Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study.

BACKGROUND: Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. METHODS: A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. RESULTS: Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'. CONCLUSION: The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.

[Alternatives to population screening for breast cancer. Is the chance detection useful?]. / Alternatives al cribado poblacional de cáncer de mama. Es útil la detección oportunística?

OBJECTIVES: 1. To evaluate the characteristics of the demand, coverage and acceptability of random detection of breast cancer at a health centre (HC) between January 1995 and December 1996. 2. To describe the cases of breast cancer diagnosed since the setting up in 1988 of random demands for screening mammographies. DESIGN: Crossover study. SETTING: La Mina Primary Care Centre, Barcelona. PATIENTS: A sample of 340 women of a population of 2796 women between 45 and 75 with a clinical history at the HC were studied. MEASUREMENTS AND MAIN RESULTS: The profile of women with neoplasms was: aged 59 +/- 8.5; 279 women attended, 273 medicine, 132 medicine and gynaecology, and 6 gynaecology. Mammographies requested were: 143 (118 through gynaecology, 12 medicine and 13 outside the centre), which was 51% of women who attended and 42% of the sample. The reason for mammography was screening (129) and symptoms (14). Screening mammographies actually done (acceptance) were 116 out of 129 (90%). Sample coverage was 34% (116/340); and 42% of the women who attended (116/279). Most studied age-group was 50-64 (coverage 45%, n = 176). 11 cases of breast cancer were diagnosed: age 54.3 +/- 9.1; 1 in situ, 3 < 10 mm, 2 between 10 and 20 mm, 4 > 20 mm, 1 without data. Diagnosis to treatment delay: 33.7 +/- 0 days. At time of writing 8 women were free of illness. CONCLUSIONS: Through random detection 34% coverage was achieved with good acceptance. Most neoplasms are diagnosed in their early stages. The general practitioner should be more attentive to periodic requests for mammographies.

[Infectious diseases in primary care]. / Patología infecciosa en atención primaria.

OBJECTIVE: To find the frequency and seasonal variability of the infectious diseases detected over a year. DESIGN: Observational prospective study. SETTING: Primary care centre. PATIENTS: Simple multi-stage random sampling of the patients over 14 seen on demand at general medical clinics and the Casualty department between June 1991 and May 1992. MEASUREMENTS AND MAIN RESULTS: Out of 49,193 attendances during the study period, the attendance sample was 2,523, of which 474 (18.8%; CI: 17.3-20.3%) were for infectious conditions. Average age of these 474 was 39 (SD: 19.17); 55% were women. Frequency of respiratory infections was 64.1% (CI: 59.8-68.5%). The correlation coefficient between respiratory infections and the total number of infections was 0.94 (R2 = 0.89). The frequency of infections oscillated between 29% (CI: 23-35%) in February and 10% (CI: 5.8-14.5%) in May. CONCLUSIONS: Infectious conditions account for a considerable percentage of the total number of primary care attendances. There is a seasonal variation in infections, which is mainly due to respiratory infections.

[Are antibiotics correctly prescribed in primary care?]. / Se prescriben correctamente los antibióticos en atención primaria?

OBJECTIVE: To identify the antibiotic prescriptions and evaluate their suitability for the infectious conditions treated at a Primary Care Centre. DESIGN: A prospective observation study. SETTING: La Mina Primary Care Centre. Sant Adrià de Besòs (Barcelona). PATIENTS AND OTHER PARTICIPANTS: The on-demand visits of patients over 14 to the General Medicine and Emergency clinics between June 1991 and May 1992 provided the data through a simple multi-stage random sample. MEASUREMENTS AND MAIN RESULTS: On the basis of the clinical notes, these variables were recorded: age, gender, diagnosis, the antibiotic prescribed and its manner of administration. The indication and choice of treatment was assessed in line with previously established criteria, as well as whether the antibiotic was first-choice in Primary Care. Infections treated in hospital or by specialists, non-bacterial cutaneous infections and Conjunctivitis were excluded. Out of 2,523 people examined, 474 presented infectious conditions (18.8%); the most common of these were infections of the upper respiratory tract (46.4%) and acute Bronchitis (17.3%). An antibiotic was prescribed in 206 cases (43.3%). The most used antibiotics were: Amoxicillin (41.5%), Penicillin (19.0%), Cloxacillin (11.2%), Erythromycin (10.2%) and Pipemidic Acid (7.8%). They were orally taken in 89.4% of cases. 92.3% of the antibiotics were first-choice. Overall fitness of treatment was 86.3% (56.5% unnecessary and non-prescribed treatment; and 29.7% necessary and using the recommended antibiotic). The least suitable treatment was observed for cases of acute Bronchitis without any risk factors. CONCLUSIONS: Prescriptions are adjusted to the recommendations on antibiotic policy in Primary Care, although less suitable treatment was observed for acute Bronchitis. The importance of applying a methodology based on objective criteria, in order to make a qualitative analysis in studies on the use of medication, is highlighted.