Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study.

OBJECTIVE: To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. METHODS: Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. RESULTS: 25,529 patients were included: 23,102 (90.5%) underwent chest radiograph and 2,497 (9.5%) a CT. The prevalence of SPN was 2.1% (95% CI 1.9 - 2.3) in radiographs and 17.0% (95% CI 15.5 - 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. CONCLUSIONS: The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. KEY POINTS: There is a lower SPN prevalence in the clinical population than in screening studies. SPN prevalence is associated with some patient characteristics: sex, age, imaging test. Nodule characteristics related to malignancy were associated with some patient characteristics.

Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART.

BACKGROUND: We assessed the impact of education on long-term overall and cause-specific mortality among 6575 injecting drug users (IDUs) according to HIV status and introduction of highly active antiretroviral therapy (HAART). METHODS: Community-based cohort study of IDUs recruited in three AIDS prevention centres (1987-1996). Causes of death were ascertained in clinical centres and Mortality Registry and classified as AIDS, drug use related, injuries, or liver diseases. Poisson regression models including education and calendar period interaction and adjusted by sex, age, and HIV were used. RESULTS: In 73 901 person-years of follow-up, there were 1493 deaths (20.2/1000 person-years): 761 related to AIDS, 234 to drug use, 179 to injuries, and 93 to liver diseases. IDUs with university studies had a lower risk of death (RR 0.52; 95% CI 0.36-0.77) than those without studies: this difference was higher after (RR 0.45; 95% CI 0.25-0.80) than before 1997 (RR 0.68; 95% CI 0.41-1.13). Compared to before 1997, while decreases in the risk of AIDS mortality were seen during 1997-2004 for both lower (RR 0.49; 95% CI 0.41-0.58) and higher (RR 0.33; 95% CI 0.23-0.48) educated, only those higher educated experienced a reduction in drug-use mortality (RR 0.54; 95% CI 0.28-1.05) and death from injuries (RR 0.52; 95% CI 0.23-1.21). CONCLUSIONS: Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.

Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Pre-AIDS mortality from natural causes associated with HIV disease progression: evidence from the European Seroconverter Study among injecting drug users.

OBJECTIVES: To study differences in pre-AIDS mortality between European cohorts of injecting drug users (IDU) and to evaluate whether pre-AIDS mortality increased with time since HIV seroconversion and decreasing CD4 count. METHODS: The study population consisted of 664 IDU with documented intervals of HIV seroconversion from eight cohort studies. Differences in pre-AIDS mortality were studied between European sites; an evaluation of whether pre-AIDS mortality increased with time since HIV seroconversion and decreasing CD4 count was carried out using Poisson regression. RESULTS: One hundred and seven IDU died, of whom 57 did not have AIDS. Pre-AIDS causes of death were overdose/suicide (49%), natural causes such as bacterial infections/cirrhosis (40%), and unintentional injuries/unknown (11%). Considering pre-AIDS death and AIDS as competing risks, 14.7% were expected to have died without AIDS and 17.3% to have developed AIDS at 7 years from seroconversion. No statistically significant differences in pre-AIDS mortality were found between European regions, men and women, age categories and calendar time periods. Overall pre-AIDS mortality did not increase with time since seroconversion, but did increase with decreasing CD4 count. Evaluating cause-specific mortality, only pre-AIDS mortality from natural causes appeared to be associated with time since seroconversion as well as immunosuppression. For natural causes, the death rate per 100 person-years was 0.13 the first 2 years after seroconversion, 0.73 in years 2-4 [risk relative (RR) to years 0-2, 5.6], 1.83 in years 4-6 (RR, 14.0) and 1.54 for > or = 6 years (RR, 11.7). This rate was 0 for a CD4 cell count > or = 500 x 10(6)/l, 1.06 for 200-500 x 10(6)/l and 4.06 for < 200 x 10(6)/l (RR versus > or = 200 x 10(6)/l, 7.0). In multivariate analysis, both CD4 count and time since seroconversion appeared to be independently associated with death from natural causes; CD4 count appeared to be the strongest predictor (adjusted RR, 5.9). CONCLUSIONS: A high pre-AIDS mortality rate was observed among IDU. No significant differences were observed across European sites. Pre-AIDS mortality from natural causes but not from overdose and suicide was associated with HIV disease progression.

Determinants of HIV-1 infection in intravenous drug users in Valencia, Spain, 1987-1991.

From 1987 through 1991, 2687 intravenous drug users recruited at three AIDS information centres in the Region of Valencia (Spain) were interviewed about drug use and sexual behaviour and subsequently tested for HIV-1 antibody. The overall seroprevalence was high, 50% (95% confidence interval [CI]: 41.8-51.9%). There were no differences by gender, but HIV-1 infection was related to older age and city of residence. After adjustment by means of logistic regression age (odds ratio [OR] = 1.80), sharing of injection equipment (OR = 2.16), duration of addiction (OR = 6.59) and prostitution (OR = 1.77) were significantly associated with HIV-1 prevalence. High educational level was inversely related to HIV-1 status (OR = 0.43) and a decreasing trend of prevalence with time was observed.

Prevalence of antibiotics to hepatitis C in a population of intravenous drug users in Valencia, Spain, 1990-1992.

BACKGROUND: Hepatitis C has been related to other viral diseases such as the human immunodeficiency virus infection (HIV) or hepatitis B (HBV). The objective of this study was to estimate the prevalence and determinants of antibodies to hepatitis C virus (HCV) in intravenous drug users (IVDU) in Valencia (Spain) and to compare the seroprevalence between the HCV, HIV and HBV in this high risk group. METHODS: A cross-sectional study was conducted in a sample of 1056 current IVDU from the Valencia area who attended the city's AIDS Information Centre between January 1990 and December 1992. Information on sociodemographic, sexual behaviour, and drug use variables was collected by means of a structured questionnaire. Antibodies to HCV, HIV and HBV were assayed by ELISA test. RESULTS: The seroprevalence of HCV for the whole period was 85.5% (95% confidence interval [CI]: 83.2-87.5%), ranging from 76.5% in 1990 (95% CI: 71.9-81.1%) to 87.8% in 1992 (95% CI: 82.5-93.1%). Year of testing and prevalence of HBV markers showed an independent association with HCV seroprevalence. When only IVDU aged < 25 years were analysed, sharing of needles also appeared as an independent dominant. Of those IVDU with less than one year of addiction, 69% were HCV seropositive compared with 41% for HBV and 14% for HIV. CONCLUSIONS: Intravenous drug users in Valencia showed one of the highest reported hepatitis C seroprevalences (85.5%). A more efficient parenteral transmission of hepatitis C virus than HBV or HIV is suggested.

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.

Geographical variation in disease progression in HIV-1 seroconverted injecting drug users in Europe?

BACKGROUND: Human immunodeficiency virus (HIV) disease progression might vary by geographical region due to differences in the spectrum of HIV-related illnesses and (access to) health care. Therefore, the effect of geographical region, next to the effect of other potential cofactors, on disease progression in 664 injecting drug users (IDU) with documented HIV seroconversion from eight cohorts in Europe was studied. METHODS: Kaplan-Meier methods and Cox proportional hazards analysis were performed to assess the effect of geographical region, other sociodemographics, drug use and repeated HIV exposure on progression from HIV seroconversion to immunosuppression, AIDS and death with AIDS. We considered the confounding effect of study-design related factors (e.g. setting of follow-up), and accounted for pre-AIDS death from natural causes by imputing when each endpoint would have occurred, had they not died without AIDS. RESULTS: Estimates of progression to AIDS and death with AIDS were substantially faster after taking pre-AIDS mortality into account. Median incubation time from seroconversion to the first CD4 count < 200 cells/microliter was 7.7 years (95% CI: 7.1-8.3) and to AIDS 10.4 years (95% CI: 9.8-infinity). The 10-year survival was 70.3% (95% CI: 62.8-76.6). The relative hazards (RH) of AIDS for IDU from central and southern Europe compared with IDU from northern Europe was 1.9 (95% CI: 1.2-3.0) and 1.2 (95% CI: 0.6-2.3), respectively, before, and 1.5 (95% CI: 0.7-3.2) and 1.1 (95% CI: 0.6-2.3) after taking differences in study-design related factors into account. Accounting for these factors, the RH of death with AIDS was 0.9 (95% CI: 0.3-2.5) for central and 1.2 (95% CI: 0.4-3.4) for southern Europe compared with northern Europe. For the first CD4 count < 200 cells/microliter these figures were 0.8 (95% CI: 0.5-1.4) and 0.8 (95% CI: 0.5-1.4). Age at seroconversion was the strongest predictor of disease progression. No statistically significant differences in disease progression were found by gender, foreign nationality, drug use and potential repeated HIV exposure. CONCLUSIONS: We found no evidence for regional variability in HIV disease progression among European IDU. Future studies evaluating geographical differences should consider the confounding effect of study-design related factors and differential non-AIDS mortality. As age is an important determinant of disease progression, it should be considered in recommending treatment.

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.

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE: To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN: A cross-sectional survey. PARTICIPANTS AND SETTING: A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS: Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS: Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.

Associated factors to psychiatric morbidity in postmenopausal phases.

BACKGROUND: The greatest risk of psychiatric morbidity during the climacteric years is linked to a greater exposure to stressful life experiences, women's dissatisfaction with their role in society and to an absence of social backup. The question to be posed now is the extent to which the longitudinal surveys can confirm, refute or complement the results of the cross-sectional analyses. METHODS: A study involving population-based cohorts was carried out on a sample of 120 women who had been previously identified as being premenopausal or menopausal during a cross-sectional examination conducted between 1987 and 1988 within the city of Valencia (Spain). The aims were to analyze the movements of specific psychosocial factors (role satisfaction, level of social support) making a comparison between the premenopausal and postmenopausal phases. RESULTS: An increase in the frequency of psychiatric episodes was detected in the later stages of the climacteric. The absence of global social support, being a possible psychiatric case and experiencing severe life events during the initial phases of the climacteric all emerge as being the most reliable factors for predicting the psychiatric morbidity during the postmenopausal phase. CONCLUSIONS: The results lend weight to the hypothesis of psychiatric morbidity being linked to social changes. A discussion of the clinical implications is presented.

[Factors associated with the use of gynecology services by climacteric women: a case-control study]. / Factores asociados a la utilización de servicios de ginecología por la mujer climatérica: un estudio de casos y controles.

BACKGROUND: The data and concepts described in the literature on menopausic women are based on observations and studies carried out in menopausic women attending medical or gynecological consultations and contrast greatly with the results obtained in women from a general population. METHODS: In a case-control study 505 women between 45-55 years of age, 142 having attended a gynecological consultation (cases) and 363 taken from a randomized sample of the general population (controls) were evaluated. Information concerning sociodemography, climacteric phase, psychic morbidity and psychosocial factors as stressing events, social support and adjustment and satisfaction with roles was collected in a personal interview. The odds ratio (OR) was used as the means of association and multiple regression analysis was performed to control possible confusing factors. RESULTS: The cases were fundamentally young women in a premenopausic phase of a high social class belonging principally to a group of widows, separated or divorcees and a group of married women with high levels of association (OR = 14.7; OR 12.14). The women attending a gynecological consultation were characterized by having greater risk of lacking social support (OR = 8.94), presenting a greater frequency of vital severely stressing events over the previous year (OR = 2.55), and demonstrating greater insatisfaction in social adjustment (OR = 2.42) particularly in their sexual and matrimonial relations. CONCLUSIONS: Women attending medical, specially gynecological, consultations during climacteric years are not representative of the population of women in these years as a whole. Purely pharmacologic management, principally substitutive hormonal therapy, was the most wide-spread treatment of preventive character should be reestablished in accordance with the results with the most manifold and multifactorial orientations and foci.

[Research on diagnostic tests in Medicina Clinica. A methodological assessment]. / Investigación sobre pruebas diagnósticas en Medicine Clínica. Valoración de la metodología.

BACKGROUND: Research on diagnostic tests have not reached the same methodological rigour as other areas of clinical research. Identification of more frequent and important methodological flaws could contribute to raise the quality of diagnostic test studies. The aim of this study was to evaluate the methodology of diagnostic test studies published in MEDICINA CLINICA. MATERIAL AND METHODS: Forty two articles about diagnostic test studies published in MEDICINA CLINICA from 1992 through 1995 were selected. Two set of methodological criteria were applied (JAMA 1995; 274: 645-651 and Revisiones en Salud Pública 1993; 3: 243-262). Each article was independently evaluated by two observers. RESULTS: Of the 42 articles evaluated, 33 determined sensitivity and specificity, and 9 only sensitivity. There was a well-defined gold-standard in the majority of the studies (90%) but it was not applied to all patients in 21% of them. Description of the diagnostic test evaluated was present in 79% and test reproducibility was assessed in only 19%. Source of patients, eligibility criteria for study subjects and spectrum composition were considered in 31, 36 and 31%, respectively. Avoidance of work-up bias and review bias was done in 69 and 36% of the articles. Only 12% considered indeterminate results, 50% reported test indexes for relevant clinical subgroups and statistical precision was provided in 17% of the studies. CONCLUSION: Methodological quality of the research on diagnostic tests published in MEDICINA CLINICA is similar to that observed in the best world clinical journals. Nevertheless, there are opportunities to improve several aspects of study design and presentation that will facilitate its clinical applicability and general utility.

[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.

[Prevalence and control of arterial hypertension in the adult population of the Valencian community, 1994]. / Prevalencia y control de la hipertensión arterial en la población adulta de la Comunidad Valenciana, 1994.

BACKGROUND: High blood pressure (HBP) is probably one of the main targets for prevention in primary health care. Knowledge of the magnitude and control is needed for monitoring this health problem at the population level. The aim of this study was to estimate the prevalence of hypertension in the adult population of Valencian Region (VR) (Spain), and to evaluate the degree of treatment and control. SUBJECTS AND METHODS: Two measurements of blood pressure (BP) were obtained for a representative sample of 1,674 participants (14 years and older) in the nutrition and health survey of the VR in 1994. A semi-automatic digital esfingmomanometer was used. HBP definition was based on the criteria of the WHO and the Fifth Joint National Committee on Detection Evaluation and Treatment on HBP. Criteria of the MONICA project were used to determine the level of treatment and control of hypertension. Prevalence of HBP was estimated for sex and age groups accounting for the study design. RESULTS: HBP prevalence was 31.7% (14.1% borderline HBP plus 17.6% defined HBP). Hypertension increased with age from a prevalence of 9.3% in the group 15-24 years of age, to 68.8% in the group > or = 65 years old. A 57% of hypertensive persons were not under treatment, a 16.6% were treated but their BP was not controlled, and a 26.4% were under treatment and presents controlled BP. The uncontrolled BP was more evident at younger ages. CONCLUSIONS: This study has shown that one third of the adult population from VR had HBP, and over the half of them are not treated. Furthermore, over one third of hypertensives under pharmacological treatment presented uncontrolled BP. These results should be taken into account if preventive actions are to be implemented at the individual and population level.

[Evaluation of the variability of rapid diagnosis of infection by Chlamydia trachomatis using direct immunofluorescence]. / Evaluación de la variabilidad del diagnóstico rápido de infección por Chlamydia trachomatis mediante immunofluorescencia directa.

The interobserver and intraobserver agreement between two microscopists was independently assessed in a blind fashion to evaluate the reproducibility of the results of the quick diagnosis of Chlamydia trachomatis infection with direct immunofluorescence. The study was carried out in two phases, and 604 samples of cervical and urethral exudate from patients seen at a center for the prevention and therapy of sexually transmitted diseases were evaluated. The two observers had a kappa index of agreement between them of 0.41, with 95% confidence intervals (95% Cl) of 0.31-0.51, while their agreement within themselves was 0.78 (95% Cl: 0.65-0.91) for the first observer and 0.61 (95% Cl: 0.47-0.75) for the second one. After discussion of the data and analysis of the reasons of disagreement, the evaluation was repeated. In this second phase, both interobserver and intraobserver agreement were substantially improved. The kappa index was 0.71 (95% Cl: 0.61-0.80) for the former, whereas regarding the latter the first observer had a kappa index of 1 (95% Cl: 0.86-1.13) and the second observer an index of 0.82 (95% Cl: 0.61-0.80). It was concluded that the test may have problems in its practical performance if the microscopists are not previously trained with systematic programs for the evaluation of results.

[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.

[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.

[Use of screening mammography and its demographic and risk determinants in women 25 to 65 years of age]. / Utilización de la mamografía de cribado y sus determinantes demográficos y de riesgo entre mujeres de 25 a 65 años.

BACKGROUND: To know the utilization of the screening mammography among women from 25 to 65 years old in an urban health zone, where there is not an specific screening program for breast cancer. To detect the demographic and risk determinants that are involved in the mammography screening use. SUBJECTS AND METHODS: A sample of 1,240 women were interviewed consecutively as they visited their physician. Risk factors, sociodemographic variables and use of health services were analyzed. The associated variables with the use of mammography screening were determined by univariant analysis. A multiple logistic regression model was designed to identify the variables independently associated with the use of mammography screening. RESULTS: The percentage of interviewed women who have completed at least one mammography screening in the last three years has been 10.2 +/- 3% (confidence level: 95%), 68.3% of them were under 50 years old. The variables independently associated with the use of mammography screening were: age (OR = 1.08); routine visit to the gynecologist (OR = 8.13); educational level (primary: OR = 2.44, secondary: OR = 3.66, university: OR = 7.43, no schooling: reference level); and knowledge about the benefits of mammography screening (OR = 6.15). Family history of breast cancer and the other risk factors were found not to be associated with the use of mammography screening. CONCLUSIONS: The use of mammography screening among women from 25 to 65 years is inadequate according to the age and other risk factors. Mammography screening among women with a family history of breast cancer and those over 50 years old is underused, so it would be recommended and their use increased for these women. But women under 40 years old without family history of breast cancer have to be dissuaded from undertaking such a screening.

[Variation in the prevention of cardiovascular risk factors. A population-based study]. / Variaciones en la prevención del riesgo cardiovascular: estudio poblacional.

BACKGROUND: Published studies on clinical practice variability have mainly focussed on variability in the rates of hospitalization and surgical procedures. The objective of this study was to evaluate variability in the measurement of cholesterolemia and blood pressure in four professional groups and in the general population. METHODS: A cross-sectional survey was performed by mail in the city of Valencia (Spain). Five population groups were selected: physicians, nurses, lawyers, architects and the general population. The sample was obtained by random sampling of each group. RESULTS: Of all the questionnaires returned, only those returned by individuals surveyed (1,755) and their partners (1,296) were used (total: 3,050). The frequency of preventive cholesterolemia measurement was greater among nurses (55.7%) and physicians (54.1%) than among architects (38.9%), lawyers (38.2%) and the general population (35.1%). The frequency of preventive blood pressure measurement was also greater among physicians (47.7%) and nurses (42.2%) followed by architects (39.4%) and lawyers (38.8%) and was lower among the general population (32.2%). After adjusting by sex, age group, marital status, level of education, and employment, only lawyers (RR = 0.79; 95% CI, 0.6-0.9) and architects (RR = 0.77; 95% CI, 0.68-0.88) showed a significantly lower probability of determining cholesterol levels than physicians (basal category) and nurses (RR = 1.05; 95% CI, 0.93-1.18). The general population showed the lowest probability of measuring blood pressure (RR = 0.8; 95% CI, 0.65-0.97), although the differences were statistically significant only when compared with physicians. CONCLUSIONS: Preventive practices should be increased among groups in which they are less frequently performed until they are performed with the same frequency as among physicians and nurses. Efforts should be directed to increasing cardiovascular prevention programs in health centers.