Urban Health District Research Articles

Validation of different tests for haemoglobin estimation

Primary health center, urban health center and district hospital rely on Sahali method for hemoglobin estimation. Sahali acid hematin method is still in vogue used, in spite of availability of more reliable and accurate methods. Sahali acid hematein method though effective and easy is not sufficiently accurate because it shows wide scatter in inter observers and intra observer result distribution. For good ethical laboratory practices it needed to develop the variability accuracy precision of hemoglobin estimation by Sahali acid hematin method compared to Drabkin cyanmethemoglobin method as per guidelines by ICMR. Hence the present study was undertaken for standardizing the hemoglobin result in district hospital laboratory. Objectives: Observe the inter-observational result variation using the Sahali method of Hemoglobin estimation and to validate the accuracy and precision of hemoglobin estimation by Sahali method as compared to Drabkin method. Material and Methods: This is a prospective hospital based study. 51 subjects from OPD were included in the study and duration of the study was 2 months. Sample for hemoglobin estimation was collected from the subjects in 3 different bottles and divided into group A, B and C according to the method of estimation. Results: Sahli's method of estimation in the samples by two different groups of workers showed a significant difference. Comparison of haemoglobin estimated by Sahli's and Drabkin method by finger prick and venepuncture method of collection not showed a significant difference.

Challenges faced by older women in Botswana in accessing services that address sexual and reproductive health, and family planning needs, in Botswana

AbstractObjective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs.Design, setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata), using probability proportional to size.Outcome measures: The study estimated the percentage use of sexual and reproductive health services (including family planning services), unmet need for family planning and factors inhibiting use of these services.Results: The study revealed that 25% of the older women used some type of FP method. Of this number, 67.9% were aged 50–59 years, 17.4% 60–69 years, 10.1% 70–79 years, and 72% had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired imm...

Avaliação de um programa de formação baseado no Mentoring para aquisição de habilidades em pequena cirurgia num centro de saúde urbano em Jaén, Andaluzia, Espanha

Objetivos: Avaliar a implantação de um programa de tutoria em habilidades para a pequena cirurgia em um centro de saúde urbano. Desenho e métodos: Estudo descritivo transversal numa zona básica de saúde urbana composta por 16000 habitantes. Recolhemos todas as intervenções cirúrgicas realizadas durante os anos de 2009, 2010 e 2011. Estas foram divididas em dois grupos. Um primeiro grupo que compreende aquelas intervenções que foram autorizadas por um médico com experiência, e outro onde encontramos as não tutoradas. Também foram considerados os tipos de intervenção, existência de consentimento informado e o envio de amostras a anatomia patológica. Resultados: Foram realizadas um total de 363 intervenções (101 em 2009, 114 em 2010 e 148 em 2011), 45% autorizadas, sem encontrar diferenças por ano de realização nem por tipo de intervenção (59% extirpação de verrugas, 25% infiltrações, 7% quistos epidérmicos). Participaram da proposta, principalmente médicos residentes (96%), seguidos de médicos de família (62%) e por último a equipe de enfermagem (29%). Um maior número de peças cirúrgicas foram enviadas a anatomia patológica nos atos cirúrgicos tutorados (83% vs 62%, p < 0.05 test c²) assim como, houve um melhor preenchimento do consentimento informado. Conclusões: O sistema de formação em habilidades por mentoring em “Pequena Cirurgia” implicou progressivamente no restante de profissionais do Centro de Saúde, aumentou a quantidade de atos cirúrgicos realizados e melhorou a qualidade do programa. Aproveitar as habilidades dos profissionais que trabalham em Atenção Primária à Saúde (APS) para formar os colegas, pode atuar como catalizador para aumentar a capacidade de resposta e inovação.

Prevalencia de violencia de género en atención primaria de Santa Cruz de Tenerife

ObjectivesTo estimate the prevalence of domestic violence (DV) in adult women attending Primary Care medical consultations, to determine the associated factors, and family physician involvement in its detection. Material and methodsWe performed a cross-sectional analytical study in two urban health districts of Santa Cruz de Tenerife, Canary Islands. A consecutive sample of women aged 18 or older, whether or not they had a current partner were selected.. The Bradley questionnaire, which is validated (26 items) and assesses physical, psychological and sexual violence was used anonymously. Demographic characteristics, and those related to the couple, health history, presence of anxiety and depression (Goldberg scale) were recorded. ResultsA total of 299 women were interviewed, and 154 women recognised some kind of abuse at least once in their life (51.5%, 95% CI: 40%-62%). Psychological violence was the most mentioned (n=153; 99.35%), followed by physical (n=39; 25.32%) and sexual violence was stated by 12 women (7.79%). Domestic violence was associated with: younger age, less time in a previous relationship, lack of social support (OR=2.18, P=.019), presence of probable anxiety (OR=1.77, P=.015) and probable depression (OR=1.58, P=.049). After multivariate analysis the association persisted with the length of time of the relationship with previous partner (OR=0.998; P<.0001) and the presence of probable anxiety (OR=1.79; P=.024). Early detection of domestic violence was recorded in the medical records of 111 women (37.1%; 95% CI: 36.90-37.23). ConclusionsAs in other studies, DV is associated with mental disorders, and there is a need for greater involvement by family physicians to detect this prevalent problem in our clinics.

Tiroiditis posparto: incidencia y estudio de los posibles factores asociados en las embarazadas de una zona de salud

Background and objective Our objective was to evaluate the presence of postpartum thyroiditis (PPT) in a group of pregnant euthyroid women. Material and method This study was prospective and descriptive in nature and was carried out over the course of three years in an urban Health District in Toledo, Spain. Information recorded included height and weight, tobacco use, previous consumption of oral contraceptives, and numbers of pregnancies and abortions prior to the current gestation. Levels of Thyroid Stimulating Hormone (TSH), free Thyroxin (FT4) and thyroid peroxidase antibodies (TPOAb) were determined during the first trimester and 3 and 6 months postpartum. A urine sample was collected for determination of iodine levels. Thyroid ultrasonography was performed on all pregnant subjects concurrently with analytical sample collection at 3 months of pregnancy and 3 months postpartum. Results The sample contained 157 pregnant women, of whom 25 (15.9%) developed PPT. Of these, 44.0% were positive for TPO antibodies in the first trimester, compared to 4.5% of the subjects who did not develop PPT ( P<.001). At the end of the first year, 5 (20%) were still afflicted with hypothyroidism. The complete study group of pregnant women displayed a median urinary iodine level of 135 μg/L. A minor BMI was found in the PPT subjects when compared with the rest of the study group (21.7 vs 24.5; P=.000). A greater frequency of PPT was found in Rh-negative women (33.3 vs 12.2%; P=.015). Conclusions The incidence of PPT exceeded that previously reported. We have only found a significant correlation between PPT and BMI and Rh factor. Based on the high incidence rate detected in our Health District, an active search for cases of PPT might be justified.

Detection of obstetric risk in women attending prenatal clinics in Kadutu Urban Health District, Democratic Republic of Congo

The fifth of the 8 Millennium Development Goals adopted by 189 nations during the 2000 United Nations Summit was to improve maternal health worldwide through the joint effort of governments and international organizations. The present study was conducted to contribute to improving maternal health in the Democratic Republic of Congo by assessing the detection of obstetric risks at prenatal clinics. Its aim was to assess the difference between the prevalence of obstetric risks actually detected in pregnant women and the prevalence of obstetric risks that could have been detected if all risk factors known to the Health District had been considered. We also wanted to know what lessons if any could be learned from the study as we strive to achieve the fifth Millennium Development Goal. Most of the women in the study were aged 20 to 39 years but 7.6% were aged 14 to 19 years. Following delivery they stayed a mean of 3 days in the maternity ward of Buholo health center the normal place of delivery for the area or at Kadutu Hospital the referral hospital. No maternal death and 15 perinatal deaths were registered. We coupled each prenatal record with the partogram of the corresponding delivery and compared the prevalence of known risks that were not detected at the prenatal clinics with the prevalence of the detected risks. Risk factors whether alone or in combination known to the Health District and therefore expected to be detected were age younger than 18 years or older than 35 years primiparity with age older than 30 years primiparity with height less than 1.5 m hydramnios twin pregnancy unfavorable presentation grand multiparity (defined as parity >or=5) history of cesarean deliveries history of unsafe abortions and narrow pelvis. In sub-Saharan Africa complications from unsafe abortions are a major health problem well supported from available evidence. The difference between the prevalence of the risk factors that remained undetected in the women and the prevalence of those that weredetected was assessed by the 2 test (P<0.05 meaning a poor detection of the obstetric risk). Epi Info version 3.2.2 (distributed by the Centers for Disease Control and Prevention Atlanta GA USA) and SPSS version 11.5 (SPSS Chicago IL USA) were used for encoding and analyzing data. There was a significant difference between the overall prevalence of the risk factors that remained undetected (34%) and the overall prevalence of those that were detected (10.2%). Yet among all the risk factors the difference was significant only for grand multiparity (18.7% vs 2.6%; P<0.001). Many studies have reported on obstetric risk factors and their implications. Age older than 35 years grand multiparity and a history of stillbirth are thought to be predictors of infant mortality; and primiparity with age older than 35 years are thought to be predictors of unfavorable presentation postpartum hemorrhage fetal abnormalities and infant morbidity and mortality. In this study the prevalence of detected risk factors was different from that of risk factors that remained undetected. The most overlooked factor was grand multiparity. It is clear from this finding that the Ministry of Health ought to consider publishing guidelines for the detection of obstetric risk based on the risk factors prevalent in the area and stressing grand multiparity. Further studies investigating risk factors related to previous disease are also needed. (full text not including Table 1. Detected and undetected obstetric risks in 761 women receiving prenatal care at three health centers in the Democratic Republic of Congo)

Cure or control: complying with biomedical regime of diabetes in Cameroon

BackgroundThe objective of the study was to explore the cultural aspect of compliance, its underlying principles and how these cultural aspects can be used to improve patient centred care for diabetes in Cameroon.MethodsWe used participant observation to collect data from a rural and an urban health district of Cameroon from June 2001 to June 2003. Patients were studied in their natural settings through daily interactions with them. The analysis was inductive and a continuous process from the early stages of fieldwork.ResultsThe ethnography revealed a lack of basic knowledge about diabetes and diabetes risk factors amongst people with diabetes. The issue of compliance was identified as one of the main themes in the process of treating diabetes. Compliance emerged as part of the discourse of healthcare providers in clinics and filtered into the daily discourses of people with diabetes. The clinical encounters offered treatment packages that were socially inappropriate therefore rejected or modified for most of the time by people with diabetes. Compliance to biomedical therapy suffered a setback for four main reasons: dealing with competing regimes of treatment; coming to terms with biomedical treatment of diabetes; the cost of biomedical therapy; and the impact of AIDS on accepting weight loss as a lifestyle measure in prescription packages. People with diabetes had fears about and negative opinions of accepting certain prescriptions that they thought could interfere with their accustomed social image especially that which had to do with bridging their relationship with ancestors and losing weight in the era of HIV/AIDS.ConclusionThe cultural pressures on patients are responsible for patients' partial acceptance of and adherence to prescriptions. Understanding the self-image of patients and their background cultures are vital ingredients to improve diabetes care in low-income countries of Sub-Sahara Africa like Cameroon.

Reducing financial barriers to emergency obstetric care: experience of cost‐sharing mechanism in a district hospital in Burkina Faso

To describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the cost-sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).

Tipología psicosocial de las enfermedades crónicas en los mayores dependientes

To find the psychosocial nature of chronic diseases in elderly dependent persons. Transversal, observational study. Two urban health districts in Granada and Jaén, Spain. One hundred five patients included in the Family and Home Care programme for elderly dependent persons. The type of chronic illness was analysed through the modified Rolland classification. Types of incapacity, demographic variables and the presence of multi-pathologies were recorded. 47.6% of the 105 participants were between 70 and 79 years old. On their psychosocial nature, 94.2% had some kind of disability, 78% had a gradual start, 61% had a progressive course of disease, and 63.8% had a possibly fatal prognosis. Psychosocial type B -- incapacitating, gradual start, progressive and possibly fatal -- was the most common (44.7%). The study of psychosocial type in elderly dependent persons is an important instrument for the analysis of families with chronic illnesses within them. Questions relating to its progressive course and the fatal prognosis may have a more determining prognostic weight.

Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population

BackgroundSF-36 has been both translated into different languages and adapted to different cultures to obtain comparable data on health status internationally. However there have been only a limited number of studies focused on the discriminative ability of SF-36 regarding social and disease status in developing countries. The aim of this study was to obtain population norms of the short form 36 (SF-36) health survey and the association of SF-36 domains with demographic and socioeconomic variables in an urban population in Turkey.MethodsA cross-sectional study. Face to face interviews were carried out with a sample of households. The sample was systematically selected from two urban Health Districts in Izmir, Turkey. The study group consisted of 1,279 people selected from a study population of 46,290 people aged 18 and over.ResultsInternal consistencies of the scales were high, with the exception of mental health and vitality. Physical health scales were associated with both age and gender. On the other hand, mental health scales were less strongly associated with age and gender. Women reported poorer health compared to men in general. Social risk factors (employment status, lower education and economic strain) were associated with worse health profiles. The SF-36 was found to be capable of discriminating disease status.ConclusionOur findings, cautiously generalisable to urban population, suggest that the SF-36 can be a valuable tool for studies on health outcomes in Turkish population. SF-36 may also be a promising measure for research on health inequalities in Turkey and other developing countries.

Factores ecológicos asociados con la presencia de larvas de Aedes aegypti en zonas de alta infestación del municipio Playa, Ciudad de La Habana, Cuba

To identify local ecological factors that might have had an impact on the higher infestation rates by the vector mosquito Aedes aegypti seen in four urban health districts of Ciudad de La Habana, Cuba, and to determine the type of containers with the highest number of larvae. This is a descriptive study that was carried out in four health areas (Docente, 28 de Enero, 26 de Julio, and 1. degrees de Enero) within Playa, a municipality belonging to Ciudad de La Habana, Cuba. These areas were chosen because of the persistent presence of the dengue vector throughout 2003. All buildings on the selected blocks were inspected between April 2004 and March 2005, and note was taken of existing water deposits (type, number, and location) and of surrounding ecological factors (existence of a patio and shade, the way tanks were covered, the presence of organic matter inside them, and the overall cleanliness of the dwelling). Using filtration, the mosquito larvae and pupae in each deposit were counted. Pupae were typified as to their taxonomic species under a stereoscopic microscope. The types of deposits where larvae and pupae of A. aegypti were most often found in all areas were low tanks and small artificial containers. In three of the study areas the greatest numbers of pupae were found in low tanks (88.6%, 100%, and 56.6%), 90.9% of which were uncovered or only partially covered. On the other hand, in the fourth study area small artificial deposits were the most commonly infested (85.7%). A correlation was noted between the number of deposits in infested houses and the presence of a patio (chi(2) = 29.59; P = 0.0001), partial shade (chi(2) = 4.108; P = 0.0001), shrubbery (chi(2) = 43.59; P = 0.0001) and trees (chi(2) = 101.459; P = 0.0001), as well as poor hygiene (chi(2) = 53.76; P = 0.0001). Artificial deposits, especially low tanks and small containers, are the most frequent breeding sites for A. aegypti and are therefore risk factors for infestation with this vector species. Uncovered tanks containing organic matter and located in the shade on the outside of homes were found to present the highest risk in this respect.

Prevalence of lower limb ulceration in an urban health district.

Before establishing a community leg ulcer programme, a survey was performed to assess the incidence and prevalence of lower limb ulceration in the Newcastle Health District. The prevalence was 1.9 per 1000 in patients over the age of 45 years, and the annual incidence 3.5 per 1000 in the same age group. Recurrent ulcers represented 47 per cent of the total and 50 per cent of all ulcers had been present for > 6 months. District nurses spent 190 h per week in the community dressing leg ulcers, making a total number of 25,922 visits each year. In the treatment of leg ulcers 35 different types of dressing were used and only 14 per cent of ulcerated limbs were treated by appropriate compression. Of all patients with leg ulcers, 35 per cent had been seen by a hospital specialist but only 7 per cent had been examined by a vascular surgeon at any time.

Clinics, Communities, and Cost Recovery

Upon coming to power in 1994, South Africa’s first postapartheid government launched its ambitious Reconstruction and Development Programme with several major primary health care initiatives. Two years later, it adopted a macroeconomic policy that put neoliberal reforms ahead of redistributive goals. Based on ethnographic research in one urban health district, this article examines the consequences of this discordant national policy configuration as manifested in the micropolitics of four community clinics. The article examines contrasting experiences of desegregation in two formerly ‘White’ facilities, and contrasting community responses to two newly built township clinics. The article finds that, in general, South Africa’s neoliberal shift undermined its health policy objectives. However, in exceptional cases where strong nurse leadership combined with relatively uncontentious local class relations, some community clinics did succeed in becoming sites for the local pursuit of health and development goals.

Proyecto EVAN-65: evaluación de la efectividad de la vacuna antineumocócica en mayores de 65 años

To assess the effectiveness of systematic pneumococcus vaccination (PV) in the over-65s by comparing rates of incidence and severity of the cases of pneumonia caught in the community (PCC), in two cohorts-those vaccinated (VC) and those not (NVC). Multi-centre study of cohorts. Primary Health Care. All those over 65 registered at 8 urban Health Districts and distributed into a VC (with PV) and an NVC. Active monitoring will be conducted for 3 years, with detection of all the PCC occurring during this period. Data sources will be the specific register of the PV programme and exhaustive review of primary Care and referral hospital clinical records (records of pneumonia cases admitted and records of pneumonia cases detected in Casualty). Variables considered will be: age, sex, and presence or otherwise of risk factors linked to greater susceptibility to catching pneumonia (diabetes mellitus, low immunity levels, cardiopathy, COPD, tobacco dependency, alcoholism, splenectomy). To measure the effect, we will calculate the annual and overall accumulated (over 3 years) rates of incidence of pneumonia, as well as the relative and attributable risks. As measurements of its severity, we will analyse the mortality index and the "fine" ordinal scale of severity. The study will give a reply in terms of effectiveness and efficiency of the vaccine and will contribute to a definitive decision on the controversial question of the systematic indication of this vaccine for the over-65 population.

Estudio de prevalencia de incontinencia urinaria en mujeres de 18 a 65 años y su influencia en la calidad de vida

To find the prevalence of urinary incontinence (IU) in women of working age and its impact on their quality of life (QL). Descriptive, cross-sectional study. Urban health district in Ourense. 1000 women between 18 and 65 were selected at random from a total of 8443. The prevalence of UI was evaluated by means of a questionnaire designed for the study and sent by mail. In addition, the Incontinence Impact Questionnaire translated into Spanish was used. This was to assess QL in women with UI. The reply rate was 43.6%, with 20% prevalence of UI. Mean age of the women studied was 43.4 (95% CI, 42.1-44.6); and for those with UI, 50.3 (95% CI, 48.4-52.4). 56.8% of women with UI had not been to the doctor. Mean score of impact on QL (from 0 to 90) was 12.7 points. 87.7% of those affected scored less than 30 points; and 1.5% were above 60 points. High prevalence of UI was found in women of working age, with low rate of medical consultation, probably because for most women it only lightly affected their QL.

Variaciones en el consumo de recursos de atención primaria por niños menores de 7 años en los medios rural y urbano. Estudio de cohortes

[corrected] To describe differences between two health districts in primary care resource use. Retrospective population cohort study. A rural healthdistrict (RD) and an urban health district (UD). A cohort of children born in 1991 in a UD (n=104) and a cohort of children born in 1991 and 1992 in an RD (n=88), registered in their primary care centres between 0 and 6 years old. Attention episodes, requested visits, practicioner programmed visits, nursery programmed visits and diagnosis tests. Significative differences were noticed in the attention episode average(ZU=34.0; 95% CI, 31.5%-36.5%); (ZR=25.6; 95% CI, 22.7%-28.5%), in requested visits (ZU=45.8; 95% CI, 41.8%-49.9%); (ZR=28.8; 95% CI, 25.3%-31.9%), in practicioner programmed visits (ZU=7.1; 95% CI, 6.6%-7.5%), (ZR=11.2; 95% CI, 10.7%-11.7%) and in nursery programmed visits (ZU=9.8; 95% CI, 9.0%-10.6%) (ZR=12.0; 95% CI, 11.4%-12.5%). At least one diagnosis test was applied to 90.3% of children in the UD and to 64.8% of children in the RD; and in the UD for each attention episode 1.32 (95% CI, 1.28%-1.36%) requested visits were attended to and 0.2 (95% CI, 0.17%-0.23%) diagnosis tests were made; whereas in the RD 1.1 (95% CI, 1.08%-1.13%) requested visits and 0.09 (95% CI, 0.06%-0.12%) diagnosis tests. In both health districts the average of attention episodes, requested visits and tests was significantly higher in children who had been hospitalized. Primary care services utilization and the number of diagnosis test and attention episode visits are higher in the urban district than in the rural one.

Hábitos dietéticos en la población de una zona básica de salud urbana

To find the eating habits of the adult population of an urban health district. Descriptive cross-sectional study. Primary care. Urban health centre. 260 people (124 men and 136 women) over 20 (mean age of 43.6 +/- 17.1; 42.0 +/- 16.4 for men and 45.1 +/- 17.7 for women), selected at random from among those living in the health district. Through a semi-quantitative questionnaire on frequencies of food consumption, filled out in all cases by a single observer, the food habits of the participants and the nature of their diet during the previous week were determined. Intake of calories and biomolecules were calculated as a function of the kind of foods. Mean daily calory intake was 2612 +/- 836 kcal, 22.5% more than the theoretical requirements of this population. Mean daily protein ingested was 96.4 +/- 28 grams, fats 130.2 +/- 42.7 grams, and carbohydrates 277.1 +/- 123.3. 21.5 +/- 5.5% of the total calory intake were monounsaturated fatty acids; 7.7 +/- 4.3% were polyunsaturated; and 13 +/- 2.9% were saturated. Cholesterol consumption was 475 +/- 213.8 mg/day, and roughage consumed was 18.6 +/- 8.0 grams. The adult population of our health district consumed the typical, not very healthy Western-style diet: over-rich in calories, rich in saturated fats and cholesterol, and poor in roughage. Nevertheless, the diet conserved the high intake of monounsaturated and polyunsaturated fatty acids which is characteristic of traditional Mediterranean food.

¿Hacemos caso del resultado de la hemoglobina glucosilada a la hora de tratar a nuestros pacientes diabéticos?

To study the influence of glycosilated haemoglobin (HbA1c) on the therapies chosen by primary care doctors when treating type-2 diabetes (DM2) patients. Retrospective observational study.Setting. Urban health district. Randomised, representative sample of 152 DM2 patients, with a total of 265 documented clinical episodes which involved request and assessment of HbA1c result in 1999-2000. For each clinical episode we assessed the HbA1c and basal glycaemia figures and the therapeutic repercussion of the result on patient treatment: no change (NC), strengthening of hygienic-dietary measures (HDM), increase of dose (ID) or change of therapy (CT). We found a mean overall figure of 0.87+/-0.03 requests for HbA1c per patient per year. Of the 265 HbA1c studied, 54.7+/-5.9% can be considered acceptable, 18.4+/-4.6% deficient, and 26.9+/-5.3% unacceptable. However, the overall result of HbA1c was NC in 40.3+/-5.8%, HDM in 18.7%, ID in 25.9+/-5.2%, and CT in 15.1+/-4.2% of cases. Therapy changes (CT or ID) occurred in 26.8% of cases when was acceptable, 60.4% of cases when the glycosilated HbA1c was deficient, and 60% when the glycosilated HbA1c was unacceptable (P<.001). It should be emphasised that, even when the HbA1c was very deficient, the dose was only increased or the treatment changed in under two-thirds of the population. It is also paradoxical that, when HbA1c with acceptable results was found, therapy was changed in around 25% of patients.

Prevalencia de la infección por Helicobacter pylori en atención primaria: estudio seroepidemiológico

To find the prevalence of Helicobacter pylori (HP) infection in primary care in our area and to study factors associated with this infection. Descriptive and prospective study.Setting. Urban health district with 30 765 people registered. 267 patients, selected by quota sampling from the census of age and sex groups, as a function of an alpha of 0.05, 0.06 accuracy, and expected prevalence of 50%. HP infection was studied through validated IgG serology (ELISA Wampole(R)). The following were studied as associated factors: age, sex, education, profession, alcohol and tobacco consumption, and non-steroidal anti-inflammatory drugs taken. Mean age was 38.4, and 51.3% were women. Prevalence of HP infection was 52.4% (95% CI, 46.4-58.4). This proportion increased steadily with age, with a minimum of 11.5% in the 0-9 years-old range and a maximum of 87.5% in the 60-69 years-old group. There was more HP in men (56.9%) than in women (48.2%). In univariate analysis a linear tendency was found between HP infection and increased age (P<.0001) and the consumption of alcohol (P=.003), with no relationship to other variables studied. In the multivariate analysis, only age maintained statistical significance (P=.001). In our area the prevalence of HP infection is similar to that in other studies: it increases steadily with age and shows en epidemiological pattern that is half-way between countries of high and low prevalence.

Estudio de la calidad de vida en pacientes con fibromialgia: impacto de un programa de educación sanitaria

To assess the impact of a programme of health education on the quality of life and frequency of attendance of persons with fibromyalgia. Community clinical trial with randomised allocation. Sant Joan Despí urban Health District (Barcelona), with a population of 13 282 inhabitants. 67 women who attended our centre for consultation and were diagnosed with fibromyalgia by the Area Rheumatologist using the criteria of the American College of Rheumatology (1990). They were distributed at random into control and intervention groups. Social and demographic variables (age, marital status, educational background, job situation), health variables (physical exercise taken, current treatment, symptoms evolution time) and frequency of attendance were gathered. The Nottingham Health Profile (NHP) for measuring quality of life was administered. The presence of psychological malaise was determined through the Mini International Neuropsychiatric Interview. After the intervention, which consisted of four health education sessions, the NHP was administered again and frequency of attendance was measured again. The most important dimension on the NHP prior to intervention was pain (78.6 points), which was not modified either by physical exercise or the disease s time of evolution. Prevalence of psychological malaise was 64.6%. After the intervention there was a significant improvement in the pain dimension (P=.003). Health education for people with fibromyalgia modifies their perception of quality of life and reduces their pain. In addition, this kind of activity increases understanding of illness and reduces dependence on the health services.