Revista de sanidad e higiene publica最新文献

Background: Incidence of human leishmaniasis in Castellón is among the highest in Spain. In order to know epidemiologic situation of leishmaniasis, human incidence, Phlebotomus' presence and canine reservoir were studied.

Methods: The study was carried out during 1989-1990, and included review of different registers of cases and glucantime use, Phlebotomus catching, and leishmaniasis serology (immunofluorescent test, IFT) of dogs from municipal kennel and rabies vaccine programme.

Results: Hospitals' underreporting visceral leishmaniasis was noted. Glucantime's distribution permitted identification of some no reported cases. 2267 sandflies were caught, which 196 were vectors: P. perniciosus (182), P. sergenti (6), P. papatasi (4) and P. ariasi (4). Dog's prevalence of leishmaniasis (IFT > or = 1/80) was 5.1% (CI 95%: 1.1-9.1) in dogs fron the municipal kennel, and 0% in dogs from the vaccine programme.

Conclusions: Human leishmaniasis is hypoendemic in Castellón, with a low-middle rank in canine leishmaniasis. Entomologic results agree with other spanish studies. However, P. sergenti and P. ariasi were not described in Catellón until now. Leishmaniasis surveillance should be maintained.

Background: The accessibility of care can be inappropriate due to a scarce or nonexistent collaboration between health and urban planners at the time of urban planning.

Methods: The study was carried in the city of Fuenlabrada (145.506 inhabitants), located in the metropolitan area of Madrid. The city is divided in six Basic Zones with a Primary Health Care Center (PHCC) in each one of them. Isometric curves between were drawn on a map between the "starting" and "destination" points (Residential points formed by group of houses and their PHCC, respectively). The average and maximal distances were calculated. A scale to measure geographical accessibility was designed.

Results: The 55.646 houses of the city were grouped into 209 "starting points" for the six PHCC ("destination points"). 93 isometric curves were drawn. The average and maximal distances were 910 and 3.900 meters, respectively. The application of our accessibility scale shows that 3 Basic Zones have optimum accessibility, 2 have good accessibility an the last one has bad accessibility.

Conclusions: The accessibility to the PHCC in Fuenlabrada is adequate. If the housing plan continues, in 1995 the city will need a new PHCC and a reorganization of Basic Zones.

Background: An epidemiological study on intestinal parasites has been carried out in Northern Morocco (province of Tangier, Tetuan and Larache). A comparative Study has been made at a provincial, city and areas (urban and rural) level. Also the SPI (simple parasitism index) and the CPI (comparative parasitism index) distribution.

Methods: The coprological method used were: direct, concentration (Fulleborn, Telemann and Kato) method and ye test technics (Ferric Hematoxylin and E. Chlorazol Black).

Results: The number of faecal samples were 4643, parasitism people 2637 and the total number of parasites were 4816. SPI 56.79% and CPI 1.83. Among the Protozoa, Entamoeba coli, followed by Endolimax nana, Giardia lamblia and Iodamoeba buetschlii prevailed, the other species coming a lung distance behind. Among the Helminths, Trichuris trichiura prevailed much more than the others; Ascaris lumbricoides followed and on the third place were Enterobius vermicularis and Hymenolepis nana. The percentage found for E. vermicularis was very high, since an appropriate technique of diagnosis was not used. The data have been statistically tested.

Conclusions: We found a high rate of parasitism in the 3 provinces that have studied and an approximate number of two parasites per person. SPI and CPI are greater in Tetuan and Larache than in Tangier.

The increase of ancient population constitutes a challenge for society in general and for the health services in particular in relation with the offer planning and adequacy. It is important to know the health needs and status of our old people population to determine the intervention priorities and, on the other part, to measure the programmes efficiency and efficacy. As years go on, body organs get old in a different way, which leads to individual variations in the speed of organs and systems deterioration; that is why, a reasonable good scale of and overall health does not exist in contrast with functional status and psychological health. Certain cultural attitudes towards aging and the health care resources availability make measurement more difficult, as well. For all elaborated with and overall point of view, by means of a systematic search of problems and a total valuation of his health needs.

Background: The early diagnosis of Human Hydatidosis through immunologic methods has been one of the most important activities displayed by the Programme of Struggle (fight) in endemic areas of Argentina, to improve the prediction of the Hydatid patient. It is of great interest to define exactly the advantages and limitations of the DD5 and Elisa techniques in the diagnosis of hydatidosis in inhabited areas with no clinic symptoms of the disease.

Methods: For this, the sensibility, the specification and predictive value of both methods has been evaluated, studying serologically 499 inhabitants from a rural community in the Province of Río Negro. The inhabitants with reactive serology to EIE and/or DD5 are studied by means of images using US, RX and TC. A controlled group is selected according to its un-reactive serology. The cases compatible with Hydatidosis are directed to surgery.

Results: The DD5 technique is shown as 100% specific but with a sensibility of only 31%; on the other hand, EIE at a cutting level of 8 DE presents a specification of 97% with a sensibility of 63%.

Conclusions: It is important to underline the value of the US as the first image prognosis, while the TC, in the present experience, did not show a great number of positive images, allowing only to confirm the US findings.

Background: GIARDIA LAMBLIA (GL) constitutes a problem of public health especially (because of its greater frequency) amongst children. The aim of this study is to determine the prevalence of GL amongst children in the ZONA BASICA DE SALUD (ZBS) in the eastern part of the province of AVILA.

Methods: An observational prospective study undertaken in the ZBS of the eastern part of the Province of Avila during the 1992-93 school year. The faeces of 318 children, aged 3 to 14, without symptoms, attending school in 8 villages of the area were studied by means of the Teleman-Rivas test.

Results: The over all Prevalence of GI is 4.4%, we found no statistically significant differences between girls and boys, or between children aged over or under 10, or between those living in villages with more or fewer than 2000 inhabitants.

Conclusions: The prevalence of GL amongst the child population of ZBS in the eastern part of the province of Avila is 4.4% which figure accords closely with those found in similar studies.

Background: The analysis of the different governmental actions taken by the UK to rationalise the use of pharmaceuticals and the possibility of applying this rationales and method in Spain.

Methods: International and British literature were reviewed before a personal visit interviewing British health professionals on the central, regional and district level. Particular attention was given to the evaluation of and or information on generic drugs; the Indicative Prescribing Scheme and the Prescribing Analyses and Cost (PACT); the new roles of medical and pharmaceutical advisers for Primary Care prescriptions; the new "Medical Resource Centres" (MeReC) and "Medical Advisers Support Centre" (MASC); the role of the pharmacist in the hospital and community pharmacy is also analysed.

Results: The British approach has improved prescription use and patient care and has helped to discipline uncontrolled growth in pharmaceutical expenditures.

Conclusions: Similar measures can probably be implemented in other health systems, independently of whether or not the basic principles behind the reformed British system which are still unproven over the long run are adopted.

Background: The relationship between diet and cancer of the pancreas was assessed in a ecological study by calculating the intakes of foods and nutrients in the different Spanish provinces, during the period 1964-65, and relating these to the provincial pattern of death from pancreatic cancer 20 years after (1984-86).

Methods: The geographical pattern of mortality was evaluated by calculating the Standardized Mortality Ratios (SMR) for each province. Intake of foods was obtained from the National Institute of Statistics. Nutrients intakes were calculated from these consumption figures, by reference to tables of food composition. Simple and multiple linear regression studies with these variables were carried out.

Results: Regression coefficients obtained with foods and nutrients in the univariate analyses were in general low. In the separate multivariate models, consumption of milk and cheese were constantly positively correlated with pancreatic cancer mortality rates in males. For females, consumption of eggs was positively associated, and fruit consumption was negatively correlated. Analyses of nutrient intake adjusted for total energy showed that proteins were the most strongly correlated of the variables considered in both sexes. Animal fat, cholesterol and saturated fat were statistically significant positively correlated with pancreatic cancer mortality.

Conclusions: The results obtained are consistent with the hypothesis that diet can play a role in the etiology of the cancer of the pancreas. Further studies are needed to obtain empirical evidence for (or against) the associations found.

Background: A Breast Cancer Screening Programme managed by the Regional Ministry of Health in Castilla-La Mancha (Spain) was started in November 1992 in two districts. The purpose of this study is to describe the short-term results after five months of running.

Methods:

Design: descriptive, cross-sectional study.

Setting: female population of Talavera de la Reina and Cuenca cities, from November 1992 to the end of March 1993.

Participants: 10.050 healthy women between 45-64 years old, who were invited, by personal letter, to attend a mammography unit.

Results: 6.503 women accepted the screening invitation (participation rate of 65%) without differences between both districts. The personal letter was the main information source to women, and the presence of beliefs, attitudes and favorable experiences were the main reasons to accept the screening. The rescreening was needed by 4% of women, and finally, 67 women (1.1%) were classified "positive". The programme cost for every women into the screening was 4.067 ptas.

Conclusion: According to these results, is it feasible as economically as from the point of view of the organization, to extend the programme in Castilla-La Mancha.