Prevalence of obesity and associated cardiovascular risk: the DARIOS study.

BACKGROUND: To estimate the prevalence of overweight and obesity in the Spanish population as measured with body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) and to determine the associated cardiovascular risk factors. METHODS: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. Participants aged 35-74 years were asked about the history of cardiovascular diseases, hypertension, diabetes and hypercholesterolemia. Height, weight, WC, blood pressure, glycaemia, total cholesterol, low-density and high-density lipoprotein cholesterol and coronary risk were measured. The prevalence of overweight (BMI 25-29.9 kg/m(2)), general obesity (BMI ≥ 30 kg/m(2)), suboptimal WC (≥ 80 cm and < 88 in women, ≥ 94 and < 102 in men), abdominal obesity (WC ≥88 cm ≥102 cm in women and men, respectively) and WHtR ≥0.5 was estimated, standardized for the European population. RESULTS: We included 28,743 individuals. The prevalence of overweight and suboptimal WC was 51% and 30% in men and 36% and 22% in women, respectively; general obesity was 28% in both sexes and abdominal obesity 36% in men and 55% in women. The prevalence of WHtR ≥0.5 was 89% and 77% in men and women, respectively. All cardiovascular risk factors were significantly associated with abnormal increased values of BMI, WC and WHtR. Hypertension showed the strongest association with overweight [OR = 1.99 (95% confidence interval 1.81-2.21) and OR = 2.10 (1.91-2.31)]; suboptimal WC [OR = 1.78 (1.60-1.97) and OR = 1.45 (1.26-1.66)], with general obesity [OR = 4.50 (4.02-5.04), and OR = 5.20 (4.70-5.75)] and with WHtR ≥0.5 [OR = 2.94 (2.52-3.43), and OR = 3.02 (2.66-3.42)] in men and women respectively, besides abdominal obesity in men only [OR = 3.51 (3.18-3.88)]. Diabetes showed the strongest association with abdominal obesity in women [OR = 3,86 (3,09-4,89). CONCLUSIONS: The prevalence of obesity in Spain was high. Overweight, suboptimal WC, general, abdominal obesity and WHtR ≥0.5 was significantly associated with diabetes, hypertension, hypercholesterolemia and coronary risk. The use of lower cut-off points for both BMI and particularly WC and could help to better identify the population at risk and therefore achieve more effective preventive measures.

Impact of the "Tobacco control law" on exposure to environmental tobacco smoke in Spain.

BACKGROUND: The initial evaluations of the introduction of legislation that regulates smoking in enclosed public places in European countries, describe an important effect in the control of exposure to environmental tobacco smoke. However, the evidence is still limited. The objective of this study is to estimate the short-term effects of the comprehensive "Tobacco control law" introduced in Spain on January 2006, which includes a total ban of smoking in workplaces and a partial limitation of smoking in bars and restaurants. METHODS: Cross-sectional, population-based study. The self-reported exposure to environmental tobacco smoke at home, at work, in bars and restaurants of the population aged 18 to 64 years in the Madrid Region during a period prior to the law (October and November 2005; n = 1750) was compared to that of the period immediately after the law came into force (January-July 2006; n = 1252). Adjusted odds ratios (OR) were calculated using logistic regression models. RESULTS: Passive exposure to tobacco smoke at home has hardly changed. However, at indoor workplaces there has been a considerable reduction: after the law came into force the OR for daily exposure > 0-3 hours versus non-exposure was 0.11 (95% CI: 0.07 to 0.17) and for more than 3 hours, 0.12 (95% CI: 0.09 to 0.18). For fairly high exposure in bars and restaurants versus non-exposure, the OR in the former was 0.30 (95% CI: 0.20 to 0.44) and in the latter was 0.24 (95% CI: 0.18 to 0.32); for very high exposure versus non-exposure they were 0.16 (95% CI: 0.10 to 0.24) and 0.11 (95% CI: 0.07 to 0.19), respectively. These results were similar for the smoking and non-smoking populations. CONCLUSION: A considerable reduction in exposure to environmental tobacco smoke in the workplace and, to a lesser extent, in bars and restaurants, is related to the implementation of the "Tobacco control law". Although only initial figures, these results already demonstrate the effectiveness of strategies that establish control measures to guarantee smoke-free places.

[Risk factor treatment and control in relation to coronary disease risk in the Spanish population of the DARIOS Study]. / Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS.

INTRODUCTION AND OBJECTIVES: The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. METHODS: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure < 140/90 mm Hg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. RESULTS: We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P<.001), 66% and 69% respectively, of patients with diabetes (P=.03), and 39% and 42% respectively, of those with hypercholesterolemia (P<.001). Control was good in 34% of men and 42% of women with hypertension (P<.001); 65% and 63% respectively, of those with diabetes (P=.626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P=.092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P<.001). The proportion of uncontrolled participants increased with coronary risk (P<.001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥ 10% coronary risk than to men (59% vs. 50%, P = 0,024). [corrected] CONCLUSIONS: The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.

Factores asociados al sobrepeso, la obesidad general y la obesidad abdominal en la población adulta de la Comunidad de Madrid, Spain. Estudio PREDIMERC / Factors associated with overweight, general obesity and abdominal obesity in the Madrid Community's adult population. Study PREDIMERC

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Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS / Risk factor treatment and control in relation to coronary disease Risk in the spanish population of the DARIOS study

Introducción y objetivos. Tratar y controlar los factores de riesgo cardiovascular es una estrategia fundamental de prevención primaria. El objetivo es analizar la proporción de población de prevención primaria de 35-74 años tratada y controlada, según niveles de riesgo coronario. Métodos. Análisis agrupado con datos individualizados de 11 estudios poblacionales de la primera década del siglo xxi . Se utilizaron cuestionarios estandarizados y medidas de presión arterial, glucohemoglobina y perfil lipídico. Se consideró buen control con presión arterial<140/90mmHg, glucohemoglobina < 7% y en la hipercolesterolemia con dos criterios: Sociedades Europeas y Programa de Actividades Preventivas y Promoción de la Salud. Resultados. Se incluyó a 27.903 participantes (el 54% mujeres). Recibían tratamiento farmacológico el 68 y el 73% de los varones y las mujeres con antecedentes de hipertensión, respectivamente (p<0,001), el 66 y el 69% de los diabéticos (p=0,03) y el 39 y el 42% de los hipercolesterolémicos (p<0,001). Tenían buen control el 34 y el 42% de los varones y las mujeres con hipertensión (p<0,001), el 65 y el 63% de los diabéticos (p=0,626), el 2 y el 3% de los hipercolesterolémicos según Sociedades Europeas (p=0,092) y el 46 y el 52% según Programa de Actividades Preventivas y Promoción de la Salud (p<0,001). La proporción de participantes no controlados aumentó con el riesgo coronario (todos, p<0,001), excepto en los varones diabéticos. Las mujeres con riesgo coronario ≥ 10% recibían más tratamiento hipolipemiante que los varones (el 59 frente al 50%; p<0,024). Conclusiones. La proporción de personas con buen control es del 65% en el mejor de los casos. Los criterios de control de la hipercolesterolemia de las Sociedades Europeas apenas se alcanzan. El tratamiento hipolipemiante no se prioriza en personas de riesgo coronario alto (AU)

Introduction and objectives. The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. Methods. Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. Results. We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P<.001), 66% and 69% respectively, of patients with diabetes (P=.03), and 39% and 42% respectively, of those with hypercholesterolemia (P<.001). Control was good in 34% of men and 42% of women with hypertension (P<.001); 65% and 63% respectively, of those with diabetes (P=.626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P=.092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P<.001). The proportion of uncontrolled participants increased with coronary risk (P<.001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P<.024). Conclusions. The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk (AU)

Evaluación de la calidad de la respuesta telefónica en los teléfonos de cita previa de los centros de salud de un área sanitaria / Evaluation of the quality of telephone responses to calls seeking appointments in the health centers of a health district

Objetivo: Evaluar la calidad de la respuesta telefónica a través de criterios de accesibilidad y saludo adecuado en las llamadas a los teléfonos de cita previa de los centros de salud (CS) del Área 4 de Madrid. Métodos: Estudio descriptivo transversal realizado en junio de 2001 en los 21 CS del área. Se efectuaron llamadas telefónicas distribuidas en días laborables en 12 tramos horarios. Se analizó la obtención de respuesta con la primera llamada y antes de la cuarta, así como el saludo adecuado al descolgar el teléfono. Resultados: Se realizaron 4.058 intentos de comunicación, con una media de 2,1 llamadas por intento. Se obtuvo respuesta telefónica con la primera llamada en un 52,2 por ciento y antes de la cuarta llamada en un 72,8 por ciento. En ambos casos se hallaron diferencias significativas entre los turnos de mañana y tarde (p < 0,001) y entre el miércoles, jueves y viernes respecto al martes (p < 0,001). El cumplimiento del saludo adecuado al descolgar el teléfono fue del 85,6 por ciento (68,7 por ciento en el turno de mañana y 96,3 por ciento en el de tarde; p < 0,001).En ambos turnos 3 centros presentaron valores inferiores a la media del área menos 3 desviaciones estándar. Conclusiones: En general, la accesibilidad y el saludo inicial son aceptables. Sin embargo, existen grandes variaciones de resultados entre los centros, lo que requiere un análisis de causas y propuestas de mejora (AU)

Análisis de las reclamaciones presentadas en un áreade atención primaria / Analysis of complaints in a Primary Health Care District

Objetivo: Analizar las características de las reclamaciones presentadas durante el año 2001 en los centros de salud del Área IV de Atención Primaria del INSALUD, Madrid. Métodos: Estudio de tipo descriptivo. Resultados: Se incluyeron 1.234 reclamaciones, lo que supone 2,36 reclamaciones por 1.000 habitantes y año. La edad media (desviación estándar [DE]) del reclamante fue de 42 (15,07) años. El 65 por ciento de las reclamaciones fue presentado por mujeres. El tiempo medio de contestación fue de 12,9 (6,58) días, el 97,3 por ciento de las mismas en menos de 30 días. El médico de familia fue el profesional que recibió más reclamaciones (47,5 por ciento), y el motivo más frecuente fue el desacuerdo con el proceso asistencial (20,3 por ciento). El 59,6 por ciento de las reclamaciones se resolvió informando sobre el funcionamiento del sistema. Conclusiones: El sistema de reclamaciones de los usuarios de atención primaria es un medio accesible y fácil para exponer opiniones e insatisfacciones. Así, el análisis de las reclamaciones es un valioso instrumento para identificar y corregir los fallos del sistema (AU)