Validation of the COPD severity score for use in primary care: the NEREA study.

Spirometry is underused for the assessment of severity of chronic obstructive pulmonary disease (COPD) in primary care (PC). Therefore, simple assessment tools are required in this setting. The aim of the present study was to validate the COPD severity score (COPDSS) for use in PC. A multicentric study was carried out in stable COPD patients in PC. The concurrent validity of the COPDSS was evaluated by examining the association between COPDSS, COPD clinical indicators and the London Chest Activity of Daily Living (LCADL) scale, European quality of life (EuroQOL) questionnaires and Charlson comorbidity index. A total of 837 patients with COPD were analysed (males 84.3%; mean+/-sd age 68+/-11 yrs; forced expiratory volume in one second 54.6+/-17.7% of the predicted value). A strong correlation was found between COPDSS and dyspnoea level and a moderate correlation between COPDSS and exacerbation number. The COPDSS discriminated between patients with varying degrees of dyspnoea (area under receiver operating characteristic (ROC) curve 0.837), and according to number of exacerbations in the last year (area under ROC curve 0.773). Higher COPDSS scores were significantly associated with lower EuroQOL scores, lower EuroQOL visual analogue scale scores and higher LCADL scores. The present results indicate that the chronic obstructive pulmonary disease severity score is a useful and reliable tool for assessing the severity of chronic obstructive pulmonary disease in primary care.

[Study of the stroke and coronary risks in hypertensive patients over 54 years of age in the primary care practice]. / Estudio del riesgo coronario y de ictus en pacientes hipertensos mayores de 54 años atendidos en Atención Primaria.

BACKGROUND AND OBJECTIVES: Quantification of stroke risk is not always performed in hypertensive patients in Primary Care. METHODS: This was an epidemiological study in hypertensive patients aged 55 years and older attending primary care centres in Spain. The D'Agostino Stroke Risk Scale, using data from the Framingham Study, was used for assessment of stroke risk. RESULTS: We analysed 4,945 patients (mean age, 66.8 years; 50.9% females). Mean blood pressure (BP) values were 145/86 mmHg in men and 143.7/84.7 mmHg in women (p < 0.001). The majority of patients (80.5%) showed high BP values that were above the values recommended in the guidelines, despite most of them (89.6%) receiving pharmacological antihypertensive treatment. 41% of patients were diabetics. The 10-year global risk of stroke was 22.5%, and was higher in men (28.6% vs. 16.8%; P < 0.001). The risk of stroke increased with age, being more marked in women. Several risk factors showed a statistically significant association with the risk of stroke. From higher to lower significance, these risk factors were: age, left ventricular hypertrophy (LVH), cardiovascular disease, systolic BP, auricular fibrillation, diabetes, cigarette smoking, control of BP, gender, and antihypertensive treatment. The 10-year coronary risk was higher in men (24.2% vs. 16.0%; p < 0.001) and was significantly related to the 10-year risk of stroke (r = 0.626). CONCLUSIONS: The risk of stroke in the Spanish hypertensive population is high, and is significantly higher in men, although it shows a larger age-related increase in women. Linear regression analysis showed a moderate, but statistically significant, correlation between coronary risk and risk of stroke. Apart from all the variables included in the Framingham Stroke Risk Model, gender, control of BP, and antihypertensive treatment accounted significantly and independently as calculated risk factors for incidence of stroke.

Compliance with an oral hyperproteic supplement with fibre in nursing home residents.

BACKGROUND: Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake. Oral supplements may improve the health status in this population, but their use may be limited by compliance and side effects. OBJECTIVES: To evaluate effects of an oral supplement of protein and fibre on compliance, on nutritional status, and on intestinal habits in nursing home residents. METHOD: A prospective observational study was carried out in 66 Spanish nursing homes. 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements. After informed consent was given, subjects received 2 daily cartons (400 ml) of a liquid oral supplement rich in protein and fibre along 3 months. Supplement intake compliance was measured at baseline and after 6 and 12 weeks. Nutritional status was assessed using the Mini- Nutritional Assessment (MNA), weight, and Body Mass Index (BMI). Changes in intestinal habits and digestive symptoms were also recorded, as well as subject's supplement acceptance. RESULTS: Compliance with the supplement intake was 97.46% at 6 weeks and 96% at 12 weeks of follow-up. Significant changes (p<0.0001) were found in nutritional status: mean value of MNA improved from baseline (MNA=14.0+/-3.9) after 12 weeks (MNA=17.0+/-4.0), as well as weight (+2.1 kg, a 4.1% increase). The BMI did not change significantly (BMI=21.43 at baseline; BMI=21.78 at 12 weeks). Undernutrition prevalence (MNA<17) decreased from 76.4 to 46.6% (p<0.0001). Intestinal habits showed a significant improvement in defecation frequency (from 4.7 to 6.1 stools per week, p<0.0001) and faeces consistency (from 53.2% to 74.5% reporting formed soft stools, p<0.0001). 48.9% of the subjects considered to have better intestinal habits after 6 weeks and 50.5% after 3 months of supplementary food intake, the rest reporting no change. Vomits and flatulence were also significantly reduced (p<0.0001). CONCLUSION: The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance. Supplements improve their nutritional status and their intestinal habits.