Prevalence of osteoporotic fracture risk factors and antiosteoporotic treatments in the Valencia region, Spain. The baseline characteristics of the ESOSVAL cohort.

UNLABELLED: This study provides information on the prevalence of the most important risk factors for osteoporosis and osteoporotic fracture in a large sample of women and men from the Valencia region and also provides the FRAX 10-year major and hip fracture risks for this population, as well as data about the use of diagnostic tests and antiosteoporotic treatments. INTRODUCTION: The purpose of this study was to describe demographic characteristics, osteoporosis risk factors, the 10-year risk of osteoporotic fracture, and the use of densitometry and antiosteoporotic treatments in the Valencia region, Spain. METHODS: A cross-sectional study using the ESOSVAL cohort baseline data was conducted. We analyze the data from 5,310 women and 5,725 men aged 50 and over who attended to 272 collaborating primary care centers in 2009-2010. We collected the demographic, anthropometric, clinical, and pharmacy data from the electronic medical record. RESULTS: The mean age of participants was 64.3 years old for women and 65.6 years old for men. The most frequent fracture risk factors were sedentary life (22.2 %) and previous fracture (15.8 %) in women and low calcium intake (21.4 %) and current smoker (20.9 %) in men. According to FRAX(®), the 10-year risk of presenting a major fracture was 5.5 % for the women and 2.8 % for the men. The 10-year risk for hip fracture was 1.9 and 1.1 % for the women and the men, respectively; 23.8 % of the women and 5.2 % of the men had a densitometry test, 27.7 % of the women and 3.5 % of the men were taking calcium and/or vitamin D supplements, and 28.2 % of the women (22.0 % in the 50-64 age group) and 2.3 % of the men were taking antiosteoporotic drugs. CONCLUSIONS: The prevalence of certain fracture risk factors not included in the FRAX tool (sedentary life, falls, low calcium intake) is high. In young women, their low risks estimated by FRAX contrast with the high figures for densitometry testing and treatment.

Agreement between semi-automatic radiographic morphometry and Genant semi-quantitative method in the assessment of vertebral fractures.

UNLABELLED: Semi-automatic morphometry is highly reproducible and not time intensive; however, no study has evaluated agreement between semi-automated morphometric methods and the Genant semi-quantitative method performed as a rule by radiologists. Our study shows substantial agreement between both methods; however, semi-automatic morphometry upgrades mild deformities and overestimates the prevalence of fractures. INTRODUCTION: The aim of this study was to evaluate the agreement between radiologists using the Genant semi-quantitative (SQ) method and semi-automated morphometry in the diagnosis of vertebral fractures in post-menopausal women. METHODS: Cross-sectional study was conducted in 2006-2007 in an age-stratified population-based sample of 824 post-menopausal women over the age of 50. From this population two sets of 95 and 50 X-ray were randomly extracted to test inter-rater agreement and agreement between SQ and semi-automated morphometry, and vertebral fractures were classified according to both methods. The Genant method was used to homogenise the diagnosis of fractures. Agreement was evaluated with weighted kappa. We evaluated each vertebral body independently and also the whole vertebral column (T4-L4) classifying women into the worst grade of fracture. For the qualitative interpretation of the agreement, we used the criteria described by Landis and Koch (Biometrics 33:159-174, 1977). RESULTS: The radiologists' agreement was 98.4% (Kappa, 0.75; 95% CI, 0.42-0.89). Agreement between semi-automated morphometry and SQ reached 97.6% and Kappa was 0.86 (95% CI, 0.66-0.94). In the whole evaluation of the spine semi-automated morphometry overestimates, the prevalence of fractures compared with the radiologists were 15.8% of women with fractures and 7.4% of women with moderate-severe fractures by semi-automated morphometry vs. 8.4% and 3.2% by the SQ method. The negative predictive value for MorphoXpress was 99% while the positive was 40%. CONCLUSIONS: Semi-automated morphometry shows high reliability and a substantial agreement with the SQ approach but overestimates the prevalence of fractures. Its role in routine clinical practice is limited because positive results should be reassessed by qualitative or semi-quantitative methods.

[Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources]. / El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios.

INTRODUCTION: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). MATERIALS AND METHODS: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. RESULTS: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. CONCLUSIONS: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients.

El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios / Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources

Introducción: Pese a la elevada prevalencia del síndrome de piernas inquietas (SPI), se cuenta con escasa información sobre este trastorno en nuestro país. El objetivo de este estudio fue obtener información sobre este problema de salud a partir de pacientes identificados mediante un cuestionario de cribado y posterior confirmación diagnóstica por médicos de Atención Primaria (AP). Material y métodos: Estudio en tres etapas, transversal y retrospectivo (utilización de recursos), en una muestra de pacientes adultos (2.047 sujetos) que acudió a consultas ambulatorias de 10 centros de Atención Primaria (Madrid, Barcelona y Valencia). Se utilizó un cuestionario de detección con los 4 criterios diagnósticos de SPI. Se realizó la evaluación clínica y confirmación diagnóstica mediante un cuestionario estandarizado. Otras variables evaluadas fueron: calidad de vida, mediante la puntuación del Cuestionario SF-36 de salud; sueño, mediante la puntuación de la escala de sueño MOS; intensidad de los síntomas de SPI, mediante la puntuación de la escala IRLS; utilización de recursos sanitarios en los 12 meses previos. Confirmación del diagnóstico del médico de AP, por un neurólogo especialista en trastornos del movimiento en una muestra reducida aleatoria de pacientes. Resultados: Un 19,7% (404 de 2.047) de los sujetos respondió positivamente a las 4 preguntas diagnósticas del cuestionario de detección del SPI. De ellos, 185 sujetos (9,0%) presentaban síntomas por lo menos dos veces a la semana, de intensidad moderada a grave. El médico de AP confirmó el diagnóstico de SPI en 79 de los 154 pacientes que completaron la entrevista diagnóstica. La prevalencia en esta población adulta fue del 4,6%. El valor predictivo del cuestionario de detección del SPI fue de un 51,3%. La edad media de inicio de síntomas fue de 42 años (rango: 20-más de 80 años). Los síntomas de SPI fueron moderados en el 50,6% y graves en el 38%. El 73,4% de los pacientes con SPI dormía mal, al menos dos noches por semana. La puntuación media de la escala IRLS (0-40) fue de 19,4. La puntuación media del cuestionario SF-36 (0-100) fue de 54,6, más baja que la de la población española de referencia (61,4). Aproximadamente un tercio de los pacientes había consultado antes con un médico por los síntomas de SPI. No obstante, sólo un 48% contaba con un diagnóstico y sólo en un 5% éste era de SPI. Conclusiones: El estudio DECODE RSL indica que muchos pacientes con síntomas clásicos de SPI visitan frecuentemente a su médico de AP sin ser diagnosticados ni, por lo tanto, recibir un tratamiento adecuado. Herramientas como la utilizada en este estudio pueden ayudar a la detección de estos pacientes (AU)

Introduction: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). Materials and methods: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. Results: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. Conclusions: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients (AU)

[Interruption to treatment with combined lopinavir/ritonavir therapy in HIV positive patients]. / Interrupción del tratamiento con la terapia combinada lopinavir/ritonavir en pacientes VIH+.

OBJECTIVE: To describe the extent of interruptions to treatment with therapies which include the combination of lopinavir-ritonavir within the SNS (Spanish National Health System), as well as identify the causes of these interruptions and analyse the factors associated with the same. METHOD: Retrospective cohort of 197 seropositive patients, who began treatment with lopinavir-ritonavir between January 2000 and October 2002. The patients attended the outpatient pharmaceutical care unit and were followed-up until December 2002. Interruptions and their causes were identified and the factors associated with the interruption were analysed using proportional hazard models. RESULTS: The mean follow-up period was 263 days and 38.6% of patients interrupted therapy. The most common causes of interruption were intolerance (30.3%), non-compliance (21.1%) and therapy failure (5.26%). The mean treatment period was 487 days (95% CI: 432 to 542) and 50% of patients who interrupted treatment did so within the first 4 months. No associations were found between patient or treatment characteristics and the risk of interruption. CONCLUSIONS: The percentage of interruptions was lower than those in other observational studies, but greater than those in clinical trials. The significance of the causes of interruption was similar and no factor associated with the risk of interruption was found.

Interrupción del tratamiento con la terapia combinada lopinavir/ritonavir en pacientes VIH+ / No disponible

Objetivo: Describir, en el entorno del Sistema Nacional deSalud (SNS), la magnitud de la interrupción del tratamiento conterapias que incluyen la combinación lopinavir/ritonavir, identificarlas causas de estas interrupciones y analizar los factores asociadosa las mismas.Método: Cohorte retrospectiva de 197 pacientes seropositivosque iniciaron tratamiento con lopinavir/ritonavir entre enerode 2000 y octubre de 2002 en la unidad de atención farmacéuticaa pacientes externos, y fueron seguidos hasta diciembre de 2002.Se identificaron los casos de interrupción y sus causas y se analizaron,utilizando modelos de riesgos proporcionales, los factoresasociados a la interrupción.Resultados: La duración media de seguimiento fue de 263días. El 38,6% de los pacientes interrumpió el tratamiento, siendolas causas más frecuentes la intolerancia (30,3%), el incumplimiento(21,1%) y el fracaso terapéutico (5,26%). La mediana deduración del tratamiento fue de 487 días (IC95%: 432-542) y el50% de los casos que interrumpieron lo hicieron antes de4 meses. No se hallaron asociaciones entre características de lospacientes o del tratamiento y el riesgo de interrupción.Conclusiones: El porcentaje de interrupciones fue inferior alde otros estudios observacionales pero superior al de los ensayosclínicos. La importancia de las causas de interrupción fue similar.No se halló ningún factor asociado al riesgo de interrupción

Objective: To describe the extent of interruptions to treatmentwith therapies which include the combination of lopinavirritonavirwithin the SNS (Spanish National Health System), as wellas identify the causes of these interruptions and analyse the factorsassociated with the same.Method: Retrospective cohort of 197 seropositive patients,who began treatment with lopinavir-ritonavir between January2000 and October 2002. The patients attended the outpatientpharmaceutical care unit and were followed-up until December2002. Interruptions and their causes were identified and the factorsassociated with the interruption were analysed using proportionalhazard models.Results: The mean follow-up period was 263 days and38.6% of patients interrupted therapy. The most common causesof interruption were intolerance (30.3%), non-compliance(21.1%) and therapy failure (5.26%). The mean treatment periodwas 487 days (95% CI: 432 to 542) and 50% of patients whointerrupted treatment did so within the first 4 months. No associationswere found between patient or treatment characteristics andthe risk of interruption.Conclusions: The percentage of interruptions was lower thanthose in other observational studies, but greater than those in clinicaltrials. The significance of the causes of interruption was similarand no factor associated with the risk of interruption wasfound

[Evaluation of the quality of inter-clinic documents. Does their proper filling out by the family doctor affect the reply obtained from the specialist?]. / Evaluación de la calidad del documento de interconsulta. 'Influye la adecuada cumplimentación del médico de familia en la respuesta que obtiene del especialista?

OBJECTIVE: To analyse the filling out of the inter-clinic form (IF) at a centre with special fields of care (CS) and to assess whether its proper filling out in primary care (PC) affects the reply from specialist care. DESIGN: Cross-sectional, descriptive study. SETTING: Primary health care area in the Community of Valencia. PARTICIPANTS: Randomised sample of IFs of patients referred for the first time from PC to specialists. MAIN MEASUREMENTS: Evaluation criteria were grouped in two: those IFs were considered acceptable (IFCA) in which the family doctor included the reason for consultation or his/her diagnostic impression, as well at least one of the following: anamnesis, personal background, physical examination, further tests or current medication. The remaining IFs were considered inadequately filled out (IFCI). RESULTS: The sample analysed for the IF audit of the CS was 392 people. The result of the audit in the specialist clinics was that 243 IFs were blank (62.0%); the specialist doctor was identified in 19% of cases; the diagnosis was given in 23.5%; treatment, in 21%, and the follow-up plan, in 20%. In the PC evaluation, there were no blank IFs; anamnesis was recorded in 41.8%; reason for consultation in 73%; suspected diagnosis in 58.2%, and treatment in 11.5%. The sample to analyse the differences in the filling of the form in specialist care according to the quality of the PC filling out was 529 IFs. 56.3% of the IFs were considered acceptable. No statistically significant differences were found in the filling of any of the criteria of evaluation by the specialist doctor between the IFs from PC of acceptable and inadequate quality, except on the question of specifying treatment. CONCLUSIONS: We found no relationship between the quality of the IF from PC and the reply from specialist care. Currently, the filling out of IFs continues to be deficient.

Carrera profesional, motivación y compromiso con la organización

No disponible

[Influence of patient's sex on the quality of medicine taken]. / Influencia del sexo del paciente en la calidad de los medicamentos consumidos.

OBJECTIVE: To analyse the relationship between patient's sex and quality of medicine taken by monitoring the most pertinent predictive variables. DESIGN: Observational cross-sectional study. SETTING: Thirteen Health Centres in the Community of Valencia. PARTICIPANTS: Adult users, selected by consecutive sampling. MAIN MEASUREMENTS: A semi-structured questionnaire collected the following variables: social and personal details, use of medicines for health problems, frequency of use of services, and place where prescription was issued. The quality of the medication was measured by its intrinsic value (IV). RESULTS: 412 of the 812 patients were women. Men took more medication with a high IV, and women more with an unacceptable IV. Women over 45 took more medication with a not-high IV. Multivariate analysis showed: a) women took one and a half times more medicines with a not-high IV than men, with differences not significant, and b) in the 45-64 age-group, being a woman operated as a modifier of effect, increasing prevalence of consumption of not-high IV to two and a half times more than men. This was adjusted for frequency of attendance, health problems and where the prescription was issued. CONCLUSIONS: The study helped clarify the influence of gender on the quality of medicine, by pointing to the greater likelihood of women between 45 and 64 taking lower-quality medication. In addition, it showed the effect of where the prescription was issued and of health problems on explaining this difference in consumption.

Influencia del sexo del paciente en la calidad de los medicamentos consumidos / Influence of patient's sex on the quality of medicine taken

Objetivo. Analizar la relación entre el sexo del paciente y la calidad del medicamento controlando por las variables predictoras más relevantes. Diseño. Estudio observacional transversal. Emplazamiento. Trece centros de salud de la Comunidad Valenciana. Participantes. Usuarios adultos, seleccionados por muestreo consecutivo. Mediciones principales. Encuesta semiestructurada que recoge variables sociodemográficas, de utilización de medicamentos por problemas de salud, frecuentación de los servicios y origen de la prescripción. La calidad del medicamento se midió con el valor intrínseco (VI).Resultados. De los 812 pacientes, 412 son mujeres. Los varones consumen más medicamentos con VI elevado (VIE) y las mujeres más de VI inaceptable. Las mujeres mayores de 45 años consumen más medicamentos de VI no elevado (VINE). El análisis multivariante pone de manifiesto: a) la prevalencia en las mujeres de uso de medicamentos de VINE es una vez y media mayor que en los varones, diferencias no significativas, y b) en el grupo de edad de 45-64 años el sexo femenino se comporta como modificador de efecto aumentando la prevalencia en el consumo de medicamentos de VINE en dos veces y media respecto a los varones ajustado por frecuentación, problemas de salud y origen de la prescripción. Conclusiones. Se contribuye a clarificar la influencia del sexo en la calidad del medicamento al señalar la mayor probabilidad de consumir medicamentos de peor calidad por el hecho de ser mujer y tener entre 45 y 64 años. Además, se demuestra el papel del origen de la prescripción y los problemas de salud en la explicación de este consumo diferencial (AU)

Carrera profesional y médicos de familia: reflexiones y propuesta (II) / Professional career and family doctors: reflections and proposal (II)

No disponible

Carrera profesional y médicos de familia: reflexiones y propuesta (I) / Professional career and family doctors: reflections and proposal (I)

No disponible

[Consumption of medicinal herbs and medicines]. / Consumo de hierbas medicinales y medicamentos.

OBJECTIVE: Given the possibility of adverse side-effects, interactions with medicines and poisoning by contaminants among herbal medicine consumers (HM), we aimed to describe the consumption of HM by health centre users being treated with medicines. DESIGN: Cross-sectional, observational study.Setting. Thirteen health centres in the Community of Valencia. PATIENTS AND OTHER PARTICIPANTS: Users of either sex, over 14, chosen for a study of use of medicines to find differences between the sexes. MEASUREMENTS AND MAIN RESULTS: The study variables, age, gender, education, consumption of medicines and use of HM, were gathered from the clinical records, the long-treatment card and an ad hoc structured survey. 801 out of 812 users took medicines. 159 took HM (19.6%; 95% CI, 16.9-22.3); average age 55.8 (SD, 16.5); women 58.5% (95% CI, 50.8-66.1). They took 226 HM (mean of 1.42; 95% CI, 1.32-1.52). Men consumed more HM (p < 0.05). There were no differences in consumption of HM for age, educational background or number of medicines taken. 42.8% (95% CI, 35.1-50.2) of those who took HM attended for consultation over 10 times in the previous year. 96.9% (95% CI, 93.7-98.4) of HM were taken by self-medication. They were consumed: <> by 36.7% (95% CI, 30.4-43.0); stomach problems, 19.5% (95% CI, 14.3-24.6); nerves/depression, 12.8% (95% CI, 8.5-17.2); intestinal disorders, 10.6% (95% CI, 6.6-14.6); insomnia 5.8% (95% CI, 3.1-9.6). 49.1% (95% CI, 42.6-52.6) were manufactured HM. CONCLUSIONS: One of every five patients being treated with medicines is also taking HM by self-medication. The health authorities and doctors should advise of the risks to health and of the counter-indications of these products.

Consumo de hierbas medicinales y medicamentos / Consumption of medicinal herbs and medicines

Objetivo. Dada la posibilidad de efectos adversos, interacciones con medicamentos e intoxicaciones por contaminantes entre consumidores de hierbas medicinales (HM), nuestro objetivo es describir el consumo de HM en usuarios de los centros de salud en tratamiento con medicamentos. Diseño. Estudio observacional, transversal. Emplazamiento. Trece centros de salud de la Comunidad Valenciana. Pacientes u otros participantes. Usuarios, de sexo indistinto, mayores de 14 años, seleccionados para un estudio de utilización de medicamentos para encontrar diferencias entre sexos. Mediciones y resultados principales. Las variables de estudio, edad, sexo, nivel educativo, consumo de medicamentos y uso de HM se recogieron desde la historia clínica, tarjeta de largo tratamiento y encuesta estructurada ad hoc. De los 812 usuarios, 801 consumen medicamentos. Toman HM, 159 (19,6 por ciento; IC del 95 por ciento, 16,9-22,3); edad media, 55,8 años (DE, 16,5); mujeres, 58,5 por ciento (IC del 95 por ciento, 50,8-66,1). Consumen HM, 226 (media, 1,42; IC del 95 por ciento, 1,32-1,52); los varones consumen más HM (p < 0,05). No existen diferencias de consumo de HM por edad, nivel educativo o número de medicamentos consumidos. Un 42,8 por ciento (IC del 95 por ciento, 35,1-50,2) de los que consumen HM acudieron a la consulta más de 10 veces en el último año. El 96,9 por ciento (IC del 95 por ciento, 93,7-98,4) de las HM se consumen por automedicación. Se consumen: 'por gusto', 36,7 por ciento (IC del 95 por ciento, 30,4-43,0); problemas de estómago, 19,5 por ciento (IC del 95 por ciento, 14,3-24,6); nervios/depresión, 12,8 por ciento (IC del 95 por ciento, 8,5-17,2); trastornos intestinales, 10,6 por ciento (IC del 95 por ciento, 6,614,6); insomnio, 5,8 por ciento (IC del 95 por ciento, 3,1-9,6). Un 49,1 por ciento (IC del 95 por ciento, 42,6-52,6) es HM manufacturadas. Conclusiones. Uno de cada 5 pacientes en tratamiento con medicamentos consume HM por automedicación. La administración sanitaria y los médicos deberían informar de los riesgos para la salud y las contraindicaciones de estos productos (AU)

[Compliance of hormone replacement therapy in menopausal women]. / Cumplimiento del tratamiento hormonal sustitutivo en mujeres menopáusicas.

BACKGROUND: The effectiveness of a given treatment is only achieved with a due compliance. Our objective was to know the compliance degree of hormone replacement therapy (HRT) in menopausal women. METHOD: A descriptive observational study was carried out in three hospitals in the Valencia Community (Spain). We included menopausal patients who were visited in a menopause unit from 1989 to 1999 and who were administered HRT. We analyzed age, age at menopause, type of menopause, age at starting HRT, education level, prescription reason, treatment duration, information level, side effects, and causes leading to withdrawal. RESULTS: The study was performed in 363 women. There were 75% probabilities that women fulfilled the therapy for 5 years. The median of fulfillment was 11 years. Those women who had side effects were more prone to withdraw the treatment. By contrast, women who experienced benefits were less prone to withdraw it. Risk of withdrawal was also lower in cases of postsurgery menopause and in women who were younger than 55 years when they started HRT. CONCLUSIONS: In our study, the compliance level was high and it was determined either by treatment benefits or side effects, type of menopause and age at starting HRT.

Evaluación de la calidad de las actividades preventivas y de promoción de la salud realizadas en la población adulta de un Centro de Salud / Evaluation of the quality of the preventive and health promotion activities carried out in the adult population in a health care center

Fundamento: las actividades preventivas y de promoción de la salud han ido aceptándose como la mejor estrategia para, integrada en la práctica clínica, mejorar el nivel de salud de la población. La heterogeneidad de criterios y la falta de consenso impide en la mayoría de los equipos una homogénea implantación y desarrollo. Es necesario evaluar periódicamente para conseguir una implantación homogénea y de calidad por el conjunto de los usuarios. Objetivo: evaluar la calidad de las actividades realizadas en el Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) y establecer medidas correctoras para mejorar el desarrollo del mismo. Diseño: estudio descriptivo transversal. Material y métodos: se incluyeron en el estudio todos los pacientes captados en el PAPPS desde octubre de 1997 a mayo de 1999 en el Centro de Salud. Las fuentes de información utilizadas fueron: la Historia de Salud, la hoja de monitorización del PAPPS, la hoja de registro de los pacientes incluidos en PAPPS y el libro de citación de enfermería. Se adoptaron seis indicadores de calidad que median cantidad y calidad de la captación y calidad científico-técnica. Resultados: se revisaron 324 usuarios con una edad media de 35,5 años, el 60,9 porciento eran mujeres. Las actividades preventivas menos realizadas han sido la detección del sangrado postmenopáusico (53,2 porciento) y la vacunación antirubeólica (57,8 porciento); la más realizada, el consejo antitabáquico (100 porciento). Al 28,7 porciento de los pacientes se les ha diagnosticado de novo de tabaquismo, al 3,5 porciento de abuso de alcohol, al 12,3 porciento de hipercolesterolemia, al 36,7 porciento de obesidad, al 60,9 porciento de sedentarismo y al 6,5 porciento de hipertensión. Conclusiones: la captación ha sido baja y heterogénea. El rendimiento del programa lo estimamos alto por el elevado número de nuevos diagnósticos incorporados a la HSAP y por el tipo de población captada. Seintroducieron seis medidas correctoras para mejorar el desarrollo del programa. Consideramos que se deben realizar evaluaciones por el propio equipo con independencia de las que se realicen en el ámbito nacional (AU)