[Survival in a cohort of patients with chronic obstructive pulmonary disease: comparison between primary and tertiary levels of care]. / Supervivencia en una cohorte con EPOC. Análisis comparativo entre el primer y tercer niveles de atención.

OBJECTIVE: To compare the cumulative probability of survival in a cohort of patients with chronic obstructive pulmonary disease (COPD) attended at primary and tertiary levels of health care. PATIENTS AND METHOD: A cohort study was carried out at the Department of Pneumology of the Centro Medico Nacional La Raza (Mexico DF) on 87 of the 114 patients with confirmed diagnosis of COPD. All patients followed a 6-month physical activity and educational program. Patients underwent the COPD diagnostic tests recommended by the American Thoracic Society and were randomized and distributed in 2 groups: Group A had 44 patients who received tertiary care, and Group B had 43 who received primary care. Follow up lasted from 1993 to 2001. Exacerbations, hospital admissions, exercise duration, hospital stay, and death or study abandonment were recorded for all patients. Respiratory function tests were performed annually. Annual and total mortality, distribution by sex, loss in life expectancy, mean age at death, and cumulative probability of survival were analyzed. RESULTS: No differences were found between the groups in population or initial characteristics. Respiratory function declined in both groups, although the decline was smaller in Group A: mean (SD) forced expired volume in 1 second, 8.93% (8.72%) compared with 17.71% (2.51%) and annual drop in blood pressure of 1.39 mm Hg compared with 1.95 mm Hg. Annual exacerbations were 0.23 in Group A compared with 2.07 in Group B; hospitalizations, 0.06 compared with 0.92, and length of stay, 15.76 days compared with 17.32 days. Mean age at death was 66.12 compared with 60.6; loss of life expectancy was 13.88 years lost compared with 19.4, and the cumulative probability of survival was 0 compared with 0.224. CONCLUSIONS: There are many reasons for the differences found: better medical management, health education, and family involvement at the tertiary level. These factors, included in international COPD guidelines, must be incorporated into primary health care.

No-scalpel vasectomy: review of the first 1,000 cases in a family medicine unit.

In Mexico, the Mexican Institute of Social Security (IMSS) had adopted the no-scalpel vasectomy technique by the end of 1989. The technique was described by Dr. Li Shunquiang in 1974, and more than 60 million no-scalpel vasectomies have been performed in 26 countries. Among the advantages with no-scalpel vasectomy is that it has fewer complications (0.4%) compared to the traditional technique (3.1%). We studied 1,000 clinical charts of the subjects operated on between January, 1990 and January, 1993, with the objective of reporting our experiences as well as analyzing whether there existed a correlation between the subject's social and demographic characteristics and the number of control spermatic counts he attended postoperatively. In 97.9% of the cases, subjects had no postoperative hemorrhage or hematoma. None of the subjects had a surgical wound infection. In addition, 54.4% of the subjects came to the first control spermatic count, 39.7% came to the second, and only 18.4% came to all three controls. In an attempt to find a characteristic which defined the subject who attends his postoperative control spermatic counts, we found an association using chi2 between the attendance at two controls with the subjects who had been married from 6 - 10 years (p = 0.059), and with the subjects who had an income of three minimum wages. Regarding the attendance at all three controls, we found an association with subjects who had an income of two minimum wages (p = 0.037). We also found a weak correlation between the attendance at all three controls and the reason reported for not having more children (the couple did not want more children) (r = 0.07; p = 0.025) and with the manner in which the subjects were referred to the clinic (came on their own initiative) (r = 0.09; p = 0.006). Finally, we consider that no-scalpel vasectomy can be implemented as an adequate family planning method in Mexico's primary care centers. The lack of adequate attendance at postoperative control spermatic counts does not seem to have an important association with the subject's demographic characteristics, so it appears warranted that this issue be studied from a psychological point of view.

[Prevalence of Down's syndrome in Asturias, 1987-1993. Members of the Work Group of the RCDA]. / Prevalencia del síndrome de Down en Asturias, 1987-1993. Miembros del grupo de Trabajo del RDCA.

OBJECTIVE: To determine the frequency of Down Syndrome (DS) in Asturias and the prenatal diagnosis impact on the birth prevalence of this chromosomal anomaly. METHODS: The analysed data came from the Registry of Congenital Defects of Asturias (1990-1993) and from a retrospective study conducted by the same working group (1987-1989). The total prevalence rates and the prevalence at birth were calculated. RESULTS: Out of 55,601 births, DS was recorded in 83 cases: 69 livebirths, two fetal deaths and 12 induced abortions following prenatal diagnosis, giving a total prevalence rate of 14.9 per 10,000 and a birth prevalence of 12.8. The proportion of induced abortions was 15 per cent in this period; the proportion of cases in the high risk maternal age group (35 years and over) was around 50% of the total. The proportion of induced abortions was 15 per cent in this period. CONCLUSIONS: The frequency of DS in Asturias is comparable to the other populations. Prenatal diagnosis had little impact on the birth prevalence figures. These results may help us draw up prevention and prenatal diagnosis policies for these defects in Asturias when giving the frequency of this health problem.

[Infantile giardiasis. Study of 111 cases]. / Giardiasis infantil. Estudio de 111 casos.

One hundred eleven children with intestinal giardiasis, are studied taken into account: age, sex, place of residence, seasonal frequency, clinic, symptomatology, analyses, treatment and it efficacy and reinfections. Authors have investigated mainly the stools: presence of parasite in them, with only one sample, has been of 56.2%, reaching 70.7% when several samples were examined. Patients have been treated with metronidazole with good response in 93.3%, but 28.3% were infected again. Closed relatives of 99 children have also been examined and 21.4% presented infection.

[Previous antibiotic treatment in meningococcal infections]. / Tratamiento antibiótico previo en la infección meningocócica.

Seventy four cases of meningococcal infection were studied. They attended the "Valle del Nalón" Hospital in Asturias, from february 1979 until january 1985. Seven children died (9.4%). We divided them into two groups: A, without any previous antibiotic treatment when they arrived at the hospital (58 cases), and B, with previous antibiotic treatment (16 cases). All the children who died belonged to group A. Only 56.2% from group B had petechias, contrasting greatly with the 93.1% in group A. The most predominant meningococcus was from the serum group B. In the 22 cases of meningitis brainstem auditory evoked response was carried out to detect any hearing impairment. This was found in 21.7% of the cases.