[Mortality from ischemic cardiopathy in Spain: the trends and geographic distribution]. / Mortalidad por cardiopatía isquémica en España: tendencia y distribución geográfica.

INTRODUCTION: In order to obtain epidemiological information for health planification, age-adjusted time series and provincial distribution of ischaemic heart disease mortality have been constructed. MATERIAL AND METHODS: Analysis of time trends includes data from 1901 to 1989. Trends have been identified by linear regression analysis. For the period 1976-1986 age-adjusted and age and sex specific mortality rates have been calculated for each province. 1984 and 1989 levels have been compared to those of the European Union countries. RESULTS: After the sharp rise of the curve in the 50-70 decades, since 1976 mortality falls with an statistically significant negative slope. This change in trends cannot be explained by time variations in prevalence of the main risk factors. Although in many European countries mortality began to fall much earlier, Spain still remains between the lowest mortality rates in Europe. Provinces showing the highest rates are the islands, Andalucia, Badajoz, Murcia, Alicante and Asturias. This clear north-south pattern is maintained after stratifying by age and sex, thus indicating that geographical distribution is related more to environmental or socio-economic factors and to accessibility to qualified health care, than to the geographical distribution of age and sex related risk factors. CONCLUSIONS: Additional studies including other variables are needed to explain these time and spatial variations. Allocation of specialized health care resources can be an effective intervention, mostly in the above mentioned provinces.

Spatial distribution of stroke mortality in Spain, 1975-1986.

Cerebrovascular diseases (CVDs) constitute the most frequent cause of death in Spain. In order to identify the geographical pattern of CVD mortality, age- and sex-specific as well as age-adjusted mortality rates (ICD-8,9 rubrics 430-438) were calculated for the period 1975-1986 for each province in the country. Maps were constructed after categorization of mortality rates by quintile levels. In general, the geographical pattern was similar for the different age and sex strata. While most provinces in the northern half presented low or medium mortality, geographical areas located in the south, displayed rates in the uppermost quintiles. These results suggest that the spatial distribution of CVD mortality in Spain is not random and that the potential determinants underlying this geographical distribution, such as type of stroke, incidence, fatality, diagnostic or certification practices and competing causes of death, have an impact that is independent of age and sex and strongly associated with spatial location. Furthermore, these results can help in identifying high-risk populations.

The Dienes effect as an epidemiological tool in a paraplegic unit.

The authors study the Dienes effect in 136 P.mirabilis and 2 P.vulgaris strains, isolated from different infection or colonization sites, in 27 spinal cord injured patients, admitted to a Paraplegic Unit, during a 9 month period. It is shown that 7 cross-infection and 18 cross-contamination episodes occurred, affecting 13 of 27 patients, which indicates the great spreading capacity of these microorganisms; 97% of the results obtained were observed once again after 6 months' storage of strains. In addition, in 7 of these strains their resistance to several antibiotics was cured by treating them with acriflavine salts, demonstrating that the Dienes effect persists even when resistance to antibiotics is modified; the authors conclude that the Dienes effect is an accurate stable epidemiological tool to identify cross-infections and its origins, and to facilitate the interruption of the chain of infection.