Alcohol use and family-related factors among Spanish university students: the unHicos project.

BACKGROUND: During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. METHODS: Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student's T-Test, and non-conditional logistic regression models were carried out to examine this association. RESULTS: The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2-17.6), and that of BD was 48.8% (95% CI = 47.9-48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. CONCLUSIONS: Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.

Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study).

BACKGROUND: We analyzed the associations between diabetes and cognitive impairment (CI) and dependence in a population of patients 65 years or older. METHODS: Cross-sectional study. We randomly selected 311 participants over the age of 65 living in an urban area of Spain. The mean age of the cohort was 75.89 ± 7.12 years, and 69 of the individuals (22.2%) had diabetes. Two questionnaires were used to assess cognitive performance (MMSE and Seven Minute Screen Test), and two assessments were used to evaluate patient dependence (Barthel Index and Lawton-Brody Index). Clinical information and sociodemographic data were also gathered. RESULTS: Nearly one quarter of patients with diabetes (21.7%) lived alone. Diabetic patients were more sedentary (p = .033) than non-diabetic patients. Roughly one sixth (15.3%) of the diabetics and 10.1% of the non-diabetics were depressed (p = .332). CI was present in 26.1% of the diabetics and 14.5% of non-diabetics (p = .029). Diabetic patients had a MMSE score that was significantly worse than non-diabetics (24.88 ± 4.74 vs 26.05 ± 4.03; p <.05), but no differences were found in the Seven Minute Screen Test. Logistic regressions revealed that the presence of diabetes was independently associated with CI (adjusted for age, gender, years of education, sedentary lifestyle, body mass index, diastolic blood pressure, cholesterol, and depression (OR = 2.940, p = .013). Patients with diabetes showed greater dependence, as measured by the Barthel Index (p = .03) and Lawton-Brody Index (p <.01). Nevertheless, when dependence (dependence or not dependence for each questionnaire) used as a dependent variable in the logistic regression analyses, no significant association with diabetes was found, after adjusting for confounding variables. CONCLUSIONS: Diabetic patients over the age of 65 are more likely to present CI but not dependence. These findings support the need to include both a functional and cognitive assessment as necessary components in a standard evaluation in both clinical guides and randomized trials of therapeutic interventions in patients with diabetes.

Physical activity program for patients with dementia and their relative caregivers: randomized clinical trial in Primary Health Care (AFISDEMyF study).

BACKGROUND: The aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving.The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed. DESIGN: Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1). VARIABLES: The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life. INTERVENTION: For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care. ANALYSIS: An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result. DISCUSSION: If the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT02044887.

Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica.

OBJECTIVE: To analyze the incidence and determinants of lower-extremity amputation (LEA) in people with diabetes in a low-income community in Costa Rica. METHODS: Data on LEA incidence were collected during a seven-year follow-up (2001-2007) in a diabetes patient cohort (n = 572). Risk factors were analyzed using the Cox proportional hazards regression model and baseline variables from the year 2000 (socio- demographic characteristics, comorbidity, metabolic control, treatment, and chronic microvascular complications). RESULTS: LEA incidence was 6.02 per 1 000 person-years (8.65 in men and 4.50 in women). Known risk factors (sex, years of diabetes, elevated glycated hemoglobin [HbA1c], retinopathy, insulin therapy, and prior amputation) were highly significant. CONCLUSIONS: Those most likely to undergo LEA among Costa Rican diabetic patients were men with 10 or more years of diabetes and average HbA1c > 8% who used insulin and had diabetic retinopathy. Patients on insulin therapy were at greatest risk, especially those with a previous amputation. Diabetic patients with the above-mentioned profile should be considered to be at very high risk of LEA and followed closely by the health care system.

Retraction: López-Valverde, N.; et al. Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis. J. Clin. Med. 2020, 9, 1025.

The authors of a recent published paper [...].

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis.

BACKGROUND: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. METHODS: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: "virtual reality", "distraction systems", "dental anxiety" and "pain". Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used, and in standard care situations. RESULTS: 31 studies were identified, of which 14 met the inclusion criteria. Pain levels were evaluated in four studies (n = 4), anxiety levels in three (n = 3) and anxiety and pain together in seven (n = 7). Our meta-analysis was based on ten studies (n = 10). The effect of VR was studied mainly in the pediatric population (for pain SMD = -0.82). In the adult population, only two studies (not significant) were considered. CONCLUSIONS: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica / Incidencia y factores de riesgo de la amputación de extremidades inferiores relacionada con la diabetes: estudio prospectivo de siete años en Costa Rica

Objective. To analyze the incidence and determinants of lower-extremity amputation(LEA) in people with diabetes in a low-income community in Costa Rica.Methods. Data on LEA incidence were collected during a seven-year follow-up (2001–2007) in a diabetes patient cohort (n = 572). Risk factors were analyzed using the Coxproportional hazards regression model and baseline variables from the year 2000 (sociodemographiccharacteristics, comorbidity, metabolic control, treatment, and chronic microvascularcomplications).Results. LEA incidence was 6.02 per 1 000 person-years (8.65 in men and 4.50 in women).Known risk factors (sex, years of diabetes, elevated glycated hemoglobin [HbA1c], retinopathy,insulin therapy, and prior amputation) were highly significant.Conclusions. Those most likely to undergo LEA among Costa Rican diabetic patients weremen with 10 or more years of diabetes and average HbA1c ≥ 8% who used insulin and haddiabetic retinopathy. Patients on insulin therapy were at greatest risk, especially those with aprevious amputation. Diabetic patients with the above-mentioned profile should be consideredto be at very high risk of LEA and followed closely by the health care system.

Objetivo. Analizar la incidencia y los determinantes de la amputación deextremidades inferiores (AEI) en personas diabéticas de una comunidad con bajosingresos de Costa Rica.Métodos. Se recopilaron datos sobre la incidencia de la AEI durante un período deseguimiento de siete años (del 2001 al 2007) en una cohorte de pacientes diabéticos(n = 572). Se analizaron los factores de riesgo usando el modelo de regresión de Coxde riesgos proporcionales y los valores de referencia del año 2000 de las variables(características sociodemográficas, comorbilidad, control metabólico, tratamiento ycomplicaciones microvasculares crónicas).Resultados. La incidencia de la AEI fue de 6,02 por 1 000 personas-año (8,65 envarones y 4,50 en mujeres). Los factores de riesgo conocidos (sexo, años de evoluciónde la diabetes, glucohemoglobina [HbA1c] elevada, retinopatía, tratamiento coninsulina y amputación previa) fueron muy significativos.Conclusiones. Los pacientes diabéticos costarricenses con mayor probabilidad desufrir una AEI fueron los varones con 10 o más años de evolución de la diabetesy un promedio de HbA1c ≥ 8% que eran tratados con insulina y padecían unaretinopatía diabética. Los pacientes en tratamiento con insulina presentaban el mayorriesgo, especialmente los que habían sufrido una amputación anterior. Los pacientesdiabéticos con el perfil descrito anteriormente deben considerarse como de riesgomuy elevado de AEI y deben ser seguidos de cerca por el sistema de atención desalud.

Incidencia de diabetes tipo 2 en un área urbano marginal de Costa Rica / Type 2 diabetes in a peripheral-urban area in Costa Rica

Justificación y objetivo: La "diabetes mellitus" tipo 2 se considera actualmente como una pandemia que afecta tanto a países desarrollados como en vías de desarrollo, por lo cual es necesario conocer su prevalencia, incidencia y factores asociados para planificar estrategias para su prevención. En Costa Rica se dispone de una estimación de su prevalencia en el área metropolitana, 7-8 por ciento, pero no se tiene dato alguno de su incidencia. El presente estudio tuvo como objetivo conocer la prevalencia de personas en riesgo de desarrollar diabetes en una comunidad urbano marginal, sus factores de riesgo y la incidencia de diabetes en esa población. Materiales y métodos: De las 7039 personas de 20 años y más con expediente activo en 4 EBAIS del área 3 de Desamparados en el año 2000, 4228 tenían al menos un criterio de riesgo para desarrollar diabetes según los criterios de la Asociación Americana de Diabetes del 2000. Esta cohorte fue seguida durante 4 años para determinar la tasa de incidencia de desarrollar diabetes. Resultados: La prevalencia de personas en riesgo fue del 60.1 por ciento; sus factores de riesgo más prevalentes fueron: la dislipidemia, 67.3 por ciento, el índice de masa corporal mayor igual 27, 60.8 por ciento, edad mayor igual 45 años, 41.8 por ciento, familiares con DM, 34.9 por ciento e hipertensión arterial, 19.7 por ciento. La incidencia acumulada de diabetes fue de 4.77 por ciento con un promedio anual de 1.19 por ciento. La tasa de incidencia fue de 1.62 por 100 personas - año, IC95 por ciento: 1.38-1.86. La tasa de incidencia por 100 personas-año según sexo fue de 1.5 para las mujeres y de 1.93 para hombres, sin diferencia significativa por sexo. Conclusión: Los resultados obtenidos en este estudio han permitido disponer de la primera estimación de la Incidencia de Diabetes tipo 2 en una población de riesgo en Costa Rica. La incidencia estimada fue de 1.62 por ciento; por lo tanto podemos esperar 16 diabéticos nuevos por año...