Study of quality of life on rural hypertensive patients. Comparison with the general population of the same environment.

A comparative study about quality of life was made in the community of Riosa--north of Spain--on two groups of subjects: one affected by hypertension (n = 115), stage I and II of WHO, and another of the general population, matched in age, sex and residence with the former group and of the same size. The subjects with loss of self-care or mobility were excluded. The quality of life was evaluated with a standardized measurement approach referring to the spheres of physical, emotional, social and sexual functions. With this study the validation of the Spanish version of the questionnaire was made and the results obtained were found to be more or less the same as those reported by authors in other European countries of similar sociodemographic conditions. Hypertensive patients reported significant lower scores of quality of life than the general population in more than half of the dimensions explored: well-being and physical capacity, social functioning, positive mood and psychological functioning. In conclusion, despite the many limitations inherent to this area of research, a standardized and valid measure of relevant aspects of quality of life in the general population and especially in patients with hypertension, is available in the Spanish language.

Psychosocial factors associated with cancer behavioural risk in relatives of cancer patients.

The European Code against Cancer includes some primary cancer prevention behaviours, which can be studied in the framework of psychosocial models of human behaviour as the ASE model (attitude-social influence-efficacy model). The objective of this study was to detect the factors that better explain cancer behavioural risk in relatives of cancer patients. A convenience sample of 3031 people was selected in primary care centres. A three-step multivariate analysis was carried out by means of a multiple linear regression, introducing cancer behavioural risk as the dependent variable and the following covariables: psychosocial factors in the ASE model, sociodemographic variables and the family history of cancer. At least five difficulties and four needs were perceived in following the preventive advice by 25% of patients. The main difficulties were tobacco and alcohol addiction and the demands of a social life. Principal needs were access to cessation programmes, family support, and being controlled and pressured by health workers. The highest risk profile is to be a young man with a low sociocultural level. The ASE determinants were the best predictors of cancer behavioural risk, so programmes that forget these predictors may not achieve any impact and may waste resources.

The risk of infection with hepatitis B virus in relation to length of hospital employment.

A sero-epidemiological study was carried out on a representative sample of employees of the Hospital Clinico 'San Cecilio' in an attempt to quantify the influence of the time spent working in the hospital on the risk of becoming infected by hepatitis B virus. The results show that the rate of infection by HBV is directly proportional to the length of employment in the hospital, with a probability of infection between 0.6% and 1.4% for each working year.

Disappearance of DNA HPV in sequential specimens of occult cervical infection in a "normal" population.

OBJECTIVE: The behaviour of occult infection in the uterine cervix was studied over one year in 175 women randomly selected, to determine if the infection persisted, disappeared or if the viral genotype became modified. STUDY DESIGN: An earlier study of the prevalence of HPV cervical infection detected 11 (6.2%) occult infections. Of these the infectious genotype could only be identified in five. One year later the infected women were subjected to further colposcopical examination and molecular hybridization testing. RESULTS: In seven of the 11 cases with cervical occult infection, the DNA HPV genome was found to be completely absent at year-end. Colposcopic and cytological studies remained negative in all women. CONCLUSIONS: The loss of DNA HPV in seven of the 11 previously positive women is probably due to variability in the number of cells that became infected in a situation where small numbers of copies are made. The high proportion of occult infection with uncharacterized viruses supports the view that this type of infection is often due to new genotypes, presently non-classifiable.

A practical application of Rhame and Sudderth's formula on nosocomial infection surveillance.

We have conducted an epidemiological analysis of the utility of Rhame and Sudderth's formula--establishing a relationship between prevalence, incidence and duration of nosocomial infection--as an effective model in the surveillance of such infection. We carried out a follow-up study in a surgical service of our hospital on a sample of 799 patients admitted between January 1 and June 17, 1983 (24 weeks). We confirmed the condition of steady-state and were able to conclude that the Rhame and Sudderth model can have great utility when cross-sectional studies are performed with an adequate interval. We also concluded that the application of this model is not influenced by the size of the ward or zone of survey.

[Submandibular fold. An alternative for the assessment of subcutaneous fat]. / El pliegue submandibular. Una opción para la valoración de la grasa subcutánea.

BACKGROUND: Folds are a useful method of measuring subcutaneous fat. This study reports the feasibility of the use of the submandibular fold to evaluate the subcutaneous fat. METHODS: A transversal descriptive study was designed by a poly-staged stratified randomized sample (n = 572). A series of anthropometric measurements (weight, height, different folds and surrounding areas) were performed in addition to the measurement of the submandibular fold. In addition blood pressure was determined as well as oral glucose tolerance test. RESULTS: After correction of the effect of age, the submandibular fold was found to be related with both the Quetelet's index (BMI) (males r = 0.50; females r = 0.61, both p < 0.0001) and the Benn's index (males r = 0.53; females r = 0.60, both p < 0.0001). Their correlations with those of other folds and with the measurements of centralization place the submandibular fold in a median position with respect to central and peripheral fat deposits. Furthermore, the percentage of fat which the increase in BMI carries is practically constant. Likewise, it was associated with the presence of high blood pressure in both sexes (males F = 9.7, p < 0.025; females F = 6.1, p < 0.025), diabetes mellitus (F = 6.1, p < 0.005) and inguinal hernias (F = 10.8, p < 0.0025) in males and in females, as well as to the presence of abdominal striae in females (F = 12.2, p < 0.001). CONCLUSIONS: The submandibular fold may be used by investigators who wish to evaluate subcutaneous fat through one sole fold, which is accessible and easy to measure. This measure is intermediate between the central and peripheral zones. In addition, it may reflect the fat deposit which is produced with both an increase in the body mass index and age.

[Assessment of the transcultural equivalence of the Spanish version of the profile of quality of life for chronic patients (PECVEC)]. / Evaluación de la equivalencia transcultural de la versión española del perfil de calidad de vida para enfermos crónicos (PECVEC).

BACKGROUND: In this work the transcultural adaptation and validation of a quality of life questionnaire has been approached, taking into account its increasing interest and its practice considerations. The Profil der Lebensqualität Chronischkranker (PLC) is a German instrument and titled in Spanish. Perfil de Calidad de Vida para Enfermos Crónicos (PECVEC). The main goal of the present study is the assessment of the transcultural equivalence between the Spanish version and the original questionnaire version. SUBJECTS AND METHODS: Translations and back-translations from the original instrument, using bilingual personnel, were made. The most important goal of the study was to achieve the more accurate equivalence between the original version and the Spanish version of the questionnaire. The translations were discussed between the groups of investigators in Germany and Spain and finally adapted a pretest that showed good statistical results. The instrument was applied in two groups of subjects paired by sex and age and its validation was made. RESULTS: The results of two studies (one German and other Spanish) are compared. In the Spanish study the Cronbach's Alpha coefficient (range: 0.39-0.97) and the factorial analysis of the items showed good internal consistency. Cronbach's Alpha was higher than 0.6 for all dimensions except for the scale of Social Well-Being (0.39) with an average value 0.72. The comparison between two factorial structures showed that both are similar statistically. The adapted version showed discriminant capacity between groups ("known group validity") and the final scores of quality of life were similar to the original version. CONCLUSIONS: The adaptation process from the original version to the Spanish version has finished with a transcultural equivalence between both. This preliminary validation can be seen as an important starting point to increase, in this field, the number of instruments of assessment health-related quality of life in chronic patients in Spanish language.

[Immunological profile against the hepatitis B virus in different population groups (author's transl)]. / Determinación del perfil immunológico frente al virus HVB en grupos de población.

To study the immunological profile against the hepatitis B virus 742 sera (107 from the Renal Unit and 635 from other hospital services) were assayed for HBsAg, HBsAc, and HBcAc. The results obtained appear to indicate that the simultaneous determination of the three tests is unnecessary for diagnosis, although it is important for follow-up and prognosis. The isolated measurement of HBsAg is a good diagnostic test, but although it appears early it lasts little, a reason why it should perhaps be complemented with the other tests when considering the time factor. If only one technique is to be made available HBcAc determination seems necessary because it appears simultaneously with the HBsAg and it persists for a long time thereafter. A high degree of positivity of HBsAc and HBcAc was found in dialysis patients, a fact apparent also in the other population groups.

[Epidemiology of diabetes mellitus in the province of Leon]. / Epidemiología de la diabetes mellitus en la provincia de León.

BACKGROUND: Diabetes mellitus (DM) is a very important health problem because of its high morbidity and mortality. The aim of the present study was to investigate the prevalence of diabetes in the adult population of the León province and its possible association with the most common risk factors and markers. METHODS: A cross-sectional descriptive study was designed with a multistage stratified sampling (572 individuals). A questionnaire about several sociodemographic variables, an alimentary survey, measurements of height and weight, capillary baseline glycemia, and oral glucose tolerance test with 75 g glucose were carried out. RESULTS: The observed prevalence of diabetes mellitus was 5,6% and that of glucose intolerance 10,3%. The known/unknown DM ratio was 2,2/1. The prevalence of treated DM was 1,9%. The leading variables associated with DM were age, a positive family history of diabetes and obesity. A higher incidence of DM was found in females, in urban media, and in high social classes. BACKGROUND: Diabetes had been previously underrated in the León province. The observed prevalence values are close to those from other methodologically similar studies. In addition, an association was found between DM and some non-modifiable risk factors (age, sex or family history); by contrast, there is a very important risk factor (obesity) which may be modified by intervention.

[Workshop on primary health care]. / Análisis de un taller de trabajo sobre atención primaria de salud.

We evaluate a 32 hours-workshop on Primary Health Care. The method of the workshop was active participation and the tasks were: a) previous anonymous evaluation of knowledge, b) team work in 5-6 individuals teams in order to answer some practical problems, c) communication of results and synthesis with the whole group, and d) a second anonymous evaluation of knowledge (the same as the initial one) and an assessment of the perceived usefulness of the workshop. We present results on the modification of knowledge of the 237 students (96.2% of the students improve it), the usefulness of the workshop (91.1% consider it useful) and the evaluation of the methodology. This kind of teaching methodology is useful for stimulating the critical capacity of the students, improving their knowledge.

[Cost-effectiveness of antismoking health counselling in primary health care]. / Coste-efectividad del consejo sanitario antitabaco en atención primaria de salud.

OBJECTIVE: To study the cost-effectiveness of simple anti-smoking advice in Primary health care. METHODS: We accomplish a cost-effectiveness analysis in the area of the Primary health care. As efficiency of the advice we use own results. To evaluate the smoking cessation we base on vital tables of the "25-State Cancer Prevention Study", discounted to the 5%. The costs have been calculated as of the tariffs used for services billing lent in primary health centers to not beneficiary of the social security. It was accomplished a sensibility analysis on different aspects with possible influence on the result. RESULTS: The cost-effectiveness oscillated between 67,621 and 89,619 pesetas by year of life saved for the men and between 116,225 and 137,748 pesetas for the women, in function of the age. The relationship most favorable, for both sexes, it is between 45 and 54 years. In the group of 35 to 39 years, for the physicians, was of 89,419 and 163,934 pesetas for men and women respectively, and for the nursing personnel was oscillating between 43,955 and 81,523, for men; and between 80,584 and 149,460 pesetas for women in function of the considered salary. CONCLUSIONS: It is an intervention with a very favorable relationship cost-effectiveness, at least, comparable to that of other customarily accepted preventive measures. The nursing advice is less effective that the physician advice, but it is, at least, equal of efficient in terms of cost by year of life saved.

[Multiple causes of death in Asturias, 1988]. / Estudio de las causas múltiples de defunción en Asturias, 1988.

To analyse the frequency of the cause of death in the mortality statistical Bulletin, a study of a representative sample of the 1988 mortality statistical Bulletin (n = 595) of Asturias was conducted. The mean and the mode of the number of causes and also the complexity and density according to age and sex was analyzed. The mode of the total number of causes in Bulletins for both sexes was 3, and the mean was 3.14. The three lines (complexity) were occupied in almost 50% of the Bulletins analysed. With respect to the density of lines, line IIb (initial cause) was the one occupied most of the time (10.7%), this showing more than one diagnosis when it was the last line used. Both values, complexity and density of the last line used, increased proportionally with the age at death. This analysis was also carried out excluding the causes coded as Cardiac and Respiratory Arrest (ICD-9 = 427.5; 799.1). With these results, it was possible to confirm the usefulness of the coding of multiple causes of death in Asturias, Spain.

[The story as a health education technic for schoolchildren]. / El cuento como técnica de educación sanitaria en escolares.

Schoolchildren health education should begin as early as possible. The objective of this study is to show that to develop health education early in the lifetime is feasible by using the tale/psychodrama as tool for making class explanations more useful. An intervention study was carried out with all the children attending course level 1 of Basic General Education (BGE) in four schools, two from the city of Granada (urban) and two from two surrounding municipalities (semi-urban). They were randomly divided in two groups in order to compare the efficacy of two different health education interventions on taking care of pets: formal explanations at the classroom vs listen to a tale. Evaluation was assessed by a simple 15 yes/no items questionnaire which was administered before and after the intervention. Both interventions resulted in important improvements of children responses. The tale was clearly better than class formal explanations, the differences being statistically significant for 8 of the questions. We conclude that health education is feasible early in childhood and that tales can be more efficient than class explanations.

[Advertising, advertising legislation and health]. / Publicidad, legislación publicitaria y salud.

The media and specifically magazines and sunday supplements contain advertisements, some of which can be dangerous to one's health. We have investigated these types of advertisements, which were included in the 15 top sales magazines in Spain. The period of analysis corresponded to the period april-may, 1991. We have compared the results obtained with the results of a previous investigation carried our in 1987, using an identical method. We have tried to test if the so-called Law of Publicity of 1988 has had any effect on publicity. We have found, 1383 advertisements that could have a damaging effect on one's health. Although the total number of advertisements have decreased over this four year period, the law has hardly produced any influence on publicity, and we have found breaking of the law in the investigated material.

[Adolescence at risk: a health survey among pre-university students]. / Adolescencia en riesgo: una encuesta de salud entre estudiantes de C.O.U.

The present study investigates the level of health education in a representative sample of 804 pre-university Asturian students, randomly selected from the official list of the Ministry of Education and Science. We used a questionnaire (designed by us) in order to measure the knowledge, attitudes and behaviour related to some of the most important health determining factors. The survey was carried out by interviewing small groups of students in the classroom situation. Although it was found that the majority perceived themselves as healthy or very healthy, these young people are widely exposed to risk factors: 12% have suffered from more than 25 episodes of drunkenness during the previous year; 43.53% smoked to some extent and only 3.86% identified the days of maximum risk of pregnancy in a supposed menstrual cycle, although 31% maintained sexual relationships. Theoretically, 92% selected health as the most important factor among the three most fundamental values for life. They also think that illegal drugs are the most important health problem at present for young people. There is a contradiction between the high theoretical importance given to health, the good self-qualification of it, and the observed presence of important risk factors. A certain failure of the educational system with respect to primary prevention can be claimed.

[Advertising and health education]. / Publicidad y educación sanitaria.

Health education and advertising have a common aim: to modify human behaviour. Health education tries to induce healthy behaviours. In some occasions Publicity proposes risky behaviours. Ads appearing during a two-month period in magazines of the largest circulation in Spain are analyzed here. A total of 1,726 ads which could have a negative influence on health either because of the product or service offered or for the use of health as a persuasive argument in their text, are considered. The magazines Hola and Lecturas had the highest ratio ads/magazine. Spirits, food and drugs were the most frequently advertised products. And more than 50% of the ads used health and welfare as argument for better selling. Health educators should know and teach the critical analysis of publicity, and use advertisements as a teaching tool to enable people to see through misleading advertising.

[Bacteriocinotyping of Klebsiella. A new scheme (author's transl)]. / Bactériocinotypie du genre Klebsiella. A propos d'un nouveau schéma.

A new typing scheme of the genus Klebsiella for studying the production and different sensitivities towards some standard strains is here proposed. Owing to it, 120 Klebsiellae could be classified. The most frequently bacteriocinotypes found were 778 and 768. The overall amount obtained was of 57 different models of activity. As six clinical experiences have confirmed its efficacy, the practical use may now be faced.

[Long-term effectiveness of anti-smoking counseling in primary care: the relapse process]. / Efectividad a largo plazo del consejo antitabaco en atención primaria: el proceso de recaída.

BACKGROUND: Addiction to tobacco is the main cause of preventive morbidity, and so the fight against tobacco consumption is a priority in the developed world. Health advice is a valuable tool in this struggle and it is within the reach of all health workers. To study the long-term effectiveness of all anti-tobacco advice in Primary Aid, together with the influence that the reason for giving up (spontaneous or after advice) has upon the relapse pattern. METHOD: We carried out a clinical test on 501 patients, 242 as a participant group, receiving health advice, and 259 in a control group. We evaluated giving up the habit through a survey. The data were analysed by means of a study with a survival study, considering the relapse to be the final point. Survival curves for the two groups were compared with the Lee-Desu statistic. RESULTS: 115 patients gave up the habit for at least 24 hours (31.8% from the participant and 14.7% from the control group). After 3 years, after a biochemical check-up, 4.5% of the participant group and 1.2% of the control group were still ex-smokers (difference = 3.3; p = 0.043%; there is a confidence interval of 95%: from 0.45 to 6.33). We did not find significant differences between their survival curves (p = 0.08). CONCLUSION: We have been able to confirm the mid- to long-term effectiveness of anti-tobacco advice. We have not been able to demonstrate that anti-tobacco advice in the relapse pattern, but a statistical trend does exist towards a reduction in the participant group.

[Hygienic-sanitary conditions in school lunch rooms in the municipality of Oviedo]. / Condiciones higiénico-sanitarias de comedores escolares del municipio de Oviedo.

BACKGROUND: To ascertain the health and hygiene-related conditions of school lunchrooms within the municipality of Oviedo by means of conducting a health and hygiene inspection of these facilities. METHOD: A descriptive epidemiological cross-sectional study was made of 24 schools in the municipality of Oviedo, 9 of which were government-subsidized private schools and another 15 of which were public schools, according to information from the Ministry of Education and Science. An inspection was conducted entailing a protocol based on the Public Lunchroom Health and Hygiene Regulations. The variables are the health and hygiene-related conditions of the premises (kitchens, lunchrooms and lavatories), of the utensils, the health of the employees and the conditions of the raw materials and foods. These conditions have been considered to be inadequate or deficient whenever they failed to met the criteria of the protocol in question. RESULTS: The deficiencies found n most of the school lunchrooms inspected were the lack of protection of the lighting components, of window screens to prevent the entry of insects and of soap dispensers which are not hand-operated, disposable paper towels and liquid soap both in kitchens as well as in lavatories. The variables entailed in this study have been compared among public schools and government-subsidized private schools, for which purpose a Student T Test was employed, significant differences having been found to exist between these two types of schools solely in the condition of the kitchens and in the total of the items. CONCLUSIONS: Most of the irregularities found in both the public schools and in the government-subsidized private schools are of an organizational nature and with regard to the facilities stemming from a lack of knowledge of the laws in force. It is deemed advantageous for training in Hygiene to be provided, given the positive attitude shown by those in charge of the schools in question.

[Extracurricular activities of adolescents useful for smoking prevention programs. OCTOPUS team]. / Actividades extraescolares de los adolescentes útiles para programas de prevención del tabaquismo. Equipo OCTOPUS.

BACKGROUND: The cigarette smoking habit continues to be prevalent to a greater degree than would be desirable among teenagers. Innovative prevention programs are needed. This descriptive cross-sectional study sets out the behavior variables related to the cigarette smoking habit and the extracurricular activities in which teenagers are most frequently involved which are useful for setting out extracurricular prevention programs. METHODS: The data was collected by means of a questionnaire validated in a representative sample of school age youths (ages 10-11 and 13-14) from Asturias. The variables entailed in cigarette smoking were analyzed using the regression method. RESULTS: The starting smoker percentage is 14.5%-42.5%, regular smokers totaling 1.1% and 12.4%, respectively. Two models were constructed with the variables significantly related to smoking behavior, which are properly classified into smoker/non-smoker by 98.85% and 91.39% of the children, by ages. The environmental variables (availability of cigarettes and alcoholic beverages and regular visits to places entailing risk) are the major aspects comprising the model. The most common extracurricular activities are: watching TV, reading and listening to music and watching or playing sports. CONCLUSION: The findings provide keys to planning extracurricular activities tailored to fit in with the activities most popular among teens: TV commercials and ads on music media (CD's, tapes, etc.) and printed information mailed directly to teens at their homes, with messages conveyed by opinion-leaders among teens in the fields of sports, music and television.