[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]

INTRODUCTION

Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms.

AIMS

To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients.

PATIENTS AND METHODS

Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit.

RESULTS

We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros.

CONCLUSIONS

A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

Socioeconomic factors and cervical cancer mortality in Spain during the period 1989?1997

METHODS

A study was made of cervical cancer (CC) mortality trends in Spain during the period 1989-1997 at National, Autonomous Community and Provincial levels, in relation to different socioeconomic factors. Data were obtained from the Spanish National Institute of Statistics (Instituto Nacional de Estadística, INE). The crude mortality rates were age-adjusted using the indirect method and Gross Domestic Product (GDP) as socioeconomic status (SES) indicator.

RESULTS

National CC age-adjusted mortality rates have increasing slightly, varying from 3.09 deaths/100000 women in 1989 to 3.42 in 1996. The highest age-adjusted mortality rates corresponded to Seville, Palencia and Orense, with 4.13, 4.06 and 3.98 cases/100000 women, respectively. The lowest mortality rates were found in Las Palmas, Cantabria and Alicante with 2.63, 2.77 and 2.80 deaths/100000 women, respectively. A relative risk (RR) of 1.14 (95%CI: 0.98-1.32) ( P=0.048) was observed between the provinces with the lowest SES and highest mortality rate, and those with the highest SES and lowest mortality rate.

CONCLUSION

The results of our study show a slight increasing trend in CC mortality rates in Spain during the period 1989-1997, and suggest that the variations among provinces and Autonomous Communities could be due to CC risk factors (SES related to human papillomavirus, parity, diet, etc.) and differences in early diagnosis.

The evolution of breast cancer mortality and morbidity in Spain (1977-1988)

A study of breast cancer mortality and cancer morbidity has been carried out in Spain recently for the period 1977-1988, covering the population of the 17 Autonomous Communities and 50 provinces of the country. Data was obtained from INE, Instituto Nacional de Estadística (National Institute of Statistics), with age standardization using the indirect method. The different Autonomous Communities and provinces were compared in order to establish possible significant differences. The crude mean mortality rate was 21 cases per 100,000 inhabitants/year; Las Palmas, Gerona, Barcelona, the Balearic Islands, Navarra and Zaragoza have the highest mortality rates, with a proportional increment of 54% in that period. The crude national mean morbidity rate for the considered period was 64.0 cases per 100,000 inhabitants, and the proportional increment 180%. According to provincial figures, Alava had the highest fitted mean morbidity rate, 135 cases per 100,000 inhabitants, whilst the highest fitted mean rate was Las Palmas (28 cases/100,000 inhabitants), and the highest proportional increment was the rate for the province of Huesca (169%). When using the ANOVA test on the mean rate of the period, for mortality as well as morbidity, we observed significant differences among provinces and among Autonomous Communities (p < or = 0.05).

Subjective annoyance caused by environmental noise

We developed an acoustic study implemented throughout a neighborhood of Valencia (Spain). Acoustic recordings were made during the months of November and December 1989, on workdays between 9 a.m. and 1 p.m., and between 5 p.m. and 8 p.m. We also directly interviewed individuals living in this city area to determine their perception of noise and to evaluate the discomfort caused by it in daily life. A personal interview in the form of a questionnaire was employed to poll the neighborhood inhabitants on the magnitude of environmental noise and the distress it caused. The results showed that 40% of those interviewed considered environmental noise to cause considerable distress. On a 1 to 10 scale, over half of those interviewed rated noise in the neighborhood of 5 or higher. Traffic was considered the major source of noise, followed by noise from neighbors and factories. Of those interviewed, 9% changed the location of their bedroom as a result of noise, whereas 11% were forced to sleep with the windows closed for the same reason.

Noise in the city of Valencia: its relation to other air level contaminants

We measured environmental noise in the Spanish Mediterranean coastal city of Valencia. Simultaneously, we made a count of the passing vehicle sat the same points. We calculated the mean of traffic intensity in the points recorded in each year of the study. The recorded noise was extrapolated to the traffic recordings of previous years to establish a relation between noise and traffic intensity. The information concerning chemical contamination was obtained from 1979 to 1989 in the same points. A statistical analysis was carried out in order to determine the evolution of various atmospheric contaminants over the last decade (SO2, smoke, NO2, lead, sedimentable material) in each point and the possible relationship between acoustic contamination and the main chemical contaminants.

[An analysis of the mortality from extrapulmonary tuberculosis in the catchment areas of the community of Valencia (1976-1980)]

Tuberculosis is a chronic infectious disease produced by Mycobacterium tuberculosis or Koch's bacillus, which mainly affects the airways and, less frequently, other organs in the body. Tuberculosis is still a health and social problem in Spain. The data of this study were obtained from "Monografías Sanitarias", "Análisis de Mortalidad", published by "Generalitat Valenciana", the standard mortality rate was calculated by direct methods. Mortality is not the best sanitary parameter to study the real situation of this disease, because the present methods of treatment are effective and death caused by tuberculosis is very rare. Despite the aforementioned fact, when comparing the mortality data of different health areas during a period between 1976 and 1980, we confirm that this disease persists as a cause of death in our community.

[Iodine levels in water for public consumption in the province of Valencia]

A descriptive study has been carried out on the iodine content in the drinking water of the Valencia province, where very low levels were found in almost all the public water supplies of the province. The levels of iodine are similar in water originating from the different types of water sources. A slightly higher level is observed in industrialized areas, the same as in the water supplies that are near solid and liquid waste dumps located on land which is vulnerable to contamination and in areas close to the ocean.