Health Care Centers In Spain Research Articles

A discrete choice experiment to understand preferences of patients with type 2 diabetes about the attributes of GLP1 receptor agonists in Spain

Objective To determine the preferences regarding injection, medication frequency and complexity of GLP1 receptor agonists among patients with type 2 diabetes, treatment-naïve for such drugs in Spain. Additionally, patients’ willingness to pay according to these attributes was evaluated. Methods A discrete-choice experiment survey designed to evaluate patients’ preferences over three attributes discriminating by age, sex and patients experience with previous injectable treatment was fulfilled by patients. The resulting model was analyzed using a conditional (fixed-effects) logistic regression. Results A total of 180 patients (63.35 ± 11.49 years, 63.28% men, 48.41% with previous cardiovascular disease, 54.69% with a time of evolution of diabetes >10 years) recruited from 5 health care centers in Spain completed the survey. Patients viewed positively weekly injections (vs daily injections), but rated negatively a complex preparation of the dose (vs simple preparation). Whereas naïve patients for injectable medications did not consider administration timing of importance, no naïve patients considered it relevant. No relevant differences were observed according to age or gender. Patients were willing to pay 83.25€for a “no preparation required” dose. No naïve and naïve patients were willing to pay 34.61€ and 14.35€; p = 0.000, to change daily injection for a weekly injection. Conclusions Patients highly valued the avoidance of injections, with weekly dosing clearly preferred over daily dosing, as well as reducing the treatment complexity. These findings may provide a better understanding of what patients prefer and value in their treatment and provide guidance for clinicians making therapeutic decisions regarding treatments of patients with type 2 diabetes.

Expert system-based application for fatal ventricular arrhythmia risk level estimation based on QT-Interval prolongation

There is an overwhelming number of medications that can affect the morphology of the beating heart by delaying the ventricular depolarization and repolarization processes, resulting in an elongated QT interval. This circumstance, in turn, can lead to ventricular arrhythmias, which can result in the patient’s death, as was overwhelmingly the case at the beginning of the coronavirus pandemic. In this regard, this document presents an innovative expert system-based application devoted to estimating the level of risk of fatal ventricular arrhythmia as a consequence of QT prolonging treatments. For this purpose, the use of a fuzzy rule-based system has been considered for the decision-making process, establishing three different risk levels regarding the QT interval obtained from an electrocardiogram, its evolution from a basal electrocardiogram, and other significant clinical information of the patient such as age, sex, among others. This novel expert system-based application has been designed by considering the criteria of several specialist physicians from four different Spanish private and public hospitals. The proposed application can be especially important in primary health care centers, where the absence of specialists is remarkable because it provides clinical staff with a powerful tool for estimating the level of risk of fatal ventricular arrhythmia with 96.5% accuracy when comparing its decisions to those of specialist physicians, which could imply a significant reduction in the risk of death due to fatal ventricular arrhythmias in patients with QT prolonging treatment. In this respect, the developed application is currently used in some primary health care centers in Spain.

Diagnostic Accuracy of Abdominal Point of Care Ultrasound in Primary Care: Study Design and Protocol.

The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians (FPs) in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by FPs (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 FPs in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up.The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for unselected populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.

Adherence to the therapeutic guidelines recommendations among the people with type 2 diabetes mellitus and obesity, frailty, or recent diagnosis, attended in primary health care centers in Spain: A cross-sectional study.

Clinical practice guidelines are helpful for clinicians, and their proper implementation could improve the quality of care and management of participants with diabetes. This study aimed to evaluate the degree of adherence to the Clinical Practice Guidelines (CPG) recommendations among obese, frail, or recently diagnosed type 2 diabetes mellitus (T2DM) participants in primary care centers in Spain. We perform a cross-sectional study on a national level in two phases. In the first phase, study participants were recruited, and their clinical data were collected. In the second phase, data related to the participating physicians were collected. In total, 882 participants from 240 physicians were analyzed. According to the study questionnaire, most participants from all three clinical groups had adequate adherence to the CPG. This percentage was highest among the recently diagnosed T2DM (91.6%) and lowest percent of frail T2DM persons (74.7%). The inadequate adherence to the guidelines was observed mainly among the obese and frail participants with T2DM from medical doctors with low CPG knowledge (3.4% and 3.5%, respectively). Regarding the patient's characteristics and degree of adherence to the guidelines, the participants with inadequate adherence were generally older, with higher BMI, poorer HbA1c control, and fewer visits with primary care physicians. Most (57%) primary care physicians had moderate CPG knowledge. In our multivariable logistic model, we did not observe statistically significant odds ratios for different characteristics related to the physicians/consultation and low CPG knowledge. The results of our cross-sectional study observe adequate adherence to the clinical guidelines by the primary care physicians for the majority of the participants with obesity, frailty, or newly diagnosed with T2DM.

Obstacles and Limitations in the Use of Protocols Responding Intimate Partner Violence Against Women from the Health System in Spain.

Intimate partner violence against women (IPVAW) is a public health problem that affects women worldwide. Consequently, victims frequently go to healthcare centers, usually with a cover reason. To address this problem, national and autonomic protocols to respond to IPVAW in health systems have been developed in Spain. In this regard, the role of primary care physicians (PCPs) will be essential for addressing IPVAW, but they could encounter obstacles in doing so. The purpose of this study was to explore how IPVAW is addressed in healthcare centers in Spain. This study synthesized the information available in the protocols to address IPVAW among health care workers in Spain and analyzed it according to World Health Organization (WHO) guidelines. Additionally, PCPs' perspectives on these protocols and the nature of IPVAW attention from healthcare centers were explored through a focus group. The findings displayed that, although the protocols mostly conform to WHO guidelines, they are insufficient to address IPVAW. Generally, PCPs were unaware of the existence of the protocols and referred to the lack of training in IPVAW and protocol use as one of the main obstacles to intervening, along with a lack of time and feelings as well as cultural, educational, and political factors. The adoption of measures to ensure that PCPs apply these protocols correctly and to approach PCPs' obstacles for addressing IPVAW in consultations will be crucial for the care of victims.

The Influence of Doing Shift Work on the Lifestyle Habits of Primary Care Nurses.

Nurses’ lifestyle habits play a key role in promoting healthy lifestyles; although, they may not always be entirely healthy and can be influenced by working conditions. This paper aims to analyze the influence of doing shift work on nurses’ lifestyle habits. Participants (n = 219) were recruited from 27 primary health care centres in Spain. Data were collected on socio-demographic characteristics, working conditions and lifestyle behaviour, assessed by use of an adhoc questionnaire including validated measures. Descriptive analysis and logistic regression models were performed. A total of 95% of the nurses reported having an adequate diet; 45.2% did not engage in any type of physical activity; and 85.8% did not smoke, especially women. A total of 60.3% did shift work, especially the younger ones (80.8%; p < 0.001), these nurses being the ones with the worst food habits (81.8%). In contrast, nurses who did shift work, exercised more days a week (69.5%; p < 0.001). The dietary habits of the nurses were adequate. Low tobacco consumption and low adherence to physical activity were observed, especially among women. Shift work harmed eating habits and obesity rates, but was a protective factor in terms of adherence to physical exercise.

Peyronie's Disease Questionnaire (PDQ): Spanish translation and validation.

The Peyronie's Disease Questionnaire (PDQ) is a 15-question self-reported questionnaire that evaluates the severity and physical and psychosexual issues of Peyronie's disease (PD) symptoms in three scales: "psychological and physical symptoms," "penile pain," and "symptom bother." Previous studies validated the PDQ US version and confirmed its test-retest reliability and responsiveness. The aim is to translate and validate the Spanish version of the PDQ to be used in the clinical practice and in PD research studies in Spain. A non-interventional, observational study with 160 PD patients was conducted. Patients included from four healthcare centers in Spain and completed the PDQ in two study visits separated for a period of 4-7 days from March 2018 to June 2019. Patients received no type of treatment or intervention. Different statistical tests were applied to the data in order to validate the structural and construct of the PDQ, as well as its internal reliability, temporal stability reliability, reliability between observers, and test-retest reliability. Cronbach's alpha over 0.9 showed good internal consistency. We found an ICC agreement of 0.82 (test-retest) for the three scales of the Spanish version of the PDQ, which demonstrates good reliability. When comparing Visit 1 and Visit 2 questionnaires mean scores, the PDQ showed non-significant differences, as expected because no intervention or treatment was administered to the patients between visits. Translation and validation of the PDQ for the Spanish population makes available a valid, useful, and reliable tool to properly evaluate quality of life of men suffering PD.

Cross-Cultural Adaptation, Validation, and Piloting of the Patient Reported Experiences and Outcomes of Safety in Primary Care Questionnaire for Its Use in Spain.

This study aimed to cross-culturally adapt, validate, and pilot the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire for its use in Spain. After setting up an expert panel to determine its content validity, the questionnaire was translated and back-translated, and subjected to cognitive testing. The questionnaire was piloted in a cross-sectional study in 10 primary health care centers in Spain. Fifty patients per center completed the questionnaire while waiting for an appointment. We estimated (i) the acceptability of the questionnaire (response rate), (ii) scores distribution (floor and ceiling effects), (iii) internal consistency (Cronbach α), and (iv) construct validity (exploratory factor analyses and correlation between scales). To examine patients' evaluations of patient safety, we followed a mixed-methods approach: (i) statistical analyses at the scale and item levels based on responses to standardized items and (ii) qualitative content analysis based on responses to open-ended questions. Complete data were collected from 493 patients (participation rate, 77%). A ceiling effect was observed for 3 scales ("safety problems," "harm severity," "harm needs"). The internal consistency was adequate (α > 0.7) for the majority of scales. Exploratory factor analysis and correlation between scales suggested an appropriate construct validity. Two hundred twenty-six (45.8%) respondents experienced at least 1 safety problem, and 109 (23.2%) reported harm in the previous 12 months. The multidimensional primary health care patient safety instrument Patient Reported Experiences and Outcomes of Safety in Primary Care is now available for its use in Spain. Initial testing demonstrates its potential for use in primary care. Future developments will further address its use in actual clinical practice.

Maternal Education Level and Excessive Recreational Screen Time in Children: A Mediation Analysis.

There is increasing recognition of the adverse health consequences of excessive recreational screen time (RST) in children and adolescents. Early interventions that aim to reduce RST are crucial, but there are some controversies about which individual and parental variables affect RST in children. The aim of this study was to determine the relationship of parental education level with RST in children and early adolescents and to identify mediators of these relationships. This cross-sectional study examined a sample of children (2–14 year-old) who attended routine childcare visits in primary health care centers in Spain (n = 402; 53.7% males; mean age: 7 ± 4 year-old). A self-reported questionnaire was given to the parents to assess sociodemographic data, parental education, the home media environment, and RST in children. Separate analysis was performed for two age groups (2–6 year-old and 6–14 year-old). Path analysis, an application of structural equation modeling, was used to analyze the data. Fitty three percent of the children had excessive RST (≥2 h/day). The maternal education level, eating lunch/dinner in front of a TV, presence of a background TV, and the amount of parental TV viewing had significant associations with excessive RST in both age groups. For the younger group, the maternal education level had direct and indirect effects on RST (total effect: β = −0.29, p < 0.01). For the older group, maternal education level only had a significant indirect effect on RST, and this was mediated by the presence of a background TV and the time of parental TV viewing (total indirect effect: β = −0.11, p < 0.01). A higher maternal education level appears to be associated with certain environmental factors or habits that prevent excessive RST.

Chronic kidney disease in Spain: analysis of patient characteristics, incidence and direct medical costs (2011–2017)

Objectives To review the characteristics of patients with chronic kidney disease (CKD) who attended primary and specialized care centers in Spain, and to analyze patients’ use of medical resources and direct medical costs of specialized care. Methods Records of patients with CKD admitted to primary and specialized healthcare centers in Spain between 2011 and 2017 from two national discharge databases were analyzed in a retrospective multicenter observational study. Records were classified into one-to-five CKD stages plus a 5b stage, indicating end-stage renal disease. Results Most of the patients registered in hospital settings were in stage 5. Registered secondary conditions included hypertensive chronic kidney, diabetes, anemia, hypercholesterolemia, and hypertension. The number of cases registered in primary care settings increased over time, whereas in specialized care centers incidence decreased; hospital incidence of CKD in 2017 was 10.72 per 10,000 persons. Mean in-hospital mortality was 5.90%, which remained stable during the study period. Mortality was associated with respiratory and heart failure. Mean length of hospital stay was 8.19 days, decreasing over the study period, whilst increasing with CKD progression. Mean annual direct medical cost of specialized care was €10,436 per patient. Complications of a transplant and bacterial infections were responsible for major increases in medical costs, that otherwise decreased over the study period. Conclusions The costs of specialized care decreased with the length of hospital stay reduction. Cardiovascular risk factors were crucial in in-hospital mortality. This study provides population-based data to assist decision-makers at the national level and to contribute to worldwide evaluations and disease surveillance.

Community seroprevalence of COVID-19 in probable and possible cases at primary health care centres in Spain.

BackgroundThere is a scarcity of information about patients with mild or moderate symptoms during the coronavirus disease 2019 (COVID-19). This is especially true for those who attended and were followed up at primary care settings.ObjectivesWe aim to measure the seroprevalence of antibodies against SARS-CoV-2 infection in a community sample of possible cases and among probable cases followed in primary care.MethodsWe selected a random sample of 600 individuals stratified by age groups from a total population of 19 899 individuals from a community area in Barcelona. We also invited all the patients that had been followed by General Practitioners (GPs). For both populations, we used COVID-19 rapid lateral flow immunoassays, which qualitatively assess the presence of patient-generated Immunoglobulins G (IgG) and Immunoglobulin M (IgM).ResultsThree hundred and eleven asymptomatic individuals from the randomly selected sample participated in the study. The mean age was 43.7 years [standard deviation (SD) = 21.79] and 55% were women. Seventeen individuals were seropositive for IgM and/or IgG, resulting in an overall prevalence of 5.47% (95% confidence interval = 3.44–8.58). Six hundred and thirty-four symptomatic patients were followed up by GPs. The mean age was 46.97 years (SD = 20.05) and 57.73% were women. Of these, 244 patients (38.49%) were seropositive. Results of the multivariate logistic regression analysis showed that the odds ratio for a positive test was significantly increased in patients who had fever, ageusia and contact with a patient diagnosed with COVID-19.ConclusionsThe seroprevalence of antibodies against SARS-CoV-2 among possible cases was lower than expected. Approximately, 40% of the symptomatic patients followed up by GPs during the peak months of the pandemic were positive.

Sleep patterns and physical function in older adults attending primary health care.

Sleep disturbances may contribute to physical function impairment among older adults. To examine the associations between sleep quality and duration and impaired physical function among older adults. Cross-sectional study involving 392 non-institutionalized adults aged ≥65 years, who were recruited from primary health care centres in Spain. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index (PSQI). The FRAIL scale was used to identify physical frailty, the short physical performance battery to assess lower extremity functional impairment (LEFI) and grip strength was measured using a hand-held dynamometer to assess muscle weakness. Statistical analyses were performed with logistic regression models adjusted for potential confounders. Participants with poor sleep quality (PSQI global score ≥10) were more likely to have functional limitations; the odds ratio (95% confidence interval) was 2.90 (1.10-7.64) for physical frailty, 2.73 (1.34-5.58) for LEFI and 2.32 (1.14-4.75) for muscle weakness. Sleep quality components associated with frailty were sleep disturbances, use of sleeping medication and daytime dysfunction. The only quality component associated with LEFI was poor sleep efficiency, while subjective poor sleep quality and daytime dysfunction were linked to muscle weakness. No associations were observed between night-time sleep duration and physical function indicators. Poor self-reported sleep quality, but not sleep duration, was associated with an increased frequency of physical frailty, LEFI and muscle weakness. Interventions to improve sleep quality could contribute to healthy ageing.

A New Instrument for Measuring Dietary Knowledge in Patients With Diabetes: Psychometric Testing of the CoNOCidiet-Diabetes.

To determine the psychometric properties of the CoNOCidiet-Diabetes, a new instrument based on nursing outcome "Knowledge: prescribed diet." Methodological design. The participant were 359 patients diagnosed with diabetes visiting 27 primary healthcare centers in Spain. Reliability (internal consistency and test-retest), validity (convergent criterion validity, concurrent content validity and known-groups validity), and sensitivity to change was tested. CoNOCidiet-Diabetes has shown evidence of acceptable psychometric properties as instrument but some items should be revised. This research provides a new instrument developed to specifically measure dietary knowledge in individuals with diabetes. For nursing practice: The literalness of the CoNOCidiet-Diabetes with the nursing outcome "Knowledge: prescribed diet" facilitate its measurement using the patient's statements.

Empleo actual de la hormonoterapia neoadyuvante en cáncer de mama: resultados de una encuesta realizada en España

ObjectivesTo establish the current state of the use of neoadjuvant endocrine treatment (NET) for breast cancer in breast cancer units (BCU) in Spain. Material and methodsA 14-question electronic survey was designed and sent on-line to members of the Spanish Society of Senology and Breast Disease (SESPM) as well as to other breast cancer units in public and private healthcare centres in Spain. ResultsA total of 79 surveys were completed. Nearly three quarters (74.7%) of respondents worked in public centres, and 77.2% used NET, although most (44.3%) only used it in elderly or frail women. Follow-up was carried out by a medical oncologist in 62.0% of the cases. The preferred follow-up methods were clinical examination (64.7%), MRI (55.9%) and ultrasound (48.5%). Letrozole was the chosen drug in 45.5%, and 43.0% maintained treatment for 3-6months. Most (82.2%) respondents used NET when there were axillary-positive nodes but, of these, 47.6% restricted it to frail elderly women. Surgery was the alternative treatment in 78.5% of non-responders. In all, 72.2% of the respondents believed that the possibility of performing a genomic profile in the core biopsy would increase the chances of NET use. ConclusionsNET is a frequently employed method in BCUs in Spain, although its use is usually relegated to elderly or frail women.

PMU55 - CONSEQUENCES ON ECONOMIC OUTCOMES OF GENERIC VERSUS BRAND-NAME DRUGS USED IN ROUTINE CLINICAL PRACTICE: THE CASE OF TREATING PERIPHERAL NEUROPATHIC PAIN OR GENERALIZED ANXIETY DISORDER WITH PREGABALIN

To provide real-world evidence on treatment persistence and economic and clinical consequences of generic versus brand-name pregabalin routinely used to treat peripheral neuropathic pain (pNP) or generalized anxiety disorder (GAD). Real-world secondary data analysis of electronic-medical-records (EMR) abstracted from a database including primary healthcare centers in Spain. Brand-name (Lyrica®) and generic pregabalin data from subjects’ first starting treatment for pNP or GAD between January-2015 and June-2016 were used. Main outcomes included treatment persistence (time-to-discontinuation), medication possession ratio (MPR), healthcare and non-healthcare resource utilization, and corresponding costs. Remitter and responder rates were also assessed. A total of 4,860 EMRs of patients >18 years-old with pNP (79.1% brand-name, 20.9% generic) and 990 with GAD (68.1% brand-name, 31.9% generic) were analyzed. Discontinuation was lower with brand-name than with generic pregabalin in pNP (adjusted hazard ratio [HR]: 0.70 [95% CI: 0.58–0.85], p<0.001) and GAD patients (HR: 0.63 [0.45–0.84], p<0.001). MPR was higher for brand-name: 83.6% vs. 78.4% in pNP and 81.8% vs. 76.5% in GAD (both p<0.001). Per-patient adjusted mean total costs were lower with brand-name: €1,500 [1,428–1,573] vs. €2,003 [1,864–2,143] in pNP and €1,528 [1,322–1,734] vs. €2,150 [1,845–2,454] in GAD (both p<0.001). More patients were remitters or responders with brand-name versus generic in pNP (55.0% [53.4%–56.6%] vs. 46.7% [43.6%–49.7%] and 59.2% [57.7%–60.8%] vs. 48.4% [45.4%–51.5%], respectively; p<0.001) and GAD (58.6% [54.9%–62.3%] vs. 48.7% [43.2%–53.3%] and 64.6% [60.9%–68.1%] vs. 47.2% [41.7%–52.7%], respectively; p<0.001). Meaningful and significantly higher treatment adherence was found in patients with pNP or GAD who first started therapy with brand-name versus generic pregabalin in routine practice in Spain. Consequently, patients receiving brand-name pregabalin showed better outcomes in terms of pain or anxiety at a lower cost to payers.

IMPROVING THERAPEUTIC COMPLIANCE OF DABIGATRAN IN PREVENTING STROKE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

Objective: To assess the efficacy of a mixed intervention, educational and reminder calendar of the intake, as a strategy to improve therapeutic compliance with dabigatran in patients with non-valvular atrial fibrillation (NVAF). Design and method: Prospective, longitudinal, multicenter study, carried out in 110 specialized healthcare centers in Spain. 726 patients treated with dabigatran prescribed for stroke prevention were included. A cluster randomization was performed based on two groups: 1) Control Group (CG) as usual clinical practice and Intervention Group (IG) with a mixed strategy: a) Healthcare education and b) Use of a reminder calendar for taking the anticoagulant medication. Three visits took place: baseline and follow up at 6 and 12 months. Compliance was measured using electronic monitors (Medication Event Monitoring System - MEMS). Average compliance percentage (%; Average CP) and daily compliance (%; Daily CP) was calculated. A patient was considered complier when CP was 80–100%. Results: Six hundred twenty-five patients ended the study. There were 315 evaluable subjects in the IG and 310 in the CG, with a mean age of 73,52 ± 8,3 years and 73,32 ± 8,56 respectively. Daily CP was 91,97 % at 6 months and 91,05 % after 12 months in the IG and 82,26 % and 82,63 % in the CG. Average compliance was 90,79 % and 89,20 % in the IG and 64,51 % and 63,22 % in the CG at 6 and 12 months respectively. Significant differences were observed in the Daily CP and Average CP with higher percentages in IG. In the non-compliers group, the number of concomitant drugs, baseline and 6 months SBP values, 6 and 12 months DBP values, baseline, 6 and 12 month weight, and total cholesterol and LDL cholesterol at baseline, 6 and 12 months were significantly higher. The number needed to treat (NNT) at the end of the intervention was 3,84 patients to prevent 1 non-compliance. Conclusions: A mixed intervention with educational and reminder calendar of drug intake, has been proven to be effective as a strategy to improve therapeutic compliance with dabigatran in patients with NVAF. The percentage of compliance with dabigatran was high

Economic and Environmental Impact of Energy Saving in Healthcare Buildings

The purpose of this article is to estimate the economic and environmental impacts of energy consumption derived from healthcare buildings and proposes several energy-saving options in the sector. An experimental energy consumption study was development between 2005 and 2013 in 12 hospitals and 70 healthcare centres in Spain, built between 1980 and 2005 through audits carried out between 2005 and 2012, performed by the Extremadura Energy Agency. The study focused on electric energy, HVAC, DWH, lighting systems, renewable energies, maintenance strategy, thermal insulation, and optimal building size. Specifically, the following parameters were evaluated: energy savings, investment emission of CO2, NO2, and SO2 gases, and payback. The results revealed that through an appropriate energy management of healthcare buildings it is possible to save up to 8.60 kWh/m2 per year, for buildings of less than 5000 m2 (with no beds), which represents an expense of 1.55 €/m2. In healthcare buildings larger than 5000 m2 (with beds), it was possible to save up to 6.88 kWh/m2 per year, which represents an expense of 1.25 €/m2.

Strategies for improving dabigatran adherence for stroke prevention in patients with non-valvular atrial fibrillation: education and drug intake reminders (FACILITA study)

Objective To assess the efficacy of a mixed intervention, educational, and reminder calendar of the intake, as a strategy to improve therapeutic adherence with dabigatran in patients with non-valvular atrial fibrillation (NVAF).Methods This was a prospective, longitudinal, multi-center study, carried out in 110 specialized healthcare centers in Spain. Seven hundred and twenty-six patients treated with dabigatran prescribed for stroke prevention were included. A cluster randomization was performed based on two groups: (1) Control Group (CG) as usual clinical practice, and (2) Intervention Group (IG) with a mixed strategy: (a) Healthcare education, and (b) Use of a reminder calendar for taking the anticoagulant medication. Three visits took place: baseline and follow-up at 6 and 12 months. Compliance was measured by using electronic monitors (MEMS). Average adherence percentage (%; Average AP) and daily compliance (%; Daily AP) was calculated. A patient was considered adherent when AP was 80–100%.Results Six hundred and twenty-five patients completed the study (315 in the IG and 310 in the CG). Daily AP was 91.97% at 6 months and 91.05% after 12 months in the IG and 82.26% and 82.63% in the CG. Average adherence was 90.79% and 89.20% in the IG and 64.51% and 63.22% in the CG at 6 and 12 months, respectively. Significant differences were observed in the Daily AP and Average AP, with higher percentages in the IG. In the non-adherents group, the number of concomitant drugs, baseline, and 6 months SBP values, 6 and 12 months DBP values, and weight, total cholesterol, and LDL cholesterol were significantly higher. The number needed to treat (NNT) was 3.84 patients to prevent one non-adherence.Conclusions A mixed intervention, consisting of patient education and a simple calendar reminder of drug intake, is an effective strategy to improve dabigatran therapeutic adherence in patients with NVAF. The percentage of adherence with dabigatran was high.

Dietary Marine ω-3 Fatty Acids and Incident Sight-Threatening Retinopathy in Middle-Aged and Older Individuals With Type 2 Diabetes: Prospective Investigation From the PREDIMED Trial.

Diabetic retinopathy (DR) is a devastating complication of individuals with type 2 diabetes mellitus. The retina is rich in long-chain ω-3 polyunsaturated fatty acids (LCω3PUFAs), which are substrate for oxylipins with anti-inflammatory and antiangiogenic properties. Experimental models support dietary LCω3PUFA protection against DR, but clinical data are lacking. To determine whether LCω3PUFA intake relates to a decreased incidence of sight-threatening DR in individuals with type 2 diabetes older than 55 years. In late 2015, we conceived a prospective study within the randomized clinical trial Prevención con Dieta Mediterránea (PREDIMED), testing Mediterranean diets supplemented with extra virgin olive oil or nuts vs a control diet for primary cardiovascular prevention. The trial was conducted in primary health care centers in Spain. From 2003 to 2009, 3614 individuals aged 55 to 80 years with a previous diagnosis of type 2 diabetes were recruited. Full data were available for 3482 participants (48% men; mean age 67 years). Meeting the dietary LCω3PUFA recommendation of at least 500 mg/d for primary cardiovascular prevention, as assessed by a validated food-frequency questionnaire. The main outcome was incident DR requiring laser photocoagulation, vitrectomy, and/or antiangiogenic therapy confirmed by an external adjudication committee. Of the 3482 participants, 48% were men and the mean age was 67 years. A total of 2611 participants (75%) met target LCω3PUFA recommendation. During a median follow-up of 6 years, we documented 69 new events. After adjusting for age, sex, intervention group, and lifestyle and clinical variables, participants meeting the LCω3PUFA recommendation at baseline (≥500 mg/d) compared with those not fulfilling this recommendation (<500 mg/d) showed a 48% relatively reduced risk of incident sight-threatening DR, with a hazard ratio of 0.52 (95% CI, 0.31-0.88; P = .001). This association was slightly stronger for yearly updated LCω3PUFA intake (relative risk, 0.48; 95% CI, 0.28-0.82; P = .007). In middle-aged and older individuals with type 2 diabetes, intake of at least 500 mg/d of dietary LCω3PUFA, easily achievable with 2 weekly servings of oily fish, is associated with a decreased risk of sight-threatening DR. Our results concur with findings from experimental models and the current model of DR pathogenesis. clinicaltrials.gov Identifier: http://www.controlled-trials.com/ISRCTN35739639.

Prevalence of intimate partner violence in Spain: A national cross-sectional survey in primary care

Objectives(1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence. DesignCross-sectional study using a self-administered questionnaire. SettingPrimary Healthcare centers in Spain. Participants10,322 women (18–70 years) attending Primary Healthcare centers. Main measurementsA compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category. ResultsThe prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category. ConclusionThe results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socio-economic.