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Few studies have focused on the long-term influence of the climate on the prevalence of asthma. The aim of this study is to establish the influence of geo-climatic conditions on the prevalence of asthma symptoms both in adolescents and schoolchildren, and to discover if this influence is associated with their time trends. Eight centres in Spain performed both ISAAC phases I (1994) and III (2002) in children 13-14 years old. Six of them also surveyed children 6-7 years old. For each age group and phase, about 3,000 children were surveyed per centre. This study examines the prevalence of current wheeze and severe current wheeze in two different geo-climatic zones, coast and plateau, considering their relative humidity and temperature range. In both age groups, the mean asthma prevalence on the coast, for phase I and III, was significantly higher than on the plateau. Living on the plateau was an independent protective factor for current wheeze and severe current wheeze for the two age groups. Within the coastal centres, the increase of the annual relative humidity was a statistical significant risk factor for current wheeze, the same trend existing for current severe wheeze. These effects were independent of the sex and of the phase of the study. The prevalence of asthma and severe asthma symptoms is more frequent on the coast of Spain as compared to the inner plateau. This finding was repeated both in 1994 and in 2002.

Introduction: The incidence of multiple malignant neoplasms in the upper aerodigestive tract is high and ranges from 7% to 20%. We make a retrospective study to evaluate the incidence of multiple malignant neoplasms in head and neck squamous cell carcinomas, their main characteristics and survival., Material and Method: We studied 103 multiple malignant neoplasms from an oncological database of 1330 patients with head and neck squamous cell carcinomas. We use the SPSS v15 for analysis of the results., Results: The incidence of multiple malignant neoplasms in our series is 7.73 %. Tumours of the hypopharynx are the primary tumours most often associated with multiple malignant neoplasms (21.34 %), followed by tumours of the oropharynx (15.38 %). Lung tumours are the multiple malignant neoplasms most often associated (29.03 %). The 5-year global survival is 33 % from diagnosis of the second primary tumour, 78.02 % of which are metachronous with an average of 40 months between the diagnosis of the primary tumour and the presentation of the second tumour., Conclusions: Multiple malignant neoplasms are very frequent in the head and neck area which shows the importance of thorough regular check-ups of these patients as the presence of multiple malignant neoplasms considerably worsens the prognosis.

Introduction: Treatment of hepatitis C is based on the combination of peginterferon alfa-2a or -2b plus ribavirin; the more effective peginterferon for this purpose has not been established. The aim of this study is to compare the effectiveness of hepatitis C treatment according to the type of peginterferon used., Methods: A prospective cohort study was performed from November 2002 to May 2004, with up to 12 months of follow-up in all patients after completion of treatment. The study included naïve monoinfected patients, divided into two groups: Group A: peginterferon alfa-2a plus ribavirin and Group B: peginterferon alfa-2b plus ribavirin. The main variables studied were plasma glutamate pyruvate transferase levels (biochemical response), viral load (virologic response), and treatment effectiveness (biochemical and virologic response)., Results: A total of 202 patients were studied (Group A: 87; Group B: 115), there were no significant differences in baseline characteristics between the two groups. Sustained biochemical response: 75.8% vs. 76.2% (P = .908); Sustained virological response: 71.3% vs. 64.3% (P = .293); Effectiveness of treatment: 64.2% vs. 60.87% (P = .628)., Conclusion: No differences in the sustained virological or biochemical response were found between groups receiving peginterferon alfa-2a or peginterferon alfa-2b plus ribavirin, suggesting that the two types of peginterferon alfa are similarly effective for treating hepatitis C in monoinfected patients.

Objectives: To ascertain and analyse the drug consumption of the immobile elderly, as well as the number of potentially inappropriate medications (PIM)., Design: Cross-sectional study., Setting: Fourteen rural primary care centres., Participants: Non-institutionalised immobile patients, older than 64 years were selected by systematic sampling., Principal Measurements: Review of patients' medicine cabinets and noting the daily doses and current number of drugs, as well as the origin of the prescription. Identification of PIM (Beers criteria)., Results: One-hundred forty-three homes visits were made. The mean age was 81.3+/-7.9 years, of whom 74.8% were women. The most common drugs were: analgesics (9.2%), antacids (7.1%), nitrites-calcium antagonists (6.5%), non-steroidal anti-inflammatories (5.0%), and angiotensin converting enzyme inhibitors (4.7%). The percentage of patients who took more than 4 drugs was 76.1%. A PIM was taken by 35% of the elderly. The most common were: long-acting tranquilisers (41.5%), hypnotics (13.8%), digoxin (13.8%), indomethacin (7.7%), and antispasmodics (6.1%). In the majority of cases, the prescribing of the PIM was made by the family doctor (77.7%). Women took significantly more inappropriate drugs than men (0.50+/-0.72 vs to 0.25+/-0.50; P=.001) and those on multiple medication more than those not on multiple medication (0.50+/-0.73 vs 0.31+/-0.52; P=.008)., Conclusions: The prevalence of inappropriate therapy in the immobile elderly is high, therefore an effort must be made to reduce it. Procedures directed towards increasing the quality of prescribing could improve the state of health and quality of life of these patients.

Background: The objective of this study was to verify whether the method defined by Gail is applicable and predictive in a population of women in Valencia (Spain)., Population and Methods: Of the 685 patients diagnosed with breast cancer and attended-to in 2000-2001, 186 incident cases were identified. The variables studied were obtained from a specific questionnaire which included characteristics of reproductive history, number of biopsies and contraceptive pill consumption prior to the diagnosis. Using the model of the National Surgical Adjuvant Breast and Bowel Project (NSABP), an adaptation of the Gail model, the risk of developing breast cancer at 5 years was estimated., Results: Only 40% of those women diagnosed as having breast cancer would have been identified as a high-risk patient by the Gail method. With our population group, the method detected the elderly women with a medical history of breast cancer who developed advanced stage disease., Conclusions: The Gail method does not adapt well to the study population of Valencia. It would be necessary to add other risk-factors to the Gail method so as to identify more patients in our area.

Background and Objective: Our goal was to estimate the time trends in the prevalence of symptoms of allergic rhinitis (AR) and its geographic variations., Population and Method: During 2001-2002, the phase 3 of ISAAC study was carried out, and a comparison with the phase 1 (1993-1994) was done. This cross sectional study included 30,046 schoolchildren 13-14 years-old from 9 centers (Asturias, Barcelona, Bilbao, Cartagena, Castellon, Madrid, Pamplona, Valencia, and Valladolid). A questionnaire about rhinitis symptoms self-administered to schoolchildren was used at schools and institutes with a participation rate of 100% to 75.8%., Results: A divergent time trend of AR prevalence symptoms was observed with a decrease in Barcelona and Bilbao, a stabilization in Cartagena, Pamplona, and Valencia, and an increase in Castellon; Madrid and Valladolid; however, there was an overall increase in nasal allergy. The prevalence of rhinoconjunctivitis in the past year (Prevalence Ratio [PR] = 1,13; 95% Confidence Interval [CI], 1.07-1.19) and nasal allergy ever (PR = 1.22; 95% CI, 1.15-1.30) increased after adjusting for gender, center and season change. The prevalence of rhinoconjunctivitis and nasal allergy varied according to centres, Madrid, Asturias, Cartagena and Bilbao exhibiting the higher prevalence. Taken as a whole, these data indicate a middle prevalence of AR when compared with other countries following an ISAAC methodology., Conclusions: Two patterns of time trend of prevalence of symptoms of AR were observed. The investigation of risk factors at local level could be important in order to undertake preventive measures.

Introduction and Objectives: Cardiac troponins are highly specific and sensitive for detecting minimal myocardial damage. The aim of our study was to determine the prognostic value of troponin T levels in patients hospitalized for suspected angina or myocardial infarction without ST-segment elevation., Patients and Method: We recorded the frequency of death, acute myocardial infarction, heart failure, or need for coronary revascularization in the three months after the onset of symptoms in 346 consecutive patients admitted for suspected acute coronary syndrome, excluding those who developed myocardial infarction with persistent ST-segment elevation., Result: . Serum troponin T levels were > or = 0.1 ng/ml in 133 patients (troponin T positive group) and lower in 213 patients (troponin T negative group). The relative risk (RR) and 95 percent confidence intervals (95% CI) of individual and grouped events for the troponin T positive group were 3.2 (95% CI, 1.4-7.3; p = 0.006) for death; 2.8 (95% CI, 1.43-5.51; p = 0.003) for death or myocardial infarction; and 2.8 (95% CI, 1.6-5.0; p < 0.001) for death, myocardial infarction or heart failure. Diabetes mellitus and troponin T levels > or = 0.1 ng/ml had independent prognostic value after adjusting for age, sex, and electrocardiographic changes; with RR 2.5 (95% CI, 1.01-5.9) for death, myocardial infarction or heart failure., Conclusions: The prognosis of patients hospitalized for chest pain who do not immediately develop transmural necrosis depends on serum troponin T levels at hospital admission. Troponin T levels > or = 0.1 ng/ml almost triple the risk of major events in the three months after the acute episode. The prognostic value of troponin T is independent of age, sex, presence of diabetes mellitus, and electrocardiographic changes.

Small bowel carcinoid tumor (SBC) is a rare disease of unknown etiology but with an age-, sex-, and place-specific occurrence that may indicate an occupational origin. A European multicenter population-based case-control study was conducted from 1995 through 1997. Incident SBC cases between 35 and 69 years of age (n = 101) were identified, together with 3335 controls sampled from the catchment area of the cases. Histological review performed by a reference pathologist left 99 cases for study; 84 cases and 2070 population controls were interviewed. The industries most closely associated (a twofold or more odds ratio [OR]) with SBC, taking into account a 10-year time lag after exposure were, among women, employment in wholesale industry of food and beverages (OR, 8.2; 95% confidence interval [CI], 1.9 to 34.9]) and among men, manufacture of motor vehicle bodies (OR, 5.2; 95% CI, 1.2 to 22.4), footwear (OR, 3.9; 95% CI, 0.9 to 16.1), and metal structures (OR, 3.3; 95% CI, 1.0 to 10.4). The identified high-risk occupations with an OR above 2 were shoemakers, structural metal preparers, construction painters and other construction workers, bookkeepers, machine fitters, and welders (men). The OR for regular occupational use of organic solvents for at least half a year was 2.0 (95% CI, 1.0 to 4.2). Exposure to rust-preventive paint containing lead was suggested as another potential occupational exposure (OR, 9.1; 95% CI, 0.8 to 107). This explorative study suggests an association between certain occupational exposures and SBC, but some of these associations could be attributable to chance. All findings should be regarded as tentative.

Objective: Today, the most important demographic change taking place is the rapid aging of the population. While this phenomenon is having a growing and profound impact on all spheres of society, its greatest impact is in the health area, affecting all levels of health care and leading to the need for new resources and new structures. Out of that, in many countries have come different alternatives as well as in-patient, outpatient, and in-home programs that are geared toward improving health care and helping set priorities. One of these new initiatives is home hospitalization, or home health care. One objective of this study was to describe and analyze the characteristics of a population in Spain that was assisted through home hospitalization (HH). Another objective of the study was to comment on the role that HH can play as a mechanism for integration and coordination between health care levels, in the face of the challenges occurring with the reorganization of health care policies and programs, especially those directed at the elderly., Methods: A retrospective descriptive study was done of patients assisted through HH in Sanitary Area 9 of the Autonomous Community of Valencia, which is on the eastern coast of Spain. The area's population was 321,361, of whom 60,079 (18.7%) were 60 or older, including 43,044 (13.4%) who were 65 or older. A descriptive study of the analyzed variables was done, with the mean and standard deviation being computed for quantitative variables, and the absolute and relative frequencies (percentages) being calculated for the qualitative variables., Results: Of the patients studied, 78% of them were 65 or older, with an average age of 73 years. They were predominantly women. Of the total group, 72% of them had chronic diseases, and 67% had at least one associated secondary diagnosis. There was an important problem of communication between the two principal levels of care, primary care and hospital care, which obviously had an impact on the patients and on the quality and effectiveness of their health care. Furthermore, it was found that HH finds its greatest utility with and is an effective tool for an adult or elderly population that has multiple chronic degenerative or terminal diseases., Conclusions: The results of this study highlight the need to create or strengthen channels and mechanisms for interinstitutional communication that will guarantee continuity of care. The ongoing, effective care of the health and well-being of elderly persons requires different levels of health interventions. This care should be comprehensive, adequate, integrated, of high quality, humanized, timely, and coordinated between the two principal levels of health care. In the final analysis, these factors will determine the quality of the health care for geriatric patients and the capacity to solve their health problems.