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The objective of the study is to assess the outcome of a Primary Care programme of replacing the Percutaneous Endoscopy Gastrostomy at home.A retrospective descriptive study was conducted on all patients (n=44), of Zaragoza Health Sector III, carriers of a percutaneous endoscopy gastrostomy (PEG), who had a replacement at home by the Home Care Service (HCS), during the period from September 2008 to December 2010. Socio-demographic data, the number of PEG replacements performed on each patient, any incidents occurring with each replacement either by the Endoscopy Department or the HCS, as well as the time elapsed until the next replacement, were all recorded.The mean age of the patients was 74.02 years, and up to a 65% lived in rural areas. The main causes of dysphagia were dementia (56.82%). A total of 136 PEG replacements were performed by the HCS (mean 3.09, SD: 2.37). There were 18 cases in which complications arose. Of these, 17 were minor complications and resolved in the patients' homes. The only major complication, a peritonitis, was resolved in the hospital. The HCS made 138 trips (53.62% of them in rural areas). Each patient avoided travelling a total mean of 43.13 km, and 75.24 km in rural areas.The replacement of PEG is a simple method that can be performed at home with a low risk of complications, provided there is an effective selection of patients. This leads to increased patient and family comfort, and reduces health care costs without detriment of performance.

The objective was to determine the percentage of patients with peripheral arterial disease (PAD) with good control of their cardiovascular risk factors (CVRF) (LDL cholesterol, blood pressure and smoke cessation).Cross-sectional multicentre study. The location was Primary Care and other clinics that typically treat patients with peripheral arterial disease (Internal Medicine, Vascular Surgery, Cardiology, Endocrinology and Nephrology). The first 10 patients with peripheral arterial disease were systematically selected by 440 researchers from all regions.The study included 4087 patients. Blood pressure was controlled in 29.5% of the cases. The frequency of patients with optimal control was significantly better in primary care (p.01). There was an optimal control of LDL-C levels in 30.4% of patients. Factors associated with optimal control of LDL-C was, being diabetic, stage I of La Fontaine, and being seen by a doctor that was not the primary care physician. Control was worse in women and in smokers.Primary care physicians better manage patients with hypertension. Patients seen in by a specialist as opposed to primary care are more likely to achieve optimal control of CVRF. The situation is far from the ideal, only 6% achieved optimal control of all CVRF.

Dyspnoea is mainly of cardio-respiratory origin. A diagnosis of psychogenic origin should not be made without having undertaken the necessary complementary tests to rule out any underlying organic cause, even if the patient has a psychiatric history. We present a clinical case with a clinical picture of dyspnoea, in a 30 year-old male of African origin with a history of schizophrenia. Oedemas can also be associated with dyspnoea. Cardiomegaly and hypertrophy of the left ventricle were established, using additional basic tests. The diagnostic confirmation of dilated cardiomyopathy was obtained from the echocardiogram. He was diagnosed in D phase, with decompensated heart failure, which was refractory to treatment, and after several incidents of malignant arrhythmias, the patient died. According to the ACC/AHA classification, the definitive treatment in this phase is the heart transplant. In the present case, urgent intervention was not considered, due to the worsening of the psychiatric pathology and active drug-taking.

The percentage of women immigrants in Spain has increased in these last years, resulting in the emergence of specific needs related to sexual and reproductive health. The objective of this article was to define the contraceptive methods used by immigrant women and the determining factors that influence their choice. To estimate the use of emergency post-coital contraception and prevalence of abortion.A descriptive cross-sectional study using a survey was carried out in the first quarter of 2011 at the "Centro de Salud Delicias Sur" in Zaragoza, Spain. The target population were immigrant women of childbearing age between 15 and 45 years who attended the clinic. Non probability sampling was used.The mean age was 29.35 years (95% confidence interval (CI) = 27.95 to 30.75 years). The majority country of origin was Ecuador. Almost half the women were single and worked in paid employment. The educational level was considered as average. The average duration of residence in Spain was 5.68 years (95% CI = 4.99 to 6.37 years) and 42% of them (95% CI = 32.62 to 51.83) did not use any contraceptive method. The most used contraceptive method was the condom, followed by oral hormonal contraceptives. More than half of the women had been informed in Primary Care. Almost one third (32%) (95% CI = 23.42 to 41.60) of the women had a history of abortion. More than 19% of women (95% CI = 12.46 to 28.10) had used the emergency contraceptive method.Contraceptive methods were not used by 42% of women. The alert indicators on the failure of preventive measures in sexual health are still too high.