital discharges, and 12% were implicated in the hospital admission. It was considered that 57.3% of all the discharges with a DRP as the causing factor in the hospital admission were avoidable. Admissions due to DRP were mainly in internal medicine, cardiology and pneumology. The health problems that lead to hospital admission due to DRP are mainly circulatory (38.5%) and respiratory (11.5%).ConclusionsThe number of hospital admissions due to drug related problems is avoidably high

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied

Pleistocene and Holocene peopling of Jerada province, eastern Morocco: introducing a research project

The Aïn Beni Mathar – Guefaït (ABM-GFT) region in Eastern Morocco is the object of an archaeological, palaeontological, geological and geochronological research project, led by an international team since 2006. The research in this former fluvio-lacustrine basin, roughly 2000 km2, has revealed a significant number of Pleistocene and Holocene sites. Here we introduce the research project, that we conduct in the region, the main issues it aims to address, and the results already obtained

Le peuplement humain pendant le Pléistocène et l’Holocène dans la province de Jerada, Maroc oriental : introduction d’un projet de recherche

[EN] The Aïn Beni Mathar – Guefaït (ABM-GFT) region in Eastern Morocco is the object of an archaeological, palaeontological, geological and geochronological research project, led by an international team since 2006. The research in this former fluvio-lacustrine basin, roughly 2000 km2, has revealed a significant number of Pleistocene and Holocene sites. Here we introduce the research project, that we conduct in the region, the main issues it aims to address, and the results already obtained.[FR] Depuis 2006, la région de Aïn Beni Mathar – Guefaït (ABM-GFT) au Maroc Oriental, fait l’objet d’un projet de recherche en archéologie, paléontologie, géologie et géochronologie, mené par une équipe internationale. Ces recherches ont permis la découverte d’un nombre significatif de gisements d’âge Pléistocène et Holocène, dans un ancien bassin fluvio-lacustre, qui s’étend sur une surface de 2000 km2. Notre objectif ici est de présenter le projet de recherche, que nous entamons dans la région, la problématique qu’il traite et les premiers résultats déjà obtenus.Funding for this research was provided by: Palarq Foundation, Spanish Ministry of Culture and Sport (Ref: 42-T002018N0000042853 & 170-T002019N0000038589), Direction of Cultural Heritage (Ministry of Culture and Communication, Morocco), Faculty of Sciences (Mohamed 1r University of Oujda, Morocco), INSAP (Institut National des Sciences de l’Archéologie et du Patrimoine), Spanish Ministry of Science, Innovation and Universities (Ref: CGL2016-80975-P, CGL2016-80000-P, PGC2018-095489-B-I00 and PGC2018-093925-B-C31) and Research Groups Support of the Catalonia Government (2017 SGR 836 and 2017 SGR 859). R.S-R, M.G.CH., J.I.M., A.C., F.R., A.R.-H., E.A., I.E., F.B., J.A., HA.B., P.S., P.P., D.L., I.R. y E.M. research is funded by CERCA Programme/ Generalitat de Catalunya. J.I.M. and A.R.-H research is funded by the Spanish Minitry of Science and Innovation under the “María de Maeztu” Program for Unities of Excellence (CEX2019-000945-M). M.S. has been granted by the Research Program UAM Tomás y Valiente 2019. C.T. is funded by the Ramón y Cajal Program. M.F. and M.E.A. received a fellowship under the Erasmus Mundus Scholarship of the European Education and Culture Executive Agency in the Master in Quaternary and Prehistory at URV. The research of M.D. is funded by the Australian Research Council (ARC) Future Fellowship Grant FT150100215 and the Ramón y Cajal Program (RYC2018-025221-I). P.P. has been granted a post-doctoral post under the Spanish Ministry of Science and Innovation “Juan de la Cierva-Incorporación” Program (Ref. IJC2020-044108-I). E.M-R. is beneficiary of a PTA Ref. PTA201714619-I. G.G.-A. has been granted a “Ford - Apadrina la Ciencia” contract. C.D.-C has been granted a Fundación Atapuerca fellowship. A.C.A. was funded by Junta de Castilla y León (project BU235P18) and the European Regional Development Fund (ERDF). The Institut Catalá de Paleoecologia Humana i Evolució Social (IPHES-CERCA) has received financial support from the Spanish Ministry of Science and Innovation through the ‘María de Maeztu’ program for Units of Excellence (CEX2019-000945-M).Peer reviewe

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Tendencia de la mortalidad por cáncer orofaríngeo en España (1955-1989)

Se describe la tendencia en la mortalidad por cáncer orofaríngeo (ICD-9 140-149) en España, en el período 1955-89, analizando su contribución relativa a la mortalidad global por cáncer, las variaciones en función del grüpo de edad, y el efecto cohorte. La mortalidad por cáncer oral en España durante los últimos 35 años ha aumentado en ambos sexos, siendo las tasas truncadas en el grupo de varones de edad de 35-64 años de 12,6 por 100.000 habitantes, de entre las más altas de Europa. En las mujeres, el incremento medio en la mortalidad por cáncer orofaríngeo durante el período estudiado es de 80,4% y en el grupo de edad de 35 a 64 años del 136,7%, en el período 55-89. Entre los varones estos porcentajes han sido de 160,1% y 276,4% respectivamente. El cáncer orofaríngeo en varones ha pasado de suponer el 2,12% de todas las muertes por cáncer en 1955-59, al 3,32% en 1985-89. Ello revela la importancia del problema y la necesidad de una intervención inmediata

Tendencia de la mortalidad por cáncer orofaríngeo en España (1955-1989)

Se describe la tendencia en la mortalidad por cáncer orofaríngeo (ICD-9 140-149) en España, en el período 1955-89, analizando su contribución relativa a la mortalidad global por cáncer, las variaciones en función del grüpo de edad, y el efecto cohorte. La mortalidad por cáncer oral en España durante los últimos 35 años ha aumentado en ambos sexos, siendo las tasas truncadas en el grupo de varones de edad de 35-64 años de 12,6 por 100.000 habitantes, de entre las más altas de Europa. En las mujeres, el incremento medio en la mortalidad por cáncer orofaríngeo durante el período estudiado es de 80,4% y en el grupo de edad de 35 a 64 años del 136,7%, en el período 55-89. Entre los varones estos porcentajes han sido de 160,1% y 276,4% respectivamente. El cáncer orofaríngeo en varones ha pasado de suponer el 2,12% de todas las muertes por cáncer en 1955-59, al 3,32% en 1985-89. Ello revela la importancia del problema y la necesidad de una intervención inmediata

Azúcar y caries: aproximación a la situación epidemiológica en Catalunya y resultados de un estudio transversal

Se revisan las tendencias epidemiológicas de caries y de consumo de azúcar en Catalunya y España, así como el papel de la dieta en la etiopatogenia de la caries dental, y se presentan los principales resultados de un estudio epidemiológico sobre una muestra aleatoria de 890 escolares de las ciudades de Girona y Figueres. En este estudio se practicó un cuestionario de frecuencia de consumo de alimentos que reveló una relación positiva entre la presencia de caries y la frecuencia de consumo de helados, bollería, pastelería, pan de molde, por un lado, y chicles y caramelos duros sin azúcar y edulcorantes artificiales por el otro, y negativa con la leche descremada. Estos resultados reflejan tanto el papel de algunos alimentos en la etiopatogenia de la caries, como el fruto de una intervención dietética en individuos con alto riesgo de caries

Azúcar y caries: aproximación a la situación epidemiológica en Catalunya y resultados de un estudio transversal

Se revisan las tendencias epidemiológicas de caries y de consumo de azúcar en Catalunya y España, así como el papel de la dieta en la etiopatogenia de la caries dental, y se presentan los principales resultados de un estudio epidemiológico sobre una muestra aleatoria de 890 escolares de las ciudades de Girona y Figueres. En este estudio se practicó un cuestionario de frecuencia de consumo de alimentos que reveló una relación positiva entre la presencia de caries y la frecuencia de consumo de helados, bollería, pastelería, pan de molde, por un lado, y chicles y caramelos duros sin azúcar y edulcorantes artificiales por el otro, y negativa con la leche descremada. Estos resultados reflejan tanto el papel de algunos alimentos en la etiopatogenia de la caries, como el fruto de una intervención dietética en individuos con alto riesgo de caries