Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area.

BACKGROUND: The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. METHODS: This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. DISCUSSION: By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01006213.

El cribaje de arteriopatía periférica en Atención Primaria mediante doppler / Doppler screening of peripheral arteriopathy in Primary Care

La arteriopatía periférica es causa de numerosas complicaciones responsables de una morbi-mortalidad elevada. El cribaje de esta enfermedad mediante técnica doppler está siendo realizado por enfermeras en centros de Atención Primaria.Objetivos: conocer la relación entre los factores de riesgo cardiovascular y el resultado de la prueba de cribaje de arteriopatía periférica realizada con doppler e identificar la relevancia de la prueba.Método: estudio observacional descriptivo. Sujetos del estudio (n = 119): pacientes con diabetes mellitus II remitidos al programa de cribaje de arteriopatía periférica, mediante doppler, del Centro de Atención Primaria Florida Sur durante el año 2007, seleccionados por muestreo de conveniencia.Resultados: no se observan asociaciones estadísticamentesignificativas entre el resultado obtenido con doppler y los diferentes factores de riesgo cardiovascular que presentan los sujetos. Sólo se observan diferencias estadísticamente significativas con la varia-ble “revisión de pulsos previa”. No se registró ninguna actuación tras obtener un resultado patológicoen el 66,67% de la muestra.Conclusión: aunque no hay asociación entre el resultado positivo del ITB y la presencia de factores de riesgo cardiovascular, la técnica de cribaje con doppler es útil para la detección de arteriopatía periférica. Hay que mejorar la relevancia de su utilización en lo referente a las actuaciones posteriores al resultado positivo, especialmente, la educación sanitaria

Peripheral arteriopathy causes numerous complicationsthat lead to a high morbidity and mortality. Doppler screening of this disease is performed by nurses in Primary Care centres.Objectives: to learn about the relationship between cardiovascular risk factors and the peripheral arteriopathy screening test results performed with doppler and identify the relevance of this test.Method: descriptive observational study. Study subjects(n=119): patients with diabetes mellitus II, selected by convenience sampling referred to the peripheral arteriopathy doppler screening program in the Florida Sur Primary Care Centre during 2007.Results: no statistically significant associations were found between the results obtained by doppler and the subjects’ different cardiovascular risk factors. There were only statistically significant differences in the variable “previous pulse examination”. No measures were taken after obtaining a pathological result in 66,67% of the sample.Conclusion: even though there is no association betweenthe positive result of AAI and the presence of cardiovascular risk factors, the Doppler screening technique is useful for the detection of peripheral arteriopathy. The relevance of its use must be improved in regards to subsequent measures to be taken based on positive results, especially in healthcare education (AU)

[Prevalence and clinical course of patients in Spain with acute myocardial infarction and severely depressed ejection fraction who meet the criteria for automatic defibrillator implantation]. / Prevalencia y evolución en España de los pacientes con infarto agudo de miocardio y fracción de eyección severamente deprimida, con criterios de implantacíon de desfibrilador automático.

The Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II has broadened the indications for cardioverter defibrillator implantation. We present a retrospective study designed to estimate the number of patients in Spain eligible for an implantable defibrillator according to the MADIT-II criteria. From January 1999 to October 2002, 758 consecutive patients were admitted to our center with the diagnosis of acute myocardial infarction. Sixty-seven had a left ventricular ejection fraction < or = 30% (mean, 23[5]) and were not eligible for revascularization. Excluding patients older than 80 years and patients with marked co-morbidity, 47 patients met the MADIT-II criteria for an implantable defibrillator. After a mean follow-up of 18 months, there were 20 deaths, 6 of which were considered sudden. In conclusion, application of the MADIT-II criteria for defibrillator implantation may benefit 6% of the patients with myocardial infarction in Spain. This proportion translates as 4110 defibrillator implantations.