Psychosocial factors associated with cancer behavioural risk in relatives of cancer patients.

The European Code against Cancer includes some primary cancer prevention behaviours, which can be studied in the framework of psychosocial models of human behaviour as the ASE model (attitude-social influence-efficacy model). The objective of this study was to detect the factors that better explain cancer behavioural risk in relatives of cancer patients. A convenience sample of 3031 people was selected in primary care centres. A three-step multivariate analysis was carried out by means of a multiple linear regression, introducing cancer behavioural risk as the dependent variable and the following covariables: psychosocial factors in the ASE model, sociodemographic variables and the family history of cancer. At least five difficulties and four needs were perceived in following the preventive advice by 25% of patients. The main difficulties were tobacco and alcohol addiction and the demands of a social life. Principal needs were access to cessation programmes, family support, and being controlled and pressured by health workers. The highest risk profile is to be a young man with a low sociocultural level. The ASE determinants were the best predictors of cancer behavioural risk, so programmes that forget these predictors may not achieve any impact and may waste resources.

[Diagnostic protocol for unknown primary cancers. Review of 157 cases]. / Protocolo diagnóstico del cáncer de origen desconocido. Revisión de 157 casos.

OBJECTIVE: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, which seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. METHOD: Descriptive retrospective study (1992-96) RESULTS: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frequent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0.6 unnecessary aggressive techniques. CONCLUSIONS: The great variability in decision-making for diagnosing advises the application in of a diagnostic protocol that would avoid unnecessary damage for the patient and sanitary costs.

Epidemiología del cáncer de origen desconocido en Asturias (1992-1996) / Epidemiology of cancer of unknown primary sitye in Asturias (1992-1996)

Propósito: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) es un arduo problema médico sujeto a gran variabilidad. La protocolización basada en la evidencia científica, podría evitar gestos sanitarios innecesarios y reducir el sufrimiento del enfermo, sin disminución de la supervivencia. Se describen las características clínico-patológicas y epidemiológicas del COD en Asturias, el nivel de adecuación de las decisiones diagnósticas a un protocolo teórico, su repercusión económica y la supervivencia. Método: Estudio descriptivo longitudinal retrospectivo (1992-96) de los casos de COD diagnosticados en los hospitales de Asturias. Resultados: Se incluyeron 568 casos: edad media 66,9 años; 59,7 por ciento varones; 39,3 por ciento estudiado en Servicios de Medicina Interna; 27,1 por ciento con hallazgo del tumor primario (más frecuente, pulmonar); mediana de la supervivencia 13 semanas. El número de técnicas diagnósticas fue variable y la media de estancia hospitalaria, 24,7 días. Un buen ajuste al protocolo se asoció con un número mayor de primarios conocidos. Conclusiones: Existe variabilidad diagnóstica del COD en Asturias. La protocolización podría evitarla en parte y resultaría beneficiosa para el paciente y el sistema sanitario (AU)

Protocolo diagnóstico del cáncer de origen desconocido. Revisión de 157 casos / Unknown primary cancer: diagnostic protocol. Revision of 157 cases

Objetivo: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) está sujeta a gran variabilidad. La aplicación de un protocolo diagnóstico basado en la evidencia científica actual, podría evitarla. Se describen las características epidemiológicas del COD en Asturias y se evalúa la adecuación de las pruebas diagnósticas realizadas al protocolo teórico. Método: Estudio descriptivo retrospectivo (1992-96). Resultados: En el estudio piloto se incluyeron 157 casos: 59 por ciento varones, con edad media global de 67 años. La forma de presentación más frecuente fue hepatomegalia (29 por ciento) y la histología: adenocarcinoma (51 por ciento). El diagnóstico del primario se hizo en el 22 por ciento, localizándose en pulmón en el 31 por ciento; se hizo necropsia sólo en el 4,8 por ciento de los fallecidos. La mediana de la supervivencia fue de 13 semanas, significativamente superior para el carcinoma escamoso, sin relación con el éxito en el diagnóstico del primario. La media de estudios innecesarios por paciente fue de: 8 analíticas, 3 técnicas de imagen y 0,6 técnicas agresivas. El desvío respecto del protocolo teórico fue superior al 25 por ciento en un 47 por ciento de los casos. Conclusiones: La aplicación de un protocolo diagnóstico en el estudio del COD evitaría pruebas diagnósticas innecesarias, con el consiguiente ahorro de molestias para el paciente y de costes sanitarios (AU)

Objective: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, wich seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. Method: Descriptive retrospective study (1992-96). Results: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frecuent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0,6 unnecesary aggresive techniques. Conclusions: The great variability in decision-making for diagnosing advises the application of a diagnostic protocol that would avoid innecesary damage for the patient and sanitary costs (AU)

[Quality of life and neurologic diseases]. / Calidad de vida y enfermedades neurológicas.

BACKGROUND: The development reached by many countries of our planet has allowed that in them most of the infectious diseases have diminished and that the life expectancy is over the 75 years of life. As a result of this, degenerative and chronic diseases are every day more prevalent and their treatments are longer and complex. To value quality of life in these patients and the effect of the therapy on health is at the moment a main goal of public health. OBJECTIVES: To know the origin, the evolution, and the theoretical foundation of the concept of the quality of life, as well as their measurement methods. On the other hand, to describe the characteristics of the different available questionnaires in Spain to measure the quality of life, either of generic or specific for neurologic illness. MATERIAL AND METHODS: The most important questionnaires which have been adapted and validated into Spanish have been revised. An exhaustive revision of the bibliography related with quality of life and neurology was carried out, and all the questionnaires described in these processes were revised. RESULTS: We describe the philosophy and concepts of health, quality of life (QOL) and health related quality of life (HRQL). The following generic questionnaires are described: the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Medical Outcomes Study Short Form (SF-36), the European Profile of Quality of Life (EuroQoL), the Questionnaire of Quality of Life (CCV) and the Profile of Life quality in the Chronically ill (PLC). In an exhaustive bibliographical revision on quality of life and neurology, 52 indexed papers appeared, of those which only twelve were related with those subject. The following specific questionnaires are described: Qualité de Vie et Migraine (QVM), the Parkinson's Disease Questionnaire (PDQ-39), the Functional Status Questionnaire (FSQ), the Quality of Life in Epilepsy Inventory (QOLIE-89) and their variant of 31 items. Finally two questionnaires ad hoc are described to study migraine and epilepsy. CONCLUSIONS: The incorporation of HRQL measures in patients with neurological illnesses is an increasing and valued practice by its specialists. We observe that the availability of generic tools to measure the HRQL in Spanish is wider every day, although most of these come from other cultures. The process continued in their transcultural adaptation and validation allows us to have some tools of great reliability and effectiveness that facilitate its use. In relation to the specific questionnaires on neurologic process, the supply is considerably smaller due to the recent appearance of these methods in this clinic area.

Calidad de vida y enfermedades neurológicas / Quality of life and neurological diseases

FUNDAMENTO: El desarrollo alcanzado por muchos países de nuestro planeta ha permitido que la mayoría de las enfermedades infecciosas hayan disminuido y que la esperanza de vida sobrepase los 75 años. Esto ha dado lugar a que las enfermedades degenerativas de carácter crónico sean cada día más numerosas, y sus tratamientos, prolongados y complejos. Valorar la calidad de vida de estos pacientes y el efecto que sobre ella ejercen las terapias constituyen actualmente objetivos sanitarios de primer orden. OBJETIVOS: Conocer el origen, la evolución y el fundamento teórico del concepto de calidad de vida, así como sus métodos de medida. Por otro lado, describir las características de las diferentes herramientas disponibles en España para medir la calidad de vida, bien de carácter genérico o específicamente en procesos neurológicos. MATERIAL Y MÉTODO: Se han revisado los cuestionarios más importantes que han sido adaptados y validados en nuestro país. Se realizó una revisión exhaustiva de la bibliografía relacionada con la calidad de vida y la neurología, revisándose todos los cuestionarios descritos en estos procesos. RESULTADOS: Se exponen la filosofía y los conceptos de salud, calidad de vida (CDV) y calidad de vida relacionada con la salud (CVRS). Se describen los siguientes cuestionarios genéricos: el Perfil de Salud de Nottingham (NHP), el Perfil de las Consecuencias de la Enfermedad (SIP), el Cuestionario de Salud (SF-36), el Perfil de Calidad de Vida Europeo (EuroQOL), el Cuestionario de Calidad de Vida (CCV) y el Perfil de Calidad de Vida en Enfermos Crónicos (PECVEC). En una revisión bibliográfica exhaustiva sobre calidad de vida y neurología, aparecieron 52 trabajos referenciados, de los cuales sólo 12 estaban realmente relacionados con esos descriptores. Se describen los siguientes cuestionarios específicos: Perfil de Calidad de Vida y Migraña (QVM), el Cuestionario de la Enfermedad de Parkinson (PDQ-39), el Cuestionario del Estado Funcional (FSQ), el Inventario de Calidad de Vida en Epilepsia (QOLIE-89) y su variante de 31 ítems. Finalmente se describen dos cuestionarios realizados ad hoc para estudiar la migraña y la epilepsia. CONCLUSIONES: La incorporación de la medición de la CVRS en pacientes con enfermedades neurológicas es una práctica cada día mas frecuente y valorada por sus especialistas. Observamos que la disponibilidad de herramientas genéricas para medir la CVRS en nuestra lengua es cada día más amplia, aunque la mayoría proceden de otras culturas. El proceso seguido en su adaptación transcultural y validación permite que dispongamos de unas herramientas de gran fiabilidad y eficacia que facilitan su utilización. Con respecto a los cuestionarios específicos sobre procesos neurológicos, la oferta es considerablemente menor debido a lo reciente del empleo de estos métodos en esta área de la clínica (AU)

Neuroprotection by melatonin from glutamate-induced excitotoxicity during development of the cerebellum in the chick embryo.

This work investigated the ability of melatonin to prevent cell damage in the cerebellar cortex of chick embryo caused by glutamate administration. Cell injury was evaluated estimating, at ultrastructural level, the phenomenon of cell death and the synaptogenesis of the Purkinje cells and the cerebellar glomerular synaptic complex. Administration of glutamate during cerebellar development of the chick provokes excitotoxic neuronal degeneration characterized by a phenomenon of neuronal cell death that exhibits essentially the features of a death pattern described as necrosis and the deletion of synaptogenic processes. Our results show that melatonin has a neuroprotective effect against glutamate-induced excitotoxicity. This effect is morphologically revealed by the lack of neural cell death in the embryos treated with melatonin prior to glutamate injection and also by the degree of a synaptogenesis similar to that exhibited by the control group. Likewise, we corroborate the absence of teratological effects of melatonin on chick cerebellar development. Although the possible mechanisms involved in the neuroprotective effect of melatonin are discussed, i.e., direct antioxidant effects, up-regulating endogenous antioxidant defenses, and inhibiting nitric oxide formation activated by glutamate, further studies are required to establish the actual mechanism involved in the neuroprotective effect of melatonin.

Effects of static electromagnetic fields on chick embryo pineal gland development.

The effects of static electromagnetic fields on the development of the chick embryo pineal gland were studied. A total of 144 fertilized White Leghorn eggs were sacrificed after 5, 10 and 15 days of incubation. The stage of development was determined in all embryos using the Hamburger and Hamilton method [J Morphol 49: 88-92, 1951]. The various morphometric parameters (diameter and distance of the pineal gland and its lumen) were measured on serial 7-micron-thick sections. The data were obtained in a morphometer and processed statistically. The intensities of the static electromagnetic fields were 18 and 36 mT. Control and exposed embryos were equally distributed and randomly assigned. After 5 days of incubation, 25% of embryos exposed to a static electromagnetic field of 18 mT had a more advanced stage of development than controls and embryos exposed to 36 mT. On the 10th and 15th day, embryos exposed to either 18 or 36 mT tended to be more developed than controls. In the morphometric study, results were similar for the controls and exposed embryos after 5 and 10 days of incubation. However, the values of the 15-day-old embryos exposed to static magnetic fields were lower than the values of the controls (p > 0.01). These differences were more pronounced in the embryos exposed to 36 mT. These results seem to indicate that static electromagnetic fields affect the development and growth of embryos unequally, and that their action can depend not only on the intensity of the static electromagnetic field, but also on the length of exposure and the organ which is developing. It may be interesting to use these data in ultrastructural and physiological studies.

[Extracurricular activities of adolescents useful for smoking prevention programs. OCTOPUS team]. / Actividades extraescolares de los adolescentes útiles para programas de prevención del tabaquismo. Equipo OCTOPUS.

BACKGROUND: The cigarette smoking habit continues to be prevalent to a greater degree than would be desirable among teenagers. Innovative prevention programs are needed. This descriptive cross-sectional study sets out the behavior variables related to the cigarette smoking habit and the extracurricular activities in which teenagers are most frequently involved which are useful for setting out extracurricular prevention programs. METHODS: The data was collected by means of a questionnaire validated in a representative sample of school age youths (ages 10-11 and 13-14) from Asturias. The variables entailed in cigarette smoking were analyzed using the regression method. RESULTS: The starting smoker percentage is 14.5%-42.5%, regular smokers totaling 1.1% and 12.4%, respectively. Two models were constructed with the variables significantly related to smoking behavior, which are properly classified into smoker/non-smoker by 98.85% and 91.39% of the children, by ages. The environmental variables (availability of cigarettes and alcoholic beverages and regular visits to places entailing risk) are the major aspects comprising the model. The most common extracurricular activities are: watching TV, reading and listening to music and watching or playing sports. CONCLUSION: The findings provide keys to planning extracurricular activities tailored to fit in with the activities most popular among teens: TV commercials and ads on music media (CD's, tapes, etc.) and printed information mailed directly to teens at their homes, with messages conveyed by opinion-leaders among teens in the fields of sports, music and television.

[Bibliometric indicators, subjects analysis and methodology of research published in Spain on epidemiology and public health care (1988-1992)]. / Indicadores bibliométricos, análisis temático y metodológico de la investigación publicada en España sobre epidemiología y salud pública (1988-1992).

BACKGROUND: To describe Spanish scientific output in epidemiology and public health through the bibliometric indexes utilization and with regard to subjects, design and statistical methods employed, as well as its appropriateness, importance and funding. MATERIAL AND METHODS: Descriptive, longitudinal and retrospective study over 594 originals published in Spanish medical journals and listed in the Spanish Medical Index (Indice Médico Español) during the 5 years period 1988-1992. RESULTS: The average autors by article was of 4.9 and the Lotka's index, for the authors that publish articles on the topic, was -2.92; 82% of the authors have a productivity index equal to zero. Almost 70% of the articles are signed by an isolated institution, being a hospital in 51% of the cases. The journal that publishes most articles on the topic is Medicina Clínica. The average references by article is about 24. The Price' index is 36.5% and the isolation' index is 36.2%. "The non AIDS infections", the descriptive designs and the lack of inferential statistics methods, characterize the content of the articles. Regarding to the criteria established by the study, more than half of the analyzed research (56.5%) was appropriate and almost a fourth (22%) could be considered that was about important topics. CONCLUSIONS: Concerning bibliometric indicators, research on epidemiology and public health in Spain does not seem to differ from other medical specialties. The epidemiology as scientific method is widely used over the medical specialties, something which could explain the wide dispersion of scientific literature on this topic. There seems to be a certain lack of agreement between the research topics and the real health problems of Spain.

[Use of elements from the ISO 90000 system in Spanish hemotherapy]. / Uso de los elementos del sistema ISO 9000 en la hemoterapia española.

PURPOSE: To evaluate the prevalence of all twenty elements of ISO 9000 in the practice of the Blood Banks of Spain independently of being certified or not to ISO system. MATERIALS AND METHODS: By a survey sent in november 1996 to the Hospital-Based Blood Bank and Transfusional Services of 225 hospitals with more than 100 beds, and to 25 Community Blood Centers. The survey had 38 questions on the all elements of the ISO system and on other aspects of quality no directly related with it, as to be accredited by transfusional accreditation Committee, to have an hospital transfusion committee, informed consent of the transfusion and guidelines for using hemoderivatives. RESULTS: The survey was answered by 53 (21%) of hospitals and Community Blood Centers. None of the participant were certified to ISO system. The elements more used were the documentation of adverse reactions, procedures manual, validation of blood components, control of nonconforming products, and product identification and traceability, all of them used for more than 80% of participants. On the contrary, the elements less used were to have a quality unit, equipment manual, to validate the computer system, internal quality audits, criteria on purchasing, training and quality manual, all of them used by less than 30% of the participants. CONCLUSIONS: Generally speaking the elements of the ISO system more commonly used are those related to the basic ones of daily work and the least used are those related to the organisation aspects of quality. The Community Blood Centers score higher than hospital blood banks and among these, the best results are in the blood banks of hospitals more than 500 beds and the hospital accredited for teaching.

[Cost-effectiveness of antismoking health counselling in primary health care]. / Coste-efectividad del consejo sanitario antitabaco en atención primaria de salud.

OBJECTIVE: To study the cost-effectiveness of simple anti-smoking advice in Primary health care. METHODS: We accomplish a cost-effectiveness analysis in the area of the Primary health care. As efficiency of the advice we use own results. To evaluate the smoking cessation we base on vital tables of the "25-State Cancer Prevention Study", discounted to the 5%. The costs have been calculated as of the tariffs used for services billing lent in primary health centers to not beneficiary of the social security. It was accomplished a sensibility analysis on different aspects with possible influence on the result. RESULTS: The cost-effectiveness oscillated between 67,621 and 89,619 pesetas by year of life saved for the men and between 116,225 and 137,748 pesetas for the women, in function of the age. The relationship most favorable, for both sexes, it is between 45 and 54 years. In the group of 35 to 39 years, for the physicians, was of 89,419 and 163,934 pesetas for men and women respectively, and for the nursing personnel was oscillating between 43,955 and 81,523, for men; and between 80,584 and 149,460 pesetas for women in function of the considered salary. CONCLUSIONS: It is an intervention with a very favorable relationship cost-effectiveness, at least, comparable to that of other customarily accepted preventive measures. The nursing advice is less effective that the physician advice, but it is, at least, equal of efficient in terms of cost by year of life saved.

[Hygienic-sanitary conditions in school lunch rooms in the municipality of Oviedo]. / Condiciones higiénico-sanitarias de comedores escolares del municipio de Oviedo.

BACKGROUND: To ascertain the health and hygiene-related conditions of school lunchrooms within the municipality of Oviedo by means of conducting a health and hygiene inspection of these facilities. METHOD: A descriptive epidemiological cross-sectional study was made of 24 schools in the municipality of Oviedo, 9 of which were government-subsidized private schools and another 15 of which were public schools, according to information from the Ministry of Education and Science. An inspection was conducted entailing a protocol based on the Public Lunchroom Health and Hygiene Regulations. The variables are the health and hygiene-related conditions of the premises (kitchens, lunchrooms and lavatories), of the utensils, the health of the employees and the conditions of the raw materials and foods. These conditions have been considered to be inadequate or deficient whenever they failed to met the criteria of the protocol in question. RESULTS: The deficiencies found n most of the school lunchrooms inspected were the lack of protection of the lighting components, of window screens to prevent the entry of insects and of soap dispensers which are not hand-operated, disposable paper towels and liquid soap both in kitchens as well as in lavatories. The variables entailed in this study have been compared among public schools and government-subsidized private schools, for which purpose a Student T Test was employed, significant differences having been found to exist between these two types of schools solely in the condition of the kitchens and in the total of the items. CONCLUSIONS: Most of the irregularities found in both the public schools and in the government-subsidized private schools are of an organizational nature and with regard to the facilities stemming from a lack of knowledge of the laws in force. It is deemed advantageous for training in Hygiene to be provided, given the positive attitude shown by those in charge of the schools in question.

[Assessment of the transcultural equivalence of the Spanish version of the profile of quality of life for chronic patients (PECVEC)]. / Evaluación de la equivalencia transcultural de la versión española del perfil de calidad de vida para enfermos crónicos (PECVEC).

BACKGROUND: In this work the transcultural adaptation and validation of a quality of life questionnaire has been approached, taking into account its increasing interest and its practice considerations. The Profil der Lebensqualität Chronischkranker (PLC) is a German instrument and titled in Spanish. Perfil de Calidad de Vida para Enfermos Crónicos (PECVEC). The main goal of the present study is the assessment of the transcultural equivalence between the Spanish version and the original questionnaire version. SUBJECTS AND METHODS: Translations and back-translations from the original instrument, using bilingual personnel, were made. The most important goal of the study was to achieve the more accurate equivalence between the original version and the Spanish version of the questionnaire. The translations were discussed between the groups of investigators in Germany and Spain and finally adapted a pretest that showed good statistical results. The instrument was applied in two groups of subjects paired by sex and age and its validation was made. RESULTS: The results of two studies (one German and other Spanish) are compared. In the Spanish study the Cronbach's Alpha coefficient (range: 0.39-0.97) and the factorial analysis of the items showed good internal consistency. Cronbach's Alpha was higher than 0.6 for all dimensions except for the scale of Social Well-Being (0.39) with an average value 0.72. The comparison between two factorial structures showed that both are similar statistically. The adapted version showed discriminant capacity between groups ("known group validity") and the final scores of quality of life were similar to the original version. CONCLUSIONS: The adaptation process from the original version to the Spanish version has finished with a transcultural equivalence between both. This preliminary validation can be seen as an important starting point to increase, in this field, the number of instruments of assessment health-related quality of life in chronic patients in Spanish language.

Histological changes during development of the cerebellum in the chick embryo exposed to a static magnetic field.

Few studies have been performed to evaluate the ultrastructural changes that exposure to static magnetic fields (SMF) can cause to the processes of cell migration and differentiation in the cerebellum during development. Thus, we have studied the development of the cerebellum in the chick embryo (n = 144) under a uniform SMF (20 mT). All of our observations were done on folium VIc of Larsell's classification. The cerebella of chick embryos, which were exposed solely on day 6 of incubation and sacrificed at day 13 of incubation [short exposure (S)1; n = 24], showed an external granular layer (EGL) that was less dense than the EGL in the control group (n = 24). The molecular layer (ML) exhibited a low number of migratory neuroblastic elements. Moreover, the internal granular layer (IGL) was immature, with the cellular elements less abundant and more dispersed than in controls. In chick embryos exposed on day 6 of incubation and sacrificed at day 17 (S2; n = 24), the outstanding feature was the regeneration of the different layers of the cerebellar cortex. The cerebellar cortex of chick embryos exposed continuously to an identical field from the beginning of the incubation up to day 13 [long exposure (L)1; n = 24] or day 17 (L2; n = 24) of incubation showed a higher number of alterations than that of group S1. Electron microscopy confirmed the findings from light microscopy and, at the same time, showed clear signs of cell degeneration and delay in the process of neuronal differentiation. This was more apparent in groups L1 (100%) and L2 (100%) than in groups S1 (95.4%) and S2 (65.2%). In conclusion, the present study showed that SMF can induce irreversible developmental effects on the processes of cell migration and differentiation of the chick cerebellar cortex.

[Thematic and methodological analysis of investigation in primary care (1988-1992)]. / Análisis temático y metodológico de la investigación en atención primaria (1988-1992).

OBJECTIVE: To describe Spanish scientific output in primary care with regard to subjects, design and statistical methods employed and also its appropriateness, importance and funding. DESIGN: Descriptive, longitudinal and retrospective study. SETTING: Spanish scientific output in primary care published in medical journals and listed in the Indice Medico Español during the five year period 1988-1992. MATERIAL: 446 original articles published in thirty-four journals. MEASUREMENTS AND MAIN RESULTS: The greatest percentage of articles came under the heading "policy and health" (23.6%), next was "health services" (14.8%). There was a predominance of observational designs (79.9%) and within this category, descriptive studies (67.1%). The most common statistical methods used were contingency tables (35,9%). The majority of articles (94.8%) do not indicate the source of their funding. The appropriateness was around 50% and the importance around 4%. CONCLUSIONS: According to our study, research into primary care centres on the evaluation and organization of the health services. The majority of the designs have little inferential power and simple statistical methods. There is hardly any funding available, and only a half of the articles comply with appropriateness criteria.

[Bibliometric indicators of research in primary care (1988-1992)]. / Indicadores bibliométricos de la investigación en atención primaria (1988-1992).

AIM: To describe Spanish scientific production in primary care by means of using bibliometric indexes. SETTING: Spanish scientific production which was published in medical periodicals and indexed in the Indice Médico Español during the years 1988-1992. MATERIAL: 446 articles published in thirty-four different medical journals. DESIGN: Descriptive, longitudinal and retrospective study. MEASUREMENTS AND MAIN RESULTS: The number of articles slightly increases over the complete time of the study, principally in 1992. 98.4% were written in Spanish language. The average number of signatures per article is about five. Most of the authors are family doctors or interns of the medical specialty. In 76.46% of the cases, the articles were signed by only one institution. The majority of them (38.56%), were done in teaching units of family medicine. Barcelona is the most important producer of articles (20.2%) and 78% were published in the Atención Primaria periodical. The average number of references slightly increases during the whole period and is about 17 references in the five years studied. CONCLUSIONS: The scientific production on primary care seems to have an exponential increase according to Price's Law and it is concentrated in the Atención Primaria periodical. Most of authors are family doctors or interns of such specialty, who work in units of family medicine. Collaborative studies among institutions are uncommon. The number of signatures and the use of references were found to be similar to other medical specialties.

[Long-term effectiveness of anti-smoking counseling in primary care: the relapse process]. / Efectividad a largo plazo del consejo antitabaco en atención primaria: el proceso de recaída.

BACKGROUND: Addiction to tobacco is the main cause of preventive morbidity, and so the fight against tobacco consumption is a priority in the developed world. Health advice is a valuable tool in this struggle and it is within the reach of all health workers. To study the long-term effectiveness of all anti-tobacco advice in Primary Aid, together with the influence that the reason for giving up (spontaneous or after advice) has upon the relapse pattern. METHOD: We carried out a clinical test on 501 patients, 242 as a participant group, receiving health advice, and 259 in a control group. We evaluated giving up the habit through a survey. The data were analysed by means of a study with a survival study, considering the relapse to be the final point. Survival curves for the two groups were compared with the Lee-Desu statistic. RESULTS: 115 patients gave up the habit for at least 24 hours (31.8% from the participant and 14.7% from the control group). After 3 years, after a biochemical check-up, 4.5% of the participant group and 1.2% of the control group were still ex-smokers (difference = 3.3; p = 0.043%; there is a confidence interval of 95%: from 0.45 to 6.33). We did not find significant differences between their survival curves (p = 0.08). CONCLUSION: We have been able to confirm the mid- to long-term effectiveness of anti-tobacco advice. We have not been able to demonstrate that anti-tobacco advice in the relapse pattern, but a statistical trend does exist towards a reduction in the participant group.

Disappearance of DNA HPV in sequential specimens of occult cervical infection in a "normal" population.

OBJECTIVE: The behaviour of occult infection in the uterine cervix was studied over one year in 175 women randomly selected, to determine if the infection persisted, disappeared or if the viral genotype became modified. STUDY DESIGN: An earlier study of the prevalence of HPV cervical infection detected 11 (6.2%) occult infections. Of these the infectious genotype could only be identified in five. One year later the infected women were subjected to further colposcopical examination and molecular hybridization testing. RESULTS: In seven of the 11 cases with cervical occult infection, the DNA HPV genome was found to be completely absent at year-end. Colposcopic and cytological studies remained negative in all women. CONCLUSIONS: The loss of DNA HPV in seven of the 11 previously positive women is probably due to variability in the number of cells that became infected in a situation where small numbers of copies are made. The high proportion of occult infection with uncharacterized viruses supports the view that this type of infection is often due to new genotypes, presently non-classifiable.