[Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources]. / El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios.

INTRODUCTION: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). MATERIALS AND METHODS: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. RESULTS: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. CONCLUSIONS: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients.

El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios / Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources

Introducción: Pese a la elevada prevalencia del síndrome de piernas inquietas (SPI), se cuenta con escasa información sobre este trastorno en nuestro país. El objetivo de este estudio fue obtener información sobre este problema de salud a partir de pacientes identificados mediante un cuestionario de cribado y posterior confirmación diagnóstica por médicos de Atención Primaria (AP). Material y métodos: Estudio en tres etapas, transversal y retrospectivo (utilización de recursos), en una muestra de pacientes adultos (2.047 sujetos) que acudió a consultas ambulatorias de 10 centros de Atención Primaria (Madrid, Barcelona y Valencia). Se utilizó un cuestionario de detección con los 4 criterios diagnósticos de SPI. Se realizó la evaluación clínica y confirmación diagnóstica mediante un cuestionario estandarizado. Otras variables evaluadas fueron: calidad de vida, mediante la puntuación del Cuestionario SF-36 de salud; sueño, mediante la puntuación de la escala de sueño MOS; intensidad de los síntomas de SPI, mediante la puntuación de la escala IRLS; utilización de recursos sanitarios en los 12 meses previos. Confirmación del diagnóstico del médico de AP, por un neurólogo especialista en trastornos del movimiento en una muestra reducida aleatoria de pacientes. Resultados: Un 19,7% (404 de 2.047) de los sujetos respondió positivamente a las 4 preguntas diagnósticas del cuestionario de detección del SPI. De ellos, 185 sujetos (9,0%) presentaban síntomas por lo menos dos veces a la semana, de intensidad moderada a grave. El médico de AP confirmó el diagnóstico de SPI en 79 de los 154 pacientes que completaron la entrevista diagnóstica. La prevalencia en esta población adulta fue del 4,6%. El valor predictivo del cuestionario de detección del SPI fue de un 51,3%. La edad media de inicio de síntomas fue de 42 años (rango: 20-más de 80 años). Los síntomas de SPI fueron moderados en el 50,6% y graves en el 38%. El 73,4% de los pacientes con SPI dormía mal, al menos dos noches por semana. La puntuación media de la escala IRLS (0-40) fue de 19,4. La puntuación media del cuestionario SF-36 (0-100) fue de 54,6, más baja que la de la población española de referencia (61,4). Aproximadamente un tercio de los pacientes había consultado antes con un médico por los síntomas de SPI. No obstante, sólo un 48% contaba con un diagnóstico y sólo en un 5% éste era de SPI. Conclusiones: El estudio DECODE RSL indica que muchos pacientes con síntomas clásicos de SPI visitan frecuentemente a su médico de AP sin ser diagnosticados ni, por lo tanto, recibir un tratamiento adecuado. Herramientas como la utilizada en este estudio pueden ayudar a la detección de estos pacientes (AU)

Introduction: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). Materials and methods: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. Results: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. Conclusions: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients (AU)

[Prevalence and detection of depressive disorders in primary care]. / Prevalencia y detección de los trastornos depresivos en atención primaria.

AIM: To study the prevalence of depression in primary care, the detection of depressive disorders by primary care physicians, and the factors that influence detection. DESIGN: Cross-sectional, descriptive study. SETTING: Gavà II Primary Care Center, in Barcelona, Spain. PARTICIPANTS: A total of 400 people between the ages of 18 and 65 years were chosen randomly from among those who attended appointments with their primary care physician. MAIN MEASURES: A sociodemographic questionnaire and the Beck Depression Inventory (BDI) screening test were administered, and the participant s medical record was reviewed. In a subsample of 40 participants, the Mini-International Neuropsychiatric Interview (MINI) was also administered. The optimum cutoff score for the BDI was estimated with reference to the MINI results. RESULTS: A cutoff score of 20/21 for the BDI had a sensitivity of 86.7% and a specificity of 92%, when the MINI score was used as a reference. The adjusted prevalence of depressive disorder in our primary care setting was 20.2% overall, 8.1% in men, and 26.8% in women (odds ratio 4.15, p < 0.01). The physician detected depressive symptoms in 55.7% of all likely cases of depression. Persons who scored >= 21 on the BDI made more visits to their primary care physician, and had more stressful life events, than those who scored 20. CONCLUSIONS: The prevalence of depression in our primary care setting is high. The disorder was underdiagnosed in as many as 44.3% of the persons likely to have depressive disorder (especially women, widows and widowers, retired persons, persons who had experienced stressful life events, and frequent users of primary care services).

Prevalencia y detección de los trastornos depresivos en atención primaria / Prevalence and detection of depressive disorders in primary care

Objetivo. Estudiar la prevalencia de depresión en atención primaria (AP) y la detección de los trastornos depresivos por el médico de AP, así como los factores que influyen en ella. Diseño. Estudio transversal, descriptivo. Emplazamiento. Centro de Asistencia Primaria Gavà II (Barcelona). Participantes. Se seleccionaron de manera aleatoria 400 personas de 18-65 años que acudieron según cita previa a consulta con su médico de AP. Mediciones principales. Se administró un cuestionario sociodemográfico, el test de cribado de depresión de Beck (BDI) y se revisaron los datos clínicos de su historia. Además a una submuestra de 40 personas se les pasó la entrevista diagnóstica MINI. Se estimó el punto de corte óptimo para el BDI respecto la MINI. Resultados. Se seleccionó el punto de corte 20/21 de depresión del BDI, con sensibilidad del 86,7 por ciento y especificidad del 92 por ciento, utilizando como referencia el resultado de la entrevista MINI. La prevalencia corregida del trastorno depresivo en AP es de un 20,2 por ciento; un 8,1 por ciento en varones y el 26,8 por ciento en mujeres (odds ratio [OR] = 4,15; p < 0,01). El médico detecta sintomatología depresiva en un 55,7 por ciento de los probables casos de depresión. Las personas con BDI 21 visitan más a su médico de AP y han presentado más acontecimientos vitales estresantes que las que puntúan BDI 20. Conclusiones. Existe una elevada prevalencia de depresión en AP. Permanece infradiagnosticado un 44,3 por ciento de las personas con probable trastorno depresivo (sobre todo mujeres, viudos, jubilados, los que han presentado acontecimientos vitales estresantes y los individuos más frecuentadores) (AU)