AMH in combination with SHBG for the diagnosis of polycystic ovary syndrome.

Serum Anti-Müllerian hormone (AMH) level could be useful for the diagnosis of polycystic ovary syndrome (PCOS). We evaluated the hormonal status in women for the diagnosis of PCOS. A total of 77 PCOS women and 106 healthy women were enrolled in this study. Serum AMH, gonadotropins [luteinising hormone (LH) and follicle-stimulating hormone (FSH)], oestradiol, testosterone (total and free), 4-androstenedione (ANDST), dehydroepiandrosterone sulphate, sex hormone binding globulin (SHBG), prolactin, thyroid-stimulating hormone and insulin levels were measured in all enrolled women. Our data showed that insulin, LH, testosterone, ANDST and AHM levels were significantly higher in the PCOS group and FSH and SHBG levels were lower in the PCOS group. In Receiver operating characteristic analysis, the combination of AMH with SHBG showed higher area under curves (AUC) for PCOS diagnosis with an AUC of 0.843 and a specificity of 81.1% and a sensitivity of 72.7%. Our results suggest that a combination of serum AMH and SHBG levels could be used as a diagnostic biomarker of PCOS. Impact statement What is already known on this subject? Women with PCOS have an increased risk of hypertension, altered glucose metabolism and probably an increased lifetime risk of cardiovascular diseases. There is no consensus on the diagnostic criteria for PCOS. This leads to many patients with PCOS are being undiagnosed. It is known that AMH plays a role in the follicular status of PCOS and serum AMH level is increased significantly in women with PCOS compared with normo-ovulatory women. This is why several studies have suggested the inclusion of AMH as a diagnostic criterion in PCOS. What do the results of this study add? Extensive epidemiological data is available which demonstrates an association between higher AMH levels and PCOS, but there was no information available about the combination of AMH level with other hormones and PCOS. This is the first study that has investigated the association of AMH and SHBG, together, with PCOS. Our results suggest that serum AMH and SHBG level in combination could represent a useful and practical test to screen the general population for PCOS. What are the implications of these findings for clinical practice and/or further research? Many PCOS women in the general population are undiagnosed due to lack of consensus in diagnostic criteria. Therefore, the importance of identifying women with PCOS due to the need for follow-up in short and long-term health risk.

[Results of two surveys of immigrants and natives in Southeast Spain: health, use of services, and need for medical assistance]. / Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica.

OBJECTIVE: To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. MATERIALS AND METHODS: Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. RESULTS: Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). CONCLUSIONS: The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.

[Prescription drug consumption recovery following the co-payment change: Evidence from a regional health service]. / La recuperación del consumo farmacéutico tras la modificación del copago: evidencia de un servicio regional de salud.

OBJECTIVES: In the past few decades, increasing pharmaceutical expenditures in Spain and other western countries led to the adoption of reforms in order to reduce this trend. The aim of our study was to analyze if reforms concerning the pharmaceutical reimbursement scheme in Spain have been associated with changes in the volume and trend of pharmaceutical consumption. DESIGN: Retrospective observational study. SETTING: Region of Murcia. Prescription drug in primary care and external consultations. PARTICIPANTS: Records of prescribed medicines between January 1, 2008 and December 31, 2013. METHOD: Segmented regression analysis of interrupted time-series of prescription drug consumption. RESULTS: Dispensing of all five therapeutic classes fell immediately after co-payment changes. The segmented regression model suggested that per patient drug consumption in pensioners may have decreased by about 6.76% (95% CI; -8.66% to -5.19%) in the twelve months after the reform, compared with the absence of such a policy. Furthermore the slope of the series of consumption increased from 6.08 (P<.001) to 12.17 (P<.019). CONCLUSIONS: The implementation of copayment policies could be associated with a significant decrease in the level of prescribed drug use in Murcia Region, but this effect seems to have been only temporary in the five therapeutic groups analyzed, since almost simultaneously there has been an increase in the growth trend.

[Analysis of medications dispensed to control the main cardiovascular risks in the Murcia Region: are there gender differences?]. / Análisis de la dispensación de medicamentos para el control de los principales factores de riesgo cardiovascular en la Región de Murcia: ¿existen diferencias de género?

OBJECTIVES: To estimate the use of cardiovascular medicines and its distribution by age and sex. DESIGN: Observational study. SETTING: Region of Murcia. MAIN MEASUREMENTS: Daily doses of cardiovascular drugs prescribed and dispensed in all the pharmacies of the Region per 1,000 inhabitants-day (DHD). A comparison was made of consumption rates (DHD) by age and sex. RESULTS: The probability of receiving antiplatelet drugs increases with age, with the proportion of men being higher. The use of beta-blockers and angiotensin II increases with age up to 79 years, with an increased consumption in men up to 65 years. The probability of receiving treatment with calcium channel blockers, ACE inhibitors, or statins, linearly increases with age, and the proportion of men under treatment exceeds that of women in the early ages, tending to equalize beyond 80 years. CONCLUSIONS: This study shows that the cardiovascular disease prevention focuses on people aged 40 to 74 years. Access by women to cardiovascular therapy occurs with a delay of 3-5 years, depending on the treatment subgroup. Changes should be promoted to encourage rational and equitable access and use of the drugs.

La recuperación del consumo farmacéutico tras la modificación del copago: evidencia de un servicio regional de salud / Prescription drug consumption recovery following the co-payment change: Evidence from a regional health service

OBJETIVOS: El objetivo de este estudio es evaluar el efecto de las políticas de copago farmacéutico en la cantidad y la tendencia de consumo de medicamentos. DISEÑO: Estudio observacional retrospectivo. Emplazamiento: Región de Murcia. Prescripción de medicamentos en atención primaria y especializada. PARTICIPANTES: Registros correspondientes a las recetas dispensadas por las oficinas de farmacia entre enero del 2008 y diciembre del 2013. MÉTODO: Análisis de regresión lineal segmentada de series temporales de consumo de medicamentos expresado en número de envases y dosis por 1.000 habitantes-día (DHD), con un análisis diferenciado de los cinco grupos terapéuticos de mayor consumo. RESULTADOS: La dispensación de los 5 grupos terapéuticos analizados disminuyó inmediatamente después de la introducción de los cambios en el copago. El modelo de regresión segmentada indicó que la tasa de consumo en los beneficiarios pensionistas del SMS habría disminuido un 6,76% (IC del 95%, -8,66% a -5,19%) 12 meses después de la reforma, en comparación con la ausencia de una política de este tipo. Por otro lado, la pendiente de crecimiento del consumo se incrementó de 6,08 (p < 0,001) a 12,17 (p = 0,019). CONCLUSIONES: La aplicación de los cambios en la política de copago se podría asociar con una disminución significativa de las tasas de consumo de medicamentos en la Región de Murcia, pero parece que con un efecto temporal limitado en los grupos terapéuticos analizados, ya que de manera casi simultánea se ha producido un aumento en la tendencia de crecimiento

OBJECTIVES: In the past few decades, increasing pharmaceutical expenditures in Spain and other western countries led to the adoption of reforms in order to reduce this trend. The aim of our study was to analyze if reforms concerning the pharmaceutical reimbursement scheme in Spain have been associated with changes in the volume and trend of pharmaceutical consumption. DESIGN: Retrospective observational study. SETTING: Region of Murcia. Prescription drug in primary care and external consultations. PARTICIPANTS: Records of prescribed medicines between January 1, 2008 and December 31, 2013. Method: Segmented regression analysis of interrupted time-series of prescription drug consumption. RESULTS: Dispensing of all five therapeutic classes fell immediately after co-payment changes. The segmented regression model suggested that per patient drug consumption in pensioners may have decreased by about 6.76% (95% CI; -8.66% to -5.19%) in the twelve months after the reform, compared with the absence of such a policy. Furthermore the slope of the series of consumption increased from 6.08(P<.001) to 12.17 (P<.019). CONCLUSIONS: The implementation of copayment policies could be associated with a significant decrease in the level of prescribed drug use in Murcia Region, but this effect seems to have been only temporary in the five therapeutic groups analyzed, since almost simultaneously there has been an increase in the growth trend

Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica / Results of two surveys of immigrants and natives in Southeast Spain: health, use of services, and need for medical assistance

Objetivo. Comparar la salud, uso de servicios sanitarios y necesidad insatisfecha de atención médica (NIAM) entre inmigrantes y nativos del sureste español. Material y métodos. Estudio transversal de dos muestras representativas de población: inmigrante (n=1150) y nativa (n=1303; Encuesta Nacional de Salud). Se creó una única base de datos con ponderación específica para cada muestra y se estimaron razones de prevalencia (RP) mediante regresión multivariante. Resultados. Marroquíes, ecuatorianos y europeos del este (EE) declararon peor salud que los nativos (RPs [IC95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] y 1.44 [1.08-1.93], respectivamente). Los inmigrantes hicieron mayor uso de las urgencias (excepto EE) y consumieron menos fármacos. Los marroquíes mostraron la mayor diferencia en la frecuencia de NIAM (RP [IC95%]: 12.20 [5.25-28.37]), principalmente por razones laborales (46%). Conclusiones. La salud y el uso de servicios sanitarios difirieron significativamente entre inmigrantes y nativos. Destaca la NIAM alta en marroquíes por causa laboral.

Objective. To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. Materials and methods. Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. Results. Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). Conclusions. The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.

¿Omeprazol para todos? / Omeprazole for everybody?

No disponible

Análisis de la dispensación de medicamentos para el control de los principales factores de riesgo cardiovascular en la Región de Murcia: ¿existen diferencias de género? / Analysis of medications dispensed to control the main cardiovascular risks in the Murcia Region: Are there gender differences?

OBJETIVOS: Analizar las diferencias por género y edad en el consumo de medicamentos para el control de los principales factores de riesgo cardiovascular. DISEÑO: Estudio transversal de la dispensación de medicamentos. Emplazamiento: Región de Murcia. Medidas principales: Análisis descriptivo, estratificado por grupos de edad y sexo, del consumo de medicamentos expresado en dosis por 1.000 habitantes-día (DHD). Se calcularon las razones de DHD por edad y género comparándolas por tablas de contingencia complementadas con el test ji al cuadrado. RESULTADOS: La probabilidad de recibir tratamiento antiagregante aumenta con la edad, siendo las tasas de consumo superiores en hombres. En el caso de betabloqueantes y ARA II, su uso aumenta con la edad hasta los 79 años y el consumo es mayor en los hombres hasta los 65 años. La probabilidad de recibir tratamiento con antagonistas del calcio, IECA y estatinas aumenta con la edad, superando la proporción de hombres en tratamiento a la de mujeres en las edades tempranas, con tendencia a igualarse a partir de los 80 años. CONCLUSIONES: Este estudio pone de manifiesto que actualmente la prevención de la enfermedad cardiovascular se centra en la población de 40 a 74 años. El acceso de la mujer al tratamiento cardiovascular se produce con un retraso de 3 a 5 años, por lo que deberían promoverse cambios para mejorar la identificación precoz de enfermedad cardiovascular en la mujer

OBJECTIVES: To estimate the use of cardiovascular medicines and its distribution by age and sex. DESIGN: Observational study. Setting: Region of Murcia. Main measurements: Daily doses of cardiovascular drugs prescribed and dispensed in all the pharmacies of the Region per 1,000 inhabitants-day (DHD). A comparison was made of consumption rates (DHD) by age and sex. RESULTS: The probability of receiving antiplatelet drugs increases with age, with the proportion of men being higher. The use of beta-blockers and angiotens in II increases with age up to 79 years, with an increased consumption in men up to 65 years. The probability of receiving treatment with calcium channel blockers, ACE inhibitors, or statins, linearly increases with age, and the proportion of men under treatment exceeds that of women in the early ages, tending to equalize beyond 80 years. CONCLUSIONS: This study shows that the cardiovascular disease prevention focuses on people aged 40 to 74 years. Access by women to cardiovascular therapy occurs with a delay of 3-5 years, depending on the treatment subgroup. Changes should be promoted to encouragerational and equitable access and use of the drugs