[Mortality and associated factors of patients with complex chronic diseases in rural and social transformation areas in Andalusia]. / Mortalidad y factores asociados de los pacientes con enfermedades crónicas complejas del ámbito rural y zonas de transformación social en Andalucía.

OBJECTIVE: To determine one-year mortality and associated factors in patients with complex chronic diseases (CCP) in rural health centres and social transformation needs areas (STNA) in Primary Health Care (PHC) in Andalusia. MATERIAL AND METHODS: Design: 1-Year longitudinal observational prospective open study. SETTING: 40 health centre. SUBJECTS: consenting subjects over 18yr according multiple health condition criteria. SAMPLE SIZE: 814 subjects (confidence interval 95%, alpha risk 0.03%, p=.2; 20% of sample increase due to possible losses). End-point: 1-year Mortality. INDEPENDENT VARIABLES: socio-demographic, socio-familial, clinical, functional (Barthel Index -BI-, Lawton-Brody Index), cognitive (Pfeiffer Test), prescribed drugs, social healthcare resources consumption, and quality of life (EQ-5D). DATA SOURCE: Interview and computerised clinical history Results: A total of 832 CCP were included (48.8% women). One-year mortality was 17.8% (n=148). Logistic regression model for mortality included: aged 85 and over, having a caregiver, haemoglobin level less 10g/L, hospital admission in last year, BI under 60 points, and active neoplasia. The calibration obtained from model was good (p=.85 in the Hosmer-Lemeshow goodness-of-fit test), and the discrimination power also good (AUC=0.772 [0.68-0.77] in ROC curve). CONCLUSIONS: 1-year mortality of CCP in rural centres and STNA in PHC was 17.8%. Knowledge of the factors related to the mortality of CCP helps to approach the needs and social-health resources management.

[Prevalence of hyperalphalipoproteinemia in the general population]. / Prevalencia de las hiperalfalipoproteinemias en población general.

BACKGROUND: Hypercholesterolemia is often incorrectly treated with no normal consensus being followed. The same occurs with hyperalphalipoproteinemias (HAL). The aim of the present was to know the prevalence of HAL in a sample of an adult general population and the theoretical percentage of the same which would be treated as hypercholesterolemia if the above cited entity is not appropriately diagnosed. METHODS: A transversal study (November 1991-March 1992) was performed selecting a randomized sample representative of the adult population (13,224 individuals) from a basic health area (municipal census of 1991), and was stratified by groups of age and sex. The final sample was of 802 individuals who underwent anamnesis and in whom total cholesterol (TC), total triglycerides (TG), cHDL and cLDL were determined. In agreement with the percentile 90 of the results of the Lipid Research Clinic Programs for each group of age and sex with normal number of cLDL (3.84 mmol/l, < 150 mg/dl) and TG (2.27 mmol/l, < 200 mg/dl) the percentage of the population with HAL was established. The theoretical percentage of the population which would be treated as hypercholesterolemia was found following the recommendations of the Spanish consensus without the cHDL and cLDL being calculated. RESULTS: The prevalence of HAL was 7.8%, 92% being primary and 7.9 secondary. By ages the greatest frequency appeared in the group of 20-29 years (15.8%) and 30-39 years (8.4%) with male predominance (9%) with respect to females (6.8%). 63.5% had hypercholesterolemia. Treatment would be recommended to 661 individuals without need. CONCLUSIONS: Hyperalphalipoproteinemia is a frequent entity in general population. Correct diagnosis would avoid unnecessary treatment in 5% of the population. The determination of cHDL is required before any hypolipemic treatment is initiated.