Usefulness of seminested multiplex PCR in surveillance of imported malaria in Spain.
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The use of a new PCR-based method for the diagnosis of malaria in the Spanish Malaria Reference Laboratory has promoted an increase in confirmed cases of malaria. From August 1997 to July 1998, a total of 192 whole-blood samples and 71 serum samples from 168 patients were received from the hospitals of the Spanish National Health System. Most of the patients came from west-central African countries (85%). This molecular method showed more sensitivity and specificity than microscopy, detecting 12.4% more positive samples than microscopy and 13% of mixed infections undetectable by Giemsa stain. Plasmodium falciparum was the main species detected, with 68% of the total positive malaria cases, followed by Plasmodium malariae (29%), Plasmodium vivax (14%), and Plasmodium ovale (7%), including mixed infections in all cases. This report consists of the first wide, centralized survey of malaria surveillance in Spain. The reference laboratory conducted the analysis of all imported cases in order to detect trends in acquisition. The use of a seminested multiplex PCR permitted confirmation of the origins of the infections and the Plasmodium species involved and confirmation of the effectiveness of drug treatments. This PCR also allowed the detection of the presence in Spain of primaquine-tolerant P. vivax strains from west-central Africa, as well as the detection of a P. falciparum infection induced by transfusion. (+info)
A longitudinal study of blood pressure in Spanish schoolchildren. Working Group of Cardiovascular Risk Factors in Childhood and Adolescence.
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Blood pressure (BP) values and the phenomenon of tracking were evaluated in a group of 481 schoolchildren over a nine year period starting at age 6 years. BP values were obtained yearly by taking the mean of two measurements at one visit, measurements were taken by only two observers during the study. For both systolic and diastolic BP, correlation coefficients between year 9 and previous measurements increased as the year of examination approached year 9, and ranged from 0.79 to 0.81 for systolic BP, and from 0.52 to 0.55 for diastolic BP. For children in the upper quartile of systolic BP at any previous examination, more than 70% remained in the upper quartile at the year 9 examination. More than 90% of children who were not in the upper quartile of systolic BP at any previous examination remained in non-upper quartiles at year 9. This novel longitudinal study of BP in a cohort of Spanish schoolchildren suggests that the degree of tracking of BP during childhood years could be higher than described previously. (+info)
Increase in cervical cancer mortality in Spain, 1951-1991.
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BACKGROUND: The trend in cervical cancer mortality in Spain from 1951 to 1991 is examined. METHODS: Analysis of national mortality statistics calculating age standardised mortality rates and an age-period cohort analysis. A fit to the Gompertz function was made to estimate the influence of the environmental factors on the mortality rates evolution. MAIN RESULTS: The age standardised mortality rate in Spain is lower than in other developed countries (USA or Estonia) and equal to Norwegian and Finland rates; but whereas in these countries the trend is to decrease, the Spanish rate has increased during this period, because of a cohort effect. A misclassification bias could be responsible for the trend in women aged 40 and older but the increasing trend in younger women could not be interpreted as espurious. The Gompertzian analysis suggests an increase in environmental factors causing cervical cancer. CONCLUSIONS: Cervical cancer mortality rates are increasing in Spain because of environmental factors. (+info)
Determinants of self assessed health among Spanish older people living at home.
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STUDY OBJECTIVE: To identify the main determinants of self assessed health among community dwelling elderly. PARTICIPANTS AND SETTING: A representative sample of 677 people aged 65 and over of the city of Madrid, Spain. DESIGN: Cross sectional study. Information was collected through personal interviews at the homes of the selected subjects. The five category dependent variable was grouped into two categories: good and poor self assessed health. Age, sex, social class, use of physician services, number of chronic conditions, and functional capacity, were included as main explanatory factors. Adjusted odds ratios were estimated through multiple logistic regression models. MAIN RESULTS: A total of 49.5% of subjects rated their health as good or very good. Those aged 85 and over rated their health higher than those aged 65-74 (adjusted odds ratio (OR): 0.37; 95% confidence intervals (CI): 0.18, 0.77). The adjusted OR for an increase of three chronic conditions was 3.48 (95% CI: 2.49, 4.85). Functional capacity also showed a strong independent effect (OR: 3.64; 95% CI: 1.89, 7.02). Social class was one of the main determinants for the youngest group, with those in the upper class reporting a better health perception (OR: 3.28 95% CI: 1.70, 6.35), but showed no effect in the oldest old (OR: 1.05; 95% CI: 0.57, 1.96). CONCLUSIONS: Age, chronic conditions, and functional status were the main determinants of perceived health among Spanish elderly. The effect of social class on perceived health markedly decreases with age. This study may contribute to a better utilisation and interpretation of self ratings in research and in general practice. (+info)
Geographical patterns of excess mortality in Spain explained by two indices of deprivation.
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STUDY OBJECTIVE: To analyse the geographical patterns and the magnitude of the association between deprivation and mortality in Spain. To estimate the excess of mortality in more deprived areas of the country by region. DESIGN: Cross sectional ecological study using 1991 census variables and mortality data for 1987-1992. SETTING: 2220 small areas in Spain. MAIN RESULTS: A geographical gradient from north east to south west was shown by both mortality and deprivation levels in Spain. Two dimensions of deprivation (that is, Index 1 and Index 2) obtained by exploratory factor analysis using four census indicators were found to predict mortality: mortality over 65 years of age was more associated with Index 1, while mortality under 65 years of age was more associated with Index 2. Excess mortality in the most deprived areas accounted for about 35,000 deaths. CONCLUSIONS: Two indices of deprivation strongly predict mortality in two age groups. Excess number of deaths in the most deprived geographical areas account for 10% of total number of deaths annually. In Spain there is great potential for reducing mortality if the excess risk in more deprived areas fell to the level of the most affluent areas. (+info)
Influence of stage at diagnosis on survival differences for rectal cancer in three European populations.
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Important differences have recently been highlighted between European countries in the survival of colorectal cancer patients. As data on stage at diagnosis were available for rectal cancers in three European population-based registries (Geneva Switzerland; Cote d'Or, France; Mallorca, Spain), we compared relative survival while assessing the effect of stage in a multiple regression model. We analysed 1005 rectal cancer cases diagnosed between 1982 and 1987 and followed up for at least 5 years. In the Mallorca registry, 16% of the patients were diagnosed in the TNM stage I (versus 21% in the Cote d'Or registry and 29% in the Geneva registry, P < 10(-4)) and the 5-year relative survival rate was lower (35%) than in the other two registries (Cote d'Or 47%, Geneva 48%, P = 0.01). In the multivariate analysis, stage was the only independent prognostic factor, whereas the excess death risk did not vary significantly among registries (compared to Geneva, Cote d'Or relative risk was 1.0, Mallorca relative risk 1.11, 95% confidence interval 0.76-1.32 and 0.85-1.44 respectively). Survival differences between the registries were mainly due to stage at diagnosis. Thus, diagnostic conditions appear to be the main determinant of the survival inequalities found in those three European populations. (+info)
Hepatitis G virus infection markers (RNA and anti-E2 antibodies) in a multicenter cohort of hemophiliacs.
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BACKGROUND AND OBJECTIVE: To investigate the prevalence and evolution of hepatitis G virus (HGV) infection in hemophiliacs and to correlate evolution of HGV infection markers with immunologic parameters in those patients co-infected with HIV. DESIGN AND METHODS: HGV RNA and anti-E2 antibodies were studied in 124 patients. Serial samples were drawn every 4 months from 1992 to 1996. Lymphocyte subsets including T-helper lymphocytes, T-suppressor lymphocytes, T-cytotoxic lymphocytes, activated T-lymphocytes and natural killer cells were analyzed. RESULTS: Prevalences were 22.6% for HGV RNA and 18.5% for anti-E2. Four patients had both HGV RNA and anti E2, so the overall prevalence of HGV infection in hemophiliacs was 37.9% (11.5% in 200 controls, p<0.0001). After a median follow-up of 36.6 months 20 patients remained HGV RNA positive, whereas HGV RNA had cleared in 8, with an actuarial probability of clearance at 36 months of 34.6%. Only 2 patients developed anti-E2 antibodies. Four patients cleared anti-E2, with an actuarial probability at 36 months of 24.8%. In patients with HIV infection, both lower CD4+ lymphocyte count (p=0.01) or higher CD8+ lymphocyte count (p=0.03) showed predictive value for probability of clearing HGV-RNA. CD4+/CD8+ ratio (p=0.002) was the only variable included in the best model for HGV-RNA disappearance. INTERPRETATION AND CONCLUSIONS: A more accurate estimation of the prevalence of HGV infection can be achieved with the determination of both HGV RNA and anti-E2. Anti-E2 response can be undetectable or transitory after disappearance of HGV-RNA, giving therefore rise to the possibility of underestimating HGV prevalence with currently diagnostic methods. In HIV-positive patients, cellular immune function seems to be involved in the resolution of HGV infection, following the significant correlation found between clearance of HGV-RNA and CD4+/CD8+ lymphocyte populations. (+info)
Administration of recombinant human granulocyte colony-stimulating factor to normal donors: results of the Spanish National Donor Registry. Spanish Group of Allo-PBT.
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A Spanish National PBPC Donor Registry has recently been established for short- and long-term safety data collection in normal donors receiving rhG-CSF. To date, 466 donors have been included in the Registry. Median (range) dose and duration of rhG-CSF administration was 10 microg/kg/day (4-20) and 5 days (4-8), respectively. Donors underwent a median of two aphereses (range, 1-5). Adverse effects consisted mainly of bone pain (90.2%), headache (16.9%) and fever (6. 1%), but no donor discontinued rhG-CSF prematurely due to toxicity. Side-effects were more frequent in donors receiving >10 microg/kg/day than in those with lower doses (82.8% vs 61.8%; P = 0. 004). A significant decrease between baseline and post-apheresis platelet counts was the most important analytical finding (229 x 10(9)/l vs 140 x 10(9)/l; P < 0.0001), with a progressive reduction in platelet count with each apheresis procedure. One donor developed pneumothorax that required hospitalization due to central venous line placement. The mean CD34+ cell dose collected was 6.9 x 10(6)/kg (range, 1.3-36), with only 14 donors (2.9%) not achieving a minimum target of CD34+ cells of 2 x 10(6)/kg. No definitive information about potential long-term side effects is yet available. However, we hope this National Registry will serve as a useful basis for better monitoring of the efficiency and side-effects of cytokine administration in healthy people. (+info)