Audit of cataract surgery in Cadiz: visual outcomes and complications. / Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones.

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92±7.31. Almost all (98.3%) of patients at consultation had a VA ≥0.60logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤0.3logMAR, and 27.6% of cases achieved a VA ≤0.0logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives.

Social inequalities in HIV-TB and non-HIV-TB patients in two urban areas in southern Spain: multilevel analysis.

SETTING: Two towns in Campo de Gibraltar, southern Spain, with a small foreign population and higher tuberculosis (TB) incidence and human immunodeficiency virus (HIV) prevalence than the national average. OBJECTIVE: To determine the relationship between HIV-TB and non-HIV-TB incidence and social deprivation and other potential individual and contextual determinants. METHODS: In a cross-sectional longitudinal study, individual TB case variables were identified from three sources--routine surveillance, laboratory and hospital discharge records--from 1997 to 2007. Community variables were obtained at the census tract level. A deprivation index was calculated based on percentages of unemployment, low educational level and unskilled labour. Multilevel Poisson models were estimated for TB incidence rates for patients with and without HIV. RESULTS: A total of 490 TB cases were included. Sex and age at individual level and deprivation and residence in the port area at census tract level were associated both with HIV-related TB and with non-HIV-TB. Household crowding contextual variables were also associated with HIV-related TB incidence. Full models account for 78.9% and 51.7% reductions in second-level variance. CONCLUSION: Socio-economic deprivation is associated with higher rates of HIV-TB and non-HIV-TB. Diverse individual and contextual potential risk factors suggest different pathways of transmission. It is necessary to extend the framework for intervention beyond individual-based strategies to the socio-economic contexts in which people live.

[New technologies: support opportunities for network research]. / Nuevas tecnologías: posibilidades de apoyo a la investigación en red.

The consolidation of a support area for network research, which promotes collaborative research, training and the dissemination of knowledge through the use of ICTs, requires the organization of a work methodology to share and exchange resources in a specific network that is already running. The establishment of communication mechanisms between researchers from different groups will be necessary along with the introduction of the ICTs in the teaching and advanced environments of research training, different inventories of the research resources that are available for exchanges and shared use between groups and laboratories, and finally, a shared scientific documentation system with the appropriate maintenance of the previously listed tools. Large administrative structures and detailed plans are not needed to comply with all of the above functions. The availability of effective tools, however, to combine efforts and search for resources in all of these areas is needed, with the agility and flexibility that allow us to currently use new communication and information technologies. The results of this research support area should lead to an increase in the efficacy and quality of the network by increasing the flow of information and the inter-group collaboration in teaching, research and professional development, along with the transfer and dissemination of research results.

[Habits and lifestyles modifiable in children with overweight and obesity]. / Hábitos y estilos de vida modificables en niños con sobrepeso y obesidad.

INTRODUCTION: In the prevention for being overweight and for obesity, much attention is given to the influence of dietary factors, making the joint evaluation with other modifiable factors necessary. OBJECTIVES: The aim of this project is to study the association between modifiable factors (physical activity, sedentary lifestyle, and dietary habits) with the prevalence of being overweight or obese in the youth population. METHODS: Cross-Sectional study of 1283 school children between the ages of 3 and 16 years old, with measurements of the MBI, dietary habits, physical activity, sedentary lifestyle and family history of being overweight. Physical activity measured in MET was classified according to Pate criteria. RESULTS: 22.4% of the boys and 32.9% of the girls were overweight. The presence of a BMI>25 in parents multiplied by 2.4 the risk of being overweight in children (OR CI 95% 1.5-3.7). 63.6% of overweight boys meet physical activity recommendations compared with 52.2% of girls, although in their case, it was greater than the average (45%). Sedentary time was 141 minutes for men and 128 minutes for women, with more sedentary behaviors associated with being overweight, especially in girls over 12 years of age (66.7%). Consuming cereal (OR 0.8) and having five meals per day (OR 0.5) act as protective factors. CONCLUSIONS: In subjects with overweight, the levels of physical activity are close to those recommended levels, so which the values of a sedentary lifestyle together with dietary habits (if the parents have overweight) acquire a new relevance in intervention strategies of this problem.

Life-style factors associated with overweight and obesity among Spanish adults.

OBJECTIVES: To assess the relationship between life styles and eating habits with the overweight and obesity prevalence in a Spanish adult population. METHODS: A population-based, cross-sectional study conducted on 2640 subjects older than 15 years, in Cádiz (Spain). Surveys were conducted in subjects' homes to obtain life styles, eating habits, and anthropometric data. Logistic regression has been used to study the association between the life style variables and overweight and obesity. RESULTS: Prevalence of overweight and obesity in Cadiz is 37% and 17%, respectively; higher in males and increases with age. BMI has an inverse relationship with educational level (PR = 2.3, 1.57-2.38). The highest levels of obesity are associated with daily alcohol consumption (PR = 1.39, 1.29-1.50), greater consumption of television,and sedentary pursuit (PR 1.5, 1.07-1.24). A lower prevalence of obesity is observed among those with active physical activity (10.9% vs 21.6%), with differences between sex. Following a slimming diet is more frequent in the obese and in women but dedicate more hours than men to passive activities. In men is greater the consumption of alcohol, high energy foods and snacks. Overweight and obesity is associated with the male sex (OR = 3.35 2.75-4.07), high consumption of alcohol (OR = 1.38 1.03-1.86) and watching television (OR = 1.52 1.11-2.07), and foods likes bread and cereals (OR = 1.47 1.13-1.91). Exercise activities is a protective factor (OR = 0.76 0.63-0.98). CONCLUSIONS: Life styles factors associated with overweight and obesity present different patterns in men and women and is necessary to understand them to identify areas for behavioural intervention in overweight and obesity patients.

Characteristics of eating disorders in a university hospital-based Spanish population.

OBJECTIVE: To describe the personal and family antecedents and clinical characteristics of patients with eating disorders (EDs) in a population of the south of Spain; to analyse the influence of lifestyles, family functioning, socioeconomic status (SES), and psychological characteristics in these processes. DESIGN: A university-based case-control study. SETTING: University Hospital (Andalusia, Spain). SUBJECTS: A total of 120 patients with EDs and 240 controls. INTERVENTIONS: SCOFF, EDI, APGAR family, and SES questionnaires. RESULTS: In all, 67.5% of patients presented anorexia (AN), 15% bulimia (BN), and 17.5% mixed forms. EDs emerged at around 18-20 y (95% CI 17.9-19.8). Factors associated with EDs are psychiatric conditions (depression OR: 4.16, anxiety OR: 4.59), more frequent use of medication (OR: 2.26), dietary fibre (OR: 2.59), and laxatives (OR: 3.47). Toxics consumption, sport activity, SES, and family antecedents of pathology are not associated with EDs. An inverse relationship was found between family functioning and the scores in various subscales of the EDI. CONCLUSIONS: Eating disorders in Andalusia (Spain) are influenced significantly more by psychological, family, and cultural factors than by social factors.

Epidemiological study of the influence of family and socioeconomic status in disorders of eating behaviour.

OBJECTIVE: To analyse the differences in family functioning and socioeconomic status between subjects with disorders of eating behaviour and the healthy population, considering the possible relationship of these factors with the psychic characteristics of patients, with consumption of various substances, and with sexual practices. DESIGN: Case-control study. SETTING: 'Puerta del Mar' University Hospital (Andalusia, Spain). SUBJECTS: Conducted on a sample of 120 patients with AN and BN, and 240 controls with an identical distribution by age and sex. INTERVENTIONS: SCOFF, eating disorder inventory (EDI), Apgar family and socioeconomic questionnaires are utilised. RESULTS: Patients with disorders of eating behaviour present greater family dysfunctioning than controls; among cases, this difference is greater in the acute forms, but there are no differences between recent situations or crises due to previous episodes. Family dysfunction is associated with higher scores of multiple subscales of the EDI, which is corroborated on analysing each of the Apgar parameters independently. Family functioning is not associated with other variables such as breast-feeding or consumption of toxic substances. Socioeconomic status does not differentiate cases from controls, or acute situations from evolving ones, or new episodes from other crisis episodes, although differences may be found in the psychic manifestations according to social class. CONCLUSIONS: It is confirmed that family functioning has an influence in these types of disorder, in their evolution and in the psychic characteristics of the patients, without any evidence being found of a relationship between these disorders and socioeconomic status.

[Injury rate and incidence of accidents with biological risk among infirmary students]. / Accidentalidad e incidencia de accidentes biológicos de riesgo en estudiantes de enfermería.

BACKGROUND: A study of the incidence and characteristics of biological accidents among infirmary students during their practicals at the hospital. MATERIAL AND METHOD: A retrospective study carried out at five centres by means of two questionnaires, one on the duration of the training and the rate of accidents and the other on the characteristics, precautions and ports exposure behaviour. RESULTS: Out of 397 students, 70,5% had accidents at a rate of 64% (CI 95%, 59-68). Of these, 15% were accidents with biological risk, the majority being jabs (39%) and splashes (32,5%). It is worth note that 49,2% occurred while putting away the material and 58% in the absence of any individual protective measures. One out of 8 accidents implied a biological risk. CONCLUSIONS: A very high rate of accidents was observed with important deficiencies in security.

[Chronic complications in patients with type 2 diabetes mellitus cared for at a health center]. / Complicaciones crónicas en los pacientes con diabetes mellitus tipo 2 atendidos en un centro de salud.

OBJECTIVE: To know the chronic complications affecting a type-2 diabetic population in a health center, and to analyze the relationship between these complications and risk factors. DESIGN: Transversal study. SETTING: Puerto de Santa Maria-Norte Health Center, Cadiz, Spain. PATIENTS: Type-2 diabetic population (n = 504) included in the diabetes program of the center, aged over 12 years old, of both sexes. MEASUREMENTS AND MAIN RESULTS: The prevalence of type 2 diabetes recorded was 2.3%. Average age of the population was 63.9 years (SD 10.6), women representing 57.9% of total. Average length of evolution of the disease was 8.6 years (SD 11.4). 17.1% of patients were receiving insulin therapy, 65.4% were receiving oral antidiabetics, and 17.5% were on special diet. The most important risk factors found were: family history of diabetes (54.6%), obesity (51.2%), sedentary life style (41.1%), and hypertension (47.2%). Chronic complications affected 67.8% of the diabetic patients attending the center; predominant complications were peripheral vascular disease (31.7%), retinopathy (30.6%), ischemic heart disease (21.2%), cerebrovascular accident (10.7%), neuropathy (8.9%) and nephropathy (6.2%). The risk factors most associated with macrovascular complications were: length of evolution, smoking and age of diagnostic and hypertriglyceridemia. For the microvascular complications were: HbA1c, length of evolution and age. CONCLUSIONS: We found a significative prevalence of complications in spite of the average length of disease evolution time in the population not being very high. However the risk factors strongest associated with the existence of chronic complications are susceptible to be modified with a better metabolic control of the patients.

[Medical and psychosocial evaluation of a mentally retarded adult population]. / Evaluación médica y psicosocial de una población adulta con discapacidad intelectual.

BACKGROUND: This study is aimed at describing the psychological, psychopathological, medical and social aspects of a mentally retarded population being provided with care by AFANAS-Jerez affording the possibility of assessing this type of problem from an epidemiological standpoint. METHODS: A descriptive case series study is conducted to characterize a mentally retarded (MR) population. An assessment was made of the psychological, medical and social aspects. The degree of intelligence was analyzed using the Weschler Adult Intelligence Scale. The adaptive behavior, frequency, typology and seriousness of the behavior problems were assessed by means of the Service Planning and Individual Scheduling Inventory. A psychopathological screening examination was conducted. This study is rounded out with a social and medical evaluation by means of structured interviews. The information from the different areas was encoded and was analyzed using the EPIINFO v6.0 and C.I.A. programs. RESULTS: The average age of the mentally retarded population studied was 32.2 (S.D. 9.2 years). Seventy-three percent (73%) males as compared to 27% females. Behavior problems were found to exist among 45.1% of the subjects. We have set up a statistical relationship between the existence/non-existence of said problems and the degree of MR, such that the greater the loss of intellectual capacity, the greater the probability of having behavior problems. One of the psychopathological symptoms worthy of special mention is the anxiety found to exist among 60.2%. The medical examination reveals the large number of problems related to with MR, we thus finding 22.48% of the subjects to have epilepsy, nearly 20% Down's Syndrome, etc. Also worthy of special mention is the low educational level of the parents and the family conflicts resulting from the child's retardation. CONCLUSIONS: Special mention must be made of how MR is a highly complex whole entailing a large number of related medical, psychological, psychiatric and social disorders, this being a situation brought to fore in this study, many of the disorders revealed to exist being related to the degree of MR. We are of the opinion that an epidemiological approach to the study of MR may be of use for a better comprehension of this problem.

[Physical exercise and food habits: a study of adolescents in Cádiz]. / Ejercicio físico y hábitos alimentarios: un estudio en adolescentes de Cádiz.

BACKGROUND: A increased number of eating disorders among teen-agers are currently being reported. Physical exercise, especially when done individually, is one of the methods chosen for losing weight. We are basing this study on the hypothesis of a larger number of eating habit disorders (EHD's) in subjects who do physical exercise alone. This study describes and compares eating habits among teen-agers that do individual exercise as opposed to athletes who work out in groups or on teams. METHOD: Cross-section study of 532 teen-agers ages 14-18 who are enrolled in school and who do physical exercise, having been selected at random by means of a two-stage, stratified sampling process. The subjects were divided into two groups according whether they did individual physical exercise alone (Number: 216) or in groups (Number: 316). The eating habits of both groups were analyzed based on a questionnaire filled out by the subjects themselves. RESULTS: In the group preferring individual sports, females were predominant (degree of males 0.44). Of these females, their being on diets in order to lose weight was 3.12 times more frequent, compulsive eating episodes being 3.73 times more frequent. As regards behaviors which might be considered to be compensatory, there is a clear concentration thereof among those who do sports individually, hence 43% stated to voluntarily undergo periods of fasting (4.96 times more than those who exercise in groups), 46% stating to have brought on vomiting at one time or another for "dieting" purposes (3.76 more) and up to 26% have used laxatives with the intention of losing weight (2.56 times more than among athletes who play on teams). CONCLUSION: The existence of EHD's seems to be associated with teen-agers who play individual sports as opposed to those who play on teams.

[Hospital infections. Risky practices of nursing students]. / Infección hospitalaria. Prácticas de riesgo en estudiantes de Enfermería.

In this study the health habits performed by nursing students during their practices in hospitals are describe in the province of Cádiz, Spain and the relationship between these activities involving risk, and the level of knowledge of Public Health of these students. A total of 397 nursing students were studied, 43% male, with an average age of 21.6 years (SD 2.9); the average practice period per student was 73 days. Washing of hands before and after each intervention is performed by 97% of students, and gloves are used on all the sanitary occasions recommended by only 21%; the groups using masks least are those not vaccinated for influenza and not subjected to a Mantoux test (p < 0.05). The relationship between taking unnecessary risk in hospital practice and the low level of knowledge is positive (collective protection p < 0.05, use of gloves p < 0.05, among others).

[Anthropometric profile and prevalence of overweight in schoolchildren in Ubrique, Cádiz]. / Perfil antropométrico y prevalencia de sobrepeso de los escolares de Ubrique, Cádiz.

BACKGROUND: Adult overweight is an important risk factor for a range of chronic illnesses, and seems to be linked with overweight in childhood. The identification of children at risk of overweight could therefore be a suitable means of preventing these illnesses in adults. The aim of our study was to determine the anthropometric profile and prevalence of overweight in a population of schoolchildren in a rural town in Cadiz, which is also a major industrial centre. METHOD: A cross-sectional study was carried out, in which a representative sample of 493 schoolchildren of both sexes and aged from 4 to 14 years old was studied. They were measured for height, weight, arm circumference, triceps skinfold, and their IMC was calculated. The results were compared with a Spanish reference population. To measure obesity IMC > or = 25 kg/m2 was used. RESULTS: Height, weight, arm circumference, triceps skinfold and the IMC showed values that were slightly above those corresponding to the reference population, and there was a low incidence of overweight. These results are along the lines of studies published by the authors on the eating habits of this population.