Introduction: High levels of serum urate has been associated to a neuroprotective effect in Parkinson’s disease (PD) as an antioxidant agent. However, the relation between gout and PD remains contradictory.Objective: To study if the neuroprotective effect of serum urate is maintained in patients with gout in a large urban Mediterranean population.Methods: Primary care based matched case-control study, carried out using an electronic health record database from the public primary care health system of Barcelona. The database contains anonymous data from 1,520,934 patients. All patients, over 40 years old, with a new diagnostic record of PD, or a new prescription of dopaminergic drugs were included (incident cases). We randomly selected four controls for each case, matched by gender and age, with the frequency matching approach. Retrospective data of PD risk factors were also collected for each individual. A multivariate logistic regression model was used to evaluate the association of gout and PD, adjusted by the presence of other risk factors.Results: A new PD diagnosis was found in 17,629 individuals (incident diagnosis rate of 2.2 per 1000 individuals). Multivariate logistic regression model showed for gout: aOR = 0.83 (0.76-0.91). When stratified by age, aOR for those under 75 years was 0.99 (0.85-1.16) and 75 or over OR = 0.77 (0.70-0.86). Dyslipidemia, hypertension and diabetes mellitus were associated with an increased risk of PD. Tobacco consumption was protective. Conclusion: Our study, the first one made in a Mediterranean population, shows a PD protective effect of gout in both men and women over 75 years old.(c) 2022 Socie acute accent te acute accent franc , aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

This study aims to evaluate the effect of regularly reporting spirometry results during smoking cessation counseling from a primary care physician on the quit rate in adult smokers. Methods: A randomized, two-arm intervention study was conducted at six primary care centers. A total of 350 smokers, >= 18 years of age, who consulted their primary care physician, participated in the study. At the selection visit, smokers who gave their consent to participate underwent spirometry. Subsequently, an appointment (visit 0) was scheduled to complete a nicotine dependence test, a smoking cessation motivation questionnaire, and a sociodemographic questionnaire. Participants were also offered brief, structured advice on how to quit smoking, as well as detailed information on spirometry results. Patients were then randomized and scheduled for follow-up visits at 3, 6, 12, and 24 months. Both arms received brief, structured advice and detailed information on spirometry results at visit 0. At consecutive follow-up visits, the control group only received brief, structured smoking cessation advice, while the intervention group also received information on initial spirometry results at visits 3 and 6, and a spirometry retest at visit 12. Exhaled carbon monoxide testing was used to check smoking cessation. Results: The study included 350 smokers; 179 were assigned to the control group and 171 to the intervention group. Smoking cessation at one year was 24.0% in the intervention group compared to 16.2% in the control group. At two years, it was 25.2% in the intervention group and 18.4% in the control group. Overall, the adjusted odds of quitting smoking in the intervention group were 42% higher than in the control group (p = 0.018). Conclusions: Regular and detailed feedback of spirometry results with smokers increases smoking cessation. Specifically, the likelihood of quitting smoking in the intervention group is 1.42 times higher than in the control group (p = 0.018).

There is evidence of an association between hypertension and retinal arteriolar narrowing. Manual measurement of retinal vessels comes with additional variability, which can be eliminated using automated software. This scoping review aims to summarize research on automated retinal vessel analysis systems. Searches were performed on Medline, Scopus, and Cochrane to find studies examining automated systems for the diagnosis of retinal vascular alterations caused by hypertension using the following keywords: diagnosis; diagnostic screening programs; image processing, computer-assisted; artificial intelligence; electronic data processing; hypertensive retinopathy; hypertension; retinal vessels; arteriovenous ratio and retinal image analysis. The searches generated 433 articles. Of these, 25 articles published from 2010 to 2022 were included in the review. The retinographies analyzed were extracted from international databases and real scenarios. Automated systems to detect alterations in the retinal vasculature are being introduced into clinical practice for diagnosis in ophthalmology and other medical specialties due to the association of such changes with various diseases. These systems make the classification of hypertensive retinopathy and cardiovascular risk more reliable. They also make it possible for diagnosis to be performed in primary care, thus optimizing ophthalmological visits.

BACKGROUND & AIMS: Fibrosis-4 (FIB-4) and the nonalcoholic fatty liver disease fibrosis score (NFS) are the 2 most popular noninvasive blood-based serum tests proposed for widespread fibrosis screening. We therefore aimed to describe the accuracy of FIB-4 and NFS to detect elevated liver stiffness as an indicator of hepatic fibrosis in low-prevalence populations.
METHODS: This study included a total of 5129 patients with concomitant measurement of FIB-4, NFS, and liver stiffness measurement (LSM) by Fibroscan (Echosens, France) from 5 independent population-based cohorts from Spain, Hong Kong, Denmark, England, and France; 3979 participants from the general population and 1150 from at-risk cohorts due to alcohol, diabetes, or obesity. We correlated LSM with FIB-4 and NFS, and calculated pre- and post-test predictive values of FIB-4 and NFS to detect elevated LSM at 8 kPa and 12 kPa cutoffs. The mean age was 53 +/- 12 years, the mean body mass index was 27 +/- 5 kg/m(2), and 2439 (57%) were women. One in 10 patients (552; 11%) had liver stiffness >= 8 kPa, but 239 of those (43%) had a normal FIB-4, and 171 (31%) had normal NFS. The proportion of false-negatives was higher in at-risk patients than the general population. FIB-4 was false-negative in 11% of diabetic subjects, compared with 2.5% false-negatives with NFS. Waist circumference outperformed FIB-4 and NFS for detecting LSM >= 8 kPa in the general population. Almost one-third (28%29%) of elevated FIB-4/NFS were false-positive in both the general population and at-risk cohorts.
CONCLUSIONS: FIB-4 and NFS are suboptimal for screening purposes due to a high risk of overdiagnosis and a non-negligible percentage of false-negatives, especially in patients with risk factors for chronic liver disease. Waist circumference emerged as a potential first step to identify patients at risk for liver fibrosis in the general population.

Background Primary health care (PHC) professionals may play a crucial role in improving early diagnosis of depressive disorders. However, only 50% of cases are detected in PHC. The most widely used screening instrument for major depression is the Patient Health Questionnaire (PHQ), including the two-, eight- and nine-item versions. Surprisingly, there is neither enough evidence about the validity of PHQ in PHC patients in Spain nor indications about how to interpret the total scores. This study aimed to gather validity evidence to support the use of the three PHQ versions to screen for major depression in PHC in Spain. Additionally, the present study provided information for helping professionals to choose the best PHQ version according to the context. Methods The sample was composed of 2579 participants from 22 Spanish PHC centers participating in the EIRA-3 study. The reliability and validity of the three PHQ versions for Spanish PHC patients were assessed based on responses to the questionnaire. Results The PHQ-8 and PHQ-9 showed high internal consistency. The results obtained confirm the theoretically expected relationship between PHQ results and anxiety, social support and health-related QoL. A single-factor solution was confirmed. Regarding to the level of agreement with the CIDI interview (used as the criterion), our results indicate that the PHQ has a good discrimination power. The optimal cut-off values were: > 2 for PHQ-2, > 7 for PHQ-8 and > 8 for PHQ-9. Conclusions PHQ is a good and valuable tool for detecting major depression in PHC patients in Spain.