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Biomedical subjects

F López de Castro

Publications and source records attributed to F López de Castro.

At least 19 recordsLinked to original sources
PubMed2005

[Alcohol consumption in Toledo schoolchildren: reasons and alternatives].

OBJECTIVE: To know the consumption of alcohol in Toledo schoolchildren, to find out the reasons which cause them to drink and the alternatives proposed. DESIGN: Descriptive, transverse study. LOCATION: 2 zones in the Toledo health area. PARTICIPANTS: A total of 625 adolescents between 13 and 18 years, in the third and fourth years of Obligatory Secondary Education and first year in High School (Bachillerato) of 2 secondary education institutions in Torrijos and 1 in Toledo capital. MAIN MEASUREMENTS: Using an ad hoc designed anonymous questionnaire, with 32 items, the following data was collected: age, sex, alcohol consumption (personal, family, and friends), how much (standard drink units), knowledge and sources of information on alcohol, taking of other drugs, reasons for consuming, and the alternatives. RESULTS: 47.27% of those questioned were male. The mean age was 15.4 +/- (-)1.3 years. 93.4% had tried alcohol (95% CI, 91.1-95.2). 52.0% had been drunk at some time, which was more frequent in rural areas than in the city. 58.1% considered alcohol as a drug. Among the reasons mentioned for drinking, the main ones were "enjoyment" (46.3%), "to forget problems" (30.7%), and "curiosity" (24.6%). The alternatives to drinking which were proposed were related to computers and sport. CONCLUSIONS: The consumption of alcohol is a common habit among adolescents and its pattern differs between urban and rural areas, where it is much earlier and more intense in the latter. It forms part of their lifestyle, they use it as a means of enjoyment and a large percentage consider that alcohol is a drug. Against "street binge drinking," their proposals are computer activities and sport.

Adolescent↗
PubMed2005

[Research in primary care: 1994-2003].

OBJECTIVES: To analyse the characteristics of the original articles published in the journal Atención Primaria (Primary Care) during the last 10 years. DESIGN: Literature study. SETTING: Primary health care. PARTICIPANTS: Original articles published in Atención Primaria between 1994 and 2003. MAIN MEASUREMENTS: The professional category of the authors, whether it was a multidisciplinary or multicentred study, the autonomous community of origin, the topic, the type of study, and if it had a grant or financial assistance. RESULTS: 1229 articles have been reviewed. In 40.0% of them a family doctor is included in the authorship. 31.4% can be considered multidisciplinary and 20.5% multicentred. The Communities of Valencia, Madrid, Andalusia, and Catalonia took up 60% of the volume of publications. The most common topic is the provision and organisation of the health services (40.5%). Only 4.3% of the designs are experimental. A grant or financial aid is stated in 16.2% of the articles. CONCLUSIONS: Although the situation as regards the previous years has not varied too much, some positive findings, such as the emergence of research groups, increasing presence of multicentre and multidisciplinary studies, better access to sources of finance, etc, suggest that we are in a process of improving the quality of research in primary care.

Bibliometrics↗
PubMed2004

[Information given to patients and their participation in clinical decision-making].

OBJECTIVES: To evaluate the information provided by physicians during consultations, the information requested by patients, and patients' participation in decision-making. DESIGN: Descriptive, cross-sectional study based on observations of visits to the doctor's office and subsequent telephone interview. SETTING: Primary care centers in Toledo, Spain.Participants. 152 clinical interviews.Interventions. Questionnaire with items on age, sex, types of information provided by the physician, information requested by the patient, and evaluation of the patient's participation in decision-making and degree of satisfaction. MAIN MEASURES AND RESULTS: Mean age of the patients was 41.1 years, and 55.9% were women. The type of information given most frequently to patients was related to treatment (88.3%). Of the 152 patients whose visits were observed, 55 (36.2%) did not request additional information. The information requested most frequently when not provided spontaneously by the physician concerned treatment (35.3%) and cause of the symptoms (29.7%). Almost all patients (94.0%) considered the information received to be sufficient. However, 22.7% stated that when they left the doctor's office there was something they wished they had asked about, and 18.6% said they understood the doctor's explanations "in part." According to the observers, 69.4% of the patients did not take part in the decision about their treatment. CONCLUSIONS: The information provided by the physician was not as complete as it might have been. Patients usually ask few questions, and a large percentage of patients had something they wished they had asked about, or did not fully understand the information. Patients' participation in decision-making was low.

Adult↗
PubMed2003

[Do men and women have different perceptions of pain?].

OBJECTIVE: To evaluate possible differences between men and women's perception of a painful stimulus (venous puncture). DESIGN: Transversal, analytic and observational study.Setting. Primary care.Participants. 709 people over 14 who attended three health centres for blood extraction. 98 cases were rejected (most because they received more than one puncture). MAIN MEASUREMENTS: Age, sex, tobacco habit, perception of pain (through visual analogic scale from 1 to 10), complaints expressed (oral and/or by gestures) and patient's prior expectations. RESULTS: Mean age: 47.4; 60.1% women. The intensity of pain had an average of 1.35 (SD, 1.60; mode, 0; median, 0.8). 14.7% expressed a complaint. Median of pain was 0.95 (Q3-Q1, 1.9-0.4) in men, whereas it was 0.70 (Q3-Q1, 1.725-0.3) in women (U=40.48; P=.095). No correlation was found between valuation of pain and age (R=0.055). No differences were found for smokers (median, 0.925; Q3-Q1, 1.725-0.35) or non-smokers (0.75; 1.825-0.325) (P.05). There were statistically significant valuations that varied according to the prior expectations of pain. Equally, pain was assessed as more intense by those who expressed a complaint (median, 2.1; Q3-Q1, 3.85-0.475) versus those who did not (0.625; 1.55-0.3) (P<.001). CONCLUSIONS: We found no significant differences between men and women's perception of painful stimulus. In any case, differences were clinically irrelevant. There is wide individual variability, which suggests that the essential factors are psycho-social. We have to assess and treat properly a patient in pain, regardless of his/her gender.

Adult↗
PubMed2003

[Prevalence of chronic obstructive pulmonary disease and risk factors in smokers and ex-smokers].

OBJECTIVE: To estimate the prevalence of chronic obstructive pulmonary disease (COPD) in smokers and ex-smokers over 40 years of age and describe the associated risk factors. MATERIAL AND METHODS: A cross-sectional descriptive study at primary care level in which 444 current or ex-smokers 40 years of age or older were enrolled. Spirometry was performed with all subjects. If the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) was less than 70%, a bronchodilator test was performed and spirometry was repeated after 2 inhalations of terbutaline (500 g/dose). If the FEV1/FVC ratio continued to be less than 70% and FEV1 less than 80% of predicted, COPD was diagnosed. Age, sex, smoking, age smoking began, index of smoking history (packs per day x year) and attempts to quit smoking were also recorded. RESULTS: The patients' mean age was 53.5 years and 65.8% were men. At the time of the study, 248 subjects (55.9%) were current smokers. The median age smoking began was 16.5 years and the median pack-years index was 26.7. At least 1 attempt to quit had been made by 72.1% of the patients. COPD was diagnosed in 70 subjects (24 with the diagnosis previously established), representing a prevalence of 16.4% (95% confidence interval, 12.9-19.9). COPD was serious in 10%. A multifactorial analysis indicated that age and smoking history in pack-years were significantly associated with COPD. CONCLUSIONS: The prevalence of COPD in our study is slightly higher than in other studies, although selection bias may have affected our results given that we were unable to contact 11.9% of the population sample. Almost two thirds of cases had not been previously diagnosed. Two major risk factors are age and cumulative tobacco consumption.

Aged↗
PubMed2002

[At what care level are cyclo-oxygenase-2 inhibitors prescribed?].

OBJECTIVES: To find the evolution in the billing of prescriptions for selective cyclooxygenase-2 (COX-2) inhibitors since they came on the market and to compare this evolution in primary care (PC) and specialist care (SC).Design. Cross-sectional, descriptive study. SETTING: Toledo Health Area. Main measurements. Data were obtained from the System of Drug Information (SIFAR) to analyse the monthly turnover of NSAID prescriptions (M01A group in the official classification of medicines, including rofecoxib and celecoxib) issued by doctors in PC and SC between January 2000 and June 2001. RESULTS: In our area during the study period, 583,558 NSAID packages were prescribed; 6.61% were COX-2 inhibitors, which represented 29.08% of NSAID expenditure. 98.23% of NSAID packages and 94.61% of COX-2 inhibitors were prescribed in PC. The use of COX-2 inhibitors in SC rose from 10.03% of the total NSAIDs in February 2000 to 29.79% in June 2001; whilst in PC it rose from 1.52% to 10.78%. Rofecoxib and celecoxib were third and fifth in the lists of most prescribed NSAIDs (number of packages) in SC, and ninth and twelfth in PC. In terms of cost of prescription, they were first and second in SC, and first and fourth in PC. CONCLUSIONS: COX-2 inhibitors have become the main NSAIDs prescribed. The appearance of these drugs had a different impact on SC and PC doctors, with greater use of them and a more rapid introduction in SC.

Cross-Sectional Studies↗
PubMed1998

[Health and social problems of caregivers of patients with dementia].

OBJECTIVE: To describe the physical and psychological morbidity of carers of patients with dementia and to compare them with a group of carers of non-demented patients in the home care programme. DESIGN: Descriptive crossover study, based on face-to-face interviews, with a reference group for comparison. SETTING: Community, Toledo and Esquivias Health Districts. PARTICIPANTS: 61 carers of patients with dementia, and 61 of patients in home care. MEASUREMENTS AND MAIN RESULTS: The interview collected the following variables: social, demographic, morbidity (chronic pathologies, insomnia, anxiety-depression...), medication and interference with social life. Both samples were homogeneous for age, sex, marital status, relationship to patient and educational level of the carers, and age and sex of the patients. The problems most often referred to by the two groups of carers were osteo-muscular. The most commonly used drugs were analgesic-NSAIDs, hypertension and anxiety-depression drugs. Insomnia was significantly more common (p < 0.05) in carers of demented patients (63.93%) than in the other group (44.26%), although consumption of sleeping draughts was similar. The Goldberg test was positive in 49.18% of carers of demented patients and in 31.15% of the others (p < 0.05). Carers of demented patients had a more restricted social life (p < 0.01). Only 25.41% thought that their doctor and/or nurse were concerned about their situation as carer. CONCLUSIONS: We found more anxiety-depression and insomnia in carers of demented patients. Interference of care with their social life was greater in this group. Carers view the interest shown in their problems by health-workers as insufficient.

Adult↗
PubMed1998

[Should we change our point of view on pregnancy in adolescence?].

OBJECTIVE: To find the profile of pregnant teenagers in our area and the repercussion of pregnancy on their lives. DESIGN: A mixed study: descriptive crossover and qualitative. SETTING: The Toledo Health Area. PARTICIPANTS: All the adolescent mothers (192) and a control group of 195 mothers over 19, who gave birth in Toledo's Virgen de la Salud Hospital in 1995-96. INTERVENTIONS: Data on pregnancy monitoring, birth and the new-born were taken from the obsteric histories. 30 teenage girls were interviewed face to face to investigate the social, family and personal repercussions of their pregnancies. RESULTS: 3.3% of births in 1995-96 were of teenage mothers. Monitoring of teenage pregnancies was deficient. There were no significant differences between the two groups of women in the incidence of obstetric complications. The general profile of the women interviewed was as follows: they lived in a rural area with their parents. They had received no sexual education. Most of the pregnancies were unwanted, though only two thought of abortion. In general, the emotional link to their partner was reinforced after birth, although they didn't create a life in common. Family and social acceptance was the norm. They didn't modify their life-style. Although they didn't think there were any negative repercussions, they said they were afraid of a new pregnancy and sought to prevent it. CONCLUSIONS: Our study did not find higher obstetric risk in pregnant teenagers. Motherhood does not appear to have too many repercussions on their life-style, although it should be prevented by improved sexual education.

Adolescent↗
PubMed1995

[Treatment of pain and anxiety in terminal oncologic patients in the Castilla-La Mancha community].

OBJECTIVE: To find what palliative treatment, in particular for pain and anxiety, terminal cancer patients in the Community of Castilla La Mancha receive. DESIGN: A descriptive, retrospective study by means of a questionnaire. SETTING: Primary Care. Autonomous Community of Castilla La Mancha. PATIENTS AND OTHER PARTICIPANTS: A survey of 157 doctors with data referring to their last cancer patient deceased in the period from January to August, 1994. MEASUREMENTS AND MAIN RESULTS: Data on 157 patients were received. Of all the tumours, lung cancer was the most common (22.93%). Pain was the symptom most often mentioned (92.91%); anxiety appeared in 70.06%. The most commonly used non-opiate analgesic was Paracetamol (58.22%). Morphine was used in 46.48%, for an average period of 2.35 months (SD = 2.21). Side-effects due to morphine appeared in 22.06%. Complementary drugs to treat pain were used in 13.01% of cases. 12% were referred to specialists for analgesic control. Doctors used pain measurement tables in 5.48% of cases. 19.09% of patients suffering anxiety received no type of treatment. CONCLUSIONS: We think that analgesic tables to monitor the treatment should be used. Attention should be paid to the appearance of side-effects of morphine, the circulation of pain graduation tables and the evaluation of anxiety in this category of patient.

Acetaminophen↗
PubMed1995

[Common health disorders: self-care and self-medication].

SETTING: Community level. "Santa María de Benquerencia" Health District, Toledo. PARTICIPANTS: People over 15, chosen by random sampling from the municipal census, who stated that they had suffered some health disorder over the previous fortnight. MEASUREMENTS AND MAIN RESULTS: 212 surveys were accepted as valid (average age 42.75, 51.89% male and 48.11% female). 73% had suffered one of the disorders included in the survey during the previous fortnight. The commonest response was self-medication (39.84%), especially when dealing with pain and Pyrosis. Pyrazolones and Salicylates were the most commonly used drugs. The instructions were only read in 48.64% of cases. No measure was adopted in 34.56% of the disorders. The doctor was only consulted in 6.86% of cases. Both these responses were more common in men and young people. Non-pharmacological self-care was adopted in 30.07% of cases. This was generally of a dietetic or physical nature and was commoner in women and elderly people. CONCLUSIONS: Self-care, whether pharmacological or not, is the most common response to the perception of some symptom. These practices (especially self-medication because of its possible attendant problems) should be directed and used as one tool more in health care.

Adult↗
PubMed1994

[Adverse reactions to drugs in a health center].

OBJECTIVE: To study the adverse side-effects to medication and define their principle characteristics. DESIGN: A descriptive, crossover, observation study with no random distribution. SETTING: The population cared for at a Health Centre in Toledo. PATIENTS: Those over 15 years old during a 6-month period. MEASUREMENTS AND MAIN RESULTS: 64 adverse side-effects were detected, classified as follows: definite, 10.9%; probable, 68.7%; possible, 20.3%. The rate of adverse side-effects was 2.67 per thousand prescriptions and 2.22 per thousand consultations. Distribution by gender was 62.5% women and 37.5% men. The 35-45 age group was the one with most adverse side-effects. The most affected systems were the digestive apparatus (46.50%), followed by the nervous system (27.50%) and the skin (16.22%). The most commonly involved pharmacological groups were: analgesics and non-steroid anti-inflammatories (34.37%) and drugs for the cardiovascular system (26.56%). 98.43% were trivial and none serious. Evolution was: 59.37% recovered on stopping the drug and 23.43% with the help of treatment. CONCLUSIONS: The number of suspected adverse side-effects in the Centre is high, but they were trivial. It was confirmed that adverse side-effects suppose a frequent medical problem in Primary Care. It is important to make health professionals aware so that, when prescribing, they bear in mind the drug risk/benefit relationship. The identification and communication of adverse side-effects, especially of medicines newly on the market, is also important.

Adolescent↗
PubMed1994

[Adolescents' reasons for visiting a doctor].

OBJECTIVE: To discover what use adolescents make of the medical services in a Health Area and why they attend. DESIGN: A descriptive epidemiological study of a crossover type. SETTING: Santa Maria de Benquerencia Health Centre, Toledo. PATIENTS AND OTHER PARTICIPANTS: Between July 1992 and June 1993, 717 clinical records selected by means of systematic sampling out of 2127 records of 14 to 18 year old adolescents were examined. MEASUREMENTS AND MAIN RESULTS: Frequency of attendance was 2.15 per adolescent per year, with a standard error of 0.096. Significantly less males than females attended (p < 0.05). 66.53% attended at least once a year. The CIPSAP-2 groups most commonly found were: Respiratory System diseases (433 attendances), Supplementary Classification (231) and Dermatological diseases (177). We found a significantly higher attendance (p < 0.05) in males in the groups for Endocrino-metabolic illnesses and injuries/side-effects, and in females (p < 0.05) in illnesses of the Locomotive System. The commonest individual reasons for attendance were: Respiratory Infection of the upper passages, Prescriptions/Forms/Letters, Tonsillitis and Acne. CONCLUSIONS: Adolescents use the health services less than the rest of the population. Out of the pathologies giving rise to their attendance, the problems arising from the physiological changes and physical activity inherent to this age-group have great specific weight. However such important problems as those arising from so-called "life-style risks" do not appear to be common causes of adolescents seeking health care. We conclude with the need to devote greater and better Primary Health Care to this age-group in order to tackle this situation.

Adolescent↗
PubMed1992

[Occupational health in the province of Toledo: comparison with national data].

OBJECTIVE: To gain some preliminary understanding of the health situation in the workplace and to strengthen this field at the Primary Care level. DESIGN: A retrospective and analytical study into the period 1985 to 1988, both inclusive. SITE. Pathologies at work (accidents and work-derived illnesses) declared in Toledo province and in the rest of Spain during the period stated above. MAIN MEASUREMENTS AND RESULTS: A lower rate of accidents at work was observed in Toledo than in the rest of Spain (47.68 per 1,000 workers as against 66.44 per 1,000; chi 2 = 806.45). However Toledo showed higher mortality (0.35% as against 0.20%; chi 2 = 40.71) and a higher percentage of time off work (81.56% as against 68.77%; chi 2 = 483.93). Looking at work accidents in relation to sectors of activity, industry and construction, we found more in Industry and Construction than in Agriculture and Services. Work-derived illnesses made up a low percentage of work pathology (0.33% in Toledo and 0.39% in Spain). The main illnesses were: dermatosis, bursitis, illness caused by vibrations and disease arising from lead and its derivatives. CONCLUSIONS: It is essential to study much more thoroughly both health at work and the more general work context, emphasising the key importance of Primary Care and the need to improve the present system for notifying pathologies at work.

Accidents, Occupational↗
PubMed1992

[Quality control of care provided for urinary infections].

OBJECTIVE: To evaluate the quality of the care provided for low-level urinary infections in the Toledo Health Area. DESIGN: Retrospective study based on data on procedures supplied from clinical histories. SITE. Primary Care teams in the Toledo Health Area. PATIENTS OR OTHER PARTICIPANTS: Those patients over 14 with a provisional diagnosis of low-level urinary infection, who were attended between June and November, 1991, at the Health Centres participants (n = 243). MAIN MEASUREMENTS AND RESULTS: The fulfillment level of six previously defined criteria was analysed. Looking at the clinical histories, we noted 75.3% non-fulfillment of Criterion 1 (anamnesis and examination), 51.8% of Criterion 5 (follow-up) and 59.3% of Criterion 6 (referral). Among the reasons we identified as causes of these findings were inadequate use of registration systems and the existence in different Centres of various procedures for treating urinary infections. CONCLUSIONS: The initial suspicion that the treatment and control of urinary infections in our Area contained a problem of attendance was confirmed. Corrective measures were established for the re-assessment. The positive role of quality controls, carried out under the aegis of Area managements, was clear.

Adolescent↗
PubMed1989

[Results of a continuing education program using teaching consultations].

The results of a continued education program for PCS in the clinical area by means of a method using teaching interconsultations are reported. The program was carried out in the Toledo province in the first six months of 1988. Its initial aims were the development of the program and the approaching between the different levels of health care. The program was carried out with the active participation of the members from PCS, who specified the areas of interest to be developed. The overall expense were 946,540 pesetas, with a mean expense per session and interconsultation of 6,352.6 pesetas. The degree of fulfillment of the program was 79.6% (149 of the programmed 187 interconsultations), with a mean of 3.3 interconsultations/health center/months (planned mean 4.1). In addition, the degree of compliance of each PCS and cooperating specialists was evaluated, with an analysis of the causes of noncompliance. It was concluded that continued education programs for PCS are necessary and that the method of teaching interconsultations is valid with limitations in health areas of small size.

Education, Medical, Continuing↗