EPIDEMIOLOGY (4)

Author: ESCOLAR REINA PILAR.
Year: 2006.
University: MURCIA [More theses of this university] [www.um.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Evidenciada that inadequate adherence to existing home exercises and physiotherapy sessions assistance is a problem among patients with back pain or cervicalgia, there have been several studies with the goal of identifying explanatory variables. There are no studies on the therapeutic adherence to other activities usually included in the council physiotherapy (self pain and self-backs) nor between different types of exercise (aerobics, specific), or components of dosage (frequency, duration). Moreover, most of the studies on factors associated with the council exercises or attendance at meetings, the selection of the factors in evaluating the prospect has depended on professional and / or scientific, ignoring the views of the patients themselves . Therefore, the objectives being pursued with the completion of this study are: 1. To explore the perceptions of patients with back pain or cervicalgia with regard to the relevant factors for adherence to the council physiotherapy and their interaction. 2. Describing the existing bond at the end of the treatment period physiotherapy council provided physiotherapy for patients with back pain and cervicalgia. 3. Explore potential explanatory variables through multivariate regression models to determine its relative importance as explanatory factors for adherence to various activities recommended by physiotherapists. To achieve these targets are used in a sequential manner different methodological approaches. To explore the perception of patients with respect to factors related adhesion technique is used qualitative focus group. The results, together with a review of the scientific literature on the subject, guiding the selection process variables for the next study. Through a descriptive study of longitudinal, are determined at the end of the treatment period the frequency of inadequate adherence to attendance at meetings, home exercises, the pain and self-self of the back or neck, and identify models explaining adherence to each such behavior bond. They are used as tools two questionnaires and a pre another post, and a record clinical ad hoc. The results of this study suggest that the group interviews are a useful and valid method for understanding the phenomenon of adhesion terapéutica.La bond inadequate physiotherapy council is a problem whose size varies depending on the type of activities. The explanatory models developed explain a percentage of the variability expresses very acceptable. According to the models: a) the waiting time is the only variable that predicts an organizational level of adherence to proper assistance at the meetings, b) the habits of health behavior can predict pre adherence to the home c ) physiotherapist can increase largely adherence to treatment physiotherapy reporting on the disease and the usefulness of the council, clarifying doubts, designing programs with a number of moderate exercise and monitor their learning d) beliefs on temporary barriers in the daily routine and self-efficacy also relate to their bond.

Author: NÚÑEZ GARCÍA DIEGO.
Year: 2006.
University: SEVILLA [More theses of this university] [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Introduction: Diabetes Mellitus (DM) is a chronic process that affects large numbers of people, and it is a problem of public health personnel and daunting, with the high prevalence of the disease globally. To know the magnitude of the problem, are indispensable cross epidemiological studies on the general population, which reveals the most accurate dimension of the problem and complications. In this regard, the declaration of Sant Vincent emphasis on the importance of attempting an approximation as possible to the actual epidemiology of diabetes in each European country to establish strategies for the prevention and treatment of diabetes and its complications. Assumptions and objectives: The hypothesis of our study is that the prevalence of DM2 in the province of Seville is higher than 6%. The main objectives are to estimate the prevalence of DM in the province of Seville, both diabetes known as the unknown (also prevalence of Impaired Glucose Tolerance and Impaired Glucose Basal) and compare different methods to estimate the prevalence of DM (methods analytical diabetes recorded consumption of drugs, surveys). Materials and Methods: A cross-sectional descriptive study (prevalence). The scope of study is the province of Seville with age greater than or equal to 18 years The sample was selected randomly from 15 municipalities in the province of Seville, depending on age and sex, using as a source of municipal sampling pattern. N = 542 subjects (prevalence of diabetes expected 6% confidence level of 95% (z = 1.96), precision 2%). It conducted a stratified random sampling polietápico. Results: valid sample of 537 (249 males and 288 females). The average age of 45.32 years (95% CI 43.93 to 46.71 years), the median is 44.23 years. The BMI half of the sample was 26.91 Kg./m2 (95% CI 26.47 to 27.34 Kg./m2), the median is 26.56 Kg./m2. The 50.8% of the people included in the sample presents overweight or obese. The 7.1% (95% CI 4.8-9.3) in the sample show DM2 known (Women 6.6% (95% CI 3.5-9.6) men 7.6% (95% CI 4,1-11,1). Prevalence of GVA of the sample is 5.2% (95% CI 3.1-7.2) and the TAG of 8.6% (95% CI 5.9 -11.2). Prevalence of DM2 unknown is 2.8% (95% CI 1.3-4.2). Crude DM2 in our sample (known diabetes more diabetes unknown) is 9.9 % (95% CI 7.25-12.42), men 11.2 (95% CI 7.12-15.32) and women's 8.7% (95% CI 5,25-12,10 ). our sample glycated hemoglobin, the capillary blood glucose and fructosamina, no discrimination diagnostic for DM2. Discussion: Overall turnout was 62.8% (95% CI 59.5-66.1) (n = 537), very similar to epidemiological studies of this nature. result of the study presents a crude DM2, the population aged 18 or over in the province of Seville, 9.9% (7.1% known and 2 , 8% unknown). Distribution of the DM2, in the various age strata established (15 years), have the highest rates specified in the last 2 layers (60-74 and older than 75 years), ie there is a prevalence in higher in the sample groups of people with older. sex-specific rates, is 11.2% in males and 8.7% in females. standardized rate for the population of the province of Seville more than 18 years is 10.1% to Andalusia this standardized rate for this population was 10.4% and for the Spanish population is 10.9%. Where are standardized rates for the world's population of Segi (30-64 years) (OR 3.5), and obesity (OR 8.6) and should therefore be screened for diabetes should make all people under the age of 50 years if present relatives in the first degree type 2 diabetics, obesity or being overweight. Se trata recommendations and similar to those recently published guidelines for scr 8 eening p 2f3 oblacional by the ADA.

Author: REBOSA DOMINGUEZ LUIS FERNANDO.
Year: 2006.
University: EXTREMADURA [More theses of this university] [www.unex.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE EXTREMADURA.
Place of preparation: UNIVERSIDAD DE EXTREMADURA.

Summary: INTRODUCTION Suicide is a universal phenomenon which has been present in the history of mankind from its principles. And although historically has been given in different societies treated very dissipate today becomes very important coming to represent a real public health problem. OBJECTIVES Knowing that the rate of suicide consummated occurred in Raya Extremadura during the decade 1990-1999. It identifies the characteristics of the suicidal act and the victim, evaluating factors such as personal and social risk factors. It is also set out a series of proposals for intervention from Primary Care (PA). DESIGN retrospective epidemiological study. MATERIALS AND METHODS Sources used are judicial records in which concludes a medico-origin suicide as a cause of death on file with the Court of First Instance and Instruction of the six that make up the Judicial Party Raya Extremadura. Of the diligence and judicial police are extracted the data according to our protocol were of interest doing descriptive statistics and hypothesis by contrast SPSS 11.0. RESULTS During the decade 1990-1999 are recorded in the bay of Extremadura, a total of 339 deaths medical etiology of suicide an average rate of 8.10 suicides per 100,000 inhabitants and years. This far exceeds the rate you get by using data supplied by the National Statistical Institute for the same period in Extremadura (5.13) and for the whole of Spain (5.38). The specified rate is higher in rural than in urban areas. It is more common in men with a man / woman from 3 / 1. The largest absolute number of suicides and the highest average specific rate, in excess of 18 suicides per 100,000 inhabitants per year, are among the largest in 64 years. Predominantly suicide consummated between married and this is true in both sexes. The predominant activity in the suicide bordered Extremadura is the pensioner. The hours of the night are preferred to consummate suicide followed by the evening. In absolute terms the method used most often is the ahorcadura with differences between the two sexes: males while predominates ahorcadura in women is more frequent rainfall and flooding. In 70% of cases could be a possible cause or trigger Precipitating suicide, and dominated the history of psychiatric pathology. In less than 15% of the cases there is an attempt autolítico prior and just over 10% are written notes, most of justification of the act. CONCLUSIONS The profile of suicide bordered Extremadura is a married man, a resident of rural core, more than 64 years, usually retired, with a history of mental pathology, which consumes suicide over night paralo which employs generally ahorcadura and that is not conducive to leave written notes. The doctor AP as a first level of care is one of the players involved in the prevention of suicide phenomenon.

Author: VALLÈS CASANOVA FRANCES XAVIER.
Year: 2006.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Author: GONZALEZ ARRIAGA PATRICIA.
Year: 2006.
University: OVIEDO [More theses of this university] [www.uniovi.es].
Place of defense: INST. UNIVER. DE ONCO. PRINCI.DE ASTURIAS.
Place of preparation: INSTITUTO UNIVERSITARIO DE ONCOLOGIA DEL PRINCIPADO DE ASTURIAS.

Summary: Lung cancer is one of the major health problems in industrialized countries. Its development is mainly due to the influence of environmental factors, such as snuff, which is the main risk factor. Despite this, several studies suggest the existence of genetic factors that contribute to the development and evolution of lung cancer. The metaloproteasas of extracellular matrix (MMPs) are proteases able to degrade all the components of the extracellular matrix, so that its expression is increased in many processes tumor. This study has investigated the relationship between polymorphisms in the promoter of the gene of MMPs, belonging to the families of the colagenasas (-1607 1G/2G MMP1, +17 C / G MMP8 and -77 A / G MMP13), gelatinasas (-735 C / T MMP2 and -1562 C / T MMP9) and estromalisinas (-1171 5A/6A MMP3) and the risk of developing lung cancer as well as an estimate of the survival of the cases already diagnosed, a case control study base hospital in which they collected 501 incident cases of lung cancer and 510 controls matched by age, gender and area of residence. Different genotypes were determined by PCR-RFPL and the results were analyzed by logistic regression. It has been found that polymorphisms in the promoter of MMP1 and MMP13 not associated with the risk of developing lung cancer, however appear to increase the survival time after diagnosis. By contrast, polymorphisms in the promoter of the gene MMP2 and MMP9 appear to protect the risk of developing lung cancer and is associated with better survival. On the other aldo, polymorphisms in MMP3 seem to be associated with some protection and improved survival in certain groups of stratification. In conclusion, our results suggest that polymorphisms in the promoter of the gene of MMPs may contribute to individual susceptibility to developing lung cancer and modify the survival time after diagnosis.

Author: MARTÍNEZ-PUGA Y LÓPEZ ELISA LOURDES.
Year: 2006.
University: LEÓN [More theses of this university] [www.unileon.es].
Place of defense: FACULTAD DE VETERINARIA.
Place of preparation: HOSPITALES PÚBLICOS DE GALICIA (LA CORUÑA Y LUGO).

Summary: Malnutrition in hospitals is set at around 45-65% of patients admitted and poses an added problem for the patient who suffers and their entire environment. The first point of attack is to act to prevent it, analyzing nutritional screening first, and an assessment of nutritional status later, though, there was no consensus on which are the best method for each of the processes. With this work the proposed objectives were: 1, - Knowing the prevalence of malnutrition among the population of patients admitted to public hospitals in the north of Galicia. 2-Know the types and degrees of malnutrition prevalent in this population. 3-Know the main risk factors associated with the presence of malnutrition in our hospital and their relationship to the basic pathology. 4-estimate the validity of the methods of screening for malnutrition through its correlation with nutritional diagnostic methods, in order to select the most sensitivity and specificity for our environment. 5, propose feasible and reliable methods for screening, diagnosis and monitoring of malnutrition hospital in Galicia. The methodology of work has been the study of a random sample of adult patients on any given day (+ -2) were admitted to public hospitals in the public of the Northern provinces of this Community. We evaluated parameters antorpométricos and biochemical as well as your intake and physical capacity in the last 3 to 5 days. As a result, have been studied 190 patients in medical and surgical areas. The third had already lost weight and half of them did a complete diet. We found a significant deterioration of the functional capacity (58.3%). Applying the METHODS OF SCREENING for the risk of malnutrition are different figures: Cardona -48.9%, Elmore-20, 1%, Conut-51, 1%, Must-41, 9%, NRS-2002-38, 6% (Pearson R = 0597, P less 0001) THE DIAGNOSIS NUTRITIONAL was established by the Valuation Subjective Global (47.2% undernourished), and according to Chang detected some degree of malnutrition in 66.9% of patients, where Most see their affected compartment proteico-visceral (46.1%), followed by the allocation of exclusive compartment protein (32.5%). STUDY DIFFERENTIAL: Applying contingency tables of scale compared to the other determines the reliability and predictive ability of each to detect malnourished patients whose values comparáramos with the method described by Cardona considered the "Golden method for detecting malnutrition in patients hospitalized; find values precitivos above 72.2%. Doing the same for the methods of diagnosis and Nutrition compared the results with the predictive value of 72.2%. Doing the same thing paralos methods of diagnosis and Nutrition compared the resutlados with the Global Assessment subjective, noting a significant positive correlation (p less 0.0001) for the type and degree of malnutrition regarding VGS. How conclusion of this study is detected a prevalence of malnutrition around 50.5%, mainly visceral compartment protein, and perhaps the risk factor identified is the most important age. The scales diagnostic nutritional exhibit excellent correlation, especially Cardona, and the nutritional assessment methods both have great diagnostic accuracy. It also presents a strategy for diagnosing malnutrition I.

Author: NAVARRO GINÉ ALBERT.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAT DE MEDICINA.
Place of preparation: FACULTAT DE MEDICINA.

Summary: Every time there is an increased interest associated with the need to implement methods of analysis of the survival data sets with multiple observations by individual. This includes multiple occurrences of the same event and many different types of events. Sample first could be the number of readmissions of a patient after an operation, while an example of the second would be the set of complications that can occur shortly thereafter. It is defined as a recurring event that in the event that an individual may submit more than one occurrence. They are defining characteristics of this kind of events: that the occurrences can not occur simultaneously in a single subject and that, therefore, there is a management logic of the same, (as opposed to the occurrence of many events that they can agree the time on the same person). In the context of analysis of the occurrence of recurrent events there are two key issues: the dependence of occurrence and the individual heterogeneity. The unit courrencia refers to the possibility that the occurrence of an event on the risk of a new occurrence in the individual who has suffered, while the individual heterogeneity links with the idea that some individuals have a higher (or lower) , the risk of presenting a ocrrencia other effects due to unknown or unregistered. This paper focuses its interest in the study of the models called marginal since it is considered now presentna the best alternative to the analysis of recurring events. Specifically, the approaches proposed by Andersen and Gill (GA), Wei, Lin and Weissfeld (WLW) and Prentice, Williams and Ptersen (PWP), who are conceptually best ajsutan analysis of recurring events. It also revises the fragility models, specifically the most used in the context appellant, which is the model of fragility gamma comaprtida because it is assumed that sometimes concrete high heterogeneity individual can be an interesting alternative and simple way for who knows marginal models. Thus, in the first chapter will be of interest to the justification of this work and define the assumptions and objectives that have motivated. Then, in the chapter on inserting, is a review of the multiple methods, which have been used for the analysis of the occurrence of an event and its associated factors. It was part of the classic methods of standardization, in accordance with the modeling fee mediane the Poisson distribution. Ste Jan point describes the possible causes and consequences of the phenomenon of sobredispersión, which invalidates the use of distribuicón Poisson and the problems it represents, at the aggregate level, which can generate an improper analysis of recurring events. The following are alternatives to the Poisson model if sobredispersión placing special emphasis on the most commonly used, the Negative Binomial model. He then introduces the analysis of survival as instantaneous analysis of the occurrence of an event, and finally presents the model of Cox proportional hazards. The following chapter, methods, is divided into three sections. The first detailed approaches to the analysis of the occurrence of an event recurring instant introducing the formulation countign process as a prelude to describe in detail marginal models in a broad context of multivariate analysis of survival. Subsequently reflected in the analysis of recurring events with models Andersen and Gill, of Wei, Lin and Weissfeld and those of Prentice, Williams and Peterson. Below are the main features of the model gragilidad, especially the fragility gamma shared. The second section presents the example from l which were generated substudies used for various rea 8 lizar the 933 compraicón of models of interest. It also provides analysis of the strategy designed to achieve the proposed objectives. Regarding the example it can be said that this is not anything other than precisely an example. The intent of the analysis of these data, in this case, not designed to obtain any results extrapolates to the field of occupational health, simply used to illustrate the use of statistical methods that you really are the object of study of this work. Finally, it presents a jemplo specific elq ue applies deeper models discussed. The last paragraph refers to the statistical software used. The fourth chapter corresponds with the results and is divided into three sections. The first presents the resutlados obtendiso for each of the substudies selected for ejempalrizar implementation of the various models, following the strategy raised analysis methods. The second performs a summary of the results of the three substudies in order to facilitate comparison at apliación of models. The third section presents the results of such implementation. Following is the discussion. This has been structured into five blocks, which are: 1 .- Detection dependence on single occurrence and heterogeneity. 2 .- Analysis Models occurrences accumulated in front of analysis models the occurrence instantly. 3 .- models with common baseline risk compared to models with specific baseline risk. 4 .- Models marginal compared to models of fragility. 5 .- WLW adequacy model for the analysis of recurring events

Author: MARTINEZ ALVAREZ NOELIA.
Year: 2006.
University: OVIEDO [More theses of this university] [www.uniovi.es].
Place of defense: EDIFICIO CIENTIFICO TECNICO.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Summary: The salmonella no-tifoideas that cause infections in humans today are often epidemic and antimicrobial-resistant (R), as well as virulent (V). The evolution of bacteria in the acquisition of determinantes-Vy / R is primarily due to the incorporation, often sequential pieces of DNA, the combination of which creates new genetic elements, which are immediately subject to selection naturally in a changing environment. The genes-Vy-R can be isolated, forming small clusters (islets) and / or larger groups (genomic or pathogenicity islands), and can chromosomal location or plasmídica. The genes-R, once selected, can be kept in bacteria originating and their offspring or bacteria spread among more or less connected through the mobile genetic elements (EGMs) among which the system integrón-casete gene, transposons , plasmids and genomic islands of resistance. In this thesis studies were carried out on molecular epidemiology in 176 isolates of Salmonella enterica serotype belonging to three non prevalent, but causing epidemiological alerts: Hadar, Brandenburg and Ohio. It was determined the epidemiological impact of the same, identifying the types prevalent and endemic in the Principality of Asturias and his possible presence in other geographical areas. The subtypes were traced through analysis macrorrestricción genómica-PFGE and genotipos-Ry-V. As an example we must subtypes prevalent Hadar may be considered endemic in Spain and one of them caused a national outbreak associated with the sauce grilled chicken business in 2005. Studies of resistance revealed a large percentage of strains with multiple resistance (MR) and a correlation between this and the presence of EGMs. In the three serotypes were identified plásmidos-R, variable size (9-300 Kb) and different genotipos-R, most of whom were conjugativos. In isolates with MRI of Brandenburg and Ohio, but not Hadar, was detected integrón class 1 (1600/dfrA1-aadA1), associated with transposons type Tn21 and these, in turn, Tn9. In those resistant to tetracycline was found transposons type Tn1721 and Tn10, carriers of genes tet tet (A) and (B), respectively. This is the first time that we study the profiles genes-R in plasmids serotype Hadar and organization of EGMs involved in MRI serotypes in Brandenburg and Ohio. The determination of perfiles-V revealed slight differences intra-serotipo in the case of Hadar and Brandenburg (presence / absence of sopE). Variations inter-serotipo were seniors Hadar lacked genes agfA, sugR and rhuM present in the other two serotypes, whereas all isolates of Ohio filed a gene sugR delecionado and were negative for sopE. All isolates had the five islands of pathogenicity (SPI1-5) identified in the type strain S. Typhimurium LT2.

Author: MORCILLO ESPINA SONSOLES.
Year: 2006.
University: MÁLAGA [More theses of this university] [www.uma.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA - UNIVERSIDAD DE MÁLAGA.

Summary: Diabetes mellitus is one of the major health problems in the world. The type 2 diabetes accounts for 90-95% of cases of diabetes. This type of diabetes comprises a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. Diabetes is a complex disease in which genetic and environmental factors. The alterations in one or both factors may cause insulin resistance and / or alterations in the secretion of insulin which would result in a hyperglycaemia and ultimately lead to the onset of diabetes. We need to look at two factors and the interactions between them to find potential mechanisms that may be involved in the etiology of diabetes. In this work we have studied genetic polymorphisms of the following candidates: CLUSTER APOA1/C3/A4 (polymorphisms Xmnl and 75G / A gene APOA1 and polymorphism Sstl gene APOC3), the polymorphism Ala54Thr gene FABP2, polymorphism Pro12Ala gene PPARG2 and Trp64ARg gene ADRB3. It has been studied as a factor environmental intake of fatty acids from the diet. This work raises the search for interactions gen-gen and gen-dieta in a town in southern Spain (Slate) who may be implicated in the etiology of diabetes. Among the specific objectives is to evaluate the influence on the pattern of insulin resistance of the population both polymorphisms studied diet and evaluate the influence of interactions gen-gen and gen-dieta on the risk of developing diabetes type 2 or any of the disorders associated with the metabolism of carbohydrates you. The work has been conducted in 1226 subjects of the population of Slate (Malaga) aged between 18 and 65 years. In all subjects was conducted clinical assessment, anthropometric and biochemistry, including a test of oral glucose tolerance (OGTT) (75 g) and genotipado polymorphisms by PCR and RFLP in real time. The results have led to the following conclusions: 1-polymorphism 75G / A gene APOA1, within the cluster Apo AI / C-III / A-IV is associated with the risk of type 2 diabetes regardless of age, sex, obesity and insulin resistance pattern population, all of them well-known risk factors such as diabetes, regardless of the levels of HDL-cy plasma triglycerides whose association with the metabolism of Apo AI is well known in the answered the metabolic syndrome. 2 - There is an interaction between the polymorphism 75G / A gene APOA1, and polymorphism Trp64Arg gene ADRB3 and the risk of developing type 2 diabetes. The presence of the two variants of both polymorphisms increases the risk of glucose intolerance and type 2 diabetes. 3 - The presence alone of polymorphism Trp64Arg gene ADRB3 is not a risk factor for the development of some of the metabolic disorders hidrocarbonado. 4-People with the allele Ala12 of polymorphism Pro12Ala gene PPARG2 have a lower risk of developing type 2 diabetes, regardless of age, sex, obesity and pattern population insulín resistance. 5 - There is an interaction between the polymorphism Pro12Ala gene PPARG2 and monounsaturated acid intake on the pattern of insulin resistance population. The obese, with the allele Ala12 and lower consumption of monounsaturated fatty acids show greater values of the index of insulin resistance HOMA-IR. 6, - The effect of the fatty acids in the diet on the pattern of insulin resistance population is not independent of polimorifsmo Ala54Thr gene FABP2, with an interaction between the polymorphism and intake gra 8 sa the 1b4 diet in the study population.

Author: SOLER GONZALEZ JORGE.
Year: 2006.
University: LLEIDA [More theses of this university] [www.udl.es].
Place of defense: FACULTAD DE MEDICINA..
Place of preparation: FACULTAD DE MEDICINA.

Summary: Introduction: The increase in our environment of the immigrant population, produced in a relatively short time, requires us to consider the health status of this population and the use of services that our health care system provides them. Objectives: To identify and characterize the state of health of several groups of immigrants residing in the city of Lleida, through discussions of labor temporary disabilities, the frequency of use of health services, medication use and urgent care hospital . Metología: In the first part, we conducted a study observational, cross multicenter 1,699 patients of immigrant origin, served in the Primary Care (AP) 5 Areas Basic Health (ABS) in the city of Lleida during March 2005 and August 2005. For comparison was obtained a random sample consisting of 4156 patients natives. Immigrants were grouped into five areas of origin. The dependent variables were introduced in the software e-CAP (station Primary Care clinic) and extracted from the same clinical data were obtained and patronage. The information concerning the requirements was received directly through the Registry of Pharmacy and from the database of the Department of Pharmacy at the ICS Lleida. Computerized registration was obtained from the following variables: age, gender, diagnostic coding (ICD-10), episodes of low labor with the various reasons and duration of the low, visits and finally made the derivations. He then conducted an observational study was descriptive of all hospital emergency room treated in the University Hospital Arnau Vilanova Lleida during the period 1-1-2004 to 31-12-2005. We extracted utilization rates of emergency department by restricting the study to residents in Lleida city where he knew denominators population depending on the place of origin of the residents in Lleida at the midpoint of the period estudio.Como registration system is using computerized medical records and it is extracted the following variables: age, sex, country of origin, current place of residence, number of visits, the high diagnostic coding (ICD-9), number of hospital admissions, grounds income Hospital, the number of days of stay and discharge hospitalaria.Análisis statistical destinations: Study of the immigrant population and indigenous utilized primary care: study disability (IT). We performed a descriptive analysis of the percentage of individuals who suffered IT and total days of IT. We used Poisson regression models to estimate the relative risk (RR) of getting as IT area of origin. For individuals who suffered IT took linear regression models, in order to assess the effect of varying age, sex and area of origin in the total days of IT during the period studied. Given the skewed distribution of the variable total days of IT, we used the log transformation of the same as the dependent variable. Study of admissions at the various services for Primary Care. It described the visits in the different services of AP and distribution frequency of visits specialties. We used multinomial regression models to estimate the relative risk of having carried out the visits. Study of pharmaceutical expenditure: A descriptive analysis of pharmaceutical expenditure and adjusted multinomial regression models, which resulted in estimating the relative risks of making spending low, moderate or high, depending on place of origin. We studied prescribed medications both immigrants and the native population groups forming therapeutic. It also collected the number of patients treated during the study period for each group therapy, the number of containers required, the total cost represe 8 ntaba the 1100 group therapy and finally spending per patient. Study of the immigrant population and native who used the emergency department: It described the demographics of individuals served and an estimated attendance rates (number of visits per hundred inhabitants and year) based on residents in the city of Lleida . It analyzed the number of visits per person and distribution of diagnoses. Were adjusted multivariable logistic regression models for obtaining odds ratios of hospital admissions according to the characteristics of patients and their provenance. Results: 51.2% of the immigrants who participated in the study were men of the PA, with a mean age of 30.5 years (13.8). The origin of the patients was: Latin America (30.1%), North Africans (27.1%), Eastern Europeans (22.8%), and SSA (18.2%). A 11.1% of immigrants had some episode of IT, compared to 13.2% of the natives. The average length of IT was 19.4 days in immigrants and 33.5 days in the West Papuans. The adjusted relative risk of IT among natives regard to immigrants was 1.69 (95% CI: 1.42, 2.00). The duration of the IT natives was 1.5 times higher than those of immigrants. Among the individuals who attended the AP the number of visits in general medicine was 7 times higher among immigrants than in the vernacular while nursing the number of individuals who attended the consultation was 0.6 times lower in immigrants in the West Papuans. The most frequent cause of IT in immigrants was dorsalgia (21.8%), followed by upper respiratory acute (9.3%) and gastroenteritis (5.1%). The pharmaceutical expenditure by the locals was a 41% higher than caused by immigrants. In the emergency department Hospital Arnau Vilanova Lleida during the years 2004 and 2005 were carried out a total of 168,111 visitors, of which 17% were immigrants, with the average age of these past 29 years old face average age was 40 years for natives. The 4.7% of the visits came from North African patients, 4.2% in Latin America, 2.3% of immigrants from Eastern Europe and 2.9% in SSA. The largest group of immigrants to the collective processes diagnosed was the injury and poisoning (22.7%), virtually the same as that of natives (23.7%). In the pediatric age group, the first three classes of most frequent diagnoses were equal in both groups (upper respiratory infections, gastroenteritis, and general symptoms). In men, there was a 38% local revenue in more immigrants (95% CI: 1.26-1.51). As for women, the number of entries in native was reduced by 16% compared to that of the immigrants (95% CI: 0.79-0.88). Conclusions: Among the people who came to visit the centers AP, immigrants are visited more frequently both in general and in medicine specialist care and use up more evidence that the natives. Immigrants have fewer IT and they are less durable. The causes of IT are similar in both groups. Immigrants spend less on pharmaceuticals that the indigenous population. Immigrants come more frequently Hospital emergency department and immigrant women entering more times in the hospital, as a result of increased numbers of births. However, the reasons for consultations at the hospital do not differ significantly in both groups.