Subolesin/Akirin vaccines for the control of arthropod vectors and vectorborne pathogens.

Diseases transmitted by arthropod vectors such as mosquitoes, ticks and sand flies greatly impact human and animal health, and therefore, their control is important for the eradication of vectorborne diseases (VBD). Vaccination is an environmentally friendly alternative for vector control that allows control of several VBD by targeting their common vector. Recent results have suggested that subolesin (SUB) and its orthologue in insects, akirin (AKR) are good candidate antigens for the control of arthropod vector infestations and pathogen infection. SUB was discovered as a tick-protective antigen in Ixodes scapularis. Vaccination trials with recombinant SUB/AKR demonstrated effective control of arthropod vector infestations in various hard and soft tick species, mosquitoes, sand flies, poultry red mites and sea lice by reducing their numbers, weight, oviposition, fertility and/or moulting. SUB/AKR vaccination also reduced tick infection with tickborne pathogens, Anaplasma phagocytophilum, A. marginale, Babesia bigemina and Borrelia burgdorferi. The effect of vaccination on different hosts, vector species, developmental stages and vectorborne pathogen infections demonstrated the feasibility of SUB/AKR universal vaccines for the control of multiple vector infestations and for reduction in VBD.

Factores pronósticos en el ictus. De la fase aguda a los tres años / Prognostic factors in stroke. From the acute phase to three years

Introducción. El ictus constituye la primera causa de invalidez permanente en adultos. La mayor atención se centra en la fase aguda. Los estudios centrados en la fase subaguda o crónica son más escasos. Objetivo. Analizar la situación funcional de pacientes que han sufrido un ictus y qué factores influyen en el cambio funcional. Pacientes y método. Estudio prospectivo longitudinal observacional. Se evaluó a los pacientes que ingresaron en nuestro hospital con el diagnóstico de ictus desde mayo hasta julio de 2004, en la fase aguda, a los 6 meses y a los 3 años. Se analizó la evolución funcional comparando el cambio del valor en las escalas de Rankin modificada e índice de Barthel mediante la prueba de Wilcoxon. El análisis de los factores que influyen en el cambio funcional se realizó con las tablas de contingencia para variables cualitativas, la prueba de la t para variables cuantitativas con distribución normal y pruebas no paramétricas (U de Mann-Whitney) para variables cuantitativas con distribución no normal. Significación estadística, p<0,05. Resultados. Se incluyó a 61 pacientes. El 64%, varones. Media de edad, 72,4±10,1 años. Los factores que influyen de forma significativa con la mejora funcional son: el Rankin previo, la puntuación del NIHSS en el momento agudo, la presencia de déficit y realizar tratamiento de rehabiltación. Conclusiones. Tras un ictus, se produce una pérdida funcional que tiende a la mejoría durante los primeros 6 meses y se estabiliza posteriormente. La funcionalidad previa, puntuación NIHSS inicial y realizar tratamiento de rehabilitación se relacionan con mejor evolución funcional(AU)

Introduction. Stroke is the first cause of permanent disability in adults. The greatest attention is given to the acute phase. There are very few studies focused on the subacute or chronic stages. Objective. To evaluate functional status and the factors that determine improvement in stroke survivors. Patients and methods. Longitudinal, observational and prospective study. All stroke patients admitted to our hospital from May to July 2004 were evaluated during the first week, at 6 months and three years. Functional improvement was evaluated by change in Barthel index and modified Rankin scale using Wilcoxon signed-rank test. The analysis of those factors related to functional change was done with contingence tables for categorical variables, t-test for quantitative variables with normal distribution and non-parametrical tests (Mann Whitney U Test) for non normal distribution. Statistical significance P<.05. Results. A total of 61 patients, 64% males, were included. Average age was 72.4 years (SD 10.1). The factors that significantly affected functional improvement were: Previous Rankin, NIHSS score in acute phase, presence of impairment and undergoing a rehabilitation program. Conclusions. Stroke produces a functional loss that tends to improve during the first six months and stabilizes afterwards. Previous functionality, initial NIHSS punctuation, and rehabilitation treatment are associated with better functional progress(AU)

Ictus maligno: funcionalidad posterior a la hemicraniectomía descompresiva / Malignant stroke: functionality following decompressive hemicraniectomy

Introducción. La hemicraniectomía descompresiva es un método terapéutico utilizado en el ictus maligno (IM) con aceptables resultados funcionales según las publicaciones disponibles. El objetivo de nuestro estudio fue valorar la capacidad funcional a los 6 meses de evolución en los pacientes diagnosticados de IM intervenidos mediante hemicraniectomía descompresiva en nuestro hospital. Material y métodos. Se trata de un estudio descriptivo de una serie de casos realizado mediante una encuesta telefónica. Se incluyó a 6 pacientes diagnosticados de IM desde mayo a septiembre de 2008. Como variables descriptivas de la muestra recogimos la localización del ictus, la comorbilidad, la edad, el sexo, la lateralidad encefálica, la escala modificada de Ictus del Instituto Nacional de Salud, el índice de Barthel (IB) y la escala de Rankin iniciales, y el tiempo desde el ictus hasta la cirugía descomprensiva. Para la evaluación de la situación funcional utilizamos el IB, la escala de Rankin, la Glasgow Outcome Scale y la Escala Observacional de Síntomas Depresivos aplicable a enfermos afásicos o con demencia en los que no es posible la anamnesis. Resultados. Los pacientes tenían una edad media de 47,2 años y la mayoría eran varones. Previo al ictus, todos los pacientes eran funcionalmente independientes con escasa comorbilidad. Se realizó un seguimiento de 7 meses de media. En ese momento, la supervivencia era del 100% y el IB medio era de 56; todos puntuaron 4 en la escala de Rankin y 3 en la Glasgow Outcome Scale, y la puntuación media en la Escala Observacional de Síntomas Depresivos era de 5,4, es decir, el 60% presentaba una puntuación que sugería depresión. Conclusión. En nuestra serie, la hemicraniectomía descompresiva tuvo una supervivencia elevada. Sin embargo, a los 6 meses de evolución, existía una grave alteración de la capacidad funcional(AU)

Introduction. Decompressive hemicraniectomy is a therapeutic method used in malignant. Stroke with acceptable functional outcome results in recent publications. The aim of our study is to evaluate functional outcome at six months, in patients that had a decompressive hemicraniectomy in our hospital. Materials and methods. It is a descriptive prospective. We included all patients diagnosed of malignant stroke from September to May 2008. As descriptive variables we analyzed: localization of the stroke, vascular territory and side, comorbidities, age, gender, NIHSS, Barthel Index, Modified Rankin Scale, time from onset of symptoms to surgery. To evaluate six months functional outcome we used Barthel Index, Glasgow Outcome Scale, modified. Rankin scale and an observer-rated screening scale for depression applicable to aphasic patients. Results. Average age was 47.2 years. Previous to stroke, all patients were functionally independent and with few comorbidities. Average follow up was 7 months. 100% surveillance at follow up. Average Barthel Index was 56, all patients scored 4 at modified Rankin Scale and 3 at GOS and 60% of patients had depression symptoms. Conclusion. The results of this study show that surgical decompression in malignant stroke has a high surveillance rate although survivors have poor functional outcome at six months follow up(AU)

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study.

BACKGROUND: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume. OBJECTIVE: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations. PATIENTS AND METHOD: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and follow-up mortality, complications, re-interventions, and relapse rates. RESULTS: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 patients (98%) were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months), were identified. CONCLUSIONS: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.

Proceso asistencial y resultados en la cirugía de cáncer digestivo: diseño y resultados iniciales de un estudio de cohortes multicéntrico / Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Antecedentes: la mayoría de estudios que analizan la influenciade factores de estructura sobre los resultados son retrospectivos,realizados con bases de datos clínico-administrativas y basadosprincipalmente en el volumen de intervenciones.Objetivo: estudiar la variabilidad en el proceso y los resultadosde la cirugía oncológica de esófago, estómago, páncreas, metástasishepáticas y recto en Cataluña, así como los factores asociadosa esta.Pacientes y método: estudio de cohortes multicéntrico retrospectivo(2002) y prospectivo (2003-05). Se recogió informaciónsobre el paciente, el proceso y los resultados de la atenciónpreviamente a la cirugía, al alta, y a los 3 y 6 meses.Resultados: participaron 49 (80%) hospitales en la etapa retrospectiva,de los cuales 44 (90%) prosiguieron en la prospectiva.Se incluyeron 3.038 pacientes (98%). No se observaron diferenciasen el perfil de pacientes operados según el nivel de complejidaddel hospital pero no se pudo analizar el estadiaje clínico-patológicoy otras variables de estado funcional por presentar más del20% de valores ausentes. Existió una variabilidad importante en elvolumen de intervenciones por centro así como en algunos aspectosdel proceso asistencial según el tipo de cáncer y la complejidaddel centro. Se identificaron elevadas tasas de mortalidad en esófago(18,2% al alta, 27,3% a los 6 meses) y de complicaciones yreintervenciones en todos los cánceres evaluados, especialmenteen cáncer de recto (18,4% de reintervenciones a los 6 meses).Conclusiones: el estudio de la variabilidad identificada requeriráun adecuado ajuste del riesgo y debería tener en cuenta diferentesfactores de estructura. Es necesario mejorar la informaciónrecogida en la historia clínica(AU)

Background: most studies that analyze the influence of structurefactors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume.Objective: to study variations in the process and outcomes ofoncologic surgery for esophagus, stomach, pancreas, liver metastasesand rectum cancers in Catalonia, as well as the factors associatedwith these variations.Patients and method: a retrospective (2002) and prospective(2003-05) multicenter cohort study. Data forms were designedto collect patient, process, and care outcome characteristicsbefore surgery, at hospital discharge, and at 3 and 6 monthsafter discharge. Main outcome measures were hospital and followupmortality, complications, re-interventions, and relapse rates.Results: 49 hospitals (80%) participated in the retrospectivephase, 44 of which (90%) also participated in the prospectivephase: 3,038 patients (98%) were included. No differences wereobserved in the profile of operated patients according to hospitallevel of complexity, but clinical-pathological staging and otherfunctional status variables could not be assessed because of over20% of missing values. There was significant variability in the volumeof interventions as well as in certain aspects of the healthcareprocess depending on type of cancer and center complexity. Highrates of esophageal cancer mortality (18.2% at discharge, 27.3%at 6 months) and of complications and re-interventions for all cancersassessed, especially rectal cancer (18.4% re-interventions at6 months), were identified.Conclusions: the study of the variability identified will requireadequate risk-adjustment and should take into account differentstructure factors. It is necessary that information included in medicalrecords be improved(AU)

Strategies to improve the insecticidal activity of Cry toxins from Bacillus thuringiensis.

Bacillus thuringiensis Cry toxins have been widely used in the control of insect pests either as spray products or expressed in transgenic crops. These proteins are pore-forming toxins with a complex mechanism of action that involves the sequential interaction with several toxin-receptors. Cry toxins are specific against susceptible larvae and although they are often highly effective, some insect pests are not affected by them or show low susceptibility. In addition, the development of resistance threatens their effectiveness, so strategies to cope with all these problems are necessary. In this review we will discuss and compare the different strategies that have been used to improve insecticidal activity of Cry toxins. The activity of Cry toxins can be enhanced by using additional proteins in the bioassay like serine protease inhibitors, chitinases, Cyt toxins, or a fragment of cadherin receptor containing a toxin-binding site. On the other hand, different modifications performed in the toxin gene such as site-directed mutagenesis, introduction of cleavage sites in specific regions of the protein, and deletion of small fragments from the amino-terminal region lead to improved toxicity or overcome resistance, representing interesting alternatives for insect pest control.

[Approximation to palliative care in the advanced non-malignant diseases]. / Aproximación a los cuidados paliativos en las enfermedades avanzadas no malignas.

Nowadays Palliative Medicine (PM) is changing from a specific point of view towards patients with advanced cancer, to another more generic that also keep in mind patients with advanced non malignant disease. Likewise it is more and more deeply rooted customs that the end-of-life care has become a fundamental right of our Society. But as a matter of fact, these patients with non-cancer diseases unusually go into a Palliative Care (PC) programme. It is known the difficulty to diagnosis the end of life clinical condition (EOLCC) in them. In this article we comment the justification and restriction of PC in patients with non-malignant cancer diseases, as well as the paradoxical situation to come out, in spite of the increasing programes of PC gradually. But above all we propose in a practical way resolve when a patient with non malignant organ advanced disease (NMOAD) could be subsidiary of PC. For that purpose we have to know the diagnosis and the prognostic factors in connection with the EOLCC of the NMOAD more common (advanced chronical pulmonary disease, advanced chronical heart failure, advanced cirrhosis hepatic, advanced chronical renal failure and very evolved dementia), to set up an appropriate make decisions keeping in mind the preferences and wishes of the patient and family, to document and record in the clinical history all those parameters and offerer to the patient the treatment more suitable with the intention to get a worthy death bearing in mind clinical, cultural and ethical standards. It is pointed out the necessity to carry out prospective studies to help setting up some inclusion criterions in PC programmes for patients with NMOAD.

Aproximación a los Cuidados Paliativos en las enfermedades avanzadas no malignas / Approximation to palliative care in the advanced nonmalignant diseases

En la actualidad la Medicina Paliativa (MP) está cambiando desde una visión específica dirigida a los pacientes con cáncer avanzado hacia otra más genérica que abarca también a los pacientes con enfermedades avanzadas no malignas. También está cada vez más arraigado que los cuidados al final de la vida constituyen un derecho fundamental de la sociedad. Pero en realidad estos pacientes no oncológicos excepcionalmente entran en programas de Cuidados Paliativos (CP). Se sabe que es por la dificultad en diagnosticar la situación clínica de enfermedad terminal (SCET). En el presente artículo comentaremos la justificación y limitación de los CP en los pacientes no oncológicos así como la situación paradójica que tiene lugar a pesar del incremento paulatino de los programas de cuidados paliativos. Pero sobre todo proponemos una manera práctica de poder determinar cuando un paciente con enfermedad avanzada de órgano no maligna puede ser subsidiario de unos adecuados CP. Para ello tenemos que conocer el diagnóstico y los factores pronósticos relacionados con la SCET de las patologías crónicas avanzadas de órgano más frecuentes (enfermedad pulmonar crónica avanzada, insuficiencia cardiaca crónica avanzada, cirrosis hepática avanzada, insuficiencia renal crónica avanzada y demencias muy evolucionadas), establecer una adecuada toma de decisiones teniendo en cuenta las preferencias o deseos del paciente y familia, documentar y registrar en la historia clínica todos estos parámetros y ofrecer al paciente el tratamiento más adecuado con el fin de conseguir una muerte digna y considerando unos estándares clínicos, culturales y éticos. Se destaca la necesidad de llevar a cabo estudios prospectivos que ayuden a establecer unos criterios de inclusión en programas de CP a pacientes con enfermedades avanzadas de órgano no malignas (AU)

Nowadays Palliative Medicine (PM) is changing from a specific point of view towards patients with advanced cancer, to another more generic that also keep in mind patients with advanced non malignant disease. Like wise it is more and more deeply rooted customs that the end-of lifecare has become a fundamental right of our Society. But as a matter of fact, these patients with non-cancer diseases unusually go into a Palliative Care (PC) programme. It is known the difficulty to diagnosis the end of life clinical condition (EOLCC) in them. In this article we comment the justification and restriction of PC in patients with non-malignant cancer diseases, as well as the paradoxical situation to come out, inspite of the increasing programes of PC gradually. But above all we propose in a practical way resolve when a patient with non malignant organ advanced disease (NMOAD) could be subsidiary of PC. For that purpose we have to know the diagnosis and the prognostic factors in connection with the EOLCC of the NMOAD more common (advanced chronical pulmonary disease, advanced chronical heart failure, advanced cirrhosis hepatic, advanced chronical renal failure and very evolved dementia), to set up an appropriate make decisions keeping in mind the preferences and wishes of the patient and family, to document and record in the clinical history all those parameters and offerer to the patient the treatment more suitable with the intention to get a worthy death bearing in mind clinical, cultural and ethical standards. It is pointed out the necessity to carry out prospective studies to help setting up some inclusion criterions in PC programmes for patients with NMOAD

Experimental infection of C3H/HeJ mice with the NY18 isolate of Anaplasma phagocytophilum.

Human granulocytic anaplasmosis (HGA), an emerging disease of public health concern in many areas of the world, is caused by Anaplasma phagocytophilum. Small animal models of A phagocytophilum in laboratory mice have been developed and used to study the pathogenesis of HGA. In this study, we characterized the pathologic changes in acute infection of C3H/HeJ mice experimentally infected with the NY18 isolate of A phagocytophilum. Although no clinical signs were noted, acute infection was associated with gross splenomegaly, microscopic inflammatory lesions in the lung and liver, hyperplastic lesions on the spleen, and clinical pathology abnormalities including neutropenia and monocytosis. This study emphasizes the use of well-defined animal models as a valuable tool for the study of A phagocytophilum infections.

Evaluación de tecnología médica en el ámbito hospitalario. Aplicación al diagnóstico por la imagen / No disponible

Los avances tecnológicos en el área del diagnóstico por la imagen llevados a cabo en las últimas décadas han contribuido de forma significativa al diagnóstico, y manejo de un gran número de patologías. Las técnicas diagnósticas no sólo proporcionan hoy soporte al diagnóstico clínico, sino que también se aproximan más al paciente mediante la aplicación de técnicas diagnósticas invasivas (p. ej. biopsia guiada) y terapéuticas (p. ej. tratamiento con radiofármacos). No obstante, estos avances junto con el rápido crecimiento de la industria sanitaria y la globalización y fácil acceso a todo tipo de información, están contribuyendo a generar una demanda creciente clínica y social por la adquisición de la última y más novedosa tecnología médica (TM). Debe explicitarse que bajo el término de TM se incluyen equipos, fármacos, prótesis, procedimientos médi¬cos y quirúrgicos, susceptibles de ser utilizados por los profesionales de la medicina para la prevención, diagnósti¬co, tratamiento y rehabilitación de condiciones clínicas con¬cretas; también se incluyen los sistemas de información y apoyo a la atención sanitaria (AU)

No disponible

Correlación de los datos isocinéticos y la resonancia magnética en las lesiones de cofia rotadora / Correlation of the isokinetics data and magnetic resonance the lesions of the rotator cuff

Objetivos: Analizar los resultados isocinéticos en lesiones de cofia rotadora del hombro y la búsqueda de patrones isocinéticos que tengan correlación con la lesión anatómica confirmada por RM. Material y método: Recogimos una muestra de 25 pacientes (15 hombres y 10 mujeres) de edades comprendidas entre los 42 y los 70 años, todos ellos con criterios clínicos de lesión de cofia rotadora, confirmada posteriormente con un estudio por imagen (RM) con secuencias en SE T2 y FFE T2 en los tres planos del espacio a nivel del hombro afecto. La etiología era degenerativa en todos los casos. Este grupo lo hemos comparado con un grupo control de 25 sujetos. Hemos utilizado un dinamómetro isocinético CYBEX NORM II. El test se realizó en sedestación, con el tronco fijado y el brazo en el plano de la escápula (anteflexión de 30° y abdución de 45°), siempre en régimen concéntrico, valorándose la fuerza (Peak torque) y el conjunto del trabajo total (Set Total Work) de rotación externa y rotación interna, y a velocidades angulares de 90° y 180°.Análisis estadístico con programa SPSS, Test de Mann-Whitney y test de Wilcoxon. Resultados: Grupo control-grupo afecto: Diferencia estadisticamente significativa (p < 0,05) para peak torque y set total Work.Grupo control-grupo afecto por sexos p < 0,05 para peak toeque y set total work. Conclusiones: El test isocinético es una prueba útil para valorar la pérdida de fuerza en lesiones de cofia rotadora. No hemos encontrado un patrón característico para las distintas lesiones de cofia rotadora. Hemos apreciado una disminución global de fuerza en el grupo antagonista (AU)

Inconsistent journalism: the coverage of chronic diseases in the Mexican press.

The mass media are recognized by many social scientists as important sources of medical information for lay people and as a positive influence on those working in the health care professions. However, there is a lack of study about print and mass media reporting on major health problems in developing countries such as Mexico. This article presents the findings of a study conducted to identify specific messages that the Mexican print media convey to the general reader about chronic diseases, especially one of the most important and pervasive, diabetes. We undertook a comprehensive review and content analysis of secondary source media reporting in the Boletin (Bulletin)--published by the Department of Education and Health, Universidad Autónoma Metropolitana, Xochimilco. The Boletin summarizes all articles related to health matters published in 12 national daily newspapers and 3 magazines. Our study covered all issues of the Boletin from 1992 through 1996. Our findings indicate that at times the press and popular print media disseminate an incomplete and often biased picture of chronic diseases prevalent in Mexico. Specifically, the press gives equal or more important coverage of acute diseases, or to AIDS, than to other major chronic conditions. The press also reproduces the biomedical model of disease and does not address topics important to certain segments of the population, including the patient. Moreover, the media may present an overly idealized impression of the capability of health services. Consequently, this failure to address the issues of certain widespread, chronic illnesses is severe enough to ask about the role of the press in medical health care reform. We conclude by suggesting areas for further research.

Effect of parasite burden on the detection of Fasciola hepatica antigens in sera and feces of experimentally infected sheep.

The effect of Fasciola hepatica parasite burden on the detection of excretory/secretory (E/S) antigens in sera and feces of experimentally infected sheep was evaluated using a double antibody-based capture enzyme-linked immunosorbent assay (ELISA). Four groups of five sheep each were used. The first three groups were infected with 50, 100 and 200 metacercariae of F. hepatica, and the fourth group remained as non-infected control. On the day of infection and weekly thereafter, serum and fecal samples were taken. ELISA detected F. hepatica E/S antigen levels in serum from the first week post-infection (wpi) and in fecal supernatant from the fourth wpi, which were significantly (p<0.05) higher than controls. F. hepatica eggs were not detected until after the eighth wpi. The correlation between absorbance of E/S antigens in serum with the fluke burden was 0.77 (p<0.0001) and in feces 0.76 (p<0.0001) at 12th wpi. The sensitivity of the assay to detect E/S antigens in serum was 86.6% and in feces 93.3%. It is concluded that the ELISA technique used in this study offers a diagnostic alternative for detecting early infections of F. hepatica in sheep.

Evaluación de tecnología médica en el ámbito hospitalario. Aplicación al diagnóstico por la imagen / Evaluation of Medical Technology in the Hospital Field as Applied to Diagnosis by images

No disponible

Open heart surgery in public and private practice.

OBJECTIVES: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. METHODS: Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. RESULTS: Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68; 95% CI from 0.94 to 3.0). CONCLUSIONS: Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.

[A descriptive study of pediatric dermatologic diseases diagnosed at the Manises Health Center over 1 year]. / Estudio descriptivo de la patología dermatológica pediátrica diagnosticada en el Centro de Salud de Manises durante un año.

OBJECTIVE: To determine the frequency and types of paediatric dermatological pathologies diagnosed at a Primary Care Centre, and the referrals for them to specialists. DESIGN: Descriptive study. SETTING: Primary Care Paediatrics clinic at the Manises Health Centre, Valencia. PATIENTS: Children under 14 attending the clinic during 1995. MEASUREMENTS AND RESULTS: The diagnostic groups were: skin infections, Dermatitis-Eczema, Urticaria-Erythema, Zoonosis, hair and nail disorders, pigmentation disorders and miscellaneous. Age groups were: under one, from 1 to 4, from 5 to 9 and from 10 to 13. Referrals were to the Specialist Centre and to the hospital. There were 1309 first dermatological consultations (5.91% if all paediatric consultations). 38.20% were for skin infections; 25.67% for Dermatitis; 17.11% for Urticarias; 8.33% for Zoonosis; 4.89% for disorders of hair and nail; 1.83% for pigmentation disorders; and the remaining 3.97% miscellaneous. 160 (12.22%) were referred to specialists. CONCLUSIONS: There is a great deal of dermatological pathology in non-hospital paediatric clinics. Over 90% of this pathology is in one of the first five groups above.

[Approach to the use of screening mammography in 2 health regions]. / Aproximación a la utilización de la mamografía de cribado en dos regiones sanitarias.

OBJECTIVE: To find the present use of mammography screening in relation to the reference criteria on what age to begin breast cancer screening, as defined in the Health Plan for Catalonia, and to evaluate the activity of the mammography technicians. DESIGN: Crossover survey. SETTING: The Costa de Ponent and Centre de Cataluña Health Regions. PATIENTS: There were 1,587 mammography requests from patients seen in these health sectors. MEASUREMENTS AND MAIN RESULTS: The variables collected were age, date of investigation, place of residence, reason for request. 45.4% of screening mammographies requested in the health sectors under study corresponded to the age-group recommended in the reference criteria. Similar results were observed in the centres where mammographies were performed. Average daily activity per mammogram technician is 11.1 investigations (average: 11.1 mammographies; SD 4.5). CONCLUSIONS: About half the mammographies performed as part of screening for breast cancer are performed outside the recommended age-group and for ages where effectiveness has not been demonstrated. Therefore, publicising the recommended screening criteria must be a priority when initiating preventive activities. It is also important to use the available resources efficiently in line with the criteria laid down for breast cancer screening.