[Acute renal failure after intake of mushrooms]. / Insuficiencia renal aguda tras consumo de setas.

The picking and consumption of wild mushrooms is a frequent practice in our region and may lead to accidental poisoning when confused with edible mushrooms. We describe the case of a 9-year-old boy who, following the ingestion of a poisonous mushroom, presented with uncontrollable vomiting and subsequent hepatic, haematological and renal failure some hours later. The patient required haemodialysis. The clinical course, laboratory findings and renal histology, which showed tubular necrosis with basal membrane preserved and lymphocytic interstitial infiltrate, confirmed the diagnosis of a severe mixed syndrome. The patient evolved favourably after the poisoning, recovering renal and liver function. In any case of acute renal failure of unknown cause in children, it would be necessary to rule out ingestion of mushrooms, since the patient could benefit from early treatment with haemoperfusion and thus prevent the deterioration of the renal function and other organs. In our patient, haemoperfusion was not carried out due to the lengthy period of latency since the ingestion of the toxic substance until diagnosis.

[Guidelines of the Spanish Society of Nephrology. Clinical practice guidelines for peritoneal dialysis]. / Guías Sociedad Española de Nefrología. Guías de práctica clínica en diálisis peritoneal.

In Spain and in each of its autonomous communities, the dialysis treatment of chronic renal disease stage 5 is totally covered by public health. Peritoneal dialysis, in any of its modalities, is established as the preferred home dialysis technique and is chosen by high percentage of patients as their choice in dialysis treatment. The Spanish Society of Nephrology has promoted a project of creation of performance guides in the field of peritoneal dialysis, entrusting a work group composed of members of the Spanish Society of Nephrology a with the development of these guides. The information offered is based on levels of evidence, opinion and clinical experience of the most relevant publications of the topic. In these guides, after defining the concept of << peritoneal dialysis>>, the obligations and responsibilities of the sanitation team of the peritoneal dialysis unit are determined, and protocols and performance procedures that try to include all the aspects that concern the patient with chronic renal disease in substitute treatment with this technique are developed. They propose prescription objectives based on available clinical evidence and, lacking this, on the consensus of the experts' opinions. The final aim is to improve the care and quality of the of the patient in peritoneal dialysis, optimizing in this way the survival of the patient and of the technique. In Spain, as in other neighbouring countries, peritoneal dialysis has an incidence and prevalence that is much lower than that of hemodialysis, ranging in the last evaluation by the Spanish Society of Nephrology between 5 and 24% in the different autonomous communities. The great majority of peritoneal dialysis units form part of the public network of the Spanish state, with special representation as a Satellite Unit or Concerted Center related to the public hospital of reference, on which it must depend.

[Evaluation of therapeutic strategies in congenital nephrotic syndrome of the Finnish type]. / Evaluación de las estrategias terapéuticas en el síndrome nefrótico congénito tipo finlandés.

INTRODUCTION: Congenital nephrotic syndrome of the Finnish type (CNFS) is caused by mutations in the nephrin gene. This disease manifests as massive proteinuria, gross peripheral edema, and ascites during the first weeks of life. In the last few years the prognosis has improved due to new treatment strategies: antiproteinuria drugs, intensive nutrition, nephrectomy, dialysis, and renal transplantation. The aim of this study was to determine the impact of these therapeutic measures. PATIENTS AND METHOD: We performed a descriptive retrospective epidemiological study of 12 patients diagnosed with CNSF between January 1985 and August 2005. We included patients aged less than 14 years old with massive proteinuria and generalized edema during the neonatal period, a large placenta (> 25 % of birth weight), and normal glomerular filtration rate during the first 6 months of life, in whom other causes of congenital nephrotic syndrome were ruled out. RESULTS: The diagnosis was established after a median period of 17 days (range 6-30). The most commonly used treatments were albumin infusions (91.7 %), angiotensin-converting enzyme inhibitors (66.7 %), and indomethacin (58.3 %). Dialysis was started in 58.3 %, at a median age of 3.76 years (2.81-7.6). The main complication was acute peritonitis (85.7 %). Renal transplantation was performed in 58.3 % of the patients; of these, 71.4 % have normal renal function after a median follow-up of 3.73 years (0.8-6.3). The median plasma albumin level during the pretransplant period was 0.17 g/dL (0.12-0.28). Plasma cholesterol and triglyceride levels decreased significantly after renal transplantation (p = 0.043). Fifty percent of the patients achieved adequate height and weight for their age and gender. Mortality was 33.3 %. CONCLUSION: Antiproteinuria drugs and intensive nutritional therapy improve clinical control and delay the start of dialysis and renal transplantation, increasing the probability of success.

[Study of tuberculosis in Huelva prison]. / Estudio de tuberculosis en la prisión de Huelva.

OBJECTIVES: Knowing about the rate of tuberculous infection and disease in prison population and workers in Huelva prison, and the association of tuberculosis with the sociosanitary risk factors. EQUIPMENT AND METHODS: Descriptive research for a year in 141 male prisoners at the age of 20 to 52 years old, from the 1sT of February in 1994 to the 1sT in 1995. RESULTS: The prevalence on tuberculous infection is 46.4% (accumulative incidence); and tuberculous disease 3.5% (accumulative incidence 1.4%) on the prisoners and the prevalence on tuberculous infection on the prison officers is 18.8% (there wasn't incidence) and the was no disease. CONCLUSIONS: It's perceived a high rate of tuberculous disease on the prisoners at the expense of people with infection by HIV and drugs addicts by parenteral way. The socio-cultural variables affect the tuberculous infection and disease tuberculous.

[Social attitude towards health participation]. / Actitud Social ante la participación en salud.

BACKGROUND: The community health participation is an important issue for all health systems based on a Primary Health Care, which emphasizes prevention and promotion, as a complement to assistance. In this survey, the social attitude towards health participation is studied, taking into account the different research paradigms on Social Sciences, the models of health behaviours, the meaning of participation and the meaning of the own attitudes. METHODS: A Likert scale of 18 items, which constitutes a part of a general health survey of 128 variables, is elaborated and validated. It is complemented with a personal interview to 1371 persons in a random sample from four health areas. RESULTS: The data obtained show that there are neither statistical significant differences among areas in relation with having or not a Health Council, nor between men and women. The attitudes towards participation are more favourable among young people, bachelors and persons from a high socioeconomic status, hig degree studies, white collar professions, and the persons going to the doctor with the lowest frequency, show a positive tendency. The factorial analysis identifies three dimensions: a) Self-care, b) political and c) community health agent. The discriminant analysis shows that variables (age, civil, status, socioeconomic level, studies...) classify correctly 74% of cases. CONCLUSIONS: The personal profile, showing a health participative attitude, is consistent, in most variables, with that published by previous reports.

[Rational structures in health education models: basics and systematization]. / Estructuras de racionalidad en educación para la salud: fundamentos y sistematización.

The different Health Education (HE) models appeared in the scientific literature are analyzed, trying to eliminate the confusion produced by its great diversity, applying a general and systematic point of view. Due to the relevance of that topic in the activities of Health Promotion in Primary Health Care it is urgent a deep reappraisal due the heterogeneity of scientific papers dealing with that topic. The curriculum, as the confluence of thought and action in Health Education, is the basic concept thanks to which it is possible to integrate both scientific logic, the biological one and that pertaining to the social sciences. Of particular importance have been the different paradigms that have emerged in the field of HE from the beginning of the present century: a first generation with a "normative" point of view, a second one orientated from positivistic bases, and a third generation adopting an hermeneutic and critic nature. This third generation of paradigms in HE has taken distances from the behaviouristic and cognitive perspectives being more critical and participative. The principal scientific contributors in the field of HE, internationals as well as spaniards are studied and classified. The main conclusions obtained from this Health Education paradigm controversy are referred to both aspects: 1) planning, programming and evaluating activities, and 2) models, qualitative and quantitative methodologies. Emphasis is given to the need of including Community Participation in all phases of the process in critic methodologies of HE. It is postulated the critic paradigm as the only one able to integrate the rest of the scientific approaches in Health Education.

[Knowledge of the hygiene habits of schoolchildren: a course of urban collaboration in health]. / Conocer los hábitos higiénicos de los escolares: cauce de colaboración ciudadana en salud.

AIM: To study the hygiene habits of schoolchildren in Santa Maria de Gracia (an urban site) and La Nora (a rural site), both in Murcia. This stemmed from an initiative of the Health Councils of these places, with the aim of later developing an effective project of Health Education. The Community was conceived as the main player in the Health-Illness process: passive behaviour models were thus abandoned. DESIGN: This was a transversal study of the hygiene customs of school-children from Second and Seventh Grade E.G.B. (General Basic Education: from 8 to 13) in the rural area; from Second and Fifth Grade EGB, from Second Grade BUP (Baccalaureate: from 14 to 16) and from the Second Course of Second Grade FP (Professional Formation) in the urban area. Questionnaires covered the whole of the above population. Crosses according to age, sex and the rural or urban environment were made. PARTICIPANTS: Professionals from both the Primary Care Teams, from Educational Centres, from the Department of Socio-Health Sciences of the Faculty of Medicine and schoolchildren interviewed. INTERVENTIONS: Using a participatory methodology, a questionnaire was designed and answered by a total of 1,182 students, belonging to 13 Educational Centres. MAIN FINDINGS: There are shortcomings open to improvement in practically all areas of hygiene habits; with important differences, in particular customs, between boys and girls, between town and country and between younger and older students.

[Renal failure as a factor leading to epileptic seizures]. / Insuficiencia renal como factor desencadenante de crisis epilépticas.

OBJECTIVE: To analyze the incidence of convulsive seizures in renal failure by studying the semiological characteristics of the convulsive episodes, their subsequent evolution and the presence of possible sequelae. The relationship between the different potential causes of the seizures and their evolution and treatment was also analyzed. MATERIAL AND METHODS: We retrospectively reviewed the clinical histories of 108 patients admitted to the hospital over a 20-year period with a diagnosis of renal failure: 55 were undergoing predialysis, 42 renal transplantation, 7 peritoneal dialysis and 3 hemodialysis. One patient was excluded for not fulfilling the selection criteria. Computer study of the 18 quantitative and qualitative variables was carried out with the SPSS 9.0.1 program. RESULTS: Of the 107 patients, 16 (14.95 %) had suffered some type of convulsive seizure. None was in the predialysis group. As triggering factors, hydroelectrolyte imbalance was found in eight patients and hypertension was found in four. In the remaining patients the causes were not well-defined. Only three patients with epilepsy prior to renal failure presented sequelae. CONCLUSIONS: Epileptic seizures in renal failure in childhood can be considered as occasional seizures that do not usually become chronic or produce sequelae. Information on the management of seizures in renal failure should be disseminated among professionals treating systemic diseases.

[Educational and health dimensions of health education at school: a participative total experience in 2 health regions of Murcia]. / Dímensiones educativas y sanitarias de la educación para la salud en la escuela: una experiencia participativa y global en dos zonas de salud de Murcia.

BACKGROUND: The results of and experience on School Health Education during two years and in two health areas, which intends to promote solid contacts between all people interested in carrying out activities included in daily work, and, this way, to improve the schoolchildren habits are shown. METHODS: The activity is situated in the Investigation Action paradigm. Quantitative and qualitative methods are used in the process and product evaluation. RESULTS: The programme has had an statistically significant effect on the habits considered to be of interest (dental hygiene and physical exercise) and no effects on those habits on which no work was done. There have been 13 Educational Centers, 2 Health Centers and the Faculty of Medicine Sociosanitary Sciences Department. Collaboration, among all interested people, has been increasing, although there have been found difficulties and giving up. CONCLUSIONS: Our opinion is that the role to be played by the Health Councils and the School Councils is essential to develop the recent ministerial dispositions on the matter, within the scope of health areas.

[Health Councils: assessment after 1 year of functioning]. / Los Consejos de Salud: balance de un año de funcionamiento.

OBJECTIVE: Analysis of the experience from creating and developing Health Committees in the areas of Santa Maria de Gracia and La Nora (Murcia) throughout more than one year in operation (1989-90), as bodies for community participation. DESIGN: Participative research which has meant the transformation of existing reality, and which in the process has been a source of knowledge. LOCATION: Clinic Centres, at community level, in two basic health areas, one rural and one urban. PARTICIPANTS: E.A.P., education officers, pharmacists, various associations, mayors, the Government, Department of Socio-health Sciences of the Faculty of Medicine, and the community in general. INTERVENTIONS: The analysis of developing the participative dynamics. MAIN RESULTS: The content of the Minutes of the meetings were analysed in order to give an objective, systematic and quantitative view of what has occurred, 22 variables were identified which were grouped and cross grouped. CONCLUSIONS: Everyone is invited to the Committees and the large majority attend. Citizens and professionals speak and express their views. The meetings are democratic and agreements are reached, objectives established, health problems are resolved and the only instrument used being participation. This has all been stable throughout the year of operation.

[Epidemiologic study of accidental poisoning cases treated at a pediatric hospital]. / Estudio epidemiológico de las intoxicaciones accidentales atendidas en un hospital pediátrico.

A prospective study, by epidemiological survey, was carried out in the 447 children with acute poisoning attended in our hospital between February 1, 1990 and January 31, 1991. All data was processed to analyze the possible associations that would help to better understand the factors that take part in poisoning. We observed a predominance in male infants, with a greater incidence between two and three years of age, and the accidents occurred almost exclusively at home, mainly in the kitchen or bedroom. The child is often not adequately watched and the toxic elements are usually within easy access. There was neither a seasonal nor daily predominance. We noticed an hourly predominance with most accidents occurring between 12 a.m. and 4 p.m. Drugs are the most common agents, followed by household cleaning products. Morbidity was scarce and there was no mortality.

[Health instruction in adult education as instrument for community participation. Analysis of an experiment in La Nora (Murcia)]. / La formación sanitaria en la educación de adultos como instrumento para la participación comunitaria. Análisis de una experiencia en La Nora (Murcia).

AIM: The main aim of this work is to demonstrate the possibility of establishing stable contacts between the PC study and citizens' groups, in order to promote Health Education. The experience of Adult Education in a Health Centre, initiated by its Consejo de Salud (Health Council), was analysed. DESIGN: The study's methodology is of Participatory Research based on an earlier descriptive analysis, which had followed the educational input. PLACE: It takes place in a PCC and is a Community-based activity. PARTICIPANTS: The PC study, Adult Education teachers, the Social Health Department of the Faculty of Medicine and 136 adult students from nine villages in the rural area of La Nora (Murcia), took part in the study. ACTIVITIES: Essentially to develop a programme of Health Instruction within Adult Education, in order to encourage Community Participation. RESULTS: They focus on checking the effect of the programme on all the groups concerned and analysing the characteristics of the adult student body. CONCLUSIONS: The most important have been the generally positive feelings about the experiment and thus the possibility of tackling new ones. It was important that the study had been the fruit of a programme of Community Participation, with the Health Centre as the point of reference.

[The outlook for Spanish primary care starting with a bibliometric analysis of its scientific production (1971-1994)]. / Perspectiva de la atención primaria española a partir del análisis bibliométrico de su producción científica (1971-1994).

OBJECTIVE: To establish the relative weight of the various kinds of primary health care (PHC) research collected in the IME (Spanish medical index), In order to determine their possible relationships with Spain's PHC model. DESIGN: Bibliometric analysis. PARTICIPANTS: PHC documents (1971-1994) from the IME data base (CD-ROM), subdivided by years, journals, themes and Autonomous Communities (AC). RESULTS: 3,015 studies were published, with a first phase (1970s) of under 10 documents per year, a second (1980s) with a big increase and a third (1990s) of stagnation. Of the 117 journals containing studies, Atención Primaria gave a home to almost 58% (60% after 1984). CONCLUSIONS: PHC research production has stagnated recently, though the journal Atención Primaria has maintained its undisputed leadership position. The clinical model predominant in Spanish medicine is generally followed.