Atención Primaria

To compare the local and systemic reactogenicity of two vaccine associations in infants, in order to ascertain if a greater volume of injection is associated with a greater adverse effects rate. Intervention study, without random distribution. Site. A unit of vaccinations with free access and public dependency. 228 infants (138 male, 90 female) aged 2, 4 and 6 months that were attending to compliment their vaccine schedule. To those aged 2 and 6 months (group 1: 108 children) it was administered the association DTPw + Hepatitis B + Hib (Tritanrix-HB + Hiberix) with a volume of injection of 0,5 ml, and to those aged 4 months (group 2: 120 children) the association DTPw + Hib (Anatoxal Diteper + Hibtiter) with a volume of 1 ml. The injection was applied in the thigh and paracetamol was indicated in the following 24 hours. Adverse reactions were registered through telephonic interview, and nursing visit of those which might have presented some one. There were not meaningful differences between both associations in signs or symptoms analyzed (pain, inflammation, aseptic cyst, fever, behavior alterations, diarrhea, encephalopathy, hypotonic-hyporesponsive episode or inconsolable weeping). With both associations the local reactions rate (0% of inflammation or aseptic cyst) and fever (10%) were very inferior to the previous published data. The vaccine association with a volume of injection of 1 ml did not produce more adverse effects than the association of 0,5 ml. Both produced a number of local reactions and fever much less than previously published, what is attributed to the prophylactic use of paracetamol and other preventive measures. Therefore, the association elected for the vaccination at 4 months (DTPw + Hib with a volume of 1 ml) is useful and practical to improve vaccine coverage and for the welfare of vaccinated infants, upon avoiding them an injection and without provoking more adverse reactions.

A comparative analysis of the different models of adult case history at primary care (PC) level available in the Spanish state. Their degree of homogeneity, both in design and information-gathering capacity, was evaluated. A descriptive study. Eleven individual adult PC cases histories, still open in 1991. Only four of the models allowed more than 75% of the basic data to be gathered. Three histories had up to six loose pages. In six, the presence of specific records was verified. There is a lack of standardisation both in the designs of case histories and in the information which these allow to be gathered. Information was scattered because of the presence of specific records and of loose pages. Systematic inclusion of preventive activities into the records is not sufficiently normalised.

To find the clinical and epidemiological characteristics of HIV-positive patients and to study the possible differences between patients attended by primary care teams (PCT) and by the hospital specialist unit (SU). A descriptive cross-sectional study. Six PCTs in Villaverde, Usera and Carabanchel (Madrid). Those infected with HIV and in the morbidity records between January 1992 and January 1995. 274 cases were studied. The most important risk practice was being IDU (intravenous drugs user) (80.3%). The most definitive and linked AIDS-related illness was Tuberculosis (39.7%). Patients treated with Zidovudine (or AZT) were monitored by PCTs (p = 0.004), as were those not needing day-hospital treatment (p = 0.0005). HIV infection in our environment follows the typical clinical and epidemiological pattern of this country: transmitted by IDUs, with its most frequent associated infection being tuberculosis. With the exception of AZT or day-hospital treatment, its clinical and epidemiological features are similar in PCTs and SUs. Information and responsible participation of PCT professionals in caring for HIV-positive patients are the key strategies for guaranteeing the quality of health care delivery.

The aim of this study is to analyse the validity and reliability of the functional social support questionnaire, Duke-UNC-11. Descriptive. Crossover study. Urban health centre. 656 patients were interviewed in their homes. 60 had the questionnaire repeated (30 self-filled and 30 using an interviewer) an average of 6 days later. The intraclass correlation coefficients of the 11 items in the Duke-UNC-11 were above 0.50, for both self-filled and interviewer questionnaires; the ones on the scale were 0.92 and 0.80, respectively. The factorial analysis separated two sub-scales, confidential support (7 items) and affective support (4 items). Low social support was significantly associated to: being over 40, widowed or divorced, living alone, over-user, worse subjective health, greater chronic morbidity, mental health disorder and family dysfunction. The multiple linear regression equation managed to explain 30% of the variability of social support, in which family function (family APGAR) explained 23.5%, education 3.3%, perception of internal health control 2%, mental health 1.2% and perception of susceptibility to/seriousness of illness 0.3%. The questionnaire Duke-UNC-11 is valid and reliable.

To explore intentions, motivations and country preferences related with professional emigration in a sample of advanced medical students. Cross sectional and descriptive study. 11 Universities in Spain. A total of 740 students in their two final courses. PRIMARY MEASUREMENTS: The survey used a self administered questionnaire asking about plans to emigrate, preferred destination countries and reasons for wishing to work abroad. A total of 740 valid questionnaires were collected, 711 (96%) from Spanish students and 26 (4%) from foreigner students. A preference to move abroad was indicated by 375 (51%) students, the most popular destinations being United Kingdom, USA, Canada and Portugal. The answers were classified using categories from "very important" to "not important". As a "very important" reason, "To work in a better health care system" was chosen by 276 students, "To continue with my medical education and training" by 160, "To work in an environment that allows me to progress" by 269, and "To earn a better salary" by 243 students. The study illustrates various motivational factors which of why medical students wish to move abroad in search of better professional conditions. The use of appropriate interventions could modify these attitudes. This study could be a starting point for exploring and analyzing the conditions of undergraduate medical students in Spain as a key to address the problem of medical emigration.

To evaluate the profile epidemiology and social of the patient with AIDS in our environment and the direct relation with primary care. A descriptive, analytic and retrospective study. The study was carried out in the Miguel Servet Hospital in Zaragoza. Patients with AIDS between January 1991 and june 1993 and who fulfilled the requisite diagnostic criteria. Out of the 127 patients studied, 74.8% were male and the age was 20 to 30 years old. The transmission mechanism was blood way in drug addicts in 63.8% and heterosexual way in 14.8%. It was socioeconomic problems in 40.94%, and 69.23% of them were drug addicts. The familiar support were proved in 29.13% and had relation with primary care only 15.74%. An increase of the incidence of AIDS is observed, prevailing men between 31-40 years old. The heterosexual way transmission is increasing, but the blood way in drug addicts is more frequently. The majority presents socioeconomic problems and they haven't familiar support.

Objetivo: El objetivo principal es evaluar el comportamiento del grupo relacionado de diagnóstico (GRD) 127 (insuficiencia cardíaca; ICC) en Andalucía durante el año 2002 en pacientes mayores de 45 años. Los objetivos secundarios son determinar la variabilidad en función del sexo y los factores asociados con una estancia superior a la media. Diseño: Estudio descriptivo, transversal y no concurrente. Participantes: Se seleccionó a todos los pacientes mayores de 45 años ingresados en Andalucía bajo el GRD 127 –ICC– durante el año 2002, para lo cual se utilizó como fuente el CMBD de dicho año. Las variables principales analizadas fueron: edad, sexo, estancia, número de diagnósticos al alta (NDA), número de procedimientos efectuados al alta (NP), estancia superior a la media (ESM) considerando como tal aquella superior a 9,6 días. Resultados: Se analizaron 7.893 ingresos, de los que el 58% eran mujeres. La media de edad fue de 75,98 ± 0,14 años para las mujeres frente a 72,29 ± 0,17 años para los varones (p < 0,0001). Estancia: 8,2 ± 0,12 días en las mujeres frente a 7,03 ± 0,12 días los varones (p < 0,0001). El 93,5% de los pacientes ingresó de modo urgente y el 93,1% procedía del sistema de Seguridad Social. La tasa de muerte fue del 8,5%. NDA: 1,97 ± 0,3 diagnósticos en mujeres frente a 2,02 ± 0,3 diagnósticos en varones (p < 0,0001). NP: 1,96 ± 0,22 procedimientos en el alta en mujeres frente a 1,52 ± 0,26 procedimientos en varones (p = 0,01). Los principales descriptivos del subgrupo de pacientes con ESM pueden observarse en la tabla 1. El 39,2% de las mujeres tiene ESM, frente a un 35,1% de varones (χ² = 13,33; p < 0,0001). El 33,6% de los pacientes con estancias superiores a la media pertenece a la franja etaria de 65 a 74 años, frente a un 31% que no cumple ESM (χ² = 10,18; p < 0,037). Un 80,9% de ESM tiene ≥ 5 diagnósticos frente a un 19,1% que tiene ≥ 4 diagnósticos, (χ² = 50,34; p = 0,004). El 61,8% de las muertes corresponde a mujeres, frente a un 38,2% de varones (χ² = 3,95; p = 0,047). Conclusiones y discusión: En nuestro análisis ingresan por ICC más mujeres, con una edad, una estancia media, una tasa de muertes y un NP al alta superiores a los de los varones, pero menor NDA. Se detectan como factores asociados presentar ESM, pertenecer a la franja etaria 65 a 74 años y tener más de 5 diagnósticos en el momento del alta. La ICC es un síndrome complejo, con una incidencia y una prevalencia crecientes, ligadas de un modo directo a la edad1,2; no obstante, otros factores condicionantes como la hipertensión arterial, las dislipidemias, las miocardiopatías, etc., condicionan un incremento constante³. Aunque tradicionalmente se ha considerado que la prevalencia es mayor en varones⁴, los datos de este estudio indican que la población femenina, dadas sus mayores expectativas de vida y longevidad, constituye el grupo mayoritario, hecho ya objetivado en múltiples publicaciones. Creemos que esta mayor edad media podría explicar la mayor estancia media, tasa de muertes y NP.

A study on 132 families where a lambliasis case was diagnosed is presented. An epidemiological investigation in each family was made; faeces were analyzed to find Lamblia carriers. The total number of investigated persons--lambliasis cases excluded--was 405; 30 of them (7.4%) were positive. Between people younger than fifteen the percentage of positive test was 14.7%, while over this age the rate of affectation was 4.2%. There is an statistic association with the assistance to child school. No correlation with sex or another determinant factors was found. Carriers treatment was successful in 96.1%.

Tobacco is the first addictive substance that adolescents and school-children have contact with. The presence of family members and friends as smokers in their environment is related to tobacco experimentation. To describe experimentation and consumption of tobacco in secondary school students (ESO); to identify the attitudes related to smoking; and to study the relationship between smoking by family members, friends and teachers and students' own experimentation and consumption. Observational, prospective study at the "Los Cantos" secondary school, Bullas, Murcia, Spain. Population: students from the first, second and third years of ESO, analysed in December 2000 and 2001. The variables studied were collected with the FRISC questionnaire. The population had 529 students, 293 of them boys, with average age 13.2. A total of 328 had smoked sometime (62%) and 19.1% smoked habitually. Attitudes related with smoking were: "smoking makes you feel better" (P<.001), "smoking is fun" (P<.001), "smoking helps to make friends" (P<.001) and "I'd accept a cigarette from a friend" (P<.001). Tobacco experimentation was related to friends/companions smoking (OR=2.402; 95% CI, 1.591-3.628), to the presence of a mother and older siblings smoking (OR=2.703; 95% CI, 1.574-4.642), and to the presence of friends/companions smoking (OR=6.342; 95% CI, 3.102-12.964). Experimentation and consumption of tobacco in the population studied is very high. The most important risk factors for students smoking are the conduct of friends and of older siblings.

A clinical evaluation of Sarcoidosis in our environment. A retrospective and descriptive analysis of 14 cases encountered between 1988 and 1990. SITE. In-hospital patients studied within a catchment area of 200,000 people. 13 women and 1 man ranging in age from 24 to 63 (X = 37. DS 13). All of them were confirmed histologically. Six patients received V.O. steroid treatment. 28.5% started as Nodose Erythema, 28.5% as Respiratory Syndrome, 21% as general Toxic Syndrome. 35% were without clinical symptoms; 25% Arthralgias, 21% cough. Thoracic X-ray with bilateral hiliar adenopathies 78%; interstitial pattern 28.5%. Analytically, Monocitosis was presented in 43%; Anaemia, Hypergammaglobulinemia, rise in Transaminases in 35%; a normal ACE in 50% and raised ACE in 35%. There was a positive pulmonary Cammagraphy (Galio) in 50%. Diagnostic confirmation was made by means of transbronchial B (28%), Mediastinoscopy (14%), open Pulmonary B. (14%), Hepatic B (14%), osseous B. and Daniels (14%) and peripheric adenopathy B (14%). Pulmonary circulatory capacity (DLCO-KCO) was decreased in 3 cases. Statistic 1, 71%; 11, 14%, 111, 14%. Sarcoidosis is not so rare in our environment as had been thought. Factors such as a Northerly geographical situation, low temperatures, the long duration of the disease, improvement in diagnostic methods and a high level of awareness have all influenced this high number of cases found in an area of 200,000 inhabitants. The disease's clinical behaviour in our environment does not differ from that described by other spanish and foreign authors.

Identification of factors associated with suffering Acute Respiratory Infections (ARI). A descriptive study using a direct survey. "El Naranjo" Primary Care team, Area 9 Madrid. 362 patients between 0 and 14. 362 interviews were carried out, covering items connected with personal background, living conditions, situation and quality of life and activities, 180 patients attending with clinical symptoms of ARI were interviewed, as well as 182 who attended during the same period for other reasons. The profile of the patients interviewed was mainly: females between 6 and 10, with more history of catarrh than any other pathology, and who had taken aspirin to treat symptoms and mainly Penicillin as an aetiological treatment. They lived in homes measuring 100 square metres, with three bed-rooms which were shared in the main by two people, and had one brother aged between 1 and 9. No protective factors against ARI were found in the group of children studied.

Objetivo: Analizar las manifestaciones clínicas, las enfermedades alérgicas concomitants y las concentraciones de anticuerpos IgE e IgG específicos en los casos diagnosticados de alergia al toxoide tetánico, en una consulta de alergia durante un período de 15 años (1990-2005). Diseño: Estudio descriptivo. Emplazamiento: Servicio de alergia. Hospital Universitario La Fe. Valencia. Participantes: Se ha estudiado de forma consecutiva a 14 pacientes con edades comprendidas entre los 18 y 60 años, que fueron remitidos para estudio por haber presentado síntomas alérgicos tras la administración previa de toxoide tetánico y precisar revacunación.Todos los pacientes han seguido control en régimen ambulatorio en nuestro servicio. En todos ellos se confirmó hipersensibilidad mediada por anticuerpos IgE frente al toxoide tetánico y sedescartó hipersensibilidad a otros components de la vacuna mediante pruebas cutáneas y epicutáneas con timerosal y fosfato de aluminio. Mediciones principales: Se han analizado retrospectivamente las historias clínicas, las características clínicas y biológicas de la reacción, y las enfermedades alérgicas asociadas. Se realizaron pruebas cutáneas con toxoide tetánico (prick puro e intradermorreacciones al 1/100). Se determinaron las concentraciones séricas de IgE total y específica frente a toxoide tetánico mediante ELISA (UNICAP®, Pharmacia, Suecia), así como las concentraciones de anticuerpos IgG frente a toxoide tetánico (ELISA). Resultados: Los principales datos analíticos y biológicos de los pacientes se recogen en la tabla 1. La edad media ± desviación estandar de presentación de la primera reacción adversa fue 39,2 ± 12,6 años. La media de la IgE sérica total fue de 147 ± 12,1 kU/l; la media de IgE específica frente al toxoide tetánico, de 4,2 ± 5 kU/l, y la media de IgG, 3,9 ± 1,9 U/ml. La prueba cutánea fue positiva en 8 pacientes con respuesta inmediata y en 2 de ellos con reacción tardía. La reacción adversa más frecuente fue una reacción local exagerada (57,1%), definida como la aparición de edema y rubefacción posvacunal que afectaba a las 2 articulaciones adyacentes al lugar de inyección. Un 28,6% presentó fiebre y urticaria. En el 21,4% de los casos apareció angioedema. Ningún paciente había presentado cuadros anafilácticos graves, con compromiso respiratorio o cardiovascular. Todos los pacientes presentaron titulaciones de anticuerpos IgG en un rango protector¹. Discusión y conclusiones: Las reacciones adversas al toxoide tetánico abarcan desde el enrojecimiento y el edema limitados al lugar de administración hasta fiebre, cuadros de urticaria generalizada e incluso se han descrito casos de reacciones anafilácticas graves². El toxoide tetánico se administra a menudo como tratamiento profiláctico de la infección tetánica y contiene, además del toxoide tetánico, otros agents que pueden ser potencialmente antigénicos, como el tiomersal y el fosfato de aluminio². Aunque esta vacuna se ha utilizado ampliamente, las reacciones de hipersensibilidad inmediatas son excepcionales y la incidencia de reacciones anafilácticas a lainmunización se ha establecido en torno al 0,001%³. Estas reacciones se deben al desarrollo de anticuerpos IgE específicos, cuya presencia puede evidenciarse por medio de tests cutáneos o estudios serológicos³. Sobre los efectos a largo plazo de la vacunación antitetánica, se ha observado que a los 10 años de la última dosis de la vacuna, el 71-87% de los que recibieron 3 dosis estarían protegidos⁴ con valores protectors (> 0,01 U/ml) de IgG específica frente al toxoide tetánico. En los casos que se han estudiado, las concentraciones de IgG específica se encontraban por encima del valor protector. Por ello se consideró innecesario revacunar a los pacientes, evitándose así los riesgos que implicaría la readministración del toxoide. En cualquier caso, los pacientes alérgicos a toxoide tetánico que hubiesen mostrado concentraciones no protectoras de anticuerpos podrían haber recibido un protocolo de desensibilización⁵. Es importante también señalar que se pueden detectar anticuerpos IgE específicos hasta en la mitad de los individuos inmunizados; sin embargo, este hallazgo no se correlaciona con el desarrollo de reacciones de hipersensibilidad⁶. Se considera de especial interés detectar a los pacientes con historia de reacciones alérgicas frente al toxoide tetánico y con una profesión de riesgo para contraer la infección tetánica (veterinarios, carniceros, jardineros, personal sanitario, etc.), puesto que en ellos sería necesaria con más frecuencia una revacunación. Proponemos realizar en estos casos un estudio alergológico orientado hacia la detección de anticuerpos IgE específicos frente al propio toxoide, así como a los excipientes que puedan incluirse en la vacuna y la determinación de anticuerpos IgG frente al toxoide tetánico.

To analyse the evolution over the last six years of the nutritional state of the current adolescent population (10-14 years old) of our health area in order to identify risk groups and to draw up specific therapeutic strategies. Observational, retrospective and longitudinal study. Systematic and stratified sampling. Rural primary care. Sample of 360 healthy adolescents, aged between 10 and 14 (176 boys and 184 girls) out of a sample frame of 811. Interventions. During the 1999-2000 school year (year 2000), weight, height, Quetelet index (QI) and Body Mass Index (BMI) of one in every three young people at their routine health check-up were recorded. Those with acute and/or chronic pathology that might affect their nutritional state or with dietary restrictions of any sort were excluded. The weight, height, QI and BMI of the check-ups 2, 4 and 6 years previously (1998, 1996 and 1994) were also recorded. In the year 2000, 17.5% and 16.4% of the young people evaluated had excess weight and obesity, respectively. Between 1994 and 2000 there was an increase (p < 0.05) in obesity (5.9% against 16.4%). 31.8% of the obese young people in the year 2000 were already obese 6 years previously, 18.2% were normal then, but 50% of them were already overweight in 1994. There were no significant differences between sexes. In the year 2000, 33% of adolescents between 10 and 14 in our health area had a BMI that suggested excess body fat. As excess weight in school students supposes a situation of risk of obesity in adolescence, this demands follow-up and preventive activity.

To study the prevalence of depletion of organic iron stores, ferropenia and ferropenic anemia in the adolescent population in a health care district in northern Spain. Design. Cross-sectional, with systematic sampling. Primary health care service in a rural setting. Sample of 204 healthy adolescents aged 10.0 to 14.0 years; 93 males, 111 females. Familial and personal antecedents, physical activity, date of menarche, weight, height and body mass index, hemoglobin (Hb), mean corpuscular volume (MCV), transferrin saturation index (TSI) and serum ferritin (SF) were recorded for 1 out of every 4 adolescents who visited the health center for a regular check-up. Positive C-reactive protein or erythrocyte sedimentation rate were criteria for exclusion. Iron stores were considered to be depleted when SF was < 12 ng/dL, ferropenia was said to exist when, in addition, TSI was < 14% or MCV was < 75 fL, and ferropenic anemia was said to exist when, in addition, Hb was < 12 g/dL. Some stage of iron deficiency was found in 8.6% of the males and 12.6% of the females. Iron stores were depleted in 2.2% and 6.3%, respectively; ferropenia was found in 3.2% and 3.6%, respectively; and anemia was found in 3.2% and 2.7%, respectively. There were no significant differences between the sexes. In adolescents aged 10 to 14 years in our health care setting, iron deficiency was relatively common. Health care programs for children and adolescents should aim specifically to prevent, detect and control iron deficiency.

During the last 5 years (1982-1986), a diagnosis of primary bronchopulmonary cancer was made in 157 patients. The mean rate of incidence for males in our province was 25.7 per 100,000 and per year. Among patients with neoplasia, the rate of smokers approached 100%. There was a direct relation between younger age at presentation and higher number of cigarettes per day. In ex-smokers the clinical development of the disease was later than in current smokers. The results regarding the following variables are also reported: professional background, past history, initial symptoms, time to diagnosis (for each histologic type) and radiological findings.

To determine the epidemiological and clinical characteristics of children with Cryptorchidism in our milieu. Crossover study. Specialist care. 159 children referred from Primary Care for a Cryptorchidism study. Average age of detection: 1.5-3 years. Laterality: 120 unilateral (73 right and 47 left) and 39 bilateral. Family history of Cryptorchidism in 33 cases (20.7%). 68 children (42.7%) had some anatomical malformation associated with poor testicular descent. This percentage was significantly higher in children with bilateral Cryptorchidism than with unilateral (61.5% vs 36.6%; p < 0.05). Nine children defined with multiple malformation syndromes. Location of the testes after palpation: 29.3% not able to be palpated, 22.7% high inguinal, 23.2% low inguinal, 17.1% sliding, 5% retractile and 2.5% scrotal. All cases showed normal in the hormonal study, except one case of Hypogonadotropic Hypogonadism. The diagnoses of Cryptorchidism were not early. Family history and associated malformations in the body himself often exist. Hormonal levels are normal. Echography is of little use in locating testes that cannot be palpated.

To describe the evolution of the Balint group (BG) of the Primary Care team at Galdakao (Vizcaya) during 1992 through the analysis of 16 cases. A retrospective, descriptive study. A psychoanalyst, three paediatricians, three Family and Community medicine third-year residents, a psychologist and eight family doctors. The total number of members of the BG was 16. The evaluative notes of the sessions held were analysed through study of the variables: number of sessions, control of timetable, attendance, age, gender, patient's personal and family case histories, the apparent cause of presentation, its objective and the group's summarised contributions. Results are: 1) Filling-in of 16 evaluative notes out of a total of 24 cases presented (66.7%). 2) The holding of 100% of the planned sessions. 3) The presence of psychopathological personal and/or family histories in 100% of the new cases. 4) Scant number of elderly people or adolescents presented (one and zero respectively). 5) The character of the BG was participatory, interpretative and practical. 6) The type of conflicts presented were summarised in 5 areas: maternity, couple and family, patients and complex situations, mental illness and conflicts of the doctor and/or institution. 1) The system of data-gathering employed needs changes (16 notes out of 24), as it limits the scope of the results. 2) The low number of elderly people and adolescents presented suggests difficulties in these groups for the doctor. 3) Psychiatric cases suppose a relative weight in this field as generators of conflict, with those coming from a variety of situations of normal clinical practice being more numerous. 4) The BG affects the doctor's personality, making him/her both more sensitive and more capable of reflecting on conflictual situations in everyday clinical practice.

We report a clinical and epidemiological study of 164 cases of complex urinary calculi which were seen in our hospital between 1984 and 1988. The highest incidence was found in patients aged between 40 and 50 years, with a female:male ratio of 1.27/1. In 37% of patients there were first degree relatives with calculi. The most common type were calculi with a calcium component, with a remarkably high proportion of struvite calculi and a low one of uric acid. Housewives had a high rate of struvite calculi associated with infections during pregnancy. Qualified professions have been associated with calcium oxalate and phosphate calculi. 13% has congenital renoureteral malformations, 4% had hyperuricemia and 1.2% had hyperparathyroidism. Pain was the most consistent symptom, followed by fever and urinary tract infection. 50% of patients had previously passed stones. 90% of calculi were visible in the plain abdomen X-ray film. 65% of patients required aggressive therapy.

To find out the opinions of health professionals on adolescent alcohol drinking and their evaluation of the existing legal regulation measures. Design: Qualitative and exploratory study, based on semi-structured interviews. Setting: Four cities representing four different regions in Spain: Palma de Mallorca, Granada, Barcelona and Pamplona. Participants: A total of 36 physicians and nurses from four Spanish regions, working in Primary Care and Emergency Care, selected by intentional samples. Measurements: A total of 36 deep interviews, analysed using the software Nudist Vivo 4.0. Health professionals accept their important role in preventing and intervening in adolescent alcohol drinking. Generally, they consider it as a public health problem. Prevention is associated with Primary Care, while the Emergency Departments act in specific situations of alcohol abuse. Adolescents infrequently visit Primary Care, thus prevention must centre on education system and constant coordination between health professional and parents. Health personnel do not have sufficient knowledge on legal regulations. They consider educational measures as more efficient than sanctions. Specific professional training is required in order to guarantee the coordination between the health and education systems and the family.

To find the prevalence of urinary incontinence (IU) in women of working age and its impact on their quality of life (QL). Descriptive, cross-sectional study. Urban health district in Ourense. 1000 women between 18 and 65 were selected at random from a total of 8443. The prevalence of UI was evaluated by means of a questionnaire designed for the study and sent by mail. In addition, the Incontinence Impact Questionnaire translated into Spanish was used. This was to assess QL in women with UI. The reply rate was 43.6%, with 20% prevalence of UI. Mean age of the women studied was 43.4 (95% CI, 42.1-44.6); and for those with UI, 50.3 (95% CI, 48.4-52.4). 56.8% of women with UI had not been to the doctor. Mean score of impact on QL (from 0 to 90) was 12.7 points. 87.7% of those affected scored less than 30 points; and 1.5% were above 60 points. High prevalence of UI was found in women of working age, with low rate of medical consultation, probably because for most women it only lightly affected their QL.

The dynamic demography of the village of Aldeavieja (Avila) from 1900 to 1985 was evaluated with several indicators. A reduction in mortality rate was found, stabilizing around 10% since 1950, with a greater reduction in mortality rates in children. From 1900 to 1985 the Swarop index rose from 34.55% to 92.86%, and life expectancy from 30.13 to 77.5 years. The most common causes of death were infectious diseases during the first decades of the period, being now replaced by tumors and chronic diseases. There was a great demographic loss and the population became older (17.59% are now older than 65 years). It was concluded that a knowledge of dynamic demography is needed for a rational planning and an adequate resource allocation based on needs.

To establish the relative weight of the various kinds of primary health care (PHC) research collected in the IME (Spanish medical index), In order to determine their possible relationships with Spain's PHC model. Bibliometric analysis. PHC documents (1971-1994) from the IME data base (CD-ROM), subdivided by years, journals, themes and Autonomous Communities (AC). 3,015 studies were published, with a first phase (1970s) of under 10 documents per year, a second (1980s) with a big increase and a third (1990s) of stagnation. Of the 117 journals containing studies, Atención Primaria gave a home to almost 58% (60% after 1984). PHC research production has stagnated recently, though the journal Atención Primaria has maintained its undisputed leadership position. The clinical model predominant in Spanish medicine is generally followed.

To describe mortality due to lung cancer in those over 24 by sex, age, birth cohort and year of death in Andalusia between 1975 and 1997. A descriptive population-based study. Andalusia between 1975 and 1997. All those residing in Andalusia during the study period. The following indicators were calculated: gross rates, rates adjusted by age of death and rates of potential years of life lost. The European population was used as reference, with specific rates for age-groups and year of birth. Poisson models were used to quantify trends and annual percentages of change both for the entire period and for the 23 years studied. Death from lung cancer in men during these years increased markedly. Age-adjusted rates went up from 77.37 deaths per 100,000 persons per year in 1975 to 121.92 in 1997. However, in women, there was a small drop from 10.19 to 8.22 deaths per 100,000 persons per year over the same period. Men suffered 7.59 times more mortality than women in 1975, reaching 17.25 times more in 1994. Age had a clear relationship to lung cancer mortality: the older the population, the greater the death-rate. In men there was an ascendant cohort effect until the generation born between 1950 and 1959, from which time the effect is unclear. Women had a descending cohort effect, with high variability between one generation and another. Death from lung cancer in Andalusia between 1975 and 1997 increased in men in transversal terms, whereas in women it went down. However, the analyses of birth cohorts show signs of changes in the most recent generations, although age, in both men and women, is the variable most closely related to mortality.

To describe the evolution of mortality due to traffic accidents in Andalusia between 1975 and 2001 and to predict the mortality rates for 2004. Ecological study with a population base. Residents in Andalusia between 1975 and 2001. Deaths due to traffic accidents in Andalusia between 1975 and 2001. Main measurements and results. Mortality rates adjusted for age in men and women and in three groups: under-35s, from 35 to 64, and over 64. The evolution of rates over time was studied through trend analysis. Short-term predictions of the mortality rates were made. The adjusted rates for men fell from 21.20 per 100000 inhabitants in 2001 to 20.21 in 2001. The rate for women fell from 4.87 to 4.60 during the same period. The evolution of mortality was similar for both sexes. Traffic accident mortality evolved in an oscillating way, with an important fall in numbers starting in 1989. Mortality rates increased with age. The predictions formulated indicate that the stable trend starting in 1995 will remain the same in the coming years.

To describe the evolution of mortality due to ischaemic heart diseases in Andalucia between 1975 and 1992 and predict rates up to the year 2000. Descriptive study. The Autonomous Community of Andalucia. Patients and other participants. Deaths because of ischaemic heart diseases between 1975 and 1992 were obtained. The direct method was used for the standardisation of mortality rates for age and sex, with the European population as the standard. Logarithmic transformations of the standardised rates for mortality due to ischaemic heart diseases for both sexes were performed and the regression lines were adjusted. Between 1975 and 1992 the theoretical rates went down both in men and women. If the same tendency were maintained, we would expect to see a moderate reduction between 1992 and 2000 in men and in women. The tendency of mortality due to ischaemic heart diseases in Andalucia is downwards in both men and women.

Acute respiratory infections (ARI) and influenza (flu) are extremely common illnesses, which make up the main causes of medical consultation and absence from work. OBJECTIVE. To discover the level of mortality because of ARI and flu in the Health Areas within the Community of Valencia; to analyse their possible relationship with socio-economic factors and also to identify higher-risk groups according to age and sex. DESIGN. Retrospective study. SITE. The Community of Valencia. PATIENTS OR OTHER PARTICIPANTS. Mortality data across the Community were obtained from the mortality statistics published by the Generalitat (Government) of Valencia during the five-year period of 1976 to 1980. MAIN MEASUREMENTS AND RESULTS. The results establish that Health Areas 4, 6, 7, 9-12 and 18 present less mortality because of ARI and flu. These are the better areas, socio-economically speaking, although the data are without statistical significance. A spectacular increase in mortality in the age-group of those over 70 was observed, with no great differences found between the sexes. CONCLUSIONS. Given that the main interventions to prevent these diseases are based on vaccination, it would be useful to carry out vaccination programmes with greater thoroughness in those areas identified as of high risk.

To describe trends and geographical distribution of breast cancer mortality in Andalusian women between 1976 and 1995. Descriptive study. Andalusia. Deaths from breast cancer during the period 1976 to 1995 were obtained. The following were calculated: crude mortality rates; age-adjusted rates by the direct method, using the European population as standard; rates broken down for 15-44, 45-64 and over 65 age-groups; accumulated rates for 0 to 74 years; age-adjusted rates of potential years of life lost (PYLL); specific rates for five-year age groups for each of the five-year periods studied. Between 1976 and 1995 breast cancer mortality in Andalusian women almost doubled in absolute terms. Age-adjusted rates went up by 40.31%; the rates broken down increased, especially those for over-65s, while the 15 to 44 and 45 to 64 groups also went up, as did the PYLL rates. Breast cancer in Andalusia is a growing health problem, concentrated in very concrete geographical areas. It needs a determined health intervention in order to detect it early and avoid the deaths it is causing.

To evaluate the tendency of cancer mortality in Huelva between 1980 and 1991. Study of mortality. Province of Huelva. All deaths and their causes were studied, using the Death Register of the National Institute of Statistics. Mortality due to the most common malign tumours (MI) was analysed (lung, lip, mouth cavity and pharynx, breast, body and neck of uterus, ovaries, oesophagus, stomach, colon, liver, pancreas, prostate, bladder, leukaemia, Hodgkin's, bones and cartilages, brain and skin). The standardised and theoretical rates were calculated for age, year, gender and specific rates. Cancer accounted for 20.8% of deaths (males, 25.29%; women, 16%). The mortality rates for cancer tended to rise significantly, both overall and for both genders (men in 1980, 201 per 100,000 and in 1991, 230; women in 1980, 112 and in 1991, 124). The highest rates for males were for lung, prostate and stomach MTs; and for women, breast, stomach and colon MTs. Lung MT and leukaemia increased in men; whereas breast, neck of uterus, ovaries and Hodgkin's disease increased in women. Bladder, mouth cavity, colon, pancreas and skin MTs were on the rise in both sexes. The highest specific rate was in under-45s for Leukaemia; and in over-45s, for lung MT in men and breast MT in women. Cancer is the second cause of death in Huelva and is on the rise. The rates of death in men due to lung MT and in women to breast MT are particularly high.

To find the pattern of mortality in people between 1 and 14 years old and how this evolved between 1980 and 1993. A descriptive, epidemiological study. State-wide study of mortality. The source of information were the vital statistics published by the National Institute of Statistics. The mortality statistics for the XVII groups of illnesses in the ninth ICD and the evolution of the main causes responsible. The rate of mortality in 1993 was 24.76 per 10(5) (C.I. 95%, 23.55-25.97). The main causes of death were: malign tumours (4.17 per 10(5); C.I. 95%, 3.67-4.67), traffic accidents (3.56 per 10(5); C.I. 95%, 3.10-4.02) and congenital anomalies (3.1 per 10(5); C.I. 95%, 2.67-3.53). The highest rates were for the 1 to 4 years old period (39.38 per 10(5); C.I. 95%, 36.30-42.46), in which congenital anomalies predominated (7.67 per 10(5); C.I. 95%, 6.31-9.03). Between 1980 and 1993 mortality fell for all age and sex groups, and for all the large groups of diseases except group III, which increased by 44.5%. Children between 1 and 14 years old have a low mortality rate, which is evolving constantly over time both in frequency and in its main determining causes. Mortality fell considerably in recent years for almost all diseases.

To find and compare mortality because of diabetes mellitus (DM) among the different provinces of Spain in the 1981 to 1986 period. The natural movement of population figures of the National Institute of Statistics (INE) and the census of 1981 and register of 1986 were used. A descriptive observation study of a crossover type. Standardisation of rates by the indirect method. Calculation of the ratio of standardised mortality for each province. At the national level, the Communities with an excess of mortality in 1981 were Andalusia, Melilla, the Community of Valencia, Murcia, the Balearics, the Canaries and Extremadura, as well as the provinces of Tarragona, Gerona, Ciudad Real and Albacete. In 1986 the following still had excess of mortality: Andalusia, the Community of Valencia, Murcia, the Balearics, the Canaries, Asturias and Cantabria, along with the provinces of Badajoz and Pontevedra. The provinces with an excess mortality because of diabetes mellitus are geographically grouped (with some exceptions) in the south and south-east of Spain and the island communities.

The results of a program for the early diagnosis of cervical cancer (EDC) in a health center was evaluated for the period 1981-87. This activity was included in a general program of attention to women and was carried out by the primary care staff of the center. 915 women were evaluated, and 1,279 samples for cytology were collected. The achieved coverage was 11.56%. The most usual way of recruitment was through the family planning program. We detected that the group of women included in the program had risk factors predisposing to cervical cancer; however, this was not associated with a higher incidence of dysplasia. The referrals to a higher level of care were made in early disease stages, and this was the case in 38 women. It was considered that the continuation of the program in the health center is adequate. Recruitment should be increased and directed to the women with higher risk.

To find asthma mortality in the city of Barcelona. Descriptive study of mortality. City of Barcelona. Deaths due to asthma in the city of Barcelona in the period 1983-1993 were studied through the register of mortality at Barcelona's Municipal Institute of Health, which in turn is supplied by the Statistical Gazette of Deaths. Rates of mortality per 100,000 inhabitants were calculated, overall and broken down by sex and by age. The ratio of mortality comparing city districts and the place and season of decease was also worked out. There were 716 deaths due to asthma (overall rate of 3.82/100,000 inhabitants; 3.3 in men and 4.33 in women). Almost two-thirds of deaths occurred in people over 65. Mortality was stable in the entire period except in the over-65s, in which a downwards trend was discerned (beta=-0.63; P=.037). For the 5-34 year old group, the rate oscillated between 0.1 and 0.6/100,000 inhabitants. The number of deaths in the over-65s was greater in winter (31.7%; 95% CI, 27.8-35.7). 56.2% of deaths occurred at home. Hospital deaths were more common among women (P<.001) and the under-65s, and their trend is upwards (P=.004). Asthma mortality in the city of Barcelona was stable during the period studied. Its rate for the 5-34 year-old age group was higher than for Spain and slightly greater than in similar nearby countries.

To analyze the prevalence trends for smoking and its determinants in the general population of Barcelona from 1983 to 2000. Time series study. Health survey based on home interviews of a representative sample of the general population of Barcelona. In the years 1983, 1992, and 2000 we interviewed 3134, 5004, and 10,000 persons, respectively. Between 1983 and 2000 daily tobacco use showed a steady tendency to decrease among men, with a prevalence that decreased from 54.6% to 38.3%, while in women, smoking increased between 1983 and 1992 (from 20.9% to 25.4%) but remained stable in 2000 (24.5%). The proportion of smokers who said they wanted to quit increased in both sexes from 1992 (54.2%) to 2000 (65.7%). During this period the proportion of smokers who said their doctor had advised them to quit increased from 36.1% to 48.1%. The trends for both sexes showed that consumption of tobacco products was greater among less privileged socioeconomic groups. The results of this study confirm the decrease in the prevalence of daily consumption of tobacco products and the increase in smokers who would like to quit, in parallel with the increase in advice from physicians to quit. However, the trends among younger groups remained stable, a finding that makes it necessary to intensify efforts aimed at this population group.

To more precisely define the epidemiological characteristics of meningococcal disease (MD) and to try to determine its possible risk factors, 224 cases diagnosed during the 1983-1987 period in all the hospitals of the Cordova province were evaluated. There was an incidence density (ID) of 6 cases/100,000/year. The younger ages were the most commonly involved (81.7% of cases were less than 14 years old), and males had the highest overall incidence. The greatest number of cases accumulated during the coldest months of the year (december, january, february). The highest rate of incidence was in the Guadalquivir Valley area, which has the highest population density. The poorest and socioeconomically lowest districts of the capital had the greatest morbidity (p less than 0.001). The mortality rate was 6.2%. It was higher in patients over 5 years of age and the male/female mortality rate was 0.75. It was concluded that wider and deeper epidemiological studies are required to evaluate the influence of habitat and other possible factors in the development of MD.