[Knowledge and attitude among general practitioners in Andalusia (Spain) on the identification of subjects at high risk of breast and colorectal cancer]. / Conocimientos y actitudes de los médicos de Atención Primaria de Andalucía (España) sobre la detección de personas con riesgo elevado de cáncer de mama y colorrectal.

AIMS: To assess the knowledge and attitude among general practitioners in Andalusia on the identification of subjects with elevated risk for breast cancer, colorectal cancer, and hereditary cancers, as well as to detect barriers to accessibility to the screening programs. METHODS: A descriptive, cross-sectional study was conducted based on an online survey of 24 questions. Data are shown as frequencies, and association tests were statistically used. The level of significance was set at<.05. RESULTS: Survey response rate was 32%, of which 224 were valid, and included 56% men, and a mean age±DE of 46±12 years. Established criteria for high risk breast cancer were already known by 71.4% [95% CI 65-76], being worst in those living in big cities (P<.014). Among general practitioners, 86% were allowed to order mammography in women with lumps or at moderate to high risk for breast cancer. As regards colorectal cancer, 87.9% of general practitioners knew the risk factors. Among general practitioners, 58.2% [95% CI 49-62] were allowed to order a colonoscopy if clinical suspicion was present, especially if they lived in large cities (P<.0001). CONCLUSIONS: The screening program for breast cancer is well-known by general practitioners, and the access to mammography is successful. Most of the general practitioners consider the follow-up program for persons at high risk for colorectal cancer appropriate, although half of those surveyed had some barriers to ordering colonoscopy. Knowledge on hereditary cancer is limited, and varies among areas. There is also a general lack of awareness on hereditary cancer and genetic counselling units.

[Satisfaction of patients with type 2 diabetes mellitus after starting treatment with insulin]. / Satisfacción de las personas con diabetes mellitus tipo 2 tras iniciar tratamiento con insulina.

OBJECTIVES: The objective of this study is to evaluate if overcoming the barrier of starting treatment with insulin can lead to better clinical control and a higher level of patient satisfaction with their treatment. MATERIAL AND METHODS: This is an observational, multicentre study of patients diagnosed with DM2 who attended primary care centres with poor glycaemic control (A1c≥8%) under treatment with oral antidiabetic drugs (OADs), and who were given motivational treatment to overcome their fear of injections, and started treatment with insulin. The level of satisfaction with the treatment was evaluated using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The questionnaire was used before initiating the treatment with insulin and in the follow-up visit (3-4 months from the beginning of treatment with basal insulin). RESULTS: A total of 573 patients with a mean age of 64±10 years were recruited. The overall mean score from the DTSQs satisfaction questionnaire was 18.3±6.3, and the change of treatment led to an improvement in patient satisfaction compared to the previous treatment (DTSQc mean score 8.8±5.9). A1c dropped from an initial value of 8.7% (SD 0.8) to 7.5% (SD 0.7) (P<.001). The frequency of hyperglycaemic episodes perceived by the patients was significantly lower after they overcame their fear of injections (35.6% compared to 11.5%; P<.001), but no statistically significant differences were found in the frequency of hypoglycaemic episodes (32% compared to 35%; P=.059). CONCLUSION: In patients with DM2 poorly controlled with OADs, overcoming a fear of injections and starting treatment with insulin was associated with an overall improvement in satisfaction with the new treatment, and decreased the perception of hyperglycaemic episodes. Glycaemic control and the metabolic profile of the patients also improved to a statistically significant degree with the change of treatment.

Utilización de los servicios sanitarios por las embarazadas seguidas en un centro de salud / Use of the health care services for pregnancies followed-up in a Health Care Center

Introducción: Nuestros objetivos son describir el perfil sociodemográfico de las embarazadas seguidas en el centro de salud, estimar la frecuencia de la utilización de los servicios sanitarios y analizar los factores que puedan influir en la diferente utilización. Pacientes y Métodos: Estudio descriptivo transversal con una segunda fase analítica. Centro de salud urbano. Población: embarazadas que hayan parido durante el año 2005. Variables: utilización de los servicios sanitarios, sociodemográficas, psicosociales, obstétricas y de morbilidad. Análisis estadístico: tablas de frecuencia para las variables cualitativas y resúmenes numéricos para las variables cuantitativas; análisis bivariante para relacionar cada variable independiente con cada una de las variables dependientes y creación de un modelo de regresión lineal multivariante para controlar los posibles factores de confusión. Resultados. Cuatrocientos diecinueve partos. El 64% de los embarazos se siguió en el centro, 25% en el segundo nivel y 11% en la medicina privada. La utilización media de los servicios sanitarios fue de 38,6 visitas (IC95% 37,31-39,89). Todas las mujeres acudieron al programa de control de embarazo: 7,37 visitas (IC95%: 7,24-7,50). El 98% acudió a la matrona (7,86 visitas; IC95% 15,03-16,93). El 99,6% utilizó los servicios de apoyo (media de 5,79 visitas; IC 95% 5,60-5,98). El 52% acudió a las urgencias hospitalarias (media de 0,84; IC95% 0,72-0,96). El 61% de las mujeres acudió en alguna ocasión al ginecólogo privado (media de 1,26; IC95% 1,08-1,44). Conclusiones. Se encuentra un elevado porcentaje de embarazos seguidos en Atención Primaria y una alta utilización de los servicios sanitarios durante el embarazo. La experiencia obstétrica previa parece disminuir la utilización (AU)

Introduction: We have aimed to describe the socidemographic profile of pregnant women followed-up in the health care center, estimate frequency of their use of the health care services and analyze the factors that may influence the different use. Patients and methods. Descriptive, cross-sectional study with the second analytic phase. Urban health care center. Population: pregnant women who gave birth in the year 2005. Variables: use of the health care, sociodemographics, psychosocial, obstetrics services and morbidity. Statistical analysis: frequency tables for qualitative variables and numeric summaries for the quantitative variables; bivariant analysis to compare each independent variable with each one of the dependent ones and creation of a multivariant linear regression model to control possible compounding factors. Results: Four-hundred and nineteen deliveries. A total of 64% of them were followed-up in the center, 25% were seen on the second level and 11% in private medicine. Mean use of the health care services was 38.6 visits (CI 95% 37.31-39.89). All the women came to a pregnancy control program: 7.37 visits (CI 95%: 7.24-7.50). A total of 98% came to the midwife (7.86 visits; CI 95% 15.03-16.93) and 99.6% used the support services (mean of 5.79 visits; CI 95% 5.60-5.98). A total of 52% came to the hospital emergency service (mean of 0.84; CI 95% 0.72-0.96). At some time, 61% of the women went to a private gynecologist (mean 1.26; CI 95% 1.08-1.44). Conclusions: A high percentage of pregnant women are followed-up in Primary Care. There is high use of the health care services during pregnancy. Previous obstetrics experience seems to decrease its use (AU)

[Influence of the socioeconomic and cultural level on the use of contraceptive methods]. / Influencia del nivel socioeconómico y cultural en el uso de métodos anticonceptivos.

OBJECTIVE: a) To study the most commonly used Contraceptive Methods (CM) among the population group under survey and b) to analyse the influence of socio-economic (SEL) and educational levels (CL) on their use. DESIGN: Descriptive study of a crossover type by means of a survey. SETTING: Six general medical consulting rooms in two urban Health Centres. PATIENTS: The study was based on a representative sample of 384 women between 15 and 45 years old (a.i.) who attended for health-care for whatever reason. Interventions. A survey carried out by the family doctors in the consulting rooms, where information was gathered on both the CM used and several socio-demographic variables. MEASUREMENTS AND MAIN RESULTS: For most couples, the most commonly used CM was the condom, whose use became greater as the SEL (p < 0.01) and EL (p < 0.0001) rose. Oral contraceptives were used more by women with a lower SEL (p = 0.01). Tubular ligature was more common among women with a lower educational level (p < 0.0001). CONCLUSIONS: The results obtained from our sample by our methodology support our initial hypothesis in the sense that they show the influence of EL and SEL on the use of various contraceptive methods.

[Results and analysis of research on HBsAg in pregnant women at a health center over 4 years]. / Resultados y análisis de la investigación de AgHBs en las embarazadas de un centro de salud durante 4 años.

Vertical transmission of hepatitis B is the primary means of acquiring the disease by new carriers. The Cartuja Health Center performs systemic screening of pregnant women subjects as possible carriers. The purpose of the study is to determine the prevalence of pregnant carriers, seroepidemiological characteristics and intervention guidelines followed. We reviewed 454 pregnant women with serology performed between 1986 and 1989, including factors such as age, race, HBV serology, risk, and subsequent prevention. We calculated the prevalence of carriers. Moreover, we compared the proportion of Gypsy carriers versus non-carriers, and the prevalence of Gypsy versus Payos (non-Gypsy) carriers. Fourteen cases were AgBHs (+) (3.1%). There was no age difference between carriers and non-carriers. The proportion of Gypsy women in the carrier group was higher than in the non-carrier group (p less than 0.01), while the prevalence of carriers was also higher in Gypsy women than in pregnant women of Payo origin (p = 0.00082). Only one carrier had prior risk history. Of the 14 women with AgBHs (+), 13 gave birth; the recommended guidelines were followed in 9 cases. Routine screening for AgBHs in pregnant women is justified by the low sensitivity of the risk criteria, and the possibility for prevention.