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Biomedical subjects

M Delgado Rodríguez

Publications and source records attributed to M Delgado Rodríguez.

At least 19 recordsLinked to original sources
PubMed2001

[Risk factors for nosocomial sepsis: a case-control study].

BACKGROUND: The objective of this study was to identify the risk factors associated with the nosocomial sepsis syndrome according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. PATIENTS AND METHOD: A 1-year prospective case-control study matched for sex, age (+/- 5 years), and pre-infection hospital stay (+/- 1 day) was performed in a 1,200-bed university hospital. Cases were selected according to the above criteria. Controls were randomly selected from the daily list of hospitalized patients. Crude and adjusted odds ratios (OR) were determined. RESULTS: 346 cases and 346 controls were included. Multivariate analysis identified the following intrinsic risk factors: coma in the 48 hours before sepsis (OR: 15.1; CI 95%, 5.6-41.2), renal failure (OR: 3.4; CI 95%; 1.5-10.8), neoplasm (OR: 2.4; CI 95%, 1.1-5.1), prosthesis material (OR: 2.7; CI 95%, 1.0-7.8), and serum albumin concentration at admission lower than 3.1 g/dl (OR: 5.3; CI 95%, 2.3-12.4). Main extrinsic risk factors were: previous nosocomial infection (OR: 12.5; CI 95%, 1.61-96.3), intensive care unit (ICU) stay (OR: 10.6; CI 95%, 3.1-36.2), naso-gastric tube (OR: 8.4; CI 95%, 2.3-31.3), indwelling urinary catheter (OR: 5.0; CI 95%, 1.4-18.9), H2 blockers treatment (OR: 5.0; CI 95%, 1.6-15.2), and IV central line (OR: 4.1; CI 95%, 1.2-14.0). CONCLUSION: In our study, main risk factors for development of nosocomial sepsis were presence of coma in the 48 hours before sepsis, ICU stay, and prior cross infection during hospitalization.

Adolescent↗
PubMed2001

[Differences in the quality of Spanish clinical trials published in international periodicals and of the ones presented in general medicine periodicals with wide readership].

BACKGROUND: The assessment of the methodological quality of controlled clinical trials (CCTs) carried out in Spain and published in international journals and the comparison with those published in widely read general journals of medicine (N Engl J Med, Lancet, JAMA, BMJ) may help establishing their limitations and improving quality in future studies. METHODS: Search in Medline of CCTs. Studies were evaluated according to a structured questionnaire (J Clin Epidemiol 1992; 45:225-265). The odds ratio and their 95% confidence intervals were used to compare spanish studies with the remaining studies. The following variables were considered as confounders and controlled for by logistic regression analysis: number of participating centers, sample size, funding source, and the inclusion of epidemiologists in the research team. The journal's impact factor was taken into account. RESULTS: Spanish CTTs had a smaller sample size, were mostly monocentric, reported les frequently the source of funding, and exhibited a lower participation of epidemiologists. The informed consent and the approval by the ethics committee were more frequently omitted. The major methodological differences with the other studies were: lack of pre-study sample size and statistical power estimation, lack of inclusion criteria, poor explanation of patients' flow in the selection process, lack of explanation for unmasked procedures, poor description of methods to assess intervention compliance, under-reporting confidence intervals, and less frequent use of the intention-to-treat principle. The quality score of spanish studies was lower (9.4 +/- 1.7 vs 10.7 +/- 1.5; p < 0.001). These limitations improved with higher journal's impact factor, the quality score was 8.5 in journals with an impact factor < 1.5, and 10.6 in those with an impact factor > 4.5. This last figure is almost identical to the average of CCTs published in general journals of medicine. CONCLUSIONS: Most spanish studies achieved a good quality score. Nevertheless, there are still issues which can be overcome easily. If this goal is achieved, the results will obtain a higher repercussion, as a better quality is observed in those published in journals with the highest impact factor.

Clinical Trials as Topic↗
PubMed2000

[Influence of parental smoking on pediatric hospitalization for respiratory illness among children aged less than 2 years].

AIM: To determine whether parental smoking increased the risk of hospitalization among children aged less than 2 years. DESIGN: Case-reference study conducted from April 1995-May 1996. The group of cases was composed of 40% of all the children aged 2 years or less years admitted to our hospital (n=392). The reference population was composed of 15% of the live newborns in the same the hospital (n=493). The information was obtained by face-to-face interview after delivery in both populations and by telephone interview or postal survey and was completed in the reference population one year after delivery. RESULTS: Maternal smoking increased the risk of hospitalization for lower respiratory illness (adjusted RR - 1.79; 95% CI = 1.03-3.11). Moreover, the risk of hospitalization for upper or lower respiratory illness, lower respiratory illness and bronchiolitis was increased when the mother smoked more than 19 cigarettes per day. The results were adjusted for confounding factors such as prenatal age, ethnic group, maternal education, social class, breastfeeding and hospitalization of the newborn. Parental smoking, specifically maternal smoking, affects children's health, increasing the risk of hospitalization for respiratory illness in the first 2 years of life.

Hospitalization↗
PubMed1999

[Mortality due to multiple sclerosis in Spain, 1951-1992].

UNLABELLED: FOUNDATIONS: In this work, multiple sclerosis mortality trend in Spain from 1951 to 1992 is displayed. The purpose is to identify the pattern of age-adjusted mortality evolution and to measure the effect of environmental factors. METHODS: Multiple sclerosis mortality is standardized by age using the world standard population. In each year from 1951 to 1992, age-specific mortality rates are transversely fitted to the Gompertz law. The Longitudinal Gompertzian analysis is applied to the obtained coefficients to quantify the effects of competing risks and environmental factors. RESULTS: Multiple sclerosis age-adjusted mortality increased from 1951 to 1968; a step-down is produced in 1969 (coinciding with change from 7th to 8th revision of the International Classification of Diseases) and a stability from 1970 on. Multiple sclerosis in Spain is a Gompertzian disease. Adjusting mortality for R0 (which in the Gompertz function represents the addition of the environmental factors acting in a point near the beginning of the life and the competing risks of death) the result was almost constant throughout the whole analyzed period. CONCLUSIONS: It is suggested that multiple sclerosis mortality trend in Spain is due to changes in some environmental factor acting early and in a point; on the other hand, diet or other environmental factors acting for long time or genetic factors have and little or no influence in this trend.

Adult↗
PubMed1998

[Elderly, poor, solitary and marginal patients: geriatric vulnerability in emergency services].

BACKGROUND: Status is a powerful determinant of health, and it may influence on the demand of Hospital emergency services. The aim of our investigation is to assess whether elderly patients usually wandering emergency services gather more negative socioeconomic conditions. PATIENTS AND METHODS: A cross-sectional study on 800 randomised patients cared in emergency services was carried out. A questionnaire about economic, educational and professional levels, domestic violence, loneliness and life style was applied. A crude analysis was used to assess the age-factor (>/= 65 y.o.) by BMDP (PC 90). The trial was approved by the local Bioethics board. RESULTS: Low incomes, low educational level and loneliness were clinic and statistically related with age (65 and more). Data is offered as n (%), X2 and p < 0.0001 (Fisher exact Test two sided p value). CONCLUSIONS: Elderly patients frequently demanding hospital emergency services gather more vulnerability conditions, not merely medical. Low incomes, low educational level and loneliness are probably working as key factors on the geriatric demand of emergency services.

Aged↗
PubMed1997

[Clinical and biological markers of secondary uveitis: results of a discriminant analysis].

BACKGROUND: The association of uveitis and systemic disease is well known. Patients suffering from uveitis often undergo a extensive battery of tests in order to detect underlying disease, but the efficiency of such screening is uncertain. The aim of this study was to investigate useful clinical data for recognizing secondary uveitis. PATIENTS AND METHODS: We conducted a prospective analysis of 115 patients with uveitis of unknown etiology. All of them were included in an extensive protocol study. Four groups were considered: specific ocular disease (SOD), idiopathic uveitis, HLA-B27 associated uveitis without arthritis (HLA-B27-AU) and secondary uveitis. Groups were compared by analysis of variance for continuous variables, and chi 2 test or Student's t-test for discrete variables. A stepwise multiple discriminant analysis was performed for ranking the variables in order of their usefulness for distinguishing idiopathic and secondary uveitis. RESULTS: We diagnosed 11 SOD (9.6%), 54 idiopathic uveitis (47%), 6 HLA-B27-AU (5.2%) and 41 secondary uveitis (35.7%). The discriminant analysis showed that age, an elevated erythrocyte sedimentation rate, presence of cutaneous lesion, joint pain and genital ulcers are the strongest predictors of secondary uveitis. This model classification functions detected 92.5% of idiopathic uveitis and 72% of secondary uveitis. The global percentage of patients with a correct diagnosis was 84.6%. CONCLUSIONS: Anamnesis, physical examination and basic laboratory tests are sufficient tools for the diagnostic approach of the majority of patients with uveitis. Subsequent diagnostic procedures must be planned in each patient to confirm a specific disease.

Adolescent↗
PubMed1995

[Prevalence of cardiovascular risk factors in a working population].

BACKGROUND: A high prevalence of cardiovascular risk factors (RF) has been reported in Spain. The aim of this study was to determine the main RF of heart disease (cholesterol, smoking, high blood pressure (HBP), diabetes, obesity, and sedentarism) in laboral population from Granada, Spain. METHODS: The sample included 1,555 workers (1,193 males and 362 females, mean age 42.3 years). The percentage of participation was 91.9%. Information was collected directly (standardized self administered questionnaire) and from the physicians of the companies (protocolized anamnesis, physical examination and electrocardiogram) for each worker. Serum cholesterol was measured in venous blood by an enzymatic autoanalyzer. A description of the phenomennon was studied and likewise, the multivariate models of logistic regression were adjusted to evaluate the association of the other RF with hypercholesterolemia. RESULTS: Serum cholesterol level higher than 200 mg/dl (5.17 mmol/l) was presented in 69.3% of the sample. The prevalence of HBP was 8.4%. Forty-four point two percent were smokers (48.9% males and 28.7% females). A body mass index higher than 25 kg/m2 was presented in 65.2%. The prevalence of diabetes was 3.5% and 18% of the workers classified themselves as sedentary. Only 2.8% of the males and 11.6% of the females were absolutely free of the RF studied. Diabetes, age, obesity, HBP and smoking (> 10 cigarettes/day) were significantly associated with a higher probability to present hypercholesterolemia. CONCLUSIONS: A high prevalence of classical risk factors related to cardiovascular disease, with the exception of high blood pressure, was observed, thus making the application of preventive measures necessary.

Adolescent↗
PubMed1995

[Changes in arterial pressure and smoking habit following 3 years of multifactorial intervention].

BACKGROUND: The feasibility of successfully reducing cardiovascular risk factors is supported by large studies. Nevertheless, controversy remains about the actual efficacy of some lifestyle interventions. This report assess the effectiveness of different levels of intervention at the work-site on blood pressure and smoking. METHODS: At the beginning of the program 1.193 men and 362 women were included in it. Individualized face-to-face counseling was given to employees by four different occupational physicians. After 3 years, 980 individuals remained in the study. The differences among the four groups allowed us to distinguish three different levels of intensity of interventions and a fourth group that was the reference one. Observed changes in blood pressure were compared using analysis of covariance. Adjusted odds ratio of smoking quit rates were calculated by logistic regression. RESULTS: Intensive intervention was significantly different from control group and the group of mild intervention. Moderate intervention was the only one to bring about a significant reduction of arterial blood pressures. This reduction was consistent with the lower threshold used in this group to classify diastolic blood pressure as high. Smoking quit rate was 22% for intensive and moderate interventions. Adjusted odds ratio for quitting smoking was 5.81 (95% CL 1.29-26.14) for moderate and 8.2 (IC 95% 1.75-38.46) for intensive intervention. CONCLUSIONS: A lower threshold for starting intervention measures on blood pressure is suggested to achieve better results. As the intensity of interventions was stronger, smoking quit rates were higher.

Adult↗
PubMed1994

[Proportion of disease attributable to tobacco in the province of Granada].

BACKGROUND: Smoking is the main cause of preventable morbidity and mortality in Europe. The effect of smoking is not constant with the diseases related to it. The goal of this study is to estimate poblational etiologic fractions (PEF), as the proportion of disease attributable to smoking in the reference population, for those disease clearly related to smoking in Granada. METHODS: The PEF depend upon relative risk (RR) and the proportion of exposed subjects in the target population. Meta-analytic procedures, following the Woolf's method, were applied to estimate weighted RR between smoking and each one of the diseases studied. A survey on a random sample of all Granadian population to assess the prevalence of smoking was performed. RESULTS: The PEF were always higher for males than for females. In males, the highest figures were for lung cancer (85%) and chronic obstructive lung disease (84%); whilst in females lung cancer and peripheral artery disease reached the greatest figures, 55% and 51%, respectively. CONCLUSIONS: The figures obtained outline the need for improving antismoking campaigns and allow to quantify the maximum potential benefit to be got if smoking was quit by the Granadian population.

Adolescent↗
PubMed1993

[The estimation of the cost of nosocomial infection in an intensive care unit].

BACKGROUND: Nosocomial infection (NI) represents an increase of hospital morbidity and mortality. The data available concerning the hospital expenses due to the prolongation of hospital stay associated to NI are fundamentally derived from American studies. The aim of this study was to evaluate the direct cost of nosocomial infection in an intensive medicine unit (IMU). METHODS: A study of cases and paired controls was carried out with a cohort study made up of 88 cases and 88 controls paired by age and severity (APACHE II grading). Previously identified confusion factors were controlled in the analysis. RESULTS: The mean stay in the IMU for infected patients was 17.2 days and for non infected patients 6.8 days. When these stays were adjusted by the variables associated with both NI and in the IMU this became 14.2 days for infected patients and 9.9 days for uninfected patients. The prolongation of stay in the IMU due to NI was 4.3 days. The extra cost for the hospital due to infection acquired by a patient's during stay in the IMU was estimated as 239,441 pesetas. CONCLUSIONS: The methodology used was considered as valid for estimating the prolongation of stay in intensive medicine units attributed to nosocomial infection. The high economic expense which nosocomial infection represents emphasizes the justification for measures of control of this entity.

Adolescent↗
PubMed1991

[Epidemiology of brucellosis in the Granada province (I). Occupational risks].

BACKGROUND: Brucellosis is a health problem in the Granada province. The major aim of the present study was to evaluate the professional risk to acquire brucellosis in Granada. METHODS: An epidemiologic study where the cases of brucellosis were found by active search was carried out. The study period was the year 1984. The patients (overall 804) were investigated in their residence area with a questionnaire where the major risk factors were considered. RESULTS: The disease was more common in males than in females (RR = 3); it had a significant tendency to increase with decreasing sizes of the urban nucleus (chi MH = 16.9, p less than 0.0001); and it had a significant relationship with the proportion of peasants and cattle workers in the region (r = 0.66, p less than 0.05). The professional group with the highest risk were veterinaries, in whom the disease was 31 times more common than in the rest of the population. CONCLUSIONS: Emphasis is made, in addition to other points, on the need to increase health education in the groups of more affected professionals.

Adolescent↗
PubMed1991

Effect of penicillin and chloramphenicol on the growth and endotoxin release by N. meningitidis.

The action of two antibiotics, penicillin and chloramphenicol, on bacterial growth and endotoxin liberation was studied in 18 strains of Neissevia meningitidis isolated from blood and CSF of patients with meningococcal infections. The antibiotics were administered both separately and in combined form in doses equivalent to 1 MIC and 100 MIC. Penicillin was found to produce a faster and more intense bactericidal effect than chloramphenicol during the first hour, whereas at 12 h these differences were not significant. This could explain the initial worsening observed in some infected patients when large doses of penicillin are administered. An increased liberation of endotoxin after adding penicillin was observed in six of the strains studied, whereas the remaining 12 did not show significant increases. The six strains (belonging to serogroup B) were known to have an enhanced capacity for spontaneous endotoxin liberation.

Chloramphenicol↗
PubMed1991

[The hospital stay as a modifier of the effect of other risk factors for hospital infection].

It has been suggested that the risk of hospital infection differs according to the moment of hospital stay. Through a retrospective cohort of 843 surgery patients the effect of several factors on nosocomial infection risk is studied as a function of the duration of the hospital stay. It was observed that the studied variables (operation, type of surgery, age and severity of underlying disease) had a predisposing effect on the appearance of infection in short stays (less than 14 days), being the effect greater in longer stays. It is concluded that hospital stay can act as a modifier of the effect of several factors on the risk of hospital infection.

Cross Infection↗
PubMed1990

[Infection by the human immunodeficiency virus in the Spanish population (II). A meta-analysis of the time and geographic trends].

The aim of this research was to study the prevalence of infection by the human immunodeficiency virus (HIV) among the Spanish population. Due to the lack of available data we have applied meta-analysis techniques. We analyzed 67 original publications on this field appeared between 1985 and 1989. The prevalence of the illness has progressively increased among the risk groups (ADVP, homosexuals, prostitutes, heterosexual transmission) but not in hemophilic patients. The geographical distribution showed statistically significant differences being Barcelona as the province with the area of highest prevalence of the infection in ADVP and homosexuals.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Infection by the human immunodeficiency virus among the Spanish population (I). Qualitative meta-analysis].

A meta-analysis of the original papers on human immunodeficiency virus (HIV) published in Spain was performed to better know the characteristics of HIV infection in Spain. Between 1985 and 1989, 67 investigations fulfilled the inclusion criteria. They were evaluated by means of a quantified questionnaire. The mean quality of the investigations was 44.65 +/- 1.5%. A bias in the selection was highly probable in 80% of the studies, whereas a bias in information and in confusion was less frequent (35.8% and 77.6%, respectively). The investigations of more quality were those carried out recently at the University in collaboration with other Institutions and with participation of sanitary personnel published in microbiologic journals.

Acquired Immunodeficiency Syndrome↗