[Community reorientation of primary care in a health area: ROCAP project]. / Reorientación comunitaria de la atención primaria en un área de salud: proyecto ROCAP.

AIM: Evaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area. DESIGN: During January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email. PLACE: The scope is the 11 ZBS of a health area. PARTICIPANTS: The study population is the ZBS and the respective teams represented by the medical and nursing coordinations. INTERVENTIONS: Promote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives. MAIN MEASUREMENTS: Quantitative and qualitative analysis was carried out pre and post after the first year of intervention. RESULTS: In the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health. CONCLUSIONS: The intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

Elevated Lead, Nickel, and Bismuth Levels in the Peritoneal Fluid of a Peritoneal Endometriosis Patient without Toxic Habits or Occupational Exposure following a Vegetarian Diet.

Potentially toxic elements (PTEs), found as environmental contaminants, have been related to endometriosis disease. In this context, the peritoneal fluid (PF) matrix has been poorly studied despite its importance. PF is the environment in which endometriotic lesions reside and communicate with surrounding tissues including tissues and nerve cells. In this work, our investigation group reports the special case of a peritoneal endometriosis patient presenting elevated lead, nickel, and bismuth levels in PF. This patient reported following a vegetarian diet and no toxic habits or occupational exposure. In conclusion, the elevated levels of PTEs found may result from a vegetarian diet or an unidentified environmental exposure source. This report provides new insights regarding the possible etiology of endometriosis disease and potential biomarkers for its diagnosis in early stages, although additional research is needed.

A New Advanced and Validated Method for the Determination of Potentially Toxic Metals and Trace and Ultra-Trace Elements in Peritoneal Fluid to Assess the Health Risks of Women with Gynecological Pathologies.

Toxic metals found in the environment have been linked to female infertility and gynecological illnesses. Reliable analytical methods, such as inductively coupled plasma tandem mass spectrometry (ICP-MS/MS), are necessary to determine the elemental composition of biological samples. Currently, the multielemental profile of peritoneal fluid (PF) samples has not yet been established. Due to the complexity of the PF matrix, an ICP-MS/MS-based method has been optimized to mitigate matrix effects and spectral interferences. A dilution factor of 1:4 was the best option to mitigate matrix effects while keeping sensitivity at an appropriate level. A collision gas (He) was useful to lower the extent of spectral interferences for 56Fe, 52Cr, 63Cu, and 68Zn. An intermediate validation test was performed to evaluate accuracy, achieving recoveries ranging from 90 to 110%. The method was validated in terms of intermediate precision, reproducibility, and trueness, with an expanded uncertainty lower than 15%. Afterward, it was applied to perform the multielemental analysis of 20 PF samples. The concentrations for major analytes were up to 151 µg L-1. Meanwhile,209Bi, 111Cd, 52Cr, 55Mn, 95Mo, 60Ni, 208Pb, 118Sn, and 51V were present at concentrations included within the 1-10 µg L-1 range, while 59Co and 139La were found at concentrations below 1 µg L-1.

Analytical Determination of Heavy Metals in Human Seminal Plasma-A Systematic Review.

Infertility is a growing concerning health problem affecting around 15% of couples worldwide. Conventional semen parameters have limited accuracy for male infertility potential determination. Current advances in the understanding of male infertility indicate that environmental and occupational exposure to chemical contaminants are important etiological factors leading to infertility problems. In this context, some heavy metals (HMs) can be considered as endocrine-disrupting compounds (EDCs), thus altering the seminal quality. This systematic review aims to summarize the key points to detect and quantify HMs in human seminal plasma (SP) and the involved analytical tools. Our results showed that that for HM quantification, atomic absorption spectroscopy (AAS) and inductively coupled plasma (ICP) were the most employed techniques while Zn, Cd, Pb, and Cr were the analytes most often detected. Fast, reliable, and sensitive quantification of EDCs in SP could be important for the development of accurate diagnostic and preventive strategies to address male infertility towards providing personalized therapy.

Patrón de uso del teléfono móvil e Internet en adolescentes de entre 11 y 15 años / Pattern of mobile phone and internet use among 11–15-years-old

Objetivo: Valorar el patrón de uso de Internet y del teléfono móvil para conocer un posible abuso, y describir los factores relacionados con este patrón en adolescentes de 11-15 años. Método: Estudio descriptivo transversal en 8 centros de educación primaria y secundaria adscritos a un centro de salud semirrural. Muestreo bietápico, por conglomerados y sistemático, con un tamaño final de la muestra de 446 participantes. Se contemplaron variables sociodemográficas y aquellas relacionadas con el Cuestionario de experiencias relacionadas con el móvil (CERM) y el Cuestionario de experiencias relacionadas con Internet (CERI). Resultados: Se obtuvieron 446 encuestas válidas, 228 niños (51,1%) y 218 niñas (48,9%) de 11 a 15 años. Tenían móvil propio 418 (93,7%). La mediana de uso del móvil fue de 12horas entre semana y 10 el fin de semana. Lo más usado fue WhatsApp (53,6%) y redes sociales (31,4%). Se observaron criterios de uso problemático de Internet (CERI≥26) en un 15,7%, especialmente en 2.o y 3.o de ESO. Las niñas presentaron mayores valores de CERI-conflictos interpersonales (p=0,04). Respecto al uso del móvil, las niñas presentaron mayor puntuación en CERM total (p=0,001) y CERM-uso comunicacional y emocional (p=0,001). Conclusiones: Los resultados obtenidos sitúan un inicio precoz de los problemas por uso de Internet y el móvil probablemente relacionado con la accesibilidad a las nuevas tecnologías. Se ha observado ausencia de control parental, más uso problemático de móvil e Internet en 2.o y 3.o de ESO y en las niñas mayores puntuaciones relacionadas con uso comunicacional, emocional y conflictos interpersonales. Los hallazgos del estudio pueden ayudar a incrementar la concienciación sobre este problema, así como detectarlo de forma precoz y prevenir los efectos de la adicción a las tecnologías en adolescentes.(AU)

Objective: To assess the pattern of problematic internet and mobile use in a sample of adolescents. Method: Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected. Results: 446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11 to 15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12hours on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001). Conclusions: The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.(AU)

Pattern of mobile phone and internet use among 11-15-years-old.

OBJECTIVE: To assess the pattern of problematic internet and mobile use in a sample of adolescents. METHOD: Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected. RESULTS: 446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11-15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12h on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001). CONCLUSIONS: The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.

Higher reproducibility of phase derived metrics from electrocardiographic imaging during atrial fibrillation in patients remaining in sinus rhythm after pulmonary vein isolation.

BACKGROUND: Electrocardiographic imaging (ECGI) allows evaluating the complexity of the reentrant activity of atrial fibrillation (AF) patients. In this study, we evaluated the ability of ECGI metrics to predict the success of pulmonary vein isolation (PVI) to treat AF. METHODS: ECGI of 24 AF patients (6 males, 13 paroxysmal, 61.8 ± 14 years) was recorded prior to PVI. Patients were distributed into two groups based on their PVI outcome 6 months after ablation (sinus vs. arrhythmia recurrence). Metrics derived from phase analysis of ECGI signals were computed for two different temporal segments before ablation. Correlation analysis and variability over time were studied between the two recorded segments and were compared between patient groups. RESULTS: Temporal variability of both rotor duration and spatial entropy of the rotor histogram presented statistical differences between groups with different PVI outcome (p < 0.05). The reproducibility of reentrant metrics was higher (R2 > 0.8) in patients with good outcome rather than arrhythmia recurrence patients (R2 < 0.62). Prediction of PVI success based on ECGI temporal variability metrics allows for an increased specificity over the classification into paroxysmal or persistent (0.85 vs. 0.64). CONCLUSIONS: Patients with favorable PVI outcome present ECGI metrics more reproducible over time than patients with AF recurrence. These results suggest that ECGI derived metrics may allow selecting which patients would benefit from ablation therapies.

Impact of Heavy Metals on Human Male Fertility-An Overview.

Heavy metals are endocrine disruptors which interfere with processes mediated by endogenous hormones of the organism, negatively affecting endocrine functions. Some studies have correlated heavy metal exposure with male infertility. However, the number of studies conducted on humans are limited. Therefore, the aim of this study is to summarize the current knowledge on how heavy metals influence human male fertility. Hence, three distinct databases were consulted-PubMed, Scopus and Web of Science-using single keywords and combinations of them. The total number of identified articles was 636. Nevertheless, by using the inclusion and exclusion criteria, 144 articles were finally included in this work. Results display that the development of adequate instruments for heavy metal assessment may play an important function in human male fertility diagnosis and treatment. Furthermore, clinical trials could be useful to confirm the role of heavy metals in human male fertility diagnosis. Overall, further research is required to fully understand the molecular and cellular basis of the influence of environmental and occupational exposure to heavy metals on human male infertility and reproductive outcomes.

MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression.

OBJECTIVES: To investigate the effect of cervical spondylosis (CS) in the brain with a combination of advanced neuroimaging techniques. METHODS: Twenty-seven patients with CS and 24 age- and gender-matched healthy controls were studied. Disease severity was quantified using the Modified Japanese Orthopaedic Association Scoring System (mJOHA). Magnetic resonance (MR) imaging of the brain and spinal cord, functional MR imaging (fMRI) with a bilateral rest/finger-tapping paradigm, brain diffusion tensor imaging (DTI), voxel-based morphometry (VBM), and MR spectroscopy of the sensorimotor cortex were performed. RESULTS: A total of 92.3% of patients had more than one herniated disc. In the MRI, 33.33% presented signs of myelopathy. The mJOHA score was 13.03 ± 2.83. Compared with controls, DTI results showed significant lower FA values in Corpus callosum, both corticospinal tracts and middle cerebellar peduncles (p < 0.05 corrected). Only in CS patients fMRI results showed activation in both globus pallidi, caudate nucleus, and left thalamus (p < 0.001). Subject-specific activation of the BOLD signal showed in CS patients lower activation in the sensorimotor cortex and increased activation in both cerebellum hemispheres (p < 0.05 corrected). VBM showed bilateral clusters of gray matter loss in the sensorimotor cortex and pulvinar nucleus (p < 0.05 corrected) of CS patients. NAA/Cr was reduced in the sensorimotor cortex of CS patients (p < 0.05). Linear discriminant and support vector machine analyses were able to classify > 97% of CS patients with parameters obtained from the fMRI, DTI, and MRS results. CONCLUSION: CS may lead to distal brain damage affecting the white and gray matter of the sensorimotor cortex causing brain atrophy and functional adaptive changes. KEY POINTS: • This study suggests that patients with cervical spondylosis may present anatomical and functional adaptive changes in the brain. • Cervical spondylosis may lead to white matter damage, gray matter volume loss, and functional adaptive changes in the sensorimotor cortex. • The results reported in this work may be of value to better understand the effect of prolonged cervical spine compression in the brain.

Microwave assisted high performance liquid chromatography for the separation of triacylglycerols in vegetable oils using an evaporative light scattering detector.

Microwave (MW) radiation was applied to perform the separation of triacylglycerols (TGs) in oil samples. The novelty of the work lies in the application of MW radiation to assist the separation of several non-polar compounds employing a totally organic mobile phase. Once the influence of the evaporative light scattering detector (ELSD) variables on the sensitivity was optimized, the TGs separation was compared conditioning the column with either a conventional HPLC or a MW oven. Contrary to previous applications in which the mobile phase contained water, the improvement in sensitivity using MW was not as significant in comparison with conventional heating but it allowed a shortening in the retention times of several TGs in about 50% respect elution at room temperature. The method was finally applied for the quantification of most common TGs in almond, tiger nut, and argan oil.

Introduction of organic/hydro-organic matrices in inductively coupled plasma optical emission spectrometry and mass spectrometry: a tutorial review. Part I. Theoretical considerations.

Due to their outstanding analytical performances, inductively coupled plasma optical emission spectrometry (ICP-OES) and mass spectrometry (ICP-MS) are widely used for multi-elemental measurements and also for isotopic characterization in the case of ICP-MS. While most studies are carried out in aqueous matrices, applications involving organic/hydro-organic matrices become increasingly widespread. This kind of matrices is introduced in ICP based instruments when classical "matrix removal" approaches such as acid digestion or extraction procedures cannot be implemented. Due to the physico-chemical properties of organic/hydro-organic matrices and their associated effects on instrumentation and analytical performances, their introduction into ICP sources is particularly challenging and has become a full topic. In this framework, numerous theoretical and phenomenological studies of these effects have been performed in the past, mainly by ICP-OES, while recent literature is more focused on applications and associated instrumental developments. This tutorial review, divided in two parts, explores the rich literature related to the introduction of organic/hydro-organic matrices in ICP-OES and ICP-MS. The present Part I, provides theoretical considerations in connection with the physico-chemical properties of organic/hydro-organic matrices, in order to better understand the induced phenomena. This focal point is divided in four chapters highlighting: (i) the impact of organic/hydro-organic matrices from aerosol generation to atomization/excitation/ionization processes; (ii) the production of carbon molecular constituents and their spatial distribution in the plasma with respect to analytes repartition; (iii) the subsequent modifications of plasma fundamental properties; and (iv) the resulting spectroscopic and non spectroscopic interferences. This first part of this tutorial review is addressed either to beginners or to more experienced scientists who are interested in the analysis of organic/hydro-organic matrices by ICP sources and would like to consider the theoretical background of effects induced by such matrices. The second part of this tutorial review will be dedicated to more practical consideration on instrumentation, such as adapted introductions devices, as well as instrumental and operating parameters optimization. The analytical strategies for elemental quantification in such matrices will also be addressed.

Introduction of organic/hydro-organic matrices in inductively coupled plasma optical emission spectrometry and mass spectrometry: a tutorial review. Part II. Practical considerations.

Inductively coupled plasma optical emission spectrometry (ICP-OES) and mass spectrometry (ICP-MS) are increasingly used to carry out analyses in organic/hydro-organic matrices. The introduction of such matrices into ICP sources is particularly challenging and can be the cause of numerous drawbacks. This tutorial review, divided in two parts, explores the rich literature related to the introduction of organic/hydro-organic matrices in ICP sources. Part I provided theoretical considerations associated with the physico-chemical properties of such matrices, in an attempt to understand the induced phenomena. Part II of this tutorial review is dedicated to more practical considerations on instrumentation, instrumental and operating parameters, as well as analytical strategies for elemental quantification in such matrices. Two important issues are addressed in this part: the first concerns the instrumentation and optimization of instrumental and operating parameters, pointing out (i) the description, benefits and drawbacks of different kinds of nebulization and desolvation devices and the impact of more specific instrumental parameters such as the injector characteristics and the material used for the cone; and, (ii) the optimization of operating parameters, for both ICP-OES and ICP-MS. Even if it is at the margin of this tutorial review, Electrothermal Vaporization and Laser Ablation will also be shortly described. The second issue is devoted to the analytical strategies for elemental quantification in such matrices, with particular insight into the isotope dilution technique, particularly used in speciation analysis by ICP-coupled separation techniques.

Diagnosis of the sentinel lymph node in breast cancer: a reproducible molecular method: a multicentric Spanish study.

AIMS: Standardization of the sentinel node (SN) as a diagnostic tool has not yet been achieved, because the protocol for histopathological study is highly variable between centres. We compared the results of a new method with conventional histological tests and evaluated its feasibility for intra-operative evaluation, and propose it as a method to standardize the sentinel node evaluation procedure. METHODS AND RESULTS: Trial 1 included 181 cases; in parallel, 2-mm-thick sections of the SN were processed alternately for histological analysis and for the one-step nucleic acid amplification (OSNA) procedure. A final concordance of 99.45% was observed in the first trial of our study. For trial 2, the timing of every procedural step was recorded in an electronic database in order to discern the time spent for each step, the total SN evaluation time and to identify areas of improvement. In the second trial, after a learning period and feedback on data recorded, we spent a mean of 31 min for the entire SN evaluation procedure. CONCLUSION: Our multi-centric trial using the OSNA assay for sentinel node evaluation in breast cancer demonstrates that this is a highly sensitive, specific and reproducible technique that allows for standardization of the SN diagnostic procedure, a necessary, and until now unresolved, issue.

Lo que no hay que hacer para desburocratizar la atención primaria / What has to be done to debureaucratise primary care

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Efectos adversos en la cirugía de la apendicitis aguda / Adverse outcomes in the surgical treatment of acute appendicitis

Objetivo. Describir los efectos adversos en la apendicectomía por apendicitis aguda y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos. Cohorte de 792 pacientes intervenidos de apendicitis aguda en la que se registraron prospectivamente las complicaciones postoperatorias, las reintervenciones y los fallecimientos, y se identificaron retrospectivamente los reingresos. Se utilizó una regresión logística para valorar las asociaciones entre complicaciones y características de los pacientes y del ingreso. Resultados. El 9,8% de los pacientes desarrolló alguna complicación posquirúrgica (infección de herida, 4,2%; complicaciones intraabdominales, 2,1%). El 0,7% requirió reintervención durante el ingreso, el 0,5% precisó ingreso en la UCI y 5 pacientes (0,6%) fallecieron. El 3,2% reingresó en el servicio de cirugía en el año siguiente de la intervención, por un problema relacionado con la cirugía previa. Los casos complicados tuvieron una estancia mayor que los no complicados (9,6 frente a 3,5 días). Las complicaciones posquirúrgicas se asociaron a una mayor edad (45-65 años: odds ratio = 3,62; p 65 años: odds ratio = 8,68; p < 0,001) y a la apendicitis complicada con perforación/peritonitis (odds ratio = 3,69; p < 0,005). El reingreso relacionado con la intervención previa sólo se asoció a la presencia de complicaciones durante el ingreso (odds ratio = 18,79; p < 0,001). Conclusiones. En la apendicectomía, los efectos adversos más relevantes son la infección de la herida y el absceso intraperitoneal, que se relacionan con la mayor edad de los pacientes y con la apendicitis perforada. Este subgrupo de alto riesgo debe alertar al cirujano a extremar la vigilancia en el proceso de atención hospitalaria (AU)

Objectives. To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. Material and methods. We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. Results. Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). Conclusions. In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance (AU)

[Adverse outcomes in the surgical treatment of acute appendicitis]. / Efectos adversos en la cirugía de la apendicitis aguda.

OBJECTIVES: To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. MATERIAL AND METHODS: We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. RESULTS: Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). CONCLUSIONS: In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance.