Trend and Seasonality of Hip Fractures in Catalonia, Spain: Exploring the Influence of Climate.

To describe the secular trend and seasonality of the incidence of hip fracture (HF) and its relationship with climatic variables during the period 2010-2019 in Catalonia in people aged ≥ 65 years. The results were analyzed by sex, age groups (65-74, 75-84, and ≥ 85), and types of fracture (extracapsular and intracapsular). Data on sex, age, type of fracture, year, and month of hospitalization of patients admitted with a diagnosis of HF between January 1, 2010 and December 31, 2019 were collected. Crude and standardized HF incidence (HFi) rates were obtained. Data on the monthly mean of climatological variables (temperature, insolation, icy days, rain, relative humidity, atmospheric pressure, and wind force) were obtained from the network of meteorological stations in Catalonia. Time series analytical statistics were used to identify trends and seasonality. Linear regression and a seasonal autoregressive integrated moving average (ARIMA) were used to analyze the relationship of each climatic parameter with fracture rates. In addition, generalized additive models were used to ascertain the best predictive model. The total number of HF episodes was 90,149 (74.1% in women and 25.9% in men). The total number of HFs increased by 6.4% between 2010 and 2019. The median age (SD) was 84.5 (7.14) and 54% of patients were ≥ 85 years of age. Extracapsular fractures were the most common (55%). The standardized incidence rates decreased from 728.1/100,000 (95% CI 738.6-769.3) to 624.5/100,000 (95% CI 648.7-677.0), which represents a decrease of 14.2% (p < 0.05). The decline was greater at older ages. There were seasonal variations, with higher incidences in autumn (27.2%) and winter (25.7%) and lower rates in summer (23.5%) and spring (23.6%). Seasonality was more pronounced in elderly people and men. In the bivariate regression analysis, high temperatures and greater insolation were negatively associated with the HF rate, while the number of icy days, rainy days, and high relative humidity were associated with a higher incidence of fractures in all age groups and sexes. In the regression analysis using the seasonal ARIMA model, only insolation had a consistently significant association with overall HFi, after adjusting by trend and other climatic parameters. While the global number of HFs grew in Catalonia due to increases in the elderly population, the standardized HF rate decreased during the years 2010-2019. There was a seasonal trend, with predominance in the cold months and correlations with climatic parameters, especially with insolation.

Impact of major osteoporotic fractures on the use of healthcare resources in Catalonia, Spain.

OBJECTIVES: To estimate the impact of first major osteoporotic fractures (MOF) on health resource use and healthcare expenditures in people aged ≥50 years in Catalonia, Spain. DESIGN: Observational, retrospective study. The Catalan Health Surveillance System (CHSS) registry was used to obtain sociodemographic, clinical and expenditure data from all public centres in Catalonia (Spain). SETTING AND PARTICIPANTS: Males and females aged ≥50 years who sustained a first major osteoporotic fracture between January 1, 2018, and December 31, 2020. METHODS: Data on admissions to the emergency department, hospitalization and skilled nursing facilities, primary and specialized care visits, nonemergency medical transport, outpatient rehabilitation and pharmacy prescriptions were retrieved for each patient. Monthly and yearly mean usage rates, expenditure in euros (€) and incremental costs one and two years after fracture were calculated. RESULTS: There were 64,403 patients with first MOF: 47,555 females and 16,848 males with a mean age (standard deviation) of 76.5 (12.0) years. The average annual expenditure increased from €4564 in the year before to €12,331 in the year following a hip fracture. For forearm fractures, the expenditure increased from €2511 to €4251, for vertebral fractures from €4146 to €6659, for pelvic fractures from €4442 to €7124, for humerus fractures from €3058 to €5992, and for multiple fractures from €4598 to €12,028. The average cost for overall fractures experienced a 110.3 % increase. The leading cause of health expenditure in the year following MOF was hospital admission. Expenditure in the second year post-fracture returned to pre-fracture levels. The use of some healthcare resources, especially visits to emergency services, increased in the prefracture month. Male sex, older age and high previous comorbidities were associated with a higher expenditure. CONCLUSIONS: In people with a first MOF, healthcare expenditure doubled during the first-year post-facture, mostly in relation to inpatient care. The healthcare resource use increased during the previous month. This increase could potentially be attributed to the worsening of pre-existing comorbidities.

Effects of COVID-19 confinement on the incidence and mortality of major osteoporotic fractures: an observational study in Catalonia, Spain.

There is little information on how the COVID-19 lockdown influenced the epidemiology of major osteoporotic fractures (MOF). We analyzed the incidence and mortality of MOF in 2020 compared with 2018-2019 in Catalonia, Spain. The incidence of MOF decreased steeply, and post-fracture mortality increased during the lockdown and throughout 2020. PURPOSE: To analyze the effect of the COVID-19 pandemic and lockdown on major osteoporotic fracture (MOF) incidence and mortality in Catalonia in 2020 and describe how age, sex, and the prior comorbidity burden influenced the epidemiology of MOF types. METHODS: In this retrospective observational study, data on age and sex in people aged ≥ 50 years with a new diagnosis of MOF in 2018, 2019, and 2020 were collected. Average daily rates (ADR) were estimated overall and for five MOF: hip, distal forearm, proximal humerus, vertebrae, and pelvis. Morbidity was assessed using Adjusted Morbidity Groups. ADR in 2020 and the previous years were compared for overall and site-specific MOF in four consecutive time periods: pre-confinement, lockdown, deconfinement, and post-confinement. Thirty-day post-fracture mortality was assessed. COVID-19-related mortality was obtained from the Catalan COVID-19 register. RESULTS: From 2018 to 2020, there were 86,412 MOF. The ADR of MOF initially increased in 2020 before the pandemic, decreased steeply during lockdown, and remained lower in the rest of the year. The decrease was steeper in vertebral, pelvic and arm fractures, and lower in hip fractures. Differences were more pronounced in younger age groups and people with fewer comorbidities. Mortality increased throughout 2020, reaching a 2.5-fold increase during lockdown. Excess mortality was directly associated with COVID-19. CONCLUSIONS: Mobility restrictions due to COVID-19 were associated with a reduction in MOF incidence in Catalonia, especially in younger people and in non-hip fractures. Post-fracture mortality was higher than in previous years due to the high COVID-19 mortality in the elderly.

Epidemiology of major osteoporotic fractures: a population-based analysis in Catalonia, Spain.

PURPOSE: The aim of this study was to estimate the incidence of major osteoporotic fractures in Catalonia, Spain, in 2018 and 2019 and their association with age, sex, income, climate and a set of comorbidities. METHODS: Data on age, sex, smoking, alcohol abuse, comorbidities (obesity, Parkinson's disease, arthritis, chronic kidney disease, hepatic cirrhosis, diabetes, chronic obstructive pulmonary disease, dementia, cerebrovascular disease, hyperthyroidism, multiple myeloma and epilepsy) and income levels in people aged ≥ 50 years with a new diagnosis of major osteoporotic fractures in 2018 and 2019 were collected from the Catalan Health Surveillance System (CHSS). Climatological variables were obtained from the Catalan Meteorological Service. Incidence rates were estimated for five major osteoporotic fractures (MOF). Associations between osteoporotic fractures and age, sex, income, comorbidities and climate variables were ascertained through multilevel generalized linear model analysis (Poisson's regression). RESULTS: There were 60,671 MOF. The annual incidence rate per 1000 persons/years at risk (PYAR) was 10.6 (3.1 for hip, 2.3 for distal forearm, 2.2 for vertebrae, 1.7 for pelvis and 1.5 for proximal humerus). Female sex, older age, lower income, smoking, alcohol abuse and some common comorbidities were associated with a higher incidence of MOF while obesity was a protective factor. CONCLUSIONS: MOF are frequent in the adult Catalan population, especially in older women and people on low incomes. Hip fracture is the most frequent, followed by forearm and vertebral fractures. Smoking, alcohol abuse and some comorbidities were associated with an increased incidence of fracture.

Impact of school-based nutrition and physical activity intervention on body mass index eight years after cessation of randomized controlled trial (AVall study).

BACKGROUND & AIMS: The prevalence of obesity and overweight among children is increasing, representing a new and pressing societal problem. Excess weight in childhood is an independent risk factor for adult obesity. Although school-based interventions are generally considered effective in the short term, few studies analyze their longterm impact. The aim of study was to assess if the effect of the intervention on body mass Index (BMI) immediately after the intervention remained eight years later (AVall Study). METHODS: In 2006-2008, an intervention for primary school children promoted healthy eating habits and physical activity in the school setting using the Investigation, Vision, Action and Change (IVAC) educational methodology, which involves children as active participants in healthy change. At baseline, parents reported their weight, height and educational level by questionnaire. Children's weight and height were measured in situ in 2006, 2008, 2010, 2012 and 2016, and levels of physical activity were assessed by questionnaire. Multilevel mixed effects linear regression was used to assess changes in BMI over time. RESULTS: Increases in BMI from 2006 to 2016 were 0.68 kg/m2 (95% CI, 0.02, 1.34; P = 0.045) higher in the control group than in the intervention group. The prevalence of obesity and overweight combined in 2006 and 2016 was 22.2% and 27.9%, respectively, in the control group and 25.6% and 21.2% respectively, in the intervention group. Changes in BMI in the intervention group were maintained from 2006 on: at the end of the intervention in 2008, -0.4 kg/m2 (P = 0.001); in 2010, -0.23 g/m2 (P = 0.012); in 2012, -0.63 kg/m2 (P < 0.001) and in 2016, -0.27 kg/m2 (P = 0.025). The child's BMI increased by 0.52 kg/m2 (P = 0.046) if the father was obese, by 1.26 kg/m2 (p = 0.011) if the mother was obese, and by 2.37 kg/m2 (P < 0.001) if both parents were obese. Parental education levels were not associated with childhood obesity. CONCLUSIONS: A school-based healthy eating habits and physical activity intervention using IVAC methodology contributed to lower increases in BMI among children in primary school. Although parental BMI also influenced children's BMI, the intervention was effective. TRIAL REGISTRATION: ClinicalTrials.gov NCT01156805.

Does health education affect BMI? Evidence from a school-based randomised-control trial.

We examine the effects of a comprehensive school-based health education programme (introducing healthy habits in the curriculum) to combat childhood obesity in the mid-size urban city of Granollers (Catalonia, Spain). The intervention was carried out between 2006 and 2008. New anthropometric measurements were obtained in 2008, 2010 and 2012. The length of the intervention evaluation constitutes a valuable contribution to the existing literature. Data refers to 509 schoolchildren aged 6 years old from 16 schools that were randomly assigned to either the intervention group or to the control group. Our results indicate that children's BMI in the treatment group was reduced by 1.13 kg/m(2) four years after the intervention, representing on average and for an average height, a loss of 1.6 kg. We examine heterogeneity and find that most effect is driven by children coming from disadvantaged backgrounds whilst no differences were obtained differentiating by gender.

[Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit]. / Impacto asistencial tras la introducción de la ecografía tiroidea en una unidad monográfica de atención al nódulo tiroideo.

INTRODUCTION: Worldwide incidence of thyroid cancer has increased in recent decades. OBJECTIVE: To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation. PATIENTS AND METHODS: Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed. RESULTS: A total of 1036 patients [P1: 537 (52%), P2: 499 (48%)] were seen and enrolled. Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p<0.001; FNA number/nodule: 1.68 vs 1.17, p<0.001; percent FNAs with inadequate material: 26% vs 5.3%, p<0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10mm in size: 9.9% vs 13.7%, p 0.030. Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p<0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p<0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p=0.002. CONCLUSION: A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.

Medium-term evaluation of an educational intervention on dietary and physical exercise habits in schoolchildren: the Avall 2 study.

OBJECTIVE: To assess whether the benefits seen in nutrition, physical activity. and body mass index were maintained at 2 years of completion of the educational intervention. MATERIAL AND METHODS: An experimental, longitudinal, 4-year, two-arm, parallel study with cluster randomization to assess an intervention program aimed at children in their first year of primary schooling attending schools in the city of Granollers. Intervention consisted of promoting healthy dietary habits and increasing physical activity through the educational pedagogy Investigation, Vision, Action and Change (IVAC), applied over 2 school years (2006-2008). Weight and height of each child wee measured in situ, and families self-completed a physical activity survey and the Krece Plus quick test in 2006, 2008, and 2010. RESULTS: A greater increase in body mass index was seen in 2010 in children from the control group (2.84 ± 0.22 vs 1.96 ± 0.163 kg/m(2), <.001). Prevalence of overweight and obesity increased by 8% and 0.5% respectively in schoolchildren in the control group, while the intervention group showed a 5.3% increase in prevalence of overweight and a 3.6%decrease in prevalence of obesity. Prevalence of excess weight therefore increased by 8.5% in the control group and by 1.8% in the intervention group. Reduction in body mass indexincrease was maintained 2 years after completion of educational intervention regardless of sex, origin, maternal obesity, and educational level of parents. CONCLUSIONS: These results confirm that school-based interventions may help contain the current increase in childhood obesity.

Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study.

BACKGROUND: Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. OBJECTIVE: To evaluate the efficacy of an intervention on food habits and physical activity in school children. METHODS: A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5-6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. RESULTS: Two years after the beginning of the study, the body mass index of the children in the control group was 0.8 kg/m(2) higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. CONCLUSIONS: The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.

[Weight, dietary patterns and exercise habits in first-year primary school children: the AVall study]. / Estado ponderal, hábitos alimentarios y de actividad física en escolares de primer curso de educación primaria: estudio AVall.

OBJECTIVE: To evaluate weight, dietary patterns and exercise habits in children attending the first year of primary school in the city of Granollers (Spain). METHODS: We performed a cross-sectional study of children enrolled in the schools of the city of Granollers. All the children were born in 2000. Data were collected from September to October 2006. Weight and height were measured in each schoolchild. The parents completed a questionnaire on the frequency of food intake and physical activity and the Krece Plus test. The International Obesity Task Force cut-offs for body mass index were used to define overweight and obesity. RESULTS: A total of 566 schoolchildren were included. The prevalence of overweight was 19.6% and that of obesity was 8.5%. Only 3.8% of the children had an adequate breakfast and 17.1% ate five portions of fruit and vegetables a day. Some families consumed a low amount of fruit (22%), vegetables (37%), bread/pasta/ rice/cereals (14%), fish (32%), legumes (13%) and nuts (9%). Children who had lunch at school ate more fruits (38% vs 29%), vegetables (35% vs 25%) and fish (82% vs 73%) than those who did not have lunch at school. A total of 82% of the schoolchildren exercised regularly. CONCLUSIONS: A quarter of the children who participated in the study were overweight. The schoolchildren who had lunch at school had better dietary patterns. Inappropriate family habits can determine children's dietary habits.