Estimación del riesgo cardiovascular, según la metodología de riesgos competitivos, en pacientes trasplantados renales, en el área sanitaria de A Coruña

[Resumen] La elevada prevalencia de factores de riesgo coronario en la población trasplantada renal justifica la alta incidencia y mortalidad cardiovascular. Identificar factores de riesgo «modificables» resulta esencial para mejorar su supervivencia. El objetivo de este trabajo es determinar la incidencia de eventos cardiovasculares, evaluar los scores de riesgo existentes y calcular una función de riesgo específica para pacientes trasplantados renales. Estudio observacional de seguimiento con componente retrospectivo y prospectivo en el Complexo Hospitalario Universitario de A Coruña entre 1981 y 2011. Cohorte de 2029 pacientes trasplantados. Se ha realizado un análisis de supervivencia mediante modelos de riesgos proporcionales de Cox y modelos de riesgos competitivos. Se ha desarrollado una aplicación (CVRCALC) para la realización del cálculo de diferentes scores mediante la carga masiva de datos. La implementación de una función de riesgo específica se realiza a partir de los coeficientes de Cox, de la prevalencia de los factores de riesgo involucrados y de la tasa de incidencia de acontecimientos coronarios en la cohorte estudiada. Los eventos coronarios en pacientes trasplantados renales pueden predecirse mediante el género del paciente, su edad, el hábito tabáquico pretrasplante, la presencia de hipertrofia ventricular izquierda, la diabetes y el índice de masa corporal.[Resumo]A elevada prevalencia de factores de risco coronario na poboación transplantada renal xustifica a alta incidencia e a mortalidade cardiovascular. Identificar factores de risco «modificables» resulta esencial para mellorar a súa supervivencia. O obxectivo deste traballo é determinar a incidencia de eventos cardiovasculares, avaliar os scores de risco existentes e calcular unha función de risco específica para pacientes transplantados renais. Estudo observacional de seguimento con compoñente retrospectivo e prospectivo no Complexo Hospitalario Universitario da Coruña entre 1981 e 2011. Cohorte de 2029 pacientes transplantados. Realizouse unha análise de supervivencia mediante modelos de riscos proporcionais de Cox e modelos de riscos competitivos. Desenvolveuse unha aplicación (CVRCALC) para a realización do cálculo de diferentes scores mediante a carga masiva de datos. A implementación dunha función de risco específica realízase a partir dos coeficientes de Cox, da prevalencia dos factores de risco involucrados e da taxa de incidencia de acontecementos coronarios na cohorte estudada. Os eventos coronarios en pacientes transplantados renais poden predicirse mediante o xénero do paciente, a súa idade, o hábito tabáquico pretransplante, a presenza de hipertrofia ventricular esquerda, a diabetes e o índice de masa corporal.[Abstract]The high prevalence of coronary risk factors in the renal transplant population justifies the high incidence and cardiovascular events and mortality. Identifying modifiable risk factors is essential to improve survival. The objective of this study is to determine the incidence of cardiovascular events, evaluate the existing risk scores and calculate a specific risk function in renal transplant patients. Observational follow-up study with retrospective and prospective component in the Complejo Hospitalario Universitario A Coruña between 1981-2011. 2029 renal transplant patients cohort. Survival analysis used Cox proportional hazards models and competitive risk models. Development of an application (CVRCALC) for the calculation of different scores by using the bulk load data. The implementation of a specific risk function is performed using Cox coefficients, risk factors prevalence and the rate of incidence of coronary events in the cohort studied. Coronary events in renal transplant patients can be predicted by the gender of the patient, his age, smoking pre-transplant, the presence of left ventricular hypertrophy, diabetes and body mass index

Suicide deaths and substance use in the Galician provinces between 2006 and 2020

[Abstract] Background: Suicide is a serious public health problem that affects our entire country, including the Galician provinces. The aim of this research was to study the variation in completed suicide rates, between 2006 and 2020, in the different Galician provinces and their relationship with the consumption of addictive substances. Methods: Completed suicide data from the Spanish Office for National Statistics and the Institute of Legal Medicine of Galicia were analyzed with a Joinpoint regression model to determine time trends. The relationship between the variation in completed suicide rates with sociodemographic variables obtained from the Spanish Office for National Statistics and variables related to the consumption of substances obtained from the survey on alcohol and other drugs in Spain (EDADES) of the Government Delegation for the National Plan on Drugs was also analyzed. Results: The Joinpoint regression model did not reveal any point of significant change in the period studied for any Galician province. The following variables correlated positively with the variation in completed suicide rates in the Galician provinces: masculinity ratio, average age, daily alcohol consumption and daily illegal substance consumption. Conclusion: Applying preventive strategies on the daily consumption of alcohol and illegal substances would help reduce the rates of completed suicide in the Galician provinces.Principado de Asturias; PCTI-2021-2023 IDI/2021/11

Prevalence, co-occurrence, and predictive factors for musculoskeletal pain among shellfish gatherers

[Abstract] The aims of this study are to determine prevalence and co-occurrence of musculoskeletal pain (MSP) among shellfish gatherers and its consequences for the use of medicine, health care, and sickness leave and to investigate predictive factors (sociodemographic, lifestyle, comorbidity) of MSP in five anatomical areas (neck/shoulder/higher back, lower back, elbow/wrist/hand, hip/knee, and leg/ankle/foot). Nine hundred twenty-nine shellfish gatherers (94% women) voluntarily took part in a physiotherapy workshop. A self-administered questionnaire was used to assess MSP and its consequences. Regression models were performed to determine the factors predicting the presence of MSP. The two most frequently self-reported forms of MSP were neck pain (70.9%) and lower back pain (65.5%). Sixty-four percent of respondents reported contact with their family doctor during the last 12 months due to MSP, and most subjects (88.1%) reported MSP in two or more locations. Hip/knee pain was associated with leg/ankle/foot pain (crude odds ratio = 3.14). Logistic regression analysis showed that being female and young is associated with lumbar pain, and being older is associated with pain in all areas of the lower limbs. The number of pain sites a person reported significantly predicted the presence of pain in all the anatomical areas studied. Prevalence of MSP and musculoskeletal comorbidity were high. The study shows that the presence of pain reported in one body area is highly dependent on the total number of painful areas. These findings are consistent with those of similar studies

Factors Related to Greater Functional Recovery after Suffering a Stroke

[Abstract] Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge

Gender-based violence attitudes and dating violence experiences of students in nursing and other health sciences: a multicentre cross-sectional study

[Abstract] Background: Gender-based violence is a major public health problem. Healthcare providers' ability to identify this type of violence and support victims may be influenced by their knowledge, attitudes, and beliefs, which requires solid education. Objectives: To identify the gender-based violence attitudes and dating violence experiences of students in nursing and other health sciences. Design: A multicentre cross-sectional study was performed. Settings: This study was conducted in three faculties of the University of A Coruña, Spain. Participants: Participants were undergraduate students of nursing, podiatry, occupational therapy, and physiotherapy. Methods: The Attitudes towards Gender and Violence Questionnaire and the Dating Violence Questionnaire were used from October 2019 to March 2020. Descriptive and inferential statistics were calculated to determine associated factors and identify differences in gender-based violence attitudes and dating violence experiences between sexes and degrees. Results: Data from 459 students were analysed, of whom 180 (39.2 %) studied nursing. The mean age was 20.9 (SD = 3.6) and 76.0 % were women. Statistically significant differences were obtained in attitudes towards gender-based violence according to sex where men displayed more sexist attitudes and violence justification. Results showed a significant difference in attitudes regarding the biological usefulness of sexism and violence between students of nursing and other health sciences. 61.9 % of students had experienced one or more abusive behaviours in relationships; no significant differences were detected according to the degree. However, male students experienced dating violence more often than females. It was observed that students who had suffered dating violence showed greater agreement with sexist attitudes that justify violence. Conclusion: Students of health sciences, particularly males and nursing students, show sexist attitudes that justify gender-based violence. They also frequently experience dating violence, especially psychological violence. It is necessary to intensify or include education on these types of violence in the curricula of degrees in health sciences

Clinical-pathological characteristics and prognosis of a cohort of oesophageal cancer patients: a competing risks survival analysis

[Abstract] Background: To determine the clinical course, follow-up strategies, and survival of oesophageal cancer patients using a competing risks survival analysis. Methods: We conducted a retrospective and prospective follow-up study. The study included 180 patients with a pathological diagnosis of oesophageal cancer in A Coruña, Spain, between 2003 and 2008. The Kaplan-Meier methodology and competing risks survival analysis were used to calculate the specific survival rate. The study was approved by the Ethics Review Board (code 2011/372, CEIC Galicia). Results: The specific survival rate at the first, third, and fifth years was 40.2%, 18.1%, and 12.4%, respectively. Using the Kaplan-Meier methodology, the survival rate was slightly higher after the third year of follow-up. In the multivariate analysis, poor prognosis factors were female sex (hazard ratio [HR] 1.94; 95% confidence interval [CI], 1.24-3.03), Charlson's comorbidity index (HR 1.17; 95% CI, 1.02-1.33), and stage IV tumours (HR 1.70; 95% CI, 1.11-2.59). The probability of dying decreased with surgical and oncological treatment (chemotherapy and/or radiotherapy) (HR 0.23; 95% CI, 0.12-0.45). The number of hospital consultations per year during the follow-up period, from diagnosis to the appearance of a new event (local recurrences, newly appeared metastasis, and newly appeared neoplasias) did not affect the probability of survival (HR 1.03; 95% CI, 0.92-1.15). Conclusions: The Kaplan-Meier methodology overestimates the survival rate in comparison to competing risks analysis. The variables associated with a poor prognosis are female sex, Charlson's comorbidity score and extensive tumour invasion. Type of follow-up strategy employed after diagnosis does not affect the prognosis of the disease

Podiatric skin and nail involvement and biomechanical pathology in renal transplant recipients: assessment of the foot as a contributing factor to their health

[Abstract] Although several studies show the prevalence of podiatric conditions in people with end-stage renal disease or renal replacement therapy with hemodialysis, there is little scientific literature on this when subjects are undergoing kidney transplantation. The aim of this study is to determine the prevalence of podiatric skin and nail pathology in renal transplant recipients. A descriptive, observational, prevalence study was conducted at the Nephrology Department of the University Hospital of A Coruña. A total of 371 subjects were studied. The variables studied were sociodemographic (age, sex), anthropometric (Body Mass Index), comorbidity (Charlson Comorbidity Index), and podological (skin and nail alterations). A high presence of skin (83.1%) and nail pathology (85.4%) was observed, with hyperkeratosis (68.8%), onychogryphosis (39.4%), and onychocryptosis (36.9%) being the most predominant alterations. Although it was not significant, patients with a higher risk of presenting podiatric pathology were of female sex and had a high BMI, and both age and the Charlson comorbidity index were significantly associated with this risk. There was an increased risk of both skin and nail pathology at older age and in the presence of diabetes mellitus

Tasa de sudoración y factores ambientales en regatistas juveniles de clase Láser

Summary Introduction: Recent studies have reported differences in sweat rate (SR) in laser class (LC) sailors under extreme environ-mental conditions (EC). This study aimed to determine a ‘standard-like’ SR in junior Laser 4.7 sailors under ‘not-extreme’ weather conditions to achieve an adequate fluid replacement rate for training and racing sessions. Additionally, we analysed the hypothetical relationship between SR and certain environmental factors, not just considering them as independent variables, but also including them as a whole factor, usually known as ‘windchill’ (WCh).Material and method: Nine male elite junior Laser 4.7 class athletes were included in this descriptive study. They were mo-nitored during the entire year of training and racing sessions, including national and international championships. Body mass changes as well as their food and fluid intake were measured for each sailor before and after sailing to estimate SR, absolute body mass change, and percentage body mass variation for all the sessions. Athletes were asked to maintain “ab libitum” fluid and food intake during the study. Environmental temperature, wind speed, and relative humidity were measured.Results: Significant differences (p = 0.012) were observed between training and racing sessions with respect to SR, 0.18 (± 0.14) L.h−1vs. 0.23 (± 0.12 L.h−1). Environmental temperature and WCh during racing showed an inverse relationship with SR.Discussion: This result suggests that increased fluid and food intake are required under cold weather conditions to maintain the ‘target’ weight during the competitions and improve performance.Resumen Introducción: Recientemente, algunos estudios han reportado diferencias en la tasa de sudoración (SR) en regatistas de clase láser (LC) bajo condiciones ambientales (EC) extremas. Este estudio pretende determinar una especie de “SR standard” en regatistas juveniles de Láser 4.7 bajo condiciones “no extremas”, con el objetivo de alcanzar una adecuada reposición de líquidos tanto para entrenamientos como en competición. Adicionalmente, se ha analizado una hipotética relación entre SR y los factores ambientales, considerándolos no únicamente como variables independientes, sino también como una variable compleja, conocida habitualmente como “sensación térmica” (WCh).Material y método: Nueve regatistas juveniles de Láser 4.7 han participado en este estudio descriptivo y prospectivo. Todos ellos han sido monitorizados durante todo un año de sesiones de entrenamiento y competición, incluyendo regatas nacio-nales como internacionales. Los cambios en la masa corporal, así como la ingesta de líquidos y sólidos han sido registrados de forma individual para cada regatista, antes y después de cada sesión para estimar la SR, los cambios totales en la masa corporal, así como las variaciones en el porcentaje de masa corporal. Se instó a los regatistas a ingerir comida y bebida “ab libidtum” a lo largo del estudio. La temperatura ambiental, la intensidad de viento y la humedad relativa fueron registradas.Resultados: Se observaron diferencias significativas (p = 0,012) para la SR entre los entrenos y las competiciones 0,18 (± 0,14) L.h−1vs. 0,23 (± 0,12 L.h−1). La temperatura ambiental y la WCh durante las competiciones mostraron además una relacióninversa con la SR.Discusión: Estos resultados sugieren que una mayor ingesta de líquidos y sólidos bajo condiciones de “frío ambiental” es necesaria para mantener el peso ideal, mejorando así el rendimiento durante la competición

Structural, dermal and ungual characteristics of the foot in patients with type II diabetes

[Abstract] Background and Objectives: Diabetes is a chronic and metabolic disease, considered as an important public health problem. The objective of this study was to determine the prevalence of podiatric pathology in type II diabetic patients. Materials and Methods: An observational descriptive study of prevalence in the endocrinology service of Complexo Hospitalario Universitario A Coruña (CHUAC) (A Coruña-Spain) was carried out (n = 153). Type II diabetic patients included, of legal age who signed the informed consent. Sociodemographic variables were studied (age, sex, body mass index (BMI), smoking habit, alcohol consumption, family history), disease variables (time of evolution of diabetes, treatments, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose), podiatric variables: measurement of the footprint, metatarsal and digital formula, nail, skin, hindfoot and forefoot alterations. The data collection was done in 2018 and the data analysis was carried out in 2019. Results: The patients with type II diabetes had greater age, obesity and arterial hypertension it compared to the general population. Diabetic patients had a higher prevalence of flat feet than the general population (71.2% vs. 20.7%, p < 0.001), with a predominance of normal foot according to the podoscope. The predominant podological pathology was the presence of claw toes (94.8%), followed by dermal (78.4%) and nail (71.9%) alterations, and the Hallux Valgus (66.0%). The Clarke angle and the Chippaux index showed a Kappa concordance index of 0.26 with the type of footprint measured with the podoscope. The Staheli index showed a Kappa index of 0.27 associated with an observed agreement of 54%. Conclusions: This study shows that foot problems continue to be prevalent in subjects with type II diabetes mellitus and for this reason, podiatry is essential in its treatment

Colorectal cancer recurrence and its impact on survival after curative surgery: an analysis based on multistate models

[Abstract] Aim: To investigate the usefulness of multistate models (MSM) for determining colorectal cancer (CRC) recurrence rate, to analyse the effect of different factors on tumour recurrence and death, and to assess the impact of recurrence for CRC prognosis. Methods: Observational follow-up study of incident CRC cases disease-free after curative resection in 2006-2013 (n = 994). Recurrence and mortality were analyzed with MSM, as well as covariate effects on transition probabilities. Results: Cumulative incidence of recurrence at 60 months was 13.7%. Five years after surgery, 70.3% of patients were alive and recurrence-free, and 8.4% were alive after recurrence. Recurrence has a negative impact on prognosis, with 5-year CRC-related mortality increasing from 3.8% for those who are recurrence-free 1-year after surgery to 33.6% for those with a recurrence. Advanced stage increases recurrence risk (HR = 1.53) and CRC-related mortality after recurrence (HR = 2.35). CRC-related death was associated with age in recurrence-free patients, and with comorbidity after recurrence. As expected, age≥75 years was a risk factor for non-CRC-related death with (HR = 7.76) or without recurrence (HR = 4.26), while its effect on recurrence risk was not demonstrated. Conclusions: MSM allows detailed analysis of recurrence and mortality in CRC. Recurrence has a negative impact on prognosis. Advanced stage was a determining factor for recurrence and CRC-death after recurrence.info:eu-repo/grantAgreement/ISCIII/Programa Estatal de Fomento de la Investigación Científica y Técnica de Excelencia/PI18%2F01676/ES/CARACTERIZACIÓN DE GRANDES SUPERIVIENTES EN CANCER COLORRECTAL: APLICACIÓN DE MODELOS DE CURACIÓN PARA LA ESTIMACIÓN DE LA SUPERVIVENCIA A LARGO PLAZOThe cohort in which the study was based was recruited within the framework of a multicenter project who received two other grants from the Ministry of Science and Innovation, Carlos III Institute, Healthcare Research Fund (PI051075 and PS09/0066375)Xunta de Galicia; 08CSA073916P