An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery / Evaluación económica de dos intervenciones de prevención de infecciones posquirúrgicas en cirugía cardíaca

OBJECTIVE: To conduct a cost-effectiveness analysis that compares two prophylactic protocols for treating post-surgical infections in cardiac surgery. METHODS: A cost effectiveness analysis was done by using a decision tree to compare two protocols for prophylaxis of post-surgical infections (Protocol A: Those patient with positive test to methicillin-resistant Staphylococcus aureus (MRSA) colonization received muripocin (twice a day during a two-week period), with no follow-up verification. Those who tested negative did not receive the prophylaxis treatment; Protocol B: all patients received the mupirocin treatment). The number of post-surgical infections averted was the measure of effectiveness from the health system's perspective, 30 days following the surgery. The incidence of infections and complications was obtained from two cohorts of patients who underwent cardiac surgery Hospital. The times for applying the two protocols were validated by experts. They cost were calculated from the hospital's analytical accounting management system and Pharmaceutical Service. Only direct costs were taken into account, no discount rates were applied. Incremental cost-effectiveness ratio (ICER) was calculated. A probabilistic sensitivity analysis was performed. RESULTS: A total of 1118 patients were included (721 in Protocol A and 397 in Protocol B). No statistically significant differences were found in age, sex, diabetes, exitus or length of hospital stay between the two protocols. In the control group the rate of infection was 15.3%, compared with 11.3% in the intervention group. Protocol B proves to be more effective and at a lower cost, yielding an ICER of €32,506. CONCLUSION: Universal mupirocin prophylaxis against surgical site infections (SSI) in cardiac surgery as a dominant strategy, because it shows a lower incidence of infections and cost savings, versus the strategy to treat selectively patients according to their test results prior screening

OBJETIVO: Realizar un análisis de coste-efectividad que compare dos protocolos profilácticos para el tratamiento de infecciones posquirúrgicas en cirugía cardíaca. MÉTODOS: El análisis de coste-efectividad se llevó a cabo mediante un árbol de decisiones para comparar dos protocolos sobre profilaxis de infecciones posquirúrgicas (en el protocolo A, los pacientes con resultado positivo por colonización de Staphylococcus aureus resistente a la meticilina (SARM) recibieron mupirocina (dos veces al día durante 2 semanas) sin verificación de seguimiento. Aquéllos con resultado negativo no recibieron profilaxis. En el protocolo B, todos los pacientes recibieron el tratamiento con mupirocina). La medida de la efectividad fue el número de infecciones posquirúrgicas que se habían evitado a los 30 días desde la perspectiva del sistema de salud. La incidencia de infecciones y complicaciones se obtuvo a partir de dos cohortes de pacientes a quienes se practicó cirugía cardíaca. Algunos expertos validaron los tiempos de aplicación de los dos protocolos. Los costes se calcularon a partir del sistema de contabilidad analítica del hospital y el Servicio de Farmacia. Sólo se tuvieron en cuenta los costes directos y no se aplicaron tasas de descuento. Se calculó la relación de coste-efectividad incremental (ICER) y se realizó un análisis de sensibilidad probabilístico. RESULTADOS: se incluyó a 1.118 pacientes (721 en el protocolo A y 397 en el protocolo B). No hubo diferencias estadísticamente significativas en cuanto a edad, sexo, diabetes, muerte o duración de la estancia hospitalaria entre los dos protocolos. En el grupo control, la tasa de infección alcanzó el 15,3% y el 11,3% en el grupo de intervención. El protocolo B ha demostrado ser más eficaz y con menor coste, pues se ha obtenido un ICER de 32.506€.CONCLUSIÓN: la profilaxis universal con mupirocina frente a infecciones en el sitio quirúrgico (SSI) en cirugía cardíaca se muestra como una estrategia dominante ya que muestra menor incidencia de infecciones y un ahorro de costes que la estrategia para tratar selectivamente a los pacientes de acuerdo con los resultados obtenidos en la prueba de cribado previa

An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery.

OBJECTIVE: To conduct a cost-effectiveness analysis that compares two prophylactic protocols for treating post-surgical infections in cardiac surgery. METHODS: A cost effectiveness analysis was done by using a decision tree to compare two protocols for prophylaxis of post-surgical infections (Protocol A: Those patient with positive test to methicillin-resistant Staphylococcus aureus (MRSA) colonization received muripocin (twice a day during a two-week period), with no follow-up verification. Those who tested negative did not receive the prophylaxis treatment; Protocol B: all patients received the mupirocin treatment). The number of post-surgical infections averted was the measure of effectiveness from the health system's perspective, 30 days following the surgery. The incidence of infections and complications was obtained from two cohorts of patients who underwent cardiac surgery Hospital. The times for applying the two protocols were validated by experts. They cost were calculated from the hospital's analytical accounting management system and Pharmaceutical Service. Only direct costs were taken into account, no discount rates were applied. Incremental cost-effectiveness ratio (ICER) was calculated. A probabilistic sensitivity analysis was performed. RESULTS: A total of 1118 patients were included (721 in Protocol A and 397 in Protocol B). No statistically significant differences were found in age, sex, diabetes, exitus or length of hospital stay between the two protocols. In the control group the rate of infection was 15.3%, compared with 11.3% in the intervention group. Protocol B proves to be more effective and at a lower cost, yielding an ICER of €32,506. CONCLUSION: Universal mupirocin prophylaxis against surgical site infections (SSI) in cardiac surgery as a dominant strategy, because it shows a lower incidence of infections and cost savings, versus the strategy to treat selectively patients according to their test results prior screening.

[NUTRISOL: a computer programme for communitary and hospital nutritional evaluation of free access]. / NUTRISOL: un programa informático para la evaluación nutricional comunitaria y hospitalaria de acceso libre.

We have developed the computer programme NUTRISOL, a nutritional programme destined to analysis of dietary intake by means of the food transformation to nutrient. It has been performed under Windows operative system, using Visual Basic 6.0. It is presented in a CD-Rom. We have used the Spanish CSIC Food Composition Table and domestic food measures commonly used in Spain which could be modified and updated. Diverse kind of diets and reference anthropometric data are also presented. The results may be treated using various statistical programmes. The programme contains three modules: 1) Nutritional epidemiology, which allows to create or open a data base, sample management, analyse food intake, consultation of nutrient content and exportation of data to statistical programmes. 2) Analyses of diets and recipes, creation or modification of new ones. 3) To ask different diets for prevalent pathologies. Independent tools for modifying the original tables, calculate energetic needs, recommend nutrient intake and anthropometric indexes are also offered. In conclusion, NUTRISOL Programme is an application which runs in PC computers with minimal equipment in a friendly interface, of easy use, freeware, which may be adapted to each country, and has demonstrated its usefulness and reliability in different epidemiologic studies. Furthermore, it may become an efficient instrument for clinical nutrition and health promotion.

NUTRISOL: un programa informático para la evaluación nutricional comunitaria y hospitalaria de acceso libre / Nutrisol: A computer programme for communitary and hospital nutritional evaluation of free access

Hemos desarrollado el programa NUTRISOL, un programa informático destinado al análisis de la ingesta alimentaria mediante la transformación de alimentos a nutrientes. Ha sido elaborado bajo el sistema operativo Windows®, usando el entorno Visual Basic® 6.0. En su elaboración se han usado las tablas de composición de alimentos del CSIC y medidas domésticas de alimentos de uso común en España, siendo posible modificarlas y actualizarlas. También se presentan diversas dietas y datos antropométricos de referencia. Los resultados que aporta pueden procesarse con la mayoría de los programas estadísticos. El programa ofrece tres módulos: 1) Epidemiología nutricional, en el que se pueden crear o abrir bases de datos, gestionar muestras, gestionar la ingesta, consultar contenido de nutrientes y exportar datos para tratarlos con programas estadísticos. 2) Análisis de dietas y recetas, en el que además se pueden crear o modificar las existentes y exportarlas. 3) Solicitud de distintas dietas para patologías prevalentes. También se ofrece un apartado de herramientas independientes en el que se pueden modificar las tablas originales, calcular las necesidades energéticas, las ingestas recomendadas e índices antropométricos. En conclusión, el programa NUTRISOL es una aplicación que funciona en ordenadores tipo PC-compatibles con mínimo equipamiento, con una interfaz "amigable", de uso sencillo, que se puede adaptar a cualquier región, de acceso gratuito y que ha demostrado su utilidad y fiabilidad en distintos estudios epidemiológicos. Además, puede ser un instrumento eficiente para la educación nutricional, la nutrición hospitalaria y la promoción de la salud (AU)

We have developed the computer programme NUTRISOL, a nutritional programme destined to analysis of dietary intake by means of the food transformation to nutrient. It has been performed under Windows® operative system, using Visual Basic® 6.0. It is presented in a CD-Rom. We have used the Spanish CSIC Food Composition Table and domestic food measures commonly used in Spain which could be modified and updated. Diverse kind of diets and reference anthropometric data are also presented. The results may be treated using various statistical programmes. The programme contains three modules: 1) Nutritional epidemiology, which allows to create or open a data base, sample management, analyse food intake, consultation of nutrient content and exportation of data to statistical programmes. 2) Analyses of diets and recipes, creation or modification of new ones. 3) To ask different diets for prevalent pathologies. Independent tools for modifying the original tables, calculate energetic needs, recommend nutrient intake and anthropometric indexes are also offered. In conclusion, NUTRISOL Programme is an application which runs in PC computers with minimal equipment in a friendly interface, of easy use, freeware, which may be adapted to each country, and has demonstrated its usefulness and reliability in different epidemiologic studies. Furthermore, it may become an efficient instrument for clinical nutrition and health promotion (AU)

[Quality of life in patients treated for early laryngeal cancer, in healthy people and in those with other associated pathologies]. / Calidad de vida en pacientes tratados por un cáncer de laringe inicial y en personas sanas y con otras patologías.

Nowadays there are different non aggressive treatment options for early laryngeal cancer. However, they are not free of undesirable effects. We have studied this patients' quality of life, by comparing it with that obtained from healthy population and other illness groups (post-AMI patients, Chronic Kidney patients). We have studied 62 T1-T2NoMo laryngeal carcinoma diagnosed at the "Virgen de la Victoria" clinical hospital from Malaga, Spain, between 1990 and 1998. We used the Quality of Life in Málaga (QLM), general QL questionnaire which was developed and validated at the Department of Preventive Medicine of the University of Málaga, Spain. The results were compared with those obtained from ramdom samples in healthy population from Málaga and from various pathology groups. The global QOL of our patients treated for an early glottic cancer (Index Quality of life 29.4%) was better than almost all the other ones.

Calidad de vida en pacientes tratados por un cáncer de laringe inicial y en personas sanas y con otras patologías / Quality of life in patients treated for early laryngeal cancer and healthy people and in those with other associated diseases

Hoy dia existen múltiples tratamientos, poco agresivos, para un cáncer de laringe inicial, pero ninguno está exento de efectoos secundarios. Pretendemos comparar la calidad de vida global de estos pacientes con la población sana y otros grupos de enfermedad (IAM y nefrópatas crónicos). hemos estudiado a 62 pacientes que constituyen la totalidad de los casos diagnosticados de un carcinoma laringeo inicial T1-T2NoMo en el Hospital Clinico Virgen de la Victoriade Málaga entre 1990 y 1998. Hemos aplicado el Cuestinario general de Calidad de Vida en Málaga (QLM) desarrollado por el departamento de Medicina Preventiva de la Universidad de Málaga, de propiedades psicometricas demostradas. Comparamos los resultados de nuestros pacientes con los obtenidso con muestras aleatorias de población de málaga sanas y con diversas patologias. Nuestros pacientes con un indice de Pérdida de la calidad de vida del 29,4% superaban a casi todos los grupos de comparación (AU)

Nowadays there are different non aggressive treatment options for early laryngeal cancer. However, they are not free of undesirable effects. We have studied this patients' quality of life, by comparing it with that obtained from healthy population and other illness groups (post-AMI patients, Chronic Kidney patients). We have studied 62 T1-T2NoMo laryngeal carcinoma diagnosed at the "Virgen de la Victoria" clinical hospital from Malaga, Spain, between 1990 and 1998. We used the Quality of Life in Málaga (QLM), general QL questionnaire which was developed and validated at the Department of Preventive Medicine of the University of Málaga, Spain. The results were compared with those obtained from ramdom samples in healthy population from Málaga and from various pathology groups. The global QOL of our patients treated for an early glottic cancer (Index Quality of life 29.4%) was better than almost all the other ones (AU)

Calidad de vida en pacientes tratados por un cáncer de cabeza y cuello / Quality of life in patients treated of a head and neck cancer

En este trabajo pretendemos comparar la calidad de vida global de pacientes que recibieron tratamiento por un carcinoma laríngeo inicial con la de otros pacientes tratados de un cáncer de cabeza y cuello avanzado. Hemos estudiado a 62 pacientes que constituyen la totalidad de los casos diagnosticados de un carcinoma laríngeo inicial T1, T2-N0M0 en el Hospital Clínico Virgen de la Victoria de Málaga entre 1990 y 1998. Hemos aplicado el Cuestionario EORTC QLQ C-30 y su módulo de cabeza y cuello H&N 35. Comparamos los resultados con los de un grupo heterogéneo de 48 pacientes con cánceres avanzados de cabeza y cuello. La calidad de vida de nuestros pacientes fue mejor en muchas escalas funcionales del EORTC y en varios síntomas específicos del H&N 35, pero no en los síntomas generales del cáncer (AU)

In this paper we have studied the quality of life of patients that underwent treatment for an early laryngeal carcinoma in comparison to others with an advanced head and neck cancer. We have studied 62 patients (T1N0M0, T2N0M0) with laryngeal carcinoma diagnosed between 1990 and 1998. We have applied the European EORTC QOL C-30 questionnaire, and more specifically its head and neck module (H&N 35). The results were compared with a heterogeneous group of 48 patients with different degrees of head and neck cancers. The quality of life of our patients who were treated for an early glottic cancer was better in many functional scales of the EORTC and in many specific symptom scales of the H&N 35, but not in global cancer symptoms (AU)

[Quality of life in patients treated for head and neck cancer]. / Calidad de vida en pacientes tratados por un cáncer de cabeza y cuello.

In this paper we have studied the quality of life of patients that underwent treatment for an early laryngeal carcinoma in comparison to others with an advanced head and neck cancer. We have studied 62 patients (T1N0M0, T2N0M0) with laryngeal carcinoma diagnosed between 1990 and 1998. We have applied the European EORTC QOL C-30 questionnaire, and more specifically its head and neck module (H&N 35). The results were compared with a heterogeneous group of 48 patients with different degrees of head and neck cancers. The quality of life of our patients who were treated for an early glottic cancer was better in many functional scales of the EORTC and in many specific symptom scales of the H&N 35, but not in global cancer symptoms.

Tissue stores of individual monounsaturated fatty acids and breast cancer: the EURAMIC study. European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer.

The strongest evidence that monunsaturated fat may influence breast cancer risk comes from studies of southern European populations, in whom intake of oleic acid sources, particularly olive oil, appears protective. No previous study has examined the relation of adipose tissue fatty acid content to breast cancer in such a population. We used adipose biopsies with diverse fat intake patterns gathered in 5 European centers, including southern Europe (Malaga, Spain), to test the hypothesis that stores of oleic acid or other monounsaturates are inversely associated with breast cancer. Gluteal fat aspirates were obtained from 291 postmenopausal incident breast cancer patients and 351 control subjects, frequency-matched for age and catchment area. Logistic regression was used to model breast cancer by monounsaturates, with established risk factors controlled for. Oleic acid showed a strong inverse association with breast cancer in the Spanish center. The odds ratio for the difference between 75th and 25th percentiles was 0.40 (95% CI: 0.28, 0.58) in Malaga and 1.27 (0.88, 1.85) in all other centers pooled, with a peak at 2.36 (1.01, 5.50) for Zeist. Palmitoleic and myristoleic acids showed evidence of an inverse association outside Spain, and cis-vaccenic acid showed a positive association in 3 centers. These data do not support the hypothesis that increasing tissue stores of oleic acid are protective against breast cancer in non-Spanish populations. This finding implies that the strong protective associations reported for olive oil intake in dietary studies may be due to some other protective components of the oil and not to the direct effect of oleic acid uptake. Alternatively, high olive oil intake may indicate some other protective aspect of the lifestyle of these women.

Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer.

To investigate the relationship between trans fatty acids and postmenopausal breast cancer in European populations differing greatly in their dietary fat intakes, a case control study using adipose tissue stores of trans fatty acids as a biomarker of exposure was conducted. Subjects included 698 postmenopausal incident cases of primary breast cancer and controls randomly drawn from local population and patient registries, ages 50-74 Concentrations of individual trans fatty acids in gluteal fat biopsies were measured in these women. The adipose concentration of trans fatty acids showed a positive association with breast cancer. The covariate-adjusted association with breast cancer. The covariate-adjusted OR was 1.40 (95% confidence interval: 1.02, 1.93) for the difference between the 75th and 25th percentiles of total adipose trans. The adjusted OR for trans in the lowest tertile of polyunsaturated fatty acid reached 3.6 (2.2, 6.1). These associations were not attributable to differences in age, body mass index, exogenous hormone use, or socioeconomic status. These findings suggest an association of adipose stores of trans fatty acids with postmenopausal breast cancer in European women. They require confirmation in other populations, with concomitant consideration of the potential roles of dietary saturated and monounsaturated fats.

Epidemiology of burns in Malaga, Spain.

The incidence of burns in the province of Malaga, Spain, was determined by means of a descriptive, cross-sectional, population-based study, and the individual, social and environmental conditions of the patients were analysed. Five hundred families (1846 persons), selected by a three-stage, stratified sampling, were interviewed in their homes. Five hundred and six burns were found in 406 persons (1.25 burns/person); 89.5 per cent of these were in an urban environment and 10.5 per cent in a rural environment. Eighteen and a half per cent of the sample had burnt themselves only once and 4.7 per cent more than once. The burns affected 23.3 per cent of the population, although the majority were of little clinical importance. The risk of burns is greater in the urban environment than in the rural environment, with burns occurring most often in the home (65.8 per cent), and especially in the kitchen. The most frequent burns involve hot liquids with special risk from cooking oil. The other burns (in the strict sense of the word, proper burns or true burns), were primarily caused by contact. The incidence was higher in women (33.0 vs. 21.1 per cent), with burns occurring mostly on the hands. Only 21.9 per cent of the burns received the correct first aid after the accident.

A computer program for application in epidemiological analysis.

The importance of computer science as a working tool for the health sector is an unquestionable fact in any modern society. EPIDEMO, developed by the authors, can be defined as a set of programs whose main characteristic is its ability to process a given series of data in a totally integrated way, with an epidemiological and statistical approach. EPIDEMO is a program with a good relational database, which allows preliminary statistical analyses of data that can easily be expanded with more specific statistical options, and is compatible with other programs available on the market. It is a useful, accurate and versatile tool that meets the needs of health professionals in the field of epidemiological research.

[Cost-benefit analysis of fluoridating the public water supply of the city of Málaga]. / Análisis coste-beneficio de la fluoración de las aguas de abastecimiento público de la ciudad de Málaga.

The aim of the present study was to assess the cost-benefit of the program of fluoridation of the public water supply in the city of Málaga. Marginal benefits and the rate cost/benefit were the two parameters used to evaluate the cost-benefit. We have considered all the information available about similar experiences performed in other countries and about the particular aspects of the city in which this program was going to be set up. The cost of fluoridation per inhabitant per year and the effects of the cost of fluoridation on the price of the water supplied were also estimated. The program for the fluoridation of the public water supply in Málaga is profitable from the first year, as for each peseta spent we will benefit 2.10 pesetas. After 20 years of public water fluoridation the net benefit of this program will reach between 519 and 5,300 millions pesetas.

[Contributions of the epidemiologic method to the rational study of juvenile delinquency]. / Aportaciones del método epidemiológico al estudio racional de la delincuencia juvenil.

In this study we analyze some of the contributions of the epidemiological method to the study of juvenile delinquency. We used 68,583 complaints to the Police during 1983-1986 to do so; furthermore, we asked the opinion of the citizens by means of an opinion poll of a representative sample of the population on the subject of public safety. The application of the techniques of Multivariant Analysis (Analysis of the Principal Components) allowed us to reduce the dimensions of the study and fix our attention on 8 specific crimes. We have attempted to design a system, using Predictive Epidemiology, for the evaluation of preventive measures applied to the rational fight against delinquency. Special emphasis is made on the presentation of a system of analysis for the calculation of the real rate of delinquency in a given community.

[Tobacco and cancer of the lung. A case-control study]. / Tabaco y cáncer pulmonar. Estudio caso-control.

The relationship between cigarette smoking and risk of lung cancer has been analyzed in a case control study of 98 cancer patients and 108 age matched healthy controls. This relationship has been studied based on age when smoking started, number of cigarettes per day and minimum number of cigarettes smoked, and smoke inhalation. The excess rate (ER) of lung cancer amongst those who started smoking before age 20 was 3.47 (C.I. 95% 1.33 + 9.05) above those who started smoking later. There is a progressive increase in ER as the mean daily number of cigarettes and the minimum number of cigarettes smoked increase. The ER in those who inhale smoke was 2.4 (C.I. 95% 1.6 - 5.05) when compared to those who did not inhale smoke. It is essential to quantify the magnitude of the smoking habit as well as its duration since these variables are going to determine the risk of acquiring the disease. Case control smoking-lung cancer study.