[Predictive factors of 2009 H1N1 virus infection in patients with influenza syndrome]. / Factores predictivos de infección por el virus de la gripe H1N1 2009 en pacientes con síndrome gripal.

INTRODUCTION: Polymerase chain reaction (PCR) testing is one of the better techniques for viral detection in nasopharyngeal swabs. The objective of this study was to assess the percentage of positive swabs and to determine whether there were differences according to PCR positivity. MATERIAL AND METHODS: A retrospective study of 362 patients with flu syndrome attended at the Emergency Department between July 15 and December 15, 2009, in whom PCR of nasopharyngeal swabs for the detection of H1N1 2009 influenza virus was performed. Those cases in which swab testing was adequately requested were identified, and patients were divided into two groups according to positive or negative results for H1N1 2009 influenza virus. RESULTS: Nasopharyngeal swab was inadequately ordered in 87. In the remaining 275 patients, PCR was positive in 141. Patients with positive nasopharyngeal swabs were younger (mean [SD] age 36.1 [15] vs 42.3 [18] years, P= 0.002), had lower white blood cell, neutrophil and lymphocyte counts, lower serum concentrations of C-reactive protein (5.15 [5] vs 10.5[12] mg/dL, P= 0.036) and lower incidence of radiological infiltrates (20.5% vs 33%, P= 0.036). In the logistic regression analysis, age, serum C-reactive protein levels, and lymphocyte count were independently associated with a positive nasopharyngeal swab. CONCLUSIONS: About 50% of patients with flu syndrome had positive nasopharyngeal swabs for H1N1 2009 influenza virus. Age, C-reactive protein, and lymphocyte count were independent predictors of positivity.

Mejorar la calidad asistencial en la atención a la mujermaltratada en los servicios de urgencias / Improving emergency care for battered women

Objetivo: Analizar la frecuentación, los factores de riesgo, la detección por parte del personal sanitario y el funcionamiento del circuito establecido con los servicios sociales(SS), para las mujeres atendidas por violencia de género (VG) en los servicios de urgencias(SU), con la finalidad de mejorar la calidad en la asistencia. Metodología: Estudio transversal, observacional y prospectivo de las mujeres atendidas por VG en los SU del Institut Municipal d’Assistència Sanitària (IMAS) durante el 2004.Los datos se recogieron en el mapa anatómico. Se consideró frecuentación un mínimo de tres visitas durante el año 2004.Resultados: Se realizaron 157.482 asistencias a pacientes mayores de 14 años, 79.787(50,1%) fueron mujeres. La atención por VG, 604 casos, representó el 0,76% de las asistencias. El 10,4% de los casos fueron detectados por el personal sanitario. El 29,6%eran frecuentadoras, los motivos de consulta más habituales y significativos (p < 0,001)fueron los trastornos inespecíficos, los ginecológicos, los traumatológicos, psiquiátricos, digestivos y neurológicos. El 52,6% presentaba factores de riesgo de VG, y los más frecuentes fueron gestación, abortos previos, relaciones sexuales no consentidas y aumento de la violencia. En el 3% de los casos no llegó la información a los SS. Conclusiones: Casi un tercio de las mujeres con VG fueron frecuentadoras a los SU, y más de la mitad presentaban factores de riesgo. La detección por parte del personal sanitario fue bajo (10,4%). Como resultado del estudio, se han adoptado las siguientes medidas para mejorar la calidad en la asistencia: 1. Cursos de formación para los residentes de primer año y de formación continuada dirigidos al personal del IMAS. 2. Informatización del mapa anatómico, que incluye de forma específica los factores de riesgo más frecuentes en nuestra área de influencia. 3. Se ha recomendado la detección rutinaria (AU)

Objective: To analyze the frequent use of emergency health services by battered women, risk factors for abuse, detection by health care staff, and referral to social services, with a view to improving quality of care. Methods: Prospective, cross-sectional, observational study of battered women receiving emergency care from the municipal health care services (IMAS, Institut Municipal d’Assistencia Sanitària) in Barcelona. Data were recorded on a standardized data collection sheet. Individuals who used the services at least 3 times in 2004 were considered frequent users. Results: The emergency services handled 157 482 calls for assistance from patients over the age of 14 years; 79 787(50.1%) were women. Gender-based violence accounted for 0.76% of the cases. Health care personnel detected gender-based violence in 10.4%. Of these, 29.6% women were frequent users. Nonspecific disorders, gynecologic complaints, trauma, psychiatric disorders, digestive complaints, and neurologic symptoms were significantly more frequent (P<.001) than other reasons for seeking care. Risk factors for gender-based violence were present in 52.6% of the cases, the most common factors being pregnancy, prior abortions, nonconsensual sex, and escalating violence. Social services were not contacted in 3% of the cases. Conclusions: Nearly a third of women suffering from gender based violence and more were frequent users of emergency services and more than half these women had risk factors. The rate of detection by health care staff was low(10.4%). The committee for assistance to battered women has adopted the following measures to improve quality of care: 1) training courses for first-year residents and continuing professional development courses for members of the staff; 2) computerization of the data collection sheet, including the most common risk factors in our health care area; and 3) routine detection systems (AU)

[Calcaneous ultrasonography as measurement of osteoporosis prevalence in the general population in relation to the diagnostic criterion utilized. Data of the study GIUMO]. / Prevalencia de osteoporosis en la población española por ultrasonografía de calcáneo en función del criterio diagnóstico utilizado. Datos del estudio GIUMO.

CONTEXT: In recent years, a large number of techniques have been developed to estimate the bone mineral density for the diagnosis of osteoporosis. However, diagnostic criteria established by WHO are invariably applied for the interpretation of dual radiological densitometry (DEXA), which could not be correct in the case of the interpretation of ultrasound. METHOD: We studied 2,589 randomly chosen people of both sexes, 1,138 males and 1,451 women from 10 to 99 years, in 11 spanish provinces. We carried out a measurement of the following calcaneous ultrasound parameters with the Sahara and Hologic devices: speed of the sound (SOS), coefficient of attenuation of wide band (BUA), index of consistency (QUI) and estimated bone mineral density (est. BMD). The prevalence of osteopenia and osteoporosis was calculated by applying the WHO criteria (osteopenia Tscore < or = 1 and osteoporosis Tscore < or = 2.5) and the prevalence of osteoporosis by applying a Tscore 1.8 as threshold. RESULTS: According to the WHO criteria, osteoporosis (Tscore < or = 2.5) is seen in 1.5 % males and 5.9 % females from 51 to 70 years, and in 2.6% males and 22.1% females over 70 years. Using a Tscore 1.8 as threshold, osteoporosis prevalence increases to 8.2% males and 21.9% females from 51 to 70 years, and to 8.4% males and 40.9% females over 70 years. CONCLUSION: Osteoporosis prevalence in spanish people of both sexes differs notably when applying the cut off point in a Tscore of 2.5, as WHO recommends, or in a Tscore of 1.8 as is suggested by other authors. Consensus is necessary to establish the appropriate cut off point or threshold for the diagnosis of osteoporosis with quantitative ultrasonography of calcaneum.

Evaluación del grado de conocimiento y satisfacción del tratamiento hormonal sustitutivo en una cohorte de mujeres menopáusicas / Evaluation of kowledge degree and satisfaction with hormonal replacement therapy among a cohort of menopausal women

La terapia hormonal sustitutiva (THS) posee un efecto antirresortivo que la convierte en la terapia más fisiológica para la prevención y tratamiento de la osteoporosis postmenopáusica. Conocer la opinión y el grado de satisfacción de las mujeres postmenopáusicas en THS es un dato importante para mejorar el tratamiento.Pacientes y método. Se realizó una encuesta con 16 preguntas a 100 mujeres en THS que acudieron de forma consecutiva a la Unidad de Densitometría de nuestro centro para realizar una exploración densitométrica. Una enfermera especializada realizó la encuesta y los datos se tabularon para su análisis. La comparación de medias se realizó mediante el análisis de la varianza (ANOVA) y se aplicó la prueba del Chi cuadrado para la comparación de frecuencias utilizando el paquete SPSS 8.0 for windows.Resultados. Se hallaron diferencias estadísticamente significativas en la edad de instauración de la menopausia en el grupo con menopausia natural 47 ñ 4 (media ñ DE) frente a quirúrgica 44 ñ 6 (media ñ DE), p < 0,01, y en el tiempo transcurrido desde la menopausia y la instauración del tratamiento 2,6 ñ 2,2 años (media ñ DE) en las mujeres con menopausia natural frente a 4,1 ñ 4,7 años (media ñ DE), p = 0,05, en las mujeres con menopausia quirúrgica. Un 72,2 por ciento sabía que el THS les era beneficioso para el hueso y las sofocaciones y solamente un 1 por ciento conocía su efecto sobre el aparato cardiovascular. El 59,8 por ciento desconocía los posibles efectos secundarios de la THS y solamente a un 8 por ciento le preocupaba el tema del cáncer de mama. La duración del tratamiento era 46 ñ 26 (media ñ DE) meses, con un intervalo de 4 a 120 meses. De las 128 mujeres que ya no realizaban tratamiento el 50 por ciento lo habían abandonado dentro del primer año. Un 73,2 por ciento reconocía no saber el tiempo que tenía que tomar el tratamiento.Conclusiones. Las mujeres en THS poseen escaso conocimiento del beneficio y de los efectos secundarios. Como autorreflexión, podríamos aconsejar una mayor comunicación con las mujeres menopáusicas explicándoles más ampliamente el THS, sus ventajas, inconvenientes y la duración prevista del mismo (AU)

[Estimate of the costs of osteoporotic fractures of the femur in Spain]. / Aproximación a los costes de la fractura osteoporótica de fémur en España.

To evaluate the economic impact of osteoporosis, the cost of acute attention to the osteoporotic hip fractures recorded in Barcelona during one year was investigated. The hospital records of 8637 beds (85.64% of the overall number in the city) were reviewed and the cases seen in inhabitants aged 45 years or more during 1984 were included. The cost, days of hospital admission, operations and orthopedic material were recorded. Data from 870 fractures were recovered. During the study period 1358 hip fractures took place in Barcelona, with 1269 +/- 21 (mean +/- SEM) operations, 31219 +/- 1550 (mean +/- SEM) days of hospital admission, and 408 +/- 40 (mean +/- SEM) prostheses. Their attention generated a cost amounting to 662.5 +/- 29.5 (mean +/- SEM) million pesetas. The cost of each fracture was 488200 +/- 331700 (mean +/- SD) pesetas, with a hospital stay of 23 +/- 17 (mean +/- SD) days. This represents, for the whole of Spain, 33298 +/- 1769 (mean +/- SEM) fractures, 31160 +/- 2154 (mean +/- SEM) operations, 767853 +/- 78314 (mean +/- SEM) hospital admission days and 10042 +/- 1530 (mean +/- SEM) prostheses every year. The yearly expenditure is 16295 +/- 1598 (mean +/-SEM) million pesetas (confidence interval of the estimation 95%). Thus, osteoporotic hip fracture results in a significant expenditure in this country. The enormous cost of the attention to osteoporosis and its complications warrants a greater effort for its prevention and care.