Calibratge : correcció dels errors de mesura i estandardització de la dieta

Objectiu: L’error de mesura en la dieta pot provocar l’atenuació dels efectes observats en relacionar aquella amb la incidència de càncer. Aquest projecte pretén descriure, justificar i aplicar mètodes de calibratge usant regressió lineal, per corregir els errors de mesura i estandarditzar les dades provinents de diversos centres, relatives al consum de carn en una cohort europea de més de mig milió de persones de 10 països i la relació amb l’aparició de càncer gàstric (CG). Mètodes: El calibratge consisteix a aprofitar les dades d’un qüestionari de dieta no esbiaixat (R) aplicat a una part de la cohort, per corregir els hazard ratios (HR) del consum de carn amb CG basats en les dades aportades per un mètode de mesura de menys qualitat (Q) però aplicat a tota la cohort. S’obtenen valors predits (calibrats) per a tota la cohort a partir de la regressió entre R i Q. Aquests valors calibrats s’apliquen a un model de Cox i se n’obtenen estimacions corregides dels HR’s. El projecte usarà les dades de l’estudi EPIC. Resultats: Els coeficients de calibratge varien entre 0,27 i 0,73 , segons el país i el gènere. L’ajust del model lineal entre consum de carn mesurat amb R i amb Q és molt dolent a nivell individual (r2<0,20) degut a què s’usa només un record de 24 hores com a mesura de referència, però a nivell grupal r2 puja fins al voltant de 0,60. L’aplicació de transformacions a les dades o l’exclusió de grans consumidors no aporta millores en l’ajust del model. El HR de CG obtingut per 100 grams de consum de carn es corregeix d’1,43 (IC95%=1,13-1,81) usant les dades originals a 1,97 (IC95%=1,21-3,22) usant les dades calibrades. Conclusió: Fins i tot si es vulneren algunes assumpcions en què es basa el mètode de calibratge (incorrelació entre els errors de Q i R, estimacions no esbiaixades del consum real a partir del qüestionari de referència), el calibratge serveix per corregir almenys una part del biaix amb què estimaríem els HR’s si uséssim només les dades del qüestionari general. En definitiva, el calibratge és un recurs per disminuir els efectes de l’error de mesura de la dieta en l’estimació dels paràmetres d’associació d’aquella amb la malaltia

Internet i salut: què en pensa i com l'utilitza el personal sanitari d'un EAP. Una aproximació

Resultats d'una enquesta passada als assistents a una sessió clínia en un EAP. Els objectius de l'enquesta, en relació amb els professionals de la salut, són: conèixer l'ús que fan d'Internet en l'àmbit professional; conèixer quin ús fan de la prescripció web; saber si utilitzen el correu electrònic per comunicar-se amb els pacients; saber com perceben la consulta sobre informació mèdica o de salut a Internet per part dels seus pacients; i, finalment, identificar els recursos informatius sobre salut a Internet que utilitzen més, en relació amb els seus pacients

Sessió clínica: Internet, salut i e-pacients. Eines i recursos a l'abast per a una informació de qualitat

Sessió clínica a un EAP amb dos objectius: proporcionar als professionals sanitaris de l'EAP orientacions bàsiques per ajudar els pacients a avaluar la informació sobre temes de salut localitzada a Internet, i promoure entre els professionals sanitaris l'ús de la prescripció web per formentar l'autonomia dels pacients. El contingut de la sessió va ser: breu introducció a Internet, tendències actuals en e-salut, criteris d'avaluació de pàgines web, segells de qualitat i prescripció web

Diagnosis of right bundle branch block: a concordance study

Bundle branch block; ConcordanceBloqueig de branca; ConcordançaBloqueo de rama; ConcordanciaBACKGROUND: Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS: The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS: We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION: The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block

Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up

To know the epidemiology (prevalence, incidence, progression and morbidity and mortality associated) of peripheral artery disease in general population and the factors associated with this progression is essential to know the evolution of atherosclerosis and develop preventive strategies. The aim of the study was to determine the incidence of PAD after 5 years of follow-up population-based cohort ARTPER, and the evolution of Ankle brachial Index (ABI) in this period. Peripheral artery disease incidence analysis after 5 years of follow-up of 3786 subjects > 50 years old. Peripheral artery disease incident when the second cross section Ankle brachial Index was <0.9 in any of the lower limbs, with normal baseline (0.9 to 1.4). Between 2012 and 2013 2762 individuals (77 % participation) were re-examined. Finally analyzed 2256 subjects (after excluding pathological Ankle brachial Index) followed for 4.9 years (range 3.8 to 5.8 years), totalling 11,106 person-years. Peripheral artery disease 95 new cases were detected, representing an incidence of 4.3 % at 5 years and 8.6 per 1000 person-years (95 % CI 6.9 to 10.5) being higher in men (10.2, 95 % CI 7.4 to 13.5) than in women (7.5, 95 % CI 5.5 to 9.9). Linear correlation between the baseline Ankle brachial Index and the second cross section was low (r = 0.23). The incidence of peripheral artery disease in ARTPER cohort was 8.6 cases per 1000 person-years, being higher in men, especially <65 years. The correlation between two measures Ankle brachial Index after 5 years of follow-up was low. One might consider whether Ankle brachial Index repeated measures could improve the correlation

Interarm blood pressure difference: Concordance between two methods of automatic simultaneous measurement and between visits reproducibility

Oscilómetro automático; Concordancia; ReproducibilidadAutomatic oscillometer; Concordance; ReproducibilityOscil·lòmetre automàtic; Concordança; ReproduïbilitatObjetivo La diferencia de presión arterial sistólica entre brazos (dPEB) aumentada (≥ 10 mmHg) se ha relacionado con mayor morbimortalidad cardiovascular. Hay poca evidencia sobre cómo determinar la dPEB y su fiabilidad ha sido poco estudiada. Nuestros objetivos fueron evaluar la concordancia entre 2 oscilómetros automáticos de medición simultánea de la dPEB (2 aparatos OMRON y un aparato Microlife WatchBP® [WBP]) y analizar la reproducibilidad de la dPEB entre visitas en población general atendida en un centro de atención primaria. Diseño Estudio descriptivo transversal de concordancia entre los 2 métodos y de fiabilidad de la dPEB entre 2 visitas separadas una semana. Emplazamiento Centro de Atención Primaria de Parets del Vallès, Barcelona. Participantes Población general de 35-74 años. Intervenciones y mediciones principales Ciento cuarenta y nueve pacientes completaron las 2 visitas. En cada visita se midió la dPEB 3 veces con ambos métodos, y se consideró la media de las 3 determinaciones. Mediante revisión de la historia y entrevista con el paciente se recogieron otras variables como sociodemográficas y antropométricas, antecedentes patológicos y tratamiento farmacológico. Se calculó la concordancia entre los dispositivos y la reproducibilidad entre visitas mediante el coeficiente de concordancia de Lin (CCL) para la dPEB expresada de manera continua y los índices kappa (k) para la dPEB categorizada en normal o patológica. Resultados La concordancia entre métodos para la dPEB expresada de forma continua fue baja: CCL: 0,13 (0,02-0,24). La concordancia fue también baja para la dPEB categorizada en normal o patológica (k = −0,03 [−0,05-0,00]). La reproducibilidad entre visitas fue baja para ambos métodos, y tanto para la dPEB continua como categorizada: con OMRON® CCL: 0,19 (0,03-0,34) y k = −0,02 (−0,16-0,12) y para WBP® CCL: 0,14 (−0,01-0,29) y k = 0,49 (0,33-0,64). Conclusiones La concordancia entre 2 oscilómetros automáticos en la determinación simultánea de la dPEB fue baja. La reproducibilidad entre visitas también fue baja para ambos métodos.Objective An increased interarm blood pressure difference (IAD) (≥10 mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre. Design Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. Site Parets del Vallès primary care centre (Barcelona). Participants General population aged 35-74 years. Interventions and main measurements One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological. Results Concordance for IAD expressed continuously was low: CCL = 0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k = −0.03 (−0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL = 0.19 (0.03-0.34) and k = −0.02 (−0.16-0.12) and for WBP™ CCL = 0.14 (−0.01-0.29) and k = 0.49 (0.33-0.64). Conclusions Concordance between two automatic oscillometers in the simultaneous IAD measurement was low. Reproducibility between visits was also low for both methods.Este estudio fue financiado con una ayuda a proyectos de investigación en atención primaria del Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol, número de ayuda 4R18/002-1) y con la beca del GERC 2018 (Grup d́Estudi i Recerca Cardiovascular) de la Filial del Vallès Oriental de la Acadèmia de les Ciències Mèdiques de Catalunya i de Balears

Caminar més d'una hora al dia redueix a la meitat el risc de patir arteriopatia perifèrica

L'arteriopatia perifèrica és el conjunt de signes i símptomes que es manifesten quan es produeix una disminució del flux sanguini a una extremitat, i és un potent predictor d'episodis cardiovasculars i cerebrovasculars. Un estudi realitzat amb 3.207 persones majors de 49 anys de 28 centres de l'àrea metropolitana de Barcelona i el Barcelonès Nord ha demostrat que caminar una hora al dia redueix a la meitat el risc de patir aquesta malaltia i que l'activitat física en pacients ja malalts s'associa a un menor empitjorament.La arteriopatía periférica es el conjunto de signos y síntomas que se manifiestan cuando se produce una disminución del flujo sanguíneo en una extremidad, y es un potente predictor de episodios cardiovasculares y cerebrovasculares. Un estudio realizado con 3.207 personas mayores de 49 años de 28 centros del área metropolitana de Barcelona y el Barcelonés Norte ha demostrado que caminar una hora al día reduce a la mitad el riesgo de padecer esta enfermedad y que la actividad física en pacientes ya enfermos se asocia a un menor empeoramiento

Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database

Background: Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. Methods: Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009–2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). Results: Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. Conclusions: Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients

Genetic Variants at the 9p21.3 Locus Are Associated with Risk for Non-Compressible Artery Disease: Results from the ARTPER Study

Peripheral artery disease (PAD) and non-compressible artery disease (NCAD) constitute predictors of subclinical atherosclerosis easily assessed through the ankle brachial index (ABI). Although both diseases show substantial genetic influences, few genetic association studies have focused on the ABI and PAD, and none have focused on NCAD. To overcome these limitations, we assessed the role of several candidate genes on the ABI, both in its continuous distribution and in the clinical manifestations associated to its extreme values: PAD and NCAD. We examined 13 candidate genomic regions in 1606 participants from the ARTPER study, a prospective population-based cohort, with the ABI assessed through ultrasonography. Association analyses were conducted independently for individuals with PAD (ABI 1.4) vs. healthy participants. After including potential covariates and correction for multiple testing, minor alleles in the genetic markers rs10757278 and rs1333049, both in the 9p21.3 region, were significantly associated with a decreased risk of NCAD. Associations with the ABI showed limited support to these results. No significant associations were detected for PAD. The locus 9p21.3 constitutes the first genetic locus associated with NCAD, an assessment of subclinical atherosclerosis feasible for implementation in primary healthcare settings that has been systematically neglected from genetic studies

The population-based Barcelona-Asymptomatic Intracranial Atherosclerosis Study (ASIA) : rationale and design

Large-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide. Traditional approaches have attempted to target the disease when it is already symptomatic. However, early detection of intracranial atherosclerosis may allow therapeutic intervention while the disease is still asymptomatic. The prevalence and natural history of asymptomatic intracranial atherosclerosis in Caucasians remain unclear. The aims of the Barcelona- AS ymptomatic I ntracranial A therosclerosis (ASIA) study are (1) to determine the prevalence of ASIA in a moderate-high vascular risk population, (2) to study its prognostic impact on the risk of suffering future major ischemic events, and (3) to identify predictors of the development, progression and clinical expression of this condition. Cross-over and cohort, population-based study. A randomly selected representative sample of 1,503 subjects with a mild-moderate-high vascular risk (as defined by a REGICOR score ≥ 5%) and with neither a history of cerebrovascular nor ischemic heart disease will be studied. At baseline, all individuals will undergo extracranial and transcranial Color-Coded Duplex (TCCD) ultrasound examinations to detect presence and severity of extra and intracranial atherosclerosis. Intracranial stenoses will be assessed by magnetic resonance angiography (MRA). Clinical and demographic variables will be recorded and blood samples will be drawn to investigate clinical, biological and genetic factors associated with the presence of ASIA. A long-term clinical and sonographic follow-up will be conducted thereafter to identify predictors of disease progression and of incident vascular events. The Barcelona-ASIA is a population-based study aiming to evaluate the prevalence and clinical importance of asymptomatic intracranial large-artery atherosclerosis in Caucasians. The ASIA project may provide a unique scientific resource to better understand the dynamics of intracranial atherosclerosis from its early stages and to identify new potential therapeutic targets for this condition