[Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]. / Diagnóstico y tratamiento de la eosinofilia importada en viajeros e inmigrantes: recomendaciones de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI).

According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.

Persistent infectious and tropical diseases in immigrant correctional populations.

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated.

Enfermedades infecciosas y tropicales persistentes en población inmigrante penitenciaria / Persistent infectious and tropical diseases in inmigrant correctional populations

Son muchas las enfermedades en viajeros y poblaciones inmigrantes que suponen un problema de salud pública de primer orden. Algunas tienen un periodo largo de incubación o son asintomáticas o paucisintomático durante muchos años antes de provocar manifestaciones clínicas significativas y/o complicaciones. La infección por VIH, hepatitis B y C, la tuberculosis o la sífilis latente se encuentran entre las enfermedades persistentes más relevantes en población emigrante. La esquistosomiasis y la estrongiloidiasis, por ejemplo, son infecciones helmínticas persistentes que pueden causar importante morbilidad, especialmente en pacientes coinfectados por VIH, hepatitis B y C. La enfermedad de Chagas, que inicialmente se creyó limitada a América Latina, ahora también tiene que ser considerada en los inmigrantes de países endémicos. La leishmaniasis visceral y la malaria son otros ejemplos de enfermedades parasitarias que tienen que tenerse en cuenta cuando se trata con inmigrantes encarcelados. El objetivo de este artículo es revisar el riesgo de las enfermedades tropicales desatendidas en especial dada la vulnerabilidad de la población penitenciaria y el riesgo de las enfermedades infecciosas que normalmente afectan a emigrantes pero que a menudo son infraestimadas (AU)

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated (AU)

[Externally induced prescriptions, degree of agreement and ... possibility of change in primary care?]. / Prescripción inducida, grado de conformidad y ... posibilidad de cambio en atención primaria?

OBJECTIVE: To find whether externally induced prescriptions (EIP) condition attendance through their prevalence, quality, the degree of agreement of the PC doctor and his/her capacity to alter them. DESIGN: Cross-sectional study of use of indication-prescription type medicines. SETTING: Health district. PARTICIPANTS: 2656 prescriptions for 678 patients interviewed. MEASUREMENTS: Each interview recorded: type of visit, age, sex, work situation, existence or otherwise of social problems and/or psychiatric pathology; doctor-patient relationship, pharmaceutical preparations (PP) prescribed and those which the patient remembers he/she is taking, indication, origin, duration, speciality of the prescribing person, agreement of the PC doctor issuing the prescription and the possibility of his/her changing it. For each prescription the following was analysed: therapeutic group, intrinsic value, time it lasts, cost and whether it is a recently marketed PP. MAIN RESULTS: 90% of visits to the doctor end in prescription. 58% of patients remember taking one or more EIP. 72% of the prescriptions analysed were externally caused. They came mostly from the public health system (66%), private medicine (20%) and self-medication (11%). There was no PC agreement with almost half these EIPs, but only 13% could be changed. The EIPs without agreement and without possibility of change were greater in: women, the elderly, people on a pension, psychiatric pathologies and in cases of bad doctor-patient relationship. The EIPs originated in health insurance companies, pharmacies, self-medication, former GPs and private doctors. They were associated with ill-defined signs and symptoms, circulatory diseases and locomotive disease. We found no significant differences in expenditure or use of PP recently put onto the market between self-medication and EIP, though there were in quality. CONCLUSIONS: The current model of prescribing medication causes consultations to be greatly "medicinised" at the expense of EIP. Doctors only alter a small part of the EIPs they don't agree with. Longitudinal studies are needed to monitor patients to find the evolution of EIPs (withdrawal, replacement, dragging on or new external prescription).

Prescripción inducida, grado de conformidad y... ¿posibilidad de cambio en atención primaria? / Externally induced prescriptions, degree of agreement in primary care and... the possibility of change in primary care?

Objetivos. Conocer si la medicación inducida (MI) condiciona la asistencia a través de su prevalencia, su calidad, el grado de conformidad del médico y su capacidad de modificarla. Diseño. Estudio transversal de utilización de medicamentos del tipo prescripción-indicación. Emplazamiento. Área básica de salud. Participantes. Dos mil seiscientas cincuenta y seis prescripciones correspondientes a 678 pacientes entrevistados. Mediciones. En cada entrevista se recogen: tipo de visita, edad, sexo, situación laboral, existencia o no de problemática social y/o de patología psíquica; relación médico-paciente, presentaciones farmacéuticas (PF) recetadas y las que recuerda estar tomando, indicación, origen, duración, especialidad del inductor, conformidad del transcriptor y posibilidad de cambio. En cada prescripción se analizan: grupo terapéutico, valor intrínseco, cronicidad, coste y si se trata de una PF de reciente comercialización. Resultados principales. Un 90 por ciento de las visitas acaba con prescripción. Un 58 por ciento de los pacientes recuerda tomar una o más MI. Fueron inducidas un 72 por ciento de las prescripciones analizadas, que provenían en su mayoría de la asistencia pública (66 por ciento), de la medicina privada (20 por ciento) y de automedicaciones (11 por ciento). No existe conformidad en casi la mitad de la MI, pudiéndose modificar, tan sólo, un 13 por ciento. La MI sin conformidad y sin posibilidad de cambio es superior en: mujeres, tercera edad, pensionistas, patologías psíquicas y mala relación médico-paciente. Procede principalmente de mutuas, farmacias, automedicaciones, antiguos cabeceras y privados. Se asocia a signos y síntomas mal definidos, enfermedades circulatorias y locomotoras. No encontramos diferencias significativas ni en el gasto, ni en la utilización de PF de reciente comercialización entre la medicación propia y la MI; sí las hay en lo que atañe a la calidad. Conclusiones. El actual modelo de prescripción de envases origina una gran medicalización de las consultas a expensas de la MI. El médico sólo modifica una pequeña parte de la MI sin su conformidad. Son precisos estudios longitudinales de monitorización de pacientes para conocer la evolución (retirada, sustitución, arrastre o nueva inducción) de la MI (AU)