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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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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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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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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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Monera Lucas CE, Baeza Diaz MV, Quesada JA, Lopez-Pineda A, Fernandez Martinez C, Martinez Toldos JJ, Gil-Guillén VF. Tomographic Findings in the Retina of Unvaccinated Patients with COVID Pneumonia: Prospective Longitudinal Study. Int J Environ Res Public Health 2023; 20:ijerph20095659. [PMID: 37174177 PMCID: PMC10178088 DOI: 10.3390/ijerph20095659] [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: 02/24/2023] [Revised: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
There is no definitive evidence on the extent of SARS-CoV-2's effect on the retina. This study aims to determine if the natural history of SARS-CoV-2 infection affects tomographic findings in the retina of patients with COVID-19 pneumonia. This is a prospective cohort study of patients hospitalized with COVID-19 pneumonia. The patients underwent ophthalmological explorations and optical coherence tomography during the acute phase of the infection and at a follow-up 12 weeks later. The primary outcomes were the central retinal thickness and central choroidal thickness, which were compared longitudinally and with non-COVID-19 historical controls. No statistically relevant differences were observed in the longitudinal analysis of the thickness of the central retina (p = 0.056), central choroid (p = 0.99), retinal nerve fiber layer (p = 0.21), or ganglion cell layer (p = 0.32). Patients with acute COVID-19 pneumonia showed significantly greater central retinal thickness than non-COVID controls (p = 0.006). In conclusion, tomographic measures of the retina and choroid are not influenced by the phase of COVID-19 infection and remain stable during 12 weeks. The central retinal thickness may increase in the acute phase of COVID-19 pneumonia, but more epidemiological studies using optical coherence tomography in the early stages of the disease are needed.
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Affiliation(s)
- Carlos Enrique Monera Lucas
- Retina Unit, Ophthalmology Service, General University Hospital of Elche, 03203 Elche, Spain
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Manuel Vicente Baeza Diaz
- Retina Unit, Ophthalmology Service, General University Hospital of Elche, 03203 Elche, Spain
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Jose A Quesada
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 03550 Alicante, Spain
| | - Adriana Lopez-Pineda
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 03550 Alicante, Spain
| | | | - Jose Juan Martinez Toldos
- Retina Unit, Ophthalmology Service, General University Hospital of Elche, 03203 Elche, Spain
- Department of Pathology and Surgery, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 03550 Alicante, Spain
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Gracia-Sánchez A, López-Pineda A, Lázaro-Martínez JL, Pérez A, Pomares-Gómez FJ, Fernández-Seguín LM, Gil-Guillén VF, Chicharro-Luna E. Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study. Braz J Phys Ther 2023; 27:100500. [PMID: 37079949 DOI: 10.1016/j.bjpt.2023.100500] [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: 08/12/2022] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Patients with diabetes mellitus are exposed to important complications. Currently little evidence exist on the guidelines that these patients, at some risk of foot ulceration, should follow for physical exercise. OBJECTIVES To reach a consensus among multidisciplinary and international experts on physical activity/exercise recommendations for patients with diabetes, according to foot ulcer risk. METHODS Using a three-round Delphi method, a panel composed of 28 multidisciplinary experts in the management of diabetic foot assessed 109 recommendations on physical activity/exercise for patients with diabetes mellitus, according to their risk of foot ulcer. Consensus was assumed when 80% of responses matched the same category (agreement/disagreement). RESULTS Twenty-nine experts participated in the first and second rounds of consultation, and twenty-eight did so in the third, reaching final agreement on 86 of the 109 recommendations considered (78.9%). The study, thus, generated a consensus set of recommendations concerning different aspects of diabetic footcare before, during, and after exercise (e.g. when to examine the foot, how to assess it, what type of sock and insole to use, what types of exercise to perform, and when it is advisable to return to activity after an ulceration). CONCLUSION This Delphi study generated recommendations based on the consensus of international experts on physical activity and exercise by patient with diabetes at risk of ulceration. Recommendations considered the state of the foot and the patient's history and status before physical activity and included information on intensity, duration, frequency, and progressions of physical activity/exercise, and the use of custom-made plantar orthoses, shoe prescription, and the convenience of returning to physical activity after an ulceration.
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Affiliation(s)
- Alba Gracia-Sánchez
- Nursing Service, Department of Health and Behavioral Sciences, Faculty of Medicine, University Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, University Miguel Hernández de Elche, San Juan de Alicante, Spain; Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Alicante, Spain.
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit,Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Antonio Pérez
- Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Medicine Department, Universitat Autònoma de Barcelona, CIBER de Diabetes y Enfermedades metabólicas (CIBERDEM), Barcelona, Spain
| | | | | | - Vicente F Gil-Guillén
- Clinical Medicine Department, University Miguel Hernández de Elche, San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Alicante, Spain; Research Unit, University General Hospital of Elda, Elda, Spain
| | - Esther Chicharro-Luna
- Nursing Service, Department of Health and Behavioral Sciences, Faculty of Medicine, University Miguel Hernández de Elche, San Juan de Alicante, Spain
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8
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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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9
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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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10
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Sarrió-Sanz P, Martinez-Cayuelas L, Lumbreras B, Sánchez-Caballero L, Palazón-Bru A, Gil-Guillén VF, Gómez-Pérez L. Mortality prediction models after radical cystectomy for bladder tumour: A systematic review and critical appraisal. Eur J Clin Invest 2022; 52:e13822. [PMID: 35642331 DOI: 10.1111/eci.13822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 03/09/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To identify risk-predictive models for bladder-specific cancer mortality in patients undergoing radical cystectomy and assess their clinical utility and risk of bias. METHODS Systematic review (CRD42021224626:PROSPERO) in Medline and EMBASE (from their creation until 31/10/2021) was screened to include articles focused on the development and internal validation of a predictive model of specific cancer mortality in patients undergoing radical cystectomy. CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias ASsessment Tool (PROBAST) were applied. RESULTS Nineteen observational studies were included. The main predictors were sociodemographic variables, such as age (18 studies, 94.7%) and sex (17, 89.5% studies), tumour characteristics (TNM stage (18 studies, 94.7%), histological subtype/grade (15 studies, 78.9%), lymphovascular invasion (10 studies, 52.6%) and treatment with chemotherapy (13 studies, 68.4%). C-index values were presented in 14 studies. The overall risk of bias assessed using PROBAST led to 100% of studies being classified as high risk (the analysis domain was rated to be at high risk of bias in all the studies), and 52.6% showed low applicability. Only 5 studies (26.3%) included an external validation and 2 (10.5%) included a prospective study design. CONCLUSIONS Using clinical predictors to assess the risk of bladder-specific cancer mortality is a feasibility alternative. However, the studies showed a high risk of bias and their applicability is uncertain. Studies should improve the conducting and reporting, and subsequent external validation studies should be developed.
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Affiliation(s)
- Pau Sarrió-Sanz
- Urology Services, University Hospital of San Juan de Alicante, Alicante, Spain
| | | | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, and CIBER en Epidemiología y Salud Pública, Alicante, Spain
| | | | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | | | - Luis Gómez-Pérez
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
- Urology Services, University General Hospital of Elx, Alicante, Spain
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11
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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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12
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Berenguer-Soler M, Navarro-Sánchez A, Compañ-Rosique A, Luri-Prieto P, Navarro-Ortiz R, Gómez-Pérez L, Pérez-Tomás C, Font-Juliá E, Gil-Guillén VF, Cortés-Castell E, Navarro-Cremades F, Montejo AL, Arroyo-Sebastián MDÁ, Pérez-Jover V. Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis. J Clin Med 2022; 11:2340. [PMID: 35566467 PMCID: PMC9105657 DOI: 10.3390/jcm11092340] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.
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Affiliation(s)
- María Berenguer-Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (M.B.-S.); (A.N.-S.); (V.P.-J.)
| | - Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (M.B.-S.); (A.N.-S.); (V.P.-J.)
| | - Antonio Compañ-Rosique
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Paloma Luri-Prieto
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
| | | | - Luis Gómez-Pérez
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
- General University Hospital of Elche, 03203 Elche, Spain
| | - Carla Pérez-Tomás
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
| | - Elsa Font-Juliá
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
| | - Vicente F. Gil-Guillén
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Ernesto Cortés-Castell
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Felipe Navarro-Cremades
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
| | | | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (M.B.-S.); (A.N.-S.); (V.P.-J.)
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13
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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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14
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Gracia-Sánchez A, López-Pineda A, Chicharro-Luna E, Gil-Guillén VF. A Delphi Study Protocol to Identify Recommendations on Physical Activity and Exercise in Patients with Diabetes and Risk of Foot Ulcerations. Int J Environ Res Public Health 2021; 18:10988. [PMID: 34682736 PMCID: PMC8536116 DOI: 10.3390/ijerph182010988] [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] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 01/05/2023]
Abstract
Patients with diabetes mellitus are exposed to important complications, such as diabetic neuropathy or peripheral vascular disease. The evidence on the guidelines that these patients, with a certain risk of suffering foot ulcerations, should follow before, during and after physical exercise is scarce. The objective of this study is to identify the physical exercise guidelines to recommend based on the risk of the foot of the patient with diabetes through a consensus of experts. A three-round Delphi study will be conducted. A scientific committee (multidisciplinary group of four national experts) will review the proposal of experts and the Delphi questionnaire before submitting. A group of experts in the management and approach of the diabetic foot of an international and multidisciplinary nature will form the panel of experts, who must express their degree of (dis)agreement with each of the statements contained in the Delphi questionnaire. The percentage will be calculated in response categories, and a cut-off point of 80% will be set to define the consensus of (dis)agreement of the panelists. The results of the study could provide a series of recommendations on the realization of physical exercise in diabetic patients at risk of suffering foot ulcerations.
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Affiliation(s)
- Alba Gracia-Sánchez
- Department of Behavioral and Health Sciences, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (A.G.-S.); (E.C.-L.)
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain;
| | - Esther Chicharro-Luna
- Department of Behavioral and Health Sciences, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (A.G.-S.); (E.C.-L.)
| | - Vicente F. Gil-Guillén
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain;
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15
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Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, Navarro-Ortiz R, Berenguer-Soler M, Gil-Guillén VF, Cortés-Castell E, Navarro-Cremades F, Gómez-Pérez L, Pérez-Tomás C, Palazón-Bru A, Montejo AL, Pérez-Jover V. Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case-Control Study. J Clin Med 2021; 10:jcm10194401. [PMID: 34640419 PMCID: PMC8509279 DOI: 10.3390/jcm10194401] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022] Open
Abstract
Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case–control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.
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Affiliation(s)
- Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (A.N.-S.); (M.B.-S.); (V.P.-J.)
| | - Paloma Luri-Prieto
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
| | - Antonio Compañ-Rosique
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Ramón Navarro-Ortiz
- Orthopedic Surgery and Traumatology Service, Torrevieja University Hospital, 03186 Torrevieja, Spain;
| | - María Berenguer-Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (A.N.-S.); (M.B.-S.); (V.P.-J.)
| | - Vicente F. Gil-Guillén
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Ernesto Cortés-Castell
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Felipe Navarro-Cremades
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Luis Gómez-Pérez
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Carla Pérez-Tomás
- Department of Surgery, San Juan University Hospital, 03550 San Juan, Spain; (P.L.-P.); (A.C.-R.); (L.G.-P.); (C.P.-T.)
| | - Antonio Palazón-Bru
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (V.F.G.-G.); (E.C.-C.); (F.N.-C.); (A.P.-B.)
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Department of Psychiatry, Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-63-9754-620
| | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (A.N.-S.); (M.B.-S.); (V.P.-J.)
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Tirado-González S, Navarro-Sánchez A, Compañ-Rosique A, Luri-Prieto P, Rodríguez-Marín J, Van-der Hofstadt-Román CJ, Berenguer Soler M, Navarro-Cremades F, Gil-Guillén VF, Navarro Ortiz R, Montejo AL, Pérez-Jover V. Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q). J Clin Med 2021; 10:jcm10122686. [PMID: 34207115 PMCID: PMC8235656 DOI: 10.3390/jcm10122686] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for the study of sexuality in specific non-clinical populations, such as female university students of Medicine and other Health Sciences. The CAPFS-Q includes 26 items, organized as follows: sociodemographic and relevant data (four items); aspects of sexual relations with partner (five items); sexual practices (12 from 13 items); and dysfunctional aspects of sexual relations (four items). CAPFS-Q validity and reliability were examined in a sample of Spanish female university students of Health Sciences. Exploratory and confirmatory factor analysis (FA) showed a four-factor structure which explained 71.6% of the variance. This initial version of the CAPFS-Q is a reliable measure of women's sexual behavior, with a dimensionality that replicates the initial theoretical content and with adequate indicators of internal consistency, validity, and test-retest reliability. It is easy to administer and to complete.
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Affiliation(s)
- Sonia Tirado-González
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Antonio Compañ-Rosique
- San Juan University Hospital, Miguel Hernández University, Ctra N-332, s/n, 03550 Sant Joan d’Alacant, Spain; (A.C.-R.); (P.L.-P.)
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Paloma Luri-Prieto
- San Juan University Hospital, Miguel Hernández University, Ctra N-332, s/n, 03550 Sant Joan d’Alacant, Spain; (A.C.-R.); (P.L.-P.)
| | - Jesús Rodríguez-Marín
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Carlos J. Van-der Hofstadt-Román
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - María Berenguer Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Felipe Navarro-Cremades
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Vicente F. Gil-Guillén
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Ramón Navarro Ortiz
- Torrevieja University Hospital, Carretera CV 95, s/n, 03186 Torrevieja, Spain;
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-63-9754-620
| | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
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Quesada JA, López-Pineda A, Gil-Guillén VF, Arriero-Marín JM, Gutiérrez F, Carratala-Munuera C. Incubation period of COVID-19: A systematic review and meta-analysis. Rev Clin Esp 2021; 221:109-117. [PMID: 38108501 PMCID: PMC7528969 DOI: 10.1016/j.rce.2020.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 06/24/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE The incubation period of COVID-19 helps to determine the optimal duration of the quarantine and inform predictive models of incidence curves. Several emerging studies have produced varying results; this systematic review aims to provide a more accurate estimate of the incubation period of COVID-19. METHODS For this systematic review, a literature search was conducted using Pubmed, Scopus/EMBASE, and the Cochrane Library databases, covering all observational and experimental studies reporting the incubation period and published from 1 January 2020 to 21 March 2020.We estimated the mean and 95th percentile of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables. RESULTS We included seven studies (n = 792) in the meta-analysis. The heterogeneity (I2 83.0%, p < 0.001) was significantly decreased when we included the study quality and the statistical model used as moderator variables (I2 15%). The mean incubation period ranged from 5.6 (95% CI: 5.2 to 6.0) to 6.7 days (95% CI: 6.0 to 7.4) according to the statistical model. The 95th percentile was 12.5 days when the mean age of patients was 60 years, increasing 1 day for every 10 years. CONCLUSION Based on the published data reporting the incubation period of COVID-19, the mean time between exposure and onset of clinical symptoms depended on the statistical model used, and the 95th percentile depended on the mean age of the patients. It is advisable to record sex and age when collecting data in order to analyze possible differential patterns.
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Affiliation(s)
- J A Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
| | - A López-Pineda
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España.
| | - V F Gil-Guillén
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
| | - J M Arriero-Marín
- Departamento de Neumología, Universidad Hospital de San Juan de Alicante, San Juan de Alicante, España
| | - F Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España; Departamento de Enfermedades Infecciosas, Universidad Hospital de Elche, Elche, España
| | - C Carratala-Munuera
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
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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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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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20
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Quesada JA, López-Pineda A, Gil-Guillén VF, Arriero-Marín JM, Gutiérrez F, Carratala-Munuera C. Incubation period of COVID-19: A systematic review and meta-analysis. Rev Clin Esp 2020; 221:109-117. [PMID: 33998486 PMCID: PMC7698828 DOI: 10.1016/j.rceng.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 06/24/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023]
Abstract
Background and objective The incubation period of COVID-19 helps to determine the optimal duration of the quarantine and inform predictive models of incidence curves. Several emerging studies have produced varying results; this systematic review aims to provide a more accurate estimate of the incubation period of COVID-19. Methods For this systematic review, a literature search was conducted using Pubmed, Scopus/EMBASE, and the Cochrane Library databases, covering all observational and experimental studies reporting the incubation period and published from 1 January 2020 to 21 March 2020.We estimated the mean and 95th percentile of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables. Results We included seven studies (n = 792) in the meta-analysis. The heterogeneity (I2 83.0%, p < 0.001) was significantly decreased when we included the study quality and the statistical model used as moderator variables (I2 15%). The mean incubation period ranged from 5.6 (95% CI: 5.2–6.0) to 6.7 days (95% CI: 6.0–7.4) according to the statistical model. The 95th percentile was 12.5 days when the mean age of patients was 60 years, increasing 1 day for every 10 years. Conclusion Based on the published data reporting the incubation period of COVID-19, the mean time between exposure and onset of clinical symptoms depended on the statistical model used, and the 95th percentile depended on the mean age of the patients. It is advisable to record sex and age when collecting data in order to analyze possible differential patterns.
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Affiliation(s)
- J A Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - A López-Pineda
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain.
| | - V F Gil-Guillén
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - J M Arriero-Marín
- Departamento de Neumología, Universidad Hospital de San Juan de Alicante, San Juan de Alicante, Spain
| | - F Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain; Departamento de Enfermedades Infecciosas, Universidad Hospital de Elche, Elche, Spain
| | - C Carratala-Munuera
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
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21
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Palazón-Bru A, Mares-García E, López-Bru D, Mares-Arambul E, Folgado-de la Rosa DM, Carbonell-Torregrosa MDLÁ, Gil-Guillén VF. A critical appraisal of the clinical applicability and risk of bias of the predictive models for mortality and recurrence in patients with oropharyngeal cancer: Systematic review. Head Neck 2020; 42:763-773. [PMID: 31762119 DOI: 10.1002/hed.26025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/05/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022] Open
Abstract
The use of predictive models is becoming widespread. However, these models should be developed appropriately (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies [CHARMS] and Prediction model Risk Of Bias ASsessment Tool [PROBAST] statements). Concerning mortality/recurrence in oropharyngeal cancer, we are not aware of any systematic reviews of the predictive models. We carried out a systematic review of the MEDLINE/EMBASE databases of those predictive models. In these models, we analyzed the 11 domains of the CHARMS statement and the risk of bias and applicability, using the PROBAST tool. Six papers were finally included in the systematic review and all of them presented high risk of bias and several limitations in the statistical analysis. The applicability was satisfactory in five out of six studies. None of the models could be considered ready for use in clinical practice.
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Affiliation(s)
- Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - Emma Mares-García
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - David López-Bru
- Department of Otolaryngology, General University Hospital of Elche, Elche, Alicante, Spain
| | - Enrique Mares-Arambul
- Department of Otolaryngology, General University Hospital of Elda, Elda, Alicante, Spain
| | | | - María de Los Ángeles Carbonell-Torregrosa
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
- Emergency Service, General University Hospital of Elda, Elda, Alicante, Spain
| | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
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22
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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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Martínez-Díaz AM, Palazón-Bru A, Folgado-de la Rosa DM, Ramírez-Prado D, Llópez-Espinós P, Beneyto-Ripoll C, Gil-Guillén VF. A cardiovascular risk score for hypertensive patients previously admitted to hospital. Eur J Cardiovasc Nurs 2019; 18:492-500. [PMID: 31032627 DOI: 10.1177/1474515119845791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
BACKGROUND Cardiovascular risk scales in hypertensive populations have limitations for clinical practice. AIMS To develop and internally validate a predictive model to estimate one-year cardiovascular risk for hypertensive patients admitted to hospital. METHODS Cohort study of 303 hypertensive patients admitted through the Emergency Department in a Spanish region in 2015-2017. The main variable was the onset of cardiovascular disease during follow-up. The secondary variables were: gender, age, educational level, family history of cardiovascular disease, Charlson score and its individual conditions, living alone, quality of life, smoking, blood pressure, physical activity and adherence to the Mediterranean diet. A Cox regression model was constructed to predict cardiovascular disease one year after admission. This was then adapted to a points system, externally validated by bootstrapping (discrimination and calibration) and implemented in a mobile application for Android. RESULTS A total of 93 patients developed cardiovascular disease (30.7%) over a mean period of 1.68 years. The predictors in the points system were: gender, age, myocardial infarction, heart failure, peripheral arterial disease and daily activity (quality of life). The internal validation by bootstrapping was satisfactory. CONCLUSION A novel points system was developed to predict short-term cardiovascular disease in hypertensive patients after hospital admission. External validation studies are needed to corroborate the results obtained.
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Affiliation(s)
| | - Antonio Palazón-Bru
- 2 Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | | | - Dolores Ramírez-Prado
- 3 Department of Medicinal Products, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | | | | | - Vicente F Gil-Guillén
- 2 Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
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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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López-Bru D, Palazón-Bru A, Folgado-de la Rosa DM, Gil-Guillén VF. A scoring system to predict recurrence in patients with differentiated thyroid cancer. Clin Otolaryngol 2018; 44:26-31. [PMID: 30220101 DOI: 10.1111/coa.13227] [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: 06/05/2017] [Revised: 07/24/2018] [Accepted: 09/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Though predictive models have been constructed to determine the risk of recurrence in differentiated thyroid carcinoma, various aspects of these models are inadequate. Therefore, we aimed to construct, internally validate and implement on a mobile application a scoring system to determine this risk within 10 years. DESIGN A retrospective cohort study in 1984-2016. SETTING A Spanish region. PARTICIPANTS We enrolled 200 patients with differentiated thyroid carcinoma without distant metastasis at diagnosis. MAIN OUTCOME MEASURES Time-to-recurrence. A risk table was constructed based on the sum of points to estimate the likelihood of recurrence. The model was internally validated and implemented as a mobile application for Android. RESULTS Predictive factors were follicular histology, T, N and multifocality. This risk table had a C-statistic of 0.723. The calibration was satisfactory. CONCLUSIONS This study provides an instrument able to predict rapidly and very simply which patients with differentiated thyroid carcinoma have a greater risk of recurrence.
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Affiliation(s)
- David López-Bru
- Department of Otolaryngology, General University Hospital of Elda, Elda, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Research Unit, General University Hospital of Elda, Elda, Alicante, Spain
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Gómez-Martínez L, Orozco-Beltrán D, Quesada JA, Bertomeu-González V, Gil-Guillén VF, López-Pineda A, Carratalá-Munuera C. Tendencias de mortalidad prematura por insuficiencia cardiaca por comunidades autónomas en España, periodo 1999-2013. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Palazón-Bru A, Tomás-Rodríguez MI, López-Cascales MT, Folgado-de la Rosa DM, Gil-Guillén VF. Multivariate Ordered Logistic Regression Models: Dealing with the Model-Building Strategy. J Pediatr Adolesc Gynecol 2017; 30:664. [PMID: 28663155 DOI: 10.1016/j.jpag.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
| | - María I Tomás-Rodríguez
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - María Teresa López-Cascales
- Department of Molecular Neurobiology, Neurosciences Institute (Miguel Hernández University and Consejo Superior de Investigaciones Científicas), San Juan de Alicante, Alicante, Spain
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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Tomás-Rodríguez MI, Palazón-Bru A, Martínez-St John DRJ, Navarro-Cremades F, Toledo-Marhuenda JV, Gil-Guillén VF. Factors Associated with Increased Pain in Primary Dysmenorrhea: Analysis Using a Multivariate Ordered Logistic Regression Model. J Pediatr Adolesc Gynecol 2017; 30:199-202. [PMID: 27693647 DOI: 10.1016/j.jpag.2016.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain. DESIGN A cross-sectional observational study. SETTING A Spanish University in 2016. PARTICIPANTS A total of 306 women, aged 18-30 years. INTERVENTIONS A questionnaire was filled in by the participants to assess associated factors with dysmenorrhoea. MAIN OUTCOME MEASURES Our outcome measure was the Andersch and Milsom scale (grade from 0 to 3). DEFINITION grade 0 (menstruation is not painful and daily activity is unaffected), grade 1 (menstruation is painful but seldom inhibits normal activity, analgesics are seldom required, and mild pain), grade 2 (daily activity affected, analgesics required and give relief so that absence from work or school is unusual, and moderate pain), and grade 3 (activity clearly inhibited, poor effect of analgesics, vegetative symptoms and severe pain). RESULTS Factors significantly associated with more extreme pain: a higher menstrual flow (odds ratio [OR], 2.11; P < .001), a worse quality of life (OR, 0.97; P < .001) and use of medication for PD (OR, 8.22; P < .001). CONCLUSION We determined factors associated with extreme pain in PD in a novel way. Further studies are required to corroborate our results.
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Affiliation(s)
- María I Tomás-Rodríguez
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain; Research Unit, Elda General University Hospital, Elda, Alicante, Spain.
| | | | - Felipe Navarro-Cremades
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - José V Toledo-Marhuenda
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain; Research Unit, Elda General University Hospital, Elda, Alicante, Spain
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Orozco-Beltrán D, Carratalá-Munuera C, Arriero JM, Campo P, Martínez-Moragón E, Molina J, Quintano-Jiménez JA, Gil-Guillén VF. Management and referral of patients with severe and poorly controlled asthma in primary care. Fam Pract 2016; 33:678-683. [PMID: 27543792 DOI: 10.1093/fampra/cmw081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/14/2022] Open
Abstract
BACKGROUND Over 50% of treated patients with asthma in Europe are not well controlled. Their management in primary health care (PHC) differs from that in specialized care, and there is no real coordination between the two. OBJECTIVES To identify barriers and solutions to improving the management of patients with severe and poorly controlled asthma and the communication between specialists and PHC, and to reach a consensus on the criteria for referral patients. METHODS An observational study using a modified Delphi technique. About 79 physicians from PHC, pneumology and allergy fields from different Spanish regions were invited to participate via an online questionnaire. Consensus was reached on an item when more than two-thirds of the panel members scored within the 3-point category (1-3 or 7-9) containing the median and the interquartile range of answers had to be ≤4 points. RESULTS Response rate: 52%. After the second round, consensus items were 40 (62.5%): of which 37 in agreement and 3 in disagreement. Around 92.68% of respondents agreed that it would be useful to incorporate questionnaires for asthma control into PHC computer-based searches. About 100% of participants agreed that clear consensus criteria between PHC and specialists must be determined to decide when a patient with asthma is referred from PHC to specialist or vice versa. Ten of the proposed criteria reached consensus agreement. CONCLUSION The failure to use guidelines and specific questionnaires for asthma control in PHC is one reason why there is underdiagnosis and poor control of asthma. Some strategies to improve the asthma care management emerged from the survey results.
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Affiliation(s)
| | | | - Juan M Arriero
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Paloma Campo
- Allergology Division, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Jesús Molina
- Primary Care Center, Centro de Salud Francia, Fuenlabrada, Madrid, Spain and
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain
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Orozco-Beltrán D, Sánchez E, Garrido A, Quesada JA, Carratalá-Munuera MC, Gil-Guillén VF. Trends in Mortality From Diabetes Mellitus in Spain: 1998-2013. ACTA ACUST UNITED AC 2016; 70:433-443. [PMID: 27825716 DOI: 10.1016/j.rec.2016.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/18/2015] [Accepted: 07/13/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Diabetes mellitus (DM) is a leading causes of death, mainly due to cardiovascular complications. The aim of this study was to describe DM mortality in Spain from 1998 to 2013 and to compare it between distinct provinces. METHODS Ecological time-trend study. Data sources consisted of the population register and the death rate figures, by cause of death, from Spain's National Statistics Institute. Rates were age-standardized by the direct method. Standardized mortality rates were calculated for each province every 5 years (1998-2013). Time trends in mortality were established by joint point regression models. RESULTS The standardized mortality rate for DM fell markedly, by 25.3% in men and by 41.4% in women from 1998 to 2013. At the beginning of the study period, mortality rates were higher in southern than in northern regions, but this difference gradually disappeared in later years. The highest mortality rates were consistently found in the Canary Islands. CONCLUSIONS Mortality from DM fell substantially from 1998 to 2013. The marked geographical clustering showing higher mortality in the south and southeastern areas of the country was significantly reduced during the study period, except in the Canary Islands, where mortality remains strikingly high.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain.
| | - Eva Sánchez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain
| | - Alejandro Garrido
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain
| | - José Antonio Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain
| | | | - Vicente F Gil-Guillén
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain
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Navarro-Juan M, Carbonell-Torregrosa MÁ, Palazón-Bru A, Martínez-Díaz AM, Gil-Guillén VF. Nonadherence to guidelines for prescribing antiplatelet/anticoagulant therapy in patients with atrial fibrillation. Fam Pract 2016; 33:290-5. [PMID: 27006412 DOI: 10.1093/fampra/cmw017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/13/2022] Open
Abstract
BACKGROUND We have found no papers evaluating nonadherence to guidelines for the treatment of atrial fibrillation (AF), taking into account the two risk scales [C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke (CHADS2) and C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke; V, vascular disease; A, age; Sc, sex category (CHA2DS2-VASc)] and the two types of treatment that are recommended (antiplatelet/anticoagulant therapy). OBJECTIVE To determine the extent of lack of adherence when prescribing anticoagulant and antiplatelet therapy to patients with AF and associated factors. METHODS Cross-sectional, observational study of 144 patients with AF who visited the emergency department of Elda Hospital in 2013-14 (Spain). Main variable: the patient was prescribed a therapy different from that indicated by the guidelines (nonadherence) or not prescribed any therapy. Secondary variables: CHADS2, CHA2DS2-VASc, HAS-BLED, type of AF and symptoms related to AF. Multivariate models were constructed to identify the associated factors by calculating the adjusted odds ratios (OR). RESULTS Nonadherence occurred in 90 patients [62.5%, 95% confidence interval (CI): 54.6-70.4%]. Associated factors were higher CHADS2 (OR = 1.30, 95% CI: 0.96-1.75, P = 0.091) and CHA2DS2-VASc (OR = 1.23, 95% CI: 1.02-1.47, P = 0.027), and lower HAS-BLED (OR = 0.67, 95% CI: 0.49-0.91, P = 0.011). CONCLUSIONS Nonadherence to guidelines was found in three out of every five patients. A greater cerebrovascular risk and a lower haemorrhagic risk were associated with this behaviour. Qualitative studies are needed to determine the causes.
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Affiliation(s)
| | | | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante and Research Unit, Elda Hospital, Elda, Alicante, Spain.
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante and Research Unit, Elda Hospital, Elda, Alicante, Spain
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Piqueras-Rodríguez F, Palazón-Bru A, Martínez-St John DRJ, Folgado-de la Rosa DM, Gil-Guillén VF. A Tool to Quickly Detect Short Hamstring Syndrome in Boys who Play Soccer. Int J Sports Med 2015; 37:1-5. [PMID: 26509385 DOI: 10.1055/s-0035-1554699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED There is a lack of studies of alternative techniques differing from the straight leg raise test (SLR) and the passive knee extension test (PKE) to diagnose short hamstring syndrome (SHS). We built a predictive model with simple parameters to diagnose SHS and implemented it in a mobile app. This cross-sectional study analyzed 85 Spanish boys aged 10-16 years who played soccer in 2012. OUTCOMES SHS (SLR<70° and/or PKE>15°), and grade II SHS (SLR<60° and/or PKE≥35°). Secondary variables: toe-touch test (TT), body mass index (BMI), age, laterality and number of years registered as part of a federation. A risk table implemented in a mobile app was built to estimate the probability of SHS and grade II SHS according to secondary variables. The area under the ROC curve (AUC) was calculated and we constructed risk groups. Scoring factors for SHS: low TT, younger age and lower BMI. AUC: 0.89 (95% CI: 0.82-0.96, p<0.001). Scoring factors for grade II SHS: younger age, higher BMI, left footed and lower TT. AUC: 0.78 (95% CI: 0.68-0.88, p<0.001). We provide a tool with minimum material but with a high discriminatory power to quickly calculate whether a boy who plays soccer has SHS. The models need validation studies.
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Affiliation(s)
| | - A Palazón-Bru
- Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | | | | | - V F Gil-Guillén
- Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
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Veciana-Galindo C, Cortés-Castell E, Torró-Montell L, Palazón-Bru A, Sirvent-Segura E, Rizo-Baeza MM, Gil-Guillén VF. Anti-adipogenic activity of an olive seed extract in mouse fibroblasts. NUTR HOSP 2015; 31:2747-51. [PMID: 26040391 DOI: 10.3305/nh.2015.31.6.8997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
UNLABELLED The administration of different polyphenols protects against increased body weight and fat accumulation. The aim of the study was to determine the anti-adipogenic activity of an olive-seed polyphenolic extract, by means of mouse fibroblast cell line 3T3-L1 adipocyte differentiation. MATERIAL AND METHODS Cells were incubated and differentiated (6000 cells/cup) in the presence of olive-seed extract at 10 and 50 mg/l biosecure concentrations of polyphenols, and with no extract in the control sample. After 5 to 7 days mature adipocytes are formed. The fat clusters are quantified by means of red-oil staining, 490 nm absorbance, and the expression of the leptin and PPARg genes, and then compared to the values obtained in the cultures before and after adipocyte differentiation. RESULTS The control samples, with no extract, presented an accumulation of fat of 100%. By contrast, the addition of 50 mg/l of olive-seed extract polyphenols resulted in a 50% accumulation of fat, similar to that of the non-differentiated cells. A 10 mg/l extract concentration had no effect. Anti-adipogenic activity is thus confirmed, as the expression of the PPARg and leptin genes is reduced in adipocyte differentiation in the presence of extract at 50 mg/l. In conclusion, both the formation of fatty substances characteristic of adipogenesis, and the expression of the adipogenic PPARg and leptin genes are found to be inhibited by the prior addition of olive-seed extract polyphenols at a 50 mg/l concentration.
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Affiliation(s)
| | - Ernesto Cortés-Castell
- Department of Pharmacology, Pediatrics and Organic Chemistry. Miguel Hernández University. San Juan de Alicante..
| | | | - Antonio Palazón-Bru
- Department of Clinical Medicine. Miguel Hernández University. San Juan de Alicante..
| | | | - María M Rizo-Baeza
- Department of Nursing and Nutrition. University of Alicante. San Vicente del Raspeig, Spain..
| | - Vicente F Gil-Guillén
- Department of Clinical Medicine. Miguel Hernández University. San Juan de Alicante..
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Martínez-St John DRJ, Palazón-Bru A, Gil-Guillén VF, Sepehri A, Navarro-Cremades F, Orozco-Beltrán D, Carratalá-Munuera C, Cortés E, Rizo-Baeza MM. Differences in the management of hypertension, diabetes mellitus and dyslipidemia between obesity classes. J Hum Hypertens 2015; 30:7-10. [PMID: 25833705 DOI: 10.1038/jhh.2015.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 11/09/2022]
Abstract
We did not find any paper that assessed clinical inertia in obese patients. Therefore, no paper has compared the clinical inertia rates between morbidly and nonmorbidly obese patients. A cross-sectional observational study was carried out. We analysed 8687 obese patients ⩾40 years of age who attended their health-care center for a checkup as part of a preventive program. The outcome was morbid obesity. Secondary variables were as follows: failure in the management of high blood pressure (HBP), high blood cholesterol (HBC) and high fasting blood glucose (HFBG); gender; personal history of hypertension, dyslipidemia, diabetes, smoking and cardiovascular disease; and age (years). We analysed the association between failures and morbid obesity by calculating the adjusted odds ratio (OR). Of 8687 obese patients, 421 had morbid obesity (4.8%, 95% confidence interval (CI): 4.4-5.3%). The prevalence rates for failures were as follows: HBP, 34.7%; HBC, 35.2%; and HFBG, 12.4%. Associated factors with morbid obesity related with failures were as follows: failure in the management of HBP (OR=1.42, 95% CI: 1.15-1.74, P=0.001); failure in the management of HBC (OR=0.73, 95% CI: 0.58-0.91, P=0.004); and failure in the management of HFBG (OR=2.24, 95% CI: 1.66-3.03, P<0.001). Morbidly obese patients faced worse management for HBP and HFBG, and better management for HBC. It would be interesting to integrate alarm systems to avoid this problem.
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Affiliation(s)
- D R J Martínez-St John
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - A Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Research Unit, Elda Hospital, Elda, Spain
| | - V F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,Research Unit, Elda Hospital, Elda, Spain
| | - A Sepehri
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - F Navarro-Cremades
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - D Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - C Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - E Cortés
- Department of Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernández University, San Juan de Alicante, Spain
| | - M M Rizo-Baeza
- Department of Nursing, University of Alicante, San Juan de Alicante, Spain
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Ramírez-Prado D, Palazón-Bru A, Folgado-de-la Rosa DM, Carbonell-Torregrosa MÁ, Martínez-Díaz AM, Gil-Guillén VF. Predictive models for all-cause and cardiovascular mortality in type 2 diabetic inpatients. A cohort study. Int J Clin Pract 2015; 69:474-84. [PMID: 25234387 DOI: 10.1111/ijcp.12563] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/15/2014] [Accepted: 08/31/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many authors have analysed premature mortality in cohorts of type 2 diabetic patients, but no analyses have assessed mortality in hospitalised diabetic patients. AIM To construct predictive models to estimate the likelihood of all-cause mortality and cardiovascular mortality in type 2 diabetic inpatients. DESIGN Cohort study with follow-up from 2010 to 2014. METHODS We evaluated mortality in a randomly selected cohort of 112 type 2 diabetic inpatients at the Hospital of Elda (Spain) in 2010-2012. OUTCOMES all-cause mortality and cardiovascular mortality during the follow-up. Other variables: gender, age, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidemia, insulin, pills, smoking, walking, baseline blood glucose and creatinine. Predictive tables with risk groups were constructed to estimate the likelihood of all-cause mortality and cardiovascular mortality. Calculations were made of the area under the ROC curve (AUC). RESULTS During the follow-up, 52 inpatients died (46.4%, 95% CI, confidence interval: 37.2-55.7%), 22 because of cardiovascular causes (19.6%, 95% CI: 12.3-27.0%). The mean follow-up time was 2.7 ± 1.5 years. The AUC for the all-cause mortality model was 0.84 (95% CI: 0.77-0.92, p < 0.001). Associated parameters: pills, smoking, walking, gender, insulin and age. The AUC for the cardiovascular mortality model was 0.79 (95% CI: 0.67-0.91, p < 0.001). Associated parameters: age, pills, walking, smoking, depression and insulin. CONCLUSIONS This study provides tools to predict premature mortality in type 2 diabetic inpatients. However, before their general application they require joint validation by the internal medicine unit, emergency department, primary healthcare unit and endocrinology service to enable better prediction of the prognosis and more adequate decision-taking.
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Affiliation(s)
- D Ramírez-Prado
- Research Unit, Elda Hospital, Elda, Spain; Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
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Fornós-Garrigós A, Orozco-Beltrán D, Gil-Guillén VF, Puig-Barberà J, Fluixa C, Fernández A. Appropriateness of clopidogrel use according to current recommendations. Fam Pract 2014; 31:694-8. [PMID: 25114161 DOI: 10.1093/fampra/cmu039] [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: 11/14/2022] Open
Abstract
BACKGROUND Clopidogrel is widely used in cardiovascular prevention. However, the prescription of clopidogrel in clinical practice does not match the recommendations concerning its indication and treatment duration. OBJECTIVE To assess the appropriateness of clopidogrel prescription according to the accepted indications. METHODS We undertook a retrospective observational analytical audit of the electronic clinical records in the region of Valencia, Spain (5 million inhabitants), selecting those patients on treatment with clopidogrel between 2007 and 2010. The primary outcome measure was the duration of the treatment. RESULTS A total of 45721 patients started clopidogrel treatment during the study period. Treatment was for cardiologic disorders (CD) in 56.85% of the patients, neurologic disorders (ND) in 37.06% and peripheral arterial disease in 6.08%. Treatment duration was longer than that expected from clinical recommendations in 38.8% of the CD patients and 87.8% of the ND patients. The estimated avoidable cost ranged from 2 to 4.4 million Euros per year, according to whether a cheaper generic clopidogrel or a more expensive version was considered. CONCLUSIONS Almost 40% of the cardiologic patients and 90% of the neurologic patients received excess treatment. Adjustment of treatment duration to international recommendations would result in savings of between 80.1 and 176.3 Euros per year and per patient treated.
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Affiliation(s)
- Antonio Fornós-Garrigós
- Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and
| | - Domingo Orozco-Beltrán
- Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain
| | - Vicente F Gil-Guillén
- Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain.
| | - Joan Puig-Barberà
- Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain
| | - Carlos Fluixa
- Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and
| | - Antonio Fernández
- Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain
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Martínez-Orozco MJ, Perseguer-Torregrosa Z, Gil-Guillén VF, Palazón-Bru A, Orozco-Beltran D, Carratalá-Munuera C. Suitability of antiplatelet therapy in hypertensive patients. J Hum Hypertens 2014; 29:40-5. [PMID: 24694801 DOI: 10.1038/jhh.2014.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 02/14/2014] [Accepted: 02/18/2014] [Indexed: 11/09/2022]
Abstract
Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt.
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Affiliation(s)
- M J Martínez-Orozco
- 1] Miguel Martínez Community Pharmacy, Benimantell, Spain [2] Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Z Perseguer-Torregrosa
- 1] Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain [2] Zeneida Perseguer Community Pharmacy, Petrel, Spain
| | - V F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - A Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - D Orozco-Beltran
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - C Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
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Palazón-Bru A, Gil-Guillén VF, Orozco-Beltrán D, Pallarés-Carratalá V, Valls-Roca F, Sanchís-Domenech C, Martín-Moreno JM, Redón J, Navarro-Pérez J, Fernández-Giménez A, Pérez-Navarro AM, Trillo JL, Usó R, Ruiz E. Is the physician's behavior in dyslipidemia diagnosis in accordance with guidelines? Cross-sectional ESCARVAL study. PLoS One 2014; 9:e91567. [PMID: 24626597 PMCID: PMC3953440 DOI: 10.1371/journal.pone.0091567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/12/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires ≥2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC). OBJECTIVES To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors. DESIGN Cross-sectional. SETTING All health center visits in the second half of 2010 in the Valencian Community (Spain). PATIENTS 11,386 nondyslipidemic individuals aged ≥20 years with ≥2 lipid determinations. MEASUREMENT VARIABLES Gender, atrial fibrillation, hypertension, diabetes, cardiovascular disease, age, and ESCARVAL training course. Lipid groups: normal (TC<5.17 mmol/L and normal HDL-c [≥1.03 mmol/L in men and ≥1.29 mmol/L in women], TC inertia (TC≥5.17 mmol/L and normal HDL-c), HDL-c inertia (TC<5.17 mmol/L and low HDL-c), and combined inertia (TC≥5.17 mmol/L and low HDL-c). RESULTS TC inertia: 38.0% (95% CI: 37.2-38.9%); HDL-c inertia: 17.7% (95% CI: 17.0-18.4%); and combined inertia: 9.6% (95% CI: 9.1-10.2%). The profile associated with TC inertia was: female, no cardiovascular risk factors, no cardiovascular disease, middle or advanced age; for HDL-c inertia: female, cardiovascular risk factors and cardiovascular disease; and for combined inertia: female, hypertension and middle age. LIMITATIONS Cross-sectional study, under-reporting, no analysis of some cardiovascular risk factors or other lipid parameters. CONCLUSIONS A more proactive attitude should be adopted, focusing on the full diagnosis of dyslipidemia in clinical practice. Special emphasis should be placed on patients with low HDL-c levels and an increased cardiovascular risk.
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Affiliation(s)
- Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | | | | | - Vicente Pallarés-Carratalá
- Health Surveillance Department, Mutual Society of Castellón, Castellón, Spain
- Department of Medicine, Jaume I University, Castellón, Spain
| | | | | | | | - Josep Redón
- School of Medicine, University of Valencia, Valencia, Spain
| | | | | | - Ana M. Pérez-Navarro
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Generalitat Valenciana, Valencia, Spain
| | - José L. Trillo
- Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
| | - Ruth Usó
- Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
| | - Elías Ruiz
- Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
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Márquez-Contreras E, Gil-Guillén VF, De La Figuera-Von Wichmann M, Franch-Nadal J, Llisterri-Caro JL, Martell-Claros N, Martin-De Pablos JL, Casado-Martinez JJ, Bertomeu-Gonzalez V, Pertusa Martínez S, Carratalá-Munuera C, Orozco-Beltrán D, Lopez-Pineda A. Non-compliance and inertia in hypertensive Spaniards at high cardiovascular risk: CUMPLE study. Curr Med Res Opin 2014; 30:11-7. [PMID: 24111509 DOI: 10.1185/03007995.2013.849237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess non-compliance (NC) and therapeutic inertia (TI) after 6 months of follow-up in hypertensive patients with poorly controlled blood pressure and high cardiovascular risk. RESEARCH DESIGN AND METHODS Longitudinal, multicentre study; 3900 uncontrolled hypertensive patients were recruited from 585 primary healthcare centres. Tablets were counted during visits at baseline, 1, 3 and 6 months. A tablet count between 80-100% was considered as compliant. Multivariate logistic regression was performed to determine variables associated with NC and TI. RESULTS A total of 3636 patients completed, mean age was 64.8 (SD 10.8) years, 53.7% being male. After one month, 61.8% (60.2-63.4) had uncontrolled blood pressure, 39.5% (37.9-41.1) were NC and 52.3% (50.2-54.4) had TI. At the end of follow-up, uncontrolled blood pressure was 34.6% (33.1-36.1) (p < 0.05), NC was 46.8% (45.2-48.4) (p < 0.05) and TI was 34.2% (31.6-36.8) (p < 0.05). The variable associated with NC was greatest number of antihypertensive treatments (OR 1.09, 95% CI 1.05-1.13, p < 0.001), and variables associated with TI were least number of antihypertensive drugs (OR 0.88, 95% CI 0.84-0.98, p < 0.001) and least number of diseases suffered (OR 0.95, 95% CI 0.92-0.98, p = 0.002). LIMITATIONS Due to the complexity of measuring compliance, we have to assume measurement bias. CONCLUSIONS Among uncontrolled hypertensive patients, after completing 6 months follow-up, approximately one out of two patients were NC and one out of three physicians committed TI.
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Artigao-Rodenas LM, Carbayo-Herencia JA, Divisón-Garrote JA, Gil-Guillén VF, Massó-Orozco J, Simarro-Rueda M, Molina-Escribano F, Sanchis C, Carrión-Valero L, López de Coca E, Caldevilla D, López-Abril J, Carratalá-Munuera C, Lopez-Pineda A. Framingham risk score for prediction of cardiovascular diseases: a population-based study from southern Europe. PLoS One 2013; 8:e73529. [PMID: 24039972 PMCID: PMC3764050 DOI: 10.1371/journal.pone.0073529] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/22/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity. METHODS The cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated. RESULTS The mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (P<0.001, both). Cardiovascular disease events occurred in the top risk tertiles. Of note were the negative predictive values in both sexes, and a good specificity in women (85.6%) and sensitivity in men (79.1%) when their risk for cardiovascular disease was high. This model overestimates the risk in older women and in middle-aged men. The cumulative probability of individual survival by tertiles was significant in both sexes (P<0.001). CONCLUSIONS The results support the proposal for "reclassification" of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe.
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Affiliation(s)
| | - Julio A. Carbayo-Herencia
- Medical Corps, Academia General del Aire, Murcia, Spain
- School of Medicine, University of Castilla-La Mancha, Albacete, Spain
| | | | - Vicente F. Gil-Guillén
- Clinical Medicine Department, Chair of Family, University of Miguel Hernandez, San Juan de Alicante, Spain
- Research Unit, Elda Hospital, Elda, Spain
| | - Javier Massó-Orozco
- Community Medicine, Casas de Juan Núñez Primary Health Care Centre, Albacete, Spain
| | | | | | - Carlos Sanchis
- Community Medicine, Primary Health Care Centre, Valencia, Spain
| | | | | | | | - Juan López-Abril
- Community Medicine, Zone 3 Primary Health Care Centre, Albacete, Spain
| | | | - Adriana Lopez-Pineda
- Clinical Medicine Department, Chair of Family, University of Miguel Hernandez, San Juan de Alicante, Spain
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Mira JJ, Orozco-Beltrán D, Pérez-Jover V, Martínez-Jimeno L, Gil-Guillén VF, Carratala-Munuera C, Sánchez-Molla M, Pertusa-Martínez S, Asencio-Aznar A. Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities. Fam Pract 2013; 30:56-63. [PMID: 22904014 DOI: 10.1093/fampra/cms046] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To analyse the frequency of mistakes in communication between the physician and the patient and their incidence in errors in self-administered drugs. METHODS We undertook a descriptive, cross-sectional study based on interviews with a random sample of patients older than 65 years who were polymedicated (five or more drugs) and had multiple comorbidities. Data were analysed about the patients' reports of what the physician said, medication mistakes by the patients and their consequences. RESULTS Responses were provided by 382 patients. A medication error in the last year was reported by 287 patients (75%), and 16 patients (4%) reported four or more errors. Most cases concerned the dosage, a similar appearance of the medication or a lack of understanding of the physician's instructions. Very severe consequences occurred in 19 cases (5%). Multiple comorbidities (P = 0.006) and a greater number of treatments (P = 0.002) were associated with making mistakes. Frequent changes in prescription (P = 0.02), not considering the prescriptions of other physicians (P = 0.01), inconsistency in the messages (P = 0.01), being treated by various different physicians at the same time (P = 0.03), a feeling of not being listened to (P < 0.001) or loss of trust in the physician (P < 0.001) were associated with making medication mistakes. CONCLUSIONS Mistakes by polymedicated patients with multiple comorbidities represent a real risk that should be addressed by the professionals. A review should be made of the routine control questions that the physician asks the patient to identify what other drugs the patient may be taking that have been indicated by another physician.
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Clua-Espuny JL, Piñol-Moreso JL, Gil-Guillén VF, Orozco-Beltrán D, Panisello-Tafalla A, Lucas-Noll J, Queralt-Tomás ML, Pla-Farnós R. [Primary and secondary cardiovascular prevention results in patients with stroke: relapse risk and associated survival (Ebrictus study)]. Rev Neurol 2012; 54:81-92. [PMID: 22234566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The prevalence and cardiovascular risk factors control (CVRF) are determining to suffer a stroke and its relapse which arise the mortality and disability. AIM To estimate the incidence of the first episode of ictus and describe the results in primary and secondary cardiovascular prevention. PATIENTS AND METHODS Observational and prospective study of a fix cohort of 130,649 people, 15-90-year-old assigned to participants centers between 01/04/2006 and 31/03/2008. Community based register. Analyses were performed with the use of time-to-event methods, included Cox's multivariate on survival, risk of it's relapse; the CVRF diagnosed and it's relative risk (RR); cardiovascular risk. RESULTS 553 patients were enrolled (48,8% female), average age 73.3 ± 11.6 years with the first episode of stroke. After the episode, the hypertension (74.9% vs 88.7%), atrial fibrillation (9.9% vs 16%) and dislipemia (37.8% vs 49.8%) increased significantly as well its control. The 47% (95% CI = 42.8-51.2) of the cases had high risk of relapsing. In the 15.7% of the patients happened relapse of cardiovascular event, 48.3% of which were stroke. The main predictors variables were history of recurrent cardiovascular event (RR = 6.7; 95% CI = 2.2-21.7) and the aging (RR = 1,08; 95% CI = 1.01-1.2). CONCLUSION The cardiovascular secondary prevention seems to be more effective both in CVRF's detection and its control and is extremely important to get better results of survival.
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Affiliation(s)
- Josep Ll Clua-Espuny
- Equipo de Atención Primaria Tortosa 1-est, Servicio de Atención Primaria Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, España.
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Sanfelix-Genovés J, Gil-Guillén VF, Orozco-Beltran D, Giner-Ruiz V, Pertusa-Martínez S, Reig-Moya B, Carratalá C. Determinant factors of osteoporosis patients' reported therapeutic adherence to calcium and/or vitamin D supplements: a cross-sectional, observational study of postmenopausal women. Drugs Aging 2010; 26:861-9. [PMID: 19761279 DOI: 10.2165/11317070-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Among the various treatments for osteoporosis, calcium and/or vitamin D supplements are frequently included. OBJECTIVE The objective of the study was to analyse adherence to calcium and/or vitamin D treatment and to identify related predictors of non-adherence in a sample of postmenopausal women treated for osteoporosis in primary care. METHODS A cross-sectional, observational study was conducted in a sample of postmenopausal women receiving pharmaceutical treatment for osteoporosis with vitamin D and/or calcium. Sociodemographic, general and osteoporosis-related data were collected. Patient's perceptions of the adverse effects of treatment, their knowledge of osteoporosis (Batalla test), their attitude towards treatment (Morisky-Green test) and their self-reported therapeutic adherence (Haynes-Sackett test) were assessed. RESULTS Of 630 women (mean age +/- SD 64.1 +/- 8.7 years) evaluated, 36.2% (95% CI 32.4, 39.9) had problems with treatment tolerability, 63.5% (95% CI 59.7, 67.3) had good knowledge of osteoporosis, 20.5% (95% CI 17.3, 23.6) had a good attitude to treatment and 50.0% (95% CI 46.1, 53.9) had good self-reported adherence to treatment. Patients in the poor adherence group had higher mean body mass index (p = 0.014), more concurrent pathologies (p = 0.003), more tolerability problems (p < 0.001) and worse attitude to treatment (p < 0.001). The multivariate model showed a positive relationship between therapeutic adherence and good attitude to treatment (odds ratio [OR] = 11.7; p < 0.001), not having tolerability problems (OR = 3.3; p < 0.001) and no polymedication (OR = 0.80; p = 0.017). CONCLUSIONS Only one in two postmenopausal women with osteoporosis who take calcium and/or vitamin D have good self-reported therapeutic adherence to this treatment. Determinant factors of adherence to calcium and/or vitamin D treatment were patient's attitude to the treatment, tolerability problems with the treatment and number of concurrent treatments.
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Mateo JF, Gil-Guillén VF, Mateo E, Orozco D, Carbayo JA, Merino J. Multifactorial approach and adherence to prescribed oral medications in patients with type 2 diabetes. Int J Clin Pract 2006; 60:422-8. [PMID: 16620354 DOI: 10.1111/j.1368-5031.2006.00799.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [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] [Indexed: 11/29/2022] Open
Abstract
The aims of this study were to assess adherence to oral hypoglycaemic/cardiovascular drugs and determine non-adherence predictors in type 2 diabetes patients. It was designed as a population-based cross-sectional study in which 90 patients from a primary care setting were studied. Pill count and self-report methods were used to measure adherence. Logistic regression analysis was performed to predict factors related to non-adherence. Adequate adherence to all drugs was found in 29 patients (35.4%; 95% confidence interval (CI) 25.0-45.7). Variables associated with non-adherence were HbA1c odds ratio (OR) 2.32 (95% CI: 1.09-4.95), systolic blood pressure OR 1.68 (95% CI: 1.08-2.62), total cholesterol OR 1.34 (95% CI: 1.08-1.66), number of pills OR 1.80 (95% CI: 1.26-2.55) and duration of disease OR 0.44 (CI 95%: 0.24-0.83). In conclusion, one in three patients had adequate adherence. Factors associated with non-adherence were duration of disease, complexity of drug regimen and inadequate control of cardiovascular risk factors.
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Affiliation(s)
- J F Mateo
- Primary Care at UMH, Alicante, Rafelcofer Health Centre,Valencia, Spain.
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