ABSTRACT
El objetivo de este estudio es describir algunas características sociales de la población con enfermedad por coronavirus (COVID-19) de un centro de salud de Fuenlabrada. Se incluyeron todos los pacientes valorados en consulta de forma presencial o telefónica, que fueron atendidos, tras el diagnóstico por prueba de detección de infección activa (PDIA), por las gestoras COVID-19 del centro. Los resultados principales describen una mayoría de hogares compuestos por tres habitaciones, siendo esto acorde al número de convivientes; con un baño de media y con terraza en la mayoría de ellos. Hay una gran incidencia de hogares sin personas activas laboralmente y con escasa ayuda social. Se observa ligeramente una mayor incidencia de mujeres diagnosticadas. Los determinantes sociales de la salud como las condiciones de vivienda, el estado laboral o las ayudas sociales influyen en la distribución de los recursos sanitarios. Este estudio refuerza la importancia de la Atención Primaria y sus recursos en situaciones de emergencia. (AU)
This study aims to describe some social characteristics of the population with Coronavirus Disease (COVID) infection in a Primary Care Centre in Fuenlabrada. All patients assessed in the consultation in person or by telephone, who were attended after the diagnosis by active infection diagnostic test (AIDT), by the centre's COVID tracing team, were included. The main results describe a majority of households comprising three rooms, this being in line with the number of cohabitants; with one bathroom on average and a terrace in the majority. There is a high incidence of households with unemployed people and with little social assistance. There is a slightly higher incidence of diagnosed women. The social determinants of health such as housing conditions, employment status, or social assistance influence the distribution of health resources. This study reinforces the importance of Primary Care and its emergency resources. (AU)
Subject(s)
Humans , Pandemics , Coronavirus Infections/epidemiology , Primary Health Care , Socioeconomic Factors , 50334 , Social Conditions , Spain/epidemiologyABSTRACT
OBJECTIVES: To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. DESIGN: Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). PARTICIPANTS: 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. INTERVENTIONS: The IM arm received 1 mg VB12 on alternate days in weeks 1-2, 1 mg/week in weeks 3-8 and 1 mg/month in weeks 9-52. The oral arm received 1 mg/day in weeks 1-8 and 1 mg/week in weeks 9-52. MAIN OUTCOMES: Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. RESULTS: The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were -0.7% (133 out of 135 vs 129 out of 130; 95% CI: -3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: -1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were -6.3% (103 out of 112 vs 115 out of 117; 95% CI: -11.9 to -0.1; p=0.025) and -6.8% (103 out of 140 vs 115 out of 143; 95% CI: -16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>-10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. CONCLUSIONS: Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low. TRIAL REGISTRATION NUMBERS: NCT01476007; EUDRACT (2010-024129-20).
