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The European Code against Cancer includes some primary cancer prevention behaviours, which can be studied in the framework of psychosocial models of human behaviour as the ASE model (attitude-social influence-efficacy model). The objective of this study was to detect the factors that better explain cancer behavioural risk in relatives of cancer patients. A convenience sample of 3031 people was selected in primary care centres. A three-step multivariate analysis was carried out by means of a multiple linear regression, introducing cancer behavioural risk as the dependent variable and the following covariables: psychosocial factors in the ASE model, sociodemographic variables and the family history of cancer. At least five difficulties and four needs were perceived in following the preventive advice by 25% of patients. The main difficulties were tobacco and alcohol addiction and the demands of a social life. Principal needs were access to cessation programmes, family support, and being controlled and pressured by health workers. The highest risk profile is to be a young man with a low sociocultural level. The ASE determinants were the best predictors of cancer behavioural risk, so programmes that forget these predictors may not achieve any impact and may waste resources.

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OBJECTIVE: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, which seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. METHOD: Descriptive retrospective study (1992-96) RESULTS: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frequent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0.6 unnecessary aggressive techniques. CONCLUSIONS: The great variability in decision-making for diagnosing advises the application in of a diagnostic protocol that would avoid unnecessary damage for the patient and sanitary costs.

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Propósito: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) es un arduo problema médico sujeto a gran variabilidad. La protocolización basada en la evidencia científica, podría evitar gestos sanitarios innecesarios y reducir el sufrimiento del enfermo, sin disminución de la supervivencia. Se describen las características clínico-patológicas y epidemiológicas del COD en Asturias, el nivel de adecuación de las decisiones diagnósticas a un protocolo teórico, su repercusión económica y la supervivencia. Método: Estudio descriptivo longitudinal retrospectivo (1992-96) de los casos de COD diagnosticados en los hospitales de Asturias. Resultados: Se incluyeron 568 casos: edad media 66,9 años; 59,7 por ciento varones; 39,3 por ciento estudiado en Servicios de Medicina Interna; 27,1 por ciento con hallazgo del tumor primario (más frecuente, pulmonar); mediana de la supervivencia 13 semanas. El número de técnicas diagnósticas fue variable y la media de estancia hospitalaria, 24,7 días. Un buen ajuste al protocolo se asoció con un número mayor de primarios conocidos. Conclusiones: Existe variabilidad diagnóstica del COD en Asturias. La protocolización podría evitarla en parte y resultaría beneficiosa para el paciente y el sistema sanitario (AU)

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Objetivo: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) está sujeta a gran variabilidad. La aplicación de un protocolo diagnóstico basado en la evidencia científica actual, podría evitarla. Se describen las características epidemiológicas del COD en Asturias y se evalúa la adecuación de las pruebas diagnósticas realizadas al protocolo teórico. Método: Estudio descriptivo retrospectivo (1992-96). Resultados: En el estudio piloto se incluyeron 157 casos: 59 por ciento varones, con edad media global de 67 años. La forma de presentación más frecuente fue hepatomegalia (29 por ciento) y la histología: adenocarcinoma (51 por ciento). El diagnóstico del primario se hizo en el 22 por ciento, localizándose en pulmón en el 31 por ciento; se hizo necropsia sólo en el 4,8 por ciento de los fallecidos. La mediana de la supervivencia fue de 13 semanas, significativamente superior para el carcinoma escamoso, sin relación con el éxito en el diagnóstico del primario. La media de estudios innecesarios por paciente fue de: 8 analíticas, 3 técnicas de imagen y 0,6 técnicas agresivas. El desvío respecto del protocolo teórico fue superior al 25 por ciento en un 47 por ciento de los casos. Conclusiones: La aplicación de un protocolo diagnóstico en el estudio del COD evitaría pruebas diagnósticas innecesarias, con el consiguiente ahorro de molestias para el paciente y de costes sanitarios (AU)

Objective: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, wich seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. Method: Descriptive retrospective study (1992-96). Results: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frecuent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0,6 unnecesary aggresive techniques. Conclusions: The great variability in decision-making for diagnosing advises the application of a diagnostic protocol that would avoid innecesary damage for the patient and sanitary costs (AU)

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BACKGROUND: The development reached by many countries of our planet has allowed that in them most of the infectious diseases have diminished and that the life expectancy is over the 75 years of life. As a result of this, degenerative and chronic diseases are every day more prevalent and their treatments are longer and complex. To value quality of life in these patients and the effect of the therapy on health is at the moment a main goal of public health. OBJECTIVES: To know the origin, the evolution, and the theoretical foundation of the concept of the quality of life, as well as their measurement methods. On the other hand, to describe the characteristics of the different available questionnaires in Spain to measure the quality of life, either of generic or specific for neurologic illness. MATERIAL AND METHODS: The most important questionnaires which have been adapted and validated into Spanish have been revised. An exhaustive revision of the bibliography related with quality of life and neurology was carried out, and all the questionnaires described in these processes were revised. RESULTS: We describe the philosophy and concepts of health, quality of life (QOL) and health related quality of life (HRQL). The following generic questionnaires are described: the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Medical Outcomes Study Short Form (SF-36), the European Profile of Quality of Life (EuroQoL), the Questionnaire of Quality of Life (CCV) and the Profile of Life quality in the Chronically ill (PLC). In an exhaustive bibliographical revision on quality of life and neurology, 52 indexed papers appeared, of those which only twelve were related with those subject. The following specific questionnaires are described: Qualité de Vie et Migraine (QVM), the Parkinson's Disease Questionnaire (PDQ-39), the Functional Status Questionnaire (FSQ), the Quality of Life in Epilepsy Inventory (QOLIE-89) and their variant of 31 items. Finally two questionnaires ad hoc are described to study migraine and epilepsy. CONCLUSIONS: The incorporation of HRQL measures in patients with neurological illnesses is an increasing and valued practice by its specialists. We observe that the availability of generic tools to measure the HRQL in Spanish is wider every day, although most of these come from other cultures. The process continued in their transcultural adaptation and validation allows us to have some tools of great reliability and effectiveness that facilitate its use. In relation to the specific questionnaires on neurologic process, the supply is considerably smaller due to the recent appearance of these methods in this clinic area.

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FUNDAMENTO: El desarrollo alcanzado por muchos países de nuestro planeta ha permitido que la mayoría de las enfermedades infecciosas hayan disminuido y que la esperanza de vida sobrepase los 75 años. Esto ha dado lugar a que las enfermedades degenerativas de carácter crónico sean cada día más numerosas, y sus tratamientos, prolongados y complejos. Valorar la calidad de vida de estos pacientes y el efecto que sobre ella ejercen las terapias constituyen actualmente objetivos sanitarios de primer orden. OBJETIVOS: Conocer el origen, la evolución y el fundamento teórico del concepto de calidad de vida, así como sus métodos de medida. Por otro lado, describir las características de las diferentes herramientas disponibles en España para medir la calidad de vida, bien de carácter genérico o específicamente en procesos neurológicos. MATERIAL Y MÉTODO: Se han revisado los cuestionarios más importantes que han sido adaptados y validados en nuestro país. Se realizó una revisión exhaustiva de la bibliografía relacionada con la calidad de vida y la neurología, revisándose todos los cuestionarios descritos en estos procesos. RESULTADOS: Se exponen la filosofía y los conceptos de salud, calidad de vida (CDV) y calidad de vida relacionada con la salud (CVRS). Se describen los siguientes cuestionarios genéricos: el Perfil de Salud de Nottingham (NHP), el Perfil de las Consecuencias de la Enfermedad (SIP), el Cuestionario de Salud (SF-36), el Perfil de Calidad de Vida Europeo (EuroQOL), el Cuestionario de Calidad de Vida (CCV) y el Perfil de Calidad de Vida en Enfermos Crónicos (PECVEC). En una revisión bibliográfica exhaustiva sobre calidad de vida y neurología, aparecieron 52 trabajos referenciados, de los cuales sólo 12 estaban realmente relacionados con esos descriptores. Se describen los siguientes cuestionarios específicos: Perfil de Calidad de Vida y Migraña (QVM), el Cuestionario de la Enfermedad de Parkinson (PDQ-39), el Cuestionario del Estado Funcional (FSQ), el Inventario de Calidad de Vida en Epilepsia (QOLIE-89) y su variante de 31 ítems. Finalmente se describen dos cuestionarios realizados ad hoc para estudiar la migraña y la epilepsia. CONCLUSIONES: La incorporación de la medición de la CVRS en pacientes con enfermedades neurológicas es una práctica cada día mas frecuente y valorada por sus especialistas. Observamos que la disponibilidad de herramientas genéricas para medir la CVRS en nuestra lengua es cada día más amplia, aunque la mayoría proceden de otras culturas. El proceso seguido en su adaptación transcultural y validación permite que dispongamos de unas herramientas de gran fiabilidad y eficacia que facilitan su utilización. Con respecto a los cuestionarios específicos sobre procesos neurológicos, la oferta es considerablemente menor debido a lo reciente del empleo de estos métodos en esta área de la clínica (AU)

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BACKGROUND: The cigarette smoking habit continues to be prevalent to a greater degree than would be desirable among teenagers. Innovative prevention programs are needed. This descriptive cross-sectional study sets out the behavior variables related to the cigarette smoking habit and the extracurricular activities in which teenagers are most frequently involved which are useful for setting out extracurricular prevention programs. METHODS: The data was collected by means of a questionnaire validated in a representative sample of school age youths (ages 10-11 and 13-14) from Asturias. The variables entailed in cigarette smoking were analyzed using the regression method. RESULTS: The starting smoker percentage is 14.5%-42.5%, regular smokers totaling 1.1% and 12.4%, respectively. Two models were constructed with the variables significantly related to smoking behavior, which are properly classified into smoker/non-smoker by 98.85% and 91.39% of the children, by ages. The environmental variables (availability of cigarettes and alcoholic beverages and regular visits to places entailing risk) are the major aspects comprising the model. The most common extracurricular activities are: watching TV, reading and listening to music and watching or playing sports. CONCLUSION: The findings provide keys to planning extracurricular activities tailored to fit in with the activities most popular among teens: TV commercials and ads on music media (CD's, tapes, etc.) and printed information mailed directly to teens at their homes, with messages conveyed by opinion-leaders among teens in the fields of sports, music and television.

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PURPOSE: To evaluate the prevalence of all twenty elements of ISO 9000 in the practice of the Blood Banks of Spain independently of being certified or not to ISO system. MATERIALS AND METHODS: By a survey sent in november 1996 to the Hospital-Based Blood Bank and Transfusional Services of 225 hospitals with more than 100 beds, and to 25 Community Blood Centers. The survey had 38 questions on the all elements of the ISO system and on other aspects of quality no directly related with it, as to be accredited by transfusional accreditation Committee, to have an hospital transfusion committee, informed consent of the transfusion and guidelines for using hemoderivatives. RESULTS: The survey was answered by 53 (21%) of hospitals and Community Blood Centers. None of the participant were certified to ISO system. The elements more used were the documentation of adverse reactions, procedures manual, validation of blood components, control of nonconforming products, and product identification and traceability, all of them used for more than 80% of participants. On the contrary, the elements less used were to have a quality unit, equipment manual, to validate the computer system, internal quality audits, criteria on purchasing, training and quality manual, all of them used by less than 30% of the participants. CONCLUSIONS: Generally speaking the elements of the ISO system more commonly used are those related to the basic ones of daily work and the least used are those related to the organisation aspects of quality. The Community Blood Centers score higher than hospital blood banks and among these, the best results are in the blood banks of hospitals more than 500 beds and the hospital accredited for teaching.

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OBJECTIVE: To study the cost-effectiveness of simple anti-smoking advice in Primary health care. METHODS: We accomplish a cost-effectiveness analysis in the area of the Primary health care. As efficiency of the advice we use own results. To evaluate the smoking cessation we base on vital tables of the "25-State Cancer Prevention Study", discounted to the 5%. The costs have been calculated as of the tariffs used for services billing lent in primary health centers to not beneficiary of the social security. It was accomplished a sensibility analysis on different aspects with possible influence on the result. RESULTS: The cost-effectiveness oscillated between 67,621 and 89,619 pesetas by year of life saved for the men and between 116,225 and 137,748 pesetas for the women, in function of the age. The relationship most favorable, for both sexes, it is between 45 and 54 years. In the group of 35 to 39 years, for the physicians, was of 89,419 and 163,934 pesetas for men and women respectively, and for the nursing personnel was oscillating between 43,955 and 81,523, for men; and between 80,584 and 149,460 pesetas for women in function of the considered salary. CONCLUSIONS: It is an intervention with a very favorable relationship cost-effectiveness, at least, comparable to that of other customarily accepted preventive measures. The nursing advice is less effective that the physician advice, but it is, at least, equal of efficient in terms of cost by year of life saved.

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BACKGROUND: To ascertain the health and hygiene-related conditions of school lunchrooms within the municipality of Oviedo by means of conducting a health and hygiene inspection of these facilities. METHOD: A descriptive epidemiological cross-sectional study was made of 24 schools in the municipality of Oviedo, 9 of which were government-subsidized private schools and another 15 of which were public schools, according to information from the Ministry of Education and Science. An inspection was conducted entailing a protocol based on the Public Lunchroom Health and Hygiene Regulations. The variables are the health and hygiene-related conditions of the premises (kitchens, lunchrooms and lavatories), of the utensils, the health of the employees and the conditions of the raw materials and foods. These conditions have been considered to be inadequate or deficient whenever they failed to met the criteria of the protocol in question. RESULTS: The deficiencies found n most of the school lunchrooms inspected were the lack of protection of the lighting components, of window screens to prevent the entry of insects and of soap dispensers which are not hand-operated, disposable paper towels and liquid soap both in kitchens as well as in lavatories. The variables entailed in this study have been compared among public schools and government-subsidized private schools, for which purpose a Student T Test was employed, significant differences having been found to exist between these two types of schools solely in the condition of the kitchens and in the total of the items. CONCLUSIONS: Most of the irregularities found in both the public schools and in the government-subsidized private schools are of an organizational nature and with regard to the facilities stemming from a lack of knowledge of the laws in force. It is deemed advantageous for training in Hygiene to be provided, given the positive attitude shown by those in charge of the schools in question.

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BACKGROUND: In this work the transcultural adaptation and validation of a quality of life questionnaire has been approached, taking into account its increasing interest and its practice considerations. The Profil der Lebensqualität Chronischkranker (PLC) is a German instrument and titled in Spanish. Perfil de Calidad de Vida para Enfermos Crónicos (PECVEC). The main goal of the present study is the assessment of the transcultural equivalence between the Spanish version and the original questionnaire version. SUBJECTS AND METHODS: Translations and back-translations from the original instrument, using bilingual personnel, were made. The most important goal of the study was to achieve the more accurate equivalence between the original version and the Spanish version of the questionnaire. The translations were discussed between the groups of investigators in Germany and Spain and finally adapted a pretest that showed good statistical results. The instrument was applied in two groups of subjects paired by sex and age and its validation was made. RESULTS: The results of two studies (one German and other Spanish) are compared. In the Spanish study the Cronbach's Alpha coefficient (range: 0.39-0.97) and the factorial analysis of the items showed good internal consistency. Cronbach's Alpha was higher than 0.6 for all dimensions except for the scale of Social Well-Being (0.39) with an average value 0.72. The comparison between two factorial structures showed that both are similar statistically. The adapted version showed discriminant capacity between groups ("known group validity") and the final scores of quality of life were similar to the original version. CONCLUSIONS: The adaptation process from the original version to the Spanish version has finished with a transcultural equivalence between both. This preliminary validation can be seen as an important starting point to increase, in this field, the number of instruments of assessment health-related quality of life in chronic patients in Spanish language.

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OBJECTIVE: To describe Spanish scientific output in primary care with regard to subjects, design and statistical methods employed and also its appropriateness, importance and funding. DESIGN: Descriptive, longitudinal and retrospective study. SETTING: Spanish scientific output in primary care published in medical journals and listed in the Indice Medico Español during the five year period 1988-1992. MATERIAL: 446 original articles published in thirty-four journals. MEASUREMENTS AND MAIN RESULTS: The greatest percentage of articles came under the heading "policy and health" (23.6%), next was "health services" (14.8%). There was a predominance of observational designs (79.9%) and within this category, descriptive studies (67.1%). The most common statistical methods used were contingency tables (35,9%). The majority of articles (94.8%) do not indicate the source of their funding. The appropriateness was around 50% and the importance around 4%. CONCLUSIONS: According to our study, research into primary care centres on the evaluation and organization of the health services. The majority of the designs have little inferential power and simple statistical methods. There is hardly any funding available, and only a half of the articles comply with appropriateness criteria.

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AIM: To describe Spanish scientific production in primary care by means of using bibliometric indexes. SETTING: Spanish scientific production which was published in medical periodicals and indexed in the Indice Médico Español during the years 1988-1992. MATERIAL: 446 articles published in thirty-four different medical journals. DESIGN: Descriptive, longitudinal and retrospective study. MEASUREMENTS AND MAIN RESULTS: The number of articles slightly increases over the complete time of the study, principally in 1992. 98.4% were written in Spanish language. The average number of signatures per article is about five. Most of the authors are family doctors or interns of the medical specialty. In 76.46% of the cases, the articles were signed by only one institution. The majority of them (38.56%), were done in teaching units of family medicine. Barcelona is the most important producer of articles (20.2%) and 78% were published in the Atención Primaria periodical. The average number of references slightly increases during the whole period and is about 17 references in the five years studied. CONCLUSIONS: The scientific production on primary care seems to have an exponential increase according to Price's Law and it is concentrated in the Atención Primaria periodical. Most of authors are family doctors or interns of such specialty, who work in units of family medicine. Collaborative studies among institutions are uncommon. The number of signatures and the use of references were found to be similar to other medical specialties.

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BACKGROUND: Addiction to tobacco is the main cause of preventive morbidity, and so the fight against tobacco consumption is a priority in the developed world. Health advice is a valuable tool in this struggle and it is within the reach of all health workers. To study the long-term effectiveness of all anti-tobacco advice in Primary Aid, together with the influence that the reason for giving up (spontaneous or after advice) has upon the relapse pattern. METHOD: We carried out a clinical test on 501 patients, 242 as a participant group, receiving health advice, and 259 in a control group. We evaluated giving up the habit through a survey. The data were analysed by means of a study with a survival study, considering the relapse to be the final point. Survival curves for the two groups were compared with the Lee-Desu statistic. RESULTS: 115 patients gave up the habit for at least 24 hours (31.8% from the participant and 14.7% from the control group). After 3 years, after a biochemical check-up, 4.5% of the participant group and 1.2% of the control group were still ex-smokers (difference = 3.3; p = 0.043%; there is a confidence interval of 95%: from 0.45 to 6.33). We did not find significant differences between their survival curves (p = 0.08). CONCLUSION: We have been able to confirm the mid- to long-term effectiveness of anti-tobacco advice. We have not been able to demonstrate that anti-tobacco advice in the relapse pattern, but a statistical trend does exist towards a reduction in the participant group.

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OBJECTIVE: The behaviour of occult infection in the uterine cervix was studied over one year in 175 women randomly selected, to determine if the infection persisted, disappeared or if the viral genotype became modified. STUDY DESIGN: An earlier study of the prevalence of HPV cervical infection detected 11 (6.2%) occult infections. Of these the infectious genotype could only be identified in five. One year later the infected women were subjected to further colposcopical examination and molecular hybridization testing. RESULTS: In seven of the 11 cases with cervical occult infection, the DNA HPV genome was found to be completely absent at year-end. Colposcopic and cytological studies remained negative in all women. CONCLUSIONS: The loss of DNA HPV in seven of the 11 previously positive women is probably due to variability in the number of cells that became infected in a situation where small numbers of copies are made. The high proportion of occult infection with uncharacterized viruses supports the view that this type of infection is often due to new genotypes, presently non-classifiable.

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OBJECTIVE: To find how theatre was evaluated as an instrument of Health Education by the pupil-actors of a school where a play on the European Code against Cancer was put on. DESIGN: An observational study (descriptive and crossover). SETTING: Community level. Primary Education. PARTICIPANTS: 100 pupil-actors of the 220 at a primary school in a rural area. They were selected by means of a free, voluntary and spontaneous practical theatre test. INTERVENTIONS: A theatrical show with 14 scenes was created. 8 performances, open to the public, were held in the village's Cultural Centre. MEASUREMENTS AND MAIN RESULTS: Evaluation was with a self-administered questionnaire composed for the occasion and consisting of closed multiple-choice questions. An anonymous group survey, done in class and covering each year separately, included 77 of the 100 actors. A prior pilot survey had evaluated intelligibility. The results were that 97.4% classed the experience as positive and 87% of them considered it very good. 81% had no problem at the moment of acting. 83% were helped by teachers and 81% by parents. 98% would like to do theatre again. CONCLUSIONS: Theatre is highly rated and widely accepted by children, making it a useful

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OBJECTIVE: To find the prevalence of "Generalised Pain of the Locomotive System" (GPLS) in the Principality of Asturias. DESIGN: A crossover study, consisting of an interview and a medical examination. SETTING: Urban and rural population throughout the Autonomous Community of the Principality of Asturias. PARTICIPANTS: The population group under study was chosen at random by multi-stage and proportional sampling. Criteria validated for the diagnosis of GPLS were applied. RESULTS: The response was 75.6% (702 people), in whom 9.2% prevalence of GPLS was found, with a significant preponderance of women. A statistical association of GPLS both with limitations in daily activities and with the presence of anxiety or depression was found. CONCLUSIONS: GPLS shares many features with Fibromyalgia syndrome. Its high prevalence and its association with functional and psychological disturbances indicate the important social repercussions of this disorder.

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A comparative study about quality of life was made in the community of Riosa--north of Spain--on two groups of subjects: one affected by hypertension (n = 115), stage I and II of WHO, and another of the general population, matched in age, sex and residence with the former group and of the same size. The subjects with loss of self-care or mobility were excluded. The quality of life was evaluated with a standardized measurement approach referring to the spheres of physical, emotional, social and sexual functions. With this study the validation of the Spanish version of the questionnaire was made and the results obtained were found to be more or less the same as those reported by authors in other European countries of similar sociodemographic conditions. Hypertensive patients reported significant lower scores of quality of life than the general population in more than half of the dimensions explored: well-being and physical capacity, social functioning, positive mood and psychological functioning. In conclusion, despite the many limitations inherent to this area of research, a standardized and valid measure of relevant aspects of quality of life in the general population and especially in patients with hypertension, is available in the Spanish language.

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