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Biomedical subjects

E Ramalle-Gómara

Publications and source records attributed to E Ramalle-Gómara.

At least 19 recordsLinked to original sources
PubMed2006

A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006.

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses.

Adult↗
PubMed2003

[Effectiveness of comprehensive geriatric assessment in primary care].

OBJECTIVE: To review and update evidence on the effectiveness of the comprehensive geriatric assessment (CGA) of the elderly in the community environment. DESIGN: Systematic review. DATA SOURCES: MEDLINE (January 1997 to November 2001) and The Cochrane Library, completed with a manual search. SELECTION OF STUDIES: Randomised clinical trials (RCT) to study the effects of a CGA in people over 64 and not in an institution. Trials that assessed mortality, institutionalisation and functional status were included. Those conducted after hospital discharge or not in a community environment were excluded. 133 summaries were reviewed and 16 articles analysed. DATA EXTRACTION: Methodological quality assessed with adapted Jadad scale. A data archive was worked out to collect information on characteristics of the population and the intervention and on the main findings. RESULTS: The quality of the trials was adequate, though they had important methodological differences. Eleven trials found no favourable effects in the result variables studied. Five of the twelve trials which assessed functional status and one of the twelve that evaluated admissions to institutions found some favourable effect. None of the nine studies with mortality data found favourable results. CONCLUSIONS: Evidence for the effectiveness of the CGA for the elderly not in institutions continues to be inconsistent and insufficient. Nevertheless, given the complexity of this intervention, it seems prudent to continue to conduct CGAs of the elderly in the PC environment until such time as further studies clarify the role of these programmes.

Aged↗
PubMed2002

[Appropriateness of emergency hospital admissions].

INTRODUCTION: The aim of this work is to know the proportion of inadequate urgent admissions in a general hospital. MATERIAL AND METHODS: A retrospective and descriptive study of patients admitted during 1,999 was performed. The Appropriatness Evaluation Protocol (AEP) was used in order to evaluate the appropriatness of the admissions. RESULTS: Eighteen admissions (4.5%) were inadecuated. There was a higher proportion of inappropriate admission (IA) when the physician responsible of the admission was a medical specialist (internal medicine, hematology or nephrology): odds ratio 5.3 in opposite to emergency physicians (p < 0.03). CONCLUSIONS: There was a low proportion of inadequate admissions (4.5%) and the risk of inappropriatness of the admission was major when it was ordered by a medical specialist.

Emergency Service, Hospital↗
PubMed2001

[Multicenter study of children's compliance to antibiotic treatment in primary care].

OBJECTIVES: To evaluate the degree of children's adherence to prescription of antibiotics and to determine factors linked to this adherence. DESIGN: Cross-sectional study, conducted through a telephone survey of parents of the children under study ten to fifteen days after the prescription of the antibiotic. SETTING: Thirty primary care centres in 6 Spanish provinces. PATIENTS AND OTHER PARTICIPANTS: Parents or guardians of children from 0 to 10 who attended the primary care centres between October 1998 and January 1999 for treatment of an acute infection and who were prescribed an oral antibiotic treatment with two or more daily doses. Interventions. The measuring instrument was the Morisky-Green test. MEASUREMENTS AND MAIN RESULTS: 2244 cases were studied. 1043 of them complied adequately (46.5%; 95% CI, 44.4-48.5). The factors associated with adherence were children's school situation, the age of parents or carers and the number of daily doses. CONCLUSIONS: Only half the children complied correctly with the treatment indicated. Pre-school children, those with parents or carers over 40 and those with a prescription of under three daily doses followed the treatment better. These factors need to be borne in mind by paediatricians when they prescribe an antibiotic.

Adult↗
PubMed2000

[Efficacy of an intervention in smoking cessation in patients with myocardial infarction].

BACKGROUND: The aim of this study was to evaluate the efficacy of an structured intervention based on a medical advice versus to the ordinary anti-tobacco advice in patients with miocardial infarction who are attended in an Intensive Care Unit (ICU). PATIENTS AND METHODS: 90 patients were randomly selected to receive either the specific intervention (intervention group) or the ordinary advice (control group). The medical advice was given during the ICU hospitalization and during the second, the third and the fourth week. One year later the smoking habit was evaluated. RESULTS: After one year 26 patients of the intervention group and 31 patients of the control group had stopped smoking (RR = 0.88 [CI 95% RR] 0.57 to 1.37). CONCLUSIONS: The percentage of patients who stop smoking after a miocardial infarction is high. The structured medical counselling was not effective to reduce the number of smokers at one year.

Female↗
PubMed1999

[Compliance with antibiotic treatment in nonhospitalized children].

OBJECTIVE: To evaluate compliance with antibiotic treatment in children and to determine the factors that may be associated with compliance with antibiotic treatment in children not in hospital. DESIGN: Prevalence study. SETTING: La Rioja primary care centres. PATIENTS AND OTHER PARTICIPANTS: 384 children from 0 to 10, not in hospital, who needed antibiotic treatment between October 1998 and January 1999. MEASUREMENTS AND MAIN RESULTS: Antibiotic compliance was measured with the Morisky-Green test through a phone survey of the parents ten days after the treatment was prescribed. The number of children who complied satisfactorily with the prescribed treatment was 214 (55.7%; 95% CI, 50.6-60.7). Correct compliance was more common in children with 12-hour rather than 8-hour intervals (OR: 1.87; CI OR, 1.23-2.85), and in children who went to nursery rather than children at school (OR: 1.77; CI OR, 1.08-2.91). CONCLUSIONS: Correct compliance in the study was low. Approximately half the children prescribed an antibiotic treatment at two or three doses a day took it as the paediatrician had indicated.

Ambulatory Care↗
PubMed1999

[Delay in the administration of thrombolytics in myocardial infarct].

OBJECTIVE: To evaluate whether fast track of patients with myocardial infarction, from the emergency department to the intensive care unit, significantly decreased the intrahospital delay in the administration of anti-thrombolytic agents. PATIENTS AND METHODS: Descriptive study performed in two phases (12 and 15 months, respectively) in a second-level hospital serving a community of 260,000 inhabitants (78,000 emergencies/year). RESULTS: A total of 264 patients with myocardial infarction participated (79.2% males); the intrahospital delay in the administration of anti-thrombolytic agents was 206.1 minutes (SD: 115.8) in 1995, versus 74.9 minutes (SD: 38.5) during 1997-1998, already with the fast track system in operation (difference of 2 hours statistically significant [p < 0.001]). Only five patients received therapy before 30 minutes. CONCLUSIONS: Although fast track at the intensive care unit notable decreased the delay in the administration of anti-thrombolytic agents, this delay is still excessive (over half and hour). Therefore, the authors propose the administration of the thrombolytic agents at the emergency department as additional strategy to reduce the delay.

Aged↗
PubMed1998

Competence of health professionals to check the carotid pulse.

Our objective was to establish the proportion of Emergency Room and Intensive Care doctors and nurses able to locate the carotid pulse in less than 5 s, and identify the variables that influence this ability. The method followed was locating the carotid pulse in a healthy male adult volunteer with normal blood pressure in two situations (stretcher or floor) and with the neck in either a neutral or in an extended position. We recorded the gender, age, and previous training in cardiopulmonary resuscitation (CPR) of each participant and the time spent in detecting the pulse in each of the four possible positions. A model of logistic regression was constructed to determine if the patient's position had any influence on the proportion of health workers capable of finding the pulse within 5 s. The average age of the 72 subjects studied was 33.4 years (SD = 6.6); 80% of the participants had CPR training. Thirty-one participants (43.1%; CI 95%, 31.4-55.3%) required more than 5 s to detect the pulse, although only three (4.2%; CI 95%, 0.9-11.7%) required more than 10 s. The variable 'no CPR training' was associated with the inability to detect the pulse within 5 s. The detection of the pulse was easier with an extended neck. A significant proportion of nurses and doctors were slow to locate the carotid pulse on a healthy, young volunteer with normal blood pressure. No relation was found between gender or age of the participants. More attention should be given to carotid pulse detection in CPR training.

Adult↗
PubMed1998

The effect of rescuer fatigue on the quality of chest compressions.

OBJECTIVE: The aim of this study was to evaluate the influence of rescuer fatigue on the quality of chest compressions and the influence of the rescuer's gender, age, weight, height or professional status on the reduction of quality of chest compressions caused by fatigue. MATERIAL AND METHODS: The study was carried out with the Laerdal Skillmeter Resusci Anne manikin. The participants were doctors and nurses who work in the Intensive Care and Emergency departments, with an age ranging from 25 to 45 years and trained in cardiopulmonary resuscitation (CPR). Statistical analysis of results includes analysis variance and three models of multiple linear regression. RESULTS: Thirty-eight people took part in the experiment; 20 (52.6%) were females; 15 (39.5%) staff physicians, 15 (39.5%) nurses and eight residents. Mean age was 34.1 years (SD = 4.1). We found a significant reduction in correct compression performance over the course of time: in the first minute 79.7%, in the second 24.9%, in the third 18%, in the fourth 17.7% and in the last minute 18.5%. There were no differences related to the rescuer's gender or profession. The median interval until rescuers appreciated the effect of the fatigue on chest compressions quality was 186 s (SD = 84.1); that appreciation was not influenced by gender, age, weight, height or profession. There were no differences in the percentage of correct compressions related to gender (P = 0.07), insufficient sternal depression (P = 0.23) or total number of compressions in the first minute. DISCUSSION: A decrease of compressions quality after the first minute of CPR is produced. This effect does not depend on gender, age, weight, height or rescuer's profession and it is not adequately perceived by the person who performs the chest compressions.

Adult↗
PubMed1998

[Exclusion causes to thrombolytic treatment in myocardial infarction].

BACKGROUND: Only one third of patients who have suffered a myocardial infarction can benefit from thrombolytic treatment in the daily clinic practice. The aim of this study is to know the percentage of patients who were treated in a General Hospital and the main exclusion causes to receive thrombolytic treatment. METHODS: A descriptive study in patients with infarction who were admitted to the Critical Care Unit of a 550 beds Hospital between September-95 and August-96. RESULTS: 188 patients were admitted with suspicion of myocardial infarction. The 50.53% of them received thrombolytic treatment. The main exclusion causes to receive this treatment were: delay of the patient (18.10%), normal ECG or descended ST (16.50%), contraindications (8%), patient's refusal to receive treatment (0.53%) an uncertain indication of therapy (6.40%). CONCLUSIONS: A high percentage of patients received thrombolytic therapy, maybe because these drugs can be used until 12 hours the infarction and they haven't limit of age.

Aged↗
PubMed1997

[Delayed thrombolytic administration in myocardial infarction;].

BACKGROUND: The aim of the study is to know whether the patients with acute myocardial infarction (AMI) who consulted an extrahospitalary physician before the hospital arrival delayed their admission to the critical care unit (CCU), and whether their probability to receive early thrombolytic therapy was smaller than that of the patients who cam directly to hospital. PATIENTS AND METHODS: A descriptive study in patients with AMI was performed during 1995. The following variables were studied: age, sex, town of residence, previous AMI, consultation to an extrahospitalary physician, delay time in the admission to the CCU, and whether thrombolytic treatment was performed. Comparison of proportions, Student-Fisher t-test, or Mann-Whitney U-test were used, according to the case. A multiple logistic regression was used to study the independent effect of the previous consult to an extrahospitalary physician on the chance for early thrombolytic treatment. RESULTS: A hundred and eighteen patients (79.7% males) were studied. The mean age was 63 years-old. Nine point five per cent of the patients had suffered a previous AMI and 54.2% received thrombolytic treatment. Delay to hospital arrival was the main exclusion reason to receive this treatment. The mean age of patients who consulted an extrahospitalary physician (n = 69) was 5 years older, their hospital arrival were 100 min later (difference of medians) (p < 0.001), were admitted to the CCU 124 min later (p < 0.02) and ran a higher risk to arrive to CCU after 3 hours from the onset of symptoms (odds ratio [OR]: 3.3; confidence interval [IC] 95%: 1.2 to 9.2) than those who cam directly to hospital. CONCLUSIONS: The patients with AMI who consult an extrahospitalary physician delay their admission to the CCU and have a less chance to receive early thrombolytic therapy in the first 3 hours of evolution.

Aged↗
PubMed1996

[Impact of AIDS on premature mortality in La Rioja].

OBJECTIVE: To describe the evolution of the number of potential years of life lost (PYLL) because of AIDS in La Rioja between 1986 and 1993. DESIGN: Descriptive study. SETTING: Autonomous Community of La Rioja. PATIENTS AND OTHER PARTICIPANTS: Secondary data from the regional Register of AIDS cases in La Rioja, from the Register of Deaths in La Rioja and from the mortality statistics found in the National Statistics Institute. MEASUREMENTS AND MAIN RESULTS: From 1986 the increase in PYLL because of AIDS as a percentage of all causes of premature death was constant. If proportional mortality because of AIDS is grouped in two periods (1986-1989 and 1990-1993), in the first period and for men 1.1% of all PYLL were due to AIDS, whereas in the second this figure was 7.7%. For women these figures went from 0.7 to 8,5. Expressed as a risk, for men the probability that PYLL was due to AIDS was 4 times greater in the second period than in the first. For women this probability was 12 times greater in the second period than in the first. Among men the rates of PYLL adjusted for age kept roughly constant or with a light downward tendency for all the causes studied except AIDS, which occupied second place in the last year studied. Rates of PYLL adjusted for age were more irregular over the years in the case of women, but the increase in AIDS was notable and in 1993 took third place. CONCLUSIONS: Interpreting the results of this study enables the impact of AIDS on premature mortality in La Rioja to be quantified.

Acquired Immunodeficiency Syndrome↗