Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan / La relación entre el SUV (standardized uptake value) de los ganglios linfáticos N1 y el tumor predice la enfermedad N2 en pacientes con cáncer de pulmón no célula pequeña mediante PET-TC 18F-FDG (AU)

Objective. F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. Material and method. This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. Results. There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1 ± 10.8 years. Type of resection: pneumonectomy = 4 (7.9%), lobectomy/bilobectomy = 44 (86.2%), segmentectomy = 3 (5.9%). Histology: adenocarcinoma = 26 (51.0%), squamous = 23 (45.1%), adenosquamous = 2 (3.9%). Lymph nodes after surgical resection: N0 = 21 (41.2%), N1 = 12 (23.5%), N2 = 18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. Conclusions. SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease (AU)

Objetivo. La PET-TC integrada con F-18 fluorodeoxiglucosa es utilizada frecuentemente en la estadificación preoperatoria del cáncer de pulmón(CP). El objetivo del estudio fue analizar la relación entre SUVmax de los ganglios linfáticos N1 con el tumor pulmonar para establecer un factor predictivo de enfermedad metastásica ganglionar en el mediastino(N2) en pacientes operados de cáncer de pulmón no microcítico. Material y método. Estudio retrospectivo de una base de datos prospectiva. Se incluyeron pacientes operados de CP con enfermedad N1 por PET-TC. Ninguno tuvo tratamiento previo. Se realizó una resección pulmonar estándar y linfadenectomía. Resultados. Hubo un total de 51 pacientes con N1 por PET-TC. 44(86,3%) fueron varones, edad media = 64,1 ± 10,8 años. Tipo de resección: neumonectomía = 4(7,9%), lobectomía/bilobectomía = 44(86,2%), segmentectomía = 3(5,9%). Histología: adenocarcinoma = 26(51,0), epidermoide = 23(45,1%), adenoescamoso = 2(3,9%). Ganglios linfáticos tras la resección: N0 = 21(41,2%), N1 = 12(23,5%), N2 = 18(35,3%). La relación media entre el SUVmax de los ganglios N1 con el SUVmax del tumor pulmonar (relación SUVmax N1/T) fue 0,60 (rango 0,08–2,80). El análisis de la curva ROC se realizó para determinar el punto de corte óptimo para predecir N2 (metástasis mediastínica). En el análisis multivariante encontramos que una relación de 0,46 o mayor fue un factor pronóstico independiente para N2, con una sensibilidad y especificidad de 77,8% y 69,7%, respectivamente. Conclusiones. La relación SUVmax N1/T en pacientes con CP no microcítico se correlaciona con la metástasis ganglionar mediastínica (N2) después de la resección quirúrgica. Cuando la relación SUVmax N1/T en la PET-TC es igual o mayor de 0,46 se debería prestar atención especial por la alta probabilidad de enfermedad mediastínica N2 (AU)

Estenosis aórtica y anemia ferropénica de causa no aclarada. ¿Síndrome de Heyde? / Aortic stenosis and iron deficiency anaemia of unclear cause: Heyde's syndrome?

No disponible

Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan.

OBJECTIVE: F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. MATERIAL AND METHOD: This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. RESULTS: There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1±10.8 years. Type of resection: pneumonectomy=4 (7.9%), lobectomy/bilobectomy=44 (86.2%), segmentectomy=3 (5.9%). HISTOLOGY: adenocarcinoma=26 (51.0%), squamous=23 (45.1%), adenosquamous=2 (3.9%). Lymph nodes after surgical resection: N0=21 (41.2%), N1=12 (23.5%), N2=18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. CONCLUSIONS: SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease.

[Mental health perceived demand and training necessities of primary care physicians]. / Percepción de la demanda y necesidades de formación en salud mental de los médicos de atención primaria.

OBJECTIVE: To know the opinion of the primary health care (PHC) physicians on the assistance demand in mental health (MH), their training necessities and their attitudes about this disorders. DESIGN: Observational and transversal study. SETTING: Primary care. PARTICIPANTS: The subjects of the study were PHC physicians. From a total of 1191 PHC physicians in Castilla-La Mancha region, 301 were selected by random stratified sampling. Main measurements. A self-complimented questionnaire was elaborated, being identified the following variables: professional and sociodemographics characteristics, their perceived demands of MH problems, perceived difficulties in resolution, training in MH, knowledge about specialized resources and their attitudes about mental disorders. RESULTS: 63.5% (95% confidence interval [CI], 57.6-69.4) considered that the mental problems are related with, at least, 20% of the consultations. Very frequent consulted problems were: anxiety disorders (75.9%), affective disorders (73.5%), and somatoform disorders (40.5%). 63.6% (95% CI; 57.8-69.6) considered to have enough information about specialized resources. About attitudes, 43.7% (95% CI; 37.7-49.8) said the PHC physicians cannot be taken charge of the existent demand. This opinion as significantly more frequents in physicians with more patient assigned, more assistance pressure, without postgraduate assistance formation (Spanish MIR system), with less perceived demand, without training in MH and worse knowledge of the specialized resources. CONCLUSIONS: In opinion of most of the physicians the mental disorders are related with, at least, 1 of each 5 consultations. A high proportion considers that the teams of PHC cannot be taken charge of the existent demand, mainly when it is high the assistance pressure. Most says that more specific training should exist in MH and more coordination with the specialized services.

Percepción de la demanda y necesidades de formación en salud mental de los médicos de atención primaria / Mental health perceived demand and training necessities of primary care physicians

Objetivo. Conocer la opinión de los médicos de atención primaria (AP) sobre la demanda asistencial en salud mental (SM), sus necesidades de formación y sus actitudes ante dichos trastornos. Diseño. Estudio observacional transversal. Emplazamiento. Atención primaria. Participantes. Los sujetos de estudio fueron médicos de AP. De un total de 1.191 médicos de AP en Castilla-La Mancha se seleccionó a 301 mediante muestreo aleatorio estratificado. Mediciones principales. Se elaboró un cuestionario autorrellenable y se indentificaron las siguientes variables: características profesionales y sociodemográficas, demanda percibida de problemas de SM y dificultades percibidas en su resolución, formación en SM, conocimientos sobre recursos especializados y actitudes hacia dichos trastornos. Resultados. La mayoría (63,5%, intervalo de confianza [IC] del 95%, 57,6-69,4) consideró que los problemas mentales están relacionados con, al menos, el 20% de las consultas. Los problemas señalados como motivos de consulta muy frecuentes fueron: trastornos de ansiedad (75,9%), del estado de ánimo (73,5%) y somatomorfos (40,5%). La proporción que consideró suficiente el nivel de información sobre recursos especializados ascendió hasta el 63,6% (IC del 95%, 57,8-69,6). En cuanto a las actitudes, el 43,7% (IC del 95%, 37,7-49,8) opinó que los equipos de AP no pueden hacerse cargo de la demanda existente. Dicha opinión fue significativamente más frecuente en los médicos con más pacientes asignados, mayor presión asistencial, sin formación MIR, con menor demanda percibida, sin formación en SM y peor conocimiento de los recursos especializados. Conclusiones. En opinión de la mayoría de los médicos, los problemas mentales están relacionados con, al menos, una de cada 5 consultas. Una elevada proporción considera que los equipos de AP no pueden hacerse cargo de la demanda existente, sobre todo cuando la presión asistencia les elevada. La mayoría opina que debería haber mayor formación específica en SM y mayor coordinación con los servicios especializados

Objective. To know the opinion of the primary health care (PHC) physicians on the assistance demand in mental health (MH), their training necessities and their attitudes about this disorders. Design. Observational and transversal study. Setting. Primary care. Participants. The subjects of the study were PHC physicians. From a total of 1191 PHC physicians in Castilla-La Mancha region, 301 were selected by random stratified sampling. Main measurements. A self-complimented questionnaire was elaborated, being identified the following variables: professional and sociodemographics characteristics, their perceived demands of MH problems, perceived difficulties in resolution, training in MH, knowledge about specialized resources and their attitudes about mental disorders. Results. 63.5% (95% confidence interval [CI], 57.6-69.4) considered that the mental problems are related with, at least, 20% of the consultations. Very frequent consulted problems were: anxiety disorders (75.9%), affective disorders (73.5%), and somatoform disorders (40.5%). 63.6% (95% CI; 57.8-69.6) considered to have enough information about specialized resources. About attitudes, 43.7% (95% CI; 37.7-49.8) said the PHC physicians cannot be taken charge of the existent demand. This opinion as significantly more frequents in physicians with more patient assigned, more assistance pressure, without postgraduate assistance formation (Spanish MIR system), with less perceived demand, without training in MH and worse knowledge of the specialized resources. Conclusions. In opinion of most of the physicians the mental disorders are related with, at least, 1 of each 5 consultations. A high proportion considers that the teams of PHC cannot be taken charge of the existent demand, mainly when it is high the assistance pressure. Most says that more specific training should exist in MH and more coordination with the specialized services

[Impact of cataract surgery upon functional capacity of the elderly]. / Repercusión de la intervención de cataratas en la capacidad funcional del anciano.

PURPOSE: To determine the impact of cataract intervention on visual function of the elderly and on autonomy in daily activities, analyzing the influence of clinical and sociodemographic variables. METHODS: Observational and longitudinal study. 185 elderly patients having undergone cataract surgery were compared with 179 elderly patients on a surgical waiting list. The first group was evaluated prior to surgery and at 4 months post-intervention. Control group patients were evaluated at the same times, without having received surgery. For all subjects, the state of visual function was determined by the Activities of Daily Vision Scale (ADVS). Degree of dependence in carrying out basic daily activities, cognitive state and self-perception of vision were also measured. Other variables were visual acuity, other ocular diseases and sociodemographic characteristics. RESULTS: Amongst the elderly patients having undergone surgery, the proportion of subjects able to carry out basic activities 4 months post-intervention (60.7%) was very similar to the initial pre-intervention figure (62.2%). However, in the control group, the proportion (63.1%) diminished significantly at the 4-month mark (48.8%) (p= 0.0001). Of the intervened subjects, 75.7% demonstrated improved self-perception of vision after 4 months as opposed to 15.4% of the non-intervened patients (p= 0.00001). Post-intervention, the mean score on the ADVS rose from 51.0 S.D. 28.4 to 76.0 S.D. 25.4 (p < 0.001). In contrast, the control group's mean score dropped from 54.8 S.D. 24.8 to 46.5 S.D. 27.1 (p < 0.001). CONCLUSIONS: Cataract surgery in the elderly improves visual function and prevents loss of autonomy, delaying dependency in carrying out basic daily activities.

[Pharmacological interactions of statins]. / Interacciones farmacológicas de las estatinas.

OBJECTIVE: To determine in primary care the frequency of pharmacological interactions of statins. DESIGN: Transversal observational study.Setting. Urban health centre.Participants. 384 patients taking statins who were chosen by systematic sampling based on long-treatment cards (95% CI, accuracy 5% and expected proportion of possible interactions unknown). MAIN MEASUREMENTS: Consumption of statins, the accompanying medication taken, presence of interactions according to the technical details of statins (Spanish Medication Agency, Ministry of Health and Consumption) and social and demographic variables. RESULTS: In 55 patients (14.3%) (95% CI, 10.8%-17.8%) one of the statin interactions with the other drugs was checked, especially with acenocoumarol, digoxin and anti-acid drugs. In patients with some interaction, the mean number of other drugs was significantly higher (4.51.5 vs 3.31.9 SD; P<.001). 19.1% of men and 10.8% of women showed interactions, the difference being statistically significant (P=.02). By means of logistic regression, both masculine gender (OR=1.8) and taking of other medication in quantities of 5 or more (OR=2.7) appeared as variables associated with the presence of interactions. CONCLUSIONS: The potential pharmacological interactions of statins reach 14.3% of patients with hypercholesterolaemia who take medication long-term. The possibility of reaching high plasma concentrations of statins and/or of modifying the therapeutic effect of various drugs enables a more appropriate use of statins to be recommended, with prescription of those statins that metabolise less through the P450 cytochrome.

Interacciones farmacológicas de las estatinas / Pharmacological interactions of statins

Objetivo. Determinar en el ámbito de atención primaria la frecuencia de potenciales interacciones farmacológicas de las estatinas. Diseño. Estudio observacional transversal. Emplazamiento. Centro de salud de características urbanas. Participantes. Se seleccionó a 384 pacientes consumidores de estatinas mediante muestreo sistemático a partir de las cartillas de largo tratamiento (nivel de confianza del 95 por ciento, precisión del ñ 5 por ciento y proporción esperada de posibles interacciones desconocida).Mediciones principales. Consumo de estatinas, medicación concomitante, presencia de interacciones según las fichas técnicas de las estatinas (Agencia Española del Medicamento. Ministerio de Sanidad y Consumo) y variables sociodemográficas. Resultados. En 55 pacientes (14,3 por ciento; IC del 95 por ciento, 10,8-17,8 por ciento) se comprobó alguna de las interacciones de las estatinas con el resto de los fármacos, sobre todo con acenocumarol, digoxina y antiácidos. Entre los pacientes con alguna interacción, el número medio de otros medicamentos fue significativamente superior (DE, 4,5 ñ 1,5 frente a 3,3 ñ 1,9; p < 0,001). Presentaron interacciones el 19,1 por ciento de los varones y el 10,8 por ciento de las mujeres, resultando la diferencia estadísticamente significativa (p = 0,02). Mediante regresión logística, tanto el sexo masculino (OR= 1,8) como el consumo de otros medicamentos en número de 5 o más (OR = 2,7) aparecieron como variables asociadas a la presencia de interacciones. Conclusiones. Las potenciales interacciones farmacológicas de las estatinas alcanzan al 14,3 por ciento de los pacientes con hipercolesterolemia que consumen medicación de forma crónica. La posibilidad de alcanzar concentraciones plasmáticas elevadas de estatinas o de modificar el efecto terapéutico de diversos fármacos permite aconsejar un uso más apropiado de aquéllas, prescribiendo las que utilizan en menor medida el citocromo P-450 para su metabolismo (AU)

Situación funcional de los ancianos con cataratas / Functional condition of the elderly with cataracts

OBJETIVO: Describir el estado de la función visual y la capacidad para realizar actividades básicas de la vida diaria en los ancianos diagnosticados de cataratas, analizando la influencia que ejercen sus características sociosanitarias. DISEÑO: Estudio observacional de carácter transversal realizado mediante entrevista personal. EMPLAZAMIENTO: Centros Hospitalarios del Sistema Público existentes en el Área Sanitaria de Albacete. PACIENTES: 364 sujetos de 65 o más años de edad, diagnosticados de cataratas y en lista de espera para ser sometidos a cirugía, seleccionados consecutivamente. El tamaño muestral corresponde a una precisión de ñ 2,5 puntos en la escala de función visual utilizada, una desviación estándar de 25 puntos y un nivel de confianza del 95 per cent. RESULTADOS: El estado de la función visual se evaluó mediante la Escala de las Actividades Visuales de la Vida Diaria (ADVS) y la capacidad funcional global de los ancianos a través del índice de Katz. El resto de las variables consideradas fueron: estado cognitivo, visión autopercibida, agudeza visual, clasificación de la catarata, tensión ocular, datos de morbilidad y características sociodemográficas. El tiempo medio de evolución de las cataratas fue de cinco años. Considerando exclusivamente el ojo portador de la catarata, el 96,6 per cent presentaba una agudeza visual inferior a 0,5 (20/40), estando comprendida en el 51,1 per cent de los casos entre 0 (amaurosis) y 0,05 (20/400). El tipo de catarata predominante fue la madura o completa (43,5 per cent). La puntuación media de los ancianos en la escala ADVS fue de 52,9 puntos ñ 26,9 DE (IC 95 per cent: 50,09-55,65) (rango 0-100). Dicha puntuación fue significativamente inferior en mujeres, mayores de 74 años, viudos o solteros, analfabetos o con estudios primarios incompletos, ancianos con bajo rendimiento intelectual, con alguna enfermedad visual además de la catarata, con mala o muy mala visión autopercibida y con cifras de agudeza visual inferiores a 0,5. Respecto a la capacidad funcional, los ancianos mostraron una puntuación media en la escala ADVS significativamente inferior cuando eran dependientes de otras personas en actividades como bañarse o vestirse (p< 0,001). Mediante regresión múltiple, las variables que mostraron una asociación estadísticamente significativa con una puntuación superior en la escala de función visual fueron la agudeza visual (tanto en el ojo con mejor visión como en el ojo con catarata), una buena visión autopercibida, la independencia física, menor edad, procedencia urbana y sexo masculino. CONCLUSIONES: La ADVS presenta en nuestro medio unos adecuados índices de fiabilidad, por lo que puede considerarse como un método o instrumento apropiado y útil para valorar la pérdida de función visual percibida por los pacientes con cataratas. Prácticamente todos los ancianos de nuestra muestra presentaron en el ojo con catarata una cifra de agudeza visual inferior a 0,60 (20/30) y más de tres cuartas partes inferior a 0,20 (20/100) indicando un estado muy avanzado de la enfermedad en nuestro medio cuando se accede a la intervención. Los resultados muestran que los pacientes con cataratas presentan dificultades importantes para realizar las actividades dependientes de la visión y que, por lo tanto, son susceptibles de obtener beneficio con la intervención (AU)

[Impact of prostatic symptoms in patients with prostatic benign hyperplasia]. / Repercusión de los síntomas prostáticos en los pacientes con hiperplasia benigna de la próstata.

OBJECTIVE: To analyze the impact of prostatic symptoms and to identify the factors associated with the problems caused by these symptoms. METHODS: A descriptive, transverse study was conducted on 133 patients. The problems arising from prostatism were analyzed by means of a self-administered questionnaire, using the Symptomatic Prostatic Index (SPI), which was compared with the International Prostate Symptom Score (I-PSS), uroflowmetry, morbidity, medication required and sociodemographic variables. The reliability and consistency of the SPI scale were analyzed and the variables associated with a greater impact of prostatism were determined by linear regression analysis. RESULTS: Patient mean age was 68.8 years. Mean scores were 20.1 and 4.75 for the I-PSS and IQL item, respectively. Mean and maximum urinary flow were below the 50th percentile in 95.2%. A high correlation was found between the items of the SPI questionnaire and between the items and the total score. The SPI scale showed a high discriminating power (delta = 0.95) and internal consistency (alpha = 0.82), and factorial analysis showed only one factor accounted for the 49.05% total variance. The SPI questionnaire score was 15.5 and involved the irritative symptoms, basically nocturia, proportionally more than the obstructive symptoms (p < 0.0001). A direct correlation was found between the higher SPI score and the severity of the prostatic symptoms (p < 0.0001) and, consequently, a worse quality of life (p < 0.0001). Younger patients tolerated the symptoms poorly (p = 0.002). Linear regression analysis confirmed that tolerance was worse in the younger patients with more severe symptoms and no other disease (r2 = 0.43, p < 0.0001). CONCLUSIONS: The impact of prostatism increases according to its severity, particularly for the irritative symptoms, basically nocturia. Psychological factors may probably affect the variability of patient tolerance, indicating that the decision for treatment of BPH might be based on the problems it may cause and the impact on the quality of life more than on the severity of the symptoms.

[Health education: repercussions of a self-help program on the psychological status of perimenopausal women]. / Educación para la salud: repercusión de un programa de autoayuda en el estado psíquico de mujeres perimenopáusicas.

OBJECTIVE: To establish the effect caused by a self-help programme for climacteric and menopause on the psychological state of women of menopausal age. DESIGN: A semi-experimental study with a comparison group. SETTING: Primary Care. PARTICIPANTS: 106 women between 45 and 60, users of Albacete's Area IV Health Centre, of whom 53 were in the intervention group and the other 53 in the control group. Intervention. This consisted of developing an educational programme on the changes occurring in middle-aged women (biological, psychological and social), which included exercises in body movement, relaxation and group discussions. The intervention, aimed at groups of 8 to 10 women, was performed by 4 female nurses in 10 weekly hour-long sessions. MEASUREMENTS AND RESULTS: The participants were interviewed and information was gathered on their functional ability, medicine consumption, frequency of attendance, and their social and demographic data. Their psychological well-being was assessed through the Goldberg Health questionnaire before and after the intervention. At the start, 62 women (70.5%) presented a probable mental disorder, with no statistically significant difference between the two groups. Circumstances such as lower social class, having family members to look after, greater use of consultations, greater consumption of medicines and more functional disability were linked to a higher prevalence of psychological malaise. After the intervention, 82.5% of the women in the control group had probable psychological disorders, but only 8.3% of those in the intervention group. The difference was statistically highly significant (P < 0.00001; RR = 9.9; 95% Cl, 3.8-25.3). CONCLUSIONS: Self-help programmes have a favourable impact on the psychological state of menopausal women. They may be particularly justified when there are circumstances linked to greater prevalence of mental disorders. The results show that educational programmes are very useful in the Primary Care setting.

[Major depression in consumers of benzodiazepines]. / Depresión mayor en consumidores de benzodiacepinas.

OBJECTIVE: To determine the proportion of benzodiazepines consumers who present a mayor depressive disorder and to observe the clinical evolution after restoring an antidepressive treatment. DESIGN: An observational design with a transversal character to determine the prevalence of the depression and a pre and after intervention to observe the answer to the treatment. SETTING: Primary Care. PATIENTS: Patients of the Centro de Salud Zona IV of Albacete who consume benzodiazepines (size of the sample: 91 subjects, selected by means of a consecutive pattern in three medical offices of general practice). INTERVENTION: To install an antidepressive treatment. MEASUREMENTS AND MAIN RESULTS: We explored the presence of nuclear symptoms of depression by means of a interview. The other analyzed variables were: the cognitive state, the characteristics of the consume of benzodiazepines, the problems of health, the intake of other medicines, the frequentation, the installation of the antidepressive treatment and the sociodemographic characteristics. The patients diagnosed of mayor depression were interviewed again after one month and after three months. 37 patients presented criterion of mayor depression (40.7%) (CI 95%: 30.5-51.5). In these an antidepressive treatment was restored, corresponding to selective serotonin reuptake inhibitors in the 91.9% of the occasions. The proportion of depressive patients was higher in women (p = 0.04) and under the diagnosed people we observed a lower period of benzodiazepines consume (p = 0.02), although with a much higher daily consume (p = 0.01). Among the 37 patients who initiated the treatment, only 7 presented adverse reaction. 28 patients were appraised after one month, presenting 6 of them 5 or more nuclear symptoms of depression. CONCLUSIONS: The high proportion of mayor depressive frames can justify the systematic investigation of such disorder in benzodiazepines consumers, specially in women and in patients with a high intake. The identification of the nuclear symptoms can be considered as a useful technique to orientate a mayor depression and to evaluate also the results of an antidepressive treatment.

[Factors associated with chronic drug consumption in the elderly]. / Factores asociados al consumo de medicación crónica en personas ancianas.

BACKGROUND: To determine chronic drug intake in the non-institutionalised elderly population and identify factors associated with polypharmacy. PATIENTS AND METHODS: Cross-sectional study by means of home interview. 1,015 elderly individuals were selected systematically from the 1991 municipal electoral list of Albacete, Spain (level of confidence 95%, precision 3%, response rate 93.8%). The questionnaire included, disability scales (Minimental test, index of Katz and Lawton-Brody, Yesavage scale and DUKE-UNC questionnaire), a self-preceivement of health, demographic data and qualitative and quantitative information about drug intake. We employed the anatomic classification of drugs to obtain a profile of consumption. RESULTS: 75% of those interviewed admitted to taking medication chronically (CI 95%: 72.6-78.6). The mean number of drugs was 3.17 +/- 1.94 SD. Intake was significantly higher in women (p = 0.01), widows (p = 0.04), those of lower social status (p = 0.01), greater age (p < 0.02), and a greater number of illnesses (p < 0.001), more frequent users of health resources (p < 0.001), those physically dependent (p < 0.001) and those suffering from depression or cognitive impairment (p = 0.001). The most commonly taken drugs were: cardioactive drugs (22.1%), diuretics (19.4%) and vasodilators (14.2%). Using logistic regression analysis we found that the factors associated with higher drug intake were: three or more ilnesses (OR = 2.24), poor self-assessed status of health (OR = 1.45), physical dependence (OR = 1.59), age greater than 74 years (OR = 1.63), depression (OR = 1.68), > or = 4 contacts with health providers over a three-month period (OR = 2.73) and previous hospital admissions (OR = 2.67). CONCLUSIONS: The high intake of drugs by the elderly is determined, among other factors, by sociodemographic considerations, the subject's perceived status of health and different forms of disability. These factors should be taken into account by health professionals when planning a rational use of drugs. There is a high consumption of peripheral vasodilators despite their scanty therapeutic value.

[Depression in older persons. Associated factors]. / Depresión en personas ancianas. Factores asociados.

OBJECTIVE: To determine the proportion of elderly people with depressive disorders and study the possible association with sociodemographic factors, self-perception of health, cognitive function, diseases suffered, drug consumption, sleep disorders and use of services. DESIGN: An observational crossover study using a home interview. SETTING: Community-based. PARTICIPANTS: 787 elderly people aged 65 and over, not institutionalised and living in the city of Albacete. MEASUREMENTS AND MAIN RESULTS: A questionnaire designed for the study was used to gather data on the sociodemographic variables, self-perception of health, diseases suffered, drug consumption, cognitive function, sleep disorders and contacts with the health service. The variables found by logistic regression to be associated independently to the presence of depressive disorders were: being female (OR = 2.75), habitually suffering sleep disorders (OR = 2.75), having self-perception of poor health (OR = 17.61) and cognitive deterioration (OR = 2.45). CONCLUSIONS: It would be advisable to apply a screening test to detect depressive disorders in elderly people with associated factors (being female, having sleep disorders, self-perception of poor health and cognitive deterioration), so that they could benefit from early diagnosis and adequate treatment.

[Work satisfaction of health personnel in primary care]. / Satisfacción laboral de los profesionales sanitarios en atención primaria.

OBJECTIVE: To determine the level of work satisfaction of health professionals working in Primary Care and to establish the social, demographic and professional factors which determine it. DESIGN: An observational, crossover study using a self-administered questionnaire. SETTING: Primary Care. PARTICIPANTS: All the doctors and nurses working in the Primary Care teams in the Albacete Health Area (468 in all). MEASUREMENTS AND MAIN RESULTS: The scale of work satisfaction of health professionals in Primary Care teams was used. Social, demographic and professional data were collected. 9 dimensions or components of work satisfaction were identified through a factorial analysis. The lowest scores were for motivation, opportunities for professional development and coordination with specialists. CONCLUSIONS: The findings show, in general, indifference as to work satisfaction or lack of it in areas such as motivation and opportunities for professional development. The differences observed in those polled relate to their job and work-place, and also, in the case of doctors, to specialist training.