[An epidemiological analysis of insomnia at a primary care center]. / Análisis epidemiológico del insomnio en un centro de atención primaria.

OBJECTIVE: To evaluate the real problems of insomnia, analysing its prevalence and its characteristic presentation, within the clinics using an appointment system at a Primary Care Centre. DESIGN: Observation study of a crossover type, by means of a personal interview. SETTING: Primary Care context. PATIENTS: The survey was on the basis of a sample population calculated for qualitative variables (N = 470; a = 0.05; p = 0.50; i = 0.05). A total of 490 patients, taken from the appointment lists of on-demand clinics by means of systematic sampling (K = 4), were studied. MEASUREMENTS AND RESULTS: The reply index was 100%. Out of a sample study population of 490, 278 patients with insomnia were recorded. 65.83% had proximal insomnia (difficulty in getting to sleep); 49.28%, interrupted sleep (intermittent insomnia); and 16.5% of cases, late insomnia (premature waking). Insomnia was persistent in 69.1% of cases and transitory in 30.9%. Regarding the aetiological factors linked to insomnia, non-organic mental disorder (64.29%); known organic Pathology (25%). CONCLUSIONS: 57% (CI 0.53 divided by 0.61) of the population under study had suffered insomnia at some time. 61.9% of these were suffering it at the time of the survey; and only 44% of these sought medical advice for the problem. We found that a significant relationship existed between suffering insomnia and age, civil status and socio-economic level. It is important to manage and have sufficient knowledge of insomnia, as it is a common health problem in Primary Care.

[User satisfaction in primary care: the results of a home survey]. / Satisfacción del usuario en atención primaria: resultados de una encuesta a domicilio.

OBJECTIVE: To discover the general and specific levels of satisfaction of our Primary Care centre (PCC) users, such as their satisfaction with the new Primary Care structures; to determine the relationship between satisfaction and sociodemographic factors; and to study the possible influence of certain user attitudes on satisfaction. DESIGN: Descriptive crossover study by means of a door-to-door survey. SETTING: A basic care unit of the Primary Care team of Number 3 health zone of area 19, Alcoy. PATIENTS AND OTHER PARTICIPANTS: The survey had a sample of 312 users, obtained by means of systematic sampling on the basis of our PCC's records. MEASUREMENTS AND MAIN RESULTS: Satisfaction was scored on a scale from 1 (very satisfied) to 5 (not at all satisfied). Average general satisfaction was 2.08 +/- 0.8 (quite satisfied), which in general depended on the length of time waiting to be seen. Average waiting time was 30 minutes (+/- 25 min 55 s) and the number of calls to obtain an appointment was 5.4 (+/- 4.6). Specific satisfaction with different professionals was around 2 (quite satisfied), a score which became more favorable in the case of doctors, but without statistically significant differences from the rest of the professionals. Socio-demographic factors did not show any influence on satisfaction. CONCLUSIONS: The user is in general "quite satisfied" with the attendance received at the PCC, despite the average waiting times and numbers of prior calls needed to make an appointment, which are among the highest published. This should make us aware of users' health access difficulties and should therefore forestall any over-optimism in the evaluation of a result which was generally positive as to user satisfaction. All in all, abundant information was obtained, which will assist in correcting the more negative features of the running of our PCC.

[Traffic accidents: a health problem in primary care]. / Los accidentes de tráfico: un problema de salud en atención primaria.

OBJECTIVE: To discover the prevalence and most relevant epidemiological characteristics of the victims of traffic accidents which occur in our health area. SETTING: Hospital Casualty department (HC), Health area 19, Alcoy. PATIENTS: This was an observational, crossover study, based on the collection of data from all those patients who had been brought into the HC for attention because of a traffic accident and who were attended between October 1, 1990 and September 31, 1991. MEASUREMENTS AND MAIN RESULTS: During the study period a total of 1,111 traffic accident victims were attended. Their average age was 26.62 (SD +/- 15.95), with 69.6% being men and 30.2% women. 60.7% of the victims were attended on non-working days or the eve of a non-working day. 44.5% of those involved in accidents were in four-wheeled vehicles; 40% on two-wheeled vehicles and 11.1% of the victims were pedestrians. Injuries were light in 73.3% of cases; moderate in 15.9% and in the other 8.8% serious, grave or critical. 43.7% of the total had the accident in an urban area and 40.9% on the open road. CONCLUSIONS: The high prevalence of victims of accidents (8.3 per 1000 inhabitants) observed in our health area can be explained by the type of study. It is vital to obtain valid information of the real importance of this health problem. The primary care doctor must take preventive action concerning traffic accidents: a) through full studies of traffic accident levels among primary care centre users; b) primary preventive action, through the spreading of information on norms of safety; and c) secondary and tertiary prevention, by means of effective and efficacious outpatient emergency measures, as well as a thorough rehabilitation of accident victims.

[Aneurysm of the abdominal aorta]. / Aneurisma de aorta abdominal.

OBJECTIVE: Three clinical cases of Aneurysm in the abdominal Aorta are presented, in order to make a clinical review of aneurysms in the abdominal Aorta (AAA) and underline the importance of their early diagnosis in Primary Care, given the risk factors. DESIGN: A retrospective, descriptive analysis of three cases of AAA from 1991. SITE. The patients studied had attended the hospital emergency department in the Alcoy Health area. MAIN MEASUREMENTS AND RESULTS: Case 1: A patient, who attended because of three days of bilateral lumbar pain of a colic type spreading to the mesogastrium, which did not respond to treatment for nephritic colic. The patient died in a few hours, with the diagnosis of hypovolaemic shock caused by a burst AAA. Case 2: A patient with generalised continuous abdominal pain, which over 12 hours had been located in the lower right hemiabdomen, who was admitted with the provisional diagnosis of acute pyelonephritis. Case 3: A patient who, after an emergency surgical intervention where the diagnosis of AAA was confirmed, presented after a month a clinical picture consistent with a cerebral vascular accident and died afterwards because of renal failure. CONCLUSION: Given the present increase of patients diagnosed in hospital as suffering AAA in our Health Area, we urge that special attention be paid to the early diagnosis of this pathology. It is important to look actively for this pathology in patients with chronic pathologies of high prevalence and include it in Primary Care preventive programmes.

[Pulmonary hypertension: approximation to diagnosis in general practice]. / Hipertensión pulmonar: aproximación diagnóstica en atención primaria.

Pulmonary hypertension is a syndrome which presents a wide variety of etiology and pathogens. Being able to reach an approximate diagnosis on the basis of clinical data and means available in general practice will permit an early diagnosis and therapeutic orientation.