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Objective: To study whether the visits of technical health representatives (ITS) mean that new drugs are introduced. Design. Prospective, descriptive study., Setting: Urban health centre., Participants: The products presented by 137 ITS from 83 drug laboratories in weekly sessions for a year were studied., Main Measurements: The products presented, the year they were first marketed, intrinsic value (IV), newness and use potential, cost per package and defined daily dose and material handed over were studied., Results: 472 drug products were introduced. The most common ones belonged to the cardiovascular group (27.3%), digestion and metabolism (14.8%) and anti-infection drugs (13.3%). 65.5% had been on the market for <5 years. 84.3% had a high IV. Only 31 products (6.6%) were new (95% CI, 4.5-9.2). 71% of these supposed no or very slight therapeutic improvement, 25.8% a modest improvement and 3.2% a major improvement. Mean cost was 19.3 euros per package and 2 euros per DDD, with significant differences found (P<.006) on stratifying by date of marketing (more recently marketed products cost more). 61% of the products were presented with additional material (leaflets, monographs, journals), 21.6% with gifts of symbolic value, and 19.9% with samples of the product. There were significant differences (P<.03) between the new drugs and the normal prescriptions issued at the centre. In the new drugs, there were fewer products with high IV and cost per package and per DDD was higher., Conclusions: The products introduced by the reps do not include any important new drugs. They are presented with abundant back-up and are more expensive than those normally prescribed.

Objective: To study the cardiovascular events linked to the new diagnostic categories of diabetes mellitus proposed by the American Diabetes Association., Design: Descriptive cross-sectional study.Setting. Urban health district.Participants. 2248 patients > 14, selected by simple random sampling from the medical records archive., Main Measurements: Through the medical records review, patients were classified into those with normal glucaemia, those intolerant to glucose when fasting (IGF) and those with type-2 diabetes mellitus (DM2). Patients were studied for cardiovascular events, ischaemic cardiopathy, cerebrovascular disease and peripheral arteriopathy. The likelihood of such events in patients with IGF and DM2 was compared with normal-glucose patients through logistical regression, adjustment for age, gender, hypertension, hypercholesterolaemia, hypertriglyceridaemia and tobacco dependency., Results: 1677 patients were classified: 1237 with normal glucaemia, 175 with IGF and 265 with DM2. The DM2 patients were more likely to have at least one cardiovascular event (OR, 2.7; 95% CI, 1.7-4.4), ischaemic cardiopathy (OR, 2.0; 95% CI, 1.1-3.6), cerebrovascular disease (OR, 3.0; 95% CI, 1.4-6.6) or peripheral arteriopathy (OR, 2.9; 95% CI, 1.2-7.7). Results reached no statistical significance in patients with IGF, though these were more likely to suffer a cardiovascular event (OR, 1.1; 95% CI, 0.6-2.1), ischaemic cardiopathy (OR, 1.1; 95% CI, 0.3-4.4), cerebrovascular disease (OR, 1.5; 95% CI, 0.5-4.1) or peripheral arteriopathy (OR, 1.2; 95% CI, 0.3-4.6)., Conclusions: Patients with DM2 are more likely to present cardiovascular events, a phenomenon not seen in the case of IGF.

Objective: To study the cardiovascular risk (CVR) associated with the diagnostic criteria for diabetes proposed by the American Diabetes Association., Design: Cross-sectional, descriptive study., Setting: Urban health district., Patients: 1840 patients > 14 years old, selected by simple randomised sampling from the clinical records (CR) archive, were studied., Method: Through review of the CR, the patients were classified as having: normal glycaemia, disturbed basal glycaemia (DBG) and type-2 diabetes mellitus (DM2). CVR was studied through the simplified Framingham method and the CVR factors of obesity, tobacco dependency, hypertension, hypercholesterolaemia and hypertriglyceridaemia. The likelihood of having high or very high CVR and the CVR factors described in the patients with DBG or DM2 were compared with the same in those with normal glycaemia, through logistical regression with the odds ratio adjusted for age and sex., Results: 1351 patients were classified: 995 with normal glycaemia, 146 with DBG and 210 with DM2. Patients with DBG or DM2 had greater likelihood of high or very high CVR, with some OR at 2.26 (95% CI, 1.39-3.69) and 2.74 (95% CI, 1.81-4.15), respectively. They also had differences (p < 0.05) for obesity (OR, 1.76 and 1.58), hypertension (OR, 1.75 and 2.15) and hypertriglyceridaemia (OR, 1.73 and 2.70), respectively. There were no differences (p > 0.05) for tobacco dependency and hypercholesterolaemia. No differences were found (p > 0.05) between DBG and DM2 for CVR and the CVR factors studied., Conclusions: Patients with DBG and DM2 are at high CVR.