Optimización de un método de cribado rápido de fármacos en sangre mediante la técnica de cromatografía de líquidos acoplada a espectrometría de masas

Objetivos

La cromatografía líquida acoplada a la espectrometría de masas ha ganado en popularidad en los laboratorios en los últimos años debido a una mayor especificidad de la técnica, la posibilidad de determinar múltiples analitos en una sola inyección de la muestra, la medición de analitos en una variedad de matrices diferentes y a una drástica reducción de las interferencias analíticas en comparación con el inmunoensayo. El tratamiento y preparación de las muestras biológicas es un proceso esencial cuando éstas han de ser analizadas mediante sistemas cromatográficos. Los principales interferentes en el análisis de las muestras de sangre son los fosfolípidos y las proteínas. El objetivo principal de este estudio es mejorar la sistemática analítica toxicológica en el cribado general de fármacos mediante la técnica LC-MS/MS a través de un nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos.

Métodos

Se ha evaluado el nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos mediante la tecnología LC-Q-q-LIT.

Resultados

Se ha determinado el límite de detección, el límite de cuantificación y rango de medición para las 56 moléculas seleccionadas y se han comparado los resultados de once casos con las extracciones e instrumentación tradicionales.

Conclusiones

La metodología propuesta de preparación de muestras en sangre y análisis mediante técnicas más sensibles como LC-Q-q-LIT ha resultado comparable a la metodología tradicional en cuanto a resultados y, ofreciendo, además, una reducción de tiempo y coste.

Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke

INTRODUCTION

Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective).

PATIENTS AND METHODS

The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups.

RESULTS

Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262).

CONCLUSIONS

Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.

High prevalence of asymptomatic COVID-19 in hemodialysis. Daily learning during first month of COVID-19 pandemic☆

Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100,000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit.

We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O₂ saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-Cov2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases.

Conclusions

We detected a high prevalence of COVID19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID19.

[URISCAM project: Multicenter evaluation of the UF-Series cytometer in the urinary tract infections screening]

OBJECTIVE

Urine culture, the gold standard to confirm the presence of urinary tract infection (UTI), is the most requested assay in the microbiology department. Our objective was to determine the diagnostic yield of the UF-Series cytometer as a screening method for UTI.

METHODS

All the urine samples sent to the six Microbiology Laboratories participating in a period of 5 working days were analyzed. We collected demographic variables, apart from those variables related to urine samples: source and sample type (midstream, catheterized or nephrostomy urines), collection with/without boric acid, cytometer parameters (leukocyturia, bacteriuria, bacteria morphology and epithelial cells) and urine culture results. ROC curves were plotted to determine predictive capacity of the cytometer.

RESULTS

A sample of 2,468 patients with average age of 53 years were processed (ratio women:men 2:1). Urine culture detected 23% of positive urine samples. The predictor variables of UTI were: morphology of bacilli, bacteriuria ≥21 bacteria/µL, age ≥65 years, samples collected in the emergency service and hospitalization and preserving conditions. With 21 bacteria/µL as a cut-off point, we obtained a sensitivity of 93.3% and 94.5% negative predictive value, then reducing the samples to be cultured by 28.9% with 1.6% false negatives.

CONCLUSIONS

We consider that the UF-Series is a valid and accurate tool for the detection of UTI. Therefore, it could be used as screening method in the clinical practice prior to the urine culture, reducing culture requirement by approximately 30%, with a low false negative rate.

Rapid tests reduce the burden of tuberculosis in Azerbaijan prisons: special emphasis on rifampicin-resistance

AIMS

To evaluate the impact of addition of rapid tests for tuberculosis (TB) to mass screening and passive case finding on the burden of TB in high-incidence prisons of Azerbaijan.

MATERIALS AND METHODS

All new and relapse TB cases notified in 01.01.2009-31.12.2015 were retrospectively included.

RESULTS

2,315 TB patients were identified in 19 prisons. Implementation of the rapid tests to the case finding algorithms lead to 3-, 10- and 5-fold decrease in the annual rates of the notified, smear-positive and RIF-resistant TB cases, respectively. After introduction of rapid tests into the screening algorithms, there were significant linear trends towards decrease in the notified (p=0.009), smear-positive (p=0.011) and RIF-resistant TB cases (p=0.02) with the annual rates of decrease (95% confidence interval (CI)) being -435 (-614; -255), -356 (-517; -195), and -99 (-160; -38), respectively. Utilization of rapid tests also significantly increased treatment success with first-line drugs among all cases, cases detected by mass screening and those, detected by passive case finding [adjusted odds ratio (aOR)=2.38, 95% CI:1.86-3.05, aOR=4.56, 95% CI:2.64-7.89 and aOR=2.60, 95% CI:1.81-3.75, respectively].

CONCLUSIONS

Introduction of rapid tests into the screening lead to decline in the burden of TB and RIF-resistance, and improved outcomes of treatment with first-line drugs in prisons.

Prevalence of reactivity to the tuberculin test and associated factors in the population attended at a drug addiction center in the period 2013-2016

OBJECTIVE

Epidemiological study of prevalence, carried out at Center for Drug Addiction of the center of addictions of Nou Barris (Barcelona, Spain) during 2013-2016 in order to know the prevalence of tuberculin test reactivity (TTR) and its predictive factors in drug-dependent population.

MATERIAL AND METHODS

Epidemiological and clinical variables, associated with the consumption of drugs and the practice of the tuberculin test, were collected. The reading rate and the prevalence of TTR for annual periods, as well as the predictive factors through a bivariate and multivariate logistic regression analysis.

RESULTS

389 patients were studied (109 in 2013, 84 in 2014, 111 in 2015 and 85 in 2016) and they went to the reading of the TT 337 (86.6%). The prevalence of TTR was 33.2% in the readings. At the bivariate level, TTR was associated with sex, origin and prior history. In the multivariate analysis, the predictive value of age was confirmed (more reactivity in ≥40 years; p <0.001, odds ratio [OR]: 4.85, confidence interval [IC]: 2.68-8.78), being male (p = 0.003, OR: 2.81, IC: 1.43-5.53), and being an immigrant (p <0.001; OR: 7.32, IC: 3.56-15.03).

DISCUSSION

It is concluded that the prevalence of TTR is high, especially in men, in those of more age, and in immigrants and that the drug addiction devices continue to be basic in the detection and monitoring of the latent tuberculosis infection.

Diabetic retinopathy in Tanzania: prevalence and risk factors at entry into a regional screening programme

OBJECTIVE

The number of adults with diabetes in sub-Saharan Africa (SSA) is expected to almost double by 2035. This study investigated the prevalence of diabetic retinopathy (DR) and its risk factors at entry into a community-based screening programme.

METHODS

All persons with diabetes screened for retinopathy at entry into a screening programme in Kilimanjaro Region, Tanzania between November 2010 and December 2014 were included. Fundus photographs were taken with a Topcon retinal camera following pupil dilation. Data were collected on BP, random blood sugar, duration of diabetes, BMI and visual acuity on entry.

RESULTS

A total of 3187 persons were screened for DR. The prevalence of any DR was 27.9% (95%CI 26.4-29.5%) with background diabetic retinopathy (BDR), pre-proliferative diabetic retinopathy (PPDR) and proliferative diabetic retinopathy (PDR) having a prevalence of 19.1% (95% CI 17.7-20.4%), 6.0% (95%CI 5.2-6.8%) and 2.9% (95%CI 2.3-3.5%), respectively. Maculopathy was present in 16.1% (95%CI 14.8-17.4%) of participants. Multivariable logistic regression analysis for the presence of any DR found independent associations with duration of diabetes (P < 0.0001), systolic BP (P < 0.0001), random blood sugar (P < 0.0001) and attending a government hospital diabetic clinic (P = 0.0339).

CONCLUSIONS

This study is the first to present data from a DR screening programme in SSA. The results will provide policymakers with data to aid planning of DR screening and treatment services in the African region. The study highlights the importance of managing comorbidities within DR screening programmes.

Screening of patients with diabetes mellitus for tuberculosis in community health settings in China

OBJECTIVE

To assess the feasibility and results of screening of patients with DM for TB in routine community health services in China.

METHOD

Agreement on how to screen patients with DM for TB and monitor and record the results was obtained at a stakeholders meeting. Subsequent training was carried out for staff at 10 community health centres, with activities implemented from June 2013 to April 2014. Patients with DM were screened for TB at each clinical visit using a symptom-based enquiry, and those positive to any symptom were referred to the TB clinic for TB investigation.

RESULTS

A total of 2942 patients with DM visited these ten clinics. All patients received at least one screening for TB. Two patients were identified as already known to have TB. In total, 278 (9.5% of those screened) who had positive TB symptoms were referred for TB investigations and 209 arrived at the TB centre or underwent a chest radiograph for TB investigation. One patient (0.5% of those investigated) was newly diagnosed with active TB and was started on anti-TB treatment. The TB case notification rate of those screened was 102/100,000.

CONCLUSION

This pilot project shows it is feasible to carry out TB screening among patients with DM in community settings, but further work is needed to better characterise patients with DM at higher risk of TB. This may require a more targeted approach focused on high-risk groups such as those with untreated DM or poorly controlled hyperglycaemia.

[Validation of two short versions of the Centre for Epidemiological Studies Depression Scale in Colombian adolescents]

OBJECTIVE

To establish the validity and reliability of a Brief and Ultra-short Center for Epidemiological Studies Depression (CES-D) Scale in adolescents.

DESIGN

Validation study.

SETTING

Secondary schools in Bucaramanga, Colombia.

PARTICIPANTS

A total of 474 students were selected through a three stage process; 68 did not agree to participate, 8 were excluded and 8 did not complete the process.

MAIN MEASUREMENTS

Adolescent students were evaluated with CES-D and the clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The CES-D scale was re-applied 3 to 28 days after the first application. The ten items and the three items with the highest correlation with total score were selected to construct a Brief scale and Ultra-short scale, respectively. Construct validity, criterion validity, test-retest reliability and internal consistency were analyzed.

RESULTS

For the Brief CES-D Scale the Cronbach's alpha was 0.86 and Lin's coefficient was 0.77. The area under ROC curve was 0.83, with a sensitivity of 77.8%; specificity 74.1%. Two main factors were identified to explain the 55.81% variance. For the Ultra-short Scale the Cronbach's alpha was 0.76 and Lin's coefficient was 0.74. The area under ROC curve was 0.80, with a sensitivity of 75.56%; specificity 70.67%. One main factor was identified to explain the 68.19% of variance.

CONCLUSIONS

The Brief and Ultra-Short CES-D Scale are as useful as the original scale for the screening of MDD in adolescents; Ultra-short CES-D Scale does not preserve the original factorial structure.

[Opportune intervention of family doctors in the programme of early detection of breast cancer]

OBJECTIVE

To study to what extent a brief intervention increases the rate of participation in the programme of early diagnosis of breast cancer (EDBC).

DESIGN

Before-and-after intervention study without a control group on women who had not had a mammography.

SETTING

Primary care: 3 rural lists and 2 urban ones.

PARTICIPANTS

All women between 52 and 67 who attended the clinic during a 6-month period.

INTERVENTION

If they had had no mammography in the previous 2 years, the reasons were explored and a brief structured intervention, depending on the reason, was conducted. After this, the woman was invited to make an appointment with the EDBC Unit.

MAIN MEASUREMENTS

Effective intervention: checking that the mammography had been done at the EDBC Unit. It was checked whether women who had not attended for consultation attended the unit with their mammography done.

RESULTS

Out of a target population of 565 women, 403 (71%) attended for consultation. Of these, 315 (78%) were in the programme, 51 (13%) had had a mammography outside the programme, and 37 (9%) had not had a mammography. After the intervention, 21 women had a mammography (56.7% [95% CI, 41-73] success of intervention). Seventy of the 162 women who did not attend for consultation had a mammography in the programme. The rate of participation in the EDBC rose from 68% (385/565) to 72% (406/565).

CONCLUSIONS

The brief intervention was effective in over half the women. This small increase contributed to reaching the minimum levels of coverage recommended in a programme of this kind.

[Celiac disease in close family members]

OBJECTIVES

To investigate the presence of celiac disease (CD) in close family members of celiac patients, and the possible clinical differences between family members diagnosed and their respective index cases.

DESIGN

Descriptive, observational study based on a series of cases.

SETTING

Health centre and hospital.

PARTICIPANTS

Family members of celiac patients registered with the Association of Celiacs of Andalusia, based in Sevilla.

MAIN MEASUREMENTS

Patients and family members were interviewed and 2 questionnaires were filled in. The first, aimed at celiacs, recorded details of their disease and the second recorded personal details, current illnesses, personal history and the family members of all participants. IgA endomysium antibodies were determined only in family members.

RESULTS

56 of 215 families recorded took part, with 239 participants. Of the 56 patients, 1 per family, presentation at the moment of diagnosis was malabsorption syndrome. Of 165 family members studied, 11 cases with positive IgA endomysium antibodies were found and 5 actually with CD. One of these was asymptomatic, three presented with atypical forms of CD and another was diagnosed with herpetiform dermatitis.

CONCLUSIONS

That CD was most commonly found among close family members, along with its asymptomatic or atypical clinical presentation, justifies the active search for cases. Primary care doctors should question family members as to whether they have been tested for the disease. If not, adults should be checked for the antibodies referred to and children should be referred to their paediatricians for this purpose.

[Detection of cognitive impairment in the population of persons older than 64 years: first phase of the Cuida'l project]

OBJECTIVE. To know the proportion of people with positive result in test. Design. Cross sectional study in 53 health centers. SETTING. Primary care.

PARTICIPANTS

Aleatory sample of non-institutionalised, elder than 64 years patients attended in the 53 health centers.

MEASUREMENTS

VARIABLES

age, sex, civil status, and educational level. The detection of cognitive deterioration (CD) was carried out in primary care units with Folstein's Mini Mental Test (MMT) and the Isaacs Set-Test in case of illiteracy. Cut-off points 24 and 27 respectively. CD predictor variables analysis with logistic regression.

MAIN RESULTS

The tests were applied to 4,467 individuals (56.1% females). There were found as possible cases of CD 399 patients (72.2% with MMSE). Positive percentage was 7.78% (95% CI, 5.69%-10.99%) in males and 9.45% (95% CI, 7.31%-12.43%) in female, adjusting with indirect method, according to the 1996 Catalonia list of inhabitants. Significant predictor factors were found with the multivariate analyses: primary educational level in front of illiteracy (OR=1.40, 95% CI, 1.13%-1.74%) and age-groups: 74-79 years, 75-79 years and y >= 80 years in front of <70 years old (OR=1,48, 95% CI, 1.02%-2.14%, OR=2.29; 95% CI, 1.60%-3.28% and OR=5,02; 95% CI, 3.59%-7.03% respectively).

CONCLUSIONS

The cognitive deterioration prevalence increases with age and it is less frequent in individuals with higher studies Using MMSE and Set-Test we found several possible cases of cognitive deterioration in our population.

[Levels of serum cholesterol in a catalan population. Evolution over a 6- year period (1994-1996)]

OBJECTIVE

To study the evolution of the serum levels of cholesterol in a population over 6 years. Design. cross-sectional observational study.Setting. Primary and specialist care in the county of Osona (Barcelona).

PARTICIPANTS

Study of those patients attending for health consultations in the county, whether at primary or hospital level, and who had their cholesterol level determined.

MAIN MEASUREMENTS

The levels of serum cholesterol of the 7882 patients studied during September to December 1994 was compared with those of the 10 319 patients analysed during the same months of 1999.

RESULTS

The mean levels of cholesterol increased steadily in both sexes with age, up to the fifth or sixth decade of life, at which point a slow descent started. Cholesterolaemia was higher in men than in women in the third and fourth decades of life; but from this age on, mean levels are higher in women than in men. Cholesterol levels in both sexes were higher in the 1999 period studied than in 1994. During 1999, 52.7% of men and 52.3% of women had serum cholesterol levels above 200 mg/dL, whereas in 1994 these figures were 49.1% and 49.2%, respectively.

CONCLUSIONS

Mean levels of serum cholesterol in the population under study are high and increased between the two sampling years. Preventive and hygiene-diet measures need to be fomented among the general population in order to improve control of cholesterolaemia.

[Cell anomalies in the cervix and subsequent pre-cancerous lesions in a Health Area]

OBJECTIVE

To determine the frequency of epithelial anomalies in cervical smears during the three years from August 1997 to July 2000 and of subsequent pre-cancerous lesions that are histologically confirmed, with differentiation also being made between health care levels.

DESIGN

Retrospective descriptive study.

SETTING

Anatomy Pathology referral Laboratory. Talavera de la Reina Health Area.

PARTICIPANTS

5,712 cervical smears and 70 biopsies.Intervention. Review of path reports.

MAIN MEASUREMENTS AND RESULTS

308 (5.4%) smears showed anomalies that were not attributed to a benign process. 209 (68%) of these were followed up, 139 (45%) of them through repetition of the smear and 70 (23%) through biopsy. Cell and cytology correlated in 42 women (30.2%), and cell-histology in 27 (38.6%) (0.47%, n = 5,712). 2,874 of the smears in the Area were taken in Primary Care, and 127 (22.2%) cell anomalies and 6 (0.1%) pre-cancerous lesions were found at this health care level.

CONCLUSIONS

The 5.4% frequency of anomalies is consistent with that in other population groups with an incidence of cervical cancer similar to ours. The 0.47% pre-cancerous lesions confirmed histologically is very low in comparison with the anomalies, which suggests that this intervention needs to be improved. This could be done by increasing biopsies for cell anomalies and screening of women at risk. Interpretation of smear reports, more information to the women and follow-up of the findings could all be improved, too.

[Diagnosing osteoporosis in primary care in Spain (ABOPAP 2000 study)]

OBJECTIVE

To discover how osteoporosis is tackled in Spanish primary care before the publication of the semFYC osteoporosis guide.

DESIGN

Self-filled questionnaire for primary care doctors sent out by commercial mail (in blocks per province).

SETTING

Five thousand family medicine clinics in Spain.Participants. Doctors working in primary care.Measurements. Level of activity relating to osteoporosis in daily consultations (identification of risk factors, screening, who conducts diagnosis and follow-up, level of access to densitometry and specialist) and identification data (province, type of work centre and number of consultations per day).

MAIN RESULTS

414 replies embracing reformed and non-reformed centres from the entire country, with different case overloads. 32.3% stated that osteoporosis treatment was viewed as a preventive activity in their centre and only 35.5% systematically asked for family history of osteoporosis. Osteoporosis screening was high in determined situations (82.9% in vertebral compression, 78.3% in hip fracture) and deficient in others (59.6% in glucocorticoid treatment, 46.6% in colles fractures, 36% in chronic nephropathy, 29.2% in thinness, 17.1% in chronic hepatopathy and 11.8% in treatment for epilepsy or with lithium). 73.9% could not request bone densitometry and 64.3% thought that access to other care levels was complicated. 51.9% said they continued to monitor osteoporosis. The impossibility of requesting densitometry or difficult access conditioned the screening level. There were differences in access according to autonomous communities, with Catalonia having best access to Densitometry (75%), followed by the communities of Madrid, Valencia and Euskadi (30%).

CONCLUSIONS

Diagnosis of osteoporosis in primary care is deficient and is partly conditioned by difficulty in access to diagnostic tests and the lack of systematic screening.

[Descriptive study of cervical intraepithelial neoplasia grade III (CIN III) cases in the area of the hospital of Barbastro]

OBJECTIVE

A description of early diagnosis of cervical cancer in the Barbastro Hospital area.

DESIGN

Descriptive and retrospective study on all the CIN III cases collected in the Tumor Hospital Registry from 1989 to 1998. To correlate the data to the population covered by the hospital.

PARTICIPANTS AND METHODS

59 CIN III cases were detected and 16 invasive cancers. The total smears studied were 31409. The population covered was 50220 women, 15% of whom are between the age of 35 and 64.

RESULTS

The frequency of CIN III was 12 cases per 100000 women and year and of invasive cancers 3.2. From 59 CIN III 20 belong to the first five-year period and 39 to the second. The mean age was 37 12 (20-82). No significant statistical differences were found between five-year periods. The most frequent decade was 30-39 years (50% of cases). 10489 smears were studied from the first five-year period and 20911 from the second. 75% of invasive cases did not come from screening.

CONCLUSIONS

The tendency is that when the number of screened smears increases so does the number of CIN III. The frequency of the preneoplastic disease and invasive cancer is low. Therefore, close coordination between hospital departments of gynaecology and pathology together with primary health care is vital in order to extend the coverage, to reach risk groups and rationalise the screening of cervical cancer.

[Communication, diagnosis and treatment of urinary incontinence in the elderly in a basic health area]

OBJECTIVE

To investigate the frequency in which aged people who suffers on urinary incontinence (UI) talk about this problem with primary care professionals, variables related to no healthcare-seeking as well as diagnostic and therapeutic habits of these professionals.

DESIGN

Cross-sectional study.Location. Basic Health Zone of Cabra (Córdoba, Spain).

PATIENTS

A random age-stratified sample of 869 patients selected from a total of 5139 persons >= 65 years of age.Interventions. Home interview.

MEASUREMENTS

Proper questionnaire with questions about reporting of incontinence to health professionals and the procedures used for routine screening as well as diagnostic and therapeutic assessment of incontinence. A logistic regression model was elaborated to identify explanatory factors for reporting incontinence to healthcare professionals.

RESULTS

Of 330 incontinents, only 32% reported their problem to healthcare professionals. The remaining 68% did not report their incontinence because most thought it was a minor problem and/or part of the ageing process. The explanatory factors for seeking medical help were the frequency, duration and impact of incontinence, and dependence in self-care. Physicians performed routine screening for incontinence in 10% of 827 inquired aged. In 1 out of 5 incontinents, the physician did not take any diagnostic or therapeutic measures.

CONCLUSIONS

Seeking of UI medical help was very limited and depends on variables related to perception in symptom's changes. Diagnosis and treatment done by professionals was suboptimal. Severity of UI conditions diagnosis and treatment.

[Analysis of a program of early breast cancer detection in a rural area]

OBJECTIVE

To find the results of a breast cancer early-detection programme run in a rural area, in terms of the activities corresponding to primary care.

DESIGN

Cross-sectional, observational study.

SETTING

Rural district in Primary Care Area 11, Madrid. The programme was run in this area between 1st February and 31st March 1999.

PATIENTS

Women from 50 to 64, both inclusive, who had been called for a mammography.

INTERVENTIONS

Inclusion in the breast cancer early-detection programme and open telephone survey of those who did not take part to find the reasons for not taking part in the randomised sample.

MEASUREMENTS AND MAIN RESULTS

In the period mentioned, 3902 women were called for screening (60.07% of all women between 50 and 64. The rest will be called in a second round in the year 2000). 2099 women attended for mammography (participation index 53.79%), with the following results: 5 (0.24%) highly likely to be malignant; 6 (0.29%) probably malignant; 172 (8.19%) probably benign; 1393 (66.36%) found to be benign; 438 (20.87%) negative; and 85 (4.05%) who needed further evaluation. The main reasons why 46.21% of the women called did not attend for mammography were: they had had one recently (29.9%); could not attend (22.7%); did not want to have one (17.5%); had not received the notification (17.5%).

CONCLUSIONS

The participation rate was acceptable, with fewer malignant cases found than in other programmes. It would be important to call again those women who could not attend.

[Attitude of primary care physicians to early detection of prostatic cancer through prostate-specific antigen]

OBJECTIVES

To study the attitude of primary care doctors when a high (> or = 4 ng/ml) prostate-specific antigen (PSA) is found and to examine the variables linked to a prostate biopsy and the diagnosis of prostate cancer (PC).

DESIGN

Descriptive, observational study.

SETTING

Urban health district.

PATIENTS

Ninety-four men not previously diagnosed with PC who in 1998 had a PSA figure > or = 4 ng/ml. The list was obtained from the pertinent laboratory.

MEASUREMENTS

The following variables were gathered from review of clinical records: family background of PC, age, PSA figure, reason for request for PSA (if not given, it was considered a screening), referral to the urologist, rectal touch, transrectal echography, prostate biopsy and final diagnosis.

RESULTS

Average age was 70 (SD, 9.31). The reason for requesting PSA was: urine symptoms in 25 (26.6%), other signs or symptoms in 25 (26.6%), request of patient in 2 cases (2.1%) and screening in 42 (44.7%). Rectal touch took place in 16 cases. Twenty-nine people were referred for examination to the urologist. 36 patients had an echography and biopsy. Variables linked to the prostate biopsy in the logistic model were: higher value of the PSA (OR 1.1; 95% CI, 1.03-1.18), being older (OR 0.92; CI, 0.87-0.98) and rectal touch performed (OR 3.58; CI, 1.02-12.51). Ten cases of PC were diagnosed.

CONCLUSIONS

The most common reason for a PSA request was screening. Prostate biopsy was not requested for 58 men. A primary care guide to action concerning PC diagnosis in cases of PSA > or = 4 ng/ml would be useful.