[Validity and usefulness of the RAE-CMBD studying patients hospitalised with influenza]. / Validez y utilidad del RAE-CMBD en el estudio de los pacientes hospitalizados con gripe.

OBJECTIVE: Understanding the hospital impact of influenza requires enriching epidemiological surveillance registries with other sources of information. The aim of this study was to determine the validity of the Hospital Care Activity Record - Minimum Basic Data Set (RAE-CMBD) in the analysis of the outcomes of patients hospitalised with this infection. METHODS: Observational and retrospective study of adults admitted with influenza in a tertiary hospital during the 2017/2018 and 2018/2019 seasons. We calculated the concordance of the RAE-CMBD with the influenza epidemiological surveillance registry (gold standard), as well as the main parameters of internal and external validity. Logistic regression models were used for risk adjustment of in-hospital mortality and length of stay. RESULTS: A total of 907 (97.74%) unique matches were achieved, with high inter-observer agreement (ƙ=0.828). The RAE-CMBD showed a 79.87% sensitivity, 99.72% specificity, 86.71% positive predictive value and 99.54% negative predictive value. The risk-adjusted mortality ratio of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio was higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). CONCLUSIONS: The RAE-CMBD is a valid source of information for the study of the impact of influenza on hospital care. The lower risk-adjusted mortality of patients admitted with influenza compared to other inpatients seems to point to the effectiveness of the main clinical and organisational measures adopted.

Complicaciones de la gripe: información sobre eventos cardíacos a través de un sistema de vigilancia hospitalario / Influenza complications: Reporting cardiac events through a hospital surveillance system

Antecedentes y objetivo: El objetivo de este estudio fue determinar las complicaciones de la gripe en todos los adultos hospitalizados con esta enfermedad y, de forma específica, analizar las características de los eventos cardiovasculares posinfección.Metodología: Estudio observacional y descriptivo de los episodios de gripe en adultos hospitalizados durante las temporadas 2017-2018 y 2018-2019, utilizando el registro específico de un hospital terciario. Las complicaciones analizadas fueron: neumonía, fallo multiorgánico, shock séptico, síndrome de distrés respiratorio agudo y eventos cardíacos.Resultados: Un total de 928 adultos con gripe precisaron hospitalización, de los que 303 (32,7%) presentaron una o más complicaciones. El 2,5% de los pacientes sufrieron un evento cardíaco posgripe, con mayor probabilidad de ingreso en la UCI y mayor mortalidad. La vacunación antigripal fue un factor protector del evento cardíaco (OR: 0,32; IC 95%: 0,13-0,83).Conclusiones: La gripe presenta importantes complicaciones en los pacientes hospitalizados. La elevada mortalidad de los eventos cardíacos posinfección implica acentuar las medidas preventivas, destacando la vacunación antigripal anual. (AU)

Background and aims: The aim of this study was to determine the complications of influenza in all adults hospitalized with this disease and, specifically, to analyze the characteristics of post-infection cardiovascular events.Methods: Observational and descriptive study of adults hospitalized with influenza during the 2017-2018 and 2018-2019 seasons using the specific registry of a tertiary hospital. The complications analyzed were pneumonia, multiple organ dysfunction syndrome, septic shock, acute respiratory distress syndrome, and cardiac events.Results: A total of 928 adults with influenza required hospitalization and 303 (32.7%) presented with one or more complications. A post-influenza cardiac event occurred in 2.5% of patients; they had a higher probability of ICU admission and higher mortality. Influenza vaccination was a protective factor for cardiac events (OR 0.32; 95%CI 0.13-0.83).Conclusions: Influenza can lead to important complications in hospitalized patients. The high mortality rate associated with post-infection cardiac events means that preventive measures, including annual influenza vaccination, need to be emphasized. (AU)

Influenza complications: Reporting cardiac events through a hospital surveillance system.

BACKGROUND AND AIMS: The aim of this study was to determine the complications of influenza in all adults hospitalized with this disease and, specifically, to analyze the characteristics of post-infection cardiovascular events. METHODS: This work is observational descriptive study of adults hospitalized with influenza during the 2017-2018 and 2018-2019 seasons using the specific registry of a tertiary hospital. The complications analyzed were pneumonia, multiple organ dysfunction syndrome, septic shock, acute respiratory distress syndrome, and cardiac events. RESULTS: A total of 928 adults with influenza required hospitalization and 303 (32.7%) presented with one or more complications. A post-influenza cardiac event occurred in 2.5% of patients; they had a higher probability of ICU admission and higher mortality. Influenza vaccination was a protective factor for cardiac events (OR 0.32; 95%CI 0.13-0.83). CONCLUSIONS: Influenza can lead to important complications in hospitalized patients. The high mortality rate associated with post-infection cardiac events means that preventive measures, including annual influenza vaccination, need to be emphasized.

[Proposals for the study of the second victim phenomenon in Spanish Primary Care Centres and Hospitals]. / Propuestas para el estudio del fenómeno de las segundas víctimas en España en atención primaria y hospitales.

OBJECTIVE: To identify the Spanish studies conducted since 2014 on second victims. Its main objective was to identify a global response to the second victim problem, assessing the impact of adverse events (AE) on caregivers and developing of a set of tools to reduce their impact. METHOD: Descriptive studies in which a sample of managers and safety coordinators from Hospitals and Primary Care were surveyed to determine the activities being carried out as regards second victims, as well as a sample of health professionals to describe their experience as a second victims. Qualitative studies are included to design a guide of recommended actions following an AE, an online awareness program on this phenomenon, an application (app) with activities on safety that are the responsibility of the managers, and a web tool for the analysis of AEs. RESULTS: A total of 1,493 professionals (managers, safety coordinators and caregivers) from eight Spanish regions participated. The guide of recommendations, the online program, and the developed applications are accessible on the website: www.segundasvictimas.es, which has received more than 2,500 visits in one year. DISCUSSION: Study results represent a starting point in the study of the second victim phenomenon in Spain. The tools developed raise the awareness of the medical healthcare community about this problem, and provide professionals with basic skills to manage the impact of AEs.

[Adaptation of the Medical Office Survey on Patient Safety Culture (MOSPSC) tool]. / Adaptación de la herramienta del cuestionario Medical Office Survey on Patient Safety Culture (MOSPSC).

OBJECTIVE: To adapt the Medical Office Survey on Patient Safety Culture (MOSPSC) Excel(®) tool for its use by Primary Care Teams of the Spanish National Public Health System. METHODS: The process of translation and adaptation of MOSPSC from the Agency for Healthcare and Research in Quality (AHRQ) was performed in five steps: Original version translation, Conceptual equivalence evaluation, Acceptability and viability assessment, Content validity and Questionnaire test and response analysis, and psychometric properties assessment. After confirming MOSPSC as a valid, reliable, consistent and useful tool for assessing patient safety culture in our setting, an Excel(®) worksheet was translated and adapted in the same way. It was decided to develop a tool to analyze the "Spanish survey" and to keep it linked to the "Original version" tool. The "Spanish survey" comparison data are those obtained in a 2011 nationwide Spanish survey, while the "Original version" comparison data are those provided by the AHRQ in 2012. RESULTS: The translated and adapted tool and the analysis of the results from a 2011 nationwide Spanish survey are available on the website of the Ministry of Health, Social Services and Equality. It allows the questions which are decisive in the different dimensions to be determined, and it provides a comparison of the results with graphical representation. CONCLUSIONS: Translation and adaptation of this tool enables a patient safety culture in Primary Care in Spain to be more effectively applied.

Glycemic index, glycemic load, and pulse wave reflection in adults.

BACKGROUND AND AIMS: Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS: Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS: GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.

Circuito de asistencia a pacientes con sarcomas de partes blandas de las extremidades: un tortuoso y lento camino hasta las unidades de referencia / Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units

Objetivo: Analizar los tiempos de espera transcurridos desde que los sarcomas de partes blandas (SPB) se hacen sintomáticos hasta su tratamiento específico en nuestra Unidad de Tumores Músculo-Esqueléticos (UTME) para proponer estrategias de mejora en los circuitos de derivación. Material y métodos: Estudio observacional, longitudinal y ambispectivo de una cohorte de 61 pacientes con SPB vírgenes obtenidos e identificados de forma continúa del registro de pacientes de la UTME. Se analizó la relación entre diferentes tiempos transcurridos desde que la enfermedad se hizo sintomática hasta la primera consulta en la UTME, y diversas variables ligadas a la persona, tumor y circuito asistencial. Se usó un nivel de significación _ = 0,05. Resultados: El tamaño medio de los sarcomas fue de 11,3 cm. Treinta y seis pacientes (59%) siguieron el circuito habitual del Sistema Nacional de Salud en nuestro país. El tiempo medio transcurrido desde que la enfermedad se hizo sintomática hasta la primera consulta médica fue superior a 9,5 meses; y el que transcurrió desde esta hasta la primera en nuestra UTME fue de casi 8,5 meses. Algunas variables independientes mostraron relación estadísticamente significativa con las variables dependientes analizadas. Discusión: El estudio muestra que la asistencia a los pacientes con SPB de las extremidades en nuestro medio está muy lejos de los tiempos que transcurren en los países de nuestro entorno. Conclusiones: Parece fundamental la necesidad de concienciar a la población sobre la enfermedad y recordarla entre los profesionales sanitarios, al igual que la existencia de un circuito de derivación que es necesario utilizar (AU)

Objective: To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits. Material and methods: This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was _=0.05. Results: The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables. Discussion: The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries. Conclusions: It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used (AU)

[Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units]. / Circuito de asistencia a pacientes con sarcomas de partes blandas de las extremidades: un tortuoso y lento camino hasta las unidades de referencia.

OBJECTIVE: To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits. MATERIAL AND METHODS: This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was α=0.05. RESULTS: The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables. DISCUSSION: The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries. CONCLUSIONS: It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used.

[Intramuscular lipomas: Large and deep benign lumps not to underestimated. Review of a series of 51 cases]. / Lipomas intramusculares: bultos benignos grandes y profundos. Revisión de una serie de 51 casos.

OBJECTIVE: To review a poorly studied pathology in the scientific literature. MATERIAL AND METHODS: An observational, longitudinal and ambispective study of a series of 51 intramuscular lipomas in 50 patients. The frequency distribution of qualitative variables, and the median and the interquartile range (IQR) for continuous variables were calculated. The relationship between the size of the lipomas (recoded into two values) and the study variables were analyzed using the Fisher exact test. RESULTS: Men made up 62% of the series, and the median age was 61 years, with 55% of the total being overweight. About half of the patients were diagnosed in the upper limb. More than three-quarters (78%) were strictly intramuscular lipomas. Location, clinical and image presentation, treatment and results are described. DISCUSSION: Intramuscular lipomas have their own particular characteristics. Nevertheless, MRI is sometimes unable to distinguish them from well differentiated liposarcomas. Using size as the only criterion for referring a patient with a soft tissue injury to a reference center is still debatable. CONCLUSIONS: Patients with intramuscular lipomas, although they may be typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, should be treated in experienced centers.

[Prevalence and factors associated with preventable adverse drug events leading to hospital admission]. / Prevalencia y factores asociados a los acontecimientos adversos prevenibles por medicamentos que causan el ingreso hospitalario.

OBJECTIVE: To determine the prevalence of adverse drug events (ADEs) leading to hospital admission, and to assess those that were potentially preventable, identifying the drug classes involved, types of medication errors and the factors associated with the preventable ADEs. METHOD: An observational study, over a six-month period on ADEs that lead or contributed to hospital admissions, carried out in 6 medical units of a university hospital. RESULTS: A total of 259 ADEs were detected of which 159 (61.4%) were assessed to be potentially preventable. The overall prevalence of admissions directly due to ADEs was of 6.7% (177) and to preventable ADEs of 4.7% (125). In addition, 82 ADEs that contributed to hospital admission were detected. Risk factors for preventable ADEs were patient age of 65-74 (OR = 1.40) or = 75 years (OR = 2.70), self-medication (OR = 15.55), prescription in primary care (OR = 2,88) and the use of narrow therapeutic index drugs (OR = 2.40). The drug classes most frequently involved in preventable ADEs were NSAID and aspirin (32.5%), diuretics (15.3%), antihypertensives (9.1%) and digoxin (7.7%). Inadequate therapy monitoring (20.7%), prescription of an inappropriate drug (15.7%) or of an excessive dosage (12.0%), lack of preventive treatment (15.7%), non-adherence (10.6%) and inappropriate self-medication (10.1%) were the most commonly identified types of error. CONCLUSIONS: A high proportion (4.7%) of hospital admissions are caused by potentially preventable ADEs. Results obtained justified the need to adopt measures directed at improving surveillance and prescription quality, and educating patients in safe drug use, focusing especially on older patients and narrow therapeutic index drugs.

La investigación cualitativa, el rigor en el muestreo estructural / Qualitative research: rigour in structural sampling

No disponible

No disponible

[Perceptions and expectations on primary health care: a new form of identifying improvements in the care system]. / Percepciones y expectativas sobre la atención primaria de salud: una nueva forma de identificar mejoras en el sistema de atención.

OBJECTIVE: To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction. DESIGN: Qualitative study using discussion groups and open interviews during the period January-May 2003. SETTING: Health areas of Valladolid, Spain. PARTICIPANTS: The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique. METHOD: 6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them. RESULTS: The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists. CONCLUSIONS: Personalized care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training.

Percepciones y expectativas sobre la atención primaria de salud: una nueva forma de identificar mejoras en el sistema de atención / Perceptions and expectations of primary health care: a new form of identifying in the care system

Objetivo. Analizar las opiniones de los usuarios de atención primaria sobre la atención que reciben e identificar las principales áreas de satisfacción. Diseño. Estudio cualitativo mediante grupos de discusión y entrevistas abiertas durante el período enero-mayo de 2003. Emplazamiento. Áreas de salud de Valladolid. Participantes. Los criterios de inclusión fueron: haber acudido alguna vez a la consulta de atención primaria y tener entre 35 y 80 años. La captación se ha realizado a través de informadores clave, mediante la técnica de bola de nieve. Método. Se realizaron 6 grupos de discusión y entrevistas con representantes de 3 asociaciones de enfermos y una de vecinos. Se llevó a cabo un muestreo estructural en función de las variables que influyen en la satisfacción. Las conversaciones fueron recogidas en cintas magnetofónicas y transcritas literalmente en papel. El análisis de los textos ha sido realizado por dos investigadoras y se ha buscado la concordancia entre ambas. Resultados. Las áreas principales relacionadas con la satisfacción han sido: el trato recibido de los profesionales, que se valora como una parte fundamental de la atención, unida a la calidad técnica, la continuidad de los cuidados, los servicios de admisión, los trámites burocráticos, las barreras para acceder a los servicios especializados y las listas de espera. Conclusiones. La atención personalizada, el tiempo dedicado por el profesional, la continuidad de los cuidados y las listas de espera son las principales áreas relacionadas con la satisfacción percibida por los pacientes. Las posibles respuestas para mejorar esta situación son: la implementación de cambios en la gestión y la organización asistencial que simplifiquen los procesos, la inversión de recursos (humanos y económicos), los cambios en el modelo de relación profesional-paciente y la mejora en la formación de pregrado y posgrado

Objective. To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction. Design. Qualitative study using discussion groups and open interviews during the period January-May 2003. Setting. Health areas of Valladolid, Spain. Participants. The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique. Method. 6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them. Results. The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists. Conclusions. Personalised care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training

Gestión de la calidad total. El modelo EFQM de excelencia / Total quality management. The EFQM excellence model

La adaptación a las necesidades de cada momento es un requisito de las organizaciones que quieran alcanzar un alto grado de rendimiento y gozar de una posición competitiva. Los cambios más frecuentemente demandados en las organizaciones del sector sanitario pasan por trascender de un enfoque dirigido exclusivamente a la práctica clínica y considerar que otros aspectos como la manera de gestionar, la orientación de los servicios al usuario o la participación de los profesionales en la toma de decisiones son fundamentales a la hora de mejorar la calidad de sus productos o servicios. Uno de los métodos que más rápidamente se ha difundido en el sector sanitario para afrontar este cambio organizacional es el propuesto por la European Foundation for Quality Management (EFQM). El Modelo EFQM de Excelencia se fundamenta en los principios de la Gestión de la Calidad Total y basa su desarrollo en la autoevaluación de las organizaciones como método de mejora continua. El modelo propone un repaso por todos los aspectos que pueden determinar los resultados finales para identificar las áreas que deben ser potenciadas y aquéllas en las que se deben implantar acciones de mejora. Las experiencias desarrolladas en los últimos años tanto en el ámbito de Atención Especializada como en el de Primaria previenen sobre los requisitos para que la aplicación del modelo sea exitosa y destacan los logros obtenidos con su aplicación especialmente en lo que se refiere al aprendizaje sobre la propia organización y el compromiso con la Gestión de Calidad Total (AU)

[Preventable adverse drug effects at an emergency department]. / Evitabilidad de los acontecimientos adversos inducidos por medicamentos detectados en un Servicio de Urgencias.

OBJECTIVE: To determine the incidence and evaluate the preventability of adverse drug events (ADE) associated with visits to the Emergency Department at our hospital and subsequent hospital admissions. METHODS: A six-month observational study was conducted at an Emergency Department in a University Teaching Hospital (October 15th, 1995, to April 15th, 1996). The parameters influencing the preventability were identified by means of a multivariate logistic regression analysis. RESULTS: A total of 776 ADEs (2.25%) were detected out of a total of 33,975 patients attended at the Emergency Department; 178 patients were admitted. A total of 322 cases (43.3%) were classified as preventable and were graded as mild (37.1%), moderate (32.5%), severe (27.4%), and fatal (3%). The logistic regression analysis showed that preventability was related to drugs with a narrow therapeutic index (NTI) (OR: 10.12; 95%CI: 5.36-19.07), type A ADE (OR: 4.65; 95%CI: 2.79-7.78), age > or = 65 years (OR: 3.04; 95%CI: 2.13-4.34) and self-administered medication (OR: 2.2; 95%CI: 1.32-3.65). Among admitted patients, oral anticoagulants, NSAIDs, digoxin, diuretics, and insulin caused adverse events which were considered as preventable in more than 50% of cases. The errors most frequently associated with preventable ADEs included inappropriate therapy monitoring (22.5%), increased doses with NTI drugs (22.3%), absence of preventive therapy (14.3%), excessive dose according to patient's characteristics (13.4%), and inappropriate self-administered medication (10%). CONCLUSIONS: The incidence of preventable ADEs (medication errors) is high and its severity is higher than that of non-preventable ADEs. A prompt development and implementation of measures leading to avoiding prescription errors and inappropriate treatment monitoring, the factors identified as responsible for preventable ADEs, is clearly warranted.

-Factors of dissatisfaction with health care. A Delphi study-. / Factores de insatisfacción con la asistencia sanitaria. Un estudio Delphi.

OBJECTIVE: To study the causes of the disagreement between the general atmosphere of insatisfaction inherent in the assistance offered by the health care system and the favourable evaluation that the public shows in the questionnaires carried out in the field of primary health care. The less satisfactory issues of the health service offert are also identified. DESIGN: A Delphi thecnique has been used as consensus method. SETTING: Community setting: Salamanca urban area. PARTICIPANTS: The Delphi group is made up of people working in jobs with a pronounced social character: members of neighbour associations, educators, social workers, etc. Three consecutive questionnaires were distributed among fifty people. Twenty-seven of them completed the three rounds. MEASUREMENTS AND MAIN RESULTS: The score of the reasons of disagreement perceived as the most important were: the difficulties of access at a specialised level, 8.3 points; the inequality of the services offered by the two organizative models that coexist in the primary health care, 7.1; the lack of discrimination between the primary and the specialized level, 6.8. The highest scores were for the following complaints: excessive waiting lists at the second care level (8.5), delay in solving the problems (7.8) and masification at the consultancy (7.1). The most satisfactory aspects are the possibility of free choice of doctor, 7.9 points; the previous appointement system, 7.6; and a reliable relationship with the doctor, 7.3. CONCLUSIONS: To take into account these factors in the future design and interpretation of inquiries will increase their information validity and usefulness.

[Prevalence of asymptomatic carriers of pathogenic germs in the nasopharynx. Comparison made between primary health care professionals and the population seeking care]. / Prevalencia de portadores asintomáticos de gérmenes patógenos en nasofaringe. Comparación entre profesionales sanitarios de APS y población demandante.

OBJECTIVE: To determine if the prevalence of non-symptomatic nasopharyngeal carriers of pathogenic germs is higher in health workers of primary care than in the general population. DESIGN: Cross-sectional, observational study. SETTING: Primary Care. Salamanca Urban Area. PARTICIPANTS: Seventy-six Health Centre workers from Salamanca and 152 individuals representing the general population attending the Health Centers were studied. People with pathology related to the study subject or with inmunitary problems were excluded. MEASUREMENTS AND MAIN RESULTS: A nasopharyngeal sample was carried out using a swab. The relative prevalence of carriers (sanitary workers vs general population) was 0.38 (c.i. 0.20-0.72) for Staphylococcus aureus and 0.56 (c.i. 0.34-0.93) for all pathogens. No significant differences were found according to sex. CONCLUSIONS: The prevalence of non-symptomatic nasopharyngeal carriers is higher in general population than in the group of primary care workers.