Prevalencia de violencia de género en atención primaria de Santa Cruz de Tenerife / Prevalence of domestic violence in a primary care area of Santa Cruz de Tenerife

Objetivos. Estimar la prevalencia de violencia de género (VG) en mujeres adultas que acuden a consulta de medicina de familia, conocer los factores asociados y la implicación del médico en su detección. Material y métodos. Se realizó un estudio descriptivo, transversal de corte analítico, en 2 zonas básicas de salud de ámbito urbano de Santa Cruz de Tenerife, Islas Canarias. Por muestreo consecutivo se seleccionaron mujeres de 18 o más años de edad con pareja, actual o no. Se utilizó de manera anónima el cuestionario de Bradley, validado (26 ítems), que valora violencia física, psicológica y sexual. También se midieron características sociodemográficas, referentes a la pareja, historia de salud, presencia de ansiedad y depresión (escala de Goldberg). Resultados. Se entrevistaron 299 mujeres. Reconocieron algún tipo de maltrato, al menos una vez en su vida, 154 mujeres (51,5%; IC 95%: 40-62%). La violencia psíquica fue la más admitida (n=153; 99,35%), le sigue la física(n=39; 25,32%) y la violencia sexual fue declarada por 12 mujeres (7,79%). La VG se asoció con: menor edad, menor tiempo de relación con la última pareja, carencia de apoyo social (OR=2,18; p=0,019), probable ansiedad (OR=1,77; p=0,015) y probable depresión (OR=1,58; p=0,049). Tras análisis multivariado persiste la asociación con los años de convivencia con la última pareja (OR=0,998; p<0,0001) y la probable ansiedad (OR=1,79; p=0,024). Constaba cribado de VG en la historia clínica en 111 mujeres (37,1%; IC 95%: 36,90-37,23). Conclusiones. Al igual que en otros estudios la VG se asocia a trastornos de salud mental siendo necesaria una mayor implicación del médico de familia en su detección dada su prevalencia en nuestras consultas (AU)

Objectives. To estimate the prevalence of domestic violence (DV) in adult women attending Primary Care medical consultations, to determine the associated factors, and family physician involvement in its detection. Material and methods. We performed a cross-sectional analytical study in two urban health districts of Santa Cruz de Tenerife, Canary Islands. A consecutive sample of women aged 18 or older, whether or not they had a current partner were selected.. The Bradley questionnaire, which is validated (26 items) and assesses physical, psychological and sexual violence was used anonymously. Demographic characteristics, and those related to the couple, health history, presence of anxiety and depression (Goldberg scale) were recorded. Results. A total of 299 women were interviewed, and 154 women recognised some kind of abuse at least once in their life (51.5%, 95% CI: 40%-62%). Psychological violence was the most mentioned (n=153; 99.35%), followed by physical (n=39; 25.32%) and sexual violence was stated by 12 women (7.79%). Domestic violence was associated with: younger age, less time in a previous relationship, lack of social support (OR=2.18, P=.019), presence of probable anxiety (OR=1.77, P=.015) and probable depression (OR=1.58, P=.049). After multivariate analysis the association persisted with the length of time of the relationship with previous partner (OR=0.998; P<.0001) and the presence of probable anxiety (OR=1.79; P=.024). Early detection of domestic violence was recorded in the medical records of 111 women (37.1%; 95% CI: 36.90-37.23). Conclusions. As in other studies, DV is associated with mental disorders, and there is a need for greater involvement by family physicians to detect this prevalent problem in our clinics (AU)

[Prevalence of domestic violence in a primary care area of Santa Cruz de Tenerife]. / Prevalencia de violencia de género en atención primaria de Santa Cruz de Tenerife.

OBJECTIVES: To estimate the prevalence of domestic violence (DV) in adult women attending Primary Care medical consultations, to determine the associated factors, and family physician involvement in its detection. MATERIAL AND METHODS: We performed a cross-sectional analytical study in two urban health districts of Santa Cruz de Tenerife, Canary Islands. A consecutive sample of women aged 18 or older, whether or not they had a current partner were selected.. The Bradley questionnaire, which is validated (26 items) and assesses physical, psychological and sexual violence was used anonymously. Demographic characteristics, and those related to the couple, health history, presence of anxiety and depression (Goldberg scale) were recorded. RESULTS: A total of 299 women were interviewed, and 154 women recognised some kind of abuse at least once in their life (51.5%, 95% Cl: 40%-62%). Psychological violence was the most mentioned (n = 153; 99.35%), followed by physical (n = 39; 25.32%) and sexual violence was stated by 12 women (7.79%). Domestic violence was associated with: younger age, less time in a previous relationship, lack of social support (OR=2.18, P=.019), presence of probable anxiety (OR = 1.77, P = .015) and probable depression (OR = 1.58, P = .049). After multivariate analysis the association persisted with the Length of time of the relationship with previous partner (OR = 0.998; P < .0001) and the presence of probable anxiety (OR = 1.79; P = .024). Early detection of domestic violence was recorded in the medical records of 111 women (37.1%; 95% CI: 36.90-37.23). CONCLUSIONS: As in other studies, DV is associated with mental disorders, and there is a need for greater involvement by family physicians to detect this prevalent problem in our clinics.

Graded contrast echocardiography in pulmonary arteriovenous malformations.

To compare the results of transthoracic contrast echocardiography (TTCE) adding a grading scale with the results of thoracic computed tomography (CT) in order to optimise the use of both techniques. 95 patients with hereditary haemorrhagic telangiectasia (HHT) were examined with TTCE and thoracic CT to detect pulmonary arteriovenous malformations (PAVMs). According to previous studies, TTCE was divided into a four grade scale depending on the degree of opacification of the left ventricle after the administration of a contrast agent. Of the 95 patients (50.5% female; mean age 46 yrs), none with normal or grade 1 TTCE had detectable PAVMs on thoracic CT. Shunts of grades 2, 3 and 4 were associated with PAVMs according to thoracic CT in 25, 80, and 100% of the cases. There was a statistically significant association between the TTCE grade and the detection of a PAVM by thoracic CT. There were also statistically significant associations between TTCE grade and the cardiac cycle when the contrast was first visible in the left atrium, and size of the feeding artery. Graded TTCE and timing of left atrium opacification may be useful techniques in selecting HHT patients for PAVM screening with thoracic CT scans.

Plasmacytoid lymphoma treated with rituximab as first-line monotherapy

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Utilización inadecuada deun Servicio de UrgenciaHospitalario / No disponible

Objetivo: Determinar la frecuencia de utilización inadecuadade un servicio de urgencias hospitalario (SUH) y elperfil del paciente.Sujetos y métodos:—Diseño: estudio descriptivo retrospectivo.—Ámbito: hospital de tercer nivel.—Sujetos: mayores de 14 años, salvo urgencias ginecoobstétricas,que acudieron a urgencias hospitalarias deenero a marzo de 2005, no precisando ni interconsultas nipruebas complementarias (PC), salvo las accesibles enAtención Primaria como glucemia capilar, análisis con tirareactiva en orina, electrocardiograma, pulsioximetría y tinciónocular con fluoresceína.—Mediciones: se calculó el tamaño muestral para unapoblación finita de 21.560 (prevalencia: 30%, precisión: 5%,pérdidas: 20%), siendo necesarios 396 informes. Selecciónaleatoria de los informes de alta. Variables: datos demográficos,día y hora, síntomas y tiempo de evolución, diagnóstico,PC y medicación.Resultados: De los 1.742 informes de alta revisados, el24,1% (IC95%: 20,04-28,16%) de las consultas fueron inadecuadas.El 70% eran menores de 45 años y un 40% menoresde 30. El día en el que se registra mayor proporción de consultasinadecuadas fue el viernes (30,61%). Un 40,7% acudióen horario de mañana, 36,8% por la tarde y el 22,5% denoche. El 81,8% vivía a menos de 10 km. Y el 86% acudió apetición propia o de un familiar.Los motivos más frecuentes fueron: traumatológicos(15,24%), digestivos (13,33%), generales (9,76%), cardiorrespiratorios(8,33%) y musculares (7,14%). En el 49 % la evoluciónera inferior a 24 horas. El 46,6% requirió medicación (41% analgésicos-antiinflamatorios, 14% benzodiacepinas,11% procinéticos, 9% fármacos inhalados, 7% corticoidessistémicos).Conclusiones: Una de cada cuatro visitas al SUH es inadecuada.Son sujetos jóvenes, que viven cerca, mayoritariamenteacuden en horario de mañana, por decisión propia ymotivos diversos (AU)

Objective: to determine the frequency of inadequate useat a hospital emergency service (HES) and the patients’ characteristics.Subjects and Method:—Design: retrospective descriptive study.—Setting: third-level hospital.—Subjects: older tan 14 years, gyneco-obstrectic emergenciesexcluded, that visited our HES from January toMarch 2005. They didn’t need consultation to other specialistsnor complementary test (CT), except those who can beused in in primary care, such as capillary glycaemia, urinarytest, electrocardiogram, oxymetry and fluorescein staining.—Measurements: the sample size was calculated consideringa limited population of 21,560 (prevalence: 30%, precision:5%, lost: 20%), being needed 396 reports. Randomselectionof all reports. Variables: demographics, date and hour,symptoms and evolution, diagnosis, CT and medication.Results: of the 1,742 reports revised, 24.1% (CI95%:20.04-28.16%) of the visits were inadequate. 70% wereyounger than 45 years old and 40% younger than 30. Themost frequent assistance day was Friday (30.61%). 40,7%came in the morning, 36.8% in the afternoon and 22.5 atnight. 83.5% lived nearer than 10 km. 86% came by theirown decision or by a family decision.They most frequent reasons were traumatic (15.24%),digestive (13.33%), generals (9.76%), cardio-respiratory(8.33%) and muscular (7.14%). In 49% the evolution wasinferior to 24 hours. A 46.6% needed medication (41%analgesic-antiinflammatory, 14% benzodiazepines, 11%procinetics, 9% inhaled drugs, 7% systemic corticosteroids). Conclussions: One of every four visits to our HES is inadequate.The patients are young, live near, come during themorning, by themselves and for different reasons (AU)

[Effect of apolipoprotein E phenotypes on the response to dietary treatment of children with hypercholesterolemia]. / Efecto de los fenotipos de la apolipoproteína E en la respuesta al tratamiento dietético en niños con hipercolesterolemia.

OBJECTIVE: Our objective was to determine if apo E phenotypes have any effect on the serum lipoprotein response to dietary intervention in children with hypercholesterolemia. PATIENTS AND METHODS: We have selected 76 children with total serum cholesterol levels higher than 200 mg/dL. At diagnosis, each patient met with a member of our clinic that established dietary recommendations (total and saturated fat intake: 30 and 10%, respectively, of total energy intake). At diagnosis and after 6 months of therapy we determined a lipoprotein profile. RESULTS: After 6 months of therapy, there was only a significant change in children with phenotype E3/E4, with significant decreases in serum total cholesterol (from 247 +/- 43 to 231 +/- 47 mg/dL, p = 0.002), LDL-cholesterol (from 164 +/- 47 to 149 +/- 48 mg/dL, p = 0.002) and triglycerides (from 81 +/- 36 to 71 +/- 31 mg/dL, p = 0.028) concentrations. Absolute and % delta differences in serum lipoprotein concentrations before and after dietary treatment do not show significant differences between apo E phenotype groups. CONCLUSIONS: In the group studied, apo E phenotypes do not determine the response to a low-fat, low-cholesterol diet in children with hypercholesterolemia. To know the factors that determine the variability in the response to dietary intervention in children with hypercholesterolemia it would be interesting to study other familial and genetic factors.

Effectiveness of brief intervention on non-dependent alcohol drinkers (EBIAL): a Spanish multi-centre study.

OBJECTIVE: The project was designed to compare the effectiveness of brief intervention (BI) versus simple advice (SA) in the secondary prevention of hazardous alcohol consumption. METHODS: A randomized controlled trial with a 12-month follow-up was conducted. A total of 74 community-based primary care practices (328 physicians) located in 13 Spanish autonomous regions were recruited initially. Out of 546 men screened, only 229 were randomized into BI (n = 104) and SA (n = 125); 44.6% of practices finalized the study. The interventions on the BI group consisted of a 15-minute counselling visit carried out by physicians which included: (i) alcohol quantification, (ii) information on safe limits, (iii) advice, (iv) drinking limits agreement, (v) self-informative booklet with drinking diary record and (vi) unscheduled reinforcement visits. The SA group spent 5 minutes which included (i), (ii) and (iii). RESULTS: There were no significant differences between both groups at baseline on alcohol use, age, socioeconomic status and CAGE score. After the 12-month follow-up there was a significant decrease in frequency of excessive drinkers (67% of BI group reached targeted consumption, versus 44% of SA; P < 0.001) as well as weekly alcohol intake reduction (BI reached 52 versus 32% in SA; P < 0.001). A trend to improve outcome with the number of reinforcement visits was found with BI. The only predictor of success was the initial alcohol consumption level. CONCLUSIONS: Brief intervention is more effective than simple advice to reduce alcohol intake on adult men who attend primary care services in Spain.

[Multicenter study on the efficacy of advice for the prevention of alcoholism in primary health care]. / Estudio multicéntrico sobre la eficacia del consejo para la prevención del alcoholismo en atención primaria (EMPA).

BACKGROUND: The aim of this study was to analyse and to verify the efficacy of systematic advice for alcoholism prevention, assessing the reduction of the number in risk drinkers. PATIENTS AND METHODS: A multicenter randomized controlled clinical trial was designed, to perform in general practitioner setting, on a sample of risk drinkers (alcohol intake > 280 g weekly, without dependence) sent by random in intervention group (systematic brief advice with support material and a five visit program during a year) and control group (once brief advice and a control in 1 year). The procedure to incorporate in both groups included physical exam, a blood test and the MALT questionnaire. A descriptive and analytic study on included variables was realised, assessing the percentage of drinkers who reduced alcohol intake below risk limit at the end of a year follow up, as well as the reduction intake in each group. RESULTS: Of the 139 included males, 75 were in the intervention group and 64 in the control group. The percentage of patients not excluded by MALT > 10, and/or liver disease, that finished the 1 year follow up, was 46%, being the sample average age of 43 +/- 11.8. Patients included in both groups were initially comparable. At the end of a year follow up there were statistically significant differences in: percentage of risk drinkers who decreased alcohol intake below 280 g weekly (82% intervention group; 47% control group); percentage of reduction in GPT, GGT, triglycerides, systolic blood pressure and the MALT questionnaire. CONCLUSIONS: The efficacy of isolated advice of general practitioner was proved to achieve the alcohol intake reduction below the risk limit accepted in male risk drinkers without alcohol dependence. The systematic follow up during a year significantly improves the results achieved with the isolated advice.

[Family medicine research: analysis of papers accepted at national and international congresses]. / Investigación en medicina de familia: análisis de las comunicaciones aceptadas en congresos nacionales e internacionales.

OBJECTIVE: To analyse the thematic content and the origin of the free papers presented at four Family Medicine conferences (two national and two international) during 1992 and 1993; and to check the possibility of differences between Spanish and international lines of research. DESIGN: Descriptive study. MEASUREMENTS AND MAIN RESULTS: A total of 1,339 papers were classified. There were statistically significant differences (p < 0.001) in the thematic areas of Family Medicine (25.33% in international conferences, 7.77% national), Community Medicine (18.16% international, 28.20% national) and organisation of care (17.68% international, 30.16% national). The provinces with the highest number of contributions at national conferences were Barcelona, Madrid, Valencia and Zaragoza. At international conferences (WONCA) the greatest number of contributions came from the Scandinavian countries, Holland, the United Kingdom, Israel and Spain. CONCLUSIONS: Spanish investigators do not often tackle questions of under- and post-graduate training, professional attitude, clinical interviews or Bioethics. The papers at national conferences come mainly, in quantitative terms, from large provinces. The lower participation of liberal health systems like the German, French and North-American is noticeable.

[Giving up tobacco and changes in biological parameters]. / Abandono del tabaco y modificación de parámetros biológicos.

OBJECTIVE: To study the modifications in some biological parameters in patients who stop smoking. DESIGN: An analytic observational prospective study. SETTING: Urban Health Centre. PARTICIPANTS: 152 patients included in an intervention project against tobacco addiction. MEASUREMENTS AND MAIN RESULTS: Arterial pressure (systolic and diastolic), weight and base cardiac frequency were determined, using standard procedures at the start and end of the study year on smokers who gave up the tobacco habit and on those who continued smoking. Cessation was validated for those who gave up smoking. A non-significant reduction in arterial pressure, an average reduction of 6 beats per minute (p < 0.05) and an average weight increase of 1.5 kg (p < 0.05) were observed in the ex-smokers. CONCLUSIONS: Giving up tobacco produces a benefit not comparable to the light increase in weight observed in the ex-smokers. It would be useful to study whether proper dietary advice could minimise weight gain in recent ex-smokers.

[Auditing the performance of the physician facing patient alcohol consumption]. / Auditoría de la actuación ante el consumo de alcohol.

OBJECTIVE: To assess the Primary Care doctor's performance when faced with his/her patients' alcohol consumption. DESIGN: Retrospective evaluation of data on procedures by means of explicit normative criteria and implicit check-up of those not complying. SETTING: Urban health centre. PATIENTS: A random and institutionally based sample, over a week, of patients of both sexes who came for a general medical consultation (eleven blocks) without prior appointment. RESULTS: 110 clinical histories were evaluated. 60% were not asked about alcohol consumption. In the cases of those who were asked, the amount consumed was specified. Excessive consumption was recorded in the notes as a health risk factor in 87%. A liver profile was requested for 62%. Advice to give up or reduce alcohol consumption was given in all cases. CONCLUSIONS: Poor compliance with the assessment criteria chosen justifies the implementation of the corrective measures proper to quality control methodology. We underline the importance of generalizing the implementation of the Programme of Preventive Activities in Primary Care and the need to improve health professionals' training and motivation on the question.

[Rn 222 levels at the "Las Caldas de Besaya" spa in Cantabria]. / Niveles de 222Rn en el Balneario Las Caldas de Besaya (Cantabria).

222Rn levels in the water and air of the Las Caldas de Besaya spa have been analysed during a year period. The measured values are high in the indoor air of the spa with maximum concentrations of 10(4)Bq/m3. The dose equivalent for patients and workers resulting to exposure of these radon levels were calculated and compared with the derived from the mean natural radiation.