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Objective: To analyse the association between waist-to-height ratio (WtHR) and body fat and to develop predictive adiposity equations that will simplify the diagnosis of obesity in the paediatric age group., Design: Cross-sectional study conducted in Spain during 2007 and 2008. Anthropometric dimensions were taken according to the International Biology Program. The children were classified as underweight, normal weight, overweight or obese according to national standards of percentage body fat (%BF). WtHR differences among nutritional status categories were evaluated using ANOVA. Correlation analysis and regression analysis were carried out using WtHR as a predictor variable for %BF. A t test was applied to the results obtained by the regression model and by the Siri equation. The degree of agreement between both methods was evaluated by estimating the intra-class correlation coefficient., Setting: Elementary and secondary schools in Madrid (Spain)., Subjects: Girls (n 1158) and boys (n 1161) from 6 to 14 years old., Results: WtHR differed significantly (P < 0.001) depending on nutritional status category. This index was correlated (P < 0.001) with all adiposity indicators. The mean %BF values estimated by the regression model (boys: %BF = 106.50 × WtHR - 28.36; girls: %BF = 89.73 × WtHR - 15.40) did not differ from those obtained by the Siri equation. The intra-class correlation coefficient (0.85 in boys, 0.79 in girls) showed a high degree of concordance between both methods., Conclusions: WtHR proved to be an effective method for predicting relative adiposity in 6-14-year-olds. The developed equations can help to simplify the diagnosis of obesity in schoolchildren.

Background: Burnout is a worrying problem in the medical profession and has proven to be highly prevalent in all the care settings and specialty areas in which it has been studied.We applied 2 widely used questionnaires to analyze the working conditions of Spanish allergists in terms of quality of professional life and degree of burnout perceived., Methods: Participants completed 2 questionnaires: the 22-item Maslach scale, a structured questionnaire covering different aspects of the feelings and attitudes of professionals toward their work and patients; and the Spanish Quality of Professional Life Questionnaire (CPV-35), a 35-item questionnaire evaluating job satisfaction and perceived quality of life at work., Results: We received 404 questionnaires from throughout Spain. The main sources of motivation were better pay (94.4%), more available resources/technology (85.1%), access to research activities (81%), and promotion in one's professional career (80.1%). Analysis of the scores from the Maslach scale revealed that two-thirds of the allergists interviewed experienced medium and high levels of negative burnout (67.9% and 66.2%, respectively, for emotional exhaustion and depersonalization). This situation was in part compensated for by the fact that a slightly lower proportion of the group (59.2%) obtained very high scores on personal accomplishment in their work. Analysis of the scores from the CPV-35 questionnaire revealed 3 complementary aspects of job satisfaction: perceptions of the workload borne (5.8), management support available to cope with daily patient workload (5.6), and levels of intrinsic motivation for work (7.7), which was the highest value. The score for the item summarizing self-perceived overall quality of working life was acceptable (6.4)., Conclusion: Promoting intrinsic motivation of Spanish allergists using the motivating factors identified in this study could protect against professional burnout.

Purpose: Asthma is the most common chronic disease in childhood. Hospital admissions in the child population appear to be reducing in different populations., Methods: We have retrospectively analysed admissions into hospitals in our region due to asthma in a 0 to 14 years population, between the years 1995 and 2007. The age, sex, date of admission, and length of hospital stay of each patient was recorded and analysed., Results: A total of 9106 admissions (64% males) have been included. A gradual trend towards a reduction in admissions is observed during the period analysed. There were more admissions in 1996, with 2.91 per thousand inhabitants, gradually reducing to 1.33 per thousand in 2007. There were more admissions in May and between September and December, being less frequent in July and August. The mean stay in this period was 4.18 days, which was stable during the whole period of the study. Older children tended to have a longer hospital stay., Conclusions: Our study shows that admissions due to childhood asthma tend to be decreasing, particularly due to younger males, with no change in the length of hospital stay. Asthma exacerbations seemed to be associated with infections and exposure to allergens., (Copyright © 2009 SEICAP. Published by Elsevier Espana. All rights reserved.)

Continuing medical education (CME) is a critical tool as well as a generally accepted concern for physicians, while being both a commitment and an obligation for the Administration. In Spain, during the past decades, CME has been a constant concern of many groups; however, it was not until the end of the eighties when efforts at accreditation began to emerge. A significant step was the establishment of the Commission on Continuing Education of Health Professions of the National Health System, an agency of the Consejo Interterritorial (Inter-regional Council), whose accreditation system started in 1998, using the figure of Sector Conference, included in Articles 5 and 8 of the Ley de Régimen Jurídico de las Administraciones Públicas y del Procedimiento Administrativo Común (Law on Legal Regime of Public Administration and Common Administrative Procedures), as Senior Technical Body on the matter. Since then, various Regional Committees and the Spanish Accreditation System of Continuing Medical Education (SEAFORMEC) have been created. Although we earlier published a guide, in this manuscript we have updated the steps that must be taken to apply for accreditation of CME activity in Allergology, explaining the different items in the official application form, clarifying to whom the request should be addressed, and outlining the foundations on which the activities will be evaluated for accreditation purposes, in order to ensure that the training meets the highest standards for quality, so that the objectives that lead to achieving maximum performance and competence of health professionals may be reached.

Objective: To estimate the real costs of medical care by diagnostic groups at a primary care centre., Design: Descriptive, retrospective study, based on the review of computerized medical records., Setting: Urban primary care centre (PCC)., Participants: All patients who attended the PCC during 2005., Main Measurements: Mean medical care cost per visit in euros, broken down for health professionals, diagnostic procedures and drugs costs, and stratified by diagnostic groups., Results: The most frequent visits were for pulmonary, locomotor, cardiovascular, and gastro-intestinal conditions. The mean number of visits per patient attended was 8.7 (SD, 9.4); and per patient registered at the centre, 5.9 (8.7). The highest costs were for cardiovascular (18.96%; 95% CI, 18.93%-18.99%), locomotor (11.21%; 95% CI, 11.18%-11.23%), psychological (10.69%, 95% CI, 10.66%-10.71%), pulmonary (10.20%; 95% CI, 10.17%-10.22%) and endocrinal-nutritional (9.61%; 95% CI, 9.58%-9.63%) problems. Drugs expenditure accounted for 65% of the total cost; visits to health professionals, for 33%; and procedures, for 2%. Overall cost per inhabitant was 239.1 (493.6) euros, and per patient attended was 349.5 (563.5)., Conclusions: Cardiovascular disease conditions are much the most costly ones in terms of overall medical cost. Psychological conditions are located in second place in terms of pharmaceutical cost; and in third place, in terms of overall medical-care cost.

Background: Non-compliance is a common cause of failed medical action, contributing to absence of regular check-ups. Our group has already published studies that analyse the level of non-compliance with appointments amongst patients attending our Allergology clinic, and we have made proposals for improvement., Objective: This article evaluates the results obtained three years after setting up and launching telephone reminders for patients' first appointments., Methods: All patients who were given appointments for first and subsequent visits during 2005 were included. A total of 18215 appointments were studied (3115 first appointments and 15100 subsequent ones). Of these, there were 2479 missed appointments (438 first appointments and 2041 subsequent ones), corresponding to 2215 patients (412 first visits and 1803 subsequent ones), with a mean of 1.12 appointments/patient/year., Results: The non-compliance rate was 13.61%. The most common non-compliers were men (14.11% missed appointments against 13.24% missed appointments in women) and in the age range 20-29 years and 30-39 years (16.46% and 15.28% non-compliance, respectively). The mean age of non-compliers was 34.55 +/- 14.73 years. We observed a significant number of patients who missed more than one appointment (5.12% of all non-compliers and 0.7% of all patients). Differences were found in the degree of non-compliance depending on the type of appointment (14.06% non-compliance with first visits and 13.52% with subsequent visits). We observed a significant increase in missed appointments during the Summer holidays; July and August showed the highest percentage of missed appointments for both the first visit (20.62% in July and 23.59% in August) and subsequent visits alike (16.14% in July and 14.23% in August)., Conclusions: A slight reduction in non-compliance was observed after implementing the proposals made in our previous study. In view of the high costs incurred from missed appointments, the government should finance studies to reduce this problem. The causes of non-compliance may be difficult to control, including present access to the public health service. We must be alert to and/or take preventive measures in young patients and cases of previous non-compliance. The degree of non-compliance is a quality indicator, because it reduces the yield of appointments, and it evidences a lack of cohesion of patients with Primary Health Care Units for first appointments, and with Specialist Care Units for subsequent appointments. Once certain levels of attendance have been attained, it is difficult to achieve an effect on this point in order to improve attendance rates.

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Homogeneous Functional Groups (HFG) for Diagnostic Techniques in the Allergy Department of the Virgen de la Arrixaca University Hospital in Murcia (Spain) and the healthcare products generated. Based on the 2005 budget, variable costing was used to calculate the costs of the healthcare products generated (skin tests, investigation of drug allergies, etc.) by one of the three HFG (the HFG for complementary investigations). On the basis of these costs, and taking as the unit the cost of one skin prick test, we assigned relative units of value (RUV) to each of the products in our services portfolio. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) to take the decisions required to optimize resources, clinical management and complementary tests should go hand-in-hand.

Two populations [an F(2) and a set of 77 double haploid lines (DHLs)] developed from a cross between a 'Piel de Sapo' cultivar (PS) and the exotic Korean accession PI 161375 were used to detect QTLs involved in melon fruit quality traits: earliness (EA), fruit shape (FS), fruit weight (FW) and sugar content (SSC); and loci involved in the colour traits: external colour (ECOL) and flesh colour (FC). High variation was found, showing transgressive segregations for all traits. The highest correlation among experiments was observed for FS and the lowest for FW and SSC. Correlations among traits within experiments were, in general, not significant. QTL analysis, performed by Composite Interval Mapping, allowed the detection of nine QTLs for EA, eight for FS, six for FW and five for SSC. Major QTLs ( R(2)>25%) were detected for all traits. QTLs for different traits were no clearly co-localised, suggesting low pleiotropic effects at QTLs. Sixty-one per cent of them were detected in two or more experiments. QTLs for FS were detected in more trials than QTLs for FW and SSC, confirming that FS is under highly hereditable polygenic control. ECOL segregated as yellow:green in both experimental populations. The genetic control of ECOL was found to be complex, probably involving more than two loci with epistatic interactions. One of these loci was mapped on linkage group 9, but the other loci could not be clearly resolved. FC segregated as white:green:orange. The locus responsible for the green FC was mapped on linkage group 1, and it was proposed to correspond to the previously described locus gf. The genetic control of orange FC was complex: two loci in linkage groups 2 and 12 were associated with orange flesh, but larger population sizes would be necessary to elucidate completely the genetic control of orange flesh in this cross. Exotic alleles from PI161375 showed beneficial effects on EA, FW and SSC, indicating the usefulness of PI 161375 as a new source of genetic variability to improve European and American cultivars.

The aim of our study was to determine the relationship between snoring, airway disorders and pulmonary function in the general population. We performed a stratified random sampling from the population (n = 92,364). Four hundred subjects agreed to participate and were invited to the clinic, where a detailed medical history, physical examination, spirometric test and maximal respiratory pressures measurements were carried out. Snoring was reported by 152 subjects (38%). Nasal obstruction and the presence of abnormal pharynx exploration were more frequent in subjects with snoring. Age, body mass index and neck circumference were significantly higher in the snorer group. In addition, we found that the non-snoring group had a significantly higher frequency of tonsillectomy during infancy and adolescence than the snorer group. We did not detect any significant difference in spirometric test values or in maximal respiratory pressure values between snorer group and non-snorer group. In conclusion, in the general population snoring is associated with nasal obstruction and abnormal pharynx exploration. Furthermore, snoring appears not to be associated with modifications in spirometric or in maximal respiratory pressure tests.

Purpose: To determine the prevalence of sleep disordered breathing (SDB) and sleep apnea syndrome (SAS) in a general population aged from 50 to 70 years., Subjects and Methods: We recruited 76 individuals aged between 50 and 70 years, chosen at random from the electoral census. They were invited to the clinic where a detailed medical history was taken and physical examination, ENT examination, pulmonary function tests and night time recording of respiratory variables performed., Results: The prevalence of SDB (apnea-hypopnea index >/= 5) was 28.9%, and there were no differences between men (28%) and women (30%). However, the prevalence of SAS was 6.8%, and there were differences between men (5 cases) and women (0 cases) (p = 0.0521). Subjects in the SDB group had higher systolic blood pressure than in the non-SDB group (p < 0.05)., Conclusions: SDB and SAS are common among 50- to 70-year olds. The prevalence of SDB was 28.9% and the prevalence of SAS was 6.8%.

Objective: To show the importance of preventive action in primary care in a case of tuberculosis., Design: A descriptive study., Setting: Castelldefels school, Barcelona., Participants: Students and teachers, contacts of a case of tuberculosis., Interventions: On June 30, 1995, a case of pulmonary tuberculosis in an adult at a school was notified. In line with the Procedure for Prevention and Control of Tuberculosis of the public health council, the work contacts of the case were administered the tuberculin reaction test (TR) and a thoracic X-ray, with chemoprophylaxis or chemotherapy recommended, depending on the result., Results: 394 TR (92.5%) were performed on 426 children. From the first to the second check-up at three months, 56 (14.2%) presented a positive reaction and had a thoracic X-ray. Eight cases of the illness were diagnosed and treated with chemotherapy: secondary chemoprophylaxis was recommended for 48. 36 of the 39 adults in the school had a TR, and 35 a thoracic X-ray. Two cases of the active illness were diagnosed and secondary chemoprophylaxis was recommended to a teacher. The staff of the sports' centre was also checked, with 18 monitors having a thoracic X-ray and 14 the TR. Secondary chemoprophylaxis was recommended in three cases., Conclusions: Rapid action when faced with a case of tuberculosis is basic in the fight against this disease, in order to break the epidemiological chain and find any new cases of disease. Primary care must assume a leading role in early detection and treatment of these patients. Good coordination between different care levels is essential.

Introduction: To study the possible influence of gender on in-hospital mortality in patients suffering acute myocardial infarction., Patients and Methods: We analyzed 1,951 consecutive patients admitted to our Coronary Unit between January 1986 and December 1991 with this diagnosis and with a delay of no more than 24 hours prior to admission., Results: In-hospital mortality was 12.8% in the 1,603 males and 25.6% in the 348 females (p < 0.001). Age, previous history of: not smoking, diabetes, heart failure, stable angina, myocardial infarction, stroke, right branch block, atrial fibrillation, and treatment with digoxin were variables significantly associated with greater mortality (p < 0.05) as well as the localization of the infarction, the Forrester grade and/or presence of atrioventricular block on admission and not treatment with intravenous fibrinolytics and beta-blockers. Multivariate analysis of variables associated with mortality (selection criterion for variable entry p < 0.20) shows that age, gender, previous angina, situation and extension of the infarction determined by ECG and Forrester on admission are independent predictors of in-hospital mortality., Conclusions: Gender is an independent predictor of in-hospital mortality in acute myocardial infarction (female/male odds ratio = 1.63).

Objective: To calculate the probable prevalence of mental illness in our clinics and to evaluate how it is detected by Primary Care (PC) doctors., Design: Crossover study in two parts. SITE. Basauri Health Centre (Vizcaya)., Participants: A sample made up of patients who attended the clinic without prior appointment during ten days in February and Marc, 1990., Main Measurements and Results: In the first part, 10 PC doctors distributed the GHQ-28 questionnaire to 500 patients. In the second part, qualified staff administered the standardised psychiatric interview (SPI) to a sub-sample. 41.55% were possible psychiatric cases (GHQ-28 > 6). 17.94% were diagnosed by the doctors (SD) as psychiatric cases. Prevalences adjusted to the SPI were 19% and 21% for the GHQ-28 and SD respectively., Conclusions: The GHQ-28 obtained high sensitivity (0.82%) and low specificity (60%), which characterises it as a good screening test, but a bad diagnostic method. The doctors obtained low sensitivity (0.29) and high specificity (89.7%); thus underdiagnosing mental illness, but being more accurate in their diagnoses.