Utilización inadecuada deun Servicio de UrgenciaHospitalario / No disponible

Objetivo: Determinar la frecuencia de utilización inadecuadade un servicio de urgencias hospitalario (SUH) y elperfil del paciente.Sujetos y métodos:—Diseño: estudio descriptivo retrospectivo.—Ámbito: hospital de tercer nivel.—Sujetos: mayores de 14 años, salvo urgencias ginecoobstétricas,que acudieron a urgencias hospitalarias deenero a marzo de 2005, no precisando ni interconsultas nipruebas complementarias (PC), salvo las accesibles enAtención Primaria como glucemia capilar, análisis con tirareactiva en orina, electrocardiograma, pulsioximetría y tinciónocular con fluoresceína.—Mediciones: se calculó el tamaño muestral para unapoblación finita de 21.560 (prevalencia: 30%, precisión: 5%,pérdidas: 20%), siendo necesarios 396 informes. Selecciónaleatoria de los informes de alta. Variables: datos demográficos,día y hora, síntomas y tiempo de evolución, diagnóstico,PC y medicación.Resultados: De los 1.742 informes de alta revisados, el24,1% (IC95%: 20,04-28,16%) de las consultas fueron inadecuadas.El 70% eran menores de 45 años y un 40% menoresde 30. El día en el que se registra mayor proporción de consultasinadecuadas fue el viernes (30,61%). Un 40,7% acudióen horario de mañana, 36,8% por la tarde y el 22,5% denoche. El 81,8% vivía a menos de 10 km. Y el 86% acudió apetición propia o de un familiar.Los motivos más frecuentes fueron: traumatológicos(15,24%), digestivos (13,33%), generales (9,76%), cardiorrespiratorios(8,33%) y musculares (7,14%). En el 49 % la evoluciónera inferior a 24 horas. El 46,6% requirió medicación (41% analgésicos-antiinflamatorios, 14% benzodiacepinas,11% procinéticos, 9% fármacos inhalados, 7% corticoidessistémicos).Conclusiones: Una de cada cuatro visitas al SUH es inadecuada.Son sujetos jóvenes, que viven cerca, mayoritariamenteacuden en horario de mañana, por decisión propia ymotivos diversos (AU)

Objective: to determine the frequency of inadequate useat a hospital emergency service (HES) and the patients’ characteristics.Subjects and Method:—Design: retrospective descriptive study.—Setting: third-level hospital.—Subjects: older tan 14 years, gyneco-obstrectic emergenciesexcluded, that visited our HES from January toMarch 2005. They didn’t need consultation to other specialistsnor complementary test (CT), except those who can beused in in primary care, such as capillary glycaemia, urinarytest, electrocardiogram, oxymetry and fluorescein staining.—Measurements: the sample size was calculated consideringa limited population of 21,560 (prevalence: 30%, precision:5%, lost: 20%), being needed 396 reports. Randomselectionof all reports. Variables: demographics, date and hour,symptoms and evolution, diagnosis, CT and medication.Results: of the 1,742 reports revised, 24.1% (CI95%:20.04-28.16%) of the visits were inadequate. 70% wereyounger than 45 years old and 40% younger than 30. Themost frequent assistance day was Friday (30.61%). 40,7%came in the morning, 36.8% in the afternoon and 22.5 atnight. 83.5% lived nearer than 10 km. 86% came by theirown decision or by a family decision.They most frequent reasons were traumatic (15.24%),digestive (13.33%), generals (9.76%), cardio-respiratory(8.33%) and muscular (7.14%). In 49% the evolution wasinferior to 24 hours. A 46.6% needed medication (41%analgesic-antiinflammatory, 14% benzodiazepines, 11%procinetics, 9% inhaled drugs, 7% systemic corticosteroids). Conclussions: One of every four visits to our HES is inadequate.The patients are young, live near, come during themorning, by themselves and for different reasons (AU)

Is there an association between physical exercise and the quality of life of hypertensive patients?

CONTEXT: Quality of life of hypertensive patients (QOLHP) is associated with factors that are not always taken into account in the recommendations made by doctors. OBJECTIVE: To evaluate the association between QOLHP and physical exercise in an effectiveness approach, i.e. under the actual conditions of application of these treatments. METHODOLOGY: In a sample of 361 hypertensive patients registered in a primary care center in Tenerife, Spain, the QOLHP is measured using the PECVEC questionnaire. The main factor considered is physical exercise. In addition, we compiled a set of control variables: pharmacological and dietetic treatments, pathological, clinical, functional, psychological, social, lifestyle and demographic characteristic of the patients. We explored the association between all these factors and the QOLHP by adjusting multiple linear regression models. RESULTS: The PECVEC results were between 2.0 and 3.5, with an overall Cronbach's alpha reliability statistic of 0.88. From the sample, 58% of the patients engage in physical exercise, 75% maintain a anti-hypertension diet and 89% take hypertension medication. From all the treatments evaluated, only physical exercise is associated directly with all PECVEC scales, especially for women and patients over 65. CONCLUSIONS: Recommending the practice of physical exercise may be a useful tool for doctors to improve the QOLHP.

Smoking and sickness absence among public health workers.

BACKGROUND: As well as causing sickness and death, smoking has high socio-economic costs. The aim of this paper was to examine how closely smoking is associated with sickness absence among healthcare workers. SUBJECTS AND METHODS: Cases and controls were paired by age, gender and occupation among primary healthcare workers in Tenerife, Canary Islands, Spain. Cases were selected from workers that had been absent from work due to sickness for 1 or more days in an entire year, regardless of the cause. Controls were those workers who were not absent due to sickness over the same period. Tobacco consumption was verified by telephone poll. Matched pairs analysis was performed. RESULTS: Among the 292 cases, 40% were smokers, compared with 31% of controls [odds ratio (OR)=1.51, 95% confidence intervals (CI)=1.06-2.14]. The association between smoking and sickness absence was stronger in those aged 30-45 years (OR=1.60, 95%CI=1.04-2.44) and among nurses (OR=2.08, 95%CI=1.05-4.14). When the cause of sickness absence was a respiratory disease, no association was found with smoking. However, an association was found with back pain (OR=5, 95%CI=1.45-17.27). Duration of tobacco consumption was higher in cases (a) when only current smokers were considered (P=0.002), and (b) when including the smoking duration of former smokers (P=0.0004). CONCLUSIONS: Smoking is associated with a higher risk of sickness absence among healthcare workers, particularly due to back pain. This could be used as an incentive to persuade healthcare workers to stop smoking and re-inforce the non-smoking message given to their patients.

[Accessibility to hospital pediatrics emergencies: distance and diagnostic resources]. / Accesibilidad a las urgencias pediátricas hospitalarias; distancia y medios diagnósticos.

OBJECTIVE: To study the justification of paediatric consultations in the hospital emergency services in line with the diagnosis, the need for further tests not available in primary care (PC), the need for admission or observation and the distance between home and casualty. DESIGN: A descriptive study assessing 2,906 emergency records forms. We used the chi-squared test for the statistical analysis. The extent of the associations was calculated using the odds ratio (OR) calculation. SETTING: Casualty department in the Nuestra Señora de Candelaria Hospital in Santa Cruz de Tenerife. PATIENTS AND OTHER PARTICIPANTS: Those patients between 0 and 14 attended at the casualty department. MEASUREMENTS AND MAIN RESULTS: The 80% of the patients lived closer than 10 kilometres to the hospital. The 39.8% attended because of a trauma. The 55% of attendances were considered unjustified. The fact that 70% of the traumatic injuries required an X-Ray (OR = 7) led to our establishing significant differences (p < 0.0001) between the proportion of justified consultations caused by trauma and by other reasons. The consultations by patients who lived over 10 km from the hospital were significantly more justified (p < 0.0001). CONCLUSIONS: The absence of radiological facilities in primary care emergency services means that patients with traumatic injuries have to attend hospital despite the triviality of the great majority of cases. Closeness to hospital facilities causes not only greater use of these, but a greater number of unjustified attendances.

[Smoking habit among workers of the public health system in Tenerife]. / Hábito tabaáquico en los trabajadores del sistema sanitario público de Tenerife.

OBJECTIVE: To find the prevalence of tobacco use among workers in the Public Health system and to assess their own attitudes to the possibility of giving up smoking. DESIGN: A descriptive study of a crossover type was carried out using a self-filled closed-answer questionnaire. SETTING: The Public Health system on the island of Tenerife. PARTICIPANTS: After stratified random sampling, a sample of 1,282 workers was obtained, of whom 770 (60%) answered the questionnaire. Later a reply was obtained from 10% of those who did not at first reply, without any differences from the other participants being apparent. MEASUREMENTS AND MAIN RESULTS: Overall prevalence is 43% of smokers, 13% ex-smokers and 44% non-smokers. 20% of the smokers have an important physical dependency and only 30.76% are highly motivated to stop smoking. 56% of smokers feel home pressure to stop smoking, while only 29.5% of smokers feel pressured at work. We elaborated a scale, which was useful in measuring peoples' motivation to abandon the habit. CONCLUSIONS: Almost half these workers are smokers at present. Despite belonging to the Health system, they are no more motivated than the general population they look after.