Incidencia de la diabetes mellitus tipo 1 en la población de 0-14 años de edad, de la provincia de Jaén (1995-2000) / No disponible

Antecedentes. Los estudios de incidencia de diabetes tipo 1 son prioritarios para establecer tendencias y diferencias geográficas que ayuden a clarificar los factores ambientales que pueden intervenir. Y a un mejor conocimiento de la enfermedad. Objetivo. Conocer la incidencia de diabetes tipo 1, en la población de 0-14 años de edad, de la provincia de Jaén, durante el periodo 1995-2000. Pacientes y métodos. Diseño observacional, longitudinal y retropectivo. Los criterios de definición de casos fueron: criterios diagnósticos (normas del “NDDG” y “ADA”, edad de 0-14 años, y residencia de Jaén de forma habitual. La fuente de identificación fueron las historias clínicas de la red hospitalaria provincial. La población de rieso se estableció según datos y estimaciones censales. Se calculó la densidad de incidencia por años yla incidencia media para los seis años de estudio. Resultados. La incidencia media observada en Jaén es de 15.24 casos/105 niños-año; apreciándose, desde el año 1996 a 2000 una ligerísima tendencia a la disminución de las incidencias anuales (20,2 casos /105 niños a 12,1 casos/105). Se observó un ligero predominio de incidencia entre los varones, muy marcado en el grupo de 0-4 años de edad, donde el cociente de incidencias varón: mujer alcanza una cifra de cuatro. El grupo de edad de 5-9 años es el de mayor incidencia de diabetes, siendo llamativa la baja incidencia observada en niñas de 0-4 años de edad. Conclusiones. La incidencia de diabetes tipo 1 en Jaén en menor de la esperada y se observa una relativa estabilidad o ligero descenso en el peiodo de 1996-2000 (AU)

Introduction. The studies about incidence of diabetes mellitus type 1 (DM-1) are very important in order to establish geographical differences and to clarify the role of environment factors in the pathogenesis of the illness. Objedtive. Knowing the incidence of DM_1 in children younger than 14 years old in Jaén from 1995-2000. Patients and methods. We notice a slight tendency for annual incidence to go dow (from 20,2 cases/105 children to 12,1 cases/105). There was a slightly greater incidence in males than in females, specially in children 0 to 4 years of age. The highest incidence was observed among children 5 to 9 years of age and the lowest one in children diagnosed within the first year of live. Conclusions. The incidence of DM_1 in Jaén is lower than we expected and there is an very slight tendency to lower form 1996 to 2000 (AU)

[Psychological malaise and the sociodemographic and familial characteristics of the over-user of primary care]. / Malestar psíquico y características sociodemográficas y familiares del hiperfrecuentador en atención primaria.

OBJECTIVES: To find the social, demographic and family characteristics, the psychological malaise and reasons for consultation of normal and hyper-attenders at a primary care practice. DESIGN: Crossover study with a control. SETTING: Primary care. PATIENTS: 127 hyper-attenders (they attended the practice as often as, or more often than, the mean number of visits, stratified by sex and age) and 120 normal attenders chosen by stratified random sampling. INTERVENTIONS: Questionnaire with characterisation data, family demography, psychological malaise (Goldberg general health questionnaire) and reasons for consultation. RESULTS: To be considered a hyper-attender, the number of attendances per year ranged from > or = 8 (in 15 to 44-year olds) to > or = 20 (in men over 65). Hyper-attenders were about 12% of almost all groups, except in men between 45 and 64 and women over 64, in whom it was around 18%. We found no relevant differences between normal and hyper-attenders as to demography or perception of family function. In almost 60% of hyper-attenders and 34% of normal attenders (p < 0.001), psychological malaise was detected. CONCLUSIONS: If the definition of hyper-attenders is stratified by age and sex, their social and demographic characteristics are very different from in other studies, even though there are a similar number of them. However, these demographic and/or family characteristics are similar in normal and hyper-attenders.

[The evaluation of the approach to the patient in primary care medical consultations]. / Valoración de la orientación al paciente en las consultas médicas de atención primaria.

OBJECTIVE: To study the clinical interview to find the orientation (to the patient or the illness) adopted by Primary Care doctors. DESIGN: Crossover study. SETTING: Primary Care. PATIENTS AND OTHER PARTICIPANTS: 74 clinical interviews, covering 11 Primary Care doctors and five third-year family medicine interns, were recorded on video. INTERVENTIONS: Evaluation of the interviews using a validated evaluation model, which analyses the objectives set and the information received and given. MEASUREMENTS AND MAIN RESULTS: A climate of confidence was created in 96% of the interviews. The nature of the problem was identified and associated factors were investigated in 67% of the consultations. In the problem-solving part of the interview, the course of action proposed was discussed in detail in 96% of cases, whereas in less than 10% of the consultations were patients' preferences or opinions about the diagnosis and treatment explored, or any interest shown in opinions on the same. CONCLUSION: In both the investigative and the problem-solving phases, aims to do with the biological side of the illness were mostly achieved, but there was little orientation shown towards involving the patient.

[The physician-patient relationship and the clinical interview (I): the opinion and preferences of users]. / Relación médico-paciente y entrevista clínica (I): opinión y preferencias de los usuarios.

OBJECTIVE: To find user satisfaction and preferences in the doctor-patient relationship and the clinical interview. DESIGN: Observational, descriptive, crossover study. SETTING: Community-based (city of Jaén). PATIENTS AND OTHER PARTICIPANTS: 286 people over 18, randomised with quotas for age and gender. INTERVENTIONS: Validated questionnaire including basic data, whether they are satisfied with their General Practitioner (GP) and 25 items to evaluate the importance of various aspects of the clinical interview and the doctor-patient relationship. MEASUREMENTS AND MAIN RESULTS: 31% (SE, 2.7) of those surveyed were very satisfied with their GP; 37% (SE, 2.8) satisfied; and 4% (SE, 1.1) stated that their relationship was unsatisfactory. Satisfaction, the same as the remembering and carrying out of medical advice, is greater (p < 0.01) in older patients, those with lower social and economic position, those registered at Health Centres and those who saw their GP recently. Those surveyed considered the most valued features of a visit to the doctor to be then items to do with the information provided by the doctor. CONCLUSIONS: A high level of satisfaction with the GP was found, especially from patients registered at a Health Centre. Communication in the interview was highly valued. There was less value placed on features of the consultation which focused on the patient.

[The physician-patient relationship and the clinical interview (II): the opinion and preferences of physicians]. / Relación médico-paciente y entrevista clínica (y II): opinión y preferencias de los médicos.

OBJECTIVE: To find the satisfaction and preferences of Primary Care doctors about the doctor-patient relationship and the clinical interview. DESIGN: Observational, descriptive and crossover study. SETTING: Primary Care. PATIENTS AND OTHER PARTICIPANTS: 51 doctors from 6 health centres in the province of Jaén and 21 family medicine residents. INTERVENTIONS: A validated questionnaire on job satisfaction, the clinical interview and doctors' relationship with their patients, and 25 items to assess the importance of different aspects of doctor-patient interaction. MEASUREMENTS AND MAIN RESULTS: 14% (SE, 4.1) of those polled stated they were very satisfied; 70% (SE; 5.4), satisfied; and 11% (SE, 3.7), that the relationship and process of communication with patients was unsatisfactory or very unsatisfactory. Among the most valued aspects were those referring to communication in the interview (information on treatment, use of understandable words, clarification of doubts and summary of the essential points at the end), encouragement to carry out the treatment, correct professional practice (clinical history) and ease in the consultation. CONCLUSIONS: There was great satisfaction with the relationship. The importance of providing understandable information was emphasised. Features of the consultation which focused on the patient were more negatively valued.

[Evaluation of a community experience of social interaction and promotion of exercise and leisure time: subjective impact and participant's satisfaction]. / Evaluación de una experiencia comunitaria de interacción social y promoción de ejercicio físico y tiempo de ocio: impacto subjetivo y satisfacción de las participantes.

OBJECTIVE: To evaluate an experiment in social interaction, physical exercise and use of leisure time of 50 to 75-year old women using a health centre. DESIGN: An observational and descriptive study of a qualitative nature. SETTING: A Health District in the city of Jaén. PARTICIPANTS: 40 women between 50 and 75 chosen by their G.P. because they suffered conditions which could be improved by physical exercise, had adverse social conditioning factors and/or non-specific symptoms which were probably psychosomatic. INTERVENTION: The programme developed between October '94 and June '95 included three activities. Two groups of 20 women were formed. 100% completed the programme. MEASUREMENTS AND MAIN RESULTS: 94% of the participants thought that their health had improved; 89%, their family life; and 97%, their social and personal life. On completing the programme, 71% considered their health "good or very good". 83% attended the physical exercise sessions with less than three absences; all of them stayed on for the 95-96 course. Their reasons for beginning the course corresponded fully with the benefits perceived on completing it. CONCLUSIONS: In line with the opinions of the participants in a programme of intersector activity (community social services and the health service), group physical exercise, with socializing and amusement components, has positive effects on health and social and family well-being.