The mediation effect of treatment fatigue in the association between memory and health-related quality of life in men with HIV who have sex with men.

Approximately half of all adults living with the Human Immunodeficiency Virus (HIV) experience cognitive alterations related to difficulties in treatment adherence and, therefore, to a significant decrease in quality of life. In this sense, new studies are needed to identify potential mediators related to treatment in this association, such as treatment fatigue. This fact is especially important in at specific groups of individuals with HIV, namely men with HIV who have sex with men (MSM). The objective of this study was to analyze the association between cognitive functioning, Health-Related Quality of Life (HRQoL), and treatment fatigue in MSM with HIV. A cross-sectional study was developed with a sample of 70 MSM, from the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). Participants completed questionnaires related to sociodemographic data, HRQoL, and treatment fatigue in an initial phase; in a second phase, they were administered a computerized cognitive evaluation. Our results demonstrate a significant relationship between a lower cognitive performance in the memory domain and worse HRQoL. Mediation analysis has revealed the total mediation effect of treatment fatigue, specifically, the treatment cynicism domain, on this relationship. This mediation effect remained significant after controlling the sociodemographic and clinical HIV-related variables in the model. No significant mediation effects of the rest of evaluated cognitive domains (attention, perception, reasoning, or coordination) were found in this relationship. The results of this study highlight how MSM with a significant deterioration of memory are at greater risk of developing high levels of treatment fatigue, and, therefore, a lower adherence to the same and a significant deterioration in their HRQoL.

Antifungal activity of the essential oil obtained from Cryptocarya alba against infection in honey bees by Nosema ceranae.

The honeybee disease nosemosis type C is a serious problem since its causative agent, microsporidium Nosema ceranae, is widespread among adult honey bees. Some of the feasible alternative treatments that are used to control this disease are plant extracts. The aim of the present work was to evaluate the effects of essential oils of Chilean plant species, such as Cryptocarya alba, which is used against N. ceranae, and to identify and quantify the majority active compounds in the EO as well as their potential use for the control of nosemosis. Essential oils were obtained using the stripping steam technique with Clevenger equipment and were subsequently analyzed by Gas chromatography-mass spectrometry. Mortality was recorded daily over at least 8days as worker honeybees were exposed to a range of doses of EO dispersed in a sucrose solution. C. alba oil appears to be nontoxic to A. mellifera adults at the tested concentration (the same concentration inhibits the growth of N. ceranae), showing that this oil can be used for the treatment of nosemosis. EO effectiveness was demonstrated against N. ceranae by calculating the percentage of decrease in infected bees from untreated infected groups vs infected groups treated with EO or the reference drug fumagillin. It was determined that a dose of 4µg EO/bee was most effective in controlling N. ceranae development. We determined innocuous doses of C. alba essential oil for honeybees. We demonstrated the antifungal activity of C. alba EO at 4µg/bee against N. ceranae and compared it to its major monoterpenes, such as ß-phellandrene (20µg/bee), eucalyptol (20µg/bee) and α-terpineol (20µg/bee). The major compounds of C. alba EO, α-terpineol, eucalyptol and ß-phellandrene, had significant effects against Apis mellifera infection by N. ceranae, but the antifungal effect of the complete essential oil on N. ceranae was larger than the effect of α-terpineol, eucalyptol or ß- phellandrene separately, showing that C. alba oil may be a candidate for the treatment or prevention of nosemosis.

[Population pharmacokinetics applied to optimising cisplatin doses in cancer patients]. / Farmacocinética poblacional de cisplatino aplicada a la personalización de su dosificación en pacientes oncológicos.

OBJECTIVE: To develop and internally validate a population pharmacokinetics model for cisplatin and assess its prediction capacity for personalising doses in cancer patients. METHOD: Cisplatin plasma concentrations in forty-six cancer patients were used to determine the pharmacokinetic parameters of a two-compartment pharmacokinetic model implemented in NONMEN VI software. Pharmacokinetic parameter identification capacity was assessed using the parametric bootstrap method and the model was validated using the nonparametric bootstrap method and standardised visual and numerical predictive checks. The final model's prediction capacity was evaluated in terms of accuracy and precision during the first (a priori) and second (a posteriori) chemotherapy cycles. RESULTS: Mean population cisplatin clearance is 1.03 L/h with an interpatient variability of 78.0%. Estimated distribution volume at steady state was 48.3 L, with inter- and intrapatient variabilities of 31,3% and 11,7%, respectively. Internal validation confirmed that the population pharmacokinetics model is appropriate to describe changes over time in cisplatin plasma concentrations, as well as its variability in the study population. The accuracy and precision of a posteriori prediction of cisplatin concentrations improved by 21% and 54% compared to a priori prediction. CONCLUSION: The population pharmacokinetic model developed adequately described the changes in cisplatin plasma concentrations in cancer patients and can be used to optimise cisplatin dosing regimes accurately and precisely.

[Flu vaccination in primary care: analysis of the process and proposals for increasing coverage]. / Vacunación antigripal en atención primaria: análisis del proceso y propuestas para aumentar las tasas de cobertura.

INTRODUCTION: Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. OBJECTIVES: To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. PROGRAMME: To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. DISCUSSION: After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced.

[Can we improve influenza vaccination rates in older people with chronic diseases?]. / Podemos mejorar las tasas de vacunación antigripal en los ancianos con enfermedades crónicas?

OBJECTIVE: To determine the proportion of older patients (>or= 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the 2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. DESIGN: Observational, descriptive, retrospective study. SETTING: The urban health center serving Area 19 in the Community of Valencia (eastern Spain). PARTICIPANTS: Of the 29757 inhabitants served by this center (10.4% >or= 65 years), we included 3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853 older patients with chronic diseases who were not vaccinated. MAIN MEASURES: Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. RESULTS: The vaccination rates were 52.12% (95% CI, 50.4-53.9) for older patients, 26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17% came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for nonvaccination was recorded for only 10.4%. CONCLUSIONS: Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good.

[Characteristics of health care demand in family medicine clinics in a health area of the community of Valencia]. / Características de la demanda sanitaria en las consultas de medicina de familia de un área de salud de la Comunidad Valenciana.

OBJECTIVE: To measure with primary data the kinds of family doctor consultations, the reasons for them and the interruptions. DESIGN: Observational, transversal, and multi-centred study. SETTING: All the health centres in Area 17 of the Community of Valencia. PARTICIPANTS: Representative sample of 2051 patients belonging to 20 family medicine lists at the 13 health centres in the Area, selected by sampling stratified for health centres and randomised by medical key. MAIN MEASUREMENTS: All the activity occurring during the working day was monitored by an outside observer in the consulting room, who recorded the types of consultation (prior appointment, on-demand, scheduled, urgent, at home, by phone or through a family member) and the reasons for them (as a function of their clinical content for acute pathology, chronic pathology or preventive activities, bureaucratic-administrative reasons or to collect test results). The interruptions to the consultation were recorded. The means, percentages and 95% confidence limits were calculated. RESULTS: Women occasioned 57.5% (95% CI, 55.4-59.6) of demand; and the elderly, 35.9% (33.6%-38.2%). Mean attendance time was 5.38 +/- 4.45 minutes. 23.6% (25.4%-21.8%) attended without prior appointment; in 14.7% (16.2%-13.2%) a family member attended; 6.6% (7.7%-5.5%) were urgent; and 0.7% (1.1%-0.3%) were telephone consultations. 65.3% (67.4%-63.2%) of consultations were bureaucratic, and preventive measures were taken only in 3.4% (4.2%-2.6%). 21.8% (23.6%-20%) of patients consulted for clinical + bureaucratic reasons; and 35.5% (37.6%-33.4%), solely for bureaucratic reasons. In 12% (13.4%-10.6%) there were interruptions, mainly for phone calls (3.9%). CONCLUSION: The over-65s caused over a third of all consultations. There was a high attendance without a prior appointment. There were few preventive activities. In consultations, bureaucratic activity takes up more time than clinical activity (care and prevention).

[Validity of clinical records and information systems in studies of health-care delivery in primary care]. / Validez de la historia clínica y sistemas de información en los estudios de actividad asistencial en atención primaria.

OBJECTIVES: To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery. DESIGN: Multi-centred, observational, and cross-sectonal study. SETTING: Four medical clinics at 12 health centres in the Community of Valencia, Spain. PARTICIPANTS: There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa). CONCLUSIONS: The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management.

[Influence of physician and physician list characteristics on influenza vaccination rates in older people in a health care area in the community of Valencia, Spain]. / Influencia de las características de los médicos y del cupo en la vacunación antigripal de ancianos en un área de salud de la comunidad Valenciana.

OBJECTIVE: To identify the characteristics of physicians and the patients on their list related with rates of influenza vaccination in older people, and to quantify influenza vaccination coverage in this population group. DESIGN: Observational, cross-sectional, multicenter population-based study with primary data. PARTICIPANTS: All health centers in the health care area that used computerized registries of influenza vaccinations. Vaccination records were analyzed for 73 physicians who had been at their present post for at least 2 years prior to the study, and for 19 457 older people who were vaccinated during the 2001-2002 vaccination campaign. SETTING: Primary health care area number 19. MAIN MEASURES: Physician's age and sex, whether the physician was certified as a specialist in family and community medicine, teaching accreditation, permanent or temporary post, length of time in present post, years of professional practice, type of health center administration, total number of patients in the physician's list, population and percentage of the population >65 years old in the physician's list, influenza vaccination rate referred to the total number of patients on the physician's list. The criterion evaluated was the influenza vaccination rate in older people. Descriptive analysis, bivariate analysis and multivariate analysis were used. A P value < .05 was considered statistically significant, and 95% confidence intervals were calculated. RESULTS: The overall influenza vaccination rate in older people (>65 years) was 50.9%, with considerable variability between physicians (from 18% to 77%). Vaccination rates were lowest in physicians who had been in their current post for longer (P=.001), with larger patient lists (P=.03), with more older people in their list (P=.000), and with larger proportions of older people in their list (P=.001). Lower rates of vaccination in older people were also associated with lower proportions of all patients on the list being vaccinated (P=.000). No significant associations were found for any of the other variables. After multivariate analysis only the percentage of older people on the physician's list remained significantly associated with vaccination rate. CONCLUSIONS: Influenza vaccination rates for older people were low and similar to rates reported earlier for this region of Spain. The percentage of older people in the list was the only explanatory variable in the model, and was inversely proportional to vaccination coverage.

[Validity of the non-mydriatic camera for diabetic retinopathy screening and analysis of retinopathy risk indicators]. / Validez de la cámara no midriática en el cribado de la retinopatía diabética y análisis de indicadores de riesgo de la retinopatía.

PURPOSE: Analysis of the validity of the non-mydriatic camera in detecting diabetic retinopathy and severity levels which can be referred to the ophthalmologist. Analysis of risk indicators of diabetic retinopathy which help increase the sensitivity of the screening: development time of prolonged diabetes (more than 20 years); poor metabolic control (HbA1C > 10%). METHOD: A cross-sectional study was designed to determine the validity of a diagnostic test (non-mydriatic fundus camera Topcon model TRC-NW6S). As criteria for evaluation we used validity indicators, predictive values, indicators of clinical use, and concordance. SETTING: Primary Care. Patients with severe cataracts were excluded. The sample size was 376 eyes of 188 type-2 diabetic patients. RESULTS: With reference to the distribution of diabetic retinopathy we found that 41.25% had a variable level of retinopathy. The validity indicators analysed improved as the number of fundus fields studied increased, obtaining sensitivity levels of greater than 75%; specificity greater than 95%; positive predictive values greater than 90% and almost perfect concordance when two or three fundus fields were used. CONCLUSIONS: The analysis of retinal photography in digital format can be considered a valid method with respect to the gold standard, and the severity indicators analysed can play a guiding role in obtaining greater prevalences of derivable diabetic retinopathy, but cannot be used as an isolated test for making clinical decisions.

[Clinical management of consultations: clinical content and predictability (SyN-PC Study)]. / Gestión clínica de la consulta: previsibilidad y contenido clínico (estudio SyN-PC).

OBJECTIVES: To describe care activity as a function of the nature of the consultation (predictability) and the needs of the patients (clinical content). To analyse the relationship of these with the characteristics of the consultation, of the patient and of the centre. DESIGN: Multi-centre, descriptive, observational study. SETTING: Primary care. Area 17 of the Health Department of the Community of Valencia, with 197316 inhabitants and 12 health centres. PARTICIPANTS: Information gathering in real time by outside observer. Stratified randomised sampling of 2051 patients who gave rise to 3008 reasons for medical consultation. MAIN MEASUREMENTS: Predictable consultations (Pr): their content can be foreseen (check-ups, picking up results). Unpredictable consultations (Unp): we cannot predict their content (acute problems may arise unexpectedly). These include urgent consultations. Administrative consultations (Ad): bureaucratic tasks (prescriptions, repeat sick-notes, sick certificates). Care consultations (Car): prevention, diagnosis and treatment of the illness, or monitoring of it. Variables here are the patient, the doctor and the consultation. RESULTS: 60% (1809) (95% CI, 58.69%-61.59%) of the reasons were Pr and 40% (1199) (95% CI, 36.6%-43.12%) were Unp. 50% (1509) (95% CI, 47.26%-53.06%) were Car, and 50% Ad (1499) (95% CI, 46.34%-53.39%). 40% (1189) (95% CI, 37.78%-41.28%) were Pr-Ad and only 21% (620) (95% CI, 19.16%-22.06%) were Pr-Car. 30% (889) (95% CI 27.92 %-31.18%) were Unp-Car, and 10% (310) (95% CI, 9.22%-11.4%) Unp-Ad. 48% of patients with a single reason for attendance were Pr-Ad (577) (95% CI, 44.25%-52.05). Teaching centres and computerised ones had less Pr-Ad load. Pr-Ad consultations increased with patient's age and with case-load. CONCLUSIONS: Almost 40% of the reasons for consultation are Pr-Ad, which implies inadequate clinical management. An intervention is needed to free up medical time consumed by bureaucratic questions, so that this time can be devoted fully to health-care tasks.

On-line microwave-assisted digestion of solid samples for their flame atomic spectrometric analysis.

A new procedure has been developed for the on-line digestion of solids in a microwave oven. The direct injection in a water carrier flow of dispersions of solid samples in concentrated nitric acid, the merging of these slurries with 30% (v/v) H(2)O(2) and the microwave-assisted digestion in a Teflon coil of 100 cm permit a fast and quantitative extraction of Cu and Mn from different solid matrices, such as vegetables, powdered dietary products and sewage sludges. The development of an appropriate interphase, in which digested samples are cooled and degassified, previous to their introduction into the nebulizer of a flame atomic absorption spectrometer, makes possible the full automatization of the digestion and measurement steps of the elemental analysis of solids and it provides a sample frequency of 180 injections per hour. The developed procedure has also been applied for Pb and Zn determination in certified sewage sludge samples, with accurate results obtained for Pb but low results found for Zn.

Direct FIA-AS determination of potassium and magnesium in cement samples by use of the slurries approach.

A direct procedure has been developed for the flame atomic determination of potassium and magnesium in cement samples. A 50-mg sample is dispersed in 25 ml of 0.13M nitric acid; 100 mul of this slurry is injected in a double channel FIA manifold simultaneously with 100 mul of a 10% (w/v) lanthanum solution. This procedure allows the rapid extraction of potassium and magnesium by leaching of the sample; nitric acid is not necessary if only potassium must be determined and the sample can be diluted with only distilled water. Aqueous standards are used. The manifold employed includes a well-stirred mixing chamber, which provides an adequate on-line dilution of the sample, in order to obtain emission or absorbance measurements in the dynamic range of the elements to be determined. The results obtained in the analysis of real samples agree with those found by flame atomic spectrometry after a previous alkaline fusion with lithium carbonate, and exhibit better precision. The limit of detection of the procedure is 0.007% for K(2)O and 0.01% for MgO and the precision of the entire procedure corresponds to a relative standard deviation of 1%.