Effectiveness of an exercise intervention based on preactivation of the abdominal transverse muscle in patients with chronic nonspecific low back pain in primary care: a randomized control trial

BACKGROUND

Low back pain is one of the most common disabling pathologies in humanity worldwide. Physical exercises have been used in recent decades to reduce the pain, improve the functionality of the lumbar spine and avoid relapses. The purpose of the study is to analyze the effect of a program based on re-education exercises involving preactivation of the abdominal transverse muscle compared to conventional treatment in adults with chronic nonspecific low back pain.

METHODS

A two-arm, single-blind randomized control trial with 35 primary care patients with chronic nonspecific low back pain. Both groups received a 4-week intervention. Data were collected at baseline and at the end of the intervention. Sixteen patients participated in the intervention group, and 19 patients in the control group.

RESULTS

For the experimental group, the outcomes of disability and activation of the abdominal transverse muscle decreased significantly (MD -2.9; CI 95% -5.6 to -0.35; η2 = 0.14; p = 0.028) and (MD 2.3; CI 95% 0.91 to 3.67; η2 = 0.25; p = 0.002) respectively, with a large effect size, compared to the control group. There were no differences between the groups in pain intensity, thickness, and resistance of the transverse abdominal muscle.

CONCLUSION

A 4-week specific program based on re-education exercises of the preactivation of the abdominal transverse muscle is more effective than conventional treatment for reducing disability and increasing the activation of the abdominal transverse muscle measured by VAS scale and PBU.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03097497. Date of registration: 31/03/2017.

Increase of burnout among emergency department professionals due to emotional exhaustion during the SARS-Cov2 pandemic: Evolution from 2016 to 2021

The objective is to establish there have been any significant changes in the evolution of levels of burnout and empathy at the different Emergency Department in our region, bearing the severe acute respiratory syndrome coronavirus 2 pandemic. This cross-sectional observational study was conducted in a healthy region between November 2020 and January 2021. Lleida emergency care centers. All the doctors and nurses of the health were contacted by email. Empathy was measured using the Spanish version of the Jefferson scale of physician empathy. Burnout was measured using the Maslach Burnout Inventory (MBI) in the version validated in Spanish. Sociodemographic data were also recorded. We compared the data with 2016 results. A total of 159 professionals agreed to participate in this study. A significant increase in the MBI score was observed in the 2020 to 2021 sample (39.5 vs 49.7), mostly due to an increase in the MBI-EE (21.5 vs 28.5), as well as an increase in the Jefferson scale of physician empathy score (112 vs 116). (P = .039). There were no differences when analyzing the association between professions (nurses or doctors) or years worked, burnout, and empathy. For 2020 to 2021, the 41 to 50 years age group showed the highest burnout (MBI score). Emergency department practitioners suffered more burnout compared to 2016, especially due to emotional exhaustion (P < .001). Despite practitioners' improved degree of empathy, which had been described as being preventative against burnout, during the COVID-19 pandemic, over-involvement may have led to empathic stress and emotional exhaustion, giving rise to greater burnout.

Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study

AIM

To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers.

DESIGN

Generic qualitative study.

METHODS

Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software.

RESULTS

Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain.

CONCLUSION

Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/11/2016.

Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis

PURPOSE

We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments.

METHODS

Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety.

RESULTS

Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [-0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] - 0.53 [-0.93 to -0.13]), pain (p = 0.002; SMD [95% CI] - 0.41 [-0.67 to -0.16]), anxiety (p = 0.001; SMD [95% CI] - 0.46 [-0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] - 0.33 [-0.61 to -0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate.

CONCLUSIONS

CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).IMPLICATIONS FOR REHABILITATIONCBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.

The influence of an educational internet-based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain: study protocol of a mixed methods approach

BACKGROUND

Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment.

METHODS

The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain.

DISCUSSION

This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.

Empathy and big five personality model in medical students and its relationship to gender and specialty preference: a cross-sectional study

BACKGROUND

Given the influence that personality can have on empathy, this study explores the relationship between empathy and personality, using three different measures of empathy, and taking into account gender and specialty preference.

METHODS

Cross-sectional study. One hundred and ten medical students completed the Jefferson Scale of Physician Empathy, the Interpersonal Reactivity Index, the Empathy Quotient, and the NEO-FFI Big Five personality model. Multivariable linear regression was performed to assess the association between personality traits and empathy.

RESULTS

Empathy scales showed weak and moderate correlation with personality. The strongest correlations were observed between IRI-Fantasy and Openness, and between IRI-Personal Distress and Neuroticism. Gender and specialty preference can modify this relationship. The extreme groups of Empathy Quotient had significant differences in most personality traits.

CONCLUSIONS

This study confirmed that empathy is related to personality. Using three empathy scales allows personalizing the evaluation of different empathy models and its relation with personality. These results can help to design programs to study if some personalized intervention strategies could improve the empathy in medical students.

Descriptive study of association between quality of care and empathy and burnout in primary care

Background

The doctor-patient relationship is a crucial aspect of primary-care practice Research on associations between quality of care provision and burnout and empathy in a primary care setting could improve this relationship.

Methods

Cross-sectional study of family physicians (108) and nurses (112) of twenty-two primary care centers in the health district of Lleida, Spain.

Empathy and burnout were measured using the Jefferson Physician Empathy Scale and the Maslach Burnout Inventory, while quality of care delivery was evaluated using Quality Standard Indicator scores. JPSE and MBI results were grouped into low, medium, and high scores to analyze associations with QSI scores and sociodemographic variables.

Results

The mean QSI score recorded for the family physicians and nurses was 665 (out of a total of 1000). Higher, albeit insignificant, QSI scores were observed for practitioners with high burnout. No differences were observed according to level of empathy (p > 0.05). The differences with respect to sex, age, and area of practice (urban vs rural center) were not significant. Practitioners with low empathy had higher QSI scores than those with high empathy (672.8 vs. 654.4) while those with high burnout had higher scores than those with low burnout (702 vs. 671).

Conclusions

Burnout and empathy did not significantly influence quality of care delivery scores in 22 primary care centers. More studies, however, are needed to investigate the unexpected trend observed that suggests that physicians and nurses with higher levels of burnout provide higher quality care.

The effect of information about the benefits and harms of mammography on women's decision-making: study protocol for a randomized controlled trial

BACKGROUND

The decision to participate or not in breast cancer screening is complex due to the trade-off between the expected benefit of breast cancer mortality reduction and the major harm of overdiagnosis. It seems ethically necessary to inform women so that they can actively participate in decision-making and make an informed choice based on their values and preferences. The objective of this study is to assess the effects of receiving information about the benefits and harms of screening on decision-making, in women approaching the age of invitation to mammography screening.

METHODS

A two-stage, randomized controlled trial (RCT). In the first stage, 40 Basic Health Areas (BHAs) will be selected and randomized to intervention or control. In the second stage, women within each BHA will be randomly selected (n = 400). Four breast cancer screening programs (BCSPs) of the Spanish public health system, three in Catalonia and one in the Canary Islands will participate in the study. Women in the intervention arm will receive a leaflet with detailed information on the benefits and harms of screening using mammography. Women in the control arm will receive a standard leaflet that does not mention harms and recommends accepting the invitation to participate in the biennial examinations of the BCSP. The primary outcome is informed choice, a dichotomous variable that combines knowledge, attitudes, and intentions. Secondary outcomes include decisional conflict; confidence in the decision made; anxiety about screening participation; worry about breast cancer; anticipated regret; time perspective; perceived importance of benefits/harms of screening; perceived risk of breast cancer; and leaflet acceptability. Primary and secondary outcomes are assessed 2-3 weeks after the intervention.

DISCUSSION

This is the first RCT that assesses the effect of informing about the benefits and harms of breast cancer screening in Spain in women facing the decision to be screened using mammography. It aims to assess the impact of information on several decisional outcomes and to contribute to paving the road towards shared decision-making in breast cancer screening in our country.

TRIAL REGISTRATION

ClinicalTrials.gov registry, ID: NCT03046004 . Retrospectively registered on 4 February 2017. Trial name: InforMa study.

Occupational burnout and empathy influence blood pressure control in primary care physicians

BACKGROUND

Good physician-patient communication can favor the adoption of healthy lifestyle habits, which is essential in high blood pressure (BP) management. More empathic physicians tend to have lower burnout and better communication skills. We analyzed the association between burnout and empathy among primary care physicians and nurses and investigated the influence on BP control performance.

METHODS

Descriptive study conducted in 2014 investigating burnout and empathy levels in 267 primary care physicians and nurses and BP control data for 301,657 patients under their care. We administered the Maslach Burnout Inventory and the Jefferson Scale of Physician Empathy and defined good BP control as a systolic BP <130 mmHg.

RESULTS

Low burnout and high empathy were observed in 58.8% and 33.7% of practitioners, respectively. Burnout and empathy were significantly negatively associated (p < 0.009). Practitioners with high empathy and low burnout had significantly better BP control and performance than those with low empathy and high burnout (p < 0.05).

CONCLUSIONS

Low burnout and high empathy were significantly associated with improved BP control and performance, possibly in relation to better physician/nurse-patient communication.

Corrigendum: Method for Improving EEG Based Emotion Recognition by Combining It with Synchronized Biometric and Eye Tracking Technologies in a Non-invasive and Low Cost Way

[This corrects the article on p. 85 in vol. 10, PMID: 27594831.].

Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain

Background: Burnout is a growing problem among healthcare professionals and may be mitigated and even prevented by measures designed to promote empathy and resilience.

Objectives: We studied the association between burnout and empathy in primary care practitioners in Lleida, Spain and investigated possible differences according to age, sex, profession, and place of practice (urban versus rural).

Methods: All general practitioners (GPs) and family nurses in the health district of Lleida (population 366 000) were asked by email to anonymously complete the Maslach Burnout Inventory (MBI) and the Jefferson Scale of Physician Empathy (JSPE) between May and July 2014. Tool consistency was evaluated by Cronbach’s α, the association between empathy and burnout by Spearman’s correlation coefficient, and the association between burnout and empathy and sociodemographic variables by the χ² test.

Results: One hundred and thirty-six GPs and 131 nurses (52.7% response rate) from six urban and 16 rural practices participated (78.3% women); 33.3% of respondents had low empathy, while 3.7% had high burnout. The MBI and JSPE were correlated (P < .001) and low burnout was associated with high empathy (P < .05). Age and sex had no influence on burnout or empathy.

Conclusion: Although burnout was relatively uncommon in our sample, it was associated with low levels of empathy. This finding and our observation of lower empathy levels in rural settings require further investigation.

KEY MESSAGES

More empathic primary care practitioners have lower burnout scores.

Practitioners working in rural areas have significantly lower levels of empathy than their urban counterparts have.

Interventions designed to foster attributes and skills such as empathy, resilience, and doctor–patient communication may help to reduce and prevent burnout.

Cross-Validation of the Spanish HP-Version of the Jefferson Scale of Empathy Confirmed with Some Cross-Cultural Differences

Context: Medical educators agree that empathy is essential for physicians' professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners.

Methods: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and 13 Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis (PCA) with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis (CFA). Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons.

Results: A total of 715 (80%) surveys were returned fully completed. Cronbach's alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p < 0.001).

Conclusions: The findings support the underlying factor structure of the Jefferson Scale of Empathy (JSE). The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research.

Association between Sick Leave Prescribing Practices and Physician Burnout and Empathy

OBJECTIVES

To investigate the association between sick leave prescription and physician burnout and empathy in a primary care health district in Lleida, Spain.

METHODS

This descriptive study included 108 primary care doctors from 22 primary care centers in Lleida in 2014 (183,600 patients). Burnout was measured with the Maslach Burnout Inventory and empathy with the Jefferson Scale of Physician Empathy. The reliability of the instruments was measured by calculating Cronbach's alpha and normal distribution was analyzed using the Kolmogorov-Smirnov-Lilliefors and χ2 tests. Burnout and empathy scores were analyzed by age, sex, and place of work (urban vs rural). Sick leave data were obtained from the Catalan Health Institute.

RESULTS

High empathy was significantly associated with low burnout. Neither empathy nor burnout were significantly associated with sick leave prescription.

CONCLUSION

Sick leave prescription by physicians is not associated with physicians' empathy or burnout and may mostly depend on prescribing guidelines.

[Equality in clinical practice. Proposals for patients, professionals and managers and policies to limit discrimination]

OBJECTIVE

To make feasible and practical proposals to improve equality in the course of clinical care during the patient-provider encounter.

METHODS

Design: A focus group study was conducted with a qualitative approach from the perspective of reducing health inequalities in the clinic. Setting: A classroom discussion focused on equality in clinical work. Subjects: 98 professionals from several countries. Measurement tools: An analysis of the responses was performed, grouped by themes interpreted by analysts, and restructured to provide consistency and uniformity to responses given. Data were collected using a questionnaire with open answers, allowing free-form answers to three general questions that addressed improving equality from the perspective of the professional themselves, patients, and health policy managers. No saturation horizon of analytical discourses was set, to understand that from this subjective prioritization of opinion there is no possibility that discourses reached saturation.

RESULTS

Responses were added to the 3 principal axes, recommending that professionals be aware of their discriminatory ability. Patients were asked to trust their health professionals and that they should be assigned to a professional. It was also proposed that managers provide information systems, help reduce health inequalities, and encourage professional freedom.

CONCLUSIONS

The paper presents concrete measures to promote improved equality in clinics during the delivery of health care.

The profile of general practitioners (GPs) who publish in selected family practice journals

Background

Providing support for research is one of the key issues in the ongoing attempts to improve Primary Care. However, when patient care takes up a significant part of a GP's time, conducting research is difficult. In this study we examine the working conditions and profile of GPs who publish in three leading medical journals and propose possible remedial policy actions.

Findings

The authors of all articles published in 2006 and 2007 in three international Family Medicine journals - Annals of Family Medicine, Family Practice, and Journal of Family Practice - were contacted by E-mail. They were asked to complete a questionnaire investigating the following variables: availability of specific time for research, time devoted to research, number of patients attended, and university affiliation. Only GPs were included in the study. Three hundred and ten relevant articles published between 2006 and 2007 were identified and the authors contacted using a survey tool. 124 researchers responded to our questionnaire; 45% of respondents who were not GPs were excluded. On average GPs spent 2.52 days per week and 6.9 hours per day on patient care, seeing 45 patients per week. Seventy-five per cent of GPs had specific time assigned to research, on average 13 hours per week; 79% were affiliated to a university and 69% held teaching positions.

Conclusions

Most GPs who publish original articles in leading journals have time specifically assigned to research as part of their normal working schedule. They see a relatively small number of patients. Improving the working conditions of family physicians who intend to investigate is likely to lead to better research results.

[Observational study on drug spending in the immigrant and the indigenous population in the Lleida (Catalonia) health region]

OBJECTIVE

To evaluate whether there are differences in drug spending between immigrant and Spanish-born populations and to assess whether drug consumption is associated with living environment (urban/rural).

DESIGN

Observational cross-sectional study.

SETTING

Lleida Health Region (LHR).

PARTICIPANTS

22,847 immigrants and 174,768 native born subjects, aged 15 to 64 years, residing in the LHR.

MAIN MEASUREMENTS

Drug spending during the year 2007, demographical variables, region of origin and residence area (urban/rural).

RESULTS

Native-born subjects spent more in all therapeutic drug groups than immigrants. In men, the relative risk ratio (RRR) of being in the highest quartile of expenditure was 3.2 (95% CI: 2.96-3.44) for native born versus immigrant and in women it was 2.1 (95% CI: 1.97-2.27). Immigrants from eastern Europe had the lowest risk of being in the highest quartile of expenditure, with statistically significant differences. Residents in the rural environment were more likely to have a higher pharmaceutical consumption than residents in the urban environment.

CONCLUSION

Inequalities in drug spending were observed between immigrants and native born subjects. Further studies, either qualitative or mixed, should explore which factors are related to these differences and propose strategies addressed to reducing them.

Evolution of the prevalence and incidence of consumption of antidepressants in a Spanish region (2002-2007)

Background The treatment of depressive disorders involves the administration of drugs of proven efficacy at the correct doses and for specific periods of time, in conjunction with psychotherapeutic support.Aim To assess the evolution of the consumption of antidepressants in the Health Region of Lleida (Spain).Method A retrospective cohort study of the antidepressant medication prescribed via the Spanish National Health System in the Health Region of Lleida between 2002 and 2007. The variables recorded in the study were age, sex, number of patients in antidepressant treatment in the Health Region of Lleida, length of treatment and type of drug. The prevalence of the population of the health region who were receiving antidepressant drugs and the incidence for each particular year was calculated.Results The mean prevalence of patients in treatment with antidepressant drugs was 8.5% (5% in men and 12.1% in women). The highest prevalence was observed in the higher age groups. By therapeutic groups, selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed, five times more than the next group, tricyclics/heterocyclics. The follow-up assessment of the medication prescribed showed that one out of every four patients did not continue treatment after the first month, and 38.4% did not continue after three months. Very few were treated for more than six months.Conclusion This study stresses the high rate of antidepressant treatment in the older women's group. One of every four treatments initiated did not last more than one month. Over the six-year period, 16 506 patients dropped out of treatment.

Sick leave among native and immigrant workers in Spain--a 6-month follow-up study

OBJECTIVES

The incidence and the duration of sick leave were studied among immigrants and the native-born population in Spain.

METHODS

This observational follow-up study included 1427 immigrants and 2793 Spanish natives treated at five primary care centers in Lleida in 2005 and followed for 6 months. The sick leave causes were coded according to the International Classification of Diseases (10th revision). Multivariate Poisson regressions estimated the rate ratio (RR) for sick leave adjusted for age, and linear regressions evaluated the effect of age, gender, and region of origin on the total number of sick-leave days.

RESULTS

Altogether 19.5% of the natives and 12.7% of the immigrants had at least one sick-leave episode. The incidence of new episodes per 100 person-years was lower for the immigrants than for the natives (32.5 versus 43.3 for the men and 18.6 versus 35.6 for the women, respectively). The mean duration of sick leave in the 6-month period was 19.4 (SD 29.4) days for the immigrants and 33.5 (SD 39.2) days for the natives. For the men, the risk of sick leave was greater for the natives than for the immigrants (adjusted RR 1.70, 95% confidence interval 1.43-2.02). After adjustment for age, the duration of sick leave for the native workers was 1.5 times greater than for the immigrants.

CONCLUSIONS

Even though sick leave was less frequent among the immigrants than among the natives and the immigrant sick-leave periods were of shorter duration, the two study populations did not show differences in the causes of disability.

[Use of primary care resources by immigrants and the autochthonous persons who contact the care services in the city of Lleida, Spain]

OBJECTIVE

To evaluate and compare the use of the different primary care (PC) services between immigrants and the indigenous population.

DESIGN

Cross-sectional observation study of a population seen in (PC).

SETTING

Patients seen by 15 PC doctors, in 5 basic health areas (BHA) in the city of Lleida, Spain, from March to August 2005.

PARTICIPANTS

All immigrants (1,599 patients of immigrant origin) who seen during the study period were included. A random sample of 300 patients was taken from each of the 15 participating clinics (4,156 autochthonous patients). The autochthonous was considered as those whose country of origin is Spain and the immigrant population those who come from low and medium income countries, regardless of the time of residence in the BHA.

PRIMARY MEASUREMENTS

Age, sex, type of visit made, and referrals made. Multinomial regression models were used to calculate the relative risk (RR) of having made visits.

RESULTS

Immigrants have a higher probability to make 3 visits than the indigenous population, who would make 1 or 2 visits (RR, 1.23; 95% confidence interval, 1.04-1.91). The estimation of the RR of having made visits is higher in the immigrants for all categories, except nursing.

CONCLUSIONS

Immigrants who come into contact with PC, make more frequent visits to the family doctor and gynaecology, and also have more complementary tests done. However, the frequency of use of the immigrant group for nursing visits seems to be less.

[Use of primary care resources by immigrants and the autochthonous persons who contact the care services in the city of Lleida, Spain]

OBJECTIVE

To evaluate and compare the use of the different primary care (PC) services between immigrants and the indigenous population.

DESIGN

Cross-sectional observation study of a population seen in (PC).

SETTING

Patients seen by 15 PC doctors, in 5 basic health areas (BHA) in the city of Lleida, Spain, from March to August 2005.

PARTICIPANTS

All immigrants (1,599 patients of immigrant origin) who seen during the study period were included. A random sample of 300 patients was taken from each of the 15 participating clinics (4,156 autochthonous patients). The autochthonous was considered as those whose country of origin is Spain and the immigrant population those who come from low and medium income countries, regardless of the time of residence in the BHA.

PRIMARY MEASUREMENTS

Age, sex, type of visit made, and referrals made. Multinomial regression models were used to calculate the relative risk (RR) of having made visits.

RESULTS

Immigrants have a higher probability to make 3 visits than the indigenous population, who would make 1 or 2 visits (RR, 1.23; 95% confidence interval, 1.04-1.91). The estimation of the RR of having made visits is higher in the immigrants for all categories, except nursing.

CONCLUSIONS

Immigrants who come into contact with PC, make more frequent visits to the family doctor and gynaecology, and also have more complementary tests done. However, the frequency of use of the immigrant group for nursing visits seems to be less.

Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations

Background

The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain).

Methods

Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population.

Results

Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts.

Conclusion

In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Open-label, randomized comparison trial of long-term outcomes of levofloxacin versus standard antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVE

This study investigated whether treating acute exacerbations of COPD (AE-COPD) with levofloxacin modifies the long-term outcome of COPD patients in comparison with standard antibiotic regimens.

METHODS

A 6-month open-label clinical trial of AE-COPD patients compared the outcomes of treating with levofloxacin versus standard therapy (clarithromycin, cefuroxime, or amoxicillin/clavulanate) at recommended doses for 10 days. Several variables were analysed: pulse oximetry, FEV1, health-related quality of life, infection-free interval, number of exacerbations, hospitalizations due to an exacerbation and mortality.

RESULTS

Of the 116 patients initially enrolled, completion or withdrawal information was available for 50 patients in the levofloxacin arm and 52 in the standard therapy arm. At the end of the study, there were no differences in mortality (17.8% vs. 22.9%, P = 0.53), number of exacerbations (33 vs. 41, P = 0.40), pulse oximetry (median 91.71% vs. 92.46%, P = 0.18), FEV1 (median 51.31% vs. 47.14%, P = 0.30), health-related quality of life (median 8.63 vs. 10.75, P = 0.94) and infection-free interval (median 112 vs. 101 days, P = 0.72), for the levofloxacin and standard therapy, respectively. However, 12 out of 33 (33.6%) exacerbations treated with levofloxacin required in-hospital management versus 27 out of 41 (65.8%) treated with standard therapy (P = 0.02).

CONCLUSION

This preliminary study suggests that 10-day treatment of AE-COPD with levofloxacin is associated with a reduction in hospitalizations compared with standard antibiotics despite there being no significant benefit in other outcome variables.