Evaluación de la validez de las funciones SCORE de bajo riesgo y calibrada para población española en las cohortes FRESCO / Validity assessment of low-risk SCORE function and SCORE function calibrated to the Spanish population in the FRESCO cohorts

Introducción y objetivos. Estudiar la validez de la función SCORE original de bajo riesgo sin y con colesterol unido a lipoproteínas de alta densidad y SCORE calibrada en población española. Métodos. Análisis agrupado con datos individuales de 12 estudios de cohorte de base poblacional. Se incluyó a 30.919 participantes de 40-64 años sin enfermedades cardiovasculares en el momento del reclutamiento, que se siguieron durante 10 años para la mortalidad cardiovascular contemplada en el proyecto SCORE. La validez de las funciones se analizó mediante el área bajo la curva ROC (discriminación) y el test de Hosmer-Lemeshow (calibración), respectivamente. Resultados. Se dispuso de 286.105 personas/año. La mortalidad a 10 años por causas cardiovasculares fue del 0,6%. La razón de casos esperados/observados fue de 9,1, 6,5 y 9,1 en varones y de 3,3, 1,3 y 1,9 en mujeres con las funciones SCORE original de bajo riesgo sin y con colesterol unido a lipoproteínas de alta densidad y SCORE calibrada, respectivamente; diferencias estadísticamente significativas con el test de calibración de Hosmer-Lemeshow entre la mortalidad predicha con SCORE y la observada (p < 0,001 en ambos sexos y en todas las funciones). Las áreas bajo la curva ROC con SCORE original fueron 0,68 en varones y 0,69 en mujeres. Conclusiones. Todas las versiones de las funciones SCORE disponibles en España sobreestiman significativamente la mortalidad cardiovascular observada en la población española. A pesar de la aceptable capacidad de discriminación, la predicción del número de acontecimientos cardiovasculares mortales (calibración) fue significativamente imprecisa (AU)

Introduction and objectives. To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. Methods. Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. Results. Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. Conclusions. All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate (AU)

Validity Assessment of Low-risk SCORE Function and SCORE Function Calibrated to the Spanish Population in the FRESCO Cohorts.

INTRODUCTION AND OBJECTIVES: To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. METHODS: Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. RESULTS: Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. CONCLUSIONS: All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate.

Derivation and validation of a set of 10-year cardiovascular risk predictive functions in Spain: the FRESCO Study.

OBJECTIVE: To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. METHOD: Pooled analysis of 11 population-based Spanish cohorts (1992-2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. RESULTS: The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. CONCLUSIONS: The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.

Adaptation of the Framingham-Wilson coronary risk equation for the population of Navarra (RICORNA).

INTRODUCTION AND OBJECTIVES: The Framingham equations overestimate the risk of coronary disease in populations with a low disease incidence. It is more appropriate to take the local population's characteristics into account when estimating coronary risk. Accordingly, the Framingham-Wilson equation has been adapted for the population of Navarra, Spain. This article presents 10-year overall coronary risk charts. METHODS: The Framingham-Wilson equation was adapted using data on the prevalence of cardiovascular risk factors and the coronary event rate in the population of Navarra. The version of the Framingham-Wilson equation used included high-density lipoprotein cholesterol (HDL-C). The probability of an event at 10 years for different combinations of risk factors, with an HDL-C concentration of 35-59 mg/dL, are illustrated. RESULTS: Using the Framingham equation adapted for Navarra (i.e., the RICORNA or Riesgo Coronario Navarra), the proportion with an estimated probability of a coronary event in the next 10 years greater than 9% is approximately half that in the original Framingham population, and the proportion with a high or very high probability (i.e., 20%) is one-third. An HDL-C level <35 mg/dL increases the risk by 50% and a level > or =60 mg/dL reduces it by 50%, approximately. The average HDL-C level observed in the population was 63.9 mg/dL overall, and 70.1 mg/dL in women. CONCLUSIONS: The RICORNA equation can provide a more precise estimate of overall coronary risk and could be useful in primary disease prevention in Navarra. The high HDL-C concentration observed in Navarra might contribute to the associated low coronary morbidity and mortality.

Adaptación de la función de riesgo coronario de Framingham-Wilson para la población de Navarra (RICORNA) / Adaptation of the Framingham-Wilson coronary risk equation for the population of Navarra (RICORNA)

Introducción y objetivos. Las funciones de Framingham sobrestiman el riesgo de enfermedad coronaria en poblaciones con baja incidencia. Es más apropiado estimar el riesgo coronario considerando las características poblacionales locales. En este sentido, se ha adaptado la ecuación de Framingham-Wilson para la población de Navarra. Se presentan las tablas de riesgo coronario global a 10 años. Métodos. Se ha adaptado la ecuación de Framingham-Wilson mediante los datos de prevalencia de los factores de riesgo cardiovascular y la tasa de acontecimientos coronarios de Navarra. Se ha utilizado la ecuación de Framingham-Wilson que incluye el colesterol unido a lipoproteínas de alta densidad (cHDL). Se muestran las probabilidades de acontecimientos a 10 años correspondientes a las distintas combinaciones de los factores de riesgo, para una concentración de cHDL de 35-59 mg/dl. Resultados. En la función adaptada Framingham-Navarra (RICORNA), la proporción de estimaciones de probabilidad de acontecimiento coronario a 10 años superior al 9% es aproximadamente 2 veces menor, y la de riesgo alto o muy alto (≥ 20%) es 3 veces menor que en las originales de Framingham. Los valores de cHDL < 35 mg/dl incrementan el riesgo un 50% y los valores ≥ 60 mg/dl lo reducen un 50%, aproximadamente. El cHDL observado tuvo un valor medio poblacional de 63,9 mg/dl y de 70,1 mg/dl en las mujeres. Conclusiones. La función RICORNA es una herramienta que puede ser utilizada para estimar con más precisión el riesgo coronario global en la prevención primaria de esta enfermedad en Navarra. La elevada concentración de cHDL observada en Navarra puede contribuir a su baja morbimortalidad coronaria (AU)

Introduction and objectives. The Framingham equations overestimate the risk of coronary disease in populations with a low disease incidence. It is more appropriate to take the local population’s characteristics into account when estimating coronary risk. Accordingly, the Framingham-Wilson equation has been adapted for the population of Navarra, Spain. This article presents 10-year overall coronary risk charts. Methods. The Framingham–Wilson equation was adapted using data on the prevalence of cardiovascular risk factors and the coronary event rate in the population of Navarra. The version of the Framingham-Wilson equation used included high-density lipoprotein cholesterol (HDL-C). The probability of an event at 10 years for different combinations of risk factors, with an HDL-C concentration of 35-59 mg/dL, are illustrated. Results. Using the Framingham equation adapted for Navarra (ie, the RICORNA or Riesgo Coronario Navarra), the proportion with an estimated probability of a coronary event in the next 10 years greater than 9% is approximately half that in the original Framingham population, and the proportion with a high or very high probability (ie, 20%) is one-third. An HDL-C level <35 mg dl increases the risk by 50 and a level 8805 60 reduces it approximately average hdl-c observed in population was 63 9 overall 70 1 women conclusions ricorna equation can provide more precise estimate of coronary could be useful primary disease prevention navarra high concentration might contribute to associated low morbidity mortality (AU)

Legionnaires' disease outbreak in Murcia, Spain.

An explosive outbreak of Legionnaires' disease occurred in Murcia, Spain, in July 2001. More than 800 suspected cases were reported; 449 these cases were confirmed, which made this the world's largest outbreak of the disease reported to date. Dates of onset for confirmed cases ranged from June 26 to July 19, with a case-fatality rate of 1%. The epidemic curve and geographic pattern from the 600 competed epidemiologic questionnaires indicated an outdoor point-source exposure in the northern part of the city. A case-control study matching 85 patients living outside the city of Murcia with two controls each was undertaken to identify to outbreak source; the epidemiologic investigation implicated the cooling towers at a city hospital. An environmental isolate from these towers with an identical molecular pattern as the clinical isolates was subsequently identified and supported that epidemiologic conclusion.

[International classification of functioning, disability and health (ICF) 2001]. / La clasificación internacional del funcionamiento de la discapacidad y de la salud (CIF) 2001.

The approach which had been being employed to date for dealing with and classifying those aspects related to health and disability have been revised and updated thanks to the World Health Organization (WHO) having drafted the International Classification of Functioning, Disability and Health, which has now been accepted 191 countries after revamping the prior model and reaching a consensus regarding a new international model for describing and measuring health and disability. As background information, it must be recalled that the Classification of Impairments, Disabilities and Handicaps (CIDH) previously in effect was first published by the WHO in 1980. The process of revising this classification has resulted in some changes of far-reaching importance. The change in the name has been aimed at reflecting the wish to replace the negative perspective of impairments, disabilities and handicaps for a more neutral view of structure and function, considering the positive perspectives of activities and of participation. Another new aspect has been that of including a section related to environmental factors in recognition of their importance, given that by interacting with the health condition they may give rise to a disability, or, at the opposite end of the scale, may restore functioning. The data available has enabled the WHO make estimates including that of some 500 million years of life being lost annually due to disabilities related to health problems, which totals over one half of the years lost annually due to premature deaths. The main objective of this new classification is that of providing the conceptual framework by means of unified, standardized language with a view to of the underlying challenges, setting out a valuable instrument of practical use in public health.

La Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) 2001 / International Classification of Functioning, Disability and Health (ICF) 2001

La aproximación que hasta ahora se seguía para considerar y clasificar las dimensiones relacionadas con la salud y la discapacidad se ha visto modificada y actualizada gracias a la elaboración por parte de la Organización Mundial de la Salud (OMS) de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). Esta clasificación ha sido ya aceptada por 191 países, tras replantear el modelo anterior y acordar un nuevo modelo internacional de descripción y medición de la salud y la discapacidad. Como antecedentes hay que recordar que la Clasificación de Deficiencias, Discapacidades y Minusvalías (CIDDM) anteriormente vigente fue publicada por la OMS por primera vez en 1980. El proceso de revisión de dicha clasificación ha tenido como resultado modificaciones trascendentes. Con el cambio del nombre se ha intentado reflejar el de seo de sustituir la perspectiva negativa de las deficiencias, discapacidades y minusvalías por una visión más neutral de la estructura y de la función, considerando las perspectivas positivas de las actividades y de la participación. Otro aspecto novedoso ha sido la inclusión de una sección de factores ambientales, como reconocimiento a su importancia, ya que interactuando con el estado de salud pueden llegar a generar una discapacidad o, en el otro extremo, a restablecer el funcionamiento. La información disponible ha permitido estimar a la OMS, entre otras cosas, que cada año se pierden unos 500 millones de años de vida a causa de discapacidades asociadas a problemas de salud, lo que representa más de la mitad de los años perdidos anualmente por muertes prematuras. El objetivo principal de la nueva clasificación es proporcionar el marco conceptual mediante un lenguaje unificado y estandarizado ante los retos subyacentes, constituyendo un valioso instrumento de utilidad práctica en salud pública (AU)

The approach which had been being employed to date for dealing with and classifying those aspects related to health and disability have been revised and updated thanks to the World Health Organization (WHO) having drafted the International Classification of Functioning, Disability and Health, which has now been accepted 191 countries after revamping the prior model and reaching a consensus regarding a new international model for describing and measuring health and disability. As background information, it must be recalled thatthe Classification of Impairments, Disabilities and Handicaps (CIDH) previously in effect was first published by the WHO in 1980. The process of revising this classification has resulted in some changes of far-reaching importance. The change in the name has been aimed at reflecting the wish to replace the negative perspective of impairments, disabilities and handicaps for a more neutral view of structure and function, considering the positive perspectives of activities and of participation. Another new aspect has been that of including a section related to environmental factors in recognition of their importance, given that by interacting with the health condition they may give rise to a disability, or, at the opposite end of the scale, may restore functioning. The data available has enabled the WHO make estimates including that of some 500 million years of life being lost annually due to disabilities related to health problems, which totals over one half of the years lost annually due to premature deaths. The main objective of this new classification is that of providing the conceptual framework by means of unified, standardized language with a view to of the underlying challenges, setting out a valuable instrument of practical use in public health (AU)