Risk of Upper Gastrointestinal Bleeding in a Cohort of New Users of Low-Dose ASA for Secondary Prevention of Cardiovascular Outcomes

The Health Improvement Network UK primary care database was used to identify a cohort of 38 077 individuals aged 50–84 years with a first prescription of low-dose acetylsalicylic acid (ASA; 75–300 mg/day) for secondary prevention of cardiovascular or cerebrovascular events during 2000–2007. From this cohort, 169 incident cases of upper gastrointestinal bleeding (UGIB) were identified. Controls with no UGIB (n = 2000) were frequency-matched to the cases by age, sex, and follow-up time. A nested case–control analysis was performed to determine risk factors associated with UGIB. The incidence of UGIB was 1.1 per 1000 person-years (95% CI, 1.0–1.3). Low-dose ASA users with a history of peptic ulcer disease had an increased risk of UGIB compared with those without (Relative Risk [RR], 4.59; 95% CI, 2.87–7.33). Concomitant use of ASA and clopidogrel (RR, 1.61; 95% CI, 0.85–3.05) or non-steroidal anti-inflammatory drugs (NSAIDs; RR, 2.92; 95% CI, 1.77–4.82) conferred an increased risk of UGIB compared with ASA monotherapy. Discontinuation of ASA therapy (RR: 0.71, 95% CI, 0.42–1.20) and PPI co-treatment given since the start of ASA therapy (RR, 0.56; 95% CI, 0.33–0.96) were associated with a reduced risk of UGIB. In conclusion, in a cohort of individuals receiving low-dose ASA for secondary prevention of cardiovascular or cerebrovascular events, patients with a history of peptic ulcer disease, or who were receiving clopidogrel or NSAIDs had an increased risk of UGIB. The prescription of PPI therapy at the initiation of low-dose ASA reduced the risk of UGIB by almost half

El secreto bancario frente al deber de colaboración con la Administración Tributaria

Actualmente estamos presenciando una proliferación de las tarjetas de crédito y móviles como medios de pago. Todas estas transacciones y pagos quedan reflejadas en las cuentas bancarias constituyendo información financiera relevante para el cumplimiento de las obligaciones tributarias de los contribuyentes. Mientras que por un lado, los bancos y las entidades de crédito protegen todas las operaciones que sus clientes lleven a cabo con ellas, siendo esta debida confidencialidad la materialización de la histórica institución del secreto bancario. Por otro lado, nuestro ordenamiento prevé un deber de colaboración de dichas entidades frente a los requerimientos de nuestra Administración Tributaria. La conveniencia de aplicar o levantar el secreto bancario frente a estos requerimientos genera el conflicto de interés sobre qué deber debe de preponderar

Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care

Objectives To evaluate the risk of myocardial infarction and death from coronary heart disease after discontinuation of low dose aspirin in primary care patients with a history of cardiovascular events

Mortality in working-age population during the Great Recession and austerity in Spain

OBJECTIVE: To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population. METHODS: From 2005 to 2016 we calculated the annual all-cause mortality rate and the annual mortality rate from the main causes of death in the population aged 15 to 64. We also estimated the linear trends in mortality rates during four time intervals-2005-2007 (before crisis), 2008-2010 (first part of the crisis), 2011-2013 (second part of the crisis and implementation of austerity policies) and 2014-2016 (after the crisis)- by the annual percentage change (APC). RESULTS: The all-cause mortality rate in men and women showed the greatest decline in 2008-2010 and the smallest decline in 2014-2016. The decline in 2011-2013 was higher than in 2014-2016. The APCs in 2005-2007, 2008-2010, 2011-2013 and 2014-2016 were -2.8, -4.1, -3.0 and -1.5 in men and -1.0. -2.1, -1.1 and -0.6 in women, respectively, although the APC in 2014-2016 in women was not significant. In 2014-2016, cancer mortality showed the largest decrease, mortality from cardiovascular diseases (men), respiratory diseases and traffic accidents reversed and showed an upward trend, and the downward trend in mortality from infectious diseases and digestive diseases was equal to or greater than that observed before the crisis. CONCLUSION: The decline in all-cause mortality in the working-age population during the economic crisis and the introduction of austerity measures was greater than that observed before and after the economic crisis. The slowing of the decline after the crisis was due to the reversal of the trend in mortality from cardiovascular and respiratory diseases.This work was supported by the Instituto de Salud Carlos III (PI16/00455) and the European Regional Development Fund.S

Erosion of universal health coverage and trend in the frequency of physician consultations in Spain

Background: We studied the frequency of physician visits in the native and immigrant populations in Spain before and after implementation of a governmental measure to restrict the use of public healthcare services by undocumented immigrants beginning in 2012. Methods: Data were taken from the 2009 and 2014 European Health Surveys carried out in Spain. We investigated any physician consultation in the last 4 weeks before the interview, as well as visits to a family physician, public specialist physician and private specialist physician. We estimated the frequency of visits in 2009 and in 2014 in the native and immigrant populations and the difference in the frequency between the two populations, by calculating the percentage ratio estimated by binomial regression and adjusted for different confounders that are indicators of the need for assistance. Results: The percentage of persons who consulted any physician in 2009 and 2014 was 31.7 and 32.9% in the native population, and 25.6 and 30.1% in the immigrant population, respectively. In the immigrant population, the frequency of visits to the general practitioner and public specialist physician increased, whereas in the native population only public specialist physician visits increased. The frequency of private specialist visits remained stable in both populations. After adjusting for the indicators of need for healthcare, no significant differences between the immigrant and native populations were seen in the frequency of visits, except for private specialist consultations, which were less frequent among immigrants. Conclusion: The restriction of universal healthcare coverage in Spain did not reduce the frequency of physician visits between 2009 and 2014, as the frequency of these consultations was seen to increase in both the native and immigrant populations.This study was supported by a grant from the “Plan Estatal de I + D, Ministry of Science, Innovation and Universities of Spain (no. CSO2017–83180-P)

Rural–urban disparities in the reduction of avoidable mortality and mortality from all other causes of death in Spain, 2003–2019

Aim This study aims to evaluate the trend of avoidable mortality and of mortality from all other causes of death in urban and rural areas in Spain, throughout the first 2 decades of the twenty-first century. Methods Data deaths and population by age and sex, according to the area of residence, were obtained from the National Institute of Statistics. Avoidable mortality refers to premature deaths (≤ 75 years old) for which there is reasonable scientific consensus that they should not occur in the presence of timely health care. In large urban, small urban, and rural areas, annual age-standardized mortality rates from avoidable causes and from all other causes of death were calculated from 2003 to 2019. The annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. Results Mortality rates decreased between the beginning and the end of the period analysed. Large urban areas and rural areas showed the largest and smallest reduction in mortality rate respectively. The APC in avoidable mortality was −3.5% in men and −3.0% in women in large urban areas, and −2.7% in men and −2.6% in women in rural areas. The APC in the mortality rate from all other causes of death was −2.4% in men and −1.2% in women in large urban areas, and −1.4% in men and −1.0% in women in rural areas. Conclusion In Spain, avoidable mortality and mortality from other causes of death in rural and urban areas show similar trends, which suggests the presence of a common factor responsible for such findings.Open Access funding provided by Universidad Pública de Navarra. This study was supported by the Universidad Complutense de Madrid (grant No UCM 2022-920743)

Conectando moléculas: de la síntesis orgánica a la fabricación de dispositivos electrónicos moleculares

Actualmente, bajo el nombre de electrónica molecular hay un amplio campo interdisciplinario en el que se utilizan moléculas como elementos integrados en un circuito eléctrico. En esta área se pueden distinguir dos aproximaciones: i) la que se refiere a la utilización y estudio de las propiedades de una sola molécula o molécula individual, denominada como “single molecule devices”,single “molecule junctions” o “unimolecular electronics”. ii) Aquella en la que se utilizan conjuntos de moléculas organizadas mediante diferentes técnicas generalmente en forma de monocapas, denominada como “large-area”. En ambos casos, los dispositivos basados en EM presentan importantes ventajas frente a los dispositivos basados en el silicio. El abanico de posibilidades que abarca la electrónica molecular es inmenso y la gran mayoría de ellas requieren del trabajo de investigación a nivel básico antes de poder ser adaptados a niveles de funcionamiento macroscópico. En el caso de esta tesis doctoral la investigación se ha dirigido hacia la ampliación del conocimiento respecto a los grupos de anclaje, poniendo especial atención sobre el desarrollo de grupos de anclaje bidentados en nuevos hilos moleculares y a sus propiedades, a la fabricación del electrodo superior a través de nuevas metodologías y en menor medida, a la utilización de materiales carbonosos como electrodo o como hilo molecular en dispositivos tipo sándwich. Esta tesis doctoral posee un marcado carácter interdisciplinar en la que el objetivo principal es diseñar, sintetizar, ensamblar y estudiar las propiedades eléctricas de compuestos orgánicos que puedan ser integrados posteriormente como hilos moleculares en dispositivos con aplicaciones dirigidas a la electrónica molecular.Para alcanzar el objetivo principal se han planteado diferentes objetivos parciales que son abordados en los distintos capítulos de la memoria:• Síntesis de un derivado de oligofenilenoetinileno (OPE) con grupos de anclaje monodentados que proporcionan una unión electrodo-molécula robusta a través de un anillo piridínico y la posible funcionalización del sistema por desprotección del grupo trimetilsilano.• Síntesis de compuestos con nuevos grupos de anclaje bidentados no explorados en el ámbito de la electrónica molecular.• Optimización de los procesos de ensamblaje para la fabricación de monocapas orgánicas de alta calidad.• Desarrollo de una alternativa para la fabricación del electrodo superior en sistemas tipo sándwich, sin dañar la monocapa orgánica y con un alto nivel de recubrimiento.• Determinar las propiedades eléctricas de las moléculas a nivel individual y de los ensamblados moleculares fabricados, a fin de conocer y contrastar la viabilidad de los mismos.<br /

Formación de agentes de prevención de la soledad: Acompañamiento y fomento de hábitos saludables para personas mayores en situación de soledad no deseada (ApS_Te_acompaño)

ApS_Te_acompaño es un Proyecto de Aprendizaje-Servicio de la Universidad Complutense de Madrid en el marco de la “Convocatoria Proyectos Aprendizaje Servicio Complutense 2020”. ApS_Te_acompaño trata de poner en marcha una experiencia de ApS dirigida a la formación de Agentes Prevención de la Soledad, que les capacite para el desarrollo del acompañamiento y fomento de hábitos saludables para personas mayores en situación de soledad no deseada, fragilidad y/o vulnerabilidad social. El proyecto se llevó a cabo con los/as estudiantes del Máster Universitario en Salud, Integración y Discapacidad (MSID) que se imparte en la Facultad de Medicina, fruto de la experiencia previa durante el curso 2019/20 con motivo de la situación de crisis sociosanitaria provocada por la pandemia

Classifying and communicating risks in prediabetes according to fasting glucose and/or glycated hemoglobin : PREDAPS cohort study

Information about prognostic outcomes can be of great help for people with prediabetes and for physicians in the face of scientific controversy about the cutoff point for defining prediabetes. We aimed to estimate different prognostic outcomes in people with prediabetes. Prospective cohort of subjects with prediabetes according to American Diabetes Association guidelines. The probabilities of diabetes onset versus non-onset, the odds against diabetes onset, and the probability of reverting to normoglycemia according to different prediabetes categories were calculated. The odds against diabetes onset ranged from 29:1 in individuals with isolated FPG of 100-109 mg/dL to 1:1 in individuals with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. The probability of reversion to normoglycemia was 31.2% (95% CI 24.0-39.6) in those with isolated FPG 100-109 mg/dL and 6.2% (95% CI 1.4-10.0) in those with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. Of every 100 participants in the first group, 97 did not develop diabetes and 31 reverted to normoglycemia, while in the second group those figures were 52 and 6. Using odds of probabilities and absolute numbers might be useful for people with prediabetes and physicians to share decisions on potential interventions