PUBLIC HEALTH

Author: CASTAÑEDA IÑIGUEZ MAURA SARA.
Year: 2002.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: OBJECTIVE Knowing the prevalecida and types of human papilloma virus (HPV) and assess the extent of the association between the presence of HPV and other cofactors and squamous intraepithelial lesions of low and high grade (LIEBG And LIEAG) and invasive cancer in women morelos HPV positive. MATERIALS AND METHODS cross-sectional study of population base made between 1997 and 1999. It is defined as any event HPV positive women to submit LIEBG and LIEAG / invasive cancer, diagnosed through colposcopy and confirmed by histopathology. The comparison group were HPV positive women without cervical lesion. ENDO cells were collected and EXOCERVICALES using CITOBRUSH and for the characterization rehearsing tirillas nylon format using a reverse hybridization. RESULTS A total of 246 women HPV positive, 24 different types of HPV have been identified, with the most frequent types on 16, 18, 31 and 33. The prevalence of HPV 16 in women with LIEAG and invasive cancer was 53.6%. The risk of LIEAG / DC is 37 times higher (RM + 37.8,1 83.5) if they have an infection with HPV-lato risk. Possible cofactors HPV would be the addition of parity and having more than two sexual partners. Conclusions In women morelos, the factor most strongly associated with the development of LIEAG and invasive cervical cancer is infection with the human papilloma virus at high risk (especially HPV 16).

Author: GOMEZ MORENO NIEVES VICTORIA.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: UNIVERSIDAD MIGUEL HERNÁNDEZ.

Summary: In this dissertation, has done an observational study, based on a technique Delpli amended on relations between Primary Care and Hospital, in the Valencian community. There were consensual which are the ten most prevalent problems between the two levels, as well as solutions to the ten -- those relations, and has seen its evolution over time after the Health Reform, assessing and analyzing the differences encountered at the beginning of Reform (1992) and traÂ's one building (2001).

Author: VARGAS ROMÁN MARIANA ISABEL.
Year: 2003.
University: REY JUAN CARLOS [www.urjc.es].
Place of defense: CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD. UNIVERSIDAD REY JUAN CARLOS.

Summary: INTRODUCTION assistance to emergency and health emergencies in the middle prehosipitalario, is one of the essential components of urgent medical attention. Its benefits are essential to proper care of public health. However, there are few studies examining the type and magnitude of the health and impact on health. OBJECTIVES 1-describe and analyze the characteristics of healthcare prehospitalaria in public thoroughfare developed by the Municipal Assistance Service and Rescate-Protección Civil Emergency (SAMUR-PC) in the municipality of Madrid. 2 - Promoting from epidemiology, the optimization of quality of care. MATERIALS AND METHODS The investigation process was structured in three main components: assistance prehospitalaria comprehensive health care to seriously ill patients transferred through Preaviso Hospital and consistency in the characterization of the events between operators of the Central Communications SAMUR-PC, and Speakers include Health Teams. Diseño.Descriptivo cross retrospective. Location. SAMUR-PC. Population. Totality of interventions. Period of study. Years 2001 and 2002. Variables defined and codified. Data stored in the Database Oracle 8.05, for exploitation linked to Access 97 through ODBC. To control for potential bias debugging information is the basis and records were excluded inconsistent. Statistical analysis using SPSS v 10.0 (p less 0.05 statistically significant). Legal and ethical issues. It was conducted under the Data Protection Act. RESULTS There has been a ttoal of 97,937 and 101,438 interventions in the years 2001 and 2002 respectively. The first plaintiff care and greater annual percentage increase activations was Madrid 112. In the year 2002 the total activations, 40,137 were served by the Advanced Life Support units, 37,746 for Basic Life Support Units, 18,448 by Vital PC Support Units, 2,724 by Vital Support Psychiatric Units and the remainder by other mobile resources. The average number of activations mensulaes was 8453 (DE: 673.51), 95% :8.025-8 .881, with a minimum of 7042 corresponded to the month of August and a maximum of 9,545 activations to June. The daily activity averaged 277.91 (DE: 46.55), 95% confidence interval :273,12-282, 70, with the rank of 265 activations (minimum of 170 and a maximum of 435). Interventions with psychosocial component experienced large increases at around 17% -14%. %, 95% CI 77.9-82.7), by leading cause an accident, with median response time of 7 '24''m between 12 and 14 hours, mainly in sábdo, November, in the District Municipal Center, and with pathology predominant trauma or caridovascular. Overall survival was 73.20% at 7 days, teaming age significantly higher mortality. Survivors of 7 days scored in the RTS6, 96 (DE: 1.34) and the deceased, 4.84 (DE: 1.73), with difernecia significant (p less 0001). The match in the characterization of the events between operators of the Central Communications SAMUR Civil Protection and sanitary equipment was high, K = 0.70 and K = 0.67 (years 2001 and 2002 respectively). CONCLUSIONS The epidemiological description has allowed, and to comprehensively measure the characteristics of the different stages of health care. SAMUR-PC, is giving coverage to the situation that gave rise to the systems in Spain comprehensive emergency response to the serious problem of public health representing the pathology traumatic acute cardiovascular and acute. The data confirmed SAMUR-PC, as a Instit 8 ución Sa 3a3 nitaria frontline of emergency care and health emergencies prehospitalaria in public thoroughfare, which covers the growing demand for care of a high volume of people in the municipality of Madrid.

Author: PALMA LINARES INMACULADA.
Year: 2003.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVE Analyzing hÃÂ ¡bitos food and activity fÃÂsica (AF) done in the free time of adult women Catalan asÃÂ their lifestyle. ALL MATERIAL AND MÃâ ° cross-sectional study. The shows were 1130 women Catalan 18-64 aÃÂ ± os. Survey conducted in 2 perÃÂodos of 5-6 weeks cad one. The hÃÂ ¡bitos food were evaluated travÃÂ © s Frequency Questionnaire Consumer qualitative 77 ÃÂtems and two reminders 24h. SegÃÂ º n type AF done in free time were classified as sedentary, moderately active. It valorÃÂ ³ snuff consumption of alcohol consumption, weight, height and BMI. RESULTS A 66.6% of women doing sedentary activities in their spare time. The prevalence of overweight was 28.3% and obesity from 11.2%. By linking food consumption and prÃÂ ¡ctica exercise fÃÂsico (FE), is observÃÂ ³ a trend towards increased consumption of bread, creales breakfast, muÃÂ "sli, yogurt and fruit for mÃÂ ¡s active consuming mÃÂ ¡s products pastelerÃÂa, whole milk and sausages the mÃÂ ¡s sedentary. Not AF practice in the free time suponÃÂa a risk 2.5 times higher presenting obesity, OR = 2.5 (1.45-4.31) and not practice EF suponÃÂa risk 4 times to present obesity, OR = 4 , 4 (2.29-8.5). CONCLUSIÃâN We can not say that there are lifestyles mÃÂ ¡s healthy in mÃÂ ¡s active. Although some trends have been observed in the selecciÃÂ charges for food, the consumption of food groups follows a similar nutritional profile and not necessarily mÃÂ ¡s healthy for mÃÂ ¡s active. As to hÃÂ ¡bito tabÃÂ ¡quico and alcohol have not been revealed differences in consumption, effects that may account for the type of diseÃÂ ± or study. As sÃÂ ³ what has been shown the protective factor of AF and EF compared to overweight and obesity.

Author: PASIOUNY EL-NAGGAR TAREK.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The work of the doctoral thesis, which is aimed at studying fitoquÃÂmico and farmacolÃÂ ³ gico of N.sativa species whose seeds are used in alimentaciÃÂ charges for centuries in traditional medicine and also as a autÃÂ © ntica panacea. Being a seed is prepared three estractos: hexÃÂ ¡nico, metanÃÂ ³ lico and aqueous. It iniciÃÂ ³ study by the Irwin test that indicÃÂ ³ sedative and depressant effects of SNC.Por This will prosiguiÃÂ ³ with a baterÃÂa test to determine behavioral activity on the system nerviosso Central. Analyzing together these resutados of in vivo activity has been suggested both for elextracto metanÃÂ ³ lico to the aqueous of Nigella sativa, a clear depressive effect System Nerviso Central, as it induces significantly incoordinaciÃÂ charges and reduces motor activity espontÃÂ ¡line, the capacity exploratory and body temperature so significativa.Estas tests are supported by a marked effect on potenciaciÃÂ charges of sueÃÂ ± o. Comrobada activity depresora was procediÃÂ ³ fractionation of the extract metanÃÂ ³ lico to isolate the active constituents, obteniÃÂ © ndose 11 fractions, which were submitted to monitor activity through the test potenciaciÃÂ charges of sueÃÂ ± or barbirÃÂ seventh rich. In parallel is realizÃÂ ³ studying the activity anlgÃÂ © sica.Del anÃÂ ¡lysis of the data suggests that the extracts tested have shown, to a lesser or mayro extent catividad anlgÃÂ © music. After studying N.sativa in animal integer will iniciÃÂ ³ study at the cellular level (neurons) and in various brain structures (hipotÃÂ ¡lick, and striped bark.), To test the effect of the extract metanÃÂ ³ lico of the same on the secreciÃÂ ³ n out of aminoÃÂ ¡neurotransmitters (inhibitory and escitatorios), corroborating these tests results mediantes tests "in vivo".

Author: ESTIARTE NAVARRO RAMON.
Year: 2003.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD MEDICINA.

Summary: This dissertation is the result of a cross-sectional study conducted in Spain in response to a question that remained sintener conclusive data, and focusing on the characteristics of those suffering from Crohn in Spain, including their medical history, their habits treatment complications and the same disease, their hospitalizations and surgeries, as well as aspectso related to their quality of life and cost of the enfermedad.Se select a representative sample of 635 patients suffering from CE in 39 Spanish hospitals over a period of 3 meses.De agreement with the available data and consulted, this study is the first cross-sectional study conducted epidemiological cutting-wide Spanish territory in such patients, results were published through 3 articles in reveistas impact in the field of gastroenterology, all of them forming part of this thesis. Medicine age was 31 years (median 33, range 14-83), being 52% of the sample mujeres.El 87% of patients were included while attending a routine visit to his illness, while the 13% included during a visit urgencia.Se noted that there is a family history of inflammatory bowel disease in about 14% of cases (9% CE). was found that a high percentage of patients (54%) were smokers, a fact related negatively with the disease. As for the location of the disease, 47% of patients affected a combined small intestine and large intestine (ileocecal 43%), whereas patients with bowel involvement exclusive of gado accounted for 36% of the large intestine the 17%. perianal disease accounted for 12% of cases, while the location was only gastroduodenal of 5%. In terms of symptoms, 42% of patients did not suffer recurrences durente the year prior to the inclusion, while a 10% experiment recurrences postquerúrgicas and a 23% had chronic active xon a high need for immunosuppressive therapy and surgical intervention . The most frequent pattern was inflamartorio (46%), comprobándosse that it was also significantly more frequent among women and younger subjects, mientres that it was fistulising inthe men, presenting these at highest risk for recurrence pstquirúrgicas. The aminosalicilatos, corticosteroids or imnunosupresores were used to treat 89% of patients, most commonly used being the aminosalicilatos (77% patients) and corticosteroids (41% patients). Alone any of the groups mentioned due employed in the option the 52% of pacientes.En regard to the most commonly used combination therapy were aminosalicilatos more corticosteroids (60% of combined treatment, 26% of the total sample). In quality of life (SF-36) the results were worse than the reference values of the normal population in our country, in all dimensions, with the exception of physical function. Similarly, the EC represents a substantial economic cost to society, dividing the total costs in direct (31%) and indirect (69%). The main resource utilization was due to hospitalizations and lost productivity.

Author: LIMA DE FIGUEIREDO QUEIRÓS M. MANUELA.
Year: 2003.
University: VIGO [www.uvigo.es].
Place of defense: FACULTADE DE CIENCIAS DA EDUCACIÓN.
Place of preparation: FACULTADE DE CIENCIAS DA EDUCACIÓN.

Author: ARAGON PEÑA ANDRES JOSE.
Year: 2003.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Introduction: The Public Health looking for preventing disease and improving the health of poblaciones.Para achieve these ends conducts a wide range of specific activities, regardless of their technical correction. Objective general.-Proponer a model of ethical review applicable Public Health. Metodología.-En First, recalls the basic concepts of ethics and approaches theories highest ethical importantes.A continued revising the social framework in which the activities of Health Pública.Después explores the influence of genetic variety approaches to Bioethics in analyzing ethical Health Pública.Por Finally, the contributions are reviewed latest (and direct) analysis ethical Public Health. Conclusión.-La breadth and diversity of activities especifiacas conducted by the Public Health require an ethical analysis that takes into account the many facets of these actividades.Además, requires approaches coming devarias theories éticas.Por that proposes a model ethics in Public Health analysis that takes into account the multidimensionality of their own activities (spatial dimensions, functional temporary evolutionary and político-estructural), which integrates several ethical theories, mostly Aristotelian ethics of the virtues and ethics procedimental.El model also takes into account the characteristics of the agents ocn moral responsibility in Public Health: public authorities, intermediate societies, economic corporations and the media. To check the validity of the practical analysis model proposed ethical conducts an exercise consisting of the application of the same to a field of activity specified in Public Health, in particular, the Food Safety reaching a satisfactory outcome.

Author: GARCÍA GÓMEZ JUAN JULIÁN.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE VETERINARIA.
Place of preparation: FACULTAD DE VETERINARIA.

Summary: The game meat is the result of the boom have shown that in our country, this type of activity. The autonomous community of Castilla-La Mancha is one of the most important Spanish autonomous regions in terms of volume of pieces hunting shot, and especially, the province of Toledo, is characterized by its importance in the number of hunting areas. In Zone Basic Health Valmajado, where hunting is less important, there are large number of establishments or Chambers specializing in the treatment of this type of meat, which must meet certain specific conditions, regulated by the Regulatory Técnico-Sanitaria must the Food Industries introduce a specific program Autocontrol Hazard Analysis and Critical Control Points (HACCP), which involves those responsible for the same in this meat production. Before developing a HACCP program specifically, there is a need to develop Prerequisites, relates to basic health and hygiene standards. In the present study s ehan analyzed, both Prerequisites such as HACCP program developed in this type of treatment rooms, compared with the Flow Diagram unsaturated, and which include the Hazards of different stages in this process established meat production. It also shows the presence of high levels of lead residue from the impact of lead shot, it is appropriate to incorporate this element to APPPCC as chemical danger because the consumption of such foods of animal origin, cause health problems the consumer.

Author: VIEITEZ GARCÍA PAULA.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: HOSPITAL RAMÓN Y CAJAL.

Summary: The diabetic nephropathy is the most common cause of microvascular complications in patients with type 1 diabetes mellitus. This paper focused on the study of the changes observed after the blockade glomerulares systemic and glomerular renin angiotensin system (MRS) in diabetees. It also studied the interactions between TNF-alpha and other growth factors and cytokines, and their involvement in kidney damage associated with diabetes. In rats Spague-Dawley were administered intraperitoneally estreptoxotocina, and were considered diabetic when glucose was greater than 300 mg / dL. To maintain body weight and achieve a prolonged survival, they injected insulin daily that the experiment lasted, maintaining a blood glucose greater than 300 mg / dL. As of the first week, each animal received treatment corresponding to the experimental group as appropriate: EXPERIMENT 1 20 animals diabetics and uninefrectomizados were divided into 2 groups ID n = 10, which received irbesartán (50mg/kg) cannula daily, diabetic control group (CD) n = 10 receiving vehicle, and using another group of rats not diabetic uninefrectomizadas (ND). EXPERIMENT 2 20 animals diabetic 4 months of evolution were slaughtered to extract and isolate the kidney glomerulus. These were incubated for 24 hours with increasing doses of irbesartán (0, 0.01, 0.1 and 1 umol / l). EXPERIMENT 3 20 animals diabetics and uninefrectomizados after 8 months were divided into 2 groups: group ED n = 10, who received etanercept intraperiotenalmente (0.3 mg / kg) every day and diabetic control group (CD) n = 10 receiving vehicle . after 14 days of treatment was determined the effect of this drug on renal function, glomerular expression of TGF-beta, PDGF-B, VEGF and TNF-alpha. EXPERIMENT 4 Glomérulos isolated from rats with 4 months of development of diabetes were incubated 24 hours with increasing doses of etanercept (0, 1, 10, 100 ug / ml). Later it was determined the glomerular expression of TGF-B, PDGF-B, VEGF and TNF-alpha. EXPERIMENT 5 Glomérulos isolated rat with 4 months of development of diabetes were incubated 24 hours with irbesartán, etanercept and both simultaneously. Later it was determined the glomerular expression of TGF-beta, PDGF-B, VEGF and TNF-alpha. The blockade of the local SRA plays an important role in the effect nefroprotector of irbesartán. In addition, this beneficial effect is at least partly due to the blockade of TNF-alpha system.

Author: MOGOLLON PÉREZ AMPARO SUSANA.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: OBJECTIVE analyze the conditions for access of the population displaced by the armed conflict to the State Social Companies (ESCOs) in primary care level of Bogota, in order to establish possible proposals for improvement. METHODS We conducted a qualitative study of descriptive exploratory type. It aplicacron three techniques: documentary analysis, individual semi-structured interview and case study. The final composition of the sample was 28 documents: 17 public policies for the handling of displacement forazado in Colombia, 11 enacted by the General System of Social Security in Health (SGSSS) and 81 informants come from 3 ESE: managers (10); profesinales of health (25), administrative staff (18) and users displaced (28). The case study corresponded to a displaced women, a major user of an ESCO. We used the technique of narrative analysis of the content, with a generation of mixed categories and segmetnación by type of reporting and categories. The study area is sconstituyeron four locations in Bogota. The field work was conducted during the months of April through December 2003. RESULTS There are guiding principles of the policy: the definition of forced displacement as a catastrophic event, the recognition of health care as a fundamental right, preferential attention to the vulnerable population and management agencies. As objectives emerge: enroll the displaced population SGSSS to provide comprehensive care in health and disseminate existing policies. These goals, along with the principles constitute potential facilitators of access to health services. However, the processes in place to identify the beneficiaries of the lack of clarity in the financing, the restriction in guaranteed services and continuing changes in the provisions emerge as factors that since the content of politics and from the perception of different players, restricting access to potential ESE. All actors identified weaknesses in the disclosure of the policy and in its implementation at the various levels. As for the difficulties of the institutions, managers and administrative staff, indicate the limits on the financing and billing services, while, health personnel and the displaced population focused its analysis on the problems for the effective delivery of service and geographical access. Different actors agree that the low vinel income of the displaced, combined with the low level of information to the multiple needs of health care and a shortage of social support networks, are factors relating to the displaced population that affect their access to the ESE. CONCLUSIONS During the period 1997-2003, Colombia made significant progress in the formulation of policy on health care for the displaced population, seeking its principles and its scope, were consistent with the guidelines of SGSSS. However, difficulties in membership and subsequent access to the ECS, are the main rupture introducing politics. Ignorance of the changes and the scope of politics. Ignorance of the changes and the scope of the policy of care in some service providers and in the vast majority of the displaced, reflecting the failures of the national government and health institutions in its 8 divulgac 443 ion. Finding the right balance of the financial ESE, is one of the major barriers that limit from institutions comprehensive care. Poor economic conditions are the main factor since users restrict access to potential and actual ESE, a situation that is more complex in those who have not achieved their affiliation with the SGSSS.

Author: BEDOYA DEL OLMO LUIS MIGUEL.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of preparation: FACULTAD DE FARMACIA , UCM.

Summary: We selected 25 plants in the center of the Iberian Peninsula in order to study their activity anti-VIH.Cuatro species, three Cistaceae, Citus lurifolius, Cistus monspeliensis and Tuberaria lignosa and Rosaceae, Sanguisorba minor, possession showed that activity when aqueous extracts analyzed and etanólicos.El aqueous extract and ethanol from Tuberaria lingnosa showed higher activity that extracts of the other three species when it came to his fractionation can isolate the compounds responsible for the actividad.Estos results be hydrolysable tannins, three of them called 1A, SR2 and TL3.A3S264 elagitaninos simple one, called DG21, a tamino hydrolysable high molecular weight. It established the mechanism of action of these compounds using recombinant viruses, the gene carriers indicator of the luciferasa.Los results show as both elagitaninos isolated Tuberaria lignosa as hydrolysable tannins high molecular weight had the same mode of action, and acted blocking the entry of HIV into the célula.Se was able to show that these compounds inhibit the entry of virus tropism with both R5 and X4 and its mechanism of action was specific receptor internalization of VIH.La main entry of HIV into the cell lymphoid The CD4 was demonstrated for a elagitanino simple, 1A, and tannin for a high molecular weight, DG21, and may be the mechanism responsible for the anti-HIV activity of this type of compound.

Author: GALINDO GALINDO PEDRO.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: 14000 FACULTAD DE FARMACIA.

Summary: The justification of this work stems from two reasons: * The high prevalence in society and the high economic costs caused by absence from work. * Evaluate an alternative to surgical treatment. To do so we proposed the following assumptions: * If steroids are effective and safe in the inflammatory processes in general by different routes of administration, parametasona which is a corticosteroid widely used at joints for its high efficiency and good profile Pharmaco, must be equally effective and safe, infiltrated the region epidural for the treatment of back pain. * This drug therapy, must assume that the lower cost surgical treatment. So we established the following goals: * To assess the effectiveness and safety of infiltrations parametasona in lumbalgias incapacitating. * Studying the economic cost of this technique compared with discectomy. To achieve this we conducted a clinical study of case series, prospective, observational, open and non-randomized, with a sample population of 1072 patients presenting lumbalgias at various levels, and we were seeing results depending on the level of involvement, sex, age and number of infiltration implemented. The results were as follows: * The efficiency of infiltration, was 80.69% overall, 79.7 of 939 men and 87.2% of the 133 women. The minimum savings obtained for these 1072 patients was 3,611,590 euros and the minimum savings of 3,369 euros per patient.

Author: ARTAZCOZ LAZCONA LUCÍA.
Year: 2004.
University: POMPEU FABRA [www.upf.edu].
Place of defense: DEPARTAMENTO DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.
Place of preparation: DEPARTAMENTO DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.

Author: VELARDE MAYOL CRISTINA.
Year: 2004.
University: REY JUAN CARLOS [www.urjc.es].
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: Objectives: To know the immune protection against tetanus, diphtheria and whooping cough which has the population aged 65 and over based on the seroepidemiologia, veterinary and interview the patient. To assess the concordance between recording and interview. Identify the population susceptible to tetanus, diphtheria and whooping cough. Propose immunization schedules according to the results. Design: study seroepidemiologico descriptive character cross. Materials and methods: sampling probabilístico not from the users of two of the three health centers segovia capital, older than 65 years old at the time of the study (2001). Excluded were patients with any mental disorder that prevented completion of the clinical interview, patients and displaced residents with less than 6 months of stay in the centers and elderly whose reason for consultation pudlede have any bearing on the reason for the study. In all cases was obtained appropriate informed consent. Serum samples were obtained fasting, coinciding with withdrawals requested by other causes. The sample was processed for separation of serum and frozen at -20. C. The immunological status of the subjects was evaluated quantitatively mediantes kits ellsa business. In international units per millimeter in the case of corynebacterium diphteriae and Clostridium tetani (gezyme virotech) and units equivabencia by millimeter for bordetella tertussis (pertusscan pt-g). To collect data on the vaccination history, we performed an interview the patient, we reviewed the clinical histories, central records and immunization card. Discussed the detailed interviews and data from the clinical history through the kappa index. To study the sensitivity and specificity of the interviews and records, was used as the gold standard serología. Results: were included 256 patients, of whom 5.6% rejected the serological study. The remaining 61.6% were women and 38.4% men. The average age was 74.2 years s = 6.4). The coefficient of sobreenvejecimiento was 46.8%. The 70.8% of the requests were for analysis of the control of chronic diseases. Tetanus. According to the interview, 61.6% had no history of tetanus vaccination (vat). Of the total elderly with a history of vat, spoke only registered 50% and all immunizations are spoken in recent 10años. The (nidice kappa for the agreement between recording and interview was 0.5. From 245 samples anallzables, 24.9% did not have any protection and 66.2% basic protection against tetanus. Sensitivity and specificity of the interview clinic were 94.7% and 37.5% respectively. same information for medical records were 91.6% and 28.9% respectively. Diphtheria. not the 47.1% had no immunity, and 50, 5% basic immunity. vaccination antidiftérica was also infraregistrada. seropositive of the total, only 15.5% were registered as vaccinated. sensitivity and specificity of the health records were 73.6% and 49.0% respectively . pertussis. there was no history of vaccination or clinic in the interview, nor in the medical records. 59.7% did not have any protection and the 37.4% minimum protection. none of the three diseases were no differences in function the age, sex, chronic patologias and estadoinmunitario patient. a 9.1%, 31.1% and 42.2% of patients were susceptible to three, dosa one of the diseases under study, respectively; In last group with a predominnio sifnificativo elderly immunosuppressed. Conclusions: Two-thirds of the sample had basic levels of protection against tetanus, and 24% were unprotected, and there are a significant infraregistro or incorrect registration of this 8 activitie 543 d. sensitivity the interview was better than the records to find out the background of tetanus vaccination. to 50% were unprotected against diphtheria, tetanus, and more than 25% of the elderly with registration vaccine antidifterica were seronegative. this group could benefit from a dose td booster. to 40% of HIV-positive can only be attributable to the natural infection, possibly without developing a comprehensive clinical picture may play an important role as transmitters susceptible to other groups, which leads to consider the need to introduce the vaccine in the schedule of adult vaccine.

Author: MARTIN ARRIBAS CONCEPCIÓN.
Year: 2004.
University: REY JUAN CARLOS [www.urjc.es].
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: One of the most worrisome problems in occupational health is the impact of job stress and its consequences, both physical and psychological, has on workers. Model demandacontrol-apoyo social karasek-theorell and johnson is one of the most used in public health for the study of this phenomenon. Objectives. The overall objective of the study was to determine, using the model demand social karasek-theorell-johnson, the level of work-related stress in a sample of nurses and identify the factors associated with it. Specific objectives were:-to perform a systematic search of the existing literature related to the psychosocial stress associated with work and the development of disease. - To quantify the level of work-related stress in the nurses study. - Analyzing variables related to occupational stress. - Explore the relationship between job stress and the quality of life (cvrs). Methods. Observational cross in a múestra of 1496 nurses selected by random sampling of the total registered in the community castilla-leon. The information is collected through mailings and telephone calls during the years 2002-2003 of the questionnaire "job content" and a questionnaire specific (sociodemographic data), work history, medical history and lifestyles) and euroqol-5d. It made a anallsis descriptive and adjusted logistic regression models. Results. The response rate was 45.5% (680 nurses), ranging between 68% and 35%. The 49% complained of high demands at work and 22% lack of control. Elanallsis multivariate showed that the variables that are associated with stress were: the effort flslco moderate, and very intense (OR = 4.00, 95% CI = 1.94 -8.22) and work in services operating room (OR = 3.67, 95% CI = 1.23 -10.94) uci and emergencies (OR = 3.25, 95% CI = 1.41 -7.49). The support of both the colleagues, and the supervisors appeared as a protective factor against the stress (p = increased 0.05). With respect to quality of life, the variables that explain a poorer perception of quality of life is the presence of patologias, jobs that require effort ffslco moderate / intensive and the disruption of sleep quality. The lack of support from co-workers is an associate expense of cvrs. Regarding the systematic search results, the literature review of the results of studies on the causes of stress and its effects on health are inconclusive.

Author: FEREZ RUIZ XAVIER.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE MEDICINA-UNIVERSIDAD DE MURCIA.
Place of preparation: FACULTAD DE MEDICINA- UNIVERSIDAD DE MURCIA.

Summary: SUMMARY: The objective raised in this thesis has been exploring systems modulation positive and / or negative process of cytotoxic NK cells through the use of monoclonal antibodies. We have studied on the one hand, the role of integrins beta-1 (CD29) expressed on the cell membrane of different tissues and secondly, the role itself MHC-I expressed in the cell efectora, what we have called "MHC-I self, "both from a functional point of view (conjugation processes and cytotoxic activity), topological (location on the cell surface with respect to the" rafts "and the immunological synapse) and ontogénico (expression MHC-Iy DX5 (CD49b ) can identify and differentiate stages of their life processes). To discuss some of the data obtained, we have designed a procedure nomalizado for statistical analysis of the colocalización two or more molecules of cell membranes. The results have shown that induced signaling through the integrins beta-1 (residues 207-218) expressed in leukemic cells increases the susceptibility (conjugation and lysis) to the NK cell-mediated cytotoxicity, and that the aggregation of molecules MHC- I monoclonal antibody in NK cells inhibits the ability of conjugation and lysis compared to K562 excludes proteins MHC-I the immunological synapse and "rafts" and induces intracellular phosphorylation of tirosinas. Lastly, has been characterized a subpopulation of NK cells from mouse phenotype NK1.1 + DX5- that could belong to a terminal stage NK lineage.

Author: HERVÉS GARCÍA MARÍA.
Year: 2004.
University: SANTIAGO DE COMPOSTELA [www.usc.es].
Place of defense: FACULTAD DE BIOLOGÍA.
Place of preparation: FACULTAD DE BIOLOGÍA.

Summary: INTRODUCTION It is a historical review of Aerobiology (science that studies the biological particles present in the atmosphere) since its inception in the first century BC, when Hippocrates certain diseases associated with the inhalation of air, until his great development as a science in twentieth century. The Aerobiology presents two major branches, Palynology, which deals with the study of pollen grains present in the atmosphere and Aeromicología, which deals with the fungal propagules. In this paper doctoral covers both fields, which are descriptions of the types and fungal polínicos studied, providing photographs. The importance of these medical biological particles by their nature allergenic, causing respiratory diseases kind in the world population MATERIAL AND METHODS It has been used a standard methodology that enables simultaneous sampling both pollen and spores of fungi in the air . The samples have been collected with a volumetric sensor type Hirst (VPPS-2000), which allows the aspiration of air on a continuous basis and a constant volume. The treatment in the laboratory, as well as the counting of both types of particles was carried out as recommended by the Spanish Red Aerobiology (REA). RESULTS variation is analyzed annual, monthly, daily and intra both types polínicos as fungal, during the years 2001 and 2002, in the atmosphere of Galician four locations: Santiago de Compostela, Lugo, Viveiro and A Coruna. It also discusses the relationship between their atmospheric levels and major meteorological parameters observed that in general, rain and relative humidity have a negative impact, while the temperature influenced in a positive way about their presence in the air. DISCUSSION It compares levels of the types polínicos more plentiful and of the three types fungal studied in the atmosphere of the four localities in the study, with each other for the rest of the stations of the Research Network of Galicia (RIAG) and the Network Spanish Aerobiology (REA), in addition to other stations in Europe and other continents. It also explores the relationship between weather and differences in the annual registration polínico and fungi, in addition to providing intra-distribution patterns. Finally we study the clinical incidence of both types of particles cause allergies and perform linear regression analysis in order to obtain equations predict that allow high levels in a given time.

Author: ALCALA MINAGORRE PEDRO JESUS.
Year: 2004.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: FACULTAD DE MEDICINA INSTITUTO DE NEUROCIENCIAS.
Place of preparation: DEPARTAMENTO DE SALUD PUBLICA, HISTORIA DE LA CIENCIA Y GINECOLOGÍA.

Summary: The head injury is a frequent reason for consultation in emergencies. The use of imaging tests, including radiography, is subject to significant variability in clinical practice may repercutier in the quality of care. Working Hypothesis The implementation of a protocol, consensual interdisciplinarmente and adapted to the environment of care, improve, so sustained, the diagnostic accuracy, the quality of care and resource consumption Target Chief Determinarla frequency and appropriateness of use of radiografia in patients age pediatric attended by head injury at the General Hospital of Alicante before and after the implementation of a protocol for action and Population Study Method Type: Áuditclínico, pretest-postest. It consists of two phases, each to 12 months: 1) retrospective and descriptive study on the use and determinants of radiography in skull trauma craneoencefálícos.2) intervention study to evaluate the use of radiography of the skull after the implementation of a diagnostic protocol, based on a systematic review of 'medical literature. Once the study was collected opinion on the protocol of medical users. Scope section of Pediatric Emergency General Hospital Universitario de Alicante Subjects in the study: all under 15 years old attended by head injury during the study period and did not submit any of the criteria for exclusion. Results were collected 1362 head injuries (1.71% of all pediatric emergency room served). The use of radiografia declined significantly, from 45.8% to 38.9% following the implementation of protocolo.Asi also produced a significant decrease inadequate (set of overuse and underuse) of the test, from 25 , 1% to 14.7%. The overuse rose from 17.3% to 11.3%, and spending of 7.8% to 3.4%. There were no statistically significant differences in the proportion of the use of cranial computed tomography, and there was a significant decrease in income, thereby preventing the hospitalization of 28 patients in the prospective phase of the study. Conclusions - During the 12 months prior to the implementation of the protocol was made use of radiography in 45.8% of the cranial trauma care. The 44.4% this evidence lacked clinically indicated, and in 25.1% of patients assisted the doctor's decision regarding their use was inadequate, both for over-utilization. - The development and implementation of a protocolode action based on the current recommendations, involving interdisciplinary and adapted to the needs care, produced an improvement in the quality of care, the diagnostic accuracy and the use of health resources. The Instrument AGREEse showed how useful a tool the development of the protocol, and in adapting it to the context of care. The combination of clinical sessions and explanatory panels expressed as an effective strategy for the dissemination of the protocol. - During the year following the implementation of the protocol, the proportion of patients who received X-rays for head injury decreased by 6.9%. Also, the rate of inappropriate actions regarding the use or non-radiography was reduced by 10.4%. These were that 57 children were not present to ionizing radiation. - The implementation of the protocol was not accompanied by a statistically significant increase in the use of computerized tomography. - Most of the injuries had not cared impact dínica, and could be handled ambulatoriamente, without income or test image. The implementation of the protocol was accompanied by a significant decrease d 8 the númer 4ad or revenue side head injury. - During the twelve months following the implementation of the protocol is not observed at the time of the weakening effect obtained in the frequency and appropriateness of use of radiography. - The use of the protocol was not accompanied by undesirable effects, like not detect significant injury, or redamaciones by users. - The majority of pediatricians surveyed stated that the protocol was a useful tool practice dínica applicable in most cases, and with a proper scientific basis. Although it raised the introduction of some improvement, all respondents felt necesaña the development of clinical protocols of the major pathologies urgent, and the revision of existing ones.

Author: URTIAGA DOMINGUEZ MIGUEL.
Year: 2004.
University: PÚBLICA DE NAVARRA [www.unavarra.es].
Place of defense: E.U.DE ESTUDIOS SANITARIOS.
Place of preparation: UNIVERSIDAD PUBLICA DE NAVARRA.

Summary: In 1990 it was estimated the number of users of opiates (UO) from the community of Navarra (Spain), using methodology as the search intensive cases (BIC), complemented by methods Captura-recaptura simple and the method described by Chao. The BIC is to locate UO residing in our community in various institutions and / or services, health, social, criminal, etc.. It tracked 2,033 cases, of which, once eliminated duplicates, resulting in 1,231. These 1,231 UO pose a prevalence of 2.40 per 1,000 people (1 in every 417 residents of Navarre). The prevalence was three times higher in males than in females. Mean age was 26 years and two months. The prevalence in urban areas was 3.42 times higher in the latter regard to rural areas. The age group with the highest prevalence was between 25 and 29 years, with 14.7 cases per 1,000 people (1 in every 68 inhabitants), 22.2 in men (1 for every 45 inhabitants) and 6.87 in women ( 1 out of 145). As regards the estimation of cases using capture-recapture techniques, using this simple method varies between 1,132 and 1,755, combining four surveillance systems two to two (Mental Health with 618 cases, Emergency Psychiatric with 365, with Therapeutic Communities 325 cases and the Ministry of Justice with 260 cases) and 2,026 users using the method of Chao with the four surveillance systems used for the simple method. Between 1990 and 2000 (11 years), is monitoring the vital UO identified. In that period, of 1,231 users of opiates, 105 are lost. For the 1,126 remaining it tracks 10,288 person-years, with an average of 109 months per user. To read the vital status were accessed Registration mortality, which encodes the cause of death until 1998 with ICD-9 and ICD-10 in 1999 and 2000. Moreover, checked the records of population base of HIV infection and AIDS, as well as the database of Acute Adverse Drug Reactions (Raad) of the Department of Forensic Pathology, all from the region of Navarra. In that period died 327 (29%). The average age of UO at the time of death was 31 years and 9 months. The death rate is 31.78 per 1,000 population. The relative risk (RR) of dying depending on the sex