[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

Acute and repeated ECS treatment increases CRF, POMC and PENK gene expression in selected regions of the rat hypothalamus.

The purpose of this study was to investigate the effects of acute and repeated electroconvulsive shock (ECS) on corticotropin releasing factor (CRF), proopiomelanocortin (POMC) and proenkephalin (PENK) gene expression in selected regions of the brain and pituitary of the rat. Acute ECS increased CRF gene expression in the paraventricular nucleus (PVN) by 20%, an effect that was further enhanced to 38% when rats received repeated ECS treatment. Acute and repeated ECS increased POMC gene expression in the arcuate nucleus (ARC) by 49-59% but failed to alter these mRNA levels in the anterior lobe (AL) of the pituitary gland. PENK gene expression was increased by 35% in the nucleus accumbens (NA) and by 180% the ventromedial nucleus (VMN) after acute or repeated ECS treatment but no significant changes were found in the PVN or striatum (ST). Taken together, these results indicate a differential CRF and opioid gene expression regulation after acute or repeated ECS treatment that may be relevant to their therapeutic or side effects in depression.

Newborn genetic identification: a protocol using microsatellite DNA as an alternative to footprinting.

Newborn identification by foot- or finger-printing presents serious drawbacks. This study proposes an alternative method based on DNA analysis of blood-spots taken from the newborn child. CSF1PO, TPOX and TH01 microsatellite loci were chosen to develop a fast and reliable protocol to be applied in cases where it is suspected that newborn children have been exchanged. The advantage of these loci is that one can simultaneously amplify them by PCR multiplex reaction and determine their alleles, thereby reducing the time needed for identification tests. Moreover, the amplification products of these loci are very small (< 350 bp) and so can be analyzed in samples with degraded DNA. We have been able to prove that it is possible to obtain results in blood-spots taken from newborns up to 13 years before and kept at room temperature. Thus the protocol proposed here can be applied in long-term post-natal identification cases.

Rapid screening test evaluation for microalbuminuria in diabetes mellitus.

Microalbuminuria predicts clinical nephropathy and cardiovascular disease in diabetes mellitus. This study was undertaken to evaluate a screening microalbuminuria test with the Micral test II dipstick in a general practice setting and compare whether, if three urine samples are tested, any advantage is offered over a testing single sample. Two hundred and eighty diabetic patients attending a primary health care centre were studied. The first morning urine albumin concentration was determined by dipstick over 3 consecutive days. We studied two valuation methods: Method 1. Three-sample method: the test was considered positive if albumin was equal to or above 20 mg/l in at least two of three tests; Method 2. Single-sample method: we selected the third test, i.e. the most recent urine sample; if albumin was equal to or above 20 mg/l it was considered positive. The gold standard was the albumin excretion rate measured by a nephelometric method in a 24-h urine collection. Sensitivity, specificity, predictive values and Kappa coefficient were calculated. The diagnostic performance was assessed by a receiver operating characteristic curve. Microalbuminuria was defined for different thresholds of albumin excretion rate, 15, 20, 25 and 30 microg/min: their frequency was 38, 29, 23 and 18%, respectively. For method 1, the sensitivity of Micral test II oscillated between 70-94% and the specificity between 93-83%. For method 2, the sensitivity oscillated between 64-86%, and the specificity between 88-80%. Both methods had a high diagnostic performance. The Kappa coefficient was 84 and 60% for method 1 and 2, respectively. The Micral test II is a rapid, valid and reliable method for microalbuminuria screening in diabetic patients. It constitutes an important tool for diabetic surveillance in general practice. Although the use of three samples provides better results, the use of a single sample produces acceptable results at a low cost.

Population frequency distribution of HumF13A01, HumFXIIIB, and HumLIPOL loci in the Basque Country (Northern Spain).

A population study of unrelated individuals from the Basque Country (Northern Spain) was carried out using the GenePrint STR System. The PCR products were separated on denaturing polyacrylamide gels and visualized by silver staining. Three tetrameric loci were evaluated: HumF13A01, HumFXIIIB, and HumLIPOL. All loci fit Hardy-Weinberg expectations, and independence of alleles was found between these STR loci. A comparison with other population groups indicated allele frequencies are well conserved in Caucasians, but differ from other racial groups. The calculated parameters a priori probability of exclusion (Pex) and "power of discrimination" (PD) show how informative these loci are for the determination of identity and relatedness of individuals.

Population genetics and forensic applications using multiplex PCR (CSF1PO, TPOX, and TH01) loci in the Basque Country.

A population study in a sample of 200 unrelated individuals from the Basque Country (Northern Spain) was carried out using the GenePrint STR Multiplex System. The PCR products were electrophorized on a denaturing polyacrylamide gel and visualized by silver staining. The loci are TH01, TPOX, and CSF1PO. All loci meet Hardy-Weinberg expectations, and independence of alelles at these STR loci was found. A comparison with other population groups appeared to indicate that frequencies are well conserved in Caucasians, but differ from those of other racial groups. We have also calculated Fst as a measure of population subdivision. No appreciable genetic subdivision in the Caucasian populations studied here was found. Some statistical parameters of forensic interest (Pex, PM and PD) were also calculated. No exclusions were found in 100 mother-child and father-child meiosis. To evaluate the applicability of these systems to forensic casework, we studied the minimum quantity of DNA which can be used applying the multiplex methodology, and the minimum quantity that can be typed in a mixed sample. We also examined several samples such as hair roots, semen stains, vaginal swabs, blood stains and temporary teeth, each of these of varying ages.

D1S80 locus typing by micro thermal cycler. Application to genetic identity testing.

Based on a micro thermal cycler apparatus, a new protocol for amplification of the D1S80 locus has been developed. The advantages of this system consist of a reduction in time and costs of the amplification process, which greatly facilitates the analysis of the D1S80 locus at the population level and considerably increases its applicability in forensic samples. Using this protocol, an allele distribution study of the D1S80 locus has been carried out in a sample of 257 individuals residing in the Basque Country. In this study, up to 22 different alleles, ranging from 17 to 40 repetitions have been observed; moreover, the 35 and 38-repetition alleles, not reported in the european populations analyzed to date, have been detected. The sample studied fits Hardy-Weinberg equilibrium, the observed heterozygosity being 0.74, and the expected heterozygosity 0.804 +/- 0.012. The Chance of Exclusion and Index of Discrimination are 0.638 and 0.072 respectively. Moreover, the gene frequency distribution from the Basque resident population does not show significant differences when compared to other European and U.S. Caucasian populations.

[A glucose tolerance study in the 12 months postpartum in patients with gestational diabetes]. / Estudio de la tolerancia a la glucosa en los 12 meses posparto en pacientes con diabetes gestacional.

BACKGROUND: It has been reported that patients with gestational diabetes have a considerable long term risk of developing diabetes mellitus. METHOD: Glucose tolerance was studied in the 12 months following birth in 155 patients diagnosed by the authors as having gestational diabetes and followed during pregnancy. RESULTS: It was observed that in 48% of the patients alterations persisted (33% glucose intolerance and 15% diabetes mellitus). Glucose tolerance during gestation and the perinatal results were retrospectively analyzed with a relation with the postpartum reclassification being observed. CONCLUSIONS: It was estimated that the percentage of alterations in glucose tolerance persisting postpartum is extremely high, suggesting the need for this test with a double objective: the reclassification of gestational diabetes and the early detection of glucose intolerance and diabetes mellitus.

Mitochondrial DNA haplogroup diversity in Basques: a reassessment based on HVI and HVII polymorphisms.

This study provides a more complete characterization of the mitochondrial genome variability of the Basques, including data on the hypervariable segment HVII of the D-loop region, which remains relatively unknown. To that end, genomic DNA from 55 healthy men living in the Arratia Valley (Biscay province) and the Goiherri region (Guipúzcoa province) was examined by direct sequencing. Three-generation pedigree charts were compiled to ensure the collection from autochthonous individuals. The most notable findings emerging from the analysis of haplogroup composition are: (i) lack of U8a mitochondrial lineage, a rare subhaplogroup recently identified in Basques and proposed as a Paleolithic marker, (ii) low frequency of haplogroup V, which conflicts with results of earlier analyses describing high frequencies in southwestern Europe, and (iii) high frequency of haplogroup J, especially subhaplogroups J1c1 and J2a. The frequency of haplogroup J does not coincide with previous mtDNA studies in present-day Basques, but is congruent with frequencies found in prehistoric and historic Basque populations. In explaining divergence in haplogroup composition between modern Basque samples, we hypothesized spatial heterogeneity promoted by population fragmentation due to extreme limitation of dispersal opportunities during the Pleistocene glaciations. Similarities between extinct and extant Basque populations as for the high frequency of lineage J, as well as the abundance of this haplogroup in northern Spain endorse a shift in the focus of attention of mtDNA analysts. A refined dissection of haplogroup J might provide more solid evidence about the process of postglacial recolonization of Europe, and thus about the shaping of the European gene pool.

2006 GEP-ISFG collaborative exercise on mtDNA: reflections about interpretation, artefacts, and DNA mixtures.

We report the results of the seventh edition of the GEP-ISFG mitochondrial DNA (mtDNA) collaborative exercise. The samples submitted to the participant laboratories were blood stains from a maternity case and simulated forensic samples, including a case of mixture. The success rate for the blood stains was moderate ( approximately 77%); even though four inexperienced laboratories concentrated about one-third of the total errors. A similar success was obtained for the analysis of mixed samples (78.8% for a hair-saliva mixture and 69.2% for a saliva-saliva mixture). Two laboratories also dissected the haplotypes contributing to the saliva-saliva mixture. Most of the errors were due to reading problems and misinterpretation of electropherograms, demonstrating once more that the lack of a solid devised experimental approach is the main cause of error in mtDNA testing.

Una guía clara, aplicable, recomendable y que se cumple / A clear, applicable and recommendable guide with high acceptance

Objetivos: Conocer la utilización de la guía ‘Atención a las personas cuidadoras’ por las enfermeras que han realizado intervenciones grupales con cuidadoras y averiguar su opinión sobre: - la idoneidad y estructura de las unidades didácticas - la necesidad de modificación del resto de contenidos: organización del Servicio, registro, encuesta inicial, cuestionario de calidad de vida, de evaluación del taller. - los temas no tratados que sería recomendable introducir. Metodología: Estudio descriptivo transversal mediante una encuesta aplicada a las enfermeras de Atención Primaria de Asturias que realizaron Talleres grupales con cuidadores familiares durante el periodo enero 2009- junio 2010. Resultados: El porcentaje de respuesta al cuestionario fue del 81%. La guía fue empleada para la preparación de la intervención por el 95% de las profesionales. El 96% de las encuestadas manifiestan que los contenidos de la guía responden a las necesidades de los cuidadores. Mayoritaria es también la respuesta de quienes la consideran comprensible y fácil de manejar, el 92%. Destacaron la falta de formación como dificultad para impartir los contenidos de la guía el 77%. El 91% de las encuestadas recomendaría esta guía para el desarrollo de una intervención grupal con personas cuidadoras. Conclusiones: Es bastante elevada la adherencia de las enfermeras a esta guía que orienta la intervención psicoeducativa grupal con cuidadores de personas dependientes. Se requiere llevar a cabo estrategias útiles por parte de la Administración Sanitaria con el fin de resolver las barreras identificadas que dificultan su mejor uso y aplicación, entre ellas, mejorar la formación de las enfermeras en habilidades de comunicación y de inteligencia emocional. Es necesario realizar una revisión y actualización de los contenidos de la guía para que sea una herramienta que ayude y mejore la calidad de la práctica de este Servicio (AU)

Objectives. To assess the use of the guide ‘Atención a las personas cuidadoras’ (‘Care for caregivers’) by nurses who had performed group interventions with caregivers and to obtain their opinion on: - The suitability and structure of the didactic units - The need to modify the rest of the contents: Department organization, registration, initial survey, quality of life questionnaire, workshop review questionnaire - Topics which are not dealt with but which should be included Methods. Transversal descriptive study. A survey of primary care nurses in Asturias who had conducted group workshops with family caregivers between January 2009 and June 2010 was carried out. Results. The response percentage to the survey was 81%. The guide was used to prepare interventions by 95% of the professionals. 96% of the survey group declared that the contents of the guide address the needs of the caregivers. Most nurses, 92%, also consider the guide to be easy to understand and to use. 77% of them identified a lack of training as a difficulty when trying to teach the contents of the guide. Finally, 91% of the survey group would recommend using this guide when developing a group intervention with caregivers. Conclusions. Nurse adherence to this guide, which helps direct the psychoeducational group intervention for caregivers of dependent persons, was remarkably high. The Healthcare Administration should implement useful strategies in order to overcome the identified barriers which hamper a better use and application of the guide. Its contents must be reviewed and updated so that the guide may become a helpful tool capable of improving the quality of care in this Department (AU)

[Definition and validation of quality indicators of prescription in primary care]. / Definición y validación de indicadores de calidad de la prescripción en atención primaria.

OBJECTIVE: To define and validate a battery of prescription indicators on the use of anti-hypertensives, lipid-lowerers, diabetes drugs, and insulin, as measurements of family doctors' quality of prescription in primary health care. DESIGN: Transversal, descriptive study. SETTING: Two primary care health districts, Camas and Sierra Norte, Spain. PARTICIPANTS: Eighty three family doctors, 94.32% of the doctors in the study area. DEFINITION AND VALIDATION OF INDICATORS: To construct the prescription indicators, we used evidence found in the scientific bibliography available. To validate it, we analysed its statistical relationship with a series of selected clinical tests, collected from the clinical records. RESULTS: For each doctor, there was a statistically significant relationship between the index of quality of prescription and the clinical quality seen in the records (P=.004). The variables of age, sex, and training fine-tuned the model. CONCLUSIONS: There is a statistically significant relationship between a good prescription indicator and proper control of intermediate health variables.

Short alleles revealed by PCR demonstrate no heterozygote deficiency at minisatellite loci D1S7, D7S21, and D12S11.

Short VNTR alleles that go undetected after conventional Southern blot hybridization may constitute an alternative explanation for the heterozygosity deficiency observed at some minisatellite loci. To examine this hypothesis, we have employed a screening procedure based on PCR amplification of those individuals classified as homozygotes in our databases for the loci D1S7, D7S21, and D12S11. The results obtained indicate that the frequency of these short alleles is related to the heterozygosity deficiency observed. For the most polymorphic locus, D1S7, approximately 60% of those individuals previously classified as homozygotes were in fact heterozygotes for a short allele. After the inclusion of these new alleles, the agreement between observed and expected heterozygosity, along with other statistical tests employed, provide additional evidence for lack of population substructuring. Comparisons of allele frequency distributions reveal greater differences between racial groups than between closely related populations.

Genetic characterization of APOB and D17S5 AFLP loci in a sample from the Basque Country (northern Spain).

VNTR polymorphism of AFLP loci D17S5 and APOB was analyzed in 100 unrelated individuals residing in the Basque Country by PCR amplification and polyacrylamide gel electrophoresis. Population parameters were estimated to validate these loci as routine markers in human identification. Thus, although both loci showed extensive polymorphism (with gene diversities of approximately 80% for both systems) and although concordance with Hardy-Weinberg equilibrium and linkage equilibrium was observed, comparisons with other populations displayed significant differences. Moreover, further analysis of neutral parameters limits this validation to D17S5 because APOB displays excesses of both the total number of alleles and the number of rare alleles; possible reasons for this discrepancy (presence of deleterious alleles, bottleneck effect, admixture, complexity of APOB polymorphism) are discussed.