Prevalence of parkinsonism and Parkinson's disease in the Arosa Island (Spain): a community-based door-to-door survey.

There are scarce epidemiological data on parkinsonism in Spain. Since the Arosa Island community (Northwestern Spain) has been for centuries relatively isolated, it represents a potentially useful setting to undercover genetic factors with a founder effect, as well as local environmental influences. We performed a one-stage door-to-door survey in the Arosa Island in 2004 to determine the prevalence of parkinsonism and Parkinson's disease (PD) in the population aged 65 years or over. Out of 41 individuals detected with parkinsonism, 15 were diagnosed with PD (36.6%), 13 with drug induced parkinsonism (31.7%), seven with vascular parkinsonism (17.1%), four patients had parkinsonism with associated features (9.8%) and two had unspecified parkinsonism (4.9%). We obtained a crude prevalence rate of parkinsonism of 5.44% (adjusted rate: 4.73%) and a crude prevalence rate of PD of 1.99% (adjusted rate 1.7%); both prevalence rates increased with advancing age. The prevalence rate for parkinsonism was higher than that in similar populations of Spain and other European countries while that for PD was in the range obtained from these populations. Among PD cases, 26.7% (n=4) were undiagnosed before the survey. Most cases of drug-induced parkinsonism were secondary to neuroleptics and had not been previously diagnosed. The relatively high proportion of undiagnosed drug-induced parkinsonisms and PD is surprising in a public health system which is free and universal. The lack of excess of late-onset PD among Arosans does not support the existence of specific genetic or environmental factors contributing to PD in this particular geographical area.

Valor predictivo de la PCR-hs en pacientes revascularizados por isquemia crítica de miembros inferiores / Predictive value of hs-CRP in patients revascularised due to critical lower-limb ischaemia

Introducción. Los marcadores de infl amación son reactantes de fase aguda que se elevan enprocesos infl amatorios como la isquemia crítica del miembro inferior (ICMI). La proteína C reactivade alta sensibilidad (PCR-hs) ha sido el más utilizado para predecir eventos cardiovascularesen pacientes con ateroesclerosis. El objetivo de este estudio es conocer el valor pronósticode la PCR-hs preoperatoria en pacientes con ICMI tratados mediante revascularización.Material y métodos. Estudio prospectivo de 100 pacientes con ICMI, incluidos de forma consecutivay tratados mediante revascularización. En todos se realizó PCR-hs previa al procedimiento.La evaluación durante el año siguiente incluyó: mortalidad, eventos cardiovasculares (coronarios,neurológicos y en miembros inferiores) y restenosis arterial ecográfi ca.Resultados. Se intervinieron 100 pacientes, 67 varones y 33 mujeres, con mediana de 76 años(rango intercuartílico [RIC] 65-83). Las categorías Rutherford eran: 4 (n = 29), 5 (n = 63) y 6(n = 8). La mediana de la PCR-hs era 1,5 mg/dl (RIC 0,5-3). El índice tobillo-brazo preoperatorioera 0,3 (RIC 0,19-0,45). Las modalidades de tratamiento fueron: endovascular (n = 45), quirúrgico(n = 43) e híbrido (n = 12). No hubo mortalidad perioperatoria. El seguimiento fue de11,7 meses (RIC 9,3-13,6). Fallecieron 20 pacientes y ocurrieron 90 eventos cardiovasculares en70 pacientes. Se detectaron restenosis ecográfi ca > 70 % y/u obstrucción arterial en 39 pacientes.Había mayor probabilidad de mortalidad al año cuando la PCR-hs preoperatoria era > 3 mg/dl(p = 0,022; odds ratio [OR] = 6,15; intervalo de confi anza [IC] 95 % 1,30-29,14).Conclusión. Valores elevados de PCR-hs (> 3 mg/dl) en el preoperatorio de pacientes con ICMI serelacionan con una mayor mortalidad al año(AU)

Background. Acute-phase reactants are infl ammatory markers that increase during infl ammatoryevents such as critical limb ischaemia (CLI). High-sensitivity C-reactive protein (hsCRP) is themost useful marker to predict cardiovascular events in patients with atherosclerosis. Weinvestigated whether baseline levels of hsCRP predict mid-term clinical outcome in patientswith CLI.Methods. We prospectively studied 100 consecutive patients with CLI who were treated byrevascularization. All the patients had hsCRP samples taken prior to the intervention. During thefi rst year the following endpoints were evaluated: mortality, cardiovascular events (coronary,neurological and lower limb) and echographic restenosis.Results. A total of 100 patients were intervened (67 males and 33 females). The median age was76 years (interquartile range [IQR] 65-83). Rutherford categories were: 4 (n = 29), 5 (n = 63) and6 (n = 8). The median preoperative hsCRP was 1.5 mg/dl (IQR 0.5-3). Baseline ankle-braquialindex was 0.3 (IQR 0.19-0.45). Treatment modalities were: endovascular (n = 45), surgical(n = 43) and hybrid (n = 12). There was no perioperative mortality. Median follow-up was11.7 months (IQR 9.3-13.6). During the first year, 20 patients died and there were90 cardiovascular events in 70 patients. There were 39 patients with echographic restenosis > 70 %or obstruction. There was a higher probability of death when preoperative hsCRP was > 3 mg/dl(p = 0.022; odds ratio [OR] = 6.15; 95 % confi dence interval [CI] 1.30-29.14).Conclusion. CLI patients with preoperative values of PCR-hs > 3 mg/dl are associated with deathduring the fi rst year after treatment(AU)

Treatment completion in latent tuberculosis infection at specialist tuberculosis units in Spain.

SETTING: Treatment of latent tuberculosis infection (LTBI) is essential for tuberculosis (TB) control in low-prevalence countries. However, the long treatment duration and adverse events frequently result in suboptimal treatment completion. OBJECTIVE: To determine completion rates of LTBI treatment and to identify risk factors for non-completion of treatment. DESIGN: Retrospective, observational cohort study. METHODS: All non-human immunodeficiency virus infected adults who started treatment for LTBI at two specialist TB units in Spain between January 2004 and March 2007 were included. Those who discontinued treatment due to toxicity were excluded. RESULTS: Of 599 people who started on treatment, 484 (80.8%, 95%CI 77.5-83.8) completed it. Age <36 years (OR 0.33, 95%CI 0.30-0.76, P = 0.001), male sex (OR 0.58, 95%CI 0.37-0.92, P = 0.02), immigrant status <5 years of residence (OR 0.21, 95%CI 0.12-0.37, P < 0.001) and the presence of social risk factors (OR 0.21, 95%CI 0.11-0.39, P < 0.001) were associated with lower rates of treatment completion. Short treatment regimens were not associated with better treatment completion compared with isoniazid for 6-9 months (OR 0.89, 95%CI 0.45-1.80, P = 0.76). CONCLUSIONS: Overall, completion rates of LTBI treatment in specialist TB units are good. Nevertheless, counselling should be strengthened and new strategies to enhance adherence should be sought for recent immigrants and for people in unfavourable social situations.

Calidad de vida en pacientes revascularizados por isquemia crítica de miembros inferiores / Quality of life in revascularised critical limb ischaemia patients

Introducción. La calidad de vida (CV) de los pacientes con isquemia crítica de miembro inferior (ICMI) está muy deteriorada. El cuestionario SF-36 es el más recomendado para conocer la CV en pacientes con ICMI. El SF-36 tiene 8 dominios que evalúan el estado físico y mental. El objetivo es analizar el impacto de la revascularización en la CV de pacientes con ICMI. Material y métodos. Estudio prospectivo para evaluar la CV de 100 pacientes con ICMI antes y tres meses después de su revascularización, mediante el cuestionario SF-36. Resultados. La mediana de edad era 76 años (rango intercuartílico 65-83) y había 67 varones. Las categorías Rutherford eran: 4 (n = 29), 5 (n = 63) y 6 (n = 8). Los tratamientos fueron: endovascular (n = 45), quirúrgico (n = 43) e híbrido (n = 12). De los 100 pacientes, se pudieron obtener cuestionarios completos en 69. Los pacientes tenían una percepción de la CV mucho mejor a los tres meses de la intervención, estadísticamente significativa (p < 0,05) para 7 dominios. Los mayores de 80 años mejoraban sólo en dos dominios. Los diabéticos mejoraban menos que los no diabéticos, en 5 dominios respecto a 7. Los pacientes que sufrieron amputación mejoraban sólo en dos dominios, fundamentalmente el dolor corporal. Conclusión. La revascularización tiene un efecto positivo en la CV de pacientes con ICMI, a los tres meses de la intervención. El beneficio es menor en los mayores de 80 años y en diabéticos. Cuando fracasa la revascularización, la mejoría se percibe en el alivio del dolor corporal(AU)

Background. Critical limb ischaemia (CLI) has a great effect on the quality of life (QoL) of the patients. The SF-36 questionnaire is the most recommended tool to assess the QoL of patients with CLI. It has 8 sub-scales to evaluate the physical and mental state. The aim of the study is to analyse the impact of revascularisation on the QoL of patients with CLI. Methods. A prospective study was performed to evaluate the QoL of 100 patients with CLI. Assessment was made before and three months after revascularisation, using the SF-36 questionnaire. Results. The median age was 76 years (interquartile range 65-83) and there were 67 males. Rutherford categories were as follows: 4 (n = 29), 5 (n = 63) and 6 (n = 8). Treatment modalities were: endovascular (n = 45), surgical (n = 43) and hybrid (n = 12). Complete questionnaires were obtained from 69 patients. Overall, the QoL of patients improved significantly (p < 0.05) three months after arterial reconstruction in 7 sub-scales. Patients over 80 years improved in only two sub-scales. Diabetic subjects improved less than non-diabetics (in 5 sub-scales versus 7). Patients with an amputation improved in only two sub-scales, mainly body pain. Conclusion. Revascularisation procedures have a positive effect on the QoL of patients with CLI three months after the intervention. Diabetic subjects and patients over 80 benefit less. When revascularisation fails, the improvement is mainly in the relief of body pain(AU)

[A case-control study of the influence of the smoking behaviour in multiple sclerosis]. / Estudio de casos y controles sobre la influencia del hábito tabáquico en la esclerosis múltiple.

INTRODUCTION: Several epidemiological studies have demonstrated that there is a genetic factor of susceptibility in Multiple Sclerosis (MS) and that the environmental factors play an important important role in their development. Smoking is among the environment factors studied. In fact, several studies have established a relationship between smoking and multiple sclerosis, although most of them did not find significant results or found that these were contradictory. OBJECTIVE: To evaluate the influence of the smoking habit on the risk of suffering MS. METHODS: This was a case-control matched study with 138 patients diagnosed of MS according to the McDonald criteria who were paired with the same number of controls of the same gender, residents in the same city and having the same age +/-2 years. Demographic data, smoking status (never, always smokers, ex-smokers), Kurtzke disability status scale (EDSS) and type of MS were collected. RESULTS: Out of a total of 138 MS patients (93 women, 43 men), 110 had relapsing-remitting MS, 20 secondary progressive MS and 7 primary progressive MS. Most of the patients were smokers and ex-smokers (63%). In the control group, only the 41,3% were smokers/ex-smokers. Moreover, the age of onset for smoking was earlier in the case group. CONCLUSION: Being a smoker/ex-smoker implies a 27% greater risk of developing MS compared to those who have never smoked. This risk is statistically significant for women but not for men due to the low number of them in the sample.

Estudio de casos y controlessobre la influencia del hábito tabáquicoen la esclerosis múltiple / A case-control study of the influence of the smoling behaviour in multiple sclerosis

Introducción. Diversos estudios epidemiológicos demuestranque en la esclerosis múltiple (EM) existe un factor genético de susceptibilidad,así como que los factores ambientales juegan un papelprominente en el desarrollo de la misma. Entre los factores ambientalesestudiados se encuentra el tabaco. De hecho, varios estudiosestablecen relación entre fumar y EM, pero la mayoría de ellos nohallaron resultados significativos o éstos fueron contradictorios.Objetivo. Evaluar la influencia del hábito tabáquico en el riesgode padecer EM.Material y métodos: Estudio caso-control pareado con 138 pacientesdiagnosticados de EM según los criterios de McDonald y el mismonúmero de controles del mismo sexo, residentes en el mismo municipioy la misma edad ±2 años. Se recogieron los datos demográficos, statusde fumar, escala de discapacidad de Kurtzke (EDSS) y tipo de EM.Resultados. De los 138 pacientes (93 mujeres, 43 hombres), 110presentaban EM remitente recurrente, 20 EM secundariamente progresivay 7 EM primariamente progresiva. La mayoría de los pacientesresultaron ser fumadores y exfumadores (63%) frente al (41,3%)de los controles. Asimismo, la edad de inicio en el hábito de fumar fuemás precoz en los casos que en los controles.Conclusión. Ser fumador/exfumador implica un 27% más deriesgo de desarrollar EM frente a los nunca fumadores. Este riesgo esestadísticamente significativo en mujeres y no en varones, probablementedebido al bajo número de los mismos en el total de la muestra (AU)

Introduction. Several epidemiological studies have demonstratedthat there is a genetic factor of susceptibility in MultipleSclerosis (MS) and that the environmental factors play an importantrole in their development. Smoking is among the environmentfactors studied. In fact, several studies have established arelationship between smoking and multiple sclerosis, althoughmost of them did not find significant results or found that thesewere contradictory.Objective. To evaluate the influence of the smoking habit onthe risk of suffering MS.Methods. This was a case-control matched study with 138patients diagnosed of MS according to the McDonald criteria whowere paired with the same number of controls of the same gender,residents in the same city and having the same age ±2 years.Demographic data, smoking status (never, always smokers, exsmokers),Kurtzke disability status scale (EDSS) and type of MSwere collected.Results. Out of a total of 138 MS patients (93 women, 43 men),110 had relapsing-remitting MS, 20 secondary progressive MS and7 primary progressive MS. Most of the patients were smokersand ex-smokers (63%). In the control group, only the 41,3% weresmokers/ex-smokers. Moreover, the age of onset for smoking wasearlier in the case group.Conclusion. Being a smoker/ex-smoker implies a 27% greaterrisk of developing MS compared to those who have neversmoked. This risk is statistically significant for women but not formen due to the low number of them in the sample (AU)

Experiencia con el uso de rocuronio en la intubación orotraqueal en una unidad de soporte vital avanzada móvil (USVA) / No disponible

Objetivo: Valorar la seguridad, eficacia y condicionesde la intubación orotraqueal (IOT) delbloqueante neuromuscular (BNM) no despolarizanterocuronio (R) durante la secuencia rápidade intubación (SRI) en el medio extrahospitalario,así como las posibles alteraciones hemodinámicasy la necesidad de utilizar otros BNM tras la dosisde inducción con R.Material y método: Se realizó un estudio prospectivodesde marzo de 2005 a octubre de 2007,según un protocolo de IOT con R (dosis: 0,6mg/kg) en el ámbito extrahospitalario en unaunidad de soporte vital avanzado móvil (USVA).Se analizaron: sexo, edad, motivo de IOT, condicionesde IOT mediante la clasificación deCormack-Lehane (C-L) y de Krieg (K), parámetroshemodinámicas: presión arterial media(PAM) y frecuencia cardiaca (FC) y saturaciónperiférica de oxígeno (SpO2), antes de la IOT y al1, 2 y 5 minutos, el uso de otro tipo de BNM yposibles complicaciones.Fueron motivo de exclusión: edad < 14 años,PCR y lesión cervical o maxilofacial. Resultados: Se recogieron un total de 50 pacientes,38 varones (12 mujeres), edad media 45 ± 24años, motivo de IOT: neurológico (GCS < 9) 39pacientes, cardiológico 4 y respiratorio 7 pacientes.Las condiciones de IOT según la clasificación de K:grado I (cuello y cuerdas relajadas, no tose) 36pacientes, grado II (igual pero tose) 12 pacientes,grado III (cuerdas aproximadas) un paciente ygrado IV (imposible la IOT): un paciente y según laclasificación de C-L: grado I (se visualiza la glotis):29, grado II (se visualiza la comisura posterior): 18pacientes, grado III (sólo se visualiza la epiglotis):2 pacientes y grado IV ( no se visualiza la epiglotis):1 paciente...(AU)

Aim: To evaluate the safety, efficacy and conditions for orotracheal intubation (OTI) of nondepolarizingneuromuscular blocker (NMB)rocuronium (R) for rapid sequence intubation (RSI) in the extrahospitalary environment, as well as the possibility of haemodynamic alterationsand the need for using other NMB after the induction dose with R. Methods: Aprospective and retrospective studywas carried out from March 2005 to October 2007, according to the OIT protocol with R (dose 0.6 mg/kg) in the out-of-hospital environment in themobile Advanced Life Support Units (ALSU). The following parameters were evaluated before and at minute 1, 2 and 5 after OTI: age, sex, OTI indication,OTI conditions according to Cormack-Lehane (C-L) classification and Krieg (K) scale, haemodynamic parameters: Mean Arterial Pressure (MAP),Heart Rate (HR), and arterial oxygen saturation (SatO2). The need for other type of NMB and the possible complications were also analysed.Cardiac arrest, neck or maxillofacial injury and patients < 14 years old were excluded. Results: 50 patients: 38 males (12 women) were included. Mean age was 45 ± 24 years old, OTI indications: neurological (GCS < 9) 39 patients,cardiological in 4 and respiratory in 7 patients. The conditions for OTI, according to K scale: grade I (good relaxation, vocal cords open, no coughing) in 36 patients, grade II ( same as grade I, with coughing) in 12 patients, grade III ( vocal cordsmoving) 1 patient and grade IV (epiglotis cannot be seen) in 1 patient and according to C-L: grade I (most of the glotis is seen): 29 patients; grade II(only posterior position of the glottis can be seen): 18 patients; grade III (only the epiglottis can be seen): 2 patients; grade IV (neither epiglottis nor glottis can be seen): 1 patient...(AU)

[Prevalence of asthma and rhinitis symptoms in A Coruña (Spain)]. / Prevalencia de síntomas de asma y rinitis en la población de A Coruña.

INTRODUCTION: The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. OBJECTIVE: To asses the prevalence of asthma and rhinitis symptoms in childhood. MATERIAL AND METHODS: We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. RESULTS: A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of "wheezing at some time" was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. CONCLUSIONS: The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied.

Hospital at home for acute respiratory patients.

BACKGROUND: The issue of "hospital at home" (HAH) for acute respiratory patients is one that is still being debated, partly because economic, cultural and health service differences between locations imply that HAH schemes need to be tailored to local situations. The aim of the present study was to analyze the feasibility and effectiveness of HAH for patients with acute respiratory disease at our institution. METHODS: Of all the patients admitted to our institution via the emergency department during a 34-day subject enrollment period, 25 with diagnoses of respiratory infection, pneumonia, pulmonary insufficiency or exacerbated chronic obstructive pulmonary disease who were living within 25 km of our center and who were willing to receive HAH care were assigned to HAH. Fifty sex-matched controls with the same diagnoses were given conventional hospital care (CHC) as inpatients. The dependent variables evaluated included time to discharge, readmissions within 3 months and deaths within 3 months. RESULTS: There were no significant differences between the HAH and CHC groups with regard to age, diagnoses, physical and analytical findings, or co-morbidity, or with regard to deaths (HAH 16%, CHC 10%) or readmissions (HAH 17%, CHC 24%). Time to final discharge was significantly shorter for HAH patients (7 days) than for CHC patients (12 days). Some 95% of the HAH patients were satisfied and would choose HAH again. CONCLUSIONS: HAH seems feasible for appropriately selected acute respiratory disease patients presenting in our emergency department. It frees hospital beds for other patients, its readmission and mortality rates are no higher than for conventional hospitalization, and, in general, it is favorably evaluated by patients.

[Study of hypertensive very elderly population admitted to a regional hospital]. / Estudio de la población hipertensa muy anciana ingresada en un hospital comarcal.

OBJECTIVES: To analyse the characteristics of the hospitalized very elderly people (age equal or superior to 80 years) with hypertension (HT). PATIENTS AND METHODS: Prospective study including the patients with HT who need hospitalization in our medical institution. Data collected were: demographic, clinical parameters, factors of vascular risk, hygienic-dietetic strategies, pharmacological treatment, cause of hospitalization, and biochemical determinations. RESULTS: There were included 92 very elderly patients (71 women); they represent 14 % of total hospitalized people. Two third parts had not realized academic studies, being 60 % of rural origin. Almost the half (41 %) was diabetic, and 27 % had dyslipidemia. Overall 62 % had 4 or more factors of cardiovascular risk. The hospitalization was related to the HT in the half of the cases, and 61 % had already previously some cardiovascular event. The lifestyle modifications more frequent were: not to smoke (95 %), no alcohol (81 %), and diet without salt (75 %). Diuretics were the most frequent anti-hypertensive agent used. The global mortality was two times superior to the hypertensive population < 80 years in the same period. CONCLUSIONS: The very elderly hypertensive patients of our study are fundamentally women, of rural origin and without academic studies. The above mentioned hospitalization is attributable directly to the HT in the half of the cases. They are a population of high cardiovascular risk, with previous events cardiac and cerebral-vascular. They confess to realize frequently the hygienic-dietetic strategies recommended. The diuretics are the anti-hypertensive agents most used for the HT. Since it was of waiting for the mortality in this group it is high.

Estudio de la población hipertensa muy anciana ingresada en un hospital comarcal / Study of hypertensive very elderly population admitted to a regional hospital

Objetivos: Conocer las características de la población hipertensa muy anciana (edad igual o superior a 80 años) ingresada en nuestro centro hospitalario. Material y métodos: Estudio prospectivo, incluyendo a pacientes con hipertensión (HTA) ingresados en nuestro centro. Se estudiaron: parámetros demográficos, clínicos, factores de riesgo vascular, medidas higiénico-dietéticas, tratamiento farmacológico, causa del ingreso, y determinaciones bioquímicas. Resultados: Se incluyeron 92 pacientes (71 mujeres); representan el 14% de los ingresos. Dos terceras partes no habían realizado estudios académicos; siendo el 60% de procedencia rural. Casi la mitad (41%) eran diabéticos tipo II y un 27 % tenía dislipemia. El 62% tenían 4 o mas, factores de riesgo cardiovascular. El ingreso hospitalario se relacionó con la HTA en la mitad de los casos, y un 61% ya había tenido previamente algún evento cardiovascular. Las medidas higiénico-dietéticas mas frecuentes son: no fumar (95%), no alcohol (81%), y dieta sin sal (75%). Los fármacos más usados son: diuréticos e IECAs. La mortalidad global fue dos veces superior a la de los hipertensos de menos de 80 años. Conclusiones: Los hipertensos muy ancianos ingresados en nuestro centro, son fundamentalmente mujeres, de procedencia rural y sin estudios académicos. Dicho ingreso es atribuible directamente a la HTA en la mitad de los casos. Son una población de alto riesgo cardiovascular, coneventos previos cardíacos y cerebro-vasculares. Confiesan realizar las medidas higiénico-dietéticas recomendadas. Los diuréticos son los fármacos mas utilizados para la HTA. Como era de esperar la mortalidad en este grupo es muy alta

Objectives: To analyse the characteristics of the hospitalized very elderly people (age equal or superior to 80 years) with hypertension (HT). Patients and methods: Prospective study including the patients with HT who need hospitalization in our medical institution. Data collected were: demographic, clinical parameters, factors of vascular risk, hygienic - dietetic strategies, pharmacological treatment, cause of hospitalization, and biochemical determinations. Results: There were included 92 very elderly patients (71 women) ;they represent 14 % of total hospitalized people. Two third parts had not realized academic studies, being 60 % of rural origin. Almost the half (41 %) was diabetic, and 27 % had dyslipidemia. Overall 62 % had 4 or more factors of cardiovascular risk. The hospitalization was related to the HT in the half of the cases, and 61 % had already previously some cardiovascular event. The lifestyle modifications more frequent were: not to smoke (95 %), not alcohol (81 %), and diet without salt (75 %). Diuretics were the most frequent anti-hypertensive agent used. The global mortality was two times superior to the hypertensive population < 80 years in the same period. Conclusions: The very elderly hypertensive patients of our study are fundamentally women, of rural origin and without academic studies. The above mentioned hospitalization is attributable directly to the HT in the half of the cases. They are a population of high cardiovascular risk, with previous events cardiac and cerebral-vascular. They confess to realize frequently the hygienic - dietetic strategies recommended. The diuretics are the anti-hypertensive agents most used for the HT. Since it was of waiting for the mortality in this group it is high

[Transbronchial needle aspiration of diseased mediastinal lymph nodes: predictors of positive findings]. / Factores predictores del resultado de la punción-aspiración transtraqueal de adenopatías mediastínicas neoplásicas.

OBJECTIVE: To assess the factors that may determine the effectiveness of transbronchial needle aspiration through a flexible bronchoscope in the diagnosis of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors. METHODS: Prospective study carried out at 2 hospitals between 1998 and 2004 that included all transbronchial needle aspirations performed on patients who had diseased mediastinal lymph nodes larger than 10 mm and nonlymphoid neoplasms. Univariate and multivariate analysis of the diagnostic results of transbronchial needle aspiration were performed according to the type and location of the primary neoplasm and the lymph node station biopsied, the diameter of the affected node, endoscopic findings, and the results of other bronchoscopic techniques. RESULTS: The study evaluated the transbronchial needle aspiration of 230 lymph node stations in 207 patients. Histologic examination revealed 151 cases (72.9%) of non-small cell lung cancer, 42 cases (20.3%) of small cell lung cancer, and 14 cases (6.8%) of extrapulmonary cancer. The best predictors of obtaining a diagnostic sample were a diameter of the diseased node greater than 20 mm in diameter (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7; P=.01) and a histologic diagnosis of small cell lung cancer (OR, 2.7; 95% CI, 0.9-8.2; P=.07). CONCLUSIONS: The size of the diseased node and the tumor type are the best predictors of obtaining a diagnostic sample with transbronchial needle aspiration of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors.

Factores predictores del resultado de la punción-aspiración transtraqueal de adenopatías mediastínicas neoplásicas / Transbonchial needle aspiration of diseases mediastinal lymph nodes: predictors of positive findings

Objetivo: Analizar los factores que pueden influir en la efectividad de la punción transtraqueal (PTT) a través del broncoscopio flexible en el diagnóstico de adenopatías mediastínicas en pacientes con neoplasias pulmonares o extrapulmonares. Métodos: Estudio prospectivo realizado entre 1998 y 2004 en el que se incluyeron todas las PTT realizadas a pacientes con adenopatías mediastínicas superiores a 10 mm y neoplasias no linfoides de 2 centros hospitalarios. Se realizó un análisis univariado y multivariado entre los resultados diagnósticos de la PTT según el tipo y la localización de la neoplasia primaria y la estación ganglionar analizada, el diámetro de la adenopatía, los hallazgos endoscópicos y los resultados de otras técnicas broncoscópicas. Resultados: Se incluyeron en el estudio 230 PTT de estaciones ganglionares distintas de 207 pacientes. Las estirpes histológicas fueron en 151 casos (72,9%) carcinomas no microcíticos pulmonares, en 42 (20,3%) carcinomas microcíticos y en 14 (6,8%) carcinomas extrapulmonares. Las variables que mejor predijeron la obtención de muestras diagnósticas fueron el diámetro de la adenopatía superior a 20 mm (odds ratio [OR] = 2,4; intervalo de confianza [IC] del 95%, 1,2-4,7; p = 0,01) y que el tipo de neoplasia fuera un carcinoma pulmonar microcítico (OR = 2,7; IC del 95%, 0,9-8,2; p = 0,07). Conclusiones: El tamaño de la adenopatía y el tipo de neoplasia son los factores que mejor predicen la obtención de muestras adecuadas en la PTT de adenopatías mediastínicas en pacientes con neoplasias pulmonares o extrapulmonares

To assess the factors that may determine the effectiveness of transbronchial needle aspiration through a flexible bronchoscope in the diagnosis of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors. Methods: Prospective study carried out at 2 hospitals between 1998 and 2004 that included all transbronchial needle aspirations performed on patients who had diseased mediastinal lymph nodes larger than 10 mm and nonlymphoid neoplasms. Univariate and multivariate analysis of the diagnostic results of transbronchial needle aspiration were performed according to the type and location of the primary neoplasm and the lymph node station biopsied, the diameter of the affected node, endoscopic findings, and the results of other bronchoscopic techniques. Results: The study evaluated the transbronchial needle aspiration of 230 lymph node stations in 207 patients. Histologic examination revealed 151 cases (72.9%) of non-small cell lung cancer, 42 cases (20.3%) of small cell lung cancer, and 14 cases (6.8%) of extrapulmonary cancer. The best predictors of obtaining a diagnostic sample were a diameter of the diseased node greater than 20 mm in diameter (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7; P=.01) and a histologic diagnosis of small cell lung cancer (OR, 2.7; 95% CI, 0.9-8.2; P=.07). Conclusions: The size of the diseased node and the tumor type are the best predictors of obtaining a diagnostic sample with transbronchial needle aspiration of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors

Tratamiento rehabilitador del hombro doloroso / Rehabilitating treatment of painful shoulder

Introducción. El objetivo de este estudio es conocer las características de los pacientes que consultan por hombro doloroso en nuestra área y evaluar los resultados del protocolo de tratamiento rehabilitador utilizado en nuestro servicio. Material y métodos. Se han seleccionado pacientes con hombro doloroso secundario a uno de estos cuatro diagnósticos: síndrome subacromial/tendinitis no calcificada de manguito de los rotadores o bicipital; rotura parcial o total del manguito de los rotadores; tendinitis calcificada del manguito de los rotadores; capsulitis retráctil. El tratamiento ha sido domiciliario y hospitalario basado en disminuir el dolor, conseguir un balance articular completo y potenciar el manguito de los rotadores y los músculos estabilizadores de la escápula. Se recogieron los siguientes datos: edad, sexo, profesión, antecedente traumático, diagnóstico, confirmación del diagnóstico por técnicas de imagen, tiempo de evolución del dolor, número de sesiones de tratamiento, test de Constant pre y postratamiento y la necesidad de otra consulta por el mismo proceso. Test estadísticos utilizados: test de Wilcoxon, pruebas de Mann-Whitney y Kruskal-Wallis, χ2 de Pearson y el test de correlación de Spearman. Nivel de significación 0,01 y 0,05.Resultados. Muestra de 278 pacientes: 187 mujeres y 91 varones. Edad: 56,01 ± 11,07 años. Diagnóstico más frecuente: síndrome subacromial/tendinitis no calcificada (57,20 %). Sin antecedente traumático: 70,30 %. Confirmación del diagnóstico por imagen: 50,40 %. Tiempo de evolución: 8,28 ± 6,98 meses. Número sesiones: 10,53 ± 5,11. Test de Constant:57,03 ± 10,52 puntos pre-tratamiento y 70,10 ± 11,94 postratamiento. El 74,80 % no han requerido otra consulta y el9,50 % han precisado intervención quirúrgica. Conclusiones. Concluimos que nuestro protocolo mejora el tratamiento del hombro doloroso secundario a los diagnósticos anteriormente descritos

Introduction. The aim of this study is to describe the clinical features in patients with shoulder pain referred to our consultation and to assess the results of a physical therapy protocol that we use for shoulder pain. Material and methods. We have selected patients suffering from shoulder pain caused for one of this four diagnoses: subacromial syndrome/rotator cuff tendonitis without calcification; partial-total rotator cuff tear; rotator cuff calcifying tendonitis; adhesive capsulitis. Patients have performed treatment at home and at hospital, based on relieve pain, improve movement and strengthen rotator cuff and scapular muscles. Main outcome measures: age, sex, professión, traumatic injury, diagnosis, to have or not a radiological diagnosis, pain duration, number of treatment sessions, Constant test preand post-treatment and needing another consultation for the same problem. Stadistics tests used: Wilcoxon test, Mann-Whitney and Kruskal-Wallis Test, Pearson’s χ2 and Spearman’s correlations. Significant at the 0,01 and 0,05 level. Results. Sample of 278 patients: 187 women and 91 men. Age: 56,01 ± 11,07 years. Most comon diagnoses: Subacromial syndrome/rotator cuff tendonitis without calcification:57,20 %. Not traumatic injury: 70,30 %. Clinical diagnosis was confirmed by radiological diagnosis in 50,40 %. Pain duration:8,28 ± 6,98 months. Number of rehabilitation sessions:10,53 ± 5,11. Constant test: 57,03 ± 10,52 points pre-treatment and 70,10 ± 11,94 post-treatment. The 74,80 % of the patients did not need another consultation for shoulder pain. The 9,50 % needed surgery. Conclusions. We consider our treatment protocol to be reliable to treat SP in those patients with the described diagnoses

[Space-time distribution of suicide in Galicia, Spain [1976-1998]]. / Distribución geográfica y temporal del suicidio en Galicia (1976-1998).

OBJECTIVE: To study the space-time distribution of suicide in Galicia from 1976 to 1998, taking into account gender, age, season and method of suicide. METHODS: For each sex crude and age-adjusted rates per province and age-specific rates per period (1978-84, 1985-91, 1992-98) were calculated. To estimate mortality risk and time trends in the municipalities, a Bayesian hierarchical model was used. RESULTS: In the last few years mortality from suicide has increase considerably. Age-adjusted rates of 6 per 105 at the beginning of the study rose to 10 per 105 at the end. The increase was greatest among men. The higher rates were observed in the elderly, although in terms of time trends the highest increase occurred among adolescents and young adults. In both sexes the main method of suicide was hanging. Less common methods were jumping from a height and shooting. The greatest number of suicides took place during the spring and summer months. In terms of spatial distribution, a high number of suicides were committed in the province of Lugo; in the municipalities, mortality risk decreased from North to South and an inverse temporal trend was observed in both sexes. This differed from the space-time patterns of suicides committed using methods other than hanging. CONCLUSIONS: Suicide is an important health problem in Galicia not only because to its magnitude but also because of the increasing rates, especially among young people. Geographical and temporal analysis can identify priority areas where preventive policies should be implemented.

Distribución geográfica y temporal del suicidio en Galicia (1976-1998) / Space-time distribution of suicide in Galicia, Spain [1976-1998]

Objetivo: Estudiar la distribución geográfica y temporal de la mortalidad por suicidio en Galicia desde 1976 a 1998, teniendo en cuenta el sexo, la edad, la estacionalidad y el método empleado. Métodos: Para cada sexo se calcularon las tasas provinciales, brutas y ajustadas por edad y las tasas específicas por edad y período (1978-1984, 1985-1991, 1992-1998). Para la estimación del riesgo y la tendencia temporal en el ámbito municipal se utilizó un modelo jerárquico bayesiano. Resultados: La mortalidad por suicidio aumentó considerablemente en los últimos años, pasando de tasas ajustadas en torno al 6 por 105 en los primeros años de estudio a tasas del 10 por 105 en los últimos, siendo este aumento más acentuado en los varones. Las tasas más elevadas se observan en edades avanzadas, aunque al valorar la tendencia temporal, los mayores incrementos se presentan en adolescentes y adultos jóvenes. El principal método de suicidio, tanto en varones como en mujeres, ha sido el ahorcamiento, seguido a gran distancia por la caída de lugar elevado y el uso de armas de fuego. Los meses con mayor número de suicidios corresponden a la primavera y el verano. En cuanto a la (..) (AU)

Objective: To study the space-time distribution of suicide in Galicia from 1976 to 1998, taking into account gender, age, season and method of suicide. Methods: For each sex crude and age-adjusted rates per province and age-specific rates per period (1978-84, 1985-91,1992-98) were calculated. To estimate mortality risk and time trends in the municipalities, a Bayesian hierarchical model was used. Results: In the last few years mortality from suicide has increase considerably. Age-adjusted rates of 6 per 105 at the beginning of the study rose to 10 per 105 at the end. The increase was greatest among men. The higher rates were observed in the elderly, although in terms of time trends the highest increase occurred among adolescents and young adults. In both sexes the main method of suicide was hanging. Less common methods were jumping from a height and shooting. The greatest number of suicides took place during the spring (..) (AU)