Riesgo cardiovascular en la población anciana española. Escala de riesgo EPICARDIAN / Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score

Antecedentes y objetivos: La estimación del riesgo cardiovascular en personas mayores de 70 años es problemática. La mayoría de las escalas se han creado basándose en cohortes de personas de mediana edad, con una representación insuficiente de los adultos de más edad. El poder predictivo de los factores de riesgo cardiovascular clásicos disminuye con la edad. El objetivo de este estudio es desarrollar una escala específica para estimar el riesgo cardiovascular de la población anciana española. Métodos: Este estudio se realizó en una cohorte poblacional establecida en 1995. Marco: 3 zonas geográficas de España (Madrid, Ávila y Lugo). Participantes: 3.729 personas mayores de 64 años sin enfermedades cardiovasculares (ECV) al inicio del seguimiento. Mediciones: se investigaron anualmente las sospechas de ECV mortal y no mortal (cardiopatía coronaria e ictus) y se confirmaron usando los criterios del proyecto MONICA de la OMS. Se siguió a todos los participantes hasta que apareció el primer episodio de ECV, hasta su muerte o hasta el 31 de diciembre de 2015. Resultados: La edad fue el factor predictivo más potente de ECV a los 10 años en ambos sexos. Las variables asociadas con ECV en los varones fueron el tratamiento de la hipertensión arterial (HR: 1,35; IC 95%: 1,067-1,710), la diabetes (HR: 1,359; IC 95%: 0,997-1,852) y el tabaquismo (HR: 1,207; IC 95%: 0,945-1,541), y en las mujeres, el tabaquismo (HR: 1,881; IC 95%: 1,356-2,609) y la diabetes (HR: 1,285; IC 95%: 0,967-1,707). El colesterol total no aumentó el riesgo de ECV ni en varones ni en mujeres. Sin embargo, las concentraciones de colesterol total>200mg/dL se asociaron inversamente al riesgo de ECV a los 10 años, tanto en varones como en mujeres. conclusiones: La ECV total a los 10 años aumenta significativamente en los varones españoles de edad avanzada con la edad, la diabetes y el tratamiento antihipertensivo, y en las mujeres con la diabetes y el tabaquismo (AU)

Background and objectives: Cardiovascular risk estimation in people over 70 years of age is problematic. Most scores have been created based on cohorts of middle-aged people, with an underrepresentation of older adults. The predictive power of classical cardiovascular risk factors declines with age. The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain. Methods: This work is a population-based cohort established in 1995. Setting: 3 geographical areas of Spain (Madrid, Ávila, and Lugo). Participants: 3,729 people older than 64 years with no cardiovascular diseases (CVD) at baseline. Measurements: suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were investigated annually and confirmed using the WHO-MONICA criteria. All participants were followed-up on until occurrence of a first CVD event, until death, or until December 31, 2015. Results: Age was the strongest predictor of CVD at 10 years in both men and women. In men, variables associated with CVD were high blood pressure treatment (HR: 1.35; 95% CI: 1.067-1.710), diabetes (HR: 1.359; 95% CI: 0.997-1.852), and smoking (HR: 1.207; 95% CI: 0.945-1.541) and in women, the variables were smoking (HR: 1.881; 95% CI: 1.356-2.609) and diabetes (HR: 1.285; 95% CI: 0.967-1.707). Total cholesterol did not increase the risk of CVD in men or women. However, total cholesterol levels>200mg/dL were inversely associated with 10-year risk of CVD in men and women. Conclusions: In elderly Spanish men, total CVD at 10 years is significantly increased by age, diabetes, and antihypertensive treatment and in elderly Spanish women by diabetes and smoking. Total cholesterol levels did not increase the risk of CVD, particularly in males (AU)

Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score.

BACKGROUND AND OBJECTIVES: Cardiovascular risk estimation in people over 70 years of age is problematic. Most scores have been created based on cohorts of middle-aged people, with an underrepresentation of older adults. The predictive power of classical cardiovascular risk factors declines with age. The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain. METHODS: This work is a population-based cohort established in 1995. SETTING: Three geographical areas of Spain (Madrid, Ávila, and Lugo). PARTICIPANTS: 3,729 people older than 64 years with no cardiovascular diseases (CVD) at baseline. MEASUREMENTS: Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were investigated annually and confirmed using the WHO-MONICA criteria. All participants were followed-up on until occurrence of a first CVD event, until death, or until December 31, 2015. RESULTS: Age was the strongest predictor of CVD at 10 years in both men and women. In men, variables associated with CVD were high blood pressure treatment (HR: 1.35; 95% CI: 1.067-1.710), diabetes (HR: 1.359; 95% CI: 0.997-1.852), and smoking (HR: 1.207; 95% CI: 0.945-1.541) and in women, the variables were smoking (HR: 1.881; 95% CI: 1.356-2.609) and diabetes (HR: 1.285; 95% CI: 0.967-1.707). Total cholesterol did not increase the risk of CVD in men or women. However, total cholesterol levels >200 mg/dL were inversely associated with 10-year risk of CVD in men and women. CONCLUSIONS: In elderly Spanish men, total CVD at 10 years is significantly increased by age, diabetes, and antihypertensive treatment and in elderly Spanish women by diabetes and smoking. Total cholesterol levels did not increase the risk of CVD, particularly in males.

Torta de crambe na terminação de bovinos de corte em confinamento / Crambe meal in finishing of beef cattle in feedlot

Foram utilizados cinco novilhos nelore com peso inicial médio de 335±12kg, mantidos em baias individuais, para determinação do consumo e da digestibilidade, e 40 novilhos com peso corporal médio de 345±14kg, mantidos em baias coletivas, para avaliação do desempenho. A dieta definitiva foi constituída de 82% de concentrado e 18,2% de silagem de sorgo na base da matéria seca, e os níveis de inclusão da torta de crambe foram 0 (controle), 5, 10, 15 e 20%. Os ingredientes do concentrado foram sorgo moído, casca de soja, caroço de algodão, resíduo da colheita de soja, torta de crambe e núcleo mineral proteico. Houve efeito linear decrescente de nível de inclusão de torta de crambe sobre o peso corporal, e crescente, sobre o consumo de extrato etéreo, e houve efeito cúbico sobre o consumo de fibra em detergente neutro corrigido para cinzas e proteína (CFDNcp), em que o maior valor foi observado da dieta controle e o menor na dieta contendo 20% de torta de crambe. Os consumos de MS, PB, ureia, PB de ureia e CNFcp, bem como as digestibilidades e os ganhos de peso, não foram afetados pelos tratamentos. Conclui-se que a torta de crambe pode ser utilizada em até 20% de inclusão na matéria seca de dietas de bovinos de corte em confinamento.(AU)

Five Nellore steers with average initial weight of 335±12kg were kept in individual pens for determining consumption and digestibility and 40 steers with average body weight of 345 ± 14kg were kept in collective pens for performance assessment. The final diet was 82% of concentrate and 18.2% of sorghum silage on dry matter basis and the levels of inclusion of crambe pie were 0 (control), 5, 10, 15 and 20%. The concentrate ingredients were ground sorghum, soy hulls, whole cottonseed, soybean crop residue, crambe pie and protein + mineral nucleus. There was a decreasing linear effect of level of inclusion of crambe pie on the body weight, increasing linear effect on consumption of ether extract and cubic effect on consumption of neutral detergent fiber corrected for ashes and protein (NDFap), in which the highest value was observed in the control diet and the smallest in the diet containing 20% of crambe. The consumptions of DM, CP, urea, CP of urea and NFCap, as well as the digestibility and weight gain were not affected by treatments. It can be concluded that crambe meal can be utilized up to 20% of inclusion in dry matter in beef cattle diets in feedlot.(AU)

Nursing regimens: effects on body condition, return to postpartum ovarian cyclicity in Santa Ines ewes, and performance of lambs.

The effects of nursing regimens on the body condition, onset of ovarian cyclicity postpartum and weaning weight of lambs were assessed in Santa Ines ewes. Thirty-two ewes were blocked according to parity, number of lambs, and body weight at lambing and within each block randomly allocated to treatments: continuous nursing (CN), controlled nursing (CN2) with two daily feedings for an hour after the 10th day postpartum, or early weaning (EW) with total separation from the lambs after the 10th day. The animals were evaluated from the 12th day postpartum until the first estrus or until 60th day. The dry matter and nutrients intake did not differ among treatments (P>0.05) but did differ over time (P<0.01). The weight, body condition score, serum concentrations of non-esterified fatty acids and prolactin, the percentages of ewes in estrus, of ewes that ovulated within 60th day and had ovulation silent, the period from lambing to estrus, ovulation and follicle with a diameter ≥5mm and the maximum follicular diameter did not differ (P>0.05) among the treatments. The percentage of ovulation until 30th day was greater (P<0.05) in the EW group. The percentage of short luteal phases was higher in the CN2 and EW groups (P=0.07) and normal luteal phases were higher in the CN group (P=0.01). Lamb weight weaning was lower in the EW group (P<0.05). It is possible to use CN to obtain lambing periods less than eight months in Santa Ines ewes, with the advantages of simpler management and higher lamb weaning weights.

Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project].

AIM: To evaluate the effect of an educational intervention among primary care physicians on several indicators of good clinical practice in diabetes care. METHODS: Two groups of physicians were randomly assigned to the intervention or control group (IG and CG). Every physician randomly selected two samples of patients from all type 2 diabetic patients aged 40 years and above and diagnosed more than a year ago. Baseline and final information were collected cross-sectionally 12 months apart, in two independent samples of 30 patients per physician. The educational intervention comprised: distribution of educational materials and physicians' specific bench-marking information, an on-line course and three on-site educational workshops on diabetes. External observers collected information directly from the physicians and from the medical records of the patients on personal and family history of disease and on the evolution and treatment of their disease. Baseline information was collected retrospectively in the control group. RESULTS: Intervention group comprised 53 physicians who included a total of 3018 patients in the baseline and final evaluations. CG comprised 50 physicians who included 2868 patients in the same evaluations. Measurement of micro-albuminuria in the last 12 months (OR = 1.6, 95% CI: 1.1-2.4) and foot examination in the last year (OR = 2.0, 95% CI: 1.1-3.6) were the indicators for which greater improvement was found in the IG. No other indicator considered showed statistically significant improvement between groups. CONCLUSIONS: The identification of indicators with very low level of compliance and the implementation of a simple intervention in physicians to correct them is effective in improving the quality of care of diabetic patients.

Quality of care of patients with type-2 diabetes in Galicia (NW Spain) [OBTEDIGA project].

AIMS: The aim of this study was to describe the degree of compliance of agreed practices with reference to primary care patients with Type 2 diabetes of 40 years old and older in Galicia (NW Spain). METHODS: A total of 108 primary care physicians were selected at random from the totality of doctors. Each physician selected 30 patients at random from their patients suffering from diabetes of 40 years old or older. External observers gathered information from each patient's medical record regarding their characteristics, condition and degree of compliance of selected indicators of good practice. RESULTS: Group of physicians participated in this study had a mean age of 50 years (standard deviation = 3.9); 48% of them were females; and 17.5% involved in medical residents training. A total of 3078 diabetic patients were included in the study: mean age = 69 years (SD = 10.9), 47.6% women, presence of high blood pressure (72%), hypercholesterolaemia (56%), and regular smokers (10.3%). Compliance with selected indicators such as foot examination (14%), ophthalmological examination (30.6%), abdominal circumference measurement (6.1%), measurement of total or LDL-cholesterol (78.1), blood pressure measurement (84.8), glycosylated haemoglobin measurement < 7% (54.3%) was observed. Adequate monitoring in cases of high blood pressure and hypercholesterolaemia were 34.2% and 27.4%, respectively. Variability between physicians differs according to the different indicators, with interquartile range for compliance of between 16.4 and 66%. CONCLUSIONS: There is a wide margin for improvement in the adaptation of clinical practice to recommendations for diabetic patients. The large variation existing in certain indicators would suggest that certain control objectives are less demanding than advisable in those that comply least, while low compliance and low variability in other indicators point to structural problems or unsatisfactory training of doctors.

[Prevalence of asthma and rhinitis symptoms in A Coruña (Spain)]. / Prevalencia de síntomas de asma y rinitis en la población de A Coruña.

INTRODUCTION: The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. OBJECTIVE: To asses the prevalence of asthma and rhinitis symptoms in childhood. MATERIAL AND METHODS: We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. RESULTS: A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of "wheezing at some time" was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. CONCLUSIONS: The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied.