[Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources]. / El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios.

INTRODUCTION: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). MATERIALS AND METHODS: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. RESULTS: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. CONCLUSIONS: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients.

[Use of levofloxacine in primary care for outbreaks in COPD]. / Uso de levofloxacino en el tratamiento de reagudizaciones de EPOC en atención primaria.

OBJECTIVE: To find scientific evidence to support the indication for treating outbreaks in COPD patients on an out-patient basis with levofloxacine, as against conventional treatments. DESIGN: Standardised review, following the criteria of medicine based on the evidence. A bibliographic search of the MEDLINE data base from 1966 to June 2000 was the basis for an analysis of the evidence found. SETTING: Non-hospital treatment. PATIENTS AND OTHER PARTICIPANTS: COPD patients suffering a light outbreak of probable bacterial origin, according to the Anthonisen criteria. INTERVENTIONS: The intervention analysed was treatment with 500 mg/day of levofloxacine taken orally. An attempt was made to compare this with conventional treatments such as amoxycillin-clavulanic acid and acetyl cefuroxime. The indicators of results analysed were reduction in mortality or in the number of hospital admissions. MEASUREMENTS AND MAIN RESULTS: No clinical trial was found that compared levofloxacine and amoxycillin-clavulanic acid. Two clinical trials were found that compared levofloxacine and acetyl cefuroxime. These found no significant differences between the group treated with levofloxacine and the group treated with cefuroxime. CONCLUSIONS: No scientific evidence demonstrating advantages of levofloxacine treatment over amoxycillin-clavulanic acid was found, or over acetyl cefuroxime as empirical PC first-choice treatment for patients with outbreaks of COPD.

[Impotence in diabetic patients: detection of prevalence and social-health implications]. / Impotencia en pacientes diabéticos: detección de prevalencia e implicaciones sociosanitarias.

OBJECTIVES: To classify information received from diabetics on erectile dysfunction (ED) and to find whether help is being sought or there is just passive resignation. DESIGN: Epidemiological, descriptive, crossover study. SETTING: Urban Health Centre. PATIENTS: 102 patients involved in the Diabetes Programme for over a year were studied. MEASUREMENTS AND MAIN RESULTS: A data collection sheet with the variables listed under objectives was designed. Average age was 63 +/- 12. Overall prevalence of ED was 56%, age being the most important related variable found (p < 0.01). 30% of patients with ED had requested medical care; only 18% had been treated. However, 54% of impotent diabetics accepted the theoretical possibility of treatment with intracavernous injections. CONCLUSIONS: A high prevalence of ED was detected in the diabetic patients studied. They considered the medical information on possible treatments scant (18%) and generally inadequate. Most preferred to be treated by the Primary Care doctor. Primary Care professionals must become more sensitive to ED and provide correct therapeutic information.

[Tobacco addiction in primary health care workers in the health area number 4 of Insalud in Madrid: prevalence of consumption and attitude]. / El tabaquismo en los trabajadores de atención primaria del área sanitaria número 4 del Insalud de Madrid: prevalencia de consumo y actitudes.

BACKGROUND: In developed countries, tobaccoism constitutes the main public health problem capable of prevention. Health professionals comprise the sector with the greatest power of influence in reducing smoking habits. Nevertheless, cooperation is determined by their own personal habits and attitudes to smoking. This study describes the prevalence of smoking and attitudes towards tobaccoism amongst primary medical care personnel within Area 4 of Insalud in Madrid. METHODS: Of the 910 workers surveyed, 803 responded (response rate: 88%). 42.3% were smokers (35.3% on a daily basis and 7% occasionally) and the average smoker consumed 17 cigarrettes per day. 25.9% were ex-smokers and 31.7% non-smokers. 95% of non-smokers and 85% of smokers considered that smoking should be forbidden in medical centres (p << 0.001). 11% of smokers did so in front of patients (10% of doctors and 3.3% of nursing staff). 58.4% of smokers stated that they would participate in an assistance scheme designed to help them give up the habit. CONCLUSIONS: Results indicate that there still exists a large percentage of primary medical care personnel that smoke and that attitudes are not those that would be expected from a group of people seen as an example by others. Priority must be given to intensifying awareness, assisting people to give up smoking and to training courses.