La gestión del proceso de fibrilación auricular: un abordaje integral / Managing the atrial fibrillation process: An integral approach

Objetivos. El estudio se ha desarrollado en 3 fases cuyos respectivos objetivos han sido: definir el proceso de gestión más adecuado para la fibrilación auricular (FA) desde el punto de vista de profesionales y pacientes. Conocer cómo se gestiona en la práctica diaria. Identificar los cambios necesarios para que esta práctica diaria se aproxime a una gestión adecuada del proceso. Material y métodos. Diseño: 1.a fase: se han utilizado técnicas de consenso, un análisis de modos de fallo y sus efectos (AMFE) y un grupo focal con pacientes. 2.a fase: se ha desarrollado mediante encuesta. 3.a fase: se han realizado 3 grupos nominales y 3 grupos focales. Emplazamiento: Atención Primaria y Cardiología. Participantes: en la primera fase médicos de familia, cardiólogos y pacientes. En la segunda y tercera, médicos de familia. Mediciones principales: 1.a fase: se ha definido el diagrama de flujo, con sus notas explicativas, del proceso correcto de atención para la FA. 2.a fase: se ha investigado como se atiende en la práctica en la actualidad. 3.a fase: se han identificado las barreras para una correcta atención del proceso y se han definido propuestas para su mejora. Resultados. Casi el 40% de los médicos de familia se implicó en el diagnóstico y tratamiento de sus pacientes con FA. Se identificó la formación, la colaboración entre especialidades, motivación, trabajo en equipo con enfermería y cambios organizacionales como factores imprescindibles para una correcta gestión del proceso. Conclusiones. La FA puede ser gestionada desde Atención Primaria. Para ello son necesarios cambios relevantes en la organización de la asistencia. Se ven como imprescindibles tanto la formación como el apoyo y comunicación entre niveles(AU)

Objectives. The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. Material and methods. Design: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. Setting: Primary Care and Cardiology. Participants: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. Main measurements: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. Results. Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. Conclusions. AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary(AU)

[Managing the atrial fibrillation process: an integral approach]. / La gestión del proceso de fibrilación auricular: un abordaje integral.

OBJECTIVES: The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. DESIGN: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. SETTING: Primary Care and Cardiology. PARTICIPANTS: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. MAIN MEASUREMENTS: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. RESULTS: Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. CONCLUSIONS: AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary.

[Helicobacter pylori infection in the child population in Spain: prevalence, related factors and influence on growth]. / Infección por Helicobacter pylori en población infantil: prevalencia, factores asociados e influencia sobre el crecimiento.

INTRODUCTION: A causal relationship between Helicobacter pylori infection and the occurrence of digestive diseases in adults and children has been proven. Worldwide, the prevalence of H. pylori varies and it is possibly influenced by differences in the level of development. The goals of this study were a) to ascertain the prevalence of H. pylori infection in the child population in Spain, b) to study several factors related to this infection, and c) to establish its possible influence on growth. PATIENTS AND METHODS: We performed a descriptive, cross-sectional survey of a representative sample of children aged 1 to 14 years old. The sample consisted of 284 children (prevalence 5 15 %; accuracy 5 4 %; CI > 95 %), selected at random and stratified by age and sex. A pre-coded questionnaire was used for data collection. Diagnosis of H. pylori was established by detection of H. pylori antigen in stools with enzyme immunoassay. RESULTS: The sample consisted of 144 boys and 140 girls, with a mean age of 6.89 6 4.25 years. The prevalence of H. pylori infection was 15.8 % and progressively increased with age: 1- to 3-year-olds (8.4 %), 4- to 9-year-olds (13.9 %), 10- to 14-year-olds (24 %) (p < 0.05). The prevalence was significantly higher in boys (p < 0.01). Analysis of socio-environmental variables showed a higher H. pylori infection rate in children from families with a low socioeconomic level (p < 0.01), a high rate of overcrowding (p < 0.05), and in immigrants (p < 0.001). The H. pylori infection rate was higher in children with recurrent abdominal pain (p < 0.001) and in those whose parents had suffered from gastroduodenal disease (p < 0.001). H. pylori infection was more frequent in children aged 10 to 14 years old with weight and height percentiles below the 25th percentile (p < 0.05). Comparison of means revealed no significant differences. CONCLUSIONS: The prevalence of H. pylori infection found in our study was slightly lower than that found in other studies carried out in Spain; our data were more similar to those of industrialized countries. H. pylori infection was linked to age, sex and deprived socioeconomic environments, and was more frequent in children with recurrent abdominal pain and in those whose parents suffered from gastroduodenal disease. H. pylori infection did not seem to negatively affect growth in our child population.

Tratamiento conservador de la fimosis en niños: nuestra experiencia con esteroides tópicos / Conservative treatment of phimosis in children: our experience with topical steroids

Objetivo. Evaluar los resultados del uso de esteroides tópicos a largo plazo en el tratamiento de la fimosis en la infancia. Pacientes y métodos. Estudio prospectivo realizado durante los años 2001 y 2002. Niños de 3 a 14 años con fimosis recibieron administración tópica de betametasona en crema dos veces al día durante 5 semanas, además de la retracción del prepucio después del quinto día de tratamiento. Los resultados fueron evaluados al finalizar el tratamiento, a los seis meses y un año más tarde. Resultados. Completaron el tratamiento y se realizó seguimiento en 45 niños. La edad media fue de 5,3 años. Al inicio del estudio, 13 niños tenían fimosis puntiforme, 13 presentaban anillo flmótico no retraible y 19 fimosis anular retraible. A las 5 semanas, 38 niños (84,4 por ciento) tenían la fimosis corregida totalmente; a los 6 meses y al año, esta cifra disminuyó a 32 (71,1 por ciento) y 30 (66,7 por ciento), respectivamente. No se apreciaron diferencias significativas en cuanto al porcentaje de respuesta entre los pacientes con diferentes tipos de fimosis y grupos de edad. En todos los pacientes con fimosis recurrente se pudo comprobar que el cumplimiento en las recomendaciones de manejo del prepucio fue deficiente. En todos los casos, el tratamiento fue bien tolerado, sin presencia de efectos secundarios locales ni sistémicos. Conclusiones. Con el tratamiento tópico de la fimosis mediante esteroides se obtienen muy buenos resultados; es seguro, sencillo y económico, y constituye una alternativa a la cirugía. Asimismo, es bien aceptado por los padres y los niños. Es fundamental el cambio de hábitos en la higiene y manejo del prepucio para el éxito a largo plazo (AU)

[Child vaccination: the coverage, knowledge and attitudes of the population. A study in a health area]. / Vacunación infantil: cobertura, conocimientos y actitudes de la población. Estudio en un Area de Salud.

The purpose of this study was to know the vaccination coverage in children under 16 years of age in our health care area, as well as the level of knowledge, attitudes, beliefs, vias of information and other factors that could influence the state of child vaccination. A transverse study by interviewing parents was made. Children were distributed into three groups: A (0 to 4 years of age), B (5 to 9 years of age) and C (10 to 16 years of age). Our results showed a correct global vaccination coverage rate of 58.4%. The correct vaccination coverage rate 94.5% in group A, 74.7% in group B and 30.8% in group C (p < 0.001). The correct coverage for specific vaccinations was: measles 74.6%, rubella 69%, mumps 63.1%, diphtheria-tetanus-pertussis and polio 67.6%. This coverage was also greater in the younger children. There was no statistical difference among the several basic health zones. Of those parents interviewed, 94.8% thought that vaccines were good for health. Their knowledge about dosage, the administration frequency and the different diseases and their complications was suitable. Information about vaccinations was received from pediatricians in 31.3% of the cases and from nurses in 24.8%, with the majority of the cases classifying the information as sufficient, although 36.8% classified it as deficient. There were no statistical differences of the vaccination status according to sex, family size, numerical order in the family, or if the children were from an urban zone or a rural zone. However, there was a statistical difference according to the parent's intellectual level. In conclusion, the vaccination coverage found in children up to 4 years old was very suitable, but it was worse in older children. The level of knowledge and attitude was also suitable; however better health and vaccination education is necessary.