ABSTRACT
BACKGROUND: There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes. METHOD: Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile. RESULTS: There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724-0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837-1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654-0.809) in Estonia, 0.811 (95% CI 0.736-0.886) in The Netherlands and 0.707 (95% CI 0.671-0.742) in Chile. CONCLUSIONS: PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.
Subject(s)
Anxiety Disorders/diagnosis , General Practice/methods , Panic Disorder/diagnosis , Adolescent , Adult , Aged , Algorithms , Anxiety/diagnosis , Anxiety/psychology , Anxiety Disorders/psychology , Female , General Practice/statistics & numerical data , Humans , Logistic Models , Male , Middle Aged , Panic Disorder/psychology , Psychiatric Status Rating Scales/standards , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVES: 1. To find the scientific output on communication and health both in Spain and internationally. 2. To compare the two outputs according to the type of articles published and the design of the research. DESIGN: Descriptive and bibliometric study. MATERIAL: The data bases MEDLINE (1995-2000) and IME (1990-2000) and the books summarising papers from semFYC Congresses (1995-2000) were used. MEASUREMENTS: The number of articles on MEDLINE published and indexed with the description <
Subject(s)
Bibliometrics , Communication , Physician-Patient Relations , Clinical Trials as Topic/statistics & numerical data , Humans , Meta-Analysis as Topic , Patient Education as Topic , Randomized Controlled Trials as Topic/statistics & numerical data , Research , SpainABSTRACT
Objetivos. a) Conocer la producción científica sobre comunicación y salud en el ámbito nacional e internacional. b) Compararlas según el tipo de artículos publicados y el diseño de las investigaciones. Diseño. Estudio descriptivo y bibliométrico. Material. Se utilizaron las bases de datos MEDLINE (1995-2000), IME (1990-2000) y los libros de resúmenes de comunicaciones de los congresos semFYC (1995-2000).Mediciones. En MEDLINE se cuantificó el número de artículos publicados e indexados con el descriptor 'physician-patient relations' más una serie descriptores temáticos que se pueden incluir en el epígrafe 'comunicación y salud'. En el IME y los resúmenes de congresos de semFYC se emplearon los descriptores 'comunicación, entrevista clínica, relación médico-paciente, comunicación médico-enfermo o comunicación médico-paciente'. Se comparó la proporción de artículos indexados en MEDLINE-IME según su clasificación en original, guía de práctica clínica, revisión, editorial o carta al director. Los artículos originales se categorizaron en ensayos aleatorios y no aleatorios, metaanálisis y estudios observacionales. Resultados principales. Se encontraron 6.766 artículos en MEDLINE, 42 en el IME (0,046 por ciento del total inexado) y 34 resúmenes a congresos de semFYC (1,47 por ciento del total). Entre los temas más estudiados se hallaron la información-educación a pacientes, el estrés profesional y la entrevista psicológica, y entre los menos estudiados, pacientes difíciles y agresivos, negociación y acompañantes. La proporción de artículos originales en MEDLINE-IME fue, respectivamente, 70-37 por ciento y de revisión 1144 por ciento. La proporción en MEDLINE de ensayos aleatorios fue del 1,4 por ciento y de metaanálisis un 0,08 por ciento. Conclusiones. La investigación en comunicación y salud es una investigación joven que necesita estudios descriptivos. La producción científica nacional es reducida, presentando una escasez de publicaciones de originales y un exceso de revisiones (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Bibliometrics , Rotator Cuff , Physician-Patient Relations , Communication , Patient Education as Topic , Research , Shoulder Pain , Anti-Inflammatory Agents, Non-Steroidal , Analgesics , Injections, Intra-Articular , Injections, Intradermal , Nitroglycerin , TendinopathyABSTRACT
OBJECTIVE: The aim of this study is to analyse the validity and reliability of the Apgar family questionnaire on family function. DESIGN: A crossover and descriptive study. SETTING: Urban health centre. PATIENTS: 656 patients of the Zaidín-Sur health centre in Granada were interviewed at home. The questionnaire was repeated an average of 6 days later to 60 of the patients (30 with an interviewer and 30 filling in their own). MEASUREMENTS AND MAIN RESULTS: The within-class correlation coefficients for the 5 items in the Apgar-family we over 0.55, both for self-filled and interviewer questionnaires; the scale coefficients were 0.86 and 0.81, respectively. Item-scale correlation varied between 0.61 and 0.71. Crombach's alpha was 0.84 and none of the items, when taken out of the scale, increased the alpha. The factorial analysis isolated only one factor. 16% of the sample had dysfunctional Apgar-family: the average score was 8.4. After adjustment (multiple logistic regression), the following were significantly linked to family dysfunction: lack of social support; being widowed or separated/divorced; greater perception of susceptibility to, or seriousness of, illness; being an over-user of the health service; and being a woman. CONCLUSIONS: The Apgar-family questionnaire on family function is valid and reliable.
Subject(s)
Family Characteristics , Family Health , Surveys and Questionnaires/standards , Cross-Over Studies , Female , Follow-Up Studies , Humans , Male , Marital Status , Middle Aged , Reproducibility of Results , Sex Factors , SpainABSTRACT
OBJECTIVE: The aim of this study is to analyse the validity and reliability of the functional social support questionnaire, Duke-UNC-11. DESIGN: Descriptive. Crossover study. SETTING: Urban health centre. PATIENTS: 656 patients were interviewed in their homes. 60 had the questionnaire repeated (30 self-filled and 30 using an interviewer) an average of 6 days later. MEASUREMENTS AND MAIN RESULTS: The intraclass correlation coefficients of the 11 items in the Duke-UNC-11 were above 0.50, for both self-filled and interviewer questionnaires; the ones on the scale were 0.92 and 0.80, respectively. The factorial analysis separated two sub-scales, confidential support (7 items) and affective support (4 items). Low social support was significantly associated to: being over 40, widowed or divorced, living alone, over-user, worse subjective health, greater chronic morbidity, mental health disorder and family dysfunction. The multiple linear regression equation managed to explain 30% of the variability of social support, in which family function (family APGAR) explained 23.5%, education 3.3%, perception of internal health control 2%, mental health 1.2% and perception of susceptibility to/seriousness of illness 0.3%. CONCLUSIONS: The questionnaire Duke-UNC-11 is valid and reliable.
Subject(s)
Social Support , Surveys and Questionnaires/standards , Adult , Cross-Over Studies , Female , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
OBJECTIVE: To find out the influence of gender and age on various types of utilization of primary care services. METHOD: A random sample group containing 2662 patients over 14 years of age was observed over a continuous period of a year. Having already excluded the losses subjects, health service utilization was measured using patients whose clinical records had previously been validated. RESULTS: A small number of patients (15%) use a disproportionate amount of the total number of visits. A numerical breakdown shows: 43% of global visits (GV), 45% of acute clinical visits (ACV), 68% administrative visits (AV) and 94% programmed visits (PV). The ACV, PV and GV were significantly higher in woman (p = 0.000), though in the AV was not the case. These remained a significant difference when age was controlling factor. The coefficients of correlation between age and the logarithm of the ACV, AV, PV and GV were respectively 0.27, 0.23, 0.40 and 0.41. Gender is not a consideration with regard to use of health services below 35 and above 75 years of age. In multiple lineal regression equations age stands out as the most predictive variable, followed by gender, excluding the AV where the doctor comes before gender. CONCLUSION: A small group of highusers use a desproportionate amount of the total number of visits, particularly the AV and PV. The positive correlation between age and utilization is more clear by the PV and GV. The female is more user than the male, specially among 35 and 75 years old; although the gender is not determinant by the AV. There is not much explained variability with the age and gender, but the age is more important than the gender on utilization.
Subject(s)
Primary Health Care/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Data Interpretation, Statistical , Female , Humans , Interviews as Topic , Male , Middle Aged , Office Visits , Random Allocation , Sex Factors , SpainABSTRACT
OBJECTIVE: To describe the different fractions of the time used in on-demand medical consultations and their possible association with certain indicators of attendance. DESIGN: A descriptive, observational study. SETTING: An urban health centre. PARTICIPANTS: Patients who attended with a prior appointment for on-demand consultations with one of the Health Centre's family doctors between 27th September and 29th November, 1993. MEASUREMENTS AND MAIN RESULTS: An observer with a chronometer measured the different fractions of time in 263 interviews. The 50% of the interview time was taken up by bureaucratic and recording activities; and the other 50% by doctor-patient communication and investigation. Bureaucratic recording time (prescriptions, sick-notes...) makes up 72% of total recording time, while the remaining 28% is for the writing-up of the clinical notes. Times for initial listening (23%), questioning (23%), investigation (21%) and information-education (26%) correlate positively among themselves. The average time dedicated to writing the clinical notes was significantly greater when the total consulting time was 3 to 4 hours than when it was 2 to 3 hours (p = 0.04). The average time dedicated to writing prescriptions was greater when the total number of patients per day was over 20 (p = 0.005); while the average time spent listening to the patient was greater when 21 to 25 patients per day were seen than when the figure was 10 to 20 or 26 to 29 patients per day. CONCLUSIONS: There is a need for certain organisational changes in consultations or some kind of bureaucratic-administrative support, if the fraction of interview time dedicated to doctor-patient communication is to be increased.
Subject(s)
Medical Records , Office Visits , Primary Health Care , Analysis of Variance , TimeABSTRACT
OBJECTIVE: To find the validity of the clinical and radiological methods used within Primary Care in the early diagnosis of Congenital Hip Luxation (CHL). DESIGN: A prospective observation study. SETTING: Zaidín-Sur Basic Health Area (HA), Granada. An urban Health Centre. PATIENTS: All new-born and nursing babies born in our HA between October 1991 and March 1993 (N = 352), followed and studied over an average period of 22.4 months (SD = 5.6) (Range, 12 to 30 months). RESULTS: The prevalence of clinically and/or radiologically-based suspected CHL was 19% (Cl 95%; 12.7-25.3%) and the prevalence of confirmed CHL was 4.2% (Cl 95%; 1.96-6.44%). Ortolani-Barlow sensitivity (O-B) was 46.7%, specificity 85.2%; positive predictive value 12.3%, negative predictive value 97.6%, false positives 14.8% and false negatives 53.3%. When positive O-B and/or other positive clinical signs were taken into consideration, sensitivity rose to 73.3% and false negatives went down to 26.7%. If we had not performed radiologies systematically on all the nursing children, we would have missed CHL diagnosis in 1.14% of our basic HA's population-group. CONCLUSION: We question the clinical diagnosis of CHL due to its low sensitivity and an excessive number of false negatives. We recommended systematic testing by means of a diagnostic image method, which could be X-Rays at 3 to 5 months.
Subject(s)
Hip Dislocation, Congenital/diagnosis , Age Factors , Child, Preschool , Cross-Sectional Studies , Follow-Up Studies , Hip Dislocation, Congenital/diagnostic imaging , Hip Dislocation, Congenital/epidemiology , Humans , Infant , Infant, Newborn , Primary Health Care , Prospective Studies , Radiography , Spain/epidemiology , Time FactorsABSTRACT
Of a total population of a pediatric office of the Zaidin South Health Care Center, all of the mothers that were frequent users (69) were chosen and compared with a random sample of normal users (82). Both groups carried out the anxiety scale STAI. Significant differences were found in that the high users have greater levels of anxiety about trait (p = 0.0003), as well as state (p = 0.000). The high levels of anxiety of trait are associated with being a house wife, having a child with a chronic illness, non maternal lactation, low levels of studies, health education and family income. Family income was the variable with the greatest association with the anxiety of trait (multiple regression). When we took into consideration the variables of predisposition, availability and ease of use, the maternal anxiety continued to have a significant influence. We point out the importance of maternal anxiety in the high frequency of pediatric health care use and we underline the modifiable characteristics of the anxiety factor, and therefore the possibility of reducing the high use of health care services addressed.
Subject(s)
Anxiety/psychology , Child Health Services/statistics & numerical data , Mothers/psychology , Primary Health Care/statistics & numerical data , Anxiety/etiology , Anxiety/therapy , Child , Female , Health Services Needs and Demand , Humans , Male , SpainABSTRACT
OBJECTIVE: To find the nature of the relationship between the general level of mothers' health knowledge and the over-use of paediatric facilities at the Primary Care level. DESIGN: A crossover study with a control group. SITE. Zaidin-Sur Health Centre (Granada). PATIENTS OR OTHERS PARTICIPANTS: We selected all the over-users (69) of a Paediatric office and compared them to a random sample, grouped by age, of normal users (82); n = 151. MAIN MEASUREMENTS AND RESULTS: To control confusion, we measured a total of 31 variables, grouped as to need, predisposition and expediting factors. After validating the scales, the average scores for general health understanding and the score for clinical attitudes and knowledge were significantly lower in the over-user group (p = 0.017 and p = 0.000). The scale for attitudes to and knowledge of prevention did not attain any importance (p = 0.104). We worked out a model of multiple logistical regression which included in the equation the scale of clinical attitudes and knowledge (p less than 0.005). CONCLUSIONS: We emphasised the importance of mothers' health knowledge to the question of over-use of paediatric facilities. It is desirable to attempt to intervene on this question in order to lessen excessive use of health facilities.
