Five-year outcome in alcohol dependence. A naturalistic study of 850 patients in Catalonia.

A prospective, multicentre study was designed to evaluate the impact of a treatment programme in alcohol-dependent patients (n = 850). Drinking status and measures related to quality of life such as morbidity, mortality, alcohol-related problems, and psychological and social functioning were assessed 5 years from the initial contact with the patient. Five years after the initial visit, drinking status followed a bimodal distribution: 371 patients (43.6%) were found to be abstinent, 323 (38%) were heavy drinkers, and only 55 (6.5%) were controlled drinkers. A total of 65 (7.6%) patients died during the study, 33 (3.9%) patients were lost to follow-up and three (0.3%) patients were not collaborative. Differences in health-related issues were identified for each of the drinking status categories. Abstinent patients presented with significantly better outcomes than controlled and heavy drinkers on most medical, socio-economic and psychological measures. Heavy drinkers showed significantly worse outcomes than controlled drinkers.     

Secular trends in smoking according to educational level between 1986 and 1996: The MONICA study. Catalonia

Objective: To describe trends from 1986-1996 in the prevalence of cigarette smoking between ages 25 to 64 in the MONICA-Catalonia study, according to educational level, and to validate these trends biochemically.Methods: Three cross-sectional surveys in independent random samples of the general population of central Catalonia area carried out in 1986-88, 1990-92 and 1994-96 following the World Health Organization's MONICA protocol. Serum thiocyanate was determined by the Bowler method.Results: A total of 2,571, 2,934 and 3,485 men and women were examined with response rates of 74, 67 and 72% in each survey respectively. The age-adjusted cigarette smoking prevalence decreased in men by 5.1% (95% CI: 1.5 to 8.7) and increased in women by +8.5% (95% CI: +5.6 to +11.4). The prevalence was 46.5% in men and 23.9% in women in 1994-96. The greatest decrease was in men aged 55-64 (9.9%) and the greatest increase was in women aged 35-44 (+14.8%). These trends were confirmed by serum thiocyanate levels, which decreased from 78.9 to 73.9 μmol/l (p = 0.07) in men and increased from 43.7 to 49.8 μmol/l (p < 0.01) in women during the study period. Cigarette smoking increased in less educated women (+10%) and decreased in university women (6%), while cigarette smoking in men decreased irrespective of educational level. Serum thiocyanate levels confirmed the relationship with educational level.Conclusions: The prevalence of cigarette smoking decreased in men between 1986 and 1996 but remained high in 1996. Women showed a pattern of progressive adoption of smoking, especially those with lower educational level.     

Epidemiologic study of an outbreak of clenbuterol poisoning in Catalonia,Spain.

In an investigation of 113 cases of clenbuterol poisoning in Catalonia, Spain, in 1992, more than 50 percent of those affected were found to have had symptoms of nervousness, tachycardia, muscle tremors, myalgia, and headache. There was no significant difference in the distribution of symptoms according to sex (P = 0.97). The period of incubation varied between 15 minutes and 6 hours and the duration of symptoms between 90 minutes and 6 days. Clenbuterol was detected in 47 urine samples in amounts ranging from 11 to 486 parts per billion. No traces of clenbuterol were found in serum samples. Intoxication occurred in association with the ingestion of veal liver, irrespective of the way in which the liver had been cooked. The association between consuming liver and falling ill was statistically significant (P < 0.0001). In one family, the suspected source of intoxication was meat (veal tongue) and in another canneloni. None of the patients died as a result of the intoxication. The findings reinforce the need to uphold the prohibition of the use of clenbuterol in cattle farming in those countries and communities where it already exists and to contemplate a stricter regulation of its therapeutic use.     

The seroepidemiology of B. pertussis infection in Catalonia, Spain

A survey of the seroprevalence of pertussis antibodies in a representative sample of the population from Catalonia was carried out. Ninety-seven municipalities and 30 schools were randomly selected to recruit the 2126 subjects who participated in the study. A serum sample was obtained from all individuals participating in the study in order to determine levels of pertussis toxin (PT) and filamentous hemagglutinin (FHA) antibodies by ELISA test. Sociodemographic data were collected for all subjects. The prevalence of PT antibodies was 75% and that of FHA antibodies 89%. Significant increments were observed with age, both in the prevalence of PT (P < 0.0001) and of FHA (P = 0.018). Of the sociodemographic variables studied, only urban habitat was significantly associated to PT antibodies. The agreement observed among the two types of antibodies studied was weak (K = 0.264). Routine revaccination with the acellular vaccine in children over 7 years of age, in adolescents and adults seems a reasonable strategy to prevent the appearance of cases of pertussis in the community.     

Duplicate coverage and demand for health care. The case of Catalonia.

An individual has duplicate coverage when he enjoys a compulsory medical public insurance, and in addition he has purchased a private one. This paper studies the implications of duplicate coverage on both demand for visits to specialists and on the selection process of the private insurance market. Econometric models, estimated by the generalized method of moments, accommodate both the endogeneity of insurance choice decision and the non-negativity of the variable number of visits. The choice of instrumental variables is motivated within a theoretical model of demand for health care. The results shows that endogeneity is important for the subsample of heads of household, but not for the subsample of non-heads of household. For the subsample of non-heads of household, a positive effect of duplicate coverage on the number of visits to specialists is found. Health related variables, education and income are also important. Results are consistent with the idea that heads of household that buy private insurance are the ones with poor unobservable health conditions. It is argued that this last result is related to the existence of a compulsory public insurance.     

动态血压监测在青少年高血压诊断中的价值

目的 对经Korotkoff法测量血压诊断为高血压和非高血压的青少年进行24 h动态血压监测(ABPM),比较二者的准确性与差异性.方法 选择170例经Korotkoff法测量血压高于正常的青少的患者作为研究组,65例血压正常的青少年作为对照组,分别进行24hABPM,并对结果进行对比分析.结果 研究组中采用Kortkoff法诊断为青少年高血压135例(79.4%),前期高血压35例(20.6%);采用24hABPM诊断为青少年高血压115例(67.6%),前期高血压48例(28.2%).对照组65例中有6例(9.2%)经24hABPM诊断为前期高血压.所有经24hABPM诊断为青少年高血压及前期高血压者,收缩压负荷(sPL)和舒张压负荷(1)PL)均增加.结论 24hABPM可作为诊断青少年高血压的有效手段,并可用于检出青少年前期高血压.     

Adolescent medicine among pediatricians in Catalonia.

To ascertain if Catalan pediatricians were seeing adolescent patients, an anonymous self-administered questionnaire was mailed to 188 members of the Catalan Society of Pediatrics. The instrument included questions about training in adolescent medicine, type of practice, office and clinical practices pertinent to adolescents, and opinions and perceptions regarding adolescent care. Of 188 physicians, 69 (36.7%) responded. Respondents see an average of 12 patients (mean age of 16 years) in a 5-hr office day. The reported mean duration of a first visit for an adolescent was longer than for a child (39.7 +/- 15.4 min versus 33.5 +/- 11.3, respectively; p less than 0.001), but there were no differences in length of time spent for follow-up visits. Only 20% of the pediatricians had different schedules for adolescents than for children, and 16% provided a separate waiting room; 29% preferred dealing with infants, 4.3% with children, 4.3% with adolescents, and 52.2% had no preference. Most (74%) believe that the pediatrician is the physician of choice to treat adolescent patients. Major-perceived obstacles to providing comprehensive care to teens include not having different schedules or waiting rooms, confidentiality, and the patient's perception of them as a "children's doctor." One-third think that they have the skills needed to give medical advice, 14.5% that they can offer comprehensive care, 1.5% are not interested in treating adolescents, and 43.4% would like to improve their knowledge and skills.(ABSTRACT TRUNCATED AT 250 WORDS)     

The epidemiology of invasive Streptococcus pneumoniae disease in Catalonia (Spain). A hospital-based study

The aim of this study was to investigate the incidence of invasive pneumococcal disease (IPD) in Catalonia. A hospital-based incidence study of the period 1997-1999 was carried out by reviewing the isolations of Streptococcus pneumoniae obtained from normally sterile sites reported by the hospitals that voluntarily participate in the Microbiological Reporting System of Catalonia (MRSC), and those obtained by active retrospective surveillance of cases recorded by microbiology laboratories of the remaining hospitals. Cases of pneumonia were included only if the blood culture was positive. The age, sex and clinical presentation of each patient were recorded. The global incidence of hospital-based IPD was 10.5 per 100,000 persons-year, and was much higher in subjects <2 years of age (59.6) and in those aged > or = 65 years (27.9). In subjects > or = 65 years, bacteremic pneumococcal pneumonias were more frequent in the months from December to March than they were in children <2 years of age (P<0.0001). The global incidence of IPD (10.5 per 100,000 persons-year) is high in Catalonia, greater than that of meningococcal or Haemophilus influenzae invasive disease. In children <2 years, the incidence is nearly six times higher (59.6 per 100,000 persons-year) with pneumonias (rate of 26.2 per 100,000 persons-year) and non-focal bacteremias (rate of 22.1 per 100,000 persons-year) being especially frequent.     

Diagnosis and treatment of pulmonary hypertension in the adolescent

This article discusses diagnostic and therapeutic options of adolescents with primary and secondary pulmonary hypertension. Pulmonary hypertension is an important determinant of morbidity and mortality in many diseases, including congenital heart disease and respiratory disease. Previously, the diagnosis of pulmonary hypertension in children carried a poor prognosis. However, advances in the diagnosis and treatment of pulmonary hypertension over the last decade have markedly improved survival of many patients. A targeted approach includes treatment of the underlying disease, and therefore requires an extensive evaluation. Many of the treatment modalities are based on advanced understanding of basic pulmonary vascular biology.