M Ferrer

Publications (64)360.11 Total impact

• Article: Predictors of weaning after acute respiratory failure.

  J Sellarés, M Ferrer, A Torres
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  ABSTRACT: Although weaning predictors have been extensively explored in weaning research, their use is currently under debate. From all the stages of mechanical ventilation, the measurements of weaning predictors have been considered by some authors as imperative in order to progress weaning and initiate a weaning trial. However, this practice is rejected by other authors who considered that these tests are not necessary to perform a weaning trial, based in a meta-analysis study from the American College of Chest Physicians. Among all the weaning predictors, the frequency-to-tidal volume ratio (f/VT) remains the most important predictor of weaning. Other predictors have been defined, but their narrow predictive capacity or the requirement of specific technology, have limited their use. The variability of the results obtained by the efficacy of f/VT is probably explained because in most cases weaning is initiated late, when pre-test probability of weaning success is high. In order to reduce weaning duration, weaning strategies must be performed earlier, when a failed weaning trial probably is poor tolerated and the use of f/VT could have a role. New applications of weaning predictors must be clarified in future research, in order to progress in weaning in the context of new studies. Weaning is still a challenging period during mechanical ventilation.
  Minerva anestesiologica 06/2012; 78(9):1046-53. · 2.66 Impact Factor
• Article: [Fiberoptic bronchoscopy in a respiratory intensive care unit].

  C M Lucena, P Martínez-Olondris, J R Badia, A Xaubet, M Ferrer, A Torres, C Agustí
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  ABSTRACT: To describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). A prospective, observational study was carried out. A 6-bed RICU in a tertiary university hospital. Patients admitted to RICU who required FOB. None. FOB indications and complications, endoscopic procedures, time required to perform FOB. Sixty-nine out (23%) of the 297 patients admitted to the RICU underwent a total of 107 FOB. Sixty-eight percent of FOB were performed in patients on mechanical ventilation. FOB was performed for diagnostic and therapeutic purposes in 88 (82%) and 19 cases (18%), respectively. The study of pulmonary infiltrates was the main indication for diagnostic FOB (44 cases; 50%), particularly in immunocompromised patients (24 cases; 27%). In immunocompromised patients the diagnostic performance of FOB was significantly higher than in immunocompetent subjects (48% vs 30%; p<0.01). No major complications were recorded. Only a significant drop in PaO(2)/FiO(2) ratio was observed (182 ± 74 vs 163 ± 79; p<0.005) in patients undergoing bronchoalveolar lavage. Overall mortality in patients in the RICU was 14%. In patients requiring a single FOB procedure, mortality was 25%, versus 45% among those requiring more than one FOB procedure. These results show that FOB is used commonly in the RICU. It is a safe and fast procedure that contributes significantly to clinical management. Patients requiring additional FOB during admission to the RICU show high mortality.
  Medicina Intensiva 12/2011; 36(6):389-95. · 1.07 Impact Factor
• Article: The use of non-invasive ventilation by Italian physicians in the clinical practice.

  M Ferrer, J Sellares, A Torres
  Minerva anestesiologica 10/2011; 77(10):941-2. · 2.66 Impact Factor
• Article: The effect of spontaneous breathing on systemic interleukin-6 during ventilator weaning.

  J Sellarés, H Loureiro, M Ferrer, R Amaro, R Farré, A Torres
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  ABSTRACT: During the weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate weaning, together with the potential clinical implications.
  European Respiratory Journal 07/2011; 39(3):654-60. · 5.89 Impact Factor
• Article: Respiratory impedance during weaning from mechanical ventilation in a mixed population of critically ill patients.

  J Sellares, I Acerbi, H Loureiro, R L Dellaca, M Ferrer, A Torres, D Navajas, R Farre
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  ABSTRACT: Worsening of respiratory mechanics during a spontaneous breathing trial (SBT) has been traditionally associated with weaning failure, although this finding is based on studies with chronic obstructive pulmonary disease patients only. The aim of our study was to assess the course of respiratory impedance non-invasively measured by forced oscillation technique (FOT) during a successful and failed SBT in a mixed population. Thirty-four weaning trials were reported in 29 consecutive mechanically ventilated patients with different causes of initiation of ventilation. During the SBT, the patient was breathing through a conventional T-piece connected to the tracheal tube. FOT (5 Hz, +/- 1 cm H(2)O, 30 s) was applied at 5, 10, 15, 20, 25, and 30 min. Respiratory resistance (Rrs) and reactance (Xrs) were computed from pressure and flow measurements. The frequency to tidal volume ratio f/V(t) was obtained from the flow signal. At the end of the trial, patients were divided into two groups: SBT success and failure. Mixed model analysis showed no significant differences in Rrs and Xrs over the course of the SBT, or between the success (n=16) and the failure (n=18) groups. In contrast, f/V(t) was significantly (P<0.001) higher in the failure group. Worsening of respiratory impedance measured by FOT is not a common finding during a failed SBT in a typically heterogeneous intensive care unit population of mechanically ventilated patients.
  BJA British Journal of Anaesthesia 11/2009; 103(6):828-32. · 4.24 Impact Factor
• Source

  Available from: harol.it

  Article: Non-invasive ventilation in the weaning process.

  M Ferrer
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  ABSTRACT: Patients with chronic airflow obstruction and difficulty in weaning from mechanical ventilation are at increased risk for intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Non-invasive ventilation (NIV) may avert most of the pathophysiologic mechanisms associated with weaning failure in these patients. Several randomised controlled trials have shown that the use of NIV in order to advance extubation in difficult patients can result in reduced periods of endotracheal intubation, complication rates and survival. The published data with the outcome as a primary variable are nearly exclusively from patients who had pre-existing lung disease. In addition, the patients were hemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. The use of NIV in the management of respiratory failure after extubation did not show clinical benefits, although clinical trials included a small proportion of chronic respiratory patients. In contrast, NIV immediately after extubation is effective in avoiding respiratory failure after extubation in patients at risk for this complication, particularly those with chronic respiratory disorders and hypercapnic respiratory failure.
  Minerva anestesiologica 07/2008; 74(6):311-4. · 2.66 Impact Factor
• Article: The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) project: rationale and methods

  J. Alonso, M. Ferrer, B. Romera, G. Vilagut, M. Angermeyer, S. Bernert, T.S. Brugha, N. Taub, Z. Mccolgen, G. De Girolamo, [......], J. M. Haro, C. Palacín, J. Autonell, S. J. Katz, R.C. Kessler, V. Kovess, J.P. Lépine, S. Arbabzadeh-Bouchez, J. Ormel, R. Bruffaerts
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  ABSTRACT: The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) is a new cross-sectional study investigating the prevalence and the associated factors of mental disorders, as well as their effect on health-related quality of life and the use of services in six European countries. This paper describes the rationale, methods and the plan for the analysis of the project.A total of 22,000 individuals representative of the non-institutionalized population aged 18 and over from Belgium, France, Germany, Italy, the Netherlands and Spain are being interviewed in their homes. Trained interviewers use a computer-assisted personal interview (CAPI) including the most recent version of the Composite International Diagnostic Interview (CIDI, 2000), a well-established epidemiological survey for assessing mental disorders.This is the first international study using the standardized up-to-date methodology for epidemiological assessment. Sizeable differences in prevalence, impact and level of need that is met by the health services are expected.The analysis of these differences should facilitate the monitoring of ongoing mental health reform initiatives in Europe and provide new research hypotheses. Copyright © 2002 Whurr Publishers Ltd.
  International Journal of Methods in Psychiatric Research. 03/2006; 11(2):55 - 67.
• Chapter: Non-invasive Ventilation for Respiratory Failure after Extubation

  J. Sellares, M. Ferrer, A. Torres
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  ABSTRACT: Mechanical ventilation is a life-support procedure widely used in patients with severe respiratory failure. Despite its benefits, this technique is associated with various complications that can be classified into three categories [1, 2]: 1) those directly related to the process of intubation and mechanical ventilation; 2) those caused by the loss of airway defence mechanisms, mainly ventilator-associated pneumonia (VAP), with an important mortality rate [3, 4]; and 3) post-extubation complications. When clinicians decide to proceed to withdraw mechanical ventilation, they have to assess different weaning parameters, trying to avoid unnecessary delays and to assure the success of this process 5. Although a large number of patients who have recovered from the episode of acute respiratory failure may be successfully extubated, 6 to 23% of them will need re-intubation within 48 to 72 hours after extubation [6, 7], with remarkable consequences on their clinical outcomes [6, 8]. We will review the impact and the etiology of respiratory failure after extubation, as well as the use of non-invasive ventilation (NIV) in the management and prevention of respiratory failure after extubation.
  12/2005: pages 494-501;
• Article: Non-invasive ventilation as a weaning tool.

  M Ferrer
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  ABSTRACT: Patients with chronic airflow obstruction and difficult weaning from mechanical ventilation are at increased risk for intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Non-invasive positive-pressure ventilation (NPPV) may revert most of the pathophysiologic mechanisms associated with weaning failure in these patients. Several randomised controlled trials have shown that the use of NPPV in order to advance extubation in difficult to wean patients can result in reduced periods of endotracheal intubation, complication rates and survival. The published data with outcome as a primary variable is nearly exclusively from patients who had pre-existing lung disease. In addition the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. It remains to be seen whether NPPV has a role in other patients' groups and situations. The technique is however a usual addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.
  Minerva anestesiologica 07/2005; 71(6):243-7. · 2.66 Impact Factor
• Source

  Available from: bmj.com

  Article: Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study.

  M Miravitlles, M Ferrer, A Pont, R Zalacain, J L Alvarez-Sala, F Masa, H Verea, C Murio, F Ros, R Vidal
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  ABSTRACT: A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD). A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV(1)) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George's Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals. A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV(1) 35-50% predicted); the change in SGRQ total score of moderate patients with > or =3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV(1) <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001). Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed.
  Thorax 06/2004; 59(5):387-95. · 6.84 Impact Factor
• Article: 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

  J Alonso, M C Angermeyer, S Bernert, R Bruffaerts, T S Brugha, H Bryson, G de Girolamo, R Graaf, K Demyttenaere, I Gasquet, [......], S S Joo, M Martínez-Alonso, H Matschinger, F Mazzi, Z Morgan, P Morosini, C Palacín, B Romera, N Taub, W A M Vollebergh
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  ABSTRACT: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.
  Acta psychiatrica Scandinavica. Supplementum 02/2004;
• Article: Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

  J Alonso, M C Angermeyer, S Bernert, R Bruffaerts, T S Brugha, H Bryson, G de Girolamo, R Graaf, K Demyttenaere, I Gasquet, [......], S S Joo, M Martínez-Alonso, H Matschinger, F Mazzi, Z Morgan, P Morosini, C Palacín, B Romera, N Taub, W A M Vollebergh
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  ABSTRACT: This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries. The ESEMeD study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an in-home computer-assisted interview. Common mental disorders, work loss days (WLD) in the past month and quality of life (QoL) were assessed, using the WMH-2000 version of the CIDI, the WHODAS-II, and the mental and physical component scores (MCS, PCS) of the 12-item short form, respectively. The presence of five chronic physical disorders: arthritis, heart disease, lung disease, diabetes and neurological disease was also assessed. Multivariate regression techniques were used to identify the independent association of mental and physical disorders while controlling for gender, age and country. In each country, WLD and loss of QoL increased with the number of disorders. Most mental disorders had approximately 1.0 SD-unit lower mean MCS and lost three to four times more work days, compared with people without any 12-month mental disorder. The 10 disorders with the highest independent impact on WLD were: neurological disease, panic disorder, PTSD, major depressive episode, dysthymia, specific phobia, social phobia, arthritis, agoraphobia and heart disease. The impact of mental vs. physical disorders on QoL was specific, with mental disorders impacting more on MCS and physical disorders more on PCS. Compared to physical disorders, mental disorders had generally stronger 'cross-domain' effects. The results suggest that mental disorders are important determinants of work role disability and quality of life, often outnumbering the impact of common chronic physical disorders.
  Acta psychiatrica Scandinavica. Supplementum 02/2004;
• Source

  Available from: Josue Almansa

  Article: Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

  J Alonso, M C Angermeyer, S Bernert, R Bruffaerts, T S Brugha, H Bryson, G de Girolamo, R Graaf, K Demyttenaere, I Gasquet, [......], S S Joo, M Martínez-Alonso, H Matschinger, F Mazzi, Z Morgan, P Morosini, C Palacín, B Romera, N Taub, W A M Vollebergh
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  ABSTRACT: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.
  Acta psychiatrica Scandinavica. Supplementum 02/2004;
• Source

  Available from: Josue Almansa

  Article: Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

  J Alonso, M C Angermeyer, S Bernert, R Bruffaerts, T S Brugha, H Bryson, G de Girolamo, R Graaf, K Demyttenaere, I Gasquet, [......], S S Joo, M Martínez-Alonso, H Matschinger, F Mazzi, Z Morgan, P Morosini, C Palacín, B Romera, N Taub, W A M Vollebergh
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  ABSTRACT: To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.
  Acta psychiatrica Scandinavica. Supplementum 02/2004;
• Article: Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

  J Alonso, M C Angermeyer, S Bernert, R Bruffaerts, T S Brugha, H Bryson, G de Girolamo, R Graaf, K Demyttenaere, I Gasquet, [......], S S Joo, M Martínez-Alonso, H Matschinger, F Mazzi, Z Morgan, P Morosini, C Palacín, B Romera, N Taub, W A M Vollebergh
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  ABSTRACT: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.
  Acta psychiatrica Scandinavica. Supplementum 02/2004;
• Source

  Available from: Johan Ormel

  Article: Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

  J Alonso, M C Angermeyer, S Bernert, R Bruffaerts, T S Brugha, H Bryson, G de Girolamo, R Graaf, K Demyttenaere, I Gasquet, [......], S S Joo, M Martínez-Alonso, H Matschinger, F Mazzi, Z Morgan, P Morosini, C Palacín, B Romera, N Taub, W A M Vollebergh
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  ABSTRACT: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.
  Acta psychiatrica Scandinavica. Supplementum 02/2004;
• Article: 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

  J. Alonso, M.C. Angermeyer, S. Bernert, R. Bruffaerts, T.S. Brugha, H. Bryson, G. de Girolamo, R. de Graaf, K. Demyttenaere, I. Gasquet, [......], S.S. Joo, M. Martinez-Alonso, H. Matschinger, F. Mazzi, Z. Morgan, P. Morosini, C. Palacin, B. Romera, N. Taub, W.A.M. Vollebergh
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  ABSTRACT: Objective: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. Method: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged IS years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. Results: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nation ally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. Conclusion: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity
  Acta Psychiatrica Scandinavica. 01/2004; 109:28-37.
• Article: Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

  J. Alonso, M.C. Angermeyer, S. Bernert, R. Bruffaerts, I.S. Brugha, H. Bryson, G. de Girolamo, R. de Graaf, K. Demyttenaere, I. Gasquet, [......], S.S. Joo, M. Martinez-Alonso, H. Matschinger, F. Mazzi, Z. Morgan, P. Morosini, C. Palacin, B. Romera, N. Taub, W.A.M. Vollebergh
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  ABSTRACT: Objective: To assess psychotropic drug utilization in the general population of six European countries, and the pattern Of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. Method: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium. France, Germany, Italy.. the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. Results: Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression. only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). Conclusion: These data question the appropriateness Of Current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics
  Acta Psychiatrica Scandinavica. 01/2004; 109:55-64.
• Article: Treatment and quality of life in patients with chronic obstructive pulmonary disease.

  M Miravitlles, J L Alvarez-Sala, R Lamarca, M Ferrer, F Masa, H Verea, R Zalacain, C Murio, F Ros
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  ABSTRACT: Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting beta-2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting beta-2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score (beta = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting beta-2 agonists (beta = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs (beta = 6.1, p < 0.001; and beta = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.
  Quality of Life Research 06/2002; 11(4):329-38. · 2.30 Impact Factor
• Article: Treatment and quality of life in patients with chronic obstructive pulmonary disease

  M. Miravitlles, J.L. Alvarez-Sala, R. Lamarca, M. Ferrer, F. Masa, H. Verea, R. Zalacain, C. Murio, F. Ros, R. Vidal
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  ABSTRACT: Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting -2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting -2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score ( = 4.49; p < 0.001),="" although="" this="" negative="" association="" decreased="" with="" advanced="" age.="" a="" trend="" towards="" worse="" sgrq="" scores="" was="" observed="" with="" the="" use="" of="" high="" doses="" of="" long-acting="">-2 agonists ( = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs ( = 6.1, p < 0.001;="" and=""> = 7.64, p < 0.001,="" respectively).="" these="" findings="" suggest="" that="" the="" use="" of="" multiple="" drugs="" in="" the="" treatment="" of="" patients="" with="" copd="" is="" associated="" with="" worse="" total="" sgrq="" scores.="" the="" effect="" of="" drugs,="" their="" dosages="" and="" associations="" with="" other="" drugs="" on="" hrql="" merit="" further="">
  Quality of Life Research 05/2002; 11(4):329-338. · 2.30 Impact Factor