[Subacromial sodium hyaluronate injection for the treatment of chronic shoulder pain: A prospective series of eighty patients]. / Infiltración subacromial de ácido hialurónico en el tratamiento del dolor crónico de hombro. Serie prospectiva de 80 pacientes seguidos durante un año.

OBJECTIVE: Our purpose was to assess the effectiveness of hyaluronic acid infiltrations for chronic shoulder pain as an alternative to the non-surgical and surgical treatments that are currently available. MATERIAL AND METHODS: This is a prospective study of 80 consecutive patients suffering from chronic shoulder pain followed for twelve months. Five subacromial hyaluronic acid injections on five consecutive weeks were administrated to all patients. RESULTS: A significant improvement within the whole group after six months was observed. Constant score improved by 7.7 points, DASH questionnaire decreased by 5 points and Visual Analog Scale for pain decreased by 1.6 points. Patients with history of less than 24 months of pain responded better to treatment. Females responded better. Patients with decreased subacromial space or cuff tear in the MRI improved but patients diagnosed by the MRI of acromioclavicular osteoarthritis worsened in all scales assessed. DISCUSSION: Subacromial hyaluronic acid injections are specially effective in patients with history of less than 24 months of pain, a decreased subacromial space or partial or total cuff tear but, in our experience, its result is not good in patients with acromioclavicular osteoarthritis.

OBJETIVO: Nuestro objetivo fue evaluar la efectividad de las infiltraciones subacromiales de ácido hialurónico en el tratamiento del dolor crónico de hombro como alternativa a los tratamientos quirúrgicos y no quirúrgicos actualmente disponibles. MATERIAL Y MÉTODOS: Estudio prospectivo de 80 pacientes consecutivos con dolor crónico de hombro seguidos durante 12 meses. Se realizaron cinco infiltraciones subacromiales con ácido hialurónico durante cinco semanas consecutivas y se analizaron los resultados clínicos obtenidos. RESULTADOS: La puntuación en la escala de Constant mejoró en 7.7 puntos, el cuestionario DASH disminuyó en cinco puntos y la puntuación en la escala visual analógica para el dolor disminuyó 1.6 puntos por término medio. Los pacientes que presentaban dolor de menos de 24 meses de evolución respondieron mejor al tratamiento. Las mujeres respondieron mejor. Los pacientes con disminución del espacio subacromial o lesión del manguito rotador según la resonancia magnética mejoraron, pero los pacientes que mostraron signos de artrosis acromioclavicular en la resonancia empeoraron en todas las escalas evaluadas. DISCUSIÓN: Las infiltraciones subacromiales de ácido hialurónico son especialmente efectivas en el tratamiento del dolor crónico de hombro de menos de 24 meses de evolución, con disminución del espacio subacromial o lesión parcial o total del manguito rotador, pero en nuestra experiencia, su resultado no es bueno en pacientes con artrosis acromioclavicular.

Organochlorine Pesticides Exposure and Bladder Cancer: Evaluation from a Gene-Environment Perspective in a Hospital-Based Case-Control Study in the Canary Islands (Spain).

The incidence of bladder cancer has increased significantly since the 1950s. Pesticide exposure has been linked with increasing bladder cancer incidence, although the evidence is inconclusive. However, most epidemiological studies did not evaluate the potential role played by the organochlorine pesticides, the most widely used pesticides in Western countries from the 1940s to the 1970s. Organochlorine pesticides were banned in the late 1970s because of their persistence in the environment and their carcinogenic and mutagenic effects. Organochlorine pesticides were employed in huge amounts in the Spanish archipelago of the Canary Islands; the authors, therefore, evaluated the role played by organochlorine pesticides exposure on bladder cancer. Serum levels of the most prevalent organochlorine pesticides used in the agriculture of these Islands (dichlorodiphenyltrichloroethane [p,p'-DDT], and its metabolites dichlorodiphenyldichloroethylene [p,p'-DDE] and dichlorodiphenyldichloroethane [p,p'-DDD], hexachlorobenzene, hexachlorocyclohexane isomers, aldrin, dieldrin, endrin, heptachlor, cis-chlordane, trans-chlordane, α- and ß-endosulfan, endosulfan sulfate, methoxychlor, and mirex) were measured in 140 bladder cancer cases and 206 controls. GST-M1 and GST-T1 gene polymorphisms were genotyped by polymerase chain reaction (PCR)-based methods. These results showed that serum levels of organochlorine pesticides did not increase bladder cancer risk. On the contrary, total burden of hexachlorocyclohexanes was found to be negatively associated to bladder cancer (odds ratio [OR] = 0.929, 95% confidence interval [CI]: 0.865-0.997; P = .041). This effect disappeared when the distribution of the gluthathione S-transferase polymorphisms was introduced in the statistical model. These results indicate that organochlorine pesticides are not a risk factor for bladder cancer. However, these findings provide additional evidence of gene-environment interactions for organochlorine pesticides and bladder cancer and reinforce the relevance of genes encoding xenobiotic-metabolizing enzymes in bladder cancer.

Polychlorobiphenyls and organochlorine pesticides in conventional and organic brands of milk: occurrence and dietary intake in the population of the Canary Islands (Spain).

The population of the Spanish archipelago of the Canary Islands has been studied in depth regarding its levels of contamination by organochlorine pesticides (OCs) and polychlorinated biphenyls (PCBs). Foodstuffs of animal origin, such as milk, are prominent contributors to the body burden of these contaminants. As this population presents one of the highest milk-intake in Spain and Europe, we evaluated the level of OCs and PCBs in 26 commercially available brands of milk (16 conventional and 10 organic brands) present in the market of these Islands, in order to estimate the relevance of milk as a source of these chemicals for the Canary population. Our findings showed that hexachlorobenzene, trans-chlordane, and PCB153 were present in almost all the samples with independence of the type of milk. For both types of milks, the concentration of OCs was very low, showing organic milks lower levels than conventional ones. As a consequence, the estimated daily intake for OCs was lower than the tolerable daily intake (TDI) established by International Agencies. The levels of PCBs in milk were also found to be very low, but, in this case, the situation was the opposite: there were higher levels of PCBs in organic than in conventional brands of milk. Unexpectedly, levels of dioxin-like PCBs (DL-PCBs) reached values higher than 25 pg WHO-TEQ g(-1) fat in percentile 75 for both types of milk indicating the existence of a number of brands of milk highly contaminated by these toxicants. Consequently, the population who consume the most contaminated milk brands could have estimated daily intakes well above the recommended TDI (2 pg WHO-TEQ kg(-1)b.w.d(-1)) established by European Union Authorities. These results are of concern if we consider the well known adverse health effects exerted by dioxin-like compounds.

[Assessment of a hand hygiene program on healthcare-associated infection control]. / Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias.

AIM: to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. METHODS: Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. RESULTS: an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19.6% at baseline to 40.0% (p<0.001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12.0% to 28.4%; p<0.001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12.2% in 2008. CONCLUSIONS: Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control.

Costs of QuantiFERON-TB Gold versus tuberculin skin test in Spanish healthcare workers.

We compared the cost of the tuberculin skin test (TST) with the QuantiFERON-TB Gold (QFT-G) test when screening for latent tuberculosis in 134 healthcare workers in Spain. The QFT-G test cost euro42.5 per healthcare worker, while the TST cost euro39.5. The tests varied in cost structure; most (70%) TST costs were due to time demands on the participants, whereas the QFT-G was more expensive in terms of consumables (50% of the total cost). Accordingly, the results depend on the hourly wages of the participants and the time they must dedicate to the tests. In the Spanish healthcare system, the societal costs of QFT-G are comparable to those of the TST, although their cost structures are quite distinct.

Increasing serum levels of non-DDT-derivative organochlorine pesticides in the younger population of the Canary Islands (Spain).

Organochlorine pesticides are a lipophilic class of chemicals that persist in the environment and tend to accumulate in human tissues for years. They came into widespread use in the late 1940s. Because of their capacity to bioaccumulate and biomagnify in food chains and their toxic effects, most of them were banned in industrialized countries, among them Spain, in the late 1970s and 1980s. In 1998 organochlorine pesticides were determined in a representative sample of a Spanish population (around 690 serum samples from people 6 to 75years old from the Canary Islands). Serum levels of lindane aldrin, dieldrin and endrin, were determined. Our results showed that a high percentage of samples presented detectable levels of some of the organochlorines measured, endrin being the most frequently detected (72%) and at highest concentration (mean 136.7ng/g fat). Mean concentrations of the main cyclodiene evaluated, dieldrin, was lower to those found in other Western populations. However, serum levels of lindane were higher than those described in North European populations. Influence of geographical and sociodemographic factors was evaluated. Urban populations showed the highest levels of dieldrin, while non-urban population showed the highest serum values of lindane, aldrin and endrin. Unexpectedly, serum values of lindane, aldrin and dieldrin were higher in younger than in older people. Subjects under 18years showed almost twice as high serum levels of lindane, aldrin and dieldrin than subjects of 65-75years. These results may well suggest that people living in the Canary Islands have been and are currently exposed to non-DDT-organochlorine pesticides. The type and source of exposure could vary between islands and type of habitat. Contaminated food and/or the environment could be related with this situation.

Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands.

OBJECTIVE: Assessment of relation between metabolic syndrome (MS) and Mediterranean diet (MD) adherence. DESIGN: Cross-sectional study. ATP III definition of MS was used. Adherence to MD was assessed with a Food Frequency Questionnaire. Intakes of cereal, fruit, legumes, vegetables, fish, nuts, monounsaturated to saturated ratio, alcohol from red wine, whole-fat dairy products and red meat were considered. SETTING: Representative sample of population from the Canary Islands (Spain) participating in the Canarian Nutrition Survey (ENCA). SUBJECTS: 578 adults>18 years. RESULTS: Of the subjects, 24.4% presented MS. Once adjusted, MD adherence was not related to MS prevalence, but subjects in the third tertile of adherence presented 70% lower prevalence of the blood pressure criteria and 2.5 times more prevalence of the glycaemia criteria with respect to the first tertile. Red meat intake was associated with higher prevalence of blood pressure criteria. Moderate alcohol intake from red wine was associated with lower prevalence of these criteria in women and lower prevalence of HDL cholesterol criteria in men. Fruit intake showed a protective effect on triglyceride criteria, whereas vegetable intake was associated with higher prevalence of this criterion. Cereals' intake showed a protective effect over insulin resistance measured by high insulinaemia level. Fruit intake showed a significative protective effect over high Homeostasis Model Assessment index. Whole-fat dairy products showed a significant protective effect on the glycaemia criteria. High monounsaturated to saturated fatty acid intake showed a protective effect on insulin resistance. CONCLUSIONS: Some components of the MD showed a protective effect on the MS and its components.

[Weight gain along adult life]. / Ganancia de peso a lo largo de la vida adulta.

BACKGROUND: Obesity is a serious health problem with a rather difficult treatment and prevention. Estimating weight gain along adult life may be useful for preventing adult obesity. SUBJECTS AND METHOD: This cross-sectional study included a representative sample of 1,286 adults who self-reported a weight gain from age 20 years. RESULTS: The average weight gain per decade was about 4.5 kg in males and females aged 20 to 49 years. Among subjects aged 50 to 69 years, it was 1 kg in men and 2 kg in women, approximately. Body weight decreased from age 70 years onwards. CONCLUSION: Weight gain appears to be progressive from the third up to the seventh decade of life in both sexes, yet it is more persistent in women.

Epidemiología de la anemia ferropénicaen Canarias (ENCA 97-98) / Epidemiology of iron-deficiency anemia in the Canarian Islands (ENCA 97-98)

Fundamentos: El déficit de hierro es uno de los déficits nutricionales más frecuentes. Este trabajo describe la situación de la anemia ferropénica en Canarias mediante de los marcadores bioquímicos que definen cada etapa (ferritina; volumen corpuscular medio y hemoglobina).Métodos: Se obtuvieron muestras de sangre de los 782 participantes (de 6 a 75 años) en la fase de evaluación bioquímica de la Encuesta de Nutrición de Canarias (ENCA 97-98). Se muestran los porcentajes de la población que tienen valores inferiores a los rangos de normalidad para las variables seleccionadas (ferritina <12 mg/dl; VCM<80 fl.; hemoglobina <12 g/dl; <13 g/dl para hombres mayores de 11 años).Resultados: Ferritina: Por debajo del nivel de normalidad se encuentra el 15 por ciento de los participantes (4 por ciento de los hombres, 25 por ciento de las mujeres). El grupo más afectado son las mujeres menores de 49 años (31 por ciento). VCM: El 5 por ciento de los participantes está bajo el rango de normalidad. Eritropoyesis deficitaria en hierro: (ferritina baja + VCM bajo). En esta etapa se encuentra el 2,4 por ciento de los participantes (0,6 por ciento de los hombres, 4 por ciento de las mujeres). El grupo más afectado son, de nuevo, las mujeres menores de 49 años (5,4 por ciento). Hemoglobina: hay un 7 por ciento de individuos por debajo de su rango. Anemia ferropénica: (ferropenia + hemoglobina baja). En esta situación se encuentra el 1,5 por ciento de la población estudiada (0,3 por ciento de los hombres y 2,5 por ciento de las mujeres).Conclusiones: Los criterios que definen cada etapa varían según el estudio. La prevalencia de anemia ferropénica en ENCA supera ligeramente a otros estudios nacionales. La ferritina es el parámetro que está más afectado. El grupo más vulnerable son las mujeres de 18 a 49 años (AU)

[Biochemical assessment of nutritional status in the Canary Islands population (1998)]. / Evaluación bioquímica del estado nutricional de la población canaria (1998).

UNLABELLED: Nutrition surveys include information about dietary intake and nutritional status utilising clinical, biochemical and anthropometric measurements. OBJECTIVE: To evaluate the nutritional status of the Canary Island population by means of biochemical and haematological indicators METHODOLOGY: A cross-sectional study was realised in a representative subsample aged 6 to 75 years that participated in the Nutritional Survey of the Canary Islands, 1997-98 (ENCA). We determined levels of ferritin and vitamin B12 (enzyme-immunoassay), serum and erythrocytic folic acid (automated ionic catchment), retinol, tocopherol and carotenes (high performance liquid chromatography) and minerals (atomic absorption spectrometry) RESULTS: There were neither sex, age nor socio-economic differences in the reference population sample and the ENCA sample. The participation rate was 48.8%. 25% of the women had deficit levels of ferritin and the prevalence of anaemia in women over 18 years was 2.9%. 13% of the population had low erythrocyte folic acid levels, that increased with age, and 3.4% had low vitamin B12 levels, which, on the contrary, decreased with age, 15% of the population presented a deficit of alpha-tocopherol and 5.2% of retinol, being more frequent in the youngest group, and 56.4% and 41.1% exhibited low levels of beta-carotene and lycopene respectively. Among mineral and trace elements, low levels of manganese drew attention due to its heightened prevalence, and, to a lesser extent, selenium. CONCLUSIONS: In spite of the complexity of its interpretation, this data yields a precise estimation of nutritional status for certain vitamins and minerals in the Canary Island population.

[Energy and nutrient intake and risk of inadequate intakes in Canary Islands (1997-98)]. / Ingesta de energía y nutrientes y riesgo de ingestas inadecuadas en Canarias (1997-98).

OBJECTIVES: To evaluate the consumption of energy and nutrients and to identify the risk of inadequate intakes in the Canary Island population (1997-98). DESIGN: Cross-sectional epidemiological study. METHODS: A dietary survey was conducted in a representative sample of the Canary Island population (n = 1747; 821 men and 926 women) aged 6 to 75 years. Two 24-hour recalls were utilised as the dietary survey instrument, carried out over non-consecutive days. Spanish Food Composition Tables were used and data was adjusted for intraindividual variability. RESULTS: The mean daily intakes were 1760 kcal for energy, 73 g for protein, 228 g for carbohydrates, 15 g for fibre and 62 g for fat (24 g SFA, 25 g MUFA and 8 g PUFA). Energy and nutrient consumption decreased with age excluding vitamins A. C and folate. Nutrient density increased with age, with the lowest intakes seen in children and adolescents. As for social class, decreased calorie intake was observed in the lowest category, with the highest income level showing the greatest intakes for vitamin A, B12, niacin and folate. Noteworthy findings include an overall low calorie intake, and elevated risks of inadequate intakes (percentages of the population with intakes below 2/3 of the RDI) for vitamins D (92.5%), E(87.4%), A(74%), folate(44.7%), iron(30.1%) magnesium (14.9%) and vitamin C (5.4%). Risk for inadequate protein intake was not observed.