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

Incidence of Upper and Lower Gastrointestinal Bleeding in New Users of Low-Dose Aspirin

Background & Aims: There are few data on the incidence of upper and lower gastrointestinal bleeding (UGIB and LGIB) from observational studies of low-dose aspirin users. We aimed to estimate incidence rates of UGIB and LGIB in a large cohort of new users of low-dose aspirin in the United Kingdom, with subanalyses of hospitalization status and fatalities. Methods: We performed a population-based study of 199, 079 new users of low-dose aspirin (median age, 64.0 years) identified from the Health Improvement Network primary care database (2000–2012). Individuals were followed for a median 5.4 years (maximum, 14 years) to identify new cases of UGIB and LGIB. Following multistep validation, we calculated overall and age- and sex-specific incidence rates; we performed subanalyses for health care use and death within 30 days of GIB. We also estimated rates within a matched (1:1) cohort of nonusers of low-dose aspirin at the start of the follow-up period. Results: The low-dose aspirin users had 1115 UGIB events and 1936 LGIB events; most subjects with UGIB events (58.9%) were hospitalized, whereas most subjects with LGIB events were referred to secondary care (72.8%). Crude incidence rates of GIB per 1000 person-years were 0.97 for subjects with UGIB (95% CI, 0.91–1.02) and 1.68 for subjects with LGIB (95% CI, 1.60–1.75). Incidence rates per 1000 person-years for patients hospitalized for GIB were 0.57 for UGIB (95% CI, 0.53–0.61) and 0.45 for LGIB (95% CI, 0.42–0.49); for referred (but not hospitalized) cases, these values were 0.39 for UGIB (95% CI, 0.36–0.43) and 1.22 for LGIB (1.16–1.29). Incidence rates per 1000 person-years were 0.06 for fatal UGIB (95% CI, 0.04–0.07), 0.01 for fatal LGIB (95% CI, 0.01–0.02), 0.91 for nonfatal UGIB (95% CI, 0.86–0.97), and 1.66 for nonfatal LGIB (95% CI, 1.59–1.74). Among nonusers of low-dose aspirin, incidence rates per 1000 person-years were 0.67 (95% CI, 0.63–0.75) for UGIB and 0.76 (95% CI, 0.72–0.82) for LGIB. Conclusion: In a population-based study of low-dose aspirin users, the incidence of LGIB was higher than the incidence of UGIB. However, incidence rates of hospitalized GI bleeds and 30-day mortality rates were lower for LGIB than for UGIB. These estimates are valuable for benefit–risk assessments of low-dose aspirin for cardiovascular and colorectal cancer prevention

Comportamiento observado durante el llenado de la presa de Rialb

La presa de Rialb, situada en el cauce del río Segre, fue construida con hormigón compactado con rodillo. La altura máxima de la presa es de 101 m y la longitud de coronación es de unos 605 m. En 1999 se inició el llenado de la presa de Rialb de acuerdo con el Plan de Puesta en Carga. Transcurridos más de diez años desde que se iniciase la puesta en carga, el llenado de la presa de Rialb prácticamente se ha completado. En el presente artículo se recogen los aspectos más significativos del comportamiento observado durante el llenado de la presa de Rialb haciendo referencia principalmente a la auscultación hidráulica

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

Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study

Objective To determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension

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

Gestión Ambiental de las Empresas Exportadoras de Calzado en El Salvador.

Los límites establecidos en el mercado exportador dificultan e imposibilitan el acceso de productos de las empresas del sector calzado que desconocen los reglamentos y normas internacionales, de países que promueven el progreso de una industria eco-amigable, posicionando a las empresas en niveles bajos de aceptación para la elaboración, comercialización y exportación de artículos que desfavorecen el entorno ambiental. La gestión ambiental en las empresas, está relacionada con factores internos y externos, dirigida a la obtención de objetivos predeterminados, efectuando normativas nacionales e internacionales, que inciden en su funcionamiento. En las empresas exportadoras de calzado es conveniente conocer los beneficios de gestiones ambientales. Durante la investigación monográfica se determinó en forma temporal y teórica la información obtenida para lograr observar y entender, aspectos relevantes del tema a investigar, e identificar los beneficios, determinando los elementos que afectan de manera positiva y negativa las exportaciones de calzado en El Salvador. Se dan a conocer en el marco teórico los antecedentes y generalidades, sobre las etapas de gestión ambiental adaptadas al sector calzado, los riesgos de los empresarios en el comercio internacional al exportar zapatos, relacionados con el entorno ambiental y su solución, además en el marco legal se muestra las normas y leyes que rigen en cuanto al proceso ambiental. Además, se muestran casos de empresas del sector calzado, analizando las ventajas al implementar acciones a favor del medio ambiente, y como un cambio en el empaque puede crear la diferencia entre la elección de los productos por los clientes y la incursión en nuevos mercados, entre otras ventajas. Finalmente se muestran las desventajas de realizar actividades comerciales sin contar con una gestión ambiental. El objetivo principal es identificar los beneficios para las empresas de calzado al implementar acciones ambientales para evitar pagos o gastos innecesarios por sanciones al incumplir normas y leyes, además de prevenir que su imagen frente a proveedores y clientes se deteriore, dificultando la comercialización de los productos en el exterior

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