[Prevalence of drug utilization in the adult population of Catalonia, Spain]. / Prevalencia del consumo de medicamentos en la población adulta de Cataluña.

OBJECTIVES: To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. METHODS: Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). RESULTS: A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was higher in retired individuals and pensioners (68%; 95%CI: 62-74) than in active workers (54%; 95%CI: 52-57). The most frequently used drugs were those for the nervous system (35% men and 51% women; p < 0.001), alimentary tract (15%) and the cardiovascular system (9% and 13%; p < 0.001). Most drugs (40%) were prescribed by specialists and one quarter was self-prescribed. CONCLUSIONS: The prevalence of total drug utilization in the adult population of Catalonia is high, specially among women, who self-perceived worse health status. Policies of rationalization of drug expenditures should take the epidemiological pattern into account.

Prevalencia del consumo de medicamentos en la población adulta de Cataluña / Prevalence of drug utilization in the adult population of Catalonia, Spain

Objetivos: Describir la prevalencia de la utilización de medicamentos según factores sociodemográficos y estado de salud autopercibido en la población adulta. Métodos: Examen de salud transversal del estudio CRONICAT/MONICA-Cataluña realizado en 1994-1996 en una muestra aleatoria de la población general de 25 a 64 años. Se interrogó a 3.421 participantes (tasa de respuesta del 72%) con cuestionario abierto sobre los medicamentos consumidos durante las dos semanas previas y otros hábitos de salud. Los medicamentos se codificaron posteriormente según la clasificación ATC (versión 1993). Resultados: Mayor proporción de mujeres (38%) que de varones (26%) autopercibió peor estado de salud (p < 0,001). El consumo total de medicamentos ajustado por edad fue: varones, del 57% (intervalo de confianza [IC] del 95%, 55-59), y en mujeres, del 76% (IC del 95%, 74-78). Excluyendo los anticonceptivos, el consumo regular fue: varones, del 35% (IC del 95%, 33-37), y en mujeres, del 48% (IC del 95%, 46-51). Tomaron más de un medicamento el 29% de los varones y el 48% de las mujeres (p < 0,001). Ni el nivel educativo ni el estado civil influyeron en la toma de medicamentos. Mayor proporción de jubilados o pensionistas consumieron (..) (AU)

Objectives: To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. Methods: Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). Results: A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was (..) (AU)

[Secular trends in smoking according to educational level between 1986 and 1996: The MONICA study. Catalonia]. / Tendencias seculares del tabaquismo según el nivel educativo entre 1986 y 1996: estudio MONICA-Cataluña.

OBJECTIVE: To describe trends from 1986-1996 in the prevalence of cigarette smoking between ages 25 to 64 in the MONICA-Catalonia study, according to educational level, and to validate these trends biochemically. METHODS: Three cross-sectional surveys in independent random samples of the general population of central Catalonia area carried out in 1986-88, 1990-92 and 1994-96 following the World Health Organization's MONICA protocol. Serum thiocyanate was determined by the Bowler method. RESULTS: A total of 2,571, 2,934 and 3,485 men and women were examined with response rates of 74, 67 and 72% in each survey respectively. The age-adjusted cigarette smoking prevalence decreased in men by 5.1% (95% CI: 1.5 to 8.7) and increased in women by +8.5% (95% CI: +5.6 to +11.4). The prevalence was 46.5% in men and 23.9% in women in 1994-96. The greatest decrease was in men aged 55-64 (9.9%) and the greatest increase was in women aged 35-44 (+14.8%). These trends were confirmed by serum thiocyanate levels, which decreased from 78.9 to 73.9 µmol/l (p = 0.07) in men and increased from 43.7 to 49.8 µmol/l (p < 0.01) in women during the study period. Cigarette smoking increased in less educated women (+10%) and decreased in university women (6%), while cigarette smoking in men decreased irrespective of educational level. Serum thiocyanate levels confirmed the relationship with educational level. CONCLUSIONS: The prevalence of cigarette smoking decreased in men between 1986 and 1996 but remained high in 1996. Women showed a pattern of progressive adoption of smoking, especially those with lower educational level.

[Risk factors and coronary morbimortality in a Mediterranean industrial cohort over 28 years of follow-up. The Manresa Study]. / Factores de riesgo y morbimortalidad coronaria en una cohorte laboral mediterránea seguida durante 28 años. Estudio de Manresa.

OBJECTIVE: To study the incidence and mortality of coronary heart disease (CHD) and all-cause mortality in a cohort of men followed during 28 years, and their association with serum cholesterol, systolic blood pressure, glycemia, cigarette smoking and body mass index measured at baseline. RESEARCH DESIGN AND METHODS: A cohort of 1,059 men aged 30 to 59 years and free of cardiovascular diseases at baseline in 1968, was examined every five years until 1988. The last examination was performed in 1996. Information was collected in 96.4% of the participants. RESULTS: Incidence and mortality rates from CHD and from all-causes of death per 105 person-years of observation were 499.80, 235.80 and 925.33, respectively. At the end of follow-up, high levels of serum cholesterol and smoking were independently associated with the incidence and mortality from CHD adjusted for age, blood pressure, glycemia and BMI. Serum cholesterol, hyperglycemia and smoking were independently associated with all-cause mortality. CONCLUSIONS: In this industrial cohort of men, with a relatively low incidence of CHD, smoking and serum cholesterol at baseline were independently associated with the incidence of CHD over 28 years of observation.

[Trends in prevalence, awareness, treatment and control of arterial hypertension between 1986 and 1996: the MONICA-Catalonia study]. / Tendencias de la prevalencia, conocimiento, tratamiento y control de la hipertensión arterial entre 1986 y 1996: estudio MONICA-Cataluña.

BACKGROUND: To describe temporal trends in blood pressure (BP) and in the prevalence, awareness, treatment and control of arterial hypertension(AH) between 1986-1996 in the MONICA-Catalonia study. SUBJECTS AND METHOD: Three cross-sectional health surveys in independent random samples of the general population aged 25-64, carried out in 1986-88,1990-92 and 1994-96 according to the WHO-MONICA study protocol.BP was measured twice with a random zero mercury sphygmomanometer. RESULTS: 2,571, 2,934 and 3,485 subjects were examined in each survey with response rates of 74, 67 and 72%, respectively. Age-adjusted mean of systolic BP (SBP) decreased 2 and 4 mmHg (p < 0.001)reaching 120 and 114 mmHg in 1994-96 in men and women, respectively. Diastolic BP (DBP) did not change in men (73-74 mmHg) nor in women(70-71 mmHg). Age-adjusted prevalence of AH (>= 160/95 and/or under pharmacological treatment) was 8% (men) and 10% (women)in 1994-96 and of AH (>= 140/90 and/or under pharmacological treatment) was 15% in both sexes. Awareness of hypertension (AH >= 140/90) increased from 67 to 76%. Treated hypertensives increased from 22 to 40% (men) and from 44 to 54% (women). The use of diuretics and betablockers decreased and ACE inhibitors increased. At the end of the period, 52% of hypertensives were controlled. SBP also decreased in normotensives but not DBP. CONCLUSIONS: Between 1986 and 1996, the prevalence of AH in Catalonia remained stable although awareness, treatment and control had substantially improved.SBP decreased but DBP remained stable.

Tendencias seculares del tabaquismo según el nivel educativoentre 1986 y 1996: estudio MONICA-Cataluña / Secular trends in smoking according to educational level between 1986 and 1996: The MONICA study. Catalonia (Spain)

Objetivo: Describir las tendencias entre 1986 y 1996, en el estudio MONICA-Cataluña, de la prevalencia de fumadores de cigarrillos entre 25 y 64 años de edad, según el nivel educativo, y validarlas bioquímicamente. Métodos: Tres encuestas-exámenes de salud transversales en muestras aleatorias independientes de la población general del centro de Cataluña, realizadas en los años 1986-1988,1990-1992 y 1994-1996, siguiendo el protocolo del estudio MÓNICA de la Organización Mundial de la Salud. El tiocianatosérico se determinó por el método de Bowler. Resultados: Se examinaron 2.571, 2.934 y 3.485 varones y mujeres con tasas de respuesta del 74, 67 y 72% en cada examen, respectivamente. La prevalencia de fumadores de cigarrillos ajustada por edad descendió un 5,1% (IC del 95%:–1,5 a –8,7) en varones y aumentó un 8,5% (IC del 95%: +5,6a +11,4) en mujeres. En 1994-1996, la prevalencia fue del46,5% en varones y del 23,9% en mujeres. El mayor descenso (..) (AU)

Objective: To describe trends from 1986-1996 in the prevalence of cigarette smoking between ages 25 to 64 in the MONICA-Catalonia study, according to educational level, and to validate these trends biochemically. Methods: Three cross-sectional surveys in independent random samples of the general population of central Catalonia area carried out in 1986-88, 1990-92 and 1994-96 following the World Health Organization’s MONICA protocol. Serum thiocyanate was determined by the Bowler method. Results: A total of 2,571, 2,934 and 3,485 men and women were examined with response rates of 74, 67 and 72% in each survey respectively. The age-adjusted cigarette smoking prevalence decreased in men by –5.1% (95% CI: –1.5 to –8.7)and increased in women by +8.5% (95% CI: +5.6 to +11.4).The prevalence was 46.5% in men and 23.9% in women in (..) (AU)

[Incidence, mortality and risk factors for stroke in the Manresa Study: 28 years of follow-up]. / Accidente vascular cerebral: incidencia, mortalidad y factores de riesgo en 28 años de seguimiento. Estudio de Manresa.

INTRODUCTION AND OBJECTIVES: The information concerning stroke mortality is limited in Spain, and the information on morbidity is even scarcer similarly to other countries. This is true also for the decrease of frequency observed in the last decades. The objective of this paper is to provide data in the incidence, mortality and cardiovascular risk factors associated to stroke in our surrounding through by the prolonged observation of a working population. MATERIAL AND METHODS: In the Manresa Study, which began in 1968, a cohort of 1,059 men, from 30 to 59 years old, was followed for 28 years. We recorded new cases of fatal and nonfatal stroke and the relationship between stroke incidence and risk factors of cardiovascular disease found in the initial examination. RESULTS: Incidence rate for stroke was 183 x 100,000 per year, 64% of the cases were registered after they turned 60 years of age. Mortality rate due to stroke was 88 x 100,000 per year, 91.6% of fatal cases were over 60 years old. Factors associated to the stroke morbimortality incidence were age, high blood pressure and overweight. In a bivariate regression model, stroke mortality was found significantly associated to the presence of atrial fibrillation, diabetes, hypercholesterolemia and tobacco smoking. CONCLUSIONS: Stroke frequency rates in the Manresa cohort are ranged at a medium level compared to data from other general population studies. The role of atrial fibrillation in the stroke morbimortality has been confirmed. The associated factors, age, high blood pressure and overweight, are similar role to that which was found in other research studies. The priorities in the cerebrovascular disease prevention in our surroundings are discussed.

[Strategies in the control of coronary risk factors in primary and secondary prevention]. / Estrategias en el control de los factores de riesgo coronario en la prevención primaria y secundaria.

The longitudinal observational studies began in 1948, have permitted to identify the coronary risk factors that is, the biological signs and lifestyles more frequent in the future coronary patients than in the entire cohort. The long follow-up of these studies has cooperate in the identification of other important risk factors and their role in middle aged women and in both genders older than 65 years. There are two strategies in the primary prevention, one directed to community and the other to the high risk group. As a consequence of the progress in the identification of the high risk candidates, the primary prevention of the high risk groups become similar to the strategy in the secondary prevention of the coronary patients. The advances in the reduction of the mortality and morbidity by the main risk factors control observed in the last years, increase the need of a more energetic approach to the high risk groups in the primary and secondary prevention. The differences in the coronary mortality between countries suggest the adoption of acceptable priorities for the primary prevention of coronary heart disease in each country. My recommendations for Spain are: a) To discourage boys and adolescents from beginning cigarette smoking; b) To avoid that cigarette smoking becomes a sign of autoaffirmation for young women; c) To include the education for a balanced food intake in the school programs, d) To get that non competitive sport could be accessible and desirable for the youth after the end of education period, and e) To create the adequate conditions for the identification and control of the high risk group in primary care centers.

[The future of cardiology in Spain from the perspective of the last 30 years]. / El futuro de la cardiología en España a partir de la evolución en los últimos 30 años.

Socioeconomic and geoenvironmental factors combined with technological advances play a decisive role in diseases control and in the imbalances in health care among countries and also among social groups within one country. We discuss the frequency and trends of cardiovascular disease in Spain during the last 30 years, the socioeconomical changes in health care and the role of the cardiologist over the last decade, as a background for the challenges to be addressed as the year 2000 approaches: the role of the demographic changes in the frequency of cardiac diseases, the control of "new" postsurgical populations, the integration of basic research in departments of cardiology, the selection of new technologies in terms of cost-effectiveness by means of randomized trials and the need to bridge the gap between the overflow of protocols, recommendations and consensus and their application to the population.

Coronary risk factors and a 20-year incidence of coronary heart disease and mortality in a Mediterranean industrial population. The Manresa Study, Spain.

The association between coronary risk factors measured at entry and 20-year coronary heart disease (CHD) incidence and mortality was studied in an industrial cohort of 1059 men aged 30 to 59 years and free of CHD in 1968, in Spain. Myocardial infarction and fatal CHD cases were diagnosed according to recognized criteria. Mean serum cholesterol was 223.3 mg.dl-1 and 67% of men were current smokers. Rates of CHD incidence, CHD mortality and all-causes mortality, per 10(5) persons-year of observation, were 476, 194 and 617, respectively. Age, serum cholesterol, plasma glucose, cigarettes smoked and systolic blood pressure (SBP) contributed to the risk of CHD incidence. The first four variables predicted CHD death risk. All-causes death risk was positively associated with age, plasma glucose and SBP levels. Results are consistent with prior reported low CHD mortality and morbidity rates in the Mediterranean area, and confirm the importance of coronary risk factors in this low-risk population.

[The preference for the final digits in blood pressure determination: a continuing education experience]. / La preferencia de dígitos terminales en la determinación de la tensión arterial: una experiencia de formación continuada.

The CRONICAT program is developing a Project for the Control of Hypertension in three areas of central Catalonia. In the analysis of the blood pressure data of the registry of patients from this project, carried out 18 months after its beginning, it was found that a high proportion of blood pressure (BP) readings showed 0 or 5 as the terminal digit (57.3% and 16.6% in diastolic BP, and 66.6% and 11.8% in systolic BP, respectively). To improve the quality of the reading two continuing education activities were carried out; a seminar where a practical session of blood pressure measurement was developed, using a videotape with 12 BP recordings permitting to see the interobserver and intraobserver variability, and discussion meetings with all the primary care teams which participate in the Project. 36 months after the beginning a new analysis of data was carried out, and it was found that the preference for 0 and 5 had decreased to 41.1% and 7.5% for diastolic BP and to 51.3% and 8.2% for had decreased to 41.1% and 7.5% for diastolic BP and to 51.3% and 8.2% for systolic BP, respectively. A higher preference for terminal digits was maintained in systolic BP, although the results obtained in the practical session with the videotape showed a greater dispersion of results in diastolic BP.

Recruitment methods and differences in early, late and non-respondents in the first MONICA-Catalonia population survey.

The early response rate in the first MONICA-Catalonia population survey was 52.7% and the final response rate was 73.8%. The intensity of recruitment effort in this survey led to a considerable increase in response rate (20%), with the extra cost per late respondent being relatively low ($13.9). Added recruitment effort was most effective in the youngest age group, 25-34 years. It was also more effective among women living in urban areas than among those from rural areas. In men, early respondents had a higher proportion of smokers than late respondents, and in women, early respondents had higher systolic and diastolic blood pressure levels and were more aware of their history of high blood pressure than late respondents. Non-respondents were less educated than respondents in both sexes, and this was more marked in women. No differences were found in the proportion of smokers between respondents and non-respondents. Respondents were more aware of their high blood pressure history than non-respondents. The recruitment costs and distribution of non-response components are given.