[Alternatives to population screening for breast cancer. Is the chance detection useful?]. / Alternatives al cribado poblacional de cáncer de mama. Es útil la detección oportunística?

OBJECTIVES: 1. To evaluate the characteristics of the demand, coverage and acceptability of random detection of breast cancer at a health centre (HC) between January 1995 and December 1996. 2. To describe the cases of breast cancer diagnosed since the setting up in 1988 of random demands for screening mammographies. DESIGN: Crossover study. SETTING: La Mina Primary Care Centre, Barcelona. PATIENTS: A sample of 340 women of a population of 2796 women between 45 and 75 with a clinical history at the HC were studied. MEASUREMENTS AND MAIN RESULTS: The profile of women with neoplasms was: aged 59 +/- 8.5; 279 women attended, 273 medicine, 132 medicine and gynaecology, and 6 gynaecology. Mammographies requested were: 143 (118 through gynaecology, 12 medicine and 13 outside the centre), which was 51% of women who attended and 42% of the sample. The reason for mammography was screening (129) and symptoms (14). Screening mammographies actually done (acceptance) were 116 out of 129 (90%). Sample coverage was 34% (116/340); and 42% of the women who attended (116/279). Most studied age-group was 50-64 (coverage 45%, n = 176). 11 cases of breast cancer were diagnosed: age 54.3 +/- 9.1; 1 in situ, 3 < 10 mm, 2 between 10 and 20 mm, 4 > 20 mm, 1 without data. Diagnosis to treatment delay: 33.7 +/- 0 days. At time of writing 8 women were free of illness. CONCLUSIONS: Through random detection 34% coverage was achieved with good acceptance. Most neoplasms are diagnosed in their early stages. The general practitioner should be more attentive to periodic requests for mammographies.

[Estimation of the prevalence of cognitive impairment according to the test used]. / Estimaciones de la frecuencia de déficit cognitivo según el test empleado.

OBJECTIVES: The aim of the study was to compare the findings of Folstein's Mini Mental Test (MMT), Lobo's Cognitive Mini Exam (CME) and the Isaacs Set test, in their detection of cognitive deficit in over-64 year olds; and to analyse the factors associated with variability in the scores obtained with these tests. DESIGN: An observational crossover study. SETTING: An urban Primary Care center. PATIENTS: Among the total of 1096 patients aged over 64 registered on 5 lists and with medical records, a random sample of 329 was chosen. INTERVENTIONS: The MMT, CME and Set test were administered to each patient in the same interview. Information on associated morbidity and social and demographic variables was gathered. MAIN RESULTS: 211 women (64%) and 118 men (36%) completed the tests. Women were older (73.0 +/- 6 against 71.2 +/- 6; p = 0.02) and had had less schooling (3.2 +/- 3.6 years against 4.2 +/- 3.7; p = 0.019). A higher percentage of women were illiterate (47.1% against 24.3%; p = 0.008). The MMT showed CD at 60.8%, the CME at 28% and the Set test at 11.3%. CONCLUSIONS: Estimated prevalence of CD varies depending on the test used. Variability in the MMT and CME is basically due to years of schooling, whereas in the Set test it is because of age.

[Hereditary familial neuropathies: genetic counseling and early diagnosis in primary care]. / Neuropatías heredofamiliaries: consejo genético y diagnóstico precoz en atención primaria.

We present 5 cases of sensitive-motor hereditary neuropathies which were detected or controlled in primary care. Four patients had Charcot-Marie-Tooth disease (type I) and the remaining patient is a carrier of Dejerine-Sottas disease (type III). Regardless of the age of presentation of the disease, the evolution has been slow but steady in all cases. Talipes cavus is the most frequent secondary deformity. An electroneuromyographic study and a neural biopsy were the complementary diagnostic tests used. Three of the patients presented family antecedents. We believe that early diagnosis, family study and genetic advice are of great importance in primary care.