Publications (4)8.45 Total impact
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Article: Human immunodeficiency virus (HIV) infection in parenteral drug users: evolution of the epidemic over 10 years. Valencian Epidemiology and Prevention of HIV Disease Study Group.
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ABSTRACT: Evaluation of acquired immunodeficiency syndrome (AIDS) prevention strategies requires an on-going follow up of the frequency of human immunodeficiency virus (HIV-1) infection. The aim of this study was to examine the trends in prevalence and incidence of HIV-1 infection among injecting drug users (IDU) during the period 1987-1996. Transversal and cohort studies were designed which included a consecutive sample of 7132 IDU who attended three AIDS Prevention and Information Centres in the Region of Valencia (Spain) and voluntarily asked to be tested for HIV antibodies. The prevalence was estimated for each year based on the serological status of HIV-1 when the patient first visited the centre. The annual incidence rates were calculated based on the seronegative patients in which a new determination of HIV-1 was done. In order to control the possible effects on the estimations of age, sex and duration of addiction of the people studied, Poisson and logistic regression models were adjusted. Prevalence and incidence rates of HIV-1 infection showed parallel trends over time. The overall prevalence found was 43.6% (95% confidence intervals [CI]: 42.4-44.7%). Of the 4023 seronegative individuals, 1746 were followed up over the whole of the study period. The incidence rate observed was 6.85 x 100 persons/year (95% CI : 6.04-7.66). The prevalence figures show a decrease, which is most marked from 1990 onwards and then they tend to stabilize over the past few years. The incidence rates increase slightly up to 1991 (9.8 x 100 persons/year), and then begin to decrease. Trends of prevalence of HIV-1 infection approximate trends of subjacent incidence rate. Despite decrease in HIV-1 infection frequency observed over 10 years, both the prevalence and incidence figures continue to be high in absolute terms. It is necessary to intensify and adapt preventive measures to each subgroup at risk of infection and in the case of heterosexual transmission ensure that the failure observed in the case of IDU is not repeated.International Journal of Epidemiology 05/1999; 28(2):335-40. · 6.41 Impact Factor -
Article: [The users of centers for AIDS information and prevention in the Comunidad Valenciana, Spain: a study based on cluster analysis].
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ABSTRACT: To measure the usefulness of multiple correspondence analysis (MCA) and cluster analysis applied to the epidemiological research of HIV infection. The specific are to explore the relationships between the different variables that characterize the users of the AIDS Information and Prevention Center (CIPS) and to identify clusters of characteristics which in terms of the attendance to these centers, could be considered similar. The clinical history the CIPS in the Valencian region in Spain was used as data source. The target population target were intravenous drug users (IDUSs) attending these centers between 1987 and 1994 (n = 6211). Information about socio-demographic and HIV type I infection-related variables (drug use and sexual behaviour) was collected by means of a semistructured questionnaire. A MCA was carried out to obtain a group of quantitative factors that were used in a cluster analysis. A 44.8% HIV type I prevalence was found. Five factors were detected by MCA that explain 51.14% of the total variability, of which sex, age and the usual sexual partner were the variables best explained. Cluster analysis allowed to describe 5 different subgroups of CIPS users according to their socio-demographics characteristics, risk behaviours and serologic status. It is necessary to highlight the categories 1 and 2, which collect the serologic status and the most relevant characteristics of HIV infection. Category I contains users with a negative serology and characterized by being mainly single adolescent men, with a low educational level; they stated that they have no steady sexual partner, do not share syringes and have been intravenous drug users between 3 and 10 years. They mainly come from the city of Alicante. Category 2 contains mainly people that are HIV positive and older. They also share syringes and have been intravenous drug users for a longer time; they have a higher education level and most of them come from the city of Valencia. The proposed method of analysis was able to characterise the CIPS users, identifying those socio-demographic variables and risk behaviours that are more related to the serologic status. The applicability of these techniques to epidemiologic studies of HIV type I infection is discussed.Gaceta Sanitaria 13(2):102-8. · 1.33 Impact Factor -
Article: [The short-term effects of air pollution on mortality. The results of the EMECAM project in the city of Valencia, 1994-96. Estudio Multcéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad].
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ABSTRACT: To determine the short-term impact of air pollution on mortality in the city of Valencia throughout the 1994-1996 period by employing the analysis method of the Spanish multicenter study with regard to the relationship between air pollution and the mortality (EMECAM Project). The daily levels of black smoke, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3) were obtained from the Valencia air pollution monitoring network. The death rate indicators analyzed were the daily number of death due to all causes, except the external ones, the deaths of those over age 70, and the deaths resulting from respiratory and cardiovascular diseases. Following the methods of the EMECAM Project, autoregressive Poison regression models were built up, controlling the different confounding factors (seasonality, trend, calendar, weather variables and flu impact). For total mortality except the external ones, a significant impact of black smoke (RR 10 micrograms/m3: 1.013; CI95% 1.003 to 1.023) and for CO 24 la (RR 1 mg/m3: 1.024; CI95% 1.003 to 1.046) was found. For the mortality of those individuals over 70, the estimated impact was somewhat greater than for black smoke (RR 10 micrograms/m3: 1.017; CI95% 1.005-1.029), as well as for CO2 1 h (RR 10 micrograms/m3: 1.007; CI95% 1.001-1.013). No significant relationship was found with the mortality due to respiratory or cardiovascular diseases for the entire period. The current levels of pollution in the city of Valencia show a significant impact on daily mortality. These findings are consistent with the previous research and are coherent with those obtained on analyzing the relationship between air pollution and morbidity indicators.Revista Española de Salud Pública 73(2):267-74. · 0.71 Impact Factor -
Article: Usuarios de centros de información y prevención de SIDA en la Comunidad Valenciana: un estudio basado en el análisis de conglomerados
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ABSTRACT: Objetivos: Valorar la utilidad de las técnicas de análisis de correspondencias múltiple (ACM) y análisis de conglomerados aplicadas a la investigación epidemiológica de la infección por el virus de inmunodeficiencia humana (VIH-1). Como objetivos específicos se plantea explorar las relaciones entre las diferentes variables que caracterizan a los usuarios de los Centros de Información y Prevención del SIDA (CIPS) e identificar subgrupos con características que, desde el punto de vista de la asistencia a estos centros, se puedan considerar similares. Métodos: La fuente de datos utilizada fue la historia clínica de los tres Centros de Información y Prevención del SIDA (CIPS) de la Comunidad Valenciana. La población objeto de este estudio fue el colectivo de usuarios de drogas por vía parenteral (UDVP) que durante el período comprendido entre 1987 y 1994 acudieron a estos Centros (n = 6211). Mediante cuestionario semiestructurado, se recogió información sobre variables sociodemográficas y variables relacionadas específicamente con la infección por VIH-1 (hábitos de consumo de drogas y comportamiento sexual). Se realizó un análisis de correspondencias múltiple (ACM) para obtener una serie de factores cuantitativos, y sobre estos factores se realizó un análisis de conglomerados. Resultados: La prevalencia global de la infección por VIH-1 observada fue de 44,8%. En el ACM se retuvieron cinco factores que explican el 51,14% de la variabilidad total, siendo el sexo, la edad y la pareja sexual habitual las variables mejor explicadas. El análisis de conglomerados permitió describir cinco tipologías diferentes de usuarios de los centros, según sus características sociodemográficas, de conductas de riesgo y estado serológico del VIH-1. Cabría resaltar las clases 1 y 2, que recogen el estado serológico y las características más relevantes para la infección por VIH-1. La clase 1 agrupó a los usuarios con serología negativa y caracterizados por ser mayoritariamente hombres, adolescentes, con nivel educativo bajo y estado civil soltero; manifestaron no tener pareja sexual habitual, no compartir jeringuillas y llevar consumiendo drogas parenterales entre 3 y 10 años. En su mayor parte procedieron de la ciudad de Alicante. La clase 2 la formaron principalmente sujetos VIH-1 positivos y de mayor edad, así como con prácticas de compartir jeringuillas y una mayor duración en el tiempo de consumo de drogas inyectadas; presentaron un mayor nivel de estudios y procedían más a menudo de Valencia. Conclusiones: El método de análisis propuesto ha permitido caracterizar a los usuarios de los centros, identificando las variables sociodemográficas y de conducta de riesgo más relacionadas con el estado serológico. Se discute la aplicabilidad de estas técnicas al estudio epidemiológico de la infección por VIH-1.Gaceta sanitaria: Organo oficial de la Sociedad Española de Salud Pública y Administración Sanitaria, ISSN 0213-9111, Vol. 13, Nº. 2, 1999, pags. 102-108.
