Spanish-Speaking Status: A Protective Factor in Colorectal Cancer Presentation at a Safety-Net Hospital

INTRODUCTION

Lower screening rates and poorer outcomes for colorectal cancer have been associated with Hispanic ethnicity and Spanish-speaking status, respectively.

METHODS

We reviewed sequential colorectal cancer patients evaluated by the surgical service at a safety-net hospital (SNH) (2016-2019). Insurance type, stage, cancer type, surgery class (elective/urgent), initial surgeon contact setting (outpatient clinic/inpatient consult), operation (resection/diversion), and follow-up were compared by patient-reported primary spoken language.

RESULTS

Of 157 patients, 85 (54.1%) were men, 91 (58.0%) had colon cancer, 67 (42.7%) primarily spoke Spanish, and late stage (III or IV) presentations occurred in 83 (52.9%) patients. The median age was 58 y, cancer resection was completed in 48 (30.6%) patients, and 51 (32.5%) patients were initially seen as inpatient consults. On univariate analysis, Spanish-speaking status was significantly associated with female sex, Medicaid insurance, being seen as an outpatient consult, and undergoing elective and resection surgery. On multivariable logistic regression, Spanish-speaking patients had higher odds of having Medicaid insurance (AOR 2.28, P = 0.019), receiving a resection (AOR 3.96, P = 0.006), and undergoing an elective surgery (AOR 3.24, P = 0.025). Spanish-speaking patients also had lower odds of undergoing an initial inpatient consult (AOR 0.34, P = 0.046).

CONCLUSIONS

Spanish-speaking status was associated with a lower likelihood of emergent presentation and need for palliative surgery among SNH colorectal cancer patients. Further research is needed to determine if culturally competent infrastructure in the SNH setting translates into Spanish-speaking status as a potentially protective factor.

Compliance With Surgical Oncology Specialty Care at a Safety Net Facility

BACKGROUND

Social determinants of health challenge in at-risk patients seen in safety net facilities.

STUDY DESIGN

We performed a retrospective review of surgical oncology specialty clinic referrals at a safety net institution evaluating referral compliance and times to first appointment and initiation of definitive treatment. Main outcomes measured included completion of initial visit, initiation of definitive treatment, time from referral to first appointment, and time from first appointment to initiation of definitive treatment.

RESULTS

Of 189 new referrals, English was not spoken by 52.4% and 69.4% were Hispanic. Patients presented without insurance in 39.2% of cases. Electronic patient portal was accessed by 31.6% of patients. Of all new referrals, 55.0% arrived for initial consultation and 53.4% initiated definitive treatment. Malignant diagnosis (P < .0001) and lack of insurance (P = .01) were associated with completing initial consultation. Initiation of definitive treatment was associated with not speaking English (P = .03), malignant diagnosis (P < .0001), and lack of insurance (P = .03). Times to first appointment and initiation of definitive treatment were not significantly affected by race/ethnicity, language, insurance, treatment recommended, or electronic patient portal access.

CONCLUSION

Access to surgical oncology care for at-risk patients at a safety net facility is not adversely affected by lack of insurance, primary spoken language, or race/ethnicity. However, a significant proportion of all patients fail to complete the initial consultation and definitive treatment. Lessons learned from safety net facilities may help to inform disparities in health care found elsewhere.

Diverting Ostomy: For Whom, When, What, Where, and Why

Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.

The current screening programme for congenital transmission of Chagas disease in Catalonia, Spain

Due to considerable numbers of migrants from Chagas disease-endemic countries living in Catalonia, the Catalonian Health Department has recently implemented a screening programme for preventing congenital transmission, targeting Latin American pregnant women who attend antenatal consultations. Diagnosis of Trypanosoma cruzi infection in women is based on two positive serological tests. Screening of newborns from mothers with positive serology is based on a parasitological test during the first 48 hours of life and/or conventional serological analysis at the age of nine months. If either of these tests is positive, treatment with benznidazole is started following the World Health Organization's recommendations. The epidemiological surveillance of the programme is based on the Microbiological Reporting System of Catalonia, a well established network of laboratories. Once a positive case is reported, the responsible physician is asked to complete a structured epidemiological questionnaire. Clinical and demographic data are registered in the Voluntary Case Registry of Chagas Disease, a database administered by the Catalonian Health Department. It is expected that this programme will improve the understanding of the real burden of Chagas disease in the region. Furthermore, this initiative could encourage the implementation of similar programmes in other regions of Spain and even in other European countries.

Vaccination coverage in indigenous and immigrant children under 3 years of age in Catalonia (Spain)

Vaccination coverage in a representative sample of children under 3 years of age in Catalonia (Spain) was studied. Parents of children selected were contacted and asked for the child's vaccination card. A total of 630 children were included, of whom 570 were indigenous and 60 immigrants. Primary vaccination coverage was 96.5% for indigenous and 85% for immigrant children (p=0.0001), while the coverage of primary vaccination plus booster doses was 88.6% in indigenous and 78.3% in immigrant children (p=0.02). Efforts should be made to increase primary vaccination coverage in immigrant children and booster dose coverage in both indigenous and immigrant children.

Measles outbreak in the Barcelona Region of Catalonia, Spain, October 2006 to February 2007

From 1 October 2006 to 31 January 2007, 213 confirmed cases of measles occurred in the Barcelona Region, resulting from the importation of one case.

Seroprevalence of measles, rubella, and mumps antibodies in Catalonia, Spain: results of a cross-sectional study

Determination of antibody levels against vaccine-preventable diseases is of great value to assess immunization programmes. The objective of this study was to determine the prevalence of measles, rubella, and mumps antibodies in representative samples of the child and adult population of Catalonia and compare the findings to those obtained in 1996. A representative sample of the child and adult (>or=15 years) population of Catalonia was studied. Enzyme-linked immunosorbent assay techniques were used to determine the presence of antibodies. Equivocal results for antibodies against measles and rubella were tested using an immunofluorescence technique. To compare proportions, the chi-square test and the Fisher's exact test were used. Statistical significance was set at 0.05. Adjusted odds ratios were calculated using multiple logistic regression analysis. Samples from 2,619 people were analyzed. The global prevalence of antibodies was 98.3% for measles, 91.1% for mumps, and 98.1% for rubella. The prevalence of rubella antibodies was higher in women than in men (98.8 vs. 97.2%, respectively). Compared with the results obtained in the 1996 seroprevalence study, only the prevalence of rubella antibodies showed a statistically significant increase in men (97.2 vs. 94.6%; p=0.002) and, in particular, in women (98.8 vs. 95.3%; p<0.001). The low prevalence of susceptible subjects has already led to the elimination of indigenous measles in Catalonia and should allow the elimination of indigenous rubella by 2005. The level of antibodies necessary to interrupt the transmission of mumps has still not been reached in all age groups.

Apheis: public health impact of PM10 in 19 European cities

STUDY OBJECTIVE

Apheis is a public health surveillance system that aims to provide European, national, regional, and local decision makers, environmental health professionals, and the general public with up to date and easy to use information on air pollution and public health. This study presents the health impact assessment done in 19 cities of Western and Eastern European countries.

DESIGN

Apheis developed guidelines for gathering and analysing data on air pollution and the impact on public health. Apheis has analysed the acute and chronic effects of fine particles on premature mortality using the estimates developed by Aphea2 study and two American cohort studies. This health impact assessment was performed for different scenarios on the health benefits of reducing levels of particles less than 10 microm in size (PM(10)).

MAIN RESULTS

PM(10) concentrations were measured in 19 cities (range: 14-73 microg/m(3)). The population covered in this health impact assessment includes nearly 32 million inhabitants. The age standardised mortality rates (per 100 000 people) range from 456 in Toulouse to 1127 in Bucharest. Reducing long term exposure to PM(10) concentrations by 5 microg/m(3) would have "prevented" between 3300 and 7700 early deaths annually, 500 to 1000 of which are associated with short term exposure.

CONCLUSIONS

Apheis shows that current levels of air pollution in urban Europe have a non-negligible impact on public health, and that preventive measures could reduce this impact, even in cities with low levels of air pollution.

Epidemic soybean asthma and public health: new control systems and initial evaluation in Barcelona, 1996-98

OBJECTIVE

To evaluate the new measures adopted to control the risks from soybean unloading operations in the Port of Barcelona, after an episode of epidemic asthma in June 1996.

METHODS

After an initial cautionary suspension of all soybean unloading operations, they were subsequently resumed under restrictive criteria for time, flux, simultaneity, and meteorological conditions. Emission filtration systems based on either micro pore size filters or polytetrafluoroethylene membranes on tetratex filters showed promising results.

RESULTS

Allergen emission underwent a very important decrease to levels 95% to 98% lower. Emissions from the two plants with unloading operations are in the same order of magnitude as the processing plant that does not unload soybean. Allergen concentration levels presented fluctuations initially, but the new filters decreased mean values; despite increased unloading, allergen levels did not increase-mean allergen levels on unloading days (67 U/m(3)) and on days without unloading operations (63 U/m(3)) are similar. A panel of patients detected a cluster of increased symptoms during unloading operations on a day with suboptimal meteorological conditions and comparatively low allergen levels (225-415 U/m(3)). Since the June 1996 episode, no further asthma outbreak has been detected.

CONCLUSIONS

The evaluation shows the effectiveness of the new filters in the control of soybean dust emission. With a systematic control programme, industrial soybean operations may function near urban centres without public health risks. These data may be useful in the development of future standards for allergenic agents.

An outbreak of Legionnaires' disease in an inner city district: importance of the first 24 hours in the investigation

OBJECTIVE

To present the main results of the investigation of an outbreak of Legionnaire's disease that occurred in an inner city district of Barcelona between 15 October and 15 November 2000.

METHODS

Epidemiological surveys of patients and environmental investigations were initiated on the day the first five cases were notified. Water samples and smears from cooling tower trays were taken for microbiological analysis. Maps of the distribution of cases and possible contamination foci were elaborated. Incidences were calculated for each census tract.

RESULTS

A total of 54 patients related to the outbreak were identified, with a case fatality rate of 5.5%. Incidence rate in the area closest to the cooling tower (6.40/1000) was significantly higher than that of the rest of the neighbourhood (2.23/1.000, RR 2.87, 95%CI 1.37-6.12, P = 0.0035). Cultures positive for Legionella pneumophila serogroup 1, subtypes Pontiac, Philadelphia or Allentown, were obtained from eight patients. On the 39th day of the investigation it was found that the strain isolated in one of the cooling towers coincided with the serogroup, subtype and molecular profiles identified in clinical samples.

CONCLUSIONS

Rapid coordination of clinicians, microbiologists, epidemiologists and environmentalists permitted the source of infection and the affected cases to be correlated within a few days.

Practical evaluation of standard-based low-cost video conferencing in telemedicine and epidemiological applications

The results of the evaluation of use of low-cost video conferencing systems (VCSs) in telemedicine is presented. Applications sharing, a new feature of these systems, recently has allowed high-quality computer-supported collaborative work (CSCW). The video conferencing (VCing) equipment used was Intel ProShare 200 v2.0a. It is representative of other low-cost VCSs. The areas of application are epidemiology and telemedicine (orthopaedics and radiology). Potential end users filled out 58 evaluation questionnaires concerning user profiles, contents and benefits of the sessions, organizational aspects, user friendliness, user acceptance, cost effectiveness, technical and multipoint related aspects. Although the end users had a lot of computer experience, their knowledge in VCSs was rather limited. The users assessed the system capable of being integrated into routine work, despite a high organizational impact. The VCS is user friendly, application sharing being used in almost every session. Audio quality was not always sufficient. The remote video was sufficient, as was the quality of medical images such as CT, MRI or X-ray. The user acceptance of the system was high. Multipoint sessions require a structured protocol to be effective. Some technical problems with MCUs (Multipoint Control Units) occurred. The use of low-cost standard VCSs in telemedicine is advisable and is a good substitute for real meetings.

Transient nonketotic hyperglycinaemia: ultrasound, CT and MRI: case report

We report a case of transient nonketotic hyperglycinaemia in which radiography correlated closely with clinical and biochemical findings. Only 5 patients have been previously described with this transient from of nonketotic hyperglycinaemia. Among the radiographic findings, thinning of the corpus callosum is the most characteristic.

Arteriovenous malformation animal model for radiosurgery: the rete mirabile

PURPOSE

To study the effects of single-dose radiation on the porcine rete mirabile, a tangle of microvessels that mimics human arteriovenous malformations of the brain.

METHODS

Eight retia mirabilia received a single dose of radiation under stereotactic location with digital angiography and CT. The following doses were applied: 20, 30, 40, 50, 60, 70, 80, and 90 Gy. The animals were followed up for a period of 7 months. Findings at neurologic examination, serial angiography, and histopathologic examination were analyzed.

RESULTS

Progressive occlusion as observed by angiography corresponded to the histopathologic finding of intimal hyperplasia; that is, marked thickening of the vessel wall, progressing to occlusion of the vascular lumen, and associated thrombosis. A direct dose response was noted for these changes. Neurologic findings were related to the dose distribution and to histologic findings in structures adjacent to the rete mirabile.

CONCLUSION

The rete mirabile is an excellent model by which to study the radiologic and histologic effects of single-dose radiation to the microvasculature of the central nervous system.

Repeaters count: a sentinel method for asthma outbreaks. Barcelona Soybean-Asthma Group

BACKGROUND

Asthma outbreaks have not been detected in Barcelona, Spain since the epidemic of 1981-7. On 29 October 1994 several subjects attended a Barcelona hospital because of acute attacks of asthma and were identified as former soybean epidemic asthma patients (repeaters), raising the possibility of an asthma soybean-related episode. The usefulness of counting repeaters to evaluate small increases of acute asthma in a non-epidemic period is illustrated.

METHODS

A retrospective identification of asthma admissions was performed, pollution filters collected before and after the index day were analysed for contents of low molecular weight soybean allergen, and soybean unloading activities were investigated.

RESULTS

There was no epidemic increase of asthma patients during this day in the whole of Barcelona, but an unusually high number were repeaters (seven observed v 0.483 expected). A relationship with increased levels of low molecular weight soybean allergen (U/m3) was detected in the available pollution filters collected the day before and after the index day. Two ships were unloading soybean in the city harbour on the index day.

CONCLUSION

Soybean unloading at the harbour of Barcelona released soybean dust and produced a small cluster of emergency room visits for asthma in patients formerly affected by soybean asthma epidemics. It is suggested that counting repeaters could provide the basis for a systematic epidemiological surveillance of sensitised populations.

PCR-based study of the presence of Y-chromosome sequences in patients with Ullrich-Turner syndrome

The presence of Y chromosome sequences in Ullrich-Turner syndrome (UTS) patients has been suggested in previous work. Karyotype analysis estimated at about 60% of patients with a 45, X constitution and molecular analysis (Southern blot analysis with several Y chromosome probes and PCR of specific sequences) identified the presence of Y chromosome material in about 40% of 45, X patients. We have developed a very sensitive, PCR-based method to detect Y specific sequences in DNA from UTS patients. This protocol permits the detection of a single cell carrying a Y sequence among 10(5) Y-negative cells. We studied 18 UTS patients with 4 Y-specific sequences. In 11 patients we detected a positive amplification for at least one Y sequence. The existence of a simple and sensitive method for the detection of Y sequences has important implications for UTS patients, in view of the risk for some of the females carrying Y-chromosome material of developing gonadoblastoma and virilization. Additionally, some of the UTS associated phenotypes, such as renal anomalies, could be correlated with the presence of Y chromosome specific sequences.

Predictive factors of enrollment and adherence in a breast cancer screening program in Barcelona (Spain)

This paper study the predictive factors associated to enrollment and adherence in a breast cancer screening program in Barcelona, Spain; the Program is targeted to women 50-70 years of age who are members of a Health Maintenance Organization. Data were collected by personal interview for the attending women and by telephone in the non-attending group. The questionnaire was focused on knowledge, attitudes and practices related to female cancer prevention and breast cancer risk factors. Data analysis consisted of bivariate and multivariate analysis. Enrolling in a breast cancer screening program was strongly associated with practices related to cancer prevention in the bivariate analysis. Having had a previous mammography was the only behavioral factor that showed an independent relationship with enrollment (OR = 6.45, 95% CI = 3.35-12.42) in the multivariate analysis together with being younger than 55 and having family history of cancer. Adherence was associated with having the best opinion of the program, knowing the preventive role of mammography and performing regular breast self-examination in the bivariate analysis; of these, knowing the preventive role of mammography (OR = 2.66, 95% CI = 1.14-6.18) and performing regular breast self-examination (OR = 1.99, 95% CI = 1.23-3.23) were independently associated in the multivariated analysis. Being a relative of a municipal worker and younger than 55 were also significantly associated with adherence. Getting women to participate in a breast cancer screening program is difficult--mailed invitation letters are not sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cystic fibrosis in Asturias: an elevated frequency of the delta F508 mutation]

BACKGROUND

Cystic fibrosis (CF) is the most common autosomic-recessive inherited disorder. More than 300 different mutations in the CF gene (CFTR) have been described, being delta F508 and G542X the most common in the Spanish population. The frequencies of these mutations vary between the different European populations.

METHODS

We have studied the delta F508 and G542X mutations in 20 CF-patients from Asturias. These mutations were analysed through the polymerase chain reaction (PCR).

RESULTS

The frequency of the delta F508 mutation in Asturias was 77.5%, higher than those found in most of the other Spanish populations. The frequency found in Asturias is close to the frequency described for the Basque Country population. Patients homozygous for the delta F508 mutation showed clinical symptoms similar to those described in studies on other populations.

CONCLUSIONS

The high frequency of two mutations in the CFTR gene in Asturias makes possible the direct diagnostic in most families. The delta F508 mutation is associated to severe clinical manifestations, like early pancreatic insufficiency and Pseudomonas infection.

[Clinico-epidemiologic study of human listeriosis in Barcelona (1990-1991)]

BACKGROUND

The aim of this study was to determine the incidence of human listeriosis in Barcelona in addition to its clinical form of presentation, seasonability, risk groups and evolution.

METHODS

A prospective study of the cases of listeriosis registered in the city of Barcelona, Spain (population of 1,643,542 inhabitants) over the period from January 1, 1990 to December 31, 1991 was carried out.

RESULTS

Fifty-five cases were reviewed with a global rate of incidence of listeriosis of 9.4 per one million inhabitants per year with predominance being observed in the summer months (39% in 1990, 42% in 1991). Ninety-one percent of the cases were observed in non pregnant adults, with 86% of the patients being immunosuppressed. Nosocomial listeriosis, diagnosed in 23 patients (42%), was predominant in the group with immunosuppressive treatment (p = 0.0005). The main site of isolation was blood in 45 cases (82%), in the form of primary listeriosis (p < 0.0005). Global mortality was 49%, being greater in the group of patients with nosocomial infection (p = 0.01) and with primary bacteremia (p < 0.001). No patients without known risk factors or pertaining to the perinatal group have died.

CONCLUSIONS

The use of an active system of registration of listeriosis facilitates better knowledge of its incidence, distribution and infection pattern thus allowing the early detection of epidemic outbreaks with the aim of controlling such an infection, given the social implications and morbidity of this disease.

[Reproducibility of the use of classifications of causes of death in the context of inquiries in perinatal mortality]

The objective of this study was to verify the reliability of the classifications of perinatal mortality causes. An independent observer coded the cases of perinatal death (n = 152) collected in the Encuesta Confidencial de Mortalidad Perinatal de Barcelona (ECMP, Confidential Perinatal Mortality Inquiry of Barcelona), by using both the Aberdeen classification system (regarding obstetric factors) and the Wigglesworth classification system (according to the initial pathological cause), with the same information used previously by the ECMP Commission. For the Aberdeen classification, the observed concordance index (Po) was 86% and the Kappa coefficient (K) 0.77 (95% CI: 0.68-0.86). For the Wigglesworth classification, the figures were 89% and 0.82 (95% CI: 0.74-0.90), respectively. The disagreement was mainly due to differences in the interpretation of the sequence of death, minimal information available in order to classify the cause of death, and misunderstanding of the existing information. To a lesser extent, the disagreement was caused by a failure to comply with the rules laid down for classifications. The assessment of the causes of death was not significantly influenced by birth weight, gestational age, time of death or the presence of necropsy. These results support the use of classifications of perinatal mortality causes in the context of confidential inquiries.

Incidence of listeriosis in Barcelona, Spain, in 1990. The Collaborative Study Group of Listeriosis of Barcelona

A population-based register of cases of listeriosis admitted to acute-care hospitals has been established in Barcelona, Spain, in order to estimate the basal incidence of sporadic cases and to facilitate epidemiological surveillance of potential epidemics. Eleven acute-care hospitals reported all cases of listeriosis to a central unit following a standardized protocol. During 1990, 31 patients with listeriosis were identified, 18 of whom were residents of the city, resulting in an annual incidence of 10.95 cases per million inhabitants. Twelve of the 31 cases occurred in the period from July to September 1990, ten of them being community-acquired. The incidence of listeriosis was higher in elderly (> or = 65 years) and immunosuppressed persons. Forty-two percent of the cases were considered to be nosocomial infections. The overall mortality rate was 51.6%. The incidence of listeriosis in the present study is one of the highest reported in the literature. A high sensitivity of the reporting system with good case identification techniques, or demographic and environmental characteristics related to Listeria monocytogenes infection in our area, might be possible reasons for this geographic variation.

[Diagnosis of dominant renal polycystosis in adults by analysis of DNA polymorphism]

BACKGROUND

Adult renal polycystosis (ARP) is a dominant autosomic disease. The gene responsible for this disease in most families has been located on the short arm of chromosome 16 (16 p) by restriction analysis of the DNA polymorphisms (RFLP).

METHODS

The existence of several polymorphic markers flanking this gene permits the diagnosis of any member of an affected family. A series of proximal and distal genetic markers have been used to study the segregation of the disease in a group of families with more than one affected member.

RESULTS

The clinical and genetic results obtained from a study of 10 Spanish families with ARP have been reported. A high percentage of the members under 30 years of age (40%) did not present renal cysts.

CONCLUSIONS

Restriction analysis of DNA are fundamentally for a disease in which a high percentage of carriers remain asymptomatic within the reproductive age.

Impact of tuberculosis on the new AIDS definition in Barcelona [corrected]

The impact of the new AIDS definition on tuberculosis in Barcelona is evaluated. In 1988 active epidemiological surveillance demonstrated a tuberculosis incidence rate of 58.31/100,000 and an AIDS incidence rate of 9.93/100,000 according to the old definition, and 14.16/100,000 according to the CDCs' new definition (42.5% increase). The majority of these new cases are HIV-positive drug abusers with extrapulmonary tuberculosis. Pulmonary or extra-pulmonary tuberculosis is also observed more frequently in drug abusers than in homosexuals (odds ratio = 7.4; CL 95%; 3.5-15.5). Up until 1986, 39% of AIDS cases were homosexuals and 36% drug abusers. In 1988, according to the old AIDS definition, 54.2% of AIDS cases were drug abusers and 31.9% were male homosexuals but with the new definition it is even more striking that the high risk group is still drug abusers. Today we must add to the old social problem of tuberculosis the problem of drug abusers, and all the difficulties of compliance with chemotherapy or antituberculous chemoprophylaxis. New strategies will have to be devised to deal with this new problem.

[A community outbreak of Legionnaires' disease in Barcelona: epidemiologic and environmental study]

The investigation of the outbreak of legionellosis which developed in Barcelona in February 1988 included: 1) a case-control study, with the patients with Legionella pneumophila pneumonia (n = 56) and those with pneumonia by other organisms (n = 109) in the Hospital Clínic i Provincial (HCP); 2) a review of refrigeration towers and the water supply system; 3) a meteorological study, and 4) a survey of the construction works being carried out in the HCP area. The cases lived in the urban district 2 more often than the controls (odds ratio = 3.73, 95% confidence intervals 1.8-7.6), and were not associated with hospitals of hotels. L. pneumophila was not recovered from the environmental samples. The temperatures were unusually high, with a low air humidity. In the area near the HCP demolition materials were frequently removed. A causative focus was not detected; it cannot be ruled out, however, that the source of the outbreak was the removal of demolition materials in the affected area on the days preceding the epidemic outbreak.

Predictors of the survival of AIDS cases in Barcelona, Spain

Factors influencing the outcome of disease were analysed in 289 adults presenting with AIDS in Barcelona, Spain from January 1986 (31 cases) to December 1987 (258 cases). One hundred and fifty-four (53.3%) were parenteral drug addicts and 100 (34.6%) were male homosexuals. Ninety-six (33.2%) presented with tuberculosis, 148 (51.2%), with other opportunistic infections, 34 (11.7%) with Kaposi's sarcoma, and the remaining 11 with a lymphoma. By February 1988, 144 (49.8%) of the 289 had died, with an actuarial survival probability of 46.7% at 2 years (40.7%-52.7%, 95% confidence interval). The factors selected by the multivariate analysis as independently worsening the prognosis were: having been diagnosed as having AIDS before 1986, being more than 45 years old, not being a parenteral drug addict and presenting with an opportunistic infection other than a tuberculosis or with a malignancy. In conclusion, some factors influencing the prognosis for AIDS patients are very dependent upon the geographical area of the series.

Effects of sex on differences in awareness, treatment, and control of high blood pressure

Our purpose was to explain the reasons for sex differentials in the awareness, treatment, and control of hypertension by identifying major social and behavioral predictors of these three sequential stages of high blood pressure control. We analyzed data on all 1,433 hypertensive subjects from the First Connecticut Blood Pressure Survey. Hypertensive women were more likely than hypertensive men to be aware of their high blood pressure (odds ratio = 1.40; confidence interval = 1.10-1.79) and to have controlled levels of blood pressure (odds ratio = 1.62; confidence interval = 1.08-2.44). Men and women who were aware of their hypertension were equally likely to be treated. Sex still explained differences in awareness and control of hypertension after adjusting for other significant variables. We conclude that sex is an important predictive covariate for adjustment in explaining differences in awareness and control of high blood pressure. Health care professionals should be aware of the differential role of sex when informing and treating hypertensive patients.

[Immunity in hypothyroid children (author's transl)]

For a long time investigators have focused attention on the relationship between specific immunity and hormones. In the present paper, authors investigated on 26 children, 9 males and 17 females, from 9 months to 14 and 10/12 years old, with primary hypothyroidism. All patients were in substitutive treatment. The following studies were done to all the patients: serum IgG, IgA, IgM and complement. Blood lymphocyte counts, percentages of B and T lymphocytes, as well as the response of lymphocytes to PHA. Skin tests were also carried out: tuberculin, candidin and streptokinase-streptodornase. All results obtained in both, hypothyroid and control groups fell within the range of normal age-matched values for our laboratory, and by results of statistics studies carried out they were considered of little significance, except the percentage of circulating B lymphocytes that was lower in hypothyroid group (p less than or equal to 0.01).

[Schwartz-Jampel syndrome. Report of two cases and review of the literature (author's transl)]

Two cases of Schwartz-Jampel syndrome are reported in addition to the 30 described previously. Authors present a study on the incidence of different signs and symptoms in all cases reviewed by them and on the radiological, biochemical, electromyographic, immunological and pathologic findings of all these cases concluding that the definitive data, present in all of them, is the association of facial dysmorphia, osteomuscular dystrophy and a muscular syndrome of myotonic aspect.

[Obese children. Psychical aspects studied by Rorschach's test (author's transl)]

A group of obese children comparatively to a control group of normal children using Rorschach's protocols is studied. Quantitatively it doesn't appear significant differences, although a serie of characteristics in obese children (a proportional increase in answer of small detail and human movement, less number of answer of colour-form and animal contents), is found. Cualitatively some differences (desvitalitation phenomenous and shock in front of grey colours) are also found. The present work deduces that it doesn't exist reasons to think about an specific structure and dynamic in personality of obese children.