Relación entre la inteligencia emocional y el burnout en los médicos de Atención Primaria / Relationship between emotional intelligence and burnout syndrome in Primary Healthcare doctors

OBJETIVO: Evaluar la relación de la inteligencia emocional (IE) con el síndrome de burnout (BO) en los médicos de Atención Primaria. MATERIAL Y MÉTODOS: Estudio descriptivo transversal. EMPLAZAMIENTO: todos los centros de salud y consultorios del Principado de Asturias. PARTICIPANTES: médicos de Atención Primaria que estén en activo. Intervención: en abril de 2018 se envió un cuestionario anónimo autoadministrado con variables sociodemográficas, laborales y las escalas validadas TMMS-24 (IE) y MBI (BO). VARIABLES: la variable dependiente fue el BO. Como variables independientes se tomaron las 3 dimensiones de la IE, la edad, el sexo, el estado civil, el número de hijos, el tipo de formación, el tipo de contrato, el tiempo trabajado, las horas de guardia, los pacientes al día, el cupo, el ámbito rural o urbano, el área sanitaria, la relación con enfermería/hospital y la docencia. Análisis estadístico: inferencia bayesiana. RESULTADOS: Se enviaron 647 encuestas, participando 374 sujetos (tasa de respuesta del 57,8%). La distribución posterior de la prevalencia de BO fue del 64,5% [índice de credibilidad 95%: 59,7 a 69,2]. Encontramos asociación del BO con las 3 dimensiones de la IE; tener más habilidades emocionales disminuye el riesgo de presentar BO. Mostraron, además, incrementar la odds de prevalencia de BO la edad, el tipo de contrato, el ámbito urbano y la media de pacientes/día. Mostraron disminuir la odds de prevalencia tener hijos y ser tutor. CONCLUSIONES: Cabe destacar el elevado BO de los médicos de Atención Primaria, más de uno de cada 2 médicos están quemados. Por tanto, según resultados obtenidos, proponemos profundizar en la adquisición de habilidades relacionadas con la IE y mejorar las condiciones laborales en Atención Primaria

AIM: The purpose of this study is to analyse the relationship between emotional intelligence (EI) and burnout syndrome (BOS) in doctors in Primary Health Care. MATERIAL AND METHODS: Cross-sectional descriptive study. SETTING: All healthcare centres and clinics in Asturias. PARTICIPANTS: Doctors of Primary Health Care who are active. INTERVENTION: In April 2018, an anonymous self-administered questionnaire was sent to all concerned. It included sociodemographic data, employment data, and TMMS-24 (EI) and MBI (BOS) validated scales. VARIABLES: BOS as a dependent variable. Three dimensions of EI, age, sex, marital status, number of children, form of training, contract type, time worked, on-call hours, number of patients per day, quota, rural or urban setting, healthcare area, relationship with nursing/hospital, and teaching as independent variables. Statistical analysis: Bayesian inference. RESULTS: A total of 647 questionnaires were sent, and 374 subjects took part in the study (response rate: 57.8%). The subsequent distribution of BOS prevalence was 64.5% [95% credibility index: 59.7-69.2]. BOS was associated with 3 dimensions of the EI, and to have higher social skills decreased the risk of presenting with BOS. Age, contract type, urban setting, and number of patients per day tended to increase the odds of prevalence of BOS. Having children or being a guardian tended to decrease the odds of prevalence. CONCLUSIONS: The high level of BOS in Primary Health Care doctors should be pointed out, with more than one out of 2 doctors having burnout. Therefore, we suggest looking into how emotional skills are achieved, and also how to improve working conditions in Primary Health Care

[Relationship between emotional intelligence and burnout syndrome in Primary Healthcare doctors]. / Relación entre la inteligencia emocional y el burnout en los médicos de Atención Primaria.

AIM: The purpose of this study is to analyse the relationship between emotional intelligence (EI) and burnout syndrome (BOS) in doctors in Primary Health Care. MATERIAL AND METHODS: Cross-sectional descriptive study. SETTING: All healthcare centres and clinics in Asturias. PARTICIPANTS: Doctors of Primary Health Care who are active. INTERVENTION: In April 2018, an anonymous self-administered questionnaire was sent to all concerned. It included sociodemographic data, employment data, and TMMS-24 (EI) and MBI (BOS) validated scales. VARIABLES: BOS as a dependent variable. Three dimensions of EI, age, sex, marital status, number of children, form of training, contract type, time worked, on-call hours, number of patients per day, quota, rural or urban setting, healthcare area, relationship with nursing/hospital, and teaching as independent variables. STATISTICAL ANALYSIS: Bayesian inference. RESULTS: A total of 647 questionnaires were sent, and 374 subjects took part in the study (response rate: 57.8%). The subsequent distribution of BOS prevalence was 64.5% [95% credibility index: 59.7-69.2]. BOS was associated with 3 dimensions of the EI, and to have higher social skills decreased the risk of presenting with BOS. Age, contract type, urban setting, and number of patients per day tended to increase the odds of prevalence of BOS. Having children or being a guardian tended to decrease the odds of prevalence. CONCLUSIONS: The high level of BOS in Primary Health Care doctors should be pointed out, with more than one out of 2 doctors having burnout. Therefore, we suggest looking into how emotional skills are achieved, and also how to improve working conditions in Primary Health Care.

Análisis de la atención a la población pediátrica por médicos de familia en un punto de atención continuada / Analysis of the healthcare of the paediatric population by general practitioners in a continuous care point

OBJETIVO: El objetivo principal de este estudio es analizar el manejo de las urgencias pediátricas en atención primaria por parte de los médicos de familia. El objetivo secundario es estimar el grado de adecuación de las derivaciones hospitalarias. MATERIAL Y MÉTODOS: Se realizó un estudio observacional descriptivo retrospectivo. Se analizaron las visitas realizadas por los menores de 14 años atendidos a lo largo de un año en horario de atención continuada en una zona básica de salud, tras un muestreo aleatorio por conglomerados monoetápico de 45 días. RESULTADOS: Se atendieron un total de 447 consultas urgentes por pacientes en edad pediátrica, con una media de edad de 6,83años (DE=3,82). Se resolvieron in situ el 92,8% de las consultas urgentes realizadas por menores de 14 años. El porcentaje de derivaciones al servicio hospitalario fue del 7,2% (IC95%: 4,9-10). Al 56% (IC95%: 37,7-73,6) de los niños derivados se les realizó algún tipo de intervención hospitalaria (pruebas, tratamientos, valoración por otros especialistas no pediatras, observación y/o ingreso). CONCLUSIONES: La tasa de derivación fue del 7,2%, que sitúa en el límite alto de lo encontrado en otros estudios. La mitad de los pacientes derivados requirieron algún tipo de intervención, por lo que podrían considerarse derivaciones justificadas. Además, se ha encontrado una buena concordancia (índice kappa=0,778) entre los diagnósticos desde atención primaria y el diagnóstico final de pediatría, por lo que se puede inferir que los diagnósticos realizados en edad pediátrica por médicos de familia son acertados

OBJECTIVE: The main objective of this study is to analyse the management of paediatric emergencies by Family Doctors in Primary Care. The secondary objective is to determine the appropriateness of hospital referrals. MATERIAL AND METHODS: A retrospective, observational, and descriptive study was performed. An analysis was carried out on the visits made by children less than 14years-old during one year in continued care opening hours in a basic health area, after single-stage cluster random sampling of 45 days. RESULTS: A total of 447 emergency consultations were made by paediatric patients with a mean age of 6.83years (SD=3.82). Almost all (92.8%) the emergency consultations made by children less than 14 years were resolved in situ. The referral rate to hospitals was 7.2% (95%CI: 4.9-10). Just over half (56%: 95%CI: 37.7-73.6) of the children referred had some type of hospital intervention (tests, treatments, assessments by other non-paediatric specialists, observation and or admission). CONCLUSIONS: The referral rate was 7.2%, which is in the upper limit of that found in other studies. Just over half of the children required some type of intervention, which could be considered as justified referrals. Furthermore, good agreement was found (Kappa index=0.778) between the diagnosis from Primary Care and the final diagnosis by paediatricians, inferring that the diagnosis made on paediatric patients by Family Doctors are correct

[Analysis of the healthcare of the paediatric population by General Practitioners in a Continuous Care Point]. / Análisis de la atención a la población pediátrica por médicos de familia en un punto de atención continuada.

OBJECTIVE: The main objective of this study is to analyse the management of paediatric emergencies by Family Doctors in Primary Care. The secondary objective is to determine the appropriateness of hospital referrals. MATERIAL AND METHODS: A retrospective, observational, and descriptive study was performed. An analysis was carried out on the visits made by children less than 14years-old during one year in continued care opening hours in a basic health area, after single-stage cluster random sampling of 45days. RESULTS: A total of 447 emergency consultations were made by paediatric patients with a mean age of 6.83years (SD=3.82). Almost all (92.8%) the emergency consultations made by children less than 14years were resolved in situ. The referral rate to hospitals was 7.2% (95%CI: 4.9-10). Just over half (56%: 95%CI: 37.7-73.6) of the children referred had some type of hospital intervention (tests, treatments, assessments by other non-paediatric specialists, observation and or admission). CONCLUSIONS: The referral rate was 7.2%, which is in the upper limit of that found in other studies. Just over half of the children required some type of intervention, which could be considered as justified referrals. Furthermore, good agreement was found (Kappa index=0.778) between the diagnosis from Primary Care and the final diagnosis by paediatricians, inferring that the diagnosis made on paediatric patients by Family Doctors are correct.

Estrategia de detección de disfunción tiroidea en la gestación: cribado universal o selectivo / Universal vs. selective screening for thyroid dysfunction in pregnancy

Objetivo: Estimar la efectividad del cribado selectivo frente al universal en la detección de disfunción tiroidea (DT) en el embarazo en condiciones de práctica clínica. Material y métodos: Estudio de diseño transversal basado en la identificación de gestantes con factores de riesgo (FR) de DT en una cohorte de 220 mujeres con cribado poblacional positivo. El estudio se desarrolló en el Área Sanitaria de Oviedo entre abril del 2010 y marzo del 2011. Resultados: Se identificaron FR en el 83,6% de las gestantes con DT. Los FR más prevalentes fueron la edad ≥ 30 años (70,5%), la historia de abortos previos (21,8%) y la historia familiar de patología tiroidea (20,9%). Sin tener en cuenta la edad, solo el 51,8% de las gestantes presentaba FR. Conclusiones: El cribado selectivo logra identificar una elevada proporción de gestantes con DT pero a expensas de incluir en el cribado a un gran número de mujeres, por lo que no parece una estrategia efectiva

Objective: To estimate the effectiveness of selective versus universal screening for thyroid dysfunction (TD) during pregnancy. Material and methods: Cross-sectional study applying a selective screening protocol, based on the presence of TD risk factors (RF), in a cohort of pregnant women with a positive universal screening result in the Oviedo Healthcare District. Two hundred and twenty pregnant women with TD were studied between April 2010 and March 2011. Results: Selective screening identified 83.6% of pregnant women with TD. The most prevalent RF were maternal age ≥ 30 years (70.5%), history of miscarriage (21.8%) and family history of thyroid disease (20.9%). Excluding the age factor, only 51.8% of the pregnant women included in the group had risk factors. Conclusions: Selective screening identifies a high proportion of pregnant women with TD but at the expense of screening a large number of women, so it does not appear to be an effective strategy

Cribado de retinopatía diabética en atención primaria. Concordancia diagnóstica entre médicos de familia y oftalmólogos / Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners

Objetivo. Valorar la concordancia diagnóstica en la interpretación de retinografías entre el médico de atención primaria y el oftalmólogo, así como presentar los índices de validez de un programa de cribado de retinopatía diabética durante su fase de implantación. Material y métodos. Estudio descriptivo observacional de una muestra de 243 pacientes diabéticos (tipo 1 y 2) mayores de 14 años, de 2 centros de salud urbanos, captada de manera oportunista cuando acudían a consulta entre el 21/07/2011 y el 26/01/2012. Se les realizó retinografía digital bilateral de campo único a 45°, toma de presión intraocular y agudeza visual. Los médicos de atención primaria elaboraban un informe que se remitía junto con las retinografías telemáticamente al oftalmólogo, quien revisaba las imágenes y generaba un nuevo informe con su diagnóstico. La ausencia de retinografía y/o informe valorables se consideraron como pérdidas. Se estimaron la concordancia diagnóstica entre los observadores y los índices de validez del programa de cribado. Resultados. Se obtuvo un índice kappa de 0,62 (IC 95% 0,42-0,82) y un índice PABAK de 0,89 tras ajustar por prevalencia y sesgos. Se obtuvieron los siguientes índices de validez: sensibilidad 68,8%, especificidad 96,5%, valores predictivos positivo y negativo del 61,1 y 97,5%, respectivamente. El 57,2% de los pacientes no presentó enfermedad que requiriera derivación al oftalmólogo. Conclusiones. El grado de concordancia obtenido varía entre considerable/casi perfecto dependiendo del índice usado en el análisis (kappa/PABAK, respectivamente). La realización de retinografías en los centros de salud mejora la capacidad resolutiva del médico de atención primaria y la accesibilidad de los pacientes al cribado (AU)

Aim. To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage. Material and methods. Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated. Results. The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor. Conclusions. The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening (AU)

[Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners]. / Cribado de retinopatía diabética en atención primaria. Concordancia diagnóstica entre médicos de familia y oftalmólogos.

AIM: To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage. MATERIAL AND METHODS: Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated. RESULTS: The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor. CONCLUSIONS: The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening.

Supervivencia de las paradas cardiacas extrahospitalarias atendidas por una unidad de vigilancia intensiva móvil de Asturias en 2010 / Survival of out-hospital cardiac arrests attended by a mobile intensive care unit in Asturias (Spain) in 2010

Objetivo Determinar los tiempos de asistencia, características extrahospitalarias e intrahospitalarias y supervivencia de las paradas cardiacas atendidas por una UVI móvil, al igual que los factores implicados en la supervivencia al ingreso y al alta hospitalaria. Diseño Estudio observacional retrospectivo desde el 1 de enero de 2010 al 31 de diciembre de 2010, con un seguimiento de un año desde la PCR. Ámbito Área sanitaria IV del Principado de Asturias, con 342.020 habitantes en 2010.PacientesSe incluyeron todos los pacientes que sufrieron una PCR en 2010 y fueron atendidos por la UVI móvil. Variables principales Datos demográficos, causa de la PCR, intervención por testigos, tiempos de asistencia y supervivencia al ingreso, al alta y un año después. Resultados Se atendieron un total de 177 paradas cardiacas. En 120 se indicó el soporte vital avanzado (SVA), siendo 66 de ellas (55%) de causa presumiblemente cardiaca. Recuperaron el pulso 63 pacientes (52,5%), llegando 51 de ellos con vida al hospital (42,5%). Se les dio el alta a 13 pacientes (10,8%). Al año 11 (9,2%) seguían vivos y 9 de ellos (7,5%) tenían una cerebral performance category (CPC) de 1. El ritmo inicial de fibrilación ventricular (FV) y los tiempos cortos en la asistencia se relacionaron con la supervivencia. Conclusiones La supervivencia fue superior a la publicada al ingreso al hospital y similar a la del alta. Como factores relacionados se encontraron los tiempos de asistencia y el ritmo inicial. La reanimación por el testigo fue escasa y no se usaron desfibriladores semiautomáticos (DEA) públicos (AU)

Objective To evaluate attendance timings, out- and in-hospital characteristics, and survival of cardiac arrests attended by an advanced life support unit in Asturias (Spain) in 2010. Factors related to survival upon admission and at discharge were also analyzed. Design A retrospective, observational trial was carried out involving a cohort of out-hospital cardiac arrests (OHCA) occurring between 1 January 2010 and 31 December 2010, with one year of follow-up from OHCA. Setting Health Care Area IV of the Principality of Asturias, with a population of 342,020 in 2010.PatientsAll patients with OHCA and attended by an advanced life support unit were considered. Main variables Demographic data, the etiology of cardiac arrest, bystander cardiopulmonary resuscitation (CPR), attendance timings and survival upon admission, at discharge and after one year. Results A total of 177 OHCA were included. Of these, 120 underwent CPR by the advanced life support team. Sixty-six of these cases (55%) were caused by presumed heart disease. A total of 63 patients (52.5%) recovered spontaneous circulation, and 51 (42.5%) maintained circulation upon admission to hospital. Thirteen patients (10.8%) were discharged alive. After one year, 11 patients were still alive (9.2%) - 9 of them (7.5%) with a Cerebral Performance Category (CPC) score of 1. Ventricular fibrillation and short attendance timings were related to increased survival. Conclusions The survival rate upon admission was better than in other series and similar at discharge. Initial rhythm and attendance timings were related. Public automated external defibrillators (AED) were not used, and bystander CPR was infrequent (AU)

[Survival of out-hospital cardiac arrests attended by a mobile intensive care unit in Asturias (Spain) in 2010]. / Supervivencia de las paradas cardiacas extrahospitalarias atendidas por una unidad de vigilancia intensiva móvil de Asturias en 2010.

OBJECTIVE: To evaluate attendance timings, out- and in-hospital characteristics, and survival of cardiac arrests attended by an advanced life support unit in Asturias (Spain) in 2010. Factors related to survival upon admission and at discharge were also analyzed. DESIGN: A retrospective, observational trial was carried out involving a cohort of out-hospital cardiac arrests (OHCA) occurring between 1 January 2010 and 31 December 2010, with one year of follow-up from OHCA. SETTING: Health Care Area IV of the Principality of Asturias, with a population of 342,020 in 2010. PATIENTS: All patients with OHCA and attended by an advanced life support unit were considered. MAIN VARIABLES: Demographic data, the etiology of cardiac arrest, bystander cardiopulmonary resuscitation (CPR), attendance timings and survival upon admission, at discharge and after one year. RESULTS: A total of 177 OHCA were included. Of these, 120 underwent CPR by the advanced life support team. Sixty-six of these cases (55%) were caused by presumed heart disease. A total of 63 patients (52.5%) recovered spontaneous circulation, and 51 (42.5%) maintained circulation upon admission to hospital. Thirteen patients (10.8%) were discharged alive. After one year, 11 patients were still alive (9.2%) - 9 of them (7.5%) with a Cerebral Performance Category (CPC) score of 1. Ventricular fibrillation and short attendance timings were related to increased survival. CONCLUSIONS: The survival rate upon admission was better than in other series and similar at discharge. Initial rhythm and attendance timings were related. Public automated external defibrillators (AED) were not used, and bystander CPR was infrequent.

[A case-control study of the influence of the smoking behaviour in multiple sclerosis]. / Estudio de casos y controles sobre la influencia del hábito tabáquico en la esclerosis múltiple.

INTRODUCTION: Several epidemiological studies have demonstrated that there is a genetic factor of susceptibility in Multiple Sclerosis (MS) and that the environmental factors play an important important role in their development. Smoking is among the environment factors studied. In fact, several studies have established a relationship between smoking and multiple sclerosis, although most of them did not find significant results or found that these were contradictory. OBJECTIVE: To evaluate the influence of the smoking habit on the risk of suffering MS. METHODS: This was a case-control matched study with 138 patients diagnosed of MS according to the McDonald criteria who were paired with the same number of controls of the same gender, residents in the same city and having the same age +/-2 years. Demographic data, smoking status (never, always smokers, ex-smokers), Kurtzke disability status scale (EDSS) and type of MS were collected. RESULTS: Out of a total of 138 MS patients (93 women, 43 men), 110 had relapsing-remitting MS, 20 secondary progressive MS and 7 primary progressive MS. Most of the patients were smokers and ex-smokers (63%). In the control group, only the 41,3% were smokers/ex-smokers. Moreover, the age of onset for smoking was earlier in the case group. CONCLUSION: Being a smoker/ex-smoker implies a 27% greater risk of developing MS compared to those who have never smoked. This risk is statistically significant for women but not for men due to the low number of them in the sample.

Estudio de casos y controlessobre la influencia del hábito tabáquicoen la esclerosis múltiple / A case-control study of the influence of the smoling behaviour in multiple sclerosis

Introducción. Diversos estudios epidemiológicos demuestranque en la esclerosis múltiple (EM) existe un factor genético de susceptibilidad,así como que los factores ambientales juegan un papelprominente en el desarrollo de la misma. Entre los factores ambientalesestudiados se encuentra el tabaco. De hecho, varios estudiosestablecen relación entre fumar y EM, pero la mayoría de ellos nohallaron resultados significativos o éstos fueron contradictorios.Objetivo. Evaluar la influencia del hábito tabáquico en el riesgode padecer EM.Material y métodos: Estudio caso-control pareado con 138 pacientesdiagnosticados de EM según los criterios de McDonald y el mismonúmero de controles del mismo sexo, residentes en el mismo municipioy la misma edad ±2 años. Se recogieron los datos demográficos, statusde fumar, escala de discapacidad de Kurtzke (EDSS) y tipo de EM.Resultados. De los 138 pacientes (93 mujeres, 43 hombres), 110presentaban EM remitente recurrente, 20 EM secundariamente progresivay 7 EM primariamente progresiva. La mayoría de los pacientesresultaron ser fumadores y exfumadores (63%) frente al (41,3%)de los controles. Asimismo, la edad de inicio en el hábito de fumar fuemás precoz en los casos que en los controles.Conclusión. Ser fumador/exfumador implica un 27% más deriesgo de desarrollar EM frente a los nunca fumadores. Este riesgo esestadísticamente significativo en mujeres y no en varones, probablementedebido al bajo número de los mismos en el total de la muestra (AU)

Introduction. Several epidemiological studies have demonstratedthat there is a genetic factor of susceptibility in MultipleSclerosis (MS) and that the environmental factors play an importantrole in their development. Smoking is among the environmentfactors studied. In fact, several studies have established arelationship between smoking and multiple sclerosis, althoughmost of them did not find significant results or found that thesewere contradictory.Objective. To evaluate the influence of the smoking habit onthe risk of suffering MS.Methods. This was a case-control matched study with 138patients diagnosed of MS according to the McDonald criteria whowere paired with the same number of controls of the same gender,residents in the same city and having the same age ±2 years.Demographic data, smoking status (never, always smokers, exsmokers),Kurtzke disability status scale (EDSS) and type of MSwere collected.Results. Out of a total of 138 MS patients (93 women, 43 men),110 had relapsing-remitting MS, 20 secondary progressive MS and7 primary progressive MS. Most of the patients were smokersand ex-smokers (63%). In the control group, only the 41,3% weresmokers/ex-smokers. Moreover, the age of onset for smoking wasearlier in the case group.Conclusion. Being a smoker/ex-smoker implies a 27% greaterrisk of developing MS compared to those who have neversmoked. This risk is statistically significant for women but not formen due to the low number of them in the sample (AU)

Consideraciones sobre las técnicas de muestreo, de nuevo / Further thoughts on sampling techniques

No disponible

[Prevalence and duration of breastfeeding in Asturias]. / Prevalencia y duración de la lactancia materna en Asturias.

OBJECTIVE: To estimate the prevalence and duration of breastfeeding, and factors associated with them, in Asturias (Spain). METHODS: A cross-sectional study was carried out. A stratified random sample of 453 infants was drawn on a population of 4,326 infants aged 0-8 months at the time of the study. Sociodemographic data, and information on pre- and perinatal care were obtained through a telephone survey in which mothers were also asked whether they were breastfeeding on the day of the telephone call. A univariate logistic regression model was used to estimate the prevalence curve of breastfeeding according to infant age, and multiple logistic regression was used to determine the associations between the prevalence and covariates. The discontinuity index (DI) and the cumulative breastfeeding index (CBI) were also estimated as indicators of duration. RESULTS: A total of 418 telephone calls were made. The prevalence of initial exclusive breastfeeding was 51.4% (95% CI: 46.6-56.2%) which decreased to 14.9% at day 90 and to 8.7% at day 120. The DIs were 28.6% at day 30 and 71% at day 90. In the multivariate analysis the prevalence of exclusive breastfeeding was higher among mothers living in a rural or suburban area (OR = 5.69 and OR = 3.55, respectively), than among those living in urban areas. The prevalence was also higher among mothers with a university degree (OR = 3.90; 95% CI: 1.77-8.58), and among those who had been seen by a midwife during pregnancy (OR = 2.13; 95% CI: 1.04-4.38). A negative correlation was found between exclusive breastfeeding and the newborn having received food supplements during the first hours after birth (OR = 0.43; 95% CI: 0.20-0.95). CONCLUSIONS: The prevalence of breastfeeding in Asturias, and especially its duration, is much lower than that recommended by the World Health Organization. Mothers living in urban areas do not follow the most appropriate patterns of breastfeeding.

Prevalencia y duración de la lactancia materna en Asturias / Prevalence and duration of breastfeeding in Asturias, Spain

Objetivo: Estimar la prevalencia y duración de la lactancia materna en Asturias y describir los factores asociados. Métodos: Estudio transversal. La población fueron todos los niños nacidos en los hospitales públicos de Asturias que tenían entre 0 y 8 meses de edad en el momento del estudio (4.326). Se obtuvo una muestra aleatoria estratificada de 453 niños. Los datos se obtuvieron por entrevista telefónica con cuestionario a las madres, preguntando si el día del estudio el niño tomaba el pecho. Se interrogaba además sobre datos sociodemográficos y de atención prenatal y perinatal. La estimación de la curva de prevalencia de lactancia según la edad del niño se realizó mediante regresión logística univariante, y el análisis de los factores asociados mediante regresión logística múltiple. Se estimaron como indicadores de duración el índice de discontinuidad (ID) y el índice de lactancia acumulada (ILA). Resultados: Se efectuaron 418 entrevistas. La prevalencia de lactancia materna exclusiva (LME) al inicio fue del 51,4 por ciento (intervalo de confianza [IC] del 95 por ciento: 46,6-56,2) decayendo al 14,9 por ciento a los 90 días y al 8,7 por ciento a los 120 días. Los ID fueron del 28,6 por ciento a los 30 días y del 71,0 por ciento a los 90 días. La prevalencia de LME se relacionó en el ajuste multivariado con la localidad de residencia: residir en una localidad rural o semiurbana aumentaba la probabilidad de lactar ( odds ratio [OR] = 5,69 y OR = 3,55, respectivamente) respecto al medio urbano. También se encontró relación positiva con que la madre tuviera estudios universitarios (OR = 3,90; IC del 95 por ciento: 1,778,58) y el haber sido atendida por la matrona durante el embarazo (OR = 2,13; IC del 95 por ciento: 1,04-4,38); se detectó relación inversa entre la LME y que el niño hubiera recibido suplementos en las primeras horas de vida (OR = 0,43; IC del 95 por ciento: 0,20-0,95).Conclusiones: La prevalencia de lactancia materna es muy inferior a la recomendada por la Organizacion Mundial de la Salud, especialmente su duración. En el hábitat no urbano se mantienen patrones más adecuados de lactancia (AU)

Intercepción poscoital hormonal: estudio sobre actitudes y prescripción de los médicos de atención primaria / Hormonal post-coitus interception: study on attitudes and prescription of primary care doctors

Objetivo. Estudiar los conocimientos, actitudes y práctica de los médicos de atención primaria en la prescripción de la intercepción poscoital hormonal, así como las variables sociodemográficas, formativas, legales y éticas asociadas a dicha prescripción. Diseño. Estudio descriptivo, transversal. Emplazamiento. Área IV del INSALUD de Asturias. Participantes. Médicos de familia, excluyendo refuerzos (n = 178). Mediciones y resultados. Cuestionario autoadministrado anónimo de 33 preguntas, reenviado en una ocasión, entre noviembre de 1999 y febrero del 2000. La asociación-independecia de variables fue contrastada mediante ji-cuadrado (considerándose asociación estadísticamente significativa si p < 0,05). Respondieron un 77 por ciento, de los cuales el 51 por ciento era varón. Edad media, 43 años (DE, 6,69), con experiencia profesional de 17 años trabajados (DE, 6,87); un 47 por ciento era médico de familia y el 39 por ciento, médicos generales. Trabajaba en centros de salud un 85 por ciento y en ámbito urbano el 46 por ciento. Era católico un 71 por ciento. Al 73 por ciento (IC del 95 por ciento, 66-80 por ciento) se le solicitó en al menos una ocasión la píldora poscoital (PPC) en los últimos 6 meses, siendo mayor la demanda en medio urbano (83 por ciento). Consideraba la PPC abortiva el 18 por ciento. Refería prescribirla un 88 por ciento (IC del 95 por ciento, 82,5-93,5 por ciento), de los cuales un 30 por ciento (IC del 95 por ciento, 16-44 por ciento) lo hacía según las recomendaciones de la OMS. El 100 por ciento de los 'no prescriptores' eran católicos. Conclusiones. La mayoría de los médicos recibe demandas de PPC y la prescribe cuando se la solicitan, aunque dicha prescripción varía con la edad, cualificación y especialmente las creencias religiosas. Sólo un tercio prescribe siguiendo las recomendaciones de la OMS (AU)

[Anorexic behavior in a population of high-school students of a health area]. / Conductas anoréxicas en la población de estudiantes de secundaria de un área sanitaria.

OBJECTIVES: To calculate the prevalence of eating attitudes which determine eating disorders and their relationship to social, personal and cultural variables. DESIGN: Prevalence study. PARTICIPANTS: Centres of secondary education. Gijón Health Area (Asturias). Secondary school students (n = 17,000) selected by multi-stage stratified sampling. MEASUREMENTS AND MAIN RESULTS: The self-filled questionnaire included: social and personal variables, and Eating Attitudes Test 26 (anorexic conduct defined as scores = 20). Women also filled in the "Questionnaire on Influences on the Aesthetic Model of the Body" (CIMEC-26). There were 860 valid questionnaires, with 50% women. There was 12.8% prevalence of anorexic attitudes among women (95% CI, 9-16.5), and 1.8% among men (CI, 0.8-2.8). In the group with anorexic attitudes, 87.3% were women, with mean age 16.4; 88.3% lived in a city; 84% were in middle and middle-to-low social classes; 92% were studying their bachillerato; 28.5% attended private schools; 27% undertook activities related to having a thin body; 18.3% had separated parents; 27% had mothers working outside the home; 39.7% saw themselves as fat; and 81% wished to slim. The following variables showed statistically significant differences with the normal population: sex (OR = 7.7; 95% CI, 4.5-13.4), separated parents (OR = 1.9; CI, 1.4-2.8), undertaking activities relating to having a thin body (OR = 3.7; CI, 2.7-5.2); thinking oneself fat (OR = 4.7; CI, 3.1-7.1) and wishing to slim (OR = 7.2; CI, 4.6-11.2). 94.5% of women with disordered conduct showed a disorder on the CIMEC-26. CONCLUSIONS: There is a high prevalence of eating habits similar to those of patients with anorexia nervosa, which are related to the following variables: being a woman, having separated parents, seeing oneself as fat, desiring to slim and undertaking activities related to having a thin body. We observed no significant differences with the normal population in other social and personal variables. The socially imposed aesthetic model of the body determines anorexic conduct in women.

Conductas anoréxicas en la población de estudiantes de secundaria de un área sanitaria / Anorexic conduct among secondary students in a health area

Objetivos. Estimar la prevalencia de actitudes alimentarias determinantes de trastornos del comportamiento alimentario y su relación con variables sociodemográficas y culturales. Diseño. Estudio de prevalencia. Participantes. Centros de enseñanza secundaria. Área Sanitaria de Gijón (Asturias). Alumnos de enseñanza secundaria (n = 17.000) seleccionados mediante muestreo estratificado polietápico. Mediciones y resultados principales. Cuestionario autocumplimentado incluyendo: variables sociodemográficas; 'Eating Attitudes Test-26' (considerando conducta anoréxica puntuaciones >= 20); las mujeres cumplimentaron además el 'Cuestionario de Influencias sobre el Modelo Estético Corporal' (CIMEC-26). Ochocientos sesenta cuestionarios válidos; 50 por ciento mujeres y 50 por ciento varones. Prevalencia de actitudes anoréxicas: 12,8 por ciento (IC del 95 por ciento, 9-16,5) y 1,8 por ciento (IC del 95 por ciento, 0,8-2,8), respectivamente. En el grupo con actitudes anoréxicas, un 87,3 por ciento son mujeres; media de edad, 16,4 años; el 88,3 por ciento vive en medio urbano; un 84 por ciento se distribuye en clase social media y media-baja; el 92 por ciento estudia bachillerato, un 28,5 por ciento en centros privados; practican actividades relacionadas con un cuerpo delgado el 27 por ciento; un 18,3 por ciento tiene padres separados; en un 27 por ciento sus madres trabajan fuera de casa; el 39,7 por ciento se ve gordo y un 81 por ciento desea adelgazar. Mostraron diferencias estadísticamente significativas, con la población normal, las variables: sexo (OR, 7,7; IC del 95 por ciento, 4,5-13,4), padres separados (OR, 1,9; IC del 95 por ciento, 1,4-2,8), practicar actividades relacionadas con un cuerpo delgado (OR, 3,7; IC del 95 por ciento, 2,7-5,2), considerarse gordo (OR, 4,7; IC del 95 por ciento, 3,1-7,1) y desear adelgazar (OR, 7,2; IC del 95 por ciento, 4,6-11,2). De las mujeres con conductas alteradas presentan alteración en el CIMEC-26 un 94,5 por ciento. Conclusiones. Elevada prevalencia de actitudes alimentarias similares a las de pacientes con anorexia nerviosa, encontrando relación con las variables: ser mujer, tener padres separados, verse gorda, desear adelgazar y practicar actividades relacionadas con tener cuerpo delgado. No observamos diferencias significativas con la población normal para otras variables sociodemográficas. El modelo estético corporal impuesto socialmente determina conductas anoréxicas en mujeres (AU)

[Postcoital hormonal contraception: study on the attitudes and prescription of primary care physicians]. / Intercepción poscoital hormonal: estudio sobre actitudes y prescripción de los médicos de atención primaria.

OBJECTIVE: To study the understanding, attitudes and practice of primary care doctors in the prescription of hormonal post-coitus interception, along with the social and demographic, educational, legal and ethical variables associated with this prescription. DESIGN: Cross-sectional descriptive study. SETTING: Area IV de INSALUD in Asturias. PARTICIPANTS: Family doctors, excluding locums (n = 178). MEASUREMENTS AND RESULTS: An anonymous self-administered questionnaire with 33 questions, re-sent once, between November 1999 and February 2000. The association-independence of variables was contrasted through the chi 2 test (a statistically significant association if p < 0.05). 77% responded, 51% of whom were men. Average age was 43 (SD = 6.69), with professional experience of 17 years worked (SD = 6.87). 47% were family doctors and 39% general practitioners. 85% worked in health centres; 46% in urban settings. 71% were catholics, 73% (95% CI: 66%-80%) had been asked on at least one occasion in the previous six months for the post-coitus pill (PCP), with demand greater in the urban environment (83%). 18% considered the PCP an abortion method. 88% said they would prescribe it (95% CI: 82.5%-93.5%), of which 30% (95% CI: 16%-44%) did so according to WHO recommendations. 100% of the "non-prescribers" were catholics. CONCLUSIONS: Most doctors receive requests for the PCP and prescribe it on demand, though prescription varies with age, categories and, in particular, religious belief. Only a third prescribes according to WHO recommendations.