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.

Aplicación de un modelo híbrido de aprendizaje basado en problemas como estrategia de evaluación e interrelación ‘multiasignaturas’ / Application of a hybrid model of problem-based learning as a strategy for assessment and the integration of ‘multiple subjects’

Se ha diseñado e implementado un modelo 'híbrido' de aprendizaje basado en problemas (ABP) como estrategia de enseñanza, evaluación e interrelación de las asignaturas de 'Fisiopatogenia' y 'Semiología' del grado de medicina de la Universitat Internacional de Catalunya. El modelo hibrido ha sido diseñado sobre la plataforma de tecnología de la información Moodle que facilita su desarrollo con menos recursos. El ABP implementado funciona como una actividad integradora que trata de fomentar el desarrollo de competencias transversales y el pensamiento complejo, en un entorno de aprendizaje activo. Promueve en el estudiante la construcción de su propio conocimiento para el desarrollo de competencias como el razonamiento clínico y la toma de decisiones, al tiempo que posibilita la integración de los conocimientos procedentes de distintas asignaturas. Los resultados de este trabajo han reflejado un alto grado de satisfacción del alumnado con la metodología fundamentada en el ABP, habiéndose logrado una participación activa en el proceso enseñanza aprendizaje

A 'hybrid' model of problem-based learning (PBL) was designed and implemented as a teaching strategy, assessment and means to integrate knowledge related to the subjects 'Physiopathogenesis' and 'Semiotics' of Medicine in the Universitat Internacional de Catalunya. The hybrid model was designed within the e-learning platform, Moodle, which facilitates the development of PBL methodology but with fewer resources. PBL functions as an integrative activity which seeks to promote development of generic skills and complex thought in an active learning environment. PBL encourages students to construct their own knowledge for the development of skills such as clinical reasoning and decision-making, while enabling the integration of knowledge from different subjects. The outcomes of this project indicate a high degree of student satisfaction with this PBL-based methodology as has been manifested by the achievement of active participation in the teaching-learning process

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

Introducción La incidencia de cáncer de tiroides ha aumentado en las últimas décadas en todo el mundo. Objetivo Aportar evidencias sobre la eficiencia diagnóstica y asistencial si la atención al nódulo tiroideo se realiza en una consulta monográfica que integre exploración clínica, estudio ecográfico y citología con valoración in situ. Pacientes y métodos Pacientes que acudieron a la consulta monográfica de nódulo tiroideo entre enero 2004 y junio 2010. Basado en la disposición del ecógrafo en el momento de la visita 2 períodos son definidos: primer periodo (P1: 01/2004-09/2007) sin ecógrafo en la consulta, PAAF por palpación; y segundo periodo (P2: 10/2007-06/2010) con ecógrafo, PAAF eco-guiada. Resultados Un total de 1.036 pacientes [P1: 537 (52%), P2: 499 (48%)] fueron consultados e incluidos. Eficiencia diagnóstica (P1 vs P2): número de pacientes visitados/año fue 143 vs 181, p<0,001; número de PAAF/nódulo: 1,68 vs 1,17, p<0,001; porcentaje de PAAF con material insuficiente: 26 vs 5,3%, p<0,001; tamaño medio (DE) del nódulo: 23,6 (12,4) vs 21,7 (11,7) mm, p 0,040; porcentaje de nódulos estudiados menores a 10mm: 9,9 vs 13,7%, p 0,030.Eficiencia asistencial: tiempo medio (rango) entre primera visita e indicación de cirugía: 332 (0-2177) vs 108 (0-596) días, p<0,001; relación de pacientes derivados a cirugía por sospecha citológica/por otros motivos: 1,06 vs 2,21, p<0,001; y de neoplasia/patología benigna intervenida: 0,47 vs 0,93, p=0,002.ConclusiónLa consulta monográfica del nódulo tiroideo, que integra exploración clínica, ecografía y citología con valoración in situ, aumenta la eficiencia diagnóstica y asistencial del nódulo tiroideo (AU)

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 onsite evaluation. Patients and methods: Patients attending the monographic thyroid nodule clinic from January2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the (..) (AU)

Evaluación a medio plazo de una intervención educativa en hábitos alimentarios y de actividad física en escolares: estudio Avall 2 / Medium-term evaluation of an educational intervention on dietary and physical exercise habits in schoolchildren: The Avall 2 study

Objetivo Determinar si los beneficios observados en alimentación, actividad física e índice de masa corporal se mantenían a los 2 años de haber finalizado la intervención educativa. Material y método Estudio longitudinal experimental de 4 años de duración, aleatorizado por conglomerados, para evaluar un programa de intervención dirigido a escolares de primer curso de educación primaria de las escuelas de Granollers. La intervención consistió en promover hábitos alimentarios saludables y potenciar la actividad física mediante la pedagogía educativa Investigación, Visión, Acción y Cambio (IVAC) aplicada a lo largo de 2 cursos escolares (2006-2008). Se determinó in situ el peso y la talla de cada niño, y las familias autocompletaron una encuesta de actividad física y alimentación en el 2006, 2008 y 2010.ResultadosEn el 2010 se observó un mayor incremento del índice de masa corporal de los escolares del grupo control (2,84±0,22 vs 1,96±0,163 kg/m2, p<0,001). La prevalencia de escolares con sobrepeso y obesidad aumentó respectivamente en un 8 y un 0,5% en el grupo control, mientras que en el grupo intervención se incrementó la prevalencia de sobrepeso (5,3%) y se redujo la de obesidad (3,6%). La prevalencia de escolares con exceso de peso aumentó en un 8,5% en el grupo control y en un 1,8% en el de intervención. A los 2 años de finalizar la intervención educativa se mantuvo la reducción del incremento del índice de masa corporal, independientemente del sexo, la procedencia, la obesidad materna y el nivel de estudios de los progenitores. Conclusiones La intervención educativa mediante el empleo del método pedagógico IVAC ayuda a contener el actual incremento de obesidad infantil (AU)

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 were measured in situ, and families self-completed a physical activity survey and the Krece Plus quick test in 2006, 2008, and 2010.ResultsA greater increase in body mass index was seen in 2010 in children from the control group (2.84±0.22 vs 1.96±0.163kg/m2, <0.001). 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 index increase 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 (AU)

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

Objetivo: Determinar el estado ponderal y los hábitos alimentarios y de actividad física de escolares de primer curso de primaria de la ciudad de Granollers. Diseño y población de estudio: Estudio transversal de los niños censados en todas las escuelas de la ciudad de Granollers, nacidos en el año 2000. En septiembre-octubre de 2006 se determinó el peso y la talla de cada niño, las familias respondieron una encuesta de frecuencia de consumo de alimentos y de actividad física y el test rápido Krece Plus. Para definir el sobrepeso y la obesidad se utilizaron los puntos de corte de índice de masa corporal propuestos por la International Obesity Task Force. Resultados: Se estudió a 566 escolares. La prevalencia de sobrepeso fue del 19,6% y la de obesidad, del 8,5%. Sólo el 3,9% de los escolares tomaban un desayuno adecuado y el 17,1% comían 5 raciones de fruta y verduras al día. A escala familiar, destaca el bajo consumo de frutas (22%), verduras (37%), pan/pasta alimenticia/arroz/cereales (14%), pescado (32%), legumbres (13%) y frutos secos (9%). Los alumnos que almorzaban en la escuela tomaban más fruta (el 38 frente al 29%), verdura (el 35 frente al 25%) y pescado (el 82 frente al 73%). El 82% de los niños realizaban actividad física de manera regular. Conclusiones: Uno de cada 4 escolares de primero de primaria presenta ya problemas de peso. Los niños que almuerzan en la escuela tienen mejores hábitos alimentarios. Los hábitos inadecuados de la familia pueden condicionar los hábitos del escolar (AU)

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 (AU)

Evaluación de la puesta en marcha del programa VisualCor en la práctica clínica / Assessing the implementation of the VisualCor software in medical practice

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