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Fuster D, Zuluaga P, Muga R. Substance use disorder: Epidemiology, medical consequences and treatment. Med Clin (Barc) 2024; 162:431-438. [PMID: 38218656 DOI: 10.1016/j.medcli.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
Substance use is a common health problem, and substance use disorder, which is its most severe presentation, is associated with multiple medical consequences and a negative impact on individual and on population health. Substance use disorder needs to be addressed as any chronic medical condition; therefore, it has to be detected at the early stages and has to be properly treated to prevent drug-related harm. Internists should be able to recognize and treat intoxication and abstinence. Internists should also be able to refer the patient to state of the art long term treatment, aimed to detoxification and treatment induction to promote abstinence and prevent relapse. In this narrative review we will discuss substance use epidemiology, its main medical consequences and its treatment, with a focus on alcohol, opiates, cocaine and other stimulants, cannabis and benzodiazepines.
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Affiliation(s)
- Daniel Fuster
- Unidad de Adicciones, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - Paola Zuluaga
- Unidad de Adicciones, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Robert Muga
- Unidad de Adicciones, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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García Diez S, De Nicolás Valdés M, Diéguez Varela C, Fernández Martínez P, Suárez Gil P, Navarro Rodríguez Y. [Impact of COVID-19 lockdown on the prescription of benzodiazepines]. Aten Primaria 2023; 55:102552. [PMID: 36599201 DOI: 10.1016/j.aprim.2022.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DESIGN Longitudinal observational study. LOCATION Primary care. Asturias (Spain) health district V. PARTICIPANTS People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. MAIN MEASUREMENTS Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. RESULTS DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1-12.1). There was an increase in the DHD mean in the 60-74 age group (95% CI: 2.28-21.42), in the group over 90 years old (95% CI: 21.31-40.63) and in women (95% CI: 3.51-14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. CONCLUSIONS Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.
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García Atienza EM, López-Torres Hidalgo J, Minuesa García M, Ruipérez Moreno M, Lucas Galán FJ, Agudo Mena JL. [Health-related quality of life in patients consuming benzodiazepine]. Aten Primaria 2021; 53:102041. [PMID: 33780900 PMCID: PMC8041718 DOI: 10.1016/j.aprim.2021.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the health-related quality of life (HRQoL) in benzodiazepine users and to verify whether there is an association with the characteristics of the treatment, its effectiveness, and the sociodemographic variables. DESIGN Descriptive cross-sectional study. LOCATION Family medicine consultations. PARTICIPANTS Four hundred and fifty 2patients over 18 years of age consuming benzodiazepines or similar drugs. MAIN MEASUREMENTS HRQoL was assessed using the EuroQol5-D questionnaire. Other variables: symptoms of anxiety or insomnia, sociodemographic variables and characteristics of the treatment. RESULTS The mean score in health status was 62.80 (95% CI: 60.69-64.86), lower in people without studies (59.27±21.97 SD; P=.004) and lower social category (60.02±21.27 SD; P<.001). Regarding the social rate (EQ index), a mean score of 0.6025 (95% CI: 0.5659-0.6391) was obtained, higher in people with higher education (0.6577±0.3574 SD; P=.001), plus social category (0.7286±0.3381 SD; P<.001) and age less than 65 years (0.6603±0.3426 SD; P<.001). The variables that were associated with the value of the EQ index by means of multiple regression were absence of anxiety/insomnia, belonging to higher social classes, age less than 65 years and less consumption of anxiolytics/hypnotics. CONCLUSIONS Patients who use benzodiazepines show, despite treatment, a moderate HRQL, lower than that obtained in the general population or in primary care patients. The situation is more favorable in the youngest, in those who do not present anxiety/insomnia, in those belonging to higher social classes and when the consumption of drugs is lower.
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Affiliation(s)
- Eva María García Atienza
- Servicio de Urgencias, Hospital General de Villarrobledo, Servicio de Salud de Castilla-La Mancha, AlbaceteEspaña.
| | | | - María Minuesa García
- Centro de Salud de Loja y consultorios de Ventorros de Balerma y Ventorros de la Laguna, Distrito Metropolitano de Granada, España
| | - María Ruipérez Moreno
- Servicio de Urgencias, Hospital General de Villarrobledo, Servicio de Salud de Castilla-La Mancha, AlbaceteEspaña
| | - Francisco Javier Lucas Galán
- Servicio de Urgencias, Hospital General de Villarrobledo, Servicio de Salud de Castilla-La Mancha, AlbaceteEspaña
| | - José Luis Agudo Mena
- Servicio de Dermatología, Hospital General de Villarrobledo, Servicio de Salud de Castilla-La Mancha, Albacete, España
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García-Méndez N, Briceño-Santana M, Totomoch-Serra A, Manterola C, Otzen T, Valdez PS, Campos-Durán R, Reyna GC. The hemodynamic effects of diazepam versus dexmedetomidine in the treatment of alcohol withdrawal syndrome: A randomized clinical trial. Med Clin (Barc) 2021; 157:561-568. [PMID: 33423824 DOI: 10.1016/j.medcli.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/30/2020] [Accepted: 09/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dexmedetomidine (DEX) is an alpha-2 adrenergic drug used for short sedation and as an alternative to diazepam (DZP) in the treatment of alcohol withdrawal syndrome (AWS). PURPOSE This study aims to compare the hemodynamic effect of DZP versus DEX on heart rate (HR) and blood pressure in patients with AWS. METHODS Prospective randomized clinical trial that includes 40 patients with AWS from Mérida, Yucatán, México. RESULTS Forty patients were randomly divided into two groups: one group DZP (n=20) patients received diazepam (doses 5-20mg IV) and the other group (n=20) received DEX (dexmedetomidine infusion .2-.7mcg/kg/min). We obtained statistical significance in sedation with the DEX group in the degree of traumatic brain injury I/II (p=.003). The DEX group remained haemodynamically stable in the first 24h, the mean HR (73.85±8.39) was significant comparing both groups (p=.002). In the comparison of the figures for the DEX group with the DZP (143.85±2.30-137.95±5.62) the SBP was significant with a (p=.0001). Furthermore, DEX treatment was shorter. CONCLUSION Although DEX is not indicated for the routine treatment of AWS, this study proposes a positive effect on HR, SBP and fewer days of treatment compared to the standard DZP treatment for AWS. Clinical Trials.gov ID: NCT03877120-https://clinicaltrials.gov/ct2/show/NCT03877120.
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Affiliation(s)
- Nayely García-Méndez
- PhD Program in Medical Sciences, Universidad de La Frontera, Temuco, Chile; Hospital General del Centro Médico Nacional "La Raza". Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
| | - Miguel Briceño-Santana
- Department of Internal Medicine, Hospital General Agustín O'Horán, Mérida, Yucatán, Mexico
| | - Armando Totomoch-Serra
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Carlos Manterola
- PhD Program in Medical Sciences, Universidad de La Frontera, Temuco, Chile; Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Tamara Otzen
- PhD Program in Medical Sciences, Universidad de La Frontera, Temuco, Chile; Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | | | - Ramón Campos-Durán
- Hospital General del Centro Médico Nacional "La Raza". Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Guillermo Careaga Reyna
- Hospital General del Centro Médico Nacional "La Raza". Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
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Hosseinzadeh Zoroufchi B, Doustmohammadi H, Mokhtari T, Abdollahpour A. Benzodiazepines related sexual dysfunctions: A critical review on pharmacology and mechanism of action. Rev Int Androl 2021; 19:62-8. [PMID: 32063496 DOI: 10.1016/j.androl.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/26/2019] [Accepted: 08/11/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Normal sexual functioning of both men and women, being a very complex process, is affected by numerous issues besides aging. Many factors affect the sexual function and lifestyle of the young population. In this article, we tried to review the literature to update the knowledge on benzodiazepine-related (BZD) sexual dysfunction (SD) and involved mechanisms of actions based on animal and human studies. METHODS Different standard websites such as PubMed were used to review the literature and keywords including benzodiazepines, sexual dysfunction, gammaaminobutyric acid A (GABAA) receptor and erectile dysfunction were used. RESULTS SD is one of the most common disorders in males and females which has recently been demonstrated to be associated with psychotropic medications such as antihypertensive agents, tranquilizers, antihistamines, appetite suppressants, antidepressants and anxiolytics. BZDs are among the most common psychotropic agents worldwide. SD including decreased libido, erectile dysfunction (ED) and other undesired sexual urges were observed in the patients receiving BZDs. DISCUSSION The mechanisms of action of BZDs to induce SD mainly relate to enhanced GABAA receptor function which reduces penile erection.
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Formigo Couceiro FJ, Pena Seijo M, Pose Reino A, Mayán Santos JM, Ayape Amigot FJ, Sueiro Justel J. [Prevalence and relations of orthostatic hypotension in patients 80 years old and over from a primary care unit]. Aten Primaria 2019; 51:294-299. [PMID: 29609870 PMCID: PMC6837008 DOI: 10.1016/j.aprim.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs. DESIGN Transversal observational study. LOCATION Primary care unit, Santiago de Compostela. PARTICIPANTS Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded. MAIN MEASUREMENTS Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver. RESULTS In 26.76% of patients the systolic blood pressure fell by 20mmHg or more and/or the diastolic blood pressure fell by 10mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P=.412), not existing differences for arterial hypertension (P=.881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P=.033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P=.026)]. CONCLUSION OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered.
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Affiliation(s)
| | - Marta Pena Seijo
- Hospital Provincial de Conxo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Antonio Pose Reino
- Hospital Provincial de Conxo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - José Manuel Mayán Santos
- Escuela Universitaria de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, España
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Cordovilla-Guardia S, Lardelli-Claret P, Vilar-López R, López-Espuela F, Guerrero-López F, Fernández-Mondéjar E. The effect of central nervous system depressant, stimulant and hallucinogenic drugs on injury severity in patients admitted for trauma. Gac Sanit 2017; 33:4-9. [PMID: 28784303 DOI: 10.1016/j.gaceta.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The effect of drugs other than alcohol on severity of trauma remains unclear. Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system (CNS) may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients. METHODS The presence of alcohol, stimulant drugs (cocaine, amphetamines and methamphetamines), depressant drugs (benzodiazepines, opiates, methadone and barbiturates) and hallucinogenic drugs (THC and PCP) was analyzed in 1187 patients between 16 and 70 years old admitted to a trauma hospital between November 2012 and June 2015. Injury severity was determined prospectively as the Injury Severity Score. A multivariate analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable. RESULTS Drugs other than alcohol were found in 371 patients (31.3%): 32 (2.7%) stimulants, 186 (15.3%) depressants, 78 (6.6%) hallucinogenics and 75 (5.6%) polydrug use. The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.63 (1.37-15.60) for moderate injuries and 7.83 (2.53-24.21) for severe. CONCLUSION CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption.
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Affiliation(s)
- Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain; Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Raquel Vilar-López
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain; Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Fidel López-Espuela
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Francisco Guerrero-López
- Instituto de Investigación Biosanitaria IBS, Granada, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Enrique Fernández-Mondéjar
- Instituto de Investigación Biosanitaria IBS, Granada, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain
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Viniegra Domínguez MA, Parellada Esquius N, Miranda de Moraes Ribeiro R, Parellada Pérez LM, Planas Olives C, Momblan Trejo C. [An integral approach to insomnia in primary care: Non-pharmacological and phytotherapy measures compared to standard treatment]. Aten Primaria 2014; 47:351-8. [PMID: 25443769 PMCID: PMC6983700 DOI: 10.1016/j.aprim.2014.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/08/2014] [Accepted: 07/25/2014] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION Insomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep. At some point in life, 50% of adults suffer from it, usually in stress situations. AIM To evaluate the impact of sleep hygiene measures, relaxations techniques, and herbal medicine to deal with insomnia, compared with standard measures (drug treatment). METHODOLOGY An experimental, retrospective, non-randomized study was conducted by means of a review of patients diagnosed with insomnia (2008-2010). Patients in the intervention group (IG) received an integrative approach (hygiene measures, relaxation techniques, and herbal medicine) and a control group (CG) with conventional treatment. A comparison was made of the resources used in the two groups (average monthly visits pre- and post-diagnosis), type of prescribed drug therapy and total dose. Sleep quality was evaluated at 18-24 months (Epworth test). RESULTS A total of 48 patients were included in the IG and 47 in the CG (70% women, mean age 46 years (SD: 14.3). Average monthly visit pre-diagnosis was 0.54 (SD: 0.42) in the IG and 0.53 (SD: 0.53) in the CG (P=.88). Post-diagnosis it was 0.36 (SD: 0.24) and 0.65 (SD: 0.46), respectively (P<.0001), with a statistically significant reduction being observed in the IG. More than half (52.5%) of the IG patients and 93.6% in the CG had received a benzodiazepine (P<.0001). Alprazolam and lorazepam were the most prescribed in the CG and with higher cumulative dose. In the subsequent evaluation, 17% of patients in the IG and 5% in CG did not have insomnia. Severe insomnia was present in 13% of patients in the IG and none in CG (P<.0001). CONCLUSIONS The integrative approach to insomnia may be worthwhile as it reduces resource use and side effects, as well as dependence to benzodiazepines.
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Affiliation(s)
- M Adela Viniegra Domínguez
- Médico especialista en Medicina Familiar y Comunitaria, Tutora docente de residentes en Medicina Familiar y Comunitaria, CAP María Bernades, Viladecans, Barcelona, España.
| | - Neus Parellada Esquius
- Especialista en Salud Pública, Técnico de salud en DAP Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, España
| | - Rafaela Miranda de Moraes Ribeiro
- Médico especialista en Medicina Familiar y Comunitaria, Residente de Medicina de Familia entre 2009 y 2013, CAP María Bernades, Viladecans, Barcelona, España
| | - Laura Mar Parellada Pérez
- Médico especialista en Medicina Familiar y Comunitaria, Residente de Medicina de Familia entre 2009 y 2013, CAP María Bernades, Viladecans, Barcelona, España
| | - Carme Planas Olives
- Médico especialista en Medicina Familiar y Comunitaria, Residente de Medicina de Familia entre 2009 y 2013, CAP María Bernades, Viladecans, Barcelona, España
| | - Cristina Momblan Trejo
- Médico especialista en Medicina Familiar y Comunitaria, ABS Sant Climent de Llobregat, Sant Climent de Llobregat, Barcelona, España
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Gancedo-García A, Gutiérrez-Antezana AF, González-García P, Salinas-Herrero S, Prieto-Merino D, Suárez-Gil P. [Effectiveness of short educational intervention in patients with insomnia in primary care]. Aten Primaria 2014; 46:549-57. [PMID: 24986634 PMCID: PMC6983818 DOI: 10.1016/j.aprim.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/14/2014] [Accepted: 01/17/2014] [Indexed: 11/15/2022] Open
Abstract
Objetivo Evaluar la efectividad de asociar una intervención educativa breve al tratamiento farmacológico para el insomnio en atención primaria (AP). Diseño Ensayo clínico no aleatorizado simple ciego. Emplazamiento Dos centros de salud urbanos en Gijón (Asturias). Participantes Pacientes que consultaron por insomnio entre julio de 2012 y enero de 2013 y cumplieron criterios de inclusión. Fueron asignados sistemáticamente al grupo intervención (GI) o al grupo control (GC) tras aleatorizar al primer paciente de cada grupo. Todos iniciaron lorazepam 1 mg nocturno y acudieron a 4 visitas de 15 min y una visita de revisión al mes siguiente. Intervención El GI fue instruido en medidas de control de estímulos, higiene del sueño y técnicas de relajación y respiración. Al GC se le hicieron mediciones no invasivas. Mediciones principales Se consideró curados a quienes obtuvieron Índice de Calidad de Sueño de Pittsburg (ICSP) < 6 o reducción del 50%. Se analizó secundariamente el descenso del ICSP tras las visitas (visita final) y al mes siguiente (visita revisión), y consumo de lorazepam en la visita revisión. Análisis: inferencia bayesiana. Resultados Se obtuvieron 12 curaciones entre 26 intervenidos, y una entre 24 controles. Las medias posteriores del descenso de ICSP en visita final y revisión fueron de: –4,7 (ICred95%: –5,9 a –3,5) y –6,3 (ICred95%: –7,5 a –5,1) en GI, frente a –1,8 (ICred95%: –3 a –0,5) y –1,7 (ICred95%: –2,9 a –0,4) en GC. Abandonaron lorazepam 9 intervenidos (34,6%) frente a 4 controles (16,7%). Completaron el estudio 19 intervenidos y 17 controles. El análisis por protocolo no mostró diferencias relevantes. Conclusiones Implementar una intervención educativa breve en AP mejora la calidad del sueño y potencia una menor prescripción de benzodiacepinas.
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Affiliation(s)
| | | | | | | | - David Prieto-Merino
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Londres, Reino Unido
| | - Patricio Suárez-Gil
- Unidad de Investigación Área V, Hospital de Cabueñes, Gijón, Asturias, España
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García-Baztán A, Roqueta C, Martínez-Fernández MI, Colprim D, Puertas P, Miralles R. [Benzodiazepine prescription in the elderly in different health care levels: characteristics and related factors]. Rev Esp Geriatr Gerontol 2013; 49:24-8. [PMID: 24112878 DOI: 10.1016/j.regg.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 04/05/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the prevalence of benzodiazepine (BZD) prescription and the factors related to prescribing them in the elderly in the community, in an acute general hospital (AH) and in a convalescence geriatric unit (CGU). MATERIAL AND METHODS Retrospective study of 334 CGU inpatients discharged from an AH. A comprehensive geriatric assessment included functional and cognitive evaluation before hospitalization, at admission and at discharge from CGU (Barthel index, Lawton index and Folstein Mini-Mental State Examination), as well as comorbidity (Charlson index), polypharmacy and social situation. The percentage of benzodiazepine prescriptions at the different healthcare levels was compared and their related factors were evaluated (Chi-squared test). RESULTS The prevalence of benzodiazepine prescriptions in the community was 23.6%, and being female and polypharmacy were related factors to prescribing at this level. During AH admission, this proportion increased up to 38.6%, and after CGU admission decreased to 21.,9%. Factors related to prescription in AH were, being female, polypharmacy and osteoarticular-fracture related diagnosis, and in CGU, being female and polypharmacy. CONCLUSIONS The prevalence of benzodiazepine prescribing was high among elderly people at every healthcare level (community, AH and CGU), and polypharmacy was one of the significant factors associated with prescribing. This prescribing was increased during AH admission due to a medical or surgical process.
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Affiliation(s)
- Agurne García-Baztán
- Unidad de Convalecencia, Servicio de Geriatría del Parc de Salut Mar, Centre Fórum, Hospital de la Esperanza, Hospital del Mar, Barcelona, España.
| | - Cristina Roqueta
- Unidad de Convalecencia, Servicio de Geriatría del Parc de Salut Mar, Centre Fórum, Hospital de la Esperanza, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Isabel Martínez-Fernández
- Unidad de Convalecencia, Servicio de Geriatría del Parc de Salut Mar, Centre Fórum, Hospital de la Esperanza, Hospital del Mar, Barcelona, España
| | - Daniel Colprim
- Unidad de Convalecencia, Servicio de Geriatría del Parc de Salut Mar, Centre Fórum, Hospital de la Esperanza, Hospital del Mar, Barcelona, España
| | - Pedro Puertas
- Unidad de Convalecencia, Servicio de Geriatría del Parc de Salut Mar, Centre Fórum, Hospital de la Esperanza, Hospital del Mar, Barcelona, España
| | - Ramón Miralles
- Unidad de Convalecencia, Servicio de Geriatría del Parc de Salut Mar, Centre Fórum, Hospital de la Esperanza, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
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