Impacto de la cesación tabáquica en el riesgo cardiovascular estimado de pacientes con diabetes mellitus tipo 2: El estudio DIABETES / Impact of smoking cessation on estimated cardiovascular risk in Spanish type 2 diabetes mellitus patients: The DIABETES study

Objetivos: Evaluar el riesgo cardiovascular con la herramienta UKPDS risk engine, la función y escala Framingham y comparar las características clínicas de pacientes con diabetes mellitus tipo 2 (DM2) en base a sus hábitos. Pacientes y métodos: Se llevó a cabo un análisis descriptivo. Se incluyó a un total de 890 pacientes con DM2 (444 fumadores y 446 no fumadores) en un estudio transversal, observacional, epidemiológico, multicéntrico y a nivel nacional. Se calculó el riesgo de enfermedad coronaria a 10 años utilizando, para ello, la puntuación UKPDS en ambas cohortes. Los resultados se compararon también con las puntuaciones calibradas para España (REGICOR) y la escala de riesgo de Framingham. Resultados: La probabilidad estimada de enfermedad coronaria a los 10 años según la herramienta UKPDS fue ostensiblemente superior en los fumadores que en los no fumadores. Este aumento del riesgo fue mayor en sujetos con un peor control de la glucosa en sangre, y disminuye en mujeres de 60 o más años de edad. Tanto Framingham como UKPDS confieren un riesgo estimado mayor que REGICOR a los diabéticos españoles. Conclusiones: Dejar de fumar en pacientes con DM2 implica un descenso significativo del riesgo estimado de eventos coronarios según la herramienta UKPDS. Nuestros descubrimientos avalan lo importante que es dejar de fumar en pacientes diabéticos a la hora de reducir el riesgo cardiovascular

Aims: To assess the cardiovascular risk according to the UKPDS risk engine; Framingham function and score comparing clinical characteristics of diabetes mellitus type 2 (DM2) patients according to their habits status. Patients and methods: A descriptive analysis was performed. A total of 890 Spanish patients with DM2 (444 smokers and 446 former-smokers) were included in a cross-sectional, observational, epidemiological multicenter nationwide study. Coronary heart disease risk at 10 years was calculated using the UKPDS risk score in both patient subgroups. Results were also compared with the Spanish calibrated (REGICOR) and updated Framingham risk scores. Results: The estimated likelihood of coronary heart disease risk at 10 years according to the UKPDS score was significantly greater in smokers compared with former-smokers. This increased risk was greater in subjects with poorer blood glucose control, and was attenuated in women ≥60 years-old. The Framingham and UKPDS scores conferred a greater estimated risk than the REGICOR equation in Spanish diabetics. Conclusions: Quitting smoke in patients with DM2 is accompanied by a significant decrease in the estimated risk of coronary events as assessed by UKPDS. Our findings support the importance of quitting smoking among diabetic patients in order to reduce cardiovascular risk

Impact of smoking cessation on estimated cardiovascular risk in Spanish type 2 diabetes mellitus patients: The DIABETES study. / Impacto de la cesación tabáquica en el riesgo cardiovascular estimado de pacientes con diabetes mellitus tipo 2: El estudio DIABETES.

AIMS: To assess the cardiovascular risk according to the UKPDS risk engine; Framingham function and score comparing clinical characteristics of diabetes mellitus type 2 (DM2) patients according to their habits status. PATIENTS AND METHODS: A descriptive analysis was performed. A total of 890 Spanish patients with DM2 (444 smokers and 446 former-smokers) were included in a cross-sectional, observational, epidemiological multicenter nationwide study. Coronary heart disease risk at 10 years was calculated using the UKPDS risk score in both patient subgroups. Results were also compared with the Spanish calibrated (REGICOR) and updated Framingham risk scores. RESULTS: The estimated likelihood of coronary heart disease risk at 10 years according to the UKPDS score was significantly greater in smokers compared with former-smokers. This increased risk was greater in subjects with poorer blood glucose control, and was attenuated in women ≥60 years-old. The Framingham and UKPDS scores conferred a greater estimated risk than the REGICOR equation in Spanish diabetics. CONCLUSIONS: Quitting smoke in patients with DM2 is accompanied by a significant decrease in the estimated risk of coronary events as assessed by UKPDS. Our findings support the importance of quitting smoking among diabetic patients in order to reduce cardiovascular risk.

Enfermedad urológica y el tabaco. Una revisión para la concienciación del urólogo / Urological disease and tobacco. A review for raising the awareness of urologists

Contexto: El tabaquismo es la primera causa de muerte prevenible en nuestro entorno. Su relación con la enfermedad urológica está bien documentada. Objetivo: Mostrar una revisión actualizada sobre la relación entre enfermedad urológica y consumo del tabaco, y sobre la importancia de la implicación de los urólogos en la prevención del tabaquismo. Adquisición y síntesis de la evidencia: Se ha realizado una revisión de la bibliografía actual utilizando fundamentalmente la búsqueda en PubMed, y tomando como base principal el informe sobre las consecuencias de fumar en la salud realizado por The Surgeon General. Conclusión: Los urólogos desempeñan un papel fundamental para informar de la relación entre el tabaquismo y la enfermedad urológica. Es un deber de cada urólogo asumir un papel más activo en la educación de los pacientes para promover la abstinencia tabáquica

Context: Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. Objective: To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. Acquisition and synthesis of evidence: We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. Conclusion: Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation

Self-perceived Sleep Quality and Quantity in Adults With Asthma: Findings From the CosteAsma Study.

BACKGROUND AND OBJECTIVE: Nocturnal asthma symptoms are associated with poor sleep quality, excessive daytime sleepiness, and poor daytime functioning. The aim of this study was to describe self-perceived sleep quality and quantity in asthmatic adults in a real-world setting according to different determinants of patient health status. METHODS: A cross-sectional, observational, seasonal, multiwave survey was designed. Allergists nationwide were asked to consecutively survey adult asthmatics aged 18 to 65 years, evenly distributed by seasons and asthma severity (Global Initiative for Asthma criteria). Sleep quality and quantity were assessed using the self-administered Medical Outcomes Study (MOS) Sleep Scale. The Asthma Control Test was applied to ascertain the degree of asthma symptom control. RESULTS: A total of 1098 individuals (58.7% females, 41.2 [13.6] years) were analyzed. Asthma severity was associated with poor sleep quality and quantity; patients with more severe disease scored higher on the MOS Sleep Scale (P<.001) and also reported significantly fewer daily average hours of sleep (0.3-0.5 hours, P<.001). Level of symptom control and asthma severity were both associated with poor sleep quality and quantity, with the following mean MOS sleep problem index scores: 25.3 (fully controlled asthma), 26.4 (controlled), 32.6 (partly controlled), and 44.6 (uncontrolled) (P<.001), and 48.4 (severe asthma), 39.0 (moderate), 32.6 (mild), and 26.5 (intermittent) (P<.001). Sex was significantly associated with the summary MOS sleep problem index. CONCLUSIONS: Sleep quality and quantity was significantly associated with poor health status in asthmatic patients. Guidelines should recommend asking about nocturnal asthma symptoms and encourage clinicians to take a global sleep history. Better control of nocturnal asthma symptoms could lead to improved sleep quality and a decrease in daytime sleep-related symptoms.

Urological disease and tobacco. A review for raising the awareness of urologists. / Enfermedad urológica y el tabaco. Una revisión para la concienciación del urólogo.

CONTEXT: Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. OBJECTIVE: To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. ACQUISITION AND SYNTHESIS OF EVIDENCE: We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. CONCLUSION: Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation.

Self-perceived sleep quality and quantity in adults with asthma: findings from the costeAsma study

Background and Objective: Nocturnal asthma symptoms are associated with poor sleep quality, excessive daytime sleepiness, and poor daytime functioning. The aim of this study was to describe self-perceived sleep quality and quantity in asthmatic adults in a real-world setting according to different determinants of patient health status. Methods: A cross-sectional, observational, seasonal, multiwave survey was designed. Allergists nationwide were asked to consecutively survey adult asthmatics aged 18 to 65 years, evenly distributed by seasons and asthma severity (Global Initiative for Asthma criteria). Sleep quality and quantity were assessed using the self-administered Medical Outcomes Study (MOS) Sleep Scale. The Asthma Control Test was applied to ascertain the degree of asthma symptom control. Results: A total of 1098 individuals (58.7% females, 41.2 [13.6] years) were analyzed. Asthma severity was associated with poor sleep quality and quantity; patients with more severe disease scored higher on the MOS Sleep Scale (P<.001) and also reported significantly fewer daily average hours of sleep (0.3-0.5 hours, P<.001). Level of symptom control and asthma severity were both associated with poor sleep quality and quantity, with the following mean MOS sleep problem index scores: 25.3 (fully controlled asthma), 26.4 (controlled), 32.6 (partly controlled), and 44.6 (uncontrolled) (P<.001), and 48.4 (severe asthma), 39.0 (moderate), 32.6 (mild), and 26.5 (intermittent) (P<.001). Sex was significantly associated with the summary MOS sleep problem index. Conclusions: Sleep quality and quantity was significantly associated with poor health status in asthmatic patients. Guidelines should recommend asking about nocturnal asthma symptoms and encourage clinicians to take a global sleep history. Better control of nocturnal asthma symptoms could lead to improved sleep quality and a decrease in daytime sleep-related symptoms (AU)

Introducción y Objetivo: Los síntomas nocturnos de asma, están asociados con la calidad de la falta de sueño, somnolencia diurna excesiva y mal funcionamiento durante el día. El objetivo de este estudio fue describir la calidad y cantidad del sueño percibida por el paciente asmático en un emplazamiento de vida real según diferentes determinantes del estado de salud del paciente. Métodos: Se diseñó una encuesta de corte transversal, observacional, en olas estacionales. Se les pidió a alergólogos de todo el país que realizaran una encuesta de forma consecutiva a asmáticos de 18-65 años, distribuido por estaciones y gravedad (criterios GINA). Cantidad y calidad del sueño se evaluaron utilizando la escala autoadministrada de sueño MOS-sleep scale. La escala ACT se aplicó para determinar el grado de control de síntomas asmáticos. Resultados: Un total de 1.098 sujetos [58,7% mujeres, 41,2 (13,6) años] se incluyeron en el análisis. La gravedad del asma se relacionó con calidad/cantidad de falta de sueño, con puntuaciones más altas en los pacientes más graves (p<0,001), que tenían significativamente menos horas promedio diarias de sueño: 0,3-0,5 horas (p< 0,001). El grado de control de síntomas y nivel de severidad se asociaron con problemas de sueño: 25,3 (control total), 26,4 (controlada), 32,6 (parcialmente controlada) y 44,6 (no controlada); p<0,001 y 48,4 (grave), 39,0 (moderado), 32,6 (leve) y 26,5 (intermitente), p<0,001. En nuestro estudio, el género se asoció significativamente con la puntuación resumen del índice de sueño. Conclusión: La cantidad y calidad del sueño se asoció significativamente con el estado de salud de los pacientes asmáticos. Las guías deberían recomendar preguntar tanto por los síntomas de asma nocturno como asesorar a los clínicos acerca de hacer una historia global de sueño Un mejor control de la sintomatología nocturna del asma podría conllevar a una mejor calidad del sueño y una disminución en los síntomas relacionados con el sueño durante el día (AU)

Encuesta sobre actitud y percepción de conocimientos para el abordaje del tabaquismo en los urólogos / Survey on attitude and perception of knowledge to approach smoking habit in the urologist

Introducción. Conocemos la actitud sobre el tabaquismo en algunos profesionales sanitarios, pero no en los urólogos. Material y métodos. Estudio observacional descriptivo mediante 150 encuestas aleatorias a urólogos españoles sobre actitud y percepción de conocimientos para el abordaje del tabaquismo. Se estudian: variables cuantitativas, asociación entre variables cualitativas y comparamos nuestros resultados con los de otros colectivos de nuestro país. Resultados. 150 respuestas (91% masculinas y 9% femeninas. Edad media 52,6 ± 8,7 años). 8% fumadores, 48% exfumadores y 43% no fumadores. 57% recogen el estatus de fumador, 54% informan de los riesgos del tabaco y 58% aconsejan dejar de fumar. Encontramos diferencia significativa entre urólogos fumadores vs. no fumadores en la recogida del hábito tabáquico (p = 0,074) y consejo para dejar de fumar (p = 0,0059), más frecuente entre los no fumadores. El 41% creen que no pueden ayudar a sus pacientes a dejar de fumar, 67% desconocen el consejo mínimo, y 82% dicen no tener conocimientos/habilidades para realizarlo. El 53% desconocen los fármacos y el 74% los recursos sanitarios disponibles, para la deshabituación tabáquica. El 27% piensan que no es fundamental la recomendación de dejar de fumar (más frecuente entre fumadores p = 0,0076). Conclusión. El 58% de los urólogos aconsejan dejar de fumar, pero el 67% desconocen el consejo mínimo y el 82% cómo realizarlo. 53% no conocen los fármacos y solo el 26% los recursos sanitarios disponibles para la deshabituación tabáquica. Estos resultados plantean una serie de oportunidades de mejora que se irán implementando en nuestra Asociación Española de Urología (AU)

Introduction. We have knowledge of the attitude on smoking in some health care professionals, but not in the urologists. Material and methods. Descriptive, observational study through 150 random surveys to Spanish urologists on the attitude and perception of knowledge to death with smoking habit. The following were studied: quantitative variables, association between qualitative variables and we compared our results with those of other groups of our country. Results. 150 responses (91% male and 9% female. Mean age 52.6 ± 8.7 years). 8% smokers, 48% exsmokers and 43% non-smokers. A total of 57% collect the status of smoker, 54% report on the risk of smoking and 58% recommend smoking cessation. We have found a significant difference between urologists who are smokers and non-smokers in the collection of smoking habit (p = 0.074) and recommendation to quit smoking (p = 0.0059), more frequent among the non-smokers. A total of 41% believe that their patients cannot be helped to quit smoking, 67% are not aware of the minimum advise and 82% state they do not have the knowledge/skills to do so. Of those surveyed, 53% do not know the drug and 74% the health care resources available for smoking cessation. A total of 27% think that recommending that one quits smoking is not essential (more frequent among smokers p = 0.0076). Conclusion. It was found that 58% of the urologists recommend smoking cessation, but 67% of them do not know the minimum advise and 82% do not know how to do it. The drugs for this are unknown by 53% and only 26% know the health care resources available for smoking cessation. These results suggest a series of opportunities for improvement that will be implemented in our Spanish Association of Urology (AU)

Costs associated with workdays lost and utilization of health care resources because of asthma in daily clinical practice in Spain.

BACKGROUND: Asthma is associated with high indirect costs due to lower work productivity and higher absenteeism and presenteeism. OBJECTIVES: To study loss of productivity measured using the lost workday equivalent (LWDE) index and health care utilization in asthmatics depending on age, geographical location, time period, severity, and level of asthma control. PATIENTS AND METHODS: In this cross-sectional, observational, epidemiological multicenter study, 120 allergists nationwide were asked to select asthmatic patients aged 18 to 65 years who were evenly distributed according to the 4 levels of asthma severity (Global Initiative on Asthma) during 3 different seasons. The participants collected sociodemographic data, spirometry values, Asthma Control Test (ACT) score, health care utilization data, perceived stress according to the Impact on Work Productivity Index (IMPALA, indice del Impacto de la Enfermedad en la Productividad Laboral), and score on the Sheehan disability scale. The LWDE index was used to measure the number of workdays lost and the number of workdays with asthma symptoms combined with the percentage for average performance at work. RESULTS: The study sample comprised 1098 patients (58.7% females; 48.5% aged 18-40 and 51.5% aged 41-65). According to the ACT score, disease was uncontrolled in 57.6% of patients, well controlled in 32.8%, and totally controlled in 9.6%. The mean cost due to workdays lost was Euro 285.81/patient/mo (95% CI, Euro 252.71-318.92). Indirect costs were significantly higher in older patients (41-65 years, Euro 405.08; 95% CI, 348.97-461.19), patients with more severe disease (Euro 698.95; 95% CI, 588.63-809.27), and patients with more poorly controlled asthma (Euro 466.86; 95% CI, Euro 414.39-519.33). The average cost of health care units per patient for each 3-month period was Euro1317.30 (95% CI, Euro 1151.34-Euro 1483.26). Indirect costs were significantly higher in older patients (Euro 2104.00 in patients aged 18-40 vs Euro 3301.55 in patients aged 41-65), in northern and central regions, in severe disease (Euro 2921.63), and in more poorly controlled asthma (Euro 1799.42). CONCLUSION: Our findings could prove useful for physicians and health care providers.

Costs Associated With Workdays Lost and Utilization of Health Care Resources Because of Asthma in Daily Clinical Practice in Spain

Introducción: El asma está asociada a elevados costes indirectos debido a baja productividad y alto grado de presentismo y absentismo. Objetivos: Estudiar la pérdida de productividad mediante días de trabajo equivalente (LWDE) y utilización de recursos sanitarios (HCU) en pacientes asmáticos según edad, localización geográfica, tiempo, gravedad y nivel de control del asma. Pacientes y Métodos: Estudio observacional, transversal, epidemiológico y multicéntrico.120 alergólogos a nivel nacional seleccionaron a pacientes asmáticos de edad comprendida entre 18 y 65 años, distribuidos en los 4 niveles de gravedad del asma según la GINA en 3 diferentes estaciones del año. Los datos recogidos fueron: socio-demográficos, espirometría, ACT, HCU, índice IMPALA, estrés percibido, cuestionario Sheehan de discapacidad. El LWDE consideraba el número de días laborables perdidos y el número de días trabajados con sintomatología asmática combinado con el porcentaje de rendimiento laboral promedio. Resultados: 1.098 pacientes entraron en el estudio (58,7% mujeres; 48,5% con18 40 años de edad y 51,5% con 4165 años). Según la puntuación del ACT el 57,6% tenía asma no controlada, 32,8% bien controlada y 9,6% totalmente controlada. El coste medio debido al LWDE fue de 285,81€/paciente/mes (IC 95%: 252,71-318,92€). Los costes indirectos fueron significativamente mayores en pacientes mayores (41-65 años: 405,08€; IC95%:348,97-461,219€) mayor gravedad (698,95€; IC95%: 588,63-809,7€) y peor control de asma (466,86€; IC95%: 414,39-519,33€).El coste promedio de HCU/paciente/3 meses fue de 1.317,30€ (IC 95%: 1.151,34-1.483,26€. Los costes indirectos fueron significativamente mayores en pacientes mayores 18-40 años: 2.104,00€ vs 41-65 años: 3.301,55€, en el centro y norte del país, en enfermedad grave (2.921,63€) y en asmáticos peor controlados (1.799,42€). Conclusión: Estos datos pueden ser de interés para profesionales y proveedores de la salud (AU)

Background: Asthma is associated with high indirect costs due to lower work productivity and higher absenteeism and presenteeism. Objectives: To study loss of productivity measured using the lost workday equivalent (LWDE) index and health care utilization in asthmatics depending on age, geographical location, time period, severity, and level of asthma control. Patients and Methods: In this cross-sectional, observational, epidemiological multicenter study, 120 allergists nationwide were asked to select asthmatic patients aged 18 to 65 years who were evenly distributed according to the 4 levels of asthma severity (Global Initiative on Asthma) during 3 different seasons. The participants collected sociodemographic data, spirometry values, Asthma Control Test (ACT) score, health care utilization data, perceived stress according to the Impact on Work Productivity Index (IMPALA, Índice del Impacto de la Enfermedad en la Productividad Laboral), and score on the Sheehan disability scale. The LWDE index was used to measure the number of workdays lost and the number of workdays with asthma symptoms combined with the percentage for average performance at work. Results: The study sample comprised 1098 patients (58.7% females; 48.5% aged 18-40 and 51.5% aged 41-65). According to the ACT score, disease was uncontrolled in 57.6% of patients, well controlled in 32.8%, and totally controlled in 9.6%. The mean cost due to workdays lost was €285.81/patient/mo (95%CI, €252.71-318.92). Indirect costs were significantly higher in older patients (41-65 years, €405.08; 95%CI, 348.97-461.19), patients with more severe disease (€698.95; 95%CI, €588.63-809.27), and patients with more poorly controlled asthma (€466.86; 95%CI, €414.39-519.33). The average cost of health care units per patient for each 3-month period was €1317.30 (95%CI, €1151.34-€1483.26). Indirect costs were significantly higher in older patients (€2104.00 in patients aged 18-40 vs €3301.55 in patients aged 41-65), in northern and central regions, in severe disease (€2921.63), and in more poorly controlled asthma (€1799.42). Conclusion: Our findings could prove useful for physicians and health care providers (AU)

Actitud del médico frente al paciente fumador en las unidades de hipertensión o consultas de riesgo cardiovascular / Attitude of the physicians toward patients who smoke in hypertension units or cardiovascular risk consultations

Introducción: Aunque se sabe que el tratamiento del tabaquismo es una de las intervenciones más coste-efectivas, este es uno de los factores de riesgo sobre el que menos actúa el especialista en riesgo cardiovascular. Los objetivos de este estudio fueron: a) evaluar la actitud de los médicos de las unidades de hipertensión y de las consultas externas de riesgo cardiovascular frente al consumo de tabaco, y conocer su implicación para proporcionar tratamiento para dejar de fumar, y b) caracterizar a los pacientes fumadores que presentan factores de riesgo cardiovascular. Material y métodos Se realizó un estudio epidemiológico, observacional y multicéntrico en 35 unidades de hipertensión/consultas hospitalarias nacionales de riesgo vascular. Los médicos participantes respondieron una entrevista y se revisaron las historias clínicas de los pacientes fumadores que fueron atendidos consecutivamente, al menos en 2 ocasiones durante los últimos 2 años. Resultados Los médicos participantes consideran el consumo de tabaco como uno de los factores de riesgo más difíciles de abordar y que su tratamiento es el más coste-efectivo. A pesar de todo, la revisión de las historias clínicas reveló que solo el 10,9% de los pacientes fumadores recibieron tratamiento farmacológico y que el 3,1% fueron derivados a una unidad especializada. Conclusiones Es necesario actuar más activamente sobre el consumo de tabaco en las consultas de riesgo vascular, combinando y optimizando el uso de todas las herramientas disponibles, incluyendo el tratamiento farmacológico, para controlar este factor de riesgo (AU)

Introduction: Even though it is known that treating tobacco dependence is one of the most cost-effective interventions, this is one of the risk factor least acted on by the cardiovascular risk specialist. This study has aimed to: a) assess the attitude of the doctors towards smoking in hypertensive units and cardiovascular risk external consulting rooms and to know their involvement in providing smoking cessation treatment and b) to characterize the patients who smoke and who have cardiovascular risk factors. Material and methods: An epidemiological, observational and multicenter study was performed in 35 hypertension units/vascular risk national consultations. A survey was answered by the participating physicians and the records of patients who smoked and who were observed consecutively at least 2 times over the past 2 years were reviewed. Results: The results of the physician’s survey showed that those doctors who were questioned considered smoking as one of the most difficult risk factors to address and that its treatment is the most cost-effective. Notwithstanding, the review of hospital records revealed that only 10.9% of patients who smoked received drug therapy and 3.1% were referral to a specialized unit. Conclusions: More active actions are needed regarding smoking in vascular risk consultations, combining and optimizing the use of all available tools, including drug treatment, in order to control this risk factor (AU)

[Profile of the patient who wants to quick smoking seen in the Primary Care and Specialized consultations in Spain]. / Perfil del paciente que quiere dejar de fumar atendido en consultas de Atención Primaria y especializada de España.

OBJECTIVE: To determine the profile of the smoker who wants to stop smoking. Subjects and methods. A cross-sectional, multicenter study was conducted in 1634 smokers attended by General Practitioners and Specialized Physicians in Spain who had expressed their desire to stop smoking when explicitly asked. Sociodemographic data, background of smoking and related consequences were collected. A descriptive statistical analysis was performed. RESULTS: 67.1% of patients were seen by General Practitioners. Mean age +/- standard deviation was 45.6 +/- 12.0 years old and mean age of onset of usual consumption was 20.6 +/- 7.0. Fifty-six percent of the population studied were men. Most (35.2%) had studied beyond high school and 76.4% were active workers. Seventy-one percent had previously tried to stop smoking (2.7+/- 3.0 mean attempts). Out of 39.2% smokers who had participated in some type of smoking cessation treatment the year before, 70.7% were on substitutive therapy with nicotine. At the time of the visit, 80% admitted they could not stop smoking by themselves. CONCLUSIONS: The profile of the smoker seen in Primary Care and Specialized Consultation in Spain who wants to quit smoking corresponds to a male subject in his 40's, with studies beyond high school, actively working who has made more that two previous attempts to stop smoking, mostly with substitutive therapy with nicotine and who currently believes he is not being able to achieve it by himself.

Análisis coste-efectividad de vareniclina (Champix®) en el tratamiento del tabaquismo en España / Cost effectiveness analysis of varenicline (Champix®) for the treatment of smoking in Spain

Objetivos: Analizar la eficiencia de la vareniclina (Champix®) versus bupropion y TSN (terapia sustitutiva con nicotina) y tratamiento no farmacológico en España. Métodos: Se utilizó un modelo de Markov para analizar las consecuencias clínicas y económicas del tabaquismo y distintas intervenciones para dejar de fumar. Las probabilidades fueron tomadas de la literatura y ensayos clínicos, siendo utilizadas para estimar la efectividad de las opciones comparadas (vareniclina, bupropión, TSN y no tratamiento farmacológico), para distintos horizontes temporales. Los resultados se expresaron en años de vida (AV) ganado y coste por años de vida ajustados por calidad (AVAC) ganado de vareniclina vs comparadores. El análisis se realizó desde la perspectiva del Sistema Nacional de Salud, descontando los costes al 3,5% anual. Resultados: La mayor eficacia de vareniclina supone una reducción de la morbi-mortalidad asociada al tabaquismo, que a largo plazo, compensa totalmente el coste adicional del tratamiento respecto a los comparadores.Vareniclina se muestra como una opción dominante respecto a todas las alternativas en el análisis a largo plazo (toda la vida de los sujetos). Incluso tomando horizontes temporales más cortos (20 años) resulta coste efectivo, siempre menos de 9.000 €/AVAC ganado en comparación con cualquier alternativa. Conclusiones: Vareniclina es una opción dominante (más efectiva amenor coste) comparada con los demás tratamientos, cuando se considera toda la vida del sujeto. Vareniclina es una terapia coste-efectiva incluso cuando se consideran horizontes temporales más cortos (a partir de 20 años), con un coste efectividad incremental muy por debajo del umbral aceptado en nuestro entorno

Objective: To analyse the efficiency of varenicline compared with bupropion, NRT (nicotine replacement therapy) and no pharmacological treatment in Spain. Methods: A Markov model was developed to analyse the health and economic consequences of smoking cessation therapies. The transition probabilities were taken from published studies. The model allows cost effectiveness analyses for different time frames (10 years, 20 years and life time). Outcomes are measured in terms of incremental life years gained (LYG) and QALYs. Pharmacological costs and costs of medical visits with varenicline and bupropion were considered. Treatment costs of smoking associated morbidity were taken from Spanish studies. Results: The analyses were done under the perspective of the National Health System, discounting costs and health benefits at 3%. Results:The life time cost-effectiveness analysis shows that varenicline dominates all other smoking cessation interventions (more effective at a lower cost).This is due to the higher efficacy of varenicline associated with a reductionin smoking related morbimortality, which, in the long term, accounts for health care cost savings that overcome the extra cost of varenicline. Even when shorter time frames are considered (20 years), vareniclin is cost-effective in comparison with any other alternative. Conclusions: Varenicline is a dominant option (more effective at a lower cost) compared with all other smoking cessation treatments when the timeframe is the life span of the patient. Varenicline is cost-effective even when shorter timeframes are considered (20 years or more), withan estimated incremental cost per QALY far bellow any thresh old commonly accepted in our environment

[Cost effectiveness analysis of varenicline (Champix) for the treatment of smoking in Spain]. / Análisis coste-efectividad de vareniclina (Champix) en el tratamiento del tabaquismo en España.

OBJECTIVE: To analyse the efficiency of varenicline compared with bupropion, NRT (nicotine replacement therapy) and no pharmacological treatment in Spain. METHODS: A Markov model was developed to analyse the health and economic consequences of smoking cessation therapies. The transition probabilities were taken from published studies. The model allows cost effectiveness analyses for different time frames (10 years, 20 years and life time). Outcomes are measured in terms of incremental life years gained (LYG) and QALYs. Pharmacological costs and costs of medical visits with varenicline and bupropion were considered. Treatment costs of smoking associated morbidity were taken from Spanish studies. RESULTS: The analyses were done under the perspective of the National Health System, discounting costs and health benefits at 3%. The life time cost-effectiveness analysis shows that varenicline dominates all other smoking cessation interventions (more effective at a lower cost). This is due to the higher efficacy of varenicline associated with a reduction in smoking related morbimortality, which, in the long term, accounts for health care cost savings that overcome the extra cost of varenicline. Even when shorter timeframes are considered (20 years), vareniclin is cost-effective in comparison with any other alternative. CONCLUSIONS: Varenicline is a dominant option (more effective at a lower cost) compared with all other smoking cessation treatments when the timeframe is the life span of the patient. Varenicline is cost-effective even when shorter timeframes are considered (20 years or more), with an estimated incremental cost per QALY far bellow any threshold commonly accepted in our environment.

Estudio de farmacovigilancia para evaluar la seguridad y efectividad de doxazosina GITS en pacientes hipertensos que recibían tratamiento previo con doxazosina estándar / Post-marketing study to evaluate the safety and effectiveness of doxazosin GITS in hypertensive patients previously treated with doxazosin standard

Objetivo. Valorar la seguridad y efectividad de la nueva formulación GITS (gastrointestinal therapeutic system) en pacientes hipertensos tratados previamente con doxazosina estándar. Material y métodos. Estudio de farmacovigilancia, abierto y no controlado, multicéntrico en Atención Primaria. Se incluyeron pacientes diagnosticados de hipertensión arterial (HTA) esencial no controlada. Los pacientes podían estar en tratamiento farmacológico previo a la inclusión en el estudio y éste se mantuvo sin ser modificado a lo largo del mismo. El estudio en total tuvo una duración de 6 a 9 meses dividido en dos fases. La fase I tuvo una duración mínima de 3 meses y máxima de 6 meses en tratamiento con doxazosina estándar. La fase II se iniciaba al sustituir la doxazosina estándar por la formulación GITS y tenía una duración de 12 semanas. Las variables principales a estudio incluyen la presión arterial (PA), el control de la misma y la aparición de acontecimientos adversos. Resultados. Comenzaron el estudio un total de 4.512 pacientes y finalizan el estudio 3.537 (78,4 por ciento). El porcentaje de pacientes con monoterapia fue del 70,7 por ciento, el restante 29,3 por ciento seguía terapia combinada con otro antihipertensivo además de doxazosina. La reducción de la presión arterial sistólica (PAS) a lo largo de la fase I fue de 21,3 mmHg, en la fase II descendió 3,8 mmHg adicionales. Para la presión arterial diastólica (PAD) la reducción en la fase I fue de 13,3 mmHg y en la fase II fue de 2,7 mmHg más. El porcentaje de pacientes controlados al final de la fase I fue del 47,9 por ciento y en la fase II 63,4 por ciento. Un total de 322 sujetos presentaron un total de 343 (7,2 por ciento) acontecimientos adversos; de éstos, un 0,9 por ciento (37) fueron considerados graves (un 0,6 por ciento en la fase I y un 0,23 por ciento en la fase II). Conclusiones. La doxazosina en sus dos formulaciones es un fármaco efectivo y seguro para reducir la PA tanto en monoterapia como en combinación con otros antihipertensivos, y la sustitución de la formulación estándar por la GITS es segura y probablemente aumente la efectividad del tratamiento de la HTA y mejore la tolerabilidad (AU)

Respuesta de la adición de doxazosina en hipertensos con hipertrofia benigna de próstata tratados con monoterapia

Objetivo. Evaluar la eficacia y tolerancia de la adición de doxazosina al tratamiento del hipertenso controlado con otros hipotensores que concomitante presenta prostatismo. Metodología. Estudio abierto, no comparativo, multicéntrico, observacional, prospectivo de farmacovigilancia, que se realizó en 2.363 pacientes varones, mayores de 40 años, ambulatorios, hipertensos, tratados con monoterapia antihipertensiva, con presión arterial diastólica (PAD) < 95 mmHg, susceptibles de ser tratados con doxazosina por presentar hipertrofia benigna de próstata (HBP) asociada a hipertensión (HTA). Se inició el tratamiento con una dosis de doxazosina de 1 mg/día, incrementándose a intervalos de dos semanas, a 2 mg/día y a 4 mg/día. La duración del estudio fue de catorce semanas. Se midió la presión arterial (PA) y la frecuencia cardíaca (FC) en cada una de las visitas. En la visita basal y en la visita tras catorce semanas de tratamiento se cuantificó la sintomatología de prostatismo con la Escala Internacional de Síntomas Prostáticos (I-PSS) y la valoración de calidad de vida del Comité de la Asociación Urológica Americana. Se determinó la incidencia de efectos adversos en función de la reducción de presión obtenida y de la edad de los sujetos. Resultados. En la cuarta visita, en que los pacientes tomaban 4 mg de doxazosina, la reducción de PA fue de 10,7 ñ 11,3/6,1 ñ 7,1 mmHg. Este descenso fue significativamente mayor para PAD en el grupo en tratamiento con betabloqueantes frente a los grupos tratados con calcioantagonistas o inhibidores de la enzima conversora de la angiotensina (IECA) y superior para presión sistólica en los pacientes tratados con diurético frente a los tratados con calcioantagonistas o IECA. La sintomatología de prostatismo se redujo desde 15 ñ 5,8 puntos hasta 7,9 ñ 4,3 puntos (p < 0,001) acompañada de una mejora de calidad de vida. La tolerancia fue muy buena, encontrando una incidencia de efectos adversos relacionados con doxazosina del 4,4 por ciento. Los pacientes que presentaron efectos adversos tenían mayor edad y sus presiones finales fueron menores. Conclusión. La doxazosina puede ser utilizada en pacientes con HTA + HBP tratados con otro fármaco antihipertensivo independientemente del control arterial, pues en caso de no control mostrará efecto sinérgico con casi todos los otros fármacos y en los pacientes normalizados no producirá reducciones de PA importantes y sí una mejoría sustantiva de la sintomatología prostática (AU)