[Knowledge in the prescription of Physical Exercise by Primary Care professionals in the Region of Murcia]. / Conocimiento en la prescripción de ejercicio físico en los profesionales de atención primaria de la región de Murcia.

OBJECTIVE: To determine if the Primary Health care professionals prescribe physical exercise (PE) using adequate knowledge criteria. MATERIAL AND METHOD: A comparative cross-sectional descriptive and observational study carried out in 32 health centres in the Region of Murcia. A total of 476 doctors and 327 nurses were included. A questionnaire was administered to all of them, in which the variables analysed were: Level of overall and specific knowledge by blocks of pathologies (lipids, diabetes, hypertension, obesity, and generalities) on the prescribing of PE to patients with cardiovascular risk, as well as related variables associated with the quality of prescribing PE. RESULTS: Statistically significant differences in knowledge were found in the group that recommends heart rate measurement in «30% to 70%¼ of their patients. Differences in the subgroups were observed in the sections on diabetes (P < 0.05), obesity (P < 0.05), and hypertension (P <0.05). When analysing the knowledge values obtained according to the proportion of patients to whom «very rarely¼ PE time is specified, significant differences are observed (P <0.05), showing doctors with a higher level of knowledge. The differences were accentuated between both professional groups in the group of respondents who specify time to «less than 30%¼ of their patients (P <0.01). There are no differences between those professionals who specify time to «more than 31%¼ of their patients, although the trend shows higher knowledge values among doctors. CONCLUSIONS: The prescription of physical exercise among Primary Care professionals is not carried out using adequate knowledge criteria.

[Analysis of the quality of life in patients affected by scoliosis]. / Análisis de la calidad de vida en los pacientes afectos de escoliosis vertebral.

OBJECTIVES: To assess the quality of life using the SRS 22 test in patients with scoliosis of 20 or more degrees Cobb. MATERIAL AND METHODS: A prospective descriptive study was conducted between April and May 2016 on patients with scoliosis of at least 20 degrees Cobb and aged between 10 and 20 years. A record was made of weight, height, body mass index, and the SR 22 specific quality of life questionnaire for patients with scoliosis was completed. Patients were divided into two groups for analysis: a) scoliosis between 20 and 29 degrees Cobb (n=44); and b) scoliosis with a Cobb of 30 degrees or greater (n=32). RESULTS: There were significant differences in the dimensions that assess pain, image self-perception, and satisfaction with treatment, being valued worse when the degree of scoliosis Cobb is 30 degrees or higher. There were no significant differences in function/activity or mental health. The overall score of the questionnaire was also worse in the group with the highest degree of scoliosis. The weight, height, and BMI showed no significant differences due to the varying degrees of scoliosis. CONCLUSIONS: Scoliosis significantly affects the quality of life of people who suffer it, and there is a negative correlation between the severity of scoliosis measured by degrees Cobb and quality of life.

[Assessment of control of cardiovascular risk factors in obese posmenopausal women after monitoring a structured dietary education and exercise program. (SÍSIFO Program)]. / Valoración del control de los factores de riesgo cardiovascular en mujeres menopáusicas obesas tras el seguimiento de un programa estructurado de educación dietética y ejercicio físico. (Programa SÍSIFO).

OBJECTIVE: Evaluate the influence of a specific program of physical exercise on cardiovascular risk, quality of life and eating habits of menopausal women. METHOD: Prospective, intervention study previous-after without control group for three months. 66 menopausal women were included. The intervention consisted of a structured diet and exercise program. Biochemical, anthropometric, dietary and life quality parameters were determined before and three months after surgery. RESULTS: After the intervention a decrease in weight (4.4±2,3kg) and BMI (1.83±0.84kg/m(2)) (p<.05) occurs. A decrease in SBP (p<.05) was also observed. The fasting glucose went down 13.75±11.11mg/dl and HbA1c fell by 0.19±0,12%, both with p<.05. The lipid profile follows a similar behavior, highlighting a decline of 8± 6.2mg/dl in LDL cholesterol values (p<.05). The score on the measured cardiovascular risk by the Framingham tables decreases by 3% postoperatively (p<.05). Regarding the quality of life, it is significantly improved in all analyzed areas. CONCLUSIONS: The application of a structured exercise and diet program improves close monitoring parameters associated with cardiovascular risk of the women studied. It also improves the quality of life and dietary habits.

[Role of the family doctor in the completion and registration of advance directives documents]. / Papel del médico de familia en la cumplimentación y registro del documento de instrucciones previas.

The attitude of professionals about living wills (advance directives) is not homogenous and varies depending on the specialty, experience and beliefs. Many doctors are still afraid of inconveniencing patients. The situation confronting the professional in an acute care hospital with a relatively unknown patient in a palliative care unit is not the same as consulting a family doctor who is caring for the patient holistically. Primary care has a unique position to approach the life and values of our patients and their families and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills.

[Influence of the presence of hot flashes during menopause on the metabolism of nitric oxide. Effects of hormonal replacement treatment]. / Influencia de la presencia de sofocos durante la menopausia sobre el metabolismo del óxido nítrico. Efecto del tratamiento hormonal sustitutivo.

BACKGROUND: To asses if the hot flushes during the menopause are associated to alterations in the metabolism of nitric oxide, total antioxidant activity and other biochemical parameters. To evaluate the effect of hormone replacement therapy (HRT) in the metabolism of nitric oxide, total antioxidant activity and biochemistry in menopausal women with and without hot flushes. PATIENTS AND METHODS: Experimental study. This study included 29 healthy menopausal women with hot flushes (12 with HRT) and 20 without them (6 with HRT), 45-55 years old, with duration of menopause ranging from 1 to 5 years. Control group included 14 fertile women. Determinations of estradiol, nitrite-nitrate, total antioxidant activity and basic analytic, were performed before previous and after 4-6 month of HRT therapy. RESULTS: Previously to HRT, hot flushes were associated to smaller level of total antioxidant activity (p < 0.05) in plasma, without differences in nitrite-nitrate concentrations. HRT was associated to increase in total antioxidant activity level and nitrite-nitrate concentrations (p < 0.05) in menopausal women, with and without hot flushes. CONCLUSIONS: Hot flushes during the menopause indicate a high level of oxidative stress and a higher cardiovascular risk. HRT decreased the oxidative stress level and increased the nitric oxide derivate metabolites in menopausal women with and without hot flushes.

[Persistent backache in a 62 year-old male: mechanical pain?]. / Dorsalgia persistente en varón de 62 años: ¿dolor mecánico?

The case is presented of a 62 year old man with a history of pulmonary tuberculosis, repeatedly consulting his primary care physician for treatment of analgesic / anti-inflammatory resistant back pain, and usually coincided with physical activity. It was initially diagnosed as mechanical pain, but in the absence of response to rest and treatment a magnetic resonance of the spine was requested, which reported bone metastases. The patient was then referred to Internal Medicine for further tests in hospital. The histopathology ruled out the presence of neoplastic cells, and imaging tests showed radiographic abnormalities in vertebral bodies (osteomyelitis-discitis) associated with epidural abscess, compatible with Pott's disease, a kind of tuberculous arthritis of the intervertebral joints.

[Advantages and drawbacks of current pharmacological treatments for smoking cessation]. / Tratamiento farmacológico en la deshabituación tabáquica. Ventajas e inconvenientes de los tratamientos actuales.

There are currently three families of drugs that are commonly used in the clinic to help smokers to stop; nicotine replacement therapy, bupropion and varenicline. Summary knowledge of the specific efficacy and contraindications of each of them can be useful before prescribing them to our patients.

[Impact of an on-line course on the level of knowledge of the OMI-AP program for primary care doctors]. / Impacto de curso on-line sobre el grado de conocimiento del programa OMI-AP para médicos.

OBJECTIVE: To evaluate the impact of an online course on the level of knowledge of the OMI-AP (Computerised Medical Office in Primary Care) program in medical personnel. MATERIAL AND METHODS: Improvement cycle to optimize the knowledge and use of OMI-AP by family physicians in the Murcia Health Service. A total of 55 family physicians who completed an on-line course on OMI-AP were included. Advanced level training on the OMI-AP was given over a 2 month period via 9 modules. The measurements made were performed in two phases: 1st) A questionnaire on the level of knowledge of OMI-AP (10 questions) was completed one week before the students enrolled in the course. 2nd) The same questionnaire was used one week after completing the course. RESULTS: The average score of the questionnaire was 5.31 points before the completion of the course and 7.70 points after the completion of the course (P < 05). In 9 of the 10 questions analysed the percentage of correct answers significantly improved after the completion of the course. CONCLUSIONS: The delivery of the on-line OMI-AP course for doctors has led to a significant improvement in the level of knowledge of the program, essential for the daily practice of family physicians in our health service. On-line training greatly facilitates the training of professionals by enabling time management according to student needs.

[Quality of records in OMI-AP of the patients with stroke followed in primary care]. / Calidad del registro en OMI-AP de los pacientes con ictus seguidos en atención primaria.

OBJECTIVES: 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. MATERIAL AND METHODS: Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. RESULTS: Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hypertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. CONCLUSIONS: According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors.

[The ZANyCONTROL study. The role of the pharmacy]. / Estudio ZANyCONTROL. Papel de la oficina de farmacia.

OBJECTIVE: To compare blood pressure levels measured in the pharmacy with those obtained in the patient's home or Primary Care centres (doctor's surgery or treatment room). METHOD: Multicentre, open-label, observational, and medium-term follow-up study. LOCATION: Primary Care in the Spanish healthcare system. PARTICIPANTS: 206 general or family practitioners who consecutively selected a maximum of 10 patients each; 1,588 patients were recruited. INTERVENTIONS AND MAIN MEASUREMENTS: Home blood pressure (BP)monitoring, measurements taken in clinics (doctor's surgery and treatment room) and pharmacies (usual apparatus and validated Omrom M4); ambulatory monitorization was performed on 190 patients (model Spacelab 90207). RESULTS: 1,399 patients were included (50.4% women), with a mean age of 60.1 (standard deviation [SD]: 9.7) years. BP values obtained in doctor's surgeries were significantly higher than those obtained in treatment rooms, pharmacies and at home (P < 0.01 in all cases). The smallest differences were observed between the pharmacy and home measurements, with 0.69 (SD: 8.1) for the systolic BP (p = 0.007) and 0.15 (SD: 5.48) for diastolic BP (p = 0.370). DISCUSSION: The ZANyCONTROL study supports the idea that BP measurements taken on hypertensive patients in the pharmacy properly reflect their real BP; it is an accessible and effective method for measuring blood pressure. It is important that the sphygmomanometer in the pharmacy is validated and works correctly.