Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes.

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

Photocatalytic inactivation of dual- and mono-species biofilms by immobilized TiO2.

Biofilms formed by different bacterial species are likely to play key roles in photocatalytic resistance. This study aims to evaluate the efficacy of a photocatalytic immobilized nanotube system (TiO2-NT) (IS) and suspended nanoparticles (TiO2-NP) (SS) against mono- and dual-species biofilms developed by Gram-negative and Gram-positive strains. Two main factors were corroborated to significantly affect the biofilm resistance during photocatalytic inactivation, i.e., the biofilm-growth conditions and biofilm-forming surfaces. Gram-positive bacteria showed great photosensitivity when forming dual-species biofilms in comparison with the Gram-positive bacteria in single communities. When grown onto TiO2-NT (IS) surfaces for immobilized photocatalytic systems, mono- and dual-species biofilms did not exhibit differences in photocatalytic inactivation according to kinetic constant values (p > 0.05) but led to a reduction of ca. 3-4 log10. However, TiO2-NT (IS) surfaces did affect biofilm colonization as the growth of mono-species biofilms of Gram-negative and Gram-positive bacteria is significantly (p ≤ 0.05) favored compared to co-culturing; although, the photocatalytic inactivation rate did not show initial bacterial concentration dependence. The biofilm growth surface (which depends on the photocatalytic configuration) also favored resistance of mono-species biofilms of Gram-positive bacteria compared to that of Gram-negative in immobilized photocatalytic systems, but opposite behavior was confirmed with suspended TiO2 (p ≤ 0.05). Successful efficacy of immobilized TiO2 for inactivation of mono- and dual-species biofilms was accomplished, making it feasible to transfer this technology into real scenarios in water treatment and food processing.

Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care.

The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. PURPOSE: To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. METHODS: A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. RESULTS: Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. CONCLUSIONS: The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

Diseño y validación de una herramienta observacional para el bádminton (BOT) / Design and validity of a badminton observation tool (BOT)

La metodología observacional permite analizar deportes en contexto y dinámicas habituales. El objetivo principal fue la construcción y validación de una herramienta observacional ad hoc para analizar el bádminton individual, que incluye la trayectoria de los desplazamientos como variable no analizada anteriormente. Constituida por 13 criterios y 47 categorías mutuamente excluyentes, fueron analizadas 287 acciones del Campeonato de Mundo de Bádminton 2015. Para la validación se utilizó el coeficiente Kappa de Cohen y la teoría de la generalizabilidad. Se han obtenido resultados, tanto para la herramienta como para cada uno de los criterios de forma individual, superiores a 0,98 estando por encima de 0,81 que propone la literatura como "casi perfecto". El análisis de la generalizabilidad se realizó mediante un modelo de dos facetas (Categoría/Observador = C/O) y reveló que la fiabilidad era excelente (1,00). La herramienta diseñada es válida y fiable para el análisis de las conductas del bádminton individual

Observational methodology allows analysing sports' specific behaviour context. The main purpose of this manuscript was to develop and validate an ad hoc observational tool for badminton singles games, which includes lunges trajectories as a non-analysed variable till this study. For that reason, the observational tool consists of 13 criteria and 47 categories mutually exclusive. 287actions of the 2015 Badminton World Championship were analysed. With the aim to assess the tool's validity Cohen's Kappa and generalizability theory were used. The outcomes for complete observational tool and for each criterion exceed 0.98, being above 0.81 proposed by literature as "almost perfect". Generalizability analysis was done by two sides model (Category/Observer = C/O) and showed an excellent reliability (1.00). It could be said that it is a reliable tool designed for recording and analyzing the behaviour of badminton singles players

Photoelectrocatalytic study and scaling up of titanium dioxide electrodes for wastewater treatment.

Different TiO2 photoelectrodes have been characterized and tested for the photoelectrocatalytic oxidation of methanol. Particulate electrodes (TiO2/Ti and TiO2/ITO) have been shown to notably favour charge-carrier transfer at the electrolyte interface while a thermal electrode (Ti) has been shown to favour charge-carrier separation when applying an electric potential bias according to cyclic voltammetry technique, as a consequence of differences in TiO2 surface between particulate and thermal electrodes. Particulate electrodes lead to a higher photoelectrocatalytic activity for methanol oxidation compared to that of the thermal electrode, probably due to the pure-rutile TiO2 phase composition of the latter and its lower surface area. TiO2/Ti electrode has been shown to be the most effective photoelectrode tested for methanol oxidation since its activity was improved by the combination of the particulate TiO2 layer and the high electrical conductivity of the support. Generally, photocurrent density measured in the photoelectrochemical cell seems to correlate with activity, whereas this correlation is not observed when using a larger photoelectrocatalytic reactor. In contrast, the activity obtained for the scaled-up electrode is found to be similar in terms of surface kinetic constant to that obtained at laboratory scale.

Cluster-tic syndrome as the initial manifestation of multiple sclerosis.

We report the case of a patient diagnosed as having cluster-tic syndrome as the initial manifestation of multiple sclerosis (MS). The patient's headache bouts improved after treatment with antiepileptic drugs, steroids, and beta-interferon. Magnetic resonance imaging (MRI) scans showed a pontine demyelinating lesion involving the area of the trigeminal root inlet and main sensory nucleus. Neurophysiological studies correlated well with MRI lesions. The association between cluster-tic syndrome and MS is an exception, and the mechanism of the pain is still unknown; therefore, this case might suggest a pathophysiological relationship between the trigeminal main sensory nucleus and cluster-tic syndrome.

Prevalencia de alteraciones de la conducta alimentaria, trastornos gastrointestinales e infecciones recurrentes en niños afectos de Trastornos del Espectro Autista (TEA) en comparación con sus hermanos sanos / Prevalence of feeding disorders, gastrointestinal disorders and recurrent infections in children with Autism Spectrum Disorders (ASD) compared with their healthy siblings

Introducción: Los Trastornos del Espectro Autista (TEA) están constituidos por un grupo heterogéneo de procesos neurobiológicamente diversos, que se caracterizan por la existencia de déficit en múltiples áreas funcionales. Una de las áreas de interés creciente es la relacionada con la alimentación. La causa de las alteraciones en el desarrollo del área alimentaria del niño autista no está clara y de momento no existe acuerdo para definir el carácter primario o secundario de estas alteraciones. Objetivo: Analizar los hábitos alimentarios, antecedentes de trastornos intestinales, alergias e infecciones recurrentes en una población de niños y adolescentes con TEA. Sujetos y métodos: Estudio de diseño transversal y retrospectivo de casos y controles. La muestra está compuesta por 138 sujetos: 84 niños y adolescentes afectos de TGD según criterios del DSM-IV y 54 controles escogidos entre los hermanos de los anteriores. Se diseñó un cuestionario específico para este estudio que fue cumplimentado por los padres. Resultados: Al comparar los hábitos alimentarios de los niños autistas con los controles, vemos que los niños autistas presentan más dificultades en la incorporación de alimentos sólidos, de absorber con pajita, retraso evolutivo para beber en vaso, incorporación de alimentos nuevos, dificultades en la masticación, mayores rechazos alimentarios y conductas de pica. Las diferencias en infecciones recurrentes o trastornos gastrointestinales no fueron estadísticamente significativas. Conclusión: Los niños y adolescentes afectos de trastorno autista presentan más alteraciones en el desarrollo del área alimentaria que sus hermanos sanos. Las alteraciones encontradas no se corresponden con una mayor frecuencia de trastornos gastrointestinales ni alergias

Introduction: Autism Spectrum Disorders (ASD) are a heterogeneous group of different neurobiological processes, which are characterized by the existence of deficits in multiple functional areas. One area of growing concern is that related to the diet. The cause of the alterations in the development of the feeding area in autistic children is unclear, and there is currently no agreement to define the primary or secondary nature of these alterations. Aim: To analyze feeding habits, history of intestinal disorders, allergies and recurrent infections in a population of children and adolescents with ASD. Subjects and methods: A cross-sectional design and retrospective case-control study was made. The sample comprised 138 subjects: 84 children and adolescents suffering from ASD (DSM-IV criteria) and 54 controls (brothers of the sample subjects). A questionnaire was designed specifically for this study that was completed by parents. Results: When comparing the feeding habits of children with autism and controls, we see that autistic children have more difficulties in: incorporating solid foods, absorb with straw, developmental delay to drink from a cup, incorporating new foods, difficulties chewing food, more rejections and pica behavior. Differences in recurrent infections or gastrointestinal disorders were not statistically significant. Conclusion: Children and adolescents suffering from autistic disorders have more alterations in the development of the feeding area that their siblings. These alterations do not correspond to a higher frequency of gastrointestinal disorders and allergies

[Impact of clinical practice guides on the cost of caring for community acquired pneumonia]. / Impacto de las guías de práctica clínica sobre el coste del control de la neumonía extrahospitalaria.

PURPOSE: to compare the economic cost of the diagnostic and therapeutic process of the community-acquired pneumonia (CAP) in primary care in two periods (1999 and 2004-05). During the second period they were adapted to the recommendations of three clinical practice guidelines (CPG) on diagnosis and treatment of the pneumonia. PATIENTS AND METHODS: There were 57 episodes of CAP in 1999 and 95 in 2004-05. The cost per episode in each period is estimated. RESULTS: The total cost of the diagnostic and therapeutic process in dropped in 2004-05 compared to 1999: 46.59 euros compared to 71.66 euros (p < 0.05). Six children were referred to the hospital in 1999 compared to 13 in 2004-05, there were no significant differences. CONCLUSIONS: Adherence to the recommendations of the GPC produced a decrease in the cost of the diagnostic and therapeutic process of CAP without involving a decrease in rate of resolution of the disease.

Impacto de las guías de práctica clínica sobre el coste del control de la neumonía extrahospitalaria / Impact of clinical practice guides on the cost of caring for community acquired pneumonia

Introducción: Se comparó el coste económico del proceso diagnóstico-terapéutico de la neumonía adquirida en la comunidad (NAC) en atención primaria en dos períodos (1999 y 2004-2005). Durante el segundo período se adaptaron las recomendaciones de tres guías de práctica clínica (GPC) sobre el diagnóstico y el tratamiento de la NAC. Pacientes y métodos: Se contabilizaron 57 episodios de NAC en 1999 y 95 en 2004-2005. Se estimó el coste por episodio en cada período. Resultados: Se redujo el coste total del proceso diagnóstico-terapéutico en 2004-2005 respecto a 1999: 46,59 euros frente a 71,66 euros (p < 0,05). Seis niños fueron derivados al hospital en 1999 frente a 13 en 2004-2005, sin que existiesen diferencias significativas. Conclusiones: El cumplimiento de las recomendaciones de las GPC produjo una disminución del coste del proceso diagnóstico-terapéutico de la NAC sin que ello implicara un empeoramiento del porcentaje de resolución de la enfermedad

Introduction: Purpose: to compare the economic cost of the diagnostic and therapeutic process of the community-acquired pneumonia (CAP) in primary care in two periods (1999 and 2004-05). During the second period they were adapted to the recommendations of three clinical practice guidelines (CPG) on diagnosis and treatment of the pneumonia. Patients and methods: There were 57 episodes of CAP in 1999 and 95 in 2004-05. The cost per episode in each period is estimated. Results: The total cost of the diagnostic and therapeutic process in dropped in 2004-05 compared to 1999: 46.59 euros compared to 71.66 euros (p < 0.05). Six children were referred to the hospital in 1999 compared to 13 in 2004-05, there were no significant differences. Conclusions: Adherence to the recommendations of the GPC produced a decrease in the cost of the diagnostic and therapeutic process of CAP without involving a decrease in rate of resolution of the disease

Prevalencia de asma por diagnóstico médico en un centro de Atención Primaria y factores pronósticos de la utilización de los servicios de urgencia hospitalarios / No disponible

Objetivo: determinar la prevalencia acumulada de asma y asma activo en nuestro medio mediante diagnóstico médico y construir un índice predictivo de utilización de los servicios hospitalarios por crisis aguda de asma. Material y métodos: estudio transversal efectuado en un centro de Atención Primaria que atiende a 2.300 niños menores de 15 años. Se determinó la prevalencia acumulada de asma. Los niños que presentaron síntomas en los 12 meses previos se consideraron como asma activo. Mediante análisis de regresión logística se construyó un modelo predictivo de utilización de los servicios hospitalarios. Resultados: fueron diagnosticados de asma 195 niños (8,5%; intervalo de confianza del 95% [IC 95%]: 7,4-9,7%), cifra que corresponde a la prevalencia acumulada. Presentaron asma activo 91 (46,7%; IC 95%: 39,5-53,9%). Consultaron en urgencias del hospital de referencia 48 (24,6%; IC 95%: 18,7-31,3%). Doce (6,2%; IC 95%: 3,2-10,5%) fueron ingresados. En el análisis multivariante, la edad (odds ratio [OR]: 0,85 [IC 95%]: 0,74-0,99), el asma activo (OR: 5,7 [IC 95%]: 1,5-21,6) y el nivel de gravedad (OR: 3,6 (IC 95%: 1,3-10,6) mostraron asociación significativa con la utilización de servicios hospitalarios. Conclusiones: la prevalencia de asma en nuestro medio está situada en un rango intermedio en comparación a otros estudios. El asma activo está fuertemente asociado a un mayor uso de servicios hospitalarios, por lo que es necesario reconsiderar el tratamiento de este subgrupo de pacientes. Es necesario la realización de un gran estudio multicéntrico, emplazado en Atención Primaria, que permita elaborar un modelo predictivo de utilización de los servicios hospitalarios en España

Objective: to asses the cumulative prevalence of asthma and of active asthma in our setting using the clinical diagnosis, and to build a predictive index of utilization of hospital services by acute crisis of asthma. Material and methods: cross sectional study in a Primary Care setting attending 2,300 children less than 15 years of age. Cumulative prevalence of asthma was measured. Children presenting with symptoms in the previous 12 months were considered as having active asthma. A predictive model of utilization of hospital services was build using logistic regression analysis. Results: 195 children were diagnosed of asthma (8.5%; 95% confidence interval [95% CI]: 7.4-9.7%), figure that corresponds to the cumulative prevalence. Ninety one presented active asthma (46.7%; CI 95%: 39.5-53.9%). Forty eight visited the emergency department of the reference hospital (24.6%; CI 95%: 18.7-31.3%). Twelve (6.2%; CI 95%: 3.2-10.5%) were admitted. In the multivariate analysis, age (odds ratio [OR]: 0.85 [CI 95%]: 0.74-0.99), active asthma (OR: 5.7 [CI 95%]: 1.5-21.6) and level of severity (OR: 3.6 (CI 95%: 1.3-10.6) were significantly associated to utilization of hospital services. Conclusions: the asthma prevalence in our setting is situated in an intermediate range compared to other studies. The active asthma is strongly associated to a higher use of hospital services, so it is necessary to reconsider the treatment in this subgroup of patients. It is necessary to implement a big multicentric study, in Primary Care, in order to build a predictive model of utilization of the hospital services in Sp

[The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation]. / Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica.

INTRODUCTION: Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. PATIENTS AND METHODS: In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. RESULTS: The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. CONCLUSIONS: The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches.

Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica / The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation

Introducción. El estudio neurofisiológico (ENF) como técnica de elección para el diagnóstico del síndrome del túnel carpiano (STC) ha demostrado repetidamente su utilidad y eficacia. Más recientemente se han incorporado técnicas de imagen como la ecografía (ECO), que aporta valiosos datos en cuanto a la morfología normal del nervio mediano en el canal carpiano y sus cambios patológicos. Nuestro objetivo ha sido comparar los resultados de ambos estudios, ENF y ECO, en un número reducido de pacientes de nuestra casuística con el fin de comprobar su diferente utilidad en el diagnóstico del síndrome. Pacientes y métodos. 60 pacientes diagnosticados de STC, en los que se estudió la conducción nerviosa de ambos nervios medianos y cubital mediante electrodos de superficie, así como estudio ecográfico de ambas muñecas mediante transductores lineales 5-10 Hz y 5-12,5 MHz. Resultados. Según el grado de afectación se utilizaron escalas de gravedad para ambas pruebas y los resultados se compararon estadísticamente mediante análisis de regresión, test de Pearson y test t pareado, que demostraron una ausencia de correlación entre ambas pruebas. Conclusión. La falta de correlación evidenciada entre ambas pruebas en los diferentes estudios estadísticos utilizados indica que ambas son herramientas útiles en el diagnóstico de STC. Los datos neurofisiológicos aportan información acerca de la funcionalidad del nervio y la ECO, por su parte, informa de sus alteraciones morfológicas en condiciones patológicas y las posibles lesiones o variantes anatómicas causantes del síndrome, por lo que consideramos que ambas pruebas no son excluyentes, sino complementarias

Introduction. Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. Patients and methods. In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. Results. The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. Conclusions. The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches

Trigeminal somatosensory evoked potentials in multiple sclerosis: a case report.

Somatosensory evoked potentials elicited by trigeminal nerve stimulation (TSEPs) allow the study of the trigeminal system, its peripheral to its central portion. As a routine clinical testing procedure, however, this method has not yet received greater attention and still has to wait to become a part of the diagnostic workup in multiple sclerosis (MS). A patient diagnosed as MS was presented with selective involvement of the left trigeminal nerve. Neurophysiologically, the most prominent and persistent abnormalities were found in the TSEPs. The presumed diagnosis of MS was subsequently confirmed by MRI showing evidence of demyelinating disease. There has been a scarcity of references on TSEP. Our study emphasizes its usefulness and a plea is being made for the inclusion of TSEP in protocols for the diagnostic workup in patients with MS.

[Recurrent community acquired pneumonia in young children: risk factor for the development of childhood asthma?]. / Neumonía recurrente adquirida en la comunidad en la edad pediátrica. Factor de riesgo para el desarrollo de asma infantil?

OBJECTIVE: To determine if recurrent community acquired pneumonia (RP) is a risk factor for developing childhood asthma (CA), compared with those children who only suffer one episode of pneumonia or non-recurrent pneumonia (NRP). To determine if patients with CA are more disposed to suffer RP. DESIGN: Historical cohort study. SETTING: Primary care. PARTICIPANTS: A total of 80 episodes of pneumonia identified in 65 infants between the 1st of February 1996 and 30th June 1999. PRINCIPAL MEASUREMENTS: The relative risk (RR) and confidence interval (95% CI) of childhood asthma in the presence of recurrent pneumonia as compared to non-recurrent pneumonia, and the RR of recurrent pneumonia in the presence of childhood asthma. RESULTS: Of the 65 children included, 18 had RP (27.7%; 95% CI, 16.8-38.6). The prevalence of CA was 49.2% (32 children) (95% CI, 37.1-61.4). The diagnosis of CA at any time was higher in children with RP (RR=4.1; 95% CI, 1.9-8.9). There were no differences between the incidence of RP and NRP in children previously diagnosed with CA (RR=1.28; 95% CI, 0.5-3.0). CONCLUSIONS: A special follow-up needs to be carried out on all children diagnosed with RP in primary care, since the possibility of presenting with CA is higher in these cases.

Neumonía recurrente adquirida en la comunidad en la edad pediátrica. ¿Factor de riesgo para el desarrollo de asma infantil? / Recurrent pneumonia acquired in the community at paediatric age. Factor of risk for development of childhood asthma?

Objetivo. Determinar si la neumonía recurrente adquirida en la comunidad (NR) constituye un factor de riesgo para desarrollar asma infantil (AI), comparado con los niños que padecen un sólo un episodio de neumonía o neumonía no recurrente (NNR). Determinar si los pacientes con AI están más predispuestos a padecer NR. Diseño. Estudio de cohortes históricas. Emplazamiento. Atención primaria. Participantes. Un total de 80 episodios de neumonía identificados en 65 niños entre el 1 de enero de 1996 y el 30 de junio de 1999. Mediciones principales. Riesgo relativo (RR) y su intervalo de confianza (IC del 95%) de asma infantil en presencia de neumonía recurrente frente a neumonía no recurrente, y RR de neumonía recurrente en presencia de asma infantil. Resultados. De 65 niños incluidos, 18 niños presentaron NR (27,7%; IC del 95%, 16,8-38,6). La prevalencia de AI fue del 49,2% (32 niños) (IC del 95%, 37,1-61,4). El diagnóstico en algún momento de AI fue superior en niños con NR (RR = 4,1; IC del 95%, 1,9-8,9). No hubo diferencias entre la incidencia de NR y NNR en niños previamente diagnosticados de AI (RR = 1,28; IC del 95%, 0,5-3). Conclusiones. Es necesario realizar un seguimiento especial a todo niño diagnosticado de NR en atención primaria, ya que las posibilidades de presentar AI en el futuro son mayores en estos casos

Objective. To determine if recurrent community acquired pneumonia (RP) is a risk factor for developing childhood asthma (CA), compared with those children who only suffer one episode of pneumonia or non-recurrent pneumonia (NRP). To determine if patients with CA are more disposed to suffer RP. Design. Historical cohort study. Setting. Primary care. Participants. A total of 80 episodes of pneumonia identified in 65 infants between the 1st of February 1996 and 30th June 1999. Principal measurements. The relative risk (RR) and confidence interval (95% CI) of childhood asthma in the presence of recurrent pneumonia as compared to non-recurrent pneumonia, and the RR of recurrent pneumonia in the presence of childhood asthma. Results. Of the 65 children included, 18 had RP (27.7%; 95% CI, 16.8-38.6). The prevalence of CA was 49.2% (32 children) (95% CI, 37.1-61.4). The diagnosis of CA at any time was higher in children with RP (RR=4.1; 95% CI, 1.9-8.9). There were no differences between the incidence of RP and NRP in children previously diagnosed with CA (RR=1.28; 95% CI, 0.5-3.0). Conclusions. A special follow-up needs to be carried out on all children diagnosed with RP in primary care, since the possibility of presenting with CA is higher in these cases

Estudio descriptivo de los usuarios que acuden sin concertar cita a las consultas de Atención Primaria / Descriptive study of patients attending Primary Care settings without previous appointment

Introducción y objetivos: 1. Determinar la prevalencia de las consultas sin cita ¿consultasfuera de agenda (CFA)? en nuestro medio. 2. Determinar el porcentaje de justificaciónde dichas consultas y los factores asociados a un motivo de consulta injustificado.Material y métodos: estudio descriptivo transversal realizado en dos consultas de pediatríade un centro de salud.Participantes: 392 niños de 0-15 años que acudieron sin cita, recogidos mediantemuestreo consecutivo entre el 7 de marzo y el 15 de septiembre de 2003. Mediciones principales:prevalencia de CFA, porcentaje de CFA injustificadas, factores que se asocian a dichainjustificación. Estadística: t de Student-Fisher, prueba de X2, regresión logística con estimaciónde Odds Ratio (OR) y sus IC 95% (IC 95%).Resultados: prevalencia de CFA: 23% (IC 95%: 21%-25%). El 52,8% de los niños eranmenores de cinco años. El 73% (IC 95%: 68,6%-77,4%) de las consultas se consideraronsubjetivas. La subjetividad se asoció al sexo femenino (OR: 1,62; IC 95%: 1,02-2,56) y auna edad inferior a 5 años (OR: 1,9; IC 95%: 1,2-2,9).Conclusiones: la prevalencia de CFA es superior a la constatada por otros autores. Factorestales como la corta edad de la mayoría de los pacientes atendidos y la excelente accesibilidadgeográfico-horaria de nuestro centro pueden contribuir a explicar este hecho

Introduction and objectives: 1. To establish the prevalence of patients’ visits withoutappointment –out of agenda visits (OAV)– in our settings. 2. To establish the rate of not justificationof these visits and the circumstances associated to a not justified visit. Material and methods: transverse descriptive study undertaken in two pediatric settingsof a Primary Care Centre.Participants: 392 children 0-15 years of age arriving without advanced appointment.They were collected through consecutive sampling between March 7th and September 15th2003. Main measurements: Prevalence of OAV; percentage of not justifiable OAV; circumstancesassociated. Statistics: Student-Fisher t test, X2 test, logistic regression with Odds Ratio(OR) estimation and their 95% IC.Results: OAV prevalence: 23% (95% IC: 21%-25%). 52,8% of children were under 5years. 73% (95% IC: 68,6%-77,4%) of visits were considered as subjective. Subjectivitywas associated to females (OR: 1,62; 95% IC: 1,02-2,56) and to children under 5 years(OR: 1,9; 95% IC: 1,2-2,9).Conclusions: our prevalence of AOV is higher than published by others. Circumstancessuch as the short age of most of the visited children and the excellent geographic and agendaaccessibility of our Center may contribute to explain this fact

[Antibiotic use in primary care. Do we know what parents think?]. / Utilización adecuada de antibióticos en atención primaria: sabemos qué piensan los padres?

INTRODUCTION: In Spain, studies that investigate parents' beliefs on antibiotic use are lacking. Mistaken beliefs lead to inappropriate antibiotic use and encourage overuse. The aim of the present study was to determine parents' knowledge about antibiotic use. MATERIAL AND METHODS: We performed a cross sectional, descriptive study in two health centers through a self-administered questionnaire completed by 348 parents. The response variable consisted of beliefs evaluated when the parents answered the following three statements in the affirmative: a) there are currently some infections with inadequate response to antibiotic treatment; b) if antibiotics are used too often, they can cease to have an effect; c) if your child frequently receives antibiotic treatment, subsequent use may have no effect. Independent variables consisted of sex of the responder, educational level, parental age and ethnicity, attendance at school (public or private), attendance at kindergarten, usual healthcare (public-private), and number of siblings. Statistical analysis consisted of logistic regression. RESULTS: A total of 31.6 % (95 % CI: 26.7-36.5) responded affirmatively to the three statements. Adequate knowledge was associated with the non-immigrant population (OR: 5.7; 95 % CI: 1.37-24.9) and high parental education (OR: 2.04; 95 % CI: 1.16-3.06). CONCLUSIONS: Parents' knowledge of antibiotic use is low compared with that in other countries. Health education programs to remedy this situation are urgently required.

Utilización adecuada de antibióticos en atención primaria: ¿sabemos qué piensan los padres? / Antibiotic use in primary care. Do we know what parents think?

Introducción: En España no existen estudios que investiguen las creencias de los padres sobre el uso de antibióticos. Las creencias erróneas determinan el uso inadecuado de antimicrobianos, propiciando su sobreutilización. El objetivo del presente estudio es determinar el nivel de conocimientos de los padres sobre la utilización de los antibióticos. Material y métodos: Estudio descriptivo transversal realizado en dos centros de salud (encuesta autocumplimentada por 348 padres).Creencias valoradas cuando los padres contestaron afirmativamente a tres frases (variable de respuesta): a) actualmente existen algunas infecciones que no responden adecuadamente al tratamiento con antibióticos; b) si los antibióticos se utilizan con demasiada frecuencia, es posible que dejen de hacer efecto; c) si tu hijo recibe con frecuencia tratamiento con antibióticos, es posible que cuando los vuelva a necesitar no le hagan efecto. Variables independientes: sexo de la persona que respondió la encuesta, nivel de estudios, edad y etnia de los padres, asistencia a colegio (público o privado), asistencia a guardería, asistencia médica habitual (pública-privada), número de hermanos. Como prueba estadística se aplicó la regresión logística. Resultados: El 31,6 por ciento (intervalo de confianza del 95 por ciento [IC 95 por ciento], 26,7-36,5) respondió de forma afirmativa a las tres frases. Un nivel adecuado de creencias se asoció con población no inmigrante (odds ratio [OR], 5,7; IC 95 por ciento, 1,37-24,9) y nivel elevado de estudios de los padres (OR, 2,04; IC 95 por ciento, 1,16-3,06). Conclusiones: El nivel de conocimientos es bajo comparado con otros países. Urge la puesta en marcha de programas de educación sanitaria que corrijan esta situación (AU)

[Usefulness of physical examination at a primary health centre to diagnose infant pneumonia caught in the community]. / Utilidad de la exploración física para el diagnóstico de neumonía infantil adquirida en la comunidad en un centro de atención primaria.

OBJECTIVE: To determine the diagnostic usefulness of three clinical signs (temperature, cough, crepitant stertor) for diagnosing pneumonia in children. To evaluate the agreement of two radiologists in evaluating thoracic x-rays (TXR). DESIGN: Study of diagnostic tests. SETTING: Primary care. PARTICIPANTS: 350 clinical histories of children who had an urgent TXR to diagnosis pneumonia between 1st January 1996 and 30th June 1999. MAIN MEASUREMENTS: a) Prevalence of pneumonia in the entire sample and two age-based sub-groups: aged 5 years and under, and over 5; b) positive probability quotients (PQ+) and negative ones (PQ-) and 95% confidence intervals (95% CI). The TXR was seen as the reference standard, and c) kappa index (kappa) for inter-radiologist concordance. RESULTS: Prevalence: the entire sample, 22.9% (95% CI, 18.5-27.3); children aged 5 or less, 20.4% (95% CI, 15.6-25.2); aged over 5, 31.3% (95% CI, 21.1-41.4). The signs studied were only of any use in confirming the diagnosis in children over 5: PQ+ was 3.52 (1.28-9.69). Radiologists coincided in their diagnosis in 93.1% of the TXR (kappa=0.8; 95% CI, 0.77-0.83). CONCLUSIONS: This study did not prove that there was a sub-grouping of clinical signs which confirmed unmistakably the diagnosis of pneumonia in children.

Utilidad de la exploración física para el diagnóstico de neumonía infantil adquirida en la comunidad en un centro de atención primaria / Usefulness of physical examination at a primary health centre to diagnose infant pneumonia caught in the community

Objetivo. Determinar la utilidad diagnóstica de tres signos clínicos (fiebre, tos, estertores crepitantes) para el diagnóstico de neumonía en niños; evaluar la concordancia en la interpretación de la radiografía de tórax por dos radiólogos. Diseño. Estudio de pruebas diagnósticas. Emplazamiento. Atención primaria. Material. Trescientas cincuenta historias clínicas de niños a los que se practicó una radiografía de tórax urgente para diagnosticar neumonía entre el 1 de enero de 1996 y el 30 de junio de 1999.Mediciones principales. a) Prevalencia de neumonía en toda la muestra y en dos subgrupos de edad: igual o inferior a 5 años y superior a 5 años; b) cocientes de probabilidad positivo y negativo e intervalos de confianza del 95 por ciento (IC del 95 por ciento). Se consideró la radiografía de tórax como estándar de referencia, y c) concordancia interradiólogos-índice kappa (K).Resultados. La prevalencia de neumonía en toda la muestra fue del 22,9 por ciento (IC del 95 por ciento, 18,5-27,3); en los niños de 5 años de edad o menores fue del 20,4 por ciento (IC del 95 por ciento, 15,625,2), y en los mayores de 5 años, del 31,3 por ciento (IC del 95 por ciento, 21,1-41,4). Los signos estudiados sólo tuvieron alguna utilidad para confirmar el diagnóstico en mayores de 5 años: el cociente de probabilidad positivo fue de 3,52 (IC del 95 por ciento, 1,28-9,69) y los radiólogos coincidieron en el diagnóstico en el 93,1 por ciento de las radiografías de tórax ( k = 0,8; IC del 95 por ciento, 0,77-0,83). Conclusiones. En este estudio no se constató la presencia de un subconjunto de signos clínicos que aseguren de forma inequívoca el diagnóstico de neumonía en niños (AU)