[Therapeutic effectiveness of psoralen-UV-A bath therapy in psoriasis]. / Eficacia terapéutica del baño-PUVA en psoriasis.

INTRODUCTION: The use of psoralen baths with long-wave UV radiation, known as PUVA bath therapy, is useful in the treatment of psoriasis. The therapy is not associated with systemic adverse effects and the dose of UV-A radiation administered is lower. The objectives of this study aimed to identify the variables that influence the effectiveness of PUVA bath therapy and the duration of remission, as well as to determine factors that predict relapse. It also aimed to assess the effectiveness of a protocol using the minimal phototoxic dose and to compare two concentrations of 8-methoxypsoralen. PATIENTS AND METHODS: Two hundred nine patients with moderate-severe plaque psoriasis attended between 1994 and 2000 were included in the study. The characteristics and therapeutic outcomes of the sample were recorded. Survival curves were plotted for the disease-free interval after a good response to treatment. A proportional hazard model was used to assess the factors that influence the duration of remission. RESULTS: Therapeutic outcomes were better in patients with greater photosensitivity (p = 0.03). Application of the minimal phototoxic dose protocol was not associated with greater phototoxicity during treatment. The median duration of remission was 7 months. Those patients who had previously undergone oral PUVA therapy and those who did not achieve a substantial reduction in the psoriasis area and severity index (PASI) score were at greater risk of relapse. CONCLUSIONS: A lower final PASI extended the lesion-free period.

[The handicaps and the need for services among the aged detected in the health survey OARS-Vigo]. / Discapacidades y necesidades de servicios en las personas mayores detectadas en la encuesta de salud OARS-Vigo.

BACKGROUND: In populational studies the standardized questionnaires of multidimensional functional evaluation, particularly the Older Americans Resources and Services Program-Multidimensional Functional Assessment Questionnaire (OARS), have shown to be the most adequate tools to evaluate the elderly persons living within the community. METHODS: A health care survey was performed by personal interview in the homes of a stratified randomized sample of people over the age of 65 years in Vigo, Galicia, Spain obtained from the Municipal Inhabitants Patronage (n = 841) using complete validated versions of OARS in the Spanish and Gallician languages. RESULTS: The prevalence of severe/absolute handicap in the basic functional areas among this population over 65 years was 7.7% in physical health, 6.2% in mental health, 5.2% in economic resources, 6.7% in social work, and 9.5% in daily life activities (DLA). Twenty-two percent of the population presented severe/absolute handicaps in at least one of the dimensions. One point nine percent of the population studied required institutionalization: 2.6% required economic aid, 1.4% required home help for the instrumental DLA and 1.1% required help for both the basic and the instrumental DLA although these were not being provided. One point three percent were found to be ideal candidates for a telealarm/teleaid program. CONCLUSIONS: The use of the OARS questionnaire in Spain is useful to obtain information to be applied in the planning of health care services directed at elderly people.

[Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study]. / Nutrición enteral y alteraciones del gusto en pacientes diabéticos: estudio prospectivo doble ciego.

The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.

Assessment of trends in geographical inequalities in infant mortality.

After discussing the comparative effectiveness of different measures of dispersion used as indices of inequality, the Weighted Coefficient of Variation is proposed as an appropriate indicator of geographical inequality attending infant death. Furthermore, this paper proposes a methodology based on simple linear regression to be employed for the purposes of assessing the percentage of the observed change in said inequality over any given period, as is required by the terms of Target 1 of the WHO policy document "Health for All by the Year 2000". To this end, trends in Infant, Neonatal, Postneonatal and Perinatal Mortality in Spain for the period 1975-1986 have been analysed. For the 12 years examined, the Average Spanish Rate for these four indicators fell by over 50%. We observed a statistically significant decrease (34.8%) in geographical inequalities in the case of Postneonatal Mortality. However for the same period, geographical inequalities in Perinatal Mortality showed an important and significant rise (79.33%). It is suggested that, where Spain is concerned, it is Perinatal Mortality which should be assigned priority status for monitoring purposes. A plan of action should be drawn up, duly targeted at reducing geographical inequalities in health services, in the mother-and-child care sector above all.