Variabilidad en la prescripción de antibióticos en la provincia de Ávila / Variability in the antibiotics prescription in the Avila Province

El objetivo de nuestro estudio fue analizar el consumo de antibióticos en la provincia de Ávila y en sus diferentes Zonas Básicas de Salud (ZBS) durante el año 2005. Se trata de un estudio observacional retrospectivo, referido al consumo de antibióticos sistémicos (grupo J01 de la ATC), utilizando la información del programa Concylia de la Junta de Castilla y León. El consumo se ha referido en número de dosis diarias definidas por mil habitantes, ajustado en relación a la aportación económica del usuario en el momento de adquirir el medicamento (DHDAj). Como población de referencia se utilizó la incluida en la base de la tarjeta sanitaria en 2005, año en que se consumieron en la provincia de Ávila 26,91 DHDAj de antibióticos sistémicos, con importantes diferencias entre el medio rural (36,63) y el urbano (15,44), y una gran variabilidad entre las diferentes ZBS. Las ZBS con menor número de habitantes por núcleo de población y por médico consumen más antibióticos, lo que puede estar en relación con enfermedades más graves, ausencia de autoconsumo o falta de medios diagnósticos, entre otros factores. No hay relación entre mayor consumo y mayor presión asistencial. Se concluye que el consumo de antibióticos en la provincia de Ávila es alto, a expensas del consumo en el medio rural, y que existe una elevada variabilidad entre las diferentes ZBS relacionada con el menor número de habitantes por núcleo de población y por médico, y sin relación con la presión asistencial

This study analyzed the consumption of systemic antibiotics in the province of Avila, Spain, and its Basic Health Areas (ZBS) during 2005. It was a retrospective observational study of the consumption of systemic antibiotics (ATC class J01) during 2005 using the data collected by the Concylia program. The study population was identified from the 2005 Medical Card Register database. Consumption data was expressed in defined daily doses (DDD) per 1,000 inhabitants per day (DID), calculated in relation to the contribution of the user at the time of acquiring the prescription. It was found that antibiotic consumption in the province of Avila in 2005 was 26.91 DHDAj. There was a considerable difference between rural (36.63) and urban areas (15.44) with a large variability among the different Basic Health Areas. The areas with a smaller number of inhabitants per town or city and per doctor, used more antibiotics, which could be due to more severe pathology, absence of self-medication or lack of diagnostic resources, among other factors. There is no relation between greater consumption and workload. It was concluded that the consumption of antibiotics in the province of Avila is high due to their use in rural areas. A high variability in the consumption of antibiotics was observed between the different areas, which was related to the smaller number of inhabitants per city or town and per doctor, but had no relation to workload

Forma de diagnóstico del cáncer colorrectal. Información del RIMCAN 1991-2001 / How colorectal cancer is diagnosed. Information from RIMCAN, 1991-2001

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[Analysis of automedication with antibiotics in Spain]. / Análisis de la automedicación con antibióticos en la población española. Grupo Urano.

BACKGROUND: The aim of this study was to determine the incidence of automedication with antibiotics in Spain, analyzing the magnitude, importance and possible consequences of this problem. METHODS: A quantitative study was carried out in the pharmacies by personal interview with people who had acquired a pharmaceutical speciality. The study was performed according to territorial distribution proportional to the population of different autonomic communities and urban and rural environments. The questionnaires were done over one year with four cut offs, each coinciding with one of the annual seasons. RESULTS: Automedication with antibiotics was observed in 32.1% of the people who had acquired an antibiotic in a pharmacy, being 28.8% with pharmaceutical specialities acquired. In 20% of the cases (18.1% of the specialities), automedication was produced by direct request of the user, while in 12.1% of the cases (10.7% of the specialities) this was by recommendation by the pharmacist/ pharmaceutical auxillary. Of the people obtaining an antibiotic by self-medication, two out of three acquired a wide-ranging semisynthetic penicillin, while 23% acquired a macrolide. The remaining therapeutic subgroups acquired were tetracyclins (3.3%) and cephalosporins, quinolones and cotrimoxazoles being 1.6% each. Automedication was most frequent in people from 30 to 39 years of age (36.1%) followed by those from 40 to 49 years (29.5%). Men showed a slightly greater incidence than women with 39% of the women acquiring an antibiotic directly doing so for someone other than themselves. Pharyngoamigdalitis was the most frequent process for which an antibiotic was acquired by automedication (34.5% of the cases). The most frequent therapeutic schedule was three times a day for one week. There was little correspondence between the dosage schedule and length of treatment and the number of doses contained in the drug acquired. CONCLUSIONS: Antibiotic automedication is a widespread practice in Spain, specially in the treatment of infectious respiratory and bucal processes. Together with therapeutic unfulfillment and storage of antibiotics in the homes, automedication is currently one of the most serious problems in antibioticotherapy since it is frequently accompanied by bad usage. Health care education programs should be developed with the aim of making the public aware of the negative effects of automedication and orienting patients as to the rational use of antibiotics.

[Study of the demand for laboratory tests in primary care]. / Estudio de la demanda de pruebas de laboratorio en antención primaria.

OBJECTIVE: To study the demand for laboratory test from a sample of Primary Care doctors. DESIGN: A crossover observational study. SETTING: Primary care medical clinics in Spain and Andorra. PARTICIPANTS: Volunteer doctor with primary care practices. INTERVENTION: The study was based on: a) a questionnaire to the doctors taking part, on their clinical consultations, b) recording of the age and gender of patients seen during four consecutive weeks, and c) the logging of the laboratory tests requested during these four weeks. MAIN RESULTS: 82 doctors took part. They had 37,383 clinical consultations, asking for 1,965 analytical studies with 7,248 tests; i.e., they generated 5.25 requests for analysis per hundred consultations. The doctors who requested most analyses had less consultations/day and less consultations/inhabitants/year. When the distance to the laboratory increased, the analyses per consultation lessened and the analyses per inhabitant went up. The most common reason for requesting analysis was the follow-up of an already-known pathology. CONCLUSIONS: A request for analysis is made in 5.25% of primary care consultations. The most common reason is to follow up an already-known pathology.

[Infestation by Giardia lamblia of children in the basic health area of East Rural Avila]. / Infestación por Giardia Lamblia en la población infantil de la Zona Básica de Salud de Avila Rural Este.

BACKGROUND: GIARDIA LAMBLIA (GL) constitutes a problem of public health especially (because of its greater frequency) amongst children. The aim of this study is to determine the prevalence of GL amongst children in the ZONA BASICA DE SALUD (ZBS) in the eastern part of the province of AVILA. METHODS: An observational prospective study undertaken in the ZBS of the eastern part of the Province of Avila during the 1992-93 school year. The faeces of 318 children, aged 3 to 14, without symptoms, attending school in 8 villages of the area were studied by means of the Teleman-Rivas test. RESULTS: The over all Prevalence of GI is 4.4%, we found no statistically significant differences between girls and boys, or between children aged over or under 10, or between those living in villages with more or fewer than 2000 inhabitants. CONCLUSIONS: The prevalence of GL amongst the child population of ZBS in the eastern part of the province of Avila is 4.4% which figure accords closely with those found in similar studies.

[Impact of consensus conferences held in Spain]. / Aproximación al impacto de las conferencias de consenso celebradas en España.

OBJECTIVE: To show the impact of these consensus meetings on health-workers. DESIGN: A descriptive study using a postal survey. SITE. The Province of Avila. PATIENTS OR OTHERS PARTICIPANTS: Registered doctors and nurses in the Province of Avila, in the month of March, 1991. MAIN MEASUREMENTS AND RESULTS: 19.2% of the doctors and 13% of the nurses answered the survey. The consensus meetings were known to 29.6% of the doctors and 13.5% of the nurses. Out of these, 70.3% of the doctors and 54.5% of the nurses refer to a modification in their behaviour. Nevertheless, the majority of the health-workers saw well-monitored hypertense patients monthly and believe that the entire population's level of cholesterol should be determined. This runs against the recommendations of the consensus meetings. There were no differences on this between those who knew of the meetings and those who did not. CONCLUSIONS: The results and recommendations of the consensus meetings were inadequately publicized. They have little or no effect on healthworkers' behaviour.

[An MMPI subscale for assessment alexithymia in duodenal ulcer patients]. / Una subescala del M.M.P.I. para la medida de la alexitimia en pacientes con E.U.D.

We measured the alexithymia by the Kleiger-Kinsman scale in 36 patients with D.U.D. We employed 34 patients with irritables Bowel Syndrome and 30 patients with chronic organic pathologia as control groups. Our results show two possible conclusions: 1) The absence alexithymia's specificity in our ulcerous patients and/or the incapacity of this M.M.P.I.'s subescale to discriminate this feature in the psichosomatic diseases.

[Measurement of aggressiveness and its direction in patients with duodenal ulcer. A double-control study]. / La medida de la agresividad y su dirección en pacientes con ulcus duodenal. Un estudio de doble control.

We measure aggressivity in 36 patients with DUD (duodenal ulcer disease). We use two control groups as sample: normal population and other group of chronic organic pathologies. The results denote that the autoaggression-inhibition factor is the best discriminate variable to our group of duodenal ulcer patients of both sexes.

[Dynamic demography from 1900 to 1985 in Aldeavieja (Avila)]. / Demografía dinámica desde 1900 a 1985 en Aldeavieja (Avila).

The dynamic demography of the village of Aldeavieja (Avila) from 1900 to 1985 was evaluated with several indicators. A reduction in mortality rate was found, stabilizing around 10% since 1950, with a greater reduction in mortality rates in children. From 1900 to 1985 the Swarop index rose from 34.55% to 92.86%, and life expectancy from 30.13 to 77.5 years. The most common causes of death were infectious diseases during the first decades of the period, being now replaced by tumors and chronic diseases. There was a great demographic loss and the population became older (17.59% are now older than 65 years). It was concluded that a knowledge of dynamic demography is needed for a rational planning and an adequate resource allocation based on needs.