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The aim of this study was to characterize the evolution of gonorrhea in the general population by correlating epidemiological, genotypic, and antimicrobial resistance data of Neisseria gonorrhoeae ...

Introduction Suicide is, at present, an important global public health problem; detection of risk factors can be used as a method for prevention and intervention. This study aims to identify predictors of suicide in patients with suicidal attempt retry (SAR), who are followed-up an in the Intensive Intervention Program (PII). Methods The sample includes patients followed up at the PII because of a previous suicidal attempt. The following variables were collected during the 12 months follow-up (baseline, 6 months and 12 months): Repeated attempts, socio-demographic and clinical variables, lack of adherence and the Beck Depression Inventory and Hopelessness Scale. Statistic analysis The association between SAR and qualitative study variables was performed using Chi-Square and for the quantitative, T-Student was used. The analysis was carried out with the software SPSS 19.0. The study has been approved by the Research Ethics Committee of Galicia. Results Of the 319 patients, 29 (9 %) of them committed a new suicidal attempt, 22 (76 %) of these new attempts happened during the first 6 month of the Program. Of those who repeat the attempt, 7 (24 %) have a history of a previous attempt that precede the basal attempt (p = 0.033) in less than 180 days. Medication overdose is the most used method, as it was used by 240 of the patients (76 %). 27 (93 %) kept drug overdose as their retry method, also reaching significance (p Conclusions Overdose as a method of attempt and re-attempt, and the time elapsed from the previous attempt, are the highlighted risk factors associated with repeated suicidal attempts. For this reason, it is crucial to identify patients with a new suicide attempt so that a more intense intervention and drug treatment control is delivered during the first 180 days.

Resumen Introduccion El suicidio representa un problema destacado en la actualidad; una linea de prevencion e intervencion es la deteccion de los factores de riesgo. En este estudio se pretende identificar los predictores de suicidio en pacientes con repeticion de intento de suicidio (RIS) en seguimiento en un programa de intervencion intensiva. Material y metodos La muestra la forman los pacientes incluidos en el programa de intervencion intensiva por intento de suicidio. Se registran las variables sociodemograficas y clinicas, los abandonos, la RIS, las faltas a consulta y los resultados obtenidos en las escalas de depresion y desesperanza de Beck a lo largo de los 12 meses de seguimiento en el programa (inicial, 6 meses y 12 meses). Analisis estadistico La asociacion entre RIS y variables cualitativas de estudio se realizo empleando Chi-Cuadrado y para las cuantitativas T-Student. Los analisis se hicieron utilizando el software SPSS 19.0. El estudio ha sido aprobado por el Comite Autonomico de Etica de la Investigacion de Galicia. Resultados De la muestra de 319 pacientes, 29 (9%) realizan una RIS, 22 (76%) durante los primeros 6 meses del programa. De los pacientes con RIS, 7 (24%) tienen historia de intento previo durante un periodo inferior a 180 dias al intento indice (p = 0,033). La intoxicacion medicamentosa fue el metodo mas empleado pues fue utilizada en el intento indice por 240 pacientes (76%). Veintisiete (93%) mantienen el metodo en la RIS (p Conclusiones La sobreingesta de farmacos como metodo de intento y reintento, y el tiempo transcurrido desde el intento previo son los factores de riesgo destacados asociados a la RIS, de ahi la importancia de identificar a los pacientes con historia de intento de suicidio para llevar a cabo una intervencion mas intensiva y un ajuste adecuado del tratamiento sobre todo en los primeros 180 dias.

The aim of this study was to characterize the evolution of gonorrhea in the general population by correlating epidemiological, genotypic, and antimicrobial resistance data of

Leptospirosis is a zoonosis of global distribution, caused by the infection of pathogenic Leptospira, a group of bacteria capable of infecting both domestic and wild animals. Mink (Neovison vison) in southern Chile is recognized as a wild and synanthropic rodent predator (among various other prey), and Leptospira infection in them can be acquired through contact with the pathogen in the environment or by eating infected prey. Thus, the aim of this study was to provide more specifics regarding the source of the infection for the American mink under the conditions of Southern Chile. Minks were captured in the Los Rios region, southern Chile, in an area with well-developed dairy farming. Two areas were selected for mink trapping, one with a high degree of dairy farming and a second with a low degree of dairy farming. Within them, 16 study sites were visited, and 45 American mink were trapped and euthanized to obtain kidney tissue and blood serum samples for bacteria isolation and determination of antibodies titers, respectively. Molecular characterization of the isolated strains was performed. Three minks from sites of high-dairy farming industry and only one from sites with low-degree dairy farming were detected as infected through molecular confirmation. This study shows evidence that confirms previous findings made in southern Chile, regarding mink as host of Leptospira interrogans serovar Hardjo-prajitno associated to cattle-farming areas. However, typing information ( Leptospira interrogans Copenhageni and Icterohaemorrhagiae ) suggests that the consumption of rodents may also be a potential source of infection.

Introduction and objectives: There is insufficient data regarding sex-related prognostic differences in patients with a non-ST elevation acute coronary syndrome (NSTEACS). We performed a sex-specific analysis of cardiovascular outcomes after NSTEACS using a large contemporary cohort of patients from two tertiary hospitals. Methods: This work is a retrospective analysis from a prospective registry, that included 5,686 consecutive NSTEACS patients from two Spanish University hospitals between the years 2005 and 2017. We performed a propensity score matching to obtain a well-balanced subset of individuals with the same clinical characteristics, resulting in 3,120 patients. Cox regression models performed survival analyses once the proportional risk test was verified. Results: Among the study participants, 1,572 patients (27.6%) were women. The mean follow-up was 60.0 months (standard deviation of 32 months). Women had a higher risk of cardiovascular mortality compared with men (OR (Odds ratio) 1.27, CI (confidence interval) 95% 1.08-1.49), heart failure (HF) hospitalization (OR 1.39, CI 95% 1.18-1.63) and risk of all-cause mortality (OR 1.10, CI 95% 1.08-1.49). After a propensity score matching, female gender was associated with a significant reduction in the risk of total mortality (OR 0.77, CI 95% 0.65-0.90) with a similar risk of cardiovascular mortality (OR 0.86, CI 0.71-1.03) and HF hospitalization (OR 0.92, CI 95% 0.68-1.23). After baseline adjustment, the risk of all-cause mortality and cardiovascular mortality was lower in women, whereas the risk of HF remained similar among sexes. Conclusions: In a contemporary cohort of patients with NSTEACS, women are at similar risk of developing early and late HF admissions, and have better survival compared with men, with a lower risk of all-cause mortality and cardiovascular mortality. The implementation of NSTEACS guideline recommendations in women, including early revascularization, seems to be accompanied by improved early and long-term prognosis.

Resumen: Introducción: El dolor abdominal agudo inespecífico es el principal proceso que requiere diagnóstico diferencial con la apendicitis en la práctica clínica. El objetivo de este estudio es evaluar la utilidad del Pediatric Appendicitis Score (Regla de predicción clínica de apendicitis pediátrica) para diferenciar estas 2 entidades. Material y métodos: Se evaluó prospectivamente a los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años, incorporando al estudio casos de dolor abdominal agudo inespecífico y apendicitis. Se recogieron diferentes variables, incluyendo las que conforman el Score y la proteína C reactiva, que se analizaron estadísticamente de manera descriptiva, univariante y multivariante, y mediante pruebas de rendimiento diagnóstico (curvas ROC). Resultados: Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La temperatura y el dolor a palpación en fosa iliaca derecha fueron las únicas variables que no mostraron diferencias significativas entre los grupos, careciendo de poder de discriminación. El dolor con la tos, el salto y/o la percusión fue la variable con mayor asociación a apendicitis. El Score estratificó correctamente a los pacientes en grupos de riesgo. La sustitución de la temperatura por la proteína C reactiva en el Score aumentaba su rendimiento diagnóstico, aunque sin diferencias significativas. Conclusiones: El Pediatric Appendicitis Score ayuda en el diagnóstico diferencial entre apendicitis y dolor abdominal agudo inespecífico. Sería recomendable la sustitución de la temperatura en el Score, pues carece de poder de discriminación entre estos grupos. La proteína C reactiva, categorizada en el valor 25,5 mg/L, podría ser utilizada en su lugar. Abstract: Introduction: Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. Material and methods: All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. Results: A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. Conclusions: The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5 mg/L value could be used instead.

Aims Neuroendocrine gastroenteropancreatic tumors are infrequently found neoplasms. Our objective was to analyze the survival rates for all sites that they occur in by studying different variables. Materials and methods A retrospective study was carried out using records for a 7-year period from January 1, 2008 to December 31, 2014 on neuroendocrine gastroenteropancreatic tumors patients diagnosed at the Pontevedra-Salnes Hospital Complex. The variables used were as follows: age at diagnosis, tumor size, presence or absence of metastases at diagnosis, cell proliferation index, Ki-67 of each tumor, treatments received, postdiagnosis survival time, existence or not of tumor progression, and time from diagnosis to progression and from diagnosis to mortality. In relation to treatments, the information recorded was whether the treatment was endoscopic, surgical, or pharmacological. Results Ninety-three neuroendocrine tumors made up a ratio of 4.42 cases per 100,000 inhabitants per annum. The median patient follow-up time was 44 months. The overall 5-year survival rate for patients who were followed up for a minimum of 60 months (49 patients) was 65.3%. The progression-free survival was 75.6% for 41 patients who were followed up for a minimum of 60 months. The survival rate for patients receiving endoscopic treatment was 100%, as there was no patient mortality recorded for those treated by endoscopic resection during the follow-up period. Conclusion Pancreatic neuroendocrine tumors may be managed conservatively in elderly patients by either monitoring them with imaging studies or treating them with somatostatin analogs. In the case of digestive tract tumors (stomach, duodenum, and rectum) that meet the criteria for endoscopic resection, this is a reliable and safe technique in the long term.

Purpose:The purpose of our study was to investigate the clinical outcomes of colonoscopic perforations in patients.Materials and Methods:We retrospectively studied patients with perforations secondary to diagnostic/therapeutic colonoscopy between 2009 and 2015 at the Pontevedra Hospital Complex. We analyzed age, closure method, length of hospitalization, and long-term progress.Results:Of the 34 perforations detected, 67.6% occurred in patients aged below 75 years. Most perforations occurred in the descending colon (55%). Perforations occurred in 55.9% of outpatients and 45% of inpatients. Diagnostic and therapeutic colonoscopies caused perforations in 20.6% and 79.4% of patients, respectively. Conservative treatment alone was performed in 5.9%, complete or partial endoscopic closure in 14.7%, and surgery in 79.4% of patients. Patients treated only conservatively or with concomitant endoscopic closure showed no mortality. The mortality rate was 14.8% in those treated surgically, and 55% of these patients required a subsequent ostomy.Conclusions:Conservative management with antibiotics and parenteral nutrition concomitant with complete/partial endoscopic closure effectively treats perforations, provided intraprocedural diagnosis is possible with immediate administration of antibiotics after the procedure. Nevertheless, studies with larger number of patients and statistical analysis are necessary in the near future.

To determine the prevalence of eating disorders (ED) in a cohort of patients with type 2 diabetes (T2DM), to identify the more predominant forms of ED, and to clarify if ED is associated with impaired metabolic control. A cohort of 517 patients with T2DM aged≥40 years and a control cohort of 304 patients without diabetes, age and gender matched, were enrolled from 3 primary care centres. All subjects completed the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R), followed by a structured interview (EDE 17th version). The overall prevalence of ED in patients with T2DM and control cohorts was 32.5% and 19.7%, respectively (p ED have a high prevalence in patients with T2DM, and the coexistence of type 2 diabetes and ED significantly affects metabolic control in these patients.

The aim of this study is to assess the diagnostic accuracy of ultrasound to differentiate appendicitis from nonspecific acute abdominal pain, that is the most common process requiring differential diagnosis in clinical practice.Patients admitted for suspicion of appendicitis were prospectively evaluated in our hospital during two years (2013-2014). Cases of nonspecific acute abdominal pain and appendicitis assessed by ultrasound were enrolled in the study. The different variables collected were statistically analyzed by descriptive, univariate and diagnostic accuracy studies.A total of 275 patients were studied, 143 cases of nonspecific acute abdominal pain and 132 cases of appendicitis. Ultrasound sensitivity and specificity to differentiate appendicitis were 94.7% and 87.4% respectively, with a 12.6% rate of false positives and a 5.3% rate of false negatives. The rate of false negatives in perforated group was 17.4% and analysis according to Pediatric Appendicitis Score risk groups showed a 12.2% rate of false positives in low-risk group and a 6.3% rate of false negatives in high-risk group.The use of ultrasound in low clinical probability cases of appendicitis could rise unnecessary surgery rate, due to the significant number of false positives in this group of patients. In high probability clinical cases, ultrasound does not contribute too much to diagnosis and it could be a confusion factor by the significant number of false negative associated to perforated appendicitis.El objetivo del estudio es evaluar el rendimiento diagnóstico de la ecografía para diferenciar la apendicitis del dolor abdominal agudo inespecífico, principal proceso con el que requiere diagnóstico diferencial en la práctica clínica.Se evaluaron los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años (2013-2014), incorporando al estudio los casos de dolor abdominal agudo inespecífico y apendicitis en los que se realizó ecografía. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva, univariante y con estudios de rendimiento diagnóstico.Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La sensibilidad y especificidad de la ecografía para diferenciar apendicitis fue del 94,7% y 87,4%, respectivamente, con un porcentaje de falsos positivos del 12,6% y de falsos negativos del 5,3%. El porcentaje de falsos negativos en el grupo de apendicitis perforada alcanzó el 17,4% y el análisis según los grupos de riesgo establecidos por el Pediatric Appendicitis Score mostró un porcentaje de falsos positivos del 12,2% en el grupo de bajo riesgo y de falsos negativos del 6,3% en el grupo de alto riesgo.El uso de la ecografía en casos de baja probabilidad clínica de apendicitis podría incrementar la tasa de cirugía innecesaria, debido al significativo número de falsos positivos en este grupo de pacientes. En casos de alta probabilidad clínica de apendicitis, la ecografía aporta poco al diagnóstico, e incluso podría ser un factor de confusión por el significativo número de falsos negativos asociados a la apendicitis perforada.

Objectives: The purpose of this study was to evaluate the effect of low level laser therapy compared to light emitting diode (LED) therapy on the process of skin healing in aged rats. Background data: Studies demonstrated the effectiveness of therapy with coherent light in the visible spectrum to optimize the process of tissue repair, and some studies suggests that comparable effectiveness could be reached with the lower costs noncoherent light in the same spectral region. Materials and methods: We used 54 elderly male albino Wistar rats (14 months old) which were submitted to surgical lesions in the dorsum, with a punch of 0.8 cm diameter. The animals were separated into: three groups were selected as controls, three groups were treated with laser (660 nm, 30 mW) and three groups were treated with LED (640 nm, 40 nm bandwidth, 54 mW). The lesions of the control group did not receive any light therapy. The lesion’s treatments in the laser and LED groups were initiated 30 min. after injury with fluence of 6 J/cm2 and repeated every 48 h in three application’s sessions. Animals were sacrificed at the 144, 312 and 480 h postsurgery. Histomorphological and histomorphometrical parameters were quantified in the lesioned areas. Results: showed an increase in the number of inflammatory cells, blood vessels, fibroblasts and collagen in all treated groups, demonstrating that the laser and LED improved the quality of the heal in the elderly animals. Conclusion: The LED therapy promoted better healing quality than laser.

Introduction: Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare disease characterized by a severe deficiency of the enzymatic activity of ADAMTS13 caused by autoantibodies, with an incidence of 3-4 x106inhabitants per year according to the few published data available. Accurate estimates of the incidence of aTTP are important to assess the resources required for current treatments and to anticipate the need to develop new treatments. The aim of this study was to determine the actualincidence of aTTP in Spain, as well as its diagnosis, management, and associated complications. Material and methods:A cross-sectional surveywascarried out among hematologists working in Spanish hospitals by means of an email that was sent to all members of the three main hematological scientificsocieties of Spain. All participants were asked to report the number of patients over the age of 16 years with a de novodiagnosis and relapses examined between Jan 2015 and Dec 2017. They were also asked about the number of patients that were known and alive in each hospital without having experienced any episode during such period. The population area of each participating hospital was consideredto calculate the incidence and prevalence of the disease. We also estimated the hospitalization service, mean hospital stay, percentage of ADAMTS13 activity at diagnosis and during follow-up, initial management, refractory cases and exacerbations (as defined by Scully et al.), treatment-related complications, and sequelae of aTTP. The median, interquartile ranges, and percentages were used for the descriptive analysis. Given that no personal data were treated, this study did not require the approval of a Research Ethics Committee. Results:A response was received from 42 centers (Figure 1). All hospitals except a private one belonged to the Spanish public health system, which provides health coverage to the entire Spanish population.A total of 203 episodes were reported (138 new episodes). The calculated population of the participating centers was nearly 21 x 106inhabitants. The incidence was 2.25 x106inhabitants per year, and the prevalence 19 x106inhabitants. Six patients died before they could start treatment (all but one in first episodes) and five were sent to other hospitals; thus, a total of 192 episodes were eventually treated. Table 1 and 2 show the data of the enzymatic activity of ADAMTS13 and the ADAMTS13 inhibitor at diagnosis, as well asthe complications. Plasma exchange (PEX) was performed by the Hematology and Nephrology Departments of 29 (70.7%) and 12 (29.3%) hospitals, respectively. The median hospital stay was 14 days (IQR: 10-20). Seventy-five episodes (39.1%) required admission to the intensive care unit with a median stay of 4 days (IQR: 3-7). During first-time episodes, a median of 12 PEX procedures (IQR: 8-19) were performed per patient, whereas in the case of relapses, a median of 9 (7-10) PEX procedures were carried out per patient. One plasma volume (PV) was used in the PEX procedures performed in 34% of the episodes, while 1.5 PVs were used in 56% of the episodes, and other PVs were used in the remaining 9.8%. The median duration of the PEX procedures was 121 minutes (IQR: 118-180). PEX and corticosteroids were the initial treatments administered in 98.4% of the episodes. Rituximab was used as a first-line treatment for new episodes in 18 of the 127 patients (14.1%), as a second-line treatment in 34 patients (26.6%), and as a prophylactic treatment (followingremission) in 4 patients (3.5%). In addition to the 6 early deaths, 9 patients died despite receiving the treatment (15 of 203 episodes, accounting for a mortality rate of 7.3%). Refractoriness to the PEX + corticoids was observed in 31 episodes of the 192 ones treated (16.1%), and at least one exacerbation (26.5%) took place in 51 episodes. Conclusion.Wecalculated the incidence ofclinically diagnosed aTTP associated with a severe ADAMTS13 deficiency inalmost half of the Spanish population which provided a high accuracy to our findings. These data are concordant with those published previously in other countries. Despite the currently available therapies, considerable rates of refractoriness and mortality still persist.Our data will be very useful for estimating the budget invested in this pathology and proposing standards for the diagnosis and treatment of this disease in our region. Disclosures Pascual Izquierdo: Novartis: Consultancy; Sanofi: Consultancy. De La Rubia:AMGEN: Consultancy; Celgene Corporation: Consultancy; Takeda: Consultancy; AbbVie: Consultancy; Janssen: Consultancy. Mingot-Castellano:Novartis: Consultancy; Novonordisk: Consultancy; Roche: Consultancy; Takeda: Consultancy; Bayer: Consultancy; Amgen: Consultancy; CSL Behring: Consultancy; Sobi: Consultancy.

Introduction: Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. Material and methods: All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. Results: A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. Conclusions: The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5 mg/L value could be used instead. Resumen: Introducción: El dolor abdominal agudo inespecífico es el principal proceso que requiere diagnóstico diferencial con la apendicitis en la práctica clínica. El objetivo de este estudio es evaluar la utilidad del Pediatric Appendicitis Score (Regla de predicción clínica de apendicitis pediátrica) para diferenciar estas 2 entidades. Material y métodos: Se evaluó prospectivamente a los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años, incorporando al estudio casos de dolor abdominal agudo inespecífico y apendicitis. Se recogieron diferentes variables, incluyendo las que conforman el Score y la proteína C reactiva, que se analizaron estadísticamente de manera descriptiva, univariante y multivariante, y mediante pruebas de rendimiento diagnóstico (curvas ROC). Resultados: Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La temperatura y el dolor a palpación en fosa iliaca derecha fueron las únicas variables que no mostraron diferencias significativas entre los grupos, careciendo de poder de discriminación. El dolor con la tos, el salto y/o la percusión fue la variable con mayor asociación a apendicitis. El Score estratificó correctamente a los pacientes en grupos de riesgo. La sustitución de la temperatura por la proteína C reactiva en el Score aumentaba su rendimiento diagnóstico, aunque sin diferencias significativas. Conclusiones: El Pediatric Appendicitis Score ayuda en el diagnóstico diferencial entre apendicitis y dolor abdominal agudo inespecífico. Sería recomendable la sustitución de la temperatura en el Score, pues carece de poder de discriminación entre estos grupos. La proteína C reactiva, categorizada en el valor 25,5 mg/L, podría ser utilizada en su lugar.

Uno de los indicadores mas relevantes para evaluar la seguridad del paciente es la incidencia de eventos adversos (EA). Las ulceras por presion (UPP) son un EA con una incidencia muy elevada en las unidades de cuidados intensivos. El objetivo de este estudio es valorar la efectividad de una intervencion formativa en prevencion de UPP a traves de la valoracion de la incidencia y la gravedad de las lesiones en una unidad de cuidados intensivos quirurgicos. Se llevo a cabo un estudio cuasi experimental de controles antes-despues. Los resultados muestran que la incidencia de UPP disminuye tras la intervencion formativa.

Resumen Objetivo Describir las variaciones existentes en las tasas de utilizacion de los diversos procedimientos relacionados con el parto, en las diferentes comunidades autonomas espanolas, provincias y tipos de hospital. Sujetos y metodos Estudio transversal; la unidad de analisis fueron los partos realizados en Espana (2001-2006) y la fuente de informacion, el CMBD al alta hospitalaria. Se realizo una agregacion de los datos y un analisis descriptivo en funcion de las variables de estudio. Resultados El numero de partos se incremento en Espana a un ritmo de 10.000-15.000 partos al ano. El porcentaje de partos no instrumentados fue del 62,7%, el de partos instrumentados del 15,1% y el de cesareas del 22,2%. Se observo una gran variabilidad en todos los procedimientos estudiados, tanto entre provincias, como CCAA o tipos de hospitales. Conclusiones Los resultados obtenidos muestran la gran variabilidad existente en la asistencia al parto, tanto desde el punto de vista temporal, geografico, y de la practica clinica.

Resistance increases with the use and abuse of antibiotics. Since physicians are primarily responsible for the decision to use antibiotics, ascertaining the attitudes and knowledge that underlie their prescribing habits is thus a prerequisite for improving prescription. Three-year follow-up cohort study (2008-2010) targeting primary-care physicians (n = 2100) in Galicia, a region in NW Spain. We used data obtained from a postal survey to assess knowledge and attitudes. A physician was deemed to have demonstrated Appropriate Quality Prescription of Antibiotics (dependent variable) in any case where half or more of the indicators proposed by the European Surveillance of Antimicrobial Consumption had values that were better than the reference values for Spain. The mail-questionnaire response rate was 68·0% (1428/2100). The adjusted increase in the interquartile OR of displaying good prescribing of antibiotics for each attitude was: 205% for fear ("When in doubt, it is better to ensure that a patient is cured of an infection by using a broad-spectrum antibiotic"; 95%CI: 125% to 321%); 119% for better knowledge ("Amoxicillin is useful for resolving most respiratory infections in primary care"; 95%CI: 67% to 193%); and 21% for complacency with patients' demands ("Antibiotics are often prescribed due to patients' demands"; 95%CI: 0% to 45%). Due to the fact that physicians' knowledge and attitudes are potentially modifiable, the implementation of purpose-designed educational interventions based on the attitudes identified may well serve to improve antibiotic prescription.

Resumen basado en el de la publicación Se recoge la experiencia de los servicios de atención comunitaria psicológica y educativa que, desde un ámbito municipal desarrollan distintos programas de intervención y actividades de carácter preventivo y comunitario. Las actividades parten de un análisis de necesidades que permiten una actualización permanente de sus objetivos de actuación y basado en un modelo de competencia y metodologías evaluables. Este servicio cubre las necesidades y un espacio de trabajo determinado para el que no hay respuesta desde ningún otro servicio u organismo. Madrid Biblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5; 28014 Madrid; Tel. +34917748000; biblioteca@mecd.es ESP

Brazil is an important example to study the situation of poverty and its determinants. Brazil owns a great part of the poor population of Latin America and presents great potential to eradicate this situation. The present study tries to show the association between the mortality risk and poverty in the city of Fortaleza.Cross-sectional ecological study, the unit of analysis was the districts of the city of Fortaleza. We included any death happened during year 2007. Mortality data were obtained through Unique System of Health, socioeconomic indicators and number of inhabitants was extracted from the Census of Inhabitants and Houses of the Brazilian Institute of Statistics of the year 2000. An index composed from the main simple indicators of deprivation was calculated using a Cluster technique. The deprivation index was divided in five groups, group 1 presented the best socio-economic conditions and group 5 the worst ones. Correlation analysis was done to evaluate the association between socioeconomic level and mortality.We observed a significant association of the socioeconomic level with total mortality (p0.001), circulatory disease (p0.001) and external causes (p0.001). In addition, 86% of the cases of aggression happened in groups 4 and 5.The results show a relation between socioeconomic conditions and mortality by any cause, by circulatory causes and by external causes.

To report a case of Poland syndrome in a 67-year-old woman.The patient was questioned and examined for a history of malformations characteristic of this syndrome on a routine medical visit. Thorax, bone thorax, and comparative hand X-ray were taken. Mammary ultrasound, mastography, and computed axial tomography were taken also. The right hemithorax showed a thin subcutaneous cell tissue. Axillary alopecia, mammary hypoplasia and areola-nipple complex retraction, hypoplasia of major pectoral muscles was observed. In the right upper limb, there was forearm shortening, hypoplasia of the second phalanx in all five fingers, and absence of distal phalanx in the index finger.The patient showed 4 out of the 5 characteristics considered as typical by Hester and Bostwick. In terms of hand anomalies, she was classified as type 1 according to Gausewitz and according with Al-Qaifan, the patient belongs to type 2.

Fundamentos: Brasil es un ejemplo para estudiar la situación de la pobreza y sus determinantes, ya que posee una gran parte de la población pobre de América Latina y presenta gran potencial para erradicar esta pobreza. El presente trabajo pretende mostrar la asociación entre la mortalidad y el índice de pobreza en la ciudad de Fortaleza, capital del estado Ceará. Métodos: Estudio ecológico transversal, la unidad de análisis fueron los barrios de la ciudad de Fortaleza. Los datos de mortalidad se obtuvieron a través del Sistema Único de Salud, incluyendo todas las defunciones del año 2007 y sus causas. Los indicadores socioeconómicos y número de habitantes se extrajeron del Censo de Habitantes y Viviendas del Instituto Brasileño de Estadísticas del año 2000. Se calculó un índice compuesto de privación a partir de los principales indicadores simples de privación utilizando una técnica de agrupamiento tipo Cluster y se realizó un análisis de correlación para valorar la asociación entre nivel socioeconómico y mortalidad. El índice compuesto de privación se dividió en cinco grupos, el grupo 1 presentaba las mejores condicionessocioeconómicas y el 5 las peores. Resultados: Se observó asociación significativa del nivel socioeconómico con la mortalidad total (p