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J Belda

Publications and source records attributed to J Belda.

62 records · Page 4Linked to original sources

[A four year study of therapeutical observation of patients with hypertension].

We attempt to quantify compliance with hypotension medication regimens in 620 patients with hypertension at the Centros de Salud (community health centers) of Novelda and Elche (in the province of Alicante) and to assess the impact of a mixed-strategy health education program. The method used to evaluate compliance is the self-communicated interview as indicated by Haynes-Sackett. The intervention consisted of individualized instruction, family support, educational leaflets, and written instructions. Among the results obtained, we emphasize the following. First, 64% completed the treatment as prescribed, 16% stopped taking the medication, and 20% followed the regimen in a sporadic fashion, lack of motivation and forgetfulness being the main reasons cited for the latter. Second, 27% of the patients with hypertension--among them, primarily young people and men--do not visit the center for monitoring. Third, the health education program is responsible for a significant increase in blood pressure measurements and in therapeutic compliance, also reducing the number of drop-outs. Fourth, 26% did not come to the unit at the end of the study period (four years) despite phone calls and house visits as reminders.

Adult↗

[Validity of four indirect methods which evaluate therapeutic compliance for arterial hypertension].

OBJECTIVES: To validate 4 indirect methods for detecting therapeutic non-compliance in 157 patients in a community health center Centro de Salud "Carrus" in Elche, Alicante. MATERIALS AND METHODS: The methods employed are self related compliance (SC), therapeutic gains obtained, Morinsky-Green Test, and the level of knowledge of Batalla disease (LK). For verification purposes, pills were counted, allowing the formation of 2x2 tables to calculate indices of validity. The statistical analysis employed is the calculation of 95% confidence intervals. RESULTS: SC yields significantly the lowest sensitivity (13.7 +/- 7.9%) and the highest specificity (85.7% +/- 7.5%). The LK presents the highest sensitivity 79.5 +/- 9.3%. SC underestimates non-compliance (32.5%) significantly, and the LK overestimates noncompliance (23.6%). CONCLUSIONS: The LK is a good method for detecting problems of low compliance and SC those of high compliance. It is recommended that both methods should be employed in a systematic fashion in clinical practice. However, the LK and SC cannot be used to calculate prevalences of therapeutic noncompliance in population-based studies.

Antihypertensive Agents↗

[Induced sputum in asthma: study of validity and repeatability].

To assess the validity and reproducibility of determining total and differential cell (DC) counts and of eosinophilic cationic protein (EPC) levels in induced sputum. Clinical analysis of validity and reliability of a measurement tool. Twenty-one asthmatics [age: 31(14) years; FEV1: 78(21)% of reference value; PC20FEV1: 0.02(1.1)mg/ml] and 10 healthy subjects [age: 30(3) years, FEV1: 99(12)% of reference value, PC20FEV1: > 8(3.7)mg/ml]. A sputum sample was collected from each individual using hypertonic saline. Sputum was separated from saliva and then divided into two portions as uncontaminated as possible by squamous cells. Both portions were treated independently and simultaneously within two hours with a solution of bithiothreitol to disperse the cells, and then centrifuged. The supernatant was poured off and frozen al -70 degrees for later determination of EPC. The sediment was stained with Papanicolaou stain, toluidine blue and eosinhematoxylin. DC count was expressed as a percentage of total inflammatory cells. ECP was determined with a CAP-System and a commercial kit (Pharmacia Diagnostics SA, Uppsala, Sweden). Two subjects in each group were unable to produce valid sputum samples (20% of healthy subjects and 10% of asthmatics). The validity of the method was demonstrated by significant differences between asthmatics and healthy subjects in both eosinophil and EPC levels. The reproducibility of method was verified by comparing the results for the sputum fractions; no significant differences were found in cell counts or EPC levels. The within-group correlation coefficients for the sputum fractions ranges between 48 and 77% for all cell types, except squamous cells, which gave a coefficient of 18%. For EPC the correlation coefficient was 98%. DC and EPC determinations in sputum induced by hypertonic saline are valid and reproducible.

Adult↗

[Total IgE in the sputum and serum of patients with asthma].

BACKGROUND: The correlation between total IgE in induced sputum (IS) and serum is not well defined. The aim of this study was to investigate the relationship between total IgE in IS and total IgE in serum and airway inflammation. METHODS: Twenty-one patients with stable asthma and thirteen healthy controls were studied. Clinical and spirometric data were collected and a skin prick test to the 13 most common aeroallergens in our area was performed in all subjects. Total IgE in IS and serum was determined by the UNICAP immunoanalysis system (Pharmacia Uppsala, Sweden) while albumin concentration in IS and serum was determined using the Cobas Integra turbidimetric method (Roche Diagnostics, Basel, Switzerland). RESULTS: The percentage of eosinophils in EI was 8.7 (11.8) in asthmatic subjects and was 0.5 (1) in healthy controls. Total IgE (KU/L) was 43.2 (23) in asthmatics vs 25.6 (3) in healthy controls in IS, and was 329 (413) in asthmatics vs 57 (78) in controls in serum. Total IgE in IS was significantly correlated with total IgE in serum; r = 0.71 (p = 0.048), but not with the albumin relative index. No correlation was found between IgE and the number of eosinophils in IS. CONCLUSIONS: Total IgE can be measured in IS. Total IgE in IS is mildly correlated with total IgE measured in serum. The lack of correlation between total IgE and albumin in IS suggests that IgE in IS could be locally produced, at least in part.

Adolescent↗

[Headache after spinal puncture. Treatment alternatives: epidural blood patch].

Headache is one of the most frequent complications of the subarachnoid puncture. Physiopathology and the different clinical factors involved in this type of headache are reviewed. The treatment is based in two types of procedures: those increasing cerebrospinal fluid production and those trying to decrease its leakage, like the epidural blood patch.

Adult↗

[Care according to patient gender in emergency services: different or unequal?].

It has been recently published different studies that support the idea that the health services make variability according to the patient's gender. In this sense, the aim of this study is to find out if there are gender differences in diagnostic and therapeutic care in health problems attended in emergency services. With the purpose of assessing this problem in a public hospital in Spain we have make a secondary analysis of the patient's findings got in the Emergency Service of Elche Hospital during four weeks in 1985.3, 709 patients were attended during this period. The results show a greater utilization of this service by men ORmale/female = 1.37 (1.29-1.47). The waiting time was higher for women (35 minutes) than men (29 minutes) (p = 0.0001), and also the time of getting a diagnostic (86 minutes vs 76) (p = 0.003). Diagnostic test were more frequent perform to women than men ORmale/female = 0.75 (0.64-0.85) meanwhile men receive treatment more often, ORmale/female = 1.34 (1.09-1.47). The associations are adjusted for age, diagnostic groups and patient's destination. Taking into account the possibility of more severity diseases among men that could explain the shorter waiting time and the therapeutic effort, the results show the possibility of an inequality attitude in the emergency services that would need further investigations. The more frequent use of diagnostic tests among women and consequently the longer diagnostic time, could be explain by the fact of the higher rates of nonspecific pathology.

Adolescent↗