[Utility of normality low limit of spirometry in diagnosed COPD patients]. / Utilidad del límite inferior de normalidad de la espirometría en pacientes diagnosticados de EPOC.

AIM: To evaluate the differences in COPD patients below the lower limit of normal (LLN) of the fixed ratio FEV1/FVC < 0.70 and those above this limit. PATIENTS AND METHODS: Cross-sectional study. COPD patients between 40 and 85 years old included in primary care clinical record database were randomly selected. Baseline and postbronchodilator spirometries were performed. Two groups of patients were established: FEV1/FVC<0.70 and ≤LIN (group1) and FEV/FVC<0.70 and >LIN (group 2). Sociodemographic, clinical, pulmonary obstruction, quality of life and attendance to health services variables were measured. The results of both groups were compared. RESULTS: 22.3% of the subjects were misdiagnosed FEV1/FVC < 0,70. Patients in group 2 (FEV1/FVC<0.70 y > LLN) are diagnosed at an older age, they have a lower exposure to tobacco and better pulmonary function (FEV1: 74.9% vs 54.6%). 35.5% of those patients belong to stage i of GOLD, vs 8.5%, this patients have an increased comorbidity. Patients in group 1 have more COPD exacerbations, worse quality of life, a higher BODEx index 2,3 (1.8) vs 1.1 (1.5); 55.1% of those patients were high risk patients (GoldC or Gold D). Diagnose before being 56 years old, an increased exposure to tobacco, the FEV>50%, and a lower comorbidity are associated with a greater chance of suffering COPD with LLN criteria. CONCLUSION: We obtain two groups of patients with differentiated clinical characteristics if we use LLN. Subjects with FEV1/FVC<0.7 and >LLN have less obstruction, less severity and more comorbidity, suggesting the possibility of overdiagnosis or misdiagnosis. On the other hand, younger age at the time of diagnosis, higher tobacco consumption and more severe obstruction are related with FEV1/FVC >0.70 and

[Intervention in elderly patients with multiple morbidities and multiple medications: results of the prescription and the quality of life]. / Intervención en ancianos con multimorbilidad y polimedicados: resultados en la prescripción y en la calidad de vida.

OBJECTIVE: To evaluate the effect of an intervention using STOPP/START criteria and the Garfinkel algorithm on prescription and the health-related quality of life (HRQoL) in elderly patients with multimorbidity and prescribed multiple medications. MATERIAL AND METHOD: A before-after intervention study on 381 patients over 67 years old and prescribed multiple medications by 71 Primary Care doctors. INTERVENTION: The doctors were trained in the STOPP / START criteria and Garfinkel algorithm. Each doctor then reviewed all the drugs of their selected patients and then made appointments with them for an initial medical consultation and clinical assessment. Treatment was modified according to the criteria and the HRQoL measured using the SF-12 questionnaire. Two months later, in a second medical consultation, a new clinical assessment was made and the HRQoL was measured. The dimensions of the HRQoL between the first and the second consultation were compared using the paired Student-t test. RESULTS: The intervention involved the removal of a mean of 1.5 drugs per patient. The dose was modified in 4% of drugs, and 8.9% of patients were prescribed a new drug. Non-Steroidal Anti-inflammatory drugs (NSAID), psychoactive drugs and proton pump inhibitors were the most modified. Social Function and Physical Component Summary of the HRQOL improved significantly (P<.05) after intervention. CONCLUSION: The intervention using the Garfinkel algorithm and STOPP -START criteria improved HRQoL and reduced the number of prescribed drugs.

[The appropriate use of pharmacological treatment in patients with chronic heart failure. A perspective from Primary Care]. / Grado de adecuación del tratamiento farmacológico en pacientes con insuficiencia cardíaca crónica. Visión desde atención primaria.

INTRODUCTION AND OBJECTIVE: The appropriate use of pharmacological treatment according to the indications in Clinical Guidelines reduces morbidity and mortality in patients with chronic heart failure (CHF). There are numerous studies regarding this in the hospital environment, but there are few studies done in Primary Care. The objective of this study is to evaluate the degree of compliance by Primary Care doctors to the Clinical Guidelines of the European Society of Cardiology in patients with CHF. METHODS: A descriptive, observational study on the use of indication-prescription drugs was conducted. POPULATION AND SAMPLE: Primary Care teams of the Leon Health Area (9 urban and 19 rural). The study population included patients with a diagnosis of New York Heart Association (NYHA) Grade II-IV chronic heart failure, from a register of 2047 with chronic heart failure patients treated by 97 Primary Care doctors. A proportional representative random sample of 474 patients from the urban and rural areas was studied. MAIN MEASUREMENTS: Adherence to the drugs recommended in the Clinical Guidelines was evaluated using two indicators; one overall, and another for drugs with a higher level of evidence (A1: angiotensin converting enzyme inhibitors-angiotensin II receptor antagonists [ACE-I/ARA-II], ß-blockers [BB] and spironolactone). RESULTS: A total of 456 patients were studied, with a mean age of 78.4 years, and 53.1% females. Arterial hypertension (AHT) and ischaemic heart disease were present in 64.7% of patients. The mean comorbidity rate, excluding CHF, was 2.9. Around 40% were diagnosed a NYHA Grade 11-1V. The overall compliance rate (diuretics, ACE-I/ARA-II, ß-blockers, spironolactone, digoxin, and oral anticoagulants) and rate of adherence to evidence-based ones was 55.2% and 44.6%, respectively. There was low compliance by 39.5%, and only 12.9% of patients showed perfect compliance with the drugs with a higher level of evidence, while to be less than 70 years-old, a history of ischaemia, AHT, and a hospital admission, were variables associated with better adherence to treatment. CONCLUSION: There is a low use of the drugs recommended by the Clinical Guidelines for heart failure, particularly of those with better evidence for reducing morbidity and mortality.

[Prevalence and duration of breast-feeding: its influences on the weight and the morbidity]. / Prevalencia y duración de la lactancia materna: Influencia sobre el peso y la morbilidad.

OBJECTIVE: To estimate the prevalence and the average length of Lactation. To describe the development of the weight during the first year of life and the demand of paediatric consultations in relation to the type of lactation. METHODS: A cross-sectional study was done using retrospective data. There was gathered a random sample of clinical histories of born children between years 2000 and 2005. There was estimated the prevalence of breast-feeding from the beginning until three and six months. An index of global desertion was elaborated. The average weight and the number of paediatric consultations were related to the type of lactation. RESULTS: The children initiate exclusive breastfeeding (MEL) in a 63.5% (CI 95%: 58.6-64.5). 22.6% amount them (IC 95%: 18.4-26.9) remained it until six months age. After three months of MEL 43.4% of the subjects gave up exclusively lactation. At the age of six months only 33.6% remained with MEL. Mixed form of lactation (MTL) was kept in 80.5% of the subjects (IC 95%: 75.4-84.6). Children included in the program of MTL (exclusive or mixed) have a minor index of desertion (26.5% and 54.4% up to three and six months, respectively). A higher weight was detected in children with mixed lactation. Those on the MEL up to six months consulted the paediatrician 4.5 times a year, whereas children with artificial lactation did it 6.5 times during their first year of life. There were statistically significant differences found (p < 0.007). CONCLUSIONS: Percentage of lactation in the group studied is far from recommended levels (WHO). Exclusive breastfeeding (MEL) entails a suitable weight development, as well as a minor morbidity in the first year of life.

[Workplace accidents in health-related personnel in the province of León]. / Accidentes de trabajo en personal relacionado con la sanidad en la provincia de León.

BACKGROUND: To get an initial knowledge about the morbidity by workplace accidents in health related personal (hospital and primary attention) in Leon province. METHODS: Retrospective study relative to workplace accidents with time off work result, in health related personal, in Leon province, for 1990. RESULTS: We have observed a rate of workplace accidents in health related personal (31, 4/1000) smaller than general workers in Leon province (63, 3/1000), Castilla y Leon community (44, 7/1000) and Spain (59, 8/1000). The rate in female population (37, 4/1000) was higher than the rate in men (21,7/1000). By jobs, the attendant an maintenance personal, had more accidents (rate of 118/1000). The most frequent mechanism was "fall" (38.2%). The most frequent lesion was "swerve" (38.2%). About the part of the body, the most injured were superior members (30.9%) and inferior members (30%), 93.7% of workplace accidents were qualified as slight accidents. CONCLUSIONS: The health related personal have a lower rate of accidents than general workers. The risk of workplace accident is directly related with job and place of work. The slight pathological result is most frequent.

[An exploration of factors that influence the frequency of the use of hospital emergency services and admissions]. / Exploración de algunos factores que influyen en la frecuentación a urgencias del hospital y su ingreso.

OBJECTIVE: To examine how some factors connected with Continuous Care Points (CCP) affect attendance at hospital Casualty departments and admittance from them. DESIGN: Ecological study. SETTING: León Health area. PATIENTS AND OTHER PARTICIPANTS: All the CCP's belonging to the León Health area. MEASUREMENTS AND MAIN RESULTS: Average attendance at hospital Casualties was 15.7 per 1,000 inhabitants per month. Those patients who brought with them a P10 form were more likely to be admitted (39.5% to 26.5%) than those who did not bring this form (p < 0.01). It was concluded from a regression analysis that the distance between the CCP and the hospital decisively affects attendance at hospital Casualties (r = -0.74) and that the admission rate is positively related to distance (r = 0.72) and negatively to the said attendance at Casualties (r = -0.77). CONCLUSION: Use of hospital Casualty departments increases as accessibility (distance) improves. Distance and the ageing of the population are factors which have an important effect on the admission rates from Casualties.