Encuesta a la población para valoración y conocimiento de su percepción sobre actividades preventivas / Population survey to determine perceptions on preventive activities

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La selección del paciente de alto riesgo, punto de mira de la reducción del riesgo cardiovascular / The selection of high-risk patients, the objective for reduction of cardiovascular risk

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[Effectiveness of preventive activities analyzed within the framework of health centers involved in the Program for Preventive Activities and Health Promotion (PAPPS) of the semFYC. Group for the Evaluation of PAPPS]. / Efectividad de las actividades preventivas analizada en el ámbito de centros de salud adscritos al Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) de la semFYC. Grupo de Evaluación del PAPPS.

OBJECTIVE: To find the effectiveness of a programme of preventive activities for adults (hypertension, tobacco and alcohol) measured by the number of cases identified, the evaluation of the initial interventions and the degree of control over the identified factors. DESIGN: Retrospective study: review of clinical records. SETTING: Primary care. Multi-centre study: health centres from the whole of Spain. PATIENTS: 7562 clinical records of patients over 20, who participated voluntarily and were extracted by systematic sampling from 378 care units (doctor and nurse) at 85 health centres committed to the Programme of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC). The study period was from May 1 1995 to April 30 1997. MEASUREMENTS AND MAIN RESULTS: Age, sex, data on tobacco habit, alcohol consumption and blood pressure were obtained through a questionnaire (recording the actions taken, date of diagnosis, initial assessment and subsequent monitoring). 28.3% were tobacco-dependent, 6.9% consumed too much alcohol, and 22.2% had hypertension. About 20% cases of each risk factor were detected during the study period. Giving up tobacco was recorded in 7.6% of smokers, and giving up alcohol in 19.7% of excess drinkers. 78.6% of hyperintense patients had acceptable-optimum control. CONCLUSIONS: The number of cases detected shows that the PAPPS programme performs acceptably. The tobacco and drink given up and the hypertension control attained due to the intervention are similar to the published trials. The PAPPS is an effective programme for controlling risk factors in primary care.

Efectividad de las actividades preventivas analizada en el ámbito de centros de salud adscritos al programa de actividades preventivas y de promoción de la salud (papps) de la semfyc / Analysis of the effectiveness of preventive actions in health centres committed to the programme of Preventive Activities and Health Promotion (PAPPS) of the semFYC

Objetivo. Conocer la efectividad de un programa de actividades preventivas en el adulto (hipertensión arterial [HTA], tabaco y alcohol) medida por el número de casos detectados, evaluación de las intervenciones iniciales y el grado de control de los factores detectados. Diseño. Retrospectivo; revisión de historias clínicas. Emplazamiento. Atención primaria. Estudio multicéntrico: centros de salud de toda España. Población. Un total de 7.562 historias clínicas de pacientes de edad mayor de 20 años, extraídos mediante muestreo sistemático de 378 unidades asistenciales (médico + enfermera) de 85 centros de salud adscritos al Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) que participaron voluntariamente. El período de estudio fue entre el 1 de mayo de 1995 y el 30 de abril de 1997. Mediciones y resultados principales. Mediante cuestionario, se obtuvo: edad, sexo y datos sobre hábito tabáquico, consumo de alcohol y toma de presión arterial (consta la actividad, fecha del diagnóstico, valoración inicial y control posterior). La proporción de individuos con tabaquismo fue del 28,3 por ciento, de consumo excesivo de alcohol 6,9 por ciento y de HTA 22,2 por ciento. Alrededor de un 20 por ciento de casos de cada factor de riesgo fue detectado en el período de estudio. Estaba registrado el abandono del hábito en un 7,6 por ciento de fumadores y en el 19,7 por ciento de los bebedores excesivos. Un 78,6 por ciento de los hipertensos tenía un grado de control aceptable-óptimo. Conclusiones. El número de casos detectados indica un aceptable rendimiento del programa PAPPS. En cuanto al resultado de la intervención, los abandonos del hábito tabáquico y consumo de alcohol, así como el grado de control de la HTA son cercanos a los ensayos publicados. El PAPPS es un programa efectivo para el control de factores de riesgo en atención primaria (AU)

[The factors associated with a better compliance with the periodic health exam in adults. The Working Group of the Maresme Group of Nurses and Physicians for Evaluation and Research (the IMMAR Group)]. / Factores asociados con una mejor cumplimentación del examen periódico de salud en el adulto. El grupo de trabajo Grup d'Infermeres i Metges del Maresme d'Avaluació i Recerca (IMMAR Grup).

OBJECTIVE: To analyse specific care and user factors associated with adult compliance with preventive activities: blood pressure measurement, and questionnaire on tobacco and alcohol consumption. DESIGN: Descriptive crossover study. SETTING: Primary health care, rural setting. PARTICIPANTS: Randomised sample of 296 clinical histories of people aged 15 and over from the basic care units (BCUs), who voluntarily enrolled for the study and belonged to 4 health districts. The characteristics of the professionals taking part was also studied. MEASUREMENTS AND MAIN RESULTS: The data of each clinical history were obtained through a specific questionnaire; data of doctors and nurses, through a self-administered questionnaire. In the bivariate analysis of the patient's characteristics, female gender, chronic diseases, age, frequency of attendance and length of the clinical record were associated with better compliance with preventive activities. After multiple regression, only frequency of attendance and length of the clinical record were still associated with better compliance with preventive activities. Out of the BCU variables, pressure of attendance, work situation and in-work training were associated with better preventive practice. CONCLUSIONS: Frequency of attendance is the variable which most determines preventive practice, and so organisational systems have to be developed which increase preventive practice among young people and users who attend little. In the area of care, reforms aimed at decreasing attendance pressure and increasing job stability should be prioritised.

[Description of the habits of agricultural workers in relation to the applying of pesticides]. / Descripción de los hábitos de los agricultores en relación con la aplicación de plaguicidas.

OBJECTIVES: To find the habits of farm-workers when they apply these products, to detect dangerous practices, to find the most important defects in farm-workers' protection and to analyse the personal variables associated with the level of self-protection. DESIGN: Descriptive cross-sectional study. SETTING: Primary Care. Rural Health Centre. PARTICIPANTS: Farm-workers and spouses in our Health Area who underwent a health examination. MEASUREMENTS AND MAIN RESULTS: A questionnaire was designed specifically for the study and filled out by the doctor or nurse at the centre where the person interviewed was registered. 72.8% of the farm-workers had inadequate protection. 79.3% said they had suffered on some occasion symptoms related to pesticide use. CONCLUSIONS: In the rural health areas where there is intensive agriculture, exposure to pesticides is a major health problem, as these substances are hazardous and people applying them wear inadequate protection. Action strategies in this field involve integrating health at work services into health centres. Health education tasks have to be coordinated with the agricultural organisations in the area, such as associations for the defense of plants, cooperatives, etc.

[Symptoms related to the use of agricultural pesticides. The perspective from the primary care service]. / Síntomas relacionados con el uso de plaguicidas agrícolas. La perspectiva desde la consulta de atención primaria.

OBJECTIVE: To find whether agricultural workers seen in the general medical clinic attend due to symptoms connected with the use of pesticides. DESIGN: A crossover descriptive study comparing agricultural workers with a control group. SETTING: Primary care. PARTICIPANTS: The clinical histories of 40 agricultural workers and a control group (sample of 58 paired for age and gender) who had been seen over the previous year. MEASUREMENTS AND MAIN RESULTS: Age, gender, frequency of attendance, motives for consultation, risk factors and the number of consultations for symptoms possibly due to exposure to pesticides--in line with a previously composed list. There were no differences in frequency of attendance, overall reasons for consultation or risk factors. It was seen that agricultural workers consulted 4 times more than the control group for suspected pesticide poisoning (p = 0.0015). CONCLUSIONS: In our health area agricultural workers present symptoms which should probably be attributed to insufficient protection against pesticides. The primary care doctor working in rural zones where these products are heavily used must be able to identify these symptoms and take appropriate measures.

[Clinical records: our experience during the 1st year]. / Historiar a la población: nuestra experiencia a lo largo del primer año.

OBJECTIVE: To describe the evolution of attendance indicators over a period of a year on introducing a new model of health care. DESIGN: Observational and descriptive. SETTING: A local primary health care consulting-room. PARTICIPANTS: Population in the census, population requesting care, population with medical records, the number of visits and reasons for attendance. INTERVENTION: The introduction of clinical records, medical and nursing consultations by appointment, long-treatment booklets and a basic recording system. MAIN RESULTS: 54% of the population was recorded. Morbidity indicators, the first and subsequent visits and the number of prescriptions per patient were all stable. The percentage of bureaucratic reasons for attendance went down and the proportion of scheduled attendances increased. Requests for complementary tests and referrals to specialists also increased. CONCLUSIONS: The greatest effort in opening clinical records took place during the first four months. The most telling indicators of the evolution of attendances are the percentages of bureaucratic visits and scheduled ones, the requests for complementary tests and referrals to specialists. Other common attendance indicators have contributed no additional information, yet have supposed a greater effort of data-gathering.