Evaluación de la adherencia al tratamiento con calcio y vitamina D en ancianos de una zona básica de salud / Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area

Introducción y objetivo. El déficit de vitamina D en los ancianos es elevado. Complementar con suplementos de calcio y vitamina D es una práctica habitual en individuos con riesgo de caídas y/o fracturas que, sin embargo, obtiene un bajo grado de cumplimiento. El objetivo es determinar la adherencia al calcio y vitamina D en ancianos con hipovitaminosis D en una zona urbana de Madrid. Pacientes y métodos. Estudio de intervención en 438 individuos ≥ 65 años con hipovitaminosis D procedentes de la «Cohorte Peñagrande». Se les pautó calcio y vitamina D y se valoró la adherencia a los 3 y 12 meses mediante el test de Morisky-Green y el recuento de recetas prescritas. Resultados. Se analizaron 413 de los 438 individuos con hipovitaminosis D (18 casos no se trataron por contraindicaciones y 7 se perdieron). A los 3 y 12 meses el 63,9 y el 47,2%, respectivamente, fueron adherentes. El 19,3% de los no adherentes a los 3 meses fueron buenos cumplidores al año tras una intervención educativa breve. La comorbilidad se asoció con menor adherencia al año (46,3% versus 35,2%, p = 0,027). La principal causa de no adherencia al calcio fue la intolerancia digestiva, y a la vitamina D, los olvidos. Se observó concordancia entre valorar la adherencia con el test de Morisky y recuento de recetas prescritas (índice Kappa = 69,8%). Conclusiones. La falta de adherencia a tratamientos crónicos con calcio y vitamina D es un problema relevante en ancianos. Es importante evaluar la adherencia y aplicar estrategias de educación sanitaria en la práctica clínica (AU)

Background and objective. The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. Patients and methods. Intervention study performed on 438 individuals ≥ 65 years from the ‘Peñagrande Cohort’ with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. Results. A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P = .027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index = 69.8%). Conclusions. Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice (AU)

[Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area]. / Evaluación de la adherencia al tratamiento con calcio y vitaminaD en ancianos de una zona básica de salud.

BACKGROUND AND OBJECTIVE: The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. PATIENTS AND METHODS: Intervention study performed on 438 individuals ≥65years from the 'Peñagrande Cohort' with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. RESULTS: A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P=.027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index=69.8%). CONCLUSIONS: Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice.

Manejo de la patología suprarrenal en Atención Primaria / Management of adrenal disorders in primary care

Las glándulas suprarrenales constituyen un órgano par situado en el espacio retroperitoneal superpuestas al polo superior renal. En las suprarrenales se distinguen 2 unidades funcionales: la corteza y la médula, con distinto origen embriológico. Las suprarrenales constituyen un sistema hormonal que regula numerosas funciones esenciales para el organismo. Los glucocorticoides tienen efectos sobre el metabolismo, sistema inmunológico, procesos de crecimiento, los mineralocorticoides controlan el balance del sodio y el potasio, regulando la presión arterial y los andrógenos suprarrenales contribuyen a la iniciación de la pubertad. En la médula adrenal se sintetizan catecolaminas que intervienen en el control de la tensión arterial y respuesta ante el estrés. El objetivo de este artículo es realizar una revisión práctica de los principales cuadros clínicos de la patología suprarrenal y que con más frecuencia se pueden observar dentro del ámbito de la Atención Primaria(AU)

The adrenal glands are made up by a paired organ in the retroperitoneal space overlapping the upper pole of the kidney. Two functional units are distinguished in the adrenal glands: the cortex and medulla, with different embryological origin. The adrenal glands make up a hormone system that regulates many essential functions for the body. The glucocorticoids have effects on the metabolism, immune system, growth processes, the mineral corticosteroids control the sodium and potassium balance, regulating the blood pressure and the adrenal androgens contribute to the initiation of puberty. In the adrenal medulla, catecholamines are synthesized, these participating in the blood pressure control and the response to stress. This article has aimed to perform a practical review of the principal clinical pictures of the adrenal disorders and that are observed within the Primary Care setting more frequently(AU)

ACTUALIZACIÓN EN MEDICINA DE FAMILIA: Manejo de la patología tiroidea en Atención Primaria I. Cribado de patología tiroidea. Hipotiroidismo / UP-DATE IN FAMILY MEDICINE: Management of thyroid disease in Primary Care I. Screening of thyroid disease. Hypothyroidism

La patología tiroidea es un trastorno muy común en la consulta de Atención Primaria. Las enfermedades del tiroides tienen una elevada prevalencia en todas las edades y especialmente en el sexo femenino. Las manifestaciones clínicas son inespecíficas y de instauración lenta, por lo que es frecuente que el diagnóstico sea casual. La sospecha clínica en la consulta de Atención Primaria es fundamental para el diagnóstico. Estos tres artículos tratan de dar una visión global sobre los problemas del tiroides y su manejo en Atención Primaria. En el primero se hablará del cribado de la patología tiroidea y del hipotiroidismo; en el segundo, del hipertiroidismo y las tiroiditis y en el tercero y último, sobre el bocio y los nódulos tiroideos (AU)

Thyroid disease is a very common disorder in Primary Carevisit. Thyroid diseases have a high prevalence in all agesand especially in the female gender. The clinical manifestationsare nonspecific and of slow establishment. Thus, itsdiagnosis is often by chance. Clinical suspicion in PrimaryCare clinic is fundamental for diagnosis.These three articles will provide an overall view on thethyroid problems and their management in Primary Care. Inthe first article, screening of thyroid disease and hypothyroidismwill be discussed. The second one will deal with hyperthyroidismand thyroiditis and the third and final onewill be on goiter and thyroid nodules (AU9