Impact of the 2005 and 2010 Spanish smoking laws on hospital admissions for tobacco-related diseases in Valencia, Spain.

OBJECTIVES: This study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. STUDY DESIGN: A retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995-2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. METHODS: General population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic Data Set. Diagnoses were codified according to the International Classification of Diseases-9th revision. Data from all hospitals of the Valencian Community from 1995 to 2013 were analysed. Trend analyses in the periods before and after the approval of the 2005 law were conducted using least-squares linear regression models. RESULTS: Adjusted hospital admission rates per 100,000 inhabitants for cardiovascular diseases significantly decreased after the 2005 Law (from 550.0/100,000 in 2005 to 500.5/100,000 in 2007), with a further decrease (to 434.6/100,000) in 2013, after the 2010 Law. Reductions in hospital admissions were seen in men and women, although declining trends were more marked in men. Hospital admission rates for respiratory diseases showed a reduction of a lower magnitude, whereas for smoking-related cancer admissions there was a slight decline only among men. CONCLUSIONS: The Spanish comprehensive smoking ban resulted in a remarkable reduction of the adjusted rate of hospital admissions mainly associated to cardiovascular diseases. The decrease in the number of persons requiring in-patient care is relevant and may be viewed as an improvement of the public's health.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

[The effect of human immunodeficiency virus infection on the consumption of hospital resources. A correlation with the degree of immunodeficiency]. / Efecto de la infección por el virus de inmunodeficiencia humana en el consumo de recursos hospitalarios. Correlación con grado de inmunodeficiencia.

BACKGROUND: To calculate the real cost of the Human Immunodeficiency Virus (HIV) infection in the use of hospital resources. PATIENTS AND METHODS: All the episodes of hospitalization of the years 1993, 1994 and 1995 of a general hospital have been analyzed. The patients have been classified according to the Patients Management Categories version 5.0 system. The patients with HIV infection were also classified according to the CD4+T-lymphocyte counts and the existence of AIDS. The derived cost of the stay and the consumption of diagnostic and complementary tests were calculated according to PMC Relative Intensity Score. RESULTS: In 293 hospitalizations the hospital cost of the HIV patients ascended to 145,372,650 ptas, what represents 40,230,000 ptas 100,000 person-years. HIV patients presented mean of stay (12 vs 5 days, p < 0.001) and hospital cost (433,029 vs 218,646 ptas, p < 0.001), significantly higher than non-HIV patients. 79% of hospitalizations corresponded to patient with AIDS. As much the stay as the hospital cost vary significantly in function of the degree of immunologic deterioration (lymphocyte count and AIDS diagnostic). During the years of study a stabilization was observed in the cost and the hospital stay of these patients. CONCLUSIONS: HIV infection originates a high consumption of hospital resources, mainly in patient with advanced immunodeficiency. The hospital stay is very high to the general population. In the last years it seems to exist a tendency toward the stabilization in the use of hospital resources, possibly to expense of the non hospital cost.

Efecto de la infección por el virus de inmunodeficiencia humana en el consumo de recursos hospitalarios. Correlación con grado de inmunodeficiencia / Effect of the human immunodeficiency virus infection in hospital resources utilization: correlation with the immunodeficiency degree

Fundamento: Calcular el coste real de la infección por el virus de la inmunodeficiencia humana (VIH) en la utilización de recursos hospitalarios. Pacientes y métodos: Se han analizado todos los episodios de hospitalización de los años 1993,1994 y 1995 de un hospital general. Los pacientes fueron clasificados según el sistema Patient Management Categories (PMC) versión 5.0. Los pacientes con infección por VIH se clasificaron además según el recuento de linfocitos CD4 y la existencia de enfermedad diagnóstica de SIDA. Se calculó el coste derivado de la estancia más el consumo de pruebas diagnósticas y complementarias según el Relative Intensity Score del PMC. Resultados: En 293 hospitalizaciones el gasto hospitalario de los pacientes VIH ascendió a 145.372.650 ptas, lo que representa 40.230.000/100.000 habitantes/año. Los pacientes VIH presentaron una estancia (12 vs 5 días, p< 0,001) y un coste hospitalario anual (433.029 vs 218.646 ptas, p<0,001) significativamente superior a los no VIH. El 79 porciento de hospitalizaciones correspondieron a pacientes con SIDA. Tanto la estancia como el gasto hospitalario varió significativamente en función del grado de deterioro inmunológico (nivel de linfocitos y diagnóstico de SIDA). Durante los años de estudio se observó una estabilización en el coste y la estancia hospitalaria de estos pacientes. Conclusiones: La infección por VIH origina un elevado consumo de recursos hospitalarios, principalmente en pacientes con inmunodeficiencia avanzada. La estancia hospitalaria es muy superior a la población general. En los últimos años parece existir una tendencia hacia la estabilización del gasto hospitalario, posiblemente a expensas del gasto extrahospitalario (AU)

[Multiple nosocomial infections. An incidence study]. / Infecciones nosocomiales múltiples. Un estudio de incidencia.

BACKGROUND: Some studies point out that around 30%-50% of the nosocomial infections (NI) are multiple (MNI) and are found in 21%-30% of the patients with NI. The significance of these data and their potential consequences have led the authors to perform this study. PATIENTS AND METHODS: A longitudinal descriptive study was carried out on the incidence and characteristics of NI (MNI and single nosocomial infection [SNI]) in 26,977 patients admitted to a county hospital from 1991 to 1993. RESULTS: NI was detected in 1,246 patients with 31% presenting MNI appearing in 15% of the patients. MNI predominated in males, had a mean age were 5 to 12 years higher than the patients with SNI with a mean hospital stay of between 13-28 days more than the SNI group. The MNI were significantly less frequent in the Urology, Gynecology and Obstetrics Departments and were more frequent in the Intensive Care Unit. The localization of the infection varied significantly among the patients with one or several infections. Bacteremia, pneumonia and soft tissue infections were significantly more frequent in MNI patients. CONCLUSIONS: Multiple nosocomial infections are frequent and their basic characteristics are significantly different from those of single nosocomial infections. The patients who acquire SNI should be carefully followed to avoid the appearance of MNI.

[The investigation of the contacts of the tuberculous pediatric patient]. / La investigación de contactos en el paciente tuberculoso pediátrico.

BACKGROUND: Results of contacts investigation of tuberculous pediatric patients, usually non-infectious, are shown. Their relationship to the clinical situation on index case and the intimacy of exposure is analyzed. METHODS: 714 contacts of 111 pediatric cases (53 category II and 58 category III, according to the American Thoracic Society classification). The tuberculin skin test with 2 units of PPD-RT23 was used to identify the infected persons. Chest radiography, sputum smear and culture examination were used to diagnose current pulmonary disease. According to the intimacy of exposure to index case, contacts were defined as household, close or sporadic contacts. The possible association with clinical situation of index case and intimacy of exposure was analyzed. RESULTS: 41 new cases of tuberculosis were detected, 7 of them were infectious. Prevalence of tuberculous infection among contacts was 44%. Quimioprofilaxis was indicated to 126 contacts. The prevalences of infection and disease according to clinical situation and degree of contact did not differ significantly. CONCLUSIONS: it is advisable to investigate the contacts of tuberculous pediatric patients, even in cases of tuberculous infection without disease; the investigation must include close and sporadic contacts.