Asthma inhaler adherence determinants in adults : systematic review of observational data

Copyright ©ERS 2014. Acknowledgements We would like to thank Eric van Ganse (Claude Bernard University Lyon 1, Lyon, France) and Marcel Bouvy (Utrecht University, Utrecht, the Netherlands) for valuable discussions regarding the systematic review process, and Dan Dediu (Max Plank Institute, Nijmegen, the Netherlands) for support with conducting the review and summarising results visuallyPeer reviewedPostprin

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006–2020 in Catalonia

Menús escolars; Compliment de les recomanacions dietètiques; Nutrició infantilMenús escolares; Cumplimiento de las recomendaciones dietéticas; Nutrición infantilSchool menus; Compliance with dietary recommendations; Child nutritionBackground: The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME’s recommendations in the meals provided by school cafeterias in Catalonia during the period 2006–2020. Methods: Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System’s “Consensus document on nutrition in schools” and the Public Health Agency of Catalonia’s current guide “Healthy eating at school”. Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category. Results: Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p = < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216). Conclusions: The positive evolution in compliance with PReME’s recommendations provides evidence of the programme’s effectiveness, with an improvement in the quality of school meals delivered in Catalonia

Description of thyroid disorders the year before conception: a population-based study

ObjectiveThis study aimed to monitoring the prevalence of previously identified thyroid disorders and hypothyroidism monitoring before pregnancy.Material and methodsA retrospective cross-sectional study of women whose pregnancies occurred between 2014 and 2016 was conducted, including 120,763 pregnancies in Catalonia (Spain). The presence of thyroid disorders in women was based on disease diagnostic codes and/or prescription of levothyroxine or antithyroid drugs. To evaluate the thyroid disorder diagnosis and monitoring, thyrotropin (TSH), free T4 (FT4), antiperoxidase antibody (TPOAb), and anti-TSH receptor antibody (TRAb) records were gathered and categorised according to the reference values of each laboratory.ResultsThe prevalence of recorded thyroid disorders before the last menstrual period was 5.09% for hypothyroidism and 0.64% for hyperthyroidism,showing a significant increase with age. A thyroid monitoring test was not performed in the year before the last menstrual period in approximately 40% of women with a known thyroid disorder. Amongst the women with hypothyroidism who underwent a TSH test, 31.75% showed an above-normal result. Amongst women previously unknown to have thyroid disorders, 3.12% had elevated TSH levels and 0.73% had low TSH levels.ConclusionA high percentage of Catalan women with a known thyroid disorder were not properly monitored during the year before pregnancy. Amongst those monitored, more than one-third had TSH values outside the reference range. Therefore, it is important to evaluate women with thyroid disorders during pre-pregnancy visits

Detección de nistagmo en respuesta a la prueba de Dix-Hallpike en atención primaria: una comparación entre vértigo posicional paroxístico benigno subjetivo y objetivo

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0-10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR = 3.94, p = 0.021) and antihypertensive therapy (OR 3.02, p = 0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p = 0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV

Mejora del estreñimiento funcional con la ingesta de kiwi en una población mediterránea: Estudio piloto abierto no randomizado

Introduction: Kiwifruit consumption has shown to improve functional constipation in healthy elderly population, according to studies in New Zealand and China. The aim of this study was to evaluate the effect of kiwifruit intake on functional constipation in a Mediterranean patient population characterized by its distinctive nutritional habits.Material and Methods: An open, non-controlled and non-randomized longitudinal study was conducted in 46 patients with constipation (Rome III criteria). Patients monitored for five weeks: weeks 1 and 2 no kiwifruit and weeks 3-5 three kiwifruit per day (Green kiwifruit, Actinidia deliciosa var Hayward). Bristol Scale, volume of stools, and ease of defecation was self- reported daily. The evolution of the categorical variables was tested using the Bhapkar test; functional data methodology was used for continuous variables, and Generalized Estimating Equation (GEE) models were adjusted.Results: The percentage of patients with ≥3 stools per week increased from 82.61% (95% CI: 69–91.2) at week 1 to 97.78% (95% CI: 87.4–99.9) at week 2 of kiwifruit intake, with 76.09% (95% CI: 61.9–86.2) responding during the first week. The reporting of stable ideal stools increased from 17.39% (95% CI: 8.8–31) at week 2 to 33.33% (95% CI: 21.3–48) at week 5. According to GEE models, the number of depositions increased significantly (p-values&lt;0.001) in 0.398 daily units at week 1 the first week of intake, up to 0.593 daily units at week 5; significant improvements on facility in evacuation and volume of evacuation were found from the firstweek of intake (all p-values&lt;0.001).Conclusions: The intake of three kiwifruits per day significantly improves the quality of evacuation (number of depositions, volume, consistency and ease) in a Mediterranean patient population suffering from functional constipation.Introducción: Consumir kiwi mejora el estreñimiento funcional en la población anciana sana de Nueva Zelanda y China. Nuestro objetivo es evaluar el efecto del kiwi en la población mediterránea con estreñimiento.Material y métodos: Estudio prospectivo longitudinal no cegado no aleatorizado. 46 pacientes adultos con estreñimiento (criterios Roma-III) fueron seguidos durante cinco semanas: dos previas y tres durante la intervención (3 kiwi/día) (Green kiwifruit, Actinidia deliciosa var Hayward). Autoinforme diario del número de deposiciones, consistencia y volumen heces y facilidad de evacuación. La evolución de las variables categóricas se testó con el test Bhapkar, las variables continuas mediante metodología de análisis de datos funcionales ajustando modelos basados en las ecuaciones de estimación generalizadas (GEE).Resultados: El porcentaje de pacientes con ≥3 deposiciones/semana aumentó de 82,61% (IC 95%: 69–91,2) en la primera semana hasta 97,78% (IC 95%: 87,4–99,9) al final de semana 2 de consumo, con una respuesta del 76,09% (IC 95%: 61,9–86,2) en la primera semana. El porcentaje de heces consideradas ideales pasó de 17,39% (IC 95%: 8,8–31) en la segunda semana a 33,33% (IC 95%: 21,3–48) en la semana 5. Según los modelos GEE, el número de deposiciones aumenta significativamente (valor p&lt;0,001) en 0,398 unidades diarias en la primera semana de consumo, hasta 0,593 unidades diarias en la última semana. A partir de la primera semana se observa mejoras significativas en el volumen de las heces y en la facilidad de la defecación (valores p&lt;0,001).Conclusiones: Consumir tres kiwis al día mejora significativamente la calidad de la evacuación (número deposiciones, volumen, consistencia y facilidad evacuación), en una población mediterránea de pacientes con estreñimiento

Appropriateness of colonoscopy requests according to EPAGE-II in the Spanish region of Catalonia

Background: In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. Methods: Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). Results: The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women. Conclusions: Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC

Final Stage of Chronic Kidney Disease with Conservative Kidney Management or Renal Replacement Therapy: A Primary-Care Population Study

Background: Studies focus on the incidence and risk factors (RFs) associated with reaching the final stage of chronic kidney disease (CKD-G5) and receiving kidney replacement therapy (KRT). Analysis of those related to reaching CKD-G5 while receiving conservative kidney management (CKM) has been neglected. Methods: Retrospective cohort study analysing electronic health records of individuals aged & GE; 50 with eGFR < 60 mL/min/m(2). Cumulative incidence rates of CKD-G5, with and without KRT, were calculated. Multinomial regression models determined odds ratios (ORs) for CKD-G5 progression with KRT, CKM, or death. Results: Among 332,164 patients, the cumulative incidence of CKD-G5 was 2.79 cases per 100 person-years. The rates were 1.92 for CKD-G5 with KRT and 0.87 for CKD-G5 with CKM. Low eGFR and albuminuria were the primary RFs. Male gender and uncontrolled blood pressure had a greater impact on KRT (OR = 2.63 CI, 1.63) than on CKD-G5 with CKM (OR = 1.45 CI, 1.31). Increasing age and rurality reduced the probability of KRT but increased the probability of CKD-G5 with CKM. Higher incomes decreased the likelihood of developing CKD-G5 with and without KRT (OR = 0.49 CI). Conclusion: One-third of CKD-G5 cases receive CKM. Those are typically older, female, rural residents with lower incomes and with lesser proteinuria or cardiovascular RF. The likelihood of receiving KRT is influenced by location and socioeconomic disparities

Violencia de género durante la gestación: asociación con la interrupción voluntaria del embarazo y complicaciones de salud neonatales

Objetivo: Evaluar si la exposición a la violencia de género durante la gestación se relaciona con la interrupción voluntaria del embarazo y las complicaciones de salud neonatales que conlleven el ingreso en una Unidad de Cuidados Neonatales. Metodología: Estudio observacional, descriptivo y prospectivo, llevado a cabo en los dos centros de Atención a la Salud Sexual y eproductiva de L'Hospitalet de Llobregat (Barcelona). Cumplimentaron el cuestionario validado de detección de violencia de género Index of Spouse Abuse las mujeres gestantes asistidas por matronas de los centros participantes. Conjuntamente, se recogieron variables sociodemográficas y obstétricas. Se realizó un análisis descriptivo, bivariante y multivariante de los datos. Resultados: Se obtuvo una muestra de 120 mujeres que solicitaron una interrupción voluntaria del embarazo y 381 que continuaron con la gestación. La prevalencia de violencia de género en el último año fue significativamente mayor (p <0,001) entre las mujeres gestantes que decidieron interrumpir el embarazo (25%) que entre las que decidieron continuar con el mismo (8,92%). La exposición a la violencia de género se asocia, después de ajustar otros factores explicativos, con un mayor riesgo de solicitar una interrupción voluntaria del embarazo (odds ratio [OR]= 4,06; intervalo de confianza [IC] del 95%: 2,23-7,48; p <0,001), y con un mayor riesgo de complicaciones neonatales (OR= 2,68; IC del 95%: 1,02-6,48). Conclusiones: La exposición a la violencia de género durante la gestación se relaciona con la interrupción voluntaria del embarazo y los ingresos del recién nacido por complicaciones de salud. Por ello, es necesario preguntar sobre violencia de género durante la asistencia sanitaria, tanto a las mujeres que continúan con el embarazo como a las que deciden interrumpirlo

Double-blind placebo-controlled randomized clinical trial to assess the efficacy of montelukast in mild to moderate respiratory symptoms of patients with long COVID: E-SPERANZA COVID Project study protocol

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to affect the globe. After 18 months of the SARS-CoV-2 emergence, clinicians have clearly defined a subgroup of patients with lasting, disabling symptoms. While big strides have been made in understanding the acute phase of SARS-CoV-2 infection, the pathophysiology of long COVID is still largely unknown, and evidence-based, effective treatments for this condition remain unavailable. Objectives: To evaluate the efficacy of 10 mg oral montelukast every 24 h versus placebo in improving quality of life associated with mild to moderate respiratory symptoms in patients with long COVID as measured with the COPD Assessment Test (CAT) questionnaire. The secondary objectives will evaluate the effect of montelukast versus placebo on improving exercise capacity, COVID-19 symptoms (asthenia, headache, mental confusion or brain fog, ageusia, and anosmia), oxygen desaturation during exertion, functional status, and mortality. Methods and analysis: Phase III, randomized, double-blind clinical trial. We will include 18- to 80-year-old patients with SARS-CoV-2 infection and mild to moderate respiratory symptoms lasting more than 4 weeks. Participants will be randomly allocated in a 1:1 ratio to the intervention (experimental treatment with 10 mg/day montelukast) or the control group (placebo group), during a 28-day treatment. Follow-up will finish 56 days after the start of treatment. The primary outcome will be health-related quality of life associated with respiratory symptoms according to the COPD Assessment Test 4 weeks after starting the treatment. The following are the secondary outcomes: (a) exercise capacity and oxygen saturation (1-min sit-to-stand test); (b) Post-COVID-19 Functional Status Scale; (c) other symptoms: asthenia, headache, mental confusion (brain fog), ageusia, and anosmia (Likert scale); (d) use of healthcare resources; (e) mortality; (f) sick leave duration in days; and (g) side effects of montelukast. Ethics and dissemination: This study has been approved by the Clinical Research Ethics Committee of the IDIAPJGol (reference number 21/091-C). The trial results will be published in open access, peer-reviewed journals and explained in webinars to increase awareness and understanding about long COVID among primary health professionals