[ARAPOC Study: Prevalence of respiratory symptoms and chronic obstructive pulmonary disease in the general population]. / Estudio ARAPOC: prevalencia de síntomas respiratorios y enfermedad obstructiva crónica en población general.

OBJECTIVE: The aim of this study was to determine the prevalence of respiratory symptoms and COPD, as well as the characteristics of this population in Aragon (Spain). DESIGN AND LOCATION: It is a cross-sectional epidemiological study in a population between 40 and 75 years of age. Subjects were randomly selected and stratified by age and sex using the data from the health card of the Aragonese Health Service. PARTICIPANTS: A total of 1185 subjects agreed to participate. MAIN MEASUREMENTS: A sociodemographic questionnaire and spirometry before and after bronchodilator test. The diagnosis of COPD was made according to the criteria of the GOLD guide (FEV1/FVC<0.7). RESULTS: COPD prevalence was 10.4%, 16.9% in men and 5.7% in women. Respiratory symptoms appeared in 58% of the general population. There was a higher prevalence of COPD in women than in other studies. Factors associated with developing COPD were, being male, increasing age, smoking more, and a lower education. More than three-quarters (78.9%) of COPD were not diagnosed. Diagnosis was associated with, being older, more smoking more, more severe COPD or poorer quality of life. CONCLUSIONS: The high prevalence of COPD and the significant level of underdiagnoses lead to believe that early diagnosis of this disease is still a pending issue. New strategies need to be developed to resolve this problem.

[Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension]. / Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca.

OBJECTIVE: To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). DESIGN: Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. SETTING: Four primary health care centres. PARTICIPANTS: A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. METHODS: The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). RESULTS: Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P< .001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). CONCLUSIONS: The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP.

Estudio ARAPOC: prevalencia de síntomas respiratorios y enfermedad obstructiva crónica en población general / ARAPOC Study: Prevalence of respiratory symptoms and chronic obstructive pulmonary disease in the general population

OBJETIVO: El objetivo de este trabajo fue conocer la prevalencia de síntomas respiratorios y de EPOC, así como las características de esta población en Aragón (España). Diseño y emplazamiento: Estudio epidemiológico, transversal, en población entre 40 y 75 años. Los sujetos fueron elegidos de forma aleatoria y estratificada por edad y sexo a partir de los datos de la tarjeta sanitaria del Servicio Aragonés de Salud. PARTICIPANTES: Un total de 1.185 sujetos aceptaron colaborar. MEDICIONES PRINCIPALES: Un cuestionario sociodemográfico y clínico y espirometría forzada antes y después de una prueba broncodilatadora. El diagnóstico de EPOC se realizaba según los criterios de la guía GOLD (cociente FEV1/CVF < 0,7). RESULTADOS: La prevalencia de EPOC alcanzó un 10,4% (IC: 9,8-11,0%), un 16,9% en hombres y un 5,7% en mujeres. Los síntomas respiratorios aparecieron en un 58% de la población general. Existía mayor prevalencia de EPOC en las mujeres que en otros estudios. Los factores asociados a desarrollar EPOC fueron ser hombre, tener más edad, mayor índice tabáquico y menor nivel de estudios. El 78,9% de los pacientes con EPOC no estaban diagnosticados. Los diagnosticados fueron de más edad, más fumadores, con EPOC más graves o con peor calidad de vida. CONCLUSIONES: La alta prevalencia de EPOC y el importante nivel de infradiagnóstico nos permite creer que el diagnóstico precoz de esta enfermedad es todavía una asignatura pendiente. Necesitamos desarrollar nuevas estrategias para atajar este problema

OBJECTIVE: The aim of this study was to determine the prevalence of respiratory symptoms and COPD, as well as the characteristics of this population in Aragon (Spain). Design and LOCATION: It is a cross-sectional epidemiological study in a population between 40 and 75 years of age. Subjects were randomly selected and stratified by age and sex using the data from the health card of the Aragonese Health Service. PARTICIPANTS: A total of 1185 subjects agreed to participate. MAIN MEASUREMENTS: A sociodemographic questionnaire and spirometry before and after bronchodilator test. The diagnosis of COPD was made according to the criteria of the GOLD guide (FEV1/FVC<0.7). RESULTS: COPD prevalence was 10.4%, 16.9% in men and 5.7% in women. Respiratory symptoms appeared in 58% of the general population. There was a higher prevalence of COPD in women than in other studies. Factors associated with developing COPD were, being male, increasing age, smoking more, and a lower education. More than three-quarters (78.9%) of COPD were not diagnosed. Diagnosis was associated with, being older, more smoking more, more severe COPD or poorer quality of life. CONCLUSIONS: The high prevalence of COPD and the significant level of underdiagnoses lead to believe that early diagnosis of this disease is still a pending issue. New strategies need to be developed to resolve this problem

Respuesta de los autores: Medicina familiar y comunitaria y la enfermedad pulmonar obstructiva crónica / Author's reply: Family and community medicine and chronic obstructive pulmonary disease

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Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca / Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension

Objetivo. Describir las variaciones que se producen en el rendimiento de la automedida de la presión arterial domiciliaria (AMPAd) al emplear diferentes sistemas para calcular la media, en el diagnóstico de la hipertensión de bata blanca (HBB). Diseño. Estudio multicéntrico, descriptivo y comparativo para evaluar el rendimiento diagnóstico de una prueba. Emplazamiento. Cuatro centros de atención primaria. Participantes. Se seleccionó a 157 pacientes con hipertensión leve-moderada, recién diagnosticados y sin tratamiento farmacológico, que presentaron las 18 lecturas de AMPAd. Métodos. A cada paciente se le realizó una AMPAd (3 días consecutivos con lecturas por triplicado mañana-noche) y una monitorización ambulatoria de la presión arterial (MAPA) empleado, como prueba de referencia. Resultados. Los valores de presión arterial sistólica y diastólica del primer día y de la primera lectura (mañana-noche) eran mayores que los restantes días y lecturas (tendencia lineal p < 0,001). Al emplear todas las lecturas para calcular la media los parámetros de rendimiento diagnóstico obtenidos fueron: sensibilidad (S) 47,6%, especificidad (E) 77,4%, valores predictivos positivo y negativo 58,8 y 68,6%, coeficientes de probabilidad positivo y negativo (CPP y CPN) 2,10 y 0,67, respectivamente. Al eliminar las lecturas con mayor reacción de alerta (primer día y primera lectura mañana-noche) se incrementaba la S (61,9%) a expensas de un descenso excesivo de la E (64,5%), sin que mejorara el CPP (1,74). Conclusiones. La AMPAd en el diagnóstico de la HBB obtiene un bajo rendimiento que no mejora con el empleo de diferentes sistemas para calcular la media de presión arterial

Objective. To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). Design. Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. Setting. Four primary health care centres. Participants. A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. Methods. The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). Results. Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P<.001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). Conclusions. The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP