[Care by a primary care team for patients with eating behaviour disorders: identifying possibilities for improvement]. / Atención a pacientes con trastornos del comportamiento alimentario en un EAP: identificando oportunidades de mejora.

OBJECTIVES: Principal: to find opportunities for improvement in the care of patients with eating behaviour disorders (EBD). Secondary: a) to ascertain the profile of patients diagnosed with EBD at our health centre; b) to find out whether the handling of patients is in line with the guidelines stipulated in the bibliography as "good quality", and c) to find out whether we conduct EBD early-detection activities among adolescents. DESIGN: Transversal, descriptive study. SETTING: Urban health centre in Madrid. Ten family medicine clinics and 2 paediatrics ones. PATIENTS: Objectives 1 and 2: patients diagnosed with EBD by our primary care team (PCT) (n=13). Objective 3: randomised sample of 136 patients between 12 and 17 years old. MEASUREMENTS AND RESULTS: Thirteen patients, all women, were diagnosed with EBD. Their mean age was 21 (SD, 3.87). The most common EBD were: anorexia nervosa (46.15%) and undefined disorders (30.77%); 92.30% were diagnosed in primary care. The most common detail giving rise to suspected EBD in the clinic was family members seeking help (46.15%). At the time of study, 38.46% evolved favourably, 30.77% were cured and 30.77% were chronically ill. After diagnosis, the activity most complied with was attending a minimum of four times a year (90.9%); the least complied with were a report from the mental health services (22.2%) and weight monitoring (42.9%). Early detection was appraised in a sample of 123 females and 13 males, with an average age of 15 (SD, 2.07); 50% were evaluated for their nutrition, and 10.3% for their self-esteem. CONCLUSIONS: The most common EBD in the patients diagnosed by our PCT was anorexia nervosa. Most of those ill were diagnosed in primary care. During their treatment, few patients had their weight monitored and communication with mental health departments could be improved. Few early detection tests among adolescents, in particular appraisal of their self-esteem, were conducted.

Atención a pacientes con trastornos del comportamiento alimentario en un EAP: identificando oportunidades de mejora / Care by a primary care team for patients with eating behaviours disorders: identifying possibilities for improvement

Objetivos. Principal: buscar oportunidades de mejora en la atención a los pacientes con trastornos del comportamiento alimentario (TCA). Secundarios: a) averiguar el perfil de los pacientes diagnosticados de TCA pertenecientes a nuestro centro de salud; b) investigar si el manejo de los pacientes se ajusta a las pautas establecidas en la bibliografía como de buena calidad, y c) descubrir si realizamos actividades de detección precoz de los TCA en la población adolescente. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud urbano de Madrid. Diez consultas de medicina de familia y 2 de pediatría. Pacientes. Objetivos 1 y 2: pacientes diagnosticados de TCA de nuestro EAP (n = 13). Objetivo 3: muestra aleatoria de 136 pacientes de 12-17 años de edad. Mediciones y resultados. Pacientes diagnosticados de TCA: 13, todos mujeres. Edad media, 21 años (DE, 3,87). TCA más frecuentes: anorexia nerviosa (46,15 por ciento) y trastornos no especificados (30,77 por ciento). Diagnóstico en atención primaria en el 92,30 por ciento. Dato de sospecha clínica más frecuente: búsqueda de ayuda por parte de los familiares (46,15 por ciento). En el momento del estudio el 38,46 por ciento tenía una evolución favorable, el 30,77 por ciento se había curado y el 30,77 por ciento presentaba cronicidad. En el manejo de los pacientes tras el diagnóstico, la actividad de mejor cumplimiento fue la realización de un mínimo de 4 visitas programadas cada año (90,9 por ciento), y las de peor cumplimiento: presencia de informe de los servicios de salud mental (22,2 por ciento) y seguimiento del peso (42,9 por ciento). La detección precoz se evaluó en una muestra de 123 mujeres y 13 varones con una edad media de 15 años (DE, 2,07). Se realizó valoración nutricional en el 50 por ciento y en el 10,3 por ciento valoración de la autoestima. Conclusiones. El TCA más frecuente en las pacientes diagnosticadas de TCA en nuestro EAP es la anorexia nerviosa. La mayoría de las enfermas fue diagnosticada en atención primaria. Respecto a su tratamiento, se ha realizado seguimiento del peso a pocos pacientes y se puede mejorar la comunicación con salud mental. Se realizan pocas actividades de detección precoz en los adolescentes, sobre todo en el caso de la valoración de la autoestima (AU)

[The stability of the microalbuminuria numbers in relation to their reading time and mode of preservation]. / Estabilidad de las cifras de microalbuminuria en relación con el tiempo de lectura y el modo de conservación.

OBJECTIVE: To evaluate the stability of microalbuminuria figures in urine samples of diabetic patients, in terms of how the samples are kept, and the time between taking and reading. DESIGN: Descriptive, prospective and observational study. SETTING: Primary care. Teaching health centre, Burgos. PATIENTS: 40 type-2 diabetics had their urinary excretion of albumin measured in 91 first-in-the-morning urine samples with Micral Test II reactive strips. INTERVENTIONS: Samples were analysed the day of their collection, then protected from light and kept at +4 degrees C, with further readings at 24, 48 and 72 hours and at 7, 14, 21 and 28 days after collection. MEASUREMENTS AND MAIN RESULTS: 49 (53.84%) of the 91 samples taken did not vary over the 28 days of the study. In the first three days, there were 64 with unvaried measurements (70.2%). Friedman's test showed p = 0.905. > 93% of samples positive at the beginning remained positive all the time; > 83% of samples negative at the beginning remained negative. Concordance observed was > 90%; kappa index > 80%. CONCLUSIONS: Collection of first urine samples in the morning, stored at +4 degrees C in a fridge and protected from light, did not significantly alter the result of the reading for 4 weeks. Such samples are useful in order to aid study of the albumin excretion rate using Micral Test II reactive strips.

[The effects of long-term captopril treatment on the evolution of urinary albumin excretion in patients with non-insulin-dependent diabetes mellitus]. / Efectos del tratamiento a largo plazo con captopril sobre la evolución de la excreción urinaria de albúmina en pacientes con diabetes mellitus no insulinodependiente.

OBJECTIVES: To identify diabetics not dependent on insulin (DNDI) who are carriers of clinical proteinuria and microalbuminuria susceptible to captopril treatment and to evaluate the evolution of the urinary excretion of albumin (UEA) rate after three years of follow-up. DESIGN: A prevalence study followed by an intervention and follow-up over 3 years. SETTING: The urban Health Centre "San Agustín" in Burgos. PATIENTS: 107 DNDI included in the "Diabetes programme". INTERVENTIONS: Patients with increased UEA were treated with 25 mg of captopril (Capoten) every 12 hours for 3 years. MEASUREMENTS AND RESULTS: A steady drop in the UEA of patients with microalbuminuria was observed in their third year of treatment (p = 0.01). 5 patients (41.6%) became negative (p = 0.01). CONCLUSIONS: Captopril treatment reduced levels of UEA in DNDI who had high UEA. Significantly, evolution to clinical proteinuria of patients with persistent microalbuminuria was avoided.