Ana López-Durán

Attitudes of primary care physicians to the prescribing of antibiotics and antimicrobial resistance: a qualitative study from Spain

Background and objective. Resistance to antibiotics is a public health threat. A number of studies confirm the relationship between antibiotic use and the resistance rate. As a whole, physicians represent a large proportion of the health professionals involved in the use of this therapeutic group. Our study therefore sought to ascertain the opinions and attitudes of GPs in Spain with respect to antibiotics and resistance. Methods. We used the focus group (FG) method, with each group comprising 4–12 primary care physicians and a moderator. Based on a previous systematic review, we drew up an agenda to be followed during the holding of the sessions. Group proceedings were recorded and the transcriptions then analysed separately by two researchers. Results. Five FGs were formed, including a total of 33 physicians. The factors/attitudes that influenced the prescribing of antibiotics by GPs were fear, complacency, insufficient knowledge and external responsibility of the pharmaceutical industry, patients and over-the-counter antibiotics. The groups felt that antibiotic resistance was not a problem at a community level. Conclusions. Identification of attitudes/knowledge related with inappropriate antibiotic prescribing will enable specific interventions to be designed, with the aim of targeting these shortcomings to improve antibiotic use and help reduce resistance.

El trastorno negativista de la personalidad y su relación con el abuso de sustancias

Resumen Objetivo El trastorno negativista de la personalidad (TNP), anteriormente denominado trastorno pasivo-agresivo, es el que mas controversia genera, por diversos motivos: su estatus actual (propuesto para estudio en el DSM-IV), los criterios que se proponen para definirlo, su semejanza o cercania a otros trastornos y las diversas prevalencias halladas en poblaciones diferentes. Por otra parte, todos los estudios efectuados estiman una alta prevalencia en poblacion adicta. Los objetivos del estudio han sido determinar en que medida el MCMI-II se ajusta a los criterios del DSM-IV para evaluar el patron pasivo-agresivo/negativista de la personalidad, evaluar los rasgos que subyacen al TNP y las diferencias apreciadas con otros trastornos, asi como las que se dan entre los sujetos con un trastorno negativista y otros, con respecto a diversas variables observables. Metodo Se aplica el cuestionario MCMI-II, el BFQ, el TCI-R y una version de la entrevista SCID-II adaptada a los item del MCMI-II, y se estudia el historial clinico en una muestra de 201 sujetos que inician tratamiento por consumo de drogas. Resultados Los item principales del TNP dan informacion sobre 5 de los 7 criterios propuestos en el DSM-IV; el estudio de los rasgos subyacentes situa al TNP como una modalidad atenuada del trastorno limite de la personalidad (TLP), aunque la propia estructura del MCMI-II contribuye a esta semejanza; ambos trastornos se caracterizan, usando el TCI-R, por la combinacion de elevadas puntuaciones en busqueda de novedad y evitacion del dano, lo que les distingue claramente del resto de patrones, pero no entre si, existiendo solo una diferencia de grado. Sin embargo, los sujetos con un TNP muestran en su historial un menor numero de situaciones criticas (intentos autoliticos, mejor ajuste laboral, inexistencia de maltrato fisico en el entorno familiar, etc.) respecto a los que presentan un TLP. Conclusiones El TNP parece presentar caracteristicas diferenciales que lo hacen merecedor de mayor atencion en clasificaciones diagnosticas futuras, y, especialmente, en relacion con las conductas adictivas que pueden encontrar explicacion a partir de las caracteristicas definitorias de esta determinada estructura de personalidad. El estudio de rasgos que lo asemeja al TLP es coherente con dos premises formuladas por Millon: el TLP seria una de las modalidades descompensadas del TNP y los rasgos subyacentes, aunque comunes, no pueden explicar las diferencias entre los patrones, debido a que la configuracion estructural no se atiene a la linealidad y ortogonalidad que se presupone en los rasgos.

Gender differences in personality patterns and smoking status after a smoking cessation treatment.

BackgroundThe lack of conclusive results and the scarce use of the Millon Clinical Multiaxial Inventory-III (MCMI-III) in the study of the relationship between smoking and personality are the reasons that motivated the study reported here. The aim of the present study was to analyze the influence of personality patterns, assessed with the MCMI-III, and of nicotine dependence on treatment outcomes at the end of the treatment and at 12 months follow-up in men and women smokers receiving cognitive-behavioral treatment for smoking cessation.MethodsThe sample was made up of 288 smokers who received cognitive-behavioral treatment for smoking cessation. Personality patterns were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Abstinence at the end of the treatment and at 12-month follow-up was validated with the test for carbon monoxide in expired air.ResultsThe results showed significant differences by personality patterns that predict nicotine dependence (Narcissistic and Antisocial in men and Schizoid in women). At the end of the treatment it is more likely that quit smoking males with a Compulsive pattern and less likely in those scoring high in Depressive, Antisocial, Sadistic, Negativistic, Masochistic, Schizotypal and Borderline. In women, it is less likely that quit smoking those with the Schizoid pattern. At 12 months follow-up it is more likely that continue abstinent those males with a high score in the Compulsive pattern. Furthermore, nicotine dependence was an important variable for predicting outcome at the end of the treatment and smoking status at 12 months follow-up in both men and women.ConclusionsWe found substantial differences by gender in some personality patterns in a sample of smokers who received cognitive-behavioral treatment for smoking cessation. We should consider the existence of different personality patterns in men and women who seek treatment for smoking cessation.

Smoking cessation and depressive symptoms at 1-, 3-, 6-, and 12-months follow-up.

BACKGROUND The relationship between tobacco and depressive symptoms has been examined. However, there is little information on the evolution of these symptoms when an individual quits. The aim of this study was to analyze the evolution of depressive symptoms over time (pre-, post-treatment, 1-, 3-, 6-, and 12-months follow-up) in relation to smoking status 12 months after having received a psychological treatment for smoking cessation. METHOD The sample was made up of 242 adults who received cognitive-behavioral treatment for smoking cessation (64.4% women; mean age=41.71 years). The BDI-II was used to assess depressive symptomatology. Participants were classified into three groups according to smoking status at 12-months follow-up (abstainers, relapsers, and smokers). RESULTS There were no significant differences in depressive symptoms among the three groups at pretreatment. At the end of treatment, abstainers and relapsers presented less depressive symptomatology than smokers. At follow-up, abstainers continued to present less depressive symptomatology than smokers, whereas in relapsers, symptoms began to increase as the relapses occurred. Regarding the evolution of depressive symptomatology, the abstainer and relapser groups showed a significant reduction at the end of treatment. Only in the group of abstainers did the decrease continue during 12 months follow-up. LIMITATIONS The decrease of the initial sample size from 562 to 242 participants. Variables such as self-esteem and self-efficacy were not assessed. CONCLUSIONS Smoking cessation is associated with a decrease in depressive symptomatology, that is maintained over time. In contrast, relapse is associated with an increase of such symptoms. These findings signify the potential importance of addressing depressive symptomatology in smoking cessation treatment.

Axis II Disorders and Cigarette Smoking Among Adults From the General Population

The present study examined whether personality disorders (PDs) are associated with cigarette smoking, and the possible influence of nicotine dependence, sociodemographic variables, and the presence of any lifetime Axis I mental disorder in these relationships. The sample was made up of 1,081 adult participants from the Spanish general population and was stratified by smoking status (519 smokers and 562 nonsmokers). PDs were assessed by means of the International Personality Disorder Examination Questionnaire, Module DSM-IV. Results indicated that participants with a paranoid, a narcissistic, a borderline, an antisocial, or an obsessive-compulsive PD had a higher probability for being smokers and for being nicotine-dependent. The only exception was the schizoid PD, because participants with this Axis II disorder had a lower probability for being nicotine-dependent smokers. The association between PDs and smoking was maintained even after adjusting for all covariates. Findings are discussed in relation to the influence of Axis II disorders on smoking cessation interventions.

The association between probable personality disorders and smoking cessation and maintenance.

INTRODUCTION Although it has been suggested that persons with psychopathological disorders experience greater difficulty in quitting smoking, the few studies that have analyzed personality disorders in smokers have failed to produce conclusive results. The aim of this study was to examine whether the presence of probable personality disorders was associated with the achievement of abstinence at the end of a smoking cessation treatment, as well as the maintenance of abstinence at 6 and 12 months of follow-up. METHODS The sample comprised 290 smokers (41% men and 59% women) who participated in a psychological smoking cessation treatment and who were followed for a year. Abstinence was tested by measuring carbon monoxide in exhaled air. RESULTS Participants with a probable borderline, antisocial or avoidant personality disorder were less likely to quit smoking at the end of the treatment, whereas probable schizoid personality disorder predicted better maintenance of abstinence at 6 and 12 months. In addition, smoking 25 or more cigarettes before starting the treatment decreased the likelihood of maintaining abstinence at 6 and 12 months of follow-up. CONCLUSIONS This study revealed differential (and opposing) relationships between specific personality disorders and smoking cessation outcomes, illustrating the need to consider Axis II disorders separately when predicting treatment outcomes.

Smoking habit profile and health-related quality of life

BACKGROUND Few studies have investigated the relationship between smoking and health-related quality of life (HRQOL), and the results are not consistent. The aim of this study is to explore the association between smoking and HRQOL. METHOD Cross-sectional study of 714 Spanish adults (44.7% never smokers and 55.3% smokers) without diagnosis of physical or mental disorder. Each participant provided information about different sociodemographic variables and data on HRQOL. Smokers also reported smoking-related information about smoking-related variables. RESULTS Nicotine dependence was not associated with the physical dimension of HRQOL, but in the mental component, nicotine dependent smokers showed worse HRQOL than never smokers (p = 0.004) and than non-nicotine dependent smokers (p = 0.014). There were no differences between no-nicotine dependent smokers and never smokers. Smoking status (non smokers vs. smokers), number of cigarettes smoked per day, stage of change, quit attempts in the past year or age of smoking onset were not related to HRQOL. CONCLUSIONS In subjects without physical or mental diseases, only nicotine dependent smokers showed a significant impairment in the mental component of HRQOL. Therefore, it is important to consider nicotine dependence in the relationship between smoking and HRQOL.

Motivation to quit as a predictor of smoking cessation and abstinence maintenance among treated Spanish smokers

INTRODUCTION Although quitting motivation predicts smoking cessation, there have been inconsistent findings regarding motivation predicting long-term maintenance of abstinence. Moreover, most such research has been conducted in North America and the United Kingdom. The aim of this study was to examine motivation to quit as a predictor of smoking cessation and of abstinence maintenance in a Spanish sample. METHOD The sample comprised 286 Spanish smokers undergoing psychological treatment for smoking cessation. Motivation to quit was assessed pre-treatment and post-treatment with the Readiness to Quit Ladder. Abstinence post-treatment and at 6month follow-up was biochemically verified. RESULTS Participants with higher levels of pre-treatment and post-treatment motivation were more likely to be abstinent at the end of the treatment (OR=1.36) and at 6month follow-up (OR=4.88). Among abstainers at the end of the treatment (61.9%), higher levels of motivation to quit post-treatment predicted maintaining abstinence at 6months (OR=2.83). Furthermore, participants who failed to quit smoking reported higher levels of motivation to quit post-treatment than they had pretreatment (p<.001). CONCLUSIONS Motivation to quit smoking predicted short and long-term cessation, and also predicted long-term maintenance of abstinence. These results have implications for understanding motivational processes of smoking cessation in general, while extending research to Spanish smokers. They may also help in the design of cessation and relapse-prevention interventions. Specifically, the results suggest that motivational enhancement is important throughout the cessation and maintenance periods.

Borracheras, conducción de vehículos y relaciones sexuales en jóvenes consumidores de cocaína y éxtasis

Traffic accidents, sexually-transmitted diseases, unwanted pregnancies, drunkenness, and drug use (especially psychostimulants) are negative aspects associated with recreational nightlife. The aim of the present study is to analyze in a sample of 1214 young people (aged 15-25; 49.7% males, 50.3% females) whether psychostimulant users (cocaine and ecstasy) have a higher frequency of drunkenness and risk behaviours related to sex and to driving. We also analyze the importance of these behaviours in the prediction of psychostimulant use in the last year. The results indicate that psychostimulant users get drunk more frequently, are more likely to have seen a relative drunk, and present more risk behaviours in the contexts of driving and full sexual relations. Therefore, cocaine and ecstasy users are a risk population who need specific preventive programs.

Hazardous Alcohol Drinking as Predictor of Smoking Relapse (3-, 6-, and 12-Months Follow-Up) by Gender

Diverse studies have found a relation between alcohol consumption and smoking relapse. Few studies have analyzed the relation of smoking relapse with pretreatment alcohol consumption and gender differences. The main purpose of this study is to analyze the influence of alcohol consumption in smoking relapse over 12 months (3-, 6-, and 12-months follow-up) and to determine possible gender differences. The sample included 374 smokers who quit smoking by participating in a psychological smoking cessation treatment. We assessed hazardous pretreatment alcohol drinking (AUDIT), cigarette consumption (FTND; number of cigarettes) and sociodemographic variables. Higher scores on hazardous pretreatment alcohol drinking predict smoking relapse at 3-, 6-, and 12-months after smoking cessation. In males, higher scores on hazardous pretreatment alcohol drinking predict relapse at 6 and at 12 months. In females, higher scores on hazardous pretreatment alcohol drinking predict tobacco relapse at 3 months. Hazardous pretreatment alcohol drinking predicts relapse at all intervals after smoking cessation (3-, 6-, and 12-months follow-up). However, the influence of hazardous pretreatment alcohol drinking on smoking relapse differs as a function of gender, as it is a short-term predictor in women (3 months) and a long-term predictor in men (6 and 12 months).