Spatio-temporal analysis of infra-specific genetic variations among a Pseudomonas aeruginosa water network hospital population: invasion and selection of clonal complexes.

AIMS: To investigate infra-specific spatio-temporal dynamics of a hospital water network Pseudomonas aeruginosa population. To infer the origin of water network isolates and assess their potential health hazard. METHODS AND RESULTS: 168 P. aeruginosa strains were isolated from tap waters and swabs of tap nozzle aerators of a hospital unit, over 2 years, and from rectal swabs and nosocomial infections. Genetic diversity among this collection was assessed by pulsed field gel electrophoresis of SpeI restricted genomic DNA. Virulence gene sets, biofilm properties, and hypochlorite resistance were analysed. Exactly 68% of the water samples and 74% of the tap nozzle aerators harboured P. aeruginosa. The strains were divided into 22 clonal lineages, with one dominant clone shown to have been involved in a nosocomial infection. CONCLUSIONS: An important turnover among the P. aeruginosa hospital population was observed. Some clonal lineages were found to persist, spread in the unit, and diversify into clonal complexes. Rectal carriage appeared an important source of contamination of the water network. SIGNIFICANCE AND IMPACT OF THE STUDY: High P. aeruginosa infra-specific population diversity suggested a broad ability in colonizing water networks but persistence analysis indicated a strong selection leading to the emergence of dominant clones.

Validez del consumo declarado de tabaco en el embarazo / Validity of pregnant women´s stated tobacco consumption

Objetivos. Analizarla relación entre el consumo de tabaco declarado por las embarazadas que declaran fumar antes de la gestación y los niveles de cotinina en orina al inicio y al final de la gestación. Diseño. Estudio observacional, longitudinal. Participantes. Grupo de estudio: 147 gestantes que acuden a primera visita de control prenatal a consultas externas del Hospital del Mar de Barcelona durante 1997. Grupo de control: 50 gestantes no fumadoras atendidas para control de embarazo durante 1997. Mediciones. Número de cigarrillos que declaran fumar al día en la primera visita de control en nuestro centro y en la última visita antes del parto. Niveles de cotinina en las orinas aportadas a dichas visitas. Resultados. La media de cotinina en las gestantes que declaran haber dejado de fumar es superior a la de las no fumadoras. Existe una relación lineal estadísticamente significativa entre el número de cigarrillos declarados y los niveles de cotinina en la primera visita y en la última visita de control gestacional, así como entre la variación de número de cigarrillos y niveles de cotinina entre ambas visitas. El valor predictivo negativo de la declaración del habito tabáquico es del 82,9 por ciento. Conclusiones. Se observa cierto grado de infradeclaración entre las gestantes fumadoras, si bien hay una buena correlación entre declaración de consumo y niveles de cotinina. La infradeclaración no aumenta a pesar del consejo reiterado para dejar de fumar, por lo que, a pesar de sus limitaciones, puede ser un indicador útil para evaluar el efecto de las intervenciones orientadas a promover el abandono del tabaquismo durante la gestación (AU)

El abandono del tabaquismo durante la gestación y la recaída / Smoking cessation during pregnancy and relapses

Introducción El hábito tabáquico en las mujeres españolas está aumentando, especialmente entre las mujeres de 25 a 44 años, que es el grupo con una tasa de fertilidad más elevada. Por tanto, existe una preocupación creciente por el aumento del riesgo asociado al tabaco, de forma directa a las mujeres y de forma indirecta a los fetos y a los hijos. Sin embargo, estas mujeres realizan muchos contactos con el sistema sanitario y son muy sensible a los mensajes sanitarios, especialmente durante el embarazo. Objetivo: Evaluar la prevalencia del hábito tabaco en nuestra población de mujeres gestantes. Evaluar la proporción de mujeres que dejan de fumar durante el embarazo. Analizar los factores que podrían influir en esta tasa de abandono. Material y métodos: Setecientas seis mujeres gestantes que recibieron atención al parto en el Hospital Universitario del Mar durante los meses de enero a diciembre de 1996. Cuestionario personal retrospectivo en la estancia hospitalaria postparto y obtención de datos de las historias clínicas. Encuesta telefónica a los 6 meses postparto.Resultados: El 31 por ciento de las mujeres eran fumadoras en el momento del diagnóstico del embarazo. El 20,1 por ciento dejó de fumar antes de la primera visita prenatal y el 5 por ciento tras la primera visita y durante el primer trimestre de embarazo. Se logró seguimiento telefónico a los 6 meses en el 52 por ciento de las gestantes fumadoras, de las que un 36,4 por ciento afirmaron seguir sin fumar. La abstinencia fue más frecuente entre las gestantes que fumaban menos y las que siguieron un mejor control prenatal, mientras que la mayor incidencia de recaídas se produjo entre las que fumaban más antes de la gestación y las que no realizaron lactancia materna.Conclusiones: Nuestra población de gestantes presenta una alta prevalencia de tabaquismo. El abandono del hábito tabáquico durante la gestación y a largo plazo es inferior a los datos encontrados en la literatura. El conocimiento de este problema nos ha llevado a desarrollar un proyecto para evaluar el impacto del consejo para dejar de fumar integrado a la consulta antenatal sobre la tasa del abandono del hábito tabáquico durante el embarazo y a largo plazo (AU)

[Validity of the declared tobacco consumption in pregnancy]. / Validez del consumo declarado de tabaco en el embarazo.

OBJECTIVES: To analyse the relationship between the stated consumption of tobacco by pregnant women who say they smoked before pregnancy and the levels of cotinine in their urine at the start and end of pregnancy. DESIGN: Observational, longitudinal study. PARTICIPANTS: During 1997. STUDY GROUP: 147 pregnant women at their first pre-natal visit to outclinics of the Hospital del Mar. CONTROL GROUP: 50 non-smoker pregnant women monitored during their pregnancy. MEASUREMENTS AND MAIN RESULTS: The numbers of cigarettes per day that they said they smoked on their first monitoring visit to our centre and at the last attendance before giving birth were recorded. Cotinine levels in the urine samples taken on these visits were measured. Mean cotinine in pregnant women who said they had given up smoking was higher than in non-smokers. There was a statistically significant linear relationship between the number of cigarettes stated and cotinine levels at the first and last pregnancy monitoring visits, as well as between the variation in the number of cigarettes and cotinine levels at these two visits. The negative predictive value of what they said about their tobacco habit was 82.9%. CONCLUSIONS: There was a certain under-declaration by pregnant smokers, although their statements of consumption and cotinine levels correlated closely. The under-declaration did not increase despite reiterated advice to stop smoking, which means that, despite its limitations, it could be a useful indicator for evaluating the effect of interventions aimed at stopping women smoking during pregnancy.

[Descriptive study of patient compliance in pharmacologic antihypertensive treatment and validation of the Morisky and Green test]. / Estudio descriptivo del cumplimiento del tratamiento farmacológico antihipertensivo y validación del test de Morisky y Green.

OBJECTIVE: To ascertain the degree of correct use of a course of medication in a sample of patients with high blood pressure attending Primary Attention consultation, and to validate the Morisk and Green completion test. DESIGN: This is a transversal observational study carried out in two stages, which aims to analyse the variable rate of correct following of instructions. The sample was selected at random. SITE. The study was carried out within the framework of Primary Care. PATIENTS: The sample was drawn from patients with high blood pressure under treatment by medication, including 96 patients of whom only 86 completed the study. MAIN MEASUREMENTS AND RESULTS: Measurement of the actual incidence of correct use was carried out by means of counting the pills in the patients' homes, and the theoretical incidence of correct use by means of the Morisky and Green Test. We class those who take between 80-110% of the prescribed pills as completing the course correctly. We found: 18.6% took less medication (Margin of reliability (MR) 95%: 10, 3-26.8%), 23% took more than they should (MR 95%: 14.4-32, 2%) and 58.1% took medication as instructed (MR 95%: 48-68%, without significant differences either by sex or age. The test's sensitivity in detecting those who complied with instructions was 52%, and specificity was 44.4%. CONCLUSIONS: 1. The number of over-consumers is particularly notable. 2. Responses to the test do not show any relationship with correct use of medication in this study. 3. In our view the test could only be used in a hypothetical population where there were no over-consumers.

Clinical and behavioral evaluation of pathological gambling in Barcelona, Spain.

This paper assesses both the clinical characteristics and gambling behavior of 45 pathological gamblers (40 male, 5 female, average age 41) in a psychiatric hospital in Barcelona, Spain. These pathological gamblers tend to have other addictions and psychiatric disorders in addition to their pathological gambling. Suicidal ideation and attempts were one of the most frequent complications with these patients. Slot and fruit machines were found to be the most preferred form of gambling. Loans and crime were frequently used by the gambler to finance his or her gambling. Nevertheless, the gambler is rarely aggessive, and legal problems resulting from serious crimes are the exception. The profile presentes is similar to that found among pathological gamblers in other countries.

[Community-acquired urinary infection: the in vitro activity of trimethoprim and cotrimoxazole]. / Infección urinaria extrahospitalaria: actividad in vitro de trimetoprim y cotrimoxazol.

To evaluate the in vitro sensitivities of trimetoprim (TMP) in our area and to compare them with those to co-trimoxazole (CMX) a prospective study was carried out in females with uncomplicated lower urinary tract infection (UCLUTI), as a preliminary step for the possible use of a monodose of TMP in these patients. Fifty-five cases of UCLUTI were included. Escherichia coli was the predominating organism (70.9%). The general sensitivity to CMX was 80% and that to TMP 76.4%. The E. coli sensitivity to CMX was 79.5%, and 76.9% to TMP. The difference in the sensitivities to both antimicrobials was not statistically significant (p = 0.5). The routine introduction of TMP in the antibiogram would permit to evaluate the resistance to this antimicrobial in each area and, on the basis of the results, to assess the effectiveness of TMP in the treatment of UCLUTI.

[Qualitative study of the demand of domiciliary care at a special emergency service]. / Estudio cualitativo de la demanda de asistencia domiciliaria de un Servicio Especial de Urgencias.

The demand for home attention in the special emergency service of L'Hospitalet and Cornella de Llobregat (Barcelona) was evaluated. The data from a sample of 2046 requests for home attention were assessed, corresponding to the period between July 1st, 1985, and June 30th, 1986. This sample was randomly selected from overall 28385 home visits carried out during this period. The age group with the highest demand of care was the 0-14 years group. There was a high number of requests of care for banal symptoms. The most common group of diseases were the respiratory conditions. 83% of patients received some type of therapy. In 12% of cases, admission to a hospital was indicated; the most common cause of admission to a hospital was indicated; the most common cause of admission was cardiovascular disease. Emphasis is made on the importance of the coordination between primary care groups and special emergency services, as well as on the need for continuing education of professionals with specialties related to the care of emergencies and pediatrics.