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González-Pacheco H, Rivero-Santana A, Ramallo-Fariña Y, Valcárcel-Nazco C, Álvarez-Pérez Y, García-Pérez L, García-Bello MA, Perestelo-Pérez L, Serrano-Aguilar P. Effectiveness, safety and costs of the FreeStyle Libre glucose monitoring system for children and adolescents with type 1 diabetes in Spain: a prospective, uncontrolled, pre-post study. BMJ Open 2023; 13:e071334. [PMID: 38097245 PMCID: PMC10729222 DOI: 10.1136/bmjopen-2022-071334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness, safety and costs of FreeStyle Libre (FSL) glucose monitoring system for children and adolescents with type 1 diabetes mellitus (T1DM) in Spain. DESIGN Prospective, multicentre pre-post study. SETTING Thirteen Spanish public hospitals recruited patients from January 2019 to March 2020, with a 12-month follow-up. PARTICIPANTS 156 patients were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: glycated haemoglobin (HbA1c) change. Secondary: severe hypoglycaemic events (self-reported and clinical records), quality of life, diabetes treatment knowledge, treatment satisfaction, adverse events, adherence, sensor usage time and scans. Healthcare resource utilisation was assessed for cost analysis from the National Health System perspective, incorporating direct healthcare costs. Data analysis used mixed regression models with repeated measures. The intervention's total cost was estimated by multiplying health resource usage with unit costs. RESULTS In the whole sample, HbA1c increased significantly (0.32%; 95% CI 0.10% to 0.55%). In the subgroup with baseline HbA1c≥7.5% (n=88), there was a significant reduction at 3 months (-0.46%; 95% CI -0.69% to -0.23%), 6 months (-0.49%; 95% CI -0.73% to -0.25%) and 12 months (-0.43%; 95% CI -0.68% to -0.19%). Well-controlled patients had a significant 12-month worsening (0.32%; 95% CI 0.18% to 0.47%). Self-reported severe hypoglycaemia significantly decreased compared with the previous year for the whole sample (-0.37; 95% CI -0.62 to -0.11). Quality of life and diabetes treatment knowledge showed no significant differences, but satisfaction increased. Adolescents had lower sensor usage time and scans than children. Reduction in HbA1c was significantly associated with device adherence. No serious adverse effects were observed. Data suggest that use of FSL could reduce healthcare resource use (strips and lancets) and costs related to productivity loss. CONCLUSIONS The use of FSL in young patients with T1DM was associated with a significant reduction in severe hypoglycaemia, and improved HbA1c levels were seen in patients with poor baseline control. Findings suggest cost savings and productivity gains for caregivers. Causal evidence is limited due to the study design. Further research is needed to confirm results and assess risks, especially for patients with lower baseline HbA1c.
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Affiliation(s)
- Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Cristina Valcárcel-Nazco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Miguel Angel García-Bello
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
- Institute of Biomedical Technologies (ITB), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
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González-Colaço Harmand M, Tejera Concepción A, Farráis Expósito FJ, Domínguez González J, Ramallo-Fariña Y. Pilot Study on the Relationship between Malnutrition and Grip Strength with Prognosis in Diabetic Foot. Nutrients 2023; 15:3710. [PMID: 37686742 PMCID: PMC10490286 DOI: 10.3390/nu15173710] [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: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Sarcopenia and malnutrition have been associated in the elderly population with a poor prognosis in wound healing and with other adverse events, such as institutionalization or functional impairment. However, it is not known how these factors influence the prognosis of diabetic foot in the elderly. To answer this question, a prospective observational study of 45 patients over 65 years of age admitted with diagnoses of diabetic foot in a tertiary hospital has been conducted. All patients were assessed at admission and at 3 months after returning home to determine quality of life, pain, mobility and healing, overall hospital stay in relation to the presence of malnutrition (measured by BMI, CIPA scale and analytical parameters at admission of serum proteins and albumin), and sarcopenia measured by grip force, among other geriatric syndromes. The results found a relationship between altered sarcopenia and more pain and poorer quality of life, and altered BMI was related to a lower cure rate and worse mobility at follow-up. This study seems to indicate that, in the elderly population with diabetic foot, malnutrition and sarcopenia should be managed at the same time as the treatment of the diabetic foot itself.
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Affiliation(s)
- Magali González-Colaço Harmand
- Department of Internal Medicine-Geriatric Medicine, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Spain
| | - Alicia Tejera Concepción
- Department of Internal Medicine-Geriatric Medicine, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- Internal Medicine Department, Universidad de la Laguna, 38200 La Laguna, Spain
| | | | | | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 35019 Las Palmas de Gran Canaria, Spain;
- Network for Research on Chronicity Primary Care and Health Promotion, 28029 Madrid, Spain
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3
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Clavo B, Cánovas-Molina A, Díaz-Garrido JA, Cañas S, Ramallo-Fariña Y, Laffite H, Federico M, Rodríguez-Abreu D, Galván S, García-Lourve C, González-Beltrán D, Caramés MA, Hernández-Fleta JL, Serrano-Aguilar P, Rodríguez-Esparragón F. Effects of ozone therapy on anxiety and depression in patients with refractory symptoms of severe diseases: a pilot study. Front Psychol 2023; 14:1176204. [PMID: 37599784 PMCID: PMC10437070 DOI: 10.3389/fpsyg.2023.1176204] [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: 02/28/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Patients with refractory symptoms of severe diseases frequently experience anxiety, depression, and an altered health-related quality of life (HRQOL). Some publications have described the beneficial effect of ozone therapy on several symptoms of this kind of patient. The aim of this study was to preliminarily evaluate, in patients treated because of refractory symptoms of cancer treatment and advanced nononcologic diseases, if ozone therapy has an additional impact on self-reported anxiety and depression. Methods Before and after ozone treatment, we assessed (i) anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS); (ii) the HRQOL (according to the EQ-5D-5L questionnaire), which includes a dimension on anxiety and depression and a visual analog scale (VAS) measuring self-perceived general health. Results Before ozone therapy, 56% of patients were on anxiolytic and/or antidepressant treatment. Before and after ozone therapy, the anxiety and depression HADS subscales (i) significantly correlated with the anxiety/depression dimension of the EQ-5D-5L questionnaire and (ii) inversely correlated with the health status as measured by the VAS. After ozone therapy, we found a significant improvement in anxiety and depression measured by both the (i) HADS subscales and (ii) EQ-5D-5L questionnaire. Conclusion The addition of ozone therapy for patients with refractory symptoms of cancer treatment and advanced chronic nononcologic diseases can decrease anxiety and depression severity levels. Additional, more focused studies are ongoing to provide the needed explanatory information for this finding.
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Affiliation(s)
- Bernardino Clavo
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Radiation Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria/Tenerife, Spain
- Universitary Institute for Research in Biomedicine and Health (iUIBS), Molecular and Translational Pharmacology Group, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias de la Universidad de La Laguna, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Spanish Group of Clinical Research in Radiation Oncology (GICOR), Madrid, Spain
| | - Angeles Cánovas-Molina
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria/Tenerife, Spain
| | - Juan A. Díaz-Garrido
- Psychiatry Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Silvia Cañas
- Psychiatry Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria/Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Santa Cruz de Tenerife, Spain
- Servicio de Evaluación y Planificación del Servicio Canario de Salud (SESCS), Santa Cruz de Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de la Laguna, Santa Cruz de Tenerife, Spain
| | - Horus Laffite
- Psychiatry Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Delvys Rodríguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Saray Galván
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Carla García-Lourve
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria/Tenerife, Spain
| | - Damián González-Beltrán
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Miguel A. Caramés
- Chronic Pain Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Jose L. Hernández-Fleta
- Psychiatry Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Pedro Serrano-Aguilar
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria/Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de la Laguna, Santa Cruz de Tenerife, Spain
| | - Francisco Rodríguez-Esparragón
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria/Tenerife, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias de la Universidad de La Laguna, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Benítez-Brito N, González-Pacheco H, Pinto-Robayna B, Moreno-Redondo F, Díaz-Romero C, Ramallo-Fariña Y. Preliminary assessment of the degree of food addiction through the Spanish Yale Food Addiction Scale for Children (S-YFAS-C) in a pilot pediatric population. J Eat Disord 2023; 11:72. [PMID: 37170368 PMCID: PMC10173564 DOI: 10.1186/s40337-023-00798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION The Spanish Yale Food Addiction Scale for Children (S-YFAS-C) scale is the first tool adapted to Spanish to evaluate food addiction (FA) in the paediatric population. The aim of this study is to preliminarily evaluate the degree of FA in a non-clinical pilot paediatric population. MATERIAL AND METHODS A transversal observational study was performed on a convenience sample comprised of boys and girls aged 9 to 12 (4th to 6th year primary school). The main outcome measures were evaluation of FA (S-YFAS-C scale), child feeding attitudes (ChEAT scale) and evaluation of body image (CDRS scale). Moreover, sociodemographic and anthropometric data were collected. A descriptive and bivariate analysis of the main characteristics of subjects and outcome measures was performed. RESULTS A total of 21 boys and 24 girls were preliminarily evaluated and the minimum and maximum values obtained were for age (9.48-12.33), weight in kilograms (26.6-64.5), height in centimetres (131-163), BMI (14.2-27.9) and BMI Z-score (-1.36-2.66). The average number of FA symptoms measured with the S-YFAS-C scale is 1.67 ± 1.45 (range 0-7). A total of 20% of the sample shows three or more symptoms for FA, risk of developing a food disorder and distortion of the body image. Moreover, statistically significant differences were observed between desired body image in boys and girls (P = 0.001). CONCLUSIONS The S-YFAS-C scale enables evaluating food addiction in Spanish-speaking boys and girls. The data obtained in regard to quantifying symptoms are similar compared to the original scale (S-YFAS-C: 1.67 ± 1.45 vs. YFAS-C: 2 ± 1.81). The option to score the counting of symptoms is the most sensitive measure to evaluate subclinical food behaviours.
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Affiliation(s)
- Néstor Benítez-Brito
- Chemistry Section, Department of Chemical Engineering and Pharmaceutical Technology, Nutrition and Bromatology Area, Pharmacy Faculty, Science Faculty, University of La Laguna, Avenida Astrofísico Francisco Sánchez, s/n, Apartado 456, San Cristóbal de La Laguna, S/C of Tenerife, 38200, Tenerife, Spain.
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Berta Pinto-Robayna
- Chemistry Section, Department of Chemical Engineering and Pharmaceutical Technology, Nutrition and Bromatology Area, Pharmacy Faculty, Science Faculty, University of La Laguna, Avenida Astrofísico Francisco Sánchez, s/n, Apartado 456, San Cristóbal de La Laguna, S/C of Tenerife, 38200, Tenerife, Spain
| | - Francisco Moreno-Redondo
- Chemistry Section, Department of Chemical Engineering and Pharmaceutical Technology, Nutrition and Bromatology Area, Pharmacy Faculty, Science Faculty, University of La Laguna, Avenida Astrofísico Francisco Sánchez, s/n, Apartado 456, San Cristóbal de La Laguna, S/C of Tenerife, 38200, Tenerife, Spain
| | - Carlos Díaz-Romero
- Chemistry Section, Department of Chemical Engineering and Pharmaceutical Technology, Nutrition and Bromatology Area, Pharmacy Faculty, Science Faculty, University of La Laguna, Avenida Astrofísico Francisco Sánchez, s/n, Apartado 456, San Cristóbal de La Laguna, S/C of Tenerife, 38200, Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
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Wangüemert-Pérez AL, Figueira-Gonçalves JM, Ramallo-Fariña Y, Guanche-Dorta S, Golpe R. Ultrasound assessment of diaphragmatic dynamics in patients with chronic obstructive pulmonary disease after treatment with indacaterol/glycopyrronium. Rev Clin Esp 2023; 223:216-222. [PMID: 36931625 DOI: 10.1016/j.rceng.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/24/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Air trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to a change in the normal diaphragmatic configuration with associated functional impairment. Said deterioration improves with bronchodilator therapy. Chest ultrasound (CU) has been used to assess changes in diaphragmatic motility after short-acting bronchodilator therapy, but there are no previous studies on these changes after long-acting bronchodilator treatment. MATERIAL AND METHODS Interventional prospective study. Patients with COPD and moderate to very severe ventilatory obstruction were included in the study. Diaphragm motion and thickness were assessed by CU before and after 3 months of treatment with indacaterol/glycopirronium 85/43 mcg. RESULTS Thirty patients were included (56.6% men, mean age: 69.4 ± 6.2 years). Pre- and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9 ± 7.1 mm and 26.4 ± 8.7 mm (p < 0.0001); 42.5 ± 14.1 mm and 64.5 ± 25.9 mm (p < 0.0001); and 36.5 ± 17.4 mm and 46.7 ± 18.5 mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). CONCLUSIONS Treatment with indacaterol/glycopyrronium 85/43 mcg every 24 hours for 3 months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients.
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Affiliation(s)
- A L Wangüemert-Pérez
- Servicio de Neumología, Hospital San Juan de Dios Tenerife, Santa Cruz de Tenerife, Spain.
| | - J M Figueira-Gonçalves
- Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Y Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, Spain Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - S Guanche-Dorta
- Servicio de Neumología, Hospital San Juan de Dios Tenerife, Santa Cruz de Tenerife, Spain
| | - R Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Trujillo-Martín MM, de Armas-Castellano A, González-Hernández Y, González-Pacheco H, Infante-Ventura D, del Pino-Sedeño T, Ramallo-Fariña Y, Abt-Sack A, Rueda Domínguez A, Serrano-Aguilar P. [Scalp cooling for the prevention of chemotherapy-induced alopecia: systematic review and meta-analysis.]. Rev Esp Salud Publica 2023; 97:e202303024. [PMID: 36999663 PMCID: PMC10560963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Alopecia is one of the most common adverse effects of chemotherapy, having a significant impact on the quality of life of patients who suffer from it. Among the interventions available for its prevention, scalp cooling (SC) is the most widely used. The aim of this study was to assess the efficacy and safety of the use of SC systems during chemotherapy sessions for the prevention or the reduction of the extent of chemotherapy-induced alopecia. METHODS A systematic review of the literature published up to November 2021 was carried out. Randomized clinical trials were selected. The main outcome measure was alopecia (hair loss>50%) during and after chemotherapy treatment. When possible, a quantitative synthesis of the results was performed through meta-analysis using the Stata v.15.0 software. The risk ratio (RR) of the variable alopecia, was estimated using a random effects model following the Mantel-Haenszel method. Statistical heterogeneity of the results was evaluated graphically and through the test of heterogeneity χ2 and the Higgins I2 statistic. Sensitivity analyses and subgroup analyses were performed. RESULTS 13 studies were included, with a total of 832 participants (97.7% women). In most studies, the main chemotherapy treatment applied was anthracyclines or the combination of anthracyclines and taxanes. The results obtained indicate that SC prevents alopecia (loss>50%) by 43% compared to the control group (RR=0.57; 95% CI=0.46 to 0.69; k=9; n=494; I2=63.8%). No statistically significant difference was found between the efficacy of automated and non-automated cooling systems (P=0.967). No serious short- or medium-term adverse events related to SC were recorded. CONCLUSIONS The results suggest that scalp cooling contributes to the prevention of chemotherapy-induced alopecia.
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Affiliation(s)
- María M. Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La LagunaUniversidad de La LagunaTenerifeSpain
| | - Aythami de Armas-Castellano
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
| | - Yadira González-Hernández
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
| | - Himar González-Pacheco
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
| | - Diego Infante-Ventura
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La LagunaUniversidad de La LagunaTenerifeSpain
| | - Analía Abt-Sack
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)TenerifeSpain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
| | - Antonio Rueda Domínguez
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La LagunaUniversidad de La LagunaTenerifeSpain
| | - Pedro Serrano-Aguilar
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS)Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS)Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La LagunaUniversidad de La LagunaTenerifeSpain
- Servicio de Evaluación (SESCS) del Servicio Canario de la Salud (SCS)Servicio Canario de la Salud (SCS)TenerifeSpain
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7
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Ayala A, Ramallo-Fariña Y, Bilbao-Gonzalez A, Forjaz MJ. Mapping the EQ-5D-5L from the Spanish national health survey functional disability scale through Bayesian networks. Qual Life Res 2023; 32:1785-1794. [PMID: 36735174 DOI: 10.1007/s11136-023-03351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Preference-based measures are valuable tools for evaluating therapeutic interventions and for cost-effectiveness studies. Mapping procedures are useful when it is not possible to collect these kind of measures. The objective of this study was to evaluate which mapping method is the most appropriate to estimate the EQ-5D-5L index from the Spanish National Health Survey functional disability scale. METHODS The sample, formed by 5708 older adults (aged 65 years or older), was drawn from the Spanish National Health Survey ("Encuesta Nacional de Salud en España," ENSE in Spanish 2011-2012). The predictions of EQ-5D-5L index were performed with response mapping using Bayesian network (BN), ordered logit (Ologit), and multinomial logistic (ML). The following direct methods were used: ordinary least squares (OLS) and Tobit regression. The intraclass correlation coefficient (ICC), absolute error (MAE), mean squared error (MSE), and root-mean squared error (RMSE) were calculated to compare all models. The predictions of response models were obtained through the expected value method. RESULTS BN model showed the highest ICC (0.756, 95% confidence interval, CI 0.733-0.777) and lowest MAE (0.110, 95% CI 0.104-0.115). OLS was the model with worse accuracy results with lowest ICC (0.621, 95% CI 0.553-0.681) and highest MAE (0.159, 95%CI: 0.145-0.173). CONCLUSION Indirect mapping methods (BN, Ologit, and ML) had a better accuracy than the direct methods. The response mapping approach provides a robust method to estimate EQ-5D-5L scores from the functional disability scale.
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Affiliation(s)
- Alba Ayala
- Department of Statistics, School of Law and Social Sciences, University Carlos III of Madrid, 126-28903, Getafe, Madrid, Spain. .,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain. .,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Amaia Bilbao-Gonzalez
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain.,Kronikgune Institute for Health Services Research, Barakaldo, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
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8
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Figueira-Gonçalves JM, Hernández-Pérez JM, Cabrera-Lopez C, Wangüemert-Pérez AL, García-Talavera I, Ramallo-Fariña Y, Golpe R, González-García LM. Relationship Between the Summation of GesEPOC High-Risk Factors and the Presence of Cardiovascular Disease. Arch Bronconeumol 2023:S0300-2896(23)00010-8. [PMID: 36707328 DOI: 10.1016/j.arbres.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Juan Marco Figueira-Gonçalves
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain.
| | - José María Hernández-Pérez
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio García-Talavera
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Rafael Golpe
- Pneumology Service, University Hospital Lucus Augusti, Lugo, Spain
| | - Luis Manuel González-García
- Primary Care Centre of the Canary Islands Public Health Service, Breña Baja, La Palma, Santa Cruz de Tenerife, Spain
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9
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Clavo B, Cánovas-Molina A, Ramallo-Fariña Y, Federico M, Rodríguez-Abreu D, Galván S, Ribeiro I, Marques da Silva SC, Navarro M, González-Beltrán D, Díaz-Garrido JA, Cazorla-Rivero S, Rodríguez-Esparragón F, Serrano-Aguilar P. Effects of Ozone Treatment on Health-Related Quality of Life and Toxicity Induced by Radiotherapy and Chemotherapy in Symptomatic Cancer Survivors. Int J Environ Res Public Health 2023; 20:1479. [PMID: 36674232 PMCID: PMC9859304 DOI: 10.3390/ijerph20021479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: The continuous improvement in cancer treatment has led to improvement in patients’ survival and a subsequent increase in the number of cancer survivors living with adverse side effects of cancer treatments, sometimes with a high and adverse impact on their health-related quality of life (HRQOL). Side effects of cancer treatments are frequently associated with chronic status of oxidative stress, inflammation, and/or ischemia. The potential for ozone treatment to modulate those processes and improve some of those adverse effects has previously been described. The aim of this study was to evaluate the effect of ozone treatment on the HRQOL and grade of toxicity in symptomatic cancer survivors. (2) Methods: Before and after ozone treatment, we assessed (i) the HRQOL (according to the EQ-5D-5L questionnaire) and (ii) the grade of toxicity (according to the Common Terminology Criteria for Adverse Events of the National Cancer Institute of EEUU (CTCAE v.5.0)) in 26 cancer survivors with chronic side effects of radiotherapy and chemotherapy. (3) Results: There was a significant (p < 0.001) improvement in the EQ-5D-5L index as per the self-reported outcome evaluation of patients’ health status. All the dimensions of the EQ-5D-5L questionnaire (mobility, self-care, activities, pain/discomfort, and anxiety/depression) and the self-evaluation of the health status using the visual analog scale were significantly improved (p < 0.05). The grade of toxicity was also significantly decreased (p < 0.001). (4) Conclusions: In cancer survivors with chronic side effects of cancer treatment, ozone treatment can improve the grade of toxicity and the HRQOL. These results merit additional research. Further studies are ongoing.
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Affiliation(s)
- Bernardino Clavo
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Dr. Negrín University Hospital, 35019 Las Palmas de Gran Canaria, Spain
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 35019 Las Palmas de Gran Canaria, Spain
- Universitary Institute for Research in Biomedicine and Health (iUIBS), Molecular and Translational Pharmacology Group, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, 38296 La Laguna, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Spanish Group of Clinical Research in Radiation Oncology (GICOR), 28290 Madrid, Spain
| | - Angeles Cánovas-Molina
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Dr. Negrín University Hospital, 35019 Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 35019 Las Palmas de Gran Canaria, Spain
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 35019 Las Palmas de Gran Canaria, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Servicio de Evaluación y Planificación del Servicio Canario de Salud (SESCS), 38109 Santa Cruz de Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de la Laguna, 38296 La Laguna, Spain
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
| | - Delvys Rodríguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Saray Galván
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
| | - Ivone Ribeiro
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
| | - Susana C. Marques da Silva
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Dr. Negrín University Hospital, 35019 Las Palmas de Gran Canaria, Spain
| | - Minerva Navarro
- Chronic Pain Unit, Dr. Negrín University Hospital, 35019 Las Palmas de Gran Canaria, Spain
| | - Damián González-Beltrán
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
| | - Juan A. Díaz-Garrido
- Psychiatry Department, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
| | - Sara Cazorla-Rivero
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
- Universidad de La Laguna, 38296 La Laguna, Spain
| | - Francisco Rodríguez-Esparragón
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 35019 Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, 38296 La Laguna, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Servicio de Evaluación y Planificación del Servicio Canario de Salud (SESCS), 38109 Santa Cruz de Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de la Laguna, 38296 La Laguna, Spain
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Duarte-Díaz A, Perestelo-Pérez L, Rivero-Santana A, Peñate W, Álvarez-Pérez Y, Ramos-García V, González-Pacheco H, Goya-Arteaga L, de Bonis-Braun M, González-Martín S, Ramallo-Fariña Y, Carrion C, Serrano-Aguilar P. The relationship between patient empowerment and related constructs, affective symptoms and quality of life in patients with type 2 diabetes: a systematic review and meta-analysis. Front Public Health 2023; 11:1118324. [PMID: 37139389 PMCID: PMC10150112 DOI: 10.3389/fpubh.2023.1118324] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The aim of this systematic review is to assess the relationship between patient empowerment and other empowerment-related constructs, and affective symptoms and quality of life in patients with type 2 diabetes. Methods A systematic review of the literature was conducted, according to the PRISMA guidelines. Studies addressing adult patients with type 2 diabetes and reporting the association between empowerment-related constructs and subjective measures of anxiety, depression and distress, as well as self-reported quality of life were included. The following electronic databases were consulted from inception to July 2022: Medline, Embase, PsycINFO, and Cochrane Library. The methodological quality of the included studies was analyzed using validated tools adapted to each study design. Meta-analyses of correlations were performed using an inverse variance restricted maximum likelihood random-effects. Results The initial search yielded 2463 references and seventy-one studies were finally included. We found a weak-to-moderate inverse association between patient empowerment-related constructs and both anxiety (r = -0.22) and depression (r = -0.29). Moreover, empowerment-related constructs were moderately negatively correlated with distress (r = -0.31) and moderately positively correlated with general quality of life (r = 0.32). Small associations between empowerment-related constructs and both mental (r = 0.23) and physical quality of life (r = 0.13) were also reported. Discussion This evidence is mostly from cross-sectional studies. High-quality prospective studies are needed not only to better understand the role of patient empowerment but to assess causal associations. The results of the study highlight the importance of patient empowerment and other empowerment-related constructs such as self-efficacy or perceived control in diabetes care. Thus, they should be considered in the design, development and implementation of effective interventions and policies aimed at improving psychosocial outcomes in patients with type 2 diabetes. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192429, identifier CRD42020192429.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, (ULL), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- *Correspondence: Lilisbeth Perestelo-Pérez
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, (ULL), Tenerife, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Libertad Goya-Arteaga
- Multiprofessional Unit of Family and Community Care of La Laguna-Norte, Tenerife, Spain
| | - Miriam de Bonis-Braun
- Multiprofessional Unit of Family and Community Care of La Laguna-Norte, Tenerife, Spain
| | | | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Carme Carrion
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
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Gurbani N, Acosta-Sorensen M, Díaz-Pérez D, Figueira-Goncalves JM, Ramallo-Fariña Y, Trujillo-Castilla JL. Clinical outcomes and lung ultrasound findings in COVID-19 follow up: Calm comes after the storm? Respir Med Res 2022; 82:100907. [PMID: 35870365 PMCID: PMC9299820 DOI: 10.1016/j.resmer.2022.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Nikita Gurbani
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | - Marco Acosta-Sorensen
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - David Díaz-Pérez
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Marco Figueira-Goncalves
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Publica de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, ES, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), ES, Madrid, Spain
| | - José Luis Trujillo-Castilla
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Duarte-Díaz A, González-Pacheco H, Rivero-Santana A, Ramallo-Fariña Y, Perestelo-Pérez L, Peñate W, Carrion C, Serrano-Aguilar P. Factors associated with patient empowerment in Spanish adults with type 2 diabetes: A cross-sectional analysis. Health Expect 2022; 25:2762-2774. [PMID: 36047480 DOI: 10.1111/hex.13501] [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: 11/12/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of the present study is to identify factors associated with patient empowerment in people living with type 2 diabetes mellitus (T2DM) in the Canary Islands (Spain). METHODS Secondary cross-sectional analysis was carried out of data obtained in the INDICA study: A 24-month cluster randomized-controlled trial evaluating the effectiveness of educational interventions supported by new technology decision tools for T2DM patients. Sociodemographic variables, clinical data (years since diagnosis, glycated haemoglobin level, creatine, triglycerides, waist hip index, body mass index and number of comorbidities), diabetes knowledge (DIATEK), affective outcomes (Beck Depression Inventory-II, the State subscale of the State-Trait Anxiety Inventory and The Diabetes Distress Scale) and diabetes-related quality of life (The Audit of Diabetes-Dependent Quality of life) were assessed as potential correlates of patient empowerment, assessed using the Diabetes Empowerment Scale-Short Form. Multilevel mixed linear regression models on patient empowerment were developed. RESULTS The analysis included the baseline data of 2334 patients. Results showed that age (B = -0.14; p < .001), diabetes knowledge (B = 0.61; p < .001) and state-anxiety (B = -0.09; p < .001) are significantly associated with patient empowerment. Sex, education level, living alone, employment status, country of birth, time since diagnosis, number of comorbidities, glycated haemoglobin level, depression and distress were not independently associated with patient empowerment in the multivariate analyses. CONCLUSION Younger age, lower state-anxiety and greater diabetes-specific knowledge are important correlates of patient empowerment. In line with the results of the INDICA study, interventions based on patient-centred care might be effective in improving patient empowerment in adults with T2DM. Understanding the factors associated with empowerment may help clinicians and policymakers to identify high-risk groups, prioritize resources and target evidence-based interventions to better support people with T2DM to be actively involved in their own care. PATIENT OR PUBLIC CONTRIBUTION Patients with T2DM were actively involved in the design of the INDICA study. Two patient associations were included as part of the research team and actively participated in designing the interventions and selecting outcome measures.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna (ULL), Tenerife, Spain
| | | | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna (ULL), Tenerife, Spain
| | - Carme Carrion
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
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Clavo B, Rodríguez-Abreu D, Galván S, Federico M, Martínez-Sánchez G, Ramallo-Fariña Y, Antonelli C, Benítez G, Rey-Baltar D, Jorge IJ, Rodríguez-Esparragón F, Serrano-Aguilar P. Long-term improvement by ozone treatment in chronic pain secondary to chemotherapy-induced peripheral neuropathy: A preliminary report. Front Physiol 2022; 13:935269. [PMID: 36111149 PMCID: PMC9468657 DOI: 10.3389/fphys.2022.935269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Pain secondary to chemotherapy-induced peripheral neuropathy (CIPN) can limit the administration of chemotherapy, cancer-treatment outcomes, and the quality of life of patients. Oxidative stress and inflammation are some of the key mechanisms involved in CIPN. Successful treatments for CIPN are limited. This report shows our preliminary experience using ozone treatment as a modulator of oxidative stress in chronic pain secondary to CIPN. Methods: Ozone treatment, by rectal insufflation, was administered in seven patients suffering from pain secondary to grade II or III CIPN. Pain was assessed by the visual analog scale (VAS). Results: All patients, except one, showed clinically relevant pain improvement. Median pain score according to the VAS was 7 (range: 5–8) before ozone treatment, 4 (range: 2–6) at the end of ozone treatment (p = 0.004), 5.5 (range: 1.8–6.3) 3 months after the end of ozone treatment (p = 0.008), and 6 (range: 2.6–6.6) 6 months after the end of ozone treatment (p = 0.008). The toxicity grade, according to the Common Terminology Criteria for Adverse Events (CTCAE v.5.0), improved in half of the patients. Conclusion: This report shows that most patients obtained clinically relevant and long-lasting improvement in chronic pain secondary to CIPN after treatment with ozone. These observed effects merit further research and support our ongoing randomized clinical trial (NCT04299893).
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Affiliation(s)
- Bernardino Clavo
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
- Molecular and Translational Pharmacology Group, Universitary Institute for Research in Biomedicine and Health (iUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias de la Universidad de La Laguna, Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Spanish Group of Clinical Research in Radiation Oncology (GICOR), Madrid, Spain
- *Correspondence: Bernardino Clavo, ; Francisco Rodríguez-Esparragón,
| | - Delvys Rodríguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Saray Galván
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Carla Antonelli
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Gretel Benítez
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Dolores Rey-Baltar
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Ignacio J Jorge
- Chronic Pain Unit, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Francisco Rodríguez-Esparragón
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias de la Universidad de La Laguna, Tenerife, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Bernardino Clavo, ; Francisco Rodríguez-Esparragón,
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Servicio de Evaluación y Planificación del Servicio Canario de Salud (SESCS), Santa Cruz de Tenerife, Spain
- Red de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, Spain
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Valcárcel-Nazco C, Ramallo-Fariña Y, Linertová R, Ramos-Goñi JM, García-Pérez L, Serrano-Aguilar P. Health-Related Quality of Life and Perceived Burden of Informal Caregivers of Patients with Rare Diseases in Selected European Countries. Int J Environ Res Public Health 2022; 19:ijerph19138208. [PMID: 35805867 PMCID: PMC9266302 DOI: 10.3390/ijerph19138208] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
Most of rare disease (RD) patients are assisted in their homes by their family as informal caregivers, causing a substantial burden among family members devoted to care. The role of informal caregivers has been associated with increased levels of stress, poor physical/mental health and impaired HRQOL. The present study assessed the impact on HRQOL and perceived burden of long-term informal caregiving, as well as the inter-relationships of individuals affected by different RD in six European countries, taking advantage of the data provided by the BURQOL-RD project (France, Germany, Italy, Spain, Sweden and UK). Correlation analysis was used to explore the relation between caregiver HRQOL and caregiver burden (Zarit Burden Interview). Multinomial logistic regression models were used to explore the role of explanatory variables on each domain of caregivers HRQOL measured by EQ-5D. Caregivers' HRQOL is inversely correlated with burden of caring. Mobility dimension of EQ-5D was significantly associated with patients age, time devoted to care by secondary caregivers, patient gender and patient utility index. Patients' age, burden scores and patient utility index significantly predict the capacity of caregivers to perform activities of daily living. Employed caregivers are less likely of reporting 'slight problems' in pain/discomfort dimensions than unemployed caregivers. The EQ-5D instrument is sensitive to measure differences in HRQOL between caregivers with different levels of burden of care.
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Affiliation(s)
- Cristina Valcárcel-Nazco
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 38109 Santa Cruz de Tenerife, Spain; (C.V.-N.); (Y.R.-F.); (L.G.-P.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain;
- Research Network on Health Services in Chronic Diseases (REDISSEC), 28029 Madrid, Spain;
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 38109 Santa Cruz de Tenerife, Spain; (C.V.-N.); (Y.R.-F.); (L.G.-P.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain;
- Research Network on Health Services in Chronic Diseases (REDISSEC), 28029 Madrid, Spain;
| | - Renata Linertová
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 38109 Santa Cruz de Tenerife, Spain; (C.V.-N.); (Y.R.-F.); (L.G.-P.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain;
- Research Network on Health Services in Chronic Diseases (REDISSEC), 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-922-47-83-24
| | - Juan Manuel Ramos-Goñi
- Research Network on Health Services in Chronic Diseases (REDISSEC), 28029 Madrid, Spain;
- EuroQol Research Foundation, 3068 AV Rotterdam, The Netherlands
| | - Lidia García-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 38109 Santa Cruz de Tenerife, Spain; (C.V.-N.); (Y.R.-F.); (L.G.-P.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain;
- Research Network on Health Services in Chronic Diseases (REDISSEC), 28029 Madrid, Spain;
| | - Pedro Serrano-Aguilar
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain;
- Research Network on Health Services in Chronic Diseases (REDISSEC), 28029 Madrid, Spain;
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), 38109 Santa Cruz de Tenerife, Spain
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15
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García-Pérez L, Ramallo-Fariña Y, Vallejo-Torres L, Rodríguez-Rodríguez L, González-Pacheco H, Santos-Hernández B, García-Bello MA, Wägner AM, Carmona M, Serrano-Aguilar PG. Cost-effectiveness of multicomponent interventions in type 2 diabetes mellitus in a cluster randomised controlled trial: the INDICA study. BMJ Open 2022; 12:e058049. [PMID: 35396305 PMCID: PMC8995956 DOI: 10.1136/bmjopen-2021-058049] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA randomised clinical trial, from the public health system perspective. DESIGN An economic evaluation was conducted for the within-trial period (2 years) comparing the four arms of the INDICA study. SETTING Primary care in the Canary Islands, Spain. PARTICIPANTS 2334 patients with T2DM without complications were included. INTERVENTIONS Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group. OUTCOMES The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included. ANALYSIS Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure. RESULTS There were no differences between arms in terms of costs (p=0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p=0.028). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p=0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option. CONCLUSIONS The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term. TRIAL REGISTRATION NUMBER NCT01657227.
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Affiliation(s)
- Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Laura Vallejo-Torres
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | | | | | | | - Ana María Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
- University Institute for Biomedical and Health Research (iUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Montserrat Carmona
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro G Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
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16
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Figueira-Gonçalves JM, Hernández-Pérez JM, Cabrera-López C, Wangüemert-Pérez AL, García-Talavera I, Ramallo-Fariña Y, Ramos-Izquierdo C, González-García LM, Guanche-Dorta S. Characteristics of patients referred to Canary Island pneumology outpatient services for chronic obstructive pulmonary disease: the EPOCan study. BMC Res Notes 2022; 15:36. [PMID: 35144675 PMCID: PMC8830167 DOI: 10.1186/s13104-022-05930-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/12/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Assessing patients with chronic obstructive pulmonary disease (COPD) accounts for 30% of all pneumology outpatient evaluations. COPD is a heterogeneous disease and generates a massive public health problem. Overall morbidity, particularly cardiovascular disease, challenges patient management. This is an observational, multicentre study, performed at four hospitals in the Canary Islands (Spain), aimed at characterising patients with COPD referred to pneumology outpatient services. Demographic variables, lung function, and morbidity were assessed. Results Of the 877 included patients, 44.9% were active smokers with a mean (± SD) age of 68.2 ± 10.3 years. The median (IQR) score for the Charlson comorbidity index was 2 (2), and 70.6% of the patients were assigned high risk according to the Spanish Guidelines for COPD (GesEPOC) 2021. The degree of airflow obstruction defined by the GOLD 2021 stages 1, 2, 3, and 4 corresponded to 13.6%, 49%, 31%, and 6.3% of patients, respectively. The most frequently associated morbidities were arterial hypertension (59.5%), dyslipidaemia (54.3%), and type 2 diabetes mellitus (31.2%); 32% of the patients suffered heart disease. There is a high prevalence of active smoking, type 2 diabetes mellitus, and heart disease in patients referred for COPD to Canary Island pneumology outpatient services. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05930-7.
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Affiliation(s)
- Juan Marco Figueira-Gonçalves
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain. .,University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain.
| | - José María Hernández-Pérez
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio García-Talavera
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, SpainHealth Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Carolina Ramos-Izquierdo
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Luis Manuel González-García
- Primary Care Centre of the Canary Islands Public Health Service, Breña Baja, La Palma, Santa Cruz de Tenerife, Spain
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Ramallo-Fariña Y, Rivero-Santana A, García-Pérez L, García-Bello MA, Wägner AM, Gonzalez-Pacheco H, Rodríguez-Rodríguez L, Kaiser-Girardot S, Monzón-Monzón G, Guerra-Marrero C, Daranas-Aguilar C, Roldán-Ruano M, Carmona M, Serrano-Aguilar PG. Patient-reported outcome measures for knowledge transfer and behaviour modification interventions in type 2 diabetes-the INDICA study: a multiarm cluster randomised controlled trial. BMJ Open 2021; 11:e050804. [PMID: 34911711 PMCID: PMC8679133 DOI: 10.1136/bmjopen-2021-050804] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study assesses the effectiveness of different interventions of knowledge transfer and behaviour modification to improve type 2 diabetes mellitus patients' (T2DM) reported outcomes measures (PROMs) in the long-term. Design: open, community-based pragmatic, multicentre, controlled trial with random allocation by clusters to usual care (UC) or to one of the three interventions. PARTICIPANTS A total of 2334 patients with uncomplicated T2DM and 211 healthcare professionals were included of 32 primary care centres. SETTING Primary Care Centers in Canary Islands (Spain). INTERVENTION The intervention for patients (PTI) included an educational group programme, logs and a web-based platform for monitoring and automated short message service (SMS). The intervention for professionals (PFI) included an educational programme, a decision support tool embedded into the electronic clinical record and periodic feedback about patients' results. A third group received both PTI and PFI (combined intervention, CBI). OUTCOME MEASURE Cognitive-attitudinal, behavioural, affective and health-related quality of life (HQoL) variables. RESULTS Compared with UC at 24 months, the PTI group significantly improved knowledge (p=0.005), self-empowerment (p=0.002), adherence to dietary recommendations (p<0.001) and distress (p=0.01). The PFI group improved at 24 months in distress (p=0.03) and at 12 months there were improvements in depression (p=0.003), anxiety (p=0.05), HQoL (p=0.005) and self-empowerment (p<0.001). The CBI group improved at 24 months in self-empowerment (p=0.008) and adherence to dietary recommendations (p=0.004) and at 12 months in knowledge (p=0.008), depression (p=0.006), anxiety (p=0.003), distress (p=0.01), HQoL (p<0.001) and neuropathic symptoms (p=0.02). Statistically significant improvements were also observed at 24 months in the proportion of patients who quit smoking for PTI and CBI (41.5% in PTI and 42.3% in CBI vs 21.2% in the UC group). CONCLUSIONS Assessed interventions to improve PROMs in T2DM attain effectiveness for knowledge, self-empowerment, distress, diet adherence and tobacco cessation. PTI produced the most lasting benefits. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01657227 (6 August 2012) https://clinicaltrials.gov/ct2/show/NCT01657227.
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Affiliation(s)
- Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | | | - Ana Maria Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
- University Institute for Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | | | | | - Montserrat Carmona
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Health Technology Assesment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro G Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
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Rodríguez Rodríguez-Caro CJ, Acosta Artiles FJ, Cejas Méndez MR, Ramallo-Fariña Y, Fernández Garcimartin H. [Differences in the adequacy of news about suicide in Spain vs. Victoria, Australia: are interventions aimed to the media effective?]. Rev Esp Salud Publica 2021; 95:e202106083. [PMID: 34184666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/08/2021] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE News about suicide may have either a contagion effect or a protective effect. For this reason, interventions aimed to the media are a priority. However, the effectiveness of the interventions has not yet been elucidated. The objective of the study was to evaluate comparatively the characteristics and adequacy of suicide news articles between geographical areas in which interventions aimed at media either exist or not. METHODS We evaluated suicide news articles in the four main digital media of Spain (without interventions) and Victoria, Australia (with interventions), according to Alexa (a website traffic statistics). We assessed adherence to World Health Organization (WHO) recommendations, avoidability, frequency, and typology of suicide news articles. The evaluation period was 6 months. Bivariate analysis was performed comparing the samples using t-test, Chi-Squared test and Fisher's exact test according to the type of variable. RESULTS We identified 378 suicide news articles: 141 in Spain and 237 in Victoria. Suicide news articles in Spain showed a lower degree of adherence to the WHO recommendations than those from Victoria (2.97 vs. 11.8; p<0.001). Mean daily number of suicide news articles was lower in Spain (0.78 vs. 1.31; p<0.001). Typology according to contents was different between both regions (p=0.045), with greater prevalence of "suicide after murder" in Spain. However, there were no differences either in avoidability, or in typology according to behaviour. CONCLUSIONS Suicide news articles are more adequate in the geographic area in which interventions aimed at media are performed. These better characteristics imply lower risk of contagion effect, greater likelihood of protective effect and, therefore, a potential beneficial effect on the suicidal behaviour in the reference population.
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Affiliation(s)
- Carlos J Rodríguez Rodríguez-Caro
- Servicio de Psiquiatría. Hospital General de Fuerteventura. Las Palmas. España
- Servicio de Psiquiatría. Hospital Universitario y Politécnico La Fe. Valencia. España
| | - Francisco J Acosta Artiles
- Servicio de Salud Mental. Dirección General de Programas Asistenciales. Servicio Canario de la Salud. España
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Instituto de Salud Carlos III. Madrid. España
- Servicio de Psiquiatría. Complejo Hospitalario Universitario Insular Materno-Infantil. Las Palmas de Gran Canaria. España
| | - María R Cejas Méndez
- Servicio de Psiquiatría. Hospital Universitario de Canarias. Tenerife. España
- Universidad de La Laguna. Tenerife. España
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC). Santa Cruz de Tenerife. España
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Madrid. España
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Ayala A, Forjaz MJ, Ramallo-Fariña Y, Martín-Fernández J, García-Pérez L, Bilbao A. Response Mapping Methods to Estimate the EQ-5D-5L From the Western Ontario McMaster Universities Osteoarthritis in Patients With Hip or Knee Osteoarthritis. Value Health 2021; 24:874-883. [PMID: 34119086 DOI: 10.1016/j.jval.2021.01.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The mapping technique can estimate generic preference-based measure scores through a specific measure that cannot be used in economic evaluations. This study compared 2 response mapping methods to estimate EQ-5D-5L scores using the Western Ontario McMaster Universities Osteoarthritis (WOMAC). METHODS The sample consisted of 758 patients with the hip or knee osteoarthritis recruited in baseline. Bayesian networks (BN) and multinomial logistic regression (ML) were used as response mapping models. Predictions were obtained using the 6-month follow-up as a validation sample. The mean absolute error, mean squared error, deviation from the root mean squared error and intraclass correlation coefficient were calculated as precision measures. RESULTS There was 5.5% of missing data, which was removed. The mean age was 69.6 years (standard deviation = 10.5), with 61.6% of women. The BN model presented lower mean absolute error, mean squared error, root mean squared error and higher intraclass correlation coefficient than the ML model. Only the WOMAC items pain and physical function items were related with the EQ-5D-5L dimensions. CONCLUSION BN response mapping models are more robust methods, with better prediction results, than ML models. The BN model also provided a graphic representation of the dependency relationships between the EQ-5D-5L dimensions and the different WOMAC items that could be useful in the clinical investigation of patients with hip or knee osteoarthritis.
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Affiliation(s)
- Alba Ayala
- University Carlos III of Madrid, Madrid, Spain; Health Service Research Network on Chronic Diseases (REDISSEC).
| | - Maria João Forjaz
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain; Health Service Research Network on Chronic Diseases (REDISSEC)
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain; Health Service Research Network on Chronic Diseases (REDISSEC)
| | - Jesús Martín-Fernández
- Oeste Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain; Health Service Research Network on Chronic Diseases (REDISSEC)
| | - Lidia García-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain; Health Service Research Network on Chronic Diseases (REDISSEC)
| | - Amaia Bilbao
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain; Health Service Research Network on Chronic Diseases (REDISSEC); Kronikgune Institute for Health Services Research, Barakaldo, Spain
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Alvarado-Martel D, Boronat M, Alberiche-Ruano MDP, Algara-González MA, Ramallo-Fariña Y, Wägner AM. Motivational Interviewing and Self-Care in Type 1 Diabetes: A Randomized Controlled Clinical Trial Study Protocol. Front Endocrinol (Lausanne) 2020; 11:574312. [PMID: 33362714 PMCID: PMC7759186 DOI: 10.3389/fendo.2020.574312] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background Type 1 diabetes is a disease with complex therapeutic recommendations that require day-to-day lifestyle changes. Motivational Interviewing is a communication tool that has proved effective in changing behaviors in people with addictions, obesity and type 2 diabetes. Our objective is to evaluate the effects of a Motivational Interviewing intervention in people with type 1 diabetes. Methods Sixty-six patients with type 1 diabetes and hemoglobin A1c >= 8% have been included and randomly assigned (computer-generated sequence, sealed envelopes, ratio 1:1) either to the intervention or to the control group. In the intervention group, appointments every 4 months with the endocrinologist include Motivational Interviewing; in the control group, the appointments proceed as usual. Patients will be followed for 16 months. The primary outcome will be self-care behaviors, assessed by a validated questionnaire, the Diabetes Self-Care Inventory-Revised Version. Secondary outcomes include: HbA1c, motivation for self-care, self-efficacy, health-related quality of life, satisfaction with professional-patient relationship, and fulfillment of patients' own objectives. The practitioners receive training in Motivational Interviewing in order to help them promote adherence to self-care, encourage patient motivation and improve the doctor-patient relationship. The Motivational Interviewing intervention will be evaluated by two psychologists, blinded to the assigned treatment, through video recordings of the sessions and the administration of a purpose-built questionnaire, the EVEM 2.0 scale. Discussion There is evidence that MI can improve self-care in type 2 diabetes. In this study, we aim to evaluate the effect of MI on self-care and HbA1c in people with type 1 diabetes. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT03906786, identifier NCT03906786.
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Affiliation(s)
- Dácil Alvarado-Martel
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - Mauro Boronat
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - María del Pino Alberiche-Ruano
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - María Andrea Algara-González
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - Yolanda Ramallo-Fariña
- Evaluation Unit (SESCS), Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Ana M. Wägner
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
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21
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Figueira Gonçalves JM, Hernández Pérez JM, Acosta Sorensen M, Wangüemert Pérez AL, Martín Ruiz de la Rosa E, Trujillo Castilla JL, Díaz Pérez D, Ramallo-Fariña Y. Biomarkers of acute respiratory distress syndrome in adults hospitalised for severe SARS-CoV-2 infection in Tenerife Island, Spain. BMC Res Notes 2020; 13:555. [PMID: 33298124 PMCID: PMC7724618 DOI: 10.1186/s13104-020-05402-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The dramatic spread of SARS-CoV-2 infections calls for reliable, inexpensive tools to quickly identify patients with a poor prognosis. In this study, acute respiratory distress syndrome (ARDS) was assessed within 72 h after admission of each of 153 consecutive, SARS-CoV-2 infected, adult patients to either of two hospitals in Tenerife, Spain, using suitable routine laboratory tests for lymphocyte counts, as well as ferritin, lactate dehydrogenase (LDH), and C-reactive protein levels. Results were correlated with the patients’ respiratory function, defined through their pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) ratio. Results Within 72 h from admission, criteria matched ARDS (SpO2/FiO2 < 235) in 13.1% of cases. We found a significant, negative correlation between SpO2/FiO2 ratios and d-dimer, ferritin, and LDH levels (− 0.31, − 0.32, and − 0.41; p = 0.004, 0.004, and < 0.0001, respectively). In patients with ARDS, the mean LDH was 373 U/L (CI95%: 300.6–445.3), but only 298 U/L (CI95%: 274.7–323.1) when they did not develop the syndrome (p = 0.015). None of the additionally evaluated biomarkers correlated with the SpO2/FiO2 ratios. Serum LDH levels in patients hospitalised for COVID-19 correlate with ARDS, as defined by their SpO2/FiO2 ratio, and might help to predict said complication.
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Affiliation(s)
- Juan Marco Figueira Gonçalves
- Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | - José María Hernández Pérez
- Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Marco Acosta Sorensen
- Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Elena Martín Ruiz de la Rosa
- Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - José Luis Trujillo Castilla
- Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - David Díaz Pérez
- Pneumology and Thoracic Surgery Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Madrid, Spain
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22
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Del Pino-Sedeño T, González de León B, Pérez Martín EF, Martín Gandolfo AM, Estupiñán Ramírez M, Redondo M, Ramallo-Fariña Y, Trujillo-Martín MM. Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study. Prim Care Diabetes 2020; 14:729-735. [PMID: 32535089 DOI: 10.1016/j.pcd.2020.05.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/17/2020] [Accepted: 05/17/2020] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD). METHODS We conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD. RESULTS A total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03-1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7-8% (53-64 mmol/mol) (OR 1.24; 95% CI: 1.05-1.47) and 8-9% (64-75 mmol/mol) (OR 1.31; 95% CI: 1.04-1.66). CONCLUSIONS Poor glycemic control reveals a weak association with increased risk of COPD in T2D patients.
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Elías Fernando Pérez Martín
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Anna María Martín Gandolfo
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Marcos Estupiñán Ramírez
- Servicio de Atención Primaria, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
| | - Maximino Redondo
- Unidad de Investigación, Hospital Costa del Sol Marbella, Universidad de Málaga, IBIMA (Instituto de Investigación Biomédica de Málaga), Málaga, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - María M Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.
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23
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Ramallo-Fariña Y, García-Bello MA, García-Pérez L, Boronat M, Wägner AM, Rodríguez-Rodríguez L, de Pablos-Velasco P, Llorente Gómez de Segura I, González-Pacheco H, Carmona Rodríguez M, Serrano-Aguilar P. Effectiveness of Internet-Based Multicomponent Interventions for Patients and Health Care Professionals to Improve Clinical Outcomes in Type 2 Diabetes Evaluated Through the INDICA Study: Multiarm Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e18922. [PMID: 33136059 PMCID: PMC7669446 DOI: 10.2196/18922] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/20/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a chronic disease in which health outcomes are related to decision making by patients and health care professionals. Objective This study aims to assess the effectiveness of internet-based multicomponent interventions to support decision making of all actors involved in the care of patients with T2DM in primary care. Methods The INDICA study is an open, community-based, multicenter trial with random allocation to usual care or the intervention for patients, the intervention for health care professionals in primary care, or the combined intervention for both. In the intervention for patients, participants received an educational group program and were monitored and supported by logs, a web-based platform, and automated SMS. Those in the intervention for professionals also received an educational program, a decision support tool embedded in the electronic clinical record, and periodic feedback about patients’ results. A total of 2334 people with T2DM, regardless of glycated hemoglobin (HbA1c) levels and without diabetes-related complications, were included. The primary end point was change in HbA1c level. The main analysis was performed using multilevel mixed models. Results For the overall sample, the intervention for patients attained a significant mean reduction in HbA1c levels of ‒0.27 (95% CI ‒0.45 to ‒0.10) at month 3 and ‒0.26 (95% CI ‒0.44 to ‒0.08) at month 6 compared with usual care, which remained marginally significant at month 12. A clinically relevant reduction in HbA1c level was observed in 35.6% (191/537) of patients in the intervention for patients and 26.0% (152/586) of those in usual care at month 12 (P=.006). In the combined intervention, HbA1c reduction was significant until month 18 (181/557, 32.6% vs 140/586, 23.9%; P=.009). Considering the subgroup of patients uncontrolled at baseline, all interventions produced significant reductions in HbA1c levels across the entire study period: ‒0.49 (95% CI ‒0.70 to ‒0.27) for the intervention for patients, ‒0.35 (95% CI ‒0.59 to ‒0.14) for the intervention for professionals, and ‒0.35 (95% CI ‒0.57 to ‒0.13) for the combined intervention. Differences in HbA1c for the area under the curve considering the entire period were significant for the intervention for patients and the combined intervention compared with usual care (P=.03 for both). Compared with usual care, the intervention for professionals and the combined intervention had significant longer-term reductions in systolic and diastolic blood pressure. Conclusions In uncontrolled patients, the intervention for patients at baseline provided clinically relevant and significant longer-term reductions of HbA1c levels. The intervention for professionals and combined intervention also improved the cardiovascular risk profile of patients. Trial Registration ClinicalTrials.gov NCT01657227; https://clinicaltrials.gov/ct2/show/NCT01657227
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Affiliation(s)
- Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | | | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Mauro Boronat
- Department of Endocrinology and Nutrition, Insular University Hospital, Las Palmas de Gran Canaria, Spain.,University Institute for Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPG), Las Palmas de Gran Canaria, Spain
| | - Ana M Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital, Las Palmas de Gran Canaria, Spain.,University Institute for Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPG), Las Palmas de Gran Canaria, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
| | - Pedro de Pablos-Velasco
- University Institute for Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPG), Las Palmas de Gran Canaria, Spain.,Department of Endocrinology and Nutrition, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | | | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
| | - Montserrat Carmona Rodríguez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
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- See Author´s Contributions Section, Santa Cruz de Tenerife, Spain
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24
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Acosta FJ, Rodríguez CJ, Cejas MR, Ramallo-Fariña Y, Fernandez-Garcimartin H. Suicide Coverage in the Digital Press Media: Adherence to World Health Organization Guidelines and Effectiveness of Different Interventions Aimed at Media Professionals. Health Commun 2020; 35:1623-1632. [PMID: 31469595 DOI: 10.1080/10410236.2019.1654176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study evaluated the characteristics of suicide news articles in the digital press, their adherence to World Health Organization (WHO) recommendations, and the effectiveness of interventions. We assessed adherence, avoidability, frequency and typology of suicide news over a six-month period in the four main digital media outlets of the Canary Islands (Spain). A brief training and information package intervention to the Canary Islands media outlets was carried out. We compared the quality of media reporting at both the pre-intervention and post-intervention timepoints, and compared the quality of reporting at the post-intervention timepoint in Victoria (Australia), where media interventions have been well-resourced and running for several years. We evaluated 339 suicide news articles: 38 from the pre-intervention period, 64 from the post-intervention period, and 237 from Victoria. News articles showed a very low degree of adherence to WHO recommendations, especially to those recommendations thought to have a protective effect. Post-intervention news articles showed better adherence than pre-intervention ones, but lower than those of Victoria, where constant interventions have been developed for years. We conclude that adherence to WHO recommendations is low. Simple interventions aimed at media professionals can improve adherence. However, constant and complex interventions seem to be more effective.
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Affiliation(s)
- Francisco J Acosta
- Service of Mental Health, General Management of Healthcare Programs, The Canary Islands Health Service
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute
- Department of Psychiatry, Insular University Hospital of Gran Canaria
| | - Carlos J Rodríguez
- Department of Psychiatry, University of Las Palmas de Gran Canaria
- Fuerteventura General Hospital
| | - María R Cejas
- Department of Psychiatry, University Hospital of the Canary Islands
- University of La Laguna
| | - Yolanda Ramallo-Fariña
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute
- Canary Foundation of Health Research (FUNCANIS)
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25
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Acosta FJ, Navarro S, Cabrera B, Ramallo-Fariña Y, Martínez N. Painful insight vs. usable insight in schizophrenia. Do they have different influences on suicidal behavior? Schizophr Res 2020; 220:147-154. [PMID: 32229261 DOI: 10.1016/j.schres.2020.03.042] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 01/16/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicidal behavior is highly prevalent in schizophrenia. Among the risk factors, insight has been little studied and has yielded contradictory results. In addition, it has been studied neglecting relevant psychological aspects, such as beliefs about illness and coping styles. METHOD We assessed 133 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Evaluation included sociodemographic, general clinical, psychopathological, psychological and suicidal behavior variables. RESULTS Neither insight nor insight coupled with negative beliefs and/or coping styles were associated with suicidal behavior. Nevertheless, insight coupled with negative beliefs and/or coping styles was associated with greater hopelessness and depression, internalized stigma, worse control over illness and greater global severity as compared to insight coupled with positive beliefs and coping styles. Suicide attempt and suicidal ideation groups showed greater depression and hopelessness, worse global beliefs and worse control over illness, higher socio-economic level, and greater number of previous psychiatric admissions compared to the non-suicidal group. CONCLUSIONS Insight coupled with negative beliefs and/or coping style was not associated with suicidal behavior. Nevertheless, it was associated with greater depression and hopelessness, both of which are firmly established risk factors for suicide in schizophrenia. Prospective studies with long-term follow-up and large samples are needed to clarify this issue. Clinicians should assess these psychological features associated with insight, both in patients with insight and in those with poor insight when promoting it.
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Affiliation(s)
- Francisco J Acosta
- Service of Mental Health, General Management of Healthcare Programs, The Canary Islands Health Service, The Canary Islands, Spain; Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, Madrid, Spain; Insular University Hospital of Gran Canaria, Canary Islands, Spain.
| | - Santiago Navarro
- Mental Health Unit of Ciudad Alta, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, Canary Islands, Spain
| | - Beatriz Cabrera
- Mental Health Unit of Puerto, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, Canary Islands, Spain
| | - Yolanda Ramallo-Fariña
- Canary Foundation of Health Research (FUNCANIS), Canary Islands, Spain; Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Natalia Martínez
- Mental Health Unit of Ciudad Alta, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, Canary Islands, Spain
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26
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Bilbao A, Martín-Fernández J, García-Pérez L, Arenaza JC, Ariza-Cardiel G, Ramallo-Fariña Y, Ansola L. Mapping WOMAC Onto the EQ-5D-5L Utility Index in Patients With Hip or Knee Osteoarthritis. Value Health 2020; 23:379-387. [PMID: 32197734 DOI: 10.1016/j.jval.2019.09.2755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EQ-5D-5L in patients with hip or knee osteoarthritis (OA). METHODS A prospective observational study was conducted on 758 patients with hip or knee OA who completed the EQ-5D-5L and WOMAC questionnaires, of whom 644 completed them both again 6 months later. Baseline data were used to derive mapping functions. Generalized additive models were used to identify to which powers the WOMAC subscales should be raised to achieve a linear relationship with the response. For the modeling, general linear models (GLM), Tobit models, and beta regression models were used. Age, sex, and affected joints were also considered. Preferred models were selected based on Akaike and Bayesian information criteria, adjusted R2, mean absolute error (MAE), and root mean squared error (RMSE). The functions were validated with the follow-up data using MAE, RMSE, and the intraclass correlation coefficient. RESULTS The preferred models were a GLM with Pain2+Pain3+Function+Pain·Function as covariates and a beta model with Pain3+Function+Function2+Function3 as covariates. The adjusted R2 were similar (0.6190 and 0.6136, respectively). The predictive performance of these models in the validation sample was similar and both models showed an overprediction for health states worse than death. CONCLUSION To our knowledge, these are the first functions mapping the WOMAC onto the EQ-5D-5L in patients with hip or knee OA. They showed an acceptable fit and precision and could be very useful for clinicians and researchers when cost-effectiveness studies are needed and generic preference-based health-related quality of life instruments to derive utilities are not available.
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Affiliation(s)
- Amaia Bilbao
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain; Health Service Research Network on Chronic Diseases, Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Jesús Martín-Fernández
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Oeste Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain; Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Lidia García-Pérez
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Fundación Canaria de Investigación Sanitaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Juan Carlos Arenaza
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Osakidetza Basque Health Service, Basurto University Hospital, Traumatology and Orthopedic Surgery Service, Bilbao, Spain
| | - Gloria Ariza-Cardiel
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Oeste Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Fundación Canaria de Investigación Sanitaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Laura Ansola
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain
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27
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Trujillo-Martín MM, Ramallo-Fariña Y, Del Pino-Sedeño T, Rúa-Figueroa Í, Trujillo-Martín E, Vallejo-Torres L, Imaz-Iglesia I, Sánchez-de-Madariaga R, de Pascual-Medina AM, Serrano-Aguilar P. Effectiveness and cost-effectiveness of a multicomponent intervention to implement a clinical practice guideline for systemic lupus erythematosus: protocol for a cluster-randomized controlled trial. BMC Health Serv Res 2019; 19:783. [PMID: 31675957 PMCID: PMC6824022 DOI: 10.1186/s12913-019-4589-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with significant potential morbidity and mortality. Substantial gaps have been documented between the development and dissemination of clinical practice guidelines (CPG) and their implementation in practice. The aim of this study is to assess the effectiveness and cost-effectiveness of a multi-component knowledge transfer intervention to implement a CPG for the management of SLE (CPG-SLE). Methods The study is an open, multicentre, controlled trial with random allocation by clusters to intervention or control. Clusters are four public university hospitals of the Canary Islands Health Service where rheumatologists are invited to participate. Patients diagnosed with SLE at least one year prior to recruitment are selected. Rheumatologists in intervention group receive a short educational group programme to both update their knowledge about SLE management according to CPG-SLE recommendations and to acquire knowledge and training on use of the patient-centred approach, a decision support tool embedded in the electronic clinical record and a quarterly feedback report containing information on management of SLE patients. Primary endpoint is change in self-perceived disease activity. Secondary endpoints are adherence of professionals to CPG-SLE recommendations, health-related quality of life, patient perception of their participation in decision making, attitudes of professionals towards shared decision making, knowledge of professionals about SLE and use of healthcare resources. Calculated sample size is 412 patients. Data will be collected from questionnaires and clinical records. Length of follow-up will be 18 months. Multilevel mixed models with repeated time measurements will be used to analyze changes in outcomes over time. Cost-effectiveness, from both social and healthcare services perspectives, will be analyzed by measuring effectiveness in terms of quality-adjusted life years gained. Deterministic and probabilistic sensitivity analyses are planned. Discussion Impact of CPGs in clinical practice could be improved by applying proven value interventions to implement them. The results of this ongoing trial are expected to generate important scientifically valid and reproducible information not only on clinical effectiveness but also on cost-effectiveness of a multi-component intervention for implementation of a CPG based on communication technologies for chronic patients in the hospital setting. Trial registration ClinicalTrial.gov NCT03537638. Registered on 25 May 2018.
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Affiliation(s)
- María M Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Íñigo Rúa-Figueroa
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Laura Vallejo-Torres
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Iñaki Imaz-Iglesia
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Agencia de Evaluación de Tecnologías Sanitarias del Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Sánchez-de-Madariaga
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Unidad de Investigación en Telemedicina y e-Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana M de Pascual-Medina
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
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Acosta FJ, Ramallo-Fariña Y, Ruiz L, Gómez S, Hernández A, Quesada I, Lastra C, Calviño MJ. Prospective study of variables associated with nonadherence to psychotherapy. J Ment Health 2019; 29:581-589. [PMID: 30862212 DOI: 10.1080/09638237.2019.1581346] [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: 10/27/2022]
Abstract
Background: The identification of factors associated with nonadherence to psychotherapy would allow a better prevention of this problem.Aim: To investigate factors associated with nonadherence in psychotherapy, its possible effect on outcomes, and reasons for therapy dropout.Method: Prospective analytic observational study of patients who initiated psychotherapy (N = 144). Sociodemographic, general clinical, treatment-related, subjective, psychological, psychopathologic, and outcome variables were evaluated at baseline and 1, 3, 6, and 12 months later. Objective nonadherence (dropout and irregularity), subjective nonadherence (poor patient engagement), and global nonadherence (combination of both) were analyzed.Results: Global nonadherence was 66%. Global nonadherence was associated with substance use or abuse (OR = 2.64) and younger age (OR = 0.97). Objective nonadherence was associated with active working status (OR = 4.11), younger age (OR = 1.04) and substance use or abuse (OR = 2.35). Subjective nonadherence was associated with worse insight in psychotherapy (OR = 0.95) and poor pharmacologic adherence (OR = 0.55). Contextual reasons (25.8%) were the most commonly reported cause of dropout. Time in psychotherapy was associated with outcome variables.Conclusions: Nonadherence to psychotherapy is frequent. To reduce nonadherence in psychotherapy, specific interventions for reducing substance use and abuse, measures aimed at facilitating access to Community Mental Health Units, and enhancing insight in psychotherapy should be implemented.
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Affiliation(s)
- Francisco J Acosta
- Research Program on Mental Health, Service of Mental Health, General Management of Healthcare Programs, The Canary Islands Health Service, The Canary Islands, Spain.,Research Network on Health Services for Chronic Conditions (REDISSEC) Carlos III Health Institute, Madrid, Spain.,Insular University Hospital of Gran Canaria, The Canary Islands, Spain
| | - Yolanda Ramallo-Fariña
- Research Network on Health Services for Chronic Conditions (REDISSEC) Carlos III Health Institute, Madrid, Spain.,Canary Foundation of Health Research (FUNCANIS), The Canary Islands, Spain
| | - Laura Ruiz
- Mental Health Unit of La Laguna - S/C de Tenerife, Service of Psychiatry, University Hospital of the Canary Islands, Tenerife, Spain
| | - Sara Gómez
- Mental Health Unit of Canalejas, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, The Canary Islands, Spain
| | - Ayoze Hernández
- Mental Health Unit of Canalejas, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, The Canary Islands, Spain
| | - Irene Quesada
- Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, The Canary Islands, Spain
| | - Cristina Lastra
- Mental Health Unit of Telde, Service of Psychiatry, Insular University Hospital of Gran Canaria, The Canary Islands, Spain
| | - María José Calviño
- Mental Health Unit of Bañaderos, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, The Canary Islands, Spain
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29
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Suárez-Llanos JP, Vallejo-Torres L, García-Bello MÁ, Hernández-Carballo C, Calderón-Ledezma EM, Rosat-Rodrigo A, Delgado-Brito I, Pereyra-García-Castro F, Benitez-Brito N, Felipe-Pérez N, Ramallo-Fariña Y, Romero-Pérez JC. Cost-effectiveness of the hospital nutrition screening tool CIPA. Arch Med Sci 2019; 16:273-281. [PMID: 32190136 PMCID: PMC7069439 DOI: 10.5114/aoms.2018.81128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hospital malnutrition is very common and worsens the clinical course of patients while increasing costs. Lacking clinical-economic studies on the implementation of nutrition screening encouraged the evaluation of the CIPA (Control of Food Intake, Protein, Anthropometry) tool. MATERIAL AND METHODS An open, non-randomized, controlled clinical trial was conducted on patients admitted to internal medicine and general and digestive surgery wards, who were either assigned to a control (standard hospital clinical care) or to an intervention, CIPA-performing ward (412 and 411, respectively; n = 823). Length of stay, mortality, readmission, in-hospital complications, and quality of life were evaluated. Cost-effectiveness was analysed in terms of cost per quality-adjusted life years (QALYs). RESULTS The mean length of stay was higher in the CIPA group, though not significantly (+ 0.95 days; p = 0.230). On the surgical ward, more patients from the control group moved to critical care units (p = 0.014); the other clinical variables did not vary. Quality of life at discharge was similar (p = 0.53), although slightly higher in the CIPA group at 3 months (p = 0.089). Patients under CIPA screening had a higher mean cost of € 691.6 and a mean QALY gain over a 3-month period of 0.0042. While the cost per QALY for the internal medicine patients was € 642 282, the results for surgical patients suggest that the screening tool is both less costly and more effective. CONCLUSIONS The CIPA nutrition screening tool is likely to be cost-effective in surgical but not in internal medicine patients.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Spain
- Canary Islands Foundation for Health Research (FUNCANIS), Health Services Research on Chronic Patients Network (REDISSEC)
| | - Miguel Ángel García-Bello
- Division of Clinical Epidemiology and Biostatistics, Research Unit, HUNSC, Primary Care Management, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Adriá Rosat-Rodrigo
- General and Digestive Surgery Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Fundación Instituto Canario de Investigación del Cáncer, Santa Cruz de Tenerife, Spain
| | | | - Nestor Benitez-Brito
- Fundación Instituto Canario de Investigación del Cáncer, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Foundation for Health Research (FUNCANIS), Health Services Research on Chronic Patients Network (REDISSEC)
| | - Juan Carlos Romero-Pérez
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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30
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Salinero-Fort MA, Gómez-Campelo P, San Andrés-Rebollo FJ, Cárdenas-Valladolid J, Abánades-Herranz JC, Carrillo de Santa Pau E, Chico-Moraleja RM, Beamud-Victoria D, de Miguel-Yanes JM, Jimenez-Garcia R, López-de-Andres A, Ramallo-Fariña Y, De Burgos-Lunar C. Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort. BMJ Open 2018; 8:e020768. [PMID: 30249627 PMCID: PMC6157517 DOI: 10.1136/bmjopen-2017-020768] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of depression in patients diagnosed with type 2 diabetes mellitus (T2DM), and to identify sociodemographic, clinical and psychological factors associated with depression in this population. Additionally, we examine the annual incidence rate of depression among patients with T2DM. METHODS We performed a large prospective cohort study of patients with T2DM from the Madrid Diabetes Study. The first recruitment drive included 3443 patients. The second recruitment drive included 727 new patients. Data have been collected since 2007 (baseline visit) and annually during the follow-up period (since 2008). RESULTS Depression was prevalent in 20.03% of patients (n=592; 95% CI 18.6% to 21.5%) and was associated with previous personal history of depression (OR 6.482; 95% CI 5.138 to 8.178), mental health status below mean (OR 1.423; 95% CI 1.452 to 2.577), neuropathy (OR 1.951; 95% CI 1.423 to 2.674), fair or poor self-reported health status (OR 1.509; 95% CI 1.209 to 1.882), treatment with oral antidiabetic agents plus insulin (OR 1.802; 95% CI 1.364 to 2.380), female gender (OR 1.333; 95% CI 1.009 to 1.761) and blood cholesterol level (OR 1.005; 95% CI 1.002 to 1.009). The variables inversely associated with depression were: being in employment (OR 0.595; 95% CI 0.397 to 0.894), low physical activity (OR 0.552; 95% CI 0.408 to 0.746), systolic blood pressure (OR 0.982; 95% CI 0.971 to 0.992) and social support (OR 0.978; 95% CI 0.963 to 0.993). In patients without depression at baseline, the incidence of depression after 1 year of follow-up was 1.20% (95% CI 1.11% to 2.81%). CONCLUSIONS Depression is very prevalent among patients with T2DM and is associated with several key diabetes-related outcomes. Our results suggest that previous mental status, self-reported health status, gender and several diabetes-related complications are associated with differences in the degree of depression. These findings should alert practitioners to the importance of detecting depression in patients with T2DM.
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Affiliation(s)
- Miguel Angel Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
- Nodo Madrid, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - P Gómez-Campelo
- Grupo Respuesta Inmune Innata. Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
- Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain
| | | | - Juan Cárdenas-Valladolid
- Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | | | | | - Rosa M Chico-Moraleja
- Servicio de Ortopedia y Traumatología, Hospital Central de la Defensa, Madrid, Spain
| | | | | | | | - Ana López-de-Andres
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Nodo Madrid, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Carmen De Burgos-Lunar
- Nodo Madrid, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
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31
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Hernandez G, Garin O, Pardo Y, Vilagut G, Pont À, Suárez M, Neira M, Rajmil L, Gorostiza I, Ramallo-Fariña Y, Cabases J, Alonso J, Ferrer M. Validity of the EQ–5D–5L and reference norms for the Spanish population. Qual Life Res 2018; 27:2337-2348. [DOI: 10.1007/s11136-018-1877-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 11/25/2022]
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32
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Ramos-Goñi JM, Craig BM, Oppe M, Ramallo-Fariña Y, Pinto-Prades JL, Luo N, Rivero-Arias O. Handling Data Quality Issues to Estimate the Spanish EQ-5D-5L Value Set Using a Hybrid Interval Regression Approach. Value Health 2018; 21:596-604. [PMID: 29753358 DOI: 10.1016/j.jval.2017.10.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/01/2017] [Accepted: 10/30/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND The Spanish five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) valuation study was the first to use the EuroQol Valuation Technology protocol, including composite time trade-off (C-TTO) and discrete choice experiments (DCE). In this study, its investigators noticed that some interviewers did not fully explain the C-TTO task to respondents. Evidence from a follow-up study in 2014 confirmed that when interviewers followed the protocol, the distribution of C-TTO responses widened. OBJECTIVES To handle the data quality issues in the C-TTO responses by estimating a hybrid interval regression model to produce a Spanish EQ-5D-5L value set. METHODS Four different models were tested. Model 0 integrated C-TTO and DCE responses in a hybrid model and models 1 to 3 altered the interpretation of the C-TTO responses: model 1 allowed for censoring of the C-TTO responses, whereas model 2 incorporated interval responses and model 3 included the interviewer-specific protocol violations. For external validation, the predictions of the four models were compared with those of the follow-up study using the Lin's concordance correlation coefficient. RESULTS This stepwise approach to modeling C-TTO and DCE responses improved the concordance between the valuation and follow-up studies (concordance correlation coefficient: 0.948 [model 0], 0.958 [model 1], 0.952 [model 2], and 0.989 [model 3]). We recommend the estimates from model 3, because its hybrid interval regression model addresses the data quality issues found in the valuation study. CONCLUSIONS Protocol violations may occur in any valuation study; handling them in the analysis can improve external validity. The resulting EQ-5D-5L value set (model 3) can be applied to inform Spanish health technology assessments.
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Affiliation(s)
- Juan M Ramos-Goñi
- EuroQol Research Foundation, Rotterdam, The Netherlands; Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.
| | | | - Mark Oppe
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Yolanda Ramallo-Fariña
- HTA Unit of Canary Islands Health Service, Canary Islands, Spain; Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
| | | | - Nan Luo
- National University of Singapore, Singapore
| | - Oliver Rivero-Arias
- University of Oxford, Oxford, UK; Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
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Suárez-Llanos JP, Benítez-Brito N, Vallejo-Torres L, Delgado-Brito I, Rosat-Rodrigo A, Hernández-Carballo C, Ramallo-Fariña Y, Pereyra-García-Castro F, Carlos-Romero J, Felipe-Pérez N, García-Niebla J, Calderón-Ledezma EM, González-Melián TDJ, Llorente-Gómez de Segura I, Barrera-Gómez MÁ. Clinical and cost-effectiveness analysis of early detection of patients at nutrition risk during their hospital stay through the new screening method CIPA: a study protocol. BMC Health Serv Res 2017; 17:292. [PMID: 28424063 PMCID: PMC5397674 DOI: 10.1186/s12913-017-2218-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/01/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system. METHODS The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m2 (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention. DISCUSSION This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital. TRIAL REGISTRATION Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Néstor Benítez-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Laura Vallejo-Torres
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Adriá Rosat-Rodrigo
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Juan Carlos-Romero
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jennifer García-Niebla
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio Llorente-Gómez de Segura
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Manuel Ángel Barrera-Gómez
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Rivero-Santana A, Del Pino-Sedeño T, Ramallo-Fariña Y, Vergara I, Serrano-Aguilar P. [Usefulness of scoring risk for adverse outcomes in older patients with the Identification of Seniors at Risk scale and the Triage Risk Screening Tool: a meta-analysis]. Emergencias 2017; 29:49-60. [PMID: 28825270] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A considerable proportion of the geriatric population experiences unfavorable outcomes of hospital emergency department care. An assessment of risk for adverse outcomes would facilitate making changes in clinical management by adjusting available resources to needs according to an individual patient's risk. Risk assessment tools are available, but their prognostic precision varies. This systematic review sought to quantify the prognostic precision of 2 geriatric screening and risk assessment tools commonly used in emergency settings for patients at high risk of adverse outcomes (revisits, functional deterioration, readmissions, or death): the Identification of Seniors at Risk (ISAR) scale and the Triage Risk Screening Tool (TRST). We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and SCOPUS, with no date limits, to find relevant studies. Quality was assessed with the QUADAS-2 checklist (for quality assessment of diagnostic accuracy studies). We pooled data for prognostic yield reported for the ISAR and TRST scores for each short- and medium-term outcome using bivariate random-effects modeling. The sensitivity of the ISAR scoring system as a whole ranged between 67% and 99%; specificity fell between 21% and 41%. TRST sensitivity ranged between 52% and 75% and specificity between 39% and 51%.We conclude that the tools currently used to assess risk of adverse outcomes in patients of advanced age attended in hospital emergency departments do not have adequate prognostic precision to be clinically useful.
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Affiliation(s)
- Amado Rivero-Santana
- Fundación Canaria de Investigación Sanitaria (FUNCANIS). Islas Canarias, España. Fundación Canaria de Investigación Sanitaria (FUNCANIS). Islas Canarias, España
| | - Tasmania Del Pino-Sedeño
- Fundación Canaria de Investigación Sanitaria (FUNCANIS). Islas Canarias, España. Fundación Canaria de Investigación Sanitaria (FUNCANIS). Islas Canarias, España
| | - Yolanda Ramallo-Fariña
- Fundación Canaria de Investigación Sanitaria (FUNCANIS). Islas Canarias, España. Fundación Canaria de Investigación Sanitaria (FUNCANIS). Islas Canarias, España. Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, España
| | - Itziar Vergara
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC). España. Unidad de investigación AP-OSIS Gipuzkoa; Donostia, Osakidetza. País Vasco, España. Instituto Biodonostia. País Vasco, España
| | - Pedro Serrano-Aguilar
- Centro de Investigación Biomédica de las Islas Canarias (CIBICAN). Islas Canarias, España. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC). España. Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, España. Servicio de Evaluación del Servicio Canario de la salud (SESCS). Tenerife, España
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35
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Ramallo-Fariña Y, García-Pérez L, Castilla-Rodríguez I, Perestelo-Pérez L, Wägner AM, de Pablos-Velasco P, Domínguez AC, Cortés MB, Vallejo-Torres L, Ramírez ME, Martín PP, García-Puente I, Salinero-Fort MÁ, Serrano-Aguilar PG. Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients--the INDICA study: a cluster randomized controlled trial. Implement Sci 2015; 10:47. [PMID: 25880498 PMCID: PMC4397722 DOI: 10.1186/s13012-015-0233-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/11/2015] [Indexed: 01/22/2023] Open
Abstract
Background Type 2 diabetes mellitus is a chronic disease whose health outcomes are related to patients and healthcare professionals’ decision-making. The Diabetes Intervention study in the Canary Islands (INDICA study) aims to evaluate the effectiveness and cost-effectiveness of educational interventions supported by new technology decision tools for type 2 diabetes patients and primary care professionals in the Canary Islands. Methods/design The INDICA study is an open, community-based, multicenter, clinical controlled trial with random allocation by clusters to one of three interventions or to usual care. The setting is primary care where physicians and nurses are invited to participate. Patients with diabetes diagnosis, 18–65 years of age, and regular users of mobile phone were randomly selected. Patients with severe comorbidities were excluded. The clusters are primary healthcare practices with enough professionals and available places to provide the intervention. The calculated sample size was 2,300 patients. Patients in group 1 are receiving an educational group program of eight sessions every 3 months led by trained nurses and monitored by means of logs and a web-based platform and tailored semi-automated SMS for continuous support. Primary care professionals in group 2 are receiving a short educational program to update their diabetes knowledge, which includes a decision support tool embedded into the electronic clinical record and a monthly feedback report of patients’ results. Group 3 is receiving a combination of the interventions for patients and professionals. The primary endpoint is the change in HbA1c in 2 years. Secondary endpoints are cardiovascular risk factors, macrovascular and microvascular diabetes complications, quality of life, psychological outcomes, diabetes knowledge, and healthcare utilization. Data is being collected from interviews, questionnaires, clinical examinations, and records. Generalized linear mixed models with repeated time measurements will be used to analyze changes in outcomes. The cost-effectiveness analysis, from the healthcare services perspective, involves direct medical costs per quality-adjusted life year gained and two periods, a ‘within-trial’ period and a lifetime Markov model. Deterministic and probabilistic sensitivity analyses are planned. Discussion This ongoing trial aims to set up the implementation of evidence-based programs in the clinical setting for chronic patients. Trial registration Clinical Trial.gov NCT01657227
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Affiliation(s)
- Yolanda Ramallo-Fariña
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, Spain. .,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Tenerife, Spain.
| | - Lidia García-Pérez
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, Spain. .,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Tenerife, Spain.
| | - Iván Castilla-Rodríguez
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, Spain. .,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Tenerife, Spain.
| | - Lilisbeth Perestelo-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Tenerife, Spain.
| | - Ana María Wägner
- Dpto de endocrinología, Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Spain. .,Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - Pedro de Pablos-Velasco
- Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Gran Canaria, Spain. .,Dpto de endocrinología, Hospital Universitario Dr. Negrín, Gran Canaria, Gran Canaria, Spain.
| | - Armando Carrillo Domínguez
- Dpto de endocrinología, Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Spain. .,Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - Mauro Boronat Cortés
- Dpto de endocrinología, Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Spain. .,Dpto de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - Laura Vallejo-Torres
- Dpto de Economía de las Instituciones, Estadística Económica y Econometría, Universidad de la Laguna, Tenerife, Spain.
| | | | - Pablo Pedrianes Martín
- Dpto de endocrinología, Hospital Universitario Dr. Negrín, Gran Canaria, Gran Canaria, Spain.
| | - Ignacio García-Puente
- Dpto de endocrinología, Hospital Universitario Dr. Negrín, Gran Canaria, Gran Canaria, Spain.
| | - Miguel Ángel Salinero-Fort
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Gerencia Adjunta de Planificación y Calidad. Servicio Madrileño de Salud (SERMAS), Madrid, Spain.
| | - Pedro Guillermo Serrano-Aguilar
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Tenerife, Spain.
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Acosta FJ, Ramallo-Fariña Y, Bosch E, Mayans T, Rodríguez CJ, Caravaca A. Antipsychotic treatment dosing profile in patients with schizophrenia evaluated with electronic monitoring (MEMS®). Schizophr Res 2013; 146:196-200. [PMID: 23474024 DOI: 10.1016/j.schres.2013.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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] [Received: 11/05/2012] [Revised: 01/29/2013] [Accepted: 02/12/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the Medication Event Monitoring System (MEMS®) device offers accurate information on treatment dosing profile, such profile has never been studied in patients with schizophrenia. Enhancing our knowledge on this issue would help in developing intervention strategies to improve adherence to antipsychotic treatment in these patients. METHODS 74 outpatients with schizophrenia were monitored with the MEMS device for a 3-month period, for evaluation of antipsychotic treatment dosing profile, possible influence of medication schedule-related variables, adherence to treatment--considering dose intake within prescribed timeframes--and possible Hawthorne's effect of using the MEMS device. RESULTS Dose-omission gaps occurred in 18.7% of monitoring days, most frequently during weekends, almost significantly. Almost one-third of prescribed doses were taken out of prescribed time. Neither the prescribed number of daily doses nor the indicated time of the day for dose intake (breakfast, dinner), were associated with correct antipsychotic dosing. Excess-dose was rare in general, and more frequent out of prescribed dose timeframe. No Hawthorne's effect was found for the MEMS device. Adherence reached only 35% according to a definition that included dose intake within prescribed timeframes. CONCLUSIONS Antipsychotic treatment dosing was considerably irregular among patients with schizophrenia. Strategies to reduce dose-omission gaps and increase dosing within prescribed timeframes seem to be necessary. Gaining knowledge on precise oral antipsychotic dosing profiles or the influence of schedule-related variables may be useful to design strategies towards enhancing adherence. There appears to be no Hawthorne's effect associated with the use of MEMS devices in outpatients with schizophrenia.
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Affiliation(s)
- Francisco J Acosta
- Mental Health Research Program, Mental Health Service, General Health Care Program Direction, Canary Islands Health Service, Gran Canaria, Spain.
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Acosta FJ, Vega D, Torralba L, Navarro S, Ramallo-Fariña Y, Fiuza D, Hernández JL, Siris SG. Hopelessness and suicidal risk in bipolar disorder. A study in clinically nonsyndromal patients. Compr Psychiatry 2012; 53:1103-9. [PMID: 22503379 DOI: 10.1016/j.comppsych.2012.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 11/29/2011] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Attempted suicide and death due to suicide are not uncommon among patients with bipolar disorder. Although some risk factors for suicidality in bipolar patients have been identified, little is known about hopelessness and other possible trait or diathesis-related factors. Consequently, the objective of this study was to investigate variables associated with suicidal risk in clinically nonsyndromal bipolar patients. METHODS A sample of 102 outpatients with a diagnosis of bipolar disorder according to International Classification of Diseases, 10th Revision criteria during nonsyndromal stage were evaluated. On the basis of suicidal history, patients were divided into suicide attempt, suicidal ideation, and nonsuicidal groups. Sociodemographic, clinical, and psychopathological variables were assessed. RESULTS As compared with the nonsuicidal group, female sex, combined psychopharmacologic treatment, and hopelessness were independently associated with suicide attempt. Hopelessness and insight into having a mental disorder were independently associated with history of suicidal ideation. CONCLUSIONS Patients with bipolar disorder and suicidal history are characterized by the presence of hopelessness, which probably confers greater vulnerability for suicidal behavior in the presence of stress factors. This identification of the risk profile for suicidal behavior in nonsyndromal bipolar patients adds complementary information to risk factors established for suicidality during acute phases of the disease, allows for differentiated preventive and treatment approaches of patients at risk, and suggests psychotherapy as an advisable intervention in this group of patients.
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Affiliation(s)
- Francisco J Acosta
- Mental Health Research Program, Service of Mental Health, General Health Care Programs Direction, Canary Health Service, Gran Canaria, Spain.
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Serrano-Aguilar P, Ramallo-Fariña Y, Cabrera-Hernández JM, Perez-Silguero D, Perez-Silguero MA, Henríquez-de la Fe F, de Ussel JGI. Immediately sequential versus delayed sequential bilateral cataract surgery: Safety and effectiveness. J Cataract Refract Surg 2012; 38:1734-42. [DOI: 10.1016/j.jcrs.2012.05.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/29/2012] [Accepted: 05/08/2012] [Indexed: 11/28/2022]
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Serrano-Aguilar P, Abreu R, Antón-Canalís L, Guerra-Artal C, Ramallo-Fariña Y, Gómez-Ulla F, Nadal J. Development and validation of a computer-aided diagnostic tool to screen for age-related macular degeneration by optical coherence tomography. Br J Ophthalmol 2011; 96:503-7. [DOI: 10.1136/bjophthalmol-2011-300660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pérez-Silguero D, Ramallo-Fariña Y, Pérez-Silguero MA, Jiménez-García A, Peñate-Valdivielso S, Pérez-Hernández FR. [Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome]. Arch Soc Esp Oftalmol 2009; 84:549-556. [PMID: 19967607 DOI: 10.4321/s0365-66912009001100003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the effectiveness of two strategies to prevent the appearance of intraoperative floppy iris syndrome (IFIS) in patients exposed to a-blockers. METHODS We compared retrospectively the presence and severity of the appearance of IFIS in 29 patients subjected to cataract surgery, establishing two groups of 12 patients (22 eyes) and 17 patients (33 eyes). The strategy applied to group one consisted of suspending the exposure to a-blockers for at least one week prior to the intervention, the topical application of 1% atropine three times a day for two days before the intervention and the use of intracameral lidocaine. The strategy for group two consisted of suspending use of the drug for at least one week before the intervention and the intracameral application at the beginning of surgery of a solution of physiological serum, adrenaline and lidocaine. RESULTS Six patients from group one showed no evidence of IFIS, 2 exhibited bilateral mild symptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes suffered from IFIS. In group two, only 3 eyes (9.1%) from 2 patients exhibited mild symptoms. Statistical analysis showed a significant difference between both groups (p=0.002). If only those exhibiting moderate and severe symptoms are taken into account the result was highly statistically significant (p=0.0002). CONCLUSION The study shows a greater statistical effectiveness of the strategy applied to group two compared to the strategy applied to group one (Arch Soc Esp Oftalmol 2009; 84: 549-556).
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Affiliation(s)
- D Pérez-Silguero
- Sección de polo anterior, Centro Insular de Oftalmología (CIOF), Las Palmas de Gran Canaria, España.
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Serrano-Aguilar P, Ramallo-Fariña Y, Trujillo-Martín MDM, Muñoz-Navarro SR, Perestelo-Perez L, de las Cuevas-Castresana C. The relationship among mental health status (GHQ-12), health related quality of life (EQ-5D) and health-state utilities in a general population. Epidemiol Psichiatr Soc 2009; 18:229-239. [PMID: 20034201] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM To assess the relationship between mental health and health-related quality of life (HRQL) in the general population, and to map GHQ-12 as a screening test for population psychological distress to a generic health state measure (EQ-5D) in order to estimate health state values and allow deriving quality-adjusted life years. METHODS Relationship between mental health and HRQL was examined from the 2004 Canary Islands' Health Survey. Participants were classified as probable psychiatric cases according to GHQ-12. HRQL was measured by the EQ-5D index. Multivariate lineal regression analysis was used to examine the association between mental health and HRQL adjusting by socio-demographic variables and comorbidities. A multivariate regression model was built from EQ-5D to estimate health states values using GHQ-12 as exposure. RESULTS EQ-5D index scores decreased as the GHQ-12 scores increased. Clinical and socio-demographic factors influenced HRQL without changing the overall trend for this negative relationship. The regression equation explained 43% of the variance. For estimation of utility scores, the model showed a high predictive capacity, with a mean forecast errors of 16%. CONCLUSIONS HRQL progressively decreased when the probability of being a psychiatric case increased. Findings enable health state values to be derived from GHQ-12 scores for populations where utilities has not or cannot be measured directly.
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Affiliation(s)
- Pedro Serrano-Aguilar
- Planning & Evaluation Unit, Canary Islands Health Service, Santa Cruz de Tenerife, Spain
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