Valoración del dolor de tobillo: síndrome del impacto posterior del tobillo secundario a proceso de Stieda / Assessment of ankle pain: posterior ankle impingement syndrome secondary to a Stieda process

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[Management of time used to treat the chronic patient: a new approach to improve quality of health care]. / Gestión del tiempo de asistencia al paciente crónico: un nuevo enfoque para mejorar la calidad asistencial.

OBJECTIVE: Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. MATERIAL AND METHODS: Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. RESULTS: In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001]). CONCLUSIONS: Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases.

Gestión del tiempo de asistencia al paciente crónico: un nuevo enfoque para mejorar la calidad asistencial / Management of time used to treat the chronic patient: A new approach to improve quality of health care

Objetivo. La cronicidad es la principal epidemia del siglo XXI y condiciona que gran parte de los presupuestos sociosanitarios se dediquen a su atención. El objetivo de este estudio es analizar si la calidad de la atención al paciente crónico mejora implantando tiempos asistenciales no presenciales. Material y métodos. Estudio de intervención realizado en el centro de salud de Orcasitas (enero de 2012-septiembre de 2013) en pacientes con hipertensión (357), diabetes (180) y/o cardiopatía isquémica (60). La calidad asistencial se analizó mediante la efectividad reflejada en el programa de seguimiento de objetivos en atención primaria (eSOAP). Para el grupo de intervención se establecieron 4 consultas presenciales y 3 no presenciales por año, de 10 min cada una, manteniendo el grupo control su dinámica habitual. Los datos se contrastaron mediante las pruebas de McNemar, Chi-cuadrado y Q de Cochran. Resultados. En el grupo de intervención la efectividad se incrementó en el periodo analizado un 46%, un 54% y un 55,9% respectivamente para los procesos hipertensión, diabetes y control de la dislipidemia en cardiopatía isquémica, mientras que en el grupo control (Comunidad de Madrid) fue, respectivamente, del 2,54%, 1,78% y 5,44% (diferencias estadísticamente significativas [χ2 = 24,78; χ2 = 39,9 y χ2 = 67,3, p < 0,0001]). Conclusiones. Treinta minutos/año de atención no presencial suponen un cambio relevante en el grado de control del paciente crónico. Este resultado debería ser tenido en cuenta en las estrategias de abordaje de la cronicidad (AU)

Objective. Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. Material and methods. Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10 minute consultations/year and three non-physical 10 minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. Results. In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ2 = 24.78; χ2 = 39.9 y χ2 = 67.3, P < .0001]). Conclusions. Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases (AU)

Prevención de riesgos laborales y vigilancia de la salud en el ámbito médico. Una asignatura pendiente / Labor risks prevention and surveillance of the health in the medical environment. A pending subject

FUNDAMENTO. El objetivo fue analizar el impacto referido sobre problemas de salud asociados con la actividad laboral médica, así como el conocimiento e implantación de la Ley de Prevención de Riesgos Laborales (LPRL). MÉTODOS. Estudio descriptivo transversal realizado en áreas sanitarias de la Comunidad de Madrid con presencia de Delegados de Prevención. La información se obtuvo mediante encuesta anónima autocumplimentada, remitida a 2.338 médicos, que se agruparon en tres dispositivos: Atención Primaria (AP), Servicio Coordinador de Urgencias (SCU) y Dispositivos Asistenciales (DA) (UME, VIR, UAD, Refuerzos y SUAP). RESULTADOS. Se obtuvieron 290 cuestionarios válidos (12,4%). La mayoría no habían sido informados sobre los aspectos relacionados con la seguridad y salud en su puesto de trabajo (AP: 79,9% [intervalo de confianza al 95% ­IC 95%­ 0,7373; 0,8552]; DA: 82,5% [IC 95% 0,7206; 0,8996]; SCU: 87,5% [IC 95% 0,6165; 0,9845]), ni convocados a reconocimientos médicos (AP: 75,3% [IC 95% 0,6834; 0,8112], DA: 82,5% [IC 95% 0,7172; 0,8983] y SCU: 81,3% [IC 95% 0,5435; 0,9595]). Los problemas visuales fueron más frecuentes en AP y el SCU, los auditivos en el SCU y los osteomusculares entre las médicas de AP. Recibir una agresión verbal fue más frecuente en el SCU que en AP o DA y también recibirla de forma reiterada. CONCLUSIONES. Entre los médicos la LPRL es poco conocida, siendo en parte responsable el Servicio Madrileño de Salud, que no ha asumido las competencias que le son propias (artículos 18.1 y 22 LPRL). Las diferencias entre dispositivos y con relación al género y la suma de problemas de salud en el SCU son los aspectos prioritarios a evaluar

BACKGROUND. The aim of this study was to analyze the impact referred to health problems associated with the medical labor activity, as well as the knowledge and introduction of the Law of Labor Risks Prevention (LLRP). METHODS. Cross-sectional study, carried out in sanitary areas of the Regional Community of Madrid with the presence of Prevention Delegates. The information was obtained by anonymous and self-applied survey sent to 2,338 doctors grouped into three services: Primary Care (PC), Coordinating Service of Emergency (CSE) and Emergency Services (ES). RESULTS. A total of 290 valid (12.4%) questionnaires were obtained. Most had not been informed about the aspects related with the security and health in their work position (PC: 79.9%; ES: 82.5%; CSE: 87.5%), nor had been summoned to medical examinations (PC: 75.3%, ES: 82.5% and CSE: 81.3%). Visual problems were more frequent in PC and CSE, auditory ones in CSE and musculoskeletal ones among the PC doctors. The doctors in the CSE group received more verbal aggression, and also more repeatedly, than those in PC or ES. CONCLUSIONS. Among doctors, the Law of labor Risks Prevention is not well-known, the Madrid health Service being partly responsible as it has not assumed its responsibilities (articles 18.1 and 22 LLRP). The differences among services and in relation to gender in addition to the health problems in CSE are high-priority problems to evaluate

[Relationship among the eruption of the first temporal teeths, the breast feeding duration and the anthropometric development in the first two years of life]. / Duración de la lactancia materna, erupción de los primeros dientes temporales y desarrollo antropométrico alcanzado a los dos años de vida.

BACKGROUND: The anthropometric development in the first two years of life can be influenced by diverse factors, being analyzed in this study the implication of the primary tooth eruption and the breast feeding duration in this development. METHODS: Longitudinal study. 141 healthy children participated (67 boys and 74 girls), being analyzed the association among the duration of breast feeding, the number of teeth present at the 6, 7, 9 and 12 months, the anthropometrics parameters weight, height and body mass index (BMI) to the birth, 1-7, 9, 12, 15, 18 and 24 months and the growth rate. RESULTS: The weight and height at the birth or the duration of breast feeding didn't associate significantly with the weight and height at the 2 years or the number of teeth at 6,7,9 or 12 months, but the women with more weight (r = 0,366) and height (r = 0,377) at month of life have a bigger number of teeth at 9 months (p = 0,001). In both sexes, the number of teeth at the 9 months are associated significantly with the weight (boys r = 0,328, p = 0,01; girls r = 0,307, p = 0,011) and height (r = 0,352 boys and girls p = 0,005) at two years. CONCLUSIONS: In healthy children the duration of maternal nursing doesn't influence in the degree of anthropometric development reached at 2 years, but yes makes it the number of teeth present at 9 months, result that suggests that the eruption dental early could suppose an evolutive advantage.

Duración de la lactancia materna, erupción de los primeros dientes temporales y desarrollo antropométrico alcanzado a los dos años de vida / Relationship among the eruption of the first temporal teeths, the breast feeding duration and the anthropometric development in the first two years of life

Fundamento: El desarrollo antropométrico en los dos primeros años de vida puede verse influido por diversos factores, analizándose en este estudio la implicación de la dentición temporal y la duración de la lactancia materna en dicho desarrollo. Métodos: Estudio longitudinal. Participaron 141 niños (67 varones y 74 mujeres) sanos, analizándose la asociación entre la duración de la lactancia materna, el número de dientes temporales presentes a los 6, 7, 9 y 12 meses, los parámetros antropométricos peso, talla e índice de masa corporal (IMC) al nacimiento, 1-7, 9, 12, 15, 18 y 24 meses y la velocidad de crecimiento. Resultados: El peso y la talla al nacimiento o la duración de la lactancia materna no se asociaron significativamente con el peso y talla a los 2 años o el número de dientes a los 6, 7, 9 ó 12 meses, pero las mujeres con mayor peso (r = 0,366) y talla (r = 0,377) al mes de vida tienen mayor número de dientes a los 9 meses (p = 0,001). En ambos sexos, el número de dientes a los 9 meses se asoció significativamente con el peso (varones r= 0,328, p= 0,01; mujeres r = 0,307, p = 0,011) y la talla (r= 0,352 varones y mujeres, p= 0,005) a los dos años. Conclusiones: En niños sanos la duración de la lactancia materna no influye en el grado de desarrollo antropométrico alcanzado a los 2 años, pero sí lo hace el número de dientes presentes a los 9 meses, resultado que sugiere que la erupción dentaria temprana podría suponer una ventaja evolutiva (AU)

Background: The anthropometric development in the first two years of life can be influenced by diverse factors, being analyzed in this study the implication of the primary tooth eruption and the breast feeding duration in this development. Methods: Longitudinal study. 141 healthy children participated (67 boys and 74 girls), being analyzed the association among the duration of breast feeding, the number of teeth present at the 6, 7, 9 and 12 months, the anthropometrics parameters weight, height and body mass index (BMI) to the birth, 1-7, 9, 12, 15, 18 and 24 months and the growth rate. Results: The weight and height at the birth or the duration of breast feeding didn't associate significantly with the weight and height at the 2 years or the number of teeth at 6, 7, 9 or 12 months, but the women with more weight (r= 0,366) and height (r = 0,377) at month of life have a bigger number of teeth at 9 months (p = 0,001). In both sexes,the number of teeth at the 9 months are associated significantly with the weight (boys r = 0,328, p = 0,01; girls r =0,307, p = 0,011) and height (r = 0,352 boys and girls p =0,005) at two years. Conclusions: In healthy children the duration of maternal nursing doesn't influence in the degree of anthropometric development reached at 2 years, but yes makes it the number of teeth present at 9 months, result that suggests that the eruption dental early could suppose an evolutive advantage (AU)

[Height, leg length, adiposity and metabolic-cardiovascular risk in women aged 35-55 years]. / Estatura, longitud de las piernas, evaluación de la adiposidad y el riesgo metabólico-cardiovascular en mujeres de 35 a 55 años.

OBJECTIVE: To determine the relative importance of the components of height in the evaluation of the adiposity and the cardiovascular and metabolic risk profile in women aged 35-55 years. METHODS: Cross-sectional study. 30 healthy women were recruited. Components of height (total height, trunk length, leg length) was compared with body mass index (BMI), body fat, and different measures of central adiposity: waist circumference, waist-to-hip ratio, and sagittal abdominal diameter. Metabolic-cardiovascular risk was assessed by serum levels of glucose, triglycerides, total cholesterol, HDL-cholesterol; and systolic (SBP) and diastolic (DBP) blood pressures. Biological factors and socio-economic status influences was evaluated. RESULTS: Glucose levels were inversely associated with height (r = -0.395; p < 0.05). When analyzing this association for components of height, glucose was negatively related to leg length (r = -0.447; p < 0.05) and showed no association with trunk length or the superior segment. The height or its components were not significantly related to BMI, percentage of body fat, estimators of body fat distribution, blood pressure or the rest of metabolic parameters. Education level was associated with leg length (r = 0.390; p = 0.037) and negatively related to glucose levels (r = -0.517; p = 0.004) and other risk factors. CONCLUSIONS: These data support the hypothesis that adiposity is conditioned by weight and that stature is inversely related to risk of metabolic and cardiovascular disorders in women aged 35-55 years, and suggest that legs length is the component of stature that conditions this result and that socio-economic status influences in this association. Factors which might explain this association remain to be determined.

Estatura, longitud de las piernas, evaluación de la adiposidad y el riesgo metabólico-cardiovascular en mujeres de 35 a 55 años / Height, leg length, adiposity and metabolic-cardiovascular risk in women aged 35-55 years

Objetivo: Estatura y adiposidad están asociadas al riesgo metabólico-cardiovascular, aunque su interrelación no está clara, analizándose en este estudio la asociación entre los segmentos corporales que conforman la estatura y los parámetros que evalúan la adiposidad y el riesgo metabólico-cardiovascular. Métodos: Estudio descriptivo transversal. Se analizó en 30 mujeres de 35-55 años la asociación entre componentes de la estatura (talla total, segmento corporal superior, longitud del tronco y longitud de las piernas) e índice de masa corporal (IMC); porcentaje de grasa corporal; estimadores de la distribución de la grasa corporal: circunferencia de la cintura, cociente cintura-cadera y diámetro sagital; diversos parámetros bioquímicos con relevancia metabólica: glucosa, colesterol, HDL- colesterol y triglicéridos; y presión arterial. Menarquia, menopausia y nivel educativo también fueron analizados. Resultados: A diferencia del peso corporal, la correlación entre estatura e IMC, porcentaje de grasa corporal, estimadores de su distribución y presión arterial no alcanzó significación estadística. Estatura (r = - 0,395; p = 0,031) y longitud de las piernas (r = - 0,447; p = 0,013) se asociaron inversamente con la glucemia. El nivel educativo se asoció con la longitud de las piernas (r = 0,390; p = 0,037) e, inversamente, con la glucemia (r = - 0,517; p = 0,004).Conclusiones: Estos resultados apoyan la hipótesis de que el peso corporal condiciona la adiposidad y que la estatura está inversamente relacionada con el riesgo metabólico-cardiovascular en mujeres de 35-55 años, sugiriéndose que la longitud de las piernas condiciona este resultado y que el nivel socioeconómico influye en esta asociación. Parte de los factores que podrían explicar esta asociación permanecen sin determinar (AU)

Objective: To determine the relative importance of the components of height in the evaluation of the adiposity and the cardiovascular and metabolic risk profile in women aged 35-55 years. Methods: Cross-sectional study. 30 healthy women were recruited. Components of height (total height, trunk length, leg length) was compared with body mass index (BMI), body fat, and different measures of central adiposity: waist circumference, waist-to-hip ratio, and sagittal abdominal diameter. Metabolic-cardiovascular risk was assessed by serum levels of glucose, triglycerides, total cholesterol, HDL-cholesterol; and systolic (SBP) and diastolic (DBP) blood pressures. Biological factors and socio-economic status influences was evaluated. Results: Glucose levels were inversely associated with height (r = - 0,395; p < 0,05). When analyzing this association for components of height, glucose was negatively related to leg length (r = - 0,447; p < 0,05) and showed no association with trunk length or the superior segment. The height or its components were not significantly related to BMI, percentage of body fat, estimators of body fat distribution, blood pressure or the rest of metabolic parameters. Education level was associated with leg length (r = 0,390; p = 0,037) and negatively related to glucose levels (r = - 0,517; p = 0,004) and other risk factors. Conclusions: These data support the hypothesis that adiposity is conditioned by weight and that stature is inversely related to risk of metabolic and cardiovascular disorders in women aged 35-55 years, and suggest that legs length is the component of stature that conditions this result and that socio-economic status influences in this association. Factors which might explain this association remain to be determined (AU)

[Interchangeability of the fat-to-fat-free mass ratios obtained by means arm anthropometric measures, skinfold thickness, and bioelectrical impedance]. / Grado de acuerdo entre los índices adiposo-musculares obtenidos a partir de medidas antropométricas del brazo, pliegues cutáneos e impedancia bioeléctrica.

BACKGROUND: Body fat, fat free mass and the relationship between both, the fat-to-fat-free mass ratio are useful parameters in the nutritional evaluation of the patient. The aim of this study is to evaluate the degree of agreement among the fat-to-fat-free mass ratios obtained by arm anthropometric measures (fat-muscle index, FMI), Siri equation for the sum of four skinfold thickness (body fat-muscle index, BFMISiri) and triceps skinfold (BFMItriceps) and bioelectrical impedance (BFMIOmron) methods. METHODS: This is a cross-sectional study. A total of 145 patients were evaluated by anthropometry and bioelectrical impedance (Omron BF 300), being estimated the agreement through the Intraclass Correlation Coefficient (ICC) and Bland-Altman method. The reference method was BFMISiri. RESULTS: The ICC between BFMISiri-BFMItriceps were 0.9304 (0.9035; 0.9498), between BFMISiri-FMI of 0.7726 (0.6846; 0.8361) and between BFMISiri-BFMIOmron of 0.9114 (0.8771; 0.9361). BFMItriceps (limits of agreement -0.171 to 0.117) show the best agreement according to Bland-Altman analysis with BFMISiri, followed by BMFISiri-BFMIOmron (-0.186; 0.178). The agreement limits between FMI and BFMISiri (-0.2; 0.42), BFMItriceps (-0.26; 0.42) or BFMIOmron (-0.292; 0.504) were beyond of the established cut-off points (-0.2; 0.2). CONCLUSIONS: Due to the nature of the statistical agreement BFMItriceps and BFMIOmron are methods interchangeable methods between them and with BFMISiri. FMI is not interchangeable with BFMISiri, BFMIOmron or BFMItriceps. These results suggest that FMI cannot estimate properly the body composition. BFMItriceps and BFMIOmron are valid alternative methods to be used instead BFMISiri in the fat-to-fat-free mass ratio assessment.

Grado de acuerdo entre los índices adiposo-musculares obtenidos a partir de medidas antropométricas del brazo, pliegues cutáneos e impedanciabioeléctrica / Interchangeability of the fat-to-fatfree mass ratios obtained by arm anthropometric measures, skinfold thickness and bioelectrical impedance

Objetivo: La masa grasa, la masa libre de grasa y la relación entre ambas, el índice adiposo-muscular, son parámetros útiles para valorar clínicamente al paciente.El objetivo de este estudio es medir el grado de acuerdo entre los índices adiposo-musculares corporales (IAMC) obtenidos mediante los pliegues cutáneos con la ecuación de Siri para cuatro pliegues (IAMCSiri) y para el pliegue del tríceps (IAMCtríceps); por bioimpedanciometría (IAMCOmron); y mediante las áreas adiposa y muscular del brazo (IAM), valorando su intercambiabilidad. Intervenciones: Estudio descriptivo transversal. Se valoró mediante antropometría e impedancia bioeléctrica (Omron BF 300®) a 145 personas, analizándose la concordancia entre métodos mediante el coeficiente de correlación intraclase (CCI) y el método de Bland-Altman. El método de referencia fue IAMCSiri. Resultados: El CCI entre IAMCSiri e IAMCtríceps fue de 0,9304 (0,9035; 0,9498), entre IAMCSiri e IAMCOmron de 0,9114 (0,8771; 0,9361) y entre IAMCSiri e IAM de 0,7726 (0,6846; 0,8361). Con el método de Bland-Altman IAMCSiri e IAMCtríceps (- 0,171; 0,117) presentan el intervalo de concordancia más estrecho, seguido de IAMCSiri - IAMCOm ron (- 0,186; 0,178). Los límites del intervalo entre IAM e IAMCSiri (- 0,2; 0,42), IAMCtríceps (- 0,26; 0,42) o IAMCOmron (- 0,292; 0,504) superaron el punto de corte (- 0,2; 0,2). Conclusiones: IAMCtríceps e IAMCOmron son intercambiables entre sí y con IAMCSiri, pero IAM no es intercambiable con IAMCSiri, IAMCtríceps o IAMCOmron, resultado que sugiere que el IAM puede no reflejar adecuadamente la composición corporal. IAMCtríceps e IAMCOmron son alternativas válidas a IAMCSiri en la valoración del índice adiposo-muscular (AU)

Background: Body fat, fat free mass and the relationship between both, the fat-to-fat-free mass ratio are useful parameters in the nutritional evaluation of the patient. The aim of this study is to evaluate the degree of agreement among the fat-to-fat-free mass ratios obtained by arm anthropometric measures (fat-muscle index, FMI), Siri equation for the sum of four skinfold thickness (body fat-muscle index, BFMISiri) and triceps skinfold (BFMItriceps) and bioelectrical impedance (BFMIOmron) methods. Methods: This is a cross-sectional study. A total of 145 patients were evaluated by anthropometry and bioelectrical impedance (Omron BF 300(), being estimated the agreement through the Intraclass Correlation Coefficient (ICC) and Bland-Altman method. The reference method was BFMISiri. Results: The ICC between BFMISiri - BFMItricepswere 0,9304 (0,9035; 0,9498), between BFMISiri - FMI of 0,7726 (0,6846; 0,8361) and between BFMISiri - BFMIOmron of 0,9114 (0,8771; 0,9361). BFMItriceps (limits of agreement -0,171 to 0,117) show the best agreement according to Bland-Altman analysis with BFMISiri, followed by BMFISiri - BFMIOmron(-0,186; 0,178). The agreement limits between FMI and BFMISiri (-0,2; 0,42), BFMItriceps(-0,26; 0,42) or BFMIOmron (-0,292; 0,504) were beyond of the established cut-off points (-0,2; 0,2). Conclusions: Due to the nature of the statistical agreement BFMItriceps and BFMIOmron are methods interchangeable methods between them and with BFMISiri. FMI is not interchangeable with BFMISiri, BFMIOmron or BFMItriceps. These results suggest that FMI cannot estimate properly the body composition. BFMItriceps and BFMI Omronare valid alternative methods to be used instead BFMISiri in the fat-to-fat-free mass ratio assessment (AU)

Factores clínicos y biológicos que influyen en la medición de la grasa corporal mediante bioimpedanciometría con el monitor OMRON BF 300 / Biological and clinical factors influencing bioelectrical impedance analysis measurements with the OMRON BF 300 monitor

Fundamento. La estimación de la grasa corporal tiene una importancia creciente a escala clínica. El objetivo de este estudio es evaluar la influencia de factores clínicos y biológicos en la medición de grasa corporal por bioimpedanciometría (IB) con el monitor OMRON BF 300.Material y métodos. Estudio descriptivo transversal. Los factores analizados son: ingesta sólida y líquida, ejercicio, influencia de la ropa, posición de las piernas y del monitor, ciclo menstrual, errores en la medición de peso y talla y evacuación de esfínteres. En conjunto participaron 135 personas, 87 mujeres y 48 varones de 14 a 69 años de edad. Resultados. Diferentes factores influyen en el resultado: posición del monitor (p < 0,001), comida (p < 0,001), ingesta líquida (p < 0,001), paseo durante 1-2 h (p < 0,001), evacuación de esfínteres (p < 0,001) y precisión del peso (p < 0,01-p < 0,001) y de la talla (p < 0,001). Sin embargo, no influyen la posición de las piernas, la ropa y, en las mujeres, la fase del ciclo menstrual. El peso de grasa corporal aumenta durante el día, y recupera los valores basales durante la noche. Conclusiones. Múltiples factores influyen en la determinación de la grasa corporal por IB con el monitor OMRON BF 300. Recomendamos medir correctamente y con precisión la talla (1 mm) y el peso (0,1 kg), realizar las determinaciones por la mañana en ayunas, con la vejiga vacía, en ropa interior, sin haber realizado ejercicio y con una posición del monitor de 90° respecto a la vertical del cuerpo para obtener medidas fiables y reproducibles. La dieta preestablecida y el consumo líquido controlado pueden ser necesarios en algunas situaciones (AU)

[Measurement of body fat with bioelectric impedance, skinfold thickness, and equations based on anthropometric measurements. Comparative analysis]. / Medición de la grasa corporal mediante impedancia bioeléctrica, pliegues cutáneos y ecuaciones a partir de medidas antropométricas. Análisis comparativo.

BACKGROUND: There is growing clinical interest in estimating body fat percentages (%FM). The aim of this study was a comparison of body fat measurement by anthropometric equations, skinfold thickness (SFT) and bioelectrical impedance (BIA) methods. METHODS: Cross-sectional study. 149 healthy individuals (83 males and 66 females) were recruited. Height, weight, waist circumference, skinfold of biceps, triceps, subscapular and suprailiac regions, sum and log10 sum of four folds were obtained. %FM were calculated using the Siri equation (for sex or age-sex), Brozeck (sex or age-sex), Deurenberg, Lean and segmental BIA (Omron BF 300). Methodological differences among the various methods were analyzed with Spearman (SCC) and intraclass (ICC) correlation coefficients and Bland-Altman method. The reference method is the Siri-age-sex equation. RESULTS: The means of %FM were 26.8 +/- 8.3% (Siri-age-sex), 25.7 +/- 8.1% (Siri-sex), 25.97 +/- 7.6% (Brozeck-age-sex), 24.9 +/- 7.5% (Brozeck-sex), 25.6 +/- 8.8% (BIA), 28.6 +/- 8.2% (Deurenberg), 29.7 +/- 8.2% (Lean-waist circumference) and 29.4 +/- 9.3% (Lean-triceps-waist). The %FM values for all methods were highly intercorrelated (all SCC > 0.83 and CCI > 0.85). Brozeck-age-sex (average difference 0.8%; limits of agreement -0.48 to 2.08%) and BIA (1.17%; -6.21 to 8.55%) show the best agreement according to Bland and Altman analysis with Siri-age-sex equation. CONCLUSIONS: Deurenberg and Lean equations provide different body fat mass estimates than those derived from SFT measurement and BIA and thus should not be used interchangeably. The use of Siri-Brozeck equations is recommended for %FM assessment. The results suggest that segmental BIA-Omron BF 300 may be a valid alternative method.

[Validation of the OMRON BF 300 monitor for measuring body fat by bioelectric impedance]. / Validación del monitor de medición de la grasa corporal por impedancia bioeléctrica OMRON BF 300.

OBJECTIVES: To assess the accuracy of the OMRON BF 300 body fat monitor using bioelectric impedance and to validate its measurement of body fat percentage (BF%) against the Siri equation. DESIGN: Cross-sectional descriptive study. SETTING: Primary care. Coronel de Palma and San Fernando Health Centres, Móstoles. PARTICIPANTS: 88 people took part in the assessment of the accuracy of the monitor, and 91 in the validation. MEASUREMENTS AND MAIN RESULTS: The BF% were recorded in triplicate, with the mean being the figure noted. Precision was evaluated through the intra-class correlation coefficient (ICC) and the coefficient of variation (CV); validity, through technical error, the ICC and the Bland-Altman method. In the Siri equation, body density was calculated through the Durnin-Womersley equation. Precision: ICC was 0.999 and CV 0.4 +/- 0.03. VALIDATION: the difference between the BF% monitor (26.6 +/- 9.1%) and the Siri equation (27.8 +/- 8.2%) was -1.27% (p < 0.01; 95% CI -1.97 to -0.57); the technical error of the monitor was 2.2% and of the ICC 0.956 (95% CI, 0.9335-0.9710). Thus, 80.2% of the monitor-equation differences were below 5%, with a concordance interval under the Bland-Altman method of +5.45 to -7.99%. CONCLUSIONS: The OMRON BF 300 monitor satisfies the precision criteria (ICC > 0.95 and low CV) and validation (excellent technical error, ICC > 0.75 and clinically acceptable differences) and is a valid alternative to cutaneous folds as a method of assessing nutrition of the patient.

Validación del monitor de medición de la grasa corporal por impedancia bioeléctrica Omron BF 300 / Validation of the Omron BF 300 monitor for measuring body fat by bioelectric impedance

Objetivos. Valorar la precisión del monitor de grasa corporal por impedancia bioeléctrica OMRON BF 300 y validar su medición del porcentaje de grasa corporal ( por cientoGC) frente a la ecuación de Siri. Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria. Centros de Salud Coronel de Palma y San Fernando, Móstoles. Participantes. En la valoración de la precisión del monitor participaron 88 personas y 91 en la validación. Mediciones y resultados principales. Las determinaciones de por cientoGC se realizaron por triplicado, anotándose la media. La precisión se evaluó mediante el coeficiente de correlación intraclase (CCI) y el coeficiente de variación (CV). La validez, mediante el error técnico, el CCI y el método de BlandAltman. En la ecuación de Siri la densidad corporal se calculó con la ecuación de Durnin-Womersley. Precisión: el CCI fue de 0,999 y el CV de 0,4 ñ 0,03. Validación: la diferencia de por cientoGC monitor (26,6 ñ 9,1 por ciento) - ecuación de Siri (27,8 ñ 8,2 por ciento) fue de -1,27 por ciento (p 0,95 y CV bajo) y validación (error técnico excelente, CCI > 0,75 y diferencias clínicamente aceptables) y supone una alternativa válida a los pliegues cutáneos en la valoración nutricional del paciente (AU)

[The economic and labor impact of no staff replacement in primary care. Why and how we should measure it]. / Impacto económico y laboral de la no suplencia en atención primaria. Por qué y cómo debemos medirlo.

OBJECTIVES: To quantify the effect of not replacing staff in both job (mean overloads in time -MOT- and in users -MOU-) and economic terms. To calculate the effective real time worked (ERTW). DESIGN: Cross-sectional descriptive study. SETTING: Primary care, San Fernando Health Centre, Móstoles, Madrid. PARTICIPANTS: The 41 people in the team. MEASUREMENTS AND MAIN RESULTS: Records of time off in 1999, with economic and labour costs. Comparison of the mean patients per shift -MOU- with the gold standard: Royal Decree 1575/1993. 72.63% (14,227,538 pesetas) of the cost of time off (19,589,226 pesetas) was assumed by the team (negative cost, economic impact). The MOT per health professional was 6.6 weeks per year for doctors, 6.5 for nurses and 4.2 for paediatricians. The ERTW per professional was 44.1 weeks a year for paediatricians, 39.4 for doctors and 39.1 for nurses. The MOU on a professional being absent raises the lists to 2471 (medicine) and 2179 (paediatrics) on the morning shift; and to 2296 (medicine) and 1662 (paediatrics) on the afternoon one. CONCLUSIONS: The team assumes most of the economic burden, with no counter-benefit. The MOT is high and exceeds the number of weeks per year of formally allowed time off. In practice, therefore, each professional covers for their full allowed time off. The ERTW is much below the 52 weeks on which the team was assessed. RD 1575/1993 is frequently broken by current MOU. It is suggested that coordinators use these indicators in negotiating the Contract of Care Management and the Portfolio of Services.

Impacto económico y laboral de la no suplencia en atención primaria. Por qué y cómo debemos medirlo / Economic and labour impact of not covering for staff off in primary care. why and how we should measure this

Objetivo. Cuantificar el impacto de la no suplencia a nivel laboral (sobrecargas medias en tiempo [SMT] y en usuarios [SMU]) y económico. Calcular el tiempo real efectivo trabajado (TRET). Diseño.Estudio descriptivo transversal. Emplazamiento. Atención primaria. Centro de Salud San Fernando, Móstoles (Madrid). Participantes. Los 41 componentes del equipo. Mediciones y resultados principales. Registro de permisos durante 1999, contabilización económica y laboral. Comparar la suma cupo medio por turno-SMU con el estándar oro: Real Decreto 1.575/1993. Del coste de los permisos solicitados (19.589.226 pts.), un 72,63 por ciento (14.227.538 pts.) es asumido por el equipo (coste negativo, impacto económico). La SMT por profesional es de 6,6 semanas/año para médicos, 6,5 para enfermeras y 4,2 para pediatras. El TRET medio por profesional es de 44,1 semanas/año para pediatras, 39,4 para médicos y 39,1 para enfermeras. La SMU al ausentarse un profesional eleva los cupos a 2.471 (medicina) y 2.179 (pediatría) en el turno de mañana y a 2.296 (medicina) y 1.662 (pediatría) en el de tarde. Conclusiones. El equipo asume la mayor parte de la carga económica, sin ninguna contraprestación. La SMT es elevada y supera al número de semanas/año de permiso reglamentario, por lo que en la práctica cada profesional recupera el tiempo de permiso. El TRET es muy inferior a las 52 semanas sobre las que se evalúa al equipo. Con la SMU actual se vulnera con frecuencia el RD 1.575/1993. Se propone que los coordinadores utilicen estos indicadores en la negociación del Contrato de Gestión Asistencial y la Cartera de Servicios (AU)

[Adverse effects associated with influenza vaccine in pediatrics]. / Efectos adversos asociados a la vacunación antigripal en pediatría.

BACKGROUND: The difficulties which exist in order to value correctly the morbimortality caused by influenza during the childhood and the limitations of the proper vaccine make that the use of this vaccination is still limited in this phase. The objective of the present study is to value the adverse reactions associated to the influenza immunization in children. METHODS: Prospective study, carried out in the campaigns 92/93, 93/94 97/98 on 105 children of Navalcarnero with split-virion influenza vaccine with vaccinal strains recommended by the OMS. All the doses are administered by a nurse who also carries out the postimmunization-controls after 72 hours. The adverse reactions are valued, like the zone of injection, sex, age, the previous vaccination and the collection of data by telephone or in consultation. RESULTS: Of global form (318 doses), on a local level appears a reaction of 10.7%, in form of erythema (8.5%), induration (7.9%) and pain (only 97/98, 13.9%) and on a systemic level appears a reaction of 11.9%, in form of rhinorrhea (3.1%), general discomfort (2.5%), fever (2.5%), muscular pains (1.6%) and cough (1.6%). In a 89.5% the systemic effects disappear during the first 48 hours. In no case medical consultation was precised. CONCLUSIONS: The vaccine is safe. The adverse reactions that may appear are scarce, slight and well tolerated. There do not exist significant differences in terms of age, sex, the previous vaccination or the collection of the results by telephone or in consultation. The gluteus presents greater local reactogenicity that the deltoidal zone.