Children''s willingness to share activities with a physically handicapped peer: am I more willing than my classmates?

OBJECTIVE: To explore the views of Primary Care and homeopathic doctors in the same geographical and population catchment area towards Homeopathy as a discipline and the motives that bring patients to use its services. DESIGN: A qualitative study, using in-depth interviews and a focus group. SETTING: A community of 18,000 inhabitants with a Health Centre and four homeopathic physicians. PARTICIPANTS: The four homeopathic physicians and nine of the ten doctors from the Health Centre. METHOD: After face-to-face and later telephone interviews, each of the four homeopathic physicians was interviewed in depth and the author led a focus group with the 9 Health Centre doctors. MAIN RESULTS: a) From the homeopaths: they emphasised an integrated patient-centred approach. They insisted on their status as doctors and that their treatment was not iatrogenic, etc. b) From PC doctors: They were ignorant of Homeopathy. They identified it with a type of remedy of which they knew nothing, but for which they demanded scientific evidence, etc. CONCLUSIONS: PC doctors' ignorance of Homeopathy put them at risk of not understanding patients' expectations. It seems that the patient-centred, as against disease-centred, care model is, in practice, outside the scope of PC health delivery.     

Work satisfaction of health personnel in primary care

OBJECTIVE: To determine the level of work satisfaction of health professionals working in Primary Care and to establish the social, demographic and professional factors which determine it. DESIGN: An observational, crossover study using a self-administered questionnaire. SETTING: Primary Care. PARTICIPANTS: All the doctors and nurses working in the Primary Care teams in the Albacete Health Area (468 in all). MEASUREMENTS AND MAIN RESULTS: The scale of work satisfaction of health professionals in Primary Care teams was used. Social, demographic and professional data were collected. 9 dimensions or components of work satisfaction were identified through a factorial analysis. The lowest scores were for motivation, opportunities for professional development and coordination with specialists. CONCLUSIONS: The findings show, in general, indifference as to work satisfaction or lack of it in areas such as motivation and opportunities for professional development. The differences observed in those polled relate to their job and work-place, and also, in the case of doctors, to specialist training.     

Attitude and structural barriers detected in primary care physicians towards treating patients with HIV/AIDS infection

OBJECTIVES: To identify attitudes, knowledge and self-perceived risks among doctors in the Este-Oriente District of Sevilla concerning HIV/AIDS infection; to detect attitude problems and structural barriers affecting doctors' predisposition towards patients with HIV/AIDS infection. DESIGN: A cross sectional study using a self-administered questionnaire. SETTING: Este-Oriente Primary Care district, Sevilla. PARTICIPANTS: Permanent and provisional doctors and paediatricians working in the district during the survey. MEASUREMENTS AND RESULTS: Reply rate was 86% (n = 111). Most doctors (85%) had treated one or more patients with HIV. 91% thought they had to treat these persons. However, 21% would not work with them, if they had the choice. CONCLUSIONS: Attitudes of doctors and paediatricians in the Este-Oriente district of Sevilla towards HIV/AIDS patients can be qualified as positive. Most doctors need to extend their knowledge of this disease. The perception of risk of contagion is high and higher than the real risk. Important attitude and structural barriers to care provision were detected: intervention strategies were proposed by the doctors and paediatricians of this district.     

Medicine at the primary care level (optional undergraduate subject at the University of Alicante): 2 years of experience

OBJECTIVE: We want to put on record two years' experience of undergraduate teaching of an optional subject, "Medicine at the Primary Care level". This was given to sixth-year students by Family and Community Medicine specialist doctors within the Department of Medicine. DESIGN AND SETTING: A crossover study carried out at the University of Alicante. PARTICIPANTS: In the first year, 73 out of the 102 students making up the complete course took part (71.6%); and in the second year, 33 out of 93 (35.5%). MEASUREMENTS AND MAIN RESULTS: The methodology employed, the teaching staff and the documents handed out were given high marks by the students in both cases; as were the course contents in the second year. Deficiencies were noted in the presentation of practical hypotheses. In the first course the students criticised the lack of certain points, basically the tackling of the more common chronic pathologies, something which was corrected in the second year. The survey identified students' wishes to spend longer on the subject. CONCLUSIONS: The students valued positively the existence of a theoretical content specific to Primary Care Medicine. In particular, they requested to be taught performance patterns for prevalent pathologies and for seminars to be organised around practical hypotheses.     

Effect of preoperative transdermal ketoprofen on post-hysterectomy pain

OBJECTIVES: To find the incidence of brucellosis, and analyse its epidemiological characteristics and the evolution of the cases recorded in the Sierra de Cádiz Primary Care (PC) Area during 1992. DESIGN: A prospective longitudinal incidence analysis, with a nested study of cases and controls. SETTING: Sierra de Cádiz PC Area. PATIENTS AND OTHER PARTICIPANTS: Cases: members of the cohort who developed the disease. Controls: sample of members of the cohort free of Brucellosis paired for age, gender and town of origin. MEASUREMENTS AND MAIN RESULTS: Incidence was 52.39 per 100,000, 66.27 and 38.20 per 100,000 in men and women, respectively. Highest incidence was at between 15 and 49 years of age (67.70 per 100,000). Cases in the Spring predominated (chi 2 = 16.77, gl = 3, p < 0.05). The most affected professional group was farmers/herders (RR = 4.59, CI 95%, 2.05-10.26). CONCLUSIONS: The Sierra de Cádiz is an area with endemic brucellosis, especially in the districts of Olvera and Ubrique. Its work-related character is clear, in spite of the digestive tract being the main transmission path.     

The degree of agreement in the radiological interpretation of the growth of left cardiac cavities between the radiologist, the family physician and residents in family and community medicine

OBJECTIVE: To discover the level of agreement about the radiological interpretation of the growth of left-side cardiac cavities, between the referring radiologist (Rx), a family doctor (FD) and three interns studying the third year of family and community medicine (IFCM). DESIGN: Observational crossover study. SETTING: Primary Care (PC). The Perpetuo Socorro Health Centre in Huesca. PATIENTS AND OTHER PARTICIPANTS: Hypertense patients included in the programme of one of the general medicine sections. MEASUREMENTS AND MAIN RESULTS: There were 69 thorax radiographies (TXR), 10 of which were repeated in order to assess the level of agreement between different evaluations by the same observer (intra-observer). Out of these 69, there was agreement between observers in 39 cases (66.10%) with Kappa Index (KI) 0.39 +/- 0.12 for two IFCMs (2 and 3); in 44 (74.57%), with KI 0.55 +/- 0.12 for the first IFCM; and in 40 (67.10%), with KI 0.39 +/- 0.12 for the FD. The intra-observer agreement was 80% with KI 0.50 +/- 0.29, 60% with KI 0.20 +/- 0.23 and 90% with KI 0.80 +/- 0.23 for the three IFCM's. It was 70% with KI 0.34 +/- 0.27 for the FD and 80% with KI 0.48 +/- 0.29 for the Rx. CONCLUSIONS: Both the inter- and intra-observer agreement levels were insufficient. We propose that our training during the period of specialisation should be strengthened on the most useful questions from the PC point of view. Studies of this sort need to be carried out in PC in order to obtain maximum benefit from these complementary tests.