Secular trend in the incidence of hip fracture in Catalonia, Spain, 2003-2014.

Objectives: to describe the secular trend and seasonal variation in the incidence of hip fracture (HF) over 12 years (2003-2014) in Catalonia, the community with the highest incidence of HF in Spain. Methods: data about age, gender, type of fracture and month of hospitalisation among patients aged 65 years and older discharged with a diagnosis of HF were collected. Crude and age-standardised annual incidence rate were reckoned. To analyse HF trend, the age/sex-adjusted average annual change in incidence (incidence rate ratio, IRR) was calculated. Results: we identified 100,110 HF in the period, with an increase of 16.9% (women 13.4%; men 28.4%). Trochanteric fractures were the most frequent (55.8%). The crude incidence rate (per 100,000 population) decreased from 677.2 (95% confidence interval (95% CI) 662.0-692.7) to 657.6 (95% CI 644.0-671.5). The standardised incidence rate decreased from 754.0 (95% CI 738.6-769.3) to 641.5 (95% CI 627.7-655.3), with a sharp decrease in women (-16.8%) while it was stable in men. The incidence by type of fracture was stable. The trend throughout the period showed a slight decrease with IRR 0.99 (95% CI 0.98-0.99; P = 0.025). The incidence was stable in the oldest group (+85 years), while there was a downward trend in the younger groups. A significant seasonal pattern was observed, with more cases in winter and less in summer (spring as reference). Conclusions: the secular trend reveals a decreasing incidence of HF although the absolute number has increased in the last 12 years in Catalonia. Trochanteric fractures were the most prevalent and a seasonal pattern was observed, with more cases in winter.

Total hip replacement in an ipsilateral above-the-knee amputation: surgical technique, rehabilitation, and review of the literature.

In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.

Atención a las enfermedades músculo-esqueléticas: distintas visiones del mismo problema / Attention to musculoskeletal diseases. Different visions of the same problem

Objetivo. Detectar los principales problemas que afectan a los médicos de familia (MF) y a los especialistas hospitalarios, en la atención de las principales enfermedades del aparato locomotor en Cataluña. Método. Estudio descriptivo transversal realizado mediante una encuesta auto-administrada dirigida a MF y a especialistas hospitalarios de 4 ámbitos (cirugía ortopédica y traumatología [COT], reumatología [RMT], medicina física y rehabilitación [MFR] y unidades del dolor [UD]). Las variables recogidas evalúan datos socio-demográficos, dedicación asistencial, destreza autodeclarada, el proceso de derivación, los mecanismos de coordinación y las principales dificultades para ofrecer una atención de calidad. Resultados. Los MF consideran bueno su nivel de destreza en el manejo de las enfermedades del aparato locomotor (6,7±1,0 en una escala del 1 al 10). Menos del 25% refieren coordinarse con especialistas hospitalarios. Para los MF el mayor problema son las listas de espera en las especialidades citadas (8,2±1,6/10), seguido de la falta de información de retorno (8±1,9/10) y de la escasa coordinación (7,8±1,9/10). Según su criterio, la especialidad de referencia debería cambiar en algunas patologías (como la lumbalgia y la artrosis). Los especialistas hospitalarios son críticos respecto al papel de los MF. Para ellos, los principales problemas son la propia sobrecarga asistencial (7,8±2/10) y la ineficiencia de los sistemas de información (7,4±2/10). Conclusiones. La opinión sobre los problemas que afectan a la atención de las enfermedades del aparato locomotor difiere entre los MF y los especialistas hospitalarios. La falta de accesibilidad y la sobrecarga asistencial de la atención especializada, las deficiencias en el flujo de información y la escasa coordinación son los problemas más destacados (AU)

Objective: To identify the main problems affecting general practitioners (GPs) and specialists in the care of the main musculoskeletal problems in Catalonia. Method: Cross-sectional, self-administered survey in a representative sample of GPs and all specialists in four areas (orthopedic surgery, rheumatology, physical medicine and rehabilitation and pain units). Variables evaluated in the survey were related to socio-demographic data, attention to musculoskeletal diseases, self-declared expertise, referral process, coordination mechanisms and major constraints to provide high quality care. Results: GPs value well their expertise in the management of musculoskeletal diseases (6,7 ± 1,0 on a scale of 1 to 10). Less than 25% of GPs are coordinated with hospital specialists. For them, waiting lists are the main problem (8.2 ± 1,6/10) followed by lack of feedback (8 ± 1,9/10) and poor coordination (7.8 ± 1,9/10). Referenced specialties should change for some diseases (back pain and osteoarthritis). Specialists are critical for GPs. For specialists, the main problems are excessive workload (7,8 ± 2/10) and the inefficiency of healthcare information systems (7.4 ± 2/10). Conclusions: The vision of the problems affecting the care of musculoskeletal diseases differs between GPs and hospital specialists. The limited accessibility and workload excess, deficiencies in the flow of information and poor coordination are the most important problems in the proper care for musculoskeletal diseases (AU)

Attention to musculoskeletal diseases. Different visions of the same problem.

OBJECTIVE: To identify the main problems affecting general practitioners (GPs) and specialists in the care of the main musculoskeletal problems in Catalonia. METHOD: Cross-sectional, self-administered survey in a representative sample of GPs and all specialists in four areas (orthopedic surgery, rheumatology, physical medicine and rehabilitation and pain units). Variables evaluated in the survey were related to socio-demographic data, attention to musculoskeletal diseases, self-declared expertise, referral process, coordination mechanisms and major constraints to provide high quality care. RESULTS: GPs value well their expertise in the management of musculoskeletal diseases (6,7±1,0 on a scale of 1 to 10). Less than 25% of GPs are coordinated with hospital specialists. For them, waiting lists are the main problem (8.2±1,6/10) followed by lack of feedback (8±1,9/10) and poor coordination (7.8±1,9/10). Referenced specialties should change for some diseases (back pain and osteoarthritis). Specialists are critical for GPs. For specialists, the main problems are excessive workload (7,8±2/10) and the inefficiency of healthcare information systems (7.4±2/10). CONCLUSIONS: The vision of the problems affecting the care of musculoskeletal diseases differs between GPs and hospital specialists. The limited accessibility and workload excess, deficiencies in the flow of information and poor coordination are the most important problems in the proper care for musculoskeletal diseases.

Planificación en enfermedades reumáticas. Elaboración del Plan director de las enfermedades reumáticas y del aparato locomotor de Cataluñaa / Health planning in rheumatic diseases. Elaboration of a master plan for rheumatic and musculoskeletal diseases of Catalonia

Introducción: Las enfermedades reumáticas son el problema de salud crónico más prevalente de la población adulta catalana. Conllevan importantes problemas para el individuo y para la sociedad, con elevados costes económicos directos e indirectos. Desde el Departamento de Salud de Cataluña se propuso la creación del Plan director de las enfermedades reumáticas y del aparato locomotor, como herramienta de planificación para abordar de forma integral estos problemas. Objetivo: Presentar la metodología de trabajo que se ha utilizado para el desarrollo del Plan y las propuestas finales de este. Métodos: Inicialmente se realizó un análisis de situación de estos problemas en nuestra comunidad y se establecieron los objetivos del Plan. Posteriormente, se definieron las líneas estratégicas y se organizaron grupos de trabajo para analizar las diferentes propuestas de mejora que fueron consensuadas con los actores implicados. Resultados: Las propuestas del Plan incluyen aspectos que van desde la prevención a la rehabilitación con el objetivo de racionalizar el uso de los recursos y aumentar la eficiencia en la atención. Se propone un nuevo modelo asistencial que acerca la asistencia especializada a la atención primaria en forma de consultorías y la organización de unidades funcionales de aparato locomotor, entre otras propuestas. Conclusiones: El Plan director establece las líneas de actuación de la política sanitaria y de la planificación en relación con estos trastornos a partir del análisis de la situación, el establecimiento de objetivos de mejora de la atención y la propuesta de acciones concretas para conseguirlos (AU)

Background: Rheumatic diseases (RDs) are among the most common chronic health problems of the Catalan adult population. They cause important problems for individuals, their families and for the society overall, with high direct and indirect economic costs. The Department of Health of Catalonia promoted the creation of a Master Plan for the rheumatic diseases, as a tool for planning an integral approach to these problems. Objective: To present the work methodology that has been used in the development of the Master Plan and its final proposals. Methods: First an analysis of the burden caused by these problems in our community was performed and the objectives of the Plan were established. Later, strategic lines were defined and work groups organized to analyze proposals for improvement, which after consensus were accepted. Results: The proposals of the Plan comprise actions in the scope of prevention, rationalization in the use of resources and the formation of professionals among others. Changes in the health care model for RDs were proposed in order to improve specialized and primary care coordination with clinics and musculoskeletal functional units. Conclusions: The Master Plan recommends actions to improve the attention of the population through operative planning and the services to different providers. The Master Plan will establish the health policy action lines directed against these disorders (AU)

Health planning in rheumatic diseases. Elaboration of a master plan for rheumatic and musculoskeletal diseases of Catalonia.

BACKGROUND: Rheumatic diseases (RDs) are among the most common chronic health problems of the Catalan adult population. They cause important problems for individuals, their families and for the society overall, with high direct and indirect economic costs. The Department of Health of Catalonia promoted the creation of a Master Plan for the rheumatic diseases, as a tool for planning an integral approach to these problems. OBJECTIVE: To present the work methodology that has been used in the development of the Master Plan and its final proposals. METHODS: First an analysis of the burden caused by these problems in our community was performed and the objectives of the Plan were established. Later, strategic lines were defined and work groups organized to analyze proposals for improvement, which after consensus were accepted. RESULTS: The proposals of the Plan comprise actions in the scope of prevention, rationalization in the use of resources and the formation of professionals among others. Changes in the health care model for RDs were proposed in order to improve specialized and primary care coordination with clinics and musculoskeletal functional units. CONCLUSIONS: The Master Plan recommends actions to improve the attention of the population through operative planning and the services to different providers. The Master Plan will establish the health policy action lines directed against these disorders.

Importancia de los problemas reumáticos en la población de Cataluña: prevalencia y repercusión en la salud percibida, restricción de actividades y utilización de recursos sanitarios / Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services

Objetivo Conocer la importancia de las enfermedades reumáticas en la población adulta de Cataluña y su repercusión en la salud autopercibida, la restricción de actividades y el uso de servicios sanitarios. Métodos Encuesta poblacional a 15.926 adultos. Muestreo estratificado polietápico. Variables recogidas: características sociodemográficas, problemas de salud, salud autopercibida, restricción de actividades y uso de recursos sanitarios. Los problemas musculoesqueléticos se clasificaron en cuatro categorías: artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis. Resultados El 77,4% declara problemas crónicos de salud. La dorsalgia-lumbalgia, la cervicalgia crónica y el grupo artrosis-artritis o reumatismo, por este orden, son los más frecuentemente declarados. Tras ajustar por la edad, el sexo femenino incrementa el riesgo de declarar artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis (odds ratio [OR]=2,6, 1,5, 2,3 y 5,3, respectivamente). La prevalencia es más alta en los grupos de mayor edad con gradiente social. Tras ajustar por edad, sexo, clase social y obesidad, la percepción de la salud es peor en las personas afectadas (42,7% frente a 11%), que también declaran una mayor restricción de la actividad en el último año y en los últimos 15 días (OR=2,70 y 2,32, respectivamente), y un uso de los servicios sanitarios significativamente superior. Conclusiones Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor en las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios (AU)

Objective To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. Methods A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. Results Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. Conclusiones Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios (AU)

[Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services]. / Importancia de los problemas reumáticos en la población de Cataluña: prevalencia y repercusión en la salud percibida, restricción de actividades y utilización de recursos sanitarios.

OBJECTIVE: To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. METHODS: A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. RESULTS: Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. CONCLUSIONS: Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios.