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Biomedical subjects

C Alvarez-Dardet

Publications and source records attributed to C Alvarez-Dardet.

At least 19 recordsLinked to original sources
PubMed1992

[Infection caused by the human immunodeficiency virus type 1 in prostitutes and risk factors].

BACKGROUND: Women dedicated to prostitution constitute a group at risk of acquiring the human immunodeficiency virus-1 (HIV-1). This study was designed with the aim of knowing the frequency of this infection in prostitutes and the factors associated to the same. METHODS: A descriptive transversal study with analytic components including 444 women who voluntarily attended an AIDS prevention center from 1986-1991 was carried out. The HIV-1 antibody test was performed in 440 of the subjects. All the subjects were interrogated on sociodemographic variables and risk of infection. RESULTS: Of the 440 women studied, 24 had HIV-1 antibodies with a global prevalence (1986-1991) of 5.5% with confidence intervals of 3.4, and 7.6% at 95% (CI 95%). During the study period the prevalence remained stable: 6.8% (1986-87), 5.5% (1988), 4.3% (1989) and 4.3% (1990-91). No positive association was found between HIV-1 infection and education, time in prostitution and the use of condoms. HIV-1 infection was strongly associated to the use of drugs, adjusted odds ratio by logistic regression OR = 26.9 (CI 95%: 8.9; 9/1). Positive associations were also observed with greater number of sexual partners and syphilis but these did not reach statistical significance. The percentage of prostitutes who used condoms with more than 33% of their clients increased from 44.5% in 1986-87 to 85.9% in 1990-91. CONCLUSIONS: In this study no considerable changes were found with respect to the prevalence of infection by the human immunodeficiency virus-1 in prostitutes in Spain. Similarly, this collective has increased its use of preventive measures although they remain insufficient, indicating that more energetic preventive strategies are necessary. These measures should be particularly active with the group of young prostitutes.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Prevalence of human immunodeficiency virus infection, hepatitis B virus and syphilis in full term pregnancy].

BACKGROUND: The estimation of the frequency of infection by HIV, hepatitis B virus and syphilis in unselected populations of full-term pregnancy is useful for epidemiologic surveillance of these diseases and for decision marking in prenatal detection. METHODS: A transversal study of 3,193 women who gave birth in the Hospital General de Elche between March 1989 and February 1990 was carried out. A blind survey was developed to avoid ethic problems and bias derived from the undertaking of HIV test without patient consent. RESULTS: The prevalence of HIV was 0.5/1,000 women (CI 95%, 0-1.5); HBV 8.9/1,000 (CI 95%, 4.6-13.2) and syphilis 1.5/1,000 (CI 95%, 0.9-2.1). CONCLUSIONS: The diffusion of the AIDS epidemic in Spain to the general population does not at present seems important although studies should be performed in the future to monitor the trend. The prevalence of syphilis in Spain is low in this study in comparison with the results of other Spanish studies which may be explained by greater quality of care in to pregnancy. The prevalence of HBV suggests the need for detection and vaccination of newborns.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Quitting the tobacco habit in Spain].

BACKGROUND: The tendencies in the cessation from smoking and their determinants provide useful information to developed preventive policies and to predict the evolution of diseases associated with cigarette consumption. Spain is one of the European countries with more prevalent smoking habits in the general population, and thus the study of factors determining cessation from smoking is particularly relevant. METHODS: The socioeconomic, demographic and health-related variables associated with the cessation from smoking were evaluated using the data bank from the National Health Survey carried out by the Ministerio de Sanidad y Consumo in 1987, which includes interviews to 29,647 individuals above 16 years of age. The data were analyzed by the calculation of the quit ratio standardized for age. RESULTS: The quit ratio is influenced by age and sex; it is higher among women and it increases with age. The results are questionable regarding the relation with educational level, family income and occupation. The smokers of less than 10 or more than 25 cigarettes/day are those with a higher quit ratio. The quit ratio is also higher in individuals with health problems, a higher rate of use of health services and in those without usual alcohol consumption. CONCLUSIONS: The profile of the individuals who quit smoking in Spain has specific features when compared with other countries, particularly regarding the higher quit rate among women and the lack of a linear correlation with indicators of socioeconomic level.

Age Factors↗
PubMed1991

[Opinion of medical students about prescription, counseling and practice of voluntary interruptions of pregnancy].

BACKGROUND: A future prospect was carried out of the professional trends regarding prescription, counseling and practice of voluntary interruptions of pregnancy (VIP). METHODS: To this end, a questionnaire was administered to 177 last term students of the Valencia and Alicante Schools of Medicine regarding the opinions of the current law on VIP in Spain and the professional trends of approach, with practical examples of the four instances depenalized by the Spanish law. RESULTS: For 44% of the sample the present law is insufficient, 30% agree with it and 13% think that the present law threatens life. The instance which elicited a highest number of favorable professional trends was congenital malformation (85%), followed by physical problems (78%) and psychical problems (63%). Only 60% of students would take a favorable attitude in case of rape. The students without religious practice, who vote progressive political parties and who think that present law is insufficient have a significant tendency towards attitudes favoring VIP. Significant sex differences among students were not found. CONCLUSIONS: Although probably to a lesser degree than in the present, in the near future the unfavorable attitudes of physicians will continue hindering the access of women to the services of VIP. A wide debate and more studies are required for a better definition of the implications of this phenomenon for public health purposes.

Abortion, Induced↗
PubMed1991

Inequalities in health in intensive care patients.

In order to study the possible association between socioeconomic status (SES) and critical care mortality, we examined a cohort of 847 patients over 14 years of age, as they were consecutively admitted to three general intensive care units (ICUs). The patients with low SES (social classes IV and V according to the British Registrar General's classification) were older (62.0 v 58.5 years old, p less than 0.0001) and showed a higher ICU mortality (odds ratio (OR) = 1.61, p = 0.0204) and severity of illness on admission (mean Simplified Acute Physiology Score [SAPS] 9.9 vs 8.7, p = 0.0002) than patients with high SES (social classes I-III). The initial severity of illness differential was detected both in patients admitted from the emergency area and in patients admitted from the general hospitalization ward, suggesting the existence of some kind of preselection procedure related to the SES of the patient. The stepwise logistic regression analysis identified as independent predictive variables of ICU mortality therapeutic effort (measured with the Therapeutic Intervention Scoring System [TISS]), SAPS score, age and hospital, but not SES. The TISS/SAPS ratio according to origin of patients (emergency/general wards) was comparable in the high and low SES. We conclude that there is an inverse relationship between SES and ICU mortality. The mortality excess in the low SES patients is largely accounted for by the covariates of the low SES (especially their high age and severity of illness on admission). There is no evidence of a different relative therapeutic effort according to the SES.

Adolescent↗
PubMed1991

Study designs and statistical methods in rheumatological journals: an international comparison.

In order to determine the characteristics of papers published in the rheumatological literature, we have conducted a survey of the seven leading rheumatological journals published in 1987; 1107 original papers have been reviewed and classified according to study design, statistical techniques, and country of origin. Almost half of the published papers were clinical descriptive studies without inferential power; both authors and editors should reflect whether the impact of these studies on the knowledge of readers justifies their frequency. Analytical research was represented mainly by randomized clinical trials (15.6%), and case control studies (14.2%). Cohort studies represented 5.4% and this seems a low figure in a specialty in need of more aetiological research. Almost half of the papers originated from the USA or the UK; journals edited in these countries published papers mainly from the same country. English language journals from other countries published a larger percentage of papers from other countries, including many non-English speaking nations. Bibliometric studies are desirable to evaluate trends in publication.

Epidemiologic Methods↗
PubMed1991

Acute lymphoblastic leukaemia among Spanish children and mothers' occupation: a case-control study.

STUDY OBJECTIVE: The aim was to investigate the association between mothers' occupational exposure during pregnancy and the incidence of acute lymphoblastic leukaemia in children. DESIGN: The study was a case-control investigation. A face to face interview was used to assess exposures at work and relevant confounding variables. SETTING: The study was community based and was carried out in five provinces of Spain. SUBJECTS: 128 cases less than 15 years of age were interviewed (91% of those eligible). Controls (one for each case) were chosen from the census lists and were matched on year of birth, sex and municipality. MEASUREMENTS AND MAIN RESULTS: Children of mothers working at home had a relative risk (RR) of 7.0 (95% CI = 1.59-30.79) of developing acute lymphoblastic leukaemia. Exposure to organic dust was associated with a RR of 5.5 (95% CI = 1.21-24.8). There was a statistically significant interaction between exposure to organic dust and working at home. The majority of women working at home were hired by local industries to sew different types of tissues (cotton, wool, synthetic fibres) on a machine. CONCLUSION: A similar association has not been reported before: if confirmed, this finding may suggest a new health concern.

Adolescent↗
PubMed1990

[Rheumatology research. An analysis of the situation in Spain].

To analyze the present status of rheumatological research in Spain, three indicators have been evaluated: use of the different study designs, use of statistical techniques and relevance of the studies. This last point was determined by the comparison of the research areas that had been reported during one year and the lines of rheumatological research established as priorities by 10 investigators from the 10 units of clinical care with a higher scientific output during the period 1985-1987. A revision has been made of the 67 articles from Spain out of the 1106 reported in seven of the journals with a better national and international impact index: Scandinavian Journal of Rheumatology, Arthritis and Rheumatism, Journal of Rheumatology, Annals of the Rheumatic Diseases, British Journal of Rheumatology, Clinical Experimental Rheumatology and Revue du Rhumatisme, in addition to Revista Española de Reumatología. It was found that few studies with analytical design are being published and that complex statistical analysis techniques are not being used; therefore, most articles do not have a possible statistical inference and lack value as predictors. The reports of cases and clinical series in the Letters to the Editor section are most common, particularly in the Spanish journal. Most studies are related with clinical research, although the consulted investigators consider that basic and epidemiological research have a higher priority. It is concluded that the Spanish contribution to the international rheumatological literature is still small and has a mainly descriptive character; thus, it is necessary to emphasize the use of analytical designs to improve the competitiveness. The type of studies to be carried out in the future, according to the priorities established by the investigators themselves, should change if their wishes are to be fulfilled.

Humans↗
PubMed1990

[Age as a prognostic factor in intensive care].

In order to define the prognostic impact of the age of critical patients as well as its association with the initial severity of illness (SAPS index) and therapeutic effort (TISS index), we studied 1.102 patients older than 14 years admitted consecutively to 3 general intensive care units. The oldest patients (more than 65 years) showed a higher mean SAPS (11.00 versus 8.58, p less than 0.0001) and mortality (odds ratio = 1.99, p less than 0.0001) than the younger ones. The association between age and mortality showed a "dose-response" pattern, even after controlling for the effect of initial severity (p less than 0.0001). The effect of age was stronger in the groups of patients with low SAPS (odds ratio = 2.94, p = 0.0007) or admitted for acute myocardial infarction (odds ratio = 3.28, p less than 0.0001). The oldest group showed a lower TISS/SAPS ratio and a shorter stay in the intensive care unit than younger patients, suggesting a low relative therapeutic effort in the latter. The differential therapeutic effort did not explain, however, the mortality excess in the oldest group, because the gradient of mortality increased after adjusting for TISS/SAPS ratio (adjusted odds ratio = 2.42, p less than 0.0001).

Adolescent↗
PubMed1990

[Evaluation of the variability of rapid diagnosis of infection by Chlamydia trachomatis using direct immunofluorescence].

The interobserver and intraobserver agreement between two microscopists was independently assessed in a blind fashion to evaluate the reproducibility of the results of the quick diagnosis of Chlamydia trachomatis infection with direct immunofluorescence. The study was carried out in two phases, and 604 samples of cervical and urethral exudate from patients seen at a center for the prevention and therapy of sexually transmitted diseases were evaluated. The two observers had a kappa index of agreement between them of 0.41, with 95% confidence intervals (95% Cl) of 0.31-0.51, while their agreement within themselves was 0.78 (95% Cl: 0.65-0.91) for the first observer and 0.61 (95% Cl: 0.47-0.75) for the second one. After discussion of the data and analysis of the reasons of disagreement, the evaluation was repeated. In this second phase, both interobserver and intraobserver agreement were substantially improved. The kappa index was 0.71 (95% Cl: 0.61-0.80) for the former, whereas regarding the latter the first observer had a kappa index of 1 (95% Cl: 0.86-1.13) and the second observer an index of 0.82 (95% Cl: 0.61-0.80). It was concluded that the test may have problems in its practical performance if the microscopists are not previously trained with systematic programs for the evaluation of results.

Cervix Uteri↗
PubMed1990

Predictors of death following ICU discharge.

In order to study possible predictors of early after-discharge mortality (EADM), 700 consecutive patients discharged alive from three intensive care units (ICUs) were followed up 2 months after their admission. The observed mortality was 7.3%. Univariate analysis indicated a strong statistically significant association of the following variables with mortality: initial simplified acute physiological score (SAPS) greater than 10, therapeutic intervention score in the first 24 h of admission greater than 20, age greater than or equal to 65, length of stay in the ICU greater than 10 days, and low educational level. The multiple logistic regression analysis included as predictive independent variables the SAPS, organs or systems failure, age, and length of stay. The model built upon these four variables was able to identify a group of patients at high risk (21-46%) of EADM. We conclude that some simple variables can be used as useful markers of patients groups at high risk of EADM.

Adult↗
PubMed1990

Anaemia during pregnancy as a risk factor for infant iron deficiency: report from the Valencia Infant Anaemia Cohort (VIAC) study.

A prospective cohort study with a 1-year follow-up of 156 neonates was carried out specifically designed to test the hypothesis that there is a positive relationship between iron deficiency during pregnancy and the development of the same disease in newborn infants. Exposure was defined as being born of a mother with ferropenic anaemia at delivery, and cases as the infants who developed iron deficiency during their first year of life. A statistically significant positive association was detected with an odds ratio of 6.57 (95% confidence limits 1.81-25.97). A stratified analysis was also performed to control the effect of potential confounders such as socio-economic variables, feeding practices and other factors linked with the iron status of infants. This second analytical procedure showed no alteration in the association detected in the simple analysis but that there was a statistically significant strong interaction between the quantity of cow's milk intake and the ferropenic status of the mother. These results show a relationship between iron deficiency of the mother at delivery and the development of iron deficiency in the infants. These new findings could be important in the development of new prevention programmes applied to pregnant women.

Anemia, Hypochromic↗
PubMed1989

[Predictive value of obligatory reporting of sexually transmitted diseases].

Sexually transmitted diseases (STD) were recently included in the Spanish reporting system, or Compulsory Reporting of Diseases (EDO). In the present study, the validity of this system is evaluated with the estimation of the positive predictive values of the EDO. A preestablished questionnaire was administered by phone to the reporting physicians of the 478 cases of STD that had been reported to the EDO system from August 1987 to May 1988 in the Alicante and Valencia provinces. In this survey, in addition to data related to the reporting physician (specialty and place of work) and to the patient (sex, clinical symptoms and signs), information permitting to classify each diagnosis as certain, likely and unlikely was collected (incubation time, laboratory tests). Considered as a whole, the results suggested an acceptable accuracy (positive predictive value 79.09%, confidence limits 76.7%-81.5%) for both diseases. This permits to consider STD statistics as fairly accurate. Among the factors influencing the diagnostic precision are the disease itself, the patient's sex, the qualification of the reporting physician and his place of work. The predictive value of the cases reported from centers of diagnosis of STD was higher. We think that, although these results are acceptable for the epidemiological survey, the quality of care could be enhanced by a better organization of services and an improved undergraduate and postgraduate education.

Attitude of Health Personnel↗
PubMed1989

[Healthy carriers of enteropathogenic micro-organisms among the child population of Seville].

We have studied for 1-year period a group of 144 children (31 newborn infants, 62 aged 1 year and 51 aged 2 years) who were randomly selected from the registrar's office of Sevilla with the purpose of determining the incidence of diarrhoea and the prevalence of enteropathogenic microorganisms. Two samples of faeces (one at the beginning and the second by the second semester of the 1-year period) were obtained from all children which were processed for culture and parasite and rotavirus examination. We found a prevalence rate of enteropathogenic Escherichia coli carriers (EPEC) of 7%, of Giardia lamblia of 4% and of rotavirus of 14%. The state of EPEC was more frequent among children from high social-economic status. The state of G. lamblia carrier was six-fold higher in children with body weight alterations and in non-vaccinated or incompletely vaccinated children.

Animals↗