[Tables of coronary risk evaluation adapted to the Spanish population: the DORICA study]. / Tablas de evaluación del riesgo coronario adaptadas a la población española. Estudio DORICA.

BACKGROUND AND OBJECTIVE: Independent risk factors (smoking, hypertension, hypercholesterolemia and diabetes mellitus) are direct causes of coronary heart disease and are common in the population. Considering all independent factors together seems to be more appropriate to estimate the global risk of coronary heart disease. The objective of this paper was to estimate the global risk of coronary heart disease based on the Framingham function, adapted to the prevalence of risk factors in Spain. SUBJECTS AND METHOD: The prevalence of risk factors in the Spanish population was estimated based on pooled analysis of regional cross-sectional random population surveys. Prevalence estimates and incidence rate of coronary events were replaced in the Framingham equation accordingly. Risk probability for 10 years was estimated and risk tables were designed using a gradual color coding system according to an increasing risk. RESULTS: The estimated attributable fraction (AF) for hypertension in the Spanish population was 26.7% for men and 22.9% women; that for hypercholesterolemia was 15.7% and 12.7% for men and women, respectively. Smoking was identified in the third position of the ranking order for males (AF 13.13%) and fourth for the female group (AF 3.71%). The prevalence of obesity was 13.2% for men and 17.5% for women. AF for obesity among men was 4% and it was 5% for women. CONCLUSIONS: An adaptation of the Framingham equation according to the prevalence of independent risk factors and incidence of coronary events in the Spanish population is useful to build instruments to estimate the 10-year global risk of coronary heart disease while a specific function based on a well-designed cohort study in not available in Spain.

[Non mydriatic retinal camera: cost-effectiveness study for early detection of diabetic retinopathy]. / Cámara de retina no midriática: estudio de coste-efectividad en la detección temprana de la retinopatía diabética.

BACKGROUND AND OBJECTIVE: Cost-effectiveness analysis (ACE) for application of fundoscopic photograph with non mydriatic retinal camera (Ffo-CNM) in early diagnostic of diabetic retinopathy (RD) compared with ophthalmoscopic view by pupillary dilation. PATIENTS AND METHOD: diabetic patients, older than 14 years, attended on three Health Primary Care Areas (n=1495). Effectiveness measurement: predictive value of a positive test (VPD) and correctly diagnosed cases. Cost measurement: total cost by patient. ACE: defined as expected cost by VPD case and as expected cost by correctly diagnosed case. The results were submitted to an analysis of sensitivity for the study main variables. RESULTS: Ffo-CNM presented 90.91% of sensitivity [95% CI, 69.4-98.4%], 78.21% of specificity [95% CI, 67.1-86.4%], 54.05% positive predictive value [95% CI, 37.1-70.2%] and 96.83% of negative predictive value [95% CI, 88-99.4%]. Effectiveness, defined as VPD case, was 15.4% for ophthalmoscopic view and 19.5% for Ffo-CNM, and defined as correctly diagnosed case, was 70% and 79.8%, respectively. Cost-effectiveness ratio: a) for health care system, the cost by VPD case was 52.62 euros for ophthalmoscopic view and 28.44 euros for Ffo-CNM and cost by correctly diagnosed case was 11.58 euros and 6.95 euros, respectively, and b) for the society, cost by VPD case was 100.13 euros for ophtalmoscopic view and 34.54 for Ffo-CNM and the cost by correctly diagnosed case was 22.03 euros and 8.44 euros respectively. CONCLUSIONS: If an introduction of a early detection of RD program for the entire diabetic population was decided the option to make it using Ffo-CNM would be the most efficient.

[Prevalence of obesity in Spain: results of the SEEDO 2000 study]. / Prevalencia de la obesidad en España: resultados del estudio SEEDO 2000.

BACKGROUND AND OBJECTIVE: Obesity is a major public health problem in developed countries. It is of key importance to ascertain its magnitude and to identify main groups at risk. In this paper the prevalence of obesity in Spanish adult population aged 25-60 is estimated, based on measured height and weight. SUBJECTS AND METHOD: Pooled-analysis of regional cross-sectional nutrition surveys performed on representative random population samples. Randomly selected 9,885 free living subjects aged 25-60 years respondents of population nutritional surveys carried out in eight Spanish regions (Andalucía, Balearic Islands, Basque Country, Canary Islands, Catalunya, Galicia, Madrid and Valencia) between 1990 to 2000. Weight and height were measured on each individual by trained observers following standardised procedures and measuring instruments. The samples were pooled together and weighted according to the distribution of Spanish adult population aged 25-60 years. Obesity was defined as body mass index (BMI) >= 30 kg/m2. The protocol used in each survey was in accordance to the recommendations of the Spanish Society for the study of Obesity (SEEDO) to estimate the prevalence of obesity in population studies. RESULTS: The prevalence of obesity in Spanish adult population was 14.5% (95% CI, 13.93-15.07%), significantly higher among women 15.75% (95% CI, 14.89-16.61%), than men 13,39% (95% CI, 11.84-14.94%) (*2 = 12.470; p = 0.000). Prevalence of obesity significantly increased with age in men and women. The highest rates were estimated for the age group older than 55 years, both among males and females, 21.58% (95% CI, 18.68-24.48%) and 33.9% (95% CI, 32.73-35.07%), respectively. CONCLUSION: Obesity is a health problem which affects an important proportion of the Spanish adult population. Considering its potential impact on Public Health, it would be required to design and implement effective strategies aimed at the early detection of subjects at risk and the provision of adequate treatment, as well as to establish suitable preventive programmes.