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The aim of this study was to ascertain the relationship between social network and the appearance of mortality (cardiovascular events (CVEs)) in patients with arterial hypertension (AHT). This is a cohort study of 236 patients with a 9-year follow-up. Measurements included age, sex, blood pressure (BP), diabetes, hypercholesterolemia, marital status, social network, social support, stage of family life cycle (FLC), mortality and CVEs. Patients with a low social network registered higher global mortality (hazards ratio (HR) 2.6 (95% confidence interval (CI) 1.3; 5.5)) as did the oldest patients (HR 5.6 (1.9; 16.8)), men (HR 3.5 (95% CI 1.3; 9.3)) and subjects in the last FLC stages (HR 4.3 (95% CI 1.3;14.1)). Patients with low social support registered higher cardiovascular mortality (HR 2.6 (95% CI 1.1; 6.1)) as did the oldest patients (HR 12.4 (95% CI 2.8; 55.2)) and those with diabetes (HR 3.00 (95% CI 1.2; 7.6)). Patients with a low social network registered more CVEs (HR 2.1 (95% CI 1.1; 4.1)) than patients with an adequate network, as did the oldest patients (HR 3.1 (95% CI 1.4; 6.9)), subjects who presented with a higher grade of severity of AHT (HR 2.7 (1.3; 5.5)) and those in the last FLC stages (HR 2.5 (95% CI 1.0; 6.2)). A low social network is associated with mortality and the appearance of CVEs in patients with AHT. Low functional social support is associated with the appearance of cardiovascular mortality. more...

OBJECTIVE To culturally adapt and validate the SPICTTM to Spanish, which is a brief and simple tool to support a better identification of chronic patients who have palliative care needs. METHODS For this study, we designed a multicenter and national project between the centers of Galicia, Balearic Islands, and Andalusia. For the process of translation and cross-cultural adaptation of the SPICTTM to Spanish, we followed the steps proposed by Beaton et al. with successive translations and subsequent consensus of experts using the debriefing methodology. After the content validation was completed, the psychometric properties were validated. A prospective longitudinal study was designed with 188 patients from Galicia, the Balearic Islands, and Andalusia. The internal consistency and reliability of the test and retest was analyzed for 10 days by the same researcher. RESULTS For more than 90% of the participants of the SPICT-ESTM, it seems simple to be filled out, and they consider it written in an understandable language. The average time to apply the questionnaire without prior knowledge was 4 minutes and 45 seconds. To evaluate the internal consistency of the instrument, we used the Kuder-Richardson formula 20. Internal consistency is 0.71. The agreement index of the Kappa test is between 0.983 and 0.797 for the different items. CONCLUSIONS In this study, we demonstrate the equivalence of content with the original. In addition, the validation of the psychometric properties establishes that the SPICT-ESTM maintains adequate reliability and stability. If we add the satisfaction shown by the professionals and the ease of use, the SPICT-ESTM is an adequate tool for the identification of palliative patients with chronic diseases and palliative care needs. RESUMEN OBJETIVO Adaptar culturalmente al español y validar el SPICTTM, una herramienta breve y sencilla para apoyar una mejor identificación de pacientes crónicos que presentan necesidades de atención paliativa. MÉTODOS Para este estudio se diseñó un proyecto multicéntrico y nacional entre centros de Galicia, Islas Baleares y Andalucía. Para el proceso de traducción y adaptación transcultural del SPICTTM al castellano, se siguieron los pasos propuestos por Beaton et al. con sucesivas traducciones y posterior consenso de expertos mediante la metodología debriefing. Tras finalizar la validación de contenido se procedió a la validación de las propiedades psicométricas. Se diseñó un estudio longitudinal prospectivo en 188 pacientes de Galicia, Baleares y Andalucía. Fue analizada la consistencia interna y la fiabilidad test-retest a los 10 días por el mismo investigador. RESULTADOS A más del 90% de los participantes SPICT-ESTM les parece sencillo cumplimentarlo, y consideran que está escrito en un lenguaje comprensible. El tiempo medio para aplicar el cuestionario sin conocimiento previo fue de 4 minutos y 45 segundos. Para la evaluación de la consistencia interna del instrumento, se ha utilizado la fórmula Kuder Richardson 20. La consistencia interna es de 0,71. El índice de concordancia del test Kappa se encuentra entre 0,983 y 0,797 para los distintos ítems. CONCLUSIONES En este estudio se ha demostrado la equivalencia de contenido con el original. Además, la validación de las propiedades psicométricas establece que SPICT-ESTM mantiene una adecuada fiabilidad y estabilidad. Si añadimos la satisfacción mostrada por los profesionales y la facilidad de uso, SPICT-ESTM es una herramienta adecuada para la identificación de pacientes paliativos con enfermedades crónicas y necesidad de cuidados paliativos. more...

Nephrin belongs to a family of highly conserved proteins with a well characterized function as modulators of cell adhesion and guidance, and nephrin may have a role in metabolic pathways linked to podocyte and pancreatic β–cell survival. However, this role is incompletely characterized. In this study, we developed floxed nephrin mice for pancreatic β-cell–specific deletion of nephrin, which had no effect on islet size and glycemia. Nephrin deficiency, however, resulted in glucose intolerance in vivo and impaired glucose–stimulated insulin release ex vivo. Glucose intolerance was also observed in eight patients with nephrin mutations compared with three patients with other genetic forms of nephrotic syndrome or nine healthy controls. In vitro experiments were conducted to investigate if nephrin affects autocrine signaling through insulin receptor A (IRA) and B (IRB), which are both expressed in human podocytes and pancreatic islets. Coimmunoprecipitation of nephrin and IRB but not IRA was observed and required IR phosphorylation. Nephrin per se was sufficient to induce phosphorylation of p70S6K in an phosphatidylinositol 3-kinase–dependent but IR/Src-independent manner, which was not augmented by exogenous insulin. These results suggest a role for nephrin as an independent modulator of podocyte and pancreatic β–cell nutrient sensing in the fasting state and the potential of nephrin as a drug target in diabetes. more...

Early Online, Background: Performance indicators assessing the quality of medical care and linked to pay for performance may cause disagreement. Portuguese indicators included in recent health care reform are controversial. Objectives: To obtain consensus from opinion leaders in family medicine regarding the performance indicators for practice management used in the evaluation of Family Health Units in Portugal. Methods: Eighty-nine specialists in primary care were invited to answer the following question in an online Delphi study: 'Which performance indicators should be assessed regarding the organization and management of clinical practice in primary care in Portugal?' A Likert scale was used to evaluate validity, reliability, feasibility and sensitivity to change. Twenty-seven experts participated in the second round and achieved a high degree of consensus. Eight categories were created for analysis. Results: The experts suggested the use of existing indicators as well as new indicators. Thirty-nine indicators suggested by the experts are currently in use in Portugal. The assessment of the number of clinical acts performed, the number of administrative acts, and evaluation of the clinical demographic profile achieved a high degree of consensus. The expert panel suggested fifty new indicators. Five categories of these new indicators had a high degree of consensus, and three categories had a low degree of consensus. Conclusion: The expert panel recommended that performance indicators of practice management should first assess the quantity of clinical and administrative activities undertaken. These indicators must take into account the human and financial resources available to the clinic and its demographic context. more...

An expression genomic library of Trypanosoma cruzi (T. cruzi) constructed using pcDNA3 plasmid was used for the immunisation (25 ug) of Balblc mice. Expression of T. cruzi antigens in the muscle of inoculated mice was detected by indirect immunofluorescence 7 days after immunisation. Specific IgG antibodies were significatively increased (P ~0.05) in animals that were reimmunised with 50 ,ug of the genomic library. An antigen specific lymphoproliferative response was detected in one animal of 0 1998 Elsevier Science Ltd. All the group inoculated with one dose of the library rights reserved more...

The aim of this study was the assesment of psychometric properties of the Portuguese version of the instrument "Medical Outcomes Study - Social Support Survey (MOSSSS)". This questionnaire has been translated and adapted in a Portuguese sample of 101 patients with chronic illness of a rural health centre in Portugal. The average age of patients was 63.4 years, 56.4% female. 29% were illiterate and 2% had completed high school. 78% had arterial hypertension and the 56.4% had diabetes mellitus type 2. The internal consistency was evaluated using Cronbach's alpha. Exploratory and Confirmatory factor analysis were performed in order to confirm reliability and validity of the scale and its multidimensional characteristics. The 2-week test-retest reliability was estimated using weighted kappa for the ordinals variables and intraclass coefficient correlation for the quantitative variables. Cronbach's alphas for the subscales ranged from 0.873 to 0.967 at test, and 0.862 to 0.972 at retest. Exploratory factor analysis revealed the existence of four factors (emotional, tangible, positive interaction and affection support) that explain the 72.71% of the variance. Confirmatory factor analysis supported the existence of four factors that allowed the application of the scale with original items. The goodness-of-fit measures corroborate the initial structure, with chi2/ df=2.01, GFI=0.998, CFI=0.999, AGFI=0.998, TLI=0.999, NFI=0.998, SRMR=0.332, RMSEA=0.76. The 2-weeks test-retest reliability of the Portuguese MOS-SSS as measured by the intraclass correlation coefficient was ranged from 0.941 to 0.966 for the four dimensions and the overall support index. The weighted kappa was ranged from 0.67 to 0.87 for all the items. The MOS-SSS Portuguese version demonstrates good psychometric properties and seems to be useful to measure multidimensional aspects of social support in the Portuguese population. more...

The utilization of a coagglutination technique for the identification of a human source for feeding mosquitoes is described. The dilution of ingested blood samples in filter paper was performed in 2 mL of a sodium chloride solution at 0.85%. It was used a suspension of sensibilized Staphylococcus aureus with rabbit's serum, human plasmatic anti-proteins, and human anti-IgG rabbit's serum discriminated well between human and non human blood. No agglutination was observed with the negative control. This technique proved to be sensitive to identify 100% of the human blood samples taken to the paper 24 hours after the mosquitoes completed their feeding at a temperature of 26 to 28 degrees C. Among mosquitoes fed and collected in the fields the test had a satisfactory result. Therefore, it may be used in routine work in the fields. The results showed the sensitivity and specificity of this method for identifying human blood ingested by mosquitoes. more...

A national seroepidemiological survey was carried out to assess the prevalence of anti-Toxoplasma gondii antibodies. 8863 samples taken in filter paper through the ELISA test were analyzed and 29.70% positivity was obtained. No significant differences were found regarding sex. Seropositivity increased with age, up to the 20-29 age group, with a stable behavior in over-29-year age groups. The highest percentage of annual change was registered in the 5-9 age group (1.62%). This parameter reached 0.93% in the women's 25-29 age group. more...

ObjetivoDeterminar si el apoyo social influye en el control de la presión arterial en pacientes diagnosticados de hipertensión arterial esencial.DiseñoEstudio observacional, prospectivo, de seguimiento a un año.EmplazamientoCentro de saúde Mariñamansa-A Cuña. Ourense (Galicia). España.ParticipantesUn total de 236 pacientes diagnosticados de hipertensión arterial esencial en control en el centro de salud.MedicionesDurante el año de seguimiento se midieron las variables clínicas: edad, sexo, presión arterial, gravedad de la hipertensión, consumo de tabaco, consumo de alcohol, presencia de diabetes mellitus, hipercolesterolemia, índice de masa corporal y cumplimiento del tratamiento. Asimismo, se determinaron las siguientes variables sociofamiliares: estado civil, nivel cultural, nivel socioeconómico, tipo de familia, acontecimientos vitales estresantes y el apoyo social.ResultadosLa edad media fue de 63,51 (rango, 62,05-64,96) años, y el 66,1% fueron mujeres. La tipología familiar predominante es la familia nuclear (64,3%). El 30,2% de los pacientes refería una baja red social (0-1 contactos sociales). Detectamos un 22% de bajo apoyo social funcional. El apoyo social se mantuvo estable a lo largo del estudio.Los hipertensos con redes sociales bajas presentan, tras controlar por las posibles variables de confusión, un incremento de la presión arterial sistólica de 9,59 mmHg (rango, 2,67-16,51) y de 4,29 mmHg (rango, 0,44-8,15) en la diastólica, respecto de los pacientes hipertensos con redes sociales más amplias.ConclusiónLos hipertensos con una baja red social presentan un incremento de las cifras de presión arterial respecto de los hipertensos con redes sociales amplias.ObjectiveTo determine whether social support affects blood pressure control in patients diagnosed with essential Hypertension.DesignObservational, prospective study, with a year’s follow-up.SettingMariñamansa–A Cuña Health Centre,Ourense (Galicia), Spain.Participants236 patients diagnosed with essential hypertension in health centre controls.MeasurementsDuring the one-year follow-up the following clinical variables were measured: age, sex, blood pressure, severity of hypertension, tobacco consumption, alcohol consumption, presence of diabetes mellitus, hypercholesterolaemia, Body Mass Index and compliance with treatment. Social and family variables were: marital status, cultural level, economic and social status, type of family, stressful vital events and social support.ResultsMean age was 63.51 (62.05-64.96); 66.1% were women. Predominant kind of family was nuclear (64.3%). 30.2% had low social network (0-1 social contacts).We found 22% poor functional social support. Social support remained stable throughout the study. Hypertense patients with poor social networks had, after control for possible confusing variables, their systolic pressure 9.59 mm Hg (2.67–16.51) and diastolic pressure 4.29 mm Hg (0.44–8.15) higher than hypertense patients with broader social networks.ConclusionHypertense patients with a poor social network had higher blood pressure figures than hypertense patients with wider social networks. more...

A seroepidemiologic study of toxoplasmosis was made in Ciego de Avila province. By means of an ELISA for toxoplasma, blood samples from 284 people from the Ciego de Avila and Majagua districts were examined, for a 55.9% prevalence. An association with various factors, such as eating raw meat, contract with the earth, having cats at home, and rural origin with the occurrence of infection. 89.3% of positive sera ranged from 1:400 to 1:800 which are low titers. more...