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Background: Cardiovascular diseases are ranked among the leading causes of death in the industrialized countries. This study is aimed at ascertaining the mortality trends by ischemic heart disease (IHD) and cerebrovascular diseases (CVD) in Andalusia within the 1975-2004 period., Method: Based on the official IHD and CVD death statistics and the related populations, the gross rates (GR) and age-adjusted rates (TS) and the Potential Years of Life Lost (PYLL) were calculated. To quantify the trends and their change points, a joinpoint regression analysis was made., Results: The number of IHD deaths for females rose from 2,086 deaths in 1975 to 3,336 in 2004, the TS having dropped from 74.29 to 50.94 deaths/100,000 females, the PYLL having dropped from 173.65 years to 90.56 years/100,000 females. The number of deaths for males rose from 2,854 deaths in 1975 to 4,085 in 2004, the TS having dropped from 147, 67 to 104.96 deaths /100,000 males. The PYLL showed a like behaviour from the first to the last year of the series, showing values of 716.46 and 460.04 years / 100,000 males. For the IHD in females, the number of deaths in absolute numbers dropped from 4,712 to 4,221, the TS having dropped from 166.00 to 62.08 deaths in females, and the PYLL from 338.08 to 87.63 years / 100,000 females. For males, the number of deaths dropped from 3,714 to 2,951, the TS from 206.88 deaths /100,000 males in 1975 to 76.12 /100,000 males in 2004, and the PYLL dropping from 533.12 to 182.38 years / 100,000 males., Conclusions: The trend in mortality due to IHD was not constant either among females or males, although it has always been a downward trend, the drop being statistically significant. The drop in the CVD has been such a major one that both the absolute numbers and the gross rates are lower for the most recent years that the first years in the series studied despite the aging of Andalusias population.

Background and Objective: Patients with chronic conditions are often readmitted to hospital. A study was designed to improve health care to these patients., Patients and Methods: Patients attended at the Internal Medicine Department of a hospital area who were admitted to hospital at least three times in a year were included in the study. Within a prospective study, patients were attended by means of specific consultation with care upon request and telephone care, with the possibility of programmed admission., Results: Patients were followed for 32 months, with a 45% decrease in the admission rate, 50% in visits to the Emergency Department, and 26% in hospital stay days., Conclusions: The proposed care model decrease the attending needs for these patients.

A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.

Background: Decrease in mortality due to cardiovascular diseases during last years seems to be a widespread phenomenon in industrialized countries. This study analyses the evolution of mortality due to cardiovascular diseases in Andalucía, Spain, from 1975 to 1992. The analysis has been carried out for ischemic heart diseases, cerebrovascular diseases and cardiovascular diseases as a whole., Patients and Methods: Data of mortality have been obtained from the Natural Movement of the Population. From these data, both the annual standardized rates for age and sex through the direct method and percentage differences between 1975 and 1992, have been estimated., Results: Decrease in mortality due to cardiovascular diseases for men was of 33.5% between 1975 and 1992, with 13.8% in the ischemic cardiopathy and 46.0% for cerebrovascular diseases. For women, reduction was of 33.8, 29.3 and 42.4% respectively., Conclusions: In Andalucía and for the period analyzed, mortality due to cardiovascular diseases is clearly decreasing. Such a reduction has been produced mainly for the cerebrovascular diseases, and it is remarkable the low percentage of the average decrease due to ischemic heart disease for men during the last years.