[Rates of surgical wound infection in hip arthroplasty (2007-2015)]. / Tasas de infección de herida quirúrgica en artroplastia de cadera (2007-2015).

OBJECTIVE: To estimate the incidence of surgical site infection in the hip replacement procedure during nine years of follow-up in a local public hospital. MATERIAL AND METHODS: A prospective study conducted between 2007 and 2015, using the Clinical Indicators of Continuous Quality Improvement (INCLIMECC) tool. All primary hip prostheses and revisions were studied. The definitions, criteria and categories for surgical site infection were those estimated for the risk index of the National Nosocomial Infections Surveillance of Centres for Disease Control and Prevention. Crude and adjusted rates were calculated by risk index. RESULTS: A total of 999 interventions were included. The overall infection rate was 1.5% (95%CI: 0.75-2.25). Surgical prophylaxis was prescribed in 98.3% of the cases, and was adequate in 70.7%, with the main cause of inadequacy being its prolonged duration in 71.3%. The infection rate was 53%, being better than the rates published for Spanish hospitals INCLIMECC in the period 1997-2012. But they were 19% higher than those published for the USA according to the National Healthcare Safety Network, and 50% higher than expected according to data published for Europe by the European Centre for Disease Prevention and Control. DISCUSSION: The infection rate in the present study is better than those described in the Spanish literature, but it is higher than those published for Europe and North America. Strategies for surveillance and control of infections associated with health care allow the evaluation of trends and the impact of prevention measures.

Prevalencia y duración de la lactancia materna en Asturias / Prevalence and duration of breastfeeding in Asturias, Spain

Objetivo: Estimar la prevalencia y duración de la lactancia materna en Asturias y describir los factores asociados. Métodos: Estudio transversal. La población fueron todos los niños nacidos en los hospitales públicos de Asturias que tenían entre 0 y 8 meses de edad en el momento del estudio (4.326). Se obtuvo una muestra aleatoria estratificada de 453 niños. Los datos se obtuvieron por entrevista telefónica con cuestionario a las madres, preguntando si el día del estudio el niño tomaba el pecho. Se interrogaba además sobre datos sociodemográficos y de atención prenatal y perinatal. La estimación de la curva de prevalencia de lactancia según la edad del niño se realizó mediante regresión logística univariante, y el análisis de los factores asociados mediante regresión logística múltiple. Se estimaron como indicadores de duración el índice de discontinuidad (ID) y el índice de lactancia acumulada (ILA). Resultados: Se efectuaron 418 entrevistas. La prevalencia de lactancia materna exclusiva (LME) al inicio fue del 51,4 por ciento (intervalo de confianza [IC] del 95 por ciento: 46,6-56,2) decayendo al 14,9 por ciento a los 90 días y al 8,7 por ciento a los 120 días. Los ID fueron del 28,6 por ciento a los 30 días y del 71,0 por ciento a los 90 días. La prevalencia de LME se relacionó en el ajuste multivariado con la localidad de residencia: residir en una localidad rural o semiurbana aumentaba la probabilidad de lactar ( odds ratio [OR] = 5,69 y OR = 3,55, respectivamente) respecto al medio urbano. También se encontró relación positiva con que la madre tuviera estudios universitarios (OR = 3,90; IC del 95 por ciento: 1,778,58) y el haber sido atendida por la matrona durante el embarazo (OR = 2,13; IC del 95 por ciento: 1,04-4,38); se detectó relación inversa entre la LME y que el niño hubiera recibido suplementos en las primeras horas de vida (OR = 0,43; IC del 95 por ciento: 0,20-0,95).Conclusiones: La prevalencia de lactancia materna es muy inferior a la recomendada por la Organizacion Mundial de la Salud, especialmente su duración. En el hábitat no urbano se mantienen patrones más adecuados de lactancia (AU)

Intercepción poscoital hormonal: estudio sobre actitudes y prescripción de los médicos de atención primaria / Hormonal post-coitus interception: study on attitudes and prescription of primary care doctors

Objetivo. Estudiar los conocimientos, actitudes y práctica de los médicos de atención primaria en la prescripción de la intercepción poscoital hormonal, así como las variables sociodemográficas, formativas, legales y éticas asociadas a dicha prescripción. Diseño. Estudio descriptivo, transversal. Emplazamiento. Área IV del INSALUD de Asturias. Participantes. Médicos de familia, excluyendo refuerzos (n = 178). Mediciones y resultados. Cuestionario autoadministrado anónimo de 33 preguntas, reenviado en una ocasión, entre noviembre de 1999 y febrero del 2000. La asociación-independecia de variables fue contrastada mediante ji-cuadrado (considerándose asociación estadísticamente significativa si p < 0,05). Respondieron un 77 por ciento, de los cuales el 51 por ciento era varón. Edad media, 43 años (DE, 6,69), con experiencia profesional de 17 años trabajados (DE, 6,87); un 47 por ciento era médico de familia y el 39 por ciento, médicos generales. Trabajaba en centros de salud un 85 por ciento y en ámbito urbano el 46 por ciento. Era católico un 71 por ciento. Al 73 por ciento (IC del 95 por ciento, 66-80 por ciento) se le solicitó en al menos una ocasión la píldora poscoital (PPC) en los últimos 6 meses, siendo mayor la demanda en medio urbano (83 por ciento). Consideraba la PPC abortiva el 18 por ciento. Refería prescribirla un 88 por ciento (IC del 95 por ciento, 82,5-93,5 por ciento), de los cuales un 30 por ciento (IC del 95 por ciento, 16-44 por ciento) lo hacía según las recomendaciones de la OMS. El 100 por ciento de los 'no prescriptores' eran católicos. Conclusiones. La mayoría de los médicos recibe demandas de PPC y la prescribe cuando se la solicitan, aunque dicha prescripción varía con la edad, cualificación y especialmente las creencias religiosas. Sólo un tercio prescribe siguiendo las recomendaciones de la OMS (AU)

[Estimation of the prevalence of Parkinson's disease in Asturia, Spain. A pharmacoepidemiological study of the consumption of antiparkinson drugs]. / Estimación de la prevalencia de la enfermedad de Parkinson en Asturias (España). Estudio farmacoepidemiológico del consumo de antiparkinsonianos.

INTRODUCTION: There are few studies of the prevalence of Parkinson's disease (PD) and they have been done using different methodologies. So it is impossible to know its impact on public health in Asturias (Spain). OBJECTIVE: To estimate the prevalence of PD in Asturias, from the consumption of antiparkinson drugs (Therapeutic Group N04A) in the period between January 1, 1997 and December 31, 1998. MATERIAL AND METHODS: We calculated the defined daily dose (DDD) per 100,000 inhabitants for each antiparkinson drug prescribed during the period studied. Records of prescriptions were obtained from the Pharmacy Sub-directorate of the Health and Consumption Ministry which covers 100% of the population. RESULTS: Determination of the DDD per 100,000 inhabitants for prescriptions of levodopa was 199.13 (95% CI: 172.4-228.6) cases per 100,000 inhabitants, which means 2,115 patients with Parkinson's disease in Asturias (between 1,827 and 2,423). In the group aged under 65 years the estimated prevalence is 63.97 cases per 100,000 inhabitants (95% CI: 49.4-81.7), and for the group aged 65 years or more is 668.19 cases per 100,000 inhabitants (95% CI: 686.9-794). CONCLUSIONS: The estimated prevalence of PD in Asturias (Spain) may be considered average-high as compared to neighboring countries. However, cases of PD in patients aged 65 years or more are fewer than in neighboring countries. The methodological differences between the different studies done prevents definite conclusions being drawn.

[Postcoital hormonal contraception: study on the attitudes and prescription of primary care physicians]. / Intercepción poscoital hormonal: estudio sobre actitudes y prescripción de los médicos de atención primaria.

OBJECTIVE: To study the understanding, attitudes and practice of primary care doctors in the prescription of hormonal post-coitus interception, along with the social and demographic, educational, legal and ethical variables associated with this prescription. DESIGN: Cross-sectional descriptive study. SETTING: Area IV de INSALUD in Asturias. PARTICIPANTS: Family doctors, excluding locums (n = 178). MEASUREMENTS AND RESULTS: An anonymous self-administered questionnaire with 33 questions, re-sent once, between November 1999 and February 2000. The association-independence of variables was contrasted through the chi 2 test (a statistically significant association if p < 0.05). 77% responded, 51% of whom were men. Average age was 43 (SD = 6.69), with professional experience of 17 years worked (SD = 6.87). 47% were family doctors and 39% general practitioners. 85% worked in health centres; 46% in urban settings. 71% were catholics, 73% (95% CI: 66%-80%) had been asked on at least one occasion in the previous six months for the post-coitus pill (PCP), with demand greater in the urban environment (83%). 18% considered the PCP an abortion method. 88% said they would prescribe it (95% CI: 82.5%-93.5%), of which 30% (95% CI: 16%-44%) did so according to WHO recommendations. 100% of the "non-prescribers" were catholics. CONCLUSIONS: Most doctors receive requests for the PCP and prescribe it on demand, though prescription varies with age, categories and, in particular, religious belief. Only a third prescribes according to WHO recommendations.

[The factors related to job satisfaction and professional burnout in the primary care physicians of Asturias]. / Factores relacionados con la satisfacción laboral y el desgaste profesional en los médicos de atención primaria de Asturias.

OBJECTIVE: To determine the level of work satisfaction and professional wear and tear among primary care doctors, and related factors. DESIGN: Crossover descriptive study. SETTING: Asturias PC. SUBJECTS: General doctors (GD), family doctors (FD), residents, and PC paediatricians (n = 810). MEASUREMENTS: A survey for self-administration with social and demographic variables and suggestions. The Font Roja-PC questionnaire (FR). The Maslach Burnout Inventory (MBI). RESULTS: 497 (55.6% male) responded (61.35%). Mean age was 41 (SD = 7.18) 57.3% worked in an urban environment. 42% were FD, 35% GD, 15% paediatricians, 7% residents. The PC model was: 84% PC teams, 9% traditional model, 7% normal emergency service (NES). Mean seniority was 14 years (SD = 7.5). 89% worked solely in PC. 59% had a permanent contract, 31% provisional contracts, 7% were residents and 3% temporary. Overall mean satisfaction (OMS): 73.73 points. 43% had high professional wear and tear, 23% moderate and 32% low. Statistically significant associations: OMS/social and demographic variables: greater in men, the rural environment, paediatrics, NES, without stand-by, with less bureaucracy and less case pressure. Satisfaction/FR: greater NES, without stand-by, without sole dedication. Case pressure/FR: greater in men, rural environment, paediatrics, without sole dedication, NES, without stand-by and with less demand. Control/FR: greater in permanent and provisional posts. Relationship/FR: greater in men, FD, without stand-by. Suitability/FR: greater in men, paediatricians, permanent doctors, without stand-by. Relaxation/FR: greater in residents, young people, without sole dedication, NES. Variety/FR: greater in young people, those without children, residents, with sole dedication, those with stand-by. MBI/social and demographic variables: greater level of low emotional tiredness in workers in a rural environment and those with children. Greater low level of alienation in women. The older the doctor, the less the professional burnout. CONCLUSIONS: 1. High level of work satisfaction. 2. High-moderate professional wear and tear.