La "classe" dels hisendats

Article que analitza el comportament del grup social que controlava la propietat de les terres i que vivia de les seves rendes en la realitat agraria gironina dels segles XVlll i XIX

La piscicultura: una alternativa per a las comarques gironines

La piscicultura com una alternativa per a las comarques gironines

Tradició i llegenda: Sant Narcís i les mosques

Presentació d’un dossier que tracta l’acostament crític a la figura del bisbe Narcís i als prodigis que li han estat atribuïts, així com a la producció historiogràfica i artística que ha generat el mite

La Renovación de la atención primaria desde la consulta

Texto y contexto que responden claramente al título bajo la batuta dedos médicos de familia, Josep Casajuana y Juan Gérvas, que aman suprofesión pero que, sobre todo, llevan décadas impulsando iniciativasclínicas, gestoras y de investigación para mejorar la atención a lospacientes. De ellos (y Mercedes Pérez) son los dos capítulos inicialesque sitúan el tema: qué cambios pueden impulsar los profesionalespara recuperar el protagonismo y liberarse de ataduras y complejos ycómo, de manera muy práctica, se combina ciencia y tecnología paraobtener lo mejor de los valores y tiempo del profesional comprometido.Para acabar de tener consciencia de la situación y organización de laatención primaria en España, analizan en los dos capítulos siguientes(junto con Marc Casajuana y Roberto Sánchez) qué supone ser médicode familia en Europa y cómo en un día cualquiera se resuelven hasta17 problemas distintos de atención y seguimiento.El contexto de la consulta –en la segunda mitad del libro– plantea larenovación como exigencia social aportando investigación originalsobre: 1) cómo lo que vamos aprendiendo acerca de la elección deespecialidad médica puede ayudar a refundar la Medicina de Familia yComunitaria (Patricia Barber y Beatriz González); 2) las formas dereasignar recursos (Francisco Hernansanz); 3) cómo renovar los servicios sanitarios en su conjunto en época de crisis (Vicente Ortún y MaríaCallejón); y 4) un panorama muy documentado sobre los campos demanifiesta necesidad de mejora en atención primaria (Ricard Meneu ySalvador Peiró),cuyo abordaje da sentido y complementa la renovaciónplanteada en la primera parte del libro.

La Refundación de la atención primaria

Los misterios del Sistema Nacional de Salud en España son del alma,pero la Atención Primaria es el libro en el que se leen. Cuando la componente sanitaria del Estado de Bienestar, y particularmente su Atención Primaria, parece estar enferma, y al igual que ocurre con unpaciente, tanto o más que un diagnóstico se precisa un pronóstico. Estelibro pretende contribuir a ambos. La población, los profesionales, laindustria suministradora necesita tener un cuadro de cómo se mantendrán unos servicios sanitarios resolutivos financiados públicamente. Atodos los actores implicados va dirigido el libro.La obra se enfrenta a dos problemas clave: la huída de los médicos dela Medicina de familia y el que la carga de enfermedad asociada al usoy abuso de medicamentos quede tan solo por detrás de las enfermedades cardiovasculares y del cáncer. Se realizan propuestas tandetalladas como viables para tratar de solucionar ambos problemas.El análisis de casos, como la insuficiencia cardíaca y el aborto voluntario, ayuda a entender cómo conseguir que un sistema de saludcumpla con sus objetivos de prolongar la vida, evitar el sufrimiento yayudar a morir con dignidad.Los 7 capítulos identifican vías de avance de fácil y necesaria implementación para la muy conveniente refundación de la Atención Primaria.

Els Enclavaments laborals a les comarques gironines

El treball pretén, per una banda, conèixer a grans trets el marc normatiu sobre la inserció laboral de les persones amb discapacitat i endinsar-se en què són i com s’articulen els enclavaments laborals.D’altra banda, pretén conèixer la situació actual i real dels centres especials de treball a les comarques de Girona

El Paisatge. Del mosaic tradicional a la dicotomia ciment-bosc

El paisatge, entès com el conjunt de components que confereixen a un determinat espai unes característiques pròpies, és el reflex fidel de l'evolució econòmica, social, política i ambiental que ha viscut un territori. Els intensos canvis que el paisatge ha experimentat en aquest segle a les comarques gironines es poden resumir en dues grans tendències contraposades: una forta pressió urbanitzadora i implementadora d'infraestructures, i un increment progressiu de la superfície forestal en detriment del tradicional paisatge en mosaic, que es caracteritzava per la seva heterogeneïtat. El resultat d'ambdues tendències ha estat una homogeneïtzació paisatgística progressiva que s'ha volgut il·lustrar amb el que s'ha anomenat "dicotomia ciment-bosc"

Patrimonis fràgils: sèquies i recs

El petit però ric patrimoni hidràulic (preses, rescloses, sèquies, recs...) del país testimonia l’intens aprofitament que han tingut els nostres rius al llarg de la història. Però aquest patrimoni encara no gaudeix del reconeixement i la valoració que comencen a tenir els grans edificis o conjunts del patrimoni industrial vinculat a l’aigua

La litologia de les comarques gironines

Descripció dels trets més rellevants de la constitució litològica de les unitats de relleu del Pirineu, de la depressió Central i del Sistema Mediterrani

La construcció de la muralla medieval del Mercadal en el darrer terç del segle XIV

Descripció de la muralla medieval del segle XIV del Mercadal a la ciutat de Girona

Sant Julià de Ramis y Puig Rom: dos ejemplos de yacimientos con armamento y equipamiento militar visigodo en el noreste peninsular

We present in this work a couple of weapons and objects related to the military equipment of early VIII century from two sites on Girona's province: the castellum of Sant Julià de Ramis (in the municipality of the same name), and the fort of Puig Rom (in Roses). The comparation of these materials has permitted to recompose a quite complete panoply with various types of knives and daggers, shield-handles, axes, spearheads and javelinheads, tips (regatones), arrowheads, belt-buckles and some buckles and horse harness elements

Community pharmacist intervention in depressed primary care patients (PRODEFAR study): randomized controlled trial protocol.

Background: Treatment of depression, the most prevalent and costly mental disorder, needs to be improved. Non-concordance with clinical guidelines and non-adherence can limit the efficacy of pharmacological treatment of depression. Through pharmaceutical care, pharmacists can improve patients' compliance and wellbeing. The aim of this study is to evaluate the effectiveness and costeffectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. Methods/design: A randomized controlled trial, with 6-month follow-up, comparing patients receiving a pharmaceutical care support programme in primary care with patients receiving usual care. The total sample comprises 194 patients (aged between 18 and 75) diagnosed with depressive disorder in a primary care health centre in the province of Barcelona (Spain). Subjects will be asked for written informed consent in order to participate in the study. Diagnosis will be confirmed using the SCID-I. The intervention consists of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring patients about side-effects and stressing the importance of carrying out general practitioners' advice. Measurements will take place at baseline, and after 3 and 6 months. Main outcome measure is compliance with antidepressants. Secondary outcomes include; clinical severity of depression (PHQ-9), anxiety (STAI-S), health-related quality of life (EuroQol-5D), satisfaction with the treatment received, side-effects, chronic physical conditions and sociodemographics. The use of healthcare and social care services will be assessed with an adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This trial will provide valuable information for health professionals and policy makers on the effectiveness and cost-effectiveness of a pharmaceutical intervention programme in the context of primary care. Trial registration: NCT00794196

Chagas Disease among the Latin American Adult population attending in a primary care center in Barcelona, Spain

Background/Aims: The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. Methodology/Principal Findings: We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6-4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n = 127) of 16.53% (95% CI, 9.6-23.39%). All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. Conclusions: We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi¿infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.