Actualizaciones en medicina de familia

1. ACTUALIZACIONES

8.  Atención
Primaria en Reino Unido
 Población ≥3 años con dolor de
garganta agudo

9. CONCLUSIONES
 Uso
selectivo de antibióticos para el
dolor de garganta agudo basado en la
puntuación clínica reduce el uso de
antibióticos.
 Las
pruebas de antígenos utilizados de
beneficios similares.

16.  E-cigarettes
and the marketing push
that surprised everyone
BMJ 2013;347:f5780
No diferencias con otros métodos
sustitutivos de la nicotina

17.  Fruit
consumption and risk of type 2
diabetes: results from three
prospective longitudinal cohort
studies BMJ 2013;347:f5001

18. Abstract

Objective To determine whether individual fruits are differentially associated with risk of type 2 diabetes.

Design Prospective longitudinal cohort study.

Setting Health professionals in the United States.

Participants 66 105 women from the Nurses’ Health Study (1984-2008), 85 104 women from the Nurses’
Health Study II (1991-2009), and 36 173 men from the Health Professionals Follow-up Study (1986-2008)
who were free of major chronic diseases at baseline in these studies.

Main outcome measure Incident cases of type 2 diabetes, identified through self report and confirmed by
supplementary questionnaires.

Results During 3 464 641 person years of follow-up, 12 198 participants developed type 2 diabetes. After
adjustment for personal, lifestyle, and dietary risk factors of diabetes, the pooled hazard ratio of type 2
diabetes for every three servings/week of total whole fruit consumption was 0.98 (95% confidence interval
0.96 to 0.99). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every
three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89
(0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91
to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges,
1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe. The pooled hazard ratio for the
same increment in fruit juice consumption was 1.08 (1.05 to 1.11). The associations with risk of type 2
diabetes differed significantly among individual fruits (P<0.001 in all cohorts).

Conclusion Our findings suggest the presence of heterogeneity in the associations between individual fruit
consumption and risk of type 2 diabetes. Greater consumption of specific whole fruits, particularly
blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas
greater consumption of fruit juice is associated with a higher risk.

19.  Comparative
effectiveness of
exercise and drug interventions on
mortality outcomes:
metaepidemiological study
BMJ 2013;347:f5577

20. Abstract

Objective To determine the comparative effectiveness of exercise versus drug interventions on mortality
outcomes.

Design Metaepidemiological study.

Eligibility criteria Meta-analyses of randomised controlled trials with mortality outcomes comparing the
effectiveness of exercise and drug interventions with each other or with control (placebo or usual care).

Data sources Medline and Cochrane Database of Systematic Reviews, May 2013.

Main outcome measure Mortality.

Data synthesis We combined study level death outcomes from exercise and drug trials using random effects
network meta-analysis.

Results We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent
exercise trials, our review collectively included 305 randomised controlled trials with 339 274 participants.
Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary
prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of
diabetes), 14 716 participants were randomised to physical activity interventions in 57 trials. No statistically
detectable differences were evident between exercise and drug interventions in the secondary prevention of
coronary heart disease and prediabetes. Physical activity interventions were more effective than drug
treatment among patients with stroke (odds ratios, exercise v anticoagulants 0.09, 95% credible intervals
0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in
heart failure (exercise v diuretics 4.11, 1.17 to 24.76). Inconsistency between direct and indirect comparisons
was not significant.

Conclusions Although limited in quantity, existing randomised trial evidence on exercise interventions
suggests that exercise and many drug interventions are often potentially similar in terms of their mortality
benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart
failure, and prevention of diabetes.

22. 
In addition we separately identified 12 meta-analyses of drug
interventions (out of 534 titles and abstracts in Medline), which
were considered to be relevant drug options for each of the four
conditions that had evidence on exercise interventions: statins,18
β blockers,37 angiotensin converting enzyme inhibitors,38 and
antiplatelets for the secondary prevention of coronary heart
disease39; anticoagulants40 and antiplatelets41 for stroke42;
angiotensin converting enzyme inhibitors,43 diuretics,44 β
blockers,45 and angiotensin receptor blockers for heart failure46;
α glucosidase inhibitors, thiazolidinediones, biguanides,
angiotensin converting enzyme inhibitors, and glinides for
prediabetes.36 Publication dates for meta-analyses of drug
interventions ranged from 1999 to 2013 (see supplementary
table).

23. 
Characteristics of exercise interventions
The characteristics of the exercise interventions varied across
treatment areas. Differences included the mode of physical
activity and its frequency, intensity, and duration. Exercise based
cardiac rehabilitation was typically a component of
comprehensive cardiac care of patients with coronary heart
disease.33 Rehabilitation in this population included inpatient,
outpatient, community based, or home based exercise
interventions. Patients with stroke received a mix of
cardiorespiratory and muscle strengthening exercises.34
Similarly, exercise interventions targeting patients with chronic
heart failure included aerobic and resistance training.35 Physical
activity was often a component of multifactorial lifestyle
modification interventions to prevent diabetes among people with
impaired glucose tolerance and impaired fasting glucose—that is,
prediabetes.3