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Resumen Introduccion El objetivo del estudio es medir los resultados de un programa de recambio de sondas de gastrostomias en domicilio, realizado por atencion primaria. Material y metodos Estudio descriptivo retrospectivo. Incluyo a todos los pacientes (n = 44) del Sector III de Zaragoza portadores de gastrostomia endoscopica percutanea (GEP) a los que se les realizo el recambio de la misma en su domicilio, por el equipo de soporte de atencion domiciliaria (ESAD), desde septiembre de 2008 hasta diciembre de 2010. Se recogieron datos sociodemograficos, numero de recambios de GEP que se realizaron a cada paciente, si existio alguna incidencia en cada uno de los recambios, tanto en el servicio de endoscopias digestivas como en el domicilio y el tiempo que transcurrio hasta el siguiente recambio. Resultados La edad media de los pacientes fue de 74,02 anos; el 65% residian en zona rural. La causa principal de disfagia fueron las demencias (56,82%). El ESAD realizo 136 cambios de GEP (media de 3,09; DE: 2,37). Surgieron 17 complicaciones leves, resolviendose en el domicilio del paciente, y una complicacion grave, una peritonitis, que se soluciono en el hospital. Se realizaron 138 viajes (53,62% en medio rural). A cada paciente se le evito viajar una media de 43,13 km en total, en medio rural 75,24. Conclusiones El cambio de GEP es un metodo sencillo que puede realizarse en domicilio, con un riesgo de complicacion bajo si precede una eficaz seleccion del paciente. Esto conlleva un aumento del bienestar de los pacientes y familiares y una reduccion de gasto sanitario.

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.

Resumen Introduccion El objetivo del presente estudio es determinar el porcentaje de pacientes con enfermedad arterial periferica (EAP) con un control optimo de sus factores de riesgo cardiovascular (FRCV) (colesterol unido a las lipoproteinas de baja densidad [c-LDL], presion arterial [PA] y abandono de tabaco). Material y metodos Estudio descriptivo transversal multicentrico, realizado en consultas de atencion primaria (AP) y de otras especialidades que habitualmente atienden a pacientes con EAP, medicina interna, cirugia vascular (CV), cardiologia, endocrinologia y nefrologia. Seleccion sistematica de los 10 primeros pacientes con EAP de las consultas de 440 investigadores pertenecientes a todas las comunidades autonomas. Resultados Se incluyeron en el estudio a 4.087 pacientes. Tenian controlada la PA el 29,5% de los pacientes. La frecuencia de pacientes con control de la PA fue significativamente mejor en consultas de AP (p Conclusiones Los medicos de AP manejan mejor al paciente hipertenso. Sin embargo, los pacientes atendidos en especialidad frente a AP tienen mayor probabilidad de conseguir un control optimo de los FRCV. La situacion dista de ser la idonea, ya que solo en un 6% se consiguio el control optimo de todos los FRCV.

Resumen Introduccion En los ultimos anos el porcentaje de mujeres inmigrantes ha aumentado provocando el surgimiento de necesidades especificas referentes a su salud sexual y reproductiva. El objetivo fue conocer los metodos anticonceptivos utilizados por ellas y los condicionantes que influyen en su eleccion. Estimar como indicadores de alerta: uso de pildora poscoital y prevalencia de abortos. Material y metodos Estudio descriptivo transversal, mediante encuesta realizada en el primer trimestre del ano 2011 en el Centro de Salud Delicias Sur (Zaragoza). La poblacion diana fueron mujeres inmigrantes en edad fertil (15-45 anos) que acudieron al centro, previo consentimiento informado. Muestreo accidental por cuotas. Resultados La edad media fue de 29,35 anos (IC al 95% = 27,95-30,75 anos). El pais de origen mayoritario fue Ecuador. Casi la mitad de las mujeres estaban solteras y trabajaban por cuenta ajena, y su nivel de instruccion era medio. La media de anos de residencia en Espana fue de 5,68 anos (IC al 95% = 4,99-6,37 anos). Un 42% de las mujeres (IC al 95% = 32,62-51,83) no utilizaba ningun metodo anticonceptivo. El metodo mas utilizado fue el preservativo, seguido de la pildora. Mas de la mitad de las mujeres habian sido informadas en atencion primaria. Un 32% (IC al 95% = 23,42-41,60) de ellas tenian un antecedente de aborto. Respecto al uso de la pildora poscoital (PPC), habia recurrido a ella el 19,39% (IC al 95% = 12,46-28,10). Conclusiones El 42% no utilizaba ningun metodo anticonceptivo y los indicadores de alerta sobre el fracaso de medidas preventivas en salud reproductiva son elevados.

Resumen Fundamento y objetivo Estimar el grado de cumplimiento de la Ley 28/2005 en locales de restauracion y hosteleria de Zaragoza. Metodologia Estudio descriptivo de prevalencia, realizado durante el primer trimestre del ano 2010. Muestreo aleatorio simple. Muestra: 801 locales clasificados en tres categorias: restaurantes, bares —tabernas, cafeterias y comida rapida— y locales de ocio. Las variables: superficie del local, local con o sin humo, separaciones de acuerdo con la ley y cartel visible. Analisis estadistico: prevalencias y sus intervalos de confianza poblacionales; para detectar diferencias entre proporciones se empleo la prueba de la χ2. Resultados En Zaragoza, se permitia fumar en el 92,63% (IC del 95%, 90,66-94,29) de los establecimientos, estaba prohibido el consumo de tabaco en un 4,24% (IC del 95%, 3-5,9), y en un 2,62% (IC del 95%, 1,67-3,91) existian zonas compartimentadas entre fumadores y no fumadores. En los locales de mas de 100 m, en los bares en el 74% estaba permitido fumar. Los restaurantes representan el tipo de local en el que mas se han compartimentado los espacios. No se encontro ningun local de ocio nocturno libre de humo, y solo en un 3,4% de estos habia zonas totalmente compartimentadas. Conclusiones Tras 5 anos de la ley 28/2005, no existe una proteccion efectiva de los fumadores pasivos que deciden acudir a estos establecimientos, ni del fumador pasivo laboral, ya que en el 92,63% de los establecimientos esta permitido el consumo de tabaco.

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.