Adherence of older people with instability in vestibular rehabilitation programmes: prediction criteria.

OBJECTIVE: To determine whether demographic characteristics or balance examination findings can predict the adherence of older people with instability to a vestibular rehabilitation programme. METHODS: A prospective case-control study was conducted of 120 patients aged 65 years or more (mean age, 77.3 ± 6.33 years). Two groups were classified according to patients' adherence with the follow-up post-rehabilitation protocol. Analysed variables included: age, sex, body mass index, Timed Up and Go test findings, computerised dynamic posturography, Dizziness Handicap Inventory scores and Short Falls Efficacy Scale - International questionnaire results, number of falls, and type of vestibular rehabilitation. RESULTS: Two groups were established: adherents (99 individuals) and non-adherents (21 individuals). There were differences between the groups regarding: sex (female-to-male ratio of 4.8:1 in adherents and 1.63:1 in non-adherents), age (higher in non-adherents) and voluntary movement posturographic test results (non-adherents had poorer scores). CONCLUSION: The patients most likely to abandon a vestibular rehabilitation programme are very elderly males with low scores for centre of gravity balancing and limits of stability.

¿Es factible una intervención en registro de tabaquismo en un centro de salud? / Is an intervention in the registry of smoking habit in a health care center feasible?

Objetivo. Analizar la variación en registro de hábito tabáquico en médicos de Atención Primaria tras una intervención de concienciación. Participantes y método. Once médicos de familia y 15.754 personas asignadas a sus cupos. Estudio de intervención con evaluación pre-post de efectividad en el registro en historia clínica. Centro de Salud Novoa Santos (Ourense). Resultados. Tasa de registro de tabaquismo pre intervención 5,79%; post: 6,87% (p < 0,001). 51,6% mujeres. Media de edad 49,11 años (IC 95%: 48,30-49,92). El registro aumentó un 15,80% tras la intervención (p < 0,0001). Médicos participantes: media de edad 56,32 años (IC 95%: 56,07-56,57 años). Entre tutores el registro inicial era menor (p < 0,0001) fueron los que más incrementaron (p < 0,001). Variables que se asociaron a mayor registro post intervención en la regresión: médicas, cupos más grandes y ex fumadores. Por turno de trabajo el impacto ha sido mayor en turno de tardes fijas o deslizantes respecto a mañanas p < 0,0001. Conclusiones. Una intervención en tabaquismo es factible y produce mejora en el registro. Las variables asociadas a mayor tendencia a registrar el hábito tabáquico fueron: trabajar en turno de tarde; ser tutor, ser exfumador o fumador activo, cupos con más de 1.450 tarjetas sanitarias, y profesionales con menos tiempo trabajando en el centro (p < 0,001) (AU)

Objective. Analyze the variation in the registry of smoking habit in Primary Care physicians after an awareness-raising intervention. Participants and methods. Eleven family physicians and 15,754 persons assigned to their quota. Intervention study with pre-post evaluation of effectiveness in the clinical record registry. Health Care Site Novoa Santos (Ourense). Results. Pre-intervention smoking habit registry rate 5.79%; post: 6.87% (p < 0.001). 51.6% women. Mean age 49.11 years (CI 95%: 48.30-49.92). The registry increased 15.80% after the intervention (p < 0.0001). Participating physicians: mean age 56.32 years (CI 95%: 56.07-56.57 years). Among tutors, the initial registry was less (p < 0.0001) and the tutors were those who showed the greatest increase (p < 0.001). Variables that were associated to a higher post-intervention registry in regression: physicians, larger quotas and ex-smokers. By work shift, the impact was greater in the fixed afternoon or changing shifts regarding the morning p < 0.0001. Conclusions. An intervention in smoking habit is feasible and produces improvement in the registry. The variables associated to a greater tendency to record the smoking habit were: working in the afternoon shift; being a tutor, being an ex-smoker or active smoker, quotas with more than 1,450 health care cards, and professionals with less time working in the center (p < 0.001) (AU)

The use of CA-IX as a diagnostic method for oral leukoplakia.

The presence and degree of dysplasia are important diagnostic and prognostic criteria for oral leukoplakia, but evaluation of dysplasia is difficult and subjective. Carbonic anhydrase-IX (CA-IX) is expressed primarily in tumor cells and is considered a specific hypoxia marker. We investigated the role of CA-IX in oral leukoplakia. We investigated 30 specimens of oral leukoplakia and 35 dysplasia specimens adjacent to the tumor margin. We analyzed clinical variables including age, sex, degree of dysplasia, and smoking, clinical appearance of leukoplakia, number of lesions, location, size, clinical monitoring, malignant transformation and recurrence. For the immunohistochemical study, we used a noncommercial monoclonal antibody against human CA-IX MAb M75. We found greater CA-IX positivity in nonsmokers, erythroplakia and mottled leukoplakia, those located on the tongue, patients with multiple lesions, 2-4 cm leukoplakias and in recurrent cases, although differences were not statistically significant. All lesions in all samples without dysplasia were negative for CA-IX; however, for all other categories of dysplasia, the percentages of positivity and negativity varied. Regarding the diagnostic index values, we found a sensitivity of 32%, specificity of 100%, a positive predictive value of 100% and a negative predictive value of 13%. Leukoplakias appear mainly in females and potentially are malignant; more than 90% have some degree of dysplasia, and therefore require close clinical and histopathological monitoring. The CA-IX immunohistochemical marker may be useful for screening samples without dysplasia owing to its high specificity.

Quantitative determination of c-myc facilitates the assessment of prognosis of OSCC patients.

Myc genes are a family of proto-oncogenes whose proteins are implicated in the regulation of cell proliferation, differentiation and apoptosis, and in regulating the activity of genes involved in cell division. The aim of the present study was to establish a quantitative description of the expression of c-myc and evaluate its relationship with other clinical and prognostic factors, as well as to establish a multivariate survival prediction model. This is a retrospective study of 68 patients diagnosed with oral squamous cell carcinoma (OSCC). We constructed a tissue microarray for investigating the expression of c-myc by immunohistochemistry. Statistical analyses were carried out, and a multivariate model that predicts survival was established. The average expression of c-myc was 50.32 (SD, 26.05) with a range from 6.60 to 99.48; similar for initial and advanced tumor stages. Non-smoking patients had higher levels of c-myc, showing statistically significant differences (Kruskal-Wallis χ2=5.975; p=0.05). We found no statistically significant relationship between the quantitative expression of c-myc and any other clinical or pathological parameters. For each unit of increase of c-myc, the risk increased by 1.15 (p<0.001; HR, 1.150; 95% CI, 1062-1245). Further study of this protein, which may have a significant diagnostic, prognostic and therapeutic value is warranted. Its determination can be valuable when used together with other markers to assess the prognosis of OSCC patients.

Expression of CA IX in dysplasia adjacent to surgical resection margins of oral squamous cell carcinoma.

Carbonic anhydrase (CA) IX is a hypoxia marker located almost exclusively in tumor cells. We analyzed the expression of this marker in dysplastic lesions adjacent to the surgical resection margin in patients with oral squamous cell carcinoma. We investigated 70 archived tumors, 36 of which showed dysplasia adjacent to the surgical margin. We used tissue microarray technology to perform an immunohistochemical study of CA IX expression. We found 12 (33.3%) cases of mild dysplasia (10 negative, 2 positive for CA IX), five (13.9%) cases of moderate dysplasia (3 negative, 2 positive for CA IX), 1 (2.8%) case of severe dysplasia (negative for CA IX) and 18 (50%) cases of carcinoma in situ (10 negative, 8 positive for CA IX). In cases of intense expression of CA IX in the tumor, the same distribution of positive and negative cases was observed in all degrees of dysplasia (mild, moderate, severe), although cases of carcinoma in situ tended to be CA IX positive.

BCL10 expression is unrelated to clinico-pathological parameters or prognoses for oral squamous cell carcinomas.

BCL-10 (B-cell lymphoma 10) has been linked to a pro-apoptotic gene in mucosa-associated lymphoid tissue (MALT) lymphomas. We describe the expression of BCL10 in oral squamous cell carcinoma (OSCC) and its relation to clinical, pathological and prognostic parameters. We carried out a retrospective study of 50 patients in Spain who were diagnosed with OSCC. We constructed a tissue microarray of the samples to study the expression of BCL10 using immunohistochemistry. Diffuse and homogeneous staining was observed in the nuclei and cytoplasms of most neoplastic cells of the vast majority of tumors and no significant differences were seen in different areas of the tumors. The expression was unrelated to any clinical or pathological parameters including tumor stage. The intra-class coefficient was 0.97, which indicates the minimal variability among the determinations.

Non-computer-assisted liquid-based cytology for diagnosis of oral squamous cell carcinoma.

The development of oral squamous cell carcinoma (OSCC) occasionally follows the neoplastic progression of other premalignant lesions. Although biopsy is the definitive diagnostic method, liquid-based cytology is an adequate method for screening suspicious lesions. We compared liquid-based cytology to histology for diagnosis of OSCC in patients with oral lesions that raised clinical suspicion of malignancy. Our sample consisted of 48 patients. Cytological samples were obtained by scraping the lesion superficially using Cytobrush®. We conducted cytological and histopathological evaluation of all preparations. We estimated sensitivity and specificity levels as well as positive and negative predictive values. The degree of inter-observer agreement for both methods was assessed using the kappa index. Twenty-eight (58.3%) of the cases finally were diagnosed with OSCC and 20 (41.7%) were determined to be premalignant lesions. We observed eight false negatives and no false positives; OSCC prevalence was 56.5%. The values for diagnostic indices were: sensitivity, 69% (CI 95%, prevalence 51.87); specificity, 100%; positive predictive value, 100%; negative predictive value, 71% (CI 95% 54.82). A kappa index of 0.622 (CI 95% 0.93, 0.39) was observed.

Comparison of the Cytobrush®, dermatological curette and oral CDx® brush test as methods for obtaining samples of RNA for molecular analysis of oral cytology.

OBJECTIVE: Interest in oral exfoliative cytology has increased with the availability of molecular markers that may lead to the earlier diagnosis of oral squamous cell carcinoma. This research aims to compare the efficacy of three different instruments (Cytobrush, curette and Oral CDx brush) in providing adequate material for molecular analysis. METHODS: One hundred and four cytological samples obtained from volunteer healthy subjects were analysed using all three instruments. The clinical and demographical variables under study were age, sex and smoking habits. The three instruments were compared for their ability to obtain adequate samples and for the amount of RNA obtained using quantitative real-time polymerase chain reaction (PCR-qRT) analysis of the Abelson (ABL) housekeeping gene. RESULTS: RNA of the ABL gene has been quantified by number of copies. Adequate samples were more likely to be obtained with a curette (90.6%) or Oral CDx (80.0%) than a Cytobrush (48.6%); P < 0.001. Similarly, the RNA quantification was 17.64 ± 21.10 with a curette, 16.04 ± 15.81 with Oral CDx and 6.82 ± 6.71 with a Cytobrush. There were statistically significant differences between the Cytobrush and curette (P = 0.008) and between the Cytobrush and OralCDx (P = 0.034). There was no difference according to the demographical variables. CONCLUSIONS: Oral exfoliative cytology is a simple, non-invasive technique that provides sufficient RNA to perform studies on gene expression. Although material was obtained with all three instruments, adequate samples were more likely to be obtained with the curette or Oral CDx than with a Cytobrush. The Oral CDx is a less aggressive instrument than the curette, so could be a useful tool in a clinical setting.

Comparison of three sampling instruments, Cytobrush, Curette and OralCDx, for liquid-based cytology of the oral mucosa.

Exfoliative cytology of the oral cavity is a simple and noninvasive technique that permits the study of epithelial cells. Liquid-based cytology is an auxiliary diagnostic tool for improving the specificity and sensitivity of conventional cytology. The objective of our study was to compare the quality of normal oral mucosa cytology samples obtained using three different instruments, Cytobrush®, dermatological curette and Oral CDx® for liquid-based cytology. One hundred four cytological samples of oral cavity were analyzed. Samples were obtained from healthy volunteer subjects using all three instruments. The clinical and demographic variables were age, sex and smoking habits. We analyzed cellularity, quality of the preparation and types of cells in the samples. All preparations showed appropriate preparation quality. In all smears analyzed, cells were distributed uniformly and showed no mucus, bleeding, inflammatory exudate or artifacts. We found no correlation between the average number of cells and the type of instrument. The samples generally consisted of two types of cells: superficial and intermediate. No differences were found among the cytological preparations of these three instruments. We did not observe basal cells in any of the samples analyzed.

Activity of ß2-adrenergic receptor in oral squamous cell carcinoma is mediated by overexpression of the ADRBK2 gene: a pilot study.

The ß2-adrenergic receptor is most frequently involved in carcinogenic processes. Earlier studies have established a relation between the ß2-adrenergic receptor and various characteristics of cancer including cell proliferation, apoptosis, chemotaxis, metastasis, tumor growth and angiogenesis. Our goal was to determine differential expression of the genes involved in adrenergic receptors using DNA microarrays and to confirm their under- or overexpression using real-time quantitative PCR. Five of the nine genes investigated showed significantly altered expression levels in tumor cells (p < 0.05). The gene product with the highest Z-score (restrictive statistical technique for selection of appropriate genes to study) was ADRBK2. Significantly, most of the overexpressed genes were related to ß-adrenergic receptors. Real-time PCR analysis confirmed the up regulation observed in the microarrays, which indicated overexpression in 100% of the tumors. In oral squamous cell carcinomas, malignant cells and surrounding tissue overexpress the ADRBK2 gene.

Risk factors associated with Helicobacter pylori infection. A population-based study conducted in the province of Ourense.

OBJECTIVES: to identify the relationship between Helicobacter pylori infection and various factors that have been described in other studies in the general adult population in the province of Ourense. MATERIAL AND METHODS: three hundred and eighty-three participants were enrolled in a study on the prevalence of Helicobacter pylori infection. All participants filled in a questionnaire under supervision, and the data obtained were examined by means of a univariate analysis. The odds ratio corresponding to each variable studied was calculated with their corresponding 95% confidence intervals. Furthermore, a multivariate analysis was performed. RESULTS: the univariate analysis revealed an association between infection and: age, place of residence during childhood, current social status based on the head of the family s profession, current blue collar/white collar profession of the head of the family, sharing a bedroom during childhood, type of drinking water, and contact with animals during childhood. No association was found with respect to the presence of dyspeptic symptoms. The multivariate analysis disclosed that only age is an independent risk factor associated with infection. CONCLUSION: age has been identified as the only independent risk factor associated with Helicobacter pylori infection in this population-based study. The univariate analysis has detected other factors. No association has been identified with respect to dyspeptic symptoms.

[The tuberculin skin test in a healthy child program: should we change our practice]. / La prueba de tuberculina en los controles del niño sano. 'debemos cambiar nuestra práctica?

BACKGROUND: The Healthy Child Program and the Preventive Activities and Health Promotion Program involve systematic tuberculin skin testing at distinct ages according to different programs, with variable evaluation of its effectiveness. OBJECTIVE: To evaluate the tuberculin skin test performed in healthy children within the ongoing basic health program in order to determine whether our activity is effective in detecting latent tuberculin infection. MATERIAL AND METHODS: A prospective observational study was performed. POPULATION: Mantoux test performed in children aged 15 months to 14 years during regular health examinations in 22 primary care pediatric clinics over a 12-month period in southern Pontevedra in Spain (catchment population 300,613 inhabitants according to the official census data in January 2003, with 472,444 health cards). Descriptive study and univariate analysis were carried out. RESULTS: We studied 2,530 children with a mean age of 51.25 months (95 % CI: 49.38-53.13). Eight positive Mantoux tests were registered (0.36 %). There were three positive results in children aged less than 3 years, two positive results in children aged between 4 and 9 years old (all were immigrants) and the remaining positive results were registered in children between 10 and 14 years of age. CONCLUSIONS: Given that the tuberculin skin test is a good screening test despite its limitations in the control of latent tuberculin infection in children, its indications should be adjusted to ever-changing epidemiological characteristics. According to the results obtained in this study and considering the prevalence of tuberculosis in our environment, we propose that the systematic application of the Mantoux test be discontinued except in children from countries with a high incidence of this disease or risk factors. However, we also recommend that systematic Mantoux testing in adolescence (12-14 years of age) be maintained, when vaccination and various medical examinations are carried out. Epidemiological studies in this age group should simultaneously be performed.

La prueba de tuberculina en los controles del niño sano. ¿Debemos cambiar nuestra práctica? / The tuberculin skin test in a healthy child program: should we change our practice?

Antecedentes El programa del niño sano y el PAPPS (Programa de Actividades Preventivas y Promoción de la Salud) incluyen la realización de pruebas de tuberculina sistemáticas a diferentes edades según los diferentes programas con una variable evaluación de su efectividad. Objetivo Nos planteamos la posibilidad de evaluar la prueba de la tuberculina que se realizaba en el niño sano sin ningún tipo de patología dentro del programa de salud para ver si nuestra actividad era eficaz para la detección de la infección tuberculosa. Material y métodos Estudio observacional prospectivo, descriptivo. Población. Prueba de tuberculina realizados en niños de 15 meses a 14 años en la consulta del niño sano en 22 consultas de pediatría de atención primaria de la zona sur de Pontevedra (población de referencia 300.613 habitantes según el padrón del 1-01-2003 con 472.444 TIS); durante un período de 12 meses. Análisis univariante. Resultados Se estudiaron 2.530 niños con edad media 51,25 meses (IC 95 %: 49,38-53,13). Se registraron 8 pruebas de tuberculina positivas (0,36 %). En los menores de 3 años, hubo dos resultados positivos; tres resultados positivos en los niños menores de 9 años, todos ellos inmigrantes; el resto se dieron en niños de 10 a 14 años. Conclusiones Considerando la prueba de tuberculina como una buena prueba de cribado, a pesar de sus limitaciones para el control de la infección tuberculosa en niños, su indicación, debe ajustarse a las características epidemiológicas siempre cambiantes. Basados en nuestros resultados y considerando la prevalencia de la tuberculosis en nuestro medio, proponemos dejar la prueba de tuberculina sistemática para niños que provengan de países de alta incidencia de tuberculosis o con factores de riesgo; manteniendo la realización sistemática de una prueba de tuberculina en una edad cercana a la adolescencia como pueden ser a los 12-14 años, edades en que se realiza una revisión vacunación incluida, momento idóneo para la realización de la prueba y de manera simultánea realizar estudios epidemiológicos a esa edad

Background The Healthy Child Program and the Preventive Activities and Health Promotion Program involve systematic tuberculin skin testing at distinct ages according to different programs, with variable evaluation of its effectiveness. Objective To evaluate the tuberculin skin test performed in healthy children within the ongoing basic health program in order to determine whether our activity is effective in detecting latent tuberculin infection. Material and methods A prospective observational study was performed. Population: Mantoux test performed in children aged 15 months to 14 years during regular health examinations in 22 primary care pediatric clinics over a 12-month period in southern Pontevedra in Spain (catchment population 300,613 inhabitants according to the official census data in January 2003, with 472,444 health cards). Descriptive study and univariate analysis were carried out. Results We studied 2,530 children with a mean age of 51.25 months (95 % CI: 49.38-53.13). Eight positive Mantoux tests were registered (0.36 %). There were three positive results in children aged less than 3 years, two positive results in children aged between 4 and 9 years old (all were immigrants) and the remaining positive results were registered in children between 10 and 14 years of age. Conclusions Given that the tuberculin skin test is a good screening test despite its limitations in the control of latent tuberculin infection in children, its indications should be adjusted to ever-changing epidemiological characteristics. According to the results obtained in this study and considering the prevalence of tuberculosis in our environment, we propose that the systematic application of the Mantoux test be discontinued except in children from countries with a high incidence of this disease or risk factors. However, we also recommend that systematic Mantoux testing in adolescence (12-14 years of age) be maintained, when vaccination and various medical examinations are carried out. Epidemiological studies in this age group should simultaneously be performed

Prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense.

OBJECTIVES: to determine the prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense. MATERIAL AND METHODS: a cross-sectional study was carried out with a randomly selected populational sample. The diagnosis of Helicobacter pylori infection was reached using the 13C-urea breath test. RESULTS: three hundred and eighty-three subjects were studied, with a prevalence rate of 69.1% (95% CI: 61.7-75.1%); 69.8% (95% CI: 63.2-76.6%) in males and 68.4% (95% CI: 61.5-75.4%) in females (difference not statistically significant). Prevalence increases with age up to a maximum of 88.4% in the 45-54 years age group, and decreases thereafter to a rate of 57.1% in individuals over the age of 84 years. CONCLUSION: this study reveals that the prevalence rate of Helicobacter pylori infection is high in the general adult population of the province of Ourense. It increases with age until it peaks in the group of middle-aged individuals and is similar in both sexes.

Factores de riesgo asociados a la infección por Helicobacter pylori. Un estudio de base poblacional en la provincia de Ourense / Risk factors associated with Helicobacter pylori infection. A population-based study conducted in the province of Ourense

Objetivos: identificar en la población general adulta de la provinciade Ourense, la relación entre la infección por Helicobacterpylori y diversos factores que se han descrito en otros estudios.Material y métodos: se han incluido los 383 participantesen un estudio de prevalencia de la infección por Helicobacter pylori.Todos han completado un cuestionario bajo supervisión y losdatos se han examinado mediante análisis univariante. Se han calculadolas odds ratio correspondientes a cada variable estudiada,con sus intervalos de confianza al 95%. Además, se ha efectuadoun análisis multivariante.Resultados: el análisis univariante demuestra asociación dela infección con: edad, lugar de residencia en la infancia, clasesocial actual por la profesión del cabeza de familia, profesiónno manual/manual del cabeza de familia actual, compartir dormitorioen la infancia, tipo de agua de consumo y el contactocon animales en la infancia. No se ha encontrado asociacióncon la presencia de síntomas dispépticos. El análisis multivarianteha mostrado que solamente la edad es un factor de riesgoindependiente asociado a la infección.Conclusión: en este estudio de base poblacional la edad es elúnico factor de riesgo independiente que se ha identificado asociadoa la infección por Helicobacter pylori. En el análisis univariantese han identificado otros factores. No se demuestra asociacióncon síntomas dispépticos

Objectives: to identify the relationship between Helicobacterpylori infection and various factors that have been described inother studies in the general adult population in the province ofOurense.Material and methods: three hundred and eighty-three participantswere enrolled in a study on the prevalence of Helicobacterpylori infection. All participants filled in a questionnaire undersupervision, and the data obtained were examined by means of aunivariate analysis. The odds ratio corresponding to each variablestudied was calculated with their corresponding 95% confidenceintervals. Furthermore, a multivariate analysis was performed.Results: the univariate analysis revealed an association betweeninfection and: age, place of residence during childhood,current social status based on the head of the family’s profession,current blue collar/white collar profession of the head of the family,sharing a bedroom during childhood, type of drinking water,and contact with animals during childhood. No association wasfound with respect to the presence of dyspeptic symptoms. Themultivariate analysis disclosed that only age is an independent riskfactor associated with infection.Conclusion: age has been identified as the only independentrisk factor associated with Helicobacter pylori infection in thispopulation-based study. The univariate analysis has detected otherfactors. No association has been identified with respect to dyspepticsymptoms

Prevalencia de la infección por Helicobacter pylori en la población general adulta de la provincia de Ourense / Prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense

Objetivos: conocer la prevalencia de la infección por Helicobacterpylori en la población general adulta de la provincia deOurense.Material y métodos: se ha realizado un estudio transversalcon una muestra poblacional seleccionada al azar. El diagnósticode la infección por Helicobacter pylori se ha realizado mediantela prueba de aliento con 13C-urea.Resultados: se han estudiado 383 sujetos, obteniéndoseuna prevalencia del 69,1% (IC 95%: 61,7-75,1%), del 69,8%(IC 95%: 63,2-76,6%) en hombres y del 68,4% (IC 95%:61,5-75,4%) en mujeres, diferencia no significativa. La prevalenciaaumenta en relación con la edad, hasta un máximo del88,4% en el grupo de 45-54 años, y decrece en los grupos siguienteshasta alcanzar el 57,1% en los individuos de más de84 años.Conclusión: este estudio muestra que la prevalencia de la infecciónpor Helicobacter pylori es elevada en la población generaladulta de la provincia de Ourense. Aumenta con la edad hastaalcanzar un máximo en el grupo de edad media, y es similar enambos sexos

Objectives: to determine the prevalence of Helicobacter pyloriinfection in the general adult population of the province ofOurense.Material and methods: a cross-sectional study was carriedout with a randomly selected populational sample. The diagnosisof Helicobacter pylori infection was reached using the 13C-ureabreath test.Results: three hundred and eighty-three subjects were studied,with a prevalence rate of 69.1% (95% CI: 61.7-75.1%);69.8% (95% CI: 63.2-76.6%) in males and 68.4% (95% CI:61.5-75.4%) in females (difference not statistically significant).Prevalence increases with age up to a maximum of 88.4% in the45-54 years age group, and decreases thereafter to a rate of57.1% in individuals over the age of 84 years.Conclusion: this study reveals that the prevalence rate of Helicobacterpylori infection is high in the general adult populationof the province of Ourense. It increases with age until it peaks inthe group of middle-aged individuals and is similar in both sexes

Relación de la calidad de vida profesional y el burnout en médicos de atención primaria / Relationship between the quality of professional life and the burnout of primary health care doctors

Objetivo. Conocer la relación, si es que la hay, entre la calidad de vida profesional (CVP) y burnout de facultativos de atención primaria. Diseño. Estudio transversal mediante cuestionario CVP-35 y MBI (Maslach Burnout Inventory), por correo postal. Ámbito. Tres centros urbanos y 3 zonas de atención rural. Participó un total de 131 profesionales. Mediciones. Del CVP-35 se obtienen puntuaciones que van de 0 (mínimo) a 10 (máximo). El cuestionario Maslach clasifica en nivel alto, medio y bajo de cada dimensión. Resultados. Contestó a la encuesta el 71,7%. La edad media era de 44 años y la media de tarjetas sanitarias, 1.339. El número de consultas/día fue de 37; en cuanto las visitas domiciliarias, realizaban una diaria. El valor medio de la CVP fue de 4,48 (intervalo de confianza [IC] del 95%, 4,08-4,88). La percepción de la demanda tuvo una puntuación de 5,9 (IC del 95%, 5,6-6,1); la motivación intrínseca del profesional se situó en 6,5 (IC del 95%, 6,2-6,7) y el apoyo de los directivos en 3,8 (IC del 95%, 3,6-4,1). En cuanto al cuestionario MBI, se observó una despersonalización alta en el 54,3%, cansancio emocional alto en un 56,2% y realización personal alta en el 9,3%. La correlación mayor fue entre las demandas en el puesto y el cansancio emocional (r = 0,6; p < 0,0001), la motivación intrínseca y la realización personal (r = 0,46; p < 0,0001) y la calidad de vida profesional frente al cansancio emocional (r = ­0,4; p < 0,0005). Conclusiones. La CVP y el burnout miden dimensiones diferentes pero relacionadas. Por tanto, su utilidad es diferente en función de los objetivos. Con estos instrumentos se pueden identificar elementos clave de la gestión de personas que pueden mejorar la calidad de vida profesional

Objective. To know the relationship, if this exists, between the quality of professional life (CPL) and the burnout of primary health care staff. Design. Transversal study employing CVP-35 test and MBI (Maslach Burnout Inventory), both sent by postmail. Setting. 3 urban centers and 3 rural centers. Total: 131 professionals. Measures. In the CVP-35 test, scores from 0 (minimum) to 100 (maximum) are obtained. Maslach categorised each dimension into high, medium and low level. Results. 71.7% answered. Medium age 44 years, average of 1339 sanitary cards. The number of visits/day was 37, home visits 1 per day. The CVP average was 4.48 (95% CI, 4.08-4.88). The damage perception in the post 5.9 (95% CI, 5.6-6.1); the professional intrinsic motivation 6.5 (95% CI, 6.2-6.7), and the manager support 3.8 (95% CI, 3.6-4.1). MBI: high depersonalization 54.3%, emotional exhaustion (r=0.6; P<.0001), intrinsic motivation, and personal accomplishment (r=0.46; P<.0001) and profesional quality of life front emotional fatigue (r= ­0.4; P < .0005). Conclusions. CPL and burnout measure different but related dimensions. Therefore, its utility is dependent on the objectives. Target elements, which can improve the quality of professional life, can be identified from these tools

[Auricular fibrillation as a risk factor of cerebrovascular events in the over-65s. Is clinical practice in anticoagulant prophylaxis adequate?]. / Fibrilación auricular como factor de riesgo de acontecimientos cerebrovasculares en personas mayores de 65 años: es adecuada la práctica clínica en profilaxis anticoagulante?

AIM: To describe the clinical practice in antithrombotic therapy to prevent stroke in older patients with atrial fibrillation (AF). DESIGN: Cross-sectional study. SETTING: Ourense's area with 95,840 inhabitants over 65 years. PARTICIPANTS: Patients over 65 with non rheumatic AF, chronic or paroxistic; 411 cases, 69.6% older than 75 year. MAIN MEASUREMENTS: Demographic characteristics, personal history, stroke risk, diagnostic characteristics of AF, antithrombotic treatment, and its adequacy. RESULTS: Only 33% high risk patients received oral anticoagulation (OCA) with warfarin at diagnosis. Some features were found to be significant independent risk factors for OCA: age (older than 75 vs 65-74 years; odds ratio =0.32; 95% confidence interval, 0.18-0.59), and prior stroke (odds ratio =2.02; 95% confidence interval, 1.16-3.55). CONCLUSIONS: Warfarin prophylactic is insufficiently prescribed, especially in older than 75 years (with high baseline risk of stroke and no counter-indications). There was inadequate prescription in 73.4% cases.

Fibrilación auricular como factor de riesgo de acontecimientos cerebrovasculares en personas mayores de 65 años: ¿es adecuada la práctica clínica en profilaxis anticoagulante? / Auricular fibrillation as a risk factor of cerebrovascular events in the over-65s. Is clinical practice in anticoagulant prophylaxis adequate?

Objetivo. Analizar las pautas de profilaxis antitrombótica en pacientes con fibrilación auricular (FA) mayores de 65 años y su adecuación a la evidencia. Diseño. Estudio transversal. Emplazamiento. Área de salud de Ourense, con 95.840 habitantes mayores de 65 años. Participantes. Personas mayores de 65 años con FA no reumática, crónica o paroxística (411 casos; un 69,6% mayor de 75 años). Mediciones principales. a) Variables sociodemográficas, antecedentes personales y riesgo de accidente cerebrovascular (ACV), y b) características diagnósticas de la FA, tratamiento antitrombótico prescrito y adecuación a la evidencia científica. Resultados. En el momento del diagnóstico se prescribió anticoagulación oral (ACO) al 33% de los casos con riesgo alto. La probabilidad de recibir ACO se modificó por la edad (mayores de 75 años frente al grupo de 65-75 años; odds ratio, 0,32; intervalo de confianza del 95%, 0,18-0,59) y por la presencia de ACV previo (odds ratio, 2,02; intervalo de confianza del 95%, 1,16-3,55). Conclusiones. Resulta insuficiente la prescripción de ACO profiláctica, sobre todo en los mayores de 75 años con riesgo alto de ACV y baja frecuencia de contraindicaciones; el porcentaje de inadecuación es del 73,4% en este grupo

Aim. To describe the clinical practice in antithrombotic therapy to prevent stroke in older patients with atrial fibrillation (AF). Design. Cross-sectional study. Setting. Ourense's area with 95 840 inhabitants over 65 years. Participants. Patients over 65 with non rheumatic AF, chronic or paroxistic; 411 cases, 69.6% older than 75 year. Main measurements. Demographic characteristics, personal history, stroke risk, diagnostic characteristics of AF, antithrombotic treatment, and its adequacy. Results. Only 33% high risk patients received oral anticoagulation (OCA) with warfarin at diagnosis. Some features were found to be significant independent risk factors for OCA: age (older than 75 vs 65-74 years; odds ratio =0.32; 95% confidence interval, 0.18-0.59), and prior stroke (odds ratio =2.02; 95% confidence interval, 1,16-3,55). Conclusions. Warfarin prophylactic is insufficiently prescribed, especially in older than 75 years (with high baseline risk of stroke and no counter-indications). There was inadequate prescription in 73.4% cases

Efectos del VIH y otras variables sobre el resultado del tratamiento antituberculoso en España / Effects of HIV status and other variables on the outcome of tuberculosis treatment in Spain

Objetivo: Analizar el efecto del virus de la inmunodeficiencia humana (VIH) y otras variables sobre el resultado del tratamiento antituberculoso en España. Pacientes y métodos: Estudio multicéntrico de cohorte retrospectivo en 6 comunidades autónomas (de mayo de 1996 a abril de 1997). Se recogió información sobre el resultado del tratamiento en casos nuevos de tuberculosis siguiendo la normativa europea. Se realizó seguimiento de los casos hasta 3 meses después de la fecha prevista de finalización del tratamiento. Resultados: De los 4.899 pacientes incluidos, se observó un resultado satisfactorio en 3.417 (69,7%), 438 (8,9%) murieron antes o durante el tratamiento y 1.044 (21,4%) tuvieron un resultado potencialmente insatisfactorio. Estratificando por el estado de la infección por el VIH, las cifras fueron, respectivamente: para los que la presentaban, del 43,4, el 21,5 y el 35,1%; para los seronegativos, del 71, el 6,2 y el 22,8%, y para aquellos en quienes no constaba, del 74,3, el 7,5 y el 18,2%. El VIH modificaba el efecto de diversas variables sobre el resultado del tratamiento, por lo que se ajustaron modelos de regresión logística separados para cada categoría VIH. Entre los seropositivos, la mortalidad aumentó en enfermos con neoplasias y en usuarios de drogas por vías distintas de la parenteral, mientras que los resultados potencialmente insatisfactorios aumentaron en usuarios de drogas por vía intravenosa y en las mujeres. Conclusiones: En España, el resultado del tratamiento antituberculoso es mucho peor en enfermos infectados por el VIH. El uso de drogas y el hecho de padecer neoplasias tienen un papel importante sobre la mortalidad

Objective: To analyze the effect of human immunodeficiency virus (HIV) status and other variables on the outcome of tuberculosis treatment in Spain. Patients and Methods: Multicenter retrospective cohort study in 6 autonomous communities of Spain (from May 1996 to April 1997). Data on treatment outcome were collected for new cases of tuberculosis in accordance with European guidelines. Follow up of patients continued for 3 months after scheduled end of treatment. Results: Of the 4899 patients included, 3417 (69.7%) had a satisfactory outcome, 438 (8.9%) died before or during treatment, and 1044 (21.4%) had a potentially unsatisfactory outcome. On stratification by HIV status, satisfactory outcome, mortality, and potentially unsatisfactory outcome were reported for 43.4%, 21.5%, and 35.1%, respectively, of HIV-positive patients; 71%, 6.2%, and 22.8%, respectively, of HIV-negative patients; and 74.3%, 7.5%, and 18.2%, respectively, of patients with no HIV status available. HIV modified the effect of several variables on the outcome of treatment, and so separate logistic regression models for each HIV category were constructed. Among HIV-positive patients, mortality increased in patients with neoplastic disease and in users of drugs by nonintravenous routes of administration, whereas potentially unsatisfactory outcomes increased in intravenous drug users and in women. Conclusions: In Spain, the outcome of tuberculosis treatment is much worse in HIV-positive patients. Drug use and presence of neoplastic disease substantially affect mortality