OBJECTIVES: To evaluate whether between hypertension and type 2 diabetes (T2D)-established drivers of chronic kidney disease (CKD) progression-one might be more strongly associated with CKD progression than the other. DESIGN: Cohort study using a primary care database (electronic health records). SETTING: Primary care in Catalonia, Spain. PARTICIPANTS: 438 273 patients with CKD identified from the Information System for Research in Primary Care database in Catalonia (2007-2017) and stratified into four mutually exclusive groups based on the presence/absence of hypertension and/or T2D. Distribution of the CKD study cohort was as follows: CKD with hypertension (51.1%), CKD with T2D (3.9%), CKD with hypertension and T2D (32.8%), CKD without hypertension and T2D (12.2%). PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were followed up to identify the occurrence of severe kidney impairment (SKI) and kidney failure (kidney replacement therapy/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m(2)). Subdistributional hazard ratios (sHRs) were estimated using Cox regression adjusted for confounders. RESULTS: Compared with the CKD without hypertension and T2D group, adjusted sHRs (95% CIs) for SKI/kidney failure were 1.77 (1.65 to 1.89) for CKD with hypertension and T2D, 1.50 (1.41 to 1.59) for CKD with hypertension and 1.21 (1.09 to 1.34) for CKD with T2D, and for kidney failure were 1.24 (1.10 to 1.39) for CKD with hypertension, 0.74 (0.61 to 0.90) for CKD with T2D and 1.09 (0.96 to 1.24) for CKD with hypertension and T2D. The strongest risk factors for CKD progression were low eGFR and albuminuria, even at mild-moderate levels. CONCLUSIONS: Hypertension could be associated with an equal/greater risk of CKD progression as T2D. Efforts to slow CKD progression should target both patients with hypertension and T2D, focusing on the identification, close monitoring and effective management of albuminuria and reduced eGFR.

Routinely obtaining a sexual history is a necessary first step to identify which patients have specific sexual behaviours that may put them at risk and use appropriate protective measures, especially in vulnerable populations. However, late diagnosis of HIV infection remains very high. Combination prevention strategies based on condom promotion, harm reduction programs for people who inject drugs plus PrEP and HIV PEP are the best options to prevent new infections. Screening for STIs (including hepatotropic viruses) and early diagnosis and treatment are essential for the person since it improves the prognosis and complications and also for the community because it breaks the chain of transmission. People living with HIV who have an undetectable viral load do not transmit the virus sexually (undetectable=untransmittable). (c) 2024 The Authors. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction We aim to explore the association between NSAIDs consumption, Symptomatic Slow Action Drugs for Osteoarthritis (SYSADOA), analgesics, and antiplatelet drugs, and decline in renal function by estimated Glomerular Filtration Rate (eGFR). Methods We performed a case-control study using the SIDIAP database in Catalonia. We considered defined cases, patients with an eGFR value <= 45 ml/min/1.73 m2 in the period 2010-2015 with a previous eGFR value >= 60, and no eGFR >= 60 after this period. Controls had an eGFR >= 60 with no previous eGFR < 60. Five controls were selected for each case, matched by sex, age, index date, Diabetes Mellitus and Hypertension. We estimated Odds Ratios (OR, 95% Confidence Intervals) of decline in renal function for drugs group adjusting with logistic regression models, by consumption measured in DDD. There were n = 18,905 cases and n = 94,456 controls. The mean age was 77 years, 59% were women. The multivariate adjusted model showed a low risk for eGFR decline for NSAIDs (0.92;0.88-0.97), SYSADOA (0.87;0.83-0.91) and acetaminophen (0.84;0.79-0.89), and an high risk for metamizole (1.07;1.03-1.12), and antiplatelet drugs (1.07;1.03-1.11). The low risk in NSAIDs was limited to propionic acid derivatives (0.92;0.88-0.96), whereas an high risk was observed for high doses in both acetic acid derivatives (1.09;1.03-1.15) and Coxibs (1.19;1.08-1.30). Medium and high use of major opioids shows a high risk (1.15;1.03-1.29). Triflusal showed high risk at medium (1.23;1.02-1.48) and high use (1.68;1.40-2.01). Conclusion We observed a decline in renal function associated with metamizole and antiplatelet agent, especially triflusal, and with high use of acetic acid derivates, Coxibs, and major opioids. Further studies are necessary to confirm these results.

Background: The effectiveness of statin treatment to reduce coronary events and mortality has been hardly examined considering goals of LDL-C. We aimed to analyse such association in secondary cardiovascular prevention. Methods: Retrospective cohort analysis of electronic health records from the SIDIAP database, Catalonia-Spain. Recruitment period was from 2006 to 2017 and study period finished at the end of 2018. We included 54,175 people aged >= 35 years in cardiovascular secondary prevention starting statin treatment. We analysed the association of achieved LDL-C goals after statin initiation with coronary heart disease and all-cause mortality. Results: Mean age was 69 years and 20,146 (37.2%) were women. Coronary heart disease occurred in 5687 (10.5%) participants, and 10,676 (19.7%) persons passed away. Median follow-up lasted 5.7 years (interquartile range, 3.4-8.1). The coronary heart disease HRs (95% CI) for the LDL-C goals of 70-100, <70-55 and <55 mg/dL were .86 (.81-.92), .83 (.76-.9) and .8 (.72-.88), respectively. They were .89 (.83-.96) in the group with 30%-40% reduction and .86 (.8-.93) in the groups with 40%-50% and >= 50% reduction. We observed no association with mortality. We observed no relevant differences by sex or age. Conclusions: This population-level retrospective analysis of real-world data observed that treatment with statins is effective to achieve certain LDL-C goals and CHD reduction. The lack of significant difference between LDL-C goals needs confirmation in additional studies with real-world data. The LDL-C target should consider the magnitude of the decrease in coronary events.

In this paper we approach three clinical syndromes with different microbial agents that cause sexually transmitted diseases (STD) with a common condition: the symptomatology is in the genital area. Some of these microbial agents are transmitted strictly sexually, but not all. In this section we will discuss about vulvovaginitis, genital ulcers and human papilloma virus, three syndromes which have increased their incidence in recent years and primary care must know its management: diagnosis, correct treatment, controls, and study of sexual contacts. The optimal approach is as important as knowing how to recommend prevention of STD, contact study and screening for other infections that can be present at the same time although asymptomatically.(c) 2023 Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

ObjectiveThis study aimed to monitoring the prevalence of previously identified thyroid disorders and hypothyroidism monitoring before pregnancy.Material and methodsA 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.ResultsThe 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.ConclusionA 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.

Background: Studies focus on the incidence and risk factors (RFs) associated with reaching the final stage of chronic kidney disease (CKD-G5) and receiving kidney replacement therapy (KRT). Analysis of those related to reaching CKD-G5 while receiving conservative kidney management (CKM) has been neglected. Methods: Retrospective cohort study analysing electronic health records of individuals aged & GE; 50 with eGFR < 60 mL/min/m(2). Cumulative incidence rates of CKD-G5, with and without KRT, were calculated. Multinomial regression models determined odds ratios (ORs) for CKD-G5 progression with KRT, CKM, or death. Results: Among 332,164 patients, the cumulative incidence of CKD-G5 was 2.79 cases per 100 person-years. The rates were 1.92 for CKD-G5 with KRT and 0.87 for CKD-G5 with CKM. Low eGFR and albuminuria were the primary RFs. Male gender and uncontrolled blood pressure had a greater impact on KRT (OR = 2.63 CI, 1.63) than on CKD-G5 with CKM (OR = 1.45 CI, 1.31). Increasing age and rurality reduced the probability of KRT but increased the probability of CKD-G5 with CKM. Higher incomes decreased the likelihood of developing CKD-G5 with and without KRT (OR = 0.49 CI). Conclusion: One-third of CKD-G5 cases receive CKM. Those are typically older, female, rural residents with lower incomes and with lesser proteinuria or cardiovascular RF. The likelihood of receiving KRT is influenced by location and socioeconomic disparities.

IntroductionCigarette smoking is a significant public health problem, and it is essential to work actively with young people to limit the incorporation of this addiction. This study aimed to identify characteristics associated with tobacco use in adolescents in a real setting. MethodsEpidemiologic, cross-sectional study including secondary school students aged 12-17 years in the 1st, 2nd, and 3rd grades of “Joan Fuster High School” in the city of Sueca, Valencia (Spain). An anonymous, self-administered questionnaire was used to collect data on demographics, cigarette smoking history, alcohol consumption, nicotine dependence, and exposure to parental cigarette smoking. ResultsThe final sample of individuals surveyed included 306 students (50.6% females) with a median age of 13 years. The prevalence of cigarette smoking was 11.8% (13.5% in females and 9.9% in males). The mean age of cigarette smoking onset was 12.7 +/- 1.6 years. Ninety-three students (30.4%) were repeaters, and 114 (37.3%) reported alcohol consumption. Significant factors associated with tobacco use were being a repeater (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.75-10.55, p = 0.002), alcohol consumption (OR 4.06, 95% CI 1.75-10.15, p = 0.002) and parental cigarette smoking (OR 3.76, 95% CI 1.52-10.74, p = 0.007). DiscussionAn operational profile of features associated with tobacco consumption was identified in the presence of parental cigarette smoking, alcohol consumption, and poor academic performance. Consideration of these factors could be useful in the operational design of cigarette smoking cessation interventions for young people in a context where there is a great need for better prevention and control of cigarette smoking.

Introduction: Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life.Methods: Cluster clinical trial with data collection through an ad hoc self-administered, semi -structured questionnaire. The target population encompassed the students aged 4–6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari (R) methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post-intervention by means of the ques-tionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups.Results: A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3-12 months compared to baseline was significantly better (P <.001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the "mouth -nose-eyes " mnemonic.Conclusions: The RCParvulari (R) methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education.