[Health literacy in patients with type 2 diabetes: A cross-sectional study using the HLS-EU-Q47 questionnaire]. / Alfabetización en salud en pacientes con diabetes tipo 2: un estudio transversal con el cuestionario HLS-EU-Q47.

OBJECTIVE: The aim of this study was to determine the level of health literacy of diabetic patients aged 50 to 75 years, from Ourense, Spain, as well as its relationship with the glycated haemoglobin (HbA1c) concentration and cardiovascular risk of the patient. MATERIAL AND METHODS: Cross-sectional study using a self-completed questionnaire. From a multi-stage sampling, urban, type 2 diabetic patients were randomly included. The level of health literacy, using the HLS-EU-Q47 questionnaire, the last concentration of HbA1c, and both total and fatal cardiovascular risk at 10 year follow-up, measured using the UKPDS (U.K. Prospective Diabetes Study) algorithm, were determined. The age, gender, level of education, level of social support, social class, and comorbidities were used as covariates. RESULTS: A total of 103 patients were analysed. Out of all the patients, 81.5% (84) had an unsuitable health literacy level (29.1% had an inadequate level and 52.4% had a problematic level). A clear association was seen between a higher level of health literacy and higher levels of education. Moreover, the level of health literacy was seen to be inversely related to the level of control of the patients' diabetes measured on the basis of their HbA1c (P=.03) concentration. However, no such association was found with the cardiovascular risk (P=.3). CONCLUSIONS: The results of the present study show that the level of literacy of the analysed population was insufficient, and that its improvement could result in a better outcome in the treatment of diabetic patients.

[Dual antiplatelet therapy and haemoglobin level: An observational study]. / Antiagregación plaquetaria dual y nivel de hemoglobina: un estudio observacional.

INTRODUCTION: To determine the degree of association between dual antiplatelet therapy (DAPT) (clopidogrel plus acetylsalicylic acid) and haemoglobin (Hb) in clinical practice. MATERIAL AND METHODS: A retrospective longitudinal analysis was conducted on all patients on DAPT for at least 6 months. The required sample size was 63 patients. Hb value was determined before DAPT and at least 6 months after, as well as length of treatment, drugs, and diseases that might reduce the Hb. Changes in Hb after DAPT and the emergence or worsening of pre-existing anaemia was determined. Before and after Hb was compared using the t-test for paired samples. The occurrence of anaemia was considered dependent variable in a logistic regression analysis. RESULTS: A total of 122 cases were included. There were 92 (75.4%) males, and the mean age was 74.5 (SD 9.9) years. DAPT duration was 19.3 (11.8) months. The pre-treatment Hb was 14.3 (1.4) g/dl and 12.8 (1.9) g/dl post-treatment. The prevalence of pre-DAPT anaemia was 9.1% (11 cases), and 45.9% post-treatment (56 cases). Comparison of means showed a decrease of 1.5g/dl (1.6) (95% CI; 1.2-1.8, P<.001). Anaemia post-treatment was associated with concomitant causes of anaemia, bleeding in the follow-up, and inversely with pre-treatment Hb level. CONCLUSIONS: DAPT is associated with a decrease in Hb. Anaemia or worsening of previous anaemia appeared in about half of the subjects, and this effect was most likely in patients with bleeding in the follow-up and if other causes of anaemia were present.

Defectos de cierre orofaciales: paladar hendido y labio leporino. Una revisión bibliográfica / Orofacial closure defects: cleft lip and palate. A literature review

Los defectos de cierre orofaciales son un problema relativamente frecuente que supone un importante consumo de recursos sanitarios, además del sufrimiento que llevan implícito para el paciente y su familia. Existen diversas teorías que explican su origen, aunque ninguna tiene evidencias suficientemente sólidas. Las más aceptadas suponen una importante base genética que podría verse modificada por la presencia de agentes externos. Conocer las causas que los provocan permitiría intentar prevenir su aparición, campo en el que el médico de familia puede tener un importante papel (AU)

Orofacial clefts are a common problem that can lead to significant healthcare use and costs, as well as suffering on the part of the affected individuals and families. There are several theories explaining their origin, but some of the findings are inconsistent. The most accepted theories involve a major genetic basis that could be modified by the presence of external agents. Understanding the underlying causes could help to prevent its occurrence, an area in which the family physician can play an important role (AU)

[Orofacial closure defects: cleft lip and palate. A literature review]. / Defectos de cierre orofaciales: paladar hendido y labio leporino. Una revisión bibliográfica.

Orofacial clefts are a common problem that can lead to significant healthcare use and costs, as well as suffering on the part of the affected individuals and families. There are several theories explaining their origin, but some of the findings are inconsistent. The most accepted theories involve a major genetic basis that could be modified by the presence of external agents. Understanding the underlying causes could help to prevent its occurrence, an area in which the family physician can play an important role.

[The adequacy of the diagnostic in chronic obstructive pulmonary disease]. / Adecuación diagnóstica en la Enfermedad Pulmonar Obstructiva Crónica.

OBJECTIVES: To assess the adequacy to the clinical guides (GOLD/SEPAR) for the diagnosis of the patients classified as COPD. MATERIAL AND METHODS: We selected all COPD cases in the registry of chronic patients of 28 general practitioners from 9 Health Centres in the province of Ourense (Spain). A total of 382 cases were included. Diagnostic accuracy was determined according to the results of spirometry. We identify factors associated with correct diagnosis by logistic regression which included age, gender, residence (rural/urban), smoking, severity, level of follow up and time since diagnosis. RESULTS: Of the total number included, 297 were male (77.7%) and 172 patients (45.0%) came from rural areas. The average age was 77.0 (SD=±11.0) years, with a mean age at diagnosis of 64.9 (±12.0) years and the time from diagnosis was 11.5 (±8.0) years. Less than half (49.1%) patients had been smokers, and 13.1% still smoked. Twenty-six cases (6.8%) were diagnosed in Primary Care. The FEV(1)/FVC ratio was recorded in 174 (45.5%) patients, with less than 0.7 in 138 cases (36.1%), which were considered as correctly diagnosed. In these patients the FEV(1) had been recorded in 125 cases (90.6%). A correct diagnosis was associated with severe or very severe disease (OR 5.2; 95% CI; 1.5-17.4), urban areas (OR 6.1; 95% CI, 1.7-21.2), and younger than 60 years (OR 3.7; 95% CI, 1.3-11.2). CONCLUSION: The number of spirometry results recorded in the Primary Care medical records of patients diagnosed with COPD was found to be low, and with little adaptation to the accepted diagnostic criteria in the guidelines that are used routinely.

Investigación médica en poblaciones pequeñas / Medical research in small populations

No disponible

[Opinion of primary care physicians from Ourense on various features of the pharmaceutical prescription]. / Opinión de los médicos de atención primaria de Ourense sobre algunos aspectos de su prescripción farmacéutica.

BACKGROUND: To learn the opinion of the primary care Physicians of Ourense (Spain) with respect to certain aspects of their prescription of medicines, such as their awareness of the price of drugs, the induced prescribing perceived, their relationship with the pharmaceutical industry and their opinions concerning possible measures for reducing the expenditure on medicines. METHODS: In this transversal descriptive study, all of the primary care physicians in the province of Ourense (243) were surveyed by means of a previously-approved questionnaire sent to them by post. The questionnaire included demographic characteristics of the physicians, the influence of cost when prescribing medicines, their estimate of the price of 15 drugs routinely prescribed and their opinion on different aspects relating to induced prescription, the pharmaceutical industry and different strategies in order to curtail the expenditure on medicines. In order to analyze the results, the chi 2 and Student's t tests and an analysis of the variance were used, together with the Spearman correlation coefficient with alpha = 0.05. RESULTS: The level of participation of the physicians surveyed was 42.8% (104). The average daily duration of visits by pharmaceutical company representatives was 13.6 minutes, with new specialities being the topic of greatest interest. Close to 27% admitted to having participated in clinical testing sponsored by the industry. 23% considered the price to be a priority when prescribing. Induced prescription accounted for 39.7% of the total. The majority of physicians chose co-payment as the means for reducing expenditure on medicines. In the estimate of prices, the overall percentage of error was 45.7%, underestimating the more expensive medicines and overestimating the less expensive. CONCLUSIONS: There is a significant lack of awareness of the price of drugs among the primary care physicians. Most of the physicians do not feel that the price of a drug should be a priority when prescribing medicines. There is a high percentage of induced prescription perceived. With regard to the expenditure on pharmaceuticals, the majority of those surveyed feel that financial measures, specifically co-payment, are the most effective in order to curtail rising costs.

[Factors related to the health education practice for primary care physicians in Galicia, Spain]. / Factores relacionados con la práctica de educación sanitaria por los médicos de atención primaria de Galicia.

BACKGROUND: Health education on the part of primary care physicians has been shown to improve the health of the population, but, generally speaking, physicians are not pursuing this to the recommended degree. The end purpose of this study is that of ascertaining what factors have an influence on health education being carried out by primary care physicians in Galicia (Spain), how they perceive their training in this regard, what obstacles they encounter as regards to providing this education and how the existence of unhealthy habits on the part of the physician has a bearing on carrying out this activity. METHODS: A cross-sectional study has been conducted. A previously-tested, self-answer mail-out questionnaire was sent to a random sample stratified by provinces of 420 primary care physicians from the "Servicio Galego de Saúde" (Galician Health Care Service). A comparative analysis was made with those who failed to reply. The main analysis of the data was conducted by means of a multivariate (logic regression) analysis. RESULTS: Seventy-three percent (73%) of the replies were valid, without any differences among strata. Sixty-four percent (64%) of the physicians surveyed considered their training in health education to be insufficient, being better among family doctors and among those who had taken courses specifically devoted to this subject. The main obstacle reported was the lack of time. 38.4% of the physicians reported that they carry out health education, an activity related to the female gender (Odds Ratio 1.70), better training concerning this subject (Odds Ratio 2.20) and a better personally perceived ability to carry out the same (Odds Ratio 1.32). No relationship was found to exist between the carrying out of health education and the existence of unhealthy habits. CONCLUSIONS: Being female, feeling efficient at providing health education and considering oneself to be well-trained regarding this subject being related positively to this activity being carried out by primary care physicians, solely one third of whom report doing so.

Control of primary hypertension by pharmacologic monotherapy in primary care. / El control de la hipertensión arterial mediante monoterapia farmacológica en Atención Primaria.

OBJECTIVE: To analyze the control degree and characteristics of arterial pressure (AP) obtained with monotherapy. SUBJECTS AND METHODS: A sample was obtained of 277 hypertensive patients (83 men and 194 women) on monotherapy from cluster sampling. All included patients were older than 18 years and had essential hypertension (HBP). Both systolic and diastolic pressure values (mean of two measurements), prescribed drug, age and sex were recorded. RESULTS: Less than 30% of subjects had adequate control (< 140/90), mainly because of poor control of systolic BP. The drug group most commonly was ACEI, followed by calcium blockers (CAB); enalapril and chlortalidone were the most commonly prescribed drugs. Diuretics were used most frequently by women (OR 4.2). The use of diuretics, calcium channel antagonists and alphaadrenergic blockers increased with age. The opposite was true for ACEI and beta blockers. CONCLUSIONS: A poor control of HBP in patients on monotherapy was observed, particularly for the systolic component. There is a higher use of ACEI and HBP. There is a highly significant difference regarding the use of diuretics between men and women which has no theoretical basis.

El control de la hipertensión arterial mediante monoterapia farmacológica en Atención Primaria / Control of primary hypertension by pharmacologic monotherapy in Primary Care

Fundamento. Analizar el grado de control de la presión arterial (PA) conseguido con monoterapia y las características de la misma. Sujetos y métodos. Se obtuvo una muestra de 277 hipertensos (83 varones y 194 mujeres) en tratamiento con monoterapia a partir de un muestreo en conglomerados. Todos los pacientes incluidos eran mayores de 18 años y presentaban hipertensión arterial esencial (HTA). Se registraron PA sistólica y diastólica (media de dos tomas), fármaco, edad y sexo. Resultados. Menos del 30 por ciento de los sujetos presentaban control adecuado (<140/90 mmHg), fundamentalmente por mal control de la PA sistólica. El grupo farmacológico más usado era el de los inhibidores de la enzima convertidora de la angiotensina (IECA), seguido de los bloqueadores del calcio (BCA), siendo las sustancias más prescritas enalapril y clortalidona. Los diuréticos (DIU) se usaban más en mujeres (OR 4,2). El uso de DIU, BCA y bloqueadores alfaadrenérgicos se incrementaba con la edad, al contrario que IECA y bloqueadores beta. Conclusiones. Se constata un mal resultado en el control de la HTA en pacientes tratados con monoterapia, especialmente para el componente sistólico. Hay un mayor uso de IECA y BCA. Existe una diferencia muy significativa en el uso de diuréticos entre varones y mujeres que no tiene justificación teórica (AU)

[Personalized appointments as a recruitment method for anti-flu vaccination in the elderly]. / La citación personalizada como método de captación para la vacunación antigripal en ancianos.

OBJECTIVE: To determine the effectiveness of personal appointments for increasing flu vaccine coverage in over-65s who showed no intention of being vaccinated of their own accord. DESIGN: Controlled, intervention study, single-blind and with randomised distribution. SETTING: Primary health centre. PARTICIPANTS: Population over 65 in the municipality of San Cristovo de Cea (Ourense) who had not been vaccinated after three-quarters of the flu vaccine campaign had elapsed. MEASUREMENTS AND MAIN RESULTS: After three-quarters of the flu vaccine campaign, a randomised sample (n = 162) was taken from the over-65 population not vaccinated (N = 640). These 162 were sent a personal letter reminding them of the vaccination campaign, the personal risk they ran and advising them to be vaccinated. They were given an appointment time. During the remaining 14 days of the campaign, all the vaccinations continued to be monitored. Afterwards, the control group and those who had received the intervention were compared. 28 people were vaccinated, 19 from the intervention group (11.7%) and 9 from the control group (1.9%) (RR = 6.2; 95% CI, 2.9-13.5; FA = 84%). There were no significant differences between sexes. CONCLUSIONS: Personal appointments were effective in increasing vaccine coverage, even among people at first reluctant to be vaccinated, the group at which the intervention should be aimed.

[The diet of 13-year-old students in the city of Saragossa]. / La alimentación de los escolares de trece años del municipio de Zaragoza.

BACKGROUND: The importance of diet as a cause of different diseases and the possibility of educational involvement during the school-age years leads to it being advisable to ascertain the attitudes of young people with regard to nutrition and their eating habits. METHODS: Cross-section study. A self-test survey was conducted regarding the nutrition-related habits and knowledge on a sample randomly taken from among 543 students from the 1st level school-leaving certificate studies (age 13) in the city of Saragossa, including an assessment of the foods eaten by means of 24-hour recall and a questionnaire regarding how often different foods are eaten weekly. A pilot study was conducted on 50 individuals, with validation by means of personal interviews in 15 cases. RESULTS: A total of 516 questionnaires were analyzed. The subjects were found to possess an average degree of knowledge regarding nutrition-related matters. A total 41.5% of the sample acknowledged advertising having an impact on their diet. A greater diet-related impact was found to exist among the females analyzed. The eating survey revealed a diet consisting of normal calorie intakes, but excessive protein and low carbohydrate intakes, excess fat intake being noted among males. An excessive amount of Meat and meat products and Sweets and candies was noted, contrasting with the low Grain, Fish and Potato intake. CONCLUSIONS: Educational measures must be taken among school-age children with regard to informing them concerning the composition of foods and a correct diet, teaching them to take a critical stance with regard to food advertising. They must be counseled to lessen their intakes of Meats and Sweets and to increase the amount of complex carbohydrates and Fish.