8 research outputs found
Riesgo de eventos cerebrovasculares en pacientes atendidos en atención primaria por mareo: Cohortes históricas pareadas por factores de riesgo vascular
Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Faculta de Medicina, Departamento de Medicina. Fecha de lectura: 19-01-201
The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD.
Purpose: Heart failure (HF) is a chronic, frequent and disabling condition but with a
modifiable course and a large potential for improving. The aim of this study was to validate
the two available clinical prediction rules for mortality at one year in patients with primo-
hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to
evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients
hospitalized for a first episode of the disease.
Patients and methods: A prospective multicenter cohort study, which included 180
patients hospitalized with “de novo” HF was conducted to validate the PREDICE score.
Calibration and discrimination measurements were calculated for the PREDICE model and
the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score
(using both the development and the validation cohort of the PREDICE).
Results: For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence
interval [CI]: 0.57–0.79) and the calibration slope 0.65 (95% CI: 0.21–1.20). For the PREDICE
score AUC was 0.59 (95% CI: 0.47–0.71) and slope 0.42 (95% CI: −0.20–1.17). For the AHEAD
score the AUC was 0.68 (95% CI: 0.62–0.73) and slope 1.38 (95% CI: 0.62–0.73) when used the
development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49–0.67), and slope 0.68
(95% CI: −0.06 to 1.47) when used its validation cohort.
Conclusion: The present study shows that the two risk scores available for patients with
primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently
valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized
patients with new-onset HF has been modified over time. The study underscores the need to
validate the prognostic models before clinical implementation.Ministerio de Sanidad PI070945
Characteristics of clinical trials of influenza and respiratory syncytial virus registered in ClinicalTrials.gov between 2014 and 2021
The randomized clinical trial (RCT) is the ideal and mandatory type of study to verify the effect and safety of a drug. Our aim is to examine the fundamental characteristics of interventional clinical trials on influenza and respiratory syncytial virus (RSV). This is a cross-sectional study of RCTs on influenza and RSV in humans between 2014 and 2021 registered in ClinicalTrials.gov. A total of 516 studies were identified: 94 for RSV, 423 for influenza, and 1 for both viruses. There were 51 RCTs of RSV vaccines (54.3%) and 344 (81.3%) for influenza virus vaccines (p < 0.001). Twelve (12.8%) RCTs for RSV were conducted only with women, and 6 were conducted only with pregnant women; for RCTs for influenza, 4 (0.9%) and 3, respectively. For RSV, 29 (31%) of the RCTs were exclusive to people under 5 years of age, and 21 (5%) for influenza virus (p < 0.001). For RSV, there are no RCTs exclusively for people older than or equal to 65 years and no phase 4 trials. RCTs on influenza virus and RSV has focused on vaccines. For the influenza virus, research has been consolidated, and for RSV, research is still in the development phase and directed at children and pregnant women
Encuesta nacional sobre conocimientos de lactancia materna de los residentes de pediatría en España
Background: Increasing breastfeeding rates is a
desirable goal for improving maternal and child health.
Pediatricians have a main role in this subject. The objective
was to document breastfeeding knwoledge in Pediatric
residents, and its relationship with the BFHI (Baby
Friendly Hospital Initiative) status of their hospitals.
Methods: Transversal study with a validated online
survey (ECoLa). Polietapic sampling of Pediatric residentes
in Spain by strata (BFHI degree) and clusters
(hospitals). Estimated sample size was 142 residents. 312
surveys were sent to 21 hospitals. Main variable was the
percentage of correct answers to survey questions, it was
analyzed with non parametric techniques.
Results: 189 answers (response rate 60%). Global median
(Me) of correct answers was 76.9% (95% Confidence
Interval [95CI] 74.2-79.6). There was no difference
among first and second year residents (Me=76.9%) and
third and fourth year residents (Me=73.1%) (p=0.541).
Residents from BFHI hospitals (Me=84.6%) achieved
better results than those from non-BFHI hospitals
(Me=73.1%) (p=0.002). Variability at non-BFHI hospitals
was considerable, where some hospitals showed unacceptable
scores. Prevalence of courses was greater at BFHI
hospitals (95% vs 52%).
Conclusions: There are some deficiencies in
Pediatric residents’ breastfeeding training. There are
hospitals whose residents have an insufficient breastfeeding
knowledge. No low scores were found in residents
from BFHI hospitals. We consider neccesary to systematize
and universalize breastfeeding training during
Pediatric Residency.Fundamentos: Una de las metas para mejorar la salud
materno-infantil es aumentar las tasas de lactancia, y la
Pediatría tiene un papel fundamental en ello. El objetivo del
estudio fue averiguar el nivel de conocimientos sobre lactancia
materna de los residentes de Pediatría y su relación
con la acreditación IHAN (Iniciativa para la Humanización
de la Asistencia al Nacimiento y la Lactancia).
Métodos: Se realizó un estudio transversal mediante
encuesta validada (ECoLa) de cumplimentación online.
Se elaboró un muestreo por estratos y conglomerados
de los residentes de Pediatría en España. El tamaño
muestral necesario fue de 142 sujetos. Se enviaron 315
encuestas a 21 hospitales. La variable principal fue el
porcentaje de aciertos a las preguntas de la encuesta, que
se evaluó con técnicas no paramétricas.
Resultados: Hubo 189 respuestas (tasa de respuesta
del 60%). La Mediana (Me) global de aciertos fue
del 76,9% (Intervalo de Confianza al 95%=[IC95] 74,2-
79,6). La mediana de aciertos no difirió entre residentes
de primer y segundo año (Me=76,9%) y los de tercer
y cuarto año (Me=73,1%) (p=0,541). Los residentes
de los hospitales acreditados por la IHAN (Me=84,6%)
obtuvieron mejores resultados que los de hospitales no
acreditados (Me=73,1%) (p=0,002). En los hospitales
no acreditados, la variabilidad de conocimientos fue amplia,
con puntuaciones muy bajas en algunos de ellos. El
porcentaje de residentes que había realizado cursos específicos
fue muy superior en los hospitales acreditados
por la IHAN (95% vs 52%).
Conclusiones: Se detectan lagunas en la formación
en lactancia de los residentes de Pediatría. Existen hospitales
cuyos residentes tienen unos conocimientos en
la materia claramente insuficientes, aunque no se hallan
carencias en residentes de hospitales acreditados por la
IHAN. Consideramos necesario universalizar y sistematizar
la formación en lactancia
Variability of nutrients intake, lipid profile and cardiovascular mortality among geographical areas in Spain : The DRECE study
It has often been suggested that cardiovascular mortality and their geographical heterogeneity are associated with nutrients intake patterns and also lipid profile. The large Spanish study Dieta y Riesgo de Enfermedades Cardiovasculares en Espana (DRECE) investigated this theory from 1991 to 2010. Out of the 4,783 Spanish individuals making up the DRECE cohort, 220 subjects (148 men and 72 women) died (4.62%) during the course of the study. The mean age of patients who died from cardiovascular causes (32 in all) was 61.08 years 95% CI (57.47-64.69) and 70.91% of them were males. The consumption of nutrients and the lipid profile by geographical area, studied by geospatial models, showed that the east and southern area of the country had the highest fat intake coupled to a high rate of unhealthy lipid profile. It was concluded that the spatial geographical analysis showed a relationship between high fat intake, unhealthy lipid profile and cardiovascular mortality in the different geographical areas, with a high variability within the country
Characteristics of clinical trials of influenza and respiratory syncytial virus registered in ClinicalTrials.gov between 2014 and 2021
© 2023 Lora, García-Reyne, Lalueza, Maestro de la Calle, Ruíz-Ruigómez, Calderón and Menéndez-Orenga. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.The randomized clinical trial (RCT) is the ideal and mandatory type of study to verify the effect and safety of a drug. Our aim is to examine the fundamental characteristics of interventional clinical trials on influenza and respiratory syncytial virus (RSV). This is a cross-sectional study of RCTs on influenza and RSV in humans between 2014 and 2021 registered in ClinicalTrials.gov. A total of 516 studies were identified: 94 for RSV, 423 for influenza, and 1 for both viruses. There were 51 RCTs of RSV vaccines (54.3%) and 344 (81.3%) for influenza virus vaccines (p < 0.001). Twelve (12.8%) RCTs for RSV were conducted only with women, and 6 were conducted only with pregnant women; for RCTs for influenza, 4 (0.9%) and 3, respectively. For RSV, 29 (31%) of the RCTs were exclusive to people under 5 years of age, and 21 (5%) for influenza virus (p < 0.001). For RSV, there are no RCTs exclusively for people older than or equal to 65 years and no phase 4 trials. RCTs on influenza virus and RSV has focused on vaccines. For the influenza virus, research has been consolidated, and for RSV, research is still in the development phase and directed at children and pregnant women.This study was funded by the Instituto de Salud Carlos III (ISCIII) through the project “PI21/01815” and co-funded by the European Union.Peer reviewe
Variability of nutrients intake, lipid profile and cardiovascular mortality among geographical areas in Spain: The DRECE study
It has often been suggested that cardiovascular mortality and their geographical heterogeneity are associated with nutrients intake patterns and also lipid profile. The large Spanish study Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) investigated this theory from 1991 to 2010. Out of the 4,783 Spanish individuals making up the DRECE cohort, 220 subjects (148 men and 72 women) died (4.62%) during the course of the study. The mean age of patients who died from cardiovascular causes (32 in all) was 61.08 years 95% CI (57.47-64.69) and 70.91% of them were males. The consumption of nutrients and the lipid profile by geographical area, studied by geospatial models, showed that the east and southern area of the country had the highest fat intake coupled to a high rate of unhealthy lipid profile. It was concluded that the spatial geographical analysis showed a relationship between high fat intake, unhealthy lipid profile and cardiovascular mortality in the different geographical areas, with a high variability within the country
The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD
[Purpose] Heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this study was to validate the two available clinical prediction rules for mortality at one year in patients with primo-hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients hospitalized for a first episode of the disease.[Patients and methods] A prospective multicenter cohort study, which included 180 patients hospitalized with “de novo” HF was conducted to validate the PREDICE score. Calibration and discrimination measurements were calculated for the PREDICE model and the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score (using both the development and the validation cohort of the PREDICE).[Results] For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence interval [CI]: 0.57–0.79) and the calibration slope 0.65 (95% CI: 0.21–1.20). For the PREDICE score AUC was 0.59 (95% CI: 0.47–0.71) and slope 0.42 (95% CI: −0.20–1.17). For the AHEAD score the AUC was 0.68 (95% CI: 0.62–0.73) and slope 1.38 (95% CI: 0.62–0.73) when used the development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49–0.67), and slope 0.68 (95% CI: −0.06 to 1.47) when used its validation cohort.[Conclusion] The present study shows that the two risk scores available for patients with primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized patients with new-onset HF has been modified over time. The study underscores the need to validate the prognostic models before clinical implementation.This study was funded by the Spanish Ministry of Health (grant number: PI070945).Peer reviewe