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

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

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

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

Classifying and communicating risks in prediabetes according to fasting glucose and/or glycated hemoglobin : PREDAPS cohort study

Information about prognostic outcomes can be of great help for people with prediabetes and for physicians in the face of scientific controversy about the cutoff point for defining prediabetes. We aimed to estimate different prognostic outcomes in people with prediabetes. Prospective cohort of subjects with prediabetes according to American Diabetes Association guidelines. The probabilities of diabetes onset versus non-onset, the odds against diabetes onset, and the probability of reverting to normoglycemia according to different prediabetes categories were calculated. The odds against diabetes onset ranged from 29:1 in individuals with isolated FPG of 100-109 mg/dL to 1:1 in individuals with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. The probability of reversion to normoglycemia was 31.2% (95% CI 24.0-39.6) in those with isolated FPG 100-109 mg/dL and 6.2% (95% CI 1.4-10.0) in those with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. Of every 100 participants in the first group, 97 did not develop diabetes and 31 reverted to normoglycemia, while in the second group those figures were 52 and 6. Using odds of probabilities and absolute numbers might be useful for people with prediabetes and physicians to share decisions on potential interventions

The role of prenatal exposure to antidepressants, anxiolytic, and hypnotics and its underlying illness on the risk of miscarriage using BIFAP database

Purpose: Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period is still controversial. We aimed to separately assess the role of effects of the antidepressants and anxiolytic and the underlying illness, controlled by potential confounding associated with miscarriage onset. Methods: We used data from a validated pregnant cohort aged 15–49 years from 2002 to 2016 using BIFAP database. All confirmed miscarriages were used to perform a nested control analysis using conditional logistic regression. Women were classified according to use of each drug of interest into four mutually exclusive groups: nonusers, users only during prepregnancy, continuers, and initiators during first trimester. Adjusted odds ratios (aORs) for major confounders during pregnancy such as number of visits to primary care practitioners visits, obesity, smoking, HTA, diabetes with 95% confidence intervals were calculated. Results: Compared with nonusers, antidepressants continuers had the highest increased risk of miscarriage aOR (95%) of 1.29 (1.13–1.46), being continuers of paroxetine and fluoxetine the antidepressants with the strongest association. Likewise, continuers of anxiolytics and initiators showed an increased risk of 1.19 (1.04–1.37) and 1.30 (1.13–1.50). When separating the effect between the condition itself or the treatment, women exposed during first trimester, regardless treatment duration and/or the underlying illness, had the highest risk 1.27 (1.08–1.51) for antidepressants and 1.25 (1.13–1.39) for anxiolytics. Conclusions: Our analysis showed an association between prenatal exposure to antidepressants and anxiolytics and miscarriage onset after controlling by potential confounding adjusting for confounders and the underlying illness. This association was not supported for hypnotic medications. Further studies are warranted to evaluate the risk of miscarriage among subpopulation of pregnant women requiring these medications

Formación de agentes de prevención de la soledad: Acompañamiento y fomento de hábitos saludables para personas mayores en situación de soledad no deseada II (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 2021”. ApS_Te_acompaño trata de mantener la experiencia de ApS comenzada en el curso 2020_21, 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) y de la asignatura de Práctica Clínica II: Intervención Neurocognitiva y Social del Grado en Terapia Ocupacional que se imparte en la Facultad de Medicina

La aplicabilidad de los conocimientos y competencias adquiridos en el aula desde la perspectiva laboral como herramienta docente en salud pública

Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmitte

Fomento del autoaprendizaje mediante la construcción de exámenes tipo test

Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmitte