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This document analyzes a survey conducted in three geographical areas in Spain, focusing on centers for individuals with cerebral palsy (CP). The study aims to determine the adherence rate to recommended physical activity guidelines, assess if there is a decline in interest in physical activity over time, identify the stage at which this decline occurs, and explore potential mechanisms, tools, or strategies to sustain long-term engagement in regular physical activity for this population. The 36-item questionnaire comprises multiple-choice, open-ended, and Likert scale-type questions. Data were collected on physical activity frequency and duration, daily living activities, and demographics. Statistical analysis identified patterns and relationships between variables. Findings reveal that only a 17.6% meets the World Health Organization (WHO) recommendations regarding regular physical activity (RPA), decreasing in frequency or number of days a week, (3.7 d/w to 2.9 d/w; p < 0.01) and duration (50.5 min/d to 45.2 min/d; p < 0.001) with age, especially for those with higher Gross Motor Function Classification System (GMFCS) mobility levels. Obesity slightly correlates with session duration (ρ = −0.207; p < 0.05), not mobility limitations. Gender has no significant impact on mobility, communication, or physical activity, while age affects variables such as body mass index (BMI) and engagement (p < 0.01). A substantial proportion follows regular physical activities based on health professionals' advice, with interest decreasing with age. To improve adherence, focusing on sports-oriented goals, group sessions, and games is recommended. These findings emphasize the importance of personalized programs, particularly for older individuals and those with greater mobility limitations. [ABSTRACT FROM AUTHOR]

This paper aims to identify the inter-relationships between the social factors that influence epidemiological patterns in the city neighbourhood of Casablanca, Zaragoza (Spain). Data for a cross-sectional survey were collected between January 2008 and April 2008 from a representative random sample of 1032 residents aged more than 15 years. The study interview contained information scales on healthcare behaviours, treatment evaluation, the number of medical consultations in the weeks pervious to the interview and the perceived health status of the respondents, using The Health Perception Questionnaire. The global index (continuous variable) allowed inferences to be made on the individual's perception of his/her own health. The assessment of social vulnerability was based on the occupational, educational and economic conditions of the interviewees. An individual was considered to belong to a vulnerable subeconomic group if he/she had a personal income of 6000 euros or less; or had no formal education or had been educated up to primary school level only; or was not in paid employment at the time of the interview. A descriptive and comparative analysis of the vulnerable and non-vulnerable population groups for perceived and diagnosed health variables was undertaken using parametric and non-parametric tests. A total of 550 interviewees (53.3%) were considered vulnerable people. Low level of instruction (primary or no education) was the main characteristic of this group (356 subjects, 64.7% of those identified as vulnerable). Binary logistic regression was used to analyse the association between belonging to the vulnerable group and a number of health variables adjusted for gender, age and area of residence. The vulnerable group had worse levels of perceived health even when controlled for gender and area of residence. In Casablanca, the place of residence is an important social stratification indicator reflected in the characteristics of the vulnerable population group and its perceived health. [ABSTRACT FROM AUTHOR]

Purpose -- This paper's aim is to examine the relationship between intimate partner violence, childhood abuse and psychiatric disorders among 118 female drug users in treatment in Barcelona, Spain. Design/methodology/approach -- Secondary analysis of a cross-sectional study of the psychiatric, behavioural and social risk factors for HIV. DSM-IV disorders were assessed using the Spanish Psychiatric Research Interview for Substance and Mental Disorders; the Composite Abuse Scale assessed intimate partner violence and the Child Maltreatment History Self-Report assessed childhood physical and sexual abuse. Findings -- The odds of experiencing intimate partner violence were 2.42 times greater among those with any depressive disorder (95 per cent CI 1.13, 5.20), over three times greater for those who reported ever attempting suicide (OR 3.20; 95 per cent CI 1.29, 7.94), met criteria for borderline personality disorder (OR 3.05; 95 per cent CI 1.31, 7.11), had been abused in childhood (OR 3.38; 95 per cent CI 1.45, 7.85) or currently lived with a substance user (OR 3.74; 95 per cent CI 1.29, 10.84). In multiple logistic regression, only living with a substance user (OR 3.42; 95 per cent CI 1.08, 10.86) and a history of childhood abuse (OR 2.87; 95 per cent CI 1.05, 7.86) remained significant in the model examining intimate partner violence victimisation. Research limitations/implications -- The small sample size, together with the fact that the study was not originally powered to examine differences in intimate partner violence may have increased the possibility of type II errors. Originality/value -- Histories of psychiatric disorders, intimate partner violence and childhood abuse are common in female substance users in treatment. Research suggests that such histories result in poorer treatment outcomes. Histories of intimate partner violence and childhood abuse should be identified and addressed in substance abuse treatment to enhance treatment outcomes. [ABSTRACT FROM AUTHOR]

As future employers, nurse managers are in a key position to assess the correspondence between the competence of graduating nursing students and work life demands. The aim of the present study was to assess the competence of graduating nursing students from the perspective of managers, and analyze the factors linked to it. Among European managers in six countries, a cross-sectional survey design with a convenience sample was applied. Data were collected using the Nurse Competence Scale. The study was reported using the STROBE guidelines. Managers (n =538, 65.8%) assessed the level of competence of graduating nursing students as good, but there were statistically significant differences between countries. In a multivariable analysis, managers who had a Doctoral/Master’s degree and were dissatisfied with the nursing program in their country assessed the level of competence as lower. Overall, graduating nursing students seem to meet the competence demands of current work life rather well. Further research is needed to confirm the connection between the managers’ competence assessment and their individual background factors. [ABSTRACT FROM AUTHOR]

Aim: We aim to describe the relationship between job satisfaction and compare levels of resilience among out‐of‐hospital emergency medical service professionals. Background: The study of the impact of the working environment on health professionals has raised great interest. Job‐related variables and resilience can be a protective factor against stressful and demanding events at work. Methods: A cross‐sectional survey comprising sociodemographic and job‐related variables was conducted among 406 workers (doctors, nurses, psychologists, and ambulance technicians) from the out‐of‐hospital emergency medical system in Spain. Resilience was self‐reported using the Connor‐Davidson Resilience Scale. Results: Nursing professionals were less resilient compared with ambulance technicians (score difference 1.709, p =.008). As age increased, resilience was lower (r = −.118). Professionals with higher resilience scores were more satisfied in their work (OR = 1.06, 95% CI: 1.02–1.11), and professionals with higher psychological strength, gained from working with other colleagues, also showed greater job satisfaction (OR = 5.47, 95% CI: 2.55–11.73). Conclusion: There was a positive association between resilience, job satisfaction and collaborative work. Professionals with greater psychological strength, gained from working with other colleagues, also showed higher levels of job satisfaction. Implications for Nursing Management: Managers can use these results to influence the work environment to enhance job satisfaction and hence improve the resilience of the out‐of‐hospital emergency health care professionals. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID‐19 outbreak in Spain. Design: A cross‐sectional study reported in line with the STROBE guidelines. Methods: Nursing students were invited to complete an online questionnaire at the end of the 2019–2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID‐19, habits and lifestyle using the World Health Organization Five Well‐Being Index (WHO‐5) and the Generalized Anxiety disorder‐7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, Results: The prevalence of low psychological well‐being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID‐19 and having been afraid of getting infected. Conclusions: The levels of anxiety due to the COVID‐19 pandemic in nursing students have been high, and levels of psychological well‐being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID‐19 or being afraid of getting infected are associated with the highest scores for anxiety. Relevance to clinical practice: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic. [ABSTRACT FROM AUTHOR]

Incarcerated women are at high risk of exposure to traumatic events with subsequent development of post-traumatic stress disorder (PTSD). The present study builds on prior research by adding new findings from Spain on the association between childhood and prison victimization, and negative emotional states with PTSD symptoms during incarceration among women. The study sample (N = 174) included female prison inmates enrolled from two prisons located in Southeast Spain. Participants completed self-report questionnaires including demographic and criminal variables, childhood and prison victimization (including emotional, physical and sexual victimization), negative emotional states (including depression, anxiety, and stress symptoms) and PTSD symptoms. Logistic regression analysis revealed that women screening positive for trauma had significantly greater odds for the assortment of childhood victimization, prison victimization (specifically physical victimization) and depression, anxiety, and stress. Current findings suggest a need to include these construct assessments in the screening and identification of PTSD among incarcerated women in Spain. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this paper is to explore the prevalence of psychiatric morbidity in different immigrant groups in Spain. In keeping with prior studies carried out in Europe, it is expected that the immigrant population will have elevated levels of psychopathology, with some variation across immigrant groups. Method: Design: Multicenter, observational, cross-sectional study. Setting: Primary care settings of two Spanish regions. Sample: N=1.503 immigrants paired with the same number of Spanish controls, adjusted by gender and age. Variables: Demographic variables, MINI International Neuropsychiatric Interview and Standardized Polyvalent Psychiatric Interview, somatic symptoms section. Student''s t tests, ORs and logistic regressions were used to analyze the data. Results: No differences in psychiatric morbidity were found (native born 30.9%, population vs. immigrants 29.6%, OR=.942, CI=.806–1.100) when comparing immigrants to native born Spaniards. Relative to Spaniards (30.9%), Latin American immigrants had significantly higher levels of psychopathology (36.8%), Sub-Saharan Africans (24.4%) and Asians (16%) had significantly lower levels, and Eastern Europeans (31.4%) and North Africans (26.8%) showed no significant difference. Conclusions: The hypotheses were only partially supported. Although overall immigrants did not differ from the native born population, when analyzed by geographic origin, only Latin Americans had higher levels of psychopathology. It is concluded that multiple factors need to be taken into consideration when studying the mental health of immigrants given that different immigrant groups have different levels of psychopathology. [Copyright &y& Elsevier]

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care. [ABSTRACT FROM AUTHOR]

Background Protein-energy wasting ( PEW) is a highly prevalent condition in haemodialysis patients ( HD). The potential usefulness of nutritional-inflammatory markers in the diagnosis of PEW in chronic kidney disease has not been established completely. We hypothesised that a combination of serum albumin, percentage of mid-arm muscle circumference and standard body weight comprises a better discriminator than either single marker of nutritional status in HD patients. Methods A cross-sectional study was performed in 80 HD patients. Patients were categorised in two groups: well-nourished and PEW. Logistic regression analysis was applied to corroborate the reliability of the three markers of PEW with all the nutritional-inflammatory markers analysed. Results PEW was identified in 52.5% of HD patients. Compared with the well-nourished patients, PEW patients had lower body mass index, serum pre-albumin and body cell mass (all P < 0.001) and higher C-reactive protein (s- CRP) ( P < 0.01). Logistic regression analyses showed that the combination of the three criteria were significantly related with s- CRP >1 mg dL−1, phase angle <4°, and serum pre-albumin <30 mg dL−1 (all P < 0.05). Other indicators, such as lymphocytes <20% and Charlson comorbidity index, were significantly involved (both P < 0.01). A receiver operating characteristic curve ( area under the curve) of 0.86 ( P < 0.001) was found. Conclusions The combined utilisation of serum albumin, percentage of mid-arm muscle circumference and standard body weight as PEW markers appears to be useful for nutritional-inflammatory status assessment and adds predictive value to the traditional indicators. Larger studies are needed to achieve the reliability of these predictor combinations and their cut-off values in HD patients and other populations. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess the accuracy of periapical radiography in measuring peri-implant bone levels. Materials and Methods Twenty-five subjects with 46 implants in need of surgical treatment for peri-implantitis were included in this cross-sectional study. Prior to surgery, periapical radiographs were taken, a prediction of type of defect was made and radiographic peri-implant bone levels ( Rx BL) were determined at the mesial and distal aspects. Intra-operatively, the peri-implant bone level ( Surg BL) was assessed mesially, distally, buccally and orally and the type of defect was recorded. A paired t-test was applied to detect differences between inter-proximal Rx BL and Surg BL. ANOVA was used to compare Surg BL at different circumferential positions. Results The mean inter-proximal Rx BL was 4.0 ± 2.2 mm and the mean inter-proximal Surg BL was 5.3 ± 2.3 mm. The difference between Rx BL and Surg BL was statistically significant ( p = 0.014). There were no significant differences in Surg BL at the mesial, distal, buccal and oral aspects ( p > 0.05). Conclusions The intra-operatively measured peri-implant bone levels were more apical than the radiographic bone levels. The intra-operatively assessed peri-implant bone levels ( Surg BL) were similar at all the circumferential positions around the implant. [ABSTRACT FROM AUTHOR]

Background: In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. Methods: Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). Results: The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women. Conclusions: Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC. [ABSTRACT FROM AUTHOR]

The immigrant population in Seville has grown over the last 10 years, most of which are Latin Americans. Our aim was to describe the health status perceived in this emerging population. In 2011, a cross-sectional study was performed on a representative sample of 190 Latin American immigrants between the ages of 25 and 44 years residing in Seville (Spain). The self-sensed health status was 18 % excellent, 28 % very good, 42 % good, 11 % regular, and 1 % poor. The average number of days of satisfactory health status during the last month was 22. Statistically significant differences were found: (a) higher satisfactory perception of health in men than in women (30 vs. 9 %) and (b) higher average number of days with excellent health in people with satisfactory perception than those with an unsatisfactory perception of their health status (23 and 15, respectively). Logistic regression, educational level, number of days of good health, and doing physical exercise were the variables that best explained the satisfactory perception of health status. Most people studied have a positive self-assessment of their health status, especially men, who engage in physical activity and those who have 3 and more weeks of good health per month. Our results permit us to support, to a large extent, the theory of the 'healthy immigrant'. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between dietary glycaemic index (GI) and dietary glycaemic load (GL) with cardiovascular disease (CVD) risk factors in a rural elderly population. Methods: A cross-sectional study was conducted in 343 subjects (60-74 years) residing in a Spanish rural area (Priego de Córdoba). Subjects were selected using stratified random sampling. Food intake was assessed using a validated food frequency questionnaire (FFQ). We assigned GI values to each item of the FFQ to estimate dietary GI and GL. Multivariate linear regression models were fitted to assess the association between GI/GL with CVD risk factors (blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein A1, body mass index, waist circumference and blood pressure). The potential modifying effect of sex, smoking status, diabetes and medication has been explored. Results: A statistically significant inverse association between dietary GI and blood glucose was found in the multivariate model ( p = 0.029): for every 10 unit increment of GI, serum glucose levels decreased by 0.2 units. However, statistical significance was lost after controlling for diabetes or hypoglycaemic medication. In the crude model, dietary GL was associated with triglycerides ( ß for every 10 GL units increase = 0.70, p = 0.005), but statistical significance was lost in the multivariate model ( p = 0.508). No associations were found between dietary GI/GL and the rest of the variables studied. Conclusions: Neither dietary GI nor GL were associated with CVD risk factors in the study population of Priego de Córdoba. Results obtained suggest the necessity to consider the diagnosis of diabetes in these studies. [ABSTRACT FROM AUTHOR]

Aim. To explore the mechanisms by which some children select disruptive behaviours to cope with stressful dental events. In particular, the relationships between dental fear, expected effectiveness of destructive coping, and intentions of displaying uncooperative behaviours were analysed. Design. Participants were 170 children who filled out a questionnaire survey. Descriptive statistics by gender and group age as well as comparisons of means were calculated. Spearman's rho correlation coefficients and binary logistic regression analysis were used to test hypotheses of the relationships among variables. Results. Both dental fear and the expected effectiveness of destructive coping strategies were significantly associated with children's uncooperative intentions at the dentist. In addition, children who strongly endorsed the effectiveness of destructive coping strategies had a higher probability of uncooperative intentions as dental fear increased. In contrast, this relationship was not statistically significant among children who did not expect negative behaviours to be effective. Conclusions. Children's expectations about the effectiveness of destructive coping behaviours can help explain variations in the use of these strategies in stressful dental situations. Dental fear as well as children's inadequate expectancies about coping alternatives should be explored and targeted to prevent and modify uncooperative behaviour intentions at the dentist. [ABSTRACT FROM AUTHOR]

Over the last decade, the immigrant population of the Balearic Islands archipelago (Spain), in the Mediterranean, has risen to 22 % of its total population. The aim of this study was to assess food consumption patterns among Balearic Islands' adolescents depending on their origin. A population-based cross-sectional nutritional survey was carried out in the Balearic Islands (2007-2008; n = 1,231; 12-17 years old). Dietary assessment was based on a 145-item semi-quantitative food-frequency questionnaire. Food consumption differences between the adolescents' point of origin and time of arrival were been studied, as well as average daily meals and snacks. The adolescents' origin and number of years living in the Balearic Islands were also assessed. Native adolescents and immigrants from other Mediterranean countries showed healthier food consumption patterns than their peers from non-Mediterranean countries. Immigrant adolescents adapted their eating patterns to native dietary patterns increasingly, the longer they lived in the Balearic Islands. [ABSTRACT FROM AUTHOR]

Aims To estimate the frequency of alcohol consumption among nursing students and describe their behaviour patterns in relation to excessive consumption. Background Most alcohol-related problems appear in individuals who indulge in hazardous consumption, with hazardous drinkers constituting a priority in the field of preventive activities. According to previous studies, there is a high proportion of hazardous drinkers among university students. Design Descriptive cross-sectional study. Methods Over the course of the 2012-2013 academic year, we assessed 1060 nursing degree students, ascertaining their socio-demographic characteristics, lifestyle and alcohol consumption by means of the Systematic Alcohol Consumption Interview ( Interrogatorio Sistematizado de Consumos Alcohólicos/ ISCA) and Alcohol Use Disorders Inventory Test ( AUDIT). Results Hazardous alcohol consumption was observed in 43·4% of students. Moreover, 14·9% of men and 18·7% of women met criteria for hazardous drinkers, without any statistically significant difference between the sexes. The frequency of hazardous drinkers was significantly higher among participants aged under 21 years, those living outside the family nucleus and smokers. Conclusion A considerable proportion of students show evidence of hazardous alcohol consumption and, while there are no sex-related differences, the proportion of hazardous drinkers tends to be higher among the youngest subjects, smokers and persons living outside the family nucleus. Alcohol-prevention activities should envisage greater protection of university settings, particularly where future health professionals are involved. [ABSTRACT FROM AUTHOR]

Background There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions. Objective To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making. Study Design Cross-sectional study with 764 patients and 327 physicians. Study Setting and participants Fourteen health centres belonging to three primary care districts and three hospitals in Spain. Principal Findings Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P < 0.001) and severity of illness (38 vs. 46%, P = 0.002) increased the tendency to take a passive role. In 85.1% (650) (95% CI 83.3, 88.3%) of the cases, patients reported having received sufficient information. Lack of consultation time (29.6%, 95% CI 25.8, 32.5%) and patients' use of Internet or other sources (19.2%, 95% CI 16.4, 22.2%) were identified as new obstacles to doctor-patient communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions. Discussions and Conclusions The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety. [ABSTRACT FROM AUTHOR]

A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model., The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends., The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment. [ABSTRACT FROM AUTHOR]

This study tests a model of physical aggression in a sample of 194 men being treated for physical or psychological aggression in the greater Madrid area of Spain. The prevalence of aggression in this sample was lower than in a US batterer sample. In the path model highlighted here, borderline personality traits and alcohol problems were identified as risk factors for physical aggression perpetration and the role of borderline traits was mediated by psychological aggression. A reciprocal relationship was found between psychological perpetration and victimization but not physical perpetration and victimization. These findings are discussed within a cross-cultural context; conceptual and treatment implications are also addressed. [ABSTRACT FROM AUTHOR]

Background: The Living with COPD (LCOPD), COPD and Asthma Fatigue Scale (CAFS), and COPD and Asthma Sleep Impact Scale (CASIS) are instruments developed to assess the overall impact of chronic obstructive pulmonary disease (COPD) on daily life, fatigue, and sleep impairment, respectively. Objectives: To assess the usefulness of these instruments and to identify factors associated with the concepts they measure. Method: The questionnaires were administered to patients with moderate to severe COPD. Descriptive analyses of sociodemographic and clinical data were performed, and bivariate and multivariate analyses were used to identify factors associated with the overall impact of COPD on patients' lives, fatigue, and sleep impairment. Results: A total of 408 patients was included (mostly males, 91.2%), with an average age of 68 years (SD = 9.3). Statistically significant differences were observed in the scores of the three questionnaires with regard to level of education, presence of chronic cough or expectoration, level of dyspnea, number of exacerbations, physical activity level, presence of depression and anxiety, and number of treatments indicated for COPD. The LCOPD and CAFS questionnaires also discriminated between different levels of airflow obstruction and, in the case of CAFS, age and gender. Linear regression showed that level of dyspnea, physical activity, and presence of anxiety were significantly related to the LCOPD, CAFS and CASIS scores. The presence of depression was significant in the LCOPD and CAFS questionnaires and chronic cough was significant in the CAFS questionnaire. Conclusions: The LCOPD, CAFS, and CASIS instruments are valid and useful in understanding the overall impact of COPD on daily life, fatigue, and sleep impairment in patients with moderate to severe COPD. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Neighbourhood characteristics may contribute to differences in physical inactivity. Purpose To evaluate whether the availability of sports facilities helps explain the differences in physical inactivity according to the economic context of the neighbourhood. Methods 6607 participants representative of the population aged 16–74 years, resident in Madrid (Spain) in 2005, were analysed. Using ORs calculated by multilevel logistic regression, the association between per capita income of the neighbourhood of residence and physical inactivity was estimated, after adjusting for age, population density, individual socioeconomic characteristics and the availability of green spaces. The analysis was repeated after further adjustment for the availability of sports facilities to determine if this reduced the magnitude of the association. Results Residents in the neighbourhoods with the lowest per capita income had the highest OR for the prevalence of physical inactivity. In participants aged 16–49 years, after adjusting for the availability of sports facilities, the magnitude of the OR in the poorest neighbourhoods with respect to the richest neighbourhoods increased in men (from 2.22 to 2.35) and declined by 13% in women (from 2.13 to 1.98). In contrast, in the population aged 50–74 years, this adjustment reduced the magnitude of the OR by 21% in men (from 2.00 to 1.80) and by 53% in women (from 2.03 to 1.48). Conclusions The poorest neighbourhoods show the highest prevalence of physical inactivity. The availability of sports facilities explains an important part of this excess prevalence in participants aged 50–74 years, but not in younger individuals. [ABSTRACT FROM AUTHOR]

Objective The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. Design Cross-sectional study. Subjects A total of 1,006 patients with chronic musculoskeletal pain from a representative sample of primary care centers were evaluated. Outcome Measures Pain was measured using a visual analog scale and the Primary Care Evaluation of Mental Disorders questionnaire was used to measure mood disorders. Results We observed a high prevalence of undiagnosed mood disorders in chronic musculoskeletal pain patients (74.7%, 95% confidence interval [ CI] 71.9-77.4%), with greater comorbidity in women (adjusted odds ratio [ OR] = 1.91, 95% CI 1.37-2.66%) and widow(er)s (adjusted OR = 1.87, 95% CI 1.19-2.91%). Both sleep disturbances (adjusted OR = 1.60, 95% CI 1.17-2.19%) and pain intensity (adjusted OR = 1.02, 95% CI 1.01-1.02%) displayed a direct relationship with mood disorders. Moreover, we found that chronic musculoskeletal pain patients with comorbid mood disorders availed of health care services more frequently than those without ( P < 0.001). Conclusions The prevalence of undiagnosed mood disorders in patients with chronic musculoskeletal pain is very high in primary care settings. Our findings suggest that greater attention should be paid to this condition in general practice and that sleep disorders should be evaluated in greater detail to achieve accurate diagnoses and select the most appropriate treatment. [ABSTRACT FROM AUTHOR]

Objective: Chronic pain and depression are frequent conditions in primary care patients. Depression is frequently overlooked in the presence of pain of uncertain origin. The aim is to measure the prevalence and clinical correlates of unrecognized comorbid mood disorders and chronic pain of uncertain origin in older primary care patients, and to elucidate the differences with younger adults with the same conditions. Design: Cross-sectional study. Setting: Primary care centres in Spain. Participants: Patients (n= 2720) with persistent pain of uncertain origin. Measurements: Pain characteristics, sites and intensity (Visual Analogical Scales), depression (PRIME-MD interview), clinical characteristics and health services use. Results: We observed a similarly high (80.5%) prevalence of undiagnosed mood disorders (especially major depressive disorders) among older and younger adult patients with comorbid chronic pain complaints of uncertain origin. Older patients suffered pain that was more intense, longer lasting and located in a higher number of different areas, when compared to younger patients. Pain intensity was a factor associated with suffering from mood disorders among patients above 65 years, whilst the number of pain sites was a more important factor among younger patients. Conclusions: Depression is highly associated with pain of uncertain origin in older patients with differences in pain characteristics when compared to younger patients. The robust comorbid relationship between both conditions should alert clinicians to specifically look for depression in the presence of poorly explained painful symptoms. [ABSTRACT FROM AUTHOR]

Background: Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians. Objective: The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it. Methods: An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia. Main Outcome Measure: Clinical inertia was defined when physicians did not modify treatment despite knowing that the therapeutic target had not been reached. Clinical inertia was considered to be justified (JCI) when physicians provided an explanation for not intensifying treatment and as not justified (nJCI) when no reasons were given. Results: JCI was observed in 30.1 % (95 % CI 27.8-32.4) of patients ( n = 451) and nJCI in 69.9 % (95 % CI 67.6-72.2) ( n = 1,058). JCI was associated with higher blood pressure (BP) values (both systolic and diastolic) and diabetes ( p = 0.012) than nJCI. nJCI was associated with patients having an isolated increase of systolic or diastolic or high borderline BP values or cardiovascular disease. Conclusion: Physicians provided reasons for not intensifying treatment in poorly controlled patients in only 30 % of instances. Main reasons for not intensifying treatment were borderline BP values, co-morbidity, suspected white coat effect, or perceived difficulty achieving target. nJCI was associated with high borderline BP values and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Purpose: To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators. Methods: Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups. Results: The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71). Conclusions: Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population. [ABSTRACT FROM AUTHOR]

Background and Aims: Poor adherence to anti-dementia drugs is common among patients with Alzheimer's disease. This study evaluated whether caregivers were more satisfied with, and patients more adherent to, transdermal rivastigmine than oral rivastigmine. Methods: Neurologists, psychiatrists and geriatricians collected sociodemographic and clinical data from 1,078 patients and administered the Treatment Satisfaction with Medicines (SATMED-Q) and the Morisky-Green questionnaires to their caregivers at outpatient consultations. Results: Satisfaction reported was greater with transdermal than oral rivastigmine: mean ± SD of the total SATMED-Q score, 72.5 ± 14.1 vs. 65.2 ± 12.5, p < 0.001. The proportion of adherent patients was greater with transdermal than with oral rivastigmine (65.0 vs. 41.4%, p < 0.001). Satisfaction, in turn, was significantly greater in adherent cases than in nonadherent cases. Conclusions: Facilitating the administration of anti-dementia drugs would improve adherence. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The objective of this study was to identify the social factors that explain the differences in knowledge with regards to HIV/AIDS among immigrants in the Basque Country (Spain). We conducted a cross-sectional study based on information obtained in the Basque Health Survey for 754 immigrants from: 86 China, 368 Latin America, 237 the Maghreb and 74 Senegal. Odds ratios (95% CI) were calculated from logistic regression models to measure the degree of association between inadequate knowledge regarding transmission, prevention and places where HIV testing is offered, and the independent variables. We found that this inadequate knowledge is associated with place of birth, sex, a lower level of education, immigration status, difficulties in understanding Spanish, and not receiving advice about AIDS in primary care. These findings indicate that initiatives must be developed to promote equity in the provision of healthcare through clinical guidelines, including details of the specific needs of different groups of immigrants and considering gender issues. [ABSTRACT FROM AUTHOR]

Migrant workers usually show higher rates of work-related health problems than natives. However, little information is available about their exposure to occupational risks. We describe self-reported working exposure in Spanish and foreign-born workers. A cross-sectional survey was conducted as part of the ITSAL Project. Data on sociodemographic and self-reported occupational exposure in 1,841 foreign-born and 509 Spanish workers were collected through face-to-face interviews. Prevalence and adjusted odds ratios-aOR- (by age, education, type of contract) were calculated. Foreign-born men in non-services sectors and those in manual occupations perceived exposure to occupational risks with lower prevalence than Spanish workers. Foreign-born women reported higher prevalence of exposure than Spanish female workers. By occupation, foreign-born female workers were more likely than Spanish workers to report working many hours/day (aOR2.68; 95 % CI 1.06-6.78) and exposure to extreme temperatures (aOR2.19; 95 % CI 1.10-4.38). Some groups of migrant workers may need increased protection regarding some occupational exposures. [ABSTRACT FROM AUTHOR]

Aims: To describe central nervous system (CNS) drug consumption patterns depending on the time to diagnosis of Alzheimer's disease (AD), and to check whether the cases diagnosed later are associated with greater severity and consuming more CNS drugs. Methods: Cross-sectional study using 952 cases of the Registry of Dementias of Girona. A binary logistic regression was used to detect variables associated with the use of CNS drugs depending on the time to diagnosis. Results: CNS drugs were consumed by 95.8% of the AD patients. Only antipsychotics presented a statistically significant increase in the frequency of prescription to patients with longer time elapsed from symptom onset to AD diagnosis. Conclusion: Longer time elapsed from the onset of symptoms to the diagnosis resulted in increased probability of antipsychotic consumption. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Research on women's responses to intimate partner violence (IPV) has largely been limited to women who have been exposed to severe physical violence with scarce generalisation. This study aimed to analyse how Spanish abused women from different backgrounds and with different IPV characteristicsrespond to violence.Method: Women experiencing IPV before the previous year (1469) were selected from a large cross-sectional national survey of adult women recruited during 2006-7among female patients seeking medical care for whatever reason in primary healthcare services. The outcome variables were women's responses to IPV and the predictor variables were personal and social resources profiles and characteristics of the abuse (type,duration and women's age at onset). Stepwise logistic regression models were fitted.Results: 87.5% of abused women took some kind of action to overcome IPV. Significant differences on personal and social profile and type and duration of the abuse were detected between the three strategic responses: distancing, in process and inhibition. The probability of a woman responding with a distancing strategy (seeking outside help or leaving temporarily) is almost three times greater if she is employed, was young when the abuse began, had experienced physical and psychological abuse and when the abuse was under 5 years.Conclusions: The results of this study show that personal and social resources and the specificcircumstances of the abuse should be taken into account to understand women's responses to IPV.Well-validated interventions targeted at abusedwomen's needs and the circumstances of IPV remain a priority. [ABSTRACT FROM AUTHOR]

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Previous studies on the association between alcohol intake and the development of the metabolic syndrome (MetS) have yielded inconsistent results. Besides, few studies have analysed the effects of red wine (RW) consumption on the prevalence of the MetS and its components. As moderate RW drinkers have a better lipid profile and lower incidence rates of diabetes, hypertension and abdominal obesity, all components of the MetS, it was hypothesised that moderate RW consumption could be associated with a lower prevalence of the MetS. In the present cross-sectional study of 5801 elderly participants at a high cardiovascular risk included in the PREDIMED (Prevención con Dieta Mediterránea) study, 3897 fulfilled the criteria of the MetS at baseline. RW intake was recorded using a validated 137-item FFQ. Multiple logistic regression analysis was carried out to estimate the association between RW intake and the prevalence of the MetS. Compared with non-drinkers, moderate RW drinkers ( ≥ 1 drink/d) were found to have a reduced risk of prevalent MetS (OR 0·56, 95 % CI 0·45, 0·68; P< 0·001), a lower risk of having an abnormal waist circumference (OR 0·59, 95 % CI 0·46, 0·77; P< 0·001), low HDL-cholesterol concentrations (OR 0·42, 95 % CI 0·32, 0·53; P< 0·001), high blood pressure (OR 0·28, 95 % CI 0·17, 0·45; P< 0·001) and high fasting plasma glucose concentrations (OR 0·67, 95 % CI 0·54, 0·82; P< 0·001) after adjusting for several confounders. This association was found to be stronger in female participants, in participants aged < 70 years and in participants who were former or current smokers. No significant association was found between RW intake ( ≥ 1 drink/d) and TAG concentrations. In conclusion, moderate RW consumption is associated with a lower prevalence of the MetS in an elderly Mediterranean population at a high cardiovascular risk. [ABSTRACT FROM PUBLISHER]