[Naltrexone use in the treatment of alcoholism in Spain]. / Utilización de naltrexona en el tratamiento del alcoholismo en España.

To analyse the causes that prompted health care professionals to select naltrexone to treat alcoholism. One-year multicentric, prospective study conducted with 221 doctors specialized in alcoholism treatment and analysis of data derived from 1,396 patients attended. Naltrexone was not prescribed to 446 patients. The medical barriers to the prescription of naltrexone included the mode of understanding alcoholism by doctors (20 % of doctors), patients reluctance to take naltrexone (26.9 % of patients), the presence of a concomitant condition (27.6 %) and barriers associated with health care system (6 % of patients). The logistic regression model explained why doctors tended not to prescribe naltrexone when patients had a long course of their disease or had previously received acamprosate.

Utilización de naltrexona en el tratamiento del alcoholismo en España / Naltrexone use in the treatment of alcoholism in Spain

El objetivo del presente estudio es analizar algunas de las causas de la selección de naltrexona por parte de los médicos de nuestro país para el tratamiento de la dependencia alcohólica. Se diseñó un estudio prospectivo y multicéntrico en el que se incluyeron 221 médicos dedicados al tratamiento de la dependencia alcohólica y datos dobre 1.396 pacientes atendidos a lo largo de un año. En 446 casos no se prescribió naltrexona. Las barreras para dicha prescripción por parte de los médicos radicaban en su forma de entender el alcoholismo (20 por ciento de los médicos), las resistencias de los pacientes a tomar la medicación (26,9 por ciento de los pacientes), la presencia de patología concomitante (27,6 por ciento de los pacientes) y las derivadas del sistema sanitario (6 por ciento de los pacientes). El modelo de regresión logística para explicar la prescripción de naltrexona indicaba que los médicos tendían a no prescribir dicho fármaco cuando los pacientes tenían una prolongada evolución o habían recibido anteriormente acamprosato (AU)

[Alcohol consumption among primary care doctors]. / Consumo de alcohol entre profesionales médicos de atención primaria.

OBJECTIVE: To find the personal alcohol consumption of primary care (PC) doctors. DESIGN: Observational, descriptive and cross-sectional study. SETTING: All the PC doctors in our region. PARTICIPANTS: 486 doctors, excluding paediatricians. MATERIAL: Closed, anonymous and self-administered survey, divided into two sections: a) social and demographic and work variables (7 items); b) Questionnaire on personal alcohol consumption (4 questions). MEASUREMENTS AND INTERVENTIONS: Descriptive analysis and simple correlations. RESULTS: 227 valid surveys were obtained (47.7% participation rate). A) Social and demographic and work variables: 67.6% were male, with 63.9% between 36 and 45 years old. 55.3% worked in a mixed health centre, 54.4% with tenure. > 40 patients/day (46.6%) demanded care. 82.1% were married. Two-child family units predominated (44.4%). B) Questionnaire on personal consumption of alcohol: 75.7% of the professionals who answered the questionnaire said they were consumers, with "occasionally" the most common pattern of consumption (32.33%). In 63.3% the starting age was between 16 and 20. Beer was the most common kind of drink. In general, consumption predominated in male professionals (78%). However, excess/risk consumption was proportionally higher in women (27.7%). CONCLUSIONS: a) Alcohol consumption among the doctors surveyed is similar to that found in the general population. b) Risk consumption is higher among women doctors.

Consumo de alcohol entre profesionales médicos de atención primaria / Alcohol consumption among primary care doctors

Objetivos. Conocer el consumo personal de alcohol de los médicos de atención primaria (AP).Diseño. Observacional, descriptivo y transversal. Ámbito de estudio. Todos los médicos de AP de nuestra región. Sujetos. Un total de 486 médicos, excluidos pediatras. Material. Encuesta cerrada, anónima y autoadministrada, dividida en dos apartados: a) variables sociodemográficas y laborales (7 ítems), y b) cuestionario de consumo personal de alcohol (4 preguntas).Mediciones e intervenciones. Análisis descriptivo y correlaciones simples. Resultados. Se obtuvieron 227 encuestas válidas (tasa de participación del 47,7 por ciento). A) Variables sociodemográficas y laborales: un 67,6 por ciento era varón de 36-45 años (63,9 por ciento). El 55,3 por ciento trabajaba en un centro de salud mixto, siendo un 54,4 por ciento propietario. Presentan una demanda > 40 pacientes/día (46,6 por ciento). Un 82,1 por ciento era casado. Predominaban las unidades familiares de 2 hijos (44,4 por ciento). B) Cuestionario de consumo personal de alcohol: un 75,7 por ciento de los profesionales que contestaron al cuestionario se declaró consumidor, siendo el patrón de consumo más frecuente 'ocasionalmente' (32,33 por ciento). La edad de inició en el 63,3 por ciento correspondió a 16-20 años. El tipo de bebida más frecuente es la cerveza. El consumo, en general, predomina en el profesional varón (78 por ciento); sin embargo, su consumo excesivo/de riesgo es mayor porcentualmente en la profesional mujer (27,7 por ciento).Conclusiones. a) El consumo de alcohol entre los profesionales encuestados es similar al de la población general, y b) el consumo de riesgo predomina en el profesional femenino (AU)

[The attitude of primary care physicians to patients with an excessive consumption of alcohol]. / Actitud de los médicos de atención primaria sobre los pacientes con consumo excesivo de alcohol.

OBJECTIVES: To find the attitudes of primary care doctors to excess alcohol consumption and to establish the relationships of this with independent variables. DESIGN: Observational, descriptive, crossover study. SETTING: All the primary care doctors in our region. PARTICIPANTS: 486 doctors, excluding paediatricians. MEASUREMENTS AND MAIN RESULTS: A closed, anonymous, self-administered survey, consisting of 12 social/demographic and work variables and a questionnaire on attitudes, evaluated by the Likert scale. 227 valid surveys were returned. a) Social/demographic and work variables: 67.6% were males between 36 and 45 years old. 64% had completed their degree course between 1976 and 1985. 55.3% worked in a mixed health centre, with 54.4% holding a permanent post. 61.4% worked in towns of < 20,000 inhabitants, with a case-load of > 40 patients per day (46.6%). b) Validation of the questionnaire on attitudes. 6 factors were found to explain 63% of total variability: factor 1, "interest in on-going training" (2.20); factor 2, "professional reticence" (3.71); factor 3, "job satisfaction" (3.07); factor 4, "legitimacy" (2.12); factor 5, "self-perception of skills" (2.24); factor 6, "self-perception of knowledge" (3.06). c) Associations: 1. The older the doctor, the less reticence in his/her work. 2. Interesting differences in attitudes to on-going training, legitimacy and skills between doctors in different health areas. 3. Those who finished their studies before 1970 were more resistant to on-going training; those who finished between 1971 and 1975, more indifferent to it. CONCLUSIONS: The doctors surveyed saw themselves as having the legitimacy, sufficient skill and lack of reticence to carry out their work with over-users of alcohol. However they were dissatisfied with their insufficient knowledge and broadly wanted on-going training on this question.

[The diagnostic and therapeutic outlooks in the diffuse pulmonary hemorrhage syndrome]. / Actitud diagnóstico terapéutica en el síndrome de hemorragia pulmonar difusa.

Diffuse pulmonary hemorrhage syndrome (DPHS) is reviewed and classified according to the international classification. We analyse the more characteristic features, as well as the most appropriate diagnosis methods which ensure early and effective treatment. We conclude by proposing the therapeutic attitude to be taken for DPHS.

[Evidence of abnormal kidney processing of uric acid in patients with insulin-dependent diabetes mellitus]. / Evidencia del manejo renal anormal de ácido úrico en pacientes diabéticos insulinodependientes.

Renal uric acid handling in 62 insulin dependent diabetic (IDD) patients of both sexes, without clinical or biochemical signs of nephropathy or hypertension was studied and compared to healthy age matched control groups. IDD adults (n = 38, age 45-64) presented uremia similar to controls (n = 9 age 45-64). Neither, the tubular charge or filtration charge (CFU) or the uric acid excretion fraction showed statistically significant differences. Young IDD (n = 24, age 13-37) presented levels uric acid than significantly (p less than 0.001) lowers to young controls (n = 10, age 13-38) and adults IDD (p less than 0.001). The CFU is lower in both, young and adult IDD when compared to young controls (p less than 0.02). Nevertheless, the CFU is higher in young IDD than in controls of the same age (p less than 0.001) or in adult IDD (p less than 0.001). In summary, we conclude the existence of an abnormal (uric acid) renal management caused by a tubular defect probably lying on the proximal tubular segment where the uric acid secretion is carried out.