Prescripción potencialmente inadecuada: utilidad de los criterios STOPP/START versión 2 a nivel poblacional en Cataluña / Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population

Objetivo: Analizar la prevalencia de la prescripción potencialmente inadecuada (PPI) en ancianos en Cataluña, utilizando los criterios Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) versión 2. Evaluar la asociación de la PPI con diversas variables (polimedicación, sexo, edad y características sociodemográficas). Material y métodos: Diseño: estudio descriptivo retrospectivo transversal. Emplazamiento: Ámbito de Atención Primaria. Cataluña, España. Participantes Se analizan los datos de la población de 70 años o más atendida en los Centros de Salud de Cataluña en 2014 (700.058 pacientes). Mediciones principales: Cincuenta y cinco indicadores STOPP, y 19 START. Se ajustan modelos de regresión logística para evaluar su asociación con diversas variables. Resultados: La edad media es de 79,2±6,5 años. El 58,5% son mujeres. El 38,7% tiene 7 o más fármacos prescritos, y más del 50% acumulan más de 10 visitas anuales. Los indicadores STOPP que acumulan una mayor PPI son los relacionados con el uso de antiinflamatorios no esteroideos, antiagregantes, anticoagulantes, y benzodiacepinas. En cuanto a los criterios START destaca la omisión de suplementos de vitamina D y calcio, antidepresivos, y fármacos relativos al sistema cardiovascular. La PPI es mayor en mujeres, pacientes institucionalizados y domiciliarios, y en aquellos con mayor número de fármacos y número de visitas. Conclusiones: Se detectó una PPI poblacional con una alta prevalencia (89,6%). La PPI se relaciona de forma más significativa con determinadas condiciones del paciente y grupos farmacológicos. El conocimiento de esta asociación es trascendental para la futura implementación de medidas de seguridad en prescripción farmacológica (AU)

Objective: To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions). Materials and methods: Design: Retrospective cross sectional population study. Settings: Primary Health Care, Catalonia, Spain. Participants: The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients). Main analysis: 55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors. Results: The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres. Conclusions: The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription (AU)

[Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population]. / Prescripción potencialmente inadecuada: utilidad de los criterios STOPP/START versión 2 a nivel poblacional en Cataluña.

OBJECTIVE: To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions). MATERIALS AND METHODS: Design: Retrospective cross sectional population study. SETTINGS: Primary Health Care, Catalonia, Spain. PARTICIPANTS: The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients). MAIN ANALYSIS: 55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS: The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres. CONCLUSIONS: The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription.

Risk factors and comorbidities associated with severe aortic stenosis: A case-control study.

BACKGROUND AND OBJECTIVE: Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS: We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS: The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p < .001), tobacco use (OR, 2.60; p < .001), hypertension (OR, 2.41; p = .010) and low HDL cholesterol readings (OR, 2.20; p = .007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p = .017), stroke (OR, 4.14; p = .024), chronic renal failure (OR, 3.78; p < .001) and low haemoglobin levels (OR, 0.76; p < .001). CONCLUSIONS: Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.

Factores de riesgo y comorbilidades asociadas a la estenosis aórtica grave: estudio de casos y controles / Risk factors and comorbidities associated with severe aortic stenosis: a case-control study

Antecedentes y objetivo La estenosis aórtica (EA) es una de las enfermedades cardiovasculares más prevalentes en sujetos≥65años. Algunos estudios epidemiológicos sugieren que ciertos factores de riesgo cardiovascular (FRCV) y comorbilidades pueden estar asociados con la EA. El objetivo del estudio es evaluar la asociación de FRCV y comorbilidades con la EA grave sintomática en pacientes≥65años en una región sanitaria española. Pacientes y métodos Se realizó un estudio epidemiológico de casos y controles procedentes del mismo centro de atención primaria. Se recogió información sobre la exposición a FRCV y comorbilidades, y se determinó la asociación de ambos con la EA con odds ratio ajustadas (ORa), mediante modelos de regresión logística múltiple. Resultados Se incluyeron un total de 102 casos (edad media=77,6 años) y 221 controles (edad media=75,5 años). Los FRCV significativamente asociados con la EA grave sintomática fueron hipercolesterolemia (ORa=2,67; p<0,001), tabaquismo (ORa=2,60; p<0,001), hipertensión (ORa=2,41; p=0,010) y cifras bajas de colesterol-HDL (ORa=2,20; p=0,007). Las comorbilidades significativamente asociadas con la EA grave sintomática fueron estenosis carotídea (ORa=14,5; p=0,017), accidente vascular cerebral (ORa=4,14; p=0,024), insuficiencia renal crónica (ORa=3,78; p<0,001) y bajos niveles de hemoglobina (ORa=0,76; p<0,001). Conclusiones La hipercolesterolemia, el tabaquismo, la hipertensión arterial y los niveles bajos de colesterol-HDL son los FRCV que comportan mayor riesgo de EA grave. Asimismo, esta enfermedad se asocia con algunas comorbilidades (insuficiencia renal crónica, accidente vascular cerebral, estenosis carotídea y niveles de hemoglobina más bajos) que podrían ser marcadores de E (AU)

Background and objective Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. Patients and methods We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. Results The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p<.001), tobacco use (OR, 2.60; p<.001), hypertension (OR, 2.41; p=.010) and low HDL cholesterol readings (OR, 2.20; p=.007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p=.017), stroke (OR, 4.14; p=.024), chronic renal failure (OR, 3.78; p<.001) and low haemoglobin levels (OR, 0.76; p<.001). Conclusions Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS (AU)

Risk factors and comorbidities associated with severe aortic stenosis: a case-control study. / Factores de riesgo y comorbilidades asociadas a la estenosis aórtica grave: estudio de casos y controles.

BACKGROUND AND OBJECTIVE: Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS: We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS: The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p<.001), tobacco use (OR, 2.60; p<.001), hypertension (OR, 2.41; p=.010) and low HDL cholesterol readings (OR, 2.20; p=.007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p=.017), stroke (OR, 4.14; p=.024), chronic renal failure (OR, 3.78; p<.001) and low haemoglobin levels (OR, 0.76; p<.001). CONCLUSIONS: Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.

Cardiac complications during pregnancy are better predicted with the modified WHO risk score.

BACKGROUND/OBJECTIVE: Several risk scores (RSs) have been used to stratify risk of cardiac complications (CCs) in pregnant patients with heart disease. We aimed to compare and contrast the accuracy of several RSs for predicting CC in this population. METHODS: Prospective inclusion of all consecutive pregnant patients with heart disease, and follow-up until 6 months postpartum. CCs were defined as primary if admission was required due to heart failure, arrhythmia or thromboembolic events, and secondary if the decline in NYHA class compared with baseline was >2 or urgent invasive cardiac procedures were needed. The discriminatory power of each RS was assessed by the area-under-the receiver-operating characteristic (ROC) curve (AUC). RESULTS: 179 patients, mean age: 32 years, accounted for 13.4% of CC (primary 11.7%, secondary 1.7%); the main diagnosis was congenital heart disease (CHD) in 68% followed by valvulopathies in 16%, arrhythmia in 7% and myocardiopathies in 5%. 22% (n=40) were classified as mWHO=1, 59% (n=105) mWHO=2 including subgroup 2-3, 14% (n=26) mWHO=3 and 4%(n=7) mWHO=4; 1 patient was unclassifiable. mWHO showed a better AUC (0.763) than CARPREG (0.67). For the CHD population, ZAHARA RS showed an AUC of 0.74, and Khairy an AUC of 0.632. CONCLUSIONS: mWHO was better at predicting CC than CARPREG; mWHO was also better at predicting CC than the specific CHD RS in the CHD subgroup. PRACTICE: There are an increasing number of pregnant women with HD. IMPLICATIONS: Improved prediction of CC risk during pregnancy can provide better preconception assessment in women with HD.

Encuesta sobre el conocimiento y manejo de los pacientes con ataque isquémico transitorio entre médicos y enfermería de Atención Primaria / Survey of the knowledge and management of transient ischemic attacks among primary care physicians and nurses

Introducción: La principal fuente de consulta de los pacientes con ataque isquémico transitorio (AIT) agudo en nuestra área sanitaria son los centros de salud de Atención Primaria. Existen muy pocos estudios sobre el conocimiento del AIT y su manejo entre profesionales de la medicina comunitaria y de familia.Objetivo: Estimar el conocimiento del AIT, su manejo y las pruebas complementarias necesarias entre médicos y personal de enfermería de Atención Primaria de nuestra área de influencia. Para ello se envió una encuesta electrónica cerrada a 640 profesionales con 7 preguntas sobre el AIT.Resultados: Se obtuvo una alta tasa de respuestas: 285 (46,7% médicos). 239 (83,9%) participantes mostraron un conocimiento adecuado de la duración del AIT. Sólo 40 (14%) de la sintomatología. Mientras que el 67% contestó adecuadamente que es necesaria una prueba de neuroimagen urgente. Sólo el 42,5% reconoció la necesidad una exploración con dúplex de troncos supraórticos precoz. Únicamente, el 35,4% conocía qué es un doppler transcraneal, mientras que el 78,2% supo que era más adecuado enviar a estos pacientes a urgencias hospitalarias. El predictor independiente de mejor conocimiento fue ser un médico de Atención Primaria (MAP) (odds ratio [OR]: 2,138; IC 95%: 1,124-4,067; p = 0,021) pero no hubo diferencias entre MAP y enfermería en el conocimiento del manejo de estos pacientes. En enfermería fue peor el conocimiento en el ámbito rural (OR: 0,410; IC 95%: 0,189-0,891; p = 0,024). Conclusión: El conocimiento de la actitud ante un AIT es correcto en la mayoría de casos, sin embargo es necesario mejorar el conocimiento de la sintomatología de los AIT (AU)

Introduction: Transient ischaemic attack (TIA) patients often report that Primary Care physicians(PCPs) and nurses are their main medical contacts after onset of symptoms in our healtharea. There are few studies on the knowledge and management of TIA among Community andFamily Medicine professionals.Material and methods: Our aim was to study the current knowledge and practice in the managementof TIA patients among Primary Care physicians and nurses. A cross-sectional survey withseven questions about TIA was conducted among 640 PCPs and nurses from Primary Care centresin our health area.Results: In total, 285 (46.7% PCPs) took participate in the study. Of these, 239 (83.9%) participantsknew the duration of a TIA. However only 40 (14%) recognised all clinical symptoms.An urgent neuroimaging was preferred by 67%. Only 42.5% agreed that an urgent cervicalduplex would be useful in these patients. Transcranial Doppler was recognised by only 35.4%.A majority (78.2%) of participants agreed that TIA patients must be admitted to hospital. PCPshad the best knowledge of TIA (odds ratio [OR] 2.138; 95% CI 1.124-4.067; P = 0.021) but therewere no differences between physicians and nurses on the management of these patients.Nurses from rural Primary Care centers had the worst level of knowledge (OR 0.410; 95% CI0.189-0.891; P = 0.024).Conclusion: TIA was well recognized as a medical emergency. However, knowledge of clinicalsymptoms of TIA must be improved (AU)

Survey of the knowledge and management of transient ischemic attacks among primary care physicians and nurses.

INTRODUCTION: Transient ischaemic attack (TIA) patients often report that Primary Care physicians (PCPs) and nurses are their main medical contacts after onset of symptoms in our health area. There are few studies on the knowledge and management of TIA among Community and Family Medicine professionals. MATERIAL AND METHODS: Our aim was to study the current knowledge and practice in the management of TIA patients among Primary Care physicians and nurses. A cross-sectional survey with seven questions about TIA was conducted among 640 PCPs and nurses from Primary Care centres in our health area. RESULTS: In total, 285 (46.7% PCPs) took participate in the study. Of these, 239 (83.9%) participants knew the duration of a TIA. However only 40 (14%) recognised all clinical symptoms. An urgent neuroimaging was preferred by 67%. Only 42.5% agreed that an urgent cervical duplex would be useful in these patients. Transcranial Doppler was recognised by only 35.4%. A majority (78.2%) of participants agreed that TIA patients must be admitted to hospital. PCPs had the best knowledge of TIA (odds ratio [OR] 2.138; 95% CI 1.124-4.067; P = 0.021) but there were no differences between physicians and nurses on the management of these patients. Nurses from rural Primary Care centers had the worst level of knowledge (OR 0.410; 95% CI 0.189-0.891; P = 0.024). CONCLUSION: TIA was well recognized as a medical emergency. However, knowledge of clinical symptoms of TIA must be improved.

Estudio de prevalencia de la deficiencia de yodo en una población escolarizada de 6 años / Prevalence study of iodine deficiency in a 6-year-old school population

Introducción: El yodo es un oligoelemento cuyo déficit provoca diferentes complicaciones agrupadas bajo el nombre de trastornos por déficit de yodo. La ingesta de alimentos ricos en yodo es la única vía de administración del mismo. Se considera déficit leve de yodo una yoduria inferior a 100μg/l; aumentando la posibilidad de trastornos por déficit de yodo. Objetivo: Determinar la prevalencia de déficit de yodo en los niños de 6 años de la provincia de Lleida. Métodos: Estudio trasversal de selección aleatoria, en niños escolarizados en la provincia de Lleida. Tras la aceptación, se cumplimentó un cuestionario y se realizó un análisis de orina para determinar el nivel de yodo. Resultados: Inclusión de 328 niños (5 sin muestra de orina), 46,8% varones, 54,27% en escuelas públicas, 17,2% inmigrantes y 40,95% utilizaba el comedor escolar. El 62,42% comía pescado 2 o más veces a la semana, sal yodada el 60,98% y el 90,65% leche diariamente. La yoduria media se situó en 234,4μg/l (DT=133,7). El déficit de yodo fue establecido al 9,29% (6,12–12,45%) de la muestra, relacionándose significativamente con el tipo de centro (concertado o público), origen del niño, sal yodada, consumo de pescado y leche. Conclusiones: La prevalencia de déficit leve de yodo en Lleida es inferior a la de estudios parecidos anteriores, mostrando unos buenos parámetros nutricionales. El déficit de yodo es superior en niños inmigrantes, aunque se presentan modificaciones nutricionales que pueden establecer mejoras superiores a la de la población autóctona (AU)

Introduction: Iodine is a dietary element, a deficiency of which leads to complications grouped with the name Iodine Deficiency Disorders (IDD). The intake of foods rich in iodine is the only route of iodine administration. Iodine is considered to deficient when its concentration is less than 100μg/L in urine, thus increasing the possibility of IDD. Aim: To determine the prevalence of iodine deficiency in 6-year-old school children in the region of Lleida. Methods: A randomised cross-sectional study of 6-year-old school children in the area of Lleida was selected. After the acceptance, a questionnaire had to be filled in and a urine sample was collected to determine the urinary iodine. Results: A total of 328 subjects were included (5 without urine sample), 46.8% boys, 54.27% in public schools, 17.2% immigrants and 40.95% had lunch at school. The majority (62.42%) ate fish twice or more a week, 60.98% used iodised salt and 90.65% drank milk daily. The iodine mean was 234.4μg/l (SD=133.7). Only 9.29% (6.12–12.45%) had iodine deficiency which was associated to the type of school the children attended (private or public), immigrant origin, iodised salt, fish and milk nutrition. Conclusions: The prevalence of iodine deficiency in Lleida is lower than in previous publications, shown by the good nutrition parameters. The shortage of iodine is higher in immigrant boys, although better nutrition measures could be taken to improve their situation (AU)

[Prevalence study of iodine deficiency in a 6-year-old school population]. / Estudio de prevalencia de la deficiencia de yodo en una población escolarizada de 6 años.

INTRODUCTION: Iodine is a dietary element, a deficiency of which leads to complications grouped with the name Iodine Deficiency Disorders (IDD). The intake of foods rich in iodine is the only route of iodine administration. Iodine is considered to deficient when its concentration is less than 100 microg/L in urine, thus increasing the possibility of IDD. AIM: To determine the prevalence of iodine deficiency in 6-year-old school children in the region of Lleida. METHODS: A randomised cross-sectional study of 6-year-old school children in the area of Lleida was selected. After the acceptance, a questionnaire had to be filled in and a urine sample was collected to determine the urinary iodine. RESULTS: A total of 328 subjects were included (5 without urine sample), 46.8% boys, 54.27% in public schools, 17.2% immigrants and 40.95% had lunch at school. The majority (62.42%) ate fish twice or more a week, 60.98% used iodised salt and 90.65% drank milk daily. The iodine mean was 234.4 microg/l (SD=133.7). Only 9.29% (6.12-12.45%) had iodine deficiency which was associated to the type of school the children attended (private or public), immigrant origin, iodised salt, fish and milk nutrition. CONCLUSIONS: The prevalence of iodine deficiency in Lleida is lower than in previous publications, shown by the good nutrition parameters. The shortage of iodine is higher in immigrant boys, although better nutrition measures could be taken to improve their situation.