[Validation of taking arterial pulse in Primary Care for the detection of atrial fibrillation and other cardiac rhythm disorders in patients over 65 years old]. / Validación de la toma del pulso arterial en atención primaria para la detección de fibrilación auricular y otros trastornos del ritmo cardiaco en mayores de 65 años.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. RESULTS: The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. CONCLUSIONS: The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years.

[Epidemiological study of the hepatitis C virus in our population and vaccine coverage]. / Estudio epidemiológico del virus de la hepatitis C en nuestra población y cobertura vacunal.

OBJECTIVE: Epidemiological study of patients with chronic hepatitis C and its serological status in relation to the hepatitis A (HA) and B (HB) viruses. DESIGN: Descriptive cross-sectional study. SETTING: Two urban health centres. Participants. 291 patients with chronic hepatitis C. VARIABLES: age, sex, year and reason for diagnosis, personal histories, alcohol intake, serological status of the HA and HB viruses and HIV, and initial level of transaminases. RESULTS: Mean age, 55 +/- 16. Sex, 52% women. Prevalence, 0.98%. Reason for diagnosis, 41% health study, 15% study of hepatic pathology, 18% study of other pathologies. Personal histories, surgical intervention, 37.5%; intravenous drug users, 21.4%; transfusion, 14%; high-risk sexual conduct, 2.4%; health material used more than once, 2.4%; family member HC positive, 1.4%; no personal history recorded, 26.5%. Alcoholism, 17.9%. Mean transaminases: AST, 79.7 +/- 100 (9-920); ALT, 114.8 +/- 160 (6-1640). HB serological status: natural immunity, 22%; chronic, 9%; vaccine immunity, 3%; negative, 44%; not recorded, 21%. HA serological status: natural immunity, 2%; vaccine immunity, 2.5%; negative, 9%; not recorded, 87%. HIV-positive: 4.5%. CONCLUSIONS: Prevalence was below the expected level. Knowledge of serological status needs to be improved, especially for HA. The degree of vaccine coverage in these patients for HA and HB should be increased.

Estudio epidemiológico del virus de la hepatitis C en nuestra población y cobertura vacunal / Epidemiological study of the hepatitis C virus in our population and vaccine coverage

Objetivo. Estudio epidemiológico de los pacientes con hepatitis C crónica y su estado serológico en cuanto a los virus de la hepatitis A (VHA) y B (VHB).Diseño. Estudio transversal descriptivo. Emplazamiento. Dos centros de salud urbanos. Participantes. Un total de 291 pacientes afectados de hepatitis C crónica. Mediciones principales. Variables: edad, sexo, año y motivo del diagnóstico, antecedentes personales, enolismo, estado serológico de los VHA, VHB y VIH, y concentración de transaminasas inicial. Resultados. Edad media: 55 ñ 16. Sexo: 52 por ciento mujeres. Prevalencia: 0,98 por ciento. Motivo del diagnóstico: 41 por ciento estudio de salud, 15 por ciento estudio de enfermedad hepática, 18 por ciento estudio de otras enfermedades. Antecedentes personales: intervención quirúrgica 37,5 por ciento, usuarios de drogas por vía parenteral 21,4 por ciento, transfusión 14 por ciento, conducta de riesgo sexual 2,4 por ciento, material sanitario de más de un uso 2,4 por ciento, familiar VHC positivo 1,4 por ciento, no consta ningún antecedente personal 26,5 por ciento. Enolismo: 17,9 por ciento. Media de transaminasas: AST 79,7 ñ 100 (9-920), ALT 114,8 ñ 160 (6-1.640). Estado serológico VHB: inmunidad natural 22 por ciento, crónica 9 por ciento, inmunidad vacunal 3 por ciento, negativo 44 por ciento, no consta 21 por ciento. Estado serológico VHA: inmunidad natural 2 por ciento, inmunidad vacunal 2,5 por ciento, negativo 9 por ciento, no consta 87 por ciento. VIH-positivos: 4,5 por ciento. Conclusiones. La prevalencia fue inferior a la esperada. Es necesario mejorar el conocimiento del estado serológico, sobre todo del VHA. Sería importante aumentar el grado de cobertura vacunal de los VHB y VHA en estos pacientes (AU)