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Over the last two decades there has been an increase in outbreaks of arboviral diseases, being Spain at high risk for disease emergence. This paper reviews the current evidence regarding the transmissibility, disease epidemiology, control strategies and mosquito-borne disease drivers and maintaining factors in Spain. There is risk of autochthonous cases and outbreaks in Spain due to recent transmission occurrence. Recently, there has been an expansion of Aedes Albopticus, a vector for Dengue, Zika and Chikungunya; and Cullex spp., vector for West Nile Virus, already endemic in Spain. Their establishment has been facilitated by climate and environmental drivers. If climate change projections are to be met, an increase in disease transmission is to be expected, as well as the re-establishment of other vectors such as Aedes Aegypti. Our review supports the need to understand the threat of these emerging diseases and implement preventive strategies in order to minimise their impact., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Patients with thalassaemia major (TM) and sickle cell disease (SCD) in Spain have been counted since the creation of the Spanish registry of haemoglobinopathies (REHem). The objective of this paper is to update the published data after the increase in cases due to the inclusion of adults and introduction of new-born screening in almost the whole country., Material and Methods: An observational, descriptive, multicentre and ambispective study that included patients with haemoglobinopathies registered in the REHem, started in January 2014 and followed up annually. The data presented correspond until December 31, 2017., Results: Nine hundred and fifty-nine patients were collected. There were 75 cases of thalassaemia (62 TM), 826 of ECF and 58 of other types of haemoglobinopathies. The main diagnostic reason in the TM cohort was anaemia symptoms (70.6%), with a mean age at diagnosis of .7 years; in the SCD cohort it was neonatal screening (33.1%), with a mean age at diagnosis of 2.7 years; 26 patients with TM (41.9%) and 30 with SCD (3.6%) underwent a transplant. There were 2 deaths (3.2%) with TM and 19 (2.3%) with SCD. Overall survival was 96.7% in the TM and 97.5% in the SCD cases at 15 years., Conclusions: Since the previous publication and after the diffusion of new-born screening, the most frequent diagnostic method, to the majority of autonomous regions, and the inclusion of adult patients to the registry, the REHem has increased by more than 240 cases, reaching a total of 959 records., (Copyright © 2019. Published by Elsevier España, S.L.U.)

Introduction and Objectives: One of the main sources of energy in Spain is still coal combustion. It releases multiple pollutants into the atmosphere, such as PM 2.5 , that has been linked to an increase in cardiovascular morbidity and mortality. The objectives of this paper are: 1) to determine the national distribution of these particles and their proximity to coal plants, 2) to estimate the cardiovascular impact of PM 2.5 particles in Spain in 2014., Methods: In order to complete the national pollutant dispersion study, we used the CALPUFF model. The epidemiologic and demographic data were obtained from the National Statistics Institute. The associations «pollutant-effect» were obtained by internationally validated methodologies., Results: The total number of deaths due to coal pollutants were 709, from which 586 (82.6%) were related to PM 2.5 particles. Most of them were due to myocardial infarctions, fatal strokes and heart failure, adding up to 170 cases of mortality related to PM 2.5 (29%). The greatest densities were found in the regions of Asturias and Castilla y León., Conclusions: This study describes an increase in cardiovascular mortality and morbidity in Spain, due to coal combustion pollutants. It finds a greater impact in the provinces of Asturias and Castilla León, where a higher presence of coal power plants can be found. This reflects that the people that live in those areas have a greater risk of cardiovascular death due to PM 2.5 pollutant exposure from coal., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Liver transplantation (LT) is a proven effective treatment of severe liver disease. The aim of this paper is to analyze the results of LT in Spain during the period 1984-2012., Patients and Method: We analyze the results of the database of Spanish Liver Transplant Registry., Results: A total of 20,288 transplants were performed in 18,568 patients. The median age of the donor and recipient increased during the analysis period: 25 years (95% confidence interval [95% CI] 18-40) and 47 years (95% CI 34-55), respectively, in the period 1984-1994 compared to 59 years (95% CI 33-65; P<.05) and 55 years (95% CI 48-61; P<.01), respectively, in the period 2010-2012. The most frequent indications were liver cirrhosis (63.18%) and hepatocellular carcinoma (19.62%). The overall patient and graft survival was respectively 85.1 and 77.8% in the first year, 72.6 and 63.5% the fifth year and 62 and 52.6% in the tenth year. First year patients and graft survival increased respectively from 77.8 and 66.3% in the period 1984-1994 to 88.5 and 83% in 2010-2012 (P<.01). Donor and recipient age, etiology of underlying disease, and hepatitis C virus serological status, were factors associated with decreased survival in univariate and multivariate analysis., Conclusions: Results of LT improved significantly over the review period, despite a progressive increase in donor and recipient age., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system., (Copyright © 2014. Published by Elsevier Espana.)

Background and Objective: Lung transplantation (LT) in chronic obstructive pulmonary disease (COPD) is a procedure with a high rate of morbimortality. The aim of this paper is to analyze the early and late rates of complications and mortality in COPD patients undergoing LT., Patients and Method: Retrospective study of 107 COPD patients transplanted in the Hospital Universitario La Fe, between 1991 and 2008. Preoperative variables were collected as well as all the complications, medical and surgical, occurred in the follow-up, which are expressed as mean or percentage as appropriate. The 30-day mortality and long term survival were established., Results: A total of 94 men (87.9%) and 13 women (12.1%) were transplanted with a mean age (SD) of 52.58 (8.05) years with 71% of double-lung LT. BODE score was 7.24 (1.28). The rate of primary graft dysfunction was 39.3%. The most common surgical complications were phrenic paralysis (16.8%), hemothorax (17.8%) and pleural effusion (30.8%). There was a high number of postoperative hospitalization (30%) and medical complications such as hypertension (36%), diabetes mellitus (16.7%) and renal failure (40%), secondary to treatment. Perioperative mortality was 14% and 34.5% after a year, being the most frequent causes infections (34.6%) and chronic rejection (BOS) (17.8%). Five-year survival was 40.9% with bronchiectasis and smoking history being the risk factors., Conclusions: LT is a procedure with a high early mortality rate associated with high medical and surgical complications that affect the outcome., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Background and Objective: The objective of the present paper is to study the incidence and survival of esophageal cancer from data of the Population-Based Cancer Registries of Zaragoza., Patients and Methods: Crude and adjusted incidence rates were calculated according to sex and the Joinpoint log-linear regression was utilized to calculate trends in adjusted incidence rates for the period 1978-2002. The observed survival was calculated by utilizing the Kaplan-Meier method. For relative survival, the automate calculation of the Oncology Institute of Catalonia was utilized., Results: Joinpoint analysis revealed stability in the incidence rates with Annual Percentage Change of 0.16 (CI 95%: -0.8; 1.1) for men and 0.04 for women (CI 95%: -2.8; 2.8). Observed survival in the period 1978-2002 was 33.2% in the first year and 15.3% in the last year. Relative 1-year survival for males and females was 36.3% (CI 95%: 32.7-40.4) and 23.8% (CI 95%: 20.0-28.4) after 5 years., Conclusions: Data suggest that there were no significant changes in the incidence rates of esophageal cancer in the province of Zaragoza and that survival was low., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

The purpose of this paper is to describe the hospital at home (HaH). The HaH is proposed as a tool of the hospital organization to provide a response to the increasing health care demands. It consists of providing hospital range clinical attention at the patient's home instead of institutional care. Patients depend on the hospital, and their health care professionals constitute the staff that provide care. The characteristics of the HaH are: willingness of the patient, a care provider at home, the task to be carried out must be hospital-based, and can be performed at the patient's home. The development of the HaH requires a prolonged clinical leadership as well as good relationship with the referring clinicians. The evaluation must be carried out as part of a continuum of services of the health system. Both clinical effects and repercussions on the hospital organization must be taken into account. The HaH can provide training and knowledge to physicians about real life patients as well as the opportunity to work alongside a multidisciplinary team. The research must always include a rigorous methodology., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon., (Copyright © 2011 Elsevier España S.L. All rights reserved.)

The aim of this study is to analyze biomedical publications on health surveys (HS) in the Catalan territory from documents published in various bibliographic databases to 2010. Analysis of 1,287 HS documents on 3 bibliographic sources of information relating to Catalonia, between 1991 and 2010. Scientific papers on HS in the Catalan territory have been 196. We studied the variables related to the topic of the article published, the magazine publication of the survey, the characteristics of sampling and the sample size, geographical area and timing of the survey. The articles reviewed represent 15.23% of all original documents. Half of them have been published in Spanish journals, stressing Gaceta Sanitaria and Medicina Clínica and the most studied issues are health and lifestyles. A 40.8% clearly explicit the characteristics of the sample, the size of them range between 49 and 23,126 individuals. It is suggested that HS in Catalonia are useful for generating knowledge about health, lifestyle and health resource utilization of the population, and its disclosure among health experts and the public., (Copyright © 2011 Elsevier España S.L. All rights reserved.)

The Health Survey of Catalonia (ESCA) gives essential population information for health planning and evaluation. On the edition of 2006, 18,126 non-institutionalized persons were interviewed. The sample design is complex with the aim to guarantee the representatively also in small geographic areas with interest in health and service planning. There are certain novelties in the third edition such as the relevance given to the territory, questionnaires adaptations to the interviewed population and new subject areas studied. This paper describes the useful methodological aspects for the ESCA 2006 users. In the first part we describe the sample design, questioners, field work, interviewer's formation, codification and quality micro data control. In the second part compound variables, used tools and their references are shown. And the third part describes the indicators construction since the sample design determines the use of weighing and elevation factors to obtain representative estimation values., (Copyright © 2011 Elsevier España S.L. All rights reserved.)

Background and Objectives: The recent approval of influenza A H1N1 monovalent vaccine has attracted considerable public health interest. The aim of this paper is to assess the development of vaccination campaign in Castilla y Leon., Material and Method: We have performed a descriptive analysis of the number of vaccines given in Castilla y Leon from November 16, 2009 to January 17, 2010, inside the designed campaign for that purpose., Results: The total number of vaccines administered has been 116,243, 86,810 of which were from Focetria(®) which were administered to 3286 children under 18 years; 28,439 were from Pandemrix(®) and 994 from Panenza(®). The estimated vaccination coverage for all of the target groups has reached a percentage of 26.3% while the coverage achieved in pregnant women has been 4.7%. Of all the vaccines administered during this period, 82.2% were applied in the first month of the vaccination campaign., Conclusion: The introduction of pandemic vaccine in target groups of Castilla y Leon has been lower than expected, with a mismatch between the different health areas., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objective: There are no studies in Spain on the extent of obesity in adult immigrants. The aim of this paper is to present the frequency and distribution of obesity among immigrants living in Madrid., Patients and Method: We selected subjects between 18 and 64 years of age. Body Mass Index was used as an estimator of obesity. Immigrant status was defined according to country of birth. The results show the unadjusted and adjusted prevalence of obesity for different immigrant groups., Results: The percentage of obesity was higher in the immigrant population than in the Spanish population, except for the group of immigrants from western countries. According to gender, male immigrants from Eastern Europe and Latin America and women from Asia, Africa and Eastern Europe were the most obese., Conclusion: The highest prevalence of obesity among immigrants has also been observed in studies conducted in other countries. The prevalence of obesity among immigrants may be due to a more intense exposure to obesogenic factors both before arrival and during their residence in Spain.

Background and Objectives: A safety culture is essential to minimize errors and adverse events. Its measurement is needed to design activities in order to improve it. This paper describes the methods and main results of a study on safety climate in a nation-wide representative sample of public hospitals of the Spanish NHS., Material and Method: The Hospital Survey on Patient Safety Culture questionnaire was distributed to a random sample of health professionals in a representative sample of 24 hospitals, proportionally stratified by hospital size. Results are analyzed to provide a description of safety climate, its strengths and weaknesses. Differences by hospital size, type of health professional and service are analyzed using ANOVA., Results: A total of 2503 responses are analyzed (response rate: 40%, (93% from professionals with direct patient contact). A total of 50% gave patient safety a score from 6 to 8 (on a 10-point scale); 95% reported < 2 events last year. Dimensions "Teamwork within hospital units" (71.8 [1.8]) and "Supervisor/Manager expectations and actions promoting safety" (61.8 [1.7]) have the highest percentage of positive answers. "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" could be identified as weaknesses. Significant differences by hospital size, type of professional and service suggest a generally more positive attitude in small hospitals and Pharmacy services, and a more negative one in physicians., Conclusions: Strengths and weaknesses of the safety climate in the hospitals of the Spanish NHS have been identified and they are used to design appropriate strategies for improvement.

In 1995 INSALUD began to develop performance measures in the field of risk management, and following transfer of powers to the regions, these led to the development of operational units in individual healthcare centres. These units, which consist of a group of health professionals, including managers, aim to identify, evaluate, analyse and deal with health risks, to enhance patient safety. Their organisational structure can vary in accordance with the needs, resources and philosophy of each individual organisation. This paper presents the experience of the risk management units developed in four Spanish regions: Madrid, the Basque Country, Galicia and INGESA (Ceuta and Melilla). It also includes reflections on assessment of their impact and on their future role in improving safety in healthcare services.

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs.

Background and Objectives: The assessment and prioritisation of research activity are essential components of any Science, Technology and Industry System. Data on researchers' perspectives in this respect are scarce. The objective of this paper was to describe Spanish scientists' point of view on the current evaluation system in Spain and how they believe this system should be functionally structured., Subjects and Method: From the sampling frame formed by established Spanish scientists, listed in the databases of CSIC and FIS (Institute of Health Carlos III), clinical, biomedical-non clinical, and physics and chemical researchers were randomly selected. Two hundred and eleven interviews were carried out by means of a computer-assisted telephone interviewing system., Results: Researchers expressed their acknowledgement of progress in the Spanish research field but made their wish clear to progress towards better scientific scenarios. In their assessment, they gave a score of 5.4 to scientific policy, as opposed to 9.4 when speaking about the goals, reflecting the desire for a better policy definition, with clear objectives, stable strategies and better coordination of R&D activities (the current coordination received a score of 3.9, while the desirable coordination was valued as high as 9.2). There was certain agreement regarding the need for a prioritisation criteria which preserves some degree of creativity by researchers. They also stated that they would like to see an independent research structure with social prestige and influence., Conclusions: The interviewed researchers believe that the evaluation of scientific activities is fundamental in formulating a sound scientific policy. Prioritisation should arise from appropriate evaluation. Strategies properly coordinated among all the stakeholders (including the private sector) should be fostered. Budget sufficiency, stability, and better organization of independent researchers should be the backbone of any strategy tailored to increase their capacity to influence future scientific policies.

In Spain, owing to the rise of international travels and immigration, the number of patients with imported infectious diseases has increased, many of them from tropical or subtropical areas. In parallel, there has been a multiplication in the number of scientific papers with Spanish authors about imported infections due to parasites, fungus, mycobacteriae, bacteriae or viruses. The risk for public health is low, althought for their correct prevention and control it is important to ease an universal access to healthcare and fair socioeconomic conditions, along with maintaining an updated clinical and epidemiological training of the health personnel. These nationwide measures must be supplemented with worldwide initiatives of global control of these infections.

Background and Objective: To asses the human immunodeficiency virus (HIV) seroprevalence evolution of newborns' mothers., Population and Method: Unlinked anonymous study of HIV antibodies in blood spots for congenital metabolic disorders detection in newborns, from 1996 to 2005; in Baleares, Canarias, Castilla-La Mancha, Castilla y León, Galicia, Melilla and Murcia Regions, including Valencia from 2003 on. HIV-antibodies screening was performed through ELISA and results were confirmed using immunoblot., Results: Global prevalence rates were stable through the period in the 7 initially enrolled regions, near to 1 per thousand; however, during the first 5-year period the prevalence tended to increase (p < 0.05), while a reverse trend was observed in the following 5 years (p < 0.05). Baleares and Valencia showed the highest rates, although Baleares showed a declining trend. Canarias is the only region that displays an increasing trend., Conclusions: HIV prevalence in newborns' mothers remained steady during the 10-year period, but after a phase of significant increase the tendency has reverted. Data presented in this paper show the importance of monitoring HIV prevalence among women who give birth, and emphasise the need of improving antenatal prophylaxis programmes to prevent mother-to-child transmission.

Background and Objective: Sense of Coherence (SOC) is a construct relating to coping strategies in the face of traumatic events. SOC is defined as a personal disposition towards perceiving life experiences as understandable, manageable and meaningful. The construct has shown itself to be a predictor of self-reported and objective health in a variety of contexts. Although the SOC construct has been studied, among the elderly in particular, the scale has never been validated in the Spanish aged population. This paper reports on the cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in a sample of Spanish senior citizens., Subjects and Method: We studied a sample of population from 8 locations across Spain, totaling 419 subjects aged 70 years or over. The psychometric attributes of the scale were studied. These included acceptability, scale assumptions, internal consistency, factor structure, construct validity (convergent validity, differential analyses, inter-domains correlation), and precision., Results: The internal consistency of the scale was adequate (Cronbach = 0.80). SOC showed moderate correlations with self-reported indices of physical health, quality of life and depression. The scale was found valid in differential analyses conducted for gender, age groups, levels of disability and functional impact of diseases. Principal components analysis yielded four factors accounting for 65.59% of the variance. The Meaningfulness domain acted as an independent factor., Conclusions: The OLQ-13 is a valid and reliable instrument for use on Spanish elderly populations, including those with low educational level.

Background and Objective: Independent risk factors (smoking, hypertension, hypercholesterolemia and diabetes mellitus) are direct causes of coronary heart disease and are common in the population. Considering all independent factors together seems to be more appropriate to estimate the global risk of coronary heart disease. The objective of this paper was to estimate the global risk of coronary heart disease based on the Framingham function, adapted to the prevalence of risk factors in Spain., Subjects and Method: The prevalence of risk factors in the Spanish population was estimated based on pooled analysis of regional cross-sectional random population surveys. Prevalence estimates and incidence rate of coronary events were replaced in the Framingham equation accordingly. Risk probability for 10 years was estimated and risk tables were designed using a gradual color coding system according to an increasing risk., Results: The estimated attributable fraction (AF) for hypertension in the Spanish population was 26.7% for men and 22.9% women; that for hypercholesterolemia was 15.7% and 12.7% for men and women, respectively. Smoking was identified in the third position of the ranking order for males (AF 13.13%) and fourth for the female group (AF 3.71%). The prevalence of obesity was 13.2% for men and 17.5% for women. AF for obesity among men was 4% and it was 5% for women., Conclusions: An adaptation of the Framingham equation according to the prevalence of independent risk factors and incidence of coronary events in the Spanish population is useful to build instruments to estimate the 10-year global risk of coronary heart disease while a specific function based on a well-designed cohort study in not available in Spain.

Background and Objective: The objective of this paper was to determine the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and human T lymphotropic virus (HTLV) infections in active heroin users in Spain., Subjects and Method: A cross-sectional study was carried out in 440 heroin users in three different urban areas of Spain: Barcelona, Madrid, and Seville. Specimens were analyzed for the presence of anti-HIV, anti-HCV, anti-HBc, and anti-HTLV antibodies., Results: The rate of anti-HIV antibodies was 20% (CI 95%, 16.3-23.7%); anti-HBc: 21.4% (CI 95%, 17.5-25.2%); anti-HCV: 59.1% (CI 95%, 54.5-63.7%); and anti-HTLV (HTLV-II in all cases): 3.4% (CI 95%, 1.7-5.1%). Barcelona and Madrid had similar rates for each virus, yet these were lower in Seville especially with regard to HCV (Barcelona: 59.7% [CI 95%, 53.1-66.3%]; Madrid: 63.8% [CI 95%, 56.7-70.9%]; Seville: 41.8% [CI 95%, 28.8-54.9%])., Conclusions: HCV is the most prevalent infection among active heroin users in Spain. The rate of infection by blood-borne viruses is higher in Madrid and Barcelona than in Seville (notably for HCV), most likely due to a lower rate of intravenous users in this city.

Background and Objective: Since 1992, the recommendation on the ingestion of folic acid (FA) to prevent congenital defects has become general in developed countries. In this paper, we analyze such a situation in Spain in most recent years., Patients and Method: We used the information concerning mothers of infants selected as controls in the ECEMC database. These mothers make up a sample of pregnant women of the general population. We analyzed the evolution of the consumption of FA/calcic folinate (CF) by pregnant women over the last 22 years, considering the period of pregnancy during which this vitamin was taken and the dosage., Results: The proportion of women who take FA/CF during the first trimester of pregnancy increased dramatically in the last 9 years, up to 80% in 2002. However, only about 9% took the vitamin before becoming pregnant. Moreover, many daily doses are much higher than those internationally recommended for the general population of women planning pregnancy., Conclusions: In our country, the use of FA/CF to prevent congenital defects is correct in a small part of the population of pregnant women. Therefore, it is necessary to continue disseminating appropriate guidelines not only among gynecologists but also among family and general practitioners and health professionals working at family planning centers. Thus, they can transmit to women the need of using FA/CF and the right way to do it.

Background and Objective: Obesity is a major public health problem in developed countries. It is of key importance to ascertain its magnitude and to identify main groups at risk. In this paper the prevalence of obesity in Spanish adult population aged 25-60 is estimated, based on measured height and weight., Subjects and Method: Pooled-analysis of regional cross-sectional nutrition surveys performed on representative random population samples. Randomly selected 9,885 free living subjects aged 25-60 years respondents of population nutritional surveys carried out in eight Spanish regions (Andalucía, Balearic Islands, Basque Country, Canary Islands, Catalunya, Galicia, Madrid and Valencia) between 1990 to 2000. Weight and height were measured on each individual by trained observers following standardised procedures and measuring instruments. The samples were pooled together and weighted according to the distribution of Spanish adult population aged 25-60 years. Obesity was defined as body mass index (BMI) >= 30 kg/m2. The protocol used in each survey was in accordance to the recommendations of the Spanish Society for the study of Obesity (SEEDO) to estimate the prevalence of obesity in population studies., Results: The prevalence of obesity in Spanish adult population was 14.5% (95% CI, 13.93-15.07%), significantly higher among women 15.75% (95% CI, 14.89-16.61%), than men 13,39% (95% CI, 11.84-14.94%) (*2 = 12.470; p = 0.000). Prevalence of obesity significantly increased with age in men and women. The highest rates were estimated for the age group older than 55 years, both among males and females, 21.58% (95% CI, 18.68-24.48%) and 33.9% (95% CI, 32.73-35.07%), respectively., Conclusion: Obesity is a health problem which affects an important proportion of the Spanish adult population. Considering its potential impact on Public Health, it would be required to design and implement effective strategies aimed at the early detection of subjects at risk and the provision of adequate treatment, as well as to establish suitable preventive programmes.

Background and Objectives: The aim of this paper was determine the prevalence of antibodies against Francisella tularensis in the representative sample of people from Castilla-León (Spain) before epidemic outbreak of end 1997., Subjects and Method: We obtain 4,825 sera (between april-1996 and april-1997) of people from Castilla-León. All sera were tested by a microagglutination technique to detect antibodies against Francisella tularensis. The positive sera were tested to determine cross-reaction with Brucella, Yersinia enterocolitica and Proteus in the tube agglutination tests., Results: We detected antibodies against Francisella tularensis in 9 (0,19%) of the 4,825 sera. Only one serum from the 9 seropositive was positive in the tube agglutination against Brucella. None of the 9 sera were positive against the remaining bacterial antigen tested., Conclusions: In the people of Castilla-León before 1997 the prevalence of antibodies against Francisella tularensis was 0,19%.

Background: Research aimed at developing artificial liver support systems has experienced a notable increase in the last decade. Hybrid systems including bioreactors containing hepatocytes which are perfused by liver failure patients blood or plasma have been deviced for the first time. The purpose of such a strategy is to substitute, at least in part, the impaired hepatic function thus improving the prognosis of patients with severe acute or chronic liver diseases., Case Report: In the present paper, we report the first such a case treated in Spain in the context of a controlled, randomized, multicenter international study aimed at investigating the usefulness and safety of a bioartificial liver support system based on cryopreserved porcine hepatocytes in patients with acute liver failure or having a non-functioning primary graft after liver transplantation., Results: In this first experience, two sessions of treatment could be completed before a patient with acute liver failure underwent a successful emergency liver transplantation. After more than two years of follow-up, the patient is in her normal life activities and she has not presented any adverse event related to the bioartificial liver support therapy so far., Conclusion: Bioartificial liver support systems are starting to be available for use in clinical practice. Yet it is mandatory to establish their safety and efficacy before a widespread recommendation.

Background: Tobacco use in Spain is still high, with many smoking related deaths. However, a decrease in smoking prevalence in men has been observed in recent years, with a stabilisation or an increase among women. This paper studies the evolution of cancer mortality in Barcelona city (Catalonia, Spain) according to age and sex over the period 1984-1998., Subjects and Method: The evolution of annual mortality by age and sex was calculated. Specific mortality rates were estimated by age and sex strata; crude and standardized death rates for each year were also determined. Finally, for the 35-64 years population, specific mortality rates were estimated for each 5-year period (1984-1988, 1989-1993, and 1994-1998)., Results: Mortality rates do not change for men aged 35-39, 50-54 and 55-59 years. There was a decrease in lung cancer mortality rates in the 1994-1998 period compared to the first period for those men in the 60-64 years group. In men in the 40-44 and 45-49 years groups, rates increased in the second and stabilize in the last period. Global rates in men in the 35-64 years group, both crude and adjusted, were in the first and last 5-year periods. Among women, rates are much lower, although there was a significant increase in the 35-39 and 45-49 years groups. Crude and adjusted rates in all women aged 35 to 64 years displayed an increase in the last 5-year period., Conclusions: These results show that in Barcelona the decrease in smoking prevalence among males is now leading to an initial decrease in lung cancer mortality. The turning point seems to be in the period 1989-1993. On the contrary, there is a clear increase among young women, although the rates are still much lower.

Background: To analyze the research output of Spanish authors on human immunodeficiency virus (HIV) infection/AIDS., Methods: Papers published over 1991-1999 which were recorder in the MedLine database (CD-ROM) were selected by using the key words Spain or Espana in the address of author field and HIV, AIDS, VIH or sida in any field. Papers were analyzed according to publication journal specialty of authors, subjecte matter of the paper, institution, center of origin and geographical distribution., Results: A total of 2,065 papers were studied. Their number doubled, from 148 in 1991 to 295 in 1999 (r = 0.917; p < 0.0001). The number of papers published in foreign journals trebled, from 51 to 182 (r = 0.933; p < 0.001). The journal with the highest number o papers published was Medicina Clínica: 241 (11.7%). Although the main topic was the clinical manifestations of HIV infection (64.6%), the proportion of papers on this subject decreased from 71.4% in 1991-93 to 58.3% in 1997-99 (p < 0.001). On the other hand, the percentage of articles on antiretroviral therapy increased from 3.6% in 1991-93 to 12.4% in 1997-99 (p < 0.001). The greatest number of contributions came from hospitals (79.8% of papers), followed by universities (9.5%). Centers with the highest output were the Hospital Clínic (Barcelona) (5.7%) and the Hospital Carlos III (Madrid) (5.5%). The Autonomous Communities of Madrid (33.1%) and Catalonia (25.3%) concentrated more than half of the total output, followed by Andalusia (11.5%) and the Valencian Community (8.1%)., Conclusions: Spanish output on HIV infection/AIDS research grew during the 1991-1999 period. There was a remarkable increase in the papers published in foreign journals. Moreover, topics changed according to the epidemiological changes observed in HIV infection during the past decade.

Background: Neurocysticercosis is the CNS involvement caused by Taenia solium larvae and the most frequent cerebral parasitation. It has a cosmopolitan distribution but endemic in the low income countries. The paper analizes the geographic origin, clinical characteristics of patients and the diagnostic and therapeutic modalities., Patients and Method: Retrospective revision of clinical files in patients with the diagnosis of neurocysticercosis between the period January 1990 to March 2000., Results: Ten patients were included of which only one was of Spanish nationality. The others were immigrants or travellers to Central/South America (7), Africa (1) and South East Asia (1). Nine patients presented with convulsive crisis, generalized in 7 and 3 cases suffered headaches. The diagnosis was obtained through biopsy technique (3 cases) and the rest through CT scan or MR and serology. ELISA specific serology was positive in 60% of cases. Eight patients were treated with praziquantel or albendazol solely with good clinical evolution., Conclusions: Neurocysticercosis is prevalent among the immigrant population and in our case imported mostly from Latin America. Diagnosis is reached through imaging and serological techniques. Treatment with praziquantel or albendazol improves the clinical picture and controls the convulsive crisis.

Background: A relevant increase in the clinical relevance of respiratory system area has occurred in the last few years. The aims of this study were: to analyze the evolution of production and impact of Spanish scientific activity in the respiratory system area between 1987 to 1998; and to assess the participation of the different Spanish autonomic communities in this activity., Methods: Papers published in 38 international journals of respiratory system during this period of time were selected by the MedLine system, delimiting Spanish production. Geographical and institutional distribution of the production, specialist of authors, main publication journals and type of publication were recorded. Production and impact bibliometric indicators were estimated., Results: The number of Spanish documents from 1987 to 1998 multiplied by eight, reaching the 1.49% of the total published documents in 1998. However, the growth model of scientific production during this period was lineal. The increase in the scientific production was associated with a increase over time in the expected impact factor. In 1998, expected impact factor was 2. 206. Forty-two percent of the papers were signed by pneumologists. The highest contributor were hospitals. The most productive autonomous communities were Catalonia, Cantabria and Madrid. The communities with the highest expected impact factor were Balears and Catalonia., Conclusions: A relevant increase has occurred in the scientific production and impact of Spanish biomedical activity in respiratory system area.

Background: To identify the Spanish scientific production amongst different areas of clinical knowledge, and to compare it with those of five other European Union countries., Method: Review of MEDLINE data base, for the period 1993-1997. Search limited to four journals, selected, for 10 different medical specialties (Cardiology, Endocrinology, Infectious Diseases, Gastroenterology-Hepatology, Haematology, Nephrology, Pneumology, Neurology, Oncology, Rheumatology). Articles published by authors from Germany, France, Italy, The Netherlands, Sweden and Spain. Journals included in the Internal Medicine subject classification were independently analysed. Data were also related with several econometric indexes., Results: A total of 1,763 original articles published by Spanish authors were identified in the journal's sample over the analysed period (2.08 articles per 100 all published articles). Spain contributes to the total achieved by the six European countries analysed with 9.07 articles per 100 published articles. Gastroenterology-Hepatology was the medical specially which has more articles published by Spanish authors (total: 338 articles; 4.15 articles/100 published articles); and Oncology the one with less articles published (1.26 articles/100 published articles). The mean IF value per journal by article is highest for Gastroenterology-Hepatology (4.86 FI/article) and lowest for Pneumology (2.42 FI/article). Spain is the last amongst all six European countries analyzed in Endocrinology, Oncology and Haematology, and second to last in all others except for Gastroenterology-Hepatology (4th place). Mean cost for each article produced by Spanish authors in the analyzed sample was 0.49 US $ according the health expenditures per capita, and 0.07 US $ according the R+D expenditures per capita. Data from the independent analysis of Internal Medicine journals also showed that Gastroenterology and Hepatology is the subspecialty with a higher number of papers published in those journals., Conclusions: All efforts devoted to improve the quality of Spanish biomedical research, specially in clinical research, had produced positive, but uneven, results, measured by the number and impact factor of original articles published in top ranked biomedical journals. The overall distribution of high impact factor scientific production by specialties is poor when compared to the European Union countries included in the analysis. Those results showed several improvement opportunities. Besides increasing the overall budget for R+D, its is likely that the time has come for backing the highest quality Spanish biomedical research, the one that offers greater and better chances for achieving scientifically valid results, and is published in high impact factor biomedical journals.

Background: The handling of upper gastrointestinal hemorrhage (UGH) usually includes the hospitalization of all patients, regardless of severity and prognosis. The aim of this paper is to assess the security of the outpatient control of some UGH, after their assessment in the hospital emergency room., Patients and Methods: Prospective cohort of 533 patients who attended over 1994 and 1995 hospital emergency room for an episode of UGH not linked to portal hypertension. After clinical and endoscopical assessment in the emergency department, 422 cases (79%) were admitted and 111 (21%) discharged for outpatient care. An analysis is presented of the characteristics of both groups, their clinical outcomes and a multivariate analysis to assess the factors associated with the decision to admit the patient., Results: Outpatients were young, with less comorbidity and better haemodynamic status than hospitalized patients. Most of outpatient cases UGH was due to gastroduodenitis, oesophagitis and Mallory-Weiss syndrome, as opposed to the greater importance of peptic ulcer in those admitted. All outpatients presented clean lesions or haematic remains. 25 (5.9%) hospitalized patients presented rebleeding, vs. only 1 (0.9%) outpatient (p < 0.05). When more severity cases were excluded from hospital group, the differences were not significant. All cases with active bleeding, severe haemodynamic repercussion or without endoscopy were admitted. For the remainder, the decision to admit was associated with the presence of bleeding stigmata, haemodynamic repercussion, some causes of hemorrhage, older age, and urea levels., Conclusions: Although the scarce sample do not permit definitive conclusions, results guide towards that a substantial part of UGH not linked to portal hypertension may be monitored without hospitalizing the patient, thereby minimizing care costs and increasing the productive capacity of the hospital, without increasing risks for the patient.

Background: After the resurgence of tuberculosis in the eighties, several institutions pushed to rapidly create tuberculosis programs and to improve the effectiveness of those in existence. The objective of this paper is to evaluate the programs of the Autonomous Communities of Spain., Material and Methods: A questionnaire was sent to 17 Autonomous Communities and two cities Ceuta and Melilla. A table with minimum objectives was made in order to evaluate the impact of each program. The study period was 1996., Results: The percentage of answers was 100%. Fourteen Autonomous Communities (82%) confirmed they have a tuberculosis program, but with important limitations. There are 3.8 public health workers per 1,000 cases of tuberculosis. Eleven Autonomous Communities had active surveillance, but only 4 know adherence rates to tuberculosis treatments, 3 had supervised treatments, and 3 know diagnostic delays. Ten know results about the percentage of cases with revised contacts. 70% of 19 revised programs did not fulfill the recommended basic objectives., Conclusions: Tuberculosis control in Spain is not adequate for a developed country. An improvement of the programs in needed, with increase of resources and with reference support centers which would carry out annual evaluations.

Background: The demand for sex reassignment in transsexual patients has increased as have the number of treatments. However, these patients run into troubles to be treated in Spanish public hospitals and the patients usually make use of self-therapy, without medical control, by suffering frequent side effects. In this paper, we have analysed these effects., Patients and Methods: Cross-sectional and descriptive study of the side effects of cross-gender hormone self-administration in 57 transsexuals, aged (median [SD]) 30(7) years., Results: Combined treatment with estrogen and cyproterone acetate in 31 male-to-female transsexuals was associated with hyperprolactinemia in 24/31 patients (77.4%) and elevation of liver enzymes in 4/31 (12.9%). Androgen treatment in 26 female-to-male transsexuals was associated with hyperprolactinemia in 10/26 patients (38.5%), elevation of liver enzymes in 5/26 (19.2%). The levels of total cholesterol, LDL-cholesterol and triglycerides were higher in female-to-male that in male-to-female transsexuals (197.3 [40.2] vs 160.6 [38.0] mg/dl, p = 0.033; 131.4 [29.4] vs 104.8 [26.4] mg/dl, p = 0.049; and 131.3 [62.7] vs 67.4 [25.6], p = 0.001, respectively). Total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios were higher in female-to-male that in male-to-female transsexuals, too (4.94 [1.20] vs 3.32 [0.71], p = 0.006; and 3.20 [0.87] vs 2.04 [0.63], p = 0.003, respectively)., Conclusions: The alteration of the cardiovascular risk, the presence of hyperprolactinemia and the elevation of liver enzymes must be taken into account in transsexual patients with hormone treatment.

The importance of the atherosclerotic cardiovascular disease (which is multifactorial in its origin) in Spain and the need for and efficient management of the treatments make especially useful to consider the overall cardiovascular risk of the individual in order to take clinical decisions towards the follow-up and treatment of the disease. Current evidence from cardiovascular risk situations supports this strategy of considering all the risk factors as a whole instead of evaluating each of them separately. This paper tries to revalidate this approach with the most reliable of the available evidence from case studies. The global cardiovascular risk is suggested to be evaluated by a risk chart based on Framingham's study. A revision of the clinical priorities in cardiovascular disease prevention is made. Finally, some views on ordinary clinical cases are given, suggesting the treatment based on a global risk evaluation, considering and opposing evidence and recommended guidelines from the most common Spanish guides on prevention of cardiovascular diseases, evaluating the potential benefit of treatment for the patient, and making a clinical decision.

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. One of the differential traits of the practice of public health when compared to clinical medicine is that it does not concentrate in individual patients, but rather in the health problems of the population in a given time. In public health interventions, besides the importance of efficacy, aspects related to the process of implementation become also crucial. This paper develops some principles for evidence-based public health, which are then applied to a given problem: tuberculosis control in our context. Tuberculosis control poses challenges which go beyond clinical practice, and require a collective organized effort. This is precisely what makes it a public health issue and not only a clinical problem, as it requires not only health care dimensions but also public health dimensions, which require policies that are feasible, have high efficacy, and a moderate cost. To illustrate the problem and the results of public health policies, available data and indicators are used, with special reference to the authors experience in the program for the prevention and control of tuberculosis in Barcelona (Catalonia, Spain).

Background: This paper studies smoking epidemiology in school-age students., Material and Methods: A cross-sectional survey of 8th grade students (13-14 years-old) in the schools of Barcelona (Catalonia, Spain) in 1987, 1992 and 1994., Results: The perception of smoking in the students environment has decreased. The proportion of regular smokers decreases, from 12.6% in 1987 to 9.5% in 1994 (p < 0.05) (an annual decrease of 3.5%) although the proportion who experiment with tobacco remains table., Conclusions: There is a decrease in the prevalence of regular smoking in the school-age population (13-14 years-old) in Barcelona (Spain).

Background: Cumulative risk reflects the lifetime probability that a person will develop a disease or will die from a disease. In this paper we estimate the cumulative risk of developing cancer and dying from cancer during the period 1988-1992 in Catalonia (Spain)., Material and Methods: Data from the Tarragona Cancer Registry and Catalonia Mortality Registry are used. Cancer incidence from Tarragona is extrapolated to the total Catalan population. Cumulative risk is estimated from cumulative rate and with a life table method, which takes into account competing risks. The change in risk with age is also studied., Results: Lifetime risk of developing cancer in Catalonia is 38.9% for men and 28.0% for women. Risk of dying from cancer is 26.3% for men and 17.2% for women, that is, a 67.6% and a 61.5% of incident cases, respectively. One in 14 men will develop lung cancer and nearly all of them will die from the disease. One in 14 women will develop breast cancer and 45% of them will die from the disease., Conclusion: Cancer is an important health problem in Catalonia because its high impact at the individual level shown by the cumulative risk. More than one in 3 men and one in 4 women are diagnosed of cancer during their lives and, among them, two thirds die because the disease.

Background: In 1993 a first study on the scientific production of Spain in 1986-1989 on Biomedicine and Health Sciences, through the Science Citation Index (SCI) was published. The analysis attained the level of centres, with special emphasis in those related to the Health Care System. This paper analyses the period 1990-1993, offers a wider coverage including the Social Science Citation Index (SSCI) database, and compares both time periods., Material and Methods: Documents indexed by SCI and SSCI, CD-ROM version, with at least one Spanish address, published in biomedical and medical journals during the years 1990, 1991, 1992 and 1993, have been studied. Quantitative and qualitative bibliometric indicators for the analysis by subject matter, geographic distribution, institutional sector and centre of origin have been used. Global data were also analysed according to economic and human resources., Results: A total of 21,434 documents were studied, of which 67.9% were journal articles. The highest contributors were Universities (48.8% of the documents) and Hospitals (45.3%). The autonomous communities of Madrid (31.9%) and Catalonia (26.9%) concentrate more than half the production-developed principally by hospitals-followed by Andalucía (11.7%) and C. Valenciana (7.8%). The most active disciplines were biochemistry/molecular biology (13%), neurosciences/neurology (8.4%), pharmacology/pharmacy (8.4%) and medicine, general/internal (7.9%). Comparing the results with period 1986-1989, some of the differences observed could be explained by the fact of MEDICINA CLINICA being included in SCI since 1992. An increase in the number of citable items (72.9%), number of journals used (from 1,086 to 1,346) and international cooperation rate (13.5% to 18.3%) was detected. The institutional sectors with the highest growth rate were Hospitals (92.9%) and Consejo Superior de investigaciones Cientificas (CSIC) (119.3%). Scientific production and visibility of publications (measured as impact factor of journals used) grew in most disciplines, being the quantitative increase greater in cancer/oncology, gastroenterology/hepatology, genetics/heredity and cardiovascular system. No substantial changes as to geographic distribution of documents or most active centres were observed., Conclusions: Spanish scientific activity grew steadily every year and its visibility improved, being the Health sector one of the main actors. When comparing both four-year period. Spain moved up from the seventh to the sixth position in the ranking of EU countries according to its scientific output in biomedicine and health sciences.

Background: According to World Health Organization estimates, from the beginning of the epidemics to the end of 1994, the number of children infected by human immunodeficiency virus (HIV) was 1.5 million. This paper describes the evolution of some clinical and epidemiologic characteristics of vertically transmitted HIV infection., Patients and Methods: All children born to HIV-infected mothers who delivered at a university hospital in Barcelona, Spain, between 1987 and 1992, were included in the study. Rates of HIV vertical transmission, HIV infection incidence and mortality due to HIV were estimated, and trends for the study period analyzed. Odds ratios were used to assess associations between variables., Results: 192 newborns were identified and allocated, with respect to the year of birth, in three cohorts of 71, 58 and 63 children. Overall HIV vertical transmission rate was 16.5% and did not differ between cohorts. Infection incidence density rates increased over time (0.2, 4.9 and 8.1 cases/100 child-years, respectively; p = 0.016), while incubation periods decreased significantly (248, 103 and 114 days; p = 0.0004). There were no changes in mortality density rates (2.2 deaths/100 child-years). Regarding mothers' characteristics, a significant temporal trend (p < 0.001) for being older at delivery, belonging to the heterosexual transmission group and having symptomatic infection was observed over time., Conclusions: Certain clinical and epidemiologic aspects of HIV vertical transmission have changed over time, however the number of new cases has remained fairly constant. In our setting, both early diagnosis and clinical management of these children have improved, but primary prevention for HIV vertical transmission has not been effective. Better counselling for HIV-infected women of childbearing age is needed.

Background: This paper has two objectives. The first is to examine the consistency of the main nutritional studies carried out in Spain over the last fifty years. The second is to use these studies to describe the changes in the Spanish diet over this period and to characterize the present dietary pattern., Material and Methods: We have used three types of studies. First, food balance sheets elaborated by Barbancho, FAO, OECD and the Department of Agriculture. Second, surveys on the foods purchased by population groups, in particular the household budget surveys, and the "panel de consumo alimentario" from the Department of Agriculture. Third, food consumption surveys from Catalonia, Vasque Country, Murcia, Madrid, and Reus., Results: Protein, lipid and total caloric intake have increased over the last fifty years. Carbohydrate intake has been stable. Caloric intake from lipids has increased, caloric intake from protein has been stable and that from carbohydrates has decreased. All studies are consistent in that, from 1980 onwards, caloric intake from protein has been 12.5-16.7%, caloric intake from carbohydrates has been 39.3-48.1%, and that from lipids has been 36.6-46.0%. The monounsaturated/saturated ratio has been 1.2-1.7 and the polyunsaturated/saturated ratio 0.4-0.7. All data sources show a high consumption of foods typical of the Mediterranean diet, in particular fruit, vegetables, fish and vegetable oil, rich in unsaturated fats. Consistency among data sources is higher when data are expressed as percentage of total caloric intake than when they are expelled in absolute quantities., Conclusions: All data sources suggest that the Spanish diet has changed with the economic development, but it still keeps most of the characteristics of the Mediterranean diet.

Background: This paper describes the ponderal distribution of a representative adult population sample of the Community of Valencia (CV) in Spain. Moreover it estimates the prevalence of obesity by sex, age groups and levels of education., Subjects and Methods: Weight and height data obtained by direct measurement of 1.787 participants in the Survey of Nutrition and Health of the CV in 1994 with a representative population sample of adults over the age of 14. Quetelet's index (QI) (QI - kg/m2) was used as ponderal indicator and established populations with Q1 > or = 30 as being obese. The prevalence of obesity was estimated by age groups, sex and level of education adjusted by the age structure of the same sample., Results: The overall prevalence of obesity was 16.4%, 17.8% in women versus 14.7 in men. The obesity varied with age from 3.7% in the 15-24 age group to 32.4% in the 50-64 age group and 28.6% for the over 65 years age group. Obesity was more frequent in men under 34 years, and in women over 50 years of age. In reference to levels of education, a higher prevalence was observed in individuals with a lower education., Conclusions: The results of this study make it evident that the prevalence of obesity in the CV is more than in other autonomous Spanish communities. The frequency of obesity increased with age up to 65 years, and was more prevalent in women and in individuals with lower levels of education.

Background: Journals that are not published solely in English have the titles of papers translated into English, the international language of medicine. The aim of this paper is to analyse the accuracy and quality of such translations in Medicina Clínica and to assess the influence of the morphology and syntax of Spanish on the English versions of the titles., Methods: Two professional medical translators, one Spanish and the other English, each with a knowledge of both languages, compared the original Spanish and the English translations of the titles of the 292 papers and communications published in the 20 issues of volume 100 of Medicina Clínica. The discrepancies or "errors" were classified in five groups of increasing seriousness., Results: Of the titles studied, 77% contained some sort of error (458 errors were detected). In 100 titles (34%) there were differences in meaning between the original Spanish and the English translations. Another 72 titles contained serious orthographical, lexical or grammatical mistakes, though the basic meaning was not distorted. Approximately a third of the lexical and grammatical errors were attributable to the direct influence of Spanish., Conclusions: The English translations of titles in Medicina Clínica contain numerous orthographical, lexical and gammatical mistakes. Serious errors of meaning in a number of translated titles could result in misinterpretation by readers who do not know Spanish. We recommend that the authors should play a part in the translation of the titles, as this should provide a simple and effective mean of improving the accuracy of the translations. Our comparison yielded much worse results than had been expected, which suggests that similar studies with other medical journals in Spanish and other languages would be justified.

Background: Mortality caused by acute adverse drug reactions (AADR) increased in Spain over the eighties and has become one of the major causes of death for youth. This paper presents the results of a study in the city of Barcelona during the 1983-92 decade; based in the city drug information system., Methods: The study includes all deaths caused by AADR autopsied in the Forensic Institute between 1983 and 1992. Mortality of city residents is analyzed by cohort, grouping data in two-years and adjusting Poisson regression to mortality rates by age group, birth cohort and period of study., Results: During this period a sharp increase in AADR mortality is seen, as there were 19 deaths in the city in 1983 and 160 in 1992. The increase concentrates in the years 1987-89. Although previously the increasing mortality of drug users was related by some observers with the progressive deterioration of their health status, linked to their increasing age and to the cumulative effects of years of substance dependence, the mortality analysis points to a clear period effect, resulting in an increased mortality across all age groups, for cohorts born after 1960., Conclusions: These results point to changes in the illegal drug market in the city or in the patterns of abuse as most likely causes for the increase. The results also suggest that since 1989 there is a stabilization in mortality due to AADR, which deserves further study.

Background: The European Study of Asthma was designed to study the variability of the prevalence of asthma in Europe. The aim of the present paper was to report the results obtained on the participation and prevalence of symptoms related to asthma in 5 Spanish areas: Albacete, Barcelona, Galdakao, Huelva and Oviedo., Methods: A sample population of 16,884 individuals between 20-44 years of age was studied with a questionnaire adapted from the International Union Against Tuberculosis and Lung Disease., Results: Response was obtained from 14,269 (84.5%) individuals. The frequency of symptoms related to asthma over the last year varied widely from area to area. Night attacks of shortness of breath varied from 3.6% to 11.6%; asthma attacks from 1.4% to 3.4%; medication for asthma from 1.2 to 5.6%. The global frequency of these symptoms in men and women respectively was 4.9% and 5.0% in Galdakao, 6.3% and 6.6% in Barcelona, 9.4% and 9.3% in Oviedo, 10.7% and 9.1% in Albacete and 14.3% and 14.9% in Huelva. With regard to the remaining symptoms, night attacks of coughing and wheezing were of note because of their high prevalence ranging, according to areas, from 24.6% and 36.0% and 13.3% and 33.7%, respectively., Conclusions: This is the first providing population data on the prevalence of symptoms related to asthma in adults in Spain. The global prevalence of symptoms varied from 4.9% to 14.3% in men and 5.0% to 14.9% in women. Although posterior analysis based on atopy data and bronchial hyperreactivity will allow better interpretation of these prevalence rates, they suggest that asthma is a frequent disease in individuals from 20 to 44 years of age in Spain.

Background: The development of an evaluation protocol for assessing the scientific contribution and the impact on medical care of the sabbatical leaves granted in a large Spanish teaching hospital., Methods: The sabbatical leaves for all faculty staff of the Hospital Clínic i Provincial of Barcelona (HCPB) were analyzed since 1980 trough 1991. The scientific production analysis was done according to the impact factor (IF) score of the Science Citation Index. Descriptive statistical techniques as well as parametric and non-parametric tests were used for comparisons., Results: A total of 52 sabbatical leaves was analyzed of all 60 leaves granted (87%). Mean duration of the leave was 7.94 +/- 3.86 months. The scientific production includes 89 original articles published in peer-reviewed medical journals, with a total score of 300.82 IF points (mean score: 5.78 +/- 7.12 IF points by leave). There were significant differences in the mean duration, number of papers published and IF points score by sabbatical leave between the Medicine, Surgery and Other Departments. In 16 cases (31%) there was a professional promotion following the sabbatical leave and in 20 cases (39%) an academic promotion. In 27 cases (60%) there was no promotion after the leave. Most of the faculty staff physicians (96%) are still employed in the same institution, and believe that the sabbatical leave has significantly contributed to their promotion (67%). A high percentage (94%) has also been able to develop afterwards the methods and techniques learned during the sabbatical leave., Conclusions: The experience of the Hospital Clinic of Barcelona in granting sabbatical leaves has been highly positive. The scientific performance of the individuals on leave is high. Our institution has been able to add and develop most of the techniques and methods learned overseas. The future of the sabbatical leaves in other Spanish Universities and Hospitals should be regarded as a high priority target. The performance of these leaves is supported by its scientific results, that could be quantified.

Background: Childhood mortality from tumors has decreased in industrialized countries. The aim of this paper is to study the trend of mortality from tumors in children (under 15 years old) during the period 1975-1992., Methods: Using data from the Department of Health and Social Security's Register of Mortality, age-group standardized (to world population) mortality rates for each sex were analyzed. Analysis was carried out on total mortality caused by childhood tumors and on main causes of death (leukemia, brain cancer, non-Hodgkin lymphoma, bone cancer and non-specified tumors). A Poisson's regression model was used to analyze mortality trends., Results: Childhood tumors caused 8.7% of all deaths in boys and 8.5% of all deaths in girls between 1990-1992. Thus, standardized mortality rates have decreased significantly, in 1975-1977 standardized mortality rates for boys and girls were 71.20 and 68.05 respectively, in 1990-1992 these rates had fallen to 55.45 and 41.30. The annual percentage decrease in cancer mortality rates for boys was 2% and for girls was 3.1%. Main causes of deaths were leukemia and brain cancer., Conclusions: Between 1975-1992 a significant downward trend in childhood tumors mortality has been observed, more prominent in main causes of death and in girls. The principal explanation for this trend is an increased survival, consequence of changes in childhood tumors therapy.