[Patient safety: Patients perception at primary care level at an urban healthcare district]. / Seguridad del paciente: percepción de los pacientes en atención primaria de un distrito sanitario urbano.

OBJECTIVES: Patient safety is a quality objective and a priority in healthcare. Most of the research has focused on the hospital setting and from the professional perspective. The objective of our study is to know the opinion of the patient who attends primary care regarding its safety in this area. MATERIAL AND METHODS: Cross-sectional observational study. A survey carried out with patients chosen through four health centres representing different socioeconomic levels of the same Basic Health Zone. Fifty patients per centre were surveyed. RESULTS: Two hundred patients surveyed of whom more than 90% reported no negative experiences in terms of errors in medication, identification, diagnosis or clinical management, highlighting the good care received and the good resolution of their problem. However, only around half claimed to understand the explanations of the healthcare professionals or to have had the opportunity to give an opinion or have shared decision-making on their management. These factors were closely related to the perceived lack of time in consultation and constant change of physician. CONCLUSIONS: The vast majority of our patients report no adverse effects or safety issues during their primary care attendance. However, there is evidence of the need to strengthen aspects related to consultation time and increase the number and stability of human resources in health centres to improve patient satisfaction with the health system.

[Analgesia for childbirth in a patient with factor V Leiden mutation]. / Analgesia para trabajo de parto en paciente con mutación del factor V Leiden.

Factor V Leiden mutation is the most common congenital thrombophilic disorder, affecting between 5% and 8% of the Caucasian population. Pregnancy creates a state of hypercoagulability and all factors that increase the risk of thrombosis should be considered, as they may be cumulative. In recent years, the diagnosis of new allelic variants of thrombophilic states have increased the incidence of pregnant women receiving anticoagulant therapy, with the anesthetic considerations that implies. We report the case of a 33-year-old woman with heterozygous Leiden factor V mutation who was admitted with spontaneous amniorrhexis in the 38th week of gestation. She was taking low molecular weight heparin therapy. An epidural catheter was inserted to provide analgesia for labor, with all safety precautions to prevent an epidural hematoma. Epidural anesthesia is the technique of choice for obstetric labor in patients with hypercoagulability because of its effects of favoring blood flow and inhibiting clot formation.

[The Institute for Scientific Information journal selection criteria. Its application to Archivos de la Sociedad Española de Oftalmología]. / Evaluación de Archivos de la Sociedad Española de Oftalmología según criterios del "Institute for Scientific Information" para la selección de revistas científicas.

OBJECTIVE: Application of Institute for Scientific Information (ISI) Journal Selection Criteria (JSC) to Archives of the Spanish Society of Ophthalmology. METHODOLOGY: Information about the journal, as well as instructions for authors, were sampled through 24 issues (2003-2004). ISI criteria were converted into quantitative indicators and applied to the journal in question and by extension to other Spanish medical journals. RESULTS: Compliance with international standards: Article titles (means of 7.3 keywords, 2 descriptors, 1.4 MeSH headings), author affiliation (included in 100% of cases, 21% error rate), bibliographic references (12% error rate in abbreviated journal titles), titles in English (8% translation error rate), abstracts (196 words average, 100% structured), keywords (4 words average, 1.2 coincidence with MeSH). External peer-review system is mentioned but no annual information is given on results. There was a 228-day delay on average between reception and acceptance and a 35-day delay between acceptance and publication. The journal covers 87% of ophthalmology research articles published in Spain. International scope: 57% of editorial board members publish in international journals of impact. National scope, but low presence (11%) of foreign authors. Citations to relevant international literature accredited by ISI journals are included. The journal appears in leading biomedical databases. Citations: 133 international citations between 1998 and 2005. Its impact factor potential (0.165) is superior to the last journals listed in the JCR under the heading of <>. Editorial board citations: 261 for the 2000-2004 period. CONCLUSIONS: Archives is an excellent means of communicating research results. It is the dominant dissemination channel for published and visible ophthalmology in Spain. Its international projection is good and the impact of its contents shows promising results.

Editorial quality, diffusion and bibliometric indicators of the Revista Espaãnola de Enfermedades Digestivas.

AIM: To evaluate the editorial quality, diffusion, relevance of the scientific content, and the publication practices of the specialised journal Revista Española de Enfermedades Digestivas. MATERIALS AND METHODS: We checked 136 parameters based on ISO standards, the recommendations of scientific and editorial organisations, and studies of scientific editing and international publishing practices for biomedical journals. Diffusion was calculated using national and international databases, specialised libraries in Spain, and Internet sources. The analysis of the scientific content and publication practices was based on bibliometric indicators for the journal, authorship, and contributions. The sample for this study comprised six alternate issues of volume number 88 (1996), the last issue of this volume, and the first issue of volume 89 (1997). The samples used for the bibliometric analysis varied depending on the characteristics of specific indicators and the availability of information. RESULTS: The overall mean value for compliance with standards was 46.1%, while the real mean was calculated at 72.21%. The editorial procedures at the journal are similar to those of analogous international journals. The Revista Española de Enfermedades Digestivas is included in international databases of biomedical journals, and in the interdisciplinary international database SCI. It was found to be present in 70% of the medical libraries of Spanish universities, and in 73% of the hospital libraries studied. Bibliometric indicators showed co-authorship to be 5.5%; the origin of the authors grouped by province and by type of institutional affiliations showed 27.8% of all authors to be from Madrid, and that more were affiliated with general hospitals than with university hospitals. The mean delay between initial receipt of a manuscript and its publication was 300 days. Cocitation analysis gave the journal a central position amongst the 38 Spanish biomedical journals considered representative of the field. The journal's impact factor for 1996 was 0.260. CONCLUSIONS: The Revista Española de Enfermedades Digestivas is a high-quality vehicle of research results, and has acceptable internal editorial procedures. The journal is widely distributed, though its visibility on the Internet should be improved. Co-authorship is similar to that seen in other medical journals. Steps should be taken to make this journal better known within Spain, and to reduce the delay between the initial receipt and the final publication of manuscripts. Its impact factor is increasing steadily.

[Prevalence of tuberculosis infection in the school age in Guadalajara, Spain]. / Prevalencia de la infección tuberculosa en el medio escolar de Guadalajara.

OBJECTIVES: To estimate the prevalence of tuberculosis infected children in the first grades of Primary Education and to analyse the distribution of infected people among social class groups and other previous circumstances. METHODS: Cross-sectional study with diagnostic test application and questionnaire survey, in a representative sample of the school population of the province of Guadalajara, Spain (two stages sampling design). Tuberculin skin tests with 2 I.U. of P.P.D. RT-23 and the Sokal method for lecture were used. For occupational classification and social class definition were used the criteria of the last report of Spanish Epidemiology Society. RESULTS: A total of 1,093 children (50.8% males) between 6 and 9-year-old were studied. The overall prevalence of infected children was 1.64 (I.C.:1-2.3). The distribution of infection did not show significant differences between urban/rural population, previous disease, family antecedent, social class, dwelling area and occupational activities of parents. The prevalence increased in the older upper school years and among the older children. Prevalence ranged from 0.4% (CI: 0.01-1.3) in the first year to 3.53% (CI: 2.4-4.6) in the last year. Children born in 1988 had a 3.23% prevalence (CI: 1.2-5,1), while those born in 1989; 1990 and 1991 had a prevalence of 0.73 (CI: 0-1.77), 1.88% (CI: 0.2-3.51) and 0.4% (0-1.2), respectively. CONCLUSIONS: Tuberculosis infection is less prevalent at school ages than other areas of Spain. In spite of the increase prevalence per school year, the low frequency and sample size did not allow to test for other associations.

[Epidemiology of leprosy through the study of frequency of visits to the Trillo Specialized Hospital in 1943-1995]. / Epidemiología de la lepra a través del estudio de la frecuentación en el hospital especializado de Trillo durante el período 1943-1995.

BACKGROUND: The purpose of this study is to describe the social-demographic and clinical profile of hospitalised leprosy patients and to check whether typology has changed during the history of the centre. METHODS: Descriptive and retrospective study, performed by means of reviewing a sample of the patient records registered at the Centre since it was founded in 1943 until 1995. 366 cases were chosen by means of a systematic random sample and questionnaires completed on social-demographic and clinical variables. RESULTS: Most of the patients were male (71.9%, IC: 67.3-76.4), young (39.6 years of age, IC: 37.9-41.4), single (46.2%, IC: 41-51.3%) with low levels of education (illiteracy: 54.1%, IC: 40-69) with occupations relating to farming (35.5%, IC: 30.6-40.4) from Southern Spanish regions (patients from Andalucía 52.8%, IC: 45.8-54). The disease showed a family background in 31.1% of cases (IC: 26.4-35.9) and serious multibacillary forms (Lepromatose Leprosy 66.1%, IC: 61.2-71), which affected lower limbs in 72.1% of cases, heads in 63.1% and upper limbs in 64.4%. Global mortality of people admitted to hospital was 31.1% (IC: 26.4-35.9). During the surveyed period, patient age increased, and symptoms and mortality decreased. In general, hospital stays were for long periods (7.1 years, IC: 6.1-8.1), although at the end of the surveyed period, stays decreased considerably, in accordance with the duration of treatment (2.2 years). CONCLUSIONS: A Young male, in a precarious financial situation living in the South of Spain appear to be the patient profile which, with severe initial anatomical symptoms and later favourable results may represent the disease in a country with an autocuthonous endemy and characteristic epidemiology, which is in the pre-eradication phase.

[Anales de Medicina Interna: standardization, dissemination and bibliometric indicators. (I) Standards evaluation]. / Anales de Medicina Interna: Normalización, difusión e indicadores bibliométricos. (I) Evaluación normativa.

The evaluation of scientific journal has become a necessary exercise for a variety of purposes and parties. We evaluated compliance with ISO standards for periodicals by the Spanish biomedical journal An. Med. Interna. Compliance with 136 data items based on different standards was evaluated with the help of a specially developed data sheet, and expressed as overall mean compliance (49.2%) and actual mean compliance (83.4%), i.e., compliance with those items considered necessary for the effective transfer of information via data bases. Items for which standardization was not optimal were examined in detail and specific recommendations for correction were given. We conclude that An. Med. Interna effectively fulfills its mission as an instrument for the communication of research results. In comparison with Spanish journals covering different areas and published by different organizations, compliance with international standards was better in An. Med. Interna.

[Anales de Medicina Interna: standardization, dissemination and bibliometric indicators. (II) Bibliometric analysis]. / Anales de Medicina Interna: Normalización, difusión e indicadores bibliométricos. (II) Análisis bibliométrico.

National and international diffusion, composition of the collective of authors who publish in the journal, and cocitation were studies for the journal An. Med. Interna. Diffusion was analyzed by examining the presence of the journal in medical data bases and specialized libraries in Spain. The institutional affiliations and geographical location of authors were determined on the basis of the affiliations given in the article by-lines. The journal is included in the major medical data bases and in approximately 80% of the libraries studied. The predominant professional affiliation among authors was clinical (hospital); the geographical origin of the authors (expressed as a percentage of all authors) approximately paralleled the volume of scientific publications generated by each of Spain's 17 autonomous regions. The cocitation study showed that An. Med. Interna ranked somewhere in the middle of the group' of 38 Spanish medical journals considered representative of research being done in Spain.

[Anesthesia for carbon dioxide laser surgery to correct Zenker's diverticulum]. / Anestesia para la cirugía del divertículo de Zenker con láser CO2.

Two 48- and 62-year-old men, the latter with a history of ischemic heart disease, underwent endoscopic carbon dioxide laser surgery to correct Zenker's diverticulum. We provided total intravenous anesthesia, taking into consideration the special requirements of laser surgery. The pathogenesis of Zenker's diverticulum, the most common type of esophageal diverticulum, is poorly understood and the treatment approach depends on size and overall patient status. Patients with Zenker's diverticulum need a thorough preoperative assessment with special attention to airway permeability and the degree of difficulty of intubation. Anesthesia should be maintained in a manner that provides the safest, most effective surgical conditions.

[International visibility and impact of the Spanish research on prison health (2002-2011)]. / Visibilidad internacional e impacto de la producción científica española en Sanidad Penitenciaria (2002-2011).

OBJECTIVE: This paper sets out to analyze the dissemination and impact of Spanish research published in international scientific journals on Prison Health over the last decade. MATERIAL AND METHODS: Descriptive, longitudinal and retrospective analysis of scientific output. We used the Medline-Pubmed database as an information resource. We focus on the bibliometric aspects of journals, papers and authors using the indicators offered by the Web of Science, the Journal Citation Reports and the Essential Science Indicators. We identify the output of Spanish researchers, journals in which they are published, authors and main research fields. RESULTS: From 2002 to 2011, Spanish researchers published 159 papers, that is, nearly 2% of the world's share in Prison Health. The publication profile is mainly in international journals with an average impact on JCR. The Revista Española de Sanidad Penitenciaria is the most productive journal (9.09%), although its role is not prominent. Only two authors can be considered as medium-high productive authors with 10 papers in the study time period. The co-authors network shows a dense network with 14 authors along with minor fragmented networks. As regards citations, 6 papers have been cited 15 or more times and only two can be considered as highly cited. Three main research fronts have been identified: infectious diseases, drugs and psychiatric-psychological problems. CONCLUSIONS: The Spanish research production on Prison Health represents a similar share of the world output similar to that of other disciplines (1.9%), although slightly lower (General Medicine represents 3.05%; Public Health, 2.38%; Psychiatry, 2.29%; Toxicology, 2.46%). It seems likely that this share will increase as a result of the inclusion of its main journal in Medline along with an increasing number of researchers working on this discipline at an international level. However, inclusion has not yet led to integration into high-impact journals or a larger number of citations. The average Journal Impact Factor is relatively low (2.062) and few papers are published in first-class journals (Q1). There are few articles with a good citation average according to the discipline's standard. Likewise, the collaboration pattern still shows a poor state for Spanish research on Prison Health.

Spanish personal name variations in national and international biomedical databases: implications for information retrieval and bibliometric studies.

OBJECTIVES: The study sought to investigate how Spanish names are handled by national and international databases and to identify mistakes that can undermine the usefulness of these databases for locating and retrieving works by Spanish authors. METHODS: The authors sampled 172 articles published by authors from the University of Granada Medical School between 1987 and 1996 and analyzed the variations in how each of their names was indexed in Science Citation Index (SCI), MEDLINE, and Indice Medico Español (IME). The number and types of variants that appeared for each author's name were recorded and compared across databases to identify inconsistencies in indexing practices. We analyzed the relationship between variability (number of variants of an author's name) and productivity (number of items the name was associated with as an author), the consequences for retrieval of information, and the most frequent indexing structures used for Spanish names. RESULTS: The proportion of authors who appeared under more then one name was 48.1% in SCI, 50.7% in MEDLINE, and 69.0% in IME. Productivity correlated directly with variability: more than 50% of the authors listed on five to ten items appeared under more than one name in any given database, and close to 100% of the authors listed on more than ten items appeared under two or more variants. Productivity correlated inversely with retrievability: as the number of variants for a name increased, the number of items retrieved under each variant decreased. For the most highly productive authors, the number of items retrieved under each variant tended toward one. The most frequent indexing methods varied between databases. In MEDLINE and IME, names were indexed correctly as "first surname second surname, first name initial middle name initial" (if present) in 41.7% and 49.5% of the records, respectively. However, in SCI, the most frequent method was "first surname, first name initial second name initial" (48.0% of the records) and first surname and second surname run together, first name initial (18.3%). CONCLUSIONS: Retrievability on the basis of author's name was poor in all three databases. Each database uses accurate indexing methods, but these methods fail to result in consistency or coherence for specific entries. The likely causes of inconsistency are: (1) use by authors of variants of their names during their publication careers, (2) lack of authority control in all three databases, (3) the use of an inappropriate indexing method for Spanish names in SCI, (4) authors' inconsistent behaviors, and (5) possible editorial interventions by some journals. We offer some suggestions as to how to avert the proliferation of author name variants in the databases.