Evaluación de la actitud y las dificultades que los médicos de Atención Primaria tienen ante el diagnóstico y el tratamiento del sobrepeso y la obesidad / Evaluation of the attitude and difficulties of Primary Care doctors regarding diagnosis and treatment of overweight patients and obesity

INTRODUCCIÓN. El conocimiento de los problemas que dificultan el manejo de la obesidad ayudará a desarrollar estrategias para su abordaje. El objetivo del presente trabajo es evaluar la actitud de los médicos de Atención Primaria con respecto al diagnóstico y el tratamiento del sobrepeso y la obesidad y conocer los problemas que dificultan su manejo. MATERIAL Y MÉTODO. Estudio transversal con muestreo aleatorio. Emplazamiento: centros de Atención Primaria de Galicia. Participantes: médicos de Atención Primaria. Cuestionario autoaplicable validado de 61 ítems que exploran variables sociodemográficas, medios, procedimientos, actitudes y necesidades. RESULTADOS. Se distribuyeron 200 cuestionarios. Tasa de respuesta: 63%. Varones, 48,15%; mujeres, 51,58%. Edades: el 59,26% entre 45-54 años y el 29,63% entre 35-44 años. Tiempo por consultas a demanda: 5,42 ± 1,73 min. El 83,33% considera la falta de tiempo por la presión asistencial, el 68,52% declara falta de formación en dietas individualizadas, para el 72,22% los pacientes no aceptan la obesidad como problema de salud y para el 77,78%, éstos no colaboran. El 64,88% siente frustración ante la dificultad para conseguir que los pacientes pierdan peso. El 89,19% de los médicos consideran que disponer de más tiempo, más formación (92,59%) y profesionales con formación específica (87,04%) mejoraría la atención a la obesidad. CONCLUSIONES. Los médicos mayoritariamente consideran problemas: la falta de percepción por los pacientes de la obesidad como problema de salud y la negativa a reconocer sus malos hábitos alimentarios, la presión asistencial y la falta de formación. Hay frustración y dificultad para conseguir y mantener objetivos de peso aceptables (AU)

INTRODUCTION. Being aware of the problems that make it difficult to manage obesity will help to develop strategies to deal with it. This paper aims to evaluate the attitude of the Primary Care doctors regarding the diagnosis and treatment of overweight patients and obesity and to define the problems that challenge its proper management. MATERIAL AND METHOD. A cross-sectional random sample study. Location: Primary Care centers in Galicia. Participants: Primary Care doctors. Method: a 61-item self-completed questionnaire that examines sociodemographic variables, resources, procedures, attitudes and needs. RESULTS. Two hundred questionnaires were distributed with a response rate of 63%. Men: 48.15% and women: 51.58%. Age: 59.26% were between 45-54 years and 29.63% between 35-44 years. Time for consultation upon request 5.42 ± 1.73 min. A total of 83.33% of the doctors surveyed consider these problems to be lack of time due to care pressure, 68.52% lack of training about individualized diets, 72.22% that patients do not accept obesity as a health problem and do not cooperate (77.78%). A total of 64.88% express feeling frustra- ted regarding the difficulty they have to get their patients to lose weight. 89.19% of the doctors consider that having more time, more training (92.59%) and professionals with specialized training (87.04%) would improve obesity care. CONCLUSIONS. Most of the doctors consider that the problems are lack of awareness of the patients of obesity as a health problem and their refusal to recognize that they have bad nutritional habits, health care pressure and lack of training. There is a feeling of frustration and that it is difficult to achieve and keep acceptable weight targets in their patients (AU)

Check-ups in obese and diabetic patients: preventive medicine.

Obesity is a chronic disease associated with important additional diseases, such as DM 2, that both reduce life quality and increase morbimortality from any cause. In the Western world, obesity is directly responsible for most deaths due to associated chronic disease. Therefore, substantial effort should be directed towards adequate primary prevention campaigns and policies, as well as towards an intensive and long-term multidisciplinary treatment of obesity, in an attempt to combat this threat to the health of a large part of our population.

Hipoglucemia facticia: a propósito de un caso / Factitious hypoglycemia: case report

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Acarbosa y diabetes mellitus. Implicaciones prácticas / Acarbose and diabetes mellitus. Practical implications

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[Familial hypophosphoremic rickets: pathogenic considerations based on two cases (author's transl)]. / Raquitismo hipofosforémico familiar: consideraciones patogénicas a propósito de dos observaciones.

Familial hypophosphoremic rickets, although exceptional, is a frequent form of presentation in communities where nutritional rachitism has been eradicated. Hypophosphoremia is the biochemical defect which led to an insuffieient osseous mineralization. The real pathogenic mechanism of the disease is still unknown. Two patients, mother and son, who presented anamnesic, biochemical and roentgenographic characteristics suggesting a familial hypophosphoremic rachitism are reported. Clinical, biochemical and roentgenologic data of a secondary reactive hyperparathyroidism were absent in both cases. The present knowledge on the metabolic pathway of vitamin D and its metabolites led us to consider that the basic pathogenic defect appears as a consequence of an intestinal malabsorption of phosphates due to an altered synthesis of 1,25-dihydroxycholecalciferol or its precursor 25-hydroxycholecalciferol.

Clinical studies with d-TRP6-luteinizing hormone-releasing hormone in men with hypogonadotropic hypogonadism.

Three male patients, diagnosed to have hypogonadotopic hypogonadism, were treated with intramuscular injections of 10 microgram of D-Trp6-luteinizing hormone-releasing hormone (D-Trp6-LH-RH) every 8 hours for more than 90 days (13 to 17 weeks). The gonadotropin and testosterone concentrations reached levels twice as great during the treatment as those measured previously and on one occasion increased 5-fold. Before treatment, the patients were clinically in grade 1 on Tanner's scale (Growth at Adolescence, Second Edition. Oxford, Blackwell Scientific Publications, 1962) but after treatment they advanced to grades 2 to 4. Testicular sizes before treatment were between 2 and 2 according to the scales of Waaler et al. (Acta Paediatr Scand [Suppl]249:1, 1974) and afterwards between 4 and 10. The penis of one of the patients grew 3 cm. The testicular biopsy after treatment showed significant increases in the number of Leydig and Sertoli cells. After treatment, spermatogonia were present in increased number, together with a much higher population of cells corresponding to additional stages of development (spermatids). We are of the opinion that therapy with D-Trp6-LH-RH may be beneficial for such patients.

Clinical studies with d-Trp 6-luteinizing hormone-releasing hormone in anovulatory women.

Nine anovulatory patients with hypothalamic-pituitary dysfunction were treated with d-Trp6-luteinizing hormone-releasing hormone, an analog with far greater gonadotropin-releasing activity than luteinizing hormone-releasing hormone. Four of eight patients, who were formerly unsuccessfully treated with clomiphene, human chorionic gonadotropin, and human menopausal gonadotropin, ovulated after treatment with the peptide alone or with peptide preceded by clomiphene, and three became pregnant. The ninth patient, who had amenorrhea and anovulation due to excessive loss of weight caused by anorexia nervosa, also ovulated after treatment with the analog. These results demonstrate the effectiveness of this potent analog for induction of ovulation and pregnancy and point favorably toward clinical applications.