Manejo de la depresión en fase de remisión en Atención Primaria / Management of depression in remissionphase in Primary Care

OBJETIVO. La depresión es el problema de salud mental más frecuente en Atención Primaria (AP). Su manejo terapéutico puede ser diferente en AP al del ámbito especialista, sobre todo durante la fase de estabilización. El objetivo del presente estudio fue conocer la actitud del médico de AP frente al paciente depresivo en remisión y evaluar si la resolución total del cuadro es un objetivo factible en este ámbito. MÉTODOS. 1.a parte: encuesta a médicos de AP sobre su experiencia en el manejo de la depresión en remisión. 2.a parte: estudio transversal, multicéntrico, donde se recogieron datos clínicos de pacientes con depresión en fase de remisión, según criterio clínico. Cada médico debía recoger datos de 5 pacientes, de forma consecutiva, durante 3 meses. Se evaluó la proporción de pacientes con remisión total según escala HDRS, versión reducida de 6 ítems (remisión total: HDRS-6 ≤5), y los factores relacionados con un peor estado clínico mediante un test de regresión lineal. RESULTADOS. 1.a parte: la mayoría de entrevistados coincidía en la necesidad de un tratamiento prolongado (entre 6 meses y 1 año), con el mismo fármaco y dosis a las que respondió el paciente. La baja adherencia fue referida como el principal problema de esta etapa. 2.a parte: el 37% de pacientes reunían criterios de remisión total. Edad, ocupación, tiempo de evolución, comorbilidad psiquiátrica, antecedentes depresivos o satisfacción al tratamiento se relacionaron con un peor estado clínico. CONCLUSIONES. El manejo clínico de la depresión en fase de remisión en AP coincide con las guías terapéuticas vigentes. La proporción de pacientes con remisión total fue similar a la observada en otros ámbitos clínicos

OBJECTIVE. Depression is the most common problem of psychiatric disorders encountered in Primary Care. Its management can differ from the psychiatrist's management, mainly during the remission phase. This study aimed to explore attitudes on management of depressed patients in remission in Primary Care and evaluate whether full remission is a feasible objective in this setting. METHODS. Part 1: semi-structured interview to Primary Care physicians on the management of depression in remission. Part 2: cross-sectional, multicenter study. Clinical data from depressed patients in remission (according to physician's criterion) were collected. Each physician should collect data on 5 consecutive patients seen over 3 months. The percentage of patients with full remission was evaluated by the Hamilton Depression Rating scale (6 items-short version) (full remission: HDRS-6 ≤5). Factors related with a worst clinical condition were evaluated by a lineal regression test. RESULTS. Part 1: most of the physicians agreed with the requirement to continue full-dose maintenance therapy for 6 to 12 months. Low adherence to treatment was reported as the main problem in this period. Part 2: 37% of patients met the full-remission criteria. Age, occupation, episode duration, psychiatric comorbidity, psychiatric antecedents, and treatment satisfaction were related with worst clinical condition. CONCLUSIONS. The long-term management of depression in Primary Care agrees with the current treatment guidelines. The percentage of patients fulfilling remission criteria was similar to the reports in other clinical settings

Propuesta para un registro clínico de demencias / A proposal for a clinical registry of dementias

Objetivo. Se presenta una propuesta de las característicasestructurales y funcionales necesarias para desarrollar un registrode demencias que permita recoger con garantías de fiabilidady validez la información estandarizada de los casos diagnosticadosde demencia en los centros sanitarios de atención especializada deun área geográfica definida. Desarrollo. Debido a la falta de informaciónsobre los aspectos relativos al impacto de las demenciassobre el sistema sanitario, en términos de utilización de recursos yen patrones de detección, derivación, diagnóstico y tratamiento enla práctica clínica habitual por parte de atención primaria y secundaria,se propone una implementación secuencial del registro paraadaptarse a cada territorio o región sanitaria. En primer lugar, sedeberían identificar los casos y las fuentes de información; en segundolugar, desarrollar un sistema de recogida de datos que permitaadoptar de forma estandarizada la recogida de información yestablecer una estrecha colaboración con los especialistas que llevena cabo el diagnóstico de demencia; y, en tercer lugar, aportar alregistro una estructura logística y de personal que centralice todaslas funciones y actividades del registro. Conclusiones. La vigilanciaepidemiológica es un instrumento fundamental para la planificación,gestión y distribución de los recursos sociosanitarios, para elseguimiento de la evolución natural de enfermedades crónicas asícomo para evaluar el impacto de programas preventivos. En estesentido, y desde un punto de vista funcional, la propuesta de unregistro de demencias cumple todos los requisitos básicos de la vigilanciaepidemiológica

Aims. We outline a proposal for the structural and functional features needed to develop a registry of dementiaswhich can be used to collect standardised information that is both reliable and valid concerning cases of dementia in thespecialised health care centres within a particular geographical area. Development. Due to the shortage of information aboutaspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns ofdetection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequentialimplementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identifythe cases and sources of information; second, a system for collecting data must be developed that allows information to begathered in a standardised manner while at the same time making it possible to work in close collaboration with thespecialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all thefunctions and activities of the registry. Conclusions. Epidemiological surveillance is an essential instrument for planning,managing and distributing community health resources, for following up the natural history of chronic diseases and forassessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry ofdementias meets all the basic requirements of epidemiological surveillance

[A proposal for a clinical registry of dementias]. / Propuesta para un registro clinico de demencias.

AIMS: We outline a proposal for the structural and functional features needed to develop a registry of dementias which can be used to collect standardised information that is both reliable and valid concerning cases of dementia in the specialised health care centres within a particular geographical area. DEVELOPMENT: Due to the shortage of information about aspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns of detection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequential implementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identify the cases and sources of information; second, a system for collecting data must be developed that allows information to be gathered in a standardised manner while at the same time making it possible to work in close collaboration with the specialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all the functions and activities of the registry. CONCLUSIONS: Epidemiological surveillance is an essential instrument for planning, managing and distributing community health resources, for following up the natural history of chronic diseases and for assessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry of dementias meets all the basic requirements of epidemiological surveillance.

[Spanish version of ECBI (Eyberg Child Behavior Inventory): measurement of validity]. / Versión española del ECBI (Eyberg Child Behavior Inventory): medida de validez.

OBJECTIVES: To translate into Castilian (Spanish) and measure the validity of the ECBI (Eyberg Child Behaviour Inventory), a questionnaire to screen behavioural disorders in pre-school children. DESIGN: Translation and back-translation of the ECBI. A descriptive crossover study. SETTING: Primary Care Paediatrics. PATIENTS: All the 3, 4 and 5-year olds from 4 paediatric clinics at 4 Health Centres (n = 527). One refusal. MEASUREMENTS AND MAIN RESULTS: The questionnaire was filled in by the children's mothers and was repeated 20 days afterwards for 35 children. High coefficients of internal consistency (Cronbach's alpha = 0.87) and stability (intragroup correlation = 0.89 [0.78-0.94]) were obtained. There was good factorial validity, as 84% of the variance was explained by the four factors with value greater than 1. CONCLUSIONS: The Spanish version of the ECBI is a brief and easy questionnaire with good results in psychometric assessment. Therefore, it can be recommended for use in paediatric Primary Care in order to detect children with behavioural problems.