[Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments]. / Calidad percibida en hospitales del Servicio Sanitario Andaluz. El caso de los servicios de neurocirugía.

OBJECTIVE: To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. MATERIAL AND METHODS: Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. RESULTS: The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). CONCLUSIONS: There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management.

Calidad percibida en hospitales del Servicio Sanitario Andaluz. El caso de los servicios de neurocirugía / Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments

Objetivo: Analizar las características de la calidad percibida de los usuarios del sistema público hospitalario de salud de Andalucía y compararla con las de los usuarios de los servicios de neurocirugía andaluces. Material y métodos: Encuestas aleatorizadas ajustadas por población activa en la comunidad andaluza mediante cuestionario telefónico basado en modelo SERVQUAL con modificación propia, y selección posterior de subgrupo relacionado con los servicios de neurocirugía. Se dividió la calidad percibida en calidad técnica, funcional y de infraestructuras. Resultados: La satisfacción general fue del 76,3%. Del análisis de frecuencias se observó que las variables relacionadas con la calidad técnica (buenos médicos, éxito en operaciones, personal preparado, etc.) obtuvieron resultados más favorables. Aquellas relacionadas con el tiempo (espera, en consulta, organización de horarios) obtuvieron resultados más desfavorables. Las variables de atención a familiares obtuvieron resultados desfavorables. No existieron diferencias entre el global de la sanidad andaluza y los servicios de neurocirugía. En el análisis de medias las mujeres y las personas de mayor edad presentaron respuestas más favorables, sobre todo para variables relacionadas con la calidad de infraestructuras. En el análisis de cluster se observó tendencia a respuestas más favorables conforme la edad era mayor sin predominio de género (p < 0,009). Conclusiones: No hay diferencias en la calidad percibida entre los servicios de neurocirugía y el resto de la sanidad. La calidad percibida en la sanidad andaluza es mayor conforme la edad del usuario es mayor. El análisis de calidad percibida es útil para plantear proyectos de mejora de la gestión clínica (AU)

Objective: To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Material and methods:Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. Results: The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P < .009). Conclusions: There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management (AU)

Paternal isodisomy 7q secondary to monosomy 7 at recurrence in a Down syndrome child with acute myelogenous leukemia.

We report a boy with Down syndrome and leukemia who acquired uniparental isodisomy of chromosome 7q as a secondary chromosomal change during recurrence of the disease. His karyotype before therapy was 46,XY,der(1)t(1;1)(p36;q32),-7,+21c/46,idem,del(9)(p22), whereas at recurrence it was 46,XY,der(1)t(1;1)(p36;q32,-7,der(7)(qter-->p22 through pter::q10-->qter),del(9)(p22),+21c/47,XY,+21c. By using polymerase chain reaction amplification of D7S493 and D7S527 markers, we identified the loss of the maternal chromosome 7 with a consequent paternal isodisomy in the clone with dup7q. This rearrangement could be implicated in the progression of the disease by causing (1) nullisomy for a gene or genes located on 7p22-->pter, (2) functional double doses of exclusively paternal expressed genes, and (3) restoration of the effects produced by haploinsufficiency of biparental expressed genes.

The role of Ki67 proliferation assessment in predicting local control in bladder cancer patients treated by radical radiation therapy.

PURPOSE: To assess whether tumour proliferation as measured by Ki67 immunostaining has any predictive value for local control in bladder cancer patients treated by radiotherapy. PATIENTS AND METHODS: Fifty-five patients suffering from infiltrating bladder carcinoma recommended for radical radiotherapy (66 Gy/6-7 weeks) were included in this study. Paraffin-embedded pre-treatment tumour sections were stained with the Ki67 antibody. The percentage of Ki67-positive nuclei was correlated with established prognostic factors, local control and survival. RESULTS: The Ki67 index was not related to local control in our patients when the median was selected as the cut-off value. Patients with tumours with a very low (<27%) Ki67 index had better local control at 5 years (69%) than patients with tumours with greater (>27%) Ki67 expression indices (31.5%) (P<0.05; log-rank test). CONCLUSIONS: Ki67 immunostaining was a feasible method to estimate tumour proliferation. Patients with very low proliferating tumours seemed to achieve better local control after fractionated radiotherapy compared to other patients. Further studies are needed with a greater number of patients to accurately define the role of Ki67 expression in predicting tumour repopulation during fractionated radiotherapy.

Translocation (6;9;22)(p25;q34;q11.2) identified by FISH in acute leukemia.

Fluorescence in situ hybridization (FISH) study of bone marrow cells from a patient with clinically and immunologically acute leukemia showed that an apparent t(6;22)(p25; q11.2) identified by routine banding techniques concealed a complex t(6;9;22)(p25;q34; q11.2). This observation further supports the importance of FISH in those cases where a chromosome rearrangement could not be reliably detected by conventional cytogenetic study.

Reacciones adversas a los alimentos en niños de guardería / Adverse food allergy in children the nurseries

Se efectuó una encuesta descriptiva y prospectiva, en 291 niños de tres guarderías del ISSSTE en Guadalajara. Se realizaron historias clínicas a los sospechosos de los cuales 11 fueron positivas (3.78 por ciento). La edad más frecuente de presentación es a los 2 (34.7 por ciento) y a los 4 (34.7 por ciento) años. La relación entre los sexos fue de 1:1, las reacciones prevalecientes fueron: intolerancia a la lactosa 1.7 por ciento, alergia al huevo 0.6 por ciento, conservadores 0.6 por ciento, a la zanahoria 0.3 por ciento, salchicha y jamón 0.3 por ciento. Se obtuvo una prevalencia de reacciones adversas a los alimentos del 3.7 por ciento de esta población de guardería. El inicio de la ablactación se inició a temprana edad (2 a 3 meses) con alimentos sumamente alergénicos como son: cítricos (43.4 por ciento), huevo (13 por ciento). Como manifestaciones clínicas se encontraron: evacuaciones diarreicas, vómito, dolor, distensión abdominal, flatulencia, edema palpebral, nasal, de mejillas y manos

[Adverse reactions to food in daycare children]. / Reacciones adversas a los alimentos en niños de guardería.

A prospective descriptive survey was applied to 291 children of three different nurseries in Guadalajara, México. Medical history was done to the suspicious ones, from those, only 11 were positive (3.78%). The presumptive diagnosis of food allergy was based on the patient's history, food challenges and food elimination. The most frequent age of presentation was at 2 (34.7%) and at 4 (34.7%) years old. The food reactions were: lactose intolerance (1.7%), allergy to eggs (0.6%), carrots (0.3%), food additives (0.6%), sausages and ham (0.3%), gettina a prevalence of adverse reaction of 3.7% to food in this population. The ablactation began before three months of age in all the children with allergenic meals like: citrics (43.3%) and eggs (13%). The clinical manifestations found were diarrhea, vomiting, abdominal pain, abdominal distense, flatulence palpebral edema of nose, cheeks and hands.

[Sociodemographic conditions and nutritional status of children under 1 year old in peripherical areas of Guadalajara, México]. / Condiciones sociodemograficas y estado nutricional de niños menores de un año en areas perifericas de Guadalajara, México.

A random population sample was studied with a view to determining the proportion of children of less than on year of age whose weight is less than the minimum adequate weight (MAW) for their age, as well as to identifying factors of a socio-demographic nature that could be associated with this problem and the socio-sanitary importance of these factors. The sample studied was of children of less than one year of age, born between 05/01/1990 and 04/30/1991, whose mothers were entitled to the services of the Mexican Institute of Social Security, in Tlaquepaque and Tonalá, municipalities adjacent to the Metropolitan Zone of Guadalajara, the second most important city in Mexico. The ponderal assessment of the infants was performed on the basis of tables which the Latin-American Perinatology Center had developed for this purpose. Through the use of logistic regression, Odds Ratios (OR) were estimated, with 90% confidence intervals (CI). The model thus prepared was adjusted by means of the H* statistics. Likewise, the population's attributable risk (PAR) was calculated, as well as the probability that a child would not reach the MAW for its age, in the presence or absence of particular risk factors. The results indicate that nearly one fifth of the infants studied do not reach MAW.(ABSTRACT TRUNCATED AT 250 WORDS)

Ag-positive regions on unusual chromosome locations.

A 28-year-old woman with a 46,XX,t(13;21)(q14;p11) karyotype showed both chromosome unstability and an unusual Ag-positivity on her chromosomes. Since there are reports about affinity of the NORs for broken chromosome ends, the two different phenomena observed in the present case are probably related.

fra(1) (p11), fra(1) (q22) and r(1) (p11q22) in a retarded girl.

A mentally retarded girl with a 46,XX/47, XX+r(1) (p11q22q22p11)/47, XX+r(1) (p11q22) fra(1) (p31) fra(1) (p11) fra(1) (q22) karyotype who inherited the fragile sites from the normal mother was studied. The conicidence of fra(1) (p11) and fra(1) (q22) with the ring chromosome breakpoints strongly suggests a cause-effect relationship. This finding agrees with other reported associations between fragile sites and structural chromosome abnormalities and constitutes the fourth reported of a de novo structurally abnormal chromosome as a consequence of presumed in vivo fragile sites instability. Although risk figures for chromosome anomalies and cancer associated with fragile sites are lacking, carriers of fra (1) (p11) may have a higher risk for abnormalities of chromosome 1 in somatic and gonadal cells than the general population.