Evolución del control de la presión arterial en España en el período 2002–2006. Estudios PRESCAP / Evolution of the control of blood pressure in Spain in the period 2002–2006. PRESCAP Studies

ObjetivosDiscutir la evolución del grado de control de la presión arterial (PA) en una amplia muestra de pacientes hipertensos españoles durante el período 2002–2006.Material y métodosLos PRESCAP fueron estudios transversales y multicéntricos diseñados para la estimación de prevalencias, que se realizaron en los años 2002 y 2006 con la misma metodología en poblaciones similares asistidas en atención primaria (AP). Éstos incluyeron a pacientes ≥18 años diagnosticados de hipertensión arterial (HTA) que recibían tratamiento farmacológico antihipertensivo. Se consideró buen control de la HTA cuando la PA fue <140 y<90mmHg en general (<130 y<80mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). Se realizó estadística descriptiva y comparación de medias y porcentajes con el paquete SPSS versión 15.0.ResultadosSe incluyó a 12.754 pacientes (el 57,2% eran mujeres) con una edad media de 63,3±10,8 años en PRESCAP 2002 y a 10.520 pacientes (el 53,7% eran mujeres) con una edad media de 64,6±11,3 años en el PRESCAP 2006. En el año 2002 se observó un control de la PA sistólica (PAS) y de la PA diastólica (PAD) del 36,1% (intervalo de confianza del 95% [IC 95%]: 35,2–36,9) y en 2006 del 41,4% (IC 95%: 40,5–42,4). El porcentaje de pacientes diabéticos con PA controlada resultó del 9,1% (IC 95%: 8,0–10,2) en 2002 y del 15,1% (IC 95%: 13,8–16,5) en 2006.ResultadosEn el PRESCAP 2002 el 56,0% recibía monoterapia antihipertensiva, el 35,6% recibía combinaciones de dos fármacos y el 8,4% recibía tres o más fármacos, y en el PRESCAP 2006 estos porcentajes fueron del 44,4; el 41,1 y el 14,5%, respectivamente.Conclusiones(..) (AU)

ObjectivesDiscuss the evolution of blood pressure (BP) control grade in a large sample of Spanish hypertensive patients in the period of 2002–2006.Material and methodsThe PRESCAP were cross-sectional and multicenter studies designed to calculate prevalences that were conducted in 2002 and 2006 using the same methodology in similar populations attending in primary care (PC). They included patients ≥18 years diagnosed of high blood pressure (HBP) who received anti-hypertensive drug treatment. Good control of HBP was considered as BP<140 and<90mmHg in general (<130 and<80mmHg in patients with diabetes, nephropathy or cardiovascular disease). A descriptive statistical study and comparison of means and percentages with the SPSS version 15.0 were made.ResultsA total of 12,754 patients (57.2% women) with mean age of 63.3±10.8 years were included in PRESCAP 2002 and 10,520 (53.7% women) with a mean age of 64.6±11.3 years in PRESCAP 2006. In the year 2002, control of systolic BP (SBP) and diastolic BP (DB) of 36.1% (95% CI, 35.2–36.9) was observed and, in 2006, of 41.4% (95% CI, 40.5–42.4). The percentage of diabetic patients with controlled BP was 9.1% (95% CI, 8.0–10.2) in 2002 and 15.1% (95% CI, 13.8–16.5) in 2006.ResultsIn the PRESCAP 2002, 56.0% received antihypertensive monotherapy, 35.6% combinations of two drugs and 8.4% three or more drugs, and in the PRESCAP 2006 these percentages were 44.4%, 41.1% and 14.5%, respectively.ConclusionsThe control grade of HBP in Spain improved in the period of 2002–2006. The factors that may have had an influence in these results are the extensive amount of bibliography generated during this period on the need to achieve adequate control of BP and the change in the prescription profile of the PC physician, which indicates a greater percentage of combinations of antihypertensive drugs(AU)

[Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study]. / Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006.

INTRODUCTION: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. RESULTS: A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. CONCLUSIONS: Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.

[Clinical characteristics of patients diagnosed of chronic heart failure attended in Primary Care. The CARDIOPRES study]. / Características clínicas de los pacientes diagnosticados de insuficiencia cardíaca crónica asistidos en Atención Primaria. Estudio CARDIOPRES.

INTRODUCTION: Scarce information is available on the clinical characteristics and risk factors of patients with chronic heart failure (CHF) attended in Primary Care (PC) setting. The aim of this study was to analyze the clinical characteristics of this population in PC. PATIENTS AND METHODS: Multicenter, cross-sectional study in patients with CHF, consecutively recruited by 232 physicians in PC. The collected data included sociodemographic, etiologic, clinical and therapeutic variables. RESULTS: Eight hundred forty seven (847) patients were included (age 73.0 +/- 9.6 years; 50.5% men). Of these, 84.3% had arterial hypertension (AHT), 59.2% hypercholesterolemia and 34.9% diabetes mellitus. The most frequent associated clinical disorders were ischemic heart disease (40.1%) and peripheral artery disease (28.6%). In 69.6% of the patients the physicians knew the type of dysfunction (32.4% systolic, 37.2% diastolic). The main etiologies of CHF were the hypertensive cardiomyopathy (75.0%) and ischemic heart disease (40.1%); the most frequent trigger factor was atrial fibrillation (43.9%). Loop diuretics (72.3%) and angiotensin-converting enzyme inhibitors (60.9%) were the treatments used most and 6.7% of the patients were receiving treatment with beta blockers. CONCLUSIONS: AHT appears to be primary cause of CHF in PC. Diastolic dysfunction is more frequent than the systolic one, and the PC physicians do not know the cause of the ventricular dysfunction in one third of the cases. Loop diuretics and angiotensin-converting enzyme inhibitors were the most frequently used in these patients; the use of beta blockers in CHF is very scarce in PC.

Características clínicas de los pacientes diagnosticados de insuficiencia cardíaca crónica asistidos en Atención Primaria. Estudio CARDIOPRES / Clinical characteristics of patients diagnosed of chronic heart failure attended in Primary Care. The CARDIOPRES study

Introducción. Se dispone de escasa información sobre las características clínicas de los pacientes con insuficiencia cardíaca crónica (ICC) asistidos en Atención Primaria (AP). El objetivo de este estudio fue analizar las características clínicas de estos enfermos en AP. Pacientes y métodos. Estudio multicéntrico y transversal realizado en pacientes con ICC reclutados consecutivamente por 232 médicos de AP. Se recogieron datos sociodemográficos, etiológicos, clínicos y terapéuticos. Resultados. Se incluyeron 847 pacientes (el 50,5% hombres) con una edad media de 73,0 ± 9,6 años. El 84,3% padecía hipertensión arterial (HTA), el 59,2% hipercolesterolemia y el 34,9% diabetes mellitus. Los trastornos clínicos asociados más frecuentes fueron la cardiopatía isquémica (40,1%) y la arteriopatía periférica (28,6%). En el 69,6% los médicos conocían el tipo de disfunción (el 32,4% sistólica; el 37,2% diastólica). Las principales causas de ICC fueron la cardiopatía hipertensiva (75,0%) y la cardiopatía isquémica (40,1%); el factor desencadenante más frecuente de la aparición de ICC fue la fibrilación auricular (43,9%). Los fármacos más utilizados en el tratamiento fueron los diuréticos de asa (72,3%) y los inhibidores de la enzima convertidora de la angiotensina (60,9%); el 6,7% de los pacientes recibía tratamiento con bloqueadores beta. Conclusiones. La principal causa de ICC en AP es la HTA, la disfunción diastólica es más frecuente que la sistólica y en una tercera parte de los casos el médico desconoce el tipo de disfunción. Diuréticos de asa e inhibidores de la enzima convertidora de la angiotensina son los fármacos más frecuentemente prescritos en estos pacientes; la prescripción de bloqueadores beta es muy pobre (AU)

Introduction. Scarce information is available on the clinical characteristics and risk factors of patients with chronic heart failure (CHF) attended in Primary Care (PC) setting. The aim of this study was to analyze the clinical characteristics of this population in PC. Patients and methods. Multicenter, cross-sectional study in patients with CHF, consecutively recruited by 232 physicians in PC. The collected data included sociodemographic, etiologic, clinical and therapeutic variables. Results. Eight hundred forty seven (847) patients were included (age 73.0 ± 9.6 years; 50.5% men). Of these, 84.3% had arterial hypertension (AHT), 59.2% hypercholesterolemia and 34.9% diabetes mellitus. The most frequent associated clinical disorders were ischemic heart disease (40.1%) and peripheral artery disease (28.6%). In 69.6% of the patients the physicians knew the type of dysfunction (32.4% systolic, 37.2% diastolic). The main etiologies of CHF were the hypertensive cardiomyopathy (75.0%) and ischemic heart disease (40.1%); the most frequent trigger factor was atrial fibrillation (43.9%). Loop diuretics (72.3%) and angiotensin-converting enzyme inhibitors (60.9%) were the treatments used most and 6.7% of the patients were receiving treatment with beta blockers. Conclusions. AHT appears to be primary cause of CHF in PC. Diastolic dysfunction is more frequent than the systolic one, and the PC physicians do not know the cause of the ventricular dysfunction in one third of the cases. Loop diuretics and angiotensin-converting enzyme inhibitors were the most frequently used in these patients; the use of beta blockers in CHF is very scarce in PC (AU)

[Blood pressure measurement devices used in primary care office]. / Aparatos de medida de la presión arterial utilizados en las consultas de atención primaria.

OBJECTIVE: To know different blood pressure (BP) measurement devices used in primary care (PC). DESIGN: Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country. SETTING: Primary care practices from all the country. PARTICIPANTS: PC patients treated and they all were of age. METHODS: Two consecutive BP measures were made and measurement devices used in this process by physicians were booked. RESULTS: In this study participated 3592 PC physicians, BP were measured to 14,137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device. CONCLUSIONS: In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted.

[Primary care physicians behaviour in inadequate blood pressure control]. / Conducta del médico de atención primaria ante el mal control de la presión arterial.

PURPOSE: To investigate the behaviour of primary care (PC) physicians on inadequate hypertension control. DESIGN: Cross-sectional and multicentric study. SETTING: PC clinics in the whole of Spain. PATIENTS: Patients > or =18 years old who followed pharmacological antihypertensive treatment since at least 3 months before, selected by a consecutive sampling. MEASUREMENTS: Blood pressure measured by family doctors. The therapeutic diagram used before and after the visit was registered, and in those cases in which some kind of modification was adopted, the reasons why. RESULTS: 12,754 hypertensive patients were included. The average age was 63.3+/-10.9 years (57.3% women). A 65% lived in urban areas and the 35% in semi-urban o rural areas. The 63.9% (95% confidence interval, 63.1%-64.8%) showed a bad control of hypertension. The majority of the patients followed a therapeutic regimen of monotherapy (56%) being the ACE inhibitors the most prescribed drug (34.8%), followed by the calcium antagonist (21.3%), and angiotensin II antagonists (17.4%). The percentage of patients with inadequate control of the blood pressure, in which the therapeutic behaviour was modified was 18.3% (95% confidence interval, 17.5%-19.1%) (a change of drug in 47%, association in 34.7% and an increase in the dose in 18.3%). The main reasons for which the therapeutic behaviour was modified was because no drug efficacy (63.7%) and the presence of adverse events (5.5%). The price of the therapy originated 1.2% of the modifications. CONCLUSIONS: PC physicians behaviour was conservative in uncontrolled hypertension cases. Amongst the doctors who modified their behaviour, by inadequate blood pressure control, the change of drug was the decision most adopted.

Aparatos de medida de la presión arterial utilizados en las consultas de atención primaria / Blood pressure measurement devices used in primary care office

Objetivo. Conocer diferentes aparatos de medida de la presión arterial (PA) utilizados en atención primaria (AP). Diseño. Estudio transversal, multicéntrico, con muestreo no probabilístico de selección de casos consecutivos. Emplazamiento. Consultas de atención primaria de todo el Estado. Participantes. Pacientes hipertensos tratados > 18 años de edad. Métodos. Se hicieron 2 medidas consecutivas de PA y se anotaron los aparatos de medida utilizados. Resultados. Participaron en el estudio 3.592 médicos de AP que midieron la PA en 14.137 pacientes. En un 69,8% de los pacientes, la PA se midió con un esfigmomanómetro de mercurio, en un 16,5% con un aparato electrónico, en un 11,8% con un manómetro aneroide y en un 1,9% con más de un método de medida. En el medio rural se utilizaron más los aparatos electrónicos y los manómetros aneroides, observándose diferencias en las distintas comunidades autónomas de nuestro país. Había diferencias en los valores de PA según el método de medida; la tercera medida la realizaron con más frecuencia los médicos que empleaban aparatos electrónicos y la utilización de los dígitos 0 y 5 fue mayor cuando el método de medida no era un aparato electrónico. Conclusiones. En las consultas de AP se siguen utilizando preferentemente los esfigmomanómetros de mercurio y también los aparatos aneroides. Su utilización implica sesgos importantes en el proceso de medición: por ello, se debería fomentar el uso de los aparatos electrónicos para medir la PA

Objective. To know different blood pressure (BP) measurement devices used in primary care (PC). Design. Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country. Setting. Primary care practics from all the country. Participants. PC patients treated and they all were of age. Methods. Two consecutive BP measures were made and measurement devices used in this process by physicians were booked. Results. In this study participated 3592 PC physicians, BP were measured to 14 137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device. Conclusions. In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted

Conducta del médico de atención primaria ante el mal control de la presión arterial / Primary care physicians behaviour in inadecuate blood pressure control

Objetivos. Conocer la conducta del médico de atención primaria (AP) ante la falta de control de la hipertensión arterial. Diseño. Estudio descriptivo, multicéntrico. Emplazamiento. Consultas de AP del conjunto de España. Participantes. Hipertensos mayores de 18 años que seguían tratamiento farmacológico antihipertensivo desde al menos 3 meses antes, reclutados mediante muestreo no probabilístico de casos consecutivos. Mediciones principales. Presión arterial medida por los médicos de familia. Se registró el esquema terapéutico utilizado antes y después de la visita, y en los casos en los cuales se adoptó alguna modificación, los motivos de ésta. Resultados. Se incluyó a 12.754 pacientes hipertensos. La edad media fue de 63,3 ± 10,9 años (un 57,3% mujeres). El 65% habitaba en medio urbano y el 35% en medio semiurbano o rural. El 63,9% (intervalo de confianza del 95%, 63,1-64,8%) presentó mal control de la hipertensión arterial. La mayoría de los pacientes seguía un régimen terapéutico de monoterapia (56%). Los fármacos más prescritos fueron los inhibidores de la enzima de conversión de la angiotensina (34,8%), seguidos de los antagonistas del calcio (21,3%) y los antagonistas de los receptores de la angiotensina (17,4%). El porcentaje de pacientes con inadecuado control de la presión arterial en quienes se modificó la pauta terapéutica fue del 18,3% (intervalo de confianza del 95%, 17,5-19,1%) (cambio de fármaco en un 47%, asociación en el 34,7% y aumento de dosis en un 18,3%). Los principales motivos por los que se modificó la pauta terapéutica fueron la falta de eficacia del tratamiento (63,7%) y la presencia de acontecimientos adversos (5,5%). El precio del medicamento originó el 1,2% de las modificaciones en la pauta. Conclusiones. La conducta terapéutica del médico de AP fue conservadora en los hipertensos no controlados. En los médicos que modificaron su conducta ante el mal control, el cambio de fármaco fue la decisión más adoptada

Purpose. To investigate the behaviour of primary care (PC) physicians on inadequate hypertension control. Design. Cross-sectional and multicentric study. Setting. PC clinics in the whole of Spain. Patients. Patients >=18 years old who followed pharmacological antihypertensive treatment since at least 3 months before, selected by a consecutive sampling. Measurements. Blood pressure measured by family doctors. The therapeutic diagram used before and after the visit was registered, and in those cases in which some kind of modification was adopted, the reasons why. Results. 12 754 hypertensive patients were included. The average age was 63.3±10.9 years (57.3% women). A 65% lived in urban areas and the 35% in semi-urban o rural areas. The 63.9% (95% confidence interval, 63.1%-64.8%) showed a bad control of hypertension. The majority of the patients followed a therapeutic regimen of monotherapy (56%) being the ACE inhibitors the most prescribed drug (34.8%), followed by the calcium antagonist (21.3%), and angiotensin II antagonists (17.4%). The percentage of patients with inadequate control of the blood pressure, in which the therapeutic behaviour was modified was 18.3% (95% confidence interval, 17.5%-19.1%) (a change of drug in 47%, association in 34.7% and an increase in the dose in 18.3%). The main reasons for which the therapeutic behaviour was modified was because no drug efficacy (63.7%) and the presence of adverse events (5.5%). The price of the therapy originated 1.2% of the modifications. Conclusions. PC physicians behaviour was conservative in uncontrolled hypertension cases. Amongst the doctors who modified their behaviour, by inadequate blood pressure control, the change of drug was the decision most adopted

[Self health care when faced with acute pathology in childhood]. / Autocuidados de salud ante patología aguda en la infancia.

OBJECTIVE: To quantify and describe the self-care practices for children up to 14 seeking care because of an acute pathology. DESIGN: An observation study carried out by means of a questionnaire administered to the person accompanying the patient. SETTING: Primary Care: an urban Health Centre. PATIENTS AND OTHER PARTICIPANTS: The total number of cases of acute pathology treated during April and May 1993 in the Centre's paediatric clinics. MEASUREMENTS AND MAIN RESULTS: 248 cases were studied (53% boys and 47% girls, with an average age of 5.3 +/- 3.85). Self-care (self-medication, 84.6%; non-pharmacological measures, 11.5%; both of these, 3.9%) was practised in 61.3% of cases (CI 95%: 55.2-67.4). The most common drugs were: antipyretics-analgesics (60%), antitussives (9.6%) and antibiotics (8.1%). Self-care was practised most often on patients presenting respiratory symptoms (69.6%) (p < 0.001), with self-medication predominant (91.2%) (p < 0.001). The number of days occurring between the appearance of symptoms and the medical consultation was greater among those who did not practise self-care (4.5 +/- 5.2 as against 2.1 +/- 1.8) (p < 0.001). CONCLUSIONS: Self-care is a very common practice among people seeking paediatric treatment. Self-medication, especially for respiratory trouble, is the most common form. Patients who practise self-care tend to be earlier in seeking a medical consultation.

[Validation of a method for calculating the cardiovascular risk in primary care]. / Validación de un método de cálculo del riesgo cardiovascular en atención primaria.

OBJECTIVE: To design a simple method to calculate overall cardiovascular risk (CVR), which could be used in Primary Care (PC). DESIGN: A descriptive study to correlate and validate our method (called CVR-PC) using the Framingham, the British Regional Heart study and the Spanish Society to fight against Arterial Hypertension methods. SETTING: Urban health centre. PATIENTS: 670 patients of both sexes chosen at random in clinics, to apply a programme of preventive measures. MEASUREMENTS AND MAIN RESULTS: The age, gender, blood pressure, tobacco consumption, Cholesterolaemia and Glycaemia were determined for each patient. A multiplicative memory method was designed to obtain the index of cardiovascular risk without recourse to electronic support. Figures obtained were correlated with those from the equation of the Framingham study. The Pearson r values were: 0.85 for the series total (0.85 for men and 0.83 for women). The cut-off point for high/low-moderate risk was identified. From this 76.3% sensitivity and 95.7% specificity were obtained. CONCLUSIONS: The method studied shows adequate correlation as well as high sensitivity and specificity when compared with the Framingham method. It can be useful in Primary Care clinic for identifying individuals at high cardiovascular risk.

[A serum cholesterol study in a consulting population and its implications in clinical practice]. / Estudio del colesterol sérico en población consultante y sus implicaciones en la práctica asistencial.

OBJECTIVE: To investigate serious cholesterol levels in the population seeking medical attention, utilising HOTH (How Often That High) graphs, and to look at implications these results have for recording of cholesterol incidence. DESIGN: This was a non-longitudinal, retrospective, observational study. SETTING: Carried out at the general practice level, in the Valdefierro Basic Health Area (Zaragoza Province). PATIENTS: 742 subjects aged between 18 and 65 years with no previous history of dyslipemia. MEASUREMENTS AND MAIN RESULTS: After obtaining the figures on cholesterolemia, the HOTH graph was drawn from which, for a given cholesterol value, the percentage of the population with a given value can be seen. The mean cholesterol value was 201 mg/dl. A total of 54% of male subjects and 40% of female subjects were situated above the threshold figure of 200 mg/dl. Furthermore, 15% of male subjects and 10% of female subjects were situated above 250 mg/dl. CONCLUSIONS: The application of recording procedures for cholesterol, based on a globally discriminatory score, reveals a startling number of patients who need tests and treatment. We suggest a strategy based on the different levels according to age, sex, bloodstream cholesterol level, and the existence or otherwise of other cardiovascular risk factors. Lastly, we would mention the usefulness of the HOTH graphs in improving our knowledge of the cholesterol levels in a population.

[Single oral dose of phosphomycin trometamol versus pipemidic acid and norfloxacin in treating uncomplicated low-level urinary tract infections]. / Fosfomicina trometamol en dosis oral única versus ácido pipemídico y norfloxacino en el tratamiento de las infecciones urinarias bajas no complicadas.

OBJECTIVE: To make an assessment of the effectiveness and safety of a single oral dose compared with the conventional way of treating low-level Urinary Infections presenting no complications. DESIGN: This was an investigative and prospective study, using a control, a simple blind and randomised sample. SITE. Health Centres in Oviedo and Zaragoza. PATIENTS OR OTHERS PARTICIPANTS: We looked at 150 patients and included 106 females between the ages of 16 and 75 in the study. Their clinical symptoms were compatible with low-level urinary infections presenting no complications. INTERVENTIONS: 49 patients were given Trometamol Phosphomicine (TP) in a single oral dose; 36 took Pipemidic Acid (PA) and 21 Norfloxacine (NFX), both of these in a dose of 400 mg twice a day for 5 to 7 days. MAIN MEASUREMENTS AND RESULTS: Clinical and bacteriological assessments of the results were made 3, 7, and 28 days after treatment. A total of 75 gems were isolated: E. coli was the most common (68%). In all three groups, the main symptoms rapidly disappeared after the start of the treatment. CONCLUSIONS: Having considered the bacteriological and clinical findings, as well as tolerance levels, we are able to conclude that a single oral dose of Trometamol Phosphomicine is a good alternative to conventional therapy for the treatment of low-level Urinary Infections Which present no complications.

[Quality control of a computer system for repeat prescriptions]. / Control de calidad de un sistema informatizado de prescripción repetida.

The results of a quality control of a computer system of repeated prescription (RPS) and its basic features are reported. The selected quality criteria were the following: reduction of the bureaucratic index in the visit, correct fulfillment of the treatment order, health attention circuits of the RPS, and compliance of the patient with the treatment. The record of activities and a random sample of treatment orders (TO) were used as sources of data. Quality indexes near the optimal standard (OS) were achieved: bureaucratic index 12.8% (OS = 15%), fulfillment of the TO 94% (OS = 100%), specified dosages 86% (OS = 100%), prescriptions in out-of-date orders 7% (OS = 0%), use higher than calculated 1% (OS = 0%), and use lower than calculated 36% (OS = 25%). Finally, the corrective measures for the detected quality problems are proposed, and the advantages of the computer RPS are discussed.

[Vaccination coverage in a pediatric population attended by a primary health care center]. / Estudio sobre la cobertura vacunal en la población pediátrica atendida en un centro de salud.

It is hereby presented a quality control study of a systematic vaccination program developed in an urban primary care center. Target population were children between 0 and 8 years attended in the center. They were considered as having a correct vaccination coverage those cases in which it was possible to verify documented accomplishment of the local vaccination schedule. Out of the 538 children included in our study, 168 (31%) were founded not to have appropriate vaccination coverage evidenced in their clinical records, and their families were requested for an interview: 126 (75%) attended de appointment. In 93 of them it was founded a recording mistake, and 33 cases were verified as no correctly covered. Vaccination coverage rate was 86%, being inverse relationship between age and coverage rate. They are discussed corrective actions derived from the quality control.

[An epidemiological study on mental health in a health area]. / Estudio epidemiológico en salud mental en una zona de salud.

To identify the prevalence of psychological abnormalities in the adult population of the Valdefierro Health Area, we carried out an epidemiological study following the methodology of the cross sectional two-phase study. A random sample of 400 individuals, stratified for age and sex, was selected from the population over 15 years of age. In a first phase, the GHQ positive individuals underwent the semistructured interview Clinical Interview Schedule (CIS). The prevalence of psychological distress detected by the GHQ questionnaire was 13.4%. There was a significant association between psychological distress and female gender, educational level, working status, marital status and use of health care services. 42 of the 51 GHQ positive cases (82%) were considered as psychiatric conditions by the CIS. This represents a 11% prevalence of psychiatric disorders in the evaluated sample.

[Results and evaluation of a pilot study for the implementation of a program of preventive activities in primary health care]. / Resultados y valoración de un ensayo piloto para la implantación de un programa de actividades preventivas en atención primaria.

Following the guidelines for preventive and health promoting activities in Primary Health Care presented by the S.E.M.F.Y.C., we developed a study to evaluate the adequacy of the parallel nurse clinic for their implementation. 209 individuals (94 males and 115 females, mean age 36,4 +/- 13 years) were included in the study. The results showed a remarkably high prevalence of risk factors in the study series and a good acceptance of the program by the users. The opportunistic screening by means of a referral to a nurse clinic was shown to be an adequate strategy for the development of the program, with a multimplicator effect on the whole of nursing activities to be evaluated at the time of planning their implementation rate.