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Objective: To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services., Methods: A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis., Results: Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services., Conclusions: Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background and Objective: Hypovitaminosis D is frequent in the elderly, and it is especially prevalent among patients with hip fracture. The prevalence of vitamin D deficiency and its related factors are not well known in our population. The objective of this study was to determine the prevalence of hypovitaminosis D in patients with osteoporotic hip fracture and to analyze which factors are associated with this deficit., Patients and Method: Transversal study. Inclusion of all consecutive patients older than 65 years, admitted in our hospital with osteoporotic hip fracture during the period of March 2002-February 2003. The prevalence of hypovitaminosis D and secondary hyperparathyroidism were analysed. Sunlight exposure, functional and nutritional status, and presence of comorbidity were investigated., Results: 324 patients were included. Mean (standard deviation) age was 83 (7) years, and 80% were female. Vitamin D deficiency was observed in 217 cases (67%; 95% confidence interval [CI], 62-72%); and 57% of these patients had secondary hyperparathyroidism. A low nutritional status -albumin < 4 g/l (odds ratio [OR] = 4.5; 95% CI, 1.3-16; p = 0.019)- and a low functional status (Barthel index < 60; OR = 3; 95% CI, 1.3-6.7; p = 0.008) - were factors independently associated with hypovitaminosis D. However, an active sunlight exposure was a protective factor (OR = 0.09; 95% CI, 0.02-0.5; p = 0.004)., Conclusions: The prevalence of hypovitaminosis D is high in patients with osteoporotic hip fracture, and in more than a half of the cases a secondary hyperparathyroidism is observed. The vitamin D deficiency is especially prevalent among patients with low sunlight exposure and low nutritional and functional status.

Objectives: To study functional status and survival in patients with chronic obstructive pulmonary disease (COPD) following a pulmonary rehabilitation program., Patients and Methods: We assessed lung function, 6-minute walk distance, Borg score for dyspnea upon completion of the 6-minute walk, workload in watts on a cycle ergometer, quality of life using the St George's Respiratory Questionnaire (SGRQ); the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; and survival., Results: One hundred five patients participated in the pulmonary rehabilitation program. The patients had a mean (SD) age of 63.9 (9.3) years, body mass index of 24.5 (4.56) kg/m2, and forced expiratory volume in 1 second (FEV1) of 0.91 (0.46) L. The mean distances walked in 6 minutes were 412.8 (79.4) m before the pulmonary rehabilitation program and 443.46 (81.57) m after rehabilitation. The mean workloads on the cycle ergometer before and after rehabilitation, respectively, were 47.9 (29.6) W and 77.76 (20.88) W. The mean Borg scores were 2.2 (1.37) before and 1.47 (1.37) after rehabilitation, and the SGRQ scores at the same times were 27.63 (16.02) and 25.45 (15.12). Mortality due to respiratory disease (105 months) was 19%. Cumulative survival rates at 1 year, 3 years, and 6 years were 91%, 86.7%, and 6.75%, respectively. Survival was related to an FEV1 greater than 1.02 L (P = .05), a 6-minute walk distance over 448 m before rehabilitation (P = .04) and 454 m after rehabilitation (P = .05), and a workload on the cycle ergometer of over 54 W before rehabilitation (P = .01) and 72 W (P = .02) afterwards. The correlations between survival and both SGRQ and BODE scores were weaker., Conclusions: We observed improved exercise capacity, dyspnea ratings, and, to a lesser extent, better SGRQ scores in our COPD patients following pulmonary rehabilitation. The best predictors of survival were FEV1, the 6-minute walk distance, and the cycle ergometer workloads.

Objective: To know the specific health problems referred as ambulatory care sensitive conditions (ACSC) and to identify the primordial interventions of primary health care (PHC) in reducing hospitalisations due to ACSC., Design: Descriptive study of hospital discharges generated in Catalonia during 1998-1999, and a Delphi study to reach information about PHC primordial interventions., Measures: Diagnostic codes of ACSC selected as markers of PHC effectiveness were used. We analysed hospital discharge distribution by age groups and overall, and hospitalisation rates with its 95% confidence intervals. Descriptive analysis of consensus reached by experts using self-administrated questionnaires was done., Results: The 8.42% of total discharges were due to ACSC. The majority of these (86.9%) fell in 4 of the 13 diagnostic categories included in the ACSC list. A great variety of pathologies with different frequencies were identified. Primary prevention and early diagnoses and treatment were considered as primordial interventions. Chronic health problems needed multimodal interventions., Conclusions: Diagnostic codes included in each diagnostic category were congruent with the diseases identified. Interventions that could prevent hospitalisations due to ACSC are contemplated as role of PHC. Indicator validity to assess PHC effectiveness is maintained by both results.

Background: Osteoporosis in the elderly is a common and severe disease, vitamin D deficiency being an important causative factor. Hypovitaminosis D is frequent in old people, particularly those living in nursing homes., Subjects and Method: We performed a cross-sectional study of 100 randomly recruited elderly institutionalized subjects. The prevalence of hypovitaminosis D and its possible repercussion on the phosphocalcium metabolism were assessed. The degree of sun exposure and the existence of co-morbidity were also recorded. Individuals with hypovitaminosis D were included in a longitudinal study (6 months' duration) aimed at assess the efficacy of treatment with calcium and two different therapeutic regimens with calcidiol (16,000 IU/week or 16,000 IU every 3 weeks)., Results: 87% of individuals had hypovitaminosis D; 21.8% of them had secondary hyperparathyroidism. The study population had a low degree of sun exposure and a high level of co-morbidity. The two doses of calcidiol led to a normalization of 25-OHD3 levels, increased calciuria and compensated secondary hyperparathyroidism, yet higher 25-OHD3 levels were achieved with the weekly therapeutic scheme., Conclusions: Hypovitaminosis D prevalence appears to be very high In the elderly institutionalized population. Calcium and calcidiol supplementation normalized 25-OHD3, improved calcium absorption and compensated secondary hyperparathyroidism. Calcium and vitamin D supplementation should be employed routinely in the elderly institutionalized population.