[Domestic violence as a factor associated to women's health problems]. / La violencia contra la mujer en la pareja como factor asociado a una mala salud física y psíquica.

OBJECTIVE: To study the impact of intimate partner violence (IPV) on women's physical and psychological health. DESIGN: Cross-sectional study. SETTING: Primary care centers in 3 Andalusian provinces. PATIENTS: A total of 425 women, aged 18 to 65 years, were recruited following the same randomisation process in 6 primary care centers. MEASUREMENTS: A self-administered structured questionnaire for this study was used to gather the information. As well as sociodemographic variables, the instrument included questions about IPV, physical health indicators (chronic disease and type, lifetime surgeries, days in bed), psychological health (psychological morbidity, use of tranquilizers, antidepressants, pain killers, alcohol and recreational drugs), self-perceived health and social support. RESULTS: Of 425 women, 31.5% ever experienced any type of partner violence. Women experiencing IPV were more likely to suffer a chronic disease. IPV was significantly associated with a number of adverse health outcomes, including spending more than 7 days in bed in the last three months (ORa=2.96; CI 95%, 1.00-8.76), psychological morbidity (ORa=2.68; CI 95%, 1.60-4.49) and worse self-perceived health (ORa=1.89; CI 95%, 1.04-3.43), after controlling for potential confounding variables. CONCLUSION: This study shows that ever experiencing IPV is associated with a worse psychological and self-perceived health. Physical injuries are not the only "evidence" of the presence of IPV. Primary health care professionals are in a privileged position to help women who are abused by their partners.

Infarto bulbar peculiar y oclusión de la arteria vertebral / Unusual bulbar infarct and occlusion of the vertebral artery

Introducción. Los infartos bulbares aislados son poco frecuentes. Por motivos anatómicos vasculares la región más afectada es la lateral, cuya semiología deficitaria incluye síntomas y signos variados que se suelen agrupar bajo el nombre de síndrome de Wallenberg. Desde la aparición de la resonancia magnética (RM) ha podido correlacionarse la extensión y localización del área laterobulbar afectada con la topografía vascular y la etiopatogenia más probables. Caso clínico. Presentamos el caso de una paciente de 69 años con sintomatología completa de síndrome de Wallenberg y dos causas potenciales de ictus (cardiopatía embolígena y oclusión vascular aterotrombótica), donde la RM cerebral demostró la presencia de una lesión bulbar aislada de morfología peculiar y previamente descrita como de origen trombótico. Conclusiones. Pese a la reducida extensión del área encefálica que se afecta, en los infartos laterobulbares la RM ha permitido definir diferentes patrones topográficos de lesión isquémica. Algunos de estos patrones se han relacionado con una etiología concreta del infarto. Por este motivo, la importancia de la RM cerebral en caso de sospecha de isquemia lateral del bulbo es doble, ya que no sólo facilita el diagnóstico y las correlaciones clinicopatológicas, sino que, como en el caso que presentamos, ayuda además a sospechar la etiopatogenia más probable del ictus (AU)

[Consensus on care for the users of the Maintenance Program with Methadone at the health centers of the province of Cádiz]. / Consenso para la atención a los usuarios del Programa de Mantenimiento con Metadona en los centros de salud de la provincia de Cádiz.

OBJECTIVES: To reach a consensus on primary care actions concerning transmissible illnesses in users of the methadone maintenance programme. To promote coordination between levels. To find the needs of primary care professionals. DESIGN: Qualitative study based on the nominal group technique. SETTING: Cádiz province, including primary care districts, NHS hospitals and county drug-dependency centres. PARTICIPANTS: 76 health professionals: two doctors and a nurse from each health centre, selected for their experience and motivation; hospital specialists in preventive medicine and internal medicine also with experience and motivation, and with knowledge of primary care; a doctor from each county drug-dependency centre, chosen by the Provincial Drug-Dependency Management. INTERVENTIONS: The study had two phases: a) nominal group technique with homogeneous groups for each professional environment; b) modified nominal group with heterogeneous groups of professionals from all environments by hospital areas. MEASUREMENTS AND MAIN RESULTS: The final result of the study was the overall consensus in the four areas. The prioritized activities focused on "recruitment and study of patients and contacts", "educational and health promotion interventions", "immunisation programme", "monitoring therapy compliance", and "unified record of actions". What was needed to put into practice the interventions was agreed by consensus. CONCLUSIONS: Consensus techniques are a useful tool for planning primary care activities. A high degree of reproducibility can be reached if the participants are properly selected. Restrictions in being able to introduce some of the agreed interventions could be avoided with user participation and involvement of the health authorities.

Consenso para la atención a los usuarios del Programa de Mantenimiento con Metadona en los centros de salud de la provincia de cádiz / Consensus for care of Methadone Maintenance Programme users in the health centres of Cádiz province

Objetivos. Consensuar la actuación en atención primaria sobre enfermedades transmisibles en usuarios del Programa de Mantenimiento con Metadona. Fomentar la coordinación interniveles. Conocer necesidades de profesionales de atención primaria. Diseño. Estudio cualitativo basado en la técnica del grupo nominal. Emplazamiento. Provincia de Cádiz, incluyendo distritos de atención primaria, hospitales del SAS y centros comarcales de drogodependencias. Participantes. Setenta y seis profesionales: 2 médicos y un enfermero de cada centro de salud, seleccionados por experiencia y motivación; especialistas en medicina preventiva y medicina interna de hospitales con los criterios anteriores y conocimiento de la atención primaria; un médico de cada centro comarcal de drogodependencias, seleccionado por la Dirección Provincial de Drogodependencias. Intervenciones. El estudio se desarrolló en dos fases: a) técnica de grupo nominal con grupos homogéneos por ámbito profesional, y b) grupo nominal modificado con grupos heterogéneos de profesionales de todos los ámbitos por áreas hospitalarias. Mediciones y resultados principales. El conjunto de los consensos de las 4 áreas constituye el resultado final del trabajo, centrándose las actividades priorizadas en 'captación y estudio de pacientes y contactos', 'intervenciones educativas y de promoción de salud', 'programa de inmunizaciones', 'seguimiento del cumplimiento terapéutico' y 'registro de actividades unificado'. Se consensuaron las necesidades para aplicar las intervenciones. Conclusiones. Las técnicas de consenso son una herramienta útil para planificar actividades en atención primaria. Se puede alcanzar un alto grado de reproductibilidad seleccionando adecuadamente los participantes. La limitación en la capacidad para implantar algunas de las intervenciones consensuadas podría obviarse con participación de los usuarios e implicación de las autoridades sanitarias (AU)

[Unusual bulbar infarct and occlusion of the vertebral artery]. / Infarto bulbar peculiar y oclusión de la arteria vertebral.

INTRODUCTION: Isolated bulbar infarcts are infrequent. Because of the vascular anatomy the lateral region is the most commonly affected, and in this clinical disorder the various signs and symptoms are grouped together as the so-called Wallenberg's syndrome. Since the introduction of magnetic resonance (MR) it has been possible to correlate the extent and site of the laterobulbar area involved with the most probable vascular topography and etiopathogenesis. CLINICAL CASE: We describe the case of a 69 year old female patient with all the symptoms of Wallenberg's syndrome and two potential causes of stroke (emboliogenic cardiopathy and atherothrombotic vascular occlusion), in whom MR showed the presence of an isolated bulbar lesion of unusual morphology which had previously been described as being of thrombotic origin. CONCLUSIONS: In spite of the small area of the brain involved, in laterobulbar infarcts MR permits definition of different topographic patterns of ischemic lesions. Some of these patterns have been correlated with the specific aetiology of an infarct. Therefore there is twice the importance of cerebral MR in cases of suspicion of lateral bulbar ischaemia, since it not only assists in diagnosis and its clinicopathological correlations, but also, as in our case, helps to have a clinical suspicion of the most likely etiopathogenesis of the stroke.