Data supporting the morphological/topographical properties and the degradability on PET/PLA and PET/chitosan blends.

These data display evidence of the fracture through the morphologies and the topographical features as well as roughness data of different ratios of R(recycled)-PET/PLA, PET(virgin)/PLA, PET(virgin)/Chitosan and R(recycled)-PET/chitosan. Also, data of the morphologies after degradation under accelerated weathering test and degradation mechanisms are revealed. The data supplement the article "Comparative assessment of miscibility and degradability on PET/PLA and PET/chitosan blends".

Plan Universitario de Formación en Dolor de la Sociedad Española del Dolor / No disponible

No disponible

Utilidad de GATA-3 como marcador de epitelio seminal en las biopsias de próstata / Usefulness of GATA-3 as a marker of seminal epithelium in prostate biopsies

Objetivos: La presencia incidental de epitelio de la vesícula seminal en las biopsias por aguja de próstata es generalmente reconocible mediante el estudio microscópico de rutina. Sin embargo, en ocasiones, se puede interpretar erróneamente como maligno debido a sus características arquitecturales y citológicas, y la inmunohistoquímica puede ser útil para identificarlo correctamente. Nuestro objetivo ha sido analizar la posible utilidad de GATA-3 como marcador de epitelio seminal. Material y métodos_ Se han estudiado mediante inmunohistoquímica con un anticuerpo monoclonal anti-GATA-3 (clon L50-823) secciones de vesícula seminal procedentes de 20 piezas de prostatectomía, 12 biopsias por aguja de la próstata que contenían tejido de vesícula seminal y 68 biopsias de próstata sin epitelio de vesícula seminal, 36 de las cuales presentaban adenocarcinoma. Resultados: La tinción para GATA-3 fue intensa en las 20 vesículas seminales de las piezas de prostatectomía y en las 12 biopsias por aguja de próstata que contenían epitelio seminal. En las 60 biopsias sin vesícula seminal GATA-3 fue positiva en las células basales de la próstata, e incluso en las células secretoras (57 casos), aunque con menor intensidad en 55 de los casos. Uno de los 36 adenocarcinomas prostáticos fue GATA-3 positivo. Conclusiones: La expresión inmunohistoquímica intensa de GATA-3 en el epitelio de la vesícula seminal puede ayudar a identificarlo en las biopsias prostáticas. Este marcador también es positivo en las células basales de la próstata normal y, con menor intensidad, en las secretoras. Raramente se observa positividad, débil o moderada, en adenocarcinomas prostáticos

Objectives: The incidental presence of seminal vesicle epithelium in prostate needle biopsies is generally recognisable through routine microscopy. However, the biopsy can sometimes be erroneously interpreted as malignant due to its architectural and cytological characteristics, and immunohistochemistry can be useful for correctly identifying the biopsy. Our objective was to analyse the potential usefulness of GATA-3 as a marker of seminal epithelium. Material and methods: Through immunohistochemistry with a monoclonal anti-GATA-3 antibody (clone L50-823), we studied seminal vesicle sections from 20 prostatectomy specimens, 12 prostate needle biopsies that contained seminal vesicle tissue and 68 prostate biopsies without seminal vesicle epithelium, 36 of which showed adenocarcinoma. Results: Staining for GATA-3 was intense in the 20 seminal vesicles of the prostatectomy specimens and in the 12 prostate needle biopsies that contained seminal epithelium. In the 60 biopsies without a seminal vesicle, GATA-3 was positive in the prostate basal cells and even in the secretory cells (57 cases), although with less intensity in 55 of the cases. One of the 36 prostatic adenocarcinomas tested positive for GATA-3. Conclusions: The intense immunohistochemical expression of GATA-3 in the seminal vesicle epithelium can help identify the epithelium in prostate biopsies. This marker is also positive in the basal cells of healthy prostates and, with less intensity, in the secretory cells. Positivity, weak or moderate, is observed on rare occasions in prostatic adenocarcinomas

Usefulness of GATA-3 as a marker of seminal epithelium in prostate biopsies. / Utilidad de GATA-3 como marcador de epitelio seminal en las biopsias de próstata.

OBJECTIVES: The incidental presence of seminal vesicle epithelium in prostate needle biopsies is generally recognisable through routine microscopy. However, the biopsy can sometimes be erroneously interpreted as malignant due to its architectural and cytological characteristics, and immunohistochemistry can be useful for correctly identifying the biopsy. Our objective was to analyse the potential usefulness of GATA-3 as a marker of seminal epithelium. MATERIAL AND METHODS: Through immunohistochemistry with a monoclonal anti-GATA-3 antibody (clone L50-823), we studied seminal vesicle sections from 20 prostatectomy specimens, 12 prostate needle biopsies that contained seminal vesicle tissue and 68 prostate biopsies without seminal vesicle epithelium, 36 of which showed adenocarcinoma. RESULTS: Staining for GATA-3 was intense in the 20 seminal vesicles of the prostatectomy specimens and in the 12 prostate needle biopsies that contained seminal epithelium. In the 60 biopsies without a seminal vesicle, GATA-3 was positive in the prostate basal cells and even in the secretory cells (57 cases), although with less intensity in 55 of the cases. One of the 36 prostatic adenocarcinomas tested positive for GATA-3. CONCLUSIONS: The intense immunohistochemical expression of GATA-3 in the seminal vesicle epithelium can help identify the epithelium in prostate biopsies. This marker is also positive in the basal cells of healthy prostates and, with less intensity, in the secretory cells. Positivity, weak or moderate, is observed on rare occasions in prostatic adenocarcinomas.

IL-6 blockade reverses the abnormal STAT activation of peripheral blood leukocytes from rheumatoid arthritis patients.

Considering the interplay of multiple STATs in response to cytokines, we investigated how IL-6 and its blocking affect STAT signaling in rheumatoid arthritis (RA). Leukocytes obtained from RA patients before and after tocilizumab treatment and healthy donors (HDs) were cytokine-stimulated and STAT phosphorylation was analyzed by cytometry. RA patients had significantly fewer pSTAT1+, pSTAT3+, and pSTAT6+ monocytes and pSTAT5+ lymphocytes than HDs. After 24weeks of treatment, percentages of IFNγ-induced pSTAT1+ and IL-10-induced pSTAT3+ monocytes in RA patients increased, reaching levels comparable to HDs. pSTAT1+ and pSTAT3+ cells correlated inversely with RA disease activity index and levels of pSTAT+ cells at baseline were higher in patients with good EULAR response to tocilizumab. IFNγ-induced pSTAT1+ cells correlated inversely with memory T cells and anti-CCP levels. IL-10-induced pSTAT3+ cells correlated with Treg/Teff ratio. Our findings suggest that IL-6 blocking reduces the inflammatory mechanisms through the correction of STAT1 and STAT3 activation status.

Estudio epidemiológico del dolor en la comunidad autónoma de Andalucía / No disponible

Objetivos: se ha realizado un estudio sobre el dolor crónico en una muestra de población de Andalucía para explorar su prevalencia, características, forma de diagnóstico, tratamiento e impacto. Material y métodos: se llevó a cabo un estudio transversal con muestreo aleatorio estratificado, con 1.200 entrevistas telefónicas mediante el sistema CATI (Computer Assisted Telephone Interviewing), diseñado por el IMC (Instituto de Investigación, Marketing y Comunicación, Sevilla), a sujetos residentes en Andalucía, mayores de 18 años a los que se les realizaron diferentes preguntas sobre el dolor. Resultados: de los 1.200 entrevistados se obtuvo una muestra de 405 pacientes con dolor reciente (30% del total de entrevistados con dolor actual y 3,8% con dolor en el último mes, pero no en este momento). El 15,5% de la población sufre un dolor de tipo crónico. La puntuación media de la intensidad del dolor es de 5,4 (escala 1-10). El dolor afecta sobre todo a espalda, piernas y rodillas; y domina el de tipo reumatológico. El impacto sobre la calidad de vida es notable. El 77,5% de la población con dolor toma medicación oral de prescripción. Casi la mitad de la población ha oído hablar de las unidades del dolor, y la opinión al respecto es favorable. Conclusiones: los datos del estudio aportan información sobre la presencia del dolor en la población andaluza y servirán de base para diseñar estrategias para hacerle frente (AU)

Aims: a study on chronic pain has been performed in a sample of people in Andalusia, in order to assess its prevalence, features, diagnosis, treatment, and impact. Material and methods: a cross-sectional survey with stratified randomised sampling, including 1,200 phone interviews on pain was performed in people aged > 18 years in Andalusia, by means of the CATI system (Computer Assisted Telephone Interviewing) designed by IMC (Instituto de Investigación, Marketing y Comunicación, Sevilla). Results: from 1,200 interviewees, a sample of 405 patients with recent pain was obtained (30% of participants with current pain; 3.8% with pain in previous month but not currently). 15.5% of participants have chronic pain. Mean intensity is 5.4 (on a 1-10 scale). Most common sites are back, legs and knees; and rheumatologic pain is the most common type. Impact on quality of life is high. 77.5% of people with pain use prescribed oral drugs. About half of participants have heard about pain units, and have a positive opinion on them. Conclusions: current data provide information on the presence of pain in Andalusian population, and will be useful to build up strategies to deal with it (AU)

Infrared diffuse interstellar bands in the Galactic Centre region.

The spectrum of any star viewed through a sufficient quantity of diffuse interstellar material reveals a number of absorption features collectively called 'diffuse interstellar bands' (DIBs). The first DIBs were reported about 90 years ago, and currently well over 500 are known. None of them has been convincingly identified with any specific element or molecule, although recent studies suggest that the DIB carriers are polyatomic molecules containing carbon. Most of the DIBs currently known are at visible and very near-infrared wavelengths, with only two previously known at wavelengths beyond one micrometre (10,000 ångströms), the longer of which is at 1.318 micrometres (ref. 6). Here we report 13 diffuse interstellar bands in the 1.5-1.8 micrometre interval on high-extinction sightlines towards stars in the Galactic Centre. We argue that they originate almost entirely in the Galactic Centre region, a considerably warmer and harsher environment than where DIBs have been observed previously. The relative strengths of these DIBs towards the Galactic Centre and the Cygnus OB2 diffuse cloud are consistent with their strengths scaling mainly with the extinction by diffuse material.

The development of a simple questionnaire to screen patients with SLE for the presence of neuropsychiatric symptoms in routine clinical practice.

AIM: The creation of a physician-administered questionnaire to screen patients with Systemic Lupus Erythematosus (SLE) for the presence of symptoms suggestive of neuropsychiatric involvement (NPSLE). METHODS: The development of the questionnaire followed three phases. First, a list of manifestations was prepared based on the ACR case definitions for NPSLE. A first questionnaire was constructed including 119 items. To reduce their number, a Delphi analysis was carried out and a second questionnaire with 62 questions was developed. This questionnaire was administered to 139 patients with SLE (58 with NPSLE: 29 active, 29 inactive; and 81 without NPSLE: 39 active, 42 inactive). Questions relevant to the screening of patients were selected on the basis of the receiver operating characteristic (ROC) curve analysis. RESULTS: Twenty-seven questions concerning central nervous system and psychiatric manifestations were found to be relevant; the remaining could be eliminated without significantly affecting AUC. The area under the ROC curve (AUC) was 0.69 (95% CI 0.61-0.78). A score above 17 was considered as suggestive of the presence of NPSLE with a sensitivity of 92.9% (95% CI 85.1-97.3 %) and specificity of 25.4% (95% CI 14.7-39.00 %). CONCLUSIONS: This questionnaire could represent a 'core set' of questions that could help in clinical practice to identify patients with neuropsychiatric symptoms requiring further evaluation.

Sternal and vertebral fractures, a well-known association, usually overlooked: review of six clinical cases / Fraturas vertebrais e fraturas concomitantes do esterno: revisão de seis casos / Fracturas vertebrales y fracturas concomitantes del esternón: revisión de seis casos

OBJECTIVE: the association of sternal and vertebral fractures has previously been described in the literature. These lesions are frequently overlooked at the initial evaluation. The purpose of this study was to review and discuss the diagnostic methods used to diagnose these lesions and to highlight the importance of early recognition of these fractures. METHODS: we performed a retrospective analysis of six patients who suffered sternal and concomitant vertebral fractures. Clinical charts and imaging studies were reviewed. RESULTS: all patients were diagnosed with sternal fractures at the initial evaluation, but only two were diagnosed with vertebral fractures. CONCLUSION: failure to recognize these fractures at initial evaluation may be associated with the fact that the upper thoracic region is difficult to explore. In the presence of sternal fractures, a vertebral fracture must be ruled out even though major injuries are not present. A computer tomography (CT) scan and magnetic resonance imaging (MRI) should be obtained despite negative X-rays if clinical suspicion is present.

OBJETIVO: a associação de fraturas do esterno e vertebral tem sido previamente descrita na literatura. Essas lesões são frequentemente negligenciadas na avaliação inicial. O objetivo deste estudo foi analisar e discutir os métodos diagnósticos utilizados para essas lesões e salientar a importância do reconhecimento precoce dessas fraturas. MÉTODOS: foi realizada uma análise retrospectiva de seis pacientes que sofreram, concomitantemente, fraturas do esterno e vertebrais, por meio da análise de prontuários e exames de imagem. RESULTADOS: todos os pacientes foram diagnosticados com fraturas do esterno na avaliação inicial, mas somente dois foram diagnosticados com fraturas vertebrais. CONCLUSÃO: o não-reconhecimento dessas fraturas na avaliação inicial pode ser associado à dificuldade de explorar a região torácica superior. Na presença de fraturas do esterno, uma fratura vertebral deve ser descartada, embora lesões maiores não sejam presentes. A tomografia computadorizada (TC) e a ressonância magnética (RM) devem ser obtidas se houver suspeita clínica, apesar de os raios-X serem negativos.

OBJETIVO: la asociación de las fracturas del esternón y vertebrales ha sido descrita previamente en la literatura. Estas lesiones son frecuentemente descuidadas en la evaluación inicial. El objetivo de este estudio fue analizar y discutir los métodos diagnósticos utilizados para estas lesiones y resaltar la importancia del reconocimiento precoz de estas fracturas. MÉTODOS: fue realizado un análisis retrospectivo de seis pacientes que sufrieron concomitantemente fracturas del esternón y vertebrales, por medio del análisis de las historias clínicas y exámenes de imagen. RESULTADOS: todos los pacientes fueron diagnosticados con fracturas del esternón en la evaluación inicial, pero solamente dos fueron diagnosticados con fracturas vertebrales. CONCLUSIONES: el hecho de no reconocer estas fracturas en la evaluación inicial puede estar asociado a la dificultad de explorar la región torácica superior. En la presencia de fracturas del esternón, una fractura vertebral debe ser descartada, así no estén presentes lesiones mayores. La tomografía computarizada y la resonancia magnética deben ser obtenidas en el momento de sospecha clínica, aunque el rayo-X sea negativo.

The Andalusian population from Huelva reveals a high diversification of Y-DNA paternal lineages from haplogroup E: Identifying human male movements within the Mediterranean space.

BACKGROUND: Gene flow among human populations is generally interpreted in terms of complex patterns, with the observed gene frequencies being the consequence of the entire genetic and demographic histories of the population. AIMS: This study performs a high-resolution analysis of the Y-chromosome haplogroup E in Western Andalusians (Huelva province). The genetic information presented here provides new insights into migration processes that took place throughout the Mediterranean space and tries to evaluate its impact on the current genetic composition of the most southwestern population of Spain. SUBJECTS AND METHODS: 167 unrelated males were previously typed for the presence/absence of the Y-chromosome Alu polymorphism (YAP). The group of YAP (+) Andalusians was genotyped for 16 Y-SNPs and also characterized for 16 Y-STR loci. RESULTS: The distribution of E-M81 haplogroup, a Berber marker, was found at a frequency of 3% in our sample. The distribution of M81 frequencies in Iberia seems to be not concordant with the regions where Islamic rule was most intense and long-lasting. The study also showed that most of M78 derived allele (6.6%) led to the V13* subhaplogroup. We also found the most basal and rare paragroup M78* and others with V12 and V65 mutations. The lineage defined by M34 mutation, which is quite frequent in Jews, was detected as well. CONCLUSIONS: The haplogroup E among Western Andalusians revealed a complex admixture of genetic markers from the Mediterranean space, with interesting signatures of populations from the Middle East and the Balkan Peninsula and a surprisingly low influence by Berber populations compared to other areas of the Iberian Peninsula.

Manejo quirúrgico del síndrome de Bertolotti: a propósito de un caso / Surgical management of the Bertolotti´s syndrome: case report

We present the case of a 31 year-old man with a story of chronic low back pain in the presence of a transitional lumbosacral vertebra with transverse mega apophysis articulating with the sacrum (Bertolotti´s syndrome). After unsuccessful conservative treatment, an anesthetic blockade in the transverse process and sacral ala joint was performed with complete but brief relief of pain. For that reason, a resection of the transverse process was performed. There is no agreement in the relationship between back pain and the presence of a mega-apophysis. Therefore, surgical treatment of this condition is even more controversial. In the absence of other pain generators, the known biomechanical dysfunction of lumbosacral transitional vertebra in conjunction with a positive injection test lead us to consider surgical resection of the mega-apophysis as an alternative treatment in refractory low back pain. The proven biomechanical alteration of lumbosacral transitional junction and the systematic searching of sources of pain through anesthetic blocks allows that in cases of refractory pain surgical treatment of the mega-apophysis can be an effective alternative.

Presentamos el caso de un paciente varón de 31 años con historia de dolor lumbar crónico mecánico portador de una anomalía de transición lumbosacra con mega-apófisis transversa articulada al ala sacra. El paciente luego de varios tratamientos médicos fallidos fue sometido a bloqueo anestésico de la pseudo articulación transverso sacra con alivio completo pero pasajero de su dolor. Finalmente, se realiza una resección de la mega apófisis con buenos resultados a corto y largo plazo. La relación entre dolor lumbar y la presencia de una mega-apófisis es controvertido. De igual forma el tratamiento quirúrgico consistente en resección de la mega-apófisis es más controvertido aún. La probada alteración biomecánica del segmento lumbosacro transicional junto al descarte sistemático de otras fuentes de dolor y la confirmación diagnóstica mediante bloqueos anestésicos permite plantear que en casos de dolor refractario a tratamiento conservador la resección de la mega-apófisis puede ser una alternativa eficaz.

Mielopatía cervical por pseudogota, reporte de un caso clínico / Cervical myelopathy due to pseudogout: case report

Compressive myelopathy due to calcium pyrophosphate crystals deposit is an uncommon pathology. This disease can be isolated or associated with other articular deposits. We present a 78 year-old women with a story of lower limbs weakness and limitation of motion. Myelopathic signs where found on physical examination, so a cervical spine MRI was performed showing C6-C7 thickening and calcification of yellow ligament with compression of the spinal cord from the back. A surgical procedure with decompressive laminectomy and posterior instrumentation from C5 to C7 was performed The patient evolved favorable without postoperative complications and with neurological recovery from M3 to M4 in lower limbs. Histological study of the yellow ligament showed deposits of calcium pyrophosphate crystals. Calcium pyrophosphate crystals deposit is uncommon in the cervical spine, but it must be considered in the differential diagnosis of posterior cervical cord compression.

La mielopatía cervical por depósito de cristales de pirofosfato de calcio es una patología poco frecuente. Ésta puede presentarse aislada o asociada a otros depósitos articulares. Presentamos el caso clínico de una mujer de 78 años con historia de debilidad de extremidades inferiores y limitación de la marcha. Al ingreso la paciente presentaba signos clínicos de mielopatía. La resonancia nuclear magnética de columna cervical evidenció a nivel C6-C7 engrosamiento y calcificación del ligamento amarillo con compresión del cordón medular de atrás adelante. La paciente fue sometida a una laminectomía descompresiva y fusión posterior instrumentada C5-C7 No hubo complicaciones post operatorias y se observó recuperación neurológica de M3 a M4 en el post operatorio. El estudio anatomopatológico del ligamento amarillo mostró reacción inflamatoria crónica y depósitos de cristales de pirofosfato de calcio. El depósito de cristales de pirofosfato de calcio es poco frecuente en la columna cervical, pero debe considerarse en el diagnóstico diferencial de la mielopatía cervical por compresión medular posterior.

Osteotomía del trocánter mayor tipo flip en el tratamiento quirúrgico de fracturas de acetábulo / Trochanteric flip osteotomy in the treatment of acetabular fractures

Objective: Analyze a series of patients that underwent surgery for an acetabular fracture in which a trochanteric flip osteotomy was used and discuss the advantages of this surgical procedure. Materials and Method: The clinical files of 8 patients treated of acetabular fractures with this approach is reported. Functional results are evaluated with the Merle d´Aubigne scale. Also, postoperative complications were age of patients was 41 years (range: 28-60 years). Mean follow-up was 13.8 months (range: 4-41 months). Functional results were excellent in 2 patients, good in 4 patients, regular in one patient and poor in one patient. Postoperative complications include two cases of heterotopic ossifications. No loosening of the osteotomy or avascular necrosis of the femoral head was observed. Conclusions: This technique facilitates in selected acetabular fractures, to obtain better visualization and more accurate reduction, by allowing safely dislocation of the femoral head and assessment of the intraarticular reduction.

Objetivo: Revisar los resultados radiológicos y funcionales de una serie de pacientes operados por fractura de acetábulo en que se utilizó un abordaje posterior con osteotomía del trocánter mayor tipo "flip", discutir ventajas y complicaciones potenciales de esta técnica. Material y Método: Se revisaron las fichas clínicas de 8 pacientes operados por fractura de cotilo en que se utilizó la osteotomía del trocánter mayor tipo "flip". Se evaluaron las complicaciones observadas y los resultados clínicos con la escala de Merle d`Aubigne. Resultados: La edad promedio de los pacientes fue de 41 años (rango: 28-60 años). El seguimiento promedio fue de 13,8 meses (rango: 4-41 meses). En cuanto a los resultados funcionales, en 2 pacientes fueron excelentes, en 4 pacientes buenos, en 1 paciente regular y en 1 paciente malo. Las complicaciones fueron 2 casos de osificaciones heterotópicas grado I y II de Broker. No hubo casos de aflojamiento de trocánter mayor o necrosis avascular. Conclusiones: Esta técnica quirúrgica facilita el tratamiento en casos seleccionados de fracturas acetabulares, al permitir luxar la cadera y mejorar la visualización de la reducción intraarticular, sin agregar mayores complicaciones.

Does better access to primary care reduce utilization of hospital accident and emergency departments? A time-series analysis.

BACKGROUND: Availability of primary care emergency facilities has been improved to help curb heavy growth in the use of Accident and Emergency Departments (A&EDs). The aim of this paper is to analyse the relationship between time series for visits to hospital A&EDs and primary care centres. METHODS: Using a co-integration time series we analyse the visits to the emergency services of the county hospital and seven healthcare primary centres in the healthcare district of Mieres, Asturias, España, during the period 1992-1999. The main outcome measured is the relationship between the time series for emergency visits to the primary care centres and the hospital A&ED, for groups aged 0-14 years, over 14 years and the total. RESULTS: A total of 506,158 visits to the emergency services of the primary care centres (62.4%) and hospital A&ED (37.6%) have been studied. Emergency visits rose by 40.9% during the period studied (50.3% in primary care centres and 26.5% in the hospital). The gross rise in visits was higher for adults (51.2%) than for 0-14 year olds (6.6%). The co-integration time-series analysis showed that in both age groups and in the total, there was a significant and positive relationship between the primary care and hospital series, indicating that the use of both services had grown simultaneously. The use of the hospital services did not decrease as a result of the increase in primary care services. CONCLUSIONS: The rise in use of primary care emergency services did not reduce use of the hospital A&ED.

[Primary care resources use variation by under seven year old children in a rural and an urban area. Cohort study]. / Variaciones en el consumo de recursos de atención primaria por niños menores de 7 años en los medios rural y urbano. Estudio de cohortes.

OBJECTIVE: [corrected] To describe differences between two health districts in primary care resource use. DESIGN: Retrospective population cohort study. SETTING: A rural healthdistrict (RD) and an urban health district (UD). PARTICIPANTS: A cohort of children born in 1991 in a UD (n=104) and a cohort of children born in 1991 and 1992 in an RD (n=88), registered in their primary care centres between 0 and 6 years old. MAIN MEASUREMENTS: Attention episodes, requested visits, practicioner programmed visits, nursery programmed visits and diagnosis tests. RESULTS: Significative differences were noticed in the attention episode average(ZU=34.0; 95% CI, 31.5%-36.5%); (ZR=25.6; 95% CI, 22.7%-28.5%), in requested visits (ZU=45.8; 95% CI, 41.8%-49.9%); (ZR=28.8; 95% CI, 25.3%-31.9%), in practicioner programmed visits (ZU=7.1; 95% CI, 6.6%-7.5%), (ZR=11.2; 95% CI, 10.7%-11.7%) and in nursery programmed visits (ZU=9.8; 95% CI, 9.0%-10.6%) (ZR=12.0; 95% CI, 11.4%-12.5%). At least one diagnosis test was applied to 90.3% of children in the UD and to 64.8% of children in the RD; and in the UD for each attention episode 1.32 (95% CI, 1.28%-1.36%) requested visits were attended to and 0.2 (95% CI, 0.17%-0.23%) diagnosis tests were made; whereas in the RD 1.1 (95% CI, 1.08%-1.13%) requested visits and 0.09 (95% CI, 0.06%-0.12%) diagnosis tests. In both health districts the average of attention episodes, requested visits and tests was significantly higher in children who had been hospitalized. CONCLUSIONS: Primary care services utilization and the number of diagnosis test and attention episode visits are higher in the urban district than in the rural one.

Variaciones en el consumo de recursos de atención primaria por niños menores de 7 años en los medios rural y urbano. Estudio de cohortes / Primary care resources use variation by under seven year old children in a rural and an urban area. Cohort study

Objetivo. Describir las diferencias entre dos zonas de salud en el consumo de recursos en atención primaria. Diseño. Estudio de cohortes poblacionales retrospectivo. Emplazamiento. Una zona de salud urbana (ZU) y otra rural (ZR) de Asturias. Participantes. Cohorte de niños nacidos en 1991 en la ZU (n = 104) y nacidos en 1991 y 1992 en la ZR (n = 88), adscritos al centro de salud entre los 0 y 6 años. Mediciones principales. Número de episodios de atención, consultas a demanda, consultas programadas con el médico, consultas programadas de enfermería y pruebas diagnósticas. Resultados. Se observaron diferencias significativas en el promedio de episodios de atención (ZU = 34,0; IC del 95 por ciento, 31,536,5 por ciento; ZR = 25,6; IC del 95 por ciento, 22,728,5 por ciento), de consultas a demanda, (ZU = 45,8; IC del 95 por ciento, 41,8-49,9 por ciento; ZR = 28,8; IC del 95 por ciento, 25,3-31,9 por ciento, de consultas programadas con el médico (ZU = 7,1; IC del 95 por ciento, 6,6-7,5 por ciento; ZR = 11,2; IC del 95 por ciento, 10,7-11,7 por ciento) y con enfermería (ZU = 9,8; IC del 95 por ciento, 9,0-10,6 por ciento; ZR = 12,0; IC del 95 por ciento, 11,4-12,5 por ciento).Al 90,3 por ciento de los niños de la ZU y al 64,8 por ciento de la ZR se les realizó al menos una prueba diagnóstica y, en la ZU, por cada episodio de atención se realizaron 1,32 (IC del 95 por ciento, 1,28-1,36 por ciento) consultas a demanda y 0,2 (IC del 95 por ciento, 0,17-0,23 por ciento) pruebas diagnósticas, mientras que en la ZR fueron 1,1 (IC del 95 por ciento, 1,08-1,13 por ciento) consultas a demanda y 0,09 (IC del 95 por ciento, 0,06-0,12 por ciento) pruebas diagnósticas. En las dos zonas de salud la media de episodios, consultas a demanda y pruebas fue significativamente mayor en los niños que habían tenido un ingreso hospitalario. Conclusiones. La utilización de los servicios de atención primaria y el número de pruebas diagnósticas y consultas por episodio de atención es mayor en la zona urbana que en la rural (AU)

[Emergency department utilization by children aged less than two years old]. / Utilización de los servicios de urgencias hospitalarios por niños menores de dos años.

BACKGROUND: Emergency department visits are rising although birth rate is decreasing. OBJECTIVE: To compare emergency department.(ED) utilization in the cohorts of children born in 1991 and 1996 in a health district. METHOD: We performed a two-year retrospective cohort study in the health district of Mieres (Spain). All children born in the health district in 1991 (n 600) and 1996 (n 423) were included. The number of visits to the ED was obtained and the frequency and mean number of visits in the first 2 years of life were calculated according to age, sex, and area of residence. RESULTS: The gross number of visits did not vary (1991: 852; 1996: 853), despite a decrease in birth rate. The number of children who attended the ED at least once increased by 34.8 % (1991, 60.6 %; 1996, 82 %) and the frequency of visits increased by 41.7 % (1991, 142.2 %; 1996, 201.4 %). More than 60 % of visits were made by 20 % (1991) of the children and by 29 % (1996). The percentage of children who attended the ED, the frequency rate and the mean number of visits were significantly higher in the municipality nearest the hospital than in the remaining municipalities in the health district. CONCLUSIONS: Although the gross number of visits to the ED remained unchanged, ED utilization increased substantially in only 5 years.

Utilización de los servicios de urgencias hospitalarios por niños menores de dos años / Emergency department utilization by children aged less than two years old

Antecedentes: Parece existir un incremento de las visitas en los servicios de urgencia hospitalarios (SUH), no homogéneo, en un contexto de disminución de la natalidad. Objetivo Comparar la utilización del SUH de las cohortes de niños nacidos en 1991 y 1996 en un área sanitaria. Método Estudio retrospectivo de cohortes con 2 años de seguimiento, en el área sanitaria de Mieres (Asturias). Se incluyen todos los niños nacidos en el área de salud en 1991 (n 600) y 1996 (n 423). Se mide el número de visitas realizadas al SUH y se calculan la tasa de visitas y promedio de visitas en los primeros 2 años, en función de la edad, sexo y municipio de residencia. Resultados El número bruto de visitas no varió (1991, 852; 1996, 853) pese a la disminución de nacimientos. El número de niños que acudió a urgencias al menos una vez se incrementó el 34,8 per cent (1991, 60,6 per cent; 1996, 82,0 per cent), y la frecuentación el 41,7 per cent (1991, 142,2 per cent; 1996, 201,4 per cent). El 20 per cent (1991) y el 29 per cent (1996) de los niños generaron más del 60 per cent de las visitas. En el municipio más cercano al hospital el porcentaje de niños que utilizó el SUH, la frecuentación y el promedio de visitas fue significativamente mayor que en el resto de los municipios. Conclusiones Aunque el número bruto de visitas permaneció estable, la utilización del SUH experimentó un importante crecimiento en 5 años (AU)

[Factors associated with the use and adaptation of hospitalization in people over than 64 years of age]. / Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años.

BACKGROUND: Some social, medical or functional aspects are associated with a greater use of health care resources, although this does not necessarily imply an inappropriate usage of the same. The aim of this research is that of ascertaining the influence of health condition on hospital stays and inappropriate stays among the population over 64 years of age. METHODS: A cohort representative of the population over age 64 in the Judicial District of Toledo (n = 3214) whose health condition had been previously evaluated was studied over an eighteen-month period identifying the income and length of stays at the public hospitals, the appropriateness of which was evaluated by the Appropriateness Evaluation Protocol. Associations analyzed were those of the cohort socio-demographic characteristics, health condition-related variables and morbidity with frequency and hospitalization rates and with inappropriate stays and admissions. RESULTS: During the 18 months of study 410 individuals were hospitalized, who generated 546 admissions (frequency rate = 17.0 admissions/100 rooms) and 7015 stay days (hospitalization rate = 218.3 stays/100 rooms), 18.9% of the admissions and 49.9% of the stays were evaluated as inappropriate. Hospitalization was associated with a worse health condition, institutionalization, male sex, certain pathologies and previous health services usage. Patients characteristics were not associated with the percentage of inappropriate stays. 97.5% of inappropriate stays were attributed to hospital scheduling problems and physicians' practices. CONCLUSIONS: Socio-demographic factors, morbidity, health condition and previous health service usage are shown as good hospitalization predictors for senior citizens, but these factors are not related to inappropriate hospitalization usage.

[Evolution of childhood hospitalization in Spain. Variation among autonomous communities]. / Evolución de la hospitalización infantil en España. Variabilidad entre comunidades autónomas.

BACKGROUND: To describe trends in children hospitalization in Spain during 1985-1994 and its variability among regions. METHODS: Description between 1985 and 1994, by autonomous regions, of the evolution in the rates of available beds, discharges, stays and visits and average length of stay, from data provided by the health care centres with inpatient statistics. RESULTS: The average length of stay decreased 23.9%, but there was a 4.5% increase in bed availability, a 39.5% increase in the discharges rate and 36.8% in the visits rate. Regions showed large differences in all indicators, that trends to converge in beds availability and discharges, but not in length of stay and visits rate. CONCLUSIONS: There has been an increase in hospital performance with strong variation among regions. Differences tends to reduce in some indicators but not in others.