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Resumen Objetivo Evaluar la influencia de una intervencion formativa en las derivaciones a consultas hospitalarias, su adecuacion y motivos de derivacion, y analizar diferencias entre medio urbano y rural. Material y metodos Estudio prospectivo de una intervencion fundamentalmente de tipo formativo (consultas compartidas y sesiones clinicas) entre Gastroenterologia y atencion primaria, realizada mensualmente en un centro de salud urbano y otro rural, comparandolos con 2 correspondientes centros control. El periodo de estudio fue de noviembre de 2004 a junio de 2008, con un periodo de referencia de 12 meses y uno de intervencion de 30 meses, dividido en 2 subperiodos (1 y 2). Los parametros (cambios en las derivaciones, y sus motivos y pertinencia) se evaluaron en 1.449 derivaciones realizadas desde atencion primaria a las consultas externas de aparato digestivo. Resultados En relacion con el periodo de referencia, descendio significativamente el porcentaje de derivaciones en los centros de intervencion: 51 y 57 % en los subperiodos 1 y 2, respectivamente. Analizando las diferencias entre los centros de intervencion y los centros control, el descenso en la proporcion de derivaciones fue de aproximadamente un 30 % en ambos periodos, que fue solo significativo en el medio rural. No se encontraron cambios significativos en la pertinencia ni en los motivos de las derivaciones. Conclusiones La intervencion resulto en conjunto eficaz en disminuir derivaciones a las consultas hospitalarias de gastroenterologia, aunque sugerimos medidas que mejoren su pertinencia.

Fundamento y objetivo Debido a la mayor morbimortalidad de la hepatitis aguda por el virus de la hepatitis A (VHA) cuando ocurre en pacientes con infeccion cronica por el virus de la hepatitis C (VHC), interesa conocer la prevalencia de inmunizacion frente al VHA en estos pacientes. Pacientes y metodo Se determinaron los anticuerpos de tipo inmunoglobulina G (IgG) frente al VHA (IgG anti-VHA) en 313 pacientes con infeccion cronica por el VHC (anti-VHC) y en 313 individuos anti-VHC negativo. Resultados La prevalencia de IgG anti-VHA encontrada fue identica en ambos grupos: un 81,2%. Sin embargo, entre los menores de 41 anos esta prevalencia era mayor en los anti-VHC positivo que en los individuos del grupo control. La adiccion a drogas por via parenteral y los tatuajes fueron mas frecuentes en el primer grupo. La presencia de IgG anti-VHA se asocio con la edad y con la procedencia del medio rural en ambos grupos. Conclusiones La prevalencia de IgG anti-VHA aumenta con la edad y es mas elevada entre los individuos de procedencia rural. Tambien podria ser mayor entre los pacientes jovenes anti-VHC positivo, en comparacion con los controles de edad similar. Este hallazgo puede deberse a las peores condiciones higienicas probablemente asociadas con ciertas practicas mas communes entre estos individuos, como la adiccion a drogas por via parenteral y los tatuajes.

Introduction: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. Objectives: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. Material and methods: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. Results: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). Conclusion: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.

Because of high fatality rate associated with acute infection by hepatitis A virus (HAV) in chronic hepatitis C patients, it is of interest to know the prevalence of immunization against HAV in these patients.Immunoglobulin G (IgG) IgG HAV antibodies (IgG anti-HAV) were determined in 313 hepatitis C virus antibodies (anti-HCV) positive patients and in 313 anti-HCV negative subjects (control group). Several epidemiological factors were recorded (age, sex, rural vs urban precedence, tattoos, parenteral drugs use, alcohol consumption and surgery).The prevalence of IgG anti-HAV was identical in both groups: 81.2%. However, in those younger than 41 years, this prevalence was greater in those anti-HCV positive than in the control group. Parenteral drugs use and tattoos were more frequent in the first group. The presence of IgG anti-HAV was associated with age and the rural origin in both groups.The prevalence of IgG anti-HAV increases with age, and is more frequent in individuals with rural origin. It was also greater in young anti-HCV positive patients, when compared with controls of the same age. This finding can be due to the poor standards of hygiene probably associated with some practices more common in this population, such as parenteral drugs use, tattoos and others.