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H Galdós-Tangüis

Publications and source records attributed to H Galdós-Tangüis.

11 recordsLinked to original sources
PubMed2004

Current status of treatment completion and fatality among tuberculosis patients in Spain.

OBJECTIVES: To determine treatment completion among patients with tuberculosis (TB), and to analyse factors associated with treatment default and fatality. METHODS: A prospective cohort study of patients who began treatment between 1 June 1999 and 31 May 2000 in areas where members of the SEPAR Tuberculosis and Respiratory Infections Group work. Factors associated with treatment default and fatality were studied using logistic regression, calculating odds ratios (OR) and their 95% confidence intervals (95%CI). RESULTS: The study involved 142 physicians from 76 different hospitals who provided information on 1515 cases. Eighty-two per cent of the patients completed treatment correctly, 14% defaulted, 5% died, 0.5% failed, and 8.7% interrupted treatment due to transfer or other reasons. The variables associated with default were intravenous drug use (IVDU) (OR 6.00, 95%CI 2.59-13.89) and immigration (OR 8.57, 95%CI 3.78-19.45); sex, age, homelessness, incarceration, directly observed treatment (DOT) or hospitalisation were not associated with default. Variables found to be predictive of fatality were alcoholism (OR 6.38, 95%CI 2.09-19.48), human immunodeficiency virus (HIV) infection (OR 7.08, 95%CI 2.08-29.15) and age >64 years (OR 10, 95%CI 2.9-34.07), whereas sex, IVDU, homelessness, DOT and hospitalisation were not. CONCLUSIONS: In industrialised countries, IVDU patients and immigrants should be targeted for DOT, while to reduce fatality rates stricter monitoring is required for patients who are alcoholic, HIV-infected, or aged >64 years.

Adolescent↗
PubMed2001

Screening for tuberculosis upon admission to shelters and free-meal services.

BACKGROUND: The homeless are at very high risk of suffering tuberculosis (TB). The aims of this study were to determine the prevalence and risk factors for tuberculosis infection and disease among the homeless in Barcelona and to evaluate the roles of case finding and contact investigation. METHODS: Observational prevalence study carried out between 1997 and 1998. PARTICIPANTS: 447 homeless patients (394 men and 53 women) were evaluated before admission to shelters and free-meal services. At the same time, 48 co-residents with smear-positive TB patients in 2 long-term shelters were evaluated too. A chest X-ray and Tuberculin Skin Test were performed on all subjects. Sputum smears were processed by the Ziehl-Neelsen and Löwenstein-Jensen procedures in patients with radiographic findings consistent with pulmonary TB. RESULTS: Of the 447 homeless examined, 335 (75%) were infected with Mycobacterium tuberculosis. Active pulmonary TB was diagnosed in five persons (1.11%), and 62 (13.8%) had radiographic evidence of inactive pulmonary TB. Tuberculosis infection was associated with age and smoking, but not with sex or alcohol abuse. No significant differences in infection rates were found between the main group and 48 homeless co-residents of smear-positive subjects. Only 16.9% of the homeless with active TB in Barcelona in the same period were diagnosed through active case-finding, the remainder being mainly detected in hospitals (69.8%) and other several centres (13.3%). CONCLUSIONS: Homeless individuals have a very high risk of TB infection and disease and contact investigation requires specific methods for them. Programmes of screening and supervised treatment should be ensured in this group.

Adolescent↗
PubMed2001

Proposing indicators for evaluation of tuberculosis control programmes in large cities based on the experience of Barcelona.

OBJECTIVE: To evaluate the effectiveness of the Barcelona Tuberculosis (TB) Control Programme and to propose evaluation indicators. MATERIALS AND METHODS: Using quantitative indicators, the results and impact of the programme over the period 1987 to 1999 were evaluated. Statistical analysis was based on a description of indicators, including tests for trends, and on the evolution of the incidence. RESULTS: The incidence of tuberculosis rose between 1987 and 1991 (P = 0.10), and fell between 1991 and 1999 (P < 0.001). During the study period statistically significant improvements were observed in the percentage of cases notified by the medical profession, adherence to treatment and the percentage of cases on directly observed treatment (DOT), and meningitis among children aged 0 to 4 years fell notably. However, diagnostic delay in smear-positive cases and the percentage of cases whose contacts were examined did not vary significantly. The evaluation indicated an average annual decline in tuberculosis incidence of 6.7%, and rates of adherence to treatment (94.5% among smear-positive cases) achieved their objectives. The average median diagnostic delay (36 days) and the percentage of cases with contacts examined (mean 59.8%) were rather less optimistic. CONCLUSIONS: The results of the evaluation were in general positive. Decline in incidence, meningitis in children, treatment adherence rates, diagnostic delay and percentage of cases with studied contacts were considered the best indicators for evaluation of TB programmes.

Child↗
PubMed1999

[Evaluation of the tuberculosis control programs of the autonomous regions of Spain].

BACKGROUND: After the resurgence of tuberculosis in the eighties, several institutions pushed to rapidly create tuberculosis programs and to improve the effectiveness of those in existence. The objective of this paper is to evaluate the programs of the Autonomous Communities of Spain. MATERIAL AND METHODS: A questionnaire was sent to 17 Autonomous Communities and two cities Ceuta and Melilla. A table with minimum objectives was made in order to evaluate the impact of each program. The study period was 1996. RESULTS: The percentage of answers was 100%. Fourteen Autonomous Communities (82%) confirmed they have a tuberculosis program, but with important limitations. There are 3.8 public health workers per 1,000 cases of tuberculosis. Eleven Autonomous Communities had active surveillance, but only 4 know adherence rates to tuberculosis treatments, 3 had supervised treatments, and 3 know diagnostic delays. Ten know results about the percentage of cases with revised contacts. 70% of 19 revised programs did not fulfill the recommended basic objectives. CONCLUSIONS: Tuberculosis control in Spain is not adequate for a developed country. An improvement of the programs in needed, with increase of resources and with reference support centers which would carry out annual evaluations.

Catchment Area, Health↗
PubMed1999

[Evidence-based tuberculosis control: a public health approach].

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. One of the differential traits of the practice of public health when compared to clinical medicine is that it does not concentrate in individual patients, but rather in the health problems of the population in a given time. In public health interventions, besides the importance of efficacy, aspects related to the process of implementation become also crucial. This paper develops some principles for evidence-based public health, which are then applied to a given problem: tuberculosis control in our context. Tuberculosis control poses challenges which go beyond clinical practice, and require a collective organized effort. This is precisely what makes it a public health issue and not only a clinical problem, as it requires not only health care dimensions but also public health dimensions, which require policies that are feasible, have high efficacy, and a moderate cost. To illustrate the problem and the results of public health policies, available data and indicators are used, with special reference to the authors experience in the program for the prevention and control of tuberculosis in Barcelona (Catalonia, Spain).

Evidence-Based Medicine↗
PubMed1998

[Tuberculosis trends in Barcelona (1987-1995). Impact of the human immunodeficiency virus and control measures].

BACKGROUND: To study the epidemiology to tuberculosis (TB) in Barcelona, Spain from 1987 to 1995, analyzing the influence of HIV infection and the impact of control measures. PATIENTS, MATERIAL AND METHODS: All cases detected by the Barcelona Tuberculosis Prevention and Control Program were included in the study of the evolution of TB incidence according to different variables. The impact of HIV infection was analyzed through the attributable risk per cent (AR), and control measures through the evolution of the rate of treatment compliance, contact studies, and diagnostic delay. RESULTS: We detected 8,942 patients, 23.2% of whom were found through the active epidemiological surveillance system, representing an average annual incidence of 60.4/100,000. The incidence peaked in 1991 (68.7/100,000) and slowly declined to 55.7/100,000 in 1995. Men showed higher incidence (RR: 2.74; CI 95%: 2.62-2.87), particularly among the young (25-34 years olds), 53.3% of whom were HIV (+). The AR for HIV was 92.7%. In this period there was an increase in TB HIV (+), IVDU, and prisoners. Treatment compliance (80.8% in 1987 to 93.8% in 1995) and contact studies (3.2 studies/case in 1995) evolved favorably, unlike but diagnostic delay (35 days in 1995) did not. CONCLUSIONS: The Active Epidemiological Surveillance System has affored us a clear view of the actual situation regarding TB in Barcelona, Spain. Despite the HIV epidemics and the high number of IVDU, the evolution of TB has shown a steady decline due to improvement in control measures.

Adolescent↗
PubMed1997

Characteristics of tuberculosis patients who generate secondary cases.

OBJECTIVE: To determine the characteristics of smear positive tuberculosis (TB) patients who generate secondary TB cases. METHODS: Those smear positive TB patients detected by the Barcelona Tuberculosis Program between 1990-1993, and for whom contact studies had been performed, were studied. We analyzed the predictive role of the variables: age, sex, intravenous drug use (IVDU), the presence of the acquired immune deficiency syndrome (AIDS), human immunodeficiency virus (HIV) infection, radiology pattern, district of residence, history of imprisonment, alcoholism, smoking, history of TB, treatment compliance and the number of secondary cases generated. Statistical analysis was based on the logistic regression model, calculating the odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Of the 1079 patients studied, 78 (7.2%) had generated only one secondary case, and 30 (2.8%) two or more. The variables associated with generating two or more secondary cases were: IVDU (P < 0.001; OR = 4.06; CI: 1.80-9.15), cavitary radiology pattern (P = 0.002; OR = 3.69; CI: 1.62-8.43), and age (P = 0.016; OR = 0.98; CI: 0.96-0.99). When we examined those who had generated one or more secondary cases, the following variables were significant: IVDU (P = 0.043; OR = 1.75; CI: 1.02-3.02), cavitary radiology pattern (P < 0.001; OR = 3.07; CI: 1.98-4.77) and age (P < 0.001; OR = 0.98; CI: 0.97-0.99). CONCLUSION: The study of the contacts of smear positive TB patients allows us to detect an important number of secondary cases. Young adults, those with cavitary radiology pattern, and IVDU are more likely to generate secondary cases.

AIDS-Related Opportunistic Infections↗
PubMed1996

The influence of intravenous drug use and HIV infection in the transmission of tuberculosis.

OBJECTIVE: To investigate whether smear-positive pulmonary tuberculosis (TB) patients present a different risk of TB transmission according to their HIV status, in an area where the majority of HIV-infected patients studied were intravenous drug users (IVDU). METHODS: A case-control study was performed on smear-positive pulmonary TB patients diagnosed between 1990 and 1993 for whom a contact study had been performed. Patients with and without HIV infection were matched by age (+/- 3 years), sex and hospital of diagnosis. A micro-epidemic was defined if two or more secondary cases were detected from the same index case. Data were analysed comparing the percentage of contacts with TB in both groups. RESULTS: Thirty-six secondary cases were detected in 436 contacts of 124 HIV-infected TB patients, whereas only 24 were identified in 624 contacts of 124 HIV-seronegative TB patients [odds ratio (OR), 2.14; 95% confidence interval (CI), 1.22-3.77; P = 0.004]. Comparing the contacts of HIV-infected patients, 34 secondary cases of TB were detected in 371 contacts of 97 IVDU, whereas only two cases were detected in 85 contacts of 27 non-IVDU (OR, 4.19; 95% CI, 1.09-15.95). HIV-seropositive index cases were observed to cause more micro-epidemics than seronegative cases (eight versus four), indicating that micro-epidemic cases were more frequent in the contacts of HIV-infected subjects (27 out of 36 versus 10 out of 24; OR, 1.41; 95% CI, 1.41-12.49; P = 0.009). All index cases in eight micro-epidemics were HIV-seropositive IVDU, whereas only four micro-epidemics were generated by HIV-seronegative subjects, none of whom were IVDU. CONCLUSIONS: Smear-positive pulmonary TB patients were more likely to transmit TB if they were HIV-infected, as evidenced by the role of IVDU in generating micro-epidemics.

Adult↗
PubMedDate not supplied

[Cholera in the world. The cholera epidemic of 1991 in Peru].

The objective of this article was to review the epidemic of cholera disease that affected Peru in 1991, its epidemiologic impact and the natural regions most affected. Also it is reviewed the state of this epidemic two years after. A description of the incidence of natural regions, the main mechanisms of transmission and the control strategy that public health authorities hold on. This review concludes that professionals and public health authorities should be prepared to control this disease, that can suddenly erupt in any country or region, due to the easy way of transmission of Vibrio cholerae.

Cholera↗