Francisco Caamaño

Sociodemographic factors related to self-medication in Spain

To identify the sociodemographic factors associated to self-medication (i.e. use of non-prescription medicines) and undesirable self-medication, a cross-sectional study was carried out using a sample (n = 20,311) representative of the population of adults of 16 years of age and older in Spain. Multivariate Coxs regression was used. The prevalence of self-medication in the sample was 12.7% during the two weeks preceding the interview. Self-medication is more prevalent among women, persons who live alone, and persons who live in large cities. For persons who reported acute disorders, self-medication prevalence was higher among those with higher educational levels. The prevalence of undesirable self-medication in the sample was 2.5% during the two weeks previous to the interview. Undesirable self-medication is twice as common among persons older than 40 years, as compared to persons younger than 27 years. Undesirable self-medication prevalence is 53.0% higher among those who live alone as compared to those who live with their partner (95% confidence intervel (CI): 15.2–103.2) and 36.8% higher among students as compared to full-time workers (95% CI: 1.9–83.5). People over 40 years of age, people living alone, and students should be the priority target populations for public health education programs aimed at improving the quality of self-medication behavior.

Factors related to dental health in 12-year-old children: a cross-sectional study in pupils.

OBJECTIVE The aim of this study was to identify factors related to the prevalence of caries in 12-year-old schoolchildren. METHODS A cross-sectional study was carried out using a representative sample (n = 1217) of the population of 12-year-old schoolchildren in Galiza (northwest Spain). Independent variables were measured through a questionnaire, and dependent variables were determined through oral examination. Multiple and logistic regression were applied. RESULTS The decayed, missing and filled permanent teeth/decayed, filled primary teeth (DMFT-dft) value in the sample was 1.83 (95% confidence interval [CI], 1.67-1.98), the DMFT value was 1.53 (95% CI, 1.37-1.67), and the prevalence of caries was 61% (95% CI, 57.7-64.5). The prevalence of caries was directly related to a low frequency of brushing, greater use of toothpaste, and a higher consumption of sweets. The prevalence of caries was higher in rural than in urban areas. In contrast, the higher the mothers level of education and the greater the subjects knowledge of dental health, the lower the prevalence of caries. CONCLUSIONS The main goals of dental health programmes should be to achieve quality brushing every day in children, to reduce the consumption of sweets, and to increase knowledge of dental health.

Data collection methods for analyzing the quality of the dispensing in pharmacies

Objective: To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies. Methods: A bibliographic search was carried out in MEDLINE (1980‐2000). Articles with Medical Subject Heading (Mesh) “pharmacies”written in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selected.Results: Various data collection methods were observed. To analyze the quality of the structure, questionnaires and pharmacist interviews were used. To analyze the quality of the process, self‐completed records, external observers and simulated clients were used. For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected. Conclusions: The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity. On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources. Therefore, an analysis of the quality of the process is the best option. Methods utilizing external observers and simulated clients may best conjugate both internal and external validity.

Interaction between aspirin and ACE Inhibitors: resolving discrepancies using a meta-analysis.

AbstractBackground: Recently, studies have attempted to explore the interaction between ACE inhibitors and aspirin (acetylsalicylic acid) when both drugs are used concomitantly to reduce mortality in patients with coronary artery disease. Results have been conflicting due, in part, to sub-optimal methods used to explore this interaction. Methods: We reviewed systematically all studies on mortality in patients treated with ACE inhibitors and aspirin and conducted a meta-analysis in order to explore the interaction between both drugs and resolve discrepancies. To be included, each study had to provide data on mortality of patients who received both drugs, either drug and no drug. These data were necessary to calculate the synergy index (S) and its 95% confidence interval (CI) that we used to quantify the effect due to interaction between ACE inhibitors and aspirin. After testing for heterogeneity of effects, we pooled the S values from the individual studies into one summary measure.Subsequently, we compared our results with those obtained through the most common but incorrect method of evaluating interaction. This method uses significance testing of the relative risk of mortality when a ‘product term’ between ACE inhibitors and aspirin is entered in a logistic regression model. Results: Eight studies met the inclusion criteria. The pooled synergy index S indicates slight but precise antagonism between ACE inhibitors and aspirin (S = 0.91; 95% CI 0.80 to 1.03). In contrast, the pooled ‘product term’ is not significant and would have lead to the conclusion of absence of interaction (p = 0.15). Conclusion: There seems to be an antagonistic interaction between ACE inhibitors and aspirin. Former discrepancies were due to inadequate assessment of interaction. Results from the Studies on Left Ventricular Dysfunction (SOLVD) and Heart Outcome Prevention Evaluation (HOPE) trials that assessed the effect of combined administration of ACE inhibitors and aspirin were not included in this meta-analysis because those trials did not provide enough data to compute the S statistic. It is possible that results from on-going trials such as Women’s Atovarstatin Trial on Cholesterol (WATCH) will shed more light on ACE inhibitor and aspirin interaction in the future.

Variables explicativas del gasto evitable generado por la no prescripción de la especialidad equivalente de menor precio

Objetivo: Identificar las variables explicativas del gasto evitable por la no prescripcion de la especialidad de menor precio. Metodos: Se diseno un estudio transversal sobre la poblacion de medicos generales de atencion primaria de Galicia (n = 1.500). Se selecciono una muestra de 405 sujetos. Se recogieron las siguientes variables independientes a traves de cuestionario postal: especialidad del medico, percepcion de la calidad de las distintas fuentes de informacion de medicamentos, integracion en equipos de atencion primaria y numero de pacientes. Las caracteristicas del entorno fueron obtenidas a traves de fuentes secundarias. Se generaron dos modelos de regresion multiple utilizando como variables dependientes dos indicadores basados en el gasto evitable generado por la no prescripcion de la especialidad esencialmente similar de menor precio. Resultados: El porcentaje de respuesta fue del 77,4%. La eficiencia de la prescripcion no se encontro asociada con el nivel de formacion del medico ni con las variables de utilizacion y de calidad atribuida a la informacion comercial o institucional. Tampoco la variable modelo sanitario resulta significativa. Unicamente el numero de cartillas y el porcentaje de cartillas de pensionista muestran significacion estadistica. Conclusiones: Los resultados del estudio sugieren la escasisima importancia que los medicos conceden a la eficiencia en la prescripcion. Asi, con el fin de disminuir el gasto evitable por la no prescripcion de la especialidad esencialmente similar de menor precio se deberia reorientar los planes de estudios en la linea de asegurar que sus contenidos reflejen las prioridades sanitarias nacionales y los recursos existentes.

The community pharmacists and their practice as health care providers

The pharmacists are probably the health professionals who are closest and most accessible to the patients and the general population. Their opinions related to health education have an important impact on the health of the population. The pharmacist may play the role of an active health educator by implementing interventions tending to reduce the tobacco habit or to minimizing the risks of AIDS contagion. The characteristics of the pharmacists that implement these interventions have not been identified until now. Within a cross-sectional study carried out on a sample of 150 pharmacies of the NW of Spain, the objective of which was to identify the factors associated with the quality of dispensing. We included several items on the interventions of the pharmacist related to health education. The objective of this analysis is to estimate the proportion of pharmacists who carry out prevention activities about tobacco and AIDS and to analyze if these activities are associated with their opinion about health education. Level of agreement with the assertion «The pharmacist must be a health educator» (Likert-like scale 1 to 5) were considered as exposure. This variable was dichotomized: no health educator (1 to 3) and health educator (4 to 5). The presence of «do not smoke» poster, the request to customers to put out their cigarette; the availability of an automatic condom dispenser, and the availability of kits of disposable syringes for drugs addicts were considered as dependent variables. Two new dichotomous variables have been created: tobacco activities (0 = there isn’t poster and he doesn’t request to customers to put out the cigarette; 1 = at least one activity); AIDS activities (0 = there isn’t preservative dispenser and he doesn’t dispense kits; 1 = at least one activity). Chi-square and multiple logistic regression were used for data analysis. Of the 150 sampled pharmacists, 4 were excluded. The 84.2% participated. The 69.9% were females, mean age is 42.7 and median 39, the 32.5% smoked and the 18.7% considered that the pharmacist must be a health educator. The proportion of pharmacies with preservative dispenser was 13.2% (95% CI: 7.8-20.6) and that with «Do not smoke» posters was 11.6% (95% CI: 6.5-18.7). The proportion of pharmacists who request customers to put out their cigarette was 19% (95% CI: 12.4-27.1), while 50.4% (95% CI: 41.2-59.6) dispensed kits for drug addicts. The 36% of the health educator pharmacists requested to customers to put out the cigarette vs. the 15% of the no health educator pharmacists (OR = 3.06, adjusting by sex, age and tobacco; 95% CI: 1.06-8.83). The 22.7% of the health educator pharmacists had «Do not smoke» poster vs. the 9.1% of the no health educator pharmacists (p = 0.07). The 50% of the health educator pharmacists carried out at least one activity about tobacco vs. the 21.2% of the no health educator pharmacists (OR = 3.57, adjusting by sex, age and tobacco; 95% CI: 1.30-9.79). On the contrary, the 13% of the pharmacists had automatic preservative dispenser and the 50% of the pharmacist dispensed kits for drugs addicts, independently of their opinion about health education. Finally, the 50% of the male pharmacists carried out at least one activity about tobacco vs. the 23.6% of the female pharmacists (OR = 2.98, adjusting by opinion about health education, age and tobacco; 95% CI: 1.23-7.20). And, in relation to age, the 24.7% of the pharmacists younger than 50 years old carried out at least one activity about tobacco vs. the 18.7% of the pharmacists older than 50 years old. The proportion of pharmacists who carried out activities about AIDS is higher than the proportion of pharmacists who carried out activities about tobacco. However, it is amazing that the pharmacist opinion about health education is not translated into his practices in relation to AIDS. The effect shown by the pharmacist opinion on his duty of acting as a health educator on tobacco activities turns out to be logic. Finally, the effect of age is also consistent with other studies that have shown a higher level of availability of younger health professionals towards health promotion programs. Our study has not been designed to analyze factors related to health education interventions. This may reduce the validity of the results. However, the coherence of our results and their consistency with other studies is an argument for the association to be real. Further research should be specifically designed to determine and quantify the pharmacists’ characteristics associated with health promotion interventions by the pharmacists.

Comment. Drug utilization studies. The need to know the indication

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