ABSTRACT
INTRODUCTION: Restless legs syndrome (RLS) is a usual neurologic disorder, often undiagnosed and treatable, usually associated with sleep disturbance. Our goal was to study prevalence of RLS in our practice. PATIENTS AND METHODS: Descriptive, cross-sectional study, in a Primary care center. 283 patients 50 years old or older, which come to the office for any reason, were evaluated with a questionnaire about the four essential criteria stated by the international RLS study group in 1995. RESULTS: Prevalence of RLS was 11.6% (95% CI: 7.9-15.3%). 73.5% were women and 26.5% men (ratio 3:1). Only 15% reported major repercussion in their quality of life, them we estimated that RLS clinically significant is present in 1.9% of our patients. By means of logistic regression only high number of consults at the office, daily sleepiness and use of hypnotics were associated to RLS. CONCLUSIONS: Prevalence of RLS in more than 50 years old patients is high: 11.6% but 1.9% of medically significant RLS. Must be suspected specially in women, frequent consultants or with sleep disorders in treatment with hypnotics.
Subject(s)
Primary Health Care , Restless Legs Syndrome/epidemiology , Aged , Female , Humans , Hypnotics and Sedatives/adverse effects , Male , Middle Aged , Quality of Life , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/physiopathology , Surveys and QuestionnairesABSTRACT
Introducción. El síndrome de piernas inquietas (SPI) es un trastorno neurológico común, infradiagnosticado y tratable, que se asocia casi siempre con problemas de sueño. Nos planteamos estudiar su prevalencia en nuestro medio. Pacientes y métodos. Estudio descriptivo transversal desarrollado en un centro de atención primaria. 283 pacientes mayores de 50 años que consultaron por cualquier motivo fueron encuestados sobre cumplimiento de los criterios diagnósticos establecidos internacionalmente en 1995 por el Grupo Internacional para el Estudio del SPI. Resultados. La prevalencia hallada fue del 11,6% (IC 95%: 7,9-15,3%). Un 73,5% fueron mujeres y un 26,5%, hombres (razón casi de 3 a 1). Sólo un 15% refieren repercusión importante en su calidad de vida, por lo que estimamos el SPI clínicamente relevante en un 1,9%. Por regresión logística sólo la frecuentación elevada, la somnolencia diurna y precisar hipnóticos para dormir, se asoció al SPI. Conclusiones. La prevalencia de SPI hallada en pacientes mayores de 50 años en nuestro medio es elevada, un 11,6%; un 1,9% si nos ceñimos al clínicamente relevante. Debe descartarse especialmente en mujeres, pacientes frecuentadores o con trastornos del sueño en tratamiento con hipnóticos
Introduction. Restless legs syndrome (RLS) is a usual neurologic disorder, often undiagnosed and treatable, usually associated with sleep disturbance. Our goal was to study prevalence of RLS in our practice. Patients and methods. Descriptive, cross-sectional study, in a Primary care center. 283 patients 50 years old or older, which come to the office for any reason, were evaluated with a questionnaire about the four essential criteria stated by the international RLS study group in 1995. Results. Prevalence of RLS was 11,6% (95% CI: 7,9-15,3%). 73.5% were women and 26,5% men (ratio 3:1). Only 15% reported major repercussion in their quality of life, them we estimated that RLS clinically significant is present in 1,9% of our patients. By means of logistic regression only high number of consults at the office, daily sleepiness and use of hypnotics were associated to RLS. Conclusions. Prevalence of RLS in more than 50 years old patients is high: 11,6% but 1,9% of medically significant RLS. Must be suspected specially in women, frequent consultants or with sleep disorders in treatment with hypnotics
Subject(s)
Male , Female , Middle Aged , Humans , Restless Legs Syndrome/complications , Restless Legs Syndrome/epidemiology , Primary Health Care/statistics & numerical data , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/etiology , Restless Legs Syndrome/drug therapy , Cross-Sectional Studies , Prevalence , Spain/epidemiology , Severity of Illness IndexABSTRACT
Introducción. Estudiar en condiciones de práctica clínica habitual el efecto de la automedición domiciliaria (AMPA) sobre el descenso de presión arterial (PA) en hipertensos. Material y métodos. Estudio experimental en Atención Primaria. Participaron 109 pacientes con hipertensión arterial (HTA) ligera, mal controlados en consulta, aleatorizados en grupo intervención (GI), que fue instruido para la AMPA, facilitándosele un automedidor electrónico validado, y grupo control (GC) que siguió el programa de HTA del área. Se controlaron sus PA con una monitorización ambulatoria de la presión arterial (MAPA), al inicio, 18 y 30 meses. Se consideró controlada la PA con media por MAPA de 24 horas menor de 130/80 mmHg. Se registró el consumo de fármacos por dosis diaria definida, el índice de bienestar psicológico y las visitas por HTA y totales al Centro de Salud y otras variables demográficas y factores de riesgo cardiovascular. Se realizó análisis bivariante y multivariante por regresión lineal múltiple y/o regresión logística. Resultados. El descenso de la PA fue similar en ambos grupos, con tendencia a ser menor en el GI que en el GC a los 30 meses (diferencia de 3,6 mmHg para la PA sistólica y 2,3 mmHg la diastólica en el MAPA de 24 horas; "p", respectivamente, de 0,036 y 0,052) a expensas de la presión nocturna, no habiendo diferencias significativas en la diurna. No hay diferencias significativas en el control de la PA. El GI consume menos fármacos (1,1 frente a 1,3; p = 0,010). Discusión. Constatamos un menor descenso de la PA en el grupo de AMPA, en cifras moderadas, a expensas de la presión nocturna. El impacto sobre el proceso asistencial es favorable con un menor consumo de fármacos
Introduction. Study the effect of home self-measurement (HSM) on decrease in blood pressure (BP) in hypertensive subjects under usual clinical practice conditions. Material and methods. Experimental study in Primary Health Care. A total of 109 patients with mild hypertension poorly controlled in the consultation, participated. They were randomized into intervention group (IG), that was instructed on the use of HSM, providing them with a validated electronic self-measurer, and the control group (CG) who followed the area hypertension program. Blood pressure (BP) was measured with ambulatory blood pressure monitoring (ABPM), at onset, 18 and 30 months. BP was considered to be controlled by ABPM with a mean of 24 hours less than 130/80 mmHg. Drug consumption was recorded by daily defined dose, psychological wellbeing index and visits due to hypertension and total visits to the Health Center and other demographic variables and cardiovascular risk factors. Bivariate and multivariate analysis were performed by multiple linear regression and/or logistic regression. Results. Decrease of BP was similar in both groups, with tendency to be less in the IG than in the CG at 30 months (difference of 3.6 mmHg for systolic BP and 2.3 mmHg for diastolic in the 24 hour ABPM, "p" respectively of 0.036 and 0.052) at expense of nocturnal pressure. There were no significant difference in the daytime pressure. There were no significant differences in the BP control. IG consumed fewer drugs (1.1 vs 1.3; p = 0.010). Discussion. We observe less BP decrease in the ABPM group, in moderate values, at expense of nocturnal pressure. The impact of the health care process is favorable with less drug usage
Subject(s)
Male , Female , Adult , Aged , Middle Aged , Humans , Hypertension/prevention & control , Antihypertensive Agents/administration & dosage , Blood Pressure Determination/methods , Case-Control Studies , Hypertension/drug therapy , Self Care/methods , Blood Pressure Monitoring, Ambulatory/methods , Cardiovascular Diseases/prevention & control , Risk FactorsABSTRACT
BACKGROUND: The cigarette smoking habit continues to be prevalent to a greater degree than would be desirable among teenagers. Innovative prevention programs are needed. This descriptive cross-sectional study sets out the behavior variables related to the cigarette smoking habit and the extracurricular activities in which teenagers are most frequently involved which are useful for setting out extracurricular prevention programs. METHODS: The data was collected by means of a questionnaire validated in a representative sample of school age youths (ages 10-11 and 13-14) from Asturias. The variables entailed in cigarette smoking were analyzed using the regression method. RESULTS: The starting smoker percentage is 14.5%-42.5%, regular smokers totaling 1.1% and 12.4%, respectively. Two models were constructed with the variables significantly related to smoking behavior, which are properly classified into smoker/non-smoker by 98.85% and 91.39% of the children, by ages. The environmental variables (availability of cigarettes and alcoholic beverages and regular visits to places entailing risk) are the major aspects comprising the model. The most common extracurricular activities are: watching TV, reading and listening to music and watching or playing sports. CONCLUSION: The findings provide keys to planning extracurricular activities tailored to fit in with the activities most popular among teens: TV commercials and ads on music media (CD's, tapes, etc.) and printed information mailed directly to teens at their homes, with messages conveyed by opinion-leaders among teens in the fields of sports, music and television.
Subject(s)
Adolescent Behavior , Health Education , Smoking Prevention , Adolescent , Alcohol Drinking , Child , Confidence Intervals , Humans , Music , Radio , Regression Analysis , Spain , Surveys and Questionnaires , TelevisionABSTRACT
BACKGROUND: The published data on the effectiveness of programs in schools to prevent addiction to tobacco are not consistent. These programs have not been sufficiently studied, and their variables give rise to confusion. The aim of this study was to evaluate the process of educational action taken in schools. METHOD: Student leaders and teachers, who were trained and given guides, developed a socially based program. Two students selected at random from each class were interviewed, using a validated and directed questionnaire. A total of 318 children were interviewed. The Kappa Index was used to measure confidence, and the Inter-Class Coefficient of Correlation and Pearson's Coefficient were used together with analysis of individual differences to compare the data for program adjustment, as supplied by pupils and teachers. RESULTS: Mean adjustment per class was 30.07 points (48-100% adjustment). 26% of children were unable to mention any alternative to the advantages of smoking, 71.7% were unaware of the frequency of consumption amongst adults and 19.5% were unable to mention any of the tricks used in cigarette advertising. Less than half had performed psychodrama on this subject, as was required. The ICC was 0.21, Pearson's Coefficient was 0.25 (p = 0.02) and the interval of agreement between the descriptions of teachers and students was 6.93 points (-1.70 to 5.23). CONCLUSIONS: The degree to which implementation complied with the proposed model of program was insufficient. We found little agreement between the self-assessment of teachers and the score attained by pupils in compliance with the program. It is essential that this process be evaluated for its impact to be evaluated correctly.
Subject(s)
Health Education , Smoking Cessation , Smoking/epidemiology , Adolescent , Adolescent Behavior , Adult , Female , Humans , Male , Spain/epidemiology , StudentsABSTRACT
OBJECTIVE: To study the cost-effectiveness of simple anti-smoking advice in Primary health care. METHODS: We accomplish a cost-effectiveness analysis in the area of the Primary health care. As efficiency of the advice we use own results. To evaluate the smoking cessation we base on vital tables of the "25-State Cancer Prevention Study", discounted to the 5%. The costs have been calculated as of the tariffs used for services billing lent in primary health centers to not beneficiary of the social security. It was accomplished a sensibility analysis on different aspects with possible influence on the result. RESULTS: The cost-effectiveness oscillated between 67,621 and 89,619 pesetas by year of life saved for the men and between 116,225 and 137,748 pesetas for the women, in function of the age. The relationship most favorable, for both sexes, it is between 45 and 54 years. In the group of 35 to 39 years, for the physicians, was of 89,419 and 163,934 pesetas for men and women respectively, and for the nursing personnel was oscillating between 43,955 and 81,523, for men; and between 80,584 and 149,460 pesetas for women in function of the considered salary. CONCLUSIONS: It is an intervention with a very favorable relationship cost-effectiveness, at least, comparable to that of other customarily accepted preventive measures. The nursing advice is less effective that the physician advice, but it is, at least, equal of efficient in terms of cost by year of life saved.
Subject(s)
Primary Health Care/economics , Smoking Cessation/economics , Adolescent , Adult , Age Distribution , Aged , Cost-Benefit Analysis , Counseling/economics , Female , Humans , Male , Middle Aged , Sex Distribution , SpainABSTRACT
OBJECTIVE: To validate the "ankle/arm" index (AAI) or "Yao index" for the primary care assessment of chronic arteriopathy in the lower limbs (CALL). DESIGN: A descriptive crossover study. SETTING: Primary care. PATIENTS: 21 with suspected or diagnosed CALL. MEASUREMENTS AND MAIN RESULTS: Four primary-care doctors made 164 examinations by means of palpation and determination of blood pressure with Doppler waves. The presence or absence of pulses was recorded and the AAI calculated. The interobserver Kappa ranged from 0.20 to 0.47 and the intraobserver from 0.52 to 0.76, according to the pulse examined. The intraclass interobserver correlation coefficient for the AAI was 0.80 and the intraobserver 0.79. Interobserver SD for the AAI was 0.14, and intraobserver SD 0.15. CONCLUSIONS: The ankle-arm index obtained by primary-care doctors using Doppler is a reliable method of studying CALL. However, due to its wide variability, it is advisable always to evaluate its evolution together with clinical data.
Subject(s)
Ankle/blood supply , Arm/blood supply , Arterial Occlusive Diseases/physiopathology , Leg/blood supply , Primary Health Care , Aged , Blood Pressure Determination/methods , Blood Pressure Determination/statistics & numerical data , Chronic Disease , Cross-Sectional Studies , Female , Humans , Male , Observer Variation , Pulse , Reproducibility of ResultsABSTRACT
BACKGROUND: Addiction to tobacco is the main cause of preventive morbidity, and so the fight against tobacco consumption is a priority in the developed world. Health advice is a valuable tool in this struggle and it is within the reach of all health workers. To study the long-term effectiveness of all anti-tobacco advice in Primary Aid, together with the influence that the reason for giving up (spontaneous or after advice) has upon the relapse pattern. METHOD: We carried out a clinical test on 501 patients, 242 as a participant group, receiving health advice, and 259 in a control group. We evaluated giving up the habit through a survey. The data were analysed by means of a study with a survival study, considering the relapse to be the final point. Survival curves for the two groups were compared with the Lee-Desu statistic. RESULTS: 115 patients gave up the habit for at least 24 hours (31.8% from the participant and 14.7% from the control group). After 3 years, after a biochemical check-up, 4.5% of the participant group and 1.2% of the control group were still ex-smokers (difference = 3.3; p = 0.043%; there is a confidence interval of 95%: from 0.45 to 6.33). We did not find significant differences between their survival curves (p = 0.08). CONCLUSION: We have been able to confirm the mid- to long-term effectiveness of anti-tobacco advice. We have not been able to demonstrate that anti-tobacco advice in the relapse pattern, but a statistical trend does exist towards a reduction in the participant group.
