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Biomedical subjects

M T Ruiz

Publications and source records attributed to M T Ruiz.

36 records · Page 2Linked to original sources
PubMed1994

Reliability of the diagnosis of rheumatic conditions at the primary health care level.

OBJECTIVE: To assess the reliability of the diagnosis given to rheumatic disease patients at the primary care level, the clinical records of 612 patients at the outpatient clinic of rheumatology of the main General Hospital in Alicante (Spain) were studied. METHODS: The accuracy indices (sensitivity, specificity), the predictive values of tentative diagnosis made by the referring physicians and the degree of agreement (Kappa statistics) with the final diagnoses made by rheumatologists at the outpatient clinic of rheumatology were calculated. RESULTS: There were differences in diagnosis agreement depending on the age of the referring doctor, with a greater degree of concordance among younger ones. More than 50% of the referral diagnoses were modified at the rheumatology outpatient clinic. In the most frequent diagnoses (inflammatory rheumatic diseases, osteoarthritis, soft tissue rheumatism) the level of concordance and the predictive values were low. CONCLUSION: Our results highlight the need for upgrading courses in rheumatology for primary care physicians who have not been exposed to systematic training in rheumatology during their undergraduate studies. The epidemiological studies on rheumatic diseases based on primary care data should be interpreted with caution.

Adult↗
PubMed1993

Thomas McKeown and Archibald Cochrane: a journey through the diffusion of their ideas.

In the 1970s Thomas McKeown and Archibald L Cochrane were two of the most influential voices in criticizing the dominance of medical thinking. A bibliometric study of the citations to McKeown's The Role of Medicine: Dream, Mirage or Nemesis and Cochrane's Effectiveness and Efficiency: Random Reflections on Health Services was performed from the publication of each book until 1988 to study how their ideas have been disseminated. During the study period 430 papers in the Science Citation Index or the Social Sciences Citation Index cited Cochrane's book, 133 cited McKeown's, and 166 cited both. The citations came mainly from original papers published in journals of internal medicine or public health and epidemiology (35%) and written by authors from the United States or the United Kingdom. Cochrane's book was cited most frequently in medical journals, suggesting a higher degree of penetration of his ideas among medical scientists. Although the dominance of original papers among the citations suggests that these books have been important in stimulating new knowledge, the main problems that McKeown and Cochrane identified--namely, the relatively small impact of clinical medicine on health outcomes and the poor use of scientific methods in clinical practice--are still with us.

Bibliometrics↗
PubMed1993

[Undergraduate training in primary health care: 6 years' experience at the University of Alicante].

OBJECTIVE: To assess the opinion of medical students on the teaching offered in the Primary Care context (TOPC). DESIGN: Observational and crossover study. The assessment used an opinion questionnaire. PARTICIPANTS: 296 sixth-year medical students between 1987 and 1992. INTERVENTIONS: The TOPC consisted of four weeks stay in a Health Centre with an eminently practical programme. However this also included hour-long theoretical seminars on the most important Primary Care questions and the student's completion of a research project related to Primary Care. RESULTS: The students expressed satisfaction with the TOPC (average score of 4 out of 5). Moreover this satisfaction increased over the five years (from 3.7 to 4.6, p = 0.0001). They believed the TOPC to be useful (3.6 to 4.7, p = 0.0001) and relevant to their future professional activity (3.1 to 4.6, p = 0.0001). They thought that the tutors were very competent (4 out of 5, with no significant variation) and the Health Centres' teaching facilities suitable (3.8 to 4, with no significant variation). Finally, they considered that TOPC should become a compulsory undergraduate subject (3.9 out of 5). CONCLUSIONS: Medical students give a positive rating to the Primary Care teaching offered and believe it should be integrated into the Medicine syllabus as a compulsory subject.

Adult↗
PubMed1992

A simplified histoscore for the estrogen receptor assay in breast cancer.

Different histoscores combining the number of positive cells and the intensity of staining have been used to evaluate the estrogen receptor immunocytochemical assay (ER-ICA). Our aim was to investigate if the simple estimation of the amount of positive cells could be sufficient for the semiquantitative analysis of ER-ICA. Tissue from 51 women with ductal breast carcinoma was used. Half of each sample was processed with the quantitative assay (ER-EIA) and the other half with ER-ICA. Microscopical analysis was performed by two independent observers and classified on a simple scale from 0 to 4+. With EIA 31 cases (60.78%) were positive and 20 (39.21%) negative. With ER-ICA 29 (56.86%) had immunostaining, whereas 22 (43.13%) did not. 95.83% of the ER-ICA positive cases and 77.7% of ER-ICA negative had a good correlation with EIA values. Statistical analysis showed a high degree of correlation (r = 0.88 p 0.001). Hence, simple semiquantitative estimation in ER-ICA is sufficient to provide useful information for clinical use about ER content in tissue sections.

Adenocarcinoma↗
PubMed1991

[Opinion of medical students about prescription, counseling and practice of voluntary interruptions of pregnancy].

BACKGROUND: A future prospect was carried out of the professional trends regarding prescription, counseling and practice of voluntary interruptions of pregnancy (VIP). METHODS: To this end, a questionnaire was administered to 177 last term students of the Valencia and Alicante Schools of Medicine regarding the opinions of the current law on VIP in Spain and the professional trends of approach, with practical examples of the four instances depenalized by the Spanish law. RESULTS: For 44% of the sample the present law is insufficient, 30% agree with it and 13% think that the present law threatens life. The instance which elicited a highest number of favorable professional trends was congenital malformation (85%), followed by physical problems (78%) and psychical problems (63%). Only 60% of students would take a favorable attitude in case of rape. The students without religious practice, who vote progressive political parties and who think that present law is insufficient have a significant tendency towards attitudes favoring VIP. Significant sex differences among students were not found. CONCLUSIONS: Although probably to a lesser degree than in the present, in the near future the unfavorable attitudes of physicians will continue hindering the access of women to the services of VIP. A wide debate and more studies are required for a better definition of the implications of this phenomenon for public health purposes.

Abortion, Induced↗
PubMed1991

Higher incidence of carpal tunnel syndrome in oophorectomized women.

To determine whether the hormonal changes of the menopause are related to the onset of carpal tunnel syndrome (CTS), 53 healthy women, younger than 44 years, and subjected to bilateral oophorectomy between 1 and 4 years before the study, were evaluated. Seventy healthy menstruating women matched for age were used as controls. In those complaining of symptoms and presenting signs suggestive of CTS, sensory and motor nerve conduction studies were done. In the oophorectomized group, 17 of 53 (32%) had clinical CTS, while only seven of 70 of the control group (10%) did so (relative risk for the oophorectomized group = 4.25; 95% confidence intervals 1.47 and 12.61). The nerve conduction studies were abnormal in 14 of 16 oophorectomized women (87.5%), and in only one of seven of the control group (14.2%; P less than 0.002). Symptoms tended to be milder in the controls. Symptoms developed in the first year after oophorectomy in 14 of the 17 women with CTS. This suggests that women develop CTS after oophorectomy more frequently than controls.

Adult↗
PubMed1991

Study designs and statistical methods in rheumatological journals: an international comparison.

In order to determine the characteristics of papers published in the rheumatological literature, we have conducted a survey of the seven leading rheumatological journals published in 1987; 1107 original papers have been reviewed and classified according to study design, statistical techniques, and country of origin. Almost half of the published papers were clinical descriptive studies without inferential power; both authors and editors should reflect whether the impact of these studies on the knowledge of readers justifies their frequency. Analytical research was represented mainly by randomized clinical trials (15.6%), and case control studies (14.2%). Cohort studies represented 5.4% and this seems a low figure in a specialty in need of more aetiological research. Almost half of the papers originated from the USA or the UK; journals edited in these countries published papers mainly from the same country. English language journals from other countries published a larger percentage of papers from other countries, including many non-English speaking nations. Bibliometric studies are desirable to evaluate trends in publication.

Epidemiologic Methods↗
PubMed1990

[Rheumatology research. An analysis of the situation in Spain].

To analyze the present status of rheumatological research in Spain, three indicators have been evaluated: use of the different study designs, use of statistical techniques and relevance of the studies. This last point was determined by the comparison of the research areas that had been reported during one year and the lines of rheumatological research established as priorities by 10 investigators from the 10 units of clinical care with a higher scientific output during the period 1985-1987. A revision has been made of the 67 articles from Spain out of the 1106 reported in seven of the journals with a better national and international impact index: Scandinavian Journal of Rheumatology, Arthritis and Rheumatism, Journal of Rheumatology, Annals of the Rheumatic Diseases, British Journal of Rheumatology, Clinical Experimental Rheumatology and Revue du Rhumatisme, in addition to Revista Española de Reumatología. It was found that few studies with analytical design are being published and that complex statistical analysis techniques are not being used; therefore, most articles do not have a possible statistical inference and lack value as predictors. The reports of cases and clinical series in the Letters to the Editor section are most common, particularly in the Spanish journal. Most studies are related with clinical research, although the consulted investigators consider that basic and epidemiological research have a higher priority. It is concluded that the Spanish contribution to the international rheumatological literature is still small and has a mainly descriptive character; thus, it is necessary to emphasize the use of analytical designs to improve the competitiveness. The type of studies to be carried out in the future, according to the priorities established by the investigators themselves, should change if their wishes are to be fulfilled.

Humans↗
PubMed1989

The ordinary light microscope: an appropriate tool for provisional detection and identification of crystals in synovial fluid.

To determine if the ordinary light microscope is a useful tool in the detection and identification of crystals in synovial fluid 63 fluids (13 with monosodium urate (MSU), 14 with calcium pyrophosphate dihydrate (CPPD), one with both types of crystal, and 35 without crystals) were examined blindly by two observers, first with an ordinary light microscope, then with a polarising light microscope. Tentative identification of the crystals by their shape was attempted. The sensitivity of the ordinary light microscope for the detection of crystals was 96.2% and 100%, with specificity of 100% and 97.1% for observers 1 and 2, both with respect to the polarising light microscope. The concordance between observers for the ordinary light microscope was chi = 0.90 (0.897, 0.902) and for the polarising light microscope chi = 0.96 (0.958, 0.961). The specificity for identification of MSU and CPPD crystals by their shape with respect to the polarising light microscope was 92.3% and 85.7% for observers 1 and 2. When a polarising light microscope is not available examination of synovial fluid by an ordinary light microscope may allow a provisional diagnosis; definitive identification of the crystals requires a polarising light microscope.

Crystallization↗
PubMedDate not supplied

[Control of Chagas' disease in Guarani communities: knowledge and hygiene habits within the Project to Improve Living Conditions in Bolivia].

The aim of this study was to identify knowledge and control of vectorial transmission (Triatoma infestans, known as vinchuca) of Chagas' disease in Guaraní Communities in Bolivia. We performed a descriptive study of a series of 98 individuals through a semi-structured questionnaire. Interviewees were asked about their familiarity with vinchuca, whether they thought vinchuca produced disease, the name of the disease and its consequences, as well as behavior related to eliminating the domestic insect vectors, such as cleaning of the home, backyard and corral.The insect vector was sufficiently well known (98%), although the name of the disease was identified by only 14.3% of the interviewees. Although the dwellings favored insect proliferation, they were not frequently cleaned: 28.6% cleaned their homes while and 42.9% cleaned the backyard and 7.1% cleaned the corral. Gender differences were found in the division of labor: women cleaned the homes and backyards, while men clean the corral. Experience has shown that the usefulness of projects for building healthy living areas and for health education depends on the value given to these projects by the community. Women are probably the best target group, because they perform a greater number of preventive tasks and seldom leave the community for extended periods of time.

Adolescent↗
PubMedDate not supplied

Evaluation of a simple semiquantitative assay for estrogen receptors in breast cancer.

A number of studies have been published to evaluate the inmunocytochemical assay for ER using monoclonal antibodies. Histoscores so far used consider two variables: the number of cells and the intensity of the reaction. There are however indications that only the proportion of stained cells are important for assessment and show a direct correlation with quantitative data. We studied 77 breast invasive adenocarcinomas stained with the Abbott ERICA kit and used a simple scale of 0 to 4 for the estimation of ER. Tissues were snap frozen in liquid N and immunostained with the specific antibody and peroxidase. Immunostaining was estimated in a simple observational scale from 0-4+ where 0 = no staining or few scattered positive cells; 1+ up to 25%; 2+ up to 50%; 3+ up to 75% and 4+ more than 75% of stained malignant cells. Counts were performed in at least 100 malignant cells in various microscopic fields. Staining was always nuclear and a considerable heterogeneity in the number of cells and the intensity of the reaction was observed. Grading specimens from 0-4+ was found simple and reproducible. In 45% there was no immunostaining and 54% were positive for ER. In patients greater than 50 years of age 67% were positive; in patients less than 50 years of age only 33% had ER. This procedure has many advantages for clinical use: it is simple, it does not require sophisticated equipment, it is reproducible and can be performed in small tissue fragments, such as needle aspiration material, as well as in cytological smears.

Breast Neoplasms↗