Pilot study to validate a computer-based clinical decision support system for dyslipidemia treatment (HTE-DLP).

UNLABELLED: Pilot study to validate a Computerized Decision Support Systems (CDS) (HTE-DLP) for improving treatment of hyperlipidemia. METHODS: HTE-DLP was programmed to offer automatic specific reminders for lipid treatment. Seventy-seven patients with high cardiovascular risk were randomized. 10 expert physicians in cardiovascular-risk management were recruited. We assessed number of patients at LDL <70 mg/dl after 12 weeks of treatment. RESULTS: A greater proportion of intervention group reached the LDL-C <70 mg/ml [55.0% vs 12.5%, p = 0.003; OR: 3.26 IC (1.16-9.15)]. "High potency statins" and combined therapy were used more frequently in the intervention group than the control group (p = 0.001). Seven adverse effects were documented in the intervention group and two in the control group. An acceptable relationship was observed with regard to costeffectiveness in the intervention group. Physicians expressed good agreement with HTE-DLP (86.1%) and comfortable ease-of-use (85%). CONCLUSIONS: Use of a CDSS in high-risk cardiovascular patients resulted in a significant reduction in LDL-C levels.

[Prevalence of drug utilization in the adult population of Catalonia, Spain]. / Prevalencia del consumo de medicamentos en la población adulta de Cataluña.

OBJECTIVES: To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. METHODS: Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). RESULTS: A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was higher in retired individuals and pensioners (68%; 95%CI: 62-74) than in active workers (54%; 95%CI: 52-57). The most frequently used drugs were those for the nervous system (35% men and 51% women; p < 0.001), alimentary tract (15%) and the cardiovascular system (9% and 13%; p < 0.001). Most drugs (40%) were prescribed by specialists and one quarter was self-prescribed. CONCLUSIONS: The prevalence of total drug utilization in the adult population of Catalonia is high, specially among women, who self-perceived worse health status. Policies of rationalization of drug expenditures should take the epidemiological pattern into account.

Prevalencia del consumo de medicamentos en la población adulta de Cataluña / Prevalence of drug utilization in the adult population of Catalonia, Spain

Objetivos: Describir la prevalencia de la utilización de medicamentos según factores sociodemográficos y estado de salud autopercibido en la población adulta. Métodos: Examen de salud transversal del estudio CRONICAT/MONICA-Cataluña realizado en 1994-1996 en una muestra aleatoria de la población general de 25 a 64 años. Se interrogó a 3.421 participantes (tasa de respuesta del 72%) con cuestionario abierto sobre los medicamentos consumidos durante las dos semanas previas y otros hábitos de salud. Los medicamentos se codificaron posteriormente según la clasificación ATC (versión 1993). Resultados: Mayor proporción de mujeres (38%) que de varones (26%) autopercibió peor estado de salud (p < 0,001). El consumo total de medicamentos ajustado por edad fue: varones, del 57% (intervalo de confianza [IC] del 95%, 55-59), y en mujeres, del 76% (IC del 95%, 74-78). Excluyendo los anticonceptivos, el consumo regular fue: varones, del 35% (IC del 95%, 33-37), y en mujeres, del 48% (IC del 95%, 46-51). Tomaron más de un medicamento el 29% de los varones y el 48% de las mujeres (p < 0,001). Ni el nivel educativo ni el estado civil influyeron en la toma de medicamentos. Mayor proporción de jubilados o pensionistas consumieron (..) (AU)

Objectives: To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. Methods: Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). Results: A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was (..) (AU)

[Secular trends in smoking according to educational level between 1986 and 1996: The MONICA study. Catalonia]. / Tendencias seculares del tabaquismo según el nivel educativo entre 1986 y 1996: estudio MONICA-Cataluña.

OBJECTIVE: To describe trends from 1986-1996 in the prevalence of cigarette smoking between ages 25 to 64 in the MONICA-Catalonia study, according to educational level, and to validate these trends biochemically. METHODS: Three cross-sectional surveys in independent random samples of the general population of central Catalonia area carried out in 1986-88, 1990-92 and 1994-96 following the World Health Organization's MONICA protocol. Serum thiocyanate was determined by the Bowler method. RESULTS: A total of 2,571, 2,934 and 3,485 men and women were examined with response rates of 74, 67 and 72% in each survey respectively. The age-adjusted cigarette smoking prevalence decreased in men by 5.1% (95% CI: 1.5 to 8.7) and increased in women by +8.5% (95% CI: +5.6 to +11.4). The prevalence was 46.5% in men and 23.9% in women in 1994-96. The greatest decrease was in men aged 55-64 (9.9%) and the greatest increase was in women aged 35-44 (+14.8%). These trends were confirmed by serum thiocyanate levels, which decreased from 78.9 to 73.9 µmol/l (p = 0.07) in men and increased from 43.7 to 49.8 µmol/l (p < 0.01) in women during the study period. Cigarette smoking increased in less educated women (+10%) and decreased in university women (6%), while cigarette smoking in men decreased irrespective of educational level. Serum thiocyanate levels confirmed the relationship with educational level. CONCLUSIONS: The prevalence of cigarette smoking decreased in men between 1986 and 1996 but remained high in 1996. Women showed a pattern of progressive adoption of smoking, especially those with lower educational level.

[Trends in prevalence, awareness, treatment and control of arterial hypertension between 1986 and 1996: the MONICA-Catalonia study]. / Tendencias de la prevalencia, conocimiento, tratamiento y control de la hipertensión arterial entre 1986 y 1996: estudio MONICA-Cataluña.

BACKGROUND: To describe temporal trends in blood pressure (BP) and in the prevalence, awareness, treatment and control of arterial hypertension(AH) between 1986-1996 in the MONICA-Catalonia study. SUBJECTS AND METHOD: Three cross-sectional health surveys in independent random samples of the general population aged 25-64, carried out in 1986-88,1990-92 and 1994-96 according to the WHO-MONICA study protocol.BP was measured twice with a random zero mercury sphygmomanometer. RESULTS: 2,571, 2,934 and 3,485 subjects were examined in each survey with response rates of 74, 67 and 72%, respectively. Age-adjusted mean of systolic BP (SBP) decreased 2 and 4 mmHg (p < 0.001)reaching 120 and 114 mmHg in 1994-96 in men and women, respectively. Diastolic BP (DBP) did not change in men (73-74 mmHg) nor in women(70-71 mmHg). Age-adjusted prevalence of AH (>= 160/95 and/or under pharmacological treatment) was 8% (men) and 10% (women)in 1994-96 and of AH (>= 140/90 and/or under pharmacological treatment) was 15% in both sexes. Awareness of hypertension (AH >= 140/90) increased from 67 to 76%. Treated hypertensives increased from 22 to 40% (men) and from 44 to 54% (women). The use of diuretics and betablockers decreased and ACE inhibitors increased. At the end of the period, 52% of hypertensives were controlled. SBP also decreased in normotensives but not DBP. CONCLUSIONS: Between 1986 and 1996, the prevalence of AH in Catalonia remained stable although awareness, treatment and control had substantially improved.SBP decreased but DBP remained stable.

Tendencias seculares del tabaquismo según el nivel educativoentre 1986 y 1996: estudio MONICA-Cataluña / Secular trends in smoking according to educational level between 1986 and 1996: The MONICA study. Catalonia (Spain)

Objetivo: Describir las tendencias entre 1986 y 1996, en el estudio MONICA-Cataluña, de la prevalencia de fumadores de cigarrillos entre 25 y 64 años de edad, según el nivel educativo, y validarlas bioquímicamente. Métodos: Tres encuestas-exámenes de salud transversales en muestras aleatorias independientes de la población general del centro de Cataluña, realizadas en los años 1986-1988,1990-1992 y 1994-1996, siguiendo el protocolo del estudio MÓNICA de la Organización Mundial de la Salud. El tiocianatosérico se determinó por el método de Bowler. Resultados: Se examinaron 2.571, 2.934 y 3.485 varones y mujeres con tasas de respuesta del 74, 67 y 72% en cada examen, respectivamente. La prevalencia de fumadores de cigarrillos ajustada por edad descendió un 5,1% (IC del 95%:–1,5 a –8,7) en varones y aumentó un 8,5% (IC del 95%: +5,6a +11,4) en mujeres. En 1994-1996, la prevalencia fue del46,5% en varones y del 23,9% en mujeres. El mayor descenso (..) (AU)

Objective: To describe trends from 1986-1996 in the prevalence of cigarette smoking between ages 25 to 64 in the MONICA-Catalonia study, according to educational level, and to validate these trends biochemically. Methods: Three cross-sectional surveys in independent random samples of the general population of central Catalonia area carried out in 1986-88, 1990-92 and 1994-96 following the World Health Organization’s MONICA protocol. Serum thiocyanate was determined by the Bowler method. Results: A total of 2,571, 2,934 and 3,485 men and women were examined with response rates of 74, 67 and 72% in each survey respectively. The age-adjusted cigarette smoking prevalence decreased in men by –5.1% (95% CI: –1.5 to –8.7)and increased in women by +8.5% (95% CI: +5.6 to +11.4).The prevalence was 46.5% in men and 23.9% in women in (..) (AU)

Recruitment methods and differences in early, late and non-respondents in the first MONICA-Catalonia population survey.

The early response rate in the first MONICA-Catalonia population survey was 52.7% and the final response rate was 73.8%. The intensity of recruitment effort in this survey led to a considerable increase in response rate (20%), with the extra cost per late respondent being relatively low ($13.9). Added recruitment effort was most effective in the youngest age group, 25-34 years. It was also more effective among women living in urban areas than among those from rural areas. In men, early respondents had a higher proportion of smokers than late respondents, and in women, early respondents had higher systolic and diastolic blood pressure levels and were more aware of their history of high blood pressure than late respondents. Non-respondents were less educated than respondents in both sexes, and this was more marked in women. No differences were found in the proportion of smokers between respondents and non-respondents. Respondents were more aware of their high blood pressure history than non-respondents. The recruitment costs and distribution of non-response components are given.