Oriol Cunillera

Institut Universitari d'Investigació en Atenció Primària Jordi Gol

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Jesús Almeda

Institut Universitari d'Investigació en Atenció Primària Jordi Gol

Betlem Salvador-González

Institut Universitari d'Investigació en Atenció Primària Jordi Gol

Montse Ferrer

Hospital Del Mar

Ricard Carrillo Muñoz

Institut Català de la Salut

Yolanda Pardo

Hospital Del Mar

Iván Villar Balboa

Institut Català de la Salut

Yolanda Rando Matos

Institut Català de la Salut

Ferràn Guedea

Institut Català d'Oncologia

Neus Gil-Terrón

Institut Universitari d'Investigació en Atenció Primària Jordi Gol

Jordi Mestre-Ferrer

Institut Universitari d'Investigació en Atenció Primària Jordi Gol

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Institut Català de la Salut

121

Institut Universitari d'Investigació en Atenció Primària Jordi Gol

Universitat Autònoma de Barcelona

Hospital Del Mar

Universitat de Barcelona

Bellvitge University Hospital

Hospital del Mar Research Institute

Instituto de Salud Carlos III

Municipal Institute for Medical Research

Institut Català d'Oncologia

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Description of thyroid disorders the year before conception: a population-based study

Frontiers in Endocrinology (2023)

Glòria Tena Vivó Neus Parellada Esquius Oriol Cunillera Mercè Albareda Riera Mónica Isidro Albaladejo

Objective This study aimed to monitoring the prevalence of previously identified thyroid disorders and hypothyroidism monitoring before pregnancy. Material and methods A retrospective cross-sectional study of women whose pregnancies occurred between 2014 and 2016 was conducted, including 120,763 pregnancies in Catalonia (Spain). The presence of thyroid disorders in women was based on disease diagnostic codes and/or prescription of levothyroxine or antithyroid drugs. To evaluate the thyroid disorder diagnosis and monitoring, thyrotropin (TSH), free T4 (FT4), antiperoxidase antibody (TPOAb), and anti-TSH receptor antibody (TRAb) records were gathered and categorised according to the reference values of each laboratory. Results The prevalence of recorded thyroid disorders before the last menstrual period was 5.09% for hypothyroidism and 0.64% for hyperthyroidism,showing a significant increase with age. A thyroid monitoring test was not performed in the year before the last menstrual period in approximately 40% of women with a known thyroid disorder. Amongst the women with hypothyroidism who underwent a TSH test, 31.75% showed an above-normal result. Amongst women previously unknown to have thyroid disorders, 3.12% had elevated TSH levels and 0.73% had low TSH levels. Conclusion A high percentage of Catalan women with a known thyroid disorder were not properly monitored during the year before pregnancy. Amongst those monitored, more than one-third had TSH values outside the reference range. Therefore, it is important to evaluate women with thyroid disorders during pre-pregnancy visits.

Levothyroxine

Thyroid disorder

Trab

Thyroid disease

10.3389/fendo.2023.1236505

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Citations (4)

Heart failure admission across glomerular filtration rate categories in a community cohort of 125,053 individuals over 60 years of age

Hypertension Research (2019)

Laia Alcober-Morte Carmen Barrio-Ruiz Neus Parellada-Esquius Isaac Subirana Josep Comín‐Colet

Medical record

10.1038/s41440-019-0315-6

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Citations (8)

PRM17 Suitability of CLAD-CQR Models for Obtaining QALYs

Value in Health (2011)

Oriol Cunillera Gemma Vilagut Antònia Medina R. Tresserra Jordi Alonso

Tobit model

Ordinary least squares

10.1016/j.jval.2011.08.1048

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Then, where do we put our limited resources on the medium and longe-term?; Comments on rehm and colleague’s hypothesis

Informaciones psiquiátricas: Publicación científica de los Centros de la Congregación de Hermanas Hospitalarias del Sagrado Corazón de Jesús (2021)

Carles Barcons Marcelo Sánchez Oriol Cunillera Josep Lluís Matalí M. Guitart

Durante la primera ola de la pandemia no observamos en nuestra practica diaria un claro aumento de la demanda de tratamiento ni un elevado numero de infecciones por COVID-19 entre pacientes en tratamiento por adicciones, segun nuestros datos. Al interpretar estos resultados, respondemos al ensayo de Jurgen Rehm y colaboradores. Ellos Propusieron dos escenarios principales con predicciones opuestas en relacion con el impacto de la crisis actual sobre el nivel y los patrones de consumo de alcohol. Nos sentimos obligados a imaginar no solo lo que sucederia si su hipotesis se hiciera realidad, sino tambien como esta se desarrollaria. Nuevamente podriamos prever dos escenarios que de alguna manera serian opuestos, en relacion a la demanda de recursos para los pacientes con dependencia del alcohol durante la pandemia a medio y largo plazo: el primer escenario favoreceria el refuerzo de los centros especializados de tratamiento de adicciones para hacer frente a este supuesto aumento del consumo de alcohol; el segundo escenario apoya a los centros de atencion primaria. Concluimos que los centros de atencion primaria deberian de ser los primeros reforzados

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Responses to the Dix-Hallpike test in primary care: A comparison between subjective and objective benign paroxysmal positional vertigo

Atención Primaria (2021)

José Luis Ballvé Moreno Ricard Carrillo Muñoz Yolanda Rando Matos Iván Villar Balboa Oriol Cunillera

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0-10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR=3.94, p=0.021) and antihypertensive therapy (OR 3.02, p=0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p=0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV.

Cervical spondylosis

Depression

10.1016/j.aprim.2021.102023

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Evaluating the controlled reopening of nightlife during the COVID-19 pandemic: a matched cohort study in Sitges, Spain, in May 2021 (Reobrim Sitges)

BMJ Open (2022)

Oriol Cunillera Sara Contreras-Martos Mercè Marzo‐Castillejo Darío López Gallegos Mateo Acedo Anta

Objectives To assess the impact of relaxing the state of alarm restrictions on SARS-CoV-2 infections at 14 days among people attending reopened nightclub venues. Design Matched cohort study with a paired control group (1:5 ratio). Setting Five small nightclubs with indoor areas and outdoor terraces, in a nightlife-restricted area in Sitges, Spain, on 20 May 2021. Wearing masks was mandatory, drinking was allowed and social distance was not required. Participants Volunteers were selected through a convenience sampling. To attend the event, participants were required to be older than 17 years, with a negative rapid antigen diagnostic test (Ag-RDT) on the same afternoon, without a positive reverse-transcription PCR (RT-PCR) or Ag-RDT and/or symptoms associated with COVID-19 in the previous 7 days, to not having knowingly been in close contact with someone infected in the previous 10 days and to not have knowingly had close contact with someone with a suspicion of COVID-19 in the previous 48 hours. A control group was paired by exact age, gender, residence municipality, socioeconomic index, previous SARS-CoV-2-confirmed infection and vaccination status, in a 1:5 ratio, from the primary care electronic health records. Primary outcome Evidence of infection at electronic health records by SARS-CoV-2 at 14-day follow-up. Results Among the 391 participants (median age 37 years; 44% (n=173) women), no positive SARS-CoV-2 cases were detected at 14 days, resulting in a cumulative incidence estimation of 0 (95% CI 0 to 943) per 100 000 inhabitants. In the control group, two cases with RT-PCR test were identified, resulting in a cumulative incidence of 102.30 (12.4 to 369) per 100 000 inhabitants. Conclusions Nightlife attendance under controlled conditions and with a requirement for a negative Ag-RDT was not associated with increased transmissibility of SARS-CoV-2 in a pandemic context of low infection rates. In such circumstances, secure opening of the nightlife sector was possible, under reduced capacity and controlled access by Ag-RDT, and environments where compliance with sanitary measures are maintainable.

Contact tracing

Pandemic

10.1136/bmjopen-2021-058595

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Citations (2)

Enfermedad renal crónica en individuos hipertensos ≥60 años atendidos en Atención Primaria

Nefrología (2017)

Betlem Salvador-González Jordi Mestre-Ferrer Maria Soler-Vila Luisa Pascual-Benito Eva Alonso-Bes

La hipertensión arterial (HTA) es la segunda causa de insuficiencia renal. En hipertensos con enfermedad renal crónica (ERC) el control de la presión arterial (PA) es la intervención más importante para minimizar la progresión. Para el diagnóstico de ERC se recomienda la determinación estandarizada de creatinina y filtrado glomerular estimado (FGe) según CKD-EPI. Describir la prevalencia y los factores asociados a la disminución moderada del FGe (según CKD-EPI) y el control de PA en individuos con HTA. Estudio descriptivo transversal en individuos ≥60 años incluidos en la base de datos SIDIAP plus con HTA y registro de creatinina sérica estandarizada y PA en últimos 2 años. Criterios de exclusión: FGe < 30, diálisis o trasplante renal, enfermedad cardiovascular previa, atención domiciliaria. Variable principal: FGe según CKD-EPI. Covariables: datos demográficos, exploración, factores de riesgo cardiovascular, diagnósticos de insuficiencia cardiaca y fibrilación auricular y fármacos (antihipertensivos con acción sobre función renal, antiagregantes, hipolipidemiantes). Criterio de control de la PA: ≤130/80 mmHg en individuos con albuminuria, ≤140/90 en el resto. Prevalencia FGe < 60: 18,8%. Factores asociados: edad, sexo, insuficiencia cardiaca, cociente albúmina/creatinina, fibrilación auricular, hábito tabáquico, dislipidemia, diabetes y obesidad. Control de la PA: 66,14 y 63,24% en FGe ≥ 60 y FGe < 60 respectivamente (p < 0,05). La exposición a fármacos fue superior en FGe < 60. Uno de cada 5 hipertensos sin enfermedad cardiovascular ≥60 años en atención primaria presentó disminución moderada del FGe. Además de la edad y el sexo, la albuminuria y la insuficiencia cardiaca fueron los principales factores asociados. A pesar de la mayor exposición a fármacos, el control de la PA fue inferior en ERC. Hypertension (HT) is the second leading cause of kidney failure. In hypertensive patients with chronic kidney disease (CKD), blood pressure (BP) control is the most important intervention to minimise progression. For CKD diagnosis, standardised creatinine and estimated glomerular filtration rate (eGFR) testing by CKD-EPI is recommended. To describe the prevalence and factors associated with a moderate decrease in eGFR (by CKD-EPI) and BP control in subjects with HT. Cross-sectional descriptive study in subjects ≥ 60 years included in the SIDIAP plus database with hypertension and standardised serum creatinine and BP tests in the last 2 years. Exclusion criteria: eGFR < 30, dialysis or kidney transplantation, prior cardiovascular disease, home care. Primary endpoint: eGFR by CKD-EPI formula. Covariates: demographic data, examination, cardiovascular risk factors, heart failure and auricular fibrillation diagnosis, and drugs (antihypertensive agents acting on renal function, antiplatelet and lipid lowering agents). BP control criteria: ≤130/80 mmHg in individuals with albuminuria, ≤140/90 in all other subjects. Prevalence of eGFR <60 = 18.8%. Associated factors: age, gender, heart failure, albumin/creatinine ratio, auricular fibrillation, smoking, dyslipidaemia, diabetes and obesity. BP control: 66.14 and 63.24% in eGFR ≥ 60 and eGFR <60, respectively (P<.05). Exposure to drugs was higher in eGFR < 60. One in 5 hypertensive patients without cardiovascular disease ≥60 years in primary care presented with a moderate decrease in eGFR. In addition to age and sex, albuminuria and heart failure were the main associated factors. Despite the increased exposure to drugs, BP control was lower in CKD.

Albuminuria

10.1016/j.nefro.2017.02.008

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Starting point for improving the approach to vertigo in primary care

British Journal of General Practice (2023)

Eva Peguero-Rodríguez Jenniffer Perez-Patiño Josep Lluís Ballve Ivan Villar Yolanda Rando

Background Benign paroxysmal positional vertigo (BPPV) is a prevalent and disabling pathology. Its diagnosis and treatment according to clinical practice guidelines is carried out through canalicular repositioning maneuvers, but these maneuvers are not performed routinely in primary care consultations. Aim To analyse the baseline data from the VERTAP randomised community trial that evaluates whether a blended course is effective in improving the adherence of primary care physicians to clinical practice guidelines. Method Baseline data 2021. Scope: 20 primary healthcare centers with an assigned population of 514157. Outcome variables: sex, age, diagnoses related to vertigo/dizziness, anti-vertigo medications prescribed, number of referrals to the otolaryngologist and neurologist, complementary examinations, and sick leave. Results Vertigo/dizziness-related diagnoses totaled 21 359 cases, with a prevalence of 4.15%. Women made up 51.49% of cases. Median age was 52.00 (41.00, 65.00) years. Non-specific diagnoses totaled 18 617 (87.16%), including dizziness ( n = 13 846, 64.83%), unspecified vestibular function disorder ( n = 962, 4.50%), aural vertigo ( n = 7, 0.03%), and other ( n = 3802, 17.80%). Specific diagnoses totalled 2742 (12.84%), including BPPV ( n = 1665, 7.80%), vestibular neuritis ( n = 24, 0.11%), Menière’s disease ( n = 992, 4.64%), and central vertigo ( n = 61, 0.29%). Anti-vertigo drugs prescribed included betahistine ( n = 13 338, 62.45%), sulpiride ( n = 3379, 15.82%), and dimenhydrinate ( n = 20, 0.093%). Complementary examinations included computed tomography ( n = 5704, 26.70%) and magnetic resonance ( n = 604, 2.83%). One temporary disability for work ( n = 1468, 6.87%); ≥2 temporary disability for work ( n = 275, 1.29%). Conclusion The majority of diagnostic records related to vertigo/dizziness were non-specific (9 out of 10). The number of prescriptions for betahistine, and referrals, mainly to an otolaryngologist, are considerable and an avoidable expense. Better knowledge about vertigo/dizziness in care could improve the diagnostic and therapeutic accuracy of this pathology as well as the social and health costs it produces.

Betahistine

10.3399/bjgp23x734205

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Violencia de género durante la gestación: asociación con la interrupción voluntaria del embarazo y complicaciones de salud neonatales

Matronas profesión/Matronas profesión (2021)

Ma Analía Gómez Fernández Montserrat Payà Sánchez Oriol Cunillera Pilar Cabrera García Carmina Vidal Ventura

Objetivo: Evaluar si la exposicion a la violencia de genero durante la gestacion se relaciona con la interrupcion voluntaria del embarazo y las complicaciones de salud neonatales que conlleven el ingreso en una Unidad de Cuidados Neonatales. Metodologia: Estudio observacional, descriptivo y prospectivo, llevado a cabo en los dos centros de Atencion a la Salud Sexual y Reproductiva de L’Hospitalet de Llobregat (Barcelona). Cumplimentaron el cuestionario validado de deteccion de violencia de genero Index of Spouse Abuse las mujeres gestantes asistidas por matronas de los centros participantes. Conjuntamente, se recogieron variables sociodemograficas y obstetricas. Se realizo un analisis descriptivo, bivariante y multivariante de los datos. Resultados: Se obtuvo una muestra de 120 mujeres que solicitaron una interrupcion voluntaria del embarazo y 381 que continuaron con la gestacion. La prevalencia de violencia de genero en el ultimo ano fue significativamente mayor (p <0,001) entre las mujeres gestantes que decidieron interrumpir el embarazo (25%) que entre las que decidieron continuar con el mismo (8,92%). La exposicion a la violencia de genero se asocia, despues de ajustar otros factores explicativos, con un mayor riesgo de solicitar una interrupcion voluntaria del embarazo (odds ratio [OR]= 4,06; intervalo de confianza [IC] del 95%: 2,23-7,48; p <0,001), y con un mayor riesgo de complicaciones neonatales (OR= 2,68; IC del 95%: 1,02-6,48). Conclusiones: La exposicion a la violencia de genero durante la gestacion se relaciona con la interrupcion voluntaria del embarazo y los ingresos del recien nacido por complicaciones de salud. Por ello, es necesario preguntar sobre violencia de genero durante la asistencia sanitaria, tanto a las mujeres que continuan con el embarazo como a las que deciden interrumpirlo.

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Carga clínica de los nuevos casos detectados de enfermedad renal crónica en atención primaria por comorbilidades DM2 y/o IC en Cataluña. Estudio REDIC

Oriol Cunillera José G. Romano Sílvia Cobo Alexandra Solé Angel Trueba

10.48158/semg24-584

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