[The scientific information that the pharmaceutical industry provides to family doctors]. / La información científica que la industria farmacéutica proporciona a los médicos de familia.

OBJECTIVE: To check whether the information in the written publicity that the pharmaceutical industry gives to family doctors really is based on the scientific studies that support it. DESIGN: Cross-sectional study. SETTING: Health centre on the outskirts of a big city. PARTICIPANTS: Over a year, all the scientific studies that laboratory reps gave family doctors along with the advertising for medicines were collected. A total of 63 paired studies and advertising pieces were obtained. MAIN MEASUREMENTS: 1-3 advertising messages with each supporting study were selected and reviewed in a structured fashion. Then whether or not the messages selected were based on the study was appraised. RESULTS: 44.5% of the advertising messages were not based on the accompanying study; 29.9% clearly were based on the study; and in the rest there was a half-and-half relationship. There was a significant relationship between the evaluation of the advertising messages and the kind of study, masking and the kind of result variable. CONCLUSIONS: A high proportion of advertising messages are not based on the study that is reputed to support them. A critique of these studies has to be undertaken before the advertising messages can be looked at.

La información científica que la industria farmacéutica proporciona a los médicos de familia / The scientific information that the pharmaceutical industry provides to family doctors

Objetivo. Verificar si la información contenida en los soportes escritos que la industria farmacéutica entrega a los médicos de familia se deriva de los estudios científicos que la avalan. Diseño. Estudio transversal. Emplazamiento. Centro de salud de la periferia de una gran ciudad. Participantes. Durante un año se recogieron todos los estudios científicos que los representantes de laboratorios entregaron a los médicos de familia, junto con la publicidad de medicamentos adjunta. Se obtuvo un total de 63 parejas de estudios y soportes publicitarios. Mediciones principales. Se seleccionaron 1-3 mensajes publicitarios por cada soporte publicitario y se realizó una revisión estructurada por pares de los estudios correspondientes y sus características, para después valorar si los mensajes seleccionados se consideraban o no derivados del estudio. Resultados. El 44,5% de los mensajes publicitarios no se deriva del estudio que lo acompaña, el 29,9% se deriva claramente del estudio y en el resto aparece una relación intermedia. Se observa una relación significativa de la valoración de los mensajes publicitarios con el tipo de estudio, el enmascaramiento y el tipo de variable de resultado. Conclusiones. Gran proporción de mensajes publicitarios no se deriva del estudio que supuestamente los avala. Es necesario hacer una crítica de estos estudios antes de considerar los mensajes publicitarios

Objective. To check whether the information in the written publicity that the pharmaceutical industry gives to family doctors really is based on the scientific studies that support it. Design. Cross-sectional study. Setting. Health centre on the outskirts of a big city. Participants. Over a year, all the scientific studies that laboratory reps gave family doctors along with the advertising for medicines were collected. A total of 63 paired studies and advertising pieces were obtained. Main measurements. 1-3 advertising messages with each supporting study were selected and reviewed in a structured fashion. Then whether or not the messages selected were based on the study was appraised. Results. 44.5% of the advertising messages were not based on the accompanying study; 29.9% clearly were based on the study; and in the rest there was a half-and-half relationship. There was a significant relationship between the evaluation of the advertising messages and the kind of study, masking and the kind of result variable. Conclusions. A high proportion of advertising messages are not based on the study that is reputed to support them. A critique of these studies has to be undertaken before the advertising messages can be looked at

[Effectiveness of preventive activities at 8 years of their introduction in a general medicine practice in a health center]. / Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud.

OBJECTIVES: Main: to assess the change in coronary risk (CR) in adults after 8 years of their involvement in the Programme of Preventive Activities and Health Promotion (PAPPS). Secondary: to determine the level of anti-tetanus vaccination reached and patients' compliance with activities. DESIGN: "Before and after" intervention study without random allocation. SETTING: A general medical clinic at a health centre. PATIENTS: 429 patients (204 men, 225 women) between 30 and 65 monitored for 8 years, recruited by active search for cases at daily consultations. INTERVENTIONS: Blood pressure, cholesterol, weight, tobacco habit, alcohol intake, anti-tetanus vaccination state, CR calculation at 10 years on the Framingham scale, and degree of compliance with activities were all determined at the start, at 4 years and at 8 years. Data was obtained from the clinical notes. RESULTS: Total population: a 0.8 drop in CR (CI difference: 0.4-1.2), equivalent to 8.5% of the initial figure. 64.4% increase in correct anti-tetanus vaccination (CI difference: 59.9-69). Compliance with activities at the start and after eight years: pressure 100%, 71%; tobacco consumption 99.5%, 71%; cholesterol determination 89%, 64%. Initially high CR sub-group: 6.7 drop of CR at 8 years (CI difference: 4.9-8.5), equivalent to 24.8% of the initial figure. CONCLUSIONS: In the total population, the CR drop found was not clinically significant, whereas in the initially high CR sub-group the drop was. There should probably be an active search made for patients with high CR and action taken on them.

Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud / Effectiveness of preventive activities eight years after their introduction at a general medical clinic in a health centre

Objetivo. Principal: valorar la modificación del riesgo coronario (RC) en pacientes adultos tras 8 años de su incorporación al Programa Actividades Preventivas y Promoción Salud (PAPPS).Secundario: determinar nivel de vacunación antitetánica alcanzado y cumplimiento de actividades. Diseño. Estudio de intervención sin asignación aleatoria 'antes-después'. Emplazamiento. Una consulta de medicina general de un centro de salud. Pacientes. Un total de 429 pacientes (204 varones, 225 mujeres) de 30-65 años seguidos durante 8 años, captados por búsqueda activa de casos en la consulta diaria. Intervenciones. Determinación de tensión arterial, colesterol, peso, tabaquismo, ingesta etílica, estado vacunal antitetánico, cálculo del RC a los 10 años según Framinghan y grado de cumplimiento de actividades. Estas variables se determinaron al inicio, a los 4 y a los 8 años. Datos obtenidos de la historia clínica. Resultados. Población total: a los 8 años descenso del RC, 0,8 (IC diferencia, 0,4-1,2), equivalente al 8,5 por ciento del inicial. Incremento obtenido de la vacunación antitetánica correcta del 64,4 por ciento (IC diferencia, 59,9-69 por ciento). Cumplimiento actividades al inicio y al octavo año: tensión, 100 por ciento, 71 por ciento; consumo tabaco, 99,5 por ciento, 71 por ciento; determinación colesterol, 89 por ciento, 64 por ciento. Subgrupo RC inicial alto: a los 8 años descenso del RC, 6,7 (IC diferencia, 4,9-8,5), equivalente al 24,8 por ciento del inicial. Conclusiones. En la población total el descenso del RC obtenido no es clínicamente significativo, mientras que en el subgrupo con RC inicial alto el descenso sí lo ha sido. Probablemente debería hacerse búsqueda activa de los pacientes con RC alto y actuar sobre ellos (AU)

[Do we adequately use the sphygmomanometer for improving the prevention of arterial hypertension in primary care?]. / Utilizamos adecuadamente el esfigmomanómetro para mejorar la prevención de la hipertensión arterial en atención primaria?

OBJECTIVE: To assess the monitoring of arterial pressure (AP) in non-hypertensive patients at a health centre and to compare the results of two types of consultations. DESIGN: A retrospective observation study over 5 years. SETTING: Urban health care. PATIENTS: After the exclusion of hypertensive patients, 337 medical records, which were active over the period under assessment, were chosen by systematic sampling of the adult population. Consultation types were: CT1 (stable staff, MIR training, habitual development of the PAPPS); CT2 (staff not stable, training uneven, without systematic development of the PAPPS). Records were considered indicated when they contained symptoms suggestive of AHT or when AP had been measured because the patients had been included in a health programme; the rest of the records were considered not indicated. Data were analysed using the Chi-squared test. MEASUREMENTS AND RESULTS: 152 of the 337 records belonged to CT1 and 185 to CT2. In 151 records there was no measurement of AP: 50 belonging to CT1 and 101 to CT2. 508 measurements of AP were performed, 274 in CT1 and 234 in CT2. Of the 151 cases where measurements were not indicated (64 in CT1 and 87 in CT2. CONCLUSIONS: The percentage of patients without any monitoring is high (44.8%), similar to the percentage of AP measurements not indicated, which would imply the need to rationalise use of the sphygmomanometer in the consulting-room. CT1 consultations seem to have the most rational measurements of AP.

[The introduction of a program of preventive activities at a health center]. / Implantación de un programa de actividades preventivas en un centro de salud.

OBJECTIVE: To define the effect of preventive activities on the population served by a health centre; and to make a comparison between the two different shifts, on one of which a preventive programme functioned, whereas on the other it did not. DESIGN: A descriptive study, using systematic random sampling and internal crossed auditing of the health centre's clinical records. SETTING: An urban primary care centre. PATIENTS AND OTHER PARTICIPANTS: Two samples of 175 patients from both morning and afternoon shifts were compared. INTERVENTIONS: The following were studied: antitetanus and German measles vaccinations; control of arterial tension; control of cholesterolaemia; a questionnaire on tobacco and alcohol consumption. MEASUREMENTS AND MAIN RESULTS: No differences were observed in the homogeneity of the tests carried out (DVS = 413.28, p = NS; chi squared = 9.67, p = NS). Important differences were observed in the percentages for the preventive activities carried out. These differences were in favour of the morning shift, where the tests were part of the programme, and were statistically significant for all tests. Differences were greater in the younger age-groups. CONCLUSIONS: Introducing and integrating a programme of preventive activities into the daily activity of the consulting room, significantly improves the effectiveness of these activities. We believe therefore that the introduction of such activities in the form of a programme should be encouraged.

[Gastric cancer]. / Cáncer gástrico.

Gastric cancer represents a disorder which incidence has come down last years. Its etiology is unknown, but diet is the principal determinant risk of suffering it. Clinic history is not much useful, because in the early stage symptoms can fail and in the late stage are inespecific. Election diagnosis is endoscopy. Surgery is the only curative treatment. By these features, it would be useful to left under vigilance to: a) patients 40 years older with dispepsia; b) patients following gastric operations; c) patients with disorders presenting aclorhidria. The authors report a clinic case that can be of frequent presentation in primary assistance.