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Background Benzodiazepines (BZDs) and Z-drugs (BZDRs) are among the most prescribed medications for anxiety and insomnia, especially among older adults. Our objective was to investigate the association between the use of BZDRs and the risk of dementia. Methods A community-based retrospective cohort study was conducted based on the data available from 2002 to 2015 in Catalan Health Service. This cohort included all BZDR users (N = 83 138) and nonusers (N = 84 652) older than 45 years. A minimum 5-year lag window and an adjustment for psychiatric problems were applied for the data analysis. Results The hazard ratio (HR) for the risk of incident dementia among BZDR users was 1.22 (95% CI = 1.15 to 1.31). This risk was not significant after adjusting the data confounding factors (HR = 1.01; 95% CI = 0.94 to 1.08). We observed a higher risk with short-to-intermediate half-life BZDs (HR = 1.11; 95% CI = 1.04 to 1.20) and Z-drugs (HR = 1.20; 95% CI = 1.07 to 1.33) than for intermediate-to-long half-life BZDs (HR = 1.01; 95% CI = 0.94 to 1.08). We demonstrated a higher risk of incident dementia (HR = 1.23; 95% CI = 1.07 to 1.41 and odds ratio = 1.38; 95% CI = 1.27 to 1.50, respectively) in patients who received 91 to 180 defined daily doses (DDDs) and >180 DDDs compared with patients who received Conclusion We found that the incidence of dementia was not higher among all BZDR users. Short half-life BZDs and Z-drugs increased the risk of dementia at the highest doses, especially in female patients, showing a dose-response relationship.

Excess weight, smoking and risky drinking are preventable risk factors for colorectal cancer (CRC). However, several studies have reported a protective association between aspirin and the risk of CRC. This article looks deeper into the relationships between risk factors and aspirin use with the risk of developing CRC. We performed a retrospective cohort study of CRC risk factors and aspirin use in persons aged >50 years in Lleida province. The participants were inhabitants with some medication prescribed between 2007 and 2016 that were linked to the Population-Based Cancer Registry to detect CRC diagnosed between 2012 and 2016. Risk factors and aspirin use were studied using the adjusted HR (aHR) with 95% confidence intervals (CI) using a Cox proportional hazard model. We included 154,715 inhabitants of Lleida (Spain) aged >50 years. Of patients with CRC, 62% were male (HR = 1.8; 95% CI: 1.6–2.2), 39.5% were overweight (HR = 2.8; 95% CI: 2.3–3.4) and 47.3% were obese (HR = 3.0; 95% CI: 2.6–3.6). Cox regression showed an association between aspirin and CRC (aHR = 0.7; 95% CI: 0.6–0.8), confirming a protective effect against CRC and an association between the risk of CRC and excess weight (aHR = 1.4; 95% CI: 1.2–1.7), smoking (aHR = 1.4; 95% CI: 1.3–1.7) and risky drinking (aHR = 1.6; 95% CI: 1.2–2.0). Our results show that aspirin use decreased the risk of CRC and corroborate the relationship between overweight, smoking and risky drinking and the risk of CRC. his work was supported by contract 2019-DI-43 of the Industrial Doctorate Program of the Government of Catalonia. Project PID2020-113614RB-C22 was funded by the Spanish Ministry of Science and Innovation. Some authors are members of the 2014-SGR163 research group, funded by the Generalitat de Catalunya.

Background Suicide prevention is one of the greatest challenges in mental health policies. Since a previous suicide attempt is the main predictor of future suicidal behaviour, clinical management of suicide attempters is vital for lowering mortality. Psychopharmacological interventions are still nonspecific, and their effectiveness have often been questioned. In this study, we aim to identify predictors of suicide re-attempt in a cohort of suicide attempters, with particular focus on different aspects of psychopharmacological treatment. Methods This is a prospective study. Adults presenting with a suicide attempt were approached to take part in our study, resulting in a final sample of 371 participants. Participants were followed from inclusion to next suicide attempt, death by other causes, loss of the patient, or after a maximum of two years. We conducted Kaplan–Meier survival analyses and a multivariate Cox regression model for several exposure variables. Results During the study period, 70 participants (18,9%) re-attempted. 60% of re-attempts occurred within the first 6 months. Three factors were independently associated with risk of re-attempt in the Multivariate Cox regression model: diagnosis of a Cluster B personality disorder, good treatment compliance, and at least one previous suicide attempt prior to the index event. Limitations Indication bias precludes a clear interpretation of our results regarding psychopharmacological treatment. Poor adherence may also be a consequence of relapse rather than just one of its causes. Conclusions A correct psychopharmacological treatment is insufficient to prevent re-attempts in populations at risk. Strategies to increase compliance should be taken into account as part of prevention programs.

Proton pump inhibitors (PPIs) are among the most prescribed medications. Previous epidemiological studies have presented contradictory results about PPIs and the risk of dementia. Our objective was to investigate the association between the use of PPIs and an increasing risk of incident AD or non-AD dementias. A community-based retrospective cohort study was conducted based on the data available from 1st January 2002 to 31st December 2015 in the Catalan health service (CatSalut) system. This cohort included all PPI users (N = 36,360) and non-users (N = 99,362). A lag window of 5 years was considered between the beginning of the PPI treatment and the diagnosis of dementia. PPI use was not associated with the risk of AD (adjusted odds ratio (OR) 1.06) (95% CI 0.93–1.21; p = 0.408). A weakly but significantly increased risk of non-AD dementias was observed among PPI users (adjusted OR 1.20, 95% CI 1.05–1.37; p = 0.007). A higher dose of PPIs was not associated with an increased risk of either AD or non-AD dementias (OR 1.20; 95% CI 0.91–1.61 and OR 0.95; 95% CI 0.74–1.22, respectively). Regarding the number of PPIs used, we observed an increased risk of AD (OR 1.47; 95% CI 1.18–1.83) and non-AD dementias (OR 1.38; 95% CI 1.12–1.70) in users of two types of PPIs compared with those who used only one type. We did not find a higher incidence of AD among PPI users, but a weak increase in the risk of non-AD dementias among PPI users was observed.

ResumenObjetivoRacionalizar la prescripción en la población anciana es una prioridad de los sistemas sanitarios. Los criterios STOPP/START permiten detectar la prescripción potencialmente inadecuada (PPI) a nivel individual. Su aplicación a nivel poblacional permite determinar la prevalencia de PPI y su relación con diversas variables del paciente y del sistema sanitario. El objetivo de este estudio es analizar la prevalencia de PPI en población anciana a partir de bases de datos clínicos y de farmacia.DiseñoEstudio descriptivo transversal.EmplazamientoÁmbito de atención primaria de la Región Sanitaria de Lleida, España.ParticipantesSe incluyen 45.408 pacientes de 70 años o más atendidos en los centros de salud como mínimo una vez en el último año.Mediciones principalesSe calcula la frecuencia de incumplimiento de 43 indicadores STOPP y 12 indicadores START, a partir de los fármacos prescritos durante un año y se ajustan modelos de regresión logística para evaluar su asociación con diversas variables.ResultadosEl 58% son mujeres. La edad media es de 79,7 años. El 58,1% incumplen como mínimo un criterio STOPP y/o START, relacionados principalmente con el uso de benzodiacepinas, antiinflamatorios no esteroideos e inhibidores de la bomba de protones por exceso, y los tratamientos para la osteoporosis, antiagregantes, estatinas, metformina y betabloqueantes por omisión. La PPI aumenta con la edad y la polifarmacia y es superior en pacientes ingresados en centros geriátricos y domiciliarios que en los ambulatorios.ConclusionesLos criterios STOPP/START identifican PPI en más de la mitad de pacientes ancianos de una región sanitaria española.AbstractObjectiveRational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases.DesignCross-sectional population study.SettingsPrimary Care, Lleida Health Region, Spain.Participants45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year.Methods43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors.Results45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care.ConclusionsIn our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria.

Background Pesticide exposure poses a health risk for farmworkers. This analysis documents lifetime and current pesticide exposure of North Carolina Latino migrant farmworkers, with comparison to non-farmworker Latino immigrants. Methods During May to October 2012, 235 Latino farmworkers and 212 Latino non-farmworkers completed interviews with items to construct measures of lifetime, current residential and occupational pesticide exposure. Results Farmworkers experience levels of lifetime and residential pesticide exposure that are consistently greater than among non-farmworkers. Farmworkers report a large number of occupational pesticide exposures. Lifetime exposure and current residential pesticide exposure are related to social determinants. Education is inversely related to lifetime pesticide exposure for farmworkers and non-farmworkers; farmworkers with H-2A visas report greater residential pesticide exposure than those without H-2A visas. Conclusions Occupational safety policy needs to consider these patterns of lifetime exposure when setting standards. Health care providers should be aware of the lifetime and current exposure of this vulnerable population. Am. J. Ind. Med. 57:776–787, 2014. © 2014 Wiley Periodicals, Inc.

Background Although acute exacerbations are key events in the progression of chronic obstructive pulmonary disease (COPD), their frequency and the factors associated with acute exacerbation are not fully known. Objective To determine the incidence and risk factors of very frequent exacerbations in COPD (⩾3 per year). Patients and methods In a cohort study to analyse acute exacerbation and associated factors in 512 primary care patients during a 2-year follow-up, variables of interest were collected for each patient. Acute exacerbation was defined as an event that required antibiotics and/or systemic steroids (moderate) or hospital admission (severe). Odds ratios (OR) were used to determine factors associated with exacerbation. Results Incidence of exacerbation was 61.7% in the first year of follow-up and 63.9% in the second year. During the first year, the factors associated with very frequent exacerbation were previous hospital admission (OR 1.69), dyspnoea (moderate [OR 2.86] and severe-very severe [OR 5.83]) and the Charlson Index (OR 1.19); during the second year, associated factors were female sex (OR 4.17), history of previous hospital admissions (OR 2.90), smoking (smoker/ex-smoker) (OR 2.00) and forced vital capacity (OR 0.98). Conclusions Incidence of exacerbation is high in COPD patients. Previous admission for exacerbation is a strong predictor and can identify patients at risk.

ResumenIntroducciónDeterminar la incidencia anual acumulada de tuberculosis (TB) en la Región Sanitaria (RS) de Lleida a través de los casos declarados, y/o retirada de fármacos indicados. Evaluar el grado de cumplimiento del tratamiento, sobre la base de los fármacos dispensados con prescripción.MétodosEstudio descriptivo de incidencia sobre la base de los casos declarados de TB y dispensación de fármacos antituberculosos (ATB) en la RS de Lleida, Cataluña, entre el año 2007 y el 2009.ResultadosLa incidencia anual de la RS entre los años 2007 y 2009 oscila entre 38 y 29 casos por 100.000 habitantes. El 72,6% de los casos fueron declarados mientras que el resto han sido detectados a través de los fármacos indicados retirados en farmacia. Existe una mayor incidencia de TB entre la población inmigrante. Los autóctonos presentan un mejor porcentaje de buen cumplimiento (el 75,8% versus el 61,2%). El colectivo magrebí presenta un menor cumplimiento (43,7%) y el colectivo de América Latina es el colectivo inmigrante con un mayor cumplimiento (82,4%).ConclusionesLa incidencia de la TB en nuestra región sanitaria ha descendido entre los años 2007 y 2009, con más incidencia entre la población inmigrante. Existe una elevada infranotificación de los casos de TB. La población autóctona presenta una mayor adherencia al tratamiento y entre el colectivo inmigrante, la población magrebí es la que menos cumple. Se debe realizar una gran tarea de información para la detección de la enfermedad, sobre todo en atención primaria, y una tarea informativa en el colectivo inmigrante para favorecer el cumplimiento terapéutico. Sería interesante estudiar los factores socioeconómicos que pueden determinar la incidencia y el peor cumplimiento entre la población inmigrante.AbstractIntroductionTo determine the annual incidence of tuberculosis (TB) in the health region of Lleida (RS) through the reported cases, and/or dispensing of the treatment drugs, as well as the level of compliance, based on the prescription drugs dispensed.MethodsDescriptive study of incidence based on reported cases of TB and TB drug dispensing (ATB) in the RS of Lleida, Catalonia in the period 2007-2009.ResultsThe incidence in the Health Region between 2007 and 2009 ranged between 38 to 29 cases per 100,000 population. The majority (72.6%) of cases were notified, while the rest were detected by identifying the treatment drugs dispensed in pharmacies. There was a higher incidence of TB among the immigrant population. Spanish-born patients had a higher percentage of compliance (75.8% versus 61.2%). Among the immigrant groups, those from North Africa had the lowest compliance (43.7%), and those from Latin America had the highest compliance (82.4%).ConclusionsThe incidence of TB in our health region has declined between 2007 and 2009, with the highest incidence among the immigrant population. There is a high amount of non-notified cases of tuberculosis. The Spanish-born population has a greater adherence to treatment. There is a lot of work to be done on disease notification, particularly among primary care doctors, as well as information on treatment adherence for the immigrant population. It would be interesting to study the socioeconomic factors that could determine the incidence and the poor adherence to treatment by immigrant populations.

Resumen Introduccion Determinar los factores del paciente y el medico asociados a la variabilidad en la prescripcion de antibioticos. Material y metodos Estudio observacional de prevalencia de las dispensaciones de medicamentos antibacterianos en poblacion mayor de 14 anos. Fuente de datos: receta oficial, historia clinica y tarjeta sanitaria individual. Las variables del usuario fueron: edad, sexo, numero de consultas al medico durante el ano, presencia de comorbilidad, envase antibacteriano dispensado con prescripcion, y las variables del medico: edad, sexo, numero de usuarios asignados, centro de trabajo y ruralidad. Las variables asociadas a la prescripcion se estudiaron mediante la estimacion de la odds ratio (OR) a partir del ajuste de modelos de regresion logistica multinivel. Resultados La tasa de prescripcion de antibioticos durante un ano en la poblacion es de un 31,4%. Los factores asociados a la prescripcion fueron la mayor frecuentacion (usuarios con mas de 5 visitas-ano multiplican la probabilidad de recibir antibiotico respecto los no visitados: OR = 10,8), la edad con mas prescripcion en jovenes y mayores y el sexo con mas prescripciones en mujeres (OR = 1,5). Ni la edad ni el sexo del profesional presentaron asociacion con la prescripcion. Los medicos con alta carga asistencial tienen una mayor probabilidad de prescripcion de antibioticos. Conclusiones El principal factor asociado al aumento de prescripciones es la frecuentacion en consulta. Tambien reciben mas antibioticos las mujeres, los jovenes y los mayores. Los medicos con mas carga asistencial prescriben mas antibioticos. Se debe realizar una intervencion multifactorial (sobre demanda, pacientes y medicos) para reducir la prescripcion.

Background Several studies have documented poor housing conditions for farmworkers but none has focused on migrant farmworker housing, which is often provided as a condition of employment. Farmworker housing quality is regulated, but little documentation exists of compliance with regulations. Methods A 2007 survey of 43 randomly selected farmworker camps and a 2008 survey of 27 camps randomly selected from the 2007 sample documented housing conditions via interviewer administered questionnaire and housing checklist. Results Substandard conditions are common in migrant housing. All camps had at least one exterior housing problem; 93% had at least one interior problem. Housing conditions worsen across the agricultural season. Characteristics including no residents with H2A visa and 11 or more residents are associated with poorer conditions. Conclusions Housing standards are not adequately enforced. An increase in post-occupancy inspections and targeting camps with characteristics that place them at increased risk for substandard conditions are recommended. Am. J. Ind. Med. 54:533–544, 2011. © 2011 Wiley-Liss, Inc.

ResumenObjetivosAnalizar si hay diferencias en el gasto farmacéutico entre inmigrantes y autóctonos en la población general y si el ámbito de residencia (urbano/rural) está asociado al gasto en farmacia.DiseñoEstudio observacional transversal.EmplazamientoRegión Sanitaria Lleida.ParticipantesSe estudiaron 22.847 inmigrantes y 174.768 autóctonos de 15 a 64 años de edad, residentes en la Región Sanitaria Lleida.Mediciones principalesGasto en farmacia durante el año 2007, variables demográficas, zona de procedencia y área de residencia (urbana/rural).ResultadosEn todos los grupos terapéuticos, los individuos autóctonos gastaron más que los inmigrantes. En los hombres, la ratio de riesgo relativo de estar en el cuartil superior de gasto era de 3,2 (ICntervalo de confianza [IC] 95%: 2,96–3,44) en autóctonos respecto a inmigrantes y en las mujeres era de 2,1 (IC 95%: 1,97–2,27). Los inmigrantes de Europa del Este eran los que tenían un riesgo inferior de realizar gasto farmacéutico elevado (último cuartil), con diferencias estadísticamente significativas. Los residentes en el medio rural tenían riesgo superior de realizar gasto farmacéutico elevado respecto a los residentes en el medio urbano.ConclusiónSe observaron desigualdades en el gasto en medicamentos entre inmigrantes y autóctonos. Futuros estudios, cualitativos o mixtos, deberían indagar qué factores se asocian a estas diferencias y proponer acciones dirigidas a reducirlas.AbstractObjectiveTo evaluate whether there are differences in drug spending between immigrant and Spanish-born populations and to assess whether drug consumption is associated with living environment (urban/rural).DesignObservational cross-sectional study.SettingLleida Health Region (LHR).Participants22,847 immigrants and 174,768 native born subjects, aged 15 to 64 years, residing in the LHR.Main measurementsDrug spending during the year 2007, demographical variables, region of origin and residence area (urban/rural).ResultsNative-born subjects spent more in all therapeutic drug groups than immigrants. In men, the relative risk ratio (RRR) of being in the highest quartile of expenditure was 3.2 (95% CI: 2.96–3.44) for native born versus immigrant and in women it was 2.1 (95% CI: 1.97–2.27). Immigrants from eastern Europe had the lowest risk of being in the highest quartile of expenditure, with statistically significant differences. Residents in the rural environment were more likely to have a higher pharmaceutical consumption than residents in the urban environment.ConclusionInequalities in drug spending were observed between immigrants and native born subjects. Further studies, either qualitative or mixed, should explore which factors are related to these differences and propose strategies addressed to reducing them.

BackgroundMany patients discontinue antidepressant therapy long before the six-month minimum duration recommended for the treatment of major depression and many other diagnoses.PurposeTo estimate the duration of antidepressant treatment and to analyse the following factors in relation to treatment adherence: age, sex, polypharmacy and type of drug.MethodsRetrospective cohort followed up for five years (2003–2007) based on prescription database. Selection criteria: Users who had received at least one antidepressant prescription in 2003 and who had not received antidepressants during the previous 12 months.Variables studiedAge, sex, drug, polypharmacy, period of treatment, packs dispensed. Adequate adherence was defined as dispensation of medication during at least 80% of the treatment period, and compliance was defined as good when, in addition, the treatment lasted more than four months.ResultsOf the 7525 patients selected, 56% abandoned medication during the first four months. Men were more likely to give up medication before time than women. Good compliance was recorded in 22% of patients and was twice as frequent in patients with high levels of polypharmacy than in those with low levels (31% vs. 15.3%). Patients receiving maprotiline, venlafaxine, mirtazapine, citalopram, clomipramine and fluoxetine presented the highest percentages of good compliance.ConclusionsOnly one out of five patients complied with treatment for over four months. Treatment periods were shorter in men. In chronic processes, patients receiving polypharmacy presented the best compliance.

Background Farmworkers can be exposed to a wide variety of pesticides. Assessing cholinesterase activity over time can be used to monitor exposure to organophosphorus and carbamate pesticides. Objectives The goal of this study was to document patterns and variation in cholinesterase levels across the agricultural season (May–August) among field-workers, and to explore the association of cholinesterase depression with pesticide exposure across the agricultural season. Methods Dried blood samples collected from 231 migrant farmworkers sampled from camps in eastern North Carolina up to four times across a summer agricultural season were analyzed for cholinesterase activity, and urine samples were analyzed for metabolites of organophosphorus and carbamate pesticides. Reductions of ≥ 15% from an individual’s highest value were identified and considered evidence of meaningful cholinesterase activity depression. Results The average cholinesterase activity levels were lowest in June, with significantly higher mean values in July and August. When adjusted for age, sex, minutes waited to shower, and days worked in the fields, the number of organophosphorus and carbamate pesticides detected in urine predicted reductions in cholinesterase activity. Conclusions These data demonstrate that workers are experiencing pesticide exposure. Greater enforcement of existing safety regulations or strengthening of these regulations may be warranted. This study demonstrates that serial measurements of cholinesterase activity across an agricultural season can detect exposure to pesticides among field-workers.

Migrant farmworkers are exposed to numerous workplace hazards, with pesticides being a ubiquitous occupational exposure. This analysis describes farmworker experiences of field and camp safety conditions and their safety behaviors, and delineates farmworker characteristics associated with safety conditions and behaviors. Data were collected from 255 migrant farmworkers up to four times at monthly intervals during the 2007 agricultural season in eastern North Carolina. Measures assess field safety conditions and camp sanitation required by federal and state regulations. Most of the farmworkers were Latino men from Mexico. About 20% had not received pesticide safety training across the season; many of those who received such training did not understand it. Water for washing was not available for about one-third of the workers; soap and towels were not available for over half. About 20% lived in camps with more than eight workers per showerhead and about 20% lived in camps that failed to meet the standard of 30 or fewer workers per washtub/washing machine. Important predictors of variation included H2A visa status and years of experience. Four themes emerged from the analysis: (1) safety regulations are not consistently met; (2) farmworkers do not always practice safety behaviors; (3) camps become more crowded and less compliant during the middle of the agricultural season; and (4) workers with H2A visas experience better conditions and practice more safety behaviors than do workers who do not have H2A visas. Further research needs to account for social and cultural factors. Regulations should be compared with pesticide metabolite levels to measure their effectiveness. More effort is needed to enforce existing regulations.

This analysis describes the detection of urinary pesticide metabolites for Latino farmworkers across the agricultural season. Two hundred and eighty four farmworkers were recruited from 44 camps in eastern North Carolina in 2007. Data were collected at one month intervals for a total of 939 data points. The OP insecticide metabolites 3,5,6-trichloropyridinol (46.2%), malathion dicarboxylic acid (27.7%), and para-nitrophenol (97.4%); the pyrethroid metabolite 3-phenoxybenzoic acid (56.4%); and the herbicides 2,4-D (68.1%), acetochlor (29.2%), and metolachlor (16.9%) were found in sizable percentages of the samples. The percentage of farmworkers for whom metabolites were detected varied across the agricultural season. None of the farmworker characteristics were significantly associated with the detection of any pesticide metabolite. Seasonality overrides the effects of other farmworker characteristics in predicting detection of pesticide urinary metabolites. Future research needs to collect multiple exposure measures at frequent intervals over an extended period to characterize factors associated with exposure.

Background: This study estimates the prevalence of self-reported skin problems among Latino farmworkers and identifies associated risk factors. Methods: The study used a longitudinal surveillance design. Participants were interviewed up to five times and reported skin problems and personal, work, and environment characteristics. Frequencies and counts were calculated for 13 skin problems. Adjusted odds ratios were obtained for six skin problems. Results: More than one-third of participants reported skin problems, including skin and nail fungus; sunburn; bumps, pimples, or acne; calluses; itching; rash; and insect bite. A variety of work and environment factors were associated with higher rates of skin problems. One of the strongest predictors was working in wet clothes or shoes. Conclusions: Programs are needed to educate farmworkers about measures they can take to decrease their risk of skin problems. Changes in work practices and personal protective equipment provided could help decrease the prevalence of skin problems.

Objetivo Determinar si hay diferencias por sexo en la incapacidad laboral transitoria (IT) por depresion respecto a la edad, el diagnostico, la duracion y la frecuentacion. Pacientes y metodo Estudio descriptivo y transversal, realizado en 2004. Poblacion diana: poblacion de mas de 15 anos de la region sanitaria (RS) de Lleida, laboralmente activa, con baja por depresion. Medidas: estadistica descriptiva; comparacion de medias y proporciones. Resultados De las 182.895 personas de la RS, 1.902 estuvieron de baja por depresion. El 2,7% eran mujeres. La edad media ± desviacion estandar (DE) fue 40,5 anos ± 11,3 anos, sin diferencias significativas por sexos (mujeres, 40 anos; varones, 41 anos; p = 0,3188). El 50,1% presentaba un trastorno depresivo; el 48,1%, un trastorno mixto por ansiedad-depresion y el 1,8%, un trastorno bipolar. La distribucion de diagnosticos por sexo mostraba un predominio del trastorno bipolar en los varones (el 3,94 frente al 0,5%) y del mixto en las mujeres (el 49,66 frente al 45,49%) (χ 2 = 31,86; p La duracion media fue de 88 ± 98 dias (mediana, 46 dias), con un promedio de 7 ± 7 visitas (mediana, 4 visitas), sin diferencias significativas por sexo (p = 0,3186 y p = 0,3382, respectivamente). Conclusiones A pesar que la mayoria de casos de IT por depresion corresponden a mujeres, el sexo no determina diferencias en el proceso de IT. La distribucion de diagnosticos por sexo refleja la de la poblacion general.

OBJECTIVES: We used geographic information systems (GIS) to delineate whether farmworker labor camps were hidden and to determine whether hidden camps differed from visible camps in terms of physical and resident characteristics. METHODS: We collected data using observation, interview, and public domain GIS data for 180 farmworker labor camps in east central North Carolina. A hidden camp was defined as one that was at least 0.15 miles from an all-weather road or located behind natural or manufactured objects. Hidden camps were compared with visible camps in terms of physical and resident characteristics. RESULTS: More than one third (37.8%) of the farmworker labor camps were hidden. Hidden camps were significantly larger (42.7% vs 17.0% with 21 or more residents; P ≤ .001; and 29.4% vs 13.5% with 3 or more dwellings; P = .002) and were more likely to include barracks (50% vs 19.6%; P ≤ .001) than were visible camps. CONCLUSIONS: Poor housing conditions in farmworker labor camps often go unnoticed because they are hidden in the rural landscape, increasing farmworker vulnerability. Policies that promote greater community engagement with farmworker labor camp residents to reduce structural vulnerability should be considered. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e6. doi:10.2105/AJPH.2015.302797). Language: en

Farmworkers experience significant work-related health risks including pesticide-associated cognitive impairment. Practice effect is a surrogate for learning ability. This study examined differences in cognitive function and learning capacity in Latino farmworkers and nonfarmworkers.Tasks of learning and short-term memory, executive function and working memory, perceptual coding, and psychomotor function were assessed at baseline and 3-month follow-up in 136 farmworkers and 116 nonfarmworkers.Farmworkers had better performance on visuospatial learning and short-term memory at baseline (P0.05). Nevertheless, nonfarmworkers showed more practice effects, or improvement on cognitive performance, at 3-month follow-up relative to farmworkers. Furthermore, the amount of improvement on visuospatial learning ability, short-term visuospatial memory, and perceptual coding ability was significantly higher in nonfarmworkers than in farmworkers.Practice effects may serve as an additional cognitive readout to differentiate healthy individuals from those with cognitive impairment.

ObjetivoAnalizar el consumo de fármacos antidepresivos y la duración del tratamiento antidepresivo durante los años 2002 a 2004.DiseñoEstudio descriptivo, transversal, de las dispensaciones de medicamentos antidepresivos realizadas mediante receta del Sistema Nacional de Salud.EmplazamientoRegión Sanitaria de Lleida.ParticipantesHan participado 54.890 individuos que han recibido algún fármaco antidepresivo durante los años 2002 a 2004.Mediciones principalesEdad, sexo, medicamento, período de dispensación, centro.ResultadosLa prevalencia anual de tratamiento antidepresivo ha sido del 8,4% en 2002 (368.976 habitantes), del 8,6% en 2003 (376.638 habitantes) y del 8,7% en 2004 (388.148 habitantes). El incremento en el porcentaje de pacientes en tratamiento en 2004 respecto al 2002 es de un 9,4%. La prevalencia en los varones es del 5,4% y en las mujeres del 12,7%. La distribución por grupos de fármacos antidepresivos es la siguiente: inhibidores selectivos de la recaptación de serotonina un 73,7%, antidepresivos tricíclicos un 26,2%, heterocíclicos un 10% e inhibidores de la monoaminooxidasa un 0,1%. La duración del tratamiento ha sido de 1-3 meses en el 43%, 4-12 meses en el 22,7%, 13-24 meses en el 14,4% y>24 meses en el 19,9%.ConclusionesHay un incremento progresivo en las prescripciones de antidepresivos, con predominio de nuevas moléculas. Respecto a la duración del tratamiento, un porcentaje elevado de individuos realiza tratamientos

Fundamento: El hipotiroidismo es una enfermedad frecuente, que cursa con una sintomatología, en ocasiones inespecífica, lo que dificulta el diagnóstico. El objetivo del estudio es estimar la prevalencia de hipotiroidismo en Lleida a través de las prescripciones de la hormona tiroidea y comparar los resultados con los de otras regiones. Métodos: Estudio observacional retrospectivo. 2.854 personas que reciben tratamiento con hormona tiroidea mediante receta de la Seguridad Social. Meses de octubre a diciembre del 2001. Variables: la edad, el sexo y región sanitaria. Resultados: La prevalencia de hipotiroidismo en el 2001 es de 8,4 casos por 1.000 habitantes día (IC 95%:9,23-7,47). La edad media es de 60 años (DS

Background: Clinical practice guidelines consider the use of antidepressants as one of the standard treatments for anxiety disorders, due to the significant improvements obtained in quality of life and functional disability. In addition, in patients who have not achieved a favorable response after 3 months of psychotherapy, antidepressants are recommended as part of a combined treatment approach. This combination with psychotropic drugs and psychotherapy appears to be indicated from baseline in patients with moderate, severe or recurrent depression. In the last decade, antidepressant prescription rates in general practice have increased between 4 and 10 times. Depression presents high rates of relapse and recurrence. Treatment is often interrupted prematurely, leading to increases in both relapse rates and health care costs. Few studies have analysed the chronic use of antidepressant drugs and long-term adherence. Objective: To evaluate compliance with antidepressant treatment between 2003 and 2011 and to explore the associated factors. Methods: Retrospective cohort study of antidepressant dispensing. Setting: Health Region of Lleida between 2003 and 2011. Participants: Patients with chronic prescription of antidepressants (ATC code NO6A) during 2003 were followed up until December 2011. The sample comprised 3684 subjects. Main measures: The compliance rate was calculated on the basis of the number of units withdrawn from the pharmacy and the theoretical number of units required according to the scheduled duration of treatment: compliance was defined in cases with scores greater than or equal to 80 %. Results: 12.5 % of patients received chronic antidepressant treatment for at least 4 years. Mean age was 54 years, and 73.2 % of patients were female. Almost a third (32.4 %) presented anxiety disorders and 26.5 % mood disorders. The overall compliance rate was 22 % (28 % in patients with depression, and 21 % in patients with anxiety). According to gender, compliance rates were 21.4 % for males and 22.4 % for females. Compliance was more likely in patients with polypharmacy. Conclusions: One in 4 patients complied with treatment. Factors associated with better compliance were polypharmacy and diagnosis of depressive or mixed anxiety-depressive disorder.

Oral bisphosphonates are first-line drugs in the treatment of osteoporosis under most guidelines, and have been shown to decrease risk of first fracture only in asymptomatic vertebral fractures and in clinical trial populations that are generally very different from the general population. Objective To compare incidence of first osteoporotic fracture in two cohorts of postmenopausal women, one treated with bisphosphonates and the other only with calcium and vitamin D. Design Retrospective population cohort study with paired matching based on data from electronic health records. Setting Women aged 60 years and older in 2005, from 21 primary care centers in a healthcare region of Spain. Participants Two groups of women aged 60 years and older (n = 1208), prescribed either calcium and vitamin D (CalVitD) or bisphosphonates (BIPHOS) with or without calcium and vitamin D, were compared for the end point of first recorded osteoporotic-related fracture, with 5-years follow-up. Main Outcome Measure Incidence of first fracture: Vertebral fracture, osteoporosis with pathological fracture, fracture of the upper humeral epiphysis, fracture of the lower radial epiphysis, or femur fracture. Results Estimated 10-year risk of fracture was 11.4% (95% confidence interval: 9.6 to 13.2), 11.8% (9.2 to 14.3) in the BIPHOS group and 11.1% (8.6 to 13.6) in the CalVitD group. No significant differences were found between groups in total fractures (Hazard ratio = 0.934 (0.67 to 1.31)) or location (vertebral, femoral, radial or humeral). Conclusions In postmenopausal women, bisphosphonates have not been shown to better decrease risk of first fracture compared with calcium and vitamin D therapy alone.

Farming is one of the most dangerous industries in the United States [NIOSH 2010]. Stress in farmworkers has emerged as an important public health concern, with nearly 40% of farmworkers studied having significant levels of stress [Hiott et al. 2008]. Farmworkers face numerous stressors, including occupational hazards, poverty, nature of rural life and social isolation, health and safety concerns, and separation from family [Arcury and Quandt 2007;Hovey and Seligman 2005;Magana and Hovey 2003]. Stressors inherent in farm work and the farmworker lifestyle are associated with poor physical [Gregoire 2002;Walker and Walker 1988] and mental health outcomes [Hiott et al. 2008;Hovey and Magana 2002;Magana and Hovey 2003]. Stress has been documented to have deleterious effects on brain structure and cognitive function [Crowe et al. 2007;McEwen 2000;Sapolsky 1996]. Hippocampal atrophy is associated with cognitive dysfunction in humans and in animal models [de Quervain et al. 2003;McEwen et al. 1999]. Studies have shown that acute stressors can cause short-term but reversible deficits in tasks of memory, while chronic stress could lead to irreversible loss of hippocampal neurons and cognitive impairment [Lupien et al. 2005;Lupien et al. 2009;McEwen 2000]. Stress-related outcomes including cognitive impairment may lead to poor work performance or even injury [NIOSH 2009]. In view of the evidence of the adverse effect of stress on cognitive function, it is important to examine the potential impact of stress on cognitive function. However, stress-related cognitive function is rarely examined in farmworkers. About 85% of migrant and seasonal farmworkers in the United States are Latinos [Carroll et al. 2005]. Most of these Latino farmworkers experience numerous stressors inherent in farmwork [Hiott et al. 2008;Hovey and Magana 2000;Magana and Hovey 2003]. This study examined the role of stress in predicting change in cognitive function (e.g., cognitive decline) over an agricultural season in a sample of Latino farmworkers. Longitudinal approaches were used to provide information as to the dynamic or reversible effects as a function of changes in exposure. The relationship between stress and cognitive function was explored in three ways: (1) cross-sectional relationship between baseline stress and baseline cognitive function (2) baseline stress as a predictor of subsequent cognitive function; and (3) change in stress as a predictor of change in cognitive function. We first hypothesized that baseline stress would be associated with baseline cognitive function, and with subsequent cognitive function. Secondly, we hypothesized that changes in stress would be associated with changes in cognitive function. Understanding these associations will be helpful in understanding mechanisms and planning interventions to reduce stress-related disorders including cognitive impairment.

Background The quality of housing provided to migrant farmworkers is often criticized, but few studies have investigated these housing conditions. This analysis examines housing regulation violations experienced by migrant farmworkers in North Carolina, and the associations of camp characteristics with the presence of housing violations. Methods Data were collected in183 eastern North Carolina migrant farmworker camps in 2010. Housing regulation violations for the domains of camp, sleeping room, bathroom, kitchen, laundry room, and general housing, as well as total violations were assessed using North Carolina Department of Labor standards. Results Violations of housing regulations were common, ranging from 4 to 22 per camp. Housing regulation violations were common in all domains; the mean number of camp violations was 1.6, of sleeping room violations was 3.8, of bathroom violations was 4.5, of kitchen violations was 2.3, of laundry room violations was 1.2, and of general housing violations was 3.1. The mean number of total housing violations was 11.4. Several camp characteristics were consistently associated with the number of violations; camps with workers having H-2A visas, with North Carolina Department of Labor Certificates of Inspection posted, and assessed early in the season had fewer violations. Conclusions These results argue for regulatory changes to improve the quality of housing provided to migrant farmworkers, including stronger regulations and the more vigorous enforcement of existing regulations. Am. J. Ind. Med. 55:191–204, 2012. © 2011 Wiley Periodicals, Inc.

Background Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region. Methods Population-based (n=206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4months and when patients withdrew more than 80% of the packs required. Results 5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives=3months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42). Conclusions In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.

Previous studies report that immigrants underuse psychiatric hospitalization services and are less exposed to antipsychotic medication. The objective of this study is to determine whether immigrant and Spanish native groups with psychotic disorder adhere differently to antipsychotic drugs. Retrospective study including two matched samples of 47 immigrants and 47 native-born patients with psychotic disorder admitted to a psychiatric Unit (2006–2007). Adherence was measured after one-year follow-up. Only 30 % of patients adhered to treatment (40.4 % of native-born, and 19.1 % of immigrants). The lowest rate of adherence was found in sub-Saharans. Fifty per cent of non-adherents were readmitted after 12 months, compared with 21.4 % of adherents, the effect was observed in both native and immigrants. This alarmingly poor adherence in immigrant patients with psychosis underlines the need for preventive strategies to minimize the negative clinical, social and economic outcomes.

ResumenObjetivoDeterminar la prevalencia de consumo de antibióticos y su distribución por edad y sexo, así como el grupo terapéutico más prescrito.DiseñoEstudio observacional descriptivo con datos retrospectivos.EmplazamientoRegión Sanitaria de Lleida.ParticipantesPersonas que reciben prescripción de antibacterianos entre los años 2002 y 2007.Mediciones principalesSe calcula la dosis habitante día (DHD) y los pacientes expuestos a tratamiento. Las variables de estudio son: edad, sexo, número de pacientes con tratamiento antibacteriano y grupo farmacológico.ResultadosLa prevalencia de pacientes expuestos a tratamiento con antibacterianos en un año es del 37% con un 33,5% en hombres y un 40,4% en mujeres. La DHD de Lleida durante el año 2007 fue de 23,52. Un 56% han recibido antibiótico una sola vez durante el año. La prevalencia de consumo tiene una forma de V en relación a la edad con cifras superiores en los grupos extremos (niños y ancianos). En el grupo de edad de 0 a 4 años un 58,8% de niños se encuentra expuesto a antibiótico al año. El principio activo más prescrito es la amoxicilina/ácido clavulánico.ConclusionesObservamos una elevada prescripción de antibióticos con un mayor consumo en las edades extremas de la vida, siendo llamativa la elevada prevalencia en la infancia, así como un mayor consumo de antibióticos en mujeres de 5 a 74 años y en hombre mayores de 74 años. También se constata una desviación de las prescripciones hacia moléculas de amplio espectro.AbstractPurposeTo determine antibiotic use and its distribution by age and gender, as well as the most prescribed therapeutic group.DesignObservational descriptive with retrospective data.Settings and participantsPopulation from the Lleida (Spain) Health Region receiving antibiotic prescriptions from 2002 to 2007.MeasurementsDaily Dose Per Inhabitant (DID) was calculated, as well as the number of patients under treatment. The study variables were: age, gender, number of patients under antibiotic treatment and pharmacological group.ResultsMean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and 40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had received antibiotics once a year. The antibiotic consumption prevalence has a “V” shape with higher values among children and old people. There is an annual exposure to antibiotics in 58.8% of the 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic.ConclusionsWe observe a high antibiotic prescription rate among children and older people, the high consumption in childhood being of note. There is also a higher use of antibiotics among women and changing of prescription towards broad spectrum antibiotics.

BackgroundRaised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences.ObjectiveTo compare exposure to antipsychotic medications in immigrant and native-born populations in Spain.MethodDescriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008.Results1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant.ConclusionsAll immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.

Background Limited data document the multiple and repeated pesticide absorption experienced by farmworkers in an agricultural season or their risk factors. Methods Data were collected from 196 farmworkers four times at monthly intervals in 2007. Urine samples were tested for 12 pesticide urinary metabolites. Questionnaire data provided measures of exposure risks. Results Farmworkers had at least one detection for many pesticide urinary metabolites; for example, 84.2% had at least one detection for acephate, 88.8% for 3,5,6-trichloro-2pyridinol. Most farmworkers had multiple detections for specific metabolites; for example, 64.8% had two or more detections for acephate, 64.8% for 3,5,6-trichloro-2-pyridinol, 79.1% for 3-phenoxybenzoic acid, and 86.7% for 2,4-dichlorophenoxyacetic acid. Housing type had a consistent significant association with metabolite detections. Conclusions Farmworkers are exposed to multiple pesticides across an agricultural season, and they experience repeated exposures to the same pesticides. Reducing farmworker pesticide exposure and delineating the health outcomes of this exposure require more detailed data. Am. J. Ind. Med. 53:802–813, 2010. 2010 Wiley-Liss, Inc.

Background Health professionals and organizations in developed countries adapt slowly to the increase of ethnically diverse populations attending health care centres. Several studies report that attention to immigrant mental health comes up with barriers in access, diagnosis and therapeutics, threatening equity. This study analyzes differences in exposure to antidepressant drugs between the immigrant and the native population of a Spanish health region. Methods Cross-sectional study of the dispensation of antidepressant drugs to the population aged 15 years or older attending the public primary health centres of a health region, 232,717 autochthonous and 33,361 immigrants, during 2008. Data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies. Age, sex, country of origin, visits, date of entry in the regional health system, generic drugs and active ingredients were considered. Statistical analysis expressed the percentage of persons exposed to antidepressants stratified by age, gender, and country of origin and prevalence ratios of antidepressant exposition were calculated. Results Antidepressants were dispensed to 11% of native population and 2.6% of immigrants. Depending on age, native women were prescribed antidepressants between 1.9 and 2.7 times more than immigrant women, and native men 2.5 and 3.1 times more than their immigrant counterparts. Among immigrant females, the highest rate was found in the Latin Americans (6.6%) and the lowest in the sub-Saharans (1.4%). Among males, the highest use was also found in the Latin Americans (1.6%) and the lowest in the sub-Saharans (0.7%). The percentage of immigrants prescribed antidepressants increased significantly in relation to the number of years registered with the local health system. Significant differences were found for the new antidepressants, prescribed 8% more in the native population than in immigrants, both in men and in women. Conclusions All the immigrants, regardless of the country of origin, had lower antidepressant consumption than the native population of the same age and sex. Latin American women presented the highest levels of consumption, and the sub-Saharan men the lowest. The prescription profiles also differed, since immigrants consumed more generics and fewer recently commercialized active ingredients.

To determine patient and physician-related factors associated with variability in antibiotic prescription.Observational study of the prevalence of antibacterial medication prescription14 years old.official prescriptions, clinical histories and individual health cards. Patient-related variables were: age, sex, number of medical visits-year, comorbidity, antibacterials dispensed with prescription. Physician-related variables were age, sex, number of patients assigned, place of work and rurality. Variables associated with prescription were studied by estimating the odds ratio (OR) from the fit of the multilevel logistic regression models.The rate of antibiotic prescription-year in the population was 31.4%. Factors associated with prescription were high rate of visits (users with more than 5 annual visits multiply the probability of receiving antibiotics, compared to those who madeno visits: OR=10.8), age (non-linearly, with a greater likelihood in the young and the elderly) and sex, with a higher rate in women (OR=1.5). No association was found between prescription and age and sex of the physician, but an association was found with workload: the higher the physician's workload, the higher the likelihood of antibiotic prescription.The most important factor associated with the increase in prescription rate was the frequency of visits. In addition, women, the young and the elderly receive more antibiotics. A multi-factor intervention focusing on demand, patients, and physicians should be carried out to reduce prescription rates.

Background Community Participatory Approach to Measuring Farmworker Pesticide Exposure, PACE3, used a longitudinal design to document pesticide biomarkers among farmworkers. This article presents an overview of PACE3 and provides a descriptive analysis of participant characteristics and one set of pesticide biomarkers, the dialkylphosphate (DAP) urinary metabolites of organophosphorus (OP) pesticides. Methods Two hundred eighty seven farmworkers were recruited during 2007 from 44 farmworker camps in 11 eastern North Carolina counties. Participants provided interviews, urine samples, blood samples, and saliva samples up to four times at monthly intervals beginning in May. A total of 939 data points were collected. Results Farmworkers were largely men (91.3%) from Mexico (94.8%) with a mean age of 33.7 years (SE 0.82); 23.3% spoke an indigenous language. Across all data points, frequencies of detection and median urinary concentrations were 41.3% and 0.96 µg/L for dimethylphosphate (DMP), 78.3% and 3.61 µg/L for dimethylthiophosphate (DMTP), 33.3% and 0.04 µg/L for dimethyldithiophosphate (DMDTP), 40.5% and 0.87 µg/L for diethylphosphate (DEP), 32.3% and 0.17 µg/L for diethylthiophosphate (DETP), and 8.09% and 0.00 µg/L for diethyldithiophosphate (DEDTP). The frequencies of detection and urinary concentrations of the DAP metabolites increased during the season. Conclusions More PACE3 participants were from Mexico, male, migrant workers, and spoke an indigenous language compared to national data. PACE3 participants had comparable frequencies of detection and urinary metabolite concentrations with participants in other studies. Variability in the frequencies of detection and urinary concentrations of the DAP metabolites indicates the importance of longitudinal studies of biomarkers of currently used pesticides in farmworker populations. Am. J. Ind. Med. 52:539–550, 2009. © 2009 Wiley-Liss, Inc.

Background Immigrant farmworkers are a population at risk for numerous environmental and occupational exposures. The metals arsenic, lead, mercury, and cadmium are known neurotoxins to which workers can be exposed both in the US and in their country of origin. Because farmworkers are exposed to neurotoxic pesticides, they may be at risk for adverse health effects from the combined exposure. Objectives To examine the relationship between exposure to metals, as measured in urine, with personal and work-related characteristics of Mexican migrant and seasonal farmworkers in the US. Methods We analyzed data on metals found in urine of 258 farmworkers recruited from 44 camps in eastern North Carolina in 2007. Geometric means and 95% confidence intervals (CI) were used to compare data with data from the National Health and Nutrition Examination Survey (NHANES). We used multivariate regression models fitted for each metal to estimate the association of creatinine-corrected urinary metals and worker characteristics related to environmental and occupational exposures. Results Geometric mean urinary metals concentrations (μg/g creatinine) exceeded NHANES reference values for arsenic (13.23 [CI 11.11, 15.35] vs. 8.55 [CI 7.23, 9.86]) and lead (1.26 [CI 1.08, 1.43] vs. 0.63 [CI 0.60, 0.66]). Age, being from the central region of Mexico, and pack years of cigarette smoking were significant predictors of metals exposure; being a current smoker and years worked in US agriculture were not. Conclusions This first study to examine indicators of worker body burdens of metals shows that workers have body burdens related to exposures other than work in the US. Further research should address their risk for adverse health outcomes due to combined exposures to neurotoxins in pesticides.

Background Gender-related differences are seen in multiple aspects of both health and illness. Ischemic heart disease (IHD) is a pathology in which diagnostic, treatment and prognostic differences are seen between sexes, especially in the acute phase and in the hospital setting. The objective of the present study is to analyze whether there are differences between men and women when examining associated cardiovascular risk factors and secondary pharmacological prevention in the primary care setting. Methods Retrospective descriptive observational study from January to December of 2006, including 1907 patients diagnosed with ischemic heart disease in the city of Lleida, Spain. The clinical data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies with official prescriptions. Data was analyzed using bivariate descriptive statistical analysis as well as logistic regression. Results There were no gender-related differences in screening percentages for arterial hypertension, diabetes, obesity, dyslipemia, and smoking. A greater percentage of women were hypertensive, obese and diabetic compared to men. However, men showed a tendency to achieve control targets more easily than women, with no statistically significant differences. In both sexes cardiovascular risk factors control was inadequate, between 10 and 50%. For secondary pharmaceutical prevention, the percentages of prescriptions were greater in men for anticoagulants, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, with age group variations up to 10%. When adjusting by age and specific diagnoses, differences were maintained for anticoagulants and lipid-lowering agents. Conclusion Screening of cardiovascular risk factors was similar in men and women with IHD. Although a greater percentage of women were hypertensive, diabetic or obese, their management of risk factors tended to be worse than men. Overall, a poor control of cardiovascular risk factors was noted. Taken as a whole, more men were prescribed secondary prevention drugs, with differences varying by age group and IHD diagnosis.

OBJECTIVE: To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. DESIGN: Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. SETTING: Lleida Health Region, Spain. PARTICIPANTS: A total of 54 890 patients received an antidepressant drug between 2002 and 2004. MEASUREMENTS: Age, sex, medicine, prescription period, centre. RESULTS: The prevalence of antidepressant treatment was: 8.4% in 2002 (368 976 inhabitants); 8.6% in 2003 (376 638 inhabitants); and 8.7% in 2004 (388 148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%.The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). CONCLUSIONS: A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system.

Hypothyroidism is a common disease sometimes showing no specific symptoms, thus being difficult to diagnose. This study is aimed at estimating the prevalence of hypothyroidism in Lleida by way of thyroid hormone prescriptions and comparing the results with those from other regions.A retrospective observational study. A total of 2,854 individuals undergoing thyroid hormone treatment through Social Insurance prescriptions. Moths of October-December 2001.age, sex and healthcare region.The prevalence of hypothyroidism for 2001 is 8.4 cases per 1000 inhabitants/day (IC 95%: 9.23-7.47). Average age: 60 (DS:16.6). Age spread: 2.4@1000 among males and 12.4@1000 among females. By age groups: Under age 15:3., 6@1000, 15-64 age group, 6.8@1000 and those over age 64, 12.5@1000. The highest figures were found in the rural areas (Seu d'Urgell: 10.5@1000), and the lowest in urban areas (Example: 5.8@1000, Balafia: 5.4@1000) CONCLUSIONS: Hypothyroidism under treatment figure is, as in other studies, higher among females and predominant among those over 64 years of age. We however found prevalence values lower than the data from a prior populational study for the same region, indicating a possible underdiagnosing of this disease.

Acute coronary syndrome; Coronary heart disease; Sick leave Síndrome Coronario Agudo; Enfermedad Coronaria; Ausencia por enfermedad Síndrome coronari agut; Malaltia coronària; Absència per malaltia BACKGROUND The prevalence of ischemic heart disease is high. Few recent studies have investigated the periods of sick leave of these patients. Our aim is to determine the length of sick leave after an acute coronary syndrome, its costs, associated factors and to assess the use of antidepressants and/or anxiolytics. METHODS An observational study of a retrospective cohort of patients on sick leave due to ischemic heart disease in a health region between 2008-2011, with follow-up until the first return to work, death, or end of the study (31/12/2012). MEASUREMENTS length of sick leave, sociodemographic variables and medical prescriptions. RESULTS Four hundred and ninety-seven patients (mean age 53 years, 90.7% male), diagnosed with acute myocardial infarction (60%), angina pectoris (20.7%) or chronic form of ischemic heart disease (19.1%). Thirty-seven per cent of patients took anxiolytics the year after diagnosis and 15% took antidepressants. The average duration of sick leave was 177 days (95% CI: 163-191 days). Patients diagnosed with acute myocardial infarction returned to work after a mean of 192 days, compared to 128 days in cases with angina pectoris. Patients who took antidepressants during the year after diagnosis returned to work after a mean of 240 days. The mean work productivity loss was estimated to be 9,673 euros/person. CONCLUSIONS The mean duration of sick leave due to ischemic heart disease was almost six months. Consumption of psychotropic medication doubled after the event. Older age, suffering an acute myocardial infarction and taking antidepressants were associated with a longer sick leave period.

Background There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations. Methods Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex. Results The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure. Conclusion Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Background The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015. Methods An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated. Results Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall —18.8% in women and 9.6% in men—and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%). Conclusion The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.