Periodontitis impacts quality of life in postmenopausal women.

AIM: Interrelationships between traditional dental variables are becoming more evident in far-reaching aspects of life such as psychosocial interaction, self-esteem, overall health and even occupational performance. This study compares quality of life in postmenopausal women with chronic periodontitis with that of healthy postmenopausal women. METHOD: A total of 128 randomly recruited postmenopausal women received a comprehensive periodontal evaluation and completed the Utian Quality of Life Survey. The participants were divided into healthy and periodontitis groups based on comprehensive periodontal examination. Mean scores were calculated for each quality-of-life item, domain and the overall summary score. Periodontitis patients' quality-of-life outcomes were compared to those of healthy patients using the t-test with threshold of significance at p < 0.05. RESULTS: Quality-of-life scores in all fields measured were significantly poorer in the periodontitis patients compared to the healthy patients, occupational (25.74 ± 8.25 vs. 21.40 ± 9.19), health (26.46 ± 5.93 vs. 19.64 ± 10.24), emotional (21.04 ± 10.20 vs. 16.40 ± 10.84), sexual (9.23 ± 4.92 vs. 5.96 ± 5.20), and total score (82.48 ± 23.74 vs. 63.69 ± 26.61). CONCLUSION: This study has identified that postmenopausal women with chronic periodontitis report significantly poorer quality of life than healthy patients. Clinicians caring for postmenopausal women should be aware that periodontitis also impacts quality of life when making referral decisions for oral health care.

[Letournel ilioinguinal approach in the management of acetabular fractures]. / Abordaje ilioinguinal de Letournel en el manejo de fracturas de acetábulo.

The ilioinguinal approach described by Emile Letournel in 1961 allows an extensive exposure of the anterior elements of the pelvis and acetabular fractures involving the anterior wall and/or column, pubic symphysis, and sacroiliac joint. It also facilitates a rapid recovery of muscle function and leaves a cosmetic scar.

El abordaje ilioinguinal descrito por Emile Letournel en 1961 permite una extensa exposición de los elementos anteriores de la pelvis y de las fracturas acetabulares que involucran la pared o columna anterior, sínfisis del pubis y articulación sacroilíaca. Facilita una rápida recuperación de la función muscular y deja una cicatriz cosmética.

Direct anterior approach complications for total hip arthroplasty.

The direct anterior approach (DAA) for total hip arthroplasty has been popularized in the last decade as a minimally invasive approach used by many surgeons, including the authors, to preserve the integrity of muscle groups and their insertions and the dynamic hip stability resulting in less surgical trauma and faster recovery process with decreased postoperative pain. This surgical approach is not without a variety of complications and pitfalls. This review aims to identify any potential drawbacks and challenges associated with the DAA in THA and guide surgeons on minimizing and avoiding them.

El abordaje anterior directo (AAD) en artroplastía total de cadera se ha popularizado en la última década como un abordaje de mínima invasión utilizado por varios cirujanos, incluyendo a los autores, con la ventaja de preservar la integridad de los grupos musculares de la cadera y sus inserciones, así como la estabilidad dinámica de la articulación, resultando en menor trauma quirúrgico y una recuperación más rápida con menos dolor postoperatorio, a pesar de esto, el abordaje quirúrgico no está exento de complicaciones. El propósito de esta revisión es describir los riesgos y complicaciones potenciales relacionados al abordaje anterior directo en cirugía de artroplastía total de cadera y presentar una guía de cómo minimizarlas o evitarlas.

Geographical gradients in Argentinean terrestrial mammal species richness and their environmental correlates.

We analysed the main geographical trends of terrestrial mammal species richness (SR) in Argentina, assessing how broad-scale environmental variation (defined by climatic and topographic variables) and the spatial form of the country (defined by spatial filters based on spatial eigenvector mapping (SEVM)) influence the kinds and the numbers of mammal species along these geographical trends. We also evaluated if there are pure geographical trends not accounted for by the environmental or spatial factors. The environmental variables and spatial filters that simultaneously correlated with the geographical variables and SR were considered potential causes of the geographic trends. We performed partial correlations between SR and the geographical variables, maintaining the selected explanatory variables statistically constant, to determine if SR was fully explained by them or if a significant residual geographic pattern remained. All groups and subgroups presented a latitudinal gradient not attributable to the spatial form of the country. Most of these trends were not explained by climate. We used a variation partitioning procedure to quantify the pure geographic trend (PGT) that remained unaccounted for. The PGT was larger for latitudinal than for longitudinal gradients. This suggests that historical or purely geographical causes may also be relevant drivers of these geographical gradients in mammal diversity.

[Laparoscopic Nissen fundoplication: results and prognostic factors]. / Fundoplicatura de Nissen laparoscópica: resultados y factores pronósticos.

INTRODUCTION: Laparoscopic Nissen fundoplication is the technique of choice in the surgical treatment of gastroesophageal reflux disease. AIMS: To review the cases of laparoscopic Nissen fundoplication carried out at our hospital and to analyze the prognostic factors that influenced surgical outcome. MATERIAL AND METHODS: A total of 226 patients that underwent laparoscopic Nissen fundoplication within the time frame of 1996 to 2010 were retrospectively reviewed. Surgical results and prognostic factors were evaluated in 182 patients that had a follow-up longer than one year. RESULTS: The Nissen-Rossetti technique was carried out in 219 patients, without short gastric vessel division, and the "floppy"-Nissen technique was performed on seven patients. Intraoperative complication rate was 3.1%, conversion rate was 6.6%, and postoperative complication rate was 4%. Mortality was 0. After surgery, 19% of patients presented with dysphagia that was persistent in only 3.5%. Of the 182 patients with a follow-up longer than one year, 166 (91.2%) were satisfied with the surgical results. In the univariate analysis, esophagitis (OR=0.59) was a protective factor, while a DeMeester score >50 (OR=1.97) and medical treatment resistance (OR=1.75) were risk factors. In the multivariate analysis a DeMeester score >50 (OR=4.24) was the only independent prognostic factor associated with poor outcome. CONCLUSIONS: Our results with laparoscopic Nissen fundoplication are comparable to those found in the medical literature, with a high degree of patient satisfaction. Esophagitis is associated with good outcome, while massive reflux and medical treatment resistance are negative prognostic factors.

[Uncemented total hip arthroplasty by anterior approach. Report of the first 50 cases]. / Artroplastía total de cadera no cementada por abordaje anterior. Reporte de los primeros 50 casos.

INTRODUCTION: The anterior direct approach to the hip has become popular in recent years, as it favors rapid recovery and better evolution, as well as shorter hospital stay time, painkiller consumption, physical therapy requirement and thus a possible overall reduced cost. The results of the first 50 cases are reported, with this technique assisted by the use of a special traction table. MATERIAL AND METHODS: Retrospective study of 50 hip arthroplasties in 47 patients by said method and special table, between April 2018 and April 2020. Etiology, gender, affected age and side, surgical lapse, transoperative bleeding and implant size were recorded. Immediate clinical and radiographic evolution was evaluated at the start and during the first 90 days. RESULTS: Sample of 18 men and 29 women. The average age was 67.7 years (range 28 to 94). Mean surgical time two hours 37 minutes, average bleeding 513 ml, clinical progress according to Harris scale: excellent 42 (84%), seven good (14%) and one bad (2%), due to infection. There were two calcar fractures without the need to remove an implant, eight cases of muscle mass injury, bruising in four (8%), femorocutaneous nerve paresis in six (12%), superficial infection two cases (4%). No dislocations. CONCLUSION: The anterior approach is a safe and reliable technique with immediate satisfactory outcomes and minor complications.

INTRODUCCIÓN: El abordaje anterior directo de cadera se ha popularizado en estos últimos años, ya que favorece una rápida recuperación y mejor evolución, así como reducción en tiempo de estancia hospitalaria, en consumo de analgésicos, requerimiento de terapia física y con todo ello un posible costo en general disminuido. Se reportan resultados de los 50 primeros casos usando esta técnica, auxiliada del uso de una mesa especial de tracción. MATERIAL Y MÉTODOS: Estudio retrospectivo de 50 artroplastías de cadera, mismo implante en 47 pacientes mediante el citado abordaje y utilizando dicha mesa, entre Abril de 2018 y Abril de 2020. Se registraron etiología, género, edad y lado afectado, tiempo quirúrgico, sangrado transoperatorio y tamaño de los implantes. Se evaluó el progreso clínico y radiográfico inmediatos y en los 90 días iniciales. RESULTADOS: Muestra de 18 varones y 29 mujeres. La media de edad fue 67.7 años (rango de 28 a 94). Lapso quirúrgico promedio dos horas 37 minutos, sangrado promedio 513 ml, evolución clínica de acuerdo a escala de Harris: excelente 42 (84%), bueno siete (14%), malo uno (2%) por infección. Se presentaron un par de fracturas de calcar sin necesidad de retirar implante, ocho casos de lesión de masa muscular, hematoma en cuatro (8%), paresia del nervio femorocutáneo en seis (12%), infección superficial en dos (4%). No se presentaron luxaciones. CONCLUSIÓN: El abordaje anterior es una técnica segura y confiable con consecuencias inmediatas satisfactorias y complicaciones menores.

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors.

BACKGROUND: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. The effect of anti-TNF-alpha therapy on periodontitis also was assessed. METHODS: Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-alpha before randomization. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index (PI), RA disease activity score 28 (DAS28), and erythrocyte sedimentation rate (ESR) were measured at baseline and 6 weeks later. Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not. RESULTS: Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (P <0.001), and serum TNF-alpha (P <0.05). There was no statistically significant decrease in these parameters in patients not receiving periodontal treatment. Anti-TNF-alpha therapy resulted in a significant improvement in CAL, PD, BOP, and GI. CONCLUSIONS: Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition. Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition.

18FDG PET/CT & arterial inflammation: predicting cardiovascular events in lung cancer.

BACKGROUND: 18F-FDG PET/CT predicts cardiovascular disease. To analyze the predictive value of cardiovascular events from inflammation and arterial calcification in patients who underwent an 18F-FDG PET/CT for lung cancer. METHODS: A retrospective study of 274 patients with primary lung neoplasia. We determined: (i) TBR (target-to-background ratio), and (ii) the calcium score, at eight common arterial segments. We took as arteriosclerosis, a TBR ≥1.6 and ≥15 Calcium Score sum. We registered cardiovascular risk factors, comorbidities, histology, stage, treatment, status at the last clinical review, cause of death and cardiovascular event during the follow-up. RESULTS: The territory presenting the greatest uptake of 18F-FDG, was the thoracic aorta with an average of 1.77 (± 0.27 TBR) in the aortic arch, while the greatest degree of calcification was obtained in the abdominal aorta (52% with a Calcium Score ≥ 3). 24% of the patients presented a sum Calcium Score ≥15, and 17% a TBR ≥1.6. Patients with high TBR, (17%), had not a higher frequency of cardiovascular comorbidities beforehand, nor did they in the follow-up. However, those with a sum Calcium Score ≥15 (24%), were older, had more cardiovascular risk factors and ischemic events during follow-up. The calcium score, but not the TBR, predicted the emergence of a cardiovascular event (HR 4.9 IC95% 2.1-9.1, P < 0.05). CONCLUSION: In our cohort, a high Calcium Score was an independent predictor for developing cardiovascular events.

Long-term data from a small mammal community reveal loss of diversity and potential effects of local climate change.

Climate change affects distribution and persistence of species. However, forecasting species' responses to these changes requires long-term data series that are often lacking in ecological studies. We used 15 years of small mammal trapping data collected between 1978 and 2015 in 3 areas at Doñana National Park (southwest Spain) to (i) describe changes in species composition and (ii) test the association between local climate conditions and size of small mammal populations. Overall, 5 species were captured: wood mouse Apodemus sylvaticus, algerian mouse Mus spretus, greater white-toothed shrew Crocidura russula, garden dormouse Eliomys quercinus, and black rat Rattus rattus. The temporal pattern in the proportion of captures of each species suggests that the small mammal diversity declined with time. Although the larger species (e.g., E. quercinus), better adapted to colder climate, have disappeared from our trapping records, M. spretus, a small species inhabiting southwest Europe and the Mediterranean coast of Africa, currently is almost the only trapped species. We used 2-level hierarchical models to separate changes in abundance from changes in probability of capture using records of A. sylvaticus in all 3 areas and of M. spretus in 1. We found that heavy rainfall and low temperatures were positively related to abundance of A. sylvaticus, and that the number of extremely hot days was negatively related to abundance of M. spretus. Despite other mechanisms are likely to be involved, our findings support the importance of climate for the distribution and persistence of these species and raise conservation concerns about potential cascading effects in the Doñana ecosystem.

[Kocher-Langenbeck approach in the surgical management of posterior wall fractures of the acetabulum]. / Abordaje de Kocher-Langenbeck en el manejo quirúrgico de las fracturas posteriores del acetábulo.

Surgical treatment of acetabular fractures is indicated in displaced cases in order to restore and stabilize the hip joint and the pelvic ring integrity. Posterior structure fractures must be treated through posterior pelvic surgical approaches. The Kocher-Langenbeck is the most recommended approach for the majority of posterior acetabular fractures.

Las fracturas de acetábulo son lesiones articulares que en la mayoría de los casos requieren manejo quirúrgico para restablecer la integridad de la articulación de la cadera y el anillo pélvico. Las fracturas de elementos posteriores del acetábulo deben ser tratadas por abordajes posteriores. El de Kocher-Langenbeck es el más recomendado en la mayoría de los casos.

[Veracity of smokers' reports of abstinence at smoking cessation clinics]. / Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica.

OBJECTIVE: To assess the reliability of smokers' response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement. PATIENTS AND METHODS: A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated. RESULTS: A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables. CONCLUSION: The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence.

Diagnostic performance of arginase activity in colorectal cancer.

Arginase activity was measured in serum and biopsy from healthy individuals and colorectal cancer patients. Arginase activity in tumor samples (87 +/- 7.7 U/g tissue) was significantly higher than in controls (40.7 +/- 3.3 U/g tissue). However, serum arginase activity did not show any significant change in both groups. Finally, the micromethod used to quantify arginase activity in this study is superior to other methods because it has increased sensitivity, requires less sample, and is less time-consuming. Arginase differences are significant, according to the t-test (P<0.05)

[Pelvic fractures: early management of hemodinamically unstable patients]. / Fracturas de pelvis en pacientes hemodinámicamente inestables.

INTRODUCTION: Fractures that compromise pelvic and/or acetabular mechanical stability are usually injuries caused by high energy mechanisms and are life threatening. OBJECTIVE: To present the treatment options for the early stabilization of pelvic rim injuries and acetabular fractures in hemodinamically unstable patients. MATERIAL AND METHODS: Retrospective, cross-sectional, descriptive study in patients with diagnosis of pelvic ring or acetabular fracture and hemodynamic instability seen in the emergency room between January 2002 and December 2010. The mechanisms of injury were identified and the following variables were considered: sex, age, type of fracture, time course, associated injuries, early and definitive management. RESULTS: Fifteen patients were included; 9 with pelvic fracture, and 6 with acetabular fracture or both, who had hemodynamic instability resulting from hypovolemia: 8 males (53.3%) and 7 females (46.6%) with an age range of 18-72 years. The most common mechanism of injury was motor vehicle accident in 8 cases (53.3%), motorcycle accident in 2 (13.3%), fall in 2 (133%), and being run over in 3 patients (20%). All of them had associated injuries. Initial management consisted of external fixation with a standard fixator in 6 cases; C clamp in one case; girdle-like pelvic bandage in 2; laparotomy with packing and definitive primary osteosynthesis in one case. Results were assessed after a minimum of 3 years and were classified into excellent, 10 (76.9%) good, 1 (7.7%) fair, 0 and poor 1 (7.7%). One female patient (7.7%) died 8 hours after admission. CONCLUSION: Unstable pelvic or acetabular fractures are injuries produced mostly by high energy mechanisms and are life threatening in most cases. Initial management is extremely important for treatment course and final outcome. In cases that present initially with hemodynamic instability mortality is higher and management should be much more aggressive.

[Research and the recent evolution of primary health care]. / La investigación y la evolución reciente de la atención primaria.

Primary care in Spain has undergone a burgeoning phase in the 80's, followed by a decade of stagnation in the 90's, with little creativity, a routinisation of tasks, and the set up of service port-folios and program-contracts. On the other hand, the recent changes in the orientation of the research promoted by the health administration, in favor of basic research, at the expense of health services research and clinical epidemiology, are in contrast with the importance of primary care as a natural setting for the management of many causal agents and risk factors for health. Despite such limitations, the culture of research has become present in many primary care centres and pharmacies, and primary care research is increasingly present in scientific journals. Nevertheless, it is necessary, also for the case of primary care, to manage research, in differentiated and specific ways, favoring priorization, evaluation and responsibility through flexible organisational formulas and information systems. This should include contracting procedures allowing for at least part-time research, as well as professional career models acknowledging research and teaching activities. Scientific and professional associations in primary care face the challenge of maintaning research projects, of increasing their presence among professionals, of formulating opinions regarding the problems of their sector, as well as of reinforcing their organizational and communication capabilities.

[The mortality at 2 years in chronic patients confined to home]. / Mortalidad a los 2 años en pacientes crónicos confinados en el domicilio.

OBJECTIVE: To analyse the relationship between the mortality of the chronically ill confined to their homes and the risk of death predicted by the doctor and other variables. DESIGN: Longitudinal descriptive study. PATIENTS: 223 patients were studied over 2 years. MEASUREMENTS AND MAIN RESULTS: Survival was related to the variables measured at the beginning of the follow-up: age, sex, social class, time of confinement, number of diagnoses, hours in bed, evaluation with the Katz index and the Nottingham health profile, number of medicines, family help available, and doctor's opinion on the risk of death. 67% of the patients considered at very serious risk of death died within 6 months, as against 6.91 who died in the same period but had a different prognosis. 40.6% at serious risk died within a year, against 12.4% with a different prognosis. The variables independently associated with higher mortality are: the doctor considering that the risk of death is serious/very serious, OR and 95% CI; 2.57 (1.64-4.03); remaining over 16 hours a day in bed, OR 2.39 (1.31-4.36); being over 80, OR 3.41 (1.74-6.66) and being male, OR 1.61 (1.11-2.33). CONCLUSIONS: The prognostic judgement of the general doctor behaved as a predictor of mortality, and may be an indirect indicator of his/her capacity to foresee the need for health services.

[Antirabies vaccine from the brain of the suckling rat: antigen composition and immunogenic capacity]. / Vacuna antirrábica de cerebro de ratón lactante: composición antigénica y capacidad inmunógena.

Suckling mouse brain (SMB) rabies vaccine is the preparation most widely used in the countries of Latin American and the Caribbean. This vaccine, prepared according to the Fuenzalida and Palacios method, consists of three fixed rabies virus strains (CVS, 51, and 91). However, the World Health Organization recommends that rabies vaccines for human use be prepared using only a single strain of this virus. In order to determine whether any one of the antigens of the SMB vaccine could be eliminated from the preparation, the immunogenic capacity of the standard trivalent SMB vaccine was compared with that of experimental bivalent (CVS-51, CVS-91, and 51-91) and monovalent (CVS, 51, and 91) SMB vaccines. The study was conducted using adult and suckling albino mice provided by the laboratory at the Pan American Zoonoses Center, Buenos Aires, Argentina, and different strains of fixed and street rabies virus. The experimental vaccines were prepared using the Fuenzalida-Palacios method. Potency and cross-immunity tests were conducted. The results showed that the trivalent vaccine was the most effective in protecting the mice against both fixed and street rabies virus infections and also in inducing rapid development of neutralizing antibody at high titers.

[The frequency of illnesses attended and its relationship with the maintenance of the family doctor's skill]. / La frecuencia de las enfermedades atendidas y su relación con el mantenimiento de la destreza del médico de familia.

OBJECTIVE: To describe the incidence of health problems dealt with less often in primary care medical consultations, and to discuss its relationship with the maintenance of professional skill, with in-work training and case-load planning. DESIGN: A prospective observational study based on a year's recording. SETTING: The clinics of 44 primary care doctors from 10 autonomous communities. PATIENTS: 418,98 people were attended. INTERVENTIONS: The unit of analysis was the care episode. The incidence per 1000 people attended, in total and by demographic mean, of the less common health complaints (incidence less than 1/1000) was calculated. RESULTS: Primary care doctors attended at greater frequency than 1/1000 all diseases of eyes, ears, mastoids (except salpingitis) and menstrual disorders codifiable under the classification CIPSAP; almost all the respiratory, skin and locomotive diseases, and more than half of the circulatory, genito-urinary, digestive and endocrine-metabolic diseases. Incidence was less than 1/1000 in all the malignant tumours and contagious diseases, except viral hepatitis and tuberculosis in the urban setting. CONCLUSIONS: Primary care doctors do not often attend certain serious diseases, which are nevertheless present in many differential diagnoses (malignant tumours). This should be borne in mind in the training strategies aimed at maintaining doctor's diagnostic skills.

Ligation of CD4 concomitant to activation induces primary CD4+ T-cell adhesion and pseudopodia formation in vitro.

A regulatory function for CD4 molecules in lymphocyte adhesion and motility was investigated. Murine splenic CD4+ T cells, activated in the presence of phorbol ester and immobilized anti-CD4 mAb, adhered to the plastic surface and formed extended cytoplasmic projections (pseudopodia). Pseudopod formation was cell-density-dependent, peaked at Day 3, and disappeared by Day 5 in culture. This response could be inhibited by soluble anti-CD4 and by RGD-containing peptide. Ligation of CD4 was required at a late stage in cell activation, and stimulated cell motility in vitro. Addition of IL-4, but not IL-2, upregulated pseudopod formation induced by suboptimal stimuli. Anti-IL-4 mAb blocked pseudopod formation, and exogenous IL-4 restored the response. A combination of IL-4 plus phorbol ester, but not IL-2 plus phorbol ester, induced pseudopod formation in concert with CD4 ligation. Exogenous IL-2, on the other hand, blocked pseudopod formation. CD45RBlow CD4+ T cells were much more efficient than CD45RBhigh CD4+ T cells for pseudopod formation. These results indicate that CD4 ligation induces CD4+ T-cell adhesion and motility, mainly in the memory/activated subset, which might be relevant for immune responses in vivo.

[The debate on the organization, functions and efficiency of nursing in primary care: apropos of a qualitative study]. / El debate sobre la organización, las funciones y la eficiencia de enfermería en atención primaria: a propósito de un estudio cualitativo.

OBJECTIVE: To show the opinions that doctors and nurses express on the organisation and competences of primary care nursing, and on inter-professional relations. DESIGN: Qualitative research study based on the group discussion technique known as Philips 66. SETTING AND PARTICIPANTS: Three discussion groups, one of nurses, one of doctors and a third mixed, with 6 components each, half from Cáceres and the rest from other provinces, and all involved in primary care health delivery. MEASUREMENTS AND MAIN RESULTS: In the discussions, the three groups coincided in the importance given to nursing clinics and home visits, in the organisational advantages that the attachment as a norm of the population to a nursing clinic would bring, in the ability of nurses to perform the techniques they have habitually used, and in defence of one sole clinical record per patient. They blamed each other mutually for making few home visits. Doctors attributed to nurses under-use of records and nurses alleged doctors took no notice of their notes. On the question of their relations, doctors thought that nurses did not take on joint responsibility for the work-loads in health centres; and nurses thought that doctors did not wish to share tasks, but rather delegate or order them. CONCLUSIONS: The attachment of the population to nursing clinics would favour the extension of care, the commitment to the population and the real delivery of services, as well as professional autonomy and recognition.