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David Monterde Emili Vela Montse Clèries Luis García Eroles Pol Pérez Sust 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):153-161
Objective
To compare the performance in terms of goodness of fit and explanatory power of 2 morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG).Design
Cross-sectional study.Location
PC in the Catalan Institute for the Health (CIH), Catalonia, Spain.Participants
Population allocated in primary care centers of the CIH for the year 2014.Main measurements
Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3 variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change.Results
The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy.Conclusions
The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs. 相似文献5.
Miguel Ángel Cantero-Braojos Andrés Cabrera-León María Angeles López-González Luís Angel Saúl 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):162-171
Objective
To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms.Design
A randomized clinical trial with a control group, taking three measurements over three months.Setting
Granada, Spain.Participants
A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM).Interventions
Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3 h was planned and the total of the program was developed during five weeks.Main measurements
Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM).Results
Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were ‘very important’ on intensity of pain (d = –1.01, d = –0.97) and interference of pain (d = –0.85, d = –0.74), with an improvement percentage from 21% to 30%.Conclusions
Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life. 相似文献6.
Cristina Domingo Fernando Aros Agurtzane Otxandategi Idoia Beistegui Ariadna Besga Pedro María Latorre 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):142-152
Objective
To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate.Desing
Quasi-experimental research with control group.Settings
Twelve primary health care centres and 3 hospitals from the Basque Country.Participants
Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV.Interventions
Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care.Main measurements
The rate of readmission for HF and health-related quality of lifeResults
One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio = 0.59, CI 95%: 0.36-0.98; P = .049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up.Conclusions
ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables 相似文献7.
María del Mar Martín-Rodríguez José Antonio Díaz-Berenguer José Luis Alonso-Bilbao Antonio Cabeza-Mora Francisco Navarro-Vázquez Alberto Espiñeira-Francés Lidia Nuez-Herrera 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5):300-309
Objective
To estimate the effect of the influenza vaccination in Primary Healthcare workers and the general population vaccinated during the 2015/2016 campaign.Design
Cross-sectional study.Setting
All the Primary Healthcare centres within the Gran Canaria healthcare region.Participants
A total of 1,868 Primary Healthcare workers (33.5% men; 66.5% women) and 795,605 individuals from the general population (49.4% men; 50.6% women).Principal measurements
The outcome variables in Primary Healthcare workers were: influenza cases reported to the Epidemiological Surveillance System, and the sick leave days due to illness. In the general population: reported flu cases and vaccination coverage in connection with the vaccination status of the healthcare professional. The magnitude of association between vaccination and morbidity was estimated applying logistic regression models.Results
Although not statistically significant, healthcare professionals that were not vaccinated had 1.7-fold increase in the risk of having influenza than those vaccinated. In the general population the association was significant in the female population (OR: 1.3; 95% CI: 1.1-1.5). Population coverage was significantly higher when both the doctor and nurse were vaccinated (OR: 1.3; 95% CI: 1.3-1.3), and reported flu cases decreased when the nurse was vaccinated (OR: 0.9; 95% CI: 0.9-0.9).Conclusion
A possible protective effect of influenza vaccination was observed in the general population, as well as an influence of Primary Healthcare workers on the patients regarding this. Even so, the low coverages registered point to a need to implement measures that may lead to a more favourable attitude towards influenza vaccination. 相似文献8.
C. Lepez W. Mehtelli J. Azuar F. Bellivier F. Vorspan 《Revue d'épidémiologie et de santé publique》2019,67(3):175-180
Aim
Cannabis use, as well as the prevalence of cannabis use disorder, are not known among the population attending general practices in France. We wanted to describe the characteristics of current cannabis users, estimate cannabis use disorder and self-rating of cannabis dependence, and describe medical conditions associated with cannabis use in a general practice in Paris.Methods
An anonymous questionnaire was proposed to every patient aged 18–65 in a general practice during three months from June to August 2014. Cannabis use in the last six months was recorded and cannabis use disorder was assessed according to three different means: answering yes to the question: do you feel like you are dependent on cannabis? or answering yes to the question: do you smoke cannabis in the first 5 minutes after awakening? or CUDIT score ≥ 8 points.Results
Two hundred and fifty-eight questionnaires were analyzed. Cannabis use in the past six months was found in 54 subjects (21%). Subjective feeling of cannabis dependence was endorsed by 18 subjects (6.9%). Cannabis use in the first 5 minutes after awakening was found in five subjects (1.9%) and 23 (8.9%) had a CUDIT score ≥ 8 points. Cannabis smokers had more often addictive and psychiatric associated medical conditions.Conclusion
General practitioners could ask about cannabis use and self-rated cannabis use disorder because it is frequent and patients with cannabis use disorder deserve specific care. 相似文献9.
Francisco Javier Formigo Couceiro Marta Pena Seijo Antonio Pose Reino José Manuel Mayán Santos Francisco Javier Ayape Amigot Jesús Sueiro Justel 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5)
Objective
To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs.Design
Transversal observational study.Location
Primary care unit, Santiago de Compostela.Participants
Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded.Main measurements
Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver.Results
In 26.76% of patients the systolic blood pressure fell by 20 mmHg or more and/or the diastolic blood pressure fell by 10 mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P = .412), not existing differences for arterial hypertension (P = .881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P = .033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P = .026)].Conclusion
OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered. 相似文献10.
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Magdalena Millá Perseguer Natividad Guadalajara Olmeda David Vivas Consuelo 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(4)
Objective
To analyze the prevalence of Cardiovascular Risk Factors (CVRF) in the context of a Basic Health Area and the impact they generate on morbidity and consumption of healthcare resources in the stratified population according to the Clinical System Risk Groups (CRG) in Primary Care, with the purpose of identifying the population with multimorbidity to apply preventive measures, as well as the one that generates the highest care burden and social needs.Design
Observational, cross-sectional and population-based study for a basic health area during 2013.Location
Department of Health 2 (Castellón), Comunidad Valenciana (CV). Includes outpatient care in Primary Care and specialized.Participants
All citizens registered in the Population Information System, N = 32,667.Measurements
From the computerized system Abucasis we obtained the demographic, clinical and consumption variables of health resources. We consider the prevalence of CVRF based on the presence or absence of the ICD.9.MC diagnostic codes. The relationship of the CVRF with the 9 CRG health states was analyzed and a predictive analysis was performed with the logistic regression model to evaluate the explanatory capacity of each variable. In addition, an explanatory model of ambulatory pharmaceutical expenditure was obtained through multivariate regression.Results
The population of health status CRG 4 and above had multimorbidity. The CRG 7 and 6 health states have a higher prevalence of CVRF; it was predictive that the higher the morbidity, the greater the consumption of resources through OR above the mean, p < 0.05 and the 95% confidence intervals. It was observed that 59.8% of ambulatory pharmaceutical expenditure was explained by the CRG system and all the CVRF (p < 0.05 and R2 corrected = 0.598). Regarding the effect of the CVRF on the CRG health states, there was a significant association (p < 0.05) for the alteration of blood glucose, dyslipidemia and HBP in all the CRG states.Conclusions
The study of CVRF in a stratified population using the CRG system identifies and predicts where the greatest impact on morbidity and consumption of healthcare resources is generated. It allows us to know the groups of patients where to develop prevention and chronicity strategies. At the level of clinical practice, a new concept of multimorbidity is provided, defined from the state of health CRG 4 and above. 相似文献13.
E. Farfour A.G. Si Larbi E. Cardot L. Limousin D. Mathonnet P. Cahen M. Vasse P. Lesprit 《Médecine et maladies infectieuses》2019,49(3):202-207
Objective
Pathogens are usually identified from blood cultures using a two-step procedure: Gram staining on the day of bacterial growth (D0), followed by identification and susceptibility testing the following day (D1). We aimed to evaluate the use of rapid tests performed on D0 in patients presenting with Enterobacteriaceae bacteremia.Patients and methods
Patients with ≥ 1 positive monomicrobial blood culture with Gram staining suggestive of an Enterobacteriaceae were prospectively included. Two successive strategies were evaluated: i) conventional strategy (CS), ii) combination of a rapid identification test and third-generation cephalosporin susceptibility testing (rapid strategy, e.g. RS).Results
Eighty-three patients were included (CS = 42; RS = 41). Compared with CS, the median delay of identification was significantly shorter with RS (22 hours [20–27] vs. 47 hours [42–53]; P < 0.001). Patients in the RS group more frequently received an effective (82.9% vs. 73.8%, P = 0.43) and appropriate (70.7% vs. 54.7%, P = 0.17) antibiotic therapy on D1. Moreover, all five RS patients infected with a non-susceptible strain received an effective therapy on D1 versus only three of eight CS patients.Conclusions
Use of rapid testing was associated with a reduced time to result availability. This strategy should be useful to initiate an early effective and appropriate therapy and to improve the care of patients. 相似文献14.
E. Chanzy M. Gentile M. Nahon A.-C. Paty O. Stibbe J.-P. Tourtier T. Petrovic L. Goix F. Adnet F. Lapostolle 《Revue d'épidémiologie et de santé publique》2019,67(3):201-204
Introduction
The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48 hours. A specific medical cover was organized in a particular “post-attacks” context and with harsh constraints due to delimitation of an inner zone under the sole UN authority (“blue zone”).Objective
To evaluate medical means involved and medical activity.Methods
Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the “blue zone”. End-points: engaged workforce, number of visits, including transfers and medicalized transfers.Results
In “France zone” (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In “blue zone”: 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24 hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43 ± 1 years. Trauma patients were most numerous (20%).Conclusion
Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required. 相似文献15.
Arleen De León-Robert Isabel Hidalgo-García Juan Gascón-Cánovas José Antón-Botella Carmen López-Alegría Heidi Campusano Castellanos 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(4):208-217
Objective
To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care.Design
Validation study of a diagnostic test.Setting
Primary care team in Murcia, Spain.Population
One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring.Main measurements
Performing HBPM for 24 hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots.Results
The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots.Conclusion
The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns. 相似文献16.
J.M. Bohbot A. Goubard F. Aubin Y. Mas E. Coatantiec N. Lucas F. Verrière 《Médecine et maladies infectieuses》2019,49(3):194-201
Objective
An empirical treatment of infectious vaginitis is justified because of its multiple etiologies, the frequent uncertainty of clinical diagnosis and limits of microbiological analysis. Our aim was to comparatively investigate nystatin-neomycin-polymyxin B combination (NNP, Polygynax®) and miconazole.Patients and methods
In this European multicenter, double-blind PRISM trial, participating women presenting with infectious vaginitis were randomized to receive one vaginal capsule containing either NNP for 12 days or miconazole for 3 days followed by 9 days of placebo.Results
The clinical success rate was higher in the NNP group (n = 302) than the miconazole group (n = 309), with a difference between groups close to statistical significance (91.1% vs. 86.7%, P = 0.0906). The risk of treatment failure was 36% lower in the NNP group (odds ratio, 0.64; 95% confidence interval, 0.38–1.07). Vaginal burning on Day 2 and vaginal discharge on Day 4 were significantly less intense in the NNP group than in the miconazole group (39.1 vs. 42.3, P = 0.031 and 34.6 vs. 37.6, P = 0.031, respectively). Adverse drug reactions were reported by 1.2% and 2.1% of patients in the NNP and miconazole group respectively, with the ratio of adverse drug reactions relative to total adverse events significantly higher in the miconazole group (20.3% vs. 6.9%, P = 0.022).Conclusion
The widespread use of NNP for several decades and its good efficacy and safety profile, as well as the frequent diagnostic uncertainties due to the various pathogens sustain the initiation of this broad-spectrum empirical treatment in infectious vaginitis. 相似文献17.
M. Lauda-Maillen E. Liuu M. Catroux A. Caupenne M. Priner F. Cazenave-Roblot C. Burucoa P. Ingrand M. Paccalin 《Médecine et maladies infectieuses》2019,49(3):173-179
Objective
Age > 65 years is associated with the recurrence and poor prognosis of Clostridium difficile infection (CDI). Data on elderly patients (≥ 75 years) is scarce, and little is known about compliance with European guidelines in terms of specific treatment. We aimed to analyze the treatment and prognosis of CDI in two groups of patients aged < and ≥ 75 years.Patients and methods
We performed a prospective survey from May 2014 to April 2015 in a university hospital including all patients presenting with microbiologically confirmed CDI. Sociodemographic and clinical data, treatment of CDI, recurrences (< 8 weeks after CDI treatment completion), new episodes, and mortality were recorded. Follow-up was performed until February 2016.Results
Overall, 101 patients were included; 45 were aged ≥ 75 years (44.6%). More than two-thirds of CDIs (71/101) were severe. Seven per cent of patients presenting with severe CDI and 10% of patients at increased risk of recurrence received the adequate treatment as per European guidelines. Mean follow-up was 15 ± 4 months (range: 10–22). Among patients aged ≥ 75 years, we observed the same number of recurrences and new episodes of CDI during the follow-up. The 3-month case fatality was significantly higher in the elderly group (P < 0.001). The one-year survival rate was 73.2% in younger patients and 45.7% in elderly patients (P = 0.0004).Conclusion
This study confirms the poor prognosis of CDI in elderly patients and highlights the lack of compliance with treatment guidelines. 相似文献18.
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E. Laurent A. Lemaignen G. Gras J. Druon K. Fèvre P. Abgueguen G. Le Moal E. Stindel A.-S. Domelier S. Touchais C. Arvieux L. Bernard P. Rosset L. Grammatico-Guillon 《Revue d'épidémiologie et de santé publique》2019,67(3):149-154
Background
In France, the most severe bone and joint infections (BJI), called “complex” (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification.Methods
Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients.Results
Inter-expert agreement during one MTM was moderate (κ = 0.49), and fair (κ = 0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ = 0.50, range 0.27–0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ = 0.58), it was better between MTMs with professor (κ = 0.65) than without (κ = 0.51) and with longer median time per case (κ = 0.60) than shorter (κ = 0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ = 0.40).Conclusion
The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM. 相似文献20.
Ferrán Catalá-López Manuel Ridao Enrique Bernal-Delgado David Moher José R. Repullo 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(3):255-258