Arterial hypertension diagnosis: A problem? / Diagnóstico de hipertensión arterial: ¿un problema?

Introduction: Arterial hypertension (AHT), a leading risk factor in terms of attributable mortality, is a major public health problem, especially for primary care where most patients are diagnosed and followed up. Correct AHT diagnosis requires adequate theoretical knowledge and technical skills in physicians and nurses. The aim of this study was to evaluate the knowledge and skills used in initial AHT diagnosis by health professionals and to describe the factors that contribute to variability. Methodology: Cross-sectional observational study in a sample of 385 primary care physicians and nurses recruited in a Catalan health region. Using a validated questionnaire called ARC, we evaluated theoretical knowledge and analysed factors that may contribute to response variability. We also evaluated practical measurement skills using objective structured clinical examination tests. Results: Medical and nursing primary care professionals had deficient knowledge and skills for initial AHT diagnosis and measurement, despite self-perceiving their knowledge to be sufficient. However, professionals who had received postgraduate or other AHT training in the previous year scored better in the ARC questionnaire. Conclusions: The results of this study point to insufficient AHT expertise to ensure quality clinical practice, suggesting that ongoing theoretical and practical training needs to be improved. (AU)

Introducción: La hipertensión arterial (HTA) es un factor de riesgo destacado en términos de mortalidad atribuible, y un gran problema de salud pública, en especial para la atención primaria, donde se diagnostica y se realiza el seguimiento a la mayoría de los pacientes. El diagnóstico correcto de HTA requiere un conocimiento teórico y una competencia técnica adecuados por parte de médicos y enfermeros. El objetivo de este estudio fue evaluar el conocimiento y las competencias aplicados al diagnóstico inicial de HTA por parte de los profesionales sanitarios, así como describir los factores que contribuyen a la variabilidad. Metodología: Estudio observacional transversal de una muestra de 385 médicos y enfermeros de atención primaria seleccionados en una región sanitaria de Cataluña. Utilizando un cuestionario validado denominado ARC, evaluamos el conocimiento técnico y analizamos los factores que probablemente contribuyen a la variabilidad de la respuesta. También evaluamos las técnicas prácticas de medición utilizando una prueba de examen clínico objetivo. Resultados: Los profesionales médicos y enfermeros de atención primaria tenían un conocimiento deficiente para realizar el diagnóstico y la medición iniciales de HTA, a pesar de autopercibir que dicho conocimiento es suficiente. Sin embargo, los profesionales que recibieron formación de posgrado en HTA durante el último año obtuvieron una mejor puntuación en el cuestionario ARC. Conclusiones: Los resultados de este estudio señalan una experiencia insuficiente sobre HTA para garantizar una práctica clínica de calidad, lo cual demuestra que debe mejorarse la formación teórica y práctica continua. (AU)

Arterial hypertension diagnosis: A problem?

INTRODUCTION: Arterial hypertension (AHT), a leading risk factor in terms of attributable mortality, is a major public health problem, especially for primary care where most patients are diagnosed and followed up. Correct AHT diagnosis requires adequate theoretical knowledge and technical skills in physicians and nurses. The aim of this study was to evaluate the knowledge and skills used in initial AHT diagnosis by health professionals and to describe the factors that contribute to variability. METHODOLOGY: Cross-sectional observational study in a sample of 385 primary care physicians and nurses recruited in a Catalan health region. Using a validated questionnaire called ARC, we evaluated theoretical knowledge and analysed factors that may contribute to response variability. We also evaluated practical measurement skills using objective structured clinical examination tests. RESULTS: Medical and nursing primary care professionals had deficient knowledge and skills for initial AHT diagnosis and measurement, despite self-perceiving their knowledge to be sufficient. However, professionals who had received postgraduate or other AHT training in the previous year scored better in the ARC questionnaire. CONCLUSIONS: The results of this study point to insufficient AHT expertise to ensure quality clinical practice, suggesting that ongoing theoretical and practical training needs to be improved.

Respuesta a la carta al editor referida a «Importancia del conocimiento óptimo de los profesionales sanitarios en el diagnóstico inicial de la HTA para su valoración» / Reply: Importance of the optimal knowledge of healthcare professionals in the initial diagnosis of high blood pressure

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A new validated international questionnaire on health professionals' knowledge of hypertension diagnosis.

INTRODUCTION: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals' theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. AIM: To design and validate an instrument for gauging health professionals' theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. METHODOLOGY: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. RESULTS: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. CONCLUSIONS: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge.

A new validated international questionnaire on health professionals’ knowledge of hypertension diagnosis

Introduction: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals’ theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. Aim: To design and validate an instrument for gauging health professionals’ theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. Methodology: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. Results: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. Conclusions: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge.(AU)

Introducción: La hipertensión arterial es el principal factor de mortalidad atribuible. Es por eso que se considera uno de los problemas de salud pública más importantes. Los profesionales de la salud necesitan una formación y unas habilidades especiales para realizar un diagnóstico. En la literatura actual no se han encontrado estudios que utilicen un instrumento validado (cuestionario) para evaluar los conocimientos teóricos y prácticos de los profesionales de la salud en el diagnóstico de la hipertensión o medición de la tensión arterial. Objetivo: Diseñar y validar un instrumento para medir los conocimientos teóricos de los profesionales de la salud en la medida de la tensión arterial para el diagnóstico inicial de la hipertensión. Metodología: Diseño, desarrollo y validación de un cuestionario en tres idiomas (inglés, español y catalán) para evaluar los conocimientos basados en el modelo de Rasch (teoría de la respuesta al ítem). Resultados: Se construyó y validó un cuestionario en tres idiomas. Constaba de 23 preguntas sobre los conocimientos teóricos en el diagnóstico inicial de hipertensión que se denominó cuestionario ARC. Cumplió con todos los criterios del modelo Rasch-IRT: medición de ajuste (fit) al ítem y a la persona, unidimensionalidad, independencia local, invarianza, targeting y fiabilidad. Conclusiones: El cuestionario ARC es una herramienta validada que permite realizar análisis objetivos y uniformes de los conocimientos en el diagnóstico inicial de la hipertensión entre profesionales de medicina y de enfermería, comparándolos en el tiempo. Permite desarrollar estrategias establecidas para potenciar este conocimiento.(AU)

Estudio observacional retrospectivo multicéntrico de pacientes con vejiga hiperactiva en tratamiento con mirabegrón y oxibutinina en condiciones de práctica clínica habitual / A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions

Objetivo. Evaluar la persistencia terapéutica, el coste sanitario y las reacciones adversas en pacientes tratados con oxibutinina y mirabegrón para el tratamiento de la vejiga hiperactiva en condiciones de práctica médica habitual. Pacientes y métodos. Se diseñó un estudio observacional, multicéntrico, retrospectivo, realizado a partir de registros médicos de pacientes pertenecientes a 3 áreas geográficas distintas (Barcelona, Girona, Asturias). Se analizaron los 2 grupos de estudio (oxibutinina y mirabegrón). El seguimiento se realizó durante un año. La persistencia se definió como el tiempo (meses) sin abandono del tratamiento inicial o sin cambio a otra medicación al menos 60 días después de la prescripción inicial. Principales medidas: comorbilidad, uso de recursos sanitarios y reacciones adversas. Programa SPSSWIN; p<0,05. Resultados. Se analizaron 1.277 sujetos. La media de edad fue de 69,3 años y el 53,2% fueron mujeres. Por grupos: 42,9% oxibutinina y 57,1% mirabegrón. Las características demográficas y la morbilidad fueron parecidas. Los pacientes en tratamiento con oxibutinina en comparación con mirabegrón presentaron una similar persistencia al tratamiento (35,0 vs. 32,2%, p=0,294), aunque menores costes (1.151,2 vs. 1.809,6€, p<0,001). Las diferencias mayores se observaron en el precio de la medicación (279,2 vs. 692,3€, p<0,001; diferencia: −4131,€) y en las reacciones adversas (9,7 vs. 4,9%, p<0,001). Conclusiones. Los pacientes en tratamiento con oxibutinina frente a mirabegrón para la vejiga hiperactiva se asociaron a una parecida persistencia al tratamiento, menores costes sanitarios y mayores tasas de reacciones adversas de oxibutinina frente a mirabegrón

Objective. To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. Patients and methods. An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. Results. Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. €1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. €692.3, P<.001; a variation of: −€413.1); and adverse events (9.7 vs. 4.9%, P<.001). Conclusions. Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates (AU)

[A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions]. / Estudio observacional retrospectivo multicéntrico de pacientes con vejiga hiperactiva en tratamiento con mirabegrón y oxibutinina en condiciones de práctica clínica habitual.

OBJECTIVE: To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. PATIENTS AND METHODS: An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. RESULTS: Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. €1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. €692.3, P<.001; a variation of: -€413.1); and adverse events (9.7 vs. 4.9%, P<.001). CONCLUSIONS: Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates.

Medición de la microcirculación retiniana luego del tratamiento antihipertensivo / Measuring retinal circulation after antihypertensive treatment

Background and objective: With the development of image processing techniques, it has become possible to measure the changes in retinal vessels of hypertensive patients by means of eye fundus photographs. Patients and method: In this paper we aim to classify retinal vessels automatically into arterioles and venules. In order to do so, we have compared three different strategies based on the colour of the pixels in images through an analysis of 78 hypertensive patients' eye fundus images. The first strategy classifies all the vessels by applying a clustering algorithm. The second divides the retinal image into four quadrants and classifies the vessels that belong to the same quadrant independently from the rest of the vessels. The third strategy classifies the vessels by dividing the retinal image into four quadrants that are rotated inside the mentioned image. Results: The third strategy was the one that obtained the best results, since it minimizes the number of unclassified vessels. In the initially analysed set of 20 images, we correctly classified 86.53% of the vessels, and this percentage remains similar in a set of 58 images examined by three medical experts. This confirms the validity of the method that automatically calculates the arteriovenous ratio (AVR).Conclusion: Our results are an improvement on those previously described in the bibliography, reducing the number of non-classified vessels. Furthermore, the method entails low computational costs.

Fundamento y objetivo: El desarrollo de técnicas de procesado de imágenes ha devuelto interés para poder medir de una forma objetiva los cambios en la estructura microvascular del hipertenso a través de las fotografías digitales del fondo de ojo. Pacientes y método: Para clasificar de forma automática los vasos de la retina en arteriolas y vénulas, con una elevada precisión, hemos comparado tres estrategias diferentes basadas en la información del color de los pixeles de la imagen del fondo de ojo, analizando 78 imágenes de fondo de ojo de hipertensos. La primera estrategia clasificaría todos los vasos aplicando un algoritmo de agrupamiento. La segunda divide la retina en cuatro cuadrantes y clasifica los vasos que pertenecen al mismo cuadrante independientemente del resto de los vasos. La tercera estrategia clasifica los vasos dividiendo la retina en cuadrantes que son rotados. Resultados: La mejor estrategia resultó la tercera porque minimiza el error y el número de vasos no clasificados. La característica vectorial más determinante está basada en la media o la mediana del componente gris del espacio de color RGB. Para las 20 imágenes inicialmente analizadas hemos clasificado correctamente el 86.53% de los vasos, y este porcentaje permanece similar en el grupo de 58 imágenes examinadas por tres expertos, lo que confirma la validez del método, para el cálculo del índice arteriovenoso de forma automática. Conclusión: Nuestros resultados son superiores a los descritos previamente, reduciendo además el número de vasos no clasificados. Por otro lado, el costo computacional del método es bajo

Persistencia y medicación concomitante en pacientes con vejiga hiperactiva tratados con antimuscarínicos en atención primaria: estudio de base observacional / Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study

Objetivo: Evaluar la persistencia terapéutica y su relación con la medicación concomitante en pacientes tratados con fesoterodina frente a tolterodina y solifenacina para el tratamiento de la vejiga hiperactiva en condiciones de práctica médica habitual. Material y métodos: Se efectuó un diseño observacional, multicéntrico, retrospectivo, realizado a partir de registros médicos de pacientes seguidos en atención primaria. Se analizaron los 3 grupos de estudio. La persistencia se definió como el tiempo (meses), sin abandono del tratamiento inicial o sin cambio a otra medicación al menos 30 días después de la prescripción inicial. La medicación concomitante fue: antidepresivos, ansiolíticos/hipnóticos, antibióticos, antisépticos, laxantes y productos-dermatológicos. Se utilizó el programa SPSSWIN versión 17 (significación estadística: p < 0,05). Resultados: Se seleccionaron para el estudio 3.094 pacientes. La media de edad fue de 54,0 años y el 62,2% fueron mujeres. Los pacientes tratados con fesoterodina mostraron mayor persistencia al tratamiento (12 meses) en comparación con solifenacina y tolterodina (40,2% frente al 34,7% y 33,6%; p = 0,008), respectivamente. Además, también mostraron un menor uso de medicación concomitante (1,1 frente a 1,2 y 1,2 fármacos; porcentajes: 61,6% frente a 67,1% y 70,1%; p < 0,03). Conclusiones: Los pacientes en tratamiento con fesoterodina frente a solifenacina y tolterodina para la vejiga hiperactiva se asociaron a una mayor persistencia al tratamiento, con una reducción de la medicación concomitante

Objective: To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. Material and methods: An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P < .05). Results: We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P = .008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P < .03). Conclusions: The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication

Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study.

OBJECTIVE: To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. MATERIAL AND METHODS: An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P<.05). RESULTS: We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P=.008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P<.03). CONCLUSIONS: The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication.

Computer aided diagnosis system for retinal analysis: automatic assessment of the vascular tortuosity.

The tortuosity of a vessel, that is, how many times a vessel curves, and how these turns are, is an important value for the diagnosis of certain diseases. Clinicians analyze fundus images manually in order to estimate it, but there is many drawbacks as it is a tedious, time-consuming and subjective work. Thus, automatic image processing methods become a necessity, as they make possible the efficient computation of objective parameters. In this paper we will discuss Sirius (System for the Integration of Retinal Images Understanding Service), a web-based application that enables the storage and treatment of various types of diagnostic tests and, more specifically, its tortuosity calculation module.

¿Interfiere en el control de la HTA el consumo de paracetamol en formulaciones solubles? / Do soluble formulations of acetaminophen affect control of high blood pressure?

ResumenNumerosos fármacos pueden dificultar el control de la hipertensión arterial (HTA), entre ellos los antiinflamatorios no esteroideos. Recientemente, algunos estudios de cohortes, han sugerido que el paracetamol también puede interferir en este control. Además, es bien conocida la relación entre el consumo de sal y la HTA.ResumenPor otro lado, surge la duda para el clínico de si las formulaciones solubles de paracetamol, cada vez más presentes en la farmacopea y que consiguen la solubilidad mediante sales que contienen sodio, pueden tener algún efecto sobre la presión arterial. El objetivo de este trabajo es revisar la relación entre el consumo de sal y la HTA, así como analizar las evidencias existentes sobre el efecto que puede tener el consumo de paracetamol en la HTA y si las sales de los compuestos solubles inciden sobre dicho control (AU)

AbstractThere are many medications that may complicate control of high blood pressure (HBP), among them non-steroidal anti-inflammatory drugs. Recently, some cohort studies have suggested that paracetamol (acetaminophen) can also interfere in this control. The relationship between salt consumption and HBP is also well known.AbstractFurthermore, the question also arises for the clinicians about whether soluble formulations of acetaminophen, which are increasingly more present in the pharmacopoeia and that achieve solubility through salts that contain sodium, may have some effect on blood pressure. This study has aimed to review the relationship between salt consumption and HBP and to analyze the existing evidence on the effect that acetaminophen may have on HBP and whether the salts of the soluble compounds have any impact on such control (AU)

Ejercicio físico y calidad de vida autopercibida en el anciano hipertenso / Physical exercise and quality of self-perceived life in the hypertensive elderly subject

Objetivo. Determinar la relación entre el ejercicio físico y la calidad de vida (CdV) autopercibida en pacientes hipertensos mayores de 70 años.DiseñoEstudio transversal y analítico de una muestra de pacientes ambulatorios que acudieron a las consultas de atención primaria de los investigadores.Material y métodoSe incluyeron pacientes de 70 años de edad o mayores, diagnosticados de hipertensión arterial (HTA). Se excluyeron los pacientes institucionalizados o los que no cumplían los criterios del estudio. A todos los participantes se les efectuó analítica, valoración de la comorbilidad y exploración física básica que incluyó la medida de la presión arterial estandarizada. La actividad física se cuantificó en metabolic equivalents (METS) semanales mediante un cuestionario validado. La CdV se midió mediante el cuestionario de autopercepción de la salud de 12 ítems (SF-12).ResultadosSe incluyeron 191 pacientes (edad 77,8 años; el 58,1% mujeres). Media de 1.837 METS semanales (DE: 1.906,5). La CdV según el cuestionario SF-12, 43,2 para la dimensión fisica y 52,4 para la psíquica. La puntuación de la CdV fue inferior en los pacientes situados en los cuartiles inferiores de ejercicio físico (p<0,02). El ejercicio físico a partir de 1.635 METS por semana y la comorbilidad se asociaron de forma independiente con el componente físico de la CdV, mientras que el ejercicio físico a partir de 840 METS semanales, el sexo, la comorbilidad, el HDL colesterol y la diabetes tipo 2 lo hicieron con el componente psíquico de la CdV.ConclusionesExiste una asociación independiente entre la práctica de ejercicio físico y la CdV autopercibida en los pacientes hipertensos mayores de 70 años. El nivel de ejercicio que recomienda la Guía Europea de HTA se asocia a una mejor percepción del componente psíquico de la CdV, mientras que para el componente físico es necesario un nivel más elevado de ejercicio(AU)

Objective. Determine the relationship between physical exercise and self-perceived quality of life in hypertensive patients over 70 years of age.DesignCross-sectional and analytic study of a sample of out-patients who came to the investigators’ primary care medical offices.Material and methodPatients of 70 years or older diagnosed of arterial hypertension were included. Those institutionalized or who did not meet the study criteria were excluded. All the participants underwent laboratory analysis, evaluation of comorbidity, basic physical examination that included measurement of standardized blood pressure. Physical activity was quantified in metabolic equivalents (METS) per week using a validated questionnaire. Quality of life was measured with the SF-12 questionnaire.ResultsA total of 191 patients (age 77.8 y; 58.1% women) were included. Mean of 1837 METS per week (SD:1906.5) .Quality of life SF-12, 43.2 for the physical dimension and 52.4 for the psychic one. Quality of life score was lower in the patients located in the lower quartiles of physical exercise (p<0.02). Physical exercise after 1635 METS per week and comorbidity were associated independently with the physical component of quality of life while physical exercise after 840 METS per week, gender, comorbidity, HDL cholesterol and type 2 diabetes did so with the psychic component of quality of life.ConclusionsThere is an independent association between the practice of physical exercise and self-perceived quality of life in hypertensive patients over 70 years. The exercise level recommended by the European Guide of AHT is associated with a better perception of the psychic component of quality of life while a higher exercise level is necessary for the physical one(AU)

[Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona]. / Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona.

AIM: To perform a descriptive analysis of the outpatient activity in a neurological department in terms of the frequency and type of neurological diseases that were attended. PATIENTS AND METHODS: A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerised hospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the International Classification of Diseases, 10th edition (CIE-10). RESULTS: The mean age was 60.6 +/- 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year 2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The most common diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies. CONCLUSIONS: The frequency of visits increases with age and the order, in terms of frequency, was: episodic and paroxysmal, degenerative and demyelinating, psychotic and behavioural disorders, and extrapyramidal syndromes.

Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona / Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona

Objetivo. Análisis descriptivo de la actividad ambulatoria en un servicio de neurología en relación con la frecuenciay tipo de enfermedades neurológicas atendidas. Pacientes y métodos. Estudio retrospectivo y trasversal de los pacientesremitidos a la consulta ambulatoria de neurología. Se registraron consecutivamente los casos visitados por primera vez durantelos años 2006 y 2007. Se evaluó la documentación médica a partir de los registros hospitalarios informatizados, recogiéndose:zona de salud de referencia, fecha de visita, edad, sexo y diagnóstico según la Clasificación Internacional de Enfermedades,9.ª edición, modificación clínica (CIE-9-MC), reconvertida a la Clasificación Internacional de Enfermedades, 10.ªedición (CIE-10). Resultados. La media de edad fue de 60,6 ± 20,9 años (rango: 4-95 años) y el 61,4% fueron mujeres. El índicede frecuentación fue de 4,3 solicitudes/1.000 habitantes para el año 2006 y de 3,9 para el año 2007, y se observó unincremento con la edad para las enfermedades neurodegenerativas. Respecto a la CIE-10, las enfermedades se clasificaroncomo episódicas y paroxísticas (25%), degenerativas y desmielinizantes (18,6%), trastornos mentales orgánicos (14,7%), síndromesextrapiramidales (10,5%), enfermedades de la circulación cerebral (3,5%), trastornos relacionados con el estrés y somatomorfos(3,5%) y enfermedades del oído interno (3,3%). Las demás patologías no alcanzaron el 3%. El 61% de los pacientespresentó enfermedades del sistema nervioso central y el 20,3%, trastornos psiquiátricos. Las enfermedades más frecuentesfueron los trastornos cognitivos (31,5%), las cefaleas (18,6%) y los trastornos del movimiento (11,7%), seguidas delas enfermedades psiquiátricas, epilepsias, enfermedades cerebrovasculares y neuropatías(AU)

Aim. To perform a descriptive analysis of the outpatient activity in a neurological department in terms of thefrequency and type of neurological diseases that were attended. Patients and methods. A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerisedhospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the InternationalClassification of Diseases, 10th edition (CIE-10). Results. The mean age was 60.6 ± 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The mostcommon diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies(AU)

[Telemedicine and dementia: a need for the 21st century]. / Telemedicina y demencia: una necesidad para el siglo XXI.

INTRODUCTION: The ongoing process of information and communication technologies in health services implies a change in the conception, organization and management of these services. Telemedicine is a working method that allows health professionals to explore and/or treat a patient from an off-site location. In this review we provide a historical background on telemedicine, the evolution of its bibliometric impact, and its application for people with dementia. DEVELOPMENT: Telemedicine's applications have been developed in order to provide greater availability and easier access to healthcare to underserved people. The bibliometric study of telemedicine literature shows an increase in the number of bibliographic references related to telemedicine since 1995. During the last few years in Spain the research and development of telemedicine programs have increased significantly and at present there are telemedicine programs in all regions of the country. Although some of the needs of the patients with dementia may be unsuitable for communication and information technologies, their application could offer an added value to health services. This technology does not attempt to replace face-to-face medical consultations but rather to prevent some difficulties this kind of patients can present and improve their quality of life. CONCLUSIONS: Dementia could be an appropriate field in order to implement some telemedicine programs that may improve patient medical care, and reduce medical and management expenses for social and healthcare services.

Telemedicina y demencia: una necesidad para el siglo XXI / Telemedicine and dementia: a need for the 21st century

Introducción. La incorporación de las tecnologías de la información y comunicación en los servicios de salud implica un cambio en la concepción, organización y gestión de estos servicios. La telemedicina es un método de trabajo que permite al profesional sanitario explorar y/o tratar a un paciente a distancia. En esta revisión se realiza un recorrido histórico sobre la telemedicina y su evolución bibliométrica, y se valora su aplicación en el campo de las demencias. Desarrollo. Las aplicaciones de la telemedicina se han desarrollado con la intención de acercar los recursos de salud a los pacientes más alejados de ellos. La revisión del impacto bibliométrico muestra un incremento de las referencias bibliográficas relacionadas con la telemedicina a partir de 1995. Durante los últimos años en España se ha producido un incremento en la investigación y el desarrollo de programas de telemedicina, y actualmente existen programas en todas las comunidades autónomas. Aunque algunas de las necesidades que presentan los pacientes con demencia no son propicias para la utilización de las tecnologías de la información y comunicación, su aplicación puede dar un valor añadido a la asistencia sanitaria. No pretende sustituir la consulta médica presencial, sino evitar algunas de las dificultades que presentan estos pacientes y mejorar su calidad de vida en el proceso asistencial. Conclusiones. Las demencias podrían ser un modelo adecuado para la implantación de diversos programas de telemedicina que mejorarían la asistencia al paciente y ahorrarían en costes y gestión sociosanitaria

Introduction. The ongoing process of information and communication technologies in health services implies a change in the conception, organization and management of these services. Telemedicine is a working method that allows health professionals to explore and/or treat a patient from an off-site location. In this review we provide a historical background on telemedicine, the evolution of its bibliometric impact, and its application for people with dementia. Development. Telemedicine’s applications have been developed in order to provide greater availability and easier access to healthcare to underserved people. The bibliometric study of telemedicine literature shows an increase in the number of bibliographic references related to telemedicine since 1995. During the last few years in Spain the research and development of telemedicine programs have increased significantly and at present there are telemedicine programs in all regions of the country. Although some of the needs of the patients with dementia may be unsuitable for communication and information technologies, their application could offer an added value to health services. This technology does not attempt to replace face-to-face medical consultations but rather to prevent some difficulties this kind of patients can present and improve their quality of life. Conclusions. Dementia could be an appropriate field in order to implement some telemedicine programs that may improve patient medical care, and reduce medical and management expenses for social and healthcare services

Las modificaciones del estilo de vida en los pacientes hipertensos / Life style modifications in hypertensive patients

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