[Frequency, characteristics and consequences of falls in a cohort of institutionalized elderly patients]. / Frecuencia, características y consecuencias de las caídas en una cohorte de ancianos institucionalizados.

OBJECTIVE: Falls in the elderly are a major problem because of their high morbility and mortality rates and health expenditures. However, there are few studies about this problem in our country. The purpose of the present study was to know the frequency, features and consequences of falling among institutionalized elders. METHODS: We carried out a prospective cohort study using a sample of 190 persons aged 65 years and older living in two nursing homes. All subjects underwent a comprehensive evaluation at the onset of the study. During a mean follow-up period of 310 days, all falls were recorded. RESULTS: There were a total of 121 falls in 72 (37.9%) subjects, twenty five of whom (34.7%) experienced two or more falls. The fall incidence per person-year was 0.75. As compared with males, females had a density ratio (DR) of 2 (1.2-3.2; 95% confidence interval-CI). Falling was more frequent in the bedrooms and living rooms (43.8%). DISCUSSION: This results agree with others studies about the high fall incidence in the elderly and bring out new features about circumstances and consequences of falls.

[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.

[The tobacco habit of the population of the province of Granada]. / Hábito tabáquico de la población de la provincia de Granada.

The aims of this study are to reveal the prevalence of smoking habit amongst the residents in the Granada province and to study some components of the general attitude towards the tobacco habit. The study was a cross-sectional design which is the result of a survey based on a sample of 1537 subjects (all of them being 16 years or over and residents in this province). The participants were chosen by stratified sampling which was realized in two stages: the units of the first stage were censual sections and the second ones were usual family houses. The percentage of smokers was 51.8% male and 17.5% female. The ex-smokers' prevalence was 11.1% (19.0% and men and 3.4% women). 32.5% smokers and 75.0% ex-smokers identified tobacco as a health problem. 45% of smokers had attempted to drop tobacco one or more times. The most frequent motive being the diagnosis of disease or the smoking-related symptoms. This study has revealed the high prevalence of the smoking habit in the province of Granada.

[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.

[Quality of medical records at a primary care center]. / Estudio de la calidad de los registros en un centro de atención primaria.

The quality of the clinical records included in the clinical charts is assessed through a sample of the clinical charts existing at the Health Center Zaidin-Sur (Granada, Spain). The quality was ascertained via the number of visits annotated, the number of records considered as essential (life style, family and personal history), and the number of received or requested consultation. This information is compared to the data of the general files of the Health Center, to the information gathered by a direct interview (performed to assess the validity of the essential records), and to the results of a protocol studying the visit activities. The analysis of data shows that just a 40.4% of the visits are annotated on the clinical chart. A lower percentage of the essential records were annotated, 37.6%. The requested consultations are annotated in 43.8% and the received ones in 87.6%. We discuss on the need of periodic evaluation of the records to show their limitations and deficiencies. This is the first step to improve them.

[Studying the levels of endotoxemia in meningococcal sepsis. Its relations to pregnancy and antibiotic treatment]. / Estudio de los niveles de endotoxemia en las sepsis meningococias. Su relación con la gravedad del proceso y el tratamiento antibiótico.

The most frequent cause of toxic shock in our area is meningococcal sepsis. It is currently assumed that endotoxin produce by this bacteria, a lipopolysaccharide with toxic properties, is able to trigger shock and DIC by stimulating both arachidonic acid pathways, among other actions. Previous studies in our laboratory demonstrated significant differences (p +/- 0.001) in the amounts of endotoxins released in vitro by strains from patients and healthy carriers and statistically related criteria of severity with mortality in 256 patients in our center over the last 10 years. In the present study we attempted to establish whether plasma levels of endotoxin were correlated with the severity of the disease. We studied 32 patients with meningococcal sepsis, dividing the subjects into two groups: those in whom six or more criteria of severity were present, and those in whom less than six criteria were found. Blood levels of endotoxin were determined upon admission and after the administration of antibiotics (penicillin and chloramphenicol) using the limulus test with a chromogenic substrate (Coatest, Endotoxin, Kabivitrum, Sweden). Levels of endotoxins were significantly higher in patients with more than six criteria of severity both upon admission (0.6 +/- 0.03) ng/ml) and 4 h. afterward (0.74 +/- 0.006 ng/ml) in comparison to children in whom the clinical picture was less serious (0.27 +/- 0.18 ng/ml and 0.27 +/- 0.18 ng/ml and 0.27 +/- 0.16 ng/ml7 t = 5.8 y t = 5.6 respectively. Endotoxin levels were highest in patients presenting shock, disseminated intravascular coagulation in the hypocoagulability phase and more than 8 criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

Microbial content in fresh vegetables: roots, tubers and bulbs

Se han analizado 204 muestras de vegetales procedentes de huertas de la Vega de Granada, establecimientos pequeños, supermercados y mercado de mayoristas de la ciudad, recogidas desde febrero de 1981 a marzo de 1983, correspondientes a raices, tubérculos y bulbos. Los indicadores microbiológicos estudiados fueron bacterias aerobias, NMP de coliformes y NMP de E. coli. El porcentaje de aislamientos de Salmonella fue 4.9, corespondiente a las serovariedades S. typhimurium, S. kapemba y S, london