[New devices of fecal diversion and collection: adverse effects described in the literature]. / Nuevos dispositivos de derivación y colección fecal: efectos adversos descritos en la bibliografía.

UNLABELLED: Among products for the management and control of faeces in patients with fecal incontinence, there are new devices that allow the diversion and collection of fecal matter. This study has aimed to know the complications related to these new devices described in the literature. METHOD: A search was made in the main bibliographic databases, obtaining publications on the new devices. The relevant documents were selected, these being those that described complications. After these were described. RESULTS: A total of 13 relevant documents were recovered. There were 45 adverse events 36 patients. Those having the greatest incidence were rectal bleeding (10 patients) and abdominal distension (6 patients). CONCLUSION: In order to provide the best patient care, it is essential to know the possible complications in order to be able to prevent them. The cares given these patients need to be reevaluated.

[Can we improve the therapeutic management of allergic rhinitis in primary care?]. / ¿Podemos mejorar el manejo terapéutico de la rinitis alérgica en atención primaria?

OBJECTIVE: To evaluate improvement in therapeutic management of allergic rhinitis. DESIGN: Study of level of quality (longitudinal, prospective, intervention). SETTING: Primary care. PATIENTS AND OTHERS PARTICIPANTS: First evaluation (second quarter of 1995): 73 out of 305 patients were sampled (confidence 5%, accuracy 10%). Second evaluation (second quarter of 1996). Sample of 51 patients from a total of 210. INTERVENTIONS: Explicit criteria and standard procedure, based on consensus, for rhinitis treatment and an overall indicator of the general quality of rhinitis management were analysed. Criterion 1 (C1): correctly scaled treatment; criterion 2 (C2): initial treatment of choice with inhaled corticoids; criterion 3 (C3): correct use of oral corticoids or immunotherapy; criterion 4 (C4): coadjutant therapy according to predominant symptoms. Corrective measures: ongoing training and routine use of guide to practice. STATISTICS: index of compliance with criteria, Chi squared and Fisher's Z tests of a tail to compare both evaluations. MEASUREMENTS AND MAIN RESULTS: First evaluation: index of compliance with C1 = 59% (CI +/- 11), C2 = 41% (CI +/- 11), C3 = 90% (CI +/- 6) and C4 = 83% (CI +/- 8). Criteria and summary indicator obtained better results in patients attended by allergists. Second evaluation with overall improvement: C1 = 68.6% (CI +/- 13), C2 = 57% (CI +/- 13), C3 = 94% (CI +/- 6), C4 = 98% (CI +/- 3). Significant differences for C4 and C2 (p < 0.05). Overall quality and quality of criteria improved for patients attended in our environment. The summary indicator went up from 35.6% to 57% (p = 0.019), with the quality levels (C1-C4) becoming the same as those of the patients with allergy attended and with significant differences in the first evaluation disappearing. CONCLUSIONS: Ongoing training and routine use of guides to practice enables the therapeutic management of allergic rhinitis in primary care to be improved.

¿podemos mejorar el manejo terapéutico de la rinitis alérgica en atención primaria? / Can we improve therapeutic management of allergic rhinitis in primary care?

Objetivo. Evaluar mejora del manejo terapéutico de la rinitis alérgica. Diseño. Estudio de nivel de calidad (longitudinal, prospectivo, de intervención).Emplazamiento. Atención primaria. Pacientes u otros participantes. Primera evaluación (segundo trimestre de 1995): entre 305 pacientes se muestrearon 73 (confianza, 5 por ciento; precisión, 10 por ciento). Segunda evaluación (segundo trimestre de 1996). Tamaño muestral de 51 pacientes de un total de 210.Intervenciones. Se analizaron criterios explícitos y normativos de proceso basados en consenso de tratamiento de rinitis y un indicador resumen de calidad de manejo global. Criterio 1 (C1): tratamiento correctamente escalonado. Criterio 2 (C2): tratamiento inicial electivo con corticoides inhalados. Criterio 3 (C3): correcta utilización de corticoides orales o inmunoterapia. Criterio 4 (C4): terapia coadyuvante según síntomas predominantes. Medidas correctoras: formación continuada y uso rutinario de guía para la práctica. Estadística: índice cumplimiento criterios, 2 y Z de Fisher con test de una cola para comparar ambas evaluaciones. Mediciones y resultados principales. Primera evaluación: índice cumplimiento C1 = 59 por ciento (IC ñ 11); C2 = 41 por ciento (IC ñ 11); C3 = 90 por ciento (IC ñ 6), y C4 = 83 por ciento (IC ñ 8). Los criterios y el indicador resumen obtuvieron mejores resultados en los pacientes atendidos por alergólogos. Segunda evaluación con mejora global: C1 = 68,6 por ciento (IC ñ 13); C2 = 57 por ciento (IC ñ 13); C3 = 94 por ciento (IC ñ 6), y C4 = 98 por ciento (IC ñ 3). Diferencias significativas para C4 y C2 (p < 0,05). La calidad global y de criterios mejoró entre los pacientes atendidos en nuestro ámbito. El indicador resumen pasó del 35,6 por ciento al 57 por ciento (p = 0,019), igualándose los niveles de calidad (C1-C4) a los de pacientes atendidos en alergia y desapareciendo las diferencias significativas de la primera evaluación. Conclusiones. La formación continuada y la utilización rutinaria de guías para la práctica permite mejorar el manejo terapéutico de la rinitis alérgica en atención primaria. (AU)

[Is stated income a valid indicator of the socioeconomic status?]. / Son válidos los ingresos declarados como indicador del nivel socioeconómico de la población?

OBJECTIVE: 1) To analyse the validity of the reply to the question on socio-economic income included in health questionnaires. 2) To identify other valid indicators of socio-economic status. DESIGN: Crossover and retrospective observation study. SETTING: Community (Molina de Segura Health District). PARTICIPANTS: 1,071 people over 18, selected by means of simple random sampling. INTERVENTIONS: Analysis of 16 questions relating to home furnishing, consumer goods and stated income. We used Factorial Analysis and the ji2 test. RESULTS: We identified three levels by means of the factorial analysis: a) basic--consisting of hot water, washing-machine, absence of damp patches in the house, individual heating and television. b) Intermediate--consisting of car, video and telephone. c) High--with dishwasher, domestic help and air-conditioning. On analysing the relationship between stated income and socio-economic status we detected association to p < 0.001. The basic level answered more often than expected that their income was less than 50,000 pesetas; the intermediate, between 50 and 100,000; and the high, over 101,000. CONCLUSIONS: 1) It is possible to identify the socio-economic profile of the general population by the belonging of selected of determined consumer items. 2) Stated income is a reliable indicator of socio-economic status. Despite a tendency to a low reply to the question on income, income is not generally under-declared.