State of health in the European Union: A European Health Index.

INTRODUCTION: In this paper we propose an index to measure the state of health of the 28 countries of the European Union. MATERIAL AND METHODS: Using the Principal Components Analysis method, we construct the European Health Index as a combination of six dimensions: (1) Working conditions, (2) General state of health, (3) Health system, (4) Quality of Life, (5) Mental health and drug abuse, and (6) Risk health factors, that are in turn made up of 29 distinct variables. RESULTS: We find the Netherlands, Denmark, Sweden and Ireland in the first four positions, and Estonia, Lithuania, Poland and Bulgaria at the end of the ranking. Within the European Union, two blocks stand out above the rest, the ex-soviet countries and northern Europe. CONCLUSION: The European Health Index could be used to assist public policies designed to improve health perception in regions where it is needed.

Dietary inflammatory index and anthropometric measures of obesity in a population sample at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) trial.

The dietary inflammatory index (DII) is a new tool to assess the inflammatory potential of the diet. In the present study, we aimed to determine the association between the DII and BMI, waist circumference and waist:height ratio (WHtR). We conducted a cross-sectional study of 7236 participants recruited into the PREvención con DIeta MEDiterránea trial. Information from a validated 137-item FFQ was used to calculate energy, food and nutrient intakes. A fourteen-item dietary screener was used to assess adherence to the Mediterranean diet (MeDiet). Sex-specific multivariable linear regression models were fitted to estimate differences (and 95 % CI) in BMI, waist circumference and WHtR across the quintiles of the DII. All nutrient intakes, healthy foods and adherence to the MeDiet were higher in the quintile with the lowest DII score (more anti-inflammatory values) except for intakes of animal protein, saturated fat and monounsaturated fat. Although an inverse association between the DII and total energy was apparent, the DII was associated with higher average BMI, waist circumference and WHtR after adjusting for known risk factors. The adjusted difference in the WHtR for women and men between the highest and lowest quintiles of the DII was 1·60 % (95 % CI 0·87, 2·33) and 1·04 % (95 % CI 0·35, 1·74), respectively. Pro-inflammatory scores remained associated with obesity after controlling for the effect that adherence to a MeDiet had on inflammation. In conclusion, the present study shows a direct association between the DII and indices of obesity, and supports the hypothesis that diet may have a role in the development of obesity through inflammatory modulation mechanisms.

Calendario de vacunaciones sistemáticas del adolescente y adulto recomendado por la sociedad española de medicina preventiva, salud Pública e higiene (actualización del año 2014) / No disponible

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Under-notification of cryptosporidiosis by routine clinical and laboratory practices among non-hospitalised children with acute diarrhoea in Southern Spain.

INTRODUCTION: In a prevalence study of 400 stool samples from non-hospitalised children under 7 years of age with diarrhoea, the presence of Cryptosporidium was evaluated. METHODS: In addition to standard microbiological analyses used for testing for bacteria, parasites, adenoviruses and reoviruses, all samples were re-evaluated for the presence of Cryptosporidium by means of microscopy using a modified acid-fast staining technique, a rapid immunoassay for the qualitative detection of C. parvum and Giardia lamblia, the ImmunoCard STAT! test, and nested polymerase chain reaction (PCR). For identifying the genotypes of Cryptosporidium, the gene 18S ssu rRNA was amplified and sequenced. RESULTS: Thirty-two samples were positive by microscopy, 26 by immunoassay and 61 by nested PCR. Twenty-seven of these organisms were identified as Cryptosporidium hominis, 31 as Cryptosporidium parvum and, in four samples, it was impossible to identify the species. C. parvum was significantly more frequent in girls and C. hominis was significantly more frequent in boys (Fisher's exact test, p = 0.034). Although Cryptosporidium is only notified in a very small number of patients (1-4%) with diarrhoea in Spain, the microorganism was identified by nested PCR in 15.1% of the samples. CONCLUSION: This study, therefore, highlights the under-notification of infections caused by Cryptosporidium in Southern Spain and poses the question of whether its routine testing should be carried out in cases of gastroenteritis in children.

Antimicrobial effect of medical textiles containing bioactive fibres.

Over the last few years, the textile industry has developed different methods for obtaining fabrics and fibres with an antimicrobial action for use in hospital environments and for other purposes. This study evaluates the antimicrobial action of Bioactive(®)-treated fabric (BTF), a commercially available textile containing silver for use in healthcare environments. Unlike other biocides used in hospital fabrics, the prolonged use of silver has not been related to the appearance of resistant bacteria or cross-resistance to antibiotics, in spite of being extensively used in some treatments. Thirty-three hospital strains of bacteria were tested. This study showed the capacity of BTF for significantly reducing the number of microorganisms present, compared with the reduction observed in control fabrics (CF). The antimicrobial action of BTF was expressed as log(10) reduction (LR) from an initial inoculum of about 10(5) colony-forming units (cfu). According to the bacterial species, an LR of between 2.6 and 5.0, and 4.1 and 5.0 (5.0 indicating total inhibition of bacterial growth) were observed, respectively, after 24 and 48 h for BTF. Acinetobacter strains were the most resistant to CF after 72 h (0.8 LR). All of the microorganisms, except two strains of Enterococcus faecalis, were totally inhibited after 72 h on BTF.

Vacunaciones en viajeros internacionales / No disponible

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Calendario de vacunaciones sistemáticas del adolescente y adulto recomendado por la sociedad española de medicina preventiva, salud pública e higiene (actualización del año 2009) / No disponible

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A 3-year intervention with a Mediterranean diet modified the association between the rs9939609 gene variant in FTO and body weight changes.

INTRODUCTION: The aim of this study was to analyze the effects of the rs9939609 (T/A) gene variant in fat mass and obesity-associated gene (FTO) on body weight changes after 3 years and its modification by a randomized nutritional intervention with a Mediterranean-style diet in a population of subjects at high cardiovascular risk. DESIGN: A substudy of PREDIMED, which is a randomized trial aimed at assessing the effect of the Mediterranean diet (MD) for primary cardiovascular disease prevention. There were three nutritional intervention groups: two of them with a Mediterranean-style diet and the third was a control group advised to follow a conventional low-fat diet. SUBJECTS: A total of 776 high cardiovascular risk subjects aged 55-80 years. MEASUREMENTS: Anthropometric measurements were recorded at baseline and at 3 years. The participants were genotyped by RT-PCR, followed by allelic discrimination. RESULTS: Homozygous subjects had the highest baseline body weight. The dominant model showed that subjects carrying the A allele had the lowest body weight gain (B=-0.685; P=0.022) after 3 years of nutritional intervention compared with nonmutated subjects (TT genotype) regardless of the nutritional intervention. Moreover, this effect was statistically significant in carriers of the A allele only among those allocated to the MD groups (B=-0.830; P=0.018), but it was not significant among those allocated to the control group (P for interaction=0.649). CONCLUSION: This study confirmed the association between body weight and the FTO rs9939609 polymorphism. Interestingly, our results showed that, although at baseline the A allele was associated with higher body weight, after 3 years of nutritional intervention with a Mediterranean-style-diet, A-allele carriers had lower body weight gain than wild type subjects. No interaction between nutritional intervention and the polymorphism was found.

Antimicrobial efficacy in vivo of a new formulation of 2-butanone peroxide in n-propanol: comparison with commercial products in a cross-over trial.

The use of hand rub to obtain maximum decrease in bacterial load is important because the reduction needed to avoid transmission is unknown. The monomer of 2-butanone peroxide is a peroxygen derivative with potential biocidal use in hospitals. The aim of this study was to compare the efficacy of hand rub with an alcoholic solution of peroxide 2-butanone versus five antiseptic products, against E. coli K12 (CECT 433) transient flora acquired by hand immersion in a broth culture following the UNE-EN-1500 standard. Isopropanol 60% (control) obtained 99.99% reductions, driving down the bacterial load from 10(6) cfu/mL in the initial inocula to <100 cfu/mL. Products A, B and C (different alcoholic solutions ranging from 65% to 75% with low amounts of biguanidines and/or quaternary ammonium compounds) resulted in significantly lower amounts, reducing initial inocula to approximately 500 cfu/mL. Products D and E (70-75% alcohol solutions containing higher amounts of different quaternary ammonium compounds and triclosan in the case of product E) produced reductions similar to that of isopropanol, with significantly larger reductions than products A, B and C. The product with the solution of 2-butanone peroxide produced the same effect as products D and E with mean reductions of approximately 4log(10) (99.99%), driving the initial inocula down to < or = 100 cfu/mL, despite the low concentration (35%) of propanol in the solution. This novel peroxygen biocide offers high in-vivo cidal activity against acquired E. coli transient flora, offering an alternative to products with higher alcohol concentrations.

Indicadores de infección nosocomial / Nosocomial infection indicators

Los indicadores de infección nosocomial (IN) son una expresión de la calidad asistencial así como de la seguridad de los pacientes durante su estancia en el hospital. La cuantificación de los indicadores de infección se realiza mediante la aplicación de sistemas y/o programas de vigilancia. Los sistemas actuales de vigilancia de IN se basan tanto en estudios de prevalencia como de incidencia. En España se realiza desde el año 1990 el estudio de prevalencia EPINE, promovido por la Sociedad Española de Medicina Preventiva, Salud Pública e Higiene, que ha desarrollado 25 indicadores relacionados con IN en el conjunto de pacientes hospitalizados. Asimismo, desde el año 1994, se realiza el estudio de incidencia ENVIN-HELICS promovido por el Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias que ha desarrollado 9 indicadores relacionados con infección adquirida en unidades de cuidados intensivos (UCI) en pacientes críticos. La participación en ambos sistemas de vigilancia es voluntaria y ha crecido de forma progresiva año tras año. Los dos sistemas de vigilancia ofrecen resultados de diferentes realidades en el entorno de la IN son complementarios entre si y han contribuido a crear una formación y una sensibilización del personal sanitario ante la IN y la seguridad del paciente. Este artículo muestra los indicadores correspondientes al año 2007 obtenidos por ambos programas, así como los estándares de referencia (AU)

Nosocomial infection indicators are a reflection of healthcare quality and patient safety in hospitals. Infection indicators are calculated using surveillance programs and/or systems. Current nosocomial infection surveillance systems are based on both prevalence and incidence studies. Since 1990 the EPINE prevalence study, promoted by the Spanish Society for Preventive Medicine, Public Health and Hygiene, has developed 25 nosocomial infection indicators in hospital patients in Spain. And since 1994 the ENVIN-HELICS incidence study, promoted by the Infectious Diseases Working Group of the Spanish Society for Intensive and Critical Care Medicine and Coronary Units, has developed nine ICU-acquired infection indicators in critical patients. Participation in both surveillance systems is voluntary and has gradually increased over the years. These two control systems present the results of two different situations in the area of nosocomial infection and each complements the other; in addition, they have helped to train health professionals and to raise their awareness of nosocomial infection and patient safety. This article presents the indicators obtained in 2007 through both surveillance programs as well as their standards of reference (AU)

Value of hormonal levels in patients with male androgenetic alopecia treated with finasteride: better response in patients under 26 years old.

BACKGROUND: Finasteride is a 5alpha-reductase inhibitor that has proved to be an effective treatment for men with androgenetic alopecia. OBJECTIVES: To investigate the hormonal influence of finasteride 1 mg daily on hormonal levels and hair growth in men of different ages and with different degrees of alopecia according to the Hamilton-Norwood scale. METHODS: Two hundred and seventy men aged 14-58 years with male androgenetic alopecia III-VI Hamilton-Norwood score (II-III Ebling score) were treated with finasteride 1 mg daily. Steroid hormone (free testosterone, 5alpha-dihydrotestosterone, dehydroepiandrosterone-sulphate, delta4-androstenedione, 17-hydroxyprogesterone), prostate-specific antigen (PSA) and sebum levels, and trichogram changes were determined at baseline, and at 6 and 12 months of treatment. RESULTS: According to significant hormonal statistical analysis, the patients were divided by age (up to or over 26 years). In the group of patients26 years. No variations in sebum levels were observed. CONCLUSIONS: High levels of 5alpha-dihydrotestosterone in patients

[Nosocomial infection indicators]. / Indicadores de infección nosocomial.

Nosocomial infection indicators are a reflection of healthcare quality and patient safety in hospitals. Infection indicators are calculated using surveillance programs and/or systems. Current nosocomial infection surveillance systems are based on both prevalence and incidence studies. Since 1990 the EPINE prevalence study, promoted by the Spanish Society for Preventive Medicine, Public Health and Hygiene, has developed 25 nosocomial infection indicators in hospital patients in Spain. And since 1994 the ENVIN-HELICS incidence study, promoted by the Infectious Diseases Working Group of the Spanish Society for Intensive and Critical Care Medicine and Coronary Units, has developed nine ICU-acquired infection indicators in critical patients. Participation in both surveillance systems is voluntary and has gradually increased over the years. These two control systems present the results of two different situations in the area of nosocomial infection and each complements the other; in addition, they have helped to train health professionals and to raise their awareness of nosocomial infection and patient safety. This article presents the indicators obtained in 2007 through both surveillance programs as well as their standards of reference.

Ofuji papuloerythroderma evolving to cutaneous T-cell lymphoma.

Ofuji papuloerythroderma is an uncommon entity of unknown aetiology, characterized by a pruritic eruption of widespread, red-brown, flat papules that leads to spare skin folds. A number of cases have been described associated with tumour pathology, mainly cutaneous T-cell lymphomas. We report a new case of Ofuji papuloerythroderma evolving to cutaneous T-cell lymphoma in an 85-year-old woman who had been previously diagnosed with papuloerythroderma 7 years previously.

Assessing the residual antibacterial activity of clinical materials disinfected with glutaraldehyde, o-phthalaldehyde, hydrogen peroxide or 2-bromo-2-nitro-1,3-propanediol by means of a bacterial toxicity assay.

This study investigated the use of a rapid bacterial toxicity test for detecting disinfectant residues released by disinfected materials. The test substances included an environmental disinfectant used in hospitals in high-risk areas, such as critical care units or emergency services, and three disinfectants used on clinical devices when a high level of disinfection is required. The test materials were polyurethane, polypropylene, glass, latex and cotton from different instruments and utensils used in hospitals. Of the four test disinfectants, o-phthalaldehyde (OPA) and 2-bromo-2-nitro-1,3-propanediol (BNP) showed the greatest inhibitory activity (as much as 300-fold greater than hydrogen peroxide in the case of OPA) according to the toxicity text. However, with the exception of hydrogen peroxide on latex, it was the most porous test materials, namely latex and cotton, that accumulated the least residue. BNP was the disinfectant that left the least residue on the five test materials, while the greatest residual concentration was left by hydrogen peroxide on latex (as much as 5 microg/cm2). The biotest used in this study permitted the detection of disinfectant residues released by different types of previously disinfected clinical materials, and can be adapted to simulate elution conditions similar to those existing in routine hospital practice.

Myocardial infarction risk in relation to zinc concentration in toenails.

Zn is an essential mineral. The role of Zn in atherosclerosis is not clear. Epidemiological studies, which have reported contradictory results, are limited by the use of serum Zn levels as a marker of intake. We assessed the association of toenail Zn, which integrates dietary Zn intake over 3 to 12 months, with the risk of a first myocardial infarction. Toenail Zn concentrations were determined by neutron activation analysis in the European multi-centre case-control study on antioxidants, myocardial infarction and breast cancer. This multi-centre case-control study included 684 cases and 724 controls from eight European countries and Israel. Toenail Zn levels of controls (adjusted for age and study centre) were positively associated with age, alpha-tocopherol and Se, but not with additional dietary variables or with classical risk factors for CHD. Average toenail Zn was 106.0 mg/kg in cases (95 % CI 103.1, 108.9) and 107.5 mg/kg in controls (95 % CI 104.5, 110.7). After controlling for cardiovascular risk factors and for centre, the adjusted odds ratios of myocardial infarction for quintiles 2-5 of toenail Zn with respect to the first quintile were 0.97 (95 % CI 0.59, 1.58), 1.15 (95 % CI 0.72, 1.85), 0.91 (95 % CI 0.56, 1.50), and 0.85 (95 % CI 0.52, 1.39). The P for trend was 0.45. In conclusion toenail Zn levels (reflecting long-term dietary intake) were not significantly associated with acute myocardial infarction.

Methodological quality and reporting of ethical requirements in clinical trials.

OBJECTIVES: To assess the relationship between the approval of trials by a research ethics committee (REC) and the fact that informed consent from participants (ICP) was obtained, with the quality of study design and methods. DESIGN: Systematic review using a standardised checklist. MAIN MEASURES: Methodological and ethical issues of all trials published between 1993 and 1995 in the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association and the British Medical Journal were studied. In addition, clinical trials conducted in Spain and published by at least one Spanish author during the same period in any other journal were also included. RESULTS: We studied the published articles of 767 trials and found the following indicators of lower methodological quality to be independent predictors for failure to disclose REC approval or ICP: absence of concealment of allocation, lack of justification for unblinded trials, not using a treatment for the patients in the control group, absent information on statistical methods, not including sample size estimation, not establishing the rules to stop the trial, and omitting the presentation of a baseline comparison of groups. CONCLUSION: Trials of higher methodological and scientific quality were more likely to provide information about their ethical aspects.

Determinants of p,p-dichlorodiphenyldichloroethane (DDE) concentration in adipose tissue in women from five European cities.

To identify the determinants of p,p'-dichlorodiphenyldichloroethane (p,p'-DDE) in adipose tissue in subjects who participated in a cross-sectional study, we analyzed fatty acids, antioxidants, and p,p'-DDE in aspirates of adipose tissue of 328 postmenopausal women from 5 European countries. The overall mean of p,p'-DDE concentration was 1.66 microg/g of fatty acids (95% confidence interval = 1.46, 1.88). In a multiple-regression analysis, the main predictors of log10(p,p'DDE) were center of recruitment (p < .0001), adipose arachidic acid (p = .001), and adipose retinol (p = .04). These factors explained 14.9% of the overall variability of log10(p,p'-DDE). In our subjects, adipose tissue p,p'DDE concentrations were only weakly related with biomarkers reflecting intake of fish and other foods. This result is consistent with the notion that p,p'-DDE exists in different foods and, given the widespread contamination of the food chain, is relatively evenly distributed among foods.

Development and testing of a microbiological assay to detect residual effects of disinfectant on hard surfaces.

We describe a glucuronidase bioassay for detecting residual bactericidal activity from the use of disinfectants on hard surfaces; in this assay we used formaldehyde, ethanol, isopropanol, chlorine, and a commercial preparation containing 2-bromo-2-nitro-1, 3-propanediol. Chlorine and the commercial preparation showed bactericidal activity (53.5% and 98.2%, respectively) for a week after disinfection.

Flexible flat feet in children: a real problem?

OBJECTIVES: To estimate the prevalence of flexible flat feet in the provincial population of 4- to 13-year-old schoolchildren and the incidence of treatments considered unnecessary. SETTING: Province of Málaga, Spain. METHODS: We examined and graded by severity a sample of 1181 pupils taken from a total population of 198 858 primary schoolchildren (CI: 95%; margin of error: 5%). The sample group was separated into three 2-year age groups: 4 and 5 years, 8 and 9 years, and 12 and 13 years. The plantar footprint was classified according to Denis1 into three grades of flat feet: grade 1 in which support of the lateral edge of the foot is half that of the metatarsal support; grade 2 in which the support of the central zone and forefoot are equal; and grade 3 in which the support in the central zone of the foot is greater than the width of the metatarsal support. The statistical analysis for the evaluation of the differences between the groups was performed with Student's t and chi2 tests as appropriate. RESULTS: The prevalence of flat feet was 2.7%. Of the 1181 children sampled, 168 children (14.2%) were receiving orthopedic treatment, but only 2.7% had diagnostic criteria of flat feet. When we inspected the sample, we found that a number of children were being treated for flat feet with boots and arch supports. Most of them did not have a flat plantar footprint according to the criteria that we used for this work. Furthermore, in the group of children that we diagnosed as having flat feet, only 28.1% were being treated. We found no significant differences between the number of children receiving orthopedic treatments and the presence or absence of a flat plantar footprint. Children who were overweight in the 4- and 5-year-old group showed an increased prevalence for flat feet as diagnosed by us. CONCLUSION: The data suggest that an excessive number of orthopedic treatments had been prescribed in the province. When extrapolated to the 1997 population of schoolchildren within the age groups studied the figures suggested that approximately 28 167 children in Málaga province probably would have been receiving orthopedic treatments with boots and insoles at the time of our study. Consequently, the total expenditure on orthopedic boots and insoles that year could be estimated as 676 008 000 pesetas ($4 447 422 in US currency).