[Abdominal aortic aneurysm ultrasound screening in men with risk factors in Primary Care]. / Cribado mediante ecografía de aneurisma de aorta abdominal en varones con factores de riesgo en Atención Primaria.

OBJECTIVE: to describe the implantation of ultrasound screening for Abdominal Aortic Aneurysm (AAA) in our healthcare district in men from 65 to 79 years of age who have had an identifiable risk factor for developing AAA, such as smoking or a history thereof, hypertension, family history of aneurysms, aneurysms in other locations and clinical atherosclerosis, acute myocardial infarction, intermittent claudication, or stroke. Analyse the performance of said screening. SETTING: Primary Care. PARTICIPANTS AND INTERVENTIONS: 656 patients were screened, representing 40% of the target population of 1,658 patients. The remaining part of the target population could not be screened because of the outbreak of the COVID-19 pandemic. 608 ultrasound examinations were performed. MAIN MEASUREMENTS: coverage of the screening programme, prevalence of abdominal aortic aneurysms, prevalence of smoking and other risk factors in patients with/without aneurysms. RESULTS: 19 patients with ectatic aorta (25-29mm) and 11 with abdominal aortic aneurysms (1.81%) were found. 5 were active smokers (45%, compared to 20% in the entire sample) and 6 were former smokers. None of the aneurysm patients were non-smokers. 7 of them were hypertensive. CONCLUSIONS: The prevalence of aneurysms in our sample was 2.6%, which was lower than expected. The wide use of ultrasound and its progressive generalisation in the Primary Care setting should lead to a decrease in the number of undiagnosed AAA.

Mapping analysis to predict EQ-5D-5 L utility values based on the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires in the Spanish population suffering from lower limb osteoarthritis.

BACKGROUND: The EQ-5D-5 L is a quality-of-life questionnaire based on individuals' preferences that is widely employed for cost-effectiveness analysis. Given the current demand for mapping algorithms to directly assign "utilities", this study aimed to generate different mapping models for predicting EQ-5D-5 L utility values based on scores of the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires provided by patients suffering from hip and knee osteoarthritis (OA), respectively, and to assess the predictive capability of these functions. METHODS: This was a prospective, observational study. Following the criteria of the American Rheumatism Association, 361 patients with hip OA and 397 with knee OA from three regions in Spain were included. Health-related quality of life (HRQoL) was assessed through the EQ-5D-5 L general questionnaire and the OHS and OKS specifically for lower limb OA. Based on the scores on the OHS and OKS questionnaires, EQ-5D-5 L utilities were estimated using 4 models: ordinary least squares (OLS), Tobit, generalized linear model (GLM), and beta regression (Breg). The models were validated on the same patients after 6 months: the mean absolute error (MAE) and mean squared error (MSE) with their 95% confidence intervals (CI), mean values of standard errors (SE), intraclass correlation coefficients (ICC), and Bland-Altman plots were obtained. RESULTS: The lowest MAEs were obtained using GLM and Breg models, with values of 0.1103 (0.0993-0.1214) and 0.1229 (0.1102-0.1335) for hip OA, and values of 0.1127 (0.1014-0.1239) and 0.1141 (0.1031-0.1251) for knee OA. MSE values were also lower using GLM and Breg. ICCs between predicted and observed values were around or over the 0.8 cut-off point. Bland-Altman plots showed an acceptable correlation, but precision was lower for subjects with worse HRQoL, which was also evident when comparing MAEs of the bottom and top halves of the utilities scale. Predictive equations for utilities based on OHS/OKS scores were proposed. CONCLUSIONS: The OHS and OKS scores allow for estimating EQ-5D-5 L utility indexes for patients with hip and knee OA, respectively, with adequate validity and precision. GLM and Breg produce the best predictions. The predictive power of proposed equations is more consistent for subjects in better health condition.

Cribado mediante ecografía de aneurisma de aorta abdominal en varones con factores de riesgo en Atención Primaria / Abdominal aortic aneurysm ultrasound screening in men with risk factors in Primary Care

Objetivo: Describir la implantación de cribado ecográfico de aneurisma de aorta abdominal (AAA) en nuestra zona básica a los varones entre 65 y 79 años y que tuviera algún factor de riesgo identificable para desarrollar AAA: tabaquismo o antecedentes del mismo, hipertensión, antecedentes familiares de aneurisma, aneurisma en otras localizaciones y ateroesclerosis clínica: infarto agudo de miocardio, claudicación intermitente o ictus. Analizar el rendimiento de dicho cribado. Emplazamiento: Atención Primaria. Participantes e intervenciones : Se ofreció cribado a 656 pacientes, lo que supone un 40% de la población diana de 1.658 pacientes, al tener que interrumpirse prematuramente por la pandemia COVID-19 y se realizaron 608 exploraciones ecográficas. Mediciones principales: Cobertura del programa de cribado, prevalencia de aneurismas de aorta abdominal, prevalencias de tabaquismo y otros factores de riesgo en pacientes con/sin aneurisma. Resultados: Se encontraron 19 pacientes con aortas ectásicas (25-29mm) y 11 con aneurismas de aorta abdominal (1,81%). Cinco eran fumadores activos (45%, frente al 20% de toda la muestra) y seis eran exfumadores. Ninguno de los pacientes con aneurisma era no fumador. Siete de ellos eran hipertensos. Conclusiones: La prevalencia de aneurismas en nuestra muestra se situó en el 2,6%, siendo más baja de lo esperada. La amplia utilización de la ecografía y la progresiva generalización de la misma en el ámbito de la Atención Primaria debería suponer una disminución en el número de AAA sin diagnosticar.

Objective: to describe the implantation of ultrasound screening for Abdominal Aortic Aneurysm (AAA) in our healthcare district in men from 65 to 79 years of age who have had an identifiable risk factor for developing AAA, such as smoking or a history thereof, hypertension, family history of aneurysms, aneurysms in other locations and clinical atherosclerosis, acute myocardial infarction, intermittent claudication, or stroke. Analyse the performance of said screening.Setting: Primary Care.Participants and interventions: 656 patients were screened, representing 40% of the target population of 1,658 patients. The remaining part of the target population could not be screened because of the outbreak of the COVID-19 pandemic. 608 ultrasound examinations were performed.Main measurements: coverage of the screening programme, prevalence of abdominal aortic aneurysms, prevalence of smoking and other risk factors in patients with/without aneurysms.Results: 19 patients with ectatic aorta (25-29mm) and 11 with abdominal aortic aneurysms (1.81%) were found. 5 were active smokers (45%, compared to 20% in the entire sample) and 6 were former smokers. None of the aneurysm patients were non-smokers. 7 of them were hypertensive.Conclusions: The prevalence of aneurysms in our sample was 2.6%, which was lower than expected. The wide use of ultrasound and its progressive generalisation in the Primary Care setting should lead to a decrease in the number of undiagnosed AAA.

Examen de salud a inmigrantes en Atención Primaria / No disponible

Fundamento: Diversos protocolos recomiendan la realización de pruebas de cribado a población inmigrante. Existen dudas sobre su aplicación indiscriminada. Presentamos los resultados de su aplicación en un Centro de Salud. Métodos: Hemos realizado un estudio observacional descriptivo transversal. El emplazamiento ha sido un centro de salud urbano de Madrid. Los participantes son extranjeros de países extracomunitarios mayores de 14años que acuden a consulta médica entre diciembre de2001 y mayo de 2003. Se aplica un examen de salud, que consiste en anamnesis, exploración física y diversas pruebas complementarias (hemograma, bioquímica, serología, Mantoux y parásitos en heces).Resultados: Se realizó el examen de salud a 263inmigrantes. 65% son mujeres y 75% proceden de América Latina. La edad media es 32,7 años (IC 95% 31,4-34). Estancia media de 2,6 años. Fuma un 19% y consume alcohol un 23%. Un 35% no usa métodos de planificación familiar efectivos. Un 49% tienen sobrepeso uobesidad. Detectamos eosinofilia en un 14% y anemia en un 11% de las mujeres no embarazadas y 22% en embarazadas. Un 43% presentaron un Mantoux ≥10mm. Un7,8% tiene parásitos patológicos en heces. Las serologías son positivas en un 1,33% para VIH, 2,12% para VHC, un 1,90% para sífilis y un 3,38% es portador de VHB. Conclusiones: En el inmigrante no deberían realizarse programas de cribado indiscriminado. Proponemos la aplicación de las actividades preventivas generales habituales de la población española valorando en todo caso la realización del Mantoux. Se precisan estudios por subgrupos (AU)

Introduction: Diverse protocols recommend screening tests for the immigrant population. There are doubts concerning their indiscriminate application. Thus, we wanted to evaluate their pertinence the daily life in a health centre. Material and methods: We made a cross-sectional descriptive observational study. The location was an urban health centre in Madrid. The participants were foreigners from countries outside the European Union, of at least 14years of age, that came for medical consultations between December 2001 and May 2003. A health examination was conducted, that consisted of a clinical history, a physical examination and diverse complementary tests (he mogram, biochemistry, serology, PPD and stool examination for parasites).Results: The health exams were conducted on 263immigrants. 65% were women and 75% came from Latin America. The average age was 32.7 years old (CI 95%31.4-34). The average length of residence in Spain was2.6 years. 19% smoked and 23% consumed alcohol.35% did not use effective methods of family planning and49% were overweight or obese. We detected eosinophiliain 14% of the group and anemia in 11% of non-pregnant and 22% of pregnant women. 43% presented a PPD ≥10 mm and 7.8% had pathological stool examination. The serologies were positives in 1.33% for HIV, 2.12%for HCV, 1.9% for syphilis and a 3.38% were carrying HBV. Conclusions: Programs of indiscriminate screening shouldn’t be conducted on the immigrant population. We propose the application of the same general preventive activities as for the Spanish population or at the most the addition of the PPD. Studies by sub-groups are needed (AU)