Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management

BACKGROUND: The Spanish National Health Service is a universal and free health care system. Non-specific low back pain (LBP) is a prevalent disorder, generating large health and social costs. The objectives of this study were to describe its management in primary care, to assess patient characteristics that influence physicians' decisions, and to describe clinical outcome at 2 months. METHODS: A cross-sectional sample of 648 patients with non-specific low back pain was recruited by 75 physicians (out of 361 – 20.8%) working in 40 primary care centers in 10 of the 17 administrative regions in Spain, covering 693,026 out of the 40,499,792 inhabitants. Patients were assessed on the day they were recruited, and prospectively followed-up 14 and 60 days later. The principal patient characteristics that were analyzed were: sex, duration of the episode, history of LBP, working status, severity of LBP, leg pain and disability, and results of straight leg raising test. Descriptors of management were: performance of the straight leg raising test, ordering of diagnostic procedures, prescription of drug treatment, referral to physical therapy, rehabilitation or surgery, and granting of sick leave. Regression analysis was used to analyze the relationship between patients' baseline characteristics and physicians' management decisions. Only workers were included in the models on sick leave. RESULTS: Mean age (SD) of included patients was 46.5 (15.5) years, 367 (56.6%) were workers, and 338 (52.5%) were females. Median (25th–75th interquartile range) duration of pain when entering the study was 4 (2–10) days and only 28 patients (4.3%) had chronic low back pain. Diagnostic studies included plain radiographs in 43.1% of patients and CT or MRI scans in 18.8%. Drug medication was prescribed to 91.7% of patients, 19.1% were sent to physical therapy or rehabilitation, and 9.6% were referred to surgery. The main determinants of the clinical management were duration of the episode and, to a lesser extent, the intensity of the pain (especially leg pain), a positive straight leg raising test, and degree of disability. The main determinant of sick leave was the degree of disability, followed by the characteristics of the labor contract and the intensity of leg pain (but not low back pain). After at least 2 months of treatment, 37% of patients were still in pain and approximately 10% of patients had not improved or had worsened. CONCLUSION: Although the use of X-Rays is high, determinants of physicians' management of LBP in primary care made clinical sense and were consistent with patterns suggested by evidence-based recommendations. However, after 2 months of treatment more than one third of patients continued to have back pain and about 10% had worsened

Poblacion general de España : sus trofeos, blasones, y conquistas heroycas ... ; Reales genealogias, y catalogos de dignidades eclesiasticas, y seglares

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Densidad de la poblacion de España por Partidos Judiciales según el censo de 1860

Coordenadas referidas al meridiano de Madrid (O 7°25'--E 9°31'/N 43°26'--N 34°46'). Red geográfica de 1° en 1°. Mención nominal de los puntos cardinalesIndican la densidad de población en cada partido judicial con cifras y clave cromáticaInserta: "Provincia de las Islas Canarias: Parte occidental" y "... Parte Oriental". Escala [1:2.500.000

Survey on colour blindness at the Faculty of Fine Arts UCM and interviews with colour blind students of the Degree in Fine Arts UCM

Respuestas a encuesta online; texto (entrevistas individuales)Esta base de datos está configurada por resultados de encuesta sobre daltonismo y entrevistas a alumnado daltónico del Grado en Bellas Artes, todo dentro de la Facultad de Bellas Artes de la UCM.Universidad Complutense de Madrid, Vicerrectorado de CalidadDepto. de Pintura y Conservación-RestauraciónFac. de Bellas Artesunpu

The long-term patterns of regional income inequality in Spain, 1860–2000

This paper studies the evolution of Spanish regional inequality from 1860 to 2000. The results point to the coexistence of two basic forces behind changes in regional economic inequality: differences in economic structure and labor productivity across regions. In the Spanish case, the initial expansion of industrialization during the period 1860-1900, in a context of growing economic integration of regions, promoted the spatial concentration of manufacturing in certain regions, which also benefited from the greatest advances in terms of labor productivity. Since 1900 and until 1985, the diffusion of manufacturing and services production to a greater number of locations generated the emulation of production structures and a process of catching-up in labor productivity and wages. So, in these first 125 years, national market integration and economic growth has been followed by a Ushaped evolution of regional incomes inequality. Nevertheless, some productivity differentials remained and, from 1985 on, the Spanish entry in the UE generated a new upsurge of divergence in productivity across Spanish regions that could be in the base of a new phase of regional income divergence