Substance use among road traffic casualties admitted to emergency departments

OBJECTIVE

To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments.

METHODS

A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005-2006). Information sources were an interview, an oral fluid specimen and the patient's clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians.

RESULTS

The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25-30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18-30-year age group.

CONCLUSIONS

A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

[Mohs micrographic surgery: aplication of this technique to penile neoplasms]

Mohs micrographic surgery is a surgical technique that allows the excision in successive layers of cutaneous malignancies with the higher cure rates. At the same time, this surgical technique offers the maximal preservation of normal tissue. That is possible because Mohs surgery provides the advantage of microscopically controlled tumor-free borders in each stage guiding the surgeon in the tumor persistence until the complete surgical excision. Mohs micrographic surgery is a precise treatment for penile neoplasms and its utility is justified because the removal of a substantial surgical margin of normal tissue is obviated. MoHs micrographic surgery is indicated in the treatment of penile verrucous carcinoma due to the significant risk of loco-regional recurrence after conventional surgery. Although infrequent, other penile neoplasms that can benefit from Mohs micrographic surgery are: basal cell carcinoma, extrammamary Paget's disease, in situ melanoma and granular cell tumor.

Síndrome de Frey en la infancia

Frey's syndrome, also known as auriculotemporal syndrome is characterized by recurrent episodes of facial flushing and/or sweating along the distribution of the auriculotemporal nerve, that occurs in response to gustatory stimuli. The disorder is rare in children. We report a 4-year-old girl with flushing without hyperhidrosis in the left cheek on eating.

Cambios en el consumo de tabaco en la población general en Barcelona, 1983–2000

OBJECTIVES

To analyze the prevalence trends for smoking and its determinants in the general population of Barcelona from 1983 to 2000.

DESIGN

Time series study.

SETTING

Health survey based on home interviews of a representative sample of the general population of Barcelona.

PARTICIPANTS

In the years 1983, 1992, and 2000 we interviewed 3134, 5004, and 10,000 persons, respectively.

MAIN OUTCOME MEASURES AND RESULTS

Between 1983 and 2000 daily tobacco use showed a steady tendency to decrease among men, with a prevalence that decreased from 54.6% to 38.3%, while in women, smoking increased between 1983 and 1992 (from 20.9% to 25.4%) but remained stable in 2000 (24.5%). The proportion of smokers who said they wanted to quit increased in both sexes from 1992 (54.2%) to 2000 (65.7%). During this period the proportion of smokers who said their doctor had advised them to quit increased from 36.1% to 48.1%. The trends for both sexes showed that consumption of tobacco products was greater among less privileged socioeconomic groups.

CONCLUSIONS

The results of this study confirm the decrease in the prevalence of daily consumption of tobacco products and the increase in smokers who would like to quit, in parallel with the increase in advice from physicians to quit. However, the trends among younger groups remained stable, a finding that makes it necessary to intensify efforts aimed at this population group.

[Trends in tobacco, alcohol and cannabis consumption among secondary school pupils in Barcelona, Spain (1987-1999)]

OBJECTIVE

To describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999.

METHODS

Cross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys.

RESULTS

Regular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes.

CONCLUSIONS

During the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

Ambient pH signaling regulates nuclear localization of the Aspergillus nidulans PacC transcription factor

The Aspergillus nidulans zinc finger transcription factor PacC is activated by proteolytic processing in response to ambient alkaline pH. The pH-regulated step is the transition of full-length PacC from a closed to an open, protease-accessible conformation. Here we show that in the absence of ambient pH signaling, the C-terminal negative-acting domain prevents the nuclear localization of full-length closed PacC. In contrast, the processed PacC form is almost exclusively nuclear at any ambient pH. In the presence of ambient pH signaling, the fraction of PacC that is in the open conformation but has not yet been processed localizes to the nucleus. Therefore, ambient alkaline pH leads to an increase in nuclear PacC by promoting the proteolytic elimination of the negative-acting domain to yield the processed form and by increasing the proportion of full-length protein that is in the open conformation. These findings explain why mutations resulting in commitment of PacC to processing irrespective of ambient pH lead to permanent PacC activation and alkalinity mimicry. A nuclear import signal that targets Escherichia coli beta-galactosidase to the nucleus has been located to the PacC zinc finger region. A mutation abolishing DNA binding does not prevent nuclear localization of the processed form, showing that PacC processing does not lead to nuclear localization by passive diffusion of the protein made possible by the reduction in size, followed by retention in the nucleus after DNA binding.

Solvent effects on oxygen-17 chemical shifts in methyl formate: linear solvation shift relationships

A multiple linear regression analysis has been carried out using the Kamlet-Abboud-Taft solvatochromic parameters in order to quantify the solvent effects on the (17)O chemical shifts of methyl formate (MF). The influence of the solvents upon the carbonyl oxygen chemical shifts is smaller for MF than for N-methylformamide (NMF). The influence (in parts per million) of the solvent polarity-polarizability reduces from -21.9pi* in amides to -9.6pi* in MF. The influence of the solvent hydrogen-bond-donor acidities reduces from -42.0alpha in formamides to -16.9alpha in MF. The solvent effects upon the dicoordinated oxygen chemical shifts of MF are smaller in magnitude and opposite in direction, i.e., 4.8pi* and 2.6alpha, than those for the carbonyl oxygen. (17)O hydration shifts have been calculated for the NMF + (H(2)O)(6) and MF + (H(2)O)(5) complexes by the ab initio GIAO method at the 6-311 + G** level. The hydration shifts calculated for the carbonyl oxygens of NMF and MF and for the dicoordinated oxygen of MF, -102.4, -64.7, and 17.6 ppm, respectively, show the same trend as the corresponding empirical hydration shifts, -101.7, -42.0, and 14.2 ppm.

A homogeneous method to measure aminoacyl-tRNA synthetase aminoacylation activity using scintillation proximity assay technology

A new method to measure the aminoacylation of tRNA based upon the use of the scintillation proximity assay (SPA) technology has been developed. The assay detects incorporation of radiolabeled amino acids into cognate tRNA, catalyzed by a specific aminoacyl-tRNA synthetase (aaRS). Under acidic conditions, uncoated yttrium silicate SPA beads were found to bind tRNA aggregates, while the radiolabeled amino acid substrate remains in solution, resulting in good signal discrimination of these two species in the absence of any separation steps. The usefulness of this approach was demonstrated by measurement of steady-state kinetic constants and inhibitor binding constants for a range of aaRS enzymes in comparison with data from standard, trichloroacetic acid-precipitation-based assays. In all cases, the data were quantitatively comparable. Although the radioisotopic counting efficiency of the SPA method was less than that of standard liquid scintillation counting, the statistical performance (i.e., signal to background, variability, stability) of the SPA assays was at least equivalent to the separation-based methods. The assay was also shown to work well in miniaturized 384-well microtiter plate formats, resulting in considerable reagent savings. In summary, a new method to characterize aaRS activity is described that is faster and more amenable to high-throughput screening than traditional methods.

Effects of genistein and 2-methoxyestradiol on matrix metalloproteinases and their inhibitors secreted by Ehrlich ascites tumor cells

BACKGROUND

Ehrlich ascites tumor is an experimental tumor model very suitable for performing comparative studies relating its growth in vitro and in vivo. We used this tumor model to study the potential modulatory effects of genistein and 2-methoxyestradiol, two anti-angiogenic compounds, on the proteolytic balance MMP/TIMP. Ehrlich cells grown in vitro secreted MMP-9, MMP-2 and two TIMPs; the treatment with either of the anti-angiogenic compounds here tested stimulated all these activities, but the increase in TIMPs activities of genistein-treated cells were higher than those of MMPs, thus inducing a decrease in the proteolytic balance. On the other hand, Ehrlich cells growing in vivo did not produce any detectable TIMP activity, but accumulated MMP-9 and MMP-2 during tumor growth. Both compounds induced significant decrease of MMPs activity when tumor cells were actively proliferating. It was concluded that both genistein and 2-methoxyestradiol could shift the proteolytic balance MMP/TIMP towards antiproteolysis in media or ascitic fluid conditioned by actively growing Ehrlich cells.

On how a transcription factor can avoid its proteolytic activation in the absence of signal transduction

In response to alkaline ambient pH, the Aspergillus nidulans PacC transcription factor mediating pH regulation of gene expression is activated by proteolytic removal of a negative-acting C-terminal domain. We demonstrate interactions involving the approximately 150 C-terminal PacC residues and two regions located immediately downstream of the DNA binding domain. Our data indicate two full-length PacC conformations whose relative amounts depend upon ambient pH: one 'open' and accessible for processing, the other 'closed' and inaccessible. The location of essential determinants for proteolytic processing within the two more upstream interacting regions probably explains why the interactions prevent processing, whereas the direct involvement of the C-terminal region in processing-preventing interactions explains why C-terminal truncating mutations result in alkalinity mimicry and pH-independent processing. A mutant PacC deficient in pH signal response and consequent processing behaves as though locked in the 'closed' form. Single-residue substitutions, obtained as mutations bypassing the need for pH signal transduction, identify crucial residues in each of the three interactive regions and overcome the processing deficiency in the 'permanently closed' mutant.

[Preventive behaviors for the sexual transmission of AIDS, other infections, and pregnancy in high-school students]

OBJECTIVES

To describe preventive behaviors and behavioral intentions related to AIDS sexual transmission, other sexually transmitted diseases and unwanted pregnancies among 10th grade Barcelona students.

DESIGN

Cross-sectional study. Stratified random sample from Barcelona secondary schools in 1996.

SETTING

Secondary schools.

PARTICIPANTS

981 students at 35 10th grade classrooms.

MAIN RESULTS

82% of the students are 15-16 years old. 58% are girls. 16% have had sexual intercourse (boys 18% and girls 14%); among those, 43% of males and 30% of females have had only once sexual intercourse. 78% use always or almost always a condom. 22% of boys and 44% of girls have refused at least an opportunity of unprotected intercourse. Boys feel more confident to buy, carry on and use a condom, however girls feel more confident in convincing their partner and refusing unprotected sex. Among those with sexual experience, partner opinion predicts condom use (boys OR = 30.8 and girls OR = 8.8), as well as partner use (boys OR = 14.2 and girls OR = 15.4). Intention to use condoms with a regular partner is related to the perception of youth normative behaviors (boys OR = 10.9 and girls OR = 4.4) and friends opinion (boys OR = 6.2 and girls OR = 5.4). Condom use with a non regular partner is related also to the perception that its use avoids infections and unwanted pregnancies (boys OR = 9.9 and girls OR = 8.0). Intention to refuse unprotected sex relates, in both genders, to youth normative behaviors and self-efficacy to refuse unprotected intercourse.

CONCLUSIONS

16% of the 10th grade students have had a sexual intercourse. Only half part of them use always condom, although it is the contraceptive method more frequently used. Condom use relates mainly to partners opinions and their current use. Intentions to use condoms are associated also to friends opinion and youth social norm perception. Intention to use a condom with non regular partners aims avoiding diseases and unwanted pregnancies.

The identification of phosphatidylinositol 3,5-bisphosphate in T-lymphocytes and its regulation by interleukin-2

In recent times 3-phosphoinositides have emerged as important regulators of cell metabolism, survival, and proliferation. During the last year, the phospholipid phosphatidylinositol 3, 5-bisphosphate (PtdIns3,5P2) was identified in yeast, fibroblasts, SV40-transformed kidney (COS-7) cells, and platelets. The discovery of this novel phospholipid has increased the complexity of the metabolism relating to the generation of biologically active inositol-containing lipids. We describe here the identification of PtdIns3,5P2 in the CTLL-2 mouse T-lymphocyte cell line using two in vivo radiolabeling protocols. Treatment of the cells with UV radiation led to an increase in the cellular content of PtdIns3,5P2. In contrast, preincubation of the cells with wortmannin or treatment with hypertonic medium (high concentration sorbitol) led to the opposite effect. Herein we demonstrate that interleukin-2 (IL-2), the growth factor required for CTLL-2 cell proliferation, was able to increase the level of PtdIns3,5P2 with similar kinetics to that of the formation of phosphatidylinositol 3,4-bisphosphate (PtdIns3, 4P2). An increase in this novel 3-phosphorylated lipid in response to IL-2 seems to be a general property of this cytokine because a similar result was obtained when the pre-B cell line BaF/3 expressing the high affinity IL-2 receptor was used. Using a constitutively active regulatory subunit of type I phosphatidylinositol 3-kinase and cells expressing a deletion of the serine-rich domain of the IL-2 receptor beta chain, which is required for IL-2-stimulated type I phosphatidylinositol 3-kinase activation, we demonstrate that IL-2-induced generation of PtdIns3, 5P2 is related to the activation of this enzyme. The results show for the first time the identification of PtdIns3,5P2 in both T- and B-lymphocytes and indicate its positive regulation by the mitogen IL-2.

[Trends in smoking among school children: Barcelona, 1987-1996]

OBJECTIVE

Despite the growth of aids and of other causes of premature death, smoking is the main single cause of avoidable mortality in Spain. Given the addictive nature of tobacco and the difficulties experienced by many smokers to quit, the primary prevention of smoking is crucial. In recent years several initiatives have been developed to this end. The objective of this paper is to monitor smoking among schoolchildren by repeated surveys over a decade, to ascertain the impact of current interventions and to reorient them according to evidence.

DESIGN

Cross sectional surveys over a decade, from 1987 to 1996, while several smoking prevention efforts were developed. Survey instruments were similar self administered and anonymous questionnaires. SITE: Schools in Barcelona (Catalonia, Spain).

PARTICIPANTS

Around 1000 participants in each survey were selected through representative samples of 8th grade students (predominantly 13-14 years old), stratified by school type and size in each round.

MAIN RESULTS

Ever smoking declined, specially for boys (global decline 12.4%, p = 0.05). There is a clear and steady decline, statistically significant, in the proportion smoking in the month prior to the survey (global decline 50.5%, p < 0.0001). The proportion of regular smokers declines from 1987 to 1994, and then is stabilized (global decline 23%, p < 0.05). The proportion of daily smokers fluctuates, but globally it is the lowest of the decade in 1996. No changes are visible in the proportion who declare buying tobacco for personal use.

DISCUSSION

From 1987 to 1996 several smoking indicators show a decline among 8th grade schoolchildren in Barcelona, Spain. The pattern suggests a decline in global smoking experimentation and in the intensity of experimentation, with a small reduction in the prevalence of regular use, while the small proportion of daily smokers at this young age does not change.

[AIDS prevention among adolescents in school: a systematic review of the efficacy of interventions]

BACKGROUND AND AIMS

Preventive interventions are considered useful although poorly evaluated. Since 1990 there are growing evidences of effective school aids prevention interventions. This paper aims to identify school aids prevention programs among youngsters aged 13 to 19, published between 1990 and 1995, to analyze each evaluation and intervention quality, to assess their effectiveness as well as identifying the possible contributing factors.

METHODS

Location of reports by means of a Medline computerized search of published articles and reviews, which should include the following criteria: school aids prevention programs, addressed to youngsters aged 13 to 19, published in Spanish, French or English between 1990 and 1995 in scientific literature, and evaluating changes in behavior or its determinants through quantitative measures. Analysis of the evaluation quality through the assessment of the sample size, the use of a control group, the groups comparability, the drop out analysis and the time between the pretest and the posttest. Intervention quality analysis through the use of a psychological behavioral change model and the number of sessions. The effectiveness of the high quality interventions in changing behaviors, intentions, attitudes and knowledge was assessed.

RESULTS

29 studies were selected. Of these studies, relating the quality of evaluation criteria, a 28% was considered a high quality study, a 14% an intermediate quality study and a 58% a low quality one. In relation to intervention quality criteria, a 27% was found to be a high quality study, a 41% an intermediate quality study and 32% a low quality one. 38% (11 studies) showed high or intermediate quality criteria at the same time in intervention and in evaluation. All these studies modified knowledge and attitudes, an 80% modified the intention to behave and a 86% modified behavior. The increase in knowledge and attitudes was in general quite important, greater than 10%, and changes in intentions and behaviors were smaller than 10%, although relevant.

CONCLUSIONS

Only 38% of the studies may be considered of high or intermediate quality. Preventive interventions correctly evaluated which rely on a theoretical model and offer 4 or more sessions show evidence of moderate but relevant reduction of aids risk practices, and important changes of the future behavior determinants.

[Health-related behaviors in secondary-school students: sexual relations and tobacco, alcohol and cannabis consumption]

BACKGROUND AND OBJECTIVES

The main premature mortality causes among youngsters are related to risk behaviors, usually initiated in adolescence. The study objective is to describe substance use and sexual behaviours among 10th-grade Barcelona students in 1996 (last year of compulsory education), as well as the interrelations between these variables and several sociodemographic variables.

METHODS

Cross sectional study. Random sample including 35 10th grade classrooms (958 students whose mean age is 15.8 years old) stratified by academic or vocational studies, public or private school, school neighbourhood socioeconomical level and school size. Measurement instrument is a previously validated questionnaire. Tobacco, alcohol, and cannabis consumption, sexual intercourse as well as gender, age, weekly available money, parental instruction and type of studies are studied. Bivariate chi 2 analysis and multivariate gender specific log-linear model are performed.

RESULTS

27% of the students smoke daily and 31% drink alcohol weekly. 15% have had sexual intercourse, and among those 79% use always or almost always condoms. Among girls tobacco consumption is related to alcohol (OR = 4.2), to cannabis (OR = 5.9) and sexual intercourse (OR = 3.9), and, less strongly, with age, available money and vocational studies. Alcohol is associated with tobacco and cannabis use (OR = 4.2). Having had sexual intercourse is related to tobacco use, age (OR = 3.4), vocational studies (OR = 2.4) and cannabis experience (OR = 2.8). Among boys tobacco consumption is related to alcohol, (OR = 2.7), to cannabis (OR = 7.6) and sexual intercourse (OR = 4.4), and, less strongly, to available money and type of studies. Alcohol consumption is associated with tobacco and cannabis use (OR = 5.5). Sexual intercourse is related to tobacco use and age (OR = 2.5).

DISCUSSION

Risk behaviors among final year secondary school students are strongly and significantly interrelated, both among boys and among girls, and are more frequent among older students, those with more money available and those in vocational curricula.

[Early and late epileptic crisis following cerebral hemisphere ischemia]

INTRODUCTION

There is no agreement as to the frequency and characteristics of epileptic seizures (ES) associated with cerebrovascular disease (CVD).

OBJECTIVE

To analyze the presence of early (Se) and late (SI) ES, factors related to these, prognosis and conversion to epilepsy.

PATIENTS AND METHODS

We made a retrospective study of 386 patients with cerebral hemisphere ischemia (100 TIA and 286 infarcts). Follow-up was 29.69 +/- 13.92 months. Two groups were defined: a) Patients without ES, and b) patients with ES. Those occurring within 15 days of the episode of ischemia were considered to be Se and the others Sl. We studied the prognosis (modified Rankin scale on discharge from hospital) and mortality.

RESULTS

Twenty three patients (6%) had crises (18 Se and 5 Sl). The commonest type was simple partial motor crises (13 or 56.5%) followed by generalized tonic-clonic crises (9 or 39.1%) which predominated in the Se group. There were 6 solitary crises (Se) and 17 (73.9%) recurrences (66.6% of the Se and 100% of the Sl) (p = 0.049). There was an association between the presence of a family history of epilepsy (p < 0.001) and increased risk factors for epilepsy and CVD, particularly previous ictus and cardiopathy respectively (p = 0.034). No patient with TIA or lacunar infarct had ES. Extensive infarcts showed and increased tendency to the associated with hemorrhagic transformation, involvement of the cortex (p < 0.001) and cardioembolic incidents (p = 0.025). They had a worse prognosis, led to more disability (p < 0.001) and earlier mortality (38.4%) (during the first three months) (p = 0.015). These factors were associated (p < 0.001).

CONCLUSIONS

Postischemic cerebral seizures are frequent and have a high recurrence rate, especially in patients with extensive infarcts involving the cortex and these of embolic origin. The prognosis is worse when crises occur early.

[Smoking and school children: context, opinions and behavior]

BACKGROUND

This paper studies smoking epidemiology in school-age students.

MATERIAL AND METHODS

A cross-sectional survey of 8th grade students (13-14 years-old) in the schools of Barcelona (Catalonia, Spain) in 1987, 1992 and 1994.

RESULTS

The perception of smoking in the students environment has decreased. The proportion of regular smokers decreases, from 12.6% in 1987 to 9.5% in 1994 (p < 0.05) (an annual decrease of 3.5%) although the proportion who experiment with tobacco remains table.

CONCLUSIONS

There is a decrease in the prevalence of regular smoking in the school-age population (13-14 years-old) in Barcelona (Spain).

Role of the new azoles in the treatment of fungal osteoarticular infections

OBJECTIVES

To analyze the usefulness of the new azoles for the treatment of fungal osteoarticular infections, and to report three cases of fungal knee arthritis treated with fluconazole in our unit.

METHODS

The medical literature was reviewed for all cases of osteoarticular infection caused by fungi and treated with fluconazole or itraconazole registered in the MedLine Silver Platter database from 1972 to 1997.

RESULTS

The total number of patients included in this review was 56; 19 were treated with fluconazole and 37 with itraconazole. The most frequent causative agents implicated were fungi of the genuses Candida and Aspergillus. There were eight therapeutic failures, and there were no statistically different findings among the patients in terms of their health status. Adverse effects were unusual.

CONCLUSIONS

Controlled studies are necessary to establish the true role of the new azole drugs in the treatment of fungal osteoarticular infections, but they seem to be a promising therapeutic option.

[Maternity in adolescents in the districts and neighborhoods of Barcelona: its association with the socioeconomic level and the prevalence of low weight at birth. The Working Group of Maternal-Child Health of the Municipal Institute of Health of Barcelona]

OBJECTIVE

To describe the distribution of birth rates and low birth weight among teenagers from the health districts and neighbourhoods of Barcelona and their association with social and economic level.

DESIGN

Environmental study.

SETTING

City of Barcelona.

METHODS

The birth rates for under-20 year olds resident in Barcelona for the periods 1980-1982, 1987-1992 and 1990-1992 were calculated. The index of family economic capacity (IFEC) was used as a social and economic indicator. The coefficient of Spearman was used as a correlative measurement.

MEASUREMENTS AND MAIN RESULTS

Between the periods 1980-1982 and 1990-1992, a 65% drop in the adolescent birth rate was observed. The correlation of birth rates with the IFEC for the district fell from -0.91 to -0.69 in the same period.

CONCLUSIONS

Adolescent birth rates have very uneven geographical distribution, which correlates with the distribution of income. The percentage of low weight at birth is higher in the poorest districts, but the association with IFEC is much weaker.

Analysis of compliance with oral contraception in Spain

OBJECTIVE

The study was designed to analyze factors related to compliance in oral hormonal contraception in Spain.

METHOD

A review study and a multicenter analysis of experience of compliance by 300 doctors, by means of a questionnaire and discussion about the determinants of contraceptive use.

RESULTS

Compliance is a major problem in Spain, being influenced mainly by side-effects, the general perception of the method and personal factors. The different factors involved in non-compliance in Spain were analyzed, with regard to the perspective of the professionals.

CONCLUSIONS

Strategies to improve compliance in Spain aim mainly at improving the general perception of the method and the accessibility of family planning centers. Factors associated with compliance are still not well known in our country. Better knowledge of the determinants of non-compliance in Spain is needed. For this purpose, another research group was formed to conduct a national study among women.

Evaluation of a social health intervention among homeless tuberculosis patients

SETTING

Homeless and other fringe groups are a priority in the global strategies of tuberculosis prevention and control in big cities, as a consequence of their generally poor adherence to treatment and concurrent multiple social and health problems.

OBJECTIVE

To evaluate a social care and health follow-up programme targeting homeless tuberculosis patients in Ciutat Vella District, Barcelona, which covered 210 patients from 1987 to 1992. During directly observed treatment, primary health care and, if necessary, accommodation was provided.

DESIGN

The differential tuberculosis incidence rate between Ciutat Vella and the other districts of Barcelona, the percentage of successfully completed treatments and the days of hospitalization saved by the programme were measured.

RESULTS

There was a significant decrease in the tuberculosis incidence rate among homeless patients in Ciutat Vella (from 32.4 per 10(5) inhabitants in 1987, to 19.8 per 10(5) in 1992, P = 0.03), compared to an unchanged rate elsewhere (1.6 per 10(5) inhabitants in 1987, compared to 1.7 per 10(5) in 1992, P = 0.34). A smaller than expected proportion, 19.6%, of patients failed to complete their treatment, and a decrease in the mean period of hospitalization for tuberculosis in the district hospital was recorded, falling from a mean 27.1 days in 1986 to a mean 15.7 days in 1992.

CONCLUSION

The programme appears to be both effective and efficient, as it has enabled a large number of homeless patients to complete their treatment successfully, at the same time saving twice the amount of funds invested.

[Inequalities in maternal-child health: impact of an intervention]

We present the evaluation of the population impact of a social and health maternal and child intervention, implemented in a low income urban area (Ciutat Vella) in Barcelona, Spain. Intervention was based on increasing access to health and social services for pregnant women and for the children. A quasiexperimental design with a nonequivalent control group and multiple measurements was used. We compared infant and perinatal cumulative mortality rates between Ciutat Vella District and the rest of the city, before (1983-86) and after the intervention (1987-89, 1990-92). Results showed that the significant differences found previously to the program between the mortality rates disappeared with the development of the program. Infant mortality in Ciutat Vella was 17.7/.000 births in 1983-86, and became 13.1/1.000 births in 1987-89, and 13.4 in 1990-92; in the rest of the city, infant mortality was 9.5/1.000 births in 1983-86, and became 8.8/ and 7.7/1000 births respectively. A comprehensive social and health care program implemented in small low income areas may contribute to reduce inequalities in maternal and child health.

[Maternity in adolescents at high social risk]

OBJECTIVE

To analyse for the 1987-1990 period the indicators of prenatal care and the social-health follow-up of adolescent girls included in the mother-child programme of Ciutat Vella (Barcelona). This programme was aimed at pregnant women resident in the district and with high social risk profiles.

DESIGN

Descriptive and retrospective study.

MEASUREMENTS AND MAIN RESULTS

175 adolescent mothers were included in the programme during the period under study. This represented 82.9% coverage of all births in the district to this age group. In 10.9% of cases the mother stated she lived alone. 10.2% had had a previous child. There were drug addiction antecedents in 5% of the mothers. The first prenatal check took place during the first three months only in 56% of the pregnancies, with the proportion of low weight births (LWB: weight at birth below 2,500 grams) at 13.1%. During the period under study the proportion of pregnant women checked in the first three months went up from 45.6% to 62.5%, while the proportion of LWB's went down from 19.3% to 6.3%.

CONCLUSIONS

There has been both a striking improvement in the indicators of prenatal care and less low weight births during the first four years of this programme. It is worth noting the worrying fact that one third of pregnant adolescents do not attend for a prenatal check-up before three months of their pregnancy have elapsed.

[Vaccinal coverage at 2 years of age in a socially disadvantaged urban area]

OBJECTIVE

To assess vaccination coverage at two years of age among the children of the Old City District of Barcelona (Spain), a socially deprived urban area.

DESIGN

Cross-sectional, based on a random sample of the children born in 1987.

SETTING

Community.

PARTICIPANTS

A random sample of children born in 1987 from mothers resident in the district.

MEASUREMENTS AND MAIN RESULTS

83.8% had a vaccination card. Vaccination coverage is 68.1% for measles, mumps and rubella and 65.5% with four doses of DTP and OVP. Of these children, 16.2% were not found in the computerized City Vaccination Program, based on births records, and these children have very low immunization levels: their vaccination cover is only 42.1% for measles, mumps and rubella and 28.9% with four doses of DTP and OPV.

CONCLUSIONS

These results confirm a lower immunization coverage in this area. Although artifactual explanations for this finding have to be ruled out, these results suggest that the health indicators in this district are influenced by a concentration of population with severe problems instead of reflecting a higher diffuse frequency of problems in the whole population.

[Our experience with Kufs disease: familial form and sporadic case]

Our experience on Kufs' disease includes a familiar, neurovisceral form and a sporadic case. The familiar form shows an autosomal, dominant inheritance, and belongs to Berkovic's type B. A variability on the age of onset was observed, being more protracted in women. The sporadic case belongs to Berkovic's type A. Her EEG showed a periodic, short-interval, activity for a long period of illness. NMR findings were nonspecific for the diagnosis. All cases showed granular osmiophilic deposits, but not storage characterized by fingerprint profiles. Visceral storage in many cases on Kufs' disease suggests the utility of visceral biopsy evaluation for the diagnosis during life.