[Calculation of the number of terminally ill patients through their use of opioid analgesics and tumor mortality]. / Estimación de la población de enfermos en situación terminal a través de la utilización de analgésicos opioides y de la mortalidad por tumores.

OBJECTIVE: To find the number of patients in terminal care in Madrid Health District 3. DESIGN: Ecological, descriptive study. SETTING: Eleven Health Districts. Madrid, Spain, 2002. MAIN MEASUREMENTS: Two models were used to calculate the number of patients in terminal care and were compared with data from the Primary Care Service Portfolio. Model A: consumption of morphine and fentanyl. The number of defined daily doses (DDD) of these active principles and the DDD per 1000 inhabitants and day (DID) were calculated. Prescription details: prescriptions charged to Social Security from registered doctors in Madrid (primary care and specialists). Model B: tumor mortality, i.e. the number of deaths due to tumors in the year 2000, published in 2004. RESULTS: The number of terminal patients calculated by the 2 models in 7 of the 11 Health Districts and in the Community of Madrid is higher than in the Primary Care Service Portfolio. In the Community of Madrid, morphine and fentanyl are prescribed basically in primary care (96%). There was an important jump in fentanyl prescription from 2001 to 2002, due to the main fentanyl prescribed being transdermal. CONCLUSIONS: There are differences between the models in calculation of terminal patients. Moreover, the models offer heterogeneous results between health districts. Fentanyl consumption has become greater than morphine use in Madrid. The registers of terminal patients and/or their recruitment need to be improved.

Six hundred consecutive carotid endarterectomies with temporary shunt and vein patch angioplasty: early and long-term results.

PURPOSE: This retrospective study evaluates the long-term clinical outcome and the survival of 600 consecutive carotid endarterectomies performed with a temporary shunt. All arteriotomies were closed by vein patch angioplasty. MATERIALS AND METHODS: Between November 1989 and November 1998, 600 isolated carotid endarterectomies (CEA) were performed in 540 patients by a uniform surgical technique at the University Clinic of Mont-Godinne. An intraluminal shunt and patch closure were systematically used. The mean age was 68 yr (ranging from 41 to 91 yr), 400 patients were men. The risk factors included hypertension in 73%, smoking history in 60%, coronary artery disease in 51% and hyperlipidemia in 35%. The indications were asymptomatic stenosis in 47%, transient ischemic attack in 40%, vertebrobasilar symptoms in 7% and stroke in 6%. EARLY RESULTS: The combined 30-day stroke and death rate was 0.9%. There were four deaths. The stroke and TIAs rates were 0.2% and 1.5% respectively. The incidence of early carotid occlusion was 0.5%. Cranial or cervical nerve dysfunction was identified in 6.3%. LATE RESULTS: The median follow-up was 49 months with a range of 2-124 months. Cumulative survival rates at 5 and 10 yr were 92+/-1% and 89+/-2% respectively. Thirty-two patients died during long-term follow-up; the death was stroke-related in only three patients. CONCLUSION: Carotid endarterectomy using an intraluminal shunt and vein patch closure is a safe and effective procedure associated with low morbidity and mortality rates at short and long-term follow-up.

Estimación de la población de enfermos en situación terminal a través de la utilización de analgésicos opioides y de la mortalidad por tumores / Calculation of the number of terminally ill patients through their use of opioid analgesics and tumor mortality

Objetivo. Conocer el número de pacientes en situación terminal del Área 3 de Madrid. Diseño. Estudio descriptivo, ecológico. Emplazamiento. Once áreas de salud. Comunidad de Madrid (CM). Año 2002. Mediciones principales. Se utilizan dos modelos para estimar a la población de pacientes en situación terminal y se comparan con los datos obtenidos en la cartera de servicios: ­ Modelo A. Consumo de opioides mayores (fentanilo y morfina). Se calcula el número de dosis diarias definidas (DDD) y la dosis diaria definida por 1.000 habitantes y día (DHD) para estos principios activos. Datos de prescripción: recetas facturadas por la Seguridad Social de médicos colegiados de la CM (atención primaria y especializada). ­ Modelo B. Mortalidad por tumores: número de defunciones por tumores del año 2000, publicado en 2004. Resultados. El número de pacientes en situación terminal estimado por los 2 modelos en 7 de las 11 áreas y en la CM es superior al obtenido en la cartera de servicios. La prescripción de opioides mayores se realiza fundamentalmente en atención primaria (96%) en la CM. Se produce un salto cuantitativo en la utilización de fentanilo entre 2001 y 2002, debido a la prescripción mayoritaria de fentanilo transdérmico. Conclusiones. Hay diferencias en la estimación de pacientes en situación terminal según los distintos modelos. Además, los modelos no presentan resultados coherentes entre las distintas áreas de salud. La utilización de fentanilo ha desplazado a la morfina en la CM. Es importante mejorar los registros y/o la captación de pacientes en situación terminal

Objective. To find the number of patients in terminal care in Madrid Health District 3. Design. Ecological, descriptive study. Setting. Eleven Health Districts. Madrid, Spain, 2002. Main measurements. Two models were used to calculate the number of patients in terminal care and were compared with data from the Primary Care Service Portfolio. Model A: consumption of morphine and fentanyl. The number of defined daily doses (DDD) of these active principles and the DDD per 1000 inhabitants and day (DID) were calculated. Prescription details: prescriptions charged to Social Security from registered doctors in Madrid (primary care and specialists). Model B: tumor mortality, i.e. the number of deaths due to tumors in the year 2000, published in 2004. Results. The number of terminal patients calculated by the 2 models in 7 of the 11 Health Districts and in the Community of Madrid is higher than in the Primary Care Service Portfolio. In the Community of Madrid, morphine and fentanyl are prescribed basically in primary care (96%). There was an important jump in fentanyl prescription from 2001 to 2002, due to the main fentanyl prescribed being transdermal. Conclusions. There are differences between the models in calculation of terminal patients. Moreover, the models offer heterogeneous results between health districts. Fentanyl consumption has become greater than morphine use in Madrid. The registers of terminal patients and/or their recruitment need to be improved

Varicela: hacia una vacunación sistemática / Varicella: towards to systematic vaccination

Las clásicas "barreras" potenciales a la inmunización contra la varicela poco a poco han ido desapareciendo. La varicela no es siempre una enfermedad leve y es posible una vacunación segura y eficaz. En el momento actual se plantea la aplicación sistemática de la vacunación antivaricela a la población general con el objetivo de eliminar esta enfermedad exantemática. En este artículo se revisa la epidemiología de la varicela, se detallan cuales son las vacunas disponibles y las ventajas y desventajas de las estrategias vacunales aceptadas (AU)