Determining factors of pulse oximetry accuracy: a literature review.

OBJECTIVE: Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry. METHODS: We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results. RESULTS: 23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO2, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal. CONCLUSIONS: The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO2, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.

Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis. / Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis.

INTRODUCTION: Spinal disc biopsy is a necessary tool in diagnosing and treating spondylodiscitis. Its profitability varies according to the technique, concomitant antibiotics therapy or causative germ. We studied the results of this procedure in our institution. MATERIALS AND METHODS: Retrospective analysis of all cases requiring disc biopsy due to possible spondylodiscitis over a 5year period, both percutaneous (26 cases) and open (13 cases). We collected filiation and clinical data, comorbidity, concomitant antibiotic therapy, imaging tests, biopsy type, cultures results and clinical evolution. RESULTS: 39 patients; 66.7% male, 66.9years of average age. 74% has known risk factors. The main symptom was pain (89.7%). Fever occurred in 5%. MRI performed in 87%. Lumbar involvement in 76.9%. 9 patients (23%) received antibiotic treatment simultaneously with biopsy. In these cases biopsy always yielded a negative result, but positive in patients without antibiotics at the time of the biopsy (53.3%), with statistical significance. Most frequent isolated microorganisms were gram-negative bacilli (31.2%) and gram-positive cocci (31.2%). We found 2 deaths during admission for sepsis (within the first month after diagnosis). Of the rest of patients, 5 died late during the follow-up: 3 due to new infections and 2 due to subsequent complications of previous pathologies. The remaining patients with final diagnosis of spondylodiscitis evolved satisfactorily with antibiotic therapy. CONCLUSIONS: Spondylodiscitis is potentially serious and requires an adequate diagnosis, with disc biopsy being a necessary procedure on occasions. Patients poor clinical condition can make it impossible to withdraw antibiotics, which drastically reduces the performance of the biopsy.

Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis / Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis

Introduction: Spinal disc biopsy is a necessary tool in diagnosing and treating spondylodiscitis. Its profitability varies according to the technique, concomitant antibiotics therapy or causative germ. We studied the results of this procedure in our institution.Materials and methods: Retrospective analysis of all cases requiring disc biopsy due to possible spondylodiscitis over a 5year period, both percutaneous (26 cases) and open (13 cases). We collected filiation and clinical data, comorbidity, concomitant antibiotic therapy, imaging tests, biopsy type, cultures results and clinical evolution. Results: 39 patients; 66.7% male, 66.9years of average age. 74% has known risk factors. The main symptom was pain (89.7%). Fever occurred in 5%. MRI performed in 87%. Lumbar involvement in 76.9%. 9 patients (23%) received antibiotic treatment simultaneously with biopsy. In these cases biopsy always yielded a negative result, but positive in patients without antibiotics at the time of the biopsy (53.3%), with statistical significance. Most frequent isolated microorganisms were gram-negative bacilli (31.2%) and gram-positive cocci (31.2%). We found 2 deaths during admission for sepsis (within the first month after diagnosis). Of the rest of patients, 5 died late during the follow-up: 3 due to new infections and 2 due to subsequent complications of previous pathologies. The remaining patients with final diagnosis of spondylodiscitis evolved satisfactorily with antibiotic therapy. Conclusions: Spondylodiscitis is potentially serious and requires an adequate diagnosis, with disc biopsy being a necessary procedure on occasions. Patients poor clinical condition can make it impossible to withdraw antibiotics, which drastically reduces the performance of the biopsy.(AU)

Introducción: La biopsia discal es una herramienta necesaria en el proceso diagnóstico y terapéutico de las espondilodiscitis. Su rentabilidad es variable según condicionantes como la técnica utilizada, el uso concomitante de antibióticos o el germen causante. Estudiamos los resultados de este procedimiento en nuestro centro en un periodo de 5años. Material y métodos: Análisis retrospectivo de todos los casos que requirieron biopsia discal por posible espondilodiscitis en nuestro centro entre enero de 2015 y noviembre de 2019, tanto percutánea (26 casos) como abierta (13 casos). Recogemos datos de filiación y clínicos, comorbilidad, antibioterapia concomitante, pruebas de imagen, tipo de biopsia, resultado de cultivos y evolución clínica. Resultados: Treinta y nueve pacientes: 66,7% varones, 66,9años de edad media. El 74% con factores de riesgo conocidos. El síntoma principal es dolor mayoritariamente (89,7%) y fiebre en el 5%. La RMN en la prueba más frecuentemente realizada (87%). Los segmentos lumbares se afectaron en el 76,9%, por el 23% los dorsales. En 9 casos (23%) los pacientes reciben tratamiento antibiótico simultáneamente a la realización de la biopsia. En estos casos la biopsia siempre arrojó un resultado negativo. Los cultivos fueron positivos más frecuentemente en los pacientes sin antibióticos en el momento de la biopsia (53,3%), con significación estadística. Los microorganismos aislados de manera más repetida fueron los bacilos gramnegativos (31,2%) y los cocos grampositivos (31,2%). Constatamos 2 fallecimientos durante el ingreso por sepsis (dentro del primer mes tras el diagnóstico). Del resto de los pacientes fallecieron 5 de manera tardía durante el seguimiento: 3 por nuevas infecciones complicadas de manera tardía y 2 por complicaciones ulteriores de patologías previas. El resto de pacientes con diagnóstico final de espondilodiscitis evolucionaron satisfactoriamente con antibioterapia.(AU)

Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis / Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis

Introducción: La biopsia discal es una herramienta necesaria en el proceso diagnóstico y terapéutico de las espondilodiscitis. Su rentabilidad es variable según condicionantes como la técnica utilizada, el uso concomitante de antibióticos o el germen causante. Estudiamos los resultados de este procedimiento en nuestro centro en un periodo de 5años. Material y métodos: Análisis retrospectivo de todos los casos que requirieron biopsia discal por posible espondilodiscitis en nuestro centro entre enero de 2015 y noviembre de 2019, tanto percutánea (26 casos) como abierta (13 casos). Recogemos datos de filiación y clínicos, comorbilidad, antibioterapia concomitante, pruebas de imagen, tipo de biopsia, resultado de cultivos y evolución clínica. Resultados: Treinta y nueve pacientes: 66,7% varones, 66,9años de edad media. El 74% con factores de riesgo conocidos. El síntoma principal es dolor mayoritariamente (89,7%) y fiebre en el 5%. La RMN en la prueba más frecuentemente realizada (87%). Los segmentos lumbares se afectaron en el 76,9%, por el 23% los dorsales. En 9 casos (23%) los pacientes reciben tratamiento antibiótico simultáneamente a la realización de la biopsia. En estos casos la biopsia siempre arrojó un resultado negativo. Los cultivos fueron positivos más frecuentemente en los pacientes sin antibióticos en el momento de la biopsia (53,3%), con significación estadística. Los microorganismos aislados de manera más repetida fueron los bacilos gramnegativos (31,2%) y los cocos grampositivos (31,2%). Constatamos 2 fallecimientos durante el ingreso por sepsis (dentro del primer mes tras el diagnóstico). Del resto de los pacientes fallecieron 5 de manera tardía durante el seguimiento: 3 por nuevas infecciones complicadas de manera tardía y 2 por complicaciones ulteriores de patologías previas. El resto de pacientes con diagnóstico final de espondilodiscitis evolucionaron satisfactoriamente con antibioterapia.(AU)

Introduction: Spinal disc biopsy is a necessary tool in diagnosing and treating spondylodiscitis. Its profitability varies according to the technique, concomitant antibiotics therapy or causative germ. We studied the results of this procedure in our institution.Materials and methods: Retrospective analysis of all cases requiring disc biopsy due to possible spondylodiscitis over a 5year period, both percutaneous (26 cases) and open (13 cases). We collected filiation and clinical data, comorbidity, concomitant antibiotic therapy, imaging tests, biopsy type, cultures results and clinical evolution. Results: 39 patients; 66.7% male, 66.9years of average age. 74% has known risk factors. The main symptom was pain (89.7%). Fever occurred in 5%. MRI performed in 87%. Lumbar involvement in 76.9%. 9 patients (23%) received antibiotic treatment simultaneously with biopsy. In these cases biopsy always yielded a negative result, but positive in patients without antibiotics at the time of the biopsy (53.3%), with statistical significance. Most frequent isolated microorganisms were gram-negative bacilli (31.2%) and gram-positive cocci (31.2%). We found 2 deaths during admission for sepsis (within the first month after diagnosis). Of the rest of patients, 5 died late during the follow-up: 3 due to new infections and 2 due to subsequent complications of previous pathologies. The remaining patients with final diagnosis of spondylodiscitis evolved satisfactorily with antibiotic therapy. Conclusions: Spondylodiscitis is potentially serious and requires an adequate diagnosis, with disc biopsy being a necessary procedure on occasions. Patients poor clinical condition can make it impossible to withdraw antibiotics, which drastically reduces the performance of the biopsy.(AU)

Periodicity characterization of the nonlinear magnetization dynamics.

In this work, we study numerically the periodicity of regular regions embedded in chaotic states for the case of an anisotropic magnetic particle. The particle is in the monodomain regime and subject to an applied magnetic field that depends on time. The dissipative Landau-Lifshitz-Gilbert equation models the particle. To perform the characterization, we compute several two-dimensional phase diagrams in the parameter space for the Lyapunov exponents and the isospikes. We observe multiple transitions among periodic states, revealing complex topological structures in the parameter space typical of dynamic systems. To show the finer details of the regular structures, iterative zooms are performed. In particular, we find islands of synchronization for the magnetization and the driven field and several shrimp structures with different periods.

Exercise improves metformin 72-h glucose control by reducing the frequency of hyperglycemic peaks.

PURPOSE: To determine the separated and combined effects of metformin and exercise on insulin sensitivity and free-living glycemic control in overweight individuals with prediabetes/type 2 diabetes (T2DM). METHODS: We recruited 16 adults with BMI of 32.7 ± 4.3 kg m-2 and insulin resistance (HOMA-IR 3.2 ± 0.4) under chronic metformin treatment (1234 ± 465 g day-1) enrolled in a high-intensity interval training (HIIT) program. Participants underwent four 72-h experimental trials in a random-counterbalanced order: (1) maintaining their habitual metformin treatment (MET); (2) replacing metformin treatment by placebo (CON); (3) placebo plus two HIIT sessions (EX + CON), and (4) metformin plus two HIIT sessions (MET + EX). We used intermittently scanned continuous glucose monitoring (isCGM) during 72 h in every trial to obtain interstitial fluid glucose area under the curve (IFGAUC) and the percentage of measurements over 180 mg dL-1 (% IFGPEAKS). Insulin sensitivity was assessed on the last day of each trial with HOMA-IR index and calculated insulin sensitivity (CSI) from intravenous glucose tolerance test. RESULTS: IFGAUC was lower in MET + EX and MET than in CON (P = 0.011 and P = 0.025, respectively). In addition, IFGAUC was lower in MET + EX than in EX + CON (P = 0.044). %IFGPEAKS were only lower in MET + EX in relation to CON (P = 0.028). HOMA-IR and CSI were higher in CON in comparison with MET + EX (P = 0.011 and P = 0.022, respectively) and MET (P = 0.006 and P < 0.001, respectively). IFGAUC showed a significant correlation with HOMA-IR. CONCLUSION: Intense aerobic exercise in patients with diabetes and prediabetes under metformin treatment reduces free-living 72-h blood hyperglycemic peaks. This may help to prevent the development of cardiovascular complications associated with diabetes.

Insulin sensitivity improvement with exercise training is mediated by body weight loss in subjects with metabolic syndrome.

AIM: To determine whether exercise training improves insulin actions through concomitant body weight loss (BWL). METHODS: Subjects (aged 55±8 years) with metabolic syndrome (MetS), prediabetes (fasting blood glucose: 111±2mg·dL-1, HbA1c: 5.85±0.05%) and abdominal obesity (waist circumference: 104±7.9cm) were randomly allocated to either a group performing aerobic interval training (EXER; n=76) or a sedentary group receiving lifestyle counselling (CONT; n=20) for 16 weeks. RESULTS: At baseline, insulin sensitivity (according to HOMA2 and intravenous glucose tolerance test; CSI), body composition and VO2max were similar between the groups. After the intervention, both groups had similar BWL (1-2%), but only the EXER group showed decreased [mean (95% CI)] trunk fat mass [from 18.2 (17.4-18.9) to 17.3kg (16.6-17.9); P<0.001] and HOMA2 scores [from 1.6 (1.5-1.7) to 1.4 (1.3-1.5); P=0.001], and increased VO2max [from 2.07 (1.92-2.21) to 2.28 (2.11-2.45) LO2·min-1; P<0.001]. However, CSI did not improve in any group. Within-group subdivision by BWL (≤0%, 0-3%, ≥3%) revealed higher CSI in those with BWL≥3% in both groups. Trunk fat mass reductions were closely associated with CSI and HOMA-IR improvement (r=-0.452-0.349; P<0.001). CONCLUSION: In obese MetS subjects with prediabetes, 3% BWL is required for consistent improvement in insulin sensitivity. Thus, exercise-training programmes should be combined with calorie restriction to achieve BWL levels that prevent the development of diabetes.

La importancia de los estudios descriptivos. Eczema y urticaria en Portugal / Eczema and Urticaria in Portugal: On the Importance of Descriptive Studies

No disponible

Numerically efficient real space theory of scattering from colloidal crystals.

The production of high-quality colloidal crystals demands precise quantitative characterization of their nanostructures. While small-angle radiation scattering is the technique of choice, a procedure for a comprehensive quantitative modeling of the data is still pending. A novel theory based on the pertinent radial pair distribution which takes into account orientational, positional, stacking disorder and grain effects is developed here. We also show how the scattering length density of the particles can be estimated from the positions of minima in the form factor. The obtained results can be cast as sums of analytical functions over the distribution function and, as such, are suitable for easy (automatic) parallelization. On the experimental side, we report on a strong extinction effect coming from grazing incidence specular reflection that we have been able to model analytically.

Mortalidad asociada a la depresión en pacientes hospitalizados en medicina interna y seguidos en atención primaria: factores etiopatogénicos y “autopsia biopsicosocial” / No disponible

No disponible

La informatización de la atención primaria.Un nuevo sistema de información de la actividad asistencial para el apoyo a la gestión de la demanda

La universalidad, entendida como el derecho a la salud de todos los hombres y La universalidad, una de las principales características de la atención primaria de salud, lleva asociada una de sus mayores cargas: la presión asistencial. Por ello la gestión de la demanda se convierte en un objetivo prioritario para la optimización del sistema. La irrupción de la informática en la atención primaria hace posible un conocimiento mucho más exhaustivo de lo que permiten los sistemas de información tradicionales. Gracias a la informatización de las agendas, es posible cuantificar las visitas generadas por cada usuario, así como detectar a los no utilizadores. Se pretende explorar las posibilidades de análisis que proporcionan las bases de datos poblacionales generadas por los programas informáticos utilizados, descendiendo desde el nivel de área de salud hasta el de usuario; se concluyese que permiten realizar una gestión ágil desde un nivel gerencial hasta un nivel de unidad clínica (AU)

[Outbreak of trichinellosis in the region of la Vera (Carceres, Spain) caused by Trichinella britovi]. / Brote de triquinosis en la comarca de la Vera (Cáceres) causado por Trichinella britovi.

OBJECTIVE: To describe the clinical and epidemiological aspects of a trichinellosis outbreak in the region of La Vera that took place during January and February 2002, related to the consumption of pork meat infected with Trichinella britovi. MATERIAL AND METHODS: When the first suspected case was discovered, the presumed infected meat was checked and all the people who might have eaten it were examined. An epidemiological interview and a clinic evaluation were carried out in each patient. RESULTS: We found 52 exposed people that had eaten the presumptive infected meat, 35 males and 17 females, with an age ranging from 2 to 86 years old. A confirmed positive diagnosis was established in 16 patients. The most frequent symptoms were: diarrhea (present in all the cases), fever, myalgia and facial edema. Eosinophilia was an early and characteristic analytic sign. All diagnosed cases were found to have positive serology, although this was not a required criterion to start medical treatment. Treatment was started once the clinical suspicion of trichinellosis was determined, based on compatible clinical signs and eosinophilia. There were no complications and none of the patients required hospitalization. The meat sample was claimed by the Health Authorities and destroyed, thus avoiding further extension of the outbreak. CONCLUSIONS: Sporadic outbreaks of trichinellosis have been described in Spain. In the present paper an outbreak caused by Trichinella britovi has been studied. Early diagnosis suspicion and its communication to the Health Authorities allowed the control of the outbreak and the identification of the contaminated meat. Treatment must be started after clinical suspicion and eosinophilia.

Brote de triquinosis en la comarca de la Vera (Cáceres) causado por Trichinella britovi / An outbreak of trichinellosis in the region of la Vera (Cáceres, Apain) caused by Trichinella britovi

Objetivo: Descripción de los aspectos epidemiológicos y clínicos de un brote de Triquinosis (TQ) en la comarca de La Vera (provincia de Cáceres) durante los meses de enero y febrero del 2002, en relación con el consumo de carne de cerdo infectada por Trichinella britovi. Material y métodos: Al efectuarse el primer diagnostico de sospecha de TQ se localizó la pieza cárnica infectada y todas las personas expuestas a su consumo. Se realizó encuesta epidemiológica y valoración clínica (en urgencias o consulta programada) con los siguientes exámenes complementarios: hemograma completo, urea, creatinina, iones, CPK, LDH, mioglobina y serología de Trichinella. Resultados: Se localizaron 52 personas expuestas de las cuales 35 eran varones y 17 mujeres, con edades comprendidas entre los 2 y 86 años. El diagnóstico definitivo de TQ se estableció en 16 expuestos. Los síntomas mas frecuentes fueron: diarrea (en todos los casos), fiebre, mialgias y edema facial. La eosinofilia fue el dato analítico precoz y característico. Todos los casos diagnosticados positivizaron la serología aunque este dato no fue determinante para el inicio del tratamiento, que se comenzó ante la sospecha basada en clínica compatible y eosinofilia.No hubo complicaciones y ningún paciente requirió ingreso hospitalario.La pieza cárnica fue bloqueada lográndose interrumpir la propagación del brote. Conclusiones: Se siguen describiendo esporádicamente brotes de TQ en España, en este caso producido por Trichinella britovi. La sospecha diagnóstica precoz y su comunicación a las autoridades sanitarias logra bloquear la carne infectada e interrumpe la propagación del brote. El tratamiento se debe indicar ante cuadro clínico compatible y la presencia de eosinofilia (AU)

[Evaluation of the proper use of medicines in primary care. How can this be improved?]. / Evaluación del uso apropiado de medicamentos en atención primaria. Cómo se puede mejorar?

INTRODUCTION: The process of medicating a patient embraces the identification of the health problem, the doctor's prescription to treat this indication, the dispensing of the medicine and its consumption. The studies of use of medicine analyse this process in order to detect those factors that impinge on the correct use of medicines. OBJECTIVE: To evaluate the quality of the prescription of certain primary care medicines as a function of the indication for which they were prescribed, detecting those features of the patients, prescribing doctors, primary care centre and health district that affect their inappropriate use. METHOD: Prescription-indication study based on the calculation of multiple-level models with individualised data bases for the prescriptions. These include characteristics of the prescriptions, patients, doctors, health centres and the health district involved. These models are a step forward in this kind of study, in that they enable analysis of the information from different levels at the same time as calculation of the respective degrees of responsibility for inadequacies of prescription. DISCUSSION: Apart from its methodological originality, which may serve for subsequent studies, the main interest of this study lies in the pioneering nature of its massive use of population micro-data to evaluate prescription quality. These data are taken from the computerised clinical records in primary care.

Evaluación del uso apropiado de medicamentos en atención primaria. ¿Cómo se puede mejorar? / Evaluation of the proper use of medicines in primary care how can this be improved?

Introducción. El proceso de medicación de un paciente abarca la identificación de su problema de salud, la prescripción para esa indicación por parte del médico, la dispensación farmacéutica y el consumo del fármaco. Los estudios de utilización de medicamentos analizan dicho proceso con el objeto de detectar los factores que alteran el uso correcto de los fármacos. Objetivo. Evaluar la calidad de la prescripción de ciertos medicamentos en atención primaria en función de la indicación para la que fueron prescritos, detectando aquellas características de los pacientes, médicos prescriptores, centros de atención primaria y áreas de salud que influyen en su uso inapropiado. Método. Estudio prescripción-indicación basado en la estimación de modelos multinivel con bases de datos individualizadas de las prescripciones, que contienen características de las prescripciones, pacientes, médicos, centros de salud y áreas de salud de pertenencia. Estos modelos suponen un avance en este tipo de estudios ya que permiten analizar de forma conjunta la información de distintos niveles y estimar sus respectivas 'cuotas de responsabilidad' en la inadecuación de la prescripción. Discusión. Además de su interés metodológico, que puede guiar estudios posteriores, el principal interés del trabajo estriba en su carácter pionero en la utilización masiva de microdatos poblacionales para evaluar la calidad de la prescripción, que proceden de las historias clínicas informatizadas de atención primaria. (AU)

[The integrated management software of primary care,a tool for analysing indicators of use]. / El software de gestión integral de la atención primaria, una herramienta de análisis de los indicadores de utilización.

OBJECTIVES: To analyse the indicators of use in the Gran Canaria Health Area. To characterise over-users so that the primary care team can take corrective measures. To design a computer tool giving appropriate useful information to the management, that can be directly put into practice in primary care. DESIGN: Retrospective descriptive study. SATTING: Gran Canaria Health Area. Hierarchical descent in the analysis of data in the base health area and family care unit, in the year 2000. PARTICIPANTS: Users of the Canaries Health Service registered on the individual health card data base. MAIN MEASUREMENTS AND RESULTS: The activity generated by 636 270 users with 2 876 394 appointments was studied. Mean frequency of attendance in the Gran Canaria Health Area was 4.52, with a 67.3% use rate. The user causing 11 or more visits per year was defined as an over-user. 13.4% of users were over-users and caused among them 52.3% of visits. 32.7% of users registered made no visit. CONCLUSIONS: A small section of the population causes over half the consultations. The characteristics of these users need to be analysed so that programmes can be worked out to decrease their frequency of use. The integrated management software for primary care enables this information to be analysed and serves as a support for the primary care teams. Special attention needs to be paid to the population that does not use the health centres.

El software de gestión integral de la atención primaria, una herramienta de análisis de los indicadores de utilización / The comprehensive management software primary care, an analysis tool utilization indicators

Objetivo. Analizar los indicadores de utilización del Área de Salud de Gran Canaria. Caracterizar al grupo hiperfrecuentador con el fin de emprender medidas correctoras desde el equipo de atención primaria. Diseñar una herramienta informática que aporte información adecuada y útil a la gestión y que sea de aplicación directa en los equipos de atención primaria. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Área de Salud de Gran Canaria. Descenso jerárquico en el análisis de los datos a zona básica de salud y unidad de atención familiar. Año 2000.Participantes. Usuarios del Servicio Canario de la Salud registrados en la base de datos de la tarjeta sanitaria individual. Mediciones y resultados principales. Se estudió la actividad creada por 636.270 usuarios que generaron 2.876.394 citas. La frecuentación media del Área de Salud de Gran Canaria fue de 4,52, con una tasa de utilización del 67,3 por ciento. Se definió como hiperfrecuentador al usuario que genera 11 o más citas en un año. El 13,4 por ciento de los usuarios fue hiperfrecuentador, y generó el 52,3 por ciento de las visitas. Un 32,7 por ciento de los usuarios no generó ninguna visita. Conclusiones. Una pequeña parte de la población genera más de la mitad de la consulta. Se hace preciso analizar las características de estos usuarios con el fin de elaborar programas destinados a disminuir su frecuentación. El software de gestión integral de la atención primaria permite analizar esta información, y sirve como apoyo a los equipos de atención primaria. Es necesario prestar atención especial a la población no frecuentadora. (AU)

Outbreak of trichinellosis in Cáceres, Spain, December 2001-February 2002.

An outbreak of trichinellosis by T. britovi occured in Cáceres, Spain, between 18 December 2001 and 11 February 2002, following the consumption of insufficiently cooked meat from a domestic pig. Among the 56 people exposed, 26 cases of trichinellosis were diagnosed, of which 17 serologically confirmed. The mean incubation period was 23.5 days (3-45). Among the foodstuffs suspected, salami-type sausages were associated with an attack rate of 93.3% (14/15), and a dose-response relationship was observed. Trichinella britovi is essentially a sylvatic species, but this study suggests a change in the epidemiology of trichinellosis.

Deposition of conformal copper and nickel films from supercritical carbon dioxide.

Device-quality copper and nickel films were deposited onto planar and etched silicon substrates by the reduction of soluble organometallic compounds with hydrogen in a supercritical carbon dioxide solution. Exceptional step coverage on complex surfaces and complete filling of high-aspect-ratio features of less than 100 nanometers width were achieved. Nickel was deposited at 60 degrees C by the reduction of bis(cyclopentadienyl)nickel and copper was deposited from either copper(I) or copper(II) compounds onto the native oxide of silicon or metal nitrides with seed layers at temperatures up to 200 degrees C and directly on each surface at temperatures above 250 degrees C. The latter approach provides a single-step means for achieving high-aspect-ratio feature fill necessary for copper interconnect structures in future generations of integrated circuits.