Revista de sanidad e higiene publica最新文献

Background: The results of and experience on School Health Education during two years and in two health areas, which intends to promote solid contacts between all people interested in carrying out activities included in daily work, and, this way, to improve the schoolchildren habits are shown.

Methods: The activity is situated in the Investigation Action paradigm. Quantitative and qualitative methods are used in the process and product evaluation.

Results: The programme has had an statistically significant effect on the habits considered to be of interest (dental hygiene and physical exercise) and no effects on those habits on which no work was done. There have been 13 Educational Centers, 2 Health Centers and the Faculty of Medicine Sociosanitary Sciences Department. Collaboration, among all interested people, has been increasing, although there have been found difficulties and giving up.

Conclusions: Our opinion is that the role to be played by the Health Councils and the School Councils is essential to develop the recent ministerial dispositions on the matter, within the scope of health areas.

Background: Cardiovascular diseases appear as the first cause of mortality in the Autonomous Community of Extremadura, which represents 48% of all deaths. The rates of hospital morbidity situated them as the 3rd cause of hospital admissions. Because of its part in the production of atherosclerosis and its associations with ischaemic heart disease, the hypercholesterolemia is one of the necessary factors to be controlled in populations, in order to reduce mortality by coronary disease. Therefore, it becomes necessary to know the magnitude and prevalence of serum cholesterol and lipoproteins in our community, for there exist no published data on the matter and as a previous step to the introduction of intervention programmes.

Methods: An observational transversal study, stratified by blood pressure and municipalities, in a population of 30 years or more, is carried out. The size of the sample is 1060 persons; out of them 548 persons are hypertensive and 512 normotensive; these are taken as control group. In this populations, analytic tests are made to know the total cholesterol, HDL-cholesterol, LDL-cholesterol and Triglyceride levels. The TEST, the Odds Ratio Calculation, the means comparison (Student T) and means estimation are used in the analysis.

Results: Out of the total sample, 44. 18% show equal or higher than 240 mg/dl cholesterol levels and 53. 96% show higher than 150 mg/dl LDL-C levels; plasmatic triglyceride concentrations higher than 200 mg/dl appear in 10% of the sample. The estimated cholesterol average in the population of Extremadura, older than 30 years, is 202.9 : 252 in normotensive men and 230. 68: 241.1 in hypertensive men. In women, intervals are 230. 5:241:8, and 231.7 [corrected] 248.5 respectively. The association of hypertension with hypercholesterolemia converges in 46.17%, and frequency in normotensive persons is 43.36%; These differences are almost significant. The indicated coexistence represents an important increase of coronary risk. With regard to age, it is directly associated to cholesterolemia and LDL-C values with an Or of 2.47 and 2.41 respectively. On the contrary. Triglyceridemia acts as an independent variable, when studying its relation with age. For sex variable, a statistically significant association with Triglyceride concentration is proved: These concentrations are higher in women with ar Or of 2.64. With regard to cholesterol levels, there exists a predominance in men of less than 45 years, which is surpassed by women in the age group of 45-60 and becomes equal in normotensive populations after this age. No correlation is found between the pathologic antecedents of cardio/cerebrovascular disease and plasmatic cholesterol levels.

Conclusions: The authors opinion is that these important figures in the Autonomous Community, must compel, on the one hand, to study in further depth the main outside or environmental ri

Background: The routine chest radiography has been legally suppressed because of its low diagnostic profitability in non selected populations. Health surveillance of occupational populations at respiratory risk is entering a transitional period, where new guidelines are needed. Therefore, we determined to study the percentage of pathological findings in the chest radiographies of health examinations for hospital workers and whether it was possible to obtain explicative models allowing to calculate the probability of radiographies alteration.

Methods: A representative stratified sample of workers belonging to the Hospital La Paz in Madrid is studied, elaborating a transversal study based on the first health examination of their clinical history and two chest radiographies of further examinations. We carried out a multivariant analysis to calculate the probability of their alteration.

Results: We obtain alterations percentages of 19% for the first chest radiography; 23.5%, 22% and 21% for the two further ones and for the total, respectively. The explicative models obtained are based on age, family and personal antecedents of the respiratory disease, number of cigarettes smoked, cholesterol levels, the Mantoux test and the previous radiographies alteration.

Conclusions: These equations may be an additional instrument together with labour environment considerations and within a clinical context, to help to the health specific occasional surveillance of the respiratory risk of hospital personnel.

Background: Physicians' legal liability regarding malpractice has reached a previously unknown importance in Spain. This paper brings forward some statistical data on judicial claims presented by patients and their relatives.

Methods: The whole of resolutions of the First and Second Court of the Supreme Court were collected between 1870 and 1992. In Madrid, the number of lawsuits in proceedings were obtained from a sample of the Courts at the Plaza de Castilla in April 1990, and figures on legal complaints, accusations and demands were obtained through consultations at the Medical College.

Results: The great majority of verdicts, both in Civil and Penal Jurisprudence, correspond to the last 13 years. In Madrid, the average of penal cases in proceedings was 3.8 per Court, and an appreciable increase of claims can be noticed, with an annual rate of about 0.4 per 100 physicians.

Conclusions: Appealing to Justice in order to accuse a practitioner for presumed malpractice is no longer an unusual event. Various reasons contribute in this respect. However, other reasons exist to consider the Spanish situation very far from the level in the United States of America.

A bibliographic-historical review of leishmaniasis in Spain during the period 1912-1985 is carried out. The bibliographical prospecting has allowed to collect a total of 402 works; out of them only 79 are included in this review. From reading them, it can be deduced that, starting from its discovery in the coast of Levante in 1912, leishmaniasis has been a very well known disease in Spain, during the first third of our century, period in which a remarkable prevalence took place, as it follows from the works published basically by Pittaluga and colleagues. In them, plentiful clinical and epidemiologic data are collected, many of them having laid the foundations of this disease knowledge in our country. Nevertheless, the extrapolation of data from other geographical regions introduced confusions, which have continued till recent time, basically on what refers to the existing relation between the aetiological agent and the clinical case. On the other hand, nowadays, current important matters such as the part of person's immune response in the appearance of a visceral or cutaneous case of leishmaniasis, independently from the parasites specific identity or the presence of asymptomatic leishmaniasis, are already found in pioneer works. In the course of the work, a review is made of the information, obtained form the Spanish bibliography, on the leishmaniasis aetiological agent in Spain, the vector and the host as well as the various clinical cases of human and canine leishmaniasis, their epidemiology, diagnostic and treatment.

Background: A process of techniques perfection of the epidemiologic surveillance of morbidity by Acute Respiratory Infections, with the purpose of obtaining a better and more appropriate description of the problem, was carried out.

Methods: A mathematical model of Fourier harmonic analysis and an Arima model was applied to the time series of weekly consulting rates for those diseases by age groups and provinces. This allowed to identify the epidemical moments, based on the prediction of expected values and an specific cut-off.

Results: The application of this technique made it possible and early and appropriate identification of an epidemical rise in children of less than 1 year, between July and August of 1988, with the identification of the Respiratory Syncytial Virus, as the aetiological agent. In the age-group of 5-14 years, a rise was observed in September, at the beginning of the school-year, and a smaller one between May-June of 1989. In the group age of 65 years and more, an epidemical increase took place from July to October.

Conclusions: The use of these techniques provided new possibilities to make more precise and appropriate recommendations to improve epidemiological surveillance of these diseases at a national level.