[The elderly at risk in the province of Guadalajara]. / El anciano de riesgo en la provincia de Guadalajara.

OBJECTIVE: To study fragile elderly people in the population, their characteristics and their distribution according to fragility markers. DESIGN: Cross-sectional, descriptive study using a survey. SETTING: Primary care. Elderly people living in Guadalajara in January 2002. PARTICIPANTS: 434 people were interviewed (1.24% of population). There were 157 losses (26.6%). INTERVENTIONS: The questionnaire contained social and demographic variables (age, sex, setting), care variables (medication, pathologies, home care) and evaluative scales (Barthel, Folstein, Yesavage, Diaz-Palacios). MAIN MEASUREMENTS: Fragility markers: 3 or more pathologies, 6 or more drugs, dementia, and/or positive on one of the four scales used. RESULTS: Subjects lived in rural areas more (56.7%; CI, 52-61.3), but there were not more women. Fragile elderly, n=257 (59.2%; CI, 54.6-63.8), were more women (OR=1.8; CI, 1.5-2.2) and over 70 (OR=80-84, 5.2; CI, 3.7-7.5; OR=85-89, 8.2; CI, 5.3-12.8). Prevalence of markers was: 3 or more pathologies, 30.2% (95% CI, 25.8-34.5); cognitive deterioration, 22.6% (95% CI, 18.7-26.5); social risk, 20.8% (95% CI, 16.3-23.8); multi-medication, 18.7% (95% CI, 15-22.3); Barthel incapacity, 11.7 (95% CI, 8.7-14.8); depression, 5.3% (95% CI, 3.2-7.5); and dementia, 3.2% (95% CI, 1.6-4.9). Women suffered cognitive deterioration more. The over-80s suffered cognitive deterioration, social risk and incapacity more. CONCLUSIONS: There was high prevalence of fragility with cognitive deterioration, multi-medication and social risk; and lower presence of dementia. Women and the most elderly people were most affected.

[Prevalence of cancer in the Guadalajara health area]. / Prevalencia de cáncer en el área de salud de Guadalajara.

OBJECTIVE: To quantify the prevalence of cancerand its distribution in adults. DESIGN: Descriptive study of point prevalence through research into primary and secondary sources. SETTING: Primary care, Guadalajara Health Region. 133 539 people over 14 years old. PARTICIPANTS: Patients previously diagnosed with cancer, who had a health card in the health area in June 1999. MEASUREMENTS: Demographic and diagnostic details (location according to CIE-9, date and diagnostic method). DATA SOURCES: primary care clinical records, cancer morbidity records and attendance orders. Overall crude and adjusted rates, in function of sex and age group, and specific to locations, were calculated. They were compared with data from other studies and data calculated for Spain on the basis of WHO information. RESULTS: 2717 tumours (2595 patients). Mean age, 68.2 (95% CI, 67.6-68.7); diagnostic age, 62.8 (95% CI, 62.1-63.5), in both cases higher in men (P<.01). Most common tumours: prostate, bladder, colon and lung (men); breast, colon, endometrium and ovaries (women). Crude prevalence: men, 2303.8/100 000; women, 1763.8. Adjusted to world population: 1394.2 and 1227.4/100 000, respectively (prevalence ratio, 1.14; 95% CI, 1.03-1.25). Truncated rate higher in women than in men (1638/100 000 against 1308). Five-year period with highest prevalence: 75-79 years old in men (8763.5/100 000) and 80-84 in women (4558.7/100 000). CONCLUSIONS: Cancer prevalence in adults is slightly above 2%. Once adjusted for age, values are similar to other studies and as expected for our country. The most common tumours are in the digestive apparatus, breast and the genito-urinary system. The man/woman proportion is higher than that described in other studies.

[Prevalence of tuberculosis infection in the school age in Guadalajara, Spain]. / Prevalencia de la infección tuberculosa en el medio escolar de Guadalajara.

OBJECTIVES: To estimate the prevalence of tuberculosis infected children in the first grades of Primary Education and to analyse the distribution of infected people among social class groups and other previous circumstances. METHODS: Cross-sectional study with diagnostic test application and questionnaire survey, in a representative sample of the school population of the province of Guadalajara, Spain (two stages sampling design). Tuberculin skin tests with 2 I.U. of P.P.D. RT-23 and the Sokal method for lecture were used. For occupational classification and social class definition were used the criteria of the last report of Spanish Epidemiology Society. RESULTS: A total of 1,093 children (50.8% males) between 6 and 9-year-old were studied. The overall prevalence of infected children was 1.64 (I.C.:1-2.3). The distribution of infection did not show significant differences between urban/rural population, previous disease, family antecedent, social class, dwelling area and occupational activities of parents. The prevalence increased in the older upper school years and among the older children. Prevalence ranged from 0.4% (CI: 0.01-1.3) in the first year to 3.53% (CI: 2.4-4.6) in the last year. Children born in 1988 had a 3.23% prevalence (CI: 1.2-5,1), while those born in 1989; 1990 and 1991 had a prevalence of 0.73 (CI: 0-1.77), 1.88% (CI: 0.2-3.51) and 0.4% (0-1.2), respectively. CONCLUSIONS: Tuberculosis infection is less prevalent at school ages than other areas of Spain. In spite of the increase prevalence per school year, the low frequency and sample size did not allow to test for other associations.

[Prevalence of human immunodeficiency virus type 1 and Mycobacterium tuberculosis infections in a prison population in the years 1989 to 1995]. / Prevalencia de infección por el virus de la inmunodeficiencia humana tipo 1 y de Mycobacterium tuberculosis en una población reclusa entre los años 1989 y 1995.

BACKGROUND: This study was carried out to know the prevalence of human immunodeficiency virus type 1 (HIV-1) and Mycobacterium tuberculosis infection in a penitentiary center, the risk factors and the prevention measures to reduce this infection. SUBJECTS AND METHODS: 1,173 men from a penitentiary center between 1989-1995 were included. Demographic data, risk factors and penitentiary variables were studied. Antibodies against HIV were found and confirmed using Western blot; tuberculin skin reaction (PPD) and CD4 lymphocyte cant were studied. RESULTS: The mean age was 31.8 (SD 8.8 years). They were 61.5% Spanish people and 48.1% were in prison for second time. The 49.7% used illegal drugs. Overall prevalence of HIV-1 infection was 24.3%. The differences of percentages for HIV-1 infection in intravenous drug users (IVDU) were 67.7% and in non IVDU were 3.8% with a significant statistical difference (chi 2 = 557.5; p < 0.0001). Using a multivariate test (stepwise method) we found that the probability to be HIV-1 positive in a penitentiary center was 21.9 times higher in IVDU, 5.6 times in Spanish prisoners, 2.6 times in subjects with more than one prison stay and 1.7 times if they had tatoos. The global prevalence of tuberculosis infection (PPD positive) was a 43.8%, and was associated to the second time inmates in this penitentiary center (chi 2 = 22.1; p < 0.001). A 54.4% of HIV-1 positive people showed a CD4 T lymphocyte count > or = 500 x 10(6)/l. CONCLUSIONS: We found a high prevalence of HIV-1 and tuberculosis infection and drug use in this penitentiary center. HIV-1 was transmitted and related by sharing syringes between IVDU independent of the stay in prison. The diagnosis of HIV-1 infection was made soon. The treatments of drug users in penitentiary centers and programs for lowering the risk are very important.

[Epidemiology of leprosy through the study of frequency of visits to the Trillo Specialized Hospital in 1943-1995]. / Epidemiología de la lepra a través del estudio de la frecuentación en el hospital especializado de Trillo durante el período 1943-1995.

BACKGROUND: The purpose of this study is to describe the social-demographic and clinical profile of hospitalised leprosy patients and to check whether typology has changed during the history of the centre. METHODS: Descriptive and retrospective study, performed by means of reviewing a sample of the patient records registered at the Centre since it was founded in 1943 until 1995. 366 cases were chosen by means of a systematic random sample and questionnaires completed on social-demographic and clinical variables. RESULTS: Most of the patients were male (71.9%, IC: 67.3-76.4), young (39.6 years of age, IC: 37.9-41.4), single (46.2%, IC: 41-51.3%) with low levels of education (illiteracy: 54.1%, IC: 40-69) with occupations relating to farming (35.5%, IC: 30.6-40.4) from Southern Spanish regions (patients from Andalucía 52.8%, IC: 45.8-54). The disease showed a family background in 31.1% of cases (IC: 26.4-35.9) and serious multibacillary forms (Lepromatose Leprosy 66.1%, IC: 61.2-71), which affected lower limbs in 72.1% of cases, heads in 63.1% and upper limbs in 64.4%. Global mortality of people admitted to hospital was 31.1% (IC: 26.4-35.9). During the surveyed period, patient age increased, and symptoms and mortality decreased. In general, hospital stays were for long periods (7.1 years, IC: 6.1-8.1), although at the end of the surveyed period, stays decreased considerably, in accordance with the duration of treatment (2.2 years). CONCLUSIONS: A Young male, in a precarious financial situation living in the South of Spain appear to be the patient profile which, with severe initial anatomical symptoms and later favourable results may represent the disease in a country with an autocuthonous endemy and characteristic epidemiology, which is in the pre-eradication phase.