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21.
22.

Aim

The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients.

Design

No blind randomized controlled clinical trial.

Setting

Northern Huelva Health District.

Participants

154 patients.

Interventions

Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via.

Measurements

Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons.

Results

A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered “excessive time and effort consuming”. 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity.

Conclusions

Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an “excessive time and effort consuming” to General Practitioners and was not all that beneficial to complex patients  相似文献   
23.

Objective

To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters.

Methods

Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain).

Results

Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule.

Conclusions

These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term “anti-vaccines” from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built.  相似文献   
24.
25.
Isotactic polypropylenes (iPP) with different melt flow indexes (MFI) were used to fabricate nanocomposites (NCs) with 10 wt % loadings of multi-wall carbon nanotubes (MWCNTs) using ultrasound-assisted extrusion methods to determine their effect on the morphology, melt flow, and electrical properties of the NCs. Three different types of iPPs were used with MFIs of 2.5, 34 and 1200 g/10 min. Four different NC fabrication methods based on melt extrusion were used. In the first method melt extrusion fabrication without ultrasound assistance was used. In the second and third methods, an ultrasound probe attached to a hot chamber located at the exit of the die was used to subject the sample to fixed frequency and variable frequency, respectively. The fourth method is similar to the first method, with the difference being that the carbon nanotubes were treated in a fluidized air-bed with an ultrasound probe before being used in the fabrication of the NCs with no ultrasound assistance during extrusion. The samples were characterized by MFI, Optical microscopy (OM), Scanning electron microscopy (SEM), Transmission electron microscopy (TEM), electrical surface resistivity, and electric charge. MFI decreases in all cases with addition of MWCNTs with the largest decrease observed for samples with the highest MFI. The surface resistivity, which ranged from 1013 to 105 Ω/sq, and electric charge, were observed to depend on the ultrasound-assisted fabrication method as well as on the melt flow index of the iPP. A relationship between agglomerate size and area ratio with electric charge was found. Several trends in the overall data were identified and are discussed in terms of MFI and the different fabrication methods.  相似文献   
26.
27.
The associations between saturated fatty acid (SFA) consumption and risk of breast cancer (BC) remains inconclusive. Therefore, we conducted this meta-analysis to determine the quantitative relations between dietary SFA intake and incidence of BC.Literatures published up to April 2015 were systematically screened through Pubmed and Web of Science. Relevant publication quality was evaluated by conducting the Newcastle-Ottawa scale. We used fixed effects models or random effect models to calculate the summary relative risks (RRs) and odds ratios (ORs), and conducted sensitivity analyses and evaluated the publication bias.We identified a total of 52 studies (24 cohort studies and 28 case–control studies), with over 50,000 females diagnosed with BC. The associations between dietary SFA intake and risk of BC were 1.18 for case–control studies (high vs low intake, 95% confidence interval [CI] = 1.03–1.34) and 1.04 for cohort studies (95% CI = 0.97–1.11). When restricted analyses to population-based studies, positive associations were observed for both cohort (RR [95% CI] = 1.11 [1.01–1.21]) and case–control studies (OR [95% CI] = 1.26 [1.03–1.53]). Additionally, for case–control studies, significant positive associations between higher SFA intake and BC risk were observed for Asian (OR [95% CI] = 1.17 [1.02–1.34]) and Caucasian (OR [95% CI] = 1.19 [1.00–1.41]), as well as for postmenopausal women (OR = 1.33, 95% CI: 1.02–1.73). In contrast, higher dietary SFA intake was not associated with risk of BC among premenopausal women, in cohort studies or hospital-based studies.A positive association between higher dietary SFA intake and postmenopausal BC risk was observed in case–control but not in cohort studies. More studies are warranted to confirm these findings.  相似文献   
28.

Background and aims

Since accelerated atherosclerosis has been reported in systemic lupus erythematosus (SLE), predictive biomarkers of cardiovascular disease (CVD) are needed. Among non-traditional risk factors, bone mineral density (BMD) has been related to CVD. However, its role in SLE remains controversial. This study aims to analyze the associations of subclinical atherosclerosis with traditional and non-traditional CV risk factors.

Methods and results

In a cross-sectional study, atherosclerosis burden was compared between 112 female SLE patients and 31 controls. Plaque number and carotid intima-media wall thickness (cIMT) were assessed by ultrasonography. In a retrospective study, BMD determinations obtained 5-years before the ultrasonography assessment were analyzed in a subgroup of 62 patients. Plaque frequency was increased in SLE, even in patients without CV events or carotid wall thickening. cIMT was increased in patients with CVD, positively correlated with body mass index (BMI). Interestingly, a paradoxical effect of BMI on carotid parameters was observed. Whereas underweight patients (BMI < 20) showed increased prevalence of carotid plaques with low cIMT, those with BMI > 30 showed higher cIMT and plaque burden. Overweight patients (25 < BMI<30) exhibited both elevated cIMT and plaque number. BMI was an independent predictor of BMD. In our retrospective study, patients with either clinical or subclinical CVD exhibited lower BMD levels than their CV-free counterparts. A low lumbar spine BMD independently predicted CVD development after adjusting for confounders.

Conclusion

SLE was associated with a higher subclinical atherosclerosis burden, a bimodal effect being observed for BMI. Decreased BMD can be a CV risk biomarker in SLE.  相似文献   
29.
The Latin American population has a double way of immigration, one toward the United States by proximity and another toward Spain by sociocultural affinity. This population increase is affecting organ donation and transplantation in receiving countries.

Objective

To analyze the brain death (BD) concept knowledge in the Dominican Republic immigrant population in Florida (United States) and Spain.

Method

Population under study: Population born in the Dominican Republic, resident in Florida (United States) and in Spain. Inclusion criteria: Population older than 15 years stratified by age and sex. Assessment instrument: Donation attitude questionnaire PCID-DTO-Ríos. Fieldwork: Random selection based on stratification. Immigration support association collaboration in Florida and Spain was needed to locate potential respondents. Completion was anonymous and self-administered, with verbal consent.

Results

A total of 123 respondents, 57 residents in Spain and 66 in Florida, have been included in the study. The 27% (n = 33) of the respondents knowledgeable of the BD concept consider it the death of an individual. Of the remainder, 52% (n = 64) do not know about it, and the remaining 21% (n = 26) believe it does not mean the death of a patient. No differences were observed regarding migration countries (P > .05). There was no association of the BD concept with other psychosocial factors analyzed or with the attitude toward organ donation.

Conclusions

Knowledge of the BD concept among the Dominican immigrant population is similar in Spain and Florida, and, unlike most studies, there is no objective association with the attitude toward organ donation.  相似文献   
30.
Metabolomics may reveal novel insights into the etiology of prostate cancer, for which few risk factors are established. We investigated the association between patterns in baseline plasma metabolite profile and subsequent prostate cancer risk, using data from 3,057 matched case–control sets from the European Prospective Investigation into Cancer and Nutrition (EPIC). We measured 119 metabolite concentrations in plasma samples, collected on average 9.4 years before diagnosis, by mass spectrometry (AbsoluteIDQ p180 Kit, Biocrates Life Sciences AG). Metabolite patterns were identified using treelet transform, a statistical method for identification of groups of correlated metabolites. Associations of metabolite patterns with prostate cancer risk (OR1SD) were estimated by conditional logistic regression. Supplementary analyses were conducted for metabolite patterns derived using principal component analysis and for individual metabolites. Men with metabolite profiles characterized by higher concentrations of either phosphatidylcholines or hydroxysphingomyelins (OR1SD = 0.77, 95% confidence interval 0.66–0.89), acylcarnitines C18:1 and C18:2, glutamate, ornithine and taurine (OR1SD = 0.72, 0.57–0.90), or lysophosphatidylcholines (OR1SD = 0.81, 0.69–0.95) had lower risk of advanced stage prostate cancer at diagnosis, with no evidence of heterogeneity by follow-up time. Similar associations were observed for the two former patterns with aggressive disease risk (the more aggressive subset of advanced stage), while the latter pattern was inversely related to risk of prostate cancer death (OR1SD = 0.77, 0.61–0.96). No associations were observed for prostate cancer overall or less aggressive tumor subtypes. In conclusion, metabolite patterns may be related to lower risk of more aggressive prostate tumors and prostate cancer death, and might be relevant to etiology of advanced stage prostate cancer.  相似文献   
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