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Álvarez-Guisasola F, Quesada JA, López-Pineda A, García RN, Carratalá-Munuera C, Gil-Guillén VF, Orozco-Beltrán D. Multicausal analysis of mortality due to diabetes mellitus in Spain, 2016-2018. Prim Care Diabetes 2024; 18:138-145. [PMID: 38326176 DOI: 10.1016/j.pcd.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES This study aimed to assess multicausal mortality due to diabetes from 2016-2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered cause on the death certificate. MATERIALS AND METHODS A cross-sectional descriptive study taking a multicausal approach. RESULTS Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases. CONCLUSIONS In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.
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Affiliation(s)
| | - José A Quesada
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Rauf Nouni García
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain; Institute of Health and Biomedical Research of Alicante, Alicante General University Hospital, Diagnostic Center, Fifth floor. Calle Pintor Baeza 12, 03110 Alicante, Spain.
| | - Concepción Carratalá-Munuera
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain; Institute of Health and Biomedical Research of Alicante, Alicante General University Hospital, Diagnostic Center, Fifth floor. Calle Pintor Baeza 12, 03110 Alicante, Spain; Primary care research center, Miguel Hernández University, Elche, 03002 Alicante, Spain
| | - Domingo Orozco-Beltrán
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
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Lopez-Pineda A, Cordero A, Nouni-García R, Quesada JA, Castellano-Vazquez JM, Orozco-Beltrán D, Nolasco A, Carratalá-Munuera C, Gil Guillén VF. Design and validation of a new questionnaire with a gender perspective to measure medication adherence for secondary prevention of ischaemic heart disease: study protocol. BMJ Open 2024; 14:e077982. [PMID: 38553079 PMCID: PMC10982786 DOI: 10.1136/bmjopen-2023-077982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Only about 50% of chronic patients in high-income countries adhere to their treatment. There are methods to measure medication adherence but none of them can be considered optimal. This study will aim to design and validate a questionnaire to measure medication adherence in patients with ischaemic heart disease using a direct method as a gold-standard adherence measure and taking into account the gender perspective. Moreover, the profile of low adherence in these patients will be determined. METHODS AND ANALYSIS First study phase consists on the questionnaire design following the next steps: identification of the dimensions, definition of the target population, questionnaire items and order, response coding, questionnaire instructions, content validity by experts and understandability. In the second phase, a cross-sectional study will be performed to end the questionnaire development and validate it. Four hundred and forty patients (50% female) with acute coronary syndrome receiving treatment within the previous 12 months will be included. Patient will answer the initial questionnaire and adherence to aspirin and statin will be measured using a direct method (drug concentration analysis in blood) and other questionnaires. From the set of preselected questionnaire items, those most closely associated with the gold standard measure will be selected using multivariate statistics. ETHICS AND DISSEMINATION All participants gave their written informed consent before participating in the study. The study protocol follows the recommendations of the Declaration of Helsinki and was approved by the ethics committees of the three participating centres. The results of this study will be displayed at national and international conferences and in peer-reviewed scientific journals.
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Affiliation(s)
- Adriana Lopez-Pineda
- Department of Clinical Medicine, University of Miguel Hernandez Elche, Sant Joan d'Alacant, Comunidad Valenciana, Spain
- Research Network on Chronicity Primary Care and Prevention and Health Promotion, Barcelona, Spain
- Primary Care Research Center, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Alberto Cordero
- Biomedical Network Research Center for Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology, Hospital San Juan de Alicante, San Juan de Alicante, Spain
| | - Rauf Nouni-García
- Department of Clinical Medicine, University of Miguel Hernandez Elche, Sant Joan d'Alacant, Comunidad Valenciana, Spain
- Research Network on Chronicity Primary Care and Prevention and Health Promotion, Barcelona, Spain
| | - Jose A Quesada
- Department of Clinical Medicine, University of Miguel Hernandez Elche, Sant Joan d'Alacant, Comunidad Valenciana, Spain
- Research Network on Chronicity Primary Care and Prevention and Health Promotion, Barcelona, Spain
- Primary Care Research Center, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Jose Maria Castellano-Vazquez
- Comprehensive Center for Cardiovascular Diseases, Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, University of Miguel Hernandez Elche, Sant Joan d'Alacant, Comunidad Valenciana, Spain
- Research Network on Chronicity Primary Care and Prevention and Health Promotion, Barcelona, Spain
- Primary Care Research Center, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Andreu Nolasco
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicant, San Vicente del Raspeig, Alicante, Spain
| | - Concepción Carratalá-Munuera
- Department of Clinical Medicine, University of Miguel Hernandez Elche, Sant Joan d'Alacant, Comunidad Valenciana, Spain
- Research Network on Chronicity Primary Care and Prevention and Health Promotion, Barcelona, Spain
- Primary Care Research Center, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Vicente F Gil Guillén
- Department of Clinical Medicine, University of Miguel Hernandez Elche, Sant Joan d'Alacant, Comunidad Valenciana, Spain
- Research Network on Chronicity Primary Care and Prevention and Health Promotion, Barcelona, Spain
- Primary Care Research Center, Miguel Hernandez University, San Juan de Alicante, Spain
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Quesada JA, López-Pineda A, Orozco-Beltrán D, Carratalá-Munuera C, Barber-Vallés X, Gil-Guillén VF, Nouni-García R, Carbonell-Soliva Á. Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach. Prim Care Diabetes 2024:S1751-9918(24)00064-0. [PMID: 38514366 DOI: 10.1016/j.pcd.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic. METHODS This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included RESULTS: The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0-54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65-74 years (RR=71.01) was associated with a significantly higher risk of premature mortality. CONCLUSIONS Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.
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Affiliation(s)
- José A Quesada
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Domingo Orozco-Beltrán
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Concepción Carratalá-Munuera
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Xavier Barber-Vallés
- Center for Operations Research, University Miguel Hernández of Elche, Elche, Alicante, Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain; Primary care research center, Miguel Hernández University, Elche, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante. Diagnostic Center, Fifth floor. Pintor Baeza street, 12, Alicante 03110, Spain
| | - Rauf Nouni-García
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain; Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante. Diagnostic Center, Fifth floor. Pintor Baeza street, 12, Alicante 03110, Spain.
| | - Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain
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Sánchez Molla M, Candela García I, Orozco-Beltrán D, Gil-Guillén VF, Carratalá-Munuera C, García RN. [Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. Aten Primaria 2024; 56:102814. [PMID: 38029654 PMCID: PMC10716497 DOI: 10.1016/j.aprim.2023.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.
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Affiliation(s)
- Manuel Sánchez Molla
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Medicina Familiar y Comunitaria, Cap El Raval Elx-Centro, Elche, Alicante, España
| | - Inmaculada Candela García
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España
| | - Domingo Orozco-Beltrán
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Vicente F Gil-Guillén
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Salud e Investigación Biomédica de Alicante, Hospital General Universitario de Alicante, Centro de Diagnóstico, Alicante, España
| | - Concepción Carratalá-Munuera
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Salud e Investigación Biomédica de Alicante, Hospital General Universitario de Alicante, Centro de Diagnóstico, Alicante, España.
| | - Rauf Nouni García
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Instituto de Salud e Investigación Biomédica de Alicante, Hospital General Universitario de Alicante, Centro de Diagnóstico, Alicante, España
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Carbonell-Soliva Á, Nouni-García R, López-Pineda A, Cordero-Fort A, Pérez-Jover V, Quesada JA, Orozco-Beltrán D, Nolasco A, Castellano-Vázquez JM, Mira-Solves JJ, Gil-Guillen VF, Carratala-Munuera C. Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups. BMC Prim Care 2024; 25:59. [PMID: 38365594 PMCID: PMC10870481 DOI: 10.1186/s12875-024-02286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence. METHODS An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified. RESULTS Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. CONCLUSIONS Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.
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Affiliation(s)
- Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
| | - Rauf Nouni-García
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- Institute of Health and Biomedical research of Alicante, Alicante Spain General University Hospital of Alicante, Diagnostic center, Fifth floor. Pintor Baeza street, 12, Alicante, 03110, Spain
| | - Adriana López-Pineda
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain.
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain.
- Foundation for the Promotion of Health and Biomedical Research of the Valencian, Community. N-332, 03550 San Juan de Alicante, Alicante, Spain.
| | - Alberto Cordero-Fort
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
- Biomedical Network Research Center for Cardiovascular Diseases (CIBERCV), Madrid, 28029, Spain
| | - Virtudes Pérez-Jover
- Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Jose A Quesada
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
| | - Domingo Orozco-Beltrán
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, 03550, Spain
| | - Andreu Nolasco
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Jose Maria Castellano-Vázquez
- Comprehensive Center for Cardiovascular Diseases, Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain
| | | | - Vicente F Gil-Guillen
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- Institute of Health and Biomedical research of Alicante, Alicante Spain General University Hospital of Alicante, Diagnostic center, Fifth floor. Pintor Baeza street, 12, Alicante, 03110, Spain
- General University Hospital of Elda, Alicante, 03600, Spain
| | - Concepción Carratala-Munuera
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
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Sanz-Garcia FJ, Quesada JA, Carratala-Munuera C, Orozco-Beltrán D, Gil-Guillén VF, Prieto-Castello MJ, Marhuenda-Amorós D, Micó Pérez RM, Navarro Cremades F, Cordero A, Bertomeu-Gonzalez V, Arrarte V. [Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]. Med Clin (Barc) 2024; 162:112-117. [PMID: 37925274 DOI: 10.1016/j.medcli.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. METHODS Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. RESULTS In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. CONCLUSIONS The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.
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Affiliation(s)
- Francisco J Sanz-Garcia
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Centro de Salud Muro de Alcoy, Muro d'Alcoi, Alicante, España
| | - José A Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | | | - Domingo Orozco-Beltrán
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Vicente F Gil-Guillén
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - María J Prieto-Castello
- Departamento de Patología y Cirugía, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Dolores Marhuenda-Amorós
- Departamento de Patología y Cirugía, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Rafael M Micó Pérez
- Cátedra de cronicidad SEMERGEN-UMH, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Felipe Navarro Cremades
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Cátedra de cronicidad SEMERGEN-UMH, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Alberto Cordero
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Servicio de Cardiología, Hospital Universitario de San Juan, Sant Joan d'Alacant, Alicante, España
| | - Vicente Bertomeu-Gonzalez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Servicio de Cardiología, Hospital Clínica Benidorm, Benidorm, Alicante, España.
| | - Vicente Arrarte
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Servicio de Cardiología, Hospital General de Alicante Dr. Balmis, Alicante, España
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7
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Orozco-Beltrán D, Pineda AL, Quesada JA, Artime E, Díaz-Cerezo S, Redondo-Antón J, Santos MRD, Spaepen E, Munuera MCC. Barriers and solutions for the management of severe hypoglycaemia in people with diabetes in Spain: A Delphi survey. Prim Care Diabetes 2024; 18:65-73. [PMID: 38044201 DOI: 10.1016/j.pcd.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Severe hypoglycaemia (SH) imposes a significant burden for people with diabetes (PwD), their caregivers (CGs), and the healthcare system. The study aimed to identify barriers and solutions in the management of SH in PwD in Spain, gathering consensus from physicians and nurses. MATERIAL AND METHODS Expert opinion from physicians and nurses who manage PwD was collected via a 2-round online Delphi method. Consensus was predefined as ≥ 70% of the panellists agreeing or disagreeing with the statement. RESULTS Physicians (n = 25) and nurses (n = 17) reached ≥ 90% consensus on the following barriers for the management of SH: absence of symptoms, cost to the health system, lack of implementation of glucose monitoring devices, lack of patient training to identify and manage SH, and the fear of SH in children and CGs. Main solutions, identified with ≥ 70% consensus, included training, education, and psychological support using diabetes nurse educators and the use of new glucose monitoring technologies and applications. CONCLUSIONS This study provides valuable insights on the barriers and solutions in the management of SH in Spain. Structured self-management training, the support of diabetes educators, and the use of insulin delivery devices and glucose monitoring technologies is required for the management of SH.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Universidad Miguel Hernández, Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Adriana López Pineda
- Universidad Miguel Hernández, Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - José Antonio Quesada
- Universidad Miguel Hernández, Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
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Pérez A, Redondo-Antón J, Romera I, Lizán L, Rubio-de Santos M, Díaz-Cerezo S, Orozco-Beltrán D. Disease and Economic Burden of Poor Metabolic and Weight Control in Type 2 Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2024; 15:325-341. [PMID: 37989829 PMCID: PMC10838877 DOI: 10.1007/s13300-023-01503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Poor metabolic control and excess body weight are frequently present in people with type 2 diabetes (PwT2D). METHODS A systematic literature review was conducted to identify observational studies reporting clinical, economic, and health-related quality of life (HRQoL) outcomes associated with poor metabolic (according to HbA1c, blood pressure [BP] and low density lipoprotein cholesterol [LDL-C] levels) and/or weight control (defined by a body mass index [BMI] ≥ 30 kg/m2) in adults with T2D in Spain, including articles published in either Spanish or English between 2013 and 2022 and conference abstracts from the last 2 years. RESULTS Nine observational studies were included in the analysis. Poor glycemic control (HbA1c ≥ 7%) was associated with cardiovascular disease (CVD), increased requirements for antidiabetic medications, higher and more frequent weight gain, a greater probability of hypoglycemia and dyslipidemia, and worse health-related quality of life (HRQoL). Uncontrolled BP in PwT2D was related with the presence of CVD, worse metabolic control, and higher BMI and abdominal perimeter values. Poor LDL-C control or dyslipidemia was associated with CVD, hypoglycemia, and elevated HbA1c and triglycerides levels. The presence of a BMI ≥ 30 kg/m2 was related to CVD and hypoglycemia, a higher prevalence of metabolic syndrome and worse BP control. Direct medical costs were found to be higher in PwT2D when coexisting with HbA1c levels ≥ 7%, uncontrolled BP or obesity. Increased total costs, including productivity losses, were also detected in those who presented uncontrolled BP and a BMI ≥ 30 kg/m2, and when poor weight control existed together with HbA1c ≥ 8% and poorly controlled BP. CONCLUSION Gathered evidence supports the high clinical, economic and HRQoL burden of poor metabolic and/or weight control in PwT2D in Spain and reinforces the importance of prioritizing its control to reduce the associated burden, at both the individual and healthcare system levels.
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Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | | | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Luís Lizán
- Outcomes'10, S.L., Castellón de la Plana, Spain
- Departamento de Medicina, Universidad Jaume I, Castellón de la Plana, Spain
| | | | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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9
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Cebrián-Cuenca AM, Moreno-Pérez O, Campuzano-Ruiz R, Soler MJ, García de Lucas MD, Orozco-Beltrán D. Multidisciplinary Panel Consensus for the Management of Patients with Type 2 Diabetes: A Delphi Study. Arch Med Res 2024; 55:102923. [PMID: 38141271 DOI: 10.1016/j.arcmed.2023.102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/29/2023] [Accepted: 11/16/2023] [Indexed: 12/25/2023]
Abstract
AIM To reach a multidisciplinary consensus on managing patients with type 2 diabetes among specialists in family medicine, cardiology, endocrinology, internal medicine, and nephrology. METHODS A two-round Delphi study was conducted using a questionnaire with 68 positive/negative statements distributed in four thematic blocks on diabetes management: early diagnosis and prediabetes, referral criteria, treatment and comorbidities, and clinical management. The expert panel was composed of 105 physicians from different specialties (family medicine, cardiology, endocrinology, internal medicine, and nephrology) with experience in managing patients with diabetes and who were members of a diabetes-related society. RESULTS Response rates for the first and second rounds were 86.7 and 75.2%, respectively. After both rounds, a consensus was reached on 52 (76.5%) items. The recommendations with the highest degree of consensus (median = 10, IQR = 0.00) were related to anti-smoking education, cardiovascular risk factor target control, and diabetic kidney disease. There were significant differences between family physicians and other specialties for some items. CONCLUSIONS This study provides a set of recommendations for diabetes management agreed upon by specialists from different healthcare settings.
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Affiliation(s)
- Ana M Cebrián-Cuenca
- Family Medicine Health Center of Cartagena Casco, Primary Care Research Group, Biomedical Research Institute of Murcia, Cartagena, Spain
| | - Oscar Moreno-Pérez
- Endocrinology Department, Dr. Balmis General University Hospital - Alicante Institute of Health and Biomedical Research, Alicante, Spain; Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain.
| | | | - Maria Jose Soler
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | - Domingo Orozco-Beltrán
- Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain; Family Medicine Health Center of Cabo Huertas, Alicante, Spain
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10
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Nouni-García R, Carbonell-Soliva Á, Orozco-Beltrán D, López-Pineda A, Tomás-Rodríguez MI, Gil-Guillén VF, Quesada JA, Carratalá-Munuera C. Association of Visiting the Physiotherapist with Mortality in the Spanish General Population: A Population-Based Cohort Study. Medicina (Kaunas) 2023; 59:2187. [PMID: 38138290 PMCID: PMC10744916 DOI: 10.3390/medicina59122187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The purpose of this retrospective population-based cohort study was to analyse the association between attendance of physiotherapy with mortality in the Spanish general population and describe the profile of people who do not visit a physiotherapist in Spain. Material and Methods: The data sources were the 2011/2012 National Health Survey (ENSE11) and the national database of death in Spain, and the participants were all adult respondents in the ENSE11. Results: Of 20,397 people, 1101 (5.4%) visited the physiotherapist the previous year, and the cumulative incidence of total mortality was 5.4% (n = 1107) at a mean follow-up of 6.2 years. Visiting the physiotherapist was associated with lower all-cause mortality in the population residing in Spain, quantified at 30.1% [RR = 0.699; 95% CI (0.528-0.927); p = 0.013]. The factors associated with not visiting a physiotherapist were the following: rating one's health as good (9.8%; n = 1017; p < 0.001), not having any hospital admission in the previous year (9.6%; n = 1788; p < 0.001), not having visited the general practitioner in the previous month (9.6%; n = 1408; p < 0.001), and not having attended a day hospital in the previous year (9.7%; n = 1836; p < 0.001). Conclusions: Visiting a physiotherapist was associated with a lower mortality from all causes in the population living in Spain.
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Affiliation(s)
- Rauf Nouni-García
- Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante, Diagnostic Center, Fifth Floor, Pintor Baeza Street, 12, 03110 Alicante, Spain; (R.N.-G.); (V.F.G.-G.)
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| | - Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), University Hospital of San Juan de Alicante, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain
| | - Domingo Orozco-Beltrán
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), University Hospital of San Juan de Alicante, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain
| | - Adriana López-Pineda
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), University Hospital of San Juan de Alicante, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain
| | - María Isabel Tomás-Rodríguez
- Pathology and Surgery Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 Alicante, Spain;
| | - Vicente F. Gil-Guillén
- Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante, Diagnostic Center, Fifth Floor, Pintor Baeza Street, 12, 03110 Alicante, Spain; (R.N.-G.); (V.F.G.-G.)
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| | - José A. Quesada
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| | - Concepción Carratalá-Munuera
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
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Orozco-Beltrán D, Alvarez-Guisasola F, López-Simarro F, Miranda-Fernández-Santos C, Pérez Pérez A. Opinion of primary care physicians on the use of continuous glucose monitoring in type 2 diabetes. ENDOCRINOL DIAB NUTR 2023; 70:656-658. [PMID: 38000968 DOI: 10.1016/j.endien.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Domingo Orozco-Beltrán
- Medicina de Familia, Universidad Miguel Hernández de Elche. Departamento de Medicina Clínica, Centro de Salud Cabo Huertas, Alicante, Spain.
| | - Fernando Alvarez-Guisasola
- Medicina de Familia, Sociedad Española de Medicina de Familia y Comunitaria (SEMFYC), Centro de Salud Ribera de Órbigo, Benavides de Órbigo, León, Spain
| | - Flora López-Simarro
- Medicina de Familia, Barcelona, Spain; Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, Spain
| | | | - Antonio Pérez Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, CIBERDEM, Barcelona, Spain.
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12
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Forcano-Queralt E, Lemes-Quintana C, Orozco-Beltrán D. Ambulatory management of low-risk febrile neutropenia in adult oncological patients. Systematic review. Support Care Cancer 2023; 31:665. [PMID: 37921996 PMCID: PMC10624743 DOI: 10.1007/s00520-023-08065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/22/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Recent clinical practice guidelines have recommended ambulatory management of febrile neutropenia in patients with low risk of complications. Although some centers have begun developing management protocols for these patients, there appears to be a certain reluctance to implement them in clinical practice. Our aim is to evaluate the strengths and weaknesses of this strategy according to available evidence and to propose new lines of research. METHODS Systematic review using a triple aim approach (efficacy, cost-effectiveness, and quality of life), drawing from literature in MEDLINE (PubMed), Embase, and Cochrane Library databases. The review includes studies that assess ambulatory management for efficacy, cost-efficiency, and quality of life. RESULTS The search yielded 27 articles that met our inclusion criteria. CONCLUSION In conclusion, based on current evidence, ambulatory management of febrile neutropenia is safe, more cost-effective than inpatient care, and capable of improving quality of life in oncological patients with this complication. Ambulatory care seems to be an effective alternative to hospitalization in these patients.
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Affiliation(s)
- Ester Forcano-Queralt
- Gran Canaria Island Maternal-Infant University Hospital Complex, 35016, Las Palmas de Gran Canaria, Spain
| | - Cristina Lemes-Quintana
- Gran Canaria Island Maternal-Infant University Hospital Complex, 35016, Las Palmas de Gran Canaria, Spain
| | - Domingo Orozco-Beltrán
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, 03550, San Juan de Alicante, Spain.
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Martínez-Perez P, Orozco-Beltrán D, Pomares-Gómez F, Gil-Guillén VF, Quesada JA, López-Pineda A, Nouni-García R, Carratalá-Munuera C. [Factors associated with dissatisfaction with pharmacological treatment in patients with type 2 diabetes mellitus: A cross-sectional study]. J Healthc Qual Res 2023; 38:120-127. [PMID: 35933321 DOI: 10.1016/j.jhqr.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/31/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Diabetes is a chronic disease with a high impact on both health and Quality of Life Related to Health (QLRH). To evaluate the satisfaction of treatment in patients with type 2 diabetes mellitus through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and its relationship with sociodemographic variables, with antidiabetic medication and clinical-analytical variables. MATERIALS AND METHODS This cross-sectional study was conducted in General University Hospital of San Juan de Alicante between September 2016 and December 2017. Two hundred thirty-two patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, treated with antidiabetic medication were included. The Spanish version of the DTSQ scale was used to measure satisfaction with treatment. Factors associated with low satisfaction were analyzed by applying the Chi-square test for qualitative variables and Student-T for quantitative variables. To estimate magnitudes of association, logistic models were adjusted. RESULTS Two hundred thirty-two patients were included in this study. 21.5% of the patients presented low satisfaction with the treatment. Patients who presented low satisfaction with treatment were associated with medications that could cause hypoglycemia (OR: 2.872 [1.195-6.903]), HbA1c levels higher than 7% (OR: 2.260 [1.005-5.083]) and drugs administered by the route oral (OR: 2.749 [1.233-6.131]). CONCLUSIONS Patients with type 2 diabetes mellitus who had a lower score on the DTSQ questionnaire were associated with medications that produced hypoglycaemia, and with higher levels of HbA1c higher than 7%, and those who took oral medication.
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Affiliation(s)
- P Martínez-Perez
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - D Orozco-Beltrán
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - F Pomares-Gómez
- Servicio de Endocrinología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, España
| | - V F Gil-Guillén
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - J A Quesada
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - A López-Pineda
- Fisabio, Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, Valencia, España
| | - R Nouni-García
- Fisabio, Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, Valencia, España
| | - C Carratalá-Munuera
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
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Quesada JA, Carratalá-Munuera C, Carbonell-Soliva A, Segura-Aparicio JC, González-Fernández J, Salazar-Sánchez L, Gil-Guillén VF, López-Pineda A, Nouni-García R, Orozco-Beltrán D. Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020. Postgrad Med 2023; 135:128-140. [PMID: 36227619 DOI: 10.1080/00325481.2022.2135865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020. METHODS We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. RESULTS We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. CONCLUSIONS Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.
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Affiliation(s)
- Jose A Quesada
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Concepción Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Alvaro Carbonell-Soliva
- Fisabio: Foundation for the Promotion of Health and Biomedical Research in the Valencian Community. San Juan de Alicante, Alicante
| | - Jean Carlo Segura-Aparicio
- Medical Integration Section. Faculty of Medicine, University of Costa Rica. Rodrigo Facio University City, San José, Costa Rica
| | | | - Lizbeth Salazar-Sánchez
- Faculty of Medicine, University of Costa Rica. Rodrigo Facio University City, San José, Costa Rica
| | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).,Fisabio: Foundation for the Promotion of Health and Biomedical Research in the Valencian Community. San Juan de Alicante, Alicante.,Isabial: Institute of Sanitary and Biomedical Research of Alicante, San José, Costa Rica
| | - Adriana López-Pineda
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).,Fisabio: Foundation for the Promotion of Health and Biomedical Research in the Valencian Community. San Juan de Alicante, Alicante
| | - Rauf Nouni-García
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).,Isabial: Institute of Sanitary and Biomedical Research of Alicante, San José, Costa Rica
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
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Orozco-Beltrán D, Lecumberri-Pascual E, Quesada JA, Moreno-Pérez O, Ruiz-Quintero MA, Pomares-Gómez FJ, Jodar-Gimeno E, Pardo-Ruiz C, Mascarell-Martinez I, Mirete-López RM, Morant-Bes B, Borrachero-Guijarro JM, Zapatero-Larrauri M, Aparicio-Egea MC, Paniagua-Merchán C, Requena-Ferrer RM, Caride-Miana E, Fernández-Giménez A, López-Pineda A, Nouni-García R, Carratalá-Munuera C, Cebrián-Cuenca AM. Psychometric properties of the Clarke questionnaire for hypoglycemia awareness in the Spanish population with type 2 diabetes. Postgrad Med 2023; 135:141-148. [PMID: 36475508 DOI: 10.1080/00325481.2022.2138469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Clarke questionnaire, validated in Spanish language, assesses hypoglycemia awareness in patients with type 1 diabetes. This study aimed to analyze its psychometric properties in patients with type 2 diabetes (T2DM). METHODS This was a questionnaire validation study. Patients with T2DM and treated with insulin, sulfonylureas or glinides were consecutively recruited from six endocrinology consultations and six primary care centers. The internal structure of the 8-item Clarke questionnaire was analyzed by exploratory (training sample) and confirmatory (testing sample) factor analysis; the internal consistency using Omega's McDonald coefficient; and goodness of fit with comparative fit index (CFI, cutoff >0.9), Goodness of Fit Index (GFI, cutoff >0.9), and root mean-square error of approximation (RMSEA, cutoff <0.09), as well as unidimensionality indicators. RESULTS The 265 participants (56.8% men) had a mean age of 67.8 years. Confirmatory factor analysis for one dimension obtained poor indicators: fit test (p < 0.001); CFI = 0.748; RMSEA = 0.122 and SRMR = 0.134. Exploratory factor analysis showed 2 or 3 dimensions with poor adjustment indicators. Omega's McDonald was 0.739. CONCLUSIONS The Spanish version of the Clarke questionnaire was not valid or reliable for assessing hypoglycemia awareness in people with T2DM in Spanish population.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
| | | | - Jose A Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - Oscar Moreno-Pérez
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-FISABIO), Alicante, Spain
| | | | - Francisco J Pomares-Gómez
- Sección de Endocrinología y Nutrición, Hospital Universitario de San Juan de Alicante, Alicante, Spain
| | - Esteban Jodar-Gimeno
- Departamento de Endocrinología y Nutrición Clínica, Hospital Universitario Quirón Salud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Carlos Pardo-Ruiz
- Sección de Endocrinología y Nutrición, Hospital Virgen de los Lirios, Alcoi, Alicante, Spain
| | | | - Rosa M Mirete-López
- Sección de Endocrinología y Nutrición, Hospital Universitario de San Juan de Alicante, Alicante, Spain
| | - Borja Morant-Bes
- Sección de Endocrinología y Nutrición, Hospital Universitario de San Juan de Alicante, Alicante, Spain
| | | | - Miriam Zapatero-Larrauri
- Departamento de Endocrinología y Nutrición Clínica, Hospital Universitario Quirón Salud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | - Antonio Fernández-Giménez
- Instituto de Investigación INCLIVA, Hospital Clínico Universitario de Valencia. Universidad de Valencia, Valencia, Spain
| | - Adriana López-Pineda
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - Rauf Nouni-García
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
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Fuentes-Merlos Á, Quesada-Rico JA, Reina R, Orozco-Beltrán D. Healthcare use among people with diabetes mellitus in Europe: a population-based cross-sectional study. Fam Med Community Health 2022; 10:fmch-2022-001700. [PMID: 36357008 PMCID: PMC9660559 DOI: 10.1136/fmch-2022-001700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to determine the association of health determinants, lifestyle and socioeconomic variables on healthcare use in people with diabetes in Europe. DESIGN A cross-sectional study was conducted using data from the European Health Interview Survey wave 2 (ie, secondary analysis). SETTING The sample included data from 25 European countries. PARTICIPANTS The sample included 16 270 patients with diabetes aged 15 years or older (49.1% men and 50.9% women). RESULTS The survey data showed that 58.2% of respondents had seen their primary care physician in the past month and 22.6% had been admitted to the hospital in the past year. Use of primary care was associated with being retired (prevalence ratio (PR) 1.13, 95% CI 1.07 to 1.19) and having very poor self-perceived health (PR 1.80, 95% CI 1.51 to 2.15), long-standing health problems (PR 1.14, 95% CI 1.04 to 1.24), high blood pressure (PR 1.06, 95% CI 1.03 to 1.10) and chronic back pain (PR 1.07, 95% CI 1.04 to 1.11). Hospital admission was associated with very poor self-perceived health (PR 3.03, 95% CI 2.14 to 4.31), accidents at home (PR 1.54, 95% CI 1.40 to 1.69), chronic obstructive pulmonary disease (COPD) (PR 1.34, 95% CI 1.22 to 1.47), high blood pressure (PR 1.08, 95% CI 1.01 to 1.17), chronic back pain (PR 0.91, 95% CI 0.84 to 0.98), moderate difficulty walking (PR 1.33, 95% CI 1.21 to 1.45) and severe difficulty walking (PR 1.67, 95% CI 1.51 to 1.85). CONCLUSIONS In the European diabetic population, the high cumulative incidences of primary care visits and hospital admissions are associated with labour status, alcohol consumption, self-perceived health, long-standing health problems, high blood pressure, chronic back pain, accidents at home, COPD and difficulty walking.
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Affiliation(s)
- Álvaro Fuentes-Merlos
- Faculty of Medicine, Miguel Hernandez University of Elche, Sant Joan D'Alacant, Spain
| | | | - Raul Reina
- Department of Sports Sciences, Sport Research Centre, Miguel Hernandez University of Elche, Elche, Spain
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Orozco-Beltrán D, Brotons Cuixart C, Banegas Banegas JR, Gil Guillén VF, Cebrián Cuenca AM, Martín Rioboó E, Jordá Baldó A, Vicuña J, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. Aten Primaria 2022; 54 Suppl 1:102444. [PMID: 36435583 PMCID: PMC9705225 DOI: 10.1016/j.aprim.2022.102444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Medicina Familiar y Comunitaria, Unidad de Investigación Centro de Salud Cabo Huertas, Departamento San Juan de Alicante. Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - Carlos Brotons Cuixart
- Medicina Familiar y Comunitaria. Instituto de Investigación Biomédica (IIB) Sant Pau. Equipo de Atención Primaria Sardenya, Barcelona, España
| | - Jose R Banegas Banegas
- Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Vicente F Gil Guillén
- Medicina Familiar y Comunitaria, Hospital Universitario de Elda. Departamento de Medicina Clínica. Universidad Miguel Hernández, San Juan de Alicante, España
| | - Ana M Cebrián Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco Antiguo, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, España
| | - Enrique Martín Rioboó
- Medicina Familiar y Comunitaria, Especialista en Medicina Familiar y Comunitaria, Centro de Salud Poniente, Córdoba, IMIBIC Hospital Reina Sofía Córdoba. Colaborador del grupo PAPPS
| | - Ariana Jordá Baldó
- Medicina Familiar y Comunitaria, Centro de Salud San Miguel, Plasencia, Badajoz, España
| | - Johanna Vicuña
- Medicina Preventiva y Salud Pública, Hospital de la Sant Creu i Sant Pau, Barcelona, España
| | - Jorge Navarro Pérez
- Medicina Familiar y Comunitaria, Hospital Clínico Universitario. Departamento de Medicina. Universidad de Valencia. Instituto de Investigación INCLIVA, Valencia, España
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Lázaro-Sánchez AD, Juárez Marroquí A, Quesada Rico JA, Orozco-Beltrán D. Risk Factors for Cancer Mortality in Spain: Population-Based Cohort Study. Int J Environ Res Public Health 2022; 19:9852. [PMID: 36011484 PMCID: PMC9408698 DOI: 10.3390/ijerph19169852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cancer is considered a major public health problem due to its increasing incidence and high mortality. This study aims to identify risk factors for cancer mortality in Spain. METHODS Retrospective population-based cohort study in 20,397 participants of the 2011/2012 National Health Survey in Spain. Risk factors associated with mortality due to neoplasm from 2011 to 2017 were analyzed, and hazard ratios were calculated with a multivariate Cox model with competing risks for mortality from other causes. RESULTS Myocardial infarction, chronic obstructive pulmonary disease, cirrhosis, and mental disorders were associated with an increased risk of mortality due to neoplasm. Male sex, age over 50 years, history or current smoking habit, negligible intake of legumes, and poorer self-perceived health were also associated with increased cancer mortality. CONCLUSIONS Comorbidities, tobacco use, poor diet, and worse self-perceived health were the main risk factors for cancer mortality in Spain.
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Affiliation(s)
- Antonio D. Lázaro-Sánchez
- Medical Oncology Service, University Hospital of Sant Joan d’Alacant, 03550 Sant Joan d’Alacant, Spain
| | - Asunción Juárez Marroquí
- Medical Oncology Service, University Hospital of Sant Joan d’Alacant, 03550 Sant Joan d’Alacant, Spain
| | - Jose Antonio Quesada Rico
- Department of Clinical Medicine, University Miguel Hernández de Elche, Ctra. Nnal. 332, s/n, 03202 Elche, Spain
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, University Miguel Hernández de Elche, Ctra. Nnal. 332, s/n, 03202 Elche, Spain
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Orozco-Beltrán D, Morales C, Artola-Menéndez S, Brotons C, Carrascosa S, González C, Baro Ó, Aliaga A, Ferreira de Campos K, Villarejo M, Hurtado C, Álvarez-Ortega C, Gómez-García A, Cedenilla M, Fernández G. Effects of a digital patient empowerment and communication tool on metabolic control in people with type 2 diabetes: DeMpower Study (Preprint). JMIR Diabetes 2022; 7:e40377. [PMID: 36190763 PMCID: PMC9577714 DOI: 10.2196/40377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/21/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A1c (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)–related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease. Objective This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM. Methods The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app–empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c≤7.5% with a ≥0.5% reduction in HbA1c at week 24. Results Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app–empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c≤7.5% (64% vs 24%; P=.02) or HbA1c≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (−0.81, SD 0.89 vs −0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed. Conclusions The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.
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Affiliation(s)
| | - Cristóbal Morales
- Department of Endocrinology, Hospital Universitario Virgen Macarena, Seville, Spain
- Department of Endocrinology, Hospital Vithas, Seville, Spain
| | | | - Carlos Brotons
- Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | | | - Cintia González
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Centro de Investigacion Biomèdica En Red- Biotecnologia Biomedicina Nanotecnologia, Barcelona, Spain
| | - Óscar Baro
- Galapagar Primary Care Center, RedGDPs Foundation, Madrid, Spain
| | - Alberto Aliaga
- Department of Endocrinology, Clínica New Technologies in Diabetes and Endocrinology, Seville, Spain
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20
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Nouni-García R, Lara-López Á, Carratalá-Munuera C, Gil-Guillén VF, López-Pineda A, Orozco-Beltrán D, Quesada JA. Factors Associated with Colorectal Cancer Screening in Spain: Results of the 2017 National Health Survey. Int J Environ Res Public Health 2022; 19:5460. [PMID: 35564855 PMCID: PMC9100170 DOI: 10.3390/ijerph19095460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022]
Abstract
This study aimed to determine the CRC screening coverage of people aged between 50 and 69 years who were living in Spain in 2017 and describe the factors associated with not having had a faecal occult blood test (FOBT). A cross-sectional study was performed using data from the Spanish National Health Survey 2017. We analysed 7568 individuals between the ages of 50 and 69 years. The proportion of respondents between 50 and 69 years old who had had an FOBT was 29.0% (n = 2191). The three autonomous communities with the lowest proportion of respondents who had had an FOBT were Extremadura (8.7%, n = 16), Ceuta-Melilla (10.4%, n = 3), and Andalucia (14.1%, n = 186). The variables associated with not having had an FOBT were being 50-54 years old (PR = 1.09; 95% CI 1.04-1.14), having been born outside of Spain (PR = 1.11; 95% CI 1.06-1.16), not having been vaccinated against the flu (PR = 1.09; 95% CI 1.04-1.15), never having had a colonoscopy (PR = 1.49; 95% CI 1.40-1.59), not having had an ultrasound scan in the last year (PR = 1.09; 95% CI 1.04-1.14), and not having seen a primary care physician in the last month (PR = 1.08; 95% CI 1.04-1.12). The factors associated with not getting an FOBT were young age, having been born outside of Spain, not having been vaccinated against the flu in the last campaign, and not making frequent use of healthcare services.
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Affiliation(s)
- Rauf Nouni-García
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Ángela Lara-López
- San Juan de Alicante Campus, Faculty of Medicine, Miguel Hernández University, 03202 San Juan de Alicante, Spain;
| | - Concepción Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Vicente F. Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Adriana López-Pineda
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Jose A. Quesada
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
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21
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Orozco-Beltrán D, Merino-Torres JF, Pérez A, Cebrián-Cuenca AM, Párraga-Martínez I, Ávila-Lachica L, Rojo-Martínez G, Pomares-Gómez FJ, Álvarez-Guisasola F, Sánchez-Molla M, Gutiérrez F, Ortega FJ, Mata-Cases M, Carretero-Anibarro E, Vilaseca JM, Quesada JA. Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care—APHOSDIAB—COVID-19 Multicenter Study. J Clin Med 2022; 11:jcm11082092. [PMID: 35456185 PMCID: PMC9025638 DOI: 10.3390/jcm11082092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47–3.15), fever (OR 4.31, 95% CI 2.87–6.47), cough (OR 1.89, 95% CI 1.28–2.80), asthenia/malaise (OR 2.04, 95% CI 1.38–3.03), dyspnea (4.69, 95% CI 3.00–7.33), confusion (OR 8.87, 95% CI 1.68–46.78), and a history of hypertension (OR 1.61, 95% CI 1.08–2.41) or immunosuppression (OR 4.97, 95% CI 1.45–17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80–1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Health Center Cabo Huertas, Consejeria de Sanidad Univesal y Salud Pública, 03540 Alicante, Spain;
- Spanish Diabetes Society, 28002 Madrid, Spain;
- Clinical Medice Department, University Miguel Hernández, 03550 Alicante, Spain; (F.G.); (J.A.Q.)
| | - Juan Francisco Merino-Torres
- Endocrinology and Nutrition Service, University of Valencia, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
| | - Antonio Pérez
- Spanish Diabetes Society, 28002 Madrid, Spain;
- Medicine Department, Autonoums University of Barcelona, 08193 Barcelona, Spain
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), 20029 Madrid, Spain
- Hospital Santa Creu i Sant Pau, Servicio Catalán de Salud, 08041 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-556-56-61
| | - Ana M. Cebrián-Cuenca
- Primary Care and Prediabetes Group of the Spanish Diabetes Society, 30201 Cartagena, Spain;
- Health Center Cartagena Casco, Servicio Murciano de Salud, 30201 Cartagena, Spain
- Primary Care Research Group, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Ignacio Párraga-Martínez
- Spanish Society of Family and Community Medicine (semFyC), 28004 Madrid, Spain; (I.P.-M.); (F.Á.-G.)
- Health Center Zone VIII, Servicio de Salud Castilla la Mancha, 02006 Albacete, Spain
| | - Luis Ávila-Lachica
- Secretario GAPP-SED, Grupo DM-semFyC, 28004 Madrid, Spain;
- Consultorio de Almáchar, UGC Vélez Norte, 29718 Malaga, Spain
| | - Gemma Rojo-Martínez
- Spanish Diabetes Society, 28002 Madrid, Spain;
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), 20029 Madrid, Spain
- Biomedical Research Institute (IBIMA), Endocrinology and Nutrition Clinical Management Unit, Malaga Regional University Hospital, 29010 Malaga, Spain
| | - Francisco J. Pomares-Gómez
- Diabetes Mellitus Plan of the Valencian Community, University Hospital San Juan de Alicante, 03550 Alicante, Spain;
| | - Fernando Álvarez-Guisasola
- Spanish Society of Family and Community Medicine (semFyC), 28004 Madrid, Spain; (I.P.-M.); (F.Á.-G.)
- Health Center Ribera de Órbigo, Consejería de Salud Castilla León, 24280 León, Spain
| | | | - Felix Gutiérrez
- Clinical Medice Department, University Miguel Hernández, 03550 Alicante, Spain; (F.G.); (J.A.Q.)
- Internal Medicine, Elche General University Hospital, 03203 Elche, Spain
- CIBER Infectious Diseases, 28029 Madrid, Spain
| | - Francisco J. Ortega
- Health Center Campos-Lampreana, Conserjería de Salud Castilla y León, 49137 Zamora, Spain;
| | - Manel Mata-Cases
- Primary Care Center La Mina, Sant Adrià de Besòs, Servicio Catalán de Salud, 08930 Barcelona, Spain;
- Group DAP-Cat, Research Support Unit, Jordi Gol University Institute for Primary Healthcare Research, CIBERDEM, 08036 Barcelona, Spain
| | | | | | - Jose A. Quesada
- Clinical Medice Department, University Miguel Hernández, 03550 Alicante, Spain; (F.G.); (J.A.Q.)
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Carrasco-Sánchez FJ, Carretero-Anibarro E, Gargallo MÁ, Gómez-Huelgas R, Merino-Torres JF, Orozco-Beltrán D, Pines Corrales PJ, Ruiz Quintero MA. Executive Summary from Expert consensus on effectiveness and safety of iDPP-4 in the treatment of patients with diabetes and COVID-19. ENDOCRINOL DIAB NUTR 2022; 69:209-218. [PMID: 35353681 PMCID: PMC8853860 DOI: 10.1016/j.endien.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND This consensus aims to clarify the role of Dipeptidyl Peptidase-4 inhibitors (iDPP-4) in managing patients with diabetes during the COVID-19 pandemic. MATERIALS AND METHODS A PubMed bibliographic search was carried out (December 2019-February 2021). Oxford methodology was used for the evaluation of evidence and possible recommendations were established by consensus. RESULTS Diabetes appears to be an independent factor in COVID-19 disease (evidence 2b). No increased risk of contagion with iDPP-4 is demonstrated (evidence 2b), and its use has been shown to be safe (evidence 2b). The use of this drug may present a specific benefit in reducing mortality, particularly in in-hospital use (evidence 2a), reducing admission to intensive care units (evidence 2b) and the need for mechanical ventilation (evidence 2b). CONCLUSIONS The use of iDPP-4 appears to be safe in patients with COVID-19, and quality studies are needed to clarify their possible advantages further.
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Affiliation(s)
- Francisco Javier Carrasco-Sánchez
- Unidad Cardiometabólica, Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain; Representante de la Sociedad Española de Medicina Interna
| | - Enrique Carretero-Anibarro
- Médico de Familia, Centro de Salud José Gallego Arroba, Puente Genil, Córdoba, Spain; Representante de la Fundación redGDPS
| | - Manuel Ángel Gargallo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Fundación Jiménez Díaz, Madrid, Spain; Representante de la Sociedad Española de Endocrinología y Nutrición
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain; Representante de la Sociedad Española de Medicina Interna; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn)
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Universidad de Valencia, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Representante de la Sociedad Española de Diabetes
| | - Domingo Orozco-Beltrán
- Universidad Miguel Hernández, Departamento de Medicina Clínica, Unidad de Investigación, San Juan de Alicante, Alicante, Spain; Representante de la Sociedad Española de Diabetes
| | - Pedro José Pines Corrales
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Representante de la Sociedad Española de Endocrinología y Nutrición.
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Carrasco-Sánchez FJ, Carretero-Anibarro E, Gargallo MÁ, Gómez-Huelgas R, Merino-Torres JF, Orozco-Beltrán D, Pines Corrales PJ, Ruiz Quintero MA. Resumen Ejecutivo del Consenso de expertos sobre la eficacia y seguridad de los iDPP-4 en el tratamiento de pacientes con diabetes y COVID-19. ENDOCRINOL DIAB NUTR 2022; 69:209-218. [PMID: 34778721 PMCID: PMC8570981 DOI: 10.1016/j.endinu.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 01/30/2023]
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Valdivieso MG, Orozco-Beltrán D, López-Pineda A, Gil-Guillén VF, Quesada JA, Carratalá-Munuera C, Nouni-García R. Early Detection of Atrial Fibrillation in Community Pharmacies-CRIFAFARMA Study. J Cardiovasc Pharmacol Ther 2022; 27:10742484221078973. [PMID: 35200057 DOI: 10.1177/10742484221078973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia to appear in clinical practice. People with AF have 5 times the risk of stroke compared to the general population. OBJECTIVE This study aimed to determine the prevalence of AF in people over the age of 50 without known AF, who presented to a community pharmacy to check their cardiovascular risk factors, to identify risk factors associated with AF, and to assess the risk of stroke in people who screened positive for AF. METHODS A multicenter observational descriptive study of a screening program took place from May to December 2016. A blood pressure monitor (Microlife Watch BP Home) was used to screen for AF, and the CHA2DS2-VASc questionnaire was used to assess stroke risk. RESULTS The study included 452 adults over the age of 50. The CRIFAFARMA study detected a prevalence of AF of 9.1%. Risk factors for AF were: age of 75 years or older (P = .024), lack of physical activity (P = .043), diabetes (P < .001), dyslipidemia (P = .003), and history of cardiovascular disease (P = .003). Diabetes (OR 2.79, P = .005) and dyslipidemia (OR 2.16, P = .031) had a combined explanatory capacity in the multivariable logistic regression model adjusted for age. 85% were at high risk of stroke according to the CHA2DS2-VASc scale. CONCLUSIONS AF was detected in more than 9% of the included population. Factors associated with AF were advanced age, lack of physical activity, diabetes, dyslipidemia, and history of cardiovascular disease, with diabetes and dyslipidemia standing out as the factors with independent explanatory capacity.
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Affiliation(s)
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
| | - Adriana López-Pineda
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
| | | | - José A Quesada
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
| | | | - Rauf Nouni-García
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
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Cebrián-Cuenca AM, Mata-Cases M, Franch-Nadal J, Mauricio D, Orozco-Beltrán D, Consuegra-Sánchez L. Half of patients with type 2 diabetes mellitus are at very high cardiovascular risk according to the ESC/EASD: data from a large Mediterranean population. Eur J Prev Cardiol 2022; 28:e32-e34. [PMID: 33733654 DOI: 10.1093/eurjpc/zwaa073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Ana M Cebrián-Cuenca
- Primary Health Care Center Cartagena Casco, Cartagena, Servicio Murciano de Salud. Calle Maestro Francés, 1. 30201 Cartagena, Murcia, Spain
| | - Manel Mata-Cases
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut. Plaça Maria Angels Rosell Simplicio, 1. 08930 Sant Adrià de Besòs, Barcelona, Spain.,DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina. Carrer Sardenya 375 Entresol. 08025 Barcelona, Spain.,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029 Madrid, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina. Carrer Sardenya 375 Entresol. 08025 Barcelona, Spain.,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029 Madrid, Spain.,Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut. Avinguda de les Drassanes, 17-21. 08001 Barcelona, Spain
| | - Dídac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina. Carrer Sardenya 375 Entresol. 08025 Barcelona, Spain.,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029 Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau. Carrer de Sant Quintí, 89. 08041 Barcelona, Spain
| | - Domingo Orozco-Beltrán
- Clinical Medicine Department, Miguel Hernandez University. N-332, km 87 s/n. 03550 San Juan de Alicante, Alicante, Spain
| | - Luciano Consuegra-Sánchez
- Cardiology Department, Hospital Universitario Santa Lucía, Cartagena, Servicio Murciano de Salud, Calle Minarete, s/n. 30202 Cartagena, Murcia, Spain
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Múgica-Jauregui L, Orozco-Beltrán D, López-Pineda A, Gil-Guillén VF, Cheikh-Moussa K, Nouni-García R, Carratalá-Munuera C, Quesada JA. [Analysis of two health attendance models for the non-hospital emergencies in Gipuzkoa: Retrospective study]. J Healthc Qual Res 2021; 37:247-253. [PMID: 34972679 DOI: 10.1016/j.jhqr.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Out-of-hospital medical emergency services are defined as a functional organization that performs a set of sequential human and material activities. The objective of this study was to compare the mortality of patients attended by the out-of-hospital medical emergency services in 2 neighboring Spanish regions with different models of healthcare transport assistance for emergency care. MATERIAL AND METHOD Retrospective observational cohort study, done between June 1, 2007 and December 31, 2008 in 2 regions of Gipuzkoa, Alto Deba (AD) and Bajo Deba (BD). The study variables were age, sex and place of exposure (AD/BD), heart rate, blood pressure, initial reason for the call defined by the European Resuscitation Council, unconsciousness and digestive bleeding. 3452 subjects were analyzed. RESULTS The risk of in situ mortality in BD was 1.31 times higher than in AD (P=.050), that of hospital mortality in BD was 0.71 times lower than in AD (P=.011) and the risk of mortality at one year between counties and the combined mortality (in situ+hospital) did not contribute significant differences. CONCLUSIONS Mortality (in situ+in-hospital, and one year aftercare) of patients treated by the out-of-hospital emergency medical services in AD (non-medicalized healthcare transport model) was similar to that of the BD region (mixed healthcare transport model).
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Affiliation(s)
| | - D Orozco-Beltrán
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - A López-Pineda
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - V F Gil-Guillén
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - K Cheikh-Moussa
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - R Nouni-García
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - C Carratalá-Munuera
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - J A Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
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27
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Salvador-Marín J, Ferrández-Martínez FJ, Lawton CD, Orozco-Beltrán D, Martínez-López JF, Kelly BT, Marzo-Campos JC. Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients. Sci Rep 2021; 11:24082. [PMID: 34916570 PMCID: PMC8677748 DOI: 10.1038/s41598-021-03415-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48-0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.
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Affiliation(s)
- Jorge Salvador-Marín
- Orthopedic Surgery and Traumatology Service, Sant Joan d'Alacant University Hospital, Alicante, Spain
| | | | - Cort D Lawton
- Hospital for Special Surgery, Sports Medicine Institute, 535 East 70th Street, New York, NY, 10021, USA
| | | | | | - Bryan T Kelly
- Hospital for Special Surgery, Sports Medicine Institute, 535 East 70th Street, New York, NY, 10021, USA
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Cortijo LC, Quesada JA, Lopez-Pineda A, Orozco-Beltrán D, Gil-Guillen VF, Carratala-Munuera C. A Bibliometric Evaluation of Worldwide Research of the Podiatry Field from 1965 to 2017. J Am Podiatr Med Assoc 2021; 111. [PMID: 35061596 DOI: 10.7547/18-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To identify the strengths and weaknesses in a given research area, it is necessary to analyze the published literature. International studies on podiatry research productivity are scarce. This study aimed to analyze scientific productivity in the area of podiatric medicine from 1965 to 2017. METHODS This was a retrospective, observational, bibliometric study. The MEDLINE database was used to identify research published between 1965 and 2017. Literature searches were performed in 2010 and 2017 through RefWorks, and research production per year, author, document type, country, institution, journal, and language were calculated. Podiatry's contribution to global scientific production was measured by calculating the ratio of podiatry publications to total production, and Price's law was applied to analyze the temporal evolution. Author productivity index, coauthorship, geographic distribution, and the distribution by institution type and journal (Bradford's law) were analyzed. RESULTS The MEDLINE search yielded 1,256 publications, representing 4.75 articles per 100,000 publications in global scientific research. The growth rate followed Price's law after linear adjustment. The 2,229 identified authors presented a transience index of 85.73%; 0.38% were highly productive authors. The coauthorship index increased from 1.40 in 1965 to 5.80 in 2017. The most common document type was the journal article, whereas 2.1% were clinical trials. Only one document reported a controlled clinical trial. The United States led scientific production, with 77.15% of the documents; 60.5% of the publications were concentrated in four journals. CONCLUSIONS Podiatry is still an emerging research field, and literature is concentrated in a small number of journals, categorized into different subjects.
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Orozco-Beltrán D, Pomares-Gómez F, Ortega-Ruiz P, Molina Ribera J, Iranzo-García N. ["Working without patients": a new strategy to improve the glycemic control in patients with type 2 diabetes. Avoiding therapeutic inertia.]. Rev Esp Salud Publica 2021; 95:e202110133. [PMID: 34645780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Inertia has been described as one of the causes of persistent poor glycemic control. The aim of this study was to evaluate, after one year of implementation in a health area, the effect of an intervention to improve the degree of glycemic control of patients with type 2 diabetes (DM2). METHODS A pre-post intervention study was carried out in one health department during 2018. Health department with 222,767 inhabitants, 111 primary care physicians and 14,154 patients with DM2. Each primary care physician reviewed, outside consultation hours ("working without patients"), the electronic health record to identify patients with DM2 and with poor glycemic control, and they cited them for review. The glycemic control for the month of December 2017 and 2018 were compared, defined as the percentage of patients who reach the control objective of glycosylate hemoglobin (HbA1c). RESULTS The proportion of patients with good glycemic control was 44.8% in 2017 and 50.1% in 2018, being the department that obtained the greatest improvement in the indicator in 2018 in the Valencian Community. The proportion of primary care physicians that had at least half of their patients with good glycemic control increased from 39% to 51% after the intervention. CONCLUSIONS The strategy "working without patients" was associated with an improvement in the degree of glycemic control of patients with DM2.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Departamento de Medicina Clínica. Universidad Miguel Hernández. San Juan de Alicante. España
- Unidad de Investigación. Hospital Universitario de San Juan de Alicante. San Juan de Alicante. España
| | - Francisco Pomares-Gómez
- Endocrinología y Nutrición. Hospital Universitario de San Juan de Alicante. San Juan de Alicante. España
| | | | | | - Norma Iranzo-García
- Medicina Preventiva y Salud Pública. Escuela Nacional de Sanidad-Instituto de Salud Carlos III. Madrid. España
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30
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Fuentes-Merlos Á, Orozco-Beltrán D, Quesada Rico JA, Reina R. Quality-of-Life Determinants in People with Diabetes Mellitus in Europe. Int J Environ Res Public Health 2021; 18:ijerph18136929. [PMID: 34203455 PMCID: PMC8297329 DOI: 10.3390/ijerph18136929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023]
Abstract
This study aims to analyze self-perceived health and lifestyles in the European Union Member States Iceland, Norway, and the United Kingdom, examining associations with diabetes prevalence; and to identify the demographic, economic and health variables associated with diabetes in this population. We performed a cross-sectional study of 312,172 people aged 15 years and over (150,656 men and 161,516 women), using data collected from the European Health Interview Survey (EHIS). The EHIS includes questions on the health status and health determinants of the adult population, as well as health care use and accessibility. To estimate the magnitudes of the associations with diabetes prevalence, we fitted multivariate logistic models. The EHIS data revealed a prevalence of diabetes in Europe of 6.5% (n = 17,029). Diabetes was associated with being physically inactive (OR 1.14; 95% CI 1.02–1.28), obese (OR 2.75; 95% CI 2.60–2.90), male (OR 1.46; 95% CI 1.40–1.53) and 65–74 years old (OR 3.47; 95% CI 3.09–3.89); and having long-standing health problems (OR 7.39; 95% CI, 6.85–7.97). These results were consistent in the bivariate and multivariate analyses, with an area under the receiver operating characteristic curve of 0.87 (95% CI 0.87–0.88). In a large European health survey, diabetes was clearly associated with a poorer perceived quality of life, physical inactivity, obesity, and other comorbidities, as well as non-modifiable factors such as older age and male sex.
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Affiliation(s)
- Álvaro Fuentes-Merlos
- Department of Primary Health Care, San Juan de Alicante University Hospital, 03550 San Juan de Alicante, Spain;
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain;
| | - Jose A. Quesada Rico
- Department of Clinical Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain;
- Correspondence: ; Tel.: +34-965-919-449
| | - Raul Reina
- Department of Sport Sciences, Sport Research Centre, Miguel Hernández University, 03202 Elche, Spain;
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Gómez-García A, Ferreira de Campos K, Orozco-Beltrán D, Artola-Menéndez S, Grahit-Vidosa V, Fierro-Alario MJ, Alonso-Jerez JL, Villabrille-Arias MC, Zuazagoitia-Nubla JF, Ledesma-Rodríguez R, Fernández G. Impact of Advanced Diabetes Centers on the healthcare experience of patients with type 2 diabetes using the IEXPAC tool. ENDOCRINOL DIAB NUTR 2021; 68:416-427. [PMID: 34742475 DOI: 10.1016/j.endien.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/16/2020] [Indexed: 06/13/2023]
Abstract
AIMS To determine the experience with healthcare among patients with type 2 diabetes according to the assistance model provided in their primary care centers, and to determine factors related with their experience. METHODS This was a cross-sectional study performed in patients with type 2 diabetes with cardiovascular or renal complications. The patients were divided in two groups according to whether they had been attended in Advanced Diabetes centers (ADC) or the traditional assistance centers. Patient's healthcare experience was assessed with the "Instrument for Evaluation of the Experience of Chronic Patients" (IEXPAC) questionnaire, with possible scores ranging from 0 (worst experience) to 10 (best experience). RESULTS A total of 451 patients (215 from ADC and 236 from traditional assistance centers) were included. The mean overall IEXPAC scores were 5.9 ± 1.7 (ADC) and 6.0 ± 1.9 (traditional assistance centers; p = 0.82). In the multivariant analyses, in ADC, the regular follow-up by the same physician (p = 0.01) and follow-up by a nurse (p = 0.01), were associated with a better patient experience, whereas receiving a higher number of medications with a worse patient experience (p = 0.04). In the traditional assistance centers, only the regular follow-up by the same physician was associated with a better experience (p = 0.02). Patients from ADC centers reported a higher score in the quality of life scale (69.1 ± 16.5 vs 64.6 ± 17.5; p = 0.008). CONCLUSIONS In general, the healthcare experience of type 2 diabetic patients with their sanitary assistance can be improved. Patients from ADC centers report a higher score in the quality of life scale.
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Affiliation(s)
| | | | - Domingo Orozco-Beltrán
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Sara Artola-Menéndez
- Centro de Salud José Marvá, SED (Sociedad Española de Diabetes) - Grupo de Diabetes, Madrid, Spain
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Arriero-Marín JM, Orozco-Beltrán D, Carratalá-Munuera C, López-Pineda A, Gil-Guillen VF, Soler-Cataluña JJ, Chiner-Vives E, Nouni García R, Quesada JA. A modified Delphi consensus study to identify improvement proposals for COPD management amongst clinicians and administrators in Spain. Int J Clin Pract 2021; 75:e13934. [PMID: 33675283 DOI: 10.1111/ijcp.13934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS To identify the obstacles hindering the appropriate management of chronic obstructive pulmonary disease (COPD) in Spain based on consensus amongst clinicians and administrators. METHODS A two-round modified Delphi questionnaire was sent to clinicians (pulmonologists and GPs) and administrators, all experts in COPD. The scientific committee developed the statements and selected the participating experts. Four areas were explored: diagnosis, training, treatment, and clinical management. Panellists' agreement was assessed using a 9-point Likert scale, with scores of 1 to 3 indicating disagreement and 7 to 9, agreement. Consensus was considered to exist when 70% of the participants agreed or disagreed with the statement. RESULTS Respective response rates for the first and second round were 68% and 91% for clinicians, and 60% and 100% for administrators. The statements attracting the highest degree of consensus were: "Not enough nursing resources (time, staff, duties) are allocated for performing spirometry" (85.3% clinicians; 75% administrators); "Nurses need specific training in COPD" (84.8% clinicians; 100% administrators); "Rehabilitation programs are necessary for treating patients with COPD" (94.1% clinicians; 91.7% administrators); and "Integrated care processes facilitate the deployment of educational programs on COPD" (79.4% clinicians; 83.3% administrators). CONCLUSIONS This document can inform the development and implementation of specific initiatives addressing the existing obstacles in COPD management. WHAT'S KNOWN COPD is a prevalent and underdiagnosed disease that causes substantial morbidity and mortality. The National COPD Strategy established objectives and work programmes to apply in Spain. There are barriers impeding the application of interventions contemplated in the COPD strategy. WHAT'S NEW Different agents involved in COPD management agree that the main challenges to improve COPD management are resource shortages in primary care nursing and lack of training in the use of COPD clinical guidelines. Clinicians and administrators involved in COPD management support the implementation of urgent measures to tackle the underdiagnosis of COPD, especially in primary care, along with the routine inclusion of respiratory rehabilitation programmes for COPD.
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Affiliation(s)
- Juan Manuel Arriero-Marín
- Chair of COPD, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
- Pneumology Unit, San Juan de Alicante University Hospital, San Juan de Alicante, Spain
| | - Domingo Orozco-Beltrán
- Chair of COPD, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
- Research Unit, San Juan de Alicante University Hospital, San Juan de Alicante, Spain
| | | | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
| | - Vicente F Gil-Guillen
- Chair of COPD, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
- Research Unit, Elda University Hospital, Elda, Spain
| | - Juan José Soler-Cataluña
- Chair of COPD, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
- Pneumology Unit, Arnau de Vilanova Hospital, Valencia, Spain
| | - Eusebi Chiner-Vives
- Chair of COPD, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
- Pneumology Unit, San Juan de Alicante University Hospital, San Juan de Alicante, Spain
| | - Rauf Nouni García
- Clinical Medicine Department, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
| | - José A Quesada
- Clinical Medicine Department, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
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Orozco-Beltrán D, Artola-Menéndez S, Hormigo-Pozo A, Cararach-Salami D, Alonso-Jerez JL, Álvaro-Grande E, Villabrille-Arias C, de Toro-Santos FJ, Galindo-Puerto MJ, Marín-Jiménez I, Gómez-García A, Ledesma-Rodriguez R, Fernández G, Ferreira de Campos K. Healthcare experience among patients with type 2 diabetes: A cross-sectional survey using the IEXPAC tool. Endocrinol Diabetes Metab 2021; 4:e00220. [PMID: 33855220 PMCID: PMC8029499 DOI: 10.1002/edm2.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
Aim To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients’ demographic variables and healthcare‐related characteristics which may affect their experience. Methods A cross‐sectional survey was delivered to T2DM adults. Patient experiences were assessed with the ‘Instrument for Evaluation of the Experience of Chronic Patients’ (IEXPAC) questionnaire, a validated 12‐item survey, which describes patient experience within the last 6 months (items 1–11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self‐management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow‐up call or visit after discharge. Multivariate analyses identified that regular follow‐up by the same physician and follow‐up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow‐up after hospitalization, and a comprehensive multidisciplinary approach with regular follow‐up by the same physician and a nurse.
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Affiliation(s)
| | - Sara Artola-Menéndez
- José Marvá Heath Care Center SED (Spanish Diabetes Society) Diabetes Group Madrid Spain
| | | | | | | | | | | | | | - María José Galindo-Puerto
- Internal Medicine Department Clinic University Hospital Valencia Spain.,Research Department SEISIDA (Spanish AIDS Multidisciplinary Society Madrid Spain
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Orozco-Beltrán D, Guillen-Mollá A, Cebrián-Cuenca AM, Navarro-Pérez J, Gil-Guillén VF, Quesada JA, Pomares-Gómez FJ, Lopez-Pineda A, Carratalá-Munuera C. Hospital admissions trends for severe hypoglycemia in diabetes patients in Spain, 2005 to 2015. Diabetes Res Clin Pract 2021; 171:108565. [PMID: 33242511 DOI: 10.1016/j.diabres.2020.108565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
AIMS To analyze hospital admissions trends, inpatient mortality, and mean length of hospital stay due to hypoglycemia in patients with diabetes in Spain from 2005 to 2015. METHODS National Institute of Statistics provided information on hospital discharge and mortality. Hospital admissions due to severe hypoglycemia were identified using ICD-9 codes. Age-adjusted admission and mortality rates were stratified by sex and year. Joinpoint regression models were used to estimate trends. RESULTS Admissions rates per 100,000 population were higher for men than women in 2005 (30.2, 95%CI:29.3, 31.0 versus 21.5, 95%CI:20.9, 22.1) and 2015 (23.7, 95%CI:23.0, 24.4 versus 13.2, 95%CI:12.7, 13.6). Mortality per 100,000 population was also higher for men in both years (2005: 9.4, 95%CI:7.8, 11.0 versus 8.6, 95%CI:7.4, 9.8; 2015: 6.4, 95%CI:5.3, 7.6 versus 4.1, 95%CI:3.3, 4.8). Mortality dropped 5.2 percentage points annually (95%CI:-8.4, -1.9) in men and 7.0 percentage points annually (95%CI:-8.7, -5.2) in women from 2005 to 2015. Mean length of hospital stay changed only for women: 7.8 days (95%CI:7.5, 8.0) to 6.7 days (95%CI:6.4, 6.9). CONCLUSIONS Hospital admissions and inpatient mortality due to hypoglycemia in diabetes patients decreased from 2005 to 2015. This trend was more pronounced in women. Mean length of hospital stay decreased in women.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Alberto Guillen-Mollá
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | - Jorge Navarro-Pérez
- Biomedical Research Institute INCLIVA, University of Valencia Clinical Hospital, Valencia, Spain; CIBER, Epidemiology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain
| | - Vicente F Gil-Guillén
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Jose A Quesada
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | | | - Adriana Lopez-Pineda
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Concepción Carratalá-Munuera
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
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de Toro J, Cea-Calvo L, García-Vivar ML, Pantoja L, Lerín-Lozano C, García-Díaz S, Galindo MJ, Marín-Jiménez I, Fernández S, Mestre Y, Orozco-Beltrán D. The Experience With Health Care of Patients With Inflammatory Arthritis: A Cross-sectional Survey Using the Instrument to Evaluate the Experience of Patients With Chronic Diseases. J Clin Rheumatol 2021; 27:25-30. [PMID: 31356399 PMCID: PMC7748048 DOI: 10.1097/rhu.0000000000001155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care-related factors. METHODS Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care-related characteristics that may affect patients' experience. RESULTS A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave "always/mostly" answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. CONCLUSIONS This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care.
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Affiliation(s)
- Javier de Toro
- From the Rheumatology Department, Hospital Universitario A Coruña, Universidade da Coruña, INIBIC, A Coruña
| | | | | | | | | | - Silvia García-Díaz
- Rheumatology Department, Hospital Transversal Sant Joan Despí Moisès Broggi-General, Consorci Sanitari Integral, Barcelona
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Pallarés-Carratalá V, Quesada JA, Orozco-Beltrán D, Amigó-Grau N, Lopez-Pineda A, Fernández Giménez A, Gil-Guillén VF, Correig X, Masana L, Monleón D, Redón J, Pascual R, Carratalá-Munuera C. Analysis of LDL and HDL size and number by nuclear magnetic resonance in a healthy working population: The LipoLab Study. Int J Clin Pract 2021; 75:e13610. [PMID: 32648987 DOI: 10.1111/ijcp.13610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIM Atherosclerosis is the underlying process in cardiovascular disease (CVD), the first cause of death in developed countries. We aimed to identify people with no known CVD and normal values of LDL-C and HDL-C, but with alterations in the number and size of lipoprotein particles (as measured by nuclear magnetic resonance [NMR]) and to analyse their sociodemographic, clinical and biochemical characteristics. METHODS Cross-sectional study in occupational risks prevention centre in Castellón (Spain) in 2017 and 2018, in consecutively recruited adults (18-65 years) with no known CVD. Sociodemographic, clinical and biochemical variables were collected. Lipid profiles were analysed (Liposcale test), along with the concentration, size and number of the main types of lipoprotein particles, determined by 2D diffusion-ordered NMR spectroscopy. Using contingency tables, we analysed the characteristics of people with normal LDL and HDL cholesterol but abnormal levels of LDL and HDL particles. The magnitude of association between explanatory variables and abnormal levels of each kind of lipoprotein was assessed with multivariable logistic regression models. RESULTS Of the 400 total participants (31.3% women; age 46.4 ± 4.3 years), 169 had normal LDL and HDL cholesterol. Abnormal lipoprotein particle values depended on the subtype: prevalence of abnormal LDL levels ranged from 8.3% to 36.7%; and of HDL, from 28.4% to 42.6%. High systolic blood pressure and total cholesterol were significantly associated with abnormal LDL levels. Male sex and high systolic blood pressure were associated with abnormalities in HDL. CONCLUSIONS An extended lipids profile, obtained by NMR, enables the identification of people with normal HDL-C and LDL-C levels who present abnormal levels of LDL-P and/or HDL-P. Higher total cholesterol, systolic blood pressure, BMI and male sex were significantly associated with these abnormal values.
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Affiliation(s)
- Vicente Pallarés-Carratalá
- Health Surveillance Unit, Castellón Mutual Insurance Union, Castellon, Spain
- Department of Medicine, Jaume I University, Castellón, Spain
| | - Jose A Quesada
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Nuria Amigó-Grau
- Biosfer Teslab, Reus, SL, Spain
- CIBER of Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Adriana Lopez-Pineda
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
- Research Unit General University Hospital of Elda, Elda, Spain
| | - Xavier Correig
- CIBER of Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Metabolomics Platform, Universitat Rovira i Virgili, IISPV, Reus-Tarragona, Spain
| | - Lluis Masana
- CIBER of Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Unit of research in lipids and arteriosclerosis (URLA), Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Daniel Monleón
- Department of Pathology, Universidad de Valencia, Spain
- INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Josep Redón
- INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Reyes Pascual
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
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Orozco-Beltrán D, Navarro-Pérez J, Cebrián-Cuenca AM, Álvarez-Guisasola F, Caride-Miana E, Mora G, Quesada JA, López-Pineda A, Cardona-Llorens AF, Redón J, Gil-Guillen VF, Fernández A, Carratalá-Munuera C. The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study. Prim Care Diabetes 2020; 14:678-684. [PMID: 32605878 DOI: 10.1016/j.pcd.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/31/2022]
Abstract
AIM Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. METHODS Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008-2012. We included men and women aged≥70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted. RESULTS 5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables. CONCLUSION These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.
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Affiliation(s)
| | - Jorge Navarro-Pérez
- Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, University of Valencia, Valencia, Spain; Ciber of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| | | | | | | | | | - José A Quesada
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | | | - Josep Redón
- Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, University of Valencia, Valencia, Spain; Ciber of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| | - Vicente F Gil-Guillen
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | - Antonio Fernández
- Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, University of Valencia, Valencia, Spain; Ciber of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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Orozco-Beltrán D, Brotons Cuixart C, Alemán Sánchez JJ, Banegas Banegas JR, Cebrián-Cuenca AM, Gil Guillen VF, Martín Rioboó E, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2020 update]. Aten Primaria 2020; 52 Suppl 2:5-31. [PMID: 33388118 PMCID: PMC7801219 DOI: 10.1016/j.aprim.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022] Open
Abstract
The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: Epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; Cardiovascular (CV) risk tables and recommendations for the calculation of CV risk; Main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; Indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation. The quality of testing and the strength of the recommendation are included in the main recommendations.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Unidad de Investigación CS Cabo Huertas, Departamento San Juan de Alicante, Departamento de Medicina Clínica. Universidad Miguel Hernández, España.
| | | | | | | | | | | | - Enrique Martín Rioboó
- Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC Hospital Reina Sofía. Unidad de gestión clínica Poniente. Distrito sanitario Córdoba Guadalquivir, Córdoba, España
| | - Jorge Navarro Pérez
- Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Instituto de Investigación INCLIVA, Valencia, España
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Orozco-Beltrán D, de Toro J, Galindo MJ, Marín-Jiménez I, Casellas F, Fuster-RuizdeApodaca MJ, García-Vivar ML, Hormigo-Pozo A, Guilabert M, Sánchez-Vega N, Fernández G, Cea-Calvo L. Healthcare Experience and their Relationship with Demographic, Disease and Healthcare-Related Variables: A Cross-Sectional Survey of Patients with Chronic Diseases Using the IEXPAC Scale. Patient 2020; 12:307-317. [PMID: 30430456 PMCID: PMC6525115 DOI: 10.1007/s40271-018-0345-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. Objectives Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. Methods A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). Results Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. Conclusions Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality. Electronic supplementary material The online version of this article (10.1007/s40271-018-0345-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Ignacio Marín-Jiménez
- IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University, Madrid, Spain
| | - Francesc Casellas
- Crohn-Colitis Care Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernández University, Elche, Alicante, Spain
| | | | - Gonzalo Fernández
- Medical Affairs Department, Merck Sharp and Dohme Spain, Madrid, Spain
| | - Luis Cea-Calvo
- Medical Affairs Department, Merck Sharp and Dohme Spain, Madrid, Spain.
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Cea-Calvo L, Marín-Jiménez I, de Toro J, Fuster-RuizdeApodaca MJ, Fernández G, Sánchez-Vega N, Orozco-Beltrán D. Association between non-adherence behaviors, patients' experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions. Curr Med Res Opin 2020; 36:293-300. [PMID: 31580168 DOI: 10.1080/03007995.2019.1676539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients' experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions.Methods: Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients' experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models.Results: Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients (p < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores (p < .001 for all), and with a lower IEXPAC self-management score (p = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients (p < .001).Conclusions: Patients' beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease.
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Affiliation(s)
- Luis Cea-Calvo
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Ignacio Marín-Jiménez
- IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Gonzalo Fernández
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
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Cea-Calvo L, Marín-Jiménez I, de Toro J, Fuster-RuizdeApodaca MJ, Fernández G, Sánchez-Vega N, Orozco-Beltrán D. Different Associations of Intentional and Non-Intentional Non-Adherence Behaviors with Patient Experience with Healthcare and Patient Beliefs in Medications: A Survey of Patients with Chronic Conditions. Patient Prefer Adherence 2020; 14:2439-2450. [PMID: 33363360 PMCID: PMC7754618 DOI: 10.2147/ppa.s281985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications. PATIENTS AND METHODS This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire). RESULTS Among 1530 respondents, 53% showed ≥1 non-adherence behavior; 35% had ≥1 non-intentional non-adherence behavior, and 33% had ≥1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection. CONCLUSION The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence.
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Affiliation(s)
- Luis Cea-Calvo
- Medical Affairs Department, MSD Spain, Madrid, Spain
- Correspondence: Luis Cea-Calvo Medical Affairs Department, MSD Spain, Josefa Valcárcel 38, Madrid28027, SpainTel +34 913210740 Email
| | - Ignacio Marín-Jiménez
- IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | - María J Fuster-RuizdeApodaca
- SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Lázaro-Sánchez AD, Salces-Ortiz P, Velásquez LI, Orozco-Beltrán D, Díaz-Fernández N, Juárez-Marroquí A. HLA-G as a new tumor biomarker: detection of soluble isoforms of HLA-G in the serum and saliva of patients with colorectal cancer. Clin Transl Oncol 2019; 22:1166-1171. [PMID: 31748960 DOI: 10.1007/s12094-019-02244-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Recent medical investigations suggest that HLA-G, due to its tolerogenic properties, can be used as a biomarker in the diagnosis, treatment, and prognosis of different neoplasms. This observational prospective pilot study aims at detecting sHLA-G in the serum and saliva of patients diagnosed with colorectal cancer (CRC). For this purpose, we compared the expression of sHLA-G from patients with a control sample from a healthy population. MATERIALS AND METHODS Using the specific enzyme-linked immunosorbent assay (ELISA) method, the expression of sHLA-G in the serum and saliva samples from patients affected by CRC (n = 20) and in a control sample (n = 10) were analyzed. RESULTS The data showed that in patients with CRC, salivary sHLA-G values were significantly higher than in the control group (18.84 U/ml versus 6.3 U/ml, p = 0.036). In addition, higher levels of sHLA-G were observed in the saliva of patients with CRC in more advanced stages, compared with patients in early stages (24.2 U/ml vs. 8.1 U/ml, p = 0.019). A significant correlation was observed between the concentration of sHLA-G in the serum and saliva of the analyzed samples (Spearman correlation 0.7, p = 0.004). CONCLUSIONS This study demonstrates, for the first time, the possibility of detecting sHLA-G in the saliva of patients with CRC, resulting in a less invasive alternative to venipuncture. Likewise, we propose that sHLA-G could be an attractive molecular target based on its significant high levels in advanced stages.
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Affiliation(s)
- A D Lázaro-Sánchez
- Medical Oncology Service of the University Hospital of Sant Joan d'Alacant, Ctra. Nnal. 332, s/n, 03550, Alicante, Spain.
| | - P Salces-Ortiz
- Medical Oncology Service of the University Hospital of Sant Joan d'Alacant, Ctra. Nnal. 332, s/n, 03550, Alicante, Spain
| | - L I Velásquez
- Department of Clínical Medicine of the Miguel Hernández University of Elche, Alicante, Spain
| | - D Orozco-Beltrán
- Department of Clínical Medicine of the Miguel Hernández University of Elche, Alicante, Spain
| | - N Díaz-Fernández
- Medical Oncology Service of the University Hospital of Sant Joan d'Alacant, Ctra. Nnal. 332, s/n, 03550, Alicante, Spain
| | - A Juárez-Marroquí
- Medical Oncology Service of the University Hospital of Sant Joan d'Alacant, Ctra. Nnal. 332, s/n, 03550, Alicante, Spain
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Bertomeu-González V, Soriano Maldonado C, Bleda-Cano J, Carrascosa-Gonzalvo S, Navarro-Perez J, López-Pineda A, Carratalá-Munuera C, Gil Guillén VF, Quesada JA, Brotons C, Orozco-Beltrán D. Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia. Atherosclerosis 2019; 290:80-86. [DOI: 10.1016/j.atherosclerosis.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/15/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
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Redón J, Usó R, Trillo JL, López C, Morales-Olivas F, Navarro J, Sanchís J, Gil V, Orozco-Beltrán D. Number of drugs used in secondary cardiovascular prevention and late survival in the population of Valencia Community, Spain. Int J Cardiol 2019; 293:260-265. [DOI: 10.1016/j.ijcard.2019.05.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/06/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
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Quesada JA, Lopez-Pineda A, Gil-Guillén VF, Durazo-Arvizu R, Orozco-Beltrán D, López-Domenech A, Carratalá-Munuera C. Machine learning to predict cardiovascular risk. Int J Clin Pract 2019; 73:e13389. [PMID: 31264310 DOI: 10.1111/ijcp.13389] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022] Open
Abstract
AIMS To analyse the predictive capacity of 15 machine learning methods for estimating cardiovascular risk in a cohort and to compare them with other risk scales. METHODS We calculated cardiovascular risk by means of 15 machine-learning methods and using the SCORE and REGICOR scales and in 38 527 patients in the Spanish ESCARVAL RISK cohort, with 5-year follow-up. We considered patients to be at high risk when the risk of a cardiovascular event was over 5% (according to SCORE and machine learning methods) or over 10% (using REGICOR). The area under the receiver operating curve (AUC) and the C-index were calculated, as well as the diagnostic accuracy rate, error rate, sensitivity, specificity, positive and negative predictive values, positive likelihood ratio, and number needed to treat to prevent a harmful outcome. RESULTS The method with the greatest predictive capacity was quadratic discriminant analysis, with an AUC of 0.7086, followed by Naive Bayes and neural networks, with AUCs of 0.7084 and 0.7042, respectively. REGICOR and SCORE ranked 11th and 12th, respectively, in predictive capacity, with AUCs of 0.63. Seven machine learning methods showed a 7% higher predictive capacity (AUC) as well as higher sensitivity and specificity than the REGICOR and SCORE scales. CONCLUSIONS Ten of the 15 machine learning methods tested have a better predictive capacity for cardiovascular events and better classification indicators than the SCORE and REGICOR risk assessment scales commonly used in clinical practice in Spain. Machine learning methods should be considered in the development of future cardiovascular risk scales.
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Affiliation(s)
- Jose A Quesada
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Adriana Lopez-Pineda
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Ramón Durazo-Arvizu
- Public Health Department, Stritch School of Medicine, Universidad Loyola Chicago, Maywood, IL, USA
| | | | - Angela López-Domenech
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
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Álvarez-Guisasola F, Orozco-Beltrán D, Cebrián-Cuenca AM, Ruiz Quintero MA, Angullo Martínez E, Ávila Lachica L, Ortega Millán C, Caride Miana E, Navarro-Pérez J, Sagredo Perez J, Barrot de la Puente J, Cos Claramunt FX. [Management of hyperglycaemia with non-insulin drugs in adult patients with type 2 diabetes]. Aten Primaria 2019; 51:442-451. [PMID: 31320123 PMCID: PMC6836897 DOI: 10.1016/j.aprim.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Treatment of diabetes mellitus type2 (DM2) includes healthy eating and exercise (150minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used.
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Affiliation(s)
| | - Domingo Orozco-Beltrán
- Medicina Familiar y Comunitaria, Unidad Investigación, Centro de Salud Cabo Huertas, Dpto. San Juan de Alicante, Alicante, España
| | - Ana M Cebrián-Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco, Cartagena, Murcia, España.
| | | | | | - Luis Ávila Lachica
- Medicina Familiar y Comunitaria, UGC Vélez Norte, consultorio de Almáchar, Almáchar, Málaga, España
| | - Carlos Ortega Millán
- Medicina Familiar y Comunitaria, Centro de Salud de Pozoblanco, Pozoblanco, Córdoba, España
| | - Elena Caride Miana
- Medicina Familiar y Comunitaria, Centro de Salud Foietes, Benidorm, Alicante, España
| | - Jorge Navarro-Pérez
- Medicina Familiar y Comunitaria, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, CIBERESP, Valencia, España
| | - Julio Sagredo Perez
- Medicina Familiar y Comunitaria, Centro de Salud Parque Europa, Pinto, Madrid, España
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47
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Fuster-RuizdeApodaca MJ, Sánchez-Vega N, Galindo MJ, Marín-Jimenez I, de Toro J, Orozco-Beltrán D, Cotarelo M, López JC. The Influence of Patient Experience with Healthcare on the Health-Related Quality of Life of People Living with HIV: An Observational Cross-Sectional Survey. Infect Dis Ther 2019; 8:369-382. [PMID: 31290081 PMCID: PMC6702509 DOI: 10.1007/s40121-019-0252-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction Patient experience is central to the quality of healthcare delivery, showing positive associations with several outcome measures. The main objectives of this study are to analyze the influence of patient experience on the health-related quality of life in people living with HIV and the role played by treatment complexity and clinical care. Methods We conducted a cross-sectional survey with 467 patients with HIV. We used the Instrument for Evaluation of the Experience of Chronic Patients and the Health-related Quality of Life Questionnaire (EQ-5D-5L). We analyzed a predictive model through the partial least squares (PLS) method. Results The patient self-management scores showed the highest positive relationship with the patient’s health-related quality of life (β = 0.24, β = 0.32, p < 0.0001). Patients’ treatment complexity had a negative influence on health-related quality of life (β = − 0.21, β = − 0.28, p < 0.0001). The complexity of clinical care had negative effects on health-related quality of life, both directly (β = − 0.37, β = − 0.19, p < 0.0001) and through its negative influence on the productive interactions with healthcare professionals (β = − 0.21, p < 0.0001) and patient self-management factors (β = − 0.21, p < 0.0001). The effects of patient experience dimensions on their health-related quality of life were higher in people living with HIV > 50 years old (p < 0.05). Conclusions Patient experience mainly influenced the health-related quality of life of older people living with HIV. The treatment and clinical care complexity played an important role in degrading the patients' experience and their quality of life. More integrated care would benefit the health-related quality of life of people living with HIV. Funding This project was funded by Merck Sharp & Dohme, Spain. Electronic supplementary material The online version of this article (10.1007/s40121-019-0252-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - María J Galindo
- Research Department, SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain.,Internal Medicine Department, Clinic University Hospital, Valencia, Spain
| | - Ignacio Marín-Jimenez
- IBD Unit, Gastroenterology Department Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón Hospital, Madrid, Spain
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Manuel Cotarelo
- Medical Affairs Department, Merck Sharp and Dohme Spain, Madrid, Spain
| | - Juan Carlos López
- Research Department, SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain.,HIV Unit, Clinical Microbiology and Infectious Diseases Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón Hospital, Madrid, Spain
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48
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Marín-Jiménez I, Casellas F, Cortés X, García-Sepulcre MF, Juliá B, Cea-Calvo L, Soto N, Navarro-Correal E, Saldaña R, de Toro J, Galindo MJ, Orozco-Beltrán D. The experience of inflammatory bowel disease patients with healthcare: A survey with the IEXPAC instrument. Medicine (Baltimore) 2019; 98:e15044. [PMID: 30946348 PMCID: PMC6456160 DOI: 10.1097/md.0000000000015044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To assess inflammatory bowel disease (IBD) patients' experience of chronic illness care and the relationship with demographic and healthcare-related characteristics.This cross-sectional survey used the Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC) questionnaire to identify parameters associated with a better healthcare experience for IBD patients. IEXPAC questionnaire responses are grouped into 3 factors - productive interactions, new relational model, and patient self-management, scoring from 0 (worst) to 10 (best experience). Scores were analyzed by bivariate comparisons and multiple linear regression models.Surveys were returned by 341 of 575 patients (59.3%, mean age 46.8 (12.9) years, 48.2% women). Mean (SD) IEXPAC score was 5.9 (2.0); scores were higher for the productive interactions (7.7) and patient self-management factors (6.7) and much lower for the new relational model factor (2.2). Follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines were associated with higher (better) overall patient experience score, and higher productive interactions and self-management factor scores. A higher productive interactions score was also associated with patients receiving medication subcutaneously or intravenously. Higher new relational model scores were associated with follow-up by a nurse, affiliation to a patients' association, receiving help from others for healthcare, a lower number of medicines and a higher educational level.In patients with IBD, a better overall patient experience was associated with follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines.
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Affiliation(s)
- Ignacio Marín-Jiménez
- IBD Unit, Gastroenterology Department; Clinical Research Institute Gregorio Marañón (IiSGM); Gregorio Marañón University Hospital, Madrid
| | - Francesc Casellas
- Crohn-Colitis Care Unit, Hospital Universitari Vall d’Hebron, Barcelona
| | | | | | - Berta Juliá
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid
| | - Luis Cea-Calvo
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid
| | - Nadia Soto
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid
| | | | - Roberto Saldaña
- Confederation of Patients with Inflammatory Bowel Disease of Spain (ACCU)
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña
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49
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Hidalgo-Vega Á, Martell N, Orozco-Beltrán D, Galgo A, Muñiz O, Górriz JL, Ferrer-Vidal D, Sabaté N, Merino M. [Tools to improve efficiency in the clinical management of hypertensive patients]. Hipertens Riesgo Vasc 2019; 36:70-84. [PMID: 30037730 DOI: 10.1016/j.hipert.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. MATERIAL AND METHODS A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). RESULTS A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). CONCLUSIONS The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time.
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Affiliation(s)
| | - N Martell
- Hospital Clínico San Carlos, Madrid, España
| | | | - A Galgo
- Centro de Salud Espronceda, Madrid, España
| | - O Muñiz
- Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Górriz
- Hospital Clínico Universitario, Valencia, España
| | | | - N Sabaté
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Merino
- Weber, Economía y Salud, Majadahonda, España.
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50
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Carratalá-Munuera C, Arriero-Marin JM, Orozco-Beltrán D, Cuneo Amat B, Lopez-Pineda A, Soler-Cataluña JJ, Gil-Guillén VF, Quesada Rico JA. Percepción de calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica en España. Open Respiratory Archives 2019. [DOI: 10.1016/j.opresp.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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