Prevalence and epidemiological characteristics of chronic pain in the Spanish population. Results from the pain barometer.

BACKGROUND: Chronic pain (CP) is a public health problem worldwide. AIM: To update the prevalence of CP and compare the clinical and social characteristics of people with CP with those with non-chronic continuous pain and a group without pain. METHODS: An observational cross-sectional study was carried out in a representative sample of 7058 adults from the Spanish population. Sociodemographic data, the presence of CP and non-chronic continuous pain, characteristics of pain, limitations on activities of daily living (ADL), the presence and level of anxiety and depression (HADS), quality of life (SF-12v2) and social support (DUKE) were collected. Descriptive and bivariate analyses were performed. RESULTS: The prevalence of CP was 25.9% (95% CI;24.8-26.9) and that of non-chronic continuous pain was 7.7% (95% CI;7.1-8.3). Women presented a higher prevalence of both CP (30.5% vs. 21.3%) and non-chronic continuous pain (8.8% vs. 6.6%). CP was more common in the group between 55 and 75 years old (30.6%, 95% CI = 28.6-32.6%), non-chronic continuous pain affected most the population between 18 and 34 years old (11.2%, 95% CI = 9.6-12.7%). The median duration of CP was 4 years. The lumbar was the most frequent pain site (58.1%), and 27.1% did not know the cause. A greater frequency of limitations on ADL, more anxiety and depression, and worse quality of life were shown among the subjects with CP. CONCLUSION: CP affects one in four Spanish people and impairs the mental, physical and social health. Differences exist by sex and age in its frequency. Identifying subjects with non-chronic continuous pain is fundamental to prevent their pain from becoming chronic. SIGNIFICANCE STATEMENT: Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Due to its high prevalence and impact on quality of life, chronic pain has become one of the main health problems nowadays. Attention must be paid to it both from a clinical and social perspective, trying to raise awareness among the population of its possible causes and consequences. In routine clinical practice, greater consideration is given to groups of people with a higher prevalence of chronic pain, such as women and people with middle age, and with no chronic pain to prevent the appearance of chronic pain.

Understanding the impact of the COVID-19-related lockdown in university workers. Identifying groups through cluster analysis.

Objective: To analyse the COVID-19-related lockdown impact on University workers, to identify groups based on this information, and to study the factors associated with each group. Study design: Cross-sectional study. Methods: A survey was conducted 3.5 weeks after COVID-19-related lockdown in University workers in Spain. Sociodemographic variables, housing, work, health conditions, levels of anxiety, stress and depression (DASS-21), and social support (MSPSS) were collected. A cluster analysis was performed to identify groups depending on the impact of the lockdown. Differences between groups were tested using Chi-square and Mann-Whitney-U tests, and associated factors with binary logistic regression. Results: We identified two groups of workers. "G1: Consequences in the daily life routine" was mainly composed of men, Research and Teaching Personnel (RTP) with more stable professional categories, higher income level, and bigger houses than people in G2. Participants in "G2: Concerns for the current and future well-being" presented worse intensity of pain than before the lockdown, more anxiety, depression, stress and less social support than people in G1. ASP (Administration and Services Personnel) had more risk of belonging to G2 than RTP (OR = 5.863). A higher number of people living at home decreased the risk of being in G2 (OR = 0.439). People with lower pain intensity had less risk of being in G2 (OR = 0.014), and this risk decreased as friends support increased (OR = 0.833). Conclusions: In G1, the consequences were immediately reflected in the stress resulting from changes in their daily work routine. In G2, the concerns were related to their professional future, with worse mental health, greater intensity of pain and less social support.

Understanding the different relationships between mood and sleep disorders in several groups of non-oncological patients with chronic pain.

OBJECTIVE: To compare sleep dimensions in patients suffering from chronic pain of different origins, and with a group of pain-free subjects. To analyze the relationship between depression and/or anxiety and sleep disorders in musculoskeletal, neuropathic, and fibromyalgia patients. METHODS: This cross-sectional study included patients diagnosed with neuropathic pain (NP) (n = 104), musculoskeletal pain (MSK) (n = 99), or fibromyalgia (FM) (n = 51), and pain free subjects (n = 72). Information about sleep dimensions (MOS-sleep), duration and intensity of pain (Visual Analog Scale), and anxiety and depression (Hospital Anxiety and Depression scale) was collected. RESULTS: Of the 254 patients with chronic pain (PCP) studied, the mean pain intensity was 6.6 (SD = 1.9), with an average duration of 9 years. The scores in all sleep dimensions of the MOS-sleep were higher in CPP (more disturbances) compared to pain free patients, and differences were observed among the three groups of PCP, with FM most severely affected. Anxiety (ß = 1.3), depression (ß = 1.1), intensity (ß = 1.7), and duration of pain (ß = 0.04) were associated with more sleep problems in MSK patients. In contrast, anxiety (ß = 2.5) and duration of pain (ß = 0.05) were negatively related to sleep in the NP patients, and only depression (ß = 1.3) affected FM patients. CONCLUSIONS: The sleep pattern differs among groups of PCP in the presence or absence of mood disorders. Understanding these disorders in each specific group of PCP is fundamental, and it can contribute to improve the clinical situation of the patients and better orientating therapeutic strategies.

Factors related to the evolution of Health Related Quality of Life in coronary patients. A longitudinal approach using Weighted Generalized Estimating Equations with missing data.

BACKGROUND: The aim is to know the factors related to the evolution of Health Related Quality of Life (HRQL) in Coronary Patients (CP) from a longitudinal perspective using an appropriate method that handles missing data adequately when the mechanism of missingness is uncertain. METHODS: Prospective study with repeated measures at baseline, 3 and 6months. 250 patients with acute myocardial infarction or unstable angina were studied. Sociodemographic and clinical data were collected at baseline. Mental health (GHQ-28) and HRQL (SF-36v1) were assessed during the follow-up. The missingness mechanism was tested. Friedman test and partial eta-squared were used to analyse changes in SF-36 scores and WGEE were used to identify the predictors of the evolution of HRQL. RESULTS: 95 dropped out after 3months and 72 after 6months. The missingness was likely to be at random. All the dimensions of the SF-36 improved over time, except PF. The factors related to the evolution of HRQL were: being woman (B=-23.9 in RE; B=-6.9 in MCS), older age (B=-0.5 in BP; B=-0.3 in VT), being single/separated (B=-14.5 in GH; B=-14.1 in SF; B=-23.3 in MH) and widow(er) (B=-23.2 PF; B=-29.8 in SF), hypertensive (B=-19.8 in RP; B=-8.9 in VT), worse mental health (B=-3 in PF; B=-2.8 in RP; B=-3.1 in BP; B=-1.2 in PCS; B=-3.8 in VT; B=-2.6 in SF), previous history of CHD (B=-12.5 in PF; B=-5.2 in PCS), and performing heart-healthy physical activities (B=13.9 in PF). CONCLUSIONS: HRQL improves over time. A global approach, including age, marital status, performing physical activities or hypertension, is required to improve HRQL in CP.

Assessing the Construct Validity and Internal Reliability of the Screening Tool Test Your Memory in Patients with Chronic Pain.

Patients with chronic pain often complain about cognitive difficulties, and since these symptoms represent an additional source of suffering and distress, evaluating the cognitive status of these patients with valid and reliable tests should be an important part of their overall assessment. Although cognitive impairment is a critical characteristic of pain, there is no specific measure designed to detect these effects in this population. The objective was to analyze the psychometric properties of the "Test Your Memory" (TYM) test in patients with chronic pain of three different origins. A cross-sectional study was carried out on 72 subjects free of pain and 254 patients suffering from different types of chronic pain: neuropathic pain (104), musculoskeletal pain (99) and fibromyalgia (51). The construct validity of the TYM was assessed using the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADs), Index-9 from MOS-sleep, SF-12, and through the intensity (Visual Analogical Scale) and duration of pain. An exploratory factor analysis was also performed and internal reliability was assessed using Cronbach's alpha. After adjusting for potential confounders the TYM could distinguish between pain and pain-free patients, and it was correlated with the: MMSE (0.89, p<0.001); HAD-anxiety (-0.50, p<0.001) and HAD-depression scales (-0.52, p<0.001); MOS-sleep Index-9 (-0.49, p<0.001); and the physical (0.49, p < .001) and mental components (0.55, p < .001) of SF-12. The exploratory structure of the TYM showed an 8-factor solution that explained 53% of the variance, and Cronbach's alpha was 0.66. The TYM is a valid and reliable screening instrument to assess cognitive function in chronic pain patients that will be of particular value in clinical situations.

Unexplained pain complaints and depression in older people in primary care.

OBJECTIVE: Chronic pain and depression are frequent conditions in primary care patients. Depression is frequently overlooked in the presence of pain of uncertain origin. The aim is to measure the prevalence and clinical correlates of unrecognized comorbid mood disorders and chronic pain of uncertain origin in older primary care patients, and to elucidate the differences with younger adults with the same conditions. DESIGN: Cross-sectional study. SETTING: Primary care centres in Spain. PARTICIPANTS: Patients (n= 2720) with persistent pain of uncertain origin. MEASUREMENTS: Pain characteristics, sites and intensity (Visual Analogical Scales), depression (PRIME-MD interview), clinical characteristics and health services use. RESULTS: We observed a similarly high (80.5%) prevalence of undiagnosed mood disorders (especially major depressive disorders) among older and younger adult patients with comorbid chronic pain complaints of uncertain origin. Older patients suffered pain that was more intense, longer lasting and located in a higher number of different areas, when compared to younger patients. Pain intensity was a factor associated with suffering from mood disorders among patients above 65 years, whilst the number of pain sites was a more important factor among younger patients. CONCLUSIONS: Depression is highly associated with pain of uncertain origin in older patients with differences in pain characteristics when compared to younger patients. The robust comorbid relationship between both conditions should alert clinicians to specifically look for depression in the presence of poorly explained painful symptoms.

High prevalence of confirmed, but also of potential and believed, neuropathic pain in pain clinics.

BACKGROUND AND AIMS: Epidemiological data about neuropathic pain are still scarce. A national survey, based on neurologic clinical diagnosis, was performed to determine its prevalence among patients attending pain clinics. METHODS: An epidemiological cross-sectional study involving pain clinics across all regions in Spain was carried out. Pain specialists evaluated the medical files and the clinical condition of patients attending their practices systematically during 1 day. They used the revised definition and grading system proposed in 2008 to decide whether a given patient had definite (i.e., confirmed), probable (potential) or possible (believed) neuropathic pain. Also, they provided a diagnostic label for neuropathic pain conditions and appraised treatment adequacy. RESULTS: In a single day, 178 pain specialists provided data from 2173 patients. Definite, probable and possible neuropathic pain was cited in 639 (29.4%), 304 (14.0%) and 97 (4.5%) patients, respectively. Almost two-thirds of these were women. A diagnostic label of primary pure central and/or peripheral neuropathic pain was cited in 344 (15.8%) patients. The most common diagnostic label (568 patients) was low back pain or sciatica causing mixed neuropathic pain. Definite neuropathic pain diagnosis was less likely in patients with mixed pain conditions and in women derived from primary care. Co-morbid depressive or anxiety symptoms were usual. CONCLUSIONS: Definite (confirmed) neuropathic pain alone was as prevalent as neuropathic pain ascertained with screening questionnaires in prior recent European studies. The clinical relevance of the surplus of patients with potential and believed neuropathic pain ascertained by clinicians is uncertain.

[Automated detection of microaneurysms by using region growing and Fuzzy Artmap neural network]. / Detección automatizada de microaneurismas mediante crecimiento de regiones y red neuronal Fuzzy Artmap.

OBJECTIVE: To assess whether the methodological changes of this new algorithm improves the results of a previously presented strategy. METHODS: We enhance the image and filter out the green channel of the digital color retinography. Multitolerance thresholding was applied to obtain candidate points and make a seed growing region by varying intensities. We took 15 characteristics from each region to train a Fuzzy Artmap neural network using 42 retinal photographs. This network was then applied in the study of 11 good quality retinal photographs included in the diabetic retinopathy early detection screening program, with initial stages of retinopathy, obtained with the Topcon NW200 non-mydriatic retinal camera. RESULTS: Two experienced ophthalmologists detected 52 microaneurysms in 11 images. The algorithm detected 39 microaneurysms and 3,752 more regions, confirming 38 microaneurysm and 135 false positives. The sensitivity is improved compared to the previous algorithm, from 60.53 to 73.08%. False positives have dropped from 41.8 to 12.27 per image. CONCLUSIONS: The new algorithm is better than the previous one, but there is still room for improvement, especially in the initial determination of seeds.

Pain as a symptom of depression: prevalence and clinical correlates in patients attending psychiatric clinics.

BACKGROUND: The need to assess the prevalence and characteristics of painful symptoms among depressed patients attended by psychiatrists in their regular clinical practice. METHODS: A multi-centre, cross-sectional study was carried out in a large sample (n=3566) of patients attending out-patient psychiatric facilities in Spain. All types of DSM-IV-TR depressive disorders were included. Data on the diagnosis, specific symptoms, intensity of depression and antidepressant and analgesic drug treatments were collected. The presence and characteristics of significant pain (visual analogue scale score>40) at the time of the study were also recorded. RESULTS: The prevalence of pain in depressed patients was 59.1% (CI 95%: 57.7%; 60.7%). Factors associated independently with the existence of significant pain were: being female, presence of loss of energy and the diagnosis of dysthymia or depression induced by physical disorders. In addition, age and the intensity of depression were two risk factors, where each year of age and each point in the Hamilton scale increased the risk of having pain by 2% and 8% respectively. The presence of anhedonia and the diagnosis of depression induced by illegal drugs were factors inversely related to pain. LIMITATIONS: The cross-sectional naturalistic characteristics of the study. CONCLUSION: Our data show a high prevalence of pain among depressive patients attending psychiatric clinics. Painful symptoms are modulated differently depending on the type of depression and the presence of specific symptoms, such as loss of energy or anhedonia. Psychiatrists should ask their depressive patients for the presence of pain on a regular basis.

Fibromyalgia and psychiatric comorbidity: their effect on the quality of life patients.

Patients with fibromyalgia (FM) often have associated mental disorders. As well as being very prevalent, the two conditions also have sociodemographic and clinical similarities. If both of these clinical conditions lead independently to a limitation of the health-related quality of life (HRQL) of the patients, it may be thought that their conjunction could have a greater adverse effect on this parameter. Equally, it could be assumed that the factors that worsen the HRQL of patients with FM or with mental illness could have a more serious effect on the HRQL of those in whom the two clinical conditions coexist. Although this conclusion seems evident, as far as we know there have been no studies to assess how much or in what way psychiatric comorbidity affects the HRQL of patients with FM, or any studies to analyze the particular factors that may affect their HRQL. This study approaches the importance of psychiatric comorbidity in patients with fibromyalgia and analyzes the combined effect that these two conditions have on the overall HRQL of these patients.

Assessing health-related quality of life among coronary patients: SF-36 vs SF-12.

OBJECTIVE: to compare health-related quality of life (HRQL) assessed using the Short Form-12 (SF-12) and the Short Form-36 (SF-36) questionnaires in coronary patients with different diagnoses, testing the hypothesis that the SF-12 is capable of discriminating between patients with acute myocardial infarction (AMI) and patients with unstable angina in the same way as the SF-36. STUDY DESIGN: Cross-sectional study. METHODS: HRQL was studied in 186 patients admitted to hospital for ischaemic cardiopathy, using the SF-36 and SF-12. Intraclass correlation coefficients were calculated for each summary component. The proportion of variability of the physical and mental summary components of the SF-36 (PCS-36 and MCS-36) explained by each component of the SF-12 was examined using a linear regression model, adjusted for age and gender. RESULTS: The mean scores observed were similar in the two questionnaires. The degree of agreement was high, and the corresponding regression model explained 87% of the variability in the PCS-36 and 93% of the variability in the MCS-36. The SF-12 identified the differences between AMI and angina in the same way as the SF-36. CONCLUSIONS: The SF-12 replicates the information of the summary component scores of the SF-36, and discriminates between patients with AMI and those with unstable angina. Its use allows the same information to be obtained as from the SF-36, with less effort for the patient and the doctor.

Women, mental health and health-related quality of life in coronary patients.

OBJECTIVE: To establish clusters of Health-Related Quality of Life (HRQL) in a population of patients hospitalised for suspected Coronary Heart Disease (CHD), and to examine the relationship between mental health and other sociodemographic and clinical variables associated with worse HRQL. METHODS: We conducted a cross-sectional study of 185 patients admitted to the Cardiology Service. We used the General Health Questionnaire (GHQ-28) to assess the mental status, and the SF-36 to assess Health Related Quality Life (HRQL). Using the patients' scores obtained from the SF-36, we performed a cluster analysis and used a logistic model for the analysis of the variables associated with HRQL clusters. RESULTS: We identified two HRQL clusters: good quality of life, for which the patients scored highest in all the dimensions of SF-36, and worse quality of life, for which patients had lower scores in all dimensions. The variables associated with the worse quality of life group were: female gender, previous history of Coronary Heart Disease (CHD), and poor mental health. CONCLUSIONS: Being female, having poor mental health and a previous history of CHD were identified as representing a vulnerable group with worse HRQL.

[Ethical attitudes in Spanish pediatric critical care units]. / Encuesta de ética en las unidades de cuidados intensivos pediátricos españolas.

OBJECTIVES: To assess physicians' awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs). MATERIAL AND METHODS: Questionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain. RESULTS: Ninety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs. The occurrence of ethical dilemmas in the PICU was recognized by 96.8 % of the respondents. The most frequent method of solving these problems was through medical consensus (80 %), while family participation in the decision making process was highly variable. A total of 95.8 % of respondents stated that decisions to limit therapy were made in their PICU, although only one third of these decisions were written in the medical record. The most frequent form of therapeutic limitation was the do not resuscitate order. One third (32.6 %) of participants considered there were ethical differences between withdrawal and withholding of treatment. Attending physicians had greater experience of therapeutic limitation than did residents, but their opinions on the subject were similar. CONCLUSIONS: Ethical dilemmas are common in the PICU. In this setting, decisions about limitation of therapy are frequent, although many physicians admit to not being clear on this issue or on other aspects of clinical ethics. Family members' participation in the decision making process is insufficient in Spanish PICUs.

Predictive factors of mental disorders in patients with suspected ischaemic cardiopathy.

OBJECTIVE: To identify the predictive factors of mental disorders in patients with suspected Ischaemic Cardiopathy (IC). METHOD: The patients admitted to the Cardiology Service of an University Hospital (SW Spain) for acute thoracic pain with suspected IC were studied. Patients were classified into four diagnostic groups (acute myocardial infarction, unstable angina, non-ischaemic cardiological process, non-cardiological) based on clinical, electrocardiographical and biochemical data. The sociodemographic and clinical variables were obtained by a 'ad hoc' questionnaire and the clinical records of the patient. The GHQ-28 questionnaire was used to assess the status of mental health, and a score of > or = 6 was taken as the cut-off point for being a 'probable psychiatric case'. Crude odds ratios (OR +/- 95% CI), and adjusted OR according to a logistic model, were calculated in order to study the variables associated with the mental disorders. The tabulation and analysis of data was carried out with the SPSS v.8 (for Windows) program. RESULTS: From June 1996 to November 1997, 185 patients were studied; 72% were males and the mean age was 60.2 years (SD = 10.4). 49.2% of the patients were scored at > or = 6 on the GHQ-28, and the sub-scale accounting for the highest scores was that of somatic symptoms of psychological origin. The adjusted ORs showed that female sex (OR: 2.5; 95% CI: 1.2-5.0), previous personal history of IC (OR: 2.3; 95% CI: 1.1-4.4), and the presence of arterial hypertension (OR: 2.0; 95% CI: 1.1-3.9), were the predictive variables for being a 'probable psychiatric case', whereas neither age nor comorbidity were predictive. CONCLUSIONS: The percentage of subjects considered to be a 'probable psychiatric case' among patients with suspected ischaemic cardiopathy was high. Screening for mental disorders and intervention to control the risk factors associated are measures recommended in these patients.

Comparison between the GHQ-28 and SF-36 (MH 1-5) for the assessment of the mental health in patients with ischaemic heart disease.

OBJECTIVE: To assess the mental health of patients admitted to hospital with suspected ischaemic heart disease, by means of two instruments, the General Health Questionnaire (GHQ-28) and the MH (1-5) dimension of the SF-36 Health Survey Questionnaire, and to compare the psychometric properties of both questionnaires in this population. METHODS: A study was conducted of 185 patients consecutively admitted to hospital with suspected ischaemic heart disease, classified into four groups: Acute Myocardial Infarctus (AMI), unstable angina, non-ischaemic cardiologies, and non-cardiological conditions. Their mental health was assessed by means of the GHQ-28 and the MH 1-5 sub-scales of the SF-36; the validity of the results were analysed by the association of each instrument with socio-demographic (age, sex, social class, and educational level) and clinical (co-morbidity, risk factors, diagnostic groups and background to the illness) variables. The correlation of each instrument with other sub-scales of the SF-36 was studied. The internal consistency was measured by Cronbach's alpha, together with the item-internal consistency and item-discriminant validity. RESULTS: Of the population studied, 71.9% were males and the mean age was 60.2 years (SD: 10.4). The diagnosis for 33.5% was AMI and for 37.8% unstable angina. For all the variables studied, the scores in the two instruments were ordered in the same way, and were significantly worse for females and for the most disadvantaged social class. None of the scales discriminated in respect of the diagnostic group or the presence of comorbidity. However, a linear relationship was observed with risk factors. Cronbach's alpha was 0.95 for the GHQ-28 and 0.80 for the MH 1-5. Correlations with the other dimensions showed ranges of -0.35 to -0.61 for the GHQ-28 and of 0.26 to 0.61 for the MH 1-5. These were highest for the Vitality and Social Functioning sub-scales in both instruments. CONCLUSIONS: The subjective perception of mental health is measured in a similar way by both the MH 1-5 scale of the SF-36 and the GHQ-28. However, since the MH 1-5 questionnaire is shorter, it should be administratively easier to introduce into routine cardiological practice.

Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease.

The validity and reliability of the SF-36 has been studied in 185 patients hospitalized with suspected ischemic cardiopathy, classified into four groups (AMI, unstable angina, nonischemic cardiologies, and absence of cardiologies). The validity of the construct has been analyzed by means of the association of the SF-36 with sociodemographic and clinical variables, and with diagnostic groups. The correlation of the subscales with GHQ-28 scores and the factorial structure have been studied. Internal consistency was measured by Cronbach's alpha and the item-internal consistency and item-discriminant validity. The validation result was as expected, although the scores were significantly lower in patients with unstable angina, only in the PF, VT, and GH subscales. The correlations with the GHQ-28 were high for MH and VT. The internal consistency was high (Cronbach's alpha 0.72-0.94). Factorial analysis identified eight factors, with the "anxiety" component of subscale MH remaining as an independent factor. These results suggest that the SF-36 is a useful scale for the differentiated clinical forms of ischemic cardiopathy, with the additional capability of reflecting the level of anxiety in these patients.

Psychological and occupational predictive factors for back pain among employees of a university hospital in southern Spain.

OBJECTIVES: To identify the individual and occupational factors that are predictors for low back pain among the employees of a university hospital in southern Spain. METHODS: A transverse study was conducted in which the population used was the hospital employees who volunteered to participate. The information was obtained by using a questionnaire, which included demographic and anthropometric variables, habits, characteristics of the work done, and of any pain experienced. The mental health condition of subjects was measured using the GHQ-28, using a score of > or = 6 as the cut-off point. To study the variables associated with pain, crude odds ratios (ORs) were calculated (+/- 95% CI) and adjusted according to a logistic regression model. RESULTS: One thousand one hundred and four subjects participated in the study but only 890 of these completed the questionnaire in full (rate of response, 35.7% of total employees). The population studied was notable for the high proportion of women, for subjects > 41 years of age, and subjects who undertook little or no physical exercise. In addition, according to the GHQ-28 test, 29.9% of the total were 'probable psychiatric cases'. The crude ORs were high in all the occupational categories in comparison with the doctors, with the exception of the maintenance, cleaning, and catering group. They were also higher among women, among subjects with poor mental health, and among women with one or more children. The adjusted ORs showed that having a GHQ-28 score of > or = 6, and belonging to the auxiliary technician category, were independent risk factors for suffering low back pain. Being older than 41 years and in temporary employment were protective variables. CONCLUSIONS: The presence of probable mental illness is the variable most strongly associated with the presence of low back pain in the population studied. Its diagnostic confirmation and appropriate treatment could contribute to reducing the prevalence of vertebral pains in this occupational group.

Evolution and factors associated with biological-risk accidents reported in a university hospital in Spain, 1989 to 1995.

BACKGROUND: The objective of this study was to describe the profile and evolution of accidents involving risk of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) reported in a large Spanish hospital, together with the preventive measures administered and the factors associated with high-risk accidents. METHODS: Data used were the accidents recorded in the hospital during the period from January 1989 to December 1995. A logistic model, using age, gender, service, occupation, and year of accident as independent variables was constructed to study the factors associated with these accidents. RESULTS: The study included 1,009 accidents. Accidents were more common among nurses, female doctors, younger workers, and persons who worked in surgical settings. Of the total sources of infection studied, 11.6% were positive for HBV, 28.2% for HCV, and 24.4% for HIV. No seroconversions were detected in the partial follow-ups conducted. The factors associated with high-risk accidents were gender (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.24-3.60); occupation as physician (RR, 2.57; CI95, 1.54-4.29) or as nursing staff (RR, 1.80; CI95, 1.12-2.89); and working in a surgical service (RR, 2.01; CI95, 1.27-3.18). Younger workers had more accidents overall, but older workers were more likely to have high-risk exposure. In the multivariate analysis, the occupation (physician and nursing staff) was the most important variable when adjusted by the other factors. CONCLUSIONS: Our results suggest that a greater effort still is required in the application and evaluation of preventive measures. New safety systems, with clearly proven cost-effectiveness, should be developed and applied.

[Evaluation of nutrition of school children in the population of Sierra de Cádiz (Ubrique)]. / Valoración de la alimentación de los escolares de una población de la Sierra de Cádiz (Ubrique).

BACKGROUND: The aim of the present work was to study the nutritional pattern in the school population of a rural town in Cádiz (Spain), with an important industrial development. SUBJECTS AND METHODS: We have studied a representative sample of 344 school-children of both sexes between 8 and 15 year-old. Dietary intake was assessed by "24 hour recall" and the CUVALC program was used to transform it in nutrients. In all the age groups daily caloric and nutrients intake was adjusted to that recommended by Spanish people. RESULTS: The results observed showed that specially protein intake was high in all the age groups. Dietary lipid was high (39%). The saturated fatty acids exceeded the level recommended in 100% school children and the intake of carbohydrates (46%) and crude fiber were low. On the other hand, we observed that vitamin D in girls and calories, calcium and iron in both sexes were lower than recommended allowances in some age groups. In addition, the proportional breakfast calories intake was lower (16.6%) than the 25% recommended. CONCLUSIONS: The population of Ubrique, a rural town in Cádiz (Spain) with an important industrial development had a more occidental than mediterranean nutritional profile.