ABSTRACT
OBJECTIVES: To determine the prevalence of ankle-brachial index (ABI)<0.9 and symptomatic peripheral arterial disease (PAD), association with cardiovascular risk factors (CVRF), and impact of adding ABI measurement to coronary heart disease (CHD) risk screening. DESIGN: Population-based cross-sectional survey of 6262 participants aged 35-79 in Girona, Spain. METHODS: Standardized measurements (CVRF, ABI, 10-year CHD risk) and history of intermittent claudication (IC), CHD, and stroke were recorded. ABI<0.9 was considered equivalent to moderate-to-high CHD risk (> or =10%). RESULTS: ABI<0.9 prevalence was 4.5%. Only 0.62% presented low ABI and IC. Age, current smoker, cardiovascular disease, and uncontrolled hypertension independently associated with ABI<0.9 in both sexes; IC was also associated in men and diabetes in women. Among participants 35-74 free of cardiovascular disease, 6.1% showed moderate-to-high 10-year CHD risk; adding ABI measurement yielded 8.7%. Conversely, the risk function identified 16.8% of these participants as having 10-year CHD risk>10%. In participants 75-79 free of cardiovascular disease, the prevalence of ABI<0.9 (i.e., CHD risk> or =10%) was 11.9%. CONCLUSIONS: ABI<0.9 is relatively frequent in those 35-79, particularly over 74. However, IC and CHD risk> or =10% indicators are often missing. Adding ABI measurement to CHD-risk screening better identifies moderate-to-high cardiovascular risk patients.
Subject(s)
Ankle/blood supply , Blood Pressure Determination , Blood Pressure , Brachial Artery/physiopathology , Cardiovascular Diseases/epidemiology , Mass Screening/methods , Peripheral Vascular Diseases/epidemiology , Adult , Aged , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Cross-Sectional Studies , Female , Health Surveys , Humans , Intermittent Claudication/epidemiology , Intermittent Claudication/etiology , Intermittent Claudication/physiopathology , Male , Middle Aged , Odds Ratio , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/physiopathology , Predictive Value of Tests , Prevalence , Risk Assessment , Risk Factors , Spain/epidemiology , Time FactorsABSTRACT
Objective: To study the validity and reliability of the Kupperman test (KT), which measures climacteric symptoms. Design: Validation study. Setting: an urban primary care center (Gerona-3 primary care center) in Gerona, Spain. Patients: A randomized sample of women aged between 45 and 60 years old. Sample size for the calculation of intraclass correlation coefficient (ICC): N=256. Measurements: KT was administered on two occasions. At the baseline visit, both KT and the Nottingham Health Profile (NHP) were administered. Results: Twenty-eight patients (11%) refused to participate. Reliability: the ICC for the total KT score was 0.779, and for the diverse fields was between 0.777 (for hot flushes) and 0.531 (for arthralgias). Validity: the correlation between NHP and KT was 0.605 (P<.0005). The KT score for menopausal (159) and non-menopausal women (69) showed no statistically significant differences (12.96 vs 10.51; P=.055). The ICC of the KT revealed that this test was suitable for group use but not for individual use (ICC< 0.9). KT measures quality of life in women between 45 and 60 years old indirectly (through symptoms). The lack of significant differences between menopausal and non-menopausal women could be due to the low power of KT (AU)
Objetivo: Estudiar la validez y la fiabilidad de la prueba de Kupperman (PK), que mide sintomatología climatérica. Diseño: Estudio de validación. Emplazamiento: Zona básica de salud urbana. Pacientes: Muestra aleatoria de mujeres con edades comprendidas entre los 45 y los 60 años. Tamaño muestral para el cálculo del coeficiente de correlación intraclase (CCI), n = 256. Mediciones: Se administró la PK en dos ocasiones, en la primera cita junto con el Nottingham Health Profile (NHP). Resultados: Se negaron a participar 28 (11%) mujeres. Fiabilidad: el CCI para la puntuación total de la PK fue de 0,779 y para los diversos campos CCI oscilaba entre el 0,778 de los sofocos hasta 0,531 de las artralgias. Validez: la correlación entre el NHP y prueba de PK fue de 0,605 (p < 0,0005). La puntuación para la PK entre mujeres menopáusicas (159) y no menopáusicas (69) mostraba diferencias no estadísticamente significativas (12,96 frente a 10,51; p = 0,055) Conclusiones: La PK no presenta unos CCI adecuados para su uso individual (CCI < 0,9), sino para su uso grupal. LA PK mide de modo indirecto (a través de los síntomas) la calidad de vida de las mujeres de 45 a 60 años. La falta de diferencias significativas entre menopáusicas y no menopáusicas puede deberse a poca potencia (AU)
Subject(s)
Humans , Female , Middle Aged , Predictive Value of Tests , Quality of Life , Menopause/physiology , Climacteric/physiology , Body Mass Index , Cardiovascular Diseases/epidemiology , Psychometrics/methods , Primary Health Care/methods , Value of Life , Climacteric/psychology , Libido/physiology , Psychometrics/statistics & numerical data , Psychometrics/trendsABSTRACT
AIM: To determine whether the Framingham function accurately predicts the 10 year risk of coronary disease and to adapt this predictive method to the characteristics of a Spanish population. METHOD AND RESULTS: A Framingham function for predicting 10 year coronary deaths and non-fatal myocardial infarction was applied to the population of the province of Gerona, Spain, where the cumulated incidence rate of myocardial infarction has been determined since 1988 by a specific registry. The prevalence of cardiovascular risk factors in this region of Spain was established in 1995 by a cross sectional study on a representative sample of 1748 people. The number of cases estimated by the Framingham function for 10 year coronary deaths and non-fatal myocardial infarction was compared with that observed. The Framingham function estimated 2425 coronary heart disease cases in women and 1181 were observed. In men, 9919 were estimated and 3706 were observed. Recalibrating the Framingham equations to the event rate and the prevalence of the risk factors in Gerona led to estimates very close to the number of cases observed in Gerona men and women. CONCLUSIONS: The Framingham function estimates more than doubled the actual risk of coronary disease observed in north east Spain. After calibration, the Framingham function became an effective method of estimating the risk in this region with low coronary heart disease incidence.
Subject(s)
Coronary Disease/etiology , Risk Assessment/standards , Adult , Aged , Algorithms , Female , Humans , Male , Mediterranean Region , Middle Aged , Reproducibility of Results , Risk Factors , Spain/epidemiologyABSTRACT
Objetivo: describir un programa de formación sobre medidas de prevención de riesgos biológicos de transmisión parenteral en un centro hospitalario y evaluar sus resultados inmediatos. Material y métodos: la población a la que iba dirigido el programa fueron los profesionales en contacto con pacientes o material biológico del hospital. Se realizaron 60 sesiones en grupos pequeños, de una hora de duración. Se entregó un cuestionario auto-contestado y anónimo a cada participante antes de la sesión y otro idéntico al final. Se analizó el porcentaje de preguntas bien contestadas y se compararon los resultados antes y después de las sesiones. Resultados: el nivel de participación fue del 40,7 por ciento. El colectivo con mayor porcentaje de participación fue el de auxiliares, seguido del de enfermeras, y el más bajo el de los médicos. Sólo un 24 por ciento sabía previamente qué son las medidas estándar, y un 65,5 por ciento contestó correctamente a ello después de las sesiones. La mayoría sabía cuándo hay que utilizar guantes (85,7 por ciento) y es necesario cambiarlo s (88,3 por ciento), y dónde hay que depositar el material punzante o cortante (85,7 por ciento). Sólo un 50,7 por ciento utilizaba guantes para realizar extracciones o similares. Un 66,3 por ciento sabía que no hay que encapuchar las agujas y sólo un 14,5 por ciento que el material reutilizable de los pacientes infectados requiere una limpieza y desinfección habituales. Todos estos porcentajes mejoraron sensiblemente después de cada sesión. Conclusiones: la formación en prevención es necesaria y puede ser efectiva, pero debe complementarse con cambios y mejoras en las medidas preventivas y los procedimientos de trabajo (AU)
