Initial risk perception and feeling of preparedness of primary care physicians regarding the COVID-19 pandemic in Belgium, France and Spain in February 2020.

BACKGROUND: The knowledge of risk perceptions in primary care could help health authorities to manage epidemics. METHODS: A European multi-center cross-sectional study was conducted in France, Belgium and Spain to describe the perceptions, the level of anxiety and the feeling of preparedness of primary healthcare physicians towards the COVID-19 infection at the beginning of the pandemic. The factors associated with the feeling of preparedness were studied using multivariate logistic regressions. RESULTS: A total of 511 physicians participated to the study (response rate: 35.2%). Among them, only 16.3% (n=82) were highly anxious about the pandemic, 50.6% (n=254) had the feeling to have a high level of information, 80.5% (n=409) found the measures taken by the health authorities suitable to limit the spread of COVID-19, and 45.2% (n=229) felt prepared to face the epidemic. Factors associated with feeling prepared were: being a Spanish practitioner (adjusted OR=4.34; 95%CI [2.47; 7.80]), being a man (aOR=2.57, 95%CI [1.69; 3.96]), finding the measures taken by authorities appropriate (aOR=1.72, 95%CI [1.01; 3.00]) and being highly informed (aOR=4.82, 95%CI [2.62; 9.19]). CONCLUSIONS: Regarding the dramatic evolution of the pandemic in Europe in the weeks following the study, it appears that information available at this time and transmitted to the physicians could have given a wrong assessment of the spread and the severity of the disease. It seems essential to better integrate the primary care physicians into the information, training and protection channels. A comparison between countries could help to select the most effective measures in terms of information and communication.

Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias / Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks

INTRODUCCIÓN: El deterioro cognitivo es una entidad clínica en la que las funciones intelectuales están parcial o totalmente alteradas y supone un problema de salud pública y un reto para los servicios sanitarios y sociales. El objetivo de este trabajo es estimar la prevalencia de estos trastornos en la población mayor de 65 años que consulta en atención primaria en 5 redes centinelas sanitarias. MÉTODO: Se realizó el test Mini-Cog de cribado de deterioro cognitivo en una muestra de pacientes que acudieron a su médico de familia en 4 días seleccionados al azar. La confirmación se hizo con el test Mini-Mental y el Alzheimer's Questionnaire. Se estimaron tasas brutas y ajustadas por las variables demográficas y sociales. RESULTADOS: Se estudiaron 4.624 pacientes, que representan a una población de 1.723.216 personas de 5 comunidades autónomas. La prevalencia ajustada para el conjunto de la población estudiada fue del 18,5% (IC 95% 17,3-19,7), con diferencias entre las redes centinelas. Las mujeres presentan tasas ajustadas significativamente más elevadas que los hombres: 18,5 y 14,3%, respectivamente. La prevalencia por grupo de edad alcanza el 45,3% por encima de los 85 años y presenta diferencias por nivel de estudios alcanzado y tipo de convivencia. CONCLUSIONES: El deterioro cognitivo es un motivo de consulta frecuente en atención primaria. Es mayor en mujeres y aumenta exponencialmente con la edad. Tanto la sospecha como la confirmación del deterioro cognitivo pueden realizarse por el médico de familia con instrumentos sensibles y validados, lo que permite iniciar un tratamiento precoz

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7), with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients

Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks. / Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias.

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7], with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients.

Evolución de los factores de riesgo cardiovascular entre 2004 y 2009 en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL) / Trend in cardiovascular risk factors from 2004 to 2009 in the cohort of the Cardiovascular Disease Risk Study in Castilla y León (RECCYL)

INTRODUCCIÓN: Los factores de riesgo cardiovascular (FRCV) se modifican con la edad y las medidas de prevención y control. El objetivo de este estudio es describir la evolución de la hipertensión, diabetes, hipercolesterolemia, obesidad y hábito tabáquico en una cohorte de población de Castilla y León. MATERIAL Y MÉTODOS: En 2004 se inició el estudio RECCyL en personas ≥15 años residentes en Castilla y León con una anamnesis, exploración física y analítica. En 2009 se realizó un nuevo examen de salud a la muestra superviviente. Se calculó la incidencia acumulada en 5 años para cada FRCV en la población libre de ese factor en 2004. RESULTADOS: De la muestra original de 4.013 personas, se estudió en el año 2009 a 2.954. La incidencia de hipertensión en el quinquenio fue de 17,9%, de diabetes 3,9%, de hipercolesterolemia 15,6%, de obesidad 9,1% y de fumadores (nuevos y recaídas) 6,8%. Los nuevos diagnósticos de hipertensión, diabetes y tabaquismo fueron más frecuentes en edades tempranas. La incidencia fue más elevada en hombres para hipertensión, diabetes, hábito tabáquico e hipercolesterolemia (salvo en la cohorte de ≥75). Para la obesidad, la incidencia total fue mayor en las mujeres excepto en cohortes de edad más tempranas. CONCLUSIONES: Las prevalencias de los FRCV (exceptuando el hábito de fumar) han aumentado desde 2004, con desigual intensidad dependiendo del sexo y la edad. Conocer la incidencia y características de los nuevos diagnósticos, principalmente la distribución de la edad de aparición, es extremadamente útil para establecer actividades de prevención y control de los principales FRCV

INTRODUCTION: Cardiovascular risk factors change with age, as well as with the prevention and control measures. The aim of this study is to describe the trend in hypertension, diabetes, hypercholesterolemia, obesity, and smoking in a population cohort from Castilla y León. MATERIAL AND METHODS: In 2004 the RECCyL study began by recordingmedical history, a physical examination, and blood tests in a sample of the population ≥ 15 years old living in the Community of Castilla y León. In 2009 a new health examination was performed on the survivor sample. The cumulative 5-year incidence was calculated for each cardiovascular risk factor in the population that was free of that factor in 2004. RESULTS: From the original sample of 4013 people, 2954 were studied in 2009. Incidence of hypertension in the period was 17.9%, diabetes 3.9%, hypercholesterolemia 15.6%, obesity 9.1%, and smokers (new and relapse) 6.8%. New diagnoses of hypertension, diabetes and smoking were more common in younger ages. The incidence was higher in men for hypertension, diabetes, smoking, and hypercholesterolemia (except in the cohort of ≥75 years). In the case of obesity, the total incidence is higher for women, except in younger age cohorts. CONCLUSIONS: The prevalences of the cardiovascular risk factors (except smoking) have increased since 2004, with variable intensity depending on sex and age. To know the incidence and characteristics of newly diagnosed people, mainly the distribution of age at onset, is very useful to establish prevention and control activities of the principal cardiovascular risk factors

[Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)]. / Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL).

INTRODUCTION: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. MATERIAL AND METHODS: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mm Hg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. RESULTS: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mm Hg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. CONCLUSION: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities.

Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL) / Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)

Introducción: Las enfermedades cardiovasculares y sus factores de riesgo suponen un reto para la salud pública por la mortalidad y el coste sanitario que conllevan. El objetivo de este estudio es conocer el grado de control de la presión arterial en una cohorte poblacional y determinar los factores asociados al mal control. Material y métodos: En 2004 se llevó a cabo un examen de salud cardiovascular con anamnesis, exploración y analítica básica, en una muestra aleatoria de 4.013 personas ≥15 años residentes en Castilla y León. En 2009 se realizó un nuevo examen de salud a 2.954 personas de la muestra inicial de las que 1.306 tenían hipertensión arterial. Se consideró control estricto si la presión arterial era <140/90. Se realizó análisis bivariante y se calcularon odds ratio en un modelo de regresión logística. Resultados: El 55,9% presentaron valores de presión arterial por encima de los límites establecidos, sin diferencias entre hombres y mujeres. El modelo de regresión mostró que la diabetes, la obesidad, el hábito de fumar y los valores previos de presión arterial sistólica, con odds ratio de 3,87; 1,58; 1,49 y 1,13 por cada 5 mmHg respectivamente, se asociaban de manera independiente con un mal control. La edad no presentaba significación estadística. Conclusión: Más de la mitad de los pacientes con hipertensión arterial no están bien controlados. Este estudio aporta información sobre las características de los pacientes hipertensos de Castilla y León que presentan un mal control, lo que permitirá desarrollar actividades de prevención primaria y secundaria

Introduction: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. Material and methods: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mmHg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. Results: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mmHg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. Conclusion: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities

Prevención de la gripe en la edad pediátrica / Influenza prevention in the pediatric age group

No disponible

[Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology]. / Incidencia y características clínicas de los exantemas maculopapulares de etiología viral.

OBJECTIVE: To estimate the incidence of maculo-papular viral exanthemas and to describe the epidemiological and clinical patterns. DESIGN: Observational descriptive study with a sample design. PARTICIPANTS AND SETTING: 154 practitioners from the Castilla y León Sentinel Network with a surveilled population of 23 237 people-year under 15 years old, notified in 2002 the cases of diseases by means of a standard form with the variables and inclusion and exclusion criteria. MAIN MEASUREMENTS: It was included the maculo-papular exanthemas associated to a presumable systemic virus disease in patients under 15 years old. It was excluded the infectious mononucleose, the chickenpox, and other non viral infections or exanthemas. RESULTS: 368 cases were notified which represent a incidence rate of 158.37 cases per 10 000 (95% CI, 142.31-174.42). The incidence was maximum under four years old, more than 350 per 10 000, decreasing significantly in children over this age. Erythema infectiousum presented the highest rate, followed by exanthema subitum. The exanthemas caused by measles or rubella were insignificants. CONCLUSIONS: Childhood exanthematous diseases of presumable viral etiology have an important incidence in primary care, although the majorities are banal and self-limited diseases. Clinical characteristics supported the suspicion diagnosis, which was consistent with the observed epidemiological description and expected presentations of each disease. Although serological analysis could diminish the uncertainly on notification and control of diseases submited to especial programs of vaccination and eradication, they would not improve substantially the diagnosis and treatment of these patients.

Incidencia y características clínicas de los exantemas maculopapulares de etiología viral / Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology

Objetivo. Estimar la incidencia de exantemas maculopapulares de presumible etiología viral y describir las características epidemiológicas y clínicas. Diseño. Estudio observacional, descriptivo, de diseño muestral. Participantes y emplazamiento. Ciento cincuenta y cuatro médicos integrantes de la Red de Médicos Centinelas de Castilla y León, en una población vigilada de 23.237 personas-año menores de 15 años, notificaron durante el año 2001 los casos de la enfermedad a través de una ficha estándar que contenía las variables requeridas y los criterios de inclusión y exclusión.Mediciones principales. Se incluyeron los exantemas maculopapulares asociados a enfermedad sistémica de presumible etiología viral en menores de 15 años. Se excluyeron la mononucleosis infecciosa, la varicela y otras infecciones o exantemas no virales. Resultados. Se notificaron 368 casos, que suponen una tasa de incidencia de 158,37 casos por 10.000 (IC del 95 por ciento, 142,31174,42). La incidencia fue máxima en los menores de 4 años, superior a 350 por 10.000, reduciéndose significativamente en los niños mayores de esa edad. El eritema infeccioso presentó la tasa más elevada, seguido del exantema súbito. Los exantemas ocasionados por sospecha de sarampión o rubéola fueron insignificantes. Conclusiones. Las enfermedades exantemáticas en la infancia de presumible etiología viral tienen una incidencia importante en atención primaria, si bien la mayoría son enfermedades leves y autolimitadas. Las características clínicas fundamentaron el diagnóstico de sospecha etiológico, que fue coherente con la descripción epidemiológica observada y las manifestaciones esperadas para cada enfermedad. Si bien los análisis serológicos permitirían disminuir la incertidumbre en la notificación y el control de enfermedades sometidas a programas especiales de vacunación y eliminación, no mejorarían sustancialmente el diagnóstico y tratamiento de estos pacientes (AU)