The people's campaign against health care counter-reforms in Spain

Since 1996, when the conservative Partido Popular was elected in Spain, it has attempted to weaken and dismantle the national health service. It has focused on three areas: privatization of health facilities and services, increasing patient copayments and decreasing publicly financed benefits, and increasing the role of private insurance in health coverage and care. A major role in this neoliberal strategy has been the creation in one of the regions of "Fundaciones," independent substitutes for NHS facilities and services, which are essentially copies of the "Trusts" developed by the Conservative government in the U.K. The paper describes the development of a broad people's movement which campaigned successfully to combat the "Fundaciones"; these were returned to the regional public sector, and the conservative government in Madrid announced they would abandon their previous principal policy of transforming public hospitals into "Fundaciones."

Smoking and apolipoproteins in adolescents. The Niño Jesus Group

The relation between smoking and blood lipids and apolipoproteins (A1,B100) were studied in a group of 1024 12- to 18-year-old school children in the Comunidad de Madrid. The percentage of smokers was 19% (17% for girls and 21% for boys). The average consumption of cigarettes per day was 7.83 +/- 5.06 in boys and 6.04 +/- 3.49 in girls (p less than 0.05). As compared with male nonsmokers, male smokers showed a higher mean level of low-density lipoprotein (LDL) cholesterol (112 versus 100 mg/dL, p less than 0.05), a higher LDL cholesterol to HDL-cholesterol ratio (2.27 versus 1.94, p less than 0.001), a higher mean level of apolipoprotein B100 (59 versus 53 mg/dL, p less than 0.05), and a higher apolipoprotein B100 to apolipoprotein A1 ratio (0.45 versus 0.40, p less than 0.01). Female smokers tended to show the same results, although significant differences were only found for LDL cholesterol to HDL cholesterol ratio and apolipoprotein B100 to apolipoprotein A1 ratio (1.8 versus 1.59 and 0.41 versus 0.38 respectively, both p less than 0.05). This work provides new data about the effects of smoking on apolipoproteins in adolescents and emphasizes on the need for preventive programs.

Is a parental history of coronary arterial disease in children as discriminating as their lipoprotein profile? Niño Jesus Group

The relationship between hyperlipidemia and a parental history of heart attack and other related disorders was studied in 2224 two- to 18-yr-old children in Madrid (Spain). Children were divided into three groups: those with a parental history of heart attack (first group), a parental history of stroke, hypertension, diabetes mellitus or hypercholesterolemia (second group), and no parental history of disease (third group). The number of children with higher than normal levels of total cholesterol (greater than 200 mg/dl), LDL-cholesterol (greater than 135 mg/dl) and/or apolipoprotein B100 (greater than 75 mg/dl) was significantly higher in the first and second group (positive parental history) than in the third (no parental history). Children and adolescents with a parental history of heart attack (first group) had significantly higher mean levels of total cholesterol and LDL-cholesterol; in the 2- to 13-yr age group a significantly higher level of apolipoprotein B was also found. Children and adolescents belonging to the second group had a significantly higher level of LDL-cholesterol, and a significantly higher level of apolipoprotein B was also found in the 2- to 13-yr age group. However, only 15% of children with hypercholesterolemia had a parental history of heart attack or other related disorders. This percentage was 41% when second-degree relatives were included in the family history. We conclude that a parental history is not enough to detect children with an abnormal lipid profile who might be at risk for early development of coronary arterial disease.

[Pediatric primary care seen through a hospital emergency service]

We have studied the procedures for taking care of the 1,044 patients who arrived in the Emergency Room at the Niño Jesus Hospital on weekday mornings, in order to evaluate the operation of primary pediatric care as the possible generator of the demand for emergency hospital care. We also took into account the motivations which the parents of the children gave for not having gone to their doctors. The diagnosis and/or prior treatment were considered adequate in 83.81% of cases, and in 64.63% of cases in which these were known for a fact. 35.7% of the children were periodically checked out by their doctors even though they were not ill. Among the motives given by the parents for going directly to the Emergency Room, only 5.69% and 8.41% respectively said that it was due to an emergency situation or a worsening of the patient's state. 35.89% pointed out that their pediatricians had afternoon hours, and 20.91% that they went to the Emergency Room systematically regardless of the problem. Only 10.27% said that they were unhappy with their doctor. From our data it would seem that the demand for emergency pediatric hospital care is due more to a lack of health education of the population than to deficiencies in primary care.

Renal handling of uric acid in normal children by means of the pyrazinamide and sulfinpyrazone tests

Thirteen normal children have been studied with the Sulfinpyrazone and Pyrazinamide tests, in order to evaluate the mechanisms of urate tubular management. A decrease in presecretory reabsorption, and an increase in tubular secretion have been identified, with regard to what has already been reported in adults. These facts could explain the higher fractional excretion of uric acid found in childhood.