[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.

[An analysis of the interconsultations and complementary tests requested by a health center in a 3-year period]. / Análisis de las interconsultas y pruebas complementarias solicitadas por un centro de salud en un período de tres años.

We report the results of a study aiming at the description and analysis of the interconsultations and laboratory studies at secondary level from the family medicine and pediatrics practices during 1986, 1987 and 1988. 87.8% of the referrals were made from general practices and 12.2% from pediatric practices. The family doctors referred 6.23%, 7.13% and 6.22% of the consultations from 1986, 1987 and 1988, respectively, while the pediatricians did so in 3.50%, 3.94% and 3.40%. A mean of 4.12% of consultations were referred to the secondary level. Laboratory studies were requested in 6.7% of the overall consultations and radiological studies in 1.93%. Ophthalmology, obstetrics-gynecology, otorhinolaryngology, traumatology and dermatology were the five more often consulted specialities. We emphasize the usefulness of this type of studies to identity possible areas for updating and for assignation of human resources.

[Cytological diagnosis of thyroid nodules by fine needle aspiration. A study of 385 cases from primary care]. / Diagnóstico citológico del nódulo tiroideo mediante punción-aspiración con aguja fina (PAAF). Estudio de 385 casos procedentes del nivel de atención primaria.

A retrospective study of fine needle aspiration (FNA) of thyroid nodules was carried out in patients from the primary level of care in our city during the last four years. Overall 385 aspirations were carried out in 361 patients (93.2% females and 6.8% males). From the overall number of evaluated FNA, 88.31% had cytological criteria of benign disease; the remaining 11.7% corresponded to neoplastic lesions. Histological confirmation was obtained for all the latter. The patients with benign cytology underwent clinical follow up and eventual cytological controls. In the 45 instances of neoplastic cytology there were 2 false positive diagnoses (4.4%). The technique was highly cost effective. FNA should be include in the follow up of thyroid nodules, and it should be available by request from primary care teams.

[Evaluation of the quality of care of diabetic population at a health center]. / Evaluación de la calidad asistencial prestada a la población diabética en un centro de salud.

An evaluation study of the quality of care was carried out in diabetic patients aged 20 years or more diagnosed since the primary health care center had been opened. 20 criteria accepted by consensus were evaluated in all be clinical records of the diabetic population. A remarkable result was the high rate of incorrectly diagnosed patients (36.8%), although there were no significant differences in the rate of criteria recording between these and the true diabetics. The most commonly recorded criteria were the classification of the type of diabetes and the measurement of blood sugar (100%), while the least common were the measurement of A1C hemoglobin (2.6%) and neurologic examination (9%). Overall 13.3% of records had 17 or more recorded criteria, and 53.4% had between 13 and 16 criteria. The importance to include the methods for the evaluation and control of the quality of care in the major aims of the primary care teams is stressed.

[Population study of users of long term-treatment cards in an urban health center. A system for the evaluation and improvement of the quality of prescription]. / Estudio de la población usuaria de cartillas de largos tratamientos en un Centro de Salud urbano. Un sistema para evaluación y mejora de la calidad de prescripción.

The results of the analysis of the Prolonged Treatment Cards (PTC) for 1988 are presented. The total PTC cases for which care was provided numbered 15,643, which means a 24.3% reduction in the volume of demands for medical attention, with an average decrease of 10.5 patients/day in each one of the family practices. The breakdown of the PTC into age groups revealed that it is the patients over 60 years of age who are in possession of the greatest number of these cards (58.8%). Essential hypertension (40.5%) is the most frequent diagnosis, followed by diabetes (13.8%) and osteoarthritis (13.3%). By subgroups according to treatment, the most frequently used medications are antihypertensives, with diuretics being the ones ranked in the top position (40.72%). The existing discrepancy between the high degree to which benzodiazepines are prescribed and the low percentage of cases diagnosed which can be treated using said medications is also stressed. The conclusion is drawn that the PTC's are of great use to patients and to the Primary Care Teams.

[Compulsory reporting diseases notified in 1986 and 1987 by a team of urban primary care]. / Análisis de las enfermedades de declaración obligatoria notificadas en 1986 y 1987 por un equipo de atención primaria urbano.

We present the results of the analysis of communicable diseases which were notified in 1986 and 1987. The number of cases of such diseases was 10,087 (4,865 and 5,222) with a rate of incidence per 10(4) inhabitants of 271.7 and 266.7 in 1986 and 1987 respectively. These diseases represented 39.7% and 29.5% of visits due to new pathologies, and 25.4% of spontaneous home visits. The most frequently reported disease was infection of the upper respiratory apparatus, which accounted for 24.8% of pediatric visits. The rates incidence for most diseases were lower than our domestic ones, and although we do not know the exact contribution of each of the possible causes, we think it is necessary to demand the improvement of the information circuit and the uniformity of criteria from the authorities and health professionals, something which is vital to ensure the quality of the system of epidemiological monitoring.

[Quality control and results of prevention and health promotion activities in infirmary consultations]. / Control de calidad y resultados en actividades de prevención y promoción de salud en consultas de enfermería.

BACKGROUND: To evaluate nursing practice in periodic health examination. METHODS: We make a retrospective evaluation of process data through 10 explicit criteria. We selected a random sample (in evaluation process) and a institutional based sample and population universe (re-evaluation process) of both male and female patients who underwent health examination in nursing consults of a urban health center. RESULTS: We found a substantial improvement in fulfilling degree in 8 out of criteria, although best standard only was reached in 3 criteria (blood pressure determination, somatometrics and tobacco smoking investigation). We also remark the high proportion of risk factors, tobacco smoking (51.6%), obesity (37.6%) and dyslipemia (25.5%). CONCLUSIONS: We remark the importance of entering and developing evaluation and quality assurance methodology among common tasks of primary care teams and correct ubication of periodic health examination in nursing process.

[Results of periodic health examinations in an adult population aged 15-60 years]. / Resultados de exámenes periódicos de salud en población adulta de 15-60 años.

We report the results of 510 periodical health examinations in adults aged 16-60 years (43% males and 57% females), carried out by the nursing staff in our center (belonging to the PAPPS of the SEMFyC). In the results there was a remarkably high rate of risk factors: 46.6% of obesity, 46% of smokers, 40% of sedentarism, 20% of hyperlipidemia, and 5.1% of hypertension. There was a higher prevalence of smokers among the female population between 15-44 years of age; 6.3% of the surveyed population consumed more than 50 g of alcohol/day, 3.7% had abnormal urine reactive strips and 1.6% had abnormal carbohydrate metabolism. In our experience, the periodical health examination perfectly fits the role of nurses and is well accepted by the population.

[Medical audit of the clinical history of the infantile population treated at a primary care facility]. / Audit médico de historias de población infantil atendida en atención primaria.

Authors present qualitative and quantitative results of a health quality assurance study of pediatric population in primary care. Ten criteria were accepted by consensus and level of 90% of fulfilling was taken as optimal standard. None of the criteria reached that level. The best fulfilled ones were those referring to pregnancy (89%), vaccination (87.7%), lactancy (87%), weight at birth (86.7%), parturition (84%) and newborn period (82%). Among qualitative results most remarkable were vaccination coverage (95.7%), length of breast-feeding (1-3 months, 60.6%) and untimely introduction of cereals with gluten (35.4%) and full-fat cow milk (50.3%). Authors consider that this kind of study is useful in primary care centers. It is necessary to include health care quality assurance activities among basic goals of these centers.

[Determination of the degree of renal functioning and cardiovascular risk factors in an aged population seen at a health center]. / Determinación del grado de funcionamiento renal y factores de riesgo cardiovascular en la problación anciana adscrita a un centro de salud.

We report the results of a study to assess the glomerular filtration rate in the elderly population seen at the center and to investigate the prevalence of cardiovascular risk factors and use of drugs in this age group. The glomerular filtration rate could be measured in 64.6% of the elderly population. In 94 (17.6%) of the 825 evaluated individuals the clearance values were 50 ml/min or lower. Only 6 of them had previously known chronic renal failure. A high prevalence of concomitant cardiovascular risk factors was found (48.7% were hypertensive, 25.1% diabetic, 19% smokers, 24.1% had hyperlipidemia and 38.8% were obese). The rate of drug use was also high (69.6% took two or more drugs sustainedly). These findings indicate the need to evaluate the renal function in elderly people before prescribing drug therapy.

[Evaluation of the quality of care of diabetic patients in 3 health centers]. / Evaluación de la calidad asistencial prestada a pacientes diabéticos en tres centros de salud.

The results of a retrospective health care quality assurance study are presented. This study was designed to evaluate the quality of health care rendered to diabetic patients who were diagnosed and/or treated in three medical centres. Nineteen criteria were chosen for the evaluation stage (385 diabetics, analysed) and 20 were used in the reevaluation (108 diabetics). The complementary test group met the most criteria, and the explorations group met the least, with the exception of blood pressure readings (77% of record). In the reevaluation stage, the percentage met of all the criteria under study increased, with statistically significant differences in all but three of the criteria. The standard of 100% was not attained in any of the cases, but the 85% mark was exceeded in 7 of the 20 criteria. A substantial improvement in the number of criteria recorded in the histories was observed, with an increase to 36.09% of histories with 17 or more criteria met, and a reduction, from 26.02% to 11.11%, of histories with 6 or less criteria met.