BACKGROUND: Atopic dermatitis (AD) is one of the most prevalent skin diseases, but there are numerous knowledge gaps surrounding the impact this disease has on quality of life (QoL), mental health, and out-of-pocket expenses involved in the management of AD. The available scientific evidence on the multidimensional burden of AD is usually based on studies with measures reported by patients themselves.
METHODS: In this context, the MEASURE-AD trial was developed as a cross-sectional, multicenter, multinational trial using patient- and physician-reported measures to characterize the multidimensional burden of AD in adults with moderate-to-severe AD.
RESULTS: This paper presents the results of the Spanish cohort. We found that Spanish adults with moderate-to-severe AD and high EASI score (21.1-72) had a significantly increased disease burden, high severity of symptoms such as itch and sleep disturbances, impaired mental health and QoL, higher use of health care resources, and more out-of-pocket expenses than patients with low EASI scores (0-7 or 7.1-21).
CONCLUSIONS: This study provides information to better understand disease burden, and identify aspects to be improved in the management of AD.

To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series.
Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time.
Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series).
The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.
Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España.
Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente.
Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p 0,001; OR = 0,63; p 0,001, respectivamente).
En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE.

The COPD Assessment Test (CAT) measures quality of life in patients with chronic obstructive pulmonary disease (COPD) as well as disease impact on activities of daily living. The questionnaire consists of 8 items related to breathing (cough, phlegm, chest tightness, and breathlessness) and other symptoms (low energy level, sleep disturbances, limitations on daily activities, and confidence when leaving the home). We investigated the relative impact of respiratory versus nonrespiratory scoring on the total CAT score at different moments in the course of COPD exacerbations: baseline (24 hours before an exacerbation), during the exacerbation, 15 days later, and 2 months later. To assess the influence of the respiratory item score on decisions to hospitalize patients treated for exacerbated COPD in our hospital emergency department (ED).
Prospective cohort study. We recruited patients who came to our ED for symptoms consistent with exacerbated COPD. Sociodemographic and clinical data were recorded. Clinical information, including treatments pleustarted in the ED and CAT scores, were also recorded. The event was defined as highly symptomatic if the patient\'s score was 3 points or higher on at least 3 of the 4 respiratory items at baseline. The outcome measures for the first objective were the total CAT score and item scores at the 4 time points before (baseline), during (ED), and after the exacerbation. The outcome for the second objective was hospital admission.
A total of 587 patients were included. The mean (SD) total CAT score was 13.48 (7.29) at baseline, 24.86 (7.25) in the ED, 14.7 (7.47) at 15 days, and 13.45 (7.36) at 2 months. The respiratory item scores accounted for a mean 53.4% (20.76%) of the total score at baseline and 48.2% (11.47%) of the total score in the ED. Eighty-two patients (14.0%) were classified as being highly symptomatic. A total of 359 (61.2%) were admitted. Predictors of hospital admission were classification as highly symptomatic, odds ratio (OR, 3.045; 95% CI, 1.585-5.852, P .001), dyspnea at rest (OR, 2.906; 95% CI:1.943-4.346, P .001), and start of the following treatments in the ED: oxygen therapy (OR, 4.550; 95% CI, 3.056-6.773; P .0001), diuretic (OR, 1.754; 95% CI, 1.091-2.819; P = .02), and intravenous antibiotics (OR, 1.536; 95% CI, 1.034-2.281; P = .03). The model achieved an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.763-0.836).
Hospital admission from the ED is highly likely in patients with COPD exacerbation who have high baseline CAT scores, dyspnea at rest in the ED, and require oxygen therapy, diuretics, or intravenous antibiotics in the ED. The total CAT score and scores on respiratory items provide a tool for tailoring pharmacalogic and nonpharmacologic treaments and can facilitate follow-up evaluations.
El CAT (COPD Assessment Test) es un cuestionario de calidad de vida que mide el impacto que la enfermedad pulmonar obstructiva crónica (EPOC) está teniendo en el bienestar y vida diaria de los pacientes. Consta de 8 ítems divididos en 4 respiratorios y 4 no respiratorios. Conocer el impacto de las puntuaciones de los ítems respiratorios y no respiratorios en la puntuación CAT total, en diferentes momentos de la exacerbación de EPOC (24 horas antes de la exacerbación o basal, en la exacerbación, a los 15 días y a los 2 meses). Secundariamente, se valoró la influencia de los ítems respiratorios de la puntuación CAT total, en la decisión de ingreso de los pacientes atendidos por exacerbación de EPOC (EA-EPOC) en un servicio de urgencias hospitalario (SUH).
Estudio de cohortes prospectivo. Se reclutaron pacientes que acudían al SUH con síntomas compatibles con EA-EPOC. La variable “Paciente respiratorio altamente sintomático”(PRAS) se definió como el paciente que tiene 3 puntos o más en al menos 3 de los 4 ítems respiratorios del CAT basal. Las variables de resultado fueron para el primer objetivo: la puntuación CAT total y desglosada por ítems, en los 4 momentos estudiados. Para el segundo objetivo fue el ingreso hospitalario.
Se incluyeron 587 pacientes. La media de la puntuación CAT total basal fue 13,48 (7,29), en urgencias fue 24,86 (7,25), a los 15 días fue 14,7 (7,47) y a los 2 meses 13,45 fue (7,36). La proporción sobre la puntuación CAT basal total de los ítems respiratorios fue de 53,4% (20,76) y en el momento de llegar a urgencias del 48,2% (11,47). Los PRAS fueron 82 (14,0%). Ingresaron 359 pacientes (61,2%). Los predictores de ingreso hospitalario fueron: PRAS (OR 3,045, IC 95%: 1,585-5,852, p 0,001), disnea de reposo (OR 2,906, IC 95%: 1,943-4,346, p 0,001) y algunos tratamientos instaurados en el SUH (oxigenoterapia: OR 4,550, IC 95%: 3,056-6,773, p 0,001; diurético: OR 1,754, IC 95%: 1,091-2,819, p = 0,02; y antibiótico iv: OR 1,536, IC 95%: 1,034-2,281, p = 0,03). Este modelo logra un área bajo la curva COR de 0,80 (IC 95%: 0,763-0,836).
En pacientes con EA-EPOC atendidos en urgencias, la alta puntuación de ítems respiratorios en el CAT basal, la disnea de reposo a su llegada al SUH y varios de los tratamientos instaurados en urgencias (oxigenoterapia, diuréticos y antibioterapia intravenosa) demostraron tener buena capacidad de predicción de ingreso hospitalario. La puntuación CAT total así como la puntuación en los ítems respiratorios del mismo son una herramienta que podría ayudar al clínico a individualizar el tratamiento o los controles posteriores.