The protective effect of calcium on bone mass in postmenopausal women with high selenium intake.

OBJECTIVE: Nutritional factors, especially the two essential nutrients calcium and vitamin D, have been shown to play an important role in bone health. We wanted to determine the possible protective effect of calcium intake in adequate amounts on bone mass as assessed by quantitative ultrasound in postmenopausal women who also have a high intake of selenium. SETTING: Health district of Cáceres, Spain. PARTICIPANTS AND STUDY DESIGN: 335 postmenopausal women aged 60.9 (SD = 8.1) years. Women were stratified based on the vitamin D, vitamin E, calcium intake and the calcium/protein and calcium/phosphorous index. MEASUREMENTS: Bone status (Ad-SoS measured at the phalanges) was assessed with an ultrasound device model DBM Sonic 1200R. Food intake was quantified using dietetic scales, measuring cups, and spoons based on 7 days of diet records. Urine samples were collected the morning of testing after an overnight fast. Venous blood samples for the hematological and biochemical studies were also obtained in the fasting state. RESULTS: In the group of women with Ca intake < 800 mg / d we found a significant and negative relationship between Ad-SoS with age (ß= -4.020, F = 23.327) and selenium intake (ß = -0.419, F = 10.067), as well as a positive relationship with Ca intake (ß= 0.104 and F = 7.084) (p <0.0001 in all). In the group of women with Ca intake > 800 mg / d, age has a significant and negative relationship (ß = -4.829 and F = 106.745), whereas folic acid intake has a significant and positive relationship (ß = 0.047 and F = 5.858) (p <0.0001 in both). CONCLUSION: Elevated selenium intake negatively affects bone mass measurements in postmenopausal women over the age of 51 but only if calcium intake is also less than 800 mg / day. When calcium intake is greater than 800 mg/day, selenium did not appear to affect bone mass.

[Incidence and prevalence of hip fractures in the province of Cáceres and their evolutionary trend]. / Incidencia y prevalencia de las fracturas de cadera en la provincia de Cáceres y su tendencia evolutiva.

OBJECTIVE: There are great variations in the yearly incidence and the evolution of hip fractures secondary to bone fragility and associated to minimum trauma in patients older than 50. Because of the lack of data about these fractures in the province of Cáceres, we carried out a study to know their incidence and prevalence, and their evolutionary trend. MATERIAL AND METHODS: One thousand five hundred seventy seven hip fractures in the years 1997 through 2000 (both included) are studied. The type of fracture is obtained through 820.00 to 829.00 corresponding codes. RESULTS: One thousand one hundred ninety nine occur in women and 378 in men, being the average presentation age 81 +/- 9 years and 74 +/- 18 years, respectively; both data were significantly lower in men (p < 0.0001). The incidence index by sex is 2.6 women/men/100,000 inhabitants/year. The percentage of fractures by sex do not vary, depending on the anatomical location. The higher number of fractures in both sexes is in the trochanter (p < 0.0001); in men is higher in the year 2000 than in 1997 (p < 0.0001); in women their incidence and prevalence is also higher in the year 2000 than in the previous years (p < 0.0001). In conclusion we can point out that the incidence of the hip fractures secondary to low-energy trauma in the province of Cáceres population is increasing in the last few years, and that this incidence is higher in women than men, although the percentage of the fracture type according to its anatomical location is the same in women and men.

Epidemiological changes in diagnosed coeliac disease in a population of Spanish children.

AIM: To investigate the incidence rate of diagnosed coeliac disease among the paediatric population in the province of Cáceres and the changes over the years. METHODS: The incidence rate of diagnosed coeliac disease between the years 1981 and 1999, age at diagnosis and clinical presentation form were investigated. The study was carried out over two periods: A (1981 to 1990) and B (1991 to 1999). RESULTS: The incidence rate for period A was 6.87/100,000 (CI 95%: 5.26-8.83) and for period B 16.04/100,000 (CI 95%: 12.99-19.59) (p < 0.0001). The relative risk of receiving a diagnosis of coeliac disease during the first four years of life was 2.31% (CI 95%:1.61-3.31) greater in period B than in period A. The mean age at diagnosis was 37.4 +/- 47.4 mo and 43.9 +/- 43.7 mo in A and B, respectively (p = 0.0058). The typical clinical pattern was the most frequent (83.6% in A and 58.3% in B). The mean age of introduction of gluten to the diet was 4.6 +/- 2.0 mo and 6.9 +/- 1.7 mo, for period A and B, respectively (p < 0.0001). CONCLUSION: The incidence rate of coeliac disease has increased during the two periods studied. In recent years, the relative risk of receiving a diagnosis of coeliac disease during the first four years of life has increased. The atypical clinical presentation has also increased, although the typical clinical form is still the most frequent in younger children.

[Implantable subcutaneous venous access. Management]. / Acceso venoso subcutáneo implantable. Manejo.

In this second article on subcutaneous venous access implants, the authors make an in depth presentation on how to handle these devices. The main topics which are covered include: nomenclature, indications, complications, how to set or implant this device and nursing treatment. Under the nursing treatment section, the authors explain care and maintenance, general regulations, what procedure to follow if one confronts an unusual resistance during an injection, fibrinolithic treatment, and the intraspinal system.

[Implantable subcutaneous venous access. 1. Reasons that justify its use]. / Acceso venosa subcutáneo implantable. 1. Razones que justifican su uso.

Chemotherapy treatment or the administering parenteral feeding requires permanent venous access during weeks, months or perhaps years. To have available an adequate venous access while treating gravely ill patients is fundamental in order to guarantee the perfusion of fluids blood transfusions administration of medicines, to supply intravenous feeding, to draw blood samples, etc. In this article, which will have a follow-up which concentrates on proper handling, the authors expose the reasons why subcutaneous venous access implants and used as well as how to deal with one of their main complications; extravasation. A bibliography will accompany the follow-up article.

[Cortical bone mass and risk factors for osteoporosis among postmenopausal women in our environment]. / Masa ósea cortical y factores de riesgo para osteoporosis en mujeres postmenopáusicas en nuestro medio.

OBJECTIVE: To evaluate the relevance of the so called risk factors for osteoporosis among women. MATERIALS AND METHODS: A total of 150 consecutive postmenopausal women who had been enrolled in the gynecology outpatient clinics of the Health Areas affiliated to the Alcalá de Henares University Hospital. Bone mass of these women was calculated as index of metacarpal cortical area/total area (CA/TA) (mm2), measured by radiogrammetry. RESULTS: With the ANOVA test, a late menarchial age and a shorter reproductive life induced a lower bone mass (p < 0.0005 and < 0.05, respectively); also, a history of bone fractures without previous relevant trauma (p < 0.05) was obtained. By correlational studies, there was a negative significance between CA/TA index and chronological age, menarchial age, menopausal age and number of fractures (r = -0.20 to -0.30; p < 0.05 to < 0.0001) and a positive significance with years of reproductive life (r = 0.17; p < 0.05). These values virtually remain unchanged when with partial correlation are weight adjusted, but with the multiple regression model, the CA/TA index is negatively significant only with menopause years (p < 0.005). Taking the average of the metacarpal CA/TA index as value, a sensitivity of 50% and an specificity of 78% were obtained to indicate fractures and a negative predictive value of 92%. CONCLUSION: These results indicate the greater importance of menarchial age, of reproductive life years and therefore of menopausal years, as determinants of postmenopausal bone mass and show a very acceptable specificity of the CA/TA index as predictive for bone fracture.

[Home oxygen therapy: nursing care]. / Oxigenoterapia domiciliaria: cuidados de enfermería.

The authors present a brief historical summary of the use of oxygen therapy in a patient's home from its start in 1970 to the present time, analyzing the controversies which have developed and the interest in oxygen therapy in a patient's home. For a review of the indications, initial evaluation, requirements and dose of this treatment, one should consult the article written by these authors published in Revista Rol de Enfermeria 2000; 23(4):257-261. In continuation, the authors explain the main nursing care which a patient receiving oxygen therapy at home requires, the circumstances which can compromise its efficiency, its secondary effects and complications, and the follow-up that is necessary to carry out on patients using this therapy.

[Indications and administration: home oxygen therapy]. / Indicaciones y administración. Oxigenoterapia domiciliaria.

At the present time, it has been clearly demonstrated that at home oxygen therapy either on a long term basis or on a continuous basis brings important benefits for a patient: his/her physical and neuro-psychological conditions improve and his/her quality of life increases. However, given that this is some controversy about its indications, therapeutic effects and manner to administrate it, the authors review all these aspects, drawing from very up-to-date bibliographical references. At a later date, in another article, these same authors will evaluate nursing treatment corresponding directly to at home oxygen therapy.

[A health study of older persons in Extremadura: drug taking and the most frequent chronic diseases]. / Estudio de salud de las personas mayores en Extremadura: consumo de fármacos y patologías crónicas más frecuentes.

BACKGROUND: To ascertain the use of drugs among the non-institutionalised elderly population, the factors related to polypharmacy and pinpointing the relationship thereof with chronic diseases. METHODS: Cross-sectional epidemiological study by means of door-to-door survey. The population systematically selected totalled 960 individuals age 65-93. The questionnaire included demographic data, self-assessed health condition, quantitative and qualitative aspects of the use of medications, chronic diseases and assessment of functional ability. RESULTS: 91.62% of those surveyed were taking medication, a greater number of females (p < 0.002) than males. The medications taken to the greatest extent were blood pressure drugs (42.4%), analgesics (38.7%) and heart drugs (24.8%). Drugs were used to a greater extent among the oldest age group (p < 0.0001), those having the lowest educational level (p < 0.001), those with impaired eyesight and hearing (p < 0001), those having the lowest social status (p < 001), more contacts with the health care services (p < 0001), worse self-assessed health condition (p < 0001), a greater number of chronic diseases (p < 0.0001) and depressive disorders (p = 0.004). The linear regression analysis revealed a positive relationship between the number of medications taken and the number of chronic diseases (r = 0.518; p < 0.0001). Females report worse health conditions (p < 0.05). The variables analyzed with regard to polypharmacy by means of logistic regression are age (over age 75; OR = 1.1478), three or more chronic diseases (OR = 1.83) and poor self-assessed health condition (OR = 1.22). CONCLUSIONS: Physical checkups on the elderly must include a review of the medications being taken, especially among those over age 75 who have a worse self-assessed health condition and a larger number of chronic diseases.

Evaluation of reagent strips for the rapid diagnosis of nitrite poisoning.

Two commercial urine test strips based on the Griess nitrite-specific diazonium salt reaction, having sulfanilamide and para-arsanilic acid as substrates, respectively, were studied as qualitative tests in the rapid diagnosis of nitrite/nitrate poisoning. Their usefulness was compared to other rapid tests, such as the sulfanilic acid-1 naphthylamin and diphenylamine blue tests. The practical sensitivity limit to nitrites in plasma and in water of both the reagent strips and SA-1NA test was 0.50 micrograms NO2/mL, while the diphenylamine test, which is not nitrite specific, showed a positive reaction to nitrites in plasma and in water above 50 micrograms NO2/mL and 5 micrograms NO2/mL, respectively. The in vitro assays were evaluated in vivo by the sublethal intoxication of a sheep with nitrite, demonstrating that commercial urine test strips may be useful for the rapid diagnosis of nitrite/nitrate poisoning.

An outbreak of lupinosis in sheep.

Lupinosis is a mycotoxicosis caused by the ingestion of toxins produced by the fungus phomopsis leptostromiformis which grows on lupin plants. An outbreak of natural lupinosis in lambs occurred in Caceres, Spain. Clinical signs were inappetence, depression, constipation, weakness and different degrees of jaundice. Blood samples were analysed every 7 d for 5 w for hematocrit, total protein, glucose, total bilirubin, and GOT, GPT and alkaline phosphatase activities. The last 4 parameters were increased and returned to normal values after 2-3 w. The liver was swollen and a bright yellow color; microscopically fatty metamorphosis, necrotic areas and infiltration of polymorphonuclears were observed. This is the first time that lupinosis is described in Spain.