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1.
Teodoro Durá-Travé Fidel Gallinas-Victoriano María Jesús Chueca-Guindulain Sara Berrade-Zubiri Paula Moreno-Gónzalez María Malumbres-Chacón 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(7):422-429
Objective
To analyse the prevalence of hypovitaminosis D and associated factors in school children and adolescents living in a region of northern Spain.Design
Cross-sectional study (convenience sampling).Setting
Primary Health Care.Participants
A total of 602 Caucasian individuals (aged 3.1 to 15.4 years) were included in the study.Main measurements
Prevalence of hypovitaminosis D were calculated (dependent variable). Hypovitaminosis D is defined according to the US Endocrine Society criteria: deficiency (calcidiol < 20 ng/mL), insufficiency (calcidiol: 20-29 ng/mL), and sufficiency (calcidiol ≥ 30 ng/mL). Gender, age, body mass index, residence, and season of the year were recorded (independent variables), and their association with hypovitaminosis D was analysed by multiple regression.Results
The prevalence of hypovitaminosis D was 60.4% (insufficiency: 44.6%; deficiency: 15.8%). Multivariate analysis showed that factors associated to hypovitaminosis D were being female (OR: 1.6; 95% CI: 1.1-2.3), pubertal age (OR: 1.8; 95% CI: 1.2-2.6), autumn (OR: 9.5; 95% CI: 4.8-18.7), winter (OR: 8.8; 95% CI: 4.5-17.5) and spring time (OR: 13.2; 95% CI: 6.4-27.5), living in urban areas (OR:1.6; CI 95%: 1.1-2.2), and severe obesity (OR: 4.4; 95% CI: 1.9-10.3).Conclusions
There is a high prevalence of hypovitaminosis D in juvenile populations. being female, pubertal age, autumn, winter and spring seasons, severe obesity, and living in urban areas are factors associated to hypovitaminosis D. Consideration should be given to the administration of vitamin supplements and/or the increase in the ingestion of natural vitamin D dietary sources. 相似文献2.
3.
Fran Calvo Xavier Carbonell Ramón Valero Jordi Costa Oriol Turró Cristina Giralt Marissa Ramírez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(8):477-485
Aim
The aim of this study is to define the risk factors associated with early discharge in out-patients clinics.Design
Cross-sectional and observational study.Setting
Substance abuse clinics in Girona (Catalonia, Spain).Participants
A total of 264 individuals were included in the sample, and 34.8% of them abandoned the process within two months of starting the therapy (n = 92).Procedure
Clinical and socio-demographic variables of the clinical history were compared between participants with/without adherence.Main measurements
The Student t test was used to measure the comparison, and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression model was adjusted, with adherence as the dependent variable.Results
The results indicated that attending the appointments unaccompanied (OR = 3.13), being female (OR = 2.44), having cocaine related issues (OR = 1.14), and being younger (OR = 0.89) are the factors which increase the risk early abandonment. Contrarily, being referred to specialists from a Primary Health Centre reduces the risk (OR = 0.28).Conclusions
It is concluded that special attention must be devoted to the patients’ families, women, and young patients. Moreover, the appropriate coordination between specialist services and basic services increases adherence to treatment among drug users. 相似文献4.
Javier C. Angulo María P. Calderín Yolanda Fernández Miriam González Esther Gómez Maria B. Herreros Purificación Peñasco Manuela Zapatero Juan F. Dorado 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(2):79-87
Objective
Determining the prevalence of symptoms suggestive of overactive bladder (OAB) in a Spanish population and evaluate the impact of these symptoms on well-being and labour productivity in this population.Design
Transversal study.Location
Primary health care, Madrid, Spain.Participants
Males and females > 30 years.Interventions
Classification by primary care physicians with the Overactive Bladder Awareness Tool abbreviated version (OAB-V3). Subjects with score ≥ 3 and a similarly balanced control population with score < 3 were clinically investigated.Principal measurements
History, physical examination, urinalysis, sonography, general well-being scale and the questionnaires PPBC, OAB-q y WPAI-SHP.Results
A total 923 subjects were screened, of which 209 (22.6%), 35% males and 65% females, had probable OAB. Age distribution increased from 11.1% in 4th decade to 44.4% in 9th decade. Kappa coefficient between suspected OAB and definite diagnosis was .83. The area under ROC curve for diagnosis based on OAB-V3 questionnaire and the presence of perceived bother and coping strategies was 92%. Subjects classified by score ≥ 3 had worse well-being, higher PPBC score and worse parameters on total OAB-q and transformed scores for each OAB-q subscale (P < .0001). In these subjects labour productivity was not affected (P = .14) but the capacity to perform regular activities was (P < .0001).Conclusions
OAB-V3 is a simple questionnaire to screen OAB with good predictive accuracy in a primary care setting and reveals important implications on health related quality of life issues. 相似文献5.
Andrés Cabrera-Leon Miguel Ángel Cantero-Braojos 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(9):527-538
Objective
To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services.Design
Cross-sectional population study with face-to-face interview.Setting
Andalusian Health Survey (2011 edition).Participants
6,507 people over the age of 16 (p = q = 0.5; confidence level = 95%; sampling error = 1.49, design effect = 1.52).Interventions
Not applicable.Main measurements
Dependent variable: DCP: population limited in their activity by any of the CP specified in the survey. Independent variables: quality of life, absence from work, consumption of medication and utilization of health services.Results
Compared to a population without CP, DCP impact is 6 points less on the mental quality of life and 12 points on the physical one, medication consumption is triple, health services utilization is almost double, and long absence from work is triple. On the other hand, a population with nondisabling chronic pain (nDCP) presents similar results to a population without CP.Conclusions
We have considered DCP as another CP category because of its huge impact, as is shown in our study, on the study variables. On the contrary, the population with nDCP does not obtain significant impact differences when compared to the population without CP. Therefore, we believe that Primary Care and Public Health should lead different prevention strategies for DCP as well as for the identification of the nDCP population to decrease its possible deterioration towards DCP. 相似文献6.
7.
Marta Castillo Aurora Astudillo Omar Clavero Julio Velasco Raquel Ibáñez Silvia de Sanjosé 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(3):151-158
Objective
To assess the impact of screening history on the incidence of cervical cancer from 2000 to 2010 in Asturias.Design
Retrospective study.Location
All public hospitals in Asturias.Mean measurements
From 374 women diagnosed with cervical cancer were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals.Results
Women between 25 and 70 years had no records of a previous cytology within 5.5 years of cancer diagnosis in 65.6%. This proportion was related with older age, presence of symptoms and an advance tumor stage at diagnosis. Women over 70 years old had no records of a previous cytology in 83.3%.Conclusion
An organized cervical cancer screening program and optimal quality of the system, monitored through audits, could help to reduce cervical cancer incidence and mortality in Asturias. 相似文献8.
Francisco Javier Valverde Bolívar Miguel Pedregal González Herminia Moreno Martos Inmaculada Cózar García Jesús Torío Durántez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(10)
Objective
To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style.Design
Cross-sectional multicentre study.Location
Primary Healthcare Centres in Andalusia, Spain.Participants
A total of 119 tutors and family medicine physician residents.Principal measurements
Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care.Results
The mean duration of consultations was 8.8 min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37 ± 4.19 min vs 7.54 ± 2.98 min; p = 0.001), and when there was joint decision-making (9.79 ± 3.96 min vs 7.73 ± 3.42 min: p = 0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r2 = 0.32). There was no correlation between physician or patient gender, or problem type.Conclusion
A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation. 相似文献9.
10.
Melika Chihaoui Imen Sebai Ibtissem Oueslati Wafa Grira Meriem Yazidi Chourouk Rissouli Bochra Ftouhi Rachid Ksantini Fatma Chaker Hedia Slimane 《Nutrition Clinique et Métabolisme》2018,32(3):201-207
Aims of the study
To investigate the effect of bariatric surgery on anthropometric and metabolic parameters in morbidly obese Tunisian subjects.Methods
It is a retrospective study including 47 morbidly obese patients who have had a bariatric surgery between 2004 and 2012. The mean age was 36.5 ± 8.9 years and the sex ratio 0.08. Pre- and post-operative clinical and paraclinical parameters were collected from patients’ medical records.Results
Mean excess weight loss (EWL) was 50.6% [17.9–99.8]. Failure rate (EWL < 25%) was 21.3%. Gastric bypass surgery was the intervention which led to the best weight loss rate (EWL of 63.4%), followed by gastric banding (EWL = 54.5%) and sleeve gastrectomy (EWL = 40.8%). The remission rates from hypertension, type 2 diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and hyperuricemia were 40%, 75%, 17%, 75% and 68% respectively.Conclusion
This study has proven the efficiency of bariatric surgery in morbidly obese Tunisian patients in achieving a significant EWL and in the remission of the comorbidities. 相似文献11.
12.
Laura Illamola Martin Juan José Rodríguez Cristobal Carlos Alonso-Villaverde Betlem Salvador-González Irene Moral Pelaez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(6):325-331
Objectives
To determine whether the benefit on cardiovascular risk factors (CVRF) persists 5 years after an intensive intervention in lifestyle (LS) that lasted 2 years, in patients with hyperfibrinogenaemia and moderate or high cardiovascular risk.Design
multicentre prospective observational study.Location
13 Primary Care Centres in Barcelona and Baix Llobregat.Participants
A total of 300 patients who completed the EFAP study (146 intervention group, 154 control group).Interventions
The EFAP study, conducted on patients with normal cholesterol and elevated fibrinogen showed that lifestyle interventions are effective in reducing CVRF. After the EFAP study, the 2 groups followed the usual controls, and re-assessed after 5 years.Main measurements
Age, gender, cardiovascular diseases (CVD) (diabetes, dyslipidaemia, hypertension, obesity), laboratory parameters (fibrinogen, glucose, full blood count, cholesterol, triglycerides), blood pressure, weight, height, body mass index (BMI), tobacco and alcohol use, REGICOR.Results
At 5 years, the intervention group had a lower abdominal circumference (98 and 101 cm, respectively, P = .043), a lower weight (76.30 and 75.04 kg, respectively, P < .001), and BMI (29.5 and 30.97 kg/m2, P = .018). Fibrinogen level was lower in the intervention group (330.33 and 320.27 mg/dl respectively, P < .001), and REGICOR risk was also lower in the intervention group (5.65 and 5.59 respectively, P < .06).Conclusion
The benefit of an intensive intervention in LS for 2 years to reduce CVRF persists at 5 years, but decreases its intensity over time. It is recommended to repeat the interventions periodically to maintain the beneficial effect on LS. 相似文献13.
Ingrid Solanes Ignasi Bolíbar Maria Antònia Llauger Meritxell Peiro Pepi Valverde Mar Fraga Casimira Medrano Teresa Bigorra Montserrat Freixas Iskra Ligüerre Maria Antònia Pou Leandra Domínguez Carles Valero Judit Solà Jordi Giner Vicente Plaza 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(3):184-196
Objective
To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD).Design
A study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2 months.Setting
Primary Care Centres in two Barcelona Health Areas and their referral hospitals.Participants
Patients with COPD selected by simple random sampling using any disease code corresponding to COPD.Interventions
I1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared.Main measurements
Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations.Results
Of the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P = .034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P < .001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P < .003]).Conclusions
Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD. 相似文献14.
Daniela Dubois Marques Vicente Mora Llabata Julián Pacheco Arroyo Salvador Gasull Insertis Manuela Vicente Cañizares Ildefonso Roldán Torres 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(6):340-349
Objective
To determine whether antithrombotic treatment (ATT) in patients with non-valvular atrial fibrillation in a health area complies with the recommendations of current clinical guidelines.Design
Prospective observational study.Location
Primary Health Care Centres and Cardiology Department of a Health Department of the Valencian Community, Spain.Participants
A total of 505 patients with nonvalvular atrial fibrillation were included in the study.Main measurements
ATT was deemed to be inappropriate in patients with a CHA2DS2-VASc score ≥ 1 and who were not under oral anticoagulation, in patients treated with antivitamin K drugs, and poor control of oral anticoagulation, or with antiplatelet therapy inappropriately associated with anticoagulation, and in patients on ATT with a CHA2DS2-VASc score = 0.Results
The median age was 77.4 ± 10 years. The ATT was considered inadequate in 58% of cases. Factors independently associated with inadequate ATT were age (OR: 1.02 [1-1.04]; P = .029), hypothyroidism (OR: 1.98 [1.14-3.43]; P = .015), ischaemic heart disease (OR: 1.3 [1.15-2.59]; P = .008) and paroxysmal non-valvular AF (OR: 2.11 [1.41-3.17]; P < .0001).Conclusions
These data underline the high prevalence of inadequate ATT in daily practice, as well its different causes. 相似文献15.
16.
Mariano de la Figuera Sergio Cinza Nuria Marín Isabel Egocheaga Miguel Angel Prieto 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(6):359-367
Objective
To analyse the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC).Design
Observational, cross-sectional and multicentre study.Location
Autonomous Communities in which the general practitioner can prescribe DOAC (n = 9).Participants
The study included a total of 790 patients on chronic treatment with anticoagulants, and on whom therapy was changed, as well as being currently on treatment with DOAC for at least for 3 months.Main measures
A record was made of the sociodemographic and clinical management date.Results
Mean age was 78.6 ± 8.4 years, and 50.5% of patients were men. Mean CHADS2 score was 2.6 ± 1.2, mean CHA2DS2-VASc score was 4.3 ± 1.6, and the mean HAS-BLED score was 2.3 ± 1.0. Mean duration of treatment with DOAC was 15.8 ± 12.5 months. Rivaroxaban was the DOAC most frequently prescribed (57.8%), followed by dabigatran (23.7%), and apixaban (18.5%). Of the patients receiving rivaroxaban, 70.2% were taking the dose of 20 mg/daily. Of the patients receiving dabigatran, 41.7% were taking the dose of 150 mg twice daily, and in the case of apixaban, 56.2% were taking the dose of 5 mg twice daily. Satisfaction (ACTS Burdens scale 52.0 ± 7.2 and ACTS Benefits scale 12.1 ± 2.2), and therapeutic adherence (97.8% of patients took their medication regularly) with DOAC were high.Conclusions
Patients treated with DOAC in Spain have a high thromboembolic risk. A significant proportion of patients receive a lower dose of DOAC than that recommended according to their clinical profile. Satisfaction and medication adherence are high. 相似文献17.
18.
Olga Ochoa-Gondar Ángel Vila-Córcoles Cinta de Diego Eva Satué Angel Vila-Rovira María Aragón 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(9):553-559
Objectives
To know antipneumococcal vaccination coverages among Catalonian adults and evaluate the adequacy of vaccine use according to 3 distinct current vaccination guidelines.Design
Population-based cross-sectional study.Setting
Primary Health Care. Catalonia, Spain.Participants
A total of 2,033,465 individuals ≥ 50 years-old registered in the Catalonian Health Institute.Main measurements
Vaccination status for the 23-valent pneumococcal polysaccharide vaccine (PPV23) and/or the 13-valent pneumococcal conjugate vaccine (PCV13) was revised at 1/01/2015. Adequacy of vaccination status was determined according to 3 distinct vaccination recommendation guidelines: Spanish Ministry of Health (basically coinciding with Catalonian Health Institute's recommendations), Spanish Society of Family Physicians (semFYC) and Centers for Disease Control and Prevention (CDC).Results
Overall, 789,098 (38.8%) persons had received PPV23 and 5,031 (0.2%) had received PCV13. PPV23 coverage largely increased with increasing age (4.8% in 50-59 years, 35.5% in 60-69 years, 71.9% in 70-79 years and 79.5% in ≥ 80 years; P < .001), whereas PCV13 coverage was very small in all age groups. Considering the 3 analysed vaccine guidelines a 46.1% of the overall study population were adequacy vaccinated according to Spanish Ministry's recommendations, 19.3% according to semFYC's recommendations and 4.6% according to CDC's recommendations.Conclusion
PPV23 coverage among Catalonian adults may be considered as intermediate, but PCV13 coverage is very small. The institutional recommendations (Spanish Ministry) are more followed than corporative (semFYC) or less local (CDC) recommendations in clinical practice. 相似文献19.
Ana Fernández-Feito Raquel Antón-Fernández María Paz-Zulueta 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(5):291-298
Aim
To estimate the association between the human papillomavirus (HPV) vaccine and sexual risk behaviour, as well as the participation in the Cervical Cancer Screening Program (CCSP).Design
Cross-sectional study.Location
School of Medicine and Health Sciences, School of Law, and School of Economics and Business (University of Oviedo).Participants
Female university students.Main measurements
Information was collected about contraceptive methods, sexual behaviours, HPV knowledge, and participation in the CCSP. Furthermore, proportions and odds ratio (OR) were estimated with their corresponding 95% confidence intervals (95% CI).Results
Approximately two-thirds (67.7%) of the sample was vaccinated against HPV, and 216 women (65.3%) were sexually active. Barrier contraceptive methods were used by 67.6% during their current intimate relationships, being less frequent in non-vaccinated women (54.9% vs. 75.4% in vaccinated female students) (P = .002). The risk of having at least one sexual risk behaviour was higher in non-vaccinated women: OR 2.29 (95% CI: 1.29-4.07). In addition, the probability of having a PAP test within the CCSP was higher in non-vaccinated women: OR 2.18 (95% CI: 1.07-4.47).Conclusions
The prevalence of sexual risk behaviours in non-vaccinated women is elevated, and it is related to the lack of use of barrier contraceptive methods. The vaccination against HPV could affect sexual behaviours and the participation in the CCSP. Therefore, the information received by young people about contraceptive methods, sexually transmitted diseases, and cancer prevention should be reinforced. 相似文献20.
Gloria Aranda Auserón M. Rosario Elcuaz Viscarret Carmen Fuertes Goñi Victoria Güeto Rubio Pablo Pascual Pascual Enrique Sainz de Murieta García de Galdeano 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(3):141-150