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Producción Científica, La identidad étnica es una de las múltiples formas de la identidad colectiva, y se adscribe según unos criterios variables pero concretos a un grupo de personas que se consideran a sí mismas, y son consideradas por otras personas, como verdaderamente diferentes. Entre las principales propiedades de esa diferencia cabe mencionar una herencia que se supone común y unas características culturales específicas, compartidas entre los y las integrantes del grupo. La emergencia de esa forma de identificación es la consecuencia de diferentes procesos históricos y mecanismos sociales que actúan en el seno de las redes de interacción. La etnicidad no es una realidad ontológica, sino epistemológica – no es un objeto en el mundo, es una perspectiva sobre el mundo. [Texto extraído del capítulo de David Jesús Poza Garcia]., Ministerio de Economía y Competitividad (HAR2016-77672-P), Ministerio de Ciencia, Innovación y Universidades (HAR2017-90883-REDC)

Proyecto Red de Excelencia “Simular el pasado para entender el comportamiento humano” (Redes de Excelencia 2017 i – Ref. HAR2017-90883-REDC), financiado por el Ministerio de Ciencia, Innovación y Universidades; estando también vinculada al proyecto CULM – Modelado del cultivo en la Prehistoria (HAR2016-77672-P), financiado por el Ministerio de Economía y Competitividad.

Resumen Introduccion y objetivos Estudiar la validez de la funcion SCORE original de bajo riesgo sin y con colesterol unido a lipoproteinas de alta densidad y SCORE calibrada en poblacion espanola. Metodos Analisis agrupado con datos individuales de 12 estudios de cohorte de base poblacional. Se incluyo a 30.919 participantes de 40-64 anos sin enfermedades cardiovasculares en el momento del reclutamiento, que se siguieron durante 10 anos para la mortalidad cardiovascular contemplada en el proyecto SCORE. La validez de las funciones se analizo mediante el area bajo la curva ROC (discriminacion) y el test de Hosmer-Lemeshow (calibracion), respectivamente. Resultados Se dispuso de 286.105 personas/ano. La mortalidad a 10 anos por causas cardiovasculares fue del 0,6%. La razon de casos esperados/observados fue de 9,1, 6,5 y 9,1 en varones y de 3,3, 1,3 y 1,9 en mujeres con las funciones SCORE original de bajo riesgo sin y con colesterol unido a lipoproteinas de alta densidad y SCORE calibrada, respectivamente; diferencias estadisticamente significativas con el test de calibracion de Hosmer-Lemeshow entre la mortalidad predicha con SCORE y la observada (p Conclusiones Todas las versiones de las funciones SCORE disponibles en Espana sobreestiman significativamente la mortalidad cardiovascular observada en la poblacion espanola. A pesar de la aceptable capacidad de discriminacion, la prediccion del numero de acontecimientos cardiovasculares mortales (calibracion) fue significativamente imprecisa.

The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity [Hazard Ratio=2.34 (95% confidence interval: 1.19-4.61) and 5.65 (1.54-20.73), respectively]. Overweight and obesity significantly increased the risk of cancer death in women [3.98 (1.53-10.37) and 11.61 (1.93-69.72)]. Finally, obese men had an increased risk of cancer death and overall mortality [1.62 (1.03-2.54) and 1.34 (1.01-1.76), respectively]. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations.

ResumenIntroducción y objetivosLa empatía es la capacidad de transmitir comprensión hacia las emociones de otros individuos. La empatía de los profesionales sanitarios se ha asociado a mejores resultados clínicos y de relación con el paciente. El objetivo del estudio era conocer el nivel de empatía de los estudiantes de Medicina, y su evolución después de recibir un curso sobre Entrevista Clínica y Comunicación.MétodosEstudio longitudinal prospectivo con intervención (módulo de Comunicación y Entrevista Clínica de un mes de duración) y sin grupo control. La empatía se midió con el cuestionario Índice de Reactividad Interpersonal (IRI) que tiene 2 dimensiones cognitivas (toma de perspectiva y fantasía) y 2 emocionales (preocupación empática y distrés personal). La empatía percibida se obtuvo mediante autoevaluación del 0 al 10.ResultadosParticiparon 136 alumnos, un 72% eran mujeres, con una edad media de 20,3 años. La empatía percibida correlacionó con las dimensiones del IRI, excepto con distrés personal. Después de la intervención educativa se observaron incrementos en los hombres en toma de perspectiva (de 16,5 a 17,8; p = 0,005) y en las mujeres en fantasía (de 15,5 a 16,7; p = 0,001), con aumento en ambos sexos de la empatía percibida autoevaluada (de 6,9 a 7,4 en hombres; p = 0,009 y de 7,4 a 7,8 en mujeres; p

Problem statement: Clinician-patient communication is a basic skill that medical students should learn as part of their training process. Communication skills curriculums aim to develop effective communication with patients, carers, and colleagues by working on both verbal and non-verbal skills. These include being able to take a history and share information, and particularly explaining procedures and discussing treatment options and their effects. Students taking the Communication, interview and clinical history module are asked to follow a simulated-patient clinical interview, which is recorded and then self and tutor- assessed using standardized questionnaires. Purpose of study: The aim of this study is to conduct a pilot test to compare questionnaire results for self and tutor-assessed video-recorded clinical interviews. Methods: The results of students’ self-assessment questionnaires within the Communication, interview and clinical history module (second year of the medical degree) were compared with those of their tutors. The questionnaire used was a shortened version of the 17-itemCICCA-D (Conectar-Identificar-Comprender-Acordar-Ayudar – Connect-Identify-Understand-Agree- Help) instrument (score of 2, 1 or 0 for each item), based on patient-centred interviews. The assessments were carried out independently from one another, with no previous training, after watching the clinical interview video recording. Results: A total of 47 student and tutor assessments were carried out. Differences in the global average scores were statistically significant (p-value < 0.05). The students’ mean self-assessment score was 13 (SD = 5), while the tutors’ was 15 (SD = 5). A weak direct and statistically significant correlation was observed in the global questionnaire score between both self and tutor assessment (n = 47): with an ICC of 0.41 (confidence interval [CI] 95%, (0.09 – 0.66). Conclusions: Pilot test results show that tutors consider students having better communication skills than students themselves. Lack of previous training in the use of the questionnaire could be relevant. Further research is needed to confirm these preliminary results

ResumenObjetivoDeterminar la utilidad y viabilidad del Programa CRONIGICAT.DiseñoEstudio descriptivo transversal. Método de evaluación cualitativo y cuantitativoEmplazamiento y participantes26 equipos de atención primaria (EAP) del Institut Català de la Salut de Girona.Intervenciones20 proyectos dentro del programa. Inicio 2011Mediciones principalesGrado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad).ResultadosValoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado.ConclusionesRespecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual.AbstractObjectiveTo determine the utility and viability of a chronic care program.DesignCross-sectional descriptive study with qualitative and quantitative evaluation.Setting and participants26 primary care teams (PCT) from the Catalan health service of Gerona.Interventions20 projects within the program. Start 2011.Main outcome measuresThe degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]).ResultsEvaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care.ConclusionsWhen assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.

Objective To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. Method Pooled analysis of 11 population-based Spanish cohorts (1992–2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. Results The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. Conclusions The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.

Introduction and objectives To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. Methods Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. Results Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. Conclusions All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate.

BACKGROUND: Evidence is lacking about the effectiveness of risk reduction interventions in patients with asymptomatic peripheral arterial disease. OBJECTIVES: This study aimed to assess whether statin therapy was associated with a reduction in major adverse cardiovascular events (MACE) and mortality in this population. METHODS: Data were obtained from 2006 through 2013 from the Catalan primary care system's clinical records database (SIDIAP). Patients age 35 to 85 years with an ankle-brachial index ≤0.95 and without clinically recognized cardiovascular disease (CVD) were included. Participants were categorized as statins nonusers or new-users (first prescription or represcribed after at least 6 months) and matched 1:1 by inclusion date and propensity score for statin treatment. Conditional Cox proportional hazards modeling was used to compare the groups for the incidence of MACE (myocardial infarction, cardiac revascularization, and ischemic stroke) and all-cause mortality. RESULTS: The matched-pair cohort included 5,480 patients (mean age 67 years; 44% women) treated/nontreated with statins. The 10-year coronary heart disease risk was low (median: 6.9%). Median follow-up was 3.6 years. Incidence of MACE was 19.7 and 24.7 events per 1,000 person-years in statin new-users and nonusers, respectively. Total mortality rates also differed: 24.8 versus 30.3 per 1,000 person-years, respectively. Hazards ratios were 0.80 for MACE and 0.81 for overall mortality. The 1-year number needed to treat was 200 for MACE and 239 for all-cause mortality. CONCLUSIONS: Statin therapy was associated with a reduction in MACE and all-cause mortality among participants without clinical CVD but with asymptomatic peripheral arterial disease, regardless of its low CVD risk. The absolute reduction was comparable to that achieved in secondary prevention. This project was supported by clinical research grants from the Ministerio de Salud (EC10-84, EC10-83); Spain’s Ministry of Science and Innovation through the Carlos III Health Institute, cofinanced with European Union ERDF funds (Network for Prevention and Health Promotion in primary Care RedIAPP RD12/0005, Programa HERACLES RD12/0042, and Miguel Servet Contract CP12/03287); and by the Departament de Salut, Generalitat de Catalunya, Agency for Health Technology Assessment (AATRM 034/33/02), and Agency for Management of University and Research Grants (2005SGR00577). Drs. Ramos and Garcia-Gil collaborate (without receiving any personal fee) in 2 projects of primary care for the institute IDIAP Jordi Gol funded by AstraZeneca and AMGEN that are unrelated to the present work. Dr. Marrugat has received lecture fees from Ferrer-in-Code; holds a patent with Gendiag SL; and has received payment for development of educational presentations from AstraZeneca.

Most ex-post evaluations of research funding programs are based on bibliometric methods and, although this approach has been widely used, it only examines one facet of the project's impact, that is, scientific productivity. More comprehensive models of payback assessment of research activities are designed for large-scale projects with extensive funding. The purpose of this study was to design and implement a methodology for the ex-post evaluation of small-scale projects that would take into account both the fulfillment of projects' stated objectives as well as other wider benefits to society as payback measures. We used a two-phase ex-post approach to appraise impact for 173 small-scale projects funded in 2007 and 2008 by a Spanish network center for research in epidemiology and public health. In the internal phase we used a questionnaire to query the principal investigator (PI) on the outcomes as well as actual and potential impact of each project; in the external phase we sent a second questionnaire to external reviewers with the aim of assessing (by peer-review) the performance of each individual project. Overall, 43% of the projects were rated as having completed their objectives "totally", and 40% "considerably". The research activities funded were reported by PIs as socially beneficial their greatest impact being on research capacity (50% of payback to society) and on knowledge translation (above 11%). The method proposed showed a good discriminating ability that makes it possible to measure, reliably, the extent to which a project's objectives were met as well as the degree to which the project contributed to enhance the group's scientific performance and of its social payback.

Resumen Introduccion y objetivos Las bases de datos clinicas de atencion primaria ofrecen un gran potencial para la investigacion. Nuestro objetivo es analizar la validez de los datos del estudio EMMA, basado en el Sistema de Informacion para el Desarrollo de Investigacion en Atencion Primaria. Metodos Se compararon las prevalencias de los factores de riesgo cardiovascular —hipertension, diabetes mellitus, hipercolesterolemia (y sus tratamientos), obesidad y tabaquismo— observadas en el EMMA con datos equivalentes del estudio Registre Gironi del Cor (REGICOR) en el ano 2000. Tambien se compararon la incidencia de enfermedad vascular y su asociacion con dichos factores de riesgo en un seguimiento a 5 anos. Resultados Se analizaron datos de 34.823 participantes de 35 a 74 anos incluidos en el EMMA y 2.540 participantes del estudio REGICOR2000. Las prevalencias de los factores de riesgo no difirieron significativamente entre los dos estudios, excepto para la prevalencia de exfumadores varones, que fue superior en el REGICOR2000 (el 24,7% [intervalo de confianza del 95%, 23,9-25,5%] frente al 30,1% [intervalo de confianza del 95%, 27,1-33,1%]) y la proporcion de hipertensos tratados y pacientes con tratamiento hipolipemiante, que fueron superiores en el EMMA (el 46,9 frente al 32,7% y el 8,7 frente al 6,3%, respectivamente). No se observaron diferencias entre uno y otro estudio en la comparacion de la incidencia de enfermedad vascular (varones, el 2,1% en ambos estudios; mujeres, el 1,18% [intervalo de confianza del 95%, 0,7-1,7%] en el REGICOR2000 frente al 0,75% [intervalo de confianza del 95%, 0,64-0,87%] en el EMMA) ni en su asociacion con los factores de riesgo. Conclusiones Las prevalencias de los factores de riesgo cardiovascular y su relacion con la incidencia de enfermedades vasculares observada en el EMMA concuerdan con las observadas en un estudio epidemiologico estandarizado de base poblacional.

Resumen Introduccion y objetivos Examinar el grado en que la disminucion de las tasas de mortalidad por cardiopatia isquemica en Espana entre 1988 y 2005 podria explicarse por cambios en los factores de riesgo cardiovascular y por el uso de tratamientos medicos y quirurgicos. Metodos Se utilizo el modelo IMPACT previamente validado para combinar y analizar datos de las tendencias en la prevalencia de factores de riesgo y el uso y la efectividad de tratamientos cardiacos basados en la evidencia, entre varones y mujeres adultos de 35-74 anos de edad. Las principales fuentes de datos incluyeron estadisticas oficiales de mortalidad, resultados de estudios longitudinales, encuestas nacionales, ensayos clinicos aleatorizados y metaanalisis. La diferencia entre las muertes coronarias observadas y esperadas en 2005 se distribuyo entre los tratamientos y los factores de riesgo. Resultados Desde 1988 a 2005, la tasa de mortalidad ajustada por edad cayo un 40%, y hubo 8.530 muertes menos en 2005. Aproximadamente el 47% de la caida en la mortalidad se ha atribuido a los tratamientos. Los abordajes que contribuyeron en mayor medida fueron el tratamiento en fase aguda de los sindromes coronarios (11%), la prevencion secundaria (10%) y el tratamiento de la insuficiencia cardiaca (9%). El 50% de la reduccion de la mortalidad se ha atribuido a cambios en los factores de riesgo. El mayor beneficio en la mortalidad viene de los cambios en el colesterol total (cerca de un 31% de la caida de la mortalidad) y de la presion arterial sistolica (cerca de un 15%). Pero se observaron importantes diferencias entre sexos en las tendencias de los factores de riesgo: se incremento la diabetes mellitus y la obesidad entre los varones y la prevalencia del consumo de tabaco entre las mujeres jovenes, lo cual produjo muertes adicionales. Conclusiones Aproximadamente la mitad del descenso en la mortalidad coronaria en Espana se ha atribuido a la reduccion de los principales factores de riesgo y la otra mitad, a los tratamientos basados en la evidencia. Estos resultados incrementan la comprension de tendencias pasadas y ayudaran a planificar futuras estrategias preventivas y de tratamientos en poblaciones con bajo riesgo.

The recommendation of screening with ankle brachial index (ABI) in asymptomatic individuals is controversial. The aims of the present study were to develop and validate a pre-screening test to select candidates for ABI measurement in the Spanish population 50-79 years old, and to compare its predictive capacity to current Inter-Society Consensus (ISC) screening criteria.Two population-based cross-sectional studies were used to develop (n = 4046) and validate (n = 3285) a regression model to predict ABI0.9. The validation dataset was also used to compare the model's predictive capacity to that of ISC screening criteria. The best model to predict ABI0.9 included age, sex, smoking, pulse pressure and diabetes. Assessment of discrimination and calibration in the validation dataset demonstrated a good fit (AUC: 0.76 [95% CI 0.73-0.79] and Hosmer-Lemeshow test: χ(2): 10.73 (df = 6), p-value = 0.097). Predictions (probability cut-off value of 4.1) presented better specificity and positive likelihood ratio than the ABI screening criteria of the ISC guidelines, and similar sensitivity. This resulted in fewer patients screened per diagnosis of ABI0.9 (10.6 vs. 8.75) and a lower proportion of the population aged 50-79 years candidate to ABI screening (63.3% vs. 55.0%).This model provides accurate ABI0.9 risk estimates for ages 50-79, with a better predictive capacity than that of ISC criteria. Its use could reduce possible harms and unnecessary work-ups of ABI screening as a risk stratification strategy in primary prevention of peripheral vascular disease.

ResumenObjetivoEvaluar la efectividad de un programa de intervención multifactorial y comunitario para disminuir el número de caídas y sus complicaciones en la población de 70 años o más de una comunidad.DiseñoEstudio de intervención comunitaria, multicéntrico, con grupo control y sin asignación aleatorizada.EmplazamientoDos zonas básicas de salud de la provincia de Girona (España).ParticipantesMuestra aleatorizada de personas 70 años o más, 2.515 en el grupo de intervención (GI) y 1.212 en el grupo control (GC).El GI recibió una intervención multifactorial con actividades comunitarias, individuales en la consulta o domicilio y sobre los profesionales durante 2 años. El GC recibió la atención sanitaria habitual.Mediciones y resultados principalesSe valoró la situación basal de 2 muestras aleatorizadas representativas, GI (n=329) y GC (n=379), y la situación posintervención del GI (n=292) y el GC (n=310) mediante una encuesta.Personas con caídasGI basal, el 29% (intervalo de confianza [IC] del 95%: 25,8–31,9) y posintervención, el 31% (IC del 95%: 25,6–36,5); GC basal, el 32% (IC del 95%: 28,8–35,2) y posintervención, el 30% (IC del 95%: 24,9–35,4). Caídas con fracturas: GI basal, el 10,4% (IC del 95%: 6–16,3) y posintervención, el 5,3% (IC del 95%: 2–11,2); GC basal, el 7% (IC del 95%: 4–11,2) y posintervención, el 10,7% (IC del 95%: 5,8–17,7). Caídas con asistencia médica: GI basal, el 45,4% (IC del 95%: 37–54) y posintervención, el 43,8% (IC del 95%: 34,4–54,4); GC basal, el 30,3% (IC del 95%: 24,3–36,8) y posintervención, el 40,8% (IC del 95%: 31–51,2).ConclusionesUn programa de intervención comunitario multifactorial en personas de 70 años o más no reduce el número de caídas a los 2 años, pero se observa una tendencia a la reducción de sus consecuencias y puede integrarse dentro de la actividad asistencial habitual.AbstractObjectiveTo evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the ≥70 years population in a community.DesignMulticentre, community intervention study, with no random assignment and with controls.SettingTwo basic health areas in the province of Girona (Spain).ParticipantsRandom sample of people ≥70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG).The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care.Measurements and primary outcomesThe baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey.Results(People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8–31.9) and post-intervention 31% (95% CI: 25.6–36.5). CG baseline 32% (95% CI: 28.8–35.2) and post-intervention 30% (95% CI: 24.9–35.4). Falls with fractures: IG baseline 10.4% (95% CI:6–16.3) and post-intervention 5.3% (95% CI:2–11,2); CG baseline 7% (95% CI:4–11.2) and post-intervention 10.7% (95% CI:5.8–17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37–54) and post-intervention 43.8% (95% CI: 34.4–54.4). GC baseline 30.3% (95% CI: 24.3–36.8) and post-intervention 40.8% (95% CI: 31–51.2).ConclusionsA multifactorial community intervention programme in people ≥70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

Fundamento y objetivo Determinar la prevalencia de insuficiencia renal cronica (IRC) oculta y las variables clinicas asociadas en pacientes con diabetes mellitus de tipo 2 (DM2). Pacientes y metodo Estudio observacional, analitico y transversal en pacientes con DM2 ambulatorios de atencion primaria. De la historia clinica electronica se registraron datos demograficos y antropometricos, antecedentes patologicos y medidas de riesgo cardiovascular y de funcion renal. Se determino la prevalencia de IRC oculta, definida en pacientes con valores de creatinina (Cr) plasmatica normales (Cr =1,4mg/dl en las mujeres y Cr =1,5mg/dl en los varones), y la estimacion del filtrado glomerular (eFG) reducida (

Introduction: The Programme for Prevention and Care of Chronic Illness in Girona CRONIGICAT aims to provide sustainable, integrated, quality care to chronic patients, targeted levels of care and interventions, and collaboration with other healthcare providers and social services. CRONIGICAT emerged during 2011 in the Girona Primary Care Region of the Institut Catala de la Salut as a result of the Health Plan 2011-2015 by the Department of Health of the Generalitat de Catalunya (Spain), which aimed to achieve a more chronic care oriented health care system. Short description of practice change implemented: CRONIGICAT includes a total of 20 different projects strategically related to the integration of care, continuity with social services, adapting the organization to the needs of chronic patients, patient involvement and self-care, prevention and health promotion, technological innovation, professional development and research. Aim and theory of change: To determine the usefulness and viability of a chronic care programme. CRONIGICAT has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116939 – http://www.ijic.org/ 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 Targeted population: A population of approximately 500,000 people registered in 26 primary care teams (PCT). Stakeholders: 7 hospitals and 76 nursing homes Timeline: 2011-present Highlights: Design: Cross-sectional descriptive study with qualitative and quantitative evaluation. Main measures: The degree of development of the programme, consensus indicators for chronic care proposed by the policy maker, the Department of Health of the Generalitat de Catalunya, and the Assessment of Readiness for Chronicity in Health Care Organisations (ARCHO/IEMAC) tool. Outcomes: • Evaluation of the degree of development: 75% of projects were partially or fully implemented. • Improvement trends were found in the consensus indicators for process (e.g. patients contacted 48 hours after hospital discharge, population included in chronic care programmes). • Slight decline in the consensus indicators for effectiveness (e.g. readmissions, mean length of hospital stay, avoidable hospital admissions, medicines expenditure, number of emergency appointments, and mortality). • The dimensions receiving the highest scores on the ARCHO/IEMAC tool were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. Comments on sustainability: CRONIGICAT is sustainable in its implementation as all actions and projects are integrated within routine clinical practice. No additional resources are required for evaluation as the consensus indicators used are already compiled by the Department of Health. Comments on transferability: Implementation of projects directly focused on chronic patients carry a high degree of transferability of the actions designed. Conclusions: CRONIGICAT is useful, viable and sustainable. Discussions: Evaluation of a health care program can prove complex and it must take into account qualitative and quantitative aspects. Lessons learned: The need for integration within the health care system of the practical implementation of chronic care projects and their evaluation to allow the use of existing resources, and the involvement of all stakeholders towards common goals.

Objectives We investigated the relationship between leukocyte subtype counts and vascular structure and function based on carotid intima-media thickness, pulse wave velocity, central augmentation index and cardio-ankle vascular index by gender in intermediate cardiovascular risk patients. Methods This study analyzed 500 subjects who were included in the MARK study, aged 35 to 74 years (mean: 60.3 +/- 8.4), 45.6% women. Measurement: Brachial ankle Pulse Wave Velocity (ba-PWV) estimate by equation, Cardio-AnkleVascular Index (CAVI) using the VaSera device and Carotid ultrasound was used to measure carotid Intima Media Thickness (IMT). The Mobil-O-Graph was used to measure the Central Augmentation Index (CAIx). Results Total leukocyte, neutrophil and monocyte counts were positively correlated with IMT (p < 0.01) in men. Monocyte count was positively correlated with CAIx in women (p < 0.01). In a multiple linear regression analysis, the IMT mean maintained a positive association with the neutrophil count (beta = 1.500, p = 0.007) in men. CAIx maintained a positive association with the monocyte count (beta = 2.445, p = 0.022) in women. Conclusion The results of this study suggest that the relationship between subtype circulating leukocyte counts and vascular structure and function, although small, may be different by gender. In men, the neutrophil count was positively correlated with IMT and in women, the monocyte count with CAIx, in a large sample of intermediate-risk patients. These association were maintained after adjusting for age and other confounders., This work was supported by grants funded by the Spanish Ministry of Science and Innovation (MICINN) and Carlos III Health Institute/European Regional Development Fund (ERDF) (MICINN, ISCIII/FEDER) (Red RedIAPP RD06/0018, Research Groups: RD06/0018/2009, RD06/0018/0045/RD06/0018/0027) and by the Health Research Fund(FIS PI10/01088, PI10/02077, PI10/02043) and Regional Health Management of the Castilla and Leon(GRS 635/A/11). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Communicating with the patient in clinical practice refers to the way in which the doctor and the patient interact both verbally and nonverbally, in order to achieve a shared understanding of problems and solutions. Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of professional practice. Problem Based Learning (PBL) has been put forward as an alternative to the mere reproduction of knowledge and pre-established patterns, enabling students to develop their own learning strategies to overcome problems in their future professional practice. The challenge is to determine how to assess the acquisition of clinical communication skills. The authors have recommended a summative assessment of clinical communication skills based on the combination of different methods. It highlights the importance of feedback-based formative assessment. This raises the need to develop and validate assessment scales in clinical communication at an undergraduate level. Based on this work, the authors put forward a "fanned out" assessment in terms of clinical communication skills in Medicine degrees, with the use of different instruments in a "spiraled" manner, where the greater the contact with clinical practice in the various degree and integral courses, the greater difficulty experienced, with the participation of all the stakeholders involved (self, hetero and peer assessment) without precluding the involvement of patients (real or simulated) in the design of assessment instruments

Introduction : The Program for Prevention and Care of Chronic Disease in Girona (CRONIGICAT) 1 From 2011 has developed its objectives to provide a level of quality of integrated care for chronic patients. In early 2014 began to develop under this same direction, a strategy regarding social services of the territory, that within the framework of the Interdepartmental Plan Assistance and Social Intervention and Health (PIAISS) of the Department of Health of Catalonia mark sheet route in different areas of Girona. Practice description : The strategy implemented in our territory aims to achieve integrated social and health care to better respond to patients considered most vulnerable priority Patients with Mental Disorder, Chronic Patients complex (PCC) and Advanced Chronic Disease (MACA). The scope includes 29 primary care teams (EAP) of the Catalan Institute of Health (ICS), 3 EAPs Healthcare Institute (IAS), 4 Consortium of Social Services Girones, Garrotxa, Pla de l'Estany and Alt Emporda, and 4 reference hospitals. With a population of about 400,000 people assigned. The strategy is to develop a col • laboratory between social and healthcare tailored to each territory depending on your organization's work. Results and Impact : The impact assessment of projects comprehensive care is complicated by the participation of different interest groups may have differing views on what results are considered more important. a strategy of qualitative and quantitative evaluation is used. 1.Evaluacion qualitative degree of Territorial implementation of socio-integrated health care: Your valuation as high, medium or low is based on four criteria: 1.1. Having well defined and agreed goals. 1.2. Having identified who works well and who leads. 1.3. Having planned action. 1.4. Having indicators of process and outcome. Rating 4 territories in the implementation phase: HIGH: Garrotxa and Pla de l'Estany MEDIA: Girones BAJA: Alt Emporda 2. Evaluation with quantitative: 2.1. Number of shares companies evaluated. 2.2. Indicators consensus on attention to chronicity made by Aqua. It is shown as an example of the Garrotxa Source: Data from the Observatory website Health System of Catalonia. summaries 2014 Data format: Indicator - Value - Reference in Catalonia Hospital emergency rate - 447-428 Emergency Level 4 and 5 of triage (%) - 61.8 to 67.1 Emergency rate level 4 and 5 selection - 281-299 1.000h avoidable hospitalizations .-- 7.3 to 9.8 COPD hospitalizations for 1.000h .-- 0.9 to 2.10 Hospitalizations from 2.08 to 3 .-- ICC 1.000h polypharmacy patients (%) - 0.002 to 0.07 Population served in home care (%) program - from 6.11 to 10.3 average stay of hospital care - from 4.6 to 6.1 emergency admissions (%) - 62.5 to 66.2 hospital mortality (discharge) by ICC - 10.3 to 8.50 Total mortality 30dies CHF - 15.7 to 12.1 Readmissions within 30 days for selected causes - from 5.9 to 9.6 Readmissions within 30 days ICC - 7.5 to 14 Readmissions within 30 days for COPD - from 12.6 to 16 emergencies admitted (%) - 5.9 to 12 best results are observed compared with the values of Catalonia for almost all indicators Featured We appreciate the need for a body to ensure that the commitment set out in the Governance Body develops within a reasonable time and in the manner, according to the targets set in each territory. The implementation process has led to a learning common work that has enabled initiate some actions as unify the terminology, identify the target population, and to avoid duplication. It has also allowed establish dynamic shared work to agree on the minimum data necessary and indispensable to share. Conclusion : As for sustainability and transferability consider essential use for evaluation indicators consensus and aggregate data compiled by the Department of Health itself. The advantages of this option are obvious. It is an independent source of information with a high degree of validity and reliability. It allows sharing the same results between suppliers with a common terminology and a global vision. Data are published and are accessible online on the website of Health System Observatory of Catalonia. Therefore, decrease own costs associated with the combine • selection, processing and data analysis. It is information that is used by the Department of Health to purchase services. Complement associated with the qualitative evaluation allows to assess the impact of socio-health care more integrated locally.

To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2).Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation.The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia.The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

OBJECTIVE: To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the ≥70 years population in a community. DESIGN: Multicentre, community intervention study, with no random assignment and with controls. SETTING: Two basic health areas in the province of Girona (Spain). PARTICIPANTS: Random sample of people ≥70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. MEASUREMENTS AND PRIMARY OUTCOMES: The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. RESULTS: (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8–31.9) and post-intervention 31% (95% CI: 25.6–36.5). CG baseline 32% (95% CI: 28.8–35.2) and post-intervention 30% (95% CI: 24.9–35.4). Falls with fractures: IG baseline 10.4% (95% CI:6–16.3) and post-intervention 5.3% (95% CI:2–11,2); CG baseline 7% (95% CI:4–11.2) and post-intervention 10.7% (95% CI:5.8–17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37–54) and post-intervention 43.8% (95% CI: 34.4–54.4). GC baseline 30.3% (95% CI: 24.3–36.8) and post-intervention 40.8% (95% CI: 31–51.2). CONCLUSIONS: A multifactorial community intervention programme in people ≥70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

To improve quality of life, anxiety and depression in caregivers of patients in home care.We performed a randomized clinical trial in 79 main caregivers (39 control group and 40 intervention group) of patients in the home care program of a primary care health center between 2000 and 2001. Quality of life, anxiety and depression were measured by the COOP/WONCA and Goldberg questionnaires, respectively, at the beginning and at the end of the study. Interventions consisted of two medical visits to take a bio-psychosocial history of the caregiver and a nurse visit for health education. Two letters, adapted to each carer's needs, were sent and two telephone calls were made.The intervention group scored significantly better than the control group in relation to WONCA-feelings (p=0.03), WONCA-social activities (p=0.05), and WONCA-quality of life (p=0.02).A short multidisciplinary intervention program adapted to routine consultations could prevent deterioration in caregivers' quality of life.

ObjectivesTo determine the prevalence of ankle-brachial index (ABI)10%. In participants 75–79 free of cardiovascular disease, the prevalence of ABI

Background: Cardiovascular risk functions fail to identify more than 50% of patients who develop cardiovascular disease. This is especially evident in the intermediate-risk patients in which clinical management becomes difficult. Our purpose is to analyze if ankle-brachial index (ABI), measures of arterial stiffness, postprandial glucose, glycosylated hemoglobin, self-measured blood pressure and presence of comorbidity are independently associated to incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate-risk population. Methods/Design: This project involves 3 groups belonging to REDIAPP (RETICS RD06/0018) from 3 Spanish regions. We will recruit a multicenter cohort of 2688 patients at intermediate risk (coronary risk between 5 and 15% or vascular death risk between 3-5% over 10 years) and no history of atherosclerotic disease, selected at random. We will record socio-demographic data, information on diet, physical activity, comorbidity and intermittent claudication. We will measure ABI, pulse wave velocity and cardio ankle vascular index at rest and after a light intensity exercise. Blood pressure and anthropometric data will be also recorded. We will also quantify lipids, glucose and glycosylated hemoglobin in a fasting blood sample and postprandial capillary glucose. Eighteen months after the recruitment, patients will be followed up to determine the incidence of vascular events (later follow-ups are planned at 5 and 10 years). We will analyze whether the new proposed risk factors contribute to improve the risk functions based on classic risk factors. Discussion: Primary prevention of cardiovascular diseases is a priority in public health policy of developed and developing countries. The fundamental strategy consists in identifying people in a high risk situation in which preventive measures are effective and efficient. Improvement of these predictions in our country will have an immediate, clinical and welfare impact and a short term public health effect., This work was supported by grants funded by: the Spanish Ministry of Science and Innovation (MICINN) and Carlos III Health Institute/European Regional Development Fund (ERDF) (MICINN, ISCIII/FEDER) (Red RedIAPP RD06/0018, Research Groups: RD06/0018/2009, RD06/0018/0045/RD06/0018/0027) and by the Fondo de Investigacion Sanitaria (FIS PI10/01088, PI10/02077, PI10/02043) and Regional Health Management of the Castilla y Leon (GRS 635/A/11).

Terra Incognitase ha configurado como unLibro Blancoque pretende identificar tendencias y reflexionar sobre las diferentes concepciones y prácticas de la investigación no disciplinar en nuestro entorno académico (el Sistema Español de Ciencia y Tecnología). Esta es una transición que implica un cierto cambio de paradigma, muy alineado con la investigación dirigida a retos sociales. Terra Incognitaes resultado de laRed de ExcelenciaSimPastNet– Simular el pasado para entender el comportamiento humano(Redes de Excelencia 2017 I, HAR2017-90883-REDC). Esta red, coordinada por el Grupo de Ingeniería de Organización de la Universidad de Burgos (UBU), está formada por 10 grupos de investigación y 40 investigadores. Los integrantes de la red pertenecen tanto a grupos de investigación en Ciencias Sociales y Humanidades (Arqueología, Antropología y Sociología), como a grupos de investigación en Ciencias Formales (Matemáticas, Ingeniería e Informática). Todos ellos se caracterizan por su perspectiva transdisciplinar y presentan una larga experiencia de colaboración con especialistas de diferentes dominios. La Red SimPastNet surgió del proyecto de Investigación Consolider IngenioSimulPast. Simulating the Past to Understand Human Behavior(MINECO – CSD2010-00034) un proyecto de Humanidades (fundamentalmente arqueológico), dirigido a promover el modelado y la simulación en la investigación histórica y, por tanto, con un marcado carácter innovador y transdisciplinar. A pesar de queTerra Incognitatrate aspectos generales y ofrezca visiones de conjunto, esta genealogía explica el porqué de su perspectiva fundamentalmente anclada en las Ciencias Humanas y Sociales. Además, nos centraremos especialmente en el papel de lasHumanidades y las Ciencias Sociales,porque constituyen una parte importante de esosámbitos desde los que se están generando grandes aportaciones a esa transición que implica posicionarse en nuevos territorios, ajenos a las trayectorias históricas de nuestras disciplinas.