Dissertations / Theses on the topic 'Prevalence'

El presente trabajo tuvo como objetivo principal determinar la prevalencia de Hidatidosis ovina en el centro de Faenamiento FRILISAC (Camal de Yerbateros de Lima) durante los años 2012-2015 y como objetivos específicos determinar la prevalencia mensual y la prevalencia según procedencia, así como las pérdidas económicas producidas. El trabajo consistió en una investigación cuantitativa con diseño Retrospectivo, Descriptivo y Analítico. El material de estudio consistió en el análisis de las fichas de registro de beneficio mensual según especie, sexo y procedencia y del consolidado mensual de decomiso de órganos según especie. Se evaluó un total de 344073 ovinos, de ambos sexos y edades, procedentes de los departamentos de Lima, Ayacucho, Ica y Arequipa, registrados en fichas correspondientes a los años 2012-2015. La prevalencia total de Hidatidosis ovina obtenida durante los cuatro años de estudio fue de 0,32%. Los meses donde más se presentó la Hidatidosis ovina marzo, abril, mayo y diciembre. El departamento donde se obtuvo la mayor tasa de prevalencia fue el departamento de Ayacucho seguido por Lima e Ica donde se obtuvieron prevalencias más bajas, en el departamento de Arequipa no se obtuvo prevalencia alguna durante los años de estudio. El órgano más parasitado fue el pulmón. La pérdida económica total por el decomiso de órganos durante los cuatro años fue de US$ 1, 541,42 dólares. Los resultados obtenidos demuestran que probablemente se están realizando programas de control por parte de los ganaderos para evitar que sus animales contraigan el parásito, por lo cual existiría un riesgo menor para la salud animal y humana en los departamentos evaluados.The present work had as main objective to determine the prevalence of ovine Hidatidosis in the center of Slaughtering FRILISAC (slaughterhouse of Herbalists of Lima) during 2012-2015 and as specific objectives to determine the monthly prevalence and provenance prevalence, as well as economic losses produced. The work consisted in a quantitative research with retrospective, descriptive and analytical design. The study material consisted of monthly benefit record sheets according to species, sex and origin and monthly consolidated of organ confiscation by species. Was evaluated A total of 344,073 sheep, of both sexes and ages, from the departments of Lima, Ayacucho, Ica and Arequipa, registered in record sheets corresponding to the years 2012 to 2015. The overall prevalence of ovine Hidatidosis obtained during the four years of study was 0.32%. The months that presented the highest prevalences of ovine Hidatidosis were march, april, may and december. The department where the highest rates of prevalence were obtained was Ayacucho followed by Lima and Ica where the lowest prevalences were obtained, in the department of Arequipa was obtained any prevalence during the study. The most parasitized organ was the lung. The total economic losess for the confiscation of organs during the four years was US $ 1, 541.42 dollars. The obtained results demonstrate that there is a probably control by farmers to keep their animals from contracting the parasite, so there is a low risk for animal and human health in the departments of ovine tested.

La leptospirosi és una zoonosi re-emergent, causada per un bacteri del gènere Leptospira. És la zoonosi bacteriana més estesa a tot el món. El seu principal reservori són els mamífers, inclosos els gats domèstics. Sol propagar-se a través de terres i aigües contaminades. Un animal infectat pot desenvolupar un estat agut de la malaltia o esdevenir un reservori. Les investigacions realitzades durant els últims 8 anys han estudiat el gat com a reservori de la infecció. Actualment, no hi ha dades sobre l’epidemiologia de la infecció en gats a Espanya i és possible que la prevalença variï segons la ubicació geogràfica, tal com s’ha publicat a nivell mundial. La major part de les dades clínic-patològiques publicades relacionades amb la leptospirosi en gats provenen d’infeccions agudes o experimentals. No obstant això, la informació en l’espècie és escassa en els casos de portadors renals crònics. Les diferències en els paràmetres clínic-patològics entre animals infectats de forma natural i no infectats, podrien ajudar als clínics en el reconeixement i diagnòstic de portadors renals crònics de leptospires en gats. L’objectiu general d’aquesta tesi va ser proporcionar un coneixement més ampli sobre la infecció per leptospires en gats, per mitjà dels següents objectius específics: 1. Avaluar la presència d’anticossos contra espècies patògenes de Leptospira i determinar la presència d’ADN en l’orina i la sang, en gats de vida lliure de dues àrees geogràfiques diferents d’Espanya. 2. Determinar les diferències en els paràmetres hematològics, bioquímics i de l’urianàlisi, entre gats infectats de forma natural i gats lliures de la infecció. 3. Valorar les variables de la resposta inflamatòria i de l’estat antioxidant en gats infectats de forma natural i gats lliures de la infecció. Es van realitzar tres estudis. En el primer, vam determinar la prevalença d’anticossos, la presència d’ADN de Leptospira spp. patògena en sang i orina en gats de vida lliure de dues regions geogràfiques d’Espanya. Es van detectar anticossos en 10/244 gats (4,1%). El serovar trobat amb més freqüència va ser Cynopteri. Mostres de sang de 1/89 gats (1,12%) i mostres d’orina de 4/232 (1,72%) gats, van amplificar per la presència d’ADN leptospiral. En conclusió, els gats de vida lliure a Espanya poden eliminar en la seva orina ADN de leptospires patògenes i ser una possible font per a la infecció humana. En el segon estudi, es van avaluar les diferències en l’hematologia, el perfil bioquímic i els paràmetres urinaris entre els gats infectats de forma natural per leptospires patògenes i els lliures de la infecció. Els gats infectats de forma natural van tenir valors més baixos d’eritròcits, hemoglobina, albúmina, creatinina i urea, comparats amb els gats lliures de la infecció. Els gats positius que van amplificar l’ADN de Leptospira spp. (orina o sang) van tenir un risc més gran de desenvolupar anèmia no regenerativa mentre que en els gats seropositius era més probable que es produís proteïnúria. La infecció crònica i l’exposició a leptospires porta a anormalitats hematològiques i a alteracions lleugeres en el perfil bioquímic i el urianàlisi. En el tercer estudi mitjançant una anàlisi de components principals (ACP) es van avaluar les proteïnes inflamatòries (PFA) i la capacitat antioxidant total (CAT) per obtenir un major coneixement sobre el curs de la malaltia en gats. El nostre treball va concloure que els gats infectats per l’ADN de Leptospira spp. van tenir una resposta inflamatòria de fase aguda, a diferència dels gats seropositius. A més, hi va haver un augment en les concentracions sèriques de la CAT que indiquen una resposta antioxidant en aquesta infecció, la qual és proporcional al títol d’anticossos i no a la presència d’ADN bacterià.
La leptospirosis es una zoonosis re-emergente, causada por una bacteria del género Leptospira. Es la zoonosis bacteriana más extendida en todo el mundo. Su principal reservorio son los mamíferos, incluidos gatos domésticos. Suele propagarse a través de suelos y aguas contaminadas. Un animal infectado puede desarrollar un estado agudo de la enfermedad o convertirse en un reservorio. Las investigaciones realizadas durante los últimos 8 años han estudiado al gato como reservorio de la infección. Actualmente, no existen datos sobre la epidemiología de la infección en gatos en España y es posible que la prevalencia varíe según la ubicación geográfica, tal y como se ha publicado a nivel mundial. La mayor parte de los datos clínico-patológicos publicados relacionados con la leptospirosis en gatos, provienen de infecciones agudas o experimentales. Sin embargo, la información en la especie es escasa en el caso del estado de portador renal crónico. Las diferencias en los parámetros clínico-patológicos entre animales infectados de forma natural y no infectados, puedan ayudar a los clínicos en el reconocimiento y diagnóstico de portadores renales crónicos de leptospiras en gatos. El objetivo general de esta tesis fue proporcionar un conocimiento más amplio sobre la infección por leptospiras en gatos, por medio de los siguientes objetivos específicos: 1. Evaluar la presencia de anticuerpos frente a especies patógenas de Leptospira y determinar la presencia de ADN en la orina y la sangre, en gatos de vida libre de dos áreas geográficas diferentes de España. 2. Determinar las diferencias en los parámetros hematológicos, bioquímicos y del uroanálisis, entre gatos infectados de forma natural y gatos libres de la infección. 3. Valorar las variables de la respuesta inflamatoria y del estado antioxidante en gatos infectados de forma natural y gatos libres de la infección. Se realizaron tres estudios. En el primero, determinamos la prevalencia de anticuerpos, la presencia de ADN de Leptospira spp. patógenas en sangre y orina, en gatos de vida libre en dos regiones geográficas de España. Se detectaron anticuerpos en 10/244 gatos (4,1%). El serovar encontrado con más frecuencia fue Cynopteri. Muestras de sangre de 1/89 gatos (1,12%) y muestras de orina de 4/232 (1,72%) gatos, amplificaron para la presencia de ADN leptospiral. En conclusión, los gatos de vida libre en España pueden eliminar en su orina, ADN de leptospiras patógenas y ser una posible fuente para la infección humana. En el segundo estudio, se evaluaron las diferencias en la hematología, el perfil bioquímico y los parámetros urinarios, entre los gatos infectados por leptospiras patógenas de forma natural y los libres de la infección. Los gatos infectados de forma natural tuvieron valores más bajos de eritrocitos, hemoglobina, albúmina, creatinina y urea, comparados con los gatos libres de la infección. Los gatos positivos que amplificaron el ADN de Leptospira spp. (orina o sangre), tuvieron un riesgo mayor de desarrollar anemia no regenerativa, mientras que, en los gatos seropositivos era más probable que se produjera proteinuria. La infección crónica y la exposición a leptospiras conduce a anormalidades hematológicas y a alteraciones ligeras en el perfil bioquímico y el uroanálisis. En el tercer estudio se evaluaron a través de un Análisis de Componentes Principales (ACP), las proteínas inflamatorias (PFA) y la capacidad antioxidante total (CAT) para obtener un mayor conocimiento sobre el curso de la enfermedad en los gatos. Nuestro trabajo concluyó que los gatos infectados por el ADN de Leptospira spp. tuvieron una respuesta inflamatoria de fase aguda, a diferencia de los gatos seropositivos. Además, hubo un aumento en las concentraciones séricas de la CAT, que indican una respuesta antioxidante en esta infección, la cual es proporcional al título de anticuerpos y no a la presencia de ADN bacteriano.
Leptospirosis is a re-emerging zoonosis, caused by a bacterium of the genus Leptospira. It is the most widespread bacterial zoonosis worldwide. Its main reservoir are mammals, including domestic cats. It is usually spread through contaminated soil and water. An infected animal may develop an acute state of the disease or become a reservoir. Research carried out during the last 8 years, has studied the cat as a reservoir of the infection. Currently, there are no data on the epidemiology of the infection in cats in Spain and prevalence may vary depending on the geographical location, as it has been published worldwide. Most of the clinicopathological data published associated with leptospirosis in cats are from acute or experimental infections. Nevertheless, the information in the species is very scarce in case of the chronic renal carrier state. The differences in clinicopathological parameters between naturally infected and leptospires-free animals may assist clinicians in the recognition and diagnosis of chronic renal carrier state of leptospires in cats. The general goal of this thesis was to provide more extensive knowledge about leptospires infection in cats, through the following specific objectives: 1. To evaluate the presence of antibodies against pathogenic Leptospira species and to determine the presence of DNA in urine and blood in free-roaming cats from two different geographical areas in Spain. 2. To determine differences in haematology, biochemical profile and urinary parameters between naturally infected cats and leptospires-free cats. 3. To assess the variables of the inflammatory response and antioxidant state in naturally infected cats and leptospires-free cats. Three studies were carried out. In the first one, we determined antibodies prevalence, blood DNA, and shedding of DNA from pathogenic Leptospira species in the urine of free-roaming cats, in two geographical regions in Spain. Antibodies were detected in 10/244 cats (4.1%). The most common serovar detected was Cynopteri. Blood samples from 1/89 cats (1.12%) and urine samples from 4/232 cats amplified for leptospiral DNA (1.72%). In conclusion, free-roaming cats in Spain can shed pathogenic Leptospira spp. DNA in their urine and may be a source of human infection. In the second study, the differences in haematology, biochemical profile and urinary parameters between naturally infected by pathogenic leptospires and leptospires-free were studied. Cats naturally infected had lower values of RBC, haemoglobin, albumin, creatinine and urea compared to leptospires-free cats. Positive Leptospira spp. DNA amplification cats were at high risk for the development of non-regenerative, whereas, seropositive cats were more likely to have proteinuria. Chronic infection and exposure to leptospires lead to haematological abnormalities and slight alterations in the biochemical profile and urinalysis. The third study evaluated the inflammatory proteins (APPs) and the total antioxidant capacity (TAC) to gain knowledge about the course of the disease in cats, through a Principal Component Analysis (PCA). Our work concludes that Leptospira spp. DNA infected cats had an acute phase response, unlike, to seropositive cats. Besides, there was an increase in TAC serum concentrations indicating an antioxidant response in the infection, which is proportional to the antibody titre and not to the presence of bacterial DNA.

The fitness costs and benefits of conforming to ones ingroup vary depending upon the dangers inherent in the immediate environment. In threatening environments, conformity is likely to be more beneficial than it is in less threatening environments. One specific threat that has had a profound selective influence on humans is infectious disease. Therefore, it was predicted that cultures inhabiting regions where risk of disease transmission is high would have more conformist orientations. Across four divergent measures of conformity, this was shown to be the case. Laboratory manipulations of disease, however, did not change levels of conformity. In two laboratory studies in which participants made judgments about either physical quantities (such as weight or volume) or about subjective liking for abstract art, participants did not conform more to normative information when disease was made salient compared to control conditions. Implications are discussed.

Introduction Three cases of M. ozzardi infection from 2 suburban communities in Iquitos, Peru, led to a suspicion of local transmission. The objective of the study was to determine the prevalence of filariasis by M. ozzardi and its associated factors among these communities. Materials and methods A cross-sectional study was performed, as well as an epidemiological survey and a thick smear blood test. Larvae and mosquitoes were collected. The adjusted OR (aOR) using multiple logistic regression was calculated. Results A total of 433 participants were enrolled; 58% were women. The prevalence of M. ozzardi was 1.4% and the associated factors included being a fisherman (aOR: 8.7; 95%CI: 1.1–76.0) and being on the Alto Nanay river (aOR: 11.2; 95%CI: 1.2–112.5). No significant evidence of simulidos or culicoides was found. Conclusion The low prevalence of M. ozzardi found suggests a foreign infection, probably derived from the Alto Nanay river.
narrospide@ins.gob.pe
Introducción Tres casos de infección por Mansonella ozzardi (M. ozzardi) en muestras de malaria que provenían de 2 comunidades periurbanas de Iquitos (Perú) dieron la sospecha de transmisión local. El objetivo del estudio fue determinar la prevalencia y factores asociados con la filariosis por M. ozzardi en estas comunidades. Materiales y métodos Se realizó un estudio transversal en las comunidades de Laguna Azul y La Unión en Iquitos. A todos los pobladores se les tomó una gota gruesa para la detección de M. ozzardi y se les realizó una encuesta epidemiológica. Se realizó colecta de larvas y mosquitos para identificación de potenciales vectores. Se calcularon los OR ajustados (ORa) usando regresión logística múltiple. Resultados Se evaluaron a 433 personas; 58% fueron mujeres; la mediana de edad fue de 20 años; 58,2% fueron migrantes, 3,7% pescadores y 12,9% habían viajado por las cuencas del Alto Nanay. La prevalencia de M. ozzardi fue de 1,4% (6/433) y el más joven de los casos tuvo 31 años; se encontró asociación con ser pescador (ORa: 8,7; IC 95: 1,1-76,0) y con haber realizado viajes por la cuenca del Alto Nanay (ORa: 11,2; IC 95: 1,2-112,5). No se evidenció densidad significativa de vectores simúlidos o culicoides. Conclusión Las comunidades estudiadas tuvieron una baja prevalencia de M. ozzardi y por la edad de los casos y los factores asociados encontrados se sospecha infección foránea a la zona de estudio, en especial en la cuenca del Alto Nanay.

Aspirin is the most commonly used antiplatelet drug in the secondary prevention of cardiovascular events. Many patients experience thromboembolic events despite daily aspirin therapy. On the basis of clinical and laboratory findings, an issue of concern has emerged, frequently referred to as “aspirin resistance”. The aim of this thesis was to establish the prevalence of laboratory aspirin resistance in patient populations and to elucidate the reasons for aspirin failure. The thesis comprises two independent studies in which I assessed a range of clinical and laboratory measures in patients with peripheral arterial disease (PAD) and patients with acute ischaemic stroke. The effect of in-hospital aspirin administration on platelet response was determined in acute stroke patients. Laboratory tests for platelet and aspirin response were compared with the current gold standard assay of optical platelet aggregometry with arachidonic acid. A cut-off value for definition of incomplete response to aspirin was determined. The current literature is reviewed and discussed. Incomplete aspirin response was found in 18% of aspirin-treated patients with PAD. There were no significant differences in any of the measured markers nor in clinical parameters between responders and incomplete responders. The prevalence of incomplete aspirin response in acute ischaemic stroke or TIA was 43%. However, after observed aspirin administration in hospital, this percentage decreased to 29%, suggesting incomplete compliance in some patients. On admission, platelets from patients with incomplete response were significantly more sensitive to adenosine diphosphate (ADP) when compared with those from responders. There were no other differences that characterised the incomplete responders to aspirin. The data support the growing body of opinion that true biochemical resistance to aspirin is uncommon. Incomplete adherence to therapy was found to be a major cause of incomplete response to aspirin and therefore amenable to intervention. The problem remains of which laboratory methods should be employed as no single test has emerged as clinically informative.

Thesis: Ph. D., Massachusetts Institute of Technology, Engineering Systems Division, 2014.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 119-129).
Governments around the world are investing significant resources in the development and expansion of logistics clusters. This dissertation analyzes the cluster phenomenon focusing on four topics. First, it develops a methodology to identify clusters and applies it to the context of the US. By analyzing the case of logistics clusters, this thesis contributes to a more general debate in the industrial clusters literature: while many authors see industrial clusters growing, others see them dispersing. Evidence of increasing concentration of the logistics industry in clusters in the US over time is tested and documented. In addition, some evidence that logistics activities in counties inside clusters show higher growth than in counties outside clusters is found. Second, this thesis studies the relationship between freight accessibility and logistics employment in the US. It develops an accessibility measure based on a gravity model, focusing on four different modes of transportation: road, rail, air, and maritime. Using a Partial Least Squares model, these four different freight accessibility measures are combined into two constructs, continental and intercontinental freight accessibility, and then analyzed against logistics employment. Results show that highly accessible counties attract more logistics employment than other counties. The analyses also show that it is important to control for the effect of population, since it explains the most variation in the logistics employment across counties. Third, this dissertation also analyzes the benefits of logistics clusters, possibly explaining their continuous growth and wide popularity among both private agents and policy makers during the last decade. Using interview data and grounded theory, four major driving forces that may explain their growing presence are identified: collaboration, value added services, upward mobility and job creation at different levels. Finally, using a quantitative approach this thesis analyzes two major effects of agglomeration on firms located within logistics clusters: more collaboration and the provision of more value added services. Using survey data and structural equation modeling these hypotheses are tested using information from the Zaragoza (Spain) Logistics Cluster. The results show that companies located in logistics clusters do collaborate more and offer more value added services than companies that are not agglomerated.
by Liliana Rivera.
Ph. D.

381 dogs between 4 and 18 months of age were tested for the presence of antibodies to Coccidioides one time. Dogs were reported as either healthy or sick by the referring veterinarian. Owners were asked to complete a questionnaire regarding their dog's risk factors associated with exposure to Coccidioides at the time of sample collection.

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una patología infradiagnosticada con una repercusión socio-sanitaria muy importante que se refleja en el gasto sanitario y mortalidad que ocasiona. Los pacientes con EPOC suelen presentar un alto riesgo cardiovascular y es una causa importante de muerte entre estos pacientes. Las unidades de riesgo vascular están implantadas en la mayoría de hospitales por su adecuada relación coste-eficiencia. Se podría intentar realizar despistaje de EPOC en estas unidades para reducir el infradiagnóstico de EPOC e intentar mejorar el pronóstico. Objetivo: Determinar la prevalencia de EPOC en una Unidad de Riesgo Vascular, evaluando el infradiagnóstico y las características asociadas a su presencia. Pacientes y método: Estudio observacional transversal realizado en la Unidad de Riesgo Vascular del Parc Sanitari Sant Joan de Déu en pacientes con alto riesgo cardiovascular. Se excluyeron únicamente los pacientes con deterioro cognitivo o riesgo cardiovascular bajo. Se estimó como clínicamente significativa un 15% de prevalencia, precisando un tamaño muestral de 168 individuos (potencia 80%, error-α 5%). Resultados: Se incluyeron 169 individuos con una edad mediana de 68 años y siendo el 67% varones. La presencia de hipertensión (98.2%), dislipemia (79.9%) y diabetes mellitus tipo 2 (43.8%) son muy frecuentes. El 74% presentan enfermedad cardiovascular. La prevalencia de EPOC en nuestro estudio es de 21.3% (IC95% 15.5-28.4), siendo un 24% para los pacientes con enfermedad cardiovascular y 13.6% en su ausencia. Las variables asociadas con EPOC son el género masculino, una mayor exposición tabáquica, mayor proporción de anemia y nefropatía, niveles más elevados de creatinina, más bajos de colesterol LDL, mayor número de ingresos previos y mayor presencia de síntomas en la encuesta CECA. El infradiagnóstico es del 47%, siendo mayor para las mujeres (83.3% vs 40%), que son el 16.6% de los individuos con EPOC. La alteración espirométrica más frecuente en nuestro estudio fue el patrón mixto (24%) Discusión: Es el primer estudio que determina la prevalencia de EPOC en una unidad de riesgo cardiovascular. Ésta es el doble (21.3%) que en la población general (10.2%), por la relación entre enfermedad cardiovascular y EPOC. Muestran enfermedad cardiovascular con elevada frecuencia siendo la nefropatía la más habitual, presentándose mayor insuficiencia renal establecida en los pacientes con obstrucción más grave. Los individuos con EPOC presentan más comorbilidades, con un Índice de Charlson total y corregido por edad significativamente más elevados. Las mujeres presentan una proporción reducida de todos los individuos con EPOC pero su infradiagnóstico es mayor en relación con una menor sospecha clínica inicial. Los pacientes sin diagnóstico previo presentan poca sintomatología y una obstrucción respiratoria leve o moderada (GOLD I-II). No se han podido determinar variables clínicas asociadas con la incidencia de EPOC que identifiquen a pacientes de alto riesgo. La generalización de la espirometría favorecería el diagnóstico de la EPOC desde estadios iniciales y permitiría conocer con mayor precisión su evolución natural. Entre los individuos con trastorno ventilatorio mixto se podrían encontrar algunos pacientes con EPOC que no ha sido posible diagnosticar en el presente estudio, y que podrían modificar la relevancia de algunas características clínicas que hayan pasado desapercibidas. Conclusiones: La prevalencia de EPOC en estos pacientes es del 21.3% y entre los pacientes con enfermedad cardiovascular establecida es significativamente mayor (24%). El riesgo vascular de estos pacientes con EPOC es alto y la nefropatía es la lesión orgánica más frecuente. No se han identificado variables clínicas que permitan estratificar de manera fiable el riesgo de EPOC. El infradiagnóstico afecta casi a la mitad de los pacientes y la práctica rutinaria de un estudio espirométrico lo disminuye. La alteración espirométrica más frecuente en toda la muestra es el trastorno ventilatorio mixto.
Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in developed countries, yet it is often underdiagnosed. Patients diagnosed with COPD are at least at a moderate risk for developing cardiovascular disease, which is frequently their main cause of death. Cardiovascular risk units have shown their cost-effectiveness preventing cardiovascular events and are widespread. These hospital facilities could serve as a COPD-screening tool for early diagnosis and long-term prognosis improvement. Objective: To estimate COPD prevalence on a cardiovascular risk unit, evaluating underdiagnosis and description of related clinical features. Methods: Transversal observational study performed at the Cardiovascular Risk Unit at Parc Sanitari Sant Joan de Déu. All patients attending this unit were invited to join the study. Only those with low cardiovascular risk (measured through CardioRisc score) or cognitive impairment were excluded. We estimated a clinical relevant COPD prevalence on 15%. The sample size needed to demonstrate this prevalence with an alpha error of 5% and a 80% power was calculated in 168 individuals. Results: 169 individuals were included. Mean age was 68 years-old and 67% are men. Hypertension (98.2%), dyslipemia (79.9%) and diabetes (43.8%) were the most frequent comorbidities. At inclusion, 74% of patients had organic cardiovascular damage. COPD prevalence was 21.3% (IC95% 15.5-28.4), ranging from 24% for those with cardiovascular organic damage to 13.6% in those without. Variables related to COPD were gender (male), heavy tobacco use, presence of renal damage, elevated creatinine plasma levels, lower LDL-Cholesterol plasma levels, more hospital admissions in previous year, higher scores in CECA questionnaire (more symptomatic) and anaemia. Total underdiagnosis was 47%, with gender differences (83.3% women, 40% men). Women were 16.6% of total COPD patients. The most frequent spirometric alteration in our study was mixed pattern (combined obstructive and restrictive) (24.3%) Discussion: This is the first study determining COPD prevalence at a Cardiovascular risk Unit. This result (21.3%) doubles the standard general population prevalence in our setting (10.2%), related to the association between COPD and cardiovascular disease. The more frequent cardiovascular organ damage was nephropathy, and the grade of obstruction in spirometry was directly related to renal impairment. COPD patients had more comorbidities reflected on the Charlson and age corrected Charlson index, which were clearly higher. Women constituted a low proportion of all COPD patients but their underdiagnosis was higher than in men, probably linked to a lower suspicion from physicians. Individuals with not previously known COPD had low level simptomatology, low ratio of hospital admissions in previous year and better spirometric values (mainly GOLD I-II). The lack of relevant clinical findings related to incident COPD hampers the selection of a high-risk group for developing COPD. The generalization of this test will probably lead to earlier diagnosis of COPD and a better understanding of its natural evolution. Finally, we probably could find some COPD among the individuals with mixed pattern spirometry, and their inclusion could modify some characteristics of this subgroup of patients. Conclusions: COPD prevalence in our study was 21.3%, near the double of global population in our country. Among patients with cardiovascular organ damage, COPD was significantly higher (24%). The overall cardiovascular risk in our patients is elevated and nephropathy is the more frequent organ affected by cardiovascular damage. There are no significantly variables that can lead to a better stratification of COPD risk. Underdiagnosis involves one-half of patients with COPD, double in women compared with men, and routine spirometry can reduce it. The most frequent spirometric alteration in our study was the mixed pattern.

Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations. The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer. In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008. The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis. The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly. Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.

During a surveillance programme all the known diabetics (1150) were identified from a general population of 97,034 representing all patients registered with 10 general practices. A control group of 751 non-diabetic subjects were also drawn from the same general population. A single observer reviewed 1077 (93.6%) of the diabetics and 480 (69%) of the controls. Peripheral vascular disease was detected using doppler ankle/brachial pressure index in 20.6% (95% CI 18.2-23.0) of diabetics and 9.6% (95% CI 7.0-11.2) of controls. There was no significant difference between the prevalence in non-insulin dependent and insulin dependent diabetics after adjusting for age. The prevalence in either type of diabetes was however significantly greater than in controls. Multiple logistic regression analysis revealed that age, cerebrovascular disease, coronary artery disease, mean systolic blood pressure, blood glucose, proteinuria and serum cholesterol were significantly and independently associated with the presence of peripheral vascular disease in diabetics. Body mass index was inversely associated. For controls only age and smoking were found to be significant variables. Neuropathy determined by clinical evaluation and sensory vibration thresholds was found in 16.8% (95% CI 14.6-19.0) of diabetics and 2.9% (95% CI 1.4-4.3) of controls (p