Prevalencia de obesidad infantil en la Región de Murcia, valorando distintas referencias para el índice de masa corporal / Prevalence of childhood obesity in the Murcia Region; an assessment of different references for body mass index

Introducción: La obesidad infantil es un problema de elevada magnitud y con graves repercusiones en el estado de salud, lo que justifica conocer su prevalencia a nivel local para identificar factores condicionantes y emprender acciones preventivas. El objetivo de este trabajo consiste en estimar la prevalencia de sobrepeso y obesidad en población infantil de la Región de Murcia a partir del índice de masa corporal (IMC) aplicando los criterios de referencia del International Obesity Task Force (IOTF), y comparar estos resultados con los obtenidos con otras referencias de uso frecuente en España. Material y método: Se determinó el IMC correspondiente a 178.894 niños de 2 a 14 años de edad. La prevalencia de sobrepeso y obesidad se valoró según los criterios del IOTF, de los estudios de la Organización Mundial de la Salud, de la Fundación Orbegozo (FO), y del Estudio Transversal Español de Crecimiento (ETEC). La concordancia entre los diferentes resultados fue evaluada mediante el índice kappa. Resultados: La prevalencia, mediante los puntos de corte del IOTF, fue para sobrepeso del 20,6% (IC 95%: 20,4-20,8), para obesidad del 11,4% (IC 95%: 11,2-11,5) y para sobrecarga ponderal del 32% (IC 95%: 31,8-32,2), siendo esta última mayor en niñas (33,2%) que en niños (30,9%). La mayor concordancia se da entre el IOTF y FO-2011 (kappa=0,795), y entre este y el ETEC (kappa=0,794). Conclusiones: Se encontraron altas prevalencias de sobrepeso y obesidad en niños de la Región de Murcia. El ETEC y el estudio FO-2011 mostraron las concordancias más altas con los resultados obtenidos según los criterios del IOTF (AU)

Introduction: Childhood obesity is a problem of high magnitude with serious repercussions on health, which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions. The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region, using the body mass index (BMI) and applying the International Obesity Task Force (IOTF) criteria, and to compare these results with the ones obtained from other frequently used references in Spain. Material and methods: The BMI of 178,894 children aged from 2 to 14 years was determined. The prevalence of overweight and obesity was compared to the IOTF, to the studies of the World Health Organization, as well as those of the Orbergozo Foundation (FO), and the Cross sectional Spanish Growth Study (ETEC) references. The agreement between the different results was evaluated using the kappa index. Results: The evaluation using the IOTF cut-off points gave an overweight prevalence of 20.6% (95% CI: 20.4-20.8), an obesity prevalence of 11.4% (95% CI: 11.2-11.5) and an overweight plus obesity prevalence of 32% (95% CI: 31.8-32.2), with this last one being higher in girls (33.2%) than in boys (30.9%). The highest agreement is between IOTF and FO-2011 (kappa = .795) and between FO-2011 and ETEC (kappa = .794). Conclusion: A high prevalence of overweight and obesity in children in the Region of Murcia was found. The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria (AU)

[Prevalence of childhood obesity in the Murcia Region; an assessment of different references for body mass index]. / Prevalencia de obesidad infantil en la Región de Murcia, valorando distintas referencias para el índice de masa corporal.

INTRODUCTION: Childhood obesity is a problem of high magnitude with serious repercussions on health, which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions. The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region, using the body mass index (BMI) and applying the International Obesity Task Force (IOTF) criteria, and to compare these results with the ones obtained from other frequently used references in Spain. MATERIAL AND METHODS: The BMI of 178,894 children aged from 2 to 14 years was determined. The prevalence of overweight and obesity was compared to the IOTF, to the studies of the World Health Organization, as well as those of the Orbergozo Foundation (FO), and the Cross-sectional Spanish Growth Study (ETEC) references. The agreement between the different results was evaluated using the kappa index. RESULTS: The evaluation using the IOTF cut-off points gave an overweight prevalence of 20.6% (95% CI: 20.4-20.8), an obesity prevalence of 11.4% (95% CI: 11.2-11.5) and an overweight plus obesity prevalence of 32% (95% CI: 31.8-32.2), with this last one being higher in girls (33.2%) than in boys (30.9%). The highest agreement is between IOTF and FO-2011 (kappa=.795) and between FO-2011 and ETEC (kappa=.794). CONCLUSION: A high prevalence of overweight and obesity in children in the Region of Murcia was found. The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria.

In silico analysis identifies a C3HC4-RING finger domain of a putative E3 ubiquitin-protein ligase located at the C-terminus of a polyglutamine-containing protein.

Almost identical polyglutamine-containing proteins with unknown structures have been found in human, mouse and rat genomes (GenBank AJ277365, AF525300, AY879229). We infer that an identical new gene (RING) finger domain of real interest is located in each C-terminal segment. A three-dimensional (3-D) model was generated by remote homology modeling and the functional implications are discussed. The model consists of 65 residues from terminal position 707 to 772 of the human protein with a total length of 796 residues. The 3-D model predicts a ubiquitin-protein ligase (E3) as a binding site for ubiquitin-conjugating enzyme (E2). Both enzymes are part of the ubiquitin pathway to label unwanted proteins for subsequent enzymatic degradation. The molecular contact specificities are suggested for both the substrate recognition and the residues at the possible E2-binding surface. The predicted structure, of a ubiquitin-protein ligase (E3, enzyme class number 6.3.2.19, CATH code 3.30.40.10.4) may contribute to explain the process of ubiquitination. The 3-D model supports the idea of a C3HC4-RING finger with a partially new pattern. The putative E2-binding site is formed by a shallow hydrophobic groove on the surface adjacent to the helix and one zinc finger (L722, C739, P740, P741, R744). Solvent-exposed hydrophobic amino acids lie around both zinc fingers (I717, L722, F738, or P765, L766, V767, V733, P734). The 3-D structure was deposited in the protein databank theoretical model repository (2B9G, RCSB Protein Data Bank, NJ).

In silico analysis identifies a C3HC4-RING finger domain of a putative E3 ubiquitin-protein ligase located at the C-terminus of a polyglutamine-containing protein

Almost identical polyglutamine-containing proteins with unknown structures have been found in human, mouse and rat genomes (GenBank AJ277365, AF525300, AY879229). We infer that an identical new gene (RING) finger domain of real interest is located in each C-terminal segment. A three-dimensional (3-D) model was generated by remote homology modeling and the functional implications are discussed. The model consists of 65 residues from terminal position 707 to 772 of the human protein with a total length of 796 residues. The 3-D model predicts a ubiquitin-protein ligase (E3) as a binding site for ubiquitin-conjugating enzyme (E2). Both enzymes are part of the ubiquitin pathway to label unwanted proteins for subsequent enzymatic degradation. The molecular contact specificities are suggested for both the substrate recognition and the residues at the possible E2-binding surface. The predicted structure, of a ubiquitin-protein ligase (E3, enzyme class number 6.3.2.19, CATH code 3.30.40.10.4) may contribute to explain the process of ubiquitination. The 3-D model supports the idea of a C3HC4-RING finger with a partially new pattern. The putative E2-binding site is formed by a shallow hydrophobic groove on the surface adjacent to the helix and one zinc finger (L722, C739, P740, P741, R744). Solvent-exposed hydrophobic amino acids lie around both zinc fingers (I717, L722, F738, or P765, L766, V767, V733, P734). The 3-D structure was deposited in the protein databank theoretical model repository (2B9G, RCSB Protein Data Bank, NJ).

[Prescription of drugs in family medicine: on the trail of efficiency]. / Prescripción de medicamentos en medicina de familia: tras las pistas de la eficiencia.

OBJECTIVE: To analyse the effect of various factors on the efficiency of drug prescription by general practitioners (GPs). DESIGN: Descriptive, cross-sectional study. SETTING: Primary care in Murcia, Cartagena, and Lorca, in which 535 GPs work in the care of 921,281 people. Murcia Region (Spain).Participants. Prescriptions issued by the 288 GPs who were working constantly and continuously in May-June 1998 and who were away from work for no longer than 10% of the time (53.8%). MAIN MEASUREMENTS: We measured their efficiency with two general indicators--potential saving (PS) and prescription of generics (PG)--and 3 specific indicators: efficiency of prescription of omeprazole (EO), enalapril (EE), and ranitidine (ER). We analysed their relationship with structural-organisational factors and with the population attended, the doctor and his/her action. Bivariate and multivariate analyses (logistic regression) were used. RESULTS: There was an association with programmed consultation (PC); a weak inverse relationship with age of doctor, years qualified, pensioners allocated, case load and inter-consultations conducted; and a direct correlation with the length of the consultation. PG was related to rural environment, being non-permanent, specialist in family medicine, belonging to a primary care team. In the multivariate analysis PC was related to all the indicators: PS (OR=1.96), PG (OR=2.10), EO (OR=2.63), ER (OR=2.84), EE (OR=2.06); and the inter-consultations conducted with general efficiency of PS (OR=1.70), PG (OR=1.91). Rural environment was the worst for PS (OR=2.43). CONCLUSIONS: The main factors related to the efficiency of GPs prescription can be changed. The most important is the existence of PC. A lot of inter-consultations and working in a rural environment means worse general efficiency.

[Classification of medication interactions in family medicine and effectiveness of an intervention to improve them]. / Tipificación de interacciones medicamentosas en medicina de familia y efectividad de una intervención para su mejora.

OBJECTIVE: a) To build a detection and evaluation tool of drug interactions (DI) in family practice prescribing; b) to elaborate and to offer a DI report, including appearance mechanism, clinical consequences and appropriate alternatives; c) to evaluate their effectiveness to diminish the DI incidence, and d) to check effectiveness of different diffusion methods. DESIGN: Previous phase: we will build the tool and will elaborate the report. Intervention phase: longitudinal, interventional, multicenter. SETTING: Primary care, Murcia Region. PARTICIPANTS: Family doctors (FD) with computerized clinical history frequently used to prescribe, with indefinite contract and who don't reject to participate. INTERVENTIONS: Randomly we will form 4 FD groups to carry out monthly (6 months): a) Minimal intervention: we mail DI reports; b) generic intervention: DI report is delivered in collective session managed by a trained doctor; c) personalized intervention: discussion peer-to-peer between FD and the trained doctor; d) control group: they won't receive DI information. MAIN MEASUREMENTS: We will measure the evolution of DI incidence and their classification according to relevance and repercussions. Different aspects related with FD and patient characteristics and with organizational environment are measured for subject's describing, inclusion-exclusion criteria assurance and conditioning and confusion factors analysis. DISCUSSION: Limitations. Using a new DI classification make difficult external comparisons, although it is useful because we use generalised and prestigious data sources. Applicability. The project produces a tool to avoid prescription errors. Checking the effectiveness in different corrective measures allows to take reasoned decisions for future interventions in quality care.

Utilización de antihipertensivosen Atención Primaria / Antihypertensive drug use in Primary Health Care

Objetivo. Analizar el uso de antihipertensivos en Atención Primaria en el período comprendido entre 1999 y 2001 y valorar la introducción de los antagonistas de los receptores de la angiotensina II (ARA-II).Métodos. Estudio observacional retrospectivo. Se seleccionaron todas las prescripciones de antihipertensivos mediante recetas de la Seguridad Social en la gerencia de Atención Primaria de Murcia. Las fuentes de datos fueron las cintas de facturación mensual de recetas de la Seguridad Social, nomenclator digitalis de noviembre de 2001, bases de datos de médicos y población con tarjeta sanitaria. Los resultados se expresan en dosis diaria definida (DDD) por 1.000 habitantes y día (DHD).Resultados. El consumo de antihipertensivos se incrementó de 161,7 DHD en 1999 a 183,22 en 2001 (13,3 por ciento).Las prescripciones de antihipertensivos supusieron el 11,67 por ciento del total de recetas. Los fármacos más utilizados fueron los inhibidores de la enzima de conversión de la angiotensina (IECA) (28 por ciento de las DHD totales) y los de mayor crecimiento los ARA-II (incremento del 108 por ciento).Aunque en 2001 los IECA duplicaron a los ARA-II en DHD, el consumo por precio de venta al público (PVP) fue prácticamente el mismo. El uso de diuréticos y betabloqueantes fue del 12,3 por ciento y 8,8 por ciento, respectivamente, en DHD. El fármaco más consumido en todo el período fue enalapril, seguido a distancia por amlodipino, captopril, atenolol y valsartán en 2001.Conclusiones. Los antihipertensivos mantienen una tendencia ascendente de consumo determinada por el incremento de ARA-II. Los IECA continúan siendo los más prescritos y los diuréticos y betabloqueantes probablemente estén infrautilizados. El incremento de ARA-II ha originado un cambio cualitativo en la terapéutica antihipertensiva: se ha detenido la tendencia ascendente de los IECA y se ha incrementado el coste del tratamiento. (AU)

[Effectiveness of a personalized information system on the quality of family doctors' medical prescription]. / Efectividad de un sistema de información personalizada sobre la calidad de prescripción de medicamentos en médicos de familia.

OBJECTIVES: To evaluate the effectiveness of a system of personalised prescription information (PPI) to improve prescription habits of family doctors (FD); to examine how useful PPI is in maintaining these habits, and to analyse its influence through factors of the doctor and his/her environment. DESIGN: Cross-sectional, descriptive pilot study to analyse conditioning factors and possible confusion; quasi-experimental intervention study to assess the effectiveness of PPI, with two groups (experimental and control) and 4 determinations (before the PPI and after: short, medium and long-term).Setting. Family doctors in the Murcia Region. SUBJECTS OF STUDY: The prescriptions of all family doctors in the Murcia region which started before PPI and which continued until the end of the study and without absences of over 10% at each measurement.Intervention. The family doctors from the Murcia city area formed the experimental group: they received PPI with specific proposals for improvement. The FDs of Cartagena and Lorca, who did not receive PPI, made up the control group. Statistical analysis. Logistical regression to identify conditioning factors. Z comparison of proportions contrasted with one-tail hypothesis to check the effectiveness of PPI. LIMITATIONS OF THE DESIGN: Non-randomised allocation to groups made comparison difficult: conditioning factors for stratification or adjustment were studied. PRACTICAL APPLICATION: Confirmation of PPI s effectiveness justifies its dissemination. If there is no such confirmation, it will have to be perfected. Isolating the factors conditioning prescription that can be modified helps find ways to improve PPI.

[Evaluating, improving and monitoring generic drug prescription]. / Evaluación, mejora y monitorización de la prescripción de medicamentos genéricos.

OBJECTIVE: To evaluate and improve generic drug prescription by family physicians in a regional primary care district with a specially-designed intervention. DESIGN: Uncontrolled study of an intervention, based quality evaluation and improvement methods. We selected an indicator that could be constructed with the available data (monthly reports of prescriptions dispensed through the public national health system) and determined the proportion of prescriptions for generic drugs to the total number of prescriptions dispensed, for those medications that had a generic alternative (percentage of generic prescriptions, PGP). After these data were evaluated, an intervention was implemented to increase generic prescriptions. Prescribing behavior was again evaluated and monitored at the end of the intervention period. Setting. Forty-five primary care teams in the Murcia (Southeast Spain) regional primary care district. PARTICIPANTS: A total of 339 family physicians. Interventions. During 15 months, individual reports of prescribing practices, in which changes over time were graphed, were sent to each participating prescriber. Each semester the physicians received a personal letter and a specially-printed, updated card showing the generic medications available and their pharmaceutical forms. One to three face-to-face clinical outreach sessions were held with each primary care team. Specific prescribing goals for the PGP were set and incentives to attain the goals were included in the terms of the contract for clinical services signed between the regional office of primary care management and each primary care team. MAIN OUTCOME MEASURES: The PGP increased from a pre-intervention rate of 2.7% to a post-intervention rate of 17.63%. Absolute improvement was therefore 14.84%, and relative improvement was 15.27%. Variability was monitored and analyzed with control charts. There was no significant variability within the pre- and post-intervention phases, whereas variability increased significantly (indicating improvement) during the intervention phase. CONCLUSIONS: The increase in PGP showed that prescribing for generic preparations improved. Statistical quality control tests were useful in evaluating and tracking the results of the intervention, and were indispensable for monitoring and promptly detecting opportunities to improve prescribing behavior and take appropriate measures.

Efectividad de un sistema de información personalizada sobre la calidad de prescripción de medicamentos en médicos de familia / Effectiveness of a personalised information system on the quality of family doctors' medical prescription

Objetivo. Evaluar la efectividad de un sistema de información personalizada de prescripción (IPP) en la mejora de los hábitos de prescripción de los médicos de familia (MF); conocer su utilidad para mantener estos hábitos, y analizar su influencia por factores del médico y su entorno. Diseño. Estudio descriptivo, transversal, previo para analizar factores condicionantes y de confusión; estudio de intervención cuasiexperimental para valorar la efectividad del IPP, con 2 grupos (experimental y control) y 4 determinaciones (antes del IPP y después: corto, medio y largo plazo).Emplazamiento. MF de la Región de Murcia. Sujetos de estudio. Prescripciones de todos los MF de la Región de Murcia existentes antes del IPP, que continúan hasta finalizar el estudio y sin ausencias superiores al 10 por ciento en cada medición. Formación de los grupos. Intervención: los MF de la Gerencia de Murcia formarán el grupo experimental; reciben el IPP con propuestas específicas de mejora. Los MF de Cartagena y Lorca no reciben el IPP y constituyen el grupo control. Análisis estadístico. Regresión logística para identificar factores condicionantes. Z de comparación de proporciones con contraste de hipótesis unilateral para comprobar la efectividad del IPP. Limitaciones del diseño. La no asignación aleatoria de los grupos dificulta su comparabilidad: se estudian factores condicionantes para estratificación o ajuste. Aplicabilidad práctica. Confirmar la efectividad del IPP justifica su difusión. No hacerlo obligará a perfeccionarlo. Aislar factores modificables condicionantes de la prescripción ayuda a actuar para mejorar (AU)

Evaluación, mejora y monitorización de la prescripción de medicamentos genéricos / Evaluating, improving and monitoring generic drug prescription

Objetivo. Evaluar y mejorar la prescripción de medicamentos genéricos por los médicos de familia de una gerencia de atención primaria (GAP) mediante un programa de intervención. Diseño. Estudio de intervención no controlado, basado en la metodología de evaluación y mejora de la calidad. Seleccionamos un indicador capaz de ser construido con los datos disponibles (cinta de facturación), eligiendo la proporción de genéricos prescritos sobre el total de envases en que existe alternativa genérica (PPEFG).Evaluamos, diseñamos una intervención para mejorar, reevaluamos y monitorizamos. Emplazamiento. Cuarenta y cinco EAP de la GAP de Murcia. Participantes. Un total de 339 médicos de familia. Intervenciones. Realizadas durante 15 meses, fueron: remisión de informe mensual personalizado mostrando la evolución del PPEFG mediante gráficos de desarrollo; edición y entrega personalizada semestral de una tarjeta con los medicamentos genéricos disponibles y sus presentaciones; realización de 1-3 sesiones/EAP, e inclusión de un objetivo en PPEFG explícito e incentivado en los contratos de gestión. Mediciones y resultados principales. El PPEFG preintervención fue del 2,79 por ciento y el postintervención de un 17,63 por ciento. La mejora absoluta es del 14,84 por ciento y la relativa de un 15,27 por ciento. Se ha monitorizado y analizado la variabilidad mediante gráficos de control. No se detecta variabilidad significativa en las fases pre y postintervención y sí (hacia la mejora) durante la intervención. Conclusiones. Ha mejorado la prescripción de genéricos medida en PPEFG. Las técnicas de control estadístico de la calidad aplicadas son útiles en la evaluación y seguimiento de la intervención e imprescindibles para monitorizar, detectar precozmente oportunidades de mejora y actuar en consecuencia. (AU)