Marta Fajó-Pascual

Lifestyle Factors Associated with BMI in a Spanish Graduate Population: The SUN Study

Objective: To study the association between BMI and lifestyle factors such as alcohol consumption, smoking habits, education level and marital status in a Spanish graduate population. Method: Cross-sectional analysis of 8,706 participants (3,643 men and 5,063 women) from the Seguimiento Universidad de Navarra (SUN) Study, an ongoing dynamic cohort study in Spain. Data on body weight, height and sociodemographic characteristics, and lifestyle habits were collected with self-administered validated questionnaires. Results: Among older participants (above sex-specific median age), educational level was a factor independently associated with BMI. University graduates with a lower educational level (3-year college degree or 5-year university degree) had a significantly higher BMI than those with doctorate which requires, at least, 8 years of university studies in Spain. Mean BMI was significantly higher among past smokers than among never smokers. Alcohol consumption, marital and smoking status were associated with BMI only among men. Conclusion: In a study whose members were all university graduates, several factors were independently associated with a higher BMI, such as less years of higher education, past smoking, marital status and higher alcohol consumption.

Case–control study of risk factors for sporadic Campylobacter infections in northeastern Spain

BACKGROUND An age-matched case-control study was conducted in northeastern Spain to identify major risk factors for sporadic Campylobacter infections and their relative importance. METHODS Cases were aged >6 months, residents of Sector Sanitario Huesca with diarrhea and confirmed culture of Campylobacter not related to outbreak. For each case <15 years of age, the patient closest in age to the case was selected from the medical records of the cases pediatrician to serve as a control. If the case was >or=15 years of age, the control was nominated by the case. RESULTS Eighty one cases (median age 2.3 years, 79% <15 years) and 81 controls were enrolled. Three exposures, in the 7 days prior to symptom onset, were independent predictors for illness after multivariate conditional logistic regression analysis: consuming three or more times chicken [odds ratio (OR)(adjusted) = 6.1; confidence interval (CI): 2.0-18.5; population attributable fraction (PAF) = 36.1%], consuming sliced deli meat unhygienically handled at retail stores (OR(adjusted) = 4.1; CI: 1.2-13.2; PAF = 24.5%) and contact with animals (OR(adjusted) = 2.8; CI: 1.1-7.3; PAF = 19. 0%). Among cases <15 years of age, only consuming chicken >or=3 times (OR(adjusted) = 7.8; CI: 2.2-26.7; PAF = 43.6%) and contact with animals (OR(adjusted) = 3.7; CI: 1.2-11.0; PAF = 25.1%) were independent predictors for disease. Consuming sliced deli meat unhygienically handled at retail stores was significantly more frequent among <15-year age group (56.3% versus 26.6.0%, P = 0.04). CONCLUSION A control programme for Campylobacter in the food chain and targeted food-safety education to prevent cross-contamination seem warranted to decrease the opportunity of human exposure to the pathogen in northeastern Spain.

Initial medication non‐adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients

AIMS Adherence to medicines is vital in treating diseases. Initial medication non-adherence (IMNA) - defined as not obtaining a medication the first time it is prescribed - has been poorly explored. Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system. METHODS This is a retrospective, register-based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non-initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013-June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation. RESULTS Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin-converting-enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident-training centre. CONCLUSIONS The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.

Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain

BACKGROUND Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave. AIM To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups. DESIGN AND SETTING A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012. METHOD Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre. RESULTS Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term. CONCLUSION Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.

Effect of copayment policies on initial medication non-adherence according to income: a population-based study

Objective Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. Design A population-based study was conducted using real-world evidence. Setting Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Participant Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). Outcomes IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups. Results Before changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners. Conclusion Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.