Ricard Tresserras

Estimación de la incidencia poblacional y la mortalidad de la enfermedad cerebrovascular establecida isquémica y hemorrágica en 2002

Introduccion y objetivos Se pretende obtener una aproximacion a la incidencia poblacional de las enfermedades cerebrovasculares (ECV) en el ano 2002. Metodos Se han combinado los datos del Registro de Mortalidad y el Registro del Conjunto Minimo Basico de Datos de 65 de los 84 hospitales generales catalanes durante el ano 2002 (el 90,7% de las camas de hospitalizacion aguda), de los pacientes de mas de 24 anos. Se han estimado las tasas poblacionales de mortalidad, incidencia acumulada y hospitalizacion, brutas y estandarizadas por edad, y la mortalidad a los 28 dias por ECV, excluidas las traumaticas y la transitoria, en Cataluna. Resultados La tasa bruta de mortalidad por 100.000 de ECV en Cataluna en mayores de 24 anos fue de 92 en varones y 119 en mujeres, y la estandarizada por edad, 58 (intervalo de confianza [IC] del 95%, 56-61) y 43 (IC del 95%, 41-44), respectivamente. Las tasas de incidencia acumulada de ECV fueron 218 (IC del 95%, 214- 221) en varones y 127 (IC del 95%, 125-128) en mujeres. La letalidad poblacional cruda a 28 dias fue del 36,2% (el 30,3% en varones y el 42,0% en mujeres). El 62,5% de los pacientes (el 57,2% de los varones y el 66,4% de las mujeres) murio por ECV fuera de los hospitales. Conclusiones Los resultados indican que la mortalidad y la incidencia de ECV en Cataluna se situan entre las mas bajas de los paises desarrollados. Mas de la mitad de las muertes ocurridas en los 28 dias siguientes al inicio de los sintomas se produce fuera de los hospitales.

Pharmacoeconomic considerations in the management of hypertension.

Hypertension is highly prevalent in developed and developing countries (more than 30% of the adult population when a threshold value of 140/90mm Hg is selected). It constitutes one of the major cardiovascular risk factors and accounts for more than 5% of total deaths worldwide.The economic impact of hypertension is enormous, representing

Epidemiology of renal involvement in Type II diabetics (NIDDM) in Catalonia

US23.74 billion in the US in 1995 and approximately

Prevalencia del tabaquismo en Cataluña, 1982-1998: una perspectiva de género

US1685 million in Spain in 1994. Direct costs amount to more than 50% of the total costs of hypertension, and almost 70% of these are attributable to drug treatment. Furthermore, hypertensive patients use medical services 50% more than normotensive individuals, and hypertension represents one of the 3 leading causes of visits to primary healthcare centres.When considering the cost effectiveness of hypertension treatment, there is no doubt that it is cost effective in comparison with other interventions, although some controversies exist, mainly with respect to mild-to-moderate hypertension and to the long term versus short term benefits. The controversy about the absolute risk of hypertension influences the cost-effectiveness analysis.Because of the limitations of the available cost-effectiveness analyses, it is currently impossible to recommend the use of any particular antihypertensive drug for all patients with hypertension. Consequently, the choice of antihypertensive in any patient should be guided by clinical experience and the recommendations of the present international guidelines.

Normas de referencia para el Cuestionario de Salud SF-12 version 2 basadas en poblacion general de Cataluna

The aim of this cross-sectional study was to establish the prevalence of renal involvement and to identify associations with its most important possible risk factors in a group of patients with Type II diabetes mellitus, representative of the population living in Catalonia. One thousand two hundred and three patients (47% males, mean age: 61 +/- 6 years, diabetes duration 9 +/- 6 years) were studied. Overnight urine samples were collected to determine urinary albumin excretion (UAE). If UAE was > 15 micrograms/min, a new 24-h urine collection for UAE measurement to establish the existence of microalbuminuria (20-200 micrograms/min) or macroalbuminuria (> 200 micrograms/min) was obtained. Clinic and metabolic evaluations were also performed. The prevalence (%) of microalbuminuria, macroalbuminuria and hypertension were, respectively, 23. 1, 5.4 and 42. In comparison with normoalbuminurics, patients with microalbuminuria were predominately male (P < 0.03), with a significantly higher systolic (P < 0.001) and diastolic (P < 0.001) blood pressure and body mass index (P < 0.001). The prevalence of smokers (former + current) was higher in patients with microalbuminuria (43 vs 32%, P < 0.025). Moreover, patients with nephropathy had more prevalence of retinopathy (P < 0.001), neuropathy (P < 0.001), peripheral angiopathy (P < 0.001) and coronary disease (P < 0.001). The prevalence of microalbuminuria in Type II diabetes in Catalonia is similar to that observed in other european countries. The existence of microalbuminuria is associated with several diabetic complications, as well as tobacco consumption and obesity.

Quality of In-Hospital Stroke Care According to Evidence-Based Performance Measures Results From the First Audit of Stroke, Catalonia (Spain) 2005/2006

Fundamento Describir la evolucion del habito tabaquico en la poblacion catalana entre 1982 y1998, a partir de un analisis de perspectiva de genero. Sujetos y metodo Se incluyeron datos de las encuestas llevadas a cabo por el Departament deSanitat i Seguretat Social en 1982, 1986, 1990, 1994 y 1998. Se analizaron el «status» defumador, el numero de cigarrillos diarios fumados, la edad y el sexo, asi como variables relacionadascon el tipo de tabaco fumado, la edad de inicio y la duracion del habito. Los resultadosse presentan como proporciones con sus intervalos de confianza del 95% y como medias consus desviaciones estandar. Resultados La prevalencia global del habito tabaquico en la poblacion de 15-64 anos se mantieneestable entre 1982 y 1998 (variacion porcentual de –1,1%) y se situa en un 37,5% defumadores actuales en 1998. En las mujeres, la prevalencia se incrementa un 53,5% durantedicho periodo y alcanza el 30,7% en 1998. En los varones se reduce un 23,8% y alcanza el44,4%. Entre 1994 y 1998 se rompe la tendencia decreciente que se habia producido hastaentonces en los jovenes de ambos sexos. En 1998, el 26,1% de las mujeres fuma tabaco«light» frente a un 10,4% de los varones; las mujeres fuman una media de 13,8 (8,8) cigarrillosdiarios frente a la media de 19,7 (12,6) cigarrillos que fuman los varones; la media de duraciondel habito entre las mujeres es de 13,9 (10,1) anos mientras que en los varones es de22,6 (16,0). Conclusiones Hasta el ano 1998, la prevalencia del habito tabaquico en Cataluna se mantuvoelevada a pesar de producirse una disminucion importante de la masculina. La situacion fueparticularmente desfavorable para los jovenes de ambos sexos y las mujeres, cuyo habito tabaquicopresenta caracteristicas especificas.

Estadísticas de alta hospitalaria del infarto agudo de miocardio: declive aparente con la extensión de espacios sin humo

BACKGROUND AND OBJECTIVE The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

The utilization of dental care services according to health insurance coverage in Catalonia (Spain)

Background and Purpose— Evidence-based standards are used worldwide to determine quality of care. We assessed quality of in-hospital stroke care in all acute-care hospitals in Catalonia by determining adherence to 13 evidence-based performance measures (PMs) of process of care. Methods— Data on PMs were collected by retrospective review of medical records of consecutive stroke admissions (January to June, 2005). Compliance with PMs was calculated according to 3 hospital levels determined by their annual stroke case-load (level 1, <150 admissions/yr; level 2, 150 to 350; and level 3, >350). We defined sampling weights that represented each patient’s inverse probability of inclusion in the study sample. Sampling weights were applied to produce estimates of compliance. Factors that predicted good/bad compliance were determined by multivariate weighted logistic regression models. An external monitoring of 10% of cases recruited at each hospital was undertaken, after random selection, to assess quality of data. Results— We analyzed data from 1791 stroke cases (17% of all stroke admissions). Global interobserver agreement was 0.7. Eight PMs achieved compliances ≥75%, 4 of which were more than 90%, and the remaining showed adherences ≤62%. Analysis of compliance across hospital levels displayed some significant differences that persisted after multivariate analysis. We observed lower adherences to “early mobilization,” “assessment of rehabilitation needs,” and “prescription of anticoagulants for atrial fibrillation” in females and in the elderly. Conclusions— In 2005, in-hospital stroke care in Catalonia was heterogeneous across hospital levels. Rehabilitation-related measures showed poor compliances compared to acute care-related ones, which achieved more satisfactory adherences.

La detección de factores de riesgo cardiovascular en la red reformada de atención primaria en Cataluña. Comparación entre los años 1995 y 2000

Estudios recientes indican que regulaciones del consumo de tabaco reducen los infartos agudos de miocardio (IAM). Se analiza la evolucion del IAM en la region metropolitana de Barcelona con la ley de 2006. Se obtuvo informacion sobre altas financiadas por el Servicio Catalan de la Salud para 2004-2006. Se incluyo a los pacientes mayores de 24 anos residentes en la zona con diagnostico principal de IAM. Se estimaron tasas anuales de hospitalizacion por IAM estratificadas por edad y sexo con intervalos de confianza (IC) del 95% para cada ano. Las tasas en 2004 son mayores que en 2005 para la mayoria de los estratos, pero los IC se solapan. Las tasas en 2006 son menores que en 2005 para todos los grupos, y los IC no se solapan en varones. Las regulaciones sobre espacios sin humo se acompanan de una disminucion de los IAM hospitalizados.

OriginalNormas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de CataluñaReference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population

The aim of this study was to assess the relationship of dental care service use with health insurance and its evolution. The Catalan Health Interview Survey is a cross-sectional study conducted in 1994 (n = 15 000) and 2001-2 (n = 8400) by interviews at home to a representative sample of Catalonia (Spain). All the estimates were obtained by applying weights to restore the representativeness of the Catalonia general population. In the bivariate analysis, age, gender, social class and health insurance coverage were statistically associated with a dental visit in the previous year (P < 0.001). Analysis with logistic regression showed that health insurance status has a statistically significant association with utilization (P < 0.001), which was independent of the other socio-economic factors (age, gender, country of birth, and social class). However, the falling trend of differences by health insurance coverage is of note (adjusted OR = 2.2 and 1.5 at 1994 and 2002, respectively); as well as the positive evolution of the overall rate of dental service care use in the previous year, from 26.7% in 1994 to 34.3% in 2002. Future studies will be needed to monitor this tendency.