[Exposure to environmental tobacco smoke at home increases the need for medical attention for respiratory diseases in childhood]. / La exposición al humo de tabaco en el hogar aumenta la frecuentación por patología respiratoria en la infancia.

OBJECTIVES: Children are highly vulnerable to damage from passive smoking as they are unable to avoid environmental tobacco, if present. Some reports have suggested that domestic exposure to environmental tobacco smoke can increase respiratory diseases in children. The aim of this study was to assess whether domestic passive smoking is associated with new respiratory events. METHODS: A descriptive, retrospective study was performed of 410 children aged less than 14 years old. The variables studied were: a) smokers in the household, b) the number of cigarettes smoked per day, c) school attendance, d) the number of siblings, e) previous respiratory diseases among parents and siblings, f) maternal smoking in pregnancy, and g) the number of respiratory events recorded in the previous year. Univariate, bivariate and multivariate analyses were performed. RESULTS: A total of 50.2 % of the children cohabited with smokers at home. The mean number of upper respiratory tract events per child living in environments free of tobacco smoke was 2.53 versus 3.52 when one of the household members smoked. For respiratory disease as a whole, an inverse association with age was found [OR = 0.83; (95 % CI: 0.76-0.90)] and a direct association was found with maternal smoking [OR = 4.56 (95 % CI; 1.84-11.34)]. With upper respiratory tract disease, the OR was 1.4 if the mother smoked 11-20 cigarettes/day, and was 1.9 if the number of cigarettes was > 20. With lower respiratory diseases, the odds ratio was 3.48 (95 % CI; 2.07-6.06) if the mother smoked. CONCLUSIONS: Fifty percent of the children studied were exposed to environmental tobacco smoke in the home. Younger children were at higher risk. The major risk factor for respiratory disease was maternal smoking and the risk increased with the number of cigarettes smoked. Health education is essential to protect children from tobacco smoke exposure.

[Mid-term evaluation of a help program for smokers]. / Evaluación a medio plazo de un programa de ayuda a los fumadores.

BACKGROUND: Medical counsel to smokers is an intervention that has proved useful to motivate smokers to stop smoking. This study pretends evaluate the long-term impact (2 years and 9 months) of systematic and structured health counsel on the smoke habit from the primary health care. MATERIAL AND METHODS: In April 1990, in four primary care centers from Barcelona and Zaragoza, Spain, a program of systematic counselling to stop smoking with an offer of subsequent follow-up was initiated in all adult smokers (15-65 years of age). According to the answer, every patient was classified on one of seven established categories that allowed a individualized follow-up. Data from the total population included in the program from the beginning till January 1993, are analyzed. RESULTS: From 683 known smokers (59.2% males and 40.8% women), 20 were excluded for different reasons and 343 were included in the program (56.4% cover). Average age of included smokers was 35.1 years (SE = 0.6) and average number of visits of 5.3 (SE = 0.2) which was significantly higher than those not included in the program (33.4; SE = 0.6, and 2.7; SE = 0.1). An average follow-up of 14.3 months (SE = 0.5) and of 2.6 (SE = 0.1) interventions on each individual were done. The average daily number of cigarettes was 18.4 (SE = 0.6) in the initial period and 13.3 (SE = 0.6) on the last program evaluation. The final answers showed a 18.1% of quitters and a decrease of more than 50% on the initial consume on 32.6%. In 12% the answer was negative. CONCLUSIONS: Programs of systematic help for smokers show a higher level of favourable responses than does normal counselling.

[Smoking and nonfatal traffic accidents]. / Consumo de tabaco y accidentes de tráfico no fatales.

OBJECTIVE: To investigate the possible associations between smoking and nonfatal traffic accidents, and to evaluate the possible influence of other factors on traffic accidents. DESIGN: Cross-sectional study of associations.Setting. Eight health centers in the city of Zaragoza. PARTICIPANTS: 1214 drivers between 25 and 65 years of age, who visited the health center during the months of July to September 2001, and who drove on at least 2 days of the week. MAIN MEASURES. We recorded data on sex, age, marital status, level of education, profession, diseases, use of prescription and nonprescription drugs, drinking, smoking, illegal drug use, accidents and traffic infractions. RESULTS: We found accidents to be most common among unmarried men between 25 and 29 years of age. There were no significant differences in accident rates between drinkers and nondrinkers. The accident rate was 50% higher in smokers than in nonsmokers (OR, 2.22; 95% CI, 1.49%-3.09%), and there were no significant differences between smokers who smoked while driving and those who refrained from smoking while driving. CONCLUSIONS. The prevalence of accidents is highest in unmarried men younger than 45 years of age. In statistical terms, smokers have twice as many accidents as nonsmokers. The absence of significant differences between smokers who do and do not smoke while driving suggests that smoking increases the risk of being involved in traffic accidents regardless of whether drivers refrain from smoking at the wheel.

[Study of smoking habit among the adult population of Aragón]. / Estudio del hábito tabáquico en población adulta aragonesa.

We determined the prevalence of tobacco consumption among the general population and established its distribution considering socioeconomical variables. We performed a cross-sectional study with 2781 subjects from 93 rural and urban areas, selected by randomized, census-based, multi-staged and stratified sampling. 40.9% of the population from Aragon are regular smokers (58.6 of men and 23% of women). Heavy smokers comprise 17.2% of the total (30.1% of men and 3.8% of women). The higher proportion of smokers in observed among single men over 40 and single women under 40. The percentage of smokers is lower among 20 to 29-years-old young people from high socio-economical than from low levels. In general, the mean percentage of smokers among men and, specially, among women from rural areas is higher than in the rural areas. In Aragon, tobacco is a risk factor affecting 41% of the adult population and, specially, young people, men, single persons from both sexes and living in urban areas. It seems that young people with a high socio-economical level are becoming smokers at a lower frequency.

[Validation of a method for calculating the cardiovascular risk in primary care]. / Validación de un método de cálculo del riesgo cardiovascular en atención primaria.

OBJECTIVE: To design a simple method to calculate overall cardiovascular risk (CVR), which could be used in Primary Care (PC). DESIGN: A descriptive study to correlate and validate our method (called CVR-PC) using the Framingham, the British Regional Heart study and the Spanish Society to fight against Arterial Hypertension methods. SETTING: Urban health centre. PATIENTS: 670 patients of both sexes chosen at random in clinics, to apply a programme of preventive measures. MEASUREMENTS AND MAIN RESULTS: The age, gender, blood pressure, tobacco consumption, Cholesterolaemia and Glycaemia were determined for each patient. A multiplicative memory method was designed to obtain the index of cardiovascular risk without recourse to electronic support. Figures obtained were correlated with those from the equation of the Framingham study. The Pearson r values were: 0.85 for the series total (0.85 for men and 0.83 for women). The cut-off point for high/low-moderate risk was identified. From this 76.3% sensitivity and 95.7% specificity were obtained. CONCLUSIONS: The method studied shows adequate correlation as well as high sensitivity and specificity when compared with the Framingham method. It can be useful in Primary Care clinic for identifying individuals at high cardiovascular risk.

[The evaluation of a semiautomatic arterial pressure monitor]. / Validación de un monitor semiautomático de presión arterial.

OBJECTIVE: To study the reliability and precision of the arterial pressure digital monitor, Palm Monitor-2 FS-40, model 1083 (DM). The mercury sphygmomanometer (MSM) was used as the reference. DESIGN: Comparative crossover study. SETTING: Primary Care Centre. PATIENTS: 81 patients of both sexes between 26 and 65 found at random in a consultation during November and December, 1991. 24 of them had systolic arterial pressure (SAP) above 140 mmHg and/or diastolic arterial pressure (DAP) above 90 mmHg. MEASUREMENTS AND MAIN RESULTS: Four measurements of AP for each patient were carried out at one minute intervals: the first and the fourth with the MSM and the second and third with the DM. The SAP averages with the DM were 130.27 mmHg in the first take and 129.36 in the second. The DAP averages were 82.53 and 81.88, respectively. The Pearson correlation r between the averages for both devices and the difference of averages, both absolute and in so much per cent, were obtained. The values obtained were 0.887 for SAP and 0.810 for DAP. The difference between averages was -3.83 mmHg (-2.86%) for SAP and -2.55 mmHg (-3.04%) for DAP. CONCLUSIONS: The measurements obtained with this DM are quite reliable, although a tendency to underestimate the AP values in relation to the MSM was noted. Overall it can provide useful information on certain aspects of the diagnosis and follow-up of AHT.

[The epidemiology of heart failure in the elderly]. / Epidemiología de la insuficiencia cardíaca en el anciano.

OBJECTIVE: To find the prevalence and aetiology of chronic cardiac failure (CCF) among elderly people in a health area. DESIGN: Retrospective, crossover study. SETTING: Delicias Sur Health Centre, Zaragoza. PATIENTS AND OTHER PARTICIPANTS: A representative sample of the population over 65 registered at the Health Centre. Systematic random sampling: n = 1,635. MEASUREMENTS AND MAIN RESULTS: 104 cases of cardiac failure were identified, which corresponded to a 6.3% (+/- 0.01) prevalence. By age groups, prevalence was 4.5% (+/- 0.01) for the 65-74 group and 8.5% (+/- 0.02) for those over 75. Regarding aetiology, 50.9% was due to arterial hypertension, 21.2% coronary failure, 22.1% valvulopathies and 17.3% reason unknown. CONCLUSIONS: CCF prevalence in the community increases with age and in our ambit exceeds that found in other countries. Almost half the cases are related to arterial hypertension.

[The conduct stemming from the application of a program of preventive activities]. / Actuación derivada de la aplicación de un programa de actividades preventivas.

OBJECTIVE: To evaluate the results of putting into practice the Programme of Preventive Measures and Health Promotion of the SEMFYC and the level of intervention into each risk factor. DESIGN: Descriptive study of a sample of clinical records of patients included in the program. SITE. The population seen at a Health Centre. PATIENTS: A sample of 772 clinical records, 51.1% being women. Average age was 31.8. MAIN MEASUREMENTS AND RESULTS: 389 smokers, 35 people with hypertension, 175 with hypercholesterolemia, 96 heavy drinkers and 268 suffering from overweight were found. The level of intervention recorded in the clinical histories is low by the criteria of the Programme: it swings between 27.68% for overweight and 47.6% for tobacco dependency. CONCLUSIONS: The Programme of Preventive Measures and Health Promotion (PAPPS in Spanish) is seen to be useful as a method of detecting health problems in the asymptomatic population. But it needs to be followed up with some minimal intervention and control of the problem, if the desired aims are to be met.

[The evaluation of the preventive services for the pediatric population in Agaronese health centers]. / Evaluación de las actividades preventivas en poblagión infantil de centros de salud aragoneses.

BACKGROUND: We have shown the coverage of periodic health examinations made in children aged between 0 and 14 years old in Aragón during 1991, comparing with results obtained at national level and results obtained during 1990. METHODS: A descriptive transversal study was developed by reviewing clinic records of 9 primary health centers selected by systematic sampling. Sampling consisted on 436 histories. RESULTS: Main results were: age of child in the first visit: 83.5% below 1 month; metabolic disease screening: no data on 31.8%; DTP-polio: no data on 20.9%; triple viric: no data on 24.3%. CONCLUSIONS: Obtained data showed better results than those at national level. We should improve the metabolic diseases screening and vaccinations recording system.

[Effect of follow-up offer versus counseling alone in a sample of dissonant smokers. Evaluation of the influence of the tobacco habit of health professionals in this intervention]. / Efecto de la oferta de seguimiento versus consejo aislado en una muestra de fumadores disonantes. Evaluación de la influencia del hábito tabáquico de los profesionales en esta intervención.

We report the results of an intervention trial comparing the counseling (group A) of the general practitioner to encourage to quit smoking in dissonant smokers and an intervention based on counseling and offer of follow up at 2 and 3 weeks and at 3 and 6 months (group B). Both interventions were globally evaluated to assess the influence of the smoking habits of health professionals on the results. In the 93 group B patients there was a higher quitting rate than in group A. The rates of success after one year follow up were 26.9% and 11.9% (p less than 0.05). Forty-seven of the 152 patients were counseled by smoking physicians and 105 by non-smoking physicians; at one-year follow-up, the verified quitting rates were 10.6% and 25.7%, although the difference was not significant. It was concluded that the reinforcement of counseling by follow-up may increase the rate of quitting smoking in dissonant smokers in a primary care setting, and that the influence of the habit of the health professional can be limited through more systematic interventions.