Sex-dependent effect of socioeconomic status on cardiovascular event risk in a population-based cohort of patients with type 2 diabetes.

BACKGROUND: Socioeconomic status (SES) factors often result in profound health inequalities among populations, and their impact may differ between sexes. The aim of this study was to estimate and compare the effect of socioeconomic status indicators on incident cardiovascular disease (CVD)-related events among males and females with type 2 diabetes (T2D). METHODS: A population-based cohort from a southern European region including 24,650 patients with T2D was followed for five years. The sex-specific associations between SES indicators and the first occurring CVD event were modeled using multivariate Fine-Gray competing risk models. Coronary Heart Disease (CHD) and stroke were considered secondary outcomes. RESULTS: Patients without a formal education had a significantly higher risk of CVD than those with a high school or university education, with adjusted hazard ratios (HRs) equal to 1.24 (95%CI: 1.09-1.41) for males and 1.50 (95%CI: 1.09-2.06) for females. Patients with <18 000€ income had also higher CVD risk than those with ≥18 000€, with HRs equal to 1.44 (95%CI: 1.29-1.59) for males and 1.42 (95%CI: 1.26-1.60) for females. Being immigrant showed a HR equal to 0.81 (95%CI: 0.66-0.99) for males and 1.13 (95%CI: 0.68-1.87) for females. Similar results were observed for stroke, but differed for CHD when income is used, which had higher effect in females. CONCLUSION: Socioeconomic inequalities in CVD outcomes are present among T2D patients, and their magnitude for educational attainment is sex-dependent, being higher in females, suggesting the need to consider them when designing tailored primary prevention and management strategies.

[Indication of magnetic resonance imaging in cases of headaches in adults: results following the RAND/UCLA appropriateness method]. / Indicacion de resonancia magnetica ante cefalea en adultos: resultados siguiendo el metodo RAND/UCLA de uso apropiado.

INTRODUCTION. The number of requests for magnetic resonance imaging (MRI) scans in healthcare systems is continually on the rise. An MRI scan of the head is one of the most frequent locations, which if used inappropriately entails a loss of resources. Consequently, guidelines are needed to help the physician make decisions and allow better management of resources. AIM. To establish the key indications of MRI scans in cases of adults with headache. MATERIALS AND METHODS. The RAND/UCLA appropriateness method was used, that is, following a systematic review, a list of possible indications of MRI in cases of headache was drawn up. This list was then assessed by a panel of experts and given a score between 1 ('totally inappropriate') and 9 ('totally appropriate'). An initial round of scoring was carried out online, the results were then discussed at a face-to-face meeting of the experts and finally another online round was undertaken. MRI was considered appropriate in each indication if the mean score was 6.5 or higher and there was agreement among the experts (using the IPRAS index). RESULTS. MRI scanning was considered appropriate in cases of: new headache, new headache in immunodeficient patients, sudden intense headache, headache with focal neurological symptoms, postural headache, headache due to physical effort or Valsalva manoeuvres, suspected thrombosis in the venous sinuses, systemic involvement, progressive headache, headache in pregnancy, autonomic trigeminal headache or severe cranial traumatic injury with focus. CONCLUSIONS. It seems that indication can be summed up in headaches with a suspected secondary pathology. The methodology employed makes it possible to establish MRI indications that can be useful both in clinical practice and for healthcare management practitioners.

TITLE: Indicacion de resonancia magnetica ante cefalea en adultos: resultados siguiendo el metodo RAND/UCLA de uso apropiado.Introduccion. El numero de peticiones de resonancia magnetica (RM) en los sistemas sanitarios es cada vez mayor. La RM craneal es una de las localizaciones mas frecuentes, cuya mala utilizacion supone una perdida de recursos, lo que obliga a disponer de guias que ayuden a los clinicos en la toma de decisiones y permita una mejor gestion de los recursos. Objetivo. Establecer las principales indicaciones de RM en los casos de cefalea en adultos. Materiales y metodos. Se utilizo el metodo de uso apropiado RAND/UCLA: tras una revision sistematica se elaboro un listado con posibles indicaciones de RM ante cefalea que un panel de expertos puntuo del 1 ('totalmente inapropiado') al 9 ('totalmente apropiado'). Se realizo una primera ronda de puntuacion online, luego se presentaron y se discutieron los resultados en una reunion presencial y se emprendio una ronda final online. La RM se considero apropiada en cada indicacion si la puntuacion mediana era de 6,5 o mayor y habia acuerdo (empleando el indice IPRAS). Resultados. La RM se considero apropiada ante: nueva cefalea, nueva cefalea en paciente inmunodeprimido, cefalea intensa subita, cefalea con sintomatologia neurologica focal, cefalea postural, cefalea por esfuerzo fisico o maniobras de Valsalva, sospecha de trombosis del seno venoso, afectacion sistemica, cefalea progresiva, cefalea en embarazada, cefalalgia trigeminal autonomica o traumatismo craneal grave con focalidad. Conclusiones. La indicacion parece resumirse en cefaleas con sospecha de patologia secundaria. La metodologia empleada permite establecer indicaciones de RM que pueden ser de utilidad tanto para el clinico como para el gestor sanitario.