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Concepción Carratalá-Munuera,1 Ernesto Cortés-Castell,2 Emilio Márquez-Contreras,3 José Maria Castellano,4,5 María Perez-Paramo,6 Adriana López-Pineda,1 Vicente F Gil-Guillen1 1Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain; 2Department of Pharmacology, Pediatrics, and Organic Chemistry, Miguel Hernandez University, San Juan de Alicante, Spain; 3Primary Health Center of Molino de la Vega, Huelva, Spain; 4Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; 5Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario Monteprincipe, Grupo HM Hospitales, Madrid, Spain; 6Medical Department, Pfizer GEP SLU, Madrid, SpainCorrespondence: Adriana López-Pineda, Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, San Juan de Alicante, 03550, Spain, Tel +1 34 965919309, Email adriannalp@hotmail.comPurpose: To identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician’s opinion of primary care and hospital settings.Methods: An observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement.Results: A total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas.Conclusion: A consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians’ opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease.Keywords: treatment adherence and compliance, chronic disease, general practitioners, family practice, hospital medicine, consensus

Abstract Background Family function may have an influence on the mental health deterioration of the caregivers of dependent family members and it could have a varying importance on the care of dependents. Little attention has been paid to the preparation of minor stroke survivors for the recovery trajectory or the spouse for the caregiving role. Therefore, this study protocol intends to analyze the influence of family function on the protection of patients with stroke sequels needing physiotherapy in the family environment. Methods/Design This is an analytical observational design, prospective cohort study and using a qualitative methodology by means of data collected in the “interviews of life”. The study will be carried out by the Rehabilitation Service at Hospital of Elda in the Valencia Community. All patients that have been diagnosed with stroke and need physiotherapy treatment, having a dependency grade assigned and consent to participate in the study, will undergo a monitoring of one year in order to assess the predictive factors depending on the dependence of the people affected. Discussion Our research aims to analyze the perception of caregivers, their difficulties to work, and the influence of family function. Moreover, it aims to register the perception of the patients with stroke sequel over the care received and whether they feel protected in their family environment.

Objectives: This study aimed to evaluate gender-based disparities in preventable adverse events due to low-value practices (LVPs) in primary care. Methods: A retrospective cohort study in Alicante, Spain. Results: A total of 1,516 patient records were examined, finding that older individuals and women experienced more LVP-related events. Female patients faced a higher volume of such events than males with the same health issue. Interaction analysis revealed patients treated by male physicians had more severe events, while those attended by females experienced milder ones. Adverse events were more frequent in LVPs associated with gender-based reasons. Conclusion: These results highlight the need for tailored healthcare professional awareness programs on overuse's impact on safety. Addressing outcome differences between male and female patients should inform awareness campaigns., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Mira, Carratala-Munuera, Vicente, Astier-Peña, García-Torres, Soriano, Sánchez-García, Chilet-Rosell, Gil-Guillén, López-Pineda and Pérez-Jover.)

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., (© 2024. The Author(s).)

Introduction and Objectives: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension., Methods: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed., Results: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction., Conclusions: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: Substantial evidence shows that diagnostic inertia leads to failure to achieve screening and diagnosis objectives for arterial hypertension (AHT). In addition, different studies suggest that the results may differ between men and women. This study aimed to evaluate the differences in diagnostic inertia in women and men attending public primary care centers, to identify potential gender biases in the clinical management of AHT., Study Design/materials and Methods: Cross-sectional descriptive and analytical estimates were obtained nested on an epidemiological ambispective cohort study of patients aged ≥30 years who attended public primary care centers in a Spanish region in the period 2008-2012, belonging to the ESCARVAL-RISK cohort. We applied a consistent operational definition of diagnostic inertia to a registry- reflected population group of 44,221 patients with diagnosed hypertension or meeting the criteria for diagnosis (51.2% women), with a mean age of 63.4 years (62.4 years in men and 64.4 years in women)., Results: Of the total population, 95.5% had a diagnosis of hypertension registered in their electronic health record. Another 1,968 patients met the inclusion criteria for diagnostic inertia of hypertension, representing 4.5% of the total population (5% of men and 3.9% of women). The factors significantly associated with inertia were younger age, normal body mass index, elevated total cholesterol, coexistence of diabetes and dyslipidemia, and treatment with oral antidiabetic drugs. Lower inertia was associated with age over 50 years, higher body mass index, normal total cholesterol, no diabetes or dyslipidemia, and treatment with lipid-lowering, antiplatelet, and anticoagulant drugs. The only gender difference in the association of factors with diagnostic inertia was found in waist circumference., Conclusion: In the ESCARVAL-RISK study population presenting registered AHT or meeting the functional diagnostic criteria for AHT, diagnostic inertia appears to be greater in men than in women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pallares-Carratala, Carratala-Munuera, Lopez-Pineda, Quesada, Gil-Guillen, Orozco-Beltran, Alfonso-Sanchez, Navarro-Perez and Martin-Moreno.)

There is no evidence for the superiority of conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) using donor oocytes. This retrospective descriptive study aimed to compare the outcomes of conventional IVF ( n  = 506) and ICSI ( n  = 613) with donor oocytes in ( n  = 968) normozoospermic patients. Although the fertilization rate was statistically higher in the ICSI group ( p  < 0.001), conventional IVF provided better results than ICSI with respect to embryo quality (number of grade A embryos, p  < 0.001). In addition, we observed more blastocysts in the conventional IVF group ( p  < 0.001) and more good quality embryos were obtained for cryopreservation compared to ICSI ( p  < 0.001). Regarding clinical results, there were no statistical significant differences in the positive pregnancy test, clinical pregnancy and clinical miscarriage rates between IVF and ICSI. However, the implantation rate was statistically higher when IVF was performed (50.4% vs. 43.0%, p  = 0.031, OR (95% CI): 1.185 (1.050-2.530)). In conclusion, with the use of normozoospermic samples in our oocyte donation programme, IVF offers more embryo efficiency and increased implantation rates than ICSI.

Background: To identify the strengths and weaknesses in a given research area, it is necessary to analyze the published literature. International studies on podiatry research productivity are scarce. This study aimed to analyze scientific productivity in the area of podiatric medicine from 1965 to 2017., Methods: This was a retrospective, observational, bibliometric study. The MEDLINE database was used to identify research published between 1965 and 2017. Literature searches were performed in 2010 and 2017 through RefWorks, and research production per year, author, document type, country, institution, journal, and language were calculated. Podiatry's contribution to global scientific production was measured by calculating the ratio of podiatry publications to total production, and Price's law was applied to analyze the temporal evolution. Author productivity index, coauthorship, geographic distribution, and the distribution by institution type and journal (Bradford's law) were analyzed., Results: The MEDLINE search yielded 1,256 publications, representing 4.75 articles per 100,000 publications in global scientific research. The growth rate followed Price's law after linear adjustment. The 2,229 identified authors presented a transience index of 85.73%; 0.38% were highly productive authors. The coauthorship index increased from 1.40 in 1965 to 5.80 in 2017. The most common document type was the journal article, whereas 2.1% were clinical trials. Only one document reported a controlled clinical trial. The United States led scientific production, with 77.15% of the documents; 60.5% of the publications were concentrated in four journals., Conclusions: Podiatry is still an emerging research field, and literature is concentrated in a small number of journals, categorized into different subjects.

Background: The main barrier for an appropriate primary management of the reproductive health was lack of knowledge about the risk factors and prevention measures for infertility and the main recommendations was to involve primary care physicians in reproductive health., Aims: To reach a consensus around barriers and enablers for appropriate primary management of the reproductive health., Methods: An observational study was performed using the modified Delphi technique, from October 2017 to April 2018 in private and public assisted reproduction clinics in Spain. A questionnaire consisted of 58 items, divided into four blocks to explore consensus among a group of experts by synthesizing opinions., Results: In the first Delphi round, the response rate was 50% and panelists reached a 72.4% of consensus. In second round, the response rate was 55% and panelists reached a 25% of consensus. To minimize limitations related to the use of a structured questionnaire, a space for free text responses was provided. The following items yielded unanimous agreement: "It is necessary to promote reproductive planning-not just contraception-from secondary school," "The media should not trivialize pregnancies in women aged over 50," "Postponing family formation is the main cause of the increase in assisted reproduction treatments in Spain," and "Postponing motherhood implies an inherently decreased probability of having children.", Conclusions: These recommendations could set the basis for a public health action plan for primary management of reproductive health. The findings may be applicable to any country whose health services system provides primary healthcare.

This study aimed to assess atrial fibrillation (AF) incidence and predictive factors in hypertensive patients and to formulate an AF risk assessment score that can be used to identify the patients most likely to develop AF. This was a cohort study of patients recruited in primary healthcare centers. Patients aged 40 years or older with hypertension, free of AF and with no previous cardiovascular events were included. Patients attended annual visits according to clinical practice until the end of study or onset of AF. The association between AF incidence and explanatory variables (age, sex, body mass index, medical history and other) was analyzed. Finally, 12,206 patients were included (52.6% men, and mean age was 64.9 years); the mean follow-up was 36.7 months, and 394 (3.2%) patients were diagnosed with AF. The incidence of AF was 10.5/1000 person-years. Age (hazard ratio [HR] 1.06 per year; 95% confidence interval [CI] 1.05-1.08), male sex (HR 1.88; 95% CI 1.53-2.31), obesity (HR 2.57; 95% CI 1.70-3.90), and heart failure (HR 2.44; 95% CI 1.45-4.11) were independent predictors (p < 0.001). We propose a risk score based on significant predictors, which enables the identification of people with hypertension who are at the greatest risk of AF.

Background: Hallux valgus (HV) is widely treated by Chevron osteotomy (CO); however, a modified CO may improve patient outcomes and recovery., Methods: A prospective study was designed to analyze plantar pressure measurements and clinical and radiographic outcomes of a modified CO for HV. Recruitment was between February 2016 and February 2017., Inclusion Criteria: diagnosis of moderate HV; an indication for surgical correction due to discomfort, pain or difficulty with shoe wear; and age over 18 years. Clinical and radiographic outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) guidelines and a visual analog scale (VAS)., Results: Forty-four patients met inclusion criteria. After surgery, the highest percentage in mean pressure was in the first and fifth metatarsal heads. At 12 months' follow-up, the AOFAS score improved, but differences in VAS scale were only significant at baseline., Conclusions: Modified CO is a good option for people with HV, improving foot activity compared to preoperative levels while limiting the time needed for recovery., (Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate if the vaginal microbiome influences the IVF outcome., Methods: Thirty-one patients undergoing assisted reproductive treatment (ART) with own or donated gametes and with cryotransfer of a single euploid blastocyst were recruited for this cohort study. Two vaginal samples were taken during the embryo transfer procedure, just before transferring the embryo. The V3 V4 region of 16S rRNA was used to analyze the vaginal microbiome, and the bioinformatic analysis was performed using QIIME2, Bioconductor Phyloseq, and MicrobiomeAnalyst packages. Alpha diversity was compared between groups according to the result of the pregnancy test., Results: Fourteen (45.2%) patients did not and seventeen (54.8 %) did achieve pregnancy under ART. A greater index of alpha diversity was found in patients who did not achieve pregnancy comparing to those who did, although this difference was not significant (p = 0.088). In the analysis of beta diversity, no statistically significant differences were observed between groups established as per the pregnancy status. Samples from women who achieved pregnancy showed a greater presence of Lactobacillus spp. The cluster analysis identified two main clusters: the first encompassed the genera Lactobacillus, Gardnerella, Clostridium, Staphylococcus, and Dialister, and the second included all other genera. Women who achieved pregnancy were mainly detected microorganisms from the first cluster., Conclusions: The vaginal microbiome can influence the results of ART. The profiles dominated by Lactobacillus were associated with the achievement of pregnancy, and there was a relationship between the stability of the vaginal microbiome and the achievement of pregnancy.

This study aimed to assess the cost-effectiveness of the "Fédération Internationale de Football Association (FIFA) 11" injury prevention programme for ankle and hamstring injuries. This retrospective cohort study included eighty-four male amateur football players aged 18-40 years. The exposed group performed the FIFA 11 protocol twice a week throughout the 2010-2011 and 2011-2012 seasons; the unexposed group performed the usual training during the 2008-2009 and 2009-2010 seasons. Lateral ankle ligament and hamstring injuries were recorded over the whole study period. We compared the mean costs associated with lateral ankle ligament and hamstring injuries in the two groups. The mean cost per player and lateral ankle injury was EUR 928 in the unexposed group versus EUR 647 in the exposed group ( p  = 0.19). The mean cost of hamstring injury per player was EUR 1271 in the unexposed group versus EUR 742 in the exposed group ( p  = 0.028). The mean total cost per player was EUR 2199 in the unexposed group versus EUR 1273 in the exposed group ( p  = 0.008). We concluded that the use of the FIFA 11 injury prevention programme reduced both the direct and indirect costs associated with lateral ankle ligament and hamstring injuries.

Background: Randomised clinical trials are considered to be the most reliable study design for assessing the efficacy and safety of health interventions., Aims: To analyse worldwide obstetrics research carried out through randomised clinical trials, from 2002 to 2013., Methods: A bibliometric analysis was performed. Publications on obstetrics that were published journals indexed in the MEDLINE database from 2002 to 2013 were analysed. The major medical subject headings used in the search were obstetrics, pregnancy complications and obstetrics surgical procedures. The main study outcome was index of research productivity., Results: Our study search strategy yielded a total of 142,659 articles and 9967 clinical trials. The growth rate of scientific production in obstetrics during this period was 55.43% (n = 5094). The growth rate of production of randomised clinical trials in this specialty, meanwhile, was 97.84% (n = 544). Most of the identified authors (n = 22,622, 71.21%) published only one paper during the study period. Patterns of co-authorship among the 20 most productive authors were identified. After applying Bradford's law, six journals in the nucleus (the most prolific journals) were found. Of all the clinical trials in obstetrics published between 2002 and 2013, 10.3% were published in journals belonging to categories other than Obstetrics and Gynecology. The most common research topic in 2002 and 2013 was the use of analgesia and anesthesia in obstetrics., Conclusions: Total scientific production rate in obstetrics increased from 2002 to 2013, especially randomised clinical trials. However, randomised clinical trials continue to represent a small proportion of total production.

Aim: To assess the association between periodontitis and preterm birth in women of childbearing age., Materials and Methods: This review included analytical case-control studies and prospective cohort studies evaluating the association between maternal periodontitis and preterm birth. Of the 3104 screened articles, 31 met the inclusion criteria for the review, and 20 met the quality criteria. The selected studies included a total of 10 215 women., Results: Twenty articles contributed to the meta-analysis; 16 used a case-control design, and 4 were prospective cohort studies. The study heterogeneity was low (Q = 24.2464; P = 0.1869; I 2  = 21.63%). A positive association between maternal periodontitis and preterm birth was found in 60% of the studies. Under the random-effects model, meta-analysis gave an odds ratio (OR) of 2.01 (95% CI 1.71, 2.36), representing a significant positive association between the explanatory and outcome variables., Conclusion: Pregnant mothers with periodontitis double the risk of preterm birth. There is a lack of international consensus for diagnosing maternal periodontitis., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Echocardiography is currently the main diagnostic technique in pediatric cardiology, but sometimes it is difficult to use in very young children, as a complete and accurate study depends on the patient's and family's cooperation. Children's behavior is one of the main problems for this procedure, and interventions like sedative medication have been used to facilitate its performance. The aim of this study was to analyze the effects of TV entertainment in infants and preschool children during echocardiography. We designed an experimental study in children with a heart murmur. An examination room was prepared with a TV on the ceiling, giving the children an unobstructed view during the echocardiography procedure. Fifty-eight patients were randomized into two groups: TV intervention vs. usual care (consisting of other distraction measures). The primary outcome was echocardiography time, but we also assessed blood pressure, quality of technique, child behavior, and parents' stress level. The TV group showed a statistically significant reduction in duration of the echocardiography and systolic and diastolic blood pressure, as well as better quality of technique and child behavior. Consequently, we recommend the use of a TV as a simple and useful distraction method for improving echocardiography in young children.