[Variability in the in-hospital management of acute myocardial infarction in Spain. IBERICA Study (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda)]. / Variabilidad en el manejo hospitalario del infarto agudo de miocardio en España. Estudio IBERICA (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda)

Introduction and objective. Although some in-hospital studies have described the management of acute myocardial infarction (MI) patients in Spain, none has been able to guarantee the exhaustiveness of patient registry. This study sought to determine the clinical characteristics and in-hospital management of patients with MI in eight Spanish population registries.Methods. The IBERICA study is a population-based MI registry carried out in the 25 to 74 year-old population, in eight Spanish regions in 1997. A standardized methodology was used to register and investigate all MI arriving alive to a hospital. Clinical characteristics, cardiovascular risk factors prevalence, pharmacological treatment, invasive and non-invasive procedures performed and complications at 28 days of evolution were recorded. A descriptive analysis was performed and the variation coefficient (VC) was calculated.Results. In 1997, 4,041 MI patients were registered, 79.9% were men with a mean age of 61.1 years. Although 10.9% (95% CI: 9.9-11.9%) were not admitted to the coronary care unit, a large variability existed among different areas (VC = 53%). There was a high variability in the utilization and performance of non-invasive and invasive procedures among regions, as well as in the use of pharmacological treatment. Only the use of antiaggregants (91.5%) and thrombolytic therapy (41.8%) showed a low variability (VC < 10%). Twenty-eight day mortality was 16.2% (95% CI: 15.1-17.4%) with a high variability being observed among the different regions (VC = 20.6%).Conclusion. Patient characteristics vary among the different Spanish regions. The differences in management and prognosis suggest a lack of equality in the health care provided to MI patients in the different regions in Spain.

[Are occupation and education interchangeable as social indicators in community health? A study in an employed population]. / Son la ocupación y la educación intercambiables como indicadores sociales en salud comunitaria? Un estudio en población ocupada.

OBJECTIVE: Epidemiological studies and interventions to reduce inequalities in community health require the assignation of exhaustive and easy-to-obtain social indicators. Occupation and education are two of the most often used. In this study we attempt to evaluate the association between education and occupation among adult working population because if, in the absence of one of these two variables, it will be feasible to use the remaining with the lesser lost of socio-economic information. DESIGN: From a representative sample (n = 3091) of general population (18-65 years old) drawn out from a prevalence survey on chronic disease risk factors performed in the Region of Murcia, a log-lineal analysis has been made between education and occupation among working people (65.8% of males and 34.2% of females from the original sample). RESULTS: Men present significant association between managerial positions and university education. The association drops between clerks and high school graduates to increase among all manual workers with or without primary schooling education. Among women--with a lesser number of participants--the education/occupation association describes the same pattern but with higher magnitudes in the positive associations between managerial positions and university education. For both genders, the greatest associations are found in both diagonals of the education by occupation tables indicating: better occupation, more education, and the opposite. CONCLUSIONS: The classification of working people according to education and occupation presents association, internal consistency and gradient. In absence of comprehensive information regarding occupation, education could be an alternative as socio-economic indicator.

[Cardiovascular risk factors in the region of Murcia, Spain]. / Factores de riesgo cardiovascular en la región de Murcia, España.

BACKGROUND: The Region of Murcia is an area, within the Spanish context, of high coronary and stroke mortality. Moreover, the trend in ischaemic heart disease mortality, decreasing for almost all geographical Spanish areas, has suffered in Murcia a slight increase during the period 1985-1991. In this study the population prevalences to different cardiovascular risk factors are evaluated. METHODS: Survey of a random sample of adult population (aged 18-65) with a response rate of 61%. Standardised measurement of arterial blood pressure, obesity and serum lipids besides a questionnaire of tobacco consume, physical activity and diabetes. Presentation of standardised results for overall age groups and for the truncated 35-64 age group. The field work were from november 1991 to march 1993. RESULTS: Tobacco smoking prevalence rises up to 54.4% in men and 31.3% in women. Figures for hypertension are less favourable in men (32.3% prevalence, 16.4% treatment, 2.6% hypertension control among all hypertensives, and 15.6% control among only treated hypertensives) that among women (23.7%, 34.3%, 9.5% y 27.8%, respectively). The average serum concentrations of cholesterol are low in both sexes, as high are the HDL-cholesterol concentrations. Mean Body Mass Index is 26.7 for both sexes, although women present wider variability in the measurements. The prevalence of self informed diabetes is around 3-4%. CONCLUSIONS: Comparing these figures, for the corresponding age groups, with those offered by the MONICA study and with other studies on Spanish adult population it is possible to observe that, exception made for the high tobacco consumption and Body Mass Index seen in the Region of Murcia, the overall figures of cardiovascular risk factors are located in the lowest end of the distribution of MONICA centres ranked according their prevalence of cardiovascular risk factors. It might exist, therefore, differences in the management of the coronary patient that could explain at least part of the unfavourable coronary heart mortality trends observed in the Region of Murcia.

[Validity of a questionnaire on recent physical activity]. / Validez de un cuestionario de actividad física reciente.

This study aims to validate a frequency questionnaire for categorically ranking people according to recent physical activity (PA) (previous two weeks), applicable to both sexes. Seven one-day PA records were collected for 30 males and 32 females during two weeks. After, the frequency questionnaire was administered covering the same period. The differences (paired-test) between the means obtained by both methods were globally significant for females and for some subgroups of activities in both sexes. The Pearson's correlation coefficient between both methods was 0.78 for males and 0.65 for females. The degree of agreement among methods classifying the subjects on terciles of total PA was lower in males (weighted kappa kw = 0.35, p < 0.06) than in females (KW = 0.52, p < 0.004). Although the study size prevents to infer definitive conclusions, the questionnaire performs better when measuring basic, occupational and total PA than leisure time PA. Its use as a way of ranking individuals in three categories (terciles) of total PA will produce an approximated degree of misclassification of 30% in the lowest tercile of males meanwhile this degree will not go far beyond than 10% for other categories in both sexes.

[Infectious endocarditis in parenteral drug addicts: study of 57 cases]. / Endocarditis infecciosa en adictos a drogas por vía parenteral: estudio de 57 casos.

We present 57 cases of infectious endocarditis (IE) in 51 parenterally drug addicts (PDA) admitted at the Internal Medicine Service of the Hospital Clínico of Valencia between January ist, 1988 and January 15th, 1992. The disease affected young patients, 84% of them being HIV-1+ and 86% presenting CD4+ lymphocytes lower than 200 cells/mm3. Fever was the most constant symptom, with radiological disorders and presence of vegetations by echocardiogram in 65% and 53% of episodes, respectively, and affectation of the tricuspid valve in 59% of patients. The diagnosis of endocarditis was definitive in 51% of cases, possible in 15% and probable in 22%, being cardiac failure the most severe complication, present in 23% of episodes. The detection of significant valve regurgitation in patients with IE and without developing cardiac failure is not predictive of future complications, nor its absence identifies patients with a favourable prognosis. Staphylococcus aureus was the most frequently isolated germ (48%), being methicillin-resistant in 15% of cases and with a slower response to the treatment with vancomycin than the methicillin-sensitive. Five patients died, all of them with CD4+ lower than 50 cells/mm3, which may have a predictive value in the follow-up of these patients.