Biomedical subjects
Publications and source records attributed to J Baeza.
A survey of practices in a primary care group in outer London found many were poorly prepared for implementing clinical governance. More than half consisted of one doctor, and a quarter of practices were not computerised. Only a third had a staff development plan. Only a minority had sought patients' views about new services. Although three-quarters of practices were using guidelines, few had been trained in the use of protocols and guidelines.
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The degradation, by several advanced oxidation reactions, of a pulp mill ECF bleaching effluent, was studied. The initial biodegradability of the organic matter present in the effluent, estimated as the BOD5/COD, was low (0.3). When the effluent was submitted to ozonation and to five different advanced oxidation systems (O3/UV, O3/UV/ZnO, O3/UV/TiO2, O2/UV/ZnO, O2/UV/TiO2), the biodegradability increase significantly. After five minutes of reaction, the O3/UV system appears as the most efficient in to transform the organic matter to more biodegradable forms. A similar effect was observed when the effluent was submitted to an activated sludge treatment. The COD, TOC and toxicity reduction correlated well with the biodegradability enhancement after AOPs treatments.
Iron-chelating low-molecular-weight compounds or catecholate siderophores have been suggested to be involved in wood biodegradation. To help in understanding the mechanism involved in the enzyme-like activity of catecholate siderophores, the oxidative properties of 2,3-dihydroxybenzoic acid (DHBA) and 3, 4-dihydroxyphenylacetic acid (DHPAA) chelated with iron were studied. The pH and catechol/Fe(III) ratios were optimized for o-dianisidine oxidation, obtaining a maximum at pH 7.0, in the absence of buffer, and a catechol/Fe(III) ratio of 1:2 to DHBA and 1:1 to DHPAA was found. Under these conditions, the catechols were able to reduce Fe(III) to Fe(II) acting like siderophore models. The Fe(III) complex of DHBA and of DHPAA degraded dioxane-lignin in 60% after 2 h and 85% after 24 h, respectively. DHBA/Fe(III) oxidized the bleaching effluent (E1) in 80% in 5 min under the studied conditions.
A survey of health authorities in England to establish GPs' health promotion activities found that anti-smoking and heart disease prevention were the most common initiatives. Many HAs were dissatisfied with the current arrangements, feeling that they had little control of GPs' health promotion activities. Two-thirds of HAs reported problems with monitoring GPs' health promotion activities. Few health promotion initiatives addressed mental health, cancer or accident prevention.
This study was designed to assess "tracking" of serum lipids and apolipoproteins in three age groups of Spanish children over a 5 year period. A total of 84 6-year-old, 89 10-year-old and 64 14-year-old children were evaluated in 1989 (with measurement of serum total cholesterol, triglycerides, lipoproteins and apolipoproteins A1 and B), and re-evaluated in 1994. Correlation coefficients between initial and final lipid and apolipoprotein values were as follows: total cholesterol, 0.66; low-density lipoprotein (LDL) cholesterol, 0.65; high-density lipoprotein (HDL) cholesterol, 0.61; triglycerides, 0.61; apolipoprotein A1, 0.60; apolipoprotein B, 0.66. When age groups were analysed separately, children who were 14 years old at the beginning of the study showed higher correlation coefficients, particularly for total cholesterol and LDL cholesterol ( > 0.7 in both cases). More than 70% of children who were in the top quintile of total, LDL or HDL cholesterol as well as apolipoprotein A1 or B in 1989 remained in the top quintile 5 years later.
OBJECTIVE: To study the relation between diet and serum lipid and apolipoprotein levels in a large, homogeneous group of Spanish children. DESIGN: Survey. SETTING: Eleven schools chosen at random in Madrid City and the surrounding area. SUBJECTS AND METHODS: Subjects comprised 1682 children, 2 to 12 years of age. Dietary data were obtained with a 24-hour record performed by the child's main caregiver. For statistical analysis the sample was divided into tertiles on the basis of calorie-adjusted consumption of dietary components. RESULTS: Children in the highest tertile of total fat consumption, compared with children in the lowest tertile, had significantly higher mean serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (Apo A) and apolipoprotein B-100 (Apo B). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of TC, LDL-C, and Apo B, and lower mean levels of HDL-C and Apo A. Children in the highest tertile of monounsaturated fat consumption, compared with children in the lowest tertile, had significantly higher mean levels of HDL-C and Apo A, and lower mean levels of TC, LDL-C, and Apo B. CONCLUSIONS: Our findings suggest that diet composition strongly influences lipid profile in children and point out the importance of monounsaturated fatty acids as modulators of serum lipid and apolipoprotein levels.
OBJECTIVE: To determine the effectiveness and compliance of dietary restriction in a group of children and adolescents with hypercholesterolemia. RESEARCH DESIGN: Prospective clinical trial. SETTING: Pediatric hospital in Madrid, Spain. PARTICIPANTS: Four hundred fifty-one children and adolescents of both sexes aged 2 to 18 years diagnosed as having hypercholesterolemia and treated with dietary restriction (American Heart Association Step-One and Step-Two Diets). The follow-up period ranged from 6 months to 2 years and was performed by one pediatrician. RESULTS: Total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 levels as well as the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio decreased significantly (P < .01) from the first month of dietary restriction, whereas the high-density lipoprotein cholesterol level increased (P < .01). The apolipoprotein A-I level increased significantly (P < .01) only after 6 months of diet therapy. After 12 months of follow-up, 30.7% (58/189) of patients did not follow the diet strictly. In this group, significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 were found. CONCLUSIONS: Diet therapy is effective in the treatment of hypercholesterolemia in children and adolescents. Dietary restriction has a beneficial effect not only on total cholesterol and low-density lipoprotein cholesterol levels but also on apolipoprotein A-I and B-100 levels.
Studies done on adults reveal a significant role of fibrinogen (FG) in cardiovascular disease. The main purpose of our study was to determine the level of plasma FG in children, its distribution according to age and sex, and its relationship to other cardiovascular risk factors such as cigarette smoking, plasma lipid disturbances, and a positive family history for other cardiovascular risk factors. We studied a population of 2224 children, aged 2 to 18 years, from five different schools located in Madrid. We found a significantly higher level of FG in the groups of females aged 6 to 8 and 16 to 18 years than in males of the same ages (p < 0.001). The study population was distributed into two groups according to the plasma fibrinogen level: > 394 mg/dl and < 394 mg/dl. In both groups we determined plasma levels of total cholesterol, triglycerides, and very low-density lipoprotein (VLDL) cholesterol and found these parameters significantly higher in the group with an FG level > 394 mg/dl (p < 0.05).
The relation between smoking and blood lipids and apolipoproteins (A1,B100) were studied in a group of 1024 12- to 18-year-old school children in the Comunidad de Madrid. The percentage of smokers was 19% (17% for girls and 21% for boys). The average consumption of cigarettes per day was 7.83 +/- 5.06 in boys and 6.04 +/- 3.49 in girls (p less than 0.05). As compared with male nonsmokers, male smokers showed a higher mean level of low-density lipoprotein (LDL) cholesterol (112 versus 100 mg/dL, p less than 0.05), a higher LDL cholesterol to HDL-cholesterol ratio (2.27 versus 1.94, p less than 0.001), a higher mean level of apolipoprotein B100 (59 versus 53 mg/dL, p less than 0.05), and a higher apolipoprotein B100 to apolipoprotein A1 ratio (0.45 versus 0.40, p less than 0.01). Female smokers tended to show the same results, although significant differences were only found for LDL cholesterol to HDL cholesterol ratio and apolipoprotein B100 to apolipoprotein A1 ratio (1.8 versus 1.59 and 0.41 versus 0.38 respectively, both p less than 0.05). This work provides new data about the effects of smoking on apolipoproteins in adolescents and emphasizes on the need for preventive programs.
We report the clinical characteristics and course of 38 children with fulminant liver failure. A viral etiology was demonstrated in 19 patients out of 25 with serologic screening (virus A in 17 patients, B in 2 patients). One patient had toxic liver damage from ingestion of a caustic substance. Mean age was 4 years and 6 months. Jaundice was present in all but 2 patients at admission. Encephalopathy developed at a mean of 13 days and 17 children were admitted with stage 3 or 4 coma. Evidence of severe liver failure was present in every patient. A lower prothrombin time and higher bilirrubin concentration were shown by non survivors. Hypoglycemia developed in 37% of patients, seizures in 37%, gastrointestinal bleeding in 45%, respiratory failure in 32% and severe infection in 32%. Overall mortality rate was 42% raising to 83% in patients with stage 3 coma at admission. Thus, although the etiology of fulminant liver failure differs in children as compared to adults, mortality rate and complications are similar.
The prevalence of coronary heart disease (CHD) was studied in parents and grandparents of 2,419 children surveyed for lipid levels. Children and their families were divided into 3 groups depending on the level of each lipid and lipoprotein studied in children: high greater than or equal to 95 percentile (p), medium 5-95 p, and low less than 5 p. Total cholesterol (Chol) and triglycerides (TG) were determined by enzymatic techniques in autoanalyzer. C-HDL was determined by precipitation method. C-LDL and C-VLDL were obtained by Friedewald-Fredrickson's equation. The prevalence of CHD in parents and grandparents was ascertained from clinical history. Fathers of children in the high groups of Chol, TG, C-LDL/C-HDL, and low group of C-HDL had increased prevalence of CHD compared with those of the low groups of Chol, TG, C-LDL, C-LDL/C-HDL and high group of C-HDL. The strongest association was with C-HDL. Maternal and paternal grandfathers of children in the high groups of Chol had also increased prevalence of CHD compared with those of low group of Chol. There was no association with any other variable. The association was not significant neither in mothers nor in maternal and paternal grandmothers. Childhood lipid and lipoprotein levels could identify families at elevated risk for CHD.
Anthropometric variables were studied in 2,153 healthy children, 1,115 males and 1,038 females, aged 0 to 18 years, of the Fuenlabrada population, Madrid. Height was measured by an anthropometer and weight by a weighting scale. Tricipital and subscapular skinfold thickness were measured by Holtain caliper. Body mass index (kg/m2) and ponderal index (kg/m3) were calculated from weight and height. In the total population skinfold thickness had the highest correlation with total body fat. But, when only obese children (greater than 95 p) were analyzed, other variables like body mass index and ponderal index had also high correlation. Different fatness trends were observed between sexes, although females always were the fattest. In our population the correlation of skinfold thickness, body mass index and ponderal index with lipids, blood pressure, glycemia and uric acid were significant. Obese children and adolescents had nearly a twofold increase in relative risk of arterial hypertension, hypertriglyceridemia, hyperuricemia and low C-HDL.
UNLABELLED: Familial aggregation of coronary heart disease (CHD) and coronary risk factors (CRF) were evaluated by clinical history in adult relatives of children surveyed for CRF. Population was divided into two groups: Group I included 2,153 children without parental history of CHD. Group II included 266 children of 112 families with parental history of early CHD (before 56 years). In 105 cases the patients were the fathers and in 7 cases the mothers. All the patients were admitted to a coronary care unit. Familial aggregation of CHD was 9.7 times more frequent in paternal families of group II (p less than or equal to 0.0001) than in group I; there was no differences in maternal families. Higher prevalence of hyperlipidaemia, blood pressure hypertension, smoking habits, diabetes and obesity in fathers of group II was observed. Children in group II showed increased levels of C-LDL and decreased levels of C-HDL compared with those of group I. The prevalence of CRF was also significantly higher in children of group II, although in the 33% of the children of group II no CRF was detected. CONCLUSION: a substantial proportion, but not all cases, of familial aggregation of CHD could be explained by known CRF.
Blood pressure was studied in 2,153 healthy children of both sexes, from 0 to 18 years of age; 1,115 were males and 1,038 females. Systolic and diastolic blood pressures were measured in the sitting position by the auscultatory method on the right arm with a mercury sphygmomanometer using an appropriate cuff size. Systolic blood pressure was measured on the first sound and diastolic blood pressure in the fourth phase of Korotkoff. In children younger than 3 years blood pressure was measured in the decubitus supine position using the Doppler technique. There were no significant differences in mean systolic and diastolic blood pressure in both sexes. But the percentage of systolic blood pressure greater than or equal to 130 mmHg was higher in males than females (p less than or equal to 0.01). 8.4% of the total population had systolic blood pressure greater than or equal to 130 mmHg, and 1.3% had diastolic blood pressure greater than or equal to 90 mmHg. The annual increase rates of systolic and diastolic blood pressure were 2.31/0.94 mmHg in males and 2/0.97 mmHg in females. Children with blood pressure greater than or equal to the 95th percentile had a higher prevalence of hypertriglyceridemia and obesity. 54% of the variation in systolic blood pressure was explained by the association of weight, subscapular skinfold, body mass index and C-HDL. 30% of the variation in diastolic blood pressure was explained by the association of weight, obesity index, subscapular skinfold and C-HDL.
Fuenlabrada is at the present time the most industrialized town placed at the south are of Madrid. This population has some peculiar attractive characteristics from the epidemiologic point of view. Perhaps the most important is that the majority of its inhabitants are immigrant from other depressed rural areas of the country, with a low socio-economic and cultural level. The new conditions of life could have changed the life expectation and the causes of morbidity and mortality of this population. Between 1981 and 1984 we have studied the prevalence of cardiovascular risk factors in children and adolescents of its population, the relationships with cardiovascular risk factors and cardiovascular disease of the family and type of lactancy of the newborn. The variables studied were: height, weight, skin fold, blood pressure, lipids, lipoproteins, glycemia, uric acid and tobacco habit. The laboratory technics were standardized with serums of reference. The index of participation in the study of the required population was approximately of 80%.
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