Variaciones de las células de cuadrícula y de posicionamiento de la corteza entorrinal y del giro dentado de 6 humanos de 56 a 87 años / Variations of the grid and place cells in the entorhinal cortex and dentate gyrus of 6 individuals aged 56 to 87 years

Introducción: La relación entre la corteza entorrinal y el hipocampo ha sido estudiada por diferentes autores, que han destacado la importancia de las células de cuadrícula, las células de posicionamiento y la conexión trisináptica en los procesos que regulan: la persistencia de la memoria espacial, explícita y reciente, y su posible afección con el envejecimiento. Objetivo: Observar si existen diferencias en el tamaño y número de células de cuadrícula contenidas en la lámina iii de la corteza entorrinal y en la capa granular del giro dentado del hipocampo de pacientes mayores. Métodos: Realizamos estudios posmortem del cerebro de 6 sujetos de edades comprendidas entre los 56 y 87 años. Los cortes de cerebros que contenían el giro dentado del hipocampo y la corteza entorrinal adyacente se tiñeron con el método de Klüver-Barrera, después se midió, mediante el programa Image J, el área neuronal individual, el área neuronal total, así como el número de neuronas, contenidas en cuadrículas rectangulares a nivel de la lámina iii de la corteza entorrinal y la lámina ii del giro dentado y se llevó a cabo un análisis estadístico. Resultados: Se ha observado una reducción de la población celular de la capa piramidal externa de la corteza entorrinal, así como de las neuronas de la capa granular del giro dentado relacionada con el envejecimiento. Conclusión: Nuestros resultados indican que el envejecimiento produce una disminución en el tamaño y la densidad neuronal en las células de cuadrícula de la corteza entorrinal y de posicionamiento del giro dentado.(AU)

Introduction: The relationship between the entorhinal cortex and the hippocampus has been studied by different authors, who have highlighted the importance of grid cells, place cells, and the trisynaptic circuit in the processes that they regulate: the persistence of spatial, explicit, and recent memory and their possible impairment with ageing. Objective: We aimed to determine whether older age causes changes in the size and number of grid cells contained in layer III of the entorhinal cortex and in the granular layer of the dentate gyrus of the hippocampus. Methods: We conducted post-mortem studies of the brains of 6 individuals aged 56-87 years. The brain sections containing the dentate gyrus and the adjacent entorhinal cortex were stained according to the Klüver-Barrera method, then the Image J software was used to measure the individual neuronal area, the total neuronal area, and the number of neurons contained in rectangular areas in layer III of the entorhinal cortex and layer II of the dentate gyrus. Statistical analysis was subsequently performed. Results: We observed an age-related reduction in the cell population of the external pyramidal layer of the entorhinal cortex, and in the number of neurons in the granular layer of the dentate gyrus. Conclusion: Our results indicate that ageing causes a decrease in the size and density of grid cells of the entorhinal cortex and place cells of the dentate gyrus.(AU)

Evaluación de la intervención de fisioterapia en los pacientes con sarcopenia y fractura de cadera: una revisión sistemática / Evaluation of physiotherapy intervention in patients with sarcopenia and hip fracture: A systematic review

Introducción La sarcopenia en los pacientes con fractura de cadera es cada vez más habitual en la población envejecida, aumentando el riesgo de hospitalización, dependencia y mortalidad. Objetivos Valorar el tratamiento de fisioterapia más efectivo en los pacientes con sarcopenia y fractura de cadera a través de la revisión de evidencia sistemática. Métodos Se realizó una búsqueda entre febrero y mayo de 2022 en 8 bases de datos electrónicas (Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar y Springer Link), con el fin de extraer ensayos clínicos publicados en los últimos 12 años en español e inglés. Resultados Se seleccionaron 3 ensayos clínicos que cumplían los criterios de inclusión. En todos ellos las intervenciones de fisioterapia incluían ejercicio aeróbico, de fuerza, de alta intensidad, de movilizaciones y combinados. La calidad metodológica se evaluó con la escala PEDro (puntuación media entre 6 y 10). Uno de los estudios no encuentra diferencias entre el tratamiento estándar y el grupo que recibe además entrenamiento progresivo de fuerza muscular. Otro constata una mejora a corto plazo en el grupo que recibe además del tratamiento convencional entrenamiento en cinta rodante con soporte del peso corporal durante el ejercicio con seguimiento a los 3 y 6 meses. El estudio que suplementa con aminoácidos esenciales es el único que constata una mejoría en los pacientes con sarcopenia. Conclusión Los pacientes con sarcopenia y fractura de cadera, pueden tener una mejor evolución si combinan ejercicios de fisioterapia con un protocolo nutricional. Son necesarias más investigaciones metodológicamente rigurosas sobre este tema para poder ampliar la evidencia. (AU)

Introduction Sarcopenia in patients with hip fracture is increasingly common in the elderly population, increasing the risk of hospitalization, dependency, and mortality. Objectives To assess the most effective physiotherapy treatment in patients with sarcopenia and hip fracture through systematic evidence review. Methods Electronic databases were searched from February to May 2022 using Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar, and Springer Link in order to extract randomized clinical trials published in full text both English and Spanish for the last 12 years. Results Three clinical trials that met the inclusion criteria were selected. In all of them, the physiotherapy interventions included aerobic, strength, high intensity, mobilization, and combined exercises. Methodological quality was assessed using the PEDro scale (average score between 6 and 10). One of the studies found no differences between the standard treatment and the group that also received progressive muscle strength training. Another found a short-term improvement in the group that received, in addition to conventional treatment, treadmill training with body weight support during exercise with follow-up that was not maintained at three and six months. The study that supplements with essential amino acids is the only one that confirms an improvement in patients with sarcopenia. Conclusion Patients with sarcopenia and hip fracture may have a better evolution if they combine physiotherapy exercises with a nutritional protocol. More methodologically rigorous research on this topic is needed to expand the evidence. (AU)

Evaluación de la intervención de fisioterapia en los pacientes con sarcopenia y fractura de cadera: una revisión sistemática / Evaluation of physiotherapy intervention in patients with sarcopenia and hip fracture: A systematic review

Introducción La sarcopenia en los pacientes con fractura de cadera es cada vez más habitual en la población envejecida, aumentando el riesgo de hospitalización, dependencia y mortalidad. Objetivos Valorar el tratamiento de fisioterapia más efectivo en los pacientes con sarcopenia y fractura de cadera a través de la revisión de evidencia sistemática. Métodos Se realizó una búsqueda entre febrero y mayo de 2022 en 8 bases de datos electrónicas (Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar y Springer Link), con el fin de extraer ensayos clínicos publicados en los últimos 12 años en español e inglés. Resultados Se seleccionaron 3 ensayos clínicos que cumplían los criterios de inclusión. En todos ellos las intervenciones de fisioterapia incluían ejercicio aeróbico, de fuerza, de alta intensidad, de movilizaciones y combinados. La calidad metodológica se evaluó con la escala PEDro (puntuación media entre 6 y 10). Uno de los estudios no encuentra diferencias entre el tratamiento estándar y el grupo que recibe además entrenamiento progresivo de fuerza muscular. Otro constata una mejora a corto plazo en el grupo que recibe además del tratamiento convencional entrenamiento en cinta rodante con soporte del peso corporal durante el ejercicio con seguimiento a los 3 y 6 meses. El estudio que suplementa con aminoácidos esenciales es el único que constata una mejoría en los pacientes con sarcopenia. Conclusión Los pacientes con sarcopenia y fractura de cadera, pueden tener una mejor evolución si combinan ejercicios de fisioterapia con un protocolo nutricional. Son necesarias más investigaciones metodológicamente rigurosas sobre este tema para poder ampliar la evidencia. (AU)

Introduction Sarcopenia in patients with hip fracture is increasingly common in the elderly population, increasing the risk of hospitalization, dependency, and mortality. Objectives To assess the most effective physiotherapy treatment in patients with sarcopenia and hip fracture through systematic evidence review. Methods Electronic databases were searched from February to May 2022 using Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar, and Springer Link in order to extract randomized clinical trials published in full text both English and Spanish for the last 12 years. Results Three clinical trials that met the inclusion criteria were selected. In all of them, the physiotherapy interventions included aerobic, strength, high intensity, mobilization, and combined exercises. Methodological quality was assessed using the PEDro scale (average score between 6 and 10). One of the studies found no differences between the standard treatment and the group that also received progressive muscle strength training. Another found a short-term improvement in the group that received, in addition to conventional treatment, treadmill training with body weight support during exercise with follow-up that was not maintained at three and six months. The study that supplements with essential amino acids is the only one that confirms an improvement in patients with sarcopenia. Conclusion Patients with sarcopenia and hip fracture may have a better evolution if they combine physiotherapy exercises with a nutritional protocol. More methodologically rigorous research on this topic is needed to expand the evidence. (AU)

Variations of the grid and place cells in the entorhinal cortex and dentate gyrus of 6 individuals aged 56 to 87 years.

INTRODUCTION: The relationship between the entorhinal cortex (EC) and the hippocampus has been studied by different authors, who have highlighted the importance of grid cells, place cells, and the trisynaptic circuit in the processes that they regulate: the persistence of spatial, explicit, and recent memory and their possible impairment with ageing. OBJECTIVE: We aimed to determine whether older age causes changes in the size and number of grid cells contained in layer III of the EC and in the granular layer of the dentate gyrus (DG) of the hippocampus. METHODS: We conducted post-mortem studies of the brains of 6 individuals aged 56-87 years. The brain sections containing the DG and the adjacent EC were stained according to the Klüver-Barrera method, then the ImageJ software was used to measure the individual neuronal area, the total neuronal area, and the number of neurons contained in rectangular areas in layer III of the EC and layer II of the DG. Statistical analysis was subsequently performed. RESULTS: We observed an age-related reduction in the cell population of the external pyramidal layer of the EC, and in the number of neurons in the granular layer of the DG. CONCLUSION: Our results indicate that ageing causes a decrease in the size and density of grid cells of the EC and place cells of the DG.

Influence of Seminal Metals on Assisted Reproduction Outcome.

Increased levels of metal ions in human seminal fluid have a significant correlation with male fertility. Few publications explain the effect of metals in semen and their influence on assisted reproductive treatments. Semen parameters and the levels of twenty-two metals were measured in the seminal fluid of 102 men attended in a Reproductive Unit. Metals were determined by optical emission spectrophotometry. A statistical relationship was found between spermiogram and iron, which was lower than expected in pathological spermiograms (p = 0.032); zinc (p = 0.066), calcium (p = 0.047), and magnesium (p = 0.048) mean levels were higher in normozoospermics. More days of sexual abstinence correlates with higher seminal zinc (p = 0.001) and magnesium levels (p = 0.002). Lower vanadium values were found to be associated with higher fertilization rates (p = 0.039). Higher values of lead (p = 0.052) and vanadium (p = 0.032) were obtained in patients who did not reach 100% embryo cleavage rate. Aluminium (p = 0.042) and sodium (p = 0.002) were found in lower amounts associated with better blastocyst rates. The implantation rate shows an inverse association with women's age and iron and calcium content, compared to magnesium and sodium which presented a significant direct association with this percentage. A significant direct relationship was found between the positive evolution of pregnancy and the values of zinc (p = 0.004), calcium (p = 0.013), potassium (p = 0.002), and magnesium (p = 0.009). The study confirms that zinc, iron, calcium, sodium, aluminium, magnesium, vanadium, and lead have positive-negative effects on reproduction and support the analysis of metals in semen as a new line of study on male fertility with implications for reproductive outcomes.

Variations of the grid and place cells in the entorhinal cortex and dentate gyrus of 6 individuals aged 56 to 87 years. / Variaciones de las células de cuadrícula y de posicionamiento de la corteza entorrinal y del giro dentado de 6 humanos de 56 a 87 años.

INTRODUCTION: The relationship between the entorhinal cortex and the hippocampus has been studied by different authors, who have highlighted the importance of grid cells, place cells, and the trisynaptic circuit in the processes that they regulate: the persistence of spatial, explicit, and recent memory and their possible impairment with ageing. OBJECTIVE: We aimed to determine whether older age causes changes in the size and number of grid cells contained in layer III of the entorhinal cortex and in the granular layer of the dentate gyrus of the hippocampus. METHODS: We conducted post-mortem studies of the brains of 6 individuals aged 56-87 years. The brain sections containing the dentate gyrus and the adjacent entorhinal cortex were stained according to the Klüver-Barrera method, then the Image J software was used to measure the individual neuronal area, the total neuronal area, and the number of neurons contained in rectangular areas in layer III of the entorhinal cortex and layer II of the dentate gyrus. Statistical analysis was subsequently performed. RESULTS: We observed an age-related reduction in the cell population of the external pyramidal layer of the entorhinal cortex, and in the number of neurons in the granular layer of the dentate gyrus. CONCLUSION: Our results indicate that ageing causes a decrease in the size and density of grid cells of the entorhinal cortex and place cells of the dentate gyrus.

Construcción de un modelo de cálculo y registro del percentil de peso neonatal / Construction of model for calculating and recording neonatal weight percentiles

OBJETIVOS: Elaborar unas curvas de peso neonatal con una metodología que permita el acceso al cálculo automático del percentil, el registro y almacenamiento secuencial de los resultados y compararlas con otros modelos creados para niños españoles. MATERIAL Y MÉTODOS: Se realizó un análisis de regresión múltiple considerando como variable dependiente el peso del recién nacido (RN) y la edad gestacional (EG) y el sexo como independientes, para construir un modelo de cálculo del peso óptimo y de los correspondientes percentiles. Se comparan los resultados al clasificar a los RN como grandes o pequeños para la EG con el modelo propuesto y con el de Carrascosa, con el de Figueras y con los de Ramos. RESULTADOS: Modelo de cálculo del peso óptimo: 3.311,062 + 68,074 *sexo + 143,267 *EG40 -13,481 * EG402 - 0,797 *EG403 + sexo* (5,528 *EG40 - 0,674 *EG402 - 0,064 *EG403). Los percentiles de peso se obtuvieron de los datos estandarizados usando el coeficiente de variación del peso óptimo. El grado de concordancia entre el modelo construido y el de Carrascosa, el de Ramos dado en percentiles empíricos y el de Ramos en percentiles suavizados resultó «casi perfecto», κ = 0,866, κ = 0,872 y κ = 0,876 (p < 0,001), respectivamente; y con el de Figueras «considerable», κ = 0,720 (p < 0,001). CONCLUSIONES: El modelo construido es comparable con los utilizados para niños españoles y ofrece como ventajas: La posibilidad de cálculo automático, actualizado y sin ajustes, del percentil de peso. Disponibilidad de forma abierta. Y la posibilidad de registrar y exportar los resultados a cualquier base de datos, puntualmente, o para el seguimiento longitudinal del crecimiento fetal

OBJECTIVES: To construct a model for calculating optimal foetal and neonatal weight curves with a method that allows automatic calculation of the percentile and sequential recording of results. MATERIAL AND METHODS: A model was constructed for calculating optimal weight and the corresponding percentiles for gestational age and sex from a sample of 23,578 newborns, after excluding cases with diseases. Birth weight was modelled using stepwise multiple regression analysis. Newborns were classified as small or large for gestational age (SGA or LGA) using the proposed model. The resulting classification was compared with those derived from other models designed for Spanish children. RESULTS: Optimal weight model: 3,311.062 + 68.074 *sex + 143.267 *GE40 -13.481 *GE402 - 0.797*GE403 + sex* (5.528 *GE40 - 0.674 *GE402 - 0.064 *GE403). (GE, gestational age). Weight percentiles were obtained from standardized data using the coefficient of variation of the optimal weight. The degree of agreement between our model classification and those of the Carrascosa model and Ramos model, with empirical and smooth percentiles, was «almost perfect» κ = 0.866, κ = 0.872, and κ = 0.876 (P<0.001), respectively), and between our model and that proposed by Figueras it was «substantial» κ = 0.720, (P<0.001). CONCLUSIONS: The new model is comparable to those used for Spanish children and allows accurate, updated automatic percentile calculation for gestational age and sex. The results can be digitally stored to track longitudinal foetal growth. Free access to the model is offered, together with the possibility of automatic calculation of foetal and neonatal weight percentiles

Effect of pregestational diabetes mellitus on first trimester placental characteristics: three-dimensional placental volume and power Doppler indices.

OBJECTIVE: To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. METHODS: This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free ß human chorionic gonadotrophin (ß-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. RESULTS: 3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. CONCLUSIONS: Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.

[Construction of model for calculating and recording neonatal weight percentiles]. / Construcción de un modelo de cálculo y registro del percentil de peso neonatal.

OBJECTIVES: To construct a model for calculating optimal foetal and neonatal weight curves with a method that allows automatic calculation of the percentile and sequential recording of results. MATERIAL AND METHODS: A model was constructed for calculating optimal weight and the corresponding percentiles for gestational age and sex from a sample of 23,578 newborns, after excluding cases with diseases. Birth weight was modelled using stepwise multiple regression analysis. Newborns were classified as small or large for gestational age (SGA or LGA) using the proposed model. The resulting classification was compared with those derived from other models designed for Spanish children. RESULTS: Optimal weight model: 3,311.062+68.074 *sex+143.267 *GE40 -13.481 *GE40(2) - 0.797 *GE40(3)+sex* (5.528 *GE40 - 0.674 *GE40(2) - 0.064 *GE40(3)). (GE, gestational age). Weight percentiles were obtained from standardized data using the coefficient of variation of the optimal weight. The degree of agreement between our model classification and those of the Carrascosa model and Ramos model, with empirical and smooth percentiles, was "almost perfect" (κ=0.866, κ=0.872, and κ=0.876 (P<.001), respectively), and between our model and that proposed by Figueras it was "substantial" (κ=0.720, P<.001). CONCLUSIONS: The new model is comparable to those used for Spanish children and allows accurate, updated automatic percentile calculation for gestational age and sex. The results can be digitally stored to track longitudinal foetal growth. Free access to the model is offered, together with the possibility of automatic calculation of foetal and neonatal weight percentiles.

First-trimester screening for large-for-gestational-age infants.

OBJECTIVES: To examine the relationship between newborn birth weight and first-trimester uterine artery (UtA) pulsatility index (PI), maternal characteristics, serum pregnancy-associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (ß-hCG) and fetal nuchal translucency (NT) thickness. We also examined the results of screening for large-for-gestational-age (LGA) neonates by an integrated first-trimester approach incorporating these parameters. METHODS: We evaluated maternal characteristics, fetal NT, PAPP-A, free ß-hCG and UtA-PI in 2097 singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Linear models based on quasi Akaike's Information Criterion were used to determine the best predictive model for fetal birth weight. The patient-specific risk of delivering an LGA infant was derived from multiple logistic regression analysis and the performance of screening was determined by receiver-operating characteristics curve analysis. RESULTS: The best predictive models for fetal birth weight included UtA-PI, PAPP-A, NT, parity, maternal age, smoking status, weight, height and free ß-hCG. In pregnancies delivering LGA newborns compared with non-LGA pregnancies, PAPP-A and NT thickness were significantly increased (P = 0.016 and 0.001, respectively) and UtA-PI was significantly decreased (P = 0.011). A combination of maternal factors with PAPP-A, fetal NT and UtA-PI identified 34.4% of LGA newborns for a false-positive rate of 10%. CONCLUSIONS: This study showed an association between newborn birth weight and maternal factors, and first-trimester PAPP-A, ß-hCG, fetal NT and UtA-PI. Together, these factors can be used to identify over a third of pregnancies that will deliver LGA infants.

Estudio comunitario sobre prevalencia de morbilidad psiquiátrica en personas con parasuicidios previos / Community study on psychiatric morbidity prevalence in people with previous parasuicides

Introducción: El objetivo es conocer la prevalencia de patología psiquiátrica en un grupo de personas que habían cometido parasuicidios 2,5-6,5 años antes y compararla con otro grupo que en el mismo período habían presentado cuadros afectivos (pero no parasuicidios). Metodología: Estudio descriptivo, transversal, realizado en el ámbito comunitario incluyendo 48 casos y 48 controles. Se entrevistaron, se recogieron datos sociodemográficos y se realizó un diagnóstico psiquiátrico utilizando los criterios diagnósticos de investigación (RDC). Se aplicaron escalas de ide%; z=ación suicida, depresión, ansiedad, desesperanza, impulsividad, MALT, MMPI-2 y una escala de acontecimientos vitales. Resultados,: Los controles tuvieron una mayor proporción de “depresión actual” (68,7 vs. 45,8%, z=2,06, p=0,03). Los parasuicidas repetidores presentaban más patología psiquiátrica que los no repetidores (87,5 vs. 50%; z=2,49, p=0,01) y puntuaban significativamente más alto en las escalas de depresión y desesperanza. Conclusiones: Alta prevalencia de patología psiquiátrica años después de un parasuicidio, superior entre los parasuicidas repetidores

Introduction: This study aims to know the prevalence of psychiatric patology in a group of persons with a history of previous parasuicides (2.5-6.5 years earlier) and to compare to those with previous affective disorders at the same period (without parasuicides). Method: Descriptive, transversal, community, case-control study, including 48 cases and 48 controls. All participants were interviewed, sociodemographic data were collected and was made a psychiatric diagnosis using the Research Diagnostics Criteria (RDC),¡. The Scale for Suicide Ideation, Depression, Anxiety, Hopelessness, Impulsivity, MALT, MMPI-2 and a questionnaire of life-events items were applied. Results: Controls had a higher proportion of current depression (68.7 vs. 48.8%; z=2.06, p=0.03). Among the repeaters the percentage of depression was higher than among no-repeaters (87.5 vs. 50%; z=2.49, p=0.01) and they had a significant higher score in BDI and BHS. Conclusion: A high proportion of people suffer from some psychiatric disorder years after a parasuicide. This proportion is higher among repeaters (AU)

The Epidemiology of parasuicide in Canary Islands

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Objective: To analyze the epidemiology of parasuicide in Canary Islands. Methods: Emergency Department reports at every Hospitals and clinical data of all Mental Health Units were revised in Tenerife (1992-1996) and in Gran Canaria (1994-1996). Data about age, sex, address, educational level, marital status, job situation, time and methods used for committing parasuicide and previous parasuicide events were collected. Results: In Tenerife Island the annual average was 355 parasuicides among which 24.9% of the episodes were repeaters. The average crude rate was 70.99 cases per 100.000 inhabitants and the standardized rate was 61.81. In Gran Canaria Island the annual average was 634 and 21.3% were repeaters. The average crude rate was 120.23 per 100.000 and the standardized rate was 103.7 per 100.000. The age group 15-34 years, showed the higher rate values. Women presented higher rates as compared to men in all age categories. Conclusion: These findings are in agreement with those of the WHO-EURO Multicentre Project on Parasuicide. We found in Tenerife the lowest parasuicide rate values published in Europe (AU)

A cost-minimization analysis of oncology home care versus hospital care.

We compared the costs of patient care for two groups of 10 oncology patients. The test group was treated at home and had access to 24 h telephone support, and the control group was treated in hospital, either as inpatients or as outpatients. Direct variable costs were provided by health insurance companies. The time invested by the health-care staff was recorded. The amount of time devoted to patients was more uniform in hospital than in the patients' homes, which suggests that patients at home received a less generic, more specific form of care. The nurses spent four times as long caring for home care patients as for hospital patients. The total cost of home care was 64% of that of hospital care, although this difference was not significant. The mean daily costs were three times lower at home than in hospital. All direct costs, except laboratory tests, were lower at home. Pharmaceutical costs were six times lower at home. Telephone support for home oncology care was cost saving and avoided 27 nursing home visits, which represented 35 working hours and Pta270,000 in savings to the health insurance companies.