[Encuesta Internacional de Indicadores de Salud Referidos por los Pacientes: el protocolo del Estudio PaRIS en España.] / International Patient-Reported Indicators Surveys: The PaRIS study protocol in Spain.

OBJECTIVE: The PaRIS Survey is an initiative led by the Organization for Economic Cooperation and Development in twenty-one countries, including Spain, to promote people-centred health care. The objective of the study aimed to describe PROMS and PREMS (Patient Reported Outcomes and Experience Measures, respectively) from patients who were in contact with Primary Care Centres, in order to establish a set of reliable, valid and internationally comparable indicators. METHODS: A cross-sectional study with two questionnaires will be carried out: one applied online for professionals from Primary Care Centres and another by telephone or online for patients aged forty-five and older of the same Health Care Centres. The domains covered are: characteristics of the Health Centre and of the professionals; sociodemographic characteristics of the patients; lifestyles; health care capacities; PROMs and PREMs. CONCLUSIONS: The study offers a unique opportunity to evaluate the health outcomes and experiences of the care received in Primary Care from patient's perspective. This information is essential to help policymakers better understand the performance of their health system and how it could be improved, particularly in relation to chronic care in Primary Care.

OBJETIVO: La Encuesta de Indicadores Referidos por los Pacientes (PaRIS, por sus siglas en inglés) es una iniciativa liderada por la Organización para la Cooperación y el Desarrollo Económicos en veintiún países, incluyendo España, para promover una atención sanitaria centrada en las personas. El objetivo del estudio fue describir los resultados en salud y las experiencias referidas por los pacientes (PROMs y PREMs, por sus siglas en inglés Patient Reported Outcomes and Experience Measures, respectivamente) que tuvieron contacto con los Centros de Atención Primaria (CAP), con la finalidad de establecer un conjunto de indicadores confiables, válidos e internacionalmente comparables. METODOS: Se realizará un estudio transversal, con dos cuestionarios: online para profesionales de los Centros de Atención Primaria y telefónico u online para los pacientes de cuarenta y cinco años y más, que acudieron a los CAP. Los dominios abarcados son: características del Centro de Atención Primaria y de los profesionales; características sociodemográficas de los pacientes; estilos de vida; capacidades; PROMs y PREMs. CONCLUSIONES: PaRIS ofrece una oportunidad para medir resultados de salud y las experiencias en Atención Primaria desde la perspectiva del paciente. Esta información es fundamental para ayudar a los gestores a comprender mejor el desempeño del sistema de salud y detectar posibilidades de mejora, particularmente en relación con la atención crónica.

Encuesta Internacional de Indicadores de Salud Referidos por los Pacientes: el protocolo del Estudio PaRIS en España / International Patient-Reported Indicators Surveys: The PaRIS study protocol in Spain

Fundamentos: La Encuesta de Indicadores Referidos por los Pacientes (PaRIS, por sus siglas en inglés) es una iniciativa liderada por la Organización para la Cooperación y el Desarrollo Económicos en veintiún países, incluyendo España, para promover una atención sanitaria centrada en las personas. El objetivo del estudio fue describir los resultados en salud y las experiencias referidas porlos pacientes (PROMs y PREMs, por sus siglas en inglésPatient Reported Outcomes and Experience Measures, respectivamente) quetuvieron contacto con los Centros de Atención Primaria (CAP), con la finalidad de establecer un conjunto de indicadores confiables,válidos e internacionalmente comparables. Métodos: Se realizará un estudio transversal, con dos cuestionarios: online para profesionales de los Centros de Atención Primaria y telefónico u online para los pacientes de cuarenta y cinco años y más, que acudieron a los CAP. Los dominios abarcados son: características del Centro de Atención Primaria y de los profesionales; características sociodemográficas de los pacientes; estilos devida; capacidades; PROMs y PREMs. Conclusiones: PaRIS ofrece una oportunidad para medir resultados de salud y las experiencias en Atención Primaria desde laperspectiva del paciente. Esta información es fundamental para ayudar a los gestores a comprender mejor el desempeño del sistemade salud y detectar posibilidades de mejora, particularmente en relación con la atención crónica.(AU)

Background: The PaRIS Survey is an initiative led by the Organization for Economic Cooperation and Development in twenty-onecountries, including Spain, to promote people-centred health care. The objective of the study aimed to describe PROMS and PREMS(Patient Reported Outcomes and Experience Measures, respectively) from patients who were in contact with Primary Care Centres, inorder to establish a set of reliable, valid and internationally comparable indicators. Methods: A cross-sectional study with two questionnaires will be carried out: one applied online for professionals from Primary CareCentres and another by telephone or online for patients aged forty-five and older of the same Health Care Centres. The domains coveredare: characteristics of the Health Centre and of the professionals; sociodemographic characteristics of the patients; lifestyles; health carecapacities; PROMs and PREMs. Conclusions: The study offers a unique opportunity to evaluate the health outcomes and experiences of the care received inPrimary Care from patient’s perspective. This information is essential to help policymakers better understand the performance oftheir health system and how it could be improved, particularly in relation to chronic care in Primary Care.(AU)

How do we measure adherence to anti-tuberculosis treatment?

INTRODUCTION: Completion of anti-tuberculosis (TB) treatment is of paramount importance for TB patients, as well as for the global efforts of TB control. However, there is neither a gold-standard measure to monitor adherence to TB treatment nor a widely used definition for different levels of adherence. Areas covered: in this review we aim to describe the different methods used to measure patients' adherence to anti-TB treatment, identifying their main strengths and limitations, with a focus on low resource settings. Expert commentary: there is a need for continuing the quest for a low cost, reliable and acceptable measure of adherence to TB treatment. We should harmonize treatment adherence measurement to allow adequate comparison of different interventions aimed at increasing adherence to TB treatment, although the way we ensure adherence can affect adherence endpoints themselves. The accuracy of adherence measurement is of importance in the context of drug clinical development.

Glycated Hemoglobin, Fasting Insulin and the Metabolic Syndrome in Males. Cross-Sectional Analyses of the Aragon Workers' Health Study Baseline.

BACKGROUND AND AIMS: Glycated hemoglobin (HbA1c) is currently used to diagnose diabetes mellitus, while insulin has been relegated to research. Both, however, may help understanding the metabolic syndrome and profiling patients. We examined the association of HbA1c and fasting insulin with clustering of metabolic syndrome criteria and insulin resistance as two essential characteristics of the metabolic syndrome. METHODS: We used baseline data from 3200 non-diabetic male participants in the Aragon Workers' Health Study. We conducted analysis to estimate age-adjusted odds ratios (ORs) across tertiles of HbA1c and insulin. Fasting glucose and Homeostatic model assessment - Insulin Resistance were used as reference. Here we report the uppermost-to-lowest tertile ORs (95%CI). RESULTS: Mean age (SD) was 48.5 (8.8) years and 23% of participants had metabolic syndrome. The ORs for metabolic syndrome criteria tended to be higher across HbA1c than across glucose, except for high blood pressure. Insulin was associated with the criteria more strongly than HbA1c and similarly to Homeostatic model assessment - Insulin Resistance (HOMA-IR). For metabolic syndrome, the OR of HbA1c was 2.68, of insulin, 11.36, of glucose, 7.03, and of HOMA-IR, 14.40. For the clustering of 2 or more non-glycemic criteria, the OR of HbA1c was 2.10, of insulin, 8.94, of glucose, 1.73, and of HOMA-IR, 7.83. All ORs were statistically significant. The areas under the receiver operating characteristics curves for metabolic syndrome were 0.670 (across HbA1c values) and 0.770 (across insulin values), and, for insulin resistance, 0.647 (HbA1c) and 0.995 (insulin). Among non-metabolic syndrome patients, a small insulin elevation identified risk factor clustering. CONCLUSIONS: HbA1c and specially insulin levels were associated with metabolic syndrome criteria, their clustering, and insulin resistance. Insulin could provide early information in subjects prone to develop metabolic syndrome.

Association of ferritin elevation and metabolic syndrome in males. Results from the Aragon Workers' Health Study (AWHS).

CONTEXT: Ferritin concentration is associated with metabolic syndrome, but the possibility of a nonlinear association has never been explored. OBJECTIVE: This study aimed to examine the relationship between serum ferritin levels and the metabolic syndrome in Spanish adult males. DESIGN: This was a cross-sectional analysis of baseline data from the Aragon Workers' Health Study. SETTING: Healthy workers from a factory were studied during their annual checkup. PARTICIPANTS: Spanish male adults (n = 3386) between the ages of 19 and 65 years participated. We excluded participants with ferritin > 500 µg/L, ferritin < 12 µg/L, or C-reactive protein > 10 mg/L. MAIN OUTCOME MEASURE: Metabolic syndrome was defined according to the 2009 consensus definition from the Joint Interim Statement of several international societies. RESULTS: Metabolic syndrome prevalence was 27.1%. We found a positive association between elevated iron stores, measured as serum ferritin concentration, and metabolic syndrome and its criteria. Participants within the highest serum ferritin quintile had a higher risk than those in the lowest quintile for central obesity (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.46-2.42), hypertriglyceridemia (OR, 2.15; 95% CI, 1.69-2.74), and metabolic syndrome (OR, 1.92; 95% CI, 1.48-2.49). The association was nonlinear and occurred at serum ferritin concentrations > 100 µg/L (∼ 33th percentile). Ferritin was also associated with insulin resistance, measured by homeostatic model assessment-insulin resistance (HOMA-IR) (P trend < .001). CONCLUSIONS: Our findings suggest that serum ferritin is significantly associated with metabolic syndrome and its criteria (especially central obesity and hypertriglyceridemia), suggesting that ferritin could be an early marker of metabolic damage in the development of metabolic syndrome.

A genetic variant in the LDLR promoter is responsible for part of the LDL-cholesterol variability in primary hypercholesterolemia.

BACKGROUND: GWAS have consistently revealed that LDLR locus variability influences LDL-cholesterol in general population. Severe LDLR mutations are responsible for familial hypercholesterolemia (FH). However, most primary hypercholesterolemias are polygenic diseases. Although Cis-regulatory regions might be the cause of LDL-cholesterol variability; an extensive analysis of the LDLR distal promoter has not yet been performed. We hypothesized that genetic variants in this region are responsible for the LDLR association with LDL-cholesterol found in GWAS. METHODS: Four-hundred seventy-seven unrelated subjects with polygenic hypercholesterolemia (PH) and without causative FH-mutations and 525 normolipemic subjects were selected. A 3103 pb from LDLR (-625 to +2468) was sequenced in 125 subjects with PH. All subjects were genotyped for 4 SNPs (rs17242346, rs17242739, rs17248720 and rs17249120) predicted to be potentially involved in transcription regulation by in silico analysis. EMSA and luciferase assays were carried out for the rs17248720 variant. Multivariable linear regression analysis using LDL-cholesterol levels as the dependent variable were done in order to find out the variables that were independently associated with LDL-cholesterol. RESULTS: The sequencing of the 125 PH subjects did not show variants with minor allele frequency ≥ 10%. The T-allele from g.3131C > T (rs17248720) had frequencies of 9% (PH) and 16.4% (normolipemic), p < 0.00001. Studies of this variant with EMSA and luciferase assays showed a higher affinity for transcription factors and an increase of 2.5 times in LDLR transcriptional activity (T-allele vs C-allele). At multivariate analysis, this polymorphism with the lipoprotein(a) and age explained ≈ 10% of LDL-cholesterol variability. CONCLUSION: Our results suggest that the T-allele at the g.3131 T > C SNP is associated with LDL-cholesterol levels, and explains part of the LDL-cholesterol variability. As a plausible cause, the T-allele produces an increase in LDLR transcriptional activity and lower LDL-cholesterol levels.

Association of global DNA methylation and global DNA hydroxymethylation with metals and other exposures in human blood DNA samples.

BACKGROUND: The association between human blood DNA global methylation and global hydroxymethylation has not been evaluated in population-based studies. No studies have evaluated environmental determinants of global DNA hydroxymethylation, including exposure to metals. OBJECTIVE: We evaluated the association between global DNA methylation and global DNA hydroxymethylation in 48 Strong Heart Study participants for which selected metals had been measured in urine at baseline and DNA was available from 1989-1991 (visit 1) and 1998-1999 (visit 3). METHODS: We measured the percentage of 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) in samples using capture and detection antibodies followed by colorimetric quantification. We explored the association of participant characteristics (i.e., age, adiposity, smoking, and metal exposure) with both global DNA methylation and global DNA hydroxymethylation. RESULTS: The Spearman's correlation coefficient for 5-mC and 5-hmC levels was 0.32 (p = 0.03) at visit 1 and 0.54 (p < 0.001) at visit 3. Trends for both epigenetic modifications were consistent across potential determinants. In cross-sectional analyses, the odds ratios of methylated and hydroxymethylated DNA were 1.56 (95% CI: 0.95, 2.57) and 1.76 (95% CI: 1.07, 2.88), respectively, for the comparison of participants above and below the median percentage of dimethylarsinate. The corresponding odds ratios were 1.64 (95% CI: 1.02, 2.65) and 1.16 (95% CI: 0.70, 1.94), respectively, for the comparison of participants above and below the median cadmium level. Arsenic exposure and metabolism were consistently associated with both epigenetic markers in cross-sectional and prospective analyses. The positive correlation of 5-mC and 5-hmC levels was confirmed in an independent study population. CONCLUSIONS: Our findings support that both epigenetic measures are related at the population level. The consistent trends in the associations between these two epigenetic modifications and the characteristics evaluated, especially arsenic exposure and metabolism, suggest the need for understanding which of the two measures is a better biomarker for environmental epigenetic effects in future large-scale epidemiologic studies.

Escala para la predicción de la aparición de hipertensión arterial en población activa masculina / Score to predict hypertension in working male population

Fundamento y objetivo: La hipertensión arterial es el factor de riesgo más prevalente. Nuestro objetivo fue describir los factores asociados a la progresión de la presión arterial (PA) desde valores normales. Sujetos y método: Estudio prospectivo y observacional con 7 años de seguimiento. Se consideró hipertensión valores de PA≥140/90mmHg. Se elaboró un modelo multivariante para identificar los factores asociados a la progresión de la PA y una escala de predicción. Resultados: Los 2.236 varones, con una mediana de edad de 42 años, presentaron características diferenciales en función de su categoría de PA basal. Al final de los 7 años de seguimiento, el 31.,9% de los sujetos normotensos al inicio del estudio presentaron un incremento de la PA como para ser diagnosticados de hipertensión arterial. Los sujetos basalmente normotensos que presentaron progresión de PA partían de valores más cercanos al límite de la normalidad y un perfil lipídico más desfavorable. Se elaboró una escala que incluyó las siguientes variables: edad, antecedentes familiares de hipertensión, categorías de índice de masa corporal, glucosa>100mg/dl, triglicéridos>150mg/dl y ácido úrico. La puntuación total obtenible tiene que estar entre -2 y 24 y se calculó para cada uno de los valores el riesgo de progresión. Conclusiones: La progresión de la PA desde la normotensión a la hipertensión en los siguientes 7 años en varones jóvenes es alta y se puede estimar con una simple escala de riesgo (AU)

Background and objective: Hypertension is the most prevalent risk factor in the community. The aim of this study was to describe the risk factors for the progression of blood pressure (BP) from correct values. Subjects and methods: Prospective and observational study with 7 years follow-up. BP > 140/90 mmHg was considered hypertension. A multivariate model was performed to assess risk factors for BP progression and a predictive score. Results: The 2,236 males, median age 42 years, had differential characteristics according to their baseline BP category. At the end of the 7-years follow-up 31.9% of baseline-normotensive subjects had an increase of their BP to the range of hypertension. Baseline-normotensive subjects who experienced a progression of BP had higher baseline BP and less favourable lipid profile. A risk score was performed using the following variables: age, hypertension familiar history, overweight and obesity, glucose > 100 mg/dl, triglycerides > 150 mg/dl and uric acid. Total score ranged between -2 and 24; the risk of BP progression beyond normal thresholds increased linearly as the score increased. Conclusions: Progression of BP from normotension to higher BP categories into the next 7 years in young males and the risk can be estimated by a simple score (AU)

[Score to predict hypertension in working male population]. / Escala para la predicción de la aparición de hipertensión arterial en población activa masculina.

BACKGROUND AND OBJECTIVE: Hypertension is the most prevalent risk factor in the community. The aim of this study was to describe the risk factors for the progression of blood pressure (BP) from correct values. SUBJECTS AND METHODS: Prospective and observational study with 7 years follow-up. BP>140/90 mmHg was considered hypertension. A multivariate model was performed to assess risk factors for BP progression and a predictive score. RESULTS: The 2,236 males, median age 42 years, had differential characteristics according to their baseline BP category. At the end of the 7-years follow-up 31.9% of baseline-normotensive subjects had an increase of their BP to the range of hypertension. Baseline-normotensive subjects who experienced a progression of BP had higher baseline BP and less favourable lipid profile. A risk score was performed using the following variables: age, hypertension familiar history, overweight and obesity, glucose>100mg/dl, triglycerides>150 mg/dl and uric acid. Total score ranged between -2 and 24; the risk of BP progression beyond normal thresholds increased linearly as the score increased. CONCLUSIONS: Progression of BP from normotension to higher BP categories into the next 7 years in young males and the risk can be estimated by a simple score.

Aragon workers' health study--design and cohort description.

BACKGROUND: Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers' Health Study (AWHS) to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to describe the study design, aims and baseline characteristics of participants in the AWHS. METHODS/DESIGN: Longitudinal cohort study based on the annual health exams of 5,400 workers of a car assembly plant in Figueruelas (Zaragoza, Spain). Study participants were recruited during a standardized clinical exam in 2009-2010 (participation rate 95.6%). Study participants will undergo annual clinical exams and laboratory assays, and baseline and triennial collection of biological materials for biobanking and cardiovascular imaging exams (carotid, femoral and abdominal ultrasonography, coronary calcium score, and ankle-arm blood pressure index). Participants will be followed-up for 10 years. RESULTS: The average (SD) age, body mass index, and waist circumference were 49.3 (8.7) years, 27.7 (3.6) kg/m² and 97.2 (9.9) cm, respectively, among males (N = 5,048), and 40.8 (11.6) years, 24.4 (3.8) kg/m², and 81.9 (9.9) cm, among females (N = 351). The prevalence of overweight, obesity, current smoking, hypertension, hypercholesterolemia, and diabetes were 55.0, 23.1, 37.1, 40.3, 75.0, and 7.4%, respectively, among males, and 23.7, 8.3, 45.0, 12.1, 59.5, and 0.6%, respectively, among females. In the initial 587 study participants who completed all imaging exams (94.5% male), the prevalence of carotid plaque, femoral plaque, coronary calcium score >1 to 100, and coronary calcium score >100 was 30.3, 56.9, 27.0, and 8.8%, respectively. 67.7% of study participants had at least one plaque in the carotid or femoral arteries. DISCUSSION: Baseline data from the AWHS show a high prevalence of cardiovascular risk factors and of sublinical atherosclerosis. Follow-up of this cohort will allow the assessment of subclinical atherosclerosis progression and the link of disease progression to traditional and emergent risk factors.

Mortalidad a largo plazo y reingreso hospitalario tras infarto agudo de miocardio: un estudio de seguimiento de ocho años / Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study

Introducción y objetivos. El infarto agudo de miocardio es en los países desarrollados la causa más importante de mortalidad, así como de un gran número de ingresos hospitalarios. Concretamente, en España cada año se producen alrededor de 140.000 muertes y 5 millones de hospitalizaciones a causa de infarto agudo de miocardio, lo cual corresponde a unos costes de asistencia sanitaria que suponen un 15% de los gastos totales. En este artículo se presenta, pues, un análisis exhaustivo del infarto agudo de miocardio y el pronóstico que comporta en cuanto a recurrencia y mortalidad. Métodos. Este estudio observacional se llevó a cabo en España. Los datos se obtuvieron de la Base de Datos Administrativa de Altas Hospitalarias para el periodo comprendido entre 2000 y 2007, ambos inclusive. Concretamente, se registraron 12.096 casos de infarto agudo de miocardio (8.606 mujeres y 3.490 varones) durante ese periodo, con un total de 2.395 reingresos por ese diagnóstico. Se analizó la frecuencia y la duración de los reingresos mediante regresión logística y con el modelo de supervivencia de Wang. La mortalidad se analizó mediante una regresión logística. Resultados. Las tasas de reingreso fueron del 50% en los pacientes de menos de 45 años y del 38% en los de más de 75 años (p<0,001). Los varones reingresaron con mayor frecuencia que las mujeres durante todo el periodo de seguimiento. Las variables relacionadas con la mortalidad hospitalaria por infarto agudo de miocardio fueron diabetes mellitus, antecedentes de cardiopatía isquémica y enfermedad cerebrovascular. Conclusiones. Los reingresos hospitalarios a medio plazo son muy frecuentes en los pacientes que sobreviven a un infarto agudo de miocardio. El sexo masculino, los antecedentes de enfermedad coronaria y el número de factores de riesgo cardiovascular clásicos son factores predictivos importantes del riesgo de reingreso. Nuestros resultados resaltan la necesidad de una mejora de la asistencia médica durante el ingreso por infarto agudo de miocardio, de manera integrada en los programas de prevención secundaria (AU)

Introduction and objectives. Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140 000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. Methods. This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12 096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. Results. Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. Conclusions. Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs (AU)

Psychiatric morbidity as a risk factor for hospital readmission for acute myocardial infarction: an 8-year follow-up study in Spain.

BACKGROUND AND OBJECTIVE: Most previous studies assess the effect of depression and other psychiatric variables as risk factors for acute myocardial infarction; however, studies that assess the effect of psychiatric disorders as a whole are scarce, compared with other non-psychiatric factors. The aim of this study is to assess the importance of psychiatric morbidity, compared with other risk factors, in hospital readmission for acute myocardial infarction. METHODS: This is a 8-year follow-up study in which the Hospital Discharge Administrative Database was used. RESULTS: From the total sample (11,062 patients), 590 patients (4.88%) were diagnosed with some mental disorder. Psychiatric disorders were more common in women than in men with myocardial infarction (4.76 % and 6.20%, respectively, p-value = 0.002). For those who have had recurrence of stroke, mental disease influences in the consecutive readmission for AMI with the same severity as did tobacco, diabetes, or obesity. CONCLUSIONS: The main finding of this study is the enormous impact of psychiatric disorders on readmissions for AMI, comparable to diabetes, obesity, cerebral vascular disease, and hypertension. Interestingly, the efforts made to treat and prevent psychiatric disorders in AMI patients are clearly lower than those health authorities make with respect to classic risk factors.

Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study.

INTRODUCTION AND OBJECTIVES: Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140,000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. METHODS: This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12,096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. RESULTS: Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. CONCLUSIONS: Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.

Comentarios a las guías de práctica clínica sobre manejo de las dislipemias de la Sociedad Europea de Cardiología y la Sociedad Europea de Aterosclerosis 2011. Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología / Comments on the ESC/EAS guidelines for the management of dyslipidaemias 2011. A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology

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Factores de riesgo cardiovascular y estilo de vida asociados a la aparición prematura de infarto agudo de miocardio / Cardiovascular risk factors and lifestyle associated with premature myocardial infarction diagnosis

Los pacientes jóvenes diagnosticados de infarto agudo de miocardio tienen diferente perfil de riesgo cardiovascular, presentación clínica, hallazgos angiográficos y pronóstico que los demás pacientes. En este estudio se analizan las características y la evolución de los pacientes diagnosticados de infarto agudo de miocardio con edad < 46 años (AU)

Young and old patients with acute myocardial infarction have different risk factor profiles, clinical presentation, angiographic findings and prognosis. In the present study we investigated the clinical profile of patients aged <46 years with acute myocardial infarction (AU)

[Cardiovascular risk factors and lifestyle associated with premature myocardial infarction diagnosis]. / Factores de riesgo cardiovascular y estilo de vida asociados a la aparición prematura de infarto agudo de miocardio.

Young and old patients with acute myocardial infarction have different risk factor profiles, clinical presentation, angiographic findings and prognosis. In the present study we investigated the clinical profile of patients aged <46 years with acute myocardial infarction.

Infrequent opioid overdose risk reduction behaviours among young adult heroin users in cities with wide coverage of HIV prevention programmes.

BACKGROUND: Opioid overdose risk reduction behaviours include some preventive behaviours to avoid overdoses (PB) and others to avoid death after overdose, such as never using heroin while alone (NUA). Few studies have examined the prevalence and predictors of these behaviours. AIM: To establish the prevalence and predictors of PBs and NUA among heroin users, both injectors and non-injectors, in three Spanish cities. METHODS: 516 injecting and 475 non-injecting heroin users aged 18-30 were street-recruited in 2001-2003 and interviewed by face-to-face computer-assisted interview. PBs and NUA in the last 12 months were explored using open-ended and precoded questions, respectively. Specific predictors for three PB categories were investigated: control of route of drug administration, control of quantity or type of heroin used, and control of co-use of other drugs. Bivariate and logistic regression methods were used. RESULTS: Overall, the most prevalent PBs were: using a stable and not excessive amount of heroin (12.7%), injecting or using the whole heroin dose slowly or dividing it into smaller doses (12.4%), reducing or stopping heroin injection (8.3%), and not mixing heroin with tranquillisers (5.1%). Most PBs were significantly more prevalent among injectors than non-injectors. No one mentioned reducing the amount of heroin after an abstinence period. Some 36.2% had NUA. In multiple regression analysis, knowledge of risk factors for opioid overdose was a predictor of specific PBs, although this was not always the case. Use of syringe exchange programmes was a predictor of PB among injectors. However, attending methadone maintenance treatment (MMT) or other drug-dependence treatment was not a predictor of any opioid overdose reduction behaviour. Only ever having witnessed or experienced an overdose predicted PB in both injectors and non-injectors. CONCLUSIONS: The proportion of heroin users with opioid overdose risk reduction behaviours is very low. Additional specific measures to prevent overdose are needed, as well as increased emphasis on reducing the risk of overdose in programmes to prevent HIV and other blood-borne infections in heroin injectors.

Estudio de marcadores de inflamación en el aire exhalado de pacientes con bronquiectasias no asociadas a fibrosis quística / Inflammation Markers in the Exhaled Air of Patients with Bronchiectasis Unassociated with Cystic Fibrosis

IntroducciónEl propósito del estudio ha sido analizar la relación entre la intensidad de la inflamación de las vías aéreas respiratorias, expresada por marcadores de estrés oxidativo, y la gravedad de la enfermedad en pacientes con bronquiectasias no asociadas a fibrosis quística.Pacientes y métodosSe ha estudiado a 25 pacientes con bronquiectasias estables (15 mujeres y 10 varones). Como determinantes de gravedad se recogieron las siguientes variables: grado de disnea, número de exacerbaciones/ingresos en el último año, volumen diario medio de esputo, color del esputo (escala gradual de color), colonización bacteriana, exploración de la función respiratoria, calidad de vida (cuestionario St. George) y extensión radiológica de las lesiones (escala de Bhalla). La inflamación se analizó mediante la medición del óxido nítrico, pH y concentración de nitritos, nitratos e isoprostano en el condensado de aire exhalado. Asimismo se determinaron los valores de proteína C reactiva y velocidad de sedimentación globular en sangre periférica.ResultadosNo hubo relaciones significativas entre los marcadores en condensado de aire exhalado y la afectación clínica, radiológica, funcional o de calidad de vida de los pacientes. Sólo la colonización bacteriana (16 casos) se relacionó con valores más altos de nitratos en aire exhalado (media±desviación estándar: 18±4 frente a 7±2μM; r2=0,6) y un mayor número de exacerbaciones (3,1±1,9 frente a 1,7±1,9; r2=0,3).ConclusionesEn nuestra muestra, el estudio de marcadores de inflamación en aire exhalado sólo se relaciona con algunos parámetros de gravedad en pacientes con bronquiectasias colonizadas(AU)

IntroductionThe aim of the study was to analyse the relationship between the intensity of the respiratory tract inflammation, expressed by oxidative stress markers, and the severity of the disease in patients with bronchiectasis unassociated with cystic fibrosis.Patients and methodsThe study included 25 patients with stable bronchiectasis (15 females and 10 males). As determining factors of severity, the following parameters were collected: degree of dyspnoea, number of exacerbations/admissions in the last year, mean daily sputum volume, sputum colour (graduated colour scale), bacterial colonisation, respiratory function tests, quality of life (St. George questionnaire) and radiological extension of the lesions (Bhalla scale). Inflammation was analysed using the measurement of nitric oxide, pH and concentration of nitrites, nitrates and isoprostane in the exhaled air condensate. The C reactive protein and erythrocyte sedimentation rate were also determined in peripheral blood.ResultsThere were no significant relationships between the markers in the exhaled air condensate and the clinical, radiological and functional involvement or the quality of life of the patients. Only bacterial colonisation (16 cases) was associated with higher values of nitrates in exhaled air (mean±standard deviation: 18±4 compared to 7±2μM; r2=0.6) and a higher number of exacerbations (3.1±1.9 compared to 1.7±1.9; r2=0.3).ConclusionsIn our study, the measurement of inflammation markers in exhaled air is only associated with some parameters of severity in patients with bacterial bronchiectasis(AU)

Usefulness of triglycerides-to-high-density lipoprotein cholesterol ratio for predicting the first coronary event in men.

Overweight and obesity potentiate the development of cardiovascular risk factors but many doubts have arisen recently regarding their role in coronary events. We evaluated the predictive value of a surrogate maker of insulin resistance, the ratio of triglyceride (TG) to high-density lipoprotein (HDL), for the incidence of a first coronary event in men workers according to body mass index (BMI). We designed a case-control study of active subjects collected from a single factory through their annual health examination and medical reports. Case subjects included those with myocardial infarction, unstable angina pectoris, or subclinical myocardial ischemia detected through electrocardiographic abnormalities. The sample was constituted by 208 case and 2,080 control subjects (mean age 49.9 years, 49.6 to 50.2). General characteristics of case and control subjects were well matched. The TG/HDL ratio was significantly higher in case subjects compared to controls. Stratification of the sample revealed an increasing prevalence of case subjects and mean TG/HDL in each category of BMI. Multivariable analysis, adjusted by smoking, demonstrated that TG/HDL increased 50% the risk of a first coronary event (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.26 to 1.71), whereas low-density lipoprotein cholesterol values indicated a more moderate increased risk (OR 1.01, 95% CI 1.005 to 1.012); metabolic syndrome (OR 1.76, 95% CI 0.94 to 3.30) and hypertension (OR 1.50, 95% CI 0.81 to 2.79) did not reach statistical significance. The TG/HDL ratio was associated with a first coronary event in all categories of BMI. In conclusion, the TG/HDL ratio has a high predictive value of a first coronary event regardless of BMI.