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Introduction: The estimated seroprevalence of hepatitis C virus (HCV) in Spain is 1.7%, but is much higher in the at-risk population. The most efficient national screening strategy is unclear., Aims: To estimate the prevalence of HCV among the at-risk population seen in primary care (PC), and to determine their epidemiological profile., Materials and Methods: Cross-sectional descriptive prevalence study that included adult patients with risk factors for HCV infection seen in PC in the southwest Madrid region between 2010 and 2012., Results: A total of 158 patients (men=51.3%), mean age 46 years (SD=16.6), were included. The most common risk factors were hypertransaminasaemia (44.3%) and major surgery (13.3%). Immigration, unsafe sexual practices, and tattoos or body piercing were more prevalent in patients younger than 45 years of age. Fifteen patients (9.5%) were positive for anti-HCV; 9 of these (5.7%) were HCV-ARN positive. Of the positive patients, 4 (44.4%) had significant fibrosis at diagnosis (F3-F4). Male patients had a higher rate of positive anti-HCV results (13.8 vs. 5.3%; P=.072), as did patients older than 45 years of age (12.8 vs. 6.3%; P=.167). Intravenous and intranasal drug use were associated with a higher rate of positive anti-HCV results (50 vs. 8.5%; P=.005 and 66.7 vs. 8.4%; P=.001, respectively)., Conclusions: Patients with risk factors for HCV infection have high seroprevalence. Screening programmes must therefore be implemented to detect HCV infection in this population in PC., (Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.)

The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Objective: To identify the opinions of patients of the Murcia Health Service on the adoption of personal health records (PHRs) and the factors associated with these opinions., Methods: A cross sectional and descriptive study was performed by personal survey of a sample of individuals (N=156) aged between 14 and 80 years old in five public health facilities of districts VI and VII of the Health Service of Murcia., Results: A total of 87.8% of the population stated they would use PHRs. Respondents aged 24-33 years old were 13.15 times more willing to use PHRs (95% CI: 1.09-157.42) than people over 63 years old. A lower probability of using PHRs was found in people who did not use the Internet, with an odds ratio of 0.31 (95% CI: 0.07-1.29); this difference was not statistically significant., Conclusions: Most of the patients surveyed had never heard of PHRs but most would be willing to use them., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background and Objective: To determine the characteristics influencing pneumococcal serotype colonization in healthy pre-school aged children, the distribution of serotypes and their antimicrobial susceptibility, after the introduction of pneumococcal 7-valent conjugate vaccine (VNC-7 v). SUJETOS AND METHODS: Nasopharyngeal samples were collected from children under 6 years of age attending well-child examinations in the province of Zaragoza (Spain). Logistic regression was used to study different variables related to the status of the carriers., Results: Of the 371 children studied 30.7% were found to be carriers. With a vaccine coverage rate of 66%, factors related with presence of pneumococcal carriage were found to be the number of siblings (OR 1.44; CI 95% 1.05-1.97 for each sibling), attending a school or child day care centre (OR 3.99; CI 95% 2.00-7.96) and suffering from a minor upper respiratory tract infection (URTI) (OR 1.72; CI 95% 1.02-2.90). Only 8.7% corresponded to VNC-7 v serotypes. The most common non VNC-7 v serotypes isolated were 19A, 6A, 15B, 11, and 15A. Significantly greater resistance was detected among VNC-7 v serotypes., Conclusion: Children in the setting of this study carried pneumococci more commonly when they have siblings, attend school or day care, or suffer from minor URTI. In the VNC-7 v vaccine era, VNC-7 v serotypes have become rare occurrences (8.7%) and emerging serotypes present better susceptibility to antibiotics., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objective: To evaluate a training programme in the primary care of acute coronary syndrome., Design: A before-during-after comparative cross-sectional study., Setting: Health areas of Lleida, High Pyrenees and Aran (Spain), from 2003-2006., Participants: Patients with acute coronary syndrome admitted to the intensive medicine unit and the coronary unit of the Arnau de Vilanova University Hospital of Lleida after being referred from home, general practitioner or health centre., Intervention: A training program was introduced to establish protocols of pre-hospital performance in acute coronary syndrome (the administration of acetylsalicylic acid, nitroglycerin and morphine chloride, the performing of an electrocardiogram, the insertion of an intravenous tube and to speed up care times)., Main Measures: Linear trend of the three periods of the study was analyzed through prevalences ratio and linear trend test., Results: The intervention showed a statistically significant linear increase in the application of the aforementioned therapeutic procedures, with the exception of nitroglycerin, which started out with a higher baseline level, and an improvement of care times. The application of an electrocardiogram obtained almost optimal levels. Care times considerably improved., Conclusions: Training programs are a useful tool in improving treatment of acute coronary syndromes in primary care. Advance diagnosis and an early start to treatment almost certainly results in a decrease of its morbidity-mortality., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Introduction: Asymptomatic unilateral tonsillar enlargement is usually treated with systematic tonsillectomy under suspicion of malignancy. Due to the fact that most of the cases are benign pathologies, we set out to study the clinical signs that would help us in the diagnosis in order to avoid unnecessary tonsillectomies., Material and Methods: We reviewed 267 tonsillectomies performed from 1996 to 2006 and 30 of these were indicated because of asymmetry. We evaluated risk factors for malignancy: cervical lymphatic node enlargement, sex, age, tonsillar enlargement noticed by the patient, suspicious appearance, systemic symptoms, history of malignancy and immunocompromise., Results: Histopathologic study revealed 80 % to be benign and 20 % malignant. The risk factors with the strongest association were enlargement of cervical lymphatic nodes and suspicious appearance of the tonsil., Conclusions: Strict control of a unilateral tonsillar enlargement is possible, but it is mandatory to perform a tonsillectomy when the appearance of the tonsil raises suspicions or there are enlarged lymphatic nodes.

Introduction and Objectives: Pharyngocutaneous fistula is the most frequent complication after total laryngectomy. Risk factors involved in its appearance have been studied by many authors without conclusive results. Our main objective is to identify the risk factors involved in the onset of fistulae at our institution., Methods: A retrospective case-control study was designed. Thirty-three patients subjected to total laryngectomy with the same protocol were included in both groups. Patients who required a complex surgical reconstruction were excluded in order to avoid biases., Results: The only risk factor with statistical significance (P=.04) for the onset of fistulae in our setting is the extension of the surgery to the pharynx (OR=2.83). The association of prior radiotherapy and concurrent neck dissection displayed a notable trend (OR=0.32) but without significance (P=.099). Patient age, prior radiotherapy, concurrent neck dissection, prior tracheotomy and post-operative haemoglobin level did not predispose to this complication in our study. Non-surgical closure of the pharyngocutaneous fistula was achieved in most cases (72.7 %) but patients who had pre-operative radiotherapy required surgical closure more frequently (P< .01) than those not irradiated., Conclusions: At our centre the main risk factor associated with post-laryngectomy fistulae is the extension of surgery to the pharynx. In previously-irradiated patients, fistulae have a lower incidence of non-surgical closure and require more aggressive surgery to resolve them.