Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Efecto de la variante Ómicron sobre la incidencia y la letalidad durante la 6 onda epidémica COVID-19 en España / Effect of the Omicron variant on cumulative incidence of infection and lethality during the sixth wave of the COVID-19 epidemic in Spain

La pandemia COVID-19 ha puesto a prueba los sistemas sanitarios a nivel mundial. Las sucesivas ondas epidémicas han mostrado características diferentes. La variante Ómicron del SARS-CoV-2 modificó el comportamiento epidémico que habían seguido las variantes previas. El objetivo de este análisis fue determinar las características epidemiológicas de la COVID-19 durante la 6.ª onda epidémica y sus diferencias según predominara las variantes Delta u Ómicron. Se analizaron los datos epidemiológicos correspondientes a la 6.ª onda epidémica publicados por los organismos oficiales, y se analizaron la incidencia acumulada de infección (IA-I) y las tasas de letalidad (TL), tanto del conjunto de España como de las diferentes Comunidades Autónomas, en el conjunto de la población y por grupos etarios. Los resultados mostraron que la IA-I era mayor con la variante Ómicron (10,89 vs. 0,75% con Delta) mientras que la TL lo era con la variante Delta (4,2 vs. 1,3‰ con Ómicron), así como una mayor tasa de hospitalización e ingreso en UCI con la variante Delta.(AU)

The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2‰ vs 1.3‰ with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.(AU)

[Effect of the Omicron variant on cumulative incidence of infection and lethality during the sixth wave of the COVID-19 epidemic in Spain]. / Efecto de la variante Ómicron sobre la incidencia y la letalidad durante la 6.ª onda epidémica COVID-19 en España.

The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2‰ vs 1.3‰ with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.

Case-fatality rate of SARS-CoV-2 infection during the third and fifth epidemic waves in Spain: Impact of vaccination / Tasa de letalidad de la infección por SARS-CoV-2 durante la tercera y quinta oleadas epidémicas en España: impacto de la vacunación

Introduction During the first and second epidemic waves in Spain, the SARS-CoV-2 case-fatality rates (CFRs) showed significant differences between Autonomous Communities (ACs). Comparing CFRs in the third and fifth epidemic waves can provide information on the impact of the different vaccination coverages in the ACs. Objective To evaluate the impact of vaccination on COVID-19 CFRs in the third and fifth epidemic waves in Spain, according to sex, age, and AC. Methods This work is an observational, descriptive study which uses data on COVID-19 infections, deaths, and vaccinees published by the Spanish Ministry of Health and the regional Health Departments of the ACs. The third epidemic wave was defined as the period from 26th December 2020 to 19th April 2021, and the fifth wave, from 19th July to 19th September 2021. The CFRs (deaths per 1000 infected [‰]) were calculated according to sex, age group, and AC. The standardized case-fatality ratio (SCFR) was adjusted for age and sex for each wave. We estimated the correlation between CFRs and their change between the two epidemic waves with the vaccination coverages reached at the beginning of the fifth wave. Results The CFR in the fifth wave (5.7‰) was lower than in the third wave (16.5‰). In addition, the CFR in both waves was significantly higher in men than in women, and in older people than in younger ones. A decrease in the CFR between both waves was only observed in those older than 49. A strong direct and positive correlation (R2a=0.8399) was found between vaccination coverage by age group and decrease in CFR between both epidemic waves. Significant differences were seen between ACs in the two waves, as regards both CFRs and SCFRs. When comparing ACs, a direct correlation was observed between vaccination coverage and CFRs in the fifth wave, and also – although weak – between vaccination coverage and decrease in CFR between both waves (AU)

Introducción Durante la primera y segunda oleadas epidémicas en España, las tasas de letalidad (TL) por SARS-CoV-2 mostraron diferencias significativas entre comunidades autónomas (CC. AA.). La comparación de las TL en la tercera y quinta oleadas epidémicas puede aportar información sobre el impacto de las diferentes coberturas vacunales en las CC. AA. Objetivo Evaluar el impacto de la vacunación sobre las TL de COVID-19 en la tercera y quinta onda epidémica en España, según sexo, edad y CC. AA. Métodos Este trabajo es un estudio observacional, descriptivo, que utiliza los datos de infectados, fallecidos y vacunados por COVID-19 publicados por el Ministerio de Sanidad y las Consejerías de Sanidad de las CC. AA. La tercera onda epidémica se definió como el periodo comprendido entre el 26 de diciembre de 2020 y el 19 de abril de 2021, y la quinta onda, entre el 19 de julio y el 19 de septiembre de 2021. Las TL (muertes por cada 1.000 infectados [‰]) se calcularon en función del sexo, el grupo de edad y la CC. AA. La razón estandarizada de letalidad (REL) se ajustó por edad y sexo para cada oleada. Se estimó la correlación entre las TL y su cambio entre las 2 oleadas epidémicas con las coberturas de vacunación alcanzadas al inicio de la quinta oleada. Resultados La TL en la quinta onda (5,7‰) fue inferior a la de la tercera onda (16,5‰). Además, la TL en ambas oleadas fue significativamente mayor en varones que en mujeres, y en personas mayores que en jóvenes. Solo se observó una disminución de la TL entre ambas oleadas en los mayores de 49 años. Se encontró una fuerte correlación directa y positiva (R2a=0,8399) entre la cobertura de vacunación por grupo de edad y la disminución de la TL entre ambas oleadas epidémicas (AU)

Case-fatality rate of SARS-CoV-2 infection during the third and fifth epidemic waves in Spain: Impact of vaccination.

INTRODUCTION: During the first and second epidemic waves in Spain, the SARS-CoV-2 case-fatality rates (CFRs) showed significant differences between Autonomous Communities (ACs). Comparing CFRs in the third and fifth epidemic waves can provide information on the impact of the different vaccination coverages in the ACs. OBJECTIVE: To evaluate the impact of vaccination on COVID-19 CFRs in the third and fifth epidemic waves in Spain, according to sex, age, and AC. METHODS: This work is an observational, descriptive study which uses data on COVID-19 infections, deaths, and vaccinees published by the Spanish Ministry of Health and the regional Health Departments of the ACs. The third epidemic wave was defined as the period from 26th December 2020 to 19th April 2021, and the fifth wave, from 19th July to 19th September 2021. The CFRs (deaths per 1000 infected [‰]) were calculated according to sex, age group, and AC. The standardized case-fatality ratio (SCFR) was adjusted for age and sex for each wave. We estimated the correlation between CFRs and their change between the two epidemic waves with the vaccination coverages reached at the beginning of the fifth wave. RESULTS: The CFR in the fifth wave (5.7‰) was lower than in the third wave (16.5‰). In addition, the CFR in both waves was significantly higher in men than in women, and in older people than in younger ones. A decrease in the CFR between both waves was only observed in those older than 49. A strong direct and positive correlation (R2a=0.8399) was found between vaccination coverage by age group and decrease in CFR between both epidemic waves. Significant differences were seen between ACs in the two waves, as regards both CFRs and SCFRs. When comparing ACs, a direct correlation was observed between vaccination coverage and CFRs in the fifth wave, and also - although weak - between vaccination coverage and decrease in CFR between both waves. CONCLUSION: The CFR significantly decreased in Spain between the third and the fifth epidemic waves in population aged 50 or older, probably due to the high vaccination coverage in that age group. Differences were observed between CFRs and SCFRs between ACs that are not explained by the differences in vaccination coverage, suggesting the need for further research and evaluation.

Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes / Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study

Objetivos: Conocer el grado de control óptimo simultáneo de la diabetes (DM), hipertensión arterial (HTA) e hipercolesterolemia y determinar los factores asociados. Material y métodos: Estudio descriptivo transversal en pacientes diabéticos de 18 o más de edad, seleccionados consecutivamente en consultas de medicina de familia (MF). Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró buen control metabólico una HbA1c < 7%, buen control de la presión arterial (PA) valores < 140/80 mmHg y buen control de colesterol LDL (c-LDL) valores < 100 mg/dL. Se realizó análisis bivariante y se calcularon odds ratio (OD) en un modelo de regresión logística. El estudio fue aprobado por el CEIm del Hospital Clínico San Carlos (Madrid). Resultados: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años. El 75,9% eran hipertensos y el 69,1% dislipémicos. Los valores de HbA1c fueron de 6,9 (1,2) %, PA sistólica 135,0 (16,8) mmHg, PA diastólica 75,9 (10,6) mmHg y LDL-colesterol 93,7 (32,8) mg/dL. El buen control metabólico de la DM se alcanzó en el 63% (intervalo de confianza [IC] 95%: 60,4-65,5), el buen control de la HTA en el 42,6% (IC 95%: 40,0-45,2) y el buen control de colesterol LDL en el 61,1% (IC 95%: 58,4-63,7) de los pacientes. El buen control de los tres factores de riesgo cardiovascular (FRCV) simultáneamente se alcanzó en el 16,1% (IC 95%: 14,2-18,1). Se observó una asociación positiva e independiente (p < 0,05) entre el buen control simultáneo de los FRCV con la edad (OR: 1.017) y los antecedentes personales de enfermedad cardiovascular (OR: 1.596). Conclusiones: Los resultados de nuestro estudio indican que una proporción pequeña, menos de dos de cada 10 pacientes cumplen los objetivos de buen control recomendados por las guías de práctica clínica (AU)

Objectives: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. Material and method: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. Results: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4–65.5), good control of HTA at 42.6% (95% CI: 40.0–45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4–63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2–18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). Conclusions: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease (AU)

Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España / Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain

Introducción: En España, los sistemas sanitarios están transferidos a las Comunidades Autónomas (CC.AA.), constituyendo 19 sistemas sanitarios con gestión y recursos diferenciados. Durante la primera onda epidémica de la COVID-19 se objetivaron diferencias en los sistemas de declaración y en las tasas de letalidad (TL) entre las CC.AA. El objetivo de este estudio fue analizar las TL por CC.AA. durante la segunda onda epidémica (del 20 de julio al 25 de diciembre de 2020) y su relación con la prevalencia de la infección. Material y métodos: Se realizó un estudio observacional descriptivo con la información disponible sobre el número de fallecidos por COVID-19 registrados en el Ministerio de Sanidad, Consejerías de Salud y los Departamentos de Salud Pública de las CC.AA. y según el exceso de mortalidad informado por el Sistema de Monitorización de Mortalidad Diaria (MoMo). La prevalencia de la infección se estimó a partir de las diferencias entre la segunda y cuarta ronda del estudio ENE-COVID y sus intervalos de confianza del 95%. Se calcularon las TL (fallecidos por cada mil infectados) globales, por sexo, grupos de edad (< 65 y ≥ 65 años) y CC.AA. Se calculó la razón estandarizada de letalidad por edad (REL) de las CC.AA. utilizando las TL de España para cada grupo de etario. Estas estimaciones se realizaron con las defunciones declaradas oficialmente (TLo) y el exceso de defunciones estimadas por MoMo (TLMo). Se estimaron las correlaciones entre las prevalencias de infección y las TLo y TLMo, ponderando por población. Resultados: Para el conjunto de España, la TLo durante la segunda onda epidémica fue del 7,6%, oscilando entre 3,8% de Baleares y 16,4% de Asturias, y la TLMo fue de 10,1%, oscilando entre el 4,8% de Madrid y el 21,7% en Asturias. Se observaron diferencias significativas entre la TLo y la TLMo en Canarias, Castilla la Mancha, Extremadura, Comunidad Valenciana, Andalucía y las Ciudades Autónomas de Ceuta y Melilla (AU)

Introduction: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. Material and methods: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. Results: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%) (AU)

[Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain]. / Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España.

INTRODUCTION: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. MATERIAL AND METHODS: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. RESULTS: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%). The FRo and FRMo were significantly higher in the age group ≥ 65 years (55.4% and 72.2% respectively) than in the group <65 years (0.5% and 1.4% respectively). The Basque Country, Aragon, Andalusia and Castilla la Mancha presented SFR significantly higher than the global FR of Spain. The correlations between the prevalence of infection and the FRo were inverse. CONCLUSIONS: The case-fatality from COVID-19 during the second epidemic wave in Spain improved compared to the first wave. The case-fatality rates were higher in men and the elderly people, and varied significantly between AC. It is necessary to delve into the analysis of the causes of these differences.

[Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study]. / Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes.

OBJECTIVES: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. MATERIAL AND METHOD: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. RESULTS: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4-65.5), good control of HTA at 42.6% (95% CI: 40.0-45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4-63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2-18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). CONCLUSIONS: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease.

[Application of the PCR number of cycle threshold value (Ct) in COVID-19]. / Aplicación del valor umbral del número de ciclos (Ct) de PCR en la COVID-19.

The SARS-CoV-2 pandemic persists with all its virulence despite 650,382,819 doses of COVID vaccine worldwide. The reference test for infection identification is reverse transcription polymerase chain reaction (RT-qPCR). The usefulness of this test may be diminished by simplifying its result as positive or negative. Determining the number of cycles (Ct) in positive RT-qPCR tests can assist in decision-making when interpreted in the clinical context of patients.

Aptitudes percibidas por el médico de familia en la atención a pacientes inmigrantes / Skills perceived by general practitioners for providing care to immigrant patients

OBJETIVO: Conocer las aptitudes percibidas por los médicos de familia como competencia en la atención a las personas inmigrantes. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal con recogida de datos mediante encuesta de 21 preguntas cumplimentada electrónicamente por médicos de familia y validada por la Comisión Nacional de Validación de SEMERGEN. Se estructuró con preguntas tipo test, cerradas, de opción múltiple de respuesta, incluyendo variables relacionadas con el médico y variables relacionadas con el paciente inmigrante. El grado de competencia profesional se valoró con una escala Likert, de 1 a 10. RESULTADOS: Respondieron la encuesta 610 médicos de familia, con una edad media de 47,5± 12,3 años; 64,1% mujeres. De ellos, 112 (18,4%) estaban en periodo de residencia. Tasa de respuesta 4,9%. El 72,6% no había realizado cursos de formación continuada en atención a personas inmigrantes en los últimos 5años. Los médicos contestaron que percibieron dificultad en la consulta: en el 73% de los casos con el idioma, en el 38,7% con el tiempo asignado y en el 32,3% con el conocimiento de la cultura. El 96,9% de los pacientes asistió a consulta por enfermedad común. En el 14,4% la causa estaba relacionada con el proceso migratorio (enfermedad infecciosa adquirida en el país de origen) y en el 26,4% con las condiciones de salud en el país de acogida (falta de vivienda estable, hacinamiento y condiciones de trabajo). El grado de competencia percibido fue de 6,2 ±1,9. CONCLUSIONES: La competencia percibida por el médico de familia en la atención a personas inmigrantes es moderada. Las barreras más importantes para estos profesionales son el desconocimiento del idioma, la falta de tiempo asignado para la consulta y el desconocimiento de la cultura del paciente

OBJECTIVE: To identify the skills perceived by general practitioners for providing competent care to immigrants MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection using a 21-item questionnaire completed electronically by the general practitioners and validated by the National Validation Commission of SEMERGEN. It was structured with closed-ended, multiple-choice test questions, including variables related to the doctor and variables related to the immigrant patient. The level of professional competence was assessed using a 1 to 10 Likert scale. RESULTS: A total 610 family physicians with a mean age of 47.5±12.3 years responded and 64.1% were women. Of these, 112 (18.4%) were residents. The response rate was 4.9%. A large majority (72.6%) had not taken part in continuing education courses on caring for immigrants in the last 5years. Participants reported difficulties in the clinic: 73% of the cases with the language, 38.7% with the allotted time, and 32.3% due to knowledge of the culture. Most (96.9%) of patients attended the clinic due to a common illness. The cause in 14.4% was related to the migratory process (infectious disease acquired in the country of origin), and in 26.4% with the health conditions in the host country (lack of stable housing, overcrowding, and conditions of work). The perceived level of competence was 6.2±1.9. CONCLUSIONS: The competence perceived by general practitioners in providing care to immigrants is moderate. The most important barriers for these professionals are ignorance of the language, lack of time allocated for consultation, and ignorance of the patient's culture

Análisis de las tasas de letalidad de la infección por SARS-CoV-2 en las comunidades autónomas de España / Analysis of fatality rates case of SARS-CoV-2 infection in the Autonomous Communities of Spain

INTRODUCCIÓN: La pandemia por el virus SARS-CoV-2 ha supuesto un auténtico reto para los sistemas sanitarios. En España, la distribución heterogénea del virus y las diferentes estrategias sanitarias han condicionado la morbilidad y la letalidad. El objetivo de este estudio fue analizar la letalidad de la infección por sexo y rangos de edad en las comunidades autónomas (CC.AA.) de España. MATERIAL Y MÉTODOS: Para realizar el análisis, los datos se extrajeron del Ministerio de Sanidad, Consejerías y Departamentos de Salud Pública de las diferentes CC.AA. Se estimó la población infectada a partir de los resultados del ENE-COVID19 y de la población censada a 1 de enero de 2020 (INE) para una validez del test de anticuerpos IgG con 80% de sensibilidad y 100% de especificidad. La tasa de letalidad (TL) (fallecidos/1.000 infectados estimados) por sexo y edad (< 20 años, 20-64 y ≥ 65 años) se calculó para cada CC.AA. Se calculó la razón estandarizada de letalidad (REL) por el método exacto (EPIDAT). RESULTADOS: La prevalencia estimada de infección por SARS-CoV-2 en España fue del 6% (rango, 1,4% [Ceuta] - 14,1% [Comunidad de Madrid]). La TL para el conjunto de España fue del 9,6/1.000, oscilando entre el 1/1.000 en Melilla y el 26,6/1.000 en La Rioja, sin que se encontrara correlación entre letalidad y prevalencia de la infección. La TL fue mayor en hombres (10,2/1.000, razón 1,17 respecto de mujeres), excepto en Cataluña (razón 0,92), y especialmente elevada en los mayores de 64 años en La Rioja (143,5/1.000), Asturias (69,2/1.000) y País Vasco (46,6/1.000). Se encontró un exceso de letalidad (REL) global superior al 30% en La Rioja (2,91; IC 95%: 2,36-3,57), Asturias (1,51; IC 95%: 1,27-1,80), País Vasco (1,42; IC 95%: 1,31-1,54) y Extremadura (1,37; IC 95%: 1,20-1,57) y en los mayores de 64 años en Madrid y Canarias. CONCLUSIONES: La infección por el virus SARS-CoV-2 se ha distribuido de forma muy irregular en las diferentes CCAA, existiendo una gran diferencia en la tasa de letalidad entre comunidades, siendo especialmente elevada en La Rioja, Asturias y País Vasco. Es relevante el exceso de letalidad respecto a la media nacional en la población mayor de 64 años en las CC.AA. de Madrid y Canarias

INTRODUCTION: The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain. MATERIAL AND METHODS: To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (< 20 years, 20-64 and ≥ 65 years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT). RESULTS: The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] - 14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64 years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95% CI: 2.36-3.57), Asturias (1.51; 95% CI: 1.27-1.80), Basque Country (1.42; 95% CI: 1.31-1.54) and Extremadura (1.37; 95% CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands. CONCLUSIONS: SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64 years of age in the ACs of Madrid and the Canary Islands

COVID-19. La historia se repite y seguimos tropezando con la misma piedra / COVID-19. History repeats itself and we keep stumbling on the same stone

La pandemia por COVID-19 ha provocado un desajuste en todos los sistemas de salud. La mayoría de los países habían olvidado cómo comportarse ante una epidemia de estas características sin disponer de los recursos adecuados. Es preciso realizar un balance de todo lo sucedido, instruir a la población y generar un nuevo conocimiento que nos permita afrontar nuevas epidemias

The COVID-19 pandemic has caused a mismatch in all health systems. Most countries had forgotten how to behave in the face of such an epidemic without adequate resources. We need to take stock of everything that has happened, instruct the population and generate a new knowledge that allows us to face new epidemics

[COVID-19. History repeats itself and we keep stumbling on the same stone]. / COVID-19. La historia se repite y seguimos tropezando con la misma piedra.

The COVID-19 pandemic has caused a mismatch in all health systems. Most countries had forgotten how to behave in the face of such an epidemic without adequate resources. We need to take stock of everything that has happened, instruct the population and generate a new knowledge that allows us to face new epidemics.

[Analysis of fatality rates case of SARS-CoV-2 infection in the Autonomous Communities of Spain]. / Análisis de las tasas de letalidad de la infección por SARS-CoV-2 en las comunidades autónomas de España.

INTRODUCTION: The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain. MATERIAL AND METHODS: To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (<20years, 20-64 and ≥65years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT). RESULTS: The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] -14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95%CI: 2.36-3.57), Asturias (1.51; 95%CI: 1.27-1.80), Basque Country (1.42; 95%CI: 1.31-1.54) and Extremadura (1.37; 95%CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands. CONCLUSIONS: SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64years of age in the ACs of Madrid and the Canary Islands.

Análisis del grado de cumplimiento de las recomendaciones de las guías de práctica clínica para el diagnóstico y seguimiento de las complicaciones crónicas vasculares en la diabetes tipo 2 en atención primaria / Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type 2 diabetes in Primary Care

OBJETIVOS: Evaluar el grado de cumplimiento de las recomendaciones de las guías de práctica clínica (GPC) en el diagnóstico y seguimiento de las principales complicaciones crónicas vasculares de los pacientes con diabetes tipo2 (DM2) en atención primaria (AP). MATERIAL Y MÉTODOS: Estudio descriptivo transversal retrospectivo en pacientes de 18 o más años de edad seleccionados consecutivamente a medida que acudieron a la consulta en AP. Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró adecuada la determinación y el registro de microalbuminuria (MALB), filtrado glomerular (FG), exploración pies (palpación pulsos, monofilamento o diapasón) y electrocardiograma (ECG) si habían sido realizados de manera anual, y del fondo de ojo (FO) cada dos años. RESULTADOS: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años y una media de 9,3 (6,2) años de evolución de su diabetes. El índice de masa corporal (IMC) medio (kg/m2) fue de 30,1 (5,4) en mujeres y de 29,5 (4,7) en varones (p = 0,023) y la HbA1c (%), de 6,9 (1,2). El buen control metabólico de la DM se alcanzó en el 63,0% (IC95%: 60,4-65,5). Tenían realizado FO en los dos últimos años 976 pacientes (68,7%; IC95%: 66,2-71,1). La MALB se había realizado a 1.228 pacientes (86,5%; IC95%: 84,6-88,2), el FG estimado a 1.391 (98,0%; IC95%: 97,1-98,6), la exploración de los pulsos del pie a 626 (44,1%; IC95%: 41,5-46,7) y la exploración neurológica a 473 (33,3%; IC95%: 30,8-35,8). CONCLUSIONES: Los resultados de nuestro estudio indican que en una proporción importante de los pacientes con DM2 no se explora la presencia de retinopatía ni de neuropatía. A siete de cada diez pacientes se les ha cribado de retinopatía, uno de cada tres tiene realizada exploración neurológica y uno de cada cuatro tiene realizadas todas las exploraciones recomendadas por las GPC

OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG

[Skills perceived by general practitioners for providing care to immigrant patients]. / Aptitudes percibidas por el médico de familia en la atención a pacientes inmigrantes.

OBJECTIVE: To identify the skills perceived by general practitioners for providing competent care to immigrants MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection using a 21-item questionnaire completed electronically by the general practitioners and validated by the National Validation Commission of SEMERGEN. It was structured with closed-ended, multiple-choice test questions, including variables related to the doctor and variables related to the immigrant patient. The level of professional competence was assessed using a 1 to 10 Likert scale. RESULTS: A total 610 family physicians with a mean age of 47.5±12.3 years responded and 64.1% were women. Of these, 112 (18.4%) were residents. The response rate was 4.9%. A large majority (72.6%) had not taken part in continuing education courses on caring for immigrants in the last 5years. Participants reported difficulties in the clinic: 73% of the cases with the language, 38.7% with the allotted time, and 32.3% due to knowledge of the culture. Most (96.9%) of patients attended the clinic due to a common illness. The cause in 14.4% was related to the migratory process (infectious disease acquired in the country of origin), and in 26.4% with the health conditions in the host country (lack of stable housing, overcrowding, and conditions of work). The perceived level of competence was 6.2±1.9. CONCLUSIONS: The competence perceived by general practitioners in providing care to immigrants is moderate. The most important barriers for these professionals are ignorance of the language, lack of time allocated for consultation, and ignorance of the patient's culture.

[Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type2 diabetes in Primary Care]. / Análisis del grado de cumplimiento de las recomendaciones de las guías de práctica clínica para el diagnóstico y seguimiento de las complicaciones crónicas vasculares en la diabetes tipo 2 en atención primaria.

OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG.

Neurological injury as a complication of spinal surgery: incidence, risk factors, and prognosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess the rate, injury site, aetiology and outcomes in elective spinal surgery patients who sustained a spinal cord injury (SCI). SETTING: SCI national centre Toledo, Spain. METHODS: The study sample included patients who sustained an SCI after elective spinal surgery from 2013 to 2017. Oncological patients and patients receiving interventional therapies were excluded. Data collected included: demographics, aetiology, precipitating cause, injury mechanism, injury site, neurological status (AIS), SCIMIII at admission and discharge, hypertension, diabetes mellitus, obesity, dyslipidemia, depression and hospital length of stay. RESULTS: One thousand two hundred and eighty-two patients were admitted in this period of whom 114 met the inclusion criteria with a median (IQR) age of 58 (45-69) years; 46% female. The prevalence of SCI as a complication following spinal surgery in the total number of patients admitted to our centre was 9%. In 43%, the injury was to the dorsal spine with T12 being the most common neurological level of injury (20% of cases following laminectomy secondary to spinal canal stenosis). The most frequent precipitating cause was epidural haematoma (38% of cases). The median (IQR) SCIMIII scores at admission and discharge were (31) points (20-54) and (67) points (34-81), respectively. General AIS at admission were C (35%) and D at discharge (54%). The presence of hypertension, diabetes mellitus, obesity and dyslipidemia adjusted by age was not linked to a higher complication rate. The median (IQR) hospital length of stay was 120 days (60-189). CONCLUSION: In total 8.9% of patients admitted with SCI were the result of elective spinal surgery.

Riesgo de caídas y consumo de fármacos en los pacientes mayores de 65 años. Estudio PYCAF / Risk of falls and drug use in patients over 65 years of age. The PYCAF study

OBJETIVO: Evaluar el riesgo de caídas y su relación con el policonsumo de fármacos en ancianos no institucionalizados. MATERIALES Y MÉTODOS: El estudio PYCAF (Prevalencia Y Características del Anciano Frágil) es un estudio transversal, descriptivo y multicéntrico en pacientes > 65 años. Se consideró riesgo elevado de caídas cuando se tardó más de 20 s en realizar el test Timed Up and Go. Se consideró polimedicación el consumo entre 5 y 9 fármacos, y polimedicación extrema (PE) el consumo de 10 o más fármacos. Mediante modelos de regresión logística ajustados se valoró la asociación de la polimedicación y la PE con el riesgo de caídas. RESULTADOS: Se incluyó a 2.461 pacientes (57,9% mujeres), edad media +/- desviación estándar 76,0 +/- 7,0 años. El consumo medio de medicamentos fue de 6,6 +/- 3,7, rango 0-23. La polimedicación estaba presente en el 50,6% y la PE en el 19,2% de los pacientes. El 13,7% de los pacientes presentaron elevado riesgo de caídas. La prevalencia de riesgo elevado de caídas fue más de 2veces superior en los pacientes con PE (ORa = 2,07; IC del 95%, 1,27-3,38) y polimedicados (ORa =1,95; IC del 95%, 1,26-2,99). CONCLUSIONES: La polimedicación y la PE se asocian con un elevado riesgo de caídas en pacientes de más de 65 años. Debe valorarse el riesgo de caídas de los pacientes ancianos antes de prescribir medicación

OBJECTIVE: To evaluate the risk of falls and its relationship with the multiple drug use in the non-institutionalised elderly. MATERIALS AND METHODS: The PYCAF study (Prevalence and Characteristics of the Fragile Elderly) is a cross-sectional, descriptive and multicentre study in patients> 65 years of age. A fall was considered high risk when it took more than 20seconds to perform the Timed Up and Go test. Consuming between 5 and 9 drugs is considered multiple drug (MD) use, and extreme multiple drug (EMD) use the consumption of 10 or more drugs. Adjusted logistic regression models evaluated the association between multiple drug use and EMD and the risk of falls. RESULTS: A total of 2,461 patients (57.9% women), with a mean age (SD) 76.0 (+/- 7.0) years, were included in the study. The mean consumption of medications was 6.6 +/- 3.7, range 0-23. Multiple drug use was present in 50.6%, and EMD in 19.2% of patients. A high risk of falls was observed in 13.7% of patients. The prevalence of high risk of falls was more than 2times higher in patients with EMD (ORa = 2.07, 95% CI = 1.27 - 3.38) and MD (ORa = 1.95, 95% CI = 1.26 - 2.99). CONCLUSIONS: MD and EMD are associated with a high risk of falls in patients over 65 years of age. The risk of falls in elderly patients should be assessed before prescribing medication