Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study).

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). Conclusions: The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state.

Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided.

[Validation of taking arterial pulse in Primary Care for the detection of atrial fibrillation and other cardiac rhythm disorders in patients over 65 years old]. / Validación de la toma del pulso arterial en atención primaria para la detección de fibrilación auricular y otros trastornos del ritmo cardiaco en mayores de 65 años.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. RESULTS: The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. CONCLUSIONS: The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years.

[Evaluation of topical vasoconstrictors in pterygium surgery and their role in reducing intraoperative bleeding]. / Evaluación de vasoconstrictores tópicos en la cirugía del pterigión y su papel en la disminución del sangrado intraoperatorio.

OBJECTIVE: To reduce vascularisation before surgery through the application of topical vasoconstrictors, decreases the rate of intraoperative bleeding, improves the dynamics of the surgery and reduces the difficulty in surgical performance. METHODS: Only patients with primary pterygium were included in the study. A prospective randomized clinical trial was designed to compare intraoperative bleeding, need for cauterization and surgical time a group that was administered phenylephrine. preoperatively and one which did not receive it. The sample was divided into two groups: 1st (n=27) received topical phenylephrine (F) 0.1 ml (10%), twice in 5 minutes before surgery. 2nd (n=30) did not receive phenylephrine (NoF). The technique was similar in both groups using conjunctival autograft suturing. In both groups, the subconjunctival aneasthesia was performed with 0.5% bupivacaine hydrochloride with epinephrine 1:200,000. RESULTS: A total of 57 patients were included in the study. The mean operation time for group F was 15.57 minutes (SD: 1.8 min) and the NoF group 16.51 min (SD to 1.82 min, P=.057). In the group F, it was necessary to use diathermy in 2 patients (7.4%) and in the NoF group cauterisation was used in 14 patients (46.7%, Chi-Square=10.848, P=.001. There is a relative risk 6.3 (95% CI 1.57 - 25.27) times greater than having to cauterise without phenylephrine when used phenylephrine. CONCLUSIONS: The use of topical vasconstrictors prior to pterygium surgery reduces the rate of bleeding and the time of surgery.

[Effectiveness of medical counseling for alcoholic patients and patients with excessive alcohol consumption seen in primary care]. / Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria.

AIM: To determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers. DESIGN: Quasi-experimental, open, multicenter before-after study.Setting. 14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain). PARTICIPANTS: 306 patients of both sexes, recruited with a case-finding strategy, who consumed >=35 (men) or >=21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O>=11). Interventions. All patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later. MAIN MEASURES: The response variable was self-reported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis. RESULTS: Of the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05). CONCLUSIONS: Counseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS.

Effectiveness of a learner-centred training programme for primary care physicians in using a patient-centred consultation style.

OBJECTIVE: The aim of the present study was to find out if a training programme adapted to family physicians with several years of clinical experience changes their behaviour when they deal with fibromyalgic patients in the sense of introducing the communication skills that define the 'patient-centred' approach. METHODS: A randomized, and simple blind, educative study was carried out. Twenty full-time family physicians were invited to participate. They were allocated randomly to two groups: an intervention and a control group. A total of 110 patients were recruited from people attending physicians' surgeries for the first time and who complained of generalized pain that finally fulfilled criteria for generalized musculoskeletal chronic pain/fibromyalgia. This was done for an entire year. The intervention group received an 18 hour intensive course. One week after the course, all doctors carried out a video-recorded encounter with a patient who played the part of a typical fibromyalgia clinical case. The interviews were coded by an observer blind to the training status of the participants, using the GATHARES-CP questionnaire. All patients were contacted by telephone during a 1-2-month period by a different interviewer who was 'blinded' to the patient's experimental status. They were asked to respond to three questions that represent the key components of patient-centred style. RESULTS: The average score on the GATHARES-CP questionnaire was 11.3 +/- 0.9 and 9 +/- 2.3, for doctors from the intervention and control groups, respectively (P < 0.01). For 11 items, scores were higher in the intervention group. The patients' answers to all three questions showed statistically significant differences in a positive direction for the trained doctors. CONCLUSIONS: The doctors improved the use of strategies and skills for carrying out patient-centred consultations after they had received an interactive course. The doctors' behaviour appeared to have changed as much in a more experimental situation as in the actual consultations. Moreover, the gain was observed immediately after the intervention was completed, and after having run for a variable period of time up to 1 year.

[Effectiveness of preventive activities analyzed within the framework of health centers involved in the Program for Preventive Activities and Health Promotion (PAPPS) of the semFYC. Group for the Evaluation of PAPPS]. / Efectividad de las actividades preventivas analizada en el ámbito de centros de salud adscritos al Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) de la semFYC. Grupo de Evaluación del PAPPS.

OBJECTIVE: To find the effectiveness of a programme of preventive activities for adults (hypertension, tobacco and alcohol) measured by the number of cases identified, the evaluation of the initial interventions and the degree of control over the identified factors. DESIGN: Retrospective study: review of clinical records. SETTING: Primary care. Multi-centre study: health centres from the whole of Spain. PATIENTS: 7562 clinical records of patients over 20, who participated voluntarily and were extracted by systematic sampling from 378 care units (doctor and nurse) at 85 health centres committed to the Programme of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC). The study period was from May 1 1995 to April 30 1997. MEASUREMENTS AND MAIN RESULTS: Age, sex, data on tobacco habit, alcohol consumption and blood pressure were obtained through a questionnaire (recording the actions taken, date of diagnosis, initial assessment and subsequent monitoring). 28.3% were tobacco-dependent, 6.9% consumed too much alcohol, and 22.2% had hypertension. About 20% cases of each risk factor were detected during the study period. Giving up tobacco was recorded in 7.6% of smokers, and giving up alcohol in 19.7% of excess drinkers. 78.6% of hyperintense patients had acceptable-optimum control. CONCLUSIONS: The number of cases detected shows that the PAPPS programme performs acceptably. The tobacco and drink given up and the hypertension control attained due to the intervention are similar to the published trials. The PAPPS is an effective programme for controlling risk factors in primary care.

[Alcohol consumption among students in a basic health area in Córdoba]. / Consumo de alcohol entre los escolares de una zona básica de salud de Córdoba.

BACKGROUND: To determine alcohol consumption amongst schoolchildren, and to discover the factors which are associated with the said consumption. METHODS: A cross-sectional study, by means of a health questionnaire administered to 548 schoolchildren in the 6th and 8th years of Primary Education (EGB) in schools within the Basic Health Area of Cordoba, with a median age of 12.4 years old (limits at 10 and 15 years old). Data were gathered on the consumption of alcohol by schoolchildren and in their social environment, as well as other variables in the lives of schoolchildren. RESULTS: 43.7% (interval of confidence at 95% -IC95%: 39.4-47.9) have tried alcohol, 3.8% (IC95% 2.5-5.9) drink regularly, while 26.8% (IC95% 23.2-30.8) drink occasionally. By means of logical regression analysis we found a connection between the consumption of alcohol and increasing age (Odds Ratio -OR: 0.83; IC95% 0.07-0.98), being male (OR: 1.78; IC95% 1.16-2.73), the consumption of alcohol by older brothers or sisters (OR: 2.25; IC95% 1.35-3.75), the consumption of medicines to treat nervousness (OR: 5.33; IC95%: 1.26-22.5), poor educational performance (OR: 1.002; IC95% 1.0-1.005), the consumption of tobacco (OR: 4.55; IC95% 2.4-8.61) and the feeling of loneliness (OR: 1.41; IC95% 1.01-1.97). CONCLUSIONS: Although the number of schoolchildren who try alcohol is low in comparison with other areas, the percentage of current drinkers is very similar. It would seem that older brothers and sisters have an important influence on starting consumption. The profile of a school age child who drinks corresponds to a male, a smoker, and having feelings of loneliness.

[Tobacco consumption among the student population. Related factors]. / Consumo de tabaco entre la población escolar. Factores relacionados.

OBJECTIVE: To know smoking prevalence among schoolchildren and factors related with this habit. METHODS: A cross-sectional study. 548 school-children in their 6th and 8th years of primary studies at schools from an area of Córdoba (Spain) were interviewed. INTERVENTIONS: Autoadministered questionnaire. RESULTS: Tobacco was tried in 22% (CI 95%: 18.7-25.8) school-children. The average age for starting with this habit was 11.6 (SD)(CI 95%: 11.4-11.8). 12.1% smoked regularly and 1.3% smokers every day. The tobacco consumption in children was related with age (OR = 2.96; CI 95%: 1.12-7.82), cough medicines consumption (OR = 3.15; CI 95%: 1.32-7.48), to have a smokers sister (OR = 2.53; CI 95%: 1.06-6.00) and best friend (OR = 4.42; CI 95%: 1.85-10.60) and drinking beer (OR = 3.68; CI 95%: 1.15-11.7). CONCLUSIONS: The prevalence of smoking in our school-children is very close to that reported by others. Among the factors accounted with the tobacco consumption in schoolchildren, highlight the presence of this habit in the eldest sister and the best friend.

Biopsychosocial features of patients with widespread chronic musculoskeletal pain in family medicine clinics.

OBJECTIVES: We aimed to describe the clinical and psycho-socio-familial features of patients with widespread chronic musculoskeletal pain (WCMP)/fibromyalgia (FM) in primary care settings. To detect differences and similarities between both 'entities'. METHODS: An observational study was carried out with a newcoming clinical case series. Five family medicine surgeries were included. Patients aged from 18 to 50 attended the clinic to fulfil pain criteria for WCMP. Differences between WCMP and FM were based on the presence of 'tender points'. Measurements were made of general characteristics, occupation, pain description, symptoms, tender points, radiographic and laboratory studies, and questionnaires to assess self-rated health (NHP), social support (DUKE), family support (Family-APGAR), and psychopathological traits (CAQ). RESULTS: We identified 48 patients (23 WCMP;25 FM) with a mean age of 38.4 +/- 8.4; 95.8% were females. The back was the anatomical place most frequently reported (93.7%) and 34.8% of the patients pointed out the nape as being the most painful place. The average duration of pain was 6.7 +/- 7 years. Unsteadiness (72.9%), impairment in symptoms with weather (70.8%), with activity (70.8%) and general fatigue (68.8%) were the most frequently detected symptoms. 'Pain' (59.5) and 'energy' (54.4) were the scales of the NHP test most affected. Half of the patients were poorly satisfied with the responses of their families to their needs and over 60% showed psychopathological traits. The patients with FM reported worse self-rated health than those with WCMP; the number of years of pain (4.9 versus 8.2) and the number of symptoms (6.6 versus 8.9) were both greater in patients with FM. CONCLUSIONS: The clinical and psychological features of patients with WCMP-FM are similar to those reported by others. The self-rated health reported by these patients is poor and closer to that reported by patients suffering other chronic osteoarticular diseases. These results support the hypothesis that FM should be considered as more advanced clinical stage of the widespread musculoskeletal pain continuum.

[Evolution in consumption of and attitude towards tobacco towards physicians at the regional hospital "Reina Sofía," Córdoba]. / Evolución del consumo y actitud ante el tabaco de los médicos del hospital regional "Reina Sofía, Córdoba.

OBJECTIVES: to study the evolution of the smoking prevalence and the personal attitudes about smoking among doctors of a university hospital. MATERIAL & METHODS: cross-sectional study. A survey. Study population was all physicians working in "Reina Sofía" University Hospital of Cordoba (N=738). By systematic sampling we select a random sample of 250 especialist physicians. We designed a self-administered questionnaire with items measuring the prevalence of smoking, the brand they used, the degree of smoking dependence, and their opinion about the new anti-smoking law. We also study the measures for smoking cessation that doctors considered most useful. We compared our data with other similar study carried out in 1987. RESULTS: the prevalence of tobacco use was 42% (CI:95%: 35.5-48.9), below the figure we obtained in 1987 (56.3%; p < 0.001). Doctors between 36-45 years had the highest rates of tobacco consumption (p < 0.01). 86.9% of smokers thought that smoking was unhealthy and among these 83.3% accepted the risk derived of smoking. 86.7% of smokers used to smoke inside the hospital. 86.8% of doctors thought that the new public places restrictive smoking law must be implemented. Doctors smoke more often (68.5%) when they are on call and 26.4% of them recognize to smoke when they inform the patient's family. CONCLUSIONS: we highlight a reduction of the prevalence of smoking among this kind of physicians. We still consider important the high number of physicians which smoke inside the hospital, although this figure have significantly decreased.

[Yield of active search of tuberculosis in a marginal population]. / Rentabilidad de la búsqueda activa de tuberculosis en una población marginal.

OBJECTIVES: A prevalence study on tuberculosis infection among school-children in our area. A study of the family, contacts and teachers of infected children. An analysis of the level of compliance with diagnostic and therapeutic procedures. DESIGN: Observational and descriptive. Clinical-epidemiological. SETTING: An urban Basic Health Area with 18,000 inhabitants. PATIENTS AND OTHER PARTICIPANTS: 393 people were included in the study: 162 school-children doing first-year EGB [c. six years old], 199 family members and contacts of the infected children and 32 EGB teachers. MEASUREMENTS AND MAIN RESULTS: Mantoux intradermoreaction. Application of the study procedure. Following of the evolution and monitoring of the treatment. We found 6 infected children (3.7% of the school-children), all of whom came from the same marginalised area. Among the 231 family members, contacts and teachers studied, we found 30 cases of active Tuberculosis (13%) and 71 cases of infection (30.7%). Antituberculous treatment was indicated for all cases of illness and secondary Chemoprophylaxis for 49 cases. The study could not be completed in 62 cases. CONCLUSIONS: The prevalence of tuberculous infection among school-children from the marginalised area is high. Examination of the infected childrens' contacts showed a high level of tuberculous infection. Follow-up of the diagnostic and therapeutic procedures was incomplete for a significant percentage of those under study.