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Gasteiz / Vitoria, Spain

Zubero M.B.,Cruces University Hospital | Arana-Arri E.,Cruces University Hospital | Arana-Arri E.,Biocruces Health Research Institute | Pijoan J.I.,Cruces University Hospital | And 10 more authors.
Frontiers in Pharmacology

Background: The aim of screening for colorectal cancer is to improve prognosis by the detection of cancer at its early stages. In order to inform the decision on the specific test to be used in the population-based program in the Basque Autonomous Region (Spain), we compared two immunochemical fecal occult blood quantitative tests (I-FOBT). Methods:Residents of selected study areas, aged 50-69 years, were invited to participate in the screening. Two tests based on latex agglutination (OC-Sensor and FOB Gold) were randomly assigned to different study areas. A colonoscopy was offered to patients with a positive test result. The cut-off point used to classify a result as positive, according to manufacturer's recommendations, was 100 ng/ml for both tests. Results: The invited population included 37,999 individuals. Participation rates were 61.8% (n = 11,162) for OC-Sensor and 59.1% (n = 11,786) for FOB Gold (p = 0.008). Positive rate for OC-Sensor was 6.6% (n = 737) and 8.5% (n = 1,002) for FOB Gold (p < 0.0001). Error rates were higher for FOB gold (2.3%) than for OC-Sensor (0.2%; p < 0.0001). Predictive positive value (PPV) for total malignant and premalignant lesions was 62.4% for OC-Sensor and 58.9% for FOB Gold (p = 0.137), respectively. Conclusion: OC-Sensor test appears to be superior for I-FOBT-based colorectal cancer screening, given its acceptance, ease of use, associated small number of errors and its screening accuracy. FOB Gold on the other hand, has higher rate of positive values, with more colonoscopies performed, it shows higher detection incidence rates, but involves more false positives. © 2014 Zubero, Arana-Arri, Pijoan, Portillo, Idigoras, López-Urrutia, Samper, Uranga, Rodríguez and Bujanda. Source

Cristobal I.,La Zarzuela Hospital | Cristobal I.,Francisco de Vitoria University | Neyro J.-L.,Cruces University Hospital | Lete I.,Araba University Hospital | Lete I.,University of the Basque Country
European Journal of Obstetrics Gynecology and Reproductive Biology

Unintended pregnancies still remain a worldwide public health problem. They have received much attention in adolescents given the strong impact they have on their present and future lives. Young women wishing to delay maternity are also especially vulnerable to unintended pregnancies. Studies have revealed a pattern of use of contraceptive methods that is likely to increase this risk. Methods of long-acting reversible contraception (LARC), among which copper and levonorgestrel-releasing intrauterine devices (IUD and IUS) are the most common, have been widely recommended to avoid unintended pregnancy at any age. Despite this, the use of these devices is very limited. Several barriers to their wide spread use have been identified, which specially affect a higher use by nulliparous women. A new levonorgestrel-releasing IUS containing only 13.5 mg of levonorgestrel (IUS12) recently marketed as Jaydess® in Europe, has a smaller size, provides a shorter duration of action, and a lower hormonal content compared to Mirena®, along with a similar efficacy and safety profile, may offer a long-term option that better addresses the needs of nulliparous women. Evidence on the risk of unintended pregnancies in young women - with a special emphasis in Europe, barriers associated with a lower-than-desirable use of LARC methods - especially intrauterine devices (IUD and IUS), and the potential benefits of the new IUS12 including changes in bleeding pattern, safety and user satisfaction - especially with respect to nulliparous and adolescents - are reviewed here. Evidence supports that IUS12 may offer a LARC option that better addresses the needs of these women. © 2015 Elsevier Ireland Ltd. All rights reserved. Source

Barbe F.,Hosp Universitari Arnau Of Vilanova And Santa Maria | Barbe F.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | Sanchez-De-la-torre A.,Hosp Universitari Arnau Of Vilanova And Santa Maria | Sanchez-De-la-torre A.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | And 17 more authors.
European Respiratory Journal

The goal of this study was to evaluate the influence of obstructive sleep apnoea on the severity and short-term prognosis of patients admitted for acute coronary syndrome. Obstructive sleep apnoea was defined as an apnoea-hypopnoea index (AHI) >15 h-1. We evaluated the acute coronary syndrome severity (ejection fraction, Killip class, number of diseased vessels, and plasma peak troponin) and short-term prognosis (length of hospitalisation, complications and mortality). We included 213 patients with obstructive sleep apnoea (mean±SD AHI 30±14 h-1, 61±10 years, 80% males) and 218 controls (AHI 6±4 h-1, 57±12 years, 82% males). Patients with obstructive sleep apnoea exhibited a higher prevalence of systemic hypertension (55% versus 37%, p<0.001), higher body mass index (29±4 kg·m-2 versus 26±4 kg·m-2, p<0.001), and lower percentage of smokers (61% versus 71%, p=0.04). After adjusting for smoking, age, body mass index and hypertension, the plasma peak troponin levels were significantly elevated in the obstructive sleep apnoea group (831±908 ng·L-1 versus 987±884 ng·L-1, p=0.03) and higher AHI severity was associated with an increased number of diseased vessels (p=0.04). The mean length of stay in the coronary care unit was higher in the obstructive sleep apnoea group (p=0.03). This study indicates that obstructive sleep apnoea is related to an increase in the peak plasma troponin levels, number of diseased vessels, and length of stay in the coronary care unit. Copyright © ERS 2015. Source

Sanchez-De-La-Torre M.,University of Santa Maria in Ecuador | Sanchez-De-La-Torre M.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | Nadal N.,University of Santa Maria in Ecuador | Nadal N.,Primary Care Unit of Lleida | And 19 more authors.

Objective To evaluate whether follow-up of patients with obstructive sleep apnoea (OSA) undergoing CPAP treatment could be performed in primary care (PC) settings. Design Non-inferiority, randomised, prospective controlled study. Settings Sleep unit (SU) at the University Hospital and in 8 PC units in Lleida, Spain. Participants Patients with OSA were randomised to be followed up at the SU or PC units over a 6-month period. Main outcomes measured The primary outcome was CPAP compliance at 6 months. The secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, body mass index (BMI), blood pressure and cost-effectiveness. Results We included 101 patients in PC ((mean±SD) apnoea-hypopnoea index (AHI) 50.8±22.9/h, age 56.2 ±11 years, 74% male) and 109 in the SU (AHI 51.4 ±24.4/h, age 55.8±11 years, 77% male)). The CPAP compliance was (mean (95% CI) 4.94 (4.47 to 5.5) vs 5.23 (4.79 to 5.66) h, p=0.18) in PC and SU groups, respectively. In the SU group, there were greater improvements in ESS scores (mean change 1.79, 95% CI +0.05 to +3.53, p=0.04) and patient satisfaction (-1.49, 95% CI -2.22 to -0.76); there was a significant mean difference in BMI between the groups (0.57, 95% CI +0.01 to +1.13, p=0.04). In the PC setting, there was a cost saving of 60%, with similar effectiveness, as well as a decrease in systolic blood pressure (-5.32; 95% CI -10.91 to +0.28, p=0.06). Conclusions For patients with OSA, treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative. Source

Reviriego E.,Researcher | Cidoncha M.A.,Basque Health Service Osakidetza | Asua J.,Head of Basque Office for Health Technology Assessment | Gagnon M.P.,Laval University | And 3 more authors.
BMC Medical Education

Background: Research is an essential activity for improving quality and efficiency in healthcare. The objective of this study was to train nurses from the public Basque Health Service (Osakidetza) in critical appraisal, promoting continuous training and the use of research in clinical practice. Methods. This was a prospective pre-post test study. The InfoCritique course on critical appraisal was translated and adapted. A sample of 50 nurses and 3 tutors was recruited. Educational strategies and assessment instruments were established for the course. A course website was created that contained contact details of the teaching team and coordinator, as well as a course handbook and videos introducing the course. Assessment comprised the administration of questionnaires before and after the course, in order to explore the main intervention outcomes: knowledge acquired and self-learning readiness. Satisfaction was also measured at the end of the course. Results: Of the 50 health professionals recruited, 3 did not complete the course for personal or work-related reasons. The mean score on the pre-course knowledge questionnaire was 70.5 out of 100, with a standard deviation of 11.96. In general, participants' performance on the knowledge questionnaire improved after the course, as reflected in the notable increase of the mean score, to 86.6, with a standard deviation of 10.00. Further, analyses confirmed statistically significant differences between pre- and post-course results (p < 0.001). With regard to self-learning readiness, after the course, participants reported a greater readiness and ability for self-directed learning. Lastly, in terms of level of satisfaction with the course, the mean score was 7 out of 10. Conclusions: Participants significantly improved their knowledge score and self-directed learning readiness after the educational intervention, and they were overall satisfied with the course. For the health system and nursing professionals, this type of course has the potential to provide methodological tools for research, promote a research culture, and encourage critical thinking for evidence-based decision making. © 2014 Reviriego et al.; licensee BioMed Central Ltd. Source

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