[The outlook for Spanish primary care starting with a bibliometric analysis of its scientific production (1971-1994)]. / Perspectiva de la atención primaria española a partir del análisis bibliométrico de su producción científica (1971-1994).

OBJECTIVE: To establish the relative weight of the various kinds of primary health care (PHC) research collected in the IME (Spanish medical index), In order to determine their possible relationships with Spain's PHC model. DESIGN: Bibliometric analysis. PARTICIPANTS: PHC documents (1971-1994) from the IME data base (CD-ROM), subdivided by years, journals, themes and Autonomous Communities (AC). RESULTS: 3,015 studies were published, with a first phase (1970s) of under 10 documents per year, a second (1980s) with a big increase and a third (1990s) of stagnation. Of the 117 journals containing studies, Atención Primaria gave a home to almost 58% (60% after 1984). CONCLUSIONS: PHC research production has stagnated recently, though the journal Atención Primaria has maintained its undisputed leadership position. The clinical model predominant in Spanish medicine is generally followed.

[Scientific agriculture in the nineteenth century Murcian press as seen by local authors]. / La agricultura científica en la prensa murciana del siglo XIX a través de los autores autóctonos.

This article studies the writings on agriculture published by local authors in the cultural and scientific press in the Region of Murcia during the second half of the nineteenth century. All magazines of the period were reviewed, and the most important information from ten of them, published between 1865 and 1898, was extracted. The articles in these magazines defended three main ideas: the use of chemical fertilizers, the recourse to other sciences (such as meteorology and electricity) within agriculture, and the need to renovate and improve traditional agricultural industries (silk and esparto). But the measures proposed by local scientists did not have the desired impact on the landowning class.

[Prior appointment, profile of the patient and accessibility]. / La cita previa, perfil del consultante y accesibilidad.

OBJECTIVES: To analyse the impact of the prior appointment system on still unevaluated care indicators and how the system connected with other factors affecting access to health care. DESIGN: Intervention study. SETTING: Santa María de Gracia Health Centre in Murcia. PATIENTS AND OTHER PARTICIPANTS: 831 and 724 patients seen at two general medical clinics at the health centre during the same period in two consecutive years, before and after the start of the prior appointment system. INTERVENTIONS: The start of the prior appointment system. A questionnaire given to patients at the end of their consultation. MEASUREMENTS AND MAIN RESULTS: Variables concerning patients' profiles and habitual conduct, resource use and distribution of waiting and consultation times, and health service use connected to other factors of access to care, were compared for before and after the introduction of the prior appointment system. There were significant differences in the distribution of waiting time, which became shorter (p < 0.01); and consultation time, with an increase in intermediate length and a decrease in extreme times (p < 0.05). Health service use also varied according to distance from the centre and place of residence of the patient: it increased for those living further away (p < 0.01). CONCLUSIONS: The prior appointment system, over and above a decrease in waiting time and increase in consultation time, meant a rationalisation of both time and health service use dependent on other factors connected with access to health care. The absence of modifications in patients' profiles and in their habitual conduct during the consultation were also confirmed.

[Examinations and referrals at a health center: a study of associated factors]. / Exploraciones y derivaciones en un centro de salud: estudio de los factores asociados.

OBJECTIVES: To determine the profile of the use of physical examination, further tests and referrals; and the impact which socio-family and behavioural factors, questions connected with patients' morbidity and other variables in health service use, have on these resources. DESIGN: Descriptive crossover study. SETTING: Urban health centre. PATIENTS AND OTHER PARTICIPANTS: 719 attendances of patients seen over a two and a half month period in two general medical clinics at the health centre were analysed. A questionnaire on health care was presented by the doctor to the patient at the end of the visit and also covered the activities and resources used during the visit. MAIN RESULTS: A multivariant analysis identified the factors which best explained variability in the frequency of physical examination as symptoms and, in particular, the type of consultation. None of the factors studied affected the use of analysis, radiology or referral to specialists. CONCLUSIONS: Symptoms and, in particular, the type of consultation are the factors which affect the use of physical examination. The scant relevance of other factors analysed and the comparison of our findings with other studies published suggest that the use of further examinations and referrals depend basically on other variables, such as those connected to the availability of resources and accessibility to them.

[Analysis of research in primary health care in the Murcia region (1988-1992)]. / Análisis de la producción científica en atención primaria de salud en la región de Murcia (1988-1992).

OBJECTIVE: To analyse Primary Health Care (PHC) research in Murcia between 1988 and 1992, looking at the possible influence of regional PHC conferences (RC) on the production of scientific work, which might be presented to RC, national conferences (NC) or national reviews (NR), as well as the impact of personal factors. DESIGN: A crossover, retrospective and descriptive study. PARTICIPANTS: Publications in NR and presentations at Murcia PHC RC and at NC between 1988 and 1992. 176 works were analysed. There were two sources of information: a) documents on PHC done in the region, articles, editorials or letters to the editor in NR collected in the IME (Spanish Medical Index), or as oral contributions, papers or posters in PHC RC or NC; b) personal and professional data of the authors. MEASUREMENTS AND MAIN RESULTS: Documents: title, authors, sources, date, theme, type, work centre and describer. Authors: sex, age, work activity, work situation, place of work and number of jobs. Statistical treatment: Chi squared and variance analysis. Between 1988 and 1992 works presented to RC duplicated (16 to 39) and increased by six to NC (1 to 6) and NR (2 to 13). Health Centres (62% of studies) made the greatest scientific contribution. CONCLUSIONS: The celebration of RC has a positive impact on the number of articles sent to NR, but not on the presentation of work in NC. Increase in the number of PHC research works (18 in 1988 and 52 in 1992) does not imply higher proportional collaboration of nonmedical health staff.

A study of disability pensions in Spain (1971-1987).

In the region of Murcia (in the south-east of Spain), which has one million inhabitants, the prevalence rate of severe disability pensions, 68.92 per 1000, is much higher than that of old-age pensions, 43.50 per 1000, the reverse of what is seen in Spain in general. The administrative procedure followed in order to obtain a severe disability pension has been studied with the aim of identifying the nature of its components. A random sample of 1948 case records has been analysed from the overall number of 98,485 requests arising between 1971 and 1987. The average annual rate of disability applications was 5.4 per 1000 inhabitants, increasing with time from 1971 to 1982, and decreasing from 1983 onwards due to the creation and functioning of a new official controlling body. In the great majority of cases, 89.5%, the evaluating commission gave a disability pension, mainly at the higher grade ('total disability') until 1982 and at an inferior grade ('severe disability') from 1983 onwards. Those applicants working in hotel services, domestic services and so on, mainly women, had the highest rates of disability applications.

[Rational structures in health education models: basics and systematization]. / Estructuras de racionalidad en educación para la salud: fundamentos y sistematización.

The different Health Education (HE) models appeared in the scientific literature are analyzed, trying to eliminate the confusion produced by its great diversity, applying a general and systematic point of view. Due to the relevance of that topic in the activities of Health Promotion in Primary Health Care it is urgent a deep reappraisal due the heterogeneity of scientific papers dealing with that topic. The curriculum, as the confluence of thought and action in Health Education, is the basic concept thanks to which it is possible to integrate both scientific logic, the biological one and that pertaining to the social sciences. Of particular importance have been the different paradigms that have emerged in the field of HE from the beginning of the present century: a first generation with a "normative" point of view, a second one orientated from positivistic bases, and a third generation adopting an hermeneutic and critic nature. This third generation of paradigms in HE has taken distances from the behaviouristic and cognitive perspectives being more critical and participative. The principal scientific contributors in the field of HE, internationals as well as spaniards are studied and classified. The main conclusions obtained from this Health Education paradigm controversy are referred to both aspects: 1) planning, programming and evaluating activities, and 2) models, qualitative and quantitative methodologies. Emphasis is given to the need of including Community Participation in all phases of the process in critic methodologies of HE. It is postulated the critic paradigm as the only one able to integrate the rest of the scientific approaches in Health Education.

[Public health during Franco's regime]. / La Salud Pública durante el franqismo.

We compare the most relevant characteristics of the evolution of public health as a science during Franco's regime with the behavior of significant parameters in the evolution of health care in Spain (mortality and morbidity rates, spending on health care, institutional development of the health care system). Our purpose was to characterize how the legacy inherited by current health care legislation in Spain has given rise to the problems currently faced. The backslide during the post-Civil War periiod as a result of the victors' identification of the advances achieved in the Second Republic with leftist policies, delayed modernization imposed by the accelerated process of industrialization, and obstacles caused by the consolidation of National Health Insurance, led to a paradigm based exclusively on medical care.

[Educational and health dimensions of health education at school: a participative total experience in 2 health regions of Murcia]. / Dímensiones educativas y sanitarias de la educación para la salud en la escuela: una experiencia participativa y global en dos zonas de salud de Murcia.

BACKGROUND: The results of and experience on School Health Education during two years and in two health areas, which intends to promote solid contacts between all people interested in carrying out activities included in daily work, and, this way, to improve the schoolchildren habits are shown. METHODS: The activity is situated in the Investigation Action paradigm. Quantitative and qualitative methods are used in the process and product evaluation. RESULTS: The programme has had an statistically significant effect on the habits considered to be of interest (dental hygiene and physical exercise) and no effects on those habits on which no work was done. There have been 13 Educational Centers, 2 Health Centers and the Faculty of Medicine Sociosanitary Sciences Department. Collaboration, among all interested people, has been increasing, although there have been found difficulties and giving up. CONCLUSIONS: Our opinion is that the role to be played by the Health Councils and the School Councils is essential to develop the recent ministerial dispositions on the matter, within the scope of health areas.

[Social attitude towards health participation]. / Actitud Social ante la participación en salud.

BACKGROUND: The community health participation is an important issue for all health systems based on a Primary Health Care, which emphasizes prevention and promotion, as a complement to assistance. In this survey, the social attitude towards health participation is studied, taking into account the different research paradigms on Social Sciences, the models of health behaviours, the meaning of participation and the meaning of the own attitudes. METHODS: A Likert scale of 18 items, which constitutes a part of a general health survey of 128 variables, is elaborated and validated. It is complemented with a personal interview to 1371 persons in a random sample from four health areas. RESULTS: The data obtained show that there are neither statistical significant differences among areas in relation with having or not a Health Council, nor between men and women. The attitudes towards participation are more favourable among young people, bachelors and persons from a high socioeconomic status, hig degree studies, white collar professions, and the persons going to the doctor with the lowest frequency, show a positive tendency. The factorial analysis identifies three dimensions: a) Self-care, b) political and c) community health agent. The discriminant analysis shows that variables (age, civil, status, socioeconomic level, studies...) classify correctly 74% of cases. CONCLUSIONS: The personal profile, showing a health participative attitude, is consistent, in most variables, with that published by previous reports.

[Knowledge of the hygiene habits of schoolchildren: a course of urban collaboration in health]. / Conocer los hábitos higiénicos de los escolares: cauce de colaboración ciudadana en salud.

AIM: To study the hygiene habits of schoolchildren in Santa Maria de Gracia (an urban site) and La Nora (a rural site), both in Murcia. This stemmed from an initiative of the Health Councils of these places, with the aim of later developing an effective project of Health Education. The Community was conceived as the main player in the Health-Illness process: passive behaviour models were thus abandoned. DESIGN: This was a transversal study of the hygiene customs of school-children from Second and Seventh Grade E.G.B. (General Basic Education: from 8 to 13) in the rural area; from Second and Fifth Grade EGB, from Second Grade BUP (Baccalaureate: from 14 to 16) and from the Second Course of Second Grade FP (Professional Formation) in the urban area. Questionnaires covered the whole of the above population. Crosses according to age, sex and the rural or urban environment were made. PARTICIPANTS: Professionals from both the Primary Care Teams, from Educational Centres, from the Department of Socio-Health Sciences of the Faculty of Medicine and schoolchildren interviewed. INTERVENTIONS: Using a participatory methodology, a questionnaire was designed and answered by a total of 1,182 students, belonging to 13 Educational Centres. MAIN FINDINGS: There are shortcomings open to improvement in practically all areas of hygiene habits; with important differences, in particular customs, between boys and girls, between town and country and between younger and older students.

[Health instruction in adult education as instrument for community participation. Analysis of an experiment in La Nora (Murcia)]. / La formación sanitaria en la educación de adultos como instrumento para la participación comunitaria. Análisis de una experiencia en La Nora (Murcia).

AIM: The main aim of this work is to demonstrate the possibility of establishing stable contacts between the PC study and citizens' groups, in order to promote Health Education. The experience of Adult Education in a Health Centre, initiated by its Consejo de Salud (Health Council), was analysed. DESIGN: The study's methodology is of Participatory Research based on an earlier descriptive analysis, which had followed the educational input. PLACE: It takes place in a PCC and is a Community-based activity. PARTICIPANTS: The PC study, Adult Education teachers, the Social Health Department of the Faculty of Medicine and 136 adult students from nine villages in the rural area of La Nora (Murcia), took part in the study. ACTIVITIES: Essentially to develop a programme of Health Instruction within Adult Education, in order to encourage Community Participation. RESULTS: They focus on checking the effect of the programme on all the groups concerned and analysing the characteristics of the adult student body. CONCLUSIONS: The most important have been the generally positive feelings about the experiment and thus the possibility of tackling new ones. It was important that the study had been the fruit of a programme of Community Participation, with the Health Centre as the point of reference.