[The unequal clinical profile, quality of life and hospital mortality in patients undergoing aortocoronary bypass in the public and private centers of Catalonia. The CIRCORCA Study]. / Desigual perfil clínico, calidad de vida y mortalidad hospitalaria en pacientes operados de injerto aortocoronario en centros públicos y privados de Cataluña. El estudio CIRCORCA.

INTRODUCTION AND AIMS: The influence of the type of health care funding and management of hospital centres on hospital mortality in coronary artery bypass surgery (CABG) has not been analyzed in detail. We therefore assessed clinical and quality of life preoperative profiles and in-hospital mortality in public and private patients undergoing coronary bypass surgery in Catalonia. METHODS: Clinical questionnaires, Duke Activity Status Index (DASI) and SF-36 were preoperatively administered to all patients undergoing first coronary bypass surgery without associated procedures in Catalonia between November 1996-June 1997. In-hospital morbidity and mortality were recorded. RESULTS: Predictors of in-hospital death, including DASI, SF-36 and comorbidity scores, were significantly worse in public than in private patients. In-hospital mortality rate was more than ten times greater in public than in private patients (8.2% vs 0.7%; p < 0.001). Multivariate analysis identified private funding of health care, among others, as an independent predictor of in-hospital survival. Non evidence-based indications for surgery were significantly more common in private than in public patients (6% vs 0.7%, p < 0.001). CONCLUSIONS: a) In catalonia, the risk profile of public patients undergoing coronary bypass surgery was significantly higher than that of private patients, accounting, at least in part, for a remarkable mortality difference; b) non evidence-based indications for surgery were more common in private than in public patients; c) these unequal patterns raise questions about the adequacy of care and referral patterns in both private and public sectors.

[Effectiveness of omeprazole, clarithromycin and amoxycillin therapy to eradicate Helicobacter pylori in patients with active peptic ulcer. Preliminary results of GENPY study]. / Efectividad de la combinación de omeprazol, claritromicina y amoxicilina en la erradicación de Helicobacter pylori en pacientes con ulcus péptico activo: resultados preliminares del Estudio GEHPY. Grupo de Estudio de Helicobacter pylori.

BACKGROUND: To compare the effectiveness of two length of the same therapy to eradicate Helicobacter pylori in patients with non complicated active peptic ulcer. PATIENTS AND METHODS: 223 patients visited at primary health centres. A randomised controlled trial was carried out to compare the results of 6 or 7 days of treatment with clarithromycin 500 mg, amoxicillin 1 g and omeprazole 20 mg, b.i.d. All patients received omeprazole for other 14 days. RESULTS: 108 patients were randomised to the 6 days group and 115 to the 7 days one. Both groups were comparable with respect to basic characteristics except for sex: the proportion of men was higher in the 6 days group (p = 0.04). 91.4% of the patients received all the treatment correctly. By intention to treat analysis, eradication rates were 76.9% in the 6 days group and 77.4% in the seven days group (IC 95% of the difference from -10.5 to 11.6). There were not statistically significant differences in eradication rates in relation to age, sex, ulcer location, recurrence or tobacco consumption. CONCLUSIONS: Although eradication rates are lower than expected, in this study there are no differences between 6 or 7 days of therapy.

[Non-steroid anti-inflammatory agents and gastrointestinal protection: adequate prescription in primary care?]. / Antiinflamatorios no esteroides y protección gastrointestinal: prescripción adecuada en atención primaria?

OBJECTIVES: To find the frequency of prescription of gastro-intestinal protectors (GIP) at the same time as non-steroidal anti-inflammatory drugs (NSAID). To find certain characteristics linked to their use in primary care. To evaluate how correctly they are prescribed. DESIGN: A crossover descriptive study. SETTING: A base urban health area. PATIENTS: Patients over 14, who attended in 1994, who had a medical history and were treated with NSAID. MEASUREMENTS AND INTERVENTIONS: 1,115 medical histories were obtained by simple randomised sampling, of whom 205 were under treatment with NSAID. A questionnaire was used to evaluate: age, sex, NSAID treatment, GIP, history of peptic ulcer, corticoid or acenocoumarol treatment, tobacco, alcohol and related pathology. After a complete bibliographic review, some criteria were fixed for when it is correct to give GIP-NSAID. RESULTS: The prevalence of NSAID prescription was 18.39%. 34 patients treated with NSAID received GIP at the same time. Aceclophenac was the most widely prescribed NSAID; and H2 antihistamines, the drugs most commonly used as GIP.