Evolución del riesgo cardiovascular de los inmigrantes residentes en España según procedencia y años de estancia

ObjectiveTo assess whether there are differences in the immigrant population in terms of the years since their arrival in Spain and their geographical area of origin.DesignA cross-sectional study was conducted in three immigrant groups.ParticipantsThe groups selected were: a group of Latin American immigrants (298), a group of North African immigrants (130) and a group from Eastern Europe (114). A control group of 100 from a Spanish population of similar age and sex was also included.MethodsAnthropometric variables were measured, including biochemical inflammatory markers, blood pressure and cardiovascular risk estimation according to the tables of the European Societies of Hypertension and Cardiology.ResultsThe cardiovascular risk of the three groups of immigrants is similar between them (added cardiovascular risk high or very high at 5.5% in Latin Americans, 4.3% in North Africans, and 1.6% in immigrants from eastern countries), but significantly lower than the Spanish control group (28%). After 8 years in Spain, cardiovascular risk increases in the three groups of immigrants, with those from North Africa and eastern countries being comparable to the Spanish group (added cardiovascular risk high or very high of 18.5% in North Africans, and 20% in group from eastern countries). This cardiovascular risk was higher than the other groups, including the Spanish control group (Latin American immigrants 48.7% vs 28% in Spanish group).ConclusionsThe cardiovascular risk of immigrants increases over the years in Spain, with this increase being higher if they come from Latin America. This increase becomes clinically significant after the 8 years of stay in Spain.     

Trastornos del sueño y condiciones ambientales en mayores de 65 años

ObjectivesTo establish the prevalence and characteristics of insomnia and its relationship to other health problems, medication, socio-health status and sleep hygiene in the elderly over 65 years of age.DesignCross sectional study of prevalence.SettingAlbacete (Castilla-La Mancha), 2004–2005.ParticipantsA non-institutionalized elderly patient population (n=424).MethodSemi-structured interview. Study variables were: sleep characteristics, socio-familial repercussions, sleep hygiene, health problems, medication, health care utilization and socio-demographic variables. Primary insomnia (PI) was diagnosed according to DSM-IV criteria.ResultsReported sleeping difficulties, 34.2%; in 95.7% the sleep disturbance was chronic. The most frequent repercussions were: sensation of insufficient night-time sleep (62.1%) and daytime tiredness or sleepiness (52.2%). 20.3% (95% CI, 16.5–24.1) met criteria for PI. Insomnia rates were significantly higher in females and in subjects maintaining irregular hours and expressing dissatisfaction with bedroom environmental conditions. Psychopharmaceuticals were regularly consumed by 26.9% of the subjects (95% CI, 22.7–31.1). The average number of health problems was higher in subjects with insomnia (2.4±1.6 compared with 1.7±1.5 in non-insomniacs; P<.001). By means of logistic regression, female gender (OR=2.8; 95% CI, 1.6–4.8) and the existence of 2 or more health problems (OR=2; 95% CI. 1.2–3.4) were associated with PI.ConclusionsPI affects approximately one fifth of people over the age of 65. It is more frequent in females and is related to the existence of other health problems, medication and inadequate sleep hygiene.     

Desigualdades socioeconómicas y diferencias según sexo y edad en los factores de riesgo cardiovascular

ObjectiveTo describe the cardiovascular risk factors in a working population in the Balearic Islands and to examine whether differences by social class vary according to age and gender.MethodsA cross-sectional study was carried out in a sample of active workers aged 20-65 years in the Balearic Islands. The participants were included in the study during their annual work health assessment in 2011. The following variables were collected: occupation, social class, age, gender, height, weight, smoking, blood pressure, lipid profile, and glucose levels. Cardiovascular risk was calculated using two different equations (Framingham and REGICOR).ResultsDifferences by social class were observed for most cardiovascular risk factors. The pattern of these differences differed depending on age group and gender. Differences in obesity by social class increased with age in women but decreased in men. More differences in hypertension by social class were found among women than among men, with differences increasing with age in both genders. Significant differences by social class were found among women in lipid profile, and these differences increased with age, mainly for low levels of high-density lipoprotein-cholesterol.ConclusionsInequalities in cardiovascular risk factors by social class were higher among women than among men. Some cardiovascular risk factors such as smoking and obesity showed significant inequalities from a very early age.     

Efectos del cambio de apariencia de medicamentos en seguridad y adherencia en pacientes crónicos mayores de 65 años en atención primaria. Estudio CAMBIMED

ObjectiveTo study whether the changes in bioequivalent drugs with different appearances are associated with an increase in lack of adherence and medication use errors, in patients > 65 years old treated with antihypertensive and lipid-lowering medications.DesignObservational longitudinal prospective cohort study with a one-year follow-up period between 1 January 2013 and 31 December 2014.LocationPrimary Healthcare Centres in the Community of Madrid.ParticipantsPatients ≥ 65 years-old with a diagnosis of hypertension and/or dyslipidaemia receiving treatment with Enalapril and/or Amlodipine and/or Simvastatin.Main measurementsVariables collected during a Primary Care consultation by means of a personal interview were: sociodemographic (age, gender, level of education), clinical variables, adherence (Morisky-Green test and direct counting), medication errors (number and type), medication changes and number, analytical (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) and combined variable (error and/or adherence). There were 1 baseline and 4 quarterly visits.ResultsThe study included 274 patients with a mean age 72 (6.6) years, of whom 47.8% were female. Some medication changes were observed in 134 patients (48.9%), with a median of 3 (IQR 1-5) and a maximum of 11 changes. The risk of presenting with a medication use error or decreased adherence was increased in patients exposed to changes in all visits with RR 1.14 (1.16-1.69) at one year of follow-up. The most frequent error was the loss of dose. For each change in medication, the probability of a combined event increases by 41%.ConclusionsThe changes made in bioequivalent drugs with different appearance could increase the number of medication use errors and decrease the adherence. More studies should be carried out to assess how much this affects the control of the disease.The intervention section is not considered because it is an observational study.     

La investigación en los servicios públicos de salud y su reconocimiento en las carreras profesionales de las comunidades autónomas en España

ObjectiveHealth research is an accessory activity for most health professionals in the national health service of Spain. One way to recognize your worth is through professional careers. The objective of this paper has been to compare how research activity is valued in the professional careers of the health services of the different regions of Spain.DesignReview of agreements, resolutions and decrees that define the professional careers of each community collected from the corporate websites of health services and health ministries.SiteHealth Research and Innovation Commission of the Extremadura Health Service.ParticipantsMembers of said commission.MethodsThe following was considered for comparison: if the research activity is valued in isolation from other concepts, if it is considered to advance in different levels, if it is a requirement for any of them, and the percentage of score assigned to the block to which it belongs.ResultsAlmost all the regions consider research as merit at all career levels. The score of the research block is between 4 and 50% of overall. They are only considered independently, of others activities, in the Canary Islands, Castilla-La Mancha, Castilla-León, Cataluña, Madrid and Murcia. They are required to climb a certain level in the Canary Islands and Castilla-León.ConclusionsThere is a high variability in the recognition of research activity between regions. The careers that best value research would be those of the Canary Islands and Castilla-León, which consider it an independent activity and it becomes a requirement. The regions that have a more negative approach are those that can be promoted to the highest level, without making any contribution to research.     

Consumo de tabaco y alcohol según la jornada laboral en España

ObjectiveTo examine the association between smoking and alcohol consumption and the type of working day in the Spanish populationMethodsCross-sectional study among employees residing in Spain aged >18 years (N = 8,736). We took data from the National Health Survey (2011-2012). Information was collected on the type of working day (morning, afternoon, evening, part-time, reduced hours, and shift-work) and smoking and drinking habits. Demographic characteristics and health- and work-related factors were also taken into account. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated through log-binomial regressions.ResultsAmong respondents, 32.1% smoked regularly, especially those working the night shift (43.5%). Moderate alcohol consumption was found in 54.8% of workers and excessive consumption in 1.5%. Most of the moderate and heavy drinkers worked part-time, with 57.6% and 1.8% respectively. The aOR of being a smoker was higher among night workers (OR = 1.58; 95% CI: 1.01-2.46). None of the work shifts were significantly associated with alcohol consumption.ConclusionsNight shift work was associated with regular smoking. This collective of workers should be monitored closely by occupational health services and regularly undergo programs to control tobacco consumption and smoking-related diseases. Additional research to elucidate the reasons for this association could help to achieve preventive and therapeutic success.     

Estudio de la situación nutricional de pacientes mayores de 65 años incluidos en el programa de atención domiciliaria de una población urbana

Objective

To analyse the nutritional status of patients older than 65 years included in the home care program (PAD).

Conductas de riesgo para la salud según la ocupación en población empleada en España

ObjectiveThis study aims to analyze the variations in the prevalence of different health risk behaviors according to occupation in working population in Spain.MethodCross-sectional study with data from the Spanish National Health Survey of 2017. The analysis includes adults between 18 and 65 years with employment at the time of the survey. Health risk behaviors are obesity, physical inactivity in free time, tobacco consumption and excessive alcohol consumption. The primary explanatory variable is the occupation, using the National Classification of Occupations of 2011. Sociodemographic characteristics are gender, age, country of birth and educational level. The prevalences (P) of risk behaviors have been calculated, as well as the odd and adjusted odds ratios (aOR).ResultsThe highest figures of obesity are observed in operators of installations and machinery and assemblers (P: 20.0%; ORa: 1.26; A95%CI: 1.04–1.52). The higher level of physical inactivity during free time appears in elementary occupations (P: 83.4%; ORa: 1.70; A95%CI: 1.45–1.99). Tobacco consumption is higher in operators of installations and machinery and assemblies (P: 37.4%; ORa: 1.22; A95%CI: 1.05–1.43). Excessive alcohol consumption appears to a greater extent on skilled workers in the agricultural sector, livestock, forestry and fisheries (P: 3.9%; ORa: 1.51; A95%CI: 0.83–2.75).ConclusionsThe results indicate a greater relationship between risk behaviors for health and manual or lower-skilled occupations.     

Accesibilidad y utilización de la espirometría en los centros de atención primaria de Cataluña

ObjectiveExamine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia.DesignCross-sectional study using a survey.ParticipantsThree hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010.MeasurementsSurvey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants.Main resultsResponse rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals. > 50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record. > 50% recognized a high priority strategies for improving the quality.ConclusionDespite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.