Revista de sanidad e higiene publica最新文献

In order to facilitate the convenience of fluorating or not the public use waters, a bibliographic review about the positive or negative aspects of this public health measure has been made. The different epidemiologic surveys about dental health conditions in our country, since 1969 till the present time, have been reviewed. From the analysis of these works, it can be deduced that the degree of caries severity index (DMF) is situated at a moderate to low level, according to the classification of the World Health Organization. The advantages, inconvenience, cost and percentage of caries reduction of the different methods to prevent dental caries are studied. It is considered positive to go on with the policy of public use waters fluoration, provided that is is based on a series of prerequisites which guarantee the highest level of effectiveness and efficiency. Among the different objective criteria to fluorate waters, the following ones stand out: a high prevalence of caries, a good system of waters out: a high prevalence of caries, a good system of waters diffusion, a natural fluor concentration lower than 0.7 grams/litre, the cost-benefit analysis, the population size. The elaboration of studies to determine the total quantity of fluorides, ingested by the population from various sources, is recommended.

Background: Malignant tumour in cervix is an important cause of death in young women. Through community programmes of detection and early diagnosis, a significant reduction in the incidence of invading forms and mortality due to this cause has been achieved. Knowing the Prevalence of premalignant lesions and cancer in the sexually active women population, establishing the frequency of risk to different factors and associated risk to these ones in this population, constitutes a part of this study objectives.

Methods: A transversal study is carried out, with a sample of population older than 20 years or younger, but sexually active, constituted by 4262 women, selected at random from a population of 7222 persons cared in family planning centers and distributed in 15 localities. In every case, the colposcopy has been made in a systematic way, associated to the cytology with a biopsy of every atypical image. Among the risk factors studied, the expositions to Rx, sexual promiscuity, genital infections, mycosis and infertility are included. The existence, as a clinical discovery, of a suspected lesion or an atypical colposcopy are includes as risk markers. The test of, the calculation of Odds Ratio, and 95% confidence interval, the etiological fractions, the multivariant analysis and the calculation of OR, adjusted to qualitative variables and the comparison of means for quantitative variables, are used in the analysis. The programme SAS is used as a software.

Results: The prevalence of cancer found was 0.938 per one thousand women and the frequency of precursory lesions was 38.2 per one thousand. The comparative study with regard to different variables between women with benign deteriorations or normality and women presenting a diagnosis of premalignant lesions or carcinoma, proves that, without existing differences in relation to age, beginning of sexual relations ans number of pregnancies, the risk of suffering from cervix cancer increases with sexual promiscuity, exposition to Rx, genital infections, mycosis and infertility.

Conclusions: On the basis of the prevalence detected, it is considered necessary keep and to increase the coverage of actions of cervix cancer prevention in women, increasing the participation of the whole of sexually active women in the programmes. The presence of risk factor would modify the number and periodicity of gynecological controls.

Background: The community health participation is an important issue for all health systems based on a Primary Health Care, which emphasizes prevention and promotion, as a complement to assistance. In this survey, the social attitude towards health participation is studied, taking into account the different research paradigms on Social Sciences, the models of health behaviours, the meaning of participation and the meaning of the own attitudes.

Methods: A Likert scale of 18 items, which constitutes a part of a general health survey of 128 variables, is elaborated and validated. It is complemented with a personal interview to 1371 persons in a random sample from four health areas.

Results: The data obtained show that there are neither statistical significant differences among areas in relation with having or not a Health Council, nor between men and women. The attitudes towards participation are more favourable among young people, bachelors and persons from a high socioeconomic status, hig degree studies, white collar professions, and the persons going to the doctor with the lowest frequency, show a positive tendency. The factorial analysis identifies three dimensions: a) Self-care, b) political and c) community health agent. The discriminant analysis shows that variables (age, civil, status, socioeconomic level, studies...) classify correctly 74% of cases.

Conclusions: The personal profile, showing a health participative attitude, is consistent, in most variables, with that published by previous reports.

Background: Tuberculosis infection is a suitable method to evaluate a community tuberculosis endemic. The calculation of infection indexes (incidence, prevalence, year risk and their decline) have been used to analyze this endemic and ist tendency during 22 years in a suburbial city.

Methods: Practice of the tuberculin test (Mantowx) to almost the totality of schoolchildren during the academic years. 1968-69, 1980-81 and 1981-82; and 1989-90 and 1990-91 as well. During the years 1981-82 and 1990-91, the test was repeated in a sample of schoolchildren to detect the reaction converters (incidence of infection).

Results: The prevalence of tuberculosis infection is very high (7.5% in the first primary school year and 15.2% in the 8th primary school year during 1968-69, and decreases to 5.1% and 11.7% during 1980-82 was 2.6% and 1.5% in 1989-91. The decline of the infection risk is very low: about 6% during the whole period, and it is higher: 9%, in its second part.

Conclusions: The high tuberculosis can be related to the population social deficiencies. The favourable tendency observed, during the last ten years, can be attributed to an improvement in the health care and, specifically, in the treatment of patients of tuberculosis.

Background: The risk of infection by the hepatitis B virus (HBV) in institutions for children with deficiencies has been established in several studies. The purpose of this work was to know the prevalence of HBV markers, among the employees in an institution of that kind, and its association with several risk factors.

Methods: A transveral epidemiologic survey has been carried out to determine the markers prevalence of infection by hepatitis B virus (HBV) and its association with certain risk factors, among the 200 workers of an institution for children with deficiencies. Determinations, by radioimmunoassay were: HBs Ag, anti-HBs and anti HBe.

Results: The participation was 95%, with a prevalence of any marker of 7.9% (IC95 + 4.1-11.7). No HBs Ag carriers were detected, taking occupation as an indicator variable with three categories: Trades and auxiliary health personnel versus teachers, the logistic regression analysis showed odds ratios, adjusted for age, sex and working time, for trades and auxiliary health personnel, respectively.

Conclusions: Vaccination is the preventive recommendation for HBV in these institutions, because of the difficulty to find other factors associated to HBV. The possibility of introducing a universal vaccination is controversial.

Background: Potential years of life lost (PYLL) constitute a health indicator, used to study premature mortality. If applied, it produces an order in causes of death, which can be very different from that one, obtained with mortality rates.

Methods: Mortality, due to different pathologies, was analyzed with this indicator and, particularly, mortality due to cancer in Asturias and Spain. The estimation of (PYLL) was made using fixed age limits: the first anniversary, as the lowest limit, and 65 years, as the highest limit.

Results: Cancer happened to be the first cause of (PYLL) in both populations (286,473 PYLL in Spain; out of them 9,985 belonging to Asturias); road accidents were the second cause (139,673 and 4,755 respectively) and acute myocardium infarcts were the third cause (70,106 PYLL and 2,897 PYLL). Lung tumours, leukaemias and breast cancer in women are the malignant tumours which produce the highest number of PYLL.

Conclusions: Malignant tumours, road accidents and ischaemic heart disease are the three major causes responsible for the PYLL production in Spain and Asturias. These three pathologies are associated to well known risk factors, whose disappearance would considerably reduce early mortality. Likewise, an excess of premature mortality is observed in Asturias compared with Spain, and in men compared with women.

Background: In order to facilitate interprofessional collaboration and continuing education, it is necessary to define the family doctor (FD) work profile in ophthalmology and that this profile is accepted by FD and specialized doctors.

Methods: A questionnaire with 42 activities and 18 skills, belonging to the scope of ophthalmology was sent to 20 ophthalmologists in the Health Area of Pamplona. They were asked to value each item and to express whether they thought it belonged to the FD activity scope. The answers from 16 specialized doctors are compared with the answers from 16 FD.

Results: 30 activities and 12 skills are considered to be a part of the FD scope by 75% of them, compared with 22 activities and 10 skills accepted by the ophthalmologists. More that 75% of these ones express their disagreement with three activities: identification of traumatic wounds in both cameras, surveillance of eye-pressure in patients at risk, surveillance of chronic glaucoma and early care of wounds in the eye globe; and in three skills: valuation of iridocorneal angle, enlargement of the eye pupil and verification of lacrimal conduct permeability. In 9 items, statistically significant differences were found (p 0.05) between both groups answers. Among them, the examinations and surveillance of retinopathies in vascular and metabolic diseases, stands out.

Conclusions: Our study shows a disparity of positions, which may raise difficulties to the interprofessional collaboration between both groups. It is recommended to study the factors, which might have an influence on this disagreement. The elaborated list constitutes a progress in the definition of FD profile in ophthalmology, although it would be necessary to carry out more studies.