Spanish Patients Research Articles

The Role of Spiritual Well-Being in Spanish Cancer Patients: Exploring the Relationship Between Health, Religiosity and Spirituality, and the Underlying Psychosocial and Behavioral Pathways

ABSTRACT This study aims to examine the interactions of spiritual well-being with different psychosocial and behavioral aspects that have been proposed in the literature as pathways underlying the relationship of religiosity and spirituality (R/S) with physical health, specifically in cancer patients (N = 351). Using a cross-sectional research design, a series of hierarchical regression analyses show the predictive power of different elements of R/S (attachment to God, religious practice, commitment and coping, and spiritual experiences) on spiritual well-being. In turn, spiritual well-being (meaning/peace and faith) predicts gratitude and compassion (as psychological pathways). Thus, finally, spiritual well-being, together with gratitude and compassion, correlates to the rest of the psychological (positive and negative emotions), social (social support) and behavioral (healthy behaviors) pathways to different extents. Spiritual well-being may play an important role in understanding the relationships between R/S and health, so considering it along with its associated factors may be key to improving the health and quality of life of people affected by cancer in Spain.

Cost-Utility of Real-Time Continuous Glucose Monitoring versus Self-Monitoring of Blood Glucose in People with Insulin-Treated Type 2 Diabetes in Spain.

Management of advanced type 2 diabetes (T2D) typically involves daily insulin therapy alongside frequent blood glucose monitoring, as treatments such as oral antidiabetic agents are therapeutically insufficient. Real-time continuous glucose monitoring (rt-CGM) has been shown to facilitate greater reductions in glycated hemoglobin (HbA1c) levels and improvements in patient satisfaction relative to self-monitoring of blood glucose (SMBG). This study aimed to investigate the cost-utility of rt-CGM versus SMBG in Spanish patients with insulin-treated T2D.. The analysis was conducted using the IQVIA Core Diabetes Model (CDM V9.5). Baseline characteristics of the simulated patient cohort and treatment efficacy data were sourced from a large-scale, United States-based retrospective cohort study. Costs were obtained from Spanish sources and inflated to 2022 Euros (EUR) where required. A remaining lifetime horizon (maximum 50 years) was used, alongside an annual discount rate of 3% for future costs and health effects. A willingness-to-pay (WTP) threshold of EUR 30,000 per quality-adjusted life year (QALY) was adopted, based on precedent across previous cost-effectiveness studies set in Spain. A Spanish payer perspective was adopted. Over patient lifetimes, rt-CGM yielded 9.933 QALYs, versus 8.997 QALYs with SMBG, corresponding to a 0.937 QALY gain with rt-CGM. Total costs in the rt-CGM arm were EUR 2347higher with rt-CGM versus SMBG (EUR 125,365 versus EUR123,017). The base case incremental cost-utility ratio was therefore EUR 2506 per QALY gained, substantially lower than the WTP threshold of EUR 30,000 per QALY. The analysis also projected a reduction in cumulative incidence of ophthalmic, renal, neurological, and cardiovascular events in rt-CGM users, with reductions of 16.03%, 13.07%, 7.34%, and 9.09%, respectively. Compared to SMBG, rt-CGM is highly likely to be a cost-effective intervention for patients living with insulin-treated T2D in Spain.

P199 Real-world outcomes on Spanish patients with metastatic renal cancer treated with first-line immunotherapy combinations

P199 Real-world outcomes on Spanish patients with metastatic renal cancer treated with first-line immunotherapy combinations

Limited Availability and Readability of Spanish Language Patient Educational Material: A Review of the Nation's Top Children's Hospitals.

Cleft lip with or without cleft palate (CL/P) is a common congenital facial pathology that occurs at higher incidences in Hispanic communities. The authors analyzed the availability and readability of Spanish-written patient education materials (PEMs) on CL/P from top-ranking U.S. children's hospitals to determine the presence of health literacy barriers. Availability of PEM was evaluated by 2 methods: (1) Google search and (2) evaluation of the official hospital websites. For each institution, a Google search was conducted using the phrase, "labio leporino y/o paladar hendido (translation: CL/P) + (hospital name)." In addition, each hospital website was assessed for Spanish PEM availability. Spanish PEMs were then categorized by whether they had been generated by an automated translation function or if they were independently written Spanish text. English PEM readability was assessed using the Simple Measure of Gobbledygook (SMOG). Spanish PEM readability was assessed using spanish orthgraphic length (Spanish Orthographic Length), the SMOG converted for the Spanish language. Unpaired 2-tailed t tests were used to compare readability. Of a total of 85 pediatric hospitals, 28 (37.3%) had Spanish PEM. Five (6.7%) hospitals created their own Spanish-language document. The average spanish orthgraphic length reading level was 9.49 compared with an average SMOG of 11.38 (P < 0.001). Institutions that did not provide Spanish PEM in any format had a significantly higher SMOG for English PEM of 12.13 compared with 11.38 of those that had SMOG with English PEM (P = 0.04). Health literacy barriers not only exist for Spanish PEM but also for English PEM, indicating an opportunity to improve communication.

Identification of patient-reported outcomes measures (PROMs) and patient-reported experiences measures (PREMs) in Gaucher disease in Spain

BackgroundPatient-reported outcome measures (PROMs) and patient-reported experiences measures (PREMs) are crucial for understanding the impact of GD on quality of life and patient's perceptions on care, but also to guide decision-making processes. Nevertheless, no specific PREMs in GD have been published, neither PROMs for Spanish GD patients have been developed. MethodsTwo project coordinators selected key-points to be included in a PROMs/PREMs questionnaire, and the scientific committee and a group of expert patients contributed to the initial draft. Then, 9 meetings with experts were held to discuss controversial points. After, a questionnaire with 103 items regarding symptomatology, aspects of daily life and care experience was developed. Finally, it was conducted a Delphi survey among a multidisciplinary group of experts in GD. ResultsConsensus was reached on 85 out of the 103 items. Recommendations on PROMs and PREMs regarding symptomatology, aspects of daily life and care experience were obtained. Consensus was reached on the importance of considering fatigue, concentration problems, and communication issues in GD patients using 5-step analog scales. Panelists recommended asking GD patients about the impact on social functioning and work/school performance. Finally, consensus was reached on considering care experiences, such as treatment satisfaction, treatment interruptions or transitions and healthcare professionals involved in patient's management to perceive patient's perceptions. ConclusionThis expert consensus may help developing GD-specific PROMs/PREMs for improving GD management. Properly developed and validated PROMs/PREMs may help decision-making, establishing patient-tailored therapeutic and follow-up goals.

New Insights Into the Spectrum of RASopathies: Clinical and Genetic Data in a Cohort of 121 Spanish Patients.

Noonan syndrome and related disorders are a group of well-known genetic conditions caused by dysregulation of the Ras/mitogen-activated protein kinase (RAS/MAPK) pathway. Because of the overlap of clinical and molecular features, they are now called RASopathies. In this study, we retrospectively analyzed the clinical data of 121 patients with a molecularly confirmed diagnosis of RASopathy, describing frequencies for clinical features in all organ systems as well as molecular data. The most common clinical diagnosis was Noonan Syndrome and the most frequently affected gene was PTPN11 followed by SOS1, RAF1, LZTR1, and RIT1. All patients had distinctive craniofacial features indicative of the RASopathy spectrum but we report some atypical features regarding craniofacial shape, such as craniosynostosis and microcephaly. We also describe uncommon clinical characteristics such as aortic dilation, multivalvular heart disease, abnormalities of the posterior fossa, and uterine congenital anomalies in female patients. Furthermore, the presence of multiple giant cell granulomas was observed specifically in patients with SOS1 variants. This comprehensive evaluation allows broadening the phenotypic spectrum of our population and their correlation with the genotype, which are essential to improve the recognition and the follow up of RASopathies as a multisystemic disease.

Can AI hear me? Nine facts about the artificial intelligence scribe

This article summarizes important features of artificial intelligence scribe (AIS) and its application as a digital scribe through the utilization of voice recognition as it is integrated into the clinical practice of medicine. This discussion will include 1) digital scribe technology, 2) practical utility, 3) liability, 4) privacy, 5) integration to electronic health records (EHR), 6) technology burden, 7) case use, 8) AIS documentation styles, and 9) cost. The use of AIS technology in healthcare is a promising tool and will result in variability applications requiring healthcare providers to be aware of the complexities of the tool before utilization, during implementation, the effect of it on workflow, and its acceptance by the patients we serve. AIS technology promises to decrease the cognitive workload of the healthcare provider, through application by relieving the ever-increasing burden of documenting the medical record, organizing, and capturing relevant medical data, by improving integration of this data into cumbersome EHRs, thus providing better work life balance. The authors piloted a version of an AIS in a primarily Spanish patient population. This article provides a unique perspective towards the usability of an AIS in a Hispanic patient population.

Consequences of the Poor Anticoagulation Control of Patients with Non-Valvular Atrial Fibrillation Treated with Vitamin K Antagonists.

Background: The prevention of thromboembolisms through anticoagulation and heart rate control is crucial in managing non-valvular atrial fibrillation (NVAF). This study aimed to analyze the consequences of poor anticoagulation control with vitamin K antagonists (VKAs) in Spanish patients with NVAF, focusing on thrombotic events, bleeding, mortality, healthcare resources (HRU), and costs. Methods: This observational, retrospective study used electronic medical records (BIG-PAC® database) of NVAF patients who started VKA treatment between 1 January 2016 and 31 December 2018. Patients were followed up for two years and classified by poor or adequate anticoagulation control. Demographic and clinical characteristics, treatments, incidence of cardiovascular events, mortality rates, HRU, and costs were analyzed. Results: Patients with poor control (n = 2136) had a 75% greater probability of suffering a cardiovascular event compared to patients with adequate control (n = 2351) (HR, 1.75 [95%CI: 1.43-2.14; p < 0.001]). Cardiovascular events, major bleeding, minor bleeding, systemic thromboembolism, and ischemic strokes were reduced by 32.1%, 46.2%, 29.6%, 22.2%, and 16.1%, respectively. It was estimated that adequate anticoagulant control saved EUR 455/patient with NAVF due to reduced hospitalization for cardiovascular events. Conclusions: For VKA-treated NVAF patients, poor anticoagulation control was associated with a higher number of cardiovascular events, greater consumption of HRU, and higher management costs than for patients with adequate control.

Changes in the diagnostic landscape of transthyretin amyloid cardiomyopathy (ATTR-CM): a comparison of tests ordered and test Intervals in 2020 Q4 and 2023 Q4

Abstract Background Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is a genetic disease caused when misfolded transthyretin protein is deposited in the myocardium. Amyloidosis driven stiffness in heart muscles results in heart failure symptoms. ATTR-CM is underdiagnosed, requiring specialized tests to identify the condition. Purpose This paper examines and compares diagnostic tests and the time intervals between rounds of testing conducted to identify ATTR-CM in 2020 Q4 and 2023 Q4 in France (FR), Germany (DE), Italy (IT), Spain (ES) and the United Kingdom (UK). Methods A multi-centre online medical chart review was performed between November and December 2020, with 210 (FR: 46, DE: 40, IT: 43, ES: 42, UK: 39) cardiologists/internists providing data on 320 (FR: 71, DE: 63, IT: 64, ES: 63, UK: 59) patients diagnosed with ATTR-CM; and between October and November 2023, with 225 (FR: 45, DE: 48, IT: 48, ES: 45, UK: 39) cardiologists/Internists providing data on 780 (FR: 151, DE: 163, IT: 172, ES: 175, UK: 119) patients. Participants were screened for ATTR-CM patient management. We analysed the diagnostic tests ordered and tracked the intervals between batteries of tests to understand how the timing of diagnosis has changed across the EU4+UK. Results The average number of ATTR-CM diagnostic tests received by reported patients rose from 5.9 in 2020 to 7.4 in 2023, with ECHO with strain imaging (87%), Genetic tests (78%), Cardiac MRI (74%), Laboratory tests (67%), and Scintigraphy tests (65%) as the top 5 tests in Q4 2023. There was a notable increase in the use of ECHO with strain imaging, Laboratory tests, and Scintigraphy tests recorded in the Spanish patient cohort (p&amp;lt;0.01). Reported patients in Italy, Spain &amp; UK received an increased average number of tests (p&amp;lt;0.05) [Table 1]. The recorded interval between the 1st and 2nd test batteries remained consistent between Q4 2020 and Q4 2023 (4.8-4.9 wks.), but the interval between the 2nd to 3rd rounds increased from 4.3 to 5.0 weeks. Timings between batteries increased in the France, Germany, Italy and UK data. Reported patients in Germany continue to experience the shortest intervals between batteries of tests (4.1 wks. between 1st and 2nd; 4.4 wks. between 2nd and 3rd batteries). Between Q4 2020 and Q4 2023, reported patients in Spain had an increase in the average number of tests received from 5.2 to 7.2, and were the only group with decreased time intervals (7.3 to 4.5 wks. between 1st and 2nd; 5.8 to 5.1 wks. between 2nd and 3rd batteries) Conclusion Results indicate that the use of certain diagnostic tests as well as the number of tests used to diagnose ATTR-CM has increased, however, intervals between testing batteries have also increased. This suggests that the increase in the number of tests used to diagnose ATTR-CM is possibly negating the necessity for more frequent testing. Further research in needed to confirm this and assess its impact on early detection of ATTR-CM.Table 1:Diagnostic Procedures by RegionTable 2:Testing battery intervals

CYP3A4*1B but Not CYP3A5*3 as Determinant of Long-Term Tacrolimus Dose Requirements in Spanish Solid Organ Transplant Patients.

Tacrolimus (TAC) is a commonly used immunosuppressive drug in solid organ transplantation. Pharmacogenetics has been demonstrated before to be decisive in TAC pharmacotherapy. The CYP3A5*3 variant has been reported to be the main determinant of TAC dose requirements; however, other polymorphisms have also proven to be influential, especially in CYP3A5 non-expressor patients. The aim of this study is to evaluate the influence of genetic polymorphisms in TAC therapy in a cohort of Spanish transplant recipients. Genetic analysis including ten polymorphic variants was performed, and demographic and clinical data and pharmacotherapy of 26 patients were analyzed. No significant differences were found in weight-adjusted dose between CYP3A5 expressors and non-expressors (0.047 mg/kg vs. 0.044 mg/kg), while they were found for carriers of the CYP3A4*1B allele (0.101 mg/kg; p < 0.05). The results showed that patients with at least one CYP3A4*1B allele had a higher TAC dose and lower blood concentration. Dose-adjusted TAC blood levels were also lower in CYP3A4*1B carriers compared to non-carriers (0.72 ng/mL/mg vs. 2.88 ng/mL/mg). These results support the independence of CYP3A5*3 and CYP3A4*1B variants as determinants of dose requirements despite the linkage disequilibrium present between the two. The variability in genotype frequency between ethnicities may be responsible for the discrepancy found between studies.

Gut Microbiota Alterations in Alzheimer's Disease: Relation with Cognitive Impairment and Mediterranean Lifestyle.

Recently, an association between dysbiosis of the gut microbiota (GMB) and the development of several diseases, such as Alzheimer's disease (AD), has been proposed. Dysbiosis involves changes in microbial diversity influenced by environmental factors, like diet or lifestyle. In this study, we investigated the role of GMB parameters in Spanish AD patients, assessing the impact of adherence to the Mediterranean lifestyle (ML), as well as to characterize these parameters in relation to neuropsychological, neuropsychiatric, emotional, and functionality parameters. A case-control study was conducted to investigate the association between the composition of the GMB and cognitive, emotional, neuropsychiatric, and functionality status in Spanish AD patients, along with a shotgun metagenomics approach. Richness and alpha-diversity were significantly lower in the AD group compared to the controls. PERMANOVA and ANOSIM tests of Bray-Curtis dissimilarity, Aitchison distance, and Jaccard similarity did not showed significant differences in beta-diversity between the two groups. Moreover, associations between various phyla of the AD group and orientation performance, food consumption, and activities of daily living were identified. Dysbiosis observed in Spanish AD patients is characterized by reductions in richness and alpha-diversity, alongside alterations in GMB composition, which may be linked to adherence to the ML and cognitive and functionality symptoms.

False HbA1c value due to a rare variant of hemoglobin Petie Salpetriere coinherited with alpha thalassemia

Abstract Objectives To describe a variant hemoglobin that interferes with HbA1c analysis by cation exchange HPLC. Case presentation A 78 years-old Spanish male patient visited the Internal Medicine Clinic for a routine check-up, with HbA1c included to screen for diabetes. He had suffered hypertension and dyslipidemia, and the patient had no previous symptoms suggestive of diabetes such as hyperglycemia, weight loss, polydipsia, polyuria or tiredness. Diabetes screening by HbA1c measurement was assessed using cation exchange HPLC and an immunoassay point-of-care analyzer. Routine hemoglobinopathy screening was performed including CBC, HbF and HbA2 measurement by cation exchange HPLC and capillary electrophoresis (CE). Further variant characterization was undertaken by DNA sequencing. Discordant HbA1c results were obtained for our subject, with elevated HbA1c of 52 mmol/mol measured by cation exchange HPLC and a normal level of 34 mmol/mol by immunoassay. Abnormal HbA1c peak shape prompted hemoglobinopathy screening to investigate potential variant interference. A globin gene analysis was performed, and the results showed a variant hemoglobin named ‘Hb Petie Salpetriere’. This variant arises from a Val → Phe substitution due to a mutation of c.103G&gt;T of the beta-globin gene [BETA34 (B16) Val&gt;Phe; HBB:c.103G&gt;T]. Conclusions This is the first reported case involving the Hb Petie Salpetriere variant in a Spanish patient. The present results show that the Hb Petie Salpetriere variant can affect the results of HbA1c analysis through ion-exchange HPLC, but not that obtained from the latex agglutination immunoassay. Only ion-exchange HPLC suggested the presence of the Hb variant in this case, suggesting that a careful review of the resulting chromatogram might reveal a potential variant.

Model-Informed Precision Dosing for Personalized Ustekinumab Treatment in Plaque Psoriasis.

Implementing model-informed precision dosing (MIPD) strategies guided by population pharmacokinetic/pharmacodynamic (PK/PD) models could enhance the management of inflammatory diseases such as psoriasis. However, the extent of individual experimental data gathered during MIPD significantly influences the uncertainty in estimating individual PK/PD parameters, affecting clinical dose selection decisions. This study proposes a methodology to individualize ustekinumab (UTK) dosing strategies for 23 Spanish patients with moderate to severe chronic plaque psoriasis., considering the uncertainty of individual parameters within a population PK/PD model. An indirect response model from previous research was used to describe the PK/PD relationship between UTK serum concentrations and the Psoriasis Area and Severity Index (PASI) score. A maximum inhibition drug effect (Imax) model was selected, and a first-order remission constant rate of psoriatic skin lesion (kout = 0.016 d-1) was estimated. The MIPD approach predicted that 35% and 26% of the patients would need an optimized and intensified dosage regimen, respectively, compared to the regimen typically used in clinical practice. This analysis demonstrated its utility as a tool for selecting personalized UTK dosing regimens in clinical practice in order to optimize the probability of achieving targeted clinical outcomes in patients with psoriasis.

The Immune Modulation HLA-G*01:01:01 Full Allele Is Associated with Gastric Adenocarcinoma Development.

The Human Leukocyte Antigen (HLA) system contains a set of genes involved at many levels in the innate and adaptive immune response. Among the non-classical HLA class I genes, HLA-G stands out for the numerous studies about its pivotal role in regulating/modulating immune responses. Also, its involvement in extravillous cytotrophoblast function, viral infections, autoimmunity, and cancer has been extensively documented. The present study explores for the first time the relationship between natural alleles of HLA-G, rather than STSs, SNPs, or partial gene polymorphisms, and the development of gastric adenocarcinoma, by analyzing the genetic profile of a cohort of 40 Spanish patients with this type of tumor using DNA extracted from paired biopsies of tumoral and adjacent non-tumoral gastric tissue. Our results reveal a significant statistical relationship between the presence of the HLA-G*01:01:01 allele and the development of gastric cancer, while other common alleles such as -G*01:04 or -G*01:05N did not demonstrate a significant correlation. Studying the involvement of HLA genes in the development of many diseases is relevant to understanding their pathophysiology. However, the absence of specific mechanisms underlying these associations suggests that investigating complete HLA natural alleles' extended haplotypes or complotypes may offer a more precise and valuable approach to elucidating the association of HLA with the pathogenesis of disease.

Microbiome characterization of skin biopsies in Spanish patients with hidradenitis suppurativa shows a decrease in D1 and H1 lineages of Cutibacterium acnes.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder, with dysbiosis and loss of Cutibacterium acnes commonly observed in affected skin. This study analyzed the microbiome of lesional, perilesional, and healthy skin samples, finding significant differences, including increased Mycoplasma and Bacillus in lesional skin. The reduction of Cutibacterium variants D1 and H1 in HS-affected skin highlights their potential as therapeutic targets, suggesting a strategy of topical replacement therapy.

Psychometric characteristics of the Spanish version of the HIV Symptom Index

BackgroundThe aim of this study was to determine the psychometric properties of the Spanish-language version of the HIV-Symptom Index (HIV-SI) questionnaire in Spanish patients undergoing antiretroviral therapy.MethodsBetween 2014 and 2016, an observational, multicenter, prospective cohort study was conducted in seventeen Spanish hospitals to validate HIV-SI questionnaire in terms of: construct validity (confirmatory factor analysis), internal consistency (Cronbach’s alpha), convergent validity (Pearson’s correlation coefficient) and Known-group validity. In addition, a sensitivity to change analysis was also performed.ResultsA total of 232 patients were included in the study. They had a mean age of 46.17 (SD9.82) and were 75% male. The median overall score for the HIV-SI was 10 (IQR 4– 19.5) and the most common symptoms reported were feelings of nervousness or anxiety, fatigue or energy loss, feeling sad or depressed, stomach pain or bloating, and difficulty sleeping. In the current study, the Spanish HIV-SI questionnaire showed a high internal consistency (α = 0.89) and adequate construct validity (CFI and TLI > 0.90). When contrasted with the MOS-HIV questionnaire, an inverse correlation was found. It showed a good association with the mental (r=-0.61; P < 0.0001) and physical score (r=-0.60; P < 0.0001). In a multivariate analysis, the age of the patient, female condition, hepatitis C coinfection, concomitant treatment and non-adherence resulted in a higher HIV-SI score.ConclusionsOur study has shown that the Spanish HIV-SI is a valid and reliable self-administered PROM for routine measurement of patient- reported symptoms among Spanish patients on antiretroviral treatment.

A comparative analysis of patients with breast cancer with and without language barriers.

340 Background: About 20% of Americans speak a language other than English at home, among these over one-third experience language barriers when interacting in English. These populations face additional barriers, which can lead to adverse outcomes in the case of a cancer diagnosis. Diverse older adults are at highest risk for sub-optimal care and toxicity from cancer therapies due to the intensity of treatment, their age, comorbidities, in addition to the burden of historic inequities they experience due to sub-optimal communication and insufficient communication of risk. Methods: This retrospective observational study explores the role of language barriers on patient characteristics among patients diagnosed with advanced left-side breast cancer (LSBC). LSBC requires radiotherapy which can pose a risk for cardiotoxicity. Electronic medical records for N=1795 patients were extracted at a tertiary cancer center; analyses were conducted on a secure virtual research desktop using SAS 9.4. This study was IRB approved. Results: Overall, most patients were female (99.5%) and NH White, with a large proportion of Latine patients 17.8%. Most were married or had a partner (49.6%) and were on Medicare (43.2%) or private insurance (34.7%), very few were on Medicaid (5.0%). 9.7% reported a disability that left them unable to work and 13.3% of patients requested an interpreter at their last encounter. Nearly 9% of patients reported a history of heart disease. When we compared patients by those that did and did not request an interpreter as a proxy for limited English proficiency (LEP), we found that patients who were reported Spanish as their preferred language (84.8%, p&lt;.0001) were more likely to be request an interpreter. This group was followed closely by speakers from languages spoken in the Middle East and N. Africa (MENA) region (80.5%, p&lt;.0001). Conversely, we observed patients on Medicaid to be more likely to request an interpreter vs other payer types (39.3%, p&lt;.0001), finally we found significantly fewer patients with a history of heart disease experiencing language barriers. Conclusions: Our assessment demonstrates language barriers remain a significant barrier for Spanish and MENA-region breast cancer patients. Patients with language barriers may have different risk factors and unique needs that require further study. Thus, improved outcomes can be encouraged with tailored management and support for communication barriers.

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Prevalence of Obesity in Primary Care Patients: IBERICAN Study

Background and aimsObesity has an important role in the prognosis of the patients, and important regional differences were described in Spain. The aim is to determine the prevalence of obesity in Spanish primary care patients and its geographical distribution. Methods and resultsPrevalence study that included patients from the baseline interview of the IBERICAN study. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m2 and abdominal obesity as a WC greater than or equal to 102 cm in men and 88 cm in women. Prevalence risks were calculated using unconditional logistic regression models, adjusting for socio-demographic variables and lifestyles. 58.8% of the patients were obese according to any of the criteria used and 30.5% met both criteria simultaneously. 33.7% had a BMI greater than or equal to 30 kg/m2 and 55.6% had abdominal obesity. Women, older patients, rural residents, and retirees presented a higher risk of obesity. On the other hand, a higher economic status or education, regular exercise and high adherence to a Mediterranean diet were protective factors. The prevalence of obesity was heterogeneously distributed, and Canary Islands, Cantabria and Castilla la Mancha had significantly high risks of combined obesity (aOR=1.80; 1.50 and 1.46 respectively). ConclusionsObesity is a highly prevalent disease in primary care patients, with significant geographical differences in Spain.

532P Clinical, pathological, and genetic characteristics of 27 Spanish patients with POLG-related disorders

532P Clinical, pathological, and genetic characteristics of 27 Spanish patients with POLG-related disorders