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BACKGROUND: Oral lichen planus (OLP) is an inmuno-mediated mucocutaneous chronical inflammatory disease. Multiple predisposing factors are considered, such as autoimmune response, microorganisms, medications, dental materials, psychological stress, genetic predisposition or nutritional deficiencies. The deficiency of vitamin D has been related to various autoimmune diseases like OLP. MATERIAL AND METHODS: The electronic search was conducted in the MEDLINE (Pubmed), Scopus, Cochrane Library and Web of Science databases. To assess any potential risk of bias, the authors critically appraised each study by the Newcastle-Ottawa Scale for cohort and case-control studies. Pooled analyses were performed using a random-effects model. Heterogeneity of the studies was assessed by the I2 statistics. Forest Plots were performed to graphically represent the difference between vitamin D concentrations in the OLP compared to healthy group, with a 95% confidence interval. RESULTS: After applying our inclusion and exclusion criteria, 7 articles were included in our review. The median concentration vitamin D in ng/ml found in serum for patients with OLP was of 26,6311,75ng/ml and for healthy patients was of 31,438,7ng/ml. Regarding the quantitative analysis, 7 studies were included. The difference in the concentration of vitamin D in healthy patients and patients with OLP statistically significant (Weighted Mean Difference (WMD): -6.20, 95% CI: -11.24 to -1.15, p=0.02 and I2 heterogeneity: 94%, p<0.00001). CONCLUSIONS: The patients with OLP have statistically lower vitamin D levels than healthy patients.
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BACKGROUND: Traditional protocols for implant surgery suggest a healing period of 2-3 months from dental extraction to implant placement. Based on all the volumetric modifications produced by that approach, there are authors who advocate for immediate implantology. The aim of the present study was to determine the prevalence of different sockets, and the dimensions of the bone around the upper anterior incisors and canines, to determine the predictability of immediate implants in our population. MATERIAL AND METHODS: This is an observational, cross-sectional study based on cone-beam computed tomography images of the anterior maxila of patients attending the Odontological Hospital of the University of Barcelona (OHUB) and requesting for implant treatment. Different measurements were performed on every analyzed tooth, and also they were categorized by using the main dental sockets classifications. RESULTS: Bone attachment levels and cortical thickness are lower in women compared to men in all three types of teeth (the difference in the bone attachment levels ranges from 4.68%-8.63% and in the bone thickness goes from 0.02-0.58mm). Bone attachment level gradually reduces with age. The reductions observed in all the measurements are higher in the case of canines, compared with the other teeth. The differences from patients <45 years old and patients between 55-64 years old are 13.58±14.55mm in the case of central incisors, 10.04±5.52 in the case of lateral incisors and 22.39±13.65mm in the case of canines. CONCLUSIONS: According to our results, the canines are the teeth with the greatest complexity when it comes to immediate implantology treatments. Furthermore, that kind of treatment is more complex as age increases, since we observed a gradual percentage of unfavourable sockets in older patients.
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Alvéolo Dental , Humanos , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Alvéolo Dental/cirurgia , Adulto , Idoso , Adulto Jovem , Carga Imediata em Implante Dentário , Tomografia Computadorizada de Feixe CônicoRESUMO
BACKGROUND: Recurrent Aphtous Stomatitis (RAS) is the most common process affecting the oral mucosa. It is painful, multifactorial and generally recurrent. The aim of this systematic review is to know the last treatment approaches and their effectivity. MATERIAL AND METHODS: we compared the outcome of different kind of treatments in terms of the improvement of the lesions, reduction of the size of those lesions and the time needed for their healing. Inclusion criteria were: clinical trials, articles written in English or Spanish and published less than 5 years ago. RESULTS: we used the following keywords: "treatment", "aphtous stomatitis", "canker sores"; combined with Boolean operators AND y OR. We selected 28 articles for reading the whole text, and after applying the eligibility criteria, we selected 17 articles for our revision. Among all the treatments, we emphasize the barrier method based in compound of cellulose rubber and a calcium/sodium copolymer PVM/MA, with which the difference in the 3rd and 7th day was of -6,29 ± 0,14 points in the pain score. The treatment with insulin and chitosan gel, brought a pain suppression on the third day, with no reactivation of the pain during the whole study. The application of a film composed of polyurethane and sesame oil with chitosan, brought a reduction in the size of the lesions of 4,54 ± 2,84mm on the 6th day compared with the situation before the beginning of the treatment. The different kinds of laser, which produced a reduction in the pain score just at the beginning of the treatment up to 8,1 ± 1,6 points, and a reduction of the size of the lesions of 4,42 ± 1,02mm on the 7th day. CONCLUSIONS: Besides the classic treatments for RAS, we have to take into account other treatment modalities, above all the different kinds of laser.
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Quitosana , Estomatite Aftosa , Estomatite , Humanos , Estomatite Aftosa/tratamento farmacológico , Mucosa Bucal , DorRESUMO
Introducción: Las enfermedades periodontales necrotizantes son cuadros agudos que se acompañan de signos y síntomas locales y sistémicos que se caracterizan por la necrosis de tejidos gingivales, periodontal, pudiendo incluir otros tejidos orales dependiendo de la severidad de la infección. En esta revisión sistemática queremos evaluar cuáles son los factores predisponentes de mayor relevancia para el desarrollo de estas infecciones, así como las medidas terapéuticas más efectivas para tratarlas. Material y métodos: Realizamos una búsqueda bibliográfica en tres bases de datos (PubMed, Cochrane y Scopus) de los últimos 10 años. Se usaron las siguientes palabras clave: necrotisingulcerative gingivitis, necrotising ulcerative periodontitis, necrotising ulcerative stomatitis y aetiology; combinados con los operadores boleanosAND y OR. Resultados: Después de aplicar los criterios de exclusión, quedan 19 artículos. Entre los factores de riesgo más importantes encontramos la malnutrición severa, la mala higiene oral y los depósitos de placa dental, las infecciones previas y los cuadros de inmunosupresión. En cuanto a las intervenciones terapéuticas, la literatura destaca el desbridamiento supra y subgingival. La terapia farmacológica más utilizada es el metronidazol como monoterapia o combinado con amoxicilina. Los coadyuvantes más empleados fueron los colutorios de clorhexidina y el peróxido de hidrógeno. Conclusiones: Las enfermedades periodontales necrotizantes son entidades de etiología mayormente bacteriana inespecífica que están sujetas a factores causales que afectan al estado general del paciente. El tratamiento de las mismas se basa en el control de los factores de riesgo a la vez que se soluciona la infección. (AU)
Introduccion: Periodontal necrotising diseases are acute conditions accompanied by local and systemic signs and symptoms characterised by gingival tissues necrosis; however, they can include periodontal or other oral tissues depending on the severity of the infection. In this systematic review we want to evaluate which are the most relevant predisposing factors for the development of these infections, as well as the therapeutic approaches that have shown affectivity against them. Material and methods: A bibliographic search of the last 10 years was conducted in three databases (PubMed, Cochrane y Scopus). We used the following keywords: necrotising ulcerative gingivitis, necrotising ulcerative periodontitis , necrotising ulcerative stomatitis y aetiology; combining them with Boolean operators (AND and OR). Results: After applying the exclusion criteria, 19 papers remained. Among the most important risk factors we found severe malnutrition, the bad oral hygiene and deposits of tartar, previous infections and immunosuppression. Regarding to therapeutic interventions, literature highlights supragingival and subgingival debridement. The most used pharmacological strategy is monotherapy with metronidazole or combined with amoxicillin. The most used adjuvant treatments are chlorhexidine and peroxide mouthwashes. Conclusions: Periodontal Necrotising diseases are entities which have a mainly unspecific bacterial cause and depend on causative factors that affect to patient's general state. Their treatment is based on the control of risk factors while we solve the infection. (AU)
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História do Século XXI , Doenças Periodontais/tratamento farmacológico , Fatores de Risco , Prevalência , Doenças Periodontais/terapia , Bases de Dados Bibliográficas , Bases de Dados como AssuntoRESUMO
OBJETIVO: Conocer las aptitudes percibidas por los médicos de familia como competencia en la atención a las personas inmigrantes. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal con recogida de datos mediante encuesta de 21 preguntas cumplimentada electrónicamente por médicos de familia y validada por la Comisión Nacional de Validación de SEMERGEN. Se estructuró con preguntas tipo test, cerradas, de opción múltiple de respuesta, incluyendo variables relacionadas con el médico y variables relacionadas con el paciente inmigrante. El grado de competencia profesional se valoró con una escala Likert, de 1 a 10. RESULTADOS: Respondieron la encuesta 610 médicos de familia, con una edad media de 47,5± 12,3 años; 64,1% mujeres. De ellos, 112 (18,4%) estaban en periodo de residencia. Tasa de respuesta 4,9%. El 72,6% no había realizado cursos de formación continuada en atención a personas inmigrantes en los últimos 5años. Los médicos contestaron que percibieron dificultad en la consulta: en el 73% de los casos con el idioma, en el 38,7% con el tiempo asignado y en el 32,3% con el conocimiento de la cultura. El 96,9% de los pacientes asistió a consulta por enfermedad común. En el 14,4% la causa estaba relacionada con el proceso migratorio (enfermedad infecciosa adquirida en el país de origen) y en el 26,4% con las condiciones de salud en el país de acogida (falta de vivienda estable, hacinamiento y condiciones de trabajo). El grado de competencia percibido fue de 6,2 ±1,9. CONCLUSIONES: La competencia percibida por el médico de familia en la atención a personas inmigrantes es moderada. Las barreras más importantes para estos profesionales son el desconocimiento del idioma, la falta de tiempo asignado para la consulta y el desconocimiento de la cultura del paciente
OBJECTIVE: To identify the skills perceived by general practitioners for providing competent care to immigrants MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection using a 21-item questionnaire completed electronically by the general practitioners and validated by the National Validation Commission of SEMERGEN. It was structured with closed-ended, multiple-choice test questions, including variables related to the doctor and variables related to the immigrant patient. The level of professional competence was assessed using a 1 to 10 Likert scale. RESULTS: A total 610 family physicians with a mean age of 47.5±12.3 years responded and 64.1% were women. Of these, 112 (18.4%) were residents. The response rate was 4.9%. A large majority (72.6%) had not taken part in continuing education courses on caring for immigrants in the last 5years. Participants reported difficulties in the clinic: 73% of the cases with the language, 38.7% with the allotted time, and 32.3% due to knowledge of the culture. Most (96.9%) of patients attended the clinic due to a common illness. The cause in 14.4% was related to the migratory process (infectious disease acquired in the country of origin), and in 26.4% with the health conditions in the host country (lack of stable housing, overcrowding, and conditions of work). The perceived level of competence was 6.2±1.9. CONCLUSIONS: The competence perceived by general practitioners in providing care to immigrants is moderate. The most important barriers for these professionals are ignorance of the language, lack of time allocated for consultation, and ignorance of the patient's culture
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Assistência à Saúde Culturalmente Competente , Emigração e Imigração , Competência Profissional , Competência Cultural , Médicos de Família , Aptidão , Estudos TransversaisRESUMO
OBJECTIVE: To determine the prevalence of hypotension and associated factors in hypertensive patients treated in the Primary Care setting. MATERIALS AND METHODS: A cross-sectional, descriptive, and multicentre study was conducted with a total of 2635 general practitioners consecutively including 12,961 hypertensive patients treated in a Primary Care setting in Spain. An analysis was performed on the variables of age, gender, weight, height, body mass index, waist circumference, cardiovascular risk factors (diabetes, dyslipidaemia, smoking, obesity, sedentary lifestyle), fasting plasma glucose, complete lipid profile, as well as the presence of target organ damage (left ventricular hypertrophy, microalbuminuria, carotid atherosclerosis) and associated clinical conditions. Hypotension was defined as a systolic blood pressure less than 110mmHg or a diastolic blood pressure less than 70mmHg. A multivariate analysis was performed to determine the variables associated with the presence of hypotension. RESULTS: The mean age was 66.2 years, and 51.7% of patients were women. The mean time of onset of hypertension was 9.1 years. A total of 13.1% of patients (95% confidence interval 12.4-13.6%) had hypotension, 95% of whom had low diastolic blood pressure. The prevalence of hypotension was higher in elderly patients (25.7%) and in those individuals with coronary heart disease (22.6%). The variables associated with the presence of hypotension included a history of cardiovascular disease, being treated with at least 3 antihypertensive drugs, diabetes, and age. CONCLUSIONS: One out of 4-5 elderly patients, or those with cardiovascular disease, had hypotension. General practitioners should identify these patients in order to determine the causes and adjust treatment to avoid complications
OBJETIVO: Determinar la prevalencia de hipotensión y los factores asociados en pacientes hipertensos tratados en atención primaria. MATERIAL Y MÉTODOS: Estudio transversal, descriptivo y multicéntrico; 2.635 médicos generales incluyeron consecutivamente a 12.961 pacientes hipertensos tratados y atendidos en atención primaria en España. Fueron analizados: edad, sexo, peso, altura, índice de masa corporal, perímetro de cintura, factores de riesgo cardiovascular (diabetes, dislipidemia, tabaquismo, obesidad, sedentarismo), glucemia en ayunas, perfil de lípidos, así como la presencia de daño en órgano diana (hipertrofia ventricular, microalbuminuria, aterosclerosis carotídea) y enfermedades clínicas asociadas. La hipotensión se definió como presión arterial sistólica inferior a 110mmHg o presión arterial diastólica inferior a 70mmHg. Se realizó un análisis multivariante para determinar las variables asociadas a la presencia de hipotensión. RESULTADOS: La edad media fue de 66,2 años, un 51,7% de los pacientes eran mujeres. La antigüedad de la hipertensión fue de 9,1 años. Un 13,1% de los pacientes (intervalo de confianza del 95%: 12,4-13,6%) tenían hipotensión, de los cuales el 95% era presión arterial diastólica baja. La prevalencia de hipotensión fue mayor en pacientes de edad avanzada (25,7%) y en individuos con enfermedad coronaria (22,6%). Las variables asociadas con la presencia de hipotensión incluyeron los antecedentes de enfermedad cardiovascular, pacientes tratados con al menos 3 fármacos antihipertensivos, diabetes y edad. CONCLUSIONES: Uno de cada 4-5 pacientes de edad avanzada o con enfermedad cardiovascular tenía hipotensión. Los médicos generales deben identificar a estos pacientes para determinar las causas y ajustar el tratamiento para evitar complicaciones
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Doenças Cardiovasculares/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Fatores Etários , Anti-Hipertensivos/efeitos adversos , Pressão Arterial/fisiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Prevalência , Primeiros Socorros , Fatores de Risco , Espanha/epidemiologiaRESUMO
OBJETIVO: Estudiar si los parámetros basales de la espirometría forzada pueden influir en la positividad de la prueba de broncodilatación (PBD) y si esto pudiera influir en futuros criterios de positividad. MATERIAL Y MÉTODOS: Estudio descriptivo transversal multicéntrico con emplazamiento en Atención Primaria. Fueron incluidos todos los pacientes derivados por su médico de familia, para la realización de espirometría forzada por tabaquismo, síntomas respiratorios o seguimiento de enfermedades respiratorias, entre los meses de junio de 2015 y febrero de 2017. A todos ellos se les realizó una espirometría forzada con PBD. RESULTADOS: Se incluyeron 295 pacientes, con una edad media de 53,4+/-15,5 años, el 62% fueron hombres. En el 20% de las espirometrías se obtuvo un patrón obstructivo; presentando el 67,5% una obstrucción leve, 18% moderada, 9,6% moderada-grave y un 4,8% muy grave. El 8,8% de las espirometrías obtuvieron PBD positiva; 11,2% fueron positivas únicamente en volumen y el 17,6% fueron positivas únicamente en porcentaje. Se observó que los pacientes con una PBD positiva en porcentaje presentaban de forma basal menor volumen espiratorio forzado en el primer segundo (1,66 l/sg vs.2,74 l/sg; p <0,001), y menor capacidad vital forzada (2,85 l vs.3,73 l; p < 0,001). Los pacientes con PBD positiva en volumen presentaban menor volumen espiratorio forzado en el primer segundo (2,59 l/sg vs.2,62 l/sg; p <0,001), y mayor capacidad vital forzada (3,89 l vs.3,58 l; p < 0,001). CONCLUSIONES: El volumen espiratorio forzado en el primer segundo y la capacidad vital forzada basales influyen en la positividad de la PBD. Debería valorarse esta circunstancia a la hora de establecer los criterios de positividad de la PBD
OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4+/-15.5 years, and 62% were male. An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs.2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs.2.62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs.3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Broncodilatadores/administração & dosagem , Pneumopatias/diagnóstico , Atenção Primária à Saúde , Espirometria/métodos , Estudos Transversais , Capacidade VitalRESUMO
INTRODUCCIÓN Y OBJETIVOS: El sobrepeso y la obesidad predisponen a la enfermedad cardiovascular y a la mortalidad general. No está claro qué índices de obesidad se deben utilizar en clínica. El objetivo es examinar la relación entre el índice de masa corporal (IMC), la circunferencia de la cintura (C-cintura), el cociente cintura/talla (cociente-CT) y el índice de conicidad (I-conicidad) con el riesgo cardiovascular (RCV) a 10 años estimado por la ecuación de Framingham. MATERIAL Y MÉTODOS: Estudio transversal poblacional en ≥ 18 años del Área Sanitaria de Toledo. Selección por muestreo aleatorio. Medición de IMC, C-cintura, talla y peso con métodos estandarizados. RCV Framingham. Cálculo de áreas bajo la curva ROC (ABC) y puntos de corte óptimo. RESULTADOS: Se analizaron 1.309 personas, con edad media de 48,9 ± 15,8años; el 55% fueron mujeres. Tasa de respuesta: 36,6%. En mujeres, el índice que mejor se asoció con el RCV ≥ 10% es el cociente-CT con ABC = 0,85 (IC95%: 0,81-0,88). En hombres es el I-conicidad, con ABC = 0,81 (IC95%: 0,77-0,84). Puntos de corte: para IMC similar en mujeres (27,08 kg/m2) y hombres (26,99 kg/m2). Para C-cintura, inferior en mujeres (87,75 cm) que en hombres (94,5 cm). Para cociente-CT, superior en mujeres (0,59) que en hombres (0,56). Para I-conicidad, ligeramente inferior en mujeres (1,25) que en hombres (1,28). En mujeres, todas las curvas ROC estuvieron más próximas entre sí. CONCLUSIONES: Los índices de obesidad central (C-cintura y cociente-CT) discriminan el RCV mejor que el IMC. En mujeres, todos los índices tienen mayores áreas bajo la curva que en los hombres, excepto el I-conicidad
INTRODUCTION AND OBJECTIVES: Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS: Population cross-sectional study in subjects ≥ 18 years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS: The study included 1,309 subjects, with mean age of 48.9 ± 15.8 years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC = 0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC = 0.81 (95% CI: 0.77-0.84). Cut points for BMI were similar in women (27.08 kg/m2) and men (26.99 kg/m2). The WC was lower in women (87.75 cm) than in men (94.5 cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS: The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doenças Cardiovasculares/etiologia , Obesidade Abdominal/epidemiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Antropometria , Índice de Massa Corporal , Estudos Transversais , Obesidade/fisiopatologia , Obesidade Abdominal/fisiopatologia , Sobrepeso/fisiopatologia , Circunferência da Cintura/fisiologia , Razão Cintura-Estatura , Fatores de Risco , Fatores SexuaisRESUMO
Parece necesario que las sociedades científicas de AP, ámbito en el cual la prevalencia de HTA es considerable, evalúen periódicamente las directrices internacionales para el manejo de la HTA, sobre todo ante recomendaciones dispares que dificultan la toma de decisiones, en la práctica clínica diaria. El presente documento tiene como objetivo analizar los cambios y novedades propuestos en la guía del American College of Cardiology y de la American Heart Association (ACC/AHA 2017) y en la guía de la European Society of Cardiology y de la European Society of Hypertension (ESC/ESH 2018). Además, analizar las posibles diferencias, limitaciones y su aplicabilidad a la AP de España. En definitiva, se trata de extraer la información más relevante disponible y pertinente, e integrarla para homogeneizar la asistencia al paciente hipertenso desde una perspectiva crítica, pero también razonada. Las discrepancias entre ambas GPC en aspectos tan trascendentales como el manejo de la enfermedad obligan a la recopilación y análisis crítico de la información que nos permita tomar posición como sociedad científica, interesada en trasladar a todos los médicos de AP las recomendaciones más relevantes, pero a la vez sensatas, de ambas GPC
The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines
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Humanos , Hipertensão/terapia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/organização & administração , Médicos de Atenção Primária/organização & administração , Sociedades Médicas , EspanhaRESUMO
No disponible
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Humanos , Masculino , Feminino , Adulto , Emigrantes e Imigrantes , Malária/diagnóstico , Viagem , Nigéria , EspanhaRESUMO
Objetivo. Conocer la fiabilidad en la interpretación del electrocardiograma (ECG) por médicos de familia en ejercicio y médicos residentes en periodo de formación, utilizando para ello la comparación con la interpretación realizada por el cardiólogo. Material y métodos. Estudio observacional. Se incluyeron médicos de familia en ejercicio del Área de Salud de Toledo, médicos internos residentes de Medicina Familiar y Comunitaria y los médicos internos residentes de Cardiología de los 3 años iniciales del periodo formativo (R1-R3). Se utilizó un cuestionario con 13 ECG sin datos clínicos del paciente. Los 13 ECG fueron seleccionados y sus diagnósticos consensuados por 2 cardiólogos del Complejo Hospitalario de Toledo. Resultados. El porcentaje de respuestas correctas más alto (82,3%) correspondió al ECG 5 (fibrilación auricular), y el más bajo (26,5%), al ECG 11 (ritmo de la unión). La competencia diagnóstica más alta fue alcanzada por los médicos residentes de Cardiología, los médicos de familia en ejercicio, los tutores de residentes y los médicos con trabajo en el Servicio de Urgencias del hospital. Los valores más altos de odds ratio para una mayor competencia diagnóstica fueron trabajar en el Servicio de Urgencias y ser médico de familia en ejercicio, ambas con resultados casi significativos (p<0,10). Conclusiones. Los médicos de familia y los médicos residentes tienen un grado de fiabilidad medio en la interpretación del ECG con relación al cardiólogo
Objective. To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. Material and methods. An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. Results. The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). Conclusions. Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Eletrocardiografia , Médicos de Família/educação , Internato e Residência , Atenção Primária à Saúde , Medicina de Família e Comunidade/educação , Eletrocardiografia/estatística & dados numéricos , Inquéritos e Questionários , Espanha , Educação MédicaRESUMO
Introducción. El objetivo fue investigar prevalencias de factores de riesgo cardiovascular (FRCV), lesión de órgano diana (LOD) y enfermedad cardiovascular (ECV) en población general del Área Sanitaria de Toledo para determinar el riesgo cardiovascular (RCV). Material y métodos. Estudio epidemiológico observacional que analizó una muestra de población general ≥18años seleccionada de la base de datos de tarjeta sanitaria por muestreo aleatorio sistemático estratificado por sexo y grupos de edad. Se realizaron anamnesis, exploración clínica y pruebas complementarias, congelándose a −85°C alícuotas de sangre total y suero para valorar posibles estudios genéticos. Se realizó análisis estadístico estándar. El RCV se estimó con las escalas del Proyecto SCORE calibrada para población española y del Framingham Heart Study. Resultados. Se incluyeron a 1.500 individuos (edad media 49,1±15,8años; 55,6% mujeres). Prevalencias: dislipemia 56,9% (intervalo de confianza al 95% [IC95%]: 54,3-59,4), hipertensión arterial 33,0% (IC95%: 30,6-35,4), diabetes mellitus 8,6% (IC95%: 7,17-10,1), tabaquismo 24,2% (IC95%: 22,0-26,4), obesidad 25,3% (IC95%:23,1-27,5) y sedentarismo 39,4% (IC95%: 36,9-41,8). El 21,1% no mostró ningún FRCV y el 18,6% presentó de 3 a 5. LOD: hipertrofia ventricular izquierda electrocardiográfica 4,3%, arteriopatía periférica con eco-doppler10,1% y con dispositivo oscilométrico 15,3%, microalbuminuria 4,3%, enfermedad renal oculta 3,2% y nefropatía 3,8% (CKD-EPI). El 9,2% padecía alguna ECV. El 44,6% mostró RCV (SCORE) bajo. Conclusiones. De cada 10 personas, 6 presentan dislipemia, 4 sedentarismo, 3 hipertensión, 2 tabaquismo, 2 obesidad, y casi una diabetes. Más de la mitad de los individuos muestran RCV moderado-alto-muy alto y las prevalencias de LOD y ECV son importantes
Introduction. The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. Material and methods. Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at −85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. Results. A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. Conclusions. Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Doenças Cardiovasculares/complicações , Hiperlipidemias/epidemiologia , Fumar/epidemiologia , Comportamento Sedentário , Obesidade/epidemiologia , Doenças Cardiovasculares/mortalidade , Anamnese/métodos , 28599 , Intervalos de Confiança , Espanha , Doenças CardiovascularesRESUMO
Introducción. El objetivo principal es conocer en la población del Área Sanitaria de Toledo las prevalencias de factores de riesgo cardiovascular (FRCV), lesión de órgano diana (LOD) y enfermedad cardiovascular (ECV), así como los hábitos de vida (ejercicio físico y consumo de alcohol y de dieta mediterránea), para determinar el riesgo cardiovascular (RCV). Material y métodos. Estudio epidemiológico observacional que analizará una muestra de población general≥ 18 años seleccionada de la base de datos de tarjeta sanitaria por muestreo aleatorio sistemático estratificado por sexo y grupos de edad. Se realizarán anamnesis, exploración clínica y pruebas complementarias, y se congelarán a -85°C alícuotas de sangre total y suero para valorar futuros estudios genéticos. El RCV se estimará con las escalas del proyecto SCORE calibrada para población española y del Framingham Heart Study. Alcanzado el tamaño muestral estimado y transcurridos al menos 5 años de la inclusión, se realizará seguimiento de la muestra final de sujetos, analizando la evolución de FRCV, LOD, ECV y del control de FRCV, y los eventos sucedidos mortales y no mortales. Discusión. El estudio RICARTO pretende conocer las prevalencias de los principales FRCV, LOD y ECV, para determinar el RCV de la población general del Área Sanitaria de Toledo, y realizar un seguimiento de la muestra final de individuos cuando hayan transcurrido al menos 5 años de la inclusión para analizar la incidencia de eventos cardiovasculares y la evolución temporal de los estilos de vida, las prevalencias de FRCV, LOD y ECV
Introduction. The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). Material and methods. Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of -85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. Discussion. The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Exercício Físico , Hipertensão/epidemiologia , Dislipidemias/epidemiologia , Estilo de Vida Saudável , Dieta Saudável/métodos , Estudos Epidemiológicos , 35513 , Obesidade Abdominal/epidemiologia , Alcoolismo/epidemiologia , Dieta Mediterrânea , Análise de VariânciaRESUMO
Objetivos. Conocer las diferencias entre comunidades autónomas en el grado de control de los pacientes con fibrilación auricular no valvular, tratados con antagonistas de la vitamina K, incluidos en el estudio PAULA. Métodos. Estudio observacional retrospectivo/transversal. Participaron 139 investigadores de 99 centros de salud de todas las Comunidades Autónomas (excepto La Rioja). El grado de control se determinó mediante tiempo en rango terapéutico, por método directo (mal control<60%), y por Rosendaal (mal control<65%). Resultados. Fueron incluidos 1.524 pacientes. Se observaron pequeñas diferencias entre las características basales de los pacientes. Se apreciaron diferencias en el porcentaje de tiempo en rango terapéutico, según el método Rosendaal (media 69,0±17,7%), desde 78,1%±16,6 (País Vasco) a 61,5%±14 (Baleares), según método directo (media 63,2±17,9%), desde 73,6%±16,6 (País Vasco) al 57,5%±15,7 (Extremadura). Al comparar comunidades, donde el médico de familia asume de forma integral el control y no existen restricciones a la prescripción, el porcentaje de tiempo en rango terapéutico por el método directo fue 63,89 frente 60,95%, en las que sí existen (p=0,006), por Rosendaal, del 69,39% frente al 67,68% (p=0,1036). Conclusiones. Existen diferencias significativas en el grado de control entre comunidades siendo inadecuado en algunas. Comunidades donde el médico de familia asume la gestión integral de la anticoagulación, el tiempo en rango terapéutico es algo superior y muestra una tendencia favorable a mejor control. Estos hallazgos pueden tener implicación clínica, merecen una reflexión y un análisis específico (AU)
Aims. To determine the differences between regions in the level of control of patients with non-valvular atrial fibrillation treated with vitamin K antagonists, included in the PAULA study. Methods. Observational, and coss-sectional/retrospective study, including 139 Primary Care physicians from 99 Health Care centres in all autonomous communities (except La Rioja). Anticoagulation control was defined as the time in therapeutic range assessed by either the direct method (poor control <60%), or the Rosendaal method (poor control <65%). Results. A total of 1,524 patients were included. Small differences in baseline characteristics of the patients were observed. Differences in the percentage of time in therapeutic range were observed, according to the Rosendaal method (mean 69.0±17.7%), from 78.1%±16.6 (Basque Country) to 61.5±14% (Balearic Islands), by the direct method (mean 63.2±17.9%) from 73.6%±16.6 (Basque Country) to 57.5±15.7% (Extremadura). When comparing regions, in those where the Primary Care physicians assumed full control without restrictions on prescription, the percentage of time in therapeutic range by the direct method was 63.89 vs. 60.95% in those with restrictions (p=.006), by Rosendaal method, 69.39% compared with 67.68% (p=.1036). Conclusions. There are significant differences in the level of control between some regions are still inadequate. Regions in which the Primary Care physicians assumed the management of anticoagulation and without restrictions, time in therapeutic range was somewhat higher, and showed a favourable trend for better control. These findings may have clinical implications, and deserve consideration and specific analysis (AU)
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Humanos , Anticoagulantes/administração & dosagem , Infarto do Miocárdio/prevenção & controle , Fibrilação Atrial/tratamento farmacológico , Conduta do Tratamento Medicamentoso/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Vitamina K/antagonistas & inibidores , Estudos RetrospectivosRESUMO
Objetivo: Conocer la prevalencia y las características clínico-epidemiológicas de los pacientes con HTA resistente en Atención Primaria en España. Pacientes y métodos: Estudio transversal y multicéntrico, que incluyó hipertensos de 18 años o más atendidos en el ámbito de la Atención Primaria. Se consideró HTA resistente la persistencia del mal control de la presión arterial en pacientes tratados con al menos 3 fármacos, siendo uno de ellos un diurético. Resultados: De los 12.961 pacientes hipertensos del estudio PRESCAP 2010, 962 (7,4%) cumplían criterios de HTA resistente; de ellos, el 51% eran mujeres y tenían una edad media (DE) de 68,8 (11,4) años. Los pacientes con HTA resistente presentaron mayor edad (68,80 [10,69] vs. 66,06 (11,44) años, p < 0,001), mayor prevalencia de obesidad (55,2 vs. 38,6%, p < 0,001), mayor perímetro abdominal (103,90 [13,89] vs. 99,32 [13,69] cm, p < 0,001) y mayor prevalencia de DM (48,3 vs. 29,5%, p<0,001). Las prevalencias de lesión de órganos diana (73,0 vs. 61,4%, p < 0,001) y de enfermedad cardiovascular (46,7 vs. 26,8%, p < 0,001) fueron superiores en los pacientes con HTA resistente. El análisis multivariante mostró que las variables asociadas a la HTA resistente fueron la existencia de enfermedad cardiovascular, diabetes mellitus, sedentarismo, microalbuminuria, el índice de masa corporal, la antigüedad de la HTA y el nivel de triglicéridos. Conclusiones: En Atención Primaria, la prevalencia de HTA resistente está relacionada con estilos de vida inadecuados y la presencia de lesión de órganos diana y enfermedad cardiovascular (AU)
Objective: To determine the prevalence and clinical and epidemiological characteristics of Primary Care patients with resistant hypertension (RHT) in Spain. Patients and methods: A cross-sectional multicenter study was conducted on hypertensive patients aged 18 or over and seen in a Primary Care clinic. RHT was considered as the presence of uncontrolled blood pressure in patients treated with at least 3 drugs, one of which is a diuretic. Results: Of the 12,961 hypertensive patients in the PRESCAP 2010 study, 962 (7.4%) fulfilled criteria for RHT, of whom 51% were women, and with a mean age (SD) 68.8 [11.4] years. Patients with RHT were older (68.80 [10.69] years vs. 66.06 [11.44] years, P < .001), had a higher prevalence of obesity (55.2 vs. 38.6%, P < .001), a higher waist circumference (103.90 [13.89] vs. 99.32 [13.69] cm, P < .001), and a higher prevalence of DM (48.3 vs. 29.5%, P < .001). The prevalence of target organ damage (73.0 vs. 61.4%, P < .001) and cardiovascular disease (46.7 vs. 26.8%, P < .001) were higher in patients with resistant hypertension. The multivariate analysis showed that the variables associated with resistant hypertension were the presence of cardiovascular disease, diabetes mellitus, sedentary life style, microalbuminuria, body mass index, duration of AHT, and triglycerides. Conclusions: The prevalence of RHT in Primary Care patients is related to inappropriate lifestyles, the presence of target organ damage, and cardiovascular disease (AU)
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Humanos , Hipertensão Maligna/epidemiologia , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Atenção Primária à Saúde/estatística & dados numéricos , Diuréticos/uso terapêutico , Distribuição por Idade e Sexo , Estudos Transversais , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricosRESUMO
Objetivos. Conocer el grado de control de la presión arterial (PA) en los pacientes hipertensos diabéticos atendidos en atención primaria y determinar los factores asociados al mal control. Material y métodos. Estudio transversal, multicéntrico que incluyó a hipertensos diabéticos, reclutados mediante muestreo consecutivo por médicos de familia de toda España en junio de 2010. Se consideró buen control de la hipertensión arterial al promedio de PA inferior a 140/90 mmHg. Se evaluó también el porcentaje de pacientes con PA< 130/80 mmHg, 140/80 mmHg y 140/85 mmHg. Se registraron datos sociodemográficos, clínicos, factores de riesgo cardiovascular y tratamientos farmacológicos. Resultados. Se incluyeron 3.993 pacientes (50,1% mujeres) con una edad media (desviación típica) de 68,2 (10,2) años. El 73,9% recibía terapia combinada. Presentaron cifras de buen control de ambas cifras tensionales (< 140/90 mmHg) el 56,4% (IC 95%: 54,3-58,4) de los casos; el 58,5%(IC 95%: 57-60) solo de la PA sistólica y el 84,6% (IC 95%: 83,2-85,8) únicamente de la PA diastólica. Las variables con mayor fuerza de asociación con el mal control fueron la presencia de albuminuria, el colesterol total elevado, el sedentarismo y no tomar la medicación el día de la entrevista. Conclusiones. Los resultados del estudio PRESCAP-Diabetes 2010 indican que el 43,6% de los hipertensos diabéticos asistidos en atención primaria tiene mal controlada la PA, fundamentalmente la PA sistólica (AU)
Objectives. To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. Material and methods. A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90 mmHg was considered as good control of arterial hypertension. The percentages of patients with < 130/80 mmHg PA, 140/80 mmHg, and 140/85 mmHg, respectively, were also determined. Sociodemographic, clinical, cardiovascular risk factors, and pharmacological treatments were recorded. Results. A total of 3,993 patients were enrolled (50.1% female) with a mean age (standard deviation) of 68.2 (10.2) years, of whom 73.9% received combination therapy. The figures showed good control of both blood pressure values (< 140/90 mmHg) in 56.4% (95% CI: 54.3 to 58.4) of the cases, with 58.5% (95% CI: 57.0-60.0) only in systolic BP, and 84.6% (95% CI, 83.2 to 85.8) only in diastolic BP. The variables with strongest association with poor control were the presence of albuminuria, elevated total cholesterol, physical inactivity, and not taking the medication on the day of the interview. Conclusions. The PRESCAP-Diabetes 2010 study results indicate that 43.6% of diabetics with hypertension seen in primary care have a poorly controlled BP, in particular, systolic BP (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pressão Arterial , Pressão Arterial/imunologia , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde , Estudos Transversais/métodos , Estudos Transversais/tendências , Espanha/epidemiologiaRESUMO
No disponible
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Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Infecções Comunitárias Adquiridas/diagnóstico , Derrame Pleural/diagnóstico , Atenção Primária à Saúde , Diagnóstico DiferencialRESUMO
Introducción. Es necesario tener mayor información sobre la inercia terapéutica en la hipertensión arterial (HTA). El objetivo de este estudio fue conocer la conducta del médico de atención primaria (AP) en pacientes hipertensos que presentan mal control de presión arterial (PA) y determinar los factores asociados. Pacientes y métodos. Estudio transversal y multicéntrico realizado en hipertensos asistidos en el ámbito de la AP española. Se registraron datos de los pacientes (sociodemográficos, clínicos y tratamiento) y médicos (asistenciales, formativos y conducta ante el mal control de PA). Se consideró mal control cuando el promedio de PA era >= 140/90mmHg. Resultados. Se incluyeron 12.961 hipertensos (52,0% mujeres), con una edad media de 66,3 (11,4) años y antigüedad media de la HTA de 9,1 (6,7) años. El 62,4% recibía terapia combinada (44,2%, 2 fármacos, y 18,2%, 3 o más). El 38,9% (IC 95%: 38,1-39,7) presentó mal control de PA. El médico modificó el tratamiento en el 41,8% (IC 95%: 40,4-43,2) de los 5.036 pacientes mal controlados. La conducta terapéutica más frecuente fue la asociación farmacológica (55,6%). La percepción por parte del médico de buen control de PA en el hipertenso mal controlado y la presencia de terapia combinada fueron las variables que mostraron mayor probabilidad de no modificar el tratamiento farmacológico. Conclusiones. El médico de AP modifica el tratamiento antihipertensivo en tan solo 4 de cada 10 hipertensos mal controlados. La percepción por parte del médico de buen control de PA es la variable que más incrementa la probabilidad de no modificar el tratamiento farmacológico (AU)
Introduction. There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. Patients and methods. Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where >=140/90mmHg. Results. A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. Conclusions. The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Hipertensão/diagnóstico , Hipertensão/terapia , Imperícia/tendências , Ética Profissional , Atenção Primária à Saúde/normas , Atenção Primária à Saúde , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Má Conduta Profissional/psicologia , Má Conduta Profissional/tendências , Estudos Transversais/métodos , Estudos Transversais/tendências , Fatores de Risco , Análise de VariânciaRESUMO
El proyecto CARDIORISC es una iniciativa de la Sociedad Española de Hipertensión Arterial (SEH-LELHA), avalado por la Sociedad Europea de Hipertensión (ESH), que se inicia en el año 2004 y que tiene como objetivo general optimizar la asistencia al paciente hipertenso en España. Hasta esa fecha la disponibilidad de monitorización ambulatoria de la presión arterial (MAPA) era muy escasa en la Atención Primaria (AP) de España, lo cual obligaba a que nuestros pacientes fuesen derivados a unidades específicas de hipertensión arterial (HTA) al objeto de ser evaluados con estos dispositivos. El registro MAPAPRES ha permitido introducir la MAPA como herramienta rutinaria en la valoración del paciente hipertenso en la práctica clínica en España, generando numerosas evidencias científicas basadas en el análisis de la base de datos de más de 110.000 pacientes, aportadas por más de 1.250 investigadores, muchos de ellos de AP. La experiencia, tras 5 años de implantación del proyecto, ha supuesto una excelente fuente de información para el médico de AP respecto a la identificación de la HTA de bata blanca, HTA enmascarada, HTA nocturna y, lo que es más importante, un manejo más adecuado y eficiente en el diagnóstico, tratamiento, seguimiento y control del paciente hipertenso (AU)
CARDIORISC is a project of the Spanish Society of Hypertension-Spanish League for the Fight against Hypertension, endorsed by the European Society of Hypertension. This project was started in 2004 and aims to optimize the management of hypertensive patients in Spain. Until then, general practitioners had little access to ambulatory blood pressure monitoring (ABPM) and patients had to be referred to specific hypertension units for evaluation. CARDIORISC has allowed ABPM to be widely introduced in primary care settings in Spain under conditions of daily clinical practice, generating wide scientific evidence based on analysis of the database of more than 110,000 hypertensive patients, with data contributed by more than 1,250 researchers, many of whom work in primary care. Five years since its initiation, the project has produced a huge body of evidence on issues of key interest for general practitioners such as identification of white-coat hypertension, masked hypertension, and nocturnal hypertension. Most importantly, the data generated by the CARDIORISC project is improving the diagnosis, treatment and follow-up of hypertensive patients attending primary care (AU)