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Introduction: Owing to controversy information surrounds effect of glucocorticoids on the evolution of COVID-19, we evaluate the effects of outpatient glucocorticoid use on the severity and progression of COVID-19 and risk of infection and analyse the effect of window of exposure and dose. Methods: We conducted a population-based case − control study, involving 4 substudies: (i) Hospitalisation; (ii) Mortality, using subjects hospitalised with a PCR + as cases and subjects without a PCR + as controls; (iii) Progression, including subjects with a PCR + (hospitalised versus non-hospitalised); and (iv) Susceptibility, with all subjects with a PCR + and subjects without a PCR +. Adjusted odds ratios (ORa) and their 95% confidence intervals (95% CI) were calculated. Results: The outpatient glucocorticoid use was associated with an increased risk of hospitalisation (aOR 1.79; 95% CI 1.56–2.05), mortality (aOR 2.30; 95% CI 1.68–3.15), progression (aOR 1.69; 95% CI 1.43–2.00) and susceptibility (aOR 1.29, 95% CI 1.19–1.41). Furthermore, the effects was observed to be greater at higher doses and the closer that drug use approached the outcome date, with an almost fourfold increase in mortality among users in the previous month (aOR 3.85; 95% CI 2.63–5.62). Conclusions: According to the results of this real-world data study, outpatient glucocorticoid use should be considered in making decisions about intrahospital treatment. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of prior chronic treatment with angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin-receptor blockers (ARBs), both as a group and by active ingredient, on severity (risk of hospitalization and mortality), progression of and susceptibility to COVID-19. Methods: We conducted a multiple population-based case–control study in Galicia (north-west Spain). The study data were sourced from medical, administrative and clinical databases. We assessed: (1) risk of hospitalization, by selecting all patients hospitalized due to COVID-19 with PCR + as cases, and a random sample of subjects without a PCR + as controls; (2) COVID-19 mortality risk; (3) risk of disease progression; and (4) susceptibility to SARS-CoV-2, considering all patients with PCR + as cases, and the same subjects used in the previous model as controls. Adjusted odds ratios (aORs) were calculated. Results: ACEIs and ARBs were shown to decrease the risk of hospitalization (aOR = 0.78 [95%CI 0.69–0.89] and aOR = 0.80 [95%CI 0.72–0.90] respectively), risk of mortality (aOR = 0.71 [95%CI 0.52–0.98] and aOR = 0.69 [95%CI 0.52–0.91] respectively), and susceptibility to the virus (aOR = 0.88 [95%CI 0.82–0.94] and aOR = 0.92 [95%CI 0.86–0.97] respectively). By active ingredient: use of enalapril was associated with a significantly lower risk of hospitalization (aOR = 0.72 [95%CI 0.61–0.85]), mortality (aOR = 0.59 [95%CI 0.38–0.92]) and susceptibility to COVID-19 (aOR = 0.86 [95%CI 0.79–0.94]); and use of candesartan was associated with a decreased risk of hospitalization (aOR = 0.76 [95%CI 0.60–0.95]), mortality (aOR = 0.36 [95%CI 0.17–0.75]) and disease progression (aOR = 0.73 [95%CI 0.56–0.95]). Conclusion: This large-scale real-world data study suggest that enalapril and candesartan are associated with a considerable reduction in risk of severe COVID19 outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Galicia Clínica is the property of Sociedad Gallega de Medicina Interna and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Evidence of the effect of statins on patients with coronavirus disease (2019) COVID‐19 is inconsistent. The aim of this study was to evaluate the association between chronic use of statins—both overall and by active ingredient—and severe outcomes of COVID‐19 (risk of hospitalization and mortality), progression to severe outcomes, and susceptibility to the virus. We conducted a population‐based case–control study with data from electronic records to assess the risk of (1) hospitalization: cases were patients admitted due to COVID‐19 and controls were subjects without COVID‐19; (2) mortality: cases were hospitalized patients who died due to COVID‐19 and controls were subjects without COVID‐19; (3) progression: cases were hospitalized COVID‐19 subjects and controls were nonhospitalized COVID‐19 patients; and (4) susceptibility: cases were patients with COVID‐19 (both hospitalized and nonhospitalized) and controls were subjects without COVID‐19. We collected data on 2821 hospitalized cases, 26 996 nonhospitalized cases, and 52 318 controls. Chronic use of atorvastatin was associated with a decreased risk of hospitalization (adjusted odds ratios [aOR] = 0.83; 95% confidence interval [CI]: 0.74–0.92) and mortality (aOR = 0.70; 95% CI: 0.53–0.93), attributable in part to a lower risk of susceptibility to the virus (aOR = 0.91; 95% CI: 0.86–0.96). Simvastatin was associated with a reduced risk of mortality (aOR = 0.59; 95% CI: 0.40–0.87). The wide degree of heterogeneity observed in the estimated odds ratios (ORs) of the different statins suggests that there is no class effect. The results of this real‐world study suggest that chronic use of atorvastatin (and to a lesser degree, of simvastatin) is associated with a decrease in risk of severe COVID‐19 outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To explore dental clinics' performance on periodontal education by comparing knowledge about periodontal health of regular and inconsistent dental attenders. Subjects and Methods: A population‐based study with a cross‐sectional design was performed in Galicia (Northwestern Spain). Participants were randomly selected from 16 different areas and a questionnaire applied face‐to‐face. The survey included items on socio‐demographic features, habits and routines, periodontal status and periodontal health knowledge. Participants were grouped according to the median of overall knowledge, and a logistic regression analysis was performed to explore the relationship between good periodontal knowledge and frequency of dental visits. Results: A total of 8,206 individuals were invited to enter the study, and 3,553 of them accepted the invitation (43.3%). Most participants (59.3%; n = 1,945) fit within the regular dental attenders' group. Younger women holding a university degree and visiting their dentist regularly elicited higher knowledge about periodontal health. Regular use of dental services increased the chances of being in the higher knowledge group (OR: 1.67; 95% CI: 1.40–2.00). Conclusions: Reported regular dental attendance is related to periodontal health knowledge. Specific interventions for promoting tailored patient education on periodontal topics during routine dental visits may have a positive effect on laypersons' knowledge about periodontal health. [ABSTRACT FROM AUTHOR]

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION:The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.METHODS:Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.RESULTS:From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.CONCLUSIONS:Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development. [ABSTRACT FROM AUTHOR]

Objective: The health crisis caused by COVID-19 required the prompt launch of research in order to generate scientific evidence pertaining to the new disease oriented to control its devastating effects and continuous spread. Therefore, it was essential to adapt the work flow of Research Ethics Committees, to prioritize and to accelerate the evaluation of projects related to this disease., Methods: This work analyses the evaluation conducted by our Regional Ethics Committees during the initial period of the health emergency (between 13th March and 28th May 2020)., Results: 81 research projects were evaluated, 73 of them of regional scope (62 single-centre), 4 national and 4 international. 57 projects obtained a favourable opinion, 4 were withdrawn by the sponsors, 6 did not require ethics approval and 14 did not respond to the clarifications requested up to the date of the study's closure., Conclusions: The most important research procedures to be analysed in this context are those related to the methodology and informed consent process. It is also essential to address aspects related to the privacy of personal data, and to take into account the workload of the researchers. As an improvement proposal, we think that greater collaboration between the different research teams should be encourage to obtain more robust results.

Objective: To describe family nurses self-reported oral hygiene practices and to compare them with those of their potential patients in a public, free, and universal primary healthcare system., Material and Methods: Cross-sectional study using an anonymous questionnaire applied to randomly selected participants and their family nurses., Results: A total of 1,394 people entered the study (1,326 laypersons, 66 nurses). Not all nurses reported to brush their teeth daily. Daily interdental cleaning scored percentages lower than mouthwashes. Devices like oral irrigators or tongue scrappers were not used by family nurses., Conclusions: Nurses' oral self-care routines are similar to those of university graduates, with poor reported interdental cleaning. Oral health promotion activities may contribute to nurse's oral health and could have a positive effect on their patients.

Objective: To determine the views held by Family practice (FP) residents on the different dimensions of patient safety, in order to identify potential areas for improvement., Design: A cross-sectional study., Location: Seven FP of Galicia teaching units., Participants: 182 FP residents who completed the Medical Office Survey on Patient Safety Culture questionnaire., Measurements: The Medical Office Survey on Patient Safety Culture questionnaire was chosen because it is translated, validated, and adapted to the Spanish model of Primary Care. The results were grouped into 12 composites assessed by the mentioned questionnaire. The study variables were the socio-demographic dimensions of the questionnaire, as well as occupational/professional variables: age, gender, year of residence, and teaching unit of FP of Galicia., Results: The "Organisational learning" and "Teamwork" items were considered strong areas. However, the "Patient safety and quality issues", "Information exchange with other settings", and "Work pressure and pace" items were considered areas with significant potential for improvement. First-year residents obtained the best results and the fourth-year ones the worst., Conclusions: The results may indicate the need to include basic knowledge on patient safety in the teaching process of FP residents in order to increase and consolidate the fragile patient safety culture described in this study., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the patterns of substance abuse of students attending the Lugo School of Nursing., Method: Observational, descriptive and cross-sectional study in the classroom carried out by survey research in April 2015., Results: 61.5% of students participated (185), 83.2% of whom were females. The first addictive substance consumed by participants was tobacco (at 15 years old). In the last month cigarettes were consumed by 36.2% of students, while alcohol was consumed by 89.9% (58.4% of the total got drunk). 2.2% were consuming tranquilizers/hypnotics in the same time period. The most widely used illegal drug was cannabis (17.8%) and then cocaine (2.2%). There is a significant correlation between illegal drug consumption and being male, smoking cigarettes or drinking alcohol, living alone or with friends (not family), have poor academic performance and public drinking (botellón). There were no association between illegal drugs and sports or reading. Polydrug use was also studied: a 16.2% declared to have consumed alcohol and cannabis simultaneously, and a 4.9% alcohol and cocaine., Conclusions: Consumption patterns are similar compared to the general population in that age group, with some of them being higher. Therefore, it is necessary to take measures in order to prevent substance abuse at the university level., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Objectives: To compare the use profile of statins in patients with clinical diagnosis of heterozygous family hypercholesterolaemia (HFH) and the use profile of the general population treated with statins. DESIGN. Retrospective, observational study., Setting: Galician Health Service, Spain., Participants: Patients under 65 years old treated with statins., Main Measurements: In patients with HFH: number of patients, age, gender, statins used and defined daily dose per patient and day (DDD/patient/day). Variables in the rest of the population treated with statins: number of patients, statins used and DDD/patient/day., Results: In a sample of 331 under-65 patients with HFH, 185 were men (55.86%) and 146 women (44.14%). Their average age was 44.56 years old (95% CI, 43.33-45.80), without statistically significant differences between men and women. Relevant differences in the daily mean consumption (DDD/patient/day) of statins between the studied sample and the rest of the under-65 population treated with statins were found (3.03 DDD/patient/day [95% CI, 2.70-3.36] vs 1.33 DDD/patient/day [95% CI, 1.16-1.40]; P< .001). These differences were caused by atorvastatin: 70% of HFH patients were being treated with atorvastatin (versus 37.6% of the rest of the population treated with statins). Differences in daily mean consumption of atorvastatin between HFH and the rest of the statin-treated population were also found (3.58 DDD/patient/day [95% CI, 3.15-4.02] vs 1.64 DDD/patient/day [95% CI, 1.37-1.90]; P< .001)., Conclusions: The DDD/patient/day of statins in HFH patients is double that of the rest of the population treated with statins. The different pattern of use of atorvastatin in HFH is the main reason for these results.

Background: The therapeutic options to treat Alzheimer-type dementia (ATD) in recent years, have made it increasingly necessary to become familiar with the employment pattern of these new medicinal products., Methods: A cross-sectional observational study of the population with ATD treated with acetylcholinesterase inhibitors and/or memantine in the Gallician Health Service. Databases were compiled with the demographic variables and use data during April 2005 of the medicinal products studied., Results: Of the 5110 patients with ATD, 70.47% were women. The mean age of the women was 80.12 and of the men was 78.61 years old, with standard deviations of 6.66 and 7.03, respectively. The female sex was one of the factors associated with presenting ATD to pharmacological treatment (OR: 1.932 [CI 95%: 1.819-2.052]). The medication used most was donepezyl (44.46% of patients). Significant differences were found in that memantine was used to treat more patients in the group of patients < or =64 years (19.7% in < or =64 years vs. 14% in >64 years [p < 0.05]), and donepezyl was preferentially used in patients > or =95 years (75% in > or =95 years vs. 46.9% in <95 years [p < 0.03]). No significant differences were observed in the use of anti-dementia therapy, expressed in DDD/patient/day between the sexes, age groups, or in the age groups separated according to sex., Conclusions: The use of memantine (in monotherapy or in combination) is more frequent in patients under 64 years old. Female sex was found to be a factor associated with presenting ATD to pharmacological treatment.