Asociación entre el síndrome de movilidad articular limitada y el riesgo de caídas accidentales en pacientes diabéticos / Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients

Introducción: El síndrome de movilidad articular limitada (SMAL) aparece exclusivamente en pacientes con diabetes, tanto tipo 1 como tipo 2. Se manifiesta como una limitación en la movilidad articular que inicialmente afecta a las falanges proximales de las manos, seguidas, por orden de frecuencia, por muñecas, codos, hombros, rodillas y esqueleto axial. El diagnóstico se puede realizar mediante pruebas sencillas, como «el test de la oración». El objetivo fue conocer la prevalencia de pacientes diabéticos con SMAL, evaluar la asociación entre el SMAL y el grado de control glucémico y el riesgo de caídas accidentales. Pacientes y métodos: Estudio observacional transversal en el Centro de Salud de San Fernando II, Madrid (periferia). La muestra fueron 184 pacientes con un diagnóstico de diabetes superior a 5 años entre noviembre-marzo de 2013. Se utilizó el test de la oración para evaluar si los pacientes presentaban SMAL. El riesgo de caídas fue determinado según el test Timed Up & Go. Resultados: Un total de 99 pacientes (53,8%) (IC 95% 46,6-61) presentaron un test de la oración positivo. No se obtuvo una relación estadísticamente significativa con la HbA1c, en cambio, sí que se vio una asociación entre el test Timed Up & Go y el SMAL (p < 0,001) (IC 95% 1,173-1,611). Los pacientes con SMAL presentaban un riesgo moderado de caídas frente a aquellos sin SMAL, que presentaban un riesgo bajo. Conclusiones: Existe una alta prevalencia de SMAL en nuestro medio. Presentamos el primer estudio en donde se relaciona el SMAL con el riesgo de caídas en los pacientes diabéticos (AU)

Introduction: Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple «prayer sign» test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. Patients and methods: A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. Results: A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P < .001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. Conclusions: The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients (AU)

[Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients]. / Asociación entre el síndrome de movilidad articular limitada y el riesgo de caídas accidentales en pacientes diabéticos.

INTRODUCTION: Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. PATIENTS AND METHODS: A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. RESULTS: A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. CONCLUSIONS: The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients.

Detección de víctimas de bullying en un centro de Atención Primaria / Detection of bullying victims in a Primary Care site

INTRODUCCIÓN. El término bullying hace referencia al acoso escolar. Los estudios publicados hasta ahora se han realizado en centros escolares. Artículos publicados demuestran que ser víctima de bullying tiene consecuencias en la salud, por lo que este trabajo analiza la detección de víctimas de acoso escolar en un centro de Atención Primaria. MATERIAL Y MÉTODOS. La población diana son los 1.256 adolescentes de 13 a 16 años pertenecientes a un centro de salud de la periferia de Madrid. Se hace un estudio descriptivo transversal de una muestra aleatorizada de 90 adolescentes, siendo los criterios de inclusión estar escolarizado y dar consentimiento escrito, y los criterios de exclusión no saber leer o escribir, no hablar castellano, padecer algún tipo de enfermedad mental o no disponer de teléfono de contacto. Las variables recogidas fueron: sexo, edad, nacionalidad, núcleo de convivencia, repetidor, índice de masa corporal (IMC), patología previa, víctima de violencia escolar, criterios de ser víctima de acoso escolar, problema de autoestima, fumador, bebedor y consumo de drogas. RESULTADOS. El 37,8% de la muestra alguna vez habían sido agredidos física, verbal o psicológicamente, encontrando relación con el IMC. El 3,3% cumplía criterios de ser víctima de acoso escolar. El 12,2% eran fumadores, el 11,1% bebían alcohol y el 3,3% consumían drogas. Un 16,7% tenían problema de autoestima, siendo esto más frecuente en las mujeres. CONCLUSIONES. El estudio demuestra que si preguntamos en la consulta por este problema, la detección de víctimas de bullying es similar a la de los centros escolares. Por lo tanto, el abordaje de este problema debe ser interdisciplinar, y en él se debe implicar el médico de familia (AU)

INTRODUCTION. "Bullying" refers to abuse at school. The studies published up to date have been conducted in schools. They show that there are consequences for the health of those bullied, so that this work analyzes the detection of school bullying victims in a primary health care center. MATERIAL AND METHODS. The target population is 1256 teenagers aged between 13 to 16 years assigned to a Primary Care Center located in the Madrid suburbs. A cross-sectional, descriptive study was made using a random sample of 90 teenagers, the inclusion criteria being in school and having given written consent. The exclusion criteria were not knowing how to read or write, not being able to speak Spanish, suffering any kind of mental illness or those who could not be contacted via telephone. The variables gathered were: gender, age, nationality, living environment, whether they had repeated a year, body mass index (BMI), previous diseases, instances of being a victim of school violence or other forms of harassment, self-esteem problems, smoker, drinker and drugs use. RESULTS. A total of 37.8% of the persons surveyed indicated that had experienced some form of physical, verbal or psychological abuse and a relationship was found with BMI. A total of 3.3% of the people met the criteria of bullying, 12.2% were smokers, 11.1% drank alcohol and 3.3% took drugs and 16.7% had self-esteem problems. This last point was more frequent among women. CONCLUSIONS. Detection of bullying victim in this work-place is similar to those found in schools. Thus, the approach to this problem should be interdisciplinary and the family doctor should be involved (AU)

¿Qué factores influyen en la concesión de una incapacidad permanente? / No disponible

No disponible

Laxitud articular: prevalencia y relación con dolor musculosquelético / Joint hypermobility: prevalence and relationship with musculoskeletal pain

Objetivos: Determinar la prevalencia de laxitud articular en niños de 4 a 14 años sin patología orgánica del aparato locomotor; comparar la prevalencia de laxitud en niños con y sin artralgias, y analizar la contribución de las variables recogidas al desarrollo de artralgias. Pacientes y métodos: Estudio observacional realizado en una muestra de niños de 4 a 14 años de edad residentes en el Área 4 de la Comunidad de Madrid. La movilidad articular se valoró utilizando un goniómetro. La laxitud se definió utilizando los criterios de Beighton. Resultados: Se analizaron 222 sujetos, 176 en una consulta de atención primaria y 46 en urgencias del hospital de referencia. Referían artralgias 43 niños. La prevalencia de laxitud (>= 4 criterios) fue del 55 por ciento (123/222), y alcanzó el 71 por ciento (49/69) en menores de 8 años. No existían diferencias significativas en la prevalencia de laxitud en niños con y sin artralgias (65 y 53 por ciento, respectivamente). De las variables analizadas (edad, sexo, país de origen, captación en atención primaria/urgencias) sólo se detectaron diferencias en el número absoluto de criterios de Beighton presente en niños con y sin artralgias (4,34 2,47 y 3,48 2,35; p 0,03), que desaparecían al exigir la presencia de al menos cuatro criterios (definición de laxitud). Conclusiones: El 55 por ciento de la población estudiada y el 71 por ciento de los menores de 8 años cumplen criterios de laxitud articular. En la muestra analizada no se confirma que la presencia de laxitud articular favorezca el desarrollo de artralgias (AU)

[Joint hypermobility: prevalence and relationship with musculoskeletal pain]. / Laxitud articular: prevalencia y relación con dolor musculosquelético.

OBJECTIVES: (1) To determine the prevalence of joint hypermobility in children aged 4-14 years old without organic disease of the locomotor system; (2) to compare the prevalence of hypermobility in children with and without arthralgia and (3) to analyze the influence of certain variables on the development of arthralgia. PATIENTS AND METHODS: We performed an observational study in a sample of children aged 4-14 years old living in Area 4 of the Community of Madrid (Spain). Joint hypermobility was evaluated using a goniometer. Hypermobility was defined using Beighton's criteria. RESULTS: A total of 222 subjects were analyzed: 176 in the primary care setting and 46 in the emergency department of a referral hospital. Of the 222 children, 43 reported arthralgia. The prevalence of hypermobility (> or = 4 criteria) was 55 % (123/222), reaching 71 % (49/69) in children aged less than 8 years. No significant differences were found in the prevalence of hypermobility in children with and without arthralgia (65 % and 53 % respectively). Of the variables analyzed (age, sex, country of origin, primary care/emergency department setting) only differences in the absolute number of Beighton criteria present in children with and without arthralgia (4.34 +/- 2.47 and 3.48 +/- 2.35, p = 0.03) were detected, which disappeared when at least four criteria (definition of hypermobility) were required. CONCLUSIONS: Fifty-five percent of the population studied and 71 % of those younger than 8 years old met the criteria for joint hypermobility. In the sample analyzed, the presence of joint hypermobility did not seem to favor the development of arthralgias.

[Use of inhaled bronchodilators by primary care patients]. / Estudio sobre el empleo de broncodilatadores inhalados por los pacientes de atención primaria.

OBJECTIVE: To find how widespread incorrect inhalation techniques are in patients on long-term inhalation treatments, comparing different methods and the health control standard. DESIGN: A descriptive crossover study. SETTING: Three Health Centres in Burgos. PATIENTS: People over 15 with at least a month on inhalation treatment. MEASUREMENTS AND MAIN RESULTS: A questionnaire was composed to find the characteristics of the patients and their illness. Then their inhalation method was qualified as correct, acceptable or incorrect, using a scale based on Newman's classic criteria. Average age was 63.8 +/- 15.6, with 66.5% men. 11.6% of patients were active smokers. The most common diagnosis was COPD (61.6%). 65% of the patients were monitored within primary care (PC). The most common inhalation method was pressurised aerosol (61%); 26.2% of patients used two or more different methods. Only 21.3% of patients correctly performed the technique of inhalation, with better results for patients under specialist care (SC) than PC. 10.5% of patients had never received instruction on an inhalation technique. The method with the best results was the dry dust one, with differences close to statistical significance. CONCLUSIONS: There is widespread incorrect use of methods of inhalation. Most people use a pressurised aerosol. There are a large number of patients who have never been shown the correct way to inhale.

[Hospital oxygen therapy: routine or ignorance?]. / Oxigenoterapia hospitalaria: rutina o desconocimiento?

To determine how oxygen therapy is being used in general surgery (GS), internal medicine (IM) and pneumology (PN) units of Hospital General Yagüe in Burgos (Spain), as well as to study patient compliance with treatment. Cross-sectional descriptive study. Case histories taken on 2 randomly chosen days one month apart were reviewed. For patients receiving oxygen therapy we analyzed both physician and nursing records on diagnosis, flow, route, form of oxygen administration (continuous-discontinuous), determining the agreement of medical records with what was actually used by the patient. Baseline pulse oximetry readings were available for all patients. One hundred one patients were enrolled in the study. The most frequently recorded diagnosis was chronic obstructive pulmonary disease (COPD). Therapy was prescribed based on gasometric criteria in 62.5% of IM patients, 73.1% of PN patients and 23% of GS patients. The route and flow were recorded mainly in IM and PN wards, but not in GS; form of administration, however, was recorded for only 2 patients. We found agreement between physician and nursing orders in 26.8% in the IM ward, in 60% in the PN unit and in 5.3% of GS cases. The administrative route ordered was that which was actually used in 80% in PN 42.9% in IM and 10.5% in GS. The patients received oxygen fewer days than prescribed (a coefficient of 1 for days ordered/days used in 54.5%).(ABSTRACT TRUNCATED AT 250 WORDS)