Perspectiva de los médicos de atención primaria sobre el manejo de la dislipemia en pacientes sin enfermedad cardiovascular aterosclerótica: estudio transversal

Antecedentes: un alto porcentaje de pacientes con dislipemia no alcanza los objetivos terapéuticos de colesterol unido a lipoproteínas de baja densidad (C-LDL) en el nivel primario de atención. Objetivo: Describir el manejo terapéutico de la dislipemia en pacientes sin enfermedad cardiovascular aterosclerótica (ECA) establecida, desde la perspectiva del médico de atención primaria en España. Material y Métodos: Estudio transversal mediante encuesta electrónica dirigida a médicos de atención primaria para explorar su manejo terapéutico farmacológico de la dislipemia en pacientes sin ECA, que se centraba en su conocimiento y adherencia a las guías de la Sociedad Europea de Cardiología/Sociedad Europea de Aterosclerosis (ESC/AES) de 2019 y su perspectiva con respecto a las barreras para alcanzar los objetivos de C-LDL. Resultados: Un total de 279 médicos de atención primaria completaron la encuesta. La mayoría (80,65%) afirmaron que ya habían adoptado las guías de la ESC/EAS de 2019 en su práctica. Sin embargo, alrededor del 30% seguía los objetivos terapéuticos de las guías anteriores (2016) y muchos trataban a sus pacientes con estatinas en monoterapia y dosis menores a la máxima tolerada. Adicionalmente un 50,18% era poco adherente a las guías de la ESC/EAS de 2019, especialmente al algoritmo de tratamiento. Las barreras más importantes para alcanzar los objetivos de C-LDL eran la subestimación del riesgo cardiovascular y la reticencia a aumentar la dosis o a utilizar terapia combinada. Conclusiones: Aunque los médicos de atención primaria afirman que seguían las guías ESC/EAS de 2019, los resultados indican que no las habían integrado completamente en su práctica clínica.

Background: Evidence suggests many dyslipidemic patients do not reach target low-density lipoprotein and cholesterol (LDL-C) levels in primary health care. Objective: We aimed to describe the pharmacologic therapeutic management of dyslipidemia in patients without established atherosclerotic cardiovascular diseases (ASCVD) from the primary care physician's perspective in Spain. Material and Methods: We conducted a cross-sectional study through an online survey directed to primary care physicians to explore their therapeutic management of dyslipidemia in patients without ASCVD, focusing on their knowledge and adherence to the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines and their perspective concerning the barriers to achieving LDL-C therapeutic targets. Results: In total, 279 primary care physicians completed the survey. Most interviewees (80.65%) stated they had already adopted the 2019 ESC/EAS guidelines in their clinical practice. Nevertheless, around 30% adhered to therapeutic targets by previous ESC/EAS guidelines (2016), and most treated their patients mainly with statins in monotherapy, prescribing doses below the maximum tolerated. Additionally, 50.18% were classified as low adherence to the 2019 ESC/EAS guidelines, especially to the treatment algorithm. According to the physicians, the underestimation of patients' cardiovascular risk and the reluctance to increase doses or use combined therapy were the most critical barriers to achieving LDL-C targets. Conclusions: Although primary care physicians in our survey reported adherence to the 2019 ESC/EAS guidelines recommendations, our observations indicate they need to integrate them better into their clinical practice.

[Perspective of primary care physicians on the management of dyslipidaemia in patients without atherosclerotic cardiovascular disease: a cross-sectional study]. / Perspectiva de los médicos de atención primaria sobre el manejo de la dislipemia en pacientes sin enfermedad cardiovascular aterosclerótica: estudio transversal.

BACKGROUND: Evidence suggests many dyslipidemic patients do not reach target low-density lipoprotein and cholesterol (LDL-C) levels in primary health care. OBJECTIVE: We aimed to describe the pharmacologic therapeutic management of dyslipidemia in patients without established atherosclerotic cardiovascular diseases (ASCVD) from the primary care physician's perspective in Spain. MATERIAL AND METHODS: We conducted a cross-sectional study through an online survey directed to primary care physicians to explore their therapeutic management of dyslipidemia in patients without ASCVD, focusing on their knowledge and adherence to the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines and their perspective concerning the barriers to achieving LDL-C therapeutic targets. RESULTS: In total, 279 primary care physicians completed the survey. Most interviewees (80.65%) stated they had already adopted the 2019 ESC/EAS guidelines in their clinical practice. Nevertheless, around 30% adhered to therapeutic targets by previous ESC/EAS guidelines (2016), and most treated their patients mainly with statins in monotherapy, prescribing doses below the maximum tolerated. Additionally, 50.18% were classified as low adherence to the 2019 ESC/EAS guidelines, especially to the treatment algorithm. According to the physicians, the underestimation of patients' cardiovascular risk and the reluctance to increase doses or use combined therapy were the most critical barriers to achieving LDL-C targets. CONCLUSIONS: Although primary care physicians in our survey reported adherence to the 2019 ESC/EAS guidelines recommendations, our observations indicate they need to integrate them better into their clinical practice.

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Relationship beetween Primary and Hospital Care in cardiovascular prevention and treatment of dyslipidemias. Derivation algorithm. Discharge criteria. / Relación entre Atención Primaria y Hospitalaria en la prevención cardiovascular y tratamiento de las dislipidemias. Algoritmo de derivación. Criterios de alta.

Effective cardiovascular prevention requires taking advantage of all opportunities for patient contact with the Health Services in order to detect risk factors (CVRF) and global cardiovascular risk stratification (CVR). This particularly involves the Primary Care (PC) services, which must be coordinated with the Hospital Care (HC) in order to make all health resources available to the population. In addition, it is necessary to take into account the contribution of Occupational Health and Pharmacy services. There are hopeful signs as regards the possibility of overcoming the barriers that limit the necessary exchange of information between PC and HC professionals, as a basis for adequate coordination between both levels of care. This includes the implementation of referral and discharge algorithms (in this review this means those related to dyslipidaemias) accepted by professionals at both levels, and currently facilitated by the availability of new corporate tools (mobile, email, virtual consultations). The challenge lies in seizing the opportunity they offer to make their implementation effective.

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. / Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Consensus document of the Spanish Society of Arteriosclerosis (SEA) for the prevention and treatment of cardiovascular disease in type 2 diabetes mellitus. / Documento de consenso de la Sociedad Española de Arteriosclerosis (SEA) para la prevención y tratamiento de la enfermedad cardiovascular en la diabetes mellitus tipo 2.

A consensus document of the Diabetes working group of the Spanish Society of Arteriosclerosis (SEA) is presented, based on the latest studies and conceptual changes that have appeared. It presents the cardiovascular risk in type 2 diabetes mellitus (T2DM) and the action guidelines for the prevention and treatment of cardiovascular disease (CVD) associated with T2DM. The importance of lipid control, based on the objective of LDL-C and non-HDL-C when there is hypertriglyceridemia, and the blood pressure control in the prevention and treatment of CVD is evaluated. The new hypoglycemic drugs and their effects on CVD are reviewed, as well as the treatment and control guidelines of hyperglycemia. Likewise, the use of antiplatelet agents is considered. Emphasis is placed on the importance of global and simultaneous action on all risk factors to achieve a significant reduction in cardiovascular events. This supplement is sponsored by Laboratorios Esteve, S.A.

Usefulness of plant sterols in the treatment of hypercholesterolemia / Utilidad de los esteroles vegetales en el tratamiento de la hipercolesterolemia

A consumption of 2 grams per day of plant sterols produces an inhibition of intestinal absorption of cholesterol and reduces the plasma concentration of c-LDL (cholesterol associated with low-density lipoprotein) by around 10%, which has determined its incorporation into different food products like margarines or dairy. The plant sterols develop their action in the intestine, where they reduce the absorption of cholesterol increasing their elimination fecal. In clinical practice, the use of functional foods with plant sterols at the recommended doses can be considered as a complement to lifestyle modifications, in individuals with hypercholesterolemia and low cardiovascular risk but who do not require hypocholesterolemic pharmacological treatment, and also in those patients receiving pharmacological treatment with lipid-lowering drugs and who do not get the therapeutic goals of c-LDL. The hypocholesterolemic effect of plant sterols is additive to that achieved with changes in lifestyle and/or other lipid-lowering agents. Coadministration with statins generates a hypocholesterolemic effect usually greater than that obtained when the statin dose is doubled.

Un consumo de 2 gramos diarios de esteroles vegetales produce una inhibición de la absorción intestinal de colesterol y reduce la concentración plasmática de c-LDL (colesterol asociado a lipoproteínas de baja densidad) alrededor de un 10%, lo que ha determinado su incorporación a diferentes productos alimenticios como margarinas o lácteos. Los esteroles vegetales desarrollan su acción en el intestino, donde dificultan la absorción del colesterol aumentando su eliminación a través de las heces.En la práctica clínica, la utilización de alimentos funcionales con esteroles vegetales a las dosis recomendadas se puede considerar como complemento de las modificaciones del estilo de vida, en individuos con hipercolesterolemia y riesgo cardiovascular global bajo, pero que no precisen tratamiento farmacológico hipocolesterolemiante, y también en aquellos pacientes que reciben tratamiento farmacológico con hipolipemiantes y que no alcanzan los objetivos terapéuticos de c-LDL. El efecto hipocolesterolemiante de los esteroles vegetales es aditivo al alcanzado con los cambios del estilo de vida y/o con otros hipolipemiantes. La coadministración con estatinas genera un efecto hipocolesterolemiante habitualmente superior al obtenido cuando se dobla la dosis de estatina.

Utilidad de los esteroles vegetales en el tratamiento de la hipercolesterolemia / Usefulness of plant sterols in the treatment of hypercholesterolemia

Un consumo de 2 gramos diarios de esteroles vegetales produce una inhibición de la absorción intestinal de colesterol y reduce la concentración plasmática de c-LDL (colesterol asociado a lipoproteínas de baja densidad) alrededor de un 10%, lo que ha determinado su incorporación a diferentes productos alimenticios como margarinas o lácteos. Los esteroles vegetales desarrollan su acción en el intestino, donde dificultan la absorción del colesterol aumentando su eliminación a través de las heces. En la práctica clínica, la utilización de alimentos funcionales con esteroles vegetales a las dosis recomendadas se puede considerar como complemento de las modificaciones del estilo de vida, en individuos con hipercolesterolemia y riesgo cardiovascular global bajo, pero que no precisen tratamiento farmacológico hipocolesterolemiante, y también en aquellos pacientes que reciben tratamiento farmacológico con hipolipemiantes y que no alcanzan los objetivos terapéuticos de c-LDL. El efecto hipocolesterolemiante de los esteroles vegetales es aditivo al alcanzado con los cambios del estilo de vida y/o con otros hipolipemiantes. La coadministración con estatinas genera un efecto hipocolesterolemiante habitualmente superior al obtenido cuando se dobla la dosis de estatina (AU)

A consumption of 2 grams per day of plant sterols produces an inhibition of intestinal absorption of cholesterol and reduces the plasma concentration of c-LDL (cholesterol associated with low-density lipoprotein) by around 10%, which has determined its incorporation into different food products like margarines or dairy. The plant sterols develop their action in the intestine, where they reduce the absorption of cholesterol increasing their elimination fecal. In clinical practice, the use of functional foods with plant sterols at the recommended doses can be considered as a complement to lifestyle modifications, in individuals with hypercholesterolemia and low cardiovascular risk but who do not require hypocholesterolemic pharmacological treatment, and also in those patients receiving pharmacological treatment with lipid lowering drugs and who do not get the therapeutic goals of c-LDL. The hypocholesterolemic effect of plant sterols is additive to that achieved with changes in lifestyle and/or other lipid-lowering agents. Coadministration with statins generates a hypocholesterolemic effect usually greater than that obtained when the statin dose is doubled (AU)

Consensus on the Statin of Choice in Patients with Impaired Glucose Metabolism: Results of the DIANA Study.

INTRODUCTION AND OBJECTIVES: Despite the recognized clinical benefit of statins on cardiovascular prevention, providing correct management of hypercholesterolaemia, possible adverse effects of their use cannot be disregarded. Previously published data shows that there is a risk of developing diabetes mellitus or experiencing changes in glucose metabolism in statin-treated patients. The possible determining factors are the drug characteristics (potency, dose), patient characteristics (kidney function, age, cardiovascular risk and polypharmacy because of multiple disorders) and the pre-diabetic state. METHODS: In order to ascertain the opinion of the experts (primary care physicians and other specialists with experience in the management of this type of patient) we conducted a Delphi study to evaluate the consensus rate on diverse aspects related to the diabetogenicity of different statins, and the factors that influence their choice. RESULTS: Consensus was highly significant concerning aspects such as the varying diabetogenicity profiles of different statins, as some of them do not significantly worsen glucose metabolism. There was an almost unanimous consensus that pitavastatin is the safest statin in this regard. CONCLUSIONS: Factors to consider in the choice of a statin regarding its diabetogenicity are the dose and patient-related factors: age, cardiovascular risk, diabetes risk and baseline metabolic parameters (which must be monitored during the treatment), as well as kidney function.

Consenso Delphi sobre el diagnóstico y manejo de la dislipidemia en pacientes con enfermedad renal crónica: análisis post-hoc del estudio DIANA / Delphi consensus on the diagnosis and management of dyslipidaemia in chronic kidney disease patients: A post hoc analysis of the DIANA study

Antecedentes y objetivos: Este estudio post hoc analizó la percepción de la importancia de la enfermedad renal crónica (ERC) en el cribado de la dislipidemia y en la elección del tratamiento con estatinas entre médicos de Atención Primaria (MAP) y otras especialidades mediante cuestionario Delphi. Métodos: El cuestionario incluyó 4 bloques de preguntas alrededor del paciente dislipémico con alteración del metabolismo hidrocarbonado. Aquí se presentan los resultados relacionados con la consideración de la ERC en el cribado y la elección de la estatina. Resultados: De los 497 expertos incluidos, el 58% eran MAP y el 42%, especialistas (35, el 7%, nefrólogos). Hubo consenso en realizar un cribado de la dislipidemia en los pacientes con ERC, sin diferencias entre MAP y especialistas; y también en realizar el cribado en la práctica clínica habitual. Sin embargo, no se alcanzó el consenso en considerar el filtrado glomerular estimado (aunque sí entre MAP y nefrólogos) o la albuminuria en la elección de la estatina, ni en su determinación durante el seguimiento después de instaurar un tratamiento con estatinas (aunque hubo consenso entre nefrólogos). Conclusiones: El consenso en analizar el perfil lipídico en los pacientes con ERC indica el reconocimiento del alto riesgo cardiovascular de esta enfermedad. La ausencia de acuerdo en considerar la función renal o la albuminuria, tanto en la elección de la estatina como durante el seguimiento, indica un conocimiento limitado de las diferencias entre estatinas en relación con la ERC, por lo que sería deseable disponer de una guía/documento de consenso sobre uso de estatinas en la ERC (AU)

Background and objectives: This post hoc study analysed the perception of the relevance of chronic kidney disease (CKD) in dyslipidaemia screening and the choice of statin among primary care physicians (PCPs) and other specialists through a Delphi questionnaire. Methods: The questionnaire included 4 blocks of questions concerning dyslipidaemic patients with impaired carbohydrate metabolism. This study presents the results of the impact of CKD on screening and the choice of statin. Results: Of the 497 experts included, 58% were PCPs and 42% were specialists (35, 7% were nephrologists). There was consensus by both PCPs and specialists, with no difference between PCPs and specialists, that CKD patients should undergo a dyslipidaemia screening and that the screening should be part of routine clinical practice. However, there was no consensus in considering the estimated glomerular filtration rate (eGFR) (although there was consensus among PCPs and nephrologists), or considering albuminuria when selecting a statin, or in determining albuminuria during follow-up after having initiated treatment with statins (although there was consensus among the nephrologists). Conclusions: The consensus to analyse the lipid profile in CKD patients suggests acknowledgment of the high cardiovascular risk of this condition. However, the lack of consensus in considering renal function or albuminuria, both when selecting a statin and during follow-up, suggests a limited knowledge of the differences between statins in relation to CKD. Thus, it would be advisable to develop a guideline/consensus document on the use of statins in CKD (AU)

La utilización de los esteroles vegetales en la práctica clínica: de la química a la clínica / Using plant sterols in clinical practice: From the chemistry to the clinic

En este trabajo se describe qué son los esteroles vegetales, la estructura química de los mismos para entender su mecanismo de acción hipocolesterolemiante, así como sus indicaciones y sus contraindicaciones en la práctica clínica

This paper describes what are plant sterols, the chemical structure to understand their mechanism of cholesterol-lowering action, and indications and contraindications in clinical practice

Biodemographic Analysis of Factors Related to Perinatal Mortality in Portugal (1988-2011).

Background. The purpose of this paper is to determine the relative mortality risks at delivery and during the first week of life with regard to maternal and foetal characteristics. Methods. Yearly individual digital records on live births and early neonatal mortality were used to infer the possible factors involved in perinatal deaths. Results. The results show that the number of births per year declined with time throughout the period studied. At the same time, rates decreased in 66.4% for stillbirths and in 70.2% for early neonatal mortality. Logistic regressions modelled the interaction of the two mortality indicators and covariables such as birth weight and the duration of gestation. Conclusions. This research provides a first biodemographic approach to the knowledge of factors influencing perinatal mortality in Portugal based on a set of foetal and maternal variables. Although the magnitude of the different perinatal mortality rates may be affected by the criteria used for selecting cases (multiple-singletons; minimum birth weight or minimum duration of gestation), one of the conclusions of the present analysis is that the relationship among the maternal and foetal variables that determine the relative risk remains unaltered. Certain resemblance with the factors determining negative birth outcomes in Spain is appreciated.

Delphi consensus on the diagnosis and management of dyslipidaemia in chronic kidney disease patients: A post hoc analysis of the DIANA study. / Consenso Delphi sobre el diagnóstico y manejo de la dislipidemia en pacientes con enfermedad renal crónica: análisis post-hoc del estudio DIANA.

BACKGROUND AND OBJECTIVES: This post hoc study analysed the perception of the relevance of chronic kidney disease (CKD) in dyslipidaemia screening and the choice of statin among primary care physicians (PCPs) and other specialists through a Delphi questionnaire. METHODS: The questionnaire included 4blocks of questions concerning dyslipidaemic patients with impaired carbohydrate metabolism. This study presents the results of the impact of CKD on screening and the choice of statin. RESULTS: Of the 497 experts included, 58% were PCPs and 42% were specialists (35, 7% were nephrologists). There was consensus by both PCPs and specialists, with no difference between PCPs and specialists, that CKD patients should undergo a dyslipidaemia screening and that the screening should be part of routine clinical practice. However, there was no consensus in considering the estimated glomerular filtration rate (eGFR) (although there was consensus among PCPs and nephrologists), or considering albuminuria when selecting a statin, or in determining albuminuria during follow-up after having initiated treatment with statins (although there was consensus among the nephrologists). CONCLUSIONS: The consensus to analyse the lipid profile in CKD patients suggests acknowledgment of the high cardiovascular risk of this condition. However, the lack of consensus in considering renal function or albuminuria, both when selecting a statin and during follow-up, suggests a limited knowledge of the differences between statins in relation to CKD. Thus, it would be advisable to develop a guideline/consensus document on the use of statins in CKD.

Is it possible to achieve functional recovery in schizophrenia? A qualitative and quantitative analysis of psychiatrist´s opinion.

INTRODUCTION: Psychiatrist´s opinion on functional recovery (FR) of patients with schizophrenia may modulate the therapeutic expectations and how to manage the disease. OBJECTIVE: This study aims to know the opinion of psychiatrists on FR, and to analyze the relationship between functioning and symptoms. METHODS: A qualitative and quantitative, descriptive and exploratory study. Two data collection techniques were used: a) a written survey consisting of 12 questions, directly, anonymously and confidentially answered by 132 psychiatrists; b) 5 focus group discussions involving 42 psychiatrists. RESULTS: 69.8% of psychiatrists considered realistic to get FR in schizophrenia and another 30.1% chose an intermediate response. The clinical priority for the 94% is to optimize the functional outcome of their patients, but only 14.4% commonly use rating scales. 91.7 % believed that there are differences between typical and atypical antipsychotics in terms of FR, and 83.3% believed essential to implement psychosocial interventions to achieve this goal. According to psychiatrists, FR is a complex concept and a primary therapeutic goal. Negative and cognitive symptoms are the strongest predictors of poor functioning. The low functioning of a patient, even in symptomatic stability, usually requires a re-evaluation of treatment. CONCLUSION: For psychiatrists, FR is a useful concept and a clinical priority, although there are doubts about how to achieve it.

[Using plant sterols in clinical practice: From the chemistry to the clinic]. / La utilización de los esteroles vegetales en la práctica clínica: de la química a la clínica.

This paper describes what are plant sterols, the chemical structure to understand their mechanism of cholesterol-lowering action, and indications and contraindications in clinical practice.

¿Es posible la recuperación funcional en la esquizofrenia?: un análisis cuali-cuantitativo de la opinión de los psiquiatras / Is it possible to achieve functional recovery in schizophrenia? A qualitative and quantitative analysis of psychiatrist´s opinion

Introducción. La opinión de los psiquiatras acerca de la recuperación funcional (RF) de los pacientes con esquizofrenia puede modular las expectativas terapéuticas y la forma de abordar la enfermedad. Objetivo. El presente estudio pretende conocer la opinión de los psiquiatras sobre la RF, y la relación que consideran que existe entre funcionalidad y sintomatología. Metodología. Análisis cuali-cuantitativo, descriptivo exploratorio, en el que se utilizaron dos técnicas de recogida de información: a) una encuesta escrita, compuesta de 12 preguntas, respondida de forma directa, anónima y confidencial por 132 psiquiatras; b) 5 grupos focales de discusión en el que participaron 42 psiquiatras. Resultados. El 69,8% de psiquiatras considera realista conseguir la RF en la esquizofrenia y otro 30,2 % opta por una respuesta intermedia. La prioridad clínica para el 94% es optimizar la funcionalidad de sus pacientes, pero sólo un 14,4% utiliza habitualmente escalas de evaluación. El 91,7% considera que hay diferencias entre los antipsicóticos atípicos en cuanto a la RF, y un 83,3% cree imprescindible implementar intervenciones psicosociales para conseguir este objetivo. Según los psiquiatras consultados, la RF es un concepto complejo, dependiente de factores ambientales y una ambiciosa meta terapéutica. Los síntomas negativos y cognitivos son los más predictivos de pobre funcionalidad. La baja funcionalidad de un paciente, aun en estabilidad sintomatológica, requiere una re-evaluación de tratamiento. Conclusión. Para los psiquiatras la RF es un concepto útil y una prioridad clínica, aunque existen dudas sobre cómo alcanzarla

Introduction. Psychiatrist's opinion on functional recovery (FR) of patients with schizophrenia may modulate the therapeutic expectations and how to manage the disease. Objective. This study aims to know the opinion of psychiatrists on FR, and to analyze the relationship between functioning and symptoms. Methods. A qualitative and quantitative, descriptive and exploratory study. Two data collection techniques were used: a) a written survey consisting of 12 questions, directly, anonymously and confidentially answered by 132 psychiatrists; b) 5 focus group discussions involving 42 psychiatrists. Results. 69.8% of psychiatrists considered realistic to get FR in schizophrenia and another 30.1% chose an intermediate response. The clinical priority for the 94% is to optimize the functional outcome of their patients, but only 14.4% commonly use rating scales. 91.7 % believed that there are differences between typical and atypical antipsychotics in terms of FR, and 83.3% believed essential to implement psychosocial interventions to achieve this goal. According to psychiatrists, FR is a complex concept and a primary therapeutic goal. Negative and cognitive symptoms are the strongest predictors of poor functioning. The low functioning of a patient, even in symptomatic stability, usually requires a re-evaluation of treatment

Determinants of birth weight in Portugal: 1988 to 2011.

The objective of this paper is to analyse temporal birth weight variation, its relationship to the frequency of premature births in Portugal, and the influence of native and immigrant mothers' characteristics as well as to determine the possible existence of a pattern of temporal change in birth weight in the Iberian Peninsula as a whole. Individual mother-child data from the Portuguese National Institute of Statistics regarding live births (N = 2,661,542) permitted an analysis, for the first time, of weight at birth in Portugal from a bio-demographic perspective. The results obtained show that from 1988 to 2011 there was a gradual decline in the average weight at birth in Portugal that may be related to shifts in the duration of gestation. An initial rapid decline in the relative frequency of post-term births took place, followed by small variations from 1995 on. Logistic regressions indicated a pattern unaffected by maternal origin or the sex of the newborn. With regard to weeks of gestation, the odds values obtained were < 1 when the reference category was < 28 weeks. For this factor, no significant differences were found in relation to the mother's origin. Portuguese mothers over 35 years were associated with a higher incidence of low birth weight. Regardless of maternal origin, being a newborn of parity 1, and with the mother not in a couple, resulted in unfavourable outcomes with regard to low birth weight. On the other hand, long gestation periods and having secondary or university education constituted a protective factor.

Control de la dislipidemia aterogénica en paciente diabético tipo 2: Procedimientos en la práctica clínica - Estudio LIPEDIA / Patient's care and management of dyslipidemia in type 2 diabetic patients in the clinical practice in Spain: The LIPEDIA study

Introducción: El tratamiento de la dislipidemia aterogénica en el paciente con diabetes tipo 2 (DM2) debe ir encaminado al control global del perfil lipídico. El objetivo de este estudio fue analizar cómo se realiza el control de la dislipidemia aterogénica en la DM2 por médicos especialistas hospitalarios (ME) y de atención primaria (MAP). Métodos: Estudio ecológico, descriptivo, transversal y multicéntrico que recogió la información de 497 ME y de 872 MAP sobre su actividad asistencial mediante un cuestionario. Resultados: El 66% de los ME y el 30,5% de los MAP reconocen que el riesgo cardiovascular del paciente con DM2 es «muy alto». La mayoría considera unos objetivos concretos de concentración de colesterol asociado a las lipoproteínas de baja densidad (cLDL) basados en las guías europeas. Las estatinas más empleadas por ambos son la atorvastatina y la simvastatina, si bien ambos consideran que la estatina más adecuada sería la rosuvastatina. El 82 y el 68% de los ME y MAP, respectivamente, reconocen que consiguen los objetivos de cLDL en > 50% de sus pacientes, siendo la falta de adherencia y la presión de la administración las razones más importantes para no alcanzarlos. El 74% de los ME reconoce que no existen protocolos comunes con MAP. Conclusiones: La distinta percepción del riesgo real del paciente, el menor uso de estatinas consideradas más adecuadas, la falta de adherencia y la falta de la percepción en el control de cLDL pueden contribuir a que no se alcancen los objetivos terapéuticos de la dislipidemia aterogénica en pacientes con DM2

Introduction: Treatment of atherogenic dyslipidemia (AD) in type 2 diabetes (DM2) should focus on the global control of dyslipidemia. The aim of this study was to determine how hospital (MSs) and primary care specialist (GPs) from Spain manage AD in DM2 during their daily practice. Methods: An observational, cross-sectional, multicentric study was conducted. Information about daily practice was obtained from 497 MSs and 872 GPs across Spain. Results: 66% of MSs and 30.5% of GPs considered DM2 patients to be high-risk. Most consider the c-LDL targets based on European guidelines. The statins most widely used are atorvastatin and simvastatin. However both MSs and GPs considered rosuvastatin to be the most appropriate statin for these patients. 82% of MSs and 68% of GPs considered that > 50% of their patients achieved the c-LDL target. The main reasons of not achieving this target were lack of treatment adherence and pressure from the administration. Seventy four percent of MSs reported that there are no common clinical protocols with GPs. Conclusions: The differences in the perception of the real cardiovascular risk of the patient, low use of more appropriate statins, lack of adherence and poor perception of real c-LDL control may contribute to the failure in achieving lipid targets in DM2

Regional differences in low birth weight in Spain: biological, demographic and socioeconomic variables.

The geographic and demographic dimensions of Spain, in terms of surface and number of inhabitants, and its heterogeneous socioeconomic development offer an adequate opportunity to study the provincial differences in birth weight from 1996 to 2010, focusing on possible factors determining the relative frequency of low birth weight. The study analysed geographic differences with regard to biological, demographic and socioeconomic factors that interfere with the female reproductive pattern. The variables considered here were: birth order, proportion of premature deliveries, mother's age, multiparity, mother's country of origin and professional qualifications. Two periods (1996-2000 and 2006-2010) were compared by means of principal components analysis. An increase in the relative frequency of deliveries weighing less than 2500 g occurred in most of the 52 geographic units studied, differences being significant in 42. Only in five cases was there a non-significant reduction in the proportion of low weight births. The first component after principal component analysis indicated that low birth weight was positively related to maternal age and to multiple deliveries, and negatively to the mother's low professional qualification. The second component related positively to the incidence of premature deliveries and to non-Spanish status and negatively in the case of primiparous mothers. The progressive increase in low birth weight incidence observed in Spain from 1996 onwards has occurred with considerable variation in each province. In part, this diversity can be attributed to the unequal reproductive patterns of immigrant mothers.

[Patient's care and management of dyslipidemia in type 2 diabetic patients in the clinical practice in Spain: The LIPEDIA study]. / Control de la dislipidemia aterogénica en paciente diabético tipo2: Procedimientos en la práctica clínica - Estudio LIPEDIA.

INTRODUCTION: Treatment of atherogenic dyslipidemia (AD) in type 2 diabetes (DM2) should focus on the global control of dyslipidemia. The aim of this study was to determine how hospital (MSs) and primary care specialist (GPs) from Spain manage AD in DM2 during their daily practice. METHODS: An observational, cross-sectional, multicentric study was conducted. Information about daily practice was obtained from 497 MSs and 872 GPs across Spain. RESULTS: 66% of MSs and 30.5% of GPs considered DM2 patients to be high-risk. Most consider the c-LDL targets based on European guidelines. The statins most widely used are atorvastatin and simvastatin. However both MSs and GPs considered rosuvastatin to be the most appropriate statin for these patients. 82% of MSs and 68% of GPs considered that >50% of their patients achieved the c-LDL target. The main reasons of not achieving this target were lack of treatment adherence and pressure from the administration. Seventy four percent of MSs reported that there are no common clinical protocols with GPs. CONCLUSIONS: The differences in the perception of the real cardiovascular risk of the patient, low use of more appropriate statins, lack of adherence and poor perception of real c-LDL control may contribute to the failure in achieving lipid targets in DM2.