Study of the metabolomic relationship between lung cancer and chronic obstructive pulmonary disease based on direct infusion mass spectrometry.

The high prevalence of lung cancer (LC) has triggered the search of biomarkers for early diagnosis of this disease. For this purpose the study of metabolic changes related to the development of lung cancer could provide interesting information about its early diagnosis. In this sense, chronic obstructive pulmonary disease (COPD), a disease associated with tumor development, is a comorbidity that increases the risk of onset and progression of lung neoplasia and has also to be considered in the study of pathology related to lung cancer. This work develop a metabolomic approach based on direct infusion mass spectrometry using a hybrid triple quadrupole-time of flight mass spectrometer (DI-ESI-QqQ-TOF-MS) in order to identify altered metabolites from serum of LC and COPD patients and evaluate its relationship and implication in the progression of LC. This methodology has been applied to 30 serum samples from LC, 30 healthy patients used as controls (HC) and 30 serum samples from COPD to found altered metabolites from both LC and COPD diseases. In addition, some metabolic differences and similarities were found in Pulmonary Emphysema and Chronic Bronchitis patients. On the other hand, altered metabolites were studied in different stages of LC (II, III and IV) to evaluate the perturbation of them throughout the progression of disease. The sample treatment consisted of the extraction of polar and non-polar metabolites from serum that was later infused into the mass spectrometer using an electrospray ionization source in positive and negative mode. Partial least squares discriminant analysis (PLS-DA) allowed a classification between LC, HC and COPD groups in all acquisition modes. A total of 35 altered and common metabolites between LC and COPD, including amino acids, fatty acids, lysophospholipids, phospholipids and triacylglycerides were identified, being alanine, aspartate and glutamate metabolism the most altered. Finally, ROC curves were applied to the dataset and metabolites with AUC value higher than 0.70 were considered as relevant in the progression of LC.

Clinical markers of asthma and IgE assessed in parents before conception predict asthma and hayfever in the offspring.

BACKGROUND: Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences offspring's asthma and allergy in humans. OBJECTIVE: We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs. after birth, with offspring asthma and hayfever. METHODS: The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991 to 1993, and data on 9100 offspring born 1972-2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions. RESULTS: Offspring asthma with hayfever was more strongly associated with parental BHR and specific IgE measured before conception than after birth [BHR: aRRR = 2.96 (95% CI: 1.92, 4.57) and 1.40 (1.03, 1.91), respectively; specific IgEs: 3.08 (2.13, 4.45) and 1.83 (1.45, 2.31), respectively]. This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11-22 years with information on parental disease activity both before and after birth. CONCLUSION & CLINICAL RELEVANCE: Parental BHR and specific IgE were associated with offspring asthma and hayfever, with the strongest associations observed with clinical assessment before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hayfever.

Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after total knee replacement. / Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla.

INTRODUCTION: Total knee replacement is usually a very painful procedure. A single-dose of femoral nerve block has been shown to provide similar analgesia to an epidural, with fewer side effects, but limited in time. OBJECTIVE: To compare the analgesia provided by dexamethasone used at perineural level in the femoral nerve block after total knee replacement with the one used at intravenous level, and with that of a control group. MATERIAL AND METHODS: A prospective, randomised, double-blind controlled trial was conducted on 81 patients randomly assigned to one of three groups: 1)IV dexamethasone (8mg); 2)perineural dexamethasone (8mg), and 3)placebo. All patients received 20ml of ropivacaine 0.5% for femoral nerve block. The primary outcome was the duration of the sensory-analgesic block of the femoral nerve block. The secondary outcomes included pain intensity measurements, patient satisfaction, and incidence of complications. RESULTS: Randomisation was effective. Analgesia duration was significantly higher (P<.0001) in the perineural dexamethasone group (mean 1152.2min, 95% confidence interval [95% CI]: 756.9-1547.6) in comparison with the control group (mean 186min, 95%CI: 81.2-292) and dexamethasone IV group (mean 159.4min, 95%CI: 109.8-209). Postoperative pain, complications and side effects were also lower in this group. CONCLUSIONS: Dexamethasone prolongs sensory block of single dose of femoral nerve block using ropivacaine. It also provides better analgesia and patient satisfaction, with fewer side effects.

Estudio epidemiológico de seguimiento de asma en adolescentes de la ciudad de huelva / Epidemiological study of the follow up of asthma in adolescents of Huelva city

Objetivo: Analizar y comparar la incidencia de asma en adolescentes y adultos de Huelva. Determinar los cambios (aparición, persistencia y remisión) de sibilancias, hiperreactividad bronquial (HB) y asma, así como esclarecer los posibles factores de riesgo de asma incidente. Metodología: Seguimiento de 9 años de la cohorte original tras el estudio transversal inicial. Se realizó una segunda evaluación de los 2 grupos analizados, 401 niños del Estudio de Enfermedades Respiratorias y 204 adultos del Estudio Europeo de Enfermedades Respiratorias. Ambos realizaron un cuestionario sobre síntomas respiratorios, una espirometría y una prueba de metacolina. Resultados: La incidencia anual acumulada de asma en los niños (15,69/1000 personas-año) fue tres veces superior a la de los adultos (4,76/1000 personas-año). En los niños hubo un 24,2% de apariciones y un 4,3% de remisiones de sibilancias en los últimos 12 meses. De esta forma, las apariciones superaban a las remisiones (p < 0.001). También se produjeron más apariciones que remisiones en HB (13,9% vs 5,4%;p = 0,02) y asma (9,3% vs 3%; p = 0,004). En los adultos se encontraron más apariciones que remisiones (15,7%vs6,9%;p= 0,011)de sibilancias e HB (10,1% vs3% ; p =0,017) no se hallaron cambios significativos en el seguimiento de asma. Los factores de riesgo más importantes relacionados con asma incidente fueron: tener sibilancias (RR: 8,12) y opresión torácica(RR: 9,17) al estar cerca de un animal. Conclusiones: La incidencia de asma en adolescentes es tres veces superior a la de los adulto (AU)

Objective: To analyse and to compare the incidence of asth main adolescents and adults of Huelva. To determine the changes (appearance, persistence and remission) of wheezing, bronchialhyper-responsiveness(BH) and asthma, as well as to clarify the potential risk factors for incidence of asthma. Methodology: Nine year follow-up of the original cohort after the initial cross-sectional study. A second evaluation was made of the 2 analysed groups, 401 children of the Respiratory Diseases Study and 204 adults of the European Respiratory Diseases Study. Both groups completed a questionnaire on respiratory symptoms, spirometry and methacholine challenge test. Results: The accumulated annual incidence of asthma in children(15.69/1000 persons / year) was three times higher than in adults (4.76/1000 persons / year). In children there were24.2% of occurrences and 4.3% of remissions of wheezing in the last 12 months. Thus, the occurrences exceeded remissions(p < 0.001). There were also more occurrences than remissions in BH (13.9% vs. 5.4%; p = 0.02) and asthma (9.3%vs. 3%; p = 0.004). In adults, there were more occurrences than remissions (15.7% vs. 6.9%; p= 0.011) of wheezing and BH (10.1% vs. 3%; p =0,017) with no significant changes found in the asthma follow-up. The most important risk factors associated with incident asthma were presence of wheezing (RR: 8.12) and thoracic oppression (RR: 9.17) when being near an animal. Conclusions: The incidence of asthma in adolescents is three times higher than in adults (AU)

Premenstrual asthma and leukotriene variations in the menstrual cycle.

BACKGROUND: Several authors have reported an increase in leukotriene C4 in the premenstrual phase in women with severe premenstrual asthma, indicating that antileukotrienes could be used in treatment. OBJECTIVE: To analyse the role of leukotrienes in premenstrual asthma. METHODS: A questionnaire on respiratory symptoms and peak flow during one complete menstrual cycle was given to women of fertile age to define them as asthmatics who suffered from premenstrual asthma or not. Premenstrual asthma (PMA) was defined as a clinical or functional deterioration (≥20%) in the premenstrual phase compared with the preovulatory phase. Blood samples to measure leukotriene C4 were taken during the preovulatory and premenstrual phases. RESULTS: Blood samples were taken in 62 asthmatic women, 34 of whom (54.3%) presented PMA criteria, all with a premenstrual deterioration of between 20 and 40%. There was no difference in leukotriene C4 levels between the preovulatory and premenstrual phases in the women who suffered from PMA (1.50ng/mL vs. 1.31ng/mL; p=0.32) and those who did not (1.40ng/mL vs. 1.29ng/mL; p=0.62). Neither were there any differences in leukotriene levels between women with or without PMA. The results were similar for each category of asthma severity. CONCLUSIONS: Our data show that leukotriene C4 does not appear to be involved in the pathogenesis of premenstrual asthma, or support the use of anti-leukotrienes in the specific treatment of premenstrual asthma, at least in women with a moderate premenstrual deterioration. No differences appeared in any of the categories of asthma severity.

Variability in the prevalence of premenstrual asthma.

Our aim is to analyse the differences in the prevalence of premenstrual asthma (PMA) according to a set of criteria, the relationship between them and the influence of asthma severity. The answer "Yes" to "Does your asthma get worse before menstruation?" was considered subjective PMA. A daily respiratory symptoms register of fertile asthmatic females was taken during two consecutive menstrual cycles. For the semi-objective diagnosis, an exacerbation of > or =20% was required in the symptoms register. Objective diagnosis was a premenstrual worsening of > or =20% of peak flow. We selected 103 patients. Subjective premenstrual deterioration was perceived in 43.7%. The semi-objective deterioration of symptoms in the first cycle occurred in 44.7%, and in 22.3% in both cycles. A total of 54.3% of females with semi-objective criteria in the first cycle perceived a subjective deterioration of symptoms, versus 35.1% of those without semi-objective criteria (p = 0.05). PMA was present at all levels of asthma severity, with no clear link to the degree of severity. The detection of PMA prevalence, the subjective perception of this deterioration and its presence at all levels of asthma severity lead us to urge research into possible premenstrual deterioration in all fertile asthmatic females.

Asma premenstrual, relación con la severidad del asma y su apreciación subjetiva / Premenstrual Asthma, relation between the severity of the asthma and its subjective appreciation

Introducción: diversos estudios, aunque con resultados dispares, han relacionado el asma premenstrual (AP) con la severidad delasma. Por otra parte, no existe uniformidad respecto al hecho de que las pacientes con AP manifiesten una percepción subjetiva de empeoramiento de su asma en el periodo premenstrual. Objetivo: estudiar en mujeres asmáticas, con o sin criterios de AP, la relación con la clasificación del asma (GINA 2005) y el hecho de manifestar un empeoramiento de su asma en el periodo premenstrual. Material y método: se ha realizado un estudio observacional trasversal sobre una población de mujeres asmáticas en edad fértil en las que se realizó un cuestionario en el que se recogía, entre otros aspectos, la clasificación del asma (GINA 2005) y el hecho de manifestar un empeoramiento de los síntomas asmáticos en el periodo premenstrual. Por otra parte, se recogía diariamente durante un ciclo menstrual completo un cuestionario de síntomas respiratorios–SR– (tos, disnea, sibilancias y opresión torácica) y los valores depeak flow (PF) matutino y vespertino durante dicho ciclo. Se considera AP al empeoramiento > 20% en el PF y/o en los síntomas asmáticos (>20%) en el periodo premenstrual. Resultados: hasta el momento, han completado la recogida de los cuestionarios y los valores de PF, en los distintos hospitales participantes,82 pacientes. (6 graves, 29 moderados, 26 persistentes leves y 21 intermitentes leves). De ellas, 35 (42,7%; IC 95%: 31,96-53,41) presentaban criterios clínicos de asma premenstrual. Presentaban criterios funcionales 3 de las mujeres (3,7%), cumpliendo todas ellas también criterios clínicos. El asma premenstrual se distribuyó con frecuencia similar en los distintos grupos de gravedad(p=0,98). Las mujeres con AP reconocían con mayor frecuencia(61,8% frente a 40,4%) el empeoramiento premenstrual de sus síntomas (p=0,06).(..) (AU)

Introduction: A number of studies, although with incongruent results, have related premenstrual asthma (PA) to the severity of the asthma. On the other hand, there is no uniformity regarding the fact that patients with PA express a subjective perception of a worsening of their asthma during the premenstrual period. Objective: To study asthmatic women with/without PA criteria, the relationship between the classification of the asthma (GINA2005) and whether there is a worsening of their asthma during the premenstrual period. Materials and method: A transverse observational study was carried out on a population of fertile, asthmatic women, who completed a questionnaire in which included, amongst other aspects, the asthma classification (GINA 2005) and whether there was a manifest worsening of the asthmatic symptoms during the premenstrual period. On the other hand, a questionnaire of respiratory symptoms (RS), including cough, dyspnea, sibilance and thoracic oppression, was completed daily, during a complete menstrual cycle, plus the Peak Flow values in the morning and evening during this cycle. PA is consider edif there is a worsening >20% during the PF and/or in the asthmatic symptoms (>20%) during the premenstrual period. Results: Up to now, the completed questionnaires have been collected and the values of the Peak Flow (PF), at the different participating hospitals, 82 patients (6 serious, 29 moderate, 26 persistent light and21 intermittent light). Of these, 35 (42.7%; IC95%: 31.96-53.41) presented clinical criteria of Premenstrual Asthma. Three of the women presented functional criteria (3.7%), all them also fulfilling clinical criteria. Premenstrual asthma was distributed with a similar frequently in the different groups of seriousness (p=0.98). The women with PA recognized with more frequency (61.8% as against 40.4%) the premenstrual worsening of their symptoms (p=0.06). (..) (AU)

[Inter-observer variability in the diagnosis and classification of diabetic retinopathy through biomicroscopy]. / Variabilidad interobservador en el diagnóstico y clasificación de la retinopatía diabética mediante biomicroscopía.

OBJECTIVE: Analysis of the inter-observer variability of biomicroscopy used for the diagnosis of Diabetic Retinopathy. METHODS: This was a descriptive study. Parallel observer-blind evaluations of the degree of retinopathy in type 2 diabetic patients, as defined on biomicroscopic photographs, were performed by two ophthalmologists. The sample size required for the Kappa index among ophthalmologists with a disagreement ratio of 15%, precision ratio of 5% and confidence level of 95% is n=196 (<> being the number of eyes). The only variable measured was the degree of Diabetic Retinopathy, according to the modified Early Treatment Diabetic Research Study (ETDRS) classification. RESULTS: The average age of the 217 patients photographed was of 65.42 years (SE= 9.91). In 191 instances there was total agreement between the 2 ophthalmologists. In 24 instances the discrepancy was only of one degree of the classification of the ETDRS, and in 2 the discrepancy was of two degrees. In no case was it greater than this. (Quadratic weighed Kappa = 0.876, IC95%: 0.655-0.952 and linear weighed Kappa = 0.804, IC95%: 0.729-0.878). CONCLUSIONS: The Weighed Kappa index demonstrated a <> agreement of the degree of diabetic retinopathy. The discrepancies were slight, were of no clinical importance, and would not have affected treatment decisions. The results indicate that this examination, performed by a single ophthalmologist, can be utilised as a reference standard in Diabetic Retinopathy diagnosis.

Cambios en la prevalencia de síntomas de asma e hiperreactividad bronquial en el seguimiento de dos cohortes poblacionales de la ciudad de Huelva / Changes in the prevalence of asthma symptoms and bronchial hyper-reactivity in the follow-up of two population groups of the Huelva city

Objetivo: Analizar los cambios en la prevalencia de síntomas asmáticos e hiperreactividad bronquial (HB) que ocurren con la edad en dos cohortes de adolescentes y adultos jóvenes de la ciudad de Huelva. Material y métodos: Se ha realizado una segunda evaluación en el seguimiento de las dos poblaciones estudiadas entre 1991 y1993: jóvenes adolescentes de 11 a 16 años (n= 714), incluidos en el Estudio de Enfermedades Respiratorias de Huelva (EERH-I), y adultos jóvenes de 20-44 años (n=271), incluida en el Estudio Europeo de Enfermedades Respiratorias (ECRHS-I) de la ciudad de Huelva, a las que se realizaron cuestionario de síntomas respiratorios(SR) y prueba de hiperreactividad bronquial inespecífica con metacolina (MT). En la segunda evaluación, realizada con un seguimiento promedio de 9 años, se consiguió estudiar a 401 de los “niños - adolescentes” y 204 de los “adultos jóvenes”. Al igual que en la fase previa, se ha realizado en ambas población es el mismo cuestionario sobre síntomas respiratorios, una espirometría y una prueba de provocación bronquial inespecífica con metacolina. Se comparan las prevalencias de sibilancias (Sib), HB y asma encontradas en la misma población (niños o adultos), en ambos cortes trasversales (1991 y 2.001). Se comparan los resultados obtenidos entre ambas poblaciones. Resultados: Entre los años 1991 a 2001, tanto en jóvenes como en adultos, se incrementan los síntomas respiratorios, especialmente las sibilancias y la disnea, en reposo y al ejercicio. La hiperreactividad bronquial se incrementa claramente en los jóvenes(p<0.001) y sólo ligeramente en los adultos (NS). Como consecuencia de lo anterior, el diagnóstico epidemiológico de asma (sibilancias+ HB) se incrementó de forma significativa sólo en los jóvenes. Otro dato destacable en los niños era que recibían tratamiento para el asma sólo la mitad de los que estaban diagnosticados de asma por un médico y que éstos eran menos que los que referían haber tenido sibilancias en los últimos 12 meses. La discrepancia entre sibilancias y diagnóstico de asma era más evidente en adultos. Conclusiones: En la década de los 90 y en la ciudad de Huelva, una ciudad con elevada prevalencia de sibilancias (Sib) y nivel medio-bajo de hiperreactividad bronquial (HB) y asma, los SR y la HB se van incrementando durante la adolescencia y se estabilizan en la edad adulta. Esto podría explicarse tanto por la historia natural de la enfermedad como por la diferente influencia de las condiciones ambientales en las diferentes edades

Objective: To analyze the changes in the prevalence of asthmatic symptoms and bronchial hyper-reactive (BHR) conditions, which occur with age, in two groups of adolescents and young adults from the city of Huelva. Material and Methods: A second follow-up evaluation was performed on the two populations studied between 1991 and 1993:adolescents between 11 and 16 years of age (n = 714), included in the Study of Breathing Illnesses of Huelva (EERH-I), and young adults 20-44 years old (n=271), included in the European Study of Breathing Illnesses (ECRHS-I) of the city of Huelva. A questionnaire about breathing symptoms (BS) and a non-specific test of bronchial hyper-reactivity with methacholine (MT) were administered. In the second evaluation, carried out with an average follow up of 9 years, it was possible to study 401 of those “child-adolescents” and 204 of those “young adults.” The same as in the previous phase, both populations were administered the same questionnaire about breathing symptoms, aspirometry and a non-specific bronchial provocation test with methacholine was performed. The prevalence of wheezing, BHR and asthma found in the same population (children or adults) was compared in both cross samples (1991 and 2001). The results obtained were compared between both populations. Results: Between the years 1991 and 2001, both in adolescents and adults, the breathing symptoms increased, especially wheezing and dyspnea, at rest and at exercise. Bronchial hyper-reactivity had a clear increase in the adolescents (p < 0.001) and only a slight increase in the adults (NS). As a consequence of the above, the epidemiologic diagnosis of asthma (wheezing + BHR) increased significantly in adolescents. Another outstanding fact in the children was that only half of those medically diagnosed with asthma received treatment for their asthma, and amongst these, there were fewer that said they had experienced wheezing in the last 12 months. The discrepancy between wheezing and the diagnosis of asthma was more evident in adults. Conclusions: In the 90s and in the city of Huelva, a city with a high prevalence of wheezing and medium-low level of bronchial hyper-reactivity (BHR) and asthma, BS and the HR have increased during adolescence and stabilized in adulthood. This could be explained both by the natural evolution of the disease and by the different influences of the environmental conditions at the different ages

[Improper use of medications with alcohol at a rural office]. / Uso inadecuado de fármacos junto con alcohol en un consultorio rural.

OBJECTIVES: To determine the prevalence of the joint use of alcohol and medication with the risk of interaction with alcohol, the social and personal features of patients most likely to use the two combined, and the extent of anti-alcohol medical counselling of these patients. DESIGN: Prevalence study. SETTING: Primary care. Rural local clinic at Trigueros (Huelva). PARTICIPANTS: 581 histories of patients over 14, started between October 1993 and December 1996. MEASUREMENTS AND MAIN RESULTS: From the clinical histories we obtained the social and personal features, toxic habits, type and number of medicines prescribed, and whether or not there was medical counselling on alcohol consumption. Potential interactions were looked for through the list provided by Mengual Sandra and Gila Azañedo. 10.15% (95% CI, 7.8-12.9) of the subjects consumed at the same time medication with risk of interaction and alcohol. Males (OR = 7.1), over-65s (OR = 4.9), married people (OR = 3.1) and smokers (OR = 2.3) were more likely to combine alcohol and at-risk medication. 6.8% of the patients with potential risk of interaction were counselled against alcohol. CONCLUSIONS: The simultaneous use of alcohol (as drinks or a component of medicine) and at-risk drugs is a common reality in primary care. Men, the over-65s, smokers and married people are at greater risk. Medical counselling of patients at potential risk of interaction is quite rare, although it is greater than of drinkers who do not take at-risk medicines.

Uso inadecuado de fármacos junto con alcohol en un consultorio rural / Improper combined use of medicines and alcohol at a rural clinic

Objetivos. Determinar la prevalencia de uso conjunto de alcohol y medicación con riesgo de interacción con el alcohol, las características sociodemográficas de los sujetos con más probabilidad de este uso conjunto y la prevalencia de consejo médico antialcohol en los citados sujetos. Diseño. Estudio de prevalencia. Emplazamiento. Atención primaria. Consultorio local rural de Trigueros (Huelva). Participantes. El total de 581 historias de pacientes mayores de 14 años, abiertas en el período de octubre de 1993 a diciembre de 1996. Mediciones y resultados principales. Obtuvimos de las historias clínicas las características sociodemográficas, hábitos tóxicos, tipo y número de fármacos prescritos y si hubo o no consejo médico sobre el consumo de alcohol. Se realizó la búsqueda de potenciales interacciones a través del listado proporcionado por Mengual Sandra y Gila Azañedo. Un 10,15 por ciento (IC del 95 por ciento, 7,8-12,9 por ciento) de los sujetos historiados consume conjuntamente alcohol y medicación de riesgo de interacción. Los varones (OR, 7,1), mayores de 65 años (OR, 4,9) casados (OR, 3,1) y fumadores (OR, 2,3) tienen más probabilidad de combinar medicación de riesgo y alcohol. El consejo antialcohol se realizó en un 6,8 por ciento de los sujetos historiados con riesgo potencial de interacción. Conclusiones. El uso concurrente de alcohol (como componente de medicación o bebidas) y fármacos de riesgo es una realidad frecuente en atención primaria. Los varones, mayores de 65 años, fumadores y casados presentan mayor riesgo. El consejo médico a pacientes con riesgo potencial de interacción es muy poco habitual, aunque más que en bebedores que no consumen fármacos de riesgo (AU)

[Professional unemployment in Andalucia. Expectations and difficulties in the nursing profession]. / Desempeño profesional en Andalucía. Expectativas y dificultades en enfermería.

The primary objective of this article is to know the professional, academic and formative expectations in Nursing and those problems which hinder the performance of this profession among the Andalucian public health centers. The authors carried out an extensive descriptive study during the years 1994-1996 based on a sampling of 1020 nursing professionals pertaining to the Andalucian Health Service. These samples were obtained by means of a random stratification by provinces and care level, with an affixation proportional to the size of the stratum, having a 95% confidence rate and a 3.5% error rate. The data were acquired by means of a self-administered questionnaire sent in by mail. Among the most significant results, the authors highlight that fact that the professional, academic and performance expectations among Andalucian Nursing professionals center on research and investigation (71.5%), postgraduate courses (75%), possible Licentiate in Nursing (82.4%) and some nursing specialty (78.7%). Among the difficulties identified for professional performance, the items which stands out were those derived from the absence of a legal definition for Nursing functions (90.8%).

[Maternity education in primary care. Efficacy, utility and satisfaction of pregnant women]. / Educación maternal en atención primaria. Eficacia, utilidad y satisfacción de las embarazadas.

OBJECTIVE: To evaluate the Maternity Education (ME) programme: improvement of previous knowledge, changes in hygiene and dietary habits, attitudes to giving birth, satisfaction with the development of the sessions and perceived use. DESIGN: Pre-test/post-test. SETTING: Urban Health Centre. PARTICIPANTS: 222 pregnant women who attended ME. 211 answered the first questionnaire, 145 also the second, and 113 all three. MEASUREMENTS AND MAIN RESULTS: Self-administered questionnaires on social and demographic profile, hygiene and diet habits and knowledge of pregnancy, birth and caring for the new-born. Satisfaction and perceived use survey. Mean overall knowledge went up by 4.97 points (CI 95%: 4.5-5.44). Age (p < 0.0001), greater educational level (p < 0.001) and not being primiparas (p < 0.001) were linked to better initial knowledge. 46.7% of smokers stopped smoking between the start of pregnancy and the start of ME. By the end 23.6% of the women smoked, with an average of 4.53 cigarettes per day. Consumption of milk products per day went up from 2.78 to 3.07 (p = 0.002). Those taking physical exercise went up from 22.4% to 57.6% (p = 0.0001). 99.5% considered the sessions very pleasant; 89%, easily understandable; and 100% took part freely in the discussions. 86.7% had little or no fear of giving birth. 92.8% found the breathing exercises useful; and 69.8% the relaxation exercises. 98.2% thought that all pregnant women should experience ME. CONCLUSIONS: Group ME is effective for improving knowledge and health habits. Pregnant women thought it useful for confronting the birth and were very satisfied with the methods used.

[European study of asthma. Prevalence of atopy in young adults of 5 areas in Spain. Spanish Group of European Asthma Study]. / Estudio Europeo del Asma. Prevalencia de atopia en adultos jóvenes de 5 áreas españolas. Grupo Español del Estudio Europeo del Asma.

BACKGROUND: The aim of the current study is to show the prevalence of atopy in five Spanish areas, and its variability according to area, age and gender. PATIENTS AND METHODS: From a populational based sample of 16,884 individuals aged 20 to 44 years-old, we obtained a randomized 20% subsample (n = 3,310). Participants performed specific IgE measurements, skin prick tests, forced spirometries and metacholine challenges to measure bronchial hyperresponsiveness. The response rate was 40%, and 1,313 individuals were finally included in the study. Specific atopy to the following aeroallargens was determined: cat dander, Cladosporium, Dermatophagoides, Phleum, Parietaria, birch, Alternaria, ambrosia, olive, rye grass and dog dander. RESULTS: The global prevalence of atopy (detectable specific antibodies IgE in serum and/or skin reactivity) widely varied by area, skin reactivity ranking in males from a minimum in Albacete (24.6%; 95% CI: 18-33) to a maximum in Huelva (39.6%; 95% CI: 30-53), and in females ranking from a minimun in Galdakao (10.3%; 95% CI: 6-17) to a maximum in Barcelona (28.8%; 95% CI: 19-43). Considering separately seropositivity and skin reactivity we observed a similar trend. Males showed a higher prevalence of global atopy (40.1%) than females (29.4%). Our data indicate that there is a decrease in the prevalence of atopy according to age in the general population, but only significant in men. Dermatophagoides pteronyssinus is the most common allergen in all ares but Albacete, where the most common allergen is the olive pollen. CONCLUSIONS: By means of a standard methodology, we report population data of the prevalence of atopy in five Spanish areas. The distribution of the prevalence of atopy varies widely in the five areas surveyed, according to the composition of the most common environmental allergens.

[An analysis of the reliability of a data-gathering form. An interobserver concordance study]. / Análisis de la fiabilidad de una hoja de recogida de datos. Estudio de concordancia interobservador.

OBJECTIVES: To measure the reliability of a data-gathering from by analysing the concordance between observers, and to check the efficacy of the corrective measures applied to improve it. DESIGN: A pre-test/post-test design, without a control. SETTING: Urban Health Centre. PATIENTS AND OTHER PARTICIPANTS: Random selection of 50 clinical records from the list of Type 2 diabetics in the centre's computerised files. INTERVENTIONS: Alterations in the data-gathering form in order to improve concordance between two independent observers, measured by means of the Kappa index for qualitative variables and absolute concordance for quantitative ones. The quality criteria defined by the Diabetes in Primary Health Care Study Group were applied. MEASUREMENTS AND MAIN RESULTS: The Kappa index average improved after the intervention from 0.71 to 0.89 (p = 0.019). There were no significant changes in concordance for quantitative variables (6 out of 8 items with 100% concordance at start and finish). CONCLUSIONS: It is important to verify the reliability of the measuring instruments. Our results justify this concern: two independent observers do not always obtain the same reading from the same source. Concordance improved significantly when the form was altered, so guaranteeing greater data-gathering reliability and improving the overall quality of the research.

[Hyperalphalipoproteinemias and medical advise in primary care. Changes of the lipid pattern]. / Las hiperalfalipoproteinemias y el consejo médico en atención primaria. Modificaciones del patrón lipídico.

OBJECTIVE: To analyse the modifications in the lipid pattern experienced in the observance of patients with Hyperalpha-lipoproteinaemia (HAL). DESIGN: A prospective follow-up study. SETTING: La Orden Primary Care Centre, Huelva. PATIENTS: 120 diagnosed with HAL (cHDL higher than the 90 percentile of their same age and sex group from a reference population with cLDL and Triglycerides less than 150 and 200 mg/dl, respectively) and observed for 2.5 +/- 1.5 years. MEASUREMENTS AND RESULTS: Blood pressure, weight, size, cholesterol, cHDL, cLDL, Triglycerides, Glucaemia and Uric acid were determined. The modifications in the diagnosis of HAL, and changes in averages and percentages of several variables, were calculated. Out of 95 people (79.1%) (Age: 42.6 +/- 16), HAL was confirmed in 42.1% (CI, 24.8-59.4) and Hypercholesterolaemia 11a in 20%. There was no lipid disorder in 37.9%. CONCLUSIONS: HAL at a high rate was not confirmed. After HAL is diagnosed, we must be cautious in our advice on cardiovascular protection, as it could be secondary or be modified over time.

[Relation between asthma and atopy markers in children and young adults]. / Relación entre asma y marcadores de atopia en niños y adultos jóvenes.

The aim of this study was to assess whether atopy, measured as total IgE level (IgEt) and/or skin test (ST) reactivity is related to bronchial asthma in the same way in children and young adults. Three hundred fifty-three children between 11 and 15 years of age (mean 12.6 years) and 208 adults between 20 and 44 years old (mean 32.1 years) were selected randomly as representative of persons living in the city of Huelva (Spain). All subjects filled out a questionnaire on respiratory symptoms (The European Community Respiratory Health Survey--[ECRHS]) and were given a methacholine challenge test (MT) with results expressed as PD20 as well as IgEt and ST assessments of atopy. We defined bronchial asthma as the association of having experienced wheezing within the last 12 months and having a positive ST. Among children, 4.5% suffered bronchial asthma. Among adults the proportion was 5.3%. The IgEt value that best discriminated between asthmatics and non asthmatics was 145.5 U/ml in children (sensitivity 75% and specificity 69.1%) and 96.6 U/ml in adults (sensitivity 90.9% and specificity 73.6%). A logarithmic transformation (log IgEt) was used to study the relation between bronchial asthma and IgEt. By simple analysis, IgEt and ST were related to bronchial asthma in children (p = 0.002 and p < 0.0001, respectively), while only IgEt (p < 0.001) was related in adults. By multiple regression analysis, controlling for both factors simultaneously as well as for smoking in adults, we found that ST (p = 0.023) but not IgEt was related in children, whereas IgEt (p = 0.0005) but not ST was related in adults. We conclude that the two markers of atopy studied are related to bronchial asthma differently and have different manifestations at different stages of life. ST is more useful in children, whereas IgE determination is of more use in adults.

[Respiratory symptoms in a pediatric population]. / Síntomas respiratorios en población infantil.

With the aim of determining the prevalence of respiratory symptoms and rhinitis among adolescents in Spain, we sent a brief questionnaire about respiratory symptoms to all school children (9,644) in the sixth, seventh and eight grades in our city. We identified a symptomatic group (SG) consisting of adolescents who reported having had one or more of the following three signs within the past 12 months: a) waking with a feeling of stuffiness; b) experiencing an asthma attack, or c) taking medication for asthma. Returned questionnaires accounted for 74.4% of those distributed. The following symptoms were reported: wheezing by 13.4%, nighttime oppression by 8.4%, stuffiness at night by 7.3%, nighttime coughing by 24.8%, asthma attack by 4.5%, taking asthma medication by 6.1% and seasonal rhinitis by 15.4%. The proportion of symptomatic children was 11.6% (833). All symptoms studied that were not required for inclusion in SG correlated highly with that group (p < 0.0001). Neither age nor sex were related to inclusion.

[Epidemiology of dyslipidemias in a general adult population of the basic health area "La Orden de Huelva"]. / Epidemiología de las dislipemias en población general adulta de la zona básica de salud La Orden de Huelva.

OBJECTIVE: To find the prevalence of dyslipaemias in the general adult population. DESIGN: A crossover epidemiological study of a population base. SETTING: Primary Care. "La Orden" Health Centre, Huelva. PARTICIPANTS: 878 people over 19 chosen by random sampling stratified according to age and gender; obtained from the 1991 Municipal Census covering our Health area. MEASUREMENTS AND MAIN RESULTS: 802 people completed the study, which included a survey of demographic data, personal histories, cigarette consumption and recordings of weight, height, blood pressure, glycaemia, total cholesterol (TC), cHDL, cLDL, and triglycerides (TG). Prevalence of Hypercholesterolaemia (TC > 250) was 25.5% (CI 95%: 22.4-28.6); breaking down as 28.7% in men and 22.5% in women. Hypertriglyceridaemia (TG > 200) was 8.9% (CI 95%: 6.2-11.6); 15% in men and 3.2% in women. cHDL < 35 was 3.5% (CI: 2.2-4.8); 5.7% in men and 1.5% in women. cLDL > 150 was 43.6% (CI: 40.1-47.1%); 48.9% in men and 41.4% in women. Multiple linear regression showed links of TC and cLDL to age (p < 0.001). TGs increase in line with age, the Quetelet index (QI) and cigarette consumption (CC) (p < 0.001). cHDL diminishes in line with increases in the QI and CC (p < 0.0001). CONCLUSIONS: Given the high levels of dyslipaemias found, intervention measures must be based on the search for lipid disturbances in patients attending clinics as well as on strategies directed towards modifying hygiene-dietary habits, something necessary for over 70% of the population.