ABSTRACT
OBJETIVO: Evaluar la prevalencia de asma no controlada (puntuación < 20 en el Asthma Control Test [ACT]) en la práctica clínica habitual en España. DISEÑO: Estudio observacional, transversal. Emplazamiento: Cincuenta y ocho centros de atención primaria de 13 comunidades autónomas. PARTICIPANTES: Pacientes asmáticos atendidos por consulta administrativa sin empeoramiento subjetivo (grupo A) o por empeoramiento de sus síntomas (grupo B). Mediciones principales: Características sociodemográficas (edad, sexo, educación y tabaquismo), nivel de gravedad del asma según el médico, terapia actual para el asma, enfermedades concomitantes, utilización de recursos sanitarios (consultas, hospitalizaciones y urgencias), absentismo laboral y escolar, puntuación ACT y adherencia al tratamiento. RESULTADOS: Se incluyeron 376 pacientes del grupo A y 262 del grupo B. El 59% eran mujeres, edad media de 45 años, 21% fumadores y tiempo medio de evolución del asma 8,9 años. El 87% usaban agonistas beta-2 de corta duración, el 62% beta-2 de larga duración asociados con corticoides inhalados y el 13,8% corticoides inhalados regularmente. Se observó mal control del asma en el 75,6% del grupo B y en el 23,4% del grupo A; solo el 5,3% del grupo A presentaba control total (ACT = 25). Un peor control del asma se asociaba significativamente con mayor duración de la enfermedad y mayor uso de recursos. CONCLUSIONES: La prevalencia de asma no controlada en pacientes que acuden a la consulta de atención primaria por empeoramiento de sus síntomas continúa siendo muy elevada. El mal control del asma se asocia con un elevado uso de recursos e impacta significativamente en la carga de la enfermedad
OBJECTIVE: To evaluate the acceptability and feasibility of the opportunistic search of HIV according to primary care doctors' experience. To set up the profile of the physician involved in this study. DESIGN: Observational, transversal study. LOCATION: Primary Care Centers of the National Health System. PARTICIPANTS: General practitioners and residents who participated in VIH-AP study to measure the acceptability of HIV opportunistic search by patients. MAIN MEASUREMENTS: Self-filling survey to collect data on age, sex, teaching skills, amount of years dedicated to research, time working with the same quota of patients, acceptability and feasibility of opportunistic HIV search. RESULTS: A total of 197 physicians with a mean age of 45.2 ± 9.7 (SD) years. 18.8% were under 36years old, 70.1% were women and 62.4% had teaching skills. 55.8% worked in towns with a population over 100,000 inhabitants and the mean of years working with the same quota of patients was 6.4 ± 6.6. 91.9% (95% CI: 88.1-98.7) of them considered the opportunistic search of HIV acceptable and 89.3% (95% CI: 85.0-93.6), feasible to perform. The multivariate analysis showed positive relation between the acceptability/feasibility and teaching skills (OR: 2.74; 95% CI: 1.16-6.49). The acceptance of the screening by patients was 93.1% and this was positively related to how long the doctor had worked with the same quota, teaching skills and the amount of years dedicated to research. CONCLUSIONS: HIV opportunistic search is an acceptable and feasible method for primary care professionals
Subject(s)
Humans , AIDS-Related Opportunistic Infections/epidemiology , HIV Infections/epidemiology , Cross-Sectional Studies , Primary Health Care/statistics & numerical data , Early Diagnosis , Mass Screening/methods , Health Care Surveys/statistics & numerical dataABSTRACT
OBJECTIVE: To evaluate the acceptability and feasibility of the opportunistic search of HIV according to primary care doctors' experience. To set up the profile of the physician involved in this study. DESIGN: Observational, transversal study. LOCATION: Primary Care Centers of the National Health System. PARTICIPANTS: General practitioners and residents who participated in VIH-AP study to measure the acceptability of HIV opportunistic search by patients. MAIN MEASUREMENTS: Self-filling survey to collect data on age, sex, teaching skills, amount of years dedicated to research, time working with the same quota of patients, acceptability and feasibility of opportunistic HIV search. RESULTS: A total of 197 physicians with a mean age of 45.2±9.7 (SD) years. 18.8% were under 36years old, 70.1% were women and 62.4% had teaching skills. 55.8% worked in towns with a population over 100,000 inhabitants and the mean of years working with the same quota of patients was 6.4±6.6. 91.9% (95%CI: 88.1-98.7) of them considered the opportunistic search of HIV acceptable and 89.3% (95%CI: 85.0-93.6), feasible to perform. The multivariate analysis showed positive relation between the acceptability/feasibility and teaching skills (OR: 2.74; 95%CI: 1.16-6.49). The acceptance of the screening by patients was 93.1% and this was positively related to how long the doctor had worked with the same quota, teaching skills and the amount of years dedicated to research. CONCLUSIONS: HIV opportunistic search is an acceptable and feasible method for primary care professionals.
Subject(s)
Attitude of Health Personnel , HIV Infections/diagnosis , Primary Health Care , Adult , Aged , Cross-Sectional Studies , Female , Health Care Surveys , Health Facilities , Humans , Male , Middle Aged , SpainABSTRACT
OBJETIVO: Valorar la aceptabilidad de la prueba del virus de la inmunodeficiencia humana (VIH) mediante búsqueda oportunista. DISEÑO: Estudio observacional, transversal. Emplazamiento: Centros de atención primaria (CAP) del Sistema Nacional de Salud. PARTICIPANTES: Pacientes de 18 a 65 años a los que hubiese que realizar una analítica y que nunca antes se hubiesen realizado la prueba del VIH. MEDICIONES PRINCIPALES: Edad, sexo, pareja estable, nivel de instrucción, consumo de tabaco/alcohol, motivo de la analítica, aceptabilidad de la prueba del VIH, motivo por el que no acepta o por el que no se le ha realizado antes. Se realizó un análisis estadístico descriptivo, bivariante y multivariante (regresión logística). RESULTADOS: Doscientos ocho médicos de 150 CAP captaron 3.314 pacientes. La aceptabilidad del test del VIH fue del 93,1% (IC 95%: 92,2-93,9). De estos, el 56,9% no se la habían realizado antes por no considerarse en riesgo, y el 34,8% por no habérsela ofertado su médico. Del 6,9% que rechazaron la serología, el 73,9% alegaron no considerarse en riesgo. Mediante análisis de regresión logística las variables que mostraron relación con la aceptabilidad de la prueba positivamente fueron: la edad (grupo de 26 a 35 años; OR = 1,79; IC 95%:1,10-2,91) y ser no fumador (OR = 1,39; IC 95%: 1,01-1,93). Los residentes en poblaciones entre 10.000 y 50.000 habitantes (OR = 0,57; IC 95%: 0,40-0,80) fueron los que en menor grado aceptaron la prueba. La prevalencia de VIH detectada fue del 0,24%. CONCLUSIONES: La prueba serológica del VIH tiene una alta aceptación entre los usuarios que acuden para hacerse un análisis de sangre a los CAP. La búsqueda oportunista es coste-efectiva
OBJECTIVE: To assess the acceptability of opportunistic search for human immunodeficiency virus (HIV). DESIGN: Cross-sectional, observational study. LOCATION: Primary Care Centres (PCC) of the Spanish National Health Care System. PARTICIPANTS: patients aged 18 to 65 years who had never been tested for HIV, and were having a blood test for other reasons. Recorded variables: age, gender, stable partner, educational level, tobacco/alcohol use, reason for blood testing, acceptability of taking the HIV test, reasons for refusing to take the HIV test, and reasons for not having taken an HIV test previously. A descriptive, bivariate, multivariate (logistic regression) statistical analysis was performed. RESULTS: A total of 208 general practitioners (GPs) from 150 health care centres recruited 3,314 patients. Most (93.1%) of patients agreed to take the HIV test (95% CI: 92.2-93.9). Of these patients, 56.9% reported never having had an HIV test before because they considered not to be at risk of infection, whereas 34.8% reported never having been tested for HIV because their doctor had never offered it to them. Of the 6.9% who refused to take the HIV test, 73.9% considered that they were not at risk. According to the logistic regression analysis, acceptability was positively associated to age (higher among between 26 and 35 year olds, OR = 1.79; 95% CI: 1.10-2.91) and non-smokers (OR = 1.39; 95% CI: 1.01-1.93). Those living in towns with between 10,000 and 50,000 inhabitants showed less acceptance to the test (OR = 0.57; 95% CI: 0.40-0.80). The HIV prevalence detected was 0.24%. CONCLUSIONS: Acceptability of HIV testing is very high among patients having a blood test in primary care settings in Spain. Opportunistic search is cost-effective
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Immunologic Deficiency Syndromes/blood , Immunologic Deficiency Syndromes/epidemiology , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/epidemiology , Serology/methods , AIDS Serodiagnosis/methods , HIV Seroprevalence/trends , Primary Health Care/methods , Primary Health Care/trends , Early Diagnosis , Opportunistic Infections/epidemiology , Opportunistic Infections/prevention & control , Mass Screening/methodsABSTRACT
OBJECTIVE: To assess the acceptability of opportunistic search for human immunodeficiency virus (HIV). DESIGN: Cross-sectional, observational study. LOCATION: Primary Care Centres (PCC) of the Spanish National Health Care System. PARTICIPANTS: patients aged 18 to 65 years who had never been tested for HIV, and were having a blood test for other reasons. RECORDED VARIABLES: age, gender, stable partner, educational level, tobacco/alcohol use, reason for blood testing, acceptability of taking the HIV test, reasons for refusing to take the HIV test, and reasons for not having taken an HIV test previously. A descriptive, bivariate, multivariate (logistic regression) statistical analysis was performed. RESULTS: A total of 208 general practitioners (GPs) from 150 health care centres recruited 3,314 patients. Most (93.1%) of patients agreed to take the HIV test (95%CI: 92.2-93.9). Of these patients, 56.9% reported never having had an HIV test before because they considered not to be at risk of infection, whereas 34.8% reported never having been tested for HIV because their doctor had never offered it to them. Of the 6.9% who refused to take the HIV test, 73.9% considered that they were not at risk. According to the logistic regression analysis, acceptability was positively associated to age (higher among between 26 and 35 year olds, OR=1.79; 95%CI: 1.10-2.91) and non-smokers (OR=1.39; 95%CI: 1.01-1.93). Those living in towns with between 10,000 and 50,000 inhabitants showed less acceptance to the test (OR=0.57; 95%CI: 0.40-0.80). The HIV prevalence detected was 0.24% CONCLUSIONS: Acceptability of HIV testing is very high among patients having a blood test in primary care settings in Spain. Opportunistic search is cost-effective.
Subject(s)
AIDS Serodiagnosis , HIV Infections/diagnosis , Patient Acceptance of Health Care , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Health Facilities , Humans , Male , Mass Screening , Middle Aged , Primary Health Care , Spain , Young AdultABSTRACT
Primary familial brain calcification (PFBC) is a neurological disease characterized by calcium phosphate deposits in the basal ganglia and other brain regions and has thus far been associated with SLC20A2, PDGFB or PDGFRB mutations. We identified in multiple families with PFBC mutations in XPR1, a gene encoding a retroviral receptor with phosphate export function. These mutations alter phosphate export, implicating XPR1 and phosphate homeostasis in PFBC.
Subject(s)
Brain Diseases, Metabolic, Inborn/genetics , Calcinosis/genetics , Receptors, G-Protein-Coupled/genetics , Receptors, Virus/genetics , DNA Mutational Analysis , Female , Genetic Association Studies , Genetic Predisposition to Disease , HEK293 Cells , Humans , Lod Score , Male , Middle Aged , Mutation, Missense , Neurodegenerative Diseases/genetics , Pedigree , Xenotropic and Polytropic Retrovirus ReceptorABSTRACT
Next generation sequencing (NGS) is transforming the diagnostic approach for neurological disorders, since it allows simultaneous analysis of hundreds of genes, even based on just a broad, syndromic patient categorization. However, such an approach bears a high risk of incidental and uncertain genetic findings. We report a patient with spastic paraplegia whose comprehensive neurological and imaging examination raised a high clinical suspicion of SPG11. Thus, although our NGS pipeline for this group of disorders includes gene panel and exome sequencing, in this sample only the spatacsin gene region was captured and subsequently searched for mutations. Two probably pathogenic variants were quickly and clearly identified, confirming the diagnosis of SPG11. This case illustrates how combination of expert clinical characterization with highly oriented NGS protocols leads to a fast, cost-efficient diagnosis, minimizing the risk of findings with unclear significance.
