[Compliance with contact isolation precautions of multidrug-resistant microorganisms in a tertiary hospital]. / Cumplimiento de las precauciones de aislamiento de contacto por microorganismos multirresistentes en un hospital de tercer nivel.

INTRODUCTION: Preventive isolation of patients with multidrug-resistant microorganisms is considered an effective measure to prevent outbreaks in hospitals. The objective of this study is to assess compliance by healthcare workers and family of contact isolation precautions in colonised/infected patients with multidrug-resistant microorganisms. METHODS: An observational study was conducted from October 2014 to March 2015. A checklist with a structure was designed (equipment trolley), including knowledge of the situation and compliance by the patients, families, and healthcare workers. Univariate and bivariate analyses were performed. Non-parametric tests Mann-Whitney and Kruskal-Wallis were used. RESULTS: Out of the 467 observations made, the equipment trolley was correctly situated in 97% (453) of cases, the sphygmomanometer in 90% (421), the stethoscope 43.9% (205), and thermometer 16.5% (77). A dustbin and the alcoholic solution were observed in over 98.7% (461) of cases. The antiseptic soap for patient hygiene was observed to be correctly placed in 348 (74%) of occasions. The situation was known by 84.9% (305) of patients and 91.4% (234) of families. As regards compliance by professionals with the placement/removal of disposable gowns and gloves was about 50% for entering the room (49.5%, 56 gown and 53.09%, 60 gloves), and 40% (28) for leaving the room by professionals. Hand hygiene compliance was 26.5% (30) for entering and 35.2% (25) when leaving. CONCLUSIONS: There is significant room for improvement in the compliance with isolation precautions. Non-compliance to isolation procedures is not due to a deficit of materials, but to individual behaviours. It is important to implement and evaluate programs based on psychosocial intervention models that can change attitudes and behaviours related to contact isolation precautions for multidrug-resistant microorganisms.

[Bibliometric indicators, subjects analysis and methodology of research published in Spain on epidemiology and public health care (1988-1992)]. / Indicadores bibliométricos, análisis temático y metodológico de la investigación publicada en España sobre epidemiología y salud pública (1988-1992).

BACKGROUND: To describe Spanish scientific output in epidemiology and public health through the bibliometric indexes utilization and with regard to subjects, design and statistical methods employed, as well as its appropriateness, importance and funding. MATERIAL AND METHODS: Descriptive, longitudinal and retrospective study over 594 originals published in Spanish medical journals and listed in the Spanish Medical Index (Indice Médico Español) during the 5 years period 1988-1992. RESULTS: The average autors by article was of 4.9 and the Lotka's index, for the authors that publish articles on the topic, was -2.92; 82% of the authors have a productivity index equal to zero. Almost 70% of the articles are signed by an isolated institution, being a hospital in 51% of the cases. The journal that publishes most articles on the topic is Medicina Clínica. The average references by article is about 24. The Price' index is 36.5% and the isolation' index is 36.2%. "The non AIDS infections", the descriptive designs and the lack of inferential statistics methods, characterize the content of the articles. Regarding to the criteria established by the study, more than half of the analyzed research (56.5%) was appropriate and almost a fourth (22%) could be considered that was about important topics. CONCLUSIONS: Concerning bibliometric indicators, research on epidemiology and public health in Spain does not seem to differ from other medical specialties. The epidemiology as scientific method is widely used over the medical specialties, something which could explain the wide dispersion of scientific literature on this topic. There seems to be a certain lack of agreement between the research topics and the real health problems of Spain.

[Cost-effectiveness of antismoking health counselling in primary health care]. / Coste-efectividad del consejo sanitario antitabaco en atención primaria de salud.

OBJECTIVE: To study the cost-effectiveness of simple anti-smoking advice in Primary health care. METHODS: We accomplish a cost-effectiveness analysis in the area of the Primary health care. As efficiency of the advice we use own results. To evaluate the smoking cessation we base on vital tables of the "25-State Cancer Prevention Study", discounted to the 5%. The costs have been calculated as of the tariffs used for services billing lent in primary health centers to not beneficiary of the social security. It was accomplished a sensibility analysis on different aspects with possible influence on the result. RESULTS: The cost-effectiveness oscillated between 67,621 and 89,619 pesetas by year of life saved for the men and between 116,225 and 137,748 pesetas for the women, in function of the age. The relationship most favorable, for both sexes, it is between 45 and 54 years. In the group of 35 to 39 years, for the physicians, was of 89,419 and 163,934 pesetas for men and women respectively, and for the nursing personnel was oscillating between 43,955 and 81,523, for men; and between 80,584 and 149,460 pesetas for women in function of the considered salary. CONCLUSIONS: It is an intervention with a very favorable relationship cost-effectiveness, at least, comparable to that of other customarily accepted preventive measures. The nursing advice is less effective that the physician advice, but it is, at least, equal of efficient in terms of cost by year of life saved.

[Advertising, advertising legislation and health]. / Publicidad, legislación publicitaria y salud.

The media and specifically magazines and sunday supplements contain advertisements, some of which can be dangerous to one's health. We have investigated these types of advertisements, which were included in the 15 top sales magazines in Spain. The period of analysis corresponded to the period april-may, 1991. We have compared the results obtained with the results of a previous investigation carried our in 1987, using an identical method. We have tried to test if the so-called Law of Publicity of 1988 has had any effect on publicity. We have found, 1383 advertisements that could have a damaging effect on one's health. Although the total number of advertisements have decreased over this four year period, the law has hardly produced any influence on publicity, and we have found breaking of the law in the investigated material.

[Adolescence at risk: a health survey among pre-university students]. / Adolescencia en riesgo: una encuesta de salud entre estudiantes de C.O.U.

The present study investigates the level of health education in a representative sample of 804 pre-university Asturian students, randomly selected from the official list of the Ministry of Education and Science. We used a questionnaire (designed by us) in order to measure the knowledge, attitudes and behaviour related to some of the most important health determining factors. The survey was carried out by interviewing small groups of students in the classroom situation. Although it was found that the majority perceived themselves as healthy or very healthy, these young people are widely exposed to risk factors: 12% have suffered from more than 25 episodes of drunkenness during the previous year; 43.53% smoked to some extent and only 3.86% identified the days of maximum risk of pregnancy in a supposed menstrual cycle, although 31% maintained sexual relationships. Theoretically, 92% selected health as the most important factor among the three most fundamental values for life. They also think that illegal drugs are the most important health problem at present for young people. There is a contradiction between the high theoretical importance given to health, the good self-qualification of it, and the observed presence of important risk factors. A certain failure of the educational system with respect to primary prevention can be claimed.

[Advertising and health education]. / Publicidad y educación sanitaria.

Health education and advertising have a common aim: to modify human behaviour. Health education tries to induce healthy behaviours. In some occasions Publicity proposes risky behaviours. Ads appearing during a two-month period in magazines of the largest circulation in Spain are analyzed here. A total of 1,726 ads which could have a negative influence on health either because of the product or service offered or for the use of health as a persuasive argument in their text, are considered. The magazines Hola and Lecturas had the highest ratio ads/magazine. Spirits, food and drugs were the most frequently advertised products. And more than 50% of the ads used health and welfare as argument for better selling. Health educators should know and teach the critical analysis of publicity, and use advertisements as a teaching tool to enable people to see through misleading advertising.

[Long-term effectiveness of anti-smoking counseling in primary care: the relapse process]. / Efectividad a largo plazo del consejo antitabaco en atención primaria: el proceso de recaída.

BACKGROUND: Addiction to tobacco is the main cause of preventive morbidity, and so the fight against tobacco consumption is a priority in the developed world. Health advice is a valuable tool in this struggle and it is within the reach of all health workers. To study the long-term effectiveness of all anti-tobacco advice in Primary Aid, together with the influence that the reason for giving up (spontaneous or after advice) has upon the relapse pattern. METHOD: We carried out a clinical test on 501 patients, 242 as a participant group, receiving health advice, and 259 in a control group. We evaluated giving up the habit through a survey. The data were analysed by means of a study with a survival study, considering the relapse to be the final point. Survival curves for the two groups were compared with the Lee-Desu statistic. RESULTS: 115 patients gave up the habit for at least 24 hours (31.8% from the participant and 14.7% from the control group). After 3 years, after a biochemical check-up, 4.5% of the participant group and 1.2% of the control group were still ex-smokers (difference = 3.3; p = 0.043%; there is a confidence interval of 95%: from 0.45 to 6.33). We did not find significant differences between their survival curves (p = 0.08). CONCLUSION: We have been able to confirm the mid- to long-term effectiveness of anti-tobacco advice. We have not been able to demonstrate that anti-tobacco advice in the relapse pattern, but a statistical trend does exist towards a reduction in the participant group.

[Extracurricular activities of adolescents useful for smoking prevention programs. OCTOPUS team]. / Actividades extraescolares de los adolescentes útiles para programas de prevención del tabaquismo. Equipo OCTOPUS.

BACKGROUND: The cigarette smoking habit continues to be prevalent to a greater degree than would be desirable among teenagers. Innovative prevention programs are needed. This descriptive cross-sectional study sets out the behavior variables related to the cigarette smoking habit and the extracurricular activities in which teenagers are most frequently involved which are useful for setting out extracurricular prevention programs. METHODS: The data was collected by means of a questionnaire validated in a representative sample of school age youths (ages 10-11 and 13-14) from Asturias. The variables entailed in cigarette smoking were analyzed using the regression method. RESULTS: The starting smoker percentage is 14.5%-42.5%, regular smokers totaling 1.1% and 12.4%, respectively. Two models were constructed with the variables significantly related to smoking behavior, which are properly classified into smoker/non-smoker by 98.85% and 91.39% of the children, by ages. The environmental variables (availability of cigarettes and alcoholic beverages and regular visits to places entailing risk) are the major aspects comprising the model. The most common extracurricular activities are: watching TV, reading and listening to music and watching or playing sports. CONCLUSION: The findings provide keys to planning extracurricular activities tailored to fit in with the activities most popular among teens: TV commercials and ads on music media (CD's, tapes, etc.) and printed information mailed directly to teens at their homes, with messages conveyed by opinion-leaders among teens in the fields of sports, music and television.

[Diagnostic protocol for unknown primary cancers. Review of 157 cases]. / Protocolo diagnóstico del cáncer de origen desconocido. Revisión de 157 casos.

OBJECTIVE: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, which seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. METHOD: Descriptive retrospective study (1992-96) RESULTS: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frequent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0.6 unnecessary aggressive techniques. CONCLUSIONS: The great variability in decision-making for diagnosing advises the application in of a diagnostic protocol that would avoid unnecessary damage for the patient and sanitary costs.

[Unknown primary cancer: revision of our experience. Preliminary study]. / Cáncer de origen desconocido: revisión de nuestra experiencia. Estudio preliminar.

The unknown primary cancer is a hazardous diagnostic and limited therapeutic medical problem with too much variability. It is possible to design a standard procedure using the world-wide scientific literature, which could be able to decrease patient suffering and to avoid unnecessary sanitary costs, without diminishing survival. First of all we have conducted a retrospective descriptive study including all the patients with unknown primary neoplasms detected in our Internal Medicine service during 1994. We have met 18 cases, most of them adenocarcinoma and undifferentiated carcinoma, and hepatomegaly as clinical presentation. In 8 cases (44%) was the primary tumour site identified, mainly with CT. Only 3 (16%) patients were alive at the end of the study, with a mean survival of 5 months. The mean stay and time until diagnosis were 16.5 and 21.5 days respectively. Further studies will let us to asses the effectiveness of a theoretic diagnostic protocol.

[School acceptance of the theater as a method of health education]. / Aceptación escolar del teatro como método de educación para la salud.

OBJECTIVE: To find how theatre was evaluated as an instrument of Health Education by the pupil-actors of a school where a play on the European Code against Cancer was put on. DESIGN: An observational study (descriptive and crossover). SETTING: Community level. Primary Education. PARTICIPANTS: 100 pupil-actors of the 220 at a primary school in a rural area. They were selected by means of a free, voluntary and spontaneous practical theatre test. INTERVENTIONS: A theatrical show with 14 scenes was created. 8 performances, open to the public, were held in the village's Cultural Centre. MEASUREMENTS AND MAIN RESULTS: Evaluation was with a self-administered questionnaire composed for the occasion and consisting of closed multiple-choice questions. An anonymous group survey, done in class and covering each year separately, included 77 of the 100 actors. A prior pilot survey had evaluated intelligibility. The results were that 97.4% classed the experience as positive and 87% of them considered it very good. 81% had no problem at the moment of acting. 83% were helped by teachers and 81% by parents. 98% would like to do theatre again. CONCLUSIONS: Theatre is highly rated and widely accepted by children, making it a useful

[Thematic and methodological analysis of investigation in primary care (1988-1992)]. / Análisis temático y metodológico de la investigación en atención primaria (1988-1992).

OBJECTIVE: To describe Spanish scientific output in primary care with regard to subjects, design and statistical methods employed and also its appropriateness, importance and funding. DESIGN: Descriptive, longitudinal and retrospective study. SETTING: Spanish scientific output in primary care published in medical journals and listed in the Indice Medico Español during the five year period 1988-1992. MATERIAL: 446 original articles published in thirty-four journals. MEASUREMENTS AND MAIN RESULTS: The greatest percentage of articles came under the heading "policy and health" (23.6%), next was "health services" (14.8%). There was a predominance of observational designs (79.9%) and within this category, descriptive studies (67.1%). The most common statistical methods used were contingency tables (35,9%). The majority of articles (94.8%) do not indicate the source of their funding. The appropriateness was around 50% and the importance around 4%. CONCLUSIONS: According to our study, research into primary care centres on the evaluation and organization of the health services. The majority of the designs have little inferential power and simple statistical methods. There is hardly any funding available, and only a half of the articles comply with appropriateness criteria.

[Bibliometric indicators of research in primary care (1988-1992)]. / Indicadores bibliométricos de la investigación en atención primaria (1988-1992).

AIM: To describe Spanish scientific production in primary care by means of using bibliometric indexes. SETTING: Spanish scientific production which was published in medical periodicals and indexed in the Indice Médico Español during the years 1988-1992. MATERIAL: 446 articles published in thirty-four different medical journals. DESIGN: Descriptive, longitudinal and retrospective study. MEASUREMENTS AND MAIN RESULTS: The number of articles slightly increases over the complete time of the study, principally in 1992. 98.4% were written in Spanish language. The average number of signatures per article is about five. Most of the authors are family doctors or interns of the medical specialty. In 76.46% of the cases, the articles were signed by only one institution. The majority of them (38.56%), were done in teaching units of family medicine. Barcelona is the most important producer of articles (20.2%) and 78% were published in the Atención Primaria periodical. The average number of references slightly increases during the whole period and is about 17 references in the five years studied. CONCLUSIONS: The scientific production on primary care seems to have an exponential increase according to Price's Law and it is concentrated in the Atención Primaria periodical. Most of authors are family doctors or interns of such specialty, who work in units of family medicine. Collaborative studies among institutions are uncommon. The number of signatures and the use of references were found to be similar to other medical specialties.

[An analysis of the potential years of life lost to cancer in Asturias and Spain]. / Análisis de los años potenciales de vida perdidos por cáncer en Asturias y España.

BACKGROUND: Potential years of life lost (PYLL) constitute a health indicator, used to study premature mortality. If applied, it produces an order in causes of death, which can be very different from that one, obtained with mortality rates. METHODS: Mortality, due to different pathologies, was analyzed with this indicator and, particularly, mortality due to cancer in Asturias and Spain. The estimation of (PYLL) was made using fixed age limits: the first anniversary, as the lowest limit, and 65 years, as the highest limit. RESULTS: Cancer happened to be the first cause of (PYLL) in both populations (286,473 PYLL in Spain; out of them 9,985 belonging to Asturias); road accidents were the second cause (139,673 and 4,755 respectively) and acute myocardium infarcts were the third cause (70,106 PYLL and 2,897 PYLL). Lung tumours, leukaemias and breast cancer in women are the malignant tumours which produce the highest number of PYLL. CONCLUSIONS: Malignant tumours, road accidents and ischaemic heart disease are the three major causes responsible for the PYLL production in Spain and Asturias. These three pathologies are associated to well known risk factors, whose disappearance would considerably reduce early mortality. Likewise, an excess of premature mortality is observed in Asturias compared with Spain, and in men compared with women.