Parallel prediction of dengue cases with different risks in Mexico using an artificial neural network model considering meteorological data.

In 2022, Mexico registered an increase in dengue cases compared to the previous year. On the other hand, the amount of precipitation reported annually was slightly less than the previous year. Similarly, the minimum-mean-maximum temperatures recorded annually were below the previous year. In the literature, it is possible to find studies focused on the spread of dengue only for some specific regions of Mexico. However, given the increase in the number of cases during 2022 in regions not considered by previously published works, this study covers cases reported in all states of the country. On the other hand, determining a relationship between the dynamics of dengue cases and climatic factors through a computational model can provide relevant information on the transmission of the virus. A multiple-learning computational approach was developed to simulate the number of the different risks of dengue cases according to the classification reported per epidemiological week by considering climatic factors in Mexico. For the development of the model, the data were obtained from the reports published in the Epidemiological Panorama of Dengue in Mexico and in the National Meteorological Service. The classification of non-severe dengue, dengue with warning signs, and severe dengue were modeled in parallel through an artificial neural network model. Five variables were considered to train the model: the monthly average of the minimum, mean, and maximum temperatures, the precipitation, and the number of the epidemiological week. The selection of variables in this work is focused on the spread of the different risks of dengue once the mosquito begins transmitting the virus. Therefore, temperature and precipitation were chosen as climatic factors due to the close relationship between the density of adult mosquitoes and the incidence of the disease. The Levenberg-Marquardt algorithm was applied to fit the coefficients during the learning process. In the results, the ANN model simulated the classification of the different risks of dengue with the following precisions (R2): 0.9684, 0.9721, and 0.8001 for non-severe dengue, with alarm signs and severe, respectively. Applying a correlation matrix and a sensitivity analysis of the ANN model coefficients, both the average minimum temperature and precipitation were relevant to predict the number of dengue cases. Finally, the information discovered in this work can support the decision-making of the Ministry of Health to avoid a syndemic between the increase in dengue cases and other seasonal diseases.

Lactobacillus delbrueckii UFV-H2b20 increases IFN-γ production and CD39+CD73+ Treg cell numbers in lungs, and protects mice against experimental allergic asthma.

Asthma is a disorder characterized by airflow obstruction, inflammation, declining airway function, bronchial hyperresponsiveness and tissue remodelling. Probiotics are defined as "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host". The use of probiotics is becoming increasingly studied and recent evidence has suggested that it may provide therapeutic benefits in asthma and other diseases. Lactobacillus delbrueckii UFV-H2b20 fulfils all the requirements to be classified as probiotic. Previous studies have already shown the ability of L. delbrueckii UFV-H2b20 to stimulate the immune system. Our objective was to evaluate the protective effects of L. delbrueckii UFV-H2b20 in experimental allergic asthma. We used a murine model of ovalbumin-induced allergic airway inflammation to mimic allergic asthma. Oral treatment with L. delbrueckii UFV-H2b20 improves respiratory parameters and inhibits the inflammatory response in the lungs by decreasing the numbers of inflammatory monocytes, eosinophils and alveolar macrophages, as well as IgE levels. Treatment increased the IFN-γ/IL-4 cytokine ratio. Levels of IL-10 in the lungs were also increased in treated animals. Our results also showed that the probiotic administration increases the number of CD39+CD73+ T regulatory lymphocytes in the lung, suggesting a role for purinergic signals in the regulation of inflammation promoted by the treatment. Understanding the mechanisms of modulation of the immune system by probiotics could allow the development of probiotic preparations that are safe and have a direct action. Our results suggest that oral administration of L. delbrueckii UFV-H2b20 could be helpful to treat chronic inflammatory airway diseases, such as asthma.

[Place of death of people with conditions needing palliative care in the different regions of Spain]. / Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España.

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities.

AIM: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. METHODS: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. RESULTS: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). CONCLUSIONS: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

Effectiveness of a programme to reduce the burden of catheter-related bloodstream infections in a tertiary hospital.

The objective of this study was to assess the effectiveness of a catheter-related bloodstream infection (CR BSI) reduction programme and healthcare workers' compliance with recommendations. A 3-year surveillance programme of CR BSIs in all hospital settings was implemented. As part of the programme, there was a direct observation of insertion and maintenance of central venous catheters (CVCs) to determine performance. A total of 38 education courses were held over the study period and feedback reports with the results of surveillance and recommendations were delivered to healthcare workers every 6 months. A total of 6722 short-term CVCs were inserted in 4982 patients for 58 763 catheter-days. Improvements of compliance with hand hygiene was verified at the insertion (87·1-100%, P < 0·001) and maintenance (51·1-72·1%, P = 0·029) of CVCs; and the use of chlorhexidine for skin disinfection was implemented at insertion (35·7-65·4%, P < 0·001) and maintenance (33·3-45·9%, P < 0·197) of CVCs. There were 266 CR BSI incidents recorded with an annual incidence density of 5·75/1000 catheter-days in the first year, 4·38 in the second year [rate ratio (RR) 0·76, 95% confidence interval (CI) 0·57-1·01] and 3·46 in the third year (RR 0·60, 95% CI 0·44-0·81). The education programme clearly improved compliance with recommendations for CVC handling, and was effective in reducing the burden of CR BSIs.

Seguridad quirúrgica y cumplimentación del registro de información intraquirúrgica en España: Un análisis comparativo de dos instrumentos de registro / Surgical safety and filling-in of the records about intraoperative information in Spain: A comparative analysis of two recording instruments

El objetivo del presente estudio es describir y comparar los porcentajes de no cumplimentación de dos instrumentos de registro: hoja circulante (HC) y lista de verificación quirúrgica (LVQ), en un mismo entorno quirúrgico para una muestra de pacientes de características similares. Metodología: Estudio descriptivo realizado sobre registros intraquirúrgicos de 3024 pacientes de Cirugía de Ortopedia y Traumatología. 1732 pacientes intervenidos en 2009 con modelo de hoja circulante, cumplimentada al finalizar la intervención y 1292 en 2010 intervenidos con modelo de registro lista de verificación quirúrgica (checklist) cumplimentado durante la intervención en tres tiempos. Se han calculado características descriptivas (media, desviación típica, mínimo y máximo) del porcentaje de no cumplimentación global en ambos registros y el porcentaje de no cumplimentación (intervalo de confianza al 95%) de cada ítem de los registros estudiados. Resultados: Se observa mayor porcentaje de cumplimentación global y, en general, también individual, en la hoja circulante que en la lista de verificación quirúrgica. Conclusiones: El registro intraquirúrgico que mayor porcentaje de cumplimentación ha tenido de manera global ha sido la hoja de circulante y se evidencia la necesidad de implantar estrategias para mejorar el grado de cumplimentación de la LVQ por su relación con la seguridad de pacientes (AU)

The objective of this study is to describe and compare the percentages of non-filling-in two recording instruments: Current sheet and surgical checklist in the same surgical setting for a sample of patients with similar characteristics. Methods: Descriptive study carried out with the intraoperative records of 3024 patients from Orthopedic Surgery and 1732 patients who were operated in 2009 with current sheet model completed at the end of the surgery and 1292 patients in 2010 with surgical checklist as recording model, completed during the intervention in three stages. Descriptive characteristics (mean, standard deviation, minimum and maximum) were calculated from the overall percentage of non-completion in both records, as well as the non-filling-in percentage (and confidence interval at 95%) of each item of the records studied. Results: A higher overall - and also individual, in general- percentage of filling-in is observed in the current sheet than in the surgical checklist. Conclusions: In general terms, the intraoperative recording with the highest percentage of being filled-in has been the circulating sheet and it has been observed the necessity to implement strategies to improve the level of filling-in due to its relationship with surgical clinical safety (AU)

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999-2008.

Spain's immigrant population has increased 380% in the last decade, accounting for 13.1% of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999-2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (-17.8% for men and -16.6% for women) as well as in the foreign-born one (-45.9% for men and -35.7% for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Self-rated health and mortality: a follow-up study of a Spanish population.

OBJECTIVES: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. STUDY DESIGN: Longitudinal study. METHODS: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. RESULTS: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. CONCLUSIONS: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

[Factors associated with willingness to be vaccinated against pandemic flu A/H1N1 in the adult population of the Health Department of Elche (Spain)]. / Factores asociados a la predisposición a vacunarse contra la gripe pandémica A/H1N1 en población adulta del Departamento de Salud de Elche (España).

BACKGROUND: To assess, in the general population, the information sources, attitudes and willingness to be vaccinated against pandemic influenza A/H1N1 in 2009. METHODS: We carried out a cross sectional study between 25th November and 30th December 2009, through face to face interviews with a random sample (826) of adults resident in the Health Department of Elche (Spain). RESULTS: Respondents reported that television (57%) and the family doctor (47.9%) were their main sources of information about vaccinations. Eighty-two point two percent had a good opinion of vaccinations, 30.5% perceived A/H1N1 to be more severe than seasonal flu, with a higher rate among older and less educated people. Twenty-five point four percent of respondents were concerned about contracting it, especially among the less educated. Forty-two point one percent expressed their willingness to be vaccinated against seasonal flu. Eighteen point four percent intended to be vaccinated against A/H1N1. The bias towards vaccination increases with age and in the case of A/H1N1 decreases among more educated people. The family doctor was the main source of information when people wanted to be immunized against seasonal flu (OR = 1.43) and A/H1N1 (OR = 2.47). CONCLUSIONS: Low acceptance of the pandemic vaccination and low perceived severity of influenza A/H1N1. Previous vaccination experience with seasonal flu creates a predisposition to immunization against A/H1N1. Although the media were the leading source of information during this period, the family doctor's influence on their decision to be vaccinated was significant.

Factores asociados a la predisposición a vacunarse contra la gripe pandémica A/H1N1 en población adulta del Departamento de Salud de Elche (España). Influencia de las fuentes de información / Factors associated with willingness to be vaccinated against pandemic flu A/H1N1 in the adult population of the Health Department of Elche (Spain). The influence of sources of information

Fundamento. Evaluar en población general las fuentes de información, actitudes y predisposición hacia la vacunación contra la gripe pandémica A/H1N1 de 2009.Métodos. Estudio descriptivo de carácter transversal realizado entre el 25 de noviembre y 30 de diciembre de 2009 mediante entrevista personal cara a cara a una muestra aleatoria (826) de adultos residentes en el Departamento de Salud de Elche (España). Resultados. Los encuestados manifestaron que la televisión (57%) y el médico de familia (47,9%) eran su fuente principal de información sobre vacunas. El 82,2% tenía una buena opinión sobre las vacunas, un 30,5% percibía la gripe A/H1N1 como más grave que la estacional, siendo esta percepción creciente entre los de mayor edad y con menos estudios. Un 25,4% de encuestados sentía preocupación por padecerla , sobre todo los de menor nivel educativo. Un 42,1% manifiesta su buena predisposición para vacunarse contra la gripe estacional, disminuyendo hasta un 18,4% la intención hacia la gripe A/H1N1. La predisposición hacia la vacunación crece con la edad y en el caso de la gripe A/H1N1 decrece a mayor nivel educativo. El médico de familia es la fuente de información más determinante para inmunizarse frente a gripe estacional (OR 1,43) y gripe A/H1N1 (OR 2,47). Conclusiones. Existe baja aceptabilidad de la vacuna pandémica y baja percepción de gravedad sobre la gripe A/H1N1. La experiencia previa de vacunación ante gripe estacional predispone hacia la inmunización contra gripe A/H1N1. Aunque los medios de comunicación encabezan la fuente de información más usual durante este episodio, la influencia del médico de familia en la decisión de vacunarse resulta significativa(AU)

Background. To assess, in the general population, the information sources, attitudes and willingness to be vaccinated against pandemic influenza A/H1N1 in 2009. Methods. We carried out a cross sectional study between 25th November and 30th December 2009, through face to face interviews with a random sample (826) of adults resident in the Health Department of Elche (Spain). Results. Respondents reported that television (57%) and the family doctor (47.9%) were their main sources of information about vaccinations. Eighty-two point two percent had a good opinion of vaccinations, 30.5% perceived A/H1N1 to be more severe than seasonal flu, with a higher rate among older and less educated people. Twenty-five point four percent of respondents were concerned about contracting it, especially among the less educated. Forty-two point one percent expressed their willingness to be vaccinated against seasonal flu. Eighteen point four percent intended to be vaccinated against A/H1N1. The bias towards vaccination increases with age and in the case of A/H1N1 decreases among more educated people. The family doctor was the main source of information when people wanted to be immunized against seasonal flu (OR = 1.43) and A/H1N1 (OR = 2.47). Conclusions. Low acceptance of the pandemic vaccination and low perceived severity of influenza A/H1N1. Previous vaccination experience with seasonal flu creates a predisposition to immunization against A/H1N1. Although the media were the leading source of information during this period, the family doctor’s influence on their decision to be vaccinated was significant(AU)

Work ability, psychosocial hazards and work experience in prison environments.

BACKGROUND: Work ability is predicted by age- and work-related psychosocial hazards; however, its association with work experience has not been studied. Work ability has not been studied in prison environments as well. AIMS: To describe work ability and its associates among prison workers. METHODS: A cross-sectional study was carried out in two prisons in Spain, one large and one medium prison, randomly selected from 17 in total. Prison workers were randomly administered a voluntary anonymous questionnaire to measure work ability [Work Ability Index (WAI)], work-related psychosocial hazards (Spanish version of COPSOQ), sociodemographic, lifestyle and work-related variables. RESULTS: Four hundred and forty-one workers (54%) participated. Results confirmed that older and more experienced workers (analysis of variance analysis) and workers in large prisons (t-student) presented significantly lower WAI scores. Quantitative and emotional demands, family work conflict, low work control, low autonomy, low social support from colleagues and stress had negative significant associations with WAI. Age, which highly correlated with work experience (Spearman's r = 0.85), had significant association with WAI (beta = -0.62). In the stepwise linear regression, the association between age and WAI lost statistical significance after controlling for work experience, which maintained significant correlation with WAI (beta = -0.37). CONCLUSIONS: The apparent association between age and WAI was confounded by work experience. Interventions to improve work ability among prison workers may benefit from results of this study to focus their efforts on the risk groups in such a psychologically demanding work environment rarely examined in previous research.

Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study.

BACKGROUND: Empirical evidence of the efficacy and effectiveness of psychosocial family intervention and of the specificity of its effects on the course of schizophrenia is limited. The aim was to study the efficacy and effectiveness of psychosocial family intervention with regard to clinical and social functioning and family burden after controlling for compliance and several prognostic factors. METHOD: A 2-year randomized controlled trial with blind assessments. Fifty patients with DSM-IV schizophrenia and persistent positive symptoms and/or previous clinical relapse were allocated to psychosocial family intervention, individual counselling and standard treatment versus individual counselling and standard treatment. RESULTS: Family intervention was associated with fewer clinical relapses, hospitalizations and major incidents, and an improvement in positive and negative symptoms, social role performance, social relations, employment and family burden. The reduction in hospitalizations in the family intervention group was significantly greater than that observed in the group of patients who refused to participate but this was not the case for the control group. The effects of family intervention were independent of compliance and prognostic factors. CONCLUSIONS: Family intervention is effective in severe schizophrenia independently of compliance and prognostic factors.

Health-related quality of life in patients with home nutritional support.

BACKGROUND: Home nutritional support (HNS) aims to improve or maintain the patient's quality of life. Given the high social cost of such treatment, however, it is important to investigate whether the perceived quality of life of patients receiving HNS does in fact reflect these objectives. The present study aimed to evaluate the health-related quality of life (HRQoL) of patients who receive HNS. METHODS: A multicentre, cross-sectional study of 267 patients was carried out. HRQoL was evaluated using the EuroQoL-5-Dimensions (EQ-5D) questionnaire. The Visual Analogue Scale (VAS) was used to complement the EQ-5D, aiming to provide an overall estimation of patient quality of life. RESULTS: The EQ-5D questionnaire showed that 25% of the subjects valued their HRQoL at between -0.08 and 0.15, 50% at between 0.16 and 0.69 and 25% at between 0.70 and 1. Results from the VAS showed that 75% of patients claimed to have a HRQoL > 40. The median for the VAS was 50. Pathologies were oncological (44.0%), neurological (36.6%) and others (19.3%). The results obtained demonstrate that neurological patients placed a lower value on their HRQoL compared to those of other groups (P < 0.001). In addition, women rated their quality of life lower than men in all pathologies (P = 0.006). CONCLUSIONS: Perceived HRQoL varied depending on pathology and sex. It was difficult to draw conclusions concerning the impact of HNS because of a lack of baseline data and relevant validated measurement tools. The present study highlights the need for more research into the relationship between HNS and HRQoL.

Classification and scoring systems in myelodysplastic syndromes: a retrospective analysis of 311 patients.

The main objective of this study was to evaluate the role of the recent World Health Organization (WHO) classification for assessing prognosis in patients with myelodysplastic syndromes (MDS). To this effect, we analyzed the prognostic impact of the WHO and French-American-British (FAB) morphologic classifications and of four different scoring systems in a series of 311 patients with primary MDS diagnosed between October 1990 and June 2001. Both the FAB and WHO classifications identified groups with different prognoses (p<0.0001), those presenting refractory anemia (RA) and refractory anemia with ringed sideroblasts (RARS) showing the best prognosis. The WHO classification subdivided RA into RA with only red cell dysplasia, and refractory cytopenia with multilineage dysplasia (RCMD), and RARS into RARS plus refractory cytopenia with multilineage dysplasia and ringed sideroblast (RCMD-RS). In our population, we have shown that the two subtypes characterized by dysplasia affecting exclusively the erythroid population (RA and RARS) have a better prognosis, with a median survival of 122.2 and 81.9 months, respectively, than those with multilineage dysplasia (RCMD and RCMD-RS) with a median survival of 32.3 and 43.2 months, respectively. There were no significant differences in median survival comparing RA with RAS (p<0.95), or comparing RCMD with RSCMD (p<0.97). Besides, the four scoring systems discriminated our MDS patients in terms of survival, and an increase in prognostic capacity was achieved on adding the score to the morphological classifications. Risk scoring had a greater prognostic impact than the FAB and WHO classifications. Prognostic scoring systems may be an important tool for risk stratification in hematological practice, and add significance to morphological classification. Combined application of the WHO classification and score system is useful for improving the identification of patients with a poorer prognosis. The WHO classification establishes more homogeneous subcategories than the FAB classification and is also able to identify groups with different prognoses.

Trabajo a domicilio: el caso de las aparadoras de calzado / Industrial homework: the case of shoe workers

Objetivo: El trabajo a domicilio que realizan un amplio número de mujeres en la industria del calzado es una actividad económica sumergida de larga implantación en la Comunidad Valenciana. El objetivo de este estudio es describir las condiciones laborales de estas mujeres que trabajan en Elche y los efectos en su salud y en la de su familia. Métodos: Investigación que combina metodología cuantitativa, estudio descriptivo transversal, y cualitativa, basada en entrevistas individuales semiestructuradas. Se seleccionaron mujeres que acudían al Centro de Salud el Plá de Elche (Alicante), con el criterio de haber trabajado o que trabajen en la actualidad a domicilio en la rama industrial del calzado. Para 30 mujeres. se obtuvo información sobre datos sociodemográficos, condiciones laborales, laborales y salud percibida. Las entrevistas fueron grabadas y transcritas para el posterior análisis en 6 mujeres. Resultados: De las 30 mujeres que participaron en el estudio, el 96,7% no utilizaban medidas protectoras frente a los factores de riesgo. La siniestralidad originada por la utilización de herramientas supone un 80,0% y los problemas osteomusculares se presentan en un 66,7%. El 26,7% ha tenido abortos. Conclusión: El trabajo productivo que realizan afecta a su salud. Estas mujeres carecen de cultura preventiva y anteponen el tener un contrato laboral a las condiciones desfavorables de su trabajo

Objective: Industrial homework undertaken by a large number of women in the footwear industry is part of the submerged economy with a long tradition in the Valencian region. The objective of this study is to identify and analyse the working conditions of women who make shoes in Elche and the effects on their heath and their family. Methods: The research combines quantitative methodology, cross-sectional descriptive study with qualitative methodology, based on semi-structural individual interviews. Women were selected from those who attend the Health Centre in Plá de Elche (Alicante), with the condition of having previously worked or are now working in industrial homework in the footwear industry. Information was obtained from 30 women about socio-demographic characteristics, working conditions and effects on health. The interviews were recorded and transcribed for the later analysis of 6 women. Results: 96. 7% of the women who took part in the study did not use protective measures against the toxicity of the adhesives. Accidents originating in the use of tools represents 80% and osteo-muscular complaints were evident in 67.7%. 26.7% had had abortions. Conclusion: The productive work they carry out causes health problems . These women lack knowledge about preventive and place more importance on having a job than on the unfavourable conditions of their work

Cholelithiasic disease and associated factors in a Spanish population.

In order to analyze the factors associated with cholelithiasic disease, 1268 participants of a population sample were studied. On univariate analysis, 11 of the 23 variables included showed a statistically significant association (P < 0.05). Five of these variables, including obesity, triglyceride level, intake of hypolipidemic drugs, and a diet rich in cholesterol and saturated fats in women, and physical exercise in men, remained significantly associated after controlling for age. On multivariate analysis among women, a positive association was found with age (P < 0.001), obesity, and the use of hypolipidemic agents (P < 0.05) and a negative one with a diet rich in cholesterol and saturated fats (P < 0.05). Among men, the same analysis revealed there was a positive association with age (P < 0.001) and triglycerides (P < 0.05) and a negative one with physical exercise (P < 0.05). In conclusion, obesity and the use of hypolipidemic agents in women and triglycerides in men, were positively associated with cholelithiasic disease, independent of age, while negative associations included the intake of cholesterol and saturated fats in women and physical exercise in men.

Use of self-assembled monolayers of different wettabilities to study surface selection and primary adhesion processes of green algal (Enteromorpha) zoospores.

We investigated surface selection and adhesion of motile zoospores of a green, macrofouling alga (Enteromorpha) to self-assembled monolayers (SAMs) having a range of wettabilities. The SAMs were formed from alkyl thiols terminated with methyl (CH(3)) or hydroxyl (OH) groups or mixtures of CH(3)- and OH-terminated alkyl thiols and were characterized by measuring the advancing contact angles and by X-ray photoelectron spectroscopy. There was a positive correlation between the number of spores that attached to the SAMs and increasing contact angle (hydrophobicity). Moreover, the sizes of the spore groups (adjacent spores touching) were larger on the hydrophobic SAMs. Video microscopy of a patterned arrangement of SAMs showed that more zoospores were engaged in swimming and "searching" above the hydrophobic sectors than above the hydrophilic sectors, suggesting that the cells were able to "sense" that the hydrophobic surfaces were more favorable for settlement. The results are discussed in relation to the attachment of microorganisms to substrata having different wettabilities.

[Evolution of epidemiological methods in clinical research in Spain (1975-1994)]. / Evolución de los diseños epidemiológicos de la investigación clínica en España (1975-1994).

BACKGROUND: Previous studies have shown a sparing utilization of analytical and experimental designs in Spanish clinical research journals. The study aims are to compare among countries, the use of epidemiologic method in articles published in scientific journals, and to determine the extent to which this research has direct funding. METHODS: Cross-sectional study including all original papers published during 1994 in Medicina Clinica [(Med Clin (Barc)], Revista Clinica Española (Rev Clin Esp), The Lancet (Lancet) and New England Journal of Medicine (N Engl J Med). They were classified according to epidemiological design and we verified the financial support mention. RESULTS: 594 papers were included. Epidemiological studies without control group prevailed in Spanish journals. The most common designs were descriptive studies in Med Clin (Barc), with 45.5%, and clinical series in Rev Clin Esp, with 41.7%. The 33.6% of original papers published in Lancet and 28.4% of N England J Med were randomized trials. We found information about financial support in 73.7% of papers published in Lancet, in 77.4% of N Engl J Med, in 23.1% of Med Clin (Barc) papers and not one in the Rev Clin Esp studies. CONCLUSIONS: In Spanish clinical journals the use of epidemiological methods with control group is limited and direct financial support unusual. Wherefore these studies have a limited applicability.

Comportamiento sexual en una población de pacientes psiquiatricos / Sexual behavior in a psychiatry population

Se estudiaron 116 pacientes psiquiátricos de la consulta externa del Hospital Dr. Luis E. Aybar de Santo Domingo, entre 18 y 60 años de edad, investigando la presencia de parafilia como forma de gratificación sexual o parafilia exclusiva durante un período de 3 meses, comprendido desde octubre 1989 hasta enero 1990. De la muestra 84 (72.41 por ciento ) de los pacientes investigados, correspondieron al sexo femenino y 32 (27.59 por ciento ) al sexo masculino. Encontramos una incidencia de parafilia en un 20.31 por ciento de los pacientes. Un paciente presentó Parafilia exclusiva para 0.86