Parámetros basales de la espirometría que pueden influir en la prueba de broncodilatación / Baseline spirometry parameters that can influence the bronchodilation test

OBJETIVO: Estudiar si los parámetros basales de la espirometría forzada pueden influir en la positividad de la prueba de broncodilatación (PBD) y si esto pudiera influir en futuros criterios de positividad. MATERIAL Y MÉTODOS: Estudio descriptivo transversal multicéntrico con emplazamiento en Atención Primaria. Fueron incluidos todos los pacientes derivados por su médico de familia, para la realización de espirometría forzada por tabaquismo, síntomas respiratorios o seguimiento de enfermedades respiratorias, entre los meses de junio de 2015 y febrero de 2017. A todos ellos se les realizó una espirometría forzada con PBD. RESULTADOS: Se incluyeron 295 pacientes, con una edad media de 53,4+/-15,5 años, el 62% fueron hombres. En el 20% de las espirometrías se obtuvo un patrón obstructivo; presentando el 67,5% una obstrucción leve, 18% moderada, 9,6% moderada-grave y un 4,8% muy grave. El 8,8% de las espirometrías obtuvieron PBD positiva; 11,2% fueron positivas únicamente en volumen y el 17,6% fueron positivas únicamente en porcentaje. Se observó que los pacientes con una PBD positiva en porcentaje presentaban de forma basal menor volumen espiratorio forzado en el primer segundo (1,66 l/sg vs.2,74 l/sg; p <0,001), y menor capacidad vital forzada (2,85 l vs.3,73 l; p < 0,001). Los pacientes con PBD positiva en volumen presentaban menor volumen espiratorio forzado en el primer segundo (2,59 l/sg vs.2,62 l/sg; p <0,001), y mayor capacidad vital forzada (3,89 l vs.3,58 l; p < 0,001). CONCLUSIONES: El volumen espiratorio forzado en el primer segundo y la capacidad vital forzada basales influyen en la positividad de la PBD. Debería valorarse esta circunstancia a la hora de establecer los criterios de positividad de la PBD

OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4+/-15.5 years, and 62% were male. An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs.2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs.2.62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs.3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT

Riesgo de declive funcional en pacientes ancianos no institucionalizados / Functional decline risk in elderly patients not institutionalized

OBJETIVO: Valorar el riesgo de declive funcional (DF) mediante varias escalas de predicción. MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional y corte transversal, dirigido a una población de 70 años o más del área de salud de Toledo. Se excluyeron los pacientes institucionalizados, terminales y dependientes para 3 o más actividades básicas de la vida diaria. La muestra (480 pacientes), fue calculada para: prevalencia DF estimada del 15%, precisión 2%, nivel de confianza 95 y 10% de pérdidas estimadas. Muestreo estratificado, primero por conglomerados (centros de salud) y posteriormente muestreo sistemático (1/15) por listado de pacientes ordenados por edad. Tasa de respuesta: 98%. VARIABLES: Sociodemográficas, de morbilidad, cuestionarios para evaluar la capacidad funcional para las actividades básicas (índice de Katz) e instrumentales (índice de Lawton-Brody) de la vida diaria y reglas de predicción de riesgo de DF (SHERPA, TRST, ISAR-PC e Inouye). Aprobado por el Comité Ético de Investigación Clínica de Toledo. RESULTADOS: Media de edad: 77,94 (DS: 6,27) años, el 54,4% mujeres. Media de enfermedades: 4,38 (DS: 2,17) y de fármacos: 5,57 (DS: 3,35). Riesgo de DF según las reglas de predicción: SHERPA: 32,7% (IC95%: 28,52-36,88) (riesgo leve: 17,2% [IC95%: 13,83-20,57]; moderado: 9,7% [IC95%: 7,06-12,34] y alto: 5,8% [IC95%: 3,72-7,88]); TRST: 42% (IC95%: 37,6-46,4); ISAR-PC: 75,4% (IC95%: 71,14-78,86); Inouye: 49,3% (IC95% 44,84-53,76) (riesgo medio: 44,5% [IC95%: 40,07-48,93] y riesgo alto: 4,8% [IC95%: 2,89-6,71]). CONCLUSIONES: Porcentaje importante de pacientes en riesgo de DF, pero gran variabilidad entre las distintas reglas. En general, el riesgo es inferior al encontrado en otros estudios, siendo necesario validar nuevas reglas adaptadas a nuestro medio

OBJECTIVE: To assess the risk of functional decline (DF) by using several prediction scales. MATERIAL AND METHODS: A multicentre, observational, cross-sectional study was conducted on a population of 70 years or more in the health area of ??Toledo. Institutionalised, terminal ill, and patients dependent for three or more basic activities of daily life, were excluded. The sample (480 patients) was calculated for an estimated DF prevalence of 15%, accuracy 2%, confidence level 95%, and 10% of estimated losses. Stratified sampling; first by conglomerates (Health Centres) and then systematic sampling (1/15) by list of patients ordered by age. Response rate: 98%. VARIABLES: Sociodemographic, morbidity, questionnaires to assess the functional capacity for basic activities (Katz index), and tools (Lawton-Brody index) of daily life and risk prediction rules of DF (SHERPA, TRST, ISAR-PC and Inouye). Approved by the Clinical Research Ethics Committee of Toledo. RESULTS: The mean age was 77.94 (SD: 6.27), with 54.4% women. Mean number of illnesses: 4.38 (SD: 2.17) and drugs: 5.57 (SD: 3.35). Risk of DF according to the prediction rules: SHERPA: 32.7% (95% CI: 28.52-36.88) (slight risk: 17.2% [95% CI: 13.83-20.57]; moderate: 9.7% [95% CI: 7.06-12.34] and high: 5.8% [95% CI: 3.72-7.88]); TRST: 42% (95% CI: 37.6-46.4); ISAR-PC: 75.4% (95% CI: 71.14-78.86); Inouye: 49.3% (95% CI: 44.84-53.76) (mean risk: 44.5% [95% CI: 40.07-48.93], and high: risk 4.8% [95% CI: 2.89-6.71]). CONCLUSIONS: A significant percentage of patients are at risk of DF, but there is a wide variation between the different rules. In general, the risk is lower than that found in other studies, and it is necessary to validate new rules adapted to our environment

[Functional decline risk in elderly patients not institutionalized]. / Riesgo de declive funcional en pacientes ancianos no institucionalizados.

OBJECTIVE: To assess the risk of functional decline (DF) by using several prediction scales. MATERIAL AND METHODS: A multicentre, observational, cross-sectional study was conducted on a population of 70 years or more in the health area of ??Toledo. Institutionalised, terminal ill, and patients dependent for three or more basic activities of daily life, were excluded. The sample (480 patients) was calculated for an estimated DF prevalence of 15%, accuracy 2%, confidence level 95%, and 10% of estimated losses. Stratified sampling; first by conglomerates (Health Centres) and then systematic sampling (1/15) by list of patients ordered by age. Response rate: 98%. VARIABLES: Sociodemographic, morbidity, questionnaires to assess the functional capacity for basic activities (Katz index), and tools (Lawton-Brody index) of daily life and risk prediction rules of DF (SHERPA, TRST, ISAR-PC and Inouye). Approved by the Clinical Research Ethics Committee of Toledo. RESULTS: The mean age was 77.94 (SD: 6.27), with 54.4% women. Mean number of illnesses: 4.38 (SD: 2.17) and drugs: 5.57 (SD: 3.35). Risk of DF according to the prediction rules: SHERPA: 32.7% (95% CI: 28.52-36.88) (slight risk: 17.2% [95% CI: 13.83-20.57]; moderate: 9.7% [95% CI: 7.06-12.34] and high: 5.8% [95% CI: 3.72-7.88]); TRST: 42% (95% CI: 37.6-46.4); ISAR-PC: 75.4% (95% CI: 71.14-78.86); Inouye: 49.3% (95% CI: 44.84-53.76) (mean risk: 44.5% [95% CI: 40.07-48.93], and high: risk 4.8% [95% CI: 2.89-6.71]). CONCLUSIONS: A significant percentage of patients are at risk of DF, but there is a wide variation between the different rules. In general, the risk is lower than that found in other studies, and it is necessary to validate new rules adapted to our environment.

[Baseline spirometry parameters that can influence the bronchodilation test]. / Parámetros basales de la espirometría que pueden influir en la prueba de broncodilatación.

OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4±15.5 years, and 62% were male.An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs. 2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs. 2. 62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs. 3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT.

Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes / Reliability study on the interpretation of electrocardiograms by general practitioners and trainees

Objetivo. Conocer la fiabilidad en la interpretación del electrocardiograma (ECG) por médicos de familia en ejercicio y médicos residentes en periodo de formación, utilizando para ello la comparación con la interpretación realizada por el cardiólogo. Material y métodos. Estudio observacional. Se incluyeron médicos de familia en ejercicio del Área de Salud de Toledo, médicos internos residentes de Medicina Familiar y Comunitaria y los médicos internos residentes de Cardiología de los 3 años iniciales del periodo formativo (R1-R3). Se utilizó un cuestionario con 13 ECG sin datos clínicos del paciente. Los 13 ECG fueron seleccionados y sus diagnósticos consensuados por 2 cardiólogos del Complejo Hospitalario de Toledo. Resultados. El porcentaje de respuestas correctas más alto (82,3%) correspondió al ECG 5 (fibrilación auricular), y el más bajo (26,5%), al ECG 11 (ritmo de la unión). La competencia diagnóstica más alta fue alcanzada por los médicos residentes de Cardiología, los médicos de familia en ejercicio, los tutores de residentes y los médicos con trabajo en el Servicio de Urgencias del hospital. Los valores más altos de odds ratio para una mayor competencia diagnóstica fueron trabajar en el Servicio de Urgencias y ser médico de familia en ejercicio, ambas con resultados casi significativos (p<0,10). Conclusiones. Los médicos de familia y los médicos residentes tienen un grado de fiabilidad medio en la interpretación del ECG con relación al cardiólogo

Objective. To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. Material and methods. An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. Results. The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). Conclusions. Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist

[Reliability study on the interpretation of electrocardiograms by general practitioners and trainees]. / Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes.

OBJECTIVE: To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. MATERIAL AND METHODS: An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. RESULTS: The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). CONCLUSIONS: Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist.

[Eating disorders among secondary students in a health area]. / Trastornos del comportamiento alimentario en una población de estudiantes de enseñanza media.

OBJECTIVES: To study the prevalence of eating disorders among adolescent in a health area. Design. Cross-sectional descriptive study.Setting. The primary care centres of secondary education. PARTICIPANTS: Students with age between 13-16 years. MEASUREMENTS: The validation of the Spanish translation of the Eating Attitudes Test-40 was administered to students, previous authorization of their parents. In the positive cases, we reported with a letter to their parents. The date were incorporate to a data base and in order to their treatment tools of analytic and descriptive statistic they were used. RESULTS: There were 503 valid questionnaires (95% students of the health area). The absolute mean score was 13.42 points (CI, 12.57-14.28), in women 14.71 points and in man 11.82 points. According to age groups, the mean score for 13, 14.15 and 16 years was 14.05, 13.85, 13.08 and 12.60 points respectively. 16.97% presented >= 20 points (sensitivity, 91%; specificity, 69.2%) and 16.97% of the sample >= 30 points (sensitivity, 67,9%; specificity, 85.9%). There were more positive cases in women than men (2 = 22.4; p < 0.001). The age variable did not show statistically significant differences (2 = 3.379; p > 0.05). CONCLUSIONS: There is a high prevalence of eating disorders among secondary students, being more frequently among women. We think it is necessary to make preventive services task in these problems and seek positive cases.

Trastornos del comportamiento alimentario en una población de estudiantes de enseñanza media / Eating disorders among secondary students in a health area

Objetivo. Estudiar la prevalencia de trastornos alimentarios en la población adolescente en una zona básica de salud. Diseño. Observacional, transversal. Emplazamiento. Tres centros urbanos de enseñanza media de Toledo. Participantes. Estudiantes de 13-16 años. Mediciones principales. Se administró la versión validada al castellano del Eating Attitudes Test-40, previa autorización de sus padres, para detectar la presencia de trastornos alimentarios. En los casos positivos, se informó mediante carta a los progenitores. Resultados. Realizaron el cuestionario 503 estudiantes, lo cual representa más del 95 por ciento de los adolescentes de la zona. La puntuación media absoluta obtenida fue de 13,42 puntos (IC, 12,57-14,28), siendo en mujeres de 14,71 puntos y de 11,82 en varones. Según los grupos de edad, la puntuación media para 13, 14, 15 y 16 años fue de 14,05, 13,85, 13,08 y 12,60 puntos, respectivamente. Presentaron 20 puntos (sensibilidad, 91 por ciento; especificidad, 69,2 por ciento) un 16,97 por ciento y 30 puntos (sensibilidad, 67,9 por ciento; especificidad, 85,9 por ciento) el 6,79 por ciento de la muestra. Hubo un mayor porcentaje de positividad en mujeres que en varones ( 2 = 22,4; p 0,05). Conclusiones. Existe una alta prevalencia de trastornos alimentarios en este colectivo, siendo más frecuente en mujeres. Parece justificado realizar intervenciones de prevención de este tipo de problemas así como su búsqueda activa. (AU)

¿Controlamos correctamente la presión arterial en nuestros pacientes diabéticos? (Evolución 1995-2000) / Do we control blood pressure in our diabetic patients? (Evolution 1995-2000)

Los objetivos de nuestro estudio fueron conocer el control tensional en pacientes diabéticos e hipertensos en 1995 y 2000, así como los perfiles terapéuticos empleados. Para ello se diseñó un estudio observacional con 2 cortes transversales (1995 y 2000). Como población se recogió a todos los diabéticos diagnosticados de hipertensión arterial en 3 cupos de Medicina General. De la historia clínica se extrajeron la presión arterial sistólica (PAS) y presión arterial diastólica (PAD) medias en 1995 (3 primeras tomas) y 2000 (3 últimas tomas), tratamiento prescrito y presencia de otros factores de riesgo cardiovascular. Para su clasificación se emplearon los criterios de la Organización Mundial de la Salud (OMS). Los resultados principales fueron: PAS media de 148,2 (IC 95 por ciento, 144,2-152,2) en 1995 y 142,4 (140,1-144,7) en 2000 (p < 0,05); PAD media de 83,6 (81,2-86) en 1995 y 79,8 (IC 95 por ciento, 78,3-81,4) en 2000 (p< 0,01). El porcentaje de pacientes con cifras normalizadas fue de 22,2 por ciento y 40 por ciento en 1995 y 2000, respectivamente (p < 0,05). En cuanto al tratamiento prescrito, existe disminución del tratamiento dietético en 2000 (13 por ciento frente a 6 por ciento) y aumento de tratamiento con asociaciones farmacológicas (31,5 por ciento frente a 40 por ciento). Comparando los grupos farmacológicos más empleados en 1995 y 2000 observamos un incremento de inhibidores de la enzima convertidora de la angiotensina (IECA) (44,7 por ciento frente al 62,7 por ciento de los pacientes) y una disminución del empleo de diuréticos (53,2 por ciento frente al 39,3 por ciento) como datos más relevantes. Concluimos que existe incremento en el grado de control de estos pacientes asociado a disminución de cifras de PAS y PAD medias en posible relación con la actitud terapéutica más agresiva. Si bien existe aumento del empleo de IECA, la tendencia es susceptible de mejora (AU)

[Causes of non-compliance and associated factors in non-attendance of scheduled consultation]. / Causas de incumplimiento y factores asociados en una consulta concertada.

OBJECTIVE: To find the degree of non-attendance at scheduled consultations and associated factors, with the aim of introducing the necessary corrective measures. DESIGN: An analytic observational study. SETTING: Sillería Health Centre, Toledo. PATIENTS: People on a medical list with scheduled medical and/or nursing appointments over the period of a year. MEASUREMENTS AND MAIN RESULTS: There were 253 cases of non-attendance (13.16%) out of a total of 1,922 scheduled consultations. Different variables were analysed, with statistically significant results being found in user's age and profession (p < 0.01), season of the year (p = 0.00067), the number of previous appointments (p < 0.01) and the number of previous non-attendances (p < 0.001). A profile of the non-attender emerged as: a young person, unemployed or student, single or separated, with average or higher education and who makes an appointment for control of risk factors cardiovascular, to open a medical history or for pregnancy monitoring. CONCLUSIONS: The level of attendance using present appointment methodology is acceptable. Nevertheless we believe a change of strategy, which would involve the community more both in preventive activities and in taking responsibility for their own attendance is needed.

[The family characteristics of overusers of primary care health services]. / Características familiares de los hiperutilizadores de los servicios sanitarios de atención primaria.

OBJECTIVE: To discover the family characteristics of overusers of a family medical practice. DESIGN: Descriptive study. SETTING: Sonseca Health Centre (Toledo). PARTICIPANTS: Overusers of the health services at a family medical practice. Variables of structure, family function and their use were studied. MEASUREMENTS AND MAIN RESULTS: The family type of the overusers was described as a nuclear family (61.11%), formed by 2-4 members (76.39%) in a period of decline in their life cycle (72.22%), with a certain level of familial dysfunction (13.4%) and overuse of the health services (70.49%). All these findings concurred with data published on the question. CONCLUSIONS: The study demonstrated the importance of tackling the family as a whole within the primary care field and the relevance of studies which investigate the relationship between family variables and use of services.

[Occupational health in the province of Toledo: comparison with national data]. / Salud laboral en la provincia de Toledo: comparación con datos nacionales.

OBJECTIVE: To gain some preliminary understanding of the health situation in the workplace and to strengthen this field at the Primary Care level. DESIGN: A retrospective and analytical study into the period 1985 to 1988, both inclusive. SITE. Pathologies at work (accidents and work-derived illnesses) declared in Toledo province and in the rest of Spain during the period stated above. MAIN MEASUREMENTS AND RESULTS: A lower rate of accidents at work was observed in Toledo than in the rest of Spain (47.68 per 1,000 workers as against 66.44 per 1,000; chi 2 = 806.45). However Toledo showed higher mortality (0.35% as against 0.20%; chi 2 = 40.71) and a higher percentage of time off work (81.56% as against 68.77%; chi 2 = 483.93). Looking at work accidents in relation to sectors of activity, industry and construction, we found more in Industry and Construction than in Agriculture and Services. Work-derived illnesses made up a low percentage of work pathology (0.33% in Toledo and 0.39% in Spain). The main illnesses were: dermatosis, bursitis, illness caused by vibrations and disease arising from lead and its derivatives. CONCLUSIONS: It is essential to study much more thoroughly both health at work and the more general work context, emphasising the key importance of Primary Care and the need to improve the present system for notifying pathologies at work.

[Results of a continuing education program using teaching consultations]. / Resultados de un programa de formación continuada a través de interconsultas-docentes.

The results of a continued education program for PCS in the clinical area by means of a method using teaching interconsultations are reported. The program was carried out in the Toledo province in the first six months of 1988. Its initial aims were the development of the program and the approaching between the different levels of health care. The program was carried out with the active participation of the members from PCS, who specified the areas of interest to be developed. The overall expense were 946,540 pesetas, with a mean expense per session and interconsultation of 6,352.6 pesetas. The degree of fulfillment of the program was 79.6% (149 of the programmed 187 interconsultations), with a mean of 3.3 interconsultations/health center/months (planned mean 4.1). In addition, the degree of compliance of each PCS and cooperating specialists was evaluated, with an analysis of the causes of noncompliance. It was concluded that continued education programs for PCS are necessary and that the method of teaching interconsultations is valid with limitations in health areas of small size.