Juan Jesus Gestal-Otero

A meta-analysis of coffee drinking, cigarette smoking, and the risk of Parkinson's disease.

We conducted a systematic review to summarize the epidemiological evidence on the association between cigarette smoking, coffee drinking, and the risk of Parkinsons disease. Case–control and cohort studies that reported the relative risk of physician‐confirmed Parkinsons disease by cigarette smoking or coffee drinking status were included. Study‐specific log relative risks were weighted by the inverse of their variances to obtain a pooled relative risk and its 95% confidence interval (CI). Results for smoking were based on 44 case–control and 4 cohort studies, and for coffee 8 case–control and 5 cohort studies. Compared with never smokers, the relative risk of Parkinsons disease was 0.59 (95% CI, 0.54–0.63) for ever smokers, 0.80 (95% CI, 0.69–0.93) for past smokers, and 0.39 (95% CI, 0.32–0.47) for current smokers. The relative risk per 10 additional pack‐years was 0.84 (95% CI, 0.81–0.88) in case–control studies and 0.78 (95% CI, 0.73–0.84) in cohort studies. Compared with non–coffee drinkers, relative risk of Parkinsons disease was 0.69 (95% CI, 0.59–0.80) for coffee drinkers. The relative risk per three additional cups of coffee per day was 0.75 (95% CI, 0.64–0.86) in case–control studies and 0.68 (95% CI, 0.46–1.00) in cohort studies. This meta‐analysis shows that there is strong epidemiological evidence that smokers and coffee drinkers have a lower risk of Parkinsons disease. Further research is required on the biological mechanisms underlying this potentially protective effect.

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.

Physicians' attitudes and adverse drug reaction reporting : a case-control study in Portugal.

AbstractObjectives: Voluntary adverse drug reaction (ADR) reporting is fundamental to medical drug safety surveillance; however, substantial under-reporting exists and is the main limitation of the system. This study sought to identify the knowledge-and attitude-related factors associated with ADR reporting by physicians in Northern Portugal. Methods: Case-control study covering a population of National Health Service medical practitioners. The 88 cases comprised physicians who had reported at least one ADR to the drug surveillance unit from the year 2000 to the date of enrolment in the study. The 771 controls were randomly selected from among the remaining physicians. All interviews were conducted using a self-administered questionnaire. Knowledge and attitudes regarding spontaneous ADR reporting were based on Inman’s ‘seven deadly sins’. Agreement with the questions included in the questionnaire was measured using a horizontal, continuous visual analogue scale, which was unnumbered. Recorded answers were read in a range from zero (total disagreement) to ten (total agreement). We used logistic regression to determine the ADR reporting adjusted odds ratio (ORadj) for a change in exposure corresponding to the interquartile range for each attitude. Results: A total of 397 questionnaires were received from 731 eligible practitioners (54.3%). Physicians who worked in primary versus hospital care (ORadj 7.74 [95% CI 1.85, 32.30]) and in general medicine (ORadj 1.05 [95% CI 0.30, 3.69]) versus medical specialities were more likely to report ADRs. In contrast, physicians working in the medical-surgical/surgical fields were significantly less likely to report ADRs compared with medical specialists (ORadj 0.10 [95% CI 0.02, 0.46]). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by: (i) 87% (p < 0.05) for complacency (the belief that really serious ADRs are well documented by the time a drug is marketed); (ii) 109% (p < 0.01) for insecurity (the belief that it is nearly impossible to determine whether a drug is responsible for a particular adverse reaction); (iii) 143% (p < 0.001) for diffidence (the belief that one would only report an ADR if one were sure that it was related to the use of a particular drug); (iv) 220% (p < 0.001) for indifference (the belief that the one case an individual doctor might see could not contribute to medical knowledge); and (v) 71% (p < 0.05) for ignorance (the belief that it is only necessary to report serious or unexpected ADRs). Conclusion: This study shows that there are attitudes strongly associated with under-reporting. The implementation of purpose-designed educational interventions based on the attitudes identified in this study may serve to improve reporting substantially.

Influence of Pharmacists' attitudes on adverse drug reaction reporting : A case-control study in portugal

AbstractIntroduction: Pharmacists can play a fundamental role in adverse drug reaction (ADR) reporting, although the factors that affect underreporting among these professionals are unknown. The objectives of this study were to identify (i) professional or demographic characteristics; and (ii) attitudes associated with pharmacists’ ADR reporting in northern Portugal. Methods: We conducted a case-control study on a population of pharmacists employed in hospital and community pharmacies across Portugal’s Northern Regional Health Authority catchment area in 2003. Cases (n = 34) comprised pharmacists who had reported at least one ADR to the northern region’s drug surveillance unit, and controls (n = 280) were randomly sampled from pharmacists who had never reported an ADR. All were interviewed using a mail questionnaire. Most attitudes were based on Inman’s ‘seven deadly sins’ and were measured using a continuous visual analogue scale. Answers were recorded in a range from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to determine the ADR reporting adjusted odds ratio (OR) for a change in exposure corresponding to the interquartile range for each attitude. Results: The response rate was 86.8%. Reporting probability proved higher among hospital versus community pharmacists (adjusted OR 20.0; 95 CI 3.3, 125.0; p < 0.001). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by (i) 223% (95% CI 51, 595; p < 0.05) for “Really serious ADRs are well documented by the time a drug is marketed”; (ii) 240% (95% CI 89, 508; p = 0.002) for “I would only report an ADR if I were sure that it was related to the use of a particular drug”; (iii) 316% (95% CI 44, 1104; p = 0.010) for It is only necessary to report serious or unexpected ADRs; and (iv) 171% (95% CI 13, 549; p = 0.020) for “I do not have time to think about the involvement of the drug or other causes in ADRs”. Conclusions: ADR under-reporting is strongly associated with certain attitudes, possibly indicating that under-reporting could be minimised through educational interventions targeted at changing such attitudes. Pharmacists’ ADR education must be improved and educational programmes should be focused on altering attitudes identified by the study as being associated with under-reporting. Our data also indicate that community pharmacists must be a priority target for this intervention.

A Cohort Study of Stress and the Common Cold

The common cold is one of the major causes of work absenteeism. Former studies, based on artificial inoculation of rhinovirus, implicated psychological stress in the occurrence of this syndrome, either by increasing susceptibility to the virus or by causing the subject to overrate the perception of the symptoms. Nevertheless, few studies on the effect of stress on the naturally acquired common cold have been conducted. We carried out a 1-year prospective cohort study among the faculty and staff of a Spanish university (N = 1,149). By means of standardized questionnaires, validated in a random sample of the population, we assessed the relation between the occurrence of common cold episodes and exposure to four dimensions of stress: stressful life events, negative affect, positive affect, and perceived stress. All four aspects of stress were related to the occurrence of the common cold. Subjects with a high (fourth quartile) index of negative affect showed an incidence rate ratio of 3.7 (95% confidence interval = 2.2–6.2). The incidence rate ratios for the fourth quartile were 2.5 (95% confidence interval = 1.5–4.1) and 1.9 (95% confidence interval = 1.1–3.2) for perceived stress and stressful events, respectively. A high index of positive affect was associated with an incidence rate ratio of 0.6 (95% confidence interval = 0.3–1.0). These findings suggest that psychological stress is a risk factor for the common cold.

Influence of physicians' attitudes on reporting adverse drug events: a case-control study.

BACKGROUND Voluntary physician reporting of adverse drug events (ADEs) in among their patients remains the single most important source of information on serious and rare ADEs. Yet, substantial under-reporting exists and the factors producing its causes are unclear. OBJECTIVES The objectives of the study are to: (1) identify the practitioners demographic and professional characteristics associated with ADE reporting; and (2) identify knowledge, attitudes, and opinions associated with ADE reporting. DESIGN Case-control study. SUBJECTS Physicians within the National Health Service in Galicia (Northwestern Spain). The 194 case doctors are those who reported at least one ADE to the regional drug surveillance center between 1991 and their enrollment in the study. The 498 controls were randomly selected among the remaining physicians. All were interviewed using a mail questionnaire. MAIN OUTCOME MEASURES We used logistic regression to determine the ADE reporting odds ratio. RESULTS The response rate was 63.7%. The probability of reporting ADEs increases with increasing volume of prescriptions and decreases with increasing patient load. The following attitudes are associated with a smaller probability of reporting: (1) belief that really serious adverse drug events are well documented by the time a drug is marketed; (2) belief that it is nearly impossible to determine if a drug is responsible for a particular adverse event; (3) only reporting an adverse drug reaction if one is sure that it is related to the use of a particular drug; and (4) belief that the one case an individual physician might see cannot contribute to medical knowledge. CONCLUSIONS Some physician attitudes regarding ADEs are associated with underreporting.

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

Objectives.The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. Methods.A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. Results.One-to-one education obtained an average prescribing behavior improvement of 6.5% (P <0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P <0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. Conclusions.A single, short educational session to primary care doctors can improve their prescribing standards during long periods of ≥9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.

Improving the Reporting of Adverse Drug Reactions : A Cluster-Randomized Trial Among Pharmacists in Portugal

AbstractBackground: Adverse drug reaction (ADR) reporting systems are the basic component for comprehensive postmarketing surveillance of the risk of drug-induced adverse effects. The aim of this study was to evaluate the effectiveness of educational outreach visits aimed at improving ADR reporting by pharmacists. Methods: The study population comprised all pharmacists working in a catchment area covered by Portugal’s Northern Regional Health Authority. Using unequal randomization, four spatial-clusters were assigned to the intervention group (n = 342) and eleven to the control group (n = 1091). The intervention took the form of 1-hour long educational outreach visits tailored to training needs detected in a previous study, with a 13- to 16-month follow-up period (March–June 2004 through June 2005). This study is registered as an international standard randomized controlled trial, number ISRCTN45 894687. Results: At baseline, ADR reporting rates (per 1000 pharmacist-years) did not differ significantly between the intervention and control groups (32.28 vs 29.16). The adjusted increase in ADR reporting attributable to the intervention was 275.63 per 1000 pharmacist-years (95% CI 162.15, 389.12; relative risk RR] = 5.87, 95% CI 1.98, 17.39). The intervention succeeded in multiplying the reporting rate of: serious ADRs, 10-fold (RR = 9.79; 95% CI 2.24, 42.66); unexpected ADRs, 4-fold (RR = 4.41; 95% CI 1.11, 17.53); high-causality ADRs, 9-fold (RR = 8.67; 95% CI 2.12, 35.42); and new drug-related ADRs, 9-fold (RR = 9.33; 95% CI 2.53, 34.40). While the greatest effect was registered during the first 4 months post-intervention, differences remained statistically significant for 8 months. Conclusions: Educational outreach visits improve ADR reporting by pharmacists in terms of quantity and relevance.

Consumption of fruit and vegetables and risk of lung cancer: A case-control study in Galicia, Spain

OBJECTIVE We analyzed the effect of fruit and vegetable intake on lung cancer risk in a population in northwest Spain. METHODS We analyzed data from a hospital-based case-control study including 295 histologically confirmed cases and 322 controls. Controls were patients attending the hospital for minor surgery. There was a minimum age limit of 35 y and sampling was carried out on a sex-frequency basis. RESULTS After adjustment for sex, age, tobacco use, and occupation, no protective effect of overall consumption of fruit was present (odds ratio 1.49, 95% confidence interval 0.81-2.73). Green leafy vegetables conferred a protective effect (odds ratio 0.50, 95% confidence interval 0.30-0.83). CONCLUSION These findings indicate that green leafy vegetables, rather than fruit, might have a genuine protective effect against lung cancer.

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.