The protective effect of calcium on bone mass in postmenopausal women with high selenium intake.

OBJECTIVE: Nutritional factors, especially the two essential nutrients calcium and vitamin D, have been shown to play an important role in bone health. We wanted to determine the possible protective effect of calcium intake in adequate amounts on bone mass as assessed by quantitative ultrasound in postmenopausal women who also have a high intake of selenium. SETTING: Health district of Cáceres, Spain. PARTICIPANTS AND STUDY DESIGN: 335 postmenopausal women aged 60.9 (SD = 8.1) years. Women were stratified based on the vitamin D, vitamin E, calcium intake and the calcium/protein and calcium/phosphorous index. MEASUREMENTS: Bone status (Ad-SoS measured at the phalanges) was assessed with an ultrasound device model DBM Sonic 1200R. Food intake was quantified using dietetic scales, measuring cups, and spoons based on 7 days of diet records. Urine samples were collected the morning of testing after an overnight fast. Venous blood samples for the hematological and biochemical studies were also obtained in the fasting state. RESULTS: In the group of women with Ca intake < 800 mg / d we found a significant and negative relationship between Ad-SoS with age (ß= -4.020, F = 23.327) and selenium intake (ß = -0.419, F = 10.067), as well as a positive relationship with Ca intake (ß= 0.104 and F = 7.084) (p <0.0001 in all). In the group of women with Ca intake > 800 mg / d, age has a significant and negative relationship (ß = -4.829 and F = 106.745), whereas folic acid intake has a significant and positive relationship (ß = 0.047 and F = 5.858) (p <0.0001 in both). CONCLUSION: Elevated selenium intake negatively affects bone mass measurements in postmenopausal women over the age of 51 but only if calcium intake is also less than 800 mg / day. When calcium intake is greater than 800 mg/day, selenium did not appear to affect bone mass.

[Incidence and prevalence of hip fractures in the province of Cáceres and their evolutionary trend]. / Incidencia y prevalencia de las fracturas de cadera en la provincia de Cáceres y su tendencia evolutiva.

OBJECTIVE: There are great variations in the yearly incidence and the evolution of hip fractures secondary to bone fragility and associated to minimum trauma in patients older than 50. Because of the lack of data about these fractures in the province of Cáceres, we carried out a study to know their incidence and prevalence, and their evolutionary trend. MATERIAL AND METHODS: One thousand five hundred seventy seven hip fractures in the years 1997 through 2000 (both included) are studied. The type of fracture is obtained through 820.00 to 829.00 corresponding codes. RESULTS: One thousand one hundred ninety nine occur in women and 378 in men, being the average presentation age 81 +/- 9 years and 74 +/- 18 years, respectively; both data were significantly lower in men (p < 0.0001). The incidence index by sex is 2.6 women/men/100,000 inhabitants/year. The percentage of fractures by sex do not vary, depending on the anatomical location. The higher number of fractures in both sexes is in the trochanter (p < 0.0001); in men is higher in the year 2000 than in 1997 (p < 0.0001); in women their incidence and prevalence is also higher in the year 2000 than in the previous years (p < 0.0001). In conclusion we can point out that the incidence of the hip fractures secondary to low-energy trauma in the province of Cáceres population is increasing in the last few years, and that this incidence is higher in women than men, although the percentage of the fracture type according to its anatomical location is the same in women and men.

Epidemiological changes in diagnosed coeliac disease in a population of Spanish children.

AIM: To investigate the incidence rate of diagnosed coeliac disease among the paediatric population in the province of Cáceres and the changes over the years. METHODS: The incidence rate of diagnosed coeliac disease between the years 1981 and 1999, age at diagnosis and clinical presentation form were investigated. The study was carried out over two periods: A (1981 to 1990) and B (1991 to 1999). RESULTS: The incidence rate for period A was 6.87/100,000 (CI 95%: 5.26-8.83) and for period B 16.04/100,000 (CI 95%: 12.99-19.59) (p < 0.0001). The relative risk of receiving a diagnosis of coeliac disease during the first four years of life was 2.31% (CI 95%:1.61-3.31) greater in period B than in period A. The mean age at diagnosis was 37.4 +/- 47.4 mo and 43.9 +/- 43.7 mo in A and B, respectively (p = 0.0058). The typical clinical pattern was the most frequent (83.6% in A and 58.3% in B). The mean age of introduction of gluten to the diet was 4.6 +/- 2.0 mo and 6.9 +/- 1.7 mo, for period A and B, respectively (p < 0.0001). CONCLUSION: The incidence rate of coeliac disease has increased during the two periods studied. In recent years, the relative risk of receiving a diagnosis of coeliac disease during the first four years of life has increased. The atypical clinical presentation has also increased, although the typical clinical form is still the most frequent in younger children.

[Implantable subcutaneous venous access. Management]. / Acceso venoso subcutáneo implantable. Manejo.

In this second article on subcutaneous venous access implants, the authors make an in depth presentation on how to handle these devices. The main topics which are covered include: nomenclature, indications, complications, how to set or implant this device and nursing treatment. Under the nursing treatment section, the authors explain care and maintenance, general regulations, what procedure to follow if one confronts an unusual resistance during an injection, fibrinolithic treatment, and the intraspinal system.

[Implantable subcutaneous venous access. 1. Reasons that justify its use]. / Acceso venosa subcutáneo implantable. 1. Razones que justifican su uso.

Chemotherapy treatment or the administering parenteral feeding requires permanent venous access during weeks, months or perhaps years. To have available an adequate venous access while treating gravely ill patients is fundamental in order to guarantee the perfusion of fluids blood transfusions administration of medicines, to supply intravenous feeding, to draw blood samples, etc. In this article, which will have a follow-up which concentrates on proper handling, the authors expose the reasons why subcutaneous venous access implants and used as well as how to deal with one of their main complications; extravasation. A bibliography will accompany the follow-up article.

[Home oxygen therapy: nursing care]. / Oxigenoterapia domiciliaria: cuidados de enfermería.

The authors present a brief historical summary of the use of oxygen therapy in a patient's home from its start in 1970 to the present time, analyzing the controversies which have developed and the interest in oxygen therapy in a patient's home. For a review of the indications, initial evaluation, requirements and dose of this treatment, one should consult the article written by these authors published in Revista Rol de Enfermeria 2000; 23(4):257-261. In continuation, the authors explain the main nursing care which a patient receiving oxygen therapy at home requires, the circumstances which can compromise its efficiency, its secondary effects and complications, and the follow-up that is necessary to carry out on patients using this therapy.

[Indications and administration: home oxygen therapy]. / Indicaciones y administración. Oxigenoterapia domiciliaria.

At the present time, it has been clearly demonstrated that at home oxygen therapy either on a long term basis or on a continuous basis brings important benefits for a patient: his/her physical and neuro-psychological conditions improve and his/her quality of life increases. However, given that this is some controversy about its indications, therapeutic effects and manner to administrate it, the authors review all these aspects, drawing from very up-to-date bibliographical references. At a later date, in another article, these same authors will evaluate nursing treatment corresponding directly to at home oxygen therapy.

[A health study of older persons in Extremadura: drug taking and the most frequent chronic diseases]. / Estudio de salud de las personas mayores en Extremadura: consumo de fármacos y patologías crónicas más frecuentes.

BACKGROUND: To ascertain the use of drugs among the non-institutionalised elderly population, the factors related to polypharmacy and pinpointing the relationship thereof with chronic diseases. METHODS: Cross-sectional epidemiological study by means of door-to-door survey. The population systematically selected totalled 960 individuals age 65-93. The questionnaire included demographic data, self-assessed health condition, quantitative and qualitative aspects of the use of medications, chronic diseases and assessment of functional ability. RESULTS: 91.62% of those surveyed were taking medication, a greater number of females (p < 0.002) than males. The medications taken to the greatest extent were blood pressure drugs (42.4%), analgesics (38.7%) and heart drugs (24.8%). Drugs were used to a greater extent among the oldest age group (p < 0.0001), those having the lowest educational level (p < 0.001), those with impaired eyesight and hearing (p < 0001), those having the lowest social status (p < 001), more contacts with the health care services (p < 0001), worse self-assessed health condition (p < 0001), a greater number of chronic diseases (p < 0.0001) and depressive disorders (p = 0.004). The linear regression analysis revealed a positive relationship between the number of medications taken and the number of chronic diseases (r = 0.518; p < 0.0001). Females report worse health conditions (p < 0.05). The variables analyzed with regard to polypharmacy by means of logistic regression are age (over age 75; OR = 1.1478), three or more chronic diseases (OR = 1.83) and poor self-assessed health condition (OR = 1.22). CONCLUSIONS: Physical checkups on the elderly must include a review of the medications being taken, especially among those over age 75 who have a worse self-assessed health condition and a larger number of chronic diseases.

[Subcutaneous drug administration. Indications for the use in terminal patients]. / Vía subcutánea. Indicaciones de uso en el enfermo terminal.

The preferred methods to administer medicines to the sick are oral, under the tongue, or rectal; but in the case of the terminally ill patient, we may encounter the problem that the drugs which they tend to require do not come in either of these preferred administering methods since these patients symptoms and problems demand complex responses. In these cases, the subcutaneous way winds up being highly recommended; therefore, the authors present the pharmacological bases of this method, they describe continuous subcutaneous perfusion, and all those aspects of this method which might be interesting to the professionals who employ it.