RESUMEN
BACKGROUND: Recent studies show an increasing incidence of multiple sclerosis (MS) in southern Europe. Although by its geographical location and genetic characteristics Spain is expected to be similar to other southern European regions, data on incidence are scarce. The aim of this study was to determine the onset-adjusted incidence of MS in the Girona province in Catalonia (Spain). METHODS: A prospective incidence study pooling data from the population-based Catalonia MS Registry was performed. Incident cases were defined as patients who had the onset of symptoms compatible with a clinically isolated syndrome (CIS) suggestive of MS in 2009 and fulfilled McDonald-2005 criteria during follow-up. Age- and sex-specific incidence rates were obtained. RESULTS: The Registry included 182 patients residing in Girona that presented a CIS from January 2009 to December 2013. Fifty one patients had the onset of symptoms in 2009, of whom 27 patients fulfilled the diagnostic criteria, giving an incidence of 3.6 per 100,000 (CI 95% 2.4-5.3) inhabitants; 4.3 (CI 95% 2.5-7.1) for women and 2.9 (CI 95% 1.4-5.2) for men. The age-adjusted incidence rate for the European population was 3.29 (CI 95% 3.2-3.3). CONCLUSION: The incidence estimation derived in this study is consistent with recent epidemiological data of MS in southern Europe suggesting an increase in incidence in this region.
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Esclerosis Múltiple/epidemiología , Adulto , Distribución por Edad , Edad de Inicio , Anciano , Estudios de Cohortes , Planificación en Salud Comunitaria , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Examen Neurológico , Sistema de Registros/estadística & datos numéricos , España/epidemiología , Adulto JovenAsunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/efectos de los fármacos , Fluoroquinolonas/farmacología , Hospitales/estadística & datos numéricos , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Resistencia a las Cefalosporinas , Cefalosporinas/clasificación , Cefalosporinas/uso terapéutico , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Bases de Datos Factuales , Farmacorresistencia Bacteriana Múltiple , Utilización de Medicamentos , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/epidemiología , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Lactante , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Prevalencia , España/epidemiología , Adulto JovenRESUMEN
Limited information is available on the burden and epidemiology of Clostridium difficile infection (CDI) in Spain. The present report communicates the secular trends in prevalence of CDI among hospitalised patients in Spain from 1999 through 2007. Data were obtained through the EPINE study (Estudio de prevalencia de las infecciones nosocomiales en los hospitales españoles), a point prevalence study series of nosocomial infections among patients admitted to hospital in Spain. A total of 378 cases with CDI were identified. Median age was 74 years. Prevalence rates of CDI increased from 3.9 to 12.2 cases per 10,000 hospitalised patients and showed a significantly increasing secular trend from 1999 through 2007 (prevalence rate ratio per each year increment 1.09; 95% CI 1.05 - 1.14). Percentage of hospitalised patients receiving antimicrobials increased linearly from 36.0% in 1999 to 40.7% in 2007 (p <0.001) and was strongly correlated to CDI prevalence (R square = 0.73; regression coefficient =1.194, 95% CI= 1.192 - 1.196).
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Enterocolitis Seudomembranosa/epidemiología , Pacientes Internos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Clostridioides difficile/genética , Infección Hospitalaria , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , España/epidemiologíaRESUMEN
INTRODUCTION: We review the scientific evidence on the safety of the measles, mumps, and rubella (MMR) vaccine (produced in chicken embryo cell culture) in children with egg allergy. Data on the reactogenicity observed with this vaccine in a large series of children with this type of allergy immunized in an hospital immunization unit are presented. MATERIAL AND METHODS: An observational prospective study was performed in the International Immunization Unit of the Epidemiology and Preventive Medicine Service of the Vall d'Hebron University Hospital from March 2004 to December 2005. Demographic variables, clinical history of allergy, and the adverse reactions observed 30 minutes after vaccine administration were analyzed. RESULT: A total of 140 patients (106 referred for the first MMR vaccine dose, and 34 for the second) were evaluated. Of these, 75.7 % showed clinical signs after egg ingestion (severe reactions were described in only seven patients: respiratory distress in six and systemic anaphylaxis in one). The MMR vaccine was administered to 121 children. No significant adverse reactions were observed (17.8 % of the vaccinated children developed mild local symptoms). CONCLUSIONS: According to current scientific evidence and the data obtained in this study, the MMR vaccine is safe in patients with egg allergy.
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Servicios de Salud del Niño , Hipersensibilidad al Huevo/inmunología , Departamentos de Hospitales/estadística & datos numéricos , Programas de Inmunización/estadística & datos numéricos , Inmunización , Vacuna contra el Sarampión-Parotiditis-Rubéola/inmunología , Niño , Femenino , Humanos , Masculino , Estudios Prospectivos , España/epidemiologíaRESUMEN
Introducción En este estudio se revisan las evidencias científicas disponibles sobre la seguridad de la vacuna triple vírica convencional (cultivada en fibroblastos de embriones de pollo) en niños con alergia al huevo, y se evalúa la reactogenicidad vacunal en una serie amplia de niños con este tipo de alergia inmunizados con triple vírica en una unidad de vacunación hospitalaria. Material y métodos Estudio observacional prospectivo, realizado en la Unidad de Vacunación Internacional del Servicio de Medicina Preventiva y Epidemiología del Hospital Universitario Vall d'Hebron, entre marzo de 2004 y diciembre de 2005. Se analizan variables demográficas, las relativas a los antecedentes de alergia y la reactogenicidad apreciada tras la observación directa del niño durante los 30 min posteriores a la vacunación. Resultados Se han incluido en el estudio 140 pacientes (106 en primera dosis de vacuna triple vírica y 34 en segunda). El 75,7 % había presentado manifestaciones clínicas tras la ingesta de huevo o de alimentos que lo contenían (sólo siete niños habían presentado manifestaciones graves, en forma de dificultad respiratoria en 6 casos y de anafilaxia en uno). Se administró la vacuna convencional a 121 niños, y no se observó ninguna reacción adversa importante (el 17,8 % de ellos presentó reacción local leve en el punto de inyección). Conclusiones Las evidencias científicas actuales, así como los datos del presente estudio, sustentan la seguridad de la vacuna triple vírica en personas con hipersensibilidad al huevo
Introduction We review the scientific evidence on the safety of the measles, mumps, and rubella (MMR) vaccine (produced in chicken embryo cell culture) in children with egg allergy. Data on the reactogenicity observed with this vaccine in a large series of children with this type of allergy immunized in an hospital immunization unit are presented. Material and methods An observational prospective study was performed in the International Immunization Unit of the Epidemiology and Preventive Medicine Service of the Vall d'Hebron University Hospital from March 2004 to December 2005. Demographic variables, clinical history of allergy, and the adverse reactions observed 30 minutes after vaccine administration were analyzed. Result A total of 140 patients (106 referred for the first MMR vaccine dose, and 34 for the second) were evaluated. Of these, 75.7 % showed clinical signs after egg ingestion (severe reactions were described in only seven patients: respiratory distress in six and systemic anaphylaxis in one). The MMR vaccine was administered to 121 children. No significant adverse reactions were observed (17.8 % of the vaccinated children developed mild local symptoms). Conclusions According to current scientific evidence and the data obtained in this study, the MMR vaccine is safe in patients with egg allergy
Asunto(s)
Masculino , Femenino , Niño , Humanos , Vacuna contra el Sarampión-Parotiditis-Rubéola/inmunología , Vacunación/efectos adversos , Proteínas Dietéticas del Huevo/inmunología , Medicina Basada en la Evidencia , Esquemas de Inmunización , Vacunas Combinadas/administración & dosificación , Estudios ProspectivosRESUMEN
INTRODUCTION: Children aged less than 2 years old and those with chronic diseases have a high risk of complications and hospitalization due to influenza. Despite the broad consensus in the literature on the indication for annual immunization of these patients, less than 30 % of the children with high-risk underlying conditions are immunized each year. The aim of this study is to determine the influenza vaccine coverage in children with high-risk underlying conditions admitted to a university hospital. PATIENTS AND METHODS: We performed a cross-sectional study of patients aged from 6 months to 18 years old with high-risk medical conditions and who had been hospitalized between January and May, 2005 in the Vall d'Hebron University Hospital (Barcelona). Influenza vaccine coverage, factors associated with immunization, and the reasons for nonvaccination were analyzed. RESULTS: Overall vaccine coverage was 23.5 %. The highest vaccination coverage was found in patients with congenital heart disease, chronic respiratory disease, and asthma (43.2 %, 42.9 % and 28.6 %, respectively). The factors most frequently associated with influenza vaccination were the type of underlying disease, having been immunized against influenza in the previous season, having received the pneumococcal vaccine, and age younger than 5 years. The main reason for nonvaccination was the lack of influenza vaccine recommendation by health professionals (95.3 %). CONCLUSIONS: Influenza vaccine coverage in children with high-risk conditions is low. Strategies to increase awareness among health professionals on the importance of recommending influenza immunization are required.
Asunto(s)
Vacunas contra la Influenza/uso terapéutico , Vacunación/estadística & datos numéricos , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Lactante , Gripe Humana/prevención & control , Masculino , Admisión del PacienteRESUMEN
Introducción Los niños menores de 2 años y los afectos de patologías de base son los que presentan un mayor riesgo de complicaciones y hospitalizaciones a causa de la gripe. A pesar del amplio consenso en la literatura médica en la indicación de vacunación antigripal anual en estos pacientes, menos del 30 % de niños con condiciones de alto riesgo son inmunizados anualmente. El objetivo de este estudio es conocer la cobertura vacunal antigripal en los niños ingresados en un hospital de tercer nivel con patologías de riesgo. Pacientes y métodos Estudio de prevalencia en pacientes de 6 meses a 18 años con patologías de riesgo ingresados entre enero y mayo de 2005 en el Hospital Universitario Vall d'Hebron de Barcelona. Se analizan las coberturas vacunales frente a la gripe, factores asociados a la inmunización, así como los motivos de no vacunación. Resultados La cobertura vacunal global observada ha sido del 23,5 %. Los pacientes afectados de cardiopatías, enfermedad respiratoria crónica y asma son los que presentan coberturas de vacunación más elevadas (43,2, 42,9 y 28,6 %, respectivamente). El tipo de patología de base, el antecedente de vacunación en la temporada anterior, estar vacunado frente al neumococo y ser menor de 5 años son las variables más asociadas a la vacunación antigripal en estos pacientes. El principal motivo de no vacunación ha sido la falta de recomendación por parte de los profesionales sanitarios que atienden a estos pacientes (95,3 %). Conclusiones La cobertura vacunal frente a la gripe en niños que tienen indicación es baja. Se requieren estrategias para aumentar la concienciación de los profesionales sanitarios sobre la importancia de recomendar esta vacunación
Introduction Children aged less than 2 years old and those with chronic diseases have a high risk of complications and hospitalization due to influenza. Despite the broad consensus in the literature on the indication for annual immunization of these patients, less than 30 % of the children with high-risk underlying conditions are immunized each year. The aim of this study is to determine the influenza vaccine coverage in children with high-risk underlying conditions admitted to a university hospital. Patients and methods We performed a cross-sectional study of patients aged from 6 months to 18 years old with high-risk medical conditions and who had been hospitalized between January and May, 2005 in the Vall d'Hebron University Hospital (Barcelona). Influenza vaccine coverage, factors associated with immunization, and the reasons for nonvaccination were analyzed. Results Overall vaccine coverage was 23.5 %. The highest vaccination coverage was found in patients with congenital heart disease, chronic respiratory disease, and asthma (43.2 %, 42.9 % and 28.6 %, respectively). The factors most frequently associated with influenza vaccination were the type of underlying disease, having been immunized against influenza in the previous season, having received the pneumococcal vaccine, and age younger than 5 years. The main reason for nonvaccination was the lack of influenza vaccine recommendation by health professionals (95.3 %). Conclusions Influenza vaccine coverage in children with high-risk conditions is low. Strategies to increase awareness among health professionals on the importance of recommending influenza immunization are required
Asunto(s)
Lactante , Preescolar , Niño , Adolescente , Humanos , Vacunación/estadística & datos numéricos , Vacunas contra la Influenza/uso terapéutico , Estudios Transversales , Hospitales Universitarios/estadística & datos numéricos , Admisión del Paciente , Gripe Humana/prevención & controlRESUMEN
The difficulties encountered in studying the presence of extrinsic risk factors in the framework of prevalence surveys of hospital-acquired infections (HAI) have led to the use of a variety of methodological approaches. This study examined the effect of retrospective approaches for obtaining data regarding exposure to extrinsic risk factors. The EPINE database for 1990 was used and a simulation model was created. All the evaluated approaches differed in their impact upon the association between risk factors and infections. Prevalence of exposure on the day of the survey, prevalence of exposure at any time before the survey was conducted, and total prevalence were found to be significantly associated with the probability of exposure and duration of exposure. For exposure periods of less than four days, the prevalence of exposure during the week prior to the survey was higher than that encountered on the day of the survey. In studying exposure to risk factors retrospectively, no evidence-based justification could be found to determine how many days prior to the day of actual exposure should be included in the study. However, the site of infection determined the proportion of devices removed due to HAI, and this proportion was not very high in this study. Limiting data to recording the presence of the risk factor on the day of the survey, without investigating past exposures, can provide an adequate estimate of the burden of extrinsic risk factors in one-day, point-prevalence surveys.
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Cateterismo/efectos adversos , Infección Hospitalaria/epidemiología , Respiración Artificial/efectos adversos , Traqueostomía/efectos adversos , Infección Hospitalaria/etiología , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , España/epidemiologíaRESUMEN
No disponible
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Adolescente , Niño , Humanos , Síndrome Respiratorio Agudo Grave/epidemiología , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo/patogenicidad , Epidemias/estadística & datos numéricos , Infecciones del Sistema Respiratorio/epidemiología , Factores de RiesgoRESUMEN
Although closed urinary drainage systems (CUDS) reduce the risk of catheter-associated urinary tract infection (CAUTI), open systems are still used in Spain. The object of this work was to describe the progress of CUDS use and factors associated with the drainage system type used in Spanish hospitals. The databases of the EPINE study (Study of Prevalence of Nosocomial Infections in Spain) from 1990 to 2000 were used. The EPINE study includes hospitalized patients of all ages in acute-care Spanish hospitals. Seventy-six thousand, seven hundred and eighty-eight catheterized patients were studied, and the whole database was used for the trend analysis of global hospital-acquired infection (HAI). The patient and the hospital were the two units of observation used in the analysis. Full implementation was defined as 90% CUDS use. A logistic regression model was applied to study factors influencing the use of CUDS and to determine prevalence trend. An odds ratio (OR) >1 indicates an incremental trend. The Pearson correlation coefficient between annual percentage of CUDS use and CAUTI prevalence was calculated. Variables for the year 2000 were compared using the Mann-Whitney U test between hospitals with and without full implementation. The prevalence of urinary catheterized patients in Spain increased from 12.4% in 1990 to 15.2% in 2000 (OR 1.019, 95% CI 1.016-1.021). The proportion of CUDS used increased from 50.6% in 1990 to 70% in 2000 (OR 1.1, 95% CI 1.095-1.104) and correlated with a significant decrease of UTIs (r = 0.65, P = 0.03). In 1990, 28.5% of hospitals had full implementation of CUDS and by 2000 this had risen to 40.3% (OR 1.093, 95% CI 1.06-1.127). Patients in medium (200-500 beds) and large (>500 beds) hospitals, as well as those with three of more diagnoses and two or more intrinsic risk factors had an increased probability of having a CUDS, whereas being hospitalized in areas other than intensive care, being male and less than 65 years old were associated with a lower probability of CUDS use. The median prevalence of catheterized patients in hospitals with full implementation, was significantly lower than in those without it (P = 0.049). Although CUDS use is increasing, there is still much work required to reach full implementation. Keeping CUDS for more severely ill patients may reflect a higher concern over the consequences of UTI in these patients. Nevertheless, it is necessary to change a practice that exposes patients to a known UTI risk factor and reach a consensus on indications for catheter insertion.
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Infección Hospitalaria , Drenaje/instrumentación , Control de Infecciones/métodos , Cateterismo Urinario/instrumentación , Infecciones Urinarias , Adulto , Anciano , Comorbilidad , Consenso , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Drenaje/efectos adversos , Drenaje/estadística & datos numéricos , Diseño de Equipo , Femenino , Tamaño de las Instituciones de Salud/estadística & datos numéricos , Humanos , Control de Infecciones/normas , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prevalencia , Factores de Riesgo , España/epidemiología , Estadísticas no Paramétricas , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/estadística & datos numéricos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & controlRESUMEN
In a national prevalence survey setting, we studied whether the day of week selected for data collection, and the number of days needed to complete the survey, were associated with the prevalence of hospital-acquired infection (HAI). The EPINE (Estudio de Prevalencia de las Infecciones Nosocomiales en España) database (1990-2002) was analysed for the purposes of the study. Adjusting for the admission day in the week, the number of intrinsic risk factors, the number of extrinsic risk factors and the prevalence length of stay, a 'weekend effect' was confirmed in this study. The day of the week selected for data collection was related to the presence of infection in the surveyed patients, showing for the period of Saturday-Monday a higher prevalence of patients with HAI (adjusted OR 1.08, 95%CI 1.05-1.10). There was a crude positive trend between number of weeks and prevalence, but the number of days involved in data collection was finally not associated with the prevalence of HAI, once adjustment for hospital size was made. The percentage of repeated records increased linearly with hospital size, and the frequency of infections was higher within this group (OR 2.8, 95%CI 2.6-3.0). The results of this study highlight the need for encouraging hospitals to shorten the time spent in obtaining a prevalence survey. If it is impossible to carry out the survey within the limits of one day, data collection should then be limited to that period of the week, Tuesday to Friday.
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Infección Hospitalaria/epidemiología , Recolección de Datos/normas , Hospitales/estadística & datos numéricos , Vigilancia de Guardia , Tiempo , Estudios Transversales , Recolección de Datos/métodos , Bases de Datos Factuales , Humanos , Tiempo de Internación , Modelos Logísticos , Admisión del Paciente , Alta del Paciente , Prevalencia , Factores de Riesgo , España/epidemiologíaRESUMEN
No disponible
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Humanos , Síndrome Respiratorio Agudo Grave , Enfermedades Transmisibles Emergentes , Brotes de Enfermedades , Salud GlobalRESUMEN
La legionelosis es una infección emergente que ocasiona notables problemas de salud pública en muchos países. Es un proceso asociado a la industrialización y a la estancia en hospitales y hoteles, actividades que, como se ha comprobado en nuestro país, deben ser desarrolladas bajo unas elevadas condiciones de higiene y sanidad ambiental. En el presente artículo se revisa la epidemiología descriptiva de la legionelosis y se detalla su cadena epidemiológica haciendo especial énfasis en los mecanismos detransmisión (AU)
Asunto(s)
Humanos , Legionelosis/epidemiología , Legionelosis/transmisión , España/epidemiología , Incidencia , Prevalencia , Factores de Riesgo , Susceptibilidad a EnfermedadesRESUMEN
BACKGROUND: The mortality rate from lung cancer (LC) increased sharply in Spain between 1957 and 1986. This increase has been related to a previous increase in cigarette smoking. Certain features of cigarette smoking which were frequent among Spanish smokers (use of black tobacco and use of cigarettes without filter) have been related to a higher risk of LC. METHODS: A hospital-based case-control study was conducted between December 1986 and June 1990. The 325 male patients with lung cancer included in the study (cases) were compared with 325 age-matched male controls without LC. Occupation and lifetime tobacco consumption were requested using a structured questionnaire. The LC odds ratios (OR) and 95% CI were estimated with multiple logistic regression. RESULTS: Lung cancer risk increased with cigarette consumption and duration of the habit. After adjusting for lifetime cigarette consumption and for socioeconomic level, LC risk was greater among black tobacco smokers than among exclusive blond tobacco smokers (OR = 5.0, 95% CI: 2.0-12.7); LC risk among long-term (> or =20 years) filter-tipped cigarette users was lower compared to all other smokers (OR = 0.4, 95% CI: 0.2-0.7). CONCLUSIONS: The main results of the study (a higher LC risk among black tobacco users than in exclusive blond tobacco users, and a lower LC risk among long-term filter-tipped cigarette smokers than all other smokers) have been consistent with previous case-control studies and with ecologic studies which took into account past exposure levels.
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Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Fumar/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Hospitales de Enseñanza , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Fumar/efectos adversos , Clase Social , España/epidemiología , Encuestas y Cuestionarios , Tasa de SupervivenciaRESUMEN
To assess the extent of myocardial necrosis and ischemia in patients with anterior wall healed myocardial infarction depending on whether ST-segment elevation was present on precordial leads during exercise testing, 62 consecutive patients (49 men and 13 women, age [mean +/- SD] 56 +/- 11 years) with anterior wall infarcts were assessed with exercise technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile single-photon emission computed tomography and quantification of the extent of necrosis and ischemia on polar maps: 22 patients had > or = 1 mm ST-segment elevation during exercise, and 40 did not. The extent of the necrosis in the anteroseptal (p = 0.001) and apical (p = 0.002) regions, the extent of ischemia in the lateral region (p = 0.003) on polar maps, and the frequency of ventricular aneurysm as shown by cardiac catheterization (p = 0.001) were significantly greater in patients with ST-segment elevation. In a multiple logistic regression model, both extent of necrosis in the anteroseptal region (odds ratio 10.8; 95% confidence interval 2.7 to 44.0) and extent of ischemia in the lateral region (odds ratio 7.25; 95% confidence interval 1.6 to 32.7) were associated with exercise-induced ST-segment elevation. These data suggest that ST-segment elevation in anterior infarctions is associated with wider necrosis in the anteroseptal and apical regions, with a wider extent of ischemia in the lateral region and a higher frequency of ventricular aneurysm. Consequently, it cannot be used as a marker of viability.
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Medios de Contraste , Electrocardiografía , Prueba de Esfuerzo , Infarto del Miocardio/diagnóstico , Índice de Severidad de la Enfermedad , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único , Cateterismo Cardíaco , Angiografía Coronaria , Electrocardiografía/normas , Prueba de Esfuerzo/normas , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/clasificación , Necrosis , Oportunidad Relativa , Reproducibilidad de los Resultados , Tomografía Computarizada de Emisión de Fotón Único/normasRESUMEN
BACKGROUND: Inguinal hernia uncomplicated in patients aged over 17 years, diagnosis-related group (DRG) 162, generates a substantial number of hospital stays due its high frequency in our country. These stays may not be necessary, and present an important temporal and geographical variability. MATERIAL AND METHODS: We have analyzed a total of 612 days of stay belonging to the 124 admissions codified as DRG 162 during the first quarter of 1993 and 1994, using the "Appropriateness Evaluation Protocol". RESULTS: The overall mean stay of the DRG 162 was 5.0 days (2.3 days of inadequate stay and 2.7 days of clinically necessary stay). The mean stay in 1993, 5.6 days, was higher than the mean stay in 1994, 4.1 days (p = 0.006). The percentage of inappropriate admission was higher in 1993 than in 1994 (33.8% versus 18.9%; p = 0.06). Similarly, the percentage of inappropriate stay was higher in 1993 than in 1994 (46.9% versus 41.9%; p = 0.06). The more frequent reasons of inappropriate admission was premature admission (88.2%) and for the stay was delay in the discharge medical order (33.3%). CONCLUSIONS: The mean stay of DRG 162, as well as the percentage of inadequate stay and admission, has decreased from 1993 to 1994 in our hospital. According to the observed trend, the mean stay is approaching the adequate mean stay for this DRG.
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Hernia Inguinal/cirugía , Hospitalización , Grupos Diagnósticos Relacionados , Humanos , Tiempo de Internación , Persona de Mediana Edad , Población Rural , España , Factores de TiempoRESUMEN
OBJECTIVE: The purpose of this study was to know the use of addictive substances by adolescents of the city of Barcelona (Catalonia, Spain). PATIENTS AND METHODS: Data were obtained from an anonymous and self-administered questionnaire about tobacco use, alcohol use and non-institutionalized drug abuse. participants were students in 3 degrees BUP (16-17 years old) of twelve institutes that are representative of the different districts of the city. The survey was made during the 1991-1992 school year. RESULTS: Among the 426 individuals included, 32.2% reported use of tobacco, 59.2% alcohol, and 16.4% marijuana. Tobacco use was higher among females (p = 0.05), and that of alcohol (p < 0.0001) and other drugs (p = 0.02) higher among males. The parents' smoking behavior was significantly associated with the use of non-institutionalized drugs (p = 0.01). There was a positive and significant association among the use of all three kinds of addictive substances (p < 0.0001). CONCLUSIONS: The prevalence of tobacco, alcohol and non-institutionalized drug use by students in this age range is high. Compared with previous studies in this population we can appreciate a decreasing trend of use.