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The relationship between socioeconomic status and incidence or stroke mortality rates is well established. The evidence of an association between this variable and survival is less conclusive. Level of education is a widely-used measure of socioeconomic status in elderly people.To assess the relationship between one-year survival after stroke and level of education.We analysed data on 544 consecutively recruited patients admitted for acute ischaemic stroke in one the public hospitals of Bizkaia (Spain). Data were obtained through interviews with patients or accompanying persons and from medical records. We studied variables concerning previous functional status, stroke severity, cardiovascular risk factors and stroke care provided. Patients were followed up for 12 months and the dates of any deaths were recorded. Univariate and multivariate analyses were carried out to assess the relationship between level of education and survival.A total of 203 (86%) women and 273 (88.6%) men were alive at 12 months. In both sexes, individuals with a lower level of education had poorer previous functional status, more severe strokes and higher mortality rates. In the multivariate analysis, the association between level of education and survival remained significant in the adjusted model in men.In our setting, there are differences in the survival of patients with ischaemic stroke as a function of level of education. The impact of this factor was greater in men than women.Relacion del nivel de estudios con la supervivencia en el primer año tras un ictus isquemico.Introduccion. La relacion del nivel socioeconomico con las tasas de incidencia y de mortalidad por ictus esta bien establecida. La evidencia de la relacion con la supervivencia de los pacientes tras el ictus es menos concluyente. El nivel educativo es una medida de nivel socioeconomico muy utilizada en estudios con personas de edad avanzada. Objetivo. Estudiar la relacion de la supervivencia en el primer año tras el ictus con el nivel de estudios. Pacientes y metodos. Se analizaron los datos de 544 pacientes con ictus isquemico agudo ingresados en los hospitales publicos de Bizkaia (España), seleccionados consecutivamente. Se obtuvieron datos por entrevista a pacientes o acompañantes y de historia clinica. Se estudiaron variables sobre situacion funcional previa, gravedad del ictus, factores de riesgo cardiovascular y de atencion al ictus. Se hizo un seguimiento de 12 meses para registrar, en su caso, la fecha de fallecimiento. Se realizo un analisis univariado y multivariado para identificar la relacion del nivel de estudios con la supervivencia. Resultados. Tras 12 meses, sobrevivian 203 mujeres (86%) y 273 hombres (88,6%). En ambos sexos, las personas con menos estudios tuvieron peor situacion funcional previa, mayor gravedad y fallecieron en mayor proporcion. En el analisis multivariado, el nivel de estudios se mantuvo asociado con la supervivencia en el modelo ajustado para los hombres. Conclusiones. La diversidad de nivel educativo marca diferencias en la supervivencia de los pacientes con ictus isquemico en nuestro entorno. El impacto de este factor fue mayor en los hombres que en las mujeres.

According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays.To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care.We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays.Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS.EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.

A number of studies have shown that out-of-home day care in very young children increases the incidence of infectious processes in comparison with that in children cared for in a family environment. The aim of this study was to assess the influence of the type of childcare (family environment vs. collective care) and the age at which schooling begins on morbidity due to infectious processes and to determine the repercussions on the health system (frequency of visits and antibiotic consumption).The study population was composed of a cohort of children born between 1st January 2001 and 31st December 2003, drawn from five pediatric clinics. Infectious processes and health service use were recorded prospectively by the pediatrician over the 10 months of the study. The mean number and incidence of infectious processes in children attending day care and those cared for at home were compared.A total of 764 children were studied, of which 47% attended day care centers. Compared with children cared for at home, children attending day care had a significantly higher mean number of infectious episodes (6.7 vs. 4.1), antibiotic use (1.3 vs. 0.4), visits to the pediatrician (10.3 vs. 6.3) and hospital emergency visits (0.6 vs. 0.4) (p0.0001). For each age group, the greatest difference between children in day care and those kept at home was found in the first year of schooling. This difference was largest in the youngest age group (RR=2.3).If parents request advice, pediatricians should inform them of the increase in infectious morbidity that children can be predicted to experience during the first year of schooling.