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C Castells

Publications and source records attributed to C Castells.

16 recordsLinked to original sources
PubMed2005

Determinants of health system delay among confirmed tuberculosis cases in Spain.

BACKGROUND: Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. METHODS: Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. RESULTS: A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. CONCLUSION: Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.

Adolescent↗
PubMed2004

Determinants of patient delay among tuberculosis cases in Spain.

BACKGROUND: Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population. METHODS: Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated. RESULTS: A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes. CONCLUSION: Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.

Adolescent↗
PubMed2002

Tuberculosis in Spain: epidemiological pattern and clinical practice.

SETTING: Thirteen Autonomous Regions in Spain. OBJECTIVE: To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB. DESIGN: Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians. RESULTS: The overall incidence of all forms of tuberculosis was 38.5/100,000 and the incidence of smear-positive disease was 13.83/100,000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100,000 vs. 24.87/100,000) and in groups aged 25-34 and 75 years and over (61.35/100,000 and 59.35/100,000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs. CONCLUSION: The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.

Adolescent↗
PubMed1996

Spinal anesthesia with bupivacaine and fentanyl in geriatric patients.

We assessed the risks and benefits of the administration of fentanyl during spinal anesthesia in the elderly. Forty patients (70-83 yr) undergoing knee or hip replacement were studied. Preoperatively, cognitive function (minimental state examination [MMSE]), associated pathology, medications, and treatment were evaluated. Patients had spinal anesthesia with 12.5 mg bupivacaine plus saline (SS; n = 21) or 25 micrograms fentanyl (FN; n = 19). The number of ailments and drugs per patient were 2.5 and 2.3, respectively; 35%-44% of disorders were untreated, 16%-26% were symptomatic, and 33% were adequately treated. Groups were comparable regarding demographic data and characteristics of the spinal block. Group FN had more pruritus (P < 0.02) and lower SaO2 (P < 0.007), but prevalence of side effects was similar. Pain intensity (visual analog scale [VAS], facial expression test [FET] at the time of analgesia request (TAR) was lower in Group FN (P < 0.01). A poor correlation between VAS and FET (range 0.42-0.58) was obtained. MMSE at hospital discharge was no different from preoperative values. Our results show that 25 micrograms of spinal fentanyl do not modify spinal anesthesia in the elderly, but induces pruritus and O2 desaturation. The decrease in postoperative pain intensity and the preservation of cognitive function would justify the use of spinal fentanyl in the elderly.

Aged↗
PubMed1993

Mathematical morphologic analysis of aging-related epidermal changes.

Fractographic techniques based on mathematical morphology were used to study aging-related epidermal changes in abdominal skin samples obtained from 96 autopsy cases. Three linear roughness indices were evaluated for the rete peg profile and the shrinkage effect on the basal layer and interface between the granular and horny layers. Elderly subjects had a 36.3% decrease in rete peg-related roughness index when compared with younger subjects. This roughness index has been corrected, with shrinkage due to skin elasticity taken into account. For females, fitting of a logistic decay function yielded a curve with right and left asymptotes and a steeper descent between 40 and 60 years. Half value time--i.e., the time when half rete peg profile flattening occurred--was 46.8 years. In contrast, males showed almost monotonical decay. Epidermal thickness measured between rete pegs showed the same exponential decline for both sexes, with values from 22.6 to 11.4 microns. Skin shrinkage in elderly subjects decreased 22% in superficial layers and only 6% in the lower epidermis. In both cases shrinkage had a linear relation with age, and no sex differences were found.

Adolescent↗
PubMed1992

Fine-needle aspiration biopsy of hepatic papillary cystadenocarcinoma in Caroli's disease.

A case of papillary adenocarcinoma arising in Caroli's disease (CD) in a 25-yr-old woman is reported. The diagnosis of malignancy was made by ultrasound-guided, fine-needle aspiration biopsy (FNAB). As there were no metastasis, a liver transplant was performed and the diagnosis was histologically confirmed. Only 22 cases of malignant transformation of CD have been reported to date, all among middle-aged subjects (mean age: 52 yr) of both sexes. Most of these reported cases (83%) were found to be bile duct adenocarcinomas with occasional reports of hepatocellular and undifferentiated carcinomas. Our case is the youngest reported to date and the first to be diagnosed cytologically.

Adult↗
PubMed1992

[Epidemiology of obesity among the adult population of Catalonia].

Several epidemiological studies have shown that obesity is related to the mortality from cardiovascular disease. In this study, the epidemiology of obesity and the correlation between body mass index and other cardiovascular risk factors was studied in a representative sample of the adult population of Catalonia. It was obtained a random sample (n = 704) of the adult population of Catalonia aged 15 or more years. Height and weight were measured and body mass index (BMI) was calculated (height in Kg/weight2 in m2). Obesity was defined as a BMI greater than 30, and overweight as a BMI from 25 to 30. In the first 314 participants, it was determined the concentration of total cholesterol, cholesterol-HDL and triglyceride, and it was measured the blood pressure. The correlation between BMI and other cardiovascular risk factors was analysed. The study was carried out in 1989. The mean of BMI increased with age in both sexes. BMI was significantly higher in men (26 kg/m2) than women (25 kg/m2). The prevalence of obesity was of 12% in both men and women, and the prevalence of overweight was of 48.5% in men and 38% in women. The prevalence of arterial hypertension, hypercholesterolemia and diabetes was greater individuals with obesity, with differences statistically significant for hypertension (odds ratio of 3.26). The multiple logistic regression analysis showed that the association between obesity and hypertension was not statistically significant (OR adj. = 2.09), when the effect of the other risk factors, the age and sex were controlled.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Tobramycin and amikacin nephrotoxicity. Value of serum creatinine versus urinary concentration of beta-2-microglobulin.

108 patients who received tobramycin or amikacin could be evaluated for nephrotoxicity in a prospective randomized trial. Both groups had similar illnesses, and causative agents, concurrent drug administration, ages, sex ratios, initial serum creatinine and aminoglycoside levels and total dose and duration of therapy. Using urinary concentration of beta 2 microglobulin (beta 2m) as a marker, nephrotoxicity was detected in 13 (22.4%) of 58 patients given tobramycin and 13 (26%) of 50 given amikacin (n.s.). Using serum creatinine as a marker, nephrotoxicity was detected in 3 (5.2%) of 58 patients given tobramycin and in 7 (14%) of 50 given amikacin (n.s.). The whole group of 108 patients was used to compare the usefulness of serum creatinine levels versus urinary concentration of beta 2m. An elevation of serum creatinine was detected in 10 of 108 patients (9.3%). In 5 of these 10 patients the beta 2m remained normal, suggesting a functional renal failure. In 21 of the 108 patients (19.4%) the beta 2m increased while the serum creatinine remained normal, suggesting an aminoglycoside nephrotoxicity which would have remained undetected if only serum creatinine had been measured. In the remaining patients (77 of the 108; 71.3%) serum creatinine and urinary concentration of beta 2m both remained normal throughout the treatment. In conclusion no statistically significant differences were found between tobramycin and amikacin nephrotoxicity. Urinary beta 2m is more sensitive than serum creatinine and furthermore it allows one to differentiate aminoglycoside nephrotoxicity from functional renal failure.

Adult↗