[Do we agree on the technical quality of our chest X-rays? A radiologist, an expert in X-ray diagnosis, and a family doctor try to find out]. / 'Estamos de acuerdo con la calidad técnica de nuestras radiografías de tórax? Un radiólogo, un técnico especialista en radiodiagnóstico y un médico de familia intentan corroborarlo.

OBJECTIVE: To appraise the degree of concordance in the interpretation of the technical quality of chest x-rays at a health centre between an expert in x-ray diagnosis, a family doctor, and a radiologist. DESIGN: Transversal study. Setting. Primary care. Cartuja Health Centre, Granada, Spain. PARTICIPANTS: Patients at the Cartuja Health Centre who had a simple chest x-ray in 2002. 150 studies were chosen by simple randomised sampling. Two were rejected because they dealt with a repeat examination of the same patient and seven because they did not reach minimum quality. The final sample was 141 x-rays. MAIN MEASUREMENTS: The observers filled in independently, for each examination, an 11-item protocol on the technical quality of the images. The kappa index between pairs of observers was calculated for each item, as was the overall kappa index. RESULTS: 96% of the examinations were conducted with large x-ray plates (3543). There was only acceptable or good concordance between the 3 observers in 2 questions (kappa, 0.559-0.858). In 5 questions concordance was homogeneously low (kappa, 0.034-0.375). In some questions there was a strong discrepancy between the appraisal of the expert and that of the 2 other observers. CONCLUSIONS: General concordance can be considered low, although it is somewhat greater between the radiologist and the family doctor than between either of these and the expert. This poses the need to improve professional training in evaluation of the technical quality of images. In addition, there was unnecessary expense in large-size x-ray plates.

¿Estamos de acuerdo con la calidad técnica de nuestras radiografías de tórax? Un radiólogo, un técnico especialista en radiodiagnóstico y un médico de familia intentan corroborarlo / Do we agree on the technical quality of our chest X-ray? A radiologist, an expert in X-ray diagnosis, and a family doctor try to find out

Objetivo. Valorar el grado de concordancia en la interpretación de la calidad técnica de las radiografías de tórax de un centro de salud entre el técnico especialista en radiodiagnóstico (TER), el médico de familia y el radiólogo. Diseño. Estudio transversal. Emplazamiento. Atención primaria. Centro de Salud de Cartuja en Granada. Participantes. Pacientes del Centro de Salud de Cartuja con estudio radiológico simple de tórax durante 2002. Mediante muestreo aleatorio simple se seleccionaron 150 estudios. Se rechazaron 2 por tratarse de exploraciones repetidas del mismo paciente y 7 porque no presentaban una calidad mínima. La muestra final fue de 141 exploraciones. Mediciones principales. Los observadores cumplimentaron independientemente, para cada exploración, un protocolo de 11 ítems sobre calidad técnica de la imagen. Para cada ítem se calculó el índice kappa entre parejas de observadores, así como el índice kappa global. Resultados. El 96% de las exploraciones fue realizado con placas radiográficas de gran tamaño (35 x 43). Sólo en 2 preguntas hubo una concordancia aceptable o buena entre los 3 observadores (kappa = 0,559-0,858). En 5 preguntas, la concordancia fue homogéneamente baja (kappa = 0,034-0,375). En algunas preguntas se apreció una fuerte discrepancia entre la valoración del TER y la realizada por los otros 2 observadores. Conclusiones. La concordancia general puede considerarse baja, aunque algo mayor entre el radiólogo y el médico de familia que entre cada uno de éstos y el TER. Esto plantea la necesidad de mejorar la formación de los profesionales en cuanto a la valoración de la calidad técnica de las imágenes. Además, se detecta un gasto innecesario de placas radiográficas de gran tamaño

Objective. To appraise the degree of concordance in the interpretation of the technical quality of chest x-rays at a health centre between an expert in x-ray diagnosis, a family doctor, and a radiologist. Design. Transversal study. Setting. Primary care. Cartuja Health Centre, Granada, Spain. Participants. Patients at the Cartuja Health Centre who had a simple chest x-ray in 2002. 150 studies were chosen by simple randomised sampling. Two were rejected because they dealt with a repeat examination of the same patient and seven because they did not reach minimum quality. The final sample was 141 x-rays. Main measurements. The observers filled in independently, for each examination, an 11-item protocol on the technical quality of the images. The kappa index between pairs of observers was calculated for each item, as was the overall kappa index. Results. 96% of the examinations were conducted with large x-ray plates (35 x 43). There was only acceptable or good concordance between the 3 observers in 2 questions (kappa, 0.559-0.858). In 5 questions concordance was homogeneously low (kappa, 0.034-0.375). In some questions there was a strong discrepancy between the appraisal of the expert and that of the 2 other observers. Conclusions. General concordance can be considered low, although it is somewhat greater between the radiologist and the family doctor than between either of these and the expert. This poses the need to improve professional training in evaluation of the technical quality of images. In addition, there was unnecessary expense in large-size x-ray plates

[The evaluation of the preventive services for the pediatric population in Agaronese health centers]. / Evaluación de las actividades preventivas en poblagión infantil de centros de salud aragoneses.

BACKGROUND: We have shown the coverage of periodic health examinations made in children aged between 0 and 14 years old in Aragón during 1991, comparing with results obtained at national level and results obtained during 1990. METHODS: A descriptive transversal study was developed by reviewing clinic records of 9 primary health centers selected by systematic sampling. Sampling consisted on 436 histories. RESULTS: Main results were: age of child in the first visit: 83.5% below 1 month; metabolic disease screening: no data on 31.8%; DTP-polio: no data on 20.9%; triple viric: no data on 24.3%. CONCLUSIONS: Obtained data showed better results than those at national level. We should improve the metabolic diseases screening and vaccinations recording system.

[Epidemiological study of primary brain tumors in the Autonomous Community of Aragon]. / Estudio epidemiológico de los tumores primarios cerebrales en la Comunidad Autónoma de Aragón.

OBJECTIVES: a) To analyse diverse clinical features related to the symptomatology, location and anatomopathological diagnosis of primary tumours of the C.N.S. and b) to improve knowledge of the frequency of cerebral tumours in our field of study. DESIGN: A protocolized and retrospective study of those patients diagnosed as having a primary cerebral Neoplasia. SETTING: The Autonomous Community of Aragon during the decade from 1980 to 1990. PATIENTS AND OTHER PARTICIPANTS: Our total sample consisted of 759 tumours, 412 (54.28%) in men and 347 (45.72%) in women. Our criterion for inclusion was a diagnosis of primary cerebral Neoplasia, excluding Metastasis and vascular tumours. MEASUREMENTS AND MAIN RESULTS: The majority of the cerebral tumours were located in the cerebral hemispheres (56%): migraine was the most common symptom. We confirmed that the occurrence of cerebral tumours was higher in urban than in rural zones. However the age at which these neoplastic intracranial processes present is greater in rural zones. For 67% of patients 4.5 months had to pass before it was possible to establish the diagnosis of expansive intracranial process. CONCLUSIONS: a) Migraine is the most common clinical manifestation (20%), followed by a disturbance of the higher functions (15%). b) There is considerable delay in the time needed to establish the diagnosis of expansive intracranial process, due to the present health-care framework. c) The occurrence of cerebral tumours is higher in urban than in rural zones.