Prevalence of cardiovascular risk factors in an urban adult population from southern Spain. IMAP Study.

AIMS: To study the prevalence of cardiovascular risk factors in an urban population of Malaga, Spain and its relationship with educational level. METHODS: A cross-sectional study was performed with a random representative sample of 2270 individuals from the adult population (18­80 years) from a specific Health-Care Centre in Malaga City. All participants underwent a clinical interview, including social-demographical information and a physical examination. A blood sample was also drawn. RESULTS: The mean age of the participants was 43.6 ± 15.6 years and 57.6% had a low educational level. The prevalence of cardiovascular risk factors was: smoking 27.7%, hypertension 33.1%, diabetes 7.1% and dyslipidaemia 65.4%. Over 60% were either overweight or obese, and 76.7% had a sedentary lifestyle. Except for smoking and a low-HDL cholesterol, the prevalence of the other cardiovascular risk factors increased with age. A low educational level was associated with a high prevalence of cardiovascular risk factors, and this association was significant with regard to smoking, obesity, abdominal obesity and hypertriglyceridaemia. CONCLUSIONS: The population studied presents a high prevalence of cardiovascular risk factors, especially dyslipidaemia and obesity. The low academic level was associated with an increased prevalence of smoking, obesity and dyslipidaemia. People with a low socio-cultural level are a priority target for introducing policies to prevent and control cardiovascular disease.

Analysis of 27,248 hospital discharges for heart failure: a study of an administrative database 1998-2002.

AIMS: To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM). METHODS AND RESULTS: Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures. There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r(2) = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001). The global in-hospital mortality rate was 11.1% and we found differences between Cardiology and MI. MI patients were older (74 years compared to 69, p < 0.0001), had greater comorbidity, a similar length of stay (11.1 days), and a lower number of coded diagnostic procedures. Associated pathologies were different. Seasonal variation is clear. CONCLUSION: The incidence of discharges for heart failure is high and steadily increasing, although this is more evident in IM. The populations attended by the two services are different, which makes it difficult to ascertain differences in handling. The results are slightly different from those reported in other countries.

Analysis of 27, 248 hospital discharges for heart failure: a study of an administrative database 1998-2002

Objetivos. Conocer la epidemiología de lahospitalización por insuficiencia cardiaca (IC) enlos hospitales de Andalucía (España). Definir elperfil de los pacientes asistidos en MedicinaInterna (MI).Métodos y resultados. Análisis del ConjuntoMínimo Básico de Datos (CMBD) de los 32hospitales públicos de Andalucía (España) durante1998-2002, identificando los casos con diagnósticoprincipal o secundario de IC analizando edad, sexo,estancia, estacionalidad, destino, número dediagnósticos, GDR, procedimientos codificados. Seprodujeron 2.787.008 altas, 27.248 de ICC,(15.737 MI, 7.735 Cardiología y 3.776 otrosservicios). Las altas por IC crecieron desde 1998 a2003 (r2 = 0,7232). El 44% fueron hombres conedad media de 70,98 años (IC 95% 70,08-70,47) yel 56% mujeres con 74,77 (IC 95% 74,61-74,93)(p<0,0001). La tasa de mortalidad intrahospitalariaglobal fue del 11,1% y encontramos diferenciasentre Cardiología y MI. Los pacientes queingresaron en MI tenían mayor edad (74 años frentea 69, p<0,0001), mayor comorbilidad, estanciamedia similar (11,1 días) y menor número deprocedimientos diagnósticos codificados. Lapatología asociada fue diferente. La estacionalidades evidente.Conclusión. La incidencia de IC es elevada yaumenta progresivamente, aunque más en MI.Las poblaciones de uno y otro servicio sondiferentes, por lo que es difícil asegurar diferenciasde manejo. Los resultados difieren ligeramente delos comunicados en otros países

Aims. To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM).Methods and results. Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures.There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r2 = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001).The global in-hospital mortality rate was 11.1% andwe found differences between Cardiology and MI.MI patients were older (74 years compared to 69,p < 0.0001), had greater comorbidity, a similarlength of stay (11.1 days), and a lower number ofcoded diagnostic procedures. Associated pathologieswere different. Seasonal variation is clear.Conclusion. The incidence of discharges for heartfailure is high and steadily increasing, although thisis more evident in IM. The populations attended bythe two services are different, which makes itdifficult to ascertain differences in handling. Theresults are slightly different from those reported inother countries

[Internal Medicine hospital departments of Andalucian Public Health System. A description of the clinical activity in 2002]. / Servicios hospitalarios de Medicina Interna. Una descripción de la actividad en el Sistema Público de Andalucía en 2002.

BACKGROUND: Description of the patients admitted in the general Internal Medicine (IM) departments of the Public Health System in Andalusia (Spain) (PHSA) during 2002. PATIENTS AND METHODS: It is an analysis of the Minimum Basic Set of Data (MBSD) and its management by the Diagnostic Related Groups (DRG) of admission episodes in Andalusian public hospitals. We divided the hospitals into group 1: more than 600 beds; group 2: between 200 and 600 beds, and group 3: less than 200 beds. RESULTS: IM services discharged 80,514 patients (total in PHSA, 558,114); 25.9%, 29.6% and 44.5% from groups 1, 2 y 3, respectively; 87.4% were admitted from the emergency room. Gross mortality rate was 10.23%. Average age was 72 years, 8 years more than in the other medical departments. Mean diagnosis per episode was 5.4. The most frequent pathologies (33%) were chronic obstructive pulmonary disease, congestive heart failure, brain stroke and coronary heart disease. Adjusted length of stay was 9.35 days, this being somewhat longer in big hospitals. Mean weight of the episodes (DRG weight) of IM services was 20% higher than the mean of the rest and it accumulates 18.02% of the total weight. Real hours of outpatient clinics was 5.45% of the total. CONCLUSIONS: The activity of the general IM services is very high in relative and absolute terms. Higher age and the multiple pathologies are typical characteristics of IM patients in Andalusia. Author claim it is very important to be careful with the clinical and administrative records. Interventions on prevalent diseases in IM services may produce positive and valuable results due to their high volume.

Servicios hospitalarios de Medicina Interna. Una descripción de la actividad en el Sistema Público de Andalucía en 2002 / Internal Medicine hospital departments of Andalucian Public Health System. A description of the clinical activity in 2002

Fundamento. Estudio descriptivo de la patología de los servicios y/o Unidades de Medicina Interna (SSMI) del Sistema Sanitario Público de Andalucía (SSPA) en el año 2002. Material y método. Análisis del Conjunto Mínimo Básico de Datos (CMBD) y su agrupación en Grupos Relacionados por el Diagnóstico (GRD) de los episodios de ingreso en los hospitales públicos andaluces. Grupo 1: > 600 camas; grupo 2: 200 a 400, y grupo 3: < 200. Año 2002. Resultados. Los SSMI dieron 80.514 altas (total, 558.114); 25,9%, 29,6% y 44,5% de los grupos 1, 2 y 3, respectivamente. El 87,4% ingresó desde urgencias. La tasa de mortalidad bruta fue del 10,23%. La mediana de la edad 72 años, superior en más de 8 años al resto de los servicios del área médica. La media de diagnósticos por episodio fue de 5,4. Las patologías más frecuentes: EPOC, insuficiencia cardíaca, ictus cerebral y cardiopatía isquémica supusieron un tercio de los casos. La estancia media depurada fue de 9,35 días; algo mayor en los hospitales grandes. El peso medio de los episodios (peso GRD) fue un 20% superior al resto de servicios y acumula el 18,02% del peso total. Las horas de consulta externa acreditadas fueron un 5,45% del total. Discusión. La actividad desarrollada en los SSMI es, en términos relativos y absolutos, muy elevada. La edad superior y la pluripatología son características del perfil tipo de MI. Se considera altamente prioritario el rigor en la elaboración de los registros. Las intervenciones sobre patologías prevalentes en los SSMI pueden dar resultados positivos evidentes por su gran volumen

Background. Description of the patients admitted in the general Internal Medicine (IM) departments of the Public Health System in Andalusia (Spain) (PHSA) during 2002. Patients and methods. It is an analysis of the Minimum Basic Set of Data (MBSD) and its management by the Diagnostic Related Groups (DRG) of admission episodes in Andalusian public hospitals. We divided the hospitals into group 1: more than 600 beds; group 2: between 200 and 600 beds, and group 3: less than 200 beds. Results. IM services discharged 80,514 patients (total in PHSA, 558,114); 25.9%, 29.6% and 44.5% from groups 1, 2 y 3, respectively; 87.4% were admitted from the emergency room. Gross mortality rate was 10,23%. Average age was 72 years, 8 years more than in the other medical departments. Mean diagnosis per episode was 5.4. The most frequent pathologies (33%) were chronic obstructive pulmonary disease, congestive heart failure, brain stroke and coronary heart disease. Adjusted length of stay was 9.35 days, this being somewhat longer in big hospitals. Mean weight of the episodes (DRG weight) of IM services was 20% higher than the mean of the rest and it accumulates 18.02% of the total weight. Real hours of outpatient clinics was 5.45% of the total. Conclusions. The activity of the general IM services is very high in relative and absolute terms. Higher age and the multiple pathologies are typical characteristics of IM patients in Andalusia. Author claim it is very important to be careful with the clinical and administrative records. Interventions on prevalent diseases in IM services may produce positive and valuable results due to their high volume

Coste de la hospitalización por EPOC en Andalucía, 1998-2002 / Hospitalization costs for chronic obstructive pulmonary disease in Andalusia, Spain: 1998 through 2002

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[A superior vena cava syndrome secondary to a pleural fibrous mesothelioma]. / Síndrome de cava superior secundario a mesotelioma fibroso pleural.

Benign fibrous or pleural mesothelioma are rare tumors that seem to originate in the mesenchyma (subpleural fibromas). They are usually discovered by chance and the prognosis for the patient is favorable after surgery. If the tumors are large, extrapulmonary signs may be present (hypertrophic osteoarthropathy, hypoglycemia). We describe a case of unusually large fibrous mesothelioma of the pleura that presented as superior vena cava syndrome, a complication not described in the literature.

[Double primary pulmonary neoplasms: epidermoid and oat cell pulmonary carcinoma with metachronous presentation]. / Doble neoplasia pulmonary primitiva: carcinoma epidermoide y oat-cell pulmonar de presentación metacrónica.

The finding of a double primitive pulmonary neoplasm in the same patient is a fact rarely published, between 0.5 and 3.5% depending on the series, most of them surgical or necropsies series. We present the case of a patient who after being diagnosed of bronchial epidermoid carcinoma and treated with radiotherapy, developed, one year later, a relapsing homolateral pleural effusion due to an oat-cell type carcinoma. We review the incidence of this association in the scientific literature, outlining the difficulty to establish the diagnosis in patients non treated with radical surgery.