Síndrome de burnout, resiliencia y miedo a la COVID-19 en personal sanitario durante la pandemia por SARS-CoV-2 / Burnout syndrome, resilience and fear of COVID-19 in healthcare professionals during the SARS-CoV-2 pandemic

Objetivo: describir la relación entre burnout, resiliencia y miedo frente a la COVID-19 del personal de salud que trabaja en la Gerencia de Atención Primaria de Toledo (GAPTO) durante la emergencia sanitaria por la pandemia por SARS-CoV-2. Diseño: estudio descriptivo, observacional y transversal. Emplazamiento: GAPTO, España. Participantes: 96 profesionales de medicina y enfermería de la GAPTO. Mediciones principales: se incluyeron las siguientes variables: características sociodemográficas, condiciones laborales, burnout, resiliencia y miedo a la COVID-19. Resultados: la prevalencia del burnout fue de 36,5%, el riesgo de desarrollar burnout fue de 28,1%. Un 50% de los profesionales tenía alterada la subescala de agotamiento emocional (AE), que puede estar asociada o no con alteraciones de las otras subescalas. Un 42,7% de la población estudiada mostró baja resiliencia. Un 45,8% tenía poco miedo a la COVID-19; un 43,8%, un miedo moderado, y un 10,4% presentaba altos niveles de miedo. Se encontró asociación inversa entre el síndrome de burnout y la resiliencia. También se observó relación entre el miedo a la COVID-19 y el burnout. La resiliencia y el miedo a la COVID-19 tienen una asociación más fuerte que el resto de las variables. Otras variables relacionadas con la presencia de burnout fueron la profesión y el servicio donde trabajan los profesionales. Conclusiones: el síndrome de burnout afectó a una elevada proporción de profesionales de la sanidad de la GAPTO en el marco de la pandemia por COVID-19, siendo el AE la subescala predominantemente afectada, que se encuentra relacionada con los niveles de resiliencia y de miedo a la COVID-19.(AU)

Objective: to report the relationship between burnout, levels of resilience and fear of COVID-19 in health professionals working in Toledo Primary Care Management (GAPTO) during the health emergency due to the SARS-CoV-2 pandemic. Design: descriptive, observational and cross-sectional study. Location: GAPTO, Spain. Participants: 96 GAPTO medical and nursing professionals. Main measurements: the variables included were: sociodemographic characteristics, working conditions, burnout, resilience and fear of COVID-19. Results: the prevalence of burnout syndrome was 36.5%, the risk of developing burnout was 28.1%. A total of 50% of professionals underwent an alteration on the emotional exhaustion subscale, which may or may not be associated with alterations on the other subscales. A total of 42.7% of the population shows low resilience; 45.8%, 43.8% and 10.4% have little, moderate and a high fear of COVID-19. An inverse association was detected between burnout syndrome and resilience. A relationship was also found between the fear of COVID-19 and burnout. Resilience and fear of COVID-19 have a stronger association than the rest of the variables. Other variables related to the presence of burnout were the profession and the department where the professionals work. Conclusions: burnout syndrome affects a high proportion of health professionals working in GAPTO, Spain, in the framework of the COVID-19 pandemic. Emotional exhaustion is the predominantly affected subscale, which is related to levels of resilience and fear of COVID-19.(AU)

Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO / Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study

Objetivos: Conocer la edad vascular (EV) de una muestra de población general del área sanitaria de Toledo incluida en el estudio RICARTO.Pacientes y métodoEstudio epidemiológico transversal realizado en población general ≥18 años, aleatorizada según tarjeta sanitaria. La EV se calculó a partir del riesgo cardiovascular (RCV) absoluto estimado con las escalas de Framingham y SCORE (la presencia de diabetes mellitus duplicó el RCV obtenido en varones y lo cuadruplicó en mujeres). Se excluyeron los sujetos con patología cardiovascular o renal. Se realizó ANCOVA para ajustar y comparar las medias de EV por edad y sexo.ResultadosSe analizaron 1.496 individuos (53,54% mujeres), con una edad media (DE) de 48,77 (14,89) años. La EV media fue 51,37 (19,13) años con Framingham y 57,09 (17,63) años con SCORE, resultando significativamente mayor en varones, nivel de estudios bajo, hipertensión arterial, dislipidemia, hipertrigliceridemia, diabetes mellitus, obesidad abdominal, obesidad general, tabaquismo y en sujetos con 5 factores de RCV frente a ninguno (p<0,001 en todos). Las mayores diferencias (D de Cohen >0,5) se hallaron entre no diabéticos y diabéticos (1,58 Framingham; 2,44 SCORE), normotensos e hipertensos (1,64 Framingham; 1,19 SCORE) y no dislipidémicos y dislipidémicos (0,95 Framingham; 0,66 SCORE).ConclusionesEn nuestra muestra la EV es 2,5años superior a la cronológica con la ecuación de Framingham y más de 8años con la del SCORE. El control de los factores de RCV es clave para lograr una EV más próxima a la real y lograr una mejor salud cardiovascular de la población. (AU)

Objective: To know the vascular age (VA) of a sample of general population included in the RICARTO study.Patients and methodEpidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex.Results1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE).ConclusionsVA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population. (AU)

Cumplimiento terapéutico en pacientes en tratamiento con anticoagulantes orales en Atención Primaria / Therapeutic compliance in patients being treated with oral anticoagulants in Primary Care

Objetivo: evaluar y comparar el cumplimiento terapéutico entre los diferentes anticoagulantes orales. Diseño: estudio descriptivo transversal. Emplazamiento: Atención Primaria. Zona Básica de Salud de Bargas. Participantes: se incluyó a pacientes que llevasen más de 6 meses en tratamiento con anticoagulantes orales, pertenecientes a seis cupos de Medicina Familiar. Se excluyó a pacientes desplazados, incapaces de tomar la medicación de forma autónoma, ingresados o fallecidos durante el estudio. Mediciones principales: las variables estudiadas fueron: edad, sexo, nivel educativo, unidad familiar, tiempo de tratamiento, tipo de anticoagulante, efectos secundarios, polimedicación, tipo de receta, educación para la salud y cumplimiento terapéutico. Se realizó estadística descriptiva y analítica. Resultados: se evaluaron 110 pacientes con una edad media de 73,02 (desviación estándar [DE]: 12,06) años. Un 29,1% en tratamiento con anticoagulantes orales de acción directa (ACOD). La mediana de tiempo de tratamiento fue de 47 meses (rango intercuartílico: 16-77,25), el 84,5% eran polimedicados (7,36 ± 3,96 fármacos de media). Fueron cumplidores en total el 81,81% (intervalo de confianza [IC] 95% 73,32-88,52%). El 93,75% fue cumplidor con ACOD (IC 95% 79,19-99,23%) frente al 76,92% con acenocumarol (IC 95% 66,00-85,71%) (p = 0,055). El cumplimiento en polimedicados fue del 86%, frente al 58,8% en no polimedicados (p = 0,02). Conclusión: Nuestro estudio ha mostrado una aparente mayor adherencia terapéutica en los pacientes tratados con ACODs con respecto a los tratados con acenocumarol. La adherencia al tratamiento es mayor en los pacientes polimedicados.(AU)

Aim: To evaluate and compare treatment compliance among different oral anticoagulants. Design: Transversal descriptive study. Location: Primary Care. Bargas Basic Healthcare Area. Participants: Patients in treatment with oral anticoagulants more than 6 months who belonged to six Family Medicine quotas were included. Displaced patients, those unable to take medication autonomously, admitted to hospital or who died during the study were excluded. Primary endpoints: The variables studied were: age, sex, educational level, family unit, treatment time, type of anticoagulant, side effects, polymedication, type of prescription, education for health and treatment compliance. Descriptive statistics and analysis were performed. Results: 110 patients with a mean age of 73.02 (SD: 12.06) years old were studied. A total of 29.1% were in treatment with oral anticoagulants (OACs). Median treatment time was 47 months (interquartile range: 16-77.25). A total of 84.5% were polymedicated (7.36±3.96 drugs on average). In total 81.81% (95%CI 73.32-88.52%) were compliant. A total of 93.75% complied with OACs (95%CI 79.19-99.23%) compared to 76.92% with acenocumarol (95%CI 66.00-85.71%) (p=0.055). Compliance in polymedicated patients was 86% compared to 58.8% in non-polymedicated patients (p=0.02). Conclusion: Our study revealed an apparent greater treatment adherence in patients treated with OACs in regard to those treated with acenocumarol. Treatment adherence is greater in polymedicated patients.(AU)

[Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study]. / Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO.

OBJECTIVE: To know the vascular age (VA) of a sample of general population included in the RICARTO study. PATIENTS AND METHOD: Epidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. RESULTS: 1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). CONCLUSIONS: VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

Mean Blood Pressure of the General Population with the Mean of Three Measurements Versus the Mean of the Second and Third Measurements. Ricarto Study.

INTRODUCTION: Our aim was to determine the difference between measuring blood pressure (BP) with the mean of three determinations versus the mean of the second and the third determinations in a random general population sample. METHODS: Epidemiological study of the general population aged ≥ 18 from the Health Area of Toledo (Spain), based on the health card database. Three readings of systolic and diastolic BP were taken with validated oscillometric devices OMRON HEM-907. The mean of the three readings was compared with the mean of the second and third readings after discarding the first measurement. We analyzed age, sex, BMI, abdominal obesity, dyslipidemia, diabetes mellitus, smoking and sedentary lifestyle. A descriptive study was conducted, as well as the agreement in the diagnosis of hypertension. RESULTS: 1532 subjects were analyzed (mean age 49.01 ± 15.79 years old, 55.5% women). Response rate 36.3%. The mean systolic BP with three readings was 125.39 ± 17.43 mmHg, versus 124.33 ± 17.07 mmHg with the mean of the second and third readings (mean difference 1.01 ± 4.31; Cohen's D = 0.059). The mean diastolic BP was 73.93 ± 10.89 versus 73.71 ± 10.93 mmHg with both methods (mean difference 0.19 ± 2.11; Cohen's D = 0.017). Differences by age, sex, BMI, abdominal obesity, dyslipidemia, diabetes, smoking and sedentary lifestyle were all small (Cohen's D < 0.08). The agreement between both models for classifying subjects as hypertensive/non-hypertensive showed a Kappa value = 0.936 (McNemar's test p < 0.001). CONCLUSIONS: Determining the mean of three readings of BP does not make a significant difference in relation to the reading of the second and third measurements in a sample of general population.

Impacto de la guía de HTA del ACC/AHA en la frecuencia y la necesidad de tratamiento de la hipertensión arterial. Estudio RICARTO / Impact of the ACC/AHA AHT guidelines on the frequency of hypertension and the need for treatment. The RICARTO study

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La implantación del cribado poblacional del cáncer de cuellos uterino en Castilla-La Mancha / Implementation of population screening for cervical cancer in Castilla-La Mancha

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Burnout y su relación con el estrés percibido y la satisfacción laboral en profesionales sanitarios de Atención Primaria de una Comunidad Autónoma / Burnout and its connection with perceived stress and job satisfaction in primary healthcare professionals in an Autonomous Community

Objetivo: Evaluar la prevalencia de burnout y sus componentes en profesionales sanitarios de Atención Primaria de Castilla-La Mancha, así como su relación con el estrés percibido y la satisfacción laboral. Diseño: Estudio descriptivo observacional transversal. Emplazamiento: Estudio multicéntrico realizado en equipos de Atención Primaria de seis Áreas Sanitarias de Castilla-La Mancha. Participantes: Todos los profesionales de medicina y enfermería de Atención Primaria de las Áreas Sanitarias participantes. Mediciones Principales: Incluidas las siguientes variables: características de participantes (sociodemográficas/laborales), características lugar de trabajo, estrés percibido (Perceived Stress Scale), burnout (Maslach Burnout Inventory) y satisfacción laboral (cuestionario Font-Roja). Resultados: La prevalencia de burnout fue del 20,7 % (IC 95 %: 16,6-24,7). Un 53,3 % presentó alterada al menos una subescala. El 38,9 % mostró alto grado de despersonalización, 28,2 % agotamiento emocional y 8,0 % baja realización personal. La puntuación de estrés percibido fue significativamente superior al aumentar el grado de burnout en las tres subescalas (p<0,001). Mediante regresión logística, las variables asociadas a burnout fueron: mayor puntuación escala estrés percibido (OR: 1,20; IC95 %: 1,12-1,28), menor puntuación en escala satisfacción (OR: 8,42; IC 95 %: 1,96-36,10), contar con mayor número de pacientes en cupo (OR: 1,01; IC 95 %: 1,00-1,02) y no ser tutor de residentes (OR: 2,88; IC 95 %: 1,06-8,25). Conclusiones: El burnout afecta a uno de cada cinco profesionales de Atención Primaria de nuestra Comunidad Autónoma, siendo la despersonalización la subescala más alterada. Los profesionales con burnout presentan puntuaciones superiores de estrés percibido e inferiores de satisfacción laboral. Otras variables relacionadas con el puesto de trabajo también se asocian con la presencia de burnout

Objective: To evaluate the prevalence of burnout and its components in health care providers in primary care of Castilla-La Mancha, as well as its relation with perceived stress and job satisfaction. Design: Descriptive, observational cross-sectional study. Location: Multicenter study carried out by Primary Care Teams of six health areas of Castilla-La Mancha. Participants: Every health care professional (doctors and nurses) of the six health areas of Castilla-La Mancha. Main measurements: The variables included were: features of the participants (sociodemographic/occupational), work place features, perceived stress (Perceived-Stress-Scale), burnout (Maslach-Burnout-Inventory) and job satisfaction (Font-Roja test). Results: Prevalence of burnout: 20.7 % (CI 95 %: 16.6 - 24.7). About 53.3 % had at least one altered subscale. 38.9 % showed high level of depersonalization, 28.2 % emotional exhaustion and 8.0 % low personal fulfillment. Perceived stress score was significantly higher as the level of burnout increased in all three subscales (p<0.001). By using logistic regression, burnout associated variables were: Higher score in perceived stress scale (OR: 1.20; CI 95 %: 1.12-1.28), lower score in satisfaction scale (OR: 8.42; CI 95 %: 1.96-36.10), having more patients in their quota (OR: 1.01; CI 95 %:1.00-1.02) and no resident supervision (OR: 2.88; CI 95 %: 1.06-8.25). Conclusion: Burnout affects one in five primary care providers in our Autonomous Community, being depersonalization the most altered subscale. Professionals with burnout present higher perceived stress and lower job satisfaction. Other job-related variables are also associated with the presence of burnout

Diferencias de presión arterial entre una toma y la media de 3 tomas medidas automáticamente. Estudio SPRINT / Blood pressure differences between one automatic measurement and the mean value of 3 automatic measurements. SPRINT trial

Fundamento y objetivos: Existe discrepancia sobre cómo medir la presión arterial (PA). El objetivo de este trabajo fue estudiar la diferencia entre una determinación y la media de 3 determinaciones automáticas de la PA. Pacientes y método: Se utilizan 2 poblaciones de pacientes: una muestra poblacional (n=1.337) en la que la medición se realiza por una enfermera en el centro de salud, y una serie consecutiva de pacientes en los que se realiza delante del médico, en la consulta (n=200). Resultados: Las diferencias halladas entre la primera lectura y el promedio de 3 determinaciones son pequeñas en ambos casos. En la muestra poblacional oscila entre 2,07-3,21mmHg y en los pacientes en los que se determina en presencia del médico, es de 2,71±3,82mmHg en la sistólica, con mínimas diferencia en la PA diastólica. Conclusiones: En la determinación automática de la PA, existe escasa diferencia entre la primera determinación y el promedio de 3 lecturas (AU)

Background and objectives: There are discrepancies regarding how to measure blood pressure (BP). The goal of this study was to determine the differences between one automatic BP measurement and the mean of 3 automatic BP measurements. Patients and method: Two patient populations were used. A sample population (n=1,337) in which the measurement was performed by a nurse at the health center, and a consecutive series of patients (n=200) who had the measurement performed in front of the doctor in the office. Results: The differences found between the first reading and the average of 3 determinations were small in both cases. In the population sample, BP levels ranged from 2.07 to 3.21mmHg, and in patients who had their BP levels measured in the presence of doctor, this value ranged from 2.71±3.82mmHg (systolic pressure), with minimal differences in diastolic BP levels. Conclusions: Little difference was found between the first determination and the average of 3 automatic BP readings (AU)

Fractura atípica de fémur secundaria al uso de bifosfonatos / Atypical femur fracture secondary to biphosphonate use

Mujer de 80 años que consultó por dolor en muslo izquierdo sin irradiación y sin ningún mecanismo traumático. En Atención Primaria se realizaron radiografías y ecografía de la zona afectada que se informaron como normales. Tras un año y medio de seguimiento del dolor y estudios por diferentes especialidades, se observó en una nueva radiografía de fémur efectuada un engrosamiento de la cortical de dicho hueso. Dado este hallazgo y que la paciente se encontraba en tratamiento con ácido ibandrónico desde hacía más de cuatro años, se derivó a traumatología, donde le solicitaron una resonancia magnética y gammagrafía. Estando a la espera de dichas pruebas y sin ningún mecanismo traumático, comenzó con dolor, impotencia funcional y deformidad de dicha extremidad inferior, por lo que fue derivada a urgencias, diagnosticándose de fractura atípica de fémur secundaria al uso de bifosfonatos. El médico de familia debe prestar atención a realizar una correcta valoración y prescripción de estos fármacos, así como a identificar los síntomas prodrómicos de sus complicaciones (AU)

80-year-old woman who consulted for pain in left thigh without radiation and without traumatic mechanism. The Primary Care physician ordered X-rays and ultrasound of the affected area, both reported to be normal. After a 1.5 year follow-up and study of the pain by different specialties, a new femur radiography showed a cortical thickening. Given this finding and that the patient had been undergoing treatment with ibandronic acid for more than four years, she was referred to traumatology where physicians ordered magnetic resonance imaging and scintigraphy. While waiting for these tests and without any traumatic mechanism, the patient began experiencing pain, functional impotence and deformity of the lower limb. She was therefore referred to emergency, where she was diagnosed with atypical femur fracture secondary to biphosphonate use. The family physician must ensure an adequate assessment and prescription of such drugs, as well as identify the prodromal symptoms of their complicationst (AU)

Blood pressure differences between one automatic measurement and the mean value of 3 automatic measurements. SPRINT trial. / Diferencias de presión arterial entre una toma y la media de 3 tomas medidas automáticamente. Estudio SPRINT.

BACKGROUND AND OBJECTIVES: There are discrepancies regarding how to measure blood pressure (BP). The goal of this study was to determine the differences between one automatic BP measurement and the mean of 3 automatic BP measurements. PATIENTS AND METHOD: Two patient populations were used. A sample population (n=1,337) in which the measurement was performed by a nurse at the health center, and a consecutive series of patients (n=200) who had the measurement performed in front of the doctor in the office. RESULTS: The differences found between the first reading and the average of 3 determinations were small in both cases. In the population sample, BP levels ranged from 2.07 to 3.21mmHg, and in patients who had their BP levels measured in the presence of doctor, this value ranged from 2.71±3.82mmHg (systolic pressure), with minimal differences in diastolic BP levels. CONCLUSIONS: Little difference was found between the first determination and the average of 3 automatic BP readings.

El programa de prevención de cáncer colorrectal en Castilla-La Mancha: una importante actividad que requiere una adecuada evaluación / No disponible

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Valoración del riesgo de fractura osteoporótica / Risk assessment of osteoporotic fractures

La osteoporosis es la enfermedad metabólica ósea más frecuente en los países occidentales. Las fracturas por fragilidad son la consecuencia clínica más importante de esta enfermedad, con una importante morbimortalidad y un gran impacto sociosanitario. El abordaje fundamental de la osteoporosis por parte del médico de familia está en el control de los factores de riesgo, con el fin de evitar la aparición de fracturas. Entre los múltiples factores involucrados en el desarrollo de la osteoporosis, muchos están relacionados con la masa ósea, y solo unos pocos presentan una fuerte potencia de asociación y uniformidad en distintos estudios. Se han propuesto diferentes escalas clínicas de riesgo de osteoporosis y fractura, teniendo en cuenta los factores de riesgo más importantes.El presente artículo pretende revisar de forma somera los factores de riesgo involucrados en el desarrollo de la osteoporosis y de las fracturas osteoporóticas, así como ofrecer al médico de familia unas herramientas en forma de escalas de valoración del riesgo que le supongan una ayuda en su labor clínica diaria para responder a las preguntas anteriormente planteadas. Se realiza una revisión de las escalas de valoración de riesgo de baja masa ósea y las escalas de valoración del riesgo de fractura. Sin embargo, estas escalas no deben sustituir el abordaje holístico del paciente, propio del médico de familia (AU)

Osteoporosis is the most frequent metabolic bone disease in western countries. Fragility fractures are the most important clinical outcome of osteoporosis, with an important morbi-mortality and a great socio-sanitary impact.The main objective of the family physician’s approach to osteoporosis is the control of risk factors in order to prevent osteoporotic fractures. Among the numerous factors involved in the development of osteoporosis, most of them are related to bone mass, and only a few present high evidence of association and similar results in different studies. Some clinical scales of osteoporosis and fracture risk have been proposed, attending to the most important risk factors.The present article briefly reviews the risk factors related to the development of osteoporosis and osteoporotic fractures, as well as offering family physicians risk assessment scales that will help them in their daily clinical work. A review of the low bone mass risk assessment and fracture risk assessment scales is made. However, these scales can not replace the patient holistic attention as the basic approach of the family physician (AU)

Necesidades formativas de las enfermeras de Atención Primaria en la atención al dolor y al sufrimiento en la etapa final de la vida / No disponible

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Disponibilidad de información sobre manejo del dolor desde webs institucionales de los servicios de salud de las comunidades autónomas de España / Availability of information on pain management from institutional health services websites of the autonomous regions of Spain

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Concordance between automated oscillometric measurement of ankle-brachial index and traditional measurement by eco-Doppler in patients without peripheral artery disease.

AIM: To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care. METHODS: The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. RESULTS: A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. CONCLUSIONS: The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.

Los pacientes con reacciones adversas a medicamentos presentan una mayor prevalencia de alteraciones emocionales / Patients with adverse drug reactions have a higher prevalence of emotional disorders

Objetivo: Examinar la frecuencia de alteraciones emocionales (ansiedad y depresión) en pacientes con reacciones adversas (RA) a medicamentos, y compararla con la que se da en pacientes sin las mismas. Diseño del estudio: Casos y controles. Emplazamiento: Centro de Salud de Santa María de Benquerencia (Toledo). Participantes: Pacientes mayores de 14 años de ambos sexos de una consulta de medicina de familia. Mediciones y resultados: El total de pacientes fue de 311 (108 casos y 203 controles), siendo el 53,7% varones. La edad de los casos fue de 54,1 años y la de los controles 46,0 (t=4,254; p<0,001). El 45,5% de los casos presentaba antecedentes de ansiedad y el 41,7% de depresión, frente al 19,7 y 15,3%, respectivamente, de los controles (p<0,001). El promedio de enfermedades crónicas en casos fue de 5,8 y en controles 3,5 (p<0,001). El número de medicamentos tomados para los casos fue de 3,7 y para los controles de 1,7 (p<0,001). En la regresión logística, la probabilidad de haber presentado ansiedad está aumentada 2,5 veces en los pacientes con RA a medicamentos (IC 95%: 1,12-4,51) y la de haber presentado depresión 2 veces (IC 95%: 1,06-3,66). Los grupos de medicamentos que más RA presentaron fueron los del sistema nervioso central, los antibióticos y los antiinflamatorios. Conclusiones: 1) La comunicación de RA a medicamentos se asocia con la presencia de ansiedad o depresión, lo cual podría usarse como marcador de problemática psicosocial. 2) Debemos prestar atención a los pacientes con ansiedad o depresión a la hora de realizar prescripciones. 3) Los antibióticos, antiinflamatorios y fármacos que actúan en el sistema nervioso central son los más proclives a producir RA(AU)

Aim: To examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders. Study design: Case-control. Setting: Santa María de Benquerencia Health Centre (Toledo).ParticipantsPatients over 14 years old of both sexes managed in a Primary Care Clinic. Measurements and results: A total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t=4.254; P<0.001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P<0.001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P<0.001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P<0.001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely (1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories. Conclusions: 1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR(AU)

¿Se puede establecer una relación entre los índices FRAX® y QFracturescoresTM? / Can a relationship between FRAX® indices and QFracturescoresTM be established?

Objetivo: Establecer una correlación entre los valores de riesgo de fractura obtenidos con las herramientas FRAX® y QFractureScoresT. Diseño del estudio: Observacional descriptivo retrospectivo. Emplazamiento: Centro de Especialidades de Toledo. Participantes: Pacientes con osteoporosis de una consulta de Metabolismo Óseo. Mediciones: Revisión de historias clínicas, obteniendo los datos del momento en que se inició el tratamiento antiosteoporótico, aplicando los índices de riesgo FRAX®, con y sin densitometría (en los casos en que la tengan), y QFractureScoresT, y estableciendo la correlación entre ambos. Resultados: 99 pacientes (88,9% mujeres), edad media (± desviación estándar) 62,3 ± 9,3 años. El valor medio del FRAX® sin densitometría fue de 7,37 ± 6,33 para fractura osteoporótica mayor (FOM) y de 2,6 ± 3,71 para fractura de cadera (FC). Con densitometría (n=74) los valores fueron de 8,6 ± 7,35 y 3,36 ± 4,64, respectivamente. El riesgo a 10 años con QFractureScoresT fue de 4,56 ± 2,83 para FOM y de 1,58 ± 1,91 para FC. El 37,4% presentaba un índice FRAX® (FOM / FC) ≥ 20% / 3%. La correlación entre FRAX® y QFractureScoresT para FOM fue de 0,751 (IC95% 0,620-0,882) y para FC de 0,771 (IC95% 0,645-0,897), disminuyendo al incluir los valores de las densitometrías [r=0,573 en FOM (IC95% 0,384-0,762) y r=0,487 en FC (IC95% 0,286-0,688)]. Conclusiones: Los índices FRAX® y QFractureScoresT presentan una correlación moderada-fuerte, especialmente si no se incluyen los valores de las densitometrías. Su uso puede recomendarse en Atención Primaria, sobre todo para valorar los factores de riesgo de osteoporosis. Actualmente no disponemos de puntos de corte fiables para tomar decisiones diagnóstico-terapéuticas en nuestro medio (AU)

Objective: To establish a correlation between the values of fracture risk obtained by FRAX® and QFractureScoresT tools. Design of the study: Retrospective observational study Location: Speciality Centre in Toledo. Participants: Patients with osteoporosis from a Bone Metabolism consultation. Measurements: Review of clinical history, with data obtained from the moment the antiosteoporotic treatment was commenced, applying FRAX® risk indices, with and without densitometry (in the cases affected by it) and QFractureScoresT, and establishing a correlation between them. Results: 99 patients (88.9% female) average age (± standard deviation) 62,3 ± 9,3 years. The average FRAX® value without densitometry was 7,37 ± 6,33 for major osteoporotic fracture (MOF) and 2,6 ± 3,71 for hip fracture (HF). With densitometry (n=74), the values were 8,6 ± 7,35 and 3,36 ± 4,64, respectively. A 10 year risk with QFractureScoresT was 4,56 ± 2,83 for MOF and 1,58 ± 1,91 for hip fracture. 37.4% showed a FRAX® (MOF / HF) ≥ 20% / 3% index. The correlation between FRAX® and QFractureScoresT for MOF was 0,751 (IC95% 0,620-0,882) and HF, 0,771 (IC95% 0,645-0,897), getting lower when densitometry values are included [r=0,573 in MOF (IC95% 0,384-0,762) and r=0,487 in HF (IC95% 0,286-0,688)]. Conclusions:FRAX® and QFractureScoresT indices show a moderate to strong correlation, especially if densitometry values are not included. Its use can be recommended in primary health care, above all in order to assess the risk of osteoporosis. We do not currently have a reliable benchmark to take diagnostic and therapeutic decisions in our environment (AU)

[Patients with adverse drug reactions have a higher prevalence of emotional disorders]. / Los pacientes con reacciones adversas a medicamentos presentan una mayor prevalencia de alteraciones emocionales.

AIM: To examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders. STUDY DESIGN: Case-control. SETTING: Santa María de Benquerencia Health Centre (Toledo). PARTICIPANTS: Patients over 14 years old of both sexes managed in a Primary Care Clinic. MEASUREMENTS AND RESULTS: A total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t=4.254; P<.001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P<.001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P<.001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P<.001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely(1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories. CONCLUSIONS: 1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR.