Infectious morbidity and resource use in children under 2 years old at childcare centres.

AIM: To analyse the associations between childcare centres and infectious morbidity and resource consumption. METHODS: Cohort study from birth to 2 years. OUTCOME VARIABLE: number and types of infections, drug consumption and medical visits. Exposure variable: attending or not attending a childcare centre. School age: 6-12, >12-18, >18-24 months. RESULTS: The initial cohort comprised 445 children, and the final cohort comprised 419 children. The mean number of recurrent infections and wheezing was higher in children attending childcare centres in all age groups with significant differences. Recurrent acute otitis media was observed in the 12- to 18-month group with an odds ratio of 6.04 (95% confidence interval, 1.3-27.6; P = 0.001) in the children attending childcare centres. In children older than 6 months, there was greater consumption of antibiotics, inhaled bronchodilators, oral and inhaled corticosteroids and montelukast. CONCLUSIONS: Attending a childcare is associated with an increased frequency of recurrent infections and wheezing, as well as the consumption of antibiotics, bronchodilators, corticosteroids and montelukast.

Epidemiology of osteoporotic fractures in Andalusia, Spain, from 2000-2010. / Epidemiología de las fracturas osteoporóticas en Andalucía en el período 2000-2010.

BACKGROUND AND OBJECTIVE: The aim of this study was to examine the epidemiological data on osteoporotic fractures in Andalusia in the period 2000-2010. In view of the lack of epidemiological studies of fractures in Andalusia, we set out to ascertain the number and incidence rates of osteoporotic fractures and their distribution by gender and age, location, comorbidity, seasonality and secular trend. METHODS: Cohort study observed over a period of 11 years analysing the data provided by the Minimum Basic Data Set register for the period 2000-2010. RESULTS: There were a total of 96,458 osteoporotic fractures, with a crude incidence rate of 374.18 fractures per 100,000 population. Fractures increased in this period by 27% (p<.01, IC 95%, 0.71; 0.73). We found a trend change in female/male ratio, from 3.4 to 3.2, and in the reduction in fractures in the last two years, especially in the past year, with a decrease of 11.2% in hip fractures (p<.001, IC 95%, 0.88; 0.895). CONCLUSIONS: In this period, there has been an increase in fractures as a consequence of the ageing of the population, but also a change in trend, with fractures decreasing in some age groups. The incidence rate of fractures varies between different countries and regions of Spain, and between different provinces of Andalusia.

[The situation as regards diabetes mellitus type 1 in Andalusia. Care data, use of advanced therapies and human resources]. / Situación de la diabetes mellitus tipo 1 en Andalucía. Datos asistenciales, uso de terapias avanzadas y recursos humanos.

INTRODUCTION: The representation of Spain in European epidemiological studies on diabetes is limited, with only one centre in the Hvidoere study and another in the SWEET study. No Spanish studies have been published that combine epidemiological data and care resources. The aim of this study was to determine the epidemiological data, care resources, and use of new technologies in all Andalusian hospitals that care for children with Diabetes Mellitus type 1 (DM1) under 14 years. MATERIAL AND METHODS: An electronic questionnaire of 18 questions was sent to all paediatric endocrinologists who treated children with diabetes in Andalusian hospitals. RESULTS: There was a mean of 3.12 (SD: 2.58) paediatric endocrinologist for every 100 patients, with a mean diabetes nurse educator ratio of 2.50 (SD: 3.94) per 100 patients and centre. Only 1 of the 29 centres had a psychologist, 9/29 had a day hospital, and 11/29 had a 24-hour telephone line. The mean of days of consultations exclusively for patients with DM1 was 1.56 days (SD: 1.21) per week. Continuous insulin infusion was used to treat 5% of patients, with a significant increase in centres with more than 150 patients. CONCLUSIONS: This study offers, for the first time, current data on the epidemiological situation related to health care data, comparing them with the recommendations of European standards, highlighting a low ratio of endocrinologists and educators in diabetes, absence of psychologists and low technology penetrance.

Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis.

INTRODUCTION AND OBJECTIVES: Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial. METHODS: This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (> or =2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug-eluting stent (DES; i.e. rapamycin or paclitaxel; n=128). The following clinical outcomes (i.e. major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke and repeat revascularization at 2 years. RESULTS: Patients who received DESs were older (67.5+/-7 years vs. 65.3+/-8 years; P=.05) and more often had a previous MI (49.2% vs. 28.2%; P< .01), but no more often had a depressed left ventricular ejection fraction < or =45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9+/-7 vs. 18.5+/-6; P< .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P< .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09). CONCLUSIONS: In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke.

Caracterización del proceso de evaluación del aprendizaje del contenido estadístico en la carrera de Medicina / Characterization of the process of evaluation of the learning of statistical content in medicine

Este trabajo tiene como objetivo caracterizar el proceso de evaluación del aprendizaje del contenido estadístico en la carrera de Medicina. Los resultados obtenidos evidencian que el nivel de asimilación alcanzado por los estudiantes en muchas ocasiones es el reproductivo, lo que refleja la necesidad de seguir profundizando en los estudios de esta problemática.

Issues related to the learning evaluation have been present throughout the teaching learning process history. The following research aims at characterizing the learning process of evaluation of the statistical content in medicine. Results demonstrate that the assimilation level reached by students, on many occasions, is the reproductive one, as a need to deepen on methodology of the design of the system of evaluation of the statistical content learning in medicine.