Epidemiology of infectious diseases in migrant populations from endemic or high-endemic countries: A multicentric primary care-based study in Spain.

OBJECTIVES: We aimed to evaluate the epidemiology of seven infections (Chagas disease, strongyloidiasis, schistosomiasis, human immunodeficiency virus, hepatitis B and C virus, and active tuberculosis) in migrant populations attended at primary care facilities in Catalonia, Spain. METHODS: This is a cross sectional study conducted from March to December 2018 at eight primary care centres in Catalonia, Spain where health professionals were recommended to systematically screen multiple infections in migrants considering the endemicity of the pathogens in their country of birth. Routine health data were retrospectively extracted from electronic health records of the primary care centres. The proportion of cases among individuals tested for each infection was estimated with its 95% confident interval (CI). Mixed-effects logistics regression models were conducted to assess any possible association between the exposure variables and the primary outcome. RESULTS: Out of the 15,780 migrants that attended primary care centres, 2410 individuals were tested for at least one infection. Of the 508 (21.1%) migrants diagnosed with at least one condition, a higher proportion originated from Sub-Saharan Africa (207, 40.7%), followed by South-East Europe (117, 23.0%) and Latin-America (88, 17.3%; p value <0.001). The proportion of migrants diagnosed with Chagas disease was 5/122 (4.1%, 95%CI 0.5-7.7), for strongyloidiasis 56/409 (13.7%, 95%CI 10.3-17.0) and for schistosomiasis 2/101 (2.0%, 95%CI 0.0-4.7) with very few cases tested. The estimated proportion for human immunodeficiency virus was 67/1176 (5.7%, 95%CI 4.4-7.0); 377/1478 (25.5%, 95%CI 23.3-27.7) for hepatitis B virus, with 108/1478 (7.3%, 95%CI 6.0-8.6) of them presenting an active infection, while 31/1433 (2.2%, 95%CI 1.4-2.9) were diagnosed with hepatitis C virus. One case of active tuberculosis was diagnosed after testing 172 migrant patients (0.6%, 95%CI 0.0-1.7). CONCLUSIONS: We estimated a high proportion of the studied infections in migrants from endemic areas. Country-specific estimations of the burden of infections in migrants are fundamental for the implementation of preventive interventions.

Kinetics and toxicity of nanoplastics in ex vivo exposed human whole blood as a model to understand their impact on human health.

The ubiquitous presence of nanoplastics (NPLs) in the environment is considered of great health concern. Due to their size, NPLs can cross both the intestinal and pulmonary barriers and, consequently, their presence in the blood compartment is expected. Understanding the interactions between NPLs and human blood components is required. In this study, to simulate more adequate real exposure conditions, the whole blood of healthy donors was exposed to five different NPLs: three polystyrene NPLs of approximately 50 nm (aminated PS-NH2, carboxylated PS-COOH, and pristine PS- forms), together with two true-to-life NPLs from polyethylene terephthalate (PET) and polylactic acid (PLA) of about 150 nm. Internalization was determined in white blood cells (WBCs) by confocal microscopy, once the different main cell subtypes (monocytes, polymorphonucleated cells, and lymphocytes) were sorted by flow cytometry. Intracellular reactive oxygen species (iROS) induction was determined in WBCs and cytokine release in plasma. In addition, hemolysis, coagulation, and platelet activation were also determined. Results showed a differential uptake between WBC subtypes, with monocytes showing a higher internalization. Regarding iROS, lymphocytes were those with higher levels, which was observed for different NPLs. Changes in cytokine release were also detected, with higher effects observed after PLA- and PS-NH2-NPL exposure. Hemolysis induction was observed after PS- and PS-COOH-NPL exposure, but no effects on platelet functionality were observed after any of the treatments. To our knowledge, this is the first study comprehensively evaluating the bloodstream kinetics and toxicity of NPL from different polymeric types on human whole blood, considering the role played by the cell subtype and the NPLs physicochemical characteristics in the effects observed after the exposures.

Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study.

Background: Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods: A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results: Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions: Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.

Clinical value of a tool for managing oral anticoagulation in nonvalvular atrial fibrillation in primary health care. Randomized clinical trial.

INTRODUCTION AND OBJECTIVES: The management of atrial fibrillation is complex and requires improvement at strategic points, such as in the control of patients treated with vitamin K antagonists. The aim of this study was to evaluate the impact on health outcomes of a nonvalvular atrial fibrillation decision support tool based on visualization of the time in therapeutic range in primary care. METHODS: The present randomized clinical trial was conducted in 2018 with a 1-year follow-up in 325 primary care centers in Catalonia. In the intervention centers, the decision support tool was installed to control the time in therapeutic range of patients treated with vitamin K antagonists. The tool was not visualized in the control group. This clinical trial was registered with ClinicalTrials.gov (NCT03367325). RESULTS: In total, 44 556 patients were studied. The intervention protected against admission for stroke (adjusted odds ratio [OR], 0.70; 95% confidence interval [95%CI], 0.55-0.88). The number needed to treat was 3502 (95%CI, 3305-3725) while the number of admissions for stroke avoided was 12.63 (95%CI, 11.88-13.38). The intervention also protected against mortality (adjusted OR, 0.78; 95%CI, 0.67-0.90), with a number needed to treat of 13 687 (95%CI, 10 789-18 714) and number of deaths avoided of 3.23 (95%CI, 2.36-4.10). CONCLUSIONS: The decision support tool was associated with slight reductions in the numbers of admissions for ischemic stroke and mortality. Although the follow-up time was short and the effect of the intervention was small, the results are valuable and could improve implementation of the tool.

Effectiveness and health benefits of a nutritional, chronobiological and physical exercise primary care intervention in fibromyalgia and chronic fatigue syndrome: SYNCHRONIZE + mixed-methods study protocol.

INTRODUCTION: Chronic pain, fatigue and insomnia are classic symptoms of fibromyalgia (FM) and chronic fatigue syndrome (CFS) and seriously affect quality of life. Nutrition and chronobiology are often overlooked in multicomponent approach despite their potential. This study aims to evaluate the effectiveness of a multidisciplinary group intervention based on nutrition, chronobiology, and physical exercise in the improvement of lifestyle and quality of life in FM and CFS. METHODS: Mixed-methods study based on a randomized clinical trial and qualitative analysis with a descriptive phenomenological approach. The study will be conducted in primary care in Catalonia. The control group will follow the usual clinical practice and the intervention group the usual practice plus the studied intervention (12 hours over 4 days). The intervention based on nutrition, chronobiology and physical exercise will be designed considering participants' opinions as collected in 4 focus groups. To evaluate effectiveness, EuroQol-5D, multidimensional fatigue inventory, VAS pain, Pittsburgh Sleep Quality Index, erMEDAS-17, biological rhythms interview of assessment in neuropsychiatry, REGICOR-Short, FIQR and Hospital Anxiety and Depression Scale questionnaires will be collected at baseline, and at 1, 3, 6, and 12 months post-intervention. Food intake, body composition, resistance and, strength will also be evaluated. The effect size will be calculated using Cohen d and logistic regression models will be used to quantify the impact of the intervention by adjusting for different variables. DISCUSSION: It expected that the intervention will improve the patients' quality of life, fatigue, pain and insomnia, as well as food and physical exercise habits, providing effectiveness evidence of a new therapy in addressing these syndromes in Primary Heath Care. Improvements in the quality of life will have a positive socioeconomic impact by reducing health expenditure on recurrent medical consultation, medication, complementary medical tests, etc and favor the maintenance of an active working life and productivity.

Occurrence and distribution of contaminants of legacy and emerging concern in surface waters of two Western Mediterranean coastal areas: Mar Menor Lagoon and Ebro Delta.

The occurrence and distribution of UV filters, plastic additives, synthetic musks, other personal care products (Other PCPs), triazines, polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), organophosphorus pesticides (OPPs), polychlorinated biphenyls (PCBs) and other current-use pesticides (Other CUPs) were characterised during summer 2018 and winter 2019 in surface waters of two sensitive areas of the Spanish coast located on the Mediterranean Sea (Mar Menor lagoon and Ebro Delta). Sixty-three organic contaminants out of a total of 100 compounds were detected, thus confirming the presence of all groups of pollutants studied in surface water at concentrations of ng/L. Both areas are affected by agricultural, urban and recreational activities, PCPs (mainly UV filters) being the predominant compounds found in both seasons which showed significant increases in concentrations in summer. The contaminants found at the highest concentrations were octocrylene, homosalate and ethylhexyl salicylate, which showed risk quotients higher than 1, indicating a potential risk to aquatic organisms, particularly in summer.

Early Detection of the Start of the Influenza Epidemic Using Surveillance Systems in Catalonia (PREVIGrip Study).

Sentinel physician networks are the method of influenza surveillance recommended by the World Health Organization. Weekly clinical diagnoses based on clinical history are a surveillance method that provides more immediate information. The objective of this study is to evaluate which influenza surveillance system is capable of the earliest detection of the start of the annual influenza epidemic. We carried out an ecological time-series study based on influenza data from the population of Catalonia from the 2010-2011 to the 2018-2019 seasons. Rates of clinical diagnoses and of confirmed cases in Catalonia were used to study the changes in trends in the different surveillance systems, the differences in area and time lag between the curves of the different surveillance systems using Joinpoint regression, Simpson's 1/3 method and cross-correlation, respectively. In general, changes in the trend of the curves were detected before the beginning of the epidemic in most seasons, using the rates for the complete seasons and the pre-epidemic rates. No time lag was observed between clinical diagnoses and the total confirmed cases. Therefore, clinical diagnoses in Primary Care could be a useful tool for early detection of the start of influenza epidemics in Catalonia.

Nanoplastics are bioaccumulated in fish liver and muscle and cause DNA damage after a chronic exposure.

The extent of the widespread, planetary contamination by plastic waste is difficult to fully capture. Nanoplastics (NPs) are currently in the center of research concerning plastic litter, both for the analytical challenges they pose and for their potential to provoke hazardous effects in organisms. However, there are still many unanswered questions in this multidisciplinary field, with a crucial missing piece being the quantification of NPs in fish tissues after in vivo exposures. Another relevant question that is still greatly unexplored is how a chronic exposure to NPs will affect fish health. This study aims to provide answers to both of these relevant knowledge gaps. To this end, goldfish (Carassius auratus) were exposed to 44 nm polystyrene (PS)-NPs via water for 30 days. Following the exposure, gastrointestinal tract, liver and muscle were sampled for PS-NPs analysis by means of size exclusion chromatography coupled to high resolution mass spectrometry. PS-NPs were detected in all liver and muscle samples of exposed fish, with higher concentrations in liver than in muscle, whereas no PS-NPs were detected in the gastrointestinal tract. Nevertheless, exposure to PS-NPs did not induce changes in hematology parameters nor in cortisol and glucose levels in plasma. On the other hand, even a relatively low concentration of PS-NPs was able to cause DNA damage, measured by an increase in erythrocyte nuclear abnormalities, suggesting that PS-NPs can reach the cell nucleus and cause genotoxicity. These results show for the first time that PS-NPs find their way to fish muscle after chronic exposure, where they bioaccumulate, but do not alter fish survival nor hematological or physiological stress indicators. The accumulation of PS-NPs in fish muscle can represent a threat to human health as a possible route of exposure to small-sized plastics. The present results in a model fish species open windows for future studies in edible fish species.

Anticoagulation Control with Acenocoumarol or Warfarin in Non-Valvular Atrial Fibrillation in Primary Care (Fantas-TIC Study).

Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose-response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.

Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study).

Background: Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. Results: In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). Conclusions: Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.

Pharmaceuticals removal and microbial community assessment in a continuous fungal treatment of non-sterile real hospital wastewater after a coagulation-flocculation pretreatment.

Hospital wastewaters are a main source of pharmaceutical active compounds, which are usually highly recalcitrant and can accumulate in surface and groundwater bodies. Fungal treatments can remove these contaminants prior to discharge, but real wastewater poses a problem to fungal survival due to bacterial competition. This study successfully treated real non-spiked, non-sterile wastewater in a continuous fungal fluidized bed bioreactor coupled to a coagulation-flocculation pretreatment for 56 days. A control bioreactor without the fungus was also operated and the results were compared. A denaturing gradient gel electrophoresis (DGGE) and sequencing approach was used to study the microbial community arisen in both reactors and as a result some bacterial degraders are proposed. The fungal operation successfully removed analgesics and anti-inflammatories, and even the most recalcitrant pharmaceutical families such as antibiotics and psychiatric drugs.

Combination of nanofiltration and ozonation for the remediation of real municipal wastewater effluents: Acute and chronic toxicity assessment.

The purpose of this work was to study the ozonation of nanofiltration (NF) retentates of real municipal wastewater treatment plant (MWTP) effluents for removal of microcontaminants (MCs) and toxicity. MCs present in these effluents were monitored using LC-MS/MS. Acute and chronic toxicity was addressed with Daphnia magna, Vibrio fischeri and Selenastrum capricornutum. Up to 40 MCs were found, most of them in concentrations over 100ng/L. 90% degradation of the sum of MCs was the critical point of comparison. When the NF membrane system was applied to MWTP effluents, treatment of NF rejection needed 2.75-4.5g O3/m3,4.5g O3/m3, which is less than 50% of the ozone needed for direct treatment of MWTP effluent. Treatment time (lower than 11min) was not influenced by MCs concentration, at least in the range tested (25-190µg/L). It has been demonstrated that consumption of ozone increased with organic load and inorganic content of different real effluents. MCs were eliminated by ozonation but acute toxicity (against V. fischeri and D. magna) increased. Chronic toxicity results were different and contrary in D. magna and S. capricornutum, due to the generation of new transformation products more toxic to D. magna than the parent contaminants. S. capricornutum inhibition percentage decreased in all cases after ozonation treatment. According to these results, before ozonation is implemented in MWTPs for the removal of MCs, the transformation products must first be examined and the treatment time or ozone doses should be extended to complete degradation if necessary.

Development of an extraction and purification method for the determination of multi-class pharmaceuticals and endocrine disruptors in freshwater invertebrates.

Aquatic organisms from freshwater ecosystems impacted by waste water treatment plant (WWTP) effluents are constantly exposed to constant concentrations of pharmaceuticals, endocrine disruptors and related compounds, among other anthropogenic contaminants. Macroinvertebrates inhabiting freshwater ecosystems might be useful bioindicators of exposure to contaminants, since their lives are long enough to bioaccumulate, but at the same time may integrate short-term changes in the environment. However, studies about potential bioaccumulation of emerging contaminants in these organisms are very scarce. The objectives of this study were to develop an analytical methodology for the analysis of 41 pharmaceuticals and 21 endocrine disruptors in freshwater invertebrates. In addition, bioaccumulation of these contaminants in three macroinvertebrate taxa inhabiting a waste water treatment plant -impacted river was evaluated. The method for the simultaneous extraction of both families of compounds is based on sonication, purification via removal of phospholipids, and analysis by ultra performance liquid chromatography coupled to a mass spectrometer (UPLC-MS/MS) in tandem. Recoveries for pharmaceuticals were 34-125%, and for endocrine disruptors were 48-117%. Method detection limits (MDLs) for EDCs were in the range of 0.080-2.4 ng g(-1), and for pharmaceuticals, 0.060-4.3 ng g(-1). These pollutants were detected in water samples taken downstream the waste water treatment plant effluent at concentrations up to 572 ng L(-1). Two non-esteroidal anti-inflammatory drugs, diclofenac and ibuprofen, and four endocrine disruptors - estrone, bisphenol A, TBEP, and nonylphenol - were detected in at least one macroinvertebrate taxa in concentrations up to 183 ng g(-1) (dry weight). An isobaric interference was identified during the analysis of diclofenac in Hydropsyche samples, which was successfully discriminated via accurate mass determination by TFC-LTQ Orbitrap.

Characterization of metoprolol biodegradation and its transformation products generated in activated sludge batch experiments and in full scale WWTPs.

Metoprolol (MTP) is a compound of concern, considered as an emerging contaminant due to its high consumption, pseudopersistence and potential ecotoxicity. Activated sludge batch experiments were performed to evaluate the biological transformation of MTP and the formation of transformation products under different treatment conditions. Total MTP removal was obtained in aerobic conditions, and the formation of MTP known metabolites (metoprolol acid (MTPA), α-hydroxymetoprolol (α-HMTP) and O-desmethylmetoprolol (O-DMTP)) and unknown transformation products (TPs) was investigated. The three known metabolites and two new TPs generated along the experiments were identified by liquid chromatography coupled to high resolution mass spectrometry. For the two new TPs plausible structures were proposed based on the tentative identification. MTPA had the major ratio formation for the TPs identified along the experiments (up to 40% of initial MTP concentration after 96 h treatment) and its persistence through biological treatment was proven. Ecotoxicity studies using Vibrio fischeri bioluminescent bacteria in an acute toxicity test showed that MTP and its known TPs are not toxic with the exception of o-DMTP. Finally, MTP and its TPs were monitored in a full scale membrane bioreactor and in a full scale conventional urban wastewater treatment plant (WWTP) and the results were compared with those obtained in batch experiments. α-HMTP was detected for the first time in a WWTP influent whereas MTPA was detected in influent and effluent WWTP samples at much higher levels (up to 100 folds higher) than MTP itself remarking its high persistence.

A fast and simple procedure for determination of perfluoroalkyl substances in food and feed: a method verification by an interlaboratory study.

In this study, a simple, fast, and cheap sample preparation procedure for the analysis of three well-known representatives of perfluoroalkyl substances (perfluorooctane sulfonate, perfluorooctanoic acid, and perfluorooctane sulfonamide) was validated in accordance with Commission Decision 2002/657/EC. The method was based on extraction with methanol followed by a dispersive solid phase extraction cleanup step by addition of activated charcoal for fish tissue, fish feed, and milk samples. The novel analytical approach combined with liquid chromatography-tandem mass spectrometry makes it possible to achieve limits of quantification below 1 µg/kg (defined by Commission Recommendation 2010/161/EU). This method provides a high laboratory sample throughput: ten samples in 60 min. The validated procedure was successfully verified in an interlaboratory study.

[Characteristics of oral anti-coagulation treatment in high-risk chronic auricular fibrillation]. / Características del tratamiento anticoagulante oral en la fibrilación auricular crónica de alto riesgo.

OBJECTIVE: To calculate the prevalence of chronic auricular fibrillation (CAF), how much of it is considered high-risk (CAFhr) and the degree of coverage with oral anti-coagulation treatment (OAT). DESIGN: Multi-centre descriptive study. SETTING: 9 health districts. The "Terres de l'Ebre" Primary Care Service. PARTICIPANTS: Randomised sample of 375 patients with CAF, of whom 150 met the criteria of CAFh-r during 2002. MAIN MEASUREMENTS: Profile of patients with CAFh-r; coverage with OAT; place of follow-up; presence of vascular complications, and the time relationships between the diagnosis of CAF, vascular complications and the start of OAT. All the INR determinations taken from the patients included in the study were used. RESULTS: There was 2.2% prevalence of CAF (95% CI, 1.4-3.3). 40% of CAF had criteria of CAFh-r. 74.2% were treated with OAT. In 41.7% the diagnosis of CAF coincided with the incidence of some vascular complication. There were no differences between the overall results of the INR obtained in hospital and in PC. The expected efficacy of OAT for thromboembolism prevention in our high-risk sample was 61.12%. CONCLUSIONS: 40% of the CAF are high-risk. In over a third of patients OAT was indicated after a vascular complication linked to an unknown CAF. The INR between 2-3 is similar in PC centres and the corresponding haematology service.

[Group versus individual education for type-2 diabetes patients]. / Educación grupal frente a individual en pacientes diabéticos tipo 2.

OBJECTIVES: To compare the effectiveness of group (GE) and individual (IE) health education in type-2 diabetes patients, and identify the improvement in knowledge, metabolic control and risk factors. DESIGN: Randomised clinical trial. SETTING: Primary care.Participants. 68 patients with type-2 diabetes, diagnosed 6 months before the start of the study and who had not received GE. Patients aged over 75, those with sensory, psychological and/or physical deficiencies and those not monitored in primary care were excluded (alpha=0.05; beta=0.2).Interventions. Patients were selected according to the inclusion criteria and allocated at random to the IE (n=33) or GE (n=35) group. Individual and group lessons were given at the same time for a year. The contents were evaluated with a validated, self-administered test. MAIN MEASUREMENTS: General, demographic variables, analyses, blood pressure, the Body Mass Index (BMI), the presence of cardiovascular risk factors, diabetes-related complications and therapeutic variables were all measured. RESULTS: The two kinds of education showed no significant differences from each other. The two groups improved the level of knowledge (P<0.001), and reduced HbA1c (P<0.001), HDL-C (P<0.001), the BMI (P=0.001) and systolic pressure (P=0.004), and increased their use of reactive strips (P=0.02). CONCLUSIONS: Health education on diabetes improved knowledge of the disease, metabolic control and cardiovascular risk factors. The two educational methods evaluated were equally effective.

[Laser treatment of cutaneous vascular lesions in childhood: prospective analysis of our experience with 95 children]. / Tratamiento con láser de las anomalías vasculares cutáneas en la infancia: análisis prospectivo de nuestra experiencia en 95 niños.

BACKGROUND: Recently the flashlamp-pumped dye laser has improved treatment of cutaneous vascular lesions results since this laser acts much more vessel specific than other laser (argon, Nd:Yag). The objective of this manuscript is to analyze our experience in the treatment of vascular lesions in infancy with the pulsed dye laser. MATERIAL AND METHODS: Ninety-five patients 18 years with vascular lesions (85 nevus flammeus and 10 hemangiomas) were treated prospectively with the flashlamp-pumped dye laser. The patients received therapy until the lesion was almost clear, or until the lesion failed to respond. All patients were examined during the course of their treatment to assess the clinical evolution and the incidence of adverse effects associated with the use of the laser. RESULTS: The study consisted of 54 females and 41 males ranged in age from 3 months to 18 years, with the average age being 7.3+/-5.2 years. Only six children were treated with less than six months of age. Seventy-eight vascular lesions were located on the face, nine on the neck, eight on the extremities, five on the trunk, and two on other regions (perineal area and scalp). The number of treatment sessions needed for the resolution of the cutaneous vascular lesion (in 52 nevus flammeus and 10 hemangiomas, at the moment) was 9.8+/-7.5 (range 1 to 36), with variations in relation to the type of vascular lesion (more sessions in nevus flammeus than hemangiomas) and their anatomical location (more sessions in the face and less in shoulder, arms and lips). The adverse effects were slights and transitories. CONCLUSIONS: Laser therapy is useful and safe in the treatment of cutaneous vascular lesions in infancy. Major determinants of treatment response are type of cutaneous vascular lesion and location, and also size and patient's age.

[The investigation of the contacts of the tuberculous pediatric patient]. / La investigación de contactos en el paciente tuberculoso pediátrico.

BACKGROUND: Results of contacts investigation of tuberculous pediatric patients, usually non-infectious, are shown. Their relationship to the clinical situation on index case and the intimacy of exposure is analyzed. METHODS: 714 contacts of 111 pediatric cases (53 category II and 58 category III, according to the American Thoracic Society classification). The tuberculin skin test with 2 units of PPD-RT23 was used to identify the infected persons. Chest radiography, sputum smear and culture examination were used to diagnose current pulmonary disease. According to the intimacy of exposure to index case, contacts were defined as household, close or sporadic contacts. The possible association with clinical situation of index case and intimacy of exposure was analyzed. RESULTS: 41 new cases of tuberculosis were detected, 7 of them were infectious. Prevalence of tuberculous infection among contacts was 44%. Quimioprofilaxis was indicated to 126 contacts. The prevalences of infection and disease according to clinical situation and degree of contact did not differ significantly. CONCLUSIONS: it is advisable to investigate the contacts of tuberculous pediatric patients, even in cases of tuberculous infection without disease; the investigation must include close and sporadic contacts.