Pilar Carrasco Garrido

Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients. Results of the EPIDEPOC study

BackgroundCOPD is currently the fourth cause of morbidity and mortality in the developed world. Patients with COPD experience a progressive deterioration and disability, which lead to a worsening in their health-related quality of life (HRQoL). The aim of this work is to assess the Health-Related Quality of Life (HRQoL) of patients with stable COPD followed in primary care and to identify possible predictors of disease.MethodsIt is a multicenter, epidemiological, observational, descriptive study. Subjects of both sexes, older than 40 years and diagnosed of COPD at least 12 months before starting the study were included. Sociodemographic data, severity of disease, comorbidity, and use of health resources in the previous 12 months were collected. All patients were administered a generic quality-of-life questionnaire, the SF-12, that enables to calculate two scores, the physical (PCS-12) and the mental (MCS-12) component summary scores.Results10,711 patients were evaluated (75.6% men, 24.4% women), with a mean age of 67.1 years (SD 9.66). The mean value of FEV1 was 35.9 ± 10.0%. Mean PCS-12 and MCS-12 scores were 36.0 ± 9.9 and 48.3 ± 10.9, respectively. Compared to the reference population, patients with COPD had a reduction of PCS-12, even in mild stages of the disease. The correlation with FEV1 was higher for PCS-12 (r = 0.38) than for MCS-12 (r = 0.12). Predictors for both HRQoL components were sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions. Other independent predictors of PCS-12 were age, body mass index and educational level.ConclusionPatients with stable COPD show a reduction of their HRQoL, even in mild stages of the disease. The factors determining the HRQoL include sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions.

Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality

BackgroundHip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain.MethodsWe selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index.Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM.ResultsWe identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA.ConclusionsThe current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.

Evolución de las coberturas vacunales antigripales entre 1993-2001 en España: Análisis por Comunidades Autónomas

Fundamento: La gripe es una enfermedad con una elevada morbilidad y que ocasiona un alto coste sanitario, para la que ademas se dispone de una vacuna eficaz. El objetivo de este trabajo es evaluar la evolucion de las coberturas vacunales antigripales en Espana por Comunidades Autonomas entre 1993 y 2001. Metodos: Se han analizado un total de 42.123 registros de la Encuesta Nacional de Salud (ENS) de los anos 1993 (n=21.051) y 2001(n=21.072). Todos ellos corresponden a adultos espanoles mayores de 15 anos no institucionalizados. Ambas encuestas son representativas a nivel de Comunidad Autonoma. Resultados: Para el total de la muestra se estima una cobertura vacunal en 1993 de 17,94% (IC 95% 17,42-18,46) y de 19,30% (18,77-19,83) en 2001. En el modelo de regresion logistica, ajustado por edad, genero y enfermedad cronica asociada, se observan mejoras significativas en las coberturas del grupo de mayores de 64 anos (OR= 1,28 IC 95% 1,10-1,50) para el total de Espana y para cinco de las 17 Comunidades Autonomas entre 1993 y 2001. Sin embargo, no encontramos cambios significativos en las coberturas para el grupo de menores de 65 anos con enfermedad cronica asociada que supone una indicacion para la vacunacion. Conclusiones: Tanto en Espana como en la mayoria de las Comunidades Autonomas entre 1993 y 2001 se observa una ligera pero insuficiente mejoria en las coberturas de vacunacion en los grupos de riesgo estudiados. Las Comunidades Autonomas muestran coberturas dispares entre si. Los sujetos menores de 65 anos con enfermedades cronicas asociadas que incrementan el riesgo de sufrir las complicaciones de la gripe no han mejorado las coberturas de esta vacuna durante el periodo de estudio. La dificultad para mejorar las coberturas en este tipo de pacientes podria hacernos considerar la opcion y el beneficio potencial de rebajar la edad limite de las actuales recomendaciones de indicacion de vacuna antigripal en Espana.

Epidemiologic Intervention Framework of a Prehospital Emergency Medical Service

Objectives. To describe andanalyze the characteristics of prehospital medical assistance provided by the Madrid Municipal Emergency andCivil Rescue & Protection Service (SAMUR); and, based on the epidemiologic knowledge so gained, to prioritize public health intervention strategies. Methods. A retrospective cross-sectional analysis of all medical services performed by the SAMUR–Protección Civil in 2001 and2002. Study variables included causes, response times, hour, day of the week, month, mobile resource, Municipal District, andpathology. For analysis purposes, the relevant data were linked to Access 97 via Open Database Connectivity. Statistical analysis was performed using the SPSS computer software package, with Spearmans correlation coefficient andanalysis of variance. Values were deemed statistically significant at p < 0.05. Results. The study population comprised the 97,937 and101,438 interventions undertaken in 2001 and2002, respectively. Mean daily activity in 2002 involved 278 alerts (standard deviation: 46), 95% confidence interval: 273–282. Distributions of the interventions were similar for 2001 and2002, with peak activity from 1 to 2 pm and8 to 9 pm, andminimum activity from 6 to 7 am. Activity was at its most intense on Saturdays. The magnitude of the association between the two years by day of the week was 96% (p < 0.001). The Central Municipal District (Centro) triggered 17,875 emergency actions. The prevalent pathology was traumatologic, followed by cardiovascular. Conclusions. Epidemiologic description enabled the characteristics of the prehospital assistance procedure to be comprehensively ascertained andquantified. False alarms assume special relevance due to their implications. Emergency medical alerts with a psychosocial component are on the increase, something that must be controlled.

Clustering of unhealthy lifestyle behaviors is associated with nonadherence to clinical preventive recommendations among adults with diabetes

AIM Analyze clustering of unhealthy lifestyle behavior and its relationship with nonadherence to clinical preventive care services among Spanish diabetic adults. METHODS Cross-sectional study including 2156 diabetic adults from the 2006 Spanish National Health Survey. Subjects were asked about their uptake of BP measurement, lipid profile, influenza vaccination, and dental examination. Lifestyle behaviors included smoking status, physical activity, alcohol consumption, and dieting. Binary logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of each preventive activity. RESULTS Almost 16% and 36% of the subjects had not undergone blood pressure (BP) and blood lipids measurements, respectively. Forty percent had not been vaccinated and 72% had not received dental examination. Fourteen percent of the subjects had three to four unhealthy behaviors and this increased the probability of not having BP check-up (OR 2.32, 95% CI 1.38-3.91), blood lipids testing (OR 1.63, 95% CI 1.14-2.33), and not being vaccinated (OR 1.99, 95% CI 1.37-2.89). Number of unhealthy lifestyle behaviors is linearly associated with number of preventive measures unfulfilled. CONCLUSIONS Adherence to recommended clinical preventive services is under desirable levels among Spanish diabetes sufferers. These preventive services are provided neither equitably nor efficiently, since subjects with unhealthier lifestyles are less likely to receive them.