[Cognitive impairment in the elderly patient with symptomatic severe aortic stenosis. Therapeutic decisions and impact on one-year mortality]. / Deterioro cognitivo en el paciente mayor con estenosis aórtica grave sintomática. Toma de decisiones terapéuticas e impacto sobre la mortalidad al año.

INTRODUCTION: Interventional treatment of severe aortic stenosis includes valve replacement by surgery or transcatheter - transcatheter aortic valve implantation (TAVI). In order to make an adequate selection and to rule out patients with little/no therapeutic benefit, it is recommended to assess comorbidities, frailty and cognitive impairment. AIMS: a) To determine the prevalence of cognitive impairment in older patients with severe aortic stenosis; b) to analyse its influence on decision-making (surgery, TAVI or conservative treatment); and c) to analyse its impact on mortality at one year. MATERIAL AND METHODS: Prospective, longitudinal epidemiological study of patients aged 75 years and older with severe aortic stenosis treated by the Heart-Team. VARIABLES: sociodemographic, clinical, cardiological, functional and mental variables; cognitive impairment assessed by applying the Mini-Mental State Examination (MMSE). RESULTS: We included 300 patients in the study (83.99 ± 4.02 years old; 61.2%, women). Prevalence of cognitive impairment of 15.3%, which was associated with albumin level - odds ratio (OR): 0.082; p = 0.011 - and Barthel (OR: 0.962; p = 0.02) and Lawton (OR: 0.787; p = 0.025) index scores. Surgery was chosen in 24.7% of cases; TAVI in 63.3%; and conservative treatment in 12%. This decision was associated with the score on the Barthel (OR: 0.93; p = 0.012) and Lawton indices (OR: 0.678; p = 0.014), the Short Physical Performance Battery (OR: 0.75; p = 0.037) and the MMSE (OR: 0.691; p < 0.001). Mortality at one year was 14%, and higher in patients with MMSE scores <24 (23.5% vs. 12.8%; p = 0.094). CONCLUSIONS: Cognitive impairment is a very common geriatric syndrome in older patients with severe aortic stenosis that is associated with functional disability in activities of daily living. Cognitive impairment has a high impact on decision-making and appears to be a variable associated with increased mortality.

TITLE: Deterioro cognitivo en el paciente mayor con estenosis aórtica grave sintomática. Toma de decisiones terapéuticas e impacto sobre la mortalidad al año.Introducción. El tratamiento intervencionista de la estenosis aórtica grave incluye el recambio valvular mediante cirugía o vía transcatéter ­implante transcatéter de la válvula aórtica (TAVI)­. Para realizar una adecuada selección y descartar pacientes con escaso/nulo beneficio terapéutico, se recomienda evaluar las comorbilidades, la fragilidad y el deterioro cognitivo. Objetivos. a) Determinar la prevalencia de deterioro cognitivo en pacientes mayores con estenosis aórtica grave; b) analizar su influencia en la toma de decisiones (cirugía, TAVI o tratamiento conservador), y c) analizar su impacto sobre la mortalidad al año. Material y métodos. Estudio epidemiológico longitudinal y prospectivo sobre pacientes de 75 años o más con estenosis aórtica grave atendidos por el Heart-Team. Variables: sociodemográficas, clínicas, cardiológicas, funcionales y mentales; deterioro cognitivo evaluado aplicando el Minimental State Examination (MMSE). Resultados. Incluimos a 300 pacientes en el estudio (83,99 ± 4,02 años; 61,2%, mujeres). Prevalencia de deterioro cognitivo del 15,3%, que se asoció con el nivel de albúmina ­odds ratio (OR): 0,082; p = 0,011­ y las puntuaciones en los índices de Barthel (OR: 0,962; p = 0,02) y Lawton (OR: 0,787; p = 0,025). En el 24,7% de los casos se decidió cirugía; en el 63,3%, TAVI; y en el 12%, tratamiento conservador. Esta decisión se asoció con la puntuación en los índices de Barthel (OR: 0,93; p = 0,012) y Lawton (OR: 0,678; p = 0,014), la Short Physical Performance Battery (OR: 0,75; p = 0,037) y el MMSE (OR: 0,691; p menor de 0,001). La mortalidad al año fue del 14%, superior en los pacientes con puntuaciones en el MMSE menor de 24 (23,5% frente a 12,8%; p = 0,094). Conclusiones. El deterioro cognitivo es un síndrome geriátrico muy frecuente en pacientes mayores con estenosis aórtica grave que se asocia con incapacidad funcional en las actividades de la vida diaria. El deterioro cognitivo tiene un elevado impacto en la toma de decisiones y parece presentarse como una variable asociada a mayor mortalidad.

La técnica de superposición de cúspides en TAVI con dispositivo autoexpandible optimiza la profundidad del implante y reduce la necesidad de marcapasos permanente / Cusp-overlapping TAVI technique with a self-expanding device optimizes implantation depth and reduces permanent pacemaker requirement

Introducción y objetivos: Una profundidad más alta del implante percutáneo de una válvula aórtica autoexpandible minimiza el daño en el sistema de conducción y puede reducir las tasas de marcapasos permanente a 30 días. El objetivo es determinar la seguridad y la eficacia de modificar la técnica de implante clásica para el reemplazo percutáneo de la válvula aórtica a una técnica de proyección de superposición de cúspides (PSC) para lograr una profundidad más alta del implante y reducir la necesidad de marcapasos permanente. Métodos: Desde marzo de 2017 se incluyó a 226 pacientes consecutivos: 113 tratados con técnica de implante PSC frente a 113 casos consecutivos previos con implante clásico. La profundidad del implante se evaluó mediante 3 métodos en todos los pacientes (cúspide no coronaria a válvula cardiaca percutánea (VCP); media de cúspide no coronaria y cúspide coronaria izquierda a VCP y el borde más profundo de cúspide coronaria izquierda y cúspide no coronaria a VCP). Resultados: El grupo de PSC presentó una profundidad del implante menor que el del grupo de implante clásico (4,8±2,2 frente a 5,7±3,1 mm; p=0,011; 5,8±3,1 frente a 6,5±2,4 mm; p=0,095; 7,1±2,8 frente a 7,4±3,2 mm; p=0,392). A los 30 días de seguimiento, 40 pacientes (17,7%) requirieron el implante de marcapasos permanente, menos en el grupo de PSC (el 12,4 frente al 23%; p=0,036). La técnica de implante PSC protegió contra el evento principal (OR=0,45; IC95%, 0,21-0,97; p=0,043), con parecidos éxito del procedimiento y complicaciones. Conclusiones: La técnica de implante PSC es una simple modificación en el protocolo que proporciona una profundidad del implante más alta de la prótesis valvular autoexpandible con menores alteraciones de la conducción y tasas de marcapasos permanente (AU)

Introduction and objectives: This study aimed to determine the safety and efficacy of modifying the classic implantation technique for aortic transcatheter heart valve (THV) implantation to a cusp-overlap-projection (COP) technique to achieve a higher implantation depth and to reduce the burden of new permanent pacemaker implantation (PPMI) at 30 days. Aortic self-expanding THV carries an elevated risk for PPMI. A higher implantation depth minimizes the damage in the conduction system and may reduce PPMI rates. Methods: From March 2017, 226 patients were consecutively included: 113 patients were treated using the COP implantation technique compared with the previous 113 consecutive patients treated using the classic technique. In all patients, implantation depth was assessed by 3 methods (noncoronary cusp to the THV, mean of the noncoronary cusp and the left coronary cusp to the THV, and the deepest edge from the left coronary cusp and the noncoronary cusp to the THV). Results: The COP group had a lower implantation depth than the group treated with the classic technique (4.8 mm± 2.2 vs 5.7 mm± 3.1; P=.011; 5.8 mm± 3.1 vs 6.5 mm± 2.4; P=.095; 7.1 mm± 2.8 vs 7.4 mm±3.2; P=.392). Forty patients (17.7%) required a new PPMI after the 30-day follow-up but this requirement was significantly lower in the COP group (12.4% vs 23%, P=.036). The COP implantation technique consistently protected against the main event (OR, 0.45; 95%CI, 0.21-0.97; P=.043), with similar procedural success rates and complications. Conclusions: The COP implantation technique is a simple modification of the implantation protocol and provides a higher implantation depth of self-expanding-THV with lower conduction disturbances and PPMI rates (AU)

Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study.

Weight gain is observed in breast cancer patients receiving chemotherapy and is a well-known complication. Several factors that contributing to weight gain have been identified. However, there is a lack of information about factors associated with weight changes following adjuvant chemotherapy. A retrospective cohort of 200 pre- and post-menopausal Mexican patients treated for breast cancer was made. Anthropometric variables were measured before/after treatment. Biomarkers, cellular differentiation and chemotherapy were similar between groups. Weight gain occurred in 85.6% of pre-menopausal and 72.6% of post-menopausal women (p = .03). At the end of chemotherapy, weight and body mass index (BMI) did not differ significantly between pre-menopausal (69.3 ± 12.6 kg; 26.6 ± 4.8 kg/m2 ) and post-menopausal women (69.5 ± 10.9 kg; 27.3 ± 4.4 kg/m2 ) (p = .91 and 0.34). Dexamethasone doses were higher in pre-menopausal (85.7 ± 39.1 g) than post-menopausal patients (79.2 ± 22.5 g; p = .13). Weight loss was observed in 9.2% of pre-menopausal and 20.2% of post-menopausal patients (p = .04). A multivariate analysis revealed that age (OR = 2.7; 95% CI = 1.26-5.79; p = .01), menopausal status (OR = 2.29; 95% CI = 1.09-4.80; p = .03), dexamethasone dosage (OR = 2.1; 95% CI = 1.04-4.23; p = .03) and daily caloric intake (OR = 2.3; 95% CI = 1.12-5.10; p = .02) were independent variables that inducted weight gain. Pre- and post-menopausal women gained weight, but more pre-menopausal patients showed gain. An effort should be made to administer lower steroid doses to reduce weight gain.

Análisis de un programa de teleoftalmología para el cribado de retinopatía diabética en área rural tras cinco años / Five-year experience of tele-ophthalmology for diabetic retinopathy screening in a rural population

OBJETIVO: Estudiar la prevalencia de retinopatía diabética (RD) y los factores de riesgo asociados en la población incluida en un programa de teleoftalmología en área rural. Evaluar la capacidad diagnóstica de RD de los médicos de atención primaria (MAP) y su correcta coordinación con los oftalmólogos, cuantificando el ahorro generado. MATERIAL Y MÉTODOS: Estudio observacional transversal de una muestra aleatoria de 394 pacientes incluidos en el programa de teleoftalmología desde enero de 2010 a enero de 2015. Analizamos características clínicas, hallazgos de RD en las retinografías y la correcta derivación de imágenes por los MAP al servicio de oftalmología según los criterios establecidos: RD moderada o severa, baja agudeza visual (AV), mala calidad de imagen y presión intraocular (PIO) > 22 mmHg. Análisis estadístico con SPSS. Pruebas t de Student y χ 2. RESULTADOS: La prevalencia de RD fue del 12,1%. Los pacientes con hemoglobina glucosilada > 7,68% o tratados con combinación de antidiabéticos orales e insulina presentaron mayor riesgo de RD (p < 0,05). El 43,3% de los pacientes derivados correctamente a oftalmología presentaban retinopatía moderada o severa. Los pacientes no derivados a oftalmología de forma correcta pasaron de un 91,7% en 2010 a un 98,6% en 2014. Estimamos un ahorro global de 152.550,45€. CONCLUSIONES: El programa de teleoftalmología resulta útil como cribado de RD. Los MAP son capaces de discriminar los pacientes que requieren valoración oftalmológica, evitando consultas presenciales y generando ahorro

OBJECTIVE: To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyse diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings. MATERIAL AND METHODS: An observational randomised study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure > 22 mmHg. Statistical analysis was performed using the SPSS program (Student t and χ 2 tests). RESULTS: DR prevalence was 12.1%. Patients with glycosylated haemoglobin values > 7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR (P < .05). 43.3% of patients correctly referred to ophthalmologists showed moderate to severe DR. Unnecessary referrals to specialists were improved from 91.7% in 2010 to 98.6% in 2014. It is estimated that the program has made a total saving of €152,550.45. CONCLUSIONS: Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs

[Sex differences in the integrated stroke management in a rural healthcare area in Asturias]. / Diferencias de sexo en el abordaje integral del ictus en un area sanitaria rural de Asturias.

INTRODUCTION: Sex differences and the (rural or urban) nature of populations largely determine the integrated management of time-dependent pathologies such as strokes, which is the main cause of female hospitalisation and mortality in our setting. AIM: To determine whether any differential characteristics can be observed between male and female stroke patients in a rural healthcare area in the Principality of Asturias. PATIENTS AND METHODS: A descriptive retrospective study was conducted at the Jarrio Hospital. Different variables were reviewed using the computerised medical records of patients who suffered a stroke in 2013. RESULTS: Altogether 126 patients were discharged, 53.2% among females, who suffered the disease with a five-year delay (p < 0.008) with respect to males. These latter smoked more and also drank harmful amounts of alcohol (p < 0.000). The pre-hospital delay did not yield any significant sex differences. Language disorder was the main symptom in the female group (p < 0.008), who scored higher on the National Institute of Health Stroke Scale (p < 0.046). Complementary studies, such as Holter monitoring (p < 0.04) and ultrasound scanning of the supra-aortic trunks (p < 0.02), are conducted less often in females, who mainly received conservative treatment with greater parenteral hydration (p < 0.017) and rest. The female group suffered more complications, disability at discharge (p < 0.001) and at three months (p < 0.004), and recorded higher percentages of subsequent institutionalisation (p < 0.005). CONCLUSIONS: There are demographic sex differences in the cerebrovascular risk profile, clinical presentation, hospital management and comorbidity of stroke in this rural population, which suggest that there are areas where there is room for improvement.

TITLE: Diferencias de sexo en el abordaje integral del ictus en un area sanitaria rural de Asturias.Introduccion. Las diferencias de sexo y el caracter (rural o urbano) de las poblaciones determinan en gran medida el abordaje integral de patologias dependientes del tiempo, como el ictus, principal causa de hospitalizacion y mortalidad femenina en nuestro medio. Objetivo. Determinar si en un area sanitaria rural del Principado de Asturias se ponen de manifiesto las caracteristicas diferenciales entre mujeres y hombres con ictus. Pacientes y metodos. Estudio descriptivo retrospectivo realizado en el Hospital de Jarrio. Se revisaron variables a traves de las historias clinicas informatizadas de los pacientes que sufrieron ictus en 2013. Resultados. Se produjeron 126 altas totales, el 53,2% en las mujeres, que sufrieron la enfermedad con un retraso de cinco años (p < 0,008) en relacion con los varones, los cuales fueron mas fumadores y consumidores perjudiciales de alcohol (p < 0,000). La demora prehospitalaria no arrojo diferencias de sexo significativas. El trastorno del lenguaje fue el sintoma principal en el grupo femenino (p < 0,008), que registro una puntuacion superior en la National Institute of Health Stroke Scale (p < 0,046). Los estudios complementarios, como el Holter (p < 0,04) y la ecografia de troncos supraaorticos (p < 0,02), se realizaron menos en las mujeres, que recibieron un tratamiento principalmente conservador con mayor hidratacion parenteral (p < 0,017) y reposo. El grupo femenino sufrio mas complicaciones, discapacidad al alta (p < 0,001) y a los tres meses (p < 0,004), y registro porcentajes mas elevados de institucionalizacion posterior (p < 0,005). Conclusiones. Existen diferencias de sexo demograficas, en el perfil de riesgo cerebrovascular, la presentacion clinica, el manejo hospitalario y la comorbilidad del ictus en esta poblacion rural, que sugieren areas de mejora.

Five-year experience of tele-ophthalmology for diabetic retinopathy screening in a rural population. / Análisis de un programa de teleoftalmología para el cribado de retinopatía diabética en área rural tras cinco años.

OBJECTIVE: To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyse diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings. MATERIAL AND METHODS: An observational randomised study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure >22mmHg. Statistical analysis was performed using the SPSS program (Student t and χ(2) tests). RESULTS: DR prevalence was 12.1%. Patients with glycosylated haemoglobin values >7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR (P<.05). 43.3% of patients correctly referred to ophthalmologists showed moderate to severe DR. Unnecessary referrals to specialists were improved from 91.7% in 2010 to 98.6% in 2014. It is estimated that the program has made a total saving of €152,550.45. CONCLUSIONS: Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs.

Predictors and impact of myocardial injury after transcatheter aortic valve replacement: a multicenter registry

BACKGROUND:Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown.OBJECTIVES:This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR.METHODS:This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up.RESULTS:Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all)...

Factores de riesgo cardiovascular en estudiantes universitarios / Cardiovascular risk factors of college students

College students are in a key life stage for the adoption of lifestyles that will be practiced in the family, society and work. During this period, students gain greater autonomy and take responsibility for their own care. University time becomes a critical step in the development of lifestyles. There is a high prevalence of risk factors for non-communicable diseases in university students such as pre-hypertension especially in men and hypercholesterolemia in women. Other risk factors include smoking, physical inactivity, overweight, obesity, low fruit and vegetable consumption, and high consumption of saturated fats. Some differences of cardiovascular risk factors have been found according to gender, year of career and faculty where students attend. It is recommended to consider these differences when we design and perform educational interventions to achieve greater assertiveness and effectiveness. This article reviews the evidence about cardiovascular risk factors in university students according to gender, year of career and faculty where students attend, following the model proposed by Cecchini et al and according to the Framingham study.

Los estudiantes universitarios se encuentran en una etapa del ciclo vital clave para la adopción de estilos de vida, que practicarán en el ámbito familiar, social y laboral. En este periodo los estudiantes adquieren mayor autonomía y asumen la responsabilidad de su autocuidado, por lo cual se convierte en una etapa crítica para el desarrollo de sus estilos de vida. Existe una alta prevalencia de factores de riesgo de enfermedades crónicas no transmisibles en los universitarios, entre los que destacan pre-hipertensión especialmente en hombres y la hipercolesterolemia en mujeres. También el tabaquismo, sedentarismo, sobrepeso, obesidad, bajo consumo de frutas y verduras, y alto consumo de grasas saturadas. Se encontraron diferencias en los factores de riesgo cardiovascular de acuerdo al género, curso y facultad de los estudiantes. Se recomienda consideran estas diferencias al diseñar y realizar intervenciones educativas para lograr una mayor asertividad y efectividad. El presente artículo revisa la evidencia sobre los factores de riesgo cardiovascular en estudiantes universitarios de acuerdo al género, curso y facultad, según el modelo propuesto por Cecchini y cols. y al estudio de Framingham.

Prevalencia de consumo de drogas en estudiantes universitarios que cursan primer y cuarto año / Prevalence of tabacco, alcohol and marijuana consumption among university students

Background: University students are especially vulnerable towards substance abuse Aim: To describe and compare drug consumption in students of a Chilean university who attended first and fourth year of studies, according to gender and faculty. Material and Methods: A representative, stratified and proportional sample of305 students was randomly chosen by faculty, career, grade and gender during2009. The consumption of alcohol, tobacco and illicit drugs was evaluated using an anonymous survey. Results: Students from health care faculties had the lower prevalence of consumption of tobacco, alcohol, tobacco-alcohol and marijuana, during the first and fourth year. Education area and social sciences faculties had the highest prevalence of consumption. Fourth year students had higher rates of consumption than their first year counterparts. Females had significantly lower rates of alcohol and marijuana consumption. Conclusions: Alcohol, tobacco and marijuana consumption was higher among students from education and social sciences faculties and those attending the fourth year of studies.

[Prevalence of tabacco, alcohol and marijuana consumption among university students]. / Prevalencia de consumo de drogas en estudiantes universitarios que cursan primer y cuarto año.

BACKGROUND: University students are especially vulnerable towards substance abuse AIM: To describe and compare drug consumption in students of a Chilean university who attended first and fourth year of studies, according to gender and faculty. MATERIAL AND METHODS: A representative, stratified and proportional sample of 305 students was randomly chosen by faculty, career, grade and gender during 2009. The consumption of alcohol, tobacco and illicit drugs was evaluated using an anonymous survey. RESULTS: Students from health care faculties had the lower prevalence of consumption of tobacco, alcohol, tobacco-alcohol and marijuana, during the first and fourth year. Education area and social sciences faculties had the highest prevalence of consumption. Fourth year students had higher rates of consumption than their first year counterparts. Females had significantly lower rates of alcohol and marijuana consumption. CONCLUSIONS: Alcohol, tobacco and marijuana consumption was higher among students from education and social sciences faculties and those attending the fourth year of studies.

Validación de la versión española de 5 y 15 ítems de la Escala de Depresión Geriátrica en personas mayores en Atención Primaria / Validation of 5 and 15 items Spanish version of the geriatric depression scale in elderly subjects in Primary Health Care setting

Objetivo. Presentamos un estudio transversal cuyo objetivo fue validar una versión de cinco y quince ítems de la escala de depresión geriátrica (GDS-5 y GDS-15) en un centro de Atención Primaria frente al diagnóstico clínico (según criterios de la DSM-IV como patrón de referencia). Pacientes y método. Se incluyeron 301 pacientes mayores de 64 años. Fueron excluidos aquéllos con deterioro cognitivo (mini-examen cognoscitivo menor de 20/30), déficit severo de comunicación (cofosis) y negación a la propuesta de participar. Se realizaron tanto un análisis descriptivo como un estudio de validación de las escalas. Resultados. La prevalencia de depresión fue del 14,6%. La escala GDS-5 tuvo una sensibilidad de 0,86, una especificidad de 0,85, un valor predictivo positivo (VPP) de 0,51, un valor predictivo negativo (VPN) de 0,97, una razón de probabilidad positiva de 6. Para GDS-15 la sensibilidad fue 0,82, la especificidad 0,98, el VPP 0,86, el VPN 0,97 y la razón de probabilidad positiva 35,03. Conclusiones. La GDS-5 parece útil como prueba de cribado en Atención Primaria ya que presenta una sensibilidad mayor que la GDS-15 y un área bajo la curva muy similar (AU)

Purpose. Cross-sectional study to validate a Spanish version of the 5 and 15 items Geriatric Depression Scale (GDS 5 and 15) in a non-selected community dwelling older population, compared with the clinical diagnosis of depression (using DSM-IV criteria) as gold standard. Patients and method. A total of 301 subjects randomly selected from the >64 years old population served by a public Primary Care Center in Madrid were included. Severe cognitive impairment (MMSE < 20/30), severe hearing impairment and denial to participate were exclusion criteria. A descriptive and a screening study were performed. Results. The prevalence of depression in this population was 14.6%. The 5- item GDS had a sensitivity of 0.864 (0.762-0.965), specificity of 0.856 (0.813-0.899), PPV 0.507 (0.394-0.62), NPV 0.973 (0.952-0.994), and positive likelihood ratio 6 (4.34-8.26). The 15-item GDS had a sensitivity of 0.818 (0.704-0.932), specificity of 0.977 (0.958-0.995), PPV 0.857 (0.751-0.963), NPV 0.969 (0.948-0.99), and positive likelihood ratio 35.03 (28.76-40.77). Conclusions. GDS-5 may be useful screening test for depression in non selected elderly patients in primary care. It has better sensitivity than GDS-15 and similar area under curve (AU)

[Validation of 5 and 15 items Spanish version of the geriatric depression scale in elderly subjects in primary health care setting]. / Validación de la versión española de 5 y 15 ítems de la Escala de Depresión Geriátrica en personas mayores en Atención Primaria.

PURPOSE: Cross-sectional study to validate a Spanish version of the 5 and 15 items Geriatric Depression Scale (GDS 5 and 15) in a non-selected community dwelling older population, compared with the clinical diagnosis of depression (using DSM-IV criteria) as gold standard. PATIENTS AND METHOD: A total of 301 subjects randomly selected from the >64 years old population served by a public Primary Care Center in Madrid were included. Severe cognitive impairment (MMSE < 20/30), severe hearing impairment and denial to participate were exclusion criteria. A descriptive and a screening study were performed. RESULTS: The prevalence of depression in this population was 14.6%. The 5- item GDS had a sensitivity of 0.864 (0.762-0.965), specificity of 0.856 (0.813-0.899), PPV 0.507 (0.394-0.62), NPV 0.973 (0.952-0.994), and positive likelihood ratio 6 (4.34-8.26). The 15-item GDS had a sensitivity of 0.818 (0.704-0.932), specificity of 0.977 (0.958-0.995), PPV 0.857 (0.751-0.963), NPV 0.969 (0.948-0.99), and positive likelihood ratio 35.03 (28.76-40.77). CONCLUSIONS: GDS-5 may be useful screening test for depression in non selected elderly patients in primary care. It has better sensitivity than GDS-15 and similar area under curve.

Prevalencia de burnout entre los profesionales de Atención Primaria, factores asociados y relación con la incapacidad temporal y la calidad de la prescripción / Prevalence of burnout among primary health care professionals, factors associated and relations with temporary incapacity and quality of the prescription

INTRODUCCIÓN. El presente estudio se planteó como objetivo conocer la prevalencia del síndrome de burnout en los profesionales que desarrollan su trabajo en Atención Primaria y su relación con las bajas laborales y la calidad de la prescripción. MÉTODOS. Estudio transversal mediante cuestionario Maslach Burnout Inventory (MBI). Emplazamiento: 5 Centros de Salud y 25 Consultorios periféricos. Participantes: 145 profesionales. Variables: La puntuación en las subescalas de Cansancio Emocional, Despersonalización y Logros Personales del MBI. Variables laborales. Indicadores de prescripción. Días de baja en el último año. RESULTADOS. Tasa de participación: 79,23%. Edad media: 40,22 años. Fue detectado alto grado de burnout en el 36,6% (2-44,6) de los profesionales. Mayores puntuaciones en las diferentes subescalas se relacionaron con ser varón (p < 0,001), mayor edad (p: 0,034), ser médico de familia (p: 0,04), trabajar en un equipo de Atención Primaria (p: 0,02), mayor experiencia (p: 0,03), mayor presión asistencial (p: 0,04). Se obtiene menor grado de desarrollo personal si eres demandante de empleo (p: 0,041). El mayor cansancio emocional se relaciona con peores indicadores de prescripción: menos Especialidades Farmacéuticas Genéricas prescritas (p: 0,016), menos antimicrobianos recomendados en Atención Primaria (p: 0,002), menos antiinflamatorios no esteroideos recomendados en Atención Primaria (p: 0,015), más novedades terapéuticas tipo C (p: 0,004) y mayor tasa de derivación (p: 0,037) de forma significativa y con mayor número de días de baja (p: 0,031). CONCLUSIONES. La prevalencia de este síndrome en nuestro medio no es tan alta como en otros estudios, quizás debido a una menor presión asistencial. Observamos cómo este proceso se relaciona con mayor absentismo laboral por problemas de salud y peores indicadores de calidad. El diseño de estrategias encaminadas a prevenir este síndrome se configuran como elementos imprescindibles para mejorar la calidad de los servicios prestados

INTRODUCTION. The present study was proposed in order to know the prevalence of the burnout syndrome in professionals who carry out their work in Primary Health care and its relationship with sick leaves and the quality of the prescription. METHODS. Cross-sectional study with the questionnaire Maslach Burnout Inventory (MBI). Site: 5 Health Care Centers and 25 Peripheral medical centers. Participants. 145 professionals. Variables. The score on the subscales of Emotional Tiredness, Depersonalization and Personal Achievements of MBI. Work variables. Prescription indications. Days of sick leave in the last year. RESULTS. Participation rate: 79.23%. Mean age: 40.22 years. A high grade of burnout was detected in 36.6% (2-44.6) of the professionals. Higher scores on the different subscales were related with being male (p < 0.001), older age (p: 0.034, being a family doctor (p: 0.04), working in a primary health care team (p: 0.02), greater experience (p: 0.03), greater health care pressure (p: 0.04). A lower grade of personal development was obtained if the person was demanding employment (p: 0.041). Greater emotional tiredness was related with worse indictors of prescription (fewer generic pharmaceutical products prescribed (p: 0.016), fewer antimicrobials recommended in primary health care (p: 0.002), fewer NSAIDS recommended in primary health care (p: 0.015), more type C therapeutic novelties (p: 0.004) and greater referral rate (p: 0.037) significantly with greater number of days of sick leave (p: 0.031). CONCLUSIONS. The prevalence of this syndrome in our setting is not as high as in other studies, perhaps due to lower care pressure. We observe how this process is related with greater work absenteeism due to health problems and worse quality indicators. The design of the strategies aimed at preventing this syndrome is outlines as essential elements to advance in the improvement of the quality of the services provided

¿Por qué hay pacientes que acuden sin cita previa? / Why are there patients who come without an appointment?

OBJETIVO. Estudiar los motivos para acudir sin solicitar cita en Atención Primaria (AP). MÉTODOS. Estudio descriptivo observacional y transversal, emplazado en el Equipo de Atención Primaria (EAP) de Cirajas I y II del Área IV de Madrid. Se estudiaron 277 pacientes seleccionados consecutivamente entre los que acudieron al centro sin cita durante el 2001. Variables: edad, sexo, país, estudios, situación laboral, motivo de acudir sin cita, día, horario, profesional que lo atiende, diagnóstico, tratamiento. Se realizó un estudio descriptivo donde las variables cuantitativas se describirán con la media, la desviación estándar y la mediana; las cualitativas por la distribución de frecuencias. Posteriormente, un análisis bivariante buscando la relación de las variables con los motivos por los que se acudió sin cita utilizando la prueba exacta de Fisher y la prueba de Chi-cuadrado. RESULTADOS. El principal motivo fue la urgencia médica en un 42,24% (36,5-48,1), seguido de acudir como acompañante en un 10,7% (7,3-14,5) y a por recetas en un 7,94% (5,2-11,6). Los diferentes motivos para acudir sin cita se relacionaron de forma estadísticamente significativa con diferentes variables. Así, encontrar el teléfono ocupado se relaciona con el horario de mañana, acudir como acompañante se relaciona con inactividad laboral, horario de tarde y con acudir a su propio médico. El desconocimiento del sistema se relaciona con nacionalidad extranjera. La incompatibilidad con horario laboral se relaciona con un nivel de estudios alto. CONCLUSIONES. En nuestra zona básica de salud existen diferentes motivos que provocan que los pacientes tengan que acudir sin solicitar cita. Conociéndolos podemos establecer medidas de mejora encaminadas a reducir el número de estos pacientes, así como el impacto en el trabajo diario

OBJECTIVE. Study the reasons why some people come to Primary Care without an appointment. METHODS. Descriptive, observational and cross-sectional study conducted in the Madrid Area IV Primary Care Team of Cirajas I and II. A total of 277 patients consecutively selected between those who came to the site without an appointment during 2001 were studied. Variables: age, gender, country, studies, work situation, reason for coming without an appointment, day, time, professional who saw the patient, diagnosis, treatment. A descriptive study was conducted where the quantitative variables were described with the mean, standard deviation and median and the qualitative ones by distribution of frequencies. Subsequently, a bivariate analysis was done, seeking the relationship of the variable with the reasons for coming without an appointment, using Fisher's exact test and Chi-squared test. RESULTS. The main reason was medical emergency in 42.24% (36.5-48.1), followed by accompanying a patient in 10.7% (7.3-14.5) and for prescriptions in 7.94% (5.2-11.6). The different reasons for coming without an appointment were related in a statistically significant way with different variables. Thus, finding the phone busy is related with the morning schedule, accompany a patient is related with work inactivity, afternoon time and coming to one's own physician. Lack of knowledge of the system is related with foreign nationality. Incompatibility with work schedule is related with a high level of studies. CONCLUSIONS. In our basic health zone, there are different reasons that cause the patients to come without requesting an appointment. By knowing them, we can establish improvement measures aimed at reducing the number of these patients and the impact on the daily work

Signos y síntomas de desórdenes temporomandibulares antes y después de cirugía ortognática, comparación entre osteotomía sagital y osteotomía oblicua de rama / Signs and symptoms of temporomandibular disorders before and after orthognatic surgery; comparison between sagittal osteotomy and oblique osteotomy of the ramus

El propósito de este proyecto fue investigar la influencia de la cirugía ortognática en los signos y los síntomas presentes en los pacientes con desórdenes temporomandibulares (DTM). Se escogieron dieciséis pacientes con patrón esquelético clase iii que fueron examinados antes y después de cirugía ortognática. A ocho de los pacientes se les realizó osteotomía oblicua de rama (OOR) y a los ocho restantes se les practicó osteotomía sagital de rama (OSR). A dos pacientes de cada grupo se les realizó también osteotomía Le Fort i Los signos y síntomas relacionados con DTM fueron evaluados antes de cirugía y los cambios en estos fueron valorados al primero, tercero y sexto mes posquirúrgico. Como resultados, no se encontraron diferencias significativas en la frecuencia de ruidos articulares, o de dolor en la articulación temporomandibular (ATM) o dolor muscular, entre ambos grupos de pacientes. En las revisiones a los tres y seis meses después de la cirugía los pacientes mostraron mejoría de los signos y síntomas de los DTM. Todos los pacientes mostraron disminución de la movilidad mandibular. De seis pacientes que se quejaban de cefaleas en la evaluación prequirúrgica, cinco mejoraron significativamente después de la cirugía. Se concluyó que no hay diferencia significativa con respecto a la mejoría de los signos y los síntomas asociados a la DTM, entre la OOR y la OSR El número de casos incluidos en este estudio es reducido y por lo tanto los resultados no son concluyentes.

Seguimiento de los valores de antitrombina en mujeres en tratamiento anticonceptivo oral. Respuesta / Monitoring of antithrombin levels in women on oral contraceptive treatment. Reply

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[How suitable is thromboembolism prophylaxis for patients with chronic auricular fibrillation at 3 primary care centers]. / Adecuación de la profilaxis tromboembólica en pacientes con fibrilación auricular crónica en 3 centros de atención primaria.

OBJECTIVE: To find just how suitable thromboembolism prophylaxis (TEP) is in a group of patients with chronic auricular fibrillation belonging to the primary care environment. DESIGN: Cross-sectional and descriptive multi-centre study. SETTING: The study was performed at 3 urban primary care centres in Madrid. PARTICIPANTS: All the patients recorded up to April 2001 with the diagnosis of chronic auricular fibrillation (n=274) were included. Patients with no clinical history or who had a valve prosthesis were excluded. MAIN MEASUREMENTS: Demographic variables, existence of factors of risk of embolism, presence of counter-indications for oral anti-coagulants, and the kind of thromboembolic prophylaxis taken were collected. RESULTS: A total of 274 patients were evaluated. Average age was 75 (SD, 9) and 52% were women. 82% of patients had at least one factor of risk of thromboembolism. The most commonly used kind of TEP was oral anti-coagulants. 45% of patients did not receive suitable TEP. 13.5% of patients at risk of embolism and who had no kind of TEP were found. CONCLUSIONS: There is a high percentage of patients with chronic auricular fibrillation and a high risk of embolism, who do not receive adequate TEP, in the absence of counter-indications to taking oral anticoagulants. There is great scope for improvement, which is within professionals' possibilities.