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Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis, patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Resumen Fundamento y objetivo El objetivo del estudio fue conocer la incidencia de diabetes mellitus tipo 2 en pacientes con glucemia basal alterada y su asociacion con factores de riesgo. Pacientes y metodo Se incluyeron 115 pacientes > 18 anos, seleccionados aleatoriamente en un Centro de Salud, diagnosticados de glucemia basal alterada con los criterios de la Asociacion Americana de Diabetes de 1997 y seguidos durante 10 anos. Como factores predictivos para desarrollar diabetes mellitus se consideraron: edad, sexo, tabaquismo, hipertension arterial, hipercolesterolemia, antecedentes familiares de diabetes mellitus tipo 2, antecedente de diabetes gestacional y obesidad. Resultados En 10 anos de seguimiento evolucionaron a diabetes mellitus 33 pacientes (28,7%; intervalo de confianza del 95% [IC 95%] 20,4-37,0%), a normoglucemia 57 pacientes (49,6%; IC 95% 40,4-58,7%), permaneciendo como glucemia basal alterada 25 pacientes (21,7%; IC 95% 14,2-29,3%). Solo la obesidad se asocio con la progresion a diabetes mellitus (hazard ratio ajustada 2,01; IC 95% 1,00-4,03, p = 0,050). Conclusiones La mitad de los pacientes con glucemia basal alterada normalizaron su glucemia y el 28,7% desarrollaron diabetes mellitus, especialmente si tenian obesidad. Estos resultados sugieren una historia natural diferente respecto a la intolerancia a la glucosa.

Fundamento y objetivo Analizar el papel de la presion de pulso (PP), la presion arterial sistolica (PAS) y la diastolica (PAD) en la prediccion del riesgo cardiovascular. Pacientes y metodo Se realizo un estudio de cohortes, prospectivo, en 2 centros de salud, que incluyo a 932 personas de 35-84 anos sin episodios cardiovasculares, seleccionadas por muestreo aleatorio simple y seguidas durante 8 anos. La PP, PAS y PAD se categorizaron en terciles y el superior se comparo con los 2 inferiores. Se registro como variable combinada el primer episodio cardiovascular, mortal o no, en forma de cardiopatia isquemica, enfermedad cerebrovascular y arteriopatia periferica. Los resultados se analizaron mediante modelos de Cox ajustando por edad, sexo, tabaquismo, colesterol total, colesterol unido a lipoproteinas de alta densidad y diabetes mellitus. Se estudio la correlacion entre PP y PAS, PAD y factores de riesgo cardiovascular. Resultados Se registraron 85 episodios cardiovasculares: 43 casos de cardiopatia isquemica, 27 de enfermedad cerebrovascular y 17 de arteriopatia periferica. Los cocientes de riesgo ajustados para la variable combinada fueron: tercil superior (≥ 59 mmHg) de la PP = 1,3 (intervalo de confianza [IC] del 95%, 0,8-2,1); tercil superior (≥ 140 mmHg) de la PAS = 1,5 (IC del 95%, 1,0-2,5); tercil superior (≥ 84 mmHg) de la PAD = 1,1 (IC del 95%, 0,7-1,8). Los resultados fueron similares para los episodios cardiovasculares especificos. La PP se correlaciono con la PAS (r = 0,825; p Conclusiones La PP es un componente de la presion arterial muy relacionado con la PAS y otros factores de riesgo, pero no es mejor predictor del riesgo cardiovascular que la PAS.

The aim of this study was to define the incidence of type 2 diabetes mellitus in patients with impaired fasting glucose and its association with risk factors.115 patients aged18 years old, randomly selected in a Healthcare Center, diagnosed of impaired fasting glucose with 1997 American Diabetes Association criteria, followed 10 years. Predictive factors for developing diabetes mellitus were: age, sex, smoking, hypertension, hypercholesterolemia, family history of type 2 diabetes mellitus, antecedent of diabetes in pregnancy, and obesity.During the 10 years of follow-up, 33 patients developed type 2 diabetes mellitus (28.7%; 95% CI 20.4-37.0%), 57 patients progressed to normoglycaemia (49.6%; 95% CI 40.4-58.7%), and 25 patients remained with an impaired fasting glucose (21.7%; 95% CI 14.2-29.3%). Only obesity was associated with progression to type 2 diabetes mellitus (adjusted hazard ratio 2.01; 95% CI 1.00-4.03, p=0.050).Half of the patients with impaired fasting glucose normalized their glycaemia, and 28.7% developed diabetes mellitus, especially patients with obesity. These results suggest a different natural history to respect glucose intolerance.

To assess the validity of the questionnaire Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) compared with clinical records.A descriptive, prospective, multicenter study was performed within the framework of the Peripheral Arterial Disease Study (PERART) in 3,329 persons aged50 years old. The sample was selected by simple random sampling in 32 primary health care centers. The diagnoses included were acute myocardial infarction, angina pectoris, cerebrovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia. Treatment variables were also considered (antihypertensive, lipid-lowering and hypoglycemic agents or insulin, as well as antiplatelet or anticoagulant agents). The sensitivity, specificity, predictive values, and kappa index were computed to test the validity of the MONICA questionnaire.The mean age was 65 years (SD 8.9) and 54.8% were women. The sensitivity of the questionnaire was90% for all the variables apart from angina pectoris (89.9%) and cerebrovascular disease (86.5%). Specificity was also90%, except for angina pectoris (88.3%) and hypercholesterolemia (77.5%). The positive predictive value was90% for all the treatments;80% for angina pectoris, acute myocardial infarction and hypertension; 79.4% for cerebrovascular disease; 79.1% for hypercholesterolemia and 73.4% for diabetes mellitus. The negative predictive value was90% for all the variables. The kappa indexes were0.80 for all the variables apart from hypercholesterolemia (0.69) and diabetes mellitus (0.79).The MONICA cardiovascular questionnaire is valid in the assessment of cardiovascular disease, risk factors and treatments in patients aged50 years old.

To analize the role of pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk.A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models, adjusting for age, sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors.We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (/= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1); upper SBP tertile (/= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (/= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p0.001), age (r = 0.422; p0.001), diabetes mellitus (r = 0.242; p0.001), and smoking (r = -0.158; p = 0.01), with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9).PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.

ResumenObjetivoEstudiar la validez del cuestionario cardiovascular Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) comparado con la historia clínica.MétodosEstudio descriptivo, prospectivo, multicéntrico, realizado en 3.329 personas >50 años de edad (estudio ARTPER [arteriografía periférica]). La muestra se seleccionó por muestreo aleatorio simple en 32 centros de salud de atención primaria. Los diagnósticos considerados fueron: infarto agudo de miocardio, ángor, enfermedad vascular cerebral, hipertensión arterial, diabetes mellitus e hipercolesterolemia. Se estudió además el tratamiento con antihipertensivos, hipolipemiantes o insulina, hipoglucemiantes y antiagregantes o anticoagulantes. La validez entre cuestionario y registro en la historia clínica se estudió con la sensibilidad, la especificidad, los valores predictivos y el índice kappa.ResultadosLa edad media fue de 65 años (desviación estándar: 8,9), y el 54,8% eran mujeres. La sensibilidad del cuestionario fue >90% en todas las variables, excepto en el ángor (89,9%) y la enfermedad vascular cerebral (86,5%). La especificidad también fue >90%, excepto en el ángor (88,3%) y la hipercolesterolemia (77,5%). El valor predictivo positivo fue >90% en todos los tratamientos farmacológicos; >80% en el ángor, el infarto agudo de miocardio y la hipertensión arterial; 79,4% en la enfermedad vascular cerebral; 79,1% en la hipercolesterolemia, y 73,4% en la diabetes mellitus. Los valores predictivos negativos fueron >90% en todos los casos. Los índices kappa fueron >0,80 en todas las variables, excepto en la hipercolesterolemia (0,69) y la diabetes mellitus (0,79).ConclusionesEl cuestionario cardiovascular MONICA es un método válido para encuestar a las personas >50 años sobre sus enfermedades, factores de riesgo y tratamientos cardiovasculares.AbstractObjectiveTo assess the validity of the questionnaire Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) compared with clinical records.MethodsA descriptive, prospective, multicenter study was performed within the framework of the Peripheral Arterial Disease Study (PERART) in 3,329 persons aged >50 years old. The sample was selected by simple random sampling in 32 primary health care centers. The diagnoses included were acute myocardial infarction, angina pectoris, cerebrovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia. Treatment variables were also considered (antihypertensive, lipid-lowering and hypoglycemic agents or insulin, as well as antiplatelet or anticoagulant agents). The sensitivity, specificity, predictive values, and kappa index were computed to test the validity of the MONICA questionnaire.ResultsThe mean age was 65 years (SD 8.9) and 54.8% were women. The sensitivity of the questionnaire was >90% for all the variables apart from angina pectoris (89.9%) and cerebrovascular disease (86.5%). Specificity was also >90%, except for angina pectoris (88.3%) and hypercholesterolemia (77.5%). The positive predictive value was >90% for all the treatments; >80% for angina pectoris, acute myocardial infarction and hypertension; 79.4% for cerebrovascular disease; 79.1% for hypercholesterolemia and 73.4% for diabetes mellitus. The negative predictive value was >90% for all the variables. The kappa indexes were >0.80 for all the variables apart from hypercholesterolemia (0.69) and diabetes mellitus (0.79).ConclusionsThe MONICA cardiovascular questionnaire is valid in the assessment of cardiovascular disease, risk factors and treatments in patients aged >50 years old.