Social network, presence of cardiovascular events and mortality in hypertensive patients.

The aim of this study was to ascertain the relationship between social network and the appearance of mortality (cardiovascular events (CVEs)) in patients with arterial hypertension (AHT). This is a cohort study of 236 patients with a 9-year follow-up. Measurements included age, sex, blood pressure (BP), diabetes, hypercholesterolemia, marital status, social network, social support, stage of family life cycle (FLC), mortality and CVEs. Patients with a low social network registered higher global mortality (hazards ratio (HR) 2.6 (95% confidence interval (CI) 1.3; 5.5)) as did the oldest patients (HR 5.6 (1.9; 16.8)), men (HR 3.5 (95% CI 1.3; 9.3)) and subjects in the last FLC stages (HR 4.3 (95% CI 1.3;14.1)). Patients with low social support registered higher cardiovascular mortality (HR 2.6 (95% CI 1.1; 6.1)) as did the oldest patients (HR 12.4 (95% CI 2.8; 55.2)) and those with diabetes (HR 3.00 (95% CI 1.2; 7.6)). Patients with a low social network registered more CVEs (HR 2.1 (95% CI 1.1; 4.1)) than patients with an adequate network, as did the oldest patients (HR 3.1 (95% CI 1.4; 6.9)), subjects who presented with a higher grade of severity of AHT (HR 2.7 (1.3; 5.5)) and those in the last FLC stages (HR 2.5 (95% CI 1.0; 6.2)). A low social network is associated with mortality and the appearance of CVEs in patients with AHT. Low functional social support is associated with the appearance of cardiovascular mortality.

[Cultural adaptation and validation of the Medical Outcomes Study Social Support Survey questionnaire (MOS-SSS)]. / Adaptação cultural e validação da versão Portuguesa Questionário Medical Outcomes Study Social Support Survey (MOS-SSS).

The aim of this study was the assesment of psychometric properties of the Portuguese version of the instrument "Medical Outcomes Study - Social Support Survey (MOSSSS)". This questionnaire has been translated and adapted in a Portuguese sample of 101 patients with chronic illness of a rural health centre in Portugal. The average age of patients was 63.4 years, 56.4% female. 29% were illiterate and 2% had completed high school. 78% had arterial hypertension and the 56.4% had diabetes mellitus type 2. The internal consistency was evaluated using Cronbach's alpha. Exploratory and Confirmatory factor analysis were performed in order to confirm reliability and validity of the scale and its multidimensional characteristics. The 2-week test-retest reliability was estimated using weighted kappa for the ordinals variables and intraclass coefficient correlation for the quantitative variables. Cronbach's alphas for the subscales ranged from 0.873 to 0.967 at test, and 0.862 to 0.972 at retest. Exploratory factor analysis revealed the existence of four factors (emotional, tangible, positive interaction and affection support) that explain the 72.71% of the variance. Confirmatory factor analysis supported the existence of four factors that allowed the application of the scale with original items. The goodness-of-fit measures corroborate the initial structure, with chi2/ df=2.01, GFI=0.998, CFI=0.999, AGFI=0.998, TLI=0.999, NFI=0.998, SRMR=0.332, RMSEA=0.76. The 2-weeks test-retest reliability of the Portuguese MOS-SSS as measured by the intraclass correlation coefficient was ranged from 0.941 to 0.966 for the four dimensions and the overall support index. The weighted kappa was ranged from 0.67 to 0.87 for all the items. The MOS-SSS Portuguese version demonstrates good psychometric properties and seems to be useful to measure multidimensional aspects of social support in the Portuguese population.

[Influence of social support on patients with essential hypertension]. / Influencia del apoyo social en pacientes con hipertensión arterial esencial.

OBJECTIVE: To determine whether social support affects blood pressure control in patients diagnosed with essential Hypertension. DESIGN: Observational, prospective study, with a year's follow-up. SERRING: Mariñamansa-A Cuña Health Centre, Ourense (Galicia), Spain. PARTICIPANTS: 236 patients diagnosed with essential hypertension in health centre controls. MEASUREMENTS: During the one-year follow-up the following clinical variables were measured: age, sex, blood pressure, severity of hypertension, tobacco consumption, alcohol consumption, presence of diabetes mellitus, hypercholesterolaemia, Body Mass Index and compliance with treatment. Social and family variables were: marital status, cultural level, economic and social status, type of family, stressful vital events and social support. RESULTS: Mean age was 63.51 (62.05-64.96); 66.1% were women. Predominant kind of family was nuclear (64.3%). 30.2% had low social network (0-1 social contacts). We found 22% poor functional social support. Social support remained stable throughout the study. Hypertense patients with poor social networks had, after control for possible confusing variables, their systolic pressure 9.59 mm Hg (2.6716,51) and diastolic pressure 4.29 mm Hg (0.448.15) higher than hypertense patients with broader social networks. CONCLUSION: Hypertense patients with a poor social network had higher blood pressure figures than hypertense patients with wider social networks.

Influencia del apoyo social en pacientes con hipertensión arterial esencial / Influence of social support on patients with essential hypertension

Objetivo. Determinar si el apoyo social influye en el control de la presión arterial en pacientes diagnosticados de hipertensión arterial esencial. Diseño. Estudio observacional, prospectivo, de seguimiento a un año. Emplazamiento. Centro de saúde Mariñamansa-A Cuña. Ourense (Galicia). España. Participantes. Un total de 236 pacientes diagnosticados de hipertensión arterial esencial en control en el centro de salud. Mediciones. Durante el año de seguimiento se midieron las variables clínicas: edad, sexo, presión arterial, gravedad de la hipertensión, consumo de tabaco, consumo de alcohol, presencia de diabetes mellitus, hipercolesterolemia, índice de masa corporal y cumplimiento del tratamiento. Asimismo, se determinaron las siguientes variables sociofamiliares: estado civil, nivel cultural, nivel socioeconómico, tipo de familia, acontecimientos vitales estresantes y el apoyo social. Resultados. La edad media fue de 63,51 (rango, 62,05-64,96) años, y el 66,1 por ciento fueron mujeres. La tipología familiar predominante es la familia nuclear (64,3 por ciento).El 30,2 por ciento de los pacientes refería una baja red social (0-1 contactos sociales).Detectamos un 22 por ciento de bajo apoyo social funcional. El apoyo social se mantuvo estable a lo largo del estudio. Los hipertensos con redes sociales bajas presentan, tras controlar por las posibles variables de confusión, un incremento de la presión arterial sistólica de 9,59 mmHg (rango, 2,67-16,51) y de 4,29 mmHg (rango, 0,44-8,15) en la diastólica, respecto de los pacientes hipertensos con redes sociales más amplias. Conclusión. Los hipertensos con una baja red social presentan un incremento de las cifras de presión arterial respecto de los hipertensos con redes sociales amplias (AU)

[Cryotherapy with nitrous oxide in primary care]. / Crioterapia con óxido nitroso en atención primaria.

OBJECTIVE: To study the efficacy, tolerance and safety in primary care of the cryotherapy technique using nitrous oxide. Design. Descriptive, observational and transversal study. SETTING: Mariñamansa-A Cuña Health Centre, Ourense. PARTICIPANTS: All the patients who consulted for cutaneous lesions caused by cryotherapy between March and April 2000 (n=130). MAIN MEASUREMENTS: Age, sex, diagnosis, location, size of lesion, duration of application of the cryogenic agent, previous treatment, side-effects observed, and evolution of the lesion. RESULTS: Mean age was 36.65 (95% CI, 32.57-40.74), of whom 53.8% (95% CI, 44.80-62.50) were women. The most common lesions were common warts (68.5%), actinic Keratosis (12.3%) and plantar warts (7.7%). We found that most lesions were located on an upper limb (50.8%). The mean size of lesions was 8.65 mm2 (95% CI, 4.50-12.80). 69.7% of warts were scraped prior to cryotherapy; and 16.2% received prior keratolysis. We found no side-effects in 32.3% of the patients; the commonest side-effect detected was blisters. Mean number of cryotherapy sessions was 2.82 (95% CI, 2.39-3.29). The technique was tolerated well in 83.8% of cases. We found total cure in 87.7%. Most of the cutaneous lesions that failed were common warts. CONCLUSIONS: Nitrous oxide is effective in most lesions caused by cryotherapy. The technique is tolerated well, can be handled easily and can be used in primary care.

Variables familiares asociadas al incumplimiento de las citas programadas en pacientes con hipertensión arterial / Family variables linked to non-compliance with schedule appointments of patients with hypertension

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Crioterapia con óxido nitroso en atención primaria / Cryotherapy with nitrous oxide in primary care

Objetivo. Estudiar la eficacia, tolerancia y seguridad de la técnica de crioterapia con óxido nitroso en atención primaria. Diseño. Estudio descriptivo observacional, transversal. Emplazamiento. Centro de Saúde Mariñamansa-A Cuña, Ourense. Participantes. Todos los pacientes que consultaron por lesiones cutáneas subsidiarias de crioterapia entre marzo y abril de 2000 (n = 130).Mediciones principales. Edad, sexo, diagnóstico, localización, tamaño de la lesión, tiempo de aplicación del agente criogénico, tratamiento previo, secundarismos observados y evolución de la lesión. Resultados. La edad media fue de 36,65 años (IC del 95 per cent, 32,57-40,74); un 53,8 per cent (IC del 95 per cent, 44,80-62,50) eran mujeres. Las lesiones más frecuentes fueron verrugas vulgares (68,5 per cent), queratosis actínica (12,3 per cent) y verrugas plantares (7,7 per cent).Observamos que la mayoría de las lesiones se localizó en miembro superior (50,8 per cent). El tamaño medio de las lesiones fue de 8,65 mm2 (IC del 95 per cent, 4,50-12,80). Se realizó raspado previo a la crioterapia en el 69,7 per cent de las verrugas y un 16,2 per cent recibió queratolítico previo. No observamos secundarismos en el 32,3 per cent de los pacientes; de los secundarismos detectados el más frecuente fue la ampolla. La media de sesiones de crioterapia fue de 2,82 (IC del 95 per cent, 2,39-3,29). La técnica fue bien tolerada en el 83,8 per cent de los casos. Obtuvimos una curación global de un 87,7 per cent; las lesiones cutáneas que fracasan son sobre todo verrugas vulgares. Conclusiones. El óxido nitroso es eficaz en la mayoría de los lesiones subsidiarias de crioterapia y es una técnica bien tolerada y de fácil manejo que puede aplicarse en atención primaria (AU)

[Environmental stress and cardiovascular reactivity: the effect of stressful life events on hypertense patients]. / Estrés ambiental y reactividad cardiovascular: la influencia de los acontecimientos vitales estresantes en pacientes hipertensos.

OBJECTIVE: To assess the effect of stressful life events (SLE) on the monitoring of patients with essential hypertension. DESIGN: Observational and prospective. SETTING: Primary care. PARTICIPANTS: 236 hypertense patients selected by systematic randomised sampling. MEASUREMENTS: Age, sex, marital status, cultural level, kind of family, presence of SLE, social support, blood pressure, severity of hypertension, tobacco consumption, alcohol, presence of diabetes, hypercholesterolaemia, body mass index, compliance with hypertension treatment. RESULTS. Mean age was 63.51 (62.05; 64.96), with 66.1% being women and 33.9% men. 48.7% of the patients referred to some SLE during the follow-up. These reached a mean of 47.65 (33.16; 62.15) life change units (LCU). Patients with high-impact SLE (>150 LCU) had a significant increase of 10.91 mm Hg (0.43; 21.40) in their systolic blood pressure and of 9.48 beats per minute (3.78; 15.19) in their heart rate, after monitoring for possible factors of confusion. We observed a similar trend for diastolic pressure, but this did not reach statistical significance. CONCLUSION: The presence of SLE has a negative effect on systolic blood pressure in hypertense patients.

Estrés ambiental y reactividad cardiovascular: la influencia de los acontecimientos vitales estresantes en pacientes hipertensos / Environmental stress and cardiovascular reactivity the effect of stressful life events on hypertense patients

Objetivo. Valorar el efecto de los acontecimientos vitales estresantes (AVE) sobre el control de pacientes con hipertensión arterial esencial. Diseño. Observacional y prospectivo. Emplazamiento. Atención primaria. Participantes. Un total de 236 hipertensos seleccionados por muestreo aleatorio sistemático. Mediciones. Edad, sexo, estado civil, nivel cultural, tipo de familia, presencia de AVE, apoyo social, presión arterial, gravedad de la hipertensión, consumo de tabaco, alcohol, presencia de diabetes, hipercolesterolemia, índice de masa corporal y cumplimiento del tratamiento antihipertensivo. Resultados. La media de edad fue de 63,51 años (62,05-64,96), siendo la mayoría mujeres (66,1 por ciento). Un 48,7 por ciento de los pacientes refirieron algún AVE durante el seguimiento, y éstos alcanzaron una media de 47,65 (33,16-62,15) unidades de cambio vital (LCU). Los pacientes con AVE de alto impacto (>150 LCU) presentaron un incremento significativo de 10,91 mmHg (0,43-21,40) en la presión arterial sistólica y de 9,48 lat/min (3,78-15,19) en la frecuencia cardíaca, tras controlar por los posibles factores de confusión. Asimismo, observamos una tendencia similar respecto de la presión arterial diastólica, pero sin alcanzar significación estadística. Conclusiones. La presencia de AVE empeora el control de la presión arterial sistólica en pacientes hipertensos (AU)

[Comparison of family physicians' and gynecologists' use of the intrauterine device (IUD)]. / Comparación en el uso del dispositivo intrauterino (DIU) entre médicos de familia y ginecólogos.

OBJECTIVE: To quantify differences between general practitioners (GPs) and gynaecologists in the technique of insertion and follow-up of the intra-uterine device (IUD). DESIGN: Multicentred, descriptive, longitudinal study. SETTING: Two urban health centres and a family guidance clinic. PARTICIPANTS: Target population (n = 1700) between January 1993 and January 1996. Estimated mean of complications was 25%. Sample size was 247 for alpha = 0.05 and 1-alpha = 0.95. The sample was extended to 300 to allow for possible losses of files, estimated at 20%. MEASUREMENTS AND MAIN RESULTS: The variables age, sex, marital status, educational level, parity, abortions, previous contraception, type of job, type of IUD, post-insertion and follow-up complications, subjective evaluation, removal and average follow-up time, were analysed. 158 (54.9%) of the 288 IUDs finally studied were inserted by GPs, and 130 (45.1%) by gynaecologists. 69.5% were anchor-shaped, and 30.5% T-shaped. In 85.5% no immediate complications were found. Mean follow-up time was 22.67 months (CI 95%, 21.3-24.0), during which time 36.6% had complications detected, which led to removal of the device in 22.3% of complications. We found no statistically significant differences between the two populations for age, marital status, subjective evaluation, number of abortions, parity or previous contraception. Likewise, no differences between G.P.s and gynaecologists were detected for post-insertion or follow-up complications, percentage of IUDs removed, or period of time evaluated. There were differences found for the type of IUD used, with more anchor-shaped IUDs in primary care. There were no differences for the type of IUD or complications requiring its removal. CONCLUSIONS: In the population studied we found no differences in immediate or later complications between IUDs inserted by GPs and by gynaecologists.

[Validation of the chronometer test as a method of screening for hypoacusis in patients aged 65 years and older]. / Validación del test del cronómetro como método de cribaje de hipoacusias en pacientes de más de 65 años.

OBJECTIVE: Evaluation of the chronometry test as a screening procedure for hypoacusia compared with tonal audiometry, in patients over 65 years. DESIGN: Cross-sectional study. SETTING: Mariañamansa health area (Ourense). PATIENTS: The first 49 patients over 65 who came to the medical consultations in June and July 1992 were selected, irrespective of the reasons for their visit; there were 17 males and 32 females, with and average age of 72.4 +/- 4.6 and 71.9 +/- 4.5. Only one patients consulted directly about loss of hearing. MEASUREMENTS AND MAIN RESULTS: A statistically significant association was found between the chronometry test and the audiometry test (gold-standard), significant at p < 0.005 for the left ear and p < 0.05 for the right ear. The test achieved a sensitivity of 0.85 and specificity of 0.76 in the case of the left ear, and 0.84 (sensitivity) and 0.56 (specificity) for the right ear. The kappa rate was 0.55 for the right ear and 0.67 for the left ear, showing agreement that went well beyond chance. CONCLUSIONS: In our view, the chronometry test constitutes an cheap, effective, simple, and replicable procedure for the detection of hypoacusia in patients aged over 65, and one which can usefully be used when no audioscope is available.

[Urethral duplication: apropos a case]. / Duplicidad uretral: a propósito de un caso.

We report a case of dorsal blind-ending urethral duplicity in a 37-year-old male who presented dysuria and occasional mucopurulent discharge. The presumptive diagnosis was made on the findings at physical examination and was corroborated by retrograde urethrography. The patient was treated conservatively because the symptoms were minimal.