Validation and reliability of the Care Vulnerability Index: A study by interrater agreement and test-retest method.

AIM: The aim of this study is to determine the validity and reliability of the Care Vulnerability Index (CVI) as a tool to estimate the need and competence of care. DESIGN: A cross-sectional survey including a longitudinal component. METHODS: Content validity ratio (CVR) was calculated by interrater agreement of a group of 11 experts in two rounds. The test-retest analysis was measured in an urban population of Colombia with 96 participants through two statistical tests: Pearson's correlation coefficient and the difference in means. RESULTS: Care Vulnerability Index turned out to be valid with a CVR of 0.879. Reliability by Pearson correlation between test-retest was 0.912 (CI95: 0.872-0.941; p-value <.01) and there was no significant mean difference between test and retest in global score and in clustered groups of variables. Validating CVI will make it possible to prioritize healthcare resources in the population and identify people susceptible to care problems.

Robotic Implementation of the Necessary Mechanism for the Human Characteristics Simulation: Approach from Self-Care Conceptual Modeling.

The vertiginous development of robotics, as part of the Artificial Intelligence, is currently raising its potential from the point of view of care. The purpose of the present article is the robotic implementation of a logical sequence model of the phases that happen in proper care. This requires approaching the representation and formalization of knowledge about care, what and how the care is: starting with the conceptual dissertation between life, and human characteristics, and also consider this care with the aim to lay the groundwork for Robots based on care..

Infección nosocomial por microorganismos multirresistentes y otros de relevancia epidemiológica y consumo hospitalario de antimicrobianos / No disponible

ntroducción: El objetivo es conocer la evolución de la prevalencia de infección nosocomial por microorga-nismos multirresistentes y el consumo hospitalario de antimicrobianos. Métodos: Análisis descriptivo de los datos del EPINE del Hospital Universitario de Salamanca periodo 2004-2015. Variables: tipo infección, consumo de antimicrobianos, cirugía, profilaxis quirúrgica y factores de riesgo. Resultados: La prevalencia de infección nosocomial por gérmenes multirresistentes se incrementó desde el año 2004, destaca el aumento de infecciones por Clostridium difficile. El consumo de antimicrobianos se mantiene estable pero se ha producido un cambio en las prevalencias individuales con disminución de amoxicilina e inhibidor enzimático (IE) y aumento de otros destacando a piperacilina e inhibidor enzimático. Conclusiones: El aumento de gérmenes multirresistentes y el cambio en el consumo de antimicrobianos hace que nos planteemos el desarrollo de nuevas estrategias y la necesidad de actualizar y evaluar de manera continua los protocolos de adecuación del uso de antimicrobianos

Introduction: The objective is to know the evolution of the prevalence of nosocomial infection by multiresistant microorganisms and the hospital consumption of antimicrobials. Methods: Descriptive analysis of EPINE data from Hospital Universitario de Salamanca period 2004-2015. Variables: infection type, antimicrobial consumption, surgery, surgical prophylaxis and risk factors. Results: The prevalence of nosocomial infection by multiresistant germs has increased since 2004, with the increase in Clostridium difficile infections. The consumption of antimicrobials remains stable but there has been a change in the individual prevalences with decrease of amoxicillin and enzyme inhibitor (IE) and increase of others emphasizing piperacillin and IE. Conclusions: The increase of multiresistant germs and the change in antimicrobial consumption makes us consider the development of new strategies and the need to continuously update and evaluate protocols for adequacy of antimicrobial use

Widely power-tunable polarization-independent ultrafast mode-locked fiber laser using bulk InN as saturable absorber.

The growing demand of ultrafast mode-locked fiber lasers in the near infrared has boosted the research activity in this area. One of the most convenient ways to achieve passive mode locking consists of inserting a semiconductor saturable absorber in the laser cavity to modulate the losses. However, in such a configuration, the limited power range of operation is still an unsolved issue. Here we report the fabrication of an ultrafast, high-power, widely power-tunable and non-polarization-dependent mode-locked fiber laser operating at 1.55 µm, using an InN layer as saturable absorber. With post-amplification, this laser delivers 55-fs pulses with a repetition rate of 4.84 MHz and peak power in the range of 1 MW in an all-fiber arrangement.

Effect of doping on the far-infrared intersubband transitions in nonpolar m-plane GaN/AlGaN heterostructures.

This paper assesses the effects of Si doping on the properties of nonpolar m-plane GaN/AlGaN quantum wells (QWs) designed for intersubband (ISB) absorption in the far-infrared spectral range. For doping levels up to 3 × 10(12) cm(-2), structural analysis reveals uniform QWs with abrupt interfaces and no epitaxially induced defects. Cathodoluminescence spectroscopy confirms the homogeneity of the multiple QWs along the growth direction. Increasing the doping density in the QWs from 1 × 10(11) cm(-2) to 3 × 10(12) cm(-2) induces a broadening of the photoluminescence as well as a reduction of the exciton localization energy in the alloy. Also, enhancement of the ISB absorption is observed, along with a blue shift and widening of the absorption peak. The magnitude of the ISB absorption saturates for doping levels around 1 × 10(12) cm(-2), and the blue shift and broadening increase less than theoretically predicted for the samples with higher doping levels. This is explained by the presence of free carriers in the excited electron level due to the increase of the Fermi level energy.

Prevención de eventos adversos para la seguridad del paciente en las unidades de tratamiento del dolor crónico / Prevention of adverse events for patient safety in chronic pain treatment units

Objetivos. Identificar acciones preventivas que minimicen el riesgo para la seguridad de los pacientes atendidos en las unidades de tratamiento del dolor, y agrupar en lotes las acciones preventivas que presenten características homogéneas. El trabajo es una parte de un proyecto de mejora de la seguridad de pacientes atendidos en dichas unidades, cuyo propósito global ha sido la identificación, priorización y prevención de riesgos. Material y métodos. Se seleccionó un grupo de expertos formado por profesionales con formación clínica específica y experiencia en programas y servicios de atención al dolor. Se les proporcionó formación en seguridad de pacientes e información sobre los eventos adversos identificados, los fallos y las causas asociados. Mediante la técnica de tormenta de ideas los participantes respondieron a la pregunta: ¿qué modificaciones o mejoras habría que hacer al proceso asistencial para evitar absolutamente la aparición de cada uno de los eventos adversos? Las propuestas generadas se consensuaron y agruparon en lotes en función de su homogeneidad. Resultados. Se identificaron 456 acciones preventivas. El apartado más numeroso fue el de las modificaciones en la organización del proceso asistencial, seguido de los de las mejoras en la práctica clínica, las actividades formativas, la protocolización y la comunicación con el paciente. Conclusiones. Según el consenso de los expertos, son los cambios organizativos y las mejoras en la práctica asistencial, las intervenciones que más podrían reducir el riesgo para los pacientes en las unidades de tratamiento del dolor(AU)

Objectives. To identify preventive actions that minimise risk of patients safety in pain treatment units, and to cluster preventive actions into homogeneous groups. The current study is part of a project intended to improve patient safety in pain treatment units, and is aimed at identifying, prioritising and preventing patient safety risk. Material and methods. A group of experts was selected from professionals with a specific clinical background and experience in pain treatment units. This group was provided with information on patient safety and on known adverse events, errors and related causes. Through a brainstorming method the participants were asked: What changes or improvements would need to be undertaken to absolutely prevent the occurrence of each adverse event? The participant's proposals were analysed and grouped according to their homogeneity. Results. A total of 456 preventive actions were identified. The group that received the highest number of suggestions was the one including changes in the management of healthcare processes, followed by the group that considered improvements in clinical practice, training activities, protocols and policies, and patient communication. Conclusions. According to the consensus of the experts, management of healthcare processes and improvements in health care practices are the 2 interventions that are most likely to reduce patient safety risk in pain treatment units(AU)

[Prevention of adverse events for patient safety in chronic pain treatment units]. / Prevención de eventos adversos para la seguridad del paciente en las unidades de tratamiento del dolor crónico.

OBJECTIVES: To identify preventive actions that minimise risk of patients safety in pain treatment units, and to cluster preventive actions into homogeneous groups. The current study is part of a project intended to improve patient safety in pain treatment units, and is aimed at identifying, prioritising and preventing patient safety risk. MATERIAL AND METHODS: A group of experts was selected from professionals with a specific clinical background and experience in pain treatment units. This group was provided with information on patient safety and on known adverse events, errors and related causes. Through a brainstorming method the participants were asked: What changes or improvements would need to be undertaken to absolutely prevent the occurrence of each adverse event? The participant's proposals were analysed and grouped according to their homogeneity. RESULTS: A total of 456 preventive actions were identified. The group that received the highest number of suggestions was the one including changes in the management of healthcare processes, followed by the group that considered improvements in clinical practice, training activities, protocols and policies, and patient communication. CONCLUSIONS: According to the consensus of the experts, management of healthcare processes and improvements in health care practices are the 2 interventions that are most likely to reduce patient safety risk in pain treatment units.

Identificación y priorización de episodios adversos y fallos relacionados con la seguridad del paciente en las Unidades de Tratamiento del Dolor / Identifying and prioritising adverse episodes and failures related to patient safety in Pain Treatment Units

Objetivos. Un grupo de expertos coordinado por la Escuela Andaluza de Salud Pública identificó los episodios adversos (EA) más graves y frecuentes en las Unidades de Tratamiento del Dolor (UTD), así como los fallos y las causas subyacentes, como paso previo a la elaboración de acciones preventivas. Los objetivos del proyecto fueron identificar los episodios adversos potenciales en las UTD, identificar sus fallos y las causas que pueden originarlos y, priorizar dichos fallos según la herramienta análisis de modos de fallos y de sus efectos (AMFE). Material y métodos. La metodología empleada consistió en realizar una búsqueda bibliográfica, selección de un grupo de expertos con experiencia en UTD, creación de un catálogo de episodios adversos mediante la técnica de generación de ideas y, puesta en práctica de las herramientas AMFE e índice de prioridad de riesgo. Resultados. Se identificaron hasta 66 tipos de episodios adversos relacionados con medicación (30), técnicas invasivas (15), proceso asistencial (10), información y educación del paciente (6), práctica clínica (5). Se localizó que hasta 101 fallos pueden desencadenar esos EA y, que 242 causas pueden provocar esos fallos. Conclusiones. Los resultados indican la necesidad de trabajar principalmente en 2 sentidos: la mejora del proceso asistencial en las UTD (la organización de la asistencia), y el trabajo profesional; este último en 2 aspectos, mejora de la práctica clínica y aumento de las competencias profesionales mediante formación específica. La comunicación, ya sea interprofesional o interservicios o con el paciente y su familia, se identifica como un aspecto clave para la mejora(AU)

Objectives. An expert group coordinated by the Andalusian School of Public Health identified the most serious and frequent adverse events in Pain Treatment Units (PTU), as well the failures and underlying causes, as a prior step to preparing preventive actions. The aims of the project were to identify potential adverse events in Pain Treatment Units, identify failures and their underlying causes, and prioritise these failures according to a failure modes and effects analysis (FMEA) tool. Material and methods. The method employed consisted of a literature search, the selection of an expert group with experience in PTU, creating a catalogue of adverse events using the generation of ideas technique, and putting the FMEA and Risk Priority Index tools into practice. Results. Up to 66 types of adverse events were identified associated with; medication (30), invasive techniques (15), care process (10), patient information and education (6), and clinical practice (5). It was found that up to 101 failures could be triggered by these adverse events, and that 242 causes could lead to these failures. Conclusions. The results indicated the need to work principally in two directions, improving the care process in the PTU (the health care organisation), and the professional work, this latter having two aspects, improving the clinical practice, and increase professional skills by means of specific training. Communication, whether inter-professional or inter-department, or with the patient and their family, is identified as a key aspect for improvement(AU)

[Identifying and prioritising adverse episodes and failures related to patient safety in Pain Treatment Units]. / Identificación y priorización de episodios adversos y fallos relacionados con la seguridad del paciente en las Unidades de Tratamiento del Dolor.

OBJECTIVES: An expert group coordinated by the Andalusian School of Public Health identified the most serious and frequent adverse events in Pain Treatment Units (PTU), as well the failures and underlying causes, as a prior step to preparing preventive actions. The aims of the project were to identify potential adverse events in Pain Treatment Units, identify failures and their underlying causes, and prioritise these failures according to a failure modes and effects analysis (FMEA) tool. MATERIAL AND METHODS: The method employed consisted of a literature search, the selection of an expert group with experience in PTU, creating a catalogue of adverse events using the generation of ideas technique, and putting the FMEA and Risk Priority Index tools into practice. RESULTS: Up to 66 types of adverse events were identified associated with; medication (30), invasive techniques (15), care process (10), patient information and education (6), and clinical practice (5). It was found that up to 101 failures could be triggered by these adverse events, and that 242 causes could lead to these failures. CONCLUSIONS: The results indicated the need to work principally in two directions, improving the care process in the PTU (the health care organisation), and the professional work, this latter having two aspects, improving the clinical practice, and increase professional skills by means of specific training. Communication, whether inter-professional or inter-department, or with the patient and their family, is identified as a key aspect for improvement.

Abordaje de la neuralgia postherpética en Atención Primaria: situación actual del tratamiento farmacológico / Approach to postherpetic neuralgia inprimary health care: current situation of the drug treatment

La neuralgia postherpética es una de las complicaciones más temidas del herpes zóster ya que puede desencadenar dolores invalidantes. La incidencia de herpes zóster aumenta con la edad. Se entiende por neuralgia postherpética el dolor continuo a lo largo de un nervio y sus ramificaciones, por lo común, sin fenómenos inflamatorios, que acontece durante más de un mes una vez desaparecidas las lesiones cutáneas. El dolor que presentan los pacientes lo describen como continuo o paroxístico, evocado o espontáneo, quemante o lancinante y puede estar asociado con otras alteraciones sensitivas de la piel. Existen avances en la terapia antiviral durante la fase aguda del herpes zóster que pueden prevenir la aparición de neuralgia postherpética. Si se produce la temida complicación, el tratamiento incluye antidepresivos tricíclicos, anticonvulsivantes, opioides menores y mayores y otros fármacos. En esta revisión se recoge qué fármacos son los más recomendados para mejorar la clínica de estos pacientes

Postherpetic neuralgia is one of the most feared complications of herpes zoster that can precipitate invalidating pains. The incidence of herpes zoster increases with age. Postherpetic neuralgia is understood to be continuous pain over the nerve and its branches, generally without inflammatory phenomena, that occurs for more than one month once the skin lesions have disappeared. The pain that the patients have is described as continuous or paroxytic, evoked or spontaneous, burning or stabbing and may be associated with sensitive alterations of the skin. There are advances in the antiviral therapy during the acute herpes zoster phase that may prevent the appearance of postherpetic neuralgia. If the feared complication occurs, treatment includes tricyclic antidepressants, anticonvulsant drugs, minor and major opiates, and other drugs. This review includes which drugs are those recommended most to improve the symptoms of these patients

Hábitos del sueño en un grupo de niños de 6 a 24 meses / No disponible

Introducción: el insomnio infantil es la alteración del sueño más frecuente. Objetivos: conocer los hábitos del sueño en niños entre 6 y 24 meses; estimar la satisfacciónde los padres respecto a estos hábitos; determinar los posibles factores asociados con hábitos incorrectos del sueño. Material y métodos: se estudió a 173 niños que acudieron a las consultas de dos centros de salud del 1 de diciembre de 2003 al 31 de marzo de 2004. Se diseñó una encuesta de 36 preguntas cumplimentada por uno de los padres. Resultados: el 57,8% de los niños duerme en la habitación de los padres, haciéndolo en la cama de éstos el 8,6%. El 56% se duerme solo, mientras que el 25,7% se duerme en brazos o en otro lugar distinto. El 91,3% de los padres utiliza algún recurso para dormir a sus hijos, siendo el más recurrente el chupete (49,1%). No se despierta durante la noche el 21,3%, mientras que el 11,5% lo hace 3 ó más veces por semana y 3 ó más veces por noche. El 31% de los padres deja que concilien el sueño de nuevo solos. Se encuentra una relación estadísticamente significativa entre la satisfacción de los padres y la capacidad de dormirse solo (p = 0,001), dehacerlo en menos de 15 minutos (p = 0,016), y con el hábito de no despertarse o de hacerlo como máximo 2 veces durante la noche (p = 0,000). Conclusiones: los trastornos de sueño por hábitos incorrectos tienen una prevalencia del 54,4% en nuestro medio. La mayoría de los padres realiza de forma incorrecta el acto de dormir de sus hijos

Introduction: the infantile insomnia is the most frequent sleeping alteration. Targets: learn about the children sleeping habits (children from 6 to 24 months). Considerthe parents’ satisfaction about these habits. Determine the possible factors associated to incorrect sleeping habits.Material and methods: we studied 173 children, that went to two health centres from the 1st of December 2003 to the 31st of March 2004. A survey of 36 questions was designed, and a parent answered those 36 questions.Results: 57.8% of the children sleep in the parents’ room, 8.6% sleep in the parents’bed. 56% sleep alone, while 25.7% sleep in the parents’ arms or in a different place. 91.3% of the parents use some resource to get their children to sleep, the most frequent one is the dummy (49.1%). 21.3% of the children don’t wake up during the night, while 11.5% wake up 3 times or more a week and 3 times or more every night. 31% of the parents let the children go to sleep again on their own. We find an important relation between the parents’ satisfaction, and the capacity of the children to go to sleep on their own (p = 0.001), and the capacity of the children to go to sleep in less than 15 minutes (p = 0.016), and with the habits of not waking up or waking up twice during the night (p = 0.000). Conclusions: 54.4% of the sleeping problems are caused by incorrect habits. The majorityof the parents make the children go to sleep by an incorrect way (AU)

[Antimicrobial susceptibility of Escherichia coli isolated from bacteriurias in Bierzo health area during 2003]. / Sensibilidad microbiana de Escherichia coli en bacteriurias en el área sanitaria del Bierzo en el año 2003.

OBJECTIVE: Sensitivity to antibiotics of Escherichia coli isolated from intrahospital and extrahospital bacteriurias is analyzed. MATERIAL AND METHODS: Sensitivity to nineteen antibiotics used in the clinical practice was determined in strains of Escherichia coli isolated from intrahospital and extrahospital bacteriurias. RESULTS: The prevalence of in-vitro susceptibilities to antibiotics were (hospital, state health service clinic, health center-primary-care): imipenem (100%-100%-100%; p=NS), amikacin (100%-100%-99.7%; p=NS), fosfomicyn (98.6%-98.4%-99.6%; p=NS), cefepime (96%-96.9%-98.3%; p=NS), piperacillin-tazobactam (96%-95.3%-96.6%; p=NS), aztreonam (93.5%-94.7%-97.7%; p<0.001), ceftazidime (93.5%-94.3%-97.8%; p<0.001), cefotaxime (93.1%-95%-97.7%; p<0.001), cefixime (92.7%-94.6%-96.7%; p<0.05), nitrofurantoin (92%-94.7%-94.7%; p=NS), cefuroxime (88.4%-93.1%-95%; p<0.001), amoxicillin-clavulanic (87.7%-88.7%-93.8%; p<0.001), tobramicyn (87%-93.7%-93.8%; p<0.001), gentamcin (85.9%-92.8%-93%; p<0.001), cefazolin (84.4%-88.7%-91.6%; p<0.01), ciprofloxacin (63.8%-71.4%-78.4%; p<0.001), norfloxacin (63%-70.8%-78.2%; p<0.001), cotrimoxazole (65.2%-68.6%-74.9%; p<0.01) and ampicillin (35.5%-42.5%-47.8%; p<0.01). (*NS= No significant differences). CONCLUSIONS: The knowledge of the sensitivity of uropathogens to antimicrobians can allow us to initiate empirical therapy of urinary tract infections.

Sensibilidad microbiana de escherichia coli en bacteriurias en el área sanitaria del Bierzo en el año 2003 / Antimicrobial susceptibility of escherichia coli isolated from bacteriurias in Bierzo Health Area during 2003

OBJETIVO: Evaluar la sensibilidad a varios antibióticos en cepas de Escherichia coli aisladas en muestras de orina de pacientes hospitalarios y extrahospitalarios. MATERIAL Y MÉTODOS: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras de pacientes hospitalizados y atendidos en consultas externas hospitalarias y atención primaria. Se determinó la sensibilidad de este germen a diecinueve antibióticos de uso hospitalario y/o extrahospitalario. RESULTADOS: Según el origen hospitalario, consultas externas hospitalarias y atención primaria, respectivamente, la sensibilidad in vitro ha sido la siguiente: imipenem (100%, 100% y 100%; p=NS), amikacina (100%, 100% y 99,7%; p=NS), fosfomicina (98,6%, 98,4% y 99,6%; p=NS), cefepima (96%, 96,9% y 98,3%; p=NS), piperacilina-tazobactam (96%, 95,3% y 96,6%; p=NS), aztreonam (93,5%, 94,7% y 97,7%; p<0,001), ceftazidima (93,5%, 94,3% y 97,8%; p<0,001), cefotaxima (93,1%, 95% y 97,7%; p<0,001), cefixima (92,7%, 94,6% y 96,7%; p<0,05), nitrofurantoína (92%, 94,7% y 94,7%; p=NS), cefuroxima (88,4%, 93,1% y 95%; p<0,001), amoxicilina-clavulánico (87,7%, 88,7% y 93,8%; p<0,001), tobramicina (87%, 93,7% y 93,8%; p<0,001), gentamicina (85,9%, 92,8% y 93%; p<0,001), cefazolina (84,4%, 88,7% y 91,6%; p<0,01), ciprofloxacino (63,8%, 71,4%, 78,4%; p<0,001), norfloxacino (63%, 70,8 y 78,2%; p<0,001), cotrimoxazol (65,2%, 68,6% y 74,9%; p<0,01) y ampicilina (35,5%, 42,5% y 47,8%; p<0,01). (NS= No significativo). CONCLUSIONES: El tratamiento de las infecciones del tracto urinario frecuentemente se inicia de forma empírica. Por este motivo resulta esencial conocer los patrones de sensibilidad de las bacterias potencialmente causantes del cuadro

OBJECTIVE: Sensitivity to antibiotics of Escherichia coli isolated from intrahospital and extrahospital bacteriurias is analized. MATERIAL AND METHODS: Sensitivity to nineteen antibiotics used in the clinical practise was determined in strains of Escherichia coli isolated from intrahospital and extrahospital bacteriurias. RESULTS: The prevalence of in-vitro susceptibilities to antibiotics were (hospital, state health service clinic, health center-primary-care): imipenem (100%-100%-100%; p=NS), amikacin (100%-100%-99.7%; p=NS), fosfomicyn (98.6%- 98.4%-99.6%; p=NS), cefepime (96%-96.9%-98.3%; p=NS), piperacillin-tazobactam (96%-95.3%-96.6%; p=NS), aztreonam (93.5%-94.7%-97.7%; p<0.001), ceftazidime (93.5%-94.3%-97.8%; p<0.001), cefotaxime (93.1%-95%-97.7%; p<0.001), cefixime (92.7%-94.6%-96.7%; p<0.05), nitrofurantoin (92%-94.7%-94.7%; p=NS), cefuroxime (88.4%-93.1%- 95%; p<0.001), amoxicillin-clavulanic (87.7%-88.7%-93.8%; p<0.001), tobramicyn (87%-93.7%-93.8%; p<0.001), gentamcin (85.9%-92.8%-93%; p<0.001), cefazolin (84.4%-88.7%-91.6%; p<0.01), ciprofloxacin (63.8%-71.4%-78.4%; p<0.001), norfloxacin (63%-70.8%-78.2%; p<0.001), cotrimoxazole (65.2%-68.6%-74.9%; p<0.01) and ampicillin (35.5%-42.5%-47.8%; p<0.01). (*NS= No significant differences). CONCLUSIONS: The knowledge of the sensitivity of uropathogens to antimicrobians can allow us to initiate empirical therapy of urinary tract infections

Sensibilidad microbiana de Escherichia coli en infecciones urinarias extrahospitalarias / Antimicrobial susceptibility of Escherichia coli associated with community-acquired urinary tract infections

OBJETIVO: El tratamiento empírico de las infecciones urinarias extrahospitalarias debe tener en cuenta la sensibilidad de las bacterias potencialmente causantes de las mismas. Además, la comparación con años anteriores permite observar la evolución de la sensibilidad microbiana. Analizamos estos aspectos con respecto a Escherichia coli en nuestro medio. MATERIAL Y MÉTODOS: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras enviadas desde atención primaria en El Bierzo (León) durante los años 2002 y 1998, en número de 895 y 595, respectivamente. Se determinó la sensibilidad de este germen a nueve antibióticos de uso frecuente. Se analizó mediante chi cuadrado la existencia de diferencias estadísticamente significativas de sensibilidad en los años estudiados. RESULTADOS: El 63,4 por ciento de todos los urocultivos positivos de atención primaria en 2002 y el 50,8 por ciento en 1998 resultaron positivos para Escherichia coli. La sensibilidad in vitro en 2002 y 1998, respectivamente, ha sido la siguiente: fosfomicina (99,2 por ciento-99,3 por ciento; p=NS*), cefixima (98,3 por ciento-92,9 por ciento; p<0,001), cefuroxima (96,5 por ciento-94,1 por ciento; p<0,05), nitrofurantoína (94,5 por ciento-86,9 por ciento; p<0,001), amoxicilina-clavulánico (93,1 por ciento-90,1 por ciento; p<0,05), ciprofloxacino (77,1 por ciento-81,6 por ciento; p<0,05), norfloxacino (75,8 por ciento-80,3 por ciento; p<0,05), cotrimoxazol (71,5 por ciento-73,4 por ciento; p=NS*) y ampicilina (44 por ciento-41,4 por ciento; p=NS*). (*NS= No significativo). CONCLUSIONES: El conocimiento de los patrones de sensibilidad de los gérmenes más frecuentemente aislados en muestras de orina en cada zona permite aplicar el tratamiento empírico más adecuado en caso de infección (AU)

[Microbial sensitivity of Escherichia coli in community-acquired urinary tract infections]. / Sensibilidad microbiana de Escherichia coli en infecciones urinarias extrahospitalarias.

OBJECTIVE: For effective empiric therapy of urinary tract infections in the extra-hospital setting the susceptibility pattern of uropathogens should be considered. Moreover, the evolution in sensitivity can be observed when comparing with susceptibility patterns in the previous years. This paper presents an analysis of our experience with Escherichia coli. MATERIAL AND METHODS: During 2002 and 1998, 895 and 595 strains of Escherichia coli respectively, isolated from extrahospitalary bacteriurias were collected in ten health centers in Bierzo (León, Spain). Sensitivity to nine most commonly antibiotics used in the clinical practise was determined. The existence of significant differences of susceptibility among years (2002-1998) was analyzed by the chi square test. RESULTS: Escherichia coli accounted for 63.4% of all isolates in 2002 and 50.8% in 1998. The prevalence of in-vitro susceptibilities to antibiotics were (2002-1998): fosfomycin (99.2%-99.3%; p = NS*), cefixime (98.3%-92.9%; p < 0.001), cefuroxime (96.5%-94.1%; p < 0.05), nitrofurantoin (94.5%-86.9%; p < 0.001), amoxycillin-clavulanic acid (93.1%-90.1%; p < 0.05), ciprofloxacin (77.1%-81.6%; p < 0.05), norfloxacin (75.8%-80.3%; p < 0.05), cotrimoxazole (71.5%-73.4%; p = NS*) and ampicillin (44%-41.4%; p = NS*). (*NS = No significant differences). CONCLUSION: The knowledge of the sensitivity of uropathogens to antimicrobians in a specific medium can allow us to use antibiotics rationally and initiate empirical therapy.

[Prevalence and risk factors for erectile dysfunction in the Region of Bierzo]. / Prevalencia y factores de riesgo de disfunción eréctil en la Comarca del Bierzo.

OBJECTIVE: To analyze the prevalence and risk factors for erectile dysfunction in Bierzo (León, Spain). METHODS: A study was conducted based on a self-administered survey in males aged 19 to 90 years that consulted at the urology and family medicine services of 10 health centers in Bierzo (León, Spain). To determine the existence or absence of erectile dysfunction, the male sexual health questionnaire (SHIM) was included, and those with a score of 21 or less were considered to have some degree of erectile dysfunction. Distribution of the questionnaire began in September 1999 and ended in May 2000. Submission of the questionnaires concluded on May 31, 2000. Of 935 questionnaire that were received, 830 were valid. RESULTS: The overall prevalence of erectile dysfunction in this study was 63.9%, which increased with age and was markedly higher after age 50 years (38.6% for age 41-50 years and 72.6% for age 51-60 years). The age-adjusted analysis showed the risk factors for erectile dysfunction were depression and arterial hypertension on treatment with drugs. Diabetes mellitus on treatment with oral glucose lowering agents or insulin, heart disease and hypercholesterolemia were also associated with the more severe forms. CONCLUSIONS: The prevalence of erectile dysfunction in patients consulting at the primary care and general urological services in Bierzo (León, Spain) was outstandingly high. The present study showed erectile dysfunction to be an age-dependent disease that caused concern in slightly more than half of the patients with this condition. Apart from age, depression and vascular disease were found to be risk factors.

[Epidermoid carcinoma of the penis]. / Carcinoma epidermoide de pene.

OBJECTIVE: To analyze our series and review the prognostic factors in the treatment of epidermoid carcinoma of the penis. METHODS: Age, time to consultation, circumcision, form of presentation, local treatment, tumor stage and grade, lymph node involvement and outcome were analyzed in 27 cases of carcinoma of the penis diagnosed at our hospital from 1981 to 1999. RESULTS: The incidence rate was 1.8 cases/100,000 men/year. No patient had been circumcised, except one who was circumcised in the adult age. The median time to consultation was 24 months (interquartile range: 60-7.75). The median follow-up was 37 months (interquartile range: 84-12). All patients with pT1GI-II and pT2G-II primary tumor (n = 21; 78% of the series) and with no lymphadenopathy were disease-free at 6 months' minimum follow-up [17 of the 21 patients (81%) had more than 32 months' follow-up]. Only one patient with pT1-GII tumor, but with a vertical growth pattern, had positive inguinal lymph nodes (pN2). The remaining patients with lymph node involvement showed infiltration of the erectile tissue and moderately or poorly differentiated tumors. Only two prophylactic lymphadenectomy procedures were performed (pN0). Regardless of treatment, 5 of the 6 patients with lymph node involvement died within one year after diagnosis. CONCLUSIONS: Given the demonstrated relationship between carcinoma of the penis and hygiene, and phimosis which makes hygiene difficult, circumcision should be performed in childhood. Furthermore, circumcision at this age has been demonstrated to have a prophylactic value that disappears in the adult age.