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Biomedical subjects

J Castilla

Publications and source records attributed to J Castilla.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Trypanosomiasis from Trypanosoma brucei gambiense in the center of north-west Uganda. Evaluation of 5 years of control (1987-1991)].

In Uganda, a case-finding and treatment programme has been implemented by Médecine Sans Frontières (MSF) and the Ministry of Health in the North of West-Nile province. Data collected in the hospital of Moyo from January 1987 to June 1991 were analyzed. Forty eight hundred and twenty two cases of trypanosomiasis due to T. B. gambiense has been recorded. Cumulative incidence rate for this period was 5.6%. Passive and active case-finding strategies were used, both based on Card Agglutination Test (CATT) as screening tool, followed by parasitological examinations. The mobile teams identified 1906 of the 4,822 cases (39.5%). Case fatality rate was 2.6%. This study confirmed the association between social and political disruptions, large movements of population and extension of trypanosomiasis. Active case-finding seems to quickly reduce disease prevalence in hyper-endemic areas. An integrated programme is then necessary to control sleeping sickness transmission.

Adolescent↗
PubMed1995

Sociodemographic predictors and temporal trends of extrapulmonary tuberculosis as an AIDS-defining disease in Spain.

OBJECTIVE: To identify the factors associated with the presentation of extrapulmonary tuberculosis (EPTB) in AIDS diagnosis and to analyse its temporal trend. DESIGN: Analysis of AIDS surveillance data. METHODS: The study was based on AIDS cases diagnosed in Spain between 1988 and 1993, and reported up to September 1994. The proportion of patients presenting with EPTB at AIDS diagnosis was analysed by sociodemographic characteristics and year of diagnosis. RESULTS: Of the 22,445 AIDS cases diagnosed in Spain from 1988 to 1993, 6526 patients (29.1%; 95% confidence interval, 28.5-29.7) presented with EPTB at diagnosis, making it the most frequent AIDS-defining disease. The highest proportions of EPTB reported at AIDS diagnosis were observed for injecting drug users (IDU; 35.4%) and the heterosexual transmission category (23.5%). The proportion of EPTB was lower in women [relative risk (RR), 0.85; P < 0.001], and higher in 15-29-year-olds (34.2%) and patients with a prison record (44.3 versus 25.4%; RR, 1.75; P < 0.001). AIDS patients resident in provinces with high respiratory TB mortality rates among the general population exhibited a higher proportion of EPTB (RR, 1.45; P < 0.001). The effect of any one variable was maintained by controlling for all others. The proportion of patients with EPTB at AIDS diagnosis revealed a downward trend from 1988 to 1993 (P = 0.007), which was observed in IDU and heterosexuals but not in homosexual/bisexual men (P = 0.421). CONCLUSIONS: Factors such as injecting drug use, prison record or residence in high TB-endemic areas are associated with a greater frequency of EPTB at AIDS diagnosis. These factors must be considered for specific prophylaxis to be efficiently applied.

AIDS-Related Opportunistic Infections↗
PubMed1994

A temporal-spatial cluster of sudden infant death syndrome in Navarre, Spain.

An apparent temporal-spatial cluster of Sudden Infant Death Syndrome (SIDS) was noted in the Autonomous Community of Navarre, Spain, when four unrelated children aged between 1 and 6 months died unexpectedly within a 7-day interval in January, 1990. The population under one year of age in Navarre was approximately 4,800. The scan test of temporal clustering showed that the sudden infant deaths occurred closer to one another in time significantly more often than would be expected by chance. All four infants lived in a neighbourhood of the capital of Navarre, which accounts for approximately half the region's population. The clustered cases coincided with an outbreak of influenza type A detected by the epidemiological surveillance system and seen by the increase in 1990 over the same period in the previous year in the number of paediatric emergency-ward admissions during the 'epidemic' days. The results confirm the presence of a temporal-spatial cluster of SIDS and favour an environmental etiology where exposure to influenza A viruses is implicated.

Disease Outbreaks↗
PubMed1993

Assessment of trends in geographical inequalities in infant mortality.

After discussing the comparative effectiveness of different measures of dispersion used as indices of inequality, the Weighted Coefficient of Variation is proposed as an appropriate indicator of geographical inequality attending infant death. Furthermore, this paper proposes a methodology based on simple linear regression to be employed for the purposes of assessing the percentage of the observed change in said inequality over any given period, as is required by the terms of Target 1 of the WHO policy document "Health for All by the Year 2000". To this end, trends in Infant, Neonatal, Postneonatal and Perinatal Mortality in Spain for the period 1975-1986 have been analysed. For the 12 years examined, the Average Spanish Rate for these four indicators fell by over 50%. We observed a statistically significant decrease (34.8%) in geographical inequalities in the case of Postneonatal Mortality. However for the same period, geographical inequalities in Perinatal Mortality showed an important and significant rise (79.33%). It is suggested that, where Spain is concerned, it is Perinatal Mortality which should be assigned priority status for monitoring purposes. A plan of action should be drawn up, duly targeted at reducing geographical inequalities in health services, in the mother-and-child care sector above all.

Epidemiologic Factors↗
PubMed1983

Dialysis myopathy. Report of 13 cases.

Thirteen patients hemodialyzed for chronic renal insufficiency developed progressive paresis of the proximal musculature. Biopsies of the deltoid muscles of ten patients showed selective atrophy of type 2 fibers, the cause of which seems to be related to the osteomalacia present in those patients. Purification of the water for dialysis prior to the procedure prevents the muscle alteration: however, once the lesion is established only renal transplant will permit recovery of the muscle strength of the patient.

Adult↗
PubMedDate not supplied

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution].

OBJECTIVE: To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes. METHODS: Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected. RESULTS: 132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had). CONCLUSIONS: HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

Adult↗
PubMedDate not supplied

[HIV seroprevalence and exposure categories among adolescents tested at a sexually transmitted clinic diseases. Madrid, 1986-2000].

OBJECTIVE: To describe the time-trend in exposure categories and HIV seroprevalence among adolescents who underwent to voluntary testing in the period 1986-2000. METHODS: This study covered all adolescents, aged 13 to 19 years, at their first test for HIV in a sexually transmitted disease clinic in Madrid. Gender, age and HIV risk behaviours were collected. HIV diagnosis relies on ELISA test and Western blot confirmation. Time trends in HIV seroprevalence and exposure categories were analysed. RESULTS: A total of 1327 adolescents, 52% women and 22% under 18 years, were studied. The annual number of adolescents remained through the time, but injecting drug users (IDU) and IDU partners declined and female sex workers rose. 108 adolescents were diagnosed with HIV infection -71% were IDU-. HIV seroprevalence was 8.1% -31.3% in IDU-. It declined from 18.2% in 1986 to 1.5% in 1995, and after then it held steady under 4%. This decline involved several risk categories and was statistically significant in homo/bisexual men and female sex workers. The logistic regression analysis, adjusting for changes in exposure categories, showed an annual reduction in HIV seroprevalence (OR = 0.87; 95% CI, 0.81-0.94). CONCLUSIONS: HIV seroprevalence has decreased due to the fall of new young IDU and the decrease of seroprevalence within several exposure categories. HIV infections and risk behaviours continue happened among adolescents.

Adolescent↗
PubMedDate not supplied

[Estimating the completeness of AIDS reporting in Spain].

OBJECTIVE: To evaluate AIDS case reporting in the Spanish regions as compared with the AIDS deaths registered in mortality statistics, in order to identify possible deviations indicative of underreporting. METHODS: We carried out an ecological analysis taking each region as a unit. We compared incidence and mortality obtained from the AIDS reporting system with the HIV/AIDS deaths obtained from the mortality statistics of the Spanish Institute for Statistics. The 1986-1998 period was analysed globally, then the analysis was repeated for the 1995-1998 period. RESULTS: In the 1986-1998 period there was a good correlation (r = 0.93) between the AIDS incidence rates and HIV/AIDS mortality rates obtained from death statistics. Some regions presented an AIDS incidence lower than expected according to their mortality rate when it was compared with the national average, with Asturias (27%), Comunidad Valenciana (26%), Andalucia (20%), Ceuta (18%) and Cantabria (13%) standing out. Taking as a reference the five regions with the highest completeness, the underreporting in Spain was of 13%. In the 1995-1998 period these deviations increased moderately. In the 1986-1998 period, 18.9% less deaths were notified to the AIDS reporting system in comparison with death statistics, showing a great variability between regions. CONCLUSIONS: In Spain the reporting level of AIDS cases is acceptable for the aims of surveillance, although in some regions measures to improve it should be taken. The notification of deaths to the AIDS reporting system presents great deficiencies.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[The prediction of the minimum incidence of AIDS in Spain for the period 1992-1995].

In order to estimate minimum AIDS incidence in Spain between 1992 and 1995, annual AIDS incidence up to 1991 has been obtained from the June 1992 update of the National Register. Correction was made for reporting delays in cases diagnosed since July 1989, in order to run a subsequent back calculation on all cases and for each separate mode of transmission. It was assumed that no new HIV infections would appear after 1991. Since 1981 to 1995, more than 38,000 AIDS cases will have been diagnosed. Minimum AIDS incidence as forecast exhibits a rise between 1992 and 1995 for the total number of cases and for all categories of transmission, except for recipients of blood and blood products, and children of mothers at risk. Real incidence will probably prove higher than estimated owing to the effect of new infections which may arise, and to the underreporting of cases.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Anti-tuberculosis drug consumption as an indicator of the epidemiological situation of tuberculosis in Spain].

OBJECTIVES: To describe anti-tuberculosis drug consumption in Spain for the period, 1985-1995, compare the associated time trend and geographical pattern against case reports of tuberculosis (TB), and estimate the number of persons undergoing anti-tuberculosis therapy in 1995. METHODS: The official Drug Database was used to ascertain consumption of anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) in Spain during the period, 1985-1995. The technical units of measurement used for comparison purposes were daily defined dose (DDD) and DDD rate per day per 100,000 population. Annual trends and geographical patterns of consumption were plotted. The respective numbers of persons treated in 1995 with each of the four drugs were first estimated and then compared against TB case reports. RESULTS: There was an overall decline in the consumption of isoniazid, rifampicin and ethambutol over the period, 1985-1995, though the former two registered rises in 1991 and 1992. Pyrazinamide consumption showed growth throughout the study period. The highest 1995 consumption rates were registered by Galicia, Cantabria, Asturias, the Basque Country, Ceuta and Melilla, and the lowest by the Canary Islands and Navarre. Comparisons run against TB case reports revealed a greater degree of underreporting in certain provinces. In 1995, approximately 18,858 persons (48 per 100,000 population) must be assumed to have undergone pyrazinamide therapy in Spain, indicating that the reported TB rate of 22 per 100,000 population could well represent underreporting in excess of 100%. CONCLUSIONS: The trend in anti-tuberculosis drug consumption reflects shifts in treatment guidelines and is compatible with a rise in TB incidence in recent years. Major underreporting of TB marked by wide inter-regional and -provincial differences was in evidence. Pyrazinamide consumption is probably the best indicator for estimating minimum TB incidence.

Antitubercular Agents↗
PubMedDate not supplied

[Compulsory Diseases Notification (CDN) in Navarre 2003].

Epidemiological vigilance in Navarre covers 34 transmissible diseases, whose notification is compulsory, and epidemic outbreaks of any aetiology. Notification is carried out on a weekly basis by the doctors from paediatrics, primary and specialised level who suspect or diagnose any of these diseases. In 2003, 75.0% of all the possible notification reports (a weekly report for each doctor) were received, a percentage that has improved in the last five year period. In 2003, Influenza reached a rate of 48.9 cases per 1,000 inhabitants (Epidemic Index, EI: 0.91), showing an epidemic peak in January and another in November. The rate of respiratory tuberculosis was 11.76 cases per 100,000 inhabitants, and the rate of non-respiratory tuberculosis was 1.90, with a continuous trend to decrease in both cases. Five cases of tuberculosis occurred in two small family outbreaks. Thirty percent of the cases were produced in immigrants. The cases coinfected with HIV have fallen from 21% in 1996 to 2.5% in 2003. Fifteen cases of meningococcal disease were reported, (2.6 cases per 100,000 inhabitants), appearing in a sporadic form. Neisseria meningitidis serogroup B was isolated in 10 cases, and serogroup C in 5 cases. Eighty percent appeared in the form of sepsis, and death occurred in one case (6.7%). All of the cases younger than six years of age were vaccinated and belonged to serogroup B. The incidence of Legionnaire's disease was 3.8 cases per 100,000 inhabitants (EI: 0.92), without any epidemiological relation between them. There were 7 cases of malaria, all imported. The incidence of food borne infections has fallen (EI: 0.71).

Communicable Disease Control↗
PubMedDate not supplied

[Progress in the control of HIV infection and AIDS in Navarre, 1985-2003].

The epidemiological situation of HIV infection and AIDS in Navarre in 2003 is reviewed. Up until December 2003, 1,610 HIV infections had been diagnosed in residents of Navarre, of whom 41% had died. The new diagnoses of HIV fell by some 81% between 1993 and 2003, a year in which 28 cases were diagnosed (4.8 per 100,000 inhabitants). The fall basically occurred in infections in injection drug users, since the cases due to sexual transmission had remained stable. Over half of the infections diagnosed in the period 2000-2003 (58%) were attributable to heterosexual transmission, 18% occurred in parenteral drug users and 12% in homosexual men. Thirty-three percent were persons originally from other countries. The incidence of AIDS fell from 75 cases in 1996 to 20 in 2003, and mortality from 65 to 8 cases, respectively. In the 2000-2003 period, the average annual incidence of AIDS was 4.2 per 100,000 inhabitants and the average annual rate of mortality was 1.6 per 100,000 inhabitants. At the end of 2003, there were 902 living persons with a diagnosis of HIV monitored by the health system (1.6 known infections per 1,000 inhabitants). In 2003, 65% of the youths aged between 15 and 29 referred to coital sexual relations, a higher percentage than in previous years, but their level of information on the prevention of AIDS was acceptable. It is necessary to insist on prevention and to adapt this to the new situation.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Communicable disease surveillance in Navarre, 2004].

Epidemiological surveillance in Navarre (584,734 inhabitants) covers 34 transmissible diseases, whose notification is compulsory, and epidemic outbreaks of any aetiology. Notification is carried out on a weekly basis by the doctors from paediatrics, primary care and specialised care. In 2004, 75.8% of all the possible notification reports (a weekly report for each doctor) were received, a percentage that has improved in the last five year period. Flu only reached 14.4 cases per 1,000 inhabitants (Epidemic Index, EI: 0.30), due to the advance of the epidemic peak for the 2003-2004 season to the month of November. The rate of respiratory tuberculosis fell to 11.6 cases per 100,000 inhabitants, and the rate of non-respiratory tuberculosis rose to 2.7 per 100,000. Ten cases of tuberculosis (11.9%) were grouped into four outbreaks that affected adolescents and young adults. Thirty percent of the cases were produced in immigrants and 4.8% in persons coinfected with HIV, proportions that are similar to those of the previous year. Eleven cases of meningococcal disease were reported, (1.9 cases per 100,000 inhabitants; EI 0.73), but only in 8 cases was the clinical form sepsis and/or meningitis. Neisseria meningitidis serogroup B was isolated in 8 cases, and serogroup C in 2 cases, the latter 2 were adults and were not vaccinated. The incidence of immunopreventable diseases continues to fall, and for the fifth consecutive year no case of measles has been reported. Legionnaire's disease, which is detected through the systematic determination of the antigen in urine, rose to 5.8 cases per 100,000 inhabitants (EI: 1.42), without any epidemiological relation between them. The incidence of imported diseases rose, with 12 cases of malaria, 8 of shigellosis, 5 of hepatitis A and 2 of legionnaire's disease acquired outside Spain.

Adult↗
PubMedDate not supplied

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)].

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Adolescent↗