Diferencias de género en el uso de marcadores tumorales / Gender differences in the use of tumour markers

Introducción y objetivo. El género es uno de los factores que puede condicionar el uso de recursos sanitarios. El empleo de los marcadores tumorales está muy extendido por la importancia de estos en el seguimiento de la enfermedad oncológica. El objetivo es analizar la influencia del género en el uso de marcadores tumorales y comprobar si existen diferencias. Material y métodos. Se realizó un estudio descriptivo retrospectivo longitudinal en el área de influencia del Hospital Universitario de Padua. Se hizo un seguimiento de 2 años. Se analizaron 23.059 peticiones analíticas de marcadores tumorales. Se realizó un análisis descriptivo y de frecuencias de las variables estudiadas. Los estadísticos empleados fueron Chi cuadrado, t de Student y U de Mann-Whitney. Resultados. La media del número de peticiones solicitadas en mujeres (1,5) fue menor que en hombres (1,6). En los pacientes con enfermedad tumoral, el número de peticiones fue mayor que en aquellos sin afección tumoral. En el análisis por enfermedad y género la diferencia fue significativa. Respecto al número de marcadores tumorales por petición, la diferencia de las medias por género también fue significativa, 2,13 en hombres frente a 2,85 en mujeres. Estos resultados se mantuvieron al eliminar las peticiones con marcadores tumorales ligados a enfermedades relacionadas con el género. Conclusiones. Existen diferencias en el uso de marcadores tumorales por género; el número de peticiones por paciente masculino era superior al femenino. Al contrario ocurre con el número de marcadores tumorales por petición, que es mayor en mujeres que en los hombres (AU)

Introduction and objective. Gender is one of the factors that can influence the use of health resources. The use of tumour markers is widespread, due to the importance of these in monitoring cancer development. The aim of this study is to analyse the influence of gender on the use of tumour markers, and to investigate whether there are differences in their use. Material and methods. A longitudinal, retrospective and descriptive study, with a 2-year follow-up, was conducted in the catchment area of the University Hospital of Padua. An analysis was performed on 23,059 analytical requests for tumour markers. A descriptive and frequency analysis was performed on all variables. The statistical analysis was performed using Chi squared, Student t and Mann-Whitney U to test for significance. Results. The number of requests for women (1.5) was lower than men (1.6). In patients with tumour pathology, the number of requests was higher than in patients without tumour disease. In the analysis by disease and gender, the difference remained significant. As regards the number of tumour markers per request, the difference between genders was also significant: 2.13 in males versus 2.85 in women. Similar results were obtained when requests for tumour markers linked to gender-related diseases were eliminated. Conclusions. There are differences in the use of tumour markers by gender with the number of requests for male patients being higher than for females. However, the number of tumour markers per request is greater in women than in men (AU)

[Gender differences in the use of tumour markers]. / Diferencias de género en el uso de marcadores tumorales.

INTRODUCTION AND OBJECTIVE: Gender is one of the factors that can influence the use of health resources. The use of tumour markers is widespread, due to the importance of these in monitoring cancer development. The aim of this study is to analyse the influence of gender on the use of tumour markers, and to investigate whether there are differences in their use. MATERIAL AND METHODS: A longitudinal, retrospective and descriptive study, with a 2-year follow-up, was conducted in the catchment area of the University Hospital of Padua. An analysis was performed on 23,059 analytical requests for tumour markers. A descriptive and frequency analysis was performed on all variables. The statistical analysis was performed using Chi squared, Student t and Mann-Whitney U to test for significance. RESULTS: The number of requests for women (1.5) was lower than men (1.6). In patients with tumour pathology, the number of requests was higher than in patients without tumour disease. In the analysis by disease and gender, the difference remained significant. As regards the number of tumour markers per request, the difference between genders was also significant: 2.13 in males versus 2.85 in women. Similar results were obtained when requests for tumour markers linked to gender-related diseases were eliminated. CONCLUSIONS: There are differences in the use of tumour markers by gender with the number of requests for male patients being higher than for females. However, the number of tumour markers per request is greater in women than in men.

[Cost-effectiveness analysis of tiotropium compared to ipratropium and salmeterol]. / Análisis del coste-eficacia del tiotropio frente al ipratropio y salmeterol.

OBJECTIVE: The constant increase in health care costs, in a context of limited resources and the appearance of more costly though more effective drugs, justifies an assessment of the pharmacoeconomics of these drugs. The objective of this study was to evaluate the cost-effectiveness of one of the newest drugs for the treatment of chronic obstructive pulmonary disease (COPD)-tiotropium. MATERIAL AND METHOD: A cost-effectiveness analysis (costs and outcomes) within the framework of the Spanish National Health System was done. The alternatives to tiotropium analyzed were ipratropium and salmeterol. Direct health care costs associated with hospital treatment were calculated. Forced expiratory volume in 1 second, quality of life (with the Saint George's Respiratory Questionnaire), dyspnea transitional index, mean stay in hospital, and exacerbations were the variables used to measure effectiveness. Values for these variables were taken from the main reviews and randomized clinical trials published for tiotropium. RESULTS: For COPD patients, treatment with tiotropium leads to a greater reduction in exacerbations (37% compared to ipratropium and 25% compared to salmeterol 25%), and a reduction in the number of days in hospital (33% compared to ipratropium and 14% compared to salmeterol). Therefore, use of tiotropium could save ;100 000 for the current rates of admission and lengths of hospital stay in Spain. CONCLUSIONS: Tiotropium was more effective than ipratropium and salmeterol as measured by objective clinical variables (forced expiratory volume in 1 second) and subjective ones (the Saint George's Respiratory Questionnaire and dyspnea transitional index). Hospital stays were shorter and exacerbations fewer with tiotropium. In all cases, tiotropium was more cost-effective than the alternatives, thus use of tiotropium could help hospitals to save money.

Análisis del coste-eficacia del tiotropio frente al ipratropio y salmeterol / Cost-effectiveness analysis of tiotropium compared to ipratropium and salmeterol

Objetivo: El incesante incremento de los costes en un marco en el que los recursos son limitados, así como la aparición de nuevos medicamentos más costosos y a la vez más eficaces, justifica la evaluación económica de los medicamentos. El objetivo de este trabajo es evaluar el coste-eficacia de uno de los fármacos más novedosos para el tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC), el tiotropio. Material y método: Se ha realizado un análisis de coste-eficacia (costes y consecuencias) desde la perspectiva del Sistema Nacional de Salud. Las alternativas analizadas han sido ipratropio y salmeterol. Se han considerado sólo costes sanitarios directos en el ámbito hospitalario. Los parámetros de eficacia analizados han sido: volumen espiratorio forzado en el primer segundo, calidad de vida (mediante el Saint George's Respiratory Questionnaire), índice transicional de disnea, estancias medias y exacerbaciones. Dichos parámetros se han obtenido de las principales revisiones y ensayos clínicos aleatorizados publicados sobre el tiotropio. Resultados: Teniendo en cuenta la reducción del número de exacerbaciones conseguida con el tiotropio frente al ipratropio y salmeterol (el 37 y el 25%, respectivamente) y del número de días de estancia hospitalaria (el 33 y el 14%, respectivamente), su utilización puede suponer un ahorro superior a los 100.000 € para las cifras actuales de tasa de ingresos y días de estancia hospitalaria de los pacientes con EPOC en España. Conclusiones: El tiotropio ha sido más efectivo que el ipratropio y salmeterol tanto en parámetros clínicos (objetivos, como el volumen espiratorio forzado en el primer segundo, y subjetivos, como el Saint George's Respiratory Questionnaire y el índice transicional de disnea) como en disminución de estancias hospitalarias y exacerbaciones. En todos los casos resulta más coste-efectivo que sus alternativas, lo que supone importantes ahorros en el ámbito hospitalario

Objective: The constant increase in health care costs, in a context of limited resources and the appearance of more costly though more effective drugs, justifies an assessment of the pharmacoeconomics of these drugs. The objective of this study was to evaluate the cost-effectiveness of one of the newest drugs for the treatment of chronic obstructive pulmonary disease (COPD)-tiotropium. Material and method: A cost-effectiveness analysis (costs and outcomes) within the framework of the Spanish National Health System was done. The alternatives to tiotropium analyzed were ipratropium and salmeterol. Direct health care costs associated with hospital treatment were calculated. Forced expiratory volume in 1 second, quality of life (with the Saint George's Respiratory Questionnaire), dyspnea transitional index, mean stay in hospital, and exacerbations were the variables used to measure effectiveness. Values for these variables were taken from the main reviews and randomized clinical trials published for tiotropium. Results: For COPD patients, treatment with tiotropium leads to a greater reduction in exacerbations (37% compared to ipratropium and 25% compared to salmeterol 25%), and a reduction in the number of days in hospital (33% compared to ipratropium and 14% compared to salmeterol). Therefore, use of tiotropium could save €100 000 for the current rates of admission and lengths of hospital stay in Spain. Conclusions: Tiotropium was more effective than ipratropium and salmeterol as measured by objective clinical variables (forced expiratory volume in 1 second) and subjective ones (the Saint George's Respiratory Questionnaire and dyspnea transitional index). Hospital stays were shorter and exacerbations fewer with tiotropium. In all cases, tiotropium was more cost-effective than the alternatives, thus use of tiotropium could help hospitals to save money

[Pharmacotherapy and costs of DRD 88. Chronic obstructive pulmonary disease in hospital]. / Tratamiento farmacológico y costes hospitalarios del GRD 88. Enfermedad pulmonar obstructiva crónica.

BACKGROUND: Diagnosis-Related Group (DRG) 88 -chronic obstructive pulmonary disease is one of the most frequent groups of patients in hospital case-mix and accounts for substantial health-care costs. Our purpose was to determine drug utilization pattern and related costs for this DRG and to analyse their relationship with several factors. METHODS: 288 patients treated at a tertiary referral hospital between january and december 1997 were studied. We analysed demographic, clinical, and administrative data, as well as drugs prescription and cost for every patient. RESULTS: Most patients received antibiotics (n=267) which, in addition, represented 46% of total pharmacy cost of this DRG. Cephalosporines were the most frequently prescribed. 67% of patients were treated with inhaled B-agonists and theophillyne, whereas the combination of B-agonists and Ipratropium Bromide was less frequent (n=152). Oral or parenteral corticosteroids were used in 233 patients. This treatment regime presented differences according to main diagnosis and to department responsible for patient discharge. Cost per episode was 116,6 +/- 110,5 euros. Cost per hospital stay was 13,1+/- 15,5 euros. Correlation of pharmacy costs with length of stay was moderate. CONCLUSION: Pharmacy costs are mainly determined by the use of antibiotics. Treatment pattern shows a certain variability that can be attributed to patients clinical features as well as to physician prescribing habits.

Tratamiento farmacológico y costes hospitalarios del GRD 88. Enfermedad pulmonar obstructiva crónica / Pharmacotherapy and costs of DRD 88. Chronic obstructive pulmonary disease in hospital

Fundamentos: El Grupo Relacionado por el Diagnóstico (GRD) 88 -enfermedad pulmonar obstructiva crónica- es uno de los más frecuentes en la casuística hospitalaria y genera considerables costes sanitarios. Nuestro objetivo era conocer el coste y el patrón farmacoterapéutico asociado a este GRD y determinar los posibles factores relacionados. Método: Estudio transversal descriptivo de 288 altas asignadas al GRD 88 entre enero y diciembre de 1997 en un hospital de tercer nivel. De cada paciente, se analizaron las variables edad, género, diagnósticos, tipo de ingreso y alta, estancias y servicio de alta, así como la medicación recibida y su coste. Resultados: Los medicamentos con mayor impacto en el tratamiento fueron los antiinfecciosos, que además representaron el 46 por ciento del coste total, siendo los más utilizados las cefalosporinas . El 67 por ciento de los pacientes fueron tratados con beta-adrenérgicos inhalados y teofilinas. La combinación de beta-adrenérgicos con bromuro de ipratropio fue menos frecuente (n=152). Los corticoides sistémicos se emplearon en 233 pacientes. El patrón terapéutico presentó diferencias en función del servicio de alta, y de algunas variables clínicas, como diagnóstico que causó el ingreso o presencia de infección respiratoria. El coste/episodio fue 166,6 ñ 110,5 e. El coste/estancia fue 13,1 ñ 15,5 e. Coste farmacéutico y duración de estancia se correlacionaron moderadamente (r2 0 , 2 3 3 ) .Conclusiones: El coste viene determinado fundamentalmente por la utilización de antibióticos y la duración de estancia influye en menor medida. El patrón farmacoterapéutico está sujeto a cierta variabilidad que podría atribuirse, tanto a diferencias clínicas de los pacientes, como a distintos hábitos de prescripción. (AU)

[Correlation between subjective and objective health measurements in patients with chronic obstructive pulmonary disease (COPD)]. / Correlación entre medidas de salud subjetivas y objetivas en pacientes con enfermedad pulmonar obstructiva crónica (EPOC).

AIMS: Analyze the relation between objective health assessment (OHA) -Forced spirometry- and subjective health assessment (SHA) -quality of life- in patients with chronic obstructive pulmonary disease (COPD). Analyze the correlation between two different questionnaires to assess quality of life. DESIGN: Cross-sectional study. PARTICIPANTS: 278 patients with COPD (confidence level 95%) from two urban health centers. MAIN MEASUREMENTS: Personal interview. VARIABLES: quality of life (Nottingham Health Profile; St George Respiratory Questionnaire); sociodemographic profile; diagnose of COPD; comorbidity; recent spirometry. STATISTICAL ANALYSES: Descriptive statistics; test ji-squared, Kruskal-Wallis and the correlation coefficient. RESULTS: Age: 66,9 years; sex: 88% male. Quality of life scales (mean and confidence intervals): Nottingham Health Profile subscales (total score 100 points): energy 40 (35.6-44.4), pain 35.9 (32.3-39.5), emotional reactions 32.5 (29.4-38.6), sleep 41.9 (37.8-45.9), social isolation 15.3 (12.7-17.9), mobility 36.7 (33.9-39.5) and global score 33.4 (30.8-36). St George Respiratory Questionnaire subscales (total scores 100 points): impact 38.01 (35.08-40.18), activity 53.8 (50.2-57.4), symptoms 37.7 (35.2-40.3) and global score 40.0 (38.6-43.2). The correlation coefficients between the two questionnaires ranged between 0.12 (for the sleep and symptoms dimensions: p = 0.03) and 0.66 (for the mobility and activity dimensions; p < 0.0001). There is a positive lineal relation between the two questionnaires and the spirometric stages of COPD (measured by the maximum respiratory volume in the first second). CONCLUSIONS: We found a good correlation between the two quality of life questionnaires, but St George was more specific for respiratory illness. There is a mild-light correlation between objective and subjective health assessment in patients with COPD.

Correlación entre medidas de salud subjetivas y objetivas en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) / Correlation between subjective and objective health measurements in patientes with chronic obstructive pulmonary disea (COPD)

Objetivos. Analizar la relación entre medidas de salud objetivas (espirometría actual) y medidas de salud subjetivas (calidad de vida autopercibida). Evaluar la correlación entre 2 cuestionarios de valoración de calidad de vida. Diseño. Descriptivo, transversal. Emplazamiento. Dos centros de salud urbanos con programa de crónicos (subprograma de enfermedad pulmonar obstructiva crónica [EPOC]).Participantes. Un total de 278 pacientes diagnosticados de EPOC. Mediciones principales. Mediante entrevista personal se analizan las siguientes variables: calidad de vida autopercibida (perfil de salud de Nottingham; cuestionario respiratorio St. George; rangos de puntuación de subescalas 0-100 puntos; perfil sociodemográfico, diagnóstico de EPOC, antecedentes personales, espirometría actual. Resultados. Edad, 66,9 ñ 8,9 años; género, 88 por ciento varones. Los principales resultados de salud autopercibida fueron (medias e IC del 95 por ciento): perfil de salud de Nottingham: subescalas de energía, 40 (35,6-44,4); dolor, 35,9 (32,3-39,5); emotividad, 32,5 (29,438,6); sueño, 41,9 (37,8-45,9); social, 15,3 (12,7-17,9); movilidad, 36,7 (33,9-39,5), y total, 33,4 (30,8-36). Cuestionario de St.George: subescalas de impacto, 38,01 (35,0840,18); actividad, 53,8 (50,2-57,4) síntoma, 37,7 (35,2-40,3) y total, 40,9 (38,6-43,2).Los coeficientes de correlación entre ambos cuestionarios oscilaron entre 0,12 (para las dimensiones sueño y síntoma; p = 0,03) y 0,66 (entre las dimensiones de movilidad y actividad; p < 0,0001). Existe una relación lineal de tendencia positiva entre ambos cuestionarios y las categorías de valores (normal, leve, moderado y grave) del parámetro espirométrico, volumen espiratorio máximo en el primer segundo (p < 0,0001).Conclusiones. Encontramos una buena correlación entre ambos cuestionarios de salud autopercibida, siendo de mayor especificidad para patología respiratoria el St. George. Existe una correlación levemoderada entre las medidas de salud objetivas y subjetivas en los pacientes con EPOC en nuestro medio. (AU)

Salud autopercibida, apoyo social y familiar de los pacientes con enfermedad pulmonar obstructiva crónica / Quality of life, familiar and social network of patients with chronic obstructive pulmonary disease

Fundamentos: la EPOC es una enfermedad crónica e invalidante con gran repercusión en la calidad de vida del paciente así como en su dinámica familiar y social. La percepción por parte del paciente de sus limitaciones genera un sentimiento de baja autoestima que pone en peligro su posición ante la familia y la sociedad. Objetivos: describir características sociodemográficas y conocer en los pacientes con EPOC la calidad de vida autopercibida, el apoyo social con que cuentan y su dinámica familiar.Diseño: descriptivo transversal.Material y métodos: selección mediante muestreo consecutivo de 278 pacientes diagnosticados de EPOC. Mediante entrevista personal se recogió : perfil sociodemográfico, hábito tabáquico y antecedentes clínicos (comorbilidad), salud autopercibida (perfil de salud de Nottingham, NHP, y Cuestionario Respiratorio St George, SGRQ), apoyo social (Escala de Duke-Unc) y apoyo familiar (test de AP GAR familiar). Estadística descriptiva.Resultados: variables sociodemográficas: varones (88 por ciento), de 66,9ñ8,9 años, casados (87 por ciento), analfabetos (46,7 por ciento), jubilados (77 por ciento). Fumadores (76 por ciento) de 53,2 paquetes/año. Comorbilidad: 76 por ciento pacientes. Los principales resultados de salud autopercibida fueron (medias e IC 95 por ciento): perfil de Salud de Nottingham (0-100): subescalas de energía 40 (35,6-44,4), dolor 35,9 (32,3-39,5), emotividad 32,5 (29,4-38,6), sueño 41,9 (37,8-45,9), so cial 15,3 (12,7-17,9), movilidad 36,7 (33,9-39,5) y total 33,4 (30,8-36). Cuestionario de St. George (0-100): subescalas de impacto 38,01 (35,0840,18), actividad 53,8 (50,2-57,4), síntoma 37,7 (35,2-40,3) y total 40,9 (38,6-43,2). Apoyo social Conclusiones: la calidad de vida de los pacientes con EPOC resultó estar bastante alterada fundamentalmente en las dimensiones de sueño, energía y movilidad del NHP y en la subescala que valora la limitación de la actividad a causa de la disnea del SGRQ. Algo más de la mitad de los pacientes referían buen apoyo social, siendo mayor el afectivo que el confidencial. Consideramos importante el porcentaje de disfunción familiar (20,3 por ciento) (AU)

Clonidine decreases intraoperative bleeding in middle ear microsurgery.

BACKGROUND: The antihypertensive drug clonidine is a centrally acting alpha2 agonist useful as a premedicant because of its sedative, anxiolytic, and analgesic properties. We examined the effect of clonidine given as an oral preanesthetic medication in producing a bloodless surgical field in patients undergoing middle ear microsurgery. We also evaluated whether the administration of clonidine would alter the reflex cardiovascular response to laryngoscopy and endotracheal intubation, anesthetic requirement, postoperative pain intensity and consumption of analgesics, and pre- and postoperative sedation and anxiety. METHODS: A prospective, randomized, double-blind clinical trial was performed in 40 patients scheduled for elective middle ear surgery under general anesthesia. Twenty-one patients received clonidine (300 microg p.o.) 90 min prior to arrival at the operating theater and 19 received placebo (control group). The hemodynamic endpoint of the anesthetic management was maintenance of hypotension for producing a bloodless surgical field. The desired control of the cardiovascular system was attained with isoflurane (inspired concentration increments of 0.25 vol% up to a maximum of 1.5 vol%)+/-fentanyl (bolus of 1 microg. kg-1)+/-urapidil (bolus of 0.3 mg. kg-1) as needed. Intraoperative bleeding was assessed on a four-point scale from 0=no bleeding to 3=abundant bleeding. RESULTS: There was less bleeding in the clonidine group (mean+/-SEM) than in the control group (0.75+/-0.3 vs 1.1+/-0.4, P<0.05). Patients given clonidine required a mean inspired isoflurane concentration of 0.63+/-0.1 vol% as compared with 1.01+/-0.2 vol% in controls (P<0.05). Fentanyl requirements were also significantly lower (57.10 vs 79.42 microg. kg-1, P<0.05). Four clonidine-treated patients required urapidil to achieve satisfactory hypotension as compared with 11 controls (P<0.05). Clonidine attenuated the associated cardiovascular response following laryngoscopy and intubation, and was more effective than placebo in achieving a satisfactory preoperative sedation and decreasing intensity of postoperative pain. Preoperative anxiety and incidence of adverse events was similar in both groups. CONCLUSION: Premedication with clonidine reduced bleeding in middle ear microsurgery, attenuated hyperdynamic response to tracheal intubation, and reduced isoflurane, fentanyl, and urapidil requirements for controlled hypotension.

Reparación de defectos osteocartilaginosos de la rótula de conejos con injertos libres de periostio / Repair tissue resurfacing in osteocartilaginous defects in rabbit's patellas treated with periosteal grafts

Se diseña un modelo experimental consistente en la realización de una úlcera condral de 6 mm, en la superficie articular de la rótula, en 48 conejos distribuidos en dos series. Mientras en la serie control (24 conejos) dicha úlcera se dejó a evolución espontánea, en la experimental (24 conejos) fue cubierta con plastia libre de periostio tibia¡, para poder investigar la posibilidad de regeneración del cartilago articular. Los resultados se valoraron microscópicamente a intervalos de 1, 2,4 y 8 semanas,comprobando la ausencia de regeneración espontánea y el desarrollo de un cartílago hialino a partir de la plastia de periostio, con lo que se demuestra la capacidad condrogénica de la misma y se sugiere la posibilidad de aplicación clínica en defectos del cartilago articular (AU)

Comparative study of the reconstruction of articular cartilage defects with free costal perichondrial grafts and free tibial periosteal grafts: an experimental study on rabbits.

The purpose of this study was to compare the chondrogenic potential of free perichondrial with free periosteal grafts in the resurfacing of full-thickness defects of patellar articular cartilage in rabbits. We used adolescent New Zealand rabbits weighing between 2.4 and 3.6 kg. A 6-mm wide and 3-mm thick defect was created on the patellar articular surface. A total of 30 rabbits were randomly divided into a control group and two test groups. One test group received free perichondrial grafts (PC); the other received free periosteal grafts (PO). All the animals were killed 8 weeks after surgery. All the histological samples were scored from 0 to 17 according to a standard scoring system. Differences in the quality of the regenerated tissue were only found between the control and the test groups. There were no statistically significant histological differences between the grafted defects of the PC and the PO groups that there are not on any of the variables. The results of this study support that there are not significant differences in the quality of the repair tissue when using these two types of biological grafts.

[Evaluation of anti-thrombosis treatment in patients with chronic non-valvular atrial fibrillation]. / Valoración del tratamiento antitrombótico en pacientes con fibrilación auricular crónica no valvular.

OBJECTIVES: To assess both the indications of anti-thrombosis treatment in patients in our ambit with chronic non-valvular atrial fibrillation, and its observance in Primary Care. DESIGN: A descriptive, crossover, observational study of consecutive cases. SETTING: Third-level referral hospital in our Health District. PATIENTS: 132 adults first diagnosed with chronic atrial fibrillation between July 1st and December 31st 1996. MEASUREMENTS AND MAIN RESULTS: Patients' clinical records were used to assemble data on risk factors of embolism and counter-indications to prescribing antithrombosis treatment. A logistic regression model was performed to analyse the variables affecting the treatment at the time it was first given. 65 men (mean age 68.3) and 67 women (mean age 74.6) were included in the study. 87.9% of the patients had embolism risk factors; and 30.3% had at least one absolute or relative counter-indication to anti-coagulation. 79 patients had risk factors but no counter-indication, of whom 28% took anticoagulants, 39% had anti-aggregates prescribed and the remaining 33% received no anti-thrombosis treatment at all. Only 3 patients taking anticoagulants were referred to the Primary Care doctor. The regression model worked out signalled age under 75 and a previous embolism as factors associated with the indication and anticoagulants: We found no coherent regression model for the indication of anti-aggregates. CONCLUSIONS: Anti-thrombosis treatment is underused in Primary Care. An antecedent of an embolism is the most weight criterion for giving anticoagulants to patients. Age is shown to be the main reason for therapeutic reluctance to give anticoagulants to patients without counter-indications. There should be more patients being treated with anticoagulants in Primary Care.

[A retrospective evaluation of the behaviour of groups under out-patient care at a health center]. / Evaluación retrospectiva del comportamiento de los grupos de cuidados ambulatorios en un centro de salud.

OBJECTIVES: To study and analyse the Out-Patient Care Groups (OCGs), and evaluate how they affect use of health resources. DESIGN: An observational, retrospective study. SETTING: Ciudad Jardín Health Centre, Málaga. PARTICIPANTS: 2999 patients with a clinical history opened before 31.12.95, chosen from 5 of the 17 medical lists at the Health Centre, were included. RESULTS: The statistical analysis was performed with the SPSS software package of the Calculation Centre at Málaga University. A descriptive test produced the following results: 33% of the patients were classified in OCG 41 (combination of 2 or 3 out-patient diagnosis groups in people over 34); 19% belonged to groups of stable or unstable chronic illnesses (OCGs 8, 9 and 10); and 9% had acute children's diseases. Then multiple regression constructed a model with the OCGs as independent variable and annual visits, further tests performed and referral to specialists as dependent variables. In this model the OCGs were able to explain 20.3% of resource consumption. CONCLUSIONS: In the retrospective study and with a limited sample of 2999 patients, the OCGs are able to explain 20.3% of resource consumption. However, it does seem a valid model for discriminating between normal and over-using patients.

[Hypertensive patients treated in Spain, 1990-1993]. / Estudio sobre los enfermos hipertensos en tratamiento en España durante el período 1990-1993.

BACKGROUND: The main goal of our work was to gain knowledge from the pharmaco-epidemiological perspective on the use of anti-hypertensive drugs in our country, in order to obtain a rough estimation of the number of hypertensive patients under treatment in various Autonomous Communities. METHODS: The data regarding the consumption of hypertensive drugs (mono-medicines) from 1990 to 1993 have been obtained from the Vice-Directorate General for Treatment and Pharmaceutical Planning. The methodology used to calculate the "Estimated Prevalence Patient-day" under treatment with these drugs is based on the WHO recommendations for the Studies on the use of Medicines. Estimated Prevalence of Patient-day (EPPD) has been calculated by using the Defined Daily Dosage of each anti-hypertensive drug. RESULTS: The number of hypertensive patients under treatment with these drugs was 1.763.937, 1.966.396, 2.226.225 and 2.435.294, from 1990 to 1993, respectively. At the end of our study, in 1993, the number of hypertensive patients under treatment in Spain is nearly 50% of the total number of hypertensive patients. There are some differences amongst regions; thus, the Autonomous Communities of Aragón, Castilla-La Mancha, Cataluña, País Valenciano and Murcia are noticeable as regions where the number of hypertensive patients treated exceeds the national average. CONCLUSIONS: The number of hypertensive patients under treatment has considerably increased between 1990 to 1993 (+ 40%). An increase is observed in the number of hypertensive patients treated with calcium antagonists and ECA inhibitors and a decrease is observed in the proportion of hypertensive patients under treatment with Beta-blockers and diuretics.