[Clinical and biological markers of secondary uveitis: results of a discriminant analysis]. / Marcadores clinicobiológicos de uveítis secundaria: resultados de un análisis discriminante.

BACKGROUND: The association of uveitis and systemic disease is well known. Patients suffering from uveitis often undergo a extensive battery of tests in order to detect underlying disease, but the efficiency of such screening is uncertain. The aim of this study was to investigate useful clinical data for recognizing secondary uveitis. PATIENTS AND METHODS: We conducted a prospective analysis of 115 patients with uveitis of unknown etiology. All of them were included in an extensive protocol study. Four groups were considered: specific ocular disease (SOD), idiopathic uveitis, HLA-B27 associated uveitis without arthritis (HLA-B27-AU) and secondary uveitis. Groups were compared by analysis of variance for continuous variables, and chi 2 test or Student's t-test for discrete variables. A stepwise multiple discriminant analysis was performed for ranking the variables in order of their usefulness for distinguishing idiopathic and secondary uveitis. RESULTS: We diagnosed 11 SOD (9.6%), 54 idiopathic uveitis (47%), 6 HLA-B27-AU (5.2%) and 41 secondary uveitis (35.7%). The discriminant analysis showed that age, an elevated erythrocyte sedimentation rate, presence of cutaneous lesion, joint pain and genital ulcers are the strongest predictors of secondary uveitis. This model classification functions detected 92.5% of idiopathic uveitis and 72% of secondary uveitis. The global percentage of patients with a correct diagnosis was 84.6%. CONCLUSIONS: Anamnesis, physical examination and basic laboratory tests are sufficient tools for the diagnostic approach of the majority of patients with uveitis. Subsequent diagnostic procedures must be planned in each patient to confirm a specific disease.

[Evaluation of the cost of an intensive medicine unit. Relationship between the cost and the severity of the disease]. / Valoración del coste de una unidad de medicina intensiva. Relación del coste con la gravedad del enfermo.

BACKGROUND: The evaluation of the costs of intensive care is a subject of interest at present, due to the high resources required by this area of health care services and the rhythm at which these costs increase. Such an evaluation has rarely been carried out in Spain. The aim of this study was to quantify the cost of medical care to critical patients in an Intensive Care Unit (ICU) in addition to evaluate the relationship between the severity of the disease and the short term result of intensive health care. METHODS: A prospective study was carried out in 1,184 patients admitted (February 1985-February 1986) to the ICU of the Hospital General de Especialidades Virgen de las Nieves in Granada (Spain). Variables collected were the severity of the patient (APACHE II), therapeutic intensity (TISS) received, diagnosis on admission and state on discharge. A detailed and individualized evaluation was performed concerning the costs of hospital stay and treatment in the ICU. RESULTS: The cost per patient per day in the ICU was found to 54,438 pesetas in 1988. A significant association was demonstrated with age, severity, therapeutic intensity and the result of the stay in the unit, being much higher in the patients who died in the ICU, particularly in those in whom the prognosis "a priori" was good. CONCLUSIONS: A significant relation was found between the cost and severity of the disease, with the maximum costs being found in patients in whom survival was expected but who died and vice versa.

[Proportion of disease attributable to tobacco in the province of Granada]. / Proporción de enfermedad atribuible al tabaco en la provincia de Granada.

BACKGROUND: Smoking is the main cause of preventable morbidity and mortality in Europe. The effect of smoking is not constant with the diseases related to it. The goal of this study is to estimate poblational etiologic fractions (PEF), as the proportion of disease attributable to smoking in the reference population, for those disease clearly related to smoking in Granada. METHODS: The PEF depend upon relative risk (RR) and the proportion of exposed subjects in the target population. Meta-analytic procedures, following the Woolf's method, were applied to estimate weighted RR between smoking and each one of the diseases studied. A survey on a random sample of all Granadian population to assess the prevalence of smoking was performed. RESULTS: The PEF were always higher for males than for females. In males, the highest figures were for lung cancer (85%) and chronic obstructive lung disease (84%); whilst in females lung cancer and peripheral artery disease reached the greatest figures, 55% and 51%, respectively. CONCLUSIONS: The figures obtained outline the need for improving antismoking campaigns and allow to quantify the maximum potential benefit to be got if smoking was quit by the Granadian population.

[Possible recall bias in a case-control study of congenital hip dysplasia]. / Posible sesgo anamnésico en un estudio de casos y controles de displasia congénita de cadera.

PURPOSE: To ascertain the presence of recall or report bias in a case-control study on congenital dysplasia of the hip (CDH). METHODS: A hospital case-control study was performed. Those cases and controls with other malformations or from mothers with clinical problems were discarded. 97 cases of dysplasia, and 164 controls were collected. Mother's life style was assessed. Odds ratios (OR) (crude and multiple-factor adjusted by logistic regression analysis) and their 95% confidence intervals were estimated. Risk factors were analyzed stratifying by the results of Ortolani-Barlow maneuver, since women were interviewed after knowing these results. RESULTS: Mothers of newborns with a positive Ortolani-Barlow maneuver yielded a higher OR for positive family history than those of babies with a negative one (2.27 versus 1.38). Overall smoking and alcohol consumption, and number of health exams during pregnancy yielded a negative association with CDH. In these cases closer-to-the-null ORs were obtained in newborns with positive Ortolani-Barlow. CONCLUSIONS: The presence of a report or recall bias is suggested as one of the possibilities for explaining the results.

[Anesthetic morbimortality in a general hospital]. / Morbimortalidad anestésica en un hospital general.

INTRODUCTION: Due to the lack of data in our medium and epidemiologic study was performed with the aims of knowing the numbers of morbimortality of anesthesia in a tertiary hospital as well as identify the risk factors of the same. METHODS: A general prospective study was carried out with a sample of 5,162 anesthesias administered in our hospital from October 1986 to October 1987. The questionnaires undertaken were completed by the anesthesiologists of the hospital staff. Age, sex, ASA, emergency, associated preoperative pathologies, premedication, length of operation, duration fo anesthesia, anesthesiologist experience, type of surgery, type of anesthesia, monitoring, type of complications and evolution of the same were the variables assessed. Severe cases were also evaluated by 3 anesthesiologists of the department, independent of those involved. The relative risk and the confidence interval of 95% were calculated as were the chi of Mantel-Haenszel tendency and a test of mean comparisons. RESULTS: The mortality partially linked to anesthesia found was 1:2,581. The numbers of morbidity were of 0.77% for severe complications and 14.1% for the slight complications. Upon analysis of severe complications 28.5% of the cases were found to be due to human error. The principal risk factors were age, emergency, bad preoperative physical state, lenght of operation, type of anesthesia and surgery. CONCLUSIONS: The situation in our center does not differ from that found by other authors and not only the numbers of morbimortality but also the factors of risk found in this study are similar to those published in recent studies.

[Meta-analysis in epidemiology (2): quantitative methods]. / Metaanálisis en epidemiología (Segunda parte): métodos cuantitativos.

The main goal of this paper is to offer an introduction to the quantitative methods of meta-analysis used in epidemiology/public health, emphasizing on the most widespread used. We give also a brief reference of the methods to recognize publication bias. The limitations and advantages of the methods commented on are discussed.

[Meta-analysis in epidemiology (1): the general characteristics]. / Metaanálisis en epidemiologia (primera parte): caracteristicas generales.

In the present work the general characteristics, aims and applications of meta-analysis in public health are described. The general rules and the relevant steps for the development of this type of studies are considered. These points are illustrated with a number of real examples and the advantages and limitations of the different methodological options are commented.

[Epidemiology of brucellosis in the Granada province (I). Occupational risks]. / Epidemiología de la brucelosis en la provincia de Granada (I). Riesgo profesional.

BACKGROUND: Brucellosis is a health problem in the Granada province. The major aim of the present study was to evaluate the professional risk to acquire brucellosis in Granada. METHODS: An epidemiologic study where the cases of brucellosis were found by active search was carried out. The study period was the year 1984. The patients (overall 804) were investigated in their residence area with a questionnaire where the major risk factors were considered. RESULTS: The disease was more common in males than in females (RR = 3); it had a significant tendency to increase with decreasing sizes of the urban nucleus (chi MH = 16.9, p less than 0.0001); and it had a significant relationship with the proportion of peasants and cattle workers in the region (r = 0.66, p less than 0.05). The professional group with the highest risk were veterinaries, in whom the disease was 31 times more common than in the rest of the population. CONCLUSIONS: Emphasis is made, in addition to other points, on the need to increase health education in the groups of more affected professionals.

[Oral contraceptives and breast cancer: analysis of the statistical power of the association]. / Anticonceptivos orales y cáncer de mama: análisis de la potencia estadística de la asociación.

The power of the association between oral contraceptives and breast cancer was analysed in all the papers published up to date. Seventy-seven publications (from 44 studies) were collected and graded as to quality using meta-analytical methods. Power achieved a figure of greater than or equal to 0.8 in a 10.8% of the associations studied. It showed a significant relationship with the existence of a significant relative risk of the oral contraceptives for breast cancer. The relationship with the sample size of a study was not linear. Power did not show any significant relationship to other variables related to the design of a study (apart from matching, being the power higher in unmatched studies), or to the biases detected, although studies considered as unbiased yielded a higher power. Logistic regression analysis included as predictors of a power greater than or equal to 0.80 the existence of a significant relative risk and the lack of biases in a research.

[The hospital stay as a modifier of the effect of other risk factors for hospital infection]. / La estancia como modificador del efecto de otros factores de riesgo para la infección hospitalaria.

It has been suggested that the risk of hospital infection differs according to the moment of hospital stay. Through a retrospective cohort of 843 surgery patients the effect of several factors on nosocomial infection risk is studied as a function of the duration of the hospital stay. It was observed that the studied variables (operation, type of surgery, age and severity of underlying disease) had a predisposing effect on the appearance of infection in short stays (less than 14 days), being the effect greater in longer stays. It is concluded that hospital stay can act as a modifier of the effect of several factors on the risk of hospital infection.

[The use of incidence density in assessing the risk factors for nosocomial infection]. / Utilización de la densidad de incidencia en la valoración de factores de riesgo de la infección nosocomial.

Several authors have suggested that incidence density should be used in studying nosocomial infection. We assess several risk factors for hospital infection by two ratios, the incidence density ratio (IDR) and the relative risk (RR), in an historical cohort of 843 patients. The variables analyzed were: operation, its length, type of surgical wound, severity of underlying disease, and age. The IDR figures were always lower than those yielded by the RR. For example, the IDR for operated patients was 2.78, whereas RR yielded a figure of 6.46, or the IDR for patients greater than 60 years old was 0.96, whereas the RR achieved a significant value of 1.67. This suggests that the use of IDR to analyze risk factors for nosocomial infection improves comparability of results obtained in different hospital settings. Also, it may allow a more exact quantification of an effect. These facts influence implementation of nosocomial infection control measures.

Prevalence of dental caries in school children of the province of Granada (Spain).

A sample of 3,347 students between 5 and 14 years of age was selected from the entire student population in the province of Granada (Spain) to study the prevalence of dental caries and several risk factors for the disease. Decay was ascertained in the study population by means of the following indices: df, DMF, and DMFS. Risk factors considered were the level of oral hygiene, number of between-meal sugar-containing food, and flouride concentration in drinking water. The indices mentioned showed a clear relationship to the age of the participants in the study. The level of oral hygiene did not show a clear association with dental caries measured through the df and DMF indices. Curiously, a higher correlation was noted between the disease in deciduous teeth and fluoride concentration than between the disease in permanent teeth and the latter factor.

[Life style and level of health education in housewives from a neighborhood of Granada]. / Estilo de vida y nivel de educación sanitaria en amas de casa de un barrio de Granada capital.

In the present study some aspects of the health education level and life style of the housewives of a district of Granada were evaluated. The sample was randomly selected between the dwellings in that area. The participation rate was 60%. The survey was carried out by personal and direct interview by a female interviewer. The mean educational level was lower than high school in 97.5%. Mean age was 47 years. 13.3% of them were smokers, and 21.7% drank alcohol regularly. Only 44.1% of those in child bearing age used some contraceptive method; intrauterine devices were not used by anyone of them. Maternal lactation showed an increasing trend with age, but without statistical significance. 28.3% of women were unaware of the services of early diagnosis of genital cancer, and a similar rate ignored the preventive self-examination of the breast. The major conclusions of the study were that the educational level is directly related with the performance of beneficial health habits, and that the activities directed to health education should be promoted in the target population.