Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain.

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Assessment of two glycated hemoglobin immunoassays.

INTRODUCTION: Glycated hemoglobin (HbA1c) level reflects chronic glycemic status if reliable tests are used, however, in some regions worldwide high performing assays might not be readily available. This study aimed to asses two HbA1c immunoassays, comparing them with high-performance liquid chromatography (HPLC) assay, three methods available in Ecuador. MATERIAL AND METHODS: HbA1c were measured in 114 fresh whole blood-samples by DCA-Vantage point-of-care analyzer, I-Chroma portable fluorescent scanner immunoassay and BioRad Variant II Turbo HPLC. Normal and pathological HbA1c ranges were included. Blood samples with variants of hemoglobin were excluded. HbA1c values were expressed in National Glycohemoglobin Standardization Program percentages and mmol/mol, as mean±standard deviation. RESULTS: HbA1c results by HPLC and DCA-Vantage were similar: 6.3±1.7% (45±18.6mmol/mol) vs. 6.3±1.8% (45±19.7mmol/mol), respectively, P=0.057; while HbA1c values by I-Chroma were lower than HPLC, 5.8±1.9% (40±20.8mmol/mol), P<0.001. The coefficient of variation was below 2% for high and low HbA1c levels, in all methods studied. HbA1c values by HPLC and DCA-Vantage were highly correlated (Spearman's Rank Correlation [SRC]: 0.916), while the correlation among HPLC and I-Chroma was weak (SRC: 0.368). The mean bias between DCA-Vantage and HPLC was -0.02±0.29% (-0.2±3.2mmol/mol), while for I-Chroma and HPLC mean bias was -0.50±1.62% (-5.5±17.7mmol/mol). CONCLUSION: HbA1c immunoassays DCA-Vantage was comparable to HPLC assay, showing good correlation, appropriate precision and low bias, whereas I-Chroma assay was precise but inaccurate. Therefore, DCA-Vantage has better performance than I-Chroma. These findings suggest that is convenient to assess the HbA1c immunoassays commercially available in our country, Ecuador.

Evaluation and community prevention coalitions: validation of an integrated Web-based/technical assistance consultant model

Community coalitions (CCs) have labored with some difficulty to demonstrate empirical evidence of effectiveness in preventing a wide range of adolescent problem behaviors. Training and technical assistance (TA) have been identified as important elements in promoting improved functioning of CCs. A reliable, valid, and inexpensive method to assess functioning of CCs has been developed and is tested in this article in the context of Pennsylvania's Communities That Care (CTC) model. A CC Web-based questionnaire was developed and administered to more than 79 communities (867 participants) and the validity and reliability were assessed through multiple means, including the use of a companion TA implementation feedback questionnaire completed by TAs assigned to each of the sites. Results indicated adequate to good psychometric properties on internal reliability of the Web-based questionnaire, moderate construct validity across different reports of functioning, and relative stability throughout the course of 1 year. Implications for a variety of community prevention coalitions interested in a relatively low-cost, user friendly, and suitable methodology for evaluating coalition functioning are discussed. In addition, areas of application for future research including linking coalition functioning with the quality and nature of technical assistance, levels of risk and protective factors, and large data sets of youth risk factor and problem behavior data are highlighted. (AU)

Enfermos pluripatológicos y atención geriátrica / No disponible

No disponible

Modification of pepsinogen I levels and their correlation with gastrointestinal injury after administration of dexibuprofen, ibuprofen or diclofenac: a randomized, open-label, controlled clinical trial.

OBJECTIVE: To assess the effect of a 2-week treatment with dexibuprofen, in comparison with ibuprofen and diclofenac, on pepsinogen plasma concentrations and gastrointestinal mucosa, as well as the correlation of these changes with gastrointestinal mucosal injury. METHODS: 60 patients with rheumatologic disease in chronic therapy with NSAID, were included. After a 7-day run-in period patients were randomly assigned to receive a 14-day treatment with dexibuprofen (Group A; Day 1 - 3 = 400 mg t.i.d; Day 4 - 14 = 400 mg b.i.d.), ibuprofen (Group B; Day 1 - 3 = 800 mg t.i.d; Day 4 -14 = 800 mg b.i.d.) or diclofenac (Group C; Day 1 - 3 = 50 mg t.i.d; Day 4 - 14 = 50 mg b.i.d.). Upper gastrointestinal endoscopy (Day 15), capsule-endoscopy (Day 16, 7 patients of each group) and determination of pepsinogen plasma concentrations were performed (basal and Day 15). A semiquantitative scale was designed for the assessment of the gastrointestinal mucosa. RESULTS: No differences in plasma pepsinogen were found between treatment groups or gastrointestinal injury grades or between basal and post-therapy determinations. Dexibuprofen showed gastroduodenal mucosal injury in fewer patients (42.1%) than was the case with ibuprofen (5%; p = 0.003) and diclofenac (30%; p = N.S.). Dexibuprofen administration was also associated with more patients having no intestinal mucosal damage (42.86% vs. 28.7% in the diclofenac group and 14.29% in the ibuprofen group; p = 0.0175). The rate of clinical adverse events was similar in Groups A, B and C (28%, 38% and 34%). CONCLUSIONS: Dexibuprofen showed a lower rate of gastroduodenal and intestinal mucosal injury. This effect was not mediated by modifications of plasma pepsinogen levels.

Short- and medium-term clinical efficacy of three endoscopic therapies for achalasia: a single-blinded prospective study.

OBJECTIVE: to compare the efficacy of three endoscopic therapies for achalasia and to identify predictors of response. DESIGN: prospective, single-blinded study at short and medium term. MATERIAL AND METHODS: 22 patients (9M/13 F; mean age: 47.45 +/- 21.01 years) with confirmed clinical and manometric achalasia were randomised in three groups: intrasphincteric injections of botulinum toxin (group 1: 10 patients ), injections of 1% polidocanol (group 2:6 patients), and a combined therapy with both of them (group 3: 6 patients). Clinical response was evaluated by a score (0-5) of tested symptoms (dysphagia, regurgitation and chest pain) at 1 and 24 weeks post-treatment. RESULTS: at 24 weeks post-treatment group 2 had the best complete response (CR) rate (33.33%), whereas CR in both the botulinum toxin and combined therapy groups was 10 and 0%, respectively. Groups 1 and 2 got an overall improvement in clinical score at 1 (p= 0.02) and 24 weeks (p= 0.04). Five patients (50%) in group 1, two patients (33.33%) in group 2, and three patients (50%) in group 3 needed other therapies (dilation or surgery) because of treatment failure. Separately, neither age nor sex, time from diagnosis or type of therapy could distinguish responders from non-responders in these three groups. However, absence of response within the first week, and an initial clinical score above 7 were predictive factors of poor response at six months. CONCLUSIONS: short- and medium-term clinical response to these endoscopic therapies was limited. The absence of response at seven days and a severe initial clinical score were predictive factors of poor medium-term response.

Light and electron microscopy study of the salivary gland secretory cells of Helicoidea (Gastropoda, Stylommatophora).

We have studied the secretory goblet-cells of the salivary gland of six species of Helicoidea: Elona quimperiana, Trissexodon constrictus, Hygromia limbata, Cernuella aginnica, Cepaea nemoralis and Helix aspersa, using light microscopy and transmission electron microscopy. In each of the species studied, we have been able to demonstrate the presence of four cell types. Following a comparative study with the goblet-gland cells present in the six species in question, and the comparison of our data with previously published reports on the entire set of Stylommatophora, we have established the homologies corresponding to the cell types observed. Our hypotheses were based primarily on the morphology of the rough endoplasmic reticulum and of the secretory vesicles. Accordingly, we have defined five cell types for these six species. The first three cell types, A, B and C, appear in the six species studied and seem to be present in all the stylommatophores. In order to standardize the terminology used by the different authors, we propose that these cell types be called: 'swollen RER cisterns mucocyte', 'granular mucocyte' and 'alveolar cell', respectively. The D-cell type or 'basophilous cell' is present only in Hygromia limbata, Cernuella aginnica, Cepaea nemoralis and Helix aspersa. The E-cell type or 'vacuolated cell' appears only in Elona quimperiana and Trissexodon constrictus.

Ultrastructural analysis of the morphology and function of the spermatheca of the pulmonate slug Arion subfuscus.

A study of the histology, histochemistry and ultrastructure of the spermatheca of Arion subfuscus in different stages of its life cycle shows that the spermatheca, an accessory organ of the femal genital tract of pulmonates, is a spherical-shaped organ lined with a columnar and non-ciliated epithelium surrounded by a thin network of connective tissue with some muscle fibres. The narrow epithelial cells possess numerous microvilli that, excepting young specimens, are provided with long, thin and generally curved, membranous process. Golgi apparatus, RER and mitochondria are abundant. Basal infolds are not very deep. In specimens killed two days after-copula, the spermatheca is swollen and its lumen is full of degenerating spermatozoa, mucus masses and spermatophore fragments. The apex of the cell is rich in granules with varied content, including multivesicular bodies. In specimens killed two weeks after-copula there are numerous endocytic vesicles in the apex and big vacuoles containing lipid. It is considered that after mating the excess of exogenous spermatozoa and copulatory seminal fluids are digested in the spermatheca. First, there is extracellular digestion that may be carried out by the enzymes contained in the multivesicular bodies exocytosed to the lumen, as well as by the enzymes secreted in apocrine vesicles. The partially digested materials would then be absorbed by endocytosis and further digested intracellularly. The great accumulation of lipid in the epithelial cells two weeks after mating suggest that the spermatheca could be involved in lipid synthesis, acting as a reserve organ.

Fertility and contraception of 6 patients with ovarian pregnancy.

A series of 6 ovarian pregnancies out of 369 ectopic (1.65/100 tubal) were selected to evaluate the fertility and contraception of patients with this rare condition. Mean patients' age was 28.5 years, mean previous parity was 1.5 children and all but one were using some sort of contraception (four had an IUD inserted and one had a previous laparoscopic tubal ligation). Clinical features on admission were as reported for the ectopic pregnancy and surgical findings at laparotomy showed an otherwise intact tubes. Postoperative further contraception was used by four patients and the two non-users became pregnant easily within an 18 month period. We conclude that ovarian pregnancy is an accident which occurs in a rather fertile population with an intact genital tract and who were using intrauterine contraceptive devices. Postoperative reproduction performance shows a high fertility rate in those patients who were not using any contraceptives at all.