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Biomedical subjects

I Hernández-Aguado

Publications and source records attributed to I Hernández-Aguado.

At least 19 recordsLinked to original sources
PubMed2006

Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART.

BACKGROUND: We assessed the impact of education on long-term overall and cause-specific mortality among 6575 injecting drug users (IDUs) according to HIV status and introduction of highly active antiretroviral therapy (HAART). METHODS: Community-based cohort study of IDUs recruited in three AIDS prevention centres (1987-1996). Causes of death were ascertained in clinical centres and Mortality Registry and classified as AIDS, drug use related, injuries, or liver diseases. Poisson regression models including education and calendar period interaction and adjusted by sex, age, and HIV were used. RESULTS: In 73 901 person-years of follow-up, there were 1493 deaths (20.2/1000 person-years): 761 related to AIDS, 234 to drug use, 179 to injuries, and 93 to liver diseases. IDUs with university studies had a lower risk of death (RR 0.52; 95% CI 0.36-0.77) than those without studies: this difference was higher after (RR 0.45; 95% CI 0.25-0.80) than before 1997 (RR 0.68; 95% CI 0.41-1.13). Compared to before 1997, while decreases in the risk of AIDS mortality were seen during 1997-2004 for both lower (RR 0.49; 95% CI 0.41-0.58) and higher (RR 0.33; 95% CI 0.23-0.48) educated, only those higher educated experienced a reduction in drug-use mortality (RR 0.54; 95% CI 0.28-1.05) and death from injuries (RR 0.52; 95% CI 0.23-1.21). CONCLUSIONS: Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Trends in HIV testing, serial HIV prevalence and HIV incidence among people attending a Center for AIDS Prevention from 1988 to 2003.

AIM: To analyse trends in HIV testing, serial HIV prevalence and HIV incidence among people who underwent voluntary testing in a Center for AIDS Prevention in Valencia, Spain. METHODS: Open cohort study including all subjects who went to the Center for AIDS Prevention from 1988 to 2003. Information on sociodemographic variables and HIV test results was collected. Serial prevalence and incidence rates were calculated, and joinpoint regression was used to identify changes in trends over time. RESULTS: 21,241 subjects were analysed; 67% men, 27% injecting drug users (IDUs), 43% heterosexuals and 13% men who have sex with men (MSM). From 1988 to 1990, IDUs accounted for 57% of clinic attenders, decreasing to 14% by 1997-2003, accompanied by an increase in heterosexuals. Overall, HIV prevalence for the whole period was 15%, dropping from 35% to <10% after 1999 and to 3% by 2003, when HIV prevalence was 26% in IDUs, 6% in MSM and 2% in heterosexuals. Total HIV incidence was 2.5%. From 1988 to 1990, HIV incidence ranged from 6% to 8%, and a gradual and progressive decline observed from 1990 onwards. From 1995 onwards, HIV incidence was <2%. The highest incidence rate is seen in IDUs, 7-12% in the first period and 4-5% at the end. Among MSM, a change in the decreasing trend is seen by 1998, and increases in incidence are detected by 2002-3. CONCLUSIONS: Serial HIV prevalence has markedly decreased from 1988 in all transmission categories, although it is still high. With regard to HIV incidence, the drop has been marked too, although a worrying increase, that requires further follow-up, has been detected in MSM in the past 2 years.

Adolescent↗
PubMed2005

Analysis for crystals in synovial fluid: training of the analysts results in high consistency.

BACKGROUND: Identification of monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals in synovial fluid samples is diagnostic of gout and CPPD crystal related arthropathy. Various studies have shown poor consistency in results of crystal analysis. OBJECTIVE: To determine whether training of the analysts increases the consistency. METHODS: An expert rheumatologist gave a course on crystal detection and identification. The four trained observers then blindly and independently examined synovial fluid samples previously classified by the expert which had been obtained from patients with both crystal arthropathies and other non-crystal related inflammatory joint conditions. RESULTS: 194 observations were made on 64 synovial fluid samples: 96 without crystals (49.4%), 55 with CPPD crystal (28.4%), and 43 with MSU crystals (22.2%). For crystal detection (presence or absence of crystals), sensitivity was 95.9% and specificity 86.5%. For identification of MSU crystals, sensitivity was 95.3% and specificity 97.2%. For identification of CPPD crystals, sensitivity was 92.7% and specificity 92.1%. The kappa index of agreement with the reference standard between the observers was 0.84 for any crystal detection, 0.93 for MSU crystal sample identification, and 0.79 for CPPD crystal sample identification. CONCLUSIONS: For trained observers, the detection and identification of crystals in synovial fluid is a consistent procedure.

Arthritis↗
PubMed1999

Usefulness of pp65 antigenemia for the early diagnosis of cytomegalovirus disease in patients with AIDS.

An observational cohort study was performed to assess the effectiveness of a cytomegalovirus antigenemia (CMV-Ag) assay designed to predict clinical CMV disease in patients with AIDS. Eighty-six HIV-infected patients with CD4+ cell counts of < 100/mm3, positive CMV IgG, and no previous CMV disease were enrolled. Thirty-eight (44%) patients had at least one positive CMV antigenemia test, ten of whom eventually developed CMV focal disease. CMV disease was diagnosed in 13 (15%) patients. The CMV antigenemia assay was positive in ten of these 13 patients. Using a cut-off value of five positive cells in every 150,000 leukocytes sampled, the CMV antigenemia assay had a positive predictive value of 89% and a negative predictive value of 94%. The median time from the first positive CMV antigenemia test to the onset of CMV disease was 102 days. CMV disease probability at 6 months in patients with a CMV antigenemia value > or = 5 was 77.8% versus 6% in patients with CMV antigenemia value < 5 (log-rank test = 48.345; P < 0.001). Several independent factors were associated with the development of CMV disease: CMV antigenemia > or = 5 cells (hazard ratio: 20.44), CD4+ count < or = 25/mm3 (HR: 3.12), and sexual transmission of HIV infection (hazard ratio, 3.15). CMV antigenemia seems to be a good predictor of CMV disease in patients with AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1999

Human immunodeficiency virus (HIV) infection in parenteral drug users: evolution of the epidemic over 10 years. Valencian Epidemiology and Prevention of HIV Disease Study Group.

BACKGROUND: Evaluation of acquired immunodeficiency syndrome (AIDS) prevention strategies requires an on-going follow up of the frequency of human immunodeficiency virus (HIV-1) infection. The aim of this study was to examine the trends in prevalence and incidence of HIV-1 infection among injecting drug users (IDU) during the period 1987-1996. METHODS: Transversal and cohort studies were designed which included a consecutive sample of 7132 IDU who attended three AIDS Prevention and Information Centres in the Region of Valencia (Spain) and voluntarily asked to be tested for HIV antibodies. The prevalence was estimated for each year based on the serological status of HIV-1 when the patient first visited the centre. The annual incidence rates were calculated based on the seronegative patients in which a new determination of HIV-1 was done. In order to control the possible effects on the estimations of age, sex and duration of addiction of the people studied, Poisson and logistic regression models were adjusted. RESULTS: Prevalence and incidence rates of HIV-1 infection showed parallel trends over time. The overall prevalence found was 43.6% (95% confidence intervals [CI]: 42.4-44.7%). Of the 4023 seronegative individuals, 1746 were followed up over the whole of the study period. The incidence rate observed was 6.85 x 100 persons/year (95% CI : 6.04-7.66). The prevalence figures show a decrease, which is most marked from 1990 onwards and then they tend to stabilize over the past few years. The incidence rates increase slightly up to 1991 (9.8 x 100 persons/year), and then begin to decrease. CONCLUSION: Trends of prevalence of HIV-1 infection approximate trends of subjacent incidence rate. Despite decrease in HIV-1 infection frequency observed over 10 years, both the prevalence and incidence figures continue to be high in absolute terms. It is necessary to intensify and adapt preventive measures to each subgroup at risk of infection and in the case of heterosexual transmission ensure that the failure observed in the case of IDU is not repeated.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Factors associated with the knowledge, treatment, and control of arterial hypertension in an adult population of the community of Valencia].

OBJECTIVE: To identify the level of hypertension awareness, treatment and control in the adult population (14 years and older) at the Valencian Region. Type of treatment and associated factors to the hypertension awareness will be also explored. DESIGN: Cross-sectional study (population survey). SETTING: Valencian Region, Spain. PARTICIPANTS AND MEASUREMENTS: Data from this study are based on a representative sample of the adult population collected for the Nutrition and Health Examination Survey carried out in the Valencian Region in 1994. Blood pressure measurement was based in two readings on each person at a single sitting. RESULTS: Awareness of hypertension among subjects classified as hypertensive was 50%. The frequency of treated patients among all those subjects who knew as hypertensive, was 85%. The proportion of well controlled among treated hypertensive people was lightly higher than 50%. 14.6% of people aware of being hypertensive were not under treatment. CONCLUSIONS: The rule of halves still applies to the Valencian Region, though the proportion of diagnosed hypertensive under treatment is much better (> 85%).

Adolescent↗
PubMed1998

[Prevalence and control of arterial hypertension in the adult population of the Valencian community, 1994].

BACKGROUND: High blood pressure (HBP) is probably one of the main targets for prevention in primary health care. Knowledge of the magnitude and control is needed for monitoring this health problem at the population level. The aim of this study was to estimate the prevalence of hypertension in the adult population of Valencian Region (VR) (Spain), and to evaluate the degree of treatment and control. SUBJECTS AND METHODS: Two measurements of blood pressure (BP) were obtained for a representative sample of 1,674 participants (14 years and older) in the nutrition and health survey of the VR in 1994. A semi-automatic digital esfingmomanometer was used. HBP definition was based on the criteria of the WHO and the Fifth Joint National Committee on Detection Evaluation and Treatment on HBP. Criteria of the MONICA project were used to determine the level of treatment and control of hypertension. Prevalence of HBP was estimated for sex and age groups accounting for the study design. RESULTS: HBP prevalence was 31.7% (14.1% borderline HBP plus 17.6% defined HBP). Hypertension increased with age from a prevalence of 9.3% in the group 15-24 years of age, to 68.8% in the group > or = 65 years old. A 57% of hypertensive persons were not under treatment, a 16.6% were treated but their BP was not controlled, and a 26.4% were under treatment and presents controlled BP. The uncontrolled BP was more evident at younger ages. CONCLUSIONS: This study has shown that one third of the adult population from VR had HBP, and over the half of them are not treated. Furthermore, over one third of hypertensives under pharmacological treatment presented uncontrolled BP. These results should be taken into account if preventive actions are to be implemented at the individual and population level.

Adolescent↗
PubMed1998

False-positive tests for syphilis associated with human immunodeficiency virus and hepatitis B virus infection among intravenous drug abusers. Valencian Study Group on HIV Epidemiology.

The role of HIV, hepatitis C virus, and hepatitis B virus infections in the production of biological false-positive reactions for syphilis was evaluated in two large samples of intravenous drug abusers and homosexual men attending AIDS prevention centers in Spain. A significantly increased odds ratio (OR) for false-positive tests for syphilis [OR 2.23, 95% confidence intervals (CI) 1.76-2.83] was observed for HIV-seropositive intravenous drug abusers; biological false-positive reactions were also more frequent (OR 1.73, 95% CI 1.30-2.31) among intravenous drug abusers who were hepatitis B virus seropositive but not among those who were hepatitis C virus seropositive (OR 0.90; 95% CI 0.48-1.69). Among homosexuals, the association between HIV and biological false-positive reactions was restricted to subjects who were also intravenous drug abusers, indicating the crucial role of intravenous drug abuse. Only 20.5% of intravenous drug abusers with a previous biological false-positive reaction yielded a false-positive result in their subsequent visit.

Antibodies, Bacterial↗
PubMed1998

Variations in cotinine levels in smokers during and after pregnancy.

OBJECTIVE: To compare the antenatal and postnatal cotinine levels in smoking women after controlling for the differences in smoking practices. STUDY DESIGN: A paired comparison of two measurements of cotinine concentration was conducted in 40 smoking women voluntarily recruited in a prenatal education program held in La Fe Hospital, Valencia, Spain, during 1990 and 1991. Cotinine concentration was assayed by gas chromatography in samples of saliva obtained during and after pregnancy. The Wilcoxon matched-pairs test and multiple linear regression analysis were used. RESULTS: The cotinine per cigarette ratio during pregnancy (median 3.53 ng/ml per cigarette) was significantly lower than the ratio in the postnatal testing (median 9.87 ng/ml per cigarette). This difference persisted after allowing for differences in reported cigarette consumption. CONCLUSION: These findings suggest that the available equivalencies between cotinine level and nicotine intake obtained from adult nonpregnant populations cannot be directly applied during pregnancy.

Adult↗
PubMed1998

Prospective cohort study of female sex workers and the risk of HIV infection in Alicante, Spain (1986-96).

OBJECTIVE: To measure the incidence of HIV infection over a 10 year follow up in a cohort of female commercial sex workers in Alicante (Spain), and to determine factors associated with high risk of infection. METHODS: A prospective cohort study was carried in an AIDS information and prevention centre in Alicante, Spain. Of the 1388 female sex workers who initially sought the services of the centre since September 1986, 657 completed at least one additional follow up visit before December 1996. Main outcome measures were infection with HIV-1 and reported risk behaviours. RESULTS: During 1815 person years of observation among 657 female sex workers who were free of HIV infection (negative test), 16 women developed of HIV infection (incidence rate of HIV infection = 8.8 cases/1000 woman years, 95% confidence interval (CI): 5.4-14.4). Reported current use of injecting drugs at the first visit was associated with an increased risk of HIV infection (relative risk, RR = 12.87, 95% CI: 4.81-34.15) as well as having an usual partner with injecting drug addiction (RR = 20.89, 95% CI: 7.44-58.70). Infection also was associated with younger age (RR for 1 year = 0.86, 95% CI: 0.76-0.96). After multivariate adjustment using Poisson regression analysis, the factors that remained significantly associated with the risk of HIV infection were current use of injecting drugs (RR = 4.61, 95% CI: 1.37-15.46), and having a usual partner with injecting drug addiction (RR = 10.08, 95% CI: 2.94-34.57). There was also some evidence that a younger age could be related to infection. CONCLUSION: These data suggest that the risk of HIV infection among this cohort of female sex workers in Alicante is predominately associated with the use of injecting drugs, and having a regular partner with injecting drug addiction. An increasing number of clients did not play a role in the risk of infection.

Adult↗
PubMed1995

Trends in incidence and prevalence of HIV-1 infection in intravenous drug users in Valencia, Spain.

Our objective was to describe and compare the trends of incidence and prevalence of HIV-1 infection in intravenous drug users (IDUs) in Valencia, Spain in 1987-1992. A cohort study was carried out in AIDS Information Centers located in the Valencia Region (Spain). Point seroprevalence was calculated for in each year according to HIV status at the first contact. Incidence annual rates were calculated from those IDUs identified as seronegative in their first visit and who returned for a new testing. From a total of 4,207 IDUs who contacted these centers, 4,131 (98.2%) asked voluntarily for HIV-1 testing. The seroprevalence for the whole period was 48.4% (95% C.I., 46.88, 49.92). Follow-up information was available for 604 subjects of the total 2,130 subjects who were seronegative in their first visit. The incidence rate for the 1988-1992 period was 12.02/100 person-years (95% C.I., 9.62, 14.41). Prevalence showed an overall decreasing pattern with a minimum corresponding to the year 1992 (43.6%). Incidence rates increased mildly until 1990 (13.93 per 100 person-years), to stabilize beyond at approximately 10 per 100 person-years. Our incidence rates are very high regardless of the decline of prevalence. Effective risk reduction programs among IDUs have been almost nonexistent in Spain up to now and should become an immediate priority.

Adult↗
PubMed1994

[Factors associated with the use of gynecology services by climacteric women: a case-control study].

BACKGROUND: The data and concepts described in the literature on menopausic women are based on observations and studies carried out in menopausic women attending medical or gynecological consultations and contrast greatly with the results obtained in women from a general population. METHODS: In a case-control study 505 women between 45-55 years of age, 142 having attended a gynecological consultation (cases) and 363 taken from a randomized sample of the general population (controls) were evaluated. Information concerning sociodemography, climacteric phase, psychic morbidity and psychosocial factors as stressing events, social support and adjustment and satisfaction with roles was collected in a personal interview. The odds ratio (OR) was used as the means of association and multiple regression analysis was performed to control possible confusing factors. RESULTS: The cases were fundamentally young women in a premenopausic phase of a high social class belonging principally to a group of widows, separated or divorcees and a group of married women with high levels of association (OR = 14.7; OR 12.14). The women attending a gynecological consultation were characterized by having greater risk of lacking social support (OR = 8.94), presenting a greater frequency of vital severely stressing events over the previous year (OR = 2.55), and demonstrating greater insatisfaction in social adjustment (OR = 2.42) particularly in their sexual and matrimonial relations. CONCLUSIONS: Women attending medical, specially gynecological, consultations during climacteric years are not representative of the population of women in these years as a whole. Purely pharmacologic management, principally substitutive hormonal therapy, was the most wide-spread treatment of preventive character should be reestablished in accordance with the results with the most manifold and multifactorial orientations and foci.

Case-Control Studies↗
PubMed1994

Sharing of injection equipment among 3755 intravenous drug users in Valencia, Spain, 1987-1992.

BACKGROUND: In order to identify, in a sample of heroin intravenous drug users (IVDU), those factors associated with the predominant risk behaviour related to the transmission of HIV-1 infection--sharing of injection equipment--a cross-sectional survey was carried out in Valencia, Spain from 1987 to 1992. METHODS: Informed consent and pertinent data were obtained from 3755 heroin IVDU recruited at two public AIDS Information Centres in two cities in the region of Valencia. Data were gathered on sociodemographic variables, and sexual and drug use behaviour by interview. The subjects were subsequently tested for HIV-1 antibody. A univariate analysis was carried out to identify variables that were significantly associated with sharing injection equipment. A logistic regression model was used to control for possible confounders. RESULTS: The IVDU who were teenagers, prostitutes (OR = 1.95), who had antibodies to HIV-1 (OR = 1.30) or who had an IVDU steady partner were at significantly higher risk for sharing of injection equipment. Higher levels of education, condom use (OR = 0.65) and living in the smaller city (OR = 0.75) were inversely related to sharing injection equipment. CONCLUSIONS: Our results suggest that different subgroups of IVDU have different characteristics that place them at different risk for HIV-1 infection. These characteristics should guide the design and intensity of specific preventive interventions. Teenagers and IVDU with low educational levels should be targetted for special attention by health authorities.

Adolescent↗
PubMed1993

Determinants of HIV-1 infection in intravenous drug users in Valencia, Spain, 1987-1991.

From 1987 through 1991, 2687 intravenous drug users recruited at three AIDS information centres in the Region of Valencia (Spain) were interviewed about drug use and sexual behaviour and subsequently tested for HIV-1 antibody. The overall seroprevalence was high, 50% (95% confidence interval [CI]: 41.8-51.9%). There were no differences by gender, but HIV-1 infection was related to older age and city of residence. After adjustment by means of logistic regression age (odds ratio [OR] = 1.80), sharing of injection equipment (OR = 2.16), duration of addiction (OR = 6.59) and prostitution (OR = 1.77) were significantly associated with HIV-1 prevalence. High educational level was inversely related to HIV-1 status (OR = 0.43) and a decreasing trend of prevalence with time was observed.

Acquired Immunodeficiency Syndrome↗