[Prevalence of obesity in 14-year-olds in four primary care centers. Trends in weight changes since the age of two years old]. / Prevalencia de obesidad a los 14 años en cuatro consultas de atención primaria. Evolución desde los dos años.

INTRODUCTION: Childhood obesity is an increasingly common diagnosis in western society and is related to certain changes in lifestyle. Because of its persistence in adulthood and its relationship with several pathological entities such as cardiovascular disease and diabetes, it has become one of the most important problems in children's health. The objective of this study was to determine the prevalence of obesity and overweight in 14-year-old adolescents attending the pediatric outpatient clinics of a primary care center in 2003, and their weight changes from the age of two years old. SUBJECTS AND METHODS: A long-term study of 277 children born in 1989 was performed. Their body mass index (BMI) was calculated at the age of 2,3,4,6,8,11 and 14 years. Obesity was defined as a BMI > P95 and overweight as a BMI > P85 according to the Centers for Disease Control and Prevention (CDC) growth charts 2000. RESULTS: The prevalence of obesity in 14 year-olds was 13.2% (15.2% in boys and 11.5% in girls). The prevalence of overweight was 17.4% (18.7% in boys and 16.2% in girls). Gender differences were not significant in any of the age groups studied. CONCLUSIONS: The prevalence of obesity and overweight in 14 year-old adolescents in our centers is considerable and is similar to that reported in other Spanish regions. The pediatric outpatient clinics of primary care centers should play an active role in the control and prevention of obesity.

[Views, practices, barriers, and the will to change, when counselling to give up smoking is being given]. / Opiniones, prácticas, barreras y predisposición al cambio, a la hora de dar consejo para dejar de fumar.

OBJECTIVE: To get to know the opinions, current practices, perceived barriers and stage of change in respect to the smoking cessation advice (SCA) offered to patients by the different health professionals (HP) from primary care. DESIGN: Descriptive cross-sectional study. LOCATION: Area Sanitaria 9's Health Centers, in Madrid, Spain. PARTICIPANTS: 480 HPs, including primary care doctors, pediatricians, primary care residents, and nursery staff. MEASUREMENTS: Using a self-filled and anonymous questionnaire, we will gather sociodemographic variables and from the HP's office, regarding the attitudes towards tobacco, efficiency beliefs and use of strategies in the advice, and the perceived barriers to give it, as well as the state of change. RESULTS: 75.2% of the HPs filled the questionnaire (94.2%, 61.1%, 51.6%, and 88% by doctors, nurses, pediatricians, and residents respectively). 72% ask regularly, this rate increasing to 92.4% over tobacco-related diseases. No differences were made between sexes, professional types, tobacco habits, or previous attendance to courses. 85.8% offers tracing and 63.5% give written advices. Nearly 75% of non-smokers are considered social role models, that against only 40% of smokers. The main barriers found were lack of time and low motivation from the patients. 93.5% consider an specific education necessary to give efficient SCA. CONCLUSIONS: Inquiries are made and SCA is given, independently of the smoking habits of the SCA. Likewise, there is a good state of change by the HPs to optimize the treatment of tobacco dependency.

The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.

BACKGROUND: The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed. OBJECTIVE: To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs. METHODS: A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent. STUDY PERSPECTIVE: Primary healthcare management of 4 public health areas. RESULTS: The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1). CONCLUSIONS: In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.

[Prevalence of anti-smoking counseling in a primary care clinic: comparison of patient charts with patient reports]. / Prevalencia del consejo antitabaco en un centro de atención primaria: comparación del registro en la historia clínica con lo referido por el usuario.

OBJECTIVE: To estimate the prevalence of anti-tobacco counseling of smokers. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care center. SUBJECTS: Random sample of 1,228 patients over 14 years of age who visited a doctor or nurse over the year prior to the study. MEASURES: 1) Telephone interview: age, sex, medical history, education, smoking status, number of cigarettes daily, frequency of visits to the doctor, receipt of anti-smoking advice, reason for seeking medical care, the type of professional who saw the patient and the patient's attitude toward the advice. 2) Patient chart: record of advice given. RESULTS: Five hundred sixty-three questionnaires were valid. Smokers made up 37% (95% CI 33%-41%) of the population, with a mean age of 33.37 (18.14 years; 39.1% of men and 36.1% of the women smoked. The prevalence of anti-smoking counseling according to the patient was 62.3% (95% CI: 56-69%). There was little agreement between counseling as reported by the patients and as recorded in the patient's chart (kappa index 0.149, p = 0.01). The mean age of patients advised to quit (34.8 + 10.89 years) was higher than that of those who did not receive advice to quit. Seventy percent of patients who came to the clinic more than 3 times per year reported having been advised to quit, whereas 50% of those who came fewer than 3 times per year were so advised. Among patients who were advised to quit, 78.3% said the advice came when they had come to the clinic about matters related to smoking. According to patients, advice was usually given by a doctor (76.7%). After being advised to quit, 32.55% of the smokers did so, 6.2% of them for longer than 6 months. CONCLUSIONS: The percentage of smokers at our clinic is similar to that in the general population. The prevalence of anti-smoking counseling reported by the user is greater than that reported in other studies, but can clearly be improved. Anti-smoking advice is underreported in our patient charts in comparison with patient reports. The patients who receive advice most often are those who come to the clinic frequently and those who come for smoking-related problems. Physicians are the professionals who most often advise patients on smoking.

[Quality of life in relation to health and obesity in a primary care center]. / Calidad de vida relacionada con la salud y obesidad en un centro de atención primaria.

BACKGROUND: To evaluate the association between obesity and two aspects of health-related quality of life: self-perception of health status and psychological well-being in patients assigned to a primary care center. METHODS: 167 patients between 20 and 70 years old with a body mass index > or = were included in the study. A clinical interview was carried out to get sociodemographic and clinical data and to administer two questionnaires: 1) Nottingham Health Profile (NHP) and 2) Psychological General Well-being (PGWB) index. RESULTS: The mean scores of the NHP indicated a moderate overall impairment of perceived health in females. Pain, emotional reactions and physical mobility were the affected dimensions. Females, age group over 50, low level of education and the presence of psychiatric pathology or osteoarthritis were significantly associated with worse scores. The mean scores of PGWB indicates a small impairment of psychological well-being. In this case, worse scores were associated with females, anxiety and low level of education. CONCLUSIONS: In the study population, we identify a profile of obese patients with worse quality of life: women with age over 50, low level of education and the presence of psychiatric pathology or osteoarthritis. We think it would be a good idea to achieve a prior performance towards them.

Para avanzar en el conocimiento de la seguridad del paciente: a propósito de la biblioteca breve de seguridad del paciente / To promote knowledge on patient safety: the case of the Biblioteca Breve de Seguridad del Paciente(Brief Patient Safety Library)

FUNDAMENTOS: En el marco de la Estrategia de Seguridad del Paciente 2015-2020 la Consejería de Sanidad de la Comunidad de Madrid desarrolló dos líneas de actuación para consolidar la cultura de seguridad a través de la difusión del conocimiento científico en Seguridad del Paciente. El objetivo principal fue identificar, difundir y mejorar el acceso a la información relevante en seguridad del paciente a pacientes-ciudadanos, profesionales y a la propia organización mediante un catálogo de recursos accesible en internet e intranet. MÉTODOS: Tras un análisis de las herramientas y canales de comunicación disponibles para difundir el conocimiento en seguridad del paciente, se seleccionaron las referencias de interés por un grupo de expertos, se desarrolló una herramienta de consulta en un formato navegable en internet y se realizaron distintas acciones de difusión para darla a conocer. RESULTADOS: Se desarrolló la Biblioteca Breve de Seguridad del Paciente, accesible en la web de la Comunidad de Madrid para navegación y como documento para descargar, con 154 referencias, estructuradas en 4 áreas: Recursos generales (74 referencias), Recursos por Área temática (51 referencias), Videos y multimedia (12 referencias) y Organismos y sitios web de interés (17 referencias). CONCLUSIONES: La Biblioteca Breve de Seguridad del Paciente puede contribuir a impulsar la cultura de seguridad en los centros sanitarios y a lograr mayor implicación de los ciudadanos en su seguridad, al poner a su disposición información fiable sobre esta dimensión transversal de la práctica clínica

BACKGROUND: Within the framework of the Patient Safety Strategy 2015-2020, the Regional Ministry of Health of the Community of Madrid developed two lines of action to consolidate the Patient Safety Culture through the dissemination of scientific knowledge in Patient Safety. The main objective was to identify, disseminate and improve access to relevant information on patient safety for patient-citizens, professionals and the organization itself through a pool of resources accessible on the Internet and intranet. METHODS: After an analysis of the tools and communication channel savailable to disseminate knowledge in patient safety, the references of interest were selected by a group of experts, a consultation tool was developed in a navigable format on the internet and various dissemination actions were carried out to make it known. RESULTS: The Biblioteca Breve de Seguridad del Paciente( Brief Patient Safety Library) was developed, accessible for navigation on the web of the Community of Madrid and as a download document, with 154 references, structured in 4areas: General resources (74 references), Resources by thematic area (51references), Videosand multimedia (12references) and Organizations and websites of interest (17references). CONCLUSIONS: The Biblioteca Brevede Seguridad del Paciente (Brief Patient Safety Library) can help to promote the safety culture in health centers and to achieve greater citizen involvement in their safety, by providing reliable information on this crosscutting dimension of clinical practice

[Primary care doctors needs for information: analysis of questions and how they were answered]. / Necesidades de información de los médicos de atención primaria: análisis de preguntas y su resolución.

OBJECTIVE: To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. DESIGN: Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. PARTICIPANTS: Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. INTERVENTIONS: Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. MAIN VARIABLES: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. DISCUSSION: Restrictions: Hawthorne effect or bias in the person observed and participants stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge.

[Systematic review of group educational interventions in type-2 diabetes patients]. / Revisión sistemática de las intervenciones educativas grupales en pacientes diabéticos tipo 2.

OBJECTIVES: To evaluate the effect of group educational interventions in type-2 diabetes patients. To analyse what kind of group intervention has the best long-term effects. DESIGN: Systematic review. DATA SOURCES: Review of electronic data bases: CENTRAL, MEDLINE, EMBASE, CINAHL, and PASCAL, and of the bibliographic references of the studies selected. Contacts with experts to locate non-published articles. Selection of studies. Randomised clinical studies with controls and quasi-experimental studies that evaluate group education interventions aimed at type-2 diabetes patients over 18 years old. These interventions were of any length and in any context, and their target was to improve quality of life, self-control, or metabolic control. The comparison group included individual educational interventions and non-interventions. VARIABLES RESULT: Quality of life, self-control, and diabetes control (HbA1c, cholesterol, triglycerides, blood pressure, and smoking). REVIEW METHODS: Trial selection by 3 groups with 3 researchers in each, who independently reviewed headings, abstracts and key words of all the identified trials to decide on their eligibility. The quality of trials was evaluated by the criteria defined by the Cochrane Metabolic and Endocrine Disorders Group. Researchers assessed the articles independently; and discrepancies were resolved by discussion and consensus.

[Changes in antibiotics prescription in primary care]. / Variación de la prescripción de antibióticos en atención primaria.

BACKGROUND: Bacterial resistance to antimicrobial drugs constitutes a considerable problem in clinical practice. Overprescribing of these drugs contributes to bacterial resistance and current literature shows a growing interest in the rationalization of antibiotic use. OBJECTIVES: To observe the appropriateness of antibiotic prescriptions to children in an outpatient primary care setting, before and after a critical analysis of prescribing habits was performed. PATIENTS AND METHODS: Children aged 0-4 years attending the outpatient pediatric clinic were surveyed in two different periods: 1997 and 2000. The number of visits, infectious and respiratory diseases observed, and courses of antibiotics prescribed was determined. RESULTS: A total of 456 children, 2,339 diseases, and 829 antibiotic prescriptions were included. Several differences were observed between the two periods: the number of antibiotic courses administered to each child in one year averaged 2.3 in the first period and 1.5 in the second (p < 0.001). The number of processes receiving antibiotic prescription decreased from 38.8 % to 31.7 % (p < 0.001). The appropriateness of the decision to treat increased from 85.1 % to 93.3 % (p < 0.001), and the appropriateness of the antibiotic prescribed increased from 56.3 % to 78.7 % (p < 0.001). The most frequently diagnosed infectious diseases were common cold, tonsillopharyngitis, otitis and bronchitis. The most frequently prescribed antibiotic drugs were amoxicillin, amoxicillin-clavulanate and V penicillin. CONCLUSIONS: Physicians' knowledge of their own antibiotics prescription profiles with subsequent critical comparative analysis with current literature on the subject can help to modify prescribing habits.

[Views of primary care users concerning generic medicines and the cost of medication]. / Opinión de los usuarios de atención primaria sobre los medicamentos genéricos y el coste de la medicación.

OBJECTIVES: To assess primary care users' views on generic drugs, approach to them and degree of understanding of them; and to find the importance they attach to the economic cost of medication. DESIGN: Transversal, descriptive study. SETTING: Primary care. PARTICIPANTS: A sample of 231 patients was selected from all the people over 18 who attended the health centre for medical consultation during 2001. RESULTS: 60% (95% CI, 55.22%-67.42%) of those surveyed said they had heard of generic medicines. The communications media were the main source of information, accounting for 78.4% of cases (95% CI, 69.19%-83.96%). 48.04% (95% CI, 38.04%-58.16%) of those who had heard of generic medicines had taken them on some occasion; and 32.4% (95% CI, 23.42%-42.34%) normally took them. 76.47% (95% CI, 67.04%-84.30%) did not mind or, where appropriate, would not mind if their doctor changed a medicine they normally took for a generic one. The mean age of those who did not mind was significantly lower than that of those who did. 50% (95% CI, 42.25%-52.75%) of those questioned were very interested in the cost of drugs prescribed by their doctors: people still working were more interested than those on a pension. 67.6% (95% CI, 60.06%-74.61%) believed that doctors should try to prescribe the cheapest drugs, as long as they were equally efficacious. 78.8% of those questioned (95% CI, 71.91%-84.70%) would choose the cheaper of two drugs which were the same bar the cost. CONCLUSIONS: Most patients in our study were aware of generic drugs and were not against the replacement of a medicine they were already taking by a generic one. They did not relate drugs' cost to their quality.

[Effectiveness of two health interventions to get pregnant women to give up smoking]. / Efectividad de dos intervenciones sanitarias para conseguir el abandono del consumo de tabaco.

OBJECTIVE: To evaluate the effectiveness of the group intervention for getting pregnant women to give up tobacco consumption, measured by means of carbon monoxide levels in air breathed out, compared with a minimum intervention. DESIGN: Randomised clinical trial. SETTING: Four primary care teams from Area 9 of IMSALUD-Madrid. PARTICIPANTS: All the pregnant women attending for consultation with the midwives of the four PC teams involved during the study period, who are smoking at least one cigarette a day when they find out they are pregnant and who want to take part in the study once they have been informed of it. Intervention. The subjects included will be randomised into 2 intervention groups. The minimum intervention will consist of brief personal counselling (3 to 5 minutes) on why they should give up smoking, especially now they are pregnant. The group intervention will involve 3 sessions lasting approximately an hour and a half.

[Benzodiazepine prescription at a health center: prevalence, its use and user characteristics]. / Prescripción de benzodiacepinas en un centro de salud: prevalencia, cómo es su consumo y características del consumidor.

OBJECTIVES: To find the prevalence of prescription of benzodiazepines (BDZ) in 1997 at a health centre (HC), and the characteristics of both their consumption and the takers. DESIGN: Crossover, observational study. SETTING: Primary care urban centre. PATIENTS: From a total of 7356 patients over 14 with clinical records and belonging to four lists, a random sample stratified by lists was selected. INTERVENTION: A form was used to gather social and demographic data, educational level, family context, linked pathologies, number of visits to HC per year, BDZ prescription and variables defining the kind of consumption. MAIN RESULTS: The prevalence of BDZ prescription was 7.7% (CI, 6-10%). Consumption profile: 33% long BDZ, 31% intermediate and 33% short. 44% consumed BDZ occasionally or for less than 2 weeks, and 42% had been taking it for over a year. For 56% (95% CI, 40-70) their G.P. was the origin of the prescription. The reason for the prescription was not specified in 42% of cases. The variables which defined the profile of the consumers, included in the logistic regression, were: sex, number of visits and linked pathologies, whose OR were: 1.57 (CI, 1.08-2.03), 1.11 (CI, 1.06-1.17) and 1.61 (CI, 1.04-2.05). CONCLUSIONS: The prevalence of BDZ prescription during 1997 in the population seen at our clinics was very similar to the figures found in other studies, with higher annual consumption averages and without the reason for taking it being specified in half the cases. The profile of BDZ takers was: mainly women, people with linked pathologies, and as a function of the number of attendances.

[Tobacco consumption among adolescents. Value of the intervention of health-service staff]. / Consumo de tabaco entre los adolescentes. Valor de la intervención del personal sanitario.

OBJECTIVES: To describe the characteristics of tobacco consumption among adolescents seen at a health centre, find their opinions of the factors that affect consumption, and analyse the quality of the intervention of the health staff. DESIGN: Descriptive, cross-sectional study of adolescents attending the health centre. SETTING: Primary care (PC). PATIENTS: All the young people between 10 and 20 who attended family medicine, paediatric or nursing clinics, whether on-demand or with appointments, on Tuesdays and Wednesdays between December 2000 and February 2001. MAIN RESULTS: 23.1% of all the girls smoked (95% CI, 14.9-33.1) versus 15.3% of boys (95% CI, 8.4-24.7). Among non-smokers the main reason for not smoking was health (94.4%). 50% of smokers had tried to give up, of whom 70.5% tried for health-related reasons. 49.4% (95% CI, 41.8-57.1) of those included in the study had been asked at the health centre on some occasion whether they smoked (10.1% of these [95% CI, 4.2-19.8] were aged 10-13; 73.4% [95% CI, 60.9-83.7] 14-17; and 76.7% [CI 95%: 61.4-88.2] 18-20); and 50.6% had never been asked. Of those who were asked and did smoke, 75% (95% CI, 55.1-89.3) were advised to give up and 4.7% of these (95% CI, 0.1-23.8) were offered help to do so. 28.81% of those who did not smoke (95% CI, 17.8-42.1) were encouraged to continue not to smoke. CONCLUSIONS: Both smokers and non-smokers are highly aware of the repercussions of tobacco on health. Tobacco dependency in young people was not tackled well enough at health centre clinics, especially by paediatricians.

[The quality of the drug treatment in hyperlipemia patients from 4 health areas. The VICAF Group]. / Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud. Grupo VICAF.

OBJECTIVE: To calculate how suitable the lipid-lowering treatment prescribed for pensioners in primary care clinics in four health areas is. DESIGN: Cross-sectional descriptive study of quality of pharmacological treatment. SETTING: Four primary care health districts, INSALUD, Madrid. PARTICIPANTS: 1125 patients registered with 49 doctors, chosen at random on the basis of three strata defined by the value of the lipid-lowering drug indicator of prescription. For a year, each doctor filled in a protocol of variables for each pensioner to whom he/she prescribed a lipid-lowering drug. MEASUREMENTS AND MAIN RESULTS: An automated algorithm was designed to evaluate the suitability of the drugs treatment for each patient, according to scientific criteria including: cholesterol levels, LDL, age, and risk factors. Quality of prescription was finally measured for 1009 patients. The indication of the treatment was due to primary prevention in 65% of cases. 32% of patients were correctly treated. If LDL compliance was not demanded, the suitability figure rose to 77%. Drug treatment was more suitable when the doctor him/herself administered it (as against another doctor or a specialist; p = 0.001) or when the patient was on the list of the prescribing doctor (p < 0.0001). Proper indication was lower in patients over 74 (p < 0.0001). CONCLUSIONS: The quality of lipid-lowering drug prescription for pensioners in primary care clinics in four health districts, as a function of the criteria defined above, could be improved. LDL is the factor which most affects the procedure.

[Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipemia]. / Validez de un indicador de calidad de prescripción farmacológica en pacientes con hiperlipemia.

OBJECTIVES: The computer system for billing prescriptions (SIFAR in Spanish) enables indicators to be extracted for the study and follow-up of the use of medicines in the INSALUD primary care areas. Concretely, we studied the indicator referring to pensioners consumption of lipid-lowering drugs (PCLL), not validated, and whose value is expected to drop as quality increases. The objective was to calculate the correlation of the indicator of prescription of lipid-lowering drugs on the SIFAR with the proportion of lipid-lowerers prescribed correctly for pensioners (PCP). DESIGN: A descriptive study of correlation between two indicators of drug prescription. SETTING: Four health districts in Madrid. PARTICIPANTS: The prescriptions of 49 general practitioners, chosen at random on the basis of three strata defined by the value of the indicator, were studied. Each doctor filled out a protocol of data for each pensioner patient to whom he/she prescribed a lipid-lowerer during the study period. MEASUREMENTS AND MAIN RESULTS: The PCLL and PCP indicators were compared through the correlation of Spearman. 6,779 prescriptions for 1,125 patients were collected from the 49 participating doctors. The mean percentage of lipid-lowerers correctly prescribed was 31.9%, figure that rose to 77.5% when the LDL value was not specified. The correlation between the PCLL and the PCP was near zero. CONCLUSIONS: The PCLL indicator of the SIFAR does not discriminate quality in lipid-lowering drug prescription to people over 64.

Prevalencia de obesidad en una consulta de Pediatría de Atención Primaria. Evolución del índice de masa corporal / No disponible

Introducción: la obesidad infantil es un problema de salud cada vez más frecuente y demayor importancia por su persistencia en etapas posteriores de la vida y por su demostradarelación con entidades patológicas en la población infantil y adolescente, tales como enfermedadcardiovascular y diabetes.Objetivo: conocer la prevalencia de obesidad y sobrepeso en 2003 de la población de 2a 14 años atendida en una consulta de pediatría de un centro de Atención Primaria de Fuenlabrada(Madrid), y la variación de esta prevalencia comparada con la presentada en añosprevios.Pacientes y métodos: para determinar las prevalencias de obesidad y sobrepeso se realizaun estudio descriptivo transversal de 318 niños y niñas y se determina su índice de masacorporal (IMC) a los 2, 3, 4, 6, 8, 11 y 14 años. Se considera obesidad IMC > P95, y sobrepesoIMC > P85, según tablas CDC 2000. Para conocer la variación de estas cifras se comparancon los obtenidos a estas mismas edades en la cohorte de niños de 14 años que fueseguida longitudinalmente.Resultados: la prevalencia de obesidad en la población de 2 a 14 años es del 16,03%(18,12% en niños y 14,2% en niñas). La prevalencia de sobrepeso fue del 14,46% (11,40%en niños y 17,15% en niñas). Las diferencias entre sexos no son significativas para el totaldel grupo, ni en ninguna de las edades en las que se realizan determinaciones.Conclusiones: la prevalencia de obesidad y sobrepeso en los niños de 2 a 14 años seguidosen nuestra consulta es muy alta y comparable a las más altas de las registradas en otraszonas de España. Las consultas de pediatría de Atención Primaria son un lugar fundamentalen la prevención y el tratamiento de la obesidad (AU)

Introduction: childhood obesity is a health problem of increasing prevalence and mostprominent, not only because of its persistence in the later stages of life but also due to itsrelationship with pathological conditions during childhood and adolescence such as cardiovasculardisease and diabetes.Objective: to ascertain the prevalence of obesity and overweight in 2003 in childrenaged 2 to 14, seen in one paediatric Primary Care office in Fuenlabrada (Madrid) and thetrends of this prevalence, compared to that observed in previous years.Subject and methods: a descriptive cross study of 318 children calculating their bodymass index (BMI) at ages 2, 3, 4, 6, 8, 11 and 14. Obesity is defined as BMI > P95 and overweightas BMI > P85, according to the Center for Disease Control and Prevention (CDC)growth charts from the year 2000. Results are matched with those obtained at the sameages in the cohort of 14 year old children followed in a longitudinal study.Results: the prevalence of obesity in children aged 2 to 14 was 16.03% (18.12% inboys and 14.2% in girls). The prevalence of overweight is 14.46% (11.40% in boys and17.15% in girls). Gender differences are not significant in any of the age groups studied,neither in the whole group.Conclusions: the prevalence of obesity and overweight observed in children aged 2 to14 in our practice are very high and similar to that registered in other Spanish regions.The paediatric practices in Primary Care centers should play a relevant role in the prevention and control of obesity (AU)

Opiniones, prácticas, barreras y predisposición al cambio, a la hora de dar consejo para dejar de fumar / Views, practices, barriers, and the will to change, when counselling to give up smoking is being given

Objetivo. Conocer las opiniones, las prácticas actuales, las barreras percibidas y la predisposición al cambio con respecto al consejo para dejar de fumar (CF) ofertado a los pacientes por los diferentes profesionales sanitarios (PS) de atención primaria. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centros de salud del Área Sanitaria 9, de Madrid. Participantes. Participaron 480 PS, entre médicos de familia, pediatras, residentes de medicina familiar y comunitaria, y enfermería. Mediciones. Mediante cuestionario autocumplimentado y anónimo se recogen variables sociodemográficas, sobre actitudes, creencias y utilización de estrategias en CF y sobre barreras percibidas para darlo, así como la predisposición al cambio. Resultados. Contestó al cuestionario el 75,2% (el 94,2, 61,1, 51,6 y 88% de los médicos, enfermeros, pediatras y residentes, respectivamente). El 72% pregunta de manera habitual, con un incremento hasta el 92,4% en las enfermedades relacionadas con el tabaquismo, sin diferencias respecto al sexo, el PS, el hábito tabáquico y la formación previa. El 85,8% ofrece realizar un seguimiento y el 63,5% proporciona consejos escritos. El 75% de los no fumadores se considera modelo social, frente al 40% de los fumadores. Las principales barreras son la falta de tiempo y la baja motivación en los pacientes. El 93,5% cree que es necesaria una formación específica para proporcionar CF. Conclusiones. Se pregunta y se ofrece CF, independientemente del hábito tabáquico del PS. A pesar de las barreras, hay una adecuada utilización de las estrategias para proporcionar CF. Hay buena predisposición al cambio para optimizar el CF

Objective. To get to know the opinions, current practices, perceived barriers and stage of change in respect to the smoking cessation advice (SCA) offered to patients by the different health professionals (HP) from primary care. Design. Descriptive cross-sectional study. Location. Área Sanitaria 9's Health Centers, in Madrid, Spain. Participants. 480 HPs, including primary care doctors, pediatricians, primary care residents, and nursery staff. Measurements. Using a self-filled and anonymous questionnaire, we will gather sociodemographic variables and from the HP's office, regarding the attitudes towards tobacco, efficiency beliefs and use of strategies in the advice, and the perceived barriers to give it, as well as the state of change. Results. 75.2% of the HPs filled the questionnaire (94.2%, 61.1%, 51.6%, and 88% by doctors, nurses, pediatricians, and residents respectively). 72% ask regularly, this rate increasing to 92.4% over tobacco-related diseases. No differences were made between sexes, professional types, tobacco habits, or previous attendance to courses. 85.8% offers tracing and 63.5% give written advices. Nearly 75% of non-smokers are considered social role models, that against only 40% of smokers. The main barriers found were lack of time and low motivation from the patients. 93.5% consider an specific education necessary to give efficient SCA. Conclusions. Inquiries are made and SCA is given, independently of the smoking habits of the SCA. Likewise, there is a good state of change by the HPs to optimize the treatment of tobacco dependency

Necesidades de información de los médicos de atención primaria: análisis de preguntas y su resolución / Primary care doctors’ needs for information: analysis of questions and how they were answered

Objetivo. Determinar las necesidades de información de los médicos de atención primaria de 5 áreas de salud de Madrid mediante la descripción de la frecuencia y el tipo de preguntas clínicas, el patrón de búsqueda y nivel de resolución de éstas. Diseño. Estudio observacional descriptivo. Emplazamiento. Consultas de atención primaria. Áreas de salud 1, 3, 8, 9 y 10 de Madrid. Participantes. Muestra aleatoria, estratificada por zona y tipo de médico, de 125 médicos de cada una de las áreas (Madrid). Se excluye a los médicos residentes, a los suplentes y a los que realizan actividades de enseñanza universitaria. Intervenciones. Se invitará a los médicos a ser observados mediante cámara de vídeo durante aproximadamente 4 h de consulta a demanda. Se les pedirá que especifiquen, entre paciente y paciente, las preguntas que surjan y las fuentes de información utilizadas dentro de la consulta. Las preguntas sin resolver serán seguidas mediante contacto telefónico 2 semanas después para determinar si se han obtenido respuestas y los métodos utilizados. Mediciones principales. Variables principales: número de preguntas clínicas formuladas reconocidas y sus respuestas; número de preguntas clínicas no reconocidas (observadas a través del vídeo); tema y tipo de información de cada pregunta; tiempo utilizado en buscar respuestas; recursos de información utilizados. Otras variables: características de los profesionales de atención primaria participantes, consultas, centros de salud y presión asistencial. Discusión. Una limitación es el efecto Hawthorne o sesgo del observado y miedo escénico de los participantes. En cuanto a la aplicabilidad de los resultados de la investigación, servirán para planificar los recursos necesarios para que los médicos dispongan y apliquen la mejor evidencia científica

Objective. To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. Design. Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. Participants. Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. Interventions. Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. Main measurements. Main variables: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. Discussion: Restrictions: Hawthorne effect or bias in the person observed and participants´ stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge

Prevalencia de obesidad a los 14 años en cuatro consultas de atención primaria. Evolución desde los dos años / Prevalence of obesity in 14-year-olds in four primary care centers. Trendsin weight changes since the age of two years old

Introducción. La obesidad infantil es un diagnóstico cada vez más frecuente en las sociedades occidentales. Su aparición se relaciona con determinados cambios en los estilos de vida. Por sus implicaciones en cuanto a persistencia en etapas posteriores de la vida y relación con diversas entidades patológicas, como la enfermedad cardiovascular y la diabetes, se ha convertido en uno de los problemas de salud infantil más importantes. El objetivo de este estudio ha sido conocer la prevalencia de obesidad y sobrepeso en 2003 en la población de 14 años atendida en las consultas de pediatría de un centro de atención primaria, así como la evolución ponderal de esta cohorte desde los 2 años de edad. Pacientes y métodos. Se realiza un estudio longitudinal de los 277 niños nacidos en 1989, determinando su índice de masa corporal (IMC) a los 2, 3, 4, 6, 8, 11 y 14 años. Se considera obesidad un IMC > P95, y sobrepeso IMC > P85, según las tablas de los Centers for Diseases Control and Prevention (CDC) de 2000. Resultados. La prevalencia de obesidad a los 14 años es del 13,2 % (15,2 % en niños y 11,5 % en niñas). La prevalencia de sobrepeso es de 17,4 % (18,7 % en niños y 16,2 % en niñas). Las diferencias entre sexos no son significativas en ninguna de las edades en que se realizan determinaciones. Conclusiones. La prevalencia de obesidad y sobrepeso a los 14 años en los niños de nuestras consultas es importante y comparable a la registrada en otras zonas de España. Las consultas de pediatría de atención primaria deben tener un papel relevante en la prevención y control de la misma

Introduction. Childhood obesity is an increasingly common diagnosis in western society and is related to certain changes in lifestyle. Because of its persistence in adulthood and its relationship with several pathological entities such as cardiovascular disease and diabetes, it has become one of the most important problems in children's health. The objective of this study was to determine the prevalence of obesity and overweight in 14-year-old adolescents attending the pediatric outpatient clinics of a primary care center in 2003, and their weight changes from the age of two years old. Subjects and methods. A long-term study of 277 children born in 1989 was performed. Their body mass index (BMI) was calculated at the age of 2,3,4,6,8,11 and 14 years. Obesity was defined as a BMI > P95 and overweight as a BMI > P85 according to the Centers for Disease Control and Prevention (CDC) growth charts 2000. Results. The prevalence of obesity in 14 year-olds was 13.2 % (15.2 % in boys and 11.5 % in girls). The prevalence of overweight was 17.4 % (18.7 % in boys and 16.2 % in girls). Gender differences were not significant in any of the age groups studied. Conclusions. The prevalence of obesity and overweight in 14 year-old adolescents in our centers is considerable and is similar to that reported in other Spanish regions. The pediatric outpatient clinics of primary care centers should play an active role in the control and prevention of obesity

Revisión sistemática de las intervenciones educativas grupales en pacientes diabéticos tipo 2 / Systematic review of group educational interventions in type-2 diabetes patients

Objetivo. Evaluar el efecto de las intervenciones educativas grupales en pacientes diabéticos tipo 2. Analizar qué tipo de intervención grupal produce mayores efectos a largo plazo. Diseño. Revisión sistemática. Fuente de datos. Revisión de bases electrónicas: CENTRAL, MEDLINE, EMBASE, CINAHL y PASCAL, así como de las citas bibliográficas de los estudios seleccionados. Contactos con expertos para localizar artículos no publicados. Selección de los estudios. Ensayos clínicos aleatorizados, controlados y estudios cuasiexperimentales que evalúen intervenciones educativas grupales dirigidas a pacientes diabéticos tipo 2, mayores de 18 años, de cualquier duración, realizada en cualquier ámbito, cuya meta sea mejorar la calidad de vida, el autocontrol o el control metabólico. El grupo de comparación incluye intervenciones educativas individuales y no intervenciones. Variables resultado. Calidad de vida, autocontrol y control diabético (HbA1c, colesterol, triglicéridos, presión arterial y consumo de tabaco). Métodos de revisión. Selección de los ensayos realizada por 3 grupos, con 3 investigadores cada uno, que de forma independiente revisan los títulos, abstracts y palabras clave de todos los ensayos identificados para decidir sobre su elegibilidad. La calidad de los ensayos se evalúa usando los criterios definidos por el Cochrane Metabolic and Endocrine Disorders Group. Los investigadores evalúan de forma independiente los artículos y las discrepancias se resuelven por discusión y consenso

Objectives. To evaluate the effect of group educational interventions in type-2 diabetes patients. To analyse what kind of group intervention has the best long-term effects. Design. Systematic review. Data sources. Review of electronic data bases: CENTRAL, MEDLINE, EMBASE, CINAHL, and PASCAL, and of the bibliographic references of the studies selected. Contacts with experts to locate non-published articles. Selection of studies. Randomised clinical studies with controls and quasi-experimental studies that evaluate group education interventions aimed at type-2 diabetes patients over 18 years old. These interventions were of any length and in any context, and their target was to improve quality of life, self-control, or metabolic control. The comparison group included individual educational interventions and non-interventions. Variables result. Quality of life, self-control, and diabetes control (HbA1c, cholesterol, triglycerides, blood pressure, and smoking). Review methods. Trial selection by 3 groups with 3 researchers in each, who independently reviewed headings, abstracts and key words of all the identified trials to decide on their eligibility. The quality of trials was evaluated by the criteria defined by the Cochrane Metabolic and Endocrine Disorders Group. Researchers assessed the articles independently; and discrepancies were resolved by discussion and consensus