Osteopenia en atención primaria: ¿debemos ser más rigurosos? / Osteopenia in primary health care patients: ¿do we need to be more rigorous?

Objetivo: Describir el tratamiento prescrito a mujeres osteopénicas atendidas en un centro de atención primaria urbano y el cumplimiento de las pacientes que reciben prescripción de calcio o vitamina D. Material y métodos: Estudio transversal en mujeres con osteopenia diagnosticada por densitometría ósea (DMO) entre febrero de 2005 y enero de 2006 (n=118). Comprobación en la historia clínica de: información demográfica; antecedentes de fractura, tipo; antecedentes familiares de fractura; hábito tabáquico; toma de fármacos o antecedente de enfermedad crónica relacionados con disminución de DMO; valoración/consejo dietético, valoración de exposición solar; prescripción de calcio, vitamina D y raloxifeno/bisfosfonatos; dosis diaria media de calcio y vitamina D recogida por las pacientes de la farmacia. Análisis de la prescripción de fármacos y del cumplimiento en función de las variables recogidas. Resultados: Media de edad, 61,9±9,1 años; el 90,7% posmenopáusicas. La valoración/consejo dietético se encontró en el 30,5%. La prescripción de fármacos fue: calcio, 74,6%; vitamina D, 68,6%, y raloxifeno/bisfosfonato, 16,1%. La prescripción de todos los fármacos se asoció a valores más bajos de T-score. El cumplimiento medio de las mujeres se estimó en 423,8±321,7 mg Ca/día, y 343,1±225,9 UI de vitamina D, sin relación significativa con ninguna de las variables estudiadas. Conclusiones: Se identifica una mayor prescripción de los tratamientos farmacológicos en pacientes con valores de T-score menores. El antecedente personal de fractura no se asocia a la prescripción de fármacos ni al mejor cumplimiento por las pacientes. En la historia clínica de las mujeres osteopénicas hay una falta de registro de aspectos relevantes. El cumplimiento de los suplementos de calcio y vitamina D es muy variable (AU)

Aim: To describe the treatment prescribed to osteopenic women seen at an urban primary health care centre and the treatment compliance of those patients with a prescription of calcium and/or vitamin D. Materials and method: Cross-sectional study, osteopenic women diagnosed by bone densitometry between February 2005 and January 2006 (n=121). Clinical history review: demographic information; previous clinical history of bone fracture, type of fracture; parental history of fractures; tobacco use; osteoporosis-related medication or disease; dietary and sun exposure assessment; calcium, vitamin D and raloxiphene/bisphosphonates prescription; mean daily dose of calcium and vitamin D supplements collected at the pharmacy by patients. Analysis of treatment prescription and compliance according to the information collected was performed. Results: Mean age, 61.9±9.1 years; 90.7% post-menopausic. The dietary assessment was performed in 30.5% of the women included in the study. The drug prescription was as follows: calcium 74.6%, vitamin D 68.6% and raloxiphene/bisphosphonates 16.1%. All drug prescriptions were associated with lower T-score values. The patient's compliance of calcium supplements has been calculated as mean of 423.8±321.7 mg/day, and 343.1±225.9 IU of vitamin D; with no association with any of the studied variables. Conslusions: We identified greater drug prescription in those patients with a lower T-score. The clinical history of previous fracture did not show association with drug prescription nor a better compliance. There was a lack of information about relevant issues in the clinical history of the osteopenic women included in the study. The patient's compliance of calcium and vitamin-D supplements is very variable (AU)

Taquicardia auricular multifocal / No disponible

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[Osteopenia in primary health care patients: ¿do we need to be more rigorous?]. / Osteopenia en atención primaria: ¿debemos ser más rigurosos?

AIM: To describe the treatment prescribed to osteopenic women seen at an urban primary health care centre and the treatment compliance of those patients with a prescription of calcium and/or vitamin D. MATERIALS AND METHOD: Cross-sectional study, osteopenic women diagnosed by bone densitometry between February 2005 and January 2006 (n=121). Clinical history review: demographic information; previous clinical history of bone fracture, type of fracture; parental history of fractures; tobacco use; osteoporosis-related medication or disease; dietary and sun exposure assessment; calcium, vitamin D and raloxiphene/bisphosphonates prescription; mean daily dose of calcium and vitamin D supplements collected at the pharmacy by patients. Analysis of treatment prescription and compliance according to the information collected was performed. RESULTS: Mean age, 61.9±9.1 years; 90.7% post-menopausic. The dietary assessment was performed in 30.5% of the women included in the study. The drug prescription was as follows: calcium 74.6%, vitamin D 68.6% and raloxiphene/bisphosphonates 16.1%. All drug prescriptions were associated with lower T-score values. The patient's compliance of calcium supplements has been calculated as mean of 423.8±321.7 mg/day, and 343.1±225.9 IU of vitamin D; with no association with any of the studied variables. CONCLUSIONS: We identified greater drug prescription in those patients with a lower T-score. The clinical history of previous fracture did not show association with drug prescription nor a better compliance. There was a lack of information about relevant issues in the clinical history of the osteopenic women included in the study. The patient's compliance of calcium and vitamin-D supplements is very variable.

Anticuerpos heterófilos y falsos positivos en la determinación de troponina I en el diagnóstico de cardiopatía isquémica. Respuesta de los autores / Heterophil antibodies and false positive troponin I results in the diagnosis of myocardial ischemia. Authors’ reply

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Profilaxis antitetánica en urgencias. Respuesta de los autores / Antitetanic prophylaxis in emergency and defensive medicine. Authors’ reply

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Profilaxis del tétanos en urgencias: propuestas de mejora de calidad / Tetanus prophylaxis in an emergency medical service: a quality improvement proposal

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[Emergency contraception: evaluation of women's understanding of it, a requisite for the effectiveness of the treatment]. / Anticoncepción de emergencia: evaluación de los conocimientos de las mujeres, un requisito para la efectividad del tratamiento.

OBJECTIVE: To evaluate how much women who attend primary care consultations understand about the correct use of emergency ("morning after") contraception (EC), their information requirements and their views about free EC prescription. DESIGN: Cross-sectional study, using a questionnaire. SETTING: Les Corts Primary Care Centre, Barcelona, Spain. PARTICIPANTS: A total of 130 women aged 15 to 45 years old who attended primary care consultations in May and June, 2005, were included. One-hundred and twenty-four of them (95.4%) agreed to the questionnaire. MAIN MEASUREMENTS: We tested knowledge of EC, and we drew up a questionnaire to evaluate understanding. This had 4 multiple-choice questions, as well as socio-demographic data, contraception background, how they preferred to obtain EC, and their information requirements. RESULTS: We found a lack of knowledge about several aspects of EC use: in particular, 33% of the women thought that EC eliminated completely the risk of pregnancy. We only found differences for better knowledge of EC in women who had used it before (3.03; 95% CI, 2.29-3.77) versus those who had never used it (2.47; 95% CI, 1.54-3.4; P=.028. Free prescription of EC in health centres was approved of by 75.8%, while 83.1% said they needed more information. Their preferred method to obtain this information was by leaflet. CONCLUSIONS: Women who attend primary health care clinics have a need for information on EC. Their lack of knowledge could limit the effectiveness of treatment. A brief explanation and handing out a leaflet could solve this problem.

Anticoncepción de emergencia: evaluación de los conocimientos de las mujeres, un requisito para la efectividad del tratamiento / Emergency contraception: evaluation of women’s understanding of it, a requisite for the effectiveness of the treatment

Objetivo. Evaluar el conocimiento sobre el uso correcto del anticonceptivo hormonal de emergencia (AE) en las mujeres que acuden a las consultas de atención primaria, las necesidades de información y su opinión sobre la dispensación gratuita. Diseño. Estudio transversal mediante encuesta. Emplazamiento. Centro de atención primaria, Barcelona. Participantes. Se incluyó a 130 mujeres de 15-45 años que acudieron a atención primaria durante mayo y junio de 2005. Aceptaron realizar la encuesta 124 (95,4%). Mediciones. Pregunta acerca del conocimiento del AE y encuesta de evaluación de conocimiento sobre el AE mediante 4 preguntas tipo test, además de variables sociodemográficas y antecedentes de anticoncepción, preferencias de obtención y necesidades de información. Resultados. Se observó un desconocimiento en varios aspectos del uso del AE, del que destacaba que el 33% creía que el AE elimina completamente el riesgo de embarazo. Se observó un mayor conocimiento en las mujeres que tenían antecedentes de uso previo de AE (3,0; intervalo de confianza [IC] del 95%, 2,3-3,8) respecto de las que nunca los habían tomado (2,5; IC del 95%, 1,5-3,4; p = 0,028). El 75,8% valoró como buena la dispensación gratuita en centros sanitarios. El 83,1% consideraba que necesitaba más información sobre el AE, y el método más demandado fue la hoja informativa. Conclusiones. Hay una necesidad de información sobre el AE en las mujeres atendidas en atención primaria que puede limitar la efectividad del tratamiento. Una breve explicación junto con una hoja informativa podría resolver este problema

Objective. To evaluate how much women who attend primary care consultations understand about the correct use of emergency ("morning after") contraception (EC), their information requirements and their views about free EC prescription. Design. Cross-sectional study, using a questionnaire. Setting. Les Corts Primary Care Centre, Barcelona, Spain. Participants. A total of 130 women aged 15 to 45 years old who attended primary care consultations in May and June, 2005, were included. One-hundred and twenty-four of them (95.4%) agreed to the questionnaire. Main measurements. We tested knowledge of EC, and we drew up a questionnaire to evaluate understanding. This had 4 multiple-choice questions, as well as socio-demographic data, contraception background, how they preferred to obtain EC, and their information requirements. Results. We found a lack of knowledge about several aspects of EC use: in particular, 33% of the women thought that EC eliminated completely the risk of pregnancy. We only found differences for better knowledge of EC in women who had used it before (3.03; 95% CI, 2.29-3.77) versus those who had never used it (2.47; 95% CI, 1.54-3.4; P=.028. Free prescription of EC in health centres was approved of by 75.8%, while 83.1% said they needed more information. Their preferred method to obtain this information was by leaflet. Conclusions. Women who attend primary health care clinics have a need for information on EC. Their lack of knowledge could limit the effectiveness of treatment. A brief explanation and handing out a leaflet could solve this problem