Risk factors for invasive disease among children in Spain.

OBJECTIVE: To identify the risk factors related to invasive disease caused by Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. METHODS: Case-control study. All hospitals of the region of Valencia in Spain (covering 95% of the population of Valencia). The patients are children aged less than 15 years in whom Hib, N. meningitidis or S. pneumoniae are isolated from normally sterile sites. RESULTS: From 1995 to 1998, 275 cases of invasive disease were analysed, and 243 hospital controls were selected in the month after the onset of the case. The paediatrician completed a survey administered to the relatives at the time of admission. The risk factors related to invasive disease by Hib were exposure to tobacco smoke (number of smokers, adjusted OR (aOR) 1.74, 95% confidence interval (CI) 1.02-2.96) and living with more than four people (aOR 3.72, 95% CI 1.3-3.7). For N. meningitidis, there is a dose-response relationship; if more than 60 cigarettes are smoked daily at home, the aOR is 3.61 (95% CI 1.04-12.57). If there are more than four people living in the household, aOR 1.69 (95% CI 1.01-2.85). In children under two years of age, having siblings less than 15 years of age (OR 1.76, 95% CI 0.75-4.17) and attending a day nursery represents a risk for suffering invasive pneumococcal disease (aOR 4.21, 95% CI 1.28-13.83). CONCLUSIONS: Among the variables tested, the modifiable risk factor is smoking; if smoking was reduced at home, the number of cases of invasive disease could be reduced in children, mainly in those under 5 years of age. Identification and vaccination of these risk groups would significantly reduce these diseases.

[Brachial artery flow-mediated dilation in healthy men, men with risk factors, and men with acute myocardial infarction. Importance of occlusion-cuff position]. / Dilatación de la arteria humeral mediada por flujo en varones sanos, con factores de riesgo e infarto agudo de miocardio importancia de la posición del manguito oclusor.

INTRODUCTION AND OBJECTIVES: Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the brachial artery. We sought to determine the most suitable position for the occlusion cuff for the study of FMD in three groups of adult men. SUBJECTS AND METHODS: We included 160 subjects, mean age 58.5 7.8 years: 40 healthy subjects, 80 with cardiovascular risk factors, and 40 patients with AMI. In a subgroup of 60 subjects, the first 10, 30, and 20 of each group, respectively, FMD was evaluated twice, after upper arm occlusion and forearm occlusion to induce hyperemia. RESULTS: In the initial substudy, the FMD after upper arm occlusion was 7.6 2.4% in healthy subjects, 5.1 2.2% in men with risk factors (p < 0.0001), and 3.5 2.2% in AMI patients (p < 0.041, with respect to the risk-factor group). FMD after forearm occlusion was 4.6 1.5%, 2.3 2.1% (p < 0.006), and 2.2 1.9%, respectively, with no significant statistical differences between the risk-factor and AMI groups. Only upper arm occlusion was performed in the remaining participants, as planned, because it provided the most accurate information. Overall, the FMD was, respectively, 7.8 3.1%, 5 2.6% (p < 0.0001) and 3.3 3% (p < 0.004, with respect to the risk-factor group). FMD was directly related to HDL cholesterol and inversely related to resting diameter and number of risk factors. CONCLUSION: The best approach to studying FMD is proximal occlusion since it allows for a better stratification of the with endothelial dysfunction. With this technique, a worsening of endothelial function in acute myocardial infarction can be demonstrated.

Dilatación de la arteria humeral mediada por flujo en varones sanos, con factores de riesgo e infarto agudo de miocardio. Importancia de la posición del manguito oclusor / Brachial artery flow-mediated dilation in healthy men, men with risk factors, and men with acute myocardial infarction. Importance of occlusion-cuff position

Introducción y objetivos. La dilatación mediada por flujo (DMF) es dependiente del endotelio y puede estudiarse con ultrasonidos en la arteria humeral. Quisimos conocer la localización idónea de la oclusión arterial para analizar adecuadamente la DMF en tres grupos de varones adultos.Sujetos y métodos. Se incluyó a 160 sujetos, con edad media de 58,5 ñ 7,8 años: 40 sujetos sanos, 80 con factores de riesgo cardiovascular y 40 pacientes con IAM. En un subgrupo de 60 sujetos -los primeros 10, 30 y 20 de cada grupo, respectivamente- se evaluó la DMF por duplicado, tras oclusión en el brazo y en el antebrazo para inducir la hiperemia.Resultados. En el subestudio inicial, tras oclusión proximal, la DMF fue 7,6 ñ 2,4 por ciento en sujetos sanos, 5,1 ñ 2,2 por ciento en sujetos con factores de riesgo (p < 0,0001), y 3,5 ñ 2,2 por ciento en pacientes con IAM (p < 0,041 respecto al grupo con factores de riesgo). La DMF tras compresión distal fue respectivamente: 4,6 ñ 1,5 por ciento, 2,3 ñ 2,1 por ciento (p < 0,006), y 2,2 ñ 1,9 por ciento, sin diferencias estadísticamente significativas entre los grupos con factores de riesgo e IAM. En el resto se evaluó la DMF mediante compresión proximal por aportar datos más precisos, según estaba previsto. Globalmente, la DMF en los 160 sujetos estudiados fue 7,8 ñ 3,1 por ciento, 5 ñ 26 por ciento (p < 0,0001) y 3,3 ñ 3 por ciento (p < 0,004, respecto al grupo con factores de riesgo), respectivamente. La DMF se relacionó directamente con el cHDL e inversamente con el diámetro basal y número de factores de riesgo.Conclusión. La oclusión proximal es el método óptimo para estudiar la DMF al conseguir una mejor estratificación de los sujetos con disfunción endotelial. Esta técnica permite demostrar que en el IAM se produce un empeoramiento de la función endotelial (AU)