Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Occupational Therapy Interventions Using New Technologies in Children and Adolescents with Autism Spectrum Disorder: A Scoping Review.

New technologies (NT) are increasingly used in Occupational Therapy (OT) interventions in people with Autism Spectrum Disorder (ASD). We conducted a scoping review to describe OT interventions investigated in scientific literature which use NT in children and adolescents with ASD. Two authors independently searched the scientific databases PubMed, EMBASE, Scopus and Web of Science, carried out a peer-review screening of articles and extracted data. Twenty studies met the inclusion criteria. OT interventions lasted between 1 week and 12 months, consisted of between 1 session per day and 5 sessions per week, were carried out exclusively by an occupational therapist, and the most used NT was the computer (n = 12). The duration of the interventions and assessment measures used varied greatly between studies.

Coffee consumption and mortality from all causes of death, cardiovascular disease and cancer in an elderly Spanish population.

PURPOSE: The effect of coffee consumption on mortality has been scarcely investigated in the elderly. We assessed the association between coffee consumption and mortality from all-cause, cardiovascular disease (CVD) and cancer, in an elderly population of Spain. METHODS: We studied 903 individuals (511 women) aged 65 years and older from two population-based studies, the EUREYE-Spain study and the Valencia Nutritional Survey. Coffee consumption and diet were assessed using a validated food frequency questionnaire. Information on education, anthropometry, sleeping time, smoking, alcohol intake, physical activity and pre-existing disease was collected at baseline. Deaths were ascertained during a 12-year follow-up period, and Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HR). RESULTS: There were 403 deaths during the 12-year period (40% from CVD), 174 of which occurred during the first 6 years. We observed evidence of a lower CVD mortality among coffee drinkers in the first 6 years of follow-up. Drinkers of ≤1 cup of coffee/day and > 1 cup/day showed lower CVD mortality than non-drinkers of coffee, HR 0.82 (95% CI 0.46-1.44) and HR 0.38 (0.15-0.96), respectively (p trend = 0.04). This association of coffee with CVD mortality attenuated after 12 years of follow-up. No significant association was observed with all-cause or cancer mortality, neither for caffeinated and decaffeinated coffee. CONCLUSIONS: In this study, coffee consumption was associated with lower CVD mortality in elderly. Although this association should be further investigated, coffee consumption appears to be safe for the elderly since no increased mortality was observed in coffee drinkers.

A bibliometric study of scientific literature on obesity research in PubMed (1988-2007).

This article describes a bibliometric review of the publications on obesity research in PubMed over the last 20 years. We used Medline via the PubMed online service of the US National Library of Medicine from 1988 to 2007. The search strategy was: ([obesity] in MesH). A total of 58,325 references were retrieved, 25.5% in 1988-1997, and 74.5% in 1998-2007. The growth in the number of publications showed an exponential increase. The references were published in 3613 different journals, with 20 journals contributing 25% of obesity literature. The two journals contributing most were the International Journal of Obesity (5.1%), Obesity-Obesity Research (2.9%). North America and Europe were the most productive world areas with 44.1% and 37.9% of the literature, respectively. The US was the predominant country in number of publications, followed by the United Kingdom, Japan and Italy. The ranking of production changed when the number of publications was normalized by population, gross domestic product and obesity prevalence by countries. The great increase of publications on obesity during the period 1988-2007 was particularly evident in the second decade of the period which is concordant with the worldwide obesity epidemic. USA and Europe were leaders in the production of scientific articles on obesity.

Exposiciones laborales y riesgo de cáncer esofágico según tipos histológicos: un estudio de casos y controles en el este de España / Occupational exposures and risk of oesophageal cancer by histological type: A case-control study in eastern Spain

Objetivo. Explorar la relación entre ocupaciones y exposiciones laborales específi cas y cáncer esofágico según tipos histológicos.Métodos. Se llevó a cabo un estudio de casos y controles hospitalario multicéntrico en dos provincias del área mediterránea de España. Serecogió información laboral, sociodemográfi ca y sobre estilos de vida en 185 hombres pacientes recién diagnosticados de cáncer esofágico (147casos de células escamosas, 38 adenocarcinomas) y en 285 controles apareados por frecuencia. Se codifi có la ocupación según la Clasifi caciónNacional de Ocupaciones de 1994 (CNO-94). Se valoró la exposición laboral a una selección de agentes carcinogénicos utilizando la matrizempleo-exposición FINJEM. Se calcularon las odds ratios mediante modelos de regresión logística no condicional ajustando por edad, educacióny consumo de alcohol y tabaco.Resultados. Para la variedad de células escamosas, se encontraron asociaciones estadísticamente signifi cativas en camareros (OR 8,18,95%IC 1,98-33,75) y mineros, dinamiteros, picapedreros y tallistas (OR 10,78, 95%IC 1,24-93,7) en relación con otras ocupaciones. Para lavariedad de adenocarcinoma, se encontraron asociaciones estadísticamente signifi cativas en carpinteros (OR 9,69), producción animal y trabajadoresrelacionados (OR 5,61) y electricistas de construcción y relacionados (OR 8,26), aunque estas observaciones se basaban en un númerolimitado de casos. En cuanto a exposiciones específi cas, en el estudio se encontraron aumentos del riesgo signifi cativos para carcinomade células escamosas en relación con la exposición a radiaciones ionizantes, y para el adenocarcinoma para la exposición elevada a compuestossulfurosos volátiles (OR 3,12) y plomo (OR 5,30). Para todos los tipos histológicos de cancer esofágico, se encontró un riesgo signifi cativoy tres veces mayor en los expuestos a amianto, con tendencia estadísticamente signifi cativa (OR 3,46, 95% CI 0,99-12,10)(AU)

Conclusiones. Los datos sugieren que algunas exposiciones laborales pueden aumentar específi camente el riesgo de cáncer esofágico de célulasescamosas o adenocarcinoma, mientras que otras exposiciones como el amianto pueden aumentar el riesgo general de cáncer esofágico(AU)

Objective. To explore the relationship between occupations and specifi c occupational exposures and oesophageal cancer (OC) by histologicaltype.Methods. A multicentre hospital-based case–control study was conducted in two Mediterranean provinces of Spain. Occupational, sociodemographicand lifestyle information was collected from 185 newly diagnosed male oesophageal cancer patients (147 squamous cell, 38 adenocarcinoma)and 285 frequency matched controls. Occupation was coded according to the Spanish National Classifi cation of Occupations1994. Occupational exposure to a selection of carcinogenic substances was assessed by the FINJEM job exposure matrix. Odds ratios were calculatedby unconditional logistic regression adjusting for age, education, alcohol intake and cigarette smoking.Results. For the squamous cell variety, statistically signifi cant associations were found for waiters and bartenders (OR 8.18, 95% CI 1.98to 33.75) and miners, shotfi rers, stone cutters and carvers (OR 10.78, 95% CI 1.24 to 93.7) in relation to other occupations. For the adenocarcinomavariety, statistically signifi cant associations were observed for carpenters and joiners (OR 9.69), animal producers and related workers(OR 5.61) and building and related electricians (OR 8.26), although these observations were based on a low number of cases. Regardingspecifi c exposures, the study found a statistically signifi cant increased risk of squamous cell carcinoma for ionising radiation, and of adenocarcinomafor high exposure to volatile sulphur compounds (OR 3.12) and lead (OR 5.30). For all histological types of OC combined, a threefoldincrease in risk was found with a signifi cant trend for asbestos exposure (OR 3.46, 95% CI 0.99 to 12.10)(AU)

Conclusions. The data suggest that some occupational exposures may specifi cally increase the risk of oesophageal squamous cell carcinomaor adenocarcinoma, while other exposures such as asbestos may increase the overall risk of OC(AU)

Occupational exposures and risk of oesophageal cancer by histological type: a case-control study in eastern Spain.

OBJECTIVE: To explore the relationship between occupations and specific occupational exposures and oesophageal cancer (OC) by histological type. METHODS: A multicentre hospital-based case-control study was conducted in two Mediterranean provinces of Spain. Occupational, sociodemographic and lifestyle information was collected from 185 newly diagnosed male oesophageal cancer patients (147 squamous cell, 38 adenocarcinoma) and 285 frequency matched controls. Occupation was coded according to the Spanish National Classification of Occupations 1994. Occupational exposure to a selection of carcinogenic substances was assessed by the FINJEM job exposure matrix. Odds ratios were calculated by unconditional logistic regression adjusting for age, education, alcohol intake and cigarette smoking. RESULTS: For the squamous cell variety, statistically significant associations were found for waiters and bartenders (OR 8.18, 95% CI 1.98 to 33.75) and miners, shotfirers, stone cutters and carvers (OR 10.78, 95% CI 1.24 to 93.7) in relation to other occupations. For the adenocarcinoma variety, statistically significant associations were observed for carpenters and joiners (OR 9.69), animal producers and related workers (OR 5.61) and building and related electricians (OR 8.26), although these observations were based on a low number of cases. Regarding specific exposures, the study found a statistically significant increased risk of squamous cell carcinoma for ionising radiation, and of adenocarcinoma for high exposure to volatile sulphur compounds (OR 3.12) and lead (OR 5.30). For all histological types of OC combined, a three-fold increase in risk was found with a significant trend for asbestos exposure (OR 3.46, 95% CI 0.99 to 12.10). CONCLUSIONS: The data suggest that some occupational exposures may specifically increase the risk of oesophageal squamous cell carcinoma or adenocarcinoma, while other exposures such as asbestos may increase the overall risk of OC.

Higher prevalence of human papillomavirus infection in migrant women from Latin America in Spain.

OBJECTIVES: To estimate prevalence and determinants of high risk (HR) human papillomavirus (HPV) by country of origin in women attending a family planning centre (FPC) in Alicante, Spain. METHODS: Cross sectional study of all women attending a FPC from May 2003 to January 2004. An ad hoc questionnaire was designed and data were collected prospectively. HR HPV infection was determined through the Digene HPV test, Hybrid Capture II, and positive samples for PCR were directly sequenced. Data were analysed through multiple logistic regression. RESULTS: HR HPV prevalence in 1011 women was 10% (95% CI: 8.2 to 12). Compared to Spaniards (prevalence 8.2%) HR HPV prevalence in Colombians was 27.5% (OR: 4.24 95% CI: 2.03 to 8.86), 23.1% in Ecuadoreans (OR: 3.35 95% CI: 1.30 to 8.63), and 22.73% in women from other Latin American countries (OR: 3.29 95% CI: 1.17 to 9.19). Women with more than three lifetime sexual partners had an increased risk of HR HPV infection (OR 3.21 95% CI: 2.02 to 5.10). The higher risk of HR HPV infection was maintained in Latin American women in multivariate analyses that adjusted for age, number of lifetime sexual partners, and reason for consultation. The commonest HPV types in women with normal cervical smears were HPV-18 (20%), HPV-16 (14%) and HPV-33 (11%). CONCLUSIONS: Prevalence of HR HPV is more than three times higher in Latin Americans than in Spaniards. Latin American women's HPV prevalence resembles more that of their countries of origin. It is essential that health service providers identify these women as a priority group in current cervical screening programmes.

[Imputation of the date of HIV seroconversion in cohorts of haemophiliacs]. / Imputación del instante de seroconversión al VIH en cohortes de hemofílicos.

OBJECTIVES: To describe the methods used to impute HIV seroconversion date in the haemophiliac cohorts from GEMES project and to validate its use. METHOD: 632 haemophiliacs coming from three hemophilia units identified as HIV+ and 1.092 individuals coming from 5 project GEMES cohorts with a seroconversion window (time among test HIV and HIV+) less than 3 years where mid point (PM) was assumed as seroconversion date. For both groups, seroconversion date was imputed after estimating the probability distribution of seroconversion by means of the EM algorithm. Two imputation methods are used: one obtained from the expected value and the other from the geometric mean of 5 random samples. from the estimated distribution. Imputations have been validated in the non haemophiliacs cohorts comparing with the PM seroconversion date. Also AIDS free time and survival from the different seroconversion imputed dates were compared. RESULTS: Median seroconversion date is located in May of 1993 for the non haemophiliacs and in 1982 for the haemophiliacs. Not big differences are observed among the imputed seroconversion dates and the mid-point seroconversion date in the non-haemophiliac cohorts. Similar results are found for the haemophiliac cohorts. Also no differences are observed in the estimated AIDS-free time for both groups of cohorts. CONCLUSIONS: Geometric mean imputation from several random samples provides a good estimate of the HIV seroconversion date that can be used to estimate AIDS-free time and survival in haemophiliac cohorts where seroconversion date is ignored.

[Changes in condom use among a cohort of prostitutes]. / Cambios en el uso del preservativo en una cohorte de prostitutas.

OBJECTIVE: To describe changes in condom use among prostitutes enrolled in a prospective cohort study in Alicante (Spain), and to identify those factors associated with changes in this behaviour. METHODS: Data from this study come from a prospective cohort study of women working at prostitution enrolled in a center for AIDS preventive at Alicante from 1986 to 1996. The proportion of condom use by prostitutes with their clients was recorded during the first visit and the last one, and changes in condom use were estimated as the difference between them. Two logistic regression analyses were done to identify those factors associated with positive or negative changes in condom use. RESULTS: A statistically significant increase in the prevalence of condom use was observed between the first, 69,2%, and the last visit, 83,9% (p < 0,001). Prostitutes working private increased the condom use more than five time than those working in clubs or at the street. The higher the follow-up time the higher the prevalence of condom user, OR > 6 years = 7,6 (95% CI: 2,2-26,0). No variable was associated with a negative change in condom use. CONCLUSION: This study shows an overall increase of condom use in a cohort of prostitutes after 10 years of follow-up. Relapse in risk behavior has been infrequent. In the future, preventive strategies to increase the use of condoms among prostitutes should be adapted to the new forms of sexual commerce.

Cambios en el uso del preservativo en una cohorte de prostitutas / Changes in condom use among a cohort of prostitutes

Objetivo: Describir los cambios en el uso del preservativo en una cohorte de mujeres que ejercen la prostitución en Alicante y analizar los factores que se relacionan con los cambios en esta práctica preventiva. Métodos: Se han usado los datos de un estudio prospectivo que incluyó a las mujeres dedicadas a la prostitución que acudieron al Centro de Información y Prevención de Sida (CIPS) de Alicante desde 1986 a 1996. Se estimó la frecuencia en el uso del preservativo con los clientes en la primera y última visita al centro, se valoró el cambio entre las dos visitas y los factores asociados a ellos. Se realizaron dos análisis de regresión logística para determinar la asociación entre el cambio positivo o negativo y las variables explicativas. Resultados: La prevalencia de uso del preservativo en la última visita fue mayor que en la primera (83,9 por ciento frente al 69,2 por ciento; p 6 años frente a < de un año = 7,61; intervalo de confianza [IC] del 95 por ciento: 2,2-26,0). Conclusión: Este estudio ha puesto en evidencia un incremento en la frecuencia del uso del preservativo y la baja frecuencia de su abandono en una cohorte de prostitutas a lo largo de 10 años. En un futuro será necesario adaptar esta estrategia preventiva a las nuevas formas de prostitución menos estables y al incremento de inmigrantes, factores que motivan una menor asistencia y adhesión a centros de prevención (AU)

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.

[Evaluation of the quality of care for diabetic patients in Latin America]. / Evaluación de la calidad de la asistencia al paciente diabético en América Latina.

OBJECTIVE: To make a preliminary diagnosis of the quality of care that individuals with diabetes mellitus (DM) received in participating centers of the QUALIDIAB network in Latin America and the Caribbean, and to assess the potential usefulness of this information as well as the importance of expanding the QUALIDIAB network. METHODS: A total of 13,513 patient records from the QUALIDIAB network were analyzed, from public and private health care entities and from the Social Security systems of Argentina, Brazil, Chile, Colombia, Paraguay, and Uruguay. The study utilized: 1) quality-of-care indicators based on international reference values, 2) patient information on clinical, biochemical, and therapeutic parameters and on the rate of use of diagnostic and therapeutic materials, 3) a computer database program, and 4) a software program for statistical analysis. RESULTS: Among the patients studied, about half of them had suffered from diabetes for 5 years or less; this was true both for persons with type 1 diabetes (DM1) and for those with type 2 diabetes (DM2). Of the persons with DM1, 24% of them had a blood glucose level of < 4.4 mmol/L; this was true for 15% of those with DM2. The proportion of persons with a blood glucose level of > 7.7 mmol/L was 41% among those with DM1 and 57% among those with DM2. The frequencies of association between DM2 and other cardiovascular risk factors were: overweight/obesity, 59%; hypertension, 60%; total cholesterol > 5.5 mmol/L, 53%; high-density lipoprotein cholesterol < 1 mmol/L, 32%; triglycerides > 1.7 mmol/L, 45%; and smoking, 13%. Of the people with DM1, 20% of them had a body mass index < 19 kg/m2, probably reflecting deficient metabolic control and inadequate insulin intake. The systematic checking of metabolic control, other cardiovascular risk factors, and chronic DM complications was inadequate in from 3% to 75% of the cases, depending on the specific aspect considered. According to various patient-therapy-education indicators, only some one-quarter to one-half of the studied patients could play an active, effective role in DM control and treatment. Of the persons with DM1, 50% of them were treated with a mixed dose of insulin (NPH + regular insulin), administered in two daily injections in 43% of the cases. Among the patients, 5% of them received one daily insulin injection, and 9% of them received three daily insulin injections. Of the people with DM2, 13% of them treated it only with diet and 14% just with insulin. Among the patients receiving drug treatment, the oral hypoglycemics most used in monotherapy were sulfonylureas (33%), biguanides (9%), and a combination of these two (14%). Fewer than half of the people with diabetes received drug therapy for the associated cardiovascular risk factors. The frequency of patients' macroangiopathic and microangiopathic complications increased with the duration of their disease. Comparing patients who had had diabetes for 5 years or less with those who had had the illness for more than 20 years, the frequency of renal insufficiency and of amputations was around 7 times as great in the latter group; for peripheral neuropathy, it was 2 times as great, and for stroke 1.6 times as great. CONCLUSIONS: These results show the need to improve the quality of care for diabetic patients in Latin America and the Caribbean, and that QUALIDIAB could help do this. Expanding the QUALIDIAB network will help to more accurately diagnose the quality of that care in the Americas, and it will facilitate interventions aimed at optimizing the care. This, in turn, will improve the quality of life of persons who suffer from diabetes as well as diminish the socioeconomic costs of the disease.

[Folic acid ingestion and associated factors in adult women 15-44 years of age in the Valencian Community]. / Ingestión de ácido fólico y factores asociados en mujeres adultas de 15 a 44 años de la Comunidad Valenciana.

BACKGROUND: A low folic acid (FA) intake may increase the risk of neural tube defects (NTD). We estimated the proportion of women with a FA intake < 400 micrograms/day, at the Valencian Region, exploring those factors associated with a FA intake < 400 micrograms/day. SUBJECTS AND METHOD: Daily FA intake was estimated for 538 women aged 15 to 44 years participants in the Nutrition Survey of Valencian Region in 1994, and factors associated with an intake lower than 400 micrograms/day were analyzed. RESULTS: The average FA intake was 392 micrograms/day. A 57.6% of women presented a low FA intake. A higher prevalence of low FA intake was found among youngest women with low sports practice, low body mass index and early menarche. CONCLUSIONS: A high proportion of women with a FA intake considered at risk for NTD was observed, particularly among the youngest with low sports practice.

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.

Prospective cohort study of female sex workers and the risk of HIV infection in Alicante, Spain (1986-96).

OBJECTIVE: To measure the incidence of HIV infection over a 10 year follow up in a cohort of female commercial sex workers in Alicante (Spain), and to determine factors associated with high risk of infection. METHODS: A prospective cohort study was carried in an AIDS information and prevention centre in Alicante, Spain. Of the 1388 female sex workers who initially sought the services of the centre since September 1986, 657 completed at least one additional follow up visit before December 1996. Main outcome measures were infection with HIV-1 and reported risk behaviours. RESULTS: During 1815 person years of observation among 657 female sex workers who were free of HIV infection (negative test), 16 women developed of HIV infection (incidence rate of HIV infection = 8.8 cases/1000 woman years, 95% confidence interval (CI): 5.4-14.4). Reported current use of injecting drugs at the first visit was associated with an increased risk of HIV infection (relative risk, RR = 12.87, 95% CI: 4.81-34.15) as well as having an usual partner with injecting drug addiction (RR = 20.89, 95% CI: 7.44-58.70). Infection also was associated with younger age (RR for 1 year = 0.86, 95% CI: 0.76-0.96). After multivariate adjustment using Poisson regression analysis, the factors that remained significantly associated with the risk of HIV infection were current use of injecting drugs (RR = 4.61, 95% CI: 1.37-15.46), and having a usual partner with injecting drug addiction (RR = 10.08, 95% CI: 2.94-34.57). There was also some evidence that a younger age could be related to infection. CONCLUSION: These data suggest that the risk of HIV infection among this cohort of female sex workers in Alicante is predominately associated with the use of injecting drugs, and having a regular partner with injecting drug addiction. An increasing number of clients did not play a role in the risk of infection.

Sharing of injection equipment among 3755 intravenous drug users in Valencia, Spain, 1987-1992.

BACKGROUND: In order to identify, in a sample of heroin intravenous drug users (IVDU), those factors associated with the predominant risk behaviour related to the transmission of HIV-1 infection--sharing of injection equipment--a cross-sectional survey was carried out in Valencia, Spain from 1987 to 1992. METHODS: Informed consent and pertinent data were obtained from 3755 heroin IVDU recruited at two public AIDS Information Centres in two cities in the region of Valencia. Data were gathered on sociodemographic variables, and sexual and drug use behaviour by interview. The subjects were subsequently tested for HIV-1 antibody. A univariate analysis was carried out to identify variables that were significantly associated with sharing injection equipment. A logistic regression model was used to control for possible confounders. RESULTS: The IVDU who were teenagers, prostitutes (OR = 1.95), who had antibodies to HIV-1 (OR = 1.30) or who had an IVDU steady partner were at significantly higher risk for sharing of injection equipment. Higher levels of education, condom use (OR = 0.65) and living in the smaller city (OR = 0.75) were inversely related to sharing injection equipment. CONCLUSIONS: Our results suggest that different subgroups of IVDU have different characteristics that place them at different risk for HIV-1 infection. These characteristics should guide the design and intensity of specific preventive interventions. Teenagers and IVDU with low educational levels should be targetted for special attention by health authorities.

[The incidence of human immunodeficiency virus type-1 (HIV-1) infection in parenteral drug users]. / Incidencia de la infección por el virus de la inmunodeficiencia humana tipo 1 (VIH-1) en usuarios de drogas por vía parenteral.

BACKGROUND: Cohort studies estimating rates of incidence are scarce despite they are the most appropriate for following the epidemics of HIV-1 and evaluating the effectiveness of preventive interventions. The rate of incidence of infection by HIV-1 in intravenous drug users (IVDU) and the determining factors for such infection are estimated in the present study. METHODS: 3,693 IVDU attended in two centers for information and prevention of AIDS from 1987-1992, were included in the study. Out of 1,868 seronegative subjects, 579 attended a second visit in which a new serologic test was performed against HIV-1. The rates of incidence and 95% confidence intervals were calculated with a Poisson regression model being adjusted in order to control the confounding factors. RESULTS: The estimated global incidence was 11.7/100 people/year (CI 95%: 9.6; 14.46). Those highest rates were observed in IVDU who exchanged syringes (23.5/100 people/year), in those who had more than one sexual partner in the previous month (21.2/100 people/year), in those referring a history of prostitution (22.6/100 people/year), in carriers of hepatitis B antigens (25.6/100 people/year) and in the IVDU younger than 20 years of age (16.5/100 people/year). The variables which independently predicted the rates of incidence were: the exchange of syringes (RR = 6.85; CI 95%: 3.99; 11.75), having more than one different sexual partner in the previous month (RR = 3.51; CI 95%: 1.70; 7.20) and age, with lower risk in those under the age of 20 (RR = 0.49; CI 95%: 0.25; 0.95). CONCLUSIONS: The incidence of infection by type-1 human immunodeficiency virus observed in intravenous drug users is the highest described in Western countries. Preventive measures in general must be intensified particularly in subgroups of intravenous drug users with the greatest risk of seroconversion.

[Determinants of the prevalence of hepatitis B viral infection in parenteral drug abusers]. / Determinantes de la prevalencia de infección por virus B de la hepatitis en usuarios de drogas por vía parenteral.

In order to study the frequency of hepatitis B viral infection and its determinants, we studied 2337 intravenous drug users who visited three AIDS information and prevention centers between 1987 and 1991. The presence of three markers for HBV (AntiHBc, AntiHBs, and AgHBs) and of HIV-1 antibodies was analyzed. A structured questionnaire was used to gather data on sociodemographic information and risk factors for infection. The prevalence of HBV infection (at least one positive marker) was 78% (95% CI: 76%-80%). After adjustment via logistic regression, duration of drug addiction (OR-5.04), the number of sexual partners (OR = 1.70), and the presence of antibodies for HIV-1 (OR = 2.44) were associated with increased HBV infection were higher level of education (OR = 0.67) and residence in a smaller city (OR = 0.66). The marginalization of the practice of drug use makes prevention activities very difficult, and by the time they use health services, the majority of users have already been in contact with HBV. Other infectious agents which share parenteral transmission can reach a similar prevalence if preventive efforts are not intensified.

[Prevalence of human immunodeficiency virus infection among parenteral drug users in the community of Valencia 1987-1991)]. / Prevalencia de la infección por el virus de inmunodeficiencia humana en consumidores de drogas por vía parenteral en la Comunidad Valenciana (1987-1991).

BACKGROUND: To contribute to the knowledge of the frequency and distribution of infection by the HIV-1 in intravenous drug consumers (IVDC) the prevalence of infection in those in whom the voluntary serologic testing was practised and tendency over 5 years were studied. METHODS: The study included 2794 IVDC from centers of primary health care (70%) or those who attended directly (30%), from 1987 to 1991, to three Centers of Information and Prevention of AIDS located in the cities of Valencia, Alicante and Castellón in which the voluntary and free practice of the test of antibodies versus HIV-1 was performed. The serologic test (enzymoimmunoassay) was carried out in 2694 individuals whose positive results were confirmed by Western-blot. Risk factors of the infection in addition to sociodemographic data were collected by questionnaire. RESULTS: The estimated global prevalence was of 49.9% with confidence intervals of 95% (CI 95%) of 48.1% to 51.7%. Differences were observed according to the city with the highest being Valencia (55.3%, CI 95%: 52.8%; 57.8%) in comparison with Alicante (43.7%. CI 95%: 40.5%; 46.9%) and Castellón (41.3%, CI 95%: 35.6%, 47%). A decrease in prevalence was detected during the period studied (chi 2 of tendency = 6.37; p = 0.011), with this decrease only being produced in Alicante and Castellón. No differences were found with regard to sex in contrast to those found according to age, from 35.3% in those under 20 years of age to 59.5% in those over 29 years (chi 2 of tendency = 80.62; p < 0.0001). Only in the youngest age groups was a decreased tendency in prevalence found. The IVDC attended reported interchanging of needles at the time of consultation in 16.9% (CI 95%: 15.5%; 18.3%) with a descending temporal tendency from 27.7% in 1987 to 2.8% in 1991 (chi 2 of tendency = 14.18; p = 0.0001). Only 18.7% (CI 95%: 17.2%; 20.2%) of the IVDC used condoms in more than 66% of their sexual encounters of vaginal coitus. No differences were found with respect to sex or year of consultation. CONCLUSIONS: The prevalence of infection by the HIV-1 in intravenous drug consumers requesting the serologic test is decreasing in the Community of Valencia. This reduction in frequency should be confirmed by estimated rate of incidence of seroconversion. The frequency of the use of condoms in intravenous drug consumers is low conditioning a high risk of extension of the epidemics by sexual transmission.

[Infection caused by the human immunodeficiency virus type 1 in prostitutes and risk factors]. / Infección por el virus de la immunodeficiencia humana tipo 1 en prostitutas y factores de riesgo.

BACKGROUND: Women dedicated to prostitution constitute a group at risk of acquiring the human immunodeficiency virus-1 (HIV-1). This study was designed with the aim of knowing the frequency of this infection in prostitutes and the factors associated to the same. METHODS: A descriptive transversal study with analytic components including 444 women who voluntarily attended an AIDS prevention center from 1986-1991 was carried out. The HIV-1 antibody test was performed in 440 of the subjects. All the subjects were interrogated on sociodemographic variables and risk of infection. RESULTS: Of the 440 women studied, 24 had HIV-1 antibodies with a global prevalence (1986-1991) of 5.5% with confidence intervals of 3.4, and 7.6% at 95% (CI 95%). During the study period the prevalence remained stable: 6.8% (1986-87), 5.5% (1988), 4.3% (1989) and 4.3% (1990-91). No positive association was found between HIV-1 infection and education, time in prostitution and the use of condoms. HIV-1 infection was strongly associated to the use of drugs, adjusted odds ratio by logistic regression OR = 26.9 (CI 95%: 8.9; 9/1). Positive associations were also observed with greater number of sexual partners and syphilis but these did not reach statistical significance. The percentage of prostitutes who used condoms with more than 33% of their clients increased from 44.5% in 1986-87 to 85.9% in 1990-91. CONCLUSIONS: In this study no considerable changes were found with respect to the prevalence of infection by the human immunodeficiency virus-1 in prostitutes in Spain. Similarly, this collective has increased its use of preventive measures although they remain insufficient, indicating that more energetic preventive strategies are necessary. These measures should be particularly active with the group of young prostitutes.