Search

Javier de Miguel-Díez,1 Rodrigo Jiménez-García,2 Valentín Hernández-Barrera,2 Pilar Carrasco-Garrido,2 Héctor Bueno,3 Luis Puente-Maestu,1 Isabel Jimenez-Trujillo,2 Alejandro Alvaro-Meca,2 Jesús Esteban-Hernandez,2 Ana López de Andrés21Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; 2Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain; 3Centro Nacional de Investigaciones Cardiovasculares, Instituto de investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, SpainBackground: People with COPD suffering from coronary artery disease are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of these procedures in COPD and non-COPD patients in Spain between 2001 and 2011.Methods: We identified all patients who had undergone percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped into: COPD and no COPD.Results: From 2001 to 2011, 428,516 PCIs and 79,619 CABGs were performed. The sex and age-adjusted use of PCI increased by 21.27% per year from 2001 to 2004 and by 5.47% per year from 2004 to 2011 in patients with COPD. In-hospital mortality (IHM) among patients with COPD who underwent a PCI increased significantly from 2001 to 2011 (odds ratio 1.11; 95% confidence interval 1.03–1.20). Among patients with COPD who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 9.77% per year from 2001 to 2003, and then decreased by 3.15% through 2011. The probability of dying during hospitalization in patients who underwent a CABG did not change significantly in patients with and without COPD (odds ratio, 1.06; 95% confidence interval 0.96–1.17).Conclusion: The annual percent change in PCI procedures increased in COPD and non-COPD patients. We found a decrease in the use of CABG procedures in both groups. IHM was higher in patients with COPD who underwent a PCI than in those without COPD. However, COPD did not increase the probability of dying during hospitalization in patients who underwent a CABG.Keywords: COPD, percutaneous coronary intervention, coronary artery bypass graft surgery, hospitalization, length of stay, in-hospital mortality

Abstract Background Acute myocardial infarction (AMI) is one of the more frequent reasons diabetic patients are admitted to hospital, and there are reports that the long-term prognosis after an AMI is much worse in these patients than in non-diabetic patients. This study aims to compare hospital admissions and costs in Spanish diabetic and non-diabetic subjects due to AMI during the period 2001-2006. Methods We conducted a retrospective study of 6 years of national hospitalization data associated with diabetes using the Minimum Basic Data Set. National hospitalization rates were calculated for AMI among diabetic and non-diabetic adults. Fatality rates, mean hospital stay and direct medical costs related to hospitalization were analyzed. Costs were calculated using Diagnosis-Related Groups for AMI in diabetics and non-diabetics patients. Results During the study period, a total of 307,099 patients with AMI were admitted to Spanish hospitals. Diabetic patients made up 29.6% of the total. The estimated incidence due to AMI in diabetics increased from 54.7 cases per 100,000 in 2001 to 64.1 in 2006. Diabetic patients had significantly higher mortality than nondiabetic patients after adjusting for age, gender, and year (OR 1.11 [95% CI, 1.08-1.14]). The cost among diabetic patients increased by 21.3% from 2001 to 2006. Conclusions Diabetic patients have higher rates of hospital admission and fatality rates during the hospitalization after an AMI than nondiabetic patients. Diabetic adults who have suffered an AMI have a greater than expected increase in direct hospital costs over the period 2001-2006.

Aims: We aimed to investigate the perspective of primary care nurses on their role with patients who have chronic cardiovascular disease and to identify cultural elements shared by nurses caring for people with chronic cardiovascular disease. In primary care, the role of the nurse is essential to promote self-efficacy in cardiovascular self-care. Individuals with chronic cardiovascular disease need to integrate the disease into their life, together with the health recommendations for management and follow-up., Methods: A qualitative, focused ethnographic study was conducted. Purposeful sampling was used to include nurses who were working in primary care during the study. Data collection took place between 20 January and 20 May 2014 and consisted of semi-structured interviews. A thematic analysis was applied using the data., Results: Eleven participants were included. Cardiovascular care forces nurses to reflect on their identity and role in primary care. The relationship between the nurse and people with chronic cardiovascular disease is a complex process, which may cause nurses to feel a sense of failure and monotony in their work., Conclusions: Our findings may help to understand the role of the nurse and the care provided in patients with chronic cardiovascular disease., (© 2022 John Wiley & Sons Australia, Ltd.)

Although previously developed qualitative studies have explored the experience of illness of individuals with myalgic encephalomyelitis/chronic fatigue syndrome, these findings have not been undertaken for the purpose of enabling the identification of nursing care needs in such patients. This study aims to identify NANDA-I nursing diagnoses of adults with myalgic encephalomyelitis/chronic fatigue syndrome based on a qualitative literature review of their experience of illness. The protocol includes: searches in the electronic databases Medline, Embase, CINAHL, PsycINFO, SCI-EXPANDED, SSCI, SciELO, LILACS, and Cuiden; and manual searches in specialised journals and the references of the included studies. The authors will systematically search qualitative research studies published in databases from 1994 to 2021. Searches are limited to studies in Spanish and English. All stages of the review process will be carried out independently by two reviewers. Any disagreements shall be resolved through joint discussions, involving a third reviewer if necessary. The findings will be synthesised into a thematic analysis informed by the Domains and Classes of the NANDA-I Classification of Nursing Diagnoses, which will then serve to identify nursing diagnoses. This review will enable nursing professionals to identify the care needs of individuals with myalgic encephalomyelitis/chronic fatigue syndrome by taking into consideration their experience of illness in its entirety.

Objectives: To evaluate the relationship of the immune-checkpoint PD-1/PD-L1 with the clinical evolution of OSCC; to assess survival in OSCC based on the characteristics of TME and histologic risk score; to evaluate the clinical and histopathological relationship of OSCC with immunological TME., Material and Methods: A retrospective study was carried out on 65 samples from patients with OSCC on the floor of the mouth or tongue. Clinicopathological variables and the expression of the biomarkers PD-1, PD-L1, FoxP3, CD4, CD8, CSF1R, and p16 were recorded. The relationship of the clinical and histological variables with the expression of the biomarkers and survival was studied., Results: The univariate and multivariate analysis indicated that positive PD-1 expression was an independent protective factor for survival (overall, disease-free, disease-specific survival) and that high PD-L1 also improved survival. Poorly differentiated histological grades and metastasis were associated with a worse prognosis., Conclusions: PD-1 is a protective survival factor that is maintained independently of PD-L1 expression. High values of PD-L1 expression also improve survival. Higher expression of PD-1 is observed in smaller tumors, and higher expression of PD-L1 is more likely in women. No relationship between the tumor microenvironment and histologic risk score was found to influence the survival patterns studied in the OSCC. There is no evidence of a relationship between the histopathological features and the studied markers, although the positive PD-1 and PD-L1 cases have a lower risk of a high WPOI score, and positive PD-1 expression was associated with a lower DOI.

Background: To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain., Methods: Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately., Results: The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001-03 to 780.4 in 2013-15 (p < .001). Age increased over time (76.33 ± 10.92 years in 2001-03 vs. 79.4 ± 10.78 years in 2013-15; p < .001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p < .001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 ± 0.98 in 2001-03 vs. 2.46 ± 1.04 in 2013-15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001-03 to 12.30% in 2013-15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis., Conclusions: This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Background: To describe and compare the comorbid conditions, the in-hospital mortality (IHM) and the length of hospital stay (LOHS) among idiopathic pulmonary fibrosis (IPF) patients and non-IPF-matched patients hospitalized in Spain. We assess the performance of the Charlson Comorbidity Index[CCI] and the Elixhauser Comorbidity Index[ECI] to predict IHM in IPF and we identify the specific predictive factors of IHM in patients suffering IPF., Methods: We identified patients with IPF hospitalized in years 2002, 2006, 2010 and 2014. Cases of IPF were matched with non-IPF controls by sex, age, province of residence and year. Data were collected from the Spanish National Hospital Discharge Database., Results: We identified 10,285 hospitalizations with IPF, evidencing an increase in the number of IPF patients from 2002 to 2014. Overtime the prevalence of comorbidities included in the CCI significantly increased in patients with IPF, exception made of myocardial infarction and dementia. The prevalence of comorbidities included in the ECI, except paralysis and peptic ulcer disease excluding bleeding, increased significantly overtime. LOHS was longer among IPF patients than non-IPF controls and decreased significantly from 2002 to 2014. IHM was significantly higher in patients with IPF (adjustedOR 1.97; 95%CI 1.77-2.19). Area under the ROC curves showed that ECI model had a better performance to predict IHM than CCI., Conclusions: The incidence of hospitalizations for IPF increased significantly from 2002 to 2014. We observed an increase overtime of most of the comorbidities included in CCI and ECI. LOHS and IHM were higher in patients with IPF than in non-IPF controls., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Previous studies have demonstrated the participation of peripheral μ-opioid receptors (MOR) in the antinociceptive effect of systemically administered morphine and loperamide in an orofacial muscle pain model, induced by hypertonic saline, but not in a spinally innervated one, in rats. In this study, we determine whether this peripheral antinociceptive effect is due to the activation of MOR localized in the muscle, ganglia, or both., Methods: To determine the local antinociceptive effect of morphine and loperamide, 2 models of acute muscle pain (trigeminal and spinal) were used. Also, to study the MOR expression, protein quantification was performed in the trigeminal and spinal ganglia, and in the muscles., Results: The behavioral results show that the intramuscular injection of morphine and loperamide did not exert an antinociceptive effect in either muscle (morphine: P = .63, loperamide: P = .9). On the other hand, MOR expression was found in the ganglia but not in the muscles. This expression was on average 44% higher (95% confidence interval, 33.3-53.9) in the trigeminal ganglia than in the spinal one., Conclusions: The peripheral antinociceptive effect of systemically administered opioids may be due to the activation of MOR in ganglia. The greater expression of MOR in trigeminal ganglia could explain the higher antinociceptive effect of opioids in orofacial muscle pain than in spinal muscle pain. Therefore, peripheral opioids could represent a promising approach for the treatment of orofacial pain.

Introduction: To better understand the pathophysiology of chronic muscle pain, there are multiple animal models that mimic different acute/chronic pain conditions, such as carrageenan injection. Our previous studies demonstrated differences between muscles of different innervation in acute pain. In this study we characterized the effect of carrageenan in 2 muscles: masseter (trigeminal innervation) and gastrocnemius (spinal innervation)., Methods: Carrageenan (3%, 6%, and 9%) was injected into the masseter and gastrocnemius of rats. Mechanical, heat, and chemical nociceptive thresholds were measured for 14 days., Results: Carrageenan did not induce mechanical allodynia or thermal hypersensitivity in either muscle. Instead, it induced a short-lasting mechanical hyperalgesia, greater in the masseter than in the gastrocnemius., Conclusion: Carrageenan injected into the masseter and gastrocnemius induces a short-lasting hyperalgesia. These results could indicate a higher susceptibility of orofacial muscles to this type of insult and, consequently, a difference between trigeminal and spinal innervation. Muscle Nerve 56: 804-813, 2017., (© 2016 Wiley Periodicals, Inc.)

Background: We performed an epidemiologic study to analyze nationwide time trends in adult psychotropic drug use over a period from 2006 to 2012, and to identify those factors associated with the likelihood of consumption of these drugs during the study period; Methods: Cross-sectional study on psychotropic medication in the Spanish adult population. We used secondary individualized data drawn from the 2006 and 2012 Spanish National Health Surveys (SNHS). The dependent variable was the use of psychotropic drugs in the previous two weeks. Independent variables included socio-demographic characteristics, comorbidity, lifestyles and healthcare resource utilization. Using logistic multivariate regression models, we analyzed the temporal evolution of psychotropic medication consumption between 2006 and 2012 in both sexes; Results: The prevalence of psychotropic drug use was significantly greater in women (18.14% vs. 8.08% in 2012 ( p < 0.05). In Spanish women, the variables associated with a greater probability of psychotropic use were, age, unemployment (adjusted odds ratio (AOR), 1.60; 95% CI, 1.24-2.07), negative perception of health or taking non-psychotropic drugs. Among men, psychotropic use is associated with presence of chronic disease, negative perception of health (AOR, 3.27; 95% CI, 2.62-4.07 in 2012) or inactive status; Conclusions: Between 2006 and 2012, the probability of having taken psychotropic drugs increased by 16% among women. Unemployed women aged ≥45 years with a negative perception of their health constitute a clear risk profile in terms of psychotropic drug use. Inactive men who have a negative perception of their health are the group most likely to consume psychotropic drugs., Competing Interests: The authors declare no conflict of interest.

Background: To describe trends in the incidence and outcomes for atrial fibrillation (AF) in patients with and without type 2 diabetes (T2DM) in Spain between 2004 and 2013., Methods: We used national hospital discharge data to select all patients discharged from hospital after AF. We focused our analysis on patients with AF in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or non-diabetic). Incidence was calculated overall and stratified by diabetes status. We analyzed diagnostic and therapeutic procedures, patient comorbidities, CHA2DS2-VASc score, length of hospital stay and in-hospital mortality (IHM)., Results: We identified a total of 214,457 admissions for AF (21.1% with T2DM). The incidence was higher among people with T2DM. Women with T2DM have significant higher incidence than men in all years studied. T2DM was positively associated with AF hospitalization (IRR 3.76, 95%CI 3.72-3.80). T2DM patients were significantly older than patients without diabetes, had more comorbidity and had higher values of CHA2DS2-VASc score. Prevalence of dyslipidemia and hypertension were almost 50% higher and prevalence of obesity was two times higher (all p values<0.05). Diabetes was not associated with a higher IHM (OR: 0.99, 95%CI 0.93-1.06). For the entire sample, time trend analyses showed a significant decrease in mortality in patients admitted for AF (OR: 0.98, 95%CI 0.97-0.99)., Conclusions: Incidence rates were higher in T2DM patients. Women with T2DM have significant higher incidence rates than men. The presence of diabetes is not associated with a higher IHM during admission for AF., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aim: The objective of this study is to compare trends in outcomes for intracerebral hemorrhagic stroke in people with or without type 2 diabetes in Spain between 2003 and 2012., Methods: We selected all patients hospitalized for hemorrhagic stroke using national hospital discharge data. We evaluated annual incident rates stratified by diabetes status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, in-hospital mortality (IHM), length of hospital stay, and readmission rate in 1 month., Results: We identified a total of 173,979 discharges of patients admitted with hemorrhagic stroke (19.1% with diabetes). Incidences were higher among those with than those without diabetes in all the years studied. Diabetes was positively associated with stroke (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI] 1.35-1.40 for men; IRR = 1.31, 95% CI 1.29-1.34 for women). Length of stay decreased significantly and readmission rate remained stable for both groups (around 5%). We observed a significant increase in the use of decompressive craniectomy from 2002 to 2013. Mortality was positively associated with older age, with higher comorbidity and atrial fibrillation as risk factors. We found a negative association with the use of decompressive craniectomy. Mortality did not change over time among diabetic men and women. In those without diabetes, mortality decreased significantly over time. Suffering diabetes was not associated with higher mortality., Conclusions: Type 2 diabetes is associated with higher incidence of hemorrhagic stroke but not with IHM. Incidence among diabetic people remained stable over time. In both groups, the use of decompressive craniectomy has increased and is associated with a decreased mortality., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Type 2 Diabetes (T2DM) is the most rapidly increasing risk factor for ischemic stroke. We aimed to compare trends in outcomes for ischemic stroke in people with or without diabetes in Spain between 2003 and 2012., Methods: We selected all patients hospitalized for ischemic stroke using national hospital discharge data. We evaluated annual incident rates stratified by T2DM status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, and in-hospital outcomes. We calculated in-hospital mortality (IHM), length of hospital stay (LOHS) and readmission rate in one month after discharge. Time trend on the incidence of hospitalization was estimated fitting Poisson regression models by sex and diabetes variables. In-hospital mortality was analyzed using logistic regression models separate for men and women. LOHS were compared with ANOVA or Kruskal-Wallis when necessary., Results: We identified a total of 423,475 discharges of patients (221,418 men and 202,057 women) admitted with ischemic stroke as primary diagnosis. Patients with T2DM accounted for 30.9% of total. The estimated incidence rates of discharges increased significantly in all groups. The incidence of hospitalization due to stroke (with ICD9 codes for stroke as main diagnosis at discharge) was higher among those with than those without diabetes in all the years studied. T2DM was positively associated with ischemic stroke with an adjusted incidence rate ratio (IRR) of 2.27 (95% CI 2.24-2.29) for men and 2.15 (95%CI 2.13-2.17) for women. Over the 10 year period LOHS decreased significantly in men and women with and without diabetes. Readmission rate remained stable in diabetic and non diabetic men (around 5%) while slightly increased in women with and without diabetes. We observed a significant increase in the use of fibrinolysis from 2002-2013. IHM was positively associated with older age in all groups, with Charlson Comorbidity Index > 3 and atrial fibrillation as risk factors. The IHM did not change significantly over time among T2DM men and women ranging from 9.25% to 10.56% and from 13.21% to 14.86%, respectively; neither did among non-diabetic women. However, in men without T2DM IHM decreased significantly over time. Diabetes was associated to higher IHM only in women (OR 1.07; 95% CI, 1.05-1.11)., Conclusions: Our national data show that incidence rate of ischemic stroke hospitalization increased significantly during the period of study (2003-2012). People with T2DM have more than double the risk of ischemic stroke after adjusting for other risk factors. Women with T2DM had poorer outcomes- IHM and readmission rates- than diabetic men. Diabetes was an independent factor for IHM only in women.

Objective: This study aims to describe adherence to seven clinical preventive services among Spanish adults with diabetes, to compare adherence with people without diabetes and to identify predictor of adherence to multiple practices among adults with diabetes., Design: Cross-sectional study based on data obtained from the European Health Survey for Spain 2009 and the Spanish National Health Survey 2011. We analyzed those aged 40-69 years (n= 20,948). Diabetes status was self-reported. The study variables included adherence to blood pressure (BP) checkup, cholesterol measurement, influenza vaccination, dental examination, fecal occult blood test (FOBT), mammography and cytology. Independent variables included socio-demographic characteristics, variables related to health status and lifestyle factors., Results: The study sample included 1,647 subjects with diabetes and 19,301 without. Over 90% had measured their BP and cholesterol in the last year, 44.4% received influenza immunization, 36.4% had a dental checkup within the year and only 8.1% underwent a FOBT. Among diabetic women 75.4% had received a mammography and 52.4% a cytology in the recommended periods. The adherence to BP and cholesterol measurements and influenza vaccination was significantly higher among those suffering diabetes and cytology and dental checkup were lower. Only 63.4% of people with diabetes had fulfilled half or more of the recommended practices. Female sex, higher educational level, being married or cohabiting, higher number of chronic conditions and number of physician visits increased the adherence to multiple preventive practices. For each unhealthy lifestyle reported the probability of having a higher adherence level decreased., Conclusions: Acceptable adherence is found for BP and cholesterol checkups and mammography. Unacceptably low rates were found for influenza vaccine, dental care, cytology and FOBT. Moreover, preventive services are provided neither equitably nor efficiently so future research needs to identify individual and organizational factors that allow interventions to reach these subjects with diabetes.

Background: Our objective was to ascertain the degree of adherence to recommendations made to patients with anaphylaxis, most of whom were attended in our allergy outpatient clinic., Methods: A questionnaire was sent to 1512 patients who had experienced anaphylaxis and completed by 887. The chosen definition of anaphylaxis was that of the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network Symposium. We evaluated the prescription, purchase, and use of epinephrine auto-injectors and oral drugs, as well as the avoidance of allergens involved in previous anaphylaxis episodes., Results: Most patients (94.53%) reported that they had received advice on avoidance of responsible allergens after their allergy workup. Epinephrine auto-injectors and oral drugs were prescribed according to the subtype of anaphylaxis. Only 30.74% of patients used the epinephrine auto-injector; 54.26% took oral medication. Most patients (88.3%) avoided the allergen., Conclusions: Despite general agreement that anaphylaxis occurring in the community should be treated with epinephrine auto-injectors, use of these devices to treat recurrences was low in our patients. Oral medication intake was more common than the epinephrine auto-injector in all subtypes. In order to increase adherence to epinephrine auto-injectors, it is necessary to think beyond the measures recommended during regular visits to allergy outpatient clinics.

Background and Objectives: Previous studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context., Patients and Methods: Sex and age matched case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2., Results: We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 [1,23-16,53]), but not when hypercholesterolemia was included in the model (OR 2,2 [0,45-10,62])., Conclusion: The hypothesized relationship is independent from most but not all classical cardiovascular risk factors., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Aim: Analyze clustering of unhealthy lifestyle behavior and its relationship with nonadherence to clinical preventive care services among Spanish diabetic adults., Methods: Cross-sectional study including 2156 diabetic adults from the 2006 Spanish National Health Survey. Subjects were asked about their uptake of BP measurement, lipid profile, influenza vaccination, and dental examination. Lifestyle behaviors included smoking status, physical activity, alcohol consumption, and dieting. Binary logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of each preventive activity., Results: Almost 16% and 36% of the subjects had not undergone blood pressure (BP) and blood lipids measurements, respectively. Forty percent had not been vaccinated and 72% had not received dental examination. Fourteen percent of the subjects had three to four unhealthy behaviors and this increased the probability of not having BP check-up (OR 2.32, 95% CI 1.38-3.91), blood lipids testing (OR 1.63, 95% CI 1.14-2.33), and not being vaccinated (OR 1.99, 95% CI 1.37-2.89). Number of unhealthy lifestyle behaviors is linearly associated with number of preventive measures unfulfilled., Conclusions: Adherence to recommended clinical preventive services is under desirable levels among Spanish diabetes sufferers. These preventive services are provided neither equitably nor efficiently, since subjects with unhealthier lifestyles are less likely to receive them., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: to determine the concentrations of petrochemical compounds in the drinking water sources of communities located near oil-producing fields in the Bolivian Chaco region., Methods: data were collected on total petroleum hydrocarbons (TPH), 16 polycyclic aromatic hydrocarbons (PAH), including benzene, toluene, ethylbenzene, and xylenes (BTEX), and 22 metals in samples from 42 sources of water for human consumption located less than 30 km from an oil-producing field. Distribution of the concentration and adherence to the standards contained in the Bolivian, European, and United States regulations, as well as the recommendations of the World Health Organization, were analyzed., Results: in 76.19% of the samples, some petrochemical contaminant was found in concentrations higher than permissible in any of the four sets of regulations mentioned. The water samples with the highest contamination levels were from faucets and rivers. The most common contaminants were TPH, PAH, aluminum, arsenic, manganese, and iron., Conclusions: communities within a 30 km radius of the oil-producing fields in the Bolivian Chaco region consume water with TPH, PAH, and metal concentrations well above the levels permitted in the Bolivian regulations and international standards, putting the public health of their residents at serious risk.

This study aims to analyze gender differences in influenza vaccine coverage and predictors of vaccine uptake in Spain from year 1995 to 2006. We used data obtained from the Spanish National Health Surveys (NHSS) conducted in 1995, 1997, 2001, 2003 and 2006. Only subjects for whom the vaccine was recommended in Spain (age >or=65 years and <65 years with an associated chronic condition) during the entire study period were analyzed. Influenza vaccination status was self-reported. Independent variables included: year of survey, age, marital status, educational level, size of town, physician visits and chronic conditions. The study population included 26,653 (15,973 women and 10,680 men) individuals and 54.9% (CI 95% 54.3-55.5) were vaccinated. Vaccination coverage was higher among men than women in each and all of the NHSS analyzed. Positive predictors of vaccine uptake were the same among women and men including: higher age, being married, lower educational level, "Physician visits in last four weeks"; and the presence of associated chronic condition. Time trends 1995/1997-2006 showed that the coverage has improved for women (OR 1.12 CI 95% 1.09-1.16) and men (OR 1.11 CI 95% 1.06-1.15). Over the whole study period men had 12% greater probability of having received the vaccine. We conclude that in Spain there are significant gender differences in influenza vaccine uptake with lower coverage among women. These differences have remained throughout all years studied. We suggest that possible explanations for the lower uptake among women could include less social support, differences in the health status and provider bias., ((c) 2010 Elsevier Ltd. All rights reserved.)

Introduction: Serum vitamin B12 concentration levels in children are essential to establish values in order to compare different regions or countries, and for considering e the possibility of supplementing diets with group B vitamins as a secondary prevention against cardiovascular diseases., Material and Methods: A cross-sectional epidemiological study was carried out to asses serum vitamin B12 levels in school children, 13-15 years of age, in Madrid. Folate and vitamin B12 vitamin determinations were performed on fasting blood samples. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by PCR., Results: The mean vitamin B12 level obtained in our study was 503 pmol/l; CI 95 % CI (478-528 pmol/l). The median was 471 pmol/l; interquartile range (IR) (337-632 pmol/l). No statistically significant differences were found by age or C677T genotype for MTHFR. Serum vitamin B12 concentrations were significantly higher in females. Prevalence of vitamin B12 deficiency (< 224 pmol/l) was 6 % in males and 4 % in females., Conclusions: Reference values for serum vitamin B12 concentrations in an adolescent population are presented. Prevalence of vitamin B12 deficiencies is higher in males.

Objective: To assess rotavirus infection requiring hospitalization in children aged < or = 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain)., Material and Method: A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Mínimo Básico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Información Microbiológica [SIM]). CMBD data for all hospital admissions in children aged < or = 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed., Results: The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged < or = 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged (3/4) 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %., Conclusions: Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged < or = 5 years in the Autonomous Region of Madrid.

Objectives: To assess computed tomography (CT) imaging findings in progressive primary tuberculosis and to determine the use of the multislice images obtained., Patients and Methods: We report the case of a 37-day-old infant admitted to hospital because of persistent fever despite antimicrobial therapy. Thoracic X-ray and multislice helical CT (CT Light speed i1.6 GE) were performed with 3-dimensional and virtual endoscopy reconstructions., Results: CT showed mediastinal and hilar necrotic lymph nodes, pulmonary parenchymal involvement with miliary pattern, and multiple cavitated consolidations. Endobronchial involvement was clearly visualized by virtual endoscopy and was confirmed by fiberoptic bronchoscopy., Conclusions: Virtual endoscopy is a new, less invasive alternative radiological technique to fiberoptic bronchoscopy that may influence the management of patients with tuberculosis with endobronchial involvement.

Introduction: Arterial gas embolism (AGE) is a main iatrogenic complication resulting from the use of invasive procedures. It is difficult to diagnose if it is not clinically suspected., Case Report: A 67-year-old male patient, with a history of interventions involving a mitral prosthesis and a double aortocoronary bypass, who visited Emergency room with symptoms of a high temperature and general malaise. He was canalised peripherally and the electrocardiogram (ECG) showed an auricular fibrillation that had already been detected. While under observation he suffered a loss of consciousness, generalised hypotonia, conjugated gaze deviation towards the right, lower left facial paralysis and left Babinski positive. A new ECG showed ST segment elevation in V2-V5. A cranial computerised tomography (CAT) scan with no contrast revealed a number of serpiginous images caused by the presence of air in vascular structures. A second cranial CAT scan showed the disappearance of the visible air and signs of ischemic stroke in the territory of the right middle and posterior cerebral arteries and the left middle cerebral artery. Clinical-radiological findings suggested an AGE in the brain with massive stroke and acute myocardial infarct with similar causation., Conclusions: It is not clear what caused the air embolism in this patient but it can most probably be explained by air accidentally entering a peripheral vein. Carrying out an early cranial CAT scan can provide us with a diagnosis and a later CAT scan can evaluate the consequences of the embolism.

Objective: Effort related thrombosis of the axillo-subclavian vein is a disabling disorder that occurs primarily in healthy young individuals. The aim of this study is to show our experience in diagnosis and therapy of this entity., Methods: During a 5 years period (1994 to 1998) we studied 7 patients (6 woman and 1 man), with an average age of 26 years old. All patients underwent Doppler ultrasound examinations and, later, venography of the affected upper extremity. All of them were treated at the outset with systemic infusion of fibrinolytic agents., Results: Only one patient manifested successfully clinic outcome. Five patients were treated with surgical decompression resulting in excellent function. One patient refused surgical treatment, and he was treated with warfarin sodium showing a poor clinic response., Conclusion: Although systemic fibrinolytic therapy can restore axillo-subclavian vein patency, surgical approach is necessary to relieve the external compression.

We herein describe the ultrasonographic findings of 19 patients with clinical suspicion of acute diverticulitis. The criteria considered as evidence of the disease included the identification of the diverticuli, thickening of the wall of the loop, alteration of local mesenterium and selective pain. Diagnosis was complemented by CT scan, barium enema and, in determined cases, colonoscopy. Of the 19 cases studied, 18 corresponded to acute diverticulitis of the sigma and one to acute salpingitis. The former 18 cases were correctly diagnosed by ultrasonography (uncomplicated diverticulitis) and the posterior CT scan did not provide additional information. In conclusion, ultrasonography is a highly sensitive and specific technique for the diagnosis of acute diverticulitis when the sigmoid colon is involved.