[Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources]. / El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios.

INTRODUCTION: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). MATERIALS AND METHODS: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. RESULTS: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. CONCLUSIONS: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients.

El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios / Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources

Introducción: Pese a la elevada prevalencia del síndrome de piernas inquietas (SPI), se cuenta con escasa información sobre este trastorno en nuestro país. El objetivo de este estudio fue obtener información sobre este problema de salud a partir de pacientes identificados mediante un cuestionario de cribado y posterior confirmación diagnóstica por médicos de Atención Primaria (AP). Material y métodos: Estudio en tres etapas, transversal y retrospectivo (utilización de recursos), en una muestra de pacientes adultos (2.047 sujetos) que acudió a consultas ambulatorias de 10 centros de Atención Primaria (Madrid, Barcelona y Valencia). Se utilizó un cuestionario de detección con los 4 criterios diagnósticos de SPI. Se realizó la evaluación clínica y confirmación diagnóstica mediante un cuestionario estandarizado. Otras variables evaluadas fueron: calidad de vida, mediante la puntuación del Cuestionario SF-36 de salud; sueño, mediante la puntuación de la escala de sueño MOS; intensidad de los síntomas de SPI, mediante la puntuación de la escala IRLS; utilización de recursos sanitarios en los 12 meses previos. Confirmación del diagnóstico del médico de AP, por un neurólogo especialista en trastornos del movimiento en una muestra reducida aleatoria de pacientes. Resultados: Un 19,7% (404 de 2.047) de los sujetos respondió positivamente a las 4 preguntas diagnósticas del cuestionario de detección del SPI. De ellos, 185 sujetos (9,0%) presentaban síntomas por lo menos dos veces a la semana, de intensidad moderada a grave. El médico de AP confirmó el diagnóstico de SPI en 79 de los 154 pacientes que completaron la entrevista diagnóstica. La prevalencia en esta población adulta fue del 4,6%. El valor predictivo del cuestionario de detección del SPI fue de un 51,3%. La edad media de inicio de síntomas fue de 42 años (rango: 20-más de 80 años). Los síntomas de SPI fueron moderados en el 50,6% y graves en el 38%. El 73,4% de los pacientes con SPI dormía mal, al menos dos noches por semana. La puntuación media de la escala IRLS (0-40) fue de 19,4. La puntuación media del cuestionario SF-36 (0-100) fue de 54,6, más baja que la de la población española de referencia (61,4). Aproximadamente un tercio de los pacientes había consultado antes con un médico por los síntomas de SPI. No obstante, sólo un 48% contaba con un diagnóstico y sólo en un 5% éste era de SPI. Conclusiones: El estudio DECODE RSL indica que muchos pacientes con síntomas clásicos de SPI visitan frecuentemente a su médico de AP sin ser diagnosticados ni, por lo tanto, recibir un tratamiento adecuado. Herramientas como la utilizada en este estudio pueden ayudar a la detección de estos pacientes (AU)

Introduction: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). Materials and methods: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. Results: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. Conclusions: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients (AU)

Opiniones de los profesionales sanitarios sobre la influencia del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) en atención primaria / Opinions of health professionals on the impact of the preventive activities and health promotion program (PAPPS)

Objetivo: conocer la opinión de los profesionales de Atención Primaria (APS) sobre el impacto y el papel del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS). Diseño: estudio descriptivo cuali-cuantitativo. En una primera fase se empleó la técnica DAFO. En una segunda fase se diseñó un cuestionario de 47 ítems con respuestas mediante una escala ordinal. Ámbito: nivel de Atención Primaria de Salud. Participantes: profesionales de centros de salud PAPPS, responsables del PAPPS y gestores de APS, usando como criterios de segmentación la Comunidad Autónoma, y el tiempo de adscripción o conocimiento del PAPPS. En el estudio cualitativo se hizo una selección por muestreo teorético de 62 participantes; en el estudio cuantitativo, 198 profesionales respondieron a la encuesta. Mediciones principales: la valoración de los resultados se hizo teniendo en cuenta las respuestas a las preguntas formuladas y realizando un análisis cruzado entre fortalezas/amenazas y debilidades/oportunidades. Análisis estadístico descriptivo de las preguntas del cuestionario. Resultados: existe acuerdo en que el PAPPS ha tenido una gran influencia en el desarrollo de la APS, contribuyendo a mejorar la calidad asistencial, pero también en que es fundamental tratar de dinamizar el programa, siendo la principal debilidad la escasa implicación de los profesionales con las recomendaciones preventivas postuladas por falta de motivación y por el desgaste profesional. Conclusiones: Según los participantes el PAPPS ha contribuido de manera significativa al desarrollo de la APS en nuestro país y ha influido sobre la práctica profesional inculcando una cultura de prevención que antes apenas existía (AU)

Objective: to find out the opinion of Primary Health Care (PHC) professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS). Design: descriptive qualitative-quantitative study. In a first phase the SWOT technique was used. In a second phase a 47 items questionnaire was designed using an ordinal scale. Participants: professionals of PAPPS health centre, PAPPS managers and PHC management, using the Autonomous Community, and the time of ascribing or knowledge of PAPPS as segmentation criteria. In the qualitative study 62 participants were selected by theoretical sampling. In the quantitative study, 198 professionals took part in the survey. Principal measurements: the assessment of the results has taken into account the responses to the questions formulated and by performing a crossed analysis between strengths/threats and weaknesses/opportunities. A descriptive statistical analysis of the questions in the questionnaire. Results: there is agreement in that PAPPS has greatly influenced the development of PHC, contributing to improving the quality of care, but it is also fundamental to try revitalise the programme, as the limited involvement by the professionals in the postulated preventive recommendations is its main weakness, due to lack of motivation and professional burn-out. Conclusions: according to the participants PAPPS has contributed significantly to the development of PHC in our country and has had an influence on professional practice by instilling a prevention culture that hardly existed before (AU)

[Opinions of health professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS)]. / Opiniones de los profesionales sanitarios sobre la influencia del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) en atención primaria.

OBJECTIVE: To find out the opinion of Primary Health Care (PHC) professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS). DESIGN: Descriptive qualitative-quantitative study. In a first phase the SWOT technique was used. In a second phase a 47 item questionnaire was designed using an ordinal scale. PARTICIPANTS: Professionals of PAPPS health centre, PAPPS managers and PHC management, using the Autonomous Community, and the time of ascribing or knowledge of PAPPS as segmentation criteria. In the qualitative study 62 participants were selected by theoretical sampling. In the quantitative study, 198 professionals took part in the survey. PRINCIPAL MEASUREMENTS: The assessment of the results has taken into account the responses to the questions formulated and by performing a crossed analysis between strengths/threats and weaknesses/opportunities. A descriptive statistical analysis of the questions in the questionnaire. RESULTS: There is agreement in that PAPPS has greatly influenced the development of PHC, contributing to improving the quality of care, but it is also fundamental to try revitalise the programme, as the limited involvement by the professionals in the postulated preventive recommendations is its main weakness, due to lack of motivation and professional burn-out.. CONCLUSIONS: According to the participants PAPPS has contributed significantly to the development of PHC in our country and has had an influence on professional practice by instilling a prevention culture that hardly existed before.

Encuesta a la población para valoración y conocimiento de su percepción sobre actividades preventivas / Population survey to determine perceptions on preventive activities

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[Anemia in primary care: etiology and morphological characteristics]. / Anemias en atención primaria: etiología y características morfológicas.

OBJECTIVE: To find the morphological characteristics and causes of the types of anaemia seen at a primary care centre. DESIGN: Descriptive, observational study. SETTING: Urban health centre. PATIENTS: People attending for a year who had an anaemia defined by haemoglobin figures below 13 g/dl in males and 12 g/dl in women. MEASUREMENTS AND MAIN RESULTS: 152 patients with anaemia were identified. The most common types of anaemia were iron-deficiency anaemia (IDA), anaemia due to chronic illness (ACI) and post-haemorrhage anaemia (48%, 26.3% and 6.6%, respectively). Anaemia due to vitamin B12 deficit was detected in four patients, Thalassaemia minor in two, haemolytic anaemia in two, and a refractory anaemia in one patient. The most common cause of IDA was gynaecological in origin; and the commonest cause of ACI was neoplasm. The main findings of digestive origin in IDA were oesophagitis in two patients, duodenal ulcer in one, erosive gastritis in one, gastric neoplasm in one, colonic neoplasm in two and Crohn's disease in one. 13.7% of the anaemia studied in PC required hospital referral. CONCLUSIONS: Anaemia is a common health problem in primary care (PC), with a rough incidence of one case per month per doctor. Its main types are iron-deficiency anaemia and anaemia due to chronic illness. Most cases were detected in PC and most can be studied properly at this care level.

Anemias en atención primaria: etiología y características morfológicas / Anaemia in primary care: aetiology and morphological characteristics

Objetivo. Conocer las características morfológicas y causales de las anemias que se presentan en un centro de asistencia primaria (CAP). Diseño. Estudio observacional, descriptivo. Emplazamiento. Centro de salud urbano. Pacientes. Personas atendidas durante un año que presentaban una anemia definida por cifras de hemoglobina inferiores a 13 g/dl en el varón y 12 en la mujer. Mediciones y resultados principales. Se identificaron 152 pacientes con anemia. Los tipos de anemia más frecuentes fueron anemia ferropénica (AF), anemia por enfermedad crónica (AEC) y anemia posthemorrágica (48, 26,3 y 6,6 por ciento, respectivamente). Se detectó anemia por déficit de vitamina B12 en 4 pacientes, talasemia menor en 2, anemia hemolítica en 2 y anemia refractaria en un paciente. El origen ginecológico fue la causa más habitual de AF y las neoplasias de AEC. Los principales hallazgos en las AF de origen digestivo fueron esofagitis en 2 pacientes, ulcus duodenal en uno, gastritis erosiva en uno, neoplasia gástrica en uno, neoplasia de colon en 2 y enfermedad de Crohn en uno. Un 13,7 por ciento de las anemias estudiadas en AP precisaron derivación hospitalaria. Conclusiones. La anemia es un problema de salud frecuente en atención primaria (AP), con una incidencia aproximada de un caso al mes por médico. Sus principales causas son la AF y la AEC. La mayor parte de los casos se detectan en AP y la mayoría de ellos pueden estudiarse adecuadamente en este ámbito (AU)

[Analysis of hypercholesterolemia care costs in primary health care]. / Análisis de los costes de la atención a la hipercolesterolemia en un equipo de atención primaria.

OBJECTIVES: 1) To calculate the care costs of Hypercholesterolaemia in Primary Care in terms of the number of visits to the doctor, analyses and drugs. 2) To calculate the effectiveness of the intervention. DESIGN: A retrospective study. SETTING: Primary Care Centre. PATIENTS: 97 histories of patients diagnosed as having Hypercholesterolaemia, obtained by systematic sampling from the Centre's morbidity register, were analysed. A control with the same age, sex and risk factors was chosen for each one of them. MEASUREMENTS: The study period was 12 months. For those patients diagnosed as having Hypercholesterolaemia after the opening of the centre, the initial figures and those at the end of the study for total Cholesterol, LDL Cholesterol (cLDL) and HDL cholesterol (cHDL) were analysed. RESULTS: There were no differences between the demographic characteristics and the risk factors of the cases and controls. An excess of attendances (average of 9.0 against 6.0, p = 0.01), of hypolipaemic and non-hypolipaemic drugs (average of 4.0 against 3.0, p = 0.006) and of analyses (average of 2.0 against 0.0, p = 0.0001) were detected for the cases. The following variations were found between the initial and final figures: for total Cholesterol (-7.2%, p = 0.001), for cLDL (-11.6%, p = 0.006) and cHDL (+18.2%, p < 0.0001). CONCLUSIONS: 1) Hypercholesterolaemia care in a mainly selective manner for people at high risk was shown to be reasonably effective and affordable. 2) Before starting other strategies for detecting Hypercholesterolaemia, adequate prioritisation and evaluation of their impact on health-care delivery are required.

[Influence of passive exposure to tobacco on the development of sibilus in children]. / Influencia de la exposición pasiva al tabaco en la aparición de sibilancias en niños.

A case-control study was designed to assess the relationship between passive exposure of children to smoking and the development of respiratory diseases with ronchi and wheezing detected by the primary care physician. The clinical records of 530 children in whom at least one episode of ronchi and/or wheezing had been recorded during the four years of activity of the Family and Community Unit of Cornellà were considered as cases. All the remaining children from the same age group were considered as controls. There were no significant differences in the proportion of smoking families between cases and controls (70.5% vs 71.9, chi 2 = 0.018, p = 0.89, NS). The mean number of cigarettes per family and day was not different either. It is a concluded that, in this age group, passive exposure to smoking does not result in an increase of respiratory diseases associated with ronchi and wheezing.