[Identification of individuals with insulin resistance by means of clinical measurements and routine biochemical markers. Construction of an individual risk index]. / Identificación de individuos con resistencia a la insulina mediante mediciones clínicas y marcadores bioquímicos de rutina. Construcción de un índice de riesgo individual.

INTRODUCTION: This study aimed to know the markers and routine biochemical measures that are associated to the insulin resistance (IR) and to develop an index of individual IR risk from them. SUBJECTS AND METHODS: Cross-sectional study made in Primary Health Care population of both genders between 40 and 74 years (n = 2,143). A representative sample was obtained by simple random sampling of 305 patients after excluding the diabetic subjects. Sociodemographic variables, background, examinations, routine analyses as well as fasting insulin levels were obtained. IR was considered if HOMA was higher than 2.9. A step by step logistic regression was done to obtain the best variables to predict IR. A logistic equation, categorical scale and simple additive scale from the beta coefficients was then constructed and was compared with other instruments designed to predict IR. RESULTS: IR prevalence was 25.2%. There were no differences between genders or by age. The four variables that entered the model were fasting plasma glucose, BMI, HDL cholesterol and diastolic blood pressure. The logistic model had good adjustment. The logistic equation was: IR = 1/ 1 + exp (-[-21.011) - [0.119 * fasting plasma glucose] - [0.231 * BMI] - [-0.046 * HDL cholesterol] - [0.048 * diastolic blood pressure]). The scale constructed assesses each subject between -1 and 7 points; cutoff to predict IR was established at 3.5 points, obtaining a sensitivity and specificity similar to the McAuley index and better than the triglycerides/HDL cholesterol ratio, the first model of Stern and the diagnosis of metabolic syndrome according to ATP-III. DISCUSSION: A very easy-to-use instrument has been obtained to predict IR by means of exploratory measures and routine biochemical measures, which makes it possible to select the patients at the greatest risk in order to intensify preventive actions in them.

Prevalencia de tabaquismo en una población general y valoración de la actitud ante el cambio. ¿Están preparados nuestros pacientes para abandonar el hábito? / Prevalence of smoking in a general population and evaluation of patient attitude prior to stopping. Are our patients prepared to stop smoking?

Introducción y objetivos. El modelo teórico de los Estadios del Cambio permite entender los cambios en el grado de disposición del paciente ante un hipotético intento de abandono del tabaquismo. El objetivo del presente trabajo ha sido estudiar la prevalencia del tabaquismo, la dependencia del tabaco y los intentos del abandono del hábito, estudiar la asociación con la historia de tabaquismo en los padres, estudiar a los fumadores en función de la fase de abandono en que se encuentran y conocer si los afectados por enfermedades relacionadas con el tabaco son más proclives al abandono. Pacientes y métodos. Estudio descriptivo transversal en la población mayor de 14 años perteneciente al Consultorio de Colloto (Asturias). Se calculó una muestra de 415 personas, que se seleccionaron de forma aleatoria simple. Los datos se obtuvieron mediante encuesta. Para el análisis estadístico de los datos se utilizó el programa Epi Info (v. 6.04b). Resultados. Se evaluó a 402 individuos, un 51,7% mujeres. La prevalencia de fumadores actuales es del 29,9% (25,5-34,6%); son ex fumadores el 19,1% (15,5-23,4%) y nunca ha fumado el 51,0% (46,0-56,0%). Hay diferencias muy significativas entre sexos en el grupo de más de 64 años. De los que han sido fumadores, el 39,1% (32,3-46,3%) ha dejado el hábito. El abandono del tabaco se incrementa con la edad. Cuando los padres han sido fumadores los sujetos tienen 2 veces más posibilidades de serlo. Sólo el 13% de los fumadores tienen elevada dependencia. Se encuentra en la fase precontemplativa el 46,6% (37,5-55,0%), en la contemplativa el 40,7% (31,8-50,1%), y en la de preparación el 12,7% (7,5-20,4%). Aquellos que estaban en fase precontemplativa presentaban un grado de dependencia (índice de Fageström), una media de cigarrillos/día y de paquetes/año más altos que el resto. El 50,8% de los fumadores han intentado abandonar el tabaco. En los pacientes con enfermedades crónicas relacionadas con el tabaquismo o factores de riesgo vascular el abandono del hábito tabáquico ha sido mayor que en los que no presentaban ninguna enfermedad. Conclusiones. Se sugiere la existencia de un descenso en el número de consumidores activos. No obstante, en los más jóvenes el número de mujeres fumadoras se equipara al de varones. La distribución de los fumadores en función del modelo de los Estadios del Cambio revela un elevado número de pacientes en las fases donde es previsible una mayor eficacia de la intervención. Es notable el grado de abandono existente en pacientes con factores de riesgo cardiovascular y en aquéllos con enfermedad vascular ya presente (AU)

Introduction and objectives. The theoretical model of the Stages of Change allows us to understand changes in the degree of a patient's willingness in a hypothetical attempt to quit smoking. The aims of this study were to assess the prevalence of smoking, dependence and attempts to stop; study the link with a history of smoking by parents, classify smokers by the degree of desire to stop smoking and to ascertain whether those with smoking-related disesaes are more inclined to quit smoking. Patients and methods. Cross-sectional, descriptive study in the population aged 14 and over in Colloto (a primary care center in Asturias, Spain). The study was focused on a simple, random sample of 415 persons. Data were obtained by means of a survey. The epi-info 6.04b was used for statistical analysis. Results. A sample of 402 patients were evaluated; 51.7% were female. The prevalence of current smokers was 29.9% (25.5-34.6%); 19.1% (15.5-23.4%) had stopped smoking and 51.0% (46.0-56.0%) had never been smokers. Marked differences were observed between sexes in the over-64 age group. Among smokers, 39.1% (32.3-46.3%) had stopped. Quitting had increased with age. When parents had been smokers, the chance of their offspring also being smokers had doubled. Only 13% of smokers had high dependence. 46.6% (37.5-55.0%) were in the "precontemplative" stage, 40.7% (31.8-50.1%) in the contemplative stage and 12.7% (7.5-20.4%) in the readiness stage. Those in the precontemplative stage presented a Fageström score, a number of cigarettes-daily and packs per year consumption higher than the rest. The 50.8% of smokers had made attempts to stop. In patients with chronic tobacco-related illnesses and those at risk for vascular disease, stopping smoking was more prevalent than in those with no such symptoms. Conclusions. A decline in the number of active smokers is suggested; however, in the younger population the number of females approaches that of males. The distribution of smokers according to the Stages of Change model reveals a large number of patients in phases where there should be a high probability of intervention effectiveness. The degree of quitting in patients with higher cardiovascular risk and those who already have vascular diseases is noteworthy (AU)