Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to ...evaluate the factors that can influence physicians in their choice between a classic and a new anticoagulant in these patients.
Several variables of interest were discussed and analysed using a Workmat
methodology.
Six regional meetings were held in Spain (East, Catalonia, Andalusia-Extremadura, Madrid, North-east, and North of Spain).
Meetings were attended by 39 specialists (cardiologists, neurologists, haematologists, internists, and emergency and Primary Care physicians).
Each participant graded their level of agreement, with a score from 1 to 10, on every analysed variable.
A new anticoagulant drug was preferred in patients with previous failure of dicoumarin therapy (9.7±0.5), high haemorrhagic risk (8.7±1), prior bleeding (7.8±1.5), and high thrombotic risk (7.7±1.2). Dicoumarins were preferred in cases of severe (1.2±0.4) or moderate (4.2±2.5) kidney failure, good control with dicoumarins (2.3±1.5), cognitive impairment (3.2±3), and low haemorrhagic risk (4.3±3). Age, sex, weight, cost of drug, polymedication, and low thrombotic risk achieved intermediate scores. There were no differences between the different specialists or Spanish regions.
The presence of a high thrombotic or haemorrhagic risk and the failure of previous dicoumarin therapy lead to choosing a new oral anticoagulant in patients with non-valvular atrial fibrillation, while kidney failure, cognitive impairment, good control with dicoumarins, and a low bleeding risk predispose to selecting a classic dicoumarin anticoagulant.
Abstract
Aim. To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a ...Spanish population without peripheral artery disease attended in primary care. Methods. The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. Results. A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences − 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. Conclusions. The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.
To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients.
A transversal and multicentric study that has included immigrant patients aged 18 years or more, ...consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was > or = 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed.
1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval CI, 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3).
Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients.
To determine the number of potential deceased organ donors from out-of- hospital cardiac arrest cases (OHCA) attended by public physician-led emergency medical services in Spain, based on data ...recorded in the nationwide Spanish OHCA Registry (OHSCAR).
We analysed OHSCAR data on deceased OHCA patients in Spain during 13 months (1/10/2013 to 31/10/2014). Variables included age, sex, estimated OHCA time, cardiopulmonary resuscitation (CPR) start time and outcome. Inclusion criteria were: age 16–60 years, witnessed OHCA, no return of spontaneous circulation (ROSC) and time interval <15min between OHCA occurrence and CPR initiation.
Of a total 8789 cases, 3290 met the age criteria; of these, CPR was not witnessed in 745 cases. Among the remaining 2545 patients, 141 were included in uncontrolled donation after cardiac death (uDCD) programs, 902 arrived at the hospital with ROSC, 64 arrived with ongoing CPR and 15 cases were lost to follow-up. Of the remaining 1423 without ROSC, CPR initiation time was not recorded in 454 cases and 398 did not meet the time criteria <15min between OHCA and CPR initiation.
Finally, 571 met all the criteria and could have been potential donors. There were significant differences in the actual donors percentage from potential donors percentage between provinces with and without donor programs (141/322=43.8% versus 0/390=0%), but there were no differences in ROSC between the two types of provinces (418/1320=31.7% versus 652/1970=33.4%).
Many potential donors are missed in current clinical practice. uDCD programs are few and underused even in a country with high rates of organ transplantation.
This study analyzes how learning about social responsibility (SR) can modify the perceptions of university students about the importance of responsible behavior on the part of companies. To this end, ...a questionnaire was designed and administered to Management Accounting students before (n = 128) and after (n = 71) receiving two training activities on SR. The descriptive results obtained testify to the importance of SR in the views of the sampled students, both before and after receiving the specific learning in SR. In this latter moment, students demonstrated a vision highly committed to the need for SR to be part of the economic agenda. The results also show that there was a significant change in the perception of SR and its implications in terms of benefits and costs before and after receiving the training. All of this suggests that SR training has partially modified students’ perceptions of SR. This paper provides important insights that could be leveraged by university and business school managers for the purpose of designing or modifying curricula related to SR. At the same time, it evaluates the potential of SR learning as a tool for modifying attitudes.
Fundamento: El aumento en la frecuencia de tuberculosis (TB)
se produce por varios factores: resistencias al tratamiento, la infección
por el virus de la inmunodeficiencia humana, el paro, la pobreza
...y los movimientos migratorios. El objetivo del estudio fue conocer
la prevalencia de infección tuberculosa en población inmigrante
del Área de Salud de Toledo.
Métodos: Estudio descriptivo, transversal y multicéntrico con
emplazamiento en Atención Primaria. La captación y reclutamiento
de las personas inmigrantes se realizó sobre base de tarjeta sanitaria,
entre diciembre de 2002 y septiembre de 2003. Se realizó intradermorreacción
de Mantoux (IDRM), con 0,1 ml (2UT) de PPD RT-23,
previa firma del consentimiento informado. Otras variables recogidas
fueron: edad, sexo, peso, país de origen, situación laboral, vacunación
BCG, número de convivientes, tiempo de residencia en Europa.
Resultados: Fueron incluidos 344 inmigrantes, con una edad
media de 28,8±12,7 años. El 50% (172) eran mujeres. Llevaban un
promedio de 3,4±3,7 años de residencia en Europa. El 78,8% (271) de
las personas inmigrantes completaron el estudio. La IDRM fue positiva
en 75 de ellos 27,7% (IC 95%: 23,1-32,5). Los inmigrantes con
Mantoux positivo tenían más edad (32,5± 8,5 años) frente a (27,7 ±
13,8 años) en los que el resultado fue negativo, p=0,006. El origen
subsahariano aumentaba la probabilidad de presentar IDRM positiva.
Conclusiones: La población inmigrante del Área de Salud de
Toledo presenta una prevalencia alta de infección tuberculosa, superior
a la población general española. Existen diferencias según el
país de origen. Estos resultados indican la importancia de considerar
la prueba de Mantoux en las actividades preventivas dirigidas a la
población inmigrante.
AIM： To evaluate rational and experiential intelligence in irritable bowel syndrome （IBS） sufferers. METHODS： We recruited 100 subjects with IBS as per Rome 11 criteria （50 consulters and 50 ...non-consulters） and 100 healthy controls, matched by age, sex and educational level. Cases and controls completed a clinical questionnaire （including symptom characteristics and medical consultation） and the following tests： rational- intelligence （Wechsler Adult Intelligence Scale, 3rd edition）; experiential-intelligence （Constructive Thinking Inventory）; personality （NEO personality inventory）; psychopathology （MMPI-2）, anxiety （state-trait anxiety inventory） and life events （social readjustment rating scale）. Analysis of variance was used to compare the test results of IBS-sufferers and controls, and a logistic regression model was then constructed and adjusted for age, sex and educational level to evaluate any possible association with IBS. RESULTS： No differences were found between IBS cases and controls in terms of IQ （102.0 ± 10.8 vs 102.8 ± 12.6）, but IBS sufferers scored significantly lower in global constructive thinking （43.7± 9.4 vs 49.6 ± 9.7）. In the logistic regression model, global constructive thinking score was independently linked to suffering from IBS OR 0.92 （0.87-0.97）, without significant OR for total IQ. CONCLUSION： IBS subjects do not show lower rational intelligence than controls, but lower experiential intelligence is nevertheless associated with IBS.
The rise in the frequency of tuberculosis is due to several factors: resistance to treatment, human immunodeficiency virus infection, unemployment, poverty and migratory movements. This study is ...aimed at ascertaining the prevalence of tuberculosis infection among the immigrant population in the Toledo Health District.
Descriptive, cross-sectional, multi-center study conducted at the Primary Care level. The immigrants were attracted and recruited on the based of their health cards within the December 2002-September 2003 period. Mantoux intradermal reaction test was performed with 0.1 ml (2UT) of PPD RT-23, following informed consent. Other variables were collected: age, sex, weight, country of origin, work situation, BCG vaccination, number of individuals living with them, length of time residing in Europe.
A total of 344 immigrants were included in the study, averaging 28.8 +/- 12.7 years of age. Fifty percent were females (172). They had been living in Europe for an average of 3.4 +/- 3.7 years. A total 78.8% (271) of the immigrants completed the study. The intradermal reaction was positive in 75 of them 27.7% (CI 95%: 23-32.5). Those immigrants showing a positive Mantoux were older (age 32.5 +/- 8.5 years) than those showing a negative result (age 27.7 +/- 13.8 years), p=0.006. Originally being from the sub-Saharan area increased the probability of showing a positive intradermal reaction.
The immigrant population of the Toledo Health District shows a high prevalence of tuberculosis infection, which is higher than the general Spanish population. Differences exist depending upon the country of origin. These results indicate the importance of considering the Mantoux test among the preventive activities addressed toward this immigrant population.
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