Burden of heart failure in primary healthcare Gonzalez-Loyola, Felipe-Estuardo; Muñoz, Miguel-Angel; Navas, Elena ...
Atención primaria,
08/2022, Volume:
54, Issue:
8
Journal Article
Peer reviewed
Open access
OBJECTIVESTo determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource ...utilization. DESIGNRetrospective observational cohort study. SETTINGStudy was carried out in primary care setting. PARTICIPANTS AND INTERVENTIONSPatients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. MAIN MEASURESInformation came from electronic medical records. RESULTSA total of 64441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients' homes. CONCLUSIONHeart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.
Background: Excess sodium intake is associated with high blood pressure, a major risk factor for cardiovascular disease (CVD). It is unknown whether decreasing sodium intake to <2300 mg/d has an ...effect on CVD or all-cause mortality. Objective: The objective was to assess whether reductions in sodium intake to <2300 mg/d were associated with either an increased or a decreased risk of fatal and nonfatal CVD and all-cause mortality. Design: This observational prospective study of the PREvención con DIeta MEDiterránea (PREDIMED) trial included 3982 participants at high CVD risk. Sodium intake was evaluated with a validated food-frequency questionnaire and categorized as low (<1500 mg/d), intermediate (≥1500 to ≤2300 mg/d), high (>2300 to ≤3400 mg/d), or very high (>3400 mg/d). Subsequently, 1-y and 3-y changes in sodium intake were calculated. Multivariate relative risks were assessed by using Cox proportional hazards ratios. Marginal structural models with inverse probability weighting were used to test the effect of changes in sodium intake and the Mediterranean diet (MedDiet). Results: We documented 125 CVD events and 131 deaths after a 4.8-y median follow-up. Sodium intake <2300 mg/d was associated with a lower risk of all-cause mortality: 48% (HR: 0.52; 95% CI: 0.30, 0.91; P = 0.02) and 49% (HR: 0.51; 95% CI: 0.26, 0.98; P = 0.04) after 1 and 3 y, respectively. Increasing sodium intake after 1 y was associated with a 72% (HR: 1.72; 95% CI: 1.01, 2.91; P = 0.04) higher risk of CVD events. The incidence rate of CVD was reduced for those who reduced their sodium intake and were randomly assigned to MedDiet interventions 4.1/10,000 (95% CI: 3.1, 8.0) compared with 4.4/10,000 (95% CI: 2.7, 12.4) person-years; P = 0.002. Conclusions: Decreasing sodium intake to <2300 mg/d was associated with a reduced risk of all-cause mortality, whereas increasing the intake to >2300 mg/d was associated with a higher risk of CVD. Our observational data suggest that sodium intake <2300 mg/d was associated with an enhanced beneficial effect of the MedDiet on CVD. These results should be interpreted with caution, and other confirmatory studies are necessary. This study was registered at controlled-trials.com as 35739639.
Anisakis third-stage larvae (L3) is moderately tolerant to heat and, to mitigate the risk of live L3 intake in cooked seafood, it is important to define with precision at which point after heat ...treatment the parasite is no longer infective. We aimed to find thermal patterns that allowed to classify fish sandwiches spiked with Anisakis L3 into “low” (100% probability of mortality), “intermediate” and “high” risk groups. For that, experiments with varying set temperatures and heating times have been performed in conditions of different external heating temperatures. Decision points to classify the samples into terminal nodes associated to different risk groups have been obtained with decision tree analyses and then confirmed with linear discriminant analysis. Separation into two (i.e. low vs high + intermediate risk) or three (i.e. low, intermediate, and high risk) distinct thermal patterns (98% and 95.9% correct classifications by cross-validation respectively) was achieved. These results refine heating conditions reported in the EU Regulation, since reaching 60 °C for 1 min in the thermal centre is not sufficient to kill all L3. However, when factors such as relative temperature of heating or time to reach the set temperature are taken into account, other thermal conditions are found that are equally safe in terms of Anisakis L3 inactivation. This, together with the description of “intermediate” and “high” risk groups can help in the risk identification and management, as well as in providing clearer recommendations to consumers.
•Thermal conditions to inactivate Anisakis L3 have been studied.•Three thermal patterns from low to high risk were found.•Results refine and expand reported heating recommendations needed to kill L3.•These results can help in risk identification and management.
Anisakis L3 were subjected to freezing in domestic freezers and the risk posed by those larvae that might possibly survive freezing was analysed by determining their agar penetration ability, ...survival in gastric juice, allergenic potential and oxygen consumption rate. Anisakis L3 gradually became non-viable as the temperature fell from −1 °C to −28 °C. The faster the freezing rate, the greater the decrease in survival, but viability was not found to be affected by the proportions of Anisakis species per batch (A. simplex s.s. 83–100%, A. pegreffii 0–17%, and their heterozygote genotypes at the ITS region of rDNA 0–10%). Surviving larvae after freezing presented a drastically reduced ability to penetrate into a layer of solid agar, as compared to controls, but still 5% of them penetrated into this medium. About 80% of surviving larvae died within 24 h under conditions simulating those of gastric fluid, whereas up to 85% of the controls were able to resist for 24 h. Allergen release during freezing and after freezing was higher than in controls, and this release was compatible with a contribution of both passive (by rupture of the cuticle) and active liberation of excretion/secretion allergens during and after freezing, suggesting that the pathogenic potential of these frozen and thawed larvae cannot be discarded. These results could be of use for more precise risk assessment and providing guidelines for consumers.
•Temperature inhomogeneity may account for Anisakis L3 survival in domestic freezers.•Only 5% of the surviving L3 after freezing show agar penetration ability.•Up to 80% of surviving L3 after freezing died in artificial gastric fluid in 24 h.•There was a release of Anisakis L3 allergens during and after freezing.
Polymers undergo severe low-dimensionality effects when they are confined to ultrathin films since most of the structural and dynamical processes involving polymer molecules are correlated to length ...scales of the order of nanometers. However, the real influence of the size limitation over such processes is often hard to identify as it is masked by interfacial effects. We present the fabrication of a new type of nanostructure consisting of poly9-(1-octylnonyl)-9H-carbazole-2,7-diyl-2,5-thiophenediyl-2,1,3-benzothiadiazole-4,7-diyl-2,5-thiophenediyl (PCDTBT) thin film that is held up exclusively over tips of poly(ether–ether–ketone) (PEEK) nanopillars. The fabrication method exploits the nonwetting behavior of PCDTBT onto an ordered PEEK nanopillar array when the mobility of the PCDTBT molecules is enhanced by a solvent annealing process. We use this new configuration to characterize the mechanical behavior of free-standing thin film regions, thus in the absence of underlaying substrate, by means of an atomic force microscope (AFM) setup. First, we study how the finite thickness and/or the presence of the underlying substrate influences the mechanical modulus of the material in the linear elastic regime. Moreover, we analyze deep indentations up to the rupture of the thin film, which allow for the measurement of important mechanical features of the nanoconfined polymer, such as its yield strain, the rupture strain, the bending rigidity, etc., which are impossible to investigate in thin films deposited on substrates.
Industrial‐oriented mid‐frequency alternating current (MF‐AC) magnetron sputtering technique is used to fabricate LiNi0.5Mn1.5O4 high‐voltage thin‐film cathodes. Films are deposited on bare ...stainless‐steel substrate at room temperature and then annealed to induce crystallization in disordered spinel phase. In situ X‐ray diffraction is used to follow film structural evolution from room temperature to 900 °C. Scanning electron microscopy, X‐ray photoelectron spectroscopy, and Raman spectroscopy are used to study the evolution with temperature of film morphology, surface chemical composition, and crystal structure arrangement, respectively. Film structure evolves almost continuously in the studied temperature range. A pattern corresponding to spinel phase is observed after annealing at 600 °C, while poor crystallization is obtained for lower temperatures, and additional unwanted phase changes are observed for higher temperatures. Cyclic voltammetry, rate capability, and cycling performance of fabricated films are tested. Only the film annealed at 600 °C shows redox peaks corresponding to Ni oxidation from 2+ to 3+ and 3+ to 4+ oxidation states, confirming that this film crystallizes in disordered spinel phase. The thin‐film cathode shows good rate performance and outstanding cyclability, despite the impurities formed upon electrolyte decomposition at high voltage.
Deposited LiNi0.5Mn1.5O4 films are amorphous and they crystallize in electroactive disordered spinel phase upon annealing at 600 °C. The obtained thin‐film electrodes are tested against metallic Li in liquid electrolyte showing outstanding cycling performance.
Proposal
The aim of this study was to examine the association between the consumption of total and specific types of dairy products and the risk of incident cataracts in an elderly Mediterranean ...population at high cardiovascular risk.
Methods
We prospectively analyzed 5860 subjects from the PREvención con DIeta MEDiterránea (PREDIMED) Study. The time to cataract surgery was calculated as the time between recruitment and the date of the surgery, last visit of the follow-up, date of death, or until the end of the study. Dairy products intake was assessed using validated food frequency questionnaires. We used Cox proportional hazard regression to assess the risk of cataract surgery according to average dietary energy-adjusted total dairy products, milk, yogurt and cheese consumption.
Results
We documented a total of 768 new cataract events after a median of 5.6 years of follow-up. Subjects in the second hazard ratio (HR) 0.62; 95% CI 0.52, 0.74 and third tertile (HR: 0.71; 95% CI 0.60, 0.85) of skimmed yogurt intake had a significantly lower risk of cataracts after adjusting for potential confounders. No significant associations were observed for total dairy products, whole and skimmed milk, whole yogurt and cheese consumption.
Conclusion
The intake of skimmed yogurt was associated with a reduced risk of cataracts in an elderly Mediterranean population with high cardiovascular risk. No significant associations were observed for other type of dairy product.
Clinical Trial registration
International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.
Substantial evidence suggests that consuming 1-2 servings of fish per week, particularly oily fish (e.g., salmon, herring, sardines) is beneficial for cardiovascular health due to its high n-3 ...polyunsaturated fatty acid content. However, there is some concern that the mercury content in fish may increase cardiovascular disease risk, but this relationship remains unclear.
The PREDIMED trial included 7477 participants who were at high risk for cardiovascular disease at baseline. In this study, we evaluated associations between mercury exposure, fish consumption and cardiovascular disease. We randomly selected 147 of the 288 cases diagnosed with cardiovascular disease during follow-up and matched them on age and sex to 267 controls. Instrumental neutron activation analysis was used to assess toenail mercury concentration. In-person interviews, medical record reviews and validated questionnaires were used to assess fish consumption and other covariates. Information was collected at baseline and updated yearly during follow-up. We used conditional logistic regression to evaluate associations in the total nested case-control study, and unconditional logistic regression for population subsets.
Mean (±SD) toenail mercury concentrations (μg per gram) did not significantly differ between cases (0.63 (±0.53)) and controls (0.67 (±0.49)). Mercury concentration was not associated with cardiovascular disease in any analysis, and neither was fish consumption or n-3 fatty acids. The fully-adjusted relative risks for the highest versus lowest quartile of mercury concentration were 0.71 (95% Confidence Interval CI, 0.34, 1.14; p
= 0.37) for the nested case-control study, 0.74 (95% CI, 0.32, 1.76; p
= 0.43) within the Mediterranean diet intervention group, and 0.50 (95% CI, 0.13, 1.96; p
= 0.41) within the control arm of the trial. Associations remained null when mercury was jointly assessed with fish consumption at baseline and during follow-up. Results were similar in different sensitivity analyses.
We found no evidence that mercury exposure from regular fish consumption increases cardiovascular disease risk in a population of Spanish adults with high cardiovascular disease risk and high fish consumption. This implies that the mercury content in fish does not detract from the already established cardiovascular benefits of fish consumption.
ISRCTN35739639 .
From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious ...adverse drug reactions (SADRs) in COVID-19 patients vs. non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019.
All ALSs that reflected potential SADRs including neutropenia, pancytopenia, thrombocytopenia, anemia, eosinophilia, leukocytes in cerebrospinal fluid, hepatitis, pancreatitis, acute kidney injury, rhabdomyolysis, and hyponatremia were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients.
The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89-816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients, 95% CI 137.09-186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53-154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%).
The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.
(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver ...resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%;
= 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.
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