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Sancho A.,International University of Catalonia | Albiol R.,International University of Catalonia | Albiol R.,Institute Catala Of La Salut Ics | MacH N.,International University of Catalonia | MacH N.,Animal Breeding and Genomics Center
Atencion Primaria | Year: 2012

Objective: The objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence, underlying diseases and the nutritional status. Scope: Patients in home care program in Primary Health Care. Patients: 100 home care patients. Main variables: age, sex, caregiver, illness, BMI, haemoglobin, haematocrit, lymphocyte count, albumin, cholesterol, Barthel index, Pfeiffer, nutritional assessment (MNA) and Braden scale. Results: Fourteen percent of the ATDOM patients had malnutrition and 46% a high risk of malnutrition. The degree of dependency, and the level of cognitive impairment increased (P < 001) the risk of pressure ulcers. Furthermore, the nutritional status affected the risk of pressure ulcers (P < 001) with OR 3.73 higher in malnourished patients. Values of 3.76 ± 0.05 g/dL albumin and cholesterol of 176.43 ± 6.38 were associated with an increased risk of ulceration. There was a significant relationship between nutritional status (P < 01) and the degree of dependence. In malnourished patients albumin levels decreased to 3.46 ± 0.098, with averages of 11.41 ± 154.95 mg/dL cholesterol. Finally, a lower BMI was significantly related to malnutrition. Conclusions: The present study demonstrates that 14 % of the ATDOM patients showed malnutrition, and 46 % a high risk of malnutrition. Malnutrition, the degree of physical dependence and severity of cognitive impairment is associated with an increased risk of ulceration, which justify the need for carrying out some personalised measurements on ATDOM patients. © 2012 Elsevier España, S.L. Todos los derechos reservados. Source

Azagra R.,Autonomous University of Barcelona | Azagra R.,International University of Catalonia | Roca G.,Autonomous University of Barcelona | Martin-Sanchez J.C.,International University of Catalonia | And 6 more authors.
Medicina Clinica | Year: 2015

Background and objective To detect FRAX® threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment.Patients and methods This is a cohort study. Eight hundred and sixteen women 40-90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low < 10%, 10-20% intermediate and high > 20%) according to the real fracture incidence.Results The thresholds of FRAX® baseline for major osteoporotic fracture were: low risk < 5; intermediate ≥ 5 to < 7.5 and high ≥ 7.5. The incidence of fracture with these values was: low risk (3.6%; 95% CI 2.2-5.9), intermediate risk (13.7%; 95% CI 7.1-24.2) and high risk (21.4%; 95% CI12.9-33.2). The most cost-effective option was to refer to dual energy X-ray absorptiometry (DXA-scan) for FRAX® ≥ 5 (Intermediate and high risk) to reclassify by FRAX® with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX®, compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures.Conclusions The use of FRAX ® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score ≤ -2.5 of DXA scan. © 2013 Elsevier España, S.L.U. All rights reserved. Source

Fernandez P.,Institute Catala Of La Salut Ics | Llopis M.A.,Laboratori Clinic Barcelones Nord i Valles Oriental | Perich C.,Laboratori Clinic Bon Pastor | Alsina M.J.,Laboratori Clinic Barcelones Nord i Valles Oriental | And 13 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2014

Background: Hemolysis is the main cause of non-quality samples in clinical laboratories, producing the highest percentage of rejections in the external assurance programs of preanalytical quality. The objective was to: 1) study the agreement between the detection methods and quantification of hemolysis; 2) establish comparable hemolysis interference limits for a series of tests and analytical methods; and 3) study the preanalytical variables which most influence hemolysis production.Methods: Different hemoglobin concentration standards were prepared using the reference method. Agreement was studied between automated methods [hemolytic indexes (HI)] and reference method, as well as the interference according to hemolysis degree in various biochemical tests was measured. Preanalytical variables which could influence hemolysis production were studied: type of extraction, type of tubes, transport time, temperature and centrifugation conditions.Results: Good agreement was obtained between hemoglobin concentrations measured using the reference method and HI, for the most of studied analyzers, particularly those giving quantitative HI. The hemolysis interference cut-off points obtained for the majority of tests studied (except LDH, K) are dependent on the method/analyzer utilized. Furthermore, discrepancies have been observed between interference limits recommended by the manufacturer. The preanalytical variables which produce a lower percentage of hemolysis rejections were: centrifugation at the extraction site, the use of lower volume tubes and a transport time under 15 min at room temperature.Conclusions: The setting of interference limits (cut-off) for each used test/method, and the study of preanalytical variability will assist to the results harmonization for this quality indicator. Source

Cantera C.M.,Institute Universitari nvestigacio en Atencio Primaria Jordi Gol Jordi Gol | Cantera C.M.,Institute Catala Of La Salut Ics | Cantera C.M.,Autonomous University of Barcelona | Puigdomenech E.,Institute Universitari nvestigacio en Atencio Primaria Jordi Gol Jordi Gol | And 8 more authors.
BMJ Open | Year: 2015

Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design: A systematic review of randomised and nonrandomised controlled trials was undertaken. Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-totreat analysis and results published in English/Spanish. Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results: Of 1147 references identified, 9 studies were selected (10 204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quitsmoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results. Source

Azagra R.,Autonomous University of Barcelona | Azagra R.,Health Center Badia del Valles | Azagra R.,International University of Catalonia | Lopez-Exposito F.,Autonomous University of Barcelona | And 10 more authors.
Osteoporosis International | Year: 2014

Summary: Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. Introduction: The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. Methods: Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). Results: There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3 %/year in men and 1.4 % in women. After adjustment, the rate increased an average of 0.4 %/year in men (p<0.0001), but decreased 0.2 %/year in women (p<0.0001). In men, younger than 85, the decrease was not significant except in 70-74 years, and from 80 years, the adjusted rate increases significantly (p<0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80-84 years, and the adjusted rate increased significantly in individuals 85 years and older (p<0.0001). Mortality rates declined by 22 % in both sexes, and the index of overaging population rises 30.1 % in men and 25.2 % in women. Conclusions: This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation. Source

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