Evaluación de la información sanitaria disponible en internet sobre la vacuna antigripal / Evaluation of health information about the influenza vaccine on internet

Fundamento: La calidad de la información sanitaria en internet preocupa a gobiernos y usuarios. Nuestro objetivo fue determinar en qué medida la información sobre la vacuna antigripal se adhiere al gold estándar representado por lo establecido por el Ministerio de Sanidad español. Material y métodos: Entre junio-julio 2014 se evaluó la adhesión al gold estándar de la información sobre indicaciones, efectos adversos y contraindicaciones de la vacuna. Dicha información se obtuvo a través de Google, utilizando términos proporcionados por estudiantes de medicina. Se realizó un análisis univariante, donde variable resultado fue obtener información correctamente adherida, y variables explicativas fueron el tipo de origen de la información y su país. Resultados: Con los términos de 104 alumnos se obtuvieron 134 enlaces web diferentes. La adhesión alcanzó el 65,7% (88/134) en cuanto a la indicación en trabajadores sanitarios (TS). El 19,4% aportaron información incorrecta sobre indicación en embarazadas. La información de organismos oficiales de salud pública se adhirió significativamente mejor (indicación en TS (OR: 2,6), embarazadas (OR: 5,4) e inmunodeprimidos (OR: 2,2). La información de enlaces web españoles se adhirió peor (indicación en embarazo (OR: 0,3) y contraindicación si alergia al huevo (OR: 0,5). Conclusiones: El nivel de adhesión detectado fue mejorable. Se debe urgir y promocionar en los usuarios la utilización de las páginas web de organismos oficiales de salud pública cuando busquen información sobre la vacuna antigripal en internet (AU)

Background: The quality of health information on internet is a question of concern to governments and users. Our aim was to determine the extent to which information about the influenza vaccine adheres to the gold standard set by the Spanish Health Ministry. Methods: Between June and July 2014 information on indications, adverse effects and counter-indications of the vaccine was evaluated to see if it adhered to this gold standard. This information was obtained through Google, using terms provided by medical students. A univariate analysis was performed, where the variable result was getting information that adhered correctly to the standard, and explanatory variables were the type of origin of the information and its country. Results: Using the terms provided by 104 students, we obtained 134 different web links. Adhesion reached 65.7% (88/134) with respect to indication in health workers (HW). Nineteen point four percent provided incorrect information on indication in pregnant women. There was significantly better adherence in the information from official public health bodies (indication in HW (OR: 2.6), pregnant women (OR: 5.4) and immunodepressed patients (OR: 2.2). Adherence of information on Spanish web links was worse (indication in pregnancy (OR: 0.3) and counter-indication if allergic to eggs (OR: 0.5). Conclusions: Adhesion was improvable. It’s necessary to promote that internet users use official public health bodies websites when they search information regarding influenza vaccine on internet (AU)

Análisis de la lipocalina asociada a la gelatinasa de neutrófilos en el paciente crítico / Analysis of neutrophil gelatinase-associated lipocalin in the critical patient

OBJETIVO: Determinar si un valor de NGAL > 150 ng/ml es una buena prueba diagnóstica para detectar precozmente disfunción renal aguda (DRA) en el paciente crítico. DISEÑO: Estudio prospectivo, observacional, de cohorte. Ámbito: Unidad de cuidados intensivos y de cirugía cardíaca del Servicio de Medicina Intensiva del Hospital Germans Trias I Pujol. PARTICIPANTES: Los pacientes ingresados en el Servicio de Medicina Intensiva los días designados en el estudio. INTERVENCIONES: Análisis sanguíneo de la creatinina sérica determinada desde siete días antes del día de inicio del estudio, y diariamente durante cuatro semanas. Determinación de NGAL mediante prueba de orina, en muestra congelada, con el analizador ARCHITECT (Abbott diagnostics)por inmunoanálisis determinado el día de inicio del estudio y dos veces a la semana durante cuatro semanas, análisis de la estancia y mortalidad. RESULTADOS: Se obtuvieron 529 muestras de NGAL de 46 pacientes. El 37% de los pacientes presentaron un valor de NGAL > 150 ng/ml. La sensibilidad de la prueba para diagnosticar DRA fue del 69%, la especificidad fue del 75,7%. Sin embargo, el valor predictivo positivo fue del53%, lo cual significa que el 47% de los pacientes con NGAL alto no desarrollaron DRA. Un NGAL > 150 mg/dL se asoció de manera significativa a un SOFA más alto y a una estancia más larga en UCI. La mortalidad de los pacientes con NGAL elevado fue del 58,8%. CONCLUSIONES: Un NGAL > 150 ng/mL no parece ser una excelente prueba para detectar DRA enel paciente crítico pero si que se asocia con un peor pronóstico

OBJECTIVE: To determine if NGAL value exceeding 150 ng/mL is a good diagnostic test for acuterenal failure in critically ill patients. DESIGN: Prospective, observational cohort. SETTING: Intensive Care Unit and Cardiac Surgery Intensive Care Service at Hospital Germans Trias I Pujol. PARTICIPANTS: Patients admitted to the Intensive Care department the Designated days in the studio. INTERVENTIONS: Analysis of serum creatinine blood given from 7 days prior to the start of the study, and daily during 4 weeks and by determination of NGAL urine test in frozen sample, analyzer ARCHITECT (Abbott Diagnostics) determined by immunoassay the day baseline and 2 times a week for 4 weeks, analysis of the stay and mortality. RESULTS: A total of 529 NGAL samples were obtained from 46 patients. 37% of patients had a value of NGAL > 150 ng/mL. The Sensivity of the test to diagnose acute renal failure was 69%, Specifity was 75,7%. However, the Positive Predictive Test Value was 53%, which means that47% of patients with high NGAL did not develop AKI. A NGAL > 150 mg/dL was associated with a significantly higher SOFA and a longer stay in the ICU. The mortality of patients with elevated NGAL was 58.8%. CONCLUSIONS: A NGAL > 150 ng/mL does not seem to be an excellent test for AKI in critically lll patients but is associated with a worse prognosis

[Analysis of neutrophil gelatinase-associated lipocalin in the critical patient]. / Análisis de la lipocalina asociada a la gelatinasa de neutrófilos en el paciente crítico.

OBJECTIVE: To determine if NGAL value exceeding 150 ng/mL is a good diagnostic test for acute renal failure in critically ill patients. DESIGN: Prospective, observational cohort. SETTING: Intensive Care Unit and Cardiac Surgery Intensive Care Service at Hospital Germans Trias I Pujol. PARTICIPANTS: Patients admitted to the Intensive Care department the Designated days in the studio. INTERVENTIONS: Analysis of serum creatinine blood given from 7 days prior to the start of the study, and daily during 4 weeks and by determination of NGAL urine test in frozen sample, analyzer ARCHITECT (Abbott Diagnostics) determined by immunoassay the day baseline and 2 times a week for 4 weeks, analysis of the stay and mortality. RESULTS: A total of 529 NGAL samples were obtained from 46 patients. 37% of patients had a value of NGAL>150 ng/mL. The Sensivity of the test to diagnose acute renal failure was 69%, Specifity was 75,7%. However, the Positive Predictive Test Value was 53%, which means that 47% of patients with high NGAL did not develop AKI. A NGAL >150 mg/dL was associated with a significantly higher SOFA and a longer stay in the ICU. The mortality of patients with elevated NGAL was 58.8%. CONCLUSIONS: A NGAL>150 ng/mL does not seem to be an excellent test for AKI in critically ill patients but is associated with a worse prognosis.

[Evaluation of health information about the influenza vaccine on internet]. / Evaluación de la información sanitaria disponible en Internet sobre la vacuna antigripal.

BACKGROUND: The quality of health information on internet is a question of concern to governments and users. Our aim was to determine the extent to which information about the influenza vaccine adheres to the gold standard set by the Spanish Health Ministry. METHODS: Between June and July 2014 information on indications, adverse effects and counter-indications of the vaccine was evaluated to see if it adhered to this gold standard. This information was obtained through Google, using terms provided by medical students. A univariate analysis was performed, where the variable result was getting information that adhered correctly to the standard, and explanatory variables were the type of origin of the information and its country. RESULTS: Using the terms provided by 104 students, we obtained 134 different web links. Adhesion reached 65.7% (88/134) with respect to indication in health workers (HW). Nineteen point four percent provided incorrect information on indication in pregnant women. There was significantly better adherence in the information from official public health bodies (indication in HW (OR: 2.6), pregnant women (OR: 5.4) and immunodepressed patients (OR: 2.2)). Adherence of information on Spanish web links was worse (indication in pregnancy (OR: 0.3) and counter-indication if allergic to eggs (OR: 0.5). CONCLUSIONS: Adhesion was improvable. It's necessary to promote that internet users use official public health bodies websites when they search information regarding influenza vaccine on internet.

Prognostic factors for acute toxicity in prostate cancer patients treated with high-dose hypofractionated radiotherapy

PURPOSE: To prospectively study acute genitourinary (GU) and gastrointestinal (GI) toxicity during hypofractionated radiotherapy. PATIENTS AND MATERIALS: One-hundred and seventy-one consecutive men with cT1-T3cN0cM0 prostate cancer were treated at 2.6 Gy/fraction to a total dose of 67.6 for low risk (EQD2 = 79 Gy) and 70.2 Gy for intermediate-high risk (EQD2 = 82 Gy) over 5.2-5.4 weeks (α/β 1.5). Acute toxicity was scored according to RTOG/EORTC toxicity extended criteria after completing a 22-item questionnaire (basal, weekly, at 6 months). RESULTS: Minimum and median follow-up were 36 and 54.2 months, respectively. GU toxicity grades 0, 1, 2 and 3 were found in 30.4, 37, 32 and 0.6 % of patients, respectively. The figures for grades 0, 1, 2 and 3 GI toxicity were 66, 24, 10 and 0 %. The highest degree of acute reactions was reached at 4-5 weeks. At 6 months, 15 % of patients had GU toxicity (11 % grade 1, 4 % grade 2) and 5.8 % GI toxicity (5.3 % grade 1, 0.5 % grade 2). Multivariate analysis shows that bladder volume receiving ≥65 Gy (V 65) is associated with an increased risk of GU complications (p = 0.017, HR = 1.143, 95 % CI = 1.025-1.276), while history of TURP is linked to lower risk (p = 0.002, HR = 0.310, 95 % CI 0.004-0.370). Mean rectal dose (p = 0.013, HR = 1.089, 95 % CI 1.018-1.116) and total dose (p = 0.019, HR = 0.734, 95 % CI 0.567-0.950) are significantly related to GI toxicity. CONCLUSIONS: This 5-week dose-escalation hypofractionated radiotherapy schedule that uses 3D-conformal radiotherapy without IGRT has resulted in <1 % grade 3 acute complications. Our study suggests that reducing the mean rectal dose and the bladder V 65 helps prevent acute toxicity. TURP before radiotherapy was associated with lower acute GU toxicity (AU)

Síndrome de abstinencia en Cuidados Intensivos Pediátricos. Incidencia y factores de riesgo / Withdrawal syndrome in the pediatric intensive care unit. incidence and risk factors

Objetivo Conocer la incidencia de síndrome de abstinencia tras perfusión prolongada de fentanilo y midazolam en niños, y los factores de riesgo asociados. Diseño Estudio de cohorte histórica o retrospectiva. Ámbito UCI pediátrica de seis camas de un hospital universitario. Pacientes Se incluyen 48 pacientes pediátricos que recibieron sedoanalgesia en perfusión continua con midazolam y fentanilo exclusivamente, durante al menos 48 horas. Intervenciones Ninguna. Variables de interés principales Se recogen datos clínicos y demográficos, dosis y duración de sedoanalgesia recibida, aparición de síndrome de abstinencia, gravedad y tratamiento del mismo. Resultados El 50% desarrolló síndrome de abstinencia. Hubo diferencias significativas entre los que lo desarrollaron y los que no en cuanto a duración del tratamiento previo y dosis acumulada de ambos fármacos. Una dosis acumulada de fentanilo de 0,48mg/kg o de midazolam de 40mg/kg, y una duración de la perfusión de ambos de 5,75 días fueron factores de riesgo para el desarrollo de abstinencia. La mayoría presentó un cuadro leve o moderado, que comenzó a las 12-36 horas de suspender la perfusión. El fármaco más utilizado en el tratamiento fue la metadona. Conclusiones La incidencia de síndrome de abstinencia en niños tras perfusión prolongada de midazolam y fentanilo es elevada. El desarrollo del síndrome se relaciona con tiempos de perfusión prolongados y con dosis acumuladas elevadas de ambos fármacos (AU)

Objective To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. Design Historic or retrospective cohort study. Setting Pediatric Intensive Care Unit in an academic center. Patients Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48hours.InterventionsNone.Main variables of interest Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. Results Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48mg/kg, a cumulative midazolam dose of 40mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36hours after weaning from infusion. Methadone was used in most cases for treating with drawal. Conclusions There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome (AU)

Prognostic factors for acute toxicity in prostate cancer patients treated with high-dose hypofractionated radiotherapy.

PURPOSE: To prospectively study acute genitourinary (GU) and gastrointestinal (GI) toxicity during hypofractionated radiotherapy. PATIENTS AND MATERIALS: One-hundred and seventy-one consecutive men with cT1-T3cN0cM0 prostate cancer were treated at 2.6 Gy/fraction to a total dose of 67.6 for low risk (EQD2 = 79 Gy) and 70.2 Gy for intermediate-high risk (EQD2 = 82 Gy) over 5.2-5.4 weeks (α/ß 1.5). Acute toxicity was scored according to RTOG/EORTC toxicity extended criteria after completing a 22-item questionnaire (basal, weekly, at 6 months). RESULTS: Minimum and median follow-up were 36 and 54.2 months, respectively. GU toxicity grades 0, 1, 2 and 3 were found in 30.4, 37, 32 and 0.6 % of patients, respectively. The figures for grades 0, 1, 2 and 3 GI toxicity were 66, 24, 10 and 0 %. The highest degree of acute reactions was reached at 4-5 weeks. At 6 months, 15 % of patients had GU toxicity (11 % grade 1, 4 % grade 2) and 5.8 % GI toxicity (5.3 % grade 1, 0.5 % grade 2). Multivariate analysis shows that bladder volume receiving ≥65 Gy (V 65) is associated with an increased risk of GU complications (p = 0.017, HR = 1.143, 95 % CI = 1.025-1.276), while history of TURP is linked to lower risk (p = 0.002, HR = 0.310, 95 % CI 0.004-0.370). Mean rectal dose (p = 0.013, HR = 1.089, 95 % CI 1.018-1.116) and total dose (p = 0.019, HR = 0.734, 95 % CI 0.567-0.950) are significantly related to GI toxicity. CONCLUSIONS: This 5-week dose-escalation hypofractionated radiotherapy schedule that uses 3D-conformal radiotherapy without IGRT has resulted in <1 % grade 3 acute complications. Our study suggests that reducing the mean rectal dose and the bladder V 65 helps prevent acute toxicity. TURP before radiotherapy was associated with lower acute GU toxicity.

Withdrawal syndrome in the pediatric intensive care unit. Incidence and risk factors.

OBJECTIVE: To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. DESIGN: Historic or retrospective cohort study. SETTING: Pediatric Intensive Care Unit in an academic center. PATIENTS: Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48 hours. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. RESULTS: Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48 mg/kg, a cumulative midazolam dose of 40 mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36 hours after weaning from infusion. Methadone was used in most cases for treating withdrawal. CONCLUSIONS: There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome.

Evolución radiográfica del implante de células mesenquimales de tejido adiposo diferenciadas a osteoblastos en la reparación de defectos óseos. Estudio experimental en ovejas / Implant of adipose tissue-derived mesenchymal cells differentiated to osteoblasts in the repair of bone defects. Experimental study in sheep

Objetivo: Examinar la evolución radiográfica del implante de células mesenquimales derivadas de la grasa y diferenciadas a osteoblastos en defectos cavitarios del fémur ovino. Material y metodología: Se realizó un defecto cavitario en el cóndilo medial femoral bilateral en 22 ovejas de raza Asaaf, de 3-5 años. Se implantaron células troncales mesenquimales obtenidas del tejido graso diferenciadas a osteoblastos, plasma rico en plaquetas y heteroinjerto de hueso liofilizado. Se realizaron controles radiográficos a las 4 y 12 semanas, evaluando el crecimiento óseo según la escala de Lane y Shandu. Resultados: En ninguno de los grupos hubo formación o crecimiento óseo mayor del 25%. Se observó un mayor crecimiento óseo a las 12 semanas que a las 4 semanas no encontrando diferencias estadísticamente significativas entre los grupos. Conclusiones: El control radiográfico de la evolución de defectos óseos cavitarios tratados con células troncales diferenciadas a osteoblastos no es un método fiable ni a las 4 ni a las 12 semanas del implante (AU)

Objetive: To investigate the radiographic progress of the implant of adipose tissue-derived mesenchymal cells differentiated to osteoblasts in cavitary defects of sheep femur. Patients and methods: A cavitary defect was performed in the bilateral medial femoral condyle in 22 Asaaf sheep aged 3-5 years. Mesenchymal stem cells obtained from adipose tissue, differentiated into osteoblasts, platelet-rich plasma and lyophilised bone heterograft, were implanted. Radiographic controls were performed at 4 and 12 weeks, evaluating bone growth according to the Lane and Shandu scale. Results: Bone formation or growth were not greater than 25% in any of the groups. A greater bone growth was seen at 12 weeks than at 4 weeks, with no statistically significant differences between the groups. Conclusions: Radiographic control of the progression of cavitary bone defects treated with stem cells differentiated to osteoblasts is not a reliable method at 4 or at 12 weeks of implantation (AU)

El cuidado de los adolescentes en los hospitales españoles: los pacientes invisibles / Care of adolescents in Spanish hospitals: the invisible patients

Objetivo: El objetivo general de este trabajo fue realizar una aproximación a los modelos efectivos de atención hospitalaria no psiquiátrica que reciben los adolescentes en los hospitales españoles. En concreto, se pretendía conocer si los hospitales españoles cuentan con unidades de ingreso no psiquiátrico específicas para pacientes adolescentes, qué parámetros de edad utilizan estas unidades, las enfermedades que atienden y qué servicios educativos y de ocio se ofrecen a los pacientes ingresados en estas. Si los hospitales no disponen de unidades específicas de ingreso para pacientes adolescentes, se quería saber hasta qué edad ingresan los menores de edad en la unidad de pediatría, dónde ingresan cuando no lo hacen en pediatría, y si se ofrecen actividades alternativas de educación y de ocio a los pacientes menores de edad que ingresan en unidades distintas de pediatría. Método: Se realizó un estudio descriptivo mediante encuestas llevadas a cabo en 73 hospitales, de los cuales en 68 se admitían ingresos de menores de edad. Resultados: En la mayoría de los hospitales participantes los ingresos no psiquiátricos de los adolescentes tienen lugar en unidades que no son específicas para pacientes de su edad. Por el contrario, estos pacientes ingresan en pediatría hasta una edad de corte a partir de la cual ingresan en unidades de adultos. La edad de corte más frecuente, según los datos, es de 15 años o menos. Salvo excepciones, cuando los adolescentes ingresan en unidades de adultos no tienen garantizado el apoyo educativo durante su estancia en el hospital y las alternativas de ocio y de ocupación del tiempo de hospitalización a que pueden acceder son las mismas, básicamente, que las de los pacientes adultos .Conclusiones: La consideración de los adolescentes dentro del sistema hospitalario español presenta una serie de carencias si tenemos en cuenta los parámetros internacionales de calidad (AU)

Aim: The general aim of this work was to address the current models of non-psychiatric hospitalization received by adolescents in Spanish hospitals. Specifically, we wished to determine whether Spanish hospitals have specific non-psychiatric admittance units for adolescent patients, what are the age limits used by such units, what diseases are cared for, and what educational and leisure services are provided for hospitalised patients. If the hospitals do not have specific admittance units for adolescent patients, we wished to find out the age limit at which minors are admitted into the paediatric unit, and where they are they admitted when they are not admitted in paediatrics, and whether alternative educational and leisure activities are provided to minor patients who are admitted in units other than paediatrics. Method: We carried out a descriptive study by means of surveys in 73 hospitals, of which 68 admitted minor patients. Results: In most of the participating hospitals, adolescents with non-psychiatric illnesses were admitted to units that were not specifically for patients of their age. In contrast, these patients are admitted into paediatric units up to the cut-off age when they are admitted into adult units. According to the data, the most frequent cut-off age is 15 years or under. With some exceptions, when adolescents are admitted into adult units, they are not guaranteed any educational support during their hospitalization, and the leisure activities to occupy their time while hospitalized to which they have access are basically the same as those of adult patients. Conclusions: The treatment of adolescents within the Spanish hospital system has a series of deficiencies as regards international quality parameters (AU)

[Mortality attributable to smoking in Spain in 2006]. / Mortalidad atribuible al consumo de tabaco en España en el año 2006.

BACKGROUND: Tobacco consumption is a worldwide public health problem. Our aim was to estimate the mortality attributable to smoking and its impact on premature mortality in Spain in the year 2006. METHODS: Descriptive, cross-sectional study, carried out on the Spanish population aged > or = 35 years in 2006. The number of deaths by age, sex and cause was obtained from the vital statistics of the National Institute of Statistics. The prevalence of smoking by age and sex was obtained from the national health survey. The relative risks of death employed were adjusted by age, sex, educational level, civil status, type of work, consumption of fruit/vegetables and other confounding factors specific to certain diseases. The proportion and number of deaths attributable to tobacco, by sex and age group, were estimated on the basis of the etiological fraction of the study population. Similarly, potential years of life lost (PYLL) were calculated. RESULTS: In 2006, smoking caused 58,573 deaths (45,028 men; 13,545 women), which accounted for 16.15% of all deaths (23.94% in men; 7.76% in women). By cause, the attributable deaths were distributed in 25,500 malign tumours, 19,117 cardiovascular diseases and 13,956 respiratory diseases. Trachea-bronchial-lung cancer in men and other cardiopathies in women were those that most contributed to that mortality (33.9% and 30.9%). The PYLL were 211,251.8 (176,765.3 in men; 34,486.5 in women). CONCLUSIONS: Tobacco consumption makes a very notable contribution to mortality in Spain. The impact that this habit has on our society is an unacceptable burden.

Mortalidad atribuible al consumo de tabaco en España en el año 2006 / Mortality attributable to smoking in Spain in 2006

Fundamento. El consumo de tabaco constituye un importanteproblema de salud pública a nivel mundial.Nuestro objetivo fue estimar la mortalidad atribuible altabaquismo y su impacto sobre la mortalidad prematuraen España en el año 2006.Material y métodos. Estudio descriptivo, transversal,realizado en población española ≥ 35 años en 2006. Elnúmero de defunciones por edad, sexo y causa se obtuvode las estadísticas vitales del Instituto Nacional deEstadística. La prevalencia de tabaquismo por edad ysexo se obtuvo de la encuesta nacional de salud. Losriesgos relativos de muerte utilizados estaban ajustadospor edad, raza, nivel estudios, estado civil, tipotrabajo, consumo frutas/verduras y otros factores deconfusión específicos de ciertas enfermedades. La proporcióny el número de muertes atribuibles al tabaco,por sexo y grupo de edad, fueron estimadas a partir dela fracción etiológica poblacional. Asimismo, se calcularonlos años potenciales de vida perdidos (APVP).Resultados. En 2006, el tabaquismo ocasionó 58.573muertes (45.028 varones; 13.545 mujeres), que constituyeronel 16,15% de todos los fallecimientos (23,94% enhombres; 7,76% en mujeres). Según la causa, las muertesatribuibles se distribuyeron en 25.500 neoplasias malignas,19.117 enfermedades cardiovasculares y 13.956enfermedades respiratorias. El cáncer de tráquea-bronquios-pulmón en hombres y otras cardiopatías en mujeresfueron las que más contribuyeron a dicha mortalidad(33,9% y 30,9% de la misma). Los APVP fueron 211.251,8(176.765,3 en hombres; 34.486,5 en mujeres).Conclusiones. El consumo de tabaco contribuye muynotoriamente a la mortalidad en España. El impacto queeste hábito tiene en nuestra sociedad representa unacarga inaceptable(AU)

Background. Tobacco consumption is a worldwide publichealth problem. Our aim was to estimate the mortalityattributable to smoking and its impact on prematuremortality in Spain in the year 2006.Methods. Descriptive, cross-sectional study, carried outon the Spanish population aged ≥ 35 years in 2006. Thenumber of deaths by age, sex and cause was obtainedfrom the vital statistics of the National Institute of Statistics.The prevalence of smoking by age and sex wasobtained from the national health survey. The relativerisks of death employed were adjusted by age, sex, educationallevel, civil status, type of work, consumption offruit/vegetables and other confounding factors specificto certain diseases. The proportion and number of deathsattributable to tobacco, by sex and age group, wereestimated on the basis of the etiological fraction of thestudy population. Similarly, potential years of life lost(PYLL) were calculated.Results. In 2006, smoking caused 58,573 deaths (45,028men; 13,545 women), which accounted for 16.15% of alldeaths (23.94% in men; 7.76% in women). By cause, theattributable deaths were distributed in 25,500 maligntumours, 19,117 cardiovascular diseases and 13,956 respiratorydiseases. Trachea-bronchial-lung cancer in menand other cardiopathies in women were those that mostcontributed to that mortality (33.9% and 30.9%). The PYLLwere 211,251.8 (176,765.3 in men; 34,486.5 in women).Conclusions. Tobacco consumption makes a very notablecontribution to mortality in Spain. The impact thatthis habit has on our society is an unacceptable burden(AU)

Validación de la medición transcutánea de la presión parcial de dióxido de carbono en el paciente crítico pediátrico / Validation of the transcutaneous carbon dioxide tension measurements in critical paediatric patients

Objetivo: Valorar la fiabilidad de la medición de la presión transcutánea de dióxido de carbono (PtCO2) respecto a la medición de la presión arterial de dióxido de carbono (PaCO2). Material y métodos: Estudio analítico, observacional, longitudinal y prospectivo. Cohorte de pacientes ingresados en unidad de cuidados intensivos pediátricos. La PtCO2 se midió con el monitor digital SenTec, aplicando el sensor con un anillo específico (sensor V-sign, versión MDB 04.04.02). Se recogieron al mismo tiempo la PtCO2 y PaCO2. La significación estadística de la asociación se calculó mediante el test F de Snedecor, el coeficiente de correlación r2 de Pearson y el coeficiente de correlación intraclase. El grado de acuerdo se estimó con el método de Bland y Altman. La consistencia de los resultados se estudió con el ANOVA. Resultados: Se compararon 106 mediciones pareadas de PtCO2 y PaCO2, de 12 pacientes. Las PaCO2 y PtCO2 medias fueron 51,0±13mmHg y 50,1±14mmHg; r2=0,87 (p<0,001), CCI=0,96 (IC: 0,94–0,97). El análisis de Bland-Altman mostró una media de las diferencias de−0,9mmHg (IC:−2,0 a 0,2mmHg). La correlación fue mejor en ausencia de patología respiratoria, con asistencia respiratoria baja, con PaCO2>50mmHg y con aplicación frontal del sensor. Hubo consistencia de los resultados. No se observaron efectos secundarios derivados de la utilización del anillo. Conclusiones: La correlación obtenida entre la PtCO2 y PaCO2 fue muy buena. El monitor digital SenTec y el sensor de anillo específico constituyen una herramienta fiable, segura y fácil de utiliza (AU)

Objective: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO2) compared to the measurement of the arterial carbon dioxide tension (PaCO2). Material and methods: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO2 was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO2 and PaCO2 were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r2 correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). Results: One hundred and six paired measurements, PtCO2 and PaCO2, from twelve patients, were compared. The means of the PaCO2 and PtCO2 were 51.0±13mmHg and 50.1±14mmHg, respectively; r2=0.87 (p<0.001), ICC=0.96, (95% CI: 0.94–0.97). The Bland-Altman analysis showed a mean difference of−0.9mmHg (95% CI:−2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO2>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. Conclusion: The correlation between PtCO2 and PaCO2 is excellent and stable. The ring sensor was safe and easy to us (AU)

[Validation of the transcutaneous carbon dioxide tension measurements in critical paediatric patients]. / Validación de la medición transcutánea de la presión parcial de dióxido de carbono en el paciente crítico pediátrico.

OBJECTIVE: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO(2)) compared to the measurement of the arterial carbon dioxide tension (PaCO(2)). MATERIAL AND METHODS: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO(2) was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO(2) and PaCO(2) were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r(2) correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). RESULTS: One hundred and six paired measurements, PtCO(2) and PaCO(2), from twelve patients, were compared. The means of the PaCO(2) and PtCO(2) were 51.0+/-13mmHg and 50.1+/-14mmHg, respectively; r(2)=0.87 (p<0.001), ICC=0.96, (95% CI: 0.94-0.97). The Bland-Altman analysis showed a mean difference of-0.9mmHg (95% CI:-2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO(2)>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. CONCLUSION: The correlation between PtCO(2) and PaCO(2) is excellent and stable. The ring sensor was safe and easy to use.

Situación epidemiológica de la tuberculosis en la provincia de Salamanca e influencia de la infección VIH/sida / Epidemiological situation of tuberculosis in the province of Salamanca and the influence of HIV/AIDS infection

Los objetivos del presente trabajo fueron conocer la prevalencia real de la tuberculosis pulmonar y la influencia en ella de la infección VIH/sida. Los datos de tuberculosis se obtuvieron del Sistema EDO, del Servicio de Documentación y del Departamento de Microbiología del Hospital Universitario de Salamanca. Los datos de VIH/sida se obtuvieron del registro de seropositivos del Servicio de Medicina Preventiva. El periodo de estudio comprendió de enero de 1992 a enero de 2001 y su ámbito fue el área de salud de Salamanca. Se diagnosticaron 769 casos de tuberculosis pulmonar y se declararon 606. El 12,7 por ciento correspondieron a pacientes VIH/sida. La resistencia a la isoniazida fue del 8,7 por ciento y a la rifampicina del 8,3 por ciento. La multirresistencia se encontró en un 4,17 por ciento. Se concluye que existe relación entre tuberculosis e infección VIH/sida, la cual se puede considerar como un factor de riesgo, así como para la aparición de multirresistencias. La infradeclaración de casos refuerza la necesidad de mantener sistemas activos de vigilancia. (AU)

Comparación del índice de independencia en las actividades cotidianas pre y postquirúrgicas en pacientes con fracturas pertrocantéreas de cadera / Comparison of the independence activities daily living index preoperative and after surgery, in patient with pertrochanteric hip fractures

Se han revisado de forma retrospectiva las historias clínicas de 608 pacientes, intervenidos de fracturas extracapsulares de la extremidad proximal del fémur, mediante enclavado endomedular elástico de Ender. 352 de ellos fueron revisados directamente, en el hospital o en el domicilio de los mismos, tras la intervención quirúrgica. El 78.5 por ciento de los pacientes fueron mujeres y el 21.5 por ciento hombres. La edad media fue de 80.46 años, siendo el 87.7 por ciento mayores de 70 años. Se recogieron los datos sociales y funcionales preoperatorios y postoperatorios, evaluados mediante el índice de Katz modificado o índice de independencia de las actividades cotidianas. Todas las variables fueron incluidas en el programa informático SPSS 7.5 para su análisis, se utilizó el test estadístico de “Chi cuadrado”. Considerando el índice de Katz como un valor numérico la media antes de la fractura fue de 2.35 y postcirugía fue de 1.79.Los parámetros estudiados relacionados estadísticamente con los malos resultados fueron la edad mayor de 80 años, la presencia de antecedentes psiquiátricos, la mayor dependencia previa a la intervención, el tiempo de estancia hospitalaria mayor a 16 días, la osteoporosis moderada o avanzada, un canal medular ancho, y la demora de la deambulación inmediata después de la intervención. (AU)

Estudio epidemiológico descriptivo de una serie de 624 fracturas extracapsulares del extremo proximal del fémur / Epidemic descriptive study in 624 patients with extracapsular fracture of the upper extremity of the femur

Se han revisado de forma retrospectiva las historias clínicas de 608 pacientes afectos de fractura extracapsular de la extremidad proximal del fémur, recogiéndose datos de filiación, sociales, funcionales y los correspondientes a la fractura en sí. Las variables fueron estudiadas en el programa estadístico SPSS 7.5 para su análisis. De todas ellas se ha realizado un estudio epidemiológico descriptivo, encontrándose los siguientes resultados: el 78.5 por ciento fueron mujeres, en el 2.56 por ciento de los casos la fractura fue bilateral, y la edad media de los pacientes fue 80.4 años, siendo el 87.7 por ciento mayores de 70 años. La etiología de la fractura fue una caída casual en el 90.3 por ciento de los casos. Los datos epidemiológicos de nuestra serie son extrapolables a otras, siendo las diferencias porcentuales más significativas debido a que el estudio se refiere únicamente a fracturas extracapsulares en pacientes de mayor edad y con más discapacidad. (AU)

[Epidemiological situation of tuberculosis in the province of Salamanca and the influence of HIV/AIDS infection]. / Situación epidemiológica de la tuberculosis en la provincia de Salamanca e influencia de la infección VIH/sida.

This study aimed to determine the real prevalence of tuberculosis and the influence of HIV/AIDS infection from January 1992 to January 2001 in the health area of Salamanca. Data on tuberculosis were obtained from the EDO system of the Medical Records Service and the Microbiology Department of the University Hospital of Salamanca. Data on HIV/AIDS infection were obtained from the records on seropositive patients from the Preventive Medical Service. It was found that during the study period, 769 cases of tuberculosis were diagnosed and 606 cases were reported, 12.7% of which were in HIV/AIDS patients. There was 8.7% resistance to isoniazid and 8.3% to rifampin. Multidrug resistance was found in 4.17%. It was concluded that there is a close relationship between tuberculosis and HIV/AIDS infection, which may constitute a risk factor for the disease as well as for the appearance of multidrug resistance. The low reporting of tuberculosis cases shows the need for active surveillance systems.