[Provision of continuous health care by a unit connected to primary care centres coordinated by specialist physicians]. / Aportación al continuo asistencial de una consulta de conexión con atención primaria coordinada con internistas.

OBJECTIVE: To evaluate the efficacy and efficiency of a system set up to overcome the current disparity between primary and specialist health care and with the capacity to detect patients with significant diseases. MATERIAL AND METHODS: To describe the activity of the Unit for Connection with Primary Care Centres (UCPCC) in the Alcoy Health Area (Alicante) during its first year. RESULTS: A total of 450 visits were made, with 6.5 (95% CI 5.7-7.3) first visits, and 3.9 (95% CI 3.1-4.8) successive ones per day. There were more than 50 reasons for consultation, and more than 60 final diagnoses (65.6% non-significant, 14% undefined and 12.4% significant). Digestive (31%) and functional (14.4%) diseases were the most frequently defined diagnoses, with neoplasic and autoimmune diseases among those defined as significant ones. The great majority (86.9%) of patients required 1-2 visits, with 40% diagnosed by just reviewing the hospital files. More than 20 different complementary examinations were performed, with 38.8%, 34.4%, 21.6%, and 5.2% of patients requiring 0, 1, 2, or ≥ 3, respectively. Patients with a significant pathology were diagnosed more quickly (12.4 ± 19.4 vs. 45.3 ± 52.8 days; P = .001), with less complementary examinations (0,5 ± 0,7 vs. 0,9 ± 0,9 per patient; P = .032. 58.6% vs. 39.6% patients without complementary examinations; P = .052), and were more frequently referred to specialised medicine (58.6% vs. 18.3%, P < .0001). CONCLUSIONS: The demonstrated differential management of patients with potentially significant pathology using existing resources, make the UCPCC with internists an efficient model for the connection between health care levels.

Comparison of two HIV testing strategies in primary care centres: indicator-condition-guided testing vs. testing of those with non-indicator conditions.

OBJECTIVES: The aim of the study was to compare prospectively indicator-condition (IC)-guided testing versus testing of those with non-indicator conditions (NICs) in four primary care centres (PCCs) in Barcelona, Spain. METHODS: From October 2009 to February 2011, patients aged from 18 to 65 years old who attended a PCC for a new herpes zoster infection, seborrhoeic eczema, mononucleosis syndrome or leucopenia/thrombopenia were included in the IC group, and one in every 10 randomly selected patients consulting for other reasons were included in the NIC group. A proportion of patients in each group were offered an HIV test; those who agreed to be tested were given a rapid finger-stick HIV test (€6 per test). Epidemiological and clinical data were collected and analysed. RESULTS: During the study period, 775 patients attended with one of the four selected ICs, while 66,043 patients presented with an NIC. HIV screening was offered to 89 patients with ICs (offer rate 11.5%), of whom 85 agreed to and completed testing (94.4 and 100% acceptance and completion rates, respectively). In the NIC group, an HIV test was offered to 344 persons (offer rate 5.2%), of whom 313 accepted (90.9%) and 304 completed (97.1%) testing. HIV tests were positive in four persons [prevalence 4.7%; 95% confidence interval (CI) 1.3-11.6%] in the IC group and in one person in the NIC group (prevalence 0.3%; 95% CI 0.01-1.82%; P < 0.009). If every eligible person had taken an HIV test, we would have spent €4650 in the IC group and €396,258 in the NIC group, and an estimated 36 (95% CI 25-49) and 198 persons (95% CI 171-227), respectively, would have been diagnosed with HIV infection. The estimated cost per new HIV diagnosis would have been €129 (95% CI €107-153) in the IC group and €2001 (95% CI €1913-2088) in the NIC group. CONCLUSIONS: Although the number of patients included in the study was small and the results should be treated with caution, IC-guided HIV testing, based on four selected ICs, in PCCs seems to be a more feasible and less expensive strategy to improve diagnosis of HIV infection in Spain than a nontargeted HIV testing strategy.

Effective chemical control of psychrotrophic Bacillus cereus EPSO-35AS and INRA TZ415 spore outgrowth in carrot broth.

The growth kinetic parameters of germinated cells from heat-activated spores of the psychrotrophic Bacillus cereus EPSO-35AS strain in nutrient broth (NB) and in tyndallized carrot broth (TCB) were evaluated at different temperatures (8, 12, and 16 degrees C) for control samples and for samples acidified with citric acid or lemon juice at pH values between 4.7 and 5.5. Lowering the pH from 7.4 or 6.2 to 5.2 inhibited bacterial growth in both tested media after 60 days at 12 degrees C and lower temperatures, confirming the effectiveness of acidification in association with refrigeration to control B. cereus proliferation in minimally processed foods (MPFs) based on carrot. The activities of selected concentrations of cinnamon essential oil, cinnamaldehyde, carvacrol, and eugenol against B. cereus EPSO-35AS and INRA TZ415 strains in both media over the same temperature range were also studied. Addition of either cinnamon essential oil or cinnamaldehyde at concentrations of 5 and 2 microL 100mL(-1), respectively, caused complete inhibition of the growth of both psychrotrophic strains even if mild temperature abuse occurred (12 degrees C). Hence, a combination of one of these compounds and refrigerated storage may be useful for preservation of MPFs in which major ingredient was carrot. On the contrary, carvacrol and eugenol were not able to prevent B. cereus growth in TCB during storage at 8 degrees C. Their effects on the organoleptic characteristics of TCB are discussed.

Survival, isolation and characterization of a psychrotrophic Bacillus cereus strain from a mayonnaise-based ready-to-eat vegetable salad.

Incidence and population levels of Bacillus cereus in American salad, an industrially manufactured, packaged and refrigerated deli salad containing vegetables and mustard, were determined. Of 12 ready-to-eat samples examined, one (8.3%) was positive for B. cereus at less than 5 x 10(3)cfu g(-1). According to the ISO confirmation procedure, a strain was isolated and further characterized and identified as B. cereus EPSO-35AS by API 50CH/20E phenotypic system, combined with additional tests of motility, oxidase activity and anaerobic growth. This strain produced diarrhoeal enterotoxin in tryptic soy broth culture as detected by BCET-RPLA test, hydrolysed starch and had a low D(90)-value (2.1 min), with an estimated z-value of 6.79 degrees C. After a lengthy lag phase (9-12 days of incubation), the strain was able to grow at 8 degrees C in both nutrient broth and tyndallized carrot broth with specific growth rates from 0.009 to 0.037 h(-1), respectively. In the vegetable substrate, lag time was approximately 3 days (66 h) shorter than in laboratory medium. The effect of temperature abuses on the safety of the product during the time of use or consumption is discussed.

Effects of antimicrobial components of essential oils on growth of Bacillus cereus INRA L2104 in and the sensory qualities of carrot broth.

The possible use of antimicrobials from seven plant essential oils as food preservatives was studied by examining their effects on the growth kinetics of activated Bacillus cereus INRA L2104 spores inoculated into tyndallized carrot broth. The effects of various concentrations of borneol, carvacrol, cinnamaldehyde, eugenol, menthol, thymol, and vanillin were determined. Five microliters of cinnamaldehyde, 15 microl of carvacrol, or 30 mg of thymol per 100 ml of inoculated carrot broth completely inhibited bacterial growth for more than 60 days at 16 degrees C. Lower concentrations of the three antimicrobials prolonged the lag phase and reduced both the exponential growth rate and the final population densities of cultures. The study of the sensory characteristics of the supplemented broths suggested that low concentration of cinnamaldehyde enhanced the taste of carrot broth, and that it did not have any adverse effect on the taste and smell of carrot broth at concentrations less than 6 microl 100 ml(-1).