RESUMO
BACKGROUND: The association of uveitis and systemic disease is well known. Patients suffering from uveitis often undergo a extensive battery of tests in order to detect underlying disease, but the efficiency of such screening is uncertain. The aim of this study was to investigate useful clinical data for recognizing secondary uveitis. PATIENTS AND METHODS: We conducted a prospective analysis of 115 patients with uveitis of unknown etiology. All of them were included in an extensive protocol study. Four groups were considered: specific ocular disease (SOD), idiopathic uveitis, HLA-B27 associated uveitis without arthritis (HLA-B27-AU) and secondary uveitis. Groups were compared by analysis of variance for continuous variables, and chi 2 test or Student's t-test for discrete variables. A stepwise multiple discriminant analysis was performed for ranking the variables in order of their usefulness for distinguishing idiopathic and secondary uveitis. RESULTS: We diagnosed 11 SOD (9.6%), 54 idiopathic uveitis (47%), 6 HLA-B27-AU (5.2%) and 41 secondary uveitis (35.7%). The discriminant analysis showed that age, an elevated erythrocyte sedimentation rate, presence of cutaneous lesion, joint pain and genital ulcers are the strongest predictors of secondary uveitis. This model classification functions detected 92.5% of idiopathic uveitis and 72% of secondary uveitis. The global percentage of patients with a correct diagnosis was 84.6%. CONCLUSIONS: Anamnesis, physical examination and basic laboratory tests are sufficient tools for the diagnostic approach of the majority of patients with uveitis. Subsequent diagnostic procedures must be planned in each patient to confirm a specific disease.
Assuntos
Uveíte/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Biomarcadores , Criança , Pré-Escolar , Análise Discriminante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: The evaluation of the costs of intensive care is a subject of interest at present, due to the high resources required by this area of health care services and the rhythm at which these costs increase. Such an evaluation has rarely been carried out in Spain. The aim of this study was to quantify the cost of medical care to critical patients in an Intensive Care Unit (ICU) in addition to evaluate the relationship between the severity of the disease and the short term result of intensive health care. METHODS: A prospective study was carried out in 1,184 patients admitted (February 1985-February 1986) to the ICU of the Hospital General de Especialidades Virgen de las Nieves in Granada (Spain). Variables collected were the severity of the patient (APACHE II), therapeutic intensity (TISS) received, diagnosis on admission and state on discharge. A detailed and individualized evaluation was performed concerning the costs of hospital stay and treatment in the ICU. RESULTS: The cost per patient per day in the ICU was found to 54,438 pesetas in 1988. A significant association was demonstrated with age, severity, therapeutic intensity and the result of the stay in the unit, being much higher in the patients who died in the ICU, particularly in those in whom the prognosis "a priori" was good. CONCLUSIONS: A significant relation was found between the cost and severity of the disease, with the maximum costs being found in patients in whom survival was expected but who died and vice versa.
Assuntos
Unidades de Terapia Intensiva/economia , Índice de Gravidade de Doença , Adulto , Idoso , Estudos de Coortes , Custos e Análise de Custo , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Smoking is the main cause of preventable morbidity and mortality in Europe. The effect of smoking is not constant with the diseases related to it. The goal of this study is to estimate poblational etiologic fractions (PEF), as the proportion of disease attributable to smoking in the reference population, for those disease clearly related to smoking in Granada. METHODS: The PEF depend upon relative risk (RR) and the proportion of exposed subjects in the target population. Meta-analytic procedures, following the Woolf's method, were applied to estimate weighted RR between smoking and each one of the diseases studied. A survey on a random sample of all Granadian population to assess the prevalence of smoking was performed. RESULTS: The PEF were always higher for males than for females. In males, the highest figures were for lung cancer (85%) and chronic obstructive lung disease (84%); whilst in females lung cancer and peripheral artery disease reached the greatest figures, 55% and 51%, respectively. CONCLUSIONS: The figures obtained outline the need for improving antismoking campaigns and allow to quantify the maximum potential benefit to be got if smoking was quit by the Granadian population.
Assuntos
Pneumopatias Obstrutivas/etiologia , Neoplasias Pulmonares/etiologia , Doenças Vasculares Periféricas/etiologia , Fumar/efeitos adversos , Adolescente , Adulto , Feminino , Humanos , Pneumopatias Obstrutivas/epidemiologia , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/epidemiologia , Risco , Fumar/epidemiologia , Espanha/epidemiologiaRESUMO
PURPOSE: To ascertain the presence of recall or report bias in a case-control study on congenital dysplasia of the hip (CDH). METHODS: A hospital case-control study was performed. Those cases and controls with other malformations or from mothers with clinical problems were discarded. 97 cases of dysplasia, and 164 controls were collected. Mother's life style was assessed. Odds ratios (OR) (crude and multiple-factor adjusted by logistic regression analysis) and their 95% confidence intervals were estimated. Risk factors were analyzed stratifying by the results of Ortolani-Barlow maneuver, since women were interviewed after knowing these results. RESULTS: Mothers of newborns with a positive Ortolani-Barlow maneuver yielded a higher OR for positive family history than those of babies with a negative one (2.27 versus 1.38). Overall smoking and alcohol consumption, and number of health exams during pregnancy yielded a negative association with CDH. In these cases closer-to-the-null ORs were obtained in newborns with positive Ortolani-Barlow. CONCLUSIONS: The presence of a report or recall bias is suggested as one of the possibilities for explaining the results.
Assuntos
Viés , Estudos de Casos e Controles , Luxação Congênita de Quadril/epidemiologia , Mães/psicologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Feminino , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Recém-Nascido , Manipulação Ortopédica , Rememoração Mental , Razão de Chances , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Fatores de Risco , Estudos de Amostragem , Fumar/epidemiologia , Fumar/psicologia , Espanha/epidemiologia , UltrassonografiaRESUMO
INTRODUCTION: Due to the lack of data in our medium and epidemiologic study was performed with the aims of knowing the numbers of morbimortality of anesthesia in a tertiary hospital as well as identify the risk factors of the same. METHODS: A general prospective study was carried out with a sample of 5,162 anesthesias administered in our hospital from October 1986 to October 1987. The questionnaires undertaken were completed by the anesthesiologists of the hospital staff. Age, sex, ASA, emergency, associated preoperative pathologies, premedication, length of operation, duration fo anesthesia, anesthesiologist experience, type of surgery, type of anesthesia, monitoring, type of complications and evolution of the same were the variables assessed. Severe cases were also evaluated by 3 anesthesiologists of the department, independent of those involved. The relative risk and the confidence interval of 95% were calculated as were the chi of Mantel-Haenszel tendency and a test of mean comparisons. RESULTS: The mortality partially linked to anesthesia found was 1:2,581. The numbers of morbidity were of 0.77% for severe complications and 14.1% for the slight complications. Upon analysis of severe complications 28.5% of the cases were found to be due to human error. The principal risk factors were age, emergency, bad preoperative physical state, lenght of operation, type of anesthesia and surgery. CONCLUSIONS: The situation in our center does not differ from that found by other authors and not only the numbers of morbimortality but also the factors of risk found in this study are similar to those published in recent studies.
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Anestesia/efeitos adversos , Adolescente , Adulto , Idoso , Anestesia/mortalidade , Criança , Pré-Escolar , Feminino , Hospitais Gerais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha/epidemiologiaRESUMO
The main goal of this paper is to offer an introduction to the quantitative methods of meta-analysis used in epidemiology/public health, emphasizing on the most widespread used. We give also a brief reference of the methods to recognize publication bias. The limitations and advantages of the methods commented on are discussed.
Assuntos
Metanálise como Assunto , Viés , Modelos Teóricos , RiscoRESUMO
In the present work the general characteristics, aims and applications of meta-analysis in public health are described. The general rules and the relevant steps for the development of this type of studies are considered. These points are illustrated with a number of real examples and the advantages and limitations of the different methodological options are commented.
Assuntos
Métodos Epidemiológicos , Metanálise como Assunto , Modelos Estatísticos , Saúde Pública/métodosRESUMO
BACKGROUND: Brucellosis is a health problem in the Granada province. The major aim of the present study was to evaluate the professional risk to acquire brucellosis in Granada. METHODS: An epidemiologic study where the cases of brucellosis were found by active search was carried out. The study period was the year 1984. The patients (overall 804) were investigated in their residence area with a questionnaire where the major risk factors were considered. RESULTS: The disease was more common in males than in females (RR = 3); it had a significant tendency to increase with decreasing sizes of the urban nucleus (chi MH = 16.9, p less than 0.0001); and it had a significant relationship with the proportion of peasants and cattle workers in the region (r = 0.66, p less than 0.05). The professional group with the highest risk were veterinaries, in whom the disease was 31 times more common than in the rest of the population. CONCLUSIONS: Emphasis is made, in addition to other points, on the need to increase health education in the groups of more affected professionals.
Assuntos
Brucelose/epidemiologia , Doenças Profissionais , Medicina Veterinária , Adolescente , Adulto , Idoso , Doenças dos Trabalhadores Agrícolas/epidemiologia , Doenças dos Trabalhadores Agrícolas/etiologia , Brucelose/etiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Espanha/epidemiologiaRESUMO
The power of the association between oral contraceptives and breast cancer was analysed in all the papers published up to date. Seventy-seven publications (from 44 studies) were collected and graded as to quality using meta-analytical methods. Power achieved a figure of greater than or equal to 0.8 in a 10.8% of the associations studied. It showed a significant relationship with the existence of a significant relative risk of the oral contraceptives for breast cancer. The relationship with the sample size of a study was not linear. Power did not show any significant relationship to other variables related to the design of a study (apart from matching, being the power higher in unmatched studies), or to the biases detected, although studies considered as unbiased yielded a higher power. Logistic regression analysis included as predictors of a power greater than or equal to 0.80 the existence of a significant relative risk and the lack of biases in a research.
Assuntos
Neoplasias da Mama/induzido quimicamente , Anticoncepcionais Orais/efeitos adversos , Análise de Variância , Viés , Neoplasias da Mama/epidemiologia , Feminino , Humanos , Menopausa , Metanálise como Assunto , Análise de Regressão , RiscoRESUMO
It has been suggested that the risk of hospital infection differs according to the moment of hospital stay. Through a retrospective cohort of 843 surgery patients the effect of several factors on nosocomial infection risk is studied as a function of the duration of the hospital stay. It was observed that the studied variables (operation, type of surgery, age and severity of underlying disease) had a predisposing effect on the appearance of infection in short stays (less than 14 days), being the effect greater in longer stays. It is concluded that hospital stay can act as a modifier of the effect of several factors on the risk of hospital infection.