COPD patient profiles in primary care. Referral criteria.

COPD is a disease with a high prevalence that diminishes the quality of life of many patients. Despite this, there are still high rates of under-diagnosis in Spain, partly due to a lack of recognition of the pathology by patients. In this context, the role played by primary care teams becomes fundamental, as they are one of the first lines of entry into the health system. In this paper we explain the different COPD profiles that may be present, and update the tools for diagnosis and treatment, which, together with an attitude of active suspicion of the disease, can help in the correct management of patients, whether they are undiagnosed or have subsequent complications.

[Truth disclosure to patients diagnosed with cancer]. / Revelación de la verdad a pacientes diagnosticados de cáncer.

OBJECTIVE: To find the sort of information given to cancer patients in PC and the factors which affect the disclosure of the diagnosis. DESIGN: A descriptive crossover study, carried out through a personal interview. SETTING: A county hospital with no oncology service. PATIENTS: All those patients with cancer (histologically confirmed) admitted to the hospital during April and May 1993. MEASUREMENTS AND MAIN RESULTS: Each patient was asked what illness he/she had, who told him/her and where, along with his/her sociodemographic details. Later the date of diagnosis and the site and spread of the tumour were taken from the medical records. Out of 108 patients under study, 8 knew they had cancer, 1 said he/she had a tumour and 11 believed they had "something bad". 7 patients had no information about their illness and 81 gave alternative diagnoses (inflammation, cyst...). Disclosure was more common in the cases of breast cancer, haematological cancer and those diagnosed over 6 months previously. No significant differences regarding the spread of the tumour or the sociodemographic variables were found. CONCLUSIONS: The disclosure of a diagnosis of cancer is the exception, not the rule. Concealment is only abandoned in the case of potentially curable tumours and those which offer a longer life expectancy.

[Acceptance of recombinant hepatitis B vaccine by health personnel]. / Aceptación de la vacuna recombinante antihepatitis B en el personal sanitario.

OBJECTIVE: To find the level of acceptance of the recombinant anti-Hepatitis B vaccination by our area's health staff as well as the reasons why some staff had not been vaccinated. DESIGN: A descriptive study of a crossover type (cross-sectional), with data-gathering by means of a self-administered questionnaire. SETTING: Primary Care teams (PCT) in Asturias Area III (Avilés county) and their referral hospital. PARTICIPANTS: 379 health workers (115 from PCT and 264 from the referral hospital) from Asturias Area III, with a simple random sample selection based on the Area's staff lists. MEASUREMENTS AND MAIN RESULTS: 34 of the subjects under study stated that they were immune prior to vaccination. Out of those without immunity, and therefore available for vaccination, 77.1% (80.9% doctors, 88.5% nurses and 57.7% auxiliary staff) accepted vaccination. There were no significant differences between PCT and hospital, except for auxiliary staff, for whom there were more vaccinations in the hospital. Doctors and nurses, independently of the work centre, were vaccinated to a significantly greater extent than the auxiliary staff. Among those who were not vaccinated, the main reason for refusing the vaccination was laziness or lack of interest (36.1% in PCT and 44.1% in hospital). CONCLUSIONS: Hepatitis B vaccination in our areas is greater among health staff most exposed to risk of contagion. Despite the high vaccination rate, an important number of staff remain non-vaccinated, mainly because of their own lack of interest. This must be borne in mind when vaccination programmes are being designed.