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Biomedical subjects

V Gil

Publications and source records attributed to V Gil.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Validation of an instrument for identifying styles of the professional practice of the primary care doctor].

OBJECTIVE: To elaborate and validate a questionnaire for identifying common styles of Primary Care doctors' practice. SETTING: Primary Health Care. Public sector in Spain. DESIGN: This was a study to validate a questionnaire administered in two phases with different samples. In the first phase, the items (item-total correlation, using Alpha on eliminating item), validity of construction, empirical validity and internal consistency, were analysed. In the second, discriminatory validity and reliability of the questionnaire (test-retest) were calculated. MEASUREMENTS AND MAIN RESULTS: 81.5% of the doctors replied in the first phase; and 100% in the second. Two factors were isolated with the Principal Components procedure, which confirmed the validity of the questionnaire's construction (52% variance explained). Internal consistency (Alphas ranged between 0.55 and 0.75) and reliability (ranging between 0.50 and 0.95 in function of the time elapsed) were also demonstrated. CONCLUSIONS: This instrument could be used to differentiate two styles in practice, characterised by focusing on the physical illness vs the psycho-social aspects of the disease process. The instrument is also useful because it gives the feeling of control over the task.

Family Practice↗
PubMed1997

[Factors involved in noncompliance with drug treatment in non-insulin dependent diabetes mellitus].

OBJECTIVE: To find the level of non-compliance with treatment with oral hypoglycemics, its causes and the profile of non-compliant patients. DESIGN: Prospective study. SETTING: Primary Care Centres in the province of Alicante. PATIENTS: 107 diabetics not dependent on insulin on the lists of five General Medicine practices and all receiving pharmacological treatment. MEASUREMENTS AND MAIN RESULTS: The method used to value compliance was a surprise count of pills in the patient's home. Patients achieving 80-110% compliance were considered compliant. The level of non-compliance was 51.5% (C.I. 42.1%-61%), 36.5% being hypocompliers and 15% hypercompliers. Forgetting (40.7%) and lack of knowledge (29.5%) were the most frequent reasons for non-compliance. The factors associated with non-compliance were: over four years evolution of the disease (p = 0.02), the diet not properly observed (p = 0.03), over a year in regular treatment (p = 0.006), poor control of the disease valued by HbA1C (p = 0.003). CONCLUSIONS: A high level of non-compliance with pharmacological treatment was found for patients with Diabetes Mellitus not dependent on insulin. Its causes were identified and factors associated with poor compliance were profiled.

Aged↗
PubMed1997

[Factors involved in noncompliance with pharmacological treatment in arterial hypertension].

OBJECTIVES: To find the amount of non-compliance with medical treatment for Hypertension and its causes, and to describe the profile of non-compliant patients. DESIGN: A crossover study performed on two home visits. SETTING: A rural Health Centre at Calpe, Alicante. PATIENTS: The sample was obtained from the census of medically treated hypertense patients. 174 of the 200 patients chosen completed the study. MEASUREMENTS AND MAIN RESULTS: Compliance was evaluated by a surprise count of pills in the patient's home. Patients complying between 80 and 110% were considered compliant. There was 47.7% non-compliance (C.I. 95%: 40.3-55.1), with 31% under-compliers and 16.7% over-compliers. Lack of information (39.8%) and forgetfulness (28.9%) were the most common causes of non-compliance. CONCLUSIONS: A high amount of non-compliance was shown, including an important number of over-compliers. Its causes were defined along with other reasons predicting non-compliance.

Age Factors↗
PubMed1997

[The validity of 6 indirect methods for assessing compliance with pharmacological treatment in dyslipidemias].

OBJECTIVE: To validate six indirect methods of identifying patients who do not comply with their treatment with hypolipaemiant drugs. DESIGN: A prospective study. SETTING: Primary care centres in the province of Alicante. PATIENTS: 107 lipaemic patients, on the lists of 5 General Medical practices and on drugs treatment. MEASUREMENTS AND MAIN RESULTS: The most accurate way to assess compliance was the surprise counting of pills in patients' homes. Patients who had between 80 and 110% compliance were defined as compliant. The six indirect methods validated were: Communication of self-compliance (CS), Attendance at appointments (AA), Doctor's judgment (DJ), Information about the illness (II), the Morisky-Green test (MG) and the grade of control (GC). AA, DJ and CS were the methods with highest specificity (91.2%-89.5%). GC and II were the most sensitive (88%-82%). GC obtained the greatest negative predictive value (77.7%), and DJ the greatest positive predictive value (73.6%). The concordance index (kappa) ranged from 0.23 for GC and -0.002 for II. CONCLUSIONS: GC, DJ and CS are the methods with the best validity indicators and concordance. They could, therefore, be used together in clinical practice to identify patients not complying with their hypolipemiant treatment.

Humans↗
PubMed1997

[The validity of 6 indirect methods for assessing drug treatment compliance in arterial hypertension].

OBJECTIVE: To validate six indirect methods, which were simple and easy to apply in clinical practice, of identifying patients who did not comply with drugs treatment for hypertension. DESIGN: A prospective study based on two visits to patient's home. SETTING: rural health centre at Calpe, Alicante. PATIENTS: 174 patients (58 men and 116 women) were included. They were chosen at random from the centre's records of hypertense patients. MEASUREMENTS AND MAIN RESULTS: Compliance was assessed by the method of a surprise counting of pills in the patient's home. Patients who had between 80 and 110% compliance were defined as compliant. The six indirect methods validated were: communication of self-compliance (CS), attendance at appointments (AA), doctor's judgment (DJ), information about the illness (II), hypertension control (HC) and the Morisky-Green test (MG). II was the most sensitive (81.9%). CS reached the highest specificity (93.4%), the best positive predictive value (81.8%) and the best concordance index (kappa, 0.26). CONCLUSIONS: II and CS are the indirect methods with the best validity indicators and could be used together to assess compliance with drugs treatment for hypertension.

Aged↗
PubMed1996

[The 3-year prognosis of patients with suspected coronary disease and a normal myocardial scintigraphy with thallium-dipyridamole].

OBJECTIVES: To assess the 3-year prognosis of patients with suspected coronary artery disease and a normal dipyridamole-thallium scintigram. POPULATION: 43 patients, 16 male and 27 female, mean age 55.8 +/- 9.2 years with suspected coronary artery disease. Forty-two patients had anginal complaints. There was a previous positive treadmill exercise test in 14 patients. All the patients had a normal dipyridamole-thallium SPECT. METHODS: Dipyridamole was infused at a rate of 0.56 mg/kg in 4 minutes followed by 3 minutes of low-level cycloergometer exercise. Two mCi of thallium-201 were injected 3 minutes after the end of dipyridamole infusion. Stress and redistribution SPECT acquisitions were performed respectively 5-10 minutes and 4 hours after thallium-201 injection. The cardiac events during a 3-year follow-up were analysed. RESULTS: No patient had unstable angina, PTCA, CABG or death. One patient suffered an inferior myocardial infarction 28 months after the scintigraphy. The event rate was 0.78% per patient per year. CONCLUSION: Three-year prognosis in patients with suspected coronary artery disease after a normal dipyridamole thallium SPECT is excellent approaching that of the general population.

Adult↗
PubMed1996

[Coronary disease in women --risk factors, diagnostic and therapeutic approaches].

OBJECTIVE: To characterize and evaluate the prognosis of coronary artery disease in women. SETTING: Hospital with referral for cardiac catheterization, since 1982. PATIENTS: We studied post-menopause patients, not under hormonal replacement therapy, to whom coronary artery disease (CAD) was diagnosed by coronary angiography in the first 5 years of activity of our centre. Patients should have at least five years of follow-up (Group W-84 patients). METHODS: Risk factors for CAD were studied in Group W, and compared with a group of male patients with CAD and a group of women without CAD, that underwent coronary arteriography in the same period of time. RESULTS: Most risk factors for CAD were more prevalent in women with CAD, with special focus on hyperlipidaemia and hypertension. Cigarette smoking was more frequent in men. At the time of coronary arteriography, most patients were in NYHA class I-II and CCS class 3-4. On follow-up 68 patients were revascularized (bypass graft on most). At five years, five patients died and most survivors were a NYHA class I-II and CCS class 1-2. Patients with multivessel disease (MVD), were older, more symptomatic and with more risk factors than patients with single vessel disease (SVD). Follow-up was on medical treatment 17% of the patients and included revascularization procedures in 83% of MVD patient's disease and 77% of patients with SVD patients. Cardiac events (unstable angina, myocardial infarction, admission for cardiac failure) occurred in 49% of MVD and 32% of SVD patients, and distribution of CCS and NYHA classes at 5 years were similar in both subgroups. CONCLUSIONS: The present study characterize the group of women with CAD as having a high prevalence of risk factors, with a large proportion of multivessel disease and high rates of revascularization. Prognosis at five years was favourable in this group. Multivessel disease was associated with presence of more risk factors and increased clinical severity before catheterization, but at five years the prognostic was similar to single disease, therapeutic options, notably the high rate of revascularization, could account for these results.

Coronary Disease↗
PubMed1996

[Diagnostic efficiency of biological markers of alcohol consumption for the detection of excessive drinkers].

The objective of our study was to test the usefulness of some biological markers of alcoholism to detect heavy drinkers, using a structured interview with a 7-day memory as this is currently considered the most reliable technique for determining alcohol consumption. A transversal, observational study was designed with a sample representative of the working population of the province of Alicante seen by the Ibermutua medical service. Participants were selected randomly and classified according to region and sex. The total sample include 1,033 subjects (644 men and 389 women, mean age 36 +/- 11.7 years). Of these 13.5 were heavy drinkers (> 40 g. of alcohol per day), 23.3 moderates drinkers (20-40 g. alcohol per day). Average consumption of alcohol was from 26 g/day + 29.9 grams. In order to quantify the random error, the confidence interval was set at 95. The methods used to test the biological markers were 2 x 2 tables and the calculation of indicators of sensitivity (S). specificity (E), positive predictive value (Vp+), negative predictive value (Vp-) and effectiveness. The highest S was obtained by associating various markers (65.5%), followed by GGT with 53.9%. The GGT/ALP quotient obtained an E of 95.9% and an AST of 92.2%. The GGT/ALP quotient achieved the best effectiveness (85%) and Vp+ (36.2%) and the association of markers the best Vp-at 92.9%, followed by GGT at 91.3%. In spite of the fact that the markers studied do not meet the conditions required to be considered acceptable as screening (S and E > 80%), their use seems appropriate if their limitations are kept in mind (many false negatives). As the GGT/ALP quotient has the highest E, there are few false positives. In order to decrease the number of false negatives, an evaluation of GGT or marker association can be done for those with negative values. In order to resolve the disadvantages of Vp+, the best solution is to order tests for groups of markers that are most prevalent in heavy drinkers.

Adult↗
PubMed1996

[Infectious endocarditis caused by Q fever. Apropos of a clinical case].

Endocarditis is a rare, but some times fatal, complication of Q fever. Its diagnosis is difficult and it is based on non-specific cardiac findings and a high title of phase I antibodies. The treatment is based on tetracyclines alone or in combination with cotrimoxazole, for long periods of time. The therapeutic efficacy is evaluated by the measurement of phase I antibodies, every three months. The relapses are frequent despite the long period of antibiotic therapy. We report what is probably the first case of Q fever prosthesis endocarditis in Portugal, as a complication following an acute episode of Q fever.

Adult↗
PubMed1995

[Diabetes mellitus mortality in Spain: a comparative analysis between Spanish provinces in the period of 1981-1986].

OBJECTIVE: To find and compare mortality because of diabetes mellitus (DM) among the different provinces of Spain in the 1981 to 1986 period. SETTING: The natural movement of population figures of the National Institute of Statistics (INE) and the census of 1981 and register of 1986 were used. DESIGN: A descriptive observation study of a crossover type. Standardisation of rates by the indirect method. Calculation of the ratio of standardised mortality for each province. RESULTS: At the national level, the Communities with an excess of mortality in 1981 were Andalusia, Melilla, the Community of Valencia, Murcia, the Balearics, the Canaries and Extremadura, as well as the provinces of Tarragona, Gerona, Ciudad Real and Albacete. In 1986 the following still had excess of mortality: Andalusia, the Community of Valencia, Murcia, the Balearics, the Canaries, Asturias and Cantabria, along with the provinces of Badajoz and Pontevedra. CONCLUSIONS: The provinces with an excess mortality because of diabetes mellitus are geographically grouped (with some exceptions) in the south and south-east of Spain and the island communities.

Adult↗
PubMed1995

[Response of the left ventricular ejection fraction,assessed by by radionuclide angiography, to inotropic stimulation: its relationship with the reversibility of perfusion defects in thallium-201 scintigraphy with overload-reinjection protocol].

BACKGROUND: Reversibility of perfusion defects and left ventricular (LV) ejection fraction (LVEF) response to low-dose catecholamines may reflect complementary aspects of myocardial viability, in patients with CAD and LV dysfunction in whom revascularization is considered. OBJECTIVE: To evaluate the relationship between LVEF response to inotropic stimulation with adrenaline (delta LVEF) and myocardial perfusion. DESIGN AND SETTING: Prospective study in a cardiology department with referral for revascularization and transplantation. PATIENTS: 45 patients (pt) with compromised LVEF (< 45%) after myocardial infarction (MI). METHODS: Radionuclide ventriculography at baseline and during graded adrenaline infusion until 12 micrograms/min: an empirical cut-off value of delta LVEF of 8% was used to define groups with (CR+) or without (CR-) contractile reserve. Stress-reinjection 201TI SPECT: perfusion was classified with a weighted score based on visual analysis of extent and intensity of thallium uptake in five major myocardial segments, with results expressed as percent of myocardium classified as normal (%N), with fixed defects (%F), and with reversibility (%R). MAIN RESULTS: Groups CR+ (23 pt) and CR- (22 pt) had similar baseline LVEF (29.6 +/- 7.4 and 26.4 +/- 8.1), while delta LVEF was respectively 13.6 +/- 4.6 and 2.9 +/- 3.3. When compared to the other group, CR+ patients had, in average, 1.0 segment more with definite reversibility and 1.6 segments less with fixed defects; in terms of percentage of myocardium, CR+ patients had more extensive reversible areas (%R: 15.3 +/- 11.7 vs 4.7 +/- 5.0, p < 0.001), smaller irreversible areas (%F: 30.7 +/- 14.5 vs 45.6 +/- 16.1, p = 0.02) and similar extent of normal areas (54.0 +/- 14.6 vs 49.7 +/- 16.4). Patients with more extensive fixed defects had worse delta LVEF in response to adrenaline (p < 0.002, r = -0.45). Greater %R was positively correlated with delta LVEF (p < 0.02, r = 0.35). In all patients, delta LVEF with adrenaline was superior or equal to (%R/2)-10. No patient with %R > or = 15 had delta LVEF < 8%. However, ten patients had delta LVEF > or = 8% despite lesser degrees of %R. CONCLUSION: Our data suggest a clear association between myocardial inotropic reserve and the extent of potentially viable myocardium (as evaluated by stress-reinjection thallium SPECT), in patients with left ventricular dysfunction after myocardial infarction. Further assessment is needed to clarify the relative role of radionuclide ventriculography with inotropic stimulation in viability evaluation, notably with inclusion of regional wall motion information and with reassessment of patients after revascularization, when performed.

Adult↗
PubMed1995

[Diagnosis of ischemia and survival after myocardial infarction using perfusion scintigraphy with exercise thallium-201. Relationship with electrocardiographic and angiographic findings].

OBJECTIVE: To review the experience of the laboratory on exercise-redistribution thalium-201 scintigraphy after myocardial infarction, and to compare scintigraphy results with those of exercise test and coronary angiography. DESIGN/SETTING/PATIENTS: Retrospective analysis of data from scintigraphy, exercise test and coronary angiography from all patients evaluated after myocardial infarction at Nuclear Medicine Department of Instituto do Coração with treadmill exercise-redistribution thallium-201 SPECT, if they were also submitted to cardiac catheterization. These criteria were met by 185 patients, studied between March 1988 and July 1993. MATERIAL AND METHODS: Micro-Delta system with a Siemens Orbiter gamma camera. Visual analysis of intensity and reversibility of perfusion defects in 5 segments per patient, using oblique reconstruction of images. RESULTS: Perfusion defects were found in 97% of patients and in 418/925 analysed segments. Variable degrees of reversibility were found in 78% of patients. On patients with single-vessel disease, vessel occlusion was associated with a slightly higher prevalence of reversibility (81% vs 71%; ns), and, for anterior infarcts, also with a higher prevalence of defects in areas supposed to be remote territories (44% vs 15%, p < 0.05). For 159 patients with a conclusive exercise test, ability of exercise test in diagnosing defects with reversibility was studied. Negative predictive accuracy of exercise test was poor (33%). Angina was 86% specific. Use of isolated ST depression, depression plus elevation or isolated ST elevation as criteria for a positive test result in a progressive improvement of sensitivity, but at cost of a decrease in specificity, more marked when using isolated ST elevation. CONCLUSIONS: Thallium scintigraphy revealed perfusion defects with some degree of reversibility in a large number of patients studied after myocardial infarction, even when considering single-vessel disease or occluded infarct-related artery. Electrocardiographic treadmill exercise test had a poor negative predictive accuracy, being reasonably sensible in multivessel disease, but poorer in single vessel disease. After infarction, typical angina should probably be also considered as criterion for ischemia, regardless of electrocardiographic changes. In a perspective of eventual use of revascularization after infarction, thallium-201 scintigraphy is a valuable tool, and should probably be considered in most patients.

Adult↗