Características evolutivas de la incapacidad temporal en un centro de salud / Evolutive characteristics of temporary disability in a health care center

Introducción. El objetivo es valorar la evolución de la incapacidad temporal (IT) en un centro de salud (CS) urbano durante 12 años (1993-2004) mediante un estudio observacional retrospectivo de prevalencia. Pacientes y métodos. Las variables evaluadas son: sexo, duración IT, diagnóstico (según CIE-9), año de la IT y causa de alta obtenidas de los partes de IT registrados en tres consultas de un CS. Resultados: Se registraron 3.924 procesos (58,4% varones). La duración media de la IT es de 46,3 ± 99,4 días para varones y 54,2 ± 103,9 para mujeres (intervalo de confianza de diferencia 1,5-14,4). Para valorar la evolución se han considerado tres periodos: 1993-1996 (1.141 procesos), 19972000 (1.128 procesos), 2001-2004 (1.655 procesos). Los diagnósticos más frecuentes son los osteomusculares (30,6%), infecciosos (23%), trastornos mentales (7,9%) y digestivos (7,2%). Evolutivamente el porcentaje de las causas osteomusculares y digestivas se han mantenido, mientras que las infecciosas han descendido del 27 al 18% y las mentales han aumentado del 6,6 al 10,1%, duplicándose el número de días perdidos por esta causa, pasando de 7.642 días en el primer periodo a 15.686 en el tercero. Las causas osteomusculares son las que más días perdidos originan (76.009 días) seguidas de las mentales (31.147 días). El porcentaje de IT por población activa ha pasado de 19,8% en 1993 a 30,5% en 2004. Conclusiones: Se ha producido un aumento progresivo del porcentaje de IT con respecto a la población activa atendida. En los últimos años las IT por trastornos mentales han aumentado considerablemente, duplicándose el número de días perdidos por esta causa (AU)

Introduction: This study has aimed to assess the evolution of work disablement (WD) for an urban Primary Care Center (PCC) over 12 years (1993-2004) by means of an observational, retrospective study on prevalence. Patients and methods; Variables: Gender, WD duration, diagnosis (according to ICD-9), year of the WD, reason for discharge obtained from WD reports recorded in three doctor’s offices in the PCC mentioned. Results: We recorded 3,924 conditions (58.4% males). Average duration of the WD was 46.3 ± 99.4 days for males and 54.2 ± 103.9 for women (Confidence Interval difference varies from 1.5-14.4). Three periods were used to assess evolution: 1993-1996 (1,141 conditions), 1997-2000 (1,128 conditions), 2001-2004 (1.655 conditions). The most frequent diagnoses were osteomuscular (30.6%), infectious (23%), mental disorders (7.9%) and digestive disorders (7.2%). In regards to evolution, percentages of osteomuscular and digestive causes were maintained whereas the infectious ones decreased from 27% to 18% and the mental ones increased from 6.6% to 10.1%, the number of days lost due to this being double, ranging from 7,642 days in the 1st period to 15,686 in the 3rd one. The most work days lost were due to osteomuscular causes (76,009 days) followed by mental ones (31,147 days). The percentage of WD for the active population has increased considerably, going from 19.8% in 1993 to 30.5% in 2004. Conclusions: There has been a progressive increase in the percentage of WD due to mental disorders in the working population in recent years. WD due to mental disorders has increased considerably in recent years, the number of workdays lost due to it doubling (AU)

[Effectiveness of preventive activities at 8 years of their introduction in a general medicine practice in a health center]. / Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud.

OBJECTIVES: Main: to assess the change in coronary risk (CR) in adults after 8 years of their involvement in the Programme of Preventive Activities and Health Promotion (PAPPS). Secondary: to determine the level of anti-tetanus vaccination reached and patients' compliance with activities. DESIGN: "Before and after" intervention study without random allocation. SETTING: A general medical clinic at a health centre. PATIENTS: 429 patients (204 men, 225 women) between 30 and 65 monitored for 8 years, recruited by active search for cases at daily consultations. INTERVENTIONS: Blood pressure, cholesterol, weight, tobacco habit, alcohol intake, anti-tetanus vaccination state, CR calculation at 10 years on the Framingham scale, and degree of compliance with activities were all determined at the start, at 4 years and at 8 years. Data was obtained from the clinical notes. RESULTS: Total population: a 0.8 drop in CR (CI difference: 0.4-1.2), equivalent to 8.5% of the initial figure. 64.4% increase in correct anti-tetanus vaccination (CI difference: 59.9-69). Compliance with activities at the start and after eight years: pressure 100%, 71%; tobacco consumption 99.5%, 71%; cholesterol determination 89%, 64%. Initially high CR sub-group: 6.7 drop of CR at 8 years (CI difference: 4.9-8.5), equivalent to 24.8% of the initial figure. CONCLUSIONS: In the total population, the CR drop found was not clinically significant, whereas in the initially high CR sub-group the drop was. There should probably be an active search made for patients with high CR and action taken on them.

[Do we adequately use the sphygmomanometer for improving the prevention of arterial hypertension in primary care?]. / Utilizamos adecuadamente el esfigmomanómetro para mejorar la prevención de la hipertensión arterial en atención primaria?

OBJECTIVE: To assess the monitoring of arterial pressure (AP) in non-hypertensive patients at a health centre and to compare the results of two types of consultations. DESIGN: A retrospective observation study over 5 years. SETTING: Urban health care. PATIENTS: After the exclusion of hypertensive patients, 337 medical records, which were active over the period under assessment, were chosen by systematic sampling of the adult population. Consultation types were: CT1 (stable staff, MIR training, habitual development of the PAPPS); CT2 (staff not stable, training uneven, without systematic development of the PAPPS). Records were considered indicated when they contained symptoms suggestive of AHT or when AP had been measured because the patients had been included in a health programme; the rest of the records were considered not indicated. Data were analysed using the Chi-squared test. MEASUREMENTS AND RESULTS: 152 of the 337 records belonged to CT1 and 185 to CT2. In 151 records there was no measurement of AP: 50 belonging to CT1 and 101 to CT2. 508 measurements of AP were performed, 274 in CT1 and 234 in CT2. Of the 151 cases where measurements were not indicated (64 in CT1 and 87 in CT2. CONCLUSIONS: The percentage of patients without any monitoring is high (44.8%), similar to the percentage of AP measurements not indicated, which would imply the need to rationalise use of the sphygmomanometer in the consulting-room. CT1 consultations seem to have the most rational measurements of AP.