[Hospital morbidity of elderly population in Andalusia (Spain)]. / Morbilidad hospitalaria aguda de las personas mayores de Andalucía.

INTRODUCTION: In recent years we have seen in Spain a significant increase in the number of old people. The aim of this work was to determine hospital morbidity among the elderly. MATERIALS AND METHODS: We studied the morbidity among patients older than 65 years admitted at the hospitals of our Andalusian public health system that belongs to the Spanish National Health System. We analysed the minimal basic data set at discharge (MBDSD) over a period from January 1998 to December 1999, both inclusive. RESULTS: In the 32 hospitals studied, a total of 25,255 hospital discharges of patients older than 65 years were recorded. This means an annual hospitalization rate in this age group of 15.2% (95 % CI: 15.1-15.3). The most frequent causes of hospitalisation are: diseases of the circulatory system (20.7%), diseases of the respiratory system (14.0%), diseases of the digestive system (11.6%). CONCLUSIONS: The old population of Andalusia (Spain) has a high rate of hospital morbidity, specially for people older than 75 years, and significant variations are seen between the different provinces of the Andalusian Region. Their hospitalization is due mainly to chronic diseases of developed countries.

[Medical and psychosocial evaluation of a mentally retarded adult population]. / Evaluación médica y psicosocial de una población adulta con discapacidad intelectual.

BACKGROUND: This study is aimed at describing the psychological, psychopathological, medical and social aspects of a mentally retarded population being provided with care by AFANAS-Jerez affording the possibility of assessing this type of problem from an epidemiological standpoint. METHODS: A descriptive case series study is conducted to characterize a mentally retarded (MR) population. An assessment was made of the psychological, medical and social aspects. The degree of intelligence was analyzed using the Weschler Adult Intelligence Scale. The adaptive behavior, frequency, typology and seriousness of the behavior problems were assessed by means of the Service Planning and Individual Scheduling Inventory. A psychopathological screening examination was conducted. This study is rounded out with a social and medical evaluation by means of structured interviews. The information from the different areas was encoded and was analyzed using the EPIINFO v6.0 and C.I.A. programs. RESULTS: The average age of the mentally retarded population studied was 32.2 (S.D. 9.2 years). Seventy-three percent (73%) males as compared to 27% females. Behavior problems were found to exist among 45.1% of the subjects. We have set up a statistical relationship between the existence/non-existence of said problems and the degree of MR, such that the greater the loss of intellectual capacity, the greater the probability of having behavior problems. One of the psychopathological symptoms worthy of special mention is the anxiety found to exist among 60.2%. The medical examination reveals the large number of problems related to with MR, we thus finding 22.48% of the subjects to have epilepsy, nearly 20% Down's Syndrome, etc. Also worthy of special mention is the low educational level of the parents and the family conflicts resulting from the child's retardation. CONCLUSIONS: Special mention must be made of how MR is a highly complex whole entailing a large number of related medical, psychological, psychiatric and social disorders, this being a situation brought to fore in this study, many of the disorders revealed to exist being related to the degree of MR. We are of the opinion that an epidemiological approach to the study of MR may be of use for a better comprehension of this problem.

[Readmission rate at a regional hospital]. / Tasa de reingresos de un hospital comarcal.

BACKGROUND: The purpose of this study is that of describing the frequency of re-admissions at the "Punta de Europa" Hospital in Algeciras. METHODS: The source of information employed was that of the Minimal Basic Hospital Admission Data Set (MBHADS) for 1995-1996, a total of 24,613 cases of hospitalization being analyzed. Re-admission has been defined as any admission entailing an identical major diagnosis within the 30 days following release from the hospital. A descriptive analysis has been made of the variables of age, sex, the unit/ward to which admitted and major diagnosis involved employing conventional single-variable techniques. RESULTS: The 30-day re-admissions rate was 5% (IC95% 4.8-5.2), totaling 3.4% (IC95% 3.2-3.6) if only the emergency re-admissions are taken into account. A higher probability of re-admission is related to males, to an older age to certain diagnoses and to the units/wards to which admitted. The units/wards showing the highest percentage of re-admissions were the Psychiatric Ward, Hematology and the Otolaryngology. The Units/Wards showing the lowest percentages of re-admissions were Ophthalmology, Traumatology and Obstetrics. The most frequent re-admissions diagnoses were: impending childbirth, AIDS and complications thereof, neoplasia of the bladder, unstable angina pectoris and paranoid schizophrenia. CONCLUSIONS: Hospital re-admissions are a useful indicator of the quality of health care which must be continued to be researched in our country, particularly after its having been included as an indicator of the public hospital program contracts in Andalusia. It is also deemed necessary to improve the definition of re-admission in said program contracts.

[Specific mortality rates at the Algeciras hospital during 1995-1996]. / Tasas específicas de mortalidad en el hospital de Algeciras durante el período 1995-1996.

BACKGROUND: In-hospital mortality has been proposed as an indicator of health care quality. It is also a fact that should be used for epidemiological monitoring and health planning. The aim of this work is to analyse the mortality in Algeciras Hospital, belonging to the Andalusia Health Authority. METHODS: A descriptive study was carried out of the patients discharged from hospital between January 1995 and December 1996, using discharge data and/or their medical record. The structure of the joint basic minimum data report on hospital discharge was used. The periods of hospitalisation were grouped into the diagnosis-related groups (DRGs). Following an initial analysis of all the periods of hospitalisation, the discharges of patients under 80 years of age were analysed and the risk of death in hospital in line with the reason for admission was set. RESULTS: In Algeciras Hospital between January 1995 and December 1996 a total of 24,194 episodes of hospitalisation and a 4.1% death rate were recorded. A higher death rate was observed for males (5.3%), as opposed to females (3.2%). (P < 0.01). There were 750 in-hospital deaths in patients under 80 years of age, with a continued higher mortality rate for males. The most frequent causes of deaths in this age group are: 66 deaths caused by cerebro-vascular disease (the probability of dying in this age group if the patients were admitted to hospital because of cerebro-vascular disease IC95% 0.12-0.19), 58 deaths due to AIDS (IC95% 0.09-0.15), 51% due to bronchial and lung neoplasias (IC95% 0.18-0.30), 49 deaths from acute myocardial infarction (IC95% 0.12-0.21), 39% as a result of chronic obstructive pulmonary disease (IC95% 0.07-0.14). CONCLUSIONS: The abundant information supplied by hospital mortality statistics is confirmed, especially if the age and illness of the patients involved is taken into account. There is an evident need for health policies to prevent HIV/AIDS, cerebro-vascular disease, lung cancer and ischaemic heart disease to be adopted in the Algeciras catchment area. Thus, there is a need to monitor and draw up new indicators of hospital mortality and to expand the list of unnecessarily premature and avoidable deaths with strictly hospital causes.

[The epidemiological characteristics of brucellosis in the primary health care district of Sierra de Cádiz]. / Características epidemiológicas de la brucelosis en el distrito de atención primaria de salud Sierra de Cádiz.

OBJECTIVES: To find the incidence of brucellosis, and analyse its epidemiological characteristics and the evolution of the cases recorded in the Sierra de Cádiz Primary Care (PC) Area during 1992. DESIGN: A prospective longitudinal incidence analysis, with a nested study of cases and controls. SETTING: Sierra de Cádiz PC Area. CASES: members of the cohort who developed the disease. CONTROLS: sample of members of the cohort free of Brucellosis paired for age, gender and town of origin. MEASUREMENTS AND MAIN RESULTS: Incidence was 52.39 per 100,000, 66.27 and 38.20 per 100,000 in men and women, respectively. Highest incidence was at between 15 and 49 years of age (67.70 per 100,000). CASES in the Spring predominated (chi 2 = 16.77, gl = 3, p < 0.05). The most affected professional group was farmers/herders (RR = 4.59, CI 95%, 2.05-10.26). CONCLUSIONS: The Sierra de Cádiz is an area with endemic brucellosis, especially in the districts of Olvera and Ubrique. Its work-related character is clear, in spite of the digestive tract being the main transmission path.

[The distribution of adipose tissue and the metabolic profile in hypertensive and normotensive adults]. / Distribución del tejido adiposo y perfil metabólico en adultos hipertensos y normotensos.

BASIS: This study aimed to evaluate the Quetelet Body Mass Index (BMI), and specific anthropometric indexes of the distribution of body fat, with glycemia, insulinemia, uricemia, and the lipid profile in 124 hypertensives and 124 normotensives, selected according to age and sex. METHOD: We preset an observational case and control study, referring to a population attending health care centers. The inclusion criteria for the cases were: to be 25 years or older, having been diagnosed with essential hypertension. Incident and prevalent cases of an evolution of less than 2 years are selected. RESULTS: The hypertensives studied, presented levels which were statistically significant and higher than those seen in the normotensive, of all anthropometric indexes used, in insulinemia, glycemia, uricemia, and in the total cholesterolemia. In the cases, the waist hip ratio (WHR) presents a greater number of correlations with biochemical parameters such as uricemia (r = 0.376, p = 0.00), triglyceridemia (r = 0.252, p = 0.00), and the VLDL-cholesterol fraction (r = 0.263, p = 0.00). On the other hand, the BMI, only correlates, in the cases, with the insulinemia. In turn, insulinemia correlates with the majority of the anthropometric measures, with a similar behavior in cases and controls. CONCLUSIONS: The WHR is presented as a complementary index to the classic BMI in the evaluation of obesity and its metabolic alterations, especially in women, but also, the WHR correlates with an adverse lipid profile in hypertensives.

[Efficiency evaluation of the diabetic education unit at the hospital in Algeciras]. / Evaluación de la efectividad de la unidad de educación diabetológica del hospital de Algeciras.

BACKGROUND: Diabetic Education is a basic part of treating Diabetes Mellitus and is intended to improve a patient's quality of life. An analysis was made of the effectiveness of a diabetic education program at the Algeciras Regional Hospital. METHODS: Results achieved by the Diabetic Education Unit were measured according to frequency of hospital visits. A parallel study was therefore carried out on the Unit's first 86 patients and an analysis made of the percentage of patients admitted as well as the period of hospitalization, four years before the Diabetic Program was carried out and four years later. RESULTS: The 20.7% rate of patients admitted four years before the program was reduced to 6.1% in the four following years (IC 95% of the difference between 0.055 and 0.170). A significant decrease (p < 0.001) was also observed in the period of hospitalization, before and after the program, which was quantified in 3.54 days/patient in four years (IC 95%: 1.02 to 5.56 days). CONCLUSIONS: The educational program reduced complications of the disease and improved quality of life.

[The tobacco habit among fishermen of the Barbate coast (Cádiz)]. / El hábito del tabaco en los pescadores de bajura de Barbate (Cádiz).

BACKGROUND: Nowadays, in scientific spheres, it is unquestionable that tobacco damages health. We study the introduction of tobacco habit among inshore fishermen of Barbate (Cádiz), for we consider that this is a highly receptive population to tobacco use because of hard work and its low socio-cultural level. METHODS: A transversal descriptive study is carried out in order to determine the prevalence of tobacco use in this population. With this purpose, a questionnaire of 26 variables (epidemiological, sociodemographic and related to tobacco use) has been elaborated; 207 fishermen, equal to 10.35% of the whole inshore fishing fleet of Barbate, have been surveyed. RESULTS: The mean age of the sample is 39.9 years, with distribution per age groups from 16 to 65 years. The result of the survey carried out is an smoker percentage of 81.15% among the fishermen of the inshore fishing fleet of Barbate. CONCLUSIONS: It is obvious that this population has an important deeply rooted tobacco habit. Anyway, our results are similar to those obtained by other Spanish authors when they study tobacco habit in fishermen.

[Evaluation of the Andalusia Vaccination Program in the Sierra de Cádiz Sanitary District]. / Evaluación del Programa de Vacunación de Andalucía (PVA) en el distrito sanitario Sierra de Cádiz.

One of the foundations for good child care is the application of a vaccination program. With this report we evaluate the vaccination coverage (January 1991) of a group of children (1319), born during 1988 between January 1st and October 1st, in the Sierra of the District of Cadiz. Our results show that 87.64% participated in the Vaccination Program. The first vaccination was received by 80.06% of these children. This rate decreased as we advanced through the vaccination calendar, reaching 76.34% for the measles/mumps/rubella vaccination and 66.71% for the vaccination at 2 years of age. Therefore, one-third of this child population did not complete the vaccination schedule. The most frequently found complication was a local reaction, whereas the counter-indication most frequently observed was an acute infectious illness.

[Benzoyl peroxide in the treatment of decubitus ulcers]. / Peróxido de benzoilo en el tratamiento de úlceras de decúbito.

We communicate a case of pressure sore (decubitus ulcer) treated with 20% topic benzoyl peroxide in O/W emulsion with very satisfactory results. This substance feeds hyperbaric oxygen. Benzoyl peroxide also has antimicrobial, antipruriginous and antifungal properties all of them contributing to shorten the evolution of the lesions.