Design and validation of a new questionnaire with a gender perspective to measure medication adherence for secondary prevention of ischaemic heart disease: study protocol

INTRODUCTION AND OBJECTIVES

Only about 50% of chronic patients in high-income countries adhere to their treatment. There are methods to measure medication adherence but none of them can be considered optimal. This study will aim to design and validate a questionnaire to measure medication adherence in patients with ischaemic heart disease using a direct method as a gold-standard adherence measure and taking into account the gender perspective. Moreover, the profile of low adherence in these patients will be determined.

METHODS AND ANALYSIS

First study phase consists on the questionnaire design following the next steps: identification of the dimensions, definition of the target population, questionnaire items and order, response coding, questionnaire instructions, content validity by experts and understandability. In the second phase, a cross-sectional study will be performed to end the questionnaire development and validate it. Four hundred and forty patients (50% female) with acute coronary syndrome receiving treatment within the previous 12 months will be included. Patient will answer the initial questionnaire and adherence to aspirin and statin will be measured using a direct method (drug concentration analysis in blood) and other questionnaires. From the set of preselected questionnaire items, those most closely associated with the gold standard measure will be selected using multivariate statistics.

ETHICS AND DISSEMINATION

All participants gave their written informed consent before participating in the study. The study protocol follows the recommendations of the Declaration of Helsinki and was approved by the ethics committees of the three participating centres. The results of this study will be displayed at national and international conferences and in peer-reviewed scientific journals.

Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach

OBJECTIVE

This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic.

METHODS

This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included RESULTS: The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0-54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65-74 years (RR=71.01) was associated with a significantly higher risk of premature mortality.

CONCLUSIONS

Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.

Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups

BACKGROUND

Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence.

METHODS

An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified.

RESULTS

Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system.

CONCLUSIONS

Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Association of Visiting the Physiotherapist with Mortality in the Spanish General Population: A Population-Based Cohort Study

Background and Objectives: The purpose of this retrospective population-based cohort study was to analyse the association between attendance of physiotherapy with mortality in the Spanish general population and describe the profile of people who do not visit a physiotherapist in Spain. Material and Methods: The data sources were the 2011/2012 National Health Survey (ENSE11) and the national database of death in Spain, and the participants were all adult respondents in the ENSE11. Results: Of 20,397 people, 1101 (5.4%) visited the physiotherapist the previous year, and the cumulative incidence of total mortality was 5.4% (n = 1107) at a mean follow-up of 6.2 years. Visiting the physiotherapist was associated with lower all-cause mortality in the population residing in Spain, quantified at 30.1% [RR = 0.699; 95% CI (0.528-0.927); p = 0.013]. The factors associated with not visiting a physiotherapist were the following: rating one's health as good (9.8%; n = 1017; p < 0.001), not having any hospital admission in the previous year (9.6%; n = 1788; p < 0.001), not having visited the general practitioner in the previous month (9.6%; n = 1408; p < 0.001), and not having attended a day hospital in the previous year (9.7%; n = 1836; p < 0.001). Conclusions: Visiting a physiotherapist was associated with a lower mortality from all causes in the population living in Spain.

[Factors associated with dissatisfaction with pharmacological treatment in patients with type 2 diabetes mellitus: A cross-sectional study]

BACKGROUND AND OBJECTIVES

Diabetes is a chronic disease with a high impact on both health and Quality of Life Related to Health (QLRH). To evaluate the satisfaction of treatment in patients with type 2 diabetes mellitus through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and its relationship with sociodemographic variables, with antidiabetic medication and clinical-analytical variables.

MATERIALS AND METHODS

This cross-sectional study was conducted in General University Hospital of San Juan de Alicante between September 2016 and December 2017. Two hundred thirty-two patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, treated with antidiabetic medication were included. The Spanish version of the DTSQ scale was used to measure satisfaction with treatment. Factors associated with low satisfaction were analyzed by applying the Chi-square test for qualitative variables and Student-T for quantitative variables. To estimate magnitudes of association, logistic models were adjusted.

RESULTS

Two hundred thirty-two patients were included in this study. 21.5% of the patients presented low satisfaction with the treatment. Patients who presented low satisfaction with treatment were associated with medications that could cause hypoglycemia (OR: 2.872 [1.195-6.903]), HbA1c levels higher than 7% (OR: 2.260 [1.005-5.083]) and drugs administered by the route oral (OR: 2.749 [1.233-6.131]).

CONCLUSIONS

Patients with type 2 diabetes mellitus who had a lower score on the DTSQ questionnaire were associated with medications that produced hypoglycaemia, and with higher levels of HbA1c higher than 7%, and those who took oral medication.

Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020

OBJECTIVES

To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020.

METHODS

We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province.

RESULTS

We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women.

CONCLUSIONS

Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.

Psychometric properties of the Clarke questionnaire for hypoglycemia awareness in the Spanish population with type 2 diabetes

OBJECTIVES

The Clarke questionnaire, validated in Spanish language, assesses hypoglycemia awareness in patients with type 1 diabetes. This study aimed to analyze its psychometric properties in patients with type 2 diabetes (T2DM).

METHODS

This was a questionnaire validation study. Patients with T2DM and treated with insulin, sulfonylureas or glinides were consecutively recruited from six endocrinology consultations and six primary care centers. The internal structure of the 8-item Clarke questionnaire was analyzed by exploratory (training sample) and confirmatory (testing sample) factor analysis; the internal consistency using Omega's McDonald coefficient; and goodness of fit with comparative fit index (CFI, cutoff >0.9), Goodness of Fit Index (GFI, cutoff >0.9), and root mean-square error of approximation (RMSEA, cutoff <0.09), as well as unidimensionality indicators.

RESULTS

The 265 participants (56.8% men) had a mean age of 67.8 years. Confirmatory factor analysis for one dimension obtained poor indicators: fit test (p < 0.001); CFI = 0.748; RMSEA = 0.122 and SRMR = 0.134. Exploratory factor analysis showed 2 or 3 dimensions with poor adjustment indicators. Omega's McDonald was 0.739.

CONCLUSIONS

The Spanish version of the Clarke questionnaire was not valid or reliable for assessing hypoglycemia awareness in people with T2DM in Spanish population.

Factors Associated with Colorectal Cancer Screening in Spain: Results of the 2017 National Health Survey

This study aimed to determine the CRC screening coverage of people aged between 50 and 69 years who were living in Spain in 2017 and describe the factors associated with not having had a faecal occult blood test (FOBT). A cross-sectional study was performed using data from the Spanish National Health Survey 2017. We analysed 7568 individuals between the ages of 50 and 69 years. The proportion of respondents between 50 and 69 years old who had had an FOBT was 29.0% (n = 2191). The three autonomous communities with the lowest proportion of respondents who had had an FOBT were Extremadura (8.7%, n = 16), Ceuta-Melilla (10.4%, n = 3), and Andalucia (14.1%, n = 186). The variables associated with not having had an FOBT were being 50-54 years old (PR = 1.09; 95% CI 1.04-1.14), having been born outside of Spain (PR = 1.11; 95% CI 1.06-1.16), not having been vaccinated against the flu (PR = 1.09; 95% CI 1.04-1.15), never having had a colonoscopy (PR = 1.49; 95% CI 1.40-1.59), not having had an ultrasound scan in the last year (PR = 1.09; 95% CI 1.04-1.14), and not having seen a primary care physician in the last month (PR = 1.08; 95% CI 1.04-1.12). The factors associated with not getting an FOBT were young age, having been born outside of Spain, not having been vaccinated against the flu in the last campaign, and not making frequent use of healthcare services.

Early Detection of Atrial Fibrillation in Community Pharmacies-CRIFAFARMA Study

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia to appear in clinical practice. People with AF have 5 times the risk of stroke compared to the general population.

OBJECTIVE

This study aimed to determine the prevalence of AF in people over the age of 50 without known AF, who presented to a community pharmacy to check their cardiovascular risk factors, to identify risk factors associated with AF, and to assess the risk of stroke in people who screened positive for AF.

METHODS

A multicenter observational descriptive study of a screening program took place from May to December 2016. A blood pressure monitor (Microlife Watch BP Home) was used to screen for AF, and the CHA2DS2-VASc questionnaire was used to assess stroke risk.

RESULTS

The study included 452 adults over the age of 50. The CRIFAFARMA study detected a prevalence of AF of 9.1%. Risk factors for AF were: age of 75 years or older (P = .024), lack of physical activity (P = .043), diabetes (P < .001), dyslipidemia (P = .003), and history of cardiovascular disease (P = .003). Diabetes (OR 2.79, P = .005) and dyslipidemia (OR 2.16, P = .031) had a combined explanatory capacity in the multivariable logistic regression model adjusted for age. 85% were at high risk of stroke according to the CHA2DS2-VASc scale.

CONCLUSIONS

AF was detected in more than 9% of the included population. Factors associated with AF were advanced age, lack of physical activity, diabetes, dyslipidemia, and history of cardiovascular disease, with diabetes and dyslipidemia standing out as the factors with independent explanatory capacity.

[Analysis of two health attendance models for the non-hospital emergencies in Gipuzkoa: Retrospective study]

BACKGROUND AND OBJECTIVE

Out-of-hospital medical emergency services are defined as a functional organization that performs a set of sequential human and material activities. The objective of this study was to compare the mortality of patients attended by the out-of-hospital medical emergency services in 2 neighboring Spanish regions with different models of healthcare transport assistance for emergency care.

MATERIAL AND METHOD

Retrospective observational cohort study, done between June 1, 2007 and December 31, 2008 in 2 regions of Gipuzkoa, Alto Deba (AD) and Bajo Deba (BD). The study variables were age, sex and place of exposure (AD/BD), heart rate, blood pressure, initial reason for the call defined by the European Resuscitation Council, unconsciousness and digestive bleeding. 3452 subjects were analyzed.

RESULTS

The risk of in situ mortality in BD was 1.31 times higher than in AD (P=.050), that of hospital mortality in BD was 0.71 times lower than in AD (P=.011) and the risk of mortality at one year between counties and the combined mortality (in situ+hospital) did not contribute significant differences.

CONCLUSIONS

Mortality (in situ+in-hospital, and one year aftercare) of patients treated by the out-of-hospital emergency medical services in AD (non-medicalized healthcare transport model) was similar to that of the BD region (mixed healthcare transport model).

Effect of rowing on mobility, functionality, and quality of life in women with and without breast cancer: a 4-month intervention

PURPOSE

Of the different modalities of rowing, dragon boat training is the most analyzed in breast cancer (BC). However, other types of boats, such as the felucca, use different biomechanical techniques, which have not been studied in the scientific literature. Consequently, in this study, we sought to determine the benefits of felucca rowing on the physical, psychological, and emotional well-being of patients with BC and healthy persons.

METHODS

A pre- and post-intervention, single-arm study without a control group with a 4-month intervention was carried out in Spain in 2019. The study sample included six women with BC and 15 healthy women. The following questionnaires were administered before and after the intervention: Disabilities of the Arm, Shoulder, and Hand (DASH), Constant-Murley score (CMS), and the European Quality of Life 5 Dimensions (EQ-5D, rate your health today). Differences were determined before and after the intervention using the paired t test.

RESULTS

Significant differences (p < 0.05) were found in the results of all the questionnaires for the women with BC and for the healthy women: DASH (- 13.8 BC and - 6.7 healthy), CMS (+ 12.0 BC and 9.2 healthy), and EQ-5D (+ 8.5 BC and 10.5 healthy).

CONCLUSION

Felucca rowing showed benefits in health and quality of life in both women with BC and healthy women. In future studies with controlled design, values regarding clinical relevance, such as effect sizes/confidence intervals, are needed to corroborate our results.