[Clinical-epidemiological characteristics of the atrial fibrillation in patients 65 years of age or older diagnosed in primary care.] / Características clínico-epidemiológicas de la fibrilación auricular en pacientes de 65 años o más diagnosticados en Atención Primaria.

OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p<0.001), and as age increased (p<0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation.

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. METODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p<0,001), y más aún conforme aumentaba la edad (p<0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular.

Características clínico-epidemiológicas de la fibrilación auricular en pacientes de 65 años o más diagnosticados en atención primaria / Clinical-epidemiological characteristics of the atrial fibrillation in patients 65 years of age or older diagnosed in primary care

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. MÉTODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p < 0,001), y más aún conforme aumentaba la edad (p < 0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular

OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p < 0.001), and as age increased (p < 0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation

Knowledge, availability, and use of ambulatory and home blood pressure monitoring in primary care in Spain: the MAMPA study.

OBJECTIVE: To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain. METHODS: Online self-administered survey sent between May 2016 and February 2017 to 2221 primary-care physicians working across Spain. Clinicians were mostly identified through national primary-care scientific societies (20% overall response rate). RESULTS: Participants' mean age was 47.7 years, 55% were women, and 54% reported at least 20 years of primary-care practice. Among them, 47.5% considered ABPM the best diagnostic method for hypertension, 23% chose HBPM, and 7.1% chose office blood pressure. Also, 78.2% had AD available at their centers and 49.0% had ABPM, with slight urban/rural differences. HBPM was recommended in daily practice for hypertension diagnosis by 67% of participants, whereas 30% recommended ABPM. Cost to the patients was the main reason for not using HBPM (42.7%) as was lack of accessibility for not using ABPM (69.8%). Lack of specific training was also reported as an important reason in both cases. CONCLUSION: Even in the possibly best primary care scenario presented by highly motivated physicians (respondents to a voluntary anonymous survey), enormous gaps were observed between current guidelines' recommendations on ABPM and HBPM use for confirming hypertension and the modest degree of knowledge, availability, and use of these technologies.

Recomendaciones para la detección, investigación y derivación del dolor lumbar inflamatorio en Atención Primaria / Reccomendations for the detection, study and referral of inflammatory low-back pain in Primary Care

Objetivo. Diseñar una estrategia de detección y derivación precoz de pacientes con posible espondiloartritis mediante el desarrollo de recomendaciones consensuadas dirigidas a los médicos de Atención Primaria (AP). Métodos. Se utilizó una metodología modificada de RAND/UCLA y revisión sistemática de la literatura. Se seleccionó un grupo de discusión formado por reumatólogos y médicos de AP. Se estudió el mapa del proceso y se propusieron recomendaciones y algoritmos que fueron sometidos a 2 rondas Delphi para evaluar el grado de aceptación y preferencia de criterios en un grupo amplio de reumatólogos y médicos de AP. Del análisis de la segunda ronda Delphi se extrajeron las recomendaciones finales. Resultados. Se presentan recomendaciones, junto con su grado medio de acuerdo, para la derivación rápida de pacientes con sospecha de espondiloartritis. En concreto, se recomienda investigar el dolor lumbar crónico en menores de 45 años en 4 fases: 1) clínica: preguntas clave; 2) clínica: preguntas extra; 3) exploración física, y 4) pruebas complementarias. Se debe derivar a Reumatología si existen: 1) dolor lumbar inflamatorio; 2) signos indicativos de espondiloartritis, o 3) HLA B27 positivo, elevación de proteína C reactiva o signos radiológicos de sacroilitis. Se incluyen recomendaciones sobre el proceso de derivación y otras adicionales. Conclusiones. El grado de acuerdo con estas sencillas recomendaciones es amplio. Es necesario diseñar estrategias de formación y sensibilización desde los servicios de Reumatología para mantener una óptima colaboración de AP en la identificación de los casos y facilitar que los servicios de Reumatología estén preparados para asumir las derivaciones (AU)

Objective. To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. Methods. We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. Results. We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. Conclusions. The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments (AU)

Reccomendations for the detection, study and referral of inflammatory low-back pain in primary care.

OBJECTIVE: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. METHODS: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. RESULTS: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. CONCLUSIONS: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.

Concordancia entre observadores en el diagnóstico electrocardiográfico de la hipertrofia ventricular izquierda en hipertensos de Andalucía. Estudio PREHVIA / Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study

Objetivo: Estimar la concordancia en el diagnóstico de la hipertrofia ventricular izquierda electrocardiográfica (HVI-ECG) en sujetos hipertensos entre médicos de atención primaria (AP) y un cardiólogo experto.Diseño: Estudio transversal y multicéntrico.EmplazamientoCentros de AP de Andalucía.Participantes: 120 médicos de AP que mediante muestreo aleatorio seleccionaron a pacientes de 35 o más años con hipertensión arterial de al menos 6 meses de evolución.Mediciones principales: Se recogieron datos demográficos, de factores de riesgo y de enfermedades cardiovasculares. La HVI-ECG se evaluó aplicando los criterios de voltaje de Cornell, producto de Cornell y de Sokolow-Lyon. Los investigadores de AP realizaron una primera lectura y un cardiólogo, una segunda ciega.Resultados: Se estudió a 570 pacientes (media±desviación estándar de edad, 65±11 años; mujeres, 54,5%); la prevalencia de HVI-ECG fue del 13,7% (intervalo de confianza [IC] del 95%, 10,8-16,6; el 12,6% por Cornell y el 1,6% por Sokolow-Lyon). La concordancia en el diagnóstico de HVI-ECG entre el médico de AP y el cardiólogo fue 0,378 (IC del 95%, 0,272-0,486; desacuerdos en el 15,5% de los casos). Los investigadores de AP subestimaron levemente la prevalencia de HVI-ECG por Cornell y la sobreestimaron levemente por el criterio de Sokolow-Lyon; también fue baja la concordancia para cada uno de ellos (Cornell: κ=0,367; IC del 95%, 0,252-0,482; Sokolow-Lyon: κ=0,274; IC del 95%, 0,093-0,454).Conclusiones: La concordancia entre el diagnóstico de los médicos de AP y el cardiólogo es baja. Los resultados de este estudio indican la necesidad de mejorar la medición electrocardiográfica entre los médicos de AP; la utilización de sistemas informatizados podría ser una buena opción(AU)

Objective: To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients.Design: Cross-sectional, multicentre study.Setting: Andalusian Primary Care Centres.Participants: A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression.Primary variables: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind.Results: A total of 570 patients (mean±SD of age, 65±11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (κ=0.367; 95% CI, 0.252-0.482, for Cornell, and κ=0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon).Conclusions: The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option(AU)

[Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study]. / Concordancia entre observadores en el diagnóstico electrocardiográfico de la hipertrofia ventricular izquierda en hipertensos de Andalucía. Estudio PREHVIA.

OBJECTIVE: To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients. DESIGN: Cross-sectional, multicentre study. SETTING: Andalusian Primary Care Centres. PARTICIPANTS: A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression. PRIMARY VARIABLES: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind. RESULTS: A total of 570 patients (mean +/- SD of age, 65 +/- 11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (kappa = 0.367; 95% CI, 0.252-0.482, for Cornell, and kappa = 0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon). CONCLUSIONS: The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option.

[Prevalence of left ventricular hypertrophy, atrial fibrillation and cardiovascular disease in hypertensive patients of Andalusia, Spain. PREHVIA study]. / Prevalencia de hipertrofia ventricular izquierda, fibrilación auricular y enfermedad cardiovascular en hipertensos de Andalucía. Estudio PREHVIA.

OBJECTIVES: The objective of the PREHVIA study was to assess the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) and of atrial fibrillation (AF) among Andalusian hypertensive patients, and the relationship of this complications with cardiovascular disease (CVD). PATIENTS AND METHODS: Cross-sectional study with selection of study centres following the distribution of the Andalusian population by provinces and habitat, and randomization of patients included in the sample. Personal history was recorded, and ECG-LVH was assessed using the Cornell (voltage and product) and Sokolow-Lyon criteria, applied by the participant physicians and by an expert cardiologist. The association with ECG-HVH or CVD was studied by logistic regression models. RESULTS: In 570 patients (mean age 65 years, 54.5% women, 50.6% with obesity, 28,2% with diabetes), the prevalence of ECG-LVH was 13.7% (95% confidence interval [CI], 10.8-16.6%). Cornell criterion was fulfilled by 12.6% and Sokolow-Lyon by 1.6%. The prevalence of AF was 5.1% (95% CI, 3.9-7.5%) and 22.1% (95% CI, 18.4-25.4%) had established CVD. In the multivariate analysis, ECG-LVH was associated with female gender (odds ratio=5.10; 95% CI, 2.44-10.64) and with the presence of CVD (odds ratio=2.18; 95% CI, 1.09-4.12). The antecedent of CVD was independently associated with an advanced age, male gender, AF and, less strongly, with low glomerular filtration rate and diabetes mellitus. CONCLUSIONS: In Andalusian hypertensives, the prevalence of ECG-LVH was significantly lower than that found in other studies, greater in women and at the expense of the Cornell criterion, the prevalence of AF was 5.1% and it was 22.1% for CVD with independent associations between ECG-LVH and between CVD and AF.

Prevalencia de hipertrofia ventricular izquierda, fibrilación auricular y enfermedad cardiovascular en hipertensos de Andalucía. Estudio PREHVIA / Prevalence of left ventricular hypertrophy, atrial fibrillation and cardiovascular disease in hypertensive patients of Andalusia, Spain. PREHVIA study

Objetivos: el objetivo del estudio PREHVIA ha sido estimar la prevalencia de hipertrofia ventricular izquierda evidenciada en el electrocardiograma (HVI-ECG) y de fibrilación auricular (FA) en pacientes con hipertensión arterial (HTA) de Andalucía, y evaluar la relación de estas variables con la enfermedad cardiovascular (ECV).Pacientes y métodos se realizó un estudio transversal con selección de centros de salud según la distribución de la población andaluza por provincias y hábitat, y selección aleatoria de pacientes incluidos en la muestra. Se recogieron los antecedentes y los médicos participantes y un cardiólogo experto valoraron la HVI-ECG aplicando los criterios de Cornell (voltaje y producto) y de Sokolow-Lyon. Se valoró la asociación con la HVI o la ECV mediante modelos de regresión logística. Resultados: en 570 pacientes (edad media de 65 años, un 54,5% de mujeres, un 50,6% con obesidad y un 28,2% con diabetes), la prevalencia de HVI-ECG fue del 13,7% (intervalo de confianza [IC] del 95%, 10,8–16,6%). El 12,6% cumplió el criterio de Cornell y el 1,6% el de Sokolow-Lyon. Un 5,1% presentó FA (IC del 95%, 3,9–7,5%) y el 22,1% (IC del 95%, 18,4–25,4%) tenía antecedente de ECV. En el análisis multivariante, la HVI-ECG se relacionó con el sexo femenino (odds ratio=5,10; IC del 95%, 2,44–10,64) y la presencia de ECV (odds ratio=2,18; IC del 95%, 1,09–4,12). La ECV se relacionó independientemente con la edad avanzada, el sexo masculino y la FA, y con menos fuerza con un filtrado glomerular bajo y la diabetes mellitus. Conclusiones: en hipertensos de Andalucía la prevalencia de HVI-ECG es considerablemente inferior a la hallada en otros estudios, mucho mayor en mujeres y a expensas principalmente del criterio de Cornell. La prevalencia de FA es del 5,1% y la de ECV similar a la de estudios previos. Se observa una asociación independiente entre HVI-ECG y ECV, y entre ECV y FA (AU)

Objectives: The objective of the PREHVIA study was to assess the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) and of atrial fibrillation (AF) among Andalusian hypertensive patients, and the relationship of this complications with cardiovascular disease (CVD).Patients and methods Cross-sectional study with selection of study centres following the distribution of the Andalusian population by provinces and habitat, and randomization of patients included in the sample. Personal history was recorded, and ECG-LVH was assessed using the Cornell (voltage and product) and Sokolow-Lyon criteria, applied by the participant physicians and by an expert cardiologist. The association with ECG-HVH or CVD was studied by logistic regression models. Results: In 570 patients (mean age 65 years, 54.5% women, 50.6% with obesity, 28,2% with diabetes), the prevalence of ECG-LVH was 13.7% (95% confidence interval [CI], 10.8–16.6%). Cornell criterion was fulfilled by 12.6% and Sokolow-Lyon by 1.6%. The prevalence of AF was 5.1% (95% CI, 3.9–7.5%) and 22.1% (95% CI, 18.4–25.4%) had established CVD. In the multivariate analysis, ECG-LVH was associated with female gender (odds ratio=5.10; 95% CI, 2.44–10.64) and with the presence of CVD (odds ratio=2.18; 95% CI, 1.09–4.12). The antecedent of CVD was independently associated with an advanced age, male gender, AF and, less strongly, with low glomerular filtration rate and diabetes mellitus. Conclusions: In Andalusian hypertensives, the prevalence of ECG-LVH was significantly lower than that found in other studies, greater in women and at the expense of the Cornell criterion, the prevalence of AF was 5.1% and it was 22.1% for CVD with independent associations between ECG-LVH and between CVD and AF (AU)

Implementación y características de la población del estudio ArtRoCad, una aproximación al consumo de recursos y repercusión socioeconómica de la artrosis de rodilla y cadera en atención primaria / ArtRoCad: health resources utilization and socioeconomic impact of knee and hip osteoarthritis. I. Methods and population characteristics

Objetivo: El estudio ArtRoCad analiza el consumo de recursos sanitarios y la repercusión socioeconómica de la artrosis de rodilla y cadera en atención primaria en España. En este trabajo se describe la metodología del estudio ArtRoCad, y se presentan las principales características de la población incluida. Métodos: Estudio transversal, de pacientes ambulantes, de 50 o más años, diagnosticados de artrosis de rodilla o cadera y dolor durante 3 meses en el último año en atención primaria; seleccionados de forma consecutiva a escala estatal, de forma proporcional a la población general de 50 o más años. La localización más importante de demanda de atención sanitaria se consideró articulación señal. El estudio se realizó en octubre y noviembre de 2003. Se recogió información acerca de los datos clínicos, de calidad de vida, y consumo de recursos sanitarios y bajas laborales o días de incapacidad en los últimos 6 meses, mediante 2 entrevistas estructuradas. Resultados: Participó el 87% de los médicos previstos por el muestreo, que aportó un 82% del tamaño muestral predeterminado. En total se entrevistaron 1.071 pacientes, con la siguiente distribución por articulaciones señal: rodilla 710 (66,3%), cadera 252 (23,5%) y ambas 109 (10,2%). El 75% de la muestra tenía 65 o más años y el 74% eran mujeres. La mayoría de los enfermos estaba afectada de artrosis moderada o severa, con una mediana de evolución del dolor de entre 6 y 10 años. En más de la mitad de los casos, los pacientes tenían limitación adicional por problemas osteomusculares distintos a la artrosis de rodilla y/o cadera. Conclusiones: ArtRoCad obtuvo una excelente participación. La muestra obtenida es representativa de la población con artrosis sintomática de rodilla y cadera moderada o grave atendida en atención primaria, con una importante comorbilidad(AU)

Objective: The ArtRoCad study analyzes healthcare resource utilization and the socioeconomic impact of knee and hip osteoarthritis in primary care in Spain. The present study describes the methodology of the ArtRoCad study and presents the main characteristics of the population included. Methods: We performed a cross-sectional study of ambulatory patients in primary care, aged e 50 years old, with a diagnosis of knee or hip osteoarthritis and a history of pain for 3 months in the previous year. The patients were selected consecutively on a country-wide basis, proportional to the general population aged e 50 years. The most important localization for healthcare demand was considered the main affected joint. The study was performed in October and November, 2003. Information on clinical data, quality of life and resource consumption, sick leave from work or days of disability in the previous 6 months were gathered through 2 structured interviews. Results: Eighty-seven percent of the physicians predicted by sampling participated in the study, accounting for 82% of the predetermined sample size. A total of 1,071 patients were interviewed. The distribution of the main affected joint was as follows: knee 710 (66.3%), hip 252 (23.5%) and both knee and hip 109 (10.2%). Seventy-five percent of the sample was aged 65 years or older and 74% were women. Most of the patients had moderate or severe osteoarthritis with a median pain duration of between 6 and 10 years. More than half the patients experienced additional limitations due to musculoskeletal problems other than knee and/or hip osteoarthritis. Conclusions: Participation in the ArtRoCad study was excellent. The sample obtained was representative of the population with symptomatic moderate or severe osteoarthritis of the knee and hip in primary care, with substantial comorbidity(AU)

Diagnóstico y tratamiento antimicrobiano de las otitis externas / Diagnosis and antibiotic treatment of external otitis

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[ArtRoCad: health resources utilization and socioeconomic impact of knee and hip osteoarthritis. I. Methods and population characteristics]. / Implementación y características de la población del estudio ArtRoCad, una aproximación al consumo de recursos y repercusión socioeconómica de la artrosis de rodilla y cadera en atención primaria.

OBJECTIVE: The ArtRoCad study analyzes healthcare resource utilization and the socioeconomic impact of knee and hip osteoarthritis in primary care in Spain. The present study describes the methodology of the ArtRoCad study and presents the main characteristics of the population included. METHODS: We performed a cross-sectional study of ambulatory patients in primary care, aged ≥ 50 years old, with a diagnosis of knee or hip osteoarthritis and a history of pain for 3 months in the previous year. The patients were selected consecutively on a country-wide basis, proportional to the general population aged ≥ 50 years. The most important localization for healthcare demand was considered the main affected joint. The study was performed in October and November, 2003. Information on clinical data, quality of life and resource consumption, sick leave from work or days of disability in the previous 6 months were gathered through 2 structured interviews. RESULTS: Eighty-seven percent of the physicians predicted by sampling participated in the study, accounting for 82% of the predetermined sample size. A total of 1,071 patients were interviewed. The distribution of the main affected joint was as follows: knee 710 (66.3%), hip 252 (23.5%) and both knee and hip 109 (10.2%). Seventy-five percent of the sample was aged 65 years or older and 74% were women. Most of the patients had moderate or severe osteoarthritis with a median pain duration of between 6 and 10 years. More than half the patients experienced additional limitations due to musculoskeletal problems other than knee and/or hip osteoarthritis. CONCLUSIONS: Participation in the ArtRoCad study was excellent. The sample obtained was representative of the population with symptomatic moderate or severe osteoarthritis of the knee and hip in primary care, with substantial comorbidity.

Proposals for improvement of emergency rural health care.

Universal healthcare coverage is a right, and that includes emergency health care. The community expects such requirements to be within their reach, including all human and technological resources necessary for rapid and high-quality health assistance in an emergency. Access to and delivery of emergency care in rural areas is recognized as more difficult than that in urban areas. In this report, following the EURIPA meeting in June 2004, the authors determine the problems of dealing with emergencies in the rural healthcare context, and also make proposals for improvement.

Lumbalgia durante la práctica del Windsurfing / Backache caused by windsurfing practice

El windsurfing es, posiblemente, el deporte náutico más practicado hoy en el mundo. Pero tiene un aspecto negativo: las lesiones que provoca. Existe poca experiencia al respecto y la información no es abundante. Por estas razones, los autores realizaron una encuesta clínica a 55 personas que practican este deporte para comprobar la incidencia de tales afecciones, especialmente de la lumbalgia, así como las razones de su presentación, muy frecuente entre ellos. Hallaron que el 66 por ciento habían padecido dolor lumbar después de su práctica. Concluyen que la adopación de una postura incorrecta, motivada por el poco dominio de la técnica, el no poseer una buena preparación física previa y no efectuar un calentamiento muscular antes de cada lesión, constituye las principales causas de las lesiones y molestias musculares causadas por la sobrecarga que debe enfrentar el sistema muscular, especialmente la región lumbar

Lumbalgia durante la práctica del Windsurfing / Backache caused by windsurfing practice

El windsurfing es, posiblemente, el deporte náutico más practicado hoy en el mundo. Pero tiene un aspecto negativo: las lesiones que provoca. Existe poca experiencia al respecto y la información no es abundante. Por estas razones, los autores realizaron una encuesta clínica a 55 personas que practican este deporte para comprobar la incidencia de tales afecciones, especialmente de la lumbalgia, así como las razones de su presentación, muy frecuente entre ellos. Hallaron que el 66 por ciento habían padecido dolor lumbar después de su práctica. Concluyen que la adopación de una postura incorrecta, motivada por el poco dominio de la técnica, el no poseer una buena preparación física previa y no efectuar un calentamiento muscular antes de cada lesión, constituye las principales causas de las lesiones y molestias musculares causadas por la sobrecarga que debe enfrentar el sistema muscular, especialmente la región lumbar(AU)