Manuel Ángel Gómez Marcos

Eficacia de una intervención educativa grupal sobre cambios en los estilos de vida en hipertensos en atención primaria: un ensayo clínico aleatorio

Fundamentos: Los estilos de vida saludables se relacionan con un menor riesgo de enfermedades cardiovasculares. El objetivo del estudio es evaluar la eficacia de una estrategia educativa grupal en la modificacion de estilos de vida, control de factores de riesgo y riesgo cardiovascular (RCV) en personas hipertensas. Metodo: Ensayo clinico aleatorio en Atencion Primaria. Se seleccionaron por muestreo aleatorio 101 personas hipertensas de 35 a 74 anos, randomizando 51 al grupo de intervencion (GI)(64,5±9,7 anos, 56% mujeres) y 50 al control (GC) (65,4±8,4 anos, 68% mujeres). Se realizo una evaluacion basal, una intervencion educativa grupal sobre cambios de estilos de vida (seis sesiones durante un ano) y una evaluacion final. El efecto de la intervencion se evaluo con RCV (Framingham), presion arterial(PA), perfil lipidico, perimetro de cintura, indice de masa corporal(IMC), consumo de nutrientes con encuesta validada, ejercicio fisico con 7-PAR Day y calidad de vida con SF-36. Resultados: PA basal 136,8/82,7 mmHg en GI y 139,3/79,3 mmHg y en GC, RCV:11,1% (GI) y 12,3% (GC). La PA sistolica descendio 5,6±19,6 mmHg (p=0,07) en GI, y 7,1±16, mmHg (p=0,004) en GC, la diastolica 3,9±10,8 (p=0,02), y 2,7±11, mmHg (p=0,10) respectivamente. El IMC descendio 0,3±1,6 puntos en GI(p=0,17), y aumento 0,1±1,5 en GC(p=0,81). El RCV descendio 0,8±6,5 puntos en GI y aumento 0,2±6,8 en GC, el efecto de la intervencion fue un descenso de 1 punto (IC95%:-3,9-1,9) (p=0,48). La ingesta disminuyo en GI: 42,8±1141,2 Kcal/dia(p=0,14), y en GC: 278,9±1115,9 (p=0,62). El ejercicio (mets/hora/semana) aumento en ambos, 3,6±19 en GI(p=0,20) y 3,9±14,9 en GC(p=0,07). Conclusion: Encontramos mayor descenso del riesgo cardiovascular en el grupo de intervencion, sin existir diferencias estadisticamente significativas en los parametros evaluados entre ambos grupos.

Permanencia del efecto de una intervención de mejora de calidad en el seguimiento prolongado de pacientes hipertensos (CICLO-RISK STUDY)

OBJECTIVE To evaluate the durability of the effects achieved with a quality improvement intervention on cardiovascular risk factors and cardiovascular risk, as intermediate outcomes, in hypertensive patients on long-term follow-up long time primary health care. DESIGN Quasi-experimental study. SETTING Two urban primary care health centres. PARTICIPANTS The study included 419 and 430 hypertensive patients in the intervention (IG) and control group (CG), respectively. INTERVENTIONS Quality improvement intervention consisted of a combined program including, an audit, feedback, training sessions on the main cardiovascular risk factors clinical guidelines. MEASUREMENTS Evaluation of intermediate outcomes (blood pressure, LDL-cholesterol, HbA(1c), smoking, BMI and cardiovascular risk), were measured in both groups in March 2002, 2004 and 2006. RESULTS The mean of the durability effect (differences between IG and CG means) was: systolic blood pressure decreased from 8.9 to 4.3 and the diastolic from 3.9 to 2.3 mmHg (p<0.05). LDL-cholesterol decreased from 10 to 1.1mg/dl (p>0.05). Coronary risk fell from 2 to 1.2 percentage points and cardiovascular mortality risk from 0.6 to 0.4 percentage points (p<0.05). The percentage of patients with blood pressure<140/90 mmHg and BMI<30 lost statistical significance in the end evaluation and only remains in the percentage of patients with coronary risk less than 20% in the 2004 and 2006 results. CONCLUSIONS Quality improvement intervention was associated with reductions in cardiovascular risk factors and cardiovascular risk in post intervention evaluations with a tendency to decrease the effect achieved in the end evaluation.

Predictive performance of PAMG‐1 vs fFN test for risk of spontaneous preterm birth in symptomatic women attending an emergency obstetric unit: retrospective cohort study

To compare the performance of the placental alpha microglobulin‐1 (PAMG‐1) and fetal fibronectin (fFN) tests for the prediction of spontaneous preterm delivery in patients presenting to an emergency obstetric unit with threatened preterm labor, by conducting a retrospective audit of patient medical records from separate 1‐year periods during which either fFN or PAMG‐1 was used as the standard‐of‐care biochemical test.

Retrospective cohort study of PAMG-1 and fetal fibronectin test performance in assessing spontaneous preterm birth risk in symptomatic women attending an emergency obstetrical unit

To compare the performance of the placental alpha microglobulin‐1 (PAMG‐1) and fetal fibronectin (fFN) tests for the prediction of spontaneous preterm delivery in patients presenting to an emergency obstetric unit with threatened preterm labor, by conducting a retrospective audit of patient medical records from separate 1‐year periods during which either fFN or PAMG‐1 was used as the standard‐of‐care biochemical test.

Diet and physical activity in people with intermediate cardiovascular risk and their relationship with the health-related quality of life: results from the MARK study

BackgroundTo analyze the interplay between diet, physical activity and health-related quality of life in a Spanish randomly selected sample of individuals attended in general practitioners offices with intermediate cardiovascular risk.MethodsThis study analyzed 314 subjects, aged 35–74 years (50.6% women), from the MARK study, conducted in Spain. Health related quality of life was measured by the SF-12 questionnaire. The assessment of the lifestyles included the diet quality index, the adherence to the Mediterranean diet and the leisure time physical activity practice.ResultsThe highest values of health related quality of life were obtained in the area of vitality (51.05 ± 11.13), while the lowest were found in the general health (39.89 ± 8.85). In the multiple linear regression analysis, after adjustment for age, gender and other confounders, for each point of increase in the Mediterranean diet adherence score, there was an increase of 1.177 points in the mental component value (p < 0.01). Similarly, for each point of increase in the Diet Quality Index Score, there was an increase in the mental component of 0.553 (p < 0.05). Likewise, the physical activity was positively associated with the physical function and vitality (β = 0.090 and 0.087, (p < 0.01 and p < 0.05), respectively).ConclusionsIn people with intermediate cardiovascular risk, better food habits and greater adherence to the Mediterranean diet are associated with higher scores on the mental component of quality of life. Likewise, increased physical activity is related with positive scores on the physical function.