Abstract Background Evidence is lacking about the effectiveness of risk reduction interventions in patients with asymptomatic peripheral arterial disease. Objectives This study aimed to assess ...whether statin therapy was associated with a reduction in major adverse cardiovascular events (MACE) and mortality in this population. Methods Data were obtained from 2006 through 2013 from the Catalan primary care system’s clinical records database (SIDIAP). Patients age 35 to 85 years with an ankle-brachial index ≤0.95 and without clinically recognized cardiovascular disease (CVD) were included. Participants were categorized as statins nonusers or new-users (first prescription or represcribed after at least 6 months) and matched 1:1 by inclusion date and propensity score for statin treatment. Conditional Cox proportional hazards modeling was used to compare the groups for the incidence of MACE (myocardial infarction, cardiac revascularization, and ischemic stroke) and all-cause mortality. Results The matched-pair cohort included 5,480 patients (mean age 67 years; 44% women) treated/nontreated with statins. The 10-year coronary heart disease risk was low (median: 6.9%). Median follow-up was 3.6 years. Incidence of MACE was 19.7 and 24.7 events per 1,000 person-years in statin new-users and nonusers, respectively. Total mortality rates also differed: 24.8 versus 30.3 per 1,000 person-years, respectively. Hazards ratios were 0.80 for MACE and 0.81 for overall mortality. The 1-year number needed to treat was 200 for MACE and 239 for all-cause mortality. Conclusions Statin therapy was associated with a reduction in MACE and all-cause mortality among participants without clinical CVD but with asymptomatic peripheral arterial disease, regardless of its low CVD risk. The absolute reduction was comparable to that achieved in secondary prevention.
La empatía es la capacidad de transmitir comprensión hacia las emociones de otros individuos. La empatía de los profesionales sanitarios se ha asociado a mejores resultados clínicos y de relación con ...el paciente. El objetivo del estudio era conocer el nivel de empatía de los estudiantes de Medicina, y su evolución después de recibir un curso sobre Entrevista Clínica y Comunicación.
Estudio longitudinal prospectivo con intervención (módulo de Comunicación y Entrevista Clínica de un mes de duración) y sin grupo control. La empatía se midió con el cuestionario Índice de Reactividad Interpersonal (IRI) que tiene 2 dimensiones cognitivas (toma de perspectiva y fantasía) y 2 emocionales (preocupación empática y distrés personal). La empatía percibida se obtuvo mediante autoevaluación del 0 al 10.
Participaron 136 alumnos, un 72% eran mujeres, con una edad media de 20,3 años. La empatía percibida correlacionó con las dimensiones del IRI, excepto con distrés personal. Después de la intervención educativa se observaron incrementos en los hombres en toma de perspectiva (de 16,5 a 17,8; p = 0,005) y en las mujeres en fantasía (de 15,5 a 16,7; p = 0,001), con aumento en ambos sexos de la empatía percibida autoevaluada (de 6,9 a 7,4 en hombres; p = 0,009 y de 7,4 a 7,8 en mujeres; p < 0,001). No se modificaron las dimensiones emocionales de empatía.
Los estudiantes de Medicina no perciben dentro de la empatía el componente de distrés personal, y después de la formación se incrementaron los niveles de empatía cognitiva y percibida.
Empathy is the capacity to place oneself in another's position and understand his/her emotions. Empathy of health professionals has been associated with better clinical outcomes and relationship with the patients. The aim of the study is to define the level of empathy of Medical students and how does it evolve after following a one-month Clinical Interview and Communication training module.
The study is a non-control prospective longitudinal study. Second year Medical students have followed Clinical interview and Communication training module during one month. Empathy has been measured through the Interpersonal Reactivity Index (IRI) questionnaire that has 2 cognitive (perspective taking and fantasy) and 2 emotional (empathic concern and personal distress) dimensions. The perceived empathy was self-assessed using a 1-10 points scale
A sample of 136 students participated on this study (72% women, mean age 20.3 years). The perceived empathy correlates with the size of IRI, except personal distress. Post training intervention scores showed a significant increase in perspective taking dimension among men (from 16.5 to 17.8; P=.005) and fantasy among women (from15.5 to 16.7; P=.001), while self-assessed empathy increased in both sexes (from 6.9 to 7.4 in men; P=.009 and from 7.4 to 7.8 in women; P<.001).
Medical students don’t perceive personal distress as an empathy component. After receiving clinical interview and training module, cognitive and perceived empathy were significantly increased.
Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death.
We used the pooled analysis of individual data from 12 Spanish ...population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths.
We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes.
Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.
Resumen Objetivo Determinar la utilidad y viabilidad del Programa CRONIGICAT. Diseño Estudio descriptivo transversal. Método de evaluación cualitativo y cuantitativo Emplazamiento y participantes 26 ...equipos de atención primaria (EAP) del Institut Català de la Salut de Girona. Intervenciones 20 proyectos dentro del programa. Inicio 2011 Mediciones principales Grado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad). Resultados Valoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48 h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado. Conclusiones Respecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual.
Cardiovascular risk functions fail to identify more than 50% of patients who develop cardiovascular disease. This is especially evident in the intermediate-risk patients in which clinical management ...becomes difficult. Our purpose is to analyze if ankle-brachial index (ABI), measures of arterial stiffness, postprandial glucose, glycosylated hemoglobin, self-measured blood pressure and presence of comorbidity are independently associated to incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate-risk population.
This project involves 3 groups belonging to REDIAPP (RETICS RD06/0018) from 3 Spanish regions. We will recruit a multicenter cohort of 2688 patients at intermediate risk (coronary risk between 5 and 15% or vascular death risk between 3-5% over 10 years) and no history of atherosclerotic disease, selected at random. We will record socio-demographic data, information on diet, physical activity, comorbidity and intermittent claudication. We will measure ABI, pulse wave velocity and cardio ankle vascular index at rest and after a light intensity exercise. Blood pressure and anthropometric data will be also recorded. We will also quantify lipids, glucose and glycosylated hemoglobin in a fasting blood sample and postprandial capillary glucose. Eighteen months after the recruitment, patients will be followed up to determine the incidence of vascular events (later follow-ups are planned at 5 and 10 years). We will analyze whether the new proposed risk factors contribute to improve the risk functions based on classic risk factors.
Primary prevention of cardiovascular diseases is a priority in public health policy of developed and developing countries. The fundamental strategy consists in identifying people in a high risk situation in which preventive measures are effective and efficient. Improvement of these predictions in our country will have an immediate, clinical and welfare impact and a short term public health effect.
Clinical Trials.gov Identifier: NCT01428934.
Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of clinical communication and professional practice. This paper ...shows results of a training program in clinical communication under Problem Based Learning (PBL) methodology and correlation between student self-assessment and teachers' assessment. This involves a qualitative-quantitative cross-sectional study in usual practice in the 2nd year of the degree in Medicine. Teaching methodology is PBL, including 15 associate professors and 90 students. Educational tools for learning: PBL cases and seminars (video recorded, theoretical-practical lectures). Assessment tools: Tutorials on those cases worked on PBL (40%), knowledge test (30%), assessment of a case with PBL methodology (20%) and video recording report (10%). Communication skills are evidenced by CICCA-D scale (Connect-Understand-Identify-Agree-Help-Decision). Variables: academic performance, score on CICCA-D and academic methodological assessment. The analysis is carried out using descriptive statistics, calculating the intra-class correlation coefficients and weighted Kappa index with quadratic weights. 92.2% of students passed the course on the first round. In a range between 0 and 34 points students' self-assessment scored 13 (SD ± 5) points and teachers' 16 (SD ±7). A weak (21%-41%) or poor (< 20%) correlation was obtained between teachers and students for all questions on CICCA-D. The authors suggest a summative assessment using different instruments and techniques to assess clinical communication skills from the first year onwards, and highlight the key role of self-assessment, peer assessment and the use of video recording techniques along with feedback in formative assessment.
The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The ...objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35–79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity Hazard Ratio=2.34 (95% confidence interval: 1.19–4.61) and 5.65 (1.54–20.73), respectively. Overweight and obesity significantly increased the risk of cancer death in women 3.98 (1.53–10.37) and 11.61 (1.93–69.72). Finally, obese men had an increased risk of cancer death and overall mortality 1.62 (1.03–2.54) and 1.34 (1.01–1.76), respectively. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations.
•Obesity increases the risk of cardiovascular disease, cancer and overall death.•Cardiovascular risk factors modify the effect of obesity on adverse health outcomes.•BMI presents a dose-response pattern with no healthy pattern of increased weight.
Abstract Objective To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. Method Pooled analysis of 11 ...population-based Spanish cohorts (1992–2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. Results The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. Conclusions The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.
Most ex-post evaluations of research funding programs are based on bibliometric methods and, although this approach has been widely used, it only examines one facet of the project's impact, that is, ...scientific productivity. More comprehensive models of payback assessment of research activities are designed for large-scale projects with extensive funding. The purpose of this study was to design and implement a methodology for the ex-post evaluation of small-scale projects that would take into account both the fulfillment of projects' stated objectives as well as other wider benefits to society as payback measures.
We used a two-phase ex-post approach to appraise impact for 173 small-scale projects funded in 2007 and 2008 by a Spanish network center for research in epidemiology and public health. In the internal phase we used a questionnaire to query the principal investigator (PI) on the outcomes as well as actual and potential impact of each project; in the external phase we sent a second questionnaire to external reviewers with the aim of assessing (by peer-review) the performance of each individual project.
Overall, 43% of the projects were rated as having completed their objectives “totally”, and 40% “considerably”. The research activities funded were reported by PIs as socially beneficial their greatest impact being on research capacity (50% of payback to society) and on knowledge translation (above 11%).
The method proposed showed a good discriminating ability that makes it possible to measure, reliably, the extent to which a project's objectives were met as well as the degree to which the project contributed to enhance the group's scientific performance and of its social payback.
► Reports on a feasible and reliable tool for ex-post evaluation of public health small-scale research projects in Spain. ► Over 170 projects representing €2 million investment were assessed as regards research groups' impact and social payback. ► Projects boosting researchers' mobility and new research methods showed a high impact on a group's scientific performance. ► 82% of research projects provided actual or potential social benefits, and thus, showed a considerable return on investment.
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