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Susceptibility of Planorbarius metidjensis from Portugal and Spain to Schistosoma bovis from Salamanca, Spain.

The susceptibility of Planorbarius metidjensis from Portugal and Salamanca (Spain) to Schistosoma bovis from Salamanca was studied. The degree of susceptibility as measured by positivity rate, number of cercariae, pre-patent period and survival rate, showed that P. metidjensis from Portugal and Spain are very susceptible to S. bovis from Salamanca. The role of P. metidjensis as a host of S. haematobium is questioned and further studies are shown to be necessary. To determine if the disease exists in Portugal, the bovine and snail populations on the border with Salmanaca and Algarve are beginning to be screened.

Animals

[A multicenter study of drug use during pregnancy in Spain (IV). The drugs used during lactation. The DUP Working Group Spain].

BACKGROUND: Information on the use of drugs during breast feeding is scarce and rather anecdotal. The aim of this study was to gain knowledge on this issue in Spain. METHODS: The Spanish study on drug use in pregnancy recorded information on the use of drugs among 1,371 participating women, who delivered in 20 hospitals of 15 cities. RESULTS: When approached for interview, 157 women (11%) had opted for artificial lactation. Among those women practicing maternal lactation at the time of the interview (n = 921), the total number of drug exposures after delivery was 1,270 (mean = 1.38; SD = 1.55; range 0-10); as many medicines contained more than one drug, the total number of recorded drug exposures was 2,139. The most frequent indications for the use of these drugs were postpartum haemorrhage, pain and anti-infective prophylaxis, and the most consumed drugs were methylergometrine, metamizol, oxytocin, and amoxycillin. CONCLUSIONS: Women practicing maternal lactation frequently receive some drugs for which the information on their passage to maternal milk and on their safety for the newborn is not available.

Breast Feeding

[Multicenter study on the use of drugs during pregnancy in Spain (II). Drugs used during pregnancy. Spain DUP workshop].

A structured questionnaire administered to the 1,371 participating women was used for data collection on drug use in the multicentric study on Drug Use during Pregnancy in Spain. This paper describes and discusses the pattern of the use of medicines during pregnancy. Only 104 women (7%) stated that they had not taken any drug during their pregnancy, while 627 (45%) had taken 3 or more medicines; 39% of all medicines used were fixed-dose combinations of two or more drugs, the mean number of these taken by the participating women being 8.9. The most frequent reason for taking medicines during pregnancy was vitamin supplementation (823 women, 60%), and out of the 1,119 medicines taken to this end, 443 (30%) contained vitamin A. Other reasons for using medicines were the treatment of anaemia (497, 36%), dispepsia (235, 17%), nausea and/or vomiting (204, 14%), colds, pain, urinary tract infections, headache, and genital infections.

Drug Therapy

[Multicenter study of the use of drugs during pregnancy in Spain (III). Drugs used during the first pregnancy trimester. DUP workshop of Spain].

The Spanish Study on Drug Use in Pregnancy, promoted by the Spanish Society of Clinical Pharmacology, included overall 1,371 women. In this paper we describe the use of medicines during the first trimester of pregnancy. 85% of the drugs taken had been prescribed by the obstetrician. Pregnant women who had used any medicine during this period (n = 753) attended their physician for the first time at a mean of 9.7 weeks (sd = 5.4), while the first visit of non-users (n = 618) took place at 12.5 weeks (sd = 7.0) (p less than 0.001). The percentage of medicines taken as self-medication was only 5% of total. These three findings suggest that drug use during pregnancy is mainly decided by the obstetrician. 11% of pregnant women received at least one medicinal product containing retinol and 5% received iodide, both as vitamin supplementation; these two substances do not have a demonstrated efficacy and their safety for the embryo is very doubtful. Of all women, 15% received pharmacological treatment for nausea and/or vomiting, a proportion which does not seem to be justified according to the existing data on the prevalence of hyperemesis during the first trimester of pregnancy. This study also showed the persistence of an incorrect treatment of threatened abortion.

Drug Therapy

[A multicenter study on drug use during pregnancy in Spain (I). Methods and the demographic characteristics of the population studied. The Working Group of the DUP (Drug Use in Pregnancy) of Spain].

Between January and June 1988, the Spanish Society of Clinical Pharmacology carried out a multicentric study on drug use during pregnancy. Twenty hospitals from 15 cities participated in the study. The study includes 1,371 women who delivered 1,406 newborns. In this paper the sociological and health characteristics of the participating women--age, years of education, planning of pregnancy, visits to the obstetrician, methods for the diagnosis of pregnancy, hospitalizations during pregnancy, toxic habits and lactation--are referred. The characteristics of the newborns are also presented: mode of delivery, gestational age, birthweight and prevalence of congenital malformations and of neonatal pathologies during the first hours of life.

Abnormalities, Drug-Induced

Manufacturing processes at two French rapeseed oil companies: possible relationships to toxic oil syndrome in Spain.

The toxic oil syndrome (TOS) epidemic that occurred in Spain in spring 1981 has been associated with the consumption of rapeseed oil that was denatured with aniline for industrial use but diverted for human consumption. The precise aetiologic agent in the oil responsible for the outbreak has not been identified. To learn more about possible contaminants and how the contamination might have occurred, we visited two French companies that process rapeseed oil and that were identified in Spanish administrative and judicial records as the ones exporting aniline-denatured rapeseed oil to Spain in 1981. With the apparently full and voluntary co-operation of personnel at both companies, we reviewed the processes involved in manufacturing, treating and transporting rapeseed oil, and we have summarized the information provided to us. Of particular importance is the finding that oil exported to Spain was taken from stock, the rest of which was sold for human consumption in the French domestic market, apparently without any adverse health effects. The differences between the oil exported to Spain and the oil sold as food in France were that aniline equivalent to 2% of the weight of the oil was added to most of the Spanish oil but not to that sold in France, and that contamination of the Spanish oil may have occurred in the tank trucks used for transportation to Spain, which had previously carried industrial chemicals. There is no assurance that the trucks were cleaned appropriately for transporting a food product before the oil was loaded for the journey to Spain. Since the clinical manifestations of TOS are not those of aniline toxicity, we conclude that the aetiological agent of TOS is likely to be one of the following: (1) a contaminant in the aniline, (2) a contaminant introduced during transportation, (3) a reaction product of normal oil components or materials used in refining with either aniline or the potential contaminants mentioned under (1) or (2) above.

Aniline Compounds

Paediatric drug prescribing. A comparison of Tenerife (Canary Islands, Spain) and Sweden.

The prescribing of medicines for ambulant children below 14 years of age has been compared between Tenerife (Spain) and Sweden. Data obtained from a random sample of 1327 children in a prospective study in Tenerife were compared with data from 3901 children in a Swedish survey linking diagnosis and therapy. Upper respiratory tract infection was the main diagnosis in both countries and antibiotics was the most frequently prescribed drug group (28.2% in Tenerife and 28.8% in Sweden). Half of the children in Sweden did not receive any medication, but only 10% of those in Tenerife did not receive a prescription. Children who received a prescription on average got 1.4 drugs in Sweden and 2.3 in Spain. Amongst the ten most commonly prescribed products in Sweden there were 11 active pharmacological principles as compared to 25 in Spain. These most frequently used preparations accounted for two thirds of all the prescriptions for children in Sweden and one third in Tenerife. In conclusion, drugs were significantly more often used to treat paediatric outpatients in Tenerife than in Sweden. The prescribing physician in Spain also chose a wider variety of drugs and more commonly used fixed combination products.

Atlantic Islands

Epidemiological appraisal of the active role of women in the decline of infant mortality in Spain during the twentieth century.

This paper is concerned with the question of the role which the psycho-cultural development experienced by women in developed countries throughout this century may have played in the decline of infant mortality, taking in Spain between 1900 and 1979 as a basis for observation. We think that, by studying the psycho-cultural development of women, included under the general concept of standard of living, we can take a step forward in explaining such a frequently investigated but nonetheless incompletely understood subject as is that of the marked decline of infant mortality which has taken place in this century in developed countries in general, and in Spain in particular. To this effect, we have attempted to demonstrate the need to consider socio-cultural factors, in addition to the already repeatedly studied economic and biomedical ones; the more so when we take into account the marked decline in infant mortality which occurred in Spain in the 1940s, in which period there was a pronounced stagnation in the economy. To this purpose, we have studied fertility, not only as a gauge of the biological risks which generate a certain reproductive pattern for infant mortality, but also as an indicator of the socio-cultural development of women. Similarly, and through a review of historical documents, we have analysed the role of women in birth control, their incorporation into more qualified jobs, their level of education, their growing awareness of their own situation in society, as well as pertinent legislative changes. All these processes affect the health of children through factors which, although they are very difficult to evaluate and quantify, have previously been described and examined in other studies. Our study has shown the probable relationship between the decline of fertility and the decrease of infant mortality, in view of the fact that there has been a pronounced decrease of parity and fertility in women belonging to the oldest fertile age groups. Similarly, the indications pointed out with respect to the processes mentioned above lead us to infer that in Spain the woman has played a significant role in the decline of infant mortality produced in this century, and especially in the first half of the century. We have embarked on a scantily developed line of investigation, and suggest the need for new studies on the subject.

Adult

Biotypes, antibiotic resistance and plasmids coding for CFA/I and STa in enterotoxigenic Escherichia coli strains of serotype O153:H45 isolated in Spain.

Enterotoxigenic Escherichia coli (ETEC) strains of serotype O153:H45 have been found recently to be a frequent cause of sporadic cases and outbreaks of neonatal diarrhoea in Spain and the most important cause of infant diarrhoea in Chile. Relationships between sugar fermentation patterns, resistance to antibiotics and plasmid profiles were analysed in nine E. coli O153:H45 strains isolated in Spain that synthesised CFA/I antigen and STa enterotoxin. Derivative strains obtained by curing with acridine orange, and transconjugants rendered antibiotic resistant, were characterised phenotypically and analysed for plasmid content. Two fermentation patterns were recognised: rhamnose fermenters (four strains) and rhamnose non-fermenters (five strains). The ability to ferment rhamnose was the only differential characteristic found among 49 carbohydrate fermentation tests used to establish fermentation patterns. All nine strains possessed similar plasmid profiles of three or four plasmids of 52-87 Mda. A non-conjugative large plasmid of 82 Mda or 87 Mda, depending upon the strain, was identified as that responsible for production of both CFA/I and STa. Resistance to antibiotics was determined by plasmids other than those coding for CFA/I and STa. Two conjugative resistance factors were identified: a 52-Mda plasmid coding for resistance to ampicillin, streptomycin and sulphonamide in rhamnose-fermenting strains, and a 77-Mda plasmid coding for resistance to ampicillin, streptomycin, kanamycin, tetracycline and sulphonamide in rhamnose non-fermenting strains. Our results support the hypothesis that the prevalence and distribution of ETEC strains belonging to serotype O153:H45 in Spain and Chile could be due to the extensive cultural relations between Spain and South American from the past.

Anti-Bacterial Agents

Trends in alcohol consumption in Spain, Portugal, France and Italy from the 1950s until the 1980s.

This paper compares trends in alcohol consumption in Spain, Portugal, France and Italy starting from the beginning of the 1950's and extending until the 1980's and examines the modernization and internationalization of beverage preferences in these countries. The total consumption of alcohol has declined in Spain, France and Italy and the consumption of wine has shown a declining trend in all the countries studied. The traditional beverage, wine, has in Spain, Portugal and Italy been substituted by a new beverage with lower alcohol content, beer. In France the decline in wine consumption has not been substituted by the use of other alcoholic beverages. No noticeable internationalization in beverage preferences has taken place in Spain, Portugal or Italy, whereas imported beverages have gained some ground in France.

Alcohol Drinking

[Incidence of cancer in Spain].

An estimate is made of the number of cancer cases in Spain, broken down according to the part of the body in which the tumors are found and by Regions of the country, using the case number/death rate ratio by tumor location, sex and age group obtained from the Cancer Registry for the Population of Navarra for the 1980-1984 period and the pertinent specific death rates recorded throughout the different Regions of Spain in 1985. Using this method, a yearly number of 120,858 cases of cancer (71,436 men and 49,422 women) is obtained. According to the location of the tumors, the most important ones, with a gross rate of cases per 100,000 inhabitants for men are: lung (63.37), prostate (38.8), bladder (34.9) and stomach (31.4); for women: breast (51.92), body and unspecified part of uterus (21.14), colon (19.73), stomach (19.27) and cervix (19.17). By Regions of Spain, the highest rates are those of Asturias (355.04) and Cantabria (348.43), the lowest being those of Madrid (203.06) and the Canary Islands (217.82). This data can be useful in planning resources for the control and prevention of cancer in Spain.

Female

Years of potential life lost: application of an indicator for assessing premature mortality in Spain and Portugal.

In this article, the authors present an analysis of causes of death in Spain and Portugal in 1984 based on a calculation of the "years of potential life lost" (YPLL) between the first and the 70th birthdays, the latter age corresponding approximately to the average life expectancy in both countries. This analysis of the YPLL led to a substantially different ranking of the main causes of death, based on what might be termed "premature mortality" compared with that obtained from more conventional mortality indices. According to this criterion, which is especially appropriate for the planning and evaluation of health interventions, the main causes of premature death (1-69 years) in the two countries of the Iberian peninsula are malignant tumours and, particularly in Portugal, violent deaths (especially motor-vehicle accidents, but also suicides). This is in contrast to the predominance of cardiovascular diseases indicated by other weightings of age-specific mortality rates. Portugal shows significantly worse YPLL rates than Spain not only for general mortality (45% higher than in Spain), but also for several major groups of causes. In Spain only malignant neoplasms, diabetes and chronic rheumatic heart diseases show higher specific mortality rates than in Portugal, based on traditional mortality indicators.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Polyps of the colon in Barcelona, Spain. An autopsy study.

This study is based on a prospective survey of 212 autopsies that was conducted to determine the prevalence of colon adenomas in Barcelona, Spain. Adenomatous polyps were found in 21.7% of the patients (29.3% of the men and 12.5% of the women); multiple adenomas were found in 40% of the patients. Almost all adenomas were less than 5 mm in diameter, although 6.7% of the ones seen predominantly in the rectosigmoid colon were larger than 1 cm. The prevalence and number of adenomas increases with age. The prevalence of hyperplastic polyps was very low (1.6%). The data shows a relationship between the prevalence of colon adenomas in Spain and the incidence of colon cancer. The prevalence of colon adenomas in Spain is one of the lowest compared with that in other European countries and North America.

Adenoma

Prevalence of dominant mutations in Spain: effect of changes in maternal age distribution.

We studied the birth prevalence of autosomal dominant mutations in Spain and estimated how a decrease in maternal age distribution may lead to reduction in dominant mutations. The data were collected by the Estudio Colaborativo Español de Malformaciones Congénitas from April, 1976, to December, 1985. Among 553,270 liveborn infants monitored during the period, 66 infants with autosomal dominant conditions were identified. These included Apert, Crouzon, Hay-Wells, Treacher-Collins, Robinow, Stickler, Adams-Oliver, and the blepharophimosis syndromes, achondroplasia, cleidocranial dysostosis, and thanatophoric dysplasia. The overall rate of autosomal dominant conditions was 1.2 per 10,000 liveborn infants. Thirteen (20%) had an affected relative, and 52 (79%) had a negative family history. One case was excluded because of insufficient family data. The rate of autosomal dominant mutations was 0.9 per 10,000 liveborn infants, or 47 per 1 million gametes. A reduction in the maternal age distribution of mothers age 35 years and older from the current 10.8% to 4.9%, as in Atlanta, Georgia, would reduce the rate of Down syndrome in Spain by 33% and through a change in parternal age distribution may lead to a reduction in dominant mutations of about 9.6%. This suggests that a public health campaign to reduce older maternal age distribution in Spain may also lead to a reduction in dominant mutations and emphasizes the potential that a direct campaign for fathers to complete their families before age 35 years may have a small, but measurable, effect in the primary prevention of dominant mutations.

Adult

Relatedness of penicillin-binding protein 1a genes from different clones of penicillin-resistant Streptococcus pneumoniae isolated in South Africa and Spain.

Penicillin-resistant strains of Streptococcus pneumoniae have been common in South Africa and Spain for several years. Multilocus enzyme electrophoresis identified one clone of capsular type 6B which was prevalent in Spain and another clone of type 23F that was present in both countries. Genes for penicillin-binding proteins (PBPs) in penicillin-resistant strains are often mosaics where parts of the pneumococcal genes are replaced by homologous genes from other species. We have compared the mosaic structures of the PBP 1a genes from the two clones as well as from genetically distinct South African isolates. Four classes of mosaic PBP 1a genes were found that contained blocks of sequences divergent by 6-22% from those of sensitive genes; two classes contained sequences coming from more than one external source. Data are presented showing that the PBP 1a genes from the 23F and the 6B clone are related, and that the two PBP 1a genes from the South African isolates are also related. We suggest that the type 23F clone originated in Spain prior to distribution into other continents.

Bacterial Proteins

Geographical patterns of cancer mortality in Spain.

This report discusses the methodology and main findings of the Atlas of Cancer Mortality in Spain with special reference to some major forms of cancer. The mortality for all cancers and specifically lung cancer, for both sexes, is highest in the peripheral regions of Spain. This agrees basically with the level of urbanization and industrialization which has developed during the past several decades. Madrid is the outstanding exception to these relationships. The mortality pattern for stomach cancer is directly opposite to that of lung cancer, the more rural inland provinces having higher mortalities and most Mediterranean provinces showing lower mortalities. For breast cancer areas of higher mortality are some northern and some Mediterranean provinces. A similar pattern is shown by other uterus cancer with areas of higher mortality in the Mediterranean provinces. Considered individually, the province of Cádiz shows the greatest risk of death from cancer, being ranked first for the following cancers: lung, oral cavity and pharynx, esophagus, larynx, and prostate for males and esophagus, other uterus, and bone for females. All these findings definitely produce more questions than answers. Future research on analytical epidemiology of cancer in Spain is strongly recommended.

Cluster Analysis

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968-1986.

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.

Adolescent