Francisco López de Castro’s research while affiliated with Sociedad Española de Médicos de Atención Primaria and other places

Resumen Objetivo Conocer las necesidades formativas en la atención a pacientes con cáncer. Método Estudio descriptivo transversal, basado en encuesta a médicos de cupo que trabajan en los centros de salud de Castilla-La Mancha. La encuesta fue diseñada ad hoc e incluía variables sobre necesidades formativas en la atención a pacientes con cáncer, en fase terminal y supervivientes (en escala de 0 a 5), seguridad en el manejo de estos pacientes, opinión sobre quién debería asumir el cuidado de estos enfermos, grado de comunicación con el oncólogo y la Unidad de Cuidados Paliativos, e implicación en la atención a los pacientes. Para el análisis se utilizó el test de Chi-cuadrado de Pearson, la t de Student y el coeficiente de correlación rho de Spearman. Resultados Respondieron 172 médicos (14,9% de la población); 51,2% varones; edad media 49,1 años. La media de pacientes terminales atendidos al año es 3,9. Las mayores necesidades formativas sentidas se refieren a la atención a supervivientes (3,44). El aspecto más reclamado es la atención a urgencias terminales (3,77). En general, la mujer tiene mayor percepción de necesidades formativas (3,44 vs. 3,21; p = 0,045). El 69,2% ha realizado algún curso en los últimos 5 años. La seguridad en el manejo de oncológicos es calificada como «media» por el 74,4% y se relaciona inversamente con la necesidad de formación, siendo mayor en hombres. El 65,1% considera que la mayor responsabilidad del manejo del paciente con cáncer debe ser del oncólogo, recayendo en el MF cuando se trata de pacientes en situación terminal (según el 43,9%) o supervivientes (70,4%). La comunicación con oncólogo es «mala/muy mala» según el 53,2%, siendo este porcentaje del 9,3% cuando se refiere a Unidad de Paliativos. Para el 70,3% su grado de implicación con estos enfermos es adecuado. Respecto a una hipotética falta de implicación, la razón considerada más importante es la falta de experiencia (31,6%). Conclusiones Las necesidades formativas sentidas podemos considerarlas medio/altas, aunque, en general, se sienten razonablemente preparados para atender estos pacientes. La falta de experiencia y de formación pueden ser factores que limiten la implicación del médico de familia.

AimTo examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders.Study designCase-control.SettingSanta María de Benquerencia Health Centre (Toledo).ParticipantsPatients over 14 years old of both sexes managed in a Primary Care Clinic.Measurements and resultsA total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t = 4.254; P < .001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P < .001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P < .001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P < .001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely(1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories.Conclusions1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR.

AIM To examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders. STUDY DESIGN Case-control. SETTING Santa María de Benquerencia Health Centre (Toledo). PARTICIPANTS Patients over 14 years old of both sexes managed in a Primary Care Clinic. MEASUREMENTS AND RESULTS A total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t=4.254; P<.001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P<.001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P<.001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P<.001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely(1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories. CONCLUSIONS 1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Objective. To determine the training needs in cancer patient care. Method. Cross-sectional study based on a survey of family doctors in Castilla-La Mancha, Spain. An ad hoc questionnaire was designed which included questions on training needs (scale of 0-5), safety management and involvement in cancer patient care. Results. A total of 172 doctors (14.9% of the population) responded; 51.2% male; average age 49.1 years. The average number of terminal patients per year was 3.9. The doctors consider that the main training need is related to care of survivors (3.44). The most important is the care of emergency terminal patients (3.77). In general, women have a greater perception of training needs (3.44 versus 3.21; p = 0, 045), 69.2% has taken a course in the last 5 years. Safety management of cancer patients was rated as 'moderate' by 74.4% and was inversely related to the need for training, and was higher in male doctors. 65.1% believed oncologists should have the most responsibility for the management of cancer patients, but that the Primary Care doctor should be responsible for terminal patients (according to 43.9% of doctors) or survivors (70.4%). According to 53.2% of doctors communication with the oncologists is "poor or very poor" this percentage being 9.3% when referring to the Palliative Care Unit. For 70.3% their degree of involvement with these patients is adequate. The main reason for a hypothetical lack of involvement would be the lack of experience (31.6%). Conclusions. The doctors consider that there is a moderate to high need for training, although in general they feel reasonably prepared to treat these patients. Lack of experience and training could be factors that limit the involvement of the primary care doctor.

Objective To find out the attitudes and behaviour of women towards preventive activities related to cardiovascular disease.

To find out the attitudes and behaviour of women towards preventive activities related to cardiovascular disease. Cross-sectional descriptive study, through a self-completion questionnaire, in three Health Centres in Toledo (Spain). A total of 539 women between 18 and 65 years old answered an ad hoc developed questionnaire that contained items on knowledge, attitudes, and behaviours in preventive practices. The mean age was 40.4 years age; 361 (66.7%) came from urban areas; 354 (65.4%) were married; 221 (40.8%) had university studies; 382 (70.8%) were working; 432 (83.2%) believed that the leading cause of death in women was cancer; 174 (32.4%) said they had annual preventive medical check-ups; 411 (76.8%) considered it very dangerous to smoke, but 159 (30.0%) currently smoked. Alcohol consumption was considered very dangerous by 232 (43.4%); 92 (17.2%) were regular consumers (almost every week). Only 128 (23.8%) did exercise one or more times per week. Only 127 (24.0%) followed some type of diet. At least one annual BP and laboratory tests (cholesterol and blood sugar) were measured in 68.4%, 64.1% and 53.9%, respectively. A total of 266 (51.7%) had been advised once on their lifestyle by a healthcare professional. The impact of cardiovascular disease in women is underestimated. Our population seemed concerned about the risk of certain habits but this was not always translated into a healthy lifestyle. It seems that our advice may not change the behaviour of women in many cases, but it does increase the number of clinical and analytical controls. We must insist on the prevention of cardiovascular risk in women and improve the effectiveness of our interventions.

Objective: Clinical assessment and quality of life of the insomniac patient. Design: cross-sectional study. Setting: Primary Health Care. Toledo (Spain). Participants: Patients diagnosed with insomnia before January 2009. Measurements: Medical history review: record of diagnostic and therapeutic activities. Telephone interview: sleep history and EQ-5D questionnaire Results: N = 94. Average age 60.3 ± 14.3 years, 79.8% are women. 73.4% (95%CI 62.0-80.0%) had less than 90% sleep efficiency and 69.1% said they sleep badly. Impact: 76.8% get up feeling tired; in 70.6% insomnia interferes with their activities, in 63.2% it causes distractions and in 39.7% daytime sleepiness. 58.1% have conciliation insomnia, 25.8% have maintenance insomnia, and 8.6% early awakening. 27.8% of patients received advice on sleep hygiene. The most commonly prescribed drugs were lorazepam (47.2%), lormetazepam (23.6%) and zolpidem (19.1%). Median duration of treatment was 32 weeks (RI 58). Currently 24.7% are not taking any treatment, 21.7% of whom said they sleep well. 17.2% of those who were treated and 26.1% of those who were not considered they were in good or very good health. Older patients (r= -0.33; p = 0.001), those who said they sleep badly (55.8 vs 53.2; t = 0, 52; p > 0.05), those with early awakening (F = 3.51; p = 0.01) and those on pharmacotherapy (51.5 vs 61.5; t = 1.93 p = 0.06) had the worst scores in the EQ5D. Conclusions: Most patients with insomnia continue to sleep badly and have poor sleep efficiency, even with pharmacological treatment. The main impact is tiredness, which interferes with their normal activities. Insomnia has a negative effect on the quality of life.

Objective: Clinical assessment and quality of life of the insomniac patient. Design: cross-sectional study. Setting: Primary Health Care. Toledo (Spain). Participants: Patients diagnosed with insomnia before January 2009. Measurements: Medical history review: record of diagnostic and therapeutic activities. Telephone interview: sleep history and EQ-5D questionnaire Results: N = 94. Average age 60.3 ± 14.3 years, 79.8% are women. 73.4% (95%CI 62.0-80.0%) had less than 90% sleep efficiency and 69.1% said they sleep badly. Impact: 76.8% get up feeling tired; in 70.6% insomnia interferes with their activities, in 63.2% it causes distractions and in 39.7% daytime sleepiness. 58.1% have conciliation insomnia, 25.8% have maintenance insomnia, and 8.6% early awakening. 27.8% of patients received advice on sleep hygiene. The most commonly prescribed drugs were lorazepam (47.2%), lormetazepam (23.6%) and zolpidem (19.1%). Median duration of treatment was 32 weeks (RI 58). Currently 24.7% are not taking any treatment, 21.7% of whom said they sleep well. 17.2% of those who were treated and 26.1% of those who were not considered they were in good or very good health. Older patients (r= -0.33; p = 0.001), those who said they sleep badly (55.8 vs 53.2; t = 0, 52; p > 0.05), those with early awakening (F = 3.51; p = 0.01) and those on pharmacotherapy (51.5 vs 61.5; t = 1.93 p = 0.06) had the worst scores in the EQ5D. Conclusions: Most patients with insomnia continue to sleep badly and have poor sleep efficiency, even with pharmacological treatment. The main impact is tiredness, which interferes with their normal activities. Insomnia has a negative effect on the quality of life.