Impact of pregnancy on women's health-related lifestyle habits: Diet, physical activity, alcohol consumption, and smoking.

OBJECTIVES: To explore health-related lifestyles in women before and during pregnancy, and to determine the potential differences between both and the relevant factors. MATERIALS AND METHODS: A cross-sectional observational study including 348 women with a child <5 years of age was conducted in six health areas. The following variables were recorded: sociodemographic (age, educational level, marital status, social class, type of cohabitation, nationality), health-related habits (physical activity, diet, tobacco use, alcohol consumption), health conditions, and medication intake. RESULTS: Four lifestyle habits were compared between the pre-conception and pregnancy periods: diet, physical activity, and alcohol and tobacco use. The proportion of women who consumed alcohol (42.8 % vs 3.4 %) or smoked (19.3 % vs 12.4 %) was significantly higher before conception (p < 0.01). Conversely, the proportion of inactive women was lower before pregnancy, with 23.3 % (CI95%: 18.7-27.9) formerly classified as active versus 35.3 % (CI95%: 30.2-40.5) (p < 0.01). Similarly, adherence to the Mediterranean diet increased during pregnancy (62.9 % vs 75.0 %; p < 0.01). Furthermore, 53.2 % (CI95%: 47.8-58.5) of women reported a change from non-healthy to healthy in at least one of the evaluated habits. Logistic regression analyses revealed the variables associated with a positive change, which were being national Spanish (OR: 6.9) and experiencing the first pregnancy (OR: 1.8). CONCLUSIONS: The lifestyles of women undergo changes between the pre-gestation and pregnancy periods. However, such variations do not affect all health-related habits similarly. A positive change was observed in diet, alcohol consumption, and smoking habit, whereas pregnancy negatively impacted on physical activity and sedentary behaviours.

Knowledge and practices regarding prostate cancer screening in Spanish men: The importance of personal and clinical characteristics (PROSHADE study).

INTRODUCTION: Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening. METHODS: A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test. RESULTS: Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001). CONCLUSIONS: Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.

Influence of the mother's lifestyles on the initiation of breastfeeding: A case-control study.

INTRODUCTION: 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. MATERIAL AND METHOD: 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. RESULTS: 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). CONCLUSIONS: 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.

Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care-APHOSDIAB-COVID-19 Multicenter Study.

The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.

Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection.

BACKGROUND AND OBJECTIVE: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care. PATIENTS AND METHODS: A cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated. RESULTS: Of 1038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2). CONCLUSIONS: More than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases.

ANTECEDENTES Y OBJETIVO: La disfunción olfatoria (DO) y gustativa (DG) han demostrado ser síntomas de la infección por SARS-CoV-2. Sin embargo, su presencia en determinadas poblaciones, sobre todo en aquellas con cuadros clínicos leves, aún debe aclararse. El objetivo fue estimar la frecuencia de DO y DG, y su validez predictiva en pacientes detectados en Atención Primaria. PACIENTES Y MÉTODOS: Se realizó un estudio transversal en el Sistema Nacional de Salud español. Se administró una encuesta epidemiológica dirigida a pacientes a los que se les solicitó la prueba PCR para SARS-CoV-2. Se estimaron las odds ratio (OR) para medir la magnitud de la asociación entre la DO y DG y la existencia de infección por SARS-CoV-2. Se calculó la sensibilidad, la especificidad y los valores predictivos positivos (VPP) y negativos (VPN) de estos síntomas en la infección por SARS-CoV-2. RESULTADOS: Se captaron 1.038 pacientes, de los cuales el 20,1% presentaban infección por SARS-CoV-2. Las DO y DG estuvieron presentes en el 64,4% (IC 95% 56,0­72,1) y el 56,2% (IC 95% 47,9­64,2) de los sujetos con infección, respectivamente. La OR para la DO fue de 12,2 (IC 95% 8,26−18,06) y para la DG de 7,95 (IC 95% 5,48−11.53). La DG presentó una sensibilidad del 41,1% (IC 95% 34,4­46,1), una especificidad del 91,9% (IC 95% 89,8­93,7), un VPP del 56,2% (IC 95% 48,0­64,2) y un VPN de 86,1% (IC 95% 83,6­88,3), mientras que la DO mostró una sensibilidad del 45,0% (IC 95% 37,6­51,5), una especificidad del 93,7% (IC 95% 91,8­95,0), un VPP del 64,4% (IC 95% 56,0­72,1) y un VPN del 87,1% (IC 95% 84,7­89,2). CONCLUSIONES: Más de la mitad de los sujetos con infección por SARS-CoV-2 presentan DO o DG. La presencia de DO o de DG podría ser de utilidad diagnostica por su capacidad para predecir la infección en más de la mitad de las ocasiones.

[Frequency and predictive validity of olfactory and taste dysfunction in patients with SARS-CoV-2 infection]. / Frecuencia de aparición y validez predictiva de la disfunción olfatoria y del gusto en pacientes con infección por SARS-CoV-2.

BACKGROUND AND OBJECTIVE: Olfactory and taste dysfunction (OD, TD) have been considered symptoms of SARS-CoV-2 infection. However, its presence in certain populations, especially those with mild clinical symptoms, has not been clarified. The objective was to estimate the frequency of OD and TD, and its predictive validity in patients detected in Primary Care. PATIENTS AND METHODS: A cross-sectional study was carried out in the Spanish National Health System. An epidemiological survey was administered to patients who were requested the PCR test for SARS-CoV-2. Odds ratio (OR) were estimated to measure the magnitude of the association between OD and TD and the existence of SARS-CoV-2 infection. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of these symptoms in SARS-CoV-2 infection were calculated. RESULTS: Of 1,038 patients screened, 20.1% had SARS-CoV-2 infection. OD and DG were present in 64.4% (95% CI 56.0-72.1) and 56.2% (95% CI 47.9-64.2) of the subjects with infection, respectively. The OR for OD was 12.2 (95% CI 8.26-18.06) and for TD was 7.95 (95% CI 5.48-11.53). TD presented a sensitivity of 41.1% (95% CI 34.4-46.1), a specificity of 91.9% (95% CI 89.8-93.7), a PPV of 56.2% (95% CI48.0-64.2) and a NPV of 86.1% (95% CI 83.6-88.3), while the OD showed a sensitivity of 45.0% (95% CI 37.6-51.5), a specificity of 93.7% (95% CI 91.8-95.0), a PPV of 64.4% (95% CI 56.0-72.1) and a NPV of 87.1% (95% CI 84.7-89.2). CONCLUSIONS: More than half of the subjects with SARS-CoV-2 infection have OD or TD. The presence of OD or TD could be of diagnostic utility due to its ability to predict infection in more than half of the cases.

[Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study]. / Características clínico-epidemiológicas de la infección por el virus SARS-CoV-2 en médicos de familia: un estudio de casos y controles.

OBJECTIVE: To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies. DESING: Observational analytical case-control study. SITE: Primary care. PARTICIPANTS: 969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative). INTERVENTIONS: No. MAIN MEASUREMENTS: Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use. RESULTS: 13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4). CONCLUSIONS: Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.

[Bibliometric map of research carried out in Primary Care in Spain during the period 2013-2017]. / Mapa bibliométrico de la investigación realizada en atención primaria en España durante el periodo 2013-2017.

OBJECTIVE: To describe the Spanish scientific production of primary care during 2013-2017 and analyze their geographical distribution, impact factor, areas of research and involvement of different institutional sectors. DESIGN: Observational study bibliometric. PARTICIPANTS: The study focused on publications indexed in Medline. MAIN MEASUREMENTS: Journal and year of publication, first/last author, workplace and autonomous community. Later, articles were classified according to their content. The impact factor was obtained from the basis of bibliometric analysis Journal Citation Reports. RESULTS: Using search criteria, were selected 980 documents. The transiency rate was 78,8%. The highest proportion of articles (43.2%) came from health centers, but we observed an increase of the articles from units or research institutes (14.9% in 2013, 19.1% in 2017). Of the total, 63.3% were classified as "clinical aspects", 19.3% were published in the journal Atención Primaria, 40.6% in foreign journals and 72.4% in journals with impact factor, being this proportion significantly lower (p <0.001) in those coming from health centers (59.6%) or teaching units/management/health services (70.0%) with respect to those originated in research units/institutes (93.1%) or in universities (89.0%). In relation to population (articles/100.000 inhab.), the most productive communities were Cataluña (4.2), Aragón (3.9), e Islas Baleares (3.3). CONCLUSIONS: In primary care publications there is great diversity in both research areas such as in journals where published. Most are from health centers, treat clinical aspects and published in Spanish journals. Differences in the volume of scientific production between regions are observed.

Efficacy of a Combined Strategy to Improve Low-density Lipoprotein Cholesterol Control Among Patients With Hypercholesterolemia: A Randomized Clinical Trial.

INTRODUCTION AND OBJECTIVES: Several interventions can improve low-density lipoprotein cholesterol (LDL-C) control. Our main objective was to evaluate the efficacy of a combined intervention to improve LDL-C control in patients with hypercholesterolemia. The study also assessed the efficacy of the intervention in improving adherence (pharmacological, diet, and exercise). METHODS: A multicenter, parallel group, randomized clinical trial (primary care) was conducted in 358 adults diagnosed with hypercholesterolemia, whether receiving prior drug therapy or not. We compared 178 participants who received the combined intervention (written material, self-completed registration cards, and messages to mobile telephones) with 178 controls. The main outcome variable was the proportion of participants with adequate LDL-C control (target levels of the European guidelines on dyslipidemia and cardiovascular risk) at 24 months. RESULTS: At 24 months, the mean reduction in LDL-C was significantly higher in the intervention group (23.8mg/dL [95%CI, 17.5-30.1]) than in the control group (14.6mg/dL [95%CI, 8.9-20.4]; P=.034). The mean LDL-C decrease was 13.1%±28.6%. At 1 year, the proportion of participants with adequate control was significantly higher in the intervention group than in the control group (43.7% vs 30.1%; P=.011; RR, 1.46). Adherence was significantly higher in the intervention group, both to drug therapy (77.2% vs 64.1%; P=.029) and exercise (64.9% vs 35.8; P<.001), but not to diet. CONCLUSIONS: The combined intervention significantly reduced LDL-C (by more than 13% at 2 years) and improved the degree of LDL-C control in patients with hypercholesterolemia at 1 year.

[Determining factors for the use of anxiolytic and hypnotic drugs in the elderly]. / Consumo de ansiolíticos e hipnóticos y factores asociados en las personas mayores.

INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Treatment Satisfaction Among Patients Taking Antidepressant Medication.

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/Evaluación de la Satisfacción 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.

Effectiveness of a combined strategy to improve therapeutic compliance and degree of control among patients with hypercholesterolaemia: a randomised clinical trial.

BACKGROUND: 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. METHODS/DESIGN: 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 Autónomas), 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. DISCUSSION: 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. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02314663.

Prevalence of hazardous drinking among nursing students.

AIMS: To estimate the frequency of alcohol consumption among nursing students and describe their behaviour patterns in relation to excessive consumption. BACKGROUND: Most alcohol-related problems appear in individuals who indulge in hazardous consumption, with hazardous drinkers constituting a priority in the field of preventive activities. According to previous studies, there is a high proportion of hazardous drinkers among university students. DESIGN: Descriptive cross-sectional study. METHODS: Over the course of the 2012-2013 academic year, we assessed 1060 nursing degree students, ascertaining their socio-demographic characteristics, lifestyle and alcohol consumption by means of the Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado de Consumos Alcohólicos/ISCA) and Alcohol Use Disorders Inventory Test (AUDIT). RESULTS: Hazardous alcohol consumption was observed in 43·4% of students. Moreover, 14·9% of men and 18·7% of women met criteria for hazardous drinkers, without any statistically significant difference between the sexes. The frequency of hazardous drinkers was significantly higher among participants aged under 21 years, those living outside the family nucleus and smokers. CONCLUSION: A considerable proportion of students show evidence of hazardous alcohol consumption and, while there are no sex-related differences, the proportion of hazardous drinkers tends to be higher among the youngest subjects, smokers and persons living outside the family nucleus. Alcohol-prevention activities should envisage greater protection of university settings, particularly where future health professionals are involved.

Long-term Effects of Plant Stanols on the Lipid Profile of Patients With Hypercholesterolemia. A Randomized Clinical Trial.

INTRODUCTION AND OBJECTIVES: Plant stanol consumption may improve long-term cholesterol control. The aim of the present study was to evaluate the effectiveness of 2g/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 2g 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.

Self-assessment of alcohol consumption as a health-education strategy in nursing students.

BACKGROUND: In the field of preventive activities, early identification of excessive alcohol consumption is essential. The simplicity of existing instruments for detecting hazardous drinking makes for ready assimilation in university students. OBJECTIVE: To ascertain nursing students' level of knowledge about alcohol prevention activities and assess their skills, acquired through self-assessment of their own alcohol consumption, in managing tools designed to detect hazardous drinkers. DESIGN: Before and after intervention study. MATERIAL AND METHODS: We assessed 1060 nursing students and ascertained their level of knowledge about excessive alcohol consumption. Following an educational intervention in which students were taught to use the recommended screening instruments in clinical practice through self-assessment of their own consumption (Systematic Interview of Alcohol Consumption and Alcohol Use Disorders Inventory Test), we tested the skills acquired in detecting hazardous drinkers and their knowledge of alcohol prevention activities. RESULTS: Initially, the concept of hazardous drinker was known by only 24.1% of students and the method of quantifying alcohol consumption by only 3.1%. The prevalence of hazardous drinkers was 17.9% (95% CI: 15.5-20.3). After the educational intervention, 95.8% of students stated that they understood the concept of hazardous drinker and 92.5% stated that they understood how to quantify alcohol consumption, with these proportions being significantly higher than those obtained at baseline (p<0.001). When asked about the intervention's usefulness, 91.3% viewed it favourably. CONCLUSION: By using a simple educational intervention, nursing students can improve their knowledge and skill detection of hazardous drinkers and quantification of alcohol consumption. These concepts allow for students to be satisfactorily introduced into the prevention activities during their university education. After assessing their own consumption, a considerable proportion of students realise that they are indulging in excessive alcohol consumption, which could in turn make for greater awareness of the problem among future health professionals.

[Adherence to patients antidepressant treatment and the factors associated of non-compiance]. / Seguimiento de la adherencia al tratamiento antidepresivo en pacientes que inician su consumo.

OBJECTIVE: To know the adherence to treatment in patients who initiate antidepressant drugs and to analyze the determinant factors of non-compliance, so much clinical as sociodemographic. DESIGN: Prospective longitudinal observational study. LOCATION: Primary Health Care and Mental Health Surgeries of three Castilla-La Mancha Areas. PARTICIPANTS: 185 adults patients who were started in antidepressant treatment were evaluated. MEASUREMENTS: Treatment adherence (test Haynes-Sackett, test Morisky-Green, count of tablets and MEMS), adverse effects, intensity of depressive symptoms, sociodemographic characteristics and other characteristics related to antidepressants or participants. RESULTS: After 6months of beginning antidepressing treatment, 46.9% (95%IC: 36.5-57.3) showed an inadequate fulfilment by pill count method and 28.6% (95%IC: 19.1-38.0) with Morisky-Green's questionnaire. To 15 days the lack of adherence was 48.5% (95%IC: 40.6-56.4) and of 33.5% (95%IC: 26.1-41.0). The 38.4% (95%IC: 31.1-45.7) demonstrated some side effect during the follow-up. Using proportional risk model of Cox the variables related to compliance were: younger age, level of instruction lower than secondary studies, free medicines for pensioner, no psychotherapeutic treatment, consume a fewer antidepressants drugs and a frequency ≤ 3 visits to the family doctor 3 months previous to the study. CONCLUSIONS: The non-compliance of antidepressant treatment in primary care is high from the first weeks after initiating it. The conditioning factors are related to sociodemographic characteristics and other patient characteristics as type of financing of pharmaceutical benefit and frequentness at primary care.

[The health status of older people with insomnia]. / El estado de salud de las personas mayores que sufren insomnio.

OBJECTIVES: To evaluate the perceived health status of elderly patients with insomnia, whether primary, secondary to a medical illness, or associated with another mental disorder. METHODS: 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. RESULTS: 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 (p<0.05) 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 (p<0.05) 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. CONCLUSIONS: 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.