Mortality from tuberculosis in Spain from 1970 to 1993: changes in epidemiological trends during the acquired immune-deficiency syndrome epidemic

SETTING: Spain has the highest rates in Europe of the acquired immune-deficiency syndrome (AIDS), and probably a high rate of dual human immunodeficiency virus (HIV)/tuberculosis infection. OBJECTIVE: To determine the trends of tuberculosis mortality in Spain from 1970 to 1993, and to draw conclusions about the effects of the AIDS epidemic on these trends. DESIGN: Official population figures and data on deaths from tuberculosis were used to calculate specific tuberculosis mortality rates by age and sex (per 100000 population). Causes of death from tuberculosis were grouped according to the International Classification of Diseases. RESULTS: The crude death rate decreased from 10.28 to 1.84, with an annual mean decrease of 8.1% (95% confidence interval 7.5% to 8.7%). No changes in mortality from tuberculosis of the central nervous system (CNS) have been recorded since 1982, and none in mortality from other tuberculosis and in the age group 20-49 years since 1986. Mortality was higher among males and in the older age groups. The peak observed in the 1970s, due to the excess of deaths from CNS tuberculosis in children under the age of 5 years, has disappeared. CONCLUSION: Between 1970 and 1993, tuberculosis mortality in Spain decreased, although an excess of deaths occurred in young adults and from extra-pulmonary tuberculosis, coinciding with the AIDS epidemic.     

Geographic variation of secular trends of breast cancer mortality in Spain

Twenty-one patients with disabling spontaneous, reflex, or action myoclonus due to various causes, who had shown apparent clinical improvement on introduction of piracetam, entered a placebo-controlled double-blind crossover trial of piracetam (2.4-16.8 g daily). All but one patient had electrophysiological evidence of cortical myoclonus. Patients were randomly allocated to a 14-day course of piracetam followed by identical placebo, or placebo followed by piracetam. Nineteen patients received piracetam/placebo in addition to their routine antimyoclonic treatment (carbamazepine, clonazepam, phenytoin, primidone, sodium valproate, or tryptophan plus isocarboxazid, alone or in combination) and two received piracetam/placebo as monotherapy. All patients were rated at the end of each treatment phase using stimulus sensitivity, motor, writing, functional disability, global assessment, and visual analogue scales. Ten of the 21 patients had to be rescued from the placebo phase of the trial because of a severe and intolerable exacerbation of their myoclonus. No patients required rescue from the piracetam phase of the double-blind trial. When the 21 patients were considered together, there was a significant improvement in motor, writing, functional disability, global assessment, and visual analogue scores during treatment with piracetam compared with placebo. The total rating score also improved significantly with piracetam, by a median of 22%. Piracetam, usually in combination with other antimyoclonic drugs, is a useful treatment for myoclonus of cortical origin.     

Mortality as a function of temperature. A study in Valencia, Spain, 1991-1993

BACKGROUND: Increased mortality is associated with both very low and very high ambient temperatures. This study assesses the relationship between daily numbers of deaths and variations in ambient temperature within the city of Valencia. METHODS: The daily number of deaths from all causes (total deaths and only those occurring in people aged over 70), as well as those deaths from specific causes (e.g. cardiovascular and respiratory diseases, malignant tumours and all causes except external ones) occurring within the city of Valencia were related to the average daily temperature using autoregressive Poisson regression controlling for seasonality, day of the week, holidays, air pollution, influenza incidence, and humidity. Temperature was measured within the regression model as two complementary variables: 'Heat' and 'Cold'; also taken into account were their delayed effects up to 2 weeks after measurement. RESULTS: Graphical analysis revealed a relationship between temperature and mortality according to the time of year. For the cooler months (November-April), the temperature at which mortality was lowest was the 'minimum' (i.e. around 15 degrees C), while for the warmer months (May-October), it occurred at around 24 degrees C. Because of this, a stratified analysis was undertaken with different values for the 'Heat' and 'Cold' variables according to which of the two seasons was involved. During the colder months of the year, higher temperatures tended to exert a rapid influence on mortality and the lower temperatures a more delayed relation. During the hot season it is the heat variable which more clearly manifests an effect, and this is prolonged over the two following weeks. Variations also occur according to age and cause of death. The effect of temperature is greater in persons aged over 70 years of age, and it is also greater in cases of circulatory and respiratory diseases. CONCLUSIONS: A statistically significant association has been found between temperature and mortality. This relationship is not monotonic, but mortality increases in proportion to the variance in ambient temperature from a range of temperatures that varies from winter to summer.     

Mortality patterns and trends for lung cancer and other tobacco-related cancers in the Americas, 1955-1989

Mortality from cancers of the oral cavity and pharynx, oesphagus, larynx and lung between 1955 and 1989 has been analysed for USA, Canada and 14 countries in Latin America. Among males, Uruguay, Cuba, Argentina and Puerto Rico have the highest rates for all sites, and Peru, Ecuador, Dominican Republic, Mexico and Colombia have the lowest rates. Among females, Cuba, Colombia and Puerto Rico rank high for all sites, and Mexico, Paraguay, Ecuador and Peru rank low. For both sexes, lung cancer mortality rates from the US and Canada are high, whereas rates from other sites are intermediate. An increasing trend in lung cancer mortality over time is shown in all countries except Cuba (no changes), Argentina, Paraguay and Peru (decreasing trend). In Latin America, the tobacco-related lung cancer epidemic is in its early phase among males, and very early phase among females.     

Mortality in winter

We report on a iatrogenic perioperative injury to the coronary sinus. Although oversewing venous bleeding sites on the heart usually resolves the problem, this caused an enormous venous engorgement of the posterior and apical regions of the heart, which prompted us to direct primary suture of the coronary sinus incision. A brief literature review with possible suggestions for solving this problem is given.     

Contraception in Spain

This report analyzes various aspects of contraception in Spain. One notable finding is the wide socioeconomic, cultural and health variation among regions. Since 1975 a significant drop in the birth rate has been observed overall. Twenty per cent of the women studied at risk of pregnancy are using oral contraceptives. The most widespread contraceptive method is still coitus interruptus, followed by oral contraception and the condom, as well as the rhythm method. The highest use of oral contraceptive and IUDs is seen in Catalonia (20% and 26% respectively) followed by Andalusia, Madrid and Valencia. Although contraception has only recently become legal in Spain, it is widely available either without charge or very inexpensively; all methods including abortion are available. At present, priority is given to special interest groups such as women in special circumstances, teenagers, etc. and to special programs like "Integrated Care for Women" which includes contraception, STD, pregnancy monitoring, early diagnosis of gynaecologic cancer and menopause.     

Mortality in geriatric psychiatric inpatients

OBJECTIVE: To report current information about invasive pneumococcal infections, capsular types and antimicrobial resistance in Canada. DESIGN: Retrospective analysis. SETTING: Canada. PATIENTS: A total of 976 patients from whom Streptococcus pneumoniae was isolated from blood or cerebrospinal fluid between Jan. 1, 1992, and Dec. 31, 1995. OUTCOME MEASURES: Capsular type and antimicrobial susceptibility. RESULTS: Twenty types accounted for 90.8% of the isolates from patients over 5 years of age; all but type 15A are covered by the currently available 23-valent vaccine. Nine types accounted for 92% of the isolates recovered from children 5 years and less. Reduced susceptibility to penicillin was found in 7.8% of the collection and was associated with types 6B, 9V and 19A. Full resistance to penicillin was observed most frequently during 1995 and was associated with type 9V. Rates of reduced susceptibility over one 12-month period were 19.5% for trimethoprim-sulfamethoxazole and 4.5% or less for each of cefotaxime, ceftriaxone, chloramphenicol, erythromycin, ofloxacin and tetracycline. CONCLUSIONS: Over 90% of invasive pneumococcal infections are covered by the currently available vaccines (for people over 2 years of age) and the pneumococcal protein-polysaccharide conjugate vaccines under development for young children. The high frequency of antimicrobial resistance observed requires more complete investigation and confirmation; however, taken from a global perspective, it supports the need to develop better control strategies, including greater use of new and existing vaccines.     

Management of hemophilia in Spain

A single injection (100 mug i.m.) of Estrumate (I.C.I. 80996) was used to induce luteal regression on day 8 of the estrous cycle in 3 sheep. Progesterone levels in the utero-ovarian vein and femoral artery had fallen within 6 h to less than 50% of the concentrations seen before injection of the analogue. Luteolysis was not associated with endogenous production of PGF. The concentration of PGF in the uteroovarian vein began to increase 27-39 h after the administration of Estrumate, reaching a mean maximum concentration of 1455pg/ml 48 h after Estrumate. The mean concentration of PGF in the utero-ovarian vein between 36-69 h after Estrumate was significantly greater than during the 24 h before Estrumate (control period) or during the 0-30 h immediately after injection (both P less than 0.001). The maximum secretion of estradiol and the pre-ovulatory LH peak occurred during the period of elevated PGF concentrations in the utero-ovarian veins. The possible importance of endogenous PGF production at this time is discussed.