[Ebrictus study. Functional results, survival, and potential years of life lost after the first stroke]. / Estudio Ebrictus. Resultados funcionales, supervivencia y años potenciales de vida perdidos después del primer episodio de ictus.

AIM: To determine the mortality, degree of dependence, survival, and years of life lost (YLL) after first episode of stroke. DESIGN: Cohort study. LOCATION: Community based register. PARTICIPANTS: A total of 553 subjects between 15-90 years with a first episode of definitive or transitory stroke were recruited between 01/04/2006 and 31/03/2008. MEASUREMENTS: The analyses were performed with the use of time-to-event methods, according to the intention-to-treat principle. The level of dependency was assessed according to the Barthel Scale one year after stroke; YLL (1-70 years) from the mean life expectancies at birth; survival analysis by Kaplan-Meier's curves, bivariate analysis comparing the variables between patients who had survived and those who died, and Cox's multivariate. RESULTS: The mean age was 73.3 (±11.6 years. The mean time of follow-up was 29.7 ± 13,4 months, during which 26.6% of the patients died. The mean Barthel score fell by >20%, particularly among women. There was moderate or greater dependence in 41.5% (95%CI 30.6-52.8%) of the subjects. The overall accumulative probability of survival was 0.96 (95% CI 0.94-0.97) in the first month and 0.69 (95% CI 0.65-0.72) in the fourth year. The thrombolytic treatment showed a protective effect on mortality, particularly among the women. The main predictive variables were, history of recurrent cardiovascular event (RR 6.7, 95% CI 2.2-21.7) and aging (RR 1.08, 95% CI 1.01-1.2). The average YLL was 11.5/10000/year SD7.2, and higher among men. CONCLUSION: There are differences in functional outcome, mortality, and potential years of life lost by gender. A new cardiovascular event is an independent prognostic factor of survival.

[Prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in adolescent girls in Reus (Spain)]. / Prevalencia de anorexia nerviosa, bulimia nerviosa y otros TCA en adolescentes femeninas de Reus.

INTRODUCTION: Eating disorders are characterized by changes in eating patterns associated with a series of psychosocial conflicts, low self-esteem and poor empathy, and an obsession with slimming. OBJECTIVES: The aims of the present study were: 1. To determinate the prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in a representative sample of adolescent girls between the ages of 12 and 21 living in the city of Reus (Spain). 2. To evaluate the association between eating disorders and alterations on the Eating Attitudes Test-40 (EAT-40), Body Attitudes Test (BAT), and the Aesthetic Body Shape Questionnaire (CIMEC). MATERIAL AND METHOD: We performed a cross-sectional observational study in a random sample of adolescent girls aged between 12 and 21 years old. Information was gathered from a structured questionnaire on demographic and anthropometric factors (age, place of birth, education, etc.), clinical examination, clinical interview, DMS-IV diagnostic criteria, and three self-administered tests: EAT-40, BAT and CIMEC. RESULTS: A total of 551 adolescents were analyzed. The mean age was 17.6+/-2.5 years. Diagnostic criteria of anorexia nervosa were found in 0.9% (95% CI: 0.4-2.4), bulimia nervosa in 2.9% (95% CI: 1.7-4.7), and other eating disorders in 5.3% (95% CI: 3.6-7.5). The test showing the greatest alterations was the CIMEC (38%), followed by the BAT (27.1%) and EAT-40 (23.1%). All the adolescents that met the diagnostic criteria of anorexia nervosa showed alterations in all three tests. CONCLUSIONS: The high prevalence of eating disorders indicates the need for greater direct involvement among health professionals. The EAT-40, BAT and CIMEC are effective screening instruments for these disorders.

[Health care workers' expectations: what features of health centers do they value most? A qualitative and quantitative study]. / Las expectativas de los profesionales: 'qué aspectos valoran en un centro de salud? Un estudio cuali-cuantitativo.

OBJECTIVES: To identify features of health care centers valued by health care workers as positive, to group features into dimensions, and to determine their relative importance. DESIGN: Qualitative phase: focus groups and content analysis. Quantitative phase: survey with a questionnaire developed from the features identified in the qualitative phase. SETTING: Primary care services in Reus and Tarragona (Catalonia, northeastern Spain). PARTICIPANTS: Managers, medical care providers and admissions staff. A total of 33 workers took part in focus groups, and 136 questionnaires were distributed for the survey, with a 78.6% response rate. MAIN MEASURES: Identification by focus groups of the features to be evaluated. Features were grouped into dimensions at different levels by content analysis. Survey to determine the relative importance of different features. RESULTS: We identified 133 features to be evaluated by workers: 36 related with structural features of the center (architecture, staffing and equipment), 33 with organization (accessibility, team functioning), 23 with workers (knowledge and attitudes) 20 with the services provided (needs and information management, care services provided) and 21 with management. The most highly valued dimensions were workers´ attitudes and management. CONCLUSIONS: Relations with patients and colleagues, and management issues, were valued most highly by workers. Some problematic features such as shared decision-making, team work and minority cultures revealed different levels of awareness and sensitivity within the health care system.

[Impact on cardiovascular health results of the introduction of the clinical governance contract into primary care in Tarragona]. / Impacto en los resultados de salud cardiovascular de la implantación del contrato de Dirección Clínica en atención primaria de Tarragona.

OBJECTIVE: The objectives of this study are: 1) to determine the improvement in the cardiovascular health of the population after the introduction of the clinical governance contract for primary care team professionals in Tarragona-Reus and the Terres de l'Ebre area (Tarragona province, Spain); 2) to identify the factors predictive of better cardiovascular health after the introduction of the clinical governance contract. The introduction of the clinical governance contract, which is based on professional leadership, feed-back of care information, and monitoring of indicators of cardiovascular risk based on scientific evidence and concretised in clinical practice guidelines, will improve the cardiovascular health results of the reference population. Improvements in indicators of procedure and result are specified in "Material and methods." DESIGN: This is a before-and-after, multi-centre study. SETTING: Primary health care. PARTICIPANTS: Thirty health centres (all the primary care Centres in the area). MAIN MEASUREMENTS: Characteristics of the centre. Variables in procedures: indicators of good care practice, calculation of cardiovascular risk, application of clinical practice guidelines (hypertension, diabetes, lipaemia, tobacco and cardiovascular risk) and quality standards for drug prescription. Result variables: cardiovascular risk figures, number of ongoing care visits, hospital emergencies and admissions for angina, heart attack or stroke, and risk factor screenings of the population. DISCUSSION: This study is useful, in that clinical governance aims to be a dynamic device to bring professionals into the leadership of health care management and, through monitoring indicators and feeding the findings back to the professionals, to improve health care quality. The study aims to show that management strategy can improve the population s cardiovascular health. The originality of the study lies in the development of a new tool of evaluation based on a novel management strategy for measuring cardiovascular health findings.

[Medical record of primary care: quality and predisponding factors]. / Historia clínica de atención primaria: calidad y factores asociados.

OBJECTIVE: To obtain a method which allows quantitative evaluation of the register of risk factors in the primary care medical records of the adult population and to analyze the effect that several factors, related to primary care centers, users and physicians in primary care, determine over it. DESIGN: An observational cross-sectional study. SETTING: Primary health care. PARTICIPANTS: A total sample of 1473 medical records from eight health districts of Catalonia. MEASUREMENTS: Information was collected using a structured questionnaire, with socio-demographic data related to the primary care center, the users and the primary care physician, which also collected criteria of the risk factors of the medical records defined a priori by a consensus group of professionals in primary health care. RESULTS: Only 18.3% (95% CI: 16.3-20.3%) of the total medical records sample analyzed accomplished criteria of minimum data set register. Risk was higher due: a higher number of physicians in the Primary care centers (OR = 1.10; 95% CI: 1.01-1.20); female gender of the user (OR = 1.17; 95% CI: 1.01-1.36); older age of the user (OR = 1.02; 95% CI: 1.02-1.03); if there was one visit during last year at least (OR = 1.51; 95% CI: 1.23-1.85); and female gender of the physician who fulfilled the Medical Record (OR = 1.46; 95% CI: 1.24-1.71). CONCLUSIONS: Average of minimum data set register of the medical record of the adult population is 18.3% (95% CI: 16.3-20.3). The following factors are related to minimum data set register: more number of physicians in the primary care center, female sex of the user, year of last register in medical record, and female sex of the physician.

[ADA criteria undervalues the impact of diabetes in a high-risk Spanish population]. / Los criterios de la ADA infravaloran el impacto de la diabetes en la población española de más alto riesgo.

OBJECTIVE: The main aim was to investigate the prevalence of abnormal glucose homeostasis (impaired fasting glucose, impaired glucose tolerance and undiagnosed diabetes) on high-risk Spanish population. The second, to determine the prevalence and usefulness of classical risk factors for diabetes screening according WHO and ADA criteria and to evaluate the potential effect of different stepwise strategies. DESIGN AND SETTING: Cross-sectional, multicentric, selective screening study carried out in primary health care which involved 9 health care centres and 1 diabetes unit (230,000 inhabitants). PATIENTS: Individuals aged > 40 years, non pregnant with at least one major risk factor for diabetes: BMI > or = 30 kg/m2, a first degree relative with diabetes, previous abnormality of glucose tolerance or the use of oral hyperglycaemic drugs for a long time. MEASUREMENTS: Database including sex, age and risk factors. Diagnoses were based on measurement of fasting plasma glucose (FPG) followed by a 2h-plasma glucose (2hPG) using a 75 gr. oral glucose tolerance test (OGTT). Positive predictive value (PPV) and odds ratio were calculated for each risk factor. The FPG concentration which maximised the sensitivity and specificity with respect to the 2hPG was established by means of the ROC-curves (receiver operator characteristics). MAIN RESULTS: 580 individuals were evaluated, 250 males (43.1%), mean age 58.1 +/- 10.7 years and BMI 31.2 +/- 5.2 kg/m2. A total of 132 (22.7%) individuals presented diabetes according the WHO criteria, 79 (13.6%) according ADA and only 53 (9.1%) according both sets of criteria. FPG > or = 126 mg/dl (7 mM) predicted a diabetic 2hPG with high specificity (94.2%) but a very low sensitivity (40.2%). If that cut-point was used alone for early screening half the diabetics with normal FPG but with a diabetic 2hPG would not have been diagnosed. According the WHO criteria PPV for classical risk factors oscillated between 23.4-29.1% and were significantly higher than those obtained according ADA criteria (11.6-18.3%; p < 0.01). CONCLUSIONS: The OGTT is still the cornerstone for diabetes screening thus the FPG predictive value greatly decreases the 2hPG predictive value. ADA criteria undervalues the diabetes impact mainly on high-risk population.

[Expectations of patients: what aspects of a health centre do they value? A qualitative-quantitative study]. / Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo.

OBJECTIVES: To identify the factors valued by users of health centres; to weigh the relative importance of each factor. DESIGN: Qualitative stage (4 focus groups) to identify the factors valued. Quantitative stage (questionnaire to 225 people) to weigh their relative importance. SETTING: Primary care. PARTICIPANTS: Citizens from middle-high and middle-low social classes, urban, rural and over 65, were chosen through key informants for their interest in the health services. They were recruited with the assistance of various residents' associations and town councils. METHOD: The factors valued were identified through focus groups and classified in categories. Their relative importance was weighed through a questionnaire and a factorial analysis to identify the main components was run. RESULTS: 60 factors that could be valued by patients were identified. Eight of these referred to the centre and concrete assets, nine to organisation and acessibility, 18 to relationship with the health professionals, and 25 to the services available. The most highly valued factor was: "The centre has sufficient material available for cures, minor surgery, bandages, etc." The factorial analysis confirmed the categories established. Organisation and accessibility, and relationship with professionals were the most highly valued dimensions. CONCLUSIONS: The combination of qualitative and quantitative methods seems very fitting for this kind of study. Although many of the factors were to be expected, other little-expected ones emerged. In addition, users seem to value certain factors in a different way from how the professionals do.

[Prevalence, expression and impact of depressive disorders in primary care]. / Prevalencia, expresión e impacto de los trastornos depresivos en atención primaria.

OBJECTIVE: To determine the prevalence and forms of clinical expression of depressive disorders in primary care patients. To analyse the under-detection of depression by primary care doctors. DESIGN: Descriptive and transversal study, with two-stage sampling. Setting. Primary care consultations in the Camp de Tarragona area. PARTICIPANTS: 1000 consecutive patients visiting their doctor for any reason will make up the first-stage sample. Of these 350 go on to the second stage (all the positive results in the screening for depression test plus a random one-seventh of the negative results). MAIN MEASUREMENTS: The first stage will consist of the screening of the sample for depressive disorders with Zung's Self-Rating Depression Scale. In the sub-sample that will go on to the second stage, the Structured Clinical Interview for DSM-IV Disorders will be used to establish diagnoses of depressive disorders and other co-morbid psychiatric disorders. There will also be a range of specific questionnaires to find reasons for consultation and the form of presentation of an eventual depressive disorder, medical co-morbidity, medication taken, use of health services, the functional and vital repercussions of depression. A questionnaire for the patient's G.P. will assess and detect depression. DISCUSSION: The study will enable us to check the validity for our patients of pre-suppositions on depression in primary care obtained from studies in other countries with different health structures and social and cultural conditioners, and to find diverse information extrapolated from specialist studies.