[Primary care centers and breast-feeding]. / Centros de atención primaria y lactancia materna.

OBJECTIVE: To study activities that promote, maintain and support breast feeding in primary care centers in our health district and to evaluate the commitment of health center directors' to breast feeding, their knowledge of the subject, and programs involved in the promotion of natural breast-feeding. MATERIAL AND METHODS: A cross-sectional study was carried out through surveys to those in charge of health centers, nursing, pediatric programs and pregnancy programs. RESULTS: Eighty surveys were sent to center and program directors. Answers were obtained from 66.2 %. A total of 6.9 % of the centers had no program or protocol for the promotion and maintenance of breast-feeding, nor did they seek the collaboration of support groups. Only 28.8 % of the centers surveyed carried out activities that provided special support to mothers with difficulties in breast-feeding. In contrast, 80.4 % possessed an adequate register on the incidence of breast-feeding. In 74.5 % of the centers, health professionals were given no specific training on the subject. Only 14.9 % of the centers had rules prohibiting visible leaflets, posters or samples of formula milk. In 84.6 % of the centers, no place was provided where breast-feeding could be carried out, observed, and possible problems corrected. CONCLUSIONS: Most of the primary care centers surveyed do not promote programmed activities favoring the promotion and maintenance of breast-feeding. Nevertheless, many centers provide advice on breast-feeding. Collaboration with support groups or other resources that might exist in the community is not generally sought. Specific training in breast-feeding is not given to the centers' health professionals. Only a minority of the centers possesses an appropriate place where mothers can breast-feed if they wish and where the process of breast-feeding can be observed and modified. The results suggest that primary care centers do not provide the necessary support to ensure successful breast-feeding and that they lack the resources necessary to achieve this aim.

Centros de atención primaria y lactancia materna / Primary care centers and breast-feeding

Objetivo: Estudiar el estado de las actividades de promoción, protección y apoyo a la lactancia materna en los centros de atención primaria (CAP) de nuestra área de salud y el compromiso y conocimientos sobre la alimentación al pecho de los responsables de estos centros y de los programas implicados en la promoción de la lactancia natural. Material y métodos: Se realizó un estudio transversal mediante encuesta dirigida a los responsables de los centros y a los responsables de enfermería, así como a los responsables de los programas del niño y de la mujer embarazada. Resultados: Se remitieron 80 encuestas dirigidas a los responsables de centros y programas, de las que se contestaron el 66,2%. Se observa que en el 56,9% de los centros no se dispone de programa o de protocolo de promoción y de protección de la lactancia materna ni se busca la cooperación con grupos de apoyo. Únicamente en el 28,8% se realizan actividades de apoyo especial a las madres que presentan dificultades con la lactancia. En cambio, el 80,4% tiene un adecuado registro sobre incidencias de la lactancia. En el 74,5% de los centros no se facilita formación específica sobre este tema a los profesionales. Sólo en el 14,9% existen normas para evitar la presencia visible de folletos, carteles o muestras de leche de fórmula. En el 84,6% de los centros no se dispone de un lugar para poder alimentar al pecho, observar la lactancia y corregir los posibles problemas que existan. Conclusiones: La mayoría de los CAP consultados no realizan actividades programadas que favorezcan la protección y la promoción de la lactancia natural. Aun así, las futuras madres reciben consejo sobre aspectos de la lactancia materna en muchos centros. No se busca, en general, la cooperación de grupos de apoyo mutuo u otros recursos que pueden existir en la población. Tampoco se ha facilitado a los profesionales formación específica sobre los aspectos relacionados con la lactancia materna. La minoría de los centros de atención primaria dispone de un lugar adecuado para poder lactar las madres que lo deseen, y donde pueda observarse la lactancia y modificar los aspectos que lo requieran. Se desprende de los resultados que no se dan todos los apoyos necesarios para poder lactar en los CAP y que estos centros tienen importantes carencias para conseguir este objetivo (AU)

[What are Gypsies like and what do they suffer from?]. / Cómo son y de qué padecen los gitanos.

OBJECTIVE: To find and compare the social and demographic features and health status of two different ethnic and cultural groups, gypsies and payos (non-gypsies). DESIGN: Observational, descriptive, crossover study. SETTING: Primary care. PARTICIPANTS: The 121 gypsy patients > 14 registered at the centre and 121 controls who were matched for age. INTERVENTIONS: Social and demographic variables, risk factors, chronic illnesses and involvement in preventive and health promotion programmes were gathered. MEASUREMENTS AND MAIN RESULTS: On the basis of a questionnaire that was filled out with data from the primary care health histories, we saw that there were significant differences in educational background, jobs and work situation (p < 0.0005). Among the gypsies there were more alcohol consumers, intravenous drug users and patients at social-health risk. Hb, Hc and HIV affected gypsies significantly more (the two groups were included in preventive programmes and activities). Mean age of death among gypsies was early (40.6 years vs. 73). Paradoxically, gypsies used private medicine more. CONCLUSIONS: There were significant social-health differences between the two groups studied. The gypsies on our health centre lists need greater care from the primary care team, so that they can achieve better health status.

Cómo son y de qué padecen los gitanos / What are gypsies like and what do they suffer from?

Objetivo. Conocer y comparar las características sociodemográficas y el estado de salud de 2 grupos étnicos y culturales distintos (payos y gitanos). Diseño. Estudio observacional, descriptivo, transversal. Emplazamiento. Atención primaria. Participantes. Los 121 pacientes de cultura gitana mayores de 14 años adscritos al centro y 121 controles apareados por edad. Intervenciones. Se recogieron variables sociodemográficas, factores de riesgo, enfermedades crónicas y adscripción a programas preventivos y de promoción de la salud. Mediciones y resultados principales. A partir de un cuestionario que se rellenó con datos de las historias de salud de atención primaria, vimos que había diferencias significativas en cuanto al nivel de instrucción, profesión y situación laboral (p < 0,0005). Había mayor número de consumidores de alcohol, de tóxicos vía parenteral y superior número de pacientes con riesgo sociosanitario entre los gitanos. VHB, VHC y VIH inciden significativamente más sobre los gitanos (ambos grupos incluidos en programas y actividades preventivas). Se detecta una temprana edad media de muerte en la población gitana (40,6 años frente a 73,3 entre los payos). Paradójicamente, se da una mayor utilización de la medicina privada entre los gitanos. Conclusiones. Existen diferencias sociosanitarias significativas entre ambos grupos estudiados. La población gitana de nuestro centro de salud requiere mayor atención por parte del equipo de atención primaria, para conseguir un mejor estado de salud en este grupo (AU)

[Factors determining costs of drug prescriptions in primary health care]. / Factores determinantes del gasto por prescripción farmacéutica en atención primaria.

OBJECTIVE: To describe and explain the annual pharmaceutical expenditure generated by the professionals in a Health Area. DESIGN: An observational crossover study. SETTING: Primary Care. Doctors in a Health Area. PARTICIPANTS: 99 general practitioners who worked during 1992 in Area 3, Castellón. INTERVENTIONS: We used as a variable reply the pharmaceutical expenditure of each doctor during 1992, the expenditure per inhabitant and the expenditure per inhabitant standardised for the percentage of passives. We gathered as explanatory variables of the same: age, gender, whether the post was provisional or permanent, rural or urban area, MIR (resident) training or not, the model of Primary Care, frequency of attendance, whether the doctors worked there exclusively, the number of pensioners and the number of patients at work registered. MEASUREMENTS AND RESULTS: In the bivariant analysis we found a significant association of expenditure with being provisional in the post, the old model of primary care, an urban area, greater age of the doctor, greater frequency of attendance, non-exclusivity and the number of patients registered. These associations varied in line with the variable reply used. In the different models of multiple linear regression obtained, the influence of the number, non-exclusivity, gender and work-place characteristics predominated. CONCLUSIONS: Greater pharmaceutical expenditure appears to be related to the number of patients registered, the absence of exclusivity, doctors being women and the features of the town where they work.

[Chondrodysplasia punctata. 3 new cases and review of the Spanish literature]. / Condrodisplasia punctata. Tres nuevos casos y revisión de la literatura española.

Authors report three new cases of "chondrodysplasia punctata" two of them probably corresponding to Conradi-Hunerman's type and the third to rhizomelic type of Spranger. Series of cases published in Spain are reviewed. They conclude that clinic types of illness accepted according to Spranger (1971), in majority of spanish cases, have difficult application--own authors' opinion--because this differentiation does not solve clinic heterogeneity of illness. Genetics aspects of reviewed cases do not agree with expected and accepted results, probably because familiar antecedents were not well studied or genetics aspects are not yet well known.