[Baseline spirometry parameters that can influence the bronchodilation test]. / Parámetros basales de la espirometría que pueden influir en la prueba de broncodilatación.

OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4±15.5 years, and 62% were male.An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs. 2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs. 2. 62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs. 3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT.

[Control over the quality of care given pregnant women in a health area]. / Control de calidad de la asistencia prestada a la embarazada en un área de salud.

The results of a quality control of the assistance, given through a programme of pregnancy in 12 health centres in Area number 1 of Toledo are shown here. To do so, an auditory was performed at a public hospital level and in the participating health centres, unifying explicit and normative criteria, which were the base to check a sample of 484 clinic records. In the results found, the high percentage of observance of the criteria referring to the early captation and the puerperal visit (90.3% and 94.6% respectively) is outstanding and the adequate treatment of the ferropenic anemia is the most frequently unobserved criteria (53.3%). Correction measures are established and standards for the re-evaluation are fixed. We emphasize the need to involve the second assistance level as well as the respective Management in the performance of health programmes in its aims, assuming the improvement of results as a responsibility of all of them.

[The degree of control and care for hypertension patients in the Toledo Health Area]. / Grado de control y atención a los pacientes con hipertensión en el Area de Salud de Toledo.

OBJECTIVES: To find how well blood pressure figures of patients with hypertension in the Toledo Health District are monitored and how they are followed up. DESIGN: Cross-sectional and descriptive, based on review of clinical records. SETTING: Primary care in Toledo. PATIENTS: 391 patients diagnosed with hypertension, chosen through multi-stage random sampling and followed up at the District's Health Centres. INTERVENTIONS: The age and sex of the patient, complications, level of blood pressure monitoring (the patient was considered "under control" if the mean of the three last blood pressure figures was < 140/90 mmHg), inclusion in nursing clinic and how many times monitored for hypertension, were taken from the clinical records. MEASUREMENTS AND MAIN RESULTS: 12.3% were classified as suffering from serious hypertension, 57.9% of the patients had no visceral complication. 22.1% had a cardiac complication, and 14.9% a renal complication. 26.57% had mean blood pressure < 140/90 mmHg (CI, 22.19-30.94). 93% were followed up in the nursing clinic. Average annual hypertension controls was 2.69 with doctors and 8.73 with nurses. There was no significant association between the percentage of patients under control, and follow-up or otherwise in the nursing clinic (27.3% and 24%, respectively). There was greater attendance of patients with their blood pressure poorly controlled, both in medical (2.8 vs 2.3; p > 0.05) and nursing clinics (9.2 vs 7.5; t = 3.03; p < 0.01). CONCLUSIONS: Our results confirm the tendency towards an improvement in recent years in the monitoring of patients with hypertension in our country. In view of the important number of monitoring sessions (especially in nursing clinics) that proper follow-up requires, we wonder whether such a discreet improvement is not being achieved at too high a cost.