Incidence and clinical characteristics of Guillain-Barré syndrome in Osona (Barcelona, Spain), 2003-2016.

INTRODUCTION: According to most studies, the incidence of Guillain-Barré syndrome increases with age, with a peak incidence occurring between 70 and 80 years of age. The objective of this study is to describe the incidence (overall and by sex and age group) and clinical characteristics of Guillain-Barré syndrome in Osona (Barcelona, Spain). METHODS: We performed a retrospective, descriptive, population-based study covering the period 2003 to 2016. RESULTS: The global incidence of Guillain-Barré syndrome is 2.07 cases per 100000 person-years. Incidence increases with age, except for small peaks during childhood and between 40 and 50 years, and reaches a maximum of 6.26 cases per 100000 person-years above the age of 80. The incidences of the different variants were: AIDP, 72.1%; AMAN, 16.3%; ANSAN, 4.7%; and Miller Fisher syndrome, 4.7%. A total of 41.9% of patients had a history of respiratory tract infections, and 20.9% had a history of gastrointestinal infections. Protein in the cerebrospinal fluid was found in 76.7%. EMG findings suggested demyelination in 73.7% of the patients and axonal degeneration in 26.3%. A total of 20.9% of patients needed ventilatory support. Six-month mortality was 9.3%. Variables associated with worse prognosis were age over 80 years, delay in admission, previous gastrointestinal infection, and AMAN variant. CONCLUSIONS: The incidence observed in our study is in the upper range of estimated incidence rates reported in European and North American studies. The syndrome may be underdiagnosed in elderly patients; physicians must be vigilant to the possibility of the disease, which is associated with a high mortality rate if it is not treated early.

Untangling surface oxygen exchange effects in YBa2Cu3O6+x thin films by electrical conductivity relaxation.

The kinetics of oxygen incorporation (in-diffusion process) and excorporation (out-diffusion process), in YBa2Cu3O6+x (YBCO) epitaxial thin films prepared using the chemical solution deposition (CSD) methodology by the trifluoroacetate route, was investigated by electrical conductivity relaxation measurements. We show that the oxygenation kinetics of YBCO films is limited by the surface exchange process of oxygen molecules prior to bulk diffusion into the films. The analysis of the temperature and oxygen partial pressure influence on the oxygenation kinetics has drawn a consistent picture of the oxygen surface exchange process enabling us to define the most likely rate determining step. We have also established a strategy to accelerate the oxygenation kinetics at low temperatures based on the catalytic influence of Ag coatings thus allowing us to decrease the oxygenation temperature in the YBCO thin films.

Prevalencia de miastenia gravis en la comarca de Osona (Barcelona, Cataluña) / Prevalence of myasthenia gravis in the Catalan county of Osona

INTRODUCCIÓN: La prevalencia descrita de miastenia gravis (MG) oscila entre 5 y 24 casos por 100.000, representando los mayores de 65 años menos del 50% del total. Se presenta la prevalencia de MG en la comarca de Osona (Barcelona, España). Se describen la prevalencia y las características clínicas por grupos de edad, diferenciando los menores y mayores de 65 años. MÉTODOS: El Servicio de Neurología del Hospital General de Vic puso en marcha en el año 1991 un registro comarcal sobre los casos de MG diagnosticados. RESULTADOS: La prevalencia de MG fue de 32,89 × 105 habitantes (IC 95%, 23,86-41,91). La prevalencia estandarizada (población europea) fue del 35,47×105 habitantes (IC 95%, 26,10-44,84). La razón por sexo, mujeres/hombres, es de 1,3. De forma global, el grupo de más de 65 años representa el 62,75% de los casos. Las prevalencias de MG por grandes grupos de edad presentan un carácter marcadamente ascendente, pasando de ningún caso en el grupo de menos de 25 años, a 21,87 × 105 en el grupo de 25 a 64 años, alcanzando 122,35×105 en el grupo de 65 y más años. Las clínicas pretratamiento y a fecha de corte no presentan diferencias estadísticamente significativas (p > 0,05) entre menores y mayores de 65 años. CONCLUSIONES: Se describe la prevalencia más alta comunicada hasta la actualidad. Esta alta prevalencia es a expensas del grupo de más de 65 años. Estos resultados son una nueva alerta para evitar el infradiagnóstico de la MG en el anciano

INTRODUCTION: The reported prevalence of myasthenia gravis ranges between 5 and 24 cases per 100,000, and people over 65 years account for less than 50% of all cases. The prevalence and clinical characteristics of myasthenia gravis in the county of Osona were studied in patients younger and older than 65. METHODS: The study draws from the county-based prospective myasthenia gravis register implemented by the Neurology Department at Hospital General de Vic in 1991. RESULTS: The prevalence of myasthenia gravis was 32.89 × 105 inhabitants (95% CI, 23.86-41.91). The standardized prevalence (European population) was 35.47 × 105 inhabitants (95% CI, 26.10-44.84). The ratio of women to men was 1.3. Overall, the group of patients older than 65 accounted for 62.75% of all cases. The prevalence of myasthenia gravis increased considerably in older age groups. No cases were registered among patients under 25 years old, prevalence was 21.87 × 105 in the 25 to 64 age group, and prevalence in patients over 65 years increased to 122.35×105. The clinical characteristics prior to treatment and at the cut-off date are similar (P > .05) in patients younger than 65 and those aged 65 and older. CONCLUSIONS: These figures show the highest prevalence rate reported to date. This high prevalence is due to the rate observed among patients older than 65. These results provide a new warning that myasthenia gravis may be underdiagnosed in the elderly populatio

Functional reconstruction of acutely burnt achilles tendon with composite anterolateral thigh flap with fascia lata: a case report.

Soft tissue defects in the postero-inferior aspect of the leg are still challenging, especially when they affect the Achilles tendon due to its important functional involvement in the normal movement of the ankle. Dorsiflexion and flexion may be affected if proper reconstruction is not achieved, thus limiting daily activities such as walking, climbing stairs or running. Several techniques, including local or regional flaps, combinations of tendon substitutes with free muscular or fasciocutaneous flaps, and free composite flaps with tendon have been described for the reconstruction of complex defects caused by burn sequelae, tumors, trauma, chronic ulcers, etc. The gold standard treatment for moderate to large defects is the anterolateral thigh (ALT) flap with vascularized fascia lata. The ALT flap is reliable because of a long vascular pedicle and a large donor area. Moreover, the fascia lata mimics the Achilles tendon perfectly when rolled on itself. The aim of this article is to present the application of this technique for the first time in a case of an acute burn. The timing of reconstruction with free flaps is critical in acute burns. In our case, it was performed on the 24th day post-burn and no microsurgical complications appeared. More than six months after surgery, the patient showed a normal gait, was able to lift his own weight against gravity and no complications were detected in the donor area.

Les pertes de substance des parties molles de la région postéro inférieure de jambe constituent un problème majeur, surtout quand elles intéressent le tendon d'Achille, à cause de son importante implication dans les mouvements normaux de la cheville. La dorsiflexion et la flexion peuvent être affectées si une réparation correcte n'est pas réalisée, car elle limite les activités journalières telles que la marche, la montée d'escaliers, ou la course. Plusieurs techniques incluant les lambeaux locaux et régionaux, l'association de substituts tendineux avec des lambeaux libres musculaires ou fascio cutanés, et les lambeaux libres composites avec tendon ont été décrits pour la reconstruction des pertes de substances complexes en rapport avec séquelles de brûlures, tumeurs, traumatismes, ulcères chroniques etc. Le traitement de référence pour des pertes de substances modérées ou importantes est constitué par le lambeau antero latéral de cuisse avec fascia lata vascularisé. Ce lambeau est sûr, du fait du long pédicule vasculaire et de l'importance de la surface de la zone donneuse. Cependant, le fascia lata imite parfaitement le tendon d'Achille, que s'il est roulé sur lui-même. Le but de cet article est de présenter une application de cette technique pour la première fois dans un cas de brûlures en urgence. Le moment de la reconstruction par lambeaux libres est discuté dans les brûlures. Dans notre observation, il a été réalisé au cours du 24 e jour après la brûlure et sans complications micro chirurgicales. Plus de six mois après la chirurgie, le patient affiche une démarche normale, il est capable de se lever tout seul et aucune complication n'est apparue au niveau de la zone donneuse.

Prevalence of myasthenia gravis in the Catalan county of Osona. / Prevalencia de miastenia gravis en la comarca de Osona (Barcelona, Cataluña).

INTRODUCTION: The reported prevalence of myasthenia gravis ranges between 5 and 24 cases per 100,000, and people over 65years account for less than 50% of all cases. The prevalence and clinical characteristics of myasthenia gravis in the county of Osona were studied in patients younger and older than 65. METHODS: The study draws from the county-based prospective myasthenia gravis register implemented by the Neurology Department at Hospital General de Vic in 1991. RESULTS: The prevalence of myasthenia gravis was 32.89×105 inhabitants (95%CI, 23.86-41.91). The standardized prevalence (European population) was 35.47×105 inhabitants (95%CI, 26.10-44.84). The ratio of women to men was 1.3. Overall, the group of patients older than 65 accounted for 62.75% of all cases. The prevalence of myasthenia gravis increased considerably in older age groups. No cases were registered among patients under 25years old, prevalence was 21.87×105 in the 25 to 64 age group, and prevalence in patients over 65 years increased to 122.35×105. The clinical characteristics prior to treatment and at the cut-off date are similar (P>.05) in patients younger than 65 and those aged 65 and older. CONCLUSIONS: These figures show the highest prevalence rate reported to date. This high prevalence is due to the rate observed among patients older than 65. These results provide a new warning that myasthenia gravis may be underdiagnosed in the elderly population.

Experiencia en reconstrucción mamaria inmediata con implante y matriz acelular de pericardio bovino tras mastectomía ahorradora de piel / Experience in immediate breast reconstruction with implant and acellular bovine pericardium matrix after skin sparing mastectomy

Presentamos nuestra experiencia en reconstrucción mamaria inmediata con implante y matriz acelular de pericardio bovino. Realizamos un estudio que incluye todas las pacientes sometidas a reconstrucción mamaria inmediata con implante subpectoraly matriz acelular de pericardio bovino tras mastectomía ahorradora de piel, con o sin preservación del complejo areola-pezón, en la Unidad de Patología Mamaria del Hospital Universitario Vall d’Hebron de Barcelona (España) entre marzo de 2013 y diciembre de 2014.En total se reconstruyeron 24 mamas, de las cuales se realizó mastectomía terapéutica en 17 (70,8%) y mastectomía profiláctica en 7 (29,2%). El volumen medio del implante colocado fue de 263,3 cc (rango de 80 a 445 cc). Siete mamas(29,2%) fueron reconstruidas con expansor tisular y las otras17 (70,8%) con prótesis mamaria anatómica definitiva. La tasaglobal de complicaciones fue del 16,7% (4 casos): 3 casos de seroma (12,5%), 1 caso de hematoma (4,2%) y 1 de necrosis parcial del colgajo cutáneo (4,2%) con extrusión del implante que requirió retirada del mismo. La tasa global de complicaciones en las mamas que recibieron radioterapia postoperatoria fue del 33,3% (incluye el caso de fracaso reconstructivo).En nuestra experiencia, la reconstrucción mamaria inmediata con implante y matriz acelular de pericardio bovino es una técnica segura y fiable, que permite obtener unos resultados óptimos con una tasa de complicaciones asumible y un menor coste económico (AU)

The aim of this document is to share our experience interms of immediate breast reconstruction using breast implants and acellular matrix made of bovine pericardium. We carried out an study including all the patients treated at the Breast Pathology Unit of the Vall d' Hebron Hospital, Barcelona(Spain) who underwent an immediate breast reconstruction with a subpectoral breast implant and acellular matrix made of bovine pericardium after a skin sparing mastectomy with or without preservation of the nipple-areola complex ,between March 2013 and December 2014.A total of 24 breasts were reconstructed with this technique. Therapeutic mastectomy was made in 17 breasts (70.8%)and 7 were prophylactic (29.2%). The average volume of the implants was 263.3 cc (range 80-445 cc ). Seven breasts(29.2%) were reconstructed with a tissue expander and the other 17 (70.8%) with a definitive anatomical breast implant. The overall complication rate was 16.7% (4 cases): 3 seromas cases (12.5%), 1 hematoma (4.2%) and 1 partial skin flap necrosis(4.2 %) with extrusion of the implant which required removal. The overall complication rate in the breast that received postoperative radiation therapy was 33.3% (including the case of reconstructive failure).In our experience, immediate breast reconstruction with breast implant and acellular matrix made of bovine pericardium is a safe and reliable technique, which allows the surgeon to obtain optimum results, with an acceptable rate of complications and a lower price (AU)

Knowledge, attitude and adherence of Spanish healthcare professionals to asthma management recommendations during pregnancy

Background: The aim of the present study was to evaluate the knowledge, attitude and adherence to asthma management recommendations during pregnancy of Spanish health care professionals. Methods: A multiple choice survey with 14 questions was designed. Items assessed opinion about asthma guidelines and attitudes towards treatment, spirometry, specific immunotherapy and labour in pregnant asthmatic patients. Test completion was voluntary, individual, and anonymous. Results: A total of 1000 questionnaires were fulfilled: respiratory medicine specialists (19.8%); allergy specialists (17.2%); primary care physicians (46.1%); and gynaecologists/obstetricians (16.9%). Guidelines were considered useful by 96.5% although 64% admitted that they followed them seldom or never. Most physicians (55.9%) answered that they would maintain asthma therapy in clinically stable patients. Almost 30% of physicians would not perform spirometry in pregnant asthma patients. 19% declared they would interrupt specific immunotherapy which had proven safe and effective. Univariate analysis revealed low adherence to be associated with the following variables: age, primary care or gynaecology/obstetrician specialisation, number of asthmatics attended per month, and declared use of guidelines for pregnant asthmatic patients. Multivariate analysis showed that being a primary care physician and a gynaecologist/obstetrician, attending a low number of asthma patients per month, and poor use of spirometry during pregnancy are associated to low adherence to asthma guidelines. Conclusion: Even though the majority of Spanish physicians surveyed seem to consider guidelines useful, their adherence to those is very low if translated to managing pregnant asthmatic patients. Educational strategies seem unavoidable and should be targetted mainly to primary care and gynaecology/obstetrician physicians(AU)

Increase in the prevalence of multiple sclerosis over a 17-year period in Osona, Catalonia, Spain.

The prevalence of multiple sclerosis in the south of Europe seems to be higher than previously considered. This study aimed to probe a possible increase in the prevalence of multiple sclerosis (MS) in Osona over the past 17 years. This was a cross-sectional study including MS-confirmed cases from several sources of information. Crude and adjusted prevalence rates were obtained. One hundred and twenty patients fulfilled the study criteria. The crude prevalence of MS was 79.9 (95% CI: 66.3-95.6) per 100,000 inhabitants and 91.2 (95% CI: 75.5-109.2) per 100,000 among Spanish born individuals. The prevalence of multiple sclerosis cases in Osona has increased over the past 17 years to being one of the highest reported in Spain.

Knowledge, attitude and adherence of Spanish healthcare professionals to asthma management recommendations during pregnancy.

BACKGROUND: The aim of the present study was to evaluate the knowledge, attitude and adherence to asthma management recommendations during pregnancy of Spanish health care professionals. METHODS: A multiple choice survey with 14 questions was designed. Items assessed opinion about asthma guidelines and attitudes towards treatment, spirometry, specific immunotherapy and labour in pregnant asthmatic patients. Test completion was voluntary, individual, and anonymous. RESULTS: A total of 1000 questionnaires were fulfilled: respiratory medicine specialists (19.8%); allergy specialists (17.2%); primary care physicians (46.1%); and gynaecologists/obstetricians (16.9%). Guidelines were considered useful by 96.5% although 64% admitted that they followed them seldom or never. Most physicians (55.9%) answered that they would maintain asthma therapy in clinically stable patients. Almost 30% of physicians would not perform spirometry in pregnant asthma patients. 19% declared they would interrupt specific immunotherapy which had proven safe and effective. Univariate analysis revealed low adherence to be associated with the following variables: age, primary care or gynaecology/obstetrician specialisation, number of asthmatics attended per month, and declared use of guidelines for pregnant asthmatic patients. Multivariate analysis showed that being a primary care physician and a gynaecologist/obstetrician, attending a low number of asthma patients per month, and poor use of spirometry during pregnancy are associated to low adherence to asthma guidelines. CONCLUSION: Even though the majority of Spanish physicians surveyed seem to consider guidelines useful, their adherence to those is very low if translated to managing pregnant asthmatic patients. Educational strategies seem unavoidable and should be targetted mainly to primary care and gynaecology/obstetrician physicians.

Can the crystallization rate be independent from the crystallization enthalpy? The case of amorphous silicon.

The crystallization enthalpy measured in a large series of amorphous silicon (a-Si) materials varies within a factor of 2 from sample to sample (Kail et al 2011 Phys. Status Solidi RRL 5 361). According to the classical theory of nucleation, this variation should produce large differences in the crystallization kinetics leading to crystallization temperatures and activation energies exceeding 550 °C and 1.7 eV, respectively, the 'standard' values measured for a-Si obtained by self-implantation. In contrast, the observed crystallization kinetics is very similar for all the samples studied and has no correlation with the crystallization enthalpy. This discrepancy has led us to propose that crystallization in a-Si begins in microscopic domains that are almost identical in all samples, independently of their crystallization enthalpy. Probably the existence of microscopic inhomogeneities also plays a crucial role in the crystallization kinetics of other amorphous materials and glasses.

Gestión de la demanda de urgencias: Quiero que el médico me vea ahora. ¿Cómo lo hacemos? / Demand management of emergencies, I want the doctor to see me now. What do we do?

Objectivo. Descripción de la experiencia organizativa de gestión de la demanda en nuestro centro de salud. Valoración de la utilidad, grado de satisfacción y percepción de mejora por parte de los profesionales del centro mediante una encuesta de valoración. Material y métodos. DISEÑO: Estudio descriptivo de la experiencia y de una encuesta de valoración. EMPLAZAMIENTO: Área urbana con 29.674 pacientes asignados. PARTICIPANTES: Todo el equipo de profesionales sanitarios y no sanitarios del centro de salud. INTERVENCIONES: Disminución de la cita previa en las agendas de los facultativos con aumento de las visitas del día y creación de un circuito nuevo de atención a los pacientes con una enfermera de triaje y un médico de guardia. Aplicación de una encuesta de valoración a todos los «profesionales del centro». MEDICIONES PRINCIPALES: Análisis de las visitas de la enfermera de triaje así como del porcentaje de resolución y análisis de los resultados de la encuesta por estamentos. Resultados. La media de visitas por parte de la enfermera de triaje es de 30 con un 41% de resolución por parte de la misma. Encuesta cumplimentada por el 93,8% de los profesionales del centro. Conclusiones. Valoración elevada por parte de todo el personal de la consulta de triaje. Las mejoras y la disminución de carga de trabajo lo refieren principalmente administrativos y médicos (AU)

Objectives. Description of the experience of organizational management of demand in our health centre. Assessment of the usefulness, level of satisfaction and perception of improvement on the part of the professionals of the centre using an evaluation survey. Material and methods. DESIGN: Descriptive Study of the experience and an evaluation survey. SETTING: Urban Area with 29,674 patients assigned. PARTICIPANTS: The team of health and non-health professionals of the health centre. INTERVENTIONS: Decrease in previous appointments in the lists of the physicians, with an increase in the visits on the day and creation of a new circuit of patient care using a triage nurse and an emergency physician. Implementation of an evaluation survey of all “professionals of the centre”. MAIN MEASUREMENTS: Analysis of triage nurse visits, as well as the percentage of resolution and analysis of the results of the survey by profession. Results. The average of visits to the nurse triage was 30, with 41% of them being resolved there. The survey was completed by 93.8% of professionals of the centre. Conclusions. There were high appraisals for the triage clinic by all the staff. The improvements and the decrease in workload were mainly administrative and medical (AU)

Restricted epitaxial growth of crystallites in hydrogenated nanocrystalline silicon during thermal crystallization experiments.

Thermal crystallization experiments have been carried out on nanocrystalline silicon films. From the thermal activation of the process, it is concluded that the amorphous phase crystallizes by solid phase epitaxy around the preexisting crystallites. However, and in contrast with the usual epitaxial crystallization of wafers partially amorphized by ion implantation or ball-milled powders, the epitaxial growth is inhibited for most of the amorphous-crystalline interface. Our analysis indicates that a small fraction of the interface contributes to the epitaxial growth. Although the influence of oxidation and of Si-H groups located at the interface cannot be completely excluded, this behavior is explained in terms of a high density of microvoids located at the a-c interface. This result has implications for the models of electrical conduction of nc-Si:H.

[Prevalence of cognitive deterioration in people over 80-years-old: COGMANLLEU study]. / Prevalencia de deterioro cognitivo en personas mayores de 80 años: estudio COGMANLLEU.

INTRODUCTION: We want to detect the prevalence of cognitive prevalence deterioration in the elderly population of 80-years-old or older, their grade of deterioration and the causal pathogenic entity. DESIGN: a cross-sectional population study, including a first phase of screening and a second one of diagnosis confirmation. STUDY SUBJECTS: a total of 877 elderly people of 80-years-old or older belonging to the basic health care area of Manlleu (Osona, Catalonia midlands). In the first phase, relatives and/or caregivers were interviewed, and the participating subjects underwent a set of tests. Those who obtained 24 points or less on the Mini-Mental State Examination (MMSE) and/or an equal Global Deterioration Scale (GDS) or over 3 were admitted to the second phase. During the second phase, a general and a neurological examination were performed, along with blood tests, cranial computed tomography scan and a neuropsychological study. DSM-IV criteria were used for dementia diagnosis, NINCDS-ADRA criteria for Alzheimer's disease (AD) and NINCS-AIREN for vascular dementia. RESULTS: Half of the people over 80-years-old had cognitive deterioration. One-fourth had dementia. A total of 70.3% of these dementias corresponded to AD (47.2% AD without vascular lesions and 23.1% AD with vascular lesions) and 12% corresponded to vascular dementia. The percentage of other degenerative dementias was 17.6%. Age and gender were observed to be associated to dementia. CONCLUSIONS: The prevalence of dementia in the COGMANLLEU study is similar to other European studies. AE is the most frequent dementia.

[Genetic and environmental factors that may influence in the senile form of Alzheimer's disease: nested case control studies]. / Factores genéticos y ambientales que pueden influir en la forma senil de la enfermedad de Alzheimer: estudio de casos y controles anidado.

INTRODUCTION: We identify the genetic and environmental factors associated to Alzheimer's disease (AD) in a population aged 80 years or greater. POPULATION STUDIED: subjects who participated in the COGMANLLEU study on prevalence of cognitive deterioration in Manlleu (Osona, Central Catalonia). DESIGN: nested case control studies. The subjects who were diagnosed of AD (cases) in phases 2 of said study were paired 1:1 by age and gender with control subjects who were selected from among those who had no suspicion of cognitive deterioration and who had been examined in phase 1 of the study. The participating subjects (cases and controls) and their family or caregivers were interviewed. This included psychometric tests, physical examination, biological measurements, cranial computed tomography scan and determination of ApoE genotype. RESULTS: Age is the principal factor associated to AD: risk of getting the disease is six time greater among those over 85 years (odds ratio [OR]: 6.54; 95% confidence interval [CI]: 2.05-20.81; p<0.05). Other factors associated of AD were female gender (OR: 3.17; 95 % CI: 0.80-12.50) and having been exposed to general anesthesia (OR: 3.22; 95 % CI: 1.03-10.09; p < 0.05). Arterial hypertension (AHT) presented a negative association (OR: 0.37; 95% CI: 0.10-1.31; p<0.05). An association was also observed between AD and the presence of ApoE4 allele so that the likelihood of ApoE4 in subjects with AD was three times greater than in the control group (OR: 3.44; 95% CI: 0.67-17.62). CONCLUSIONS: The results agree with the hypothesis that senile AD is a complex, multifactorial disease in which different genetic and environmental factors play a part, among which having received general anesthesia has a role that can be considered in future research.

Prevalencia de deterioro cognitivo en personas mayores de 80 años: estudio COGMANLLEU / Prevalence of cognitive deterioration in people over 80 years old: COGMANLLEU study

Introducción. Se quiere detectar la prevalencia de deteriorocognitivo en la población de edad igual o superior a 80 años, asícomo el grado de deterioro y la entidad patológica causal.Método. Diseño: estudio transversal de base poblacional con unaprimera fase de cribado y una segunda fase de confirmación del diagnóstico.Sujetos de estudio: 877 personas de edad igual o mayor a 80años adscritas al área básica de salud de Manlleu (Osona, Cataluñacentral). En la primera fase se realizó una entrevista a familiares y/o acuidadores y se pasó una batería de tests a los sujetos participantes.Pasaron a la segunda fase los que obtuvieron una puntuación igual omenor a 24 en el Mini-Mental State Examination (MMSE) y/o una EscalaGlobal de Deterioro (GDS) igual o superior a 3. En la segunda fasese procedió a la exploración general y neurológica, a la realización deuna analítica, tomografía computerizada craneal y estudio neuropsicológico.Para el diagnóstico de demencia se utilizaron los criteriosdel DSM-IV, para la enfermedad de Alzheimer (EA) los del NINCDSADRDAy para la demencia vascular los del NINCS-AIREN.Resultados. La mitad de las personas mayores de 80 años presentabandeterioro cognitivo. Una cuarta parte presentaban demencia.El 70,3 % de las demencias correspondía a EA (47,2% EA sin lesionesvasculares y 23,2% EA con lesiones vasculares) y el 12% ademencia vascular. El porcentaje de otras demencias degenerativas ysecundarias fue del 17,6%. Se observó asociación de la demenciacon la edad y el género.Conclusiones. La prevalencia de demencia en el estudio COGMANLLEUes similar a la descrita en otros estudios europeos. La EAconstituye la demencia más frecuente (AU)

Introduction. We want to detect the prevalence of cognitiveprevalence deterioration in the elderly population of 80 years oldor older, their grade of deterioration and the causal pathogenicentity.Method. Design: a cross-sectional population study, includinga first phase of screening and a second one of diagnosisconfirmation. Study subjects: a total of 877 elderly people of 80years old or older belonging to the basic health care area of Manlleu(Osona, Catalonia midlands). In the first phase, relativesand/or caregivers were interviewed, and the participating subjectsunderwent a set of tests. Those who obtained 24 points orless on the Mini-Mental State Examination (MMSE) and/or anequal Global Deterioration Scale (GDS) or over 3 were admittedto the second phase. During the second phase, a general and aneurological examination were performed, along with bloodtests, cranial computed tomography scan and a neuropsychologicalstudy. DSM-IV criteria were used for dementia diagnosis,NINCDS-ADRA criteria for Alzheimer’s disease (AD) and NINCSAIRENfor vascular dementia.Results. Half of the people over 80 years old had cognitivedeterioration. One-fourth had dementia. A total of 70.3% of thesedementias corresponded to AD (47.2% AD without vascularlesions and 23.1% AD with vascular lesions) and 12 % correspondedto vascular dementia. The percentage of other degenerativedementias was 17.6%. Age and gender were observed to beassociated to dementia.Conclusions. The prevalence of dementia in the COGMANLLEUstudy is similar to other European studies. AE is the mostfrequent dementia (AU)

Factores genéticos y ambientales que pueden influir en la forma senil de laenfermedad de Alzheimer: estudiode casos y controles anidado / Genetic and environmental factors that may influence in the senile form of Alzheimer's disease: nested case control studies

Introducción. Se identifican los factores genéticos y ambientalesasociados a la enfermedad de Alzheimer (EA) en una población deedad igual o superior a 80 años.Método. Población estudiada: sujetos que participaron en el estudioCOGMANLLEU sobre prevalencia de deterioro cognitivo en Manlleu(Osona, Cataluña central). Diseño: estudio de casos y controles anidado.Los sujetos que fueron diagnosticados de EA (casos) en la fase 2 delmencionado estudio se emparejaron 1:1 por edad y sexo a sujetos controlque se seleccionaron entre los que no presentaron ninguna sospechade deterioro cognitivo y que habían sido examinados en la fase 1del estudio. Se realizó una entrevista a los sujetos participantes (casosy controles) y a sus familiares o cuidadores que incluyó pruebas psicométricas,exploración física, determinaciones biológicas, tomografíacomputarizada craneal y determinación del genotipo ApoE.Resultados. La edad es el principal factor asociado a la EA: elriesgo de contraer la enfermedad es seis veces superior entre los mayoresde 85 años (odds ratio [OR]: 6,54; intervalo de confianza [IC]95%: 2,05-20,81; p<0,05). Otros factores asociados a la EA fueron elsexo femenino (OR: 3,17; IC 95 %: 0,80-12,50) y haber estado expuestosa anestesia general (OR: 3,22; IC 95%: 1,03-10,09; p<0,05).La hipertensión arterial (HTA) presentaba una asociación negativa(OR: 0,37; IC 95 %: 0,10-1,31; p<0,05). También se observó asociaciónentre la EA y la presencia del alelo ApoE4 de manera que la probabilidadde ApoE4 en los sujetos con EA era tres veces superior a ladel grupo control (OR: 3,44; IC 95%: 0,67-17,62).Conclusiones. Los resultados concuerdan con la hipótesis deque la EA senil es una enfermedad compleja, multifactorial, en la queintervienen diversos factores genéticos y ambientales entre los queel recibir anestesia general puede desempeñar un papel a consideraren investigaciones futuras (AU)

Introduction. We identify the genetic and environmentalfactors associated to Alzheimer's disease (AD) in a populationaged 80 years or greater.Method. Population studied: subjects who participated in theCOGMANLLEU study on prevalence of cognitive deterioration inManlleu (Osona, Central Catalonia). Design: nested case controlstudies. The subjects who were diagnosed of AD (cases) in phases2 of said study were paired 1:1 by age and gender with controlsubjects who were selected from among those who had no suspicionof cognitive deterioration and who had been examined inphase 1 of the study. The participating subjects (cases and controls)and their family or caregivers were interviewed. This includedpsychometric tests, physical examination, biological measurements,cranial computed tomography scan and determinationof ApoE genotype.Results. Age is the principal factor associated to AD: risk ofgetting the disease is six time greater among those over 85 years(odds ratio [OR]: 6.54; 95% confidence in-terval [CI]: 2.05-20.81;p<0.05). Other factors associated of AD were female gender (OR:3.17; 95 % CI: 0.80-12.50) and having been exposed to generalanesthesia (OR: 3.22; 95 % CI: 1.03-10.09; p < 0.05). Arterialhypertension (AHT) presented a negative association (OR: 0.37;95% CI: 0.10-1.31; p<0.05). An association was also observedbetween AD and the presence of ApoE4 allele so that the likelihoodof ApoE4 in subjects with AD was three times greater thanin the control group (OR: 3.44; 95% CI: 0.67-17.62).Conclusions. The results agree with the hypothesis that senileAD is a complex, multifactorial disease in which different geneticand environmental factors play a part, among which havingreceived general anesthesia has a role that can beconsidered in future research (AU)

A community outbreak of Legionnaires' disease associated with a cooling tower in Vic and Gurb, Catalonia (Spain) in 2005.

We report the investigation of a community-acquired outbreak of Legionnaires' disease. An epidemiological, environmental, and meteorological investigation was undertaken. Fifty-five cases were reported in October and November 2005. The exposure occurred in a large area, with 12 cases (21.8%) located between 1,800 and 3,400 metres from the source. Water sample cultures showed that Legionella pneumophila serogroup 1 (Lp-1) was present in five cooling towers in two industrial locations in Gurb (plants A and B). Two Lp-1 strains were recovered from plants A and B, but only Lp-1 strains from plant A showed a pulsed-field gel electrophoresis (PFGE) profile identical to those obtained from three of the cases. Inspection of the cooling towers in plant A revealed inadequate maintenance. Weather conditions in October 2005, with mostly high temperatures and high humidity, together with the flat terrain could have been favouring factors. This study showed a community outbreak from a cooling tower as a common source in a large area. Climate and terrain could explain the dissemination of contaminated aerosols.

Community outbreak of Legionnaires disease in Vic-Gurb, Spain in October and November 2005.

This paper reports the investigation of a community-acquired outbreak of Legionnaires' disease in the municipalities of Vic and Gurb (Central Region of Catalonia, Spain). There were 55 cases reported in October and November 2005. An epidemiological and environmental investigation was undertaken. Thirty-five case patients (64%) lived in Vic or Gurb, while 36% had visited or worked in Vic or Gurb during the 10 days before onset of symptoms, but no commonly frequented building could be identified. Water probes for culture were obtained from 30 cooling towers. In five cooling towers of two industrial settings in Gurb (plants A and B), Legionella pneumophila (Lp) serogroup 1 was present. Two Lp-1 strains were recovered from cooling towers in plants A and B. The Lp-1 strain from plant A showed a PGFE profile identical with those obtained from three patients. The exposure to Legionella pneumophila apparently occurred in a large area, since 43 of the 55 cases lived, visited or worked within a distance of 1,800 m from plant A, and six cases in a distance between 2,500 and 3,400 m. The inspections of cooling towers in plant A revealed inadequate disinfectant doses of biocide, non-existent maintenance records on weekends and wrong sample points for routine microbial check-ups. Weather conditions in October 2005 template temperature and high humidity (wind conditions are unappreciable) could have been favourable factors in this outbreak together with the flat terrain of Gurb and Vic area, explaining the extensive horizontal airborne dissemination of contaminated aerosols. The outbreak could have been prevented by proper and correct maintenance of the cooling tower at plant A.

Mean field linear response within the elimination of the small component formalism to evaluate relativistic effects on magnetic properties.

The linear response within the elimination of the small component formalism is aimed at obtaining the leading order relativistic corrections to magnetic molecular properties in the context of the elimination of the small component approximation. In the present work we extend the method in order to include two-body effects in the form of a mean field one-body operator. To this end we consider the four-component Dirac-Hartree-Fock operator as the starting point in the evaluation of the second order relativistic expression of magnetic properties. The approach thus obtained is the fully consistent leading order approximation of the random phase approximation four-component formalism. The mean field effect on the relativistic corrections to both the diamagnetic and paramagnetic terms of magnetic properties taking into account both the Coulomb and Breit two-body interactions is considered.

[Smoking among adolescents: population study on parental and school influences]. / Consumo de tabaco en adolescentes. Estudio poblacional sobre las influencias parentales y escolares.

OBJECTIVE: Smoking represents a public health problem, one which begins during adolescence. The main objective of this study was to analyze the association between smoking and parental and school factors. SUBJECTS AND METHODS: The study sample consisted of the students from the 20 secondary schools in the region of Osona, Barcelona, Spain. A self-report questionnaire was used to obtain information on the following variables: smoking habit, age of initiation, frequency, type of school (state school or private-subsidized), sex, age, persons living in the home, town, whether the student had lunch at school, whether the student often had lunch or dinner alone at home. RESULTS: A total of 2280 students participated in the study (91%). Mean age was 15.5 years. Of the participants, 20% said they were smokers; 5%, ex-smokers; 34% had tried smoking at least once, and 41% had never smoked. Factors significantly associated with smoking in the multivariate analysis were age, rural town, state school, single parent family, eating alone, and not lunching at school. CONCLUSIONS: Smoking prevalence is high among adolescents in our society and there is no gender difference. Our results show that family structure and dynamics can influence smoking in adolescents. Smoking is less prevalent among adolescents who have lunch at school.