Situación de la diabetes mellitus tipo 1 en Andalucía. Datos asistenciales, uso de terapias avanzadas y recursos humanos / The situation as regards diabetes mellitus type 1 in Andalusia. Care data, use of advanced therapies and human resources

INTRODUCCIÓN: La representación de nuestro país en los estudios epidemiológicos europeos en diabetes es exigua, tan solo un centro en el estudio Hvidoere y otro en el SWEET. No existen estudios publicados en España que combinen datos epidemiológicos y recursos asistenciales. El objetivo de este estudio es conocer los datos epidemiológicos, los recursos asistenciales y el uso de nuevas tecnologías en los hospitales andaluces que atienden a niños con diabetes mellitus tipo 1 (DM1) menores de 14 años. MATERIAL Y MÉTODOS: Un cuestionario electrónico de 18 preguntas fue enviado a los endocrinólogos pediátricos que atendían a niños con DM1 en todos los hospitales andaluces. RESULTADOS: La media de la ratio de endocrinólogo pediátrico por 100 pacientes fue 3,12 (DE: 2,58). La media de la ratio de enfermero educador en diabetes por 100 pacientes y centro fue de 2,50 (DE: 3,94). Solo uno de los 29 centros disponía de psicólogo, 9/29 disponían de hospital de día y 11/29 disponían de atención telefónica durante 24 h. La media de días de consulta a la semana destinados exclusivamente a pacientes con DM1 fue de 1,56 días (DE: 1,21). Un 5% de los pacientes fueron tratados con infusor continuo de insulina, con un aumento significativo en los centros que tenían más de 150 pacientes. CONCLUSIONES: Este estudio ofrece por primera vez datos actuales de la situación epidemiológica en Andalucía en relación con los datos asistenciales; comparándolos con las recomendaciones de estándares europeos, destaca una baja ratio de endocrinólogos y educadores en diabetes, ausencia de psicólogo y baja penetrancia de tecnología

INTRODUCTION: The representation of Spain in European epidemiological studies on diabetes is limited, with only one centre in the Hvidoere study and another in the SWEET study. No Spanish studies have been published that combine epidemiological data and care resources. The aim of this study was to determine the epidemiological data, care resources, and use of new technologies in all Andalusian hospitals that care for children with Diabetes Mellitus type 1 (DM1) under 14 years. MATERIAL AND METHODS: An electronic questionnaire of 18 questions was sent to all paediatric endocrinologists who treated children with diabetes in Andalusian hospitals. RESULTS: There was a mean of 3.12 (SD: 2.58) paediatric endocrinologist for every 100 patients, with a mean diabetes nurse educator ratio of 2.50 (SD: 3.94) per 100 patients and centre. Only 1 of the 29 centres had a psychologist, 9/29 had a day hospital, and 11/29 had a 24-hour telephone line. The mean of days of consultations exclusively for patients with DM1 was 1.56 days (SD: 1.21) per week. Continuous insulin infusion was used to treat 5% of patients, with a significant increase in centres with more than 150 patients. CONCLUSIONS: This study offers, for the first time, current data on the epidemiological situation related to health care data, comparing them with the recommendations of European standards, highlighting a low ratio of endocrinologists and educators in diabetes, absence of psychologists and low technology penetrance

Epidemiología de las fracturas osteoporóticas en Andalucía en el período 2000-2010 / Epidemiology of osteoporotic fractures in Andalusia, Spain, from 2000-2010

Fundamento y objetivo: El objetivo de este estudio es conocer diferentes datos epidemiológicos de las fracturas osteoporóticas en Andalucía en el período 2000-2010. Ante la falta de estudios epidemiológicos de fracturas en Andalucía nos propusimos conocer el número y tasas de incidencia de las fracturas osteoporóticas, su distribución por sexo y edad, localización, estacionalidad y tendencia secular. Métodos: Estudio de cohorte observada durante un periodo de 11 años analizando los datos suministrados por el registro del Conjunto Mínimo Básico de Datos durante el período 2000-2010. Resultados: El total de fracturas osteoporóticas fueron 96.458 con una tasa de incidencia bruta de 374,18 fracturas por 100.000 habitantes. Las fracturas aumentaron en este período un 27% (p<0,01, IC 95%, 0,71; 0,73). Hemos encontrado un cambio de tendencia en la relación mujer/hombre pasando de 3,4 a 3,2 y en la disminución de fracturas en los dos últimos años, sobre todo en el último, con una disminución del 11,2% en las fracturas de cadera (p<0,001, IC 95%, 0,88; 0,895). Conclusiones: En este periodo se ha producido un aumento de fracturas por el envejecimiento de la población pero también un cambio de tendencia con la disminución de fracturas en algunos grupos de edad. La tasa de incidencia de fracturas es variable entre los diferentes países y regiones de España y entre las diferentes provincias de Andalucía

Background and objective: The aim of this study was to examine the epidemiological data on osteoporotic fractures in Andalusia in the period 2000-2010. In view of the lack of epidemiological studies of fractures in Andalusia, we set out to ascertain the number and incidence rates of osteoporotic fractures and their distribution by gender and age, location, comorbidity, seasonality and secular trend. Methods: Cohort study observed over a period of 11 years analysing the data provided by the Minimum Basic Data Set register for the period 2000-2010. Results: There were a total of 96,458 osteoporotic fractures, with a crude incidence rate of 374.18 fractures per 100,000 population. Fractures increased in this period by 27% (p<.01, IC 95%, 0.71; 0.73). We found a trend change in female/male ratio, from 3.4 to 3.2, and in the reduction in fractures in the last two years, especially in the past year, with a decrease of 11.2% in hip fractures (p<.001, IC 95%, 0.88; 0.895). Conclusions: In this period, there has been an increase in fractures as a consequence of the ageing of the population, but also a change in trend, with fractures decreasing in some age groups. The incidence rate of fractures varies between different countries and regions of Spain, and between different provinces of Andalusia

Epidemiology of osteoporotic fractures in Andalusia, Spain, from 2000-2010. / Epidemiología de las fracturas osteoporóticas en Andalucía en el período 2000-2010.

BACKGROUND AND OBJECTIVE: The aim of this study was to examine the epidemiological data on osteoporotic fractures in Andalusia in the period 2000-2010. In view of the lack of epidemiological studies of fractures in Andalusia, we set out to ascertain the number and incidence rates of osteoporotic fractures and their distribution by gender and age, location, comorbidity, seasonality and secular trend. METHODS: Cohort study observed over a period of 11 years analysing the data provided by the Minimum Basic Data Set register for the period 2000-2010. RESULTS: There were a total of 96,458 osteoporotic fractures, with a crude incidence rate of 374.18 fractures per 100,000 population. Fractures increased in this period by 27% (p<.01, IC 95%, 0.71; 0.73). We found a trend change in female/male ratio, from 3.4 to 3.2, and in the reduction in fractures in the last two years, especially in the past year, with a decrease of 11.2% in hip fractures (p<.001, IC 95%, 0.88; 0.895). CONCLUSIONS: In this period, there has been an increase in fractures as a consequence of the ageing of the population, but also a change in trend, with fractures decreasing in some age groups. The incidence rate of fractures varies between different countries and regions of Spain, and between different provinces of Andalusia.

[The situation as regards diabetes mellitus type 1 in Andalusia. Care data, use of advanced therapies and human resources]. / Situación de la diabetes mellitus tipo 1 en Andalucía. Datos asistenciales, uso de terapias avanzadas y recursos humanos.

INTRODUCTION: The representation of Spain in European epidemiological studies on diabetes is limited, with only one centre in the Hvidoere study and another in the SWEET study. No Spanish studies have been published that combine epidemiological data and care resources. The aim of this study was to determine the epidemiological data, care resources, and use of new technologies in all Andalusian hospitals that care for children with Diabetes Mellitus type 1 (DM1) under 14 years. MATERIAL AND METHODS: An electronic questionnaire of 18 questions was sent to all paediatric endocrinologists who treated children with diabetes in Andalusian hospitals. RESULTS: There was a mean of 3.12 (SD: 2.58) paediatric endocrinologist for every 100 patients, with a mean diabetes nurse educator ratio of 2.50 (SD: 3.94) per 100 patients and centre. Only 1 of the 29 centres had a psychologist, 9/29 had a day hospital, and 11/29 had a 24-hour telephone line. The mean of days of consultations exclusively for patients with DM1 was 1.56 days (SD: 1.21) per week. Continuous insulin infusion was used to treat 5% of patients, with a significant increase in centres with more than 150 patients. CONCLUSIONS: This study offers, for the first time, current data on the epidemiological situation related to health care data, comparing them with the recommendations of European standards, highlighting a low ratio of endocrinologists and educators in diabetes, absence of psychologists and low technology penetrance.

Infectious morbidity and resource use in children under 2 years old at childcare centres.

AIM: To analyse the associations between childcare centres and infectious morbidity and resource consumption. METHODS: Cohort study from birth to 2 years. OUTCOME VARIABLE: number and types of infections, drug consumption and medical visits. Exposure variable: attending or not attending a childcare centre. School age: 6-12, >12-18, >18-24 months. RESULTS: The initial cohort comprised 445 children, and the final cohort comprised 419 children. The mean number of recurrent infections and wheezing was higher in children attending childcare centres in all age groups with significant differences. Recurrent acute otitis media was observed in the 12- to 18-month group with an odds ratio of 6.04 (95% confidence interval, 1.3-27.6; P = 0.001) in the children attending childcare centres. In children older than 6 months, there was greater consumption of antibiotics, inhaled bronchodilators, oral and inhaled corticosteroids and montelukast. CONCLUSIONS: Attending a childcare is associated with an increased frequency of recurrent infections and wheezing, as well as the consumption of antibiotics, bronchodilators, corticosteroids and montelukast.

Caracterización del proceso de evaluación del aprendizaje del contenido estadístico en la carrera de Medicina / Characterization of the process of evaluation of the learning of statistical content in medicine

Este trabajo tiene como objetivo caracterizar el proceso de evaluación del aprendizaje del contenido estadístico en la carrera de Medicina. Los resultados obtenidos evidencian que el nivel de asimilación alcanzado por los estudiantes en muchas ocasiones es el reproductivo, lo que refleja la necesidad de seguir profundizando en los estudios de esta problemática (AU)

Issues related to the learning evaluation have been present throughout the teaching learning process history. The following research aims at characterizing the learning process of evaluation of the statistical content in medicine. Results demonstrate that the assimilation level reached by students, on many occasions, is the reproductive one, as a need to deepen on methodology of the design of the system of evaluation of the statistical content learning in medicine (AU)

Caracterización del proceso de evaluación del aprendizaje del contenido estadístico en la carrera de Medicina / Characterization of the process of evaluation of the learning of statistical content in medicine

Este trabajo tiene como objetivo caracterizar el proceso de evaluación del aprendizaje del contenido estadístico en la carrera de Medicina. Los resultados obtenidos evidencian que el nivel de asimilación alcanzado por los estudiantes en muchas ocasiones es el reproductivo, lo que refleja la necesidad de seguir profundizando en los estudios de esta problemática.

Issues related to the learning evaluation have been present throughout the teaching learning process history. The following research aims at characterizing the learning process of evaluation of the statistical content in medicine. Results demonstrate that the assimilation level reached by students, on many occasions, is the reproductive one, as a need to deepen on methodology of the design of the system of evaluation of the statistical content learning in medicine.

Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis.

INTRODUCTION AND OBJECTIVES: Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial. METHODS: This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (> or =2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug-eluting stent (DES; i.e. rapamycin or paclitaxel; n=128). The following clinical outcomes (i.e. major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke and repeat revascularization at 2 years. RESULTS: Patients who received DESs were older (67.5+/-7 years vs. 65.3+/-8 years; P=.05) and more often had a previous MI (49.2% vs. 28.2%; P< .01), but no more often had a depressed left ventricular ejection fraction < or =45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9+/-7 vs. 18.5+/-6; P< .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P< .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09). CONCLUSIONS: In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke.

Comparación de los resultados clínicos a medio plazo de los stents farmacoactivos frente a la cirugía de revascularización coronaria en una población no seleccionada de pacientes diabéticos con afección multivaso. Análisis mediante propensity score / Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis

Introducción y objetivos. La estrategia de revascularización en el paciente diabético con enfermedad multivaso en la era actual de los stents farmacoactivos es controvertida. Métodos. Comparamos a 270 pacientes diabéticos consecutivos (2000-2004) con enfermedad multivaso (al menos 2 vasos con estenosis > 70% de novo y afección de la descendente anterior proximal) a los que se practicó cirugía de revascularización coronaria (n = 142) o se implantó stents farmacoactivos (rapamicina/paclitaxel) (n = 128) mediante análisis de regresión logística multivariable con propensity score. Analizamos los resultados clínicos (eventos cardiacos y cerebrovasculares mayores): muerte, infarto no fatal, ictus y necesidad de revascularización a 24 meses. Resultados. Los pacientes que recibieron stents farmacoactivos tuvieron mayor edad (67,5 ± 7 frente a 65,3 ± 8 años; p = 0,05) y más infarto previo (el 49,2 frente al 28,2%; p < 0,01), aunque no hubo diferencias en la presencia de disfunción ventricular significativa (≤ 45%): el 32,4 frente al 28,1%. En los pacientes quirúrgicos, la anatomía coronaria fue más compleja: score SYNTAX (25,9 ± 7 frente a 18,5 ± 6; p < 0,001) y la calidad de la revascularización fue superior (revascularización anatómica completa, el 52,8 frente al 28,1%; p < 0,01). La incidencia total del evento combinado fue del 18,7% en el grupo quirúrgico y el 21,8% en el grupo percutáneo (odds ratio [OR] ajustada = 0,93; intervalo de confianza [IC] del 95%, 0,47-1,86). El evento combinado de muerte, infarto e ictus fue del 15,8% en el grupo quirúrgico, frente al 12,9% en el grupo de stent farmacoactivo (OR ajustada = 1,19; IC del 95%, 0,72-1,88). Los pacientes quirúrgicos tuvieron menor necesidad de revascularización (el 4,3 frente al 12,1%; OR ajustada = 0,42; IC del 95%, 0,16-1,14; p = 0,09). Conclusiones. En una población no seleccionada de diabéticos multivaso, la ventaja de la cirugía de revascularización coronaria se centró en reducir las revascularizaciones. No encontramos diferencias en muerte, infarto o ictus (AU)

Introduction and Objectives. Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial. Methods. This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (≥2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug eluting stent (DES; ie, rapamycin or paclitaxel; n=128). The following clinical outcomes (ie, major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke, and repeat revascularization at 2 years. Results. Patients who received DESs were older (67.5 [7] years vs 65.3 [8] years; P=.05) and more often had a previous MI (49.2% vs 28.2%; P < .01), but no more often had a depressed left ventricular ejection fraction ≤45% (32.4% vs 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9 [7] vs 18.5 [6]; P < .001) and the quality of revascularization was better (ie, anatomically complete revascularization: 52.8% vs 28.1%; P < .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] =0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR =1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs 12.1%; adjusted OR=0.42; 95% CI, 0.16-1.14; P=.09). Conclusions. In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke. and more often had a previous MI (49.2% vs. 28.2%; P < .01), but no more often had a depressed left ventricular ejection fraction ≤45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9±7 vs. 18.5±6; P < .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P < .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09). Conclusions. In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke (AU)