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Alemany A, Millat-Martinez P, Corbacho-Monné M, Suñer C, Galvan-Casas C, Carrera C, Ouchi D, Prat N, Ara J, Nadal N, Riel R, Funollet B, Ojeda-Ciurana C, Balague LE, Salvador-González B, Arcarons AF, Vidal-Alaball J, Del Cura-González MI, Barrientos RR, Ramos-Blanes R, Bou AA, Mondou E, Torres M, Campins N, Sanz A, Tang Y, Rodriguez-Arias MÀ, Bassat Q, Clotet B, Mitjà O. Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trial. EClinicalMedicine 2023; 57:101898. [PMID: 36936402 PMCID: PMC10005687 DOI: 10.1016/j.eclinm.2023.101898] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. METHODS We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. FINDINGS 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, -3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; -9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. INTERPRETATION Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. FUNDING Grifols.
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Affiliation(s)
- Andrea Alemany
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina-Universitat de Barcelona, Barcelona, Spain
- Corresponding author. Department of Infectious Diseases and Fight Infectious Diseases Foundation, Hospital Germans Trias Pujol, Badalona, Catalonia, Spain.
| | | | - Marc Corbacho-Monné
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina-Universitat de Barcelona, Barcelona, Spain
- Hospital Universitari Parc Taulí, I3PT, 08028, Sabadell, Spain
| | - Clara Suñer
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Galvan-Casas
- Fight Infectious Diseases Foundation, Badalona, Spain
- Department of Dermatology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Caty Carrera
- Fight Infectious Diseases Foundation, Badalona, Spain
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Dan Ouchi
- Fight Infectious Diseases Foundation, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Prat
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Ara
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Nuria Nadal
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Ricard Riel
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Blanca Funollet
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Carmen Ojeda-Ciurana
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Lluis Esteve Balague
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Betlem Salvador-González
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), l’Hospitalet de Llobregat, Spain
| | - Anna Forcada Arcarons
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - María Isabel Del Cura-González
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud -RICAPPS- ISCIII, Spain
| | - Ricardo Rodríguez Barrientos
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud -RICAPPS- ISCIII, Spain
| | - Rafel Ramos-Blanes
- Unitat de Suport a la Recerca de Girona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
| | - Alberto Alum Bou
- Unitat de Suport a la Recerca de Girona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
| | - Elsa Mondou
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | - Mireia Torres
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | - Neus Campins
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | - Ana Sanz
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | | | - Miquel Àngel Rodriguez-Arias
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- ICREA, Pg Lluís Companys 23, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Bonaventura Clotet
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute, Can Ruti Campus, Badalona, Spain
| | | | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
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Redondo Sánchez J, Domínguez Lázaro AM, Rodríguez Barrientos R, Barrio Cortes J, Seoane Sanz A, Bravo Acuna J, Del Cura-González I. Trends in hospitalization for urinary tract infection in the paediatric age group in the 2000-2015 period in Spain. An Pediatr (Barc) 2023; 98:175-184. [PMID: 36804332 DOI: 10.1016/j.anpede.2023.01.009] [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: 05/31/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To analyse the trends in hospital admissions related to urinary tract infection among children aged 0-14 years in Spain in the 2000-2015 period. METHODS We conducted a retrospective observational study using the minimum basic hospital discharge dataset system of Spain, which applies the International Classification of Diseases, version 9 (ICD-9) coding system. We included every hospitalisation due to cystitis, pyelonephritis and unspecified UTI among children aged less than 15 years. We collected data on patient sex and age, type of discharge, main diagnosis, comorbidities, length of stay and overall cost. We calculated crude hospitalization rates per 1000 inhabitants aged less than 15 years and performed a joinpoint regression analysis to identify temporal trends. RESULTS In the 2000-2015 period, there were 124 696 hospitalizations in children under 15 years. Of these patients, 72.97% were aged 0-1 year and 60.12% had a diagnosis of unspecified UTI, 39.27% of pyelonephritis, and 0.52% of cystitis. The crude rate of hospitalization due to UTI ranged from 1.24 in year 2000 to 0.98 in 2015. The rate of hospitalization was higher in female versus male patients. The joinpoint analysis found a decreasing trend in the rate of hospitalization due to UTI, with an average annual percent change (AAPC) of -1.5% (95% confidence interval [CI], -2.4 a -0.6). The largest decreases occurred in female patients (AAPC, -1.8; 95% CI, -2.5 a -1.0) and children aged 7-10 years (AAPC - 5.9; 95% CI, -6.7 a -5.2). CONCLUSIONS The rate of hospitalization related to UTI in Spain in patients aged up to 14 years decreased during the 2000-2015 period. The highest hospitalization rates occurred in female patients and in the 0-to-1 year age group.
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Affiliation(s)
- Jesús Redondo Sánchez
- Centro de Salud Ramon y Cajal, Alcorcón, Spain; Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Alberto Manuel Domínguez Lázaro
- Medicina Preventiva y Salud Pública, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ricardo Rodríguez Barrientos
- Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) y Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jaime Barrio Cortes
- Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Fundación para la Investigación e Innovación Biosanitaria en Atención Primaria, Madrid, Spain
| | - Andrea Seoane Sanz
- Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Bravo Acuna
- Centro de Salud El Greco, Getafe. Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Isabel Del Cura-González
- Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) y Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
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Sánchez JMR, Alonso MDCDH, Barrientos RR. [Not Available]. FMC 2021; 28:191-201. [PMID: 33776412 PMCID: PMC7984871 DOI: 10.1016/j.fmc.2021.01.006] [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] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Los pacientes en tratamiento con IECA o ARAII no tienen mayor riesgo de infección por SARS-COVID, ni mayor riesgo de COVID-19 grave ni de mortalidad. Por ello, deben continuar con el tratamiento, y solo estaría justificada su retirada por motivos clínicos. Los pacientes con COVID-19 en tratamiento con hipolipemiantes deben continuar con ellos, especialmente aquellos con alto riesgo de enfermedad cardiovascular. Se suspenderán si hay riesgo hepático o renal o si está impedida la vía oral. Se valorará el cambio de estatina si hay interacción con el tratamiento para la infección. En pacientes diabéticos con COVID-19 se recomienda suspender los iSGLT-2 (gliflozinas o uricosúricos) en caso de fiebre o diarrea, y vigilar función renal y glucemia por si es necesario ajustar el resto de los antidiabéticos. La insulina es el tratamiento de elección en caso de retirada del resto de fármacos. Los medicamentos psicotrópicos pueden interactuar con los fármacos utilizados para la COVID-19 y algunos de sus efectos adversos, especialmente los relacionados con la depresión respiratoria, pueden empeorar la evolución de la infección. No se ha encontrado asociación entre el uso de inhibidores de la bomba de protones o anti-H2 y la aparición de COVID-19. La evidencia actual no indica la necesidad de retirar el omeprazol en los casos con clara indicación. No hay evidencia científica que relacione el uso de antiinflamatorios no esteroideos (AINE) con el empeoramiento de la COVID-19, por lo que pueden usarse en el tratamiento sintomático de la infección y/u otras comorbilidades asociadas. No se deben interrumpir los tratamientos crónicos con AINE u opiáceos que están bien indicados. Se recomienda elegir opioides con menos efecto inmunosupresor. Durante la COVID-19 se recomienda suspender temporalmente los anticonceptivos y continuar con los anticoagulantes o antiagregantes que tomase previamente.
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Arancón-Monge JM, de Castro-Cuenca A, Serrano-Vázquez Á, Campos-Díaz L, Rodríguez Barrientos R, Del Cura-González I. [Effects of changing the appearance of medications in safety and adherence in chronic patients over 65 years of age in primary care. CAMBIMED Study]. Aten Primaria 2019; 52:77-85. [PMID: 31481266 PMCID: PMC7025977 DOI: 10.1016/j.aprim.2019.06.001] [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] [Received: 10/05/2018] [Revised: 05/29/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022] Open
Abstract
Objetivo Estudiar si en pacientes mayores de 65 años con tratamientos antihipertensivos e hipolipemiantes los cambios de fármacos bioequivalentes con diferente apariencia se asocian a un aumento de errores de uso y pérdida de adherencia al tratamiento. Diseño Estudio observacional, longitudinal, prospectivo, de cohorte de 1 año de seguimiento entre el 1 de enero de 2013 y el 31 de diciembre de 2014. Emplazamiento Centros de Salud de la Comunidad de Madrid. Participantes Pacientes ≥ 65 años con diagnóstico de HTA (CIAP K86) y/o dislipidemia (CIAP T93) en tratamiento con enalapril y/o amlodipino y/o simvastatina. Mediciones principales Se recogieron mediante entrevista en consulta variables sociodemográficas (edad, sexo, nivel de estudios), clínicas, adherencia (test de Morisky-Green y recuento directo), errores de medicación (número y tipo), cambios de fármacos y número, parámetros bioquímicos (colesterol total, colesterol HDL, colesterol LDL, triglicéridos) y variable combinada (error y/o adherencia). Se realizaron 5 visitas: una basal y 4 trimestrales. Resultados Se incluyeron 274 pacientes, edad media 72 (6,6) años, 47,8% mujeres. Presentaron algún cambio de medicamento 134 pacientes (48,9%), con una mediana de cambios de 3 (RIQ 1-5) y máximo de 11. El riesgo de presentar algún error o disminuir la adherencia estaba aumentado en expuestos a cambios en todas las visitas con RR 1,14 (1,16-1,69) al año de seguimiento. El error más frecuente fue la pérdida de dosis. Por cada cambio la probabilidad de un evento combinado aumenta en un 41%. Conclusiones Los cambios realizados entre fármacos bioequivalentes con diferente apariencia podrían aumentar el número de errores de medicación y disminuir la adherencia. Habría que realizar más estudios para valorar en qué medida afecta al control de la enfermedad. No se contempla el apartado intervención por tratarse de un estudio observacional.
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Affiliation(s)
- Jesús Mario Arancón-Monge
- Centro de Salud Tres Cantos I, Tres Cantos, Madrid, España; Gerencia Asistencial de Atención Primaria, Madrid, España
| | - Alicia de Castro-Cuenca
- Centro de Salud Jaime Vera, Coslada, Madrid, España; Gerencia Asistencial de Atención Primaria, Madrid, España
| | - Ángel Serrano-Vázquez
- Centro de Salud El Puerto, Coslada, Madrid, España; Gerencia Asistencial de Atención Primaria, Madrid, España
| | - Luz Campos-Díaz
- Centro de Salud Avenida de Aragón, Madrid, España; Gerencia Asistencial de Atención Primaria, Madrid, España
| | - Ricardo Rodríguez Barrientos
- Unidad de Apoyo a la Investigación, Madrid, España; Gerencia Asistencial de Atención Primaria, Madrid, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - Isabel Del Cura-González
- Unidad de Apoyo a la Investigación, Madrid, España; Gerencia Asistencial de Atención Primaria, Madrid, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, España; Área de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Alemán-Vega G, Gómez Cabañas I, Reques Sastre L, Rosado Martín J, Polentinos-Castro E, Rodríguez Barrientos R. Prevalence and risk of progression of chronic kidney disease in diabetics and hypertensive patients followed in primary care in Madrid. Nefrologia 2018. [PMID: 28648211 DOI: 10.1016/j.nefro.2016.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Laura Reques Sastre
- Medicina Preventiva y Salud Pública, Escuela Nacional de Sanidad, Madrid, España
| | | | - Elena Polentinos-Castro
- Unidad Docente de Atención Familiar y Comunitaria Norte, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - Ricardo Rodríguez Barrientos
- Unidad Docente de Atención Familiar y Comunitaria Norte, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
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Alonso Roca R, Figueroa Guerrero CA, Mainar de Paz V, Arribas García MP, Sánchez Perruca L, Rodríguez Barrientos R, Casado López M, Pedraza Flechas AM. Grado de control del tratamiento anticoagulante oral en los centros de Atención Primaria de la Comunidad de Madrid: estudio CHRONOS-TAO. Med Clin (Barc) 2015; 145:192-7. [DOI: 10.1016/j.medcli.2014.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 12/21/2022]
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Morcillo Cebolla V, de Lorenzo-Cáceres Ascanio A, Domínguez Ruiz de León P, Rodríguez Barrientos R, Torijano Castillo MJ. [Health inequalities in self-perceived health among older adults in Spain]. Gac Sanit 2014; 28:511-21. [PMID: 25189674 DOI: 10.1016/j.gaceta.2014.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Recent publications have concluded that there are social health inequalities in people older than 65 years in Spain, especially among women and people with low socioeconomic status. Self-perceived health is an indicator that is related to the possibility of chronic disease, the use of health services, and mortality. The aim of this study was to assess inequalities in self-perceived health in relation to age, gender, socioeconomic factors, and functional dependence. METHODS A systematic review was conducted following the PRISMA criteria. An exhaustive search was performed in PubMed, WOK, Science Direct, EMBASE, IME, Cochrane, JSTOR, Ovid, Proquest, the BMJ Group and in Spanish doctoral theses up to April 2013. The quality of the studies was assessed by two independent editors through the Berra Tool. RESULTS A total of 20 documents were selected. These studies were in agreement in the deterioration of self-perceived health among older people (except the oldest), in those with functional dependence, lower socioeconomic status, and in women. CONCLUSIONS This review shows that, among older people, inequalities in self-perceived health due to socioeconomic status and gender have persisted in time. Future research is needed to cast light on the factors determining the persistence of these inequalities among older people, so that specific health policies can be designed for this sector of the population.
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Affiliation(s)
| | | | | | - Ricardo Rodríguez Barrientos
- UAT, Unidad Apoyo Investigación Atención Primaria, Gerencia Adjunta de Planificación y Calidad, Red de Investigación en Servicios de Salud y Enfermedades Crónicas, REDISSEC, Madrid, España
| | - María José Torijano Castillo
- Departamento de Medicina Preventiva y Salud Pública, Hospital General Universitario Gregorio Marañón, Madrid, España
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González-Vélez AE, Barrientos RR. Consideraciones sobre la vacunación del adulto con enfermedad renal crónica. Gaceta Sanitaria 2013; 27:469-70. [DOI: 10.1016/j.gaceta.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 09/01/2012] [Indexed: 11/30/2022]
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Del-Cura González I, García-de-Blas González F, Cuesta TS, Martín Fernández J, Del-Alamo Rodríguez JM, Escriva Ferrairo RA, Del Canto De-Hoyos Alonso M, Arenas LB, Barrientos RR, Wiesmann EC, De-Alba Romero C, Díaz YG, Rodríguez-Moñino AP, Teira BG, Del Pozo MSC, Horcajuelo JF, Rojas Giraldo MJ, González PC, Vello Cuadrado RA, Uriarte BL, Yepes JS, Sanz YH, Iglesias Piñeiro MJ, Hernández ST, Alonso FG, González González AI, Fernández AS, Carballo C, López AR, Morales F, Martínez López D. Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care. BMC Public Health 2011; 11:63. [PMID: 21281464 PMCID: PMC3048533 DOI: 10.1186/1471-2458-11-63] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 10/12/2010] [Accepted: 01/31/2011] [Indexed: 11/19/2022] Open
Abstract
Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. Methods/Design This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid. The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference. Discussion Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.
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Affiliation(s)
- Isabel Del-Cura González
- Unidad de Investigación, Atención Primaria Area 9, Servicio Madrileño de Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
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