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Text: Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.

Introduction: Epidemiological studies of the risk factors of cerebrovascular disease are of great interest, particularly the identification of factors which may be modified. Previous studies carried out in the Alcoi region of Alicante province, showed a high prevalence of cerebrovascular disease. The town of Bañeres was therefore chosen for confirmation of this data and identification of the frequency of vascular risk factors., Objective: To compare the group of patients with cerebrovascular disease with the remainder of the population interviewed., Patients and Methods: In a door-to-door study in Bañeres 1,832 people were interviewed as part of the Bañeres Project. The population aged over 45 years was interviewed and filled in a questionnaire for diagnosis of transient ischemic accidents., Results: Arterial hypertension: estimated prevalence 500/1,000 inhabitants, relative risk 3.24; diabetes mellitus: estimated prevalence 195/1,000, relative risk 2.18; coronary artery disease: estimated prevalence 58/1,000, relative risk 1.88; peptic ulcer: estimated prevalence 75/1,000, relative risk 1.23; smoking: estimated prevalence 110/1,000, relative risk 0.46; complete arrhythmia: prevalence 73/1,000, relative risk 5.23. Family histories of cerebrovascular accident, arterial hypertension, diabetes and coronary artery disease were not significant., Conclusions: Arterial hypertension, diabetes mellitus and arrhythmia were significantly more prevalent amongst patients with vascular disease in our setting. We found no association with the other risk factors analyzed.

A door-to-door survey of transient ischemic attack was conducted in Muro de Alcoi using a randomized sample. We randomly choose 646 people of the 4.525 included in the census. The prevalence ratio found for TIA and stroke were 12.3 per 1,000 people (95% CI 3.9-20.7). The age-specific prevalence rates for male and for women were 12.4 per 1,000 (95% CI 0.3-24.5) and 12.3 per 1,000 (95% CI 0.4-24.2) respectively. The work suggests that methodology of ascertainment strongly influences in the obtained rates, and reinforces the data of our previous whole population work in the same area.

Background: Accidents in childhood are an important health problem, mainly in situations of social and environmental risk. Additionally, the lack of studies in primary health care, encouraged us to set up a study in order to establish the characteristics of accidents in childhood attended in a health center, their relation with the child's socio-familiar situation and medical care delivered., Methods: We describe children's accidents occurred in our area (2,543 children 0-14 years old, 788 of them living in deprived neighbourhoods) during 1992 attended in the health center. Study data was collected from data included in emergencies and medical records of the health center. We included information on: age, sex, socio-familiar situation, accident, lesion, and health care delivered characteristics., Results: We include 623 accidents: annual cumulated incidence = 245/1,000 children; males were more affected (58.4%); the accidents occurred mainly in the household (35.6%); the most frequent causes were blows (39.9%) and falls (30.5%); the most frequent lesions were injuries (29.7%) and blows (25.7%). Location of the lesions were the superior limbs (33.5%) and head and neck (25.98%). About 12.5% were delivered to the hospital, 17.8% of them required inpatient care, one died. Children of deprived boroughs have a relative risk of being attended for accident in our center of 4.2 (CI 95% = 3.64-4.84) compared with the rest of the area. 79 children have had repeated accidents, they occurred mainly in only 27 families, 92.6% of whom live in deprived areas., Conclusions: Our health center is attending a high frequency of children's accidents, most of them can be treated in the health center, the cases are concentrated in deprived boroughs and in risk families.

Objective: To evaluate the real problems of insomnia, analysing its prevalence and its characteristic presentation, within the clinics using an appointment system at a Primary Care Centre., Design: Observation study of a crossover type, by means of a personal interview., Setting: Primary Care context., Patients: The survey was on the basis of a sample population calculated for qualitative variables (N = 470; a = 0.05; p = 0.50; i = 0.05). A total of 490 patients, taken from the appointment lists of on-demand clinics by means of systematic sampling (K = 4), were studied., Measurements and Results: The reply index was 100%. Out of a sample study population of 490, 278 patients with insomnia were recorded. 65.83% had proximal insomnia (difficulty in getting to sleep); 49.28%, interrupted sleep (intermittent insomnia); and 16.5% of cases, late insomnia (premature waking). Insomnia was persistent in 69.1% of cases and transitory in 30.9%. Regarding the aetiological factors linked to insomnia, non-organic mental disorder (64.29%); known organic Pathology (25%)., Conclusions: 57% (CI 0.53 divided by 0.61) of the population under study had suffered insomnia at some time. 61.9% of these were suffering it at the time of the survey; and only 44% of these sought medical advice for the problem. We found that a significant relationship existed between suffering insomnia and age, civil status and socio-economic level. It is important to manage and have sufficient knowledge of insomnia, as it is a common health problem in Primary Care.

Objective: To discover the prevalence and most relevant epidemiological characteristics of the victims of traffic accidents which occur in our health area., Setting: Hospital Casualty department (HC), Health area 19, Alcoy., Patients: This was an observational, crossover study, based on the collection of data from all those patients who had been brought into the HC for attention because of a traffic accident and who were attended between October 1, 1990 and September 31, 1991., Measurements and Main Results: During the study period a total of 1,111 traffic accident victims were attended. Their average age was 26.62 (SD +/- 15.95), with 69.6% being men and 30.2% women. 60.7% of the victims were attended on non-working days or the eve of a non-working day. 44.5% of those involved in accidents were in four-wheeled vehicles; 40% on two-wheeled vehicles and 11.1% of the victims were pedestrians. Injuries were light in 73.3% of cases; moderate in 15.9% and in the other 8.8% serious, grave or critical. 43.7% of the total had the accident in an urban area and 40.9% on the open road., Conclusions: The high prevalence of victims of accidents (8.3 per 1000 inhabitants) observed in our health area can be explained by the type of study. It is vital to obtain valid information of the real importance of this health problem. The primary care doctor must take preventive action concerning traffic accidents: a) through full studies of traffic accident levels among primary care centre users; b) primary preventive action, through the spreading of information on norms of safety; and c) secondary and tertiary prevention, by means of effective and efficacious outpatient emergency measures, as well as a thorough rehabilitation of accident victims.