Mortalidad en niños con bacteriemia por Stenotrophomonas maltophilia: revisión sistemática / Mortality in children with Stenotrophomonas maltophilia-related bacteremia: A systematic review

Introducción: En los niños, la bacteriemia por Stenotrophomonas maltophilia es considerada una complicación severa y asociada a una elevada mortalidad. Con el objetivo de conocer la mortalidad asociada a esa condición, se realizó una revisión sistemática de la literatura. Material y métodos: Se aplicó una estrategia de búsqueda bibliográfica con las palabras clave: bacteriemia por Stenotrophomonas maltophilia, niños y adolescentes como únicos filtros. Se informan la mediana y los valores intercuartílicos de la frecuencia de la mortalidad reportada por los estudios incluidos. Resultados: Se identificaron 165 estudios potencialmente útiles. De ellos, se seleccionaron finalmente, 9 estudios para ser incluidos. La incidencia de mortalidad a consecuencia de una bacteriemia por S.maltophilia fue del 25%; Q25: 11­Q75: 36; rango: 6,06 a 40,6. Consideraciones finales: La bacteriemia por Sm tuvo un alto porcentaje de mortalidad en especial en pacientes con patología subyacente y uso de procedimientos invasivos y el uso inadecuado de antibióticos empíricos (AU)

Introduction: In children, Stenotrophomonas maltophilia-related bacteremia is considered a severe complication associated with high mortality. With the aim to determine the mortality associated with this condition, a systematic review of the literature was conducted. Material and methods: A literature search strategy was applied using the keywords: bacteremia due to Stenotrophomonas maltophilia, children, and adolescents as the only filters. The median and interquartile ranges of the mortality rates described in the studies included are reported. Results: A total of 165 potentially useful studies were identified, of which nine were finally selected to be included in the analysis. The incidence of S.maltophilia bacteremia-related mortality was 25%; Q25: 11­Q75: 36; range: 6.06 to 40.6. Final considerations: S.maltophilia-related bacteremia was associated with a high mortality rate especially in patients with an underlying disease, when invasive procedures were performed, and when emperical antibiotics were inadequately used (AU)

Effectiveness of a decision aid for patients with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a Patient Decision Aid (PtDA) for knee osteoarthritis. METHOD: Randomized controlled trial, in which 193 patients were allocated to the PtDA or usual care. Outcome measures were the Decisional Conflict Scale (DCS), knowledge of osteoarthritis and arthroplasty, satisfaction with the decision-making process (SDMP) and treatment preference, assessed immediately after the intervention. At 6 months, the same measures were applied in non-operated patients, whereas those who underwent arthroplasty completed the SDMP and the Decisional Regret Scale (DRS). RESULTS: The PtDA produced a significant immediate improvement of decisional conflict (MD = -11.65, 95%CI: -14.93, -8.37), objective knowledge (MD = 10.37, 99%IC: 3.15, 17.70) and satisfaction (MD = 6.77, 99%CI: 1.19, 12.34), and a different distribution of preferences (χ2 = 8.74, p = 0.033). Patients with less than secondary education obtained a stronger effect on decisional conflict (p = 0.015 for the interaction) but weaker for knowledge (p = 0.051). At 6 months, there were no significant differences in any variable, including the rate of total knee replacement. Operated patients showed a low level of regret, which was not affected by the intervention. CONCLUSION: The PtDA is effective immediately after its application, but it shows no effects in the medium-term. Future research should investigate which subgroups of patients could benefit more from this intervention, as well as the longitudinal evolution of decision-related psychological variables.

Grandes variaciones en la utilización de pruebas por imagen en el diagnóstico y seguimiento de los pacientes con ictus / Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients

Introducción y objetivo: El radiodiagnóstico es esencial para precisar la planificación terapéutica de las personas con ictus, pero la incertidumbre sobre su efectividad puede contribuir a la variabilidad en su indicación. Este estudio tiene por objetivo describir la evolución del uso de TAC y RM en el manejo del ictus a lo largo de 5 años en la red hospitalaria del Servicio Canario de Salud y analizar la variabilidad interhospitalaria mediante el uso de datos administrativos recogidos rutinariamente. Pacientes y método: Se explotó el CMBD de los pacientes con diagnóstico de ictus o AIT (2005-2010) en 4 hospitales. Además, se incluyó la edad y el sexo del paciente, los procedimientos realizados, los diagnósticos secundarios y la estancia. Se realizó un análisis descriptivo de las características de los pacientes y un análisis bivariante mediante t de Student o Chi-cuadrado para detectar diferencias entre los pacientes según recibieran o no RM. Las desigualdades en el acceso a RM se analizaron mediante regresión logística. Resultados y conclusiones: Se incluyeron 10.487 pacientes adultos (8.571 con ictus y 1.916 con AIT). El porcentaje de pacientes con ictus que recibieron TAC aumentó desde el 89,47% en 2005 al 91,50% en 2010; en ellos, la RM aumentó desde el 25,41% en 2005 al 36,02% en 2010. Entre los pacientes con AIT el uso de TAC creció desde el 84,64 al 88,04%, y el de RM, desde el 32,53 al 39,13%. Nuestros resultados sugieren que ser mujer, joven y presentar mayor comorbilidad aumentan las probabilidades de recibir RM

Introduction and objective: Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5 years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. Patients and method: We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. Results and conclusions: Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI

Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients. / Grandes variaciones en la utilización de pruebas por imagen en el diagnóstico y seguimiento de los pacientes con ictus.

INTRODUCTION AND OBJECTIVE: Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. PATIENTS AND METHOD: We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. RESULTS AND CONCLUSIONS: Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI.

Cost-Effectiveness Methods and Newborn Screening Assessment.

Nowadays, health funding decisions must be supported by sound arguments in terms of both effectiveness and economic criteria. After more than half a century of newborn screening for rare diseases, the appropriate economic evaluation framework for these interventions is still challenging. The validity of standard methods for economic evaluation heavily relies on the availability of robust evidence, but collection of such evidence is precluded by the rareness of the conditions that may benefit from screening. Furthermore, there are a series of conceptual and methodological limitations that warrant further careful consideration when assessing the cost-effectiveness of newborn screening programs. In this chapter we provide a general overview of current economic evaluation methods and the challenges for their application to newborn screening programs.

Calidad de vida relacionada con la salud en pacientes con ataxias espinocerebelosas / Health-related quality of life in patients with spinocerebellar ataxia

Introducción. El deterioro progresivo de los pacientes con ataxias espinocerebelosas (AEC) genera un gran impacto sobre su calidad de vida relacionada con la salud (CVRS). En este estudio se evalúa la CVRS en una muestra de pacientes diagnosticados de AEC y se pretende estimar la capacidad predictiva de un conjunto de variables sociodemográficas en las distintas dimensiones que conforman el cuestionario. Métodos. Se evaluó a un total de 80 pacientes diagnosticados de AEC, a través de un cuestionario sociodemográfico y del cuestionario genérico de salud SF-36. Se estudiaron variables sociodemográficas como sexo, edad, existencia de cuidador, situación laboral y tiempo desde el diagnóstico de la enfermedad. Resultados. Las dimensiones que componen el SF-36 muestran correlaciones positivas y significativas entre ellas. Las puntuaciones medias obtenidas en cada una de las dimensiones difieren según el sexo, siendo significativa la diferencia solo en la dimensión salud general, con media más alta en los hombres. En relación con la edad, se encuentran diferencias significativas en las dimensiones vitalidad y función social, con puntuaciones mayores en el rango de menor edad (menores de 34 años). La variable que explica la mayor parte de la varianza del cuestionario es la existencia de cuidador. Conclusiones. El Cuestionario de Salud SF-36 es un instrumento válido y fiable para medir la CVRS en pacientes con diagnóstico de AEC. Asimismo, la variable existencia de cuidador parece determinar la calidad de vida autopercibida por estos pacientes (AU)

Introduction. The progressive deterioration of patients with spinocerebellar ataxia (SCA) has a major impact on their health-related quality of life (HRQOL). This study evaluates HRQOL in a sample of patients diagnosed with SCA and aims to estimate the predictive ability of a set of sociodemographic variables for the different dimensions of the General Health Questionnaire. Methods. A total of 80 patients diagnosed with SCA were assessed using a sociodemographic questionnaire and the SF-36 General Health Questionnaire. The sociodemographic variables studied were sex, age, presence of a carer, employment status, and time elapsed from diagnosis of the disease. Results. The 8 subscales of the SF-36 show positive and significant correlations to one another. Mean scores obtained on each SF-36 subscale differ between women and men, although this difference is significant only on the general health subscale, with men scoring higher than women. We found significant age differences on the vitality and social function subscales, with higher scores among younger patients (< 34 years). The variable ‘presence of a carer’ accounts for most of the total variance of the questionnaire. Conclusions. The SF-36 is a valid and useful instrument for evaluating HRQOL in patients diagnosed with SCA. Presence of a carer seems to be a determinant of self-perceived quality of life in these patients (AU)

Utilidad de Trimetoprima-sulfametoxazol en épocas de S. aureus meticilino resistente de la comunidad / Usefulness of trimethoprim-sulfamethoxazole in times of community-acquired methicillin-resistant S. aureus.

Trimetoprima-sulfametoxazol (TMP-SMX) tiene actividad in vitro contra cepas de Staphylococcusaureus, en especial las cepas resistentes a la meticilina de la comunidad (SAMR-Co), Éste es considerado un antibiótico útil debido a su bajo costo, amplio espectro y posibilidad de administración por vía oral dada su adecuada biodisponibilidad y sabor agradable. Se realizó esta revisión narrativa de la literatura para evaluar el uso de TMP-SMX en comparación con otras opciones disponibles en el tratamiento de las infecciones por SAMR-Co en niños (AU)

Trimethoprim/sulfamethoxazole (TMP-SMX) has in vitro activity against Staphylococcus aureus, especially against community-acquired methicillin-resistant (CAMR) strains. It is considered to be a useful antibiotic because of its low cost, broad spectrum, and possibility of oral administration because of its adequate bioavailability and agreeable flavor. A review of the literature was performed to evaluate the use of TMP-SMX compared to available options for the treatment of CAMR infections in children (AU)

Health-related quality of life in patients with spinocerebellar ataxia. / Calidad de vida relacionada con la salud en pacientes con ataxias espinocerebelosas.

INTRODUCTION: The progressive deterioration of patients with spinocerebellar ataxia (SCA) has a major impact on their health-related quality of life (HRQOL). This study evaluates HRQOL in a sample of patients diagnosed with SCA and aims to estimate the predictive ability of a set of sociodemographic variables for the different dimensions of the General Health Questionnaire. METHODS: A total of 80 patients diagnosed with SCA were assessed using a sociodemographic questionnaire and the SF-36 General Health Questionnaire. The sociodemographic variables studied were sex, age, presence of a carer, employment status, and time elapsed from diagnosis of the disease. RESULTS: The 8 subscales of the SF-36 show positive and significant correlations to one another. Mean scores obtained on each SF-36 subscale differ between women and men, although this difference is significant only on the general health subscale, with men scoring higher than women. We found significant age differences on the vitality and social function subscales, with higher scores among younger patients (< 34 years). The variable 'presence of a carer' accounts for most of the total variance of the questionnaire. CONCLUSIONS: The SF-36 is a valid and useful instrument for evaluating HRQOL in patients diagnosed with SCA. Presence of a carer seems to be a determinant of self-perceived quality of life in these patients.

Effectiveness and safety of nutritional supplements in the treatment of hereditary retinal dystrophies: a systematic review.

The hereditary retinal dystrophies (HRDs) are a group of genetically determined disorders that result in loss of the visual function. There is a lack of standard pharmacological treatments or widely accepted nutritional recommendations. The objective of this review is to summarise the scientific evidence on the effectiveness and safety of nutritional supplements for the treatment of HRDs. We conducted a scientific literature search on Medline and PreMedline, EMBASE, SCI-EXPANDED, SSCI, and The Cochrane Library up to August 2014. Experimental, quasi-experimental and controlled observational studies were selected. Eight studies were ultimately included, seven on retinitis pigmentosa (RP) and one on Best disease. Vitamin A, vitamin E, docosahexaenoic acid (DHA), lutein and ß-carotene were assessed. A 15 000 IU daily dose of vitamin A was reported to have shown a small protective effect on the progression of RP, as was the use of the carotenoids lutein and ß-carotene. Different DHA doses has no effect on RP or Best disease. No supplement showed severe adverse effects in the selected studies although strong evidence of toxicity exists for high doses of vitamin A and ß-carotene in certain populations. The selected studies concluded that there may be a small beneficial effect of vitamin A, lutein and ß-carotene on the progression of RP. The limited evidence available indicates some well-designed additional studies on combined supplements strategies may achieve more robust conclusions. Moreover, the scarcity of evidence available on the treatment of HRD other than RP with nutritional supplements supports the need for further research efforts.

Revisión de estudios económicos y análisis de impacto presupuestario de la ocriplasmina como tratamiento de la tracción vitreomacular / Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction

OBJETIVO: Revisar las pruebas sobre el coste-efectividad de la ocriplasmina para la tracción vitreomacular (TVM) y estimar el impacto presupuestario que supondría su uso en el Sistema Nacional de Salud (SNS). MATERIAL Y MÉTODOS: 1) Revisión sistemática. Se realizaron búsquedas en enero del 2015 en MEDLINE, PREMEDLINE, EMBASE, CRD y The Cochrane Library, y páginas web clave. Se incluyeron evaluaciones económicas completas que comparaban ocriplasmina con tratamiento habitual (espera vigilante y/o vitrectomía) en pacientes con TVM. Las medidas de resultado de interés fueron los costes de las alternativas y la ratio coste-efectividad incremental. También se incluyeron estudios de análisis de impacto presupuestario. Se valoró la calidad metodológica y se realizó una síntesis narrativa de los estudios incluidos. 2) Estimación del impacto presupuestario. Se estimó el impacto presupuestario que supondría incorporar ocriplasmina en el SNS tomando datos de varias fuentes. RESULTADOS: Se identificaron 6 estudios, ninguno realizado en España. Los 2 estudios de mejor calidad concluyen que ocriplasmina es coste-efectiva en sus respectivos ámbitos (Canadá y Reino Unido) pero solo en pacientes con determinadas condiciones (sin membrana epirretiniana, por ejemplo). Los resultados del análisis de impacto presupuestario son contradictorios entre países. El análisis para España encontró que la introducción de ocriplasmina supondría un ahorro para el SNS superior a un millón de euros en 5 años. CONCLUSIONES: El coste-efectividad de ocriplasmina no ha sido demostrado en España aunque buenos estudios realizados en otros países encontraron que ocriplasmina es coste-efectiva en pacientes seleccionados. Dados los precios vigentes en España, ocriplasmina podría suponer un ahorro para el SNS

OBJECTIVE: To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS: 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS: Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS: The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS

Social/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe.

OBJECTIVE: The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with juvenile idiopathic arthritis (JIA) in Europe. METHODS: We conducted a cross-sectional study of patients with JIA from Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D-5L) questionnaire. RESULTS: A total of 162 patients (67 Germany, 34 Sweden, 33 Italy, 23 United Kingdom, 4 France, and 1 Bulgaria) completed the questionnaire. Excluding Bulgarian results, due to small sample size, country-specific annual health care costs ranged from €18,913 to €36,396 (reference year: 2012). Estimated direct healthcare costs ranged from €11,068 to €22,138; direct non-healthcare costs ranged from €7837 to €14,155 and labor productivity losses ranged from €0 to €8715. Costs are also shown to differ between children and adults. The mean EQ-5D index score for JIA patients was estimated at between 0.44 and 0.88, and the mean EQ-5D visual analogue scale score was estimated at between 62 and 79. CONCLUSIONS: JIA patients incur considerable societal costs and experience substantial deterioration in HRQOL in some countries. Compared with previous studies, our results show a remarkable increase in annual healthcare costs for JIA patients. Reasons for the increase are the inclusion of non-professional caregiver costs, a wider use of biologics, and longer hospital stays.

Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction. / Revisión de estudios económicos y análisis de impacto presupuestario de la ocriplasmina como tratamiento de la tracción vitreomacular.

OBJECTIVE: To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS: 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS: Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS: The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS.

Breast cancer patients' narrative experiences about communication during the oncology care process: a qualitative study.

To analyse the perception about the information and communication received to evaluate oncologic care of breast cancer patients in Spain. Qualitative study based on conducting in-depth interviews. An inductive thematic analysis of the illness narratives was performed. Intentional theoretical sampling of 41 people diagnosed with breast cancer. The information provided during care process is assessed as appropriate, as it includes personalised skills focused on communication and considers organisational and contextual issues. In some cases, the information was considered partial, heterogeneous and at times contradictory, which revealed a lack of continuity. To provide and adequately cover information needs from the patient perspective, it is necessary to ensure access, both in its physical (material) and intellectual (comprehension) dimension, keeping in mind elements of social capital (social networks) and cultural capital (values, beliefs, non-verbal language) that facilitate or hinder access. The current state of transition to a horizontal model in the doctor-patient relationship, could account for the difficulties, deficits and contradictions in communication and information that breast cancer patients perceive in many contexts.

Utilización de los servicios de urgencias en zonas rurales y urbanas / Use of emergency departments in rural and urban areas in Spain

Objetivos: Describir la utilización de los servicios de urgencias (SU) y analizar las diferencias entre zonas rurales y urbanas. Material y métodos: Con la Encuesta Nacional de Salud de los años 2006 y 2011 se describen los perfiles de los pacientes que tienen visitas al SU según tamaño del municipio de residencia y se identifican las variables asociadas con tener una visita a los SU para determinar el efecto del tamaño del municipio de residencia. Resultados: En ambos años, la mayor utilización de SU se observa en las personas que utilizan más Atención Primaria u hospitales, que tienen peor salud autopercibida y estado funcional, con más enfermedades crónicas, de clases sociales más bajas, y de menor edad. Ajustando por el resto de las variables, los residentes en municipios de más habitantes o capitales de provincia tienen una mayor frecuentación de SU que los residentes en municipios más pequeños, que tienen una mayor utilización de SU públicos y no hospitalarios, que los residentes en zonas urbanas. Discusión: Existe una utilización más elevada de los SU por los habitantes de zonas urbanas que no puede justificarse por su peor estado de salud, lo que indicaría no una infrautilización en zonas rurales, sino sobreutilización en zonas urbanas (AU)

Objectives: Describe the use of emergency departments (ED), and analyse the differences in use between residents in rural and urban areas. Material and methods: Using data from the National Health Survey of 2006 and 2011, the profiles of patients with ED visits by population size of place of residence were obtained. The variables associated with making one visit to the ED were also evaluated, in order to determine the effect of the population size of place of residence. Results: A higher use of ED is observed in persons with a higher frequency of use of Primary Care and hospital admissions, and increases with worse self-perceived health and functional status, with more chronic diseases, in people from lower social classes, and younger ages. Adjusting for the other variables, residents in larger cities have a higher use of ED than residents in rural areas, who show a higher use of public and non-hospital based ED, than residents in urban areas. Discussion: There is a higher use of ED by inhabitants of urban areas that cannot be justified by a worst health status of that population. This tends to indicate that the use of ED is not under-used in rural areas, but overused in urban areas (AU)

[Use of emergency departments in rural and urban areas in Spain]. / Utilización de los servicios de urgencias en zonas rurales y urbanas.

OBJECTIVES: Describe the use of emergency departments (ED), and analyse the differences in use between residents in rural and urban areas. MATERIAL AND METHODS: Using data from the National Health Survey of 2006 and 2011, the profiles of patients with ED visits by population size of place of residence were obtained. The variables associated with making one visit to the ED were also evaluated, in order to determine the effect of the population size of place of residence. RESULTS: A higher use of ED is observed in persons with a higher frequency of use of Primary Care and hospital admissions, and increases with worse self-perceived health and functional status, with more chronic diseases, in people from lower social classes, and younger ages. Adjusting for the other variables, residents in larger cities have a higher use of ED than residents in rural areas, who show a higher use of public and non-hospital based ED, than residents in urban areas. DISCUSSION: There is a higher use of ED by inhabitants of urban areas that cannot be justified by a worst health status of that population. This tends to indicate that the use of ED is not under-used in rural areas, but overused in urban areas.

Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Calidad de vida relacionada con la salud en pacientes con esclerosis lateral amiotrófica / Quality of life related to health in patients with amyotrophic lateral sclerosis

Introducción: El deterioro progresivo de los pacientes con esclerosis lateral amiotrófica (ELA) genera un gran impacto sobre su calidad de vida relacionada con la salud (CVRS). En este estudio se evalúa la CVRS en una muestra de pacientes diagnosticados de ELA y se pretende estimar la capacidad predictiva de un conjunto de variables sociodemográficas en las distintas dimensiones que conforman el cuestionario. Métodos: Se evaluó a un total de 63 pacientes diagnosticados de ELA, a través de un cuestionario sociodemográfico y del cuestionario genérico de salud SF-36. Se estudiaron variables sociodemográficas como sexo, edad, existencia de cuidador, situación laboral y tiempo desde el diagnóstico de la enfermedad. Resultados: El cuestionario SF-36 muestra una correlación positiva entre las diferentes dimensiones que la componen lo que demuestra su confiabilidad. Las puntuaciones medias obtenidas en cada una de las dimensiones del SF-36 son mayores en hombres que en mujeres, aunque esta diferencia es significativa solo en la dimensión Rol físico, siendo el grupo de pacientes de menor edad (menos de 56 años) quienes presentan puntuaciones medias más altas en la mayoría de las dimensiones del SF-36. La mayor parte de la variancia de la prueba queda explicada por la variable existencia de cuidador. Conclusiones: Se confirma la capacidad del SF-36 como medida válida y fiable de la CVRS para pacientes con un diagnóstico de ELA, que discrimina entre pacientes con diferentes estados de salud según su nivel de dependencia

Introduction: Progressive deterioration in patients with amyotrophic lateral sclerosis (ALS) has a major impact on their health-related quality of life (HRQOL). The objectives of this study are to evaluate HRQOL in a sample of patients diagnosed with ALS and estimate the predictive capability of a set of sociodemographic variables for the different scales covered by a general health survey. Methods: A total of 63 patients diagnosed with ALS were assessed using a sociodemographic questionnaire and the SF-36 general health survey. The sociodemographic variables studied were sex, age, presence of a caregiver, employment status, and time from diagnosis of disease. Results: The SF-36 survey shows positive correlations between the different scales composing it, which proves its reliability. The mean scores obtained for each of the SF-36 scales were higher in men than in women, although the only statistically significant difference was for the Physical Role scale. The lowest age range (less than 56 years) presented the highest mean scores for most of these dimensions. Most of the variance in the test is explained by the variable 'presence of caregiver'. Conclusions: The SF-36 health survey has been confirmed as a valid and useful tool for evaluating HRQOL in ALS patients, and it discriminates between patients in different states of health according to their level of dependency

[Health-related quality of life in patients with amyotrophic lateral sclerosis]. / Calidad de vida relacionada con la salud en pacientes con esclerosis lateral amiotrófica.

INTRODUCTION: Progressive deterioration in patients with amyotrophic lateral sclerosis (ALS) has a major impact on their health-related quality of life (HRQOL). The objectives of this study are to evaluate HRQOL in a sample of patients diagnosed with ALS and estimate the predictive capability of a set of sociodemographic variables for the different scales covered by a general health survey. METHODS: A total of 63 patients diagnosed with ALS were assessed using a sociodemographic questionnaire and the SF-36 general health survey. The sociodemographic variables studied were sex, age, presence of a caregiver, employment status, and time from diagnosis of disease. RESULTS: The SF-36 survey shows positive correlations between the different scales composing it, which proves its reliability. The mean scores obtained for each of the SF-36 scales were higher in men than in women, although the only statistically significant difference was for the Physical Role scale. The lowest age range (less than 56 years) presented the highest mean scores for most of these dimensions. Most of the variance in the test is explained by the variable 'presence of caregiver'. CONCLUSIONS: The SF-36 health survey has been confirmed as a valid and useful tool for evaluating HRQOL in ALS patients, and it discriminates between patients in different states of health according to their level of dependency.

Development and validation of a computer-aided diagnostic tool to screen for age-related macular degeneration by optical coherence tomography.

BACKGROUND: To develop and assess the technical validity of new computer-aided diagnostic software (CAD) for automated analyses of optical coherence tomography (OCT) images for the purpose of screening for neovascular age-related macular degeneration. METHODS: Artificial visual techniques were used to develop the CAD in two steps: normalisation and feature vector extraction from OCT images; and training and classification by means of decision trees. Technical validation was performed by a retrospective study design based on OCT images randomly extracted from clinical charts. Images were classified as normal or abnormal to serve for screening purposes. Sensitivity, specificity, positive predictive values and negative predictive values were obtained. RESULTS: The CAD was able to quantify image information by working in the perceptually uniform hue-saturation-value colour space. Particle swarm optimisation with Haar-like features is suitable to reveal structural features in normal and abnormal OCT images. Decision trees were useful to characterise normal and abnormal images using feature vectors obtained from descriptive statistics of detected structures. The sensitivity of the CAD was 96% and the specificity 92%. CONCLUSIONS: This new CAD for automated analysis of OCT images offers adequate sensitivity and specificity to distinguish normal OCT images from those showing potential neovascular age-related macular degeneration. These results will enable its clinical validation and a subsequent cost-effectiveness assessment to be made before recommendations are made for population-screening purposes.