Diet changes due to urbanization in South Africa are linked to microbiome and metabolome signatures of Westernization and colorectal cancer.

Transition from traditional high-fiber to Western diets in urbanizing communities of Sub-Saharan Africa is associated with increased risk of non-communicable diseases (NCD), exemplified by colorectal cancer (CRC) risk. To investigate how urbanization gives rise to microbial patterns that may be amenable by dietary intervention, we analyzed diet intake, fecal 16 S bacteriome, virome, and metabolome in a cross-sectional study in healthy rural and urban Xhosa people (South Africa). Urban Xhosa individuals had higher intakes of energy (urban: 3,578 ± 455; rural: 2,185 ± 179 kcal/d), fat and animal protein. This was associated with lower fecal bacteriome diversity and a shift from genera favoring degradation of complex carbohydrates (e.g., Prevotella) to taxa previously shown to be associated with bile acid metabolism and CRC. Urban Xhosa individuals had higher fecal levels of deoxycholic acid, shown to be associated with higher CRC risk, but similar short-chain fatty acid concentrations compared with rural individuals. Fecal virome composition was associated with distinct gut bacterial communities across urbanization, characterized by different dominant host bacteria (urban: Bacteriodota; rural: unassigned taxa) and variable correlation with fecal metabolites and dietary nutrients. Food and skin microbiota samples showed compositional differences along the urbanization gradient. Rural-urban dietary transition in South Africa is linked to major changes in the gut microbiome and metabolome. Further studies are needed to prove cause and identify whether restoration of specific components of the traditional diet will arrest the accelerating rise in NCDs in Sub-Saharan Africa.

De-escalating axillary management after neoadjuvant chemotherapy in breast cancer: The ratio of positive sentinel lymph nodes matters.

BACKGROUND: De-escalation of axillary surgery in breast cancer (BC) patients diminishes sequelae without compromising cancer outcomes. Surgical management of the axilla is challenging after neoadjuvant treatment. We aimed to identify the factors associated with residual axillary disease amenable to lymphadenectomy in patients with positive sentinel lymph node biopsy (SLNB). METHODS: We conducted a retrospective observational study in Hospital 12 de Octubre (Spain). We included BC patients with positive SLNB who underwent axillary dissection after neoadjuvant chemotherapy. Univariate and multivariate logistic regression models were performed to identify independent predictors of residual axillary disease. We estimated the ratio of positive nodes in SLNB and assessed the diagnostic validity of this ratio in relation to residual axillary disease. RESULTS: We included 103 patients in the study. Residual axillary disease was identified in 54 patients (52.4%). Clinically node positive status at diagnosis (OR = 18.3, 95%CI: 4.0-83.6) and a ratio of positive nodes in SLNB ≥0.5 (OR = 6.5, 95%CI 41.7-23.7) were associated with residual axillary disease. The sensitivity and negative predictive value of a ratio of positive nodes in SLNB ≥0.5 were 87% (95%CI 75.1%-94.6%) and 75% (95%CI 55.1%-89.3%), respectively. CONCLUSIONS: In our study, for patients with positive SLNB after neoadjuvant chemotherapy, stage N+ at diagnosis and a ratio of positive nodes in SLNB ≥0.5 were independent risk factors of positive residual axillary disease. This ratio is a feasible measure with a good diagnostic validity for residual axillary disease and could be used as a guiding factor in the surgical management of these patients.

Evaluation of water footprint of urban renewal projects. Case study in Seville, Andalusia.

This publication presents a methodology for the evaluation of the water footprint of urban renewal projects. The indirect water footprint is obtained by adding together the embodied or virtual water of the materials incorporated in the 12-month project, while the direct footprint is mainly due to the green areas and rainwater collection system over its 40-year life span. The methodology, originally defined for the agricultural sector, is adapted to an urban system that includes gardens and sustainable urban drainage systems. In an innovative way, the present work analyses the amortisation of the indirect water footprint of the construction products by improvements in the city water cycle. The project involves street renewal with water-sensitive criteria, with five green areas, and road and pavement construction. The methodology identifies changes in garden designs, soil drainage, and rainwater-collecting systems in terms of blue, green, and grey water footprints. Five scenarios of a project in Seville, Spain are studied. The indirect water footprint of the project is 2.6 times higher than that in a standard project, but, due to annual savings of 65% in its direct water footprint, the breakeven point is reached in the 10th year.

[Knowledge and attitude among general practitioners in Andalusia (Spain) on the identification of subjects at high risk of breast and colorectal cancer]. / Conocimientos y actitudes de los médicos de Atención Primaria de Andalucía (España) sobre la detección de personas con riesgo elevado de cáncer de mama y colorrectal.

AIMS: To assess the knowledge and attitude among general practitioners in Andalusia on the identification of subjects with elevated risk for breast cancer, colorectal cancer, and hereditary cancers, as well as to detect barriers to accessibility to the screening programs. METHODS: A descriptive, cross-sectional study was conducted based on an online survey of 24 questions. Data are shown as frequencies, and association tests were statistically used. The level of significance was set at<.05. RESULTS: Survey response rate was 32%, of which 224 were valid, and included 56% men, and a mean age±DE of 46±12 years. Established criteria for high risk breast cancer were already known by 71.4% [95% CI 65-76], being worst in those living in big cities (P<.014). Among general practitioners, 86% were allowed to order mammography in women with lumps or at moderate to high risk for breast cancer. As regards colorectal cancer, 87.9% of general practitioners knew the risk factors. Among general practitioners, 58.2% [95% CI 49-62] were allowed to order a colonoscopy if clinical suspicion was present, especially if they lived in large cities (P<.0001). CONCLUSIONS: The screening program for breast cancer is well-known by general practitioners, and the access to mammography is successful. Most of the general practitioners consider the follow-up program for persons at high risk for colorectal cancer appropriate, although half of those surveyed had some barriers to ordering colonoscopy. Knowledge on hereditary cancer is limited, and varies among areas. There is also a general lack of awareness on hereditary cancer and genetic counselling units.

Fast update of undetected Mycobacterium chimaera infections to reveal unsuspected cases.

Mycobacterium chimaera is involved in a worldwide alert due to contaminated heater-cooler units. A real-time polymerase chain reaction (RT-PCR)-based procedure was implemented to survey undetected cases of M. chimaera infection. PCR was negative in the 59 prosthetic heart valves from patients with PCR-16SrRNA-negative infective endocarditis. PCR identified M. chimaera in one of 15 clinically significant retrospective Mycobacterium avium-Mycobacterium intracellulare complex isolates, which corresponded to a patient who had undergone heart valve replacement in a different institution. Whole-genome sequencing demonstrated that he was the first case in Spain with involvement of the strain responsible for the global outbreak. These results highlight the relevance of retrospective tracking for undetected M. chimaera infections.

Prolonged exposure to extracellular lumican restrains pancreatic adenocarcinoma growth.

We previously demonstrated that pancreatic stellate cells within pancreatic ductal adenocarcinoma (PDAC) stroma secrete lumican and its presence is associated with prolonged survival of patients with localized PDAC. Here, we observed that extracellular lumican decreases PDAC tumour cell growth in xenograft and syngeneic orthotopic animal models, and induces growth inhibition of low-passage human PDAC cells in a species-specific manner. PDAC cells grown in variant culture conditions and exposed to extracellular lumican display typical characterizations of cancer cell in a quiescent state, such as growth inhibition, apoptosis, G0/G1 arrest and chemoresistance. Importantly, extracellular lumican is associated with diminished ERK1/2 phosphorylation and increased p38 phosphorylation within PDAC cells. We further demonstrated that extracellular lumican physically binds with EGFR to trigger EGFR internalization and downregulation of EGFR and its downstream signal molecule ERK. Lumican enhances casitas B-lineage lymphoma expression, which stabilized the TGFß Type II receptor sensitizing PDAC cells to TGFß-mediated activation of p38 and SMAD signals. These provide a mechanism for the shift in signalling and phenotypic changes we observed after prolonged exposure to lumican. Together, our findings demonstrate that stromal lumican restrains PDAC cell growth through mediating cell entry into a quiescent state.

[Satisfaction of patients with type 2 diabetes mellitus after starting treatment with insulin]. / Satisfacción de las personas con diabetes mellitus tipo 2 tras iniciar tratamiento con insulina.

OBJECTIVES: The objective of this study is to evaluate if overcoming the barrier of starting treatment with insulin can lead to better clinical control and a higher level of patient satisfaction with their treatment. MATERIAL AND METHODS: This is an observational, multicentre study of patients diagnosed with DM2 who attended primary care centres with poor glycaemic control (A1c≥8%) under treatment with oral antidiabetic drugs (OADs), and who were given motivational treatment to overcome their fear of injections, and started treatment with insulin. The level of satisfaction with the treatment was evaluated using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The questionnaire was used before initiating the treatment with insulin and in the follow-up visit (3-4 months from the beginning of treatment with basal insulin). RESULTS: A total of 573 patients with a mean age of 64±10 years were recruited. The overall mean score from the DTSQs satisfaction questionnaire was 18.3±6.3, and the change of treatment led to an improvement in patient satisfaction compared to the previous treatment (DTSQc mean score 8.8±5.9). A1c dropped from an initial value of 8.7% (SD 0.8) to 7.5% (SD 0.7) (P<.001). The frequency of hyperglycaemic episodes perceived by the patients was significantly lower after they overcame their fear of injections (35.6% compared to 11.5%; P<.001), but no statistically significant differences were found in the frequency of hypoglycaemic episodes (32% compared to 35%; P=.059). CONCLUSION: In patients with DM2 poorly controlled with OADs, overcoming a fear of injections and starting treatment with insulin was associated with an overall improvement in satisfaction with the new treatment, and decreased the perception of hyperglycaemic episodes. Glycaemic control and the metabolic profile of the patients also improved to a statistically significant degree with the change of treatment.

Utilización de los servicios sanitarios por las embarazadas seguidas en un centro de salud / Use of the health care services for pregnancies followed-up in a Health Care Center

Introducción: Nuestros objetivos son describir el perfil sociodemográfico de las embarazadas seguidas en el centro de salud, estimar la frecuencia de la utilización de los servicios sanitarios y analizar los factores que puedan influir en la diferente utilización. Pacientes y Métodos: Estudio descriptivo transversal con una segunda fase analítica. Centro de salud urbano. Población: embarazadas que hayan parido durante el año 2005. Variables: utilización de los servicios sanitarios, sociodemográficas, psicosociales, obstétricas y de morbilidad. Análisis estadístico: tablas de frecuencia para las variables cualitativas y resúmenes numéricos para las variables cuantitativas; análisis bivariante para relacionar cada variable independiente con cada una de las variables dependientes y creación de un modelo de regresión lineal multivariante para controlar los posibles factores de confusión. Resultados. Cuatrocientos diecinueve partos. El 64% de los embarazos se siguió en el centro, 25% en el segundo nivel y 11% en la medicina privada. La utilización media de los servicios sanitarios fue de 38,6 visitas (IC95% 37,31-39,89). Todas las mujeres acudieron al programa de control de embarazo: 7,37 visitas (IC95%: 7,24-7,50). El 98% acudió a la matrona (7,86 visitas; IC95% 15,03-16,93). El 99,6% utilizó los servicios de apoyo (media de 5,79 visitas; IC 95% 5,60-5,98). El 52% acudió a las urgencias hospitalarias (media de 0,84; IC95% 0,72-0,96). El 61% de las mujeres acudió en alguna ocasión al ginecólogo privado (media de 1,26; IC95% 1,08-1,44). Conclusiones. Se encuentra un elevado porcentaje de embarazos seguidos en Atención Primaria y una alta utilización de los servicios sanitarios durante el embarazo. La experiencia obstétrica previa parece disminuir la utilización (AU)

Introduction: We have aimed to describe the socidemographic profile of pregnant women followed-up in the health care center, estimate frequency of their use of the health care services and analyze the factors that may influence the different use. Patients and methods. Descriptive, cross-sectional study with the second analytic phase. Urban health care center. Population: pregnant women who gave birth in the year 2005. Variables: use of the health care, sociodemographics, psychosocial, obstetrics services and morbidity. Statistical analysis: frequency tables for qualitative variables and numeric summaries for the quantitative variables; bivariant analysis to compare each independent variable with each one of the dependent ones and creation of a multivariant linear regression model to control possible compounding factors. Results: Four-hundred and nineteen deliveries. A total of 64% of them were followed-up in the center, 25% were seen on the second level and 11% in private medicine. Mean use of the health care services was 38.6 visits (CI 95% 37.31-39.89). All the women came to a pregnancy control program: 7.37 visits (CI 95%: 7.24-7.50). A total of 98% came to the midwife (7.86 visits; CI 95% 15.03-16.93) and 99.6% used the support services (mean of 5.79 visits; CI 95% 5.60-5.98). A total of 52% came to the hospital emergency service (mean of 0.84; CI 95% 0.72-0.96). At some time, 61% of the women went to a private gynecologist (mean 1.26; CI 95% 1.08-1.44). Conclusions: A high percentage of pregnant women are followed-up in Primary Care. There is high use of the health care services during pregnancy. Previous obstetrics experience seems to decrease its use (AU)

The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study.

To compare the effects of two free radical scavengers, dimethylsulfoxide 50% (DMSO) and N-acetylcysteine (NAC), for treatment of complex regional pain syndrome I (CRPS I), a randomized, double-dummy controlled, double-blind trial was conducted. Two outpatient clinics of two university hospitals in The Netherlands participated in the study and 146 patients, were included over a period of 24 months. Patients were randomized into two treatment groups, one was instructed to apply DMSO 50% five times daily to the affected extremity, the second was treated with NAC 600mg effervescent tablets three times daily, both combined with placebo. Interventions were accompanied by pain medication, occupational therapy for upper extremity CRPS I and physical therapy for lower extremity CRPS I in specific circumstances. Treatment was given for 17 weeks, with a possibility to continue or switch medication after this period, up to 1 year following the onset of treatment. An impairment level sum score was the primary outcome measure. Upper and lower extremity skills and functions, and general health status were also evaluated. Overall, no significant differences were found between NAC and DMSO after 17 and 52 weeks on impairment level and general health status. Significant differences were found for subscores of lower extremity function, in favor of DMSO-treatment. Subgroup analysis showed more favorable results for DMSO for warm CRPS I and significantly better performance of NAC for patients with a cold CRPS I. Results tended to be negatively influenced if the duration of the complaint was longer. Treatment with DMSO and NAC are generally equally effective in treatment of CRPS I. Strong indications exist for differences in effects for subgroups of patients with warm or cold CRPS I: for warm CRPS I, DMSO-treatment appears more favorable, while for cold CRPS I, NAC-treatment appears to be more effective.

Assessment of mathematical models for predicting Staphylococcus aureus growth in cooked meat products.

The growth of Staphylococcus aureus in commercially available vacuum-packaged cooked ham, turkey breast meat, and chicken breast meat stored at 2.3, 6.5, 10, 13.5, and 17.7 degrees C was studied. Growth rates observed in these food products were compared with those predicted on the basis of various growth models found in the literature and with those generated by the Pathogen Modeling Program and the Food MicroModel software using graphical and mathematical analysis for performance evaluation. In general, the models studied overestimated the growth of S. aureus. The Dengremont and Membré model most closely matched the observed behavior of S. aureus in ham and chicken breast meat, with bias factors of 1.56 and 1.09, respectively. The Eifert et al. model accurately described the growth of S. aureus in turkey breast meat, with a bias factor of 1.51. The remaining models provided safe predictions of the growth rate of S. aureus, but with poor accuracy. Predictive microbiology models have an immediate practical application in improving microbial food safety and quality and are very useful decision support tools, but they should not be used as the sole determinant of product safety.

Direct and indirect modulation of rat cardiac sarcoplasmic reticulum function by n-3 polyunsaturated fatty acids.

Measurements were made of trans-sarcolemmal Ca(2+) fluxes and intracellular [Ca(2+)](i) in rat ventricular myocytes loaded with Indo-1 to determine how the n-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) suppresses spontaneous waves of Ca(2+) release. We report that in 10 microM EPA, the Ca(2+) efflux generated by individual waves increased by 11.3 +/- 4.9 % over control levels. However, wave-generated efflux per unit time fell overall by 19 +/- 5.3 %. On removal of EPA, wave frequency increased transiently such that Ca(2+) efflux was greater than normal and the cell lost 28.0 +/- 10.6 micromol l(-1) Ca(2+). This probably represents the loss of extra Ca(2+) accumulated by the sarcoplasmic reticulum (SR), while Ca(2+) release was inhibited. These results are evidence of inhibition of the SR Ca(2+)-release mechanism and reduced availability of Ca(2+) to the SR. From the relationship between average intracellular Ca(2+) and the frequency of spontaneous waves, we have calculated the relative contributions of these different mechanisms to the lower frequency of waves. In EPA, the frequency of spontaneous waves fell by 37.5 +/- 8.1 %, the majority of this (29.2 +/- 8.8 %) is due to inhibition of the Ca(2+)-release mechanism. In EPA, the rate of fall of Ca(2+) in the caffeine response (an indicator of surface membrane Ca(2+) efflux pathway activity) was not altered. We conclude, therefore, that the lower resting level of Ca(2+) observed in EPA is due to a lower influx of Ca(2+) across the surface membrane rather than increased activation of efflux pathways. How these effects might contribute to the anti-arrhythmic actions of EPA is discussed.

Inhibition of sarcoplasmic reticulum function by polyunsaturated fatty acids in intact, isolated myocytes from rat ventricular muscle.

1. We have studied the effects of two polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on spontaneous and electrically stimulated contractions in single, isolated ventricular myocytes from rat hearts. 2. The frequency of spontaneous waves of calcium release and contraction (induced by elevation of the bathing calcium concentration) is reduced in the presence of EPA. At the same time the resting level of intracellular calcium falls, the resting cell length increases and the amplitude of shortening decreases. All these effects are reversed on removal of EPA. 3. Imaging of the waves of calcium release shows that the amplitude and the rate of propagation of the wave is increased in EPA. Consistent with the increased amplitude, integration of the caffeine-induced Na+-Ca2+ exchange current (a measure of the sarcoplasmic reticulum (SR) calcium content) is increased by both EPA and DHA. 4. EPA has a maintained negative inotropic effect on voltage clamped myocytes. This seems to be entirely due to inhibition of the L-type calcium current. Smaller depolarising pulses in control conditions that elicit the same calcium current as in EPA also activate the same level of contraction. This is in spite of the increased SR calcium content in EPA. 5. It is concluded that PUFAs have two effects on the SR; they reduce the availability of calcium for uptake and they inhibit the release mechanism. Both of these effects should lower the frequency of spontaneous waves of calcium release. As spontaneous release of calcium can initiate arrhythmias, some of the anti-arrhythmic action of PUFAs must be exerted at the level of the SR.

[HIV infection in the health care are of Leon. Incidence from 1983-1997]. / Infección por el VIH en el área sanitaria de León. Estudio de la incidencia en el período 1983-1997.

BACKGROUND: The aim of the present work was to know the incidence of HIV infection in the sanitary area of León, and its tendency, throughout the period 1983-1997. MATERIAL AND METHODS: A register of cases with the patients attended in the area hospitals, those detected in the Penitentiary Centre of León and notifications of cases of AIDS at a national level have been used. Only the patients residing in a municipality belonging to the area at the time of detection of the infection have been included. Age, sex, risk group, year of detection of the infection, development to AIDS and mortality were analysed. The Spearman coefficient correlation range has been used for the study of tendency. RESULTS: 509 cases of HIV infection (374 males and 134 females) were detected in the area from 1983 to 1997. The accumulated incidence throughout the period of study was 1,368/million inhabitants. The annual incidence shows and upward phase until 1990, followed by another of plateau (1990-1993). In 1994-1995 there was a decrease, interrupted in 1996-1997. The curve as a whole doesn't reveal a descending tendency (p > 0.05). The annual incidence in the IDU follow a similar pattern to that of the complete group while the group of heterosexual transmission shows a tendency to increase (p < 0.025). 223 patients (43.8%) developed AIDS, 195 of whom we know the evolution. Of these, 139 have died and 56 are still alive. CONCLUSIONS: There is no evidence that the incidence of HIV infection tends to decrease in the sanitary area of León at present. This is probably related to the behaviour of the two main risk groups: a tendency to stability in the case of IDU and to increase in heterosexual transmission. It is important to insist on the prevention campaigns, especially those directed towards avoiding heterosexual transmission.

Interferon alpha treatment of chronic hepatitis C in HIV-infected patients receiving zidovudine: efficacy, tolerance and response related factors.

BACKGROUND/AIMS: In our area most of the human immunodeficiency virus (HIV) infected patients are intravenous drug users; HIV and hepatitis C virus infections often coexist in these patients. Due to the repercussions of both infections, we designed a trial to evaluate the efficacy, response-related factors and tolerance during an eight-month regime of recombinant interferon alpha-2b on hepatitis C virus infection. METHODOLOGY: We included 79 patients in an open, prospective and multicentric trial with zidovudine and interferon alpha-2b. Response to interferon treatment was evaluated by biochemical and histopathological criteria. RESULTS: A complete response (alanine aminotransferase normalization) was obtained in 57.4% of patients. The significant response-related factors were: degree of histopathological activity, CD4+ cell number and initial leukocyte number. CONCLUSIONS: Recombinant interferon therapy seems to be effective for chronic hepatitis C in HIV infected patients; the best response was in those with active chronic hepatitis and CD4+ cell counts > or = 200/mm3. General tolerance was variable, although side effects were not different from those seen in non-HIV patients. The most common side effect was flu-like syndrome (constitutional manifestations), with no interference on treatment continuity; however, hematological toxicity prevents the indiscriminate use of interferon.

Esterilización en el perro por inyección de metilcianoacrilato en la cola del epidídimo / Sterility in the dog induced by injection of methylcyanoacrylate into the tail of the epididymis

El propósito de este estudio fue producir azoospermia y como consecuencia, esterilidad en el perro, mediante la inyección de metilcianoacrilato (MCA) en la cola del epidídimo. Se seleccionaron 15 perros de talla mediana y chica a los que se les aplicó MCA en ambas colas del epidídimo y 2 perros testigos que fueron inyectados con agua estéril. La colección de semen se realizó previamente a la inyección y luego a los 15 y 30 días y después cada mes hasta los 180 días. Se presentó azoospermia en 9 perros (60 por ciento) a los 15 días de aplicado el producto y en 13 (86.7 por ciento) a los 30 días. Un animal aún tenía espermatozoides en el eyaculado a los 180 días, aunque con una alta proporción de muertos (40 por ciento) y anormales (60 por ciento). El examen histológico de los testículos en los que se inyectó MCA mostró fibrosis intersticial difusa, con infiltración de células mononucleares y necrosis delimitada a la zona de aplicación del MCA. En los animales testigo no ocurrieron cambios significativos. La aplicación de MCA en las colas del epidídimo de perros, es un método rápido, práctico, sencillo y barato, por lo que pudiera usarse en campañas de esterilización masiva, dirigidas hacia el control de la sobre población en esta especie.

[Influence of the socioeconomic and cultural level on the use of contraceptive methods]. / Influencia del nivel socioeconómico y cultural en el uso de métodos anticonceptivos.

OBJECTIVE: a) To study the most commonly used Contraceptive Methods (CM) among the population group under survey and b) to analyse the influence of socio-economic (SEL) and educational levels (CL) on their use. DESIGN: Descriptive study of a crossover type by means of a survey. SETTING: Six general medical consulting rooms in two urban Health Centres. PATIENTS: The study was based on a representative sample of 384 women between 15 and 45 years old (a.i.) who attended for health-care for whatever reason. Interventions. A survey carried out by the family doctors in the consulting rooms, where information was gathered on both the CM used and several socio-demographic variables. MEASUREMENTS AND MAIN RESULTS: For most couples, the most commonly used CM was the condom, whose use became greater as the SEL (p < 0.01) and EL (p < 0.0001) rose. Oral contraceptives were used more by women with a lower SEL (p = 0.01). Tubular ligature was more common among women with a lower educational level (p < 0.0001). CONCLUSIONS: The results obtained from our sample by our methodology support our initial hypothesis in the sense that they show the influence of EL and SEL on the use of various contraceptive methods.

[Are blood glucose controls performed with portable dosimeters valid? A comparison of the reliability and validity of 3 commonly used models]. / Son válidos los controles de glucemia que se realizan con los dosímetros portátiles? Comparación de la fiabilidad y validez de tres modelos de uso habitual.

OBJECTIVE: To evaluate and compare the reliability and validity for both normal and high glycaemia values of three models of glycaemia self-analysers: Reflolux, Glucocard and One Touch. DESIGN: Descriptive and crossover study. Validation of a measuring appliance through its comparison with a standard appliance. PARTICIPANTS: The sample was composed of 90 blood specimens chosen by suitability sampling. MEASUREMENTS AND MAIN RESULTS: The glycaemia in the specimens was measured simultaneously by each one of the self-analysers and the central laboratory. There was high reliability (reproducibility) among the self-analysers, with correlation coefficients of 0.98, 0.97 and 0.98, with no statistically significant differences. As to intra-instrument reliability (repeatability), tested by analysing the variances of the differences, no statistically significant differences were found, except in the Glucocard self-analyser which lost precision at high glycaemia levels. Validity or accuracy, measured by the method of taking the average of the differences, showed a systematic bias in the Reflolux model, which had a value of 22.3 mg/dl above the reference model, and in the One Touch of -16.3 mg/dl. The Glucocard was the most accurate with a value of -1.78 mg/dl. CONCLUSIONS: Portable glycaemia dosimeters are very useful in following up diabetic patients because of their high reliability, but are not useful in the diagnosis of diabetes because of their lack of accuracy. Before beginning to use a portable dosimeter, its characteristics in terms of reliability and validity must be known, in order to evaluate correctly its findings.

[Results and analysis of research on HBsAg in pregnant women at a health center over 4 years]. / Resultados y análisis de la investigación de AgHBs en las embarazadas de un centro de salud durante 4 años.

Vertical transmission of hepatitis B is the primary means of acquiring the disease by new carriers. The Cartuja Health Center performs systemic screening of pregnant women subjects as possible carriers. The purpose of the study is to determine the prevalence of pregnant carriers, seroepidemiological characteristics and intervention guidelines followed. We reviewed 454 pregnant women with serology performed between 1986 and 1989, including factors such as age, race, HBV serology, risk, and subsequent prevention. We calculated the prevalence of carriers. Moreover, we compared the proportion of Gypsy carriers versus non-carriers, and the prevalence of Gypsy versus Payos (non-Gypsy) carriers. Fourteen cases were AgBHs (+) (3.1%). There was no age difference between carriers and non-carriers. The proportion of Gypsy women in the carrier group was higher than in the non-carrier group (p less than 0.01), while the prevalence of carriers was also higher in Gypsy women than in pregnant women of Payo origin (p = 0.00082). Only one carrier had prior risk history. Of the 14 women with AgBHs (+), 13 gave birth; the recommended guidelines were followed in 9 cases. Routine screening for AgBHs in pregnant women is justified by the low sensitivity of the risk criteria, and the possibility for prevention.