Initial assessment of natural diversity in Mexican fig landraces.

The common fig (Ficus carica L.) was introduced into Mexico by Spanish Franciscan missionaries in the 16th century. It is widely assumed that Mexican figs are the Spanish cultivar Black Mission. We collected and propagated 12 fig plants from six landraces from different states in Central Mexico that represent different climate. All of them were grown in a greenhouse at Universidad Autónoma Chapingo, in the State of Mexico. During the experimental period, the greenhouse had an average temperature and relative humidity of 29.2° ± 5.4°C (SEM) and 78.1 ± 6.7% (SEM), respectively. Morphological characterization was done following a selected set of quantitative and qualitative descriptors established by the IPGRI. DNA analysis was based on a combination of ISSR and RFLP markers. We observed great diversity mainly in fruit weight (28.1-96.2 g), fruit shape (ovoid, pyriform), and neck length (0.97-3.80 cm), which could not be explained by environmental conditions such as temperature and relative humidity. The Nei and Li/Dice similarity coefficient between landraces was determined by cluster analysis using the UPGMA method. Based on the morphological characterization and DNA fingerprinting data presented in this study, our results showed that after hundreds of years, black figs have adapted to local environmental condition in Central Mexico, yielding at least six clearly distinct landraces that represent valuable and previously undescribed genetic diversity. We also suggested names for those landraces according to their location and established a basis for further agronomic and molecular characterization of fig landraces.

Evaluation of a heart failure knowledge questionnaire and its use in guiding the educational intervention.

INTRODUCTION AND OBJECTIVE: Patient education by nurses is a cornerstone of any heart failure (HF) program, but the models are widely heterogeneous and few specific instruments exist. Our objective is to evaluate our own questionnaire and its utility as a guide for educational intervention. METHODS: This work is a prospective cohort study of patients followed-up on in a specialized unit after diagnosis of HF. The intervention group received educational sessions guided according to their knowledge using the questionnaire and was compared to a group which received standard education. The validity and reliability of the questionnaire was evaluated. The utility of the educational model was determined by the primary composite endpoint of death and/or hospital admission or emergency care for HF. RESULTS: A total of 152 patients were included, 88 which received guided education and 64 which received standard education, with a mean follow-up time of 16±4 months. In the guided education group, the evaluation questionnaire score (qs) rose from 59% to 78.5% (p=0.018), which was associated with greater self-care (28.5-0.6*qs, p=0.04), a tendency toward better quality of life (51.1-1.1*qs, p=0.09), and adherence (5.02+0.04*qs, p=0.06), with acceptable reliability (Cronbach's alpha 0.75). The primary composite endpoint was met in 12 patients (13.6%) in the intervention group compared to 19 (29.7%) in the control group (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; p=0.019). Only educational level, age, NT-proBNP, and atrial fibrillation were predictors in the multivariate analysis. CONCLUSION: The HF knowledge questionnaire proposed is a valid, reliable tool and allows for quantifying learning. Its utility in guiding education requires a certain degree of skill from the patient that determines a group with better prognosis.

Identification of reference genes for real-time PCR cytokine gene expression studies in sheep experimentally infected with Fasciola hepatica.

The aim of this study was to validate reference genes for gene normalisation using qRT-PCR in hepatic lymph nodes (HLN) and livers from sheep infected with Fasciola hepatica during early and late stages of infection. To this end, a comprehensive statistical approach (RefFinder) encompassing four different methods of analysis (geNorm, BestKeeper, ΔCt method and NormFinder) was used to validate ten candidate reference genes. Stability analysis of gene expression followed by pairwise variation (Vn/Vn + 1) analysis revealed that PGK1, HSP90AA1 and GYPC were the most stable reference genes and suitable for qRT-PCR normalisation in both HLN and liver tissues. These three genes were validated against FoxP3, IL-10, TGF-ß, TNF-α and IL-1ß genes in the HLN tissue of sheep vaccinated with Cathepsin L1 from F. hepatica and unvaccinated infected and uninfected controls during early stages of infection. In the liver, the three reference genes were validated against TNF-α and IL-1ß during chronic stages of infection with F. hepatica and in uninfected controls. Our study is the first to evaluate and validate sheep reference genes in order to provide tools for monitoring cytokines in Fasciola hepatica infected sheep target organs. Our results present an approach to elucidate the role of different cytokines in F. hepatica vaccinated and infected sheep.

Purification and identification of the pediocin produced by Pediococcus acidilactici MM33, a new human intestinal strain.

AIMS: The aim of this study was to purify and identify the bacteriocin produced by Pediococcus acidilactici MM33, a strain previously isolated from human gut. METHODS AND RESULTS: Purification of the bacteriocin was performed by cationic exchange chromatography followed by a reverse phase step. Biochemical and mass spectrometry analysis showed homology with pediocin PA-1. To verify if P. acidilactici MM33 carried the pediocin PA-1 gene, total DNA was used to amplify the pediocin gene. The PCR product obtained was then sequenced and the nucleotide sequence revealed to be identical to that of pediocin PA-1. Treatment of P. acidilactici MM33 with novobiocin resulted in a plasmid-cured strain without bacteriocin-producing capacity. Antimicrobial assay and molecular analysis demonstrated that this strain was ped(-) suggesting that the ped cluster is plasmid encoded. Antimicrobial assay revealed that pediocin was bactericidal against Listeria monocytogenes, showing a minimal inhibitory concentration (MIC) of 200 AU ml(-1). CONCLUSIONS: A two-step purification procedure was elaborated in this study. The bacteriocin secreted by the human strain P. acidilactici MM33 is carried on a plasmid and the amino acid sequence is identical to pediocin PA-1. SIGNIFICANCE AND IMPACT OF THE STUDY: Pediococcus acidilactici MM33 is the first human pediocin-producing strain reported and could be used as probiotic to prevent enteric pathogen colonization.

OBA/Ku86: DNA binding specificity and involvement in mammalian DNA replication.

Ors-binding activity (OBA) was previously semipurified from HeLa cells through its ability to interact specifically with the 186-basepair (bp) minimal replication origin of ors8 and support ors8 replication in vitro. Here, through competition band-shift analyses, using as competitors various subfragments of the 186-bp minimal ori, we identified an internal region of 59 bp that competed for OBA binding as efficiently as the full 186-bp fragment. The 59-bp fragment has homology to a 36-bp sequence (A3/4) generated by comparing various mammalian replication origins, including the ors. A3/4 is, by itself, capable of competing most efficiently for OBA binding to the 186-bp fragment. Band-shift elution of the A3/4-OBA complex, followed by Southwestern analysis using the A3/4 sequence as probe, revealed a major band of approximately 92 kDa involved in the DNA binding activity of OBA. Microsequencing analysis revealed that the 92-kDa polypeptide is identical to the 86-kDa subunit of human Ku antigen. The affinity-purified OBA fraction obtained using an A3/4 affinity column also contained the 70-kDa subunit of Ku and the DNA-dependent protein kinase catalytic subunit. In vitro DNA replication experiments in the presence of A3/4 oligonucleotide or anti-Ku70 and anti-Ku86 antibodies implicate Ku in mammalian DNA replication.

Apoptosis of peritoneal leucocytes during early stages of Fasciola hepatica infections in sheep.

Several immunomodulatory properties have been described in Fasciola hepatica infections. Apoptosis has been shown to be an effective mechanism to avoid the immune response in helminth infections. The aim of the present work was to study apoptosis in peritoneal leucocytes of sheep experimentally infected with F. hepatica during the early stages of infection. Five groups (n=5) of sheep were used. Groups 2-5 were orally infected with 200 metacercariae (mc) and sacrificed at 1, 3, 9 and 18days post-infection (dpi), respectively. Group 1 was used as the uninfected control (UC). Apoptosis was detected using three different methods 1) immunocytochemistry (ICC) with a polyclonal antibody anti-active caspase-3; 2) an annexin V flow cytometry assay using the Annexin V-FITC/propidium iodide (PI); and 3) transmission electron microscopy (TEM). The differential leucocyte count revealed that the majority of peritoneal granulocytes were eosinophils, which increased significantly at 9 and 18 dpi with respect to the uninfected controls. The ICC study revealed that the percentage of caspase-3+ apoptotic peritoneal leucocytes increased significantly from 3 dpi onwards with respect to the uninfected controls. The flow cytometry annexin V assay detected a very significant (P<0.001) increase of apoptotic peritoneal macrophages, lymphocytes and granulocytes, which remained higher than in the UC until 18 dpi. Transmission electron microscopy studies also confirmed the presence of apoptosis in peritoneal eosinophils at 18 dpi. This is the first report of apoptosis induced by F. hepatica in the peritoneal leucocytes of sheep in vivo. The results of this work suggest the importance of apoptosis induction for the survival of the juvenile parasites in the peritoneal migratory stages of infection.

Th1/Th2 balance in the liver and hepatic lymph nodes of vaccinated and unvaccinated sheep during acute stages of infection with Fasciola hepatica.

The expression of IFNγ and IL4 was quantified using q-PCR in the liver and hepatic lymph nodes (HLN) of sheep during early stages of infection with Fasciola hepatica (1, 3, 9 and 18days post-infection, dpi). A group of animals (Group 1) were vaccinated with Fasciola hepatica recombinant cathepsin L1 (FhCL1) in montanide 70 VG prior to infection, a second group (group 2) was used as infected control and a third (group 3) was used as uninfected control. To study vaccine efficacy three additional groups were sacrificed 19 weeks post-infection (group 4 immunized with CL1, group 5 with the adjuvant and group 6 was used as infected control). The vaccinated group did not show significant fluke reduction compared to the adjuvant group and infected control group. IL4 expression was observed to increase at 9 dpi and was further elevated at 18 dpi in the liver and HLN of vaccinated and infected control groups compared to the uninfected group. IFNγ expression exhibited different dynamics in the liver and HLN compared to IL4; thus, in the liver this cytokine increased at 9 dpi in the vaccinated and at 18 dpi in vaccinated and infected control groups, while in the HLN it decreased gradually and significantly from 1 dpi onwards. These results suggest that a marked Th2 polarization is present from 9 dpi in HLN and from 18 dpi in the liver. The increase of IFNγ in the liver may correspond with tissue damage response with granuloma formation. The FhCL1 vaccine did not alter the Th1/Th2 balance when compared to unvaccinated and infected sheep. The study of IFNγ and IL4 in the various tissue compartments in sheep could facilitate selection of new adjuvants inducing a strong Th1 response for a more rationale vaccine formulation.

Fasciola hepatica induces eosinophil apoptosis in the migratory and biliary stages of infection in sheep.

The aim of the present work was to evaluate the number of apoptotic eosinophils in the livers of sheep experimentally infected with Fasciola hepatica during the migratory and biliary stages of infection. Four groups (n=5) of sheep were used; groups 1-3 were orally infected with 200 metacercariae (mc) and sacrificed at 8 and 28 days post-infection (dpi), and 17 weeks post-infection (wpi), respectively. Group 4 was used as an uninfected control. Apoptosis was detected using immunohistochemistry with a polyclonal antibody against anti-active caspase-3, and transmission electron microscopy (TEM). Eosinophils were identified using the Hansel stain in serial sections for caspase-3, and by ultrastructural features using TEM. At 8 and 28 dpi, numerous caspase-3(+) eosinophils were mainly found at the periphery of acute hepatic necrotic foci. The percentage of caspase -3(+) apoptotic eosinophils in the periphery of necrotic foci was high (46.1-53.9) at 8 and 28 dpi, respectively, and decreased in granulomas found at 28 dpi (6%). Transmission electron microscopy confirmed the presence of apoptotic eosinophils in hepatic lesions at 8 and 28 dpi. At 17 wpi, apoptotic eosinophils were detected in the infiltrate surrounding some enlarged bile ducts containing adult flukes. This is the first report of apoptosis induced by F. hepatica in sheep and the first study reporting apoptosis in eosinophils in hepatic inflammatory infiltrates in vivo. The high number of apoptotic eosinophils in acute necrotic tracts during the migratory and biliary stages of infection suggests that eosinophil apoptosis may play a role in F. hepatica survival during different stages of infection.

[Medication errors in a neonatal unit: One of the main adverse events]. / Los errores de tratamiento en una unidad neonatal, uno de los principales acontecimientos adversos.

INTRODUCTION: Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. MATERIAL AND METHODS: An analysis was performed on the ME declared in a neonatal unit. RESULTS: A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. CONCLUSIONS: It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety.

Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete.

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.

Posttranslational regulation of nitrogenase activity by fixed nitrogen in Azotobacter chroococcum.

Using anti-(Fe protein) antibody raised against the Fe protein of the photosynthetic bacterium Rhodospirillum rubrum, it was found that the Fe protein component of nitrogenase (EC 1.18.2.1) from Azotobacter chroococcum cells subjected to an ammonium shock, and hence with an inactive nitrogenase, appeared as a doublet in Western blot analysis of cell extracts. The Fe protein incorporated [32P]phosphate and [3H]adenine in response to ammonium treatment, and L-methionine-DL-sulfoximine, an inhibitor of glutamine synthetase (L-glutamate: ammonia ligase (ADP forming), EC 6.3.1.2), prevented Fe protein from inhibition and radioisotope labelling. These results support that A. chroococcum Fe protein is most likely ADP-ribosylated in response to ammonium. After ammonium treatment, when in vivo activity was completely inhibited, Fe-protein modification was still increasing. This suggests the existence of another mechanism of nitrogenase inhibition faster than Fe-protein modification. When ammonium was intracellularly generated instead of being externally added, as occurs with the short-term nitrate inhibition of nitrogenase activity observed in A. chroococcum cells simultaneously fixing molecular nitrogen and assimilating nitrate, a covalent modification of the Fe protein was likewise demonstrated.

[Study on bacteremia in the service of Internal Medicine of a group 2 hospital. Analysis of recent three years]. / Estudio de las bacteriemias en el Servicio de Medicina Interna de un hospital de grupo 2. Análisis de los tres últimos años.

INTRODUCTION: Bacteremia remains one of the most relevant problems in infectious disease. The interest of this study was to know the presentation and development pattern of bacteremia in our environment, in order to best prevent and treat this entity. PATIENTS AND METHOD: A retrospective, no interventional study, on significant bacteremia detected in the Service of Internal Medicine of a secondary level hospital over three years was carried out. Through the study length, from January 1 2001 until December 31 2003, 4,719 blood cultures were processed by the Service of Microbiology; of these, 1964 (41.6%) were submitted by the Service of Internal Medicine. Results were positive in 336 (17.1%); of these, 18 (24.1%) correlated with episodes of true bacteremia, and 255 (75.9%) were deemed as contaminations. RESULTS: Overall, 81 episodes of true bacteremia were studied, from 77 patients (4 patients presented with 2 episodes). An incidence rate of 28.25 episodes per 1000 hospital admissions was estimated. Mean age was 72 years (95% CI: 68.62-75.38). Males over 60 years-old were predominant (51.9%). Bacteremia was community-acquired in 75.3% of cases, and nosocomial in 24.7%. Commonest baseline diseases were elevated arterial blood pressure and diabetes mellitus. Bacteremia development was mostly related to genitourinary and vascular handling. Most of them were nephrourological (42.0%), respiratory (19.8%) and abdominal (13.6%) in origin. In our environment, Escherichia coli (33.0%) and Staphylococcus coagulase-negative (15.9%) were the most commonly isolated pathogens. Empiric antibiotic therapy was correct in 86.2% of cases; third generation cephalosporins were the most used. Overall mortality rate was 16% (13 patients), and bacteraemia-related mortality was 61%. CONCLUSIONS: A high incidence of bacteremia episodes is noteworthy, as compared with series from other centers. The percentage of episodes due to Staphylococcus coagulase-negative was significant, as it is the rule in recent years; thus, a thoroughly assessment of potential contaminants, as well as staff training in extraction techniques becomes necessary.

[Towards a safety culture in the neonatal unit: Six years experience]. / Caminando hacia una cultura de seguridad en la unidad neonatal: experiencia de 6 años.

INTRODUCTION: A safety culture is the collective effort of an institution to direct its resources toward the goal of safety. MATERIAL AND METHODS: An analysis is performed on the six years of experience of the Committee on the Safety of Neonatal Patient. A mailbox was created for the declaration of adverse events, and measures for their correction were devised, such as case studies, continuous education, prevention of nosocomial infections, as well as information on the work done and its assessment. RESULTS: A total of 1287 reports of adverse events were received during the six years, of which 600 (50.8%) occurred in the neonatal ICU, with 15 (1.2%) contributing to death, and 1282 (99.6%) considered preventable. Simple corrective measures (notification, security alerts, etc.) were applied in 559 (43.4%), intermediate measures (protocols, monthly newsletter, etc.) in 692 (53.8%), and more complex measures (causal analysis, scripts, continuous education seminars, prospective studies, etc.) in 66 (5.1%). As regards nosocomial infections, the prevention strategies implemented (hand washing, insertion and maintenance of catheters) directly affected their improvement. Two surveys were conducted to determine the level of satisfaction with the Committee on the Safety of Neonatal Patient. A rating 7.5/10 was obtained in the local survey, while using the Spanish version of the Hospital Survey on Patient Safety Culture the rate was 7.26/10. CONCLUSIONS: A path to a culture of safety has been successfully started and carried out. Reporting the adverse events is the key to obtaining information on their nature, etiology and evolution, and to undertake possible prevention strategies.

Empowering the deaf. Let the deaf be deaf.

Deafness is often regarded as just a one and only phenomenon. Accordingly, deaf people are pictured as a unified body of people who share a single problem. From a medical point of view, we find it usual to work with a classification of deafness in which pathologies attributable to an inner ear disorder are segregated from pathologies attributable to an outer/middle ear disorder. Medical intervention is thus concerned more with the origin, degree, type of loss, onset, and structural pathology of deafness than with communicative disability and the implications there may be for the patient (mainly dependency, denial of abnormal hearing behaviour, low self esteem, rejection of the prosthetic help, and the breakdown of social relationships). In this paper, we argue that hearing loss is a very complex phenomenon, which has many and serious consequences for people and involves many factors and issues that should be carefully examined. The immediate consequence of deafness is a breakdown in communication whereby the communicative function needs to be either initiated or restored. In that sense, empowering strategies--aimed at promoting not only a more traditional psychological empowerment but also a community one--should primarily focus on the removal of communication barriers.

Doing things together: adolescent health and family rituals.

STUDY OBJECTIVES: (1) To describe the union and life cycle of family rituals, such as specific habits of sharing daily meals, special events or other family activities, and (2) to analyse the relation between the practice of family rituals and the use by adolescents of mental health related ambulatory care services. DESIGN: A cross sectional study. SETTING: A public mental health care outpatient clinic, secondary educational centres and Alicante University (School of Social Workers and Nursing School) in Spain. PARTICIPANTS: A total of 282 living at home youngsters were included in the study. The case group, n=82, was sequential and consecutively drawn from the first consultation in a public mental health outpatient clinic attending a downtown area of Alicante. The comparison group (n=213) was made up of a conglomerate from various educational centres in the same metropolitan area. MAIN RESULTS: There was a significant difference (p=0.027) between the frequencies with which parents ate together with their offspring in the two study groups. The families of the adolescents comparison group significantly (p=0.00007) shared more family celebrations than the case group-also, the extended family was included more frequently. Moreover, differences between both groups were found in other activities and situations-adolescents in the case group reported carrying out less family activities than the adolescents in the comparison group (p=0.00001). The lower level of satisfaction in the adolescent's perception of family function led to a higher probability of presenting mental health complaints (p=0.00001). CONCLUSIONS: The youngsters with mental health complaints ate less frequently with both parents than the youngsters in the comparison group. They also shared less activities and practised less family rituals-union and life cycle-than the families of the youngsters in the comparison group, and showed a lower level of satisfaction in perceived family function.

Proteinase activity in invasive cancer of the breast. Correlation with tumor progression.

Hydrolysis of extracellular matrix is a necessary step for malignant cells to invade, and metastasize. Three groups of proteinases, mainly serine, thiol and metalloproteinases, have been found to be secreted by cancer cells and responsible for the proteolytic cascade triggered during invasion. Previous studies from our group and others have shown that the thiol proteinase cathepsin B1 is a constant indicator of tumor invasion in carcinoma of the cervix, although others point to plasminogen activators and collagenases. So far, there are no systematic studies to correlate cathepsin B and plasminogen activator activity with advancing malignant disease and thus estimate its capability as a marker of progression. The purpose of this study was to determine the activity of cathepsin B like proteinase and plasminogen activators in invasive carcinoma of the breast at various clinical stages and with different estrogen receptor status. One hundred patients with carcinoma of the breast at different clinical stages were studied. Cathepsin B and plasminogen activators activity was assessed in tumor cytosols using different synthetic oligopeptides as substrates following the method of Smith. Estrogen receptor concentration was determined with monoclonal antibodies. A statistical analysis and correlation with different clinical stages was performed. Cathepsin B-like activity had a consistent and progressive elevation in direct correlation with clinical stage (stage I, 1.97 SE +/- 0.46; stage II, 6.67 SE +/- 1.12; stage III, 28.19 SE +/- 3.48; nmol/mg/30 min), while plasminogen activators, although constantly elevated, had no correlation with tumor progression. No relation could be found with estrogen receptor status. It is concluded that cathepsin B, but not plasminogen activator, is a good indicator of tumor progression in invasive carcinoma of the breast.

A simplified histoscore for the estrogen receptor assay in breast cancer.

Different histoscores combining the number of positive cells and the intensity of staining have been used to evaluate the estrogen receptor immunocytochemical assay (ER-ICA). Our aim was to investigate if the simple estimation of the amount of positive cells could be sufficient for the semiquantitative analysis of ER-ICA. Tissue from 51 women with ductal breast carcinoma was used. Half of each sample was processed with the quantitative assay (ER-EIA) and the other half with ER-ICA. Microscopical analysis was performed by two independent observers and classified on a simple scale from 0 to 4+. With EIA 31 cases (60.78%) were positive and 20 (39.21%) negative. With ER-ICA 29 (56.86%) had immunostaining, whereas 22 (43.13%) did not. 95.83% of the ER-ICA positive cases and 77.7% of ER-ICA negative had a good correlation with EIA values. Statistical analysis showed a high degree of correlation (r = 0.88 p 0.001). Hence, simple semiquantitative estimation in ER-ICA is sufficient to provide useful information for clinical use about ER content in tissue sections.

[Disturbances in sexual function: analysis of conditioning factors of an effective health care center]. / Alteraciones de la función sexual: análisis de factores condicionantes de una atención sanitaria efectiva.

BACKGROUND: With the aim of promoting activities related with sexual problems of the population in the health care area of the province of Alicante (Spain), the following objectives were set to the teams of primary health care: to know the opinion of the professionals concerning the most frequent reasons for consultation related with sexuality, establish opinions on their knowledge and educational requirements in this area, decrease sexual myths, strengthen the habit of registration of information on sexual behavior and problems related with the sexuality of the users and increase the frequency of derivating these problems to specialists. METHODS: Information was collected with a self applied survey on variables related with the above objectives. Four seminars were then developed on human sexual response, sexologic interview, sexual dysfunction and sexual therapy from the results obtained. One year thereafter, an evaluation was carried out in which the initial survey was reapplied. RESULTS: Fifty-eight percent of the 77 primary care professionals responded to the survey adequately in the initial phase. In their opinion the first three causes for consultation are impotence (13%), dispareunia (12%) and sexual disturbances related with chronic diseases (11%). The perception of their knowledge concerning the subjects covered in the seminars was slight with training in this area being clearly required. Eighty-nine percent were in favor of the collection of information on sexuality in health care files in contrast to 20% who reported to do so. From the initial to the final evaluation a decrease was seen in the direct intervention of the primary health care teams and an increase in derivations to specialists, which was of interest since around 20% of the professionals have erroneous beliefs on sexuality, varying according to the professions. CONCLUSIONS: The low level of knowledge and abilities perceived, the need for education, possession of the erroneous beliefs of the health care professionals surveyed and the passive behavior but positive attitude towards the sexual problems of the population reconfirm the importance of adequate continued training to health care professionals, particularly to those of primary health care since they are the ideal suppliers of assistance to sexual problems.

[Rheumatology research. An analysis of the situation in Spain]. / Investigación en Reumatología. Un análisis de la situación española.

To analyze the present status of rheumatological research in Spain, three indicators have been evaluated: use of the different study designs, use of statistical techniques and relevance of the studies. This last point was determined by the comparison of the research areas that had been reported during one year and the lines of rheumatological research established as priorities by 10 investigators from the 10 units of clinical care with a higher scientific output during the period 1985-1987. A revision has been made of the 67 articles from Spain out of the 1106 reported in seven of the journals with a better national and international impact index: Scandinavian Journal of Rheumatology, Arthritis and Rheumatism, Journal of Rheumatology, Annals of the Rheumatic Diseases, British Journal of Rheumatology, Clinical Experimental Rheumatology and Revue du Rhumatisme, in addition to Revista Española de Reumatología. It was found that few studies with analytical design are being published and that complex statistical analysis techniques are not being used; therefore, most articles do not have a possible statistical inference and lack value as predictors. The reports of cases and clinical series in the Letters to the Editor section are most common, particularly in the Spanish journal. Most studies are related with clinical research, although the consulted investigators consider that basic and epidemiological research have a higher priority. It is concluded that the Spanish contribution to the international rheumatological literature is still small and has a mainly descriptive character; thus, it is necessary to emphasize the use of analytical designs to improve the competitiveness. The type of studies to be carried out in the future, according to the priorities established by the investigators themselves, should change if their wishes are to be fulfilled.

[Opinion of medical students about prescription, counseling and practice of voluntary interruptions of pregnancy]. / Opinión de los estudiantes de medicina sobre la prescripción, el consejo y la práctica de interrupciones voluntarias del embarazo.

BACKGROUND: A future prospect was carried out of the professional trends regarding prescription, counseling and practice of voluntary interruptions of pregnancy (VIP). METHODS: To this end, a questionnaire was administered to 177 last term students of the Valencia and Alicante Schools of Medicine regarding the opinions of the current law on VIP in Spain and the professional trends of approach, with practical examples of the four instances depenalized by the Spanish law. RESULTS: For 44% of the sample the present law is insufficient, 30% agree with it and 13% think that the present law threatens life. The instance which elicited a highest number of favorable professional trends was congenital malformation (85%), followed by physical problems (78%) and psychical problems (63%). Only 60% of students would take a favorable attitude in case of rape. The students without religious practice, who vote progressive political parties and who think that present law is insufficient have a significant tendency towards attitudes favoring VIP. Significant sex differences among students were not found. CONCLUSIONS: Although probably to a lesser degree than in the present, in the near future the unfavorable attitudes of physicians will continue hindering the access of women to the services of VIP. A wide debate and more studies are required for a better definition of the implications of this phenomenon for public health purposes.