Telemedicina en Atención Primaria: evaluación de la retinopatía diabética en una Zona Básica de Salud / Telemedicine in Primary Care: evaluation of diabetic retinopathy in a Primary Health Care center

OBJETIVO. Valorar la detección de retinopatía diabética utilizando como técnica de cribado el retinógrafo no midriático y evaluar los factores asociados en pacientes diabéticos de una zona básica de salud. PACIENTES Y MÉTODO. Se realizó un estudio descriptivo transversal en diabéticos con retinografía realizada en los primeros 6 meses de instauración del retinógrafo en el Centro de Salud en 2004. Variables analizadas: edad, sexo, tipo y tiempo de evolución de la diabetes mellitus (DM), tratamiento (antidiabéticos orales, insulina, dieta), control metabólico, grado de retinopatía y presencia de edema macular. RESULTADOS. Analizamos a 317 diabéticos con una media de edad de 62,31 ± 11,41 años; el 52,7% eran mujeres, mayoritariamente con DM2 (98,4%). La media del tiempo de evolución de la DM fue 6,87 ± 5,97 años. El 53% presentó buen control metabólico (glucohemoglobina < 7%). Tenía tratamiento con antidiabéticos orales el 68,1% de los pacientes, con insulina el 22,4% y sólo dieta el 9,5%. Presentaba retinopatía el 11,04% (intervalo de confianza [IC] del 95%, 7,59%- 14,49%). El grado de severidad de ésta era leve en el 71,42%, moderada en el 20%, severa en el 2,85% y proliferativa en el 5,71%. El 2,2% presentaba edema macular. Los factores predictores de la retinopatía diabética tras análisis de regresión logística fueron estar en tratamiento con insulina (odds ratio [OR] = 3,019), el mal control metabólico (OR = 4,049) y tener más de 10 años de evolución de la DM (OR = 4,958). CONCLUSIONES. La detección de retinopatía en nuestros diabéticos fue del 11,04%. Dada la disponibilidad del retinógrafo, su simplicidad y su efectividad, creemos que se debe consolidar como técnica de cribado en Atención Primaria (AU)

OBJECTIVE. To assess the detection of diabetic retinopathy using nonmydriatic retinography as screening method and to evaluate the associated factors in patients in a Primary Health Care center. PATIENTS AND METHOD. A cross-sectional, descriptive study was conducted in diabetic patients who had undergone a retinography during the first six months after initiating the technique in the health center in 2004. The variables analyzed were age, gender, diabetes type and evolution time, treatment (hypoglycemic agents, insulin, diet), metabolic control, retinopathy grade and presence of macular edema. RESULTS. We analyzed 317 patients, with a mean age of 62.31 ± 11.41 years, 52.7% of whom were women, and 98.4% of whom had type 2 diabetes. Mean evolution time of the diabetes was 6.87 ± 5.97 years. A total of 53% (HbA1c < 7%) of the patients had good metabolic control. Hypoglycemic agents were used in 68.1%, insulin in 22.4% and only diet in 9.5%. Only 11.04% of the patients had retinopathy (CI 95%: 7.59%- 14.49%). Severity was mild in 71.42%, moderate in 20%, severe in 2.85% and proliferative in 5.71%. Macular edema was detected in 2.2%. Predictive factors of diabetic retinopathy after multivariate analysis were: insulin treatment (OR = 3.02), poor metabolic control (OR = 4.05) and having more than 10 years of diabetic evolution (OR = 4.96). CONCLUSIONS. Detection of retinopathy in our diabetic patients was 11.04%. Due to the accessibility of the technique, its simplicity and effectiveness, we consider it must be consolidated into Primary Care as a screening method (AU)

[Cigarette smoking among adolescents. Estimated prevalence by a questionnaire and serum cotinine]. / Tabaquismo en adolescentes. Prevalencia estimada mediante declaración y cotinina sérica.

BACKGROUND: The tobacco smoking epidemic is causing more deaths than anyone before. Young population is the main aim of tobacco advertisements. We estimated the prevalence of tobacco use among adolescents and their environment, the agreement of questionnaire and serum cotinine and the total prevalence of exposure (active plus pasive). SUBJECTS AND METHODS: Cross-sectional study in 439 highschool students. We obtained a blood sample and anonimously inquired about their tobacco consumption and the existence of smokers in their environment. We analized the agreement between both methods. RESULTS: 56% have ever smoked tobacco. Declared prevalence of consumption was 34% (CI95%= 29.49-38.51), being 40% among girls and 23% among boys. The agreement between cotinine and declaration was high only in voluntary smokers (Kappa = 0.68 for 1 o more cigarettes/day and Kappa = 0.76 for 10 or more cigarettes/day). Smoking prevalence of the famliy, friends and school among smokers was higher (80%, 71% and 88%, respectively) than among non smokers (65%, 24% and 78%). Combining questionnaire and cotinine it was estimated that total prevalence of exposure was larger than 64%. CONCLUSIONS: The high prevalence of exposure and the asociation of tobacco smoking among adolescents and their environment demands an educational program against tobacco including family, social and school environments. The agreement between declaration and serum cotinine is high only when consumption is daily.

[Maternal participation to improve the effectiveness of diet education in children]. / Participación materna para mejorar la efectividad de la educación dietética en la infancia.

OBJECTIVE: To find out whether dietetic education in children improve its effectiveness with participation of mothers. DESIGN: We made a field try. SETTING: Two primary schools in Taco (La Laguna). SUBJECTS: We included every students who was in 7.o course in both schools (139 children). INTERVENTION: We assigned the children of one school to the educative intervention with mothers and the other school to the dietetic education without mothers. The intervention consist of four lectures about the fat food and the good feed. MEASUREMENTS AND MAIN RESULTS: We measured the dietetic knowledge with a questionnaire. And we made two plasmatic analysis to measure the lipidemia pre and postintervention. We excluded unauthorized children and those with more than one absence in our four classes. Both children groups showed a significative improvement in their knowledge (p < 0.05). The cholesterolaemia only decreased in the group with mothers (p = 0.01). It had a pradoxical diminishment of cholesterol HDL at the beginning was greater than 170 mg/dl, the reduction was more important yet in the group with mothers. CONCLUSIONS: The dietetic education can have variations in its effectiveness according the method employed and people who receive it. In the dietetic education of children the inclusion of mothers improve its effectiveness.