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Biomedical subjects

M Soler Vila

Publications and source records attributed to M Soler Vila.

6 recordsLinked to original sources
PubMed2003

[How do we refer to mental health from primary care?].

OBJECTIVES: To describe referrals from primary care (PC) to mental health (MH) and to study the diagnostic and therapeutic concordance between the two. DESIGN: Retrospective, descriptive study. SETTING: Gavà II Primary Care Centre, Barcelona.Participants. All patients referred to MH in 1998, 1999 and 2000 (n=380). MAIN MEASUREMENTS: The following from the referral form and PC medical records were analysed: general diagnosis, drugs treatment, number of words in the report, and purpose of referral; and on the first visit to MH: general diagnosis and drugs treatment. The kappa index was used to analyse the concordance between the diagnostic and therapeutic groups. RESULTS: There were 380 referrals, 63.4% of which were women. Information was obtained from the referral form in 81.6% of cases. In 50.7% the reason for referral was for the case to be supervised; and in 12.4% the reason was not recorded. 18.7% (71 cases) did not attend their first MH appointment and waited an average of 78 days (SD=70.9) until the appointment. As 92 cases were lost (71 who did not attend and 21 for whom insufficient information was obtained), only 288 cases were analysed.The greatest diagnostic concordance between PC and MH was in mental deficiency (kappa=0.85) and psychotic disorder (kappa=0.77); and the minimum was in anxiety-depressive disorder (kappa=0.24). The maximum degree of therapeutic concordance was for neuroleptic drugs (kappa=0.66). CONCLUSIONS: The diagnostic and therapeutic concordance between PC and MH is weak. The referral sheet is not present in a great many cases. The waiting-time until the first consultation may explain patient absenteeism.

Adult↗
PubMed1999

[How we use opioid drugs on patients with neoplasms].

OBJECTIVE: To find the pattern of use of opiate drugs for treating pain in terminal cancer patients. DESIGN: Retrospective descriptive study. SETTING: Gavà 2 Health Centre, located in Barcelona's industrial belt. MATERIAL AND METHOD: Systematic review of the clinical records for the deaths recorded between May 1993 and March 1998. The following variables were recorded: age, sex, cause and place of death, professional attending patient during terminal phase, use of opiates (type, how they were taken, dosage and length of treatment) and prescribing doctor. RESULTS: Of the 429 deaths reviewed, 100 (23%) were caused by neoplasm (68% males), with an average age of 69 +/- 3 years. More than half the patients (55%) died at home. In the terminal phase they were mainly attended (69%) by their Primary Care team. 52% of the patients were given opiates, with morphine being the most common (71.1%), followed by codeine (40.3%) and tramadol (17.3%). The general practitioner was the prescribing agent in 69.2% of the cases. 76% of the patients who took codeine did so at infra-therapeutic doses (< 120 mg per day). Similarly, insufficient doses of morphine (< 60 mg per day) were given to half the patients who received it. 21.62% only took it during a period of 5 days or less before death. CONCLUSIONS: Primary care teams are taking on steadily greater protagonism in caring for terminal cancer patients. Although a large number of these patients are treated with opiates, these are given at often insufficient doses and for too short time periods.

Aged↗
PubMed1998

[Risk factors associated with the consumption of antidepressant agents].

OBJECTIVES: To find the profile of the consumer of anti-depressants, identify risk factors and calculate the prevalence of the under-diagnosis of depression in our milieu. DESIGN: Case-control study. SETTING: Gavà II Health Centre, Barcelona. PARTICIPANTS AND METHODS: The study covered 134 consumers of anti-depressants and 274 controls with no treatment (one group from the Centre, the other from the community) paired for sex, age and general practitioner. The Zung-Conde self-applied depression) scale was administered. MEASUREMENTS AND MAIN RESULTS: 88% of those surveyed were women, with an average age of 50. The prescribing doctor was, in 55% of cases, their general practitioner. The anti-depressants prescribed were mainly (70.9%) from the group of selective inhibitors of serotonin uptake. There were more divorced and widowed people among the cases (p < 0.05). The pathology most often associated with the cases was digestive (31%, p < 0.02). 63% of cases had suffered some event they thought important in the 6 months before prescription. Average score on the Zung test was 51.5% in the cases, and 40% in the controls (p < 0.0001). Using 50 on the Zung scale as the cut-off point, we classified 56% of the cases and 17% of the controls as depressed. CONCLUSIONS: The profile of the consumer of anti-depressants is a women of about 50, living as one of a couple, house-wife, with primary education only, and medium to low social and economic level. The prevalence in the controls of depressive illness neither detected nor treated is similar to that found in other studies. We need to find some instrument to measure attitude, in order to reduce the number of patients who are underdiagnosed in the consulting room.

Antidepressive Agents↗
PubMed1989

[Review of the effectiveness of medical counseling in quitting smoking in primary care].

After recognizing smoking habit as a relevant problem in our media, the complex implications of this type of lifestyle are commented. After revising the main obstacles for achieving primary health care preventive measures not only for the patient, who frequently looks for a "treatment", but also for the professional who generally desires immediate therapeutic success, we describe the evolution of medical advice as a treatment for controlling smoking habit. Studies done on this topic during the last 20 years have made possible the identification of the basic factors associated with the success of this procedure, such as complementing medical advice with graphic support, establishing a date for dropping the habit, programming follow-up visits, individualization of risks and the use of alternative resources such as nicotine chewing gum. We conclude that intervention of primary health care professionals is usefull and necessary and using the information available is a good way to start.

Attitude to Health↗