ABSTRACT
BACKGROUND: Infrarenal aortic diameter (AD) values currently considered normal are based on measurements from epidemiologic studies performed over 20 years ago. Knowledge of expected normal AD is important for understanding the relevance of abdominal aortic dilatation. The aim of this study was to define contemporary reference values for normal infrarenal AD and build a predictive model based on individual features. METHODS: A cross-sectional study of participants in a population-based screening program for abdominal aortic aneurysm (AAA) was performed in a healthcare district with 400,000 inhabitants. Men and women aged 65 years were invited to participate. Cardiovascular (CV) risk factors, family history of AAA, personal history of other aneurysms, CV disease, and anthropometric parameters were evaluated. The largest anteroposterior inner-inner diameter of the infrarenal aorta was measured by ultrasound. Multiple linear regressions were used to determine independent predictors of AD. The best-fit model was obtained by randomly selecting 70% of the sample and validating the results in the remaining 30%. RESULTS: A total of 4,730 people (2,089 men and 2,641 women) were invited. The participation rate was 50.4% for men and 44.0% for women. Mean AD (standard deviation, SD) was 16.51 (3.2) mm in the overall group, 17.91 (3.51) mm in men, and 15.25 (2.32) mm in women (P < 0.001). Male sex (P < 0.001), body surface area (P < 0.001), smoking habit (P = 0.012), and history of arterial aneurysms (P = 0.013) were independently associated with increased AD. Dyslipidemia was associated with decreased AD (P < 0.001). The findings were used to build a model for predicting AD based on individual characteristics. CONCLUSIONS: ADs in our study population are smaller than those described in classic epidemiological studies. Men have a significantly larger diameter than women and the strongest predictor of increased AD is body surface area. A greater understanding of factors associated with AD will help predict expected sizes in individual members of the population.
Subject(s)
Aorta, Abdominal , Aortic Aneurysm, Abdominal , Humans , Male , Female , Risk Factors , Cross-Sectional Studies , Treatment Outcome , Aorta, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/epidemiology , Ultrasonography , PrevalenceABSTRACT
BACKGROUND: Technology has significantly changed the way health organizations operate. However, the role it plays in healthcare systems remains unclear. This aim of this study was to evaluate the opinion of physicians regarding e-health and determine what factors influence their opinion and describe the advantages, inconveniences and threats they may perceive by its use. METHODS: A cross-sectional questionnaire-based study. A questionnaire which had been previously designed and validated by the authors was used to interview physicians from the Barcelona Medical Association. 930 physicians were contacted by phone to participate in the study. RESULTS: Seven hundred sixty physicians responded to the questionnaire (response rate: 82%). The usefulness of telemedicine scored 7.4 (SD 1.8) on a scale from 1-10 (from the lowest to the highest) and the importance of the Internet in the workplace was 8.2 points (SD 1.8). Therapeutic compliance (7.0 -SD 1.8-) and patient health (7.0 -SD 1.7-) showed the best scores, and there were differences between professionals who had and had not previously participated in a telemedicine project (p < 0.05). The multivariate regression model explained the 41% of the variance for 7 factors: participation in telemedicine project (p < 0.001), quality of clinical practice (p < 0.001), patient health (p < 0.001), professional workload (p = 0.005), ease-of-use of electronic device (p = 0.007), presence of incentives for telemedicine (p = 0.011) and patient preference for in-person visits (p = 0.05). CONCLUSIONS: Physicians believe in the usefulness of e-health. Professionals with previous experience with it are more open to its implementation and consider that the benefits of technology outweigh its possible difficulties and shortcomings. Physicians demanded projects with appropriate funding and technology, as well as specific training to improve their technological abilities. The relationship of users with technology differs according to their personal or professional life. Although a 2.0 philosophy has been incorporated into many aspects of our lives, healthcare systems still have a long way to go in order to adapt to this new understanding of the relationship between patients and their health.
Subject(s)
Attitude of Health Personnel , Delivery of Health Care , Technology , Adult , Attitude to Computers , Cross-Sectional Studies , Diffusion of Innovation , Female , Humans , Internet , Male , Middle Aged , Physicians , Surveys and Questionnaires , TelemedicineABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Teaching Care Integration Services/standards , Family Practice/methods , Family Practice/organization & administration , Family Practice/standards , Education/methods , Education/trends , Education, Continuing/trends , Community Medicine/methods , Community Medicine/organization & administrationABSTRACT
Antecedentes y objetivo: Una de las limitaciones del SCORE es que no permite calcular el riesgo en mayores de 65 años. Recientemente, los investigadores del SCORE han publicado unas tablas específicas para mayores (SCORE Older Persons [SCORE OP]). El objetivo del presente estudio fue evaluar el impacto de la utilización de las tablas SCORE OP en una población española de pacientes mayores de 64 años y su comparación con las tablas SCORE en el grupo entre 65 y 69 años. Pacientes y método: Estudio transversal realizado en 2 centros de salud urbanos. Se seleccionaron individuos de entre 65 y 85 años sin antecedentes de diabetes mellitus o enfermedad cardiovascular. Se calculó el riesgo utilizando las tablas para países de bajo riesgo SCORE y las nuevas OP. Resultados: Se calculó el riesgo cardiovascular a 3.425 pacientes. En el grupo de entre 65-69 años (n = 974, 22,44%) la media de riesgo según el SCORE fue de 4,08, y según el SCORE OP, de 3,83 (p < 0,001). El porcentaje de pacientes de riesgo alto fue de un 25,46% con SCORE y de 22,90% con SCORE OP (p < 0,001). Utilizando el SCORE deberíamos tratar con hipolipidemiantes al 16,43% de los pacientes, mientras que con el SCORE OP deberíamos tratar al 13,45%. Utilizando SCORE OP en pacientes mayores de 69 años deberíamos tratar con hipolipidemiantes al 61,49% de los pacientes. Conclusiones: Las tablas SCORE OP para mayores de 64 años identifican menos pacientes de alto riesgo que las tablas SCORE, lo que implicaría tratar potencialmente menos pacientes de esas edades con hipolipidemiantes (AU)
Background and objective: Estimating cardiovascular risk with SCORE is not recommended in persons over 65 years. SCORE investigators have recently published specific tables for older people (SCORE Older Persons [SCORE OP]). The aim of this study is to assess the impact of using SCORE OP tables on a Spanish population aged over 64 years, and compare it with the use of SCORE in patients aged 65-69 years. Patients and method: Cross-sectional study carried out in 2 urban primary health care centres. Individuals between 65 and 85 years old without diabetes or established cardiovascular diseases were included. Cardiovascular risk using SCORE and the new SCORE OP tables for low risk countries was calculated. Results: Cardiovascular risk was estimated in 3,425 patients. Mean values of the original SCORE and SCORE OP were 4.08 and 3.83, respectively in the group of patients aged 65-69 years old (n = 974, 22.44%) (P < .001). The percentage of patients at high or very high risk was 25.46% and 22.90% with the original SCORE and the SCORE OP, respectively (P < .001). Using the original SCORE, 16.43% of the total patients should potentially be treated with lipid lowering drugs, while using the SCORE OP, 13.45% of the patients aged 65-69 years should potentially be treated. Using SCORE OP in patients older than 69 years, 61.49% patients should potentially be treated with lipid lowering drugs. Conclusions: SCORE OP identifies fewer patients at high or very high risk than the original SCORE, therefore, its utilization would imply treating fewer patients of this age with lipid lowering drugs (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Cardiovascular Diseases/prevention & control , Health Status Indicators , Age Factors , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Risk Assessment , Risk Factors , Retrospective StudiesABSTRACT
BACKGROUND AND OBJECTIVE: Estimating cardiovascular risk with SCORE is not recommended in persons over 65 years. SCORE investigators have recently published specific tables for older people (SCORE Older Persons [SCORE OP]). The aim of this study is to assess the impact of using SCORE OP tables on a Spanish population aged over 64 years, and compare it with the use of SCORE in patients aged 65-69 years. PATIENTS AND METHOD: Cross-sectional study carried out in 2 urban primary health care centres. Individuals between 65 and 85 years old without diabetes or established cardiovascular diseases were included. Cardiovascular risk using SCORE and the new SCORE OP tables for low risk countries was calculated. RESULTS: Cardiovascular risk was estimated in 3,425 patients. Mean values of the original SCORE and SCORE OP were 4.08 and 3.83, respectively in the group of patients aged 65-69 years old (n=974, 22.44%) (P< .001). The percentage of patients at high or very high risk was 25.46% and 22.90% with the original SCORE and the SCORE OP, respectively (P<.001). Using the original SCORE, 16.43% of the total patients should potentially be treated with lipid lowering drugs, while using the SCORE OP, 13.45% of the patients aged 65-69 years should potentially be treated. Using SCORE OP in patients older than 69 years, 61.49% patients should potentially be treated with lipid lowering drugs. CONCLUSIONS: SCORE OP identifies fewer patients at high or very high risk than the original SCORE, therefore, its utilization would imply treating fewer patients of this age with lipid lowering drugs.
Subject(s)
Cardiovascular Diseases/prevention & control , Health Status Indicators , Age Factors , Aged , Aged, 80 and over , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Male , Primary Health Care , Retrospective Studies , Risk Assessment , Risk FactorsABSTRACT
INTRODUCTION AND OBJECTIVES: In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. METHODS: In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. RESULTS: Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. CONCLUSIONS: The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting.
Subject(s)
Cardiovascular Diseases/epidemiology , Risk Assessment/methods , Adult , Aged , Blood Pressure , Cardiovascular Diseases/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Cross-Sectional Studies , Female , Humans , Hypolipidemic Agents/therapeutic use , Male , Middle Aged , Risk Factors , Smoking/epidemiology , Spain/epidemiologyABSTRACT
Introducción y objetivos. En España disponemos de tablas SCORE para el cálculo del riesgo cardiovascular en países de bajo riesgo, tablas calibradas para la población española, y unas tablas que permiten incluir el colesterol unido a lipoproteínas de alta densidad. Este estudio pretende evaluar el impacto de la utilización de una u otra tabla de riesgo en la práctica clínica. Métodos. Estudio transversal realizado en dos centros de salud. Se seleccionó a sujetos de entre 40 y 65 años de edad que contaran con un registro de presión arterial y colesterol total entre marzo de 2010 y marzo de 2012. Se excluyó a los sujetos con antecedente de diabetes mellitus o enfermedad cardiovascular. Se calculó el riesgo utilizando las tablas SCORE para países de bajo riesgo, tablas SCORE con colesterol unido a lipoproteínas de alta densidad y tablas SCORE calibrado. Resultados. Se calculó el riesgo cardiovascular a 3.716 pacientes. Los pacientes de alto o muy alto riesgo fueron el 1,24% con SCORE con colesterol unido a lipoproteínas de alta densidad, el 4,73% con SCORE para países de bajo riesgo y el 15,44% con SCORE calibrado (p < 0,01). Utilizando el SCORE calibrado, deberíamos tratar con hipolipemiantes al 10,23% de los pacientes; con el SCORE para países de bajo riesgo, al 3,12%, y con el SCORE con colesterol unido a lipoproteínas de alta densidad, al 0,67%. Conclusiones. La tabla SCORE calibrado identifica a más pacientes de alto riesgo que las del SCORE de bajo riesgo y el SCORE con colesterol unido a lipoproteínas de alta densidad, por lo que su utilización implicaría tratar a más pacientes con estatinas. Son necesarios estudios de validación del SCORE para valorar la tabla más adecuada en nuestro medio (AU)
Introduction and objectives. In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. Methods. In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. Results. Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. Conclusions. The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Risk Factors , Cardiovascular Diseases , Diagnostic Techniques, Cardiovascular/instrumentation , Diagnostic Techniques, Cardiovascular , Cross-Sectional Studies/methods , Cross-Sectional Studies , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Analysis of VarianceABSTRACT
INTRODUCTION: A spectacular increase was noticed in the number of consultations for insect bites at the Sant Cugat Primary Care Center (Barcelona, Spain). Subsequent study of the species in the area identified Aedes albopictus. OBJECTIVE: To analyze consultations for insect bites in this center (1998-2004). METHODS: A descriptive, cross sectional study with a 7-year retrospective review was performed. A total of 2,760 patients consulted. RESULTS: A continual increase in the number of consultations for insect bites was detected, reaching 16 consultations per 1,000 inhabitants. The mean age of the patients was 32 years and 62% were women. Seventy-one percent of the bites were located on the extremities and 19% were infected. Sixty-seven percent of the patients received systemic treatment. CONCLUSIONS: Primary care alerted the town council of the significant increase in consultations for insect bites. Patients consulting for this reason were predominantly young women who frequently received systemic treatment and showed a high percentage of local complications.
Subject(s)
Aedes , Insect Bites and Stings/epidemiology , Adult , Animals , Cross-Sectional Studies , Female , Humans , Insect Bites and Stings/complications , Insect Vectors , Male , Public Health , Retrospective Studies , Spain/epidemiology , Species Specificity , Wound Infection/epidemiologyABSTRACT
Introducción: En el Centro de Atención Primaria de Sant Cugat del Vallès (Barcelona) se detectó un espectacular aumento de consultas por picaduras de insectos. El posterior estudio de las especies del área permitió identificar a Aedes albopictus. Objetivo: Analizar las consultas por picaduras de insecto (1998-2004). Métodos: Estudio descriptivo transversal retrospectivo. Consultaron 2.760 pacientes durante el período 1998-2004. Resultados: Se detectó un continuo aumento de consultas por picaduras, hasta alcanzar las 16 consultas por 1.000 habitantes. Los pacientes tenían una media de edad de 32 años, y un 62% eran mujeres. El 71% de las lesiones se localizaron en las extremidades y se infectaron el 19% de ellas. El 67% de los pacientes recibió tratamiento sistémico. Conclusiones: La atención primaria alertó sobre el llamativo aumento de consultas por picaduras de insecto. El colectivo de pacientes que consultó por este motivo fue mayoritariamente femenino, joven, recibió con frecuencia tratamiento sistémico y presentó un elevado porcentaje de complicaciones locales
Introduction: A spectacular increase was noticed in the number of consultations for insect stings at the Sant Cugat Primary Care Center (Barcelona, Spain). Subsequent study of the species in the area identified Aedes albopictus. Objective: To analyze consultations for insect stings in this center (1998-2004). Methods: A descriptive, cross sectional study with a 7-year retrospective review was performed. A total of 2,760 patients consulted. Results: A continual increase in the number of consultations for insect stings was detected, reaching 16 consultations per 1,000 inhabitants. The mean age of the patients was 32 years and 62% were women. Seventy-one percent of the stings were located on the extremities and 19% were infected. Sixty-seven percent of the patients received systemic treatment. Conclusions: Primary care alerted the town council of the significant increase in consultations for insect stings. Patients consulting for this reason were predominantly young women who frequently received systemic treatment and showed a high percentage of local complications
