El Sistema Nacional de Salud: equidad frente a eficiencia / National health system: equity versus efficiency

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Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad / Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting

Objetivo. Conocer aspectos clínicos, diagnósticos y de tratamiento de la brucelosis en la provincia de Almería. Métodos. Se ha realizado un estudio epidemiológico descriptivo, a partir de las 1.595 fichas de declaración individualizada de enfermedad en la provincia de Almería, en el período 1972-1998. Los apartados de complicaciones y tratamiento aparecen en 890 fichas (57,79 por ciento), los síntomas, signos y hemograma en 565 (35,42 por ciento) y otros datos diagnósticos en la totalidad de las fichas estudiadas. Se realiza la prueba estadística de Chi Cuadrado para comparación de variables cualitativas independientes para un nivel de confianza del 95 por ciento. Resultados. En la fase inicial el síntoma más frecuente fue la astenia (95,2 por ciento); en la fase de estado la sudación (95,8 por ciento). El signo más registrado es la esplenomegalia (37,5 por ciento) y la complicación más descrita la osteoarticular (22,8 por ciento). No se han encontrado modificaciones en la sintomatología a lo largo de los años. El hemograma revela que un 30,3 por ciento de casos presentaban anemia. El hemocultivo ha sido positivo en el 91,2 por ciento. Respecto al diagnóstico serológico, la Rosa de Bengala presenta un 99,2 por ciento de positividad; el hallazgo de las aglutinaciones a Brucella o B. melitensis más frecuente es 1/640 (13,47 por ciento). El tratamiento más utilizado ha sido asociación de tetraciclina y estreptomicina (42,5 por ciento). En un 42,6 por ciento consta que se derivaron los pacientes al hospital, sobre todo a partir del año 1984. Conclusiones. En general, los datos clínicos registrados en las fichas de declaración obligatoria de la brucelosis permiten conocer las características clínicas de esta enfermedad, tras la observación de un largo período de tiempo. La prueba Rosa de Bengala debería ser utilizada como prueba de cribado en el diagnóstico de la enfermedad (AU)

[Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting]. / Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad.

OBJECTIVE: To know clinical, diagnostic, and treatment issues of brucellosis in the Almeria province. METHODS: Descriptive, epidemiological study from 1,595 disease report cards in the Almeria province during the 1972-1998 period. Issues concerning complications and treatment were reported in 890 cards (57.8%), symptoms, signs and hemograms in 565 (35.4%), and other diagnostic findings in all cards. The chi2 test was used to compare independent qualitative parameters for a 95% CI. RESULTS: In the early phase the most common symptom was asthenia (95.2%); sweating in the chronic stage (95.8%). The most commonly recorded sign was spleen enlargement (37.5%) and the most commonly reported complication was bone and joint involvement (22.8%). No changes in symptoms occurred over years. The hemogram revealed anemia in 30.3% of cases. Blood culture was positive for 91.2%. Regarding serological diagnosis, rose Bengal was positive for 99.2% of cases; the most common agglutination titer to Brucella or B. mellitensis was 1/640 (13.5%). The most commonly used therapy consisted of the association tetracycline plus streptomycin (42.4%). For 42.6% of cards, patients were transferred to hospital, particularly since 1984. CONCLUSIONS: Generally speaking, clinical data recorded in the reporting card regarding brucellosis disease reveal the clinical features of the disease, after a long surveillance period. Rose Bengal should be used as screening test for the diagnosis of this disease.

[A survey on the satisfaction of the users of the Zaidin-Sur de Granada Health Center (1989)]. / Encuesta de satisfacción a usuarios del Centro de Salud Zaidin-Sur de Granada (1989).

In order to know the users's degree of satisfaction in the Primary Health Care Center of Zaidin-Sur in Granada, a survey has been carried out by means of a personal interview at home in an aleatory sample of 615 individuals. The questionnaire has 28 closed questions with multiple answer and collects sociodemographic variables, self-perception of health condition, acceptability of medical and nursery care. The interview was anonymous and carried out by nursery students of third year. The 52% of the sample expressed that his health level was "excellent" or "good" and it was worse when the educational level was lower and the age was higher. The group of workers showed the highest valuation of health condition. The levels of trust on the doctor, the time of dedication and the information given to the patient reach slightly lower values than the ones found in literature; personal treatment and interest towards the patient have been valued the best. Center space structure and timetable have been the most penalized variables. We conclude that there is a need of improving the nursery service care a need of the information, from all the professionals working in the center, given to the patients on their problems, which are the cause of their going to the health consult, and the need of enlarging the space of the center.

[Quality of medical records at a primary care center]. / Estudio de la calidad de los registros en un centro de atención primaria.

The quality of the clinical records included in the clinical charts is assessed through a sample of the clinical charts existing at the Health Center Zaidin-Sur (Granada, Spain). The quality was ascertained via the number of visits annotated, the number of records considered as essential (life style, family and personal history), and the number of received or requested consultation. This information is compared to the data of the general files of the Health Center, to the information gathered by a direct interview (performed to assess the validity of the essential records), and to the results of a protocol studying the visit activities. The analysis of data shows that just a 40.4% of the visits are annotated on the clinical chart. A lower percentage of the essential records were annotated, 37.6%. The requested consultations are annotated in 43.8% and the received ones in 87.6%. We discuss on the need of periodic evaluation of the records to show their limitations and deficiencies. This is the first step to improve them.

[Epidemiology of brucellosis in the Granada province (I). Occupational risks]. / Epidemiología de la brucelosis en la provincia de Granada (I). Riesgo profesional.

BACKGROUND: Brucellosis is a health problem in the Granada province. The major aim of the present study was to evaluate the professional risk to acquire brucellosis in Granada. METHODS: An epidemiologic study where the cases of brucellosis were found by active search was carried out. The study period was the year 1984. The patients (overall 804) were investigated in their residence area with a questionnaire where the major risk factors were considered. RESULTS: The disease was more common in males than in females (RR = 3); it had a significant tendency to increase with decreasing sizes of the urban nucleus (chi MH = 16.9, p less than 0.0001); and it had a significant relationship with the proportion of peasants and cattle workers in the region (r = 0.66, p less than 0.05). The professional group with the highest risk were veterinaries, in whom the disease was 31 times more common than in the rest of the population. CONCLUSIONS: Emphasis is made, in addition to other points, on the need to increase health education in the groups of more affected professionals.

[The hospital stay as a modifier of the effect of other risk factors for hospital infection]. / La estancia como modificador del efecto de otros factores de riesgo para la infección hospitalaria.

It has been suggested that the risk of hospital infection differs according to the moment of hospital stay. Through a retrospective cohort of 843 surgery patients the effect of several factors on nosocomial infection risk is studied as a function of the duration of the hospital stay. It was observed that the studied variables (operation, type of surgery, age and severity of underlying disease) had a predisposing effect on the appearance of infection in short stays (less than 14 days), being the effect greater in longer stays. It is concluded that hospital stay can act as a modifier of the effect of several factors on the risk of hospital infection.

[The use of incidence density in assessing the risk factors for nosocomial infection]. / Utilización de la densidad de incidencia en la valoración de factores de riesgo de la infección nosocomial.

Several authors have suggested that incidence density should be used in studying nosocomial infection. We assess several risk factors for hospital infection by two ratios, the incidence density ratio (IDR) and the relative risk (RR), in an historical cohort of 843 patients. The variables analyzed were: operation, its length, type of surgical wound, severity of underlying disease, and age. The IDR figures were always lower than those yielded by the RR. For example, the IDR for operated patients was 2.78, whereas RR yielded a figure of 6.46, or the IDR for patients greater than 60 years old was 0.96, whereas the RR achieved a significant value of 1.67. This suggests that the use of IDR to analyze risk factors for nosocomial infection improves comparability of results obtained in different hospital settings. Also, it may allow a more exact quantification of an effect. These facts influence implementation of nosocomial infection control measures.

[The story as a health education technic for schoolchildren]. / El cuento como técnica de educación sanitaria en escolares.

Schoolchildren health education should begin as early as possible. The objective of this study is to show that to develop health education early in the lifetime is feasible by using the tale/psychodrama as tool for making class explanations more useful. An intervention study was carried out with all the children attending course level 1 of Basic General Education (BGE) in four schools, two from the city of Granada (urban) and two from two surrounding municipalities (semi-urban). They were randomly divided in two groups in order to compare the efficacy of two different health education interventions on taking care of pets: formal explanations at the classroom vs listen to a tale. Evaluation was assessed by a simple 15 yes/no items questionnaire which was administered before and after the intervention. Both interventions resulted in important improvements of children responses. The tale was clearly better than class formal explanations, the differences being statistically significant for 8 of the questions. We conclude that health education is feasible early in childhood and that tales can be more efficient than class explanations.

[Epidemiologic aspects of leprosy in the province of Jaen]. / Aspectos epidemiológicos de la lepra en la provincia de Jaén.

Jaen is the province with the greatest number of patients with lepra. This study analyzes the prevalence of the disease in Jaen during 1984 and 1985. At that time, all the patients known to the health and consume provincial delegation of Jaén were studied. The 305 patients included received a protocol aimed to study the different risk factors (age, clinical form, the people living together, socioeconomic standing, ethnic, etc ...). The disease shows to have a highly significant and special predilection in gypsies and it is located in a significant geographical area in the province. Lepra did not show a rural distribution, however it prevails in middle size urban nuclei. Although all patients belonged to a low social class, the disease did not show to exhibit any association among the ecology and the income per inhabitant.

Prevalence of dental caries in school children of the province of Granada (Spain).

A sample of 3,347 students between 5 and 14 years of age was selected from the entire student population in the province of Granada (Spain) to study the prevalence of dental caries and several risk factors for the disease. Decay was ascertained in the study population by means of the following indices: df, DMF, and DMFS. Risk factors considered were the level of oral hygiene, number of between-meal sugar-containing food, and flouride concentration in drinking water. The indices mentioned showed a clear relationship to the age of the participants in the study. The level of oral hygiene did not show a clear association with dental caries measured through the df and DMF indices. Curiously, a higher correlation was noted between the disease in deciduous teeth and fluoride concentration than between the disease in permanent teeth and the latter factor.

[Workshop on primary health care]. / Análisis de un taller de trabajo sobre atención primaria de salud.

We evaluate a 32 hours-workshop on Primary Health Care. The method of the workshop was active participation and the tasks were: a) previous anonymous evaluation of knowledge, b) team work in 5-6 individuals teams in order to answer some practical problems, c) communication of results and synthesis with the whole group, and d) a second anonymous evaluation of knowledge (the same as the initial one) and an assessment of the perceived usefulness of the workshop. We present results on the modification of knowledge of the 237 students (96.2% of the students improve it), the usefulness of the workshop (91.1% consider it useful) and the evaluation of the methodology. This kind of teaching methodology is useful for stimulating the critical capacity of the students, improving their knowledge.

[Life style and level of health education in housewives from a neighborhood of Granada]. / Estilo de vida y nivel de educación sanitaria en amas de casa de un barrio de Granada capital.

In the present study some aspects of the health education level and life style of the housewives of a district of Granada were evaluated. The sample was randomly selected between the dwellings in that area. The participation rate was 60%. The survey was carried out by personal and direct interview by a female interviewer. The mean educational level was lower than high school in 97.5%. Mean age was 47 years. 13.3% of them were smokers, and 21.7% drank alcohol regularly. Only 44.1% of those in child bearing age used some contraceptive method; intrauterine devices were not used by anyone of them. Maternal lactation showed an increasing trend with age, but without statistical significance. 28.3% of women were unaware of the services of early diagnosis of genital cancer, and a similar rate ignored the preventive self-examination of the breast. The major conclusions of the study were that the educational level is directly related with the performance of beneficial health habits, and that the activities directed to health education should be promoted in the target population.

[Evaluation of quality at the first health care level]. / Valoración de la calidad en el primer escalón sanitario.

A study of the quality of the health care process was carried out in three types of general practices: outpatients clinics, rural clinics and health centers. Data were collected from 6,163 protocols collected from the patients during the medical visit, and positive and negative parameters were elaborated from them. The highest quality was found in the health centers; there was a marked difference between them favoring the second one, in which the results were: 75.6% of medical acts, a mean time of 9 minutes 23 seconds for medical act; 65.5% of physical examinations; 15.6% of systematic medical examinations and 4.3% of questionably needed drug therapies. The satisfaction of the user was also evaluated by means of 421 questionnaires administered to the general population. Satisfaction was greatest in the health centers for the accessibility and service character, in the outpatients clinics for the perception of one's own health status, and there were no differences between the three types of centers for helpfulness and professional skill.

[Prevalence of mental subnormality recorded in the province of Jaen]. / Prevalencia de la subnormalidad mental censada en la provincia de Jaén.

It is done a cross-sectional study of the prevalence of mental retardation in the province of Jaén (Spain), based on the cumulated cases reported to the Institute of Social Services of the Social Security (INSERSO) until January 1, 1984. The main objective of this research is to know the prevalence of mental retardation in our province, and to analize its relationship with some sociodemographic variables. The prevalence obtained has been 4.09%, being a 59.27% of the prevalence due to endogenous/unexplained etiology. Mild subnormality constitutes a 8.4% of cases, being closely related with the size of the locality (municipio). Prevalence of mental subnormality showed a significative linear association with the size of the locality (r = -0.904, p less than 0.05), and with the population growth (r = -0.929, p less than 0.01). This relationship was not observed neither with the level of per capita income nor the altitude of the locality. A multiple regression analysis is made for every etiology of mental retardation and several social and geographic variables. We conclude that the figures for mental retardation in our province show a direct relationship with local development parameters.