Percepción de intimidad de los pacientes atendidos en los servicios de urgencias hospitalarios de Aragón / Patients' perception of privacy during emergency department care in hospitals in Aragon, Spain

Objetivo: Analizar el respeto a la intimidad de los pacientes en el ámbito de los servicios de urgencias hospitalarios (SUH) de Aragón. Método: Estudio prospectivo llevado a cabo mediante la cumplimentación de un cuestionario por parte de los pacientes sobre la valoración del respeto a la intimidad durante su asistencia en los SUH de diferentes hospitales de Aragón, con respuestas de cinco opciones graduales de escala Likert. Se realizó un muestreo estratificado aleatorio de los pacientes dados de alta de cada uno de los servicios incluidos. Resultados: Se analizaron 3.949 cuestionarios de pacientes. La intimidad auditiva fue valorada con una puntuación media de 3,93 (mínimo 1, máximo 5), (IC95%: 3,89-3,96). En cuanto a la privacidad visual, la puntuación media fue de 4,32 (IC 95% 4,29-4,35). La intimidad global obtuvo una puntuación media de 4,17 (IC 95% 4,15-4,21).Se halló mayor puntación en los varones vs mujeres en la intimidad auditiva (3,97 vs3,90, p < 0,05), en la intimidad visual (4,35 vs 4,30, p < 0,05) y en la intimidad global(4,21 vs 4,16, p < 0,05). Los centros privados y los de tamaño pequeño obtuvieron mejores puntuaciones en todos los ámbitos de la intimidad estudiados (p < 0,01).Conclusiones: La percepción de los pacientes sobre el respeto a la intimidad en losSUH es valorada como adecuada entre un 64-92%, y la peor puntuada fue la intimidad auditiva. Aunque las valoraciones pueden considerarse positivas, dado que evaluamos un derecho, ha de intentar alcanzarse el 100% en la percepción de respeto de la intimidad por parte de todos los pacientes (AU)

Objective: To analyze patients' perception of respect for their privacy in hospital emergency departments in Aragon. Methods: In a prospective survey patients were asked to evaluate respect for their privacy while they were treated in hospital emergency departments. Assessments were expressed on a 5-point Likert scale. The study population was a stratified random sample of patients discharged from each of the participating hospital emergency departments. Results: A total of 3949 patient questionnaires were analyzed. The mean score for auditory privacy was 3.93 (range, 1-5;95% CI, 3.89-3.96). The mean score for visual privacy was 4.32 (95% CI, 4.29-4.35). The overall privacy score was a mean of 4.17 (95% CI, 4.15-4.21). The mean scores for men were higher for auditory privacy (3.97 vs 3.90 for women, P<.05), visual privacy (4.35 vs 4.30, P<.05), and overall privacy (4.21 vs 4.16, P<.05). Private and small hospitals received better scores on all aspects of privacy (P<.01).Conclusions: Privacy is adequately respected in hospital emergency departments according to 64% to 92% of patients. Auditory privacy is the aspect that receives the lowest ratings. Although these scores can be considered positive, we must attempt to achieve a higher level that will be perceived as fully respectful given that privacy is a basic patient right (AU)

Percepciones de pacientes y profesionales sanitarios sobre la calidad de la atención a personas diabéticas / Patient and health professional perceptions on the quality of care provided to diabetic patients

Objetivo. Describir la percepción y el conocimiento de pacientes y profesionales sanitarios (PS) sobre los factores que influyen en la calidad y continuidad asistencial de los cuidados prestados en atención primaria a personas diabéticas. Material y métodos. Estudio cualitativo de trayectoria fenomenológica. Participantes: profesionales médicos y de enfermería que trabajan en diferentes centros de atención primaria de Zaragoza y pacientes con diabetes atendidos en esos centros. Entre febrero y marzo de 2010 se realizaron 2 entrevistas grupales (grupos de discusión) y 6 individuales. Se siguió un guión preestablecido con las variables a explorar. Resultados. Los pacientes y profesionales entrevistados identificaron dificultades para asumir la diabetes como una enfermedad crónica. Se observaron como factores relacionados con problemas en el cambio de hábitos y estilos de vida el sexo (las mujeres mostraron mayores dificultades para el cambio), el tipo de trabajo y la situación de actividad laboral. Por parte de los profesionales entrevistados, se identificaron como factores favorecedores la existencia de guías y protocolos y la motivación personal, y como factores que dificultan la asistencia, la falta de tiempo y los sistemas de información existentes. Hay discrepancias entre los profesionales respecto al papel de grupos de pacientes y asociaciones. Conclusiones. En el diseño de intervenciones para la modificación de estilos de vida de los pacientes diabéticos se deben tener en cuenta las dificultades para el cambio ligadas al sexo y la situación laboral de los pacientes(AU)

Objective. To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. Material and methods. A qualitative study using a phenomenological perspective. Participants. Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. Results. The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. Conclusions. It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients(AU)

[Patient and health professional perceptions on the quality of care provided to diabetic patients]. / Percepciones de pacientes y profesionales sanitarios sobre la calidad de la atención a personas diabéticas.

OBJECTIVE: To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. MATERIAL AND METHODS: A qualitative study using a phenomenological perspective. PARTICIPANTS: Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. RESULTS: The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. CONCLUSIONS: It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients.

Efectividad y seguridad de la terapia de rescate en pacientes VIH / Safety and effectiveness of salvage therapy in HIV patients

Introducción: En pacientes VIH el tratamiento aplicado tras el fracaso de al menos dos líneas de tratamiento antirretroviral se denomina pauta de rescate. El estudio pretende describir las características de pacientes VIH a los que se aplica pauta de rescate, y conocer la efectividad y seguridad del tratamiento con tipranavir (TPV), darunavir (DRV), enfuvirtida (ENF) y etravirina (ETR) combinados con un régimen antirretroviral optimizado. Pacientes y método Pacientes VIH en tratamiento con ENF, TPV, DRV o ETR, en el servicio de infecciosas de un hospital de tercer nivel, que han estado al menos 12semanas en tratamiento. Se describen las características de los pacientes y se analiza la efectividad, durabilidad y adherencia a los tratamientos. Resultados Se estudian 28 pacientes, con una media de 10 pautas de tratamiento antes del inicio con pauta de rescate (DE=3,5) (IC 95%: 8,9-11,1). En el 85,7% de las pautas los pacientes presentaron una adherencia del >90%. El 70,8% de las líneas con ENF se suspendieron durante el seguimiento. Tras la pauta de rescate se duplicó el porcentaje de casos con carga viral (CV)<400copias/ml y casi se triplicaron los casos con CV indetectable (<50copias/ml). Los tratamientos empleados no produjeron alteraciones a nivel hepático o renal, pero alteraron el perfil lipídico y aumentó el porcentaje de pacientes con hiperglucemia. Conclusiones Las pautas de rescate estudiadas han sido efectivas. La buena adherencia del paciente al tratamiento es primordial para la efectividad del mismo (AU)

Introduction: The treatment used after failure of at least two lines of antiretroviral treatment in HIV patients is called salvage therapy. The study aims to describe the characteristics of HIV patients subjected to such a regimen, and determine the safety and effectiveness of treatment with tipranavir (TPV), darunavir (DRV), enfuvirtide (ENF) and etravirine (ETR) combined with an optimised antiretroviral regimen. Patients and methods: HIV patients treated with ENF, TPV, DRV or ETR in a tertiary hospital infectious diseases department subjected to at least 12 weeks treatment. The patient characteristics are described and the effectiveness, durability and adherence to the treatment analysed. Results: There were 28 patients studied, with an average of 10 treatment regimens prior tostarting salvage therapy (SD = 3.5; 95 % CI, 8.9-11.1). A total of 85.7 % patients had treatment adherence > 90 %. For ENF, 70.8 % of the treatment lines were suspended during follow-up. After salvage therapy, the percentage of patients with viral load (VL) < 400 copies/ml doubled, and cases with undetectable CV (< 50 copies/ml) almost tripled. The treatments used did not change the liver or kidney profiles; however, they changed the lipid profile and increased the percentage of patients with hyperglycaemia. Conclusions: The salvage therapy studied was effective. Good adherence to the therapy is critical for its effectiveness (AU)

Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple / Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis

Objetivo Estudiar la frecuencia de discontinuación y el grado de adherencia en la primera línea de tratamiento con interferón beta (INFβ) en pacientes con esclerosis múltiple (EM), identificando sus causas y factores asociados. Método Estudio observacional retrospectivo que incluyó pacientes con EM clínicamente definida en tratamiento con INFβ durante el año 2001 en el área de pacientes externos de un servicio de farmacia hospitalaria. Se realizó un seguimiento desde el inicio del tratamiento hasta finales del año 2006. Las fuentes de datos utilizadas fueron la base de datos informatizada del área de pacientes externos, la historia clínica y los protocolos de solicitud de inicio y seguimiento de tratamiento para la EM. Se recopiló información sobre las características basales del paciente, tratamiento y continuidad del mismo. Resultados Se incluyeron 131 pacientes, a los que se les realizó un seguimiento medio de 7,4±2,6 años. El 64,1% fueron tratados con un solo fármaco durante todo el estudio. A los 2 años del inicio de la terapia con INFβ habían discontinuado la terapia el 9,9%, a los 5 años el 41,2% y a los 8 años y medio el 58,7%. Se mantenían más tiempo en tratamiento los hombres, pacientes con EM recurrente-remitente y tratados con INFβ1a-im, si bien solo fue significativo en los pacientes con 10 años o menos de evolución de la enfermedad al inicio del tratamiento. Las causas mayoritarias de discontinuación fueron la falta de efectividad (38,8%) y la aparición de efectos adversos (32,8%). Los pacientes adherentes discontinuaron menos el tratamiento (55,8 vs 75%).Conclusiones La continuidad a largo plazo en el tratamiento de la EM se ve reducida principalmente por la falta de efectividad y los efectos adversos. Una aproximación a la perspectiva del paciente puede ayudar a identificar aquellos con mayor riesgo de falta de adherencia para ayudar a optimizar la terapia(AU)

Objective To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFβ) in patients with multiple sclerosis (MS), identifying causes and associated factors. Material and Method A retrospective observational study that included patients with MS treated with INFβ during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients’ area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. Results The study included 131 patients. Mean follow-up was 74±26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFβ therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFβ1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%).Conclusions treatment of MS patients with IFNβ is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients’ views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment (AU)

[Safety and effectiveness of salvage therapy in HIV patients]. / Efectividad y seguridad de la terapia de rescate en pacientes VIH.

INTRODUCTION: The treatment used after failure of at least two lines of antiretroviral treatment in HIV patients is called salvage therapy. The study aims to describe the characteristics of HIV patients subjected to such a regimen, and determine the safety and effectiveness of treatment with tipranavir (TPV), darunavir (DRV), enfuvirtide (ENF) and etravirine (ETR) combined with an optimised antiretroviral regimen. PATIENTS AND METHODS: HIV patients treated with ENF, TPV, DRV or ETR in a tertiary hospital infectious diseases department subjected to at least 12 weeks treatment. The patient characteristics are described and the effectiveness, durability and adherence to the treatment analysed. RESULTS: There were 28 patients studied, with an average of 10 treatment regimens prior to starting salvage therapy (SD=3.5; 95% CI, 8.9-11.1). A total of 85.7% patients had treatment adherence >90%. For ENF, 70.8% of the treatment lines were suspended during follow-up. After salvage therapy, the percentage of patients with viral load (VL) <400 copies/ml doubled, and cases with undetectable CV (<50 copies/ml) almost tripled. The treatments used did not change the liver or kidney profiles; however, they changed the lipid profile and increased the percentage of patients with hyperglycaemia. CONCLUSIONS: The salvage therapy studied was effective. Good adherence to the therapy is critical for its effectiveness.

[Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis]. / Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple.

OBJECTIVE: To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFß) in patients with multiple sclerosis (MS), identifying causes and associated factors. MATERIAL AND METHOD: A retrospective observational study that included patients with MS treated with INFß during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients' area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. RESULTS: The study included 131 patients. Mean follow-up was 74 ± 26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFß therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFß1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%). CONCLUSIONS: treatment of MS patients with IFNß is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients' views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment.

Calidad de la recogida de la medicación domiciliaria en urgencias: discrepancias en la conciliación / Quality of Home Medication Collection in the Emergency Department: Reconciliation Discrepancies

Introducción El objetivo del estudio fue valorar la calidad de la recogida de información de la medicación domiciliaria en el servicio de Urgencias de un hospital de tercer nivel, e identificar si las posibles deficiencias en esta recogida se tradujeron en errores de conciliación al ingreso, analizar estos y clasificarlos, así como identificar los grupos farmacológicos implicados. Métodos Se realizó un estudio observacional prospectivo en el que se analizó la información farmacoterapéutica recogida en el servicio de Urgencias. Se incluyeron los pacientes que ingresaron en la Unidad de Neumología y de Medicina Interna del Hospital Universitario Miguel Servet de Zaragoza. Se elaboró un listado con la medicación domiciliaria del paciente antes del ingreso, y se valoró si las deficiencias de calidad en la información recogida en urgencias se tradujeron en errores de conciliación al ingreso. Se tuvieron en cuenta las discrepancias no justificadas y se clasificaron siguiendo los criterios del Documento de consenso sobre terminología, clasificación y evaluación de los programas de Conciliación de la Medicación 2009.ResultadosSe incluyeron 136 pacientes, hallando errores de conciliación en el 86,8%. El número total de errores de conciliación encontrados fue 519. Siendo los subtipos más frecuentes: omisión de algún medicamento, falta de dosis y falta de frecuencia de administración. Cerca de un 40% de los errores de conciliación encontrados en el servicio de Medicina Interna no fueron resueltos, el doble de los encontrados en el servicio de Neumología. El grupo farmacológico en el que se encontraron más discrepancias fue el de aparato digestivo y metabolismo, con un 24%.ConclusionesEl porcentaje de pacientes con errores de conciliación es elevado (86%), observándose una importante oportunidad de mejora al ingreso de los pacientes en el servicio de Urgencias (AU)

Introduction The objective of the study was to assess home medication data collected at the emergency department in a tertiary hospital. It also aimed to identify whether any possible deficiencies in this collection were translated as reconciliation errors on admission, to analyse and classify these data and identify the pharmacological groups involved. Methods A prospective observational study was carried out which analysed the pharmacotherapeutic data collected at the emergency department. Patients who were admitted to the Pneumology and Internal Medicine wards at the Miguel Servet University Hospital in Zaragoza were included. A list of the home drugs taken before the hospital stay was compiled, assessing whether the quality deficiencies in data collected in the emergency department translated as reconciliation errors at admission. Unjustified discrepancies were considered and classified in line with the criteria of the consensus document on terminology, classification and assessment of the drug reconciliation programmes for 2009.ResultsWe included 136 patients, finding reconciliation errors in 86.8%. The total number of reconciliation errors found was 519. The most frequent types were: omitting a drug, missing dose information, missing administration frequency information. Almost 40% of the reconciliation errors found in the Internal Medicine ward were not resolved, which was double to that of the Pneumology ward. Most discrepancies were found for the Digestive System and Metabolism group (24%).Conclusions The percentage of patients that experienced reconciliation errors was high (86%), observing an important opportunity to improve at patient admission to the emergency department (AU)

[Quality of home medication collection in the Emergency Department: reconciliation discrepancies]. / Calidad de la recogida de la medicación domiciliaria en urgencias: discrepancias en la conciliación.

INTRODUCTION: The objective of the study was to assess home medication data collected at the Emergency Department in a tertiary hospital. It also aimed to identify whether any possible deficiencies in this collection were translated as reconciliation errors on admission, to analyse and classify these data and identify the pharmacological groups involved. METHOD: A prospective observational study was carried out which analysed the pharmacotherapeutic data collected at the Emergency Department. Patients who were admitted to the Pneumology and Internal Medicine wards at the Miguel Servet University Hospital in Zaragoza were included. A list of the home drugs taken before the hospital stay was compiled, assessing whether the quality deficiencies in data collected in the emergency department translated as reconciliation errors at admission. Unjustified discrepancies were considered and classified in line with the criteria of the consensus document on terminology, classification and assessment of the drug reconciliation programmes for 2009. RESULTS: We included 136 patients, finding reconciliation errors in 86.8%. The total number of reconciliation errors found was 519. The most frequent types were: omitting a drug, missing dose information, missing administration frequency information. Almost 40% of the reconciliation errors found in the Internal Medicine ward were not resolved, which was double that of the Pneumology ward. Most discrepancies were found for the Digestive System and Metabolism group (24%). CONCLUSIONS: The percentage of patients that experienced reconciliation errors was high (86%), observing an important opportunity to improve at patient admission to the Emergency Department.

[A study of initial antiretroviral therapy effectiveness, survival and safety in HIV+ patients]. / Estudio de la efectividad, supervivencia y seguridad de las terapias antirretrovirales de inicio en pacientes VIH+.

OBJECTIVE: To study initial antiretroviral therapies indicated for HIV-infected patients during the 2001-2003 period regarding effectiveness, survival and safety. METHOD: A descriptive, retrospective study of clinical and drug-related variables of naïve HIV-infected patients through pharmacotherapeutic history. RESULTS: Mean CD4+ lymphocytes counts were 209.6 cells/mm3. Pneumonia by Pneumocystis carinii was the most commonly found condition at antiretroviral treatment onset. Most commonly used therapies included those based on a non-nucleoside reverse transcriptase inhibitor (NNRTI) combined with two nucleoside reverse transcriptase inhibitors (NRTIs). The longest mean survival was achieved by using combinations of three nucleoside reverse transcriptase inhibitors. The primary reason for initial antiretroviral therapy discontinuation were adverse effects, with stavudine exhibiting the poorest tolerability. CONCLUSIONS: Therapies based on non-nucleoside reverse transcriptase inhibitors and protease inhibitors (PIs) have shown similar effectiveness to increase CD4+ cell counts. Regarding viral load decreases, protease inhibitors were most effective. Therapies using three nucleoside reverse transcriptase inhibitors resulted in peak survival.

[Perioperative anaemia in geriatric patients with hip fracture]. / Efectividad de distintas pautas de tratamiento de la anemia perioperatoria en pacientes ancianos con fractura de cadera.

OBJECTIVE: To describe and study the effectiveness of the perioperative anaemia treatment patterns for patients older than 64 with hip fracture. METHOD: Three groups of patients were compared: Group 1: Oral iron or without iron therapy. Group 2: low doses of intravenous iron. Group 3: treated according to a blood saving programme including intravenous iron, alpha epoetin and restrictive transfusional criteria. The homogeneity of gender, age, type of fracture, ASA, preoperative period and perisurgical bleeding affecting drug consumption within the groups was analyzed. The effectiveness of the treatments was determined by means of transfusional rate, postoperative haemoglobin levels, and postoperative length of stay and infection rate. RESULTS: 329 patients were checked. Patients were comparable. Patients included in Group 3 were transfused less than the rest (36.5 of patients in group 3 vs. 52.0% in group 1 and 67.6% in group 3, p = 0.002). Decreases in the infection rate and mean postoperative stay in group 3 were not significant. Haemoglobin levels at 48 hours post surgery were higher in group 1 but haemoglobin levels at the seventh day post surgery were similar for the three groups. CONCLUSIONS: The above mentioned blood saving programme has been observed to be effective in decreasing transfusional requirements without increasing morbidity. However, further prospective studies are needed in order to define the cost-effectiveness of this programme and to determine its role in the reduction of posttransfusional infections and postoperative length of stay.

[Assessing the use of low-molecular-weight heparins fo venous thromboembolism prophylaxis in internal medicine patients]. / Evaluación de la utilización de heparinas de bajo peso molecular como profilaxis de tromboembolismo venoso en pacientes de medicina interna.

BACKGROUND: Sufficient evidence exists to recommend routine thromboembolic disease prophylaxis for medical inpatients with risk factors --with low-molecular-weight-- heparins being (LMWH) the most suitable treatment option. The objective is to determine the thromboembolic risk level of Internal Medicine patients with LMWH prophylaxis, prescription habits and their adequacy to hospital's standards, as well as prevalence of non-treated patients at risk. MATERIAL AND METHODS: Descriptive and prospective study of internal medicine patients for 2 months. Patients with prophylactic LMWH prescription were chosen, and their thromboembolic risk level and suitable LMWH dose was determined according to the hospital's "thromboembolic disease prevention standards". On the other hand, patients with no LMWH prophylaxis were analysed in order to judge their candidacy. RESULTS: 30% of patients had a prophylactical LMWH prescription, with 43.5% of these prescriptions being adequate to the risk level. The main risk factors were: age, bed-stay, hypertension, cardiopathy with risk factors, diabetes mellitus, dislipemias and COPD. Chi2(0.05) test between risk level and prescribed LMWH revealed no association. 72% of patients without LMWH prescription had a moderate or high risk level. CONCLUSIONS: 1. A high proportion of the patients studied have a considerable thromboembolic risk level. 2. There is not a statistical relationship between thromboembolic risk level and LMWH prescription. 3. There is a high percentage of patients with no LMWH prophylaxis which could be eligible for it. 4. A pharmaceutical intervention would be useful to approach pharmacological prophylaxis to each patient's risk.

[Tuberculosis in the Zaragoza province. Estimation by means of the capture-recapture method]. / La tuberculosis en la provincia de Zaragoza. Estimación mediante el método captura-recaptura.

INTRODUCTION: Tuberculosis (TB) is an underreported condition to the Communicable Diseases Control System (CDCS). The objective of this work was to estimate the actual incidence of tuberculosis and the epidemiological characteristics of the diseases in the Zaragoza province. MATERIAL AND METHODS: Retrospective study in which the capture-recapture method was used to estimate the number of tuberculosis cases, by using the microbiology laboratories and the CDSC as data sources. The socio-demographic and clinical characteristics of diagnosed patients throughout three years in this province were analyzed. RESULTS: The mean annual incidence rate of TB was 22.02 per 100,000 inhabitants according to microbiological data, and 48.5 per 100,000 according to the capture-recapture method. A total of 569 patients were studied, and 400 of them were males (70.3%). The mean age was 43.2 years, and the 25-34 year-old group had the highest number of cases (27.9%). Twenty-three percent of cases were co-infected with HIV, and 77.4% were parenteral drug abusers, and 4.4% immigrants. CONCLUSIONS: The capture-recapture method has demonstrated to be useful to know the relevance of TB in our setting. The actual incidence of tuberculosis was higher than that pointed out by the CDCS. Relevant differences were observed regarding incidence rates by age and sex groups. HIV infection and immigration do not appear to explain the frequency of this disease in our setting.

[The short-term effects of air pollution on mortality. The results of the EMECAM project in Saragossa, 1991-1995. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en Zaragoza, 1991-1995.

BACKGROUND: To assess the short-term impact of pollution on the respiratory death rate in the city of Saragossa throughout the 1991-1995 period and to pinpoint whether any differences exists in terms of age and time of the year. METHODS: The relationship of daily concentrations of smog and SO2 to the daily deaths due to respiratory diseases (CIE-9 460-486) and chronic lung blockage disease and similar EPOC-EA (490-496) was analyzed using Poisson models in keeping with the EMECAM procedure. Possible differences in the impact on those below and over age 70 and according to the six-month period in question were researched. Relative risks (RR) and 95% confidence, intervals (CI95%) WERE CALCULATED FOR 10 micrograms/m3 rises in pollutant. RESULTS: A relationship was found to exist between the respiratory and smog death rate (RR 1.028 CI95% 1.006-1051), the highest risk being during the six-months period of warm weather. For those individuals over age 70, the relationship remained the same throughout this six-month period and was negative for those individuals under age 70. The RR's for the death rate based on EPOC-EA were, overall, 1.038 (CI95% 1.002-1075) and of 1.068 (CI95%: 1.004-1.137) for the six-month period of warm weather. The SO2 pollution showed a positive relationship to the respiratory death rate for the warm period for all ages, RR 1.093 (CI95%: 1.006-1.187) and for those under age 70 (RR 1.240 CI95%: 1.028-1.496). The impact was not conclusive for the cases of pneumonia. CONCLUSIONS: Low levels of air pollution can have a significant impact on the respiratory death rate, especially among the elderly and during the six-month period of warm weather.

[Nosocomial infections in surgical patients. Problems of measuring and comparing results]. / Infección nosocomial en pacientes quirúrgicos. Problemas de medición y de comparación de resultados.

BACKGROUND: What is striking when studying the frequency of nosocomial infection (NI) is the variability of the study data. Different frequency indicators and infection criteria are used for estimates and these make it difficult to compare works. The aim of this work is to estimate the frequency of hospital infection by using different indicators to compare the results. METHODS: A market study was carried out including patients admitted to four surgical units over the period of one year. The following indicators were used: proportion of patients infected, cumulative number of cases of infection and density of number of cases. The infections were detected through active search and included those acquired in Intensive Care Units and those diagnosed after patients had been discharged from hospital. RESULTS: A total of 14.5% of the patients suffered NI and 5% of the infections were diagnosed after discharge from hospital. In 38.5% of the cases of infection a microbiological study was not requested. The General Surgery Unit had the highest figures for the three indicators. Nevertheless, the magnitude of the differences between services was modified in line with the indicator used. CONCLUSIONS: The real percentage of patients with NI is higher than the values given by the usual monitoring systems. Given the trend witnessed over recent years whereby the length of hospital stays is being reduced and early discharge programmes promoted with the aim of increasing efficiency, densities for the number of cases should be estimated and these should include the NI cases diagnosed after hospital discharge in order to make valid comparisons between different institutions and periods of time.

[The hospital costs for patients with human immunodeficiency virus infection]. / Costes hospitalarios en pacientes con infección por el virus de la inmunodeficiencia humana.

BACKGROUND: The economic issues derived from the care of HIV patients are increasingly more important and they affect to different levels of sanitary assistance. In Spain these costs are not always evaluated and there is no information about the efficiency of inverted resources. METHODS: The cost of mean hospital stay due to HIV (+) patients has been estimated and compared with two infectious diseases: respiratory tuberculosis (TBC) and viral hepatitis (VH), and we have analyzed their evolution in the period studied. The study was conducted between July 1st 1987 and December 31st 1989 at the Infectious Unit for the three mentioned diseases. RESULTS: The 227 included patients originated 292 hospitalizations. The total cost derived from hospital stays was 169,466,323 ptas. The mean cost for HIV(+) patients was 576,184 ptas, for TBC patients 1,111,115 ptas, and for VH 443,219 ptas. The number of HIV(+) stays has increased each year. CONCLUSIONS: The observed results suggest that it could be interesting to think about new systems of inpatient care.