Tuberculosis infection and disease among schoolchildren: the influence of the HIV epidemic and of other factors.

BACKGROUND: The HIV/AIDS epidemic has caused an excess of tuberculosis cases in Spain and in other countries, but its impact on tuberculosis infection is less well understood. This study presents a massive screening undertaken to estimate the prevalence of tuberculous infection in a cohort of primary school entrants. The evolution of the risk of infection is studied by comparison with previous data in the same population. METHODS: Tuberculin skin test screening with 2TU of PPD RT 23 of first grade students in the primary schools of Barcelona, in the 1994-95 school year (cohort born in 1988). Information was also sought from families of unscreened children. Contacts of PPD+ children were traced to locate index cases. The results were also linked to the case registry of the tuberculosis control programme. RESULTS: The prevalence of tuberculin reactors free of BCG vaccination among the 11,080 schoolchildren screened belonging to the 1988 cohort was 0.76%. A 3% annual decline in the annual risk of infection is estimated by comparison with previous data. The identification of 24 cases with a previous history of tuberculosis disease and of 13 cases with active disease diagnosed after the screening was possible by the follow up of these tuberculin positive children and of the information provided by families of unscreened pupils. The screening detected 1.5 new cases of tuberculosis per 1000 tuberculin tests performed. Tuberculosis infection could be traced to HIV infected tuberculosis cases for at least 6% of the positive schoolchildren. CONCLUSIONS: The decline of the annual risk of infection continues in Barcelona, although at a slower pace than before the HIV/AIDS epidemic, probably attributable to the influence of injecting drug users with smear positive tuberculosis and HIV/AIDS.

[The prevalence of caries and associated factors in 12-year-old schoolchildren of Barcelona]. / Prevalencia de caries y factores asociados en escolares de 12 años de Barcelona.

OBJECTIVE: To find the prevalence of caries in the 12-year-old school population of the city of Barcelona. DESIGN: An epidemiological crossover survey of dental caries in a representative sample of children in Barcelona. PARTICIPANTS: 739 children in the 7th year of basic education, who were twelve years old at the moment of the examination and came from 35 schools in the city of Barcelona, were examined. MEASUREMENTS AND MAIN RESULTS: Prevalence of caries was 52% (60% in girls and 45% in boys) and the CAOD index (teeth with caries, absent because of caries or permanent teeth with fillings) was 1.37 (1.70 for girls and 1.12 for boys). 51% of the permanent teeth affected by caries had been filled. The distribution of the CAOD index showed that 23% (almost a quarter of the population studied) of 12-year old schoolchildren in Barcelona had 3 teeth or more affected by caries. In the logistical regression analysis, gender (being a girl, OR = 1.69) and the absence of a regular programme of fluoride mouthwashes (OR = 1.69) were associated with having a higher caries index (CAOD equal to or above 3). CONCLUSIONS: The results show caries indices which are generally low and a tendency to stability. The programmes of fluoride mouthwashes seem to be effective in decreasing the incidence of caries.

The evolution of tuberculosis infection among schoolchildren in Barcelona and the HIV epidemic.

SETTING: First grade students in primary schools in the city of Barcelona, Spain. OBJECTIVE: To estimate the prevalence of tuberculin reaction and sources of infection; to analyse trends in comparison with previous data. DESIGN: Tuberculin screening of first grade schoolchildren (1985 birth cohort) was undertaken in 1991-92 using 2 TU of PPD RT23. RESULTS: The prevalence of reactors among the 12,007 children tested from the 1985 cohort was 0.87%, varying among districts between 0.13% and 3.03%. Follow-up of positive tests was completed for 75 children, which led to the identification of 6 cases of previously unknown clinical tuberculosis among these children, while for 14 infected children index cases were found, one of whom was a confirmed HIV-infected IVDU. CONCLUSION: The comparison of results with data from previous studies suggests that tuberculosis infection among schoolchildren in Barcelona may not be declining as in previous years, especially in areas such as the inner city, where poverty combines with HIV infection and with increasing migration from countries with a higher tuberculosis prevalence.

[Prevalence of dental caries among school children: a cross-sectional survey in the city of Barcelona]. / Prevalença de la càries dental entre els escolars: una enquesta transversal a la ciutat de Barcelona.

The results of a cross-sectional survey performed in the spring of 1990 in a sample of 533 twelve-year old schoolchildren in the city of Barcelona (Spain) are presented. The proportion of children with caries is 49.2%, with a DMFT index of 1.34 (1.09 for boys and 1.50 for girls). 63.4% of permanent decayed teeth were filled, and 2.2% were missing. There is a socioeconomic gradient in dental decay, with more caries among the lower socioeconomic strata, where missing teeth concentrate. The comparison of these results with those of other studies suggests a decline in caries incidence in school age in Spain, and greater use of dental care services.