The commodity markets

Analysis of the price volatility of commodities markets (energy, raw materials, food). Coordination of global public polic

Núcleos y ámbitos de investigación sobre adicciones:necesidad de una visión más amplia

Carta al directorSr. Director, Cada vez es más trascendente profundizar en los diversos aspectos que se relacionan con la investigación científica en el campo de salud. Hasta hace poco, el foco se dirigía principalmente hacia sobre qué se investigaba, quién lo hacía, cuál era el factor de impacto de la revista, de qué institución era el investigador y cuál era su índice h. Esto resulta de utilidad para conocer la actividad investigadora en un campo determinado y puede contribuir a una mejor toma de decisiones a la hora de adjudicar recursos o decidir plazas universitarias. Particularmente, hemos realizado una serie de aportaciones en este campo que han permitido poner de relieve el panorama investigador en nuestras respectivas especialidades (Burbano et al., 2013; Miró y Burillo-Putze, 2012; Miró, Montori, Ramos, Galicia y Nogué, 2009)

The role of the emergency department in the management of acute heart failure: an international perspective on education and research

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research

Increased severity in SARS-CoV-2 infection of minorities in Spain

Introduction: With the global spread of COVID-19, studies in the US and UK have shown that certain communities have been strongly impacted by COVID-19 in terms of incidence and mortality. The objective of the study was to determine social determinants of health among COVID-19 patients hospitalized in the two major cities of Spain. Material and methods: A multicenter retrospective case series study was performed collecting administrative databases of all COVID-19 patients ≥18 years belonging to two centers in Madrid and two in Barcelona (Spain) collecting data from 1st March to 15th April 2020. Variables obtained age, gender, birthplace and residence ZIP code. From ZIP code we obtained per capita income of the area. Predictors of the outcomes were explored through generalized linear mixed-effects models, using center as random effect. Results: There were 5,235 patients included in the analysis. After multivariable analysis adjusted by age, sex, per capita income, population density, hospital experience, center and hospital saturation, patients born in Latin American countries were found to have an increase in ICU admission rates (OR 1.56 [1.13-2.15], p<0.01) but no differences were found in the same model regarding mortality (OR 1.35 [0.95-1.92], p=0.09). Conclusions: COVID-19 severity varies widely, not only depending on biological but also socio-economic factors. With the emerging evidence that this subset of population is at higher risk of poorer outcomes, targeted public health strategies and studies are needed

Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)

Objectives. To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. Methods. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. Results. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Conclusions. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased

Predicting 30-Day Mortality for Patients With Acute Heart Failure in the Emergency Department: A Cohort Study.

Background: Physicians in the emergency department (ED) need additional tools to stratify patients with acute heart failure (AHF) according to risk. Objective: To predict mortality using data that are readily available at ED admission. Design: Prospective cohort study. Setting: 34 Spanish EDs. Participants: The derivation cohort included 4867 consecutive ED patients admitted during 2009 to 2011. The validation cohort comprised 3229 patients admitted in 2014. Measurements: 88 candidate risk factors and 30-day mortality. Results: Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score. This score predicted 30-day mortality with excellent discrimination (c-statistic, 0.836) and calibration (Hosmer-Lemeshow P = 0.99) and provided a steep gradient in 30-day mortality across risk groups (<2% for patients in the 2 lowest risk quintiles and 45% in the highest risk decile). These characteristics were confirmed in the validation cohort (c-statistic, 0.828). Multiple sensitivity analyses did not find important amounts of confounding or bias. Limitations: The study was confined to a single country. Participating EDs were not selected randomly. Many patients had missing data. Measurement of some risk factors was subjective. Conclusion: This tool has excellent discrimination and calibration and was validated in a different cohort from the one that was used to develop it. Physicians can consider using this tool to inform clinical decisions as further studies are done to determine whether the tool enhances physician decision making and improves patient outcomes. Primary Funding Source: Instituto de Salud Carlos III, Spanish Ministry of Health; Fundació La Marató de TV3; and Catalonia Govern

Papel del factor precipitante de un episodio de insuficiencia cardiaca aguda en relación al pronóstico a corto plazo del paciente: estudio PAPRICA

Objetivos: Hay pocos estudios que analicen el papel que juegan los factores precipitantes (FPre) en el manejo de la insuficiencia cardiaca aguda (ICA). El estudio PAPRICA pretende analizar la relación entre la identificación de diferentes FPre con la mortalidad precoz y las reconsultas a los 30 días. Método: Estudio retrospectivo, multicéntrico, con seguimiento de cohortes a partir de los datos incluidos en el registro EAHFE (Epidemiology Acute Heart Failure Emergency). Se recogieron datos de todos los episodios de ICA en 8 servicios de urgencias hospitalarios (SUH) españoles durante el mes de abril de 2007. Se recogieron datos del perfil clínico y la evolución a corto plazo (mortalidad y reconsulta a los 30 días). La variable clasificadora del estudio fue la ausencia o presencia conocida de FPre del episodio de ICA. Sólo se recogió un FPre por episodio. Resultados: Se incluyeron 662 casos. El 51,4% de los casos presentaron un FPre. A los 30 días se registró una mortalidad del 6,2% y un índice de reconsultas del 26,6%. Los FPre más frecuentes fueron las infecciones (22,2%), las taquiarritmias (13%), la emergencia hipertensiva (4,9%), la transgresión del tratamiento (4,2%), la anemia (3,9%) y la isquemia coronaria (3,7%). En conjunto, no hubo diferencias significativas de los pacientes que tuvieron un FPre, ni en cuanto a mortalidad (5,0% con FPre vs 7,5% sin FPre, p = 0,25) ni en lo relativo a las reconsultas (29,3% vs 23,8%, p = 0,12). Individualmente, la infección respiratoria se asoció a un menor porcentaje crudo de reconsultas a los 30 días, pero no afectó la mortalidad. Para el resto de FPre se observaron algunas tendencias, pero ninguna alcanzó una significación estadística. Conclusiones: En el estudio PAPRICA, la identificación de un FPre del episodio de ICA no se asoció con el pronóstico a corto plazo, si bien algún FPre en concreto, especialmente la infección respiratoria, podría estar ligado a un pronóstico diferente respecto a los pacientes en los que no se identifica ningún FPre. [Emergencias 2012;24:438-446