The genomic landscape of familial glioma.

Glioma is a rare brain tumor with a poor prognosis. Familial glioma is a subset of glioma with a strong genetic predisposition that accounts for approximately 5% of glioma cases. We performed whole-genome sequencing on an exploratory cohort of 203 individuals from 189 families with a history of familial glioma and an additional validation cohort of 122 individuals from 115 families. We found significant enrichment of rare deleterious variants of seven genes in both cohorts, and the most significantly enriched gene was HERC2 (P = 0.0006). Furthermore, we identified rare noncoding variants in both cohorts that were predicted to affect transcription factor binding sites or cause cryptic splicing. Last, we selected a subset of discovered genes for validation by CRISPR knockdown screening and found that DMBT1, HP1BP3, and ZCH7B3 have profound impacts on proliferation. This study performs comprehensive surveillance of the genomic landscape of familial glioma.

Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis.

BACKGROUND: Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. METHODS: This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. RESULTS: Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. CONCLUSIONS: PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.

Short-term peripheral sensitization by brief exposure to pheromone components in Spodoptera littoralis.

In insects, the olfactory system displays a high degree of plasticity. In Spodoptera littoralis, pre-exposure of males to the sex pheromone has been shown to increase the sensitivity of the olfactory sensory neurons at peripheral level. In this study, we have investigated this sensitization effect by recording the electroantennographic responses of male antennae to the major sex pheromone component (Z,E)-9,11-tetradecadienyl acetate and to the minor components (Z,E)-9,12-tetradecadienyl acetate and (Z)-9-tetradecenyl acetate. Responses to the conjugated diene acetate at 1 and 10 µg and to the unconjugated ester at 10 µg at three different times (11, 22 and 33 min) after pre-exposure (T = 0 min) were significantly higher than those at T = 0, whereas no increase of sensitivity to the pheromone was elicited by any dose of the minor monoene acetate. In addition, pre-exposed antennae to sub-threshold amounts (0.1, 1 and 10 ng) of the major pheromone component also induced an increased response to the chemical at different times (5 and 15 min) after exposure. Our results revealed that pre-exposed isolated antennae display a short-term higher sensitivity at the peripheral level when compared to naive antennae. In addition, we provide evidence of a peripheral sensitization mediated not only by the major pheromone component, but also by the minor unconjugated diene acetate, and the induction of this sensitivity appears to be dependent on the pre-exposure dose and the time span between pre-exposure and subsequent recordings. Possible implications of the sensitization effect displayed by the minor component for a more effective discrimination of the pheromone bouquets of other closely related species are highlighted.

Proteomic and transcriptomic analysis of rice tranglutaminase and chloroplast-related proteins.

The recently cloned rice transglutaminase gene (tgo) is the second plant transglutaminase identified to date (Campos et al. Plant Sci. 205-206 (2013) 97-110). Similarly to its counterpart in maize (tgz), this rice TGase was localized in the chloroplast, although in this case not exclusively. To further characterise plastidial tgo functionality, proteomic and transcriptomic studies were carried out to identify possible TGO-related proteins. Some LHCII antenna proteins were identified as TGO related using an in vitro proteomic approach, as well as ATPase and some PSII core proteins by mass spectrometry. To study the relationship between TGO and other plastidial proteins, a transcriptomic in vivo Dynamic Array (Fluidigm™) was used to analyse the mRNA expression of 30 plastidial genes with respect to that of tgo, in rice plants subjected to different periods of continuous illumination. The results indicated a gene-dependent tendency in the expression pattern that was related to tgo expression and to the illumination cycle. For certain genes, including tgo, significant differences between treatments, principally at the initiation and/or at the end of the illumination period, connected with the day/night cycling of gene expression, were observed. The tgo expression was especially related to plastidial proteins involved in photoprotection and the thylakoid electrochemical gradient.

Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009.

During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35­39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.

Design and application of GB virus C (GBV-C) peptide microarrays for diagnosis of GBV-C/HIV-1 co-infection.

The main objectives of the design of GB virus C (GBV-C) peptide microarrays are the miniaturisation of antigen-antibody interaction assays, the simultaneous analysis of several peptide sequences and the reduction in the volume of serum required from patients since this always represents a limiting factor in studies to develop new systems for diagnosing human diseases. We herein report the design of a microarray immunoassay based on synthetic peptides derived from the GBV-C E2 protein to evaluate their diagnostic value in detecting anti-E2 antibodies in HIV-1 patients. To this end, peptide microarrays were initially prepared to identify the most relevant epitopes in the GBV-C E2 protein. Thus, 124 peptides composed of 18 amino acids covering the whole E2-protein sequence, with 15 residue overlaps, were spotted in triplicate onto γ-aminopropyl silane-functionalised adsorbent binding slides. The procedure to select the E2 protein epitopes was carried out using serum samples from HIV-1-infected patients. The samples had previously been tested for the presence or absence of GBV-C anti-E2 antibodies by means of the Abbott test. Thus, 11 specific epitopes in the GBV-C E2 protein were identified. Subsequently, peptide antigen microarrays were constructed using the E2 epitopes identified to detect GBV-C anti-E2 antibodies in the serum of HIV-1-infected patients with no known GBV-C co-infection. The 11 peptides selected identified anti-E2 GBV-C antibodies among HIV-1-infected patients, and a reactivity of 47 % was established. The potential antigenic peptides selected could be considered a useful tool for designing a new diagnostic system based on peptide microarrays to determine anti-GBV-C E2 antibodies in the serum of HIV-1-infected patients.

Cuidados enfermeros en Cuidados Paliativos: Análisis, consensos y retos / Nursing care in Palliative Care: analysis, consensuses and challenges

La creciente complejidad de los cuidados que requieren las personas en situación de enfermedad avanzada y al final de vida, y la variabilidad de profesionales sanitarios que intervienen en el proceso asistencial, nos conduce a clarificar el rol profesional enfermero en el equipo multidisciplinar de Cuidados Paliativos (CP). Objetivo: reflexionar sobre la práctica enfermera en CP. Metodología: Técnica del grupo nominal. Se seleccionaron 10 enfermeras con más de 10 años de experiencia profesional en CP. Categorías elegidas para la atención enfermera: Evolución de los cuidados, de la profesión enfermera, funciones y actividades de enfermería, historia de los cuidados paliativos. Conclusiones: Necesidad de definir las competencias enfermeras en CP; Necesidad de contemplar la práctica profesional en el marco de un modelo conceptual y la aplicación del método científico enfermero; Necesidad de avanzar en prácticas reflexivas basadas en evidencias científicas; Iniciar una línea de investigación en competencias enfermeras en CP (AU)

The increasing complexity of care needed by patients with advanced diseases or end-of-life situation, added to variability of health professionals who participate in patient care, make necessary to clarify the specific role of nurses in a interdisciplinary Palliative Care team (PC). Aim: To establish a reflection about the nurse practice in PC. Methodology: Nominal group study. Ten nurses with more than 10 years of experience in PC were selected. The main areas of discussion were: the evolution of care and nursing profession, the general practice of nurses and Palliative Care history. Conclusion: There is the need: a) define nurse's competences in PC; b) describe the professional practice in the frame of a conceptual model and the application of nurse's scientific method; c) advance in a practice based on scientific evidence; d) start a research line about nurse's competences in PC (AU)

Factores asociados con la no realizacion de la prueba de la tuberculina en una cohorte de pacientes VIH positivos / Factors related to non-prescription of tuberculin skin testing in a cohort of HIV-infected people

Introduccion Dada la asociacion entre tuberculosis (TB) e infeccion por VIH, la realizacion del Mantoux esta indicada en todo paciente infectado con VIH. Este articulo analiza la frecuencia de no realizacion de la prueba de la tuberculina y sus factores asociados en una cohorte de infectados con VIH. Pacientes y metodos Entre 2000-C2002 se identifico en 10 hospitales a todos los pacientes infectados con VIH y no seguidos previamente, de forma regular, en consultas especificas. Se recogio informacion de la historia clinica sobre realizacion del Mantoux y otras variables. Se calculo el porcentaje de no realizacion del Mantoux y los factores asociados mediante la utilizacion como medida de asociacion de la odds ratio (OR) y su intervalo de confianza (IC) del 95%. Para el analisis multivariante se ajusto un modelo de regresion logistica. Resultados Mil doscientos cuarenta y dos pacientes cumplieron criterios de inclusion y a 185 pacientes no se les realizo el Mantoux (el 17,6% de aquellos en los que estaba indicado). La probabilidad de no realizacion del Mantoux fue mayor en usuarios de drogas (OR: 2,6; IC del 95%: 1,1¨C6,5) y menor entre los desempleados (OR: 0,6; IC del 95%: 0,3¨C1,0), aquellos con mas de 200 CD4 (CD4 200¨C499: OR: 0,5; IC del 95%: 0,3¨C0,9; CD4 ¡Ý500: OR: 0,3; IC del 95%: 0,2¨C0,6) y los contactos con enfermos tuberculosos (OR: 0,2; IC del 95%: 0,1¨C0,5).ConclusionesEl porcentaje de no realizacion del Mantoux es bastante elevado. La no realizacion del Mantoux parece asociarse con las expectativas del medico, tanto sobre el resultado de la prueba como sobre la correcta cumplimentacion del tratamiento preventivo anti-TB por el paciente ( AU)

Introduction Tuberculin skin testing (TST) for tuberculosis (TB) is recommended for all patients with HIV infection because of the known relationship between these two conditions. In this report we analyze the incidence and variables associated with non-prescription of TST in a cohort of HIV-infected people. Patients and methods Longitudinal study conducted between 2000 and 2002 at 10 HIV hospital-based clinics. All HIV-infected patients who had not been regularly followed-up previously in dedicated clinics were identified. Data about TST and other variables related to TB were obtained from the clinical records. We calculated the percentage of patients who did not undergo TST and the associated factors, using odds ratios (ORs) and the 95% CI to investigate associations. A multivariate logistic regression analysis was performed. Results A total of 1242 patients met the inclusion criteria. TST was not performed in 185 patients (17.6% of those eligible). The fact of being an intravenous drug abuser was associated with a higher probability of TST non-prescription (OR: 2.6, 95% CI 1.1¨C6.5), whereas being unemployed (OR: 0.6, 95% CI 0.3¨C1.0), having a CD4 cell count >200 (CD4 200¨C499: OR 0.5, 95% CI 0.3¨C0.9. CD4¡Ý500: OR 0.3, 95% CI 0.2¨C0.6), and contact with persons with TB (OR 0.2, 95% CI 0.1¨C0.5) were associated with a lower probability. ConclusionsIn this study, the percentage of TST non-prescription was quite high. The results suggest that TST non-prescription in this population is related to the clinicians¡¯ expectations regarding the results of the test and the patients¡¯ adherence to treatment for latent TB infection(AU)

Short-term impact of particulate matter (PM2.5) on daily mortality among the over-75 age group in Madrid (Spain).

BACKGROUND: The 2006 World Health Organization Air Quality Guidelines recommend using particulate matter having a diameter of under 2.5 micra (PM(2.5)) rather than PM(10) as an indicator of air particle concentration, a pattern followed by new European directives. Nevertheless, few studies have analysed this new indicator's impact at a European level on daily mortality among a high-risk group, such as persons aged over 75 years. OBJECTIVE: This study sought to analyse and quantify the effect of PM(2.5) on daily cause-specific mortality among the over-75 age group in the city of Madrid. METHODS: Using Poisson regression with Generalized Additive Models (GAM), a longitudinal, ecological time-series study examined the following causes of death: all causes except accidents (International Classification of Diseases-9th revision (ICD 9): 1-799); circulatory causes (ICD 9: 390-459); and respiratory causes (ICD 9: 460-519). These were adjusted for other chemical, biotic and acoustic pollutants. Further control variables considered were: trend; seasonality; influenza epidemics; and autocorrelation between mortality series. RESULTS: A significant statistical association was detected between daily mean PM(2.5) particle concentrations and all-cause mortality in the city of Madrid. This association was not in evidence for PM(10) concentrations. The Relative Risks found for an increase of 25 microg/m(3) in PM(2.5) concentrations were as follows: all-cause mortality, 1.057 (1.025-1.088); circulatory-cause mortality, 1.088 (1.041-1.135); and respiratory-cause mortality, 1.122 (1.056-1.189). The Attributable Risks were 5.41%, 8.12% and 10.90% respectively. This effect was observed in the short term (lags 1-2). CONCLUSION: Our results indicate a strong impact of PM(2.5) concentrations on daily mortality among the over-75 age group in Madrid, and underscore the need for measures aimed at lowering the concentration levels of this primary air pollutant in large cities, particularly by reducing motor vehicle traffic, the main source of such pollutant emission in urban atmospheres.

Subfield and layer-specific depletion in calbindin-D28K, calretinin and parvalbumin immunoreactivity in the dentate gyrus of amyloid precursor protein/presenilin 1 transgenic mice.

The depletion of neuronal calcium binding proteins deprives neurons of the capacity to buffer high levels of intracellular Ca(2+) and this leaves them vulnerable to pathological processes, such as those present in Alzheimer's disease (AD). The aim of the present study was to investigate the expression of the calcium binding proteins, calbindin-D28K, calretinin and parvalbumin in the dentate gyrus (DG) of amyloid precursor protein (APP)/presenilin 1 (PS1) transgenic (Tg) mice and their non-Tg littermates, as well as the relation with the deposition of human amyloid beta (Abeta). We measured the expression of these three proteins at seven different rostro-caudal levels, and in the molecular, granular and polymorphic layers of the DG. We found that, except in the most caudal part of the DG, there is a substantial loss of calbindin-D28K immunoreactivity in all three layers of the DG in APP/PS1 mice compared with the non-Tg mice. Significant loss of calretinin immunoreactivity is present in most of the polymorphic layer of the DG of APP/PS1 mice compared with the non-Tg mice, as well as in the rostral and intermediate part of the inner molecular layer. Compared with the non-Tg mice parvalbumin immunoreactivity is significantly reduced throughout the whole polymorphic layer as well as in the rostral and intermediate part of the granular layer of DG in APP/PS1 mice. The relatively preservation of calbindin immunoreactivity in the caudal part of molecular and granular layers as well as calretinin immunoreactivity in the caudal part of polymorphic layer of the DG is likely related to the lower Abeta expression in those parts of DG. The present data suggest an involvement of calcium-dependent pathways in the pathogenesis of AD and indicate that there exists a subfield and layer-specific decrease in immunoreactivity which is related to the type of calcium-binding protein in APP/PS1 mice. Moreover, it seems that APP expression affects more the calbindin expression then parvalbumin and calretinin expression in the DG of APP/PS1 Tg mice.

Prevalence of M. tuberculosis infection and tuberculosis disease among HIV-infected people in Spain.

OBJECTIVE: To study the prevalence of Mycobacterium tuberculosis infection (MTBI) and past/current tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons in Spain. DESIGN: Longitudinal study conducted between 2000 and 2003 at 10 HIV hospital-based clinics. Data were drawn from clinical records. Associations were measured using odds ratios (ORs) and their 95% confidence intervals (95%CI). RESULTS: Of the 1242 persons who met the eligibility criteria, most were male (75%), aged <40 years (75%) and unemployed (40%). HIV infection occurred through intravenous drug use (53%), heterosexual sex (29%) and sex between men (16%). In the initial evaluation, 315 subjects had evidence of MTBI: 84 (6.8%) had a history of TB, 23 (1.8%) current TB and 208 (16.8%) latent tuberculosis infection (LTBI). MTBI was associated with male sex, age 30-49 years, contact with a TB case, homelessness, poor education, and negatively with CD4 <100 cells/mm(3). Among subjects with MTBI, past/current TB was associated with retirement/disability (OR 6, 95%CI 1.6-22.5), CD4 <200 cells/mm(3) (OR 9.7, 95%CI 3.8-24.6), viral load >55,000 copies (OR 5.3, 95%CI 1.4-20.0), and negatively, with skilled work (OR 0.4, 95%CI 0.1-1.0) or administrative/managerial/professional work (OR 0.05, 95%CI 0.01-0.4). CONCLUSION: Social context has an impact on the effectiveness of HIV and TB control programmes even in industrialised countries with free access to health care.

Classification of surgical procedures for epidemiologic assessment of sporadic Creutzfeldt-Jakob disease transmission by surgery.

BACKGROUND: In this preparatory phase of a case-control study, we propose and evaluate a new tool for classifying surgical procedures (SPs) in categories useful for epidemiologic research on surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD). METHODS: All SPs reported to the Swedish National Hospital Discharge Registry in the period 1974-2002, and undergone by 212 Swedish patients with registered diagnosis of CJD at death, hospital discharge or notification, in the period 1987-2002, 1060 age-, sex- and residence-matched controls and 1340 randomly chosen population controls, were reclassified into one of six categories of hypothetical transmission risk level. For that purpose the following two attributes were used: non-disposable instruments involved; and highest assigned ad-hoc risk level for four tissues or anatomical structures contacting such instruments. RESULTS: A total of 1170 different SP codes were reclassified as follows: 3.1% in the high-risk, 59.1% in the lower-risk, 24.4% in the lowest-risk, and 2.1% in the no-risk groups, with 11.3% procedures negatively defined by rubric as "other than..." being assigned to two spurious diluted-high and diluted-lower risk categories. The high-risk group mainly comprised neurosurgical (53%) and ophthalmic (39%) procedures. Sensitivity of neurosurgery and of ophthalmic surgery excluding neurosurgery, for the high- and diluted-high risk vs. other categories was 46% and 84%, while specificity was 98% and 95%, respectively. Sensitivity analysis based on these indices revealed that non-significant odds ratio effects of 1.4 and 1.3 for neurosurgery and ophthalmic surgery corresponded to statistically significant values of 5.1 after reclassification. CONCLUSIONS: This classification might contribute to quantify effects masked by use of body-system SP-categories in case-control studies on sCJD transmission by surgery.

Determinants of health system delay among confirmed tuberculosis cases in Spain.

BACKGROUND: Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. METHODS: Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. RESULTS: A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. CONCLUSION: Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.

Grupos de apoyo al proceso de duelo: 5 años de evolución / Bereavement support groups: 5 years of experience

La Unidad de Cuidados Paliativos del Instituto Catalán de Oncología lleva 5 años desarrollando grupos de apoyo al proceso de duelo para familiares de personas atendidas por dicho servicio. Se trata de grupos socioterapéuticos, donde lo que se pretende es ofrecer la posibilidad de que las personas que lo deseen puedan disfrutar de un espacio donde expresen libremente sus sufrimientos, preocupaciones, dudas, etc., mediante una participación activa. Dichos grupos se llevan a cabo una vez al mes, con una duración de una hora y media y la asistencia permitida es de unos 9 meses. El grupo está conducido por dos coordinadoras, una enfermera y la trabajadora social del servicio. La función es ayudar a las personas participantes a desarrollar sus propias capacidades a través de favorecer la confianza en ellos mismos, mediante el respeto por su situación, el intercambio de experiencias y de los espacios reflexivos que se dan en el grupo. A su vez, el servicio recoge de los participantes aquellas apreciaciones sobre la asistencia recibida. Los resultados vienen dados por la asiduidad de la participación, la constancia en la asistencia y la satisfacción expresada de forma libre, abierta y espontánea por los participantes. Finalmente, para poder demostrar que el trabajo socioterapéutico ayuda a evitar complicaciones en los procesos de duelo, será necesario encontrar sistemas de evaluación comprometidos y fiables (AU)

The palliative team at the Institute Català d'Oncologia developed the bereavement support groups during five years with the families attended in service. Those groups are focussed in a social-therapeutic intervention offering the place and the opportunity to free their feelings, worries and doubts in an interactive relation, for ninety minutes session once per month, for a nine months period per person. Each group was coordinated by the trained nurse and the palliative social worker. Their objective is to help participants to develop the families' emotional resources to increase their own trust and self-confidence using a reflexive thinking, sharing experiences and respecting each particular situation. The groups, as well, facilitate the data for a feedback process about perceptions in quality and satisfaction on the service. The outcome criteria were verbal satisfaction, attendance and participation, openly expressed by families. Finally, we conclude that the social therapeutic intervention help to avoid some common difficulties in the bereavement process. We need to find adequate tools to evaluate and to validate our efficacy (AU)

Determinants of patient delay among tuberculosis cases in Spain.

BACKGROUND: Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population. METHODS: Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated. RESULTS: A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes. CONCLUSION: Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.

Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people.

OBJECTIVES: To measure the reliability of the Mini Nutritional Assessment (MNA) in institutionalized elderly people. DESIGN: 12 day interobserver reliability study. PARTICIPANTS AND SETTING: All subjects admitted to two long term geriatric units in Mataró (Barcelona, Spain) over 4 months during 1996 (n=67). MEASUREMENTS: in each center, different trained nurses independently administered the MNA on two separate occasions. RESULTS: Mean (standard deviation) scores for the two assessments of the MNA were 20.8 (5.4) and 21.3 (4.6) respectively. Internal consistency, estimated by the Cronbach's Alpha, were 0.83 and 0.74 for the first and second assessment respectively. Test-retest reliability, according to the intraclass correlation coefficient (ICC), was 0.89 for the total MNA score and higher than 0.89 for its continuous items. According to the Kappa index, test-retest reliability for the stratified total MNA was substantial (0.78); for the 18 ordinal or nominal items of the MNA it was 'almost perfect' or 'substantial' in 12 items, 5 were 'moderate' to 'fair' and in I item it was 'slight'. Subjective health evaluation, the number of glasses of liquids per day, and brachial circumference (this former with an ICC=0.91) were the items with the lowest Kappa indices. CONCLUSION: The MNA test has good levels of reliability, according to its internal consistency and its test-retest reproducibility. Some improvements can still be introduced by refining the categorization and content of some items with low reliability.

Biomonitoring study of people living near or working at a municipal solid-waste incinerator before and after two years of operation.

The authors conducted a biomonitoring study in the town of Mataró, Spain, of 104 subjects who lived near (i.e., within 0.5-1.5 km) an incinerator, 97 subjects who lived far (i.e., within 3.5 km-4.0 km) from an incinerator, and 17 workers at a new municipal solid-waste incinerator. The study commenced before the incinerator started functioning in 1995, and 2 y later (1977) the authors undertook the final part of the study. Dioxins, furans, and polychlorinated biphenyls were studied in pooled blood samples (n = 22), and individual blood and urine samples were analyzed for the detection of lead, chromium, cadmium, and mercury. In 1995, dioxin blood levels were low-both among those living close to the incinerator (mean = 13.5 ng international-dioxin toxic equivalents/kg fat) and among those living far away (mean = 13.4 ng international-dioxin toxic equivalents/kg fat). In 1997, dioxin and polychlorinated biphenyl levels had increased in both groups of residents by approximately 25% and 12%, respectively. (The increase in dioxin levels was about 10% when the authors took into account the mean of two repeated quality-control analyses.) Blood lead levels decreased, but no difference was observed for chromium, cadmium, and mercury. Minimal changes were seen among workers. Given the low dioxin stack emissions from this plant (mean = 2.5-0.98 ng international-dioxin toxic equivalents/m3) and that the blood dioxin levels did not depend on distance of residence from the incinerator, it would appear unlikely that the small increase in dioxin blood levels resulted from the incinerator's emissions.

Occupation and risk of malignant pleural mesothelioma: A case-control study in Spain.

BACKGROUND: The association of mesothelioma and asbestos exposure is well known, but some data suggest that probably many people are still being exposed to asbestos without knowing it. METHODS: Between 1993 and 1996, 132 cases (77% males) of histologically confirmed malignant pleural mesothelioma and 257 controls, residents in two provinces of Spain (Barcelona and C¿adiz), were interviewed. They were classified according to their probability and intensity of occupational asbestos exposure by a panel of industrial hygienists, based on a detailed occupational history. RESULTS: Age and sex-adjusted odds ratio (OR) for the highest probability of exposure to asbestos was 13.2 (95% confidence interval 6.4-27.3), and 27.1 (9. 28-79.3) for high intensity. A dose-response trend was observed for both, probability and intensity. Overall, 61% of cases and 42% of controls had ever worked in an occupation with risk of asbestos exposure, with an OR of 2.59 (1.60-4.22). In our population 62% of cases could be attributed to occupational asbestos exposure. CONCLUSIONS: A high risk of pleural mesothelioma due to occupational asbestos exposure is confirmed, but there is still a sizeable proportion for which no evidence of occupational exposure was found. Most of these cases could be due to other sources of asbestos exposure, mainly domestic or environmental.

[Determinants associated wtih the presence of risk behaviors in HIV infected patients]. / Determinantes asociados al mantenimiento de comportamientos de riesgo para la transmisión del VIH en pacientes ya infectados.

BACKGROUND: Determinants associated with risk behaviours are evaluated in a known HIV-infected population not belonging to the great metropolitan nuclei. PATIENTS AND METHODS: 110 unselected HIV+ patients were interviewed, including 77 variables. Their association with sharing needles, and unprotected sex is analysed. RESULTS: Sharing needles was associated to: low academic achievement (p = 0.045), no children (p = 0.045), any physical limitation (p = 0.004), previous admission to detoxification unit (p = 0.014), and depression. With unprotected sex were associated: low academic achievement (p = 0.005), lesser time of HIV infection (p = 0.009), no family support (p = 0.005), and scanty information about HIV transmission (p = 0.018). CONCLUSIONS: A cohort of HIV-infected subjects who persist with risk practices is remaining. Some easily recognizable variables may be useful for their early recognition.

Topical heparin for the treatment of acute superficial phlebitis secondary to indwelling intravenous catheter. A double-blind, randomized, placebo-controlled trial.

OBJECTIVE: To assess the clinical efficacy of a topical gel containing 1000 IU x g(-1) of heparin, applied three times daily for a maximal period of 7 days to patients with acute superficial phlebitis secondary to indwelling intravenous catheter. METHODS: A Double-blind, randomized, placebo-controlled study was conducted in one of the internal medicine wards of a tertiary General Hospital in Barcelona, Spain. Inpatients of both genders over 18 years of age that developed superficial phlebitis and gave informed consent were included in the study. The sample size estimation was 132 patients. Sixty-six patients were allocated to each group. There were five protocol deviations and 24 withdrawals in the intervention group, and one protocol deviation and 25 withdrawals in the control group. Consequently, 37 patients in the intervention group and 40 in the control group completed the trial. The main outcome measure was the disappearance of the symptoms and signs of superficial phlebitis. Clinical course, investigator's global impression and adverse events were also recorded. RESULTS: According to the intention-to-treat analysis, after treatment for 7 days superficial phlebitis healed in 27 of the 61 patients (44.3%) who received topical heparin, and in 17 of the 65 patients (26.1%) receiving placebo, giving a relative risk [95% confidence interval (CI)] of 1.69 (1.03-2.78). This indicates that six patients (95% CI, 3-72) have to be treated in order to induce one additional healing. The clinical course and the overall clinical impression were similar in both groups. One patient treated with topical heparin developed mild urticaria. CONCLUSION: Topical heparin is safe and effective for the treatment of superficial phlebitis secondary to indwelling intravenous catheter.