Prevención ambulatoria de la tromboembolia venosa / Out-patient prevention of venous thrombo-embolism

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Análisis de las derivaciones al segundo nivel desde un centro de salud urbano / Analysis of second-level referrals from an urban health centre

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[Burnout in primary care doctors of the province of cáceres]. / Burnout en médicos de atención primaria de la provincia de Cáceres.

OBJECTIVES: To analyse the degree of professional burnout in primary care doctors from our province and the effect of various factors.Design. Descriptive and analytic cross-sectional study. SETTING: Primary care (PC) in the province. PARTICIPANTS: All the PC doctors in the province of Cáceres (n=255). MAIN MEASUREMENTS AND RESULTS: Self-administered anonymous questionnaire: the Maslach Burnout Inventory that evaluates Depersonalisation (DP), Self-esteem (SE), and Emotional Exhaustion (EE); social and personal variables, work data, personal questions and measures taken if there was work stress. Student s t test, ANOVA (means), and Chi-square or Fisher test (percentages) were used. 157 valid questionnaires were returned (62% response rate). Mean age was 41.5 years old 7.2; 75% were male, 80.2% married, 73.2% had tenure, 48.9% worked in towns, and their mean case-load was 40.5 16.5 patients/day. Mean values found were: DP, 8.3 5.8; SE, 35.2 8.4; EE, 22 11.3; 65.8% scored high on one of the three. For EE mean scores were significantly higher in men, doctors with tenure, in towns, those with >10 years seniority or who saw >40 patients a day. 50% had had psycho-physical disorders in the previous 3 months; 33% withstood a lot of bureaucracy; both groups had EE averages. Dedicating <2 hours a day to leisure was associated with >EE; and being a tutor with a significantly higher level of burnout. Disorders in the family or social/work sphere were associated with high levels of DP and EE (P<.001). CONCLUSIONS: Like other studies, we found a moderate level of burnout in our sample. Seniority, social/labour or family conflict, and certain personal and job characteristics were associated with high burnout.

Burnout en médicos de atención primaria de la provincia de Cáceres / Burnout in primary care doctors of the province of Cáceres

Objetivos. Analizar el grado de desgaste profesional en médicos de atención primaria de nuestra provincia y la influencia de diversos factores.Diseño. Estudio transversal, descriptivo y analítico.Emplazamiento. Provincial, atención primaria.Sujetos. Todos los médicos de primaria de la provincia de Cáceres (n = 255).Mediciones. Cuestionario autoadministrado y anónimo, Maslach Burnout Inventory, que valora: despersonalización (DP), autoestima (PA) y agotamiento emocional (AE); variables sociodemográficas, sociolaborales, preguntas personales y medidas adoptadas si hay estrés laboral. Análisis mediante t de Student y Anova (medias) y ji-cuadrado o Fisher (porcentajes).Resultados principales. Un total de 157 cuestionarios válidos (tasa de respuesta, 62 por ciento). La edad media es 41,5 ñ 7,2 años; 75 por ciento varones, 80,2 por ciento casados, 73,2 por ciento propietarios, 48,9 por ciento ejercen en núcleos urbanos, presión asistencial media de 40,5 ñ 16,5 pacientes/día.Los valores medios obtenidos fueron: DP, 8,3 ñ 5,8; PA, 35,2 ñ 8,4; AE, 22 ñ 11,3; un 65,8 por ciento presentó elevadas puntuaciones en alguna de las tres.Para AE las medias fueron significativamente superiores en varón, propietario, de centro urbano, más de 10 años de antigüedad o atendía a más de 40 pacientes/día.Un 50 por ciento presentaba alteraciones psicofísicas en los 3 meses previos; el 33 por ciento soporta mucha burocracia; ambos grupos muestran medias AE. Dedicar AE y ser tutor un nivel significativamente superior de burnout.Alteraciones en la esfera familiar o sociolaboral asocian niveles elevados de DP y AE (p < 0,001).Conclusiones. Coincidiendo con otros estudios, encontramos un nivel moderado de desgaste profesional en nuestros encuestados. La antigüedad, conflictividad sociolaboral y familiar, y ciertas características personales y laborales se asocian con niveles altos de desgaste. (AU)

[Alcohol consumption among students of the autonomous community of Extremadura]. / Consumo de alcohol en escolares de la comunidad autónoma de Extremadura.

OBJECTIVES: To find the number of drinkers, the relationship of their environment to the habit and attitudes to alcohol of Estremaduran children in the eighth year of EGB/second of ESO. DESIGN: Crossover descriptive study of a representative sample of the students in these school years. SETTING: All the schools in our autonomous community. PARTICIPANTS: 996 students belonging to various educational establishments. MEASUREMENTS AND MAIN RESULTS: We used a self-filled questionnaire with questions on the alcohol consumption of those being surveyed and their parents, siblings, friends and teachers. Other variables such as age, sex, parents' educational qualifications and other questions touching on the attitude to alcohol were included too. The subjects were 13-14 years old (54% boys and 46% girls). 15.50% were habitual drinkers and 54.43% occasional drinkers, with the number of boys predominating in the two groups (72.72 against 27.27% and 54.07 against 45.93%, respectively). Consumption was clearly higher in the father, siblings and friends of habitual drinkers (p < 0.05, p < 0.001 and p < 0.001, respectively). Parents of non-drinkers had higher educational qualifications. Habitual drinkers, and to a lesser degree occasional drinkers, displayed favourable attitudes to consumption and a positive association with alcohol consumption. CONCLUSION: Given their age, the percentage of drinkers is worrying and is linked to the presence of the habit in their closest social environment. The positive attitudes to alcohol consumption of our school students justify the introduction of prevention programmes.

Consumo de alcohol en escolares de la Comunidad Autónoma de Extremadura / Alcohol consumption by school-children in the autonomous community of Estremadura

Objetivos. Conocer la proporción de bebedores, la relación del entorno con el hábito y las actitudes hacia el alcohol en los escolares extremeños de 8.º EGB/2.º ESO. Diseño. Estudio descriptivo transversal de una muestra representativa de los alumnos de dichos cursos. Emplazamiento. Todos los colegios de nuestra comunidad autónoma. Participantes. Novecientos noventa y seis alumnos pertenecientes a diversos centros educativos. Mediciones y resultados principales. Utilizamos un cuestionario autoadministrado con preguntas sobre el consumo de alcohol en los encuestados, en sus padres, hermanos, amigos y profesores. También se incluyen otras variables, caso de edad, sexo, nivel educativo de los padres y otras preguntas referentes a la actitud hacia el alcohol. La edad de los encuestados es de 13-14 años (54 por ciento varones y 46 por ciento mujeres). Un 15,50 por ciento es bebedor habitual y el 54,43 por ciento bebedor ocasional; en ambos grupos es superior la proporción de varones (72,72 frente a 27,27 por ciento y 54,07 frente a 45,93 por ciento, respectivamente). La presencia del hábito es claramente superior en el padre, hermanos y amigos de los bebedores habituales (p < 0,05, < 0,001 y < 0,001, respectivamente). Los padres de los no bebedores presentan niveles educativos superiores. Los bebedores habituales, y en menor medida los ocasionales, muestran actitudes favorables al consumo y una asociación positiva con la ingesta de alcohol. Conclusiones. Considerando la edad, nuestra proporción de bebedores es preocupante y se asocia a la presencia del hábito en el entorno social más próximo. Las actitudes favorables hacia el consumo en nuestros escolares justifican la introducción de programas de prevención (AU)

[Tobacco consumption in school-children from the autonomous community of Extremadura]. / Consumo de tabaco en escolares de la Comunidad Autónoma de Extremadura.

OBJECTIVES: To find the number of smokers among school-children in Extremadura in the eighth year of EGB/second of ESO, the relationship of their environment with the acquisition of the habit and their attitudes towards tobacco. DESIGN: Crossover study of a representative sample of the students doing these courses. SETTING: All the schools in our autonomous community. PARTICIPANTS: 1062 students from various schools. MEASUREMENTS: We used a self-administered questionnaire with questions on the tobacco consumption of the interviewees, their parents, siblings, friends and teachers. The study included other variables, such as age, sex, alcohol consumption, parents' educational qualifications and other questions pertinent to attitudes to tobacco. RESULTS: The age of those surveyed was 13-14 (54% boys), of whom 18.27% were habitual smokers (95% CI, 15.95-20.59). Tobacco consumption was higher in boys (20.48% against 15.24% in girls; p = 0.05). The habit is clearly higher in friends, siblings, fathers and mothers of smokers (p < 0.001; < 0.001; < 0.001, and < 0.01, respectively), but not in teachers. Parents of non-smokers had higher educational qualifications. Smokers showed favourable attitudes towards consumption and a positive association with alcohol intake. CONCLUSIONS: Given their age, the number of smokers is high and is associated with the presence of the habit in their most immediate social environment. Attitudes in our school-children which favour consumption justify the introduction of prevention programmes.

[The lipid profile in the children and adolescents of Cáceres Province]. / Perfil lipídico en niños y adolescentes de la provincia de Cáceres.

OBJECTIVE: To analyse the lipid profile of the infant and young population of our province, and to compare our findings with those of other similar Spanish studies. DESIGN: A cross-sectional descriptive study. SETTING: School population from 2 to 16 years old in the province of Cáceres (N = 91083). PARTICIPANTS: A representative and proportional sample of 2150 children, with the two sexes at 50%. INTERVENTIONS: The total cholesterol (TC), HDL-C (enzymatic technique) and LDL-C (Friedewald formula) were determined. RESULTS: The mean values of TC, LDL-C and HDL-C (mean +/- SD) were 182.77 +/- 28.96, 114.19 +/- 26.54 and 57.31 +/- 13.97, respectively. Comparison of our lipid figures by age and sex with those of other Spanish studies (Fuenlabrada, Niño Jesús, Navarra and RICARDIN) and with the North American LRCP showed, in general, higher means of TC and LDL-C and/or lesser HDL-C levels in our population. CONCLUSIONS: Comparison with earlier studies shows that children from Cáceres have a more atherogenic lipid profile. Social and methodological differences may have affected the results. However, we think that, given the time elapsed since previous studies, the differences found may reflect progressive changes in the Spanish diet towards higher consumption of saturated fats.

[Prevalence of hyperlipidemia in children adn adolescents in the Province of Cáceres]. / Prevalencia de hiperlipidemia en niños y adolescentes de la provincia de Cáceres.

BACKGROUND: The lipid factor is currently considered to be the main agent responsible for cardiovascular risk in young individuals. This is already present during infancy in proportions that give rise to concern, and is growing, as has would seem to have been shown by several national studies. This study analyses the prevalence of hyperlipidemia in children within the province of Caceres according to several different criteria, and describes changes according to age groups and sex, comparing the overall results with those of other national studies. METHODS: A cross-sectional descriptive study of a representative and proportional sample of 2,150 children aged 2 to 6 years old in the province of Caceres (N = 91,083). The following were determined: total cholesterol, fractions, apolipoproteins and risk coefficients (enzymatic technique). RESULTS: 27.9% of children presented total cholesterol values of > 200 mg/dl; 7.5% of females and 4.7% of males had figures of more than 230 mg/dl. Levels of C-LDL > 130 mg/dl appear in 26.4%, Apo-B > 75 mg/dl in 65.5% and C-NO-HDL > 165 in 8.4%. C-HDL- < 35 mg/dl was found in 3.3% of individuals, while Apo-A < 100 mg/dl was only found in 0.3%. The ratios between CT/HDL > 3.5 and LDL/HDL > 2.2 were found to be 36.1% and 39.8%, respectively. The prevalence of hyperlipidemia is higher in females and pre-puberty stages. CONCLUSIONS: Overall, and independently of the criteria used, the proportion of cases of hyperlipidemia is high, and is above the levels cited in other Spanish studies. The prevalence of hyperlipidemia is highest in females before puberty, who display the most discriminatory risk coefficients, and best identify the change in the lipid profile at puberty.