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

Objetivos. Valorar la adecuación a las guías clínicas (GOLD/SEPAR) del diagnóstico de los pacientes calificados de Enfermedad Pulmonar Obstructiva Crónica (EPOC). Material y métodos. Se seleccionaron todos los casos de EPOC del registro de pacientes crónicos de 28 cupos de 9 centros de salud de la provincia de Ourense, incluyéndose 382 casos donde se determinó la existencia de un diagnóstico correcto según resultados espirométricos. Se determinaron los factores asociados al diagnóstico correcto mediante regresión logística donde fueron incluidos edad, sexo, residencia (rural/urbana), tabaquismo, gravedad, nivel de seguimiento y tiempo desde el diagnóstico. Resultados. Eran varones 297 (77,7%) y 172 (45,0%) procedían del medio rural. La media (DE) de edad era 77,0 (±11,0) años, siendo al diagnóstico de 64,9 (±12,0) años y 11,5 (±8,0) años de tiempo de evolución. El 64,9% era o había sido fumador. Se diagnosticaron en atención primaria 26 casos (6,8%). El índice VEF1/CVF estaba registrado en 174 (45,5%) pacientes, siendo menor de 0,7 en 138 casos (36,1%), que se consideraron bien diagnosticados. En estos pacientes figuraba registrado el VEF1 en 125 casos (90,6%). El diagnóstico correcto se asociaba a enfermedad grave o muy grave (OR 5,2; IC95 1,5-17,4), procedencia urbana (OR 6,1; IC95 1,7-21,2) y edad igual o menor de 60 años (OR 3,7; IC95 1,3-11,2). Conclusión. En la historia clínica de atención primaria de los pacientes diagnosticados de EPOC existía escaso registro espirométrico y baja adecuación a los criterios diagnósticos aceptados en las guías de uso habitual (AU)

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 FEV1/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 FEV1 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 (AU)

[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.

La concepción de la enfermedad: a propósito de un caso clínico / Understanding the disease: presentation of a clinical case

Algunos pacientes presentan respuestas a la enfermedad muy diferentes a las esperadas según el vigente paradigma de la medicina occidental. La antropología y la sociología médicas ofrecen una explicación plausible de estas diferencias. Características intrínsecas del individuo, creencias sobre la enfermedad y la relación con el grupo social de pertenencia mediatizan con frecuencia dicha respuesta. Entre otros, el medio rural ofrece la posibilidad de comprobar la influencia de las diferentes alternativas que sobre la concepción de la enfermedad y el papel de enfermo pueden tener los individuos (AU)

Some patients have very different responses to the disease than those expected under the current paradigm of Western medicine. Anthropology and medical sociology offer a plausible explanation for these differences. Intrinsic characteristics of individual beliefs about the disease and its relationship with social group membership often mediate this response. Among others, rural areas offer the possibility to check the influence of the various concepts that individuals may have of the disease and the role of the patient (AU)

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.

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.