Usefulness of a national hip fracture registry to evaluate the profile of patients in whom antiosteoporotic treatment is prescribed following hospital discharge.

This study was carried out to describe the profile of prescription of antiosteoporotic treatment at discharge after a hip fracture in the Spanish National Hip Fracture Registry. Prescription rates among hospitals ranged from 0 to 94% of patients discharged. The prescription rate was higher among patients with better cognitive and functional baseline status. PURPOSE: National hip fracture registries are useful for assessing current care processes. The goals of this study were as follows: first, to know the rate of antiosteoporotic prescription at discharge among hip fracture patients in hospitals participating in the Spanish National Hip Fracture Registry (RNFC); second, to compare the differences between treated and non-treated patients; third, to analyze patients' characteristics associated with antiosteoporotic prescription at discharge; and fourth, to evaluate whether there were differences in the profile of patients discharged from hospitals with high and low prescription rates. METHOD: Patients discharged after a fragility hip fracture in 2017 and participating in the RNFC were included. Demographic variables, cognitive and functional status, prefracture osteoporosis treatment, fracture type, anesthetic risk, hospital volume, and antiosteoporotic prescription at discharge were analyzed. Given that patients were clustered within hospitals, intraclass correlation was calculated and generalized estimating equations were fitted. RESULTS: A total of 6701 patients from 54 hospitals were included. Antiosteoporotic prescription at discharge was prescribed to 36.5% (CI95% 35.8-37.2%), with a wide inter-hospital variability (range 0-94%). The intraclass correlation due of clustering of patients within hospitals was 47.9%. Antiosteoporotic prescription was more likely in patients who were younger, lived at home, previously treated for osteoporosis, had better baseline functional and cognitive status, lower anesthetic risk, and were discharged from high-volume hospitals, all with p < 0.001. The general profile of patients discharged from hospitals with high and low rate of prescription was similar. CONCLUSIONS: There is a wide variability between hospitals regarding antiosteoporotic prescription after hip fracture. This is more likely to be initiated in patients with better clinical, functional, and mental status and in those discharged from hospitals with larger volumes of patients. These results offer insights regarding the selection of patients receiving secondary prevention and raises questions on who and how many should be treated.

Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries.

Hip fracture registries have helped improve quality of care and reduce variability, and several audits exist worldwide. The results of the Spanish National Hip Fracture Registry are presented and compared with 13 other national registries, highlighting similarities and differences to define areas of improvement, particularly surgical delay and early mobilization. INTRODUCTION: Hip fracture audits have been useful for monitoring current practice and defining areas in need of improvement. Most established registries are from Northern Europe. We present the results from the first annual report of the Spanish Hip Fracture Registry (RNFC) and compare them with other publically available audit reports. METHOD: Comparison of the results from Spain with the most recent reports from another ten established hip fracture registries highlights the differences in audit characteristics, casemix, management, and outcomes. RESULTS: Of the patients treated in 54 hospitals, 7.208 were included in the registry between January and October 2017. Compared with other registries, the RNFC included patients ≥ 75 years old; in general, they were older, more likely to be female, had a worse prefracture ambulation status, and were more likely to have extracapsular fractures. A larger proportion was treated with intramedullary nails than in other countries, and spinal anesthesia was most commonly used. With a mean of 75.7 h, Spain had by far the longest surgical delay, and the lowest proportion of patients mobilized on the first postoperative day (58.5%). Consequently, development of pressure ulcers was high, but length of stay, mortality, and discharge to home remained in the range of other audits. CONCLUSIONS: National hip fracture registries have proved effective in changing clinical practice and our understanding of patients with this condition. Such registries tend to be based on an internationally recognized common dataset which would make comparisons between national registries possible, but variations such as age inclusion criteria and follow-up are becoming evident across the world. This variation should be avoided if we are to maximize the comparability of registry results and help different countries learn from each other's practice. The results reported in the Spanish RNFC, compared with those of other countries, highlight the differences between countries and detect areas of improvement, particularly surgical delay and early mobilization.

Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design.

BACKGROUND: Physical activity may reverse frailty in the elderly, but we encounter barriers to the implementation of exercise programs in this population. Our main aim is to evaluate the effect of a multicomponent physical activity program, versus regular medical practice, on reverting pre-frailty status among the elderly, 12 months post-intervention. METHODS: Randomized parallel group multicenter clinical trial located in primary care setting, among non-dependent and pre-frail patients > 70 years old, including 190 patients (95 intervention, 95 control group). INTERVENTION: Multicomponent physical activity program (MEFAP, for its acronym in Spanish) with twelve 1.5 h-weekly sessions comprised of: 1. Informative session; 2. Exercises for improving aerobic resistance, muscle strength, propioception-balance and flexibility; and 3. Handing out of at-home exercise chart (twice/week). Main variable: pre-frailty according to the Fried phenotype. Secondary variables: sociodemographic, clinical and functional variables; exercise program adherence, patient satisfaction with the program and quality of life. We will perform an intention-to-treat analysis by comparing the retrogression from pre-frailty (1 or 2 Fried criteria) to robust status (0 Fried criteria) by the end of the intervention, 6 months and 12 months post-intervention. The accumulated incidence in each group will be calculated, as well as the relative risk (RR) and the number needed to treat (NNT) with their corresponding 95% confidence intervals. Protocol was approved by the Ethics Committee Hospital la Paz. DISCUSSION: Within the context of regular clinical practice, our results will provide evidence regarding the effects of exercise interventions on frailty among pre-frail older adults, a key population given their significant potential for functional, physical, and mental health improvement. TRIAL REGISTRATION: NCT03568084 . Registered 26 June 2018. Date of enrollment of the first participant to the trial: July 2nd 2018.

Baseline and 1-year follow-up differences between hip-fracture patients admitted from nursing homes and the community. A cohort study on 509 consecutive patients (FONDA Cohort).

OBJECTIVE: To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients. METHODS: All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status. RESULTS: A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001). CONCLUSIONS: Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently.

Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation.

OBJECTIVE: To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. DESIGN: Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. STUDY SCOPE AND SUBJECTS: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. RESULTS: It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition.

Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort.

PURPOSE: To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences. METHODS: 3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality. RESULTS: Mortality rate was 26.38 cases per 1000patient-years (95% CI, 23.92-29.01), with higher rates in men (28.43 per 1000patient-years; 95% CI, 24.87-32.36) than in women (24.31 per 1000patient-years; 95% CI, 21.02-27.98) (p=0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8-76.6), 28.4 (95% CI, 22.9-34.9), 24.8 (95% CI, 21.5-28.5), 21 (95% CI, 16.3-26.6) and 23.7 (95% CI, 14.3-37) per 1000person-years for participants with a BMI of <23, 23-26.8, 26.9-33.1, 33.2-39.4, and >39.4kg/m2, respectively. The BMI values associated with the highest all-cause mortality were <23kg/m2, but only in males [HR: 2.78 (95% CI, 1.72-4.49; p<0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64-2.04; p=0.666)] (reference category for BMI: 23.0-26.8kg/m2). Higher BMIs were not associated with higher mortality rates. CONCLUSIONS: In an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.

Factors associated with health care utilization by the elderly in a public health care system.

OBJECTIVE: The objective was to determine the factors associated with the use of health care services by the elderly residing in the community. METHODS: A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status. RESULTS: The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41). CONCLUSIONS: Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.

[Main errors in the discharge report and in the registry book of a hospital]. / Análisis de los principales errores que se producen en el informe de alta y en el libro de registro de un hospital.

BACKGROUND: The registration book for admission and discharge of patients was the basis of a survey of hospital morbidity and the main source of information concerning the diseases attended in the hospitals in Spain. The aim of this study was to evaluate the quality of this information from the data of a hospital with a computerized patient registration system. METHODS: The sample collected from the registration book in 1985 by the National Institute of Statistics studied three types of errors: the main error being selection of diagnosis, coding and transcription of the principal diagnosis, and comparison of data contained in the patient discharge form. RESULTS: In the 896 releases studied an error oscillating between 1 and 2% was found in transcription. The principal diagnosis had been erroneously selected in 26% of the reports with more than one diagnosis. Important coding errors were found in 11%. Transfer between different hospital wards or death were variables found to increase the probability of error. CONCLUSIONS: Hospital registers should be submitted to quality control processes in which the physicians facilitating the data should participate.

[Factors associated with chronic drug consumption in the elderly]. / Factores asociados al consumo de medicación crónica en personas ancianas.

BACKGROUND: To determine chronic drug intake in the non-institutionalised elderly population and identify factors associated with polypharmacy. PATIENTS AND METHODS: Cross-sectional study by means of home interview. 1,015 elderly individuals were selected systematically from the 1991 municipal electoral list of Albacete, Spain (level of confidence 95%, precision 3%, response rate 93.8%). The questionnaire included, disability scales (Minimental test, index of Katz and Lawton-Brody, Yesavage scale and DUKE-UNC questionnaire), a self-preceivement of health, demographic data and qualitative and quantitative information about drug intake. We employed the anatomic classification of drugs to obtain a profile of consumption. RESULTS: 75% of those interviewed admitted to taking medication chronically (CI 95%: 72.6-78.6). The mean number of drugs was 3.17 +/- 1.94 SD. Intake was significantly higher in women (p = 0.01), widows (p = 0.04), those of lower social status (p = 0.01), greater age (p < 0.02), and a greater number of illnesses (p < 0.001), more frequent users of health resources (p < 0.001), those physically dependent (p < 0.001) and those suffering from depression or cognitive impairment (p = 0.001). The most commonly taken drugs were: cardioactive drugs (22.1%), diuretics (19.4%) and vasodilators (14.2%). Using logistic regression analysis we found that the factors associated with higher drug intake were: three or more ilnesses (OR = 2.24), poor self-assessed status of health (OR = 1.45), physical dependence (OR = 1.59), age greater than 74 years (OR = 1.63), depression (OR = 1.68), > or = 4 contacts with health providers over a three-month period (OR = 2.73) and previous hospital admissions (OR = 2.67). CONCLUSIONS: The high intake of drugs by the elderly is determined, among other factors, by sociodemographic considerations, the subject's perceived status of health and different forms of disability. These factors should be taken into account by health professionals when planning a rational use of drugs. There is a high consumption of peripheral vasodilators despite their scanty therapeutic value.

[Impact of cataract surgery upon functional capacity of the elderly]. / Repercusión de la intervención de cataratas en la capacidad funcional del anciano.

PURPOSE: To determine the impact of cataract intervention on visual function of the elderly and on autonomy in daily activities, analyzing the influence of clinical and sociodemographic variables. METHODS: Observational and longitudinal study. 185 elderly patients having undergone cataract surgery were compared with 179 elderly patients on a surgical waiting list. The first group was evaluated prior to surgery and at 4 months post-intervention. Control group patients were evaluated at the same times, without having received surgery. For all subjects, the state of visual function was determined by the Activities of Daily Vision Scale (ADVS). Degree of dependence in carrying out basic daily activities, cognitive state and self-perception of vision were also measured. Other variables were visual acuity, other ocular diseases and sociodemographic characteristics. RESULTS: Amongst the elderly patients having undergone surgery, the proportion of subjects able to carry out basic activities 4 months post-intervention (60.7%) was very similar to the initial pre-intervention figure (62.2%). However, in the control group, the proportion (63.1%) diminished significantly at the 4-month mark (48.8%) (p= 0.0001). Of the intervened subjects, 75.7% demonstrated improved self-perception of vision after 4 months as opposed to 15.4% of the non-intervened patients (p= 0.00001). Post-intervention, the mean score on the ADVS rose from 51.0 S.D. 28.4 to 76.0 S.D. 25.4 (p < 0.001). In contrast, the control group's mean score dropped from 54.8 S.D. 24.8 to 46.5 S.D. 27.1 (p < 0.001). CONCLUSIONS: Cataract surgery in the elderly improves visual function and prevents loss of autonomy, delaying dependency in carrying out basic daily activities.

[Evaluation of referrals in primary care]. / Evaluación de la demanda derivada en atención primaria.

OBJECTIVE: To study the process of referral from primary care in a health area in Madrid. The second objective was to evaluate the trends in the referral process. DESIGN: Observational, descriptive and cross-sectional study. SETTING: Three urban health centers in the Area 2. PARTICIPANTS: All referrals made by 13 doctors during 3 consecutive weeks. The total number of visits attended were 6012. The study was realized between February 2002 and January 2003. MAIN MEASUREMENTS: Patient, doctor and referral characteristics on every referral. RESULTS: 349 referrals were studied. The rate of referral 5.8% (5.21-6.39). The referred patients, 65.5% women, medium age 50.6+/-21. The specialties that received more referrals are gynecologist, ophthalmology, dermatology, otorhinolaryngology, rehabilitation, orthopedic surgeon and general surgeon. The most common conditions referred, 25.6% of all referrals, are gynecologist check, blindness, other illnesses of subcutaneous cellular tissue, arthrosis, joint pain, diabetes, benign neoplasm of skin, depression and hypoacusis. 92.3% of the referrals were sent to the specialist center. 89.7% were normal (no urgent). The reason for referral was to accede to the patient's request in 18.3% of the referrals. CONCLUSIONS: The process of referral is similar to previous studies. Although people are more participative, have more information and the defensive medicine is increasing, the process of referral have not changed.

[Geographical accessibility to health centers and urban planning in Fuenlabrada (Madrid)]. / Accesibilidad geográfica a los centros de salud y planteamiento urbanistico en Fuenlabrada (Madrid).

BACKGROUND: The accessibility of care can be inappropriate due to a scarce or nonexistent collaboration between health and urban planners at the time of urban planning. METHODS: The study was carried in the city of Fuenlabrada (145.506 inhabitants), located in the metropolitan area of Madrid. The city is divided in six Basic Zones with a Primary Health Care Center (PHCC) in each one of them. Isometric curves between were drawn on a map between the "starting" and "destination" points (Residential points formed by group of houses and their PHCC, respectively). The average and maximal distances were calculated. A scale to measure geographical accessibility was designed. RESULTS: The 55.646 houses of the city were grouped into 209 "starting points" for the six PHCC ("destination points"). 93 isometric curves were drawn. The average and maximal distances were 910 and 3.900 meters, respectively. The application of our accessibility scale shows that 3 Basic Zones have optimum accessibility, 2 have good accessibility an the last one has bad accessibility. CONCLUSIONS: The accessibility to the PHCC in Fuenlabrada is adequate. If the housing plan continues, in 1995 the city will need a new PHCC and a reorganization of Basic Zones.

[The levels of knowledge about nonclinical areas which are characteristic of the new model of primary care]. / Grado de conocimiento en áreas no clínicas propias del nuevo modelo de atención primaria.

OBJECTIVE: To evaluate the level of knowledge about the non-clinical areas which characterise the new model of primary care among doctors and nurses who work in primary care teams (PCT); and to identify the most deficient areas of knowledge and the variables associated with these lower levels of knowledge. DESIGN: An observation study of a crossover kind. SETTING: PCTs of Health Area 1 in Madrid. PARTICIPANTS: Doctors and nurses who were working in the 23 PCTs functioning when the study was carried out (321 people). MEASUREMENTS AND MAIN RESULTS: Knowledge was measured by a self-filled, anonymous questionnaire elaborated by a panel of experts. It contained 72 items with correct (C) or false (F) double reply, grouped in 12 basic areas of knowledge relating to the non-clinical aspects which characterise the new model of primary care (PC). A pilot test was done in a PCT in another Area. The data bases were performed on DBASEIII+ and the statistical analysis on SPSS v. 4.0. The required level of knowledge through the questionnaire as a whole was attained by 41.6% of the professionals. An association with the following was noted: Age (p < 0.0001), Profession (p < 0.005), Year that training ended (p < 0.01), Type of contract (p < 0.005), Nature of access to a permanent post (p < 0.0005), postgraduate academic training for doctors (p < 0.001) and Residency in Family and Community Medicine (p < 0.009). The most deficient areas of knowledge were: Evaluation of procedures and programmes (46%), Community Participation (51.6%), the filling-out and standardisation of records (55.2%), and the Evaluation of objectives and quality control mechanisms. CONCLUSIONS: Knowledge of non-clinical areas is low.

[Breast feeding in a metropolitan area: (II). Design for a promotion program]. / La lactancia materna en un área metropolitana: (II). Diseño de un programa de promoción.

Because of the importance of breast-feeding in the health of both the mother and child, and taking into consideration its poor situation at the present time, it seems fully justified to start a program to promote breast-feeding. This program basically will consist of training health professionals and in the improvement of both the mother's and hospital's practices. It is necessary to motivate health authorities and to curb the excess in formula promotion. Mass-media should be employed for the promotion of breast-feeding and a system should be implemented to obtain a proper record of the duration of breast-feeding.

[Depression in older persons. Associated factors]. / Depresión en personas ancianas. Factores asociados.

OBJECTIVE: To determine the proportion of elderly people with depressive disorders and study the possible association with sociodemographic factors, self-perception of health, cognitive function, diseases suffered, drug consumption, sleep disorders and use of services. DESIGN: An observational crossover study using a home interview. SETTING: Community-based. PARTICIPANTS: 787 elderly people aged 65 and over, not institutionalised and living in the city of Albacete. MEASUREMENTS AND MAIN RESULTS: A questionnaire designed for the study was used to gather data on the sociodemographic variables, self-perception of health, diseases suffered, drug consumption, cognitive function, sleep disorders and contacts with the health service. The variables found by logistic regression to be associated independently to the presence of depressive disorders were: being female (OR = 2.75), habitually suffering sleep disorders (OR = 2.75), having self-perception of poor health (OR = 17.61) and cognitive deterioration (OR = 2.45). CONCLUSIONS: It would be advisable to apply a screening test to detect depressive disorders in elderly people with associated factors (being female, having sleep disorders, self-perception of poor health and cognitive deterioration), so that they could benefit from early diagnosis and adequate treatment.

[Breast feeding in a metropolitan area: (I). Analysis of the current situation]. / La lactancia materna en un área metropolitana: (I). Análisis de la situación actual.

In order to elaborate a program to promote breast-feeding, it is necessary to know in advance the difficulties encountered by the mothers in the target population. For this purpose, we surveyed a sample of 400 mothers who were representative of those who gave birth in Móstoles in 1989. We found that 56% of the mothers did not exceed two months of breast-feeding. Breast-feeding was shorter in low-income families. Its duration was influenced by the husband's and grandmother's opinions and also by previous failure with elder siblings. Mothers made their choice of feeding method before getting pregnant. We also found that most health professionals acted unsatisfactorily. Other unfavorable factors included excessive insecurity of the mother and misinformation.

[Spanish version of the 7 Minute screening neurocognitive battery. Normative data of an elderly population sample over 70]. / Versión española del Test de los 7 Minutos. Datos normativos de una muestra poblacional de ancianos de más de 70 años.

INTRODUCTION: To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. METHODS: We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were obtained in the subgroup of non-demented subjects. RESULTS: The easiest and most efficient method to obtain the total score of the 7MS was the sum of the z-scores of the four subtests. We present the mean values, -1 and -1.5 standard deviations, range and percentiles of the partial and total scores of the 7MS stratified by age (71-75, 76-80, 81-85 and > or = 86 years) and education (less than primary education and primary education or greater) in the subgroup of non-demented subjects. CONCLUSIONS: The normative data of the 7MS obtained in a representative sample of the general elderly population support its rigorous use in the Spanish clinical setting.

[Importance of maternity routines in the success of maternal breast feeding]. / Importancia de las rutinas de la maternidad en el éxito de la lactancia materna.

Many of the problems that are associated with breast-feeding appear to be caused by various postnatal care procedures that take place in the majority of our hospitals. In order to identify these obstacles, a survey was carried out on a sample of 400 mothers whose children were born in Móstoles in 1989. The results were as follows: 1) The average duration of breast-feeding was 2.43 months (SD = 2.19 months). 2) The lower the baby's birth weight and the longer that he was kept in the hospital, the shorter the time that he was breast-fed. Two basic procedures in the hospital "norms" appear to contribute to the failure of breast-feeding. First, the provision of glucose water or formula bottles and second, a ridged feeding schedule. If the newborn was fed on demand in the hospital it tended to be continued once at home. In both the hospital and in the home, on demand feeding was strongly associate with successful breast-feeding. Some simple modifications to the Maternity departments are recommended.

[Prevalence of urinary incontinence and linked factors in men and women over 65]. / Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años.

OBJECTIVES: To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. DESIGN: Population survey. SETTING: Leganés (Madrid). PARTICIPANTS: Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). MAIN MEASUREMENTS: Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. RESULTS: The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. CONCLUSIONS: Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.