Demonstration of Single-Barium-Ion Sensitivity for Neutrinoless Double-Beta Decay Using Single-Molecule Fluorescence Imaging.

A new method to tag the barium daughter in the double-beta decay of ^{136}Xe is reported. Using the technique of single molecule fluorescent imaging (SMFI), individual barium dication (Ba^{++}) resolution at a transparent scanning surface is demonstrated. A single-step photobleach confirms the single ion interpretation. Individual ions are localized with superresolution (∼2 nm), and detected with a statistical significance of 12.9σ over backgrounds. This lays the foundation for a new and potentially background-free neutrinoless double-beta decay technology, based on SMFI coupled to high pressure xenon gas time projection chambers.

Alteraciones endocrinológicas en el síndrome de Down / Endocrine disorders in Down’s syndrome

La prevalencia de alteraciones endocrinológicas, generalmente de origen autoinmune, es muy elevada en las personas con síndrome de Down. Por ello, durante toda la vida se debe vigilar la función tiroidea. Es especialmente frecuente el hipotiroidismo, especialmente en su forma subclínica. La delgada línea que separa el hipotiroidismo subclínico del verdadero hace difícil la indicación terapéutica. También la diabetes es más frecuente que en la población general, ocasionalmente asociada a hipotiroidismo (AU)

The prevalence of endocrine disorders, generally of autoimmune origin, is very high in persons with Down’s syndrome. Therefore, the thyroid function should be monitored during the entire lifetime. Hypothyroidism, particularly the subclinical form, is especially common. The thin line separating subclinical hypothyroidism from true hypothyroidism makes the therapeutic indication difficult. Diabetes is also more frequent than in the general population, occasionally associated to hypothyroidism (AU)

Regulation of cyclooxygenase-1 and -2 expression in human nasal mucosa. Effects of cytokines and dexamethasone.

BACKGROUND: Cyclooxygenase (COX) converts arachidonic acid in prostanoids. COX exists in two isoforms, COX-1 is the constitutive whereas COX-2 is the inducible isoform. The regulation of COX-1 and COX-2 expression in nasal mucosa has not been previously reported. AIM: We studied expression and regulation by cytokines and corticosteroids of COX-1 and COX-2 in human nasal mucosa. Cultured human nasal explants from patients undergoing corrective nasal mucosal resection were examined for COX-1 and COX-2 expression by semiquantitative competitive PCR and Western blot. METHODS: Explants were incubated with pro-(IFNgamma, IL-1beta, and TNF-alpha) and anti(IL-10) inflammatory cytokines and dexamethasone. The mechanisms which regulate COX-2 mRNA expression were studied using inhibitors of translation (Actinomycin D) and transcription (Cicloheximide). RESULTS: The baseline expression of COX-2 mRNA was higher than COX-1 mRNA. Once in culture, there was a slight spontaneous up-regulation of COX-1 and a strong COX-2 mRNA and protein up-regulation. The incubation of nasal explants with pro-inflammatory cytokines increased the expression of COX-2 mRNA and protein, from 1 to 24 h of incubation in a dose-related manner. The regulation of these effects occurred at both transcriptional and post-transcriptional levels. Dexamethasone and IL-10 abrogated cytokine-induced COX-2 mRNA and protein expression. Pro-inflammatory cytokines, dexamethasone and IL-10 had no effect on COX-1 mRNA expression. CONCLUSIONS: As prostanoids have important regulatory effects on the immunologically mediated inflammatory responses, our findings throw some light on the mechanisms that regulate the enzymes which produce these metabolites in the human airway.

Cyclooxygenase-2 mRNA is downexpressed in nasal polyps from aspirin-sensitive asthmatics.

Exogenous prostaglandin E2 (PGE2) given by inhalation almost completely abrogates aspirin-induced asthma and the accompanying increase in cysteinyl-leukotrienes production. Cyclooxygenase (COX) may be present in cells in both constitutive (COX-1) and inducible (COX-2) forms. To increase the production of the potentially protective endogenous PGE2, COX-2 should be upregulated. We hypothesize that an abnormal regulation of COX-2 will predispose patients with asthma to develop aspirin-intolerant asthma/rhinitis (AIAR). We therefore examined the expression of COX-2 messenger RNA (mRNA) in healthy nasal mucosa (n = 11) and in nasal polyps from both patients with AIAR (n = 8) and those with aspirin-tolerant asthma/rhinitis (ATAR) (n = 20). After total mRNA extraction, COX-1 and COX-2 mRNA expression were measured using a reverse transcriptase (RT)-semiquantitative PCR technique. Hybrid primers of COX-1. glyceraldehyde-3-phosphate dehydrogenase (GAPDH) or COX-2. GAPDH were used to create PCR products that were cloned and used as internal standard controls in the competitive PCR reaction. Results are presented as mean +/- standard error of 10(6) molecules of mRNA/micrograms of total RNA. No differences in COX-1 mRNA expression were found between nasal mucosa and nasal polyps from both patients with ATAR and those with AIAR. However, COX-2 mRNA expression in nasal polyps from the AIAR group (0.38 +/- 0.10) was markedly and significantly lower than in polyps from the ATAR group (2.93 +/- 0. 52, sevenfold, p < 0.0001) and nasal mucosa (2.10 +/- 0.54, sixfold, p < 0.01). These findings suggest that an inadequate COX-2 regulation may be involved in AIAR.

[Patient preference and stereotype about the gender of the family physician]. / Preferencias y estereotipos de los pacientes sobre el género del médico de familia.

OBJECTIVE: To study the preferences of patients on the gender of the physician when consulting for particular health problems; and to know the gender stereotypes that patients assign to physicians. DESIGN: Cross-sectional study. SETTING: Five teaching health centres in Granada (Spain). PATIENTS: Randomised sample of patients that consulted 10 female and 20 female physicians during three months (17 patients per physician), for alfa = 5%, beta = 80%, to detect a difference of 12% between male and female physicians. MEASUREMENTS AND MAIN RESULTS: We used a questionnaire adapted from Fennema (Family Medicine Dept., Wisconsin University, 1990) that was administered by interviewers after the consultancy, following a previous pilot study. Preference and stereotype scales comprised 10 items, with five reponses (neutral mid-point). Differences were analysed with chi 2 with correction for continuity. Non-reponders (33%) were replaced, and their age and sex did not bias the study results. Responders were 210 males (40.9%) and 304 women (59.1%). For "flux in penis/vagina" and "haemorrhoids" 50-60% of the patients preferred a physician of the same sex, with the remainder expressing no preference. The women preferred female physicians for family problems (23%) and depression (23%). The male physicians were more often perceived to be unorganised than were the females (24% vs. 5%, p < 0.0005), while the female physicians were more often described as humane (15% vs. 10%, p < 0.0005). Characteristics expressing technical competence were more often attributed to the male physicians than to the females, while those expressing empathy were more often attributed to the female physicians. CONCLUSIONS: Patients prefer physicians of the same gender for some health problems and not for others. Patients assign gender stereotypes to physicians. These findings will permit a better interpretation of doctor-patient relationships.

[Effects of chronic diseases on the use of primary care by the aged]. / Influencia de la patología crónica sobre la utilización de atención primaria en la tercera edad.

OBJECTIVE: To analyse how often elderly people attend Primary Care (PC) consulting rooms and how attendance is affected by the number and kind of chronic pathologies those elderly people suffer. SETTING: A medical list from each of three Health Centres in the city of Granada was chosen. PATIENTS: All those over 65 registered on these lists from 1990 to 1994 inclusive, 711 people in total, were included. The number of attendances and chronic illnesses were obtained from the Clinical Records. The outcome variable "Mean Annual Consultations" (MAC) over the study period was analysed by ANOVA and multiple linear regression. RESULTS: MAC was 5.79 (SD 4.20), with a range from 0 to 27 consultations. MACs were significantly higher among the elderly registered at the Doctors' Health Centre (p < 0.001), among women (p < 0.05) and for the presence of any of the pathologies under consideration (p < 0.01) except dementia. A relationship was found between the number of comorbidities and MAC (p < 0.001). In the scaled multiple regression analysis, the number of comorbidities, the first variable introduced into the model, explained 33% of variability in use. CONCLUSIONS: The number of chronic pathologies strongly determines elderly people's attendance at PC consulting rooms, independently of the kind of illness they suffer from.

Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium.

BACKGROUND: Eosinophil infiltration is a hallmark of the inflammatory response in rhinitis and in nasal polyposis. OBJECTIVE: We studied the effect of steroids and nedocromil sodium on eosinophil survival primed by epithelial cells from healthy (nasal mucosa) and inflamed (nasal polyp) respiratory tissue. METHODS: Blood eosinophils were incubated with increasing concentrations (10(-11)-10(-5) M) of topical steroids (fluticasone propionate, budesonide, triamcinolone acetonide and beclomethasone dipropionate) and/or nedocromil sodium prior to the addition of human epithelial cell conditioned media (HECM), eosinophil viability was measured and IC50 for each drug was calculated. RESULTS: All four steroids and nedocromil sodium caused a dose-related inhibition of HECM-induced eosinophil survival. The IC50 of steroids were lower in eosinophils primed by mucosa HECM than on those primed by polyp HECM (fluticasone, 4 nM vs 114 nM; budesonide, 21 nM vs 280 nM; triamcinolone, 7 nM vs 853 nM; and beclomethasone, 171 nM vs 181 nM). The combined inhibitory effect of 10(-7) M budesonide plus 10(-5) M nedocromil (43.8 +/- 10.8%, P<0.03) was significantly higher than budesonide (28.5 +/- 9.2%) or nedocromil (16.7 +/- 5.4%) alone and close to 10(-5) M budesonide (52.3 +/- 11%). No differences were found in cytokine (IL-8, IL-6, GM-CSF, TNF alpha, IL-1beta and RANTES) concentrations between HECM from mucosa and polyps. CONCLUSION: These results suggest that topical anti-inflammatory drugs may diminish airway eosinophilic infiltration by decreasing eosinophil viability, that nasal polyp epithelial cell secretions may induce steroid resistance in eosinophils, and that nedocromil sodium has additive effects with steroids.

[Assessment of health needs of the aged]. / Valoración de necesidad en el anciano.

The increase of ancient population constitutes a challenge for society in general and for the health services in particular in relation with the offer planning and adequacy. It is important to know the health needs and status of our old people population to determine the intervention priorities and, on the other part, to measure the programmes efficiency and efficacy. As years go on, body organs get old in a different way, which leads to individual variations in the speed of organs and systems deterioration; that is why, a reasonable good scale of and overall health does not exist in contrast with functional status and psychological health. Certain cultural attitudes towards aging and the health care resources availability make measurement more difficult, as well. For all elaborated with and overall point of view, by means of a systematic search of problems and a total valuation of his health needs.

[Inter-episode continuity of primary health care: proposal for an indicator]. / La continuidad interepisodios en atención primaria de salud: propuesta de un indicador.

The objective of this study was to assess the quality of the data included in patients' personal histories and to prepare an indicator of the continuity of health care between episodes of illness based on the information contained in these records. The study was descriptive. Public health specialists from the Department of Preventive Medicine of the University of Granada, Spain, participated in the design and analysis, and the field work was carried out by specialists from family and community medicine from the Zaidín-Sur Health Center of Granada, where the research was conducted in April to December 1989. For the study, 1581 personal histories were analyzed. The most complete records were those having to do with personal background (37% of the personal histories evaluated) and the most complete histories were those of pediatric patients, women, and persons who participated in programs organized by the health center. The degree of completeness of the records was low. Based on the indicator developed, only 16% of the histories at the Center contained sufficient information to allow continuity of care. It is recommended that simple records systems be created and that primary care physicians be educated in the collection of essential data.

[A survey on the satisfaction of the users of the Zaidin-Sur de Granada Health Center (1989)]. / Encuesta de satisfacción a usuarios del Centro de Salud Zaidin-Sur de Granada (1989).

In order to know the users's degree of satisfaction in the Primary Health Care Center of Zaidin-Sur in Granada, a survey has been carried out by means of a personal interview at home in an aleatory sample of 615 individuals. The questionnaire has 28 closed questions with multiple answer and collects sociodemographic variables, self-perception of health condition, acceptability of medical and nursery care. The interview was anonymous and carried out by nursery students of third year. The 52% of the sample expressed that his health level was "excellent" or "good" and it was worse when the educational level was lower and the age was higher. The group of workers showed the highest valuation of health condition. The levels of trust on the doctor, the time of dedication and the information given to the patient reach slightly lower values than the ones found in literature; personal treatment and interest towards the patient have been valued the best. Center space structure and timetable have been the most penalized variables. We conclude that there is a need of improving the nursery service care a need of the information, from all the professionals working in the center, given to the patients on their problems, which are the cause of their going to the health consult, and the need of enlarging the space of the center.

[Quality of medical records at a primary care center]. / Estudio de la calidad de los registros en un centro de atención primaria.

The quality of the clinical records included in the clinical charts is assessed through a sample of the clinical charts existing at the Health Center Zaidin-Sur (Granada, Spain). The quality was ascertained via the number of visits annotated, the number of records considered as essential (life style, family and personal history), and the number of received or requested consultation. This information is compared to the data of the general files of the Health Center, to the information gathered by a direct interview (performed to assess the validity of the essential records), and to the results of a protocol studying the visit activities. The analysis of data shows that just a 40.4% of the visits are annotated on the clinical chart. A lower percentage of the essential records were annotated, 37.6%. The requested consultations are annotated in 43.8% and the received ones in 87.6%. We discuss on the need of periodic evaluation of the records to show their limitations and deficiencies. This is the first step to improve them.

[Anti-flu vaccination: satisfaction study in a vaccinated population]. / Vacunación antigripal: estudio de satisfacción en una población vacunada.

Most of the studies on the coverage of our country with regard to flu vaccinations reveal figures which do not surpass 50%-70% of the target population. In the USA, this figure only amounts to 20%-30%. There seems to be a certain "reticence" on the part of the population with regard to taking these injections or to continue the vaccination programs yearly. For this reason, we have made a prospective surveillance and monitoring study of the individuals vaccinated with the flu vaccine, which has taken in two flu injection campaigns (1988-1989) for the purpose of ascertaining the possible causes of this "reticence" and the degree of satisfaction achieved with the flu vaccine procedures. The study reveals the only 51.8% of the population receiving the vaccine was satisfied with the procedure, although 75.2% repeated the procedure the following year. The highest degree of insatisfaction is shown among women, and the customary patients who visit their physicians for every ache and pain, and those receiving the vaccine for the first time confuse acute respiratory symptoms with flu symptoms.