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Objective: Comparison of statistical methods and measurement scales to identify nosocomial infection risk factors in intensive care units (ICU).Design: Prospective study in 558 patients admitted to the ICU of a referral hospital between February and November 1994.Methods: Analysis using three logistic regression models, three standard Cox regression models, and two Cox regression models with time-dependent extrinsic factors. Different scales were used to measure exposures to risk factors (dichotomous, ordinal, quantitative, and time-dependent variables).Results: The most appropriate models were those that measured exposure using dichotomous variables. Models using ordinal or quantitative variables estimated biased coefficients and/or failed to comply with the statistical assumptions underlying the analyses. The Cox regression model with quantitative time-dependent variables met all the statistical assumptions, obtained a precise assessment of risk by exposure time, and estimated unbiased coefficients.Conclusions: The Cox regression analysis with quantitative time-dependent variables is the most valid alternative for assessing the risk of nosocomial infection per day of exposure to an extrinsic risk factor in the ICU. [ABSTRACT FROM AUTHOR]

Objectives: The objective of our follow-up study is to evaluate liver function tests (LFTs) and lipid profiles in patients with Gilbert's syndrome treated with isotretinoin because of severe acne., Setting: Dermatology outpatient clinics of three regional hospitals of Jaén (Spain)., Participants: Over 4 years, we included all patients diagnosed with severe acne. Only 37 patients were identified, of which 11 had Gilbert's syndrome., Interventions: All patients were treated with isotretinoin and followed-up in our outpatient clinics after 10 and 20 weeks. Patients were subjected to an interview questionnaire which included data on age, gender, complete blood count, coagulation profile, fasting blood glucose, LFTs and lipid profiles. Data and results of patients with severe acne and Gilbert's syndrome were compared with those of 26 patients with only severe acne (control group)., Primary Outcome: Blood analyses were repeated in the follow-up visits., Results: In patients with Gilbert's syndrome, bilirubin levels showed substantial decrease over the 20-week follow-up, with more decrease after 10 weeks. None of the control group patients had significant increase in total bilirubin levels after 10 and 20 weeks of follow-up. Liver enzymes were maintained within normal levels in both groups. Both study groups did not show significant pathological increase in lipid profile levels. LDL levels were increased in the two study groups, but this increase was less substantial in patients with Gilbert's syndrome., Conclusions: Our preliminary results suggest that oral isotretinoin could be an effective, safe treatment for patients with Gilbert's syndrome, and may lower bilirubin levels in the first 10 weeks of treatment. Limitations of the study include the small numbers of participants and the fact that it is restricted to one region of Spain.

Introduction: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital., Material and Methods: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated., Results: The CI of patients with SSI was 3.4% (95% CI: 3.0-3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index., Conclusions: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measures., (Copyright © 2010 AEC. Published by Elsevier Espana. All rights reserved.)

Purpose: To estimate the pooled risk of coffee consumption for Alzheimer's disease (AD)., Material and Methods: We have reviewed all observational studies that evaluated the association between AD risk and coffee consumption. Four studies were identified: two case-control studies and two cohorts. These studies were carried out between 1990 and 2002., Results: There was an obvious protective effect of coffee consumption in the pooled estimate [risk estimate: 0.73 (95% confidence interval: 0.58-0.92)]. However, the homogeneity test was highly significant (p<0.01), indicating heterogeneity across the pooled studies. Pooled analysis applying the random effect model was 0.79 with 95% confidence interval overlapping unity (95% confidence interval: 0.46-1.36). Three studies assessed coffee consumption by interview questionnaire. The risk of AD in coffee consumers versus non-consumers in studies that used interview questionnaire had a pooled risk estimate of 0.70 with 95% confidence interval 0.55-0.90., Conclusion: Although our pooled estimates show that coffee consumption is inversely associated with the risk of AD, the four studies had heterogeneous methodologies and results. Further prospective studies evaluating the association between coffee consumption and AD are strongly needed.

We estimated the pooled risk of tobacco smoking for Parkinson's disease (PD). Inclusion criteria included systematic searches of MedLine, PsycLIT, Embase, Current Contents, previously published reviews, examination of cited reference sources, and personal contact and discussion with several investigators expert in the field. Published prospective studies on PD and cigarette smoking. When two or more studies were based on an identical study, the study that principally investigated the relationship or the study that was published last was used. Seven prospective studies were carried out between 1959 and 1997, of which six reported risk estimates. Four cohorts were based on standardised mortality rates, which were exclusively of male. Only one study included risk estimates for both males and females separately. The risk of ever smoker was 0.51 (95% confidence interval, 0.43 to 0.61). There was an obvious protective effect of current smoking in the pooled estimate (relative risk, 0.35; 95% CI, 0.26-0.47). Former smokers had lower risk compared with never smokers (relative risk, 0.66; 95% CI, 0.49-0.88). Although our pooled estimates show that smoking is inversely associated with the risk of PD, the four prospective studies that were based on follow-up of mortality of smokers had many limitations. Further studies evaluating the association between smoking and PD in women are strongly needed., (Copyright 2004 Movement Disorder Society)

Our aim was to estimate the pooled risk of current and former smoking for Parkinson's disease (PD). We have reviewed all observational studies that evaluated the association between PD risk and smoking habit. Twenty six studies were identified: 21 case-control, 4 cohort and 1 cross-sectional. The cross-sectional study did not compare former with never smokers. These studies were carried out between 1968 and 2000. There was an obvious protective effect of current smoking in the pooled estimate [risk estimate 0.37 (95% confidence interval 0.33 to 0.41)]. Former versus never smokers had pooled risk estimate of 0.84 (95% confidence interval 0.76 to 0.92). Current and former smoking do not, therefore, exert the same protective effect against PD so that it is unnecessary to postulate a biological mechanism through which smoking protects against PD. The results show that the reverse direction of causation is a more probable explanation, i.e. movement disorders of PD protect against smoking. Another explanation is that failure to develop strong smoking habits in early adult life might be a prodromal symptom of the disease and could perhaps be its first clinical manifestation.

A systematic review was conducted to estimate the pooled risk of smoking for Parkinson's disease in Chinese populations. The four identified case-control studies had odds ratios with 95% confidence intervals nearly or overlapping unity. Pooled odds ratio of these studies was 0.77 with 95% confidence interval 0.60 to 0.97. It was suggested that smoking induces debrisoquine 4-hydroxylase, which is responsible for the metabolism of antipsychotic drugs and the detoxification of certain environmental toxins known to cause dopaminergic neural damage. This could be the explanation of these contradictory results as cytochrome P-450 CYP2D6 debrisoquine hydroxylase gene polymorphism is known to be much lower in Chinese than in Caucasian people. This systematic review raises concerns about generalization of the conclusion previously settled by many cohort and case-control studies.

Anisakiasis, or anisakidosis, is a parasitic zoonosis due to the infestation by nematodes of the Anisakidae family, mainly by Anisakis simplex. Notwithstanding its world wide distribution, in our country its appearance is quite recent (1991) with only 19 cases previously reported. We refer 13 cases diagnosed in different hospitals in the province of Córdoba, Spain, from September 1994 to July 1998 which represents the biggest series described in Spain so far. All the patients had a clinical onset as acute abdomen, so that they required early surgery in which a narrowing and inflammatory intestinal segment was observed and subsequently resected. Pathology revealed in such segments an intense eosinophilic infiltrate in the mucosa. Only in one of the cases parasitic fragments were detected in the intestinal mucosa and in the 12 remaining cases the diagnosis was immunological by IgE specific for Anisakis simplex determination and antigens detection of the nematode with monoclonal antibodies. As interesting epidemiologic antecedent we shall mention the fact that all patients referred a usual raw fish consumption (mainly anchovy with vinegar) which is host of third-stage larval of the parasite.

Background: To identify nosocomial infection risk factors in an intensive care unit and construct a predictive model that will enable future risk-adjusted comparisons of infection incidences., Patients and Methods: Prospective surveillance of pneumonia, bacteremia and urinary tract infections in intensive care unit patients. All patients (n = 944) admitted to the intensive care unit for at least 24 h were followed daily in a tertiary level hospital. Variables measuring extrinsic as well as intrinsic risk factors for nosocomial infections were collected from each patient during their intensive care unit stay and the Cox proportional hazards multivariable technique was applied to identify the variables mostly associated with infection in our hospital., Results: The main risk factors identified for pneumonias were intrinsic. The hazard ratios (HR) of two extrinsic risk factors were noteworthy: mechanical ventilation (HR = 7.51; 95% CI = 2.95-19.13) and sedation (HR = 2.01; 95% CI = 1.14-3.56). The extrinsic factors associated with bacteremias were, the sum of extrinsic risk factors (HR = 1.52; 95% CI = 1.17-1.97) and having a tracheostomy (HR = 3.61; 95% CI = 1.99-6.56). The urinary tract infections were negatively associated with the administration of antibiotics prior to infection onset (HR = 0.41; 95% CI = 0.21-0.78) and the male sex (HR = 0.40; 95% CI = 0.22-0.75). Conversely, urinary tract infections were positively associated with the presence of cancer (HR = 2.70; 95% CI = 1.03-7.11) and the APACHE II index (for every 5 units of increase of the APACHE II index, HR = 1.39; 95% CI = 1.09-1.79)., Conclusions: The most important risk factors identified for pneumonias and urinary tract infections in intensive care unit patients were endogenous, whereas they were exogenous for bacteremias.

Background: Accidents resulting from percutaneous exposure account for approximately one third of all accidents suffered at work by health workers in hospitals. Their importance lies in the illnesses caused by pathogens that can be transmitted in this way (hepatitis B, hepatitis C, HIV virus). The aims are to describe accidents of this type notified in a tertiary level hospital, identify factors associated with these accidents in nursing staff and build a predictive model for the individual risk of having an accident., Methods: A descriptive study of a retrospective cohort made up of all the people who notified having suffered an accident between 1-1-93 and 30-6-96. A study of cases and controls in nursing staff during the period 1-1-95 to 30-6-96, analysed through multiple logistical regression., Results: The cumulative incidence of cases of accidents in one year was 0.078 for male and female nurses. In 57.3% of cases, disposable or pre-loaded syringes were involved. The cumulative incidence of cases in one year was greater for intravenous catheterisation (8.5% per 100,000). The risk of having an accident, adjusted on account of confusing variables, was greater for female and male nurses (OR = 3.22; I.C.95% = 1.96-5.27), or workers in the Haemodialysis Unit (OR = 35.21; I.C.95% = 3.74-331.16) and for those employed on a temporary contract (OR = 4.50; I.C.95% = 2.24-9.04)., Conclusions: Accidents resulting from percutaneous exposure at this hospital are more frequent among nursing staff and are basically caused by any type of hollow needles. Factors associated with these accidents were identified, allowing specific prevention programmes to be targeted at those workers at greater risk. The model obtained is valid to estimate the degree of individual accident probability for the subjects studied.

Objective: Describe the cumulative incidence of suicide mortality and self-inflicted injuries in Spain during the period 1987-1991 and identify associated socioeconomic and meteorological factors., Design: Ecological study. SITE: Fifty Spanish provinces excluding Ceuta and Melilla., Patients: Spanish population during the study period., Main Measurements and Results: For each province, the cumulative incidence of mortality from suicide and self-inflicted injuries were calculated by gender and age groups. The associations between suicide mortality and 31 socioeconomical and meteorological variables were evaluated using multiple linear regression. The incidence of suicide deaths was stable during the study period. The most important negative associations identified were with variables indicating economical development and the positive associations with the variable measuring specific general mortality. No significant differences between genders were found. For both genders, the model with the highest coefficient of determination corresponded to the group of adults aged., Conclusions: In Spain, social and economical factors are associated with the frequency of deaths from suicide and self-inflicted injuries in both genders and specially in the adult age.

Background: The constant increase of pharmaceutical costs is of great concern to the administrators of the Spanish National Health Service. Antibiotics administered as prophilaxis prior to surgery, play an important role in this increase. The compliance of physicians with protocols for chemoprophylaxis is therefore an important factor in the control of these pharmaceutical costs. The degree of compliance with the pre-established protocols of prophylaxis prior to surgery are examined in a tertiary level hospital during 1992 and the extra costs due to the lack of compliance with these protocols are estimated using a sample of 371 subjects. The object of this study is to describe the degree of the fulfillment of the protocols of surgical chemoprophylaxis in a tertiary level hospital and to estimate the minimum additional cost due to the wrong chemoprophylaxis., Methods: A descriptive study was made of the surgical prophylaxis using a sample of 371 subjects. The cost was estimated from the price of the antibiotics administered., Results: A total of 267 (71.9% IC95% = 67.3-76.5) subjects had received incorrect prophylaxis. The most important causes of incorrect prophylaxis were the wrong antibiotic choice and the excessive duration of their administration. The incorrect prophylaxis was responsible for an additional cost of 1,117,287 ptas. The application of these estimates to the entire 1992 surgical population, at our center, would yield an estimated additional cost of 39,409,965 pesetas., Conclusions: Our health services would have substantial savings if protocols for prophylaxis prior to surgery were strictly followed by physicians.

The needlestick injuries are the most frequent accidents among hospital staff. The aim of this study is to identify some factors associated with accidents caused by needlestick injuries at hospitals, so as to measure the risk that they present. A case-control study has been made, the subject of which is the nurses working at "Reina Sofía" Hospital in Córdoba and within the period June 30, 1990 and June 30, 1991. A more significant factor in relation to needlestick injuries was the recapping of the needle after being used. The risk of injury being 3.95, 7.68 an 17.85 times higher between those who recapped sometimes, frequently and always, respectively, versus those who had never recapped needles. Professional experiences resulted in being a protector factor against the needlestick injuries (OR = 0.93; 95% CI = 0.89; 0.97;) it's estimated that the risk injuring is less than half among personnel having ten years of experience. Knowing these risk factors is important for the development of specific prevention programs. Nevertheless, it is still important to identify other risk factors.

The MIC in solid media and the B.M.C. by the dilution-neutralization test using sterile water, was determined using 10 antiseptics and disinfectants with 70 strains of 10 species of Gram negative bacteria more frequently causing nosocomial infections in Ciudad Sanitaria Reina Sofía, Córdoba, in Spain. Relationship between the two tests was searched with no positive results. The more effective antiseptics were silver nitrate and chlorhexidine, the less active was phenol. Activity of some antiseptics was similar at 30 or 60 minutes of contact with the microorganisms.

533 cases of bacterial meningitis diagnosed in the province of Cordoba over a period of seven years are analyzed. 53.7% of the cases are in males, with 71.2% of the cases being detected in children under 14 (p less than 0.001). Greater incidence has been observed in Cordoba city than in the province, with a direct relationship being between morbidity and population density. The months with lower average temperature account for 45.6 por 100 of all the diagnosed cases of meningitis. By etiology, 51.9% were meningococcal meningitis, followed by meningitis produced by unknown germs (35.3%) and by H. influenzae. The illness developed in 91.3% of cases to a cure, with sequelae in 4.1% and death in 4.4%. Meningitis produced by H: influenzae was what caused most sequelae and that produced by S. pneumoniae was the most lethal. Isolated N. meningitidis presented 100% sensitivity to penicillin and cephalosporins, H. influenzae 91.7% chloramphenicol and only 28.3% to penicillin.

This study reports the clinico-biologic characteristics, complications and the final events in 224 cases of meningococcal disease observed during a period of five years in the province of Cordoba. The prognostic factors of the disease were also evaluated. Patients were divided into three groups according to the diagnosis: meningitis, meningococcemia, and meningitis with meningococcemia. The incidence of each group was 18%, 22% and 60%, respectively. The 81.7% of the patients were below the age of 14 years. The most frequent symptoms were the fever (97.8%), vomitus (75%) and headache (52.2%) The more common exploratory findings were petechiae (76.8%) and nuchal rigidity (53.6%). Complications related to the illness were present in 27.3% of the cases. The clinical course showed a mortality rate of 6.3% with a complete recovery in 91% of patients. Sequelae was present in 2.7% of the cases. The absence of previous antibiotic therapy (p < 0.05), the presence of nuchal rigidity (p < 0.05), shock (p < 0.01), coma (p < 0.05), leukocytopenia (p < 0.001), and a prothrombin activity lower than 70% (p < 0.05) were associated with a bad prognosis.

To more precisely define the epidemiological characteristics of meningococcal disease (MD) and to try to determine its possible risk factors, 224 cases diagnosed during the 1983-1987 period in all the hospitals of the Cordova province were evaluated. There was an incidence density (ID) of 6 cases/100,000/year. The younger ages were the most commonly involved (81.7% of cases were less than 14 years old), and males had the highest overall incidence. The greatest number of cases accumulated during the coldest months of the year (december, january, february). The highest rate of incidence was in the Guadalquivir Valley area, which has the highest population density. The poorest and socioeconomically lowest districts of the capital had the greatest morbidity (p less than 0.001). The mortality rate was 6.2%. It was higher in patients over 5 years of age and the male/female mortality rate was 0.75. It was concluded that wider and deeper epidemiological studies are required to evaluate the influence of habitat and other possible factors in the development of MD.

A retrospective study of nosocomial infection and its aetiological agents antimicrobial sensitivity in a pediatric ICU during 65 months is reported. Using statistical analysis association was found between infection site and certain diagnostic-therapeutic procedures, such as urinary infection and urinary tract catheter, respiratory lower tract infection and respiratory assistance devices, bacteremia with intravenous catheters. Also found relationship between age and causal agents: Streptococcus faecalis is the main microorganism in newborns and Pseudomonas aeruginosa in older patients. Gram negative bacilli sensitivity increased significantly for some antimicrobial drugs: carbenicillin, cefotaxime, gentamicin, fosfomycin and tobramycin, whereas gram positive microorganisms sensitivity decreased to cephalothin, cefoxitin, trimethoprim-sulphamethoxazole and gentamicin.

A survey about 145 atypical mycobacteria strains belonging to the M. fortuitum y M. chelonae complex sensitivity in response to three quaternary ammonium derivates has been performed by means of the dilutional and agar spreading methods. High strain sensitivity has been detected, having the three investigated antiseptics a very similar behaviour. The correlation rates and the regression lines equations have been obtained. And as a result of the high values we have obtained, it's possible to get the strain CMI directly from the corresponding inhibition halo.