[Incidence of ischemic heart disease in the HERMEX study and its association with classical cardiovascular risk factors]. / Incidencia de cardiopatía isquémica en el estudio HERMEX y su asociación con los factores de riesgo cardiovascular clásicos.

OBJECTIVES: Knowledge about the incidence of coronary heart disease in our country is scarce and its sources are not comparable. Our aim was to determine the incidence of ischemic heart disease in a population cohort in a 7 years of follow-up, as well as the risk associated with the different classical cardiovascular risk factors. METHODS: Cohort study with a population sample of 2833 subjects, selected by the simple random method in a population between 25 and 79, from the Don Benito - Villanueva de la Serena (Badajoz) health area, response rate was 80.5%. All episodes of angina pectoris, lethal and non-lethal myocardial infarction were collected in individuals with no previous history of cardiovascular disease. Cumulative incidences and incidence rates adjusted per 100,000 person-years by sex and overall were calculated. RESULTS: From 2833 initial cohort participants, 103 were excluded due to a history of cardiovascular disease and 61 for losses, 2669 completed the follow-up (94.2%). The median follow-up was 6.9 years (IR 6.5-7.5), 56.4% women; 59 events were recorded. The overall incidence rate of ischemic heart disease was 327 cases/100,000 person-years, corresponding to 470 cases/100,000 for men and 211 cases/100,000 people-years for women. The classical cardiovascular risk factors that were associated with a higher risk of presenting events in the follow-up were dyslipidemia and arterial hypertension, in addition to male sex and age. CONCLUSIONS: The incidence of ischemic heart disease in the urban-rural population of Extremadura is high. The classical cardiovascular risk factors most strongly associated with events were dyslipidemia, and arterial hypertension.

[Analysis of the implementation of safety practices in the automated medication dispensing cabinets]. / Análisis de la implantación de prácticas seguras en los sistemas automatizados de dispensación de medicamentos.

OBJECTIVE: To determine the degree of implementation of recommended safety practices in the design and use of automated medication dispensing cabinets (ADCs) in Spanish hospitals. METHODS: A descriptive study based on completion of the "Self- Evaluation Survey on the Safety of Automated Medication Dispensing Systems" from 10/10/2012 to 4/10/2013, at voluntarily participating hospitals. The survey contained 93 items grouped into 14 core processes. RESULTS: In the 36 participating hospitals the average score for the completed survey was 307.8 points (66.2% of the highest possible score [LC 95% CI: 63.2-69.2]). The lowest scores were obtained for core processes 9, 12, 13, 8, 3, 4 and 11 referring to the establishment of guidelines for medication removed using the override function (28.4%), training for healthcare professionals (52%), risk management (53%), defining removal procedures (55.3%), use of ADCs in connection with electronic prescribing (60.9%), information that appears on ADC screens (61.8%) and eliminating medications being returned to ADCs (63.9%), respectively. The hospitals that used ADCs in connection with electronic prescribing as their principal system for distribution presented a higher level of implantation of safety practices than those that used ADCs as a complementary distribution system. CONCLUSIONS: ADC installation has been accompanied by the implementation of various safety practices, but there are still numerous areas of risk for which technical, organizational, and system monitoring safety practices must be added in order to minimize errors with this technology.

Objetivo: Conocer el grado de implantación de las prácticas seguras recomendadas para el diseño y utilización de los sistemas automatizados de dispensación (SAD) de medicamentos en los hospitales españoles. Método: Estudio descriptivo que se basó en la cumplimentación voluntaria del "Cuestionario de autoevaluación de la seguridad de los sistemas automatizados de dispensación de medicamentos", entre el 10-10-2012 y el 10-4-2013. El cuestionario contiene 93 puntos de evaluación agrupados en 14 procedimientos esenciales. Resultados: En los 36 hospitales participantes la puntuación media del cuestionario fue de 307,8 puntos (66,2% del valor máximo posible [LC 95%: 63,2-69,2]). Los valores porcentuales más bajos se obtuvieron de menor a mayor en los procedimientos esenciales 9, 12, 13, 8, 3, 4 y 11, referentes al establecimiento de directrices para las retiradas excepcionales de medicamentos (28,4%), formación a los profesionales (52%), gestión de riesgos (53%), definición de los procedimientos de retirada (55,3%), uso de SAD conectados a prescripción electrónica (60,9%), información que aparece en pantalla (61,8%) y eliminación de la devolución de medicamentos a los SAD (63,9%), respectivamente. Los hospitales que utilizaban SAD con conexión a prescripción electrónica como sistema principal de distribución presentaron un mayor grado de implantación de prácticas seguras que los que usaban SAD como sistema complementario. Conclusiones: La instalación de los SAD se ha acompañado de la implantación de varias prácticas seguras, pero existen numerosas áreas de riesgo en las que es necesario establecer prácticas de tipo técnico, organizativo y de monitorización del sistema para minimizar los errores con esta tecnología.

[Assessment of safety practices for medication-use systems in Spanish hospitals (2007)]. / Evaluación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles (2007).

BACKGROUND AND OBJECTIVE: To examine the current status of safety practices for medication-use systems in Spanish hospitals and to identify major areas of risk. MATERIAL AND METHOD: Those hospitals that completed the "Medication use-system safety self-assessment for hospitals" between June 1 and July 15, 2007, were included in the study. The survey contained 232 items for evaluation grouped into 20 core characteristics. RESULTS: A total of 105 hospitals from the 17 autonomous communities in Spain participated in the study. The average aggregate score for the survey of all the participating hospitals was 612.7 (39.7% of the maximum possible score) and there were no differences found with regard to number of beds, training activity or type of hospital. When core characteristics were analyzed, there were 3 criteria with the lowest values (< 25%), associated with professional training, skills, and the establishment of a system for reporting errors. Another 9 criteria, with percentages between 25% and 50%, reflected practices related to: access to information regarding patients and medications; communication of medication orders; prevention of errors due to naming, labeling, and packaging problems; standardization of medication delivery devices; restriction of medications in patient care units; and safety culture and double-checking procedures. CONCLUSIONS: Many opportunities for improvement have been identified, particularly in areas related to training, risk management, incorporating new technologies and patient participation. The information obtained may prove useful for prioritizing practices when establishing patient safety strategies, and as a baseline for successfully monitoring the effectiveness of the initiatives and programs consequently set into motion.

[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.

[ST-segment and myocardial enzymes evolution during myocardial infarction after fibrinolysis therapy and its relation with postinfarction angina, Killip class and mortality in intensive unit care]. / Evolución del segmento ST y las enzimas cardíacas en el infarto agudo de miocardio con fibrinólisis y su relación con la angina postinfarto, el índice de Killip y la mortalidad durante el ingreso en cuidados intensivos.

INTRODUCTION: The prognostic value of enzyme peaks, the sum of the ST segment and reperfusion arrythmias during myocardial infarction remains unclear. AIM: The aim of this study was to relate the early enzymatic peaks, the sum of the ST segment and reperfusion arrythmias after thrombolytic therapy with postinfarction angina, Killip class and mortality during the acute phase of myocardial infarction. PATIENTS AND METHODS: Of 187 patients receiving fibrinolytic therapy, 169 were consecutively and prospectively included in the study. The following myocardial enzymes were determined: CK, MB, TGO, LDH. Electrocardiograms were performed prior to and 2, 6, 12 and 24 hours after the administration of the fibrinolytic drug. RESULTS: The mean age of the patients was 60.12 +/- 11.3 years, with 138 (81.7%) being males. Myocardial infarction was anterior in 74 (43.7%) and inferior in 95 cases (56.3%). Reperfusion arrythmias were observed in 65 cases (38.5%). One hundred thirty-one (77.5%) were Killip class I, 12 (7.1%) presented postinfarction angina, and 8 (4.7%) died. A peak was observed in MB at 6 hours in cases of anterior myocardial infarction and the sum of the ST segment decreased less than 50% in the first 2 hours. No statistically significant correlation was observed between the enzymatic peaks, the reperfusion arrythmias, Killip class, postinfarction angina or early mortality. The greater the ST segment sum, the greater the severity according to the Killip class. On multivariate analysis no model was found to be related to postinfarction angina. However, age was related to mortality and sex and age were associated with heart failure. CONCLUSIONS: In our population, the variables studied were not found to be useful to determine the prognosis during the early phase of acute myocardial infarction.

[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.

[Episodes of sickness attended by general/family physicians according to demographic context. 2. Utilization]. / Episodios de enfermedad atendidos en medicina general/de familia, según medio demográfico (y II): Utilización.

OBJECTIVES: To describe the use of consultations, the place where care is given and referral demand, in function of episodes of illness and the demographic context. DESIGN: An observational, prospective study based on a year-long record. SETTING: 43 practices spread over 10 Autonomous Communities. INTERVENTIONS: Identification, date of birth and sex of each patient attended, date of their first consultation and the number of consultations per episode, the health problem, place of consultation and existence or otherwise of referral, were all recorded. RESULTS: 74.57% in the rural areas, 56.21% in the urban and 56.74% in the mixed saw the doctor over the year. In the rural context there were 2.26 consultations per episode and 5.41 consultations per person, against 1.88 and 4.55 in the urban context. Figures for the mixed context were in between. In all the illness groups (except that for accidents) the number of consultations per episode in the urban context: 13.90% against 10.74 in the rural. CONCLUSIONS: Greater use of the doctor in rural areas could be because of the lower population/doctor ratio and easier access. Higher referral rates in urban areas could be due to the closeness of the second care level. A low percentage of home consultations was observed.

[Current status of postgraduate training in family and community medicine in the rural environment]. / Situación actual de la formación posgraduado de medicina familiar y comunitaria en el medio rural.

OBJECTIVE: To find the present state of postgraduate teaching in Family and Community Medicine, (FCM) in rural areas, according to the view of teaching unit (TU) coordinators. DESIGN: A descriptive cross-sectional study using a mail questionnaire. SETTING: The 75 TUs of FCM in Spain. PARTICIPANTS: TU coordinators. INTERVENTIONS: In January 1996 a questionnaire with 29 questions was sent to the TU coordinators. In May 1996 it was sent again to those who had not replied. MEASUREMENTS AND MAIN RESULTS: 68 (90.66%) of the TUs replied, which covered all the Spanish provinces except four. Out of the TUs who replied, 42 (61.76%) had a rural Health District (RHD) or local practice (LP) in their area, and 37 (54.4%) had some RHD/LP doctor accredited as a tutor. Of the 1,894 tutors in all, 1,675 (88.43%) worked in urban areas and 219 (11.56%) in rural areas. Before 1989 there had been only three RHD/LP tutors. CONCLUSIONS: There are few RHD/LP tutors. Teaching in rural areas should be strengthened, both because of these areas' specific requirements and because they could be the future workplaces of many of our present Residents.

[Episodes of disease taken care of in general practice/family medicine according to demographic context (I): morbidity]. / Episodios de enfermedad atendidos en medicina general/de familia, según medio demográfico (I): morbilidad.

OBJECTIVES: To identify the population seen at general/family medical practices and quantity the episodes of illnesses attended, in function of the demographic context. DESIGN: An observational, prospective study based on a year-long record. SETTING: 43 practices spread over 10 autonomous communities. INTERVENTIONS: Identification, sex and date of birth of each patient attended, the type of episode, health problem and date of their first consultation, were all recorded. Standardisation by the indirect method was used to compare morbidity rates. RESULTS: 2.39 episodes per person seen were attended in rural areas, 2.42 in urban ones, and 2.45 in mixed areas. The rural context had rates below 15% of the standard rate for neoplasias, endocrine diseases, neurological illness and additional categories; and over 15% for digestive tract diseases, traumas and side-effects. The urban context had higher rates for neoplasias, endocrine, blood and neurological diseases, and additional categories; and lower for respiratory system illnesses. In the mixed areas, rates were higher for contagious, neurological, respiratory system and congenital diseases. CONCLUSIONS: The morbidity attended varies in function of context. Some differences could be due to age distribution (younger in the mixed areas) or accidents (greater in rural areas). Others could be affected by use or problem-solving criteria varying according to the demographic context.

[Effectiveness of tetanus vaccination in an adult population 10 years after the last dose]. / Efectividad de la vacunación antitetánica a los 10 años de la última dosis en una población adulta.

OBJECTIVE: To check if antitetanus immunity after a correct vaccination lasts the anticipated 10 years. DESIGN: Sero-epidemiological crossover study. Determination of tetanus antitoxin by the ELISA method. SETTING: The town of Barrado in Cáceres. PATIENTS AND OTHER PARTICIPANTS: 136 adult men and women (average age 54.6 +/- 15.9 years; range, 24 to 87) who had received their most recent vaccination during a 1981-1982 campaign. 71.32% received three doses. MEASUREMENTS AND MAIN RESULTS: 82.35% +/- 6.40 of the sera analysed (percentage +/- C.I. 95%) maintained adequate levels of protection (> or = 0.01 Ui/ml). 100% of those under 35, revaccinated in 1980-81 because they were ELISA negative in spite of earlier school vaccination, were protected. The average concentrations did not differ significantly by gender and age-groups, although a tendency to decrease with age was noted. CONCLUSIONS: Anti-tetanus vaccination in the individuals studied provided lasting protection, detectable for 10 years in 76-89% of cases. This level of effectiveness lends support to the criterion of administering back-up doses every 10 years.