Background: Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth cause of death. Exacerbations have a negative impact on the prognosis of COPD and the frequency and severity of these episodes are associated with a higher patient mortality. Exacerbations are the first cause of decompensation, hospital admission and death in COPD. The incidence of exacerbations has mainly been estimated in populations of patients with moderate-severe COPD requiring hospital care. However, little is known regarding the epidemiology of exacerbations in patients with less severe COPD forms. It is therefore possible that a high number of these less severe forms of exacerbations are underdiagnosed and may, in the long-term, have certain prognostic importance for the COPD evolution. The aim of this study was to know the incidence and risk factors associated with exacerbations in patients with COPD in primary care.

BackgroundThe value of abdominal echography in primary care is great because it is innocuous, inexpensive, easy to perform and provides a great deal of information making this the first examination to be requested in cases of probable abdominal disease. However, too many abdominal echographies are probably requested overcrowding the Departments of Radiodiagnosis with not always justified petitions or with repetition of tests based on little clinical criteria.Methods/DesignThe aim of the study is to evaluate the adequacy and quality of abdominal echographies requested by primary care physicians in the Maresme County (North of Barcelona), develop guidelines for indicating echographies and reevaluate this adequacy after implementing these guidelines.We will perform a two-phase study: the first descriptive, and retrospective evaluating the adequacy and quality of petitions for abdominal echographies, and in the second phase we will evaluate the impact of recommendations for indicating abdominal echographies for PC physicians on the adequacy and quality of echography petitions thereafter.This study will be carried out in 10 primary care centres in the Maresme (Barcelona).1067 abdominal echographies requested by primary care physicians from the above mentioned centres from January 2007 to April 2010 and referred to the Department of Radiology and the same number of applications after the intervention.All the petitions for abdominal echographies requested will be analysed and the clinical histories will be obtained to determine demographic variables, the reason for the visit and for the echography petition and diagnostic orientation, clinical and echographic data, evaluation of the echographies according to the quality and variables characterising the professionals requesting the echographies including: age, sex, laboral situation, length of time in work post, formation, etc.To achieve a consensus of the adequacy of abdominal echography, a work group including gastroenterologists, radiologists and general practitioners will be created following the nominal group. This will allow the design of guidelines for the indication of abdominal echography and posterior evaluation of their impact among physicians by diffusion and posterior reevaluation of the adequacy of the petitions.

BackgroundIn Mexico, over 60% of the population is uninsured and not able to afford private healthcare services. Women with autoimmune rheumatic diseases (ARDs) are a high-risk group during pregnancy. Morbidity associated with ARDs and pregnancy can include lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications, on the other hand these health interventions are not available to all women with ARDs because of the high prices that it represents.ObjectivesThe aim of this study was to estimate the cost of prenatal care in women with ARDs without health insurance in Northeast Mexico.MethodsTo assess the costs of prenatal care of women with ARDs in the Northeast of Mexico from the perspective of a women without any health insurance, we estimated only the direct costs of the mandatory medical follow-up. Direct costs are all healthcare costs that are directly related to the consultations with a multidisciplinary team, serological and immune laboratory test, and ultrasounds per trimester. All costs and medical fees were obtained from a university hospital in Monterrey, Mexico. To assess the impact of prenatal care in real life, we compared the health expenditure per trimester reported by the pregnancy and rheumatic diseases clinic from the same institution. The data is presented in USD. We were not able to assess indirect costs related to health coverage (like transportation) and specific medical treatment (antirheumatic drugs or other interventions).ResultsThe mean cost for medical consultations and ultrasounds per trimester was $184-277 USD. The average cost of immune test and general lab test ranges from $424-428 USD. The total cost per trimester was from $608 to 705 USD, and the direct cost per three trimesters was $1824-2115 USD.The average family income per month was $614.23 USD and the average health expenditure (per month) was 105.71 USD; which represents 16.21% of the family income. The average family health expenditure per trimester was $317.13 USD.ConclusionThe total cost for prenatal care per trimester was calculated in $608 to 705 USD. The cost of prenatal care per trimester is 193.69% higher than the average health expenditure per trimester for uninsured women with ARDs. More and new strategies are needed to solve and reduce inequalities in access to health.Table 1.Average cost of prenatal care per trimesterMedical consultations and ultrasoundsMedical ConsultationsCosts (USD)FrecuencyCOST PER TRIMESTER $184-277 USDRheumatologist$13MonthlyGenetics$49At least oneObtetrician$14MonthlyUS 1st Trimester$54Only one timeUS 2nd Trimester$49Only one timePsychologist$39If neededNutritionist$5If neededClinical testClinical testCosts (USD)FrecuencyCOST PER TRIMESTER $188 USDComplete Blood Count$9One per trimesterBlood Chemistry$38One per trimesterVitamin D (25-OH)$59One per trimesterThyroid profile test$16One per trimesterPT, TTP$36One per trimesterProtein C reactive$20One per trimesterErythrocyte sedimentation rate$5One per trimesterUrine general test$5One per trimesterImmune lab test (For patients with rheumatoid arthritis and spondylarthritis)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $240 USDRheumatoid factor$24One per trimesterAnti-CCP$33One per trimesterAnti SS-A/RO$19One per trimesterAnti-SS-B/LA$19One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterImmune lab test (For patients with lupus, antiphospholipid syndrome, Sjogren’s syndrome, vasculitis, and others) (Others: rheumatic skin and muscle diseases,)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $236 USDAnti-SS-A/RO$21One per trimesterAnti-SS-B/LA$21One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterAnti-DNA$24One per trimesterAntinuclear antibodies$25One per trimesterDisclosure of InterestsNone declared

Background:Rheumatic diseases (RD) are more frequent among women of childbearing age. Adverse events during pregnancy in RDs have been frequently reported, leading some women to avoid pregnancy. “CEER” is an outpatient clinic in Monterrey, Nuevo Leon, Mexico, that was created for pregnant women with RD.Objectives:The objective is to describe pregnancy outcomes in patients with RD surveilled at a rheumatology outpatient clinic.Methods:A single-center retrospective study of women with RD at CEER between 2017 and 2020 was conducted. Clinical features and maternal, fetal and neonatal outcomes were retrospectively collected. The rate of adverse perinatal outcomes (APO) was compared with the tertiary referral center´s general obstetric population (GOP). All data was retrieved from clinical files.Results:Overall, 62 pregnancies in women with RD were recorded. The median maternal age at conception was significantly higher in pregnancies with RD than GOP (29 [24-35] years old vs 23 [19-28] years old, p<0.001).The odds of preterm delivery were increased among pregnancies with RD (OR 1.85, 95% CI 1.03-3.30, p=0.038). Other APO are summarized in Table 1. Rheumatoid arthritis (RA) was the leading diagnosis followed by systemic erythematosus lupus (SLE) and antiphospholipid syndrome (APS).Cesarean sections were recorded in 41 pregnancies in RD group, more frequent than in GOP (66.1% vs 50.8%, p=0.016). Figure 1 shows the distribution of indications for cesarean sections, the two leading indications were previous cesarean section (43.9%) and Nonreassuring fetal heart rate pattern (19.5%) Pregnancies with RD appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (12.9% vs 15.9%, p=0.02 and 23.7% vs 12.2%, p=0.006, respectively).Conclusion:Pregnancies with RD were at increased risk for APO. Women of this population should be made aware of these risks and be closely monitored by a multidisciplinary team as a high-risk pregnancy.References:[1]Aljary H, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Pregnancy outcomes in women with rheumatoid arthritis: a retrospective population-based cohort study. J Matern Fetal Neonatal Med. 2020;33(4):618-24.[2]Alvarez-Nemegyei J, Cervantes-Díaz MT, Avila-Zapata F, Marín-Ordóñez J. [Pregnancy outcomes before and after the onset of rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2011;49(6):599-604.[3]Davutoğlu EA, Ozel A, Yilmaz N, Madazli R. Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet. 2017;296(6):1079-84.[4]Harris N, Eudy A, Clowse M. Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019;71(3):390-7.[5]Ideguchi H, Ohno S, Uehara T, Ishigatsubo Y. Pregnancy outcomes in Japanese patients with SLE: retrospective review of 55 pregnancies at a university hospital. Clin Rev Allergy Immunol. 2013;44(1):57-64.Table 1.Pregnant outcome, maternal, fetal and neonatal adverse eventsRD (n=62)GOP (n=31254)OR (CI 95%)pPregnancy outcomePregnancy lossa6 (9.68)1560 (4.99)1.94 (0.84-4.49)0.122Live birthsa60 (90.9)29694 (95)0.96 (0.67-1.35)0.8Gestational age,median (IQR) (weeks)b37.6 (37-39)39 (38-40.2)-<0.001Birth weight,mean (CI) (Kg)c2831.6(2677.4-2985.8)3022.2(2986.8-3057.6)-0.007Maternal adverse eventsPreterm deliveries(<37 weeks)a14 (23.7)3821 (12.2)1.85 (1.03-3.3)0.038<34 weeksa3 (5.1)1065 (3.4)1.42 (0.45-4.53)0.553Gestational diabetesa4 (6.5)1406 (4.5)1.43 (0.52-3.95)0.485Preeclampsiaa5 (8.1)2471 (7.89)1.02 (0.41-2.54)0.97Postpartum hemorrhagea0930 (2.97)0.27 (0.017-4.35)0.355Emergency cesarean sectiona8 (12.9)1844 (5.9)2.19 (1.05-4.57)0.037Fetal adverse eventsMiscarriagesa3 (4.8)663 (2.12)2.28 (0.71-7.29)0.164Stillbirthsa3 (4.8)897 (2.87)1.69 (0.53-5.38)0.377Congenital abnormalitiesa4 (6.5)1094 (3.5)1.84 (0.67-5.08)0.237an,%bIQR, interquartile range (25th–75th percentile)cCI, confidence interval (95%)Disclosure of Interests:None declared

Background:The reproductive capacity of women with rheumatic diseases (RD) could be affected by factors such as sexual dysfunction, reduced gonadal function, foetal losses, drugs, and personal choices [1]. Studies have suggested that women with RD may underestimate their reproductive capacity [2], which may be reflected in unplanned pregnancies and/or adverse outcomes. One study found that women with rheumatoid arthritis (RA) have longer time to pregnancy compared to those without RA, suggesting that a reduction in fertility may be involved [3]. Another study found that patients with RA have more subfertility related to medication [4]. Aspects of sexual and reproductive health are not routinely addressed, so they are areas of opportunity to improve quality in care and research.Objectives:Identify demographic and clinical factors associated with pregnancy decision in women with RD.Methods:A population study was carried out including women with RD who had their first obstetric event from September 2017 to November 2020. According to the onset of sexual life and the year of conception of the first pregnancy, two groups were formed, who conceived before and after 5 years elapsed. Demographic and clinical data were obtained from medical records. Categorical variables were assessed using χ2 test and Fisher’s exact test where appropriate. Student’s t-test was used to assess continuous variables. A p value of 0.05 or less was considered significative.Results:Data were collected from 28 women, the main diagnosis was rheumatoid arthritis (21, 75%), followed by systemic lupus erythematosus (7, 25%), 14 of them (50%) were pregnant in the first 5 years after starting sex life. There were no differences in age of onset of sex life (p = 0.362), or other clinical characteristic, but women with pregnancies in the first lustrum had lower percentages of marriage union (35% vs 42%), paid-work (21% vs 28%), and use of highly effective contraception (21% vs 28%).Conclusion:Conclusions: No factors were identified for pregnancies in the first lustrum, but there is a tendency to occur in single women, non-employees, and users of non-highly effective contraceptives methods. Further studies with a larger population are necessary to find modifiable factors and improve outcomes.Table 1.Clinical characteristics.Obstetric event before 5 yearsObstetric event after 5 yearsp-valueTotal1414Current average age24.85 +/- 4.329.92 +/- 5.70.404Age at the first obstetric event, years20.92 +/- 2.928.00 +/- 5.90.05Age at the onset of rheumatic disease, years20.71 +/- 5.523.42 +/- 4.00.135Average age of onset of sex life, n (%)18.64 +/- 2.918.07 +/- 2.50.362Alcoholism consumption, n (%)3 (21.42)4 (28.57)0.663Tobacco use, n (%)3 (21.42)3 (21.42)Diabetes mellitus, n (%)0 (0)1 (7.14)0.309Hypertension, n (%)1 (7.14)0 (0)0.309Depression, n (%)3 (21.42)1 (7.14)0.280Anxiety, n (%)2 (14.28)1 (7.14)0.541Pre-pregnancy medicationMethotrexate, n (%)3 (21.42)5 (35.71)0.403Leflunomide, n (%)1 (7.14)2 (14.28)0.541Sulfasalazine, n (%)3 (21.42)2 (14.28)0.622Hydroxichloroquine, n (%)6 (42.85)4 (28.57)0.430Azathioprine, n (%)1 (7.14)0 (0)0.309Cyclophosphamide, n (%)2 (14.28)0 (0)0.142Glucocorticoids, n (%)5 (35.71)5 (35.71)NA: Not applicable.Image 1.Demographic characteristics.References:[1]Østensen, M., 2017. Sexual and reproductive health in rheumatic disease. Nature Reviews Rheumatology, 13(8), pp.485-493.[2]Birru Talabi, M., Clowse, M., Blalock, S., Switzer, G., Yu, L., Chodoff, A. and Borrero, S., 2019. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatology, 3(1).[3]Jawaheer, D., Zhu, J., Nohr, E. and Olsen, J., 2011. Time to pregnancy among women with rheumatoid arthritis. Arthritis & Rheumatism, 63(6), pp.1517-1521.[4]Brouwer, J., Fleurbaaij, R., Hazes, J., Dolhain, R. and Laven, J., 2017. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care & Research, 69(8), pp.1142-1149.Disclosure of Interests:None declared