Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study).

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). Conclusions: The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

[Hypothyroidism in adults in a basic health area]. / Hipotiroidismo adulto en una zona básica de salud.

INTRODUCTION: The objective of the present study is to study the prevalence, as well as the clinical and epidemiological characteristics of hypothyroid disease in adults using the computerised clinical records. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study. The target population was the patients of the health centres of Lucena I and II (Córdoba). INCLUSION CRITERIA: Patients 14 years or older, diagnosed with hypothyroidism, born and resident in Lucena. Two hundred and fourteen patients were recruited by random sampling, who then underwent a clinical interview using a questionnaire. RESULTS: The mean age of the patients was 49.71 years (SD 17.03; 95% CI 47.34-51.98), with 85.5% women. A diagnosis of sub-clinical hypothyroidism was found in 74.8%, compared to 18.7% of primary hypothyroidism, and 6.5% of secondary hypothyroidism. The 53.7% (95% CI 46.81-60.59) of patients diagnosed with hypothyroidism did not have thyroid antibodies results. However, 75.2% (95% CI 68.89-80.86) were being treated with levothyroxine. The prevalence of hypothyroidism was 5.7% (95% CI 5.46-5.96). CONCLUSIONS: Sub-clinical hypothyroidism is very common in Primary Care clinics. Many patients are not correctly diagnosed and many are over-medicated, suggesting a need to review the diagnosis.

Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state.

Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided.

[Validation of taking arterial pulse in Primary Care for the detection of atrial fibrillation and other cardiac rhythm disorders in patients over 65 years old]. / Validación de la toma del pulso arterial en atención primaria para la detección de fibrilación auricular y otros trastornos del ritmo cardiaco en mayores de 65 años.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. RESULTS: The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. CONCLUSIONS: The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years.

Prevalence of renal stones in Andalusian population: results of PreLiRenA study.

INTRODUCTION: Urolithiasis is a disease having a high recurrence rate and associated morbidity. A not well quantified increase is being seen in recent years that could be related with various factors. The main purpose of our study has been to estimate urolithiasis prevalence and incidence in the region of Andalusia, determining which factors are associated. MATERIAL AND METHODS: We performed an observational and cross-sectional study. Using a multistage randomized procedure, we selected a sample of 2439 subjects, aging from 40 to 65 years old, who currently lived in Andalusia. Data was collected through phone interviews, questioning the chosen subjects about their kidney stones history, comorbidity and socio-demographic characteristics. We conducted a descriptive, bivariate and multivariate analysis with logistic regression. RESULTS: A total of 2439 subjects were surveyed. Subjects had mean age of 51.1±7.61 years - standard deviation; (95% confidence interval - 95% CI: 50.70-51.30), 48.7% of whom were male. Prevalence of urolithiasis obtained was 16.4% (95% CI: 14.87-17.85%) and an incidence of 1.2 (95% CI: .74-1.64). Variables significantly associated with the presence of urolithiasis found in the multivariate study were: presence of a family history of kidney stones (odds ratio -OR: 1.91; 95% CI: 1.51-2.40, P<.001), hypertension (OR:1.58; 95% CI:1.24-2.02; P<.001), gout (OR:1.98; 95% CI: 1.26-3,12; P=.003) and a high BMI (OR: 1.60; 95% CI 1.19-2.17; p=.008). CONCLUSIONS: A significant increase in the prevalence and incidence of urolithiasis is observed in the environment in regards to the previously available figures. The presence of a family history of urolithiasis, hypertension, gout as well as having a high BMI could influence the observed epidemiological changes in renal lithiasis.

[Prevalence and factors associated with peripheral artery disease in patients with type 2 diabetes mellitus in Primary Care]. / Prevalencia y factores asociados a la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 en Atención Primaria.

INTRODUCTION: Peripheral artery disease in the lower limbs (PAD) is a prevalent condition that entails high morbidity in diabetic patients; this study assesses PAD in these patients and its socio-demographic and clinic associated variables. MATERIAL AND METHODS: Descriptive study in a systematic sample of diabetic patients (DM2) aged 50-80 years, in Primary Care settings. The dependent variable was the presence of PAD diagnosed by ankle-brachial index (ABI) ≤ 0.9; independent variables: socio-demographic, clinical and laboratory. STATISTICS: bivariate and multiple logistic regression analyses were performed to determine the variables associated with low ABI. RESULTS: A sample of 251 patients, 52.6% women; mean age: 68.5 ±8.5. A low ABI was detected in 18.3% (95% Confidence Interval (95% CI):13.3-23.3%), with 6 subjets (2.4%) previously diagnosed as suffering PAD. Age (OR=1.07; 95% CI: 1.02-1.12) and retinopathy (OR=2.69; 95% CI: 1.06-6.81) were associated (multiple logistic regression analysis) with ABI. CONCLUSIONS: The percentage of patients diagnosed with PAD is very low, although PAD prevalence is high among DM2 patients attending Primary Care clinics, especially in older patients and those with retinopathy. We emphasize the recommendation of performing the ABI test in this population at risk.

[Food consumption patterns among adolescents]. / La alimentación en el adolescente.

BACKGROUND: Adolescence is a critical time for the establishment of healthy eating habits. The objective was to analyze food consumption patterns among adolescents and their relationship with family and social factors. METHODS: Multicentre observational cross-sectional descriptive study using a food frequency questionnaire for the last week. It was answered anonymously. The adolescent's age/gender, parents' studies/occupation and school's location/type were included. The population sample was composed of 1,095 adolescents in sixth grade at primary schools from an Andalusian region. They were chosen by polietapic random sampling that distinguished between public/private and capital/provincial schools. RESULTS: 1,005 surveys were analyzed. The mean age is 11.45 (SD: 0.59). Fifty-three percent were male. The intake of dairy products (only two-thirds taken daily), pasta, fruit and vegetables (daily consumption of 30%) is deficient. Sixty-four point five percent consume legumes weekly. Fish consumption is equal to meat, with a preference for poultry. More than half consume red meat daily. Olive oil is preferred. The intake of "empty calories" (fast food, candies, soft drink) is high. Through multivariate analysis the existence of clusters of healthy and unhealthy foods, related to the social status of the parents and the type of school, is proved. CONCLUSIONS: A healthy diet based on the nutritional pyramid is not the consumption pattern in the adolescents surveyed. There is a low consumption of diary products, legumes, fruits and vegetables. There is a relationship between the social class of the family and consumption patterns (healthy and unhealthy). Health strategies are needed to modify such inappropriate consumption.

[Evaluation of topical vasoconstrictors in pterygium surgery and their role in reducing intraoperative bleeding]. / Evaluación de vasoconstrictores tópicos en la cirugía del pterigión y su papel en la disminución del sangrado intraoperatorio.

OBJECTIVE: To reduce vascularisation before surgery through the application of topical vasoconstrictors, decreases the rate of intraoperative bleeding, improves the dynamics of the surgery and reduces the difficulty in surgical performance. METHODS: Only patients with primary pterygium were included in the study. A prospective randomized clinical trial was designed to compare intraoperative bleeding, need for cauterization and surgical time a group that was administered phenylephrine. preoperatively and one which did not receive it. The sample was divided into two groups: 1st (n=27) received topical phenylephrine (F) 0.1 ml (10%), twice in 5 minutes before surgery. 2nd (n=30) did not receive phenylephrine (NoF). The technique was similar in both groups using conjunctival autograft suturing. In both groups, the subconjunctival aneasthesia was performed with 0.5% bupivacaine hydrochloride with epinephrine 1:200,000. RESULTS: A total of 57 patients were included in the study. The mean operation time for group F was 15.57 minutes (SD: 1.8 min) and the NoF group 16.51 min (SD to 1.82 min, P=.057). In the group F, it was necessary to use diathermy in 2 patients (7.4%) and in the NoF group cauterisation was used in 14 patients (46.7%, Chi-Square=10.848, P=.001. There is a relative risk 6.3 (95% CI 1.57 - 25.27) times greater than having to cauterise without phenylephrine when used phenylephrine. CONCLUSIONS: The use of topical vasconstrictors prior to pterygium surgery reduces the rate of bleeding and the time of surgery.

[Patients' perception on attention received from Health Centres non-sanitary staff]. / Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud.

AIMS: To know patients' perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. MATERIAL AND METHODS: Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by χ(2) test. Open-ended questions were grouped in categories in a process involving three researchers independently. RESULTS: Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. CONCLUSIONS: Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres.

Evaluación de vasoconstrictores tópicos en la cirugía del pterigión y su papel en la disminución del sangrado intraoperatorio / Evaluation of topical vasoconstrictors in pterygium surgery and their role in reducing intraoperative bleeding

Objetivo: Reducir la vascularización previa a la cirugía mediante la aplicación de vasoconstrictorestópicos disminuye la tasa de sangrado intraoperatorio, mejora la dinámica de lacirugía y reduce la dificultad de la actuación quirúrgicaMétodos: Sólo los pacientes con pterigión primario se incluyeron en el estudio. Un ensayoclínico aleatorizado prospectivo fue diseñado para comparar el sangrado intraoperatorio,necesidad de cauterización y tiempo de cirugía entre los grupos a los que se les administró ono fenilefrina preoperatoriamente. Lamuestra se dividió en dos grupos: 1◦ (n = 27) recibieronfenilefrina tópica (F) 0,1 ml (10%) por dos veces 5 minutos antes de la cirugía; 2◦ (n = 30) no seadministró fenilefrina (NoF). La técnica fue similar en ambos grupos, mediante autoinjertoconjuntival y sutura. En ambos, la anestesia subconjuntival se realiza con 0,5% de clorhidratode bupivacaína con epinefrina 1:200.000.Resultados: Un total de 57 pacientes se incluyeron en el estudio. Lamedia del tiempo quirúrgicopara el grupo F fue de 15,57 minutos (SD: 1,8 min) y para el grupo de NoF de 16,51 min(SD; 1,82 min; p = 0,057). En el grupo F, fue necesario usar la diatermia en 2 pacientes (7,4%),en el NoF se usó la cauterización en 14 pacientes (46,7%; Chi-cuadrado = 10,848; p = 0,001.Existe un riesgo relativo 6,3 (IC 95%: 1,57 a 25,27) veces mayor de tener que cauterizar sinfenilefrina que cuando se usa fenilefrina.Conclusiones: El uso de vasconstrictores tópicos previos a la cirugía de pterigión disminuyela tasa de sangrado y reduce el tiempo de cirugía(AU)

Objective: To reduce vascularisation before surgery through the application of topical vasoconstrictors,decreases the rate of intraoperative bleeding, improves the dynamics of thesurgery and reduces the difficulty in surgical performance.Methods: Only patients with primary pterygium were included in the study. A prospectiverandomized clinical trial was designed to compare intraoperative bleeding, need for cauterizationand surgical time a group thatwas administered phenylephrine. preoperatively andone which did not receive it. The sample was divided into two groups: 1st (n = 27) receivedtopical phenylephrine (F) 0.1 ml (10%), twice in 5 minutes before surgery. 2nd (n = 30) did notreceive phenylephrine (NoF). The technique was similar in both groups using conjunctivalautograft suturing. In both groups, the subconjunctival aneasthesia was performed with0.5% bupivacaine hydrochloride with epinephrine 1:200,000.Results: A total of 57 patients were included in the study. The mean operation time for groupF was 15.57 minutes (SD: 1.8 min) and the NoF group 16.51 min (SD to 1.82 min, P = .057). Inthe group F, it was necessary to use diathermy in 2 patients (7.4%) and in the NoF groupcauterisation was used in 14 patients (46.7%, Chi-Square = 10.848, P = .001. There is a relativerisk 6.3 (95% CI 1.57 - 25.27) times greater than having to cauterise without phenylephrinewhen used phenylephrine.Conclusions: The use of topical vasconstrictors prior to pterygium surgery reduces the rateof bleeding and the time of surgery(AU)

Nivel funcional y capacidad de marcha en ancianos con fractura de cadera a los seis meses de un programa de rehabilitación domiciliaria / Effects of a six months' home rehabilitation program on the functional level and walking ability of old people with hip fracture

Objetivo: Conocer el nivel funcional para las actividades básicas de la vida diaria y la capacidad de marcha en ancianos con fractura de cadera (FC) a los seis meses de un programa de rehabilitación domiciliaria (PRD). Pacientes y método: Estudio prospectivo antes-después con 136 pacientes de 70 años o mayores, residentes en la comunidad, intervenidos de FC y derivados a un PRD. Se compararon el índice de Barthel (IB) y la capacidad de marcha al inicio y a los seis meses. Se aplicaron análisis de regresión lineal y logística múltiples. Resultados: El IB a los seis meses aumentó 26,32 puntos respecto al inicial (desviación estándar: 20,60; intervalo de confianza del 95%: 22,83–29,82; p<0,001). El 59,1% de pacientes tenía capacidad de marcha a los seis meses frente al 19,9% inicial (p<0,001). Los análisis de regresión relacionaron con un mejor nivel funcional y tener capacidad de marcha a los seis meses a la ausencia de comorbilidad y de complicaciones, a tener capacidad de marcha al inicio del tratamiento y al incremento del IB al alta. Conclusiones: La rehabilitación domiciliaria mejora el nivel funcional, manteniéndose a los seis meses de finalizado el tratamiento. La mejora en la capacidad de marcha disminuye a lo largo de este tiempo (AU)

Objective: To know the functional level for the basic activities of daily living and the walking ability in old men with hip fracture to the six months a home rehabilitation program. Patients and method: A before-after prospective study on 136 patients, who were ≥ 70 years old, lived in the community, had a hip fracture operation and was later referred to a home rehabilitation program. Both their Barthel index rate and ability to walk were contrasted at the beginning, on being discharged and after six months. Logistic, multiple and lineal regression analyses were made to identify variables associated with the functional level and ability to walk. Results: After six months the values of the Barthel index increased an average of 26.32 points (SD: 20.6; 95% CI: 22.82–29.82; p <0.001). Patients walking ability after 6 months were 40% higher then just after the discharge (p <0.001). A good functional level and the ability to walk after 6 months were related (regression analysis) with the following factors: not having comorbidity and side health problems, ability to walk from the beginning of the treatment and an increasing in the values of the Barthel index at the moment of the Hospital discharge. Conclusions: Home rehabilitation improve the functional level staying to the six months the treatment it is concluded. The improvement in the walking ability it diminishes along this time (AU)

[Pilot study for the inclusion of the portfolio of the family medicine specialist book in training]. / Estudio piloto para la incorporación del portafolio del libro del especialista en medicina de familia en formación.

BACKGROUND: The Spanish Family Medicine National Commission is proposing a new portfolio-type Specialist Training Book (STB). OBJECTIVE: To pilot its contents, structure, and implementation strategies. DESIGN: Cross-sectional, descriptive study. SETTING: A Provincial Family Medicine Teaching Unit. PARTICIPANTS: Twenty-eight tutors and 36 residents. METHODS: For 9 months the participants conducted a training assessment on diverse areas of competence by means of tasks at work. Tutors recorded information on the quality of reflection achieved by residents and the tasks they performed by means of the card model proposed in the STB. Residents filled in an ad hoc survey. A univariate analysis of quantitative data was conducted. RESULTS: Thirty-three surveys were received from residents; 21 tutors handed in 67 evaluation reports (average: 3 per tutor). They dealt with all the areas of competence, particularly those of communication, teaching, and ethics. Tasks most used were clinical sessions, critical incidents and video-recording. Both tutors and residents thought that the new method could be useful for reflecting on clinical practice, understanding their own areas of competence better and for strengthening the tutor-trainee relationship, especially if some suggestions to improve its practical use and reduce time and effort involved were taken into account. CONCLUSIONS: The new STB in its current version or with some modifications is a useful tool for residents' training assessment and is probably accepted well in our ambit.

[Opinions of health professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS)]. / Opiniones de los profesionales sanitarios sobre la influencia del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) en atención primaria.

OBJECTIVE: To find out the opinion of Primary Health Care (PHC) professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS). DESIGN: Descriptive qualitative-quantitative study. In a first phase the SWOT technique was used. In a second phase a 47 item questionnaire was designed using an ordinal scale. PARTICIPANTS: Professionals of PAPPS health centre, PAPPS managers and PHC management, using the Autonomous Community, and the time of ascribing or knowledge of PAPPS as segmentation criteria. In the qualitative study 62 participants were selected by theoretical sampling. In the quantitative study, 198 professionals took part in the survey. PRINCIPAL MEASUREMENTS: The assessment of the results has taken into account the responses to the questions formulated and by performing a crossed analysis between strengths/threats and weaknesses/opportunities. A descriptive statistical analysis of the questions in the questionnaire. RESULTS: There is agreement in that PAPPS has greatly influenced the development of PHC, contributing to improving the quality of care, but it is also fundamental to try revitalise the programme, as the limited involvement by the professionals in the postulated preventive recommendations is its main weakness, due to lack of motivation and professional burn-out.. CONCLUSIONS: According to the participants PAPPS has contributed significantly to the development of PHC in our country and has had an influence on professional practice by instilling a prevention culture that hardly existed before.

[Validity and reliability of a tool for assessing clinical communication in consultations: the CICAA questionnaire]. / Validez y fiabilidad de un instrumento para evaluar la comunicación clínica en las consultas: el cuestionario CICAA.

OBJECTIVE: To assess the validity and reliability of a tool for evaluating the clinical communication skills of health professionals. DESIGN: Descriptive study of the validation of a tool. SETTING: Primary and specialist care. PARTICIPANTS: Twenty communication experts, in 31 interviews with patients seen by real and standardised nurses, primary care, and specialist doctors, residents with acute and chronic patients. INTERVENTIONS: The study looked at a 36-item, multidimensional evaluative scale on 3 levels, based on the CICAA theoretical model of an interview and examined: 1) its apparent validity, consensus, and content: the clinical communication experts made 2 assessments, a qualitative one and one to weigh the importance of the remaining items; 2) its internal consistency and intra-observer reliability. An expert evaluated 31 interviews, video-recorded on 2 occasions with a 1-to-2 month interval. RESULTS: A 29-item scale was obtained. Cronbach's alpha was 0.957 (95% CI, 0.932-0.976). The overall Intra-class Correlation Coefficient was 0.967 (95% CI, 0.933-0.984). The Kappa values of the items were <0.4 in 3, 0.4-0.6 in 6, 0.6-0.8 in 14, and >0.8 in 4. CONCLUSIONS: The CICAA is a valid and reliable questionnaire for evaluating the clinical communication between various health professionals and patients.

[Validation of the AUDIT test for identifying risk consumption and alcohol use disorders in women]. / Validación del cuestionario AUDIT para la identificación del consumo de riesgo y de los trastornos por el uso de alcohol en mujeres.

OBJECTIVE: To validate the AUDIT test for identifying women with excess alcohol consumption and/or dependency syndrome (DS). DESIGN: Descriptive study to validate a test. SETTING: Two primary care centres and a county drug-dependency centre. PARTICIPANTS: 414 women from 18 to 75 recruited at the clinic. Interventions. Social and personal details were obtained through personal interview, their alcohol consumption was quantified and the AUDIT and MALT questionnaires were filled in. Then the semi-structured SCAN interview was conducted (gold standard; DSM-IV and CIE-10 criteria), and analyses were requested (GGT, GOT, GPT, VCM). 186 patients were given a follow-up appointment three-four weeks later (retest). MAIN MEASUREMENTS: Intra-observer reliability was evaluated with the Kappa index, internal consistency with Cronbach s alpha, and the validity of criteria with indexes of sensitivity and specificity, predictive values and probability quotients. To evaluate the diagnostic performance of the test and the most effective cut-off point, a ROC analysis was run. RESULTS: 11.4% (95% CI, 8.98-13.81) were diagnosed with alcohol abuse (0.5%) or DS (10.9%). The Kappa coefficients of the AUDIT items ranged between 0.685 and 0.795 (P<.001). Internal reliability, with Cronbach s alpha, was 0.932 (95% CI, 0.921-0.941). Test sensitivity was 89.6% (95% CI,76.11-96.02) and specificity was 95.07% (95% CI, 92.18-96.97). The most effective cut-off point was at 6 points. CONCLUSIONS: The AUDIT is a questionnaire with good psycho-measurement properties. It is reliable and valid for the detection of risk consumption and DS in women.

[Welcome and I'll see you again, or hello and goodbye?: Communication behaviour of medical residents at the beginning and the end of consultations]. / Bienvenido y hasta luego u hola y adiós?: Conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas.

OBJECTIVES: To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. DESIGN: Descriptive observational study. SETTING: Primary care clinics. PARTICIPANTS: Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. RESULTS: The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). CONCLUSIONS: The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations.

[Migraine prophylaxis with calcium antagonists: a haemodynamic study using transcranial Doppler ultrasound]. / Profilaxis de la migraña con antagonistas del calcio: estudio hemodinámico mediante Doppler transcraneal.

INTRODUCTION: Despite its widespread use, a good explanation for the mechanism of action of calcium antagonists (CA) in the prophylaxis of migraine has still not been proposed. AIMS: To determine whether nicardipine and flunarizine therapy is capable of inducing changes in the brain haemodynamics of migraine sufferers that lend support to a vascular mechanism of action for these drugs, as evaluated by transcranial Doppler ultrasound (TCD). PATIENTS AND METHODS: We present a prospective, descriptive study based on observation conducted in a Neurology outpatients department. Patients between the ages of 16 and 50 with migraine (following IHS criteria) who were being treated with nicardipine and flunarizine as a prophylactic measure and did not fulfil any of the exclusion criteria were selected consecutively. The TCD study was performed before and during treatment with CA (flunarizine or nicardipine), for a minimum of one month. The following haemodynamic variables were determined: mean speed, Gosling's pulsatility index and cerebrovascular reserve, determined by the breath holding index. Pre and post-prophylaxis variables were compared using the Wilcoxon signed rank test. RESULTS: Eight patients with migraine were included in the study and no significant differences in any of the three haemodynamic variables were observed between the values obtained prior to or during treatment. CONCLUSIONS: The absence of haemodynamic changes in TCD does not lend support to a vascular mechanism of action for CA in migraine.