Fundamento: Los brotes de gastroenteritis aguda de origen víri-co son actualmente uno de los problemas de salud que más están afectando a las personas residentes en instituciones de la tercera edad. El objetivo del estudio es investigar las causas del origen y transmisión de un brote de gastroenteritis aguda por virus NorwalLike.Método: En una residencia de ancianos con 141 residentes y 71 trabajadores expuestos, se investigó la relación entre un brote de gastroenteritis aguda y distintas variables: características personales, de lugar, fecha de inicio de los síntomas, clínica de la enfermedad y factores causales (alimentos y agua de consumo). Se realizó un estudio descriptivo, tabla de contingencia y test de hipótesis 2, diseño de casos y controles con el calculo de Odds Ratio cruda y posteriormente ajustada (IC al 95%) utilizando regresión logística. Resultados:No se observaron diferencias significativas en las variables de características personales y de lugar. La tasa de ataque en los residentes fue del 30,1% y en trabajadores fue del 21,12%. En el calculo de la Odds Ratio ajustada sólo tuvo valores de relación causal la mousse de nata (Odds Ratio ajustada=4,66; IC-95% 1,15-18,91; p=0,031). Se remitieron 10 muestras de heces de enfermos para su análisis, no detectándose ninguna bacteria patógena, pero si se aisló en 3 de ellas virus Norwal-Like.Conclusiones: El hallazgo de la mousse de nata como posible responsable del brote supone una primicia en la presencia de virus Norwalk, pero este resultado está sujeto a limitaciones, como el posible sesgo de clasificación por no recuerdo de consumo de alimentos. Aún así, supone un elemento a tener en cuenta en el control de gastroenteritis agudas por virus.Palabras clave: Higiene de los alimentos. Contaminación ambiental. Virus Norwal-Like. Gastroenteritis aguda. Brote epidé-mico. Ancianos. ABSTRACT Outbreak of Gastroenteritis Caused by Norwalk Virus at a Senior Citizen Assisted Living Facility in Granada, SpainBackground: The outbreaks of acute gastroenteritis caused by a virus are currently one of the health problems having the greatest impact on those living in senior citizen facilities. The objective of this study is that of investigating the causes of the start and contagion of an outbreak of acute gastroenteritis caused by a Norwalk-Like virus.Method: At a senior citizen living facility with 141 residents and 71 employees exposed, the relations between the disease in question and different independent variables: personal traits, features of location, date of onset of symptoms, clinical pattern of the disease and causal factors (food and drinking water intake). A descriptive study, a contingency table and a hypothesis ?2 test, design of cases and controls with the calculation of the unprocessed and subsequently adjusted Odds Ratio (IC 95%) were carried out using logic regression.Results: No significant differences were found in the personal trait and features of location variables. The attack rate among the residents was 30.1%, being 21.12% among the employees. ...
The quality prescribing indicator in our area was improved by the intervention developed. Further studies that include an intervention group of GPs who receive no financial incentive are required to evaluate the relative importance of an economic reward in achieving this improvement.
BackgroundDiabetes mellitus type 2 (DM2) is a chronic disease with major impact on morbidity and mortality and the use of health resources.PurposeTo analyse the evolution of consumption of antidiabetic drugs from 2001 to 2014. To study the variations in admissions due to lower extremity amputations from 2007 to 2013.Material and methodsDescriptive study of the use of antidiabetic drugs between 2001 and 2014. Field of study: two tertiary hospitals and their reference areas, the target population consisting of 675 000 people. Prescriptions under the National Health System coverage were studied. The unit of measure was defined daily doses (DDD) per 1000 inhabitants per day (DHD), using the anatomical therapeutic chemical (ATC)/DDD classification (2006). Hospitalisation data were collected from the hospital dat base. For statistical comparisons, the Student’s t test was used.ResultsDuring the study period, consumption of insulins was maintained from 17.9 DHD to 18.3 DHD but oral agents increased from 41.3 DHD to 52.7 DHD. Consumption of sulfonylureas was gradually reduced from 30.1 DHD to 16.4 DHD but metformin (alone) usage increased from 4.3 DHD to 23.7 DHD, being the most consumed agent in 2014 (45% of consumption). Oral combinations were introduced in 2004 (0.1 DHD) and were the third most consumed group in 2014 (6.5 DHD). Consumption of dipeptidyl peptidase-4 inhibitors (since 2008) and ‘other hypoglycaemic agents’ increased from 0.3 DHD (2008) to 3.8 DHD and from 1.4 DHD to 2 DHD, respectively. On the other hand, the use of thiazolidinediones (since 2004) and alpha-glucosidase inhibitors was reduced from 0.7 DHD (2004) to 0.1 DHD and from 4.5 DHD to 0.2 DHD, respectively. The number of admissions due to lower extremity amputations from 2007 to 2013 was 94, 111, 145, 140, 125, 66 and 72, respectively. The number of amputations decreased significantly from 2008 to 2011 vs. 2013 (p < 0.05).ConclusionMetformin (alone) remains the drug of choice in treating DM2.Increased consumption of oral combinations could reflect more patients in more advanced stages of disease who do not respond to monotherapy.To associate the decrease in admissions due to lower extremity amputations with a higher consumption of oral antidiabetic drugs, more studies are needed.No conflict of interest.
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