Analysis of the genotypic profile and its relationship with the clinical manifestations in people with cystic fibrosis: study from a rare disease registry.

BACKGROUND: Cystic fibrosis (CF) has a vast and heterogeneous mutational spectrum in Europe. This variability has also been described in Spain, and there are numerous studies linking CFTR variants with the symptoms of the disease. Most of the studies analysed determinate clinical manifestations or specific sequence variants in patients from clinical units. Others used registry data without addressing the genotype-phenotype relationship. Therefore, the objective of this study is to describe the genetic and clinical characteristics of people with CF and to analyse the relationship between both using data from the rare disease registry of a region in southeastern Spain. METHODS: A cross-sectional study was carried out in people with a confirmed diagnosis of CF registered in the Rare Diseases Information System (SIER) of the Region of Murcia (Spain). The patients were classified into two genotypes according to the functional consequence that the genetic variants had on the CFTR protein. RESULTS: There were 192 people diagnosed with CF reported in the Region of Murcia as of 31 December 2018. Seventy-six genotypes and 49 different variants were described, with c.1521_1523delCTT (p. Phe508del) being the most common in 58.3% of the CF patients and 37.0% of the alleles. In addition, 67% of the patients were classified as a high-risk genotype, which was associated with a lower percentage of FEV1 (OR: 5.3; 95% CI: 1.2, 24.4), an increased risk of colonization by Pseudomonas aeruginosa (OR: 7.5; 95% CI: 1.7, 33.0) and the presence of pancreatic insufficiency (OR: 28.1; 95% CI: 9.3, 84.4) compared to those with a low-risk genotype. CONCLUSIONS: This is the first study in Spain that describes the mutational spectrum and its association with clinical manifestations in patients with CF using data from a rare disease registry. The results obtained allow planning for the health resources needed by people with this disease, thus contributing to the development of personalized medicine that helps to optimize health care in CF patients.

Health-Related Quality of Life in Adult Spanish Women with Endometriomas or Deep Infiltrating Endometriosis: A Case-Control Study.

Endometriosis is a disabling disease that may significantly compromise a woman's social relationships, sexuality, and mental health. Considering the impact of endometriomas and deep infiltrating endometriosis (DIE) on quality of life and the limited number of papers on this topic, the objective of this study was to assess health-related quality of life (HRQoL) in adult Spanish women with the condition. A case-control study was conducted on a group of 99 patients with ovarian endometriomas or DIE and 157 controls. Women underwent physical and gynecological examinations, and they completed health questionnaires including the Short Form-12v2 (SF-12v2), a survey for HRQoL. Eight scales and two component summary scores (Physical (PCS) and Mental (MCS), respectively) were calculated. Women with endometriomas or DIE had significantly worse PCS: 47.7 ± 9.7 vs. 56.1 ± 5.9, respectively (p < 0.001) compared to controls, as well as lower scores on seven out of the eight scales (p < 0.01). No significant differences were found for the MCS. Conclusions: HRQoL was significantly lower in patients with endometriomas or DIE compared to controls. If confirmed, these results may have important implications for prevention, clinical practice, and intervention.

[Wilson's disease in Spain: validation of sources of information used by the Rare Diseases Registries]. / Enfermedad de Wilson en España: validación de fuentes utilizadas por los Registros de Enfermedades Raras.

OBJECTIVE: To evaluate the sources of information used by the Regional Population-based Registries of Rare Diseases (RRD) for Wilson's Disease identification in Spain; to calculate its prevalence and mortality; and to describe the sociodemographic characteristics of those affected. METHOD: Cross-sectional epidemiological study, period 2010-2015. Possible cases were identified by codes 275.1 (ICD-9-CM), E83.0 (ICD-10) and 905 (ORPHAcode) in: 15 participating RRD and the Rare Disease Patients Registry of the Carlos III Health Institute. The diagnoses were confirmed through a clinical documentation review. The positive predictive value (PPV) of the sources of information used by RRD and their combinations were obtained. The prevalence, mortality and the distribution of sociodemographic characteristics were calculated. RESULTS: The Hospital Discharge Database (HDD) was the most used source by the RRD (PPV=39.4%), followed by the Orphan Drugs Registry (ODR) (PPV=81.9%). The Clinical History of Primary Care (PC) obtains PPV=55.9%. The combinations with highest PPV were the ODR with HDD (PPV=95.8%) and the ODR with PC (PPV=92.9%). 514 cases were confirmed, 57.2% men, with a median age of diagnosis of 21.3 years. The prevalence was 1.64/100,000 inhabitants in 2015 and mortality rate was 3.0%, being both higher in men. CONCLUSIONS: Incorporation of ODR and PC into the RRD is recommended, as its combination and ODR with HDD could be used as an automatic validation criterion for Wilson's disease. The prevalence obtained was similar to that of countries close to Spain.

Health-related quality of life in women with polycystic ovary syndrome attending to a tertiary hospital in Southeastern Spain: a case-control study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a chronic condition with symptoms affecting many women at reproductive age and evaluating their health-related quality of Life (HRQoL) is an important issue. Moreover, differences in the HRQoL between women with different PCOS phenotypes have never been analyzed. Therefore, the aim of our study was to compare the HRQoL between women with PCOS -and its phenotypes- and controls attending to a tertiary hospital. METHODS: A group of 117 women with PCOS and 153 controls were studied between 2014 and 2016. Controls were women without PCOS attending the gynecological outpatient clinic for routine examinations. Cases were women attending the same setting and diagnosed with PCOS. PCOS diagnose was performed following the Rotterdam Criteria and women were further classified by anovulatory or ovulatory phenotypic subtype. Women underwent physical and gynecological exams and completed health questionnaires including the Short Form-12v2. Eight scales and two component summary scores [Physical (PCS) and Mental (MCS), respectively] were calculated. Bivariate and multivariate analyses were performed to assess differences in HRQoL between women with PCOS and controls. RESULTS: All women with PCOS and anovulatory PCOS presented lower score in PCS compared to controls [mean (95%CI): 53.7 (52.5-54.9) and 52.9 (51.5-54.4) vs. 55.8 (54.8-56.8); p-values< 0.01], as well as lower scores for five out of the eight scales (p-values < 0.05) after adjusting by age, body mass index, infertility, educational level and current occupation. No significant differences were observed for the MCS between women with or without PCOS or its phenotypic subtypes. CONCLUSIONS: HRQoL was significantly decreased in adult women with PCOS and its anovulatory phenotype compared to controls attending the outpatient clinic of a tertiary hospital. These results may have implications for the clinical practice and suggest the need for specific interventions in women with PCOS.

Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia / Population-based study of first hospitalizations for heart failure and the interaction between readmissions and survival

Introducción y objetivos: La evolución tras una primera hospitalización por insuficiencia cardiaca (IC), en particular la interacción entre supervivencia y rehospitalizaciones, no está bien establecida. Métodos: Se estudió a todos los pacientes con una primera hospitalización y diagnóstico principal de IC en el periodo 2009-2013, mediante el análisis del Conjunto Mínimo Básico de Datos en la Región de Murcia. Se diferenció entre pacientes nuevos o incidentes y recurrentes, y se calcularon tasas poblacionales y tendencias mediante regresión de joinpoint. Se realizó un seguimiento por tarjeta sanitaria individual hasta el fin de 2015, y se registraron la mortalidad y los reingresos, sus causas y la cronología de los reingresos respecto al fallecimiento. Resultados: Se identificó a 8.258 incidentes, con una tendencia creciente de la tasa anual (+2,3%; p <0,05) hasta 1,24/1.000 habitantes; esto supuso el 71% de los hospitalizados por IC y el 57% del total de altas por IC. En el primer año, el 22% reingresó por IC, el 31% por causa cardiovascular y el 54% por cualquier causa. La supervivencia a los 5 años fue del 40%, significativamente inferior a la de la población general ajustada por edad y sexo (76%) (p <0,001). Entre los fallecidos en el seguimiento, las rehospitalizaciones (1,5/paciente/año; 0,4 debidas a IC) mostraron un patrón en J, donde el 48% de reingresos se acumularon en los últimos 3 deciles de tiempo de supervivencia antes del fallecimiento. Conclusiones: La primera hospitalización por IC mantiene tasas en aumento, con elevada mortalidad y reingresos en el seguimiento, que se acumulan principalmente en el periodo previo al fallecimiento

Introduction and objectives: Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. Methods: We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. Results: A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. Conclusions: Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death

Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival.

INTRODUCTION AND OBJECTIVES: Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS: We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS: A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS: Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.

Análisis de los ingresos hospitalarios por insuficiencia cardiaca en registros sanitarios de diferentes comunidades autónomas / Analysis of hospitalization trends for heart failure in the health registries of different autonomous communities

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Tendencia y características de la hospitalización por insuficiencia cardiaca en un marco poblacional durante el periodo 2003-2013 / Trends and Characteristics of hospitalization for heart failure in a population setting from 2003 to 2013

Introducción y objetivos: Estudios poblacionales llevados a cabo en otros países indican una disminución de las tasas estandarizadas de hospitalización por insuficiencia cardiaca (IC); sin embargo, en España se carece de datos poblacionales. Métodos: A partir del Conjunto Mínimo Básico de Datos de todos los hospitales de la Región de Murcia, se obtuvieron los episodios asistenciales por tarjeta sanitaria individual con un diagnóstico principal de IC entre 2003-2013 (n = 27.158). Para cada año se estudiaron las tasas de hospitalización por 1.000 habitantes (‰), bruta y estandarizada por edad y sexo, variables clínicas y administrativas. Las tendencias temporales se analizaron con regresión de joinpoint. Resultados: La tasa de hospitalización aumentó un 76,7%, pasando del 1,28 a 2,26‰ (bruta) y del 1,06 a 1,77‰ (estandarizada); el porcentaje de cambio anual medio (PCA) fue 8,2% hasta 2007 y posteriormente 1,9% (p < 0,05). Las personas mayor o igual 75 años duplicaron su tasa, hasta 19,9‰ en 75-84 años (PCA, 5,4%) y 32,5‰ en mayor o igual 85 años (PCA, 11,7%), mientras que en < 75 años no se modificó. La tasa de hospitalización en mujeres fue un 36% mayor, pero se equiparó tras estandarizar por edad y no presentó variaciones. El índice de comorbilidad de Elixhauser aumentó casi 1 punto y los episodios > 6 puntos se duplicaron. La estancia y mortalidad hospitalarias no cambiaron. Conclusiones: Entre 2003-2013 persiste un incremento sostenido de la hospitalización por IC, que afecta a la población mayor o igual 75 años y está asociado al aumento de comorbilidad. Son necesarias estrategias específicas dirigidas a esta población (AU)

Introduction and objectives: Population-based studies in other countries have reported a reduction of standardized rates of hospitalization for heart failure (HF) but data from a well-defined population are lacking in Spain. Methods: All hospitalizations with a principal diagnosis of HF between 2003 and 2013 were obtained from the Minimum Basic Data Set, which includes all hospitals in the Region of Murcia. Health care episodes were identified by the individual health card (27 158 episodes). For each year, we studied the following parameters: crude, age-standardized and sex-standardized hospitalization rates for HF, length of stay, mortality, clinical variables, and the Elixhauser index. Time trends were analyzed using joinpoint regression. Results: Hospitalization rates increased by 76.7%, from 1.28% to 2.26% (crude) and 1.06% to 1.77% (standardized); the mean annual percentage of change (APC) was 8.2% until 2007 and was subsequently 1.9% (P < .05). Rates doubled in persons 75 years, reaching 19.9% in those aged 75 to 84 years (APC, 5.4%) and 32.5% in those aged 85 years (APC, 11.7%) but were unchanged in persons aged < 75 years. The hospitalization rate was 36% higher in women than in men but was equal after age-standardization and showed no temporal change. The Elixhauser comorbidity index increased by almost 1 point during the study period and episodes > 6 points increased by 2-fold. Length of stay and mortality were unchanged during the study period. Conclusions: Between 2003 and 2013, there was a sustained increase in standardized rates of hospitalization for HF, which affected persons 75 years and was associated with a rise in comorbidity. There is a need for strategies focused on this population (AU)

Trends, causes and timing of 30-day readmissions after hospitalization for heart failure: 11-year population-based analysis with linked data.

BACKGROUND: Reliable data are necessary if the burden of early readmissions following hospitalization for heart failure (HF) is to be addressed. We studied unplanned 30-day readmissions, their causes and timing over an 11-year period, using population-based linked data. METHODS: All hospitalizations from 2003 to 2013 were analyzed by using administrative linked data based on the Minimum Basic Set discharge registry of the Department of Health (Region of Murcia, Spain). Index hospitalizations with HF as principal diagnosis (n=27,581) were identified. Transfers between centers were merged into one discharge. Readmissions were defined as unplanned admissions to any hospital within 30-days after discharge. RESULTS: In the 2003-2013 period, 30-day readmission rates had a relative mean annual growth of +1.36%, increasing from 17.6% to 22.1%, with similar trends for cardiovascular and non-cardiovascular causes. The figure of 22.1% decreased to 19.8% when only same-hospital readmissions were considered. Most readmissions were due to cardiovascular causes (60%), HF being the most common single cause (34%). The timing of readmission shows an early peak on the fourth day post discharge (+13.29%) due to causes other than HF, followed by a gradual decline (-3.32%); readmission for HF decreased steadily from the first day (-2.22%). Readmission for HF (12.7%) or non-cardiovascular causes (13.3%) had higher in-hospital mortality rates than the index hospitalization (9.2%, p<0.001). Age and comorbidity burden were the main predictors of any readmission, but the performance of a predictive model was poor. CONCLUSION: These findings support the need for population-based strategies to reduce the burden of early-unplanned readmissions.

Trends and Characteristics of Hospitalization for Heart Failure in a Population Setting From 2003 to 2013.

INTRODUCTION AND OBJECTIVES: Population-based studies in other countries have reported a reduction of standardized rates of hospitalization for heart failure (HF) but data from a well-defined population are lacking in Spain. METHODS: All hospitalizations with a principal diagnosis of HF between 2003 and 2013 were obtained from the Minimum Basic Data Set, which includes all hospitals in the Region of Murcia. Health care episodes were identified by the individual health card (27 158 episodes). For each year, we studied the following parameters: crude, age-standardized and sex-standardized hospitalization rates for HF, length of stay, mortality, clinical variables, and the Elixhauser index. Time trends were analyzed using joinpoint regression. RESULTS: Hospitalization rates increased by 76.7%, from 1.28‰ to 2.26‰ (crude) and 1.06‰ to 1.77‰ (standardized); the mean annual percentage of change (APC) was 8.2% until 2007 and was subsequently 1.9% (P < .05). Rates doubled in persons ≥ 75 years, reaching 19.9‰ in those aged 75 to 84 years (APC, 5.4%) and 32.5‰ in those aged ≥ 85 years (APC, 11.7%) but were unchanged in persons aged < 75 years. The hospitalization rate was 36% higher in women than in men but was equal after age-standardization and showed no temporal change. The Elixhauser comorbidity index increased by almost 1 point during the study period and episodes > 6 points increased by 2-fold. Length of stay and mortality were unchanged during the study period. CONCLUSIONS: Between 2003 and 2013, there was a sustained increase in standardized rates of hospitalization for HF, which affected persons ≥ 75 years and was associated with a rise in comorbidity. There is a need for strategies focused on this population.

[Response bias in a population postal survey on Health-Related Quality of Life (sf-12v2)]. / Sesgo de respuesta en una encuesta postal poblacional sobre calidad de vida relacionada con la salud (SF-12v2).

BACKGROUND: the bias associated with the low response rate may limit the economic advantage of population surveys by mail. The factors associated with non-response were estimated with an emphasis on Health-Related Quality of Life (HRQoL). METHODS: people who had answered to the Health Survey Murcia-2007 2007 (≥ 18 years), realized by telephone, were sent another postal questionnaire four months later. Both evaluations included information about HRQoL: SF-12v2 (by phone) and EQ-5D (postal). A logistic regression was realized to identify baseline factors (sociodemographic factors, health-related behaviors and HRQoL-physical component summary (PCS) and mental component summary (MCS) of the SF-12v2) associated with non-response to the postal survey. RESULTS: 2,078 individuals (61.5%) did not answer. Multivariate analysis: non-response was associated with marital status, more likely not to respond if it was not married: widower OR: 2,24; IC95% 0,61/0,88; separate/divorced 1,69; 1,10/2,59-; single 1,53; 1,23/1,90 ) and inversely with age (25-34 years OR: 0,95; IC95% 0,69/1,29; 35-44 years 0,60; 0,43/0,85; 45-54 years 0,42; 0,29/0,60; 55-64 years 0,29; 0,20/0,43; 65-74 years 0,17; 0,11/0,26-;≥75 years 0,15; 0,09/0,23) and educational level (low-OR: 0,65; IC95% 0,48/0,86; intermediate 0,41; 0,30/0,57; high-0,22; 0,16/0,30). It was also associated with HRQoL, but differentially for PCS (those with intermediate scores have less probability of not answering OR: 0.73; 95% CI: 0.61/0.88) than for the MCS (the persons in the highest tertile were more likely to not answering 1.47; 1.22/1.78. CONCLUSION: the HRQoL influences the non- response to the postal surveys, leading to an overrepresentation of individuals with middle physical health and low mental health, which it adds small magnitude bias in the estimation of population HRQoL.

Sesgo de respuesta en una encuesta postal poblacional sobre calidad de vida relacionada con la salud (SF-12v2) / Response bias in population postal survey on helath-relate quality of life (sf-12v2)

Fundamentos: en las investigaciones que utilizan un cuestionario como fuente de información el sesgo asociado a la baja tasa de respuesta puede limitar la ventaja económica de las encuestas poblacionales por correo postal. El objetivo fue estimar los factores asociados a la no respuesta con énfasis en la Calidad de Vida Relacionada con la Salud (CVRS). Métodos: a las personas que respondieron a la Encuesta de Salud de Murcia-2007 (≥ 18 años), realizada vía telefónica, se les remitió cuatro meses después un segundo cuestionario por vía postal. Ambas evaluaciones incluían información sobre CVRS: SF-12v2 (telefónica) y EQ-5D (postal). Se realizó una regresión logística para identificar los factores basales (sociodemográficos, conductas relacionadas con la salud y CVRS - sumario físico (CSF) y sumario mental (CSM) del SF-12v2) asociados a la no respuesta postal. Resultados: 2.078 (61,5%) individuos no respondieron. Análisis multivariante: la no respuesta se asoció con el estado civil, mayor probabilidad de no responder si no estaba casado (viudo OR: 2,24; IC95% 0,61/0,88; separado/divorciado1,69;1,10/2,59; soltero 1,53;1,23/1,90) y de manera inversa con la edad (25-34 años OR:0,95;IC95% 0,69/1,29; 35-44 años 0,60; 0,43/0,85; 45-54 años 0,42; 0,29/0,60; 55-64 años-0,29; 0,20/0,43; 65-74 años 0,17; 0,11/0,26; ≥75 años 0,15; 0,09/0,23) y el nivel de estudios (primarios OR: 0,65; IC95% 0,48/0,86; secundarios 0,41; 0,30/0,57; superiores 0,22; 0,16/0,30). También se asoció con la CVRS pero de manera diferenciada para el CSF: las personas con puntuaciones intermedias presentaron menor probabilidad de no responder (OR: 0,73; IC95% 0,61/0,88) que para el CSM: las personas del tercil superior presentaron mayor probabilidad de no responder (OR: 1,47; 1,22/1,78). Conclusiones: la CVRS influye en la no respuesta de las encuestas postales, dando lugar a una sobrerrepresentación de los individuos con salud física media y con salud mental baja, lo que introduce sesgos de pequeña magnitud en la etimación de la CVRS poblacional (AU)

Background : the bias associated with the low response rate may limit the economic advantage of population surveys by mail. The factors asso- ciated with non-response were estimated with an emphasis on Health- Related Quality of Life (HRQoL). Methods: people who had answered to the Health Survey Murcia- 2007 2007 (≥ 18 years), realized by telephone, were sent another postal questionnaire four months later. Both evaluations included information about HRQoL: SF-12v2 (by phone) and EQ-5D (postal). A logistic regression was realized to identify baseline factors (sociodemographic factors, health-related behaviors and HRQoL-physical component summary (PCS) and mental component summary (MCS) of the SF-12v2) associated withRneosnu-rltess:po2n,0se78toitnhdeivpoidsutaallssu(r6v1ey.5. %) did not answer. Multivariate analysis: non-response was associated with marital status, more likely not to respond if it was not married: widower OR: 2,24; IC95% 0,61/0,88; separate/divorced 1,69; 1,10/2,59-; single 1,53; 1,23/1,90 ) and inversely with age (25-34 years OR: 0,95; IC95% 0,69/1,29; 35-44 years 0,60; 0,43/0,85; 45-54 years 0,42; 0,29/0,60; 55-64 years 0,29; 0,20/0,43; 65-74 years 0,17; 0,11/0,26-; ≥75 years 0,15; 0,09/0,23) and educational level (low-OR: 0,65; IC95% 0,48/0,86; intermediate 0,41; 0,30/0,57; high-0,22; 0,16/0,30). It was also associated with HRQoL, but differentially for PCS (those with intermediate scores have less probability of not answering OR: 0.73; 95% CI: 0.61/0.88) than for the MCS (the persons in the highest ter-tile were more likely to not answering 1.47; 1.22/1.78. Conclusion: the HRQoL influences the non- response to the postal surveys, leading to an overrepresentation of individuals with middle physical health and low mental health, wich it adds small magnitude bias in the estimation of population HRQoL (AU)

Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010 / Evolution of the Use of Noninvasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease in a Spanish Region, 1997-2010

Introducción: La ventilación mecánica no invasiva (VMNI) aparece, en los 80, como alternativa a la ventilación mecánica invasiva (VMI) en pacientes con fracaso respiratorio agudo. Se pretende valorar la introducción de la VMNI y los resultados sobre los pacientes hospitalizados por agudización de enfermedad pulmonar obstructiva crónica en la Región de Murcia. Sujetos y métodos: Estudio observacional retrospectivo basado en el conjunto mínimo básico de datos al alta hospitalaria de todos los pacientes hospitalizados en todos los hospitales públicos de la región entre 1997-2010. Se realizó análisis de tendencias temporales en la frecuentación hospitalaria, el uso de cada intervención ventilatoria y la mortalidad hospitalaria mediante regresión joinpoint. Resultados: En los 14 años estudiados se identificaron 30.027 casos. Análisis joinpoint: tendencia descendente de la frecuentación (porcentaje de cambio anual [PCA] = −3,4; IC95%: 4,8; -2,0; p < 0,05) y en el grupo sin intervención ventilatoria (PCA = −4,2; −5,6;−2,8; p < 0,05), ascendente en el uso de VMNI (PCA = 16,4; 12,0;20,9; p < 0,05); el uso de la VMI presenta una tendencia descendente sin significación estadística (PCA = −4,5; −10,3;1,7). Se aprecia una tendencia ascendente sin significación estadística en la mortalidad global (PCA = 0,5; −1,3;2,4) y en el grupo sin intervención (PCA = 0,1; −1,6;1,9); decreciente con significación estadística en el grupo VMNI (PCA = −7,1; −11,7;−2,2; p < 0,05) y sin significación estadística en el grupo VMI (PCA = −0,8; −6,1;4,8). La estancia media no varía sustancialmente. Conclusiones: La introducción de la VMNI ha hecho disminuir el grupo de pacientes que no reciben ventilación asistida. No se aprecia mejora de los resultados en términos de mortalidad o estancia media global (AU)

Introduction: Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). Subjects and methods: A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through JoinPoint regression. Results: We identified 30 027 hospital discharges. JoinPoint analysis: downward trend in attendance (annual percentage change [APC]=−3.4, 95% CI : −4.8 to −2.0, P<0.05) and in the group without ventilatory intervention (APC=−4.2%, −5.6 to −2.8, P<0.05); upward trend in the use of NIV (APC=16.4, 12.0–20.9, P<0.05), and downward trend that was not statistically significant in IMV (APC=−4.5%, −10.3 to 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, −1.3 to 2.4) and in the group without intervention (APC=0.1, −1.6 to 1.9); downward trend with statistical significance in the NIV group (APC=−7.1, −11.7 to −2.2, P<0.05) and not statistically significant in the IMV group (APC=−0.8, −6, 1–4.8). The mean stay did not change substantially. Conclusions: The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay (AU)

Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmonary disease in a Spanish region, 1997-2010.

INTRODUCTION: Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). SUBJECTS AND METHODS: A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression. RESULTS: We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC]=-3.4, 95% CI: - 4.8; -2.0, P <.05) and in the group without ventilatory intervention (APC=-4.2%, -5.6; -2.8, P <.05); upward trend in the use of NIV (APC=16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC=-4.5%, -10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, -1.3; 2.4) and in the group without intervention (APC=0.1, -1.6; 1.9); downward trend with statistical significance in the NIV group (APC=-7.1, -11.7; -2.2, P <.05) and not statistically significant in the IMV group (APC=-0,8, -6, 1; 4.8). The mean stay did not change substantially. CONCLUSIONS: The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.

Normas poblacionales de referencia de la versión española del SF-12V2para la Región de Murcia / Population based norms of the Spanish version of the SF-12V2 for Murcia (Spain)

Objetivo: Los cuestionarios de salud percibida proporcionan información sobre resultados de salud. Lavaloración de su impacto requiere disponer de valores de referencia. En la población espa˜ nola, los estudiosprevios los han proporcionado para el SF-12v1. El objetivo fue obtener, para la versión espa˜nola delSF-12v2, las normas poblacionales de referencia de la Región de Murcia.Métodos: Estudio transversal con encuesta telefónica a 3.486 personas no institucionalizadas de 18 a˜nos omás de edad, de la Región de Murcia. Se calcularon medidas de tendencia central, dispersión y percentilesde las dimensiones, y componentes sumario físico y mental (CSF y CSM) del SF-12v2. Para la evaluaciónde constructo se compararon diferencias de medias en grupos conocidos (prueba t de Student o ANOVA).Resultados: Participaron en el estudio 3.381 sujetos. El 50,5% eran hombres, con una media de 43,6a˜nos de edad, y de 46,0 en las mujeres. El CSF medio fue 48,6 (±10,6) y el CSM fue 53,6 (±10,7), y estaspuntuaciones fueron superiores (mejores) en los hombres, los grupos de edad más joven, las personas conestudios superiores y aquellas sin ninguna condición médica crónica (p=0,000). Los hombres presentaronmejores puntuaciones que las mujeres en la mayoría de las dimensiones y componentes sumario. Ladimensión peor valorada por hombres y mujeres fue la salud general y el CSF.Conclusiones: Estos resultados, aunque deben considerarse como normas poblacionales de referencia dela versión espa˜nola del SF-12v2 para la Región de Murcia, pueden ser utilizados por poblaciones similaresa la hora de establecer objetivos de salud (AU)

Objective: Questionnaires on perceived health provide information on health results. Reference valuesare needed to assess these results. Previous studies have provided Spanish population-based norms forthe SF-12v1. The aim of this study was to obtain the population-based norms for the Spanish version ofthe SF-12v2 for Murcia.Methods: A cross-sectional telephone survey was carried out in 3,486 community-dwelling personsaged over 18 years old in the region of Murcia. The central tendency, dispersion and percentiles werecalculated for each of the eight scales and the physical and mental summary components (PCS and MCS) ofthe SF-12v2. Known groups were compared to evaluate construct validity (Student’s t-test and ANOVA).Results: A total of 3, 381 persons took part in the study (50.5% men). The mean age was 43.6 years in menand 46.0 in women. The mean PSC was 48.6 (±10.6) and the mean MCS was 53.6 (±10.7). These scoreswere higher (more favorable) in men, the youngest age groups, in persons with higher education and inthose no chronic illnesses (p=0.000). In all the dimensions and summary components, men had betterscores than women. The dimension with the worst score in both men and women was general healthand the PCS.Conclusions: These results should be considered as the population-based norms for the Spanish versionof the SF-12v2 for Murcia but may also be useful to establish health aims in similar populations (AU)

[Population based norms of the Spanish version of the SF-12V2 for Murcia (Spain)]. / Normas poblacionales de referencia de la versión española del SF-12V2 para la Región de Murcia.

OBJECTIVE: Questionnaires on perceived health provide information on health results. Reference values are needed to assess these results. Previous studies have provided Spanish population-based norms for the SF-12v1. The aim of this study was to obtain the population-based norms for the Spanish version of the SF-12v2 for Murcia. METHODS: A cross-sectional telephone survey was carried out in 3,486 community-dwelling persons aged over 18 years old in the region of Murcia. The central tendency, dispersion and percentiles were calculated for each of the eight scales and the physical and mental summary components (PCS and MCS) of the SF-12v2. Known groups were compared to evaluate construct validity (Student's t-test and ANOVA). RESULTS: A total of 3, 381 persons took part in the study (50.5% men). The mean age was 43.6 years in men and 46.0 in women. The mean PSC was 48.6 (± 10.6) and the mean MCS was 53.6 (± 10.7). These scores were higher (more favorable) in men, the youngest age groups, in persons with higher education and in those no chronic illnesses (p=0.000). In all the dimensions and summary components, men had better scores than women. The dimension with the worst score in both men and women was general health and the PCS. CONCLUSIONS: These results should be considered as the population-based norms for the Spanish version of the SF-12v2 for Murcia but may also be useful to establish health aims in similar populations.

Implicación de la comorbilidad y la calidad de vida relacionada con la salud en la hospitalización de pacientes diabéticos / Comorbidity and health related quality of life implication in hospitalisation of diabetic patients

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Valores de referencia de la población diabética para la versión española del SF-12v2 / Reference values of the Spanish version of the SF-12v2 for the diabetic population

ObjetivoLos cuestionarios de salud percibida son instrumentos que proporcionan información importante para la investigación en resultados de salud. La familia de cuestionarios SF requiere valores de referencia para interpretar el impacto en calidad de vida relacionada con la salud. Estudios previos han proporcionado estos valores para la población general española, pero no para condiciones específicas de enfermedad. El objetivo de este trabajo ha sido obtener, para la versión española del SF-12v2, los valores de referencia de la población diabética de la Región de Murcia.MétodosEstudio transversal con encuesta telefónica a 1.500 personas representativas de los diabéticos tipo 1 y 2, no institucionalizados, de 18 años y más, de la Región de Murcia. Se calcularon medidas de tendencia central, dispersión y percentiles de las ocho dimensiones, e índices resumen (físico y mental), del SF-12v2.ResultadosEl índice de salud mental (ISM) medio (50,5±12,8) fue superior al físico (ISF) (42,5±11,8). En función del sexo, los hombres obtuvieron un ISM (53,6±11,6) y un ISF (44,9±11,2) mejores que las mujeres (ISM: 47,7±13,2; ISF: 40,3±11,9). La dimensión mejor valorada fue la vitalidad (hombres: 57,2±11,1; mujeres: 51,9±12,1), y la peor la salud general (hombres: 39,0±9,7; mujeres: 35,8±10,0). Estratificando por grupos de edad, los hombres seguían presentando mejores puntuaciones que las mujeres.ConclusionesEstos resultados deben ser considerados como valores de referencia de la población diabética de la Región de Murcia de la versión española del SF-12v2, y pueden ser útiles para establecer objetivos terapéuticos, comparar con población general, sana y con otras enfermedades(AU)

ObjectivePerceived health status questionnaires provide important information for health outcomes research. Reference measures are required to interpret the health-related quality of life questionnaires belonging to the short form (SF) health survey family. Previous studies have provided these reference measures for the Spanish general population, but not for specific disease conditions. The aim of the present study was to obtain diabetic population-based norms for the Spanish version of the 12-item short form health survey version II (SF-12v2) in the region of Murcia (Spain).MethodsWe performed a cross-sectional telephone survey in 1,500 non-institutionalized patients with type 1 or 2 diabetes, aged 18 years or older and representative of the region of Murcia. The central position, dispersion statistics and percentiles were calculated for each of the eight SF-12v2 scales and summary components (physical and mental).ResultsThe mental component summary (MCS) (mean: 50.5±12.8) was higher than the physical component summary (PCS) (42.5±11.8). By sex, men had more favorable MCS (53.6±11.6) and PCS (44.9±11.2) scores than women (MCS: 47.7±13.2; PCS: 40.3±11.9). The dimension with the highest score was vitality (men: 57.2±11.1; women: 51.9±12.1), while that with the lowest score was general health (men: 39.0±9.7; women: 35.8±10.0). When the groups were stratified by age, scores continued to be higher in men than in women.ConclusionsThe results of the present study should be taken as the diabetic population-based norms for the Spanish version of the SF-12v2 in the region of Murcia. These results may be useful to establish therapeutics targets, as well as for comparisons with the general, healthy and ill populations(AU)