[Cardiovascular morbidity and its relationship to left ventricular hypertrophy in a cohort of hypertensive patients: the Gòtic study]. / Morbilidad cardiovascular y su relación con la hipertrofia ventricular izquierda de una cohorte de pacientes hipertensos: estudio Gòtic.

BACKGROUND: To describe cardiovascular morbidity of a hypertensive patients cohort and relate it to the presence of left ventricular hypertrophy (LVH), LVH geometric patterns, other cardiovascular risk factors (CRF), previous pathology (PP) and a range of variables. DESIGN: Prospective study of the cohort visited in a from 1993 to 1998. Place. Downtown primary care center. PATIENTS: A random sample of 267 hypertensive patients under 80 years old was used. Method and procedures. The presence of universals of CRF, PP and a range of variables such as age, sex, systolic and diastolic blood pressure (SBP and DBP), heart rate, body mass index (BMI), left ventricular mass index (LVMI) and Cornell and Sokolov-Lyon electrocardiographic criteria were registered. Also cardiovascular events (CE) were recorded: heart failure (HF), coronary heart disease (CHD), stroke, arrythmia and peripheral vascular disease (PVD). Then the association between these variaables and CE appearance was studied. MEASURES AND RESULTS: The total amount of CE was 60, with an accumulated incidence of 22.5% (confidence interval 95% from 19.4 to 25.7%).HF was more frequent among patients with a higher BMI (p = 0.05). The patients with HF showed a stronger smoking habit as CRF and a higher PAS (p = 0.05). The PVD was more common among hypertensive patients with smoking habit as CRF (p = 0.05).EC was highly observed in those patients either with LVH or CRF, especially in those cases such as HF (90% had LVH), stroke (87.5%) and arrythmias (83.3%). However, it was less observed in those ones with PVD (66.7%) and HF (60%). No relation was found between the patterns of LVH and EC. CONCLUSIONS: The HF was more frequent among the hypertensive patients with a higher LVMI, the HF among the smokers and a higher PAS and PVD among the smokers. The LVH is strongly related to the HF, stroke and arrythmias. The differences among the populations with cardiovascular epidemiology as well as the short span of follow-up may have contributed to obtaining such results.

Dietary fat intake and prostate cancer risk: a case-control study in Spain.

OBJECTIVES: Epidemiological evidence suggests that dietary factors can play a role in the etiology of prostate cancer. Results from several case-control and cohort studies on nutrient intake and prostate cancer have been unclear. The authors examined the effect of lipid intake on the risk of prostate cancer. METHODS: In order to assess associations between lipid intake and prostate cancer risk, a case-control study was conducted between May 1994 and March 1998 in the Barcelona metropolitan area, Spain. Two hundred seventeen incident cases with histologically confirmed diagnosis of prostate cancer were matched to 434 hospital and community controls by age and residence. Information about food intake was gathered by a semiquantitative food-frequency questionnaire. Unconditional logistic regression was used for the analysis. RESULTS AND CONCLUSIONS: Animal fat intake was associated with prostate cancer with an estimated OR for highest quartile of 2.0 (95% CI 1.2-3.2). Vitamin C intake was inversely associated with prostate cancer (OR = 0.6; 95% CI 0.3-0.9). The prostate cancer risk increased in proportion to alpha-linolenic acid intake. In the analysis adjusting for energy and major covariables the estimated OR for upper quartile of alpha-linolenic acid was 3.1 (95% CI 1.1-3.8). In conclusion, the association between fat intake and prostate cancer may be correlated with alpha-linolenic acid, although the specific mechanism has to be determined.

[The process of change and sex as predictors of the quitting of tobacco consumption]. / Proceso de cambio y sexo como predictores del abandono del consumo de tabaco.

BACKGROUND: Combining drug and behavioral therapy has proved useful in helping smokers quit. One of the main predictive factors for relapse is a smoker's level of motivation. This study evaluates results in a cohort of smokers in function of motivation and sex. PATIENTS AND METHODS: This prospective study enrolled 1,045 smokers examined at a specialist unit between September 1993 and September 1997. All patients gave information about smoking history and were classified in one of three levels of motivation. Abstinence was determined by CO exhaled. Twelve months later, we compared the success rates of men and women and of subjects with different levels of motivation. Variables predicting relapse were assessed using logistical regression analysis. RESULTS: Abstinence had been achieved by 24.5% of the 1,045 patients 12 months later, the rate for men being 25% and the rate for women 23.8% (p = 0.1). No smoker in the complacent phase was abstinent at 12 months. The rates were 24.3% and 32.4%, respectively, for smokers in the contemplation and action phases (p < 0.001). Only age and degree of motivation were independently related to failure to quit. CONCLUSIONS: Strategies that combine drug treatment, behavioral therapy and follow-up achieve good rates of success among patients who are motivated to quit smoking.

[Reorganising specialist care in the Ciutat Vella Health Sector: analysis of an experience]. / La reordenación de la atención especializada en el Sector Sanitario Ciutat Vella: análisis de una experiencia.

OBJECTIVE: Analysis of the results obtained in terms of improvement in the continuity of care, its resolutive capacity and accessibility, in the framework of the organisational change brought about by the reorganisation of specialist care (RSC) in the Ciutat Vella Health Sector. DESIGN: A descriptive study of the reorganised model of specialist care introduced in 1995 and comparison between this and the previous model (1993) in terms of activity, further tests made, referral to hospital, filling in the clinical history and waiting-list. T SETTING: The experience involved 4 PCTs in the Ciutat Vella Health sector of Barcelona (covering 74,449 people). MEASUREMENTS AND MAIN RESULTS: The volume of visits was in general less in 1995, while other types of activity had been incorporated: minor surgery, cryotherapy, consultations and sessions. CONCLUSIONS: The model of RSC satisfies the basic objectives for which it was designed. It increased the specialist's ability to resolve the case within Primary Care. It improved user accessibility to specialist care in terms of waiting time. Finally, the model favours ongoing care, thanks to a single clinical history for both levels.

Risk for occupational transmission of HIV infection among health care workers. Study in a Spanish hospital.

The aim of this study was to evaluate the HIV seroconversion rate associated with different types of occupational exposures in health care workers. A longitudinal study was conducted from January 1986 to October 1992 in a teaching hospital in Spain, where HIV infection is prevalent among patients. Each health care worker was asked to complete a questionnaire regarding age, sex, staff category, lace of exposure, other exposures, type of exposure, body fluid, infected material and HIV status of source patient. These health care workers were then followed up at 6 weeks, 3 months, 6 months and 12 months with repeated test for HIV antibody. Four hundred twenty three reports of occupational exposure were analysed. Nursing was the profession with more exposures (42.8%). Ninety five percent of total exposures were percutaneous, 4% mucous membrane contacts and 1% skin contacts, 88.3% were described as blood contact and 71.8% had resulted from needlestick and suture needles. Exposures from HIV-positive patients comprised 23.2% of occupational exposures. There was a significant difference in the length of follow-up in physicians (p = 0.00009) and nurses (p = 0.00001), when we compared HIV-positive patients with patients in whom the HIV status was unknown or negative. The HIV seroconversion rate was 0.00%. We consider that the risk of acquiring HIV infection via contact with a patient is low, but not zero. Well documented cases of seroconversion have been published.(ABSTRACT TRUNCATED AT 250 WORDS)