Influencia del nivel educativo, la edad y la experiencia previa sobre los cuidados del niño con fiebre / Influence of level of education, age and prior experience on the management of a child with fever

La formación sanitaria de la población en un tema tan frecuente como el síndrome febril en la infancia es deficiente, en líneas generales, y motiva urgencias innecesarias, incrementa el gasto farmacéutico y tiene consecuencias negativas para la salud del niño (procedimientos erróneos y yatrogenia). El nivel educativo es un factor trascendente, pero un nivel educativo elevado no siempre lleva aparejado un grado de educación sanitaria suficiente. Los cuidadores menores de 20 años y mayores de 50 años, en general, destacan por su menor preparación en los cuidados del niño con fiebre. La experiencia de hijos anteriores aporta mejores conocimientos para el cuidado del niño, pero incrementa la automedicación con antibióticos (AU)

Estudio de conocimientos y actitudes de la población general ante un niño con fiebre / Study of the knowledge and attitudes of the general population concerning the management of a child with fever

Para conocer la necesidad de educación para la salud, se ha centrado la atención en una situación habitual: la fiebre. El estudio recoge 900 encuestas sobre conocimientos básicos y conducta ante un niño febril, aplicadas a personas al cuidado de niños en el momento de la realización. Las respuestas obtenidas confirman errores frecuentes en todos los apartados. La instrucción a los niños, las madres y los cuidadores se muestra esencial para reducir la urgencia innecesaria y la iatrogenia. Los cursos de puericultura dirigidos a este tipo de población deberían adquirir una mayor relevancia, incluyendo la educación general para la salud en las escuelas, a las madres potenciales y reales y, en general, al personal encargado del cuidado del niño (AU)

For the purpose of determining health education needs, we focused on a common complaint: fever. The study is based on 900 surveys dealing with basic knowledge and behavior in the event of fever in a child, distributed among caregivers working with children at the time it was carried out. This survey confirms the existence of common errors with respect to fever, antipyretic drugs and physical antipyretic measures. Education for children, mothers and caregivers is shown to be essential to reduce unnecessary emergencies and drug side effects. Greater emphasis should be placed on child care courses, including general education on health care offered in schools, to present and future mothers and, in general, to all caregivers dealing with children (AU)

[Management of myocardial infarction in Spain (1995-99). Data from the registry of the Ischaemic Heart Disease Working Group (RISCI) of the Spanish Society of Cardiology]. / Manejo del infarto de miiocardio en España (1995-99). Datos del registro de infartos de la sección de cardiopatía Isquémica y unidades coronarias (RISCI) de la Sociedad Española de Cardiología.

INTRODUCTION AND OBJECTIVES: Limited information is available on how patients with myocardial infarction are treated in Spain. In order to make up for this deficiency, in October 1994, the Ischaemic Heart Disease Working Group of the Spanish Society of Cardiology initiated a myocardial infarction registry, which is currently active. METHODS: Patients are recruited from hospitals with intensive coronary care facilities. Demographic characteristics coronary risk factors and previous conditions are collected, as well as clinical events, and diagnostic and therapeutic procedures performed during the stay in the coronary care unit. RESULTS: From 1995 to 1999, 28,357 patients were registered. During this period the mean age increased slightly (from 64.4 +/- 12.2 to 65.2 +/- 12.7; p < 0.001), although the male proportion remained stable (from 76.7% to 77.1%). The median "onset of symptoms-hospital arrival for 1st emergency" time fell from 135 min to 120 min, and the median "onset of symptoms-needle" time from 180 to 175 (NS). The use of thrombolytic therapy did not change (from 42.4 to 43.9%), but the use of aspirin (from 87.4 to 91.7%), beta-blockers (from 32.7 to 39.6%) and angiotensin-converting inhibitors (from 27.9 to 34.8%) increased significantly (p < 0.001). The Swan-Ganz catheter and the intra-aortic balloon counterpulsation were rarely placed during the five years (4.2% and 1.2% respectively in 1999). Both early mortality (11.4 to 9.3%) and the median duration of intensive coronary care stay declined, in these 5 years. CONCLUSIONS: In Spain, during the 1995-1999 period, the use of aspirin, beta-blockers, and angiotensin-converting inhibitors increased significantly during the acute phase of infarction in the coronary care unit. However, both the usage of thrombolytic therapy and the delay between the onset of symptoms and therapy initiation remained unchanged. At the same time, the length of stay in the coronary care unit and early mortality declined, although the clinical profile of the patients did not improve.

Measures to reduce HIV infection have not been successful to reduce the prevalence of HCV in intravenous drug users.

The objective of the study was to determine whether measures taken to prevent human immunodeficiency virus (HIV) infection also lead to a reduction in the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDU). Antibodies to HCV, HIV and hepatitis B virus (HBV) were determined in IDU who voluntarily attended AIDS prevention and information centres for the first time between 1990 and 1996. Of the 5473 IDU studied, determination of HCV was done in 3238 cases. The prevalence of antibodies to HCV was 85%. During the first period studied (1990-1992), the prevalence of antibodies to HCV was 84.5%, during the second (1993-1994) 84.1% and during the third (1995-1996) 87%; in the case of HBV the prevalence during the three periods was 74.5, 67.6 and 66.8% respectively, and for HIV it was 41.9, 38.8 and 36.6% respectively (RR: 0.72; 95% confidence interval (CI): 0.65-0.81). Among drug users addicted for less than 2 years, the trend of the prevalence of antibodies to HCV and HBV remained constant, while the prevalence of HIV infection decreased (RR: 0.61; 95% CI: 0.42-0.89). Measures to prevent transmission of HIV in drug users do not lead to a reduction in the prevalence of HCV infection. Further study is necessary to obtain a better understanding of how HCV is transmitted among drug users in order to apply measures which are effective in preventing HCV infection.

[The short-term effects of air pollution on mortality. The results of the EMECAM project in the city of Valencia, 1994-96. Estudio Multcéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en la ciudad de Valencia, 1994-96.

BACKGROUND: To determine the short-term impact of air pollution on mortality in the city of Valencia throughout the 1994-1996 period by employing the analysis method of the Spanish multicenter study with regard to the relationship between air pollution and the mortality (EMECAM Project). METHODS: The daily levels of black smoke, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3) were obtained from the Valencia air pollution monitoring network. The death rate indicators analyzed were the daily number of death due to all causes, except the external ones, the deaths of those over age 70, and the deaths resulting from respiratory and cardiovascular diseases. Following the methods of the EMECAM Project, autoregressive Poison regression models were built up, controlling the different confounding factors (seasonality, trend, calendar, weather variables and flu impact). RESULTS: For total mortality except the external ones, a significant impact of black smoke (RR 10 micrograms/m3: 1.013; CI95% 1.003 to 1.023) and for CO 24 la (RR 1 mg/m3: 1.024; CI95% 1.003 to 1.046) was found. For the mortality of those individuals over 70, the estimated impact was somewhat greater than for black smoke (RR 10 micrograms/m3: 1.017; CI95% 1.005-1.029), as well as for CO2 1 h (RR 10 micrograms/m3: 1.007; CI95% 1.001-1.013). No significant relationship was found with the mortality due to respiratory or cardiovascular diseases for the entire period. CONCLUSIONS: The current levels of pollution in the city of Valencia show a significant impact on daily mortality. These findings are consistent with the previous research and are coherent with those obtained on analyzing the relationship between air pollution and morbidity indicators.

[The users of centers for AIDS information and prevention in the Comunidad Valenciana, Spain: a study based on cluster analysis]. / Usuarios de centros de información y prevención de SIDA en la Comunidad Valenciana: un estudio basado en el análisis de conglomerados.

OBJECTIVE: To measure the usefulness of multiple correspondence analysis (MCA) and cluster analysis applied to the epidemiological research of HIV infection. The specific are to explore the relationships between the different variables that characterize the users of the AIDS Information and Prevention Center (CIPS) and to identify clusters of characteristics which in terms of the attendance to these centers, could be considered similar. METHODS: The clinical history the CIPS in the Valencian region in Spain was used as data source. The target population target were intravenous drug users (IDUSs) attending these centers between 1987 and 1994 (n = 6211). Information about socio-demographic and HIV type I infection-related variables (drug use and sexual behaviour) was collected by means of a semistructured questionnaire. A MCA was carried out to obtain a group of quantitative factors that were used in a cluster analysis. RESULTS: A 44.8% HIV type I prevalence was found. Five factors were detected by MCA that explain 51.14% of the total variability, of which sex, age and the usual sexual partner were the variables best explained. Cluster analysis allowed to describe 5 different subgroups of CIPS users according to their socio-demographics characteristics, risk behaviours and serologic status. It is necessary to highlight the categories 1 and 2, which collect the serologic status and the most relevant characteristics of HIV infection. Category I contains users with a negative serology and characterized by being mainly single adolescent men, with a low educational level; they stated that they have no steady sexual partner, do not share syringes and have been intravenous drug users between 3 and 10 years. They mainly come from the city of Alicante. Category 2 contains mainly people that are HIV positive and older. They also share syringes and have been intravenous drug users for a longer time; they have a higher education level and most of them come from the city of Valencia. CONCLUSIONS: The proposed method of analysis was able to characterise the CIPS users, identifying those socio-demographic variables and risk behaviours that are more related to the serologic status. The applicability of these techniques to epidemiologic studies of HIV type I infection is discussed.

Human immunodeficiency virus (HIV) infection in parenteral drug users: evolution of the epidemic over 10 years. Valencian Epidemiology and Prevention of HIV Disease Study Group.

BACKGROUND: Evaluation of acquired immunodeficiency syndrome (AIDS) prevention strategies requires an on-going follow up of the frequency of human immunodeficiency virus (HIV-1) infection. The aim of this study was to examine the trends in prevalence and incidence of HIV-1 infection among injecting drug users (IDU) during the period 1987-1996. METHODS: Transversal and cohort studies were designed which included a consecutive sample of 7132 IDU who attended three AIDS Prevention and Information Centres in the Region of Valencia (Spain) and voluntarily asked to be tested for HIV antibodies. The prevalence was estimated for each year based on the serological status of HIV-1 when the patient first visited the centre. The annual incidence rates were calculated based on the seronegative patients in which a new determination of HIV-1 was done. In order to control the possible effects on the estimations of age, sex and duration of addiction of the people studied, Poisson and logistic regression models were adjusted. RESULTS: Prevalence and incidence rates of HIV-1 infection showed parallel trends over time. The overall prevalence found was 43.6% (95% confidence intervals [CI]: 42.4-44.7%). Of the 4023 seronegative individuals, 1746 were followed up over the whole of the study period. The incidence rate observed was 6.85 x 100 persons/year (95% CI : 6.04-7.66). The prevalence figures show a decrease, which is most marked from 1990 onwards and then they tend to stabilize over the past few years. The incidence rates increase slightly up to 1991 (9.8 x 100 persons/year), and then begin to decrease. CONCLUSION: Trends of prevalence of HIV-1 infection approximate trends of subjacent incidence rate. Despite decrease in HIV-1 infection frequency observed over 10 years, both the prevalence and incidence figures continue to be high in absolute terms. It is necessary to intensify and adapt preventive measures to each subgroup at risk of infection and in the case of heterosexual transmission ensure that the failure observed in the case of IDU is not repeated.