The CORCOBIA study: Cut-off points of Alzheimer's disease CSF biomarkers in a clinical cohort.

INTRODUCTION: The analysis of the core biomarkers of Alzheimer's Disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the cut-off points of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya). METHODS: Prospective study including cognitively unimpaired individuals (CU, n = 42), subjects with amnestic mild cognitive impairment (aMCI, n = 35) and patients with dementia due to Alzheimer's Disease (AD, n = 48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyse amyloid beta peptides (Aß42, Aß40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse G600II (Fujirebio) was performed. The values of sensitivity (SE), specificity (SP), predictive values and area under the curve (AUC) were calculated, determining the cut-off point according to the Youden index by comparing the CU and AD groups. RESULTS: The resulting cut-offs and their AUC were the following: Aß42 750 pg/mL (AUC 0.809); Aß42/Aß40 0.062 (AUC 0.78); pTau181 69.85 pg/mL (AUC 0.81); tTau 522.0 pg/mL (AUC 0.79); Aß42/tTau 1.76 (AUC 0.86); Aß42/pTau181 10.25 (AUC 0.86). CONCLUSIONS: The determination of cut-off points of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aß42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.

Gestión de la demanda desde la consulta de acogida de Enfermería / Management of the demand for care from the host Nursing consultation

Objetivo: identificar el perfil del usuario que acude a la consulta de acogida de Enfermería, el motivo de la visita, la resolución de la misma y la satisfacción por parte del paciente. Como objetivo secundario se planteó analizar el cambio experimentando en las visitas espontáneas que lleva a cabo la enfermera de guardia, tras la implantación de la consulta de Enfermería de acogida. Material y método: estudio descriptivo transversal. La población objeto de estudio fueron los usuarios que acudían al centro de Raval Nord. Se eligió sistemáticamente una de cada tres visitas de lunes a viernes, a las que se aplicaba los criterios de inclusión y exclusión, durante los meses de abril a octubre de 2009. Variables de estudio: sexo, edad, país de procedencia, número de visitas previas del paciente, motivo de consulta (patología aguda, agudización patología crónica, otros), duración de la visita, intervención enfermera, satisfacción del usuario. También se cuantificó el número de visitas espontáneas que llevó a cabo la enfermera de guardia durante los meses de abril a octubre de 2008 y las realizadas por la enfermera de acogida con el nuevo rol durante el período de estudio. Resultados: 85 visitas analizadas, 47,1% hombres y 52,9% mujeres, media de edad 53,4 años. El 64,9% autóctonos y el 34,1% extranjeros. 47,6% no ha sido visitado por la enfermera en el último año. El motivo de visita: 60,7%patología aguda. Tiempo medio de la visita: 14 minutos. La resolución por parte de la enfermera es superior al 60%. Incremento relativo del 61% de visitas realizadas por la enfermera a partir de la nueva organización. Conclusiones: la resolución por parte de la enfermera es alta y la satisfacción del usuario también. Cambiar el acceso de la población a la consulta, para gestionar la demanda, optimiza la función de la enfermera (AU)

Objective: to identify the profile of the user who presents to the Host Nursing consultation office, the reason for the visit, the resolution of it and the satisfaction of the patient. A secondary objective was to analyze the change in the number of spontaneous visits undertaken by the nurse on duty, following the introduction of Host Nursing consultation. Material and methods: cross sectional descriptive study. The study population were users who presented to the health center of Raval Nord , one out of three visits from Monday to Friday was chosen systematically to which inclusion and exclusion criteria were applied during the months from April to October 2009. Study variables: sex, age, national origin, number of previous visits of the patient, reason for visit (acute disease, chronic disease exacerbations, others), duration of visit, nursing intervention, user satisfaction. We also measured the number of spontaneous visits conducted by the nurse on duty during the months of april to october 2008 and those made by the host nurse in her new role during the study period. Results: 85 visits analyzed, 47,1% men and 52,9% female, mean age 53,4years. 64,9% nationals and 34,1% foreigners. 47.6% has not been visited by the nurse in the last year. The reason for visit: 60,7% acute pathology. Average time of visit 14 minutes. Resolution by the nurse is over 60%. Relative increase of 61% of visits by the nurse as of the date of the new organisation. Conclusions: resolution of the visit by the nurse is high and so is customer satisfaction. Changing the population's access to consultation, to manage demand, optimizes the role of the nurse (AU)

[Needs perceived by elderly women living alone and receiving home care: a qualitative study]. / Necesidades percibidas por mujeres mayores que viven solas y reciben atención domiciliaria: investigación cualitativa.

OBJECTIVE: To explore self-perceived health in women aged more than 75 years old living alone who received home care, as well as their satisfaction with social services. METHOD: A qualitative study was performed. Through a descriptive analysis of discursive content, we identified the opinions of a group of women who had become almost invisible because of their isolation. The textual data obtained from the 8 interviewees were transcribed and analyzed using a content analysis approach. We then used the Atlas-ti program to generate the results. RESULTS: We observed that the initial home care received by the interviewees was diverse and complementary, and that in most cases these women had physical handicaps, felt alone, had low self-esteem, and were despaired of the future. These women were generally satisfied with the health services provided, although they had serious difficulties in expressing their needs. Finally, by way of conclusion, we believe that while legislative measures are being taken to provide solutions that go beyond simply containing the problem, nursing professionals should remain alert and establish channels to mobilize resources that could provide answers quickly and effectively.

Participation in a colorectal cancer screening programme: influence of the method of contacting the target population.

We assessed the effect of two different methods of contacting the target population on the rate of participation in a colorectal cancer screening programme. All individuals aged between 50 and 74 years enlisted in one primary health care centre in Barcelona (Spain) were included in a prospective randomized controlled trial. An invitation letter signed by a doctor together with two containers for faecal sample collection were sent by post to subjects in the 'standard' group (n = 1060), while subjects in the 'study' group (direct contact, n = 965) were visited by a trained non-health professional who supplied them with the same documentation as the standard group. The screening test consisted of an immunological method for the detection of faecal blood which does not require any prior specific dietary measures. Specimens were collected on two successive days. A significantly higher participation was observed in the study group (557/965, 57.7%) compared with the standard group (388/1060, 36.5%, P < 0.005). Specimen collection correctness was also higher in the study group (419/557, 75.1%) compared with the standard group (262/388, 67.5%, P < 0.014). There were no differences in terms of either age group or sex for the participation, nor for degree of correctness of specimen collection. Participation and specimen collection can be raised in colorectal cancer screening programmes by means of an invitation made through direct contact by a suitably trained non-health professional.

A randomized controlled trial comparing three invitation strategies in a breast cancer screening program.

BACKGROUND: The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group). METHODS: We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation. RESULTS: Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level. CONCLUSIONS: Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.

Estudio de las variables asociadas a la participación en un programa de cribaje de cáncer de mama. Relevancia de las variables psicosociales / Study of the variables associated to participation in a breast cancer screening program. Relevancy of the psychosociol variables

Introducción: El cáncer de mama es una de las causas de mortalidad más importante en las mujeres de los países desarrollados. Además su incidencia aumenta año tras año. Por tanto, es de vital importancia el estudio y mejora continua de los programas de cribaje. Material y método: Hemos realizado un estudio exploratorio de las características de una muestra de mujeres participantes en un programa de cribaje poblacional de cáncer de mama. Resultados: La participación en el programa fue del 89,2 por ciento (15021 mujeres, entre 50 y 64 años). Se encontró que sólo el 40 por ciento cumplían con prácticas preventivas básicas, que las mujeres más preocupadas por su salud eran las más conductas hacían. Se halló más patología benigna y maligna entre las que no cumplían con dichas conductas. Conclusiones: Nuestros datos sobre realización de prácticas preventivas coinciden con otros estudios. La alta participación en población asintomática sugiere que las variables psicosociales pueden tener un peso notable a la hora de decidir participar (AU)

Utilization of screening mammography as a preventive practice prior to initiating a population-based breast cancer screening program.

Factors associated with the level of utilization of screening mammography as a preventive practice were analyzed prior to initiating a population-based breast cancer screening program. A questionnaire was used to collect information about screening mammography utilization during the last 4 years among women invited to enroll in the program. Sociodemographic and health factors, and health services utilization were studied. A screening mammography in the last 4 years had been performed on 59.3% of the 8867 women interviewed. The utilization of mammography was higher among women who were younger, had a higher education level, or had previous visits to a physician (P < 0.001). The variables more strongly associated with use of screening mammography were: visit to a gynecologist and performance of a pap smear. Also associated with the utilization of screening mammography were: personal history of breast pathology, family history of breast cancer, breast self-examination, and recent visit to a general practitioner. Self-perceived health presented an inverse relation with screening mammography use (P < 0.001). The use of screening mammography appears to have increased in recent years, although inequalities persist which the breast cancer screening programs help to modulate. Mammographic frequency only would be deemed appropriate by the European guidelines in fewer than one-half of the cases.

[Attitudes and knowledge of primary care physicians about community breast cancer screening programs]. / Actitudes y conocimientos de los médicos de atención primaria sobre los programas poblacionales de cribado de cáncer de mama.

OBJECTIVE: To find the view of Primary Care doctors in relation to the need for a community programme of breast cancer screening, its effectiveness and the criteria underlying its application. DESIGN: Crossover study. SETTING: Municipal districts of Ciutat Vella and Sant Martí, Barcelona. PARTICIPANTS: General Practitioners (GPs) in the programme. INTERVENTION: A self-filled questionnaire. The questions sought the level of agreement with 11 statements concerning: importance as health problem, effectiveness of the programmes, target population and role of GP. Results were compared for: year of graduation, sex and type of centre. MEASUREMENTS AND MAIN RESULTS: Of 140 doctors, 110 (78.6%) replied. There was majority agreement with all the statements, especially so in: "Breast cancer is one of the three main causes of death in women in Barcelona"; "screening of 50-64-year old women should be recommended"; and "GPs must recommend screening to their patients". CONCLUSION: The replies to the questionnaire indicated agreement with the programme's basic orientation, except for including 40 to 49-year old women in the programme, which the programme did not propose. Hopefully, this consensus will help Primary Care professionals become involved in the screening programme.

Observaciones de micosis pulmonares oportunistas / Opportunistic pulmonary mycosis

Para conocer la frecuencia y tipo de micosis oportunistas en 240 pacientes internados en un hospital de neumología, se practicaron historia clínica y estudios micológicos consistentes en el aislamiento de hongos a partir de muestras de esputo. En cada paciente se tomaron tres muestras seriadas, las cuales fueron procesadas por examen directo, frotis y cultivo de Sabouraud. Con la metodología empleada, los resultados mostraron que de los 240 pacientes en 191 se aislaron una o más especies de hongos oportunistas (79,5%). Sin embargo, de acuerdo a la valoración clínica y a los parámetros de laboratorio, se pudo hacer el diagnóstico de candidosis pulmonar en 57 pacientes (23,7% del total), siendo la micosis oportunista la de mayor frecuencia. Otras micosis observadas fueron: aspergilosis (once), geotricosis (ocho), y nocardiosis (cinco). Asimismo se comenta la utilidad y el valor diagnóstico que tienen los estudios micológicos en el análisis clínico de pacientes con micosis oportunista