Compuestos ciclometalados de paladio y platino con iminofosforanos: preparación, caracterización y aplicaciones en catálisis

Los compuestos ciclometalados son compuestos organometálicos con estructura de anillo que presentan un enlace σ metal─carbono y un enlace covalente coordinado metal─heteroátomo. Son ampliamente estudiados debido a que pueden presentar propiedades muy interesantes tanto en el ámbito industrial como en el de la química médica, tales como la de actuar como catalizadores o como anticancerígenos. Los iminofosforanos son compuestos orgánicos que presentan un enlace doble P=N fuertemente polarizado y se pueden considerar como los análogos nitrogenados de los iluros de fósforo. En este trabajo se hicieron reaccionar ligandos iminofosforano tridentados [C,N,S], [C,N,O] y bidentados [C,N] con sales de paladio y platino con el objetivo de sintetizar nuevos compuestos ciclometalados con estos metales. Se estudió a su vez la reactividad de estos compuestos frente a diversos ligandos fosfina y difosfina, lo que dio lugar a nuevos compuestos ciclometalados. En función de la longitud de la cadena carbonada de los ligandos difosfina, estos actuaron como ligandos monodentados, bidentados quelato o bidentados puente. La caracterización de los compuestos se llevó a cabo mediante análisis elemental, espectroscopia de infrarrojo, difracción de rayos X y espectroscopia de RMN de 1H y 31P-{1H}. Posteriormente se investigaron las propiedades catalíticas de los paladaciclos obtenidos en la reacción de acoplamiento de Suzuki midiendo el porcentaje de conversión de los sustratos en distintos intervalos de tiempo. La catálisis de Suzuki es una reacción de enorme importancia en el ámbito de la química, tanto en investigación como a nivel industrial

Non-Clinical Factors Determining the Prescription of Antibiotics by Veterinarians: A Systematic Review

The misuse of antibiotics in humans, animals, and plants is related to the spread of resistant antibiotic strains among humans and animals. In this paper, we carry out a bibliographic search of Medline, Web of Knowledge, and Cab Abstracts with the main objective of ascertaining the available evidence on non-clinical factors and attitudes that could influence the prescription of antibiotics by veterinarians. A total of 34 studies fulfilled the inclusion criteria. Whereas, veterinary health professionals’ prescribing habits did not appear to be influenced by their socio-demographic characteristics, they were influenced by different attitudes, such as fear (identified in 19 out of 34 studies), self-confidence (19/34), business factors (19/34), and by complacency (16/34). Certain owner-related factors, such as lack of awareness (16/34) and demand for antibiotics (12/34), were also important, as were concurrent factors, ranging from a lack of appropriate regulations (10/34) to the expense and delays involved in performing culture and sensitivity tests (10/34) and inadequate farm hygiene (8/34). Our results appear to indicate that the non-clinical factors are potentially modifiable. This may be useful for designing interventions targeted at improving antibiotic use in animals, as part of an overall strategy to reduce the global spread of multi-resistant strainsS

Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group

Background: The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH. Accordingly, the aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary. Methods: We used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD. Results: The two compounds that were removed from the formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention. Conclusions: The results indicate that changes made in a hospital drugs formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area.S

Misprescription of antibiotics in primary care: a critical systematic review of its determinants

Background Antibiotic resistance is one of the principal public health problems worldwide. Currently, inappropriate use of antibiotics is regarded as the principal determinant of resistance, with most of these drugs being prescribed outside a hospital setting. This systematic review sought to identify the factors, attitudes and knowledge linked to misprescription of antibiotics. Methods A systematic review was conducted using the MEDLINE-PubMed and EMBASE databases. The selection criteria required that papers: (1) be published in English or Spanish; (2) designate their objective as that of addressing attitudes/ knowledge or other factors related with the prescribing of antibiotics; and (3) use quality and/or quantity indicators to define misprescription. The following were excluded: any paper that used qualitative methodology and any paper that included descriptive analysis only. Results A total of 46 papers that met the inclusion criteria were included in the review. They were very heterogeneous and displayed major methodological limitations. Doctors’ socio-demographic and personal factors did not appear to exert much influence. Complacency (fulfilling what professionals perceived as being patients’/parents’ expectations) and, to a lesser extent, fear (fear of possible complications in the patient) were the attitudes associated with misprescription of antibiotics. Conclusions Before designing interventions aimed at improving the prescription and use of antibiotics, studies are needed to identify precisely which factors influence prescribing

Association of knowledge and attitudes with practices of misuse of tranquilizers: a cohort study in Spain

Tranquilizer misuse represents a growing international public health problem with heavy social and economic consequences. We aimed to identify the psychosocial determinants of this misuse practice, focusing on modifiable factors including knowledge and attitudes towards these medicationsThis study was supported by a grant from the Regional Ministry of Education, Universities and Vocational Training, Santiago de Compostela, Spain, (ED431C 2018/20)S

Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies

Inappropriate prescription has been associated with mounting rates of antibiotic resistance worldwide, demanding more detailed studies into physicians’ decision-making process. Accordingly, this study sought to explore physicians’ perceptions of factors influencing antibiotic prescribing. A systematic search was performed for qualitative studies focused on understanding physicians’ perceptions of the factors, attitudes and knowledge influencing antibiotic prescription. Of the total of 35 papers selected for review purposes, 18 solely included physicians and the remaining 17 also included patients and/or other healthcare providers. Data collection was based mainly on interviews, followed by questionnaires and focus groups, and the methodologies mainly used for data analysis were grounded theory and thematic analysis. Factors cited by physicians as having an impact on antibiotic prescribing were grouped into those that were intrinsic (group 1) and those that were extrinsic (group 2) to the healthcare professional. Among the former, physicians’ attitudes, such as complacency or fear, were rated as being most influential on antibiotic prescribing, whilst patient-related factors (e.g. signs and symptoms) or healthcare system-related factors (e.g. time pressure and policies/guidelines implemented) were the most commonly reported extrinsic factors. These findings revealed that: (i) antibiotic prescribing is a complex process influenced by factors affecting all the actors involved, including physicians, other healthcare providers, healthcare system, patients and the general public; and (ii) such factors are mutually dependent. Hence, by shedding new light on the process, these findings will hopefully contribute to generating new and more effective strategies for improving antibiotic prescribing and allaying global concern about antibiotic resistance

Impact of Extreme Temperatures on Ambulance Dispatches Due to Cardiovascular Causes in North-West Spain

Introduction and objectives. The increase in mortality and hospital admissions associated with high and low temperatures is well established. However, less is known about the influence of extreme ambient temperature conditions on cardiovascular ambulance dispatches. This study seeks to evaluate the effects of minimum and maximum daily temperatures on cardiovascular morbidity in the cities of Vigo and A Coruña in North-West Spain, using emergency medical calls during the period 2005–2017. Methods. For the purposes of analysis, we employed a quasi-Poisson time series regression model, within a distributed non-linear lag model by exposure variable and city. The relative risks of cold- and heat-related calls were estimated for each city and temperature model. Results. A total of 70,537 calls were evaluated, most of which were associated with low maximum and minimum temperatures on cold days in both cities. At maximum temperatures, significant cold-related effects were observed at lags of 3–6 days in Vigo and 5–11 days in A Coruña. At minimum temperatures, cold-related effects registered a similar pattern in both cities, with significant relative risks at lags of 4 to 12 days in A Coruña. Heat-related effects did not display a clearly significant pattern. Conclusions. An increase in cardiovascular morbidity is observed with moderately low temperatures without extremes being required to establish an effect. Public health prevention plans and warning systems should consider including moderate temperature range in the prevention of cardiovascular morbidityD.R. was supported by a postdoctoral research followship of the Xunta de Galicia (Spain)S

Influence of Sociodemographic and Professional Characteristics on Antibiotic Prescribing: A Cross-Sectional Study In The Center Region of Portugal

Introduction Antibiotic prescribing is very complex process influenced by medical and non-medical aspects. Accordingly, our aim was to evaluate the influence of GPs’ sociodemographic and professional characteristics on the quality of antibiotic prescribing, in Portugal. Material and Methods An observational cross-sectional study was conducted (November 2011 to February 2012) in the catchment area covered by Portugal’s Centre Regional Health Administration (1094 General Practitioners (GPs) working at 84 primary care facilities). A validated, self-administered questionnaire was used to assess sociodemographic and clinical practice information. To evaluate the quality of physician antibiotic prescribing, we’ve assessed the twelve quality indicators validated by Coenen, S. et al (2007), per physician per year (2010, 2011 and 2012). Logistic regression using crude and adjusted analysis was performed. Results The response rate was 46.6%. Older GPs revealed to have better performance of antibiotic prescribing [OR (95% CI) = 2.21; 1.08 – 4.54; P < 0.05]. About GPs who also work at the emergency department, statistical significant was found on their relation with poor prescribing [OR (95% CI) = 0.29; 0.16 – 0.54; P < 0.05]. Workload also revealed to influence the quality of antibiotic prescribing: more patients seen per day [OR (95% CI) = 0.97; 0.94 – 1.00; P < 0.05] and more patients seen per week in the emergency department [OR (95% CI) = 0.98; 0.97 – 0.99; P < 0.05] were related with lower quality on antibiotic prescribing. Conclusions These findings revealed that sociodemographic and professional characteristics could influence the quality of antibiotic prescribing, which is a very important step to understand this complex process aiming to tackle a global concern: the misprescription of antibiotics

Comparing Hospital and Primary Care Physicians' Attitudes and Knowledge Regarding Antibiotic Prescribing: A Survey within the Centre Region of Portugal

Background: Antibiotic resistance is a worldwide public health problem, leading to longer hospital stays, raising medical costs and mortality levels. As physicians' attitudes are key factors to antibiotic prescribing, this study sought to explore their differences between primary care and hospital settings. Methods: A survey was conducted between September 2011 and February 2012 in the center region of Portugal in the form of a questionnaire to compare hospital (n = 154) and primary care (n = 421) physicians' attitudes and knowledge regarding antibiotic prescribing. Results: More than 70% of the attitudes were statistically different (p < 0.05) between hospital physicians (HPs) and primary care physicians (PCPs). When compared to PCPs, HPs showed higher agreement with antibiotic resistances being a public health problem and ascribed more importance to microbiological tests and to the influence of prescription on the development of resistances. On the other hand, PCPs tended to agree more regarding the negative impact of self-medication with antibiotics dispensed without medical prescription and the need for rapid diagnostic tests. Seven out of nine sources of knowledge's usefulness were statistically different between both settings, with HPs considering most of the knowledge sources to be more useful than PCPs. Conclusions: Besides the efforts made to improve both antibiotic prescribing and use, there are differences in the opinions between physicians working in different settings that might impact the quality of antibiotic prescribing. In the future, these differences must be considered to develop more appropriate interventions

Impact of infectious disease epidemics on xenophobia: A systematic review

Background Globally, xenophobia towards out-groups is frequently increased in times of economic and political instability, such as in infectious disease outbreaks. This systematic review aims to: (1) assess the xenophobic attitudes and behaviors towards migrants during disease outbreaks; and (2) identify adverse health outcomes linked to xenophobia. Methods We searched nine scientific databases to identify studies measuring xenophobic tendencies towards international migrants during disease outbreaks and evaluated the resulting adverse health effects. Results Eighteen articles were included in the review. The findings were grouped into: (1) xenophobia-related outcomes, including social exclusion, out-group avoidance, support for exclusionary health policies, othering, and germ aversion; and (2) mental health problems, such as anxiety and fear. Depending on the disease outbreak, different migrant populations were negatively affected, particularly Asians, Africans, and Latino people. Factors such as perceived vulnerability to disease, disgust sensitivity, medical mistrust individualism, collectivism, disease salience, social representation of disease and beliefs in different origins of disease were associated with xenophobia. Conclusions Overall, migrants can be a vulnerable population frequently blamed for spreading disease, promoting irrational fear, worry and stigma in various forms, thus leading to health inequities worldwide. It is urgent that societies adopt effective support strategies to combat xenophobia and structural forms of discrimination against migrants