Vagal Asystoles in a Boy With Prader-Willi Syndrome.

Prader-Willi syndrome (PWS) is a genetic hormonal disorder of the hypothalamic-pituitary-axis resulting in mental retardation, muscle hypotonia, hypogonadism, and hyperphagia leading to significant obesity. Cardiovascular morbidity and mortality in adult patients with PWS is higher than in healthy controls and mainly secondary to massive obesity. In childhood, mortality may result from respiratory or gastrointestinal illnesses. We present a case of a 10-year-old boy with PWS who experienced recurrent and asymptomatic episodes of sinus pauses caused by the ingestion of large gulps of apple juice, which could be provoked and reproduced. The asystoles could not be provoked by any other vagal maneuvers and an initial diagnostic workup revealed no indication for structural heart disease. Because of the asymptomatic character of the asystoles, no treatment was initially provided. When he re-presented 3 months later after a clinically relevant syncope at school, pacemaker therapy was initiated, and he has demonstrated no subsequent sinus pauses or syncopes. Regarding the rising awareness of subtle cardiac alterations including autonomic dysfunction and electrocardiogram changes in young patients with PWS and especially the occurrence of unexplained sudden deaths in childhood that may be precipitated by arrhythmia, we suggest that the utility of periodic screening for arrhythmia risk should be evaluated in children with PWS.

Conversion to everolimus in pediatric heart transplant recipients is a safe treatment option with an impact on cardiac allograft vasculopathy and renal function.

BACKGROUND: Cardiac allograft vasculopathy (CAV) and nephrotoxicity affect long-term survival after heart transplantation (HTX). Studies, mostly conducted in adults, showed a positive effect of everolimus (EVL) on these problems. We describe the effects of conversion of the immunosuppressive therapy to an everolimus including regime on CAV, renal function, and safety in heart transplanted children/adolescents. METHODS: This retrospective single-center study included 36 participants (mean time after HTX 6.3 ± 4.7 years). Descriptive pre/post-comparisons were performed with an observation period partially up to 4 years. Impact on CAV was assessed based on intravascular imaging and Stanford grading. Safety analysis included cytomegalovirus (CMV)-infection and acute rejection. RESULTS: In terms of CAV (9 out of 36 patients) four showed no progression, three an improvement, one a worsening; one new diagnosis. The average CrCl showed a significant improvement 6, 12, and 24 months after conversion regarding all patients (n = 29). There was no acute rejection or CMV-infection. CONCLUSION: Conversion to an EVL-based therapy after pediatric HTX is a safe immunosuppressive regime without increasing risk of acute rejection or CMV-infection. There was some evidence of reduction in progression of CAV and a significant improvement of the renal function.

Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve - German experience.

Background: After encouraging results with the Edwards Sapien and XT valves, this study aimed to review procedural data and early outcomes for the Sapien 3 valves for transcatheter pulmonary valve replacement (TPVR). Methods: We performed a multicenter, retrospective analysis of cases who underwent a Sapien 3 TPVR between 2015 and 2017 in 7 centers in Germany with a follow-up of up to 2 years. Results: 56 patients could be enrolled (weight 58,5 ± 25,0 kg; 53% Tetralogy of Fallot, 45% native RVOT). Most procedures were two-stage procedures (82,1%) with 100% prestenting. Valve sizes were 20 mm (n = 1), 23 mm (n = 15), 26 mm (n = 27), 29 mm (n = 13). Procedural success rate was 96.4%. Two patients underwent surgical valve implantation after balloon rupture during TPVR. Follow-up data were available up to 24-month post TPVR. The rate of patients with ? moderate and severe pulmonary regurgitation decreased to 0% after TPVR, peak systolic gradient decreased from 24,2 (SD±20,9) mmHg to 7,1 mmHg (SD±5,0). There were no endocarditis, severe tricuspid valve impairment or stent fractures. Conclusions: With the Edwards Sapien 3 valve, the patient pool for TPVR can be substantially extended. Continued data collection is necessary to verify long-term results.

Conclusiones del I Foro Nacional de jefes de Estudio, técnicos docentes y responsables autonómicos de Formación Sanitaria Especializada y del II Congreso Nacional de Formación Sanitaria Especializada (XIV Encuentro Nacional de tutores y jefes de Estudio). SEFSE-AREDA 2017, Madrid 28-29 de septiembre / Conclusions of I National Forum of heads, technicians and regional responsibles of Specialized Training and of the 2th National Congress of the Spanish Society for Postgraduate Medical Education (14th National Meeting of Heads and Tutors of Specialized Training). SEFSE-AREDA 2017, Madrid, September 28-29

Una buena gestión y calidad de la Formación Sanitaria Especializada (FSE) exige el compromiso explícito de los responsables de las CCAA y de los centros sanitarios. Esto implica la acreditación y reconocimiento de tutores, desarrollar el marco normativo que establece el RD 183/2008 (a los nueve años de su publicación sólo Cataluña, Canarias, Castilla y León, Extremadura, La Rioja y el País Vasco, lo han hecho), una mención explícita de la FSE en los planes estratégicos de las organizaciones sanitarias y en los contratos-programa con las unidades docentes y una participación activa de los jefes de estudio en los consejos de dirección de los centros. Por parte del Ministerio de Sanidad, es preciso agilizar la acreditación de las nuevas unidades docentes y abordar, junto con las CCAA, los problemas de financiación del proyecto de troncalidad y la organización de las unidades docentes troncales. Respecto al sentido de la formación, esta se ha de centrar en la seguridad del paciente, aquí la simulación es una metodología formativa idónea, y en la humanización, con una práctica de la medicina bajo un modelo deliberativo, siendo los formadores ejemplo para los que aprenden

The commitment of the heads of the Autonomous Communities and the health centers is key to a good management and the quality of the Specialized Healthcare Training (SHT). This implies the accreditation and recognition of tutors, developing the regulatory framework established by Royal Decree 183/2008 (nine years after its publication, only Catalonia, the Canary Islands, Castilla y León, Extremadura, La Rioja and the Basque Country have done so), an explicit mention of the SHT in the strategic plans of the health organizations and an active participation of the heads of SHT in the boards of directors. On the part of the Ministry of Health, it is necessary to speed up the accreditation process of new teaching units and, together with the Autonomous Communities, and address the financing problems of the core curriculum project and the organization of the core teaching units. Regarding the sense of training, this has to focus on safety patient, here the simulation is a suitable training methodology, and in the humanization, with a practice of medicine under a deliberative model, being the trainers an example for those who learn

The Creation of an Interatrial Right-To-Left Shunt in Patients with Severe, Irreversible Pulmonary Hypertension: Rationale, Devices, Outcomes.

PURPOSE OF THE REVIEW: Targeted pharmacotherapies did improve survival rates, exercise capacity, and quality of life (QoL) of PAH patients. However, these pharmacological interventions are expensive and not always accessible. In addition, not all patients do respond similarly to these medications and many will continue to deteriorate. This review aims to discuss the beneficial role of an artificial right-to-left shunt and highlights current interventional devices and outcomes. RECENT FINDINGS: Since patients with preexisting atrial shunts or patients with Eisenmenger's disease show better survival rates, improved exercise capacity, and QoL, PAH patients clinically do benefit from an atrial septostomy by reducing signs of right heart failure, improving left heart filling, cardiac output, and systemic oxygen transport despite hypoxia. However, an uncontrolled septostomy with unrestricted right-to-left shunt bears the risk of acute severe desaturation and death. The Atrial Flow Regulator (AFR device, Occlutech®, Sweden) provides an adjustable shunt size with restricted flow and excellent short-term outcomes. Interventional strategies for PAH palliation are on the rise. The novel AFR device provides a durable and safe option for a controlled right-to-left shunting, thus enabling an individualized management.

Guiding Antiepileptic Therapy in a Pediatric Patient with Severe Meningoencephalitis and Decompressive Craniectomy with the Use of Amplitude-Integrated Electroencephalography.

Introduction Amplitude-integrated electroencephalography (aEEG) is one of the most widely used neuromonitoring tools in neonatology today. However, little is known about its clinical indications and potential benefits in pediatric intensive care patients. Based on limited experience, its impact on therapeutic decision-making in this patient population is unclear. Case Description We report the case of a 16-year-old boy who, after a pansinusitis, developed a severe meningoencephalitis and intracranial empyema with increased intracranial pressure that required drainage and decompressive craniectomy. He subsequently developed status epilepticus despite a combination of various anticonvulsants. Only after the initialization of an aEEG, we were able to adequately diagnose and continuously monitor his seizure activity and titrate the effect of the antiepileptic drugs. During his hospital stay, we were able to clearly monitor and guide our therapy by accurately identifying the termination of status epilepticus and the recurrence of seizures. Discussion With the help of aEEG, it was easy to identify the nonconvulsive status epilepticus (NCSE) and the ongoing seizure activity in this teenage patient. NCSE is a clinical problem with an effect on the outcome of the patient and is often underdiagnosed. AEEG enabled a rapid detection and management of seizure activity and thereby reduced the overall seizure burden, which was associated with better neurologic outcome.

Transmisión comunitaria de gripe pandémica (H1N1) 2009 a partir de brotes en centros escolares de la Comunidad de Madrid. Mayo-Junio de 2009 / Community transmission of pandemic influenza (H1N1) 2009 from school outbreaks in the Madrid Region, Spain. May-June 2009

Fundamentos: El primer caso confirmado de gripe pandémica (H1N1) 2009 adquirida en la Comunidad de Madrid (CM) se detec-tó el 20 de mayo, siendo el caso índice del primer brote escolar de la CM. Los objetivos son describir los brotes escolares ocurridos en la primavera de 2009, las medidas de control implementadas, así como el inicio de la transmisión comunitaria de este virus en la región. Métodos: Estudio observacional descriptivo de los brotes esco-lares de gripe pandémica (H1N1) 2009 ocurridos en la CM entre el 20 de mayo y el 27 de junio de 2009, y de los casos totales estudiados en ese periodo. Se utiliza la definición de agrupación de casos de gri-pe adoptada a nivel nacional (3 o más casos). Se analizan los datos clínicos, epidemiológicos y microbiológicos de los casos. Resultados: Se investigaron 1.349 casos asociados a 77 centros escolares de la CM con tres o más casos de gripe notificados durante la primavera de 2009, 47,4% del total de casos en ese periodo (n=2.844). Se detectaron 36 brotes en Leganés (más de un tercio de los centros del municipio), generando las mayores tasas de inciden-cia acumulada en la Zona Básica de referencia. Se detectaron dife-rencias en la sintomatología según la edad. Se analizaron 949 mues-tras por RT-PCR, resultando positivas 555 (58,5%). Conclusiones: La transmisión del virus pandémico en la CM ocurrió de manera sostenida durante la primavera de 2009 a conse-cuencia de los brotes en centros escolares, significando el inicio de la transmisión comunitaria en España(AU)

Background: The first pandemic influenza (H1N1) 2009 confir-med case acquired in the Madrid Region was diagnosed in May 20th. This was the index case of the first outbreak in a school in the Madrid Region (MR). The aim of this paper is to describe school outbreaks that took place during the spring in 2009, the control measures implemented and the beginning of the community transmission of this virus in the Region. Methods: Descriptive observational study of school outbreaks due to pandemic (H1N1) 2009 virus reported between May 20th and June 27th, and total investigated cases in this period. It was used the definition of cluster of influenza cases adopted by National Autho-rity (three or more cases). Clinical, epidemiological and microbiolo-gical data of cases were analyzed. Results: There were identified 1.349 cases of pandemic (H1N1) 2009. They were associated with 77 school centres with three or more reported cases, 47,4% of total cases in this period (n = 2.844). 36 outbreaks were detected in Leganés (more than one third of all schools in the municipality), generating the highest cumulative inci-dence rates in the Basic Health Zone. There were differences by symptoms according to age. During this period, 949 samples were analyzed and 555 (58.5%) tested positive. Conclusions: The transmission of pandemic (H1N1) 2009 virus in the MR occurred steadily during the spring of 2009 due to schools outbreaks, meaning the onset of community transmission in Spain(AU)

[Community transmission of pandemic influenza (H1N1) 2009 from School Outbreaks in the Madrid region, Spain: May-June 2009]. / Transmisión comunitaria de gripe pandémica (H1N1) 2009 a partir de brotes en centros escolares de la Comunidad de Madrid: Mayo-junio de 2009.

BACKGROUND: The first pandemic influenza (H1N1) 2009 confirmed case acquired in the Madrid Region was diagnosed in May 20th. This was the index case of the first outbreak in a school in the Madrid Region (MR). The aim of this paper is to describe school outbreaks that took place during the spring in 2009, the control measures implemented and the beginning of the community transmission of this virus in the Region. METHODS: Descriptive observational study of school outbreaks due to pandemic (H1N1) 2009 virus reported between May 20th and June 27th, and total investigated cases in this period. It was used the definition of cluster of influenza cases adopted by National Authority (three or more cases). Clinical, epidemiological and microbiological data of cases were analyzed. RESULTS: There were identified 1.349 cases of pandemic (H1N1) 2009. They were associated with 77 school centres with three or more reported cases, 47,4% of total cases in this period (n = 2.844). 36 outbreaks were detected in Leganés (more than one third of all schools in the municipality), generating the highest cumulative incidence rates in the Basic Health Zone. There were differences by symptoms according to age. During this period, 949 samples were analyzed and 555 (58.5%) tested positive. CONCLUSIONS: The transmission of pandemic (H1N1) 2009 virus in the MR occurred steadily during the spring of 2009 due to schools outbreaks, meaning the onset of community transmission in Spain.

[Evaluation of a schoolbased intervention to promote smokefree areas]. / Evaluación de una intervención de promoción de espacios sin humo en el ámbito educativo.

OBJECTIVE: To determine the effect of an intervention in secondary schools on visible tobacco use, the prevalence and intensity of smoking, and the attitudes and behaviors of teachers and students. METHODS: We performed a quasiexperimental study in 18 public secondary schools that carried out the program and in 18 that did not (control group). Information was obtained on visible tobacco use and the number of ashtrays and smokefree posters through direct observation. Data were collected on tobacco use, the number of heavy smokers, smoking in schools, opinions on smokefree schools, smoking in front of the students, and attempts to quit smoking through questionnaires to teachers and students in the third year of compulsory secondary education (15-year-olds) and in the final year of secondary school (18-year-olds). RESULTS: Visible tobacco use was lower in the intervention group (27.9 vs. 45.6%) and twice as many posters were displayed. No differences were found in the prevalence of daily tobacco use, but the percentage of heavy smokers was lower in teachers and students in the intervention group. Smoking was lower in students in the third year of compulsory secondary education in schools carrying out the program. Opinions about smokefree schools were favorable in both groups. CONCLUSIONS: The program contributed to reducing visible tobacco use and in decreasing the number of heavy smokers among teachers and students.

Evaluación de una intervención de promoción de espacios sin humo en el ámbito educativo / Evaluation of a schoolbased intervention to promote smokefree areas

Objetivo: Conocer el efecto de un programa sobre el consumo visible de tabaco en los institutos de enseñanza secundaria (IES), la prevalencia y la intensidad del consumo del alumnado y el profesorado, y sus actitudes y conductas respecto al consumo en el centro. Métodos: Estudio casi experimental en 18 IES que realizaron el programa y en 18 que no lo realizaron (grupo control). Por observación directa se registró el consumo visible, la existencia de ceniceros y de carteles de «espacio libre de humo». Por encuesta al profesorado y al alumnado de 3.o de ESO y 2.o de Bachillerato, se recogieron datos de consumo de tabaco, grandes fumadores, consumo en el recinto escolar y opinión sobre la prohibición de fumar; a los profesores también se les preguntó sobre el consumo delante de los alumnos y sobre los intentos de dejar de fumar. Resultados: En el grupo de intervención había menor consumo en las zonas observadas (el 27,9 frente al 45,6%) y el doble de carteles. No hubo diferencias en la prevalencia de consumo diario, pero sí en el porcentaje de grandes fumadores, que fue menor en el profesorado y el alumnado del grupo de intervención; también eran menos los alumnos de 3.o de ESO que fumaban en el centro. La opinión sobre la prohibición de fumar en el centro era favorable en los dos grupos. Conclusiones: El programa contribuyó a la reducción del consumo visible y del número de cigarrillos/día consumidos por profesorado y alumnado(AU)

Objective: To determine the effect of an intervention in secondary schools on visible tobacco use, the prevalence and intensity of smoking, and the attitudes and behaviors of teachers and students. Methods: We performed a quasiexperimental study in 18 public secondary schools that carried out the program and in 18 that did not (control group). Information was obtained on visible tobacco use and the number of ashtrays and smokefree posters through direct observation. Data were collected on tobacco use, the number of heavy smokers, smoking in schools, opinions on smokefree schools, smoking in front of the students, and attempts to quit smoking through questionnaires to teachers and students in the third year of compulsory secondary education (15-year-olds) and in the final year of secondary school (18-year-olds). Results: Visible tobacco use was lower in the intervention group (27.9 vs. 45.6%) and twice as many posters were displayed. No differences were found in the prevalence of daily tobacco use, but the percentage of heavy smokers was lower in teachers and students in the intervention group. Smoking was lower in students in the third year of compulsory secondary education in schools carrying out the program. Opinions about smokefree schools were favorable in both groups. Conclusions: The program contributed to reducing visible tobacco use and in decreasing the number of heavy smokers among teachers and students(AU)

Valoración de la fiabilidad externa de las publicaciones de dos revistas científicas durante el último quinquenio / Evaluation of external fiability between two scientific journal publications in the last five years

No disponible

[Mortality and tuberculosis: analysis of multiple causes in the Community of Madrid (1991-1998)]. / Mortalidad y tuberculosis: análisis por causas múltiples en la Comunidad de Madrid (1991-1998).

BACKGROUND: Mortality from tuberculosis (TBC) is of characteristics such as to be studied with a multiple cause focus, as this disease is not generally fatal in itself, but is however linked to many deaths. This study is aimed at describing TBC as a cause of death in the Autonomous Community of Madrid throughout the 1991-1998 period. METHOD: A descriptive study of deaths in the Autonomous Community of Madrid (1991-1998) entailing TBC as the main cause or as a diagnosis mentioned in the Death Statistics Bulletin (DSB). The data was taken from the Autonomous Community of Madrid Death Registry. Variables analyzed: sex, age, year deceased, main cause and other diagnoses mentioned in the DSB. Crude annual rates, standardized rates by age and specific rates by age and sex were calculated. A comparison was made as to the average number of diagnoses per death. RESULTS: A total of 1,206 deaths "with TBC", 915 males and 291 females, were recorded. The main cause was TBC in 566 of these cases, HIV/AIDS in 442 and other diseases in 198 cases. The "with TBC" death rates showed peak values in 1995 among both males and females. There were an average of 3.4 diagnoses per death, this average having undergone an increase throughout the period under study (p < 0.05) CONCLUSIONS: With a multi-cause focus, TBC doubles in death rate statistics. Its presence is associated with other diseases, especially with HIV/AIDS for the period analyzed.

Mortalidad y tuberculosis: análisis por causas múltiplesen la Comunidad de Madrid (1991-1998) / Mortality and Tuberculosis: Analysis of Multiple Causa-of-Death Data in the Community of Madrid, 1991-1998

Fundamento: La mortalidad por tuberculosis (TBC) reúne características para ser estudiada con un enfoque de causa múltiple, ya que esta enfermedad generalmente no produce la muerte pero se encuentra vinculada a muchas defunciones. El objetivo de este estudio es describir la TBC como causa de muerte en la Comunidad de Madrid (CM) entre 1991 y 1998, teniendo en cuenta las causas múltiples. Métodos: Estudio descriptivo de defunciones en la CM (19911998) en las que aparece TBC como causa básica o como diagnóstico mencionado en el Boletín Estadístico de Defunción (BED). Los datos se obtuvieron del Registro de Mortalidad de la CM. Variables analizadas: sexo, edad, año de defunción, localización anatómica, causa básica y otros diagnósticos mencionados en el BED. Se han calculado tasas brutas anuales y estandarizadas por edad y específicas por edad y sexo. Se ha comparado el número medio de diagnósticos por defunción. Resultados: En el periodo estudiado se registraron 1.206 defunciones "con TBC", 915 hombres y 291 mujeres. La causa básica fue TBC en 566, VIH/sida en 442 y otras enfermedades en 198. Las tasas de mortalidad "con TBC" han presentado valores máximos en 1995, tanto en varones como en mujeres. El número medio de diagnósticos por defunción es de 3,4 y aumenta a lo largo del período de estudio (p<0,05). Conclusiones: Con un enfoque multicausal la TBC se duplica en las estadísticas de mortalidad. Su presencia está asociada con otras enfermedades, especialmente con el VIH/sida en el período analizado (AU)

Categorización de factores psicosociales asociados al cumplimiento farmacológico antihipertensivo / Categorization of psychosocial factors associated with adherence to antihypertensive drugs

Este estudio intenta categorizar los determinantes del cumplimiento farmacológico antihipertensivo en el modelo psicosocial A.S.E. (actitud, influencia social y autoeficacia). Es un estudio cualitativo, realizado mediante entrevista semiestructurada y grabada, con 44 pacientes (25 cumplidores y 19 incumplidores). Dos investigadores independientes realizaron un análisis temático de las respuestas, siguiendo el método de Burnand. El método se valió mediante el Índice de Kappa. La información de los pacientes sugiere que los programas educativos deberían resaltar las ventajas del tratamiento, enseñar las habilidades que mejoran la adherencia, prever las dificultades y efectos secundarios, y enseñar a soslayarlos o manejarlos. Dichos programas deberían ser impartidos por sanitarios convencidos de la eficacia del tratamiento, buenos comunicadores y dispuestos a compartir responsabilidad con el paciente y a integrar en el programa a las personas influyentes de su entorno próximo. La información obtenida es útil para la ecuación a medida y para el diseño de cuestionarios cuantitativos (AU)

This qualitative study tries to categorize the determinants of adherence to antihypertensive drugs in the A.S.E. model (attitude, social influence and self-efficacy). Data were obtained from the information of 44 patients (25 compliant and 19 noncompliant), by means of a semi-structured, recorded interview. Two independent investigators carried out a thematic analysis of the answers, following Burnard’s method. The method was validated using the Kappa Index. The information from the patients suggests that educational programs should emphasize the advantages of treatment, teach the skills that improve adherence, foresee the barriers and secondary effects, and teach avoiding or managing them. These programs should be developed by health workers convinced of the effectiveness of the treatment, who are good communicators and willing to share responsibility with patients and to integrate in the program significant people in their personal environment. The information obtained is useful for tailor made education and to elaborate quantitative questionnaires (AU)

[The Madrid autonomous community epidemiological bulletin. A survey on its dissemination and opinion thereof on among primary care physicians for the year 2000]. / Boletín epidemiológico de la Comunidad de Madrid: encuesta sobre su difusión y percepción entre los médicos de atención primaria en el año 2000.

BACKGROUND: The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers' interests. METHOD: A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out-by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher's Exact Test method, with Epi-Info v.6. RESULTS: A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. CONCLUSIONS: The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System.

Boletín epidemiológico de la Comunidad de Madrid: encuesta sobre su difusión y percepción entre los médicos de atención primaria en el año 2000 / The autonomous Community of Madrid epidemiological bulletin. A survey regarding its dissemination and opinion thereof on among primary care physicians for the year 2000

Fundamento:. El objetivo es conocer la difusión y percepción del Boletín Epidemiológico de la Comunidad de Madrid (BECAM) entre los médicos de atención primaria, con el fin de adaptar la publicación al interés de sus lectores. Método: Encuesta telefónica entre los médicos de primaria de la Comunidad de Madrid, preguntando por la frecuencia de lectura, interés y utilidad de la información contenida El tamaño muestral se estimó en 346 médicos. Se realizó un muestreo bietápico por conglomerados en la primera etapa, con selección aleatoria de 125 centros de salud y 2,7 médicos por centro, siendo el 17 per cent coordinadores de equipo. Se comparan los resultados entre médicos y coordinadores mediante Chi-cuadrado y test exacto de Fisher, con Epi-Info v.6. Resultados: Se realizó un total de 305 entrevistas: 245 médicos y 60 coordinadores. Sabían de la existencia del BECAM el 91,5 per cent (IC 95 per cent: 88,1-94,8), y el 27,2 per cent (IC 95 per cent: 21,9-32,5) conocía más del 50 per cent de los números editados durante el año. El 92,4 per cent (IC 95 per cent: 89,4-95,8) lo consideraba interesante o muy interesante, puntuando con una media de 3,5 sobre 5 su utilidad. De las secciones fijas, la mejor valorada es Brotes Epidémicos, y de los informes, los relacionados con enfermedad meningocócia, tuberculosis y VIH/Sida. Conclusiones: El BECAM es una publicación que, aunque no es conocida ampliamente entre los médicos de primaria de nuestra Comunidad, cuando se lee es bien valorada; siendo así un instrumento útil de retroalimentación en la Red de Vigilancia Epidemiológico (AU)

Background: The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers’ interests. Method: A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out - by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher’s Exact Test method, with Epi-Info v.6. Results: A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. Conclusions: The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System (AU)