Attitudes to rapid HIV testing among Spanish General Practitioners.

OBJECTIVES: The objectives of this study were to investigate the acceptability of rapid HIV testing among general practitioners in Spain and to identify perceived barriers and needs in order to implement rapid testing in primary care settings. METHODS: An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15th June and 31st October 2010. RESULTS: Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were General Practitioners (GP). Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the results obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). CONCLUSIONS: This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Acceptability of rapid HIV diagnosis technology among primary healthcare practitioners in Spain.

This study investigated the acceptability of rapid HIV testing among general practitioners (GP) and aimed to identify perceived barriers and needs in order to implement rapid testing in primary care settings. An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15 June 2012 and 31 October 2010. Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were GP. Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the result obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Impact of the introduction of rapid HIV testing in the Voluntary Counselling and Testing sites network of Catalonia, Spain.

Rapid HIV antibody tests, which provide results within 15-60 minutes, can help reduce the number of unrecognized infections by improving access to testing facilities and increase the number of people tested who know their results. After an acceptability study, rapid HIV testing was first implemented in Catalonia in 2007 within the community-based Voluntary Counselling and Testing sites network. One year after implementation, an increase of 102.9% has been observed in the number of tests performed, ranging from 8.4% to 328.3% according to the site. Despite the important immediate impact of rapid HIV testing on the number of tests performed, there was no significant change in the proportion of tests that were positive. Rapid HIV testing can help increase access to testing, but it should be complemented with specific outreach programmes targeting the most vulnerable subgroups.

[Genetic advances in attention deficit hyperactivity disorder]. / Avances geneticos en el trastorno por deficit de atención/hiperactividad.

AIM: To update the knowledge currently available on the genetic foundations of attention deficit hyperactivity disorder (ADHD). The presentation will focus especially on recent data concerning adults. DEVELOPMENT AND CONCLUSIONS: ADHD is one of the most prevalent neuropsychiatric disorders among the general childhood population. In recent years it has been shown that it often progresses into adulthood. The results from studies of families, twins and adopted children display a high degree of familial aggregation. Molecular genetics studies have brought to light positive associations with different genetic polymorphisms in neurotransmitter systems involved in the pathophysiology of ADHD, mainly with the dopaminergic, serotoninergic and noradrenergic, and neurotrophins such as the brain-derived neurotrophic factor (BDNF). The causation of ADHD is still largely unknown but the different studies published to date dealing with the genetic foundations of the disorder suggest that genetics play an important role, its inheritance is complex and it is modulated by environmental factors. ADHD in adults can be a good model for studying the genetic foundations of ADHD.

Avances genéticos en el trastorno por déficit de atención/hiperactividad / Genetic advances in attention deficit hyperactivity disorder

Objetivo. Actualizar los conocimientos existentes sobre las bases genéticas del trastorno por déficit de atención/hiperactividad (TDAH). La presentación se centrará especialmente en los datos recientes sobre adultos. Desarrollo y conclusiones. El TDAH es uno de los trastornos neuropsiquiátricos de mayor prevalencia en la población general en la infancia. Durante los últimos años se ha puesto de manifiesto su frecuente progresión a la edad adulta. Los resultados de los estudios familiares, de gemelos y de niños adoptados demuestran un elevado grado de agregación familiar. Los trabajos en genética molecular han mostrado asociaciones positivas con diferentes polimorfismos genéticos de sistemas de neurotransmisión implicados en la fisiopatología del TDAH, principalmente con el dopaminérgico, serotoninérgico, noradrenérgico y neurotrofinas como el factor neurotrófico derivado del cerebro (BDNF). La etiología del TDAH es todavía poco conocida, pero los diferentes trabajos publicados en torno a las bases genéticas del trastorno indican que presenta una alta carga genética, de herencia compleja, y modulada por factores ambientales. El TDAH en adultos puede ser un buen modelo para el estudio de las bases genéticas del TDAH (AU)

Aim. To update the knowledge currently available on the genetic foundations of attention deficit hyperactivity disorder (ADHD). The presentation will focus especially on recent data concerning adults. Development and conclusions. ADHD is one of the most prevalent neuropsychiatric disorders among the general childhood population. In recent years it has been shown that it often progresses into adulthood. The results from studies of families, twins and adopted children display a high degree of familial aggregation. Molecular genetics studies have brought to light positive associations with different genetic polymorphisms in neurotransmitter systems involved in the pathophysiology of ADHD, mainly with the dopaminergic, serotoninergic and noradrenergic, and neurotrophins such as the brain-derived neurotrophic factor (BDNF). The causation of ADHD is still largely unknown but the different studies published to date dealing with the genetic foundations of the disorder suggest that genetics play an important role, its inheritance is complex and it is modulated by environmental factors. ADHD in adults can be a good model for studying the genetic foundations of ADHD (AU)

Genotipado a gran escala en la investigación del trastorno del espectro autista y el trastorno por déficit de atención con hiperactividad / Large-scale genotyping in research into autism spectrum disorders and attention déficit hyperactivity disorder

Introducción y desarrollo. El trastorno del espectro autista (TEA) y el trastorno por déficit de atención con hiperactividad (TDAH) son dos trastornos neuropsiquiátricos de inicio en la infancia que presentan un elevado grado de agregación familiar. El TEA se caracteriza por alteraciones de la interacción social y problemas de la comunicación, mientras que los pacientes con TDAH presentan inatención persistente y/o comportamiento hiperactivoimpulsivo. A excepción de unos pocos casos de autismo en los que se han descrito anomalías citogenéticas o mutaciones en genes concretos, la etiología de estas enfermedades es desconocida. Se trata de enfermedades multifactoriales, con varios genes con un efecto menor y la contribución del ambiente. Los estudios de ligamiento genético han señalado unas 20 regiones cromosómicas sugestivas de contener genes que confieren susceptibilidad al autismo, al TDAH o a ambos trastornos. Los retos de investigación se centran en la caracterización clínica, el reclutamiento de pacientes con TEA y TDAH, estudios de cuantificación de dosis génica, metilación e hibridación genómica comparada para identificar reordenamientos cromosómicos en pacientes con autismo y retraso mental grave. Conclusión. El genotipado de amplias colecciones del tipo SNP potencialmente funcionales en genes candidatos para estos trastornos, en base a datos farmacológicos, bioquímicos, neuropatológicos, de modelos animales y de estudios de ligamiento, en una amplia colección de muestras de pacientes y controles permitirán identificar los componentes genéticos de estas patologías y definir sus bases biológicas (AU)

Introduction and development. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative genomic methylation and hybridisation in order to identify chromosomal rearrangements in patients with autism and severe mental retardation. Conclusions. Genotyping large SNP-type collections that are potentially functional in genes that are candidates for these disorders, based on pharmacological, biochemical and neuropathological data together with that coming from animal models and linkage studies in a wide collection of samples from patients and controls, will enable us to identify the genetic components of these pathologies and to define their biological foundations (AU)