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La dermatitis de craquelé o dermatitis asteatósica es una enfermedad cutánea caracterizada por piel eritematosa, pruriginosa, seca y agrietada, que afecta preferentemente a personas de edad avanzada, siendo el tipo de eccema más común en pacientes ancianos. Entre los factores que contribuyen a su aparición, destacan la edad, el clima estacional y los hábitos del baño, que pueden favorecer la alteración del estrato córneo y la aparición de fisuras. Palabras clave: eccema, prurito, envejecimiento.

To examine the performance of a novel low-cost, ultra-compact, and attractive auditory feedback device for training laypeople in external chest compressions (ECCs), we conducted a quasi-experimental cross-sectional study from September to November 2021 at the Faculty of Nursing of Albacete, University of Castille-La Mancha, Spain. The ECC sequence was performed in the laboratory with the new device for basic hands-on CPR training. Results: One hundred college students were included in this study. The compression rate/min with the new device was 97.6, and the adequate %ECC was 52.4. According to the status of body mass index (BMI) and muscle strength of the upper limbs in the bivariate analysis, it was observed that the new device discriminated between those who performed correct ECCs according to their BMI and muscle strength and those who did not, which led to significantly influenced results in terms of the percentage of ECCs with correct depth. Conclusions: The new ultra-compact auditory feedback device “Salvando a Llanetes®” demonstrated utility for teaching and learning ECCs in basic CPR. We can affirm that the analyzed device is an adequate, safe and economical method for teaching “CPR Hands-Only™” to the general population.

BACKGROUND: Adjacent segment degeneration (ASD) is a frequent complication following vertebral fusion procedures and is defined as the condition where patients recover after the initial procedure but develop compatible symptoms with radiological injuries in the segments adjacent to the fused ones at a later stage. The objective of the study was to describe the frequency and analysis of ASD related signs following a lumbar fusion procedure. METHODS: Observational descriptive retrospective study on patients with degenerative or instability conditions, operated on by posterolateral or circumferential lumbar fusion procedure. Pedicle screws, interbody peek cages (polyether-ether-ketone) and autologous bone graft were used. Clinical (pain and disability) and radiological (instability, rotation, disc height loss, radiological degeneration evaluated by X-ray and MR) variables were analysed. RESULTS: Postoperative disc height loss was observed in 159 free discs among 112 patients (42.6%) (95% CI: 36.4–48.8%). Anterior or posterior slippage (anterolisthesis or retrolisthesis) at the end of the follow-up period was observed in 33 patients (12.5%). Upper segment rotation increased in the postoperative period in 36 patients (13.6%). Radiological disc degeneration was observed in 107 discs among 72 patients, being more frequent in the immediate upper disc with grade 2 and 3 changes at the end of follow-up in 48 discs from 35 patients (13.6%) (95% CI: 13.4–23.1%). Radiological ASD signs were observed in 151 patients (57.4%; 95% CI: 51.2–63.6%) and 53 of them (20.2%; 95% CI: 15.1–25.2%) who also showed clinical ASD symptoms (clinical and radiological ASD). Degeneration changes with degrees IV and V shown by a preoperative and magnetic resonance (MR) study at end of the follow-up period performed in 73 patients (27.7%), were observed in 46 discs among 32 patients (43.8%) (95% CI: 31.8–55.9%). CONCLUSIONS: Radiological ASD signs evaluated in every free disc following a lumbar fusion procedure are observed with a variable frequency. All free discs after fusion were assessed as they could indicate mechanisms of compensation of lordosis loss and should be taken into consideration in a prospective revision surgery.

PURPOSE: We sought to compare the effectiveness of physical exercise with that of treatment with antidepressant drugs routinely used in clinical practice, in terms of decreasing depressive symptomatology in patients aged ≥65 years who present with clinical criteria of a depressive episode. METHODS: We conducted a randomized clinical trial in a primary care setting. A total of 347 patients aged ≥65 years with a clinically significant depressive episode were randomized to participation in a supervised physical exercise program or to receive antidepressant treatment by their general practitioners. RESULTS: Intention-to-treat analysis showed that the cumulative incidence of improvement in depressive symptomatology (Montgomery-Åsberg Depression Rating Scale score

The aim is to develop and validate a specific instrument for measuring satisfaction with anxiolytic and hypnotic drug treatment. We determined the questionnaire’s convergent validity with respect to clinical effectiveness, tolerance, and treatment adherence. An observational study was conducted in 171 patients being treated with anxiolytic/hypnotic medications. The questionnaire to assess Treatment Satisfaction with Anxiolytics and Hypnotics (TSAN) was evaluated for reliability, construct validity, and correlation with measurements conceptually related to the said construct. The average score on the TSAN questionnaire was 42.6 points (SD: 8.4), showing a moderate negative correlation with respect to scores obtained on the Goldberg Anxiety (−0.312) and Athens Insomnia (−0.419) scales. The TSAN questionnaire is valid and reliable. It constitutes a patient-centered measurement tool that complements clinical evaluation of the effectiveness of anxiolytic/hypnotic drug treatment.

Excessive alcohol consumption is a major public health issue that can negatively affect behavior among university students. The objective of this study was to estimate the frequency of alcohol consumption in nursing students as well as to describe the pattern of alcohol consumption after COVID-19 lockdown. A descriptive, cross-sectional observational study was carried out, in which 1162 degree-level nursing students were evaluated. Sociodemographic characteristics, lifestyles and levels of physical activity were determined using the International Physical Activity Questionnaire: Short Form (IPAQ-SF), and alcohol consumption was determined using the ISCA (Systematized Alcohol Consumption Questionnaire) and AUDIT (Alcohol Use Disorders Inventory Test) questionnaires. According to the AUDIT questionnaire, 36.7% of the students met the criteria for excessive alcohol consumption (26.8% men vs. 39.9% women; p < 0.001). The prevalence of hazardous drinkers was found to be 10.2% (95% CI 5.6–11.7), with the difference between men and women being statistically significant. The IPAQ-SF questionnaire indicated that 26.1% of students were sedentary. No relationship was observed between alcohol consumption and the level of physical activity. The frequency of hazardous drinkers was significantly higher in women (OR: 2.2) and in smokers (OR: 4.2). In conclusion, approximately 10% of nursing students can be considered hazardous drinkers, with significant differences between the sexes. The percentage is higher in women and in smokers. Strategies should be created that encourage healthy lifestyles, emphasizing preventive activities against excessive alcohol consumption. Furthermore, given the differences in excessive alcohol consumption between men and women, it would be advisable to include the gender perspective in these activities.

Resumen: Objetivo: Describir la producción científica española de atención primaria durante 2013-2017, analizando su distribución geográfica, factor de impacto, áreas de investigación y participación de diferentes sectores institucionales. Diseño: Estudio observacional bibliométrico. Participantes: Publicaciones indexadas en Medline. Mediciones principales: Revista y año de publicación, primer/último autor, centro de trabajo y comunidad autónoma. Se clasificaron los artículos según su contenido. El factor de impacto fue obtenido de la base de análisis bibliométrico Journal Citation Reports. Resultados: Incluidos 980 documentos. El índice de transitoriedad fue 78,8%. La mayoría de los artículos (43,2%) procedía de centros de salud, originados en unidades o institutos de investigación, desde 14,9% en 2013 hasta 19,1% en 2017. El 63,3% se clasificaron como «aspectos clínicos». El 19,3% fueron publicados en la revista Atención Primaria, el 40,6% en revistas extranjeras y el 72,4% en revistas con factor de impacto, siendo esta proporción significativamente inferior (p

Highlights • Proximal junctional kyphosis in adolescent idiopathic scoliosis is frequent. • Poor visualization of the sagittal plane leads to incorrect identification of curve type. • Residual or progressive symptomatic kyphosis may require surgical treatment. • Pedicle subtraction osteotomy may be an effective corrective technique., Introduction Complications in the upper thoracic spine are not uncommon after corrective surgery for deformities in adults and adolescents. Proximal junctional failure has been linked to structural osseous or ligamentous failure and proximal junctional kyphosis has been described as an increase in preoperative proximal kyphosis. Case description A 20-year-old male patient intervened after atypical development of idiopathic scoliosis, with rapid progression nearing skeletal maturity. While an increase in the magnitude of the main thoracic curve in the coronal plane was observed, the progression of structural sagittal plane deformity of the proximal thoracic curve was not identified due to poor visualization. This resulted in improper identification of curve type and choice of fusion levels, with progressive residual kyphosis across follow-up. At the age of 27, the patient was re-intervened by means of pedicle subtraction osteotomy in the apical area of the proximal thoracic deformity. Although an adequate correction was achieved, the remaining deformity of 50° and the proximal failure required extending the instrumentation and fusion to the cervical spine. This has shown itself to be an effective technique for correction of proximal residual or progressive symptomatic fixed kyphosis, thereby avoiding the morbidity of the anterior or combined approaches. Conclusions In adolescent deformity, an adequate preoperative planning including clinical and radiological study must be carried out, paying special attention to the sagittal plane to identify major and minor structural curves. The pedicle subtraction osteotomy, despite being a demanding technique and not entirely risk-free, has shown itself to be an effective corrective technique.

Breast milk is the optimal food during the first months of life. The main objective was to analyse the factors associated with not initiating breastfeeding in terms of maternal lifestyles, epidemiological characteristics and information on breastfeeding. Observational analytical study of cases and controls in 6 primary care centres. The sample included women with a child under 5 years, with an estimated necessary sample size of 166 cases (women who did not initiate breastfeeding) and 166 controls (women who began breastfeeding). Sociodemographic and maternal lifestyle variables were measured before and during pregnancy, such as physical activity using the BPAAT questionnaire, diet with the MEDAS-14 questionnaire, and tobacco and alcohol consumption. We assessed the information and opinions about breastfeeding as well as previous experience with it. The study included 348 women (174 cases and 174 controls) with a mean age of 33.4 years (SD, 5.4). The variables independently associated with not initiating breastfeeding were: absence of previous experience with breastfeeding (odds ratio [OR], 12.75), making the decision during pregnancy or delivery (OR, 10.55), not being married or in a partnership (OR, 3.42) and being sedentary for periods of 2 hours or greater/day during pregnancy (OR, 1.77). In our study, the determining factors associated with not initiating breastfeeding were the lack of previous experience with breastfeeding, the timing of the decision about breastfeeding, and marital status. When it came to lifestyle, only a sedentary lifestyle was associated with not initiating breastfeeding, while dietary or other habits had no influence.

Las pápulas perladas del pene (PPP) son lesiones benignas de aspecto blanquecino perlado que se encuentran alrededor de la corona del glande. A pesar de ser asintomáticas y benignas por naturaleza, la aparición de PPP puede causar un gran malestar psicológico tanto al paciente como a su pareja sexual, por lo que se trata de un motivo de consulta frecuente en Atención Primaria por parte de hombres jóvenes. Presentamos el caso de un joven de 22 años que consultó por hallazgo casual de lesiones indoloras en el glande. Debido a que es importante tranquilizar al paciente respecto a la naturaleza de la lesión, resulta fundamental para la médica o médico de familia conocer su localización y su aspecto típico. Palabras clave: enfermedades del pene, pene, genitales masculinos.

A cross-sectional study was conducted to evaluate 199 health sciences students in the city of Iquitos. Their socio-demographic characteristics, lifestyle, level of physical activity, type of food, substance abuse, and prevalence of overweight and obesity were ascertained using purpose-validated questionnaires, i.e., the Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado de Consumos Alcoh&oacute, licos/ISCA), a questionnaire on the frequency of dietary intake (CFCA), the International Physical Activity Questionnaire (IPAQ), and anthropometric measurements. The prevalence of overweight (body mass index (BMI) of 25.0&ndash, 29.9 kg/m2) was 26.5% (95% CI = 19.9&ndash, 33.0%) and that of obesity (BMI &ge, 30.0 kg/m2) was 7.9% (95% CI = 3.8&ndash, 12.1%). A total of 34.4% of students (95% CI = 27.4&ndash, 41.4%) presented with a BMI &gt, 25 kg/m2. The frequency of overweight was significantly higher in persons aged over 20 years (OR = 2.5) and smokers (OR = 3.2), and the frequency of obesity was significantly higher in older students (OR = 4.1) and males (OR = 5.5). In conclusion, a considerable proportion of health sciences students in the Amazonia region presented with a high BMI. The proportion of students with overweight was higher among students aged over 20 years and smokers, while that of obesity was also higher among males. In the university setting, the development of more overweight- and obesity-preventive activities and educational interventions would therefore be desirable.

Aims Analyse the compliance of criteria recommended by the European Resuscitation Council (ERC) in the layperson First Aid (FA) and Cardiopulmonary resuscitation (CPR) books published in Spanish. Methods A review of FA literature published in Spain, carried out through a systematic literature search procedure. We drew up a checklist with clarifications, based on different responses to twenty categories published in November 2015 by the ERC. The validity of the questions was analysed using the Fleiss’ Kappa measure of inter-rater reliability, with a value >0.7 being deemed valid and questions displaying the lowest level of agreement being excluded. Results Eight texts obtained from the limited search of materials published between 2016–2020 in the ISBN 13 database were analysed. Evaluation of eight texts ranging from 47 to 328 pages in length showed that only three included the upgraded 2015 CPR recommendations. Twenty categories/items were analysed, after exclusion of categories/items that displayed a low consistency. None of the handbooks was in total compliance with the new CPR recommendations, and only one included 70% of the recommendations. Seven categories were included in more than 50% of the texts, and nine categories were not included in any of them. Conclusions There is a gap between the 2015 CPR recommendations and those published in Spanish FA handbooks. The ERC Guidelines should serve to standardise FA and CPR training materials. Systematic analysis of compliance with scientific societies’ recommendations for FA handbooks enables detection of guidelines and patterns that need to be updated and adapted.

Background: We carried out an observational longitudinal retrospective study between 2000 and 2009 in 28 patients who underwent surgery for unstable vertebral fractures with neurologic deficits. Methods: For the statistical analysis, we used the Chi 2 -test to compare proportions in independent groups and the exact Fisher test and the Wilcoxon test for repeated measures, and we compared the mean values using the Mann-Whitney U test at a significance level of P vs . >8 h), and neurologic status using the American Spinal Injury Association (ASIA) Impairment Scale at baseline and at the end of follow-up were assessed. We tested the ASIA score improvement at the end of follow-up using multiple regression analysis, adjusted by variables such as ISS, timing of intervention, location, approach and type of fracture. Results: Twenty-eight patients were included in the analysis. Of the total, 11 (39.2%) underwent surgery urgently (≤8 h) and 17 (60.8%) in >8 h. The mean difference in the neurologic improvement in all patients was 0.97 (95% CI, 0.51–1.42) and was statistically significant (P=0.001). The mean difference in the neurologic improvement in patients with incomplete lesions was 1.59 (95% CI, 1.01–2.17, P=0.001). In these patients, the mean improvement for those intervened in less than 8 h was 1.73 compared to those operated on after more than 8 h (mean improve 0.47) with a difference statistically significant (P=0.007). Conclusions: Urgent surgery was associated with neurologic improvement in patients with spinal cord injury (SCI). This improvement was mainly observed in patients with an incomplete lesion.

Resumen Contexto Paciente diagnosticada de sindrome de Klippel-Trenaunay (SKT) que acude a su medico de familia para solicitar asesoramiento genetico reproductivo. El SKT constituye una patologia congenita caracterizada por malformaciones vasculares (sistema arterial, venoso y linfatico) y alteraciones en el crecimiento de hueso y/o tejidos blandos, comunmente de forma unilateral. Debido a las posibles anomalias vasculares y complicaciones tromboticas, el riesgo obstetrico puede elevarse y el embarazo estar desaconsejado. Presentacion del caso Paciente de 31 anos con deseo gestacional, diagnosticada de SKT en la infancia y de artritis reumatoide en la adolescencia. Desde el centro de salud se realizo una interconsulta a Asesoramiento Genetico. Dada la presentacion esporadica del sindrome y la dificultad para calcular el riesgo de recurrencia, no se planteo objecion al embarazo, aunque si se recomendo tratamiento anticoagulante con caracter profilactico. Tras dificultad para la concepcion, se objetivo una reserva ovarica disminuida, probablemente relacionada con la artritis reumatoide. Se procedio a una fecundacion in vitro, la cual resulto exitosa. Conclusion Ante las consultas de pacientes con enfermedades raras que pueden tener un componente genetico-hereditario, como sucede en el SKT, el medico de familia debe disponer de adecuados circuitos de derivacion a unidades de asesoramiento genetico.

Highlights • Primary vertebral leiomyosarcoma in thoracic spine is extremely rare. • Metastatic origin must be excluded. • Wide surgical excision can result in local tumor control and long-term survival., Introduction To describe an unusual primary vertebral leiomyosarcoma in thoracic spine. Presentation of case An isolated lesion of the T11 vertebra in a 62-year-old woman with no neurologic deficit is reported. Imaging findings indicated a nonspecific high-grade malignant lesion. TC-guided biopsy failed thus open incisional biopsy was needed. A diagnosis of low-intermediate mesenchymal sarcoma was made. A total en bloc spondylectomy of T11 was performed with three-column reconstruction. The histology and immunostaining showed the appearance of leiomyosarcoma. After diagnosis, post-operative radiation therapy was performed. Metastatic lesion was ruled out by CT scans of the chest, abdomen and pelvis, in addition to total body radionuclide scanning and 18-F-FDG-PET. After five years of follow-up, no signs of local recurrence, metastasis or distant lesions suggesting a primary lesion were observed. Discussion Vertebral primary leiomyosarcoma is exceedingly rare. Primary vertebral leiomyosarcoma diagnosis must be performed when the metastatic origin is excluded. For the treatment of primary tumors, total en bloc spondylectomy (TES) is the technique of choice to achieve marginal or wide tumor resection, decrease the risk of local recurrence and remote lesions and increase survival. Conclusions A well-planned pre-operative study and a wide surgical excision can result in local tumor control and long-term survival. This case presents the longest disease-free survival period of a primary leiomyosarcoma in spinal location after total en bloc spondylectomy.

ResumenObjetivoDescribir la situación funcional y la autopercepción de salud de los pacientes con osteoartritis (OA) en atención primaria, comprobando su relación con el nivel de actividad física y las características sociodemográficas.DiseñoEstudio de prevalencia y asociación cruzada.EmplazamientoConsultas de medicina de familia.ParticipantesPacientes adultos diagnosticados en su historia clínica de OA de cualquier localización articular. De un total de 487, participaron 346 (71,0%).Mediciones principalesCapacidad funcional (escala WOMAC), nivel de autopercepción de salud (cuestionario EuroQoL-5D), nivel de actividad física (cuestionario IPAQ), número de articulaciones afectadas, nivel de dolor (EVA) y características sociodemográficas.ResultadosEn la escala WOMAC se obtuvo una puntuación media de 30,2 (DE: 20,8; IC95%: 28,0-32,4), correspondiendo a dolor, rigidez y capacidad funcional puntuaciones de 6,5 (DE: 4,8), 1,9 (DE: 2,0) y 21,7 (DE: 15,7), respectivamente. La puntuación presentó una tendencia lineal (p

Resumen Introduccion Estimar la prevalencia del consumo de ansioliticos e hipnoticos referido por los mayores de 65 anos e identificar posibles factores condicionantes del citado uso. Material y metodos Estudio transversal. La poblacion de estudio fue de 1.161 sujetos de ≥65 anos no institucionalizados con suficiente capacidad para llevar a cabo una entrevista personal. Seleccion mediante muestreo aleatorizado simple del listado de tarjeta sanitaria. Las principales variables evaluadas incluyeron: consumo referido de ansioliticos/hipnoticos y otros farmacos (segun el sistema de clasificacion ATC), estado animico (GDS-VE), estado cognitivo (cuestionario Pfeiffer), valoracion fisica-funcional sobre actividades basicas de la vida diaria (indice de Katz), problemas de salud (clasificacion CIAP-2 de la WONCA) y variables sociodemograficas. Resultados La prevalencia de uso referido de ansioliticos/hipnoticos fue del 16,6% (IC 95%: 14,5-18,7). El 90,5% fueron benzodiacepinas (BZD), fundamentalmente lorazepam (39,4% de las BZD). Las BZD de vida media prolongada supusieron el 24,7% de todas. Los hipnoticos representaron el 27,5% de los ansioliticos/hipnoticos. El uso de ansioliticos/hipnoticos se asocio independientemente con consumir otros farmacos no psicotropicos (OR: 6,8; IC 95%: 2,1-22,0), presentar depresion establecida (OR: 2,5; IC 95%: 1,0-5,9), presentar 4 o mas problemas de salud (OR: 2,0; IC 95%: 1,4-2,9), ser mujer (OR: 2,1; IC 95%: 1,5-3,1) y ser dependiente para las actividades basicas de la vida diaria (OR: 1,8; IC 95%: 1,1-2,9). Conclusiones La prevalencia de uso de ansioliticos/hipnoticos es elevada en mayores de Albacete. Diversos factores han sido identificados como potenciales condicionantes de su utilizacion. Seria importante mejorar el conocimiento sobre el mal uso de estos farmacos con el fin de desarrollar estrategias de prescripcion efectivas y seguras.

Resumen El mesotelioma maligno es un tumor agresivo de superficies serosas cuya frecuencia esta aumentando en todo el mundo, probablemente en relacion con la exposicion extendida de la poblacion a asbesto, principal factor de riesgo con el que se ha asociado. El tratamiento actual incluye: cirugia (pleurectomia o neumonectomia extrapleural) seguida de radioterapia, aunque recientemente se ha anadido el uso de quimioterapia. El tratamiento paliativo puede contribuir a mejorar la calidad de vida y a alcanzar un buen control sintomatico durante anos tras el diagnostico. A continuacion presentamos un caso representativo de mesotelioma.

Background: A course in family medicine (FM) could dispel the possibility of negative stereotyping about this speciality, and instil in students a greater interest. However, when is it preferable: at the beginning or at the end of undergraduate training? Objectives: To determine changes in knowledge and attitudes towards FM by medical students completing a course in primary care at the beginning or the end of the undergraduate training and whether those changes anticipate the choice of speciality. Methods: Students from Albacete and Seville medical schools (primary care course in second and sixth years, respectively) were asked to respond to the ‘valuation of attitudes towards and knowledge of family medicine questionnaire’ (CAMF). Students from Albacete answered before and after the course, and in Seville second-year students answered at the end of the first trimester. All students were invited to respond again at the end of their undergraduate training. Afterwards, we investigated the score on the speciality exam (order for the election from highest to lowest score) and their choice of speciality. The outcome measures were the MIR exam score, the number in the ranking, the chosen speciality and the result of the CAMF. Results: In Albacete 88 and 64 and in Seville 50 and 98 students responded in their second and sixth years, respectively. In Albacete, mean CAMF scores were 15.4, 22.7 before and after the course, and 21.8 at the end while in Seville, 13.9 in the second year, and 23.5 in the sixth year. Logistic regression analysis showed an association of the choice of FM only with the score on the speciality exam (OR: 0.667; 95%CI: 0.553–0.806). Conclusion: There were no significant differences between CAMF scores at the end of undergraduate training. Only the score on the speciality exam predicts FM choice: the higher the score, the lower the probability of choosing FM.

Although currently available evidence suggests that physical exercise can be beneficial for depressed patients and might be comparable to antidepressant treatment, the best way of implementing this recommendation in clinical practice is not known. This study therefore aims to ascertain the non-inferiority of supervised physical exercise to antidepressant drug treatment, in terms of reducing depressive symptoms among patients presenting with clinical criteria of a depressive episode (ICD-10), across a follow-up period of 6 months. It will take the form of a randomised clinical trial undertaken in a primary care setting, in which a total of 312 patients over the age of 65 years with clinically significant depression will be randomly assigned to supervised physical exercise programme, or will alternatively receive treatment with antidepressant drugs habitually used in clinical practice. Participants’ physical condition will be assessed at baseline, and again at 15 days and 1, 3 and 6 months. The supervised exercise programme will consist of 2 weekly sessions in groups of 10–12 patients across a period of 6 months, in which a sports instructor will train patients to do at least 30 min of regular activity at moderate intensity on an almost daily basis, including aerobic, muscle-strengthening, flexibility, and balance-strengthening exercises. The following will be assessed at regular intervals in both groups: status of depression symptoms; level of physical activity; self-perceived health status; appearance of adverse effects; and adherence to the physical exercise programme or antidepressant treatment. The principal outcome variable will be a reduction in pre-treatment depression-symptom scale scores (Montgomery-Asberg Depression Rating Scale and Geriatric Depression Scale). In terms of the number of patients and duration of follow-up, this proposed clinical trial is a project which easily surpasses the few studies on this subject that have been previously conducted on the elderly. Its aim is to provide solid scientific evidence on a therapeutic resource -physical exercise- which has undeniable health benefits and can be applied to certain health problems, such as depressive disorders, which are of great magnitude and considerable socio-economic relevance, and have a significant impact on the quality of life of older adults. ClinicalTrials.gov NCT03358433 (retrospectively registered on 11/25/2017).

Object: Adjacent segment disease (ASD) has been described as a frequent complication after a lumbar spinal fusion procedure, though its incidence and the factors related to its appearance are not well established. The radiographic signs that identify ASD in unfused segments may be a consequence of biomechanical changes induced by the fusion procedure. This study sought to analyse the incidence of radiographic changes (radiographic ASD) in all adjacent unfused segments, the clinical changes that require a second procedure (clinical ASD), and the risk factors of their appearance evaluated at different follow-up times. Methods: We conducted a retrospective cohort study of patients fused for degenerative spine disease and instability to analyse ASD risk factors using actuarial estimation, comparison of the Kaplan-Meier survival curves of each variable, and Cox proportional-hazards regression analysis. Results: Among the 263 patients included in the study, radiographic changes were observed in 57.4% and related clinical changes in 20.2%. The univariate analysis showed a higher risk of ASD in patients with smaller post- vs. pre-operative lumbar lordosis (p = .018), diagnosis of lumbar canal stenosis (p = .019), fusion of three or more vs. fewer levels (p = .009) and those fixed with top-loading screws vs. side-connecting screws (p = .001). Cox proportional-hazards regression analysis showed that the use of top-loading pedicle screws and three or more levels of fusion led to a 3- and 2-fold higher risk of degeneration in adjacent unfused segments respectively. Conclusions: Risk of a second surgical procedure due to clinical changes is 3-fold higher in patients with three or more levels of fusion, and 2.5-fold higher in patients intervened with top-loading pedicle screws.

Resumen: Objetivo: Describir la calidad de vida relacionada con la salud (CVRS) en consumidores de benzodiacepinas y comprobar si existe asociación con las características del tratamiento, su efectividad y las variables sociodemográficas. Diseño: Estudio descriptivo de carácter transversal. Emplazamiento: Consultas de medicina de familia. Participantes: Cuatrocientos cincuenta y dos pacientes mayores de 18 años consumidores de benzodiacepinas o fármacos análogos. Mediciones principales: La CVRS se evaluó mediante el cuestionario EuroQol-5D. Otras variables: síntomas de ansiedad o insomnio, variables sociodemográficas y características del tratamiento. Resultados: La puntuación media ± desviación estándar en el estado de salud fue de 62,80 (IC del 95%: 60,69-64,86), inferior en personas sin estudios (59,27 ±21,97; p = 0,004) y menor categoría social (60,02 ± 21,27; p < 0,001). En cuanto a la tarifa social (índice EQ) se obtuvo una puntuación media de 0,6025 (IC del 95%: 0,5659-0,6391), superior en personas con mayor escolarización (0,6577 ± 0,3574; p = 0,001), más categoría social (0,7286 ± 0,3381; p < 0,001) y edad inferior a 65 años (0,6603 ± 0,3426; p < 0,001). Las variables que mediante regresión múltiple se asociaron con el valor del índice EQ fueron ausencia de ansiedad/insomnio, pertenencia a clases sociales superiores, edad menor de 65 años y menor consumo de ansiolíticos/hipnóticos. Conclusiones: Los pacientes consumidores de benzodiacepinas manifiestan, a pesar del tratamiento, una moderada CVRS, inferior a la obtenida en población general o en pacientes de atención primaria. La situación es más favorable en los de menor edad, en quienes no presentan ansiedad/insomnio, en pertenecientes a clases sociales superiores y cuando el consumo de fármacos es menor. Abstract: Objective: To describe the health-related quality of life (HRQoL) in benzodiazepine users and to verify whether there is an association with the characteristics of the treatment, its effectiveness, and the sociodemographic variables. Design: Descriptive cross-sectional study. Location: Family medicine consultations. Participants: Four hundred and fifty 2 patients over 18 years of age consuming benzodiazepines or similar drugs. Main measurements: HRQoL was assessed using the EuroQol5-D questionnaire. Other variables: symptoms of anxiety or insomnia, sociodemographic variables and characteristics of the treatment. Results: The mean score in health status was 62.80 (95% CI: 60.69–64.86), lower in people without studies (59.27 ± 21.97 SD; P=.004) and lower social category (60.02 ± 21.27 SD; P

CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option.

Introduction and objectives Plant stanol consumption may improve long-term cholesterol control. The aim of the present study was to evaluate the effectiveness of 2 g/day of plant stanols in reducing low-density lipoprotein cholesterol levels in patients with hypercholesterolemia. Methods This randomized, double-blind, and placebo-controlled study included 182 adults diagnosed with hypercholesterolemia. A yogurt drink containing 2 g of plant stanols was administered to 91 participants in the intervention group; 91 participants in the control group received unsupplemented yogurt. The primary end point was the change in the lipid profile at 12 months. Results Low-density lipoprotein cholesterol levels at 12 months were significantly more reduced in the stanol intervention group than in the control group: 13.7 (95% confidence interval, 3.2-24.1) mg/dL ( P = .011). A reduction of more than 10% in low-density lipoprotein cholesterol was achieved by a significantly higher proportion of participants in the intervention group (relative risk = 1.7; 95% confidence interval, 1.1-2.7). In this group, the mean (standard deviation) level of low-density lipoprotein cholesterol decreased by 11.0% (23.9%). Conclusions Our results confirm that administration of plant stanols at a dosage of 2 g/day for 12 months significantly reduces (by slightly more than 10%) the concentrations of low-density lipoprotein cholesterol in individuals with hypercholesterolemia. Trial registration ( www.ClinicalTrials.gov ): Current Controlled Trials NCT01406106.

Resumen Introduccion y objetivos El consumo de estanoles vegetales puede contribuir a un mejor control a largo plazo del colesterol. El objetivo es evaluar la eficacia del aporte de estanoles vegetales, a dosis de 2 g/dia, en la reduccion de las cifras de colesterol unido a lipoproteinas de baja densidad de los pacientes con hipercolesterolemia. Metodos Se realizo un ensayo clinico aleatorizado, a doble ciego y controlado con placebo, en el que se incluyo a 182 sujetos adultos diagnosticados de hipercolesterolemia. Se administro yogur liquido con 2 g de estanoles vegetales a 91 sujetos del grupo intervencion y yogur no suplementado a 91 del grupo control. La variable principal fue la variacion del perfil lipidico a los 12 meses. Resultados En comparacion con el placebo, a los 12 meses se observo una disminucion significativamente superior del colesterol unido a lipoproteinas de baja densidad en el grupo que tomo estanoles: 13,7 (intervalo de confianza del 95%, 3,2-24,1) mg/dl (p = 0,011). En este grupo fue significativamente superior la proporcion de sujetos que redujeron en mas del 10% sus cifras de colesterol unido a lipoproteinas de baja densidad (riesgo relativo = 1,7; intervalo confianza del 95%, 1,1-2,7). En el grupo tratado, el colesterol unido a lipoproteinas de baja densidad descendio, en promedio, un 11,0 ± 23,9%. Conclusiones Los resultados confirman que la administracion de estanoles vegetales en dosis de 2 g/dia durante 1 ano produce una reduccion significativa (ligeramente superior al 10%) de las concentraciones de colesterol unido a lipoproteinas de baja densidad en sujetos con hipercolesterolemia. Registro del ensayo ( www.ClinicalTrials.gov ): Current Controlled Trials NCT01406106.

Introducción: La incapacidad temporal (IT) constituye un proceso de origen multifactorial. Objetivo: Evaluar el proceso de IT en relación con la enfermedad, estado de salud, satisfacción laboral, perfil de locus de control y características sociodemográficas. Método: Estudio observacional de cohortes prospectivo sobre 404 pacientes en IT. Realizamos un análisis de supervivencia describiendo la evolución de los participantes en cuanto a su permanencia en IT. Resultados: La permanencia media en IT fue significativamente superior (p