Comentario: Adolescentes, alcohol y atención primaria / Commentary: Adolescents, Alcohol, and Primary Care

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La detección del consumo de alcohol en atención primaria / Primary care detection of alcohol cosumption

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[Self care and risk factors of diabetic foot in patients with type II diabetes mellitus]. / Autocuidado y factores de riesgo de pie diabético en pacientes con diabetes mellitus tipo II.

OBJECTIVES: To find the amount of self-care (SC), health education (HE) received and the prevalence of risk factors for diabetic foot (RFDF) in patients with type II Diabetes Mellitus (DM) attended in Primary Care. DESIGN: A descriptive crossover study. SETTING: Primary Care Centre. PATIENTS: 100 DM patients attending over 2 months (May and June 1995) to see the doctor or collect prescriptions. MEASUREMENTS AND MAIN RESULTS: Questionnaire on HE, SC habits and social and demographic data, inspection of the feet and physical investigation of lower extremities. 36% had deficient or very deficient hygiene; 73% did not go regularly to the chiropodist, 76% used scissors, 75% did not check the inside of the shoe. 38% had signs of neuropathy and 17%, of peripheric vasculopathy. 25% were at high risk of diabetic foot. Women had more RFDF. CONCLUSIONS: The amount of self-care is very low, especially in hygiene, which did not improve over time. HE on foot care is extremely poor despite its being a priority. Educational interventions are required to motivate healthworkers and patients, especially those with most RFDF, in the area of SC.

[A multicenter primary care study on alcohol consumption]. / Estudio multicéntrico sobre el abordaje del consumo de alcohol en atención primaria.

OBJECTIVES: To find records of alcoholic drink consumption in general medical records and actions taken when at-risk drinkers were identified. DESIGN: A descriptive study using clinical auditing at 4 Health Centres. PARTICIPANTS: 399 Primary Care (PC) clinical records. MEASUREMENTS AND MAIN RESULTS: Only 24.8% of the clinical records included alcoholic drink consumption over the last two years. Only 11 (2.8%)-all for men-of the records examined fulfilled the criteria for the drinker being considered at-risk. Low recording of alcohol might be for different reasons: some related to the professionals, others to the internal organisation of the PC team, yet others due to the external support structure. Causes related to internal organisation and the professionals were considered priority, as it was harder to intervene from the team into external causes. CONCLUSIONS: The results show low recording of alcohol consumption and justify the design of specific interventions. The methodology of continual quality improvement helps us identify the causes, the possible solutions and to design the strategy for change.

[Anxiety and depression in type II diabetics]. / Ansiedad y depresión en pacientes diabéticos tipo II.

OBJECTIVES: To find the prevalence of depression and the level of anxiety in a group of patients with diabetes mellitus type II (DM); to compare the presence of psychiatric pathology with different variables and contrast the diabetic group's results with those of a group of non-diabetic patients. DESIGN: A comparative crossover study. SETTING: The Ronda Prim Health Centre, Mataró. PATIENTS AND OTHER PARTICIPANTS: The diabetics controlled of 4 of the 6 Basic Care Units (BCU) of our Centre. The comparison group consisted of 85 patients who attended the Centre of their own accord, matched for gender, age and BCU. The two groups did not differ as to socio-economic level, marital status and job. MEASUREMENTS AND MAIN RESULTS: Two self-applicable tests were given to all the patients: the Stai test to measure anxiety and the Beck one to determine depression. 27% of the diabetic patients had depression, as against 47% of those in the comparison group (p = 0.001). For the diabetic group, depression and anxiety level was found to have no relationship with the length of the DM's development, its treatment and chronic complications, the performance of self-analysis techniques and glycaemic control. CONCLUSIONS: The group of diabetics studied displayed a prevalence of psychiatric pathology very much lower than the control group. No statistically significant relationship was found between depression and anxiety levels, and different variables associated with DM.

[Prevention beginning at school of tobacco use and other addictive substances]. / Prevención desde la escuela del uso de tabaco y de otras sustancias adictivas.

We review the literature on school programs of prevention of consumption of tobacco and other addictive substances among adolescents. We describe the keys of these programs. The programs enforcing the abilities to resist the social pressure to the consumption of addictive substances report better results and they achieve significant reduction in the initiation of tobacco consumption. They also report promising results for alcohol and other addictive substances, but they are not so clearly supported. Average duration of the programs is between 8 and 12 ours a year, generally in 6th and 8th course. Other purposes of similar duration based on: self-esteem, the development of activities other than drug consumption, or the simple information on drugs, have not shown significant positive results for these ages.

[Evaluation of alcohol consumption recording in the primary care clinical history]. / Valoración del registro de consumo de alcohol en la historia clínica de atención primaria.

We carried out an internal medical audit to evaluate the recording of alcohol use in the primary care clinical records. 200 records were analyzed out of overall 2250. Of these, 100 belonged to the open (older) model, and 100 to the closed (or current) one. We found that in 56% of open model records there was no mention about alcohol use, against 31% in closed model records. In addition, this latter model permits a quantitative recording of alcohol intake. In both models there was a greater amount of information in males. We conclude that the physician's interest in recording data related to alcohol intake is small. We think that primary care staff should be sensitized to the importance of evaluating and recording alcohol intake.