[Prevalence of urinary incontinence and linked factors in men and women over 65]. / Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años.

OBJECTIVES: To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. DESIGN: Population survey. SETTING: Leganés (Madrid). PARTICIPANTS: Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). MAIN MEASUREMENTS: Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. RESULTS: The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. CONCLUSIONS: Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Differential expression of integrin subunits on adherent and nonadherent mast cells

Mast cell progenitors arise in bone marrow and then migrate to peripheral tissues where they mature. It is presumed that integrin receptors are involved in their migration and homing. In the present study, the expression of various integrin subunits was investigated in three systems of adherent and nonadherent mast cells. Mesentery mast cells, freshly isolated bone marrow-derived mast cells (BMMC) and RBL-2H3 cells grown attached to tissue culture flasks are all adherent mast cells and peritoneal mast cells, and cultured BMMC and RBL-2H3 cells grown in suspension represent nonadherent mast cell populations. Pure populations of mast cells were immunomagnetically isolated from bone marrow, mesentery and peritoneal lavage using the mast cell-specific monoclonal antibody AA4. By immunomicroscopy, we could demonstrate that all of these mast cells expressed alpha4, alpha5, alpha6, ß1 and ß7 integrin subunits. The expression of the alpha4 integrin subunit was 25 percent higher in freshly isolated mesentery mast cells and BMMC. Consistent with the results obtained by immunomicroscopy, mesentery mast cells expressed 65 percent more mRNA for the alpha4 integrin subunit than peritoneal mast cells. In vitro studies were also conducted using the rat mast cell line RBL-2H3. RBL-2H3 cells grown attached to the tissue culture flasks or as suspension cultures expressed the same integrin subunits identified in bone marrow, mesenteric and peritoneal mast cells ex vivo. Similarly, the expression of alpha4 integrin was higher in adherent cells. Therefore, alpha4 integrins may play a critical role in the anchorage of mast cells to the extracellular matrix in bone marrow and in peripheral tissues

Differential expression of integrin subunits on adherent and nonadherent mast cells.

Mast cell progenitors arise in bone marrow and then migrate to peripheral tissues where they mature. It is presumed that integrin receptors are involved in their migration and homing. In the present study, the expression of various integrin subunits was investigated in three systems of adherent and nonadherent mast cells. Mesentery mast cells, freshly isolated bone marrow-derived mast cells (BMMC) and RBL-2H3 cells grown attached to tissue culture flasks are all adherent mast cells and peritoneal mast cells, and cultured BMMC and RBL-2H3 cells grown in suspension represent nonadherent mast cell populations. Pure populations of mast cells were immunomagnetically isolated from bone marrow, mesentery and peritoneal lavage using the mast cell-specific monoclonal antibody AA4. By immunomicroscopy, we could demonstrate that all of these mast cells expressed alpha 4, alpha 5, alpha 6, beta 1 and beta 7 integrin subunits. The expression of the alpha 4 integrin subunit was 25% higher in freshly isolated mesentery mast cells and BMMC. Consistent with the results obtained by immunomicroscopy, mesentery mast cells expressed 65% more mRNA for the alpha 4 integrin subunit than peritoneal mast cells. In vitro studies were also conducted using the rat mast cell line RBL-2H3. RBL-2H3 cells grown attached to the tissue culture flasks or as suspension cultures expressed the same integrin subunits identified in bone marrow, mesenteric and peritoneal mast cells ex vivo. Similarly, the expression of alpha 4 integrin was higher in adherent cells. Therefore, alpha 4 integrins may play a critical role in the anchorage of mast cells to the extracellular matrix in bone marrow and in peripheral tissues.

[Non-detected dementia and use of the health services: implications for primary care]. / Demencia no detectada y utilización de los servicios sanitarios: implicaciones para la atención primaria.

OBJECTIVES: To calculate the proportion of cases of dementia detected in people over 70 living in their homes and to describe the use made by people with dementia of the health and social services. MATERIAL AND METHODS: Population survey of the survivors of the cohort "Growing old in Leganés", started in 1993. In the third monitoring (1999-2000), the clinical diagnosis of dementia on the basis of a neurological examination and an extensive neuro-psychological battery was included. Their use of health and social services and prior diagnoses were also asked. RESULTS: In the sample of survivors (n=527), there was 12.1% prevalence of dementia. Only 30% of the demented had previously been diagnosed by the health services. The proportion of undetected dementia was significantly associated with its seriousness (light 95%, moderate 69%, severe 36%). Compared with older persons who were not demented, the demented used more often hospital services, medical and nursing consultations at home and consultations through third parties; and less often, preventive and rehabilitation services. This trend was accentuated in patients with grave dementia. The use of community social services was very low (below 8% in the most serious cases). CONCLUSIONS: The detection of dementia in the elderly is very low and efforts to detect it in primary care need to be stepped up. Specific social-health resources for this population also need to be increased and the attendance guide-lines for primary care teams, and for health professionals in general, need to be changed.

Hyperpigmentation in the Silkie fowl correlates with abnormal migration of fate-restricted melanoblasts and loss of environmental barrier molecules.

In most homeothermic vertebrates, pigment cells are confined to the skin. Recent studies show that the fate-restricted melanoblast (pigment cell precursor) is the only neural crest lineage that can exploit the dorsolateral path between the ectoderm and somite into the dermis, thereby excluding neurons and glial cells from the skin. This does not explain why melanoblasts do not generally migrate ventrally into the region where neurons and glial cell derivatives of the neural crest differentiate, or why melanoblasts do not escape from the dorsolateral path once they have arrived at this destination. To answer these questions we have studied melanogenesis in the Silkie fowl, which is a naturally occurring chicken mutant in which pigment cells occupy most connective tissues, thereby giving them a dramatic blue-black cast. By using markers for neural crest cells (HNK-1) and melanoblasts (Smyth line serum), we have documented the development of the Silkie pigment pattern. The initial dispersal of melanoblasts is the same in the Silkie fowl as in Lightbrown Leghorn (LBL), White Leghorn (WLH), and quail embryos. However, by stage 22, when all ventral neural crest cell migration has ceased in the WLH, melanoblasts in the Silkie embryo continue to migrate between the neural tube and somites to occupy the sclerotome. This late ventral migration was confirmed by filling the lumen of the neural tube with DiI at stage 19 and observing the embryos at stage 26. No DiI-labeled cells were observed in the sclerotome of LBL embryos, whereas in the Silkie embryos DiI-filled cells were found as far ventral as the mesentery. In addition to this extensive ventral migration, we also observed considerable migration of melanoblasts from the distal end of the dorsolateral space into the somatic mesoderm (the future parietal peritoneum), and into the more medioventral regions where they accumulated around the dorsal aorta and the kidney. The ability of melanoblasts in the Silkie embryos to migrate ventrally along the neural tube and medially from the dorsolateral space is correlated with a lack of peanut agglutinin (PNA) -binding barrier tissues, which are present in the LBL embryo. The abnormal pattern of melanoblast migration in the Silkie embryo is further exaggerated by the fact that the melanoblasts continue to divide, as evidenced by BrdU incorporation (but the rate of incorporation is not greater than seen in the LBL). Results from heterospecific grafting studies and cell cultures of WLH and Silkie neural crest cells support the notion that the Silkie phenotype is brought about by an environmental difference rather than a neural crest-specific defect. We conclude that melanoblasts are normally constrained to migrate only in the dorsolateral path, and once in that path they generally do not escape it. We further conclude that the barriers that normally restrain melanoblast migration in the chicken are not present in the Silkie fowl. We are now actively investigating the nature of this barrier molecule to complete our understanding of melanoblast migration and patterning.

Identification and isolation of rat bone marrow-derived mast cells using the mast cell-specific monoclonal antibody AA4.

Previous studies of mast cell maturation, structure, and function have been hampered by the lack of mast cell-specific markers. In this study, using a well-characterized mast cell-specific monoclonal antibody, MAb AA4, mast cells from rat bone marrow in various stages of maturation were isolated and characterized. The very immature mast cells, which have not been previously described, contained few granules and would not be recognized as mast cells by standard cytological methods. Pure populations of mast cells were isolated from the bone marrow using MAb AA4-conjugated magnetic beads. The same stages of maturation were observed in the isolated mast cells as were seen in the unfractionated bone marrow. All of these cells were immunopositive for the alpha-subunit of Fc epsilon RI, IgE, and c-kit, confirming their identity as mast cells. By direct counting of immunolabled cells and by flow cytometry, approximately 2.4% of the cells in the bone marrow are mast cells. Staining with toluidine blue and berberine sulfate, as well as RT-PCR of the cells, indicates that these cells are connective tissue-type mast cells. The use of immunological methods for identification of mast cell precursors should facilitate the study of these cells. (J Histochem Cytochem 49:219-228, 2001)

[Functional capacity in those over 60 and related social health factors (the ANCO Project for the Aged of Cordoba)]. / Capacidad funcional en mayores de 60 años y factores sociosanitarios asociados (proyecto ANCO).

OBJECTIVE: To evaluate the functional status (FS) of the over-60 population in our city, relating it to various social, demographic and health factors. DESIGN: A descriptive, crossover study. SETTING: City of Córdoba. PARTICIPANTS: A sample of 1,103 subjects was obtained by systematic sampling of the non-institutionalised population over 60 years old (N = 49,674), using the latest update of the 1991 census. MEASUREMENTS AND MAIN RESULTS: Application of the OARS-MFAQ-VE multidimensional questionnaire using a face-to-face home interview. We analysed 14 items from the part of the questionnaire assessing FS. Subjects were classified into three groups. 7.6% (25.0-30.3) needed help to perform at least one AS and 15.9% (13.8-18.2) were unable to perform at least one. CONCLUSIONS: This study provides a description of the functional status of the elderly, which for the most part is excellent. Various social and health factors linked to functional incapacity were identified.

[Functional evaluation of persons over 60 years of age living in an urban community. ANCO project]. / Valoración funcional de personas mayores de 60 años que viven en una comunidad urbana. Proyecto ANCO.

OBJECTIVE: To establish the grade of functional deterioration in older people and analyse associated factors. DESIGN: Cross sectional study. SETTING: City of Córdoba. PARTICIPANTS: The population over 60 years old on the Córdoba municipal roll (49,674) and living at home, from which a sample of 1,103 subjects was taken. INTERVENTIONS: The multidimensional OARS-MFAQ questionnaire was filled in. Calculation of the functional deterioration scores enabled five areas to be evaluated: physical health (PH), mental health (MH), economic resources (ER), social resources (SR) and capacity to perform daily activities (DA) autonomously. MEASUREMENTS AND MAIN RESULTS: Reply rate was 86.8%. The prevalence of serious/absolute deterioration in each of the areas was: 9.3% in SR, 8.5% in DA, 8.4% in ER, 6.9% in MH and 5.8% in PH. CONCLUSIONS: Both the prevalence of functional deterioration in the population group under study and the demand for institutional care are similar to other studies performed in our country, but higher than in Anglosaxon countries.

[The principal causes of mortality in young people in the Autonomous Community of Madrid: 1990-1991]. / Principales causas de mortalidad en jóvenes en la Comunidad Autónoma de Madrid: 1990-1991.

Our objective is to quantify the mortality from AIDS, narcotic related deaths, and traffic accidents among those between 15 and 39 years of age, in the Community of Madrid, 1990-1991. Data provided by the Regional Register of AIDS, Forensic Institute of Madrid, local police teams and the Traffic Directorate General have been used. Mortality from traffic accidents ranked first as a cause of death, followed by narcotic-related deaths and AIDS, both for men and women.

[Short-term prediction of cases of AIDS in Catalonia (1991-1994)]. / Predicción a corto plazo de los casos de SIDA en Cataluña (1991-94).

Predicting AIDS incidence is a useful strategy for health service planning and for the design of preventive and control programmes. The different predictive mathematical models of AIDS can be classified in simple and complex, according to the assumptions used. The present study presents the prediction of the minimum AIDS incidence in Catalonia for the period 1991-94 by means of three simple mathematical models. The models that have been compared are the projection method of Chin and Lwanga, the retroprojection method of Brookmeyer and Gail, and the extrapolation method of Cox and Medley. Baseline information about AIDS cases comes from the AIDS Registry of the "Generalitat" of Catalonia. In a comparable manner, the three methods point out an increase of AIDS incidence until 1994, varying from 1160 to 1733 new cases in that year depending on the method used. We conclude that it will be necessary to increase the provision of health, social and preventive resources against AIDS in Catalonia in the coming years.

[Intravenous drug addiction and the risk of HIV infection in Madrid in 1990]. / Drogadicción intravenosa y riesgo de infección por VIH en Madrid 1990.

As part of a multicenter WHO study on HIV infection among drug injectors, 472 intravenous drug users (IDUs) were interviewed, 240 recruited in the streets and 232 at drug treatment centers. The objectives of the study were to assess the prevalence of HIV infection among IDUs of Madrid, to identify factors associated with risk reduction behaviors, such as the use of sterile syringes and condoms. Chi-square and logistic regression were used to test for differences and to estimate odds ratios. Prevalence of HIV infection among IDUs in Madrid was 50% (53% among those recruited in the street and 38% among those recruited at treatment centers). Forty five per cent of those interviewed were still sharing syringes. Out of the 315 sexually active subjects, only 22% reported using condoms always or almost always. These results suggest that a range of interventions should be implemented to promote change towards healthier behaviors, including syringe-exchange programs, methadone maintenance treatments and pre- and post-test counseling in those agencies which care for this population.

The relationship between the perception of alcohol and drug harmfulness and alcohol consumption by university students.

University students find themselves at a stage when many attitudes and habits undergo change and consolidation, and it is during this period when patterns of consumption of toxic substances are partially or definitively established. A group of 955 university students (328 medical students, 347 students of veterinary medicine, and 280 law students) were studied. Sex and religion played a decisive role in determining the relation between the use of toxic substances and the subjects' attitude toward consumption in our sample. Also, the three campuses were found to differ significantly with regard to students' assessment of harmfulness and patterns of consumption.

[Jails and AIDS. Risk factors for HIV infection in the prisons of Madrid]. / Cárceles y SIDA. Factores de riesgo de infección por el VIH en las cárceles de Madrid.

The spread and risk factors for HIV infection were studied in 288 men and 95 women at the prisons of Carabanchel and Yeserias, Madrid. These men and women requested care at the AIDS prevention program in the jails of Madrid, from April to December 1987. Among the men studied at Carabanchel, 55% were positive to HIV (77% seropositivity among intravenous drug users, IVDU). Tattooing (OR = 2.8), and number of times in prison (OR = 4.5 comparing those who had been 8 or more times in prison with those who had been in prison only once) were independent risk factors for infection, after controlling for IVDU. No association was found between seropositive status to HIV and reported anal intercourse. Among the women studied at Yeserias, the proportion of HIV seropositive women was 26% (70% of the IVDUs were seropositive). Tattooing, number of times in prison, history of prostitution and history of syphilis were associated with HIV infection. When controlling for IVDU, number of times in prison and history of prostitution were not independent risk factors for infection. These data indicate that there is a need for control measures to avoid further spread of the HIV infection among the inmate population, in particular through the use of contaminated needles while in prison.

Meningites virais e bacterianas no municipio do Rio de Janeiro (Brasil). Algumas consideracoes sobre o sistema de informacoes em saude e sobre a distribuicao da doenca no espaco urbano. / Viral and bacterial meningitis in the municipality of Rio de Janeiro (Brazil). Some considerations on the health information system and the distribution of the disease in the urban space

Foram estudados 609 casos de meningites ocorridos entre 1 de julho e 31 de dezembro de 1978 no municipio do Rio de Janeiro, RJ (Brasil). Destes, 311 foram classificados como bacterianos e 298 como virais. A maioria destes foi causada pelo virus ECHO-9, responsavel por um surto ocorrido na Zona Sul do Municipio, a partir de setembro. Foram apresentadas e discutidas as questoes: a) contradicao entre significado politico e significado epidemiologico dos fatos morbidos, nem sempre homogeneos; b) ausencia de notificacao das doencas as autoridades de saude; c) significado do previlegiamento do espaco geografico na organizacao dos servicos de saude, fato que muitas vezes mascara a verdadeira distribuicao da doenca e impede um melhor equacionamento das acoes no sentido de controla-las

As meningites virais no municipio do Rio de Janeiro, RJ (Brasil), 1978. / Viral meningitis in the municipality of Rio de Janeiro, RJ (Brazil), 1978

Foram estudados 298 casos de meningites classificados como virais ocorridos no segundo semestre de 1978 no municipio do Rio de Janeiro (Brasil). A maioria destes casos ocorreu de setembro a dezembro e pertenceu a um surto epidemico causado pelo virus ECHO-9.Sao apresentadas e discutidas as caracteristicas epidemiologicas, clinicas e laboratoriais dos casos, bem como foi realizado um estudo caso-controle com parte dos casos do surto