Search

Objetivo. Estudiar la concordancia en el numero de problemas eticos identificados en la atencion a enfermos en situacion terminal entre los miembros de un equipo de soporte de atencion domiciliaria (ESAD) y un grupo de expertos antes y despues de un curso de bioetica y de la implantacion de una checklist. Diseno. Estudio de intervencion antes-despues. Emplazamiento. Area 7 de Atencion Primaria de Madrid. Participantes. Pacientes en situacion terminal atendidos por el ESAD de noviembre de 2001 a junio de 2002. Intervencion. Curso de bioetica e implantacion de una checklist. Mediciones principales. Edad, sexo, enfermedad de base, numero de problemas eticos identificados por el ESAD y por el grupo de expertos antes y despues de la intervencion. Se calcula el coeficiente de correlacion intraclase (CCI) en el numero de problemas identificados por ambos grupos antes y despues de la intervencion. Resultados. Se estudian 31 casos antes de la intervencion y 29 despues. Antes de la intervencion el ESAD identifica una media de 2,7 ± 2,3 problemas eticos por caso y el grupo de expertos, 11,8 ± 6,1. El CCI en el numero de problemas identificados es de 0,53 (correlacion moderada). Despues de la intervencion, el ESAD identifica 5,9 ± 6,5 problemas eticos por caso y el grupo de expertos, 10,7 ± 7,9. El CCI en el numero de problemas identificados es de 0,87 (correlacion alta). Conclusiones. El curso y la implantacion de una checklist facilitan a los profesionales no expertos en bioetica la deteccion de problemas eticos en pacientes en situacion terminal.

Considerando que la diabetes mellitus es la enfermedad del siglo XXI y el pie diabético una de sus complicaciones más frecuentes, nos encontramos ante un importante problema de salud que va a afectar a un gran número de personas y sobre el que el profesional de enfermería tiene mucho que decir. Por ello, hemos realizado una guía de prevención y cuidados al pie diabético que pretende abordar el problema de forma integral para mejorar la calidad de vida del paciente y reducir sus complicaciones que, de no ser tratadas de forma adecuada, pueden desencadenar una infección, necrosis de la extremidad lesionada, amputación, etc., procesos todos invalidantes. Para ello, será primordial una exhaustiva y adecuada educación sanitaria que posibilite una mejora de las condiciones del paciente en general y de sus pies en particular, tratando de evitar la aparición del problema o, una vez ya presente, proporcionando los cuidados oportunos para garantizar una atención óptima que limite en lo posible su progresión y sus secuelasConsidering in fact diabetes mellitus is a disease which affects a huge number of people during the XXI century, we carry out prevention and care of the diabetic foot procedure, one of the most frequent complications of this disease, to show the problem by the whole, and about which Nursing has many things to say.We want to improve the patients' life quality and reduce the complications of the diabetic foot because if we don't treat them in time they can cause an infection, necrosis of the injured extremity, amputation⋯(invalidated processes all of them). As a consequence of this, it would be necessary a suitable health education, in order to try to avoid either the apparition of the problem or once the problem exits, proportionate the necessary care to guarantee a best kindness which finish its progression and sequels

ObjetivoEstudiar la concordancia en el número de problemas éticos identificados en la atención a enfermos en situación terminal entre los miembros de un equipo de soporte de atención domiciliaria (ESAD) y un grupo de expertos antes y después de un curso de bioética y de la implantación de una checklistDiseñoEstudio de intervención antes-despuésEmplazamientoÁrea 7 de Atención Primariade MadridParticipantesPacientes en situación terminal atendidos por el ESAD de noviembre de 2001 a junio de 2002IntervenciónCurso de bioética e implantación de una checklistMediciones principalesEdad, sexo, enfermedad de base, número de problemas éticos identificados por el ESAD y por el grupo de expertos antes y después de la intervención. Se calcula el coeficiente de correlación intraclase (CCI) en el número de problemas identificados por ambos grupos antes y después de la intervenciónResultadosSe estudian 31 casos antes de la intervención y 29 después. Antes de la intervención el ESAD identifica una media de 2,7 ± 2,3 problemas éticos p grupo de expertos, 11,8 ± 6,1. El CCI en el número de problemas identificados es de 0,53 (correlación moderada). Después de laintervención, el ESAD identifica 5,9 ± 6,5problemas éticos por caso y el grupo deexpertos, 10,7 ± 7,9. El CCI en el númeroe problemas identificados es de 0,87(correlación alta)ConclusionesEl curso y la implantación de una checklist facilitan a los profesionales no expertos en bioética la detección de problemas éticos en pacientes en situación terminalObjectiveTo study the concordance in the number of ethical problems identified in the care of the terminally ill between the members of a home care support team(HCST) and a group of experts before and after a course in bioethics and the introduction of a checklistDesignBefore-and-after intervention studySettingArea 7 of Primary Care, MadridParticipantsTerminally ill patients attended by the HCST between November 2001 and June 2002Interventionbioethics course and introductionof a checklistMain measurementsAge, sex, basic illness, number of ethical problems identified by the HCST and by the group of experts before and after the intervention. The intraclass correlation coefficient (ICC) for the number of problems identified was calculated in both groups before and after the interventionResults31 cases before and 29 after the intervention were studied. Before the intervention the HCST identified an average of 2.7±2.3 ethical problems per case; and the group of experts found 11.8±6.1. The ICC for the number of problems identified was 0.53 (moderate correlation). After the intervention, the HCST identified 5.9±6.5 ethical problems per case; and the group of experts, 10.7±7.9. The ICC for the number of problems identified was 0.87 (closecorrelation)ConclusionsThe course and the introduction of a checklist helped professionals who were not experts in bioethics to detect ethical problems in treating terminally ill patients

ObjetivoEstimar el cupo máximo en medicina familiar que permita consultas mínimas de 10 minDiseñoTransversalAmbitoTres centros de saludSujetosUn total de 45.826 habitantesMedicionesA partir de las citas de tres centros estimamos el tiempo anual empleado por paciente y lo ajustamos asignando un tiempo mínimo de 10 min por consulta. Establecemos un modelo de regresión cúbica predictor de la carga de trabajo asistencial media por edad en medicina general y estimamos el cupo máximo si se dedica un 70% de la jornada laboral a la asistencia. Exponemos los resultados para dos centros con mayor implicación de enfermería en la atención de los pacientes, y otro en que ésta es menor. Presentamos los coeficientes R2. Estimamos los cupos máximos para los centros de salud de Navarra y los mostramos en cinco grupos elaborados a partir del porcentaje de población de 65 años o másResultadosLa edad explica el 86,1% de la variabilidad en la carga asistencial media en cada edad (un 84% en ninos y un 93,5% en adultos). Segun el porcentaje promedio de sujetos > 65 anos de edad los cupos maximos promedios para centros con mayor o menor implicacion de enfermeria son los siguientes: 7% (2.025 y 1.989); 14% (1.834 y 1.715); 21,2% (1.691 y 1.558); 27% (1.648 y 1.460); 34% (1.560 y 1.340)ConclusionesLa edad explica en gran medida la variabilidad de la carga asistencial y permite estimar el cupo maximo de pacientes que asegure un tiempo minimo por consultaObjectiveTo calculate the maximum family medicine list that gives at least ten minutes per consultationDesignTransversalSettingThree health centresSubjects45 826 inhabitantsMeasurementsWe used the appointments made at three centres to calculate the annual time employed per patient and we adjusted it to allocate a minimum of ten minutes per consultation.We established a cubic regression model to predict the mean case-load per age of patient in general medicine and calculated the maximum list if 70% of the working day were dedicated to care. The results contrasted two centres with greater nursing involvement and one with less.We showed the R2 coefficients.We calculated the maximum lists for the health centres of Navarra and showed them in five clusters worked out on the basis of the percentage of patients >65ResultsAge explained 86.1% of variability in mean case-load at each age (84% in children and 93.5% in adults). According to the mean percentage of those >65 years old, the average maximum lists for centres with more or less nursing involvement are as follows: 7.0%>65 (2025 and 1989); 14.0% (1834 and 1715); 21.2% (1691 and 1558); 27.0% (1648 and 1460), 34.0% (1560 and 1340)ConclusionsTo a great extent, age explains the variability in case-load and lets us calculate the maximum number of patients on the list that still ensures a minimum time for each consultation

Objetivo Conocer las caracteristicas epidemiologicas de los casos incidentes de tuberculosis (TB) notificados en el Area de Salud 09 de la Comunidad Valenciana durante el periodo 1998–2000. Diseno Estudio epidemiologico, observacional, descriptivo. Emplazamiento Area 09 de la Comunidad Valenciana, Unidad de Epidemiologia referente en el Centro de Salud Publica de Alzira. Participantes Casos de TB que cumplian las definiciones clinica o bacteriologica segun los Protocolos de la Red Nacional de Vigilancia Epidemiologica. Mediciones y resultados principales Se empleo la encuesta epidemiologica para declaracion de TB en la Comunidad Valenciana. Las variables incluidas fueron: sexo, edad, municipio, factores de riesgo, patologia asociada, localizacion, procedencia y estudio de contactos. Se llevo a cabo un analisis estadistico univariante a traves del programa SPSS, version 9.01. El numero de casos fue de 118. La tasa de incidencia anual oscilo entre 25,5 por 100.000 en 1999 y 43,5 por 100.000 en 1998, similar a la del ano 2000 (42,5 por 100.000). En un 64,4% de los casos se trataba de varones, el 26,3% tenia 25–34 anos. Un 64,4% fue ingresado. Se realizo estudio de contactos en el 73,7%. Un 78% de casos fue declarado por el hospital de referencia. Conclusiones La TB en el Area 09 se concentra en adultos jovenes que precisan ingreso hospitalario. El patron de declaracion de TB es hospitalario. Objective To find the epidemiological characteristics of cases of tuberculosis (TB) notified in Health Area 09 of the Valencian Community during 1998–2000. Design Descriptive, observational, epidemiological study. Setting Unit of epidemiology in the Public Health Centre of Alzira, Area 09 of the Valencian Community. Participants Cases of TB that met the clinical or bacteriological definitions according to the protocols of the National Network of Epidemiology Protection. Main measurements and results The epidemiological questionnaire for TB declaration in the Valencian Community was used. The variables included were: sex, age, town, risk factors, associated pathology, location, origin and study of contacts. A univariate statistical analysis was run, with the SPSS version 9.01. Cases numbered 118. The rate of annual occurrence ranged between 25.5 per 100 000 in 1999 and 43.5 per 100 000 in 1998, similar to that in the year 2000 (42.5 per 100 000). 64.4% were men and 26.3% were between 25 and 34 years old. 64.4% were admitted. There was a study of contacts in 73.7%. 78% of cases were declared by the referral hospital. Conclusions TB in Area 09 was concentrated in young adults needing hospital admission. TB declaration was usually made from the hospital.

ObjetivoProponer una metodología de case-mix para atención primaria, basada en edad, cronicidad y género.Describir el valor explicativo de estas variables en la variabilidad de la carga de trabajo asistencial médica.DiseñoEstudio observacional, descriptivo, retrospectivo.EmplazamientoAtención primaria. Centro de Salud Rochapea de Pamplona.Material y métodosRegistros informáticos de todas las consultas entre enero de 1996 y junio de 1997. Variable dependiente: carga de trabajo. Variables independientes: edad, género, patologías crónicas (diabetes, dislipemias, enfermedades neurológicas crónicas, EPOC-asma, enfermedades psiquiátricas crónicas, cardiopatías, hipertensión arterial, abuso alcohol y otras drogas). Se utilizó la prueba de Kruskal-Wallis para comparar cargas de trabajo por grupos de edad y análisis de regresión lineal múltiple para calcular el poder predictivo de las variables independientes.ResultadosSe observaron diferencias significativas por grupos de edad. En el modelo multivariante aplicado a médicos de familia se pudieron incluir todas las variables, explicando un 24,2% de la variabilidad de la carga de trabajo (R2). Para los pediatras se pudieron incluir la edad y asma, explicando un 23,48%.ConclusionesEdad, cronicidad y género son variables útiles para predecir, a partir de bases de datos administrativas, la carga de trabajo asistencial. Permiten su utilización en ajustes por carga asistencial aplicables a sistemas retributivos capitativos.ObjectivesTo propose a case-mix methodology for primary care, based on chronicity, type and age. To describe the explanatory value of these variables in the variability of the medical case-load.DesignObservation, descriptive and retrospective study.SettingPrimary care. Rochapea Health Centre, Pamplona.Material and methodsComputer records of all the consultations between January 1996 and June 1997. Dependent variable: case-load. Independent variables: age, type, chronic pathologies (diabetes, lipaemia, chronic neurological diseases, COPD-asthma, chronic psychiatric illnesses, cardiopathy, hypertension, alcohol and other drug abuse). The Kruskal-Wallis test was used to compare work-loads by age groups; and multiple linear regression analysis to calculate the predictive power of the independent variables.ResultsSignificant differences were observed for age groups. In the multivariate model used for general practitioners, all the variables could be included. They explained 24.2% of the variability in work load (R2). For paediatricians, age and asthma, explaining 23.48%, could also be included.ConclusionsAge, type and chronicity are useful variables for predicting case load from administrative data bases. They can be used in adjustments for case load applicable to capitation payment systems.

ObjetivoDeterminar la posible existencia de diferencias en el control de la hipertension en sujetos ancianos en comparacion con hipertensos jovenes.DisenoEstudio observacional retrospectivo de las diferencias entre las tensiones arteriales sistolica (TAS) y diastolica (TAD) iniciales y finales, y su relacion con la inclusion en tratamiento farmacologico, asi como el control obtenido segun tipo y cambios de tratamiento, asociacion farmacologica, revisiones periodicas, enfermedad vascular o factores de riesgo.EmplazamientoZona Basica de Salud de Azpilagana en Pamplona, con caracteristicas urbanas.PacientesSe estudiaron retrospectivamente 389 hipertensos: 196 de 70 o mas anos y 193 de 45-60 anos.Resultados principalesMas pacientes mayores fueron tratados con farmacos (91,8 frente a 84,5%, p = 0,024) y recibian tratamiento combinado con 2 farmacos (30,1 frente a 19,7%, p < 0,001), aunque son los jovenes los que con mayor frecuencia reciben mas de 2 antihipertensivos (11,4 frente a 2,5%, p < 0,001). El control final (< 140/90) se consiguio con mas frecuencia entre los jovenes (39,9 frente a 26,5%, p = 0,005). En el grupo de pacientes mayores la mayor tension diastolica inicial se relaciono con el control tensional final. Mas pacientes mayores siguieron las revisiones periodicas en el centro de salud (73,3 frente a 63,7%, p < 0,001), pero esta practica solo mejoro el control relativo (. 140/90) en los jovenes (p = 0,001). En pacientes mayores se emplearon mas diureticos (p < 0,001) y menos bloqueadores beta (p < 0,001), sin diferencias en otros antihipertensivos.ConclusionesHay diferencias en el tratamiento y control de los pacientes hipertensos en relacion a su edad. Los pacientes mayores con hipertension diastolica se controlan mas facilmente. En conjunto, y en ambos grupos analizados, el porcentaje de sujetos normotensos tras tratamiento es superior al resenado en otros estudios.ObjectiveTo determine possible differences between the control of hypertension in elderly patients and in young patients.DesignRetrospective observation study of the differences between initial and final systolic and diastolic blood pressure, of their relationship to inclusion in medical treatment, and of the control obtained with different kinds of, and changes in, treatment, of drug association, periodic checkups, vascular disease and risk factors.SettingThe urban Azpilagana Health District in Pamplona.Patients389 hypertense patients were studied retrospectively: 196 of 70 or over and 193 between 45 and 60.Main resultsMore older patients were treated medically (91.8% vs 84.5%, p = 0.024), and received combined two-drug treatment (30.1% vs 19.7%, p < 0.001), although the young people received more than two hypertension drugs more often (11.4% vs 2.5%, p < 0.001). Final control (

INTRODUCCIÓN: Los anticonceptivos orales son muy demandados por nuestra población (sobre todo joven) en la actualidad. Sin embargo, estos fármacos no están exentos de efectos adversos, que deben ser detectados y documentados precozmente. Éste es el caso de la incidencia de adenomas hepáticos, cuya correlación se observa claramente por su rápida desaparición tras la suspensión de los anticonceptivos en algunos casos. CASO CLÍNICO: Mujer de 30 años con el único antecedente personal de una meningitis linfocitaria en la infancia sin secuelas. No seguía ningún tratamiento habitual en la actualidad. Se inició tratamiento con anticonceptivos orales a petición de la paciente a la edad de 21 años. Acudió 2 años después a urgencias del hospital por dolor tipificado como cólico biliar. En el estudio ambulatorio de dicho cuadro se realizó una ecografía abdominal, en la que se observó una lesión nodular en segmento 5 del lóbulo hepático derecho. La resonancia magnética (RM) hepática reveló una lesión sugestiva de adenoma hepático en el segmento 5 de unos 24 mm de tamaño (fig. 1). El estudio fue completado con una punción-aspiración con aguja fina (PAAF) de la lesión, cuyas extensiones citológicas resultaron negativas para malignidad. Se suspendieron los anticonceptivos orales después de 3 años de su inicio. Posteriormente, en consultas sucesivas, la lesión hepática había desaparecido en las pruebas de imagen. En la actualidad la paciente se encuentra asintomática y no toma anticonceptivos orales. DISCUSIÓN Y CONCLUSIONES: Los adenomas hepáticos aparecen predominantemente en personas jóvenes y se localizan sobre todo en el lóbulo hepático derecho(1-3). Suelen ser solitarios en un 70-80% de los casos, aunque en ocasiones son múltiples, en relación con los anticonceptivos orales, las enfermedades de depósito de glucógeno y en la adenomatosis hepática(2). Respecto a la toma de anticonceptivos orales, se establece una relación que depende de la dosis y el tiempo de tratamiento. El riesgo suele ser mayor en pacientes > 30 años, en tratamiento durante más de 25 meses y con altas dosis de componente estrogénico(1,2). Estos fármacos también alteran la historia natural de los adenomas hepáticos, que son más numerosos y de mayor tamaño. El mecanismo de producción es desconocido; una hipótesis sugiere la transformación de los receptores esteroideos de los hepatocitos por los anticonceptivos(2). Suelen causar síntomas, como dolor abdominal en el epigastrio y el hipocondrio derechos y, a veces, como masa palpable o muerte súbita con cuadro de shock por rotura peritoneal; en menor proporción son asintomáticos(4). Los hallazgos analíticos son poco frecuentes; puede observarse una elevación de la fosfatasa alcalina y la GGT. Su malignización precoz puede descartarse mediante estudios de imagen y la determinación de incrementos séricos de alfafetoproteína(2). El diagnóstico debe realizarse con los hallazgos clínicos, las pruebas de imagen (ecografía, tomografía computarizada y RM abdominal) y/o resección quirúrgica(1-3). El mayor problema radica en la diferenciación del adenoma hepático de la hiperplasia nodular focal(5) y para el diagnóstico definitivo se requiere en ocasiones la resección quirúrgica. El manejo de estas pacientes es variable y depende de los síntomas, las características de la enferma y el tamaño y número de los adenomas hepáticos. Se suele recomendar la resección de los que causan síntomas, aunque su tamaño (aproximadamente > 5 cm) es controvertido(1,2). En pacientes embarazadas, el comportamiento de estas lesiones es impredecible y en ocasiones requieren cirugía, como en el resto de pacientes. Se puede concluir que las pacientes jóvenes consumidoras de anticonceptivos orales deberían ser revisadas periódicamente, ante la sospecha de reacción adversa hepática, bajo control ecográfico, al principio cada 2-5 meses(1), y considerar la biopsia hepática (PAAF) o la cirugía en algunos casos. La suspensión de estos fármacos es primordial, ya que en algunos casos cabe esperar una resolución espontánea, como ocurrió con nuestra paciente; sin embargo, en la mayoría de las pacientes los adenomas no varían o disminuyen ligeramente el tamaño.

Considering in fact diabetes mellitus is a disease which affects a huge number of people during the XXI century, we carry out prevention and care of the diabetic foot procedure, one of the most frequent complications of this disease, to show the problem by the whole, and about which Nursing has many things to say.We want to improve the patients' life quality and reduce the complications of the diabetic foot because if we don't treat them in time they can cause an infection, necrosis of the injured extremity, amputation⋯(invalidated processes all of them). As a consequence of this, it would be necessary a suitable health education, in order to try to avoid either the apparition of the problem or once the problem exits, proportionate the necessary care to guarantee a best kindness which finish its progression and sequels

OBJECTIVE: To study the concordance in the number of ethical problems identified in the care of the terminally ill between the members of a home care support team(HCST) and a group of experts before and after a course in bioethics and the introduction of a checklist DESIGN: Before-and-after intervention study SETTING: Area 7 of Primary Care, Madrid PARTICIPANTS: Terminally ill patients attended by the HCST between November 2001 and June 2002 INTERVENTION: bioethics course and introductionof a checklist MAIN MEASUREMENTS: Age, sex, basic illness, number of ethical problems identified by the HCST and by the group of experts before and after the intervention. The intraclass correlation coefficient (ICC) for the number of problems identified was calculated in both groups before and after the intervention RESULTS: 31 cases before and 29 after the intervention were studied. Before the intervention the HCST identified an average of 2.7±2.3 ethical problems per case; and the group of experts found 11.8±6.1. The ICC for the number of problems identified was 0.53 (moderate correlation). After the intervention, the HCST identified 5.9±6.5 ethical problems per case; and the group of experts, 10.7±7.9. The ICC for the number of problems identified was 0.87 (closecorrelation) CONCLUSIONS: The course and the introduction of a checklist helped professionals who were not experts in bioethics to detect ethical problems in treating terminally ill patients

OBJECTIVES: To evaluate the use at home of night-time pulsioxymetry to diagnose obstructive sleep apnoea syndrome in the general population DESIGN: Cros-sectional study of diagnostic tests PARTICIPANTS: Random sample of 70 individuals chosen from a Health Centre' appointment records MAIN MEASUREMENTS: Anamnesis concerning sleep and respiratory disorders during sleep, anthropometric measurements, Epworth's sleepiness scale, home night-time pulsioxymetry and polysomnography RESULTS: Visual inspection by oxymetry gave 82% sensitivity (95% CI, 62–93) and 69% specificity (95% CI, 53-82) for the diagnosis of obstructive sleep apnoea syndrome. Other indices such as the time with oxygen saturation below 90% and the number of desaturations above 4% gave a sensitivity of 82% and 86% and specificity of 63% and 65%, respectively. All the cases of clinically significant obstructive apnoea were diagnosed by pulsioxymetry CONCLUSIONS: Night-time pulsioxymetry is a useful test for general screening of obstructive sleep apnoea

OBJECTIVES: To describe the social and demographic characteristics and health problems of over-users of a health centre and to determine the number of attendances requested on demand at the general medical clinic. DESIGN: Retrospective and descriptive. Multivariate analysis: multiple linear regression. SETTING: Urban health centre. PATIENTS: Patients who requested a consultation at the health centre on at least nine occasions in 1999 (N = 7852). Random sample of 386 patients (alpha 0.05, 95% accuracy). MEASUREMENTS AND MAIN RESULTS: Dependent variable: number of on-demand consultations requested in 1999. Independent variables: age, family size, area of residence, active or pensioner, inclusion in programmes, health problems (CIAP-2), number of drugs on repeat prescription (Anatomical Classification), short-term time off work. 57% of over-users were women (CI, 52.9-62.7%); mean age 55 (SD 18.5); family size 2.7 members (SD 1.457); 58.8% pensioners. Mean number of appointments 15 (SD 6.7). Mean habitual consumption of 1.58 medicines (SD 2.46). Inclusion in programmes: 37.7% hypertension, 16% diabetes, 17% dyslipaemia, 16% nursing clinic. Most prevalent pathologies: cardiocirculatory (43.8%), endocrino-metabolic (32%), traumatology (26.7%) and mental health (21%). The regression model included the variables of age, number of medicines and having had short-term time off. CONCLUSIONS: Over-users of our health centre are middle-aged women with chronic physical health problems and with mental health problems. The number of attendances is related to age and administrative requirements: medication and sick notes.

OBJECTIVE: To determine possible differences between the control of hypertension in elderly patients and in young patients. DESIGN: Retrospective observation study of the differences between initial and final systolic and diastolic blood pressure, of their relationship to inclusion in medical treatment, and of the control obtained with different kinds of, and changes in, treatment, of drug association, periodic checkups, vascular disease and risk factors. SETTING: The urban Azpilagana Health District in Pamplona. PATIENTS: 389 hypertense patients were studied retrospectively: 196 of 70 or over and 193 between 45 and 60. MAIN RESULTS: More older patients were treated medically (91.8% vs 84.5%, p = 0.024), and received combined two-drug treatment (30.1% vs 19.7%, p < 0.001), although the young people received more than two hypertension drugs more often (11.4% vs 2.5%, p < 0.001). Final control (

OBJECTIVE: To assess the relationship between self-perception of their health and mortality in a representative sample of persons over 65 in a rural community. DESIGN: Survival study of population with three years observance. SETTING: A non-coastal and rural borough in Galicia. PARTICIPANTS: 408 people over 65, chosen by random sampling. MEASUREMENTS AND MAIN RESULTS: The demographic, social and health (objective and subjective) parameters were determined through an initial survey, with subsequent follow-up to find the date and cause of death should this have occurred. Of the 404 elderly people observed, 67 (16%) died. The main causes of death were diseases of the circulatory apparatus (48%) followed by tumours. Mortality was higher in people who were older, unmarried, didn't drink alcohol, were seriously ill, had restricted mobility, consumed more medicines and had a perception of their health as poor.We found an association between self-perceived health and mortality, after adjustment for age, sex, marital status, educational level and consumption of medicines, only when we looked at the elderly without restricted mobility (RR = 2.3; 95% CI = 1.0-5.3). CONCLUSIONS: We think that self-perception of health status can be an overall indicator of health, linked to mortality, and that in the elderly with good mobility, this association can be independent of age, sex, educational level, marital status and consumption of medicines.

OBJECTIVES: To propose a case-mix methodology for primary care, based on chronicity, type and age. To describe the explanatory value of these variables in the variability of the medical case-load. DESIGN: Observation, descriptive and retrospective study. SETTING: Primary care. Rochapea Health Centre, Pamplona. MATERIAL AND METHODS: Computer records of all the consultations between January 1996 and June 1997. Dependent variable: case-load. Independent variables: age, type, chronic pathologies (diabetes, lipaemia, chronic neurological diseases, COPD-asthma, chronic psychiatric illnesses, cardiopathy, hypertension, alcohol and other drug abuse). The Kruskal-Wallis test was used to compare work-loads by age groups; and multiple linear regression analysis to calculate the predictive power of the independent variables. RESULTS: Significant differences were observed for age groups. In the multivariate model used for general practitioners, all the variables could be included. They explained 24.2% of the variability in work load (R(2)). For paediatricians, age and asthma, explaining 23.48%, could also be included. CONCLUSIONS: Age, type and chronicity are useful variables for predicting case load from administrative data bases. They can be used in adjustments for case load applicable to capitation payment systems.

To describe the referral of hypertense patients from primary care to a hospital arterial hypertension unit, the quality of the information sent and the profile of the referred patients.A descriptive crossover study.The Hospital Clínico of San Carlos in Madrid.A simple random sample of 368 clinical records belonging to patients attended at the unit over the last 3 years.54.6% of patients were referred from primary care. 48.9% of the interclinical (IC) notes were high-quality, with 28.7% acceptable. 36.8% of referrals were considered incorrect, 30.3% because of false unresponsiveness to treatment. Good or acceptable IC notes were associated with 94.1% of correct referrals and only 65.4% of incorrect referrals.A high proportion of referrals which were incorrect by the consensus criteria were detected and were caused by inadequate or insufficient medical treatment. There was a statistically significant relationship found between correct referrals and the quality of information sent in the IC note.

To determine the proportion of elderly people with depressive disorders and study the possible association with sociodemographic factors, self-perception of health, cognitive function, diseases suffered, drug consumption, sleep disorders and use of services.An observational crossover study using a home interview.Community-based.787 elderly people aged 65 and over, not institutionalised and living in the city of Albacete.A questionnaire designed for the study was used to gather data on the sociodemographic variables, self-perception of health, diseases suffered, drug consumption, cognitive function, sleep disorders and contacts with the health service. The variables found by logistic regression to be associated independently to the presence of depressive disorders were: being female (OR = 2.75), habitually suffering sleep disorders (OR = 2.75), having self-perception of poor health (OR = 17.61) and cognitive deterioration (OR = 2.45).It would be advisable to apply a screening test to detect depressive disorders in elderly people with associated factors (being female, having sleep disorders, self-perception of poor health and cognitive deterioration), so that they could benefit from early diagnosis and adequate treatment.

Introduccion Los anticonceptivos orales son muy demandados por nuestra poblacion (sobre todo joven) en la actualidad. Sin embargo, estos farmacos no estan exentos de efectos adversos, que deben ser detectados y documentados precozmente. Este es el caso de la incidencia de adenomas hepaticos, cuya correlacion se observa claramente por su rapida desaparicion tras la suspension de los anticonceptivos en algunos casos. Caso clinico Mujer de 30 anos con el unico antecedente personal de una meningitis linfocitaria en la infancia sin secuelas. No seguia ningun tratamiento habitual en la actualidad. Se inicio tratamiento con anticonceptivos orales a peticion de la paciente a la edad de 21 anos. Acudio 2 anos despues a urgencias del hospital por dolor tipificado como colico biliar. En el estudio ambulatorio de dicho cuadro se realizo una ecografia abdominal, en la que se observo una lesion nodular en segmento 5 del lobulo hepatico derecho. La resonancia magnetica (RM) hepatica revelo una lesion sugestiva de adenoma hepatico en el segmento 5 de unos 24 mm de tamano (fig. 1). El estudio fue completado con una puncion-aspiracion con aguja fina (PAAF) de la lesion, cuyas extensiones citologicas resultaron negativas para malignidad. Se suspendieron los anticonceptivos orales despues de 3 anos de su inicio. Posteriormente, en consultas sucesivas, la lesion hepatica habia desaparecido en las pruebas de imagen. En la actualidad la paciente se encuentra asintomatica y no toma anticonceptivos orales. Discusion y conclusiones Los adenomas hepaticos aparecen predominantemente en personas jovenes y se localizan sobre todo en el lobulo hepatico derecho 1-3 . Suelen ser solitarios en un 70-80% de los casos, aunque en ocasiones son multiples, en relacion con los anticonceptivos orales, las enfermedades de deposito de glucogeno y en la adenomatosis hepatica 2 . Respecto a la toma de anticonceptivos orales, se establece una relacion que depende de la dosis y el tiempo de tratamiento. El riesgo suele ser mayor en pacientes > 30 anos, en tratamiento durante mas de 25 meses y con altas dosis de componente estrogenico 1,2 . Estos farmacos tambien alteran la historia natural de los adenomas hepaticos, que son mas numerosos y de mayor tamano. El mecanismo de produccion es desconocido; una hipotesis sugiere la transformacion de los receptores esteroideos de los hepatocitos por los anticonceptivos 2 . Suelen causar sintomas, como dolor abdominal en el epigastrio y el hipocondrio derechos y, a veces, como masa palpable o muerte subita con cuadro de shock por rotura peritoneal; en menor proporcion son asintomaticos 4 . Los hallazgos analiticos son poco frecuentes; puede observarse una elevacion de la fosfatasa alcalina y la GGT. Su malignizacion precoz puede descartarse mediante estudios de imagen y la determinacion de incrementos sericos de alfafetoproteina 2 . El diagnostico debe realizarse con los hallazgos clinicos, las pruebas de imagen (ecografia, tomografia computarizada y RM abdominal) y/o reseccion quirurgica 1-3 . El mayor problema radica en la diferenciacion del adenoma hepatico de la hiperplasia nodular focal 5 y para el diagnostico definitivo se requiere en ocasiones la reseccion quirurgica. El manejo de estas pacientes es variable y depende de los sintomas, las caracteristicas de la enferma y el tamano y numero de los adenomas hepaticos. Se suele recomendar la reseccion de los que causan sintomas, aunque su tamano (aproximadamente > 5 cm) es controvertido 1,2 . En pacientes embarazadas, el comportamiento de estas lesiones es impredecible y en ocasiones requieren cirugia, como en el resto de pacientes. Se puede concluir que las pacientes jovenes consumidoras de anticonceptivos orales deberian ser revisadas periodicamente, ante la sospecha de reaccion adversa hepatica, bajo control ecografico, al principio cada 2-5 meses 1 , y considerar la biopsia hepatica (PAAF) o la cirugia en algunos casos. La suspension de estos farmacos es primordial, ya que en algunos casos cabe esperar una resolucion espontanea, como ocurrio con nuestra paciente; sin embargo, en la mayoria de las pacientes los adenomas no varian o disminuyen ligeramente el tamano.

To find the sort of information given to cancer patients in PC and the factors which affect the disclosure of the diagnosis.A descriptive crossover study, carried out through a personal interview.A county hospital with no oncology service.All those patients with cancer (histologically confirmed) admitted to the hospital during April and May 1993.Each patient was asked what illness he/she had, who told him/her and where, along with his/her sociodemographic details. Later the date of diagnosis and the site and spread of the tumour were taken from the medical records. Out of 108 patients under study, 8 knew they had cancer, 1 said he/she had a tumour and 11 believed they had "something bad". 7 patients had no information about their illness and 81 gave alternative diagnoses (inflammation, cyst...). Disclosure was more common in the cases of breast cancer, haematological cancer and those diagnosed over 6 months previously. No significant differences regarding the spread of the tumour or the sociodemographic variables were found.The disclosure of a diagnosis of cancer is the exception, not the rule. Concealment is only abandoned in the case of potentially curable tumours and those which offer a longer life expectancy.

To find out the employment situation and the career level of family doctors (FD) trained through residency in Asturias.A descriptive crossover study carried out with a self-filled questionnaire returned by mail.All of Spain.FDs trained through residency in Asturias up to 1993.178 (89%) of the 200 FDs located replied. 8 who had not finished their course were excluded. Between 1979 and 1983 42 people began their training (24.7%); 42(24.7%) between 1984 and 1987; and 86 (50.5%) between 1988 and 1991. 96 worked in health centres (56.4%); 30 in hospital casualty (17.6%); 9 in administration and management (5.2%); 16 were unemployed (9.4%) and 8 in other posts (4.7%). 49 FD had a permanent post (28.8%); 32 of these had started their training before 1984. 63 (37.5%) chose family and community medicine (FCM) as a vocation. Of these, 26 began their training between 1979 and 1983, 17 between 1984 and 1987 and 20 after 1988. A significant relationship was found between starting training in 1984 or before and choosing FCM as a vocation; and also between starting FCM training in 1984 or before and having a stable job.The more recent FCM students had less vocational motivation for their choice of FCM and greater difficulty in obtaining a stable job, which may lead to progressive disenchantment with FCM.

To find chronic morbidity, self-perception of health status and its relationship with different socio-economic and health variables, among the elderly in our health area.A crossover study using a home questionnaire.A rural area in Galicia.408 people over 65, chosen by simple random sampling from the census.Data referring to socio-demographic features, chronic morbidity, self-perception of health, use of health services and drugs consumption, were extracted from a previously validated questionnaire containing 100 items.A high prevalence of chronic pathologies was found. 72% of those surveyed stated that they had some chronic illness, with eye disorders (71%), arthrosis (71%) and hypoacusia (44%) being the most common. 73% said they had taken medicine during the previous fortnight. 32% had consulted a health professional in the previous two weeks. Almost a quarter (23.8%) of those surveyed had self-perception of poor health, which was associated with feminine gender (p = 0.001), drug consumption (p = 0.0002), considering their economic resources insufficient (p = 0.02) and getting on badly with their family (p = 0.008). However, we found no association with living alone, nor with consulting health professionals.There is high prevalence of chronic illnesses among the elderly. Self-perception of poor health is related not only to health problems, but also to economic and family problems.

To determine the proportion of the elderly who have difficulties in their perceptive functions (seeing and hearing) and associated factors in the area of health self-perception and functional capacity.Observational and crossover, using an interview.Community.787 elderly people not in institutions; 93.8% reply rate.Using a questionnaire, data were obtained on deficiencies in their sense organs and self-perceived health. Validated scales to determine functional capacity (physical, psychic and social) were used: Katz, Lawton and Brody indexes, Cognitive mini-test, DUKE-UNC questionnaire and Geriatric Depression scale. A serious difficulty or inability to read or watch television was expressed in 17.3% of cases (CI 95%; 14.8-20.0) and to follow a normal conversation in 10.5% (CI 95%; 8.4-12.6). The proportion of the elderly dependent on others to carry out their normal daily activities was 2.2 times greater among those who displayed severe visual problems (CI 95%; 1.7-2.9) and 1.8 times greater if they had hearing difficulties (C.I. 95%; 1.4-2.3). There was a linear tendency between greater visual or auditory problems and less social support (p = 0.01), greater dependency on others for basic daily activities (p0.001) and worse perceived health (p0.001).The elderly, especially the oldest among them, frequently display hearing and visual problems, which are related to low self-perception of health and greater functional incapacity.

We try to determinate the epidemiological distribution of the different pathologies which produce laboral absenteeism.Descriptive study.IV Health Area, Asturias.Parts of discharge laboral transitory incapacity P9. INTERVENTION AND MAIN RESULTS: The gross rate of laboral transitory incapacity is 16.8%. Sex: 67.3% male, 32.7% female. The mean days for episode is 37.42 (DE = 60.47). Female average duration is 10 days more than male. For each year the mean duration increased 1.3 days (r = 0.25; p0.05). The 50% episodes has a duration less than two weeks. The three main illness groups are the breathing diseases (VIII), locomotor diseases (XIII) and accidents and traumatism (XVII). Many pathologies are associated with sex and age. Many pathologies have a stational distribution: VIII (p0.001), digestive diseases (p0.001), mental diseases (p0.05) and XVII (p0.05).1) Is interesting the exploration of the information contents in P9 parts. 2) The aged is relationed with during of absenteeism. 3) Many pathologies were associated with the sex and aged of patients. 4) Many pathologies have a stational distribution.

To find the use of serological markers for the Hepatitis B (HBV) and Hepatitis C (HCV) viruses by doctors at an urban Health Centre, assessing the number of requests and their diagnostic effectiveness.Prospective and retrospective study of observation.Primary Care. Urban Health Centre.All those for whom requests for HBV and HCV serological markers were made between 1.1.92 and 30.3.93.A total of 131 requests for HBV markers and 82 for HVC ones were made during the study period (1% of the total analyses performed). 30.5% of the HBV markers and 12.2% of the HCV ones were positive. 36% of the requests for HBV markers were for preventive as against 64% for diagnostic reasons. The diagnostic effectiveness (percentage of positives among the requests made for diagnostic reasons) was 35.7% for HBV and 13% for HCV serology. The manner of contagion could not be determined from the information collected in the clinical notes for 56% of the patients with positive serology. The performance of a Hepatic Biopsy was recorded for 10% of the patients with positive HBV or HCV serology, with diagnoses of 4 cases of active chronic Hepatitis and one of late cutaneous Porphyria.The availability of an accessible and correct request form for HBV and HCV markers could assist greater diagnostic accuracy and referral to specialists if required.

To analyse whether the variables of gender, age and type of job of those in full-time work affect short-term unfitness for work (SUW) in a study undertaken within our health area.A prospective and retrospective study of all the SUW.Primary Care. An urban Health Centre.Those people with full-time jobs registered at the Centre.The entire 1098 certificates of SUW issued in 1990 were processed. The population pyramid and job distribution among those in full-time work was obtained by a random sample of 5% of the active population. When time off for maternity (TOM) was excluded, women accounted for 44.8% of SUW and men 55.2%. There were no significant differences with the percentages these figures represent for the active population as a whole. The number of SUW per 100 people in work was 15.9 for men and 21.5 and 17.4 for women (including and excluding TOM, respectively). The average length of SUW, excluding maternity, was 27.06 days for men and 26.8 for women. On the question of age, those under 19 and over 40 contributed least to the SUW percentage. Additionally, those under 19 and over 60 were the proportions of the population least prone to SUW. On the question of type of job, we found a higher contribution to absenteeism than expected within Groups 3 and 4 and less in Groups 0/1, 5 and 7/8/9. The longest average length of time for SUW was in Group X (84.2 days/SUW).Excluding TOM, gender does not appear to be a variable that affects SUW. Age group and type of job are variables affecting SUW. It will be necessary to undertake research into whether there are additional social or labour factors which might explain.

To study the quantitative relationship that exists between mental problems and use of the general medical practitioner, and the association between such problems, increased use of the medical services, and morbidity and socio-demographic variables.Observational cross-section study. SITE. A primary care team's general medical consultations.Patients aged over 15, attending the consultations. A sample of 310 patients was selected using systematic sampling.The Mental Health GHQ, 28 items questionnaire was administered to the patients, to detect the existence of significant mental health disorders.Amongst older patients there is a greater incidence of mental illness, statistically significant at p less than 0.01. Also significant at p0.01 were the greater number of visits to the doctor amongst patients previously diagnosed as having mental disorders, amongst the elderly, those patients included in health programmes and those who showed greater take-up of supplementary explorations and interim consultations.The results demonstrate an association between mental illness and greater number of visits to the general practitioner, leading to the hypothesis that a considerable number of such visits could be attributed to mental illness. There is no doubt that it is important to integrate the mental health services into primary care practice.

To measure doctors' attitudes to the opening of Health Centres.Descriptive study. SITE. Primary Care services on the island of Gran Canaria.Doctors with tenure.From a self-administered Likert type questionnaire, it could be observed that the proportion of those polled who did not reply was linked to the number who had a "Fiscal Licence" (Odds Ratio O.R. = 6.26), a ratio which did not disappear when stratified by age (O.R. = 5.88 for those less than or equal to 40 and O.R. = 3.08 for those greater than 40). The scale presented high internal consistency (Cronbach alpha 0.937), indicating favorable attitudes from doctors integrated into Health Centres and both positive and negative attitudes in doctors of a traditional cut. Those specialising in Family Medicine, those under 40 years old, those who had no other health job and those connected with Trades Unions showed more favorable attitudes.Individual and group characteristics are linked to different attitudes. The knowledge, evaluation and behaviour components of doctor's attitudes must be improved, by involving the reference groups of both individuals and groups.

To describe the frequency and distribution of sexual conduct with risk of pregnancy, the degree of information on sexuality and contraceptive methods. To analyze the relationship between sexual conduct with risk of pregnancy and the most relevant variables of social surroundings of the adolescent: family, friends, school, etc.Descriptive survey by means of a questionnaire.Basic Neighbourhood Health Zone (Gran Canaria).Teenage students aged between 14 and 19. Measurements and main results 21% of the population in the survey have sexual relationships, and out of these, 88% run a high risk of becoming pregnant. The information they have is basically theoretical, and practical knowledge is low. Older adolescents (OR, 1,4/year), males (OR 2.08), those with parents with no qualifications (OR 1.88) and those with parents of a high income bracket (OR 4.11) have the most high-risk sexual relationships.The importance of high-risk sexual conduct in adolescence is underlined, plus the need for information of adolescents, although it does not seem enough, in order to face sexuality with guarantees.

To assess the level of immunity in a healthy population to the hepatitis A virus (HAV), according to age groups and in an urban health area.Transversal random prospective study of a sample of the population found by letters. SITE. Primary Care Centre covering the population of an urban health area in Valladolid.Random sample of 726 people with an adjustment as to sex and age according to the area's average, in line with the full census of the above area. The sample was 95% trustworthy, with a 3% margin of error. People with serious illness at the time of the study were excluded.We carried out a social-health count. We established the anti-HAV titer after its detection by enzyme immunoanalysis (HAVAB EIA Abbott); the titers were inferred from the absorbances relating then to that of a a "pool" of serums with very high titers. 69.9% (standardised rate) gave positive. The highest titers were presented in people between 31 and 50 (29.7 +/- 47.0), with significant differences both for lower (17.0 +/- 15.7) and higher (15.7 +/- 19.8) age groups (p. 0.001 for both).The highest anti-HAV titers corresponded to people in the middle age-group, with a subsequent dropping-off. This could suggest a greater susceptibility to HAV infection in the older person.

A survey was carried out in the ten Health Centers in Salamanca using a questionnaire about aspects related with hypertension, the material used, diagnostic methods, risk factors, therapeutic approach, and management of hypertensive paroxysms and emergencies. Participation was 59.5% and the median age 36 years. There was a definite male predominance (85.3%). The use of three blood pressure readings in successive visits for the diagnosis was preferred by the professionals with younger working age [Cl = 8.8 to 12.8 years; (p less than 0.05)]. Regarding the type of Center (rural, urban, semiurban), significant differences regarding the investigated issues could not be established. The most relevant conclusions were deficiencies such as inadequacy of cuffs (53.3%), lack of calibration of sphygmomanometers (41.9%), introduction of thestethoscope within the cuff (34.7%), use of beta-blockers in hypertensive diabetics (13.5%).

ObjetivosDescribir las características sociodemográficas y problemas de salud que presentan los pacientes hiperconsultadores de un centro de salud y determinar los factores que explican el número de visitas solicitadas en consulta demanda del médico de familia.DiseñoDescriptivo, retrospectivo. Análisis multivariante: regresión lineal múltiple.EmplazamientoCentro de salud urbano.PacientesPacientes que han solicitado cita para consulta demanda en el centro de salud en al menos nueve ocasiones durante 1999 (n = 7.852). Muestra aleatoria de 386 pacientes (alfa, 0,05; precisión, 95%).Mediciones y resultados principalesVariable dependiente: número de consultas demanda solicitadas en 1999. Variables independientes: edad, tamaño familiar, zona residencia, activo o pensionista, inclusión en programas, problemas de salud (CIAP-2), número de fármacos en prescripción repetida (clasificación anatómica), incapacidad laboral temporal (IT). Los hiperconsultadores son un 57,8% (IC, 52,9-62,7%) mujeres; edad media, 55 años (DE, 18,5); tamaño familiar, 2,7 miembros (DE, 1,457); 58,8% pensionistas; número medio de citas, 15 (DE, 6,7); consumo medio, 1,58 (DE, 2,46) fármacos de forma habitual; inclusión en programas: 37,7%, hipertensión; 16%, diabetes; 17%, dislipemia; 16%, consulta de enfermería. Patologías más prevalentes: cardiocirculatorias (43,8%), endocrinometabólicas (32%), traumatológicas (26,7%) y salud mental (21%). El modelo de regresión incluye las variables edad, número de fármacos y haber estado en IT.ConclusionesLos hiperconsultadores de nuestro centro de salud son mujeres de edad media con problemas de salud física de evolución crónica y problemas de salud mental. El número de visitas está relacionado con la edad y las necesidades administrativas: medicación y bajas.ObjectivesTo describe the social and demographic characteristics and health problems of over-users of a health centre and to determine the number of attendances requested on demand at the general medical clinic.DesignRetrospective and descriptive. Multivariate analysis: multiple linear regression.SettingUrban health centre.PatientsPatients who requested a consultation at the health centre on at least nine occasions in 1999 (N = 7852). Random sample of 386 patients (alpha 0.05, 95% accuracy).Measurements and main resultsDependent variable: number of on-demand consultations requested in 1999. Independent variables: age, family size, area of residence, active or pensioner, inclusion in programmes, health problems (CIAP-2), number of drugs on repeat prescription (Anatomical Classification), short-term time off work. 57% of over-users were women (CI, 52.9-62.7%); mean age 55 (SD 18.5); family size 2.7 members (SD 1.457); 58.8% pensioners. Mean number of appointments 15 (SD 6.7). Mean habitual consumption of 1.58 medicines (SD 2.46). Inclusion in programmes: 37.7% hypertension, 16% diabetes, 17% dyslipaemia, 16% nursing clinic. Most prevalent pathologies: cardiocirculatory (43.8%), endocrino-metabolic (32%), traumatology (26.7%) and mental health (21%). The regression model included the variables of age, number of medicines and having had short-term time off.ConclusionsOver-users of our health centre are middle-aged women with chronic physical health problems and with mental health problems. The number of attendances is related to age and administrative requirements: medication and sick notes.

We have evaluated the clinical and epidemiological features of hepatic cirrhosis in a retrospective study of 200 patients admitted to our Area Hospital from 1984 to 1987. 77% of patients were 40-69 years old and 74% were males, with a M/F ratio of 2.84. 56% were caused by high alcohol intake, 25% were cryptogenic and 13% post-hepatitis. 29.2% were diagnosed in a compensated stage of the disease. 52.2% presented with ascites, and 30.5% with upper gastrointestinal hemorrhage. We found superimposed hepatocellular carcinoma in 4.5% of patients, all of them males, with a mean age of 63.5 years. 18% died during their hospital admission, 50% from hepatic coma, 19.4% from hypovolemic shock and 16.6% from hepatorenal syndrome. Survival from the time of diagnosis in the patients who died was shorter than one year in 41.5%.

In the present study, 147 skin lesions suggestive of epithelioma are reported, corresponding to 129 patients evaluated in a Dermatologic clinic from the Social Security in Cordoba. In 30 lesions biopsy could not be performed owing to patient's refusal. Out of the remaining 117, 89 corresponded to epitheliomas (68 basal-cell epitheliomas and 21 squamous-cell epitheliomas). The incidence was 55.4/100 000/year, with a proportion of basal-cell epitheliomas of 3:1. The higher rate was found in males older than 50 years, peasants and with previous exposure to sun. The most common localization was the nose and malar region for basal-cell epitheliomas and the lower lip for squamous-cell epitheliomas. It is concluded that early diagnosis of skin and mucosal epitheliomas is important owing to their frequent morbidity. In addition, the need for a higher suspicion index both in the population and the general practitioners is emphasized.

We report a clinical and epidemiological study of 164 cases of complex urinary calculi which were seen in our hospital between 1984 and 1988. The highest incidence was found in patients aged between 40 and 50 years, with a female:male ratio of 1.27/1. In 37% of patients there were first degree relatives with calculi. The most common type were calculi with a calcium component, with a remarkably high proportion of struvite calculi and a low one of uric acid. Housewives had a high rate of struvite calculi associated with infections during pregnancy. Qualified professions have been associated with calcium oxalate and phosphate calculi. 13% has congenital renoureteral malformations, 4% had hyperuricemia and 1.2% had hyperparathyroidism. Pain was the most consistent symptom, followed by fever and urinary tract infection. 50% of patients had previously passed stones. 90% of calculi were visible in the plain abdomen X-ray film. 65% of patients required aggressive therapy.