Ruth Gil

Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study

BackgroundMaternal health is one of the major worldwide health challenges. Currently, the unacceptably high levels of maternal mortality are a common subject in global health and development discussions. Although some countries have made remarkable progress, half of the maternal deaths in the world still take place in Sub-Saharan Africa where little or no progress has been made. There is no single simple, straightforward intervention that will significantly decrease maternal mortality alone; however, there is a consensus on the importance of a strong health system, skilled delivery attendants, and womens rights for maternal health. Our objective was to describe and determine different factors associated with the maternal mortality ratio in Sub-Saharan countries.MethodsAn ecological multi-group study compared variables between many countries in Sub-Saharan Africa using data collected between 1997 and 2006. The dependent variable was the maternal mortality ratio, and Health care system-related, educational and economic indicators were the independent variables. Information sources included the WHO, World Bank, UNICEF and UNDP.ResultsMaternal mortality ratio values in Sub-Saharan Africa were demonstrated to be high and vary enormously among countries. A relationship between the maternal mortality ratio and some educational, sanitary and economic factors was observed. There was an inverse and significant correlation of the maternal mortality ratio with prenatal care coverage, births assisted by skilled health personnel, access to an improved water source, adult literacy rate, primary female enrolment rate, education index, the Gross National Income per capita and the per-capita government expenditure on health.ConclusionsEducation and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others.

Burden of herpes zoster requiring hospitalization in Spain during a seven-year period (1998-2004).

BackgroundA thorough epidemiological surveillance and a good understanding of the burden of diseases associated to VZV are crucial to asses any potential impact of a prevention strategy. A population-based retrospective epidemiological study to estimate the burden of herpes zoster requiring hospitalization in Spain was conducted.MethodsThis study was conducted by using data from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos (CMBD). Records of all patients admitted to hospital with a diagnosis of herpes zoster (ICD-9-MC codes 053.0–053.9) during a 7-year period (1998–2004) were selected.ResultsA total of 23,584 hospitalizations with a primary or secondary diagnosis of herpes zoster in patients ≥ 30 years of age were identified during the study period. Annually there were 13.4 hospitalizations for herpes zoster per 100,000 population in patients ≥ 30 years of age. The rate increases with age reaching a maximum in persons ≥ 80 years of age (54.3 admissions per 100,000 population >80 years of age). The mean cost of a hospitalization for herpes zoster in adult patients was 3,720 €. The estimated annual cost of hospitalizations for herpes zoster in patients ≥ 30 years of age in Spain was 12,731,954 €.ConclusionHerpes zoster imposes an important burden of hospitalizations and result in large cost expenses to the Spanish National Health System, especially in population older than 50 years of age

Epidemiology of typhoid and paratyphoid fever hospitalizations in Spain (1997-2005)

Background and Objective: This epidemiological survey was undertaken to estimate the burden of hospitalizations for typhoid and paratyphoid fever in Spain over a nine-year period (1997-2005). Patients and Methods: Hospital discharges for typhoid or paratyphoid fever reported during a nine-year period in Spanish hospitals were obtained from the national surveillance system for hospital data, which is maintained by the Ministry of Health and covers more than 97% of Spanish hospitals. Results: There were 1,106 hospitalizations for typhoid and paratyphoid fever during the study period. The annual hospitalization rate was 0.31 cases per 100,000 population. The mortality and case fatality rates were 0.003 per 100,000 population and 0.9%, respectively. The average length of hospitalization was 10.19 days. These hospitalizations impose an annual direct cost of € 334,000. Conclusions Preventive measures are vital to reduce the occurrence of typhoid fever and avoid new outbreaks. Effective prevention would result in large cost savings to the National Health Care System.

Hospitalization by pneumonia and influenza in the 50-64 year old population in Spain (1999-2002).

This epidemiological survey was undertaken to estimate the burden of hospital admissions for pneumonia and influenza in 50-64 years old persons in Spain during a four-year period (1999-2002). Data were obtained from the national surveillance system for hospital data maintained by the Ministry of Health and covering more than 95% of Spanish hospitals. There were 35,620 hospital admissions for pneumonia and influenza (ICD 9 CM 480-487; first listed diagnosis) during the study period. Annual incidence was 143 cases per 100,000 population. Rate of death and case-fatality rate were 8 per 100,000 population and 5.6%, respectively. The average length of hospitalization was 10.4 days. Men and older age groups showed a higher incidence, rate of death and case-fatality rate. These hospitalizations of 50-64 years old persons impose an annual direct cost of 12 to 24 millions euros. Preventive measures, such as vaccination will reduce pneumonia-related morbidity and could result in large cost savings to the Health Care System.

Hospitalizaciones por herpes zoster y neuralgia postherpética en la Comunidad de Madrid, 1998-2003

Resumen Objetivo El objetivo de este estudio ha sido analizar la frecuencia y las caracteristicas de las hospitalizaciones por herpes zoster (HZ) y neuralgia postherpetica (NPH) en la Comunidad de Madrid, asi como tambien estudiar el consumo de recursos y costes asociados al tratamiento hospitalario de la enfermedad. Material y metodos Estudio retrospectivo en el que se ha utilizado la informacion de los pacientes ingresados en los hospitales de la Comunidad de Madrid con diagnostico al alta de HZ o NPH, procedente del sistema nacional de datos hospitalarios, Conjunto Minimo Basico de Datos. Se recogio informacion adicional de las historias clinicas de los pacientes hospitalizados en el Hospital Universitario 12 de Octubre de Madrid durante el periodo 1998–2003 con HZ y/o NPH. Resultados Durante el periodo 1998–2003, se registraron 3.085 ingresos relacionados con HZ y/o NPH en los hospitales de la Comunidad de Madrid, lo cual supone una tasa anual de hospitalizacion de 10,0 por 100.000 habitantes (intervalo de confianza del 95%, 9,6–10,3). Esta tasa aumenta con la edad, y llega a 86,2 por 100.000 habitantes en los mayores de 85 anos. El HZ y/o la NPH fueron el primer diagnostico al alta en el 22% de los casos. El coste medio del ingreso en estos pacientes se estimo en 3.520 euros. De los casos ingresados en el Hospital Universitario 12 de Octubre, el 62% se clasifico como moderado y el 5,4%, como grave. El dolor fue el sintoma notificado de forma mas frecuente, en el 84% de los casos. El 23% de los casos presento alguna complicacion y el 66% presentaba algun diagnostico correspondiente a factores de riesgo previo al episodio. Los antivirales orales o intravenosos fue el tratamiento administrado con mas frecuencia. Conclusiones El HZ supone una fuerte carga para el sistema sanitario y un importante coste economico y social, especialmente en la poblacion de mas edad.

Hospitalizaciones por herpes zoster y neuralgia postherpética en Cataluña, 1998-2003

Resumen Objetivo Analizar la frecuencia y las caracteristicas de las hospitalizaciones por herpes zoster (HZ) y neuralgia postherpetica (NPH) en Cataluna y estimar el consumo de recursos y costes asociados al tratamiento hospitalario de la enfermedad. Material y metodos Se realizo un estudio retrospectivo utilizando informacion de pacientes hospitalizados con HZ y/o NPH procedente del sistema nacional de vigilancia de datos hospitalarios, Conjunto Minimo Basico de Datos. Se recogio informacion adicional de las historias clinicas de los pacientes ingresados con HZ y/o NPH como diagnostico principal al alta en el Hospital Clinic de Barcelona durante el periodo de estudio. Resultados Durante el periodo de 1998–2003 se registraron 3.561 ingresos con HZ y/o NPH en los hospitales de Cataluna. La tasa global de hospitalizaciones con HZ y/o NPH como cualquier diagnostico al alta fue de 9,7 por 100.000 personas. Esta tasa aumenta significativamente a partir de los 50 anos de edad. En el 35% de los casos el HZ y/o NPH fue el diagnostico principal al alta. En estos pacientes con HZ y/o NPH como motivo de ingreso, el coste medio por ingreso se estimo en 2.630 euros. De los pacientes ingresados en el Hospital Clinic de Barcelona con diagnostico principal de HZ y/o NPH, el 60% presentaba alguna complicacion asociada al HZ; en el 89% se observo algun factor de riesgo previo al episodio, y en el 94% se administro tratamiento farmacologico. Conclusiones El herpes zoster representa una importante carga clinica para el sistema sanitario en Cataluna y supone un importante coste economico y social, especialmente en la poblacion mayor de 50 anos.

Asociación entre la carga herpética y la enfermedad isquémica crónica del corazón: estudio de casos y controles

BACKGROUND AND OBJECTIVES Previous studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context. PATIENTS AND METHODS Sex and age matched case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2. RESULTS We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 [1,23-16,53]), but not when hypercholesterolemia was included in the model (OR 2,2 [0,45-10,62]). CONCLUSION The hypothesized relationship is independent from most but not all classical cardiovascular risk factors.

Folato sérico en población adolescente de la Comunidad de Madrid

Fundamento y objetivo Conocer los valores sericos de folato en ninos es imprescindible para establecer unos percentiles que permitan realizar comparaciones entre regiones o paises, asi como para plantear la suplementacion de la dieta con vitaminas del grupo B y acido folico como prevencion secundaria frente a las enfermedades cardiovasculares. El objetivo de este estudio ha sido analizar las concentraciones de folatos en adolescentes de la Comunidad de Madrid. Sujetos y metodo Se ha realizado un estudio epidemiologico descriptivo de tipo transversal con el fin de estimar los valores sericos de folato en la poblacion escolar de 13 a 15 anos de la Comunidad de Madrid. Se determinaron las concentraciones de folato y vitamina B12 en las muestras de sangre de 311 adolescentes (141 ninos y 170 ninas) obtenidas en ayunas. Se determine el genotipo C677T de la enzima metilentetrahidrofolato reductasa (MTHFR) por reaccion en cadena de la polimerasa. Resultados Los valores medios de folato obtenidos en nuestro estudio fueron de 7,83 nmol/l (intervalo de confianza del 95%, 7,42-8,23 nmol/l) y la mediana fue de 6,89 nmol/l (recorrido intercuartilico: 5,30-9,30 nmol/l). No se encontraron diferencias estadisticamente significativas por sexo, edad o presencia o ausencia de menstruacion. La concentracion serica de folato disminuyo significativamente con la mutacion del genotipo C677T de la enzima MTHFR. La prevalencia de valores deficitarios de folato ( Conclusiones El genotipo mutado C677T en homocigosis de la enzima MTHFR produce deficit de folato, especialmente en mujeres a partir de la pubertad. Se propone el valor de 5,3 nmol/l como posible punto de corte para definir el deficit de folato serico en la poblacion adolescente de nuestro pais.