[Levels of bactericidal antibodies against meningococcus C after vaccination in 2- to 6-year-old children in Andalusia]. / Niveles de anticuerpos bactericidas frente a meningococo C tras la vacunación de niños de 2 a 6 años de edad en Andalucía.

BACKGROUND: In 1997, 18.5% of the cases of Meningococcal Disease caused b serogroup C in Andalusia were children between 2 and 4 years of age; ages where the initial immune response and the duration of the capsular A + C meningococcal polysaccharide vaccine is less than in older age groups. Research was designed in order to measure the immune response produced by this vaccine in children from 2 to 6 years of age and to compare it with the natural immunity present in unvaccinated children. METHODS: I. Dual monitoring study: a) groups of children vaccinated previously and control groups, b) groups of children who were going to be vaccinated, for pre and post-vaccination (1, 6 and 12 months) analysis and a control group. II. The bactericidal activity was measured according to the standardised protocol of the CDC with regard to the strain of N. meningitidis C-11. The sera with bactericidal activity (TAB) > 1:8 were considered to be protective. RESULTS: 1 and 2 months following vaccination, the proportion of TAB > 1:8 was significantly higher than that of the control group (65.6% and 73% in comparison to 2.2% and 12%). In the pre-vaccine and post-vaccine (after 6, 7, 12 and 13 months) verification, no significant difference between vaccinated individuals and controls was observed. CONCLUSIONS: The differences between vaccinated and unvaccinated individuals 1 and 2 months following vaccination indicate seroconversion in the vaccinated individuals. For the age group of between 2 to 6 years of age, the bactericidal activity acquired decline quickly, as, after 6 months, differences between this group and the control group are no longer observed.

[Evaluation of seminars on international criteria for medical certification of cause of death]. / Evaluación de seminarios sobre criterios internacionales de la certificación médica de las causas de defunción.

OBJECTIVE: To evaluate the efficacy of seminars on the international criteria for medical certification of the causes of death. DESIGN: A pre-test/post-test evaluation, with no reference group. SETTING: A primary care health district in Andalusia, Spain. PARTICIPANTS: The 44 doctors in this district. INTERVENTION: Training seminars and evaluation of the filling-in of the Statistical Decease Forms (SDF) during the six months after the seminar. MEASUREMENTS AND MAIN RESULTS: Four quality indicators were used to assess doctors' filling-in of the SDFs, which contain the international criteria for certification of the causes of death, six months before and six months after the holding of the seminars. The results were then compared. In 11.4% the legibility of the hand-writing improved; and in 16.5% there was less confusion between the mechanism of death and the cause. The clinical sequence of causes reported and the indicator of more than one diagnosis per line did not vary significantly. CONCLUSIONS: Although the seminars on international norms of certification are necessary in order to improve the standard of mortality statistics, a change in the ways of certifying causes of death requires ongoing commitment to the training of certifying doctors.

[Epidemiological analysis of the role of fertility in the decrease of maternal mortality in the Spanish autonomic communities in the XX century]. / Análisis epidemiológico del papel de la fecundidad en el descenso de la mortalidad materna en las comunidades autónomas Españolas a lo largo del siglo XX.

The study which has been carried out has meant to show from an epidemiological perspective the relationships which exist between fecundity and maternal mortality, and has underscored the need to take into account the changes which have taken place in the reproductive conduct of women when one studies the decrease in direct maternal mortality. For the analysis of the tendencies and periods selected, we have used the regressive linear rate and the rate of determination. It is worth pointing out the appearance of decreasing rates of maternal mortality in the pre-chemotherapeutic period which are equal to or higher than those found in the chemotherapeutic period in selected Autonomous Communities. We must also point out that the negative tendency which was shown by maternal mortality in Cataluña and the Basque region since 1919 shows an inversion between the mid-50s and the mid-60s, which were years of a great increase in fecundity in the mentioned areas.

The role of the social condition of women in the decline of maternal and female mortality.

The objective of this article is to study the changes that have occurred in the mortality pattern of women of fertile age in Spain throughout the 20th century, the significance of maternal mortality in the development of this pattern, and the other causes of death that have contributed most to such changes. Female mortality has most often been approached from the perspective of the genetic differences from males--particularly from the sexual-biological, basically reproductive, aspect--without considering other possible (social) differences. We have studied the female mortality pattern from the double incline of date of death (period) and of date of birth (cohort). Using the mortality theory of competing risks as our basis, we excluded in turn maternal mortality and mortality due to tuberculosis from overall mortality, and analyzed the transformations produced in the mortality pattern. Our results show that maternal mortality alone cannot be held responsible for the excess female mortality of the 1910s and 1920s, or for the mortality pattern among women of fertile age during the first half of this century. We suggest that the social discrimination against females from infancy has been responsible for most of the differences observed in mortality patterns.

Epidemiological appraisal of the active role of women in the decline of infant mortality in Spain during the twentieth century.

This paper is concerned with the question of the role which the psycho-cultural development experienced by women in developed countries throughout this century may have played in the decline of infant mortality, taking in Spain between 1900 and 1979 as a basis for observation. We think that, by studying the psycho-cultural development of women, included under the general concept of standard of living, we can take a step forward in explaining such a frequently investigated but nonetheless incompletely understood subject as is that of the marked decline of infant mortality which has taken place in this century in developed countries in general, and in Spain in particular. To this effect, we have attempted to demonstrate the need to consider socio-cultural factors, in addition to the already repeatedly studied economic and biomedical ones; the more so when we take into account the marked decline in infant mortality which occurred in Spain in the 1940s, in which period there was a pronounced stagnation in the economy. To this purpose, we have studied fertility, not only as a gauge of the biological risks which generate a certain reproductive pattern for infant mortality, but also as an indicator of the socio-cultural development of women. Similarly, and through a review of historical documents, we have analysed the role of women in birth control, their incorporation into more qualified jobs, their level of education, their growing awareness of their own situation in society, as well as pertinent legislative changes. All these processes affect the health of children through factors which, although they are very difficult to evaluate and quantify, have previously been described and examined in other studies. Our study has shown the probable relationship between the decline of fertility and the decrease of infant mortality, in view of the fact that there has been a pronounced decrease of parity and fertility in women belonging to the oldest fertile age groups. Similarly, the indications pointed out with respect to the processes mentioned above lead us to infer that in Spain the woman has played a significant role in the decline of infant mortality produced in this century, and especially in the first half of the century. We have embarked on a scantily developed line of investigation, and suggest the need for new studies on the subject.

[Mortality in Spain. I. Infant mortality in Spain 1900-1976. Regional evaluation]. / La mortalidad en España, I. La mortalidad infantil en España 1900-1976. Valoración regional.

PIP: The overall incidence and evolution of infant mortality in Spain in the present century is assessed as a reflection of health and economic progress in the various regions and as a guide for future provision of health and social services for infants. Mortality on the 1st day of life is only included starting in 1932. In 1900 there were 128,395 deaths in the 1st year, of which 70,264 occurred in males and 58,131 in females. In 1976 there were a total of 11,590 deaths, of which 6735 were to males and 4855 to females. Rates declined from 213.29/1000 live births for males and 194.69/1000 live births for females in 1900 to 19.29 for males and 14.79 for females in 1976, a decline of 91% for males and 92% for females. Quinquennial rates declined continuously except in 1918, when an influenza outbreak occurred, and in 1937-41, during the Spanish civil war and immediate postwar period. The regions with the highest percentage decline in male infant mortality from 1900-76 were Aragon, Extremadura, Madrid, and Castilla-La Mancha, while Galicia had the smallest decline. Madrid, Castilla-La Mancha, and Navarra had the greatest decline for females, while Baleares and Galicia had the smallest declines. 3 factors in the greater than average declines in Aragon, Extremadura, and Castilla-La Mancha were probably their very high rates of infant mortality at the outset, their urbanization experience, and the considerable emigration from each. Galicia had a lower infant mortality rate at the outset and is still predominantly rural. The decline in fertility has not been as pronounced over the century as the decline in infant mortality.^ieng