Costes del ictus desde la perspectiva social. Enfoque de incidencia retrospectiva con seguimiento a tres años / Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at three years

Introducción. El coste del ictus es importante desde el punto de vista social, pues se trata de una enfermedad con gran impacto individual, familiar y social. Los estudios de coste de la enfermedad aportan una descripción total de los aspectos económicos del ictus. La perspectiva más amplia es la social, donde se incluyen todos los costes y consecuencias. La aproximación deseable es la denominada bottom-up. Objetivos. Calcular el coste del ictus desde la perspectiva social en la población de una zona básica de salud (12.000 habitantes) mediante un enfoque de incidencia retrospectiva (seguimiento a tres años) y una aproximación ‘de abajo a arriba’. Calcular la fracción atribuible a la atención primaria, la hospitalaria y la social. Pacientes y métodos. Todos los ictus diagnosticados entre el desde el 1 de enero de 1999 hasta el 31 de diciembre de 2003, pertenecientes a una zona básica de salud de Navarra (n = 91). Recogida de datos: cuestionario ad hoc –cuestionario CACV (costes del accidente cerebrovascular)–, que valora el coste ‘incremental’ provocado por el ictus y sus complicaciones. Resultados. El coste medio se sitúa en 5.759,50 € para el primer año, 3.596,60 € para el segundo y 4.671,30 € para el tercero. El coste en el primer año viene determinado por la atención hospitalaria, que supone el 50% de los costes. A partir del segundo año los costes de la atención ambulatoria adquieren una gran importancia, ya que suponen un 70% del total. Conclusiones. El coste del ictus en los tres primeros años se aproxima a los 5.000 €/año. Se necesitan más estudios de coste de la enfermedad cerebrovascular desde la perspectiva social, que debería incluir, por tanto, el coste del cuidado informal

Introduction. The costs deriving from strokes are important from a social point of view because this is a pathology with a substantial individual, familial and social impact. Cost-of-illness studies provide an overall description of the economic aspects of strokes. The widest perspective is the social one, where all the costs and consequences are included. If possible, it is wise to take a bottom-up approach. Aims. To calculate the costs deriving from strokes from the social perspective in the population of a district health service (12,000 inhabitants) by means of a retrospective incidence approach (follow-up at three years) and a bottom-up procedure. We also intended to calculate the fractions that can be attributed to primary care, hospital care and social care. Patients and methods. Our study included all the cases of stroke diagnosed between 1st January 1999 and 31st December 2003 within a basic health care district in Navarre (n = 91). Data collection: an ad hoc questionnaire –the CACV (cerebrovascular accident cost) questionnaire– which assessed the ‘incremental’ costs due to strokes and their complications. Results. The average cost was found to be 5,759.50 € for the first year, 3,596.60 € for the second and 4,671.30 € for the third. The cost in the first year is marked by the hospital care, which accounts for 50% of the total. From the second year onwards the costs of outpatient care become very important, since they represent 70% of the overall costs. Conclusions. The costs deriving from strokes in the first three years amount to almost 5,000 €/year. More cerebrovascular cost-of-illness studies need to be conducted from the social perspective and should therefore include the costs of informal care

[Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at three years]. / Costes del ictus desde la perspectiva social. Enfoque de incidencia retrospectiva con seguimiento a tres años.

INTRODUCTION: The costs deriving from strokes are important from a social point of view because this is a pathology with a substantial individual, familial and social impact. Cost-of-illness studies provide an overall description of the economic aspects of strokes. The widest perspective is the social one, where all the costs and consequences are included. If possible, it is wise to take a bottom-up approach. AIMS: To calculate the costs deriving from strokes from the social perspective in the population of a district health service (12,000 inhabitants) by means of a retrospective incidence approach (follow-up at three years) and a bottom-up procedure. We also intended to calculate the fractions that can be attributed to primary care, hospital care and social care. PATIENTS AND METHODS: Our study included all the cases of stroke diagnosed between 1st January 1999 and 31st December 2003 within a basic health care district in Navarre (n = 91). DATA COLLECTION: an ad hoc questionnaire -the CACV (cerebrovascular accident cost) questionnaire- which assessed the 'incremental' costs due to strokes and their complications. RESULTS: The average cost was found to be 5,759.50 euro for the first year, 3,596.60 euro for the second and 4,671.30 euro for the third. The cost in the first year is marked by the hospital care, which accounts for 50% of the total. From the second year onwards the costs of outpatient care become very important, since they represent 70% of the overall costs. CONCLUSIONS: The costs deriving from strokes in the first three years amount to almost 5,000 euro/year. More cerebrovascular cost-of-illness studies need to be conducted from the social perspective and should therefore include the costs of informal care.

Emergencia hipertensiva secundaria a la toma de AINE / Hypertension emergency as a side-effect of taking NSAIDs

No disponible

[Validity in a community (with outside verification) of primary prevention studies on hypercholesterolemia]. / Aplicabilidad en una comunidad (validez externa) de los estudios de prevención primaria de hipercolesterolemia.

OBJECTIVES: The main objective of this study was to determine the degree of similarity between large primary prevention trials of hypercholesterolemia and our population of patients with dyslipidemia, in order to evaluate the external validity of these studies and their applicability to the general population. DESIGN: Descriptive retrospective study. SETTING: Tafalla Health Center in Navarra (Northern Spain), serving a population of 11 500 inhabitants.Participants. All patients older than 18 years assigned to our health center who had dyslipidemia with no antecedents of ischemic heart disease. RESULTS: The percentage of patients in our sample who satisfied the inclusion criteria used in large clinical trials ranged from 2.4% to 46%, depending on the study: AFCAPS/TexCAPS 1998, 46.2%; HPS 2002, 46.1%; WOSCOPS 1995, 10.9%; HHS 1987, 10.6%; LRC-CPPT 1984, 2.4%. CONCLUSIONS: Many of our patients (54%-97%) with dyslipidemia would not have been eligible for inclusion in earlier studies of hyperlipidemia and primary prevention. The external validity (applicability to the general population) of these studies is questionable. Decision-making in clinical practice for the primary prevention of hypercholesterolemia should be based on the risk/benefit ratio of pharmacological treatment.

Síndrome de secreción inadecuada de ADH (SIADH) asociado a sertralina / Syndrome of inadequate ADH secretion linked to setraline

No disponible

Aplicabilidad en un acomunidad (validez externa) de los estudios de prevención primaria de hipercolesterolemia / Applicability to a different community (external validity) of studies of the primary prevention o hypercholesterolemia

Objetivos. El objetivo principal de nuestro estudio es determinar el grado de similitud de los grandes ensayos clínicos de prevención primaria e hipercolesterolemia y nuestra población de pacientes con dislipemia, para valorar su aplicabilidad a la población general y la validez externa de los mismos. Diseño. Estudio descriptivo retrospectivo. Emplazamiento. Centro de Salud de Tafalla (Navarra); población de 11.500 habitantes. Participantes. Todos los pacientes dislipémicos, mayores de 18 años, sin antecedentes de cardiopatía isquémica, del centro de salud. Resultados. El porcentaje pacientes de nuestra muestra que cumplen los criterios de inclusión de los grandes estudios varía del 46 al 2,4 por ciento. En el estudio AFCAPS/TexCAPS (1998) fue del 46,2 por ciento, en el estudio HPS (2002) del 46,1 por ciento, en el estudio WOSCOPS (1995) del 10,9 por ciento, en el estudio HHS (1987) del 10,6 por ciento, y en el estudio LRC-CPPT (1984) del 2,4 por ciento. Conclusiones. Un gran número de nuestros pacientes (97-54 por ciento) con dislipemia no serían incluidos en los estudios de hiperlipidemia y prevención primaria. Comprobamos que la validez externa (aplicabilidad a la población general) de estos estudios es cuestionable. La toma de decisiones en la práctica clínica de la prevención primaria en la hipercolesterolemia deberá basarse en la relación riesgo/beneficio de la introducción de un fármaco (AU)

Colitis colágena. Presentación de cuatro nuevos casos / Collagenus colitis. Presentation of four new cases

No disponible

Características clinicoanalíticas y complicaciones de pacientes con mononucleosis infecciosa derivados desde atención primaria a atención especializada / Clinical and analytic characteristics and complications in patients with infectious mononucleosis referred from primary care to specialists

No disponible