The natural history of Parkinson's disease in the province of Segovia: mortality in a longitudinal study (20-year follow-up).

OBJECTIVE: We determined mortality rates and predictors of survival in 273 patients with Parkinson's disease based on a 20-year follow-up longitudinal study. MATERIAL AND METHODS: We examined 273 patients with Parkinson's disease during a 20-year follow-up, recruited between 1978 and 1998. All patients were regularly followed at the Department of Neurology until December 31, 1998, or death. RESULTS: By then, 69 patients had died, crude mortality was rate 4.43, and standardized mortality ratio for the total patient group was 1.39 (95% CI, 1.10-1.50). As Parkinson's disease is a chronic progressive disorder in adult life, disease-related mortality would be expected to increase in later stages after 15 or 20 years. Mean age at death in our cohort was 78.27 (95% CI, 76.90-79.20). Median time of death was 11 years (95% CI, 9.50-12.49). Independent predictors of mortality during the follow-up were age at onset (hazard ratio, 1.05; 95% CI, 1.01-1.09; P = 0.01), clinical form - akinesia and rigidity (hazard ratio, 2.20; 95% CI, 1.06-4.88; P = 0.03) - and treatment with dopaminergic agonist (hazard ratio, 0.49; 95% CI, 0.23-1.03; P = 0.06). Cardiovascular disease was the most frequent cause of death in 42%. CONCLUSIONS: This study suggests a link between mortality with age of onset and treatment without dopamine agonists as initial treatment. So, there is an association between decreased mortality and tremor as initial clinical forms at onset.

[How much time does the physician dedicate to his patients? A study of contents of office visits and their length]. / Cuánto tiempo le dedica a sus pacientes? Estudio del contenido de las consultas médicas según su duración.

OBJECTIVE: To describe the content and length of General Medicine interviews at a health centre, analysing the problems dealt with and activities undertaken, in function of the time taken. DESIGN: A crossover study. SETTING: An urban health centre at Alcobendas (Madrid). PATIENTS AND OTHER PARTICIPANTS: The problems, activities and length of all the interviews (926) were recorded over a period of 10 days. MEASUREMENTS AND MAIN RESULTS: The average length of the interviews was 6.7 minutes (standard error SE = 0.13). More problems were dealt with, and more activities carried out, in the longer interviews. Problems of a psycho-social character and preventive activities were discussed in the long interviews. Significant differences were found in the length of interviews in function of the patient's age and between different professionals. CONCLUSION: To achieve integrated care which includes both preventive medicine and psycho-social problems, doctors must have more interview time, as these questions are not tackled in short interviews.

[Effect of the physician's and the patient's sex on the clinical interview]. / Influencia del sexo del médico y del paciente en la entrevista clínica.

OBJECTIVE: To analyse differences attributable to the sex of the doctor and of the patient in the activities and content of the clinic appointment in Primary Attention. DESIGN: Analysis of interaction, in terms of activities and content, in 157 clinic appointments. SITE. General medical consultations in four Primary Attention Public Health Centres. PATIENTS: Those who used the health services on the day of the study. INTERVENTION: Tape recording of the appointments. MAIN MEASUREMENTS AND RESULTS: The interviews were recorded. There were shown to be differences according to the sex of the doctor and of the patient in terms of the development and content of the interviews. The style of the woman doctor involved longer interviews with greater social content; in general sameness of sex (doctor and patient) led to greater mutual complementation in the interviews. CONCLUSIONS: It has been shown that there are differences in the activities and content of the clinic appointments in Primary Attention which depend on the sex of the patient and doctor.

[The most often quoted journals in primary care]. / Las revistas más citadas en atención primaria.

The bibliographical references of original articles published during 1988 in four primary care magazines from diverse cultural backgrounds were analysed: Canadian Family Physician (Canada), Journal of Family Practice (United States), Atención Primaria (Spain), and Journal of the Royal College of General Practitioners (United Kingdom). There are 4,225 bibliographical references used in the 328 original reviewed articles. These references had been published in 725 different magazines, of which the ten most oft-quoted account for 38% of the total references. In addition to the four magazines included in our review, the list includes the following: British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Lancet, Canadian Medical Association Journal, Annals of Internal Medicine, and American Journal of Obstetrics and Gynecology.