[Validation of the SCORE index and SCORE for old people in the Castilla y Léon cardiovascular disease risk cohort]. / Validación del índice SCORE y el SCORE para personas mayores en la cohorte de riesgo de enfermedad cardiovascular en Castilla y León.

INTRODUCTION AND OBJECTIVES: The Systematic Coronary Risk Evaluation (SCORE) is the most extended index in Europe for overall cardiovascular risk assessment. This study aims to validate the calculated risk with the observed 10-year cardiovascular mortality in a population cohort aged 40 to 75 years. METHODS: In 2014 the SCORE and the SCORE OP (for older people) were calculated in a population aged 40 to 64 years-old and 65 to 75 years-old, respectively. In 2014 the 10-year mortality was estimated with the Kaplan-Meier estimator and survival model. Sensitivity, specificity, predictive values, risk ratio of a SCORE value≥5%, and the area under the curve (C statistic) were calculated. RESULTS: Cardiovascular mortality estimated by SCORE was 3 times higher than the observed mortality. The sensitivity of a SCORE≥5% was 20% in women and 28.6% in those less than 65 years old. Predictive positive values were also low, particularly in women with 0.6%. Neither women nor those aged less than 65 years had a significant C statistic. CONCLUSIONS: The SCORE index does not suitably reflect the cardiovascular mortality pattern in Castilla y León. The prediction models for morbidity and mortality need to be periodically updated in order to adjust the prevention and treatment protocols. The SCORE OP has better validity parameters than the SCORE calculated below that age.

[Ischemic heart disease risk in the west Valladolid health area]. / Riesgo de enfermedad isquémica del corazón en el área de salud de Valladolid oeste.

INTRODUCTION AND OBJECTIVES: Cardiovascular diseases, especially ischemic heart disease present a high morbidity and mortality rate in our country. The aim of this study is to estimate the average coronary risk of people living in the west Valladolid Health District. METHODS: Cross-sectional study in a random sample of 369 people between 35 and 64 years of age from the general population, of systolic blood pressure, total serum cholesterol and cigarette smoking. With these three factors, plus sex and age, individual coronary risk was calculated through the Dundee Coronary Risk-Disk method. RESULTS: The coronary risk in the studied district, which is to say the individual probability of suffering a coronary event within five years of life, was estimated in 5.22 (95% CL: 4.75-5.69), higher among men, 5.66 (95% CL: 4.95-6.36), than among women, 4.63 (95% CL: 4.15-5.11). A descendent trend in coronary risk as age increases was found. CONCLUSIONS: This method is relatively easy to obtain for community studies and simple to use for individual risk. The coronary risk of a person from the studied population has similar levels to figures found in other studies from our settings. The community levels of isolated coronary risk factors do not permit the establishment the best option in coronary risk control, and only a multicausal approach will allow us to evaluate the most efficient interventions for each age group and sex.

[Anxiety disorders. The variability and determinants of the therapeutic approach of primary care physicians]. / Trastornos de ansiedad. Variabilidad y condicionantes de la actitud terapéutica de los médicos de atención primaria.

OBJECTIVES: To analyse the influence of independent factors, relating to the characteristics of primary care doctors, patients and the illness, on therapeutic attitudes and their variability before anxiety disorders. DESIGN: Observational study of people attending primary care family medicine clinics who are identified as suffering anxiety disorders. SETTING: The autonomous Communities of Castilla and Leon, the Basque Country and the Valencian Community. PARTICIPANTS: 3247 patients over 18 classified by their doctors as suffering an anxiety disorder. MEASUREMENTS AND RESULTS: During 1995, 317 primary care doctors collected information from patients with anxiety disorders (CIE codes F40 and F41). The information was gathered with the same questionnaire in the three communities. The data were validated monthly before the final analysis. Women doctors gave less medical advice than male doctors (OR: 0.48, 95% CI: 0.36-0.65). Patients with anxiety in Castilla and Leon were at greater "risk" of receiving drugs treatment than those in the Basque Country (OR: 1.64, CI: 1.31-2.06). When the consultation was for any mental symptom or when the kind of anxiety was a panic disorder (OR: 2.39, CI: 1.53-3.65), phobic disorder (OR: 2.17, CI: 1.52-3.08) or mixed anxiety disorder (OR: 2.20, CI: 1.77-2.73), patients were more likely to be referred for specialist treatment. If it was decided to prescribe drugs treatment, women doctors used more often than their male colleagues a mixed treatment with anti-depressants, anxiolytic drugs and drugs for psychosis (OR: 1.60, CI: 160-4.28). Castilla and Leon, and the Valencian Community were less likely to use mixed treatment than the Basque Country reference group. CONCLUSIONS: This study shows the variability in the difficulties encountered in diagnosis and finding a common standard of conduct for primary care doctors faced with patients suffering anxiety disorders. Although the treatment used for anxiety can be considered adequate in most cases, there is high variability, which depends mainly on the type and other characteristics of the process, the patient and the professional.

[Demand and HIV testing prescription in primary care. Registry of the network of sentinel physicians from Castilla y León in 1991, 1992, and 1993]. / Demanda y prescripción de test VIH en atención primaria. Registro de la red de médicos centinelas de Castilla y León en 1991, 1992 y 1993.

OBJECTIVE: the objective of this descriptive study is to improve the knowledge about the use and demand of HIV test in general population in Primary Health Care, as well as to detect lacks in general medicine related to HIV/AIDS. METHOD: from 1991 to 1993, the Red de Médicos Centinelas de Castilla y León, a voluntary sample of general practitioners and pediatrics has collected HIV test data from a covered population representative of the general population. RESULTS: one of the most important findings is the ascending frequency in tests done: On 65,107 and 125 per 100,000 inhabitants in 1991, 1992 and 1993 respectively. Intravenous drug users are the more important group risk in the register, 24%, followed by pregnant women, 17%, and the multiple heterosexual contacts, 9%. Among all the tests, 5.2% were positive. CONCLUSIONS: the comparison with other countries shows differences in frequency, cause and results, whose most probable explanation could be related to the different Health Care System and practice in general medicine and the patterns of risk infection in different populations.

[A sentinel physicians network in Castile and León: the use of cluster analysis to obtain a representative population]. / La Red de Médicos Centinelas de Castilla y León: aplicación del análisis de conglomerados para la obtención de una población representativa.

In order to establish a sentinel physicians network in Castilla y León to collect systematically population-based morbidity data, a random sample of general practitioners (GP's) whose covered population was representative of the regional population was obtained. A cluster analysis with the ZBS (Zonas Básicas de Salud) was performed according to a list of variables considered important in the diseases incidence. Five clusters were obtained in the urban areas and twenty in the rural areas, where, after stratification, the GP's random sample was selected. The outcome of the distribution, within each cluster, between all Castilla y León GP's and the sentinel GP's did not show statistically significant differences. The statistically significant difference found between the age of all GP's and the 127 sentinel GP's, due to the voluntary participation, was not found in the comparison of the two populations covered by them, confirming the efficacy of this method in the selection of a representative population from a random sampling of population groups.