Spatial distribution of heavy hydrocarbons, PAHs and metals in polluted areas. The case of "Galicia", Spain.

The aim of this work is to verify the impact of anthropogenic activities and the effects of accidental events, e.g. oil spills, on the marine environment. For this reason, marine sediments and soil samples were collected in the inner part of Vigo and Pontevedra bays, in the Galicia region, northwest Spain, an area interested by many events of oil spills and also characterized by coastal areas with intense anthropic activities; also Cíes Islands, a natural protected area facing the Vigo bay, was investigated, as background site. PAHs, heavy hydrocarbons and metals were analyzed according to standard methods, in order to satisfy quality assurance and quality check constraints. Total PAHs concentration (Σ16 compounds) were in the range of 25-4000ng/g, and 30-800ng/g for marine sediments and soil samples, respectively. Even some samples from the Cíes Islands, show a contamination with values achieving >200ng/g of PAHs. Although contamination levels have been shown to be strong at several locations in the study area, their ranges are those typical of other estuarine sites, with PAHs and hydrocarbons primarily of pyrolytic origin. This observation was further confirmed by enrichment factors of some metals (Cd, Cu, Pb and Zn) that match to those of harbor and shipyard zones of the main industrial and commercial maritime areas.

Prevalencia de malos tratos en mujeres que consultan al médico de familia / Prevalence of domestic violence among women consulting their family doctors

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¿Quién debe facilitar la difusión de las guías de práctica clínica? / Who is responsible for providing us with the clinical practice guidelines?

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Atención a la salud del área reproductiva de las mujeres, en atención primaria / Health care of women´s reproductive system in primary care

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Salud y género en las consultas de atención primaria / Health and gender in primary care clinics

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[Validity and reliability of the family Apgar family function test]. / Validez y fiabilidad del cuestionario de función familiar Apgar-familiar.

OBJECTIVE: The aim of this study is to analyse the validity and reliability of the Apgar family questionnaire on family function. DESIGN: A crossover and descriptive study. SETTING: Urban health centre. PATIENTS: 656 patients of the Zaidín-Sur health centre in Granada were interviewed at home. The questionnaire was repeated an average of 6 days later to 60 of the patients (30 with an interviewer and 30 filling in their own). MEASUREMENTS AND MAIN RESULTS: The within-class correlation coefficients for the 5 items in the Apgar-family we over 0.55, both for self-filled and interviewer questionnaires; the scale coefficients were 0.86 and 0.81, respectively. Item-scale correlation varied between 0.61 and 0.71. Crombach's alpha was 0.84 and none of the items, when taken out of the scale, increased the alpha. The factorial analysis isolated only one factor. 16% of the sample had dysfunctional Apgar-family: the average score was 8.4. After adjustment (multiple logistic regression), the following were significantly linked to family dysfunction: lack of social support; being widowed or separated/divorced; greater perception of susceptibility to, or seriousness of, illness; being an over-user of the health service; and being a woman. CONCLUSIONS: The Apgar-family questionnaire on family function is valid and reliable.

[Validity and reliability of the Duke-UNC-11 questionnaire of functional social support]. / Validez y fiabilidad del cuestionario de apoyo social functional Duke-UNC-11.

OBJECTIVE: The aim of this study is to analyse the validity and reliability of the functional social support questionnaire, Duke-UNC-11. DESIGN: Descriptive. Crossover study. SETTING: Urban health centre. PATIENTS: 656 patients were interviewed in their homes. 60 had the questionnaire repeated (30 self-filled and 30 using an interviewer) an average of 6 days later. MEASUREMENTS AND MAIN RESULTS: The intraclass correlation coefficients of the 11 items in the Duke-UNC-11 were above 0.50, for both self-filled and interviewer questionnaires; the ones on the scale were 0.92 and 0.80, respectively. The factorial analysis separated two sub-scales, confidential support (7 items) and affective support (4 items). Low social support was significantly associated to: being over 40, widowed or divorced, living alone, over-user, worse subjective health, greater chronic morbidity, mental health disorder and family dysfunction. The multiple linear regression equation managed to explain 30% of the variability of social support, in which family function (family APGAR) explained 23.5%, education 3.3%, perception of internal health control 2%, mental health 1.2% and perception of susceptibility to/seriousness of illness 0.3%. CONCLUSIONS: The questionnaire Duke-UNC-11 is valid and reliable.

[Influence of age and sex on various types of utilization of the primary health care]. / Influencia de la edad y sexo sobre los distintos tipos de utilización en atención primaria.

OBJECTIVE: To find out the influence of gender and age on various types of utilization of primary care services. METHOD: A random sample group containing 2662 patients over 14 years of age was observed over a continuous period of a year. Having already excluded the losses subjects, health service utilization was measured using patients whose clinical records had previously been validated. RESULTS: A small number of patients (15%) use a disproportionate amount of the total number of visits. A numerical breakdown shows: 43% of global visits (GV), 45% of acute clinical visits (ACV), 68% administrative visits (AV) and 94% programmed visits (PV). The ACV, PV and GV were significantly higher in woman (p = 0.000), though in the AV was not the case. These remained a significant difference when age was controlling factor. The coefficients of correlation between age and the logarithm of the ACV, AV, PV and GV were respectively 0.27, 0.23, 0.40 and 0.41. Gender is not a consideration with regard to use of health services below 35 and above 75 years of age. In multiple lineal regression equations age stands out as the most predictive variable, followed by gender, excluding the AV where the doctor comes before gender. CONCLUSION: A small group of highusers use a desproportionate amount of the total number of visits, particularly the AV and PV. The positive correlation between age and utilization is more clear by the PV and GV. The female is more user than the male, specially among 35 and 75 years old; although the gender is not determinant by the AV. There is not much explained variability with the age and gender, but the age is more important than the gender on utilization.

[Consumer satisfaction with 2 models of primary care in operation in Andalucia]. / La satisfacción de los usuarios con los dos modelos de asistencia primaria vigentes en Andalucia.

A study was completed to investigate if any differences are observed in user satisfaction with health care centres, polyclinics and solo-practice, furthermore to identify user, organizational characteristics and doctors as variables that relate to user satisfaction in health care. A sample of users was chosen from the Andalusian cities of Granada, Málaga and Sevilla with an alpha = 5%, beta = 10% and d = 11%. The variables were collected trough the use of three questionnaires. Greater satisfaction was found between health care centre users than with polyclinics and solo-practice, with values being 62.4, 58.2 and 60.6 with a p < 0.001. The variables more strongly associated with user satisfaction in health care centres are those related with doctors and organization characteristics. Therefore several are capable of improvement in order to increase user satisfaction. On the contrary in polyclinics and solo-practice the most influential variables are those related with the user characteristics, which are not modifiable by the health services intervention.

[Results and analysis of research on HBsAg in pregnant women at a health center over 4 years]. / Resultados y análisis de la investigación de AgHBs en las embarazadas de un centro de salud durante 4 años.

Vertical transmission of hepatitis B is the primary means of acquiring the disease by new carriers. The Cartuja Health Center performs systemic screening of pregnant women subjects as possible carriers. The purpose of the study is to determine the prevalence of pregnant carriers, seroepidemiological characteristics and intervention guidelines followed. We reviewed 454 pregnant women with serology performed between 1986 and 1989, including factors such as age, race, HBV serology, risk, and subsequent prevention. We calculated the prevalence of carriers. Moreover, we compared the proportion of Gypsy carriers versus non-carriers, and the prevalence of Gypsy versus Payos (non-Gypsy) carriers. Fourteen cases were AgBHs (+) (3.1%). There was no age difference between carriers and non-carriers. The proportion of Gypsy women in the carrier group was higher than in the non-carrier group (p less than 0.01), while the prevalence of carriers was also higher in Gypsy women than in pregnant women of Payo origin (p = 0.00082). Only one carrier had prior risk history. Of the 14 women with AgBHs (+), 13 gave birth; the recommended guidelines were followed in 9 cases. Routine screening for AgBHs in pregnant women is justified by the low sensitivity of the risk criteria, and the possibility for prevention.

[A hepatitis A outbreak in a Granada district]. / Estudio de una epidemia de hepatitis A en un barrio de Granada.

The aim of the present study was to define and characterize the occurrence of a hepatitis outbreak. A hepatitis outbreak developed from November 1987 and June 1988 in a peripheral district of the city of Granada. Sixty cases were diagnosed (59 confirmed and 1 probable). An increase in the incidence was observed during October, November and December. There were no sex differences in the specific attack rates and the mean age of cases was 7.14 years; the specific rates in the different age groups were higher in the 0-5 years and 6-10 years groups. The most common symptoms and signs were choluria, abdominal pain and jaundice. Anti-HVA IgM was positive in 83.3% of cases. Only 5 children required hospital admission, and the outcome of 83.3% of cases was known and favorable. The strategies adopted against the outbreak were to recommend hygienic measures in the households and school where cases had developed and to give nonspecific human immunoglobulins before or after exposure in the closed contacts of cases. We do not feel that these strategies have had a sizeable effect on the course of the outbreak.