ABSTRACT
BACKGROUND: There have been suggestions that mortality from cutaneous malignant melanoma (CMM) is starting to level off in the European Union. OBJECTIVES: To analyse changes in CMM mortality trends in Spain during 1975-2001 using joinpoint regression models. METHODS: Mortality data were obtained from the National Statistics Institute. For each gender, age group-specific and standardized (overall and truncated) rates were calculated by the direct method (using the world standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: In women, there was a marked increase from 1975 to 1994 in age-adjusted (overall and truncated) CMM mortality rates [estimated annual percentage change (EAPC) 6.6% and 7.0%, respectively; P < 0.05], followed by a levelling off (EAPC - 0.3% and - 1.3%, respectively; not significant). In men, age-adjusted (35-64 years) mortality rates increased steadily from 1975 to 1991 (EAPC 9.1%, P < 0.05) and then levelled off. CONCLUSIONS: We confirmed that CMM mortality rates in Spain rose dramatically from the mid-1970s to the beginning of the 1990s, but we also found that mortality rates are now levelling off in middle-aged adults (35-64 years), following a similar tendency to that observed in other countries.
Subject(s)
Melanoma/mortality , Skin Neoplasms/mortality , Adult , Age Distribution , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Mortality/trends , Sex Distribution , Spain/epidemiologyABSTRACT
OBJECTIVE: To find the eating habits of the adult population of an urban health district. DESIGN: Descriptive cross-sectional study. SETTING: Primary care. Urban health centre. PARTICIPANTS: 260 people (124 men and 136 women) over 20 (mean age of 43.6 +/- 17.1; 42.0 +/- 16.4 for men and 45.1 +/- 17.7 for women), selected at random from among those living in the health district. MAIN MEASUREMENTS: Through a semi-quantitative questionnaire on frequencies of food consumption, filled out in all cases by a single observer, the food habits of the participants and the nature of their diet during the previous week were determined. Intake of calories and biomolecules were calculated as a function of the kind of foods. RESULTS: Mean daily calory intake was 2612 +/- 836 kcal, 22.5% more than the theoretical requirements of this population. Mean daily protein ingested was 96.4 +/- 28 grams, fats 130.2 +/- 42.7 grams, and carbohydrates 277.1 +/- 123.3. 21.5 +/- 5.5% of the total calory intake were monounsaturated fatty acids; 7.7 +/- 4.3% were polyunsaturated; and 13 +/- 2.9% were saturated. Cholesterol consumption was 475 +/- 213.8 mg/day, and roughage consumed was 18.6 +/- 8.0 grams. CONCLUSIONS: The adult population of our health district consumed the typical, not very healthy Western-style diet: over-rich in calories, rich in saturated fats and cholesterol, and poor in roughage. Nevertheless, the diet conserved the high intake of monounsaturated and polyunsaturated fatty acids which is characteristic of traditional Mediterranean food.
Subject(s)
Diet Surveys , Feeding Behavior , Adult , Cross-Sectional Studies , Energy Intake , Female , Humans , Male , Middle Aged , Nutritional Status , Urban Health/statistics & numerical data , Urban PopulationABSTRACT
Objetivo. Conocer los hábitos alimentarios de la población adulta de una zona básica de salud urbana. Diseño. Estudio descriptivo transversal. Emplazamiento. Atención primaria. Centro de salud urbano. Participantes. Un total de 260 individuos (124 varones y 136 mujeres) mayores de 20 años (edad media de 43,6 ñ 17,1 años: 42,0 ñ 16,4 en varones y 45,1 ñ 17,7 en mujeres), seleccionados aleatoriamente entre las viviendas de la zona básica. Mediciones principales. Mediante un cuestionario semicuantitativo de frecuencias de consumo de alimentos, cumplimentado en todos los casos por un único observador, se determinaron los hábitos alimentarios de los participantes, así como el tipo de dieta realizada en la última semana. Se calculó la ingesta calórica y de principios inmediatos en función del tipo de alimentos. Resultados. La ingesta calórica media diaria fue de 2.612 ñ 836 kcal, un 22,5 por ciento más de los requerimientos teóricos calculados para esta población. La media diaria de proteínas ingeridas fue de 96,4 ñ 28 g; de grasas, 130,2 ñ 42,7 g y de hidratos de carbono, 277,1 ñ 123,3 g. Los ácidos grasos monoinsaturados representaron el 21,5 ñ 5,5 por ciento del total de la ingesta calórica; los poliinsaturados, el 7,7 ñ 4,3 por ciento, y los saturados, el 13 ñ 2,9 por ciento. El consumo de colesterol fue de 475 ñ 213,8 mg/día y el de fibra, 18,6 ñ 8,0 g. Conclusiones. La dieta consumida por la población adulta de nuestra zona básica tiene el típico y poco saludable estilo occidental: es hipercalórica, rica en grasas saturadas y colesterol y pobre en fibra; sin embargo, conserva la elevada ingesta de ácidos grasos monoinsaturados y poliinsaturados característica de la alimentación mediterránea tradicional (AU)
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Diet Surveys , Feeding Behavior , Urban Population , Urban Health , Nutritional Status , Energy Intake , Cross-Sectional StudiesABSTRACT
Objective. To validate two monitors on the market for self-measurement of blood pressure (SMBP), an automatic one (OMRON HEM-705 CP) and a semi-automatic one (OMRON M1).Design. Descriptive study of validation of diagnostic tests.Setting. Primary care. San Pablo University Health Centre, Sevilla.Participants. 85 individuals (20 men and 65 women) with a wide range of age and blood pressure (BP), belonging to the population attended at the health centre or to its staff. People with arrhythmia and Korotkoff's V phase close to zero were excluded. Main measurements and results. BP and cardiac frequency (CF) measurements obtained with the SMBP devices to be validated were compared with readings on a mercury sphygmomanometer, used as the standard method. The differences between the SMBP devices and the gold standard were quantified and are presented on the scale proposed by the protocol of the British Hypertension Society (BHS). The mean (SD) of the systolic BP differences (in mm Hg) between the devices evaluated and the standard device was 1.084.73 for the automatic monitor and 1.255.30 for the semi-automatic one. The mean differences of diastolic BP were 0.444.03 for the automatic monitor, and 0.513.90 for the semi-automatic one. The cumulative percentage differences of systolic/ diastolic BP5, 10 and 15 mm Hg were 85.5, 98, 98.8/90.6, 98.4, 100% for the automatic monitor and 82.7, 95.7, 98.8/91, 99.6, 100% for the semi-automatic one. This supposes a Grade A on the BHS procedure, which is maintained on analysis of the results by blood pressure rankings. Conclusion. As both monitors meet the internationally accepted validation criteria, they can be recommended for the monitoring and self-monitoring of BP in patients with hypertension.
Subject(s)
Blood Pressure Determination/instrumentation , Self Care/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Blood Pressure Monitors , Female , Heart Rate , Humans , Male , Middle Aged , Primary Health CareABSTRACT
Objetivo. Validar dos monitores comercializados para la automedida de la presión arterial (AMPA), uno automático (OMRON HEM-705 CP) y otro semiautomático (OMRON M1).Diseño. Estudio descriptivo de validación de pruebas diagnósticas. Emplazamiento. Atención primaria. Centro de Salud Universitario San Pablo de Sevilla. Participantes. Ochenta y cinco individuos (20 varones y 65 mujeres) con amplio rango de edades y de presión arterial (PA), pertenecientes a la población atendida en el centro de salud o al personal del mismo. Se excluyeron las personas con arritmias o con fase V de Korotkoff próxima a cero. Mediciones y resultados principales. Se comparan las medidas de PA y frecuencia cardíaca (FC) obtenidas con los aparatos de AMPA a validar frente a las obtenidas con un esfigmomanómetro de mercurio, utilizado como método de referencia. Las diferencias entre los aparatos de AMPA y el 'patrón oro' se cuantifican y representan mediante la gradación propuesta por el protocolo de la British Hypertension Society (BHS).La media (ñ DE) de las diferencias de la PA sistólica (en mmHg) entre los aparatos evaluados y el de referencia fue de 1,08 ñ 4,73 para el monitor automático y de 1,25 ñ 5,30 para el semiautomático. Las diferencias medias de la PA diastólica fueron de 0,44 ñ 4,03 para el monitor automático y 0,51 ñ 3,90 para el semiautomático. El porcentaje acumulado de diferencias de PA sistólica/diastólica 5, 10 y 15 mmHg fue del 85,5, 98, 98,8/90,6, 98,4 y 100 por ciento, respectivamente, para el monitor automático, y del 82,7, 95,7, 98,8/91, 99,6 y 100 por ciento para el semiautomático. Esto supone un grado A del protocolo de la BHS, que se mantiene al analizar los resultados por rangos de PA. Conclusiones. Ambos monitores satisfacen los criterios de validación aceptados internacionalmente, por lo que se puede recomendarlos para el seguimiento y autocontrol de la PA en el hipertenso (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Aged, 80 and over , Aged , Male , Female , Humans , Self Care , Blood Pressure Monitors , Primary Health Care , Blood Pressure Determination , Heart RateSubject(s)
Arteriosclerosis/etiology , Cerebrovascular Disorders/etiology , Chlamydia Infections/complications , Chlamydophila pneumoniae/pathogenicity , Animals , Arteriosclerosis/epidemiology , Arteriosclerosis/microbiology , Carotid Stenosis/etiology , Carotid Stenosis/microbiology , Case-Control Studies , Cerebrovascular Disorders/epidemiology , Cerebrovascular Disorders/microbiology , Chlamydia Infections/epidemiology , Chlamydophila pneumoniae/isolation & purification , Disease Susceptibility , Humans , Models, Animal , Models, Biological , Rabbits , Retrospective Studies , Seroepidemiologic StudiesABSTRACT
No disponible
Subject(s)
Rabbits , Animals , Humans , Case-Control Studies , Seroepidemiologic Studies , Carotid Stenosis , Chlamydophila pneumoniae , Models, Biological , Retrospective Studies , Models, Animal , Arteriosclerosis , Chlamydia Infections , Cerebrovascular Disorders , Disease SusceptibilityABSTRACT
OBJECTIVE: To develop and validate a rapid method for diagnosing superior anterior hemiblock, comparing it with the system seen as standard. DESIGN: Comparison study of two diagnostic tests. SETTING: Urban health centre. PARTICIPANTS: Adult population with prior diagnosis of superior anterior hemiblock included in a computer file of clinical records. MEASUREMENTS AND RESULTS: The presence or otherwise of superior anterior hemiblock was found by applying the standard criteria for electrocardiograms contained in the clinical records of the participating patients. The proposed test was then applied by finding the precise cardiac axis and the confirmation or rejection of the diagnosis of superior anterior hemiblock. Out of the 121 histories analysed, 40 had superior anterior hemiblock according to the standard criteria, and 81 did not. The system proposed detected 38 of the 40 hemiblock cases, 95% sensitivity, and rejected as normal 76 of the 81 electrocardiograms without superior anterior hemiblock according to the standard pattern, specificity of 93.8%. CONCLUSIONS: Superior anterior hemiblock can be diagnosed by an alternative method which was quicker than the standard pattern, so markedly simplifying the analysis of this feature of the electrocardiogram.
Subject(s)
Electrocardiography/methods , Heart Block/diagnosis , Adult , Electrocardiography/statistics & numerical data , Humans , Sensitivity and SpecificityABSTRACT
Objetivo. Desarrollar y validar un método rápido de diagnóstico de hemibloqueo superoanterior, comparándolo con el sistema considerado como estándar. Diseño. Estudio de comparación de 2 pruebas diagnósticas. Emplazamiento. Centro de salud urbano. Participantes. Población adulta con diagnóstico previo de hemibloqueo superoanterior incluida en un archivo informatizado de historias clínicas. Mediciones. Se constató la existencia o no de hemibloqueo superoanterior aplicando los criterios estándar en electrocardiogramas contenidos en las historias clínicas de los pacientes participantes; a continuación se aplicó el test propuesto hallando el eje cardíaco exacto y la confirmación o rechazo del diagnóstico de hemibloqueo superoanterior. Resultados. De las 121 historias analizadas, 40 tenían hemibloqueo superoanterior según los criterios estándar y 81 no lo presentaban. El sistema propuesto detectó 38 de los 40 hemibloqueos, lo que supone una sensibilidad del 95 por ciento, y rechazó como normales 76 de los 81 electrocardiogramas sin hemibloqueo superoanterior según el patrón estándar, lo que representa una especificidad del 93,8 por ciento. Conclusiones. El diagnóstico de hemibloqueo superoanterior puede hacerse por un método alternativo que resulta más rápido que el patrón estándar, simplificando de manera notable el análisis de este aspecto del electrocardiograma (AU)
Subject(s)
Middle Aged , Child , Adult , Adolescent , Aged , Male , Female , Humans , Sensitivity and Specificity , Prevalence , Cross-Sectional Studies , Hypercholesterolemia , Electrocardiography , Heart BlockABSTRACT
OBJECTIVE: The aim of the study was to explore temporal changes in stroke mortality in Andalusia over the period 1975-1994 and estimate the rates until the year 2000. DESIGN: Descriptive study. SETTING: Comunidad Andaluza. PATIENTS AND METHODS: The number of death from stroke was obtained for the period 1975-1994. Mortality raes were standardized directly using those of the "European population" as the standard, and regression analysis was undertaken. RESULTS: Age standardized overall mortality rates for stroke decreased considerably among men (45.6%). A similar pattern has been also observed among women (43.2%) during the period 1975-1992. If the trends continue during the period 1992-2000 we will observe an important reduction in both men (23.4%) and women (24.9%). CONCLUSIONS: In conclusion, this analysis shows a marked an steady fall in stroke mortality over the last two decades in Andalusia. Little is known about the factors that have led to the decline and further studies are necessary. A better understanding of these factors is important for planning the most effective intervention strategies to reduce, stroke mortality in our community.
Subject(s)
Cerebrovascular Disorders/mortality , Adolescent , Adult , Age Factors , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Sex Factors , SpainABSTRACT
The aim of this study was to explore temporal changes in stroke mortality in Andalusia over the period 1975-1992. Mortality rates were standardized directly using those of the European population as the standard, and regression analysis was undertaken. Age standardized overall mortality rates for stroke decreased considerably among men, from 199.42 to 103.74 (-3.5% per year). A similar pattern was also observed among women as mortality rates diminished from 160.48 in 1975 to 92.43 in 1992 (-3.3% per year). Despite the remarkable decline in the death rate, this disease still accounted for 1 in 35 deaths in women and for 1 in 23 deaths in men in 1992. This study confirms that time trends in stroke mortality are similar to those of most industrial countries.
Subject(s)
Cerebrovascular Disorders/mortality , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Regression Analysis , Spain/epidemiologyABSTRACT
OBJECTIVE: To describe the evolution of mortality due to ischaemic heart diseases in Andalucia between 1975 and 1992 and predict rates up to the year 2000. DESIGN: Descriptive study. SETTING: The Autonomous Community of Andalucia. Patients and other participants. Deaths because of ischaemic heart diseases between 1975 and 1992 were obtained. MEASUREMENTS AND MAIN RESULTS: The direct method was used for the standardisation of mortality rates for age and sex, with the European population as the standard. Logarithmic transformations of the standardised rates for mortality due to ischaemic heart diseases for both sexes were performed and the regression lines were adjusted. Between 1975 and 1992 the theoretical rates went down both in men and women. If the same tendency were maintained, we would expect to see a moderate reduction between 1992 and 2000 in men and in women. CONCLUSIONS: The tendency of mortality due to ischaemic heart diseases in Andalucia is downwards in both men and women.
Subject(s)
Myocardial Ischemia/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Cause of Death/trends , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Regression Analysis , Sex Distribution , Spain/epidemiologyABSTRACT
OBJECTIVE: A comparative study of the level and type of tooth loss, and the use of dental prostheses, was performed on one diabetic sample and another non-diabetic one, taken from elderly people receiving health care at the San Pablo Health Centre, Sevilla, in order to assess the repercussion of diabetes on tooth loss. DESIGN: A descriptive and observational study of a crossover type. SETTING: Primary care. San Pablo Health Centre, Sevilla. PATIENTS AND OTHER PARTICIPANTS: Patients aged > 65 requesting health care for any reason at our PC clinic during March-April 1995. MEASUREMENTS AND MAIN RESULTS: 98 patients, 42 diabetics and 56 non-diabetics, were studied. The percentage of toothlessness was significantly greater in diabetic patients than in non-diabetic ones. None of the patients had kept all their teeth. 52.4% of the diabetic patients wore complete prostheses, percentage which went down to 25% in non-diabetics. 57.1% of diabetics and 44.6% of non-diabetics wore some type of prosthesis. CONCLUSIONS: We can consider diabetes as a risk factor in tooth loss among the elderly. Applying buco-dental hygiene measures from the diagnosis of diabetes, along with regular dental check-ups, might significantly lessen diabetics' dental loss over their lives. Opening the elderly person's mouth, whether he/she is diabetic or not, and evaluating oral mucus and dental structure, should be a investigative procedure in primary care.
Subject(s)
Diabetes Complications , Tooth Loss/etiology , Aged , Dental Prosthesis/statistics & numerical data , Female , Humans , Male , Periodontal Diseases/complications , Spain/epidemiology , Tooth Loss/epidemiologyABSTRACT
BACKGROUND: The aim of the present study was to validate the SpaceLabs 90207 apparatus used in non-invasive outpatient monitoring of blood pressure. METHODS: The measurements of blood pressure (BP) and cardiac frequency (CF) obtained with the SpaceLabs monitor were compared with those obtained with a mercury sphygmomanometer used as the reference method in 86 patients with a wide range of ages and BP. The differences between both methods of measurement were quantified by a previously protocolized grade system from the British Hypertension Society (BHS). RESULTS: The mean of the differences between both systems of reading was 1.59 +/- 5.9 mmHg for systolic BP (SBP) 1.05 +/- 4.4 mmHg for diastolic BP (DBP) and -0.64 +/- 2.55 beats per minute for the CF. The accumulated percentage of differences of BP less than or equal to 5, 10 and 15 mmHg was of 74, 89 and 96%, respectively corresponding to grade B according to the validation protocol of the BHS. Grade B was obtained in all the interval differences of BP except within the range of DBP greater than or equal to 100 mmHg which showed grade A. Grades A or B were obtained in all the age groups except for grade C in the SBP of subjects over the age of 65. CONCLUSIONS: The SpaceLabs 90207 monitor satisfies the criteria of internationally accepted validation criteria, therefore, its use can be recommended for the outpatient blood pressure measurement.
Subject(s)
Blood Pressure Monitoring, Ambulatory/instrumentation , Adolescent , Adult , Aged , Aging/physiology , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Confidence Intervals , Diastole , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Primary Health Care , SystoleABSTRACT
OBJECTIVE: To describe the clinical-radiological, epidemiological, therapeutic and evolutive characteristics of an outbreak of atypical Pneumonia in a family, which was serologically diagnosed by means of the technique of complement fixation of Pneumonia caused by Mycoplasma. DESIGN: A descriptive study. SETTING: An urban Health Centre. PATIENTS AND OTHER PARTICIPANTS: A family of 7 members, consisting of father, mother and five children. MEASUREMENTS AND MAIN RESULTS: Three presented Pneumonia caused by Mycoplasma pneumoniae, with the other family members remaining asymptomatic and serologically negative. The three cases evolved until cure. Treatment was with Macrolides in two of the cases and Penicillin in the other. Clinical-radiological dissociation existed in two of the patients. 33% had a secondary attack. CONCLUSION: The accessibility of Primary Care to microserological methods, together with the greater ease with which this level of Care can reach the family environment, allows for more precise knowledge of infectious epidemic outbreaks which occur in the community.
Subject(s)
Disease Outbreaks , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/epidemiology , Adolescent , Child , Family Health , Female , Humans , Male , Pneumonia, Mycoplasma/blood , Primary Health Care , Serologic Tests , SpainABSTRACT
BACKGROUND: The possible influence of the variations in blood pressure and the plasma renin activity (PRA) after the administration of nifedipine (NIF) on the natriuretic effect of this calcium antagonist were evaluated. METHODS: The differences in the values of sodium excretion and tubular reabsorption were evaluated in 18 patients with essential hypertension with the method of the lithium clearance before and after the administration of a sublingual NIF dose. RESULTS: An increase in sodium excretion at the expense of a smaller distal reabsorption was found after NIF administration, without differences in patients with (n = 9) or without (n = 9) increase in PRA after NIF administration. The differences in several parameters when patients were classified depending on whether their mean blood pressure was reduced (n = 8) in more than 10% or not (n = 10) 90 minutes after NIF administration are discussed. CONCLUSIONS: Natriuresis induced by nifedipine is due to a diminished distal reabsorption of sodium. This effect is independent of PRA or its changes. On the other hand, the differences found in subgroups with different blood pressure response support the hypothesis that there are two populations of patients with essential hypertension depending on their acute response to calcium antagonists.
