Evaluation of antimicrobial persistent activity of alcohol-based hand antiseptics against bacterial contamination.

The purpose of this study was to evaluate persistent activity of three alcohol-based antiseptics widely used in the clinical routine containing chlorhexidine, triclosan or mecetronium after hand disinfection. Four tests were used to evaluate the antimicrobial activity of antiseptics on: (i) resident microbiota; (ii) nutrient agar plates (NAP) subsequently inoculated with a test organism; and transient microbiota acquired by contact with dry hands (iii), or (iv) a wet inert surface that had been artificially contaminated. Four reference strains (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis) and an Acinetobacter baumannii strain responsible for a hospital outbreak were used as transient microbiota. Antimicrobial activity was calculated according to the CFUs reduction by reference to non-disinfected control hands. The antiseptics were applied according to European Standard EN1500. Solutions containing chlorhexidine or triclosan showed some persistent effects on transient microbiota on inert humid surfaces and NAP, but not on contaminated dry hands. Solutions containing mecetronium showed no persistent effect on transient flora in any of the trials. All alcohol-based antiseptics tested were more effective against resident flora than soap. No persistent activity was observed for A. baumannii in any of the trials. Chlorhexidine and triclosan are preferred when an antiseptic with persistent activity is desired, but a moist environment appears to be necessary for that antibacterial activity. Accordingly, relevant conclusions regarding the persistent activity of antiseptics for clinical practice and protection against bacterial contamination cannot be derived from this study for the alcoholic solutions tested.

Excess mortality in 22 European countries in 2020 and 2021: relationship with socioeconomic indicators.

AIMS: For better understanding of the impact of COVID-19 pandemic on mortality in different countries, we studied the excess mortality from any cause during 2020 and 2021 in 22 European countries, and its relationship with three socioeconomic variables: life expectancy at birth in 2019, per capita income, and low education level. METHODS: Using an ecological design, we analyzed excess mortality data between January 2020 and December 2021 in 22 European countries, obtained from the EuroMOMO surveillance system. Using weekly Z-score data for each country, we estimated the annual average deviation in mortality during 2020 and 2021 for each country. We analyzed possible relationships between the excess mortality and three independent variables: gross domestic product per capita (GDPpc) in 2020, life expectancy at birth in 2019, and proportion of the population over age 18 years with a lower than secondary education level in 2018. RESULTS: In the 22 European countries analyzed, the total number of excess deaths in 2020 and 2021 was 800,011 (11%) more than expected, with deaths among those aged 65 years and over accounting for 87.66% of these. Excess mortality was higher in 2020, especially in Spain, UK, Italy, and France. In 2021, excess mortality was highest in Hungary, the Netherlands, France, and Germany. Excess mortality during 2021 was inversely correlated with life expectancy (r =-.489, p = .021) and income level (r =-.550, p = .008). CONCLUSION: Reducing socioeconomic inequalities among countries not only improves conditions of most disadvantages but also will help to reduce excess of mortality from future pandemics.

Under-notification of cryptosporidiosis by routine clinical and laboratory practices among non-hospitalised children with acute diarrhoea in Southern Spain.

INTRODUCTION: In a prevalence study of 400 stool samples from non-hospitalised children under 7 years of age with diarrhoea, the presence of Cryptosporidium was evaluated. METHODS: In addition to standard microbiological analyses used for testing for bacteria, parasites, adenoviruses and reoviruses, all samples were re-evaluated for the presence of Cryptosporidium by means of microscopy using a modified acid-fast staining technique, a rapid immunoassay for the qualitative detection of C. parvum and Giardia lamblia, the ImmunoCard STAT! test, and nested polymerase chain reaction (PCR). For identifying the genotypes of Cryptosporidium, the gene 18S ssu rRNA was amplified and sequenced. RESULTS: Thirty-two samples were positive by microscopy, 26 by immunoassay and 61 by nested PCR. Twenty-seven of these organisms were identified as Cryptosporidium hominis, 31 as Cryptosporidium parvum and, in four samples, it was impossible to identify the species. C. parvum was significantly more frequent in girls and C. hominis was significantly more frequent in boys (Fisher's exact test, p = 0.034). Although Cryptosporidium is only notified in a very small number of patients (1-4%) with diarrhoea in Spain, the microorganism was identified by nested PCR in 15.1% of the samples. CONCLUSION: This study, therefore, highlights the under-notification of infections caused by Cryptosporidium in Southern Spain and poses the question of whether its routine testing should be carried out in cases of gastroenteritis in children.

Antimicrobial effect of medical textiles containing bioactive fibres.

Over the last few years, the textile industry has developed different methods for obtaining fabrics and fibres with an antimicrobial action for use in hospital environments and for other purposes. This study evaluates the antimicrobial action of Bioactive(®)-treated fabric (BTF), a commercially available textile containing silver for use in healthcare environments. Unlike other biocides used in hospital fabrics, the prolonged use of silver has not been related to the appearance of resistant bacteria or cross-resistance to antibiotics, in spite of being extensively used in some treatments. Thirty-three hospital strains of bacteria were tested. This study showed the capacity of BTF for significantly reducing the number of microorganisms present, compared with the reduction observed in control fabrics (CF). The antimicrobial action of BTF was expressed as log(10) reduction (LR) from an initial inoculum of about 10(5) colony-forming units (cfu). According to the bacterial species, an LR of between 2.6 and 5.0, and 4.1 and 5.0 (5.0 indicating total inhibition of bacterial growth) were observed, respectively, after 24 and 48 h for BTF. Acinetobacter strains were the most resistant to CF after 72 h (0.8 LR). All of the microorganisms, except two strains of Enterococcus faecalis, were totally inhibited after 72 h on BTF.

Effectiveness in prevention of travellers' diarrhoea by an oral cholera vaccine WC/rBS.

OBJECTIVE: To investigate the effectiveness of an oral cholera vaccine (Dukoral((R))) in preventing travellers' diarrhoea. MATERIAL AND METHODS: A retrospective study was conducted among travellers who had attended the International Vaccination Centre in Malaga, Spain, before starting their journey. A telephone interview was undertaken from November 2005 to January 2006 after the travellers had returned from their trip. The relationship between vaccination with Dukoral((R)) and travellers' diarrhoea was analysed by means of a logistic regression model, adjusting for possible confounding variables (traveller's age, duration of trip and region visited). RESULTS: The overall incidence of diarrhoea in vaccinated travellers was 23% compared with 40% in non-vaccinated travellers (historical control group) (p=0.004). Short episodes of diarrhoea were reported in significantly more travellers of the vaccinated group than of the non-vaccinated group (average duration of diarrhoea 2.21 days versus 3.97 days, p=0.005). The incidence of diarrhoea was significantly lower among vaccinated than non-vaccinated travellers who went to Africa for less than 3 weeks (16% versus 48%, p=0.002) or India and South East Asia (19% versus 50%, p =0.052) for more than 3 weeks. No adverse events were reported in the group of vaccinated travellers. DISCUSSION: Vaccination reduced the risk of travellers' diarrhoea by 43%; possibly due to the protective effect of the oral vaccine Dukoral((R)) against travellers' diarrhoea caused by enterotoxigenic Escherichia coli (ETEC) or cholera. The efficacy of vaccination increased after adjusting for confounding factors, being modified by traveller age (under 30 years, or 45 years and older the protective effect of the vaccine is 4.8 greater, 95% confidence interval (CI): 2.1-10.7). The number needed to treat to prevent one traveller from suffering from one or more episodes of travellers' diarrhoea was 5.8.

Oral contraceptives and breast cancer. A meta-analysis.

Since the relationship between oral contraceptive use and breast cancer has not been consistent we undertook a meta-analysis of studies published to date. Papers were located by searching the MEDLINE data base, supplemented by a hand search of all the references in the articles recovered. Studies were graded as to quality. Those judged as probably unbiased were included in the analysis. The method of Woolf was used to combine relative risks. Forty-seven studies were collected: 40 case-control and 7 cohort studies. Thirty-nine of these were considered unbiased. The main results observed were: RR was 1.06 (1.02-1.10) for all studies and 1.14 for premenopausal cancer. For premenopausal cancer, higher RRs were observed in women who early used oral contraceptives with a significant linear dose-response effect: 1.25 (1.10-1.44) in OC users before age 25, and 1.17 (1.06-1.30) in users before the first full-term pregnancy. We conclude oral contraceptive use may be a risk factor for premenopausal breast cancer. Limitations to our research are discussed.

PIP: 40 case control and 7 cohort studies of the link between oral contraceptives and breast cancer were combined in a meta-analysis by the method of Woolf to estimate overall relative risks. Articles were found by a Medline search from January 1966-June 1990, a hand search of the references, and a journal search for 1990. Papers were graded for bias by 2 blinded readers. The analysis of the 39 studies considered unbiased generated a global relative risk of 1.06, and an increased risk of 1.06, and an increased risk of 1.14 for premenopausal breast cancer. For premenopausal cancer, risks were 1.25 for use before age 24, and 1.17 for use before the 1st term pregnancy. A significant linear dose response was seen, in terms of months of exposure. There was an indication of latency, since risk estimates were higher from data collected after 1981. There was no evidence of a relationship between pill use and parity, family history, or history of benign breast disease. The dad are consistent with the theory that oral contraceptives can be acting as cancer initiators or promoters. There was not enough data to judge whether users of current lower dose pills have lower risks for premenopausal breast cancer. Future studies should address the difference between premenopausal and postmenopausal cancer.

[Patterns of cocaine use among cocaine users who do not use heroin recruited outside of treatment centers]. / Patrones de uso de cocaína en un grupo de consumidores de esta droga sin consumo de heroína captados fuera de los servicios asistenciales.

BACKGROUND: In Spain cocaine use, although relatively widespread, has produced few health problems, most likely because there is a preponderance of non-intensive intranasal use. To obtain data in this regard, we investigated the history and patterns of use in a group of cocaine users. SUBJECTS AND METHODS: Cross-sectional survey carried out in 1993 among 381 cocaine users (289 men and 92 women) who did not use heroin and had not received treatment for drug dependence, recruited by non-probabilistic sampling outside of treatment centers in 35 Spanish cities. The results are presented separately for men and women. RESULTS: The persons interviewed predominantly took cocaine sporadically, during the weekend, in moderate amounts (less than 0.4 g/day) and by the intranasal route. For only 7.2% was it very difficult or impossible to give up cocaine. These characteristics had persisted throughout the users' history; few users (18.1%) had taken cocaine more than 3 times a week in any period or had used a main route other than the intranasal route (10.8%). The proportion of those interviewed who used other drugs, mainly alcohol, tobacco and cannabis, was larger than in the general population in the same age group; interviewees also had a higher educational level and a lower level of unemployment. Women used cocaine, alcohol and tobacco in smaller amounts than men, and a smaller proportion of women stated that it was very difficult or impossible to give up cocaine. CONCLUSIONS: In Spain, the cocaine users who do not use heroin have better educational and employment levels than general population, and generally they use cocaine sporadically, in moderate amounts and by the intranasal route. These circumstances may contribute to explain the relative scarcity of health problems associated to cocaine use.

[Quality of medical records at a primary care center]. / Estudio de la calidad de los registros en un centro de atención primaria.

The quality of the clinical records included in the clinical charts is assessed through a sample of the clinical charts existing at the Health Center Zaidin-Sur (Granada, Spain). The quality was ascertained via the number of visits annotated, the number of records considered as essential (life style, family and personal history), and the number of received or requested consultation. This information is compared to the data of the general files of the Health Center, to the information gathered by a direct interview (performed to assess the validity of the essential records), and to the results of a protocol studying the visit activities. The analysis of data shows that just a 40.4% of the visits are annotated on the clinical chart. A lower percentage of the essential records were annotated, 37.6%. The requested consultations are annotated in 43.8% and the received ones in 87.6%. We discuss on the need of periodic evaluation of the records to show their limitations and deficiencies. This is the first step to improve them.

[Inequalities in health: perinatal and infant mortality in Spain]. / Desigualdades en salud: la mortalidad perinatal e infantil en España.

The interregional variation coefficient (VC) has been considered as an accurate measure of the dispersion of regional infant, neonatal, postneonatal and perinatal mortality rates. Thus, trends of annual VC have been analyzed, for each rate, from 1940 to 1986, to identify the evolution in time of the regional differences with respect to these mortality rates. None of the four mortality rates showed a decreasing trend in their respective VCs. This may indicate that interregional differences do not change along time. The postneonatal mortality rate has been shown to have the highest VCs during the study period (ranging from 23 to 40%), with an independent evolution with respect to neonatal mortality rate, probably because the factors that influence both rates are clearly different.

[The story as a health education technic for schoolchildren]. / El cuento como técnica de educación sanitaria en escolares.

Schoolchildren health education should begin as early as possible. The objective of this study is to show that to develop health education early in the lifetime is feasible by using the tale/psychodrama as tool for making class explanations more useful. An intervention study was carried out with all the children attending course level 1 of Basic General Education (BGE) in four schools, two from the city of Granada (urban) and two from two surrounding municipalities (semi-urban). They were randomly divided in two groups in order to compare the efficacy of two different health education interventions on taking care of pets: formal explanations at the classroom vs listen to a tale. Evaluation was assessed by a simple 15 yes/no items questionnaire which was administered before and after the intervention. Both interventions resulted in important improvements of children responses. The tale was clearly better than class formal explanations, the differences being statistically significant for 8 of the questions. We conclude that health education is feasible early in childhood and that tales can be more efficient than class explanations.

[The use of incidence density in assessing the risk factors for nosocomial infection]. / Utilización de la densidad de incidencia en la valoración de factores de riesgo de la infección nosocomial.

Several authors have suggested that incidence density should be used in studying nosocomial infection. We assess several risk factors for hospital infection by two ratios, the incidence density ratio (IDR) and the relative risk (RR), in an historical cohort of 843 patients. The variables analyzed were: operation, its length, type of surgical wound, severity of underlying disease, and age. The IDR figures were always lower than those yielded by the RR. For example, the IDR for operated patients was 2.78, whereas RR yielded a figure of 6.46, or the IDR for patients greater than 60 years old was 0.96, whereas the RR achieved a significant value of 1.67. This suggests that the use of IDR to analyze risk factors for nosocomial infection improves comparability of results obtained in different hospital settings. Also, it may allow a more exact quantification of an effect. These facts influence implementation of nosocomial infection control measures.

[Prevalence of mental subnormality recorded in the province of Jaen]. / Prevalencia de la subnormalidad mental censada en la provincia de Jaén.

It is done a cross-sectional study of the prevalence of mental retardation in the province of Jaén (Spain), based on the cumulated cases reported to the Institute of Social Services of the Social Security (INSERSO) until January 1, 1984. The main objective of this research is to know the prevalence of mental retardation in our province, and to analize its relationship with some sociodemographic variables. The prevalence obtained has been 4.09%, being a 59.27% of the prevalence due to endogenous/unexplained etiology. Mild subnormality constitutes a 8.4% of cases, being closely related with the size of the locality (municipio). Prevalence of mental subnormality showed a significative linear association with the size of the locality (r = -0.904, p less than 0.05), and with the population growth (r = -0.929, p less than 0.01). This relationship was not observed neither with the level of per capita income nor the altitude of the locality. A multiple regression analysis is made for every etiology of mental retardation and several social and geographic variables. We conclude that the figures for mental retardation in our province show a direct relationship with local development parameters.

Calendario de vacunaciones sistemáticas del adolescente y adulto recomendado por la sociedad española de medicina preventiva, salud Pública e higiene (actualización del año 2014) / No disponible

No disponible

Endotoxin liberation by strains of N. meningitidis isolated from patients and healthy carriers.

The main objective of this study was to assess whether the capacity of Neisseria meningitidis to release endotoxin depends upon the type of strain or upon bacterial mass. Endotoxin release was studied in 32 strains isolated from patients with meningococcal infections and in 49 from asymptomatic carriers, using a quantitative test (limulus test with a chromogenic substrate). The results show that the strains from patients release significantly higher amounts of endotoxin than strains from carriers regardless of serogroup and isolation site. No correlation was found between stage of bacterial growth and the amount of endotoxin liberated. These findings suggest that endotoxin liberation is a characteristic of certain strains of N. meningitidis and is not determined simply by bacterial mass.

[Inter-episode continuity of primary health care: proposal for an indicator]. / La continuidad interepisodios en atención primaria de salud: propuesta de un indicador.

The objective of this study was to assess the quality of the data included in patients' personal histories and to prepare an indicator of the continuity of health care between episodes of illness based on the information contained in these records. The study was descriptive. Public health specialists from the Department of Preventive Medicine of the University of Granada, Spain, participated in the design and analysis, and the field work was carried out by specialists from family and community medicine from the Zaidín-Sur Health Center of Granada, where the research was conducted in April to December 1989. For the study, 1581 personal histories were analyzed. The most complete records were those having to do with personal background (37% of the personal histories evaluated) and the most complete histories were those of pediatric patients, women, and persons who participated in programs organized by the health center. The degree of completeness of the records was low. Based on the indicator developed, only 16% of the histories at the Center contained sufficient information to allow continuity of care. It is recommended that simple records systems be created and that primary care physicians be educated in the collection of essential data.

Preoperative stay as a risk factor for nosocomial infection.

To evaluate the relationship between duration of preoperative stay and the risk of nosocomial infection, we studied 449 patients who underwent surgery at the University Hospital of Granada during the first six months of 1986. Patients were chosen from two cross-sectional surveys. Nosocomial infection was studied throughout each patient's hospital stay. Other variables included preoperative stay, age, severity and total length of stay. The data were analyzed by comparing nosocomial infection for different lengths of preoperative hospitalization, age and severity by calculating the Odds Ratio. The effects of age and severity were studied by stratifying patients by duration of preoperative stay. Two multivariate regression models were used to confirm the results of the stratified analysis. The results suggest that lengthening the preoperative stay may increase the risk of nosocomial infection in surgical wounds and in other sites, and may simultaneously potentiate the effects of other risk factors such as age and severity of the patient's condition, whose influence on susceptibility to infection increases with the duration of preoperative stay.

[A survey on the satisfaction of the users of the Zaidin-Sur de Granada Health Center (1989)]. / Encuesta de satisfacción a usuarios del Centro de Salud Zaidin-Sur de Granada (1989).

In order to know the users's degree of satisfaction in the Primary Health Care Center of Zaidin-Sur in Granada, a survey has been carried out by means of a personal interview at home in an aleatory sample of 615 individuals. The questionnaire has 28 closed questions with multiple answer and collects sociodemographic variables, self-perception of health condition, acceptability of medical and nursery care. The interview was anonymous and carried out by nursery students of third year. The 52% of the sample expressed that his health level was "excellent" or "good" and it was worse when the educational level was lower and the age was higher. The group of workers showed the highest valuation of health condition. The levels of trust on the doctor, the time of dedication and the information given to the patient reach slightly lower values than the ones found in literature; personal treatment and interest towards the patient have been valued the best. Center space structure and timetable have been the most penalized variables. We conclude that there is a need of improving the nursery service care a need of the information, from all the professionals working in the center, given to the patients on their problems, which are the cause of their going to the health consult, and the need of enlarging the space of the center.

[The hospital stay as a modifier of the effect of other risk factors for hospital infection]. / La estancia como modificador del efecto de otros factores de riesgo para la infección hospitalaria.

It has been suggested that the risk of hospital infection differs according to the moment of hospital stay. Through a retrospective cohort of 843 surgery patients the effect of several factors on nosocomial infection risk is studied as a function of the duration of the hospital stay. It was observed that the studied variables (operation, type of surgery, age and severity of underlying disease) had a predisposing effect on the appearance of infection in short stays (less than 14 days), being the effect greater in longer stays. It is concluded that hospital stay can act as a modifier of the effect of several factors on the risk of hospital infection.

Hospital stay length as an effect modifier of other risk factors for nosocomial infection.

This paper addresses the problem of hospital stay length as a risk factor for nosocomial infection and as a modifier of the effect of other risk factors for hospital infection. Patients were selected form two cross-sectional studies done in two different seasons of 1986. Risk of infection rose fairly steadily as hospital stay length increased (correlation coefficient: 0.83, p less than 0.01). Several risk factors (operation, underlying disease, and age) were analyzed on the basis of 1) raw data and 2) data stratified by length of stay. The results showed that hospital stay length is a strong modifier of the remaining risk factors, generally reducing, their effect on the development of hospital infection as length of stay increases.