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Background: The difficulty in identifying and distinguishing Major Depressive Disorder (MDD) in primary care is well known. The main objective of this study is to determine the frequency of MDD in persons aged 65 years and older using the Detection of Depression in the Elderly Scale (DDES). A second objective is to determine the convergent validity of the DDES with the Geriatric Depression Scale (GDS).Methods: A cross-sectional, observational study was carried out of 1,387 subjects aged 65 years and older. The variables considered were: affective state (GDS and DDES), physical and cognitive functional state, health problems and sociodemographic characteristics.Results: Using the DDES we identified MDD in 50 subjects (4.3%). There was a moderate correlation (r = 0.570; p < 0.001) between the DDES and the GDS scores (p < 0.001). According to logistic regression analysis, the variables associated with a probable MDD (DDES +) were: dependence in activities of daily living (OR: 3.3), female gender (OR: 2.3), marital status single/widowed/divorced (OR: 2.0), and the presence of four of more health problems (OR: 2.1).Conclusions: Using the DDES scale we found a 4.3% prevalence of MDD in a representative sample of older adults. Compared to the GDS, the most commonly used scale, the DDES may be considered a more sensitive screening tool for the identification of MDD in primary care.

ResumenObjetivosEstablecer la prevalencia y las características del insomnio y su relación con otros problemas de salud, consumo de fármacos, situación sociosanitaria y hábitos higiénicos en mayores de 65 años.DiseñoEstudio de prevalencia y asociación cruzada.EmplazamientoAlbacete (Castilla-La Mancha), 2004–2005.ParticipantesPoblación mayor de 65 años no institucionalizada (n=424).MétodoEntrevista semiestructurada. Variables de estudio: características del sueño, repercusiones sociofamiliares, hábitos higiénicos del sueño, problemas de salud, medicación, utilización de servicios sanitarios y variables sociodemográficas. Insomnio primario (IP) diagnosticado con criterios DSM-IV.ResultadosDeclaró problemas para dormir el 34,2%; en el 95,7% la alteración era crónica. La repercusión más frecuente fue sensación de descanso nocturno insuficiente (62,1%) y cansancio o somnolencia diurna (52,2%). El 20,3% (intervalo de confianza [IC] del 95%, 16,5–24,1) cumplía criterios de IP. El insomnio fue mayor en las mujeres, en los que tenían horarios irregulares e insatisfacción con las condiciones ambientales del dormitorio. El 26,9% (IC del 95%, 22,7–31,1) consumía de forma habitual psicofármacos. El número medio de problemas de salud fue superior en sujetos con insomnio (2,4±1,6 frente a 1,7±1,5; p

Resumen Fundamento y objetivo Desarrollar un test adaptativo informatizado (TAI) para la medicion generica del estado de salud percibido por el paciente. Material y metodo A partir de cuestionarios de calidad de vida relacionada con la salud (CVRS) validados en Espana, un panel de expertos elaboro un banco de items con respuestas tipo Likert de 5 alternativas, que se aplico a una muestra piloto y posteriormente a otra muestra general de pacientes en 7 centros de salud de Asturias. A la muestra general se le ofrecieron 2 modalidades de respuesta: a) en papel; b) en pantalla tactil. Se evaluo el cumplimiento de los supuestos requeridos por los modelos psicometricos de la teoria de la respuesta al item (TRI) (discriminacion, fiabilidad y validez) mediante analisis factorial y otros metodos. Se analizo la funcion de informacion y se realizo un estudio de simulacion. Resultados Se creo un banco de 140 items. Comprobado el cumplimiento de los supuestos de la TRI mediante analisis factorial, se realizo una seleccion de items mediante criterio estadistico y aplicacion de la TRI: se eliminaron 35, lo que dio como resultado un test de 105 items. Al aplicarlos a la muestra general, se estimaron nuevamente los parametros de los items, se comprobo el supuesto de invariancia de los parametros y se eliminaron 9 items mas; esto dio como resultado una version definitiva de 96 items. Conclusiones El TAI desarrollado resulta apto para evaluar genericamente y de forma rapida y fiable la CVRS. Este test supondra un avance muy importante para la medicion de los resultados reportados por los pacientes en la practica clinica.

To estimate the prevalence of self-reported anxiety/hypnotics use in adults 65 years and older and identify potential factors that determine the use of these drugs.Cross-sectional study conducted on a study population of 1,161 non-institutionalised adults 65 years old and older with enough ability to conduct a personal interview. Participants were randomly selected from health care registers. The main outcomes of interest included consumption of anxiolytics, hypnotics and other drugs (filed by ATC classification system), mood (based on the Yesavage geriatric depression scale), cognitive status (Pfeiffer questionnaire), physical-functional assessment of basic activities of daily living (Katz index), health problems (ICPC-2 classification WONCA), and sociodemographic variables.The prevalence of self-reported anxiety/hypnotics consumption was 16.6% (95% CI: 14.5 - 18.7), of which 90.5% were benzodiazepines (BZD), mainly lorazepam (39.4% of BZD). Long half-life BZD accounted for 24.7% of BZD. Hypnotics accounted for 27.5% of anxiolytics/hypnotics. The use of sedatives/hypnotics was independently associated with other drugs (non-psychotropics) consumption (OR 6.8, 95% CI: 2.1-22.0), presence of established depression (OR: 2.5; 95% CI: 1.0 -5.9), presence of 4 or more comorbidities (OR: 2.0; 95% CI: 1.4-2.9), being female (OR 2.1, 95% CI: 1.5-3.1) and being dependent for basic activities of daily living (OR: 1.8, 95% CI: 1.1-2.9).The prevalence of sedatives/hypnotics use in the elderly from Albacete is high. Several factors were identified as potential determinants of sedatives/hypnotics use in our study population. It will be important to evaluate the misuse of these drugs in order to develop effective, efficient and safe prescription strategies.

Background: insomnia is a highly prevalent disorder in the general population and in clinical practice. Although pharmacological treatment is the most widespread choice, psychological treatment appears to have longer lasting effects. The main objective of this meta-analysis was to assess the cognitive-behavioural group therapy treatment for insomnia. Method: a systematic search for cognitive-behavioural therapy clinical trials in Pubmed, PsycINFO, PsycARTICLES, Scielo, WOK, Cochrane, Scopus and Embase. 153 articles were reviewed, of which 9 met inclusion criteria for the metaanalysis. Adding up the data from all 9 trials, a total of 699 people completed the post-test phase. Results: after finishing cognitive-behavioural therapy, significant improvements regarding insomnia were found according to the Pittsburgh Sleep Quality Index and Insomnia Severity Index, sleep latency, wake after sleep onset and sleep efficiency. There were no significant improvements in total sleep time. Conclusions: the results from experimental studies on cognitive-behavioural therapy as an insomnia treatment clearly suggest a positive impact on symptoms, as assessed using both validated scales and sleep diaries.

This study sought to assess treatment satisfaction among patients on antidepressants, ascertaining whether there might be an association with depressive symptomatology and other variables. Cross-sectional study conducted on 564 adult patients taking antidepressant medication. Satisfaction with antidepressant treatment was assessed using the Assessment of Satisfaction with Antidepressant Treatment Questionnaire (ESTA/Evaluacion de la Satisfaccion con el Tratamiento Antidepresivo). A moderate negative correlation was observed between satisfaction and intensity of depressive symptoms, as assessed with the Montgomery–Asberg scale. A weak negative correlation was observed between greater satisfaction and less favourable views about taking medication. Satisfaction scale scores were higher among those who took antidepressant medication for 1 year or more versus shorter periods. Most patients reported being satisfied with the antidepressant treatment but the level of satisfaction was higher among those who presented with less marked depressive symptoms, received longer-term treatment and viewed drug treatments favourably. Treatment satisfaction is one of the patient-reported outcome measures that can serve to complement clinical evaluation of depressive disorders.

Resumen Objetivo Estimar la proporción de resultados positivos en el cribado del trastorno bipolar (TB) entre los pacientes de atención primaria que consultan por problemas de naturaleza psicológica, y analizar sus características. Diseño Estudio descriptivo transversal multicéntrico. Emplazamiento Diecinueve consultas de atención primaria en diferentes comunidades autónomas. Pacientes La muestra estuvo formada por 360 pacientes consecutivos de atención primaria con edades entre 18 y 70 años visitados por síntomas psicológicos. Mediciones El cribado para TB se realizó mediante el Mood Disorders Questionnaire. Se obtuvieron datos sobre calidad de vida (EuroQol-5D), impacto funcional (Sheehan Disability Inventory) y, mediante revisión de historias clínicas, datos sobre comorbilidad psiquiátrica y consumo de psicofármacos. Resultados Se obtuvo una proporción de cribados positivos del 11,9% (IC 95%: 8,8-15,7%). Solo en 2 de estos pacientes estaba registrado el diagnóstico de TB, y aunque más de la mitad recibían tratamiento con antidepresivos, solo 2 recibían tratamiento con estabilizadores del estado de ánimo. El cribado positivo se asocia a peor calidad de vida, a disfunción laboral, social y familiar, y a mayor estrés percibido. Conclusiones El cribado del TB en pacientes de atención primaria con otros problemas psicológicos da lugar a una notable proporción de resultados positivos, lo que indica que puede haber una prevalencia relevante de pacientes con TB, la mayor parte de ellos no diagnosticados y no tratados adecuadamente. Es necesario profundizar en la investigación para determinar el eventual papel que puede o debe asumir la atención primaria en la detección, el diagnóstico o el manejo de este trastorno.

We have no questionnaires to assess satisfaction with antidepressant treatment, which affects the health related quality of life. The objective was to develop and validate a specific instrument to assess satisfaction with antidepressant treatment, determining convergent validity regarding clinical effectiveness, fulfillment of expectations, adherence and tolerability.Longitudinal observational study where 168 patients started antidepressant treatment and were followed for one year. The variables included adverse effects, compliance and intensity of depressive symptoms. The questionnaire for the Evaluation of Antidepressant Treatment Satisfaction (ESTA) consists of 11 items answered using Likert scale. We evaluated its reliability, construct validity and concurrent validity with conceptually related measures with the construct assessed.The Cronbach's alpha statistic ranged between 0.936 and 0.951. In the factor analysis one factor accounted for 64.11% of the variance. The average score of the questionnaire ranged from 40.0 to 44.7 points, showing a negative correlation regarding the Hamilton scale (-0.321 / -0.601) and Montgomery-Asberg scale (-0.491 / -0.307). After a month, the antidepressant treatment satisfaction was 39.5 points in noncompliant patients and 44.3 in compliers. In those who had adverse effects was 39.2 versus 43.3 for those who had not. At the first visit (15 days) the score was 40.0, in a month 42.6, in 3 months 44.4 and in 6 months 44.5. These differences were statistically significant (p0.05). In test-retest analysis, intraclass correlation coefficient was 0.908.The questionnaire, designed to assess satisfaction with antidepressant treatment, is valid and reliable, and provides a patient-centered instrument which is complementary to the clinical assessment of the effectiveness of antidepressant treatment.

Fundamento: No existen cuestionarios para evaluar la satisfacción con el tratamiento antidepresivo, el cual repercute en la calidad de vida relacionada con la salud. El objetivo fue desarrollar y validar un instru- mento específico para valorar la satisfacción con el tratamiento antidepre- sivo, determinando su validez convergente respecto a su efectividad clíni- ca, cumplimiento de expectativas, adherencia terapéutica y tolerabilidad. Métodos: Estudio observacional longitudinal donde 168 pacientes iniciaron tratamiento antidepresivo y fueron evaluados durante un año. Las variables incluyeron efectos adversos, cumplimiento e intensidad de síntomas depresivos. En el cuestionario para la Evaluación de la Satisfac- ción con el Tratamiento Antidepresivo (ESTA), de 11 ítems respondidos mediante escala Likert, se evaluó su fiabilidad, validez de construcción y concurrente con mediciones relacionadas conceptualmente con dicho constructo. Resultados: El α de Cronbach osciló entre 0,936 y 0,951. En el aná- lisis factorial un solo factor explicó el 63,76% de la varianza. La puntua- ción media del cuestionario ESTA osciló entre 40,0 y 44,7 puntos, obser- vándose una correlación negativa respecto a las escalas de Hamilton (-0,321/-0,601) y Montgomery-Asberg (-0,491/-0,307). La satisfacción con el tratamiento antidepresivo al cabo de un mes fue 39,5 en incumpli- dores y 44,3 en cumplidores. En quienes presentaron efectos adversos fue 39,2 frente a 43,3 de quienes no los presentaron. En la primera visita (15 días) la puntuación fue 40,0; al mes 42,6; a los 3 meses 44,4 y a los 6 meses 44,5. Estas diferencias fueron estadísticamente significativas para p

The main objective of this study was the validation of a brief support instrument for the diagnosis of insomnia in older adults.An observational study was carried out for the evaluation of the Insomnia in the Elderly Scale using the psychiatric interview as the gold standard. Data was collected in a primary care setting in the city of Albacete, Spain. Participants were 926 non-institutionalized older adults aged ≥ 65 years.Sleep characteristics, and the health and sociodemographic status of the participants were assessed. The Insomnia in the Elderly Scale is divided into two subscales for the evaluation of the Diagnostic and Statistical Manual of Mental Disorders, Fouth Edition criteria A and B for insomnia. The area under the receiver operating characteristic curve for subscale A was 0.868. The cut-off point to detect the presence of diagnostic criterion A for insomnia was a score of ≥ 3 (sensitivity: 86.4%; specificity: 69.5%). The area under the receiver operating characteristic curve for subscale B was 0.832. The cut-off point to detect the presence of diagnostic criterion B was a score of ≥ 2 (sensitivity: 86.3%; specificity: 66.4%).The Insomnia in the Elderly Scale has appropriate psychometric properties. This scale compensates for the lack of validated instruments for use in the population aged 65 years or older. The fact that it is divided into two subscales to separately evaluate the insomnia criteria enables us to detect the presence of each of them. Finally, it has been validated in participants aged 65 years and older, which is the target population for this scale.

Background Measuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs. Methods/design This is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire). Discussion Antidepressant drugs are an extraordinarily important therapeutic group in the pharmacy composition; economic repercussions and social impact associated to their use is clear. Despite their well-established efficacy in clinical trials, treatment non-compliance is a major obstacle to their effectiveness in clinical practice. The proposed study brings about useful conclusions to improve the results of these drugs. Additionally, devising a scale specifically designed to evaluate satisfaction with antidepressant treatment could be of interest in healthcare outcomes research.

The aim of this study was to determine seniors' knowledge of and attitudes toward advance directive documents.We carried out a cross-sectional descriptive study in a primary care setting in the provinces of Albacete and Guadalajara, Spain (n = 464).A total of 86.2% (95% CI: 83.0-89.5) of the participants were unaware of advance directive documents and only 3.4% (95% CI: 1.7-5.3) had formalized one. These documents were positively viewed by 76.7% of the participants (95% CI: 72.8-80.7). The variables associated with positive attitudes toward advance directives in logistic regression were educational level (OR = 4.7; 95% CI: 2.6-8.4) and experience of a situation in which such a document would have helped (OR = 1.7; 95% CI: 1.1-3.4).Seniors had positive attitudes toward advance directives, but the proportion of persons aware of these documents was low.

To evaluate the perceived health status of elderly patients with insomnia, whether primary, secondary to a medical illness, or associated with another mental disorder.We conducted a cross-sectional study in a representative sample of 926 persons aged over 65 years. A psychiatric interview was used to verify the presence of insomnia (DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, fourth ed., revised text). Interviews were conducted by health professionals to assess perceived health status (EuroQol-5D), health problems, and socio-demographic characteristics.The prevalence of primary insomnia was 8.9% (95% CI: 7.1-11.0), that of insomnia associated with another mental disorder was 9.3% (95% CI: 7.5-11.4) and that of insomnia secondary to medical illness was 7.0% (95% CI: 5.4-8.9). Patients with insomnia who used hypnotics/sedatives scored lower in self-reported health (57.6; 95% CI: 53.7-61.4), significantly lower (p0.05) than participants with insomnia not taking these drugs (65.1; 95% CI: 53.7-61.4). The mean health status score in individuals without insomnia was 0.87 and was significantly lower (p0.05) in persons with any type of insomnia: 0.80 in primary insomnia, 0.73 in insomnia secondary to a mental disorder and 0.76 in insomnia associated with medical illness.Health status was worse in older people with insomnia, whether primary, secondary to other mental illnesses or organic, and when the elderly patients consumed hypnotics/sedatives. Limitations were less severe in primary insomnia.

For a proper approach to the subjects, in which the presence of hypercholesterolemia is identified for the first time, is important to consider simultaneously both cardiovascular risk factors and the presence of other diseases. The purpose of our study was to describe the lipid profile of patients in which the presence of hypercholesterolemia is detected for the frist time and to determine their cardiovascular risk and comorbidity.Observational cross-sectional study in a Primary Care setting. In 274 subjects with a plasma cholesterol level higher or equal to 200 mg / dL ("limit" hypercholesterolemia), selected by consecutive sampling, we assessed: lipid profile, cardiovascular risk factors and cardiovascular risk (SCORE and Castelli's atherogenic index), comorbidity (Charlson's Index) and sociodemographic characteristics.The mean cholesterol level was 232.9 mg/dl. Hypercholesterolaemia was reported "definite" (= 250 mg / dl) in 21.1% (95% CI: 16.2 to 26.1). A 9.5% showed a cardiovascular risk= 5%. Lipoprotein ratio of total cholesterol/HDL cholesterol was higher in men than in women (4.4 vs. 3.8, p0.001) in subjects with Charlson's Comorbidity Index= 1 (4.1 vs. 3.9, p = 0.04), in smokers (4.3 vs. 3.9, p = 0.04) and in hypertensive subjects (4.2 vs. 3.9, p = 0.03), obese (4.2 vs 3 , 7, p0.05) or with the metabolic syndrome (4.4 vs 3.9, p = 0.02). We observed a higher proportion of subjects with moderate cardiovascular risk / high or cardiovascular disease in those with comorbidity (87.3% vs 42.3%, p0.01).More than a third of the subjects in which "limit" cholesterol was identifiyed for the first time presents comorbidity, being "defined" hypercholesterolemia in 21.1% of the cases. Takeing in consideration the Score function assessment, one outif 10 subjects presents high cardiovascular mortality risk after 10 years. Both lipoprotein ratio and cardiovascular risk are markedly higher in subjects with comorbidity.

The aims of this study were to determine the true frequency of primary insomnia (PI), sleep disorder related to another mental disorder (SDMD) and sleep disorder due to a general medical condition (SDMC) in older adults and to establish their differentiating characteristics.This is a cross-sectional study. Participants were randomly selected samples of 951 subjects who are 65 years or older. Main measures were as follows: presence (according to DSM-IV-TR diagnostic criteria) of PI, SDMD, SDMC or other sleep disorders, co-morbidity and psychotropic consumption.Of the subjects, 36.1% reported having sleep problems (95% CI: 33.0-39.2) and 37.0% reported regularly consuming a psychotropic drug. The prevalence of PI was 8.9% (95% CI: 7.1-11.0), and according to the criteria for differential diagnosis, the prevalence of SDMD was 9.3% (95% CI: 7.5-11.4) and that of SDMC was 7.0% (95%CI: 5.4-8.9). A higher percentage of PI subjects had problems in falling asleep on most days (52.5%), had frequent night-time awakenings (66.3%) and early awakenings (51.3%). In subjects with any type of insomnia, the variables that showed a statistically significant association were female gender (OR: 2.21), consumption of psychotropic drugs (OR: 1.83), presence of four or more health problems (OR: 1.88) and being single, widowed or divorced (OR: 1.43).Our results provide a true picture of the prevalence of insomnia in older adults on the basis of diagnostic criteria and indicate that it is a widespread, significant health problem. The peculiarities of PI, SDMD and SDMC need to be appropriately differentiated in clinical practice, and each needs a different approach to obtain the best outcome.

Las diferentes definiciones de telemedicina hacen referencia a las técnicas y tecnologías utilizadas para la práctica médica a distancia, manteniendo el significado etimológico del término telemedicina ("medicina a distancia"). La asistencia prestada a través de telemedicina facilita la accesibilidad a los servicios sanitarios, el seguimiento de las enfermedades crónicas y la educación sanitaria del paciente en medicina preventiva y salud publica. A pesar del aumento de la aplicación de las nuevas tecnologías al ámbito sanitario, la telemedicina no disfruta de una presencia mayoritaria en la actividad clínica y asistencial.

The purpose was to determine the reliability and validity of the DADV scale to evaluate vision-related functional limitations in persons over 65 years. Cross sectional study was performed to determine the reliability and validity of a questionnaire (9 items). A total of 1387 subjects were selected by random sampling. An analysis of the intra/inter-observer reliability was performed and the convergent validity with the Visual Function Index, 14 items (VF-14) was determined. The number of patients who had some difficulty in performing any of the activities was 223 (19.2%; 95%CI=16.9-21.5). The intraclass correlation coefficient (ICC) of the intra/inter-observer reliability analysis was 0.883 and 0.900, respectively. Factorial analysis demonstrated that one single factor explained 63.2% of the total variance (visual function). The scale showed a high degree of convergent validity (ICC=0.857) with the VF-14. Visual acuity showed a moderate correlation with the DADV score (r=0.366). The Rasch analysis showed a satisfactory model fit for the items. Although the DADV scale is a short questionnaire it showed high correlation with the VF-14 and moderate correlation with visual acuity. The results indicate that the scale has acceptable reliability and is valid to efficiently evaluate visual function.

There are recommendations to prevent falls. Our goal is to determine, in older people, the knowledge and adherence to these recommendations, and to analyze the demographic characteristics and associated morbidity.Observational study of prevalence and crossed association. The target population are older people living in the community. The subjects were randomly selected (n = 919) and interviewed about their knowledge and level of adherence to existing recommendations to prevent falls in older people, we also gathered information about their health problems and their demographic characteristics. A descriptive analysis was performed and compared the "more compliant" subjects with the rest of the participants. Using a multivariate analysis the association of adhesion with possible factors was found.50.8% were unaware that there are physical exercises recommended to prevent falls and 22.0% that taking care of your feet can contribute to this end. The recommendations with greater adherence are those related to the bathroom, where 62.2% used the shower for personal hygiene and 83.5% use non-slip floor mat in the shower or bathtub. Variables associated with increased compliance are: presence of 3 or more health problems (OR: 1.6), age over 80 years (OR: 1.4), higher level of schooling (OR: 1.5) and unmarried individuals, widowed or divorced (OR: 1.4).

To determine the association between fear of falling and health status, a history of previous falls and personal characteristics in a representative sample of elderly people.We conducted an observational, cross-sectional prevalence study in the community setting in Albacete (Spain) of 921 people older than 65 years old selected through simple randomization. Participants underwent semi-structured interviews about their history of falls, fear of falling, illnesses and sociodemographic characteristics. Multivariate analysis was used to evaluate the association between fear of falling and its possible conditioning factors.In the previous year, 26.3% of interviewees had fallen and 49.4% expressed a strong fear of falling. A high proportion (78.9%) considered the consequences of falls to be very serious, but only 44.7% believed that most of these falls could be prevented. The variables associated with a greater fear of falling were female sex (OR=5.5; 95% CI: 3.9-7.6), age more than 75 years old (OR=2.0; 95% CI: 1.5-2.8), illiteracy or lack of education beyond reading/writing skills (OR= 1.5; 95% CI: 1.1-2.1), taking psychotropic medication (OR=1.6; 95% CI: 1.1-2.2), and having cardiocirculatory disease (OR=1.5; 95% CI: 1.1-2.2), disorders of the locomotor system (OR=2.2; 95% CI: 1.5-3.1) and a history of falls (OR=1.9; 95% CI: 1.3-2.7).Approximately half of the interviewees expressed strong concern about falls. The factors associated with a fear of falling were a history of falls and certain clinical and sociodemographic characteristics. Most of the interviewees considered that falls had serious consequences but less than half believed that a large proportion of falls could be avoided.

Objetivo. Identificar factores asociados al consumo de tabaco en escolares de 1º de ESO. Diseño. Estudio analítico de casos y controles apareados por sexo (razón 1:3). Emplazamiento. Centros escolares pertenecientes a 16 zonas básicas de salud de Albacete y Ciudad Real. Participantes. Escolares de 1º de ESO seleccionados mediante cuestionario autocumplimentado. En la muestra participaron 146 escolares fumadores (casos) y 438 no fumadores (controles). Mediciones principales. Variables sobre consumo de tabaco en el entorno sociofamiliar, rendimiento escolar, consumo de alcohol, práctica deportiva y otras relacionadas con estilos de vida. Resultados. En los adolescentes fumadores fue significativamente superior (p < 0,001) la proporción de padres fumadores y con menor nivel de estudios, así como la de hermanos, amigos o profesores fumadores. El consumo de alcohol, la ausencia de práctica deportiva, mayor edad, mayor disponibilidad de dinero o menor número de asignaturas aprobadas fueron otros factores asociados (p < 0,01). Mediante regresión logística, las variables asociadas independientemente fueron: amigos fumadores (OR:11,3; IC95%:4,2-30,9), consumo de alcohol (OR:6,9; IC95%:3,1-15,1), ausencia de práctica deportiva (OR:3,3; IC95%:1,4-7,6), mayor edad (14-15 años) (OR:2,3; IC95%:1,2-4,6) y menor nivel de estudios del padre (OR:2,0; IC95%:1,1-3,9). Conclusiones. En el consumo de tabaco en adolescentes se identifican factores de exposición relacionados con el estilo de vida, tanto personal como de padres o amigos, entre ellos la presencia de fumadores en el entorno sociofamiliar o la menor dedicación a prácticas deportivas. Por otra parte, pueden ser también factores de riesgo algunas variables sociodemográficas como el menor nivel de estudios de los padres o la mayor edad del joven.

PURPOSE We wanted to design and validate the Hearing-Dependent Daily Activities (HDDA) Scale as a means of identifying the impact of hearing loss in older persons by measuring capacity to carry out hearing-dependent activities. METHODS We undertook a cross-sectional, observational study to validate a scale administered during a personal interview with 1,160 participants aged 65 years and older. When using the instrument to identify patients with hearing impairment, sensitivity and specificity were determined using an audiogram with Ventry and Weinstein criteria as the criterion standard. Standardized audiometries were performed blindly, without knowledge of results of the HDDA Scale. RESULTS According to the criterion standard, 506 participants had hearing impairment (43.6%; 95% confidence interval [CI], 40.8%–46.5%). The HDDA scale showed high internal consistency (Cronbach’s α =0.91). Regarding hearing impairment criteria, the HDDA scale obtained a sensitivity of 80.0% (95% CI, 76.3%–83.3%) and a specificity of 70.2% (95% CI, 66.5%–73.5%). CONCLUSIONS The HDDA scale constitutes a clinically useful instrument for identifying the impact of hearing loss on daily life in the elderly, a condition frequently overlooked during routine medical check-ups. This tool has acceptable psychometric properties and high internal consistency.

ResumenObjetivoDeterminar si hay asociación entre el miedo a caerse y el estado de salud, el antecedente de caídas previas y las características personales en una muestra representativa de personas de edad avanzada.MétodoEstudio observacional de prevalencia y asociación cruzada, de ámbito comunitario, realizado en Albacete, en 919 mayores de 65 años seleccionados utilizando muestreo aleatorio simple. Los participantes fueron interrogados (entrevista semiestructurada) sobre antecedentes de caídas, miedo a caerse, enfermedades y características sociodemográficas. Mediante análisis multivariado se comprobó la asociación del miedo a caerse con sus posibles factores condicionantes.ResultadosEl 26,3% de los entrevistados se había caído durante el año anterior, y manifestaron mucho miedo a caerse el 49,4% de todos los participantes. Una elevada proporción (78,9%) consideró muy importantes las consecuencias de las caídas, pero sólo para el 44,7% la mayoría podría evitarse. Las variables asociadas a un mayor miedo a caerse fueron el sexo femenino (odds ratio [OR]=5,5; intervalo de confianza del 95% [IC95%]: 3,9–7,6), tener más de 75 años (OR=2,0; IC95%: 1,5–2,8), ser analfabeto o que sólo lee/escribe (OR=1,5; IC95%: 1,1–2,1), ser consumidor de psicofármacos (OR=1,6; IC95%: 1,1–2,2), padecer enfermedades cardiocirculatorias (OR=1,5; IC95%: 1,1–2,2) o del aparato locomotor (OR=2,2; IC95%: 1,5–3,1) y tener antecedentes de caídas (OR=1,9; IC95%: 1,3–2,7).ConclusionesAproximadamente la mitad de los entrevistados manifiesta una gran preocupación por las caídas. Tanto los antecedentes de caídas como algunas características clínicas y sociodemográficas constituyen factores condicionantes del miedo a caerse. Para la mayoría constituyen un problema con importantes consecuencias, pero menos de la mitad considera que gran parte de las caídas son evitables.AbstractObjectiveTo determine the association between fear of falling and health status, a history of previous falls and personal characteristics in a representative sample of elderly people.MethodWe conducted an observational, cross-sectional prevalence study in the community setting in Albacete (Spain) of 921 people older than 65 years old selected through simple randomization. Participants underwent semi-structured interviews about their history of falls, fear of falling, illnesses and sociodemographic characteristics. Multivariate analysis was used to evaluate the association between fear of falling and its possible conditioning factors.ResultsIn the previous year, 26.3% of interviewees had fallen and 49.4% expressed a strong fear of falling. A high proportion (78.9%) considered the consequences of falls to be very serious, but only 44.7% believed that most of these falls could be prevented. The variables associated with a greater fear of falling were female sex (OR=5.5; 95% CI: 3.9–7.6), age more than 75 years old (OR=2.0; 95% CI: 1.5–2.8), illiteracy or lack of education beyond reading/writing skills (OR= 1.5; 95% CI: 1.1–2.1), taking psychotropic medication (OR=1.6; 95% CI: 1.1–2.2), and having cardiocirculatory disease (OR=1.5; 95% CI: 1.1–2.2), disorders of the locomotor system (OR=2.2; 95% CI: 1.5–3.1) and a history of falls (OR=1.9; 95% CI: 1.3–2.7).ConclusionsApproximately half of the interviewees expressed strong concern about falls. The factors associated with a fear of falling were a history of falls and certain clinical and sociodemographic characteristics. Most of the interviewees considered that falls had serious consequences but less than half believed that a large proportion of falls could be avoided.

In subjects with hypercholesterolaemia, cholesterol values remain above guideline levels. One of the limiting factors to the achievement of goals in such patients is therapeutic non-adherence. The aim of this study is to assess the effectiveness of an intervention designed to improve control of hypercholesterolaemic patients, consisting of a combined strategy that would include the delivery of printed information, treatment-compliance check cards and the dispatch of text messages as complementary measures in support of the intervention at the general practitioner’s practice. A randomised, parallel-group clinical trial will be conducted at the family medicine outpatient facilities of eight health centres in three of Spain’s Autonomous Regions (Comunidades Autonomas), covering a total of 358 subjects aged 18 years or over with diagnosis of hypercholesterolaemia. Patients in the intervention group will be supplied with printed material with information on the disease and its management, mobile-telephone text messages with guideline summaries, reminders of forthcoming appointments and/or arrangements for making new appointments in the event of non-attendance, and self-report cards to check compliance with recommendations. Both groups -intervention and control- will receive routine recommendations from their physicians in accordance with current European clinical practice guidelines for hypercholesterolaemia and cardiovascular risk management. As regards the measurements to be made, the main variable is the proportion of subjects who attain the low density lipoprotein cholesterol levels set as a target across a follow-up period of 24 months. The secondary variables are as follows: adherence to recommendations on lifestyle and adherence to drug treatment; variation in lipid profiles and cardiovascular risk levels; appearance of cardiovascular events; physical activity; food consumption; smoking habit; anthropometric measures; blood pressure; health problems; use of hypolipidaemic agents; socio-demographic data; beliefs and expectations about preventive recommendations; and degree of satisfaction with the combined strategy. Should this intervention prove effective, a recommendation could be issued on the application of this combined strategy to subjects with hypercholesterolaemia. It is a simple, relatively inexpensive intervention. ClinicalTrials.gov: NCT02314663 .

RESUMEN La fiebre y el dolor lumbar representan dos de los motivos más frecuentes de las consultas de Medicina de Familia. Es importante la realización de una historia clínica minuciosa, una exploración física detallada y una reevaluación periódica de los pacientes, siendo éstas herramientas principales para el médico de familia para poder establecer un diagnóstico diferencial y detectar la presencia de datos de alarma. Presentamos el caso de un paciente con fiebre y dolor lumbar, describiendo el proceso del diagnóstico, su tratamiento y el manejo coordinado entre Medicina de Familia y Medicina Interna.

RESUMEN Objetivo: Describir la frecuentación de los usuarios de consultas de Medicina de Familia y su relación con la calidad de vida relacionada con la salud, así como analizar los factores asociados a una mayor frecuentación. Métodos: Estudio multicéntrico observacional de carácter descriptivo realizado en 601 adultos que utilizaron las consultas de medicina de familia de cuatro Zonas Básicas de Salud de tres Áreas Sanitarias. La variable principal fue la frecuentación a consultas de medicina de familia en el último año. Otras variables fueron características sociodemográficas, problemas de salud (clasificación CIAP-2), consumo fármacos, calidad de vida (cuestionario EuroQol), características Zona Salud y visitas a medicina, enfermería y urgencias los tres años previos. Resultados: La media de visitas al médico de familia fue significativamente superior el año anterior (10,7±7,8) que los dos (8,7±7,5) y tres (8,1±7,0) previos (p

Background Studies have been conducted on supplementing the daily diet with plant sterol ester-enriched milk derivatives in order to reduce LDL-cholesterol levels and, consequently, cardiovascular risk. However, clinical practice guidelines on hypercholesterolaemia state that there is not sufficient evidence to recommend their use in subjects with hypercholesterolaemia. The main objective of this study is to determine the efficacy of the intake of 2 g of plant sterol esters a day in lowering LDL-cholesterol levels in patients diagnosed with hypercholesterolaemia. The specific objectives are: 1) to quantify the efficacy of the daily intake of plant sterol esters in lowering LDL-cholesterol, total cholesterol and cardiovascular risk in patients with hypercholesterolaemia; 2) to evaluate the occurrence of adverse effects of the daily intake of plant sterol esters; 3) to identify the factors that determine a greater reduction in lipid levels in subjects receiving plant sterol ester supplements. Methods/Design Randomised, double-blind, placebo controlled experimental trial carried out at family doctors' surgeries at three health centres in the Health Area of Albacete (Spain). The study subjects will be adults diagnosed with "limit" or "defined" hypercholesterolaemia and who have LDL cholesterol levels of 130 mg/dl or over. A dairy product in the form of liquid yoghurt containing 2 g of plant sterol ester per container will be administered daily after the main meal, for a period of 24 months. The control group will receive a daily unit of yogurt not supplemented with plant sterol esters that has a similar appearance to the enriched yoghurt. The primary variable is the change in lipid profile at 1, 3, 6, 12, 18 and 24 months. The secondary variables are: change in cardiovascular risk, adherence to the dairy product, adverse effects, adherence to dietary recommendations, frequency of food consumption, basic physical examination data, health problems, lipid-lowering medication, physical activity, smoking habits and socio-demographic variables. Discussion If plant sterol ester supplements were effective a sounder recommendation for the consumption of plant sterols in subjects with hypercholesterolaemia could be made. Trial Registration Current Controlled Trials NCT01406106.