Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica / Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients

Objetivo. Evaluar la satisfacción de los pacientes candidatos a cirugía bariátrica con la realización de un programa de preparación grupal precirugía, detectar oportunidades de mejora en el programa y evaluar la satisfacción de los participantes tras su implantación. Material y métodos. Se ha utilizado una encuesta diseñada ad hoc dirigida a evaluar la opinión sobre diferentes aspectos del programa, la satisfacción con el mismo y la identificación de mejoras. Se administró a dos grupos de pacientes: al primero un año después del programa para identificar propuestas de mejora y al segundo un año después de la implementación de la mejora. Se evaluaron 112 pacientes, 66 en el primer pase de la encuesta y 46 en el segundo. Ambos grupos fueron homogéneos en las variables sociodemográficas. Resultados. La principal mejora detectada fue la participación de pacientes expertos en el programa de preparación. Tras su implantación se produjeron ligeros cambios en las valoraciones de las diferentes preguntas, que no fueron significativos. La satisfacción general pasó de un 9,5 a 9,74 sobre 10. Otras propuestas de mejora fueron mejorar la presentación audiovisual y adaptar el mobiliario de la sala a las características de los pacientes. Conclusiones. La elevada satisfacción encontrada es habitual en los trabajos sobre satisfacción hospitalaria, siendo los resultados obtenidos aquí aún mayores que los de los estudios consultados y estando en todos los casos en niveles de excelencia. Esto impide que se produzcan diferencias estadísticamente significativas. Tampoco se encontró una diferencia significativa en los resultados pre y postimplantación de la mejora. La evaluación continua permite constatar nuevas posibilidades de mejora(AU)

Objective. To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. Method. An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables Results. The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. Conclusions. The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement(AU)

[Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients]. / Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica.

OBJECTIVE: To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. METHOD: An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables RESULTS: The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. CONCLUSIONS: The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

Bioconversion of phytosterols to androstanes by mycobacteria growing on sugar cane mud.

Direct sterol conversion of sugar cane mud (residue) by Mycobacterium sp. was demonstrated to be possible technologically, thus avoiding sugar cane oil extraction and further processes of extraction and purification of phytosterols from this oil. Indeed, mycobacterial cells were able to convert phytosterols from sugar cane mud into 4-androstene-dione (AD) and 1,4 androsta-diene-3,17-dione (ADD). For the various concentrations assayed, concomitant higher yields for both androstanes were achieved at 20% (w/w) sugar cane mud in media. Furthermore, conversions were similar to those from other substrates, such as a mixture of phytosterols. The results suggest that the mycobacterial cell is able to easily access and bioconvert sugar cane mud phytosterols.

[Importance of the "adequate blood phosphorus" concept as a risk factor for hyperphosphatemia]. / Importancia del concepto "fosfatemia adecuada" como factor de riesgo de hiperfosfatemia.

Hyperphosphatemia is an important risk factor of secondary hyperparathyroidism and extraosseous calcifications in chronic renal failure patients. In this study our hypothesis is that physicians misconception of adequate phosphatemia is a risk factor for hyperphosphatemia. In 1999 GEMOR sent a renal osteodystrophy inquiry to different hemodialysis centers in Argentina. It included 80 dialysis centers in 17 Argentinian provinces. The enquire had 33 questions about renal osteodystrophy. Here we report the section related to phosphorous metabolism. We obtained responses from 80 dialysis centers (4,512 dialysis patients), which represents about 24% of Argentinian dialysis centers. Physicians considered phosphorous levels between 4.5 to 5.5 mg/dl in 83.5% of centers as adequate, and between 5.5 to 6.5 mg/dl in 10.1%. Five out of 77 centers reported that they had no patients with hyperphosphatemia. The percentage of hemodialysis patients that had more than 6 mg/dl in each center was 28.8 +/- 15.9%. Those centers that aimed for phosphatemia between 5.5 and 6.5 mg/dl, had a higher percentage of patients with phosphatemia above 6 mg/dl than those aiming for between 4.5 and 5.5 mg/dl (42.8 +/- 16.7 vs 27.1 +/- 15.2% respectively, p = 0.007), and had higher mean of phosphatemia (6.4 +/- 0.7 vs 5.3 +/- 0.7 mg/dl respectively, p = 0.0001), than the last group. In conclusion, a higher mean phosphate level was obtained in hemodialysis centers where physicians considered higher pre-dialysis target levels. Some centers had no patients with hyperphosphatemia (neglect or good control?).

[Vascular and tissue calcifications of hemodialysis patients]. / Calcificaciones vasculares y de tejidos de pacientes en hemodiálisis.

The present paper aims to assess radiographic vascular and soft parts calcifications occurrence and its correlation with biochemical profiles. The study was performed in 47 patients (ten diabetic patients), 49 years old, who had been on dialysis for a period of 51 months. Vascular calcifications (VCs) were classified as proximal, distal and soft tissues. In addition, Ca, P, CaxP values in the six months prior to the recruitment period, PTH, FAL and calcium carbonate, calcium acetate, and vitamin D3 intake were determined. A higher frequency of VCs was observed in diabetics, yielding a significant association with proximal 60% (p = 0.05) and almost significant with distal calcifications 70% (p = 0.07). Likewise, a lower CaxP was noted for diabetic VCs in comparison to that seen in non-diabetic VCs (p < 0.05). Proximal and distal VCs in the non-diabetics population were 25% and 20%, respectively; and tissue calcifications were 24%. Age was correlated with proximal and distal VCs (p < 0.01). A higher CaxP was observed in patients with VCs and it yielded an even higher value for tissue calcifications. Lastly, calcium acetate and overall calcium intake was higher in patients with tissue calcifications (p = 0.05). VCs were more frequent in diabetics and they also showed a lower CaxP. VCs in non-diabetics were correlated with CaxP values, whereas tissue calcifications were associated with calcium intake. Therefore, the management of renal osteodystrophy should be changed in order to prevent calcifications as well as to decrease morbidity in hemodialysis patients.

Importancia del concepto «fosfatemia adecuada» como factor de riesgo de hiperfosfatemia / Physician misconception of “adequate phosphatemia” may be a determinant factor for hyperphosphatemia

En 1999 GEMOR realizó una encuesta entre centros de diálisis de Argentina para conocer la realidad de dicha patología en el país. Presentamos los resultados relacionados al fósforo. Participaron 80 centros de diálisis (24% de los centros nacionales), donde dializaban 4.512 pacientes (34% del país). El 95% determinaban Calcio y Fósforo sérico en forma mensual. El 83,5% pretendía en sus pacientes una fosfatemia entre 4,5 y 5,5 mg/dl, mientras que en el 10,1% el objetivo estaba entre 5,5 y 6,5 mg/dl. La media porcentual de fosfatemia superior a 6 mg/dl fue del 28,8 ± 15,9%. Cinco de 77 centros reportaron que no tenían pacientes hiperfosfatémicos en la última determinación mensual. Los que pretendían una fosfatemia entre 5,5 y 6,5 mg/dl, tenían un porcentaje de pacientes con fosfatemia mayor de 6 mg/dl superior a aquellos que pretendían entre 4,5 y 5,5 mg/dl (42,8 ± 16,7 vs 27,1 ± 15,2% respectivamente, p = 0,007). Mientras que la media de fosfatemia también fue superior (6,4 ± 0,7 vs 5,3 ± 0,7 mg/dl respectivamente, p = 0,0001). Esto sugiere que los centros donde se pretendía mayor fosfatemia tenían más casos de hiperfosfatemia. Existen centros sin pacientes hiperfosfatémicos. Esto supone o un buen control de la fosfatemia o resultados de laboratorio «falsos negativos» (AU)

Hyperphosphatemia is an important risk factor of secondary hyperparathyroidism and extraosseous calcifications in chronic renal failure patients. In this study our hypothesis is that physicians misconception of adequate phosphatemia is a risk factor for hyperphosphatemia. In 1999 GEMOR sent a renal osteodystrophy inquiry to different hemodialysis centers in Argentina. It included 80 dialysis centers in 17 Argentinian provinces. The enquire had 33 questions about renal osteodystrophy. Here we report the section related to phosphorous metabolism. We obtained responses from 80 dialysis centers (4,512 dialysis patients), which represents about 24% of Argentinian dialysis centers. Physicians considered phosphorous levels between 4.5 to 5.5 mg/dl in 83.5% of centers as adequate, and between 5.5 to 6.5 mg/dl in 10.1%. Five out of 77 centers reported that they had no patients with hyperphosphatemia. The percentage of hemodialysis patients that had more than 6 mg/dl in each center was 28.8 ± 15.9%. Those centers that aimed for phosphatemia between 5.5 and 6.5 mg/dl, had a higher percentage of patients with phosphatemia above 6 mg/dl than those aiming for between 4.5 and 5.5 mg/dl (42.8 ± 16.7 vs 27.1 ± 15.2% respectively, p = 0.007), and had higher mean of phosphatemia (6.4 ± 0.7 vs 5.3 ± 0.7 mg/dl respectively, p = 0.0001), than the last group. In conclusion, a higher mean phosphate level was obtained in hemodialysis centers where physicians considered higher pre-dialysis target levels. Some centers had no patients with hyperphosphatemia (neglect or good control?) (AU)

Calcificaciones vasculares y de tejidos de pacientes en hemodiálisis / Vascular and tissue calcifications in haemodialysis patients

Las calcificaciones de los tejidos se han clasificado como metastásicas debido a la elevación de Ca, P, CaxP y PTH o distróficos por anormalidad en los tejidos. La marcada rapidez con que ocurren en los pacientes con IRC sugiere que ambos mecanismos están presentes y contribuyen entre sí. Nuestro objetivo fue establecer mediante Rx la incidencia de calcificaciones vasculares y de partes blandas y relacionarlos con perfiles bioquímicos. Material y métodos: Se incluyeron 47 pacientes (24 mujeres y 23 varones), 10 diabéticos, con edad de 49 años, con un tiempo en HD de 51 ± 31 meses. Se les realizó Rx de manos, pies y hombros bilateral, abdomen, pelvis y tórax. Se clasificó a las calcificaciones vasculares (CV) en proximales (aorta, ilíacas, femoral) y distales (digitales) y de tejidos blandos a las musculares, periarticulares o de órganos. Se determinó Ca, P, CaxP durante 6 meses previos, PTH, fosfatasa alcalina e ingesta de carbonato de Ca, acetato de Ca y vitamina D3. Se estudió la relación entre diabéticos y no diabéticos y luego estos últimos fueron excluidos del análisis. Se aplicó test de Fisher, test de Kruskal-Wallis y test de Mann-Whitney. Resultados: Las CV fueron más frecuentes en diabéticos, resultando significativa la asociación de la calcificación proximal 60% (p = 0,05) y casi significativa en la distal 70% (p = 0,07) en relación a los no diabéticos. El CaxP en los diabéticos con CV fue menor que en los no diabéticos con CV (p < 0,05). En la población no diabética las CV proximal y distal fueron del 25% y 20% respectivamente y la de tejidos del 24%: la edad se correlacionó con las CV proximal (p = 0,006) y distal (p = 0,0006). El CaxP fue mayor en pacientes con CV y aún más en calcificaciones de tejidos. La ingesta de acetato de Ca y el Ca total fue mayor en pacientes con calcificación de tejidos (p < 0,0045). Conclusiones: Las CV fueron más frecuentes en diabéticos y con CaxP menor. En no diabéticos, las CV y de tejidos se relacionaron con CaxP y las de tejidos con la ingesta de Ca. Es necesario un cambio en el manejo de la osteodistrofia renal para prevenir las calcificaciones y de esta manera disminuir la morbilidad de los pacientes en hemodiálisis (AU)

The present paper aims to assess radiographic vascular and soft parts calcifications occurrence and its correlation with biochemical profiles. The study was performed in 47 patients (ten diabetic patients), 49 years old, who had been on dialysis for a period of 51 months. Vascular calcifications (VCs) were classified as proximal, distal and soft tissues. In addition, Ca, P, CaxP values in the six months prior to the recruitment period, PTH, FAL and calcium carbonate, calcium acetate, and vitamin D3 intake were determined. A higher frequency of VCs was observed in diabetics, yielding a significant association with proximal 60% (p = 0.05) and almost significant with distal calcifications 70% (p = 0.07). Likewise, a lower CaxP was noted for diabetic VCs in comparison to that seen in non-diabetic VCs (p < 0.05). Proximal and distal VCs in the non-diabetics population were 25% and 20%, respectively; and tissue calcifications were 24%. Age was correlated with proximal and distal VCs (p < 0.01). A higher CaxP was observed in patients with VCs and it yielded an even higher value for tissue calcifications. Lastly, calcium acetate and overall calcium intake was higher in patients with tissue calcifications (p = 0.05). VCs were more frequent in diabetics and they also showed a lower CaxP. VCs in non-diabetics were correlated with CaxP values, whereas tissue calcifications were associated with calcium intake. Therefore, the management of renal osteodystrophy should be changed in order to prevent calcifications as well as to decrease morbidity in hemodialysis patients (AU)

Onset of analgesia for liquigel ibuprofen 400 mg, acetaminophen 1000 mg, ketoprofen 25 mg, and placebo in the treatment of postoperative dental pain.

Ibuprofen is a peripherally acting nonsteroidal anti-inflammatory drug indicated fo ranalgesia, antipyresis, and various arthritic conditions. A solubilized 200 mg liquigel formulation of ibuprofen has been shown to have a more rapid rate of absorption compared with ibuprofen 200 mg tablets. Ibuprofen liquigels have a kinetic profile similar to ibuprofen suspension, with both a higher Cmax and an earlier tmax than any solid tablet. The objective of this single-dose, double-blind, triple-dummy, parallel-group study was to assess the time to onset of relief and overall analgesic efficacy of liquigel ibuprofen 400 mg, ketoprofen 25 mg compared with acetaminophen 1000 mg, and placebo in 239 patients with moderate or severe pain following third molar extractions. Treatments were compared over 6 hours using standard scales for pain intensity and relief and stopwatch onset of meaningful relief. All active treatments provided meaningful relief significantly faster compared with placebo. Ibuprofen provided significantly faster relief compared with acetaminophen and ketoprofen. By the end of the study (6 h), onset of meaningful relief was achieved by 36%, 99%, 96%, and 88% of the patients in the placebo, ketoprofen, ibuprofen, and acetaminophen groups, respectively. The median times to onset of relief were > 6 hours for placebo, 25.5 minutes for ketoprofen, 24.2 minutes for ibuprofen, and 29.9 minutes for acetaminophen. In addition, both ibuprofen and ketoprofen showed statistical superiority over acetaminophen at earlier time points on the time-effect curves for pain relief and pain intensity difference. Consistent results were seen with respect to the 6-hour summary efficacy variables: the three active treatments were significantly better than placebo, and ibuprofen was significantly better than both acetaminophen and ketoprofen. Liquigel ibuprofen 400 mg was shown to provide faster relief and superior overall efficacy compared with ketoprofen 25 mg, acetaminophen 1000 mg, and placebo. No serious adverse effects were reported in this single-dose study.

Técnica de medición de la presión arterial utilizada por enfermeras auxiliares del Hospital Universitario de Caracas / Measurement technical of arterial pressure utilizated by assi of Hospital Universitario de Caracas

Se compararon las variables consideradas errores técnicos frecuentes cometidos durante el procedimiento de medición de la presión arterial a 50, entre un grupo de enfermeras auxiliares entrenadas (grupo control) y no entrenadas (grupo experimental). Con respecto al grupo control, en el 97 por ciento de las mediciones el manguito fue centrado correctamente en el brazo del paciente, en el 0 por ciento fue colocado sobre la ropa del mismo, en el 99 por ciento de los casos se utilizó el método palpatorio previa medición, en el 100 por ciento se palpó la arteria braquial y se usó la campana del estetoscopio, y en el 95 por ciento la velocidad de desinflado del manguito fue apropiada; los valores correspondientes al grupo experimental fueron 46 por ciento, 36 por ciento, 0 por ciento, 46 por ciento, 2 por ciento, y 18 por ciento, respectivamente (p<0,001 en todas las comparaciones). Se evaluaron las preferencias por dígitos terminales: en el grupo experimental hubo una preferencia absoluta por el dígito terminal cero para las presiones sistólicas, y casi absoluta para las presiones diastólicas, en el grupo control la distribución de dígitos terminales fue más homogénea. Valores convencionales como 120/80mmHg se registraron en el 14 por ciento de las mediciones del grupo experimental y solo en el 0,5 por ciento de las del grupo control (p<0,001). Las consecuencias de una técnica inadecuada sobre las decisiones terapéuticas son considerables, sobre todo por efectos aditivos de los errores. Esto se expresa en que el grupo experimental clasificó como hipertensos a 14 por ciento de los pacientes cuando no lo eran, y no clasificó como hipertensos a 4 por ciento cuando sí lo eran

Effect of challenge dose and route on porcine reproductive and respiratory syndrome virus (PRRSV) infection in young swine.

Porcine reproductive and respiratory syndrome virus (PRRSV) is perceived to be highly infectious because of the rapid spread of the virus through populations of domestic swine throughout the world. However, no information has been published on the minimum infectious dose of PRRSV and the effect of challenge dose on clinical response. In this experiment, ten groups of pigs (n = 3 per group) were inoculated with one of five different quantities (10(1)-10(5) fluorescent foci units per millilitre) of PRRSV (isolate ISU-P) by either intramuscular or intranasal routes. Clinical signs and body temperature were monitored for 21 days. Serum was collected periodically throughout the study period to monitor the presence of virus in serum and the early immune response of pigs. A 2-mL inoculum containing 10(1) fluorescent foci units of virus per millilitre was found sufficient to achieve infection by either route. Time to onset of clinical signs was highly associated with challenge dose (P < 0.01), regardless of route of exposure. However, no dose- or route-dependent differences in the severity of clinical manifestation were observed. No significant differences in the time of onset or degree of humoural immune response to PRRSV infection were observed between different treatment groups. However, intramuscular exposure appeared to induce a more uniform antibody response compared to intranasal exposure. These results confirmed that PRRSV is highly infectious; a fact that should be taken into consideration when designing strategies for the prevention and control of PRRSV.

Onset and duration of analgesia for low-dose ketoprofen in the treatment of postoperative dental pain.

The objective of this single dose, double-blind study was to determine the relative analgesic efficacy of low-dose ketoprofen (6.25 mg, 12.5 mg, and 25 mg) compared with ibuprofen (200 mg) and placebo in 175 patients with moderate to severe postoperative pain secondary to extraction of impacted third molars. Analgesia was measured during the 6-hour period after administration based on onset of relief, hourly and summary variables, and duration of treatment effect. All active treatments were significantly more effective than placebo for many hourly measures and for the summary measures sum of pain intensity differences (SPID), sum of hourly pain relief values (TOTPAR), time to peak pain relief, and patient global assessment of study medication. The three ketoprofen doses were significantly more effective than placebo beginning at 30 minutes, whereas ibuprofen was significantly better than placebo beginning at 1 hour. A dose-response relationship was observed for ketoprofen, with the two higher doses providing significantly greater analgesia than the lower dose. However, a plateau effect was seen between the 12.5-mg and 25-mg dose levels. A significantly greater proportion of patients treated with each of the active treatments (ranging from 0.83 to 0.88) reported onset of relief compared with placebo (0.20). The distribution functions of onset of relief differed significantly among treatments, with ketoprofen 12.5 mg and 25 mg having a faster onset than ibuprofen 200 mg and ketoprofen 6.25 mg. The duration of effect was generally shorter for ketoprofen than for ibuprofen, and these difference were significant. This study provides evidence that at the dose levels of 12.5 mg and 25 mg, ketoprofen is an effective analgesic in providing relief of postoperative dental pain. Ketoprofen 12.5 mg and 25 mg provide significantly greater relief in the earlier time period, with a faster onset and shorter duration of effect than ibuprofen 200 mg. The two higher doses of ketoprofen provided similar analgesia, and no additional benefit was obtained by increasing the dose of ketoprofen to 25 mg. Therefore, we conclude that ketoprofen 12.5 mg is an appropriate dose for over-the-counter use.

Muscular strength and bone mineral density in haemodialysis patients.

PURPOSE: The objective of this study was to determine the relationship between muscular strength and bone mineral density (BMD) in patients undergoing regular haemodialysis. METHODS: The BMD was measured in the lumbar spine (L2-L4) and in the proximal femur (femoral neck and trochanter) with dual-energy X-ray absorptiometry DEXA (Lunar DPX). Muscular strength of the extensors, flexors and abductors muscles of the femur (proximal muscles) and the extensors muscles of the back was measured with an isometric dynamometer. Thirty patients, 15 women with a mean age of 33.7 years (18-43) and 15 men with a mean age of 45.5 years (18-65) were included in the study. RESULTS: There was a positive and significant correlation between the BMD of the femoral neck and muscular strength of the flexors (r = 0.490, P < 0.005), the extensors (r = 0.658, P < 0.01) and the abductors muscles of the femur (r = 0.671, P < 0.0008), as well as between the muscular strength of the flexors (r = 0.413, P < 0.02) and extensors muscles of the femur (r = 0.433, P < 0.01) with BMD of the trochanter. There was no correlation between the muscular strength of the back extensor muscles and the BMD of the lumbar spine (r = -0.119, P NS). There was no correlation between the BMD and the number of years of haemodialysis therapy (r = -0.032, P NS), the patient's age (r = -159, P NS), or the value of serum PTH (r = 0.369, P NS) respectively. However, there was a significant correlation between the BMD of the femoral neck with muscular strength (r = 0.602, P < 0.05). CONCLUSION: This study reveals the close relationship that exists between muscular strength of the proximal muscles and the BMD of proximal femur in patients undergoing haemodialysis.

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968-1986.

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.

Job absenteeism and arterial hypertension: results of a hypertension control program.

This study reports the findings of one of the stages of a programme for the detection and control of arterial hypertension, started in 1980 in an automobile company with a workforce of 9,782. In the initial screening, 522 hypertensive males were found using epidemiological criteria and 206 of these fulfilled the criteria of definite hypertension. The objective of this study consisted of evaluating, 9 years after the start of the program, the indirect cost in terms of the reduction in the morbidity indicator-temporary work incapacity (TWI). Analysis is based on a comparison of the prevalence of hypertension in the population when the program was begun (6%) and in 1989 (9.8%). It can be observed that the TWI rate of the hypertensive population was significantly higher than that of the rest of the workforce, and that this remained true for the reference group (RG) hypertensives a year after the study was initiated. In contrast, the intervention group (IG) showed significantly lower TWI levels, not only in comparison with the RG but also with the rest of the workers. The estimated reduction in TWI for 1989 was 4.500 days/year, which corresponds to an estimated saving of 76.500.000 pesetas/year.

Trombosis en la auricula izquierda: su expresión en la coronariografía en pacientes portadores de valvulopatía reumática / Thrombosis in left auricula: it expresion in coronariography of patients with rheumathic valvulopathy

En 26 pacientes portadores de valvulopatía mitral reumática, sometidos a cateterismo cardiáco como parte de su estudio preoperatorio, se evaluaron sus coronariografías con el fin de establecer la presencia de un ovillo vascular auricular izquierdo que además fistuliza a dicha cavidad (TAI). Se demostró que dicho hallazgo estaba presente en un 23% de los pacientes, todos los cuales tenían como ritmo de base una fibrilación o un flutter auricular. Al comparar el grupo con TAI con el sin TAI se demuestra que no hay diferencias significativas en parámetros obtenidos con eco-Doppler contemporáneo como: el tamaño de la aurícula izquierda (4.8ñ0.6 vs 4.93ñ0.65), el AVM (1.05ñ0.28 vs 1.15ñ0.29) y las mediciones del ventrículo izquierdo. Al comparar estos grupos en cuanto a sus parámetros hemodinámicos se demuestran diferencias significativas en la presión sistólica de arteria pulmonar (60.83ñ28.11 vs 39.40ñ14.95, p<0.02), la presión diastólica de arteria pulmonar (30.17ñ16.28 vs 15.13ñ6.85, p<0.01) y la presión de capilar pulmonar (23.83ñ7.34 vs 14.89ñ6.89, p<0.02). Se concluye que el TAI es un hallazgo relativamente frecuente en la coronariografía del VR y que esta información se obtiene al efectuar la coronariografía convencional, siempre que se obtiene al efectuar al efectuar imágenes tardías de los vasos que se dirigen hacia la aurícula izquierda. El TAI está asociado a presiones de arteria y capilar pulmonar significativamente mayores que el grupo sin TAI a pesar de que ambos grupos tienen un AVM similar utilizando la técnica de Doppler