Estudio PERSIRIS: estudio observacional, postautorización, prospectivo, para evaluar la persistencia al tratamiento con risedronato mensual en mujeres con osteoporosis / PERSIRIS study: observational study, postmarketing, prospective, to evaluate the persistence to treatment with monthly risedronate in women with osteoporosis

OBJETIVO: Evaluar la persistencia del tratamiento con risedronato mensual y conocer los motivos de persistencia y no persistencia terapéutica y el perfil de las pacientes no persistentes. DISEÑO: Estudio observacional, postautorización y prospectivo. Emplazamiento: Consultas de atención primaria, traumatología, reumatología, ginecología y geriatría de Cataluña. PARTICIPANTES: Mujeres con osteoporosis en tratamiento con risedronato mensual que previamente hubiesen abandonado el tratamiento con bifosfonato semanal. MEDICIONES PRINCIPALES: Porcentaje de pacientes bajo risedronato mensual persistentes al año de su prescripción, motivos de persistencia y no persistencia y perfil de pacientes no persistentes en relación a datos biodemográficos, datos clínicos y factores de riesgo de fractura. RESULTADOS: Doscientos ochenta y nueve pacientes valorables con una edad media de 68,3. A los 12 meses de inicio de risedronato mensual, un 58,1% de las pacientes persistía con el tratamiento. Motivos más frecuentes de abandono: miedo a tener efectos secundarios y creencia de que la enfermedad es propia de la edad. Motivos de persistencia destacables: comodidad/facilidad y posología. Se observaron diferencias significativas entre pacientes persistentes y no persistentes en relación a: situación laboral, número de tratamientos concomitantes y talla; sin embargo los resultados de posibles factores asociados deben contextualizarse dentro de las características del estudio y la diferencia de talla no parece clínicamente relevante. CONCLUSIONES: La administración de pautas terapéuticas más cómodas, como risedronato mensual en la osteoporosis, podría facilitar la persistencia en los pacientes mejorando la efectividad del fármaco. Sin embargo, en dicha persistencia pueden influir también variables biodemográficas y clínicas de diversa índole

OBJECTIVE: To assess the persistence of treatment with monthly risedronate and know the reasons of persistence and nontherapeutic persistence and the profile of the non-persistent patients. Desing: Observational, postmarketin and prospective study. LOCATION: Primary care, traumatology, rheumatology, gynecology and geriatrics of Catalonia. PARTICIPANTS: Women with osteoporosis treated with monthly risedronate that previously had abandoned weekly bisphosphonate therapy. MAIN MEASUREMENTS: Percentage of patients on persistent monthly risedronate year of their prescription, reasons for persistent and non persistent and profile of non persistent patients in relation to biodemographic data, clinical data and risk factors for fracture. RESULTS: 289 evaluable patients with a mean age of 68.3. At 12 months of initiation with monthly risedronate, 58.1% of patients remained on treatment. Most frequent reasons for leaving: fear of having side effects and belief that the disease is typical of the age. Reasons remarkable persistence: comfort/ease and dosage. Significant differences were observed between persistent and non-persistent patients relative to: employment status, number of concomitant therapy and height; however the results of possible associated factors must be contextualized within the study characteristics and the difference in size does not seem clinically relevant. CONCLUSIONS: The administration of therapeutic patterns more comfortable as monthly risedronate in osteoporosis, could facilitate persistence in patients improving the effectiveness of the drug. However in that persistence can also influence biodemographic and clinical variables and diverse of various kinds

[PERSIRIS study: observational study, postmarketing, prospective, to evaluate the persistence to treatment with monthly risedronate in women with osteoporosis]. / Estudio PERSIRIS: estudio observacional, postautorización, prospectivo, para evaluar la persistencia al tratamiento con risedronato mensual en mujeres con osteoporosis.

OBJECTIVE: To assess the persistence of treatment with monthly risedronate and know the reasons of persistence and nontherapeutic persistence and the profile of the non-persistent patients. DESING: Observational, postmarketin and prospective study. LOCATION: Primary care, traumatology, rheumatology, gynecology and geriatrics of Catalonia. PARTICIPANTS: Women with osteoporosis treated with monthly risedronate that previously had abandoned weekly bisphosphonate therapy. MAIN MEASUREMENTS: Percentage of patients on persistent monthly risedronate year of their prescription, reasons for persistent and non persistent and profile of non persistent patients in relation to biodemographic data, clinical data and risk factors for fracture. RESULTS: 289 evaluable patients with a mean age of 68.3. At 12 months of initiation with monthly risedronate, 58.1% of patients remained on treatment. Most frequent reasons for leaving: fear of having side effects and belief that the disease is typical of the age. Reasons remarkable persistence: comfort/ease and dosage. Significant differences were observed between persistent and non-persistent patients relative to: employment status, number of concomitant therapy and height; however the results of possible associated factors must be contextualized within the study characteristics and the difference in size does not seem clinically relevant. CONCLUSIONS: The administration of therapeutic patterns more comfortable as monthly risedronate in osteoporosis, could facilitate persistence in patients improving the effectiveness of the drug. However in that persistence can also influence biodemographic and clinical variables and diverse of various kinds.

Solicitud de VIH en condiciones indicadoras en atención primaria: resultados de una colaboración / Indicator condition guided human immunodeficiency virus requesting in primary health care: results of a collaboration

INTRODUCCIÓN: La búsqueda de pacientes con VIH mediante condiciones indicadoras (CI) es una estrategia para aumentar la detección precoz de dicho virus. El objetivo es analizar si una colaboración en 3 centros de atención primaria para concienciar de su importancia influyó en la proporción de serologías VIH solicitadas. MÉTODOS: Estudio multicéntrico, retrospectivo, de comparación basal y poscolaborativa. La colaboración consistió en sesiones formativas y la participación en el estudio HIDES (años 2009-2010). Se incluyeron pacientes entre 18 y 64 años con nuevos diagnósticos de herpes zóster, eccema seborreico, síndrome mononucleósico y leucopenia/trombocitopenia en 3 centros de atención primaria en 2008 (situación basal) y 2012 (poscolaborativa). Se evaluaron variables sociodemográficas, condicionantes de riesgo para VIH, solicitud de serología de VIH y resultado. RESULTADOS: Se incluyeron 1.219 CI (558 en 2008 y 661 en 2012). En 2008, el número de solicitudes de pruebas de VIH en pacientes con una CI fue del 3,9% y aumentó al 11,8% en 2012 (p < 0,0001). La tasa de infección por VIH fue del 2,2% (IC95%: 0,4-7,3) (n = 2). Se estimó que se habrían diagnosticado 25 nuevos casos (12 en 2008 y 13 en 2012) si se hubiera hecho la prueba a todos los pacientes con CI. Los factores predictores de solicitud del VIH fueron tener una CI en el año 2012, una menor edad, tener un síndrome mononucleósico y no ser español. CONCLUSIONES: Tras la colaboración con atención primaria, se triplicó la petición de VIH. Sin embargo, no se solicitó en el 88%, implicando pérdidas diagnósticas. Son necesarias nuevas estrategias para mejorar la detección precoz de VIH

INTRODUCTION: The search of HIV infected patients guided by indicator conditions (IC) is a strategy used to increase the early detection of HIV. The objective is to analyze whether a collaboration to raise awareness of the importance of early detection of HIV in 3 primary care centers influenced the proportion of HIV serology requested. METHODS: Multicenter retrospective study was conducted comparing the baseline and a post-collaboration period. The collaboration consisted of training sessions and participation in the HIDES study (years 2009-2010). Patients between 18 and 64 years old with newly diagnosed herpes zoster, seborrheic eczema, mononucleosis syndrome, and leucopenia/thrombocytopenia in 3 primary care centers in 2008 (baseline period) and 2012 (post-collaboration period). The sociodemographic variables, HIV risk conditions, requests for HIV serology, and outcomes were evaluated. RESULTS: A total of 1,219 ICs were included (558 in 2008 and 661 in 2012). In 2008 the number of HIV tests in patients with an IC was 3.9%, and rose to 11.8% in 2012 (P < .0001). The HIV infection rate was 2.2% (95% CI: 0.4-7.3) (n = 2). It was estimated that 25 new cases (12 in 2008 and 13 in 2012) would have been diagnosed if they had performed the test on all patients with IC. Predictors of HIV request were, having an IC in 2012, a younger age, having an mononucleosis syndrome, and not being Spanish. CONCLUSIONS: The HIV request demand tripled, after the collaboration with primary care centers, however in 88% the test was not requested, resulting in diagnostic losses. New strategies are needed to raise awareness of the importance of early detection of HIV

[Indicator condition guided human immunodeficiency virus requesting in primary health care: results of a collaboration]. / Solicitud de VIH en condiciones indicadoras en atención primaria: resultados de una colaboración.

INTRODUCTION: The search of HIV infected patients guided by indicator conditions (IC) is a strategy used to increase the early detection of HIV. The objective is to analyze whether a collaboration to raise awareness of the importance of early detection of HIV in 3 primary care centers influenced the proportion of HIV serology requested. METHODS: Multicenter retrospective study was conducted comparing the baseline and a post-collaboration period. The collaboration consisted of training sessions and participation in the HIDES study (years 2009-2010). Patients between 18 and 64 years old with newly diagnosed herpes zoster, seborrheic eczema, mononucleosis syndrome, and leucopenia/thrombocytopenia in 3 primary care centers in 2008 (baseline period) and 2012 (post-collaboration period). The sociodemographic variables, HIV risk conditions, requests for HIV serology, and outcomes were evaluated. RESULTS: A total of 1,219 ICs were included (558 in 2008 and 661 in 2012). In 2008 the number of HIV tests in patients with an IC was 3.9%, and rose to 11.8% in 2012 (P<.0001). The HIV infection rate was 2.2% (95% CI: 0.4-7.3) (n=2). It was estimated that 25 new cases (12 in 2008 and 13 in 2012) would have been diagnosed if they had performed the test on all patients with IC. Predictors of HIV request were, having an IC in 2012, a younger age, having an mononucleosis syndrome, and not being Spanish. CONCLUSIONS: The HIV request demand tripled, after the collaboration with primary care centers, however in 88% the test was not requested, resulting in diagnostic losses. New strategies are needed to raise awareness of the importance of early detection of HIV.

Validez y aplicabilidad de un nuevo método de registro para la hipertensión arterial / Validity and Applicability of a New Recording Method for Hypertension

Introducción y objetivos: El diagnóstico de la hipertensión arterial se asocia al método de medición y las condiciones en que esta se realiza. La reciente guía británica recomienda el uso sistemático de monitorización ambulatoria de la presión arterial durante 24h. Sin embargo, no todos los centros de salud disponen de dispositivos, y su uso queda restringido a 1 paciente/día. Analizamos si un nuevo método de registro de la presión arterial permite diagnosticar del mismo modo que con la monitorización de la presión arterial de 24 h. Métodos: Evaluación de un nuevo método de registro de hipertensión arterial consistente en monitorizar la presión arterial durante 1h en condiciones de práctica clínica habitual. Se comparó con los registros diurnos de la prueba estándar utilizando el coeficiente de correlación y Bland-Altman plots. Se calculó el índice kappa de concordancia y la sensibilidad y la especificidad del método. Resultados: De los 102 participantes, 89 (87,3%) obtuvieron el mismo diagnóstico con uno y otro método, con alta concordancia (κ=0,81; intervalo de confianza del 95%, 0,71-0,91). Se observaron correlaciones robustas entre las lecturas de presión arterial diastólica (r=0,85) y sistólica (r=0,76). La sensibilidad y la especificidad del nuevo método para el diagnóstico de hipertensión de bata blanca fueron del 85,2% (intervalo de confianza del 95%, 67,5-94,1) y el 92% (intervalo de confianza del 95%, 83,6-96,3). Conclusiones: La monitorización de la presión arterial de 1h es un método válido y fiable para diagnosticar la hipertensión arterial y clasificar subpoblaciones de hipertensos, especialmente en hipertensión de bata blanca e hipertensión refractaria, que permite un mayor rendimiento de los instrumentos de monitorización

Introduction and objectives: Blood pressure measurement methods and conditions are determinants of hypertension diagnosis. A recent British guideline recommends systematic 24-h ambulatory blood pressure monitoring. However, these devices are not available at all health centers and they can only be used by 1 patient per day. The aim of this study was to test a new blood pressure recording method to see if it gave the same diagnostic results as 24-h blood pressure monitoring. Methods: One-hour blood pressure monitoring under routine clinical practice conditions was compared with standard method of day time recording by analyzing the coefficient of correlation and Bland-Altman plots. The Kappa index was used to calculate degree of agreement. Method sensitivity and specificity were also analyzed. Results: Of the 102 participants, 89 (87.3%) obtained the same diagnosis regardless of method, with high between-method agreement (κ= 0.81; 95% confidence interval, 0.71-0.91). We observed robust correlations between diastolic (r=0.85) and systolic blood pressure (r=0.76) readings. Sensitivity and specificity for the new method for diagnosing white coat hypertension were 85.2% (95% confidence interval 67.5%-94.1%) and 92% (95% confidence interval, 83.6%-96.3%), respectively. Conclusions: One-hour blood pressure monitoring is a valid and reliable method for diagnosing hypertension and for classifying hypertension subpopulations, especially in white coat hypertension and refractory hypertension. This also leads to a more productive use of monitoring instruments

Validity and applicability of a new recording method for hypertension.

INTRODUCTION AND OBJECTIVES: Blood pressure measurement methods and conditions are determinants of hypertension diagnosis. A recent British guideline recommends systematic 24-h ambulatory blood pressure monitoring. However, these devices are not available at all health centers and they can only be used by 1 patient per day. The aim of this study was to test a new blood pressure recording method to see if it gave the same diagnostic results as 24-h blood pressure monitoring. METHODS: One-hour blood pressure monitoring under routine clinical practice conditions was compared with standard method of day time recording by analyzing the coefficient of correlation and Bland-Altman plots. The Kappa index was used to calculate degree of agreement. Method sensitivity and specificity were also analyzed. RESULTS: Of the 102 participants, 89 (87.3%) obtained the same diagnosis regardless of method, with high between-method agreement (κ= 0.81; 95% confidence interval, 0.71-0.91). We observed robust correlations between diastolic (r=0.85) and systolic blood pressure (r=0.76) readings. Sensitivity and specificity for the new method for diagnosing white coat hypertension were 85.2% (95% confidence interval 67.5%-94.1%) and 92% (95% confidence interval, 83.6%-96.3%), respectively. CONCLUSIONS: One-hour blood pressure monitoring is a valid and reliable method for diagnosing hypertension and for classifying hypertension subpopulations, especially in white coat hypertension and refractory hypertension. This also leads to a more productive use of monitoring instruments.