Glycemic markers and relation with arterial stiffness in Caucasian subjects of the MARK study

[EN]BACKGROUND: Effect of prediabetes and normal glucose on arterial stiffness remains controversial. The primary aim of this study was to investigate the relationship of fasting plasma glucose (FPG), postprandial glucose (PG) and glycosylated haemoglobin (HbA1c) with brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) in Caucasian adults. The secondary aim was to analyse this relationship by glycaemic status. METHODS: Cross-sectional study. Setting: Primary care. Participants: 2,233 subjects, 35-74 years. Measures: FPG (mg/dL) and HbA1c (%) of all subjects were measured using standard automated enzymatic methods. PG (mg/dL) was self-measured at home two hours after meals (breakfast, lunch and dinner) for one day using an Accu-chek ® glucometer. CAVI was measured using a VaSera VS-1500® device (Fukuda Denshi), and baPWV was calculated using a validated equation. RESULTS: CAVI and baPWV values were significantly higher in subjects with diabetes mellitus than in glucose normal and prediabetes groups (p<0.001). FPG, PG and HbA1c were positively associated with CAVI and baPWV. The β regression coefficient for: HbA1c was 0.112 (CI 95% 0.068 to 0.155) with CAVI, 0.266 (CI 95% 0.172 to 0.359) with baPWV; for PG was 0.006 (CI 95% 0.004 to 0.009 and for FPG was 0.005 (CI 95% 0.002 to 0.008) with baPWV; and for PG was 0.002 (CI 95% 0.001 to 0.003) and 0.003 (CI 95% 0.002 to 0.004) with CAVI (p<0.01 in all cases). When analysing by hyperglycaemic status, FPG, PG and HbA1c were positively associated with CAVI and baPWV in subjects with type 2 diabetes mellitus. CONCLUSION: FPG, PG and HbA1c show a positive association with CAVI and baPWV, in Caucasian adults with intermediate cardiovascular risk factors. When analysing by hyperglycaemic status, the association is only maintained in subjects with type 2 diabetes mellitus

Associations between systolic interarm differences in blood pressure and cardiovascular disease outcomes and mortality

Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02–1.08) and 1.06 (95% CI, 1.02–1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01–1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00–1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01–1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06–1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal

Predicción de dependencia en ancianos atendidos en atención primaria = Prediction of dependency in the elderly attended in primary health care

Objective: To identify the elderly population attended in primary health care with more risk of becoming dependent for activities of daily living. Methods: A longitudinal study, based on data recorded in the medical record of people from 75 years old. We constructed a Cox models to determine the risk of becoming dependent on the follow up. The discrimination capacity of the model was estimated with the concordance index. Results: The model showed as predictors of dependency: the mental impairment, according to the Pfeiffer test, severe (HR: 3,02; 95% CI 2,03-4,49) or moderate (HR: 1,35; 95% CI 1,08 to 1,68), homecare situation (HR: 1,82; 95% CI 1,44 to 2,31) and to have recorded history of falls (HR: 1,51; 95% CI 1,20 to 1,90). The C index of the derivation model was 0,72 (95% CI 0,68 to 0,76). Conclusions: The model accurately predicts patients most likely to be dependentObjetivo principal: Identificar a la población anciana atendida en atención primaria con más riesgo de ser dependiente para las actividades de la vida diaria. Metodología: estudio longitudinal, basado en datos registrados en la historia clínica informatizada de personas a partir de 75 años. Se construyó un modelo de Cox para determinar el riesgo de devenir dependiente en el seguimiento y se estimó su capacidad de discriminación. Resultados principales: el modelo mostró como variables predictoras de dependencia el deterioro mental severo (HR: 3,02; 95% IC 2,03-4,49) o moderado (HR: 1,35; 95% IC 1,08-1,68) según el test de Pfeiffer, tener la condición de atención domiciliaria (HR: 1,82; 95% IC 1,44-2,31) y tener historia de caídas registradas (HR: 1,51; 95% IC 1,20-1,90). El índice C del modelo fue de 0,72 (95% IC 0,68-0,76). Conclusión principal: El modelo predice de forma precisa aquellos pacientes con más probabilidad de ser dependiente

Programa de intervención multidisciplinaria para cuidadores de pacientes en atención domiciliaria Multidisciplinary intervention program for caregivers of patients in a home care program

Objetivos: Mejorar la calidad de vida, la ansiedad y la depresión de los cuidadores de pacientes en atención domiciliaria. Métodos: Ensayo clínico aleatorizado; 79 cuidadores principales (39 grupo control y 40 grupo intervención) de pacientes en atención domiciliaria de un centro de salud entre 2000 y 2001. La calidad de vida, la ansiedad y la depresión se midieron mediante los cuestionarios COOP/WONCA y la escala de Goldberg, respectivamente, al inicio y al final del estudio. Las intervenciones consistieron en 2 visitas médicas para realizar la anamnesis biopsicosocial del cuidador y una visita de enfermería sobre educación sanitaria. Se enviaron dos cartas adaptadas a cada cuidador y se realizaron dos llamadas telefónicas de apoyo. Resultados: Se observó una mejora significativa del grupo intervención respecto al grupo control en relación con WONCA-sentimientos (p = 0,03), WONCA-actividades sociales (p = 0,05) y WONCA-calidad de vida (p = 0,02). Conclusiones: Una intervención multidisciplinaria y adaptada a la consulta habitual podría reducir el deterioro de la calidad de vida de los cuidadores.Objectives: To improve quality of life, anxiety and depression in caregivers of patients in home care. Methods: We performed a randomized clinical trial in 79 main caregivers (39 control group and 40 intervention group) of patients in the home care program of a primary care health center between 2000 and 2001. Quality of life, anxiety and depression were measured by the COOP/WONCA and Goldberg questionnaires, respectively, at the beginning and at the end of the study. Interventions consisted of two medical visits to take a bio-psychosocial history of the caregiver and a nurse visit for health education. Two letters, adapted to each carer's needs, were sent and two telephone calls were made. vlife (p = 0.02). Conclusions: A short multidisciplinary intervention program adapted to routine consultations could prevent deterioration in caregivers' quality of life

Vascular structure and function and their relationship with health-related quality of life in the MARK study

[ENG]Background: There is limited evidence concerning the relationship between vascular disease and health-related quality of life (HRQL). We investigated the relationship between vascular structure and function with health-related quality of life in a population with intermediate cardiovascular risk. Methods: This study analyzed 303 subjects with ankle-brachial index (ABI) values ranging from 0.9 to 1.4 who were included in the MARK study (age 35 to 74 years; mean:60.5 ±8.5), of which 50.2 % were women. Measurements included: ABI, brachial-ankle pulse wave velocity (ba-PWV), and cardio-ankle vascular index (CAVI), all measured using the VaSera device. The central augmentation index was adjusted to 75 lpm (AIx_75) using the Mobil-O-Graph device. HRQL was assessed by the Spanish version of the SF-12, version2. The highest obtained CAVI and ba-PWV values and the lowest ABI values were considered for the study. Results: The cohort was composed of21 % smokers, 76 % hypertensive patients, and 24 % diabetic patients. The ABI mean was 1.09±0.07,the ba-PWV mean was 14.64±2.55 m/s with a 12.9 % of subjects higher than 17.5 m/s, AIx_75 26.46 ± 14.05, and CAVI 8.61 ± 1.08 with a 36.6 % of subjects higher than 9. Men scored higher than women in the HRQL measurements for physical (PSC-12; 49.9 vs. 46.9, p = 0.004) and mental (MSC-12) domains (51.2 vs. 47.7, p=0.003). Age was positively correlated with CAVI (r = 0.547), ba-PWV (r = 0.469), AIx_75 (r = 0.255, p < 0.01), and the MSC-12 (r =0.147, p<0.05), but not the PSC-12. In the adjusted multiple linear regression analysis, the positive association of ABI and CAVI with the PSC-12 was maintained. Conclusions: The ABI in the normal range has a positive association with the PSC-12 of HRQL evaluated with the SF-12. The CAVI also showed a positive association with the PSC-12 of HRQL. Trial Registration: ClinicalTrials.gov Identifier: NCT01428934

Primer cuestionario internacional validado sobre los conocimientos de los profesionales de la salud en el diagnóstico de la hipertensión arterial

Introduction: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals’ theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. Aim: To design and validate an instrument for gauging health professionals’ theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. Methodology: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. Results: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. Conclusions: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge.Introducción: La hipertensión arterial es el principal factor de mortalidad atribuible. Es por eso que se considera uno de los problemas de salud pública más importantes. Los profesionales de la salud necesitan una formación y unas habilidades especiales para realizar un diagnóstico. En la literatura actual no se han encontrado estudios que utilicen un instrumento validado (cuestionario) para evaluar los conocimientos teóricos y prácticos de los profesionales de la salud en el diagnóstico de la hipertensión o medición de la tensión arterial. Objetivo: Diseñar y validar un instrumento para medir los conocimientos teóricos de los profesionales de la salud en la medida de la tensión arterial para el diagnóstico inicial de la hipertensión. Metodología: Diseño, desarrollo y validación de un cuestionario en tres idiomas (inglés, español y catalán) para evaluar los conocimientos basados en el modelo de Rasch (teoría de la respuesta al ítem). Resultados: Se construyó y validó un cuestionario en tres idiomas. Constaba de 23 preguntas sobre los conocimientos teóricos en el diagnóstico inicial de hipertensión que se denominó cuestionario ARC. Cumplió con todos los criterios del modelo Rasch-IRT: medición de ajuste (fit) al ítem y a la persona, unidimensionalidad, independencia local, invarianza, targeting y fiabilidad. Conclusiones: El cuestionario ARC es una herramienta validada que permite realizar análisis objetivos y uniformes de los conocimientos en el diagnóstico inicial de la hipertensión entre profesionales de medicina y de enfermería, comparándolos en el tiempo. Permite desarrollar estrategias establecidas para potenciar este conocimiento

Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: a self-controlled case series study

Cold spells and heatwaves increase mortality. However little is known about the effect of heatwaves or cold spells on cardiovascular morbidity. This study aims to assess the effect of cold spells and heatwaves on cardiovascular diseases in a Mediterranean region (Catalonia, Southern Europe). Methods We conducted a population-based retrospective study. Data were obtained from the System for the Development of Research in Primary Care and from the Catalan Meteorological Service. The outcome was first emergency hospitalizations due to coronary heart disease, stroke, or heart failure. Exposures were: cold spells; cold spells and 3 or 7 subsequent days; and heatwaves. Incidence rate ratios (IRR) and 95% confidence intervals were calculated using the self-controlled case series method. We accounted for age, time trends, and air pollutants; results were shown by age groups, gender or cardiovascular event type. Results There were 22,611 cardiovascular hospitalizations in winter and 17,017 in summer between 2006 and 2013. The overall incidence of cardiovascular hospitalizations significantly increased during cold spells (IRR = 1.120; CI 95%: 1.10–1.30) and the effect was even stronger in the 7 days subsequent to the cold spell (IRR = 1.29; CI 95%: 1.22–1.36). Conversely, cardiovascular hospitalizations did not increase during heatwaves, neither in the overall nor in the stratified analysis. Conclusions Cold spells but not heatwaves, increased the incidence of emergency cardiovascular hospitalizations in Catalonia. The effect of cold spells was greater when including the 7 subsequent days. Such knowledge might be useful to develop strategies to reduce the impact of extreme temperature episodes on human healt