Prevalence of orthostatic hypotension in non-institutionalised elderly aged 80 and over. A diagnostic study using an oscillometric device / Prevalencia de hipotensión ortostática en ancianos mayores de 80 años no institucionalizados. Estudio de diagnóstico clínico mediante aparato de presión oscilométrico

Background: Orthostatic hypotension (OH) is a common disorder, and possibly underdiagnosed. In the elderly, OH has been considered a common cause of falls, fractures, and fear of falling. Its prevalence increases with age, probably related to the number of drug treatments, decreased fluid intake, and the progressive dysfunction of the autonomic nervous system. Objectives: To evaluate the prevalence of OH in a non-institutionalised population ≥80 years, according to different criteria based on sequential measurements taken at minute 0, 1, 3 and 5 of standing. Methods design: A diagnostic accuracy study using an oscillometric device. Setting and participants: Convenience sampling of 176 people ≥80 years attended in an urban Primary Health Care Centre. Measurements: Supine and standing blood pressure (BP) measurements, at minutes 0, 1, 3 and 5 using the OMRON 705-CP blood pressure device. OH definition: decrease ≥20 mmHg in systolic BP (SBP) and/or ≥10 mmHg in diastolic BP (DBP). Results: Mean age (Standard Deviation) was 85.2 (3.7) years, and 60.2% were women. Prevalence of OH: 30.7% at minute 0; 19.3% at minute 1; 18.2% at minute 3; and 20.5% at minute 5. Age, sedentary life, smoking, diabetes and SBP values were significantly associated with a greater BP decrease at minute 0. Conclusion: A third of the sample had OH, with a maximum prevalence at minute 0. From a clinical point of view, it is suggested that the definition of OH is prioritized according to the BP at minute 0

Introducción: La hipotensión ortostática (HO) es un fenómeno muy común posiblemente infradiagnosticado. En ancianos, la HO puede causar caídas, fracturas y miedo a caerse. Su prevalencia aumenta con la edad, seguramente en relación con el número fármacos prescritos, la disminución de ingesta de líquidos y la disfunción progresiva de su sistema nervioso autónomo. Objetivos: Evaluar la prevalencia de OH en ancianos mayores de 80años no institucionalizados según el criterio diagnóstico de HO en medidas secuenciales tomadas en los minutos 0, 1, 3 y 5 de bipedestación. Sujetos y métodos: Diseño: estudio de diagnóstico mediante aparato de presión oscilométrico. Muestra: muestreo a conveniencia de 176 pacientes ≥80 años atendidos en un centro de atención primaria urbano. Medidas: Presión Arterial (PA) en supinación y a los minutos 0, 1, 3 y 5 mediante un tensiómetro OMRON 705-CP. Definición de HO: descenso ≥20 mmHg en la PA sistólica (PAS) y/o ≥10 mmHg en la PA diastólica. Resultados: La media de edad (desviación estándar) fue de 85,2 (3,7) años, y el 60,2% fueron mujeres. Prevalencia de HO: 30,7% al minuto 0; 19,3% al minuto 1; 18,2% al minuto 3; 20,5% al minuto 5. Edad, sedentarismo, tabaquismo, diabetes y valores de PAS mostraron una asociación significativa con un mayor descenso de la PA en el minuto 0. Conclusión: Un tercio de la muestra presenta HO, con un máximo de prevalencia en el minuto 0. Desde el punto de vista clínico parece recomendable priorizar la definición de la HO según la PA en el minuto 0

Prevalence of orthostatic hypotension in non-institutionalised elderly aged 80 and over. A diagnostic study using an oscillometric device.

BACKGROUND: Orthostatic hypotension (OH) is a common disorder, and possibly underdiagnosed. In the elderly, OH has been considered a common cause of falls, fractures, and fear of falling. Its prevalence increases with age, probably related to the number of drug treatments, decreased fluid intake, and the progressive dysfunction of the autonomic nervous system. OBJECTIVES: To evaluate the prevalence of OH in a non-institutionalised population ≥80 years, according to different criteria based on sequential measurements taken at minute 0, 1, 3 and 5 of standing. METHODS DESIGN: A diagnostic accuracy study using an oscillometric device. SETTING AND PARTICIPANTS: Convenience sampling of 176 people ≥80 years attended in an urban Primary Health Care Centre. MEASUREMENTS: Supine and standing blood pressure (BP) measurements, at minutes 0, 1, 3 and 5 using the OMRON 705-CP blood pressure device. OH definition: decrease ≥20mmHg in systolic BP (SBP) and/or ≥10mmHg in diastolic BP (DBP). RESULTS: Mean age (Standard Deviation) was 85.2 (3.7) years, and 60.2% were women. Prevalence of OH: 30.7% at minute 0; 19.3% at minute 1; 18.2% at minute 3; and 20.5% at minute 5. Age, sedentary life, smoking, diabetes and SBP values were significantly associated with a greater BP decrease at minute 0. CONCLUSION: A third of the sample had OH, with a maximum prevalence at minute 0. From a clinical point of view, it is suggested that the definition of OH is prioritized according to the BP at minute 0.

[Do the new criteria of the American Diabetes Association lead to earlier diagnosis of type-2 diabetes mellitus?]. / ¿Adelantan el diagnóstico de la diabetes tipo 2 los nuevos criterios de la Asociación Americana de Diabetes?

OBJECTIVE: To analyze the period of time between the first occasional fasting hyperglycaemia (OFH) and the diagnosis of type 2 diabetes mellitus (DM2), using the World Health Organization (WHO) criteria or the American Diabetes Association (ADA) criteria. DESIGN: Retrospective, observational study. SETTING: Urban primary care centre. SUBJECTS: 104 patients with DM2 diagnosed between 1991 and 1995 who had a previous OFH. MEASUREMENTS: Age, gender and other risk factors, dates of the first OFH (fasting plasma glucose >= 110 mg/dl), the diagnosis according to WHO criteria (2 fasting plasma glucose >= 140 mg/dl or >= 200 mg/dl two hours after the oral glucose test tolerance (OGTT)) or with the ADA criteria (2 fasting plasma glucose >= 126 mg/dl), and the intervals in months between them. RESULTS: Of the 222 diagnosed patients, 104 (47%) had previous OFH. Age at diagnosis was 60.8 (SD 10.1) and 53% were women. OGTT was performed in 51 cases (49%). The median (range) of the interval between the first OFH and diagnosis was 16 months (0-101) for those who were undertaken an OGTT, and 45 months (1-104) for those who were not (p = 0.003). In these last ones, ADA criteria reduced the interval to 31 months (0-97) (p < 0.001). In 27 of these patients who did not satisfy both criteria at the same time, ADA criteria reduced the interval to 10 months (0-93) (p < 0.001). CONCLUSIONS: Not performing the OGTT means a delay in diagnosis which can be countered by applying the ADA criteria.

¿Adelantan el diagnóstico de la diabetes tipo 2 los nuevos criterios de la Asociación Americana de Diabetes? / Do new criteria of the american diabetes association lead to earlier diagnosis of type 2 diabetes mellitus?

Objetivo. Analizar el intervalo temporal entre la primera hiperglucemia basal ocasional (HBO) y el diagnóstico de diabetes mellitus tipo 2 (DM2) al aplicar los criterios de la OMS y de la Asociación Americana de Diabetes (ADA). Diseño. Estudio observacional, retrospectivo. Ámbito del estudio. Centro de atención primaria urbano. Sujetos. Un total de 104 pacientes con DM2, diagnosticados entre 1991 y 1995, con antecedentes de HBO. Mediciones o intervenciones. Edad, género y otros factores de riesgo, fechas de la primera HBO (glucemia basal 110 mg/dl), del diagnóstico según criterios OMS (2 glucemias basales 140 mg/dl o 200 mg/dl a las 2 horas de la sobrecarga oral de glucosa [SOG]) y aplicando criterios ADA (2 glucemias basales 126 mg/dl) y los intervalos en meses entre ellas. Resultados. De los 222 pacientes diagnosticados, 104 (47 por ciento) presentaban antecedentes de HBO. La edad en el momento del diagnóstico fue 60,8 años (DE, 10,1), siendo un 53 por ciento mujeres. En 51 casos (49 por ciento) se realizó SOG. La mediana (rango) del intervalo entre la primera HBO y el diagnóstico fue de 16 meses (0-101) en los que se realizó la SOG y de 45 (1-104) en los que no se practicó (p = 0,003). En estos últimos, los criterios ADA lo redujeron a 31 meses (0-97) (p < 0,001) y en 27 de ellos que no cumplían ambos criterios a la vez el intervalo fue de sólo 10 meses (0-93) (p < 0,001). Conclusiones. La no realización de la SOG comporta un retraso en el diagnóstico que puede ser contrarrestado con la aplicación de los criterios de la ADA (AU)

Use of the intrauterine device: efficacy and safety.

OBJECTIVES: To characterize the family planning center population that used an intrauterine device (IUD), to compare the reasons for its removal and types of incidents encountered by nulliparous women and women with children, and to evaluate the efficacy and safety of this method by the use of life tables. METHOD: This was an observational, descriptive, prospective study of 774 women, recruited over a 5-year period, who used an IUD by informed choice, presented no absolute contraindications and were assessed throughout the whole follow-up period. RESULTS: The mean age (standard deviation) of IUD use was 32.8 (5.9) years for non-nulliparous women and 27.4 (5.3) years for nulliparous women (p < 0.001). Follow-up was completed at the family planning center for 80.1% of women. No differences were observed between nulliparous and non-nulliparous women with respect to accidental pregnancy, suspected pelvic inflammatory disease or expulsion. Non-nulliparous women experienced more major bleeding incidents and anemia (p = 0.010). All pregnancies occurred with low-load devices. Nulliparous women discontinued IUD use more often due to a desire to become pregnant (p = 0.009) and suffered more vulvovaginal infections (p = 0.044). CONCLUSIONS: The IUD is a safe contraceptive option regardless of parity, provided that women are carefully selected.

[Type 2 diabetes mellitus: incidence and diagnosis at a primary care center]. / Diabetes mellitus tipo 2: incidencia y diagnóstico en un centro de atención primaria.

OBJECTIVE: To find the annual incidence and reasons for type-2 Diabetes Mellitus (DM2), and the methods used to diagnose it, on the basis of the validation of a computerised record for 1991-1995. DESIGN: Retrospective, longitudinal study. SETTING: Primary care centre. MEASUREMENTS AND MAIN RESULTS: Of the 387 diabetics registered as new cases in the 1991-1995 period out of 17031 people over 14 who were seen, 21 were not diabetics, 60 were cases of late diagnosis or late recording, 75 came from another centre and 9 were type-1. All these were excluded. The mean age of the 222 (57.4%) real new cases was 59 (ED 11.4). 53% were women. The most common causes of diagnosis were the existence of previous with diagnostic hiperglycemia (50.9%) and the application of protocols for other cardiovascular risk factors (19.8%). The diagnostic methods were two basal glucaemias > or = 140 mg/dl (70.7%), 1 glucaemia > or = 200 mg/dl with typical clinical picture (6.7%) and oral overload of glucose (23%). 97% of cases were diagnosed at the centre itself. The density of annual incidence was 30.1 per 10,000 inhabitants. Prevalence at start and end of the study was 4.4 and 4.9%. CONCLUSIONS: The incidence and prevalence described are greater than described in other studies. The most common reasons for diagnosis were the existence of previous nondiagnostic hyperglycemia and the application of protocols for other risk factors.

Diabetes mellitus tipo 2: incidencia y diagnóstico en un centro de atención primaria / Type-2 diabetes mellitus: incidence and diagnosis at a primary care centre

Objetivos. Conocer la incidencia anual, los motivos y los métodos utilizados para el diagnóstico de diabetes mellitus tipo 2 (DM2) en el período 1991-1995 a partir de la validación de un registro informatizado. Diseño. Estudio longitudinal retrospectivo. Emplazamiento. Centro de atención primaria. Mediciones y resultados principales. De los 387 diabéticos registrados como nuevos casos en el período 1991-1995 de una población atendida de 17.031 personas mayores de 14 años, 21 no eran diabéticos, 60 eran retrasos en el diagnóstico o en su registro, 75 provenían de otro centro y 9 eran tipo 1, por lo que fueron excluidos. La edad media de los 222 (57,4 por ciento) nuevos casos verdaderos fue de 59 (DE, 11,4) años, siendo un 53 por ciento mujeres. Los motivos de diagnóstico más frecuentes fueron la existencia de hiperglucemias no diagnósticas previas (50,9 por ciento) y la aplicación de protocolos de otros factores de riesgo cardiovascular (19,8 por ciento). Los métodos diagnósticos fueron 2 glucemias basales >= 140 mg/dl (70,7 por ciento), una glucemia >= 200 mg/dl con clínica típica (6,7 por ciento) y la sobrecarga oral de glucosa (23 por ciento). El 97 por ciento de casos se diagnosticó en el propio centro. La densidad de incidencia anual fue de 30,1 por 10.000 habitantes. La prevalencia al principio y al final del estudio fue del 4,4 y 4,9 por ciento. Conclusiones. La incidencia y la prevalencia observadas son superiores a las descritas en otros estudios. Los motivos de diagnóstico más frecuentes fueron la hiperglucemia no diagnóstica previa y la aplicación de protocolos de otros factores de riesgo (AU)

[Demographic characterization, consultation reasons and prevalent morbidity in the African immigrating community of the Maresme district]. / Caracterización demográfica, motivos de consulta y morbilidad prevalente en la comunidad de inmigrantes africanos de la comarca del Maresme.

BACKGROUND: To know the demographic condition, main symptoms and diagnosis in adult African immigrants from a reference Hospital. PATIENTS AND METHOD: A prospective protocol between 1984-1994. RESULTS: 1,321 immigrants were considered. Most of them had an unstable job and illegal situation and they did not speak any European language. Abdominal pain was the most common symptom. The most frequent diagnoses were parasitic/infections and digestive and haematological diseases. CONCLUSIONS: Immigration is not a risk for public health. The illegal situation carries poor sanitary conditions. The clinical protocols help to overcome cultural and idiomatic barriers.

[Mid-term evaluation of a help program for smokers]. / Evaluación a medio plazo de un programa de ayuda a los fumadores.

BACKGROUND: Medical counsel to smokers is an intervention that has proved useful to motivate smokers to stop smoking. This study pretends evaluate the long-term impact (2 years and 9 months) of systematic and structured health counsel on the smoke habit from the primary health care. MATERIAL AND METHODS: In April 1990, in four primary care centers from Barcelona and Zaragoza, Spain, a program of systematic counselling to stop smoking with an offer of subsequent follow-up was initiated in all adult smokers (15-65 years of age). According to the answer, every patient was classified on one of seven established categories that allowed a individualized follow-up. Data from the total population included in the program from the beginning till January 1993, are analyzed. RESULTS: From 683 known smokers (59.2% males and 40.8% women), 20 were excluded for different reasons and 343 were included in the program (56.4% cover). Average age of included smokers was 35.1 years (SE = 0.6) and average number of visits of 5.3 (SE = 0.2) which was significantly higher than those not included in the program (33.4; SE = 0.6, and 2.7; SE = 0.1). An average follow-up of 14.3 months (SE = 0.5) and of 2.6 (SE = 0.1) interventions on each individual were done. The average daily number of cigarettes was 18.4 (SE = 0.6) in the initial period and 13.3 (SE = 0.6) on the last program evaluation. The final answers showed a 18.1% of quitters and a decrease of more than 50% on the initial consume on 32.6%. In 12% the answer was negative. CONCLUSIONS: Programs of systematic help for smokers show a higher level of favourable responses than does normal counselling.