[Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. / Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria.

OBJECTIVE: To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN: A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE: The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS: Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS: Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES: To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS: Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS: The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.

Short- and medium-term effects of a single session of pain neuroscience education on pain and psychological factors in patients with chronic low back pain. A single-blind randomized clinical trial.

INTRODUCTION: Biopsychosocial approach in patients suffering chronic low back pain (CLBP) promotes pain self-management strategies. Current evidence recommends high dose of Pain Neuroscience Education (PNE) for clinically significant differences. However, the workload and time constraints experienced by healthcare providers impede the application of the recommended treatment regimen. In fact, Back School with a biomechanical model is the main approach to manage CLBP in public systems. OBJECTIVE: The objective of this study is to explore the effect of a 60 min single session of PNE as an adjunct to back school on pain intensity and psychological variables patients with CLBP. METHODS: A double-blind, two-arm randomized controlled clinical trial was conducted in patients with CLBP who attended back school sessions held in a Spanish public hospital. A total of 121 patients were randomized into control group, who received the Back School program during 5 weeks, and intervention group, who additionally received a single session of PNE. Patient-reported outcomes were the Numerical Pain Rating Scale, Central Sensitization Inventory, Pain Catastrophizing Scale, and Tampa Scale of Kinesiophobia, with a 12-week follow-up. RESULTS: A total of 113 patients were analysed. Intervention and control group presented similar effects on pain and kinesiophobia. At follow-up, intervention group exhibited reduced sensitization and catastrophism scores compared with control, including the subscales. Additionally, PNE reduced the percentage of participants classified as having central sensitization compared with control. CONCLUSIONS: Adding a single PNE session in the back school program did not reduce pain but improved psychological factors as central sensitization and pain catastrophizing at medium-term. This study highlights the potential of PNE to optimize treatment strategies for CLBP, especially in public health centres where time resources are scarce. SIGNIFICANCE STATEMENT: Adding a single PNE session in the back school program did not reduce pain but improved psychological factors as central sensitization and pain catastrophism at medium-term.

Multicausal analysis of mortality due to diabetes mellitus in Spain, 2016-2018.

OBJECTIVES: This study aimed to assess multicausal mortality due to diabetes from 2016-2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered cause on the death certificate. MATERIALS AND METHODS: A cross-sectional descriptive study taking a multicausal approach. RESULTS: Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases. CONCLUSIONS: In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.