[Comparisons between clinical practice consultation in a prison and in community health centres: differences and repercussions]. / Actividad clínica en la consulta médica a demanda de un Centro Penitenciario frente a la de un Centro de Salud.

OBJECTIVES: To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likely differences from a community Health Care Centre. To identify possible training needs when transferring health care staff from one system to another in the light of probable integration of Prison Health Care into the Public Health System. METHODS: A transversal descriptive study was used for three Primary Health Care teams: an urban health centre with a high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison). Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmed by the health professional and administrative consultancy was excluded, while efforts were made to locate troubled consultations. Comparisons were made by contrasting differences in proportions. RESULTS: The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drug abuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is a therapeutic priority). In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics. In the prison environment there is significantly higher troubled consultation. CONCLUSIONS: In a future context of integration of prison health care services into the Public Health Service, training in mental health care (especially addictive disorders) and in HIV-HCV infection management may be necessary for community health centre professionals wishing to transfer to prison health care units. The prison health care professional who wants to work in a public health centre may need training in Internal Medicine (especially Geriatrics). The statistically significant results for health care in prison, Primary Health Care and troubled consultation suggest that the GP plays a more active role in prison than in the community health centre. This should also be borne in mind when the intended integration of Prison Health Care into the Public Health Service takes place.

Actividad clínica en la consulta médica a demanda de un Centro Penitenciario frente a la de un Centro de Salud / Comparisons between clinical practice consultation in a prison and in community health centres: differences and repercussions

OBJETIVOS: Describir y cuantificar la actividad clínica en las consultas de demanda de un Centro Penitenciario (CP)para valorar las posibles diferencias respecto a un Centro de Salud (CS). Identificar los posibles requerimientos de formaciónespecífica ante eventuales traslados de profesionales entre uno y otro medio, resultantes de una supuesta integración dela Sanidad Penitenciaria (SP) en el conjunto del Sistema Público de Salud (SPS).MÉTODO: Estudio descriptivo transversal. Se aplica en tres equipos de Atención Primaria (AP): un Centro de SaludUrbano de alta carga asistencial (CSU), un Centro de Salud Rural de baja carga asistencial (CSR) y un CP provincial —notipo macro cárcel—.Muestreo aleatorio secuencial que incluye toda la actividad médica generada en la consulta de demanda. Se excluye todala actividad programada por el profesional sanitario y las consultas administrativas.Se realiza un intento de reconocimiento de consultas conflictivas para el profesional.Las comparaciones se realizan mediante el test estadístico de Contraste de Diferencia de Proporciones.RESULTADOS: En el CP se halla significación estadística (SE) de mayor actividad clínica en las áreas de salud mental,toxicomanías, manejo de infección VIH-VHC y de problemas específicos de AP (integración biopsicosocial prioritaria en sutratamiento).En ambos CS hay SE de mayor actividad en el conjunto del área de Medicina Interna (MI) y de Geriatría (G).En el medio penitenciario hay SE de mayor conflictividad en la consulta.CONCLUSIONES: En un futuro contexto de integración de derecho de la SP, puede ser necesaria formación en saludmental, particularmente en trastornos adictivos, y en manejo de infección VIH-VHC para ejercer en un CP. Puede sernecesaria formación en el conjunto de Medicina Interna, particularmente en Geriatría, de médicos de CP para que se trasladena CS (..) (AU)

OBJECTIVES: To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likelydifferences from a community Health Care Centre. To identify possible training needs when transferring health carestaff from one system to another in the light of probable integration of Prison Health Care into the Public Health System.METHODS: A transversal descriptive study was used for three Primary Health Care teams: an urban health centre witha high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison).Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmedby the health professional and administrative consultancy was excluded, while efforts were made to locate troubledconsultations. Comparisons were made by contrasting differences in proportions.RESULTS: The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drugabuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is atherapeutic priority).In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics.In the prison environment there is significantly higher troubled consultation. (..) (AU)

Actividad clínica en la consulta médica a demanda de un Centro Penitenciario frente a la de un Centro de Salud / Comparisons between clinical practice consultation in a prison and in community health centres: differences and repercussions

Objetivos: Describir y cuantificar la actividad clínica en las consultas de demanda de un Centro Penitenciario (CP) para valorar las posibles diferencias respecto a un Centro de Salud (CS). Identificar los posibles requerimientos de formación específica ante eventuales traslados de profesionales entre uno y otro medio, resultantes de una supuesta integración de la Sanidad Penitenciaria (SP) en el conjunto del Sistema Público de Salud (SPS). Método: Estudio descriptivo transversal. Se aplica en tres equipos de Atención Primaria (AP): un Centro de Salud Urbano de alta carga asistencial (CSU), un Centro de Salud Rural de baja carga asistencial (CSR) y un CP provincial -no tipo macro cárcel-. Muestreo aleatorio secuencial que incluye toda la actividad médica generada en la consulta de demanda. Se excluye toda la actividad programada por el profesional sanitario y las consultas administrativas. Se realiza un intento de reconocimiento de consultas conflictivas para el profesional. Las comparaciones se realizan mediante el test estadístico de Contraste de Diferencia de Proporciones. Resultados: En el CP se halla significación estadística (SE) de mayor actividad clínica en las áreas de salud mental, toxicomanías, manejo de infección VIH-VHC y de problemas específicos de AP (integración biopsicosocial prioritaria en su tratamiento). En ambos CS hay SE de mayor actividad en el conjunto del área de Medicina Interna (MI) y de Geriatría (G). En el medio penitenciario hay SE de mayor conflictividad en la consulta. Conclusiones: En un futuro contexto de integración de derecho de la SP, puede ser necesaria formación en salud mental, particularmente en trastornos adictivos, y en manejo de infección VIH-VHC para ejercer en un CP. Puede ser necesaria formación en el conjunto de Medicina Interna, particularmente en Geriatría, de médicos de CP para que se trasladen a CS. La significación obtenida, en la asistencia sanitaria de una prisión, de la AP y de la conflictividad, sugiere un papel más relevante del médico general en un CP que en el conjunto del SPS y puede ser un dato a tener en cuenta en la planificación de la anunciada integración de la SP en el SPS (AU)

Objectives: To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likelydifferences from a community Health Care Centre. To identify possible training needs when transferring health carestaff from one system to another in the light of probable integration of Prison Health Care into the Public Health System. Methods: A transversal descriptive study was used for three Primary Health Care teams: an urban health centre witha high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison).Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmedby the health professional and administrative consultancy was excluded, while efforts were made to locate troubledconsultations. Comparisons were made by contrasting differences in proportions. Results: The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drugabuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is atherapeutic priority).In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics.In the prison environment there is significantly higher troubled consultation.Conclusions: In a future context of integration of prison health care services into the Public Health Service, trainingin mental health care (especially addictive disorders) and in HIV-HCV infection management may be necessary for communityhealth centre professionals wishing to transfer to prison health care units. The prison health care professional whowants to work in a public health centre may need training in Internal Medicine (especially Geriatrics). The statistically significant results for health care in prison, Primary Health Care and troubled consultation suggest that the GP plays a more active role in prison than in the community health centre. This should also be borne in mind when the intended integration of Prison Health Care into the Public Health Service takes place (AU)

[Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season]. / Incidencia de la gripe y efectividad de la vacuna antigripal en la temporada 2004-2005.

BACKGROUND: To quantify the incidence of flu in different groups of the population of Navarra in the 2004-2005 season, and to evaluate the effectiveness of anti-flu vaccination. METHODS: The analysis of influenza cases in the system of compulsory notificable diseases was complemented by the individualised notifications in the network of sentinel doctors that covers a population of 22,339 inhabitants. The coverage and effectiveness of the vaccine was studied. RESULTS: Vaccine coverage in (3)65 year olds reached 62%. The incidence of influenza was 42.6 cases per 1,000 inhabitants. It reached a maximum in mid-January, exceeding 750 weekly cases per 100,000 inhabitants and 1,900 cases per 100,000 children. The highest rate of influenza was observed in under-15 year olds (49.4 cases per 1,000 inhabitants) and the lowest in non-institutionalised (3)65 year olds (2.6 per 1,000 inhabitants), although it was higher in geriatric residences (62.1 per 1,000; p<0.0001). Seventy-nine percent of the cases from 5 to 64 years resulted in absenteeism from school or work. The flu virus was identified in 42/65 (65%) nasopharyngeal smears, 90% being influenza virus A(H3). The incidence of influenza was 3.08% in the unvaccinated and 0.45% in the vaccinated (p<0.001). The global effectiveness of the anti-flu vaccine was 65%, and in (3)65 years old it was 73%. CONCLUSION: Although its effectiveness is not total, the vaccine is the main measure for preventing influenza. The network of sentinel doctors provide useful information for the coordination of care and public health activities against flu.

Incidencia de la gripe y efectividad de la vacuna antigripal en la temporada 2004-2005 / Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season

Fundamento. Cuantificar la incidencia de gripe en distintos grupos de la población de Navarra en la temporada 2004-2005 y evaluar la efectividad de la vacunación antigripal.Métodos. El análisis de los casos de gripe del sistema de enfermedades de declaración obligatoria se ha complementado con las notificaciones individualizadas de la red de médicos centinela que atiende a una población de 22.339 habitantes. Se estudió la cobertura y efectividad de la vacuna. Resultados. La cobertura vacunal en Ž65 años alcanzó el 62%. La incidencia de gripe fue de 42,6 casos por 1.000 habitantes. Alcanzó el máximo a mediados de enero, superando 750 casos semanales por 100.000 habitantes y 1.900 casos por 100.000 niños. La mayor tasa de gripe se observó en menores de 15 años (49,4 casos por 1.000 habitantes) y la menor en Ž65 años no institucionalizados (2,6 por 1.000 habitantes), aunque fue mayor en residencias geriátricas (62,1 por 1.000; p<0,0001). El 79% de los casos de 5 a 64 años causó absentismo escolar o laboral. Se identificó el virus de la gripe en 42/65 (65%) frotis nasofaríngeos, siendo el 90% virus gripal A(H3). La incidencia de gripe fue del 3,08% en los no vacunados y del 0,45% en vacunados (p<0,001). La efectividad global de la vacuna antigripal fue del 65%, y en Ž65 años del 73%.Conclusión. Aunque su efectividad no es total, la vacuna es la principal medida para la prevención de la gripe. La red de médicos centinela aporta información útil para la coordinación de actividades asistenciales y de salud pública frente a la gripe

Background. To quantify the incidence of flu in different groups of the population of Navarra in the 2004-2005 season, and to evaluate the effectiveness of anti-flu vaccination. Methods. The analysis of influenza cases in the system of compulsory notificable diseases was complemented by the individualised notifications in the network of sentinel doctors that covers a population of 22,339 inhabitants. The coverage and effectiveness of the vaccine was studied. Results. Vaccine coverage in Ž65 year olds reached 62%. The incidence of influenza was 42.6 cases per 1,000 inhabitants. It reached a maximum in mid-January, exceeding 750 weekly cases per 100,000 inhabitants and 1,900 cases per 100,000 children. The highest rate of influenza was observed in under-15 year olds (49.4 cases per 1,000 inhabitants) and the lowest in non-institutionalised Ž65 year olds (2.6 per 1,000 inhabitants), although it was higher in geriatric residences (62.1 per 1,000; p<0.0001). Seventy-nine percent of the cases from 5 to 64 years resulted in absenteeism from school or work. The flu virus was identified in 42/65 (65%) nasopharyngeal smears, 90% being influenza virus A(H3). The incidence of influenza was 3.08% in the unvaccinated and 0.45% in the vaccinated (p<0.001). The global effectiveness of the anti-flu vaccine was 65%, and in Ž65 years old it was 73%. Conclusion. Although its effectiveness is not total, the vaccine is the main measure for preventing influenza. The network of sentinel doctors provide useful information for the coordination of care and public health activities against flu

Brotes de gripe en población vacunada de residencias geriátricas en la temporada 2004-2005 / Influenza outbreaks in highly-vaccinated older institutionalised people in the 2004-2005 season

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