[Adjusted clinical groups use at a Spanish primary care center: a retrospective, population-based study]. / Utilización de los grupos clínicos ajustados en un centro de atención primaria español: estudio retrospectivo de base poblacional.

OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG) at a primary health care (PHC) in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain. The ACGs were formed according to the International Classification of Diseases, 9th Revision, Clinical Modification. The relative weight of each ACG's total average cost was calculated (in U.S. dollars) and based on these, the resources usage levels were established. The risk index (RI) and efficiency index (EI) for 2006 and the classification's explanatory power were determined. RESULTS: A total of 8 294 patients were studied (82.7% coverage), with an average of 4.1 incidents per patient, 6.9 visits per patient, and 5.7 visits per person per year. Seven GCAs accounted for 51.0% of patients seen. The RI was 1.015, the EI was 0.975 visits, and the explanatory power of the ACG classification was 53.4% for visits and 74.8% for incidents. CONCLUSIONS: The ACG system allowed this patient population to be grouped by clinical status, which can help to, among other things, allocate resources and evaluate PHC team efficiency.

Utilización de los grupos clínicos ajustados en un centro de atención primaria español: estudio retrospectivo de base poblacional / Adjusted clinical groups use at a Spanish primary care center: a retrospective, population-based study

OBJETIVOS: Evaluar los resultados de la aplicación del sistema de clasificación mediante grupos clínicos ajustados (GCA) en un centro de atención primaria de salud (APS) de una población española. MÉTODOS: Estudio transversal retrospectivo a partir de los registros médicos informatizados de los pacientes atendidos ambulatoriamente durante 2007 en el centro de salud La Roca, administrado por una empresa de gestión de servicios de salud en La Roca del Vallès, Barcelona, España. Los GCA se conformaron según la Clasificación Internacional de Enfermedades, 9.ª revisión, modificación clínica. Se calcularon los pesos relativos medios en dólares estadounidenses de cada GCA respecto al costo medio total y, a partir de ellos, se crearon las bandas de utilización de recursos. Se determinaron los índices de riesgo (IR) y eficiencia (IE) con respecto a 2006 y se estimó el poder explicativo de la clasificación empleada. RESULTADOS: Se estudiaron 8 294 pacientes, para una cobertura de 82,7 por ciento, con una media de 4,1 episodios por paciente, 6,9 visitas por paciente y 5,7 visitas por habitante al año. A siete GCA correspondió 51,0 por ciento de los pacientes atendidos. El IR fue de 1,015, el IE en las visitas de 0,975 y el poder explicativo de la clasificación en GCA fue de 53,4 por ciento para las visitas y de 74,8 por ciento para los episodios. CONCLUSIONES: El sistema de GCA permitió agrupar a los pacientes de una población según su estado clínico y puede ayudar, entre otros aspectos, en la asignación de recursos y la evaluación de la eficiencia de los equipos de APS.

OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG) at a primary health care (PHC) in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain. The ACGs were formed according to the International Classification of Diseases, 9th Revision, Clinical Modification. The relative weight of each ACG's total average cost was calculated (in U.S. dollars) and based on these, the resources usage levels were established. The risk index (RI) and efficiency index (EI) for 2006 and the classification's explanatory power were determined. RESULTS: A total of 8 294 patients were studied (82.7 percent coverage), with an average of 4.1 incidents per patient, 6.9 visits per patient, and 5.7 visits per person per year. Seven GCAs accounted for 51.0 percent of patients seen. The RI was 1.015, the EI was 0.975 visits, and the explanatory power of the ACG classification was 53.4 percent for visits and 74.8 percent for incidents. CONCLUSIONS: The ACG system allowed this patient population to be grouped by clinical status, which can help to, among other things, allocate resources and evaluate PHC team efficiency.

[Imported hookworm infection in African immigrants in Spain: study of 285 patients]. / Uncinariasis importada por inmigrantes africanos: estudio de 285 casos.

BACKGROUND AND OBJECTIVE: Hookworm infection is a worldwide intestinal parasitic disease affecting more than one billion people. It represents an important public health problem in rural areas of developing countries. In our environment, it is generally considered an imported disease due to the immigration process. PATIENTS AND METHOD: Retrospective observational study of African immigrants diagnosed with hookworm infection at the Immigration and Tropical Medicine Unit of the Hospital of Mataró over the period 1984-1999. RESULTS: We identified 285 patients, mainly young males, from Gambia or Senegal, with a precarious job who had arrived in Spain 3 years earlier or less. Abdominal pain was the commonest reason for consultation (28.8%) cases. Non digestive symptoms were 35.6% and 4.6% remained assymptomatic. 60% had a concomitant infectious disease. Laboratory tests showed iron-deficiency anemia in 28.4% and eosinophilia in 52.3%. 70% of patients did not come to visit after treatment. CONCLUSIONS: Microbiologic stool examination is recommended as part of the health assessment of immigrants from countries where hookworm infection is highly prevalent, even in the absence of abdominal symptoms or abnormalities of the red and white blood series.

Uncinariasis importada por inmigrantes africanos:estudio de 285 casos / Imported hookworm infection in African immigrants in Spain: Study of 285 patients

FUNDAMENTO Y OBJETIVO: La uncinariasis es una parasitosis intestinal de amplia distribución mundial que afecta a más de mil millones de personas. Constituye un importante problema de salud pública en áreas rurales de los países con baja renta. En España es una enfermedad generalmente importada y, dado el fenómeno inmigratorio progresivo, conviene valorar su impacto. PACIENTES Y MÉTODO: Estudio observacional retrospectivo en una población de inmigrantes africanos diagnosticados de uncinariasis en la Unidad de Medicina de la Inmigración y Tropical del Hospital de Mataró, durante el período 1984-1999. RESULTADOS: Se diagnosticaron 285 pacientes, mayoritariamente varones, jóvenes, originarios de Gambia o Senegal, con inestabilidad laboral y con 3 o menos años de migración. Los motivos de consulta fueron variados. Entre los 10 más frecuentes el dolor abdominal fue el primero (28,8 por ciento), los síntomas no digestivos representaron el 35,6 por ciento y los pacientes asintomáticos supusieron el 4,6 por ciento. El 60 por ciento presentaba otras enfermedades infecciosas asociadas. En el estudio analítico se detectó anemia ferropénica en el 28,4 por ciento y eosinofilia en el 52,3 por ciento. Hubo un 70 por ciento de pérdidas en la visita de control postratamiento. CONCLUSIONES: Es recomendable realizar un análisis microbiológico de heces en los inmigrantes procedentes de países con alta prevalencia de uncinariasis, aunque no presenten sintomatología digestiva o alteración del hemograma (AU)

[Imported diseases in African immigrants in Spain: study of 1,321 patients]. / Enfermedades importadas en inmigrantes Africanos: estudio de 1.321 pacientes.

BACKGROUND: Immigrants can carry diseases characteristic from their countries of origin. These are known as imported diseases (ID) and can be classified into tropical diseases (TD) or cosmopolitan diseases (CD). The aim of this study was to analyse the ID in African immigrants and evaluate their repercussion in the Spanish Public Health. PATIENTS AND METHOD: Observational study, retrospective protocol, carried from 1984 to 1994 in African immigrants seen in a reference Hospital. Not infectious chronic ID were excluded. The repercussion in public health was divided in 3 categories according to transmission risk to the host population: a) ID without current risk; b) ID with potential risk and, c) ID of risk. RESULTS: 1,321 African immigrants were considered. Most of them were from Sub-Saharan Africa. The most frequent TD were helminthiases and among CD, tuberculosis, sexually transmitted diseases and parasitoses. ID without transmission risk were 26.7% (2.4% CD and 24.3% TD), ID with potential risk 35.2% (33.6% CD and 1.6% TD) and ID with risk 38% (all CD). CONCLUSIONS: The CD and their association with poverty suppose a higher risk of transmission to the host country population. Global policies of helping social and economic insertion of immigrant populations, combined with international health collaboration, will rebound positively in the general population's health.

[Imported paludism: an emerging illness]. / Paludismo importado: una enfermedad emergente.

BACKGROUND: We aimed at knowing the epidemiological and clinical characteristics of imported malaria in Maresme county (Barcelona), Spain. PATIENTS AND METHOD: A descriptive and retrospective study of patients diagnosed with imported malaria at the Hospital de Mataró (HM) (1982-2000). RESULTS: 64 cases of malaria were diagnosed, which supposed a significant increase in its incidence over the last decade. The disease mostly affected men (83%) as well as young and sub-Saharan immigrants (72%). 17% of affected people were immigrants' children. 50% cases were diagnosed in August-September. 80% of species corresponded to Plasmodium falciparum, either alone or in association with other species. Only 10% of patients underwent a correct chemoprophylaxis. CONCLUSIONS: Imported malaria is an emergent, potentially mortal, illness, which has to be taken into account in high-rate immigration areas. Prophylaxis compliance and knowledge is low.

Paludismo importado: una enfermedad emergente / Imported paludism: an emerging illness

FUNDAMENTO: Conocer las características epidemiológicas y clínicas del paludismo importado en la zona del Maresme (Barcelona). PACIENTES Y MÉTODO: Estudio descriptivo retrospectivo de los pacientes diagnosticados en el Hospital de Mataró (HM) entre los años 1982 y 2000. RESULTADOS: Se diagnosticaron 64 casos de paludismo con un incremento significativo de la incidencia en la última década. Hubo un predominio en varones (83 por ciento), jóvenes e inmigrantes subsaharianos (72 por ciento). El 17 por ciento eran hijos de inmigrantes. El 50 por ciento de los casos se detectaron en el período agosto-septiembre. El 80 por ciento de las especies estaban representados por Plasmodium falciparum solo o asociado a otras especies. Sólo el 10 por ciento de los casos realizó una quimioprofilaxis correcta. CONCLUSIONES: El paludismo importado es una enfermedad emergente, potencialmente mortal, a tener en cuenta en zonas con elevada tasa de inmigración. El grado de conocimiento y cumplimiento de profilaxis es bajo (AU)