La mortalidad entre los recién nacidos de la Comunidad Balear al final del siglo XX / Mortality of new-born infants in the Balearic Islands at the end of the 20th century

Objetivo: Analizar durante la última década del siglo XX frente a la década anterior las tendencias emergentes en los parámetros de natalidad y mortalidad del recién nacido en las Islas Baleares. Material y métodos: Estudio restrospectivo basado en datos obtenidos del Instituto de Estadística Nacional y Balear y del registro del Hospital Son Dureta, referentes a natalidad y mortalidad perinatal en recién nacidos de al menos 28 semanas o peso igual o superior a 1.000 g. Durante el período 1990-1999, se determinaron también dichas tasas en los recién nacidos con un peso de 500 a 999 g en el Hospital Son Dureta. Resultados: La comparación entre la primera y segunda década pone de relieve una clara disminución en los últimos 10 años de las tasas por 1.000 de mortalidad en el conjunto de la comunidad: la mortalidad fetal tardía (MFT) pasa de 8,53 a 3,83 (p = 0,45), la mortalidad neonatal precoz (MNP) de 5,85 a 2,39 (p = 0,36) y la mortalidad perinatal (MP) de 13,17 a 6,26 (p = 0,48).Considerando el conjunto de la última década en el Hospital Son Dureta y en los demás centros, las tasas de MFT son superiores en el primero (4,6 frente a 3,4), mientras que las de MNP son inferiores (1,7 frente a 3,1) y las tasas de MP son similares (6,3 frente a 6,6).Entre 213 recién nacidos de peso inferior a 1.000 g, 75 nacieron muertos (352/1.000), 56 fallecieron en los primeros 6 días de vida (406/1.000) y 9 (65/1.000) murieron entre los días 7 y 27.Conclusiones: Entre la penúltima y la última década del siglo XX, la mortalidad fetal tardía y neonatal precoz disminuyeron en más del 50 por ciento, con lo que se logró superar ya en 1997 los logros de los países más avanzados en este campo (AU)

[Rumblings, resistances, rebellions: the implementation of censuses in colonial India (eighteenth to twentieth centuries)]. / Rumeurs, resistances, rebellions: la mise en place des recensements dans l'Inde coloniale (XVIIIe-XXe siecles).

"The author examines how the population of colonial India reacted to enumeration practices developed by the British for fiscal and demographic purposes. Three types of reactions predominated during this period: rumblings, resistance--either spontaneous (primarily among the Santhal tribes) or politically organized, sparked by the nationalist movement of the 1920s and 1930s--and violent revolts, especially among the tribal Bhil in western India. It is interesting to relate such reactions, which often intermingled, to the building of a modern colonial state." (SUMMARY IN ENG AND SPA)

A 7-year follow-up of newborns vaccinated against hepatitis B.

Of 79 children born to asymptomatic HBsAg chronic carrier mothers and vaccinated at birth against hepatitis B, a total of 71, 66 and 56 could be serologically assessed after 1, 5 and 7 years, respectively. Anti-HBs titres (geometric means) of responders decreased from 2475 to 143 IU l-1 between 1 and 5 years of age and dropped to 82 IU l-1 by 7 years. At this time, a booster dose given to 34 children who showed anti-HBs titres lower or slightly higher than 100 IU l-1 significantly increased titres from 34 to 2985 IU l-1 (p < 0.001). Children whose titres following perinatal vaccination reached 100 to 1000 IU l-1 or above 1000 IU l-1 maintained protective levels (> 10 IU l-1) for 3 and 5 years, respectively. As in adults, anti-HBs titres recorded after the initial vaccination indicate the time at which infants should receive booster vaccination.

Intradermal and intramuscular route for vaccination against hepatitis B.

A recombinant hepatitis B vaccine was administered to high-risk hospital personnel by intramuscular (20 micrograms) or intradermal (2 micrograms) injections for the primary immunization (n = 69) with three doses and booster immunization (n = 51) with one dose. Basic vaccination performed intramuscularly gave rise to significantly higher seroconversion levels (97.2% versus 78.1%) and geometric mean titres of antibody (1649 versus 126 IUl-1) as compared with the intradermal route. Intradermal administration did not boost antibody titres in patients previously vaccinated intradermally. Adverse reactions were not serious or severe. The intramuscular route is recommended as the procedure of choice when vaccinating against hepatitis B.

[Cost-effectiveness analysis of antigrippal vaccination in a rural population (La Victoria, Cordoba)]. / Análisis de rentabilidad de la vacunación antigripal en una población rural (La Victoria, Córdoba).

After 4 successive campaigns of influenza vaccination (1984-1988) in La Victoria (Córdoba), a village with a population of 1750, the economic cost-effectiveness was estimated on the basis of the effectiveness attributable to the vaccine and that actually found. The mean cost of an influenza case amounted to 69,295 pesetas. The vaccine coverage increased during the study period from 20% to 30% in the general population and from 63% to 78% in the risk population. The effectiveness of vaccination, variable among years, was as a rule lower than expected. Cost-effectiveness was not related with the magnitude of the coverage, but increased proportionally with the morbidity rate.

The maternal-infant center in the control of hepatitis B.

A seroepidemiologic survey of HBV infection was carried out in four population groups served by the Maternity Hospital of Majorca, an island in the Mediterranean. The prevalence of HBV markers (HBsAg, anti-HBs, anti-HBc), determined by enzyme-immunoassay, reached 17.2% among 864 parturients, 17.2% in 783 hospital personnel, 2.7% and 19.2% among the 186 children and 73 husbands of parturients with no HBV markers, 22.8% and 43.8%, respectively, among the 44 children and 48 husbands of HBsAg chronic carrier parturients. The prevalences of HBsAg in the same groups reached 0.9%, 1.5%, 0% and 0%, 11.4% and 2.1%, respectively. The carrier state represents 50% of all infection cases among children and 4.8% among husbands of carrier women. The prevalence of markers, which was especially high among personnel working in maintenance services (39.1%), on surgical wards (35.3%), among midwives (27.6%) and in cleaning and laundry services (27.1%), and laboratories (21.4%), is used as an indicator in defining priorities for the vaccination of people at risk. Sixty-seven newborn babies of HBsAg carrier mothers were administered one dose of HBIG and three doses of hepatitis B vaccine; at 12 months of age, the seroconversion rate was 98.5%, whereas 1 child (1.5%) became a chronic carrier. Maternity hospitals represent the ideal centers in which to carry out the detection of HBsAg in pregnant women prior to parturition, to ensure that all newborns of chronic carrier women receive passive-active immunization, and to screen their family contacts and vaccinate those who are found susceptible to the infection.

Formula for calculating vaccine profitability.

A mathematical formula is developed for calculating the profitability of real or stimulated vaccination campaigns, in relation to the years elapsed since the vaccination date and within the period of immunity given by the vaccine. According to the formula, profitability depends on the annual attack rates and corresponding costs, vaccine price and efficacy, and number of postvaccination years considered. The factors that do not affect profitability are values of local currency, annual discount rates and the absolute number of vaccines, provided the relative proportion of subjects vaccinated is maintained constant among the distinct risk groups, when comparing different policies. Examples of vaccinations against hepatitis B and measles are presented.

Natural immunity to measles, rubella and mumps among Spanish children in the pre-vaccination era.

Prior to the start of mass vaccination campaigns against measles, rubella and mumps, a prevalence study of natural immunity to these diseases was undertaken in a sample of 1700 unvaccinated Spanish children. They were representative of the 3-7 year-old population in terms of age, regional distribution and urban or rural environment. Measles infection prevalence was significantly higher than that for rubella and mumps from 3 (48.3%, 14.2%, 25.5%, respectively) through 7 years of age, (64%, 40.9%, 39%). As a function of age, naturally-acquired immunity increased according to parabolic progressions. In the 3-5 year-old group, rural environment, low socioeconomic status, no school attendance and lack of brothers were associated with statistically lower levels of measles, rubella, or mumps infection. In the 6-7 year-old group, only 12% of the children showed antibodies against the three diseases and 18.7% exhibited triple susceptibility.

Hepatitis B virus infection and vaccination in children undergoing hemodialysis.

Among 54 patients, between 2 and 18 years of age, submitted to hemodialysis due to severe chronic renal failure, the prevalence of hepatitis B virus markers was 66.7% and that of HBsAg was 13.0%. Eighteen children, with no evidence of hepatitis B virus infection, were vaccinated. Following three vaccine injections, only 2 patients did not respond and a third one developed low anti-HBs titers. The vaccine was well tolerated. No relationship was observed between the intensity of the humoral immune response and age, sex, type of renal disease and time on dialysis. Seroconversion rates (87.5%) and geometric means of anti-HBs titers (greater than 4 000 Ausab Units) of these patients are similar to those observed following vaccination of healthy adults.