Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital.

BACKGROUND: Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it. OBJECTIVE: To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU. DESIGN: Retrospective longitudinal study. AMBIT: Intensive care unit of a tertiary hospital. PATIENTS: People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019. INTERVENTIONS: None. This is an observational study. VARIABLES OF INTEREST: Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays. RESULTS: Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients. CONCLUSIONS: Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.

Evaluación del tiempo de caducidad de la capacidad desinfectante de una solución de ácido peracético y adamantina / No disponible

No disponible

Valor pronóstico de los biomarcadores procalcitonina, interleukina 6 y proteína C reactiva en la sepsis grave / Prognostic value of the biomarkers procalcitonin, interleukin-6 and C-reactive protein in severe sepsis

Objetivo: Comprobar el valor pronóstico de los biomarcadores procalcitonina, interleukina 6 y proteína C reactiva en pacientes sépticos graves Diseño: Cohorte de 81 pacientes críticos Ambito: Unidad de Críticos Hospital Dr. Peset. Valencia. Pacientes: Divididos según el grado de sepsis (sepsis, sepsis severa, shock séptico), foco de sepsis y grupo (pacientes médicos y posquirúrgicos de alto riesgo). Variables analizadas: Cuantitativas (procalcitonina, interleukina-6, proteína C reactiva, lactato, edad, Apache II y SOFA) al ingreso, 3.er y 7.o día de evolución. Cualitativas (mortalidad intra UCI, desarrollo Fallo Multiorgánico y sexo). Estadística: comparación variables cuantitativas con test U de Mann-Whitney; las cualitativas con test de χ2; análisis multivariante variables dependientes mortalidad y fallo multiorgánico e independientes las cuantitativas descritas; curvas ROC de las variables significativas en el multivariante Resultados: Pacientes con shock séptico fallecieron más y desarrollaron más fallo multiorgánico. Comparación entre vivos y fallecidos, mostró diferencias significativas Apache II, interleukina-6 y lactato (p <0,001) al ingreso, 3.er y 7.o día. Entre pacientes con fallo multiorgánico y sin él, también y los mismos días. La procalcitonina mostró diferencias solo en 3.er y 7.o día (p=0,001). Análisis multivariante con variable dependiente mortalidad la interleukina-6 mostró significación al 3.er día (O.R. 2,6). Con variable dependiente fallo multiorgánico solo SOFA tuvo significación (O.R. 2,3). Curva ROC Apache II e interleukina-6 3.er día mostró área 0,80 y 0,86 respectivamente. Conclusiones: 1) La interleukina-6 es un biomarcador inflamatorio con valor pronóstico de mortalidad; 2) Ningún biomarcador tuvo valor predictivo de fallo multiorgánico (AU)

Aim: To determine the prognostic value of the biomarkers procalcitonin, interlukin-6 and C-reactive protein in septic patients. Design: A cohort of 81 septic patients. Setting: Critical Care Unit. Dr. Peset Hospital. Valencia (Spain). Patients: Divided according to sepsis classification (sepsis, severe sepsis and septic shock), source and two different groups (medical and postsurgical). Variables analyzed: Quantitative (procalcitonin, interleukin-6, C-reactive protein, lactate, age, Apache II and SOFA scores upon admission and after 3 and 7 days). Qualitative (ICU mortality, multiorgan failure development and sex). Statistical analysis: Mann-Whitney U-test for the comparison of quantitative variables, X2 test for qualitative variables. Multivariate analysis with mortality and multiorgan failure as dependent variables and the described quantitative parameters as independent variables. ROC curves of the variables found to be significant in the multivariate analysis. Results: Septic shock patients showed greater mortality and more frequent multiorgan failure. Comparison of survivors versus deceased patients showed significant differences in Apache II score, interleukin-6 and lactate (p<0.001) upon admission and after 3 and 7 days. Similar findings applied to the comparison of patients with and without multiorgan failure, and on the same days. Procalcitonin only showed differences on days 3 and 7 (p=0.001). In the multivariate analysis with mortality as dependent variable, interleukin-6 proved significant on day 3 (OR 2.6). With multiorgan failure as dependent variable, only the SOFA score showed significance (OR 2.3). The Apache II and interleukin-6 ROC curves corresponding to day 3 showed areas of 0.80 and 0.86, respectively. Conclusions: 1) Interleukin-6 is an inflammatory biomarker with mortality prognostic value. 2) None of the biomarkers proved predictive of multiorgan failure (AU)

Prognostic value of the biomarkers procalcitonin, interleukin-6 and C-reactive protein in severe sepsis.

AIM: To determine the prognostic value of the biomarkers procalcitonin, interlukin-6 and C-reactive protein in septic patients. DESIGN: A cohort of 81 septic patients. SETTING: Critical Care Unit. Dr. Peset Hospital. Valencia (Spain). PATIENTS: Divided according to sepsis classification (sepsis, severe sepsis and septic shock), source and two different groups (medical and postsurgical). VARIABLES ANALYZED: Quantitative (procalcitonin, interleukin-6, C-reactive protein, lactate, age, Apache II and SOFA scores upon admission and after 3 and 7 days). Qualitative (ICU mortality, multiorgan failure development and sex). STATISTICAL ANALYSIS: Mann-Whitney U-test for the comparison of quantitative variables, χ² test for qualitative variables. Multivariate analysis with mortality and multiorgan failure as dependent variables and the described quantitative parameters as independent variables. ROC curves of the variables found to be significant in the multivariate analysis. RESULTS: Septic shock patients showed greater mortality and more frequent multiorgan failure. Comparison of survivors versus deceased patients showed significant differences in Apache II score, interleukin-6 and lactate (p<0.001) upon admission and after 3 and 7 days. Similar findings applied to the comparison of patients with and without multiorgan failure, and on the same days. Procalcitonin only showed differences on days 3 and 7 (p=0.001). In the multivariate analysis with mortality as dependent variable, interleukin-6 proved significant on day 3 (OR 2.6). With multiorgan failure as dependent variable, only the SOFA score showed significance (OR 2.3). The Apache II and interleukin-6 ROC curves corresponding to day 3 showed areas of 0.80 and 0.86, respectively. CONCLUSIONS: 1) Interleukin-6 is an inflammatory biomarker with mortality prognostic value. 2) None of the biomarkers proved predictive of multiorgan failure.

Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario / Adverse events and associated factors in patients who died in a University Hospital

Fundamento y objetivo. El presente trabajo de investigación pretende relacionar los eventos adversos (EA) asociados a la asistencia sanitaria con otro indicador de calidad asistencial como es la mortalidad hospitalaria, determinando la proporción de fallecidos en los que está presente algún EA y qué factores se asocian a una mayor proporción de EA en personas fallecidas. Material y métodos. Inicialmente se realizó un estudio descriptivo de mortalidad de base hospitalaria, seguido de un estudio de casos y controles en pacientes fallecidos. Se estudió la presencia de EA, la probabilidad con la que se hubieran podido prevenir y predecir y su asociación con diversos factores. Resultados. La proporción de EA encontrada fue del 19,8% (82/414), siendo la proporción de pacientes fallecidos que padeció algún EA del 15,5% (64/414). La razón de EA por persona era de 1,28. El EA más frecuente fue la infección nosocomial. El 48,8% de los EA eran prevenibles. No se ha encontrado una diferencia en la presencia de EA por edad ni por sexo. Entre los factores que se asociaron a la presencia de EA destacan la intervención quirúrgica, la estancia y el tipo de servicio en el que estaban ingresados los pacientes. Discusión. La proporción de pacientes fallecidos con EA, el porcentaje de EA prevenibles, el tipo más frecuente (la infección nosocomial) y la relación de la estancia y la intervención quirúrgica con su presencia, nos hacen centrar la atención en el desarrollo de medidas que reduzcan la estancia hospitalaria y en la difusión de las medidas de prevención y control de la infección nosocomial(AU)

Objective. This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. Methods. First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. Results. The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. Discussion. The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection(AU)

[Adverse events and associated factors in patients who died in a university hospital]. / Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario.

OBJECTIVE: This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. METHODS: First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. RESULTS: The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. DISCUSSION: The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection.

Factores predisponentes, facilitadores y reforzantes respecto al tabaquismo en trabajadores sanitarios / Predisposing, enabling and reinforcing factors regarding smoking in healthcare workers

Objetivos: Ante la elevada prevalencia de tabaquismo que continúa existiendo entre el personal sanitario, se ha llevado a cabo este estudio a fi n de identifi car y analizar los Factores Predisponentes, Facilitadores y Reforzantes (PRECEDE) respecto al tabaquismo en trabajadores de un Hospital Universitario Valenciano. Métodos: Se ha realizado un estudio cualitativo transversal, basado en un cuestionario no estructurado sobre los factores que motivan el consumo de tabaco en una muestra aleatoria de 120 trabajadores del Hospital Universitario Dr. Peset, diferenciándose cuatro categorías (n=30): Nunca fumadores, Fumadores habituales, Ex Fumadores sin recaída y Fumadores tras recaída. Resultados: Los principales factores PRECEDE identifi - cados en cada grupo fueron: Nunca Fumadores: Predisponentes (Conocimiento, “sé que es perjudicial”), Facilitadores (entorno familiar no fumador) y Reforzantes (Experiencia, “lo probé y no me gustó”). Fumadores: Predisponentes (“fumar es mi vicio”), Facilitadores (situaciones de estrés) y Reforzantes (“me hace sentir bien”). Ex Fumadores sin Recaídas: Predisponentes (problemas de salud), Facilitadores (deporte, presión familiar y social) y Reforzantes (ahorro económico). Fumadores tras Recaída: Predisponentes (creencia “por uno no pasa nada”), Facilitadores (entorno de fumadores) y Reforzantes (sensación de calma). Conclusiones: Según el estudio realizado, es recomendable que los programas de educación sanitaria contra el tabaquismo en el ámbito hospitalario presten especial atención a los factores relacionados con falsas creencias todavía existentes en el personal sanitario, así como a los entornos de los fumadores (AU)

Objectives: Since a high prevalence of tobacco addiction continues existing among healthcare workers, this study has been carried out in order to identify and to analyze Predisposing, Enabling and Reinforcing factors (PRECEDE) regarding smoking habits in healthcare workers at a Valencian University Hospital. Methods: We performed a qualitative cross-sectional study based on a non-structured questionnaire about factors that motivate smoking habit. A random sample of 120 health-care workers from Dr Peset University Hospital were interviewed and distributed among four categories (n=30): Non-smokers, Smokers, Ex- Smokers without relapses and Smokers with relapse. Results: The most important PRECEDE factor for each group was: Never-smokers: Predisposing (Knowledge, “I know that smoking is detrimental to health”), Enabling (non-smoker’s family environments) and Reinforcing (Experience, “I tried it and I did not like it”). Smokers: Predisposing (“smoking is my vice”) Enabling (stressful situations) and Reinforcing (“it makes me feel good”). Ex-Smokers without Relapses: Predisposing (Health problems), Enabling (Sport, family Pressure and social Perception) and Reinforcing (Cost). Smokers after Relapse: Predisposing (Belief It’s just one cigarette), Enabling (smoker’s environment) and Reinforcing (sensation of calm). Conclusions: According to this study, health promotion programs against smoking in hospitals should pay special attention to factors related to false beliefs among healthcare workers and smoker’s settings (AU)

[Survival analysis for localized renal cell carcinoma. Prognostic value of 1997 TNM classification]. / Análisis de supervivencia de los carcinomas de células renales organo-confinados. Valor pronóstico de la clasificación TNM 1997.

BACKGROUND: The 5th edition of TNM classification for renal cell carcinoma changed the cut-off point of the tumor size for localized tumors, achieving a better distribution of patients with similar survival. Nevertheless, because of the variable evolution of renal cell carcinoma, the prognostic significance of tumor size is questioned as a staging criterion in organ-confined renal cell carcinoma. We analyse renal cell carcinoma specific survival and the prognostic significance of tumor size in I and II stage. METHODS: We made a retrospective study with 158 renal cell carcinoma surgically treated in our hospital along 12 years. It was created a data base with clinical variables from patient and tumor and analyzed pathological staging, nuclear grade and specific survival, overall stage I and II. RESULTS: 27 renal cell carcinoma were pT1 (17.08%), 52 pT2 (32.91%), 45 pT, (28.45%), 10 pT3B (6.32%), y 24 pT4 (15.18%). The specific survival at 5 years for pT1-pT2, I-II stage, was 100% and 94% respectively, and no statistic significant differences were found between stage I and II (log-rank test 0.53, p>0.05). The specific survival at 5 years for pT3a, pT3B, y pT4 was 76.5%, 66.6% y 38.4%. There was a significant difference in survival in accordance with the tumor location, intrarenal (T1 y T2) versus extrarenal (T3A, T3B, T4) (log-rank test 9.06, p< 0.05). According to nuclear grade we don't find significant differences for pT1 y pT2 (Fisher test, p=1). Regarding the relation between pT stage and nuclear grade of the tumor we obtained a chi-square inear tendency of 38.19, p<0.001. CONCLUSION: The differences in the evolution of the organ-confined renal cell carcinoma with respect to the tumor size may be due to other molecular and biological variables, probably associated with stage, not controlled in essays. The TNM classification for organ-confined renal cell carcinoma based in tumor size seems artificial. New revisions of the classification system are necessary to identify which organ-confined carcinoma will have unfavourable evolution and to include them in a different category.

Análisis de supervivencia de los carcinomas de células renales órgano-confinados. Valor pronóstico de la clasificación TNM 1997 / Survival analysis for localized renal cell carcinoma. Prognostic value of 1997 TNM classification

Introducción: En la 5ª edición de la clasificación TNM de 1997 para tumores renales se modificó el punto de corte del tamaño del tumor primario para los estadios I y II, permitiendo una mejor agrupación de pacientes con distinta supervivencia. Sin embargo, dada la variable evolución del carcinoma de células renales determinada por su agresividad biológica, se cuestiona la utilidad del tamaño tumoral como elemento pronóstico y de estadiaje. Se realiza un estudio de supervivencia del carcinoma de células renales para valorar si la nueva clasificación TNM para el estadio I y II es la que mejor predice la supervivencia basándose en el tamaño del tumor. Material y Método: Se ha realizado un estudio retrospectivo de 158 carcinomas de células renales intervenidos en nuestro hospital en un periodo de 12 años. Se ha creado una base de datos con variables clínicas debidas al paciente y al tumor, y se ha valorado estadio patológico, grado nuclear y supervivencia causa específica, centrándonos en los estadios I y II. Resultados: Según la categoría pT obtuvimos 27 pT1 (17,08%), 52 pT2 (32,91%), 45 pT3A (28,45%), 10 pT3B (6,32%), y 24 pT4 (15,18%). La supervivencia tumor-específica a los 5 años para pT1-pT2, estadio I-II, es de 100% y 94% respectivamente, sin encontrar diferencias estadísticamente significativas entre los estadios I y II (log-rank test 0,53, p no significativa). La supervivencia tumor-específica a los 5 años para la categoría pT3A, pT3B, y pT4 es de 76,5%, 66,6% y 38,4%. Encontrando una diferencia en la supervivencia estadísticamente significativa según la localización del tumor primario intrarrenal (T1 y T2) y la extrarrenal (T3A, T3B, T4) (log-rank test 9,06, p < 0.05). Para pT1 y pT2 no se encuentran diferencias estadísticamente significativas según el grado nuclear (test exacto de Fisher, p=1). Comparando la relación entre estadio pT y grado nuclear del tumor primario obtenemos un valor para X2 de tendencia lineal de 38,19, p<0.001. Conclusiones: Las diferencias en la evolución del carcinoma de células renales órgano-confinado según el tamaño tumoral pueden ser debidas a la existencia de otras variables biológicas y moleculares, posiblemente asociadas al estadio, que no se controlan en los estudios. La clasificación TNM en los carcinomas de células renales órgano-confinados basándose en el tamaño del tumor nos parece artificiosa. Son necesarias nuevas revisiones del sistema de clasificación para identificar qué grupo de pacientes con carcinoma de células renales órgano-confinado va a presentar evolución desfavorable e incluirlos en una categoría distinta

Background: the 5th edition of TNM classification for renal cell carcinoma changed the cut-off point of the tumor size for localized tumors, achieving a better distribution of patients with similar survival. Nevertheless, because of the variable evolution of renal cell carcinoma, the prognostic significance of tumor size is questioned as a staging criterion in organ-confined renal cell carinoma. We analyse renal cell carcinoma specific survival and the prognostic significance of tumor size in I and II stage. Methods: We made a retrospective study with 158 renal cell carcinoma surgically treated in our hospital along 12 years. It was created a data base with clinical variables from patient and tumor and analyzed pathological staging, nuclear grade and specific survival, overall stage I and II. Results: 27 renal cell carcinoma were pT1 (17.08%), 52 pT2 (32.91%), 45 pT3A (28.45%), 10 pT3B (6.32%), y 24 pT4 (15.18%). The specific survival at 5 years for pT1-pT2, I-II stage, was 100% and 94% respectively, and no statistic significant differences were found between stage I and II (log-rank test 0.53, p>0.05). The specific survival at 5 years for pT3A, pT3B, y pT4 was 76.5%, 66.6% y 38.4%. There was a significant difference in survival in accordance with the tumor location, intrarenal (T1 y T2) versus extrarenal (T3A, T3B, T4) (log-rank test 9.06, p< 0.05). According to nuclear grade we don’t find significant differences for pT1 y pT2 (Fisher test, p=1). Regarding the relation between pT stage and nuclear grade of the tumor we obtained a X2 inear tendency of 38.19, p<0.001. Conclusion: The differences in the evolution of the organ-confined renal cell carcinoma with respect to the tumor size may be due to other molecular and biological variables, probably associated with stage. not controlled in essays. The TNM classification for organ-confined renal cell carcinoma based in tumor size seems artificial. New revisions of the classification system are necessary to identify which organ-confined carcinoma will have unfavourable evolution and to include them in a different category

[Incidence of pulmonary scintigraphic changes in women irradiated for breast cancer]. / Incidencia de alteraciones gammagráficas pulmonares en mujeres irradiadas por cáncer de mama.

OBJECTIVE: To determine the incidence of respiratory function changes on quantified ventilation-perfusion scintigraphy produced by breast cancer radiation therapy and its correlation with irradiated lung volume. MATERIAL AND METHODS: Prospective study on 43 patients with breast cancer who received adjuvant radiotherapy. Quantified ventilation-perfusion scintigraphy was carried out before and after radiotherapy (3 and 9 months). The differences of ventilation and perfusion were calculated subtracting the irradiated lung values from the contralateral lung values, and their correlations with the irradiated lung volume were analyzed. RESULTS: The scintigraphic parameter means of the irradiated lung were significantly lower than those of the contralateral lung, after radiotherapy. The incidence of patients with a total perfusion and ventilation decrease over 10 % was 21 %, except for the three-month ventilation, which was 23 %. The total ventilation difference was significantly correlated with the lung volume, presenting decreases over 10 % for volumes of 100 cm3 or more. All patients remained asymptomatic. CONCLUSIONS: The pulmonary scintigraphy changes derived from the breast cancer radiotherapy produced no clinical symptomatology. Regarding scintigraphy, ventilation decreases when the irradiated lung volume increases, so a follow-up of these patients' pulmonary function should be performed when the lung volume irradiation cannot be lower than 100 cm3.

Incidencia de alteraciones gammagráficas pulmonares en mujeresirradiadas por cáncer de mama / Incidence of pulmonary scintigraphic changes in women irradiated for breast cancer

Objetivo: Determinar, mediante gammagrafía de ventilación y perfusión cuantificada, la incidencia de alteraciones en la función respiratoria producidas por la irradiación en el cáncer de mama, y su correlación con el volumen de pulmón irradiado.Material y métodos: Estudio prospectivo de 43 pacientes con cáncer de mama sometidas a radioterapia complementaria. Se practicó gammagrafía pulmonar de ventilación y perfusión cuantificada antes y después de la radioterapia (a los 3 y 9 meses). Las diferencias de perfusión y ventilación se calcularon restando a los valores obtenidos para el pulmón irradiado los valores del pulmón contralateral y se estudió su relación con el volumen pulmonar irradiado.Resultados: Las medias de los parámetros gammagráficos del pulmón irradiado fueron inferiores a las del pulmón contralateral, de forma significativa, después de la radioterapia. La incidencia de pacientes con descenso de perfusión y ventilación global superiores al 10 por ciento fue 21 por ciento, excepto para la ventilación a los 3 meses, que fue 23 por ciento. La diferencia de ventilación global se correlacionó de forma significativa con el volumen pulmonar, apreciándose descensos superiores al 10 por ciento a partir de 100 cm3.Todas las pacientes permanecieron asintomáticas.Conclusiones: Los cambios gammagráficos de ventilación y perfusión derivados de la irradiación pulmonar no produjeron sintomatología clínica alguna. Gammagráficamente, la ventilación desciende con el incremento del volumen pulmonar irradiado, siendo recomendable llevar a cabo un seguimiento de la función pulmonar de estas pacientes cuando no sea factible la irradiación de un volumen de pulmón inferior a 100 cm3. (AU)

[Early carbohydrate metabolism dysfunction in chronic pancreatitis. Relation with the exocrine pancreatic function]. / Disfunción temprana del metabolismo hidrocarbonado en la pancreatitis crónica. Relación con la función exocrina pancreática.

BACKGROUND: The relationship between endocrine and exocrine dysfunction in chronic pancreatitis (CP) is controversial. Our goals were to evaluate the disturbances of carbohydrate metabolism in relation to the degree of exocrine insufficiency, to compare the usefulness of oral glucose tolerance test (OGTT) versus fasting blood glucose and to investigate the degree of exocrine and endocrine dysfunction according to the duration of CP. PATIENTS AND METHOD: 73 patients with CP were studied. Pancreas exocrine and endocrine status was evaluated by secretin-CCK test (SCT), fecal fat analysis and OGTT. RESULTS: Out of 8 patients with normal SCT, 4 had an abnormal glucose metabolism with diabetes in 2 of them. Out of 50 patients with moderate exocrine insufficiency, there was an abnormal fecal fat excretion in 20%, an endocrine dysfunction in 54% and diabetes in 40%. All patients with severe dysfunction of the exocrine pancreas were diabetics. The OGTT test demonstrated that 42% of patients with normal fasting blood glucose had an abnormal glucose metabolism. Mean evolution time of CP was shorter in patients with endocrine dysfunction than in those with steatorrhea. CONCLUSIONS: As far as functional exocrine status is concerned, in chronic pancreatitis there is a higher proportion of patients with glucose metabolism dysfunction than with abnormal fecal fat excretion. Carbohydrate metabolism dysfunction can be demonstrated by OGTT in a large proportion of patients with normal fasting blood glucose. In patients with CP, hydrocarbonate dysfunction seems to develop earlier than abnormal fecal fat excretion.

[Analysis of avoidable mortality in Valencia Community hospitals]. / Análisis de la mortalidad evitable en los hospitales de la Comunidad Valenciana.

Using a list of avoidable mortality (AM) causes as indicators of medical care (IMC) according to the Holland classification, a study on AM was conducted in the Valencia Community hospitals during 1994 and 1995. A total of 617 patients out of 106,540 discharges with IMC criteria died (mortality rate: 0.58%). The most common causes of AM included hypertension and cerebrovascular disease, with 46% of avoidable deaths; maternalperinatal disease, with 36%, and tuberculosis, 7%. According to the logistic regression analysis, men had a higher risk of AM than women, the age groups at highest risk were those over 50 years and less than 18 years, and the presence of a higher number of diagnoses was associated with increased risk.

Análisis de la mortalidad evitable en los hospitales de la Comunidad Valenciana / Analysis of avoidable deaths in the Valencia Community hospitals

Utilizando el listado de causas de mortalidad evitable (ME) conocidas como indicadores de asistencia médica (IAM) según la clasificación de Holland se ha llevado a cabo un estudio de la ME ocurrida en los hospitales de la Comunidad Valenciana durante 1994 y 1995. De 106.540 altas con criterios de IAM, fallecieron 617 pacientes (letalidad: 0,58 por ciento). Las causas más frecuentes de ME fueron la enfermedad hipertensiva y cerebrovascular, con el 46 por ciento de los fallecimientos evitables; la maternoperinatal, con el 36 por ciento, y la tuberculosis, con el 7 por ciento. Según el análisis de regresión logística, los hombres presentaron mayor riesgo de ME que las mujeres; los grupos de edad con mayor riesgo fueron los de más de 50 años y los menores de 18 años, y la presencia de un mayor número de diagnósticos se asoció a un riesgo más elevado (AU)

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[Age-period-cohort analysis of mortality caused by traffic accidents in Spain]. / Análisis edad-periodo-cohorte de la mortalidad por accidentes de tráfico en España.

OBJECTIVE: To study the evolution of traffic accidents mortality in Spain and its possible application to an age-period-cohort analysis, as well as the effect of selected road safety measures. MATERIAL AND METHODS: Road accidents rates of mortality were obtained, and five-year interval age rates for each sex, which allows the study of specific rates of age by birth cohorts. To determine the association between the selected road safety measures and mortality. Poisson regression models were adjusted. RESULTS: Two waves emerge in the evolution of traffic accidents. There was no clear effect with respect to age, nor was there a cohort effect for men or women. As to the road safety measures, we discuss the consistency between the selected models and graphic results. The compulsory use of helmet and of crossing lights is significantly associated to a reduction in mortality (RR 0.73, p < 0.05). CONCLUSIONS: Road accidents mortality shows a slight increase in the studies period. This rate performance cannot be sufficiently explained by age effects, diagnostic period nor birth cohort, however, road safety measures are considered positive.

[Occupational accidents at an Acute Care Hospital]. / Accidentes de trabajo en un hospital de agudos.

BACKGROUND: To obtain a better knowledge of the determining factors and circumstances giving rise to occupational accidents will foster the implementation of corrective measures. The aim of this study is that of describing the trend of occupational accidents (OA's) over the course of time and of determining the risk factors regarding workers being forced to take time off for sick leave at the "Dr. Peset" Hospital in Valencia. METHODS: Description and retrospective analysis of the occupational accidents having occurred at the "Dr. Peset" Hospital in Valencia throughout the 1992-1995 period. The trend and seasonality of the series (seasonal indexes, SI's) were estimated by deterministic methods. A logistic regression model was employed to identify the factors providing a prior indication workers being off on sick leave and to determine the probability of the occurrence thereof. RESULTS: The highest OA rates were found among the kitchen and laundry workers (10.00 OA's per 100 workers/year). The OA's involving sick leave continued to show a trend of around zero, February being the months showing the highest SI (SI = 139.8). Those processed without sick leave showed an upward trend (r2 = 0.23, p < 0.0001), May being the month involving the largest number of casualties (SI = 134.2). The probability of an accident resulting in a worker being forced to take time of for sick leave increases significantly with age, when the accident in question takes place in the afternoon/evening, if it takes place in the kitchen/laundry, and if a sprain or tendinitis is involved. CONCLUSIONS: The measures taken involving the number of casualties entailing OA's which result in temporary incapacity should revolve around the less-skilled positions and the kitchen and laundry departments.

[Tendencies in mortality from cardiovascular diseases in the Valencian community (1976-1992)]. / Tendencias en la mortalidad por enfermedades cardiovasculares en la Comunidad Valenciana (1976-1992).

INTRODUCTION AND OBJECTIVES: Age-adjusted cardiovascular mortality has experienced a sharp decrease in Spain and, also, in the Valencian Community since approximately the mid-seventies. The objective of the present study is to describe the evolution of mortality due to cardiovascular and cerebrovascular diseases in the Valencian Community and their provinces, during 1976-1992. MATERIAL AND METHODS: The annual series of raw, specific and age-standardized mortality rates have been constructed and analyzed for the Valencian Community and provinces, from 1976 to 1992, fitting subsequently Poisson regression models to the rates. RESULTS: There exists a significant descendent trend of cardiovascular mortality, with an even more marked decrease for cerebrovascular disease. Mortality rates are higher in the Valencian Community than in general population of Spain. There is a rise in mortality rates with the increase of age. The female gender has a significant protective effect. Valencia and Alicante present higher risks than Castellón. CONCLUSIONS: Cardiovascular mortality in the Valencian Community during the period 1976-1992 decreased in all age groups, especially for cerebrovascular mortality. A greater magnitude in the masculine rates is observed. Castellón is the province associated with the lowest risk of death by cardiovascular disease.

[The evolution of mortality due to ischemic cardiopathy in the Community of Valencia (1976-1992)]. / Evolución de la mortalidad por cardiopatía isquémica en la Comunidad Valenciana (1976-1992).

The present investigation was carried out to describe the evolution of mortality caused by coronary heart disease in the Valencia Community from 1976-1992. Annual rates were constructed for crude and specific rates for age and sex groups and standardized rates were estimated for age by the direct method. Later, a Poisson regression model was adjusted for each age group. The mortality rate due to ischaemic heart disease showed a very slight descending slope until 74 years of age, and particularly in the age group 55-64 years. A growing gradient of coronary mortality rate with age is observed. Female sex is a powerful protector factor, and its effect decreases gradually with increasing age. Alicante is the province with the highest mortality rate by ischaemic heart disease.

[The comparison of adverse reactions to anti-influenza vaccines of split-vision and surface antigens]. / Comparación de las reacciones adversas a las vacunas antigripales de virus fraccionados y de antígenos de superficie.

BACKGROUND: Fear of adverse reactions is one of the reasons why influenza immunization programs for hospital workers have not met wide acceptance. We conducted a study in order to compare the frequency of adverse reactions following administration of standard split-virion (VVF) and subunit-virion (VAS) influenza vaccines, mostly among hospital personnel. METHODS: Trial with volunteers who were systematically assigned to receive one of the vaccines, alternating every ten participants, during the influenza inmunization campaing 1994-95. The adverse effects were recorded by telephone interview 10 days after vaccination. RESULTS: Out the 182 subjects recruited, 163 were included in the study, of whom 100 received VAS and 63, VVF. Almost 13% of the participants reported any adverse effects with no significant difference between both groups (VAS: 11% and VVF: 15.6%, p = 0.38). There were also no significant differences relating to systemic and local reactions, separately. The subjects who had adverse reactions to previous influenza vaccination showed more frecuent systemic reactions (25% vs. 7.5%, p = 0.04) in a significant way. CONCLUSIONS: Both vaccines have been proved to be very safe, only causing adverse reactions in a small proportion and very mild in every case. The VAS presents a frequency of adverse effects similar to that of VVF, in spite of containing only surface antigens. It's likely that a certain hypersensitivity to influenza vaccine exists in some people, specially to the split-virion one.