Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care.

OBJECTIVE: To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity. DESIGN: Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. LOCATION: 7 PC teams from Catalonia. PARTICIPANTS: >50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. INTERVENTION: 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training. MEASUREMENTS: Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated. RESULTS: The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY. CONCLUSIONS: Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.

Burnout en los médicos de familia de Cataluña durante la quinta ola de la pandemia COVID-19 / Burnout among Catalan family doctors during the fifth wave of the COVID-19 pandemic

Objetivo: la pandemia de la COVID-19 ha tenido un impacto psicológico en los profesionales sanitarios, a menudo manifestándose como burnout. Nuestro objetivo fue estimar la prevalencia del burnout en médicas y médicos de familia de Cataluña durante la pandemia e identificar factores sociodemográficos, laborales y de salud mental asociados.Métodos: estudio descriptivo transversal basado en una encuesta online realizada entre junio y julio de 2021. Se invitó a participar a los 4.700 socios y socias de la Societat Catalana de Medicina Familiar i Comunitària (CAMFiC) y se obtuvo un 11% de respuesta (n = 522).Medidas principales: Maslach Burnout Inventory, con tres dimensiones: agotamiento emocional, despersonalización y realización personal. Análisis bivariante y regresión logística múltiple (variable dependiente: nivel elevado de afectación para cada dimensión de burnout).Resultados: el 67,5% de encuestados presentó niveles altos de agotamiento emocional, el 42,7% de despersonalización y el 29,9% de niveles bajos de realización personal. La prevalencia de agotamiento emocional elevado fue mayor entre las mujeres y los expuestos a pacientes con COVID-19. La edad y años de antigüedad laboral se asoció de forma inversa a agotamiento emocional y despersonalización alta. En el análisis multivariante, la depresión se asoció a despersonalización alta y realización personal baja, la ansiedad a agotamiento emocional alto, y el estrés a las tres dimensiones.Conclusiones: después de 1 año de pandemia, existen niveles elevados de burnout en los médicos y médicas de familia, particularmente en la dimensión de agotamiento emocional. Son necesarias medidas organizativas para proteger la salud mental de las/los profesionales.(AU)

Aim: the COVID-19 pandemic has had a psychological impact on health professionals, often manifesting as burnout. Our purpose was to estimate the prevalence of burnout in family doctors in Catalonia during the pandemic and to identify associated sociodemographic, occupational and mental health factors.Methods: cross-sectional descriptive study based on an online survey conducted June-July 2021. The 4700 members of the Catalan Society of Family and Community Medicine were invited to take part. An 11% response was obtained (n=522).Primary endpoints: Maslach Burnout Inventory, with three dimensions: emotional exhaustion, depersonalization and personal accomplishment. Bivariate analysis and multiple logistic regression (dependent variable: high level of affectation for each area dimension of burnout).Results: a total of 67.5%, 42.7% and 29.9% of respondents presented high levels of emotional exhaustion, depersonalization and low sense of personal accomplishment, respectively. The prevalence of high emotional exhaustion was higher among women and those exposed to COVID-19 patients. Age and seniority were inversely associated with emotional exhaustion and high depersonalization. Multivariate analysis revealed that depression was associated with high depersonalization and low personal accomplishment, anxiety with high emotional exhaustion, and stress with all three areas.Conclusions: One year after onset of the pandemic, we detected high levels of burnout in family doctors, particularly in terms of emotional exhaustion. Organizational measures are necessary to protect the mental health of professionals.(AU)

Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has had a major impact on the mental health of healthcare workers, yet studies in primary care workers are scarce. AIM: To investigate the prevalence of and associated factors for psychological distress in primary care workers during the first COVID-19 outbreak. DESIGN AND SETTING: This was a multicentre, cross-sectional, web-based survey conducted in primary healthcare workers in Spain, between May and September 2020. METHOD: Healthcare workers were invited to complete a survey to evaluate sociodemographic and work-related characteristics, COVID-19 infection status, exposure to patients with COVID-19, and resilience (using the Connor-Davidson Resilience Scale), in addition to being screened for common mental disorders (depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder). Positive screening for any of these disorders was analysed globally using the term 'any current mental disorder'. RESULTS: A total of 2928 primary care professionals participated in the survey. Of them, 43.7% (95% confidence interval [CI] = 41.9 to 45.4) tested positive for a current mental disorder. Female sex (odds ratio [OR] 1.61, 95% CI = 1.25 to 2.06), having previous mental disorders (OR 2.58, 95% CI = 2.15 to 3.10), greater occupational exposure to patients with COVID-19 (OR 2.63, 95% CI = 1.98 to 3.51), having children or dependents (OR 1.35, 95% CI = 1.04 to 1.76 and OR 1.59, 95% CI = 1.20 to 2.11, respectively), or having an administrative job (OR 2.24, 95% CI = 1.66 to 3.03) were associated with a higher risk of any current mental disorder. Personal resilience was shown to be a protective factor. CONCLUSION: Almost half of primary care workers showed significant psychological distress. Strategies to support the mental health of primary care workers are necessary, including designing psychological support and resilience-building interventions based on risk factors identified.

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10.

Background: Depression has a high prevalence among European countries. Several instruments have been designed to assess its symptoms in different populations. The Hopkins Symptom Checklist 25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use. There are short versions of this scale that could be useful in Primary Care (PC) settings, but their psychometric properties are unknown. Aim: To assess in PC patients the psychometric properties and diagnostic accuracy of the Spanish version of the HSCL-10 and the HSCL-5 consisting of 10 and 5 items, respectively. Methods: A multicenter, cross-sectional study was carried out at six PC centers in Spain. The HSCL-25 was administered to outpatients aged 45-75 who also participated in the structured Composite International Diagnostic Interview (CIDI). HSCL-10 and HSCL-5 were assessed and compared to HSCL-25 regarding total score correlation, internal consistency, and criterion validity against the gold-standard CIDI. This is a methodological study from a secondary data analysis and the primary data has been previously published. Results: Out of 790 patients, 767 completed the HSCL-25 and 736 the CIDI interview (96.0%). Cronbach's Alpha was 0.84 for HSCL-10 and 0.77 for HSCL-5. The known-group method and confirmatory factor analysis were acceptable for the establishment of construct validity. Sensitivity was 79.7% (CI95%, 67.7-88.0%) for HSCL-10, and 78.0% (CI95%, 65.9-86.6%) for HSCL-5, whereas specificity was 83% (CI95%, 80.0-85.7%) for HSCL-10, and 72.8% (CI95%, 69.3-76.0%) for HSCL-5. Area under the curve against CIDI was 0.88 (CI95%, 0.84-0.92%) for HSCL-10, and 0.85 (CI95%, 0.81-0.89%) for HSCL-5. Optimum cutoff point calculated with Youden Index was 1.90 for the HSCL-10 and 1.80 for the HSCL-5. Conclusion: HSCL-10 and HSCL-5 are reliable and valid tools to detect depression symptoms and can be used in PC settings.

Validation and Psychometric Properties of the Spanish Version of the Hopkins Symptom Checklist-25 Scale for Depression Detection in Primary Care.

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach's alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86-0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1-95.1%) and specificity was 76.7% (CI 95%, 73.3-79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.

Effectiveness of a Psychoeducational Group Intervention Carried Out by Nurses for Patients with Depression and Physical Comorbidity in Primary Care: Randomized Clinical Trial.

The association between physical illness and depression implies a poorer management of chronic disease and a lower response to antidepressant treatments. Our study evaluates the effectiveness of a psychoeducational group intervention led by Primary Care (PC) nurses, aimed at patients of this kind. It is a randomized, multicenter clinical trial with intervention (IG) and control groups (CG), blind response variables, and a one year follow-up. The study included 380 patients ≥50 years of age from 18 PC teams. The participants presented depression (BDI-II > 12) and a physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. The IG (n = 204) received the psychoeducational intervention (12 weekly sessions of 90 min), and the CG (n = 176) had standard care. The patients were evaluated at baseline, and at 4 and 12 months. The main outcome measures were clinical remission of depressive symptoms (BDI-II ≤ 13) and therapeutic response (reduction of depressive symptoms by 50%). Remission was not significant at four months. At 12 months it was 53.9% in the IG and 41.5% in the CG. (OR = 0.61, 95% CI, 0.49-0.76). At 4 months the response in the IG (OR = 0.59, 95% CI, 0.44-0.78) was significant, but not at 12 months. The psychoeducational group intervention led by PC nurses for individuals with depression and physical comorbidity has been shown to be effective for remission at long-term and for therapeutic response at short-term.

Calidad de vida en personas con depresión y comorbilidad física desde una perspectiva de género / Quality of life in people with depression and physical comorbidity from a gender perspective

OBJETIVO: El objetivo del estudio es describir la percepción de la calidad de vida relacionada con la salud de personas con depresión y comorbilidad física bajo una perspectiva de género. Se incluyeron 380 individuos mayores de 49 años con, al menos, una patología de las siguientes: diabetes, enfermedad obstructiva pulmonar crónica y cardiopatía isquémica, reclutadas en 31 equipos de atención primaria de Cataluña. La calidad de vida se midió con la escala EuroQol (EQ-5D). Además, se recogieron variables sociodemográficas, gravedad de depresión, índice de privación económica y ámbito de residencia. Se evaluó la relación ajustada entre el sexo y las dimensiones de calidad de vida, mediante una regresión logística multivariante. RESULTADOS: El 81,3% fueron mujeres; la media de edad fue de 68,4 años (DE: 8,8), La media de la escala visual analógica fue de 57,8 (DE: 17,4) en hombres y 55,8 (DE: 18,6) en mujeres. La media del EQ-Health Index fue de 0,74 (DE: 0,17) en hombres y 0,65 (DE: 0,21) en mujeres (p = 0,001). La probabilidad de presentar problemas en las dimensiones del EQ-5D mostró el sexo como factor de más peso (mujer = 1/hombre = 0) en: autocuidado OR: 2,29 (IC 95% 1,04 a 5,07) y actividades cotidianas OR: 3,09 (IC 95% 1,67 a 5,71). La movilidad se asoció con la edad OR: 1,87 (IC 95% 1,22 a 2,86), el ámbito de residencia con el dolor OR: 2,51 (IC 95% 1,18 a 5,34) y el Beck Depression Inventory (BDI) con la ansiedad/depresión OR: 4,77 (IC 95% 1,77 a 12,88). CONCLUSIÓN: La percepción en la calidad de vida de las mujeres con depresión y comorbilidad física es inferior a la de los hombres, siendo en ambos casos inferior a la de población general

OBJECTIVE: The aim of the study is to describe from a gender perspective how people with depression and physical comorbidity perceive their quality of life. The study included 380 people over 49 years of age with at least one of the following pathologies: diabetes, chronic obstructive pulmonary disease and ischemic heart disease. Participants were recruited from 31 teams the primary care of in Catalonia. Quality of life was measured using the EuroQol Scale. In addition, sociodemographic variables were collected, as well as the severity of depression, the index of economic deprivation and area of residence. The adjusted relationship between sex and dimensions of quality of life was assessed by means of multivariate logistic regression. RESULTS: 81.3% were women; the mean age was 68.4 years (SD: 8.8). The mean on the Visual Analogue Scale was 57.8 (SD: 17.4) in men and 55.8 (SD: 18.6) in women. The mean of the EQ-Health Index was 0.74 (SD: 0.17) in men and 0.65 (SD: 0.2) in women (p = 0.001). The probability of having problems of the EQ-5D showed sex as the most important factor (woman = 1/man = 0) in: self-care OR: 2.29 (95% CI 1.04-5.07) and daily activities OR: 3.09 (95% CI 1.67-5.71). Mobility was associated with age OR: 1.87 (95% CI 1.22-2.86), pain with area of residence OR: 2.51 (95% CI 1.18-5,34) and the BDI with anxiety/depression OR: 4,77 (95% CI 1.77-12,88). CONCLUSION: The perception quality of life of women with depression and physical comorbidity is lower than that of men and, in both cases, it is lower than that of the general population

[Quality of life in people with depression and physical comorbidity from a gender perspective]. / Calidad de vida en personas con depresión y comorbilidad física desde una perspectiva de género.

OBJECTIVE: The aim of the study is to describe from a gender perspective how people with depression and physical comorbidity perceive their quality of life. The study included 380 people over 49 years of age with at least one of the following pathologies: diabetes, chronic obstructive pulmonary disease and ischemic heart disease. Participants were recruited from 31 teams the primary care of in Catalonia. Quality of life was measured using the EuroQol Scale. In addition, sociodemographic variables were collected, as well as the severity of depression, the index of economic deprivation and area of residence. The adjusted relationship between sex and dimensions of quality of life was assessed by means of multivariate logistic regression. RESULTS: 81.3% were women; the mean age was 68.4 years (SD: 8.8). The mean on the Visual Analogue Scale was 57.8 (SD: 17.4) in men and 55.8 (SD: 18.6) in women. The mean of the EQ-Health Index was 0.74 (SD: 0.17) in men and 0.65 (SD: 0.2) in women (p = 0.001). The probability of having problems of the EQ-5D showed sex as the most important factor (woman = 1/man = 0) in: self-care OR: 2.29 (95% CI 1.04-5.07) and daily activities OR: 3.09 (95% CI 1.67-5.71). Mobility was associated with age OR: 1.87 (95% CI 1.22-2.86), pain with area of residence OR: 2.51 (95% CI 1.18-5,34) and the BDI with anxiety/depression OR: 4,77 (95% CI 1.77-12,88). CONCLUSION: The perception quality of life of women with depression and physical comorbidity is lower than that of men and, in both cases, it is lower than that of the general population.

Traducción y adaptación transcultural l español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria / Translation and cross-cultural adaptation into Spanish, Catalan and Galician of the Hopkins Symptom Checklist-25 to identify depression in Primary Care

OBJETIVO: Describir el proceso de traducción y adaptación transcultural de la escala Hopkins Symptom Checklist-25 (HSCL-25) al español, catalán y gallego. DISEÑO: Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. EMPLAZAMIENTO: Unidades de Investigación de Atención Primaria de Barcelona y Vigo. PARTICIPANTES: Médicos de familia y pacientes de Atención Primaria. MEDICIONES PRINCIPALES: Siguiendo las guías de la International Society for Pharmacoeconomics and Outcomes Research (ISPOR), se realizaron: 1) traducción directa; 2) estudio piloto basado en metodología Delphi con médicos de familia; 3) retrotraducción; 4) análisis de equivalencias; 5) análisis de comprensibilidad de las versiones obtenidas en español, catalán y gallego mediante entrevista cognitiva en una muestra de pacientes, y 6) armonización transcultural. RESULTADOS: En el estudio Delphi participaron 73 médicos de familia. El consenso se estableció en la primera ronda para la traducción española y catalana, y en la segunda ronda para la gallega. Las retrotraducciones fueron similares en los 3 idiomas. Todas las versiones fueron equivalentes entre ellas y respecto a la versión original inglesa. En la entrevista cognitiva participaron 10 pacientes por cada idioma, sin que se modificara la redacción de los ítems. CONCLUSIONES: Las traducciones de la escala HSCL-25 en español, catalán y gallego son equivalentes semántica y conceptualmente a la versión original. Las traducciones son comprensibles y bien aceptadas por los pacientes

AIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3 languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients

[Translation and cross-cultural adaptation into Spanish, Catalan and Galician of the Hopkins Symptom Checklist-25 to identify depression in Primary Care]. / Traducción y adaptación transcultural al español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria.

AIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients.

Effectiveness of a psychoeducation group intervention conducted by primary healthcare nurses in patients with depression and physical comorbidity: study protocol for a randomized, controlled trial.

BACKGROUND: Depressive disorders are the third leading cause of consultation in primary care, mainly in patients with chronic physical illnesses. Studies have shown the effectiveness of group psychoeducation in reducing symptoms in depressive individuals. Our primary aim is to evaluate the effectiveness of an intervention based on a psychoeducational program, carried out by primary care nurses, to improve the remission/response rate of depression in patients with chronic physical illness. Secondarily, to assess the cost-effectiveness of the intervention, its impact on improving control of the physical pathology and quality of life, and intervention feasibility. METHODS/DESIGN: A multicenter, randomized, clinical trial, with two groups and one-year follow-up evaluation. Economic evaluation study. SUBJECTS: We will assess 504 patients (252 in each group) aged > 50 years assigned to 25 primary healthcare centers (PHC) from Catalonia (urban, semi-urban, and rural). Participants suffer from major depression (Beck depression inventory: BDI-II 13-28) and at least one of the following: type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma, and/or ischemic cardiopathy. Patients with moderate/severe suicide risk or severe mental disorders are excluded. Participants will be distributed randomly into the intervention group (IG) and control (CG). INTERVENTION: The IG will participate in the psychoeducational intervention: 12 sessions of 90 min, once a week led by two Primary Care (PC) nurses. The sessions will consist of health education regarding chronic physical illness and depressive symptoms. MAIN MEASUREMENTS: Clinical remission of depression and/or response to intervention (BDI-II). SECONDARY MEASUREMENTS: Improvement in control of chronic diseases (blood test and physical parameters), drug compliance (Morinsky-Green test and number of containers returned), quality of life (EQ-5D), medical service utilization (appointments and hospital admissions due to complications), and feasibility of the intervention (satisfaction and compliance). Evaluations will be blinded, and conducted at baseline, post-intervention, and 12 months follow-up. DISCUSSION: Results could be informative for efforts to prevent depression in patients with a chronic physical illness. TRIAL REGISTRATION: NCT03243799 (registration date August 9, 2017).

Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis.

BACKGROUND: Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population. METHODS: MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality. RESULTS: A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7%), depressive disorders (14.7%), SMI (11.4%) and bipolar disorders (8.6%). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95% CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93%; p < 0.001). CONCLUSIONS: The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered in PROSPERO: CRD42013003898 .

Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria / Inappropriate prescribing in polymedicated patients over 64 years-old in primary care

OBJETIVO: Describir la prescripción inadecuada (PI) en la población polimedicada mayor de 64 años en atención primaria mediante los criterios STOPP/START. DISEÑO: Descriptivo, transversal y multicéntrico. Emplazamiento: Cuatro centros urbanos de atención primaria de Barcelona. PARTICIPANTES: Selección aleatoria de pacientes mayores de 64 años con más de 5 fármacos prescritos durante al menos 6 meses (n = 467). MEDICIONES PRINCIPALES: Se estudiaron los principales problemas de salud, fármacos prescritos de forma crónica y el porcentaje de PI mediante los criterios STOPP/START. Se consideró porcentaje de PI al porcentaje de pacientes con incumplimiento de al menos un criterio STOPP o START, y se calculó con un IC del 95%. Para el análisis estadístico se utilizó chi-cuadrado. RESULTADOS: La edad media fue de 77,3 (± 7,0 DE), con una media de 8,9 (± 2,8 DE) fármacos prescritos. La PI fue mayor a mayor número de fármacos prescritos (p < 0,01). Un total de 326 pacientes (76,4% [IC 95%: 72,2-80,6]) tenían al menos una PI, según los criterios STOPP/START. La PI STOPP afectó al 51,4% de los pacientes y la PI START al 53,6%. Las causas más frecuentes de PI fueron los antiagregantes -tanto por exceso de prescripción (10,2%) como por omisión (17,9%)-, el uso prolongado de benzodiacepinas (6,6%) y las duplicidades (6,4%). CONCLUSIONES: La PI en los pacientes polimedicados en atención primaria fue muy elevada. La PI fue similar respecto a fármacos que se deberían retirar o se deberían iniciar. Las causas más frecuentes de PI fueron antiagregantes, benzodiacepinas y duplicidades farmacológicas

OBJECTIVE: To describe inappropriate prescribing (IP) in the polymedicated population over 64 years-old in primary care using the STOPP/START criteria. DESIGN: The study design was descriptive, cross-sectional and multicenter. LOCATION: Four urban primary care centers in Barcelona. Participants Patients over 64 years-old with more than 5 prescribed drugs for at least 6 months (n = 467). Main measurements Major health problems, chronically prescribed drugs, and percentage of IP using the STOPP/START criteria were studied. Percentage of IP considered as the percentage of patients with at least one STOPP or START non-compliance criterion was calculated with a 95% CI. Chi-square was used for statistical analysis. RESULTS: The mean age was 77.3 (± 7.0 SD) with a mean of 8.9 (± 2.8 SD) prescribed drugs. IP was higher the greater the number of drugs prescribed (p < 0,01).326 patients (76.4% [95% CI: 72.2 to 80.6]) had at least one IP, according to STOPP/START criteria. STOPP IP affected 51.4% of the patients and START IP 53.6%. The most frequent causes of IP were antiplatelet agents, for both over-prescribing (10.2%) and omission (17.9%). Prolonged use of benzodiazepines (6.6%) and duplications (6.4%) followed in prevalence. CONCLUSIONS: IP in polymedicated patients in primary care was very high. IP was similar for drugs that should be withdrawn or started. The most common causes of IP were antiplatelet agents, benzodiazepines and drug duplication

[Inappropriate prescribing in polymedicated patients over 64 years-old in primary care]. / Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria.

OBJECTIVE: To describe inappropriate prescribing (IP) in the polymedicated population over 64 years-old in primary care using the STOPP/START criteria. DESIGN: The study design was descriptive, cross-sectional and multicenter. LOCATION: Four urban primary care centers in Barcelona. Participants Patients over 64 years-old with more than 5 prescribed drugs for at least 6 months (n=467). Main measurements Major health problems, chronically prescribed drugs, and percentage of IP using the STOPP/START criteria were studied. Percentage of IP considered as the percentage of patients with at least one STOPP or START non-compliance criterion was calculated with a 95%CI. Chi-square was used for statistical analysis. RESULTS: The mean age was 77.3 (± 7.0 SD) with a mean of 8.9 (± 2.8 SD) prescribed drugs. IP was higher the greater the number of drugs prescribed (p<0,01). 326 patients (76.4% [95%CI: 72.2 to 80.6]) had at least one IP, according to STOPP/START criteria. STOPP IP affected 51.4% of the patients and START IP 53.6%. The most frequent causes of IP were antiplatelet agents, for both over-prescribing (10.2%) and omission (17.9%). Prolonged use of benzodiazepines (6.6%) and duplications (6.4%) followed in prevalence. CONCLUSIONS: IP in polymedicated patients in primary care was very high. IP was similar for drugs that should be withdrawn or started. The most common causes of IP were antiplatelet agents, benzodiazepines and drug duplication.

To wait or not to wait 1 min between office blood pressure readings.

OBJECTIVE: It is recommended to wait at least 1 min between blood pressure (BP) readings. However, there is insufficient evidence on the utility of this recommendation using a validated automatic device. The aim was to assess differences in BP according to the waiting time between BP readings. PATIENTS AND METHODS: The study was designed as a cross-sectional descriptive study in hypertensive patients attended in primary care.Patients were seated for 5 min before six baseline BP readings: three BP measurements with no waiting time [immediate readings (IR)] between them and three BP measurements with 1 min of waiting time [waiting readings (WR)] between each reading, in random order. The intraclass correlation coefficient was calculated between IR and WR mean BP measurements, with 95% confidence intervals (CIs). RESULTS: We included 150 hypertensive patients, 49.3% women, 65.6 (12.8) years of age. The mean systolic blood pressure (SBP) values for IR and WR measurements were 137.2 (95% CI 134.2-140.2) and 137.8 (95% CI 134.8-140.8) mmHg, respectively. The mean diastolic blood pressure (DBP) values for IR and WR measurements were 79.4 (95% CI 77.5-81.4) and 79.7 (95% CI 77.7-81.8) mmHg, respectively. Intraclass correlation coefficient between IR and WR was 0.959 (95% CI 0.943-0.970) and 0.926 (95% CI 0.898-0.946) for SBP and DBP, respectively. The mean difference between both methods for SBP and DBP was -0.60 (95% CI -1.79 to 0.5) and -0.27 (95% CI -1.33 to 0.77) mmHg, respectively. CONCLUSION: We found a good agreement between waiting or not waiting 1 min between office BP readings. This demonstrates that both methods of BP measurement appear to be interchangeable.

The effectiveness of lifestyle interventions to reduce cardiovascular risk in patients with severe mental disorders: meta-analysis of intervention studies.

Patients with severe mental illness have higher prevalences of cardiovascular risk factors (CRF). The objective is to determine whether interventions to modify lifestyles in these patients reduce anthropometric and analytical parameters related to CRF in comparison to routine clinical practice. Systematic review of controlled clinical trials with lifestyle intervention in Medline, Cochrane Library, Embase, PsycINFO and CINALH. Change in body mass index, waist circumference, cholesterol, triglycerides and blood sugar. Meta-analyses were performed using random effects models to estimate the weighted mean difference. Heterogeneity was determined using i(2) statistical and subgroups analyses. 26 studies were selected. Lifestyle interventions decrease anthropometric and analytical parameters at 3 months follow up. At 6 and 12 months, the differences between the intervention and control groups were maintained, although with less precision. More studies with larger samples and long-term follow-up are needed.

Efectividad de un proyecto de colaboración entre atención primaria y salud mental para mejorar el registro de factores de riesgo cardiovascular en pacientes con psicosis / Effectiveness of a joint project between primary care and mental health to improve the recording of cardiovascular risk factors in patients with psychosis

Objetivo: Evaluar la efectividad de una intervención conjunta entre niveles asistenciales, atención primaria (AP) y salud mental (SM), en pacientes con psicosis, para mejorar la información de los factores de riesgo cardiovascular (FRCV) en la historia clínica (HC). Diseño: Estudio multicéntrico de intervención antes-después. Emplazamiento: Participan 7 centros de AP y 2 de SM, en Barcelona. Participantes: Se incluyeron los pacientes con psicosis asignados a los equipos de AP, y confirmados por estos, entre 18-65 años (n = 690). Intervención: Sesiones clínicas compartidas, para elaborar y utilizar un protocolo de colaboración entre AP-SM. Medidas principales: Variables: sexo, edad, número de citas por centro/año, registro en HC de: hábito tabáquico, presión arterial, índice masa corporal (IMC), colesterol total, colesterol HDL, triglicéridos, glucosa, perímetro abdominal, RCV. Análisis: comparación de registros de FRCV, mediante el test de Cochran (datos apareados). Cálculo de prevalencia de FRCV, según los criterios definitorios de síndrome metabólico y criterios incluidos en el protocolo. Resultados: Edad media 42,3 (DE: 11,4), hombres 67%. Todos los FRCV han presentado un aumento del registro tras la intervención. Los FRCV que han aumentado más han sido: parámetros analíticos y perímetro abdominal. El porcentaje de pacientes con niveles alterados en los criterios de síndrome metabólico supera el 35%. Los criterios para derivar al equipo de AP identifican, en el 2010, 51,9% obesos, 23,9% hipertensos, 20,4% hipercolesterolémicos y 11,6% diabéticos. Conclusiones: Mejora del registro de FRCV. Elevado porcentaje de pacientes que requieren intervención de los profesionales de AP debido a los FRCV (AU)

Objective: To evaluate the effectiveness of a joint team intervention between primary care (PC) and mental health (MH) to improve information on cardiovascular risk factors (CVRF) in psychotic patients. Design: Multicenter before-after intervention study. Location: Seven primary care and 2 mental health centers in Barcelona participated. Participants: All patients between 18-65 years old with a confirmed diagnosis of psychosis assigned to PC teams (n = 690) are included. Intervention: Shared clinical sessions, developing a joint GP-MH protocol and implement it. Primary measurements: Variables: Gender, age, number of Appointments per center/year, smoking, blood pressure, body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, glucose, waist circumference (WC), Cardiovascular Risk. Analysis: Comparison of CVRF records from 2008 to 2010 using statistical tests for paired data. Calculation of CVRF prevalence in accordance with metabolic syndrome criteria and the criteria for referral to GP. Results: The mean age was 42.3 (SD 11.4) years, with 67% males. All CVRF significantly Increased in clinical notes, particularly all blood test parameters and WC. More than 35% of patients had a CVRF according to metabolic syndrome criteria. Criteria to refer to PC physician (2010) identified: obesity 51.9%, 23.9% hypertension, high cholesterol 20.4% and 11.6% diabetes. Conclusions: CVRF recording improvement. High percentage of patients needed GP intervention due to a CVRF (AU)

[Effectiveness of a joint project between primary care and mental health to improve the recording of cardiovascular risk factors in patients with psychosis]. / Efectividad de un proyecto de colaboración entre atención primaria y salud mental para mejorar el registro de factores de riesgo cardiovascular en pacientes con psicosis.

OBJECTIVE: To evaluate the effectiveness of a joint team intervention between primary care (PC) and mental health (MH) to improve information on cardiovascular risk factors (CVRF) in psychotic patients. DESIGN: Multicenter before-after intervention study. LOCATION: Seven primary care and 2 mental health centers in Barcelona participated. PARTICIPANTS: All patients between 18-65 years old with a confirmed diagnosis of psychosis assigned to PC teams (n = 690) are included. INTERVENTION: Shared clinical sessions, developing a joint GP-MH protocol and implement it. VARIABLES: Gender, age, number of Appointments per center/year, smoking, blood pressure, body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, glucose, waist circumference (WC), Cardiovascular Risk. ANALYSIS: Comparison of CVRF records from 2008 to 2010 using statistical tests for paired data. Calculation of CVRF prevalence in accordance with metabolic syndrome criteria and the criteria for referral to GP. RESULTS: The mean age was 42.3 (SD 11.4) years, with 67% males. All CVRF significantly Increased in clinical notes, particularly all blood test parameters and WC. More than 35% of patients had a CVRF according to metabolic syndrome criteria. Criteria to refer to PC physician (2010) identified: obesity 51.9%, 23.9% hypertension, high cholesterol 20.4% and 11.6% diabetes. CONCLUSIONS: CVRF recording improvement. High percentage of patients needed GP intervention due to a CVRF.