[Revista Española de Cardiología in Journal Citation Reports].
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Cardiology↗
Biomedical subjects
J Alonso
Publications and source records attributed to J Alonso.
Evolution of self-rated health status in the elderly: cross-sectional vs. longitudinal estimates.
We assessed the perceived health status evolution among elderly subjects and examined the age-related differences in perceived health when comparing estimates obtained from cross-sectional and longitudinal approaches. Data come from a cohort of non-institutionalized individuals aged 65 years or older, living in Barcelona, Spain. One thousand three hundred fifteen (1315) elderly were successfully interviewed at baseline in 1986 and 754 (84.6% of the eligible) at the re-assessment (1993-1994). Estimates of change in perceived health status were calculated based on cross-sectional and longitudinal approaches. Cross-sectionally, no significant differences in the proportion of individuals with poor self-rated health were found (40.5 vs. 42.5%, P = 0.90). Among survivors, the proportion of individuals with poor health increased from 37.8% to 55.1% (P < 0.01), an 8.7-fold decline of perceived health when compared with the cross-sectional estimates. Comorbidity (aOR 2.1; 95%CI: 1.4-3.3) and no education (aOR 1.9; 95%CI: 1.1-3.2) were associated with a decline in health status after adjusting by baseline health status. We recommend the use of longitudinal studies to understand the evolution of perceived health in the elderly.
Aged↗
Provision of feedback on perceived health status to health care professionals: a systematic review of its impact.
OBJECTIVE: To assess the impact on the process and the outcomes of care of feeding back information on perceived health status to health care professionals in clinical practice. DESIGN: Systematic review of controlled trials. DATA IDENTIFICATION: Search in electronic databases (MEDLINE 1966-1997), manual searches, and requests to experts in the field. DATA ANALYSIS: Differences between intervention and control group were considered in process of care (use of health services, diagnosis, and treatment), patient outcomes (health status), and patient satisfaction. In a subgroup of 13 interventions that dealt with the provision of feedback about the patient's mental health, the impact on the process of care was subjected to meta-analysis. RESULTS: We identified 21 studies that satisfied the selection criteria. Eleven of 20 (55%) found significant differences (P <0.05) in at least 1 of the process indicators in favor of the intervention group. Of 11 trials that assessed patient outcomes, only 4 (36%) detected significant improvements. A similar trend but lower percentages were observed among the 8 interventions that provided general health status information. Eleven interventions that evaluated feedback information about the patient's mental health status showed a higher rate of diagnosis in the intervention group (combined odds ratio [OR]=1.91; 95% confidence interval [CI] 1.28 to 2.83). Seven of 9 studies evaluating treatment failed to show an effect on this indicator (combined OR=1.15; 95% CI 0.76 to 1.75). CONCLUSIONS: The provision of feedback on perceived health status to health professionals seems to have an effect on the process of care but not on patient functional or health status. This is especially true with regard to mental health status information. Nevertheless, there is still need for a more through evaluation of this type of intervention.
Adult↗
Factors associated with second eye cataract surgery.
AIMS: To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery. METHODS: An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Clinical characteristics, perceived health characteristics (perceived visual function and overall health status), and sociodemographic characteristics were compared between two patient groups-those with surgery in only one eye and those who had undergone surgery in both eyes by the end of the 2 year follow up period. RESULTS: Of the 242 patients studied, 125 (51.7%) underwent second eye surgery during the 2 year observation period. Patients with visual acuity 6/18 (0.3) or worse in the second eye compared with those with visual acuity over 6/12 (0.5) and patients younger than 65 years compared with patients aged 65-74 were more likely to undergo second eye surgery (adjusted odds ratio 3.9 and 1. 8, respectively). 52 (44.5%) patients in the only one eye surgery group had a visual acuity less than 6/18 (0.3) in the second eye. CONCLUSIONS: Worse visual acuity in the second eye and younger ages are strongly associated with both eyes cataract surgery. There may be a potential increase of demand for this procedure in the near future since almost half of the patients with only one eye surgery presented a low visual acuity in the second eye.
Aged↗
Exploring health preferences in sociodemographic and health related groups through the paired comparison of the items of the Nottingham health profile.
BACKGROUND: Preference weighted measures of health related quality of life are necessary for cost effectiveness calculations involving quality of life adjustment. There are conflicting data about the influence of factors such as sociodemographic and health related variables on health preferences. STUDY OBJECTIVE: The relative values attached to the items of the Spanish version of the Nottingham Health Profile (NHP) were assessed to make comparisons across social and health subgroups. DESIGN AND PARTICIPANTS: Preference values were obtained in sets of 250 to 253 persons (total n=1258) using the method of paired comparisons after all possible pairs of NHP items had been presented to respondents for judgement of severity. chi(2) Tests and Spearman's correlations among item ranks were calculated. MAIN RESULTS: Findings show that preferences elicited with the method of paired comparisons are consistent and independent of the sample from which they are obtained (mean correlation coefficients across subgroups range from 0.87 to 0.96). Conclusion-The evaluation of health did not seem to be related to sociodemographic variables (gender, age, social class) or to the health status of the respondents, suggesting that health preferences are stable across different populations.
Adult↗
Generalized grating imaging using an extended monochromatic light source
It is a well-known fact that one grating can act as an imaging element for another grating when the first is illuminated with an extended monochromatic light source. The conditions for image formation in such a system are studied when the finite size and position of the broad light source are considered. From the presented analysis, expressions for the location and the depth of focus of such images can be derived.
Journal Article↗
The pain and function of the hip (PFH) scale: a patient-based instrument for measuring outcome after total hip replacement.
The Pain and Function of the Hip (PFH) scale was developed following the recommendations of the Société International de Chirurgie Orthopedique et Traumatologie to assess the outcomes of total hip replacement (THR). This study evaluated metric properties of the PFH scale and its ability to measure clinical change (responsiveness) in consecutive patients undergoing THR. Patients were evaluated preoperatively and at 3 and at 12 months postoperatively. The PFH scale and the Nottingham Health Profile (NHP) were administered. Complete data were collected for 79 patients. Mean overall preoperative PFH score was 26.5 and mean overall PFH score 12 months postoperatively was 69.8 (P < .01). Correlation with the NHP was high (r = -0.64), and the magnitude of improvement (effect size) as assessed by the PFH scale was large (3.6 compared with 1.7 for the NHP). The PFH scale is simple and valid, and may complement routine clinical evaluation of hip replacement. Residual pain after hip replacement may have been previously underestimated.
Arthroplasty, Replacement, Hip↗
[Effectiveness and cost of total hip replacement in seven hospitals in Catalonia, Spain].
BACKGROUND: To quantify short-term benefits of total hip replacement, prognostic factors of the outcome, and to assess hospital costs of this surgical procedure in Catalonia, Spain. PATIENTS AND METHODS: Multicentric prospective study in seven hospitals in Catalonia. All patients undergoing this procedure in one year were included. They were evaluated prior to the operation, and six months later. This evaluation involved: clinical assessment, the Hip Pain and Function Scale, the Nottingham Health Profile (NHP), and the EuroQol (EQ-5D), in order to measure cost-utility. Hospital costs were estimated by means of a specific questionnaire. RESULTS: Information was obtained for 332 patients. The mean age was 65 years (range: 27-89 years); 58% were women; the most common diagnosis was arthritis; 59% of patients had associated pathology and 13% presented some type of postoperative complication. The improvement in health status was important according to all instruments. An outcome of "excellent" or "good" was achieved by 70.8% of the patients, in terms of hip function and pain. The factors associated with not achieving an outcome of this level were: associated pathology, complications, diagnoses other than arthritis, and operation carried out in a tertiary hospital. The total cost of the procedure was 838,480 pesetas. This average varied significantly with the cost of the prosthesis, and as a function of the length of stay. The three-year cost-utility of the procedure was estimated as 507,500 pesetas. CONCLUSIONS: Total hip replacement greatly improves the pain, hip function and overall perceived health of the patient. This improvement is greater among patients with a diagnosis of arthritis, with good overall health, operated on by a surgeon experienced in this procedure. The benefit is high in relation to the cost, although there is a margin for improvement, reducing complications, shortening length of stay, and controlling the price of implants.
Adult↗
[Efficacy and cost of ambulatory cataract surgery: a systemic review].
BACKGROUND: A systematic review has been performed on the literature in order to assess efficacy and costs of cataract ambulatory surgery. The objective of the review were the randomized controlled trials comparing benefits, adverse effects and costs of ambulatory and inpatient cataract surgery, including, in addition, an original trial of our investigation group. METHODS: The sources of information have been: MEDLINE (between 1985 and 1998), HealthStar (1975-98), Evidence-Based, the systematic review of the journals of ophthalmology (1992-98) and the review of the references in the documents or articles reviewed. The quality of the trials was assessed according to criteria proposed by the Evidence-Based Medicine Working Group. Data extracted from each study included: design, object population, setting, type of intervention and treatment, and follow-up period. Outcomes of ambulatory surgery were compared to those of inpatient surgery concerning to benefits (postoperative visual acuity), adverse effects (surgical complications) and costs of the surgery. RESULTS: From 44 studies satisfying inclusion criteria, only 5 randomized controlled trials and 10 observational studies had the necessary information to be included in the review. In all the studies postoperative visual acuity was similar between the two groups (inpatients and outpatients). In the quantitative synthesis of the trials included in the review, outpatients presented a higher rate of perioperatory (48 hours after surgery) complications (OR = 1.4; IC 95%: 1.1-1.8) and of increase of intraocular pressure (OR = 2.3; IC 95%: 1.3-3.9). The ambulatory surgery costs were from a 15 to a 30% lower, depending on the study analyzed. CONCLUSIONS: Ambulatory cataract surgery patients present a benefit in visual acuity similar to inpatients. However, the higher risk of surgical complications among outpatients suggests the appropriateness of improving their immediate postoperative care. Even though some variability exists in the method to calculate costs, the results suggest that ambulatory surgery is the most efficient alternative.
Aged↗
Deflectometric measurement of mechanical spectacle lens deformation.
The warpage of a set of six hard resin spherical lenses was measured when they were compressed by means of the tangential force exerted by a metal frame. The technique employed to measure the lenses improves over previous work both because greater precision is achieved, and because radii of curvature are measured in two perpendicular meridians. In this work, a representative sample of lenses has been used in order to test the way in which deformation depends on lens power and base. It is found that the induced warpage is enough to move the tested lenses between different base families, spoiling the initial design of the manufacturer.
Compressive Strength↗
Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START): a four-year follow-up.
OBJECTIVE: The purpose of this study was to test the hypothesis that stent implantation in de novo coronary artery lesions would result in lower restenosis rates and better long-term clinical outcomes than balloon angioplasty. BACKGROUND: Placement of an intracoronary stent, as compared with balloon angioplasty, has proven to reduce the rate of restenosis. However, the long-term clinical benefit of stenting over angioplasty has not been assessed in large randomized trials. METHODS: We randomly assigned 452 patients with either stable (129 patients) or unstable (323 patients) angina pectoris to elective stent implantation (229 patients) or standard balloon angioplasty (223 patients). Coronary angiography was performed at baseline, immediately after the procedure and six months later. End points were the rate of restenosis at six months and a composite of death, myocardial infarction (MI) and target vessel revascularization over four years of follow-up. RESULTS: Procedural success rate was achieved in 84% and 95% (balloon angioplasty vs. stent, respectively). The increase in the minimal luminal diameter was greater in the stent group both after the intervention (2.02 +/- 0.6 mm vs. 1.43 +/- 0.6 mm in the angioplasty group; p < 0.0001), and at six-month follow-up (1.98 +/- 0.7 mm vs. 1.63 +/- 0.7 mm; p < 0.001). The corresponding restenosis rates were 22% and 37%, respectively (p < 0.002). After four years, no differences in mortality (2.7% vs. 2.4%) and nonfatal MI (2.2% vs. 2.8%) were found between the stent and the angioplasty groups, respectively. However, the requirement for further revascularization procedures of the target lesions was significantly reduced in the stent group (12% vs. 25% in the angioplasty group; relative risk 0.49, 95% confidence interval 0.32 to 0.75, p = 0.0006); most of the repeat procedures (84%) were carried out within six months of entry into the study. CONCLUSIONS: Patients who received an intracoronary stent showed a lower rate of restenosis than those treated with conventional balloon angioplasty. The benefit of stenting was maintained four years after implantation, as manifested by a significant reduction in the need for repeat revascularization.
Aged↗
[Measurement of the perceived impact of sleep problems: the Spanish version of the functional outcomes sleep questionnaire and the Epworth sleepiness scale].
BACKGROUND: Excessive daytime sleepiness is a frequent symptom and a public health problem due to its association with automobile and work related accidents. The aim of this study was to develop and carry out a preliminary assessment of the Spanish version of the functional outcomes sleep questionnaire and the Epworth sleepiness scale, two instruments designed to evaluate patients with sleep disorders. MATERIAL AND METHODS: For the adaptation, the forward and back-translation method by bilinguals was used with professional and lay panel. Once tested for feasibility and comprehension, 39 patients with obstructive sleep apnea syndrome completed the Spanish version of the FOSQ and the Epworth sleepiness scale, together with a question on self-rated health status. RESULTS: Difficulty of translation was assessed as low and the naturalness of Spanish expressions as high for all the items of the questionnaires except for the response options of the Epworth sleepiness scale. Both questionnaires showed higher reliability than the standard proposed for individual comparisons (Cronbach's alpha > 0.9). The FOSQ vigilance scale showed a high correlation with the Epworth score (r = -0.79), while for the other scales of the FOSQ correlations were moderate (r ranging from -0.52 to -0.68). Patients who reported "regular" or "poor" health had significantly worse scores for most of the FOSQ scales. CONCLUSION: These results suggest that the Spanish versions of both questionnaires are conceptually equivalent to the originals and that they show similar characteristics of reliability and validity. The FOSQ vigilance scale assess daytime sleepiness similarly to Epworth but the others scales of the FOSQ provide additional information for these patients.
Female↗
Methadone treatment in Spain, 1994.
The objective of this study was to describe the methadone treatment (MT) network in Spain, and to evaluate compliance with criteria known to influence the spread of human immunodeficiency virus (HIV). During the last 3 months of 1994, a mailed questionnaire was sent to the coordinators of all methadone treatment centers in Spain. A total of 224 centers completed the questionnaire (90% response rate). The total number of patients receiving MT in the studied centers was 13,402. Their mean age was 29 years, 79% were male, and approximately 60% were HIV positive. The rate of patients in MT varied by Region (mean: 6.7 patients in MT per 10,000 inhabitants). Although the global mean of reported daily dose of methadone was 60 mg, in 44% of the centers it was lower than that. Despite the high number of centers involved with MT in Spain, the coverage by regions is unequal. Studied centers revealed only a moderate adherence to procedures considered to be effective in HIV prevention. Given the magnitude of HIV infection in Spain, there is a clear need for improvement.
Adolescent↗
[The size of the effect of the difference between two means: statistically significant or clinically relevant?].
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Medicine↗
Methadone and quality of life.
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Analysis of Variance↗
Comparison of performance-based and self-rated functional capacity in Spanish elderly.
Recent data have shown differences between Spain and the United States in the prevalence of reported disability among community elderly. Differences in reporting functional capacity by culture may contribute to these observed differences. The purpose of this study was to estimate the agreement between self-report of disability and performance-based measures for some basic mobility tasks in the community-dwelling elderly of a Mediterranean country. Interviews containing questions about difficulty for walking and rising from a chair, and performance-based measures (walking speed and chair stand tests) were carried out in 626 individuals aged 72 years and older in Barcelona, Spain. Kappa statistics were calculated, and logistic regression models were constructed to identify possible factors associated with under- and overreporting functional capacity. Moderate kappas (0.41-0.55) were found between self-report and performance-based measures. Patients who rated their health as "poor or very poor" were less likely to underreport disability (adjusted odds ratio (OR) = 0.2, 0.4) but more likely to overreport it (adjusted OR = 23.4, 9.9). No significant agreement differences by sex or informant source were found. These findings suggest that Spanish elderly self-report functional capacity accurately and that, contrary to previous results among US elderly, the direction of the observed disagreement is not systematic.
Activities of Daily Living↗
Search for mutations of the hRAD54 gene in sporadic meningiomas with deletion at 1p32.
The hRAD54 gene is related to a family of genes involved in DNA recombination and repair and encodes a protein with DNA helicase activity. hRAD54 has been mapped to 1p32, a region frequently involved in deletions in a variety of tumor types, including atypical and anaplastic meningiomas. To determine whether alterations of hRAD54 are a common event in meningeal tumors, by means of polymerase chain reaction-single-stranded conformation analysis we examined 29 tumor samples characterized by 1p deletions for hRAD54 mutations. Although 18 tumors displayed allelic loss at the gene region (1p32) as determined by microsatellite marker analysis, the sole coding-sequence alteration detected corresponded to a T-->C transition, with no amino-acid change. The genotype distribution was 10.34% TT, 44.8% TC, and 44.8% CC, whereas in the normal controls it was 3.77% TT, 13.2% TC, and 83.01% CC, and most meningiomas with 1 p32 deletion retained allele C. Another polymorphism due to a T-->C change was evidenced at nt 3008, in the 3' untranslated region. This change was evidenced in all cases we sequenced. These results appear to exclude the involvement of the hRAD54 gene in the pathogenesis of the nontypical meningiomas, although a detrimental effect of the hRAD54 polymorphisms cannot be ruled out.
3' Untranslated Regions↗
Study of the thermal stability and enzymatic activity of an immobilised enzymatic system for the bilirubin oxidation.
In this work, we have studied the immobilisation of the haemoglobin/glucose oxidase coupled enzymatic system in poly(vinyl alcohol) membranes. These are to be used as a reagent phase either in the development of an optical sensor or as an efficient bilirubin (BR) removal reactor. Poly(vinyl alcohol) (PVA) was chosen as the support for this purpose, due to its good biocompatibility, hydrophilicity and non-thrombogenic effects. A hydrogel containing the enzymatic system, consisting of PVA crosslinked with glutaraldehyde, was prepared and characterised by DSC, enzyme activity measurements and release tests. Investigating protein conformational changes as a function of temperature and the enzymatic system activity we have found that, in spite of the destabilizing effect of the glutaraldehyde in the acidic medium, the PVA insolubilisation conditions seem do not perturb either the conformation of the 'native state' nor the enzymatic system activity. Moreover, it was found that PVA/glutaraldehyde membranes offer a simple way to hold enzymatic system, with the possibility of controlling the conditions to obtain either the effective prevention of leaching of the entrapped proteins or the in situ delivery of the haemoglobin.
Bilirubin↗