Biomedical subjects

M Delgado-Rodríguez

Publications and source records attributed to M Delgado-Rodríguez.

At least 73 records · Page 4Linked to original sources

PubMed1996

[Risk factors associated with the development of surgical wound infection in a general surgery service].

BACKGROUND: To evaluate incidence, etiology and risk factors of surgical wound infection (SWI) in a service of general surgery in a tertiary hospital. METHODS: Retrospective cohort study. The relative risk (RR) and its 95% confidence interval (CI) have been used as a measure of association between risk factors and SWI. Multiple logistic regression has been selected as multivariate analysis. RESULTS: Of 619 surgical patients, 60 (9.7%) developed SWI. The most frequently isolated microorganism was Enterococcus (26%), but a higher prevalence of gram negative was also found. On admission, the factors associated with SWI were: diabetes mellitus (RR = 2.5, CI95% = [1.0-6.3]), age older than 65 years (RR = 2.66, CI95% = [0.8-9.0]) and contaminated and dirty surgery (linear trends chi square, p = 0.044); among the amendable medical care factors, the duration of the surgery is the unique to be pointed out with an increment of 5 /1000 per minute (p = 0.011). The admission an emergency unit presented a non significant adjusted RR of SWI near to 3 (CI95% = [0.9-9.6]). CONCLUSIONS: SWI is related most importantly to risk factors at admission not amendable by the physician. Our results showed that the only factor susceptible to be changed is the duration of the surgical intervention.

Adolescent↗

PubMed1995

Recall bias in a case-control study of low birth weight.

The role of report/recall bias in case-control studies of low birth weight (LBW) was investigated in women who gave birth at a tertiary hospital. Prenatal exposure information reported at the postpartum interview was compared with that documented during pregnancy in obstetric records. 169 cases of LBW and 198 controls were selected. The two sets of information on case mothers and control mothers were compared, using the medical record as a reference. Kappa values were estimated. No trend was observed to increase/decrease the sensitivity and specificity of recall. Agreement on alcohol use was very low (kappa = 0.11 for case mothers and 0.03 for control mothers): on obstetrical records, only 12 mothers of cases reported habitual alcohol intake at the first prenatal care visit, whereas in the interview 69 said yes to the same question; in control mothers, the figures were 4 and 89 respectively. Odds ratios (ORs) of exposure estimated from the two sets of data did not differ importantly in 8 variables. Interview data yielded ORs for hypertension (8.39 versus 4.63), anemia (0.44 versus 0.99) that were farther from the null, and ORs in the opposite direction for alcohol (0.83 versus 1.61) and any drug (0.64 versus 1.42). In conclusion, given that OR figures are similar for most variables and no trend is observed in sensitivity/specificity, mothers of normal births can be an adequate reference group, using personal interviews to obtain information on lifestyle, and medical records for conditions.

Adult↗

PubMed1995

Multivariate analysis of cutaneous markers of aging in chronic hemodialyzed patients.

BACKGROUND: Although hemodialysis has been associated with lesions of cutaneous aging, no controlled studies have been done in patients with chronic renal failure under periodic hemodialysis. Our purpose was to determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis. METHODS: One hundred fourteen patients on chronic hemodialysis were investigated for the presence of several cutaneous aging markers in a cross-sectional study, using multivariate analysis to minimize the confounding effect of age. RESULTS: Skin cancer was diagnosed in 3 patients (2.6%), actinic keratoses in 12 (10.5%), senile lentigo in 22 (20%), senile purpura in 15 (13%), and Favre-Racouchot disease in 6 (5%). There was no association with skin types or facial wrinkles with any other of the skin-aging features studied. Multivariate analysis, controlling for age as a confounding variable, indicated that the degree of facial wrinkles and the decrease in stratum corneum hydration (capacitance) correlated significantly with the length of time on hemodialysis (P = 0.012 and P = 0.012, respectively). Favre-Racouchot disease (Odds Ratio [OR] = 1.23, P = 0.055, 95% confidence interval [CI] 0.99-1.52) and actinic keratoses (OR = 1.15, P = 0.076, CI 0.98-1.34) became increasingly frequent with the duration of chronic hemodialysis. CONCLUSIONS: These data show a high prevalence of cutaneous aging lesions in patients on chronic hemodialysis. Acceleration of cutaneous aging is associated with time on hemodialysis.

Adolescent↗

PubMed1994

[Evaluation of the cost of an intensive medicine unit. Relationship between the cost and the severity of the disease].

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.

Adult↗

PubMed1994

Difficulties in assessing community-acquired infection as a risk factor for nosocomial infection at an intensive care unit.

OBJECTIVE: To analyze the relationship between presentation with a community-acquired infection (CAI) and the risk of subsequent nosocomial infection, and the assessment of a likely diagnostic bias in this association. DESIGN: A prospective cohort study. APACHE-II and TISS were used to assess severity and therapeutic intensity, respectively. Nosocomial infection (NI) was diagnosed according to SENIC and CDC diagnostic criteria. The relative risk and its 95% confidence interval were estimated. SETTING: The intensive care unit (ICU) of the University of Granada Hospital (Spain). It is a ten-bed multidisciplinary unit. PATIENTS: 448 patients admitted to the intensive care unit (ICU) between December-1986 and April-1988 who stayed at the ICU for at least 24 hours were included in the study. RESULTS: The crude analysis suggests that CAI may prevent NI. When data were stratified by other variables a previous infection acted as a preventive factor in patients admitted to the ICU from emergency room, in patients with lower severity level and in those with shorter stay lengths at ICU. Patients with a CAI showed higher severity; they were treated more aggressively, they had a longer stay at ICU before a NI was diagnosed and they remained at ICU longer. In multivariate analysis the NI risk in patients with a CAI compared with those not infected previously and controlling for other variables was of 0.36. CONCLUSION: The presence of a CAI may introduce a differential information bias in the study of NI.

Chi-Square Distribution↗

PubMed1994

Influence of nosocomial infection on mortality rate in an intensive care unit.

OBJECTIVE: To assess the impact of nosocomial infection on the mortality rate in an intensive care unit (ICU). DESIGN: Prospective cohort study. SETTING: The ICU of the University of Granada Hospital in Spain. PATIENTS: All patients (n = 279) admitted for > or = 48 hrs at the ICU between December 1986 and April 1988. MEASUREMENTS: Nosocomial infections were diagnosed according to Study on the Efficacy of Nosocomial Infection Control (SENIC) and Centers for Disease Control criteria. Patient severity on admission (using Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intensity Scoring Systems were also used. RESULTS: Mortality risk was 2.48 times higher in patients with a nosocomial infection than in noninfected patients. Relative risk of mortality in nosocomially infected patients was higher in young and less severely ill patients, in those patients with respiratory diseases, and in those patients with longer ICU stays. Logistic stepwise regression analysis, adjusting for several confounding factors (affected organ system, APACHE II score, and therapeutic intensity), showed that the risk of death in nosocomially infected patients was 2.1 times greater (95% confidence interval = 1.0 to 4.41) than in patients without such infection. CONCLUSIONS: Nosocomial infection increases the risk of death. The effect is stronger in younger and less severely ill patients.

Adult↗

PubMed1994

IV drug users: changes in risk behaviour according to HIV status in a national survey in Spain.

STUDY OBJECTIVE: To determine whether HIV positive intravenous drug users (IVDUs) who were receiving outpatient treatment for opiate and cocaine abuse or dependence used practices aimed at reducing the spread of HIV. DESIGN: Cross sectional study of behaviour and HIV serostatus in IVDUs. SETTING: A nationwide sample, from 83 health centres for outpatient treatment, stratified by autonomous regions. PARTICIPANTS: Altogether 1074 IVDUs were recruited. HIV serostatus could be verified in 738 (68.7%) of these. MEASUREMENTS AND MAIN RESULTS: Crude and adjusted odds ratios and their 95% confidence intervals were estimated to assess the association between HIV serostatus and behavioural changes. In their daily interactions with other members of the same household, seropositive subjects more frequently used preventive methods aimed at avoiding transmission than seronegative patients. Treatment for abuse or dependency before the current regimen had a greater impact in HIV positive than HIV negative subjects in terms of abstaining from risk behaviours. There was a significant trend toward lower drug consumption in HIV positive subjects, and the number of seropositive and seronegative IVDUs who stopped injecting their drugs was significantly higher among the former. Seropositive subjects were also more likely to stop sharing drug injecting equipment and to change their sexual habits; they reported an increased consistent use of condoms. CONCLUSIONS: HIV positive IVDUs were more likely to change their risk behaviours than their HIV negative counterparts.

Adolescent↗

PubMed1994

Sharing injecting equipment and sexual behavior in ambulatory intravenous drug users: a national survey (Spain).

This article examines the relationship between sharing and sexual behavior in a nationwide sample of 1,074 intravenous drug users (IVDUs) in ambulatory treatment in Spain. Of our sample, 31.9% shared or had shared injecting equipment. Sharing was associated with sex-less frequent in males--and yielded an inverse relationship with age, years of education, and age at first intravenous drug use. Sharers, especially women, engaged more frequently in sex in exchange for money. A small proportion (6.3%) of male IVDUs had bisexual or homosexual relations. Condoms were always used by 18.4% of males and 15.9% of females. The sharing of injecting equipment was not generally associated with a particular type of penetrative sexual encounter, although condom use was less frequent among IVDUs who shared injecting equipment. The limitations of the present study are discussed.

Adult↗

PubMed1994

Validity and diagnostic bias in the clinical screening for congenital dysplasia of the hip.

To assess the validity of the clinical maneuvers and signs in the screening for congenital dysplasia of the hip and the presence of a diagnostic bias in this screening, a random sample of 261 newborns was studied at a tertiary hospital. All newborns were clinically and sonographically studied in the first 48 hours after birth. Hips were classified according to Graf's scheme. Sensitivity, specificity and predictive values were estimated. Nineteen dysplasias and 100 physiologically immature hips were detected. Sensitivity and specificity for the Ortolani-Barlow maneuver were 26% and 84% respectively. A higher sensitivity was observed when all clinical maneuvers/signs were considered; however, specificity decreased, so the positive predictive value reached a similar figure to that of Ortolani-Barlow, 5%. A higher positive rate with the Ortolani-Barlow procedure was observed when newborns had risk factors for congenital disease of the hip (family history and female sex) or belonged to groups that could be considered as high-risk (low Apgar score, younger mothers). Other procedures apart from clinical examination should also be recommended as an effective screening procedure to decrease the number of cases missed and to avoid diagnostic bias in future epidemiologic research on this condition.

False Negative Reactions↗

PubMed1993

Validity of the cross-sectional study for the ascertainment of nosocomial infection risk factors.

This study was carried out in order to assess the validity of the pure cross-sectional study in the ascertainment of nosocomial infection risk-factors. The results yielded by two designs (cross-sectional and case-control) are compared. A cross-sectional design was performed in a tertiary hospital. 592 patients were studied, 38 of whom were nosocomially infected. The clinical information on all the patients included in this design was reviewed after hospital discharge. A matched case-control study was nested in the population cross-sectionally surveyed. 66 cases (28 additional patients developed a hospital infection) and 132 controls were selected. Odds ratios (ORs) for the risk factors analyzed by both designs were compared. There were no significant differences between the estimates yielded by both designs; however, a trend of lower OR estimates for the cross-sectional study was seen, which may be important for risk factors not strongly related to (low relative risk) nosocomial infection. Several factors which might account for the results observed (random error, bias introduced by matching) are discussed. It is suggested that pure cross-sectional designs for the study of risk factors of nosocomial infection may introduce a negative (toward-the-null) bias.

Bias↗

PubMed1993

Geographical variations in the prevalence of HIV infection among drug users receiving ambulatory treatment in Spain.

To identify the factors responsible for the regional differences in HIV-positive serostatus among drug users in Spain receiving outpatient treatment, the 17 autonomous regions into which Spain is divided were classified as high (mean 52%) or low prevalence groups (mean 34%) depending on the prevalence of seropositivity. In regions where the prevalence of positive serostatus was high, unemployment was more markedly associated with HIV infection than in low prevalence regions, while other potential risk factors yielded the same strength of association. Even so, adjustment for all the factors only accounted for 13% of the total difference in HIV+ prevalence between regions. The current distribution of risk factors among the two groups of autonomous regions does not explain these differences.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Influence of socioeconomic and health care development on infant and perinatal mortality in Spain 1975-86.

STUDY OBJECTIVE: This study aimed to analyse the influence of social, economic, and health development on infant and perinatal mortality in Spain between 1975 and 1986, and to identify possible changes in these relationships over time. DESIGN: Study of the association between mortality and a range of variables. SETTING: 50 Spanish provinces. MEASUREMENTS AND MAIN RESULTS: Mean infant and perinatal mortality were estimated for two periods--1975-8 and 1983-6. Social, economic, and health care indicators were collected as independent variables for these two periods. The rates of variation between periods were estimated for each variable. Multiple linear regression models were used to define the association between infant and perinatal mortality and their respective rate of variation with the former indicators. Mean familial income was the main predictive factor for infant and perinatal mortality in the first period but in the second period health care indicators were more relevant. CONCLUSIONS: The reduction in Spanish infant and perinatal mortality over the period can be attributed mainly to the improvement in prenatal and neonatal health care in Spain in recent years, while economic factors seem less important.

Birth Rate↗

PubMed1991

Usefulness of severity indices in intensive care medicine as a predictor of nosocomial infection risk.

To evaluate the relationship between severity and nosocomial infection in critical patients, we have conducted a prospective study at the Intensive Care Unit of the University of Granada Hospital (Spain). Patients' severity was evaluated by APACHE II and TISS. We found a positive association with nosocomial infection risk for an APACHE II score greater than 12 points (RR = 2.45) and for first-day TISS greater than 20 points (RR = 2.51). With a multivariate analysis we did not find an association between APACHE II and nosocomial infection risk, but each TISS point suggests an infection risk increment of 6%. We concluded TISS may be considered a good infection risk predictor. TISS could also be taken into account when nosocomial infection rates from several ICUs are compared.

Cross Infection↗

PubMed1990

Hospital stay length as an effect modifier of other risk factors for nosocomial infection.

This paper addresses the problem of hospital stay length as a risk factor for nosocomial infection and as a modifier of the effect of other risk factors for hospital infection. Patients were selected form two cross-sectional studies done in two different seasons of 1986. Risk of infection rose fairly steadily as hospital stay length increased (correlation coefficient: 0.83, p less than 0.01). Several risk factors (operation, underlying disease, and age) were analyzed on the basis of 1) raw data and 2) data stratified by length of stay. The results showed that hospital stay length is a strong modifier of the remaining risk factors, generally reducing, their effect on the development of hospital infection as length of stay increases.

Adolescent↗

PubMed1988

Quantification of risk factors in hospital infection at a surgical service.

In this paper we have analyzed several risk factors for developing nosocomial infections at a Surgical Service of the Hospital Clinico Universitario "San Cecilio", based on a retrospective follow-up program designed specifically for this study. Of all patients admitted to the Service from January 1 to June 17, 1987, we examined the following variables: age, sex, cause of admission, emergency or non-emergency admission, operation and related variables. The overall rate of nosocomial infections was 16.46%. The most significant risk factors we found were "operation", which had a linear correlation coefficient of 0.929 (p less than 0.01) with hospital infection when stratified by its length, "advanced age" (greater than 60 years old), especially in non-operated patients, and chemoprophylaxis. Such risk factors were ascertained taking into account the confounding effect produced by the variables studied in this survey.

Adult↗

PubMed1987

A practical application of Rhame and Sudderth's formula on nosocomial infection surveillance.

We have conducted an epidemiological analysis of the utility of Rhame and Sudderth's formula--establishing a relationship between prevalence, incidence and duration of nosocomial infection--as an effective model in the surveillance of such infection. We carried out a follow-up study in a surgical service of our hospital on a sample of 799 patients admitted between January 1 and June 17, 1983 (24 weeks). We confirmed the condition of steady-state and were able to conclude that the Rhame and Sudderth model can have great utility when cross-sectional studies are performed with an adequate interval. We also concluded that the application of this model is not influenced by the size of the ward or zone of survey.

Cross Infection↗

PubMedDate not supplied

Unplanned pregnancy as a major determinant in inadequate use of prenatal care.

BACKGROUND: Previous reports have stressed the importance of social class and education in prenatal care use. Unplanned pregnancy as a determinant of prenatal care use has been insufficiently studied. The objective of this report was to assess whether unplanned pregnancy is an independent predictor of inadequate use of prenatal care. METHODS: A 5% sample of women delivering at a hospital (409 women in the study population) was selected. Data on pregnancy were obtained by personal interview and from clinical charts. Prenatal care was considered inadequate according to the Kessner index. Relative risk (RR) and 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was applied to select the independent predictors of inadequate prenatal care use. RESULTS: Prenatal care use was inadequate among 16.4% of the women. Pregnancy was unplanned among 42.8% of the women. Twenty-two percent of women with an unplanned pregnancy used prenatal care inadequately, while 12% of those with planned pregnancies used prenatal care inadequately (RR = 1.9, 95% CI = 1.2-2.9). In crude analysis, inadequate prenatal care use was also related to lower social class, lower education level, no employment outside the home, and multiparity. After adjustment was made for other predictors that were included in a stepwise logistic regression model (maternal education, social class, maternal occupation, parity, and pregnancy-induced hypertension), unplanned pregnancy was a significant risk factor for inadequate use of prenatal care (odds ratio = 2.1, 95% CI = 1.2-3.7) and it was an independent predictor for a delayed first prenatal care visit and for a reduced number of visits. CONCLUSIONS: The results suggest that unplanned pregnancy is a major determinant for inadequate use of prenatal care.

Adult↗

PubMedDate not supplied

[Review: hybrid designs of cohort studies and case control studies].

Hybrid epidemiologic designs combining elements from case-control studies and cohort studies are reviewed. Firstly, the characteristics of selection of both index group and reference group are commented on. The selection of cases required a population-based disease registry. The type of selection of reference group permits to identify the main hybrid designs: the case-cohort approach, sampling from the base at the beginning of risk period, and the nested (within a cohort) case-control studies, usually with a matched density sampling. The assumptions needed for estimating without bias relative risk or rate ratio via odds ratio and without needing the condition of disease rarity are revised. Advantages, uses, and drawbacks are summarized. Lastly, general guidelines for the analysis of these designs are displayed.

Case-Control Studies↗