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Background: In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization.Objective: To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs.Methods: Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated.Results: One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost).Conclusions: Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity. [ABSTRACT FROM AUTHOR]

Objective: To examine the perceptions and expectations about Family Practice (FP) and Primary Care (PC) in 1st, 3rd and 5th year students in medical schools., Design: An observational study in two cross sections with intervals of two years., Location: Spanish Medical Schools., Participants: 1st, 3rd and 5th year students of 22 schools (1st phase) and 15 (second phase)., Primary Measurements: Self-report questionnaires completed during the first quarter of the 2009-2010 and 2011-2012 academic years. It had 70 items in three blocks: perceptions of FP (19 items), training in FP (26 items), expectations and preferences (25 items), plus 13 specific items for 3rd and 5th year students. Most of the items were answered in a 6 point Likert scale., Results: A total of 5299 responses in phase I, and 3869 in phase II were received. Students perceive FP and PC as essential areas of the health system and professional practice, but with little scientific and technical appeal. The large majortiy, 87%, consider training in FP necessary and compulsory, and it should start in third year. They prefer hospital medical specialities (88-89%), followed by surgical and paediatrics. FP is preferred by the 37-39%. Only between 24% and 28% of students have a clear preference for a specialty when they start medical studies., Conclusions: FP and PC are key areas and should be part of the curriculum, but are perceived to be of low scientific appeal., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Objective: To determine the type of Internet use carried out by adolescent schoolchildren and identify factors associated with high use., Design: Descriptive, cross-sectional study using a self-administered questionnaire., Setting: Secondary and High School Education Centres of the Autonomous Community of Madrid (rural and urban areas)., Participants: Third and fourth year Secondary and 1st and 2nd year High School pupils from 9 centres. A total of 1328 of the 1330 pupils present in the classrooms during the school term January-April 2007., Principal Measurements: Dependent variable: intensity of Internet use: very high, high, medium, low and none. Information on socioeconomic variables, smoking, drugs and drinking habits, mental health, academic failure and use of mobile telephone. An analysis was made using a two-step logical regression., Results: The mean age of the sample was 15 years, with an equal number of males and females. A total of 93.1% used the Internet, of which 5.3% (95% CI: 4-6.5%) had a very high use, 16.7% (95% CI: 14.5-18.6%) high use, 71.1% (95% CI: 68.2-73.2%) low to medium use, and 6.9% (95% CI: 5.6-8.4%), did not use it. Very high use of the Internet is associated with the male sex (OR=4.28;95% CI:2.37-7.72), being 16 years or over (OR=2.14;95% CI:1.23-3.72) and is dependent on the mobile phone (OR=5.19;95% CI: 2.97-9.08). An association with alcohol consumption was observed in the high use group (OR=1.89; 95% CI:1,35-2,65). Academic failure is more common among those who do not use the Internet (OR=1.61; 95% CI:1.02-2.55)., Conclusions: Given the relationship found between high Internet use and mental health problems and bad habits, it is important to perfect standardised tools to detect and evaluate the compulsive use of the Internet as well as aid to its responsible use.

Objective: To analyse if the use of different methods to assess fear of falling (FF), changes the risk factors for developing it, and the consequences arising from this., Design: Systematic review., Data Sources: Electronic data bases, MEDLINE, EMBZ, EMBASE, CINAHL and PBMA. Key words <>, <>, <>, <>., Period: 1966-March 2008. SELECTING THE STUDIES: Inclusion/exclusion criteria: original observational studies, clearly identifying the method employed to measure FF and which mention risk factors and/or the consequences arising from this fear. A total of 327 summaries were initially identified, from which 24 articles were selected., Data Collection: The abstracts and articles were selected by the first author. If there were doubts, the opinion of the second signatory was considered. The method for detecting FF, the risk factors and/or the consequences were collected and analysed., Results: There is a large variety of FF assessment methods, which can be grouped into three types: a) they question directly if it exists; b) they question on the limitation of activity due to this fear, and c) they use scales that detect and quantify the fear. The main risk factors: changes in gait, previous falls, failing sight, health problems, female sex and lack of social support. Main consequences: balance problems, depression, increased risk of falls and less social activity., Conclusions: The risk factors and consequences of FF are similar in the different studies, particularly those that employ direct questions. The study population, the objective and the time available have an effect on the choice of method for assessing FF.

Objective: To detect the possible differences in risk of mortality of the population aged 65 and over in Health Area 11 of the Community of Madrid and to explore their relationship with economic factors., Design: Observational, retrospective, and ecological-style study., Setting: Districts and boroughs in Health Area 11 of the Community of Madrid, Spain., Participants: People aged 65 and over., Main Measurements: The analysed variable was the total deaths occurring in the study population during the period 1996-2001. The standardized mortality rate (SMR) was calculated. As a social/economic indicator, mean available income, stratified in 3 groups, was used. The statistical method used was Poisson regression., Results: The mortality rates oscillated between 37.33 and 91.54 deaths for every thousand inhabitants (SMR ratio, 2.47). In urban areas, in men with level 2 income, mortality was 16% less (P=.0406) than the reference group, whereas in high-income men it was 20% less (P=.0042). In women the rate was about 8% less, though this did not attain statistical significance (P=.3039). The relationship in semi-rural areas was not demonstrated., Conclusions: The existence of inequalities in the mortality of the population aged 65 or over was demonstrated. There was an inverse relationship between mean available income and mortality in urban areas.

Objective: Our objective was to assess the effect of breastfeeding on the probability of hospitalization as a result of infectious processes during the first year of life, Methods: We followed 1385 infants from birth to age 1 year between 1996 and 1999. Recruitment and data collection were done at the 6-month well-infant visit under the National Child Health Program. Full breastfeeding, hospital admission, and other relevant variables related to the delivery, infant, mother, health services system, and sociologic aspects were recorded. The statistical analysis included Kaplan-Meier test, Cox regression to obtain the hazard ratio, and the adjusted attributable risk., Results: Full breastfeeding at discharge after delivery and at 3, 4, and 6 months of age were 85%, 52%, 41%, and 15%, respectively; 78 hospital admissions as a result of infections were recorded (38 respiratory tract, 16 gastrointestinal tract). Mean age at admission was 4.1 months. After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than 1 year., Conclusions: On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country.

Background and Objective: To define the parameters of normal cognitive performance in an easy to administer neuropsychological battery of a Spanish population sample of elderly over 70 years., Subjects and Method: We examined 527 home dwelling elderly from the longitudinal study Envejecer en Leganés, 71 to 99 years old (mean age [SD] 79 [6.2] years, 51.8% women, 38.7% without formal education), with an extensive clinical survey, a neurological exam and the following neuropsychological battery: Short Portable Mental Status Questionnaire, Mini Mental State Examination, Benton Orientation Test, Bell Test, Verbal Fluency, Clock Drawing Test, Trail Making Test, Free and Cued Figures Recall, Logic Memory, Naming, incidental Recall, Delayed Recall, Similarities, IQCODE Questionnaire Of Jorm and Depression Questionnaire CES-D. 111 cases who rejected the assessment or had sensomotor limitations were excluded. 368 non demented subjects (according to DSM-IV criteria; 88.5% of the de 416 remaining cases) were selected to establish the normative data of every test., Results: The analyzed subsample was representative of the total sample. The normative data for every neuropsychological test were obtained in the total group of non demented subjects and in the subgroups stratified by four age levels and two cultural levels. The mean values, standard deviations, range and percentiles for every test and subgroup are presented., Conclusions: The normative data obtained in this population sample for a neuropsychological battery easy to administer to poorly educated elderly can be useful to rigourously apply the criteria of dementia and mild cognitive impairment in future clinical and population studies.