(2) UI SAP Sants-Montjuïc-Sarrià-Les Corts-Sant Gervasi RESUMEN Fundamento: No se dispone de estudios que hayan comparado SCORE, REGICOR y Framingham. El objetivo de este trabajo es estudiar cómo clasifican el riesgo cardiovascular las funciones REGICOR y SCORE, su correlación y concordancia respecto a Framingham (1998) y si presentan diferencias respecto a los factores de riesgo cardiovascular en los casos de riesgo alto. Métodos:Estudio descriptivo transversal realizado en atención primaria. Se incluyó a 851 personas entre 35-74 años, libres de enfermedades cardiovasculares y seleccionadas por muestreo aleatorio simple. Se estudió la proporción de pacientes de riesgo alto con Framingham (≥20% a 10 años), SCORE (≥5% a 10 años) y REGICOR con puntos de corte ≥20%, ≥15%, ≥10% y ≥5% a 10 años, ya que con REGICOR ≥20% apenas hay casos con riesgo alto. Se comparó la correlación (r de Pearson) y concordancia (coeficiente Kappa) de las personas de riesgo alto de REGICOR y SCORE respecto a Framingham.Resultados: Presentaron riesgo alto 23,3% con Framingham, 15,2% con SCORE y un 1,4%, 5,8%, 17,6% y 57,0% con REGICOR con los puntos de corte descritos, respectivamente. REGICOR tuvo una correlación de 0,99 y SCORE de 0,78. REGICOR ≥10% tuvo mejor concordancia (Kappa 0,83) que SCORE (Kappa 0,61). Al comparar los factores de riesgo cardiovascular de los casos con riesgo alto (≥20% Framingham, ≥5% SCORE y ≥10% REGICOR), el segundo presentó mayor prevalencia de diabetes y menor de hipercolesterolemia (p<0,05).Conclusiones: REGICOR presentó una buena correlación con Framingham. Con el punto de corte ≥10% clasifica como riesgo alto a un número de personas similar a SCORE e inferior a Framingham. El modelo SCORE trataría con hipolipemiantes a un número parecido de pacientes que el modelo REGICOR ≥10%, pero con menor evidencia de efectividad del tratamiento. Framingham (1998) and whether any differences exist among them with regard to the cardiovascular risk factors in high-risk groups.

BackgroundThe concept of leadership has been studied in various disciplines and from different theoretical approaches. It is a dynamic concept that evolves over time. There are few studies in our field on managers’ self-perception of their leadership style. There are no pure styles, but one or another style is generally favoured to a greater or lesser degree. In the primary health care (PHC) setting, managers’ leadership style is defined as a set of attitudes, behaviours, beliefs and values. The objectives of this study were to describe and learn about the self-perception of behaviours and leadership styles among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency, and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession, type of manager years of management experience, and the type of organization.MethodsTo describe leadership styles as perceived by PHC managers, a cross sectional study was performed using an 82 items-self-administered Multifactor Leadership Questionnaire (MLQ). This questionnaire measures leadership styles, attitudes and behaviour of managers. The items are grouped into three first order variables (transformational, transactional and laissez-faire) and ten second order variables (which discriminate leader behaviours). Additionally, the questionnaire evaluates organizational consequences such as extra-effort, efficiency and satisfaction.ResultsOne hundred forty responses from 258 managers of 133 PHC teams in the Barcelona Health Area (response rate: 54.26 %). Most participants were nurses (61.4 %), average age was 49 years and the gender predominantly female (75 %). Globally, managers assessed themselves as equally transactional and transformational leaders (average: 3.30 points).Grouped by profession, nurses (28.57 % of participants) showed a higher transactional leadership style, over transformational leadership style, compared to physicians (3.38 points, p < 0.003). Considering gender, men obtained the lowest results in transactional style (p < 0.015). Both transactional and transformational styles correlate with efficiency and job satisfaction (r = 0.724 and r = 0.710, respectively).ConclusionsPHC managers’ self-perception of their leadership style was transactional, focused on the maintenance of the status quo, although there was a trend in some scores towards the transformational style, mainly among nurse managers. Both styles correlate with satisfaction and willingness to strive to work better.

Hypertension was the most prevalent cardiovascular risk factor in the Catalan population attended at primary care centers. About two thirds of individuals with hypertension or DM2 were adequately controlled; hypercholesterolemia control was particularly low.

BackgroundIt is common to find a high variability in the accuracy of heart failure (HF) diagnosis in electronic primary care medical records (EMR). Our aims were to ascertain (i) whether the prognosis of HF labelled patients whose ejection fraction (EF) was missing in their EMR differed from those that had it registered, and (ii) the causes contributing to the differences in the availability of EF in EMR.MethodsRetrospective cohort analyses based on clinical records of HF and attended at 52 primary healthcare centres of Barcelona (Spain). Information of 8376 HF patients aged > 40 years followed during five years was analyzed.ResultsEF was available only in 8.5% of primary care medical records. Cumulate incidence for mortality and hospitalization from 1st January 2009 to 31th December 2012 was 37.6%. The highest rate was found in patients with missing EF (HR 1.84, 95% CI 1.68 -1.95) compared to those with preserved EF. Patients hospitalized the previous year and those requiring home healthcare (HR 1.81, 95% Confidence Interval 1.68-1.95 and HR 1.58, 95% CI 1.46-1.71, respectively) presented a higher risk of having an adverse outcome. Older patients, those more socio-economically disadvantaged, obese, requiring home healthcare, and taking loop diuretics were less likely to have an EF registered.ConclusionsEF is poorly recorded in primary care. HF patients with EF missing at medical records had the worst prognosis. They tended to be older, socio-economically disadvantaged, and more fragile.

In spite of finding a gradient that linked socioeconomic deprivation to an increased risk of hospitalisation, there were no differences in mortality regarding SES in a universal healthcare coverage system.

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The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.