Prevalencia de obesidad infantil en la Región de Murcia, valorando distintas referencias para el índice de masa corporal / Prevalence of childhood obesity in the Murcia Region; an assessment of different references for body mass index

Introducción: La obesidad infantil es un problema de elevada magnitud y con graves repercusiones en el estado de salud, lo que justifica conocer su prevalencia a nivel local para identificar factores condicionantes y emprender acciones preventivas. El objetivo de este trabajo consiste en estimar la prevalencia de sobrepeso y obesidad en población infantil de la Región de Murcia a partir del índice de masa corporal (IMC) aplicando los criterios de referencia del International Obesity Task Force (IOTF), y comparar estos resultados con los obtenidos con otras referencias de uso frecuente en España. Material y método: Se determinó el IMC correspondiente a 178.894 niños de 2 a 14 años de edad. La prevalencia de sobrepeso y obesidad se valoró según los criterios del IOTF, de los estudios de la Organización Mundial de la Salud, de la Fundación Orbegozo (FO), y del Estudio Transversal Español de Crecimiento (ETEC). La concordancia entre los diferentes resultados fue evaluada mediante el índice kappa. Resultados: La prevalencia, mediante los puntos de corte del IOTF, fue para sobrepeso del 20,6% (IC 95%: 20,4-20,8), para obesidad del 11,4% (IC 95%: 11,2-11,5) y para sobrecarga ponderal del 32% (IC 95%: 31,8-32,2), siendo esta última mayor en niñas (33,2%) que en niños (30,9%). La mayor concordancia se da entre el IOTF y FO-2011 (kappa=0,795), y entre este y el ETEC (kappa=0,794). Conclusiones: Se encontraron altas prevalencias de sobrepeso y obesidad en niños de la Región de Murcia. El ETEC y el estudio FO-2011 mostraron las concordancias más altas con los resultados obtenidos según los criterios del IOTF (AU)

Introduction: Childhood obesity is a problem of high magnitude with serious repercussions on health, which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions. The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region, using the body mass index (BMI) and applying the International Obesity Task Force (IOTF) criteria, and to compare these results with the ones obtained from other frequently used references in Spain. Material and methods: The BMI of 178,894 children aged from 2 to 14 years was determined. The prevalence of overweight and obesity was compared to the IOTF, to the studies of the World Health Organization, as well as those of the Orbergozo Foundation (FO), and the Cross sectional Spanish Growth Study (ETEC) references. The agreement between the different results was evaluated using the kappa index. Results: The evaluation using the IOTF cut-off points gave an overweight prevalence of 20.6% (95% CI: 20.4-20.8), an obesity prevalence of 11.4% (95% CI: 11.2-11.5) and an overweight plus obesity prevalence of 32% (95% CI: 31.8-32.2), with this last one being higher in girls (33.2%) than in boys (30.9%). The highest agreement is between IOTF and FO-2011 (kappa = .795) and between FO-2011 and ETEC (kappa = .794). Conclusion: A high prevalence of overweight and obesity in children in the Region of Murcia was found. The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria (AU)

[Prevalence of childhood obesity in the Murcia Region; an assessment of different references for body mass index]. / Prevalencia de obesidad infantil en la Región de Murcia, valorando distintas referencias para el índice de masa corporal.

INTRODUCTION: Childhood obesity is a problem of high magnitude with serious repercussions on health, which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions. The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region, using the body mass index (BMI) and applying the International Obesity Task Force (IOTF) criteria, and to compare these results with the ones obtained from other frequently used references in Spain. MATERIAL AND METHODS: The BMI of 178,894 children aged from 2 to 14 years was determined. The prevalence of overweight and obesity was compared to the IOTF, to the studies of the World Health Organization, as well as those of the Orbergozo Foundation (FO), and the Cross-sectional Spanish Growth Study (ETEC) references. The agreement between the different results was evaluated using the kappa index. RESULTS: The evaluation using the IOTF cut-off points gave an overweight prevalence of 20.6% (95% CI: 20.4-20.8), an obesity prevalence of 11.4% (95% CI: 11.2-11.5) and an overweight plus obesity prevalence of 32% (95% CI: 31.8-32.2), with this last one being higher in girls (33.2%) than in boys (30.9%). The highest agreement is between IOTF and FO-2011 (kappa=.795) and between FO-2011 and ETEC (kappa=.794). CONCLUSION: A high prevalence of overweight and obesity in children in the Region of Murcia was found. The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria.

Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases.

AIM: In patients with two-stage hepatectomy (TSH) for multiple bilobar liver metastases from colorectal cancer, few clinical series compare functional remnant hypertrophy of the liver volume between right portal vein ligation (PVL) and embolisation (PVE). Our objective is to analyse the effectiveness of portal vein ligation to achieve hypertrophy of the functional remnant volume (FRV) of the liver and to compare the results with portal vein embolisation in a series of patients with multiple bilobar liver metastases from colorectal carcinoma. PATIENTS AND METHODS: Between September 2001 and September 2011 we performed a TSH in 41 patients with multiple bilobar colorectal liver metastases. A right PVL was performed in 23 patients with an insufficient FRV (three patients did not complete the second stage due to tumour progression and were excluded). We prospectively compare these results with the increased remnant volume obtained in 18 patients with right PVE. RESULTS: The median FRV was higher in the patients with PVE, rising from 501 ml (range 309-703) to 636 ml (range 387-649), than those with PVL, rising from 510 ml (range 203-824) to 595 ml (range 313-1213) (p < 0.05). The median %FRVI was higher in the patients with PVE (median 40%; range 21-65%) than those with PVL (median 30%; range 21-60%) (p < 0.05). CONCLUSIONS: PVL and PVE were effective in all cases for obtaining hypertrophy of the FRV before major liver resection. Right PVE obtains better results and should be used where necessary to achieve a further increase in volume.

Prognostic value of histological and immunohistochemical characteristics for predicting the recurrence of medullary thyroid carcinoma.

INTRODUCTION: In medullary thyroid carcinoma, there is currently no consensus about the prognostic value of histological and immunohistochemical parameters. This study was designed to analyze the value of various histological and immunohistochemical characteristics for predicting the recurrence of medullary carcinoma. METHODS: A total of 55 cases of medullary thyroid carcinoma have been reviewed. These were operated on consecutively between 1971 and 2004 after histological confirmation. The data referring to clinical characteristics and evolution were taken from the patient's clinical history. The macroscopic, microscopic, and immunohistochemical characteristics of the tumors were taken from the pathological anatomy report. RESULTS: In 14 (27%) cases, there was recurrence of the disease. The disease-free interval at 1 year was 88 +/- 5%; at 5 years 73 +/- 7%; at 10 years 73 +/- 7%; at 15 years 61 +/- 10%; and at 20 years or more 61 +/- 10%. Of the histological parameters, only vascular invasion (0.0098) was related to a higher relapse rate. No epidemiological variable or immunohistochemical marker was associated with relapse. However, it was found that staging (P = 0.0102), as well as tumor size (P = 0.0211) and lymph node affectation (P = 0.0012), are factors significantly related to relapse of the disease. According to Cox's regression model, the only variable with a statistically significant effect was vascular invasion (P = 0.0056; odds ratio = 5.2308). CONCLUSIONS: The overall recurrence rate was 27%, and the main independent prognostic factor of recurrence was tumoral vascular invasion at diagnosis. Staging, tumor size, and lymph node metastasis are prognostic factors of recurrence, although they are not significant in the multivariate analysis.

Suspicion of elder abuse in South Eastern Spain: the extent and risk factors.

Elder abuse is recognized internationally as a growing problem. Recent years have seen an increase in the number of authors recommending that the MDs systematically question old people concerning possible abuse. The aim of our study was to ascertain the extent of suspicion of elder abuse and the different types of abuse. We design a cross-sectional survey including 460 patients > or = 65 years at different health centers (South East Spain). A face-to-face interview and a physical examination was carried out. Extent of suspected abuse was 44.6%. Female sex, > or = 75 years, widowhood, living alone or with children, accommodation in house of relatives and income < or = 300 euros/month were the associated sociodemographic variables. The risk factors associated are recent worsening of health, living with a mentally ill person, excessive consumption of alcohol or illegal drugs, arguing frequently with relatives or the dependence on someone to carry out a daily activity. The signs in the physical examination associated are dehydration/malnutrition, pressure ulcers and poor body and/or mouth hygiene. There is a high extent of suspicion of elder abuse and the keyword in this respect is prevention.

Validity of self reported diagnoses of cancer in a major Spanish prospective cohort study.

INTRODUCTION: This study aims to assess the validity of self reported diagnoses of cancer by persons recruited for the Spanish EPIC (European prospective investigation into cancer and nutrition) cohort study and to identify variables associated with correctly reporting a diagnosis of cancer. METHODS: 41 440 members of EPIC were asked at the time of recruitment whether they had been diagnosed with cancer and the year of diagnosis and site. The process of validating self reported diagnoses of cancer included comparison of the cohort database with the data from the population based cancer registries. Cancer diagnostic validity tests were calculated. The association between a correct report and certain sociodemographic, tumour related, or health related variables were analysed by logistic regression. RESULTS: The overall sensitivity of self reported diagnoses of cancer is low (57.5%; 95% CI: 51.9 to 63.0), the highest values being shown by persons with a higher level of education or with a family history of cancer and the lowest values by smokers. Breast and thyroid cancers are those with the highest diagnostic validity and uterus, bladder, and colon-rectum those with the lowest. In both sexes the variables showing a significant association with a correct report of cancer are: higher education level, number of previous pathologies, invasive tumour, and, in women, a history of gynaecological surgery. CONCLUSIONS: The overall sensitivity of self reported diagnoses of cancer is comparatively low and it is not recommended in epidemiological studies for identifying tumours. However, self reported diagnoses might be highly valid for certain tumour sites, malignant behaviour, and average to high levels of education.

Primary care confidentiality for Spanish adolescents: fact or fiction?

BACKGROUND: By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to an adolescent seeking medical care. Little is known, however, about confidentiality for adolescents in primary care practices in Spain. OBJECTIVE: To ascertain the attitudes of Spanish family doctors towards the right of adolescents to confidentiality in different healthcare situations and in the prescription of treatment. METHOD: A descriptive postal questionnaire was self-administered by family doctors. RESULTS: Parents of patients under 18 years are always informed by 18.5% of family doctors, whereas parents of those under 16 years are informed by 38.8% of doctors. The patients are warned of this likelihood by 79.3% of doctors. The proportion of doctors supporting confidentiality for adolescents increases with the age and maturity of the patients, whereas workload and previous training has a negative effect. CONCLUSIONS: Spanish laws on adolescent healthcare are not reflected by the paternalistic attitude that Spanish primary care doctors have towards their adolescent patients. Doctors need to be provided with up-to-date and clinically relevant explanations on contemporary legal positions. In primary care, more attention should be paid to adolescents' rights to information, privacy and confidentiality. Doctors should be more aware of the need to encourage communication between teenagers and their parents, while also safeguarding their patients' rights to confidential care.

Estudio del crecimiento en niños desde el nacimiento hasta los 9 años de edad en Valencia / No disponible

Fundamento: El crecimento en el niño está condicionadopor diversos factores. El objetivo del estudio fue establecerel desarrollo longitudinal de los niños de Valencia,basándonos en los cambios socioculturales que se hanproducido en los últimos años y comparando estos patronesde crecimiento con otros previamente establecidos.Método: Un total de 316 niños sanos cumplían los criteriosy participaron en el estudio. Los niños habían nacidoen Valencia en 1991 y su seguimiento cubrió el periododesde su nacimiento hasta los 9 años. Periódicamentese recogieron datos sobre el peso, la altura y el perímetrocefálico que se compararon con las tablas de referenciapara la población española.Resultados: Se ha observado un menor peso al nacimientoque se compensa a los 3 meses comparado conla población de referencia. Los niños estudiados, tantoniños como niñas, presentan mayor altura, incrementoestadísticamente significativo en las niñas de nuestro estudioen relación con la población de referencia.Conclusiones: Observamos cambios antropométricos enla población estudiada en el nacimiento, 3 meses, 6 añosy 9 años en relación con la población de referencia. Sonnecesarios estudios antropométricos de crecimiento continuadosque permitan en cada momento evaluar a losniños en relación a patrones de referencia adecuados

Background: The child growth is conditioned by diversefactors. This study aims at establishing the longitudinaldevelopment of children in Valencia based on socio-culturalchanges produced in recent years, and at comparingthese growth patterns to other previously conductedSpanish studies.Methods: A total of 316 healthy infants fulfilled the studycriteria and participated in it. Children were born in Valencia(Spain) in 1991. Follow-ups covered the periodfrom their birth to 9 years of the age. Periodically weight,height, head circumference data were collected and theirevolution was compared with the Spanish traditionalpopulation reference data.Results: A lower birth weight was observed which iscompensed at 3 months of age compared with the referencepopulation. Boys and girls in the study showed a higherheight compared to the reference population. Thisincrement was statistically significant in girls in relationto the reference population.Conclusion: We observed anthropometric changes in thestudied population at birth, 3 months, 6 years and 9years in relation to the population of reference. Continuedanthropometric studies of growth which permit to evaluatechildren growth in relation to reference patterns arenecessary

Symmetrical fetal growth retardation after gestational cocaine exposure in the rat.

Cocaine use during pregnancy results in an increase in different maternal and perinatal complications. The fetal effects of cocaine could be mainly related to the disturbances in the brain development, microcephaly being the most common brain abnormality. The aim of this study was to analyze maternal outcome and fetal somatic effects of cocaine and to evaluate the hypothesis that maternal cocaine exposure would specifically impair fetal global brain development. Fifty-four timed-pregnant female Sprague-Dawley rats were daily injected with 15 or 40 mg/kg per day from gestational day (GD) 1 or 8 and sacrificed at gestational day 20. By analyzing different maternal and fetal outcomes, it could be suggested that the cocaine exposure in pregnant rats decreased maternal weight gain without significant maternal mortality, did not affect the mean number of fetuses by litter, although notably increased stillbirths, reduced fetal birth weight, and reduced the fetal central nervous system weight. Present results are globally in agreement with the literature and underline a possible selective effect of cocaine on the fetal CNS resulting in symmetrical intrauterine fetal growth retardation in contrast to the asymmetrical retardation of undernutrition.

[Longitudinal study of the growth of preterm newborn infants]. / Estudio longitudinal de crecimiento de recién nacidos pretérmino.

BACKGROUND: The growth and nutrition of premature infants should be accurately assessed. To do this, reference values of normality, obtained from population to be studied, are required. OBJECTIVES: To study the postnatal growth of premature infants in our environment and to compare their growth with intrauterine growth (Lubchenco et al). PATIENTS: A total of 103 premature infants born at 28-36 weeks of gestation in the Virgen de la Arrixaca University Children's Hospital in Murcia (Spain) from April 1994 to June 1995 were studied. Children who received medical care during the first 24 hours of life and who had no prenatal condition that could affect their growth were selected. Those who suffered from serious disease were excluded. The study was carried out from birth to a postconceptional age of 48-52 weeks. The 2-step regression model was used to calculate the percentile graphs. RESULTS: Percentile growth graphs were drawn up for the following variables: weight, length, arm circumference, head circumference, subscapular fold, and tricipital fold. In premature infants, postnatal growth in weight and length was uniform, progressive, and practically linear and did not show the flattening that is characteristic of intrauterine growth. Other corporal segments such as the head and arm circumference showed a certain slowing down at a postconceptional age of 42 or 43 weeks, and the folds showed a moderate dispersion of values as the study progressed. CONCLUSIONS: Intrauterine growth charts do not accurately assess postnatal growth in premature infants.

Estudio longitudinal de crecimiento de recién nacidos pretérmino / Longitudinal study of the growth of preterm newborn infants

Antecedentes. Es importante la valoración adecuada del crecimiento y nutrición de los recién nacidos pretérmino. Es preciso para ello disponer de valores de referencia de normalidad, obtenidos de la población que se va a estudiar. Objetivos. Estudiar el crecimiento posnatal de nuestros recién nacidos pretérmino, y comparar este crecimiento con el crecimiento intrauterino. Pacientes. Se incluyen 103 recién nacidos pretérmino de 28 a 36 semanas de gestación, ingresados en el Hospital Universitario Infantil Virgen de la Arrixaca de Murcia en el período comprendido entre abril de 1994 y junio de 1995. Se seleccionaron niños captados en las primeras 24 h de vida, sin condiciones prenatales que afectaran al crecimiento. Se excluyeron aquellos que sufrían enfermedad grave. Se realizó el estudio desde el nacimiento hasta las semanas 48 a 52 de edad posconcepcional. Se utilizó el modelo de regresión en dos etapas como método estadístico para el cálculo de las gráficas de percentiles. Resultados. Se construyeron gráficas de crecimiento de percentiles para los siguientes parámetros: peso, longitud, perímetro de brazo, perímetro cefálico, pliegue subescapular y pliegue tricipital. El crecimiento posnatal de los recién nacidos pretérmino en peso y longitud es uniforme, progresivo, prácticamente lineal, y no muestra el aplanamiento característico del crecimiento intrauterino. Otros segmentos corporales como perímetro cefálico, perímetro de brazo, experimentan una cierta disminución de la velocidad de crecimiento a las 42 o 43 semanas de edad posconcepcional, los pliegues muestran moderada dispersión de valores al avanzar el período de estudio. Conclusiones. Las gráficas de crecimiento intrauterino no son adecuadas para valorar el crecimiento posnatal del recién nacido pretérmino (AU)

[Physical sports activity in a representative sample of the population of Región de Murcia, Spain]. / Actividad física deportiva en una muestra representativa de la población de la Región de Murcia.

OBJECTIVE: To estimate the prevalence of intense physical activity according to age and sex in the region of Murcia, Spain, and to analyze its association with major demographic and socioeconomic determinants and other cardiovascular risk factors. METHODS: Survey of a representative sample of the population aged between 18 and 65 years from Murcia was performed using multistage random sampling with definition of the sample quotas. A total of 3091 individuals were surveyed. The frequency and duration of intense physical sports activity during the two weeks prior to the survey was obtained using a validated questionnaire. Information was also collected on socioeconomic variables, smoking, blood pressure, weight and height and a blood test was performed to determine plasma lipids. Intense or vigorous physical activity (> or = 6 Metabolic Equivalents [MET]) was measured in kcal/day and reduced to hours/week to give three categories: no vigorous physical activity, less than 2 hours/week, and 2 hours/week or more. RESULTS: Overall, 17.8% (95% CI: 16.6-19.0) of the adult population of the region of Murcia performed intense physical activity for > or = 2 hours/week. The figures were twice as high in men (23.1%; 95% CI: 21.0-25.2) than in women (12.5%; 95% CI: 10.9-14.1). In the logistic regression analysis, a higher frequency of intense physical activity was associated with age, level of education and employment situation. In men it was also associated with occupation and residence in urban areas. CONCLUSIONS: During the study period, one in five adults in the region of Murcia took intense physical sports activity with a frequency and duration that were compatible with the prevention of episodes of coronary ischemia.

Actividad física deportiva en una muestra representativa de la población de la Región de Murcia / Physical sports activity in a representative sample of the population of Región de Murcia, Spain

Objetivo: Estimar la prevalencia de realización de actividad física (AF) deportiva intensa en la Región de Murcia según sexo y edad y analizar su asociación con los principales determinantes demográficos, socioeconómicos, así como con otros factores de riesgo cardiovascular. Método: Encuesta sobre una muestra representativa de la población de 18 a 65 años de la Región de Murcia mediante un muestreo aleatorio polietápico con definición de cuotas muestrales. El número de personas entrevistadas fue de 3.091.Se recogió, a través de un cuestionario validado, la frecuencia y duración de realización de AF intensa deportiva durante las 2 semanas previas a la realización de la encuesta. Además, se obtuvo información sobre variables socioeconómicas, hábito tabáquico, presión arterial, peso, talla y una analítica de sangre para determinar los lípidos plasmáticos. La AF intensa o vigorosa ( 6 equivalentes a la tasa metabólica basal) se midió en kcal/día y se redujo a h/sem, considerando 3 categorías diferentes: ninguna AF, menos de 2 h/sem, e igual o más de 2 h/sem. Resultados: Globalmente, el 17,8 per cent (intervalo de confianza [IC] del 95 per cent, 16,6-19,0) de la población adulta de la Región de Murcia realiza AF intensa 2 h/sem. Por sexos las cifras varían siendo el doble en varones (23,1 per cent; IC del 95 per cent, 21,025,2) que en las mujeres (12,5 per cent; IC del 95 per cent, 10,9-14,1). En el análisis mediante regresión logística la mayor frecuencia de realización de AF deportiva intensa se asoció con la edad, el nivel de estudios y la situación de empleo. En los varones, además, con la ocupación y la residencia en áreas urbanas. Conclusiones: En el período de estudio, una de cada 5 personas adultas en la Región de Murcia realizó AF deportiva intensa con una frecuencia y duración compatible con la prevención de episodios isquémicos coronarios (AU)

Role of appendectomy in training for laparoscopic surgery.

BACKGROUND: This study aimed to evaluate a program of training in laparoscopic surgery based on clinical practice in the emergency room, in which laparoscopic appendectomy is the first technique that residents perform as surgeons. METHODS: A prospective nonrandomized study was conducted involving all the laparoscopies performed in emergencies with a diagnosis of acute abdomen, appendicular in origin, during the period between June 1991 and December 1997. RESULTS: There were no statistically significant differences between residents and assistants in terms of conversion rates (22/242 vs 15/158), mean hospital stay for each type of surgeon (5.2 days for residents and 5.1 days for assistants), and complications (12.8% for residents and 13.7% for assistants). Operating time, was significantly longer (p < 0.05) for residents (52.2 min) than for assistants (48 min). CONCLUSIONS: Apprenticeship in laparoscopic appendectomy can be accomplished with gradual clinical training and without the need for resort to animal experimentation laboratories.

[Invasive pneumococcal disease in children in the region of Murcia (Spain)]. / Enfermedad neumocócica invasiva en niños de la Región de Murcia.

OBJECTIVE: Because of the availability of a conjugate pneumococcal vaccine, the incidence and characteristics of invasive pneumococcal disease in children in the region of Murcia should be determined. This would provide information that could be useful for properly establishing the indications for vaccination. METHODS: A retrospective search was conducted for cases of invasive Streptococcus pneumoniae in children aged less 15 years old treated in hospitals in Murcia from 1991-2000. The data sources were the databases of the microbiology services, the Minimum Data Set, the Pediatric Admissions Register and the EDO Register. RESULTS: The incidence rate for the period 1996-2000 was 18.25 per 105 children per year for children aged under 1 year in the case of invasive disease (10.6 for meningitis), 13.6 for those under 2 years for invasive disease (6 for meningitis), 8.9 for those under 5 years (1.35 for meningitis) and 3.7 for those under 15 years (1.3 for meningitis). Twenty-eight percent of the patients presented risk factors. Complications occurred in 35.2% and sequelae occurred in 5%. The mortality rate was 11.8%. The prevalent serogroups were 19, 6, 18, 5, 14 and 23. CONCLUSIONS: The high percentage of patients with risk factors for invasive pneumococcal disease suggests the need to implement vaccination programs aimed at risk groups. Although the incidence of invasive pneumococcal disease in the region of Murcia differs from that in other areas, the incidence of meningitis is similar to that reported by other studies. Because of the severity of the disease, cost-effectiveness studies to evaluate the possible incorporation of the vaccine in the vaccination calendar are justified.

Enfermedad neumocócica invasiva en niños de la Región de Murcia / Invasive pneumococcal disease in children in the region of Murcia, Spain

Objetivo: La disponibilidad de una vacuna neumocócica conjugada plantea la necesidad de conocer la incidencia y características de la enfermedad neumocócica invasiva en niños de la Región de Murcia, con la finalidad de obtener información que pueda ser de utilidad para establecer adecuadamente las indicaciones de vacunación. Métodos: Se ha realizado una búsqueda retrospectiva de casos de enfermedad invasiva por Streptococcus pneumoniae en menores de 15 años de edad atendidos en hospitales de la Región de Murcia durante el período 1991-2000. Las fuentes de datos utilizadas han sido las bases de datos de los Servicios de Microbiología, el Conjunto Mínimo de Datos Básicos, registro de altas pediátricas y Registro EDO. Resultados: La tasa de incidencia para el período 1996-2000 fue, para los menores de 1 año, de 18,25 por 105 personas año en el caso de enfermedad invasiva (10,6 para meningitis); para los menores de 2 años, de 13,6 para enfermedad invasiva (6 para meningitis); para menores de 5 años, de 8,9 (1,35 para meningitis), y para los menores de 15 años, de 3,7 (1,3 para meningitis). El 28 por ciento de los casos presentaba factores de riesgo. Las complicaciones alcanzaron el 35,2 por ciento y las secuelas el 5 por ciento. La letalidad fue del 11,8 por ciento. Los serogrupos prevalentes fueron el 19, el 6, el 18, el 5, el 14 y el 23. Conclusiones: El alto porcentaje de casos con factores de riesgo de enfermedad neumocócica invasiva aconseja la implantación de programas de vacunación dirigidos a todos los niños con factores de riesgo. La incidencia de enfermedad neumocócica invasiva encontrada en la Región de Murcia difiere de la de otras zonas geográficas; sin embargo, la incidencia de meningitis es similar a la de otros estudios. La gravedad de la enfermedad justifica la realización de estudios coste-efectividad para valorar la posible incorporación de la vacuna en el calendario vacunal. (AU)

Extremely high prevalence of overweight and obesity in Murcia, a Mediterranean region in south-east Spain.

OBJECTIVE: To estimate the prevalence of obesity in the Murcia Region according to age and sex, and to analyse how obesity is related to demographic and socio-economic determinants and to other cardiovascular risk factors of interest to the community. DESIGN: Survey on a representative population sample using multi-stage random sampling with definition of the sample quotas. SUBJECTS: A total of 3091 persons aged 18-65 y residing in the Murcia Region. MEASUREMENTS: : The following data were collected: socio-economic data; tobacco smoking; recent physical activity; blood pressure; weight; height; and blood analysis to determine plasma lipids. Obesity was defined by body mass index (BMI)> or =30. Intense or vigorous physical activity (VPA> or =6 equivalents to baseline metabolic rate or METs) was measured in kilocalories per day and reduced to hours per week. RESULTS: In all, 20.5% of the adult population of the Murcia Region is obese, and 40.9% is overweight. In the logistic regression analysis, obesity in men is associated with age and level of education. In women it is associated with age, level of education, living in a non-urban area and being a housewife. When adjusted for socio-economic variables and for other cardiovascular risk factors the effect of age and level of education disappears in men and it is directly associated with hypertension and hypertriglyceridaemia and inversely related to more than 2 h VPA per week. Obesity in women is associated positively with age, hypertension, hypertriglyceridaemia and little VPA, and inversely with level of education. CONCLUSIONS: In the Murcia Region 61.4% of the adult population presents with some form of excess weight. The prevalence of obesity (BMI> or =30) is greater in women (23.7%; CI 95% 19.7-27.7) than in men (17.3%; CI 95% 15.3-19.3). The widespread nature of this factor makes it a mass problem that requires generalised interventions to prevent it.

Value of 99mTc-MIBI scintimammography in women with impalpable breast lesions seen on mammography.

OBJECTIVE: To find out if 99mTc-methoxyisobutylisonitrile scintimammography (MIBI) is useful in the evaluation of impalpable breast lesions in women referred for biopsy after mammography screening. DESIGN: Observational and prospective study. SETTING: Radiological screening campaign in Spain. PATIENTS: 36 patients referred between September 1997 and June 1998 (37 biopsies) with impalpable breast lesions referred consecutively from a screening campaign. Ages ranged from 50 to 64 years. INTERVENTIONS: Mammography, ultrasound, MIBI, and wire-guided biopsy. MAIN OUTCOME MEASURES AND RESULTS: Mean values for sensitivity, specificity, positive predictive value, and negative predictive value for scintimammography were 78.9, 72.2, 75, and 76.5 respectively (p = 0.002). The logistic regression analysis showed that 99mTc-MIBI scintimammography result predicted (p = 0.003) the risk of breast cancer in this group of patients (odds ratio: 9.75), particularly infiltrating ductal carcinoma. CONCLUSIONS: MIBI scintimammography in patients referred for biopsy after mammography screening does not so much rule out cancer as confirm the diagnosis. Its practical benefit would be not so much avoiding biopsy for these patients as aiding in planning the radicality of their excision.

Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery.

We sought to determine the analgesic efficacy, opioid-sparing effects, and tolerability of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) after spinal fusion surgery. Forty-two patients undergoing spinal stabilization surgery were randomized into two groups, which were given either an IV placebo or an IV injection of 2 g propacetamol every 6 h for 3 days after surgery. The postoperative opioid analgesic requirement was assessed with a PCA device used to self-administer morphine. Pain relief was evaluated by a visual analog pain scale and by verbal rating scores of pain relief at 8-h intervals for up to 72 h after surgery. The cumulative dose of morphine at 72 h was smaller in the Propacetamol group than in the Placebo group (60.3 +/- 20.5 vs 112.2 +/- 39.1 mg; P < 0.001). The pain scores were significantly lower in the Propacetamol group measured at two intervals of the study, although visual analog scale pain intensity scores were smaller than 3 in both groups. Most patients in the Placebo group obtained a greater degree of sedation on postoperative Day 3 (P < 0.05). This study demonstrates the usefulness of propacetamol as an adjunct to PCA morphine in the treatment of postoperative pain after spinal fusion.

Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study.

INTRODUCTION: The extrathyroid spread (ETS) is one of the risk factors that influence mortality and recurrence in patients with papillary carcinoma of the thyroid (PCT). The aim of this study is to analyze the clinical and histologic features and follow-up of a series of patients with ETS undergoing surgery for PCT and to identify patients with a greater risk of presenting with ETS. MATERIAL AND METHODS: Retrospective study of a series of 200 patients undergoing surgery for PCT, of whom 47 (23.5%) presented with ETS. The clinical and histologic features and follow-up of the patients with ETS were compared with those without ETS using the Pearson chi(2) test. We used a logistics regression model to perform a multivariant analysis for ETS. The survival and disease-free interval rates were calculated using the Kaplan-Meier method. RESULTS: ETS is most associated with patients over 50 years of age, with tumors over 4 cm that are not encapsulated, with lymph node metastasis, and with certain PCT histologic subtypes after the multivariant analysis. The overall rate of recurrence and mortality in patients with ETS was much higher than in patients without ETS. CONCLUSIONS: PCT patients with ETS have a greater risk of tumor-related recurrence and mortality than patients without ETS. There are patients with certain clinical and histologic features who have a greater risk of presenting with ETS.