Comparison of baseline clinical characteristics among people with type 2 diabetes on second-line therapy previously added with dapagliflozin or another oral glucose-lowering drug: AGORA study.

INTRODUCTION: Type 2 diabetes mellitus (T2D) has acquired epidemic proportions worldwide. In recent years, new oral glucose-lowering drugs (OGLD) have emerged that improve the cardiovascular-kidney-metabolic control in T2D people. OBJECTIVES: To compare the baseline clinical-biological characteristics among T2D people to whom had added-on dapagliflozin (DAPA group) or another OGLD (SOC group) second-line hypoglycaemic therapies among the AGORA study population. METHODS: This is a multicentre cross-sectional observational study of the baseline characteristics of T2D people recruited through competitive sampling among 46 primary care health centres in Spain for the AGORA study. The inclusion and exclusion criteria of participants, and justification of the sample size are reported. After verifying the data necessary to be evaluated and informed consent, 317 subjects were included to the DAPA group and 288 to the SOC group. Both categorical and continuous variables were analysed and compared with the usual statistics. Cohen's d was used to assess the standardised difference in means. RESULTS: Six hundred and five patients with T2D were assessed (mean age 63.5 [SD±8.1] years, 61.8% men), whom 17.4% were smokers, 47.6% had obesity, 74.8% hypertension, 87.3% dyslipidaemia, and 41.7% reported physical inactivity, with no significant differences between both comparison groups. The mean (SD) evolution time of T2D was 10.1 (5.6) years. Most baseline clinical-biological characteristics at recruitment were similar in both groups. However, DAPA group was younger (2.9 years), and had lower systolic blood pressure (SBP) (2.8mmHg), higher body weight (BW) (3.7kg), and higher glycated haemoglobin A1c (HbA1c) (0.3%) than SOC group. Only 11.5% of participants had poor glycaemic control (HbA1c>8%) at recruitment, 54.9% had good glycaemic control (HbA1c<7%), being significantly lower in the DAPA group (47.3%) than in the SOC group (63.4%). The percentage of T2D patients with high vascular risk (VR) was 46.3%, and 53.7% with very high VR, being significantly higher in the DAPA group (57.4%) than in the SOC group (49.6%). CONCLUSIONS: Most baseline cardiovascular-kidney-metabolic characteristics were similar in T2D patients whom had added dapagliflozin on second-line hypoglycaemic therapy as those whom had added-on another OGLD. However, patients whom had added-on dapagliflozin had higher VR, lower SBP, higher BW, and slightly worse HbA1c control. Future research is necessary to explain the causes of these differences in cardiometabolic control.

Mean Blood Pressure of the General Population with the Mean of Three Measurements Versus the Mean of the Second and Third Measurements. Ricarto Study.

INTRODUCTION: Our aim was to determine the difference between measuring blood pressure (BP) with the mean of three determinations versus the mean of the second and the third determinations in a random general population sample. METHODS: Epidemiological study of the general population aged ≥ 18 from the Health Area of Toledo (Spain), based on the health card database. Three readings of systolic and diastolic BP were taken with validated oscillometric devices OMRON HEM-907. The mean of the three readings was compared with the mean of the second and third readings after discarding the first measurement. We analyzed age, sex, BMI, abdominal obesity, dyslipidemia, diabetes mellitus, smoking and sedentary lifestyle. A descriptive study was conducted, as well as the agreement in the diagnosis of hypertension. RESULTS: 1532 subjects were analyzed (mean age 49.01 ± 15.79 years old, 55.5% women). Response rate 36.3%. The mean systolic BP with three readings was 125.39 ± 17.43 mmHg, versus 124.33 ± 17.07 mmHg with the mean of the second and third readings (mean difference 1.01 ± 4.31; Cohen's D = 0.059). The mean diastolic BP was 73.93 ± 10.89 versus 73.71 ± 10.93 mmHg with both methods (mean difference 0.19 ± 2.11; Cohen's D = 0.017). Differences by age, sex, BMI, abdominal obesity, dyslipidemia, diabetes, smoking and sedentary lifestyle were all small (Cohen's D < 0.08). The agreement between both models for classifying subjects as hypertensive/non-hypertensive showed a Kappa value = 0.936 (McNemar's test p < 0.001). CONCLUSIONS: Determining the mean of three readings of BP does not make a significant difference in relation to the reading of the second and third measurements in a sample of general population.

Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system.

OBJECTIVE: A good relationship between diabetes patients and their health care team is crucial to ensure patients' medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM) patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence. METHODS: An observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale) concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals. RESULTS: A total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that "complexity of medication" (97% vs 76.6%, respectively) and "adverse events" (97.5% vs 72.2%, respectively) were important medication-related factors affecting adherence. In addition, both patients (80.8%) and physicians (80.8%) agreed on the importance of "cost and co-payment" for adherence, whereas only 48.6% of pharmacists considered this factor important. It is also noteworthy that nearly half of patients (43%) agreed that "to adjust medication to activities of daily living" was the best strategy to reduce therapeutic complexity, whereas physicians believed that "reducing the frequency of administration" (47.9%) followed by "reducing the number of tablets" (28.5%) was the most effective strategy to improve patients' adherence. CONCLUSION: Our results highlight the need for pharmacists to build a stronger relationship with physicians in order to improve patients monitoring and adherence rates. Additionally, these findings may help to incorporate greater patient-centeredness when developing management strategies, focusing on adjusting medication regimens to patients' daily lives.

Blood pressure differences between one automatic measurement and the mean value of 3 automatic measurements. SPRINT trial. / Diferencias de presión arterial entre una toma y la media de 3 tomas medidas automáticamente. Estudio SPRINT.

BACKGROUND AND OBJECTIVES: There are discrepancies regarding how to measure blood pressure (BP). The goal of this study was to determine the differences between one automatic BP measurement and the mean of 3 automatic BP measurements. PATIENTS AND METHOD: Two patient populations were used. A sample population (n=1,337) in which the measurement was performed by a nurse at the health center, and a consecutive series of patients (n=200) who had the measurement performed in front of the doctor in the office. RESULTS: The differences found between the first reading and the average of 3 determinations were small in both cases. In the population sample, BP levels ranged from 2.07 to 3.21mmHg, and in patients who had their BP levels measured in the presence of doctor, this value ranged from 2.71±3.82mmHg (systolic pressure), with minimal differences in diastolic BP levels. CONCLUSIONS: Little difference was found between the first determination and the average of 3 automatic BP readings.

Professionals' perception of circuits of care for hypertensive or diabetic patients between primary and secondary care.

OBJECTIVE: To determine the flow of care for patients with type 2 diabetes mellitus (T2DM) and hypertension between primary care (PC) and specialized care (SC) in clinical practice, and the criteria used for referral and follow-up within the Spanish National Health System (NHS). DESIGN: A descriptive, cross-sectional, multicenter study. PLACEMENT: A probability convenience sampling stratified by number of physicians participating in each Spanish autonomous community was performed. Nine hundred and ninety-nine physicians were surveyed, of whom 78.1% (n=780) were primary care physicians (PCPs), while 11.9% (n=119) and 10.0% (n=100) respectively were specialists in hypertension and diabetes. KEY MEASUREMENTS: was conducted using two self administered online surveys. RESULTS: A majority of PCPs (63.7% and 55.5%) and specialists (79.8% and 45.0%) reported the lack of a protocol to coordinate the primary and specialized settings for both hypertension and T2DM respectively. The most widely used method for communication between specialists was the referral sheet (94.6% in PC and 92.4% in SC). The main reasons for referral to a specialist were refractory hypertension (80.9%) and suspected secondary hypertension (75.6%) in hypertensive patients, and suspicion of a specific diabetes (71.9%) and pregnancy (71.7%) in T2DM patients. CONCLUSIONS: Although results showed some common characteristics between PCPs and specialists in disease management procedures, the main finding was a poor coordination between PC and SC.

Seguimiento de la función renal y factores que influyen en su evolución en una cohorte de personas de 65 a 74 años de edad / Renal function monitoring and factors influencing its evolution in a cohort of persons aged 65-74

OBJETIVOS: Estudiar la evolución de la función renal en el anciano joven en un periodo de cuatro años. DISEÑO: Observacional, descriptivo, longitudinal. EMPLAZAMIENTO: Centro de Salud urbano. PARTICIPANTES: Población de entre 65 y 74 años asignado a un Centro de Salud. MEDICIONES PRINCIPALES: Creatinina y filtrado glomerular según CKD-EPI. Ademas, variables sociodemográficas, factores de riesgo cardiovascular y número de enfermedades crónicas y fármacos. RESULTADOS: La muestra inicial fueron 557 pacientes con un 13,1 % de pérdidas al final del estudio. Al inicio, edad media de 68,9 años, con un 55,1 % de mujeres. La creatinina media evolucionó desde 0,87 mg/dl (IC95% 0,83-0,91) a 0,94 (IC95% 0,87-0,99) (p < 0,05). El filtrado glomerular medio desde 79,1 ml/min (IC 95% 77,9-80,4) a 74,65 (IC95% 73,3-76,0) (p < 0,001), con una reducción media de 4,3 ml/min (IC 95% 3,4-5,2). En el corte inicial 10,2 % (IC95% 7,7-12,7) presentaban IRC, pasando dicha cifra al 15,3 % (IC95% 12,1-18,5) al final, encuadrándose todo el aumento en el estadio 3. En el análisis bivariante se encontró asociación entre una mayor disminución de filtrado y la presencia de HTA (p < 0,05), número de patologías (p < 0,01) y el sexo femenino (p < 0,05). Sin embargo, en el análisis multivariante sólo el sexo femenino se mantuvo con una asociación significativa (p < 0,05) y la HTA casi significativa (p < 0,1), pero con diferencias clínicamente irrelevantes. CONCLUSIONES: En ancianos jóvenes, la función renal parece presentar una muy lenta reducción a lo largo del tiempo, ligeramente superior en mujeres. Podría plantearse el espaciamento de las determinaciones de dicha función renal en la población general de este grupo de edad

OBJECTIVES: To study the evolution of renal function in younger elderly persons over a period of four years. DESIGN: Observational, descriptive, longitudinal study. SETTING: Urban health centre. PARTICIPANTS: Population between 65 and 74 years of age assigned to a health centre. MAIN MEASURES: Creatinine and glomerular filtration rate according to CKD-EPI. Also sociodemographic variables, cardiovascular risk factors, and number of chronic diseases and drugs. RESULTS: The initial sample included 557 patients, with 12.9 % loss at the end of the study. At the start, the average age was 68.9 years, with 55.1 % women. The mean creatinine evolved from 0.87 mg/dl (95% CI 0.83-0.91) to 0.94 (95%CI 0.87-0.99) (p < 0.05). The mean glomerular filtration rate evolved from 79.1 ml/min (95% CI 77.9-80.4) to 74.65 (95% CI 73.3-76.0) (p < 0.001), with an average decrease of 4.3 ml/min (95% CI 3.4-5.2). Initially, 10.2% of patients (95% CI 7.7-12.7) presented chronic kidney failure, which increased to 15.3 % (95% CI 12.1-18.5) at the end, being all the increase within stage 3.The bivariate analysis showed association between greater decline of filtration rate and presence of high blood pressure (p < 0.05), number of diseases (p < 0.01) and female sex (p < 0.05). However, in the multivariate analysis only female sex kept a significant association (p < 0.05), and high blood pressure had a nearly significant association (p < 0.1), but with clinically irrelevant differences. CONCLUSIONS: Among younger elderly patients, the renal function seems to present a very slow decline over time, which is slightly greater in women. Spacing of renal function determinations could be considered in general population of this age group

[Prevalence of tuberculosis infection among immigrants in the Toledo Health District, Spain]. / Prevalencia de infección tuberculosa en las personas inmigrantes del Area de Salud de Toledo.

BACKGROUND: The rise in the frequency of tuberculosis is due to several factors: resistance to treatment, human immunodeficiency virus infection, unemployment, poverty and migratory movements. This study is aimed at ascertaining the prevalence of tuberculosis infection among the immigrant population in the Toledo Health District. METHODS: Descriptive, cross-sectional, multi-center study conducted at the Primary Care level. The immigrants were attracted and recruited on the based of their health cards within the December 2002-September 2003 period. Mantoux intradermal reaction test was performed with 0.1 ml (2UT) of PPD RT-23, following informed consent. Other variables were collected: age, sex, weight, country of origin, work situation, BCG vaccination, number of individuals living with them, length of time residing in Europe. RESULTS: A total of 344 immigrants were included in the study, averaging 28.8 +/- 12.7 years of age. Fifty percent were females (172). They had been living in Europe for an average of 3.4 +/- 3.7 years. A total 78.8% (271) of the immigrants completed the study. The intradermal reaction was positive in 75 of them [27.7% (CI 95%: 23-32.5)]. Those immigrants showing a positive Mantoux were older (age 32.5 +/- 8.5 years) than those showing a negative result (age 27.7 +/- 13.8 years), p=0.006. Originally being from the sub-Saharan area increased the probability of showing a positive intradermal reaction. CONCLUSIONS: The immigrant population of the Toledo Health District shows a high prevalence of tuberculosis infection, which is higher than the general Spanish population. Differences exist depending upon the country of origin. These results indicate the importance of considering the Mantoux test among the preventive activities addressed toward this immigrant population.

Impacto de la guía de HTA del ACC/AHA en la frecuencia y la necesidad de tratamiento de la hipertensión arterial. Estudio RICARTO / Impact of the ACC/AHA AHT guidelines on the frequency of hypertension and the need for treatment. The RICARTO study

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Prevalencia de insuficiencia renal crónica y factores asociados en el 'anciano joven' / Prevalence of chronic kidney disease and associated factors in the "young elderly"

Objetivo. Conocer la función renal, y la posible relación de su deterioro con distintas variables, en un grupo de población de entre 65 y 74 años. Diseño. Observacional y transversal para el estudio de la prevalencia y de asociación cruzada para el estudio de las variables relacionadas con el deterioro. Participantes. Personas de 65 a 74 años adscritas a un Centro de Salud. Tamaño muestral calculado para una prevalencia estimada del 11 %, una precisión del 2 %, unas pérdidas/rechazos esperados del 10 % y un nivel de confianza del 95 %. Resultados. Población estudiada final de 388 personas (4,2 % perdidas). El filtrado glomerular (FG) medio fue de 78,86 (IC 95 %: 77,37-80,35) según CKD-EPI y de 85,15 (IC 95 %: 82,28-87,02) según MDRD-4. La prevalencia de IRC fue 11,1 % (IC 95 %: 9,2-12,9) según CKD-EPI y de 7,5 % (IC 95 %: 5,9-9,1) según MDRD-4, con un porcentaje en estadio 2 de la clasificación de la KDIGO del 63,7 % (IC 95 %: 60,9-66,6) y del 55,2 % (IC 95 %: 52,3-58,1) respectivamente. En el análisis multivariante por regresión lineal múltiple, la presencia de IRC y de reducción del FG se asociaron con mayor edad (p=0,06 y p<0,01), sexo masculino (p<0,01 en ambos casos) y consumo de mayor número de fármacos (p<0,01 y p<0,05). Conclusiones. Alta prevalencia de deterioro de la función renal en este grupo de edad, actuando la edad, el sexo y el consumo de medicamentos como factores predictores de dicho deterioro. Confirmación de la mayor sensibilidad de CKD-EPI sobre MDRD-4 para detectar deterioro (AU)

Prevalence of chronic kidney disease and associated factors in the 'young elderly' Objective. To assess the renal function in a population group, aged 65 to 74 years, and to analyse the possible relationship between declining renal function with different variables. Design. Cross-sectional observational study of prevalence and analysis of the variables involved in renal function decline. Participants. Patients, aged 65 to 74 years, assigned to a health centre. The sample size was calculated for an estimated prevalence of 11%, with 2% accuracy and expected losses / rejections of 10%, and a confidence interval of 95%. Results. Final study population included 388 people (4.2% of loss). The average glomerular filtration rate (GFR) was 78.86 (95%CI 77.37 to 80.35) according to CKD-EPI and 85.15 (95%CI 82.28 to 87.02) according to MDRD-4. The prevalence of CKD was 11.1% (95%CI 9.2 to 12.9) according to CKD-EPI and 7.5% (95%CI 5.9 to 9.1) according to MDRD-4, with a percentage of 63.7% (95%CI 60.9 to 66.6) and 55.2% (95%CI 52.3 to 58.1) respectively in stage 2 of KDIGO classification. In multivariate analysis by multiple linear regression, the presence of CKD and decrease in GFR were associated with older age (p=0.06 and p <0.01), male (p <0.01 in both cases) and a greater number of drugs consumed (p <0.01 and p <0.05). Conclusions. High prevalence of impaired renal function in this age group, with age, sex and drug use as predicting factors of declining renal function. Confirmation of the increased sensitivity of CKD-EPI over MDRD-4 to detect this deterioration (AU)

Percepción de profesionales sobre los circuitos asistenciales del paciente hipertenso o diabético entre la atención primaria y atención especializada / Professionals’ perception of circuits of care for hypertensive or diabetic patients between primary and secondary care

Objetivo: Conocer el flujo de atención entre la atención primaria y la atención especializada (AE), así como los criterios usados para la derivación y posterior seguimiento, en relación con el paciente con hipertensión arterial (HTA) y diabetes mellitus tipo 2 (DM2). Diseño: Estudio descriptivo, transversal y multicéntrico. Emplazamiento: Se realizó un muestreo probabilístico, de conveniencia y estratificado por número de médicos en cada CCAA. Participaron 999 médicos, 78,1% (n = 780) especialistas en atención primaria (EAP), 11,9% (n = 119) especialistas en hipertensión y 10,0% (n = 100) especialistas en diabetes. Mediciones principales: Se emplearon 2 formularios de recogida de datos, autoadministrados vía online. Resultados: El 63,7% y el 55,5% de los EAP y el 79,8% y el 45,0% de la AE declararon la falta de un protocolo de coordinación entre los niveles para el manejo del paciente con HTA y DM2, respectivamente. El método de comunicación más frecuentemente usado entre los niveles asistenciales fue la hoja de derivación (94,6% en EAP y 92,4% en AE). Los principales criterios de derivación al médico de AE del paciente con HTA fueron la hipertensión resistente (80,9%) y la sospecha de hipertensión secundaria (75,6%), siendo la sospecha de DM específica (71,9%) y el embarazo (71,7%) en el paciente con DM2. Conclusiones: Aunque se observaron coincidencias en algunos aspectos de la práctica clínica habitual entre ambos niveles asistenciales, las discrepancias evidenciadas mostraron una escasa coordinación entre EAP y AE (AU)

Objective: To determine the flow of care for patients with type 2 diabetes mellitus (T2DM) and hypertension between primary care (PC) and specialized care (SC) in clinical practice, and the criteria used for referral and follow-up within the Spanish National Health System (NHS). Design: A descriptive, cross-sectional, multicenter study. Placement: A probability convenience sampling stratified by number of physicians participating in each Spanish autonomous community was performed. Nine hundred and ninety-nine physicians were surveyed, of whom 78.1% (n = 780) were primary care physicians (PCPs), while 11.9% (n = 119) and 10.0% (n = 100) respectively were specialists in hypertension and diabetes. Key measurements: was conducted using two self administered online surveys. Results: A majority of PCPs (63.7% and 55.5%) and specialists (79.8% and 45.0%) reported the lack of a protocol to coordinate the primary and specialized settings for both hypertension and T2DM respectively. The most widely used method for communication between specialists was the referral sheet (94.6% in PC and 92.4% in SC). The main reasons for referral to a specialist were refractory hypertension (80.9%) and suspected secondary hypertension (75.6%) in hypertensive patients, and suspicion of a specific diabetes (71.9%) and pregnancy (71.7%) in T2DM patients. Conclusions: Although results showed some common characteristics between PCPs and specialists in disease management procedures, the main finding was a poor coordination between PC and SC (AU)

Introducción: Abordaje de factores de riesgo cardiovacular en el anciano / No disponible

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Introducción: Revisión de las últimas guías de patología cardiometabólica. Introducción / No disponible

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Diferencias de presión arterial entre una toma y la media de 3 tomas medidas automáticamente. Estudio SPRINT / Blood pressure differences between one automatic measurement and the mean value of 3 automatic measurements. SPRINT trial

Fundamento y objetivos: Existe discrepancia sobre cómo medir la presión arterial (PA). El objetivo de este trabajo fue estudiar la diferencia entre una determinación y la media de 3 determinaciones automáticas de la PA. Pacientes y método: Se utilizan 2 poblaciones de pacientes: una muestra poblacional (n=1.337) en la que la medición se realiza por una enfermera en el centro de salud, y una serie consecutiva de pacientes en los que se realiza delante del médico, en la consulta (n=200). Resultados: Las diferencias halladas entre la primera lectura y el promedio de 3 determinaciones son pequeñas en ambos casos. En la muestra poblacional oscila entre 2,07-3,21mmHg y en los pacientes en los que se determina en presencia del médico, es de 2,71±3,82mmHg en la sistólica, con mínimas diferencia en la PA diastólica. Conclusiones: En la determinación automática de la PA, existe escasa diferencia entre la primera determinación y el promedio de 3 lecturas (AU)

Background and objectives: There are discrepancies regarding how to measure blood pressure (BP). The goal of this study was to determine the differences between one automatic BP measurement and the mean of 3 automatic BP measurements. Patients and method: Two patient populations were used. A sample population (n=1,337) in which the measurement was performed by a nurse at the health center, and a consecutive series of patients (n=200) who had the measurement performed in front of the doctor in the office. Results: The differences found between the first reading and the average of 3 determinations were small in both cases. In the population sample, BP levels ranged from 2.07 to 3.21mmHg, and in patients who had their BP levels measured in the presence of doctor, this value ranged from 2.71±3.82mmHg (systolic pressure), with minimal differences in diastolic BP levels. Conclusions: Little difference was found between the first determination and the average of 3 automatic BP readings (AU)

Doctor, no tengo cita. ¿Podría atenderme? / Doctor, I don’t have an appointment. Can you see me?

Un paciente sin cita es algo muy frecuente en Atención Primaria (AP) y puede llegar a ser problemático. Estos pacientes ponen a prueba al Médico de Familia, ya que ha de saber valorar si la consulta no debe demorarse, a la vez que ha de hacer educación sanitaria, para que los pacientes sigan los cauces habituales para la demanda de atención. Invitamos a la reflexión y mostramos que no por ser una consulta de última hora tiene menos importancia, por lo que hemos de dedicarle el tiempo necesario para llevar a cabo una entrevista clínica correcta y hacer un diagnóstico diferencial, descartando patologías de gran importancia que pudiera presentar nuestro último paciente de la mañana (AU)

A patient without an appointment is quite a common occurrence in Primary Health care, and can be a problem. These patients test the family doctor, as he/she has to be able to judge whether the appointment should, or should not, be delayed, while at the same time giving healthcare education, so that the patients learn to follow the usual channels to obtain care. We invite reflection and show that in spite of being a last-minute consultation, it is no less important, which is why we should dedicate the necessary time to carry out a proper clinical interview and make a differential diagnosis, ruling out any important pathologies which our last patient of the morning could be suffering from (AU)

El rol de Cuidador de personas dependientes y sus repercusiones sobre su calidad de vida y su salud / The caregiver burden and its repercussions on quality of life and health

Objetivo. Conocer la sobrecarga sentida por los cuidadores y las repercusiones que este rol representa sobre su calidad de vida, su salud en las esferas física, psíquica y social y su necesidad de utilización de los recursos sanitarios (frecuentación). Diseño. Estudio observacional y analítico de casos y controles Emplazamiento. Centro de salud de características urbanas. Participantes. El grupo de estudio fue formado por 156 cuidadores principales y el grupo control por 156 personas adscritas al centro de salud que no realizaban funciones de cuidador principal, emparejadas por edad, sexo y número de patologías crónicas padecidas. Mediciones. Características clínicas y sociodemo gráficas, datos relativos al rol de cuidador (parentesco, tiempo de desempeño del rol de cuidador, etc.), sobrecarga del cuidador (escala de Zarit), frecuentación, salud percibida, calidad de vida subjetiva (cuestionario de salud de Nottingham), presencia de sintomatología, ansiedad y depresión (EADG-18), función familiar (APGAR familiar y apoyo social percibido (cuestionario de Duke-UNC).Resultados. El 66,4% de los cuidadores presentaba sobrecarga en el test de Zarit. El 48,1% los cuidadores respondió que su salud era mala o muy mala, frente al 31,4% del grupo control (OR = 2,02; IC 95%: 1,27 - 3,21). La frecuentación media en el último año fue de 8,37 visitas/año en el grupo de cuidadores y de 7,12 visitas/año en el grupo control (p<0,01). Se observó una mayor prevalencia de ansiedad y depresión en el grupo de cuidadores, así como una mayor frecuencia de posible disfunción familiar y de sensación de apoyo social insuficiente. Conclusiones. Los resultados indican la necesidad de actuaciones multidisciplinarias encaminadas a apoyar a los cuidadores tanto de forma preventiva como de soporte (AU)

Objective. To determine caregiver burden and its repercussions on quality of life, physical and mental health and social life and the use for healthcare resources (frequency).Design. Observational, analytical, case control study. Setting. Primary Health Care Centre in an urban setting. Participants. The case group was made up of 156 primary caregivers and the control group of 156personas assigned to the Primary Health Care Centre who were not primary care givers. They were paired by age, gender and number of chronic diseases. Measurements. Clinical and socio-demographic characteristics, caregiver role characteristics (kinship, time performing role of caregiver, etc.), caregiver burden (Zarit scale), frequency, perceived health, subjective quality of life (Nottingham Health Profile), presence of anxiety and depression symptoms(GADS-18), family functioning (Family APGAR) and perception of family and social support (Duke-UNC questionnaire).Results. According to the Zarit scale, burden was present in 66.4% of caregivers. Compared to31.4% of persons in the control group, 48.1% of caregivers considered their health was poor or very poor (OR = 2.02; 95% CI: 1.27 – 3.21). The mean frequency in the last year was 8.37 visits/year in the caregiver group and 7.12 visits/year in the control group (p<0.01). A higher prevalence of anxiety and depression was observed in the caregiver group, and a greater frequency of possible family dysfunction and sensation of insufficient social support. Conclusions. The results indicate the need for multidisciplinary supportive and preventive interventions for caregivers. Such interventions have obtained positive results in several aspects both for the caregiver and the person cared for person. These interventions need to be adapted to the specific characteristics and needs of each caregiver (AU)

Inercia terapéutica en pacientes hipertensos asistidos en atención primaria en España. Estudio Objetivo Kontrol / Objective KONTROL study: therapeutic inertia in hypertensive patients attended in primary care of Spain

ObjetivosConocer el grado de inercia terapéutica (IT) y determinar los factores asociados al paciente, médico y organización sanitaria en pacientes hipertensos asistidos en atención primaria (AP).DiseñoEstudio transversal y multicéntrico.EmplazamentoMuestra de Equipos de AP de toda España.ParticipantesEl estudio fue realizado entre médicos de AP mediante un cuestionario y registro clínico de 4 pacientes.Mediciones principalesSe calculó la IT para cada paciente (ITp) como la proporción de visitas en las que no se produce un cambio en la medicación cuando está indicado.ResultadosUn total de 543 médicos aportaron datos de 2.032 pacientes, que cumplían el requisito de indicación de cambio, en el 77,8% de los casos se actuó con IT. La ITp observada fue inexistente o baja para el 17,1% de los pacientes, intermedia para el 42% y alta para el 40,8%. Los factores, relativos a los pacientes, que más se asociaron con la ITp alta fueron la edad (p<0,001), diabetes (p<0,001), ictus (p<0,01), obesidad (p<0,01) y el nivel bajo de estudios (p<0,001). Ser mujer, tener menos de 45 años o más de 55, ser médico de familia con un programa de formación diferente al MIR y trabajar en el sector público aumentaron la probabilidad de ITp (p<0,001 para todos los supuestos).ConclusionesLos resultados del estudio indican que en 7 de cada 10 visitas realizadas por pacientes hipertensos en AP se produce IT. Existen diferencias importantes en función de las características clínicas de los pacientes, de los médicos y de las consultas(AU)

ObjectivesTo determine the level of therapeutic inertia (TI), and the factors associated to the patient, doctor and the health organisation, in hypertensive patients treated in Primary Care (PC).DesignCross-sectional, multicentre study.SettingA sample of PC Teams from all over Spain.ParticipantsThe study was conducted among PC doctors using a questionnaire and clinical records of 4 patients.Main measurementsThe TI was calculated for each patient (TIp) as the proportion of visits in which there was no change in medication when this was indicated.ResultsA total of 543 PC doctors provided data on 2,032 patients, who fulfilled the indication of a change in requirement. There was TI In 77.8% of cases. The TIp observed was non-existent or low for 17.1% of the patients, intermediate for 42% and high for 40.8%. For the patients, the factors most associated with TIp were, age (P<.001), diabetes (P<.001), stroke (P<.01), obesity (P<.01) and a low education level (P<.001). To be female, be less than 40years or more than 55years, to be a family doctor with a training program other than MIR and to work in the public sector increased the probability of TIp (P<.001 for all the assumptions).ConclusionsThe results of the study indicate that there is TI in 7 out every 10 visits made by hypertensive patients in Primary care. There are significant differences as regards the clinical characteristics of the patients and of the doctors(AU)

Prevalencia de infección tuberculosa en las personas inmigrantes del área de salud de Toledo / Prevalence of tuberculosis infection among immigrants in the Toledo Health District, Spain

Fundamento: El aumento en la frecuencia de tuberculosis (TB) se produce por varios factores: resistencias al tratamiento, la infección por el virus de la inmunodeficiencia humana, el paro, la pobreza y los movimientos migratorios. El objetivo del estudio fue conocer la prevalencia de infección tuberculosa en población inmigrante del Área de Salud de Toledo. Métodos: Estudio descriptivo, transversal y multicéntrico con emplazamiento en Atención Primaria. La captación y reclutamiento de las personas inmigrantes se realizó sobre base de tarjeta sanitaria, entre diciembre de 2002 y septiembre de 2003. Se realizó intradermorreacción de Mantoux (IDRM), con 0,1 ml (2UT) de PPD RT-23, previa firma del consentimiento informado. Otras variables recogidas fueron: edad, sexo, peso, país de origen, situación laboral, vacunación BCG, número de convivientes, tiempo de residencia en Europa. Resultados: Fueron incluidos 344 inmigrantes, con una edad media de 28,8±12,7 años. El 50% (172) eran mujeres. Llevaban un promedio de 3,4±3,7 años de residencia en Europa. El 78,8% (271) de las personas inmigrantes completaron el estudio. La IDRM fue positiva en 75 de ellos [27,7% (IC 95%: 23,1-32,5)]. Los inmigrantes con Mantoux positivo tenían más edad (32,5± 8,5 años) frente a (27,7 ± 13,8 años) en los que el resultado fue negativo, p=0,006. El origen subsahariano aumentaba la probabilidad de presentar IDRM positiva. Conclusiones: La población inmigrante del Área de Salud de Toledo presenta una prevalencia alta de infección tuberculosa, superior a la población general española. Existen diferencias según el país de origen. Estos resultados indican la importancia de considerar la prueba de Mantoux (AU)

Background: The rise in the frequency of tuberculosis is due to several factors: resistance to treatment, human immunodeficiency virus infection, unemployment, poverty and migratory movements. This study is aimed at ascertaining the prevalence of tuberculosis infection among the immigrant population in the Toledo Health District. Methods: Descriptive, cross-sectional, multicenter study conducted at the Primary Care level. The immigrants were attracted and recruited on the based of their health cards within the December 2002-September 2003 period. Mantoux intradermal reaction test was performed with 0.1 ml (2UT) of PPD RT-23, following informed consent. Other variables were collected: age, sex, weight, country of origin, work situation, BCG vaccination, number of individuals living with them, length of time residing in Europe. Results: A total of 344 immigrants were included in the study, averaging 28.8 ± 12.7 years of age. Fifty percent were females (172). They had been living in Europe for an average of 3.4±3.7 years. A total 78.8% (271) of the immigrants completed the study. The intradermal reaction was positive in 75 of them [27.7% (CI 95%: 23.- 32.5)]. Those immigrants showing a positive Mantoux were older (age 32.5 ± 8.5 years) than those showing a negative result (age 27.7 ± 13.8 years), p=0.006. Originally being from the sub-Saharan area increased the probability of showing a positive intradermal reaction. Conclusions: The immigrant population of the Toledo Health District shows a high prevalence of tuberculosis infection, which is higher than the general Spanish population. Differences exist depending upon the country of origin. These results indicate the importance of considering the Mantoux test among the preventive activities addressed toward this immigrant population (AU)