Study design of Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS)

Aims: The role of non-invasive telemedicine (TM) combining telemonitoring and teleintervention by videoconference (VC) in patients recently admitted due to heart failure (HF) ('vulnerable phase' HF patients) is not well established. The aim of the Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS) trial is to assess the impact on clinical outcomes of implementing a TM service based on mobile health (mHealth), which includes remote daily monitoring of biometric data and symptom reporting (telemonitoring) combined with VC structured, nurse-based follow-up (teleintervention). The results will be compared with those of the comprehensive HF usual care (UC) strategy based on face-to-face on-site visits at the vulnerable post-discharge phase. Methods and results: We designed a 24 week nationwide, multicentre, randomized, controlled, open-label, blinded endpoint adjudication trial to assess the effect on cardiovascular (CV) mortality and non-fatal HF events of a TM-based comprehensive management programme, based on mHealth, for patients with chronic HF. Approximately 508 patients with a recent hospital admission due to HF decompensation will be randomized (1:1) to either structured follow-up based on face-to-face appointments (UC group) or the delivery of health care using TM. The primary outcome will be a composite of death from CV causes or non-fatal HF events (first and recurrent) at the end of a 6 month follow-up period. Key secondary endpoints will include components of the primary event analysis, recurrent event analysis, and patient-reported outcomes. Conclusions: The HERMeS trial will assess the efficacy of a TM-based follow-up strategy for real-world 'vulnerable phase' HF patients combining telemonitoring and teleintervention

El fraude en el pago de la Contribución Industrial y de comercio en España: el caso de los harineros, 1845-1907

Producción CientíficaEn este trabajo defiendo la hipótesis de que el fraude en el pago de los impuestos que gravaba n a la industria y al comercio en España superó el 50 por ciento y, lo que es peor, creció a lo largo de la segunda mitad del siglo. El fraude fue el resultado de la complejidad de los tributos, de la complicidad de las autoridades con los grandes contribuyentes y de la ausencia de una auténtica inspección. Pero sostengo que la tolerancia al fraude fue un instrumento de la política industrial. El Gobierno lo toleró con el fin de favorecer el desarrollo de algunos sectores. Para demostrar esta hipótesis he considerado lo sucedido en la fabricación de harinas, la dedicación productiva más extendida del país.In this article, the hypothesis defended is that fraud in the payment of industry and business taxes in Spain exceded 50 percent and, worse still, it grew during the second half of the 19th century. This fraud was the result of tax complexity, complicity of authorities with wealthy taxpayers, and the absence of any real inspection. However, the study claims that tolerance to fraud was an instrument of industrial policy, by which the Government tolerated it so as to favor the development of certain sectors. To demonstrate this hypothesis, an analysis is made of flour manufacturing, the most widespread productive industry in the country

Population prevalence and control of cardiovascular risk factors: What electronic medical records tell us

Objective: To analyze the prevalence, control, and management of hypertension, hypercholesterolemia, and diabetes mellitus type 2 (DM2). Design: Cross-sectional analysis of all individuals attended in the Catalan primary care centers between 2006 and 2009. Location: History of cardiovascular diseases, diagnosis and treatment of hypertension, hypercholesterolemia, DM2, lipid profile, glycemia and blood pressure data were extracted from electronic medical records. Age-standardized prevalence and levels of management and control were estimated. Participants: Individuals aged 35–74 years using primary care databases. Main measures: A total of 2,174,515 individuals were included (mean age 52 years [SD 11], 47% men). Results: Hypertension was the most prevalent cardiovascular risk factor (39% in women, 41% in men) followed by hypercholesterolemia (38% and 40%) and DM2 (12% and 16%), respectively. Diuretics and angiotensin-converting enzyme inhibitors were most often prescribed for hypertension control (<140/90 mmHg, achieved in 68% of men and 60% of women treated). Hypercholesterolemia was controlled (low-density lipoprotein cholesterol <130 mg/dl) in just 31% of men and 26% of women with no history of cardiovascular disease, despite lipid-lowering treatment, primarily (90%) with statins. The percentage of women and men with DM2 and with glycated hemoglobin <7% was 64.7% and 59.2%, respectively; treatment was predominantly with oral hypoglycemic agents alone (70%), or combined with insulin (15%). Conclusions: Hypertension was the most prevalent cardiovascular risk factor in the Catalan population attended at primary care centers. About two thirds of individuals with hypertension or DM2 were adequately controlled; hypercholesterolemia control was particularly low