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Study Design: Observational prospective study., Objective: Validate the Spanish version of the Neck Disability Index (NDI)., Summary of Background Data: The NDI is the most widely used neck pain scale in the largest number of populations and has been validated most often against multiple measurements of function, pain, and clinical signs and symptoms., Methods: The Spanish version of the NDI was administered 2 or 3 times to 175 individuals with neck pain (including those requesting or not requesting specific healthcare at a given time and those with acute and subacute/chronic nonspecific or post-traumatic neck pain). After establishing the factorial structure by extracting the main components, the internal consistency was assessed with the Cronbach alpha method, the test-retest reliability was assessed with the Bland-Altman plot and the intraclass correlation coefficient methods, and the validity was established by calculating Pearson correlation coefficient with pain visual analogue scale values and with Northwick Park Neck Pain Questionnaire (Spanish version) values. Sensitivity to change was estimated while comparing the mean difference between the first application of the NDI score and the one after the treatment in the patients who improved, felt the same, or worsened., Results: A single factor explained 51.6% of the variance, the Cronbach alpha score was 0.89, the intraclass correlation coefficient was 0.98, the Pearson correlation coefficient with pain visual analogue scale was r = 0.65 and with Northwick Park Neck Pain Questionnaire was r = 0.89. In the subgroup of 147 subjects in whom the sensitivity to change was studied, those who reported an improvement in neck pain showed a decrease in the NDI score of 8.20, those who felt the same showed a decrease of 0.23, and those who felt worse showed an increase of 5.55., Conclusion: This first Spanish version of the Neck Disability Index is reliable, valid, and sensitive to change.

Background and Objective: The Neck Disability Index (NDI) is the most used scale for neck pain and disability. There is no validated Spanish version so far. This prospective study's objective was to evaluate a Spanish version's comprehension and metrics characteristics., Material and Method: The Spanish version of the NDI was obtained by the "translation-backward translation" method. This version and the pain visual analogue scale were both administered 2 times to 48 patients with nonnespecific or posttraumatic neck pain., Results: 16% had comprehension troubles. The cultural level had no influence on it. Items more commonly called into question were the IX (neck pain and sleeping) and the VII (neck pain and working). The scales were fulfilled in 6 min 08 s (54 s) by those with middle-high cultural level, and in 7 min 59 s (1 min 26 s) by those with low one (p < 0.001). As shown by factor analysis, our NDI version is a one-dimension scale. Internal consistence was very good (Cronbach alpha of 0.937 at the first time and 0.944 at the second one). An optimal test-retest reliability was settled by intraclass correlation coefficient (0.978) and by Bland-Altman plot. For the construct validity, correlation with the pain visual analogue Scale was 0.643 (p < 0.01) at first time, and 0.743 (p < 0.01) at second one. This was the only metric characteristic where the cultural level had any influence., Conclusions: On reformulation of some items, our NDI Spanish version's feasibility will allow its use for future definitive validation.

Water-soluble vitamins influence the development of an adequate structure of bone tissue, but there is scant information relating them with osteoporotic fractures. We analyze whether serum vitamin C, vitamin B12, and erythrocyte folate, or dietary intake of vitamin C and folate, are related with osteoporotic fractures in the elderly. A hospital-based case-control study was carried out at the Hospital of Jaén (167 cases, 167 controls), Spain. Cases were defined as patients aged 65 or more years with a low-energy fracture. Controls were people without fracture, matched for age and sex with cases. Diet was assessed by a semi-quantitative food frequency questionnaire. Serum vitamin C was measured using high-performance liquid chromatography (HPLC). Folic acid and vitamin B12 were measured using procedures of competitive or immunometric immunoassay. Multivariable analyses were also fitted to adjust for confounding using analysis of covariance (for the comparison of adjusted means) and conditional logistic regression (for estimating adjusted odds ratios). A statistically significant difference between cases and controls for vitamin C blood levels was found, being higher for controls (p = 0.01). Analysis of the association between serum vitamin C and fracture risk showed a linear trend (p = 0.03) with a significantly reduced risk for the upper quartile (OR = 0.31; 95% CI 0.11-0.87). The intake of vitamin C, folic acid, and B12 was not related to fracture risk, nor was there any association with erythrocyte folate or serum vitamin B12. In conclusion, serum vitamin C levels were lower in cases with osteoporotic fractures than in controls.

Objective: To analyze the number of inappropriate stays generated by patients admitted through a pulmonology department over a 1-year period and to identify the causes and predictors of those stays., Patients and Methods: A representative sample of hospital stays corresponding to patients admitted by the pulmonology department at Hospital de Valme, Seville, Spain, in 2004 was analyzed retrospectively using the Appropriateness Evaluation Protocol. The review was conducted by 2 physicians who did not belong to the pulmonology department. Multiple linear regression analysis was performed to identify predictors of inappropriate stay., Results: Of the 1166 stays analyzed, 1038 (89%) were judged to be appropriate and 128 (11%) inappropriate. The most common reason for inappropriate stay was the delay in performing diagnostic tests and receiving results (64%). The main justification for appropriate stay was the need for respiratory treatment (59.6%) and parenteral treatment (46.1%). The predictive model generated by multiple linear regression analysis identified the following predictors of inappropriate stay: stay on a ward other than the pulmonology ward, diagnosis on admission, and season of the year., Conclusions: The rate of inappropriate stay was low in comparison with other studies. The majority of inappropriate stays were attributed to delays in performing diagnostic tests and receiving results. Diagnosis on admission, season of the year, and stay on a ward other than the pulmonology ward were the strongest predictors of inappropriate stay.