SAS - D.S.A.P. Málaga

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Now showing 1 - 20 of 88
  • Publication
    [Impact of the COVID-19 pandemic on healthcare provided from Primary Care in a healthcare area].
    (2022-04-29) Escribano-Serrano, J; Jiménez-Varo, E; Casto-Jarillo, C; Hormigo-Pozo, A; Michán-Doña, A; en representación del grupo Gerva
  • Publication
    Metformin, testosterone, or both in men with obesity and low testosterone: A double-blind, parallel-group, randomized controlled trial.
    (2022-08-18) Fernández-García, José Carlos; Barrios-Rodríguez, Rocío; Asenjo-Plaza, Maite; Ramos-Molina, Bruno; Molina-Vega, María; Guzmán-Guzmán, Antonio; Moreno-León, Luis; Yubero-Serrano, Elena M; Rius-Díaz, Francisca; Valdés, Sergio; Martínez-González, Miguel Ángel; Jiménez-Moleón, José Juan; Tinahones, Francisco J
    Men with obesity tend to be insulin resistant and often have low-normal testosterone concentrations. We conducted a clinical trial aimed to evaluate potential therapeutic strategies for low testosterone in men with obesity. We did a 1-year, parallel, randomized, double-blind, placebo-controlled trial, where we evaluated the independent and combined effects of metformin and testosterone in 106 men with obesity, aged 18-50 years, who had low levels of testosterone and no diabetes mellitus. The primary outcome was change in insulin resistance, measured as Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) index. Secondary outcomes included changes in total and free serum testosterone, body composition, metabolic variables, erectile function, and health-related quality of life (HRQoL). In the intention-to-treat analysis, the HOMA-IR index decreased significantly in all active groups compared to placebo (metformin -2.4, 95 % CI -4.1 to -0.8, p = 0.004; testosterone -2.7, 95 % CI -4.3 to -1.1, p = 0.001; combination -3.4, 95 % CI -5.0 to -1.8, p  Among men with obesity and low testosterone concentrations, the combination of metformin plus testosterone, metformin only, and testosterone only, compared to placebo, reduced insulin resistance with no evidence of additive benefit.
  • Publication
    [Genetic protocol in primary care for rare diseases: Wolfram syndrome as a prototype].
    (2022-03-16) Esteban-Bueno, Gema; Díaz-Anadón, Lucas Ramón; Rodríguez González, Antonio; Navarro Cabrero, Miguel; Berenguel Hernández, Aída María
    Rare diseases, despite their individual low frequency, affect 7% of the population all combined. Consequently, every primary care practitioner (PCP) will have several of these patients under his care. 80% of rare diseases are genetically determined, which makes genetic counseling fundamental in these cases. The follow-up of patients with Wolfram syndrome (WS) can be used to design a protocol to support these patients, with the participation of researchers and healthcare professionals specialized in WS, the patients themselves and their familial environment. This protocol can be suitable for the diagnosis and management of other diseases as well. The main steps of every genetic clinical procedure are developed in this article, emphasizing the role of PCP in supporting patients and their families and in transmitting genetic information in a comprehensible manner.
  • Publication
    [COVID-19 clinical features in primary care: COVIDPAP study].
    (2022-05-02) Carballal-Mariño, Marta; Balaguer-Martínez, Josep Vicent; García-Vera, César; Morillo-Gutierrez, Beatriz; Domínguez-Aurrecoechea, Begoña; Jimenez-Alés, Rafael; Gallego-Iborra, Ana; Cañavate-González, Cristina; Ciriza-Barea, Edurne
    In Spain, the tools to diagnose COVID-19 were available in primary care from May 2020. Previously most studies described inpatients, and fever and cough were the most frequent symptoms. This study aims to define the clinical picture of the pediatric COVID-19 in the community. A descriptive and analytical observational study was performed including pediatric cases (0-14y) from 255 pediatricians, proportionally distributed to its population, from primary health centers in Spain, from 12th May 2020 to 30th April 2021. Diagnostics were made by PCR detection of viral RNA, rapid antigen detection test or positive IgG serology. There were 10,021 positive children included, 48.4% women, mean age 8,04 ± 4.17 years. Infection was detected due to contact tracing (70.9%), compatible symptoms (18.8%). Household was the main source of transmission (64.9%), followed by school setting (10%) or unknown (9.9%). We did not find any significant differences in the incidence between holidays and school terms. 43.2% of the children were asymptomatic. Most frequent symptoms are rhinorrhea in  9 y. An exhaustive description of objective and subjective symptoms by age is made. 18 patients were hospitalized, one with multisystem inflammatory syndrome in children. There were no deaths. Pediatric COVID-19 is a mild disease, with a large number of asymptomatic cases, with very few hospital admissions and deaths. The main setting for transmission is the household, and school closures should be a last resource measure during the COVID-19 pandemic. A specific clinical picture of pediatric COVID-19 was not found.
  • Publication
    Validity of the classification of emergency service requests related to suicidal behavior
    (Inst nac psiquiatria ramon fuente muniz, 2022-03-01) Ramos-Martin, Javier; Lourdes Rueda-Artero, Evelin; del Campo-Avila, Jose; Martinez-Garcia, Ana I.; Castillo-Jimenez, Pilar; Moreno-Kustner, Berta; [Ramos-Martin, Javier] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Malaga, Spain; [Lourdes Rueda-Artero, Evelin] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Malaga, Spain; [Moreno-Kustner, Berta] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Malaga, Spain; [del Campo-Avila, Jose] Univ Malaga, Dept Lenguajes & Ciencias Computac, Malaga, Spain; [Martinez-Garcia, Ana I.] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Castillo-Jimenez, Pilar] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Martinez-Garcia, Ana I.] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, Berta] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, Berta] Inst Biomed Malaga IBIMA, Malaga, Spain; Consejeria de Salud, Junta de Andalucia
    Introduction. Suicide attempts are the most predictive risk factor for suicide deaths. Most people who attempt suicide receive care from out-of-hospital Emergency Services (OES), where these requests are managed and classified. Objective. Validate the Emergency Coordination Center (ECC) classification for the detection of suicidal behavior requests. Method. A descriptive, cross-sectional study of requests to the ECC of M??laga (Spain) during 2013 and 2014 was conducted. To classify the requests, the authors considered the ECC categorization when answering the call and the clinical assessment of the healthcare professional when attending the person who had made the call at the scene, which was considered the reference standard. To analyze the validity of the ECC classification system, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results. The total number of requests for medical assistance analyzed was 112,599. The validity indicators of the classification system for suicidal behavior were sensitivity = 44.78%, specificity = 99.34%, PPV = 46.91% and NPV = 99.28%. Discussion and conclusion. The ECC classification system has a lower capacity to detect the presence of suicidal behavior and a higher capacity to identify its absence in the requests received. OES provide key information on suicidal behavior requests as they can be one of the first places people with this problem go to. It would therefore be extremely useful to improve the classification systems for requests related to suicidal behavior.
  • Publication
    Neuroprotective Effect of 3',4'-Dihydroxyphenylglycol in Type-1-like Diabetic Rats-Influence of the Hydroxytyrosol/3',4'-dihydroxyphenylglycol Ratio.
    (2022-03-08) Rodríguez-Pérez, María Dolores; Pérez de Algaba, Inmaculada; Martín-Aurioles, Esther; Arrebola, María Monsalud; Ortega-Hombrados, Laura; Verdugo, Cristina; Fernández-Prior, María África; Bermúdez-Oria, Alejandra; De La Cruz, José Pedro; González-Correa, José Antonio
    The aim of this study was to assess the possible neuroprotective effect of 3',4'-dihydroxyphenylglycol (DHPG), a polyphenol from extra virgin olive oil (EVOO), in an experimental model of diabetes and whether this effect is modified by the presence of another EVOO polyphenol, hydroxytyrosol (HT). The neuroprotective effect was assessed in a hypoxia-reoxygenation model in brain slices and by quantifying retinal nerve cells. The animals were distributed as follows: (1) normoglycemic rats (NDR), (2) diabetic rats (DR), (3) DR treated with HT (5 mg/kg/day p.o.), (4) DR treated with DHPG (0.5 mg/kg/day), or (5) with 1 mg/kg/day, (6) DR treated with HT plus DHPG 0.5 mg/kg/day, or (7) HT plus 1 mg/kg/day p.o. DHPG. Diabetic animals presented higher levels of oxidative stress variables and lower numbers of neuronal cells in retinal tissue. The administration of DHPG or HT reduced most of the oxidative stress variables and brain lactate dehydrogenase efflux (LDH) as an indirect index of cellular death and also reduced the loss of retinal cells. The association of DHPG+HT in the same proportions, as found in EVOO, improved the neuroprotective and antioxidant effects of both polyphenols.
  • Publication
    How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention.
    (2022-05-06) Del Cura-González, Isabel; López-Rodríguez, Juan A; Leiva-Fernández, Francisca; Gimeno-Miguel, Antonio; Poblador-Plou, Beatriz; López-Verde, Fernando; Lozano-Hernández, Cristina; Pico-Soler, Victoria; Bujalance-Zafra, Mª Josefa; Gimeno-Feliu, Luis A; Aza-Pascual-Salcedo, Mercedes; Rogero-Blanco, Marisa; González-Rubio, Francisca; García-de-Blas, Francisca; Polentinos-Castro, Elena; Sanz-Cuesta, Teresa; Castillo-Jimena, Marcos; Alonso-García, Marcos; Calderón-Larrañaga, Amaia; Valderas, José M; Marengoni, Alessandra; Muth, Christiane; Prados-Torres, Juan Daniel; Prados-Torres, Alexandra; Multi-Pap Group
    (1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65-74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was -2.42 (95% CI from -4.27 to -0.59) and, between baseline and a 12-month follow-up was -3.40 (95% CI from -5.45 to -1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: NCT02866799.
  • Publication
    Effectiveness of Physical Activity in Primary Prevention of Anxiety: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
    (2022-02-05) Moreno-Peral, Patricia; Pino-Postigo, Alberto; Conejo-Cerón, Sonia; Bellón, Darío; Rodríguez-Martín, Beatriz; Martínez-Vizcaíno, Vicente; Bellón, Juan Ángel
    The aim of this study was to evaluate the effectiveness of physical activity in the primary prevention of anxiety. A systematic review of randomized controlled trials (RCTs) was performed. RCTs were searched in seven electronic databases. We included RCTs that assessed either the incidence of anxiety or the reduction of anxiety symptoms which excluded participants with baseline anxiety. Measurements were required to have been made using validated instruments. Objective or subjective (with validated questionnaires) verification of the performance of physical activity was required. Three reviewers carried out the search, selection, data extraction, and risk assessment of Cochrane Collaboration's tool simultaneously and independently, reaching an agreement in their discrepancies by consensus. In addition, a meta-analysis of fixed-effects model was carried out. Three RCTs met inclusion criteria, comprising 350 patients from 3 different countries. A meta-analysis was performed using five comparisons extracted from the selected studies, and the pooled standardized mean difference (SMD) was -0.18 (95% CI: -0.44; 0.07), p = 0.158. The heterogeneity was irrelevant, I2 = 17.7% (p = 0.30). There is no evidence that anxiety can be prevented through physical activity, although the quality of evidence was very low.
  • Publication
    Are infections in children with juvenile idiopathic arthritis more frequent than in healthy children? A prospective multicenter observational study.
    (2022-08-11) Udaondo, Clara; Núñez Cuadros, Esmeralda; Murias, Sara; Remesal, Agustin; Alcobendas, Rosa; Guerrero, Concepción; Guillen-Martin, Sara; Escuredo, Marta; Aleo, Esther; Alonso, Daniel; Tagarro, Alfredo; De Santiago, Eloisa; Camacho-Lovillo, Marisol; Diaz, Fatima; Arenas, Dolores; Camacho, Pilar; Lirola, Maria Jose; Díaz Almirón, Mariana; Calvo, Cristina
    Children with juvenile idiopathic arthritis (JIA) might be at a higher risk of infection. Our objectives are to describe and compare infection rates in patients with JIA vs. healthy patients. A prospective, multicenter observational study was performed in Spain from January 2017 to June 2019. Patients with JIA from 7 participating hospitals and children without JIA (siblings of patients with JIA, and non-JIA children from primary health centers) were followed up with quarterly questionnaires to record infection episodes. Tuberculosis, herpes zoster, and infections requiring hospital admission were considered severe infections. Rates of infection (episodes/patient/year) were compared using a generalized estimating equations model. A total of 371 children (181 with and 190 without JIA) were included. The median age was 8.8 years (IQR 5.5-11.3); 75% of the patients with JIA received immunosuppressive treatment (24% methotrexate, 22% biologic, 26% both). A total of 667 infections were recorded; 15 (2.2%) were considered severe. The infection rate was 1.31 (95%CI 1.1-1.5) in JIA and 1.12 (95%CI 0.9-1.3) in non-JIA participants (p = 0.19). Age We found no differences in the infection rate or infection severity between patients with and without JIA. Most infections were mild. An age younger than 4 years increased the infection risk in both groups. Higher disease activity was associated with a higher infection rate.
  • Publication
    Components of case management in caring for patients with dementia: a mixed-methods study.
    (2022-06-23) Jerez-Barranco, Desirée; Gutiérrez-Rodríguez, Laura; Morilla-Herrera, Juan Carlos; Cuevas Fernandez-Gallego, Magdalena; Rojano-Perez, Remedios; Camuñez-Gomez, María Dolores; Sanchez-Del Campo, José Luis; García-Mayor, Silvia
    Case management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers. Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register. This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving.
  • Publication
    The influence of symptom severity of palliative care patients on their family caregivers.
    (2022-02-28) Valero-Cantero, Inmaculada; Casals, Cristina; Carrión-Velasco, Yolanda; Barón-López, Francisco Javier; Martínez-Valero, Francisco Javier; Vázquez-Sánchez, María Ángeles
    This study anlyzed whether family caregivers of patients with advanced cancer suffer impaired sleep quality, increased strain, reduced quality of life or increased care burden due to the presence and heightened intensity of symptoms in the person being cared for. A total of 41 patient-caregiver dyads (41 caregivers and 41 patients with advanced cancer) were recruited at six primary care centres in this cross-sectional study. Data were obtained over a seven-month period. Caregiver's quality of sleep (Pittsburgh Sleep Quality Index), caregiver's quality of life (Quality of Life Family Version), caregiver strain (Caregiver Strain Index), patients' symptoms and their intensity (Edmonton Symptom Assessment System), and sociodemographic, clinical and care-related data variables were assessed. The associations were determined using non-parametric Spearman correlation. Total Edmonton Symptom Assessment System was significantly related to overall score of the Pittsburgh Sleep Quality Index (r = 0.365, p = 0.028), the Caregiver Strain Index (r = 0.45, p = 0.005) and total Quality of Life Family Version (r = 0.432, p = 0.009), but not to the duration of daily care (r = -0.152, p = 0.377). Family caregivers for patients with advanced cancer suffer negative consequences from the presence and intensity of these patients' symptoms. Therefore, optimising the control of symptoms would benefit not only the patients but also their caregivers. Thus, interventions should be designed to improve the outcomes of patient-caregiver dyads in such cases.
  • Publication
    Professional grief among nurses in Spanish public health centers after caring for COVID-19 patients.
    (2022-09-14) Vázquez-Sánchez, María Ángeles; Ayllón-Pérez, Victoria; Gutiérrez-Sánchez, Daniel; Valero-Cantero, Inmaculada; Fernandez-Ordoñez, Eloisa; García-Gámez, Marina; Casals, Cristina
    The aim of the present study is to investigate the professional grief suffered by nurses in various medical units, after coping with the COVID-19 pandemic for the last 18 months. Addressing and acknowledging the reality of professional grief is of fundamental importance to nurses' mental health, as this condition has both professional and personal consequences. A qualitative, content analysis approach was taken. Based on 25 interviews with nursing professionals working in different health centers units were performed. The following sampling schemes were used: first, convenience sampling, then nominated sampling, and finally theoretical sampling. From our analysis of the data obtained, three main themes were identified: the impact on nurses of COVID-19 outcomes; the symptoms of professional grief; and cognitive reactions. These core elements interacted with 12 subtopics, including symptoms of grief and the cognitive impact produced. A large proportion of the nurses consulted in this study have suffered and suffered professional grief and report many related symptoms. In response to the present pandemic and any future occurrence, the question of professional grief needs to be addressed. To help them cope better with this type of situation, nurses should receive appropriate training. Moreover, healthcare institutions should be made aware of the problem and be encouraged to offer assistance to address the impact produced on nurses by the deaths of their patients. This study shows the impact of professional grief on nurses in the context of the COVID-19 pandemic. Nurses are affected personally by the deaths of patients and by alterations to their working conditions. In many cases, this grief remains unresolved and its various symptoms persist.
  • Publication
    The 2021 European Society of Cardiology Cardiovascular Disease Prevention Guidelines: adding albuminuria to the SCORE scale increases the prevalence of very high/high cardiovascular risk among patients with chronic kidney disease.
    (2022-02-10) Cebrian, Ana; Escobar, Carlos; Aranda, Unai; Palacios, Beatriz; Capel, Margarita; Sicras, Antoni; Sicras, Aram; Hormigo, Antonio; Manito, Nicolás; Botana, Manuel; Alcázar, Roberto
  • Publication
    Risk of outcomes in a Spanish population with chronic kidney disease.
    (2022-03-05) Alcázar, Roberto; Escobar, Carlos; Palacios, Beatriz; Aranda, Unai; Varela, Luis; Capel, Margarita; Sicras, Antoni; Sicras, Aram; Hormigo, Antonio; Manito, Nicolás; Botana, Manuel
    To assess mortality and cardiovascular and renal outcomes among patients with chronic kidney disease (CKD) (primary objective), with a particular focus on heart failure (HF) risk following diagnosis of CKD (secondary objective) in Spain. We conducted an observational study comprising cross-sectional and longitudinal retrospective analyses using secondary data from electronic health records. For the primary objective, adults with prevalent CKD [estimated glomerular filtration rate (eGFR) In the prevalent population, 46 786 patients with CKD without HF [75.8 ± 14.4 years, eGFR 51.4 ± 10.1 mL/min/1.73 m2; 75.1% on renin-angiotensin system inhibitors (RASis)] and 8391 with CKD and HF (79.4 ± 10.9 years, eGFR 46.4 ± 9.8 mL/min/1.73 m2) were included. In the prevalent population, the risk of all-cause death {hazard ratio [HR] 1.107 [95% confidence interval (CI) 1.064-1.153]}, HF hospitalization [HR 1.439 (95% CI 1.387-1.493)] and UACR progression [HR 1.323 (95% CI 1.182-1.481)] was greater in those patients with CKD and HF versus CKD only. For the incident population, 1594 patients with CKD without HF and 727 with CKD and HF were included. Within 24 months from the CKD diagnosis (with/without HF at baseline), 6.5% of patients developed their first HF hospitalization. Although 60.7% were taking RASis, only 3.4% were at maximal doses and among diabetics, 1.3% were taking sodium-glucose cotransporter-2 inhibitors. The presence of HF among CKD patients markedly increases the risk of outcomes. CKD patients have a high risk of HF, which could be partially related to insufficient treatment.
  • Publication
    Heterogeneity in the association between prediabetes categories and reduction on glomerular filtration rate in a 5-year follow-up.
    (2022-05-05) Manouchehri, Marjan; Cea-Soriano, Lucía; Franch-Nadal, Josep; Ruiz, Antonio; Goday, Albert; Villanueva, Rosa; Diez-Espino, Javier; Mata-Cases, Manel; Giraldez-García, Carolina; Regidor, Enrique; PREDAPS Study Group
    Prediabetes and not just diabetes can cause kidney damage. This study assess the association of prediabetes with development of impaired renal function (IRF). We used data from PREDAPS prospective study a cohort of 1072 subjects with prediabetes and another cohort of 772 subjects without prediabetes were follow-up from 2012 to 2017. Prediabetes was defined according to American Association of Diabetes criteria. IRF was defined as having a glomerular filtration rate 
  • Publication
    Factors associated with psychiatric calls for prehospital emergency services in Malaga (Spain)
    (Inst nac psiquiatria ramon fuente muniz, 2016-01-01) Guzman-Parra, Jose; Isabel Martinez-Garcia, Ana; Guillen-Benitez, Cristobalina; Castro-Zamudio, Serafina; Jimenez-Hernandez, Manolo; Moreno-Kustner, Berta; [Guzman-Parra, Jose] Hosp Reg Malaga, Unidad Gest Clin, Malaga, Spain; [Guzman-Parra, Jose] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Isabel Martinez-Garcia, Ana] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Castro-Zamudio, Serafina] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Jimenez-Hernandez, Manolo] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Moreno-Kustner, Berta] Grp Andaluz Invest Psicosocial GAP CTS 945, Malaga, Spain; [Guzman-Parra, Jose] Inst IBIMA, Malaga, Spain; [Moreno-Kustner, Berta] Inst IBIMA, Malaga, Spain; [Isabel Martinez-Garcia, Ana] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Guillen-Benitez, Cristobalina] Unidad Gest Clin Disposit Cuidados Crit & Urgenci, Malaga, Spain; [Castro-Zamudio, Serafina] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Campus Teatinos S-N, E-29071 Malaga, Spain; [Jimenez-Hernandez, Manolo] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Campus Teatinos S-N, E-29071 Malaga, Spain; [Moreno-Kustner, Berta] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Campus Teatinos S-N, E-29071 Malaga, Spain
    IntroductionIn recent years, there has been a significant increase in the demand for prehospital emergency care in different countries.ObjectiveThe aim of the present study was to identify the variables associated with psychiatric calls to the Prehospital Emergency Care Services (PECS) in the province of Malaga.MethodAn observational retrospective study based on calls made to the PECS and registered in the computerized database of the Coordination Emergency Centre during one year (N = 163 331). Independent variables included 1. sociodemographic variables: sex and age; and 2. variables related with the characteristics of each call: time of day, type of day, time of year, caller identification, number of resources needed, number of patients attended and type of solution. The x(2) test was used to compare of the variables. A multivariant logistic regression analysis was also carried out.ResultsPsychiatric calls accounted for 7% of the total calls and were associated with: younger age, female gender, calls made in the evenings and afternoons, a lower number of patients attended, the call being performed by other individual calling on the patient's behalf, and no ambulance transportation.Discussion and conclusionThe calls concerned with mental health problems have specific characteristics which need to be taken into account in order to provide a better care for psychiatric patients.
  • Publication
    How to live with COPD: patient's perception.
    (Univ murcia, 2016-01-01) Munoz-Cobos, Francisca; Acero-Guasch, Nieves; Cuenca-del-Moral, Rebeca; Barnestein-Fonseca, Pilar; Leiva-Fernandez, Francisca; Garcia-Ruiz, Antonio; [Munoz-Cobos, Francisca] Dist Sanitario Malaga, Ctr Salud El Palo, Malaga, Spain; [Acero-Guasch, Nieves] Area Salud Ibiza & Formentera, Illes Balears, Spain; [Cuenca-del-Moral, Rebeca] Dist Sanitario Costa del Sol, Ctr Salud Albarizas, Malaga, Spain; [Barnestein-Fonseca, Pilar] Dist Sanitario Malaga, Unidad Docente Multiprofes Atenc Familiar & Comun, Malaga, Spain; [Leiva-Fernandez, Francisca] Dist Sanitario Malaga, Unidad Docente Multiprofes Atenc Familiar & Comun, Malaga, Spain; [Garcia-Ruiz, Antonio] Univ Malaga, Fac Med, Dept Farmacol & Terapeut, E-29071 Malaga, Spain
    The aim of this study is to determine the mental model that patients with COPD (chronic obstructive pulmonary disease) have about their illness analyzed by the Leventhal's Common Sense of Self-Regulation Model. An exploratory-descriptive study using qualitative methodology was performed. We included COPD-diagnosed patients attending three urban and a rural primary care centres. We used video-taped group interviews and transcribed them using Atlas.Ti 5.2 program. 22 group interviews (2009 - 2011) and 58 patients were included. There were 3 additional sessions to final inform validation. The results show that patients did not have a defined mental model about COPD: this disease was insufficiently recognized; diagnosis was made in exacerbations and it was confused with other diseases; the cause of illness was related to tobacco consumption and to "something else": fumes, colds and hard work. Patients tended to minimize their symptoms and limitations. Participants had wrong beliefs about colds, smoking only a few cigarettes effects and damage of inhaled treatment. Emotions as despair, resignation and fear were reported. We conclude that COPD patients showed confusion about many aspects of the disease (causes, symptoms, treatments). It was difficult to identify a mental model of the disease among COPD patients.
  • Publication
    The family physician in the care of patients with cancer
    (Ediciones doyma s a, 2016-05-01) Lopez Verde, Fernando; Esteva, Magdalena; Vallespin, Carmen Vela; [Lopez Verde, Fernando] Serv Andaluz Salud, Ctr Salud Delicias, Malaga, Spain; [Esteva, Magdalena] Unidad Invest Gerencia Atenc Primaria Mallorca, Formac Continuada Unidad Docente Multiprofes Aten, Castellon de La Plana, Spain; [Vallespin, Carmen Vela] SAP Metropolitana Nord Inst Catala Salut, ABS Riu Nord & Riu Sud, Santa Coloma Gramenet, Barcelona, Spain
  • Publication
    Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study).
    (2021-07-02) Aznar-Lou, Ignacio; Zabaleta-Del-Olmo, Edurne; Casajuana-Closas, Marc; Sánchez-Viñas, Alba; Parody-Rúa, Elizabeth; Bolíbar, Bonaventura; Iracheta-Todó, Montserrat; Bulilete, Oana; López-Jiménez, Tomàs; Pombo-Ramos, Haizea; Martín Miguel, María Victoria; Magallón-Botaya, Rosa; Maderuelo-Fernández, Jose Ángel; Motrico, Emma; Bellón, Juan; Martí-Lluch, Ruth; Rubio-Valera, Maria; Serrano-Blanco, Antoni
    Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. NCT03136211 . Registered 02 May 2017 - Retrospectively registered.
  • Publication
    Costs and healthcare utilisation of patients with chronic kidney disease in Spain.
    (2021-06-01) Escobar, Carlos; Palacios, Beatriz; Aranda, Unai; Capel, Margarita; Sicras, Antoni; Sicras, Aram; Hormigo, Antonio; Alcázar, Roberto; Manito, Nicolás; Botana, Manuel
    Data about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain. Observational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. We identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m2). During the 2015-2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time. Between 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.