[Dental health of children and adolescents of Navarra, 2007 (4th edition)]. / La salud dental de los niños y adolescentes de Navarra, 2007 (4 feminine edición).

BACKGROUND: With five years having passed since the last survey (2002), a new survey was carried out, the 4th since 1987. The aim is to determine the state of oral health of children and adolescents in Navarre and its evolution. POPULATION AND METHODS: The sample (n=1.397) was selected through multistage probability sampling, taking as a unit the classrooms of the 1st and 6th year of Primary Education and the 2nd of Compulsory Secondary Education. The fieldwork was carried out in the months of April and May 2007 by two calibrated teams of examiners. Health variables studied: caries (measured with WHO criterion and extended criterion), periodontal state and malocclusion. The data were computerised with Access XP 2003 SP3; the statistical analysis with SPSS Windows v.15.0. RESULTS: Ten point eight percent of the sample is of foreign origin. The prevalence of caries in temporary dentition at 6 years is 35.9% with a DFT of 1.26, in permanent dentition, 28.5% and 46.4% at 12 and 14 years; the average of affected teeth 0.63 and 1.28 respectively. The index of restoration is 26.1% in temporary dentition and 68.9 and 74.1% in permanent; those of foreign origin show more caries (p<0.05) and less treatment (p<0.05) than those of Spanish origin. Sixty-two point eight percent of 14 year olds show gingival bleeding and 16.8%, calculus; 14.7% malocclusion and 19.1% wear orthodontic appliances. Conclusions. Caries are stabilised in temporary dentition in the general population, but fall significantly amongst natives (those of Spanish origin); in permanent dentition they continue their tendency to fall, although more moderately. Navarre is amongst the regions with a lower level of caries and a higher index of restoration. Immigrants show significantly more caries. The index of restoration falls slightly with respect to previous years. The periodontal health figures are poor. Malocclusion and orthodontic appliance wearers are stabilised.

La salud dental de los niños y adolescentes de Navarra, 2007 (4ª edición) / Dental health of children and adolescents of Navarra, 2007 (4th edition)

Fundamento. Transcurridos 5 años desde la última encuesta(2002), se procede a una nueva edición que supone la 4ªdesde 1987. El objetivo es conocer el estado de salud oral deniños y adolescentes de Navarra y su evolución.Población y métodos. La muestra (n=1.397) fue seleccionadamediante muestreo probabilístico polietápico, tomandocomo unidad las aulas de 1º y 6º de Enseñanza Primaria y de2º de Enseñanza Secundaria Obligatoria. El trabajo de campose realizó entre los meses de abril y mayo de 2007 pordos equipos examinadores calibrados.Variables de salud estudiadas: caries (medida con criterioOMS y con criterio ampliado), estado periodontal y maloclusión.Los datos fueron informatizados con Access XP 2003SP3; el análisis estadístico, con SPSS Windows v.15.0.Resultados. El 10,8% de la muestra es de origen extranjero.La prevalencia de caries en dentición temporal a los 6 añoses 35,9% con cod 1,26; en dentición permanente, 28,5% y46,4% a los 12 y 14 años; la media de dientes afectados 0,63y 1,28 respectivamente. El índice de restauración es 26,1%en dentición temporal y 68,9 y 74,1% en permanente; los deorigen extranjero presentan más caries (p<0,05) y menostratamiento (p<0,05) que los de origen español. El 62,8% de14 años presentan sangrado gingival y el 16,8%, cálculo; el14,7% maloclusión y el 19,1% lleva ortodoncia.Conclusiones. La caries está estabilizada en denticióntemporal en población general, pero desciende significativamenteentre los autóctonos (origen España); en denticiónpermanente continúa con su tendencia descendente,aunque más moderada. Navarra está entre las regiones conmenor nivel de caries y más alto índice de restauración. Losinmigrantes presentan significativamente más caries. El índicede restauración desciende ligeramente respecto a añosanteriores. Las cifras de salud periodontal son pobres. Maloclusióny portadores de ortodoncia están estabilizados(AU)

Background. With five years having passed since the lastsurvey (2002), a new survey was carried out, the 4th since1987. The aim is to determine the state of oral health of childrenand adolescents in Navarre and its evolution.Population and methods. The sample (n=1.397) was selectedthrough multistage probability sampling, taking as aunit the classrooms of the 1st and 6th year of Primary Educationand the 2nd of Compulsory Secondary Education. Thefieldwork was carried out in the months of April and May2007 by two calibrated teams of examiners.Health variables studied: caries (measured with WHOcriterion and extended criterion), periodontal state andmalocclusion. The data were computerised with Access XP2003 SP3; the statistical analysis with SPSS Windows v.15.0.Results. Ten point eight percent of the sample is of foreignorigin. The prevalence of caries in temporary dentition at6 years is 35.9% with a dft of 1.26; in permanent dentition,28.5% and 46.4% at 12 and 14 years; the average of affectedteeth 0.63 and 1.28 respectively. The index of restorationis 26.1% in temporary dentition and 68.9 and 74.1% in permanent;those of foreign origin show more caries (p<0.05)and less treatment (p<0.05) than those of Spanish origin.Sixty-two point eight percent of 14 year olds show gingivalbleeding and 16.8%, calculus; 14.7% malocclusion and 19.1%wear orthodontic appliances.Conclusions. Caries are stabilised in temporary dentition inthe general population, but fall significantly amongst natives(those of Spanish origin); in permanent dentition they continuetheir tendency to fall, although more moderately. Navarreis amongst the regions with a lower level of caries and a higherindex of restoration. Immigrants show significantly morecaries. The index of restoration falls slightly with respect toprevious years. The periodontal health figures are poor. Malocclusionand orthodontic appliance wearers are stabilised(AU)

Economic benefits for the family of inactivated subunit virosomal influenza vaccination of healthy children aged 3-14 years during the annual health examination in private paediatric offices.

Taking the results of a prospective cohort study by our group that evaluated the effectiveness of the inactivated subunit virosomal influenza vaccine (Inflexal V), Crucell-Berna) in the prevention of influenza-related diseases and the reduction of its negative economic consequences, the economic costs and benefits for the family of vaccinating a theoretical cohort of 1000 healthy children aged 3-14 years with no risk factors with one dose of vaccine during the yearly health examination were quantiified. The economic analysis was carried out from the family perspective and the time horizon of the study was established at 6 months. In the base case, the net present value was 21,551.62 euros (21.5 euros per vaccinated child), and the benefit-cost ratio was 2.15, meaning that 1.15 euros is saved per euro invested.

Hepatotoxicity of nevirapine in virologically suppressed patients according to gender and CD4 cell counts.

OBJECTIVES: A warning advising a higher risk of hepatotoxicity in antiretroviral-naive patients starting a nevirapine-containing combination antiretroviral therapy (NcART) has been issued by health authorities. It is unclear whether this higher risk also applies to stable virologically suppressed patients starting NcART. METHODS: We performed a meta-analysis of published randomized studies including virologically suppressed patients who switched to NcART with a follow-up >or=3 months. CD4 cell cell counts were classified as high (HCD4) (400 cells/microL for males and 250 cells/microL for females) or low (LCD4). The main endpoint was hepatotoxicity within the first 3 months. RESULTS: Four studies with a pooled total of 410 patients were included. The risk of hepatotoxicity within the first 3 months was 2% and 4% in the LCD4 and HCD4 groups, respectively, with a combined odds ratio of 1.46 [95% confidence interval (CI) 0.43-4.98; P=0.54]. The risk of hepatotoxicity at any point during the study was similar in both groups, with a combined hazard ratio of 0.8 (95% CI 0.3-2.5; P=0.80). CONCLUSIONS: In our study, virologically suppressed patients switching to nevirapine did not have a significantly higher risk of hepatotoxicity or rash when stratified by gender and CD4 cell count, although small differences may have gone undetected because of the sample size limitation.

Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia.

The utility of procalcitonin levels to improve the accuracy of clinical and microbiological parameters in diagnosing ventilator-associated pneumonia (VAP) was evaluated. Sequential measurement of procalcitonin and C-reactive protein levels and the calculation of the simplified Clinical Pulmonary Infection Scores (CPIS) were performed in 44 patients mechanically-ventilated for >48 h with neither active infection for the duration or suspicion of VAP. Patients who developed extrapulmonary infection were excluded. In total, 20 cases were suspected of having VAP and diagnosis was microbiologically confirmed in nine. In patients with confirmed VAP, procalcitonin levels were higher than in those without VAP. C-reactive protein levels and CPIS were lower in patients without suspected VAP, but could not discriminate confirmed and nonconfirmed suspicion of VAP. The best sensitivity and specificity (78 and 97%, respectively) corresponded to procalcitonin. The CPIS resulted in the same sensitivity, but had a lower specificity (80%). C-reactive protein had the worst sensitivity (56%), but a good specificity (91%). A CPIS >or=6 combined with serum levels of procalcitonin >or=2.99 ng.mL(-1) did not improve the sensitivity (67%), but resulted in 100% specificity. Procalcitonin might be useful in the diagnosis of ventilator-associated pneumonia. Combined values of Clinical Pulmonary Infection Scores and procalcitonin below the cut-off points excluded false-positive diagnoses of ventilator-associated pneumonia.

Análisis de la actividad del Servicio de Urgencias Tocoginecológicas en un hospital materno infantil de alta complejidad / Analysis of the activity of the Gynecology and Obstetrics Emergency Service in a highly complex maternal and child hospital

El objetivo de este artículo es el de determinar la actividad del Servicio de Urgencias como paso previo para elaborar un plan estratégico de mejora que refuerce los puntos débiles y premie los puntos fuertes. Se analizaron las altas de este servicio durante una semana, y se registraron múltiples variables. La mayor actividad del servicio se desarrolla con pacientes obstétricas de tercer trimestre, los días laborables y en turno diurno, el 60,7% son visitas adecuadas, y urgentes el 51,6%. Se ingresan al 28% de las pacientes. Se concluye que existe una gran actividad con pacientes parturientas, de que es inútil el crear un sistema de triage, se constata que existe una buena dotación de medios pero que escasea el personal (AU)

The aim of this work is to determine the activity of the emergency service as a prior step to designing a strategic improvement plan which will strengthen the weak points and reward the strong points. It has been observed that the department’s greatest activity is with third-term obstetric patients, on work days and during the daytime. It also concludes that there is intense activity with patients in labour for whom it is useless to create a selection system and, furthermore, the resources are good in spite of staff shortages (AU)

Síndrome del burnout y expectativas profesionales entre Residentes de Ginecología y Obstetricia en un hospital de alta tecnología / The burnout syndrome and professional expectations among gynecology and obstetrics interns in a high-technology hospital

El objetivo de este trabajo es el de investigar los rasgos de personalidad, de actividad labora y las expectativas profesionales que podrían asociarse con puntuaciones altas en las escalas de burnout (Maslach Burnout Inventory) en médicos residentes de Ginecología y Obstetrica. Es un estudio prospectivo, observacional, descriptivo, transversal y se realizo en un Hospital Universitario de alta tecnología (Hospital Clínic de Barcelona). Se realizó una encuesta directa por entrevista personal anónima. Se realizó una encuesta directa por entrevista personal anónima. Se administraron dos cuestionarios: unos de datos sociodemográficos generales que recogía asimismo aspectos laborales y expectativas profesionales, y el Maslasch Burnout inventory (MBI). En todos los dominios del MBI se detectó algún grado de burnout. La despersonalización fue mayor con los años de residencia, presentando el 100% de residentes de cuarto año puntuaciones de rango alto en este dominio. Un 75% de los residentes de cuarto año y más del 83% de los de tercer año presentaban niveles bajos/medio- bajos en la subescala de relaciones personales. Del mismo modo el 66,3% de los residentes de tercer año presentan puntuaciones de cansancio emocional alto/medio-alto. Ninguna de las variables sociodemográficas analizadas es explicativa de los resultados. Como conclusión se expone que los residentes no están inmunes al fenómeno del burnout y la afectación por el mismo es progresiva (AU)

The objective of this work is to research the characteristics of personality, work activity and professional expectations which may be associated with high scores in the burnout scales (Maslach Burnout Inventory) among interns in Gynaecology and Obstetrics Departments. The text concludes that the interns are not immune to the burnout phenomenon and the incidence is progressive (AU)

Síndrome de burnout y expectativas profesionales entre residentes de Ginecología y Obstetricia en un hospital de alta tecnología / The burnout syndrome and professionbal expectations among gynaecology and obstetrics interns in a high-technology hospital

El objetivo de este trabajo es el de investigar los rasgos de personalidad, de actividad laboral y las expectativas profesionales que podrían asociarse con puntuaciones altas en las escalas de burnout (Maslach Burnout Inventory) en médicos residentes de Ginecología y Obstetricia. Es un estudio prospectivo, observacional, descriptivo, transversal, y se realizó en un Hospital Universitario de alta tecnología (Hospital Clínic de Barcelona). Se realizó una encuesta directa por entrevista personal anónima. Se administraron dos cuestionarios: uno de datos sociodemográficos generales que recogía asimismo aspectos laborales y expectativas profesionales, y el Maslach Burnout Inventory (MBI). En todos los dominios del MBI se detectó algún grado de burnout. La despersonalización fue mayor con los años de residencia, presentando el 100% de residentes de cuarto año puntuaciones de rango algo en este dominio. Un 75% de los residentes de cuarto añó y más del 83% de los de tercer año presentaban niveles bajos/medio-bajos en la subescala de relaciones personales. Del mismo modo el 66,3% de los residentes de tercer año presentan puntuaciones de cansancio emocional alto/medio-alto. Ninguna de las variables sociodemográficas analizadas es explicativa de los resultados. Como conclusión se expone que los residentes no están inmunes al fenómeno del burnout y la afectación por el mismo es progresiva

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[Analysis and classification of hospital emergencies through Ambulatory Patient Groups]. / Análisis y clasificación de las urgencias hospitalarias mediante los Ambulatory Patient Groups.

AIM: To assess the feasibility and results of application of Ambulatory Patient Groups (APG) patient's classification system to the case-mix of patients seen at the Emergency Departments (ED) of 6 Barcelona metropolitan area hospitals. METHODS: Development of a minimum discharge data set specific for the Emergency Departments (CMBDAU). Gathering of relevant variables from a random sample of patients seen at the ED using the ED discharge reports. Use of the APG classification system to those episodes. RESULTS: A total of 11.188 episodes were codified and grouped with the APG system. Fifteen diagnostics identified 25% of all episodes. Nearly 50% of all procedures performed at the ED were common and simple procedures. Fifteen APG's grouped 50% of all cases seen at the ED. CONCLUSIONS: The ED Uniform Discharge Data Set (CMBDAU) developed is a valid instrument for describing the case-mix seen at the ED, and its grouping by means of the APG system provides consistent and meaningful results. The widespread use of systems like APG in the ED requires a former validation of relative weights assigned in the US system. The availability of human and technical resources must also be assessed, in order to guarantee the quality and sustainability of such a system.

Análisis y clasificación de las urgencias hospitalarias mediante los Ambulatory Patient Groups / Analysis and classification of hospital emergencies through Ambulatory Patient Groups

Objetivo: Describir la factibilidad y el resultado de la aplicación del sistema Ambulatory Patient Groups (APG) a la casuística atendida en los servicios de urgencias de seis hospitales del área de Barcelona. Métodos: Confección de un conjunto mínimo básico de datos específico para urgencias (CMBDAU). Obtención de las variables necesarias en una muestra aleatoria de visitas atendidas, a partir de los informes de asistencia correspondientes. Aplicación del sistema APG a los episodios seleccionados. Resultados: Se ha codificado y agrupado en APG un total de 11.188 visitas de urgencias. Quince diagnósticos identifican el 25 por ciento de los episodios. El 50 por ciento de los procedimientos de urgencias son exploraciones complementarias sencillas. Quince APG agrupan el 50 por ciento de la casuística atendida en urgencias. Conclusiones: El CMBDAU es válido para describir la casuística de urgencias y su agrupación en APG proporciona resultados consistentes e interpretables. La aplicación generalizada de sistemas como los APG en urgencias requiere una validación previa en nuestro entorno de los valores de peso norteamericanos. También debe valorarse la disponibilidad de recursos técnicos y humanos suficientes para garantizar la calidad y la continuidad de un registro de estas características (AU)

[The future of health management in neurology]. / El futuro de la gestión sanitaria en neurología.

Nowadays a humanized and scientific sanitary assistance continues to be very important. The management generically and specifically in Neurology implies two basic supposes (account system and management control) and six fundamental disciplines (knowledge of the facts, choose of finalities, meeting and organization of resources, organization of functional structures, motivation of persons, and finally control and global evaluation). The value of a Department Neurology resides in the value of its staff, fundamentally doctors, and because of its intensive use of technology can reach competitive advantages with its coordination with Neurosurgery, Neuropathology and Neuroradiology.

Evolución de la calidad percibida en los clientes ambulatorios de un Centro de Diagnostico por la Imagen / Evolution of the perceived quality in outpatient clients of a Diagnostic Imaging Centre

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[Impact of hospital admissions for pneumonia in a tertiary Spanish hospital]. / Impacto sanitario de los ingresos por neumonía en un hospital de tercer nivel.

BACKGROUND: Impact of hospital admissions for pneumonia during 1998 in the Hospital Clínic, Barcelona. PATIENTS AND METHOD: Retrospective information on the hospitalizations for pneumonia was collected. RESULTS: During 1998 a total of 626 adult were admitted with a hospital diagnosis of pneumonia (72% were >/= 65 years). The average length of stay was 10 days. Half of these patients were previously hospitalized during the preceding 5 years. CONCLUSIONS: Hospital admissions due to pneumonia (17 cases per 1.000 hospitalizations) accounted for an estimated cost of 2.3% of the cost of all the hospitalized patients.

Evaluación de la calidad percibida en un Servicio de Neonatología / Evaluation of perceived quality in neonatal services

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Immunogenicity and reactogenicity of the adult tetanus-diphtheria vaccine. How many doses are necessary?

The immunogenicity and reactogenicity of the tetanus-diphtheria adult type vaccine was compared in two groups: group I (n = 201, 18-30 years old, presumably vaccinated with the DTP vaccine) and group II (n = 147, > or = 45 years old, without vaccination antecedents). Before vaccination, the seroprotection levels for tetanus were 90.5% (group I) and 30.6% (group II). These rose to 99.5% and 81.7%, respectively, after administration of one vaccine dose. For diphtheria, prevaccination seroprotection levels were 38.3% (group I) and 19.0% (group II). These rose to 85.8% and 65.7%, respectively, after vaccination. The logistic regression analysis showed an association between antibody titre and age. In group II, 3 doses of Td vaccine were needed to reach titres similar to those achieved in group I with a single dose. Stated reactogenicity was greater in: young subjects, women, those with higher titres of tetanus antibodies and those receiving other vaccines simultaneously. These results confirm the need for vaccination schedules adapted to the characteristics of each population age-group.

Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome.

Noninvasive and invasive diagnostic techniques have been shown to achieve comparable performances in the evaluation of suspected ventilator-associated pneumonia (VAP). We studied the impact of both approaches on outcome in a prospective, open, and randomized study in three intensive care units (ICUs) of a 1,000-bed tertiary care university hospital. Patients with suspected VAP were randomly assigned to noninvasive (Group 1) versus invasive (Group 2) investigation (tracheobronchial aspirates [TBAS] versus bronchoscopically retrieved protected specimen brush [PSB] and bronchoalveolar lavage [BAL]. Samples were cultured quantitatively, and BAL fluid (BALF) was examined for intracellular organisms (ICO) additionally. Initial empiric antimicrobial treatment was administered following the guidelines of the American Thoracic Society (ATS) and adjusted according to culture results (and ICO counts in Group 2). Outcome variables included length of ICU stay and mechanical ventilation as well as mortality. Overall, 76 patients (39 noninvasive, 37 invasive) were investigated. VAP was microbiologically confirmed in 23 of 39 (59%) and 23 of 37 (62%) (p = 0.78). There were no differences with regard to the frequencies of community-acquired and potentially drug-resistant microorganisms (PDRM). Antimicrobial treatment was changed in seven patients (18%) of Group 1 and 10 patients (27%) of Group 2 because of etiologic findings (including five of 17 with ICO = 2% (p = not significant [NS]). Length of ICU stay and mechanical ventilation were also not significantly different in both groups. Crude 30-d mortality was 31 of 76 (41%), and 18 of 39 (46%) in Group 1 and 14 of 37 (38%) in Group 2 (p = 0.46). Adjusted mortality was 16% versus 11% (p = 0.53), and mortality of microbiologically confirmed pneumonia 10 of 23 (44%) in both groups (p = 1.0). We conclude that the outcome of VAP was not influenced by the techniques used for microbial investigation.

[Comparative analysis of articles published by Spanish authors (1993-1997) in biomedical journals with high impact factor]. / Análisis comparativo de las publicaciones realizadas por autores españoles (1993-1997) en revistas clínicas con factor de impacto elevado.

BACKGROUND: To identify the Spanish scientific production amongst different areas of clinical knowledge, and to compare it with those of five other European Union countries. METHOD: Review of MEDLINE data base, for the period 1993-1997. Search limited to four journals, selected, for 10 different medical specialties (Cardiology, Endocrinology, Infectious Diseases, Gastroenterology-Hepatology, Haematology, Nephrology, Pneumology, Neurology, Oncology, Rheumatology). Articles published by authors from Germany, France, Italy, The Netherlands, Sweden and Spain. Journals included in the Internal Medicine subject classification were independently analysed. Data were also related with several econometric indexes. RESULTS: A total of 1,763 original articles published by Spanish authors were identified in the journal's sample over the analysed period (2.08 articles per 100 all published articles). Spain contributes to the total achieved by the six European countries analysed with 9.07 articles per 100 published articles. Gastroenterology-Hepatology was the medical specially which has more articles published by Spanish authors (total: 338 articles; 4.15 articles/100 published articles); and Oncology the one with less articles published (1.26 articles/100 published articles). The mean IF value per journal by article is highest for Gastroenterology-Hepatology (4.86 FI/article) and lowest for Pneumology (2.42 FI/article). Spain is the last amongst all six European countries analyzed in Endocrinology, Oncology and Haematology, and second to last in all others except for Gastroenterology-Hepatology (4th place). Mean cost for each article produced by Spanish authors in the analyzed sample was 0.49 US $ according the health expenditures per capita, and 0.07 US $ according the R+D expenditures per capita. Data from the independent analysis of Internal Medicine journals also showed that Gastroenterology and Hepatology is the subspecialty with a higher number of papers published in those journals. CONCLUSIONS: All efforts devoted to improve the quality of Spanish biomedical research, specially in clinical research, had produced positive, but uneven, results, measured by the number and impact factor of original articles published in top ranked biomedical journals. The overall distribution of high impact factor scientific production by specialties is poor when compared to the European Union countries included in the analysis. Those results showed several improvement opportunities. Besides increasing the overall budget for R+D, its is likely that the time has come for backing the highest quality Spanish biomedical research, the one that offers greater and better chances for achieving scientifically valid results, and is published in high impact factor biomedical journals.

Perceived quality of care of inguinal hernia repair: assessment before and after the procedure.

OBJECTIVE: Assessment of the perceived quality of care for inguinal hernia repair procedures. DESIGN: A two-step descriptive study using specific questionnaires. SETTING: A tertiary care University Hospital. SUBJECTS: Random sample of patients diagnosed of inguinal hernia in 1996. Group A, patients seen at the outpatient clinic before admission; group B, patients seen for follow-up after the surgical procedure. INTERVENTIONS: Two different questionnaires were used. MAIN OUTCOME MEASURES: validity of the questionnaire was evaluated using Cronbach's alpha value. Scores were measured using the z value. RESULTS: Total number of patients was 194. Both groups were comparable. The questionnaire was able to explain 66.3% of the variance. The Cronbach's alpha value was 0.90. Scores recorded were significantly different (P < 0.01) regarding the health care workers' attitude and hospital commodities' variables (rated as better than expected). Differences in scores for information supplied, overall results of the surgical procedure and food variables were not statistically significant. CONCLUSIONS: (i) The study of several fields where the patient's expectations are higher or lower contributes to prioritizing efforts to improve quality in the Surgery Department. (ii) The differences seen strongly suggest the need for patient's satisfaction surveys to be specific by diagnosis/dimension and adapted to patients' expectations.

[Nosocomial infections due to opportunistic fungi: analysis of a news outbreak in the Spanish press]. / Infecciones nosocomiales por hongos oportunistas: análisis de una serie de noticias publicadas en la prensa española.

BACKGROUND: To study an outbreak of media news related to nosocomial infections due to opportunistic fungi in Spanish hospitals. CASE DEFINITION: any news related to possible nosocomial infection due to opportunistic fungi in Spanish hospitals, published in national or local daily newspapers, over the pre-epidemic (July-December, 1998) and epidemic periods (January-June, 1999). All news were reviewed and identified using global press reports summaries, prepared by two independent sources, and were analyzed by three different observers. RESULTS: Over the pre-epidemic period there were not any news related to nosocomial infections due to opportunistic fungi. Over the epidemic period, a total of 218 news were identified, 154 (71%) published in national newspapers and 64 (29%) in local ones. We analyzed separately 18 editorials or opinion articles related to this subject. The epidemic curve (distribution of news by week) showed an incidence news peak at week 5 (102 news, 46.7% of all news published). The media mentioned up to 19 different hospitals as institutions with possible cases of nosocomial fungal infections. After week 8, news incidence drop, and remain thereafter at minimum levels. CONCLUSIONS: The example provided by the analysis of this outbreak of media news, related to nosocomial infections by Aspergillus an other opportunistic fungi, is useful to allow us understand how some medical news arise, develop and were transmitted. The public alert situation created in Spain was remarkable, and it is likely that there was a transient loss of confidence in the safety of public health institutions. Today's medicine requires a great and better openness to the media, and a better cooperation between both parts.

Perceived quality of care in pregnancy assessment before and after delivery.

OBJECTIVE: To assess the perceived quality of care in a group of pregnant women attended in a public Hospital. STUDY DESIGN: All pregnant women seen at the Hospital Clinic of Barcelona in 1996. Two study groups were defined: group A, women seen at the outpatient clinic as a regular follow-up visit for pregnancy, and group B, women seen at the outpatient clinic for follow-up after delivery. A satisfaction questionnaire survey was used in a random sample of both groups of women. RESULTS: Total number of interviews performed was 174. Both groups, A and B were comparable. Scores recorded in both groups were significantly different (P<0.01) for the clinical follow-up and privacy variables (regarded as better than expected). The difference in scores for the information supplied was also statistically significant (P<0.01), but regarded as worst than expected. CONCLUSIONS: The analysis of satisfaction does not seem to follow a linear, straightforward explanation. The differences seen strongly suggest the need of patient's satisfaction surveys to be specific by dimension and tailored to patients' expectations.