Reproductive Health Practices in Spanish Women Who Underwent Voluntary Termination of Pregnancy.

Background: The incidence of Voluntary Termination of Pregnancy (VTP) is an important indicator of unplanned pregnancies and the differences in the functioning of contraceptive services and the effectiveness of their use. Its analysis is essential for monitoring the well-being of women and their partners. Our aim was to analyse the socio-demographic profile of women who request voluntary termination of pregnancy in the province of Salamanca, as well as their satisfaction with the intervention and its influence on their contraceptive methods. Methods: An intervention study (before-after) designed without a control group, including all women requesting a voluntary termination of pregnancy through the Salamanca Public Health System. Socio-demographic and reproductive health variables were used. After the termination of pregnancy, a satisfaction survey and analysis of consequences were carried out. Results: A total of 176 surveys were obtained. Women who underwent VTP in Salamanca were between 20 and 25 years old, had secondary education but were still studying or working, lived alone and had no children. The most commonly used contraceptive method was the condom (55%), followed by the pill (25%). The most frequent reason for termination of pregnancy was economic (47.7%). The abortion entailed a significant change in contraception. Whereas before the abortion only 34% used a hormonal method, 66% were willing to use one afterwards (p = 0.006). Conclusion: Reproductive health education needs to be improved so that couples use reliable contraceptive methods appropriately. Although women are generally satisfied with the care received during abortion, they would prefer better accessibility to the procedure and more comprehensive information about the process from a neutral stance.

[Has sexuality changed in pregnancy? Baby boom generation versus millennial generation]. / ¿Ha variado la sexualidad en el embarazo? Generación baby boom versus generación millennial.

Sexuality is a complex and multidimensional phenomenon that constitutes a fundamental component in human relationships. Pregnancy is a crucial period in women's life and the physiological changes that happen in this period affect their sexuality. OBJECTIVE: Knowing how pregnancy impacts on sexual behaviors in millenial generation compared to baby boom generation. MATERIAL AND METHODS: Descriptive and cross-sectional study, by means of a self-completed, population-based survey, to a sample of pregnant women in the third trimester of gestation who attended Primary Care. A descriptive study of the frequency distribution of all the variables was carried out. RESULTS: In baby boom generation and millennial generation, it is observed that during pregnancy couple's attraction decreases slightly. According to variables desire and frequency of intercourse, results obtained show that as the pregnancy progresses there is a marked decrease in desire and intercourse frequency. Women state that they do not have enough information about sexuality in their current state, despite years having passed. CONCLUSIONS: During last 35 years, sexual behaviors have not changed in pregnant women. In both generations, changes in desire and intercourse domains were particularly significant, being in third trimester of pregnancy when frequency of intercourse decline. Pregnant women continue to hold erroneous beliefs about sexuality and request more sexual education.

¿Ha variado la sexualidad en el embarazo? Generación baby boom versus generación millennial / Has sexuality changed in pregnancy? Baby boom generation versus millennial generation

La sexualidad es un fenómeno complejo y multidimensional que constituye un componente fundamental en las relaciones humanas. El embarazo es un periodo crucial en la vida de las mujeres y los cambios fisiológicos que ocurren durante este periodo inciden en su sexualidad. Objetivo: Conocer qué impacto produce la gestación en las conductas sexuales en la generación millennial comparado con la generación baby boom. Material y métodos: Estudio descriptivo y transversal, mediante encuesta autocumplimentada, de base poblacional, a una muestra de mujeres embarazadas en el tercer trimestre de gestación que acudían a una consulta del equipo de atención primaria. Se realizó un estudio descriptivo de distribución de frecuencias de todas las variables. Resultados: Tanto en la generación baby boom como en la generación millennial se observa que durante el embarazo la atracción por la pareja disminuye ligeramente. En las variables deseo y frecuencia de coito los resultados obtenidos muestran que a medida que progresa el embarazo hay una disminución marcada del deseo y la frecuencia coital. Las mujeres manifiestan que no tienen suficiente información sobre la sexualidad en su estado actual, a pesar de los años transcurridos. Conclusión: Las conductas sexuales en las mujeres embarazadas no han cambiado en los últimos 35 años. Los cambios observados en ambas generaciones, en los dominios deseo y coito, fueron particularmente notables, siendo en el tercer trimestre de embarazo cuando más decae la frecuentación del coito. Las gestantes siguen manteniendo creencias erróneas acerca de la sexualidad y solicitan más educación sexual (AU)

Sexuality is a complex and multidimensional phenomenon that constitutes a fundamental component in human relationships. Pregnancy is a crucial period in women's life and the physiological changes that happen in this period affect their sexuality. Objective: Knowing how pregnancy impacts on sexual behaviors in millenial generation compared to baby boom generation. Material and methods: Descriptive and cross-sectional study, by means of a self-completed, population-based survey, to a sample of pregnant women in the third trimester of gestation who attended Primary Care. A descriptive study of the frequency distribution of all the variables was carried out. Results: In baby boom generation and millennial generation, it is observed that during pregnancy couple's attraction decreases slightly. According to variables desire and frequency of intercourse, results obtained show that as the pregnancy progresses there is a marked decrease in desire and intercourse frequency. Women state that they do not have enough information about sexuality in their current state, despite years having passed. Conclusions: During last 35 years, sexual behaviors have not changed in pregnant women. In both generations, changes in desire and intercourse domains were particularly significant, being in third trimester of pregnancy when frequency of intercourse decline. Pregnant women continue to hold erroneous beliefs about sexuality and request more sexual education (AU)

Real-life experience of hepatitis C treatment in a Spanish prison.

OBJECTIVE: Hepatitis C virus (HCV) infection is a major public health problem that causes multiple comorbidities. People in prisons who inject intravenous drugs are at increased risk of HCV infection, and HCV infection is 15-fold more prevalent among prisoners compared with the community. The objective of this study was to analyse the clinical and epidemiological characteristics of residents of a Spanish prison with HCV infection who received antiviral treatment. METHODS: An observational, descriptive and retrospective study was performed. All patients with HCV infection diagnosed or followed up in an Infectious Diseases attached to a penitentiary were included in this study. RESULTS: Of 81 patients analysed, sixty-nine (83.1%) patients were male. The mean age was 50.1 (SD8.8) years, and 70% of the inmates had a history of injection drug use. Coinfection with HIV was detected in 30%. In up to 25% of the sample, there were data on chronic liver disease in the degree of liver cirrhosis. The diagnosis of HCV infection had been made more than 15 years earlier in 28% of those studied. Decompensations from liver disease, hepatocellular carcinoma, or hospital admissions were exceptional. Most of the inmates with HCV accepted treatment, and approximately 94% of the patients who completed treatment achieved a sustained virological response without interactions or complications of interest. CONCLUSIONS: The availability of direct-acting antivirals and their exceptional side effects constitute an opportunity to reduce the burden of HCV infection in Spain, particularly in these high-risk populations.

Satisfacción del paciente como indicador de calidad en salud mental / Patient satisfaction as a quality indicator in mental health

Objetivo. Mejorar la calidad asistencial de un hospital de salud mental e identificar el grado de satisfacción del paciente. Material y método. Se ha llevado a cabo un estudio descriptivo, longitudinal y retrospectivo, en 666 pacientes que finalizaron su tratamiento en el Hospital de día de Salud Mental del Área de Salud de Salamanca, durante el período comprendido entre 1994 a 2012, a partir de las memorias anuales de gestión del hospital. El instrumento de medida utilizado ha sido un cuestionario diseñado al efecto. Resultados. La mayoría de los pacientes valoró satisfactoriamente aspectos como la impresión general del tratamiento (90% opinó «bueno/bastante bueno») y percepción de sentirse ayudado (94% percibió «muy/bastante ayudado»). El 83% consideró que el hospital es accesible. En relación con la empatía-comprensión, destacar que un 14% se sentía descontento. Un 18% de los pacientes esperaba poder curarse por completo. El 83% de los pacientes que acabó su tratamiento había logrado, según su opinión, que los síntomas remitieran «mucho o bastante». Respecto al conocimiento que tras el tratamiento tenían sobre su enfermedad, el 30% cree que han avanzado 'mucho'. Conclusiones. Basándonos en las percepciones referidas por los pacientes se puede afirmar que, en general, el nivel de satisfacción de los usuarios del Hospital de día de Salud Mental es alto. La evaluación de la calidad a través de la opinión del usuario ayuda al control de la calidad, considerando que la satisfacción del paciente es un buen indicador de resultado de la asistencia recibida a lo largo de su hospitalización (AU)

Objective. To improve the quality of care in a Mental Health Hospital and identify the level of patient satisfaction. Material and method. A descriptive, longitudinal, and retrospective study was conducted on 666 patients who completed treatment in the Mental Health Day Hospital of Salamanca, during the period 1994-2012, using the Hospital Management Annual Reports. A questionnaire designed for this purpose was used as the measurement tool. Results. Most of the patients satisfactorily valued aspects, such as the general impression of the treatment (90% said «good/fairly good») and perception of being helped (94% perceived «very/fairly helped»); with 83% believing that the hospital is accessible. As regards empathy-understanding, it was noted that 14% feel discontent. While 18% of patients expected to be completely cured, the 83% of patients that finished their treatment have said that, in their opinion, the symptoms have subsided «very or somewhat». As regards the knowledge that they have about their disease, 30% believe it has advanced 'a lot.' Conclusions. Based on the perceptions reported by patients, it may be said that in general, the level of user satisfaction in the Mental Health Day Hospital is high. Assessing quality through the user opinions helps control the quality, considering that patient satisfaction is a good indicator of result of the care received during their hospitalisation (AU)

Acquisition of Competencies by Medical Students in Neurological Emergency Simulation Environments Using High Fidelity Patient Simulators.

The training of medical students demands practice of skills in scenarios as close as possible to real ones that on one hand ensure acquisition of competencies, and on the other, avoid putting patients at risk. This study shows the practicality of using high definition mannequins (SimMan 3G) in scenarios of first attention in neurological emergencies so that medical students at the Faculty of Medicine of the University of Salamanca could acquire specific and transversal competencies. The repetition of activities in simulation environments significantly facilitates the acquisition of competencies by groups of students (p < 00.5). The greatest achievements refer to skills whereas the competencies that demand greater integration of knowledge seem to need more time or new sessions. This is what happens with the competencies related to the initial diagnosis, the requesting of tests and therapeutic approaches, which demand greater theoretical knowledge.

[Patient satisfaction as a quality indicator in mental health]. / Satisfacción del paciente como indicador de calidad en salud mental.

OBJECTIVE: To improve the quality of care in a Mental Health Hospital and identify the level of patient satisfaction. MATERIAL AND METHOD: A descriptive, longitudinal, and retrospective study was conducted on 666 patients who completed treatment in the Mental Health Day Hospital of Salamanca, during the period 1994-2012, using the Hospital Management Annual Reports. A questionnaire designed for this purpose was used as the measurement tool. RESULTS: Most of the patients satisfactorily valued aspects, such as the general impression of the treatment (90% said «good/fairly good¼) and perception of being helped (94% perceived «very/fairly helped¼); with 83% believing that the hospital is accessible. As regards empathy-understanding, it was noted that 14% feel discontent. While 18% of patients expected to be completely cured, the 83% of patients that finished their treatment have said that, in their opinion, the symptoms have subsided «very or somewhat¼. As regards the knowledge that they have about their disease, 30% believe it has advanced «a lot.¼ CONCLUSIONS: Based on the perceptions reported by patients, it may be said that in general, the level of user satisfaction in the Mental Health Day Hospital is high. Assessing quality through the user opinions helps control the quality, considering that patient satisfaction is a good indicator of result of the care received during their hospitalisation.

Efectividad del electromiografía- biofeedback en la incontinencia fecal y la calidad de vida / Effectiveness of electromyography-biofeedback in improving fecal incontinence and quality of life

Introducción. La incontinencia fecal (IF) supone un problema clínico y social que afecta la calidad de vida (CV). Su tratamiento de elección es conservador, y el biofeedback el más recomendado. Objetivo. Conocer las variables clínicas/epidemiológicas asociadas con la IF y valorar la efectividad de un protocolo de tratamiento de electromiografía-biofeedback (EMG-BFB) con electrodos de superficie en la mejora de la CV. Material y métodos. Estudio prospectivo tipo antes/después en 31 pacientes con IF remitidos al Servicio de Rehabilitación de Salamanca entre 2008 y 2014. El tratamiento consistió en 20 sesiones de EMG-BFB bisemanales supervisadas por fisioterapeuta. Se realizó una valoración clínica y de la CV inicial/final con la escala/cuestionario de Wexner/FIQLS. Resultados. Edad media 53 años, género femenino 90,3% (ratio mujer/hombre 9:1). Los factores de riesgo más frecuentes son: historia obstétrica de embarazo/parto (80,6%), distocia (35,5%) y episiotomía (9,7%, p = 0,000). Lesión de esfínteres (38,7%). Prolapso de órganos pélvicos (35,5%, p = 0,000). Enfermedad del tejido conectivo (19,4%, p = 0,05). Cirugía urológica (12,9%, p = 0,000) y colorrectal (16,1%, p = 0,000). Neoplasia asociadas: cérvix/útero (12,9%, p = 0,000), colon (6,5%, p = 0,026 antes, p = 0,082 después). IF grave (67,75%), doble incontinencia (fecal y urinaria) (61,3%). La EMG-BFB mejora la CV significativamente en la escala Wexner y el Cuestionario FIQLS (p < 0,05). Conclusiones. La IF aumenta con la edad, prevalece en mujeres y se asocia fundamentalmente a historia obstétrica de embarazo/parto. Se asocia significativamente con la episiotomía, enfermedades del tejido conectivo, cirugía urológica/colorrectal, neoplasias de cérvix/útero/colon y prolapso de órganos pélvicos. La EMG-BFB constituye una técnica efectiva de tratamiento en los pacientes con IF, al mejorar la clínica y todos los componentes de CV del cuestionario/escala FIQLS/Wexner (AU)

Introduction. Fecal incontinence (FI) is a clinical and social problem that affects health-related quality of life (QoL). The treatment of choice is conservative, with biofeedback being the most widely recommended. Objective. To determine the clinical/epidemiological variables related to FI and to assess the effectiveness of biofeedback with surface electrodes (EMG-BFB) in improving QoL in FI patients. Material and methods. A quasi-experimental prospective before/after FI study was conducted in 31 patients referred to the Rehabilitation Service of Salamanca between 2008 and 2014. The intervention consisted of 20 sessions of EMG-BFB twice weekly, supervised by a physiotherapist. Clinical and before and after QoL assessment was performed with the Wexner/FIQLS scale/questionnaire. Results. The mean age was 53 years, and 90.3% were women (female/male ratio, 9:1). Risk factors were an obstetric history of pregnancy/delivery (80.6%), dystocia (35.5%) and episiotomy (9.7%, P = .000), sphincter injury (38.7%), pelvic organ prolapse (35.5%, P = .000), connective tissue disease (19.4%, P = .05), colorectal (16.1%, P = .000) and urological (12.9%, P = .000) surgery. Associated neoplasms consisted of tumors of the cervix/uterus (12.9%, P = .000) and colon (6.5%, P = .026/P = .082). Severe FI was found in 67.75%, and double incontinence (fecal and urinary) in 61.3%. EMG-BFB significantly improved QoL in the Wexner/FIQLS Scale/Questionnaire (P < .05). Conclusions. FI increases with age, is prevalent in women, and is associated specially with an obstetric history of pregnancy/delivery. FI is significantly associated with episiotomy, connective tissue disease, urological and colorectal surgery, neoplasms of the colon, uterus and cervix, and pelvic organ prolapse. EMG-BFB is effective in improving clinical symptoms and all components of QoL in patients with FI (AU)

Is cystic echinoccocosis re-emerging in western Spain?

Cystic echinococcosis (CE) remains an important health problem in many areas of the world, including the Mediterranean region. We performed a retrospective study of cases reported from 1998 to 2012 in order to review and update the epidemiology of this disease in a highly endemic area situated in western Spain. A total of 471 patients were diagnosed with hydatid disease. Of these cases, 55·8% were male, with an average age of 62·3 ± 19·5 years. More importantly, 1·5% of patients were children, and 20·5% were aged <45 years. An active therapeutic approach was implemented for 92·6% of the CE patients with primary diagnoses; however, a 'watch and wait' strategy was used in 59·3% of all secondary CE diagnoses. The incidence rate of hydatid disease was significantly higher compared to the incidence described in the Notifiable Disease System in this area. Furthermore, a significant decrease in hydatid incidence during the years included in the study was observed (ß = -0·4357, P < 0·001). CE incidence has diminished in recent years, although active transmission remains in paediatric cases. Additionally, CE incidence remains high in our region despite public health plans for its control. The documented incidence of CE disease clearly underestimates the real numbers.

Influencia de la formación impartida en las Facultades de Medicina en las aptitudes y actitudes de sus alumnos en tabaquismo / Influence of training given in the medical schools in the appitudes and attitudes of their students regarding the smoking habit

Objetivo. Conocer aptitudes y actitudes sobre el tabaquismo en alumnos de Medicina y valorar la formación adquirida. Métodos. Estudio transversal realizado a estudiantes de medicina durante el curso 2010-2011 utilizando un cuestionario validado, anónimo y autoaplicado. Resultados. El 36% fuman: el 18,7% los fines de semana y el 17,3% a diario, con un consumo medio de 2,08 cigarrillos/día. Han intentado dejar de fumar el 29,3% de los fumadores y desean hacerlo el 28,3% de los alumnos fumadores. Existen diferencias significativas entre los alumnos de primero y sexto en la valoración del tabaquismo como drogodependencia y enfermedad crónica y también en el conocimiento de las enfermedades relacionadas con el tabaco (p< 0,005). El análisis bivariante y multivariante indican que la mayor formación de los alumnos de sexto se relaciona significativamente con un mayor conocimiento de las enfermedades asociadas al tabaco. En relación con el diagnóstico y tratamiento, existen diferencias significativas entre los alumnos de primero y sexto en todos los ítems (p< 0,005). Las tres variables asociadas con los conocimientos adquiridos son la capacidad de recoger en la historia el consumo de tabaco, el conocimiento de los métodos de diagnóstico y del tratamiento multicomponente. Conclusiones. Los resultados muestran que a mayor conocimiento, se asocia mayor competencia profesional en la cumplimentación de la historia clínica y mayor capacidad de intervención (AU)

Objective. To study aptitudes and attitudes with regard to smoking in medical students and evaluate the education received throughout the course of the academic studies. Methods. A cross-sectional study of medical students during the academic year of 2010-2011 using a validated questionnaire, anonymous and completed individually. Results. 36% smoke: 18.7% on weekends and 17.3% daily, with an average consumption of 2.08 cigarettes/ day. 29.3% of smokers have tried to quit smoking and 28.3% of students wish to quit smoking. There are significant differences between students ofthe first and the sixth year in the valuation of smoking and the related drug dependence and also in the knowledge of diseases related to tobacco (p <0.005). The bivariate and multivariate analyses indicate that the higher level of professional education of the 6th year students is significantly related to greater knowledge of the diseases associated with smoking. With regard to diagnosis and treatment there are significant differences between students of the first and the sixth year on all items (p <0.005). The three variables associated with the acquired knowledge consist of the ability to collect data related to smoking in the anamnesis, knowledge of methods of diagnosis and tobacco treatment. Conclusions. The results show that the greater knowledge is associated with greater professional expertise in the completion of the clinical history and greater knowledge of medical intervention (AU)

[Lung cancer: how does it appear in our hospital?]. / Cáncer de pulmón: ¿cómo se presenta en nuestra consulta?

INTRODUCTION: Lung cancer is the most frequently diagnosed tumor in industrialized countries and that which causes the largest number of deaths. The aim of this study is to know the relevant clinical and epidemiological characteristics of lung cancer in the Health Care Area of Salamanca. PATIENTS AND METHODS: A cross-sectional descriptive epidemiological study conducted in 140 patients, in the Rapid Diagnosis of Lung Cancer Pneumology Department of the University Hospital of Salamanca. RESULTS: The percentage of men diagnosed is greater than for to women: 126 (90%) were men and 14 (10%) women. Ninety percent had had an active contact with the tobacco. The percentage of men who were ex-smokers is greater than that of those who smoke, there being a rate of packages per year in both groups at the time of diagnosis. Women continue to be mostly non-smokers, although there is a progressive increase of active smokers. The most frequent clinical manifestation on diagnosis is chest pain (36.4%), 46.4% of the patients having symptoms of the constitutional syndrome. The most frequent histological type among men is squamous cell carcinoma (35.7%), and among women adenocarcinoma (50%), the significant relationship (p < 0.05) between the histological stain and the principal risk factor, that is tobacco, standing out. CONCLUSIONS: The known tobacco-lung cancer relationship, corroborated in this study, makes it necessary to have a more effective fight against tobacco to reduce the incidence of lung cancer. It is also necessary to develop multidisciplinary protocols that help early diagnosis and make it possible to increase the percentage of curative treatments.

Cáncer de pulmón: ¿cómo se presenta en nuestra consulta? / Lung cancer: since it appears in our hospital?

Introducción. El cáncer de pulmón es el tumor diagnosticado más frecuente en países industrializados y el que origina mayor número de muertes. El objetivo de este estudio es conocer las características clínico-epidemiológicas relevantes del cáncer de pulmón en el Área de Salud de Salamanca. Pacientes y método. Estudio epidemiológico descriptivo —transversal— llevado a cabo a140 pacientes en la consulta de Diagnóstico Rápido de Cáncer de Pulmón del servicio de Neumología del Hospital Universitario de Salamanca. Resultados. El porcentaje de hombres diagnosticados es superior al de mujeres: 126(90%) hombres frente a 14 (10%) mujeres. El 90% ha tenido contacto de forma activa con el tabaco. El porcentaje de hombres ex fumadores sobrepasa al de fumadores, acumulando ambos grupos un elevado índice-paquetes-año en el momento del diagnóstico. Las mujeres siguen siendo mayoritariamente no fumadoras, aunque con un aumento progresivo de fumadoras activas. La manifestación clínica lo corregional más frecuente en el momento del diagnóstico es el dolor torácico (36,4%); un 46,4% de los pacientes presentaban clínica de síndrome constitucional. El tipo histológico más frecuente entre los hombres es el carcinoma epidermoide(35,7%); entre las mujeres, el adenocarcinoma (50%). Cabe destacar la relación significativa (p < 0,05) entre la estirpe histológica y el principal factor de riesgo: el tabaco. Conclusiones. La conocida relación tabaco-cáncer de pulmón, corroborada en este estudio, hace necesaria una lucha más eficaz y efectiva para reducir la incidencia de esta enfermedad; así como, el desarrollo de protocolos multidisciplinares que ayuden al diagnóstico precoz y permitan aumentar el porcentaje de tratamientos curativos (AU)

Introduction. Lung cancer is the most frequently diagnosed tumor in industrialized countries and that which causes the largest number of deaths. The aim of this study is to know the relevant clinical and epidemiological characteristics of lung cancer in the Health Care Area of Salamanca. Patients and methods. A cross-sectional descriptive epidemiological study conducted in140 patients, in the Rapid Diagnosis of Lung Cancer Pneumology Department of the University Hospital of Salamanca. Results. The percentage of men diagnosed is greater than for to women: 126 (90%) were men and 14 (10%) women. Ninety percent had had an active contact with the tobacco. The percentage of men who were ex-smokers is greater than that of those who smoke, there being a rate of packages per year in both groups at the time of diagnosis. Women continue to be mostly non-smokers, although there is a progressive increase of activesmokers. The most frequent clinical manifestation on diagnosis is chest pain (36.4%), 46.4% of the patients having symptoms of the constitutional syndrome. The most frequent histological type among men is squamous cell carcinoma (35.7%), and among women adenocarcinoma(50%), the significant relationship (p < 0.05) between the histological stain and the principal risk factor, that is tobacco, standing out. Conclusions. The known tobacco-lung cancer relationship, corroborated in this study, makes it necessary to have a more effective fight against tobacco to reduce the incidence f lung cancer. It is also necessary to develop multidisciplinary protocols that help early diagnosis and make it possible to increase the percentage of curative treatments (AU)

Medidas de frecuencia, asociación e impacto en investigación aplicada / No disponible

En la Sociedad actual del conocimiento y la información es preciso disponer de herramientas básicas para medir los fenómenos epidemiológicos como la enfermedad, la incapacidad o la siniestralidad laboral. Las formas de medir son instrumentos que se deben conocer y aplicar para planificar y tomar decisiones en Salud Pública y en Salud Laboral. El objetivo de este artículo es dar a conocer las principales medidas de frecuencia, asociación e impacto utilizadas en investigación aplicada, clínica o de Salud Pública para tratar de medir, valorar y estimar la importancia de los problemas de salud y enfermedades de relacionadas con el trabajo, de los factores de riesgo ocupacionales y otros eventos relacionados con la seguridad e higiene en el trabajo y, en definitiva, con la Salud de los trabajadores. Se describen los conceptos teóricos de las formas de medir en epidemiología, su interpretación y aplicación práctica de los indicadores básicos utilizados en la práctica habitual de los profesionales de las Ciencias de la Salud. Su utilidad fundamental es poder disponer de una información objetiva, fiable y precisa que permita tomar decisiones adecuadas y pertinentes en relación con la prevención, seguridad laboral, atención y rehabilitación de los trabajadores

In the society's current knowledge and information is necessary to have basic tools to measure the epidemic phenomena such as illness, disability or workplace accidents. The ways of measuring are instruments that they must know and apply to plan and take decisions on Public Health and Labour/Occupational Health. The aim of this article is to inform about the most important measures of frequency, association and impact used in applied research, clinical or Public Health to try to measure, to value and estimate the importance of health problems and diseases related work. The occupational risk factors and other events related to safety and healthy working conditions and ultimately with Workers 'Health. We describe the theoretical concepts of ways to measure in epidemiology, their interpretation and practical application of basic indicators used in the practice of professionals in the Health Sciences. Its usefulness is essential to have an objective, reliable and precise information to make sound decisions and allow relevant to the prevention, labour/occupational safety, care and rehabilitation of the workers

[Health-related quality of life in Spanish women with osteoporosis]. / Qualidade de vida relacionada à saúde em espanholas com osteoporose.

OBJECTIVE: To analyze the health-related quality of life in patients with osteoporosis and to compare it with the overall population. METHODS: A cross-sectional descriptive study was carried out with 60 female patients of the rheumatology service at a university hospital, in Spain, from April to October 2003. The Short Form-36 (SF-36) questionnaire was applied in order to obtain demographic data, clinical characteristics and data about lifestyles related to health. Patients were classified in age groups. The statistics tests performed were Chi-square, general linear model, Student's t-test. RESULTS: The interviewees' average age was 65.57 years old (SD: +/- 9.7 years), and average time interval for diagnosis was 3.4 +/- 2.84 years. The best scores were in social functioning (89), emotional aspects (72.2), mental health (63), and vitality (53.7). The lowest scores were in general health (45.1), physical capacity (47.7), pain (52.3) and physical aspects (59.9). The patients' average scores were lower than the general Spanish population's scores in the following dimensions: functional capacity, physical aspects, pain and overall health status. The greatest differences between the average SF-36 scores for patients and for the overall Spanish population were in the age group ranging from 55 to 64 years old. Scores were lower or similar to the general Spanish population in all other dimensions of the questionnaire. No significant associations were found between the dimensions of the SF-36 contemplated in this study and the clinical, demographic and lifestyle data. CONCLUSIONS: The patients presented bad quality of life, particularly with respect to those dimensions that are most relevant with respect to osteoporosis, when compared with the overall Spanish population. The physical dimensions were the ones most affected.

Qualidade de vida relacionada à saúde em espanholas com osteoporose / Health-related quality of life in Spanish women with osteoporosis

OBJETIVO: Analisar a qualidade de vida relacionada à saúde de pacientes com osteoporose e compará-la com a população geral. MÉTODOS: Foi realizado um estudo descritivo transversal com 60 pacientes do sexo feminino no serviço de reumatologia de um hospital universitário na Espanha, de abril a outubro de 2003. Foi aplicado o questionário Short Form-36, abordando dados demográficos, características clínicas e dados sobre estilos de vida relacionados à saúde. As pacientes foram classificadas em grupos etários. Foram utilizados os seguintes testes estatísticos: qui-quadrado, modelo linear geral, t de Student. RESULTADOS: As entrevistadas tinham idade média de 65,57 (DP: ±9,7 anos), e tempo de diagnóstico médio de 3,4±2,84 anos. As melhores pontuações foram obtidas nas dimensões aspectos sociais (89), aspectos emocionais (72,2) e saúde mental (63). As mais baixas foram em estado geral de saúde (45,1), capacidade funcional (47,7), dor (52,3) e aspectos físicos (59,9). As pontuações médias dos pacientes resultaram inferiores às pontuações conhecidas da população geral espanhola nas dimensões capacidade funcional, aspectos físicos, dor e estado geral de saúde. As máximas diferenças entre as pontuações médias do SF-36 dos pacientes e os valores populacionais espanhóis correspondem ao grupo de idade de 55 a 64 anos. Nas demais dimensões do SF-36, as pontuações foram inferiores ou similares aos valores populacionais espanhóis. Não se encontraram associações significativas entre as dimensões do SF-36 estudadas e os dados clínicos, demográficos e de estilos de vida analisados. CONCLUSÕES: Os pacientes apresentaram baixa qualidade de vida, sobretudo nas dimensões mais relevantes da enfermidade, quando comparada com valores da população espanhola em geral. As áreas físicas foram as mais afetadas.

Incumplimiento en pacientes en tratamiento por depresión / Non adherence to treatment in depressive patients

Objetivo: Identificar variables clínicas y sociodemográficas asociadas al incumplimiento terapéutico en enfermos depresivos Material y método: Estudio descriptivo transversal mediante encuesta por entrevista personal a 134 pacientes que cumplen los criterios diagnósticos de la CIE 10 para trastornos del humor depresivos y que acuden a la consulta de Psiquiatría de un equipo de Salud Mental de Salamanca, durante los meses de marzo a noviembre de 2004. El instrumento de medida es un cuestionario que incluye aspectos sociodemográficos, clínicos y adherencia al tratamiento. Resultados: De los 134 pacientes incluidos, 26 (19,4%) son hombres y 108 (80,6%) son mujeres. Media de edad 46,22 años. En el 33,6% (45) de los pacientes incluidos en el estudio se produce incumplimiento. Conclusión: A mayor gravedad de la enfermedad depresiva, mayor incumplimiento del tratamiento. La ausencia de cambios y/o el empeoramiento, está relacionado con el incumplimiento. La propia sintomatología depresiva parece interferir en el propio cumplimiento

Objective: To identify clinical and social-demographic variables associated to the therapeutical non-adherence in depressive patients. Methodology and material: Descriptive transversal study through personal interviews to 134 patients that follow the CIE 10 criteria for depressive disorders that were treated by psychiatrists in Salamanca’s Mental Health Unit from March to November 2004. A questionnaire including adherence to the treatment, social-demographic, and clinical issues is used as a measurement tool. Results: Out of the 134 patients, 26 (19.4%) are male and 108 (80.6%) female. The average age is 46.22. 33.6% of the total non-adherent to the treatment. Conclusion: The greater the depressive illness the higher the non-adherence to the treatment. The absence of changes and/or the increase in the severity of the illness is related to the non-adherence of the treatment. The depressive clinic seems to interfere in the adherence to the treatment

Nivel socio-sanitario de las personas adultas con discapacidad intelectual de Salamanca / Social-health level of adults with mental handicaps in the city and province of Salamanca (Spain)

Introducción: El objetivo del estudio es valorar el nivel sociosanitario de las personas adultas con discapacidad intelectual de Salamanca y provincia. Material y método: Se realiza un estudio transversal a traves de un cuestionario de 65 preguntas sobre variables sociodemográficas, estilos de vida, morbilidad aguda y crónica y calidad de vida relacionada con la Salud. Se realizan un total de 265 encuestas por entrevista personal a las personas con discapacidad y us familias. Resultados: El total de personas estudiadas fue de 265,185 hombres (69,8%) y 80 mujeres (30,2%) con una edad media de 35 años. El 84% (IC95%, 84+-4) de los padres y el 88% (IC95%,+-884) de las madres no tienen estudios o estudios primarios y sólo el 8% (IC95%, 41,5+-6) de los discapacitados intelectuales refieren que su salud percibida es buena y el 26% (IC95%, 26+-5) muy buena. El 59,6%(158) padece enfermedad y el 45,7%(121) recibe tratamiento habitual. Las enfermedades más frecuentes asociadas son: enfermedades articulares, enferemedad del sistema nervioso central e hipertensión arterial. Respecto a la utilización de servicios sanitarios, existe una demanda alta de consulta médica y una muy baja de consulta al dentista. Conclusion: El nivel socioeconómico de los discapacitados y sus familias es bajo o muy bajo. Se evidencia la existencia de morbilidad asociada a discapacidad intelectual con una alta prevalencia de enfermedades osteomusculares y neurológicas. La demanda de consulta médica es alta y la consulta al dentista es baja; ambas se asocian estadísticamente al bajo nivel socioeconómico de las familias del discapacitado

Introduction: The aim of the present study was to assess the social-health status of adults with mental handicaps in the city and province of Salamanca (Spain). Material and Methods: A transverse study was made using a questionnaire containing 65 items concerning socio-demographic variables, life-styles, acute and chronic morbidity, and quality of life as related to health. A total of 265 questionnaires were collected from personal interviews with people with mental handicapand their families. Results: The total number of subjects studied was 265, 185 men (69.8%) and 80 women (30.2%) with a mean age of 35 years. 84% (IC95%, 84±4) of the fathers and 88% (IC95% 88±4) of the mothers had no studies in primary education and only 8% (IC95% 8±3) and 4% (IC95% 4±2) had university level studies. 41.5% (IC95% 41.5±6) of the subjects with mental handicap reported their health to be good and 26% (IC95% 26±5) reported having very good health. 59.6% (158) hadillness and 45.7% (121) received treatment on a routine basis. The most frequent associated illnesses were: joint disease, CNS disease and arterial hypertension. Regarding the use of the health services, there was a high demand for medical consultations and a very low demand for dentistry. Conclusion: The socio-economic level of the subjects and their families is lowor very low. The mental handicap of the subjects is associated with morbidity, with a high prevalence of osteomuscular and neurological disease. The demand for medical attention is high but there is little demand for dental services; statistically, both are associated with the low socio-economic levels of the families of the handicapped subjects

Utilización del Appropriateness Evaluation Protocol en la evaluación del sobreuso de la hospitalización. Réplica

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Estimación de ingresos y estancias inadecuadas en un hospital comarcal / Admission estimation and inappropriate stays in a district hospital

La utilización hospitalaria inadecuada definida como aquella que podría haberse realizado en un nivel asistencial inferior o en menor tiempo aumenta el gasto sanitario, crea ineficiencias en la gestión e influye en la calidad asistencial. El presente trabajo tiene como objetivo valorar la adecuación e inadecuación de los ingresos y estancias en un hospital comarcal de agudos, así como las causas de dicha inadecuación. Material y métodos. Se trata de un estudio descriptivo de carácter retrospectivo basado en la revisión de historias clínicas pertenecientes a los pacientes que han necesitado hospitalización. Se seleccionó una muestra de 378 pacientes representativos de la hospitalización durante un período de 18 meses. Como instrumento de medida se utilizó el AEP (Appropriateness Evaluation Protocol), método sencillo que ha demostrado una elevada validez y fiabilidad para la identificación del uso hospitalario inadecuado. Resultados. El porcentaje de inadecuación de los ingresos hospitalarios detectado es del 13,8 por ciento, mientras que la inadecuación de las estancias hospitalarias fue del 33,9 por ciento. Por servicios clínicos, el porcentaje más alto de inadecuación se produce en Traumatología (43 por ciento). Las causas de inadecuación de los ingresos se relacionan con la necesidad de institucionalización; pero a un nivel inferior, las pruebas diagnósticas y/o tratamiento pueden realizarse en consultas externas y admisión prematura. Para las estancias, las causas más frecuentes son: no dar el alta rápidamente, estar pendiente de resultados de pruebas diagnósticas y que cualquier procedimiento diagnóstico y/o tratamiento necesario puede realizarse como paciente externo. Conclusión. El grado de inadecuación de los ingresos y de las estancias se encuentra en niveles similares al de otros hospitales de nuestro país con mayor complejidad asistencial. Las causas que intervienen en este fenómeno dependen de las decisiones del médico y de las condiciones sociosanitarias del Área (AU)