PREVENTIVE MEDICINE

Author: FERNÁNDEZ MUÑOZ JESÚS.
Year: 2001.
University: REY JUAN CARLOS.
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: The prevalence of cardiovascular risk factors in hypertensive patients with diabetes mellitus studied is very high, obesity being the fector risk of increased prevalence. More than half the patients had high cholesterol levels. Another aspect of the doctoral thesis was to assess treatment with doxazosin and in this sense we can say that the treatment was very effective in reducing hypertension influencing both systolic blood pressure in the diastolic. The strict control after 16 weeks of therapy was achieved in 33% of patients. There was no relationship between the degree of control of hypertension and consumption of snuff, alcohol or the presence of obesity. The variables that influenced this control were blood pressure, systolic and diastolic baseline. The factors that influence glycemic control prepandrial the end of the study were: blood glucose prepandrial baseline, baseline diastolic blood pressure, hemoglobin baseline. Those who influence glycemic control postpandrial were BMI, blood glucose postpandrial baseline. Those who influenced the control of hemoglobin A1C were hemoglobin A 1c and cholesterol baseline. The prevalence of adverse events with doxazosin was 2% and appeared more frequently cefales, dizziness, and orthostatic hypotension.

Author: GUIX OLIVER JOAN.
Year: 2003.
University: ROVIRA I VIRGILI.
Place of defense: MEDICINA.
Place of preparation: UNIVERSIDAD AUTÓNOMA DE BARCELONA.

Summary: One feature of the doctor-patient relationship is the asymmetry of information, which involves the establishment of a power relationship with the doctor's respect for the patient, which, at times, may affect their autonomy and dignity. As derivation of the Declaration of Human Rights, in the United States, the year 1973 was made the first statement of the Patient's Rights, in the Spanish State reflected in the inclusion of a set of rights of the patients included in the General Law on Health. In this paper examines the expectations and perceptions of expacientes, doctors and nurses from two hospitals in the Health Sector Reus, through a survey compiled from focus groups, and subsequently validated. The results indicate that patients want to be informed, but that the 37.9% did not want to participate in decisions affecting them, and even a 28% believe that they can not refuse to take their decisions regarding their own medical health. Patients want the confidentiality and privacy respected them. Mainly seen as positive the existence of some patient rights. A 5.5% have felt offended or embarrassed during his hospital stay. For doctors, the existence of patients' rights is not seen as a problem or as an interference and a 51.5% believe they can positively change the relationship médica-paciente. A 48.1% claim to know the rights of patients, while a 35.2% openly accept them unaware. A 20% believe that the patient is the only one who should decide what it wants to be done to cure their illness, while a 65.5% disagree and a 7.5% do not believe that patients want to take part in decisions affecting their illness, while a 79.5% think so. A 38.8% of the nurses surveyed are as counsel patient, even when a 39.8% do not feel well. There is an ambivalence on the part of nurses, regarding it the patient is the only one who has to take the decisions (favorable 44.1%, negative 42.0%). Through the Principal Component Analysis Categóricos (CATPCA) noted that the two dimensions more explanatory, in the three groups, information and the ability of decision.

Author: RENGIFO ABBAD DIEGO.
Year: 2003.
University: REY JUAN CARLOS.
Place of defense: CIENCIAS DE LA SALUD.
Place of preparation: UNIVERSIDAD REY JUAN CARLOS.

Summary: Descriptive cross validity of diagnostic tests for the diagnosis of patients with renal colic clinic. It was performed in all patients Rx simple, ultrasound, Urografía and without contrast helical CT and discusses rates diagnostic validity of each test. The results of each test image are: Sensitivity Specificity VPP VPN Global Value Rx mere 65.7% 83.3% 90.2% 51.4% 71% Ultrasonography 29.6% 100.0% 100.0% 29 , 6% 45.7% Urografía 52.9% 93.8% 93.4% 31.3% 60.5% Eco Rx + + IVU 79.7% 62.5% 90.2% 41.7% 76 , 5% TACh 100.0% 95.8% 97.4% 100.0% 98.4% were compared different imaging studies with the test MF Nemar with the result of better validity diangóstica of which helical CT with each test separately and together (p less 0001) for the diagnosis of lithiasis in patients with cólicol kidney. It has also been shown the diagnostic validity of the indirect signs for the diagnosis of lithiasis with an aggregate value (grouped) 91.9%. CONCLUSIONS 1, - helical CT has obtained a valid diagnostic idela almost perfect for the detection of lithiasis with a total value of nearly 100%. 2, - ray, ultrasound and Urografía intravenously, have an aggregate value for the diagnosis of lithiasis below 80%. 3, - helical CT has a very high sensitivity and specificity for diagnosing lithiasis (over 95%), pacietnes with colic renoureteral complicated. 4 - The combined strategy (Ultrasound Radiography + + Urografía), it has not achieved adequate global validity although it has been closer to 80%. 5, - helical CT, has introduced greater validity compared to the diagnostic X-ray, ultrasound and Urografía separate and joint strategy. 6, CT-h elicoidal allows us, a proper assessment of the degree of obstruction of the urinary track by lithiasis by intepretación of indirect signs.

Author: ESTEBAN HERNÁNDEZ JESÚS.
Year: 2003.
University: REY JUAN CARLOS.
Place of defense: CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: Studies on the infectious load as a risk factor for cardiovascular have so far been carried out in EE.II, Canada and Germany, seroepidemiológicos different contexts to our own. Therefore the objective of this study is to analyze whether the burden infectious defined as the sum of seropositivity (IgG) to five family Herpesviridae virus (Cytomegalovirus, simple Herpes type 1, Herpes simple type 2, Epstein-Barr Virus and Virus Varicella Zoster), the virus of Hepatitis A and Chalmaydophila pneumoniae is associated with chronic ischemic heart disease, and determine the extent to which this effect is independent of whether or not the levels of protein C Reactive ultra determined by the technique. With this goal, a longitudinal observational retrospective analysis of cases and controls matched by age and sex. Cases were recruited from among patients aged between 35 and 76 years with a history of acute myocardial infarction [CIE-9-MC: 410412] or Angina pectoris [CIE-9-MC: 413] and the present diagnosis Chronicle of Ischemic Heart Disease [CIE-9-MC: 414]. The controls were selected at the heart of health among those in the same age range without a history of acute coronary syndrome, prior myocardial or cerebral thrombosis or embolism and without clinical signs of advanced atherosclerosis (amaurosis fugax, caludicación intermittent ..). The Odd Raio and their confidence intervals were calculated using the McNemar test. Multivariate analysis was performed using conditional logistic regression. The conclusions of the thesis are: 1 - The seroprevalence for Chlamydophila pneumoniae IgG found in cases of chronic ischemic disease of the heart (53.3%), is not significantly different from that found in its controls matched (62.2%) , and is similar to that found in other studies. 2 - The high serprevalencia IgG found to Citomegalorivurs, Virus-Espstein-Barr, Varicella Zoster virus, herpes simplex type 1, and the Hepatitis A virus among cases of chronic ischemic heart disease, is not different from that of its controls paired and concurs with the previously found in the general population. 3-None of the cases were seropositive for Herpes Simplex Type 2. Despite this we can not say that the seroprevalence is different from what is found between controls, and in turn found in the general population for this age group. 4 - The high seroprevalence for IgG found Cytomegalovirus, Epstein Barr virus, Varicella Zoster Virus and Herpes simplex virus type 1 and Hepatitis A, carries a high burden infectious in our study, and is consistent with the context in which it has seroepidemiológico been done. 5, - Reactive Protein C concentration was not different in terms of serpositividad for any of the infectious agents in question, nor was it different to make that comparison in cases and controls separately. 6, - Reactive Protein C concentration was not different between the strata laid down for each one of the definitions of cargo infectious, nor when such comparison was made in cases and controls separately. 7 - The classic risk factors, especially high cholesterol and diabetes mellitus, were significantly associated with the disease. 8 - The concentration of plasma homocysteine has shown a strong association with the disease. 9-Subjects used as a healthy controls from the same health center cases, has 8 No one on 335 escape prevalence of risk factors classics, and agrees with previous studies found.

Author: REVIRIEGO ALMOHALLA BLANCA.
Year: 2003.
University: REY JUAN CARLOS.
Place of defense: CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD, UNIVERSIDAD REY JUAN CARLOS.

Summary: OBJECTIVE determine the quality of life in hypertensive patients with erectile dysfunction of any etiology treated with sildenafil in terms commonly used in the field of Primary Health Care, setting the couple's satisfaction with the treatment of erectile dysfunction with sildenafil and evaluating its effectiveness and safety in these patients. METHODOLOGY conducted a quasi-experimental study, antes-depués open non-comparative, propsectivo, multicenter quality of life. The sample consisted of 741 patients with erectile dysfunction and hypertension removed from the total of 2816 patients who were part of the study IDEAP, followed by treatment with 50 mg of sildenafil orally one hour before sexual activity with a maximum frequency of administration once daily. The dose could be adjusted between 25 and 100 mg. In accordance with criteria of tolerance and / or effective for a period of 3 months (minimum 10 weeks). To assess the impact of sildenafil in quality of life and effectiveness of using validated questionnaires the following: Life Satisfaction Check List (LSCL), International Index Eréctil Function (IIEF) Satisfaction Index and the Treatment for Eréctil dysfunction, the pair version (EDITS). RESULTS All aspects of LSCL experienced percentage increases, with greater sex life (32.57%) and with loved ones (19.41%). The majority of couples (91.42%) declaraon feel somewhat or very satisfied with the treatment. The largest percentage increases in the IIEF were for erectile function (44.40%) and function orgasmic (41.88%). At the beginning of the study, according to the IIEF the 60.32% of the patients had severe OF character, the finalizarle, most (53.04%) had erectile dysfunction mild and 37.33% completed without erectile dysfunction. Almost all the patients (96.55%) treatment with sildenafil improved their erections and more than half of the patients (66.51%) had a higher frequency of spontaneous erections. CONCLUSIONS All aspects of LSCL and dimensions of IIEF experienced percentage increases were statistically significant. Treatment with sildenafil in the field of primary care has improved the quality of life of patients with erectile dysfunction and hypertension through the improvement of erectile dysfunction with a favorable profile of effectiveness and safety and regardless of antihypertensive treatment, factors risk or age.

Author: DIAZ FRANCO M. ASUNCIÓN.
Year: 2003.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA . UNIVERSIDAD COMPLUTENSE.

Summary: This abstract discusses the state of resistance to first-line anti-tuberculosis drugs in our country. Following recommendations, estimated the prevalence of drug resistance combined primary and adquirída is investigarón factors asociados.Se conducted a cross-sectional study with prospective collection of cases with culture-positive pulmonary tuberculosis in 41 public hospitals in 12 autonomous communities, selected through a sampling complex design (January 2002 and June 2003). information was obtained clínico-epidimiológico of history clínica.El pattern of drug sensitivity was conducted in three laboratories follow standardized methods according to the Global Monitoring Project Resistances of the World Health Organization and the International Union Against Tuberculosis and Lung Disease (WHO / UICTER). 1132 cases met inclusion criteria of the study: 70.7% (95% CI :67,8-73, 5) were male, 60% (95% CI 56.1-64.0) had less than 45 years and 9, 4% (95% CI :7,2-12) had received prior treatment for tuberculosis.La combined prevalence of resistance to any drug was 6.3% (95% CI 4.8-8.1); of 5.6% (95% CI 4.1-7.7) and primary resistance acquired 13.2% (IC8 ,9-19, 1). multidrug combined was 0.5% (95% CI 0,2-1, 1), the primary 0.4% (95% CI 0.1-1.0) and learned of 1.9% (95% CI 0.5-7.0). were analyzed variables associated with the resistance through modeling Multivariate regression logística.La resistance combianda was associated with pre-treatment (OR = 2.6 95% CI 1.5-4.4) and the age of 30-40 years (OR = 2.2, 95% CI: 1, 0-4,9), the primary resistance with the group of 29-39 years (OR = 2.2 95% CI 1.0-3.9). No single factor was related to acquired resistance. The results show moderate rates of resistance framacorresistencia.La association with the pretreatment reinforces the need to improve adherence to therapy in all patients and the involvement of young adults suggests a worst TB control prior to the introduction of combination therapy .

Author: MORALES LORÓ IRENE.
Year: 2003.
University: COMPLUTENSE DE MADRID.
Place of preparation: FACULTAD MEDICINA.

Summary: Introduction: The lack of consensus on the indications of hysterectomy, bilateral ooforectomía collision and concomitant, a scenario involves itself for variations in the práctiva médida this procedure, having been raised as an objective in this study to determine the rates of hysterectomy in Spain in hospitals covered by the CMBD among añós 1997 and 2000 and describing variations depending on the age, in time, geographical and depending on the type of hospitals, in the rates of hysterectomy, their approaches, ooforectomía bilateral indications, statistics, stay and complications. Materials and methods: Studies observations cross descriptive analytical components of all women wings that they made a hysterectomy, performing from CMBD and the National Catalog Hospital. Results: 139,458 hysterectomies, annual rate: 172/10-5 women; way: 68% and 27% abdominal vaginal; 48% OBC; indications Frequently: liomioma (41%), prolapse (24%) and malignant neoplasms (14 %); average stay 9.38 days from 6.34; complications: 12%. There were variations in the rates of hysterectomy, collisions, ooforectomia biliateral concomitant indications, complications and stay, in relation to age, between 1997 and 2000, by hospitals and by CAAC (component systematic variation in the rates of hysterectomy: 1.32 and 2.54 in those from neoplasms melignas). Discussion and Conclusions: The existence of geographical variations and hospitals could reflect inequalities in the efficiency and fairness of the National Health System, and may suggest an improper use of hysterectomy and problems in the decision-making process clínicas.Hace lack deepen in research results salusd in addressing the pathology ginecologíaca will reach a greater consensus on the appropriate use of hysterectomy and its implementation through guides práctiva clinic and improve women's participation in the process of making decisions about their health.

Author: MORENO BUENO M. ÁNGELES.
Year: 2003.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD AUTÓNOMA DE MADRID.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD AUTÓNOMA DE MADRID.

Summary: The derived demand is a process common in the area of primary care, and other procedures, it is characterized by a large variability. There are many factors that influence the process of derivation, ruled on three fundamental points: those relating to the doctor, the patient and health infrastructure. In order to describe and analyze interconsultas from primary level to specialist and from their adequacy, a study has been made observational descriptive in nature cross. As a field of study was chosen Area Health Albacete. We evaluated a total of 1008 referrals of patients referred for the first time, from primary care to any of the specialties of health centers that make up the University Hospital Complex Albacete. The data were collected during the last half of the year 1998. It collected the information contained in the report of derivation: data filación patient, the doctor who led relating to the center and the specialty to be sent to the patient and clinical information from it. At the end of the consultation, both the specialist, as the family doctor observer issued their opinion on the adequacy of derivation, according to the criteria previously established referral explicit and implicit criteria for the practitioners themselves. As a dependent variable was considered the adequacy of derivation in view of a specialist in view of the family doctor observer. The results found that seven specialists which were concentrated just over half of the referrals (53%). The seven esepcialidades belonged to the area médico. Shunts were preferentially with nearly a quarter of all referrals. It was found that the quality of information provided in the parts of interconsulta was better in the derivations preferential completed by the young doctors and thus possessed training postgraduada MIR track, as well as referrals from the model of care work team. According to the expert's opinion, were derived an appropriately 72.1% of interconsultas. The adequacy relates to the interconsultas performed by physicians trained postgraduada via MIR (MIR appropriate a 81.1% and non MIR 69.4%) and those from health centers whose assistance is the model of teamwork EAP ( EAP 73.1% adequate and traditional model 43.8%). Also related to the adequacy older patients (older than 65 years). According to the opinion of the family doctor were derived an appropriately 76.9% of interconsultas. In this case the adequacy of the derivations also touched on doctors trained via MIR (MIR appropriate a 85.0% and a 74.4% non-MIR), with doctors Younger (age under 45 years), those from care centers whose model is the teamwork (EAP) (CAS adequate 77.7% and traditional model 53.1%) and patients with derivatives of the male sex (male derivatives adequately 82.5% and women 73.1%). There is a degree of agreement between the views of middle spatialist and the family doctor observer when the suitability of the derivations (Kappa 0.64). It has been found great variability in the level of consistency from the agreement in all cases in some specialties (nephrology, geriatrics), to very low levels (endocrinology Kappa: 0.19, pediatrics Kappa 0.36). It highlights the importance of developing and implementing protocols and practice guidelines to include the criteria for referral to appropriate in each specialty. This would help improve health care and streamlines r 8 ecursos 19e available.

Author: GUTIERREZ DE TERAN CASTAÑON HUGO.
Year: 2003.
University: POMPEU FABRA.
Place of defense: DEPARTAMENTO DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.
Place of preparation: DEPARTAMENTO DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.

Summary: The objective of this thesis is to provide knowledge about the biochemistry and pharmacology delos adenosine receptors, as well as understand the relationships between chemical structure and pharmacological activity of the existing ligands for these receptors. To this end have been employed various techniques and methodologies for the design of computer-aided drug. The results presented in this paper include: Developing an original strategy for selecting a sample adequately cover the molecular diversity that exists in a database of chemical compounds. Building a model of the region transmembrane receptor A1 human adenosine, which has been located and marked an agonist binding site consistent with experimental data. Theoretical predictions of the energies of union ligands, made from the complex agonista-receptor predicted on the model above, obtaining a degree in agreement with experimental data is encouraging.

Author: GIMENO RUIZ DE PORRAS DAVID.
Year: 2003.
University: POMPEU FABRA.
Place of defense: DEPARTAMENTO DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.
Place of preparation: UNIVERSITAT POMPEU FABRA.

Summary: The main objective was to assess the scope of the countries of the European Union (EU) differences on several health indicators and the absence from work due to sickness among workers in different types of jobs. Also, I think the effect is that psychosocial factors at work is the absence for health reasons to examine associations between types of employment and health, and gender. The data come from the II (n = 15,146) and III (n = 21,703) Survey European Working Conditions (EECT), conducted in 1995 and 2000, respectively. They cross surveys based on representative samples of the population older than 14 years of the 15 EU countries. Within the FOR, we determined the prevalence of absence for health reasons, after reviewing its association with psychosocial factors at work among workers with a permanent contract and those on temporary contracts. We explored the differences in health according to the type of employment relationship. Subsequently, the sample was analyzed specifically Spanish III EECT. The comparison between the two EECT showed a slight increase in all health indicators between 1995 and 2000, with very consistent results between the two surveys. Differences were observed between different types of employment concerning health indicators selected temporary workers declared greater job dissatisfaction that undefined but lower stress levels, small businesses reported more fatigue but less dissatisfaction and self loa more fatigue and back pain . The full-time workers are almost always declared worst levels of health indicators compared to part-time workers. Our results show for the first time that the prevalence of absence for health reasons is lower in the South of OF compared the rest of the DE. The high psychological demands and low control was associated with higher rates of absence for health reasons compared with the low demand and high control, respectively. However, among the temporary associations were larger, both men and women. This is the first study showing that among temporary workers low demand (or high control) is associated with lower rate of absence from work, while the high demand (or controlled) tended to be associated with higher rates of absence with reference to workers with a permanent contract with low demand (or controlled). In Spain, the high demand was associated with higher absence for a health problem of work - and under control at higher risk of absence due to accident at work. We also note that exposure to psychosocial factors worsened between 1995 and 2000 for all workers, with temponfles increased exposure in both years, although the indefinite exposure increased. The findings of our study have several implications. On the one hand, the need for governments in the conduct of interventions to reduce the burden of the individual and social absence for health reasons and exposure to psychosocial factors at work that contribute to it. On the other hand, to obtain more accurate data for the study of these psychosocial factors and their impact on health. Nor is it clear for future studies to analyze separately to the workforce according to the type of employment relationship. Lastly, given the deteriorating conditions psychosocial work, the results suggest that changes in the last decade in the job market has worsened working conditions not only in new forms of employment (especially temporary), but also the remaining workers. Accordingly, it is urgent to promote policies to curb this trend paraciisminuir worker exposure and evi 8 tar d 1a7 eterioro their health.

Author: BEJAR PRADO LUIS M..
Year: 2004.
University: SEVILLA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVES: a) make a descriptive analysis of colorectal cancer mortality in Spain. This analysis was conducted by examining mortality rates and standardized raw, rates for specific age groups and an analysis of years of potential life lost (YPLL). B) Make an analysis detaHado cohort mortality from colorectal cancer by studying the effects age, period and cohort, and its modeling applying the Poisson regression models. C) To analyze the evolution of the disease from colorectal cancer in Spain, studying the incidence of this tumor in the Cancer Registries population base and morbidity assisted in the SistemaNacional Health. METHODOLOGY. The figures for deaths from colorectal cancer were obtained from the statistics of deaths Movements Natural Population of the National Statistical Institute (INE) between 1,951 and 1,979 Yde database Tempus between 1,980 and 2,001, with a focus on codes 153.0 and 154.0 of the International Classification of Diseases and Causes of Death (6 '7 ", 8" Y9 "Revision). The population data are taken from the population censuses conducted and published by the INE The direct use of this data has two drawbacks. First, the census only provide information on the population every ten years, the populations intercensales necessary for the realization of fees. Secondly, censuses are conducted dated December 31 of each year census, except for census 1981 and 1991 that took place on 1 March, which is not available information on the exposed population in half of the study period, July 1, as they have been used periods of one year. Therefore, intercensal populations were obtained from NSI when it published populations estimated or calculated on the basis of census population statistics. The morbidity statistics were obtained from the data published by the Cancer Registries Spaniards and hospital morbidity statistics contained in the Minimum Sets Database (CMBD) of the Hospital Authority Spain. With arrays of specific mortality rates from colorectal cancer were developed three types of graphical representations: a) According to the years of death, linking the points for the same age group. This graph is helpful to know the effects associated with the year of death, as they tend to affect virtually all age groups. B) As the year of birth and, as before, joining points for the same age group. This form of graphical representation allows you to see the effects associated with the birth cohort and separating better curves of different age groups because of their displacement phased. This is the latest graphical adopted in the present work. C) Representing rates for specific age groups, uniting points for the same birth cohort, which identifies the movements for the cohort effects. To study three possible effects: age, period and cohort, we proceeded to the mathematical modeling of the data apJicando the modeJos Poisson regression. YPLL were calculated by applying the standard methodology, until the 70 years excluding the first year of life, and the calculation of its several variants. We analyzed the incidence of colorectal cancer in individual records Cancer Spain recognized by the International Agency for Research on Cancer (IARe), considering their impact on each gender and each age group, the standardized incidence rate and the older records, such as Zaragoza and Navarre, trends in the incidence of these tumors in each age group and the total. Thanks to the data provided by the Ministry of Health and Consumer Affairs, analyzed the statistics of morbidity assisted in the health facilities of 8 Spain, the 34th reflected in the Joint Minimum Database (CMBD) of each autonomous community, although in this thesis only analyzed data for the total of Spain, desglosándolos sex.

Author: MESA GARCÍA AURORA.
Year: 2004.
University: OVIEDO.
Place of defense: FACULTAD DE MEDICINA DE OVIEDO.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Summary: Breast cancer is a major health problem because of its high incidence and mortality. There is enough scientific evidence to recommend the introduction of screening programs population with mammography, for its effectiveness in preventing the disease. The complexity of these health interventions, it is necessary to carry out quality assessment screening programs. This research assesses the quality of the screening program developed at the Unit Pilot Area Health Gijon. The unit performs screening summons and screening tests (mammograms, ultrasound, fine needle aspiration puncture). The diagnostic confirmation, and / or surgical treatment is performed in hospitals and Cabueñes Jove. There will always be a descriptive observational study, building indicator s standards, measuring participation, the procedures for diagnostic tests, the results of screening, cancer screening, diagnosis and response times type of surgery performed. It ascertains the extent of matching these indicators with those recommended by the European Program Guide Quality Control. The study period extends des December 1998 to December 1999 on a target population of 12,337 women, between 50 and 65 years, with health insurance card and domiciled in several areas Basic Health Gijon. It valued the precocity Diagnostic Screening Program through an inquiry type Group Statistical Comparison studying characteristics anatomopatológics linked to the prognosis of tumors over those screened were diagnosed by clinical expression, women between 50 and 65 years, residents Gijon in the two pre-implantation screening. Statistical analysis was performed using SPSS Program. Quality standards were achieved in the participation and other indicators discussed. The waiting times for surgery were short and tumors diagnosed by screening were smaller, less infiltration, less affectation locoregional and better distribution TNM stage diagnosed by the clinical expression.

Author: ÁLVAREZ NEBREDA CARLOS CESAR.
Year: 2004.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD DE MEDICINA.

Summary: 1 .- The rate of absenteeism from work does not present a clear relationship with age. 2 .- Workers with more stable contracts, in this aso fixed and acting, have rates of absenteeism higher than workers with casual. 3 .- The graduates have a lower rate of absenteeism that occupational categories with lower academic qualifications and professional. In any professional category women have a higher rate of absenteeism than men. 4 .- The rate of absenteeism in primary care is higher than in specialized care in any professional category, except you technical training in men is similar. 5 .- In primary care there is no difference in the rate of absenteeism among the three categories with higher professional qualification in men or between the two categories more professional development women. Both men as well as women, the highest rate of absenteeism presents the category with the lowest profession. 6 .- specialized care the relationship between the professional level and the rate of absenteeism presents a clear gradient: the lowest rate seen in the category with greater skill and the highest rate is observed in the category with lower occupational qualification. 7 .- The greatest magnitude of the association between occupational status and the rate of absenteeism from work in specialized care in primary care is due to the relatively low rate of absenteeism in the category of graduates in specialized care, which is the category used as reference. 8 .- The average time for each process absenteeism increases with age. 9 .- The casual workers have an average length of absence from work processes less than regular workers and temporary workers. 10 .- The average time for each process absenteeism does not present a clear relationship with the professional level or in primary care or in specialized care.

Author: LERONES MARTIN M. CARMEN.
Year: 2004.
University: MÁLAGA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Correct cleaning and desinfeción of equipment and materials for clinical use is essential to prevent the spread of pathogenic microorganisms, especially if it is material or equipment reused as endoscopes and broncoscopios or útilies of anestesia.Un problem related to disinfection and sterilization clinical use of material that closely contact with mucous membranes, such as endoscopes or broncoscopios, is the potential for adverse reactions in patients related to the presence of residues of substances usadasa as disinfectants, attached or held on such materials. The purpose of this study was to investigate the ability of a bioassay based on the use of microorganisms indicators as evidence of screening in the detection of residues of disinfectants attached to various clinical materials. In this paper, has been evaluated the ability of this bioassay surface, based on glucuronidase activity of Eschericha coLi to determine the presence of residues of various subtancias such as formaldehyde, glutaraldehyde, bromopol, orto-phtallaldehido and hydrogen peroxide, Used as a disinfectant, polyurethane, glass, latex, stainless steel and other materials used in various instrumental hospital use disinfected with solutions of disinfectants mencionados.Igualmente analyzed the presence of residues of formaldehyde on the same materials, sterilized autoclave steam at low temperature formaldehído.Los results of biensayo were compared in this case with chemical methods espectrofotométricos detection of formaldehyde adhered materials also sterilized in the same way.

Author: IGLESIAS SANCHEZ LUIS ANGEL.
Year: 2004.
University: PAÍS VASCO.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The pneumococcal infection is a major public health problems in the world. The pneumococcus is the first etiological agent of bacterial respiratory infection. It is also the primary responsibility of meningitis and bacteremia, and other less serious illnesses such as otitis media, but very common. It is a microorganism with great ability to acquire resistance to antibiotics. For the prevention of pneumococcal disease are available polysaccharide vaccine 23-valente and other type of conjugate vaccines with increased capacity inmunógena being developed at present. The overall objective of this study is to describe the major epidemiological characteristics of pneumococcal infection in Gipuzkoa during the period between 1981 and 2001. As aims study is the incidence of invasive pneumococcal disease, potential seasonality, his mortality. We study the in vitro susceptibility to antimicrobial agents of the strains isolated from clinical samples and their evolution over time. We studied the distribution of serotypes depending on the origin of isolation, the clinical picture, sensitivity of the strain, evolving over time and population. Between 1981 and 2001 there were 3111 cases of pneumococcal infection in the population of Gipuzkoa (880 cases invasive). The less than 2 years and older than 64 are the age group where the incidence was highest. The majority of pneumococcal infections in Gipuzkoa arose during the cold months (October-March). The incidence of invasive pneumococcal disease pediatric increased over time. During the years 1999-2001 the incidence rates were 34.5 / 100000/año in children under 5 years and 48.4 in children under 2 years. During the years 1999-2001 the incidence of invasive pneumococcal disease were in adults 14.2 / 100000/año and those older than 64 years of 39.9 / 100000/año. The mortality of invasive pneumococcal disease was higher than in older patients. Between 1989 and 2001 the mortality rate in children was 1%. In adults globally was 22.5%. Resistance to antibiotics has increased over time. The resistance to penicillin was increasing during the resistance to macrolides which fell from 8% to more than 30%. The resistance to fluoroquinolones remained low but increased in recent years. The resistance to other antibiotics of little or no use, such as tetracycline, chloramphenicol and cotrimoxazole, decreased over time. The composition of the vaccine (polysaccharide 23-valente for adults and 7-valente conjugate for children) was adequate, 93.2% of the serotypes / serogroups in polysaccharide vaccine 23-valente and 60.5% of the serotypes in children identified with invasive disease were included in the conjugate vaccine heptavalente.

Author: ARA ROYO IGNACIO.
Year: 2004.
University: LAS PALMAS DE GRAN CANARIA.
Place of defense: FAC. CIENCIAS ACTIVIDAD FÍSICA Y DEPORTE.
Place of preparation: FAC. CIENCIAS ACTIVIDAD FÍSICA Y DEPORTE.

Summary: Until advances in genetics to identify and manipulate genes involved in the alarming increase in the prevalence of obesity in children and young people, the only realistic solution to the problem of childhood obesity is prevention. Attempts to improve to a single level or in one scene the problem will probably be insufficient. The solution is to act primarily on two key aspects in the energy balance: intake and energy expenditure. Therefore, a major objective is to try to change behavior of children, reducing the number of hours spent in sedentary activities and increase levels of physical activity. The data presented in these works aim to collaborate in identifying those which are most effective interventions to promote a decrease in the prevalence of obesity in children. The results included in this thesis show that adding 3 hours a week of sporting activities for those hours that are now mandatory for pre-pubertal children in school, smooths the accumulation of fat mass during growth while increasing profit muscle mass and improves the physical condition of children. Furthermore, we have found that young adults strength training six weeks has a positive effect on body composition, fat mass decreased slightly. Despite this decrease in fat mass, this type of training did not significantly influence the basal serum concentration of leptin, its soluble receptor or bioavailable fraction of leptin. Our data also suggest that strength training per se, that is, apart from its effect on fat mass, no effect on basal levels of leptin, its soluble receptor or bioavailable fraction of the hormone.

Author: COLLANTES NÚÑEZ JORGE JUAN.
Year: 2004.
University: REY JUAN CARLOS.
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: Hypothesis. If it gives the traveler a standardized health information, valid and reliable information from the origin of the management or purchase deun international travel, it will increase the rate of prevention of risks to the health and satisfaction in international travelers with regard to those who have not information received from the travel agency. Objective: To enhance the prevention of diseases related to international travel from the source of travel management. Materials and methods: Prospective observational epidemiological study cohort. A group exposed to a campaign health information from the travel agency where he performs his trip and another group not exposed to a campaign health information from the travel agency where he performs his travel and other non-exposed group that does not receive any type of information since the agency. The brochure utklizado estabva published in the collection of materials dibvulgativo for service publications of the ministry of health and consumption under the title "Health also travels." The information gathering was done on computer via the Web: www.lasaludtambienviaja.es.tt. This page data using statistical program G-STAT full program of statistical analysis multiplatform programmed in Java and developed by the department of biometry GSK glaxosmithkline sa Results: - The number of the cohort subjects who had received the campaign and that it has consulted the doctor is significantly higher than subjects who had visited the doctor and have received no information. - There were no statistically significant differences between subjects who received the campaign and voluntarily consult a center of international vaccination compared to any subject that has not received campaign. There is difference between the two cohorts, with the number of visitors to Web sites specializing in the largest cohort that has received the campaign. - The number of people who had not requested health information is significantly higher in the cohort of people who have not received campañá. Conclusions: the findings of the working hypotheses raised in the study. Those who have received the "health also travels" show a more positive attitude towards prevention. There is a lack of connection between travel agencies and health information to encourage passengers to act on prevention of health.

Author: VILLANUEVA MARTÍNEZ MANUEL JESÚS.
Year: 2004.
University: REY JUAN CARLOS.
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: The presence of pain in musculoskeletal diseases (SCS) is almost constant, so analyzing the musculo-skeletal pain (DEM) we will be able to bring so valid and reliable information to the epidemiology of SCS in spain. The objective of this thesis is to describe the prevalence, factors associated temporal evolution and impact on the daily lives of dme in the adult population in Spain. A descriptive study was conducted using cross this secondary data individuallzados provided by the national health survey of spain the years 1993, 1995, 1997 y2001. Question Do you cúal has been such pain or symptom that has forced him to cut back its activities in the leisure and / or their main activity during the past two weeks? Being the answer -dolor bones, spine or joints is the dependent variable. As independent variables were analyzed: variables: 1. Personal characteristics, socio-demographic and geographic. 2. Morbilldad perceived and use of medicines. 3. Use of health services. 4. Lifestyle. It hananalizado a total of 57862 subjects. The overall prevalence is 5.9% 6.5% and 7.3% in the polls for the years 1993, 1995-7y 2001 respectively. In all three surveys prevalence among women is higher than among hombressiendo this statistically significant difference in all cases. The variables that are associated to maner independent of the presence of dme among women in the three polls are age, the use of drugs for rheumatism or pain, the doctor's surgery in the last two weeks, attendance at emergencies and the number of hours of sleep. Among men the factors independently associated to dme are idéntificados among women except sleeping. After controlling the possible confounding variables the likelihood that a woman or a man suffering declare DME has not changed significantly between the years 1993 and 2001.

Author: FLOREZ GARCÍA MARIANO TOMÁS.
Year: 2004.
University: REY JUAN CARLOS.
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: It has developed a prototype of a clinical module of back pain integrated into a model of electronic medical record-oriented specific clinical problems. The main functions of the application are: 1) facilitate data collection so fast, simple and structured; 2) allow access to any information cllnicamente relevant; 3) incorporate support for clinical decision and the prevention of errors; 4 ) automate routine tasks (reporting, calculating scores functional assessment scales.) the structure of the application is modular, based on separate elements, which provides flexibility, personallzación and scalability. The graphical interface is integrated into the processor detextos word of microsoft and the information is organized through a menu bar options. It has been designed from the perspective of what they want and need clinical. It was demonstrated that the program could save the health professional considerable time and effort in carrying out routine tasks. A survey of 22 doctors (19 specialists in musculoskeletal and 3 primary care physicians) indicated that potential users of the application complies widely believed that the intended functions and receive very useful, attractive and easy to use.

Author: MENÉNDEZ GUTIÉRREZ SILVIA.
Year: 2004.
University: LEÓN.
Place of defense: FACULTAD DE VETERINARIA.
Place of preparation: FACULTAD DE VETERINARIA.

Summary: The gradual increase in demand for urgent assistance in the emergency department Spaniards hospital is one of the problems facing health care today in our country. From the health system seeks to meet this growing demand, while maintaining criteria of quality of care. This approach is one of the challenges of Emergency Services Hospitals. In this context, the introduction of a quality policy is needed, as well as the use of a methodology for proper management of the different elements that make up the health care. The quality tools take years to apply in the business world with satisfactory results. Given this fact why not apply in the context of health care in order to obtain positive results. This thesis has been used PERT diagrams as a tool for quality, due to its ability to graphically represent der whole process of care, as well as the network of times and events. The management processes is proposed as a management methodology for its ability to coordinate the resources of the health care system. Identifying activities where there is a further delay in a process can be proposed improvements, thus speeding up the resolution process. If improvements are proposed for the activities to suffer further delay, lso nine more frequent emergency general, these processes will be resolved faster. As the nine most common processes, improvement in time resolution reverberate secondarily in time resolution of the remaining pathologies met. We found differences between real-time and time received, the latter being the indluye in the quality experienced by the patients. Perceptions of quality on the part of patients, do not always coincide with the perception of quality on the part of health personnel. The perception of time spent in emergency is influenced by the perception of time waiting to be served. The values are appreciated by patients care and attention by emergency personnel. In light of the findings, the following improvements are proposed: - Develop protocols that simplify explorations and the request for additional tests. This reduces the workload of diagnostic radiology services and clinical analysis, secondarily decrease waiting times. - Create circuits protocolizados attention to the diseases that are serviced more frequently in emergency com. - Strengthening of medical personnel in the slots, days or times of the year in which they provide greater influx. - Involve a service on the concept and methodology of quality improvement, especially in Internal Medicine and Surgery, which are responsible for making income in the evening hours. - Provide more and better service points for urgent assistance in primary care, so descongestionaría to emergency hospital pathology more commonplace, improving the care of the more serious pathology. - Continuous training of personnel in emergency diagnostic and therapeutic measures in losprocesos who are cared more often in emergency rooms. - Opening of consultations monographic in times of flu epidemics, which would benefit the high percentage of patients who go by complicaicón of COPD. - Reform of the facilities and acortamientos of waiting times would improve the perception of quality by users.