[Characteristics of oral anti-coagulation treatment in high-risk chronic auricular fibrillation]. / Características del tratamiento anticoagulante oral en la fibrilación auricular crónica de alto riesgo.

OBJECTIVE: To calculate the prevalence of chronic auricular fibrillation (CAF), how much of it is considered high-risk (CAFhr) and the degree of coverage with oral anti-coagulation treatment (OAT). DESIGN: Multi-centre descriptive study. SETTING: 9 health districts. The "Terres de l'Ebre" Primary Care Service. PARTICIPANTS: Randomised sample of 375 patients with CAF, of whom 150 met the criteria of CAFh-r during 2002. MAIN MEASUREMENTS: Profile of patients with CAFh-r; coverage with OAT; place of follow-up; presence of vascular complications, and the time relationships between the diagnosis of CAF, vascular complications and the start of OAT. All the INR determinations taken from the patients included in the study were used. RESULTS: There was 2.2% prevalence of CAF (95% CI, 1.4-3.3). 40% of CAF had criteria of CAFh-r. 74.2% were treated with OAT. In 41.7% the diagnosis of CAF coincided with the incidence of some vascular complication. There were no differences between the overall results of the INR obtained in hospital and in PC. The expected efficacy of OAT for thromboembolism prevention in our high-risk sample was 61.12%. CONCLUSIONS: 40% of the CAF are high-risk. In over a third of patients OAT was indicated after a vascular complication linked to an unknown CAF. The INR between 2-3 is similar in PC centres and the corresponding haematology service.

[Group versus individual education for type-2 diabetes patients]. / Educación grupal frente a individual en pacientes diabéticos tipo 2.

OBJECTIVES: To compare the effectiveness of group (GE) and individual (IE) health education in type-2 diabetes patients, and identify the improvement in knowledge, metabolic control and risk factors. DESIGN: Randomised clinical trial. SETTING: Primary care.Participants. 68 patients with type-2 diabetes, diagnosed 6 months before the start of the study and who had not received GE. Patients aged over 75, those with sensory, psychological and/or physical deficiencies and those not monitored in primary care were excluded (alpha=0.05; beta=0.2).Interventions. Patients were selected according to the inclusion criteria and allocated at random to the IE (n=33) or GE (n=35) group. Individual and group lessons were given at the same time for a year. The contents were evaluated with a validated, self-administered test. MAIN MEASUREMENTS: General, demographic variables, analyses, blood pressure, the Body Mass Index (BMI), the presence of cardiovascular risk factors, diabetes-related complications and therapeutic variables were all measured. RESULTS: The two kinds of education showed no significant differences from each other. The two groups improved the level of knowledge (P<0.001), and reduced HbA1c (P<0.001), HDL-C (P<0.001), the BMI (P=0.001) and systolic pressure (P=0.004), and increased their use of reactive strips (P=0.02). CONCLUSIONS: Health education on diabetes improved knowledge of the disease, metabolic control and cardiovascular risk factors. The two educational methods evaluated were equally effective.

Educación grupal frente a individual en pacientes diabéticos tipo 2 / Group versus individual education for type-2 diabetes patients

Objetivo. Comparar la efectividad de la educación sanitaria grupal (EG) frente a la individual (EI) en pacientes diabéticos tipo 2, identificando la mejora del nivel de conocimientos, del control metabólico y de los factores de riesgo. Diseño. Ensayo clínico aleatorizado. Emplazamiento. Atención primaria. Participantes. Sesenta y ocho pacientes diabéticos tipo 2, diagnosticados 6 meses antes de haber iniciado el estudio y que no habían recibido EG, excluyendo a los de más de 75 años, a los que presentaban déficit sensoriales, psicológicos o físicos y los que no estaban controlados en nuestro nivel asistencial (alfa = 0,05, beta = 0,2).Intervenciones. Se seleccionó a los pacientes según los criterios de inclusión y se asignaron de forma aleatoria en el grupo de EI (n = 33) y EG (n = 35). Durante un año se impartieron lecciones individuales y grupales simultáneamente, y los contenidos se evaluaron con un test validado y autoadministrado. Mediciones principales. Variables generales, demográficas, analíticas, presión arterial y el índice de masa corporal (IMC), así como la presencia de factores de riesgo cardiovascular, complicaciones relacionadas con la diabetes y variables terapéuticas. Resultados. Los dos tipos de educación no mostraron diferencias significativas entre ellos y ambos grupos mostraron mejoría en el nivel de conocimientos (p < 0,001), reducción de HbA1c (p < 0,001), colesterol HDL (p < 0,001), IMC (p = 0,001), presión arterial sistólica (p = 0,004), aumento del uso de tiras reactivas (p = 0,02).Conclusiones. La educación sanitaria en la diabetes mejora los conocimientos de la enfermedad, el control metabólico y factores de riesgo cardiovascular. Los dos métodos educativos evaluados han resultado igual de eficaces (AU)