The social and psychological impact of dysphagia has not been routinely reported in large studies. We sought to determine the effects of dysphagia on broad measures of the quality of life of patients and to explore the relationship between the psychological handicaps of the condition and the frequency of diagnosis and treatment. A total of 360 patients selected on the basis of known subjective dysphagia complaints, regardless of origin, in nursing homes and clinics in Germany, France, Spain, and the United Kingdom were interviewed using an established questionnaire. Qualitative interviews with a total of 28 health professionals were conducted to improve understanding of the patient data in the context of each country. Over 50% of patients claimed that they were "eating less" with 44% reporting weight loss during the preceding 12 months. Thirty-six percent of patients acknowledged receiving a confirmed diagnosis of dysphagia; only 32% acknowledged receiving professional treatment for it. Most people with dysphagia believe their condition to be untreatable; only 39% of the sufferers believed that their swallowing difficulties could be treated. Eighty-four percent of patients felt that eating should be an enjoyable experience but only 45% actually found it so. Moreover, 41% of patients stated that they experienced anxiety or panic during mealtimes. Over one-third (36%) of patients reported that they avoided eating with others because of their dysphagia. In a largely elderly population that might accept dysphagia as an untreatable part of the aging process, clinicians need to be aware of the adverse effects of dysphagia on self-esteem, socialization, and enjoyment of life. Careful questioning should assess the impact of the condition on each patient's life, and patients should be educated on their choices for treatment in the context of any coexisting illness. Awareness of the condition, diagnostic procedures, and treatment options must be increased in society and among the medical profession.

The rate of functional problems after transoral laser surgery did not greatly decrease compared with the rate after the conventional procedure. The mayor advantage of the transoral approach was the lower incidence of temporary tracheotomies.

There has been an enormous increase in ADHD medication consumption in Castilla y León in the last few years; increase rocketed when extended-release methylphenidate was marketed. A rapid increase in the consumption is a warning on possible overdiagnosis and inappropriate prescription.

There has been an increase of anti-ulcer drug consumption in Spain. A high proportion of this consumption may be due to the use of those drugs as gastroprotective agents when co-prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to learn how these treatments are being used: the prevalence of use, the type of drug and the main features of patients. A sample of patients going to pharmacies with a NSAID prescription, with or without a gastroprotective agent, was obtained. A survey questionnaire was distributed to learn clinical and demographic data of the patients. Of the 942 patients interviewed, 41.6% were co-treated with a gastroprotective agent in addition to the NSAID. Most of these patients received proton-pump inhibitors and, to a lesser extent, histamine-2-receptor antagonists, antacids and prostaglandin analogues. The use of gastroprotective agents increased with age, treatment duration and illness chronicity; specialists prescribed a higher proportion of those co-treatments than did general practitioners. There was a high prescription rate of gastroprotective agents; in general, these were used according to recommendations. However, the type of gastroprotective agents being used does not seem to be justified by the current guidelines: histamine-2-receptor antagonists and antacid drugs have not proved their efficacy in this indication. The fact that one in four treatments with gastroprotective drugs was issued to patients without associated risk factors identifies a possible problem where an intervention could be appropriate.

No abstract