Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain.

BACKGROUND: The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. METHOD: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). RESULTS: Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. CONCLUSIONS: The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

[Variability in working systems in intensive care units]. / La variabilidad en las sistemáticas de trabajo en los Servicios de Medicina Intensiva.

INTRODUCTION: Patients attended in Intensive Medicine Services (IMS) require a high therapeutic support. To do so, each IMS elaborates a work system (monitoring of constants, insertion of catheters,...) aiming to respond to these high necessities of therapy. The objective of this study is to describe the variability among different IMS. METHODS: The study was performed in 15 hospitals in Catalonia between April and May 1995. In the end two of them did not participate in the study. In each hospital 180 pieces of data were collected referring to their material and human resources, graphics of data collection, monitoring of respiratory system (mechanical ventilator, aspirations of secretions, tracheostomy care), techniques of catheterization of artery and venous via vesical probing, prevention of pressure ulcers , hygiene of patients, nutrition, family treatment and data about medical orders and nursing courses. Similarly, the fact whether the work system was justified by studies from the same IMS, other centres, or whether it was simply unknown, was also evaluated. RESULTS: There was a great variability among the IMS studied, oscillating significatively according to assigned resources, frequency of action and cost. According to the procedure 61% of IMS did not justify the work systems depending on scientific data. CONCLUSION: it is necessary to unify the different work systems. To do so, and in our opinion, scientific societies should establish common norms, guidelines and protocols so as to obtain a higher efficiency of IMS.