Trends in acute myocardial infarction incidence and cardiovascular risk factors prevalence in 6 counties of Girona, Spain (1990-2005)

El conocimiento de la prevalencia de los factores de riesgo cardiovascular y las tasas de incidencia y mortalidad por infarto de miocardio de son clave para la adaptación de la prevención primaria de las enfermedades cardiovasculares a las características locales. La incidencia de infarto de miocardio en España ha sido, tradicionalmente, menor que la observada en otros países de Europa occidental, Estados Unidos y otros países anglosajones. Sorprendentemente, la prevalencia de los factores de riesgo cardiovascular en España es similar a la observada en países con tasas de incidencia mucho mayores. En la década 1990-1999, no se observó ningún cambio global en la incidencia de infarto de miocardio. No obstante, los hombres menores de 65 años mostraron una reducción significativa de las tasas de incidencia mientras que la tendencia en hombres de 65-74 años no se modificó significativamente. La prevalencia de factores de riesgo cardiovascular cambió de manera considerable. Los aspectos más destacables fueron una mejora en el diagnóstico, control y tratamiento de la hipertensión y el descenso de los niveles medios poblacionales de colesterol total y colesterol de las lipoproteínas de baja densidad (LDL). En este contexto, la reducción de los niveles medios de colesterol LDL fue el factor de riesgo con el mayor potencial para la prevención de la cardiopatía isquémica junto con el tabaco en individuos menores de 55 años.The primary prevention of cardiovascular disease must be adapted to local characteristics of cardiovascular risk factor prevalence, acute myocardial infarction mortality and incidence rates, and economic and cultural factors. Traditionally, acute myocardial infarction incidence in Spain has been lower than that found in north, east, and west European countries, the USA, and other English-speaking countries. However, the prevalence of risk factors in Spain was surprisingly similar to those countries with high acute myocardial infarction incidence. Essentially, no overall change in acute myocardial infarction incidence has been observed between 1990 and 1999. Nonetheless, men under age 65 showed a significant reduction in incidence rates, while the trend in men age 65-74 did not change significantly. The prevalence of cardiovascular risk factors, however, has undergone considerable change. The most noteworthy aspects are improvements in participants' awareness, control and treatment of hypertension, and improvement in total and low-density lipoprotein (LDL) cholesterol distribution. In this context, the reduction of LDL cholesterol levels had the highest potential for ischemic heart disease prevention, along with smoking prevention for people younger than 55

High-quality universal public healthcare: beneficial for patients and much more

Equity is widely accepted by the medical professions as a fundamental element of quality and providing equitable care has been included in the 2030 Agenda for Sustainable Development promoted by the United Nations.1 However, the provision of universal coverage is a necessary but insufficient requirement for achieving this goal.2 Several determinants of health have been described and the interactions among them are not a simple issue. The classical model developed by Dahlgren and Whitehead3 shows that individual lifestyles are embedded in social norms and networks, and in living and working conditions, which in turn are related to the wider socioeconomic and cultural environment. This model helps to explain the high vulnerability of the immigrant population, often attributed to social disadvantages translated into low socioeconomic status and consequently worse working conditions or housing

Eficacia, efectividad, eficiencia y seguridad de la implantación bilateral de implantes auditivos activos: implante activo de oído medio, implante de tronco cerebral e implante de conducción ósea

Implantación bilateral; Hipoacusia bilateral; Implante activo de oído medio; Implante de tronco cerebral; Implante de conducción óseaImplantació bilateral; Hipoacúsia bilateral; Implant actiu d'orella mitjana; Implant de tronc cerebral; Implant de conducció òssiaBilateral implementation; Bilateral hearing loss; Active middle-ear hearing aids; Brain stem hearing aids; Bone conduction hearing aidsThe aim of this study is to evaluate whether bilateral middle-ear, brainstem and bone conduction hearing aids are effective, efficient and safe as compared to unilateral hearing aids in patients of any age with bilateral hearing loss. This assessment was requested to determine whether or not the general National Health Service (NHS) portfolio of orthoprosthetic services for bilateral, active hearing aids should be updated. This report does not touch on cochlear hearing aids since the aforementioned NHS portfolio already includes the bilateral insertion thereof and specifies the specific situations in which it is indicated.L’objectiu és avaluar si la implantació bilateral dels implants actius d’orella mitjana, de tronc cerebral i de conducció òssia són eficaços, efectius, eficients i segurs en comparació amb la seva implantació unilateral en pacients (qualsevol edat) amb hipoacúsia bilateral. La petició d’elaborar aquest informe d’avaluació sorgeix de la necessitat de determinar si és necessari actualitzar la cartera comuna de serveis de prestacions ortoprotètiques del Sistema Nacional de Salut (SNS) pel que fa a la implantació bilateral d’implants auditius actius. En aquest informe s’han exclòs els implants coclears, perquè la cartera comuna de serveis de prestacions ortoprotètiques de l’SNS ja inclou la inserció bilateral d’aquests implants i especifica en quines situacions especials està indicat.El objetivo es evaluar si la implantación bilateral de los implantes activos de oído medio, de tronco cerebral y de conducción ósea son eficaces, efectivos, eficientes y seguros en comparación con su implantación unilateral en pacientes (cualquier edad) con hipoacusia bilateral. La petición de elaboración de este informe de evaluación surge de la necesidad de determinar si es necesario actualizar la cartera común de servicios de prestaciones ortoprotésicas del Sistema Nacional de Salud (SNS) en lo relativo a la implantación bilateral de implantes auditivos activos. En este informe se han excluido los implantes cocleares porque la cartera común de servicios de prestaciones ortoprotésicas del SNS ya incluye la inserción bilateral de estos implantes y especifica en qué situaciones especiales está indicado

Effectiveness of telephone monitoring in primary care to detect pneumonia and associated risk factors in patients with SARS-CoV-2

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience

Eficacia, efectividad, eficiencia y seguridad de la implantación bilateral de implantes auditivos activos: implante activo de oído medio, implante de tronco cerebral e implante de conducción ósea

Implantación bilateral; Hipoacusia bilateral; Implante activo de oído medio; Implante de tronco cerebral; Implante de conducción óseaImplantació bilateral; Hipoacúsia bilateral; Implant actiu d'orella mitjana; Implant de tronc cerebral; Implant de conducció òssiaBilateral implementation; Bilateral hearing loss; Active middle-ear hearing aids; Brain stem hearing aids; Bone conduction hearing aidsThe aim of this study is to evaluate whether bilateral middle-ear, brainstem and bone conduction hearing aids are effective, efficient and safe as compared to unilateral hearing aids in patients of any age with bilateral hearing loss. This assessment was requested to determine whether or not the general National Health Service (NHS) portfolio of orthoprosthetic services for bilateral, active hearing aids should be updated. This report does not touch on cochlear hearing aids since the aforementioned NHS portfolio already includes the bilateral insertion thereof and specifies the specific situations in which it is indicated.L’objectiu és avaluar si la implantació bilateral dels implants actius d’orella mitjana, de tronc cerebral i de conducció òssia són eficaços, efectius, eficients i segurs en comparació amb la seva implantació unilateral en pacients (qualsevol edat) amb hipoacúsia bilateral. La petició d’elaborar aquest informe d’avaluació sorgeix de la necessitat de determinar si és necessari actualitzar la cartera comuna de serveis de prestacions ortoprotètiques del Sistema Nacional de Salut (SNS) pel que fa a la implantació bilateral d’implants auditius actius. En aquest informe s’han exclòs els implants coclears, perquè la cartera comuna de serveis de prestacions ortoprotètiques de l’SNS ja inclou la inserció bilateral d’aquests implants i especifica en quines situacions especials està indicat.El objetivo es evaluar si la implantación bilateral de los implantes activos de oído medio, de tronco cerebral y de conducción ósea son eficaces, efectivos, eficientes y seguros en comparación con su implantación unilateral en pacientes (cualquier edad) con hipoacusia bilateral. La petición de elaboración de este informe de evaluación surge de la necesidad de determinar si es necesario actualizar la cartera común de servicios de prestaciones ortoprotésicas del Sistema Nacional de Salud (SNS) en lo relativo a la implantación bilateral de implantes auditivos activos. En este informe se han excluido los implantes cocleares porque la cartera común de servicios de prestaciones ortoprotésicas del SNS ya incluye la inserción bilateral de estos implantes y especifica en qué situaciones especiales está indicado

An end-to-end framework for intima media measurement and atherosclerotic plaque detection in the carotid artery

Background and objectives: the detection and delineation of atherosclerotic plaque are usually manually performed by medical experts on the carotid artery. Evidence suggests that this manual process is subject to errors and has a large variability between experts, equipment, and datasets. This paper proposes a robust end-to-end framework for automatic atherosclerotic plaque detection. Methods: the proposed framework is composed of: (1) a semantic segmentation model based on U-Net, with EfficientNet as the backbone, that obtains a segmentation mask with the carotid intima-media region; and (2) a convolutional neural network designed using Bayesian optimization that simultaneously performs a regression to get the average and maximum carotid intima media thickness, and a classification to determine the presence of plaque. Results: our approach improves the state-of-the-art in both co and bulb territories in the REGICOR database, with more than 8000 images, while providing predictions in real-time. The correlation coefficient was 0.89 in the common carotid artery and 0.74 for bulb region, and the F1 score for atherosclerotic plaque detecting was 0.60 and 0.59, respectively. The experimentation carried out includes a comparison with other fully automatic methods for carotid intima media thickness estimation found in the literature. Additionally, we present an extensive experimental study to evaluate the robustness of our proposal, as well as its suitability and efficiency compared to different versions of the framework. Conclusions: the proposed end-to-end framework significantly improves the automatic characterization of atherosclerotic plaque. The generation of the segmented mask can be helpful for practitioners since it allows them to evaluate and interpret the model's results by visual inspection. Furthermore, the proposed framework overcomes the limitations of previous research based on ad-hoc post-processing, which could lead to overestimations in the case of oblique forms of the carotid artery

Trends in acute myocardial infarction incidence and cardiovascular risk factors prevalence in 6 counties of Girona, Spain (1990-2005)

Descripció del recurs: 10 juny 2010El conocimiento de la prevalencia de los factores de riesgo cardiovascular y las tasas de incidencia y mortalidad por infarto de miocardio de son clave para la adaptación de la prevención primaria de las enfermedades cardiovasculares a las características locales. La incidencia de infarto de miocardio en España ha sido, tradicionalmente, menor que la observada en otros países de Europa occidental, Estados Unidos y otros países anglosajones. Sorprendentemente, la prevalencia de los factores de riesgo cardiovascular en España es similar a la observada en países con tasas de incidencia mucho mayores. En la década 1990-1999, no se observó ningún cambio global en la incidencia de infarto de miocardio. No obstante, los hombres menores de 65 años mostraron una reducción significativa de las tasas de incidencia mientras que la tendencia en hombres de 65-74 años no se modificó significativamente. La prevalencia de factores de riesgo cardiovascular cambió de manera considerable. Los aspectos más destacables fueron una mejora en el diagnóstico, control y tratamiento de la hipertensión y el descenso de los niveles medios poblacionales de colesterol total y colesterol de las lipoproteínas de baja densidad (LDL). En este contexto, la reducción de los niveles medios de colesterol LDL fue el factor de riesgo con el mayor potencial para la prevención de la cardiopatía isquémica junto con el tabaco en individuos menores de 55 años

Vitamin D supplementation and COVID-19 risk: a population-based, cohort study

Purpose: To analyze the associations between cholecalciferol or calcifediol supplementation, serum 25-hydroxyvitamin D (25OHD) levels and COVID-19 outcomes in a large population. Methods: All individuals ≥ 18 years old living in Barcelona-Central Catalonia (n = 4.6 million) supplemented with cholecalciferol or calcifediol from April 2019 to February 2020 were compared with propensity score-matched untreated controls. Outcome variables were SARS-CoV2 infection, severe COVID-19 and COVID-19 mortality occuring during the first wave of the pandemic. Demographical data, comorbidities, serum 25OHD levels and concomitant pharmacological treatments were collected as covariates. Associations between cholecalciferol or calcifediol use and outcome variables were analyzed using multivariate Cox proportional regression. Results: Cholecalciferol supplementation (n = 108,343) was associated with slight protection from SARS-CoV2 infection (n = 4352 [4.0%] vs 9142/216,686 [4.2%] in controls; HR 0.95 [CI 95% 0.91-0.98], p = 0.004). Patients on cholecalciferol treatment achieving 25OHD levels ≥ 30 ng/ml had lower risk of SARS-CoV2 infection, lower risk of severe COVID-19 and lower COVID-19 mortality than unsupplemented 25OHD-deficient patients (56/9474 [0.6%] vs 96/7616 [1.3%]; HR 0.66 [CI 95% 0.46-0.93], p = 0.018). Calcifediol use (n = 134,703) was not associated with reduced risk of SARS-CoV2 infection or mortality in the whole cohort. However, patients on calcifediol treatment achieving serum 25OHD levels ≥ 30 ng/ml also had lower risk of SARS-CoV2 infection, lower risk of severe COVID-19, and lower COVID-19 mortality compared to 25OHD-deficient patients not receiving vitamin D supplements (88/16276 [0.5%] vs 96/7616 [1.3%]; HR 0.56 [CI 95% 0.42-0.76], p < 0.001). Conclusions: In this large, population-based study, we observed that patients supplemented with cholecalciferol or calcifediol achieving serum 25OHD levels ≥ 30 ng/ml were associated with better COVID-19 outcomes

Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva

OBJECTIVE: To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS: Design, Cohort study. LOCATION: Representative population sample of a health area of Extremadura (Spain) PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. MEASUREMENTS: Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. OUTCOME VARIABLE: First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS: 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS: Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy

Association of calcitriol supplementation with reduced COVID-19 mortality in patients with chronic kidney disease: a population-based study

Treatment with calcitriol, the hormonal form of vitamin D, has shown beneficial effects in experimental models of acute lung injury. In this study, we aimed to analyze the associations between calcitriol supplementation and the risk of SARS-CoV2 infection or COVID-19 mortality. Individuals ≥18 years old living in Catalonia and supplemented with calcitriol from April 2019 to February 2020 were compared with propensity score matched controls. Outcome variables were SARS-CoV2 infection, severe COVID-19 and COVID-19 mortality. Associations between calcitriol supplementation and outcome variables were analyzed using multivariable Cox proportional regression. A total of 8076 patients were identified as being on calcitriol treatment. Advanced chronic kidney disease and hypoparathyroidism were the most frequent reasons for calcitriol supplementation in our population. Calcitriol use was associated with reduced risk of SARS-CoV2 infection (HR 0.78 [CI 95% 0.64-0.94], p = 0.010), reduced risk of severe COVID-19 and reduced COVID-19 mortality (HR 0.57 (CI 95% 0.41-0.80), p = 0.001) in patients with advanced chronic kidney disease. In addition, an inverse association between mean daily calcitriol dose and COVID-19 severity or mortality was observed in treated patients, independently of renal function. Our findings point out that patients with advanced chronic kidney disease could benefit from calcitriol supplementation during the COVID-19 pandemic