81 results on '"Aguilar‐Palacio, I."'
Search Results
2. Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities
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Aguilar-Palacio, I., Martinez-Beneito, M.A., Rabanaque, M.J., Borrell, C., Cirera, L., Daponte, A, Domínguez-Berjón, M.F., Gandarillas, A., Gotsens, M., Lorenzo-Ruano, P., Marí-Dell'Olmo, M., Nolasco, A., Saez, M., Sánchez-Villegas, P., Saurina, C., and Martos, C.
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- 2017
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3. Prospective Association of Maternal Educational Level with Child's Physical Activity, Screen Time, and Diet Quality
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Cárdenas-Fuentes G, Homs C, Ramírez-Contreras C, Juton C, Casas-Esteve R, Grau M, Aguilar-Palacio I, Fitó M, Gomez SF, and Schröder H
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prospective cohort study ,sedentary behaviors ,lifestyle behaviors in children ,physical activity ,diet quality ,maternal educational level - Abstract
Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children's lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child's physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child's socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child's screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children.
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- 2021
4. Vulnerable population and health status in a neighbourhood in Zaragoza (Spain)
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Aguilar-Palacio, I., Gil-Lacruz, M., and Gil-Lacruz, A. I.
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- 2012
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5. ¿Cómo influyen las características individuales y el área de residencia en la solicitud de interconsultas virtuales?
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Marco Ibáñez, A., Aguilar-Palacio, I., Gamba-Cabezas, A., Compés-Dea, M.L., and Aibar Remón, C.
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•La comunicación oportuna y efectiva entre médicos de Atención Primaria y otros especialistas es un elemento clave y manifiestamente mejorable de la calidad asistencial.•Si bien uno de los objetivos principales de las interconsultas virtuales es mejorar la equidad de acceso de los pacientes a atención especializada, se objetivan desigualdades en su uso en función de las características individuales del usuario.•Durante el periodo de estudio se incrementó progresivamente la solicitud de interconsultas virtuales, con distribución heterogénea para el territorio estudiado.•Mujer, baja morbilidad ajustada, residencia en zona urbana y bajo nivel socioeconómico fueron las características individuales que más determinaron la solicitud de interconsulta virtual.•En un entorno asistencial de recursos limitados y no homogéneamente distribuidos, las interconsultas virtuales deben adaptarse a las necesidades de la población local.
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- 2024
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6. Utilización de servicios sanitarios en ancianos (España 2006-2012): influencia del nivel de salud y de la clase social
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Aguilar-Palacio I, Carrera-Lasfuentes P, Solsona S, Sartolo MT, and Rabanaque MJ.
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Objetivo Conocer la utilización de servicios sanitarios de Atención Primaria (AP), Atención Especializada (AE), hospitalizaciones, Hospital de Día y Urgencias, y la hiperfrecuentación en ancianos en España, analizando la influencia del estado de salud, sexo, clase social y evolución temporal. Diseño Estudio transversal en 2 fases. Emplazamiento España. Participantes Personas encuestadas en la Encuesta Nacional de Salud 2006 y 2011-12. Mediciones principales Como variables de salud se utilizaron la salud percibida y diagnosticada (número y tipo de diagnósticos). La clase social se obtuvo a partir de la última ocupación del sustentador principal (clases manuales y no manuales). Se realizaron análisis de regresión logística, ajustando por sexo, edad, nivel de salud, clase social y año, calculando su capacidad predictiva. ResultadosEl porcentaje de población mayor que utiliza consultas médicas descendió en el periodo estudiado. Las mujeres trabajadoras manuales presentaron la mayor prevalencia de mala salud (mala salud percibida en el 2006: 70,6%). La mala salud se asoció a mayor utilización de servicios sanitarios. La salud percibida fue mejor predictor de utilización de servicios y de hiperfrecuentación que la diagnosticada, con la mayor capacidad predictiva para AE (C = 0,676). Los ancianos de clases sociales bajas utilizaron con más frecuencia AP y Urgencias, mientras que la utilización de AE y Hospital de Día fue mayor en clases altas. Conclusiones Existen diferencias en salud y utilización de servicios sanitarios en mayores según clase social. Resulta necesario prestar atención a la salud percibida como predictor de la utilización de servicios sanitarios y revisar la accesibilidad-equidad de nuestros servicios.
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- 2016
7. Comorbilidad como predictor de utilización de servicios sanitarios y mortalidad en pacientes con diabetes
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Carrera-Lasfuentes, P., Abad, J.M., Aguilar-Palacio, I., and Rabanaque, M.J.
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Las enfermedades crónicas son la principal causa de mortalidad en el mundo. El estudio de las enfermedades más prevalentes resulta fundamental, así como disponer de un indicador de frecuentación sanitaria y mortalidad para estos colectivos. El objetivo de este estudio es identificar aquella medida de comorbilidad que predice mejor la utilización de servicios sanitarios y la mortalidad de los pacientes con diabetes mellitus en nuestro medio. Métodos: Estudio longitudinal de una cohorte de pacientes diagnosticados de diabetes mellitus en 2006 en Zaragoza, seguidos hasta 2010. Se realizaron modelos predictivos de regresión logística. Como medidas de comorbilidad se utilizaron el número de diagnósticos, el número de Grupos de Diagnóstico Ambulatorio (ADG) y el número de Grupos de Diagnóstico Ambulatorio Mayores (MADG), los dos últimos del sistema ACG (Ambulatory Care Groups). Se consideró como medida de validez la mejora en la capacidad explicativa del modelo (estadístico c). Resultados: Se observó una prevalencia de diabetes mellitus del 8,8%. Tanto el número de diagnósticos como la comorbilidad se relacionaron con la utilización de servicios sanitarios y con la mortalidad. En cuanto a la mortalidad, la mejor medida de comorbilidad fue el número de MADG (c = 0,763). El modelo con las variables sexo, edad, número de MADG y número de ingresos tuvo la mayor capacidad explicativa (c = 0,818). Conclusiones: El sistema ACG permite predecir el consumo de recursos y la mortalidad de este colectivo en nuestro medio. Este estudio confirma la importante carga asistencial que generan los enfermos de diabetes mellitus y subraya la necesidad de tomar medidas al respecto.
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- 2015
8. Salud percibida y nivel educativo en España: tendencias por comunidades autónomas y sexo (2001-2012)
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Aguilar-Palacio, I, Carrera-Lasfuentes, P, and Rabanaque, MJ
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Social determinants of health ,Educational status ,Health surveys ,Nivel educativo ,Determinantes sociales de la salud ,Encuestas de salud - Abstract
Objetivo Conocer la evolución de la prevalencia de mala salud percibida en España por comunidades autónomas (CC.AA.) para el periodo 2001-2012, las diferencias por sexo y edad, y la influencia del nivel educativo. Método Estudio transversal de la Encuesta Nacional de Salud de 2001 a 2011-12, y de la Encuesta Europea de 2009. Se realizó un estudio descriptivo por sexo, edad, nivel educativo y C.A. de residencia ajustado por edad. Se utilizaron análisis de regresión logística para estudiar la evolución temporal y conocer la asociación entre el nivel educativo y la salud percibida, calculando su capacidad predictiva mediante el estadístico C. Resultados La prevalencia de mala salud percibida fue mayor en las mujeres con nivel educativo bajo y mejoró en las de nivel educativo alto (18,6% en 2001 y 14,6% en 2012). La mayor prevalencia de mala salud percibida se observó en Andalucía, Canarias, Galicia y Murcia, con diferencias por sexo. El nivel educativo bajo se asoció con una peor salud percibida en la mayoría de las CC.AA., con buena capacidad predictiva. En todas las CC.AA., excepto Asturias, existió una mayor percepción de mala salud en las mujeres que en los hombres. En España, la prevalencia de mala salud percibida se mantuvo sin cambios en el periodo analizado, pero mejoró en Baleares, Cataluña y Madrid. Conclusiones En España existen diferencias en la prevalencia de mala salud percibida por CC.AA. Aunque no varía en el periodo analizado, se observan desigualdades en su evolución según el nivel educativo y el sexo, que podrían conllevar un aumento de las desigualdades en mujeres según el nivel educativo. Objective To identify the trend in self-rated health in Spain by autonomous communities (AC) in the period 2001-2012, as well as differences by gender and age, and the influence of educational level. Methods A cross sectional study was carried out using data from the National Health Surveys from 2001 to 2011-12 and the 2009 European Survey. A descriptive analysis was conducted that included gender, age, educational level, and the AC of residence. Logistic regression analyses were developed to explore the temporal trend and the association between educational level and self-rated health. The predictive capacity of the model was calculated using the C statistic. Results The prevalence of low self-rated health was higher in women with low educational level. Self-rated health improved in women with high educational level (2001:18.6% vs. 2012:14.6%). The highest prevalence of low self-rated health was observed in Andalusia, the Canary Islands, Galicia and Murcia, with differences by gender. Low educational level was associated with low self-rated health in most AC, with good predictive capacity. In all AC except Asturias, low self-rated health was more frequent in women than in men. In Spain, the prevalence of self-rated health showed no variations in the period analyzed and improved in the Balearic Islands, Catalonia, and Madrid. Conclusions The prevalence of self-rated health in Spain differed by AC. Although health was unchanged during the period considered, inequalities were found in its temporal trend by educational level and gender, which could lead to an increase in health inequalities in women according educational level.
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- 2015
9. Morbidity and drug consumption: comparison of results between the National Health Survey and electronic medical records
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Aguilar-Palacio, I., Carrera-Lasfuentes, P., Poblador-Plou, B., Prados-Torres, A., and Rabanaque-Hernández, M.J.
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Historia clínica electrónica ,Consumo de fármacos ,Health surveys ,Prevalence ,Drug utilization ,Encuestas de salud ,Morbilidad ,Morbidity ,Prevalencia ,Electronic medical records - Abstract
Objetivo: Comparar la prevalencia de enfermedad y consumo de fármacos obtenida en la Encuesta Nacional de Salud (ENS) con los resultados de los registros de la historia clínica electrónica de atención primaria (HCE) y del Sistema de Información de Consumo Farmacéutico de Aragón (Farmasalud), en población adulta de la provincia de Zaragoza. Métodos: Estudio transversal para comparar la prevalencia de enfermedad obtenida en la ENS-2006 y en la HCE, y de consumo de fármacos en la ENS-2006 y Farmasalud. Se obtuvieron los intervalos de confianza del 95% (IC95%) estratificados por sexo y grupos de edad. Se comprobó la comparabilidad entre ambas poblaciones de referencia. Resultados: El 81,8% de los adultos de Zaragoza visitaron a algún médico durante 2006 según la ENS, y el 61,4% a su médico de atención primaria según la HCE. La hipertensión fue la enfermedad más prevalente en ambas fuentes de información (ENS: 21,5%, IC95%: 19,4-23,9; HCE: 21,6%, IC95%: 21,3-21,8). Las mayores diferencias entre la ENS y la HCE se observaron en la prevalencia de depresión, ansiedad u otros trastornos mentales (ENS: 10,9%; HCE: 26,6%). Los analgésicos fueron los más consumidos. La prevalencia de consumo varió según la fuente, con las mayores diferencias en los analgésicos (ENS: 23,3%; Farmasalud: 63,8%) y los antibióticos (ENS: 3,4%; Farmasalud: 41,7%). Las diferencias se mantuvieron al estratificar por sexo, y fueron mayores en el grupo de edad >75 años. Conclusiones: Hay diferencias en la prevalencia de morbilidad y en el consumo de fármacos según la fuente de información utilizada. Resulta aconsejable utilizar de manera complementaria diversas fuentes para estimar prevalencias reales en salud. Objective: To compare the prevalence of disease and drug consumption obtained by using the National Health Survey (NHS) with the information provided by the electronic medical records (EMR) in primary health care and the Pharmaceutical Consumption Registry in Aragon (Farmasalud) in the adult population in the province of Zaragoza. Methods: A cross-sectional study was performed to compare the prevalence of diseases in the NHS-2006 and in the EMR. The prevalence of drug consumption was obtained from the NHS-2006 and Farmasalud. Estimations using each database were compared with their 95% confidence intervals (95% CI) and the results were stratified by gender and age groups. The comparability of the databases was tested. Results: According to the NHS, a total of 81.8% of the adults in the province of Zaragoza visited a physician in 2006. According to the EMR, 61.4% of adults visited a primary care physician. The most prevalent disease in both databases was hypertension (NHS: 21.5%, 95% CI: 19.4-23.9; EMR: 21.6%, 95% CI: 21.3-21.8). The greatest differences between the NHS and EMR was observed in the prevalence of depression, anxiety, and other mental illnesses (NHS: 10.9%; EMR: 26.6%). The most widely consumed drugs were analgesics The prevalence of drug consumption differed in the two databases, with the greatest differences being found in pain medication (NHS: 23.3%; Farmasalud: 63.8%) and antibiotics (NHS: 3.4%; Farmasalud: 41.7%). These differences persisted after we stratified by gender and were especially important in the group aged more than 75 years. Conclusions: The prevalence of morbidity and drug consumption differed depending on the database employed. The use of different databases is recommended to estimate real prevalences.
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- 2014
10. Orientación en el tiempo y deterioro cognitivo
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Aguilar-Palacio I, L F Pascual-Millán, C Pérez-Lázaro, Fernández-Turrado T, Burriel-Rosello A, and Santolaria-Martinez L
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Neurology (clinical) ,General Medicine - Abstract
Introduccion. La orientacion temporal forma parte de la mayoria de los tests de cribado para el diagnostico de deterioro cognitivo. Una orientacion temporal correcta implica activar tanto informacion semantica (conceptos de la fecha del calendario) como episodica (recuerdo de la fecha actual). Objetivo. Evaluacion de la utilidad diagnostica de una tecnica de valoracion de la orientacion temporal, basada en una consigna abierta, y puntuacion de la informacion semantica y episodica generadas (0-10 puntos). Sujetos y metodos. Se evaluo un total de 24 sujetos sin deterioro, 77 pacientes con deterioro cognitivo leve (DCL) y 62 pacientes con demencia, mediante test minimental/miniexamen cognitivo de 30 puntos, test de fluidez verbal semantica, escala de deterioro global, orientacion temporal tipo minimental y orientacion temporal tipo abierto. Se han analizado las areas bajo la curva (aROC), sensibilidad y especificidad para la demencia y el deterioro cognitivo en cualquier grado (DCL y demencia). Resultados. La orientacion temporal tipo abierto presento la mayor area bajo la curva (aROC = 0,90) para la discriminacion entre pacientes con demencia y sin demencia (DCL y sin deterioro) y un aROC = 0,83 para discriminar entre pacientes con DCL o demencia y sin deterioro. Para la demencia, con un punto de corte igual o inferior a 6, presento una sensibilidad de 0,96 y una especificidad de 0,68, y para DCL y demencia, con un punto de corte igual o inferior a 7, una sensibilidad de 0,72 y una especificidad de 0,92. Conclusiones. Esta tecnica es adecuada como instrumento de cribado en el deterioro cognitivo por su utilidad, brevedad y posicion estrategica en la exploracion del estado mental. Presenta alta sensibilidad con baja especificidad para la demencia y baja sensibilidad con alta especificidad para el deterioro en cualquier grado.
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- 2011
11. The socio-economic vulnerability in a neighborhood determines the use and frequentation of health services,Vulnerabilidad socioeconómica en un vecindario como determinante de la utilización y frecuentación de servicios sanitarios
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Marta Gil-Lacruz, Gil-Lacruz, A. I., and Aguilar Palacio, I.
12. Prescribing pattern of antihypertensive drugs in two European cohorts: a population-based database study
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María Jesús Lallana, Giuseppe Limongelli, V. Russo, Isabel Aguilar-Palacio, María José Rabanaque, Enrica Menditto, Valentina Orlando, Cristina Feja, Sara Malo, Malo, S., Rabanaque, M. J., Orlando, V., Limongelli, G., Feja, C., Aguilar-Palacio, I., Lallana, M. J., Russo, V., and Menditto, E.
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Adult ,Male ,medicine.medical_specialty ,hypertension ,pharmacoepidemiology ,Databases, Factual ,Population based ,03 medical and health sciences ,0302 clinical medicine ,Drug utilization study ,Health care ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Intensive care medicine ,Antihypertensive Agents ,Aged ,Aged, 80 and over ,Primary Health Care ,business.industry ,030503 health policy & services ,Health Policy ,international comparison ,Database study ,General Medicine ,Middle Aged ,Pharmacoepidemiology ,Drug Utilization ,Antihypertensive Agent ,Italy ,Spain ,Female ,0305 other medical science ,business ,Human - Abstract
Background: Antihypertensive drugs play a crucial role in reducing cardiovascular morbidity and mortality. Variability in prescribing patterns constitutes a major challenge for current healthcare systems. This study aimed to compare patterns of use of antihypertensives in general practice in two southern European populations. Methods: Observational study. Data on antihypertensive drugs consumption in primary care setting (2016) were obtained from pharmacy refill records in Campania (Italy) and Aragon (Spain). Prescribing rates and the number of defined daily doses [DDD/1, 000 inhabitants/day (DID)] were calculated, and the Drug Utilization 90% (DU90%) approach used to reveal differences in prescribing patterns in both regions. Results: Antihypertensive prescribing rates in Campania and Aragon were 250.8 (95%CI: 250.2–251.3) and 201.7 (95%CI: 200.9–202.5) users/1, 000 inhabitants/year. Overall consumption was of 310.1 and 256.8 DID, respectively. Spanish users, especially women and the elderly, consumed a greater volume of diuretics. Conversely, other therapeutic subgroups were more consumed in Campania. However, the most prescribed subgroups accounted for comparable proportions of the total consumption in each region. Conclusions: Both prescribing rates and intensity of antihypertensive use were higher in Campania. Pharmacy refill records in cross-country comparisons allow to know the factors influencing variability in prescribing habits with a view to improving prescribing quality.
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- 2019
13. Type 2 diabetes mellitus and cancer: epidemiology, physiopathology and prevention
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María Grau, Cristina Miquel, José Miguel Baena-Díez, Isabel Aguilar-Palacio, Cristina Rey-Reñones, [Rey-Reñones C] Research Support Unit-Camp de Tarragona, Catalan Institute of Health (ICS), Tarragona, Spain. IDIAP Jordi Gol, Catalan Institute of Health (ICS), Barcelona, Spain. School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain. [Baena-Díez JM] IDIAP Jordi Gol, Catalan Institute of Health (ICS), Barcelona, Spain. La Marina Primary Care Center, Catalan Institute of Health (ICS), Barcelona, Spain. [Aguilar-Palacio I] Research Group in Health Services of Aragon, (GRISSA) IIS Aragón, University of Zaragoza, Zaragoza, Spain. [Miquel C] Department of Medicine, University of Barcelona, Barcelona, Spain. [Grau M] Serra Húnter Fellow, Department of Medicine, University of Barcelona, Barcelona, Spain. Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), Barcelona, Spain. IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain, and Departament de Salut
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medicine.medical_specialty ,Disease prevention ,QH301-705.5 ,Epidemiology ,Medicine (miscellaneous) ,Review ,General Biochemistry, Genetics and Molecular Biology ,Diabetis no-insulinodependent ,enfermedades del sistema endocrino::diabetes mellitus::diabetes mellitus tipo II [ENFERMEDADES] ,neoplasias [ENFERMEDADES] ,Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores] ,Neoplasms ,Epidemiology of cancer ,Type 2 diabetes mellitus ,medicine ,media_common.cataloged_instance ,Endocrine System Diseases::Diabetes Mellitus::Diabetes Mellitus, Type 2 [DISEASES] ,Obesity ,European union ,Biology (General) ,Intensive care medicine ,Epidemiologia ,media_common ,Tumors ,Cancer prevention ,Diabetis ,business.industry ,Diabetes ,Type 2 Diabetes Mellitus ,Cancer ,Oncologia - Malalties - Prevenció ,medicine.disease ,Metformin ,Neoplasms [DISEASES] ,Obesitat ,Thiazolidinediones ,business ,medicine.drug ,Other subheadings::Other subheadings::/complications [Other subheadings] - Abstract
Type-2 diabetes mellitus; Epidemiology; Cancer Diabetes tipo 2; Epidemiología; Cáncer Diabetis tipus 2; Epidemiologia; Càncer Individuals with type 2 diabetes mellitus are at greater risk of developing cancer and of dying from it. Both diseases are age-related, contributing to the impact of population aging on the long-term sustainability of health care systems in European Union countries. The purpose of this narrative review was to describe, from epidemiological, pathophysiological and preventive perspectives, the links between type 2 diabetes mellitus and the most prevalent cancers in these patients. Multiple metabolic abnormalities that may occur in type 2 diabetes mellitus, particularly obesity, could explain the increased cancer risk. In addition, the effectiveness of drugs commonly used to treat type 2 diabetes mellitus (e.g., metformin and thiazolidinediones) has been broadly evaluated in cancer prevention. Thus, a better understanding of the links between type 2 diabetes mellitus and cancer will help to identify the contributing factors and the pathophysiological pathways and to design personalized preventive strategies. The final goal is to facilitate healthy aging and the prevention of cancer and other diseases related with type 2 diabetes mellitus, which are among the main sources of disability and death in the European Union and worldwide.
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- 2021
14. The Need to Develop Standard Measures of Patient Adherence for Big Data: Viewpoint
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Anna Giardini, Marta Almada, Caitriona Cahir, Bernard Vrijens, Isabel Aguilar-Palacio, Przemyslaw Kardas, Enrica Menditto, Luís Midão, Carlos Luis Parra-Calderón, Enrique Pepiol Salom, Mireia Massot Mesquida, Elísio Costa, Sara Malo, Kardas, P., Aguilar-Palacio, I., Almada, M., Cahir, C., Costa, E., Giardini, A., Malo, S., Massot Mesquida, M., Menditto, E., Midao, L., Parra-Calderon, C. L., Pepiol Salom, E., Vrijens, B., Aflofarm, Fresenius Biotech, Polpharma, Sandoz, and European Commission
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medicine.medical_specialty ,Consensus ,Big data ,Psychological intervention ,Patient adherence ,Health Informatics ,Pharmacy ,030204 cardiovascular system & hematology ,lcsh:Computer applications to medicine. Medical informatics ,metrics ,03 medical and health sciences ,0302 clinical medicine ,Viewpoint ,Order (exchange) ,big data ,Health care ,medicine ,consensu ,Humans ,030212 general & internal medicine ,Digitization ,Retrospective Studies ,Medical education ,patient adherence ,business.industry ,metric ,Public health ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,Benchmarking ,3. Good health ,consensus ,Patient Compliance ,lcsh:R858-859.7 ,Metrics ,business ,Psychology - Abstract
Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable., PK received speaker honoraria from Aflofarm, Fresenius, Polpharma, and Sandoz and received grant funding from European Union’s Horizon 2020 for GATEKEEPER project (grant agreement number 857223) and The European Commission ERASMUS+ Project Skills4Adherence (grant agreement number: 2017-1-PL01-KA202-038672), outside of this work. BV is the CEO and shareholder of AARDEX Group.
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- 2020
15. [How the individual characteristics and area of residence influence the request for virtual consultations?]
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Marco-Ibáñez A, Aguilar-Palacio I, Gamba-Cabezas A, Compés-Dea ML, and Aibar Remón C
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Introduction: The foundation of virtual consultation is to improve the cooperation and the coordination between Primary Care and other specialties. However, in its use inequities related to socioeconomic determinants have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource., Material and Methods: Descriptive study of virtual and non-virtual consultations requested by Primary Care doctors from other specialists doctors in Aragon between 1 January 2020 and 31 December 2022. Characteristics of the interconsultations and variables specific to the patient treated were recorded and analyzed; and the request rate for virtual consultations by specialty and the standardized rates by age by Basic Health Zone and stratified by sex were calculated., Results: Progressive increase in the number of virtual consultations for the study period, being Traumatology, Neurology, Urology, General Surgery and Dermatology the specialties that received the most. The standardized rates by age and stratified by sex were higher in women and the Health Areas of Huesca, Calatayud and Alcañiz. The request was higher in 2022 and the specialized referral was the main type of response. Regarding variables of the patients treated, virtual consultations were requested more in urban and less dispersed areas, women, patients with lower adjusted morbidity and with free pharmacy, pensioners and active users with income less than €18,000/year., Conclusions: Despite the rise of telemedicine and its potential advantages, it is necessary to adapt it to the needs of the local population, to mitigate inequalities in access, and to integrate it with face-to-face care., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2024
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- View/download PDF
16. Gender inequalities in secondary prevention of cardiovascular disease: a scoping review.
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López Ferreruela I, Obón Azuara B, Malo Fumanal S, Rabanaque Hernández MJ, and Aguilar-Palacio I
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- Humans, Female, Male, Sex Factors, Healthcare Disparities statistics & numerical data, Cardiovascular Diseases prevention & control, Secondary Prevention methods
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Background: Despite significant progress in cardiovascular disease (CVD) management, it remains a public health priority and a global challenge. Within the disease process, health care after a cardiovascular event (secondary prevention) is essential to prevent recurrences. Nonetheless, evidence has suggested the existence of gender disparities in CVD management, leaving women in a vulnerable situation. The objective of this study is to identify all available evidence on the existence of gender differences in health care attention after a major adverse cardiovascular event., Methods: A scoping review following the structure of PRISMA-ScR was conducted. To define the inclusion criteria, we used Joanna Briggs Institute (JBI) population, concept, context framework for scoping reviews. A systematic search was performed in MEDLINE (PubMed), EMBASE and Cochrane. The methods of this review are registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) (INPLASY202350084)., Results: The initial search retrieved 3,322 studies. 26 articles were identified manually. After the reviewing process, 93 articles were finally included. The main intervention studied was the pharmacological treatment received (n = 61, 66%), distantly followed by guideline-recommended care (n = 26, 28%) and cardiac rehabilitation (CR) referral (n = 16)". Literature described gender differences in care and management of secondary prevention of CVD. Women were less frequently treated with guideline-recommended medications and seem more likely to be non-adherent. When analysing guideline recommendations, women were more likely to make dietary changes, however, men were more likely to increase physical activity. Studies also showed that women had lower rates of risk factor testing and cholesterol goals attainment. Female sex was associated with lower rates of cardiac rehabilitation referral and participation., Conclusions: This review allowed us to compile knowledge on the existence of gender inequalities on the secondary prevention of CVD. Additional research is required to delve into various factors influencing therapeutic disparities, referral and non-participation in CR programs, among other aspects, in order to improve existing knowledge about the management and treatment of CVD in men and women. This approach is crucial to ensure the most equitable and effective attention to this issue., (© 2024. The Author(s).)
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- 2024
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17. Differences in healthcare use and mortality in older adults during the COVID-19 pandemic: Exploring long-term care users' vulnerability.
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Aguilar-Palacio I, Maldonado L, Malo S, Castel-Feced S, Cebollada A, Aguilar-Latorre A, and Rabanaque MJ
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Background: The objective of our study is to analyze the health care received by older adults with COVID-19 according to their place of residence (whether or not they live in a long-term care [LTC] facility) and to find out the effect of health care on mortality., Methods: Retrospective cohort study based in Aragón (Spain) from March 2020 to March 2021 in patients aged 65 years or older with a confirmed COVID-19 infection. The population was classified according to their place of residence (living in a LTC or not). A propensity score was used to match individuals by sex and age. The effect of living in a LTC facility on healthcare delivery and mortality was conducted using adjusted multivariate models. Varimp was used to estimate the best predictors of mortality for both groups., Results: Healthcare services utilization varied depending on whether the patients lived in a LTC facility or not. The time to diagnosis was shorter in institutionalized patients, but the time to hospital admission was longer. Length of hospital stays, risk of ICU admission and 30-day mortality were also different and remained statistically significant in the adjusted models. The variables that were more important in the association between healthcare utilization and mortality were those associated with greater severity of COVID-19., Conclusions: There were differences in health care for older adults diagnosed with COVID-19 according to their place of residence. There is a need to strengthen collaboration between professionals in LTC centers and health services to provide equitable health care., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Isabel Aguilar reports financial support was provided by 10.13039/501100010067Government of Aragón. Isabel Aguilar reports financial support was provided by Research Network on Chronicity Primary Care and Prevention and Health Promotion. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)
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- 2024
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18. Initiation of lipid-lowering therapy as primary prevention of cardiovascular disease in the elderly.
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Vinuesa-Hernando JM, Aguilar-Palacio I, Rabanaque MJ, García-Cárdenas V, Lallana MJ, Gamba A, and Malo S
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Aims: This study aimed to analyse the initiation adherence phase to lipid-lowering therapy for primary prevention of cardiovascular disease in a Spanish population aged 70 years or older. The secondary objective was to identify the determinants of initiation and early discontinuation., Methods: This was an observational study conducted in the CArdiovascular Risk factors for HEalth Service research (CARhES) cohort. People aged 70 and older with a first prescription of a lipid-lowering drug and without a previous major adverse cardiovascular event (MACE) were selected (2018-2021). Data on sociodemographics, clinical conditions, drugs and use of health services were collected from clinical and administrative electronic databases. The study population was classified into: non-initiation, early discontinuation (i.e., discontinuation after the first dispensing) and initiation with more than one dispensing. Their characteristics were compared. Determinants of initiation and early discontinuation were explored., Results: Among the 15 019 people studied, 80.2% initiated the medication, 11.2% showed an early discontinuation and 8.6% were non-initiators. An older age or conditions such as dementia, diabetes or depression reduced the likelihood of initiation, while obesity and a high pharmacological burden increased it. People over 90 years of age or those prescribed a statin in combination were more likely to have an early discontinuation., Conclusions: Non-initiation and early discontinuation are common among older people prescribed lipid-lowering drugs as primary prevention of cardiovascular disease for the first time. The presence of chronic pathologies other than cardiovascular ones should be considered when assessing whether or not to prescribe these drugs in the elderly., (© 2024 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
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- 2024
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19. Exploring sex variations in the incidence of cardiovascular events: a counterfactual decomposition analysis.
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Castel-Feced S, Malo S, Aguilar-Palacio I, Maldonado L, Rabanaque MJ, and San Sebastián M
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- Humans, Male, Female, Incidence, Middle Aged, Aged, Sex Factors, Risk Factors, Hypercholesterolemia epidemiology, Adult, Diabetes Mellitus epidemiology, Prevalence, Social Class, Hypertension epidemiology, Heart Disease Risk Factors, Health Status Disparities, Cardiovascular Diseases epidemiology
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Background: Some cardiovascular risk factors (CVRFs) that occur differently in men and women can be addressed to reduce the risk of suffering a major adverse cardiovascular event (MACE). Furthermore, the development of MACE is highly influenced by social determinants of health. Counterfactual decomposition analysis is a new methodology that has the potential to be used to disentangle the role of different factors in health inequalities. This study aimed to assess sex differences in the incidence of MACE and to estimate how much of the difference could be attributed to the prevalence of diabetes, hypertension, hypercholesterolaemia and socioeconomic status (SES)., Methods: Descriptive and counterfactual analyses were conducted in a population of 278 515 people with CVRFs. The contribution of the causal factors was estimated by comparing the observed risk ratio with the causal factor distribution that would have been observed if men had been set to have the same factor distribution as women. The study period was between 2018 and 2021., Results: The most prevalent CVRF was hypercholesterolaemia, which was similar in both sexes, while diabetes was more prevalent in men. The incidence of MACE was higher in men than in women. The main causal mediating factors that contributed to the sex differences were diabetes and SES, the latter with an offsetting effect., Conclusions: This result suggests that to reduce the MACE gap between sexes, diabetes prevention programmes targeting men and more gender-equal salary policies should be implemented., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)
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- 2024
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20. Gender health care inequalities in health crisis: when uncertainty can lead to inequality.
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Aguilar-Palacio I, Obón-Azuara B, Castel-Feced S, Malo S, Teresa J, and Rabanaque MJ
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Background: In health crisis, inequalities in access to and use of health care services become more evident. The objective of this study is to analyse the existence and evolution of gender inequalities in access to and use of healthcare services in the context of the COVID-19 health crisis., Methods: Retrospective cohort study using data from all individuals with a confirmed COVID-19 infection from March 2020 to March 2022 in Aragón (Spain) (390,099 cases). Health care access and use was analysed by gender for the different pandemic waves. Univariate and multivariate analyses were conducted to evaluate the effect of sex in health care. Blinder-Oaxaca decomposition methods were performed to explain gender gaps observed., Results: The health care received throughout the COVID-19 pandemic differed between men and women. Women were admitted to hospital and intensive care units less frequently than men and their stays were shorter. Differences observed between men and women narrowed throughout the pandemic, but persisted even after adjusting for age, socioeconomic status, morbidity burden or the patient's place of residence. Differences in sociodemographic characteristics and morbidity burden could explain partially the gender inequalities found, mainly in the later phases of the pandemic, but not in the earlier waves., Conclusions: There were gender inequalities in access to and use of health services during the COVID-19 pandemic. Inequalities were greater in the first waves of the pandemic, but did not disappear. Analysis of health crises must take into account an intersectional gender perspective to ensure equitable health care., (© 2024. The Author(s).)
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- 2024
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21. [Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement].
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Marco Ibáñez A, Aguilar Palacio I, and Aibar Remón C
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- Humans, Cross-Sectional Studies, Consensus, Primary Health Care, Referral and Consultation, Communication
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Objective: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains., Design: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. SITE: Physicians with healthcare duties in primary care in Aragon., Participants: Specialist physicians and resident interns in Family and Community Medicine., Meansurements: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies., Results: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued., Conclusions: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety., (Copyright © 2023 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)
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- 2024
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22. Virtual Consultation in Dermatology: Access Inequalities According to Socioeconomic Characteristics and the Place of Residence.
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Marco-Ibáñez A, Aibar-Remón C, Gamba-Cabezas A, Maldonado L, and Aguilar-Palacio I
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Virtual consultation has been implemented as a tool to improve the cooperation and coordination between primary care and other specialties. However, in its use in dermatology, inequities have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource. We conducted a cross-sectional study. The study population was individuals living in Aragón, a region in the north-east of Spain, who were users of the Aragon Health Service in 2021. To explore the differences in individual and area characteristics, between patients with virtual and non-virtual dermatology consultation, we performed bivariate analyses. To analyse the use of virtual consultation in dermatology, a multilevel methodology stratified by sex was developed. We analysed 39,174 dermatology visits, with 16,910 being virtual (43.17%). The rates of virtual consultation were higher in urban areas and the most affluent areas, for older persons, chronic complex patients and people with more advantageous socioeconomic positions. The best multilevel model conducted showed inequalities by socioeconomic position and area of residence. There are individual and area inequalities in the use of teledermatology. As this tool should improve equity of access, teledermatology interventions must address and adapt to the needs of the local patient population.
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- 2024
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23. Cohort Profile: The CArdiovascular Risk factors for hEalth Services research (CARhES) cohort study.
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Aguilar-Palacio I, Rabanaque M, Castel S, Maldonado L, González-García J, Compés L, and Malo S
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- Humans, Cohort Studies, Risk Factors, Socioeconomic Factors, Heart Disease Risk Factors, Healthcare Disparities, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology
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- 2024
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24. Influence of cardiovascular risk factors and treatment exposure on cardiovascular event incidence: Assessment using machine learning algorithms.
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Castel-Feced S, Malo S, Aguilar-Palacio I, Feja-Solana C, Casasnovas JA, Maldonado L, and Rabanaque-Hernández MJ
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- Humans, Male, Cohort Studies, Bayes Theorem, Risk Factors, Algorithms, Machine Learning, Heart Disease Risk Factors, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Hypertension epidemiology, Hypertension complications, Diabetes Mellitus
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Assessment of the influence of cardiovascular risk factors (CVRF) on cardiovascular event (CVE) using machine learning algorithms offers some advantages over preexisting scoring systems, and better enables personalized medicine approaches to cardiovascular prevention. Using data from four different sources, we evaluated the outcomes of three machine learning algorithms for CVE prediction using different combinations of predictive variables and analysed the influence of different CVRF-related variables on CVE prediction when included in these algorithms. A cohort study based on a male cohort of workers applying populational data was conducted. The population of the study consisted of 3746 males. For descriptive analyses, mean and standard deviation were used for quantitative variables, and percentages for categorical ones. Machine learning algorithms used were XGBoost, Random Forest and Naïve Bayes (NB). They were applied to two groups of variables: i) age, physical status, Hypercholesterolemia (HC), Hypertension, and Diabetes Mellitus (DM) and ii) these variables plus treatment exposure, based on the adherence to the treatment for DM, hypertension and HC. All methods point out to the age as the most influential variable in the incidence of a CVE. When considering treatment exposure, it was more influential than any other CVRF, which changed its influence depending on the model and algorithm applied. According to the performance of the algorithms, the most accurate was Random Forest when treatment exposure was considered (F1 score 0.84), followed by XGBoost. Adherence to treatment showed to be an important variable in the risk of having a CVE. These algorithms could be applied to create models for every population, and they can be used in primary care to manage interventions personalized for every subject., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Castel-Feced et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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25. Does virtual consultation between primary and specialised care improve healthcare quality? A scoping review of healthcare quality domains assessment.
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Marco-Ibáñez A, Aguilar-Palacio I, and Aibar C
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- Humans, Patient-Centered Care, Quality of Health Care, Quality Assurance, Health Care
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Background: Virtual consultation has been proposed as a promising tool to improve the coordination and quality of healthcare between primary and specialised care. However, despite its potential facilitators, the evidence on the usefulness of virtual consultation for improving healthcare quality domains is fragmented and unclear. This scoping review aims to assess the impact of virtual consultation on different healthcare quality domains., Material and Methods: We conducted a scoping review with a rigorous search strategy on PubMed, EMBASE and Cochrane Library databases. The inclusion criteria were original articles, reviews, meta-analyses or letters to the editor, published between 1 January 2017 and 24 June 2022, and available in English, Spanish or French. For each of the articles selected, we identified the addressed healthcare quality domains, their facilitators and barriers, areas of improvement and data gaps. We have adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review reporting standards., Results: 1284 manuscripts were retrieved. Finally, 235 papers were included in this review, most of which were original, descriptive studies. The most evaluated quality domain was effectiveness (223 articles). Safety and patient-centred care were the least evaluated. Simultaneous assessment of more than one domain was observed in 117 papers, being effectiveness and timeliness the most frequent combination. Our analysis revealed that virtual consultation is in development and underused. This tool has the potential to improve access to specialised care and enhance coordination between professionals., Conclusions: Virtual consultation has the potential to provide effective, efficient, equitable and timely attention. However, its contribution to safety and patient-centered care needs further evaluation. Our review emphasises the need for more rigorous research and standardised quality assessment criteria to obtain robust evidence on the usefulness of virtual consultation for improving healthcare quality domains., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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26. Spanish translation of the ABC taxonomy for medication adherence.
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Garcia-Cardenas V, Hughes D, Aguilar-Palacio I, Benrimoj SI, Rabanaque MJ, Martinez-Martinez F, and Malo S
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- Humans, Delphi Technique, Consensus, Medication Adherence, Benchmarking
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Background: The Ascertaining Barriers to Compliance (ABC) taxonomy was developed aiming at systematizing definitions and operationalizations of medication adherence. Its translation is crucial to improve the generalizability, application and comparison of study findings., Objective: To provide a consensus translation of the ABC taxonomy from English to Spanish., Methods: A two-phased approach was used, according to the Preferred Methods for the Translation of the ABC Taxonomy for Medication Adherence. Two literature reviews were conducted: to identify Spanish synonyms and definitions of the ABC taxonomy, and to identify a panel of Spanish-speaking experts in medication adherence. A Delphi survey was designed based on the synonyms and definitions found. The experts previously identified were invited to participate in the Delphi. A consensus of ≥85% was established for the first round. A moderate consensus (50-75%), a consensus (75-95%) or a strong consensus (>95%) were considered to be necessary in the second round., Results: Forty potential synonyms of the ABC taxonomy terms were identified from a total of 270 papers. The response rate during the first Delphi round was 32% (63/197) and in the second round 86% (54/63). A strong consensus was reached for the term "inicio del tratamiento" (96%) and consensus for the term "implementación" (83%). A moderate consensus was obtained for "adherencia a la medicación" (70%), "interrupción del tratamiento" (52%), "manejo de la adherencia" (54%) and "disciplinas relacionadas con la adherencia" (74%). No consensus was reached for the term persistence. Five out of the seven definitions reached a consensus in the first round, and two definitions a moderate consensus after the second round., Conclusion: The adoption of the Spanish taxonomy will increase transparency, comparability and transferability of results in the field of medication adherence. This may facilitate benchmarking of adherence strategies between Spanish-speaking researchers and practitioners, and other language speakers., (Copyright © 2023. Published by Elsevier Inc.)
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- 2023
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27. Patterns of statin adherence in primary cardiovascular disease prevention during the pandemic.
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Malo S, Maldonado L, Rabanaque MJ, Gimeno-Miguel A, Castel-Feced S, Lallana MJ, and Aguilar-Palacio I
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Background: Study of medication adherence patterns can help identify patients who would benefit from effective interventions to improve adherence. Objectives: To identify and compare groups of statin users based on their adherence patterns before and during the COVID-19 pandemic, to characterize the profile of users in each group, and to analyze predictors of distinct adherence patterns. Methods: Participants of the CARhES (CArdiovascular Risk factors for HEalth Services research) cohort, comprising individuals aged >16 years, residing in Aragón (Spain), with hypertension, diabetes mellitus and/or dyslipidemia, took part in this observational longitudinal study. Individuals who began statin therapy during January-June 2019 were selected and followed up until June 2021. Those with a cardiovascular event before or during follow-up were excluded. Data were obtained from healthcare system data sources. Statin treatment adherence during the implementation phase was estimated bimonthly using the Continuous Medication Availability (CMA9) function in the AdhereR package. Group-based trajectory models were developed to group statin users according to their adherence pattern during July 2019-June 2021. Group characteristics were compared and predictors of each adherence pattern were analyzed using multinomial logistic regression. Results: Of 15,332 new statin users, 30.8% had a mean CMA9 ≥80% for the entire study period. Four distinct adherence patterns were identified: high adherence (37.2% of the study population); poor adherence (35.6%); occasional use (14.9%); and gradual decline (12.3%). The latter two groups included users who showed a change in adherence (increase or decrease) during the pandemic emergence. Users with suboptimal adherence were likely to be younger, not pensioners, not institutionalized, with low morbidity burden and a low number of comorbidities. Female sex and switching between statins of different intensity increased the likelihood of belonging to the occasional use group, in which improved adherence coincided with the pandemic. Conclusion: We identified four distinct adherence patterns in a population of new statin users; two of them modified their adherence during the pandemic. Characterization of these groups could enable more effective distribution of resources in future similar crisis and the routine implementation of patient-centered interventions to improve medication adherence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Malo, Maldonado, Rabanaque, Gimeno-Miguel, Castel-Feced, Lallana and Aguilar-Palacio.)
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- 2022
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28. Understanding the COVID-19 Pandemic in Nursing Homes (Aragón, Spain): Sociodemographic and Clinical Factors Associated With Hospitalization and Mortality.
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Aguilar-Palacio I, Maldonado L, Marcos-Campos I, Castel-Feced S, Malo S, Aibar C, and Rabanaque M
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- COVID-19 Testing, Female, Humans, Nursing Homes, Retrospective Studies, Spain epidemiology, COVID-19 epidemiology, Pandemics
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Old people residing in nursing homes have been a vulnerable group to the coronavirus disease 2019 (COVID-19) pandemic, with high rates of infection and death. Our objective was to describe the profile of institutionalized patients with a confirmed COVID-19 infection and the socioeconomic and morbidity factors associated with hospitalization and death. We conducted a retrospective cohort study including data from subjects aged 65 years or older residing in a nursing home with a confirmed COVID-19 infection from March 2020 to March 2021 (4,632 individuals) in Aragón (Spain). We analyzed their sociodemographic and clinical profiles and factors related to hospitalization and mortality at 7, 30, and 90 days of COVID-19 diagnosis using logistic regression analyses. We found that the risk of hospitalization and mortality varied according to sociodemographic and morbidity profile. There were inequalities in hospitalization by socioeconomic status and gender. Patients with low contributory pensions and women had a lower risk of hospitalization. Diabetes mellitus, heart failure, and chronic kidney disease were associated with a higher risk of hospitalization. On the contrary, people with dementia showed the highest risk of mortality with no hospitalization. Patient-specific factors must be considered to develop equitable and effective measures in nursing homes to be prepared for future health threats., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Aguilar-Palacio, Maldonado, Marcos-Campos, Castel-Feced, Malo, Aibar and Rabanaque.)
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- 2022
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29. Inequities in hospitalisation in a South European country: Lessons learned from the last European recession.
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Sánchez-Recio R, Alonso JP, Gil-Lacruz A, and Aguilar-Palacio I
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- Cross-Sectional Studies, Female, Humans, Male, Socioeconomic Factors, Spain epidemiology, Economic Recession, Hospitalization
- Abstract
In Spain, regional health systems (universal access) depend on each Autonomous Communities (ACs). The management of the 2008 economic crisis has been different in the ACs, which may have led to an increase in inequities in the use of health services. The objective of this study was to analyse the impact of individual and regional characteristics on public hospitalisation inequities in Spain for the period 2003-2017. We developed a repeated cross-sectional study through Spanish National Health Surveys (2003, 2006, 2011 and 2017) and the Spanish European Health Survey (2014; n = 118,499 subjects). Multilevel and Oaxaca decomposition analyses were conducted to analyse the effect of individual and regional factors in hospitalisation inequities. The results showed that the prevalence of hospitalisation was higher for women (2003: 11.2%; 2017: 9.0%) than for men (2003: 10.7%; 2017: 8.8%) and it decreased with time. Multilevel analyses showed that, after adjustment for variables related to healthcare demand, there were inequities in the probability of hospitalisation, mainly in women. The decomposition analyses showed a higher effect of the number of hospital beds available on hospitalisation in men than in women. There is a direct relationship between the number of hospital beds and the probability of hospitalisation in both sexes. In conclusion, a progressive decrease in hospitalisation use was observed in Spain in the context of the economic recession. Individual-level and regional-level factors were associated with hospitalisation inequities. It is necessary to guarantee equitable access to health services according to the need even in recession times., (© 2021 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)
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- 2022
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30. Effectiveness of Statins for Primary Prevention of Cardiovascular Disease in Low- and Medium-Risk Males: A Causal Inference Approach with Observational Data.
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Chaure-Pardos A, Aguilar-Palacio I, Rabanaque MJ, Lallana MJ, Maldonado L, Castel-Feced S, Librero J, Casasnovas JA, and Malo S
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In this study, we analyzed the effectiveness of statin therapy for the primary prevention of cardiovascular disease (CVD) in low- and medium-risk patients. Using observational data, we estimated effectiveness by emulating a hypothetical randomized clinical trial comparing statin initiators with statin non-initiators. Two approaches were used to adjust for potential confounding factors: matching and inverse probability weighting in marginal structural models. The estimates of effectiveness were obtained by intention-to-treat and per-protocol analysis. The intention-to-treat analysis revealed an absolute risk reduction of 7.2 (95% confidence interval (CI95%), -6.6-21.0) events per 1000 subjects treated for 5 years in the matched design, and 2.2 (CI95%, -3.9-8.2) in the marginal structural model. The per-protocol analysis revealed an absolute risk reduction of 16.7 (CI95%, -3.0-36) events per 1000 subjects treated for 5 years in the matched design and 5.8 (CI95%, 0.3-11.4) in the marginal structural model. The indication for statin treatment for primary prevention in individuals with low and medium cardiovascular risk appears to be inefficient, but improves with better adherence and in subjectvs with higher risk.
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- 2022
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31. Understanding the Effect of Economic Recession on Healthcare Services: A Systematic Review.
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Recio RS, Pablo Alonso Pérez De Ágreda J, José Rabanaque M, and Aguilar Palacio I
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Background: We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe., Methods: We developed a systematic review of scientific literature for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed., Results: Of 3,685 studies, 35 met inclusion criteria. Regarding "Effects of the social structure" healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding "Healthcare effect", the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services., Conclusion: Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2022 Sánchez-Recio et al. Published by Tehran University of Medical Sciences.)
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- 2022
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32. Gender Gap in Self-Rated Health: A Cohort Perspective in Eastern European Countries.
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Gil-Lacruz M, Gil-Lacruz AI, Navarro-López J, and Aguilar-Palacio I
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Background: The relationship between self-rated health and gender differs across countries and generations. The aim of this study is to analyze the effect of socioeconomic conditions on self-rated health from a generational perspective, its differential effect on gender, and its influence on the gender gap in order to explore health diversity using a multidisciplinary approach and considering policy implications in Eastern European countries., Methods: We used data drawn from the European Health Interview Survey for eight Eastern European countries and EUROSTAT from 2006 through to 2009. We conducted multilevel analyses to understand the individual and national health determinants of self-rated health by gender and to determine whether national differences remain after controlling for micro variables. In order to analyze the role of equity (Gini quartile) in gender differences, Oaxaca analyses were used., Results: The self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking, influence citizens' perceived health, and have a stronger effect on women than on men. Knowing both the characteristics (endowment effects) and the effects of individual characteristics (coefficient effects) on health is important in order to understand gender gaps among people from the silent generation., Conclusions: Our research indicates that random effects are greater for men than for women. Moreover, random effects might be explained to a certain extent by economic equity (Gini index). The combined effects of gender, cohort, and geographical differences on self-rated health have to be taken into account to develop public health policies.
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- 2022
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33. Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2.
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Baena-Díez JM, Gonzalez-Casafont I, Cordeiro-Coelho S, Fernández-González S, Rodríguez-Jorge M, Pérez-Torres CUF, Larrañaga-Cabrera A, García-Lareo M, de la Arada-Acebes A, Martín-Jiménez E, Pérez-Orcero A, Hernández-Ibáñez R, Gonzalo-Voltas A, Bermúdez-Chillida N, Simón-Muela C, Del Carlo G, Bayona-Faro C, Rey-Reñones C, Aguilar-Palacio I, and Grau M
- Abstract
Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.
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- 2021
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34. Type 2 Diabetes Mellitus and Cancer: Epidemiology, Physiopathology and Prevention.
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Rey-Reñones C, Baena-Díez JM, Aguilar-Palacio I, Miquel C, and Grau M
- Abstract
Individuals with type 2 diabetes mellitus are at greater risk of developing cancer and of dying from it. Both diseases are age-related, contributing to the impact of population aging on the long-term sustainability of health care systems in European Union countries. The purpose of this narrative review was to describe, from epidemiological, pathophysiological and preventive perspectives, the links between type 2 diabetes mellitus and the most prevalent cancers in these patients. Multiple metabolic abnormalities that may occur in type 2 diabetes mellitus, particularly obesity, could explain the increased cancer risk. In addition, the effectiveness of drugs commonly used to treat type 2 diabetes mellitus (e.g., metformin and thiazolidinediones) has been broadly evaluated in cancer prevention. Thus, a better understanding of the links between type 2 diabetes mellitus and cancer will help to identify the contributing factors and the pathophysiological pathways and to design personalized preventive strategies. The final goal is to facilitate healthy aging and the prevention of cancer and other diseases related with type 2 diabetes mellitus, which are among the main sources of disability and death in the European Union and worldwide.
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- 2021
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35. COVID-19 Inequalities: Individual and Area Socioeconomic Factors (Aragón, Spain).
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Aguilar-Palacio I, Maldonado L, Malo S, Sánchez-Recio R, Marcos-Campos I, Magallón-Botaya R, and Rabanaque MJ
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- Female, Humans, Retrospective Studies, SARS-CoV-2, Socioeconomic Factors, Spain epidemiology, COVID-19
- Abstract
It is essential to understand the impact of social inequalities on the risk of COVID-19 infection in order to mitigate the social consequences of the pandemic. With this aim, the objective of our study was to analyze the effect of socioeconomic inequalities, both at the individual and area of residence levels, on the probability of COVID-19 confirmed infection, and its variations across three pandemic waves. We conducted a retrospective cohort study and included data from all individuals tested for COVID-19 during the three waves of the pandemic, from March to December 2020 (357,989 individuals) in Aragón (Spain). We studied the effect of inequalities on the risk of having a COVID-19 confirmed diagnosis after being tested using multilevel analyses with two levels of aggregation: individuals and basic healthcare area of residence (deprivation level and type of zone). Inequalities in the risk of COVID-19 confirmed infection were observed at both the individual and area level. There was a predominance of low-paid employees living in deprived areas. Workers with low salaries, unemployed and people on minimum integration income or who no longer receive the unemployment allowance, had a higher probability of COVID-19 infection than workers with salaries ≥ €18,000 per year. Inequalities were greater in women and in the second wave. The deprivation level of areas of residence influenced the risk of COVID-19 infection, especially in the second wave. It is necessary to develop individual and area coordinated measures by areas in the control, diagnosis and treatment of the epidemic, in order to avoid an increase in the already existing inequalities.
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- 2021
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36. Evolution of Cardiovascular Risk Factors in a Worker Cohort: A Cluster Analysis.
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Castel-Feced S, Maldonado L, Aguilar-Palacio I, Malo S, Moreno-Franco B, Mur-Vispe E, Alcalá-Nalvaiz JT, and Rabanaque-Hernández MJ
- Subjects
- Body Mass Index, Cluster Analysis, Heart Disease Risk Factors, Humans, Risk Factors, Waist Circumference, Cardiovascular Diseases epidemiology
- Abstract
The identification of the cardiovascular risk factor (CVRF) profile of individual patients is key to the prevention of cardiovascular disease (CVD), and the development of personalized preventive approaches. Using data from annual medical examinations in a cohort of workers, the aim of the study was to characterize the evolution of CVRFs and the CVD risk score (SCORE) over three time points between 2009 and 2017. For descriptive analyses, mean, standard deviation, and quartile values were used for quantitative variables, and percentages for categorical ones. Cluster analysis was performed using the Kml3D package in R software. This algorithm, which creates distinct groups based on similarities in the evolution of variables of interest measured at different time points, divided the cohort into 2 clusters. Cluster 1 comprised younger workers with lower mean body mass index, waist circumference, blood glucose values, and SCORE, and higher mean HDL cholesterol values. Cluster 2 had the opposite characteristics. In conclusion, it was found that, over time, subjects in cluster 1 showed a higher improvement in CVRF control and a lower increase in their SCORE, compared with cluster 2. The identification of subjects included in these profiles could facilitate the development of better personalized medical approaches to CVD preventive measures.
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- 2021
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37. Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance.
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Menditto E, Cahir C, Malo S, Aguilar-Palacio I, Almada M, Costa E, Giardini A, Gil Peinado M, Massot Mesquida M, Mucherino S, Orlando V, Parra-Calderón CL, Pepiol Salom E, Kardas P, and Vrijens B
- Subjects
- Communication, Humans, Medication Adherence, Telemedicine
- Abstract
Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients' medication-taking patterns, as well as clinical and health outcomes.
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- 2021
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38. Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care.
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Magallón-Botaya R, Oliván-Blázquez B, Ramírez-Cervantes KL, Méndez-López-de-la-Manzanara F, Aguilar-Palacio I, Casajuana-Closas M, and Andrés-Esteban E
- Subjects
- Aged, Comorbidity, Female, Geography, Hospital Mortality, Humans, Intensive Care Units, Primary Health Care, Retrospective Studies, SARS-CoV-2, COVID-19
- Abstract
Background : The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods : A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results : The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions : Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols.
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- 2021
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39. Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers' Health Study.
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Aguilar-Palacio I, Malo S, Jarauta E, Moreno-Franco B, Maldonado L, Compés L, Rabanaque MJ, and Casasnovas JA
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The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease ( n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06-1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease.
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- 2021
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40. Desigualdades de género en la utilización de servicios sanitarios, España 2006-2017.
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Sánchez-Recio R, Alonso Pérez de Ágreda JP, Gasch-Gallén Á, and Aguilar Palacio I
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- Adolescent, Adult, Cross-Sectional Studies, Female, Health Care Surveys, Humans, Male, Sex Factors, Spain, Facilities and Services Utilization statistics & numerical data, Health Services statistics & numerical data, Healthcare Disparities statistics & numerical data
- Abstract
Objetivo. Identificar la existencia de desigualdades de género en utilización de atención primaria (AP), urgencias y consulta de enfermería. Material y métodos. Estudio transversal, con encuestas nacionales y europeas de salud (2006-2017) de población española de 16 o más años (n=98 929 personas). Se estudió la evolución en el tiempo y la influencia de los determinantes de género mediante regresiones logísticas en la utilización de servicios sanitarios. Resultados. La utilización de los tres servicios asistenciales fue mayor en mujeres. Personas pensionistas, aquellas dedi-cadas a labores del hogar, con estudios bajos y clase social manual, tuvieron mayor riesgo de utilización de AP. Urgencias: a mayor edad menor riesgo de utilización. Enfermería: aque-llas dedicadas a las labores del hogar tenían mayor riesgo de utilización. Conclusiones. Son necesarios estudios que analicen las desigualdades de género en contextos como la utilización de servicios sanitarios, así como nuevas estrategias de gestión para conseguir la equidad asistencial.
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- 2021
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41. Identifying Clusters of Adherence to Cardiovascular Risk Reduction Behaviors and Persistence with Medication in New Lipid-Lowering Drug Users. Impact on Healthcare Utilization.
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Malo S, Rabanaque MJ, Maldonado L, Moreno-Franco B, Chaure-Pardos A, Lallana MJ, Rodrigo MP, and Aguilar-Palacio I
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- Exercise, Heart Disease Risk Factors, Humans, Male, Medication Adherence, Middle Aged, Risk Factors, Risk Reduction Behavior, Cardiovascular Diseases prevention & control, Healthy Lifestyle, Hypolipidemic Agents administration & dosage
- Abstract
We sought to identify specific profiles of new lipid-lowering drug users based on adherence to a healthy lifestyle and persistence with medication, and to characterize co-morbidities, co-treatments, and healthcare utilization for each of the profiles identified. Observational study in 517 participants in the Aragon Workers' Health Study (AWHS) without previous cardiovascular disease (CVD) and who initiated lipid-lowering therapy. Data were collected from workplace medical examinations and administrative health databases (2010-2018). Using cluster analysis, we identified distinct patient profiles based on persistence with therapy and lifestyle. We then compared characteristics, morbidity, and healthcare utilization across clusters. Participants were aggregated into four clusters based on persistence with therapy, smoking status, adherence to Mediterranean diet, and physical activity. In cluster 1 ( n = 113), comprising those with a healthiest lifestyle (14.2% smokers, 84.0% with medium-high adherence to Mediterranean diet, high physical activity), 16.8% were persistent. In cluster 3 ( n = 108), comprising patients with the least healthy lifestyle (100% smokers, poor adherence to the Mediterranean diet, low level of physical activity), all were non-persistent. Clusters 2 ( n = 150) and 4 ( n = 146) both comprised patients with intermediate lifestyle behaviors, but differed in terms of persistence (100 and 0%, respectively). Compared with other clusters, the burden of morbidity, cardiovascular score, and healthcare utilization were lower in cluster 1. The healthy adherer effect was only observed in new lipid-lowering drug users of certain profiles. Furthermore, we found that differences in adherence to lifestyle and medication recommendations for CVD prevention influenced morbidity burden and healthcare utilization.
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- 2021
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42. Model Prediction for In-Hospital Mortality in Patients with COVID-19: A Case-Control Study in Isfahan, Iran.
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Abdollahpour I, Aguilar-Palacio I, Gonzalez-Garcia J, Vaseghi G, Otroj Z, Manteghinejad A, Mosayebi A, Salimi Y, and Haghjooy Javanmard S
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Case-Control Studies, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Young Adult, COVID-19 mortality, Hospital Mortality, SARS-CoV-2
- Abstract
The COVID-19 pandemic has now imposed an enormous global burden as well as a large mortality in a short time period. Although there is no promising treatment, identification of early predictors of in-hospital mortality would be critically important in reducing its worldwide mortality. We aimed to suggest a prediction model for in-hospital mortality of COVID-19. In this case-control study, we recruited 513 confirmed patients with COVID-19 from February 18 to March 26, 2020 from Isfahan COVID-19 registry. Based on extracted laboratory, clinical, and demographic data, we created an in-hospital mortality predictive model using gradient boosting. We also determined the diagnostic performance of the proposed model including sensitivity, specificity, and area under the curve (AUC) as well as their 95% CIs. Of 513 patients, there were 60 (11.7%) in-hospital deaths during the study period. The diagnostic values of the suggested model based on the gradient boosting method with oversampling techniques using all of the original data were specificity of 98.5% (95% CI: 96.8-99.4), sensitivity of 100% (95% CI: 94-100), negative predictive value of 100% (95% CI: 99.2-100), positive predictive value of 89.6% (95% CI: 79.7-95.7), and an AUC of 98.6%. The suggested model may be useful in making decision to patient's hospitalization where the probability of mortality may be more obvious based on the final variable. However, moderate gaps in our knowledge of the predictors of in-hospital mortality suggest further studies aiming at predicting models for in-hospital mortality in patients with COVID-19.
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- 2021
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43. Effect of patient and treatment factors on persistence with antihypertensive treatment: A population-based study.
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Malo S, Aguilar-Palacio I, Feja C, Lallana MJ, Armesto J, and Rabanaque MJ
- Subjects
- Adult, Antihypertensive Agents adverse effects, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Risk Factors, Spain epidemiology, Antihypertensive Agents administration & dosage, Hypertension drug therapy, Hypertension mortality, Medication Adherence
- Abstract
Purpose: To analyze patterns of antihypertensive drug use among new users in a Southern European population, and identify patient- and treatment-related factors that influence persistence., Methods: This is a retrospective observational study of new antihypertensive drug users aged ≥40 years in Aragón, Spain. Information on antihypertensive drugs (2014-2016) prescribed and dispensed at pharmacies via the public health system were collected from a regional electronic population-based pharmacy database. Persistence was assessed using the gap method. Kaplan-Meier and Cox regression analyses were conducted to analyze patterns of use and factors that influence persistence., Results: The 25,582 new antihypertensive drug users in Aragón during the study period were prescribed antihypertensive drugs in monotherapy (73.3%), fixed combination (13.9%), free combination (9.1%), or other (3.7%). One in five received antihypertensive drugs within 15 days of the prescription date, but not after. During the first year of follow-up, 38.6% of the study population remained persistent. The likelihood of treatment discontinuation was higher for participants who were male, aged ≥80 years, and received an antihypertensive drug in monotherapy compared with fixed combination., Conclusion: Overall persistence with antihypertensive therapy was poor, and was influenced by the sex, age and type of therapy. Fixed combinations appear to be a good choice for initial therapy, especially in patients with a higher risk of discontinuation. Nonetheless, adverse drug effects and the patient's preferences and clinical profile should be taken into account., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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44. Factors Associated with the Prescribing of High-Intensity Statins.
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Chaure-Pardos A, Malo S, Rabanaque MJ, Arribas F, Moreno-Franco B, and Aguilar-Palacio I
- Abstract
In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as "high-intensity" or "low-moderate-intensity". Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus <20 METs (metabolic equivalent of task) h/wk; odds ratio (OR), 1.65; 95%CI, 1.08-2.50) and, in diabetics, higher low-density lipoprotein cholesterol (LDL-C) levels (≥155 mg/dL versus <155 mg/dL; OR, 4.96; 95%CI, 1.29-19.10). The model that best predicted treatment intensity included LDL-C, diabetes, hypertension, smoking, and age (area under the Receiver Operating Characteristic curve (AUC), 0.620; 95%CI, 0.574-0.666). The prescribing and type of statin used in primary CVD prevention did not correspond with the indications in current guidelines. The probability of receiving high-intensity statins was higher in diabetics with high LDL-C levels and in more physically active individuals. These findings underscore the great variability and uncertainty in the prescribing of statins.
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- 2020
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45. New Male Users of Lipid-Lowering Drugs for Primary Prevention of Cardiovascular Disease: The Impact of Treatment Persistence on Morbimortality. A Longitudinal Study.
- Author
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Aguilar-Palacio I, Rabanaque MJ, Maldonado L, Chaure A, Abad-Díez JM, León-Latre M, Casasnovas JA, and Malo S
- Subjects
- Humans, Lipids, Longitudinal Studies, Male, Middle Aged, Primary Prevention, Cardiovascular Diseases epidemiology, Cardiovascular Diseases prevention & control, Hypolipidemic Agents therapeutic use, Pharmaceutical Preparations
- Abstract
The objective of this study was to analyse persistence to lipid-lowering drug use for primary prevention of cardiovascular disease (CVD) in a new users cohort, to explore all-cause and cardiovascular related morbidity, comorbidity and mortality in this group and, finally, to study the relationship between persistence and morbimortality. We selected subjects who started lipid-lowering treatment for primary prevention of CVD between 1 January 2010 and 31 December 2017 (N = 1424), and classified them as treatment-persistent or -nonpersistent. Bivariate analyses were performed to compare sociodemographic and clinical variables, morbimortality and time to event between groups. The association between morbidities was explored using comorbidity network analysis. The effect of persistence was analysed using logistic regression and Cox survival analyses. Only 38.7% of users were persistent with treatment. Persistent and nonpersistent users had similar sociodemographic and clinical profiles, although differed in age, smoking status, and glycemia. Comorbidity networks revealed that the number of co-occurring diagnoses was higher in nonpersistent than persistent users. Adjusted analyses indicated a protective effect of treatment persistence, especially against major adverse cardiovascular events (MACE), but this effect was not statistically significant. Observational studies are crucial to characterize real-world effectiveness.
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- 2020
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46. The Need to Develop Standard Measures of Patient Adherence for Big Data: Viewpoint.
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Kardas P, Aguilar-Palacio I, Almada M, Cahir C, Costa E, Giardini A, Malo S, Massot Mesquida M, Menditto E, Midão L, Parra-Calderón CL, Pepiol Salom E, and Vrijens B
- Subjects
- Humans, Retrospective Studies, Big Data, Patient Compliance statistics & numerical data
- Abstract
Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable., (©Przemyslaw Kardas, Isabel Aguilar-Palacio, Marta Almada, Caitriona Cahir, Elisio Costa, Anna Giardini, Sara Malo, Mireia Massot Mesquida, Enrica Menditto, Luís Midão, Carlos Luis Parra-Calderón, Enrique Pepiol Salom, Bernard Vrijens. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 27.08.2020.)
- Published
- 2020
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47. The use of health care services in the Great Recession: evaluating inequalities in the Spanish context.
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Sánchez-Recio R, Alonso JP, and Aguilar-Palacio I
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- Chi-Square Distribution, Cross-Sectional Studies, Delivery of Health Care economics, Delivery of Health Care statistics & numerical data, Educational Status, Employment economics, Employment statistics & numerical data, Female, Health Services statistics & numerical data, Health Surveys statistics & numerical data, Healthcare Disparities statistics & numerical data, Humans, Logistic Models, Male, Primary Health Care statistics & numerical data, Private Sector economics, Public Sector economics, Secondary Care statistics & numerical data, Sex Factors, Social Class, Socioeconomic Factors, Spain, Vulnerable Populations, Economic Recession, Health Services economics, Healthcare Disparities economics, Patient Acceptance of Health Care statistics & numerical data, Primary Health Care economics, Secondary Care economics
- Abstract
Objective: To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain., Method: Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex., Results: Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need., Conclusions: Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2020
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48. Correction: Risk factors control for primary prevention of cardiovascular disease in men: Evidence from the Aragon Workers Health Study (AWHS).
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Aguilar-Palacio I, Malo S, Feja C, Lallana M, León-Latre M, Antonio Casasnovas J, Rabanaque M, and Guallar E
- Abstract
[This corrects the article DOI: 10.1371/journal.pone.0193541.].
- Published
- 2020
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49. Socioeconomic status as the strongest predictor of self-rated health in Iranian population; a population-based cross-sectional study.
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Abdollahpour I, Mooijaart S, Aguilar-Palacio I, Salimi Y, Nedjat S, Mansournia MA, and de Courten M
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- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Iran, Male, Middle Aged, Young Adult, Health Status, Self Report, Social Class
- Abstract
Background: There is little evidence comparing the role of subjective versus objective indicators of socioeconomic status (SES) on individuals' self-rated health (SRH) in Iran., Objectives: We aimed to investigate underlying predictors of SRH including subjective and objective SES in Tehran, a multi-ethnic city., Method: This is an analysis of cross-sectional survey data on subjective and objective SES from a population-based case-control study conducted in Tehran, Iran (2015). We used random digit dialing for study sample recruitment. Linear regression models were used for estimating crude and adjusted coefficients (95% confidence intervals). Age, gender, SES as well as cigarette smoking were included as confounders., Results: 15-50 years old residents of Tehran were recruited in the study (n = 1057). High reported objective and subjective SES was consistently associated with a better SRH. Subjective current SES (p < .001), subjective adolescence SES (p = .018), change in subjective SES (current vs. adolescent) (p = .034) and participants' education years (p < .001). Improvements over time in current SES in comparison to SES rated during adolescence increased the participants' SRH after adjustment for potential confounders (coefficient = 0.170, 95% CI: (0.015, 0.325)). Female participants (coefficient = -0.305, 95% CI: (-0.418, -0.192)) and smokers (high category vs. never smokers) (coefficient = -0.456, 95% CI: (-0.714, -0.197)) reported significantly worse SRH. Increasing age - 0.008 (95% CI: -0.014, -0.002) was associated with decreased SRH., Conclusion: High subjective and objective SES consistently was the most important predictor of high SRH., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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50. Prescribing pattern of antihypertensive drugs in two European cohorts: a population-based database study.
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Malo S, Rabanaque MJ, Orlando V, Limongelli G, Feja C, Aguilar-Palacio I, Lallana MJ, Russo V, and Menditto E
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- Adult, Aged, Aged, 80 and over, Databases, Factual, Drug Utilization statistics & numerical data, Female, Humans, Italy, Male, Middle Aged, Practice Patterns, Physicians' standards, Spain, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Practice Patterns, Physicians' statistics & numerical data, Primary Health Care statistics & numerical data
- Abstract
Background : Antihypertensive drugs play a crucial role in reducing cardiovascular morbidity and mortality. Variability in prescribing patterns constitutes a major challenge for current healthcare systems. This study aimed to compare patterns of use of antihypertensives in general practice in two southern European populations. Methods : Observational study. Data on antihypertensive drugs consumption in primary care setting (2016) were obtained from pharmacy refill records in Campania (Italy) and Aragon (Spain). Prescribing rates and the number of defined daily doses [DDD/1,000 inhabitants/day (DID)] were calculated, and the Drug Utilization 90% (DU90%) approach used to reveal differences in prescribing patterns in both regions. Results : Antihypertensive prescribing rates in Campania and Aragon were 250.8 (95%CI: 250.2-251.3) and 201.7 (95%CI: 200.9-202.5) users/1,000 inhabitants/year. Overall consumption was of 310.1 and 256.8 DID, respectively. Spanish users, especially women and the elderly, consumed a greater volume of diuretics. Conversely, other therapeutic subgroups were more consumed in Campania. However, the most prescribed subgroups accounted for comparable proportions of the total consumption in each region. Conclusions : Both prescribing rates and intensity of antihypertensive use were higher in Campania. Pharmacy refill records in cross-country comparisons allow to know the factors influencing variability in prescribing habits with a view to improving prescribing quality.
- Published
- 2019
- Full Text
- View/download PDF
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