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About twenty nightlife venues in Lloret de Mar will hire auxiliary staff to monitor public spaces near their establishments. Their role will be to enforce the ordinance of civility and citizen coexistence that penalizes noise and shouting that affect neighborhood coexistence or the consumption of alcoholic beverages and other drugs in public areas, among other behaviors. The City Council of Lloret de Mar has signed an agreement with a total of eighteen nightclubs and music bars to ensure compliance with the behaviors outlined in the ordinance approved in , which has incorporated some changes this year. For example, the new text contemplates changes in the management of queues that form outside nightlife venues. According to the regulation, it will be the owners and hired staff who must work to prevent people from gathering unnecessarily at the doors of the venue, a situation that often leads to noise and disturbs the rest of the neighbors. The staff hired by the premises will not only ensure that there are no noises, disturbances, or the consumption of illegal substances in public places, but will also make sure that there are no acts of vandalism, street vending, or other illegal activities in the vicinity of those businesses. The companies will bear the economic cost of hiring between ten and twelve night leisure service assistants, contributing 75, euros. The amount has been calculated based on the total capacity of the various participating venues. On the other hand, the City Council will take on the formal hiring of these assistants, as the responsibility for public safety lies with the municipality. This is a pilot test that, if successful, could be extended between the years and Para usar nuestros servicios, es necesario que lo permitas. More than 75, euros Businesses will contribute more than 75, euros to a service that will start operating in mid-July For example, the new text contemplates changes in the management of queues that form outside nightlife venues. Pilot test If the pilot test is successful, it will be extended between the years and The companies will bear the economic cost of hiring between ten and twelve night leisure service assistants, contributing 75, euros. Al minuto.
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Archivos de Bronconeumologia is a scientific journal that preferentially publishes prospective original research articles whose content is based upon results dealing with several aspects of respiratory diseases such as epidemiology, pathophysiology, clinics, surgery, and basic investigation. Other types of articles such as reviews, editorials, a few special articles of interest to the society and the editorial board, scientific letters, letters to the Editor, and clinical images are also published in the Journal. It is a monthly Journal that publishes a total of 12 issues and a few supplements, which contain articles belonging to the different sections. The Journal is published monthly in English. Access to any published article, is possible through the Journal's web page as well as from PubMed, Science Direct , and other international databases. Furthermore, the Journal is also present in Twitter and Facebook. Authors are also welcome to submit their articles to the Journal's open access companion title, Open Respiratory Archives. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis TB. The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs standard regimen without ethambutol.. Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between and A total of patients were included, The percentage of 3-drug users among patients with positive sputum smear was A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain.. Se incluyeron 3. International 1—3 and Spanish 4—7 guidelines for the treatment of tuberculosis TB routinely recommend the standard administration of 4 drugs isoniazid, rifampicin, pyrazinamide, and ethambutol in the initial or intensive treatment phase of the disease. However, there is some debate as to whether the administration of the fourth drug ethambutol in the intensive phase can be avoided, depending on the level of resistance to antituberculous drugs in that region or the type of TB the patient presents disease site, microbiological data. The main reason for including ethambutol in the intensive phase is to initiate treatment with a sufficient number of effective drugs, in order to offset any existing resistance to first line drugs and to avoid the development of new resistances. Hence, the most important consideration when prescribing a 4-drug regimen is the national or regional resistance pattern. Nevertheless, in today's globalized world in which people constantly migrate from country to country, it is difficult to predict if a specific patient will be resistant or not. Aside from widespread population movements, TB has widely varying mechanisms for transmission, meaning that individuals with highly resistant strains can transmit the disease to groups traditionally associated with drug sensitive strains, and vice versa. For this reason, international and Spanish guidelines recommend the systematic use of 4 drugs in the intensive treatment of pulmonary TB, at least until the antibiotic resistance profiles have been established. A recent national multicenter study in tuberculosis resistance in Spain, 8 found 6. Moreover, a preliminary analysis of the use of 3 or 4 drugs in the intensive treatment of TB suggested that a high percentage of cases in Spain were treated with 3 drugs, 9 despite the indications given in different guidelines. In view of this situation, we identified the need for a study to determine if the guideline recommendations for intensive TB treatment with 4 drugs were being followed in Spain, and to identify the factors associated with prescribing only 3 drugs standard regimen without ethambutol in the intensive phase. Map of participating Autonomous Communities and percentage of patients in each Community. This was a retrospective, descriptive, multicenter study. The information obtained from all patients was stored in electronic case report forms CRF accessed by the investigators and study co-workers via a web-based computer platform using a password and user name. Survey and database completion was monitored by phone and email. All variables had been collected prospectively in CRFs, as described below: sociodemographic data age, sex, country of origin, working status, profession, living conditions, data and place of medical attention, smoking history, use of alcohol and other drugs. Associated diseases HIV, other immunosuppressive conditions. Clinical history TB history, date of onset of symptoms. Diagnostic methods date diagnostic tests requested, TB site, associated diseases, sputum smear, culture, radiology, drug sensitivity. Treatment regimen, treatment start date, planned completion date, clinical progress, treatment adherence, directly observed treatment, understanding of disease and treatment. Final treatment outcome cure, treatment completed, failure, transfer, dropout, death due to TB, death for other cause, date of death, extended treatment, lost-to-follow-up. Factors associated with the administration of 3 or 4 drugs in the initial treatment were analyzed using the stepwise selection method, including factors that reached significance in the bivariate analysis P P value of A total of patients were included in this study. The population was predominantly male ; Disease site was the lung in A total of Some values do not add up to the total number of cases, since some variables were missing. The results of the statistical analysis of the characteristics of the cases treated with 3 or 4 drugs and the factors associated with the use of only 3 drugs are shown in Tables 1 and 2 , respectively. It is interesting to note that the 4-drug regimen was administered to The 3-drug combination was administered to Univariate Analysis. The multivariate analysis confirmed that administration of the 3-drug combination was associated with being female; non-immigrant; retired; homeless, living alone or in a family using living in a group as reference ; having been treated in specialist units using treatment in the emergency room as reference ; no HIV infection; and negative sputum smear and positive culture Table 3. Multivariate Analysis. Treatment trends 3 drugs vs 4 drugs over the years Fig. After that, rates fall steadily, and by the proportion of patients receiving 3 drugs was even higher that those receiving 4. Number of patients treated annually with 3 or 4 drugs. No significant differences were observed in the clinical progress or final treatment outcome between patients receiving 3 or 4 drugs. Treatment was considered satisfactory cured or treatment completed in However, the remaining TB carriers were in a precarious situation, since they could well have had resistant strains that would not be determined until weeks later, at which stage the treatment would have to be changed. More patients with negative sputum smear The reason for this may be purely practical: after receiving a positive result from microbiology, the treating clinician knows that the lab will shortly send the resistance profile. Therefore, if the patient does have a resistant strain, there will be insufficient time to develop new resistances due to inappropriate treatment. It is interesting to note that in our study, only This practice is clinically inacceptable, since the resistance rates in immigrant patients are known to be higher than in Spanish nationals Spanish nationals received 3 drugs However, recent data published by our group 8 reveal a higher than expected rate of resistance in Spanish nationals 4. Interestingly, 75 patients with resistance to first-line drugs This may cause significant therapeutic problems for the afore-mentioned reasons and the treatment regimen may need to be amended if the resistance profile results are positive. This further highlights the need to start treatment with 4 drugs, since any patient can present drug-resistance that hampers treatment and can even extend the contagion period by delaying the effect of the treatment. The similar percentage of satisfactory treatment outcomes in patients with sensitive or resistant strains receiving 3 or 4 drugs may be explained by the fact that the Spanish TB physicians who participated in this study are specialists with extensive experience in managing this disease. Therefore, it is reasonable to assume that if resistances had developed, the physicians would have prescribed a new treatment regimen in accordance with the developing resistance, thus achieving a good final outcome for their patients. Trends in the use of the 3- or 4-drug regimen over the years of the study show an increase in the use of 4 drugs in and This may have been due to the influence of the recent at that time publication of the Spanish guidelines. However, rates have subsequently diminished, and by the proportion of patients receiving 3 drugs was even higher that those receiving 4, showing a growing trend towards ignoring TB guidelines. These data are worrying when viewed alongside the recent increase according to the latest 2 national multicenter studies 8,13 in both initial isoniazid resistance and MDR TB. Moreover, no specific studies have been performed in the Spanish Autonomous Communities which would justify the administration of 3- or 4-drug therapies on the basis of local resistance and MDR figures. Prompt treatment of new cases will have a significant impact on the dynamics of long-term transmission. Very few international studies have evaluated compliance with treatment recommendations in the intensive phase of TB. A Malaysian study reported that only The authors concluded that efforts needed to be made to achieve compliance with treatment guidelines. One of the limitations of our study is that we could not show if the use of 3 drugs generated cases of resistance, since no clinical—epidemiological or molecular disease transmission studies were performed. Nor could we demonstrate a difference in the final classification or outcome of patients treated with 3 or 4 drugs, possibly because the level of resistance in Spain is low, and because treatment was administered by physicians with expertise in the treatment of TB: if resistance was determined in the initial tests, they may have decided to switch to an effective regimen. The strength of the study is that it reflects the standard practice of a large group of TB specialists representing practically all the Spanish Autonomous Communities. Despite current TB treatment guidelines, a significant proportion of patients treated in the intensive phase receive 3 drugs It seems highly likely that a significant proportion of immigrants or non-Spanish natives, patients with positive sputum smears, and patients with initial resistance may have initially received the 3-drug regimen, exposing them to the risk of developing resistance. It is worrying to note that in the last year of the study, more patients received 3 drugs than 4. For these reasons, we recommend raising awareness of the guidelines, and call on the Plan for Prevention of Control of Tuberculosis in Spain to put in place systems for monitoring compliance with the recommendations of national and international TB treatment guidelines. Four drugs must be prescribed in the intensive phase of the disease, unless results are available from rapid resistance tests in a matter of hours. MC: statistical analysis. The authors declare that they have no conflict of interests. Altube Hospital Galdakao, Galdakao ; F. Blanquer Hospital Dr. Peset, Valencia ; L. Bustamante Hospital Sierrallana, Torrelavega ; J. Caminero Complejo Hospitalario Dr. Ciruelos Hospital de Cruces, Guetxo ; A. Lera Hospital Dr. Peset, Valencia , T. Melero Hospital 12 de Octubre, Madrid ; C. Zabaleta Hospital de Laredo, Laredo ; G. Arch Bronconeumol. ISSN: Open Access Option. Previous article Next article. Issue 5. Pages May More article options. Original Article. DOI: Download PDF. Corresponding author. This item has received. Article information. Table 1. Table 2. Univariate Analysis.. Table 3. Multivariate Analysis.. Show more Show less. Introduction International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis TB. The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs standard regimen without ethambutol. Methodology Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between and Results A total of patients were included, Conclusions A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain. Resultados Se incluyeron 3. Palabras clave:. Full Text. Introduction International 1—3 and Spanish 4—7 guidelines for the treatment of tuberculosis TB routinely recommend the standard administration of 4 drugs isoniazid, rifampicin, pyrazinamide, and ethambutol in the initial or intensive treatment phase of the disease. SS: sputum smear. Women 1. Spain 3. Unemployed 1. Family 3. Specialist unit 1. Family 1. Appendix A. Yew, C. Lange, C. Eur Respir J, 37 , pp. Ruiz Manzano, R. Blanquer, J. Calpe, J. Caminero, J. Cayla, J. Arch Bronconeumol, 44 , pp. Ministerio de Sanidad y Consumo. Consejo Interterritorial de la Salud Arch Bronconeumol, 45 , pp. Anibarro, R. Vidal, J. Esteban, S. Moreno, et al. Arch Bronconeumol, 46 , pp. Blanquer, T. Rodrigo, M. Casals, J. Ruiz Manzano, J. Calpe, et al. Arch Bronconeumol, 51 , pp. Ruiz Manzano, T. Pascual Pascual, J. Arch Bronconeumol, 50 , pp. Menzies, T. Cohen, H. Lin, M. Murray, J. Drobniewski, M. Cooke, J. Jordan, N. Casali, T. Mugwagwa, A. Broda, et al. Systematic review, meta-analysis and economic modelling of molecular diagnostic tests for antibiotic resistance in tuberculosis. Rodrigo, J. Caminero, R. Vidal, et al. Social, clinical and microbiological differential characteristics of tuberculosis among immigrants in Spain. Rev Esp Quimioter, 21 , pp. Atif, S. Sulaiman, A. Shafie, Z. Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?. Public Health, , pp. Figoni, B. Wyplosz, O. Aoun, O. Bouchaud, J. Survey of French physician practices in treatment and control of transmission of smear-positive tuberculosis. Int J Tuberc Lung Dis, 19 , pp. Kumar, A. Kumar, D. Gupta, A. Kanchar, S. Mohammed, S. Srinath, et al. Global guidelines for treatment of tuberculosis among persons living with HIV: unresolved issues. Int J Tuberc Lung Dis, 16 , pp. Subscribe to our newsletter. Recommended articles. Threats and Interventions During the Treatment of Instructions for authors Submit an article Ethics in publishing Contact. Free access articles. Article options. Are you a health professional able to prescribe or dispense drugs? Country of origin. Working status. Living conditions. Place of medical attention. Emergency room. Specialist unit. General practitioner. Drug resistance. Understanding of the disease and treatment. Year of diagnosis.
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