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With ageing, the risk of frailty increases, becoming a common condition that exposes older people to an increased risk of multiple adverse health outcomes. In Valencia (Spain), the ValueCare project develops and applies a value-based care approach that addresses the multidimensional nature of frailty by implementing integrated and personalized care to tackle psychosocial frailty. A pre-post controlled design with a baseline measurement at inclusion, at the end of implementation and a follow-up measurement after 6 months of intervention. In Valencia (Spain), 120 participants over 65 years of age are recruited from primary care centres to receive the ValueCare comprehensive and personalised care plan according to the results and are compared with 120 participants receiving "usual care". An assessment questionnaire is designed using validated instruments, and a personalised care plan is developed specifically for each participant based on the results obtained. The study protocol has been registered under the ISRCTN registration number ISRCTN25089186. Addressing frailty as a multidimensional and multifactorial risk condition requires the development and implementation of comprehensive assessments and care. In this context, this study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people experiencing frailty.

Objectives: To assess the internal consistency, convergent and divergent validity, and concurrent validity of the Tilburg Frailty Indicator (TFI) within community-dwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom., Design: Cross-sectional study., Setting: Primary care and community settings., Participants: In total, 2250 community-dwelling older people (60.3% women; mean age = 79.7 years; standard deviation = 5.7)., Methods: We assessed the reliability and validity of the full TFI as well as its physical, psychological, and social domains. Baseline data of the Urban Health Centers Europe project were used. The internal consistency was assessed with the Cronbach alpha. The convergent and divergent validity were assessed using Pearson correlation coefficients between the domains and alternative measures: the 12-item short-form, Groningen activity restriction scale, 5-item mental well-being scale of the 36-Item Short Form Survey, and the De Jong Gierveld loneliness scale. The concurrent validity was assessed by the area under the receiver operating characteristic curve with physically frail (Survey of Health, Ageing and Retirement in Europe-Frailty Instrument), loss of independence (Groningen activity restriction scale), limited function (Global Activity Limitation Index), poor mental health (5-item mental well-being scale of the 36-Item Short Form Survey), and feeling lonely (De Jong Gierveld loneliness scale) as criteria., Results: The internal consistency of the full TFI was satisfactory with the Cronbach alpha ≥0.70 in the total population and in each country. The internal consistency of the psychological and social domains was not satisfactory. The convergent and divergent validity of the physical, psychological, and social domains was supported by all the alternative measures in the total population and in each country. The concurrent validity of the full TFI and the physical, psychological, and social domains was supported with most area under the receiver operating characteristic curve ≥0.70 in the total population and in each country., Conclusions and Implications: The TFI is a reliable and valid instrument to assess frailty in community-dwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Self-care agency is an important determinant of healthy aging. The Appraisal of Self-care Agency Scale (ASA-R) (Sousa et al., 2010) is one of the main instrument to assess self-care capacity. The objectives of the study were: 1) to adapt and validate ASA-R scale for use in Spanish population; 2) to examine the dimensionality, validity and reliability; 3) and to establish the convergent validity of ASA-R using a self-reported health measure. The ASA-R Scale and the 12-item Short Form Health Survey (SF-12) were administered to 488 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyze the dimensionality, validity and reliability. Convergent validity was tested by correlating the ASA-R factors with the SF-12 subscales; correlations were significant (p 0.05 (0.436), RMSEA closer to 0 (0.006), SRMR 0.95 (0.996 and 0.995). The results also demonstrated that ASA-R is a reliable and valid instrument. The ASA-R has demonstrated to be a reliable (CR indices > 0.7) and valid (AVE > 0.5) instrument in measuring self-care agency among Spanish older population.

Background: Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation., Methods: In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants., Discussion: The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings., Trial Registration: ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017.

Background: Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases., Methods: The sample (n=74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users' inclusion., Results: The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users' perceptions of satisfaction and usefulness were highly positive., Conclusions: Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels., Implications: Further adjustments are needed to address a comprehensive response to the needs of the global population of reference., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: Application of The Community Assessment Risk Screen (CARS) tool for detection of chronic elderly patients at risk of hospital readmission and the viability study for its inclusion in health information systems., Design: Retrospective cohort study., Location: Health Departments 6, 10, and 11 from the Valencia Community., Participants: Patients of 65 and over seen in 6 Primary Care centres in December 2008. The sample consisted of 500 patients (sampling error=±4.37%, sampling fraction=1/307)., Variables: The CARS tools includes 3items: Diagnostics (heart diseases, diabetes, myocardial infarction, stroke, COPD, cancer), number of prescribed drugs and hospital admissions or emergency room visits in the previous 6months. The data came from SIA-Abucasis, GAIA and MDS, and were compared by Primary Care professionals. The end-point was hospital admission in 2009., Results: CARS risk levels are related to future readmission (P<.001). The value of sensitivity and specificity is 0.64; the tool accurately identifies patients with low probability of being hospitalized in the future (negative predictive value=0.91, diagnostic efficacy=0.67), but has a positive predictive value of 0.24., Conclusions: CARS does not properly identify the population at high risk of hospital readmission. However, if it could be revised and the positive predictive value improved, it could be incorporated into the Primary Care computer systems and be useful in the initial screening and grouping of chronic patients at risk of hospital readmission., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

The review of interventions currently available to alleviate the burden of informal caregivers of dependent persons has both social and political relevance considering the increasing number of elderly dependent persons. Respite services and programs for psycho-social intervention are the main methods of dealing with this burden. Study of the main research carried out to date on such interventions enables us to organize more efficient services, especially considering the enactment of the Law on Dependence in Spain in January 2007 and the need for other European and international governments to establish systems to meet the needs of the growing dependent population., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

This work analyzes the public social services system developed in Spain to attend dependent persons and their informal caregivers, examining in a more detailed way the current capacity of the Spanish public In-Home Help Service (HHS) to meet the demands of dependent elderly persons and its impact on their informal caregiver's burden. We begin with a brief introduction of the services by the Spanish public social services system developed to attend dependency; next, the evolution of the Spanish public HHS is described in a thorough way to identify the pros and cons of this service regarding the informal caregivers' burden of dependent elders. Finally, recommendations are proposed to redesign and restructure this public in-home service to lessen the informal caregiver's burden., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

The study aims at analyzing the psychosocial variables associated with the informal caregivers' burden of dependent older people. A sample of 296 dependent people and their informal caregivers (n=153) was randomly selected among users and non-users of the Spanish public In-Home Help Service (HHS) in an autonomous Spanish region (Comunidad Valenciana). Diverse variables in reference to the care context and the caregiver as well as the care recipient show major associations with the burden: those associated to disease and the social situation of the dependent person, the greater frequency and intensity of care, and the low frequency in which the caregiver receives help from others. The obtained data makes possible to establish guidelines based on the psychological and educational interventions which relieve the informal caregivers' burden of dependent senior citizens, which must be combined with respite services, in order to promote the permanence of this population group in the community environment.

Aim: This study looks at the objective and subjective characteristics of home respite service provision and its impact on the informal care burden of dependent elders., Method: A sample of 296 dependent people and their informal caregivers was randomly selected among users and non-users of the Home Help Service (HHS) in an autonomous Spanish region (Comunidad Valenciana). An experimental design was used and a field study was carrying out that collected information on sociodemographic variables of the dependent person and his/her caregiver, HHS characteristics and the assessment of the services delivered by this resource as well as the informal caregivers'burden., Results: The results show that the services of this resource are very limited, with low cover and frequency, and they do not address the real dependency needs in specific activities of daily living. However, users and caregivers are satisfied with this care and experience a higher quality of life since it was implemented, although the HHS does not alleviate informal caregivers' stress., Conclusion: These data show the need to extend the services delivered by the HHS and the duration of care, address the caregiver's need for psychological care, and look at potentially modifiable variables in the care context when designing prevention and psychosocial intervention programmes to lessen the informal caregiver's burden.

The objective of this paper is to examine the suitability of specific facilities for dependent persons for meeting users' needs. A total of 1265 users of social and health facilities for dependent persons were interviewed in a study carried out in a typical southern European region with a Mediterranean welfare system: the Valencia Autonomous Region in Spain. Data were obtained on users' socio-demographic profile, health, functional dependence, cognition, social support and housing suitability. Based on these data and the institutional definitions of the specific facilities for dependent persons, the suitability index was drawn up for each facility and suitability was evaluated using discriminant analysis. The results give a high suitability index for most of the facilities (between 0.661 for Units for Home Hospitalisation and 1.000 for Units for Psychiatric Hospitalisation). But a significant percentage of patients (17% in Hospitals for Chronically Ill and Long-stay Patients) could be cared for in different facilities to the ones they actually use.

Acute promyelocytic leukemia is characterized the PML/RARalpha chimeric fusion gene, transcript and protein; the breakpoint cluster regions (bcr) in the PML gene may occur in 3 different sites: Intron 6 (bcr1), exon 6 (bcr2) or intron 3 (bcr3). In a 10-year period in a single institution, we studied prospectively the breakpoint cluster regions of the PML/RARalpha fusion gene in 43 Mexican Mestizo patients with APL, and found that the bcr1 represented 62.7%, the bcr2 9.3% whereas the bcr3 27.9%. The prevalence of the bcr1 subtype is significantly higher than that informed in Caucasians and similar to that in Asians; these data are consonant with those described in other Latin-American patients with APL. Since other Asian genetic markers have been found in the Indian component of the Mexican mestizos, it is possible that the Asian immigration into the Americas through the strait of Behring 12,000 years ago may account for a possible genetic susceptibility to suffer certain forms of APL.

A revision of tetanus points of entry in 229 tetanic patients who were cared for at the Hospital del Mar, Barcelona, between 1970 and 1983, i carried out in order to determine in which kind of patients a adequate prophylaxis is not performed. It is found that 83% of point of entry are wounds which are not medically assisted. At the same time points of entry are classified in four main groups: a first group consisting of wounds localized in head and extremities (46.8%), second group to contaminated intramuscular injections (21.8%) a third group related to surgical and obstetric procedures (15.3%) an a fourth group which includes other points of entry not included in the previous groups (16.2%). This classification permits the detection of epidemiological characteristics of each group and the observation of the possible influence of point of entry on the evolution and prognosis of tetanus highlighting that the most severe situations are due to intramuscular injections and surgical and obstetric procedures. With this study we can conclude that an adequate antitetanic prophylaxis must not be restricted to high risk patients, but should be extended to the whole population.