Hippocampal Volumetry as a Biomarker for Dementia in People with Low Education.

BACKGROUND/AIMS: To evaluate the relationship between hippocampal volume and cognitive decline in patients with dementia due to probable Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI) and education, and the possible relationship between cognitive reserve and education in this population. METHODS: From February 2013 to October 2015, 76 patients (25 men, 51 women) were classified according to the NIA-AA diagnostic criteria. We used two 3.0-tesla MRI scanners and performed manual hippocampal volumetry. RESULTS: Twenty-six patients were found to have AD, 20 aMCI and 30 had normal aging (NA). The mean normalized hippocampal volume in age-, sex- and education (years)-matched subjects was 2.38 ± 0.51 cm3 in AD (p < 0.001), 2.91 ± 0.78 cm3 in aMCI (p = 0.019) and 3.07 ± 0.76 cm3 in NA. CONCLUSION: Psychometric test (MMSE and MoCA) scores had a good to strong positive correlation with statistically significant differences in the entire population and healthy subjects but not among dementia patients and lower educational level groups. The patients with low education had greater hippocampal volumes, which is in line with the cognitive reserve theory; lower-educated individuals can tolerate less neuropathology and will thus show less atrophy at a similar level of cognitive performance than higher-educated subjects.

¿Cuáles son las expectativas de los pacientes cuando acuden a una consulta de atención primaria y qué piensan los médicos sobre ellas? / Which are the patients’ expectations at general practitioner visit and what do doctors known about these?

Objetivos: Conocer qué expectativas valoran más los pacientes cuando acuden a las consultas de atención primaria y la opinión de los médicos de familia sobre ellas. Material y metodo: Estudio observacional, descriptivo. Se estudiaron 2 muestras: a) pacientes seleccionados aleatoriamente de entre los que acudieron a las consultas médicas de 10 centros de salud; antes de entrar a la consulta se pidió a los pacientes que de un listado de 10 expectativas valoraran y priorizaran las más importantes y las menos importantes para esa consulta, y b) a una muestra de médicos de familia se les envió el mismo listado de expectativas para que señalasen y priorizasen aquellas que consideraran eran las más importantes para los pacientes cuando acudían a la consulta. Resultados: Se incluyó a 805 pacientes y 140 médicos. El promedio de expectativas consideradas como importantes por los pacientes para esa consulta fue de 7,7 sobre un total de 10 posibles. Un 99% de los pacientes señalaron 3 o más expectativas. De las 3 expectativas más resaltadas como importantes por médicos y pacientes, éstos coincidieron en 2; la primera fue "ser escuchados". Igualmente, coincidieron con los pacientes en las 2 expectativas menos deseadas: "ser derivados al especialista" y "recibir una prescripción". Los médicos valoraron muy significativamente el deseo de los pacientes de "recibir un diagnóstico" (43%), "consejo" (40%), "derivación" (35%), "prescripción" (25%), "solicitud de una prueba" (17%) y "ser explorados" (15%). Conclusiones: Para los pacientes, las expectativas relacionadas con aspectos comunicativos son las más importantes. En general, los médicos coinciden en esta valoración; sin embargo, sobrestiman los deseos de los pacientes de recibir ciertos servicios relacionados con la atención, como recetas, derivaciones y pruebas complementarias

Aims: To assess patient expectations at general practitioner (GP) visits, and compare them with what GPs think about them. Material and method: Cross sectional study of patients attending GPs consultations. Physicians sample from Andalusia. Before the consultation patients were asked to select, from a list of 10 expectations, the most important they had for that particular visit. They were then asked to prioritise them into the 3 most and least important. Doctors received the list of 10 expectations and were asked to select which expectations they considered as the most important for a patient when consulting; doctors had also to prioritise the 3 most and least important expectations. Results: The study included 805 patients, 140 physicians. Out of the list of ten expectations, patients marked as important for that particular visit an average of 7.7. 797 (99%) patients claimed the important ones for them were three or more, but 207 (30%) were not able to prioritise more than two. When doctors prioritised the most important expectation, within the first three, they coincided with patients in two of them: the first, (listening) and the third (explaining). Similarly, doctors coincided with patients in the two least important expectations: to be referred and to receive a prescription. Out of the list of ten expectations, doctors over-scored significantly the patients wishes for receiving a diagnosis (43%), advice (40%), to be referred (35%), to receive a prescription (25%), a test (17%) and be examined (15%). Conclusions: General expectations as regards physician-patient communication are more important for patients than other more specific ones. Generally, physicians agree with patients in this assessment, but they over-estimated patient wishes of receiving prescriptions, tests or to be referred

[Not Available]. / ¿Cuáles son las expectativas de los pacientes cuando acuden a una consulta de atención primaria y qué piensan los médicos sobre ellas?

AIMS: To assess patient expectations at general practitioner (GP) visits, and compare them with what GPs think about them. MATERIAL AND METHOD: Cross sectional study of patients attending GPs consultations. Physicians sample from Andalusia. Before the consultation patients were asked to select, from a list of 10 expectations, the most important they had for that particular visit. They were then asked to prioritise them into the 3 most and least important. Doctors received the list of 10 expectations and were asked to select which expectations they considered as the most important for a patient when consulting; doctors had also to prioritise the 3 most and least important expectations. RESULTS: The study included 805 patients, 140 physicians. Out of the list of ten expectations, patients marked as important for that particular visit an average of 7.7. 797 (99%) patients claimed the important ones for them were three or more, but 207 (30%) were not able to prioritise more than two. When doctors prioritised the most important expectation, within the first three, they coincided with patients in two of them: the first, (listening) and the third (explaining). Similarly, doctors coincided with patients in the two least important expectations: to be referred and to receive a prescription. Out of the list of ten expectations, doctors over-scored significantly the patients wishes for receiving a diagnosis (43%), advice (40%), to be referred (35%), to receive a prescription (25%), a test (17%) and be examined (15%). CONCLUSIONS: General expectations as regards physician-patient communication are more important for patients than other more specific ones. Generally, physicians agree with patients in this assessment, but they over-estimated patient wishes of receiving prescriptions, tests or to be referred.

The effect of patients' met expectations on consultation outcomes. A study with family medicine residents.

OBJECTIVES: To know the patients' expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes. DESIGN: A prospective cohort study. PARTICIPANTS: Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires. MEASUREMENTS: Before each visit, the patients' expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor's suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used. RESULTS: The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32-3.75], and the fulfilling of the patients' main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73-7.8; adherence OR 1.80, CI: 1.11-2.92; clinical evolution OR 1.54, CI: 1.01-2.35; and seeking further care later OR 0.54, CI:0.36-0.81) CONCLUSIONS: Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors.

Análisis de los resultados de perfiles metabólicos en lecherías del trópico alto del eje cafetero colombiano / Appraisal of the results of metabolic profile tests on dairy herds located in upper coffee lands from Colombia

Con el objeto de establecer valores de referencia para diferentes variables bioquímicas sanguíneas en vacas productoras de leche, se tomaron 5 mL de suero durante junio de 1998 y septiembre de 1999 a diferentes grupos de bovinos lecheros en 13 predios del trópico alto de la zona cafetera colombiana (4-6º LN y 75-76º LO). Se analizaron por colorimetría o cinética la concentración de hemoglobina (Hb), proteínas totales y fraccionadas, urea, colesterol, fósforo (P), magnesio (Mg), glutatión peroxidasa (GSH-Px) y aspartato aminotransferasa (AST). Los resultados fueron analizados mediante estadística descriptiva y análisis de varianza, fijando el intervalo de confianza al 95 por ciento. El promedio y la desviación estándar encontradas fueron Hb: 11,1±1,5 g/dL, proteínas totales: 77±12 g/L, albúmina: 32±7 g/L, globulinas: 45±13 g/L, urea: 7,3±4,1 mmol/L, colesterol: 3,2±1,0 mmol/L, P: 1,9±0,7 mmol/L, Mg: 1,0±0,3 mmol/L, GSH-Px: 179±99 mmol/L, y AST: 78±28 mmol/L. Las alteraciones más frecuentes fueron la fosfatemia alta, y la disminución en las concentraciones de urea, Mg y la actividad de GSH-Px. Los valores obtenidos difieren a los reportados nacional e internacionalmente, observándose valores mayores para la concentración de urea, fósforo, magnesio y la actividad de AST, y disminuidos para la concentración de colesterol.