Population Older than 69 Had Similar Fatality Rates Independently If They Were Admitted in Nursing Homes or Lived in the Community: A Retrospective Observational Study during COVID-19 First Wave.

The aim of this study is to assess the influence of living in nursing homes on COVID-19-related mortality, and to calculate the real specific mortality rate caused by COVID-19 among people older than 20 years of age in the Balaguer Primary Care Centre Health Area during the first wave of the pandemic. We conducted an observational study based on a database generated between March and May 2020, analysing COVID-19-related mortality as a dependent variable, and including different independent variables, such as living in a nursing home or in the community (outside nursing homes), age, sex, symptoms, pre-existing conditions, and hospital admission. To evaluate the associations between the independent variables and mortality, we calculated the absolute and relative frequencies, and performed a chi-square test. To avoid the impact of the age variable on mortality and to assess the influence of the "living in a nursing home" variable, we established comparisons between infected population groups over 69 years of age (in nursing homes and outside nursing homes). Living in a nursing home was associated with a higher incidence of COVID-19 infection, but not with higher mortality in patients over 69 years of age (p = 0.614). The real specific mortality rate caused by COVID-19 was 2.270/00. In the study of the entire sample, all the comorbidities studied were associated with higher mortality; however, the comorbidities were not associated with higher mortality in the infected nursing home patients group, nor in the infected community patients over 69 years of age group (except for neoplasm history in this last group). Finally, hospital admission was not associated with lower mortality in nursing home patients, nor in community patients over 69 years of age.

Ultrasound in primary care: Consensus recommendations on its applications and training. Results of a 3-round Delphi study.

BACKGROUND: The introduction of portable and pocket ultrasound scanners has potentiated the use of ultrasound in primary care, whose many applications have been studied, analyzed and collected in the literature. However, its use is heterogeneous in Europe and there is a lack of guidelines on the necessary training and skills. OBJECTIVES: To identify the fundamental applications and indications of ultrasound for family physicians, the necessary knowledge and skills, and the definition of a framework of academic and pragmatic training for the development of these competencies. METHODS: A modified 3-round Delphi study was carried out in Catalonia, with the participation of 65 family physicians experts in ultrasound. The study was carried out over six months (from September 2020 to February 2021). The indications of ultrasound for family physicians were agreed (the > = 75th percentile was considered) and prioritised, as was the necessary training plan. RESULTS: The ultrasound applications in primary care were classified into seven main categories. For each application, the main indications (according to reason for consultation) in primary care were specified. A progressive training plan was developed, characterised by five levels of competence: A (principles of ultrasound and management of ultrasound scanners); B (basic normal ultrasound anatomy); C (advanced normal ultrasound anatomy); D (pathologic ultrasound, description of pathological images and diagnostic orientation); E (practical skills under conditions of routine clinical practice). CONCLUSION: Training family physicians in ultrasound may consider seven main applications and indications. The proposed training plan establishes five different levels of competencies until skill in real clinical practice is achieved.

Enhancing Night and Day Circadian Contrast through Sleep Education in Prediabetes and Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

BACKGROUND: Evidence supports a causal relationship between circadian disturbance and impaired glucose homeostasis. METHODS: To determine the effect of an educational intervention delivered by primary care nurses to improve sleep hygiene, a parallel, open-label clinical trial in subjects aged 18 and older with impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM) was performed. Study variables were sex, age, fasting glucose, glycated haemoglobin A1c (HbA1c), Pittsburgh Sleep Quality Index (PSQI), sleep duration and efficiency, body mass index, antidiabetic treatment, diet and physical exercise. An individual informative educational intervention was carried out following a bidirectional feedback method. The intervention aimed to develop skills to improve sleep through nine simple tips. An analysis of covariance was performed on all the mean centred outcome variables controlling for the respective baseline scores. RESULTS: In the intervention group, PSQI dropped, the duration and quality of sleep increased, and a decrease in fasting glucose and in HbA1c levels was observed. CONCLUSION: The proposed intervention is effective for improving sleep quality, length and efficiency, and for decreasing fasting glucose and HbA1c levels in only 3 months. These findings support the importance of sleep and circadian rhythm education focused on improving IFG and T2DM.

The Risk of Hospitalization in COVID-19 Patients Can Be Predicted by Lung Ultrasound in Primary Care.

BACKGROUND: The usefulness of Lung Ultrasound (LUS) for the diagnosis of interstitial syndrome caused by COVID-19 has been broadly described. The aim of this study was to evaluate if LUS may predict the complications (hospital admission) of COVID-19 pneumonia in primary care patients. METHODS: This observational study collects data from a cohort of 279 patients with clinical symptoms of COVID-19 pneumonia who attended the Balaguer Primary Health Care Area between 16 March 2020 and 30 September 2020. We collected the results of LUS scans reported by one general practitioner. We created a database and analysed the absolute and relative frequencies of LUS findings and their association with hospital admission. We found that different LUS patterns (diffuse, attenuated diffuse, and predominantly unilateral) were risk factors for hospital admission (p < 0.05). Additionally, an evolutionary pattern during the acute phase represented a risk factor (p = 0.0019). On the contrary, a normal ultrasound pattern was a protective factor (p = 0.0037). Finally, the presence of focal interstitial pattern was not associated with hospital admission (p = 0.4918). CONCLUSION: The lung ultrasound was useful to predict complications in COVID-19 pneumonia and to diagnose other lung diseases such as cancer, tuberculosis, pulmonary embolism, chronic interstitial pneumopathy, pleuropericarditis, pneumonia or heart failure.

Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia.

BACKGROUND: The COVID-19 pandemic rapidly strained healthcare systems worldwide. The reference standard for diagnosis is a positive reverse transcription polymerase chain reaction (RT-PCR) test, but results are not immediate and sensibility is variable. AIM: To evaluate the diagnostic accuracy of lung ultrasound compared to chest X-ray for COVID-19 pneumonia. DESIGN AND SETTING: A retrospective analysis of symptomatic patients admitted into one primary care centre in Spain between March and September 2020. METHOD: Patients' chest X-rays and lung ultrasounds were categorized as normal or pathologic. RT-PCR confirmed COVID-19 infection. Pathologic lung ultrasound images were further categorized as showing either local or diffuse interstitial disease. McNemar and Fisher tests were used to compare diagnostic accuracy. RESULTS: Most of the 212 patients presented fever at admission, either as a standalone symptom (37.74% of patients) or together with others (72.17% of patients). The positive predictive value of the lung ultrasound was 90% for the diffuse interstitial pattern and 46.92% for local pattern. The lung ultrasound had a significantly higher sensitivity (82.75%) (p < 0.001), but lower specificity (71%) than the chest X-ray (54.02% and 86%, respectively) (p = 0.008) for identifying interstitial lung disease. Moreover, sensitivity of the lung ultrasound for severe interstitial disease was 100%, and was significantly higher than the chest X-ray (58.33%) (p = 0.002). CONCLUSION: The lung ultrasound is more accurate than the chest X-ray for identifying patients with COVID-19 pneumonia and it is especially useful for those presenting diffuse interstitial disease.

Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias / Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency

La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest

El ritmo circadiano de la presión arterial y su relación con los factores de riesgo cardiovascular / Circadian rhytm of blood pressure and the relation to cardiovascular risk factors

Introducción: Numerosos estudios han establecido tanto la hipertensión arterial como la hipertensión de bata blanca como factores de riesgo cardiovascular. Un ritmo circadiano anómalo de la presión arterial podría aumentar el riesgo cardiovascular. Objetivo: Determinar la existencia de una relación clínicamente relevante entre un ritmo circadiano anómalo de la presión arterial y un incremento del riesgo cardiovascular en pacientes con hipertensión arterial o hipertensión de bata blanca. Material y Método: Estudio descriptivo en 166 pacientes mayores de 18 años del Área Básica de Salud de Balaguer que tuvieran una monitorización ambulatoria de la presión arterial realizada entre junio de 2014 y marzo de 2018 y cumplieran los criterios de inclusión y exclusión. Se realizó un análisis univariado y bivariado de las variables. Resultados: Se obtuvo que en casi todos los promedios de presión arterial nocturna destaca el patrón riser mostrando que el 25% tenía un riesgo cardiovascular mayor o igual al 10%, seguido del dipper extremo 16,67%, dipper 9,4% y no dipper 8,27%. Conclusión: Un ritmo circadiano alterado se relaciona con un riesgo cardiovascular más elevado y un peor control de los factores que conllevan al mismo

Introduction: Numerous studies have established both arterial hypertension and white coat hypertension as cardiovascular risk factors. An abnormal circadian rhythm of blood pressure may increase cardiovascular risk. Objective: To determine the existence of a clinically relevant relationship between an abnormal circadian rhythm of blood pressure and an increase in cardiovascular risk in patients with hypertension or white coat hypertension. Methods: A descriptive study in 166 patients older than 18 years was carried out. Patients were from the Basic Health Area of Balaguer, who had an ambulatory blood pressure monitoring, conducted between June 2014 and March 2018 and met the inclusion and exclusion criteria. Univariate and bivariate analyses of the variables were performed. Results: In almost all means nighttime blood pressure, the riser pattern stands out, showing that 25% had a cardiovascular risk greater than or equal to 10%, followed by extreme dippers 16.67%, dippers 9.4% and non-dippers 8.27%. Conclusion: An altered circadian rhythm is related to a higher cardiovascular risk and a worse control of the related factors

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. / Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias.

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest.

Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar / Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound

El médico de familia está incorporando la ecografía clínica como técnica de exploración y diagnóstico en su actividad asistencial, del mismo modo que el resto de los especialistas. Su papel generalista lo convierte en un potencial utilizador de todas las posibles aplicaciones de esta técnica, lo cual puede causar un elevado impacto en su capacidad de manejar, enfocar y resolver un gran número de situaciones clínicas. En este artículo nos dedicamos a valorar la utilidad y la efectividad de la ecografía clínica por parte del médico de familia en sus aspectos más novedosos, como son la ecocardiografía clínica y la ecografía pulmonar

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound]. / Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar.

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound.

Incidencia de la fractura de fémur en España (1997-2010) / Incidence of hip fracture in Spain (1997-2010)

Fundamento y objetivo: Analizar las diferencias en la incidencia de fractura de fémur en mayores de 65 años en las 17 comunidades autónomas (CC. AA.) del estado español en el período de 1997-2010. Material y métodos: Estudio ecológico, observacional y retrospectivo que incluye a las personas ≥ 65 años que han presentado una fractura del tercio proximal de fémur en España durante 14 años. Estos registros provienen del conjunto mínimo básico de datos de los pacientes atendidos en el conjunto de hospitales de España. Resultados: Se analizan 534.043 fracturas de fémur en personas ≥ 65 años (414.518 en mujeres y 119.525 en varones). En ≥ 75 años ocurrieron el 85,4% (86,7% en mujeres; 80,7% en varones). La tasa ajustada/100.000/año fue de 722,6 en mujeres y 284,8 en varones. Por encima de la media en mujeres hay 7 CC. AA., y destacan: Cataluña, Comunidad Valenciana y Castilla-La Mancha. Por debajo de la media hay 6 CC. AA., y destacan: Canarias y Galicia. La diferencia entre CC. AA. con mayor y menor tasa de fractura ajustada por población es un 44% menor en mujeres (Canarias frente a Castilla-La Mancha) y un 50% menor en varones (Galicia frente a Cataluña). Conclusiones: La incidencia de fractura de fémur en España en ≥ 65 años muestra una importante variabilidad entre CC. AA. y, por tanto, entre zonas geográficas. Excepto en Canarias, esta variabilidad es difícil de explicar solo por factores como la edad de la población, la exposición solar o el gradiente norte-sur. Son necesarios estudios que analicen las causas de estas importantes diferencias entre CC. AA. Españolas (AU)

Background and objective: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. Material and methods: Ecological, observational and retrospective study that includes people ≥ 65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. Results: The analysis include 534,043 hip fractures in ≥ 65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people ≥ 75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). Conclusions: The analysis of the incidence of hip fracture in Spain in people ≥ 65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC (AU)

[Incidence of hip fracture in Spain (1997-2010)]. / Incidencia de la fractura de fémur en España (1997-2010).

BACKGROUND AND OBJECTIVE: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. MATERIAL AND METHODS: Ecological, observational and retrospective study that includes people≥65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. RESULTS: The analysis include 534,043 hip fractures in≥65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people≥75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). CONCLUSIONS: The analysis of the incidence of hip fracture in Spain in people≥65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC.

FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort.

BACKGROUND: The WHO has recently published the FRAX® tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. METHODS/DESIGN: A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona) not receiving bone active drugs at baseline. Baseline measurements: known risk factors including those of FRAX® and a DXA. Follow up data on self-reported incident major fractures (hip, spine, humerus and wrist) and verified against patient records. The calculation of absolute risk of major fracture and hip fracture was by FRAX® website. This work follows the guidelines of the STROBE initiative for cohort studies. The discriminative capacity of FRAX® was analyzed by the Area Under Curve (AUC), Receiver Operating Characteristics (ROC) and the Hosmer-Lemeshow goodness-of-fit test. The predictive capacity was determined using the ratio of observed fractures/expected fractures by FRAX® (ObsFx/ExpFx). RESULTS: The study subjects were 770 women from 40 to 90 years of age in the FRIDEX cohort. The mean age was 56.8 ± 8 years. The fractures were determined by structured telephone questionnaire and subsequent testing in medical records at 10 years. Sixty-five (8.4%) women presented major fractures (17 hip fractures). Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA. The AUC ROC of FRAX® for major fracture without bone mineral density (BMD) was 0.693 (CI 95%; 0.622-0.763), with T-score of femoral neck (FN) 0.716 (CI 95%; 0.646-0.786), being 0.888 (CI 95%; 0.824-0.952) and 0.849 (CI 95%; 0.737-0.962), respectively for hip fracture. In the model with BMD alone was 0.661 (CI 95%; 0.583-0.739) and 0.779 (CI 95%; 0.631-0.929). In the model with age alone was 0.668 (CI 95%; 0.603-0.733) and 0.882 (CI 95%; 0.832-0.936). In both cases there are not significant differences against FRAX® model. The overall predictive value for major fracture by ObsFx/ExpFx ratio was 2.4 and 2.8 for hip fracture without BMD. With BMD was 2.2 and 2.3 respectively. Sensitivity of the four was always less than 50%. The Hosmer-Lemeshow test showed a good correlation only after calibration with ObsFx/ExpFx ratio. CONCLUSIONS: The current version of FRAX® for Spanish women without BMD analysed by the AUC ROC demonstrate a poor discriminative capacity to predict major fractures but a good discriminative capacity for hip fractures. Its predictive capacity does not adjust well because leading to underdiagnosis for both predictions major and hip fractures. Simple models based only on age or BMD alone similarly predicted that more complex FRAX® models.

Measuring health-related quality of life in men with osteoporosis or osteoporotic fracture.

BACKGROUND: Osteoporosis is a serious health problem that worsens the quality of life and the survival rate of individuals with this disease on account the osteoporotic fractures. Studies have long focused on women, and its presence in men has been underestimated. While many studies conducted in different countries mainly assess health-related quality of life and identify fracture risks factors in women, few data are available on a Spanish male population. METHODS/DESIGN: Observational study. STUDY POPULATION: Men ≥ 40 years of age with/without diagnosed osteoporosis and with/without osteoporotic fracture included by their family doctor. MEASUREMENTS: The relationship between customary clinical risk factors for osteoporotic fracture and health-related quality of life in a Spanish male population. A telephone questionnaire on health-related quality of life is made. STATISTICAL ANALYSIS: The association between qualitative variables will be assessed by the Chi-square test. The distribution of quantitative variables by Student's t-test. If the conditions for using this test are not met, the non-parametric Mann-Whitney's U test will be used.The validation of the results obtained by the FRAX™ tool will be performed by way of the Hosmer-Lemeshow test and by calculating the area under the Receiver Operating Characteristic (ROC) curve (AUC). All tests will be performed with a confidence intervals set at 95%. DISCUSSION: The applicability and usefulness of Health-related quality of life (HRQOL) studies are well documented in many countries. These studies allow implementing cost-effective measures in cases of a given disease and reducing the costly consequences derived therefrom. This study attempts to provide objective data on how quality of life is affected by the clinical aspects involved in osteoporosis in a Spanish male population and can be useful as well in cost utility analyses conducted by health authorities.The sample selected is not based on a high fracture risk group. Rather, it is composed of men in the general population, and accordingly comparisons should not lead to erroneous interpretations.A possible bias correction will be ensured by checking reported fractures against healthcare reports and X-rays, or by consulting health care centers as applicable.

Concordancia entre índices de dependencia en las actividades de la vida diaria. Experiencia de aplicación en población geriátrica de ámbito rural / Agreement between activities of daily living indexes. Experience of their application the geriatric population of a rural area

El envejecimiento comporta un incremento de la dependencia en la realización de las actividades de vida diaria y, por ello, un aumento de la necesidad de atención a largo plazo. El objetivo de este trabajo es conocer el grado de dependencia de las personas de 65 años o más de una área rural y comparar las escalas de valoración de las actividades de la vida diaria (AVD) de Katz y de Barthel. Realizamos un estudio observacional con una muestra de 195 individuos con historia clínica abierta en la ABS. Los resultados obtenidos fueron: a) el incremento de edad es directamente proporcional a la pérdida de función, y b) no hay diferencias significativas entre la valoración con el índice de Katz o con el de Barthel. Creemos en la necesidad de aplicar estas escalas a la población mayor de 65 años para identificar la dependencia y valorar el tipo de ayuda que requiere el anciano en las actividades de la vida diaria en concreto y prevenir las posibles complicaciones. (AU)