Impacto de la prediabetes y el sexo en el riesgo cardiovascular asociado al síndrome metabólico / Impact of prediabetes and gender in cardiovascular risk associated to the metabolic syndrome

ObjetivosAnalizar la influencia de la prediabetes y el sexo en el riesgo cardiovascular (RCV) asociado al síndrome metabólico (SM) en pacientes con índice de masa corporal ≥25kg/m2. Adicionalmente, se evaluó la calidad de la asistencia prestada a pacientes con SM y prediabetes.Material y métodosEstudio epidemiológico, transversal, multicéntrico en el que participaron 138 médicos de atención primaria de toda España que incluyeron de forma aleatoria a 2.280 pacientes. Para el diagnóstico del SM se utilizaron los criterios de la International Diabetes Federation. El RCV se estimó aplicando la ecuación de Framingham calibrada. Para la evaluación de la calidad asistencial se construyeron doce criterios de evaluación explícitos y normativos.ResultadosEl 70,4% de los pacientes presentó un nivel de glucemia basal <126mg/dl. Se obtuvieron diferencias estadísticamente significativas al comparar el RCV de los varones no diabéticos con SM y varones sin SM, que fue más elevado en el primer grupo de pacientes. Las diferencias en el RCV fueron también significativas entre las mujeres no diabéticas con SM y las mujeres no diabéticas sin SM. Al comparar el RCV de los pacientes con glucemia basal inferior a 100mg/dl y de los pacientes en situación de prediabetes se observaron diferencias estadísticamente significativas en ambos sexos.ConclusiónLa implicación de la hiperglucemia en el RCV es muy elevada, asociada o no al SM. La participación y compromiso de la atención primaria es clave para detectar a los pacientes prediabéticos con alto riesgo de desarrollo de diabetes de tipo 2 y enfermedad cardiovascular(AU)

ObjectivesTo analyze the impact of prediabetes and gender on cardiovascular risk (CVR) related to the metabolic syndrome (MS) in patients with BMI≥25kg/m2. Quality of medical care given to patients with MS and prediabetes was also evaluated.Material and methodsEpidemiological, cross-sectional, multicenter study in which 138 Primary Care Physicians from all of Spain participated. They randomly included 2,280 patients. International Diabetes Federation (IDF) criteria were used in the MS diagnosis. CVR was calculated using the calibrated Framingham function. Medical care quality was studied by constructing 12 explicit and normative evaluation criteria.ResultsA total of 70.4% of the patients presented blood fasting glucose<126mg/dl. Statistically significant differences were obtained when CVR of the non-diabetic males was compared with MS and males without MS. The differences in CVR were significantly higher between the non-diabetic women with MS and non-diabetic women without MS. When CVR of the patients with baseline glycemia less than 100mg/dl with prediabetic patients, statistically significant differences were observed in both genders.ConclusionThe impact of hyperglycemia on CVR is very high, regardless of whether it is associated to MS or not. The participation and commitment of primary care is key to detect prediabetic patients having a high risk of developing type 2 diabetes and cardiovascular disease(AU)

[Control over the quality of care given pregnant women in a health area]. / Control de calidad de la asistencia prestada a la embarazada en un área de salud.

The results of a quality control of the assistance, given through a programme of pregnancy in 12 health centres in Area number 1 of Toledo are shown here. To do so, an auditory was performed at a public hospital level and in the participating health centres, unifying explicit and normative criteria, which were the base to check a sample of 484 clinic records. In the results found, the high percentage of observance of the criteria referring to the early captation and the puerperal visit (90.3% and 94.6% respectively) is outstanding and the adequate treatment of the ferropenic anemia is the most frequently unobserved criteria (53.3%). Correction measures are established and standards for the re-evaluation are fixed. We emphasize the need to involve the second assistance level as well as the respective Management in the performance of health programmes in its aims, assuming the improvement of results as a responsibility of all of them.

[Quality control of care provided for urinary infections]. / Control de calidad de la asistencia prestada en las infecciones urinarias.

OBJECTIVE: To evaluate the quality of the care provided for low-level urinary infections in the Toledo Health Area. DESIGN: Retrospective study based on data on procedures supplied from clinical histories. SITE. Primary Care teams in the Toledo Health Area. PATIENTS OR OTHER PARTICIPANTS: Those patients over 14 with a provisional diagnosis of low-level urinary infection, who were attended between June and November, 1991, at the Health Centres participants (n = 243). MAIN MEASUREMENTS AND RESULTS: The fulfillment level of six previously defined criteria was analysed. Looking at the clinical histories, we noted 75.3% non-fulfillment of Criterion 1 (anamnesis and examination), 51.8% of Criterion 5 (follow-up) and 59.3% of Criterion 6 (referral). Among the reasons we identified as causes of these findings were inadequate use of registration systems and the existence in different Centres of various procedures for treating urinary infections. CONCLUSIONS: The initial suspicion that the treatment and control of urinary infections in our Area contained a problem of attendance was confirmed. Corrective measures were established for the re-assessment. The positive role of quality controls, carried out under the aegis of Area managements, was clear.