EPIDEMIOLOGY

Author: PRIETO ERADES ISABEL.
Year: 2002.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: Observational-cross-multicentrico made with raw data on the population of patients in an area of health are attending primary care medical consultation. It aims, as a primary objective, quantify the activity of care to manage demand, linking the predictability of consultation with its clinical content. As part of the secondary objectives, determines the validity, clinical utility and reliability of the registration systems of primary care (medical history and information system for managing primary care -SIGAP). The survey results lead us to conclude that the activity of care in consultation in a 50%. For administrative reasons. The guide clinical practice constructed with the results of the pre-registration documents show evidence to confirm but not to discard. In addition gives a variation on the information according to the document, used to reflect the activity of care.

Author: GALVEZ CASTILLO CONSUELO.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: UNIVERSIDAD MIGUEL HERNÁNDEZ.

Summary: The chronic constipation motivates an important health spending, however, the real prevalence of chronic constipation is little known because they have so far been few studies conducted in the general population and they have agreed diagnostic criteria used to define constipation. It is also what little is known about the factors that relate to the presence of constipation and frequency of medical consultation on this issue. The calving in 1991 of the Rome I criteria for the definition of functional gastrointestinal disorders and including constipation, and has identified a more objective chronic constipation in the eyes of clinical practice as to the conduct of epidemiological studies. In 1999, modified these criteria apreciendo the Rome II criteria. OBJECTIVES The main objective of the study was to determine the prevalence of chronic constipation in the general population of 18 to 65 years, analyzing their relationship to various factors. The overall goal resulted in the following specific objectives: 1-To estimate the prevalence of chronic constipation in the general population of 18 to 65 years. 3-Evaluate the validity of criteiro autodefinido and each of the symptoms included in the Rome II criteria for establishing the presence of chronic constipation. 4-Rate factors associated with the presence of chronic constipation. 5-To assess medical consultation for chronic constipation. 6-Analyze the factors associated with medical consultation for chronic constipation. MATERIALS AND METHODS We designed a study of prevalence in the general population through a self-administered questionnaire on demographics and defecatorio habit that was sent by mail to the selected sample of subjects. This study was descriptive of the prevalence of chronic constipation and the prevalence of consulting the doctor for chronic constipation and analytical valuing various circumstances related to chronic constipation and medical consultation for constipation. The chronic constipation was defined according to three criteria: test autodefinido criteria Rome I and Rome II criteria. The study was conducted in the population of Aldaya. We selected 506 individuals between 18 and 65 years. It identified three age groups between 18 to 30 years, 31 to 50 years and 51 to 65 years. The response was 71.5% with no differences by gender or age group. RESULTS 1-PREVALENCE OF ESTREÑIMIENTO The 30% of subjects were considered constipations; 19% met criteria for the 14% Rome I and Rome II. The prevalence was significantly higher in women without diferncia by age groups. In calculating the difference in prevalence in relation to gender was observed for all the criteria for constipation and all age groups in which women had around 20 cases of constipation per 100 inhabitants than in men. Likewise when calculating the rate of prevalence was that the proportion of women with chronic constipation was 2 to 4 times higher than that of men according to the diagnostic criteria used. 2-MATCH BETWEEN DIFFERENT APPROACHES DIAGNOSTICOS OF ESTREÑIMIENTO CHRONIC match between the criterion diagnosis autodefinido and criteria for Rome I was good. The match between constipation autodefinido and defined by the Rome II criteria was low. The match between constipation criteria defined by the Rome I and Rome II was good. No differences were observed in relation to gender. VALIDITY OF CRIT 8 ERO AUTO 1230 DEFINED AND SYMPTOMS INCLUDED IN ROME II CRITERIA FOR THE BREAKDOWN OF ESTREÑIMIENTO CHRONIC. The 47% of individuals who are conseraban estre?i met Rome II criteria and 64% of Rome I. The validity of the criterion autodefinido for diagnosing esteñimiento Chronic by Rome II criteria was good and VPN with a very high sensitivity, high specificity and a half VPP. The sensitivity of each of the symptoms of Rome II was media with a greater specificity to 90%. The VPP was high for all symptoms. ASSOCIATION OF VARIOUS FACTORS WITH THE PRESENCE OF ESTREÑIMIENTO CHRONIC The only factor independently associated with the presence of constipation autodefinido was female. Four variables are realcionaron with the presence of constipation defined by the Rome I criteria: gender and women taking anxiolytics as risk factors and conducting regular physical exercise and dietary intake of an average amount of fiber as protective factors . Factors that realcionaron with lapresencia constipation defined by the Rome II criteria were female gender, physical activity and the amount of fiber in the diet. CONSULTATION TO THE DOCTOR FOR ESTREÑIMIENTO CHRONIC The consulting the doctor was similar in all the diagnostic criteria of constipation, consulting just over 40% of individuals from all groups. Women consulted more frequently than men. FACTORS IN CONNECTION WITH REFERENCE TO THE DOCTOR FOR ESTREÑIMIENTO CHRONIC In univariate analysis was related to medical consultation all the diagnostic criteria for chronic constipation, the criteria included in the definition of Rome II constipation, the number of these critera, defecation prolonged The female, taking laxatives and prsencia of abdominal pain and diarrhea. It is not related to medical consultation age group, educational level, making use of anxiolytic and suppositories. The independent factors that were related to medical consultation were female gender, education secundario-superior, defecation and prolonged abdominal pain. CONCLUSIONS 1-Constipation is a very prevalent problem in the population of 18-65 years of the characteristics studied. 2-Constipation is much more prevalent in women. 3-In adults, 18 to 65 years of age, the prevalence of constipation does not vary according to age. 4 - The public regarding the suffering of chronic constipation overestimates their prevalence. 5 - The criteria for Rome I and II are similar to the diagnosis of chronic constipation. 6 - The Rome II criteria for diagnosing allow individuals with problems obstructed defecation, assuming an improvement on the Rome I criteria in the diagnosis of constipation. 7-Constipation autodefinido applies to identify individuals that meet agreed criteria for the diagnosis of chronic constipation. 8, - Symptoms included in the Rome II criteria are present in individuals without constipation and some of them, mostly manual maneuvers to get defectar frequency defecatoria less than 3 stools / week are absent in many subjects with constipation. 9 - The exclusion criterion for the presence of liquid stool or líquidos-blandos present at the Rome II criteria may be too restrictive for the diagnosis of chronic constipation. 10 - The prolonged defecation is a symptom to assess to include within the criteria for chronic constipation. 11 - The female and taking anxiolytics are risk factors for chronic constipation while the average consumption of fiber and the realization of physical exercise are protective factors. 12 - The consulting the doctor for chronic constipation is common in the general population. 13 - The consulting the doctor for chronic constipation were independently associated with the presence of certain factors: sex, educational level secundario-superior, defecation and prolonged abdominal pain.

Author: PEÑA PORTA JOSÉ M..
Year: 2003.
University: LLEIDA [More theses of this university] [www.udl.es].
Place of defense: MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSITAT DE LLEIDA.

Summary: BASIS is a need to know the epidemiological data of a chronic disease such as ESRD in a given geographical area to tackle the work in an efficient manner health detection and treatment of it and detect possible deviations from other areas. It is also of interest to recognize the prognostic factors influencing mortality and morbidity in patients undergoing hemodialysis for targeting these efforts to possible correction, and thus improve the long-term prognosis of patients. OBJECTIVES were raised two broad objectives: 1-To collect epidemiological data pertaining to ESRD and its treatment in the province of Huesca. 2 - With the subgroup of patients treated by hemodialysis in hospitals in Barbastro and St. George Huesca determine the prognostic factors associated with morbidity and mortality. DESIGN historical cohort study conducted a retrospective review of clinical data and analytical for all patients residing in the province of Huesca requiring start TSR so chronic in the period 1-1-90 and 31-12-2001 . PATIENTS AND METHODS 254 patients were started TSR and were included for the epidemiological study. We calculated rates of gross provincial incidence of ESRD, sector and areas of health, as well as the prevalence figures provincial ESRD on dialysis. A total of 191 patients conducted at hospitals in hemodialysis Barbastro and St. George, you which 11 were excluded for analysis of morbidity and mortality due not survive more than 90 days and another 2 by the loss of analytical. It was determined for each patient in the following hemodialysis clinics and analytical variables: age, sex, year of home hemodialysis, etiology of the IRCT, prior control of nephrology greater or less than 4 months, origin of the case, the Charlson comorbidity index ( ITC), vascular access initial urea, creatinine, albumin, Hematocrit, PTHi, cholesterol, uric acid, potassium, alkaline phosphatase, bicarbonate, lymphocyte count, calcium, phosphorus, Ca xP product, EPO units / kg / week, index resistance to erythropoietin, percentage reduction in urea, type of membrane dialyzer, treatment with vitamin D, type of phosphate binders used, fee revenue per patient day, cause of death, months tracking to death , transplant or closure of the study. We performed a descriptive analysis of the variables, an analysis of morbidity (multiple linear regression model with a rate of days' income as the dependent variable), and survival analysis (Cox regression model) by selecting pre-significant variables in the univariate analysis for enter the latter two models. RESULTS STUDY EPIDEMIOLÓGICO There was a progressive increase in the rates of incidence and prevalence over the 12 years of the study to stand at levels similar to the Spanish state. The rates are higher in areas of health sector 2 (Barbastro) for sector 1 (Huesca). STUDY DESCRIPTIVE The diabetic nephropathy (22%) is the leading cause of ESRD in the province of Huesca. The etiology cardiovascular (49%) was the leading cause of death among patients on dialysis. Nearly half of patients undergoing hemodialysis were identified as carriers of IRC for the first time in the hospital. IMPACT OF THE LATE REFERENCE TO NEFROLOGÍA The 22.5% of patients were referred to so late nephrologist (less than 4 months before starting treatment substitute for kidney function). This group came to the dialysis patients in worse conditions with greater malnutrition and anemia and having to use a cat 8 ether tem 8ed poral as the first vascular access to a greater percentage of cases. In the subsequent follow-up had a higher mobility in the long term (greater rate of days' income by persona-año) and a worse survival in a meaningful way in the first 2 years after adjusting for other confounding variables using a Cox regression model. ANALYSIS OF DISEASES The prognostic variables selected by the model were comorbidity index, the reference late, albúminia serum, procentaje reduction of urea and hemotocrito (R2 = 0,334, F = 16.97, p less 0,005). The linear regression equation was as follows: Fee income of days = 101.12 + (2.45 x ITC) - (12.11 x reference belated) - (11.57 x Alb.) - (0.43 x PRU) - (0.83 x Ht). ANALYSIS OF MORTALITY The median survival of patients in homodiálisis was 71.12 months. With a probability of survival of 5 and 10 years of 58 and 14% respectively. The variables selected by the Cox regression model to be associated with survival throughout the track were hemotacrito (RR =- 0,207, 95% CI 0.726-0.910, p less 0.0005), the rate of comorbidity (RR = 0,265, CI95% 1,066 - 1,594, p = 0.007), the percentage reduction in urea (RR = -0,059, CI 95% 0,893 -0,996, p = 0.038) and type of membrane dialyzer (RR = -0,771 , CI95% 0,260 - 0,822, p = 0.007). CONCLUSIONS Epidemiological data from laIRCT in Huesca province not differ from the whole country. The reference to the late nephrologist of patients who began hemodialysis resulted in greater long-term morbidity and mortality in greater early. The hematocrit, the rate of comorbidity and PRU have a tremendous impact on morbidity and mortality in patients on dialysis, in addition albumin influencing morbidity and type of membrane in mortality.

Author: ROCA ROMALDE DAVID.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FAC. MEDICINA. HOSPITAL DE SANT PAU.

Summary: INTRODUCTION Surgical treatment of pseudoartrosis of the humeral diaphysis holds a set of unknowns in terms of implant used and the technique used. Our purpose is to respond to some of these issues that are still pending. OBJECTIVES 1, - compare clinical and biomecánicamente cloves encerrojado and understanding to the board. 2-Evaluate the usefulness of graft in the treatment. 3-Evaluate the usefulness of cruentar and compress the focus during treatment. 4-Discovering the existence of prognostic factors of evolution. MATERIALS AND METHODS We conducted a retrospective multicenter clinical study between the Hospital Sant Pau, IMAS and Vall d'Hebron and a biomechanical study comparing the board and nail by the Polytechnic University of Catalonia. RESULTS There were no significant differences between the board and nail in terms of consolidation, consolidation time and complications. Biomecánicamente, the board supports the nail better than the bending and shear loads, while the nail plate that supports better traction loads, understanding and torsion. The pseudoartrosis atrófca consolidates better with cloves and hypertrophic splint (p less 0.05). The contribution of bone graft has not significantly changed the consolidation, the time of consolidation or complications in the treatment of pseudoartrosis. The opening of focus during nailed has outperformed nailed to the outbreak closed although the differences were not significant (p = 0.176). The initially simple fractures and the treatment of those conservatively have shortened significantly (p less 0.05) time of consolidation after the treatment of pseudoartrosis. CONCLUSIONS * There are no significant differences between the two implants studied with respect to the consolidation, consolidation time and complications. Biomecánicamente both produce the stability needed to ensure the consolidation process. However, the type of pseudoartrosis has proved a selection of synthesis, since the atrophic outperform with hypertrophic nail and with the board. * In the treatment of pseudoartrosis diaphyseal humeral, providing graft, either autologous or homologous, has not shown increasing consolidation. Nor has it changed the average time of consolidation or the percentage of complications. * Compression of focus is one of the gestures determinants of the consolidation of pseudoartrosis in the humeral diaphysis therefore, nailed endomedular focus should be done to open for this purpose. * In the tre prognostic factors studied, fractures initially simple and his initial conservative treatment, have been shown to reduce the time of consolidation. The initially simple fractures have also shown to reduce the frequency of complications after treatment of pseudoartrosis.

Author: BARAJAS SANTOS M. TERESA.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: One group of drugs is the most interesting of the digestive system and metabolism by high utilization and high heterogeneity. Being rational use of the drug one of the primary goals of health professionals and demanded by the WHO, the knowledge of its use is highly interesting. The objective of this work focuses on the valuation of the prescription of the digestive system and metabolism in a Center for Health and dispensed in Spain for a year. There is a high prescription of such drugs, so that one third of the population is exposed to some of them over a period of three years. The prescription of these drugs is higher in women and increases with age in both genders. The most important principles in regard to their prescription and economic costs are ranitidine and omeprazole among other antiulcer; almagato between antacids; cinitaprida and cisapride among antiemetics and stimulating intestinal motility; ispágula and lactulose among laxatives; between calcium glibenclamide and mineral supplements, acarbose and metformin among hipolgucemiantes oral. It prescribes more antiulcerosos, and oral anti-hyperglycemic to men, while prescribing more antacids, laxatives antiemetics and mineral supplements to women. With age aumetna prescribing oral hypoglycaemic antiulcerosos and decreasing the prescription antacids and antiemetics. The subgroup therapeutic largest contributor to the economic cost of antiulcersoos, prescibiéndose the most expensive to young people. When comparing the data with data from dispensing there is a greater prescription almagato, calcifediol, cholecalciferol and cinitaprida and lower prescription omeprazole, laxatives, glibenclamide and metformin.

Author: GIMENEZ ROBREDO ANA ISABEL.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The high incidence and prevalence of cardiovascular disease in developed countries makes the study of the consumption of drugs in the cardiovascular system is particularly important and that the election of the same be done under criteria of efficiency, safety, quality and cost. The objective of this work focuses on studying the evolution of the supply of such drugs in Spain for 10 years (1995-2004) as well as the supply in a two-year period (October 1998 to September 2000). There has been a significant increase in the active subgroup "Agents acting on the renin angiotensin system" in recent years. It has also increased the number of proprietary products and different presentations and totals for subgroups "beta-blockers" and "blocking the calcium channels," keeping them in the number of active ingredients almost constant. In the subgroups "Therapy cadiaca", "Antihypertensive", "Vasodilator peripherals" and "Vasoprotectores" there has been a decrease in the number of active ingredients. Subgroups therapeutic greater supply in Spain are, in this order, "Cardiac Therapy", "agents that act on the renin angiotensin system", "Diurético" and "Vasoprotectores." The active principles of supply are greater, in that order, nitroglycerin, enalapril, hydrochlorothiazide and diosmine. The annual cost of drugs cardiovascular system in Spain is more than four hundred thousand million per year, which represents nearly four million per day, with the active ingredients that contribute most to spending enalapril, amlodipine dilitiazem and nitroglycerin. The savings that could have been derived from the supply of proprietary products cheaper on the market with around one hundred and forty-five million euros annually (three hundred ninety-five thousand Euros per day)

Author: GEA RODRIGUEZ M. ELVIRA.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FAC. DE FARMACIA.

Summary: The nosocomial infection (IN) can defenirse as that produced by microorganisms acquired in the hospital, affecting patients admitted through a process different from that infection and that at the time of admission were not present even in incubation period. They produce a significant mortality and morbidity I give rise to high social and economic costs, which constitute a major public health problem. The objective of this work is focused on understanding the situation of Orthopedic Surgery Service and Traumatológica Hospital Virgen de Meritxell in terms of nosocomial infection, evaluating the impact of the commission and its risk factors. It has conducted a survey propsectivo one year of follow-up that included all patients in the Service mentioned that giving the sample composed of 695 people. All of them were conducted an epidemiological survey, which included the following variables: gender, age, BMI, alcohol, snuff, diseases that strike, treatments, data relating to intervention and analytical data. The incidence of nosocomial infection in the Service of Orthopedic Surgery and Traumatology Hospital Virgen de Meritxell Andorran figure in a 6.26%. The most common site of nosocomial infection in the patients studied is the urinary tract (15.24% of total infections; incidence of 2.70%), followed by infection of the surgical site (21.43% of all infections; incidence of 1.50%), respiratory infection (14.29% of total infections; incidence of 0.85%) and bacteremia (7.14% of total infections; incidence of 0.28%). Germs producers of nosocomial infection are more common Escherichia coli (27.27%), Pseudomonas aeruginosa (18.18%) and Proteus mirabilis (13.63% of total). The antimicrobial Frequently used in the treatment of hospital-acquired infections are the beta-lactams (37.5% of treatments), quinolones and aminoglycosides (both at 22.5% of treatments). The intrinsic factors associated with the development of nosocomial infection are older than 64 years have at least four diagnoses at discharge, low hemoglobin levels and preoperative levels preoperatively elevated glucose and blood urea. The extrinsic factors associated with the development of nosocomial infection are probing the urine and stay in the ICU. Factors associated with the intervention associated with the development of nosocomial infection are the implant material, surgery is not clean and the location of surgical intervention in the hip. In our study,'s failings in antibiotic prophylaxis are not associated with the development of infection noscomial.

Author: AVILÉS IZQUIERDO JOSE ANTONIO.
Year: 2004.
University: COMPLUTENSE DE MADRID [More theses of this university] [www.ucm.es].
Place of defense: MEDICINA.
Place of preparation: F. MEDICINA.

Summary: Despite the aumejto in the incidence of cutaneous melanoma in our population, there are hardly any studies on the epidemiology and survival of patients diagnosed with melanoma made in our country over the past 10 years. This thesis is based on data on all patients diagnosed by histopathology report, melanoma of the skin and mucous membranes during the period ell January 1994 and December 31, 2003, and were atMldidospor this reason in the University at the General Hospital "Gregorio Maranon" in Madrid. It describes the characteristics epidemiological, clinical and histopatológieas of 552 padentes diagnosed with melanoma during this period of time, as well as developments in these patients. It analyzed the variaciónde these variables over the 10-year study. Using an analytical study is seeking to establish what are the possible factors with influence on overall survival (GS) and the onset of metastatic disease-free or time (TLE), and explore the relationships between factoras forecasts, indicating what factors have independent effect on the GS and TLE. The results show. That the annual incidence of melanoma in our health area has doubled since the mid-90 until early twenty-first century. The incidence appears to have stabilized in recent years. Most melanomas is in the stadium 1en the time of diagnosis (45%). Without embargo.se still a significant proportion of diagnosing melanomas in stadiums, a: anzados (III-IY; 14.5%). The following factors were significantly asociaron.de with a lower overall survival: Old age, male; antecedent personal.de melanoma, metastatic melanomas initial location; advanced clinical stage, and without primary nodular type known; thickness in excess of 4 billion (or level Clark V); presence of ulceration and positivity for melanoma in the sentinel node. The development of metastases was associated with an increased thickness tumor, histological presence of ulceration, male sex, advanced age and type histológíco modulate the primary tumor.

Author: SAMPEDRO ORCERO JORGE.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The surgical wound infection is typical nosocomial infection in patients undergoing surgery, in order to meet the general characteristics of this type of infection, as well as find the factors involved in its appearance, a study of incidence of infection surgical wound in 1,182 patients during the years 1998-2000, grouped by level of contamination of surgery, finding that the surgical wound infection is the most common in patients undergoing surgery, regardless of the degree of contamination of the same, being its location surface which provides greater percentage. The relative risk of getting this infection increases significantly with the degree of contamination of surgery, and the average stay of the patients who suffer. For the risk of a surgical wound infection did not seem determining the characteristics of the patient. By contrast reveals a significant increase in the surgical wound infection in the analysis of the variables in surgery. Although the factors of both intrinsic and extrinsic risk increasing the relative risk of suffering a wound infection, their statistical significance varies depending on the degree of contamination of the surgery may not stratify its importance. Despite the high level of pollution correct antibiotic found, we can not say that is a significant factor in the relative risk of suffering from a surgical wound infection, except in the clean with implant surgery, and may be attributable to excessive cost this prophylaxis. In the multivariate analysis, we did not find any factor that is maintained in all locations of surgical wound infection, although the degree of contamination of surgery, disease and stay in the ICU are more constant. The models probability individual infection are purely theoretical and remain its valuation in subsequent studies.

Author: MARTÍNEZ GONZÁLEZ VALERIA SUSANA.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE CIENCIAS.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: Arsenic (As) is a natural element widely distributed and heterogeneous in nature, being highly toxic to the human body. The Ace is located at concentrations much higher than what is considered safe in drinking water of millions of people in different countries. The environmental exposure to Ace is a risk factor for various types of cancer, but the mechanism by which the ace toxicological exerts its action remains unclear. The objective of this PhD thesis has been to assess the possible genotoxic damage in a population exposed to high concentrations of arsenic in the drinking water. It has used the concentration of arsenic in urine and nails as biomarkers of internal exposure. To determine the level of cytogenetic damage, has been used micronucleus test in peripheral blood lymphocytes and cells scaling of the buccal mucosa. Given that the genetic damage can be modulated by genetic characteristics singles, has also done an analysis of genotypes for polymorphisms of genes GSTM1, GSTT1 and GSTP1 in the study population, which has been used as biomarcador Sensitivity Single. The study population, which has been used as biomarcador sensitivity individually. The exposed population has been selected in northern Chile where, for the geology of the region, there are high concentrations of arsenic in drinking water, reaching more than 0.75 mg Ace / L. This population has 106 individuals of whom 50 are ethnic Atacama. The indigenous population lives in the region under similar conditions for some 11,000 years. It has been proposed that the Atacameño have some type of resistance to exposure to Ace because they have no health problems described in other populations exposed under similar conditions. The control population has 111 individuals and has been selected in the city of Concepcion, located about 2,000 km south of the first sampling site, introducing levels of arsenic in water from 0.0002 mg Ace / L. This study has shown that exposure to Ace through drinking water poses a risk genotoxic, inducing a significant increase in the frequency of MN in lymphocytes in the exposed population. However, no damage has been detected in the cells of the oral mucosa. In connection with the alleged resistance of ethnic atacameña to high levels of arsenic environment, have not been detected significant differences between atacameños atacameños and not in terms of cytogenetic damage evaluated by testing NM, or in lymphocytes and cells the buccal mucosa, despite the fact that the population Atacama presents a higher concentration of arsenic in the nails. As for the genetic polymorphisms, only significant differences were found for him gene GSTP1, which genotype val / val (homozygous mutant) is more prevalent in the population that has an increased level of cytogenetic damage, as measured in both cell types. It has also been found more frequently in the population Atacama.

Author: CLEMENTE CASARES PILAR.
Year: 2004.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of defense: FACULTAD DE BIOLOGÍA.
Place of preparation: FACULTAD DE BIOLOGÍA.

Summary: The Hepatitis E virus (HEV) cause acute hepatitis and is transmitted by fecal-oral route. In industrialized regions, not considered endemic to the virus, are diagnosed only sporadic cases of infections by the HEV strains associated mainly imported from endemic regions, despite the fact that the values of seroprevalence observed vary between 1 and 5%. In recent years, are being identified by the HEV acute infections in industrialized areas caused by different strains native to the endemic regions. The overall objective of this dissertation is to study the molecular epidemiology of HEV in industrialized regions, by identifying strains that cause infections in people and animals of potential reservoirs. Samples were analyzed wastewater collected at the entrance of a plant in Barcelona. The HEV was detected in 24 of the 51 samples tested (47.0%), 22 of which belonged to the period between December 2000 and June 2002. We identified 18 sequences of different HEV. A study of diversity through the cloning of the PCR product of 4 samples showed that 2 had the same sequence in the 10 clones studied and the other 2 had more diversity, with 3 and 5 different sequences. We also analyzed a total of 18 samples of wastewater from 4 regions considered not endemic to the virus: Washington DC (USA), Patras (Greece), Umeá (Sweden) and Nancy (France). The HEV was detected in 1 shows Washington and Nancy. We analyzed serum samples of patients with hepatitis and IgG antiVHE at the time of hepatitis visited at the Hospital Vall d'Hebron in Barcelona. The strain was isolated causing the infection in 3 patients, in one case after a trip to Ethiopia. The study of markers of acute infection by the HEV showed that 3 patients who were identified by the genome of the virus were also those who had detectable levels of IgM antiVHE. Cases were also identified with a possible diagnosis of acute hepatitis with HEV by the absence of IgM antiVHE but higher levels of IgG antiVHE and decrease later, as well as possible coinfecciones with other viruses that cause hepatitis. For the identification of animal reservoirs of HEV in the study area were analyzed serum and stool samples of pigs from 3 commercial farms located in Catalonia. One was detected a prevalence of 18.2%. The strain was isolated By causing the infection in animals. It was very similar to strains identified infecting human population of Barcelona. It was also isolated in HEV biosolids slaughterhouse. There was identified any strain of bovine HEV in the preliminary survey. Finally, we conducted a study to identify the amino acids of epítopo neutralizing the HEV that could be potentially important in shaping this epítopo. We studied the behavior of the epítopo neutralizing antibodies against the strain Sar55 (genotype 1) compared to Mex14 (genotype 2) and peptides mutated from Sar55 containing amino acid present in Mex14. No differences were seen in the recognition by antibodies, confirming the existence of epítopos common in both strains. We have identified strains of native HEV (genotype 3) causing clinical cases in industrialized regions, justifying the review and classification of these zones in areas with varying degrees of endemism, and the establishment of protocols for the correct diagnosis of infection and evaluation the seroprevalence real, as well as the pathogenicity of these strains.

Author: MONTEJO RODRIGUEZ M. ROCIO.
Year: 2004.
University: NAVARRA [More theses of this university] [www.unav.es].
Place of defense: DEPARTAMENTO DE CIENCIAS DE LA SALUD.
Place of preparation: DEPARTAMENTO DE CIENCIAS DE LA SALUD.

Summary: Case-control study apareado by three controls per case, with the goals of determining role in endometrial cancer de.1) obesity 2) hipercoolesterolimia, hypertension, thyroid disease and diabetes, 3) snuff 4) background gynecological and obstétricios , 5) family with a history of endometrial cancer and other cancers, 6) habits nutritional 7) food consumption and micronutrientes.Muestra of 48 cases of patients with cancer of the endometrium consulting Gynecology Oncology Hospital Virgen del Camino Pamplona and 187 checks representing the población.Se conducted a questionnaire with demographic data, anthropometric, smoking and passive exposure to snuff, alcohol, background ginecolóficos, personal and family history of cancer, food frequency questionnaire of Willet validated by Martin Moreno questionnaire and dietary habits of 24 questions. The macronutrients and micronutrients were adjusted for total energy consumed by residuales.Se conducted descriptive statistics, analysis x2 Pearson, Student's t test and Kruskall Wallis way asymptotic and exacta.Se calculated odds ratios taking into account the estimate by mating a conditional maximum likelihood (conditional maximum likehood estimate). conditional logistic regression was used exacta.La obesity, thyroid disease, hypercholesterolemia and diabetés mellitus increases the risk of getting cancer endometrío with an odds ratio 5.25,7.5,3.26 and 7.82 respectively . active and passive exposure to snuff in periods of life with a fertile protects odds ratio 0.14.El have had at least one pregnancy protects with an odds ratio 0.08.Las women with a family history of endometrial cancer have increased the risk with an odds ratio 5.07.El consumption of coffee (OR = 0.22) of blue fish (OR = 0.03), octopus (OR = 0.13) and cod (OR = 0.05) decreases the risk while the white fish consumption (OR = 6.02) smoked (OR = 6.02) and oysters and clams (OR = 3.13) increase riesgo.El consumption of fatty acids polisaturados (OR = 2.83), acid nervónico (OR = 2.97) acid anteisopentadecanoico (OR = 6.30), acid trans-linolénico + acid transeicosenico (OR = 4.44) acid trans-11, 14-eleosadienoico (OR = 3.61) Vitamin B2 ( OR = 4.3899), zeanxantina (OR = 4.6945) and vitamin E (OR = 3.11) increases the risk of cancer endometrio.El consumption alfa-carotenos (OR = 0.26) acid mirístico ( OR = 0.22), acid miristelaídico (OR = 0.13), acid cis-11 ,14-cicosadienoico (OP = 0.17) acid cis-11, 14,17-eicosatrienoico (OR = 0.23), acid cis-docosenoico (OR = 0.21) and acid cis-13, 16.19, doosatrienoico (OR = 0.14) decreases the risk.

Author: RODRIGUEZ DIEZ MARIA CRISTINA.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The studies use of medications (EMT) is the basis for establishing a monitoring system farmacoepidemiológica, which allows us to establish control measures in the field of therapeutic drug. One of the groups most commonly used drugs in the field of primary care is for the respiratory system due to the high incidence of diseases affecting that system. For example, about half of the infectious processes that take place in primary care are for respiratory infections, and about 60% of these infections tracks high. The choice of a drug should be provided under the criteria of efficiency, safety, quality and cost, so as to achieve the "rational use of medicine" adopted at a WHO report, understanding by using the marketing, distribution, and use of prescription drugs in a society with special emphasis on the medical, social and economic consequences resulting. The population groups most of the drugs used are aparto respiratory women when it comes to sex, and those older than 64 years, according to the age group. Subgroups of respiratory medicines are prescribed more antitussives, asthma and nasal decongestants and anti-infectives. The active ingredients are prescribed more: closperastina, budesonide, N-acetylcysteine and codeine. The men used more asthma and nasal decongestants, and women more antitussive and antihistamines. With age increases the use of expectorants generally cloperastina and ipratropium, while decreases of anti-infectives and nasal decongestants and antihistamines in general and budesonide in particular. From an economic point of view, men and older than 64 years are the ones who spend the most money. Subgroups that produce greater cost are asthma, nasal decongestants and antihistamines and anti-infectives. The active ingredients that produce greater cost are: budesonide cloperastina, salmeterol, cetirizine, N-acetylcysteine and elastin. Men spend more on asthma, and women in nasal decongestants and antihistamines and anti-infectives. With age increases spending in general expectorants and cloperastina, N-acetylcysteine and codeine, while decreases in nasal decongestants and anti-infectives in general and budesonide and terbutaline. You can get a savings of 4.44% using cheaper alternatives in the market, especially from nasal decongestants and anti-infectives. We need to emphasize the interest of pharmacoepidemiological studies and pharmacoeconomics, and that is not expensive in its performance, policies used to detect incorrect use of medicines, in order to optimize resources and contribute to the rational use of medicine.

Author: APIÑANIZ APIÑANIZ REBECA.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: Diseases of the respiratory system have a high incidence and prevalence in our environment, leading to frequent hospital admissions and an important use of the so-called respiratory drugs and steroids. The objective of this work focuses on the valuation of consumption of such drugs in a general hospital for two years, describing the active ingredients used more frequently, evaluating the influence of age and sex on consumption, avaluando cost reflecting economic influence of age and sex on consumption, assessing the economic costs posed and conducting a cost analysis minimized in order to assess the possible savings. Virtually el4% of the patients admitted in the study period received any medication to the respiratory system and / or steroids, being significantly higher than the number of male consumers. The most commonly used therapeutic subgroups, both in exhibitions as in days of consumption, were in this order: asthma, antigripales and antitussive, and antihistamines. As for active ingredients are concerned, the most commonly used were: acetylcysteine, theophylline, ipratropium bromide, budesónido and dexclorfeniramina. The most commonly used steroid drug prednisone was. There are differences in the use of several of these drugs based on the sex, probably due to the different incidence and prevalence of certain diseases of the respiratory system in both genders. The total cost of medicines of the respiratory system was superior to 9000â ¬ and the steroids of 13000â ¬. Following the analysis minimized costs would have been possible to obtain the 2% savings on medicines of respiratory and 2.2% in steroids.

Author: CORRES SANCHEZ CRISTINA.
Year: 2004.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The nosocomial infection is a major public health problems in the hospital setting. It has conducted a case-control study with data from the studies EPINE made from 1990 to 2001 at the Hospital Txagorritxu Vitoria, in order to assess the epidemiologic variables that are associated with nosocomial infection. In these twelve years, the prevalence of nosocomial infection has decreased significantly. The risk is higher in the extreme ages of life. The area hospital with the highest prevalence of infection is the UCIO followed by the surgical site. The infection is the most common urinary tract and the surgical wound. The risk factors most often associated are intrinsic drug abuse, malnutrition, decubitus ulcer by and between the risk factors extrinsic the tracheotomy, parenteral nutrition, urinary catheter and catheter Central. It has obtained a mathematical model based on the associated risk factors, calculating that by applying the same and the possible control of the factors involved, could decrease the incidence of infection in a 14.1%. The germ is most commonly isolated E. Coli infections in the urinary tract, P. Aeruginosa in respiratory; S. Epidermidis in bacteremia and flora polimicrobiana in surgical wound. The most commonly used antibiotic in the treatment of these infections is amoxicillin - clavulanic acid, followed by ciprofloxacin.

Author: LEON LATRE MONTSERRAT.
Year: 2004.
University: ZARAGOZA [More theses of this university] [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This paper is a study epidmiológico trasversal the prevalence of metabolic syndrome and its components in Spanish workforce. Deepening in diagnostic criteria, it tries to take a broad view of the epidemiological situation of cardiovascular risk factors and the metabolic syndrome in Spanish workforce, as well as its geographical distribution and relationship to mortality from ischemic heart disease in Spain. For the diagnosis of metabolic syndrome were used criteria ATP III modified taking into account body mass index instead of the perimeter of the waist. The data come from the revisions made to health workers in a mutual health implantation throughout Spain over the year 2003. The shows were 18774 workers between 18 and 70 years mostly male (78.6% are men and 22.4% are women) distributed throughout Spain. Mean age was 40 years. We got averages standardized by age and sex of the variables analyzed: weight, height, body mass index, blood pressure, blood glucose and lipids. It was also estimated the prevalence of metabolic syndrome and the various categories of blood pressure, diabetes, obesity and lipid disorders. The conclusions were as follows: 1. The standardized prevalence of metabolic syndrome in Spanish workforce is 12%. One out of every eight workers suffering from the syndrome which is a major public health problem. 2. The metabolic syndrome is more prevalent in men than in women and increases with age. The prevalence increases in man since the beginning of the working age to stabilize from 55 years. The prevalence remains stable in women up to 40 years old from which presents its gradual ascent. 3. There is a triad of criteria which have half of the workers with metabolic syndrome as their sex: high blood pressure, hypertriglyceridemia and high body mass index if they are men and high body mass index, low HDL cholesterol and high blood pressure if they are women . 4. There are differences in the geographical distribution of metabolic syndrome with lower prevalence in regions of northern Spain. We found a correlation between mortality from ischemic heart disease and the prevalence of metabolic syndrome presenting different provinces. 5. Metabolic syndrome brings together in a common diagnosis heterogeneous groups. The profile of a worker with metabolic syndrome is different between men and women. Within these, among young women, as opposed to less than 35 years, the criterion of body mass index is high compared to other leading diagnostic criteria. 6. The criterion of an elevated basal glucose contributes little to the diagnosis of metabolic syndrome in workforce. Only listed as most important when considering older workers. 7. The use of metabolic syndrome as a criterion of a cutoff point for HDLc different for each sex has a dubious basis, at least in its application to Spanish workforce. Cause hetogeneidad profiling among diagnosed with metabolic syndrome in both sexes. 8. The prevalence of cardiovascular risk factors in workers differs from that described in similar studies conducted in recent years. The prevalence is lower in most of the risk factors discussed except in the body mass index. The percentage of obese is clearly superior to that found in previous studies. 9. The workforce can be a good group for the detection of metabolic syndrome. It is necessary to have a routine in labor health examinations of evidence required for the diagnosis of metabolic syndrome to detect these workers subjected to a higher cardiovascular risk.

Author: BELZA EGOZCUE MARIA JOSE.
Year: 2004.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: CAMPUS SAN JUAN UMH.
Place of preparation: INSTITUTO DE SALUD CARLOS III.

Summary: People prostitutes constitute a population especially vilnerable to HIV infection. The high frequency of sexual intercourse, the high number of people who maintain contacts with the sex, ignoring for most of the time the state will be logical for them, the fact often suffer from sexually transmitted infections, drug use injected or infrequent use of condoms in private life, circumstances are linked to prostitution which increase the risk against HIV. Most of the work on HIV and prostitution have focused solely on women. The men and transsexual prostitutes two groups are not very visible, difficult access and those who barely information is available on its main caracteristiacas social and about their state of health. Main Objective: To describe the sociodemographic characteristics, working conditions, conducts risk for HIV transmission and prevalence of HIV infection in people who engaged in prostitution in Spain. This objectvo could not be obtained in a single study. Being a hidden population is difficult to obtain samples with a good representation, and therefore, the combination of several strategies in its study can provide a more complete picture of this reality. It was designed and carried out successively five studies with different designs and use different sources of information have led to five articulas published in scientific journals and that are presented in this thesis. The results described in conjunction present an overview of the relationship between HIV and prostitution in Spain. In composicón current groups of people engaged in prostitution in Spain highlights a significant proportion of people from other countries, mainly from Latin America, most of whom have never used drugs injected. This comes majority conincidente with the general pattern of immigration in Spain. The three colectívos studied, women, men and transsexuals are composed of young people, síendo the younger men practicing in the street. Present risk uneven in the workplace and in private. The injecting drug use is much more prevalent in transsexuals and men than in women. While in the three groups discussed the use of condoms with clients is widespread in the practices of higher risk, in their private lives much less women use condoms and that transgender men. Stresses the high frequency of accidents with condoms at the workplace in all three groups. The prevalence of HIV infection in the transsexual (22%) and in the homnres (12%) is much higher than that found in women (less than 1%), while among those who had injected drugs as those who never have been injected.

Author: PÉREZ ESCANILLA FERNANDO.
Year: 2004.
University: EXTREMADURA [More theses of this university] [www.unex.es].
Place of defense: MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: In this thesis applies a model of socio indicators for the assessment of the health of rural populations in Extremadura and its inhabitants. INTRODUCTION. There is a need to enhance the health community health centers work with easy and fast to implement, since public health studies are prácticamentee nonexistent by the difficulties of implementation. MATERIALS AND METHODS. We have studied a sample of 45 people selected randomly among the 369 existing in Extremadura in 2000. In each village appointing a local physician is responsible for completing the data collection instrument: it does in 90% of its parts. The statistical exploitation is carried out with SPSS. RESULTS AND DISCUSSION: The predominant activity of the rural populace extremeños agriculture is their average age is 45 years and more than 23% in excess of 64 years. Women are the first to abandon the people in the working age to return in retirement. The minimum time to meet an urgency for a service intensive care in an average of 46 minutes. Spending on medicines by pop / year is 224.85 and. The prevalence in the adult population in the ETS is 14.64% and diabetes 5.74% but are on the rise. The asthma and cancer in general is less prevalent than in the general population and the incidence of ischemic heart disease and infectious diseases is higher by déficis in public health in this case. The rate of admissions is high (8.15 queries / hr / yr) and the derivation of low (4.08%). In the ten years of study have been analyzed 8,160 dead. The death rate is equivalent to the whole. Women have lower mortality rates specific to men. The average age of the deceased is 77.65 years and women live 7 years longer than men. The cardiopatía Ischemic is the most frequent cause of death (20%) higher in the male victim of the metabolic syndrome, followed by cerebrovascular disease (16%) more frequent in women, and diseases of the lung (11%). CONCLUSIONS: The rural population has an extreme level of health equal to urban. There is a need for specific community health programs for boys and social impact on women. Many of the peoples of Extremadura are in sharp decline.

Author: CAICOYA GOMEZ MORAN MARTIN.
Year: 2004.
University: SALAMANCA [More theses of this university] [www.usal.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Lung cancer in Asturias is 40% higher than the Spanish average, the proportion of smokers is no different, but vegetable consumption is lowest. The objective of this study is to examine the relationship between lung cancer and snuff, consumption of vegetables and social class MATERIALS AND METHODS. This is a case-control study of incident type, based hospital. Cases were patients with a new diagnosis of lung cancer and controls were from the surgical services. The information obtained included tobacco habits, dietary and occupational exposures and demographic variables. The analysis was done by the Odds Ratio (OR). RESULTS. It was included in the analysis 197 cases and 196 controls. The consumption of cruciferous gender brássica was associated in the analysis crude to a lower risk of lung cancer when excludes adenocarcinomas, OR = 0.47, 95% CI: 0.23-0.95, Chi2 Trend 12.6, p 0,003. The adjustment makes confusores not be meaningful partnership. The adjusted OR smoking cigarettes was 5.77 (95% CI 2.96-11.22). The risk increased with the number of cigarettes smoked per day (chi 2 56.3) the number of packages / day (chi2 48.4) age at onset of smoking (chi2 76.5). The OR decreased with the number of years since quitting (chi2 39.9). Individuals in social class V, unskilled workers, had the highest risk of lung cancer than those who were classified into social classes I, II, III and IV, OR = 1.86 (95% CI 0,95-3, 62). The chi2 trend, was 4.23, p 0.04. Conclusions. The relationship between lung cancer and snuff in Asturias is similar to that found in other studies conducted in the western world. The magnitude of the OR may explain the frequency of lung cancer in Asturias. This study points to a protective effect of cruciferous gender brássica in lung cancer, as well as to an effect of social class.

Author: MARTINEZ RAMIREZ MARIA JOSEFA.
Year: 2004.
University: JAÉN [More theses of this university] [www.ujaen.es].
Place of defense: UNIVERSIDAD DE JAÉN CAMPUS DE LAS LAGUNILLAS.
Place of preparation: UNIVERSIDAD DE JAEN. COMPLEJO HOSPITALARIO JAEN.

Summary: The low-energy fractures (osteoporotic fractures) in developed countries constitute a public health problem because of its high rate of incidence, morbidity and mortality and increased spending to generate economic. Among the factors involved in its production, nutritional have the advantage that they can be modified. Of the nutrients that have been associated with the health of the bone tissue, the most studied were those related to the mineral component of bone (calcium and vitamin D), however other nutrients, which predominantly on the organic component of bone tissue, have also been associated with the production of osteoporotic fractures. Among this group of nutrients are protein, vitamin C, vitamin K, zinc, folic acid and lipids. They focused this study. To find the relationship between these nutrients and low-energy fractures in the elderly, are designed a case-control study of secondary basis, which consisted of a questionnaire (test Mini-Mental State, index ADL), food survey ( the questionnaire frequency of consumption semi), exploration anthropometric (weight, height, ÍMC, fold tricipital and waist circumference) and analytical determinations (blood, serum vitamin C, folic acid erythrocyte, serum zinc, total cholesterol, HDL cholesterol). The group of cases comprised people of 65 years old and over who had suffered a fracture of low energy, and the controls were selected in a pair 1-1 to cases by sex and age, among patients who had not suffered a fracture in the last five years. The sample size was defined as a function of the serum vitamin C, and was estimated at 151 cases and 151 controls. It was finally included in the study 167 cases and 167 controls. For the statistical study, categorical variables were considered the Odds Ratio (OR) and confidence intervals of 95%, and continuous variables was performed a test comparing averages (test of covariance), and was conducted in a partition quartiles, with estimates of the OR and his confidence interval, as well as trend analysis. The control of confounding variables was performed using stratified analysis and multivariate. There were no significant differences in the consumption of proteins and lipids, but it was found that the group of cases consumed a significant amount of increased polyunsaturated fatty acids and monounsaturated minor, and that it had significantly lower serum concentrations of vitamin C , zinc and HDL cholesterol. The low levels of erythrocyte folate were associated with increased risk of low-energy fractures in the elderly. In conclusion, high consumption of monounsaturated fatty acids was associated with reduced risk of low-energy fractures in the elderly. The low values of vitamin C serum, serum zinc, folic acid and erythrocyte plasma HDL cholesterol, are associated with increased risk of low-energy fractures in the elderly