Réplica

Aprovada pel Plenari del Consell Municipal de 17-09-1993Digitalitzat pel SEDA

Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study

Objective To assess the impact of prehospital factors (diagnostic pathways, first presentation to healthcare services, intervals, participation in primary care) on 1-year and 5-year survival in people with epithelial ovarian cancer (EOC). Design Retrospective quasi-population-based cohort study. Setting Catalan Integrated Public Healthcare System. Participants People with EOC who underwent surgery with a curative intent in public Catalan hospitals between 1 January 2013 and 31 December 2014. Outcome measures Data from primary and secondary care clinical histories and care processes in the 18 months leading up to confirmation (signs and symptoms at presentation, diagnosis pathways, referrals, diagnosis interval) of the EOC diagnosis (stage, histology type, treatment). Diagnostic process intervals were based on the Aarhus statement. 1-year and 5-year survival analysis was undertaken. Results Of the 513 patients included in the cohort, 67.2% initially consulted their family physician, while 36.4% were diagnosed through emergency services. In the Cox models, survival was influenced by advanced stage at 1 year (HR 3.84, 95% CI 1.23 to 12.02) and 5 years (HR 5.36, 95% CI 3.07 to 9.36), as was the type of treatment received, although this association was attenuated over follow-up. Age became significant at 5 years of follow-up. After adjusting for age, adjusted morbidity groups, stage at diagnosis and treatment, 5-year survival was better in patients presenting with gynaecological bleeding (HR 0.35, 95% CI 0.16 to 0.79). Survival was not associated with a starting point involving primary care (HR 1.39, 95% CI 0.93 to 2.09), diagnostic pathways involving referral to elective gynaecological care from non-general practitioners (HR 0.80, 95% CI 0.51 to 1.26), or self-presentation to emergency services (HR 0.82, 95% CI 0.52 to 1.31). Conclusions Survival in EOC is not associated with diagnostic pathways or prehospital healthcare, but it is influenced by stage at diagnosis, administration of primary cytoreduction plus chemotherapy and patient age

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<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<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<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<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

Factores relacionados con la calidad de vida de los pacientes con enfermedad pulmonar obstructiva crónica

ResumenObjetivoDescribir la relación entre factores pronósticos, individuales o asociados en clasificaciones multidimensionales (BODE y ADO), y la calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC).DiseñoEstudio descriptivo transversal.EmplazamientoAtención primaria.ParticipantesMuestreo aleatorizado sistemático de 102 pacientes diagnosticados de EPOC. Excluidos aquellos con exacerbación aguda, demencia, enfermedad terminal o los que reciben atención domiciliaria.Mediciones principalesDatos demográficos, hábito tabáquico, índice de masa corporal y número de exacerbaciones. Comorbilidad. Grado de disnea. Prueba de función respiratoria. Capacidad de ejercicio. El índice BODE y ADO. Cuestionario EuroQol-5D (EQ-5D) y escala visual analógica (EVA).ResultadosEn EQ-5D: movilidad, 43,9%; cuidado personal, 13,3%; actividades cotidianas, 29,6%; dolor/malestar, 55,1%; ansiedad/depresión, 37,8%. El 34,7% EVA ≤ 60%.Exacerbaciones: movilidad, OR: 1,85 (IC 95%: 1,08-3,20); cuidado personal, OR: 2,12 (IC 95%: 1,03-4,76); actividades cotidianas, OR: 2,35 (IC 95%: 1,17-4,71); EVA, coeficiente regresión: −3,50 (IC 95%: −6,31- −0,70). Disnea: movilidad, OR: 4,47 (IC 95%: 1,39-14,42); actividades cotidianas, OR: 7,71 (IC 95%: 2,03-12,34)]; EVA, coeficiente regresión: −7,15 (IC 95%: −11,71- −2,59).BODE: movilidad, OR: 1,53 (IC 95%: 1,15-2,02); cuidado personal, OR: 2,08 (IC 95%: 1,40-3,11); actividades cotidianas, OR: 1,97 (IC 95%: 1,38-2,80); EVA, coeficiente regresión: −3,96 (IC 95%: −5,51- −2,42). ADO: movilidad, OR: 2,42 (IC 95%: 1,39-4,20); cuidado personal, OR: 3,21 (IC 95%: 1,67-6,18); actividades cotidianas, OR: 3,17 (IC 95%: 1,69-5,93); EVA, coeficiente regresión: −3,53 (IC 95%: −5,57- −1,49).ConclusionesLos índices BODE y ADO presentaron una importante asociación con la CVRS. Las exacerbaciones y la disnea fueron los factores individuales que mejor se relacionaron con la CVRS.AbstractObjectiveTo describe the relationship between individual or combined prognostic factors in the multidimensional classifications (BODE and ADO), and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD).DesignCross-sectional descriptive study.SettingPrimary care.ParticipantsSystematic random sample of 102 patients diagnosed with COPD, excluding those patients with acute exacerbation, dementia, terminal illness or those who receive home care.Main measurementsDemographics variables, smoking habits, body mass index and number of exacerbations. Comorbidity. Degree of dyspnea. Respiratory function tests. Exercise capacity. The BODE index and the ADO index. The EuroQol-5D questionnaire (EQ-5D), and visual analogue scale (VAS).ResultsEQ-5D: mobility: 43.9%; personal care: 13.3%; daily-life activities: 29.6%; pain/discomfort: 55.1%; anxiety/depression: 37.8%, and 34.7% VAS ≤ 60%.Exacerbations: Mobility, OR: 1.85 (95%CI: 1.08-3.20); personal care, OR: 2.12 (95%CI: 1.3-4.76); daily-life activities, OR: 2.35 (95%CI: 1.17-4.71); VAS, regression coefficient: −3.50 (95%CI: 6.31- −0.70). Dyspnea: mobility, OR: 4.47 (95%CI: 1.39-14.42); daily-life activities, OR: 7.71 (95%CI: 2.03-12.34); VAS, regression coefficient: −7.15 (95%CI: 11.71- −2.59).BODE: mobility, OR: 1.53 (95%CI: 1.15-2.02); personal care, OR: 2.08 (95%CI: 1.40-3.11); daily-life activities, OR: 1.97 (95%CI: 1.38-2.80); VAS, regression coefficient: −3.96 (95%CI: −5.51- −2.42). ADO: mobility, OR: 2.42 (95%CI: 1.39-4.20); personal care, OR: 3.21 (95%CI: 1.67-6.18); daily-life activities, OR: 3.17 (95%CI: 1.69-5.93); VAS, regression coefficient: −3.53 (95%CI: −5.57- −1.49).ConclusionsThe BODE index and the ADO index showed a significant association with HRQOL. Exacerbations and dyspnea were the best individual factors related to HRQoL

Evaluating the controlled reopening of nightlife during the COVID-19 pandemic : a matched cohort study in Sitges, Spain, in May 2021 (Reobrim Sitges)

To assess the impact of relaxing the state of alarm restrictions on SARS-CoV-2 infections at 14 days among people attending reopened nightclub venues. Matched cohort study with a paired control group (1:5 ratio). Five small nightclubs with indoor areas and outdoor terraces, in a nightlife-restricted area in Sitges, Spain, on 20 May 2021. Wearing masks was mandatory, drinking was allowed and social distance was not required. Volunteers were selected through a convenience sampling. To attend the event, participants were required to be older than 17 years, with a negative rapid antigen diagnostic test (Ag-RDT) on the same afternoon, without a positive reverse-transcription PCR (RT-PCR) or Ag-RDT and/or symptoms associated with COVID-19 in the previous 7 days, to not having knowingly been in close contact with someone infected in the previous 10 days and to not have knowingly had close contact with someone with a suspicion of COVID-19 in the previous 48 hours. A control group was paired by exact age, gender, residence municipality, socioeconomic index, previous SARS-CoV-2-confirmed infection and vaccination status, in a 1:5 ratio, from the primary care electronic health records. Evidence of infection at electronic health records by SARS-CoV-2 at 14-day follow-up. Among the 391 participants (median age 37 years; 44% (n=173) women), no positive SARS-CoV-2 cases were detected at 14 days, resulting in a cumulative incidence estimation of 0 (95% CI 0 to 943) per 100 000 inhabitants. In the control group, two cases with RT-PCR test were identified, resulting in a cumulative incidence of 102.30 (12.4 to 369) per 100 000 inhabitants. Nightlife attendance under controlled conditions and with a requirement for a negative Ag-RDT was not associated with increased transmissibility of SARS-CoV-2 in a pandemic context of low infection rates. In such circumstances, secure opening of the nightlife sector was possible, under reduced capacity and controlled access by Ag-RDT, and environments where compliance with sanitary measures are maintainable

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

How health system factors influence referral decisions in patients that may have cancer: European symposium report.

Abstract Objective: To identify the system and other non-clinical factors that may influence a General Practitioners’ decision on whether to refer a patient who may have cancer. Study design: Expert group discussion and consensus formation. Methods: A group of eight General Practitioner (GP) researchers from Croatia, England, Slovenia, Spain, Sweden and Switzerland used brainstorming to identify the non-clinical factors that could affect GPs’ decision-making when faced with patients that might have cancer. The group refined and came to a consensus on these factors. Results: Many non-clinical factors are likely to have a significant impact on referral decisions. These include levels of gatekeeping responsibility, funding systems, access to special investigations, fear of litigation, and relationships with specialist colleagues. Conclusions: Many patients with cancer present without red-flag symptoms, but nevertheless still cause a feeling of concern in their GPs. How a health system is organised is likely to influence on how GPs act on those concerns

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study

Funding Information: The publication of the article in OA mode was financially supported by HEAL-Link. Publisher Copyright: © The Author(s), 2022.Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.publishersversionPeer reviewe