Statin-associated autoimmune myopathy: A distinct new IFL pattern can increase the rate of HMGCR antibody detection by clinical laboratories.

BACKGROUND AND OBJECTIVE: Statin-associated autoimmune myopathy (SAAM) with anti-HMGCR antibodies has recently been described. Several specific immunoassays are in use to detect HMGCR antibodies. In the course of systematic autoantibody screening we recognized a new distinct IFL staining pattern on rat liver sections that regularly coincided with anti-HMGCR antibodies. In this study we investigated whether this new IFL pattern is specifically associated to statin-associated autoimmune myopathy and corresponds to anti-HMGCR antibodies. PATIENTS AND METHODS: Twenty-three patients positive for anti-HMGCR antibodies (14 diagnosed with SAAM) were investigated for anti-HMGCR antibodies by two ELISA assays and confirmed by immmunoblot. HMGCR associated liver IFL pattern (HALIP) was detected by indirect IFL and the reactivity against HMGCR was confirmed by immunoabsorption using purified human HMGCR antigen. 90 patients with other autoimmune diseases and 45 non-autoimmune statin treated patients were studied as controls. RESULTS: 21 out of 23 (91%) anti-HMGCR positive patients were HALIP positive. The staining was completely and specifically removed by immunoabsorption with human purified HMGCR. None of the control sera from autoimmune patients or non-autoimmune statin treated subjects was positive for HALIP. Statistical concordance between HALIP and anti-HMGCR antibody specific tests was 98.7%, kappa 0.95. CONCLUSIONS: A new and distinct IFL staining pattern (HALIP) is associated to HMGCR associated myopathy. Absorption and concordance studies indicate that the antigen recognized in the liver by HALIP is HMGCR or a closely related protein. Awareness of this new pattern can help to detect HMGCR autoantibodies in statin treated patients tested for autoimmune serology.

Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database.

BACKGROUND: Older subjects with type 2 diabetes mellitus (T2DM) have differential characteristics compared with middle-aged or younger populations, and require tailored management of the disease. AIMS: To evaluate how clinical characteristics, degree of control of glycaemia and cardiovascular risk factors, presence of chronic complications and treatments differ between older T2DM patients and younger adults. METHODS: Cross-sectional study using data from a population-based electronic database. We retrieved data from 318,020 patients ≥ 30 years diagnosed with T2DM, attended during 2011 in primary care centres in Catalonia, Spain. We performed descriptive and comparative analyses stratified by gender and age subgroups: ≤ 65, 66-75, 76-85 and >85 years. RESULTS: Both men and women across older age subgroups (> 65 years) had longer diabetes duration than younger adults (8.0 vs. 5.6 in men and 8.4 vs. 6.9 years in women; p < 0.001), but better glycaemic control (mean glycated haemoglobin 7.1 vs. 7.7 in men and 7.1 vs. 7.4 in women; p < 0.001), and better combined control of different cardiovascular risk factors (p < 0.001). Moreover, older patients were more likely to achieve glycaemic targets irrespective of having cardiovascular disease. The use of oral antidiabetics decreased with increasing age, and insulin in monotherapy was more frequently prescribed among patients in the older age subgroups. Diabetes-related complications were more frequent in men of all group ages. In the older age subgroups, patients of both sexes had a longer duration of T2DM but better glycaemic control. In this context, the prevalence of diabetic retinopathy decreased unexpectedly with increasing age. CONCLUSION: Control of glycaemia and cardiovascular risk factors was better among older T2DM patients. There is a need for prospective studies to quantify the weight of risk factors in each complication to adapt the therapeutic and care approaches in elderly people.

Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain.

AIMS: To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia. METHODS: Sequential cross-sectional studies were performed during 1993-2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals. RESULTS: Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA(1c) (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA(1c) ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed. CONCLUSIONS: Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia.

Elección del agente oral más apropiado, en monoterapia o en combinación, en el paciente anciano con diabetes / Selection of the most appropiate oral agent in monotherapy or in combination in the elderly patient with diabetes

El paciente anciano con diabetes presenta una serie de características que deberemos tener en cuenta al plantear el tratamiento farmacológico, como son la calidad de vida, la presencia de complicaciones crónicas, los grandes síndromes geriátricos y las preferencias del paciente. La escasa evidencia disponible, debida a los pocos estudios realizados en ancianos, explica las limitadas recomendaciones existentes en la mayoría de las guías de práctica clínica actuales. Metformina es el fármaco de elección en monoterapia y su posología debe adaptarse al grado de insufi ciencia renal, situación muy frecuente en los ancianos. Otros grupos farmacológicos también pueden utilizarse teniendo en cuenta sus limitaciones y contraindicaciones. No existe consenso sobre cuál es el tratamiento combinado más indicado en los ancianos cuando fracasa la monoterapia. Cualquier combinación puede utilizarse siempre que se respeten las indicaciones y las contraindicaciones. Ante la necesidad de insulinización se deben valorar los benefi cios y riesgos del uso de insulina, utilizando la pauta más simple y adaptada a las características del anciano y su entorno (AU)

The elderly patient with diabetes presents a series of features that we need to have in mind when considering drug therapy, such as quality of life, presence of chronic complications, major geriatric syndromes, and patient preferences. The limited evidence available due to the few studies performed in the elderly explains the limited existing recommendations in the most current clinical practice guidelines. Metformin is the drug of choice as monotherapy and its dosage should be adjusted to the degree of renal failure, a situation very common in the elderly. Other pharmacologic groups can also be used taking into account their limitations and contraindications. There is no consensus on what is the most appropriate combination therapy in the elderly when monotherapy fails. Any combination can be used provided that the indications and contraindications are considered. When insulin is necessary, benefits and risks of using insulin should be evaluated, using the simplest regimen adapted to the characteristics of the elderly and its environment (AU)

[Who monitors patients treated with psychotropic drugs in primary care?]. / 'Quién controla a los enfermos tratados con fármacos psicotropos en atención primaria?

OBJECTIVE: To analyse the degree of monitoring by doctors, nurses, and other health professionals of patients taking psychotropic medication. DESIGN. Retrospective, observational study of patients of both sexes and over 15 years old, who took psychotropic medication and had attended a minimum of ten times the same doctor-nurse primary care unit (PCU). Their monitoring during 2 year-long periods was studied: a first period (the first year after diagnosis) and a second period from October 2001 to October 2002. SETTING: Primary care in the Raval Sud District, Barcelona, Spain. PARTICIPANTS: A total of 730 clinical histories were reviewed, of which 200 (27%) met inclusion criteria. RESULTS: The most common diagnosis was anxiety-depression disorder (58%), and 14.5% of patients had no recorded diagnosis. 35.5% were patients taking more than one medicine. The most common drug group was the benzodiazepines (60.4%). Significant differences in the number of controls were found between the 2 periods and between different PCUs. The mean difference between periods was -0.5, with 95% CI at -1.0: clearly the degree of monitoring drops over time. CONCLUSIONS: These patients' follow-up was not monitored well, which poses the need to create clear aims and protocols for the doctor-nurse team, to thus assist the treatment of patients with mental health problems.

¿Quién controla a los enfermos tratados con fármacos psicotropos en atención primaria? / Who monitors patients treated with psychotropic drugs in primary care?

Objetivo. Analizar el grado de seguimiento realizado por médicos, enfermeras y otros profesionales de la salud sobre los enfermos consumidores de fármacos psicotropos. Diseño. Estudio observacional retrospectivo en el que se seleccionó a pacientes de ambos sexos mayores de 15 años, con consumo de fármacos psicotropos y visitados un mínimo de 10 veces por la misma unidad básica de atención médico-enfermera (UBA). Se estudió su seguimiento durante 2 períodos de un año: el primer año después del diagnóstico y el período octubre de 2001-octubre de 2002. Emplazamiento. Atención primaria en el Área Básica de Salud (ABS) Raval Sud, Barcelona. Participantes. Se revisaron 730 historiales de pacientes, de los cuales 200 (27%) cumplieron criterios de inclusión. Resultados. El diagnóstico más frecuente fue el trastorno de ansiedad-depresión (58%), y destacaba que un 14,5% de los pacientes no tenían un diagnóstico registrado. El 35,5% correspondió a pacientes que recibieron más de un fármaco y el grupo farmacológico más frecuente fue el de las benzodiacepinas (60,4%). Se detectaron diferencias significativas en el número de controles entre los 2 períodos, y entre las diferentes UBA. La mediana de la diferencia de períodos fue ­0,5 y su intervalo de confianza del 95%, ­1,0; se evidencia que el grado de control disminuye con el tiempo. Conclusiones. En estos pacientes se observa poco control en su seguimiento, lo que indica la necesidad de crear unos objetivos y unos protocolos claros dirigidos al equipo médico-enfermera, para así facilitar el tratamiento del paciente con problemas de salud mental

Objective. To analyse the degree of monitoring by doctors, nurses, and other health professionals of patients taking psychotropic medication. Design. Retrospective, observational study of patients of both sexes and over 15 years old, who took psychotropic medication and had attended a minimum of ten times the same doctor-nurse primary care unit (PCU). Their monitoring during 2 year-long periods was studied: a first period (the first year after diagnosis) and a second period from October 2001 to October 2002. Setting. Primary care in the Raval Sud District, Barcelona, Spain. Participants. A total of 730 clinical histories were reviewed, of which 200 (27%) met inclusion criteria. Results. The most common diagnosis was anxiety-depression disorder (58%), and 14.5% of patients had no recorded diagnosis. 35.5% were patients taking more than one medicine. The most common drug group was the benzodiazepines (60.4%). Significant differences in the number of controls were found between the 2 periods and between different PCUs. The mean difference between periods was ­0.5, with 95% CI at ­1.0: clearly the degree of monitoring drops over time. Conclusions. These patients' follow-up was not monitored well, which poses the need to create clear aims and protocols for the doctor-nurse team, to thus assist the treatment of patients with mental health problems

[Predictors factors about functional decline in community-dwelling older persons]. / Factores predictores del deterioro funcional geriátrico.

OBJECTIVES: The goal of this work was to prove the usefulness of simple standard geriatrics tools as a predictors of basic daily activities or quality of life decline in one year in older patients apparent healthy to apply in primary care. DESIGN: Prospective study of a randomised sample of 100 patients. SETTING: Urban primary care center. PATIENTS: A systematic sample of 100 patients of 75 years old or older, with Barthel index > or =90, Karnofsky scale > or =70 and without any neoformation process evaluated prospectively. MEASUREMENTS: A comprehensive geriatric assessment was done that include: physical performance, neural-psychologist performance, organic assessment, social assessment. After 12 month were assessed again basic activities of daily living (Barthel) and quality of life (Karnofsky). To estimate the odds ratio (OR) of association we used logistic regression models. RESULTS: The alterations in cognition trials (Pfeiffer >2) and in instrumental activities of daily living (Lawton <7) showed predictors about decline in basic activities of daily living (OR=4.66; CI, 1.33-16.22), (OR=4.89; CI, 1.65-14.48). The alterations in instrumental activities of daily living (Lawton <7) and in performance tests (abbreviated Guralnik test <4) showed predictors about decline in quality of life (OR=4.31; CI, 1.62-11.44), (OR=7.41; CI, 1.54-35.62). CONCLUSION: In primary care geriatric assessment tools based in instrumental activities of daily living, cognition and performance tests predict decline in basic activities of daily living and quality of life.

Factores predictores del deterioro funcional geriátrico / Predictors factors about functional decline in community-dwelling older persons

Objetivo. Demostrar la utilidad de sencillos instrumentos geriátricos como predictores del deterioro de las actividades básicas de la vida diaria (ABVD) o pérdida de calidad de vida al año en ancianos con un estado de salud previo aparentemente bueno, para poder ser aplicado en atención primaria de la salud (APS).Diseño. Estudio prospectivo. Emplazamiento. Centro de atención primaria urbano. Participantes. Muestra sistemática de 100 ancianos con edad >= 75 años, índice de Barthel (IB) >= 90, escala de Karnofsky (EK) >= 70 y ausencia de proceso neoplásico. Mediciones principales. Se les aplicó un protocolo de valoración geriátrica integral que incluía variables biopsicosociales y funcionales. Tras 12 meses se revaloraron las ABVD (IB) y la calidad de vida (EK).Se realizó la estimación de las odds ratio (OR) de asociación mediante modelos de regresión logística múltiples. Resultados. Las alteraciones en las pruebas de cognición (test de Pfeiffer > 2) y en las actividades instrumentales de la vida diaria (AIVD) (índice de Lawton [IL] < 7) se mostraron predictoras del deterioro en las ABVD (OR = 4,66; intervalo de confiaza [IC], 1,33-16,22, y OR = 4,89; IC, 1,6514,48, respectivamente).Las alteraciones en las AIVD (IL < 7) y las alteraciones en las pruebas de rendimiento (test de Guralnik abreviado < 4) se mostraron predictores del deterioro de la calidad de vida (OR = 4,31; IC, 1,62-11,44, y OR = 7,41; IC, 1,54-35,62, respectivamente).Conclusiones. En APS, los instrumentos de valoración geriátrica centrados en las AIVD, la cognición y las pruebas de rendimiento predicen el deterioro en las ABVD y en calidad de vida (AU)

[Albumin-to-creatinine ratio as a diagnostic tool for type 2 diabetic nephropathy]. / Utilidad del cociente albúmina/creatinina en el diagnóstico de la nefropatía en pacientes con diabetes mellitus tipo 2.

BACKGROUND: Given the low effectiveness of 24 hours determination of urinary albumin excretion (UAE) for the diagnosis of diabetic nephropathy in primary care, we aimed at evaluating the albumin: creatinine ratio (ACR) in the first voided morning urine sample as a diagnostic tool in this setting. PATIENTS AND METHOD: 214 patients with type 2 diabetes were studied. ACR and UAE were compared with correlation and lineal regression analyses. A receiver operating characteristic (ROC) curve analysis was performed to determine the discriminatory value for diagnosis of diabetic nephropathy. RESULTS: The correlation coefficient between ACR and UAE was 0.93 (p<0.01) and the ROC curve analysis showed a value of 2.4 g/mol for women and 1.4 g/mol for men. CONCLUSIONS: ROC curve analysis reveals that ACR is a useful method for diagnosing diabetic nephropathy, although the discriminatory value depends on sex.

[Chronic complications of type 2 diabetes mellitus. Clinical course after 5 years of follow-up]. / Complicaciones crónicas de la diabetes mellitus tipo 2. Evolución tras 5 años de seguimiento.

OBJECTIVE: To evaluate the modifications in the prevalence of complications and the incidence of end-points in diabetic patients observed for five years, and the effectiveness of a diabetes care protocol on the process indicators. DESIGN: Prospective observational study between 1991 and 1996. SETTING: Primary care centre. PARTICIPANTS: Diabetic patients monitored between 1991 and 1996. MEASUREMENTS AND MAIN RESULTS: Social and demographic variables, DM epidemiology variables, cardiovascular risk factors, complications and end-points were measured. 318 of the 352 patients selected in 1991 were followed. Average age was 68.6 (SD 11.2) and 39% were male. Mean observance was for 53 months (SD 10). There was an increase of insulin use (19%) and self-analysis (34.7%) both in men (chi 2 = 14.7, p < 0.001) and in women (chi 2 = 40.5, p < 0.001), independently of age (chi 2 = 37.77, p < 0.001). Complications increased: microvascular ones from 33.4% to 42.1%, macrovascular ones from 22.3% to 37.2%. The most common end-points were CVA (7.8%) and angor (3.6%). 22 patients died (6.9%), with ischaemic cardiopathy (30%) and neoplasm (30%) the most common causes. Hypertension increased from 51.6% to 59.8% and hypercholesterolaemia from 42.6% to 47%. Obesity (42%) and tobacco dependency (28%) remained stable. Systolic blood pressure went down by 4.7 mmHg and diastolic pressure by 3.76 mmHg, and in women, over-65s and those who had had the illness longest (> 10 years). 6.5% (CI 1-12.9%) of patients improved their blood pressure (< 135/85 mmHg). HbA1c worsened independently of sex, age or years of evolution of diabetes.

[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.

Complicaciones crónicas de la diabetes mellitus tipo 2. Evolución tras 5 años de seguimiento / Chronic complications of type-2 diabetes mellitus. Evolution after five years of observation

Objetivos. Objetivo. Evaluar las modificaciones en la prevalencia de las complicaciones y la incidencia de episodios finales en pacientes diabéticos durante 5 años de seguimiento, así como la efectividad sobre los indicadores de proceso de un protocolo de atención diabetológica. Diseño. Estudio observacional prospectivo entre 1991 y 1996. Emplazamiento. Centro de atención primaria. Participantes. Pacientes diabéticos controlados entre 1991 y 1996. Mediciones y resultados principales. Variables sociodemográficas, epidemiológicas de la DM, factores de riesgo cardiovasculares, presencia de complicaciones y de episodios finales. Resultados. Trescientos dieciocho de los 352 pacientes censados en 1991. La edad media fue de 68,6 años (DE, 11,2), un 39 por ciento varones. El seguimiento medio fue de 53 meses (DE, 10). Hubo un aumento de la insulinización (19 por ciento) y del autoanálisis (34,7 por ciento ) tanto en varones (*2, 14,7; p 10 años). El porcentaje de pacientes que presentaba un buen control tensional (< 135/85 mmHg) mejoró un 6,5 por ciento (IC, 1-12,9 por ciento). La HbA1c empeoró independientemente del sexo, la edad y los años de evolución. El insomnio es el trastorno del sueño más frecuente, incrementándose a medida que avanza la edad, lo que produce un aumento paralelo en el uso de hipnóticos. En el anciano, la prevalencia de insomnio, según distintos autores, oscila en el 17-43 por ciento en función de los criterios de diagnóstico utilizados y el tipo de población a estudio. Los objetivos de este trabajo son determinar la prevalencia de insomnio en población de edad igual o mayor a 65 años de una zona básica de salud (ZBS) y el consumo farmacéutico relacionado con él. Diseño. Estudio transversal mediante cuestionario ad hoc sobre hábitos de sueño, administrado por personal sanitario, que incluye variables sociodemográficas, consumo de psicofármacos, valoración cognitiva mediante el Mini Examen Cognitivo y escala de ansiedad-depresión de Goldberg. Se utilizaron los criterios de Hartman y DSM-IV para el diagnóstico de insomnio. Emplazamiento. Centro de Salud Cuenca I. Pacientes. Muestra aleatoria de343 sujetos a partir de una población de 2.253 personas de edad mayor o igual a 65 años. Mediciones y resultados principales. La prevalencia encontrada fue del 13,6 por ciento (Hartman) y 30,7 por ciento (DSM-IV), más frecuente en mujeres (p < 0,005), en aquellos que presentan enfermedad psiquiátrica (p < 0,01) y con puntuaciones altas en la escala de ansiedad-depresión (p < 0,001). Un 46,10 por ciento refiere hipersomnolencia diurna. El 19,1 por ciento toma algún fármaco para dormir, el 74,6 por ciento a diario. Las benzodiacepinas de vida media larga y corta son los más usados, consumiendo más las mujeres y los insomnes (p < 0,01). Conclusiones. La prevalencia de insomnio en nuestra población es ligeramente inferior a la descrita en otros estudios y el consumo de fármacos para dormir, aunque inadecuado, es similar al referido en la bibliografía (AU)

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)

[When and how do we treat our hypercholesterolemic patients?]. / Cuándo y cómo tratamos a nuestros pacientes hipercolesterémicos?

OBJECTIVES: To compare patients with hypercholesterolaemia (HC) for factors relating to the decision to treat a patient with medication or not; and to assess the suitability of a previously established protocol of HC diagnosis and treatment. DESIGN: Retrospective, descriptive study. SETTING: Primary care centre. PATIENTS: 331 patients diagnosed with HC in the register of risk factors at our centre. 175 patients treated with medication (TM) and 156 not treated with medication. RESULTS: Mean age was 61.2 and 191 were women. 68.8% of the population under study had 2 or more factors of cardiovascular risk (FCVR). 56 patients were in secondary prevention (71.4% TM). 275 patients (83.08%) were in primary prevention. 135 of these received TM, which was indicated only in 45 (37.5%). Mean plasma concentrations (PC) of cholesterol (total and LDL) were greater in the patients treated. 99.3% of non-treated patients and 96.9% of treated patients received dietary counselling. This was maintained in 95% of non-treated patients. The reduction of cholesterol in the PC reached 8% in diet-treated patients by the end of the study. Initially 42.8% were treated with fibrates, 38.9% with statins and 18.3% with resins. By the end of the study 53.6% were treated with statins. CONCLUSIONS: The association of HC and other FCVR is common. In primary prevention, a high proportion of patients treated present cardiovascular risk which does not justify medical prescription. In secondary prevention we are closer to the current guidelines.

[Variability of prescriptions in prevailing indications in primary care: a multicenter study. Study of Prescriptions in Primary Care (GEPAP)]. / Variabilidad de la prescripción en indicaciones prevalentes en atención primaria: un estudio multicéntrico. Estudio de la Prescripción en Atención Primaria (GEPAP).

OBJECTIVES: It seems convenient to have information on how drugs are used in everyday's practice in order to be able to make drug selection proposals. The aim of this study was to describe the prescription profile in a number of prevalent indications and its variability among the participating centres. DESIGN: Cross-sectional descriptive study. SETTING: Four Primary care centres. PARTICIPANTS: Each of the 32 participating physicians collected information on 200 consecutive patients who received a prescription between October 1994 and January 1995. MEASUREMENTS AND MAIN RESULTS: 5932 patients, with a mean age of 56 years (SD = 18 years) were included. We analysed the prescriptions they received for hypertension (988 patients), hyperlipidaemia (254), peptic ulcer (PU) (136), nonulcer dyspepsia (271), chronic obstructive lung disease (COLD) (293), asthma (134) and depression (261). We describe the number of different drugs used (range: 14 for PU-63 for hypertension), the number of drugs that accounted for 90% of the prescriptions (range: 5 for PU-20 for depression), the number of recently marketed drugs (range: 0 for PU-9 for hypertension) and the proportion of prescribed drugs they accounted for (range: 0% for PU-12.4% for depression). We found an important variability among the participating centres in all the considered indications; for instance, statins for hyperlipidaemia. CONCLUSION: A rather high variability in prescription habits among participating centres was found. Prescription was highly concentrated in a few number of drugs, and the use of recently marketed drugs accounted for less than 10% of all prescriptions, although data show variability according to the considered indications.

[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.

[Macroangiopathy in 297 type 2 diabetic patients: prevalence and risk factors]. / Macroangiopatía en 297 pacientes diabéticos tipo II: prevalencia y factores de riesgo.

A cross-sectional study was carried out in Cornellà with type II diabetic patients to assess their prevalence of microangiopathy and their major risk factors. The study included 297 patients (102 males and 197 females) with a mean age of 61 years. In 45.5% of cases some feature of microangiopathy was found: 35% had peripheral vascular disease; 24.5% had coronary artery disease, and 7.1% cerebrovascular disease. The variables associated with this complication were investigated with the logistic regression technique. A significant association was found between microangiopathy as a whole and the duration of diabetes mellitus, age and smoking. Peripheral vascular disease was associated with age, clinical duration and male sex; coronary artery disease was associated with male sex and the mean level of blood triglycerides, and cerebrovascular disease was associated with age.

[Prevalence of peripheral somatic neuropathy in type 2 diabetes mellitus]. / Prevalencia de la neuropatía somática periférica en la diabetes tipo II.

A cross-sectional study of 297 type 2 diabetic patients was carried out to evaluate their prevalence of peripheral somatic neuropathy. Their mean age was 61 years, with a predominance of females (65.7%) over males (34.3%). The clinical duration of diabetes was longer than 10 year in 45% of the evaluated patients, and metabolic control was poor in almost one half of them (49.5%). The most common symptom were cramps, while abnormal vibratory sense was the predominant physical finding. Neuropathy was significantly associated with mean age (t = 4.32, p less than 0.0001), the years of duration of diabetes (chi(2) = 11.16, p = 0.01) and the metabolic control degree (chi(2) = 24.2, p less than 0.001) in the bivariate analysis, while in multivariate analysis it was only associated with age (e beta = 1,637, p less than 0.0001) and the metabolic control degree (e beta = 4.02, p less than 0.0001).