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Objetivo: Al principio de conocerse la infección por el virus de la inmunodeficiencia humana (VIH), la causa más importante de su transmisión en las mujeres occidentales fue el consumo de drogas por vía parenteral. El objetivo de nuestro trabajo consistió en describir las principales características sociales y clínicas de un grupo de madres seropositivas, y en analizar su relación potencial con el uso intravenoso de drogas. Métodos: Realizamos un estudio observacional prospectivo con 220 mujeres infectadas por VIH que presentaban la particularidad de haber dado a luz niños con riesgo de infección. Se incluyeron todas las madres reclutadas en la Unidad VIH de un hospital de Valencia que tuviesen definido el diagnóstico de su infección durante el período de estudio comprendido entre el primer caso materno conocido en 1985 y 1993. El análisis de los datos se basó en un análisis univariado. Resultados: La transmisión del virus se produjo por mantener relaciones heterosexuales en un 27,7 por ciento de las mujeres estudiadas, y a través de la drogadicción parenteral en el 69,1 por ciento. Se detectó mayor número de madres que abortaron, con antecedentes penales y abandono domiciliario entre las usuarias de drogas por vía parenteral (UDVP), con odds ratio (OR) de 1,8 (p = 0,087), 8,95 (p = 0,012) y 15 (p = 0,000), al compararlas con las madres no UDVP. Además las UDVP presentaron mayor probabilidad de contraer la infección por hepatitis B o C (OR = 7,06, p = 0,000) y de tener asociados otros hábitos tóxicos como tabaquismo (OR = 6,19, p = 0,000) y alcoholismo (OR = 5,91, p = 0,117).Conclusiones: Muchas de las características analizadas en estas mujeres estaban más relacionadas con el consumo de droga inyectada que con la infección por VIH, tales como la mayor frecuencia de abortos electivos, antecedentes penales, abandono domiciliario, politoxicomanías y antecedentes patológicos como hepatitis B o C (AU)

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OBJECTIVE: In the first years after the finding of HIV-infection, the main was for its transmission among western women was the intravenous drug addiction. The objective of our work consisted in evaluating the main social and clinical characteristics of a group of seropositive mothers, and in analyzing their potential relationship with intravenous consumption of drugs. METHOD: We performed an observational prospective study in 220 HIV-infected women who had recently given birth to children with high risk for infection. We included every women at an HIV Unit of a hospital in Valencia who had been diagnosed of HIV infection at any moment between the first mother-child transmission reported in 1985 and 1993. The analysis was based on univariate analysis. RESULTS: The virus transmission was produced by heterosexual relations in a 27.7% of the study women and due to the parenteral drug addiction in 69.1%. We detected more women who had an abortion, with criminal antecedents and parental abandonment among those who were intravenous drug users (IVDU), with OR of 1.8 (p = 0.087), 8.95 (p = 0.012) and 15 (p = 0.000), when compared with those mothers non-IVDU. Besides, IVDU presented a higher probability for getting hepatitis B or C infection and for other toxic habits, as smoking (OR = 6.19, p = 0.000) or alcoholism (OR = 5.91, p = 0.017). CONCLUSION: Many of the analysed characteristics in these women were more related with the consumption of injected drug than with the HIV infection, such as the greater frequency of elective abortions, criminal antecedents, parental abandonment, multiple drug abuse and pathological precedents like hepatitis B or C.

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Although all newborns to HIV-seropositive mothers have IgG anti-HIV antibodies, since these antibodies cross the placental barrier, only a small proportion of these children are actually infected with the virus. The main objective of this study consisted in estimating the vertical transmission rate of HIV in our environment. A prospective review was conducted of 236 children with HIV infection risk as they were born to HIV seropositive mothers. To calculate the mother-to child transmission we selected only 121 children controlled from birth and for a minimal time of 18 months at Hospital Infantil La Fe. Twenty-one out of these definitely classified 121 children were infected, representing a rate of 16.5%, similar to the rate reported in other European studies. By means of the stratified analysis some factors related to an increased transmission risk for HIV from mother to child were investigated. The possible causes that can explain the variability in the calculated rates for the different groups of investigation since the first pediatric AIDS case was detected are also discussed.

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BACKGROUND: Fear of adverse reactions is one of the reasons why influenza immunization programs for hospital workers have not met wide acceptance. We conducted a study in order to compare the frequency of adverse reactions following administration of standard split-virion (VVF) and subunit-virion (VAS) influenza vaccines, mostly among hospital personnel. METHODS: Trial with volunteers who were systematically assigned to receive one of the vaccines, alternating every ten participants, during the influenza inmunization campaing 1994-95. The adverse effects were recorded by telephone interview 10 days after vaccination. RESULTS: Out the 182 subjects recruited, 163 were included in the study, of whom 100 received VAS and 63, VVF. Almost 13% of the participants reported any adverse effects with no significant difference between both groups (VAS: 11% and VVF: 15.6%, p = 0.38). There were also no significant differences relating to systemic and local reactions, separately. The subjects who had adverse reactions to previous influenza vaccination showed more frecuent systemic reactions (25% vs. 7.5%, p = 0.04) in a significant way. CONCLUSIONS: Both vaccines have been proved to be very safe, only causing adverse reactions in a small proportion and very mild in every case. The VAS presents a frequency of adverse effects similar to that of VVF, in spite of containing only surface antigens. It's likely that a certain hypersensitivity to influenza vaccine exists in some people, specially to the split-virion one.

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In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

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We studied 142 patients who received antituberculous chemoprophylaxis with isoniacide. We evaluated the increase in GOT and PGT levels, observing higher than normal values in 10.56% and 21.83% of the cases, respectively. This increase was near the limit of the statistical significance with respect to sex and it was not related with previous episodes of hepatotoxicity, although it was related to age, with a lower number of hepatic disorders among the younger groups. The presence of hepatotoxicity forced us to discontinue the therapy in just 2.81% of the cases. The level of therapy compliance was 69.1% for women and 85.25% for men, being greatest in the age group below 13 years (86.89%).

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The concept of avoidable cause of death serves as the basis for measuring the quality and diversity of a health care system. In this study the authors propose a new way to use this kind of mortality by combining with the concept of life expectancy to obtain what they call "life expectancy free of avoidable mortality" (LEFAM). This indicator was 76.9 in 1986 in Spain while life expectancy was 75.83. If these deaths were avoidable there would be a gain of 1.09 years per person born. There is an important difference between the would-be male gain of 1.76 years and the would-be female gain of 0.6. In the ecological study, LEFAM would better explain the year to year changes of the resources in the health sector, measured in terms of the human resources (R = 0.96), the hospital beds per thousand persons (R = -0.86), and would also increase the relation with other health indicators such as infant mortality rate (R = 0.98) and mortality rate (R = 0.59) as compared with life expectancy alone.

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After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.

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This study reports the findings of one of the stages of a programme for the detection and control of arterial hypertension, started in 1980 in an automobile company with a workforce of 9,782. In the initial screening, 522 hypertensive males were found using epidemiological criteria and 206 of these fulfilled the criteria of definite hypertension. The objective of this study consisted of evaluating, 9 years after the start of the program, the indirect cost in terms of the reduction in the morbidity indicator-temporary work incapacity (TWI). Analysis is based on a comparison of the prevalence of hypertension in the population when the program was begun (6%) and in 1989 (9.8%). It can be observed that the TWI rate of the hypertensive population was significantly higher than that of the rest of the workforce, and that this remained true for the reference group (RG) hypertensives a year after the study was initiated. In contrast, the intervention group (IG) showed significantly lower TWI levels, not only in comparison with the RG but also with the rest of the workers. The estimated reduction in TWI for 1989 was 4.500 days/year, which corresponds to an estimated saving of 76.500.000 pesetas/year.

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A descriptive epidemiological study of brucellosis in the province of Valencia was carried out over the period 1985-1988. In this report predominant transmission mechanisms and their relation with sex, age and profession variables are described. Moreover, the results obtained were compared with those from other brucellosis epidemiologies which were previously carried out in the province of Valencia. It can be seen that there is a relative increase in the direct contagion mechanism and a decrease in the indirect contagion mechanism with respect to the previous periods, which has effects on the variations of sex and profession distribution of the disease. The changes observed could be attributed to a better sanitary control of milk and diary products, mainly fresh cheese, which are very important in the transmission of the disease in the province of Valencia.

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We have studied asthma mortality in Spain from 1951 to 1985, applying epidemiological descriptive methodology. A global decrease in the tendency is observed when comparing it to other countries. We have observed, however, an increased mortality in the four age groups proposed (5-19, 5-39, 40-64 and 5-64), based on previous international publications which avoid interferences with other causes of death. We have also observed that when applying the method of mortality related to natality rate, there was a decrease in mortality, specially in older generations. Finally, several hypothesis related to risk factors which would explain this tendency are presented.

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The present study is a descriptive epidemiological study of the mortality trends for renal cancer based on the data available for the period spanning 1951 to 1985. The specific death rates show a rising trend that is more marked in males than in females. These have been observed to increase constantly for the group aged 60-64 years. The mortality rates by birth cohorts show the cohort effect to be less evident in the younger male and female population. A review of 81 clinical records (1984-1988) of La Fe Hospital in Valencia based on a protocol that focussed on selected risk factors showed a higher frequency (33.75%) for the group aged 60-69 followed by the 50-59 age group (26.75%) and a higher incidence in men (66.67%).

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PIP: Mortality trends in Spain from 13 major causes of death are analyzed for the period 1972-1982 and compared with trends for the same period in France. Increases in mortality in Spain are noted for three causes--malignant tumors, cardiac diseases, and suicides and homicides--whereas significant declines in mortality are noted for pneumonia, influenza, chronic bronchitis, and asthma. Excess mortality for males is common to both countries. (SUMMARY IN ENG)^ieng

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A retrospective study was made of cases of colorectal cancer and controls using 571 cases from various hospitals in Valencia (Spain) and 1,497 controls from the general population with similar sex, age and residence. The relative risks (RR) and levels of statistical significance of various "risk factors" presumably linked to this cancer were calculated. It was associated with: smoking, the Quetelet index (which relates weight and height), chronic constipation and, possibly, sedentary life style, previous cholecystectomy and biliary lithiasis. No association was observed with: civil status, weight, coffee and alcohol intake, or professional status.

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