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Biomedical subjects

L Salleras

Publications and source records attributed to L Salleras.

At least 73 records · Page 4Linked to original sources
PubMed1996

Cigarette smoking as a risk factor for tuberculosis in young adults: a case-control study.

SETTING: The association between smoking and pulmonary tuberculosis has not often been studied. OBJECTIVE: To assess the influence of cigarette smoking on the development of active pulmonary tuberculosis in young people who were close contacts of new cases of smear-positive pulmonary tuberculosis. DESIGN: A case-control study in which 46 'cases' (patients with active pulmonary tuberculosis: isolation of Mycobacterium tuberculosis or clinical and/or radiographic evidence of current pulmonary tuberculosis, with a positive tuberculin skin test) and 46 'controls' (persons with positive tuberculin reaction, negative bacteriological test and without clinical and/or radiological evidence of pulmonary tuberculosis) were included. Smoking habits were investigated by questionnaire. Univariate and multivariate analysis was performed, and odds ratio (OR) was adjusted for age, gender and socio-economic status. RESULTS: Statistically significant differences were found in active smokers (occasional and daily smokers) (OR: 3.65; 95% CI, 1.46 and 9.21; P < 0.01), daily smokers (OR: 3.53; 95% CI, 1.34 and 9.26; P < 0.05), and individuals who were both passive and active smokers (OR: 5.10; 95% CI, 1.97 and 13.22; P < 0.01) and passive and daily smokers (OR: 5.59; 95% CI, 2.07 and 15.10; P < 0.001). There was a dose-response relationship between the number of cigarettes smoked daily and the risk of active pulmonary tuberculosis. CONCLUSIONS: The data studied show that cigarette smoking is a risk factor for pulmonary tuberculosis in young people, with a dose-response relationship with the number of cigarettes consumed daily.

Adolescent↗
PubMed1996

Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study.

SETTING: Passive smoking-related respiratory disorders in children. OBJECTIVES: To assess the effect of passive smoking on the development of active pulmonary tuberculosis (PTB) in children immediately following infection by Mycobacterium tuberculosis within the family. DESIGN: An unmatched case-control study in which 93 contacts who became cases (active PTB diagnosed) and 95 contacts who did not became cases (tuberculin-positive children without evidence of active disease) were included. All were household contacts of a new case of pulmonary bacillary tuberculosis. Smoking habits were investigated by a questionnaire. Urinary cotinine was analysed. Odds Ratio (OR) was adjusted for age and socio-economic status using multiple logistic regression analysis. RESULTS: Passive smoking was a risk factor for PTB (OR: 5.29; 95% confidence interval (CI): 2.33-12.82; P < 0.00005). The adjusted OR was 5.39 (95% CI: 2.44-11.91; P < 0.00001). The risk increased when contacts were passive smokers both at home and outside the home within the family (OR: 6.35; 95% CI: 3.20, 12.72; P < 0.00001). Contacts 0-4 and 5-9 years old showed a significantly higher risk than those aged > or = 10. There was a dose-response relationship between the risk of developing active PTB immediately following infection and the number of cigarettes smoked daily by the household adults (P < 0.001). Mean (SD) urinary continine detectable concentrations (ng/ml) were different between disease contacts (119.46 [68.61]) and non diseased contacts (91.87 [73.10]). The difference was statistically significant (P < 0.001). CONCLUSIONS: Passive exposure to tobacco smoke in children was associated with an increased risk of developing pulmonary tuberculosis immediately following infection. This is an association of great concern requiring health education programmes and antitobacco medical advice.

Adolescent↗
PubMed1996

Cost-effectiveness of breast cancer screening in Spain.

In the last several years, the development of an effective breast cancer screening procedure has increased the possibility of the early detection of this cancer. We investigated the cost-effectiveness of a breast cancer screening program to screen 100,000 women 50-64 years of age in Catalonia (Spain). The cost-effectiveness ratio was measured in terms of the cost per cancer detected comparing program costs to the estimated number of cancers detected. We assumed a participation rate, sensitivity, and specificity of 70%, 92%, and 94%, respectively, and that 0.36 breast cancers could be detected per 100 women screened. We estimated a total cost of $2.1 million with $1.4 million for the mammographic stage and $0.7 million for the detection of the true positive mammographic results. The cost per woman screened was $30. We estimated that 252 cases of breast cancer could be detected with the program. The cost-effectiveness ratio obtained in this study was $8,424 per cancer detected. Sensitivity analysis has shown that cost-effectiveness results are sensitive to the variations in the following variables: specificity, cancer detection rate, and screening costs. In planning preventive programs, breast cancer screening should be considered one of the priorities.

Biopsy↗
PubMed1996

[Smoking cessation program using nicotine patch among physicians and pharmacists of Catalonia: results after 3-12 months].

Smoking abstinence rates of a group of 300 physicians and pharmacists of Catalonia (Spain) who participated in an open non-controlled follow-up design study with nicotine patch, are presented. Were eligible all the individuals who regularly smoke more than 15 cigarettes/day and get Fagerström Test score of 5 or more. Those who smoke more than 20 cig/day were offered a 3-month 24-hour transdermal nicotine treatment (30-20-10 schedule) and those smoking between 15 and 20 cig/day, received the 20-20-10 schedule. A follow up of participants was carried out at 3, 6, 9 and 12 months. After one year, 12 participants (4%) were dropped out. The overall abstinence rates at 3, 6, 9 and 12 months were respectively 55.9% (IC95%: 50.2-61.6), 42.7% (IC95%: 37.0-48.4), 35.4% (IC95% 29.9-40.9), 33.7% (IC95%: 28.2-39.2). Among predictive cessation variables, only those who had mad 1 to 3 previous attempts and those with only "cold turkey" (or slow reduction) quit experience, obtained statistically better results at 3 months. These results seem to be as good as or even better than those obtained in other similar studies with nicotine patch.

Administration, Cutaneous↗
PubMed1995

[The efficacy of the prevaccination detection of anti-HAV in hepatitis A vaccination programs].

BACKGROUND: The convenience of carrying out prevaccination detection studies of hepatitis A virus (HAV) markers depends on the relative costs of the detection and vaccination, as well as the prevalence of susceptible subjects in each population group to be vaccinated. The aim of this study was to analyze the efficacy of the systematic prevaccination detection of anti-HAV antibodies in Catalonia, Spain. METHODS: The following formula was applied: Unit cost of detection + (1-X) x Unit cost of vaccination of anti-HAV negative subjects = group vaccination cost, with X being the threshold of prevalence of marker under which detection no longer remains efficient. This prevalence was compared with the findings of a seroepidemiologic survey carried out in international travellers and food handlers. RESULTS: The unit cost of the detection of anti-HAV was calculated as 2,733 pesetas, and the unit cost of the vaccination as 9,963 pesetas obtaining a prevalence anti-HAV threshold of 27%. This prevalence corresponds to travellers under the age of 30 years and food handlers under the age of 25 years. CONCLUSIONS: The systematic detection of anti-HAV is only recommended in population groups in which prevalences higher than 27% may be expected. The vaccination is more efficient without a previous marker study under this threshold. According to this study, direct vaccination of food handlers under the age of 25 years (born after 1969) is recommended as is that of international travellers under the age of 30 years (born after 1964). In those over the age of these collectives, the prevaccination study is more efficient.

Adolescent↗
PubMed1995

[Cost-effectiveness of the methods of smoking cessation].

BACKGROUND: The cost-effectiveness of the following methods of cessation of smoking were calculated in this study: 1) medical advice, 2) medical advice and nicotine chiclets, and 3) medical advice and nicotine patches. METHODS: The costs and effectiveness of the methods of cessation of smoking compared in terms of cost per year of life gained, deducing the costs and benefits at 5%. RESULTS: The cost per year of life gained was found to be 260,000 to 434,000 pesetas in males and 441,000 to 637,000 in women for medical advice, 287,000 to 479,000 in males and 486,000 to 703,000 in females for advice and nicotine chiclets and 329,000 to 549,000 in males and 557,000 to 805,000 in females for advice and nicotine patches. Maximum efficacy was achieved with the three methods in the age group from 45-59 years in males and from 50-54 years in females. On comparison of cost and effectiveness of the methods of nicotine substitution with those calculated for medical advice the increase in cost-effectiveness was shown to be 395,000 to 658,000 in males and 668,000 to 966,000 in females for advice and chiclets and from 467,000 to 779,000 in males and 791,000 to 1,142,000 in females for advice and patches. The increase in cost-effectiveness for advice and patches versus advice and chiclets was from 539,000 to 899,000 in males and 913,000 to 1,318,000 in females. CONCLUSIONS: The efficiency of achieving the cessation of smoking is very similar for medical advice and medical advice plus nicotine chiclets and is somewhat less for medical advice and nicotine patches. The results of this study place the methods of smoking cessation among the most effective health care procedures.

Adult↗
PubMed1995

How could changes in diet explain changes in coronary heart disease mortality in Spain? The Spanish paradox.

We review and compare trends in coronary heart disease (CHD) and stroke mortality in Spain from 1966 to 1990 and changes in food consumption at national and regional levels. Since 1976, a decrease in cardiovascular disease (CVD) mortality in males and females has been observed, and standardized CHD mortality rates have fallen. Stroke mortality decreased during the same period. Trends in food consumption show increases in intakes of meat, dairy products, fish, and fruit, but decreases in consumption of olive oil, sugar, and all foods rich in carbohydrates. Although fat and saturated fat intakes increased, these changes were not accompanied by an increase in CHD mortality rates. This paradoxical situation can be explained by expanded access to clinical care, increased consumption of fruit and fish, improved control of hypertension, and a reduction in cigarette smoking. Diet appears to have an important role in this paradox, but it may not be as critical as other factors. Nevertheless, we suggest dietary guidelines for prevention of CHD in Spain.

Cerebrovascular Disorders↗
PubMed1995

Cost-effectiveness analysis of hepatitis B vaccination strategies in Catalonia, Spain.

Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 vaccination strategies (mass adolescent vaccination, mass infant vaccination and mass combined vaccination) was performed in Catalonia, Spain. Screening pregnant women for HBV infection in combination with these strategies was also evaluated. Epidemiological models to analyse patterns of HBV infection with and without vaccination and to calculate HBV-associated costs were designed. Comparison between strategies was done using cost-effectiveness analysis from the perspective of the healthcare system. Epidemiological model results indicate that implementation of HBV vaccination could prevent as many as 104,778 new acute infections, and avoid up to 5239 chronic infections, 2096 cases of cirrhosis and 419 cases of hepatocarcinoma over a 20-year period in Catalonia. Cost-effectiveness analysis shows that mass adolescent vaccination is the most efficient strategy, with lower costs per avoided case than the other 2 strategies. When any of these strategies is complemented by screening for HBV in pregnant women, the number of avoided cases is always higher and the cost per avoided case decreases or remains unchanged.

Adolescent↗
PubMed1995

Appropriateness of admissions and hospitalization days in an acute-care teaching hospital.

A cross-sectional study was made of the appropriateness of admissions and hospitalization days in an high-technology, acute-care teaching hospital. This 952-bed institution with 31 hospital services is a reference center for the metropolitan area of Barcelona. A systematic random sampling (1:11) of the registers of hospital discharges was carried out during the months of January, February and March 1991 (n = 7,142) excluding discharges from the pediatric, obstetrics and psychiatric departments. A retrospective analysis was made of 639 patients' medical records using the Appropriateness Evaluation Protocol (AEP). The rate of inappropriate hospital admissions was 9.1% (58/639) (95% confidence interval: 6.9-11.5). Inappropriate admissions were primarily attributable to hospitalizations for diagnostic and/or therapeutic services that could have been rendered on an ambulatory basis (70.7% of cases). Overall 29.2% of hospitalization days (1,963/6,731) were inappropriate (95% confidence interval: 28.1-30.3). Inappropriate admissions to hospital, an optimizable health care planning and a conservative physician's attitude (postponed discharge) were the most frequent reasons for unnecessary days of care. The interrater reliability in the use AEP criteria for appropriateness of admission showed a kappa index of 0.5 and that for appropriateness of hospitalization days 0.67. In summary, instruments, such as the AEP protocol, that allow us to determine which patients can be attended at other levels of the health care system and which levels are the most appropriate, are key elements in improving the appropriateness of hospital use in public health care systems.

Acute Disease↗
PubMed1994

[Seroepidemiology of hepatitis C virus infection in pregnant women in Catalonia].

BACKGROUND: The aim of this study was to investigate the prevalence of hepatitis C virus (HCV) infection in a population of pregnant women in Catalonia and the sociodemographic variables and risk factors associated to this prevalence. METHODS: A representative sample of the pregnant women in Catalonia (n = 4,551) randomly selected by clusters (hospitals with maternity clinics) was studied. Detection of antiHCV antibodies was performed by the third generation ELISA test. Reactive cases were confirmed with RIBA 3 and MATRIX. RESULTS: The prevalence of antiHCV was found to be 1% and was not significantly associated with any of the sociodemographic variables studied (age, social and cultural level, origin and residence). A history of blood transfusion, intravenous drug consumption and hepatitis in the sexual partner were the only risk factors associated with the prevalence of infection found on univariate analysis although these were only present in 47% of the antiHCV positive cases detected. The association between the positivity of antiHCV and the history of hepatitis in the partner was lost on stratification of the cases according to the possible existence of history of drug addiction. CONCLUSIONS: A high proportion of young asymptomatic people (1%) were found to have hepatitis C virus infection with the possible mode of infection not being detected in approximately half of these subjects. In the other half of these cases the infection was found to have been acquired by an intravenous mechanism: blood transfusion or drug use.

Adult↗
PubMed1994

[Infection by the human immunodeficiency virus type 1 in the population of prisoners of Catalonia].

BACKGROUND: The prison population represents a high risk group for the human immunodeficiency virus type 1 infection. The present study was carried out to know the prevalence of infection in this collective in three penitentiary centers in Catalonia. METHODS: All the subjects who were in or who were admitted to the three penitentiaries for men from October 1987 to April 1988 were included in the study (n = 1,579). Demographic risk factor and penitentiary variables were obtained. The determination of anti-HIV-1 antibodies was performed by enzymoimmunoanalysis (Dupont HIV ELISA). RESULTS: The global prevalence of HIV-1 infection was of 40.6%. Significant statistical differences were found among intravenous drug users (IVDU) and non IVDU (chi 2 = 376.8, p < 0.0001, OR = 9.6, CI 95% = 7.5 - 12.3) and between habitual and sporadic users (chi 2 = 23.9, p < 0.0001, OR = 3.0, CI 95% = 1.9 x 4.7). CONCLUSIONS: The penitentiary population in Catalonia is a collective with a high prevalence of infection by the human immunodeficiency virus type 1, with intravenous drug use being the fundamental factor associated to this prevalence.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Relationship between severity, costs and claims of hospitalized patients using the Severity of Illness Index.

The results of the prospective application of Horn's 'Severity of Illness Index' in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.

Adolescent↗
PubMed1994

[The association between arterial hypertension, obesity and hypercholesterolemia in a sample of the adult population of Catalonia].

BACKGROUND: The Framingham's study has demonstrated that the incidence of cardiovascular diseases increases when several risk factors are present. In this study, the association between the main cardiovascular risk factors has been studied in a random sample from the adult population of Catalonia. METHODS: A random sample was obtained (n = 314) from the adult population of Catalonia and univariate and multivariate statistical procedures were used to analyze the association between the following risk factors: HDL, hypertriglyceridemia, obesity, diabetes and tobacco consumption. RESULTS: A simple correlation was observed between most of the risk factors. The multiple linear regression analysis showed that both the diastolic and systolic arterial pressures were correlated with total levels of cholesterol, body mass index and age (r = 0.65 for SAP and r = 0.48 for DAP); levels of total cholesterol were correlated with levels of triglycerides and age (r = 0.57); levels of triglycerides were correlated with levels of total cholesterol and cholesterol-HDL, body mass index and age (r = 0.61); body mass index was correlated with levels of triglycerides, total cholesterol, cholesterol-HDL and age (r = 0.52) (p < 0.001). The prevalence of hypercholesterolemia, obesity and diabetes was higher and the prevalence of tobacco consumption was lower among the hypertensives (SAP > 140 and/or DAP > 90 mm Hg) than among normotensives, being the odds ratio 3.56 (2-6.33) for hypercholesterolemia; 3.65 (1.66-8.09) for obesity; 3.70 (1.06-13.45) for diabetes and 0.40 (0.22-0.72) for tobacco consumption. The adjusted odds ratio derived from multiple logistic regression analysis was 2.52 (1.38-4.64) for hypercholesterolemia; 2.40 (1.05-5.46) for obesity, 1.74 (0.50-6.04) for diabetes and 0.63 (0.33-1.20) for tobacco consumption, being statistically significant in the case of hypercholesterolemia (p = 0.002) and obesity (p = 0.038). CONCLUSION: We have observed an association between the cardiovascular risk factors analyzed. This association may be attributed to several physiological mechanisms and life-styles, which may influence the development of atherosclerosis and increase the cardiovascular risk.

Adolescent↗