Measuring health related quality of life in heart failure

L’objectiu global d’aquesta tesis doctoral va ser identificar les fortaleses i limitacions de les mesures de Qualitat de Vida Relacionada amb la Salut desenvolupades específicament per pacients amb insuficiència cardíaca. Una revisió sistemàtica va trobar 7 qüestionaris de Qualitat de Vida Relacionada amb la Salut específics per insuficiència cardíaca: Chronic Heart Failure Assessment Tool (CHAT), Cardiac Health Profile congestive heart failure (CHPchf), Kansas City Cardiomyopathy questionnaire (KCCQ), Left Ventricular Disease Questionnaire (LVDQ), Minnesota Living with Heart Failure questionnaire (MLHFQ), i Quality of Life in Severe Heart Failure Questionnaire (QLSHFQ). L’evidència publicada fins 2006 senyalava el MLHFQ com el qüestionari més estès i recomanable. La versió espanyola del MLHFQ va mostrar característiques similars a l’original, així com també l’avaluació conjunta de versions de 20 països. A més, l’avaluació del model de mesura va confirmar la unidimensionalitat de la puntuació total del MLHFQ, i les seves dimensions física, emocional i social. L’actualització al 2011 de la revisió sistemàtica juntament amb l’avaluació estandarditzada per experts, varen destacar les propietats mètriques del KCCQ per sobre de les del MLHFQ

Factors influencing publication of scientific articles derived from masters theses in public health

OBJECTIVES: To evaluate theses of a Masters program in Public Health (MPH), in terms of the students' and theses' characteristics that influence publication of the thesis as a scientific article. METHODS: Longitudinal study of students who successfully completed the MPH at Universitat Pompeu Fabra and Universitat Autònoma de Barcelona (Spain) from 2006 to 2010. Participants completed an electronic survey and additional data were gathered from university files. RESULTS: 162 students participated in the study (83 % response rate). 60.5 % had already published an article derived from their thesis at the time of the study or were in process of publishing it. The likelihood of publishing in a peer-reviewed journal was greater among women (aRR = 1.41), among those who had a bachelor's degree in sciences other than health (aRR = 1.40), had completed the MPH on time (aRR = 2.10), had enrolled in a doctoral program after the MPH (aRR = 1.44) or had a masters thesis score of ≥7 (aRR = 1.61). CONCLUSIONS: The majority of MPH students published their thesis in a peer-reviewed journal. The strongest predictors of successful publication were related to academic performance

Factors influencing publication of scientific articles derived from masters theses in public health.

OBJECTIVES: To evaluate theses of a Masters program in Public Health (MPH), in terms of the students' and theses' characteristics that influence publication of the thesis as a scientific article. METHODS: Longitudinal study of students who successfully completed the MPH at Universitat Pompeu Fabra and Universitat Autònoma de Barcelona (Spain) from 2006 to 2010. Participants completed an electronic survey and additional data were gathered from university files. RESULTS: 162 students participated in the study (83 % response rate). 60.5 % had already published an article derived from their thesis at the time of the study or were in process of publishing it. The likelihood of publishing in a peer-reviewed journal was greater among women (aRR = 1.41), among those who had a bachelor's degree in sciences other than health (aRR = 1.40), had completed the MPH on time (aRR = 2.10), had enrolled in a doctoral program after the MPH (aRR = 1.44) or had a masters thesis score of ≥7 (aRR = 1.61). CONCLUSIONS: The majority of MPH students published their thesis in a peer-reviewed journal. The strongest predictors of successful publication were related to academic performance

Patient-reported outcomes before treatment for localized prostate cancer: are there differences among countries? Data from the True North Global Registry

Introduction: Similar Patient-Reported Outcomes (PROs) at diagnosis for localized prostate cancer among countries may indicate that different treatments are recommended to the same profile of patients, regardless the context characteristics (health systems, medical schools, culture, preferences…). The aim of this study was to assess such comparison. Methods: We analyzed the EPIC-26 results before the primary treatment of men diagnosed of localized prostate cancer from January 2017 onwards (revised data available up to September 2019), from a multicenter prospective international cohort including seven regions: Australia/New Zealand, Canada, Central Europe (Austria / Czech Republic / Germany), United Kingdom, Italy, Spain, and the United States. The EPIC-26 domain scores and pattern of three selected items were compared across regions (with Central Europe as reference). All comparisons were made stratifying by treatment: radical prostatectomy, external radiotherapy, brachytherapy, and active surveillance. Results: The sample included a total of 13,483 men with clinically localized or locally advanced prostate cancer. PROs showed different domain patterns before treatment across countries. The sexual domain was the most impaired, and the one with the highest dispersion within countries and with the greatest medians' differences across countries. The urinary incontinence domain, together with the bowel and hormonal domains, presented the highest scores (better outcomes) for all treatment groups, and homogeneity across regions. Conclusions: Patients with localized or locally advanced prostate cancer undergoing radical prostatectomy, EBRT, brachytherapy, or active surveillance presented mainly negligible or small differences in the EPIC-26 domains before treatment across countries. The results on urinary incontinence or bowel domains, in which almost all patients presented the best possible score, may downplay the baseline data role for evaluating treatments' effects. However, the heterogeneity within countries and the magnitude of the differences found across countries in other domains, especially sexual, support the need of implementing the PRO measurement from diagnosis

Inhaler Technique Questionnaire (InTeQ) in pediatric patients with asthma

Data de publicació electrònica: 06-03-202

Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures

Background: The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose. Methods: A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed. Results: After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care. Conclusions: There is a wide variety of instruments to assess the patients' perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare

Impact of influenza on health-related quality of life among confirmed (H1N1)2009 patients

Background: We aimed to assess the changes in health-related quality of life (HRQL) in patients with confirmed diagnosis of influenza (H1N1)2009, and to estimate the individual and societal loss of quality-adjusted life years (QALYs) caused by the pandemic. Methods and Results: Longitudinal study of patients recruited at major hospitals and primary care centers in Spain. Patients reported their HRQL (EQ-5D) during their influenza episode and seven days prior to it. A subsample was monitored to evaluate HRQL after recovery. HRQL loss was estimated as the difference between EQ-5D prior to the influenza episode and during it. Individual QALY loss (disutility multiplied by the duration of the influenza episode in days) for confirmed cases was calculated and used to estimate the societal loss in Spain (with the official estimations). A total of 432 inpatients and 563 outpatients were included, of whom 145 and 184, respectively, were followed up. Baseline mean HRQL loss was 0.58 (95% CI, 0.53–0.63) for inpatients and 0.43 (95% CI, 0.40–0.46) for outpatients. The majority of the 145 inpatients and 184 outpatients who were followed up regained initial HRQL levels, presenting a mean difference of 0.01 between the EQ-5D score prior to and after the influenza episode. Individual QALY losses for inpatients (0.031, 95% CI, 0.025–0.037) were higher than for outpatients (0.009, 95% CI, 0.007–0.011), while societal QALY losses were reversed: 94 years for inpatients and 6,778 years for outpatients. For fatal cases (an official number of 318), we estimated a QALY loss of 11,981. Conclusions: The influenza (H1N1)2009 pandemic had a significant but temporary impact on the HRQL of the majority of confirmed in- and outpatients. The societal impact of the influenza pandemic in Spain was estimated to be higher than other acute conditions. These results provide useful data for future cost-utility analyses.This work was financed by the Health Institute ISCIII GR09/0026 as a commissioner Investigation; and by the AGAUR _2009 SGR 1095

Characteristics and contents of the Master's programs in public health in Spain

Objetivo: Comparar las principales características académicas y los contenidos de los distintos programas de máster en salud pública ofertados actualmente en España. Método: Se realizó una búsqueda sistemática en el Registro de Universidades, Centros y Títulos del Ministerio de Educación, Cultura y Deporte. Se analizaron las principales características académicas y los contenidos (obligatorios y optativos) de los programas de 11 másteres oficiales con la acreditación renovada en 2018 de acuerdo con los datos publicados en las páginas web de las universidades. Resultados: La mayoría de los programas son de 60 ECTS (European Credit Transfer and Accumulation System), presenciales, se imparten en español e incluyen en su plan de estudios la realización de un trabajo de fin de máster, pero no las prácticas profesionales. Los contenidos relacionados con estadística y epidemiología básica, y la actividad formativa del trabajo de fin de máster, son las únicas materias en las que coinciden todos los programas. Conclusiones: La mayoría de los programas de máster en salud pública muestran una cierta homogeneidad respecto a sus características académicas, pero una gran heterogeneidad en relación con sus contenidos. También existe mucha variabilidad en los créditos que se otorgan a las diferentes asignaturas, sobre todo a las optativas. Sería recomendable definir un core común, especialmente en los contenidos obligatorios.Objective: To compare the main academic characteristics and contents of the different master's programs in public health currently offered in Spain. Method: A systematic search has been carried out in the Register of Universities, Centers and Degrees of the Ministry of Education, Culture and Sports. The main academic characteristics and the contents (mandatory and optional) of the programs of 11 official master's degrees with the renewed accreditation in 2018 were analyzed based on the data published on the universities’ web pages. Results: Most programs are 60 ECTS (European Credit Transfer and Accumulation System), face-to-face, taught in Spanish, include in their curriculum the completion of a master's thesis but not professional practices. Only contents related to statistics and basic epidemiology, and the training activity of master's thesis, are offers by all programs. Conclusions: The majority of public health master's programs in Spain shows a certain homogeneity regarding their academic characteristics, but a great heterogeneity in relation to their contents. There is also a great heterogeneity in the credits granted to the different subjects, especially optional subjects. It would be advisable to standardize a common core, especially in the mandatory contents

Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments

Purpose: The objective was to obtain a standardized evaluation of available prostate cancer-specific quality of life instruments used in patients with early-stage disease. Methods: We carried out systematic literature reviews in the PubMed database to identify manuscripts which contained information regarding either the development process or metric properties of prostate cancer-specific quality of life instruments. Each instrument was evaluated by two experts, independently, using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0–100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden and alternative forms. Results: Eight instruments and 57 manuscripts (2–15 per instrument) were identified. The Expanded Prostate Cancer Index Composite (EPIC) was the best rated (overall EMPRO score 83.1 points). Good results were also obtained by University of California Los Angeles-Prostate Cancer Index (UCLA-PCI), Patient-Oriented Prostate Utility Scale (PORPUS) and Prostate Cancer Quality of Life Instrument (PC-QoL) with 77.3, 70.5 and 64.8 points, respectively. These four instruments passed with distinction the validity and responsiveness evaluation. Insufficient reliability results were observed for UCLA-PCI and PORPUS. Conclusions: Current evidence supports the choice of EPIC, PORPUS or PC-QoL. Attribute-specific EMPRO results facilitate selecting the adequate instrument for every purpose. For longitudinal studies or clinical trials, where responsiveness is the priority, EPIC or PC-QoL should be considered. We recommend the PORPUS for economic evaluations because it allows cost-utility analysis, and EPIC short versions to minimize administration burden.This study was supported by grants from AGAUR (2012FI_B1 00177; 2009 SGR 1095), Instituto Carlos III FEDER (PS09/02139) and RecerCAIXA (2010ACUP 00158

Utilización de servicios y costes de los pacientes con gripe (H1N1) 2009 en España: antecedentes y protocolo de investigación

Las epidemias de gripe son causa de morbi-mortalidad y tienen un gran impacto socio-económico. Ocasionalmente, los brotes de gripe generan pandemias. La última originada por el virus de la Gripe (H1N1)2009. Teniendo en cuenta la evidencia actualmente disponible y siendo la gripe una de las enfermedades de mayor impacto epidemiológico y máxima relevancia en la gestión de los servicios sanitarios, la evaluación de la utilización de recursos socio-sanitarios y sus costes asociados debería ser prioritaria. Con el objetivo de dar respuesta a esta necesidad se puso en marcha este estudio, cuyo protocolo de investigación se detalla en este manuscrito. Se trata de un estudio observacional, longitudinal y multicéntrico que pretende comparar los costes sanitarios con los derivados de la pérdida de productividad, así como estimar los costes incrementales y el coste-utilidad de las intervenciones de prevención y tratamiento, todo ello en pacientes hospitalizados y ambulatorios. Se recogerá (evaluación basal y seguimiento) información sociodemográfica, clínica, de utilización de recursos socio-sanitarios y estado de salud. Los análisis se realizarán bajo la perspectiva de la sociedad y el enfoque de la incidencia. Para la valoración monetaria se imputará el coste unitario a la frecuencia de utilización. Se calcularán los costes incrementales de las estrategias de prevención y tratamiento. El coste-utilidad se estimará a partir de la pérdida de utilidad y se analizará la pérdida global de años de vida ajustados por calidad. Nuestro estudio aportará información original que permitirá estimar el impacto económico de la gripe y ayudará en la toma de decisiones en la gestión sanitaria