Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia.

BACKGROUND AND AIMS: Cholesterol treatment for the primary prevention of cardiovascular disease is based on cardiovascular risk, as assessed by the SCORE (Systematic COronary Risk Evaluation) scale. This study aimed to assess the predictive value and clinical utility of the SCORE scale for preventing cardiovascular events and all-cause mortality in people with dyslipidemia and no lipid-lowering treatment. METHODS: Patients with dyslipidemia and no lipid-lowering treatment were included from the ESCARVAL-RISK cohort. Cardiovascular risk was calculated by means of the SCORE scale. All deaths and cardiovascular events were recorded for up to five years of follow-up. We calculated sensitivity, specificity and other predictive values for different cut-off points and assessed the effect of different risk factors on the diagnostic accuracy of the SCORE charts. RESULTS: In the final cohort of 18,853 patients, there were 1565 cardiovascular events and 268 deaths. The risk value recommended to initiate pharmacological treatment (5%) presented a specificity of 86% for death and 90% for cardiovascular events, and a sensitivity of 53% for death and 32% for cardiovascular events. In addition, the scale classified as low risk 62.8% of the patients who suffered a cardiovascular event and 46.6% of those who died. Antithrombotic treatment, diabetes, hypertension, heart failure, peripheral artery disease and chronic kidney disease were associated with a reduction in the predictive capability of the SCORE scale, whereas metabolic syndrome was related to better risk prediction. CONCLUSIONS: The predictive capability of the SCORE scale for cardiovascular disease and total mortality in patients with dyslipidemia is limited.

Prevalencia del síndrome de burnout en profesionales de medicina y enfermería de Atención Primaria en centros de salud acreditados para Formación Sanitaria Especializada de dos áreas de salud de Alicante / Prevalence of burnout syndrome in Primary Care medicine and nursing professionals in accredited health centres for specialized training in two Alicante health areas

Objetivo: estimar la prevalencia del síndrome de burnout en profesionales de medicina y enfermería de los centros de salud acreditados para formación sanitaria especializada de las Áreas de Salud de Elda y Alicante-San Juan. Diseño: estudio descriptivo observacional transversal. Emplazamiento: estudio multicéntrico realizado en equipos de Atención Primaria de dos áreas de salud de la Comunidad Valenciana. Participantes: profesionales de enfermería y medicina de Atención Primaria de las Áreas de Salud participantes.Mediciones principales: prevalencia de burnout a través del cuestionario validado Maslach Burnout Inventory y variables sociodemográficas y laborales. Análisis descriptivo de las variables cualitativas mediante cálculo de frecuencias y comparación de proporciones (test chi-cuadrado) para el análisis de la asociación entre las mismas. Resultados: se analizaron 125 cuestionarios (porcentaje de respuesta 54%). La prevalencia de burnout fue alta en la población estudiada: el 56,8% mostró agotamiento emocional (siendo la dimensión más afectada); 39,2%, alto grado de despersonalización, y 36%, realización personal baja. La afectación de dos subescalas (burnout moderado-grave) fue mayor en los profesionales de medicina de forma estadísticamente significativa (p = 0,002). No se objetivó asociación estadísticamente significativa entre el burnout y las variables sociodemográficas y laborales. Conclusiones: la prevalencia de burnout es elevada en los profesionales de medicina y enfermería de Atención Primaria.(AU)

Objective: to estimate the prevalence of burnout syndrome in physicians and nurses of accredited health centres for Specialized Health Training in Elda and Alicante-San Juan Health Areas. Design: Descriptive observational cross-sectional study. Location: a multicentre study performed by Primary Care professionals of two Health Departments in the Valencian Community. Participants: primary care healthcare professionals (physicians and nurses) from the Health Departments taking part. Main measurements: prevalence of burnout using the validated Maslach Burnout Inventory questionnaire and socio-demographic and work-related variables. A descriptive analysis of the qualitative variables was performed by calculating frequencies and comparison of proportions (Chi-square test) to analyze the association between them. Results: a total of 125 questionnaires were analyzed (response rate 54%). The prevalence of burnout was high: 56.8%, 39.2% and 36.0% revealed a high degree of emotional exhaustion (the most affected dimension), depersonalization and low personal fulfilment, respectively. The involvement of two subscales (moderate-severe burnout) was statistically significantly higher in medical professionals (P=0.002). No statistically significant association was observed between burnout and sociodemographic and work-related variables. Conclusions: the prevalence of burnout is high in primary care medical and nursing professionals.(AU)