Tratamiento de las estenosis traqueobronquiales mediante técnicas de neumología intervencionista y revisión de la literatura / Treatment of tracheo-bronchial stenosis using interventional pulmonology techniques and a review of the literature

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[Validation of a Spanish questionnaire to evaluate habits, attitudes, and understanding of exposure to sunlight: "the beach questionnaire"]. / Validación de un cuestionario en español sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar: <>

BACKGROUND: Questionnaires are the usual method for investigating sun-related behavior. However,such tools must be validated through evaluation of their measurement properties.The aim of the present study was to assess the validity and reliability of a Spanish questionnaire evaluating habits, attitudes, and understanding of exposure to sunlight. PATIENTS AND METHODS: In a cross-sectional study, the questionnaire was administered to a sample of 422 participants found on beaches. For the test-retest analysis, 70 hospital-based health professionals were interviewed on 2 separate occasions.The construct validity, internal consistency, and reproducibility were analyzed. RESULTS: Factorial analysis of the principal components confirmed the construct validity with commonalities and factor saturations > 0.50, and revealed multiple dimensions with Cronbach a values > 0.70.The items on habits and understanding showed intraclass correlation and d coefficient values > 0.70, but those on attitude had lower stability values (0.50-0.80). CONCLUSIONS: This is the first Spanish questionnaire with demonstrated validity and reliability for evaluating habits, attitudes, and understanding of exposure to sunlight. It will be a useful instrument for future epidemiologic studies and research into the prevention of skin cancer in Spain.

Validación de un cuestionario en español sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar: «Cuestionario a pie de playa» / Validation of a Spanish Questionnaire to Evaluate Habits, Attitudes, and Understanding of Exposure to Sunlight: 'The beach questionnaire'

Introducción. Los cuestionarios son el método habitual de investigación de las conductas relacionadas con la exposición solar. Sin embargo, para que un instrumento sea válido debe acreditar sus propiedades de medición. El objetivo del presente trabajo fue evaluar la validez y la fiabilidad de un cuestionario en español sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar en la playa. Pacientes y método. Se realizó un estudio de corte transversal administrándose el cuestionario a una muestra de 422 participantes a pie de playa. Para la prueba del test-retest se encuestó a 70 participantes del medio hospitalario en dos ocasiones diferentes. Se analizaron la validez, la consistencia interna y la reproducibilidad de los ítems del instrumento. Resultados. El análisis factorial de los componentes principales mostró valores de comunalidades y saturaciones factoriales > 0,50, y reveló la presencia de múltiples dimensiones que presentaron valores de coeficiente alfa de Cronbach > 0,70. Los ítems de comportamientos y conocimientos evidenciaron coeficientes de correlación intraclase y delta > 0,70. Los ítems del apartado de actitudes mostraron valores moderados de estabilidad (0,50-0,80). Conclusiones. Se presenta el primer cuestionario sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar, elaborado en español, con garantías de validez y fiabilidad. Este instrumento constituirá una herramienta de utilidad en la investigación epidemiológica y del ámbito de la prevención primaria del cáncer de piel en España (AU)

Background. Questionnaires are the usual method for investigating sun-related behavior. However, such tools must be validated through evaluation of their measurement properties. The aim of the present study was to assess the validity and reliability of a Spanish questionnaire evaluating habits, attitudes, and understanding of exposure to sunlight. Patients and Methods. In a cross-sectional study, the questionnaire was administered to a sample of 422 participants found on beaches. For the test-retest analysis, 70 hospital-based health professionals were interviewed on 2 separate occasions. The construct validity, internal consistency, and reproducibility were analyzed. Results. Factorial analysis of the principal components confirmed the construct validity with commonalities and factor saturations > 0.50, and revealed multiple dimensions with Cronbach a values > 0.70. The items on habits and understanding showed intraclass correlation and d coefficient values > 0.70, but those on attitude had lower stability values (0.50-0.80). Conclusions. This is the first Spanish questionnaire with demonstrated validity and reliability for evaluating habits, attitudes, and understanding of exposure to sunlight. It will be a useful instrument for future epidemiologic studies and research into the prevention of skin cancer in Spain (AU)

[Analysis of the epidemiological characteristics and prognostic factors in probable or confirmed invasive meningococcal disease in a cohort of adolescents and adults during an epidemic outbreak]. / Análisis de las características epidemiológicas y de los factores pronósticos en la enfermedad meningocócica invasiva probable o confirmada en una cohorte de adolescentes y adultos durante un brote epidémico.

OBJECTIVE: To describe the profile of people suffering Invasive Meningococcal Disease in Andalusia and the Canary Islands, and identify the risk factors for death. MATERIAL AND METHODS: A retrospective study was designed, recruiting cases from week 41 of 1995 to week 40 2000. Cases were probable or definite, and were extracted from the databases of the hospital by examining diagnosis at discharge or death. RESULTS: 167 cases were identified, with a mortality rate of 7.2%. Mean age was 28.88 years, this being greater in those who died (p = 0.041). There was no previous contact with the Health System before the diagnosis in 56.3% of the cases, this being associated with death (p = 0.017). The more frequent reason for contact was a low level of consciousness, and it was the only one associated to death (p = 0.036). Pharyngotonsilitis was associated with a lower incidence of death. About 24% of patients received antibiotics as out-patients and their use was associated to a lower incidence of death (p = 0.07). Temperature over 40 degrees C (p = 0.003) and heart rate lower than 60 beats per minute (p < 0.0005) were associated with death. Leucocytes in peripheral blood less than 4.500 cells/ microliter, or platelets less than 100.000 cells/microliter were associated with a greater proportion of deaths. In Cerebrospinal fluid, less than 5 leucocytes per microliter, or proteins less than 50 mg/dl were associated with more deaths. Neisseria meningitidis B was isolated in 47 patients (28.1%), and C in 77 cases (46.1%). Sepsis was significantly associated with death (p < 0.0005). CONCLUSIONS: The absence of previous contacts with the Health System reveals an abrupt onset of Meningococcal disease, with less inflammatory response and very severe. Out of hospital antibiotic treatment and pharyngoamygdalitis are associated with a better prognosis.

Análisis de las características epidemiológicas y de los factores pronósticos en la enfermedad meningocócica invasiva probable o confirmada en una cohorte de adolescentes y adultos durante un brote epidémico / Analysis of the epidemiological characteristics and prognostic factors in probable or confirmed invasive meningococcal disease in a cohort of adolescents and adults during an epidemic outbreak

Objetivos: Describir el perfil de la población afectada por enfermedad meningocócica invasiva en Andalucía e Islas Canarias, identificando los factores de riesgo de muerte. Material y métodos: Estudio retrospectivo desde la semana 41 de 1995 hasta la semana 40 de 2000. Los casos eran probables o confirmados, extraídos de las bases de datos hospitalarias (CMBD). Resultados: Se recogieron 167 casos, con una mortalidad del 7,2%. La edad media fue 28,88 años, siendo mayor en los que fallecieron (p=0,041). No hubo contacto previo con el sistema sanitario antes del diagnóstico en el 56,3% de los casos, lo que se asoció a fallecimiento (p=0,017). El motivo de consulta más frecuente fue la disminución del nivel de conciencia, y el único que se asoció a mortalidad (p=0,036). La historia de faringoamigdalitis previa fue un factor protector frente a la ocurrencia de muerte. El 24% recibieron antibióticos extrahospitalarios, y su uso se asoció a menor incidencia de muerte (p=0,07). Una temperatura superior a 40° C (p=0,003), y una frecuencia cardiaca inferior a 60 lpm (p<0,0005), la presencia de leucopenia de menos de 4.500 cel/mm3 o plaquetopenia de menos de 100.000 cel/mm3 estaban asociadas a mayor proporción de muertes. En el líquido cefalorraquídeo (LCR) menos de 5 leucocitos/mm3 o menos de 50 mg/dl de proteínas se asociaron a mayor incidencia de muerte. La Nesisseria meningitidis B fue aislada en 47 casos (28,1%) y la C en 77 (46,1%). La sepsis estuvo asociada de forma significativa (p<0,0005) a mortalidad. Conclusiones: La ausencia de contactos previos con el sistema sanitario revela un cuadro de instauración abrupta, con escasa respuesta inflamatoria sistémica y muy grave. El consumo de antibióticos previos, y la historia de faringoamigdalitis se asociaron a mejor pronóstico (AU)

Objective: To describe the profile of people suffering Invasive Meningococcal Disease in Andalusia and the Canary Islands, and identify the risk factors for death. Material and methods: A retrospective study was designed, recruiting cases from week 41 of 1995 to week 40 2000. Cases were probable or definite, and were extracted from the databases of the hospital by examining diagnosis at discharge or death. Results: 167 cases were identified, with a mortality rate of 7.2%. Mean age was 28.88 years, this being greater in those who died (p=0.041). There was no previous contact with the Health System before the diagnosis in 56.3% of the cases, this being associated with death (p=0.017). The more frequent reason for contact was a low level of consciousness, and it was the only one associated to death (p=0.036). Pharyngotonsilitis was associated with a lower incidence of death. About 24% of patients received antibiotics as out-patients and their use was associated to a lower incidence of death (p=0.07). Temperature over 40°C (p=0.003) and heart rate lower than 60 beats per minute (p<0.0005) were associated with death. Leucocytes in peripheral blood less than 4.500 cells/microliter, or platelets less than 100.000 cells/microliter were associated with a greater proportion of deaths. In Cerebrospinal fluid, less than 5 leucocytes per microliter, or proteins less than 50 mg/dl were associated with more deaths. Neisseria meningitidis B was isolated in 47 patients (28.1%), and C in 77 cases (46.1%). Sepsis was significantly associated with death (p<0.0005). Conclusions: The absence of previous contacts with the Health System reveals an abrupt onset of Meningococcal disease, with less inflammatory response and very severe. Out of hospital antibiotic treatment and pharyngoamygdalitis are associated with a better prognosis (AU)

Interpretation of a serial Mantoux test taking into account the annual risk of tuberculous infection.

BACKGROUND: Interpretation of tuberculin tests (TSTs) can be difficult. However, it is even more difficult to classify an individual as infected or non-infected if he or she has undergone a prior TST, as the difference between the booster effect and true conversion is not always clear. OBJECTIVE: To determine the size of the induration that is indicative of true infection after a second Mantoux test, based on the fact that the annual risk of tuberculous infection (ARTI) is equivalent, regardless of whether it is calculated directly or indirectly. METHOD: We performed two TSTs in the same population (aged 6 years at the first examination) with a 1-year interval. We calculated the prevalence of infection the first year (1.16%, 95%CI 0.67-1.65) and the ARTI using the indirect method (0.18%, 95%CI 0.00-0.37). For the second year, we considered different induration sizes and finally accepted a diameter of >10 mm as the criterion according to which the ARTI, calculated directly, corresponded to the value of the previous year (0.18%). CONCLUSION: Although they served as an aid in the interpretation of the TST, calculations of this type will probably be unnecessary in the future, when in vitro diagnostic tests for tuberculosis are made available in every health centre, thus enabling the classification of those individuals with indurations of intermediate size in the TST.

[Post-traumatic stress disorder in premature newborns]. / Trastorno por estrés postraumático en nacidos prematuros.

INTRODUCTION: Preterm newborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). PATIENTS AND METHODS: Prospective follow-up study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. RESULTS: The number of responses considered to be pathological observed among neonates, in the mothers' arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR = 3.3). CONCLUSIONS: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU.

Trastorno por estrés postraumático en nacidos prematuros / Post-traumatic stress disorder in premature newborns

Introducción: El recién nacido prematuro es fisiológicamente inmaduro y vulnerable. Tras el alumbramiento, se enfrenta a un contingente de estímulos adversos, radicalmente opuestos a la calidez del útero materno. En este estudio se pretende evaluar la prevalencia de las alteraciones emocionales del recién nacido y la influencia del contacto físico con la madre durante el ingreso en una unidad de cuidados intensivos neonatales (UCIN). Pacientes y métodos: Estudio de seguimiento prospectivo de una cohorte de recién nacidos ingresados en una UCIN, con grupo de comparación de recién nacidos a término, no ingresados. Resultados: Comparando el número de respuestas consideradas patológicas dentro de la incubadora/cuna y fuera de la misma en brazos de la madre, se hallaron los siguientes promedios: en brazos de la madre, 0,6/h, y en la incubadora/ cuna, 20,6/h (p < 0,001). Se encontraron diferencias estadísticamente significativas respecto a la presencia de reacciones patológicas a estímulos externos que favorecían la reexperimentación del acontecimiento traumático (riesgo relativo: 3,3). Conclusiones: Sin duda, son muchos los factores que deben considerarse en la prevención del desarrollo de trastorno por estrés postraumático, y son investigaciones de esta índole las que nos impulsan a pensar en la necesidad de realizar estudios sobre modificaciones ambientales en la UCIN

Introduction: Preterm neborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). Patients and methods: Prospective follow-up study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. Results: The number of responses considered to be pathological observed among neonates, in the mothers' arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR 3.3). Conclusions: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU

[Priority of prescribed medication in patients with heart failure in an Internal Medicine Department]. / Prioridad de las prescripciones farmacéuticas a pacientes con insuficiencia cardíaca en un Servicio de Medicina Interna.

BACKGROUND AND OBJECTIVE: Prescriptions provided to elderly patients with comorbidity on hospital discharge are usually complex. This study has aimed to know what proportion of drugs is considered essential by the prescribing doctors and the existing agreement on this qualification. METHODS: Cross-sectional study. SETTING: general acute care hospital. STUDY SUBJECTS: random sample of 60 hospital discharges in patients hospitalized due to heart failure between 2004 to 2006 with 540 prescribed drugs. INTERVENTIONS: independent review by two internal medicine specialists and qualification of each of prescribed drugs as essential, advisable or not indicated. Calculation of the proportion of prescriptions according to priority, global and by therapeutic groups, and of the agreement between reviewers. RESULTS: An average of 9 drugs (statistical deviation [SD] 2.4) and 13.5 daily takings (SD 4.6) by patient were prescribed on hospital discharge. The reviewers considered 68.4% of the prescriptions essential (95% confidence interval [CI], 65.5-71.2), advisable 25% (95% CI, 22.4-27.6) and not indicated 6.6% (95% CI, 5.1-8.1). An inverse relation between number of prescribed drugs and their proportion considered as essential was observed. Global agreement between reviewers in the classification of priority was relatively low: weighed Kappa 0.27 (95% CI, 0.19-0.36). More than 90% of the prescriptions were considered as essential in only 6 of the 15 therapeutic groups prescribed most, and good agreements in the qualification of their priority was only reached in 3 groups. CONCLUSIONS: A considerable proportion of the prescribed medication on hospital discharge in patients with heart failure was not considered essential. Agreement reached between the reviewers in this qualification was low.

Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial.

OBJECTIVE: Evaluate the efficacy of acupuncture associated with physiotherapy for patients with painful shoulder. METHODS: In a multicentre controlled randomized study, participants were recruited with a clinical diagnosis of unilateral subacromial syndrome from six rehabilitation medicine departments belonging to the Public Health System in two Spanish regions. All participants received 15 sessions of physiotherapy during the 3 weeks that the treatment lasted and were randomized to additionally receive, once a week, acupuncture or mock TENS (transcutaneous electrical nerve stimulation). The primary outcome measure was the change in the Constant-Murley Score (CMS) for functional assessment of the shoulder, at 4 weeks after randomization. This study is registered as an International Standard Randomized Controlled Trial, number ISRCTN28687220. RESULTS: A total of 425 patients were recruited. The mean score (s.d.) on the CMS had increased by 16.6 (15.6) points among the acupuncture group, compared with 10.6 (13.5) points in the control group, and the mean difference between the two groups was statistically significant (6.0 points; 95% CI 3.2, 8.8 points; P < 0.001). By the end of the treatment, 53% of the patients in the acupuncture group had decreased their consumption of analgesics, compared with a corresponding 30% among the control group (P < 0.001). CONCLUSIONS: Single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesic medicaments.

[Spanish adaptation and diagnostic validity of the Yale Global Tics Severity Scale]. / Adaptación al español y validez diagnósticade la Yale Global Tics Severity Scale.

AIM: The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global Tics Severity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument for quantifying the clinical evolution of patients with Tourette syndrome. PATIENTS AND METHODS: Analysis of the properties of the adapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis), internal consistency (Cronbach's alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change (Wilcoxon rank sum test). RESULTS: The factor analysis confirmed the existence of two dimensions on the scale, which account for 76.3% of the variability. The internal consistency, measured by Cronbach's alpha, was 0.997 for the motor tic dimension and 0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to or greater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the global scores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for the first interview (incorporation into the study group) and the second one (after 15 days' treatment). CONCLUSIONS: The Spanish version of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity and reliability is greater in the motor and phonic tic dimensions than in that of disability.

Adaptación al español y validez diagnóstica de la Yale Global Tics Severity Scale / Spanish adaptation and diagnostic validity of the yale global tics severity scale

El instrumento de medida habitualmente utilizado para valorar la gravedad clínica del síndrome deTourette es la Yale Global Tics Severity Scale (YGTSS), originariamente escrita en inglés, y no existe una versión validada enespañol que permita su aplicación directa a los pacientes hispanohablantes. Objetivo. Analizar las propiedades psicométricasde la versión de la YGTSS, traducida al español, y su sensibilidad para medir cambios, como instrumento para cuantificar laevolución en pacientes con síndrome de Tourette. Pacientes y métodos. El análisis versa sobre la validez del concepto (análisisfactorial de componentes principales), consistencia interna (alfa de Cronbach), fiabilidad intraobservadores (coeficientede correlación intraclase) y sensibilidad al cambio (test de rangos de Wilcoxon). Resultados. El análisis factorial confirmó laexistencia de dos dimensiones en la escala, que explican el 76,3% de la variabilidad. La consistencia interna fue de 0,997 parala dimensión tics motores, y de 0,996 para la dimensión tics fónicos. La fiabilidad intraobservadores fue igual o superior a0,95, tanto en los 10 ítems referidos a los tics (motores y fónicos) como en el ítem de discapacidad. En las puntuaciones globalesde tics motores, tics fónicos y discapacidad, hubo diferencias estadísticamente significativas entre la media de puntuaciónentre la primera entrevista (entrada en el estudio) y la segunda entrevista (a los 15 días de tratamiento). Conclusiones.La adaptación efectuada al español de la YGTSS cumple adecuadamente las tres propiedades psicométricas en nuestra poblaciónde estudio. La validez y fiabilidad es mayor en las dimensiones de tics motores y fónicos que en la discapacidad

The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global TicsSeverity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument forquantifying the clinical evolution of patients with Tourette syndrome. Patients and methods. Analysis of the properties of theadapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis),internal consistency (Cronbach’s alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change(Wilcoxon rank sum test). Results. The factor analysis confirmed the existence of two dimensions on the scale, which account for76.3% of the variability. The internal consistency, measured by Cronbach’s alpha, was 0.997 for the motor tic dimension and0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to orgreater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the globalscores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for thefirst interview (incorporation into the study group) and the second one (after 15 days’ treatment). Conclusions. The Spanishversion of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity andreliability is greater in the motor and phonic tic dimensions than in that of disability

Association between polymorphisms of folate-metabolizing enzymes and risk of prostate cancer.

Polymorphisms of the genes 5'-10'-methylenetetrahydrofolate reductase (MTHFR, 677CT and 1298AC), methionine synthase (MTR, 2756AC) and methionine synthase reductase (MTRR, 66AC) provoke variations in enzyme activity, which can lead to alterations in the metabolism of folates and in the synthesis of S-adenosyl-methionine (SAM), the most active methyl donor in the body. This could play an important role in carcinogenesis through the degree of DNA methylation and of nucleotide synthesis. In the present study, four polymorphisms were studied, two of the methylenetetrahydrofolate reductase gene, and the other two of methionine synthase and methionine synthase reductase. Our aim was to study the association between prostate carcinoma susceptibility and these polymorphisms. A hospital-based case-control study was conducted in 182 patients (mean age: 70.7+/-7.29 years) with histologically confirmed prostate carcinoma and in 205 control subjects (mean age: 70.3+/-7.82 years) diagnosed with benign prostatic hyperplasia (BPH). Genomic DNA was extracted from peripheral leukocytes. Comparison of the MTHFR CT and TT genotypes in patients and the controls revealed significant differences (0.57 vs 0.38) (OR: 2.19, 95% CI: 1.46-3.30) and (0.06 vs 0.15) (OR: 0.36, 95% CI: 0.17-0.73), respectively. No statistically significant differences were found between patients and controls with respect to the MTHFR 1298AC, the MTR 2756AC and the MTRR 66AC polymorphisms. However, among the patients, the MTR 2756 allele C was related to a high Gleason score. We conclude that the polymorphism MTHFR C677T is clearly related to prostatic carcinogenesis, on the contrary to the other polymorphisms studied, although the MTR 2756 allele C acts as a factor of tumor aggressiveness, this being found in tumors with high carcinogenic potential.

[Crohn's disease and pregnancy. A descriptive and retrospective study]. / Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo.

OBJECTIVES: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. MATERIAL AND METHODS: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. RESULTS: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). CONCLUSIONS: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed.

Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo / Crohn’s disease and pregnancy. A descriptive and retrospective study

Objetivos: El objetivo del presente estudio fue determinar el comportamiento de la enfermedad de Crohn durante el embarazo, así como la influencia de esta enfermedad en la presencia del recién nacido de bajo peso. Material y métodos: Se ha realizado un estudio descriptivo y retrospectivo de todas las pacientes con enfermedad de Crohn a quienes se les ha efectuado un seguimiento en el Hospital Costa del Sol. Se incluyó a 124 pacientes gestantes, que se clasificaron en 2 grupos: con embarazos antes y después del diagnóstico de la enfermedad. En todas ellas se recogieron los siguientes datos: clinicoepidemiológicos, actividad de la enfermedad durante la gestación y posparto inmediato, así como el tipo de parto asistido y el peso del recién nacido. Resultados: El 66,1% de las gestaciones se produjo antes de conocer el diagnóstico de la enfermedad, el 31,5%, después del diagnóstico, y el 2,4%, coincidió con el inicio de la enfermedad. Al comparar el tipo de parto asistido y el bajo peso al nacimiento, en las gestantes con o sin diagnóstico de la enfermedad, no se encontraron diferencias estadísticamente significativas entre ambos grupos (p = 0,064; p = 0,643). El 100% de las pacientes no fumadoras permanecía en fase quiescente y no presentaba recaídas de la enfermedad durante el transcurso del embarazo, mientras que el 61,1% de las pacientes fumadoras mantenía inactiva la enfermedad, y el 38,9% presentaba recaídas o una actividad crónica (p = 0,003). Conclusiones: El curso de la enfermedad inflamatoria intestinal no afecta de forma adversa a la evolución de la gestación o posparto inmediato, así como tampoco a la mayor presencia de recién nacidos de bajo peso o de cesáreas practicadas

Objectives: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. Material and methods: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. Results: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). Conclusions: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed

Una búsqueda bibliográfica fallida; ¿qué faltó por buscar? El caso del test de Lattinen / A failed bibliographical search. What was lacking? The case of the Lattinen test

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Resultados de la implantación del Plan de Actuación Conjunta en el Infarto Agudo de Miocardio / Results of the implementation of a joint management plan for acute myocardial infarction

Objetivos. Analizar la efectividad, fiabilidad y seguridad de la trombólisis prehospitalaria en el infarto agudo de miocardio en el Distrito Sanitario "Costa del Sol" de Málaga. Diseño. Estudio de intervención en el que se compara un periodo (fase I) en el cual aún no se realizaba trombólisis prehospitalaria, con otro posterior (fase II) en el que sí se hacía. La efectividad del proceso se midió por el porcentaje de trombólisis realizadas dentro de las dos primeras horas de evolución del infarto agudo de miocardio, la fiabilidad por el número de pacientes tratados fuera del hospital con trombólisis no indicadas, y la seguridad por el número de complicaciones relacionadas con la misma ocurridas en los tratamientos extrahospitalarios. Se realizó un ajuste mediante regresión logística en el que se tuvieron en cuenta las posibles variables de confusión relacionadas con el porcentaje de tratamientos realizados dentro de las dos primeras horas. Resultados. El porcentaje de tratamientos realizados dentro de las dos primeras horas de infarto agudo de miocardio en la fase II (49 por ciento) es significativamente mayor (p< 0,001) que en la fase I (8 por ciento). El modelo de regresión logística múltiple demostró que los pacientes que recibieron el tratamiento trombolítico extrahospitalario en la fase II tuvieron 130 veces más posibilidades de recibir dicho tratamiento dentro de las dos primeras horas del infarto agudo de miocardio que los pacientes tratados con trombolíticos en la fase I en el hospital. No se realizó ningún tratamiento prehospitalario no indicado, y no se objetivó ninguna complicación relacionada con la trombólisis prehospitalaria.Conclusiones. La trombólisis prehospitalaria en nuestro Distrito Sanitario demuestra ser una intervención efectiva, fiable y segura (AU)

Resultados de la descompresión subacromial mediante artroscopia / Results of arthroscopic subacromial decompression

Objetivo. Evaluar los resultados clínicos de la descompresión subacromial artroscópica tras la realización de un protocolo de tratamiento. Material y método. Se estudiaron 44 pacientes diagnosticados de síndrome subacromial clínica y radiológicamente. Todos fueron tratados de forma conservadora con medicación y fisioterapia durante al menos 6 meses. Fueron intervenidos mediante artroscopia, realizándose descompresión subacromial, y evaluados preoperatoriamente y a los 6 meses tras la intervención con la escala de valoración de Constant y Murley. Resultados. La puntuación pasó de 37,72 puntos preoperatoria a 73,43 a los 6 meses de la intervención. La mejoría fue estadísticamente significativa en todos los parámetros de la escala, siendo más llamativa en cuanto al dolor. El 89 por ciento de los pacientes encontró una mejoría subjetiva buena o muy buena. No se presentaron complicaciones durante la cirugía y el procedimiento se pudo realizar en el hospital de día. Conclusiones. La descompresión subacromial artroscópica es un procedimiento con buenos resultados subjetivos y objetivos, con escasas complicaciones y estancia corta (AU)

[Factors associated with hospitalization for ambulatory care sensitive conditions in municipalities]. / Factores asociados a la hospitalización por procesos sensibles a cuidados ambulatorios en los municipios.

OBJECTIVES: To describe variability in admission rates for ambulatory care sensitive conditions (ASSC) in municipalities in the catchment area of a tertiary hospital and to determine the influence of primary care characteristics, socioeconomic factors, health of the population, and geographical accessibility to the hospital on this variability. METHODS: An ecological study was carried out in 34 municipalities in the area served by the Hospital Virgen de las Nieves in Granada (Spain) including all admissions for ASSC from 1997 to 1999. The admission rates for men and women were calculated separately and were age-standardized by the indirect method. The following factors were analyzed as independent variables: characteristics of primary care (type of healthcare model and type of center), socioeconomic factors (unemployment rate, income per capita, number of business establishments, size of municipality), health (mortality rate), and accessibility (time in minutes from the municipality to the hospital). A multiple lineal regression model was estimated. RESULTS: A total of 9.8% of all hospital admissions were due to ASSC. The mean annual admission rate was 10 admissions per 1.000 inhabitants. This rate was higher for men and for persons aged more than 74 years. The standardized admission ratios were not statistically different from 1 in 56% of the municipalities and were higher than 1 in 26% and lower than 1 in 18%. Sixty-two percent of the variability in rates for men was associated with time taken to reach the hospital, size of municipality, the interaction between both variables, and mortality. Eighteen percent of the variability in rates for women was associated with time taken to reach the hospital and the unemployment rate. CONCLUSIONS: Variability in admission rates for ASSC was not associated with primary care characteristics in the geographical area analyzed. Accessibility (measured as time to the hospital) was the only variable associated with higher rates in both men and women. Admission rates for ASSC among women were higher when unemployment rates were higher, and rates among men were higher in larger municipalities and in those with higher mortality.