Prevención del tabaquismo: adaptarla a los nuevos tiempos o fracasar / Smoking prevention: adapting to the new times or failing

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Eficacia de una estrategia combinada para mejorar el control del colesterol unido a lipoproteínas de baja densidad en pacientes con hipercolesterolemia. Ensayo clínico aleatorizado / Efficacy of a combined strategy to improve low-density lipoprotein cholesterol control among patients with hypercholesterolemia: a randomized clinical trial

Introducción y objetivos: Intervenciones diferentes pueden mejorar el control del colesterol unido a lipoproteínas de baja densidad (cLDL). El objetivo principal era evaluar la eficacia de una intervención combinada para mejorar el control del cLDL de pacientes con hipercolesterolemia. También se evaluó su eficacia para mejorar el cumplimiento (farmacológico, dieta y ejercicio). Métodos: Ensayo clínico aleatorizado, de grupos paralelos y multicéntrico (atención primaria) que incluyó a 358 adultos diagnosticados de hipercolesterolemia con tratamiento previo farmacológico o no. Se comparó a 178 sujetos que recibieron intervención combinada (material escrito, tarjetas autocumplimentadas y mensajes al móvil) frente a 178 controles. La variable principal de resultado fue la proporción de sujetos con adecuado control del cLDL (valores recomendados en las guías europeas de dislipemias y riesgo cardiovascular) a los 24 meses. Resultados: El grupo de intervención mostró una reducción media del cLDL significativamente superior a los 24 meses respecto al control, 23,8 mg/dl (IC95%, 17,5-30,1) y 14,6 mg/dl (IC95%, 8,9-20,4), respectivamente (p = 0,034). El promedio de la reducción del cLDL fue del 13,1 ± 28,6%. La proporción de sujetos con adecuado control al año fue significativamente superior en el grupo de intervención (43,7 frente a 30,1%; p = 0,011; RR = 1,46). En el grupo de intervención, el cumplimiento farmacológico fue significativamente superior (77,2 frente a 64,1%; p = 0,029) y de la práctica de ejercicio (64,9 frente a 35,8%; p < 0,001), aunque no de la dieta. Conclusiones: La intervención combinada consigue una reducción significativa de las cifras de cLDL (superior al 13% al cabo de 2 años) y mejora el grado de control de pacientes con hipercolesterolemia al año (AU)

Introduction and objectives: Several interventions can improve low-density lipoprotein cholesterol (LDL-C) control. Our main objective was to evaluate the efficacy of a combined intervention to improve LDL-C control in patients with hypercholesterolemia. The study also assessed the efficacy of the intervention in improving adherence (pharmacological, diet, and exercise). Methods: A multicenter, parallel group, randomized clinical trial (primary care) was conducted in 358 adults diagnosed with hypercholesterolemia, whether receiving prior drug therapy or not. We compared 178 participants who received the combined intervention (written material, self-completed registration cards, and messages to mobile telephones) with 178 controls. The main outcome variable was the proportion of participants with adequate LDL-C control (target levels of the European guidelines on dyslipidemia and cardiovascular risk) at 24 months. Results: At 24 months, the mean reduction in LDL-C was significantly higher in the intervention group (23.8 mg/dL [95%CI, 17.5-30.1]) than in the control group (14.6 mg/dL [95%CI, 8.9-20.4]; P = .034). The mean LDL-C decrease was 13.1% ± 28.6%. At 1 year, the proportion of participants with adequate control was significantly higher in the intervention group than in the control group (43.7% vs 30.1%; P = .011; RR, 1.46). Adherence was significantly higher in the intervention group, both to drug therapy (77.2% vs 64.1%; P = .029) and exercise (64.9% vs 35.8; P < .001), but not to diet. Conclusions: The combined intervention significantly reduced LDL-C (by more than 13% at 2 years) and improved the degree of LDL-C control in patients with hypercholesterolemia at 1 year (AU)

Efficacy of a Combined Strategy to Improve Low-density Lipoprotein Cholesterol Control Among Patients With Hypercholesterolemia: A Randomized Clinical Trial.

INTRODUCTION AND OBJECTIVES: Several interventions can improve low-density lipoprotein cholesterol (LDL-C) control. Our main objective was to evaluate the efficacy of a combined intervention to improve LDL-C control in patients with hypercholesterolemia. The study also assessed the efficacy of the intervention in improving adherence (pharmacological, diet, and exercise). METHODS: A multicenter, parallel group, randomized clinical trial (primary care) was conducted in 358 adults diagnosed with hypercholesterolemia, whether receiving prior drug therapy or not. We compared 178 participants who received the combined intervention (written material, self-completed registration cards, and messages to mobile telephones) with 178 controls. The main outcome variable was the proportion of participants with adequate LDL-C control (target levels of the European guidelines on dyslipidemia and cardiovascular risk) at 24 months. RESULTS: At 24 months, the mean reduction in LDL-C was significantly higher in the intervention group (23.8mg/dL [95%CI, 17.5-30.1]) than in the control group (14.6mg/dL [95%CI, 8.9-20.4]; P=.034). The mean LDL-C decrease was 13.1%±28.6%. At 1 year, the proportion of participants with adequate control was significantly higher in the intervention group than in the control group (43.7% vs 30.1%; P=.011; RR, 1.46). Adherence was significantly higher in the intervention group, both to drug therapy (77.2% vs 64.1%; P=.029) and exercise (64.9% vs 35.8; P<.001), but not to diet. CONCLUSIONS: The combined intervention significantly reduced LDL-C (by more than 13% at 2 years) and improved the degree of LDL-C control in patients with hypercholesterolemia at 1 year.

Treatment Satisfaction Among Patients Taking Antidepressant Medication.

This study sought to assess treatment satisfaction among patients on antidepressants, ascertaining whether there might be an association with depressive symptomatology and other variables. Cross-sectional study conducted on 564 adult patients taking antidepressant medication. Satisfaction with antidepressant treatment was assessed using the Assessment of Satisfaction with Antidepressant Treatment Questionnaire (ESTA/Evaluación de la Satisfacción con el Tratamiento Antidepresivo). A moderate negative correlation was observed between satisfaction and intensity of depressive symptoms, as assessed with the Montgomery-Asberg scale. A weak negative correlation was observed between greater satisfaction and less favourable views about taking medication. Satisfaction scale scores were higher among those who took antidepressant medication for 1 year or more versus shorter periods. Most patients reported being satisfied with the antidepressant treatment but the level of satisfaction was higher among those who presented with less marked depressive symptoms, received longer-term treatment and viewed drug treatments favourably. Treatment satisfaction is one of the patient-reported outcome measures that can serve to complement clinical evaluation of depressive disorders.

Atención Primaria: la apuesta necesaria / No disponible

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Effectiveness of a combined strategy to improve therapeutic compliance and degree of control among patients with hypercholesterolaemia: a randomised clinical trial.

BACKGROUND: In subjects with hypercholesterolaemia, cholesterol values remain above guideline levels. One of the limiting factors to the achievement of goals in such patients is therapeutic non-adherence. The aim of this study is to assess the effectiveness of an intervention designed to improve control of hypercholesterolaemic patients, consisting of a combined strategy that would include the delivery of printed information, treatment-compliance check cards and the dispatch of text messages as complementary measures in support of the intervention at the general practitioner's practice. METHODS/DESIGN: A randomised, parallel-group clinical trial will be conducted at the family medicine outpatient facilities of eight health centres in three of Spain's Autonomous Regions (Comunidades Autónomas), covering a total of 358 subjects aged 18 years or over with diagnosis of hypercholesterolaemia. Patients in the intervention group will be supplied with printed material with information on the disease and its management, mobile-telephone text messages with guideline summaries, reminders of forthcoming appointments and/or arrangements for making new appointments in the event of non-attendance, and self-report cards to check compliance with recommendations. Both groups -intervention and control- will receive routine recommendations from their physicians in accordance with current European clinical practice guidelines for hypercholesterolaemia and cardiovascular risk management. As regards the measurements to be made, the main variable is the proportion of subjects who attain the low density lipoprotein cholesterol levels set as a target across a follow-up period of 24 months. The secondary variables are as follows: adherence to recommendations on lifestyle and adherence to drug treatment; variation in lipid profiles and cardiovascular risk levels; appearance of cardiovascular events; physical activity; food consumption; smoking habit; anthropometric measures; blood pressure; health problems; use of hypolipidaemic agents; socio-demographic data; beliefs and expectations about preventive recommendations; and degree of satisfaction with the combined strategy. DISCUSSION: Should this intervention prove effective, a recommendation could be issued on the application of this combined strategy to subjects with hypercholesterolaemia. It is a simple, relatively inexpensive intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02314663.

Seguimiento de la adherencia al tratamiento antidepresivo en pacientes que inician su consumo / Adherence to patients antidepressant treatment and the factors associated of non-compiance

OBJETIVO: Conocer la adherencia al tratamiento en pacientes que inician fármacos antidepresivos y analizar los factores asociados al incumplimiento, tanto clínicos como sociodemográficos. DISEÑO: Estudio observacional longitudinal prospectivo. Emplazamiento: Consultas de atención primaria y de salud mental de tres áreas sanitarias de Castilla-La Mancha. Participantes: Un total de 185 pacientes mayores de 18 años que iniciaron tratamiento antidepresivo. Mediciones principales: Cumplimiento terapéutico (test Haynes-Sackett, Morisky-Green, recuento de comprimidos y MEMS), efectos adversos, intensidad de los síntomas depresivos, características sociodemográficas y otras características relacionadas con los antidepresivos o con los participantes. RESULTADOS: Tras 6 meses del inicio del tratamiento antidepresivo, el 46,9% (IC 95%: 36,5-57,3) mostró un cumplimiento inadecuado mediante el método de recuento de comprimidos, y el 28,6% (IC 95%: 19,1-38,0) con el cuestionario de Morisky-Green. A los 15 días la falta de adherencia fue del 48,5% (IC 95%: 40,6-56,4) y del 33,5% (IC 95%: 26,1-41,0), respectivamente. El 38,4% (IC 95%: 31,1-45,7) manifestó algún efecto secundario durante el seguimiento. Mediante un modelo de riesgos proporcionales de Cox las variables relacionadas con incumplimiento fueron menor edad, nivel de instrucción inferior a enseñanza secundaria, prestación farmacéutica como pensionista, no recibir tratamiento psicoterápico, consumir menor número de fármacos no antidepresivos y frecuentación ≤ 3 visitas al médico de familia los 3 meses previos al inicio del estudio. CONCLUSIONES: El incumplimiento del tratamiento antidepresivo es elevado en atención primaria desde las primeras semanas tras iniciarlo. Constituyen factores condicionantes del mismo los relacionados con características sociodemográficas y con otras características de los pacientes como tipo de financiación de prestación farmacéutica y frecuentación a las consultas

OBJETIVE: To know the adherence to treatment in patients who initiate antidepressant drugs and to analyze the determinant factors of non-compliance, so much clinical as sociodemographic. DESIGN: Prospective longitudinal observational study. Location: Primary Health Care and Mental Health Surgeries of three Castilla-La Mancha Areas. Participants: 185 adults patients who were started in antidepressant treatment were evaluated. Measurements: Treatment adherence (test Haynes-Sackett, test Morisky-Green, count of tablets and MEMS), adverse effects, intensity of depressive symptoms, sociodemographic characteristics and other characteristics related to antidepressants or participants. RESULTS: After 6 months of beginning antidepressing treatment, 46.9% (95% IC: 36.5-57.3) showed an inadequate fulfilment by pill count method and 28.6% (95% IC: 19.1-38.0) with Morisky-Green's questionnaire. To 15 days the lack of adherence was 48.5% (95% IC: 40.6-56.4) and of 33.5% (95% IC: 26.1-41.0). The 38.4% (95% IC: 31.1-45.7) demonstrated some side effect during the follow-up. Using proportional risk model of Cox the variables related to compliance were: younger age, level of instruction lower than secondary studies, free medicines for pensioner, no psychotherapeutic treatment, consume a fewer antidepressants drugs and a frequency ≤ 3 visits to the family doctor 3 months previous to the study. CONCLUSIONS: The non-compliance of antidepressant treatment in primary care is high from the first weeks after initiating it. The conditioning factors are related to sociodemographic characteristics and other patient characteristics as type of financing of pharmaceutical benefit and frequentness at primary care

[Adherence to patients antidepressant treatment and the factors associated of non-compiance]. / Seguimiento de la adherencia al tratamiento antidepresivo en pacientes que inician su consumo.

OBJECTIVE: To know the adherence to treatment in patients who initiate antidepressant drugs and to analyze the determinant factors of non-compliance, so much clinical as sociodemographic. DESIGN: Prospective longitudinal observational study. LOCATION: Primary Health Care and Mental Health Surgeries of three Castilla-La Mancha Areas. PARTICIPANTS: 185 adults patients who were started in antidepressant treatment were evaluated. MEASUREMENTS: Treatment adherence (test Haynes-Sackett, test Morisky-Green, count of tablets and MEMS), adverse effects, intensity of depressive symptoms, sociodemographic characteristics and other characteristics related to antidepressants or participants. RESULTS: After 6months of beginning antidepressing treatment, 46.9% (95%IC: 36.5-57.3) showed an inadequate fulfilment by pill count method and 28.6% (95%IC: 19.1-38.0) with Morisky-Green's questionnaire. To 15 days the lack of adherence was 48.5% (95%IC: 40.6-56.4) and of 33.5% (95%IC: 26.1-41.0). The 38.4% (95%IC: 31.1-45.7) demonstrated some side effect during the follow-up. Using proportional risk model of Cox the variables related to compliance were: younger age, level of instruction lower than secondary studies, free medicines for pensioner, no psychotherapeutic treatment, consume a fewer antidepressants drugs and a frequency ≤ 3 visits to the family doctor 3 months previous to the study. CONCLUSIONS: The non-compliance of antidepressant treatment in primary care is high from the first weeks after initiating it. The conditioning factors are related to sociodemographic characteristics and other patient characteristics as type of financing of pharmaceutical benefit and frequentness at primary care.

[Validation of Questionnaire "ESTA": designed to assess the satisfaction with antidepressant treatment. Spain]. / Satisfacción con el tratamiento antidepresivo: validación del cuestionario "ESTA"

BACKGROUND: We have no questionnaires to assess satisfaction with antidepressant treatment, which affects the health related quality of life. The objective was to develop and validate a specific instrument to assess satisfaction with antidepressant treatment, determining convergent validity regarding clinical effectiveness, fulfillment of expectations, adherence and tolerability. METHODS: Longitudinal observational study where 168 patients started antidepressant treatment and were followed for one year. The variables included adverse effects, compliance and intensity of depressive symptoms. The questionnaire for the Evaluation of Antidepressant Treatment Satisfaction (ESTA) consists of 11 items answered using Likert scale. We evaluated its reliability, construct validity and concurrent validity with conceptually related measures with the construct assessed. RESULTS: The Cronbach's alpha statistic ranged between 0.936 and 0.951. In the factor analysis one factor accounted for 64.11% of the variance. The average score of the questionnaire ranged from 40.0 to 44.7 points, showing a negative correlation regarding the Hamilton scale (-0.321 / -0.601) and Montgomery-Asberg scale (-0.491 / -0.307). After a month, the antidepressant treatment satisfaction was 39.5 points in noncompliant patients and 44.3 in compliers. In those who had adverse effects was 39.2 versus 43.3 for those who had not. At the first visit (15 days) the score was 40.0, in a month 42.6, in 3 months 44.4 and in 6 months 44.5. These differences were statistically significant (p <0.05). In test-retest analysis, intraclass correlation coefficient was 0.908. CONCLUSIONS: The questionnaire, designed to assess satisfaction with antidepressant treatment, is valid and reliable, and provides a patient-centered instrument which is complementary to the clinical assessment of the effectiveness of antidepressant treatment.

Síndrome Doloroso Regional Complejo / The Complex Regional Pain Syndrome

El síndrome doloroso regional complejo es una enfermedad crónica y compleja cuyo diagnóstico precoz es esencial para una evolución favorable así como para evitar complicaciones. Esta entidad pasa habitualmente desapercibida, realizándose su diagnóstico principalmente por la exploración clínica del paciente y siendo por tanto de fácil identificación si conocemos sus síntomas y formas de presentación. Podemos comenzar el tratamiento farmacológico desde Atención Primaria, realizando posteriormente una correcta derivación al médico rehabilitador para la prescripción de tratamiento fisioterápico y seguimiento evolutivo(AU)

Complex regional pain syndrome is a chronic, complex illness whose early diagnosis is essential for favourable progress and in order to avoid complications. This entity usually goes unnoticed, with diagnosis taking place mainly through medical examination of the patient, and thus resulting easy to identify if its symptoms and signs are known. Drug treatment can be commenced at primary health care with subsequent referral to a rehabilitator for the prescription of physiotherapeutic treatment and monitoring(AU)

[Comorbidity and cardiovascular risk in subjects with initial diagnosis of hypercholesterolemia]. / Comorbilidad y riesgo cardiovascular en sujetos con primer diagnóstico de hipercolesterolemia.

BACKGROUND: For a proper approach to the subjects, in which the presence of hypercholesterolemia is identified for the first time, is important to consider simultaneously both cardiovascular risk factors and the presence of other diseases. The purpose of our study was to describe the lipid profile of patients in which the presence of hypercholesterolemia is detected for the frist time and to determine their cardiovascular risk and comorbidity. METHODS: Observational cross-sectional study in a Primary Care setting. In 274 subjects with a plasma cholesterol level higher or equal to 200 mg / dL ("limit" hypercholesterolemia), selected by consecutive sampling, we assessed: lipid profile, cardiovascular risk factors and cardiovascular risk (SCORE and Castelli's atherogenic index), comorbidity (Charlson's Index) and sociodemographic characteristics. RESULTS: The mean cholesterol level was 232.9 mg/dl. Hypercholesterolaemia was reported "definite" (>= 250 mg / dl) in 21.1% (95% CI: 16.2 to 26.1). A 9.5% showed a cardiovascular risk >= 5%. Lipoprotein ratio of total cholesterol/HDL cholesterol was higher in men than in women (4.4 vs. 3.8, p <0.001) in subjects with Charlson's Comorbidity Index > = 1 (4.1 vs. 3.9, p = 0.04), in smokers (4.3 vs. 3.9, p = 0.04) and in hypertensive subjects (4.2 vs. 3.9, p = 0.03), obese (4.2 vs 3 , 7, p <0.05) or with the metabolic syndrome (4.4 vs 3.9, p = 0.02). We observed a higher proportion of subjects with moderate cardiovascular risk / high or cardiovascular disease in those with comorbidity (87.3% vs 42.3%, p <0.01). CONCLUSIONS: More than a third of the subjects in which "limit" cholesterol was identifiyed for the first time presents comorbidity, being "defined" hypercholesterolemia in 21.1% of the cases. Takeing in consideration the Score function assessment, one outif 10 subjects presents high cardiovascular mortality risk after 10 years. Both lipoprotein ratio and cardiovascular risk are markedly higher in subjects with comorbidity.

Comorbilidad y riesgo cardiovascular en sujetos con primer diagnóstico de hipercolesterolemia / Comorbidity and cardiovascular risk in subjects with initial diagnosis of hypercholesterolemia

Fundamento: Para un adecuado abordaje de los sujetos en los que se identifica por primera vez la presencia de hipercolesterolemia es importante considerar simultáneamente tanto sus factores de riesgo cardiovascular como la presencia de otras enfermedades. El objetivo de nuestro estudio es describir el perfil lipídico de los sujetos en los que por primera vez se detecta hipercolesterolemia y determinar su riesgo cardiovascular y comorbilidad. Métodos: Estudio observacional transversal realizado en 274 sujetos en los que se identificó un nivel de colesterol plasmático >200 mg/dl (hipercolesterolemia “límite”), seleccionados mediante muestreo consecutivo. Se evaluó perfil lipídico, factores de riesgo cardiovascular y riesgo cardiovascular (SCORE e índice aterógénico de Castelli), comorbilidad(Índice de Charlson) y características sociodemográficas. Resultados: El nivel medio de colesterol fue de 232,9 mg/dl. Se observó hipercolesterolemia “definida” (> 250 mg/dl) en el 21,1% (IC95%: 16,2-26,1). El 9,5% mostró un riesgo cardiovascular > 5%. El cociente lipoprotéico colesterol total/colesterol HDL fue superior en hombres queen mujeres (4,4 vs 3,8 (p<0,001), en sujetos con Índice de Comorbilidad de Charlson > 1 (4,1 vs 3,9 p=0,04), en fumadores (4,3 vs 3,9 (p=0,04) y en sujetos hipertensos (4,2 vs 3,9,(p=0,03), obesos (4,2 vs 3,7 ( p<0,05) o con síndrome metabólico (4,4 vs 3,9 ( p=0,02). Se observó mayor proporción de sujetos con riesgo cardiovascular moderado/alto o enfermedad cardiovascular entre los que presentaban comorbilidad (87,3% vs 42,3% (p<0,01). Conclusiones: Más de la tercera parte de los sujetos en los que se identifica por primera vez hipercolesterolemia “límite” presenta comorbilidad, tratándose de hipercolesterolemia “definida” en el 21,1%. Considerando la función Score, uno de cada 10 pacientes presenta riesgo elevado de mortalidad cardiovascular después de 10 años. Tanto el cociente lipoprotéico como el cardiovascular son claramente superiores en sujetos que presentan comorbilidad(AU)

Background: For a proper approach to the subjects, in which the presence of hypercholesterolemia is identified for the first time, is important to consider simultaneously both cardiovascular risk factors and the presence of other diseases. The purpose of our study was to describe the lipid profile of patients in which the presence of hypercholesterolemia is detected for the frist time and to determine their cardiovascular risk and comorbidity. Methods: Observational cross-sectional study in a Primary Care setting. In 274 subjects with a plasma cholesterol level higher or equal to 200 mg / dL ("limit" hypercholesterolemia), selected by consecutive sampling, we assessed: lipid profile, cardiovascular risk factors and cardiovascular risk (SCORE and Castelli's atherogenic index), comorbidity (Charlson's Index) and sociodemographic characteristics. Results:The mean cholesterol level was 232.9 mg/dl. Hypercholesterolaemia was reported "definite" (> = 250 mg / dl) in 21.1% (95% CI: 16.2 to 26.1). A 9.5% showed a cardiovascular risk > = 5%. Lipoprotein ratio of total cholesterol/HDL cholesterol was higher in men than in women (4.4 vs. 3.8, p <0.001) in subjects with Charlson's Comorbidity Index > = 1 (4.1 vs. 3.9, p = 0.04), in smokers (4.3 vs. 3.9, p = 0.04) and in hypertensive subjects (4.2 vs. 3.9, p = 0.03), obese (4.2 vs 3 , 7, p <0.05) or with the metabolic syndrome (4.4 vs 3.9, p = 0.02). We observed a higher proportion of subjects with moderate cardiovascular risk / high or cardiovascular disease in those with comorbidity (87.3% vs 42.3%, p <0.01). Conclusions: More than a third of the subjects in which "limit" cholesterol was identifiyed for the first time presents comorbidity, being "defined" hypercholesterolemia in 21.1% of the cases. Takeing in consideration the Score function assessment, one outif 10 subjects presents high cardiovascular mortality risk after 10 years. Both lipoprotein ratio and cardiovascular risk are markedly higher in subjects with comorbidity(AU)

Acercar la Medicina de Familia al estudiante: una tarea de todos / Bringing family medicine to the student: A job for everyone

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Cinco preguntas clave en la gripe: una revisión de guías / Five key questions on flu: a review of the guidelines

La gripe es una enfermedad infecciosa aguda provocada por el virus de la influenza A, B y C, que afecta principalmente al aparato respiratorio, se transmite con gran facilidad por secreciones y objetos contaminados, presenta riesgo potencial de complicaciones, especialmente en grupos susceptibles, y es una de las causas más frecuentes de absentismo laboral. Con el objetivo de actualizar el abordaje del síndrome gripal y recopilar información que ayude al clínico en la toma de decisiones, revisamos las recomendaciones presentadas en diferentes guías de práctica clínica. Realizamos una búsqueda en las bases bibliográficas habitualmente utilizadas en el ámbito internacional seleccionando las que sustentan sus recomendaciones en niveles de evidencia y han sido actualizadas en los tres últimos años. Decidimos incluir otras guías que no mencionan niveles de evidencia pero están avaladas por sociedades científicas o instituciones de prestigio internacional. Comparamos las recomendaciones presentadas en cinco aspectos clave: diagnóstico, manejo en los centros sanitarios, tratamiento, consejos e información a la población y vacunación (AU)

Flu is an acute infectious disease caused by the viruses A, B and C. It mainly affects the respiratory system and is easily transmitted by secretions and contaminated objects. It has a potential risk of complications, especially in susceptible groups, and is one of the most common causes of work absenteeism. With the aim of updating flu management and collecting information that will help the doctor in decision making, we reviewed the recommendations given in different clinical practice guidelines. We searched the bibliographical databases commonly used internationally and chose those guidelines that based their recommendations on levels of evidence and that had been updated in the last three years. We decided to include other guidelines that do not mention levels of evidence but that are endorsed by internationally renowned scientific societies or institutions. We compared the recommendations given according to five key elements: diagnosis, management in health centres, treatment, advice and information to the general public and vaccination (AU)

Trastornos del sueño y condiciones ambientales en mayores de 65 años / Sleep disorders and environmental conditions in the elderly

Objetivos: Establecer la prevalencia y las características del insomnio y su relación con otros problemas de salud, consumo de fármacos, situación socio sanitaria y hábitoshigiénicos en mayores de 65 años.Diseño: Estudio de prevalencia y asociación cruzada.Emplazamiento: Albacete (Castilla-La Mancha), 2004–2005.Participantes: Población mayor de 65 años no institucionalizada (n = 424).Método: Entrevista semiestructurada. Variables de estudio: características del sueño, repercusiones sociofamiliares, hábitos higiénicos del sueño, problemas de salud, medicación, utilización de servicios sanitarios y variables sociodemográficas. Insomnio primario (IP) diagnosticado con criterios DSM-IV.Resultados: Declaró problemas para dormir el 34,2%; en el 95,7% la alteración era crónica. La repercusión más frecuente fue sensación de descanso nocturno insuficiente (62,1%) y cansancio o somnolencia diurna(52,2%). El 20,3%(intervalo de confianza [IC] del 95%, 16,5–24,1) cumplía criterios de IP. El insomnio fue mayor en las mujeres, en los quetenían horarios irregulares e insatisfacción con las condiciones ambientales del dormitorio.El 26,9% (IC del 95%, 22,7–31,1) consumía de forma habitual psicofármacos. El número medio de problemas de salud fue superior en sujetos con insomnio (2,471, 6 frente a1,771, 5; p<0,001). Mediante regresión logística, el sexo femenino (odds ratio[OR] = 2,8; IC del 95%, 1,6–4,8) y tener dos o más problemas de salud (OR = 2; IC del 95%, 1,2–3,4) mostraron su asociación con el IP Conclusiones: El IP afecta a una quinta parte de los mayores de 65 años. Es más frecuente en mujeres y se relaciona con otros problemas de salud, consumo de fármacos e inadecuados hábitos de sueño(AU)

Objectives: To establish the prevalence and characteristics of insomnia and itsrelation ship to other health problems, medication, socio-health status and sleep hygiene in the elderly over 65 years of age.Design: Cross sectional study of prevalence.Setting: Albacete (Castilla-La Mancha), 2004–2005.Participants: A non-institutionalized elderly patient population (n = 424).Method: Semi-structured interview. Study variables were: sleep characteristics, socio-familial repercussions, sleep hygiene, health problems, medication, health careutilization and socio-demographic variables. Primary insomnia (PI)was diagnosed according to DSM-IV criteria.Results: Reported sleeping difficulties, 34.2%; in 95.7%the sleep disturbance was chronic. The most frequent repercussions were: sensation of insufficient night-time sleep (62.1%)and daytime tired ness or sleepiness(52.2%). 20.3% (95% CI, 16.5–24.1) met criteria for PI. Insomnia rates were significantly higher in females and in subjects maintaining irregular hours and expressing dissatisfaction with bedroom environmental conditions. Psychophar-maceuticals were regularly consumed by 26.9% of the subjects (95% CI, 22.7–31.1). The average number of health problems was higherin subjects with insomnia (2.471.6 compared with 1.771.5 innoninsomniacs; P<001). By means of logistic regression, female gender (OR = 2.8; 95% CI, 1.6–4.8) and the existence of 2 or more health problems (OR = 2; 95% CI. 1.2–3.4) were associated with PI.Conclusions: PI affects approximately one fifth of people over the age of 65. It is more frequent in females and is related to the existence of other health problems, medication and inadequate sleep hygiene(AU)

Factores asociados al consumo de tabaco en adolescentes / Factors associated with smoking in adolescents

Objetivo. Identificar factores asociados al consumo de tabaco en escolares de 1º de ESO. Diseño. Estudio analítico de casos y controles apareados por sexo (razón 1:3).Emplazamiento. Centros escolares pertenecientes a 16 zonas básicas de salud de Albacete y Ciudad Real. Participantes. Escolares de 1º de ESO seleccionados mediante cuestionario autocumplimentado. En la muestra participaron 146 escolares fumadores (casos) y 438 no fumadores (controles).Mediciones principales. Variables sobre consumo de tabaco en el entorno sociofamiliar, rendimiento escolar, consumo de alcohol, práctica deportiva y otras relacionadas con estilos de vida. Resultados. En los adolescentes fumadores fue significativamente superior (p<0,001) la proporción de padres fumadores y con menor nivel de estudios, así como la de hermanos, amigos o profesores fumadores. El consumo de alcohol, la ausencia de práctica deportiva, mayor edad, mayor disponibilidad de dinero o menor número de asignaturas aprobadas fueron otros factores asociados (p<0,01).Mediante regresión logística, las variables asociadas independientemente fueron: amigos fumadores(OR:11,3; IC95%:4,2-30,9), consumo de alcohol (OR:6,9; IC95%:3,1-15,1), ausencia de práctica deportiva(OR:3,3; IC95%:1,4-7,6), mayor edad (14-15 años) (OR:2,3; IC95%:1,2-4,6) y menor nivel de estudios del padre (OR:2,0; IC95%:1,1-3,9).Conclusiones. En el consumo de tabaco en adolescentes se identifican factores de exposición relacionados con el estilo de vida, tanto personal como de padres o amigos, entre ellos la presencia de fumadores en el entorno sociofamiliar o la menor dedicación a prácticas deportivas. Por otra parte, pueden ser también factores de riesgo algunas variables sociodemográficas como el menor nivel de estudios de los padres o la mayor edad del joven (AU)

Objective. To identify factors associated with smoking in secondary school children. Design. Case-control analytical study paired by gender (ratio1:3)Setting. Secondary schools from 16 health areas of Albacete and Ciudad Real. Subjects. Secondary school children divided in two groups based on a self-completed questionnaire. Case group with 146 smokers and control group with 438 non smokers. Main measurements. Variables related to smoking in the socio-family setting, academic results, alcohol consumption, participation in sports and lifestyle. Results. The percentage of smoking parents and of lower parental educational status were significantly higher (p<0.001) in the smoking group. The percentages of smoking siblings, smoking friends and smoking teachers were also higher in this group. Alcohol consumption, non-participation in sports, older age, greater availability of money or fewer passed subjects were other factors associated(p<0.01) with the smoking group. By logistic regression, the independent associated variables were: smoking friends (OR:11.3; 95% CI: 4.2-30.9), alcohol consumption (OR:6.9; 95%CI:3.1-15.1), nonparticipation in sports (OR:3.3; 95% CI:1.4-7.6), older age (14-15 years old) (OR:2.3; 95% CI:1.2-4.6)and lower paternal educational status (OR:2.0; 95% CI:1.1-3.9)Conclusions. Smoking in secondary school children is correlated with risk factors related to personal, parental and friends’ lifestyles, such as smokers in socio-family setting or non- participation insports. In addition, some socio-demographic variables could be also be risk factors such as lower parental educational status or older age of the children (AU)

Molluscum Contagiosum / Molluscum Contagiosum

El Molluscum contagiosum es una infección viral benigna, causada por un poxvirus, que afecta habitualmente a niños entre 2 y 5 años con tasas de incidencia de entre el 5 y el 8%. Afecta también a individuos adultos sexualmente activos y los pacientes con infección por VIH presentan especial predisposición a esta infección. Generalmente las lesiones son autolimitadas y, aunque se han empleado numerosos tratamientos, no se ha demostrado que ninguna intervención sea más eficaz, por lo que se plantea el debate sobre si las lesiones del molusco contagioso deben ser tratadas o dejar que se resuelvan espontáneamente. Presentamos el caso de un adulto de 21 años con lesiones características y describimos brevemente el diagnóstico y tratamiento de esta infección (AU)

The Molluscum contagiosum is a benign viral infection. It is caused by a poxvirus and usually affects children from 2 to 5 years. The incidence rate is 5-8%. Also affects sexually active adults. Patients with HIV infection presents special predisposition to this infection. Skin lesions are usually self-limited. Although many treatments have been used, no treatment has been proved be more effective than the other. It is unknown whether the skin lesions should be treated or not. We present the case of an adult of 21 years old with characteristic lesions and we brief y describe the diagnosis and treatment of this infection (AU)

Satisfacción con el tratamiento antidepresivo: validación del cuestionario "ESTA" / Validation of Questionnaire "ESTA", designed to assess the satisfaction with antidepressant treatment. Spain

Fundamento: No existen cuestionarios para evaluar la satisfacción con el tratamiento antidepresivo, el cual repercute en la calidad de vida relacionada con la salud. El objetivo fue desarrollar y validar un instrumento específico para valorar la satisfacción con el tratamiento antidepresivo, determinando su validez convergente respecto a su efectividad clínica, cumplimiento de expectativas, adherencia terapéutica y tolerabilidad. Métodos: Estudio observacional longitudinal donde 168 pacientes iniciaron tratamiento antidepresivo y fueron evaluados durante un año. Las variables incluyeron efectos adversos, cumplimiento e intensidad de síntomas depresivos. En el cuestionario para la Evaluación de la Satisfacción con el Tratamiento Antidepresivo (ESTA), de 11 ítems respondidos mediante escala Likert, se evaluó su fiabilidad, validez de construcción y concurrente con mediciones relacionadas conceptualmente con dicho constructo. Resultados: El α de Cronbach osciló entre 0,936 y 0,951. En el análisis factorial un solo factor explicó el 63,76% de la varianza. La puntuación media del cuestionario ESTA osciló entre 40,0 y 44,7 puntos, observándose una correlación negativa respecto a las escalas de Hamilton (-0,321/-0,601) y Montgomery-Asberg (-0,491/-0,307). La satisfacción con el tratamiento antidepresivo al cabo de un mes fue 39,5 en incumplidores y 44,3 en cumplidores. En quienes presentaron efectos adversos fue 39,2 frente a 43,3 de quienes no los presentaron. En la primera visita (15 días) la puntuación fue 40,0; al mes 42,6; a los 3 meses 44,4 y a los 6 meses 44,5. Estas diferencias fueron estadísticamente significativas para p<0,05. En el análisis de fiabilidad test-retest el coeficiente de correlación intraclase fue 0,908. Conclusiones: El cuestionario ESTA, diseñado para evaluar la satisfacción con el tratamiento antidepresivo, es válido y fiable, constituyendo un instrumento de medición centrado en el paciente complementario a la valoración clínica de la efectividad del tratamiento antidepresivo (AU)

Background: We have no questionnaires to assess satisfaction with antidepressant treatment, which affects the health related quality of life. The objective was to develop and validate a specific instrument to assess satisfaction with antidepressant treatment, determining convergent validity regarding clinical effectiveness, fulfillment of expectations, adherence and tolerability. Methods: Longitudinal observational study where 168 patients started antidepressant treatment and were followed for one year. The variables included adverse effects, compliance and intensity of depressive symptoms. The questionnaire for the Evaluation of Antidepressant Treatment Satisfaction (ESTA) consists of 11 items answered using Likert scale. We evaluated its reliability, construct validity and concurrent validity with conceptually related measures with the construct assessed. Results: The Cronbach's alpha statistic ranged between 0.936 and 0.951. In the factor analysis one factor accounted for 64.11% of the variance. The average score of the questionnaire ranged from 40.0 to 44.7 points, showing a negative correlation regarding the Hamilton scale (-0.321 / -0.601) and Montgomery-Asberg scale (-0.491 / -0.307). After a month, the antidepressant treatment satisfaction was 39.5 points in noncompliant patients and 44.3 in compliers. In those who had adverse effects was 39.2 versus 43.3 for those who had not. At the first visit (15 days) the score was 40.0, in a month 42.6, in 3 months 44.4 and in 6 months 44.5. These differences were statistically significant (p <0.05). In test-retest analysis, intraclass correlation coefficient was 0.908. Conclusions: The questionnaire, designed to assess satisfaction with antidepressant treatment, is valid and reliable, and provides a patient-centered instrument which is complementary to the clinical assessment of the effectiveness of antidepressant treatment (AU)

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