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1.
Nefrologia (Engl Ed) ; 43(3): 360-369, 2023.
Article in English | MEDLINE | ID: mdl-37635013

ABSTRACT

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69, ≥70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus , Male , Humans , Female , Cardiovascular Diseases/epidemiology , Risk Factors , Life Style , Diabetes Mellitus/epidemiology , Comorbidity
2.
Clin Investig Arterioscler ; 34(4): 219-228, 2022.
Article in English, Spanish | MEDLINE | ID: mdl-35906022

ABSTRACT

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global cardiovascular disease risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (steps 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After step 1, considering proceeding to the intensified goals of step 2 is mandatory, and this intensification will be based on 10-year cardiovascular disease risk, lifetime cardiovascular disease risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm ?SCORE2, SCORE2-OP? is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal cardiovascular disease events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according to different age groups (<50, 50-69, ≥70 years). Different flow charts of cardiovascular disease risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic cardiovascular disease, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus , Aged , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Cholesterol, LDL , Diabetes Mellitus/therapy , Female , Humans , Life Style , Male , Middle Aged , Risk Factors
3.
Rev Esp Salud Publica ; 962022 Mar 01.
Article in Spanish | MEDLINE | ID: mdl-35228510

ABSTRACT

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm (SCORE2, SCORE-OP) is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (<50, 50-69, >70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.


Presentamos la adaptación española de las Guías Europeas de Prevención Cardiovascular 2021. En esta actualización además del abordaje individual, se pone mucho más énfasis en las políticas sanitarias como estrategia de prevención poblacional. Se recomienda el cálculo del riesgo vascular de manera sistemática a todas las personas adultas con algún factor de riesgo vascular. Los objetivos terapéuticos para el colesterol LDL, la presión arterial y la glucemia no han cambiado respecto a las anteriores guías, pero se recomienda alcanzar estos objetivos de forma escalonada (etapas 1 y 2). Se recomienda llegar siempre hasta la etapa 2, y la intensificación del tratamiento dependerá del riesgo a los 10 años y de por vida, del beneficio del tratamiento, de las comorbilidades, de la fragilidad y de las preferencias de los pacientes. Las guías presentan por primera vez un nuevo modelo para calcular el riesgo (SCORE2 y SCORE2 OP) de morbimortalidad vascular en los próximos 10 años (infarto de miocardio, ictus y mortalidad vascular) en hombres y mujeres entre 40 y 89 años. Otra de las novedades sustanciales es el establecimiento de diferentes umbrales de riesgo dependiendo de la edad (<50, 50-69, >70 años). Se presentan diferentes algoritmos de cálculo del riesgo vascular y tratamiento de los factores de riesgo vascular para personas aparentemente sanas, pacientes con diabetes y pacientes con enfermedad vascular aterosclerótica. Los pacientes con enfermedad renal crónica se considerarán de riesgo alto o muy alto según la tasa del filtrado glomerular y el cociente albúmina/creatinina. Se incluyen innovaciones en las recomendaciones sobre los estilos de vida, adaptadas a las recomendaciones del Ministerio de Sanidad, así como aspectos novedosos relacionados con el control de los lípidos, la presión arterial, la diabetes y la insuficiencia renal crónica.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Diabetes Mellitus/prevention & control , Female , Humans , Life Style , Male , Middle Aged , Risk Factors , Spain
4.
Clin Investig Arterioscler ; 33(2): 85-107, 2021.
Article in English, Spanish | MEDLINE | ID: mdl-33495044

ABSTRACT

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.


Subject(s)
Cardiovascular Diseases/prevention & control , Life Style , Practice Guidelines as Topic , Cardiovascular Diseases/etiology , Diet , Exercise , Health Promotion , Heart Disease Risk Factors , Humans , Medication Adherence , Smoking Cessation , Spain
5.
Child Care Health Dev ; 47(1): 94-102, 2021 01.
Article in English | MEDLINE | ID: mdl-33150963

ABSTRACT

BACKGROUND: The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia. METHODS: The Catalan Institute of Statistics provided a random sample of 0 to 14-year-old non-institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi-square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used. RESULTS: In 0 to 14-year-old children, a 12.9% (95% confidence interval [CI] [11.8-13.9]) prevalence of correctable visual impairment was observed. The prevalence of non-correctable visual impairment was 0.9% (95% CI [0.6-1.2]). Non-correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3-14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3-71.5]) among those with correctable visual impairment. When parents have a university degree or non-manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non-manual profession. CONCLUSIONS: For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non-correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status.


Subject(s)
Social Class , Vision Disorders , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Health Surveys , Humans , Infant , Infant, Newborn , Prevalence , Socioeconomic Factors , Spain/epidemiology , Vision Disorders/epidemiology
6.
Hipertens Riesgo Vasc ; 38(1): 21-43, 2021.
Article in Spanish | MEDLINE | ID: mdl-33069629

ABSTRACT

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.


Subject(s)
Cardiovascular Diseases/prevention & control , Life Style , Vascular Diseases/prevention & control , Cardiovascular Diseases/etiology , Humans , Hypertension/therapy , Medication Adherence , PCSK9 Inhibitors , Risk Factors , Spain , Vascular Diseases/etiology
7.
Rev Esp Salud Publica ; 942020 Sep 11.
Article in Spanish | MEDLINE | ID: mdl-32915170

ABSTRACT

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.


Presentamos la adaptación para España de la actualización de las Guías Europeas de Prevención Vascular. En esta actualización se hace mayor énfasis en el abordaje poblacional, especialmente en la promoción de la actividad física y de una dieta saludable mediante políticas alimentarias y de ocio y transporte activo en España. Para estimar el riesgo vascular, se destaca la importancia de recalibrar las tablas que se utilicen, adaptándolas a los cambios poblaciones en la prevalencia de los factores de riesgo y en la incidencia de enfermedades vasculares, con particular atención al papel de la enfermedad renal crónica. A nivel individual resulta clave el apoyo personalizado para el cambio de conducta, la adherencia a la medicación en los individuos de alto riesgo y pacientes con enfermedad vascular, la promoción de la actividad física y el abandono del hábito tabáquico. Además, se revisan los ensayos clínicos recientes con inhibidores de PCKS9, la necesidad de simplificar el tratamiento farmacológico de la hipertensión arterial para mejorar su control y la adherencia al tratamiento. En los pacientes con diabetes mellitus 2 y enfermedad vascular o riesgo vascular alto, cuando los cambios de estilo de vida y la metformina resultan insuficientes, deben priorizarse los fármacos con demostrado beneficio vascular. Por último, se incluyen pautas sobre enfermedad arterial periférica y otras enfermedades específicas, y se recomienda no prescribir antiagregantes en prevención primaria.


Subject(s)
Cardiovascular Diseases/prevention & control , Diabetes Mellitus, Type 2/complications , Kidney Failure, Chronic/complications , PCSK9 Inhibitors , Primary Prevention/methods , Cardiology/standards , Cardiovascular Diseases/epidemiology , Diet , Exercise , Humans , Life Style , Medication Adherence , Metformin/administration & dosage , Practice Guidelines as Topic , Primary Prevention/standards , Risk Factors , Smoking Cessation , Spain
8.
Popul Health Metr ; 16(1): 14, 2018 08 16.
Article in English | MEDLINE | ID: mdl-30115092

ABSTRACT

BACKGROUND: The EQ-5D has been frequently used in national health surveys. This study is a head-to-head comparison to assess how expanding the number of levels from three (EQ-5D-3L) to five in the new EQ-5D-5L version has improved its distribution, discriminatory power, and validity in the general population. METHODS: A representative sample (N = 7554) from the Catalan Health Interview Survey 2011-2012, aged ≥18, answered both EQ-5D versions, and we evaluated the response redistribution and inconsistencies between them. To assess validity of this redistribution, we calculated the mean of the Visual Analogue Scale (VAS), which measures perceived health. The discriminatory power was examined with Shannon Indices, calculated for each dimension separately. Spanish preference value sets were applied to obtain utility indices, examining their distribution with statistics of central tendency and dispersion. We estimated the proportion of individuals reporting the best health state in EQ-5D-5L and EQ-5D-3L within groups of specific chronic conditions and their VAS mean. RESULTS: A very small reduction in the percentage of individuals with the best health state was observed, from 61.8% in EQ-5D-3L to 60.8% in EQ-5D-5L. In contrast, a large proportion of individuals reporting extreme problems in the 3 L version moved to severe problems (level 4) in the 5 L version, particularly for pain/discomfort (75.5%) and anxiety/depression (66.4%). The average proportion of inconsistencies was 0.9%. The pattern of the perceived health VAS mean confirmed the hypothesis established a priori, supporting the validity of the observed redistribution. Shannon index showed that absolute informativity was higher in the 5 L version for all dimensions. The means (SD) of the Spanish EQ-5D-3L and EQ-5D-5L indices were 0.87 (0.25) and 0.89 (0.22). The proportion of individuals with the best health state within each specific chronic condition was very similar, regardless of the EQ-5D version (≤ 30% in half of the 28 chronic conditions). CONCLUSION: Although the proportion of individuals with the best possible health state is still very high, our findings support that the increase of levels provided by the EQ-5D-5L contributed to the validity and discriminatory power of this new version to measure health in general population, as in the national health surveys.


Subject(s)
Chronic Disease , Health Status , Health Surveys , Population Health , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety , Depression , Female , Humans , Language , Male , Middle Aged , Pain , Reproducibility of Results , Young Adult
9.
Eur Heart J ; 37(13): 1034-40, 2016 Apr 01.
Article in English | MEDLINE | ID: mdl-26586783

ABSTRACT

AIMS: The preferred reperfusion strategy for early ST elevation myocardial infarction (STEMI, defined as time from symptoms onset ≤120 min) in non-capable percutaneous coronary intervention (PCI) centres remains controversial. We sought to compare mortality of in situ fibrinolysis vs. PCI transfer in a real-life consecutive cohort of early STEMI. METHODS AND RESULTS: Prospective multicentre STEMI registry (Catalonia 'Codi IAM' network) of all-comers in a non-capable PCI centre with symptom onset to first medical contact (FMC) <120 min. Two groups were identified: in situ fibrinolysis and transfer to a PCI-capable centre. Primary endpoint was 30-day mortality. We included 2470 patients, of whom 2227 (90.2%) and 243 (9.8%) comprised the transfer and fibrinolysis groups, respectively. In the fibrinolysis group, diagnostic and system delays were shorter (24 vs. 31 min, P < 0.001; 45 vs. 119 min, P < 0.001, respectively). Thirty-day mortality was 7.7 and 5.1% in fibrinolysis and transfer groups, respectively (P = 0.09). However, patients in the transfer group whose time FMC-device was achieved within 140 min were associated with significantly lower mortality (2.0% for FMC-device <99 min, and 4.6% for FMC-device 99-140 min; P < 0.01 and P = 0.03, respectively vs. fibrinolysis). In multivariable logistic regression analysis, reperfusion with fibrinolysis was an independent 30-day mortality predictive factor (odds ratio: 1.91, 95% confidence interval: 1.01-3.50; P = 0.04), together with age and Killip-Kimball class (both P < 0.001). CONCLUSIONS: In early STEMI patients assisted in non-capable PCI centres, in situ fibrinolysis had worse prognosis than patient transfer. Transfer to a PCI-capable centre seems recommended in patients with FMC-device delay <140 min.


Subject(s)
Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/therapy , Thrombolytic Therapy/methods , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Patient Transfer , Percutaneous Coronary Intervention/mortality , Prospective Studies , Retrospective Studies , ST Elevation Myocardial Infarction/mortality , Spain/epidemiology , Thrombolytic Therapy/mortality , Time-to-Treatment
10.
BMJ Open ; 5(12): e009148, 2015 Dec 09.
Article in English | MEDLINE | ID: mdl-26656019

ABSTRACT

OBJECTIVES: To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart). DESIGN: Cost-utility analysis. SETTING: The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people. PARTICIPANTS: Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries. OUTCOME MEASURES: Costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140). RESULTS: A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30,000, results were sensitive to variations in costs and outcomes. CONCLUSIONS: The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.


Subject(s)
Length of Stay/economics , Myocardial Infarction/economics , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/economics , Aged , Angioplasty, Balloon, Coronary , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , Quality-Adjusted Life Years , Registries , Spain
12.
Article in English | MEDLINE | ID: mdl-26056439

ABSTRACT

BACKGROUND: Excluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD) are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD. METHODS: This was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied. RESULTS: A total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%]) occurred during winter, followed by autumn with 2,367 (24.1%), spring with 2,347 (23.9%), and summer with 1,446 (14.7%; P<0.001). The maximum, minimum, and mean temperatures were associated similarly with the number of hospitalizations. On average, we found that for each degree Celsius decrease in mean weekly temperature, hospital admissions increased by 5.04% (r(2)=0.591; P<0.001). After adjustment for humidity, comorbidity, air pollution, and influenza-like illness, only mean temperatures retained statistical significance, with a mean increase of 4.7% in weekly admissions for each degree Celsius of temperature (r(2)=0.599, P<0.001). CONCLUSION: Mean temperatures are closely and independently related to the number of hospitalizations for COPD.


Subject(s)
Patient Admission , Pulmonary Disease, Chronic Obstructive/epidemiology , Seasons , Temperature , Urban Health , Aged , Aged, 80 and over , Air Pollution/adverse effects , Comorbidity , Databases, Factual , Disease Progression , Female , Humans , Humidity , Influenza, Human/epidemiology , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Risk Factors , Spain/epidemiology , Time Factors
13.
J Am Heart Assoc ; 4(5)2015 May 19.
Article in English | MEDLINE | ID: mdl-25991011

ABSTRACT

BACKGROUND: Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. However, few centers around the world systematically track outcomes, and no global standards exist. Furthermore, patient-centered outcomes and longitudinal outcomes are under-represented in current assessments. METHODS AND RESULTS: The nonprofit International Consortium for Health Outcomes Measurement (ICHOM) convened an international Working Group to define a consensus standard set of outcome measures and risk factors for tracking, comparing, and improving the outcomes of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the ICHOM Working Group defined who should be tracked, what should be measured, and when such measurements should be performed. The ICHOM CAD consensus measures were designed to be relevant for all patients diagnosed with CAD, including those with acute myocardial infarction, angina, and asymptomatic CAD. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient-reported health status (Seattle Angina Questionnaire [SAQ-7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ-2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons. CONCLUSIONS: ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.


Subject(s)
Consensus , Coronary Artery Disease/diagnosis , Coronary Artery Disease/therapy , Hospitalization/statistics & numerical data , Surveys and Questionnaires/standards , Aged , Cause of Death , Coronary Artery Bypass/methods , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Female , Health Status , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/methods , Risk Factors , Treatment Outcome
14.
Arch Bronconeumol ; 51(10): 490-5, 2015 Oct.
Article in English, Spanish | MEDLINE | ID: mdl-25618455

ABSTRACT

INTRODUCTION: Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV). The aim of this study was to characterize the prevalence of HMV and variability in prescriptions from administrative data. METHODS: Prescribing rates of HMV in the 37 healthcare sectors of the Catalan Health Service were compared from billing data from 2008 to 2011. Crude accumulated activity rates (per 100,000 population) were calculated using systematic component of variation (SCV) and empirical Bayes (EB) methods. Standardized activity ratios (SAR) were described using a map of healthcare sectors. RESULTS: A crude rate of 23 HMV prescriptions per 100,000 population was observed. Rates increase with age and have increased by 39%. Statistics measuring variation not due to chance show a high variation in women (CSV=0.20 and EB=0.30) and in men (CSV=0.21 and EB=0.40), and were constant over time. In a multilevel Poisson model, hospitals with a chest unit were associated with a greater number of cases (beta=0.68, P<.0001). CONCLUSIONS: High variability in prescribing HMV can be explained, in part, by the attitude of professionals towards treatment and accessibility to specialist centers with a chest unit. Analysis of administrative data and variability mapping help identify unexplained variations and, in the absence of systematic records, are a feasible way of tracking treatment.


Subject(s)
Home Care Services/statistics & numerical data , Prescriptions , Pulmonary Disease, Chronic Obstructive/therapy , Respiration, Artificial/statistics & numerical data , Adult , Aged , Aged, 80 and over , Attitude of Health Personnel , Continuous Positive Airway Pressure/instrumentation , Continuous Positive Airway Pressure/statistics & numerical data , Data Mining , Female , Health Services Accessibility , Home Care Services/organization & administration , Hospital Units , Humans , Male , Medical Records Department, Hospital/organization & administration , Middle Aged , Nebulizers and Vaporizers , Oxygen Inhalation Therapy/instrumentation , Poisson Distribution , Prescriptions/statistics & numerical data , Pulmonary Medicine/organization & administration , Respiratory Therapy/statistics & numerical data , Spain
15.
Arch Bronconeumol ; 51(10): 483-9, 2015 Oct.
Article in English, Spanish | MEDLINE | ID: mdl-25447590

ABSTRACT

UNLABELLED: Hospitalizations for acute exacerbation of COPD (AECOPD) generate high consumption of health resources, frequent readmissions and high mortality. The MAG -1 study aims to identify critical points to improve the care process of severe AECOPD requiring hospitalization. METHODS: Observational study, with review of clinical records of patients admitted to hospitals of the Catalan public network for AECOPD. The centers were classified into 3 groups according to the number of discharges/year. Demographic and descriptive data of the previous year, pharmacological treatment, care during hospitalization and discharge process and follow-up, mortality and readmission at 30 and 90 days were analyzed. RESULTS: A total of 910 patients (83% male) with a mean age of 74.3 (+10.1) years and a response rate of 70% were included. Smoking habit was determined in only 45% of cases, of which 9% were active smokers. In 31% of cases, no previous lung function data were available. Median hospital stay was 7 days (IQR 4-10), increasing according the complexity of the hospital. Mortality from admission to 90 days was 12.4% with a readmission rate of 49%. An inverse relationship between length of hospital stay and readmission within 90 days was observed. CONCLUSIONS: In a large number of medical records, smoking habit and lung function tests were not appropriately reported. Average hospital stay increases with the complexity of the hospital, but longer stays appear to be associated with lower mortality at follow-up.


Subject(s)
Hospitals, Public/statistics & numerical data , Inpatients/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , Aged , Aged, 80 and over , Comorbidity , Diagnostic Tests, Routine/statistics & numerical data , Disease Progression , Emergency Service, Hospital/statistics & numerical data , Female , Follow-Up Studies , Forced Expiratory Volume , Hospital Departments/statistics & numerical data , Hospital Mortality , Hospital Records , Hospitalization , Humans , Length of Stay , Male , Medical Audit , Middle Aged , Noninvasive Ventilation/statistics & numerical data , Oxygen/blood , Oxygen Inhalation Therapy/statistics & numerical data , Patient Readmission/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/therapy , Severity of Illness Index , Smoking/epidemiology , Spain/epidemiology , Treatment Outcome
16.
Aten Primaria ; 46(6): 298-306, 2014.
Article in Spanish | MEDLINE | ID: mdl-24768654

ABSTRACT

OBJECTIVE: Examine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia. DESIGN: Cross-sectional study using a survey. PARTICIPANTS: Three hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010. MEASUREMENTS: Survey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants. MAIN RESULTS: Response rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals.>50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record.>50% recognized a high priority strategies for improving the quality. CONCLUSION: Despite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.


Subject(s)
Primary Health Care , Spirometry/statistics & numerical data , Cross-Sectional Studies , Humans , Spain , Surveys and Questionnaires
17.
J Epidemiol Community Health ; 68(11): 1012-9, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24619990

ABSTRACT

BACKGROUND: The use of validated multivariate cardiovascular predictive models in a population setting is of interest for public health policy makers. We aimed to validate the estimations of the CASSANDRA model (coronary heart disease (CHD) incidence and CHD risk distribution), considering the population changes in age, sex and CHD risk factors prevalence in a 10-year period. METHODS: We compared the projected CHD incidence estimated with CASSANDRA with that observed in the Girona Heart Registry (REGICOR) for 1995-2004 and 2000-2009 in the population of Girona (Spain) aged 35-74 years. We used official age and sex distributions for this population. Baseline cardiovascular risk factors prevalence and the distribution of cardiovascular risk were obtained from three cross-sectional studies performed in 1995, 2000 and 2005. To validate the future distribution of cardiovascular risk, we tested the yearly CHD risk variance over the study period. RESULTS: No significant differences between the estimated and observed annual CHD incidence per 100 000 men were found in 1995-2004 (CASSANDRA=457.8 and REGICOR=420.3, incidence rate ratio (IRR) (95% CI)=0.92 (0.89 to 0.96)) and in 2000-2009 (441.4 and 409.6, respectively, IRR=0.93 (0.90 to 0.96)). However, overpredictions of 18% and 22%, respectively, were observed in women (198.8 and 160.4, IRR=0.82 (0.77 to 0.86), and 197.1 and 152.8, IRR=0.78 (0.74 to 0.83), respectively). No significant differences were found in the CHD risk variance in the three different cross-sectional studies. CONCLUSIONS: The CASSANDRA model produces valid estimates, particularly in men, of the future burden of disease and in the distribution of cardiovascular risk in individuals aged 35-74 years.


Subject(s)
Coronary Disease/epidemiology , Models, Biological , Adult , Age Distribution , Aged , Cholesterol/blood , Comorbidity , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Incidence , Male , Middle Aged , Prevalence , Registries , Reproducibility of Results , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Sex Distribution , Smoking/epidemiology , Spain/epidemiology
18.
Optom Vis Sci ; 91(4): 464-71, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24637480

ABSTRACT

PURPOSE: To determine whether types of optical correction for refractive error are associated with sex, social class, and occupational group in the working population. METHODS: A cross-sectional study was carried out among employees in Catalonia (Spain) aged 16 to 65 years who underwent the Asepeyo Prevention Society health examination in 2009 (86,831 participants: 59,397 men and 27,421 women). The type and purpose of refractive correction used were self-reported, as were sociodemographic variables; visual acuity with habitual correction was also measured. We performed descriptive and logistic regression analyses to evaluate the prevalence and type of correction used for refractive error as a function of age, sex, social class, and occupational group. RESULTS: Forty-six percent (95% confidence interval [CI] = 45.6 to 46.3) of individuals in this sample were users of optical correction for refractive error. Use of optical correction was more common among women than among men (54.8 and 41.9%, respectively) and especially among women aged 55 to 64 years (91.8%). Nonmanual (class I) workers were three times more likely to use optical correction than manual (class V) workers (odds ratio = 3.02; 95% CI = 2.82 to 3.24). Individuals in technical, administrative, or intellectual occupations were more likely to wear optical correction than unskilled professionals. CONCLUSIONS: The use of visual correction is more prevalent among women than among men, especially in older individuals. The use of optical correction is more common among more advantaged social groups and is associated with particular occupations.


Subject(s)
Contact Lenses/statistics & numerical data , Eyeglasses/statistics & numerical data , Occupations , Refractive Errors/therapy , Social Class , Adolescent , Adult , Age Distribution , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Sex Distribution , Spain , Visual Acuity/physiology , Young Adult
19.
Qual Life Res ; 23(3): 857-68, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24005886

ABSTRACT

PURPOSE: Mental well-being has aroused interest in Europe as an indicator of population health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed in the United Kingdom showing good face validity and has been previously adapted into Spanish. The aim of this study is to assess the validity and reliability of the Spanish version of WEMWBS in the general population. METHODS: Cross-sectional home face-to-face interview survey with computer-assisted personal interviewing was administered with the 2011 Catalan Health Interview Survey Wave 3, which is representative of the non-institutionalized general population of Catalonia, Spain. A total of 1,900 participants 15+ years of age were interviewed. The Spanish version of WEMWBS was administered together with socioeconomic and health-related variables, with a hypothesized level of association. RESULTS: Similar to the original, confirmatory factor analysis fits a one-factor model adequately (CFI = 0.974; TLI = 0.970; RMSEA = 0.059; χ (2) = 584.82; df = 77; p < .001) and has a high internal consistency (Cronbach's alpha = 0.930; Guttman's lambda 2 = 0.932). The WEMWBS discriminated between population groups in all health-related and socioeconomic variables, except in gender (p = 0.119), with a magnitude similar to that hypothesized. Overall, mental well-being was higher for the general population of Catalonia (average and whole distribution) than that for Scotland general population. CONCLUSIONS: The Spanish version of WEMWBS showed good psychometric properties similar to the UK original scale. Whether better mental well-being in Catalonia is due to methodological or substantive cultural, social, or environmental factors should be further researched.


Subject(s)
Health Status , Mental Health , Psychiatric Status Rating Scales , Psychometrics/standards , Quality of Life , Adolescent , Adult , Aged , Cross-Sectional Studies , Factor Analysis, Statistical , Female , Health Surveys , Humans , Male , Middle Aged , Self Report , Socioeconomic Factors , Spain , Students/psychology , Students/statistics & numerical data , Surveys and Questionnaires , Translations , Unemployment/psychology , Unemployment/statistics & numerical data , Young Adult
20.
Arch Prev Riesgos Labor ; 16(2): 71-6, 2013.
Article in Spanish | MEDLINE | ID: mdl-23700706

ABSTRACT

OBJECTIVES: To analyze the distribution of visual problems which cause and do not cause visual impairment in a working population, and their relation to social class. METHODS: This was a cross-sectional study of 86,831 employed workers (59,397 men, and 27,421 women) in Catalonia ages 16 to 65 years who, in 2009, underwent health surveillance exams at the Asepeyo Health Prevention. The prevalence of visual problems that cause and do not cause visual impairment was calculated by age, sex and occupational social class, and associations were analyzed using logistic regression. RESULTS: 2.2% (95% CI 2.1-2.3) of the active working population studied had vision problems that cause visual impairment, even while wearing corrective lenses. After adjusting for age, workers in Class V show a 2.4-fold greater risk of visual impairment than those in Class I. CONCLUSIONS: Women, older workers and disadvantaged social groups showed the highest prevalence and risk of visual impairment. Conversely, problems resolved by vision correction that do not cause visual impairment are concentrated in non-manual workers.


Subject(s)
Occupational Diseases/etiology , Vision Disorders/etiology , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Occupational Diseases/epidemiology , Sex Distribution , Socioeconomic Factors , Spain , Vision Disorders/epidemiology , Young Adult
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