Valoración de un programa piloto de prescripción de actividad física en atención primaria en la Comunitat Valenciana / Evaluation of a pilot program of physical activity prescription in primary care in the Valencian Community (Spain)

Objetivo: Valorar el proceso de prescripción y la mejora de la autoestima y la calidad de vida relacionada con la salud en un estudio piloto de prescripción de activos de actividad física durante 3 meses. Método: Estudio cuasiexperimental antes-después sin grupo control, para la valoración del proyecto piloto (noviembre de 2017 y mayo de 2018) del programa Conecta Actius per a la Salut en seis centros de salud de la Comunitat Valenciana. Quienes aceptaron participar cumplimentaron un cuestionario con datos sociales, la escala de autoestima de Rosemberg y el cuestionario de calidad de vida EQ-5D al inicio (T0) y a los 3 meses (T1). Se realizó un análisis descriptivo por sexo, nivel educativo y oferta de activos, en el que se calcularon las diferencias de medianas entre T0 y T1 mediante el test de Wilconxon para dos muestras relacionadas. Resultados: Respondieron 82 personas en T0 y 78 en T1. Se observa una mejora de la calidad de vida (7%; p ≤0,001), la percepción de salud (12,5% p ≤0,001) y la autoestima (5,9%; p ≤0,001) entre T0 y T1. Las mujeres mejoran en mayor proporción que los hombres para las tres escalas medidas, y quienes tienen mayor nivel educativo o les han realizado la prescripción en los centros que ofertan un único activo. Conclusión: Se han obtenido beneficios en salud a corto plazo tras la prescripción de actividad física. En concreto, se observa una mejora en la calidad de vida, la percepción de salud y la autoestima. (AU)

Objective: Assess the prescription process, adherence and impact on health measured in improvement of self-esteem and health-related quality of life, as short-term health indicators, from a pilot study of prescription of physical activity assets for 3 months. Method: Quasi-experimental study before-after without a control group, for the evaluation of the pilot phase (November 2017 and May 2018) of the program Conecta Actius per a la Salut in the Valencian Community (Spain). The physical activity prescription was performed and a questionnaire was completed at the beginning (T0) and at 3 months (T1). A descriptive analysis was carried out by sex and educational level where the differences between T0 and T1 were calculated using chi square and the Wilcoxon test of two dependent samples. Results: The sample was 82 in T0 and 78 people in T1. The analysis shows an improvement between quality of life (7%; p ≤0.001), health perception (12,5%; p ≤0.001) and self-esteem (5,9%; p ≤0.001) between T0 and T1. The improvement proportion in Health perception is greater in women than in men for the three measured scales and in those who have a higher educational level or have been prescribed in centers that offer a single asset. Conclusion: Pilot study shows short-term health benefits after the physical activity prescription. Specifically, there is an improvement in the quality of life, health perception and self-esteem of the population. (AU)

[Do general practitioners follow the therapeutical recommendations of cystitis in women? INURA study]. / ¿Siguen los médicos de Atención Primaria las recomendaciones terapéuticas de las cistitis en la mujer? Estudio INURA.

OBJECTIVE: The management of lower urinary tract infections varies from physician to physician. The aim of this study was to assess whether general practitioners follow the evidence-based guidelines for the management of cystitis in women. METHODS: Cross-sectional study carried out from March to July 2009 in which physicians consecutively registered in a template during a 8-week period the first six episodes of cystitis by means attended at the medical consultation. Age, episode of infection, associated morbidity, antibiotic prescription, and type of antibiotic course (short or long regimen) were determined. RESULTS: Out of 176 physicians invited to participate, 110 included 658 women with lower urinary tract infections with antibiotic treatment being administered in 634 cases. Short courses were given to 385 women (60.7%) and 249 women were given long schedules (39.3%). A total of 343 out of all noncomplicated cystitis were treated with short courses (62.9%) and 75 out of complicated cystitis were treated with long courses (66.4%). First-choice antibiotics were administered as empiric treatment in only 111 women (17.5%). CONCLUSIONS: These results highlight a poor adherence of general practitioners to current recommendations of clinical practice guidelines in cystitis with a low utilization of first-choice antibiotics.

¿Siguen los médicos de Atención Primaria las recomendaciones terapéuticas de las cistitis en la mujer? Estudio INURA / Do general practitioners follow the therapeutical recommendations of cystitis in women?. INURA study

Objetivo: Existe variabilidad entre los médicos de Atención Primaria en el manejo de las infecciones del tracto urinario. El objetivo de este estudio fue evaluar si los médicos de Atención Primaria siguen las recomendaciones terapéuticas en el manejo de las cistitis de la mujer. Métodos: Estudio transversal realizado de marzo a julio de 2009 en el que participaron médicos de Atención Primaria de España que registraron en una hoja de recogida de datos durante ocho semanas las 6 primeras cistitis atendidas en la consulta. Se determinaron edad, episodio de la infección, antecedentes, tratamiento antibiótico y tipo de pauta antibiótica (corta o larga). Resultados: Fueron invitados a participar en este estudio un total de 176 médicos, de los cuales 110 incluyeron 658 mujeres con infecciones del tracto urinario, de las que en 634 casos se administró tratamiento antibiótico. Un total de 385 pautas prescritas fueron cortas (60,7%) y 249 fueron largas (39,3%). Un total de 343 pautas administradas en las cistitis no complicadas fueron cortas (62,9%) y en 75 de las infecciones complicadas se indicaron pautas largas (66,4%). Sólo en 111 casos se pautaron de forma empírica antibióticos de primera elección a la dosis y pauta definidas (17,5%). Conclusiones: Estos resultados demuestran un pobre seguimiento de los médicos a las recomendaciones actuales de las guías de práctica clínica en la cistitis con una baja utilización de antibióticos de primera elección(AU)

Objective: The management of lower urinary tract infections varies from physician to physician. The aim of this study was to assess whether general practitioners follow the evidence-based guidelines for the management of cystitis in women. Methods: Cross-sectional study carried out from March to July 2009 in which physicians consecutively registered in a template during a 8-week period the first six episodes of cystitis by means attended at the medical consultation. Age, episode of infection, associated morbidity, antibiotic prescription, and type of antibiotic course (short or long regimen) were determined. Results: Out of 176 physicians invited to participate, 110 included 658 women with lower urinary tract infections with antibiotic treatment being administered in 634 cases. Short courses were given to 385 women (60.7%) and 249 women were given long schedules (39.3%). A total of 343 out of all noncomplicated cystitis were treated with short courses (62.9%) and 75 out of complicated cystitis were treated with long courses (66.4%). First-choice antibiotics were administered as empiric treatment in only 111 women (17.5%). Conclusions: These results highlight a poor adherence of general practitioners to current recommendations of clinical practice guidelines in cystitis with a low utilization of first-choice antibiotics(AU)

The adherence of GPs to guidelines for the diagnosis and treatment of lower urinary tract infections in women is poor.

OBJECTIVES: To assess the adherence of GPs to evidence-based guidelines for the diagnosis and management of lower urinary tract infection (UTI) in women. METHODS: A cross-sectional study was performed from March to July 2009 in primary care offices. Physicians consecutively registered the first six UTI attended during an 8-week period. Age, days with symptoms, episode of infection, associated morbidity, signs and symptoms, diagnostic procedures performed, antibiotic prescription, allergies and referral or not were registered. The type of antibiotic course (short or long) and first-choice treatments were also taken into account. RESULTS: Of 176 physicians invited to participate, 110 (62.5%) included 658 women with lower UTI. Urine dipstick was performed in 550 cases (83.6%) and urine culture was requested in 235 women (35.7%), with criteria for culture in 49.6% and without criteria in 32.8%. Antibiotic treatment was administered in 634 cases (96.4%). Short courses were given to 385 women (60.7%) and 75 of those with complicated UTI were treated with long courses (66.4%). First-choice antibiotics were administered as empiric treatment in only 92 women with uncomplicated UTI (17.7%). CONCLUSIONS: These results highlight the poor adherence of GPs to the current recommendations of clinical practice guidelines with a high number of inappropriate urine cultures requested and a low utilization of first-choice antibiotics.

[Evolution of the bone mass of hypertense menopausal women in treatment with fosinopril]. / Evolución de la densidad ósea de mujeres menopáusicas hipertensas en tratamiento con fosinopril.

BACKGROUND AND OBJECTIVE: The renin-angiotensin system (SRA) acts on the bone metabolism and decreases the mineralization. Menopausal women frequently are hypertense and have risk of developing osteoporosis. The inhibition of SRA could favour the mineralization and protect the bone mass of hypertense women in treatment with antihypertensive drugs that are angiotensin converting enzyme inhibitors. PATIENTS AND METHOD: Cohorts prospective study. 50 menopausal women were recruited and divided in one cohort of non hypertense patients and one cohort of hypertense women who initiated antihypertensive treatment with oral fosinopril. Baseline and after 1 year bone mineral density of lumbar spine and femoral neck was made. RESULTS: There were no significant differences between the bone mass of both groups. Significant changes between the baseline and after the treatment were not demonstrated in the cohort exposed. In the group of non exposed women were demonstrated differences in lumbar spine (baseline, 0.874 g/cm(2); final, 0.854 g/cm(2); p = 0.002) and femoral neck (baseline, 0.743 g/cm(2); final, 0.725 g/cm(2); p = 0.016). CONCLUSIONS: The menopausal and hypertense women who followed treatment with fosinopril did not present the physiological loss of bone mass that affected to menopausal women without treatment.

Evolución de la densidad ósea de mujeres menopáusicas hipertensas en tratamiento con fosinopril / Evolution of the bone mass of hypertense menopausal women in treatment with fosinopril

Fundamento y objetivo: El sistema renina-angiotensina-aldosterona (SRAA) actúa en el metabolismo óseo disminuyendo la mineralización. Las mujeres menopáusicas frecuentemente son hipertensas y tienen riesgo de desarrollar osteoporosis. La inhibición del SRAA podría favorecer la mineralización y proteger la masa ósea de mujeres hipertensas en tratamiento con fármacos antihipertensivos inhibidores de la enzima de conversión de la angiotensina. Pacientes y método: Estudio observacional y prospectivo de cohortes. Se incluyó a 50 mujeres menopáusicas, divididas en una cohorte de pacientes normotensas y una cohorte de mujeres hipertensas, que iniciaron tratamiento antihipertensivo con fosinopril por vía oral. Se realizó una densitometría ósea de columna lumbar y cadera, basal y al cabo de 1 año. Resultados: No se observaron diferencias significativas de la masa ósea entre ambos grupos. En la cohorte expuesta no se evidenciaron cambios significativos antes y después del tratamiento. El grupo de mujeres no expuestas mostró diferencias en columna lumbar (densidad ósea basal, 0,874 g/cm2; final, 0,854 g/cm2; p = 0,002) y en cuello de fémur (densidad ósea basal, 0,743 g/cm2; final, 0,725 g/cm2; p = 0,016). Conclusiones: Las mujeres menopáusicas e hipertensas que siguieron tratamiento con fosinopril no presentaron la pérdida fisiológica de masa ósea que sí afectó a mujeres menopáusicas normotensas sin tratamiento

Background and objective: The renin-angiotensin system (SRA) acts on the bone metabolism and decreases the mineralization. Menopausal women frequently are hypertense and have risk of developing osteoporosis. The inhibition of SRA could favour the mineralization and protect the bone mass of hypertense women in treatment with antihypertensive drugs that are angiotensin converting enzyme inhibitors. Patients and method: Cohorts prospective study. 50 menopausal women were recruited and divided in one cohort of non hypertense patients and one cohort of hypertense women who initiated antihypertensive treatment with oral fosinopril. Baseline and after 1 year bone mineral density of lumbar spine and femoral neck was made. Results: There were no significant differences between the bone mass of both groups. Significant changes between the baseline and after the treatment were not demonstrated in the cohort exposed. In the group of non exposed women were demonstrated differences in lumbar spine (baseline, 0.874 g/cm2; final, 0.854 g/cm2; p = 0.002) and femoral neck (baseline, 0.743 g/cm2; final, 0.725 g/cm2; p = 0.016). Conclusions: The menopausal and hypertense women who followed treatment with fosinopril did not present the physiological loss of bone mass that affected to menopausal women without treatment