Does the Consumer Sociodemographic Profile Influence the Perception of Aspects Related and Not Related to Food Safety? A Study in Traditional Spanish Street Markets.

Street food markets are important for local economic development, but they must also meet visitors' demands while operating. Since consumers' trust is based on their perception on different aspects of these markets, the aim of this work was to study which factors most affected their purchase decision criteria. A total of 950 surveys were collected in 21 street markets (Canary Islands, Spain), recording data from the consumers' estimation on food safety-related items (i.e., hygiene conditions of market installations, products, and food handlers) as well as other categories (i.e., prices and staff professionalism). The gathered data let us determine whether sociodemographic consumers variables like age, gender, or education level influenced their perceptions. The scores showed a strong correlation, the subsequent principal components analysis explained 81% of variability only with the first two components. The level of tolerance toward all items underlies in the first component, which was significantly higher for those aged 60 and older, but no significant correlation was found for gender or level of education. The youngest participants were more demanding about food safety-related aspects, while the middle-aged group was more critical of prices. This was especially true of females, who demanded better quality:price ratios. Knowing these preferences could facilitate the development of more effective marketing strategies, helping make street markets more competitive.

Assessment of the association between diabetes mellitus and chronic kidney disease in adult cats.

BACKGROUND: Diabetes mellitus is the main cause of chronic kidney disease (CKD) in humans. The relationship between the 2 diseases in cats is unclear. OBJECTIVE: To assess the association between diabetes and CKD in a population of adult cats. ANIMALS: Five hundred sixty-one cats that attended 2 veterinary centers in Gran Canaria, Spain, between 2014 and 2016. METHODS: Medical records were retrospectively reviewed. Cats aged 3 years or older, with sufficient data to define whether or not they had diabetes and CKD, were selected. Cats in critical condition, with dehydration or potential causes of prerenal azotemia and those treated with nephrotoxic drugs were excluded. Diagnosis of CKD was established when creatinine concentrations were >2 mg/dL, or serum creatinine 1.6-2 mg/dL and urine specific gravity <1.035, or serum creatinine 1.6-2 mg/dL and urine protein/creatinine ratio >0.4. Factors associated with CKD were identified through multivariate logistic regression analyses. RESULTS: Sixty-seven (11.9%) cats had CKD and 16 (2.9%) cats had diabetes. Sixty cats without diabetes (11%) and 7 with diabetes (44%) had CKD. Among the latter, both conditions were diagnosed simultaneously in 6 cases, whereas diabetes preceded CKD in the other. Multivariate analysis showed that diabetes was significantly associated with CKD (odds ratio = 4.47; 95% confidence interval, 1.51-13.28; P = .007). Other variables associated with CKD were age and mixed breed. CONCLUSIONS AND CLINICAL IMPORTANCE: After adjusting for age, this study showed an association between diabetes and CKD in adult cats.

Assessment of Muscle Wasting in Long-Stay ICU Patients Using a New Ultrasound Protocol.

There is currently no standardized procedure to assess sarcopenia in long-stay catabolic patients. Our aim is to analyze a novel ultrasound muscle assessment protocol in these patients versus healthy controls, by carrying out a prospective observational study. We designed a new ultrasound protocol that assesses quadriceps rectus femoris (QRF) muscle quality in real-time B-mode, color-Doppler, and M-mode ultrasound, and evaluates QRF intramuscular central tendon thickness, cross-sectional area, and muscle thickness in ultrasound B-mode. Logistic regression was performed as a multivariable analysis on 29 cases and 19 controls. The QRF muscle area and thickness were shown to significantly decrease (p ≤ 0.001), and the central tendon thickness significantly increased (p = 0.047) in cases versus controls. The QRF muscle echogenicity and angiogenic activity fasciculations, subcutaneous edema, and intramuscular fluid were also significantly different between the two groups (p < 0.001). The selected variables in the multivariate logit analysis were the muscle area (OR per cm² = 0.07; 95% confidence interval (CI) = 0.012⁻0.41) and the central tendon thickness (OR per mm 1.887; 95% CI = 2.66⁻13.38).

Osteoporosis and metabolic syndrome according to socio-economic status, contribution of PTH, vitamin D and body weight: The Canarian Osteoporosis Poverty Study (COPS).

BACKGROUND: Poverty is associated with a great number of diseases, but the prevalence of vitamin D deficiency, secondary hyperparathyroidism and the potential association of osteoporosis, osteoporotic fractures and metabolic syndrome in this situation are less well known. OBJECTIVE: To evaluate the associations between poverty, bone density, fragility fractures and metabolic syndrome in a population of southern European postmenopausal women. Also, to assess the potential role of vitamin D and parathyroid hormone (PTH) levels in these associations. METHOD: Cross-sectional study was carried out in 1 250 postmenopausal Caucasian Spanish women. The socio-economic status of the participants was determined after a personal interview, according to the criteria of the Spanish Institute of Statistics. Participants were divided into two socio-economic levels: low (poverty) and medium or high socioeconomic level. The study protocol included a health questionnaire, a complete physical examination, lateral radiograph of the dorsal and lumbar spine and measurement of bone mineral density (BMD) at the lumbar spine (L2-L4) and proximal femur. Fasting blood was obtained to measure 25-hydroxy-vitamin D (25-OHD), intact PTH and selected biochemical variables. RESULTS: Low socio-economic status was associated with 25-OHD insufficiency, higher values of PTH, higher body weight and body mass index (BMI), lower values of BMD at the lumbar spine and a higher prevalence of fragility fractures, both vertebral and nonvertebral. Poverty was also associated with higher prevalence of metabolic syndrome, but this association was driven mainly by the higher BMI and not by poverty itself. Both vitamin D insufficiency and elevated PTH were consistently related to poverty and osteoporotic fractures. CONCLUSIONS: Poor postmenopausal women in southern Europe have a high prevalence of metabolic syndrome and osteoporotic fractures. Poverty was associated with higher BMI and metabolic syndrome on the one hand and, on the other, with 25OHD insufficiency, higher PTH levels and osteoporosis. 25OHD insufficiency and/or secondary hyperparathyroidism do not have a significant influence on the presence of metabolic syndrome in this population.

Validación de la escala de actitudes hacia el adulto mayor de kogan y evaluación de las actitudes hacia el adulto mayor por parte del personal de salud del primer nivel asistencial / Validation of Kogan's attitudes towards old people scale and an assessment of primary care level personnel attitudes towards the elderly

Introducción: Las actitudes negativas influyen en las actitudes de los profesionales de la salud, puesto que a menudo se basan en premisas erróneas sobre la utilidad de la edad cronológica como marcador de la función o la capacidad de contribuir a la sociedad. Material y Método: Estudio para validación de instrumento de la escala de actitudes hacia el adulto mayor de Kogan (Kogan's Attitudes towards Older People: KAOP) y determinar las actitudes hacia el adulto mayor por parte del personal de salud del primer nivel asistencial en Tumbes. Resultados: Se realizó la validación idiomática, validación por jueces y se determinó la confiabilidad del instrumento. Finalmente, se aplicó la encuesta validada a los trabajadores de salud del primer nivel asistencial de la Dirección de Salud de Tumbes. Se encontró un coeficiente de concordancia entre traductores y re-traductores (de kappa) de 0,81, la estimación de la validez se hizo en base a la valoración proporcionada por cada uno de los cinco jueces en cada uno de los ítems, con una coincidencia del 84 %, se determinó la confiabilidad con el coeficiente Alfa de Cronbach el cual fue de 0,82. Se encuestaron 200 trabajadores, se encontró una actitud positiva hacia el adulto mayor en el 59 % de los encuestados (118). Conclusiones: Se valida un instrumento para medir actitudes hacia el adulto mayor. Se encontró que el 59 % del personal de salud del primer nivel de atención presento actitudes positivas hacia el adulto mayor.

Introduction: A negative disposition influences the attitudes of health care professionals, since this is often based on erroneous assumptions about the usefulness of chronological age as a functional marker or with respect to elderly persons' ability to contribute to society. Material and Method: This is a study for validating an instrument, the Kogan's attitudes towards older people, and to determine attitudes towards the elderly in primary health care personnel in Tumbes. Results: A language validation was performed, the instrument was assessed by specifically appointed raters, and its reliability was also determined. Finally, the validated survey was administered to primary health care workers in Tumbes Health Direction. A 0,81 concordance coefficient (kappa) between translators and re-translators was found. The validity of the instrument was estimated on the basis of the assessment performed by the five aforementioned raters who reviewed every item. The coincidence value found was 84 %, and the reliability of the instrument was determined using the Cronbach alpha coefficient, which was 0,82. Two hundred health care workers were interviewed, and a positive attitude towards the elderly was found in 59 % (118) of all surveyed persons.

Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis.

INTRODUCTION: Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality. Very few studies have focused on the impact of candidemia on ICU patient outcome and attributable mortality still remains controversial. This study was carried out to determine the attributable mortality of ICU-acquired candidemia in critically ill patients using propensity score matching analysis. METHODS: A prospective observational study was conducted of all consecutive non-neutropenic adult patients admitted for at least seven days to 36 ICUs in Spain, France, and Argentina between April 2006 and June 2007. The probability of developing candidemia was estimated using a multivariate logistic regression model. Each patient with ICU-acquired candidemia was matched with two control patients with the nearest available Mahalanobis metric matching within the calipers defined by the propensity score. Standardized differences tests (SDT) for each variable before and after matching were calculated. Attributable mortality was determined by a modified Poisson regression model adjusted by those variables that still presented certain misalignments defined as a SDT > 10%. RESULTS: Thirty-eight candidemias were diagnosed in 1,107 patients (34.3 episodes/1,000 ICU patients). Patients with and without candidemia had an ICU crude mortality of 52.6% versus 20.6% (P < 0.001) and a crude hospital mortality of 55.3% versus 29.6% (P = 0.01), respectively. In the propensity matched analysis, the corresponding figures were 51.4% versus 37.1% (P = 0.222) and 54.3% versus 50% (P = 0.680). After controlling residual confusion by the Poisson regression model, the relative risk (RR) of ICU- and hospital-attributable mortality from candidemia was RR 1.298 (95% confidence interval (CI) 0.88 to 1.98) and RR 1.096 (95% CI 0.68 to 1.69), respectively. CONCLUSIONS: ICU-acquired candidemia in critically ill patients is not associated with an increase in either ICU or hospital mortality.

Valoración de la higiene del sueño mediante una escala modificada en adultos mayores / An assessment of sleep quality in the elderly by using a modified scale

Objetivo: Modificar el índice desarrollado por Mastin y col, para aplicarlo en Adultos Mayores. Material y método: Se realizó la traducción, validación mediante jueces y la evaluación de la consistencia interna mediante el estadístico alfa de Cronbach del “Índice de Higiene del Sueño modificado para adultos mayores” (IHS-AM), construido a partir del índice desarrollado por Mastin y col. Resultados: Se realizó la traducción del instrumento y la modificación para su aplicación en adultos mayores mediante seis expertos encontrándose una validación del instrumento mediante jueces por coincidencia del 80. Se realizó una prueba preliminar para ajuste de la escala a 50 personas mayores de 60 años, previa autorización mediante consentimiento informado, excluyéndose a aquellos iletrados, con deterioro cognitivo moderado o severo y con déficit severo visual o auditivo. El instrumento IHS-AM elaborado obtuvo una confiabilidad determinada por un alfa de Cronbach de 0,7. Conclusión: El índice de higiene del sueño modificado para adultos mayores (IHS-AM) es un instrumento útil para ser aplicado en adultos mayores.

Objective: To modify the currently used Sleep Hygiene Index by Mastin et al, in order to use it in the elderly. Material and method: An elderly-adapted version of the Sleep Hygiene Index originally proponed by Mastin et al. was translated, peer-validated and had its internal consistency assessed using Cronbach’s Alpha method. Results. The aforementioned instrument was translated and modifications for its use in the elderly were performed by six experts, and the instrument was validated for use in the elderly according to an 80 coincidence. A preliminary test for adjusting the scale was performed in 50 subjects who were more than sixty-years old, after signing an informed consent and excluding the illiterate persons, those with moderate or severe cognitive deterioration, and those with sever visual or auditory deficit. The modified instrument obtained a 0.7 value for reliability according to Cronbach’s alpha test. Conclusion: The modified Sleep Hygiene Index is a useful instrument to be applied in the elderly.

Patrón y costo del tratamiento antihipertensivo para pacientes ambulatorios en un hospital general / Pattern and costs of the antihypertensive treatment for ambulatory patients in a general hospital

El manejo de la hipertensión arterial (HTA) es muy variable e individualizado por lo que la prescripción y el costo del mismo influyen en la accesibilidad y adherencia al tratamiento. OBJETIVO: Determinar la prescripción antihipertensiva usada y los costos de la misma en pacientes que acuden a un hospital general. MATERIAL Y MÉTODOS: Estudio transversal y descriptivo de la prescripción ambulatoria de medicamentos antihipertensivos de los pacientes atendidos en el Hospital Nacional Arzobispo Loayza de Lima en el año 2003. Se registraron los nombres de los fármacos prescritos tanto con el denominador común internacional (DCI) como con el de marca comercial (MC) y se determinó el costo de la terapia en función al precio de venta sugerido al público. RESULTADOS: De un total de 303 historias clínicas de pacientes hipertensos, sólo el 4,9% de ellos registró un adecuado control de la HTA.Las drogas antihipertensivas prescritas como primera elección pertenecieron al grupo de los inhibidores de la enzima convertidora de angiotensina (IECA) en un 70,5%, seguido de los calcioantagonistas (CA) en 11,7%, los beta-bloqueadores en 6,4% y otros en11,4%. Las drogas prescritas como segunda elección pertenecieron al grupo de los diuréticos tiazídicos en 58,9%, los CA en 17,9%, los IECA en 13,7%, y otras drogas en 9,5%. El fármaco de primera línea con mayor prescripción fue el enalapril (53,8%), y el fármaco de segunda línea con mayor prescripción fue la hidroclorotiazida (50,0%). Se utilizó fármacos de MC en 13,6% del total de las prescripciones. Se calculó un costo promedio mensual de la terapia antihipertensiva prescrita de 33,9 nuevos soles, elevándose el costo en un 28,4% al haber sido prescrita en la modalidad de MC de forma parcial. CONCLUSIONES: A pesar de los beneficios ampliamente demostrados de la terapia con diuréticos tiazídicos, el uso de este fármaco es bajo; asimismo...

In our hospitals, the treatment of hypertension is highly variable and individualized, with prescriptions and costs that influence on treatment accessibility and compliance. OBJECTIVE: To know the class and costs of the antihypertensive therapy in a general hospital. MATERIAL AND METHODS: A transversal and descriptive study was done on the prescription of antihypertensive drugs from ambulatorypatients during 2003 in the Hospital Nacional Arzobispo Loayza of Lima. International Common Names and Trademark Names were registered and the cost of therapy was calculated witheach drug‘s price. RESULTS: Three hundred and three medical records were collected. An optimal control of blood pressure was registered in only 4,9%. First choice antihypertensive class drugwas angiotensin converter enzyme inhibitors (ACEI) in 70,5%, followed by calcium channel blockers (CCB) in 11,7%, beta blockers (BB) in 6,4% and other drugs 11,4%. Second choice antihypertensive class drug was thiazide diuretics in 58,9%, CCB in 17,9%, ACEI in 13,7% and other drugs 9,5%. Most prescribed first line drug was enalapril in 53,8% and most prescribed second line drug was hydrochlorothiazide in 50,0%. Trademark Names prescriptionswere done in 13,6%. The monthly cost of the antihypertensive therapy was S/ 33,9 nuevos soles with an increase of 28,4% because of partially prescribed Trademark Names drugs. CONCLUSIONS: Despite of the known benefits of thiazide diuretic therapy,the use of this class of drug was low, and that the prescription of Trademark Names drugs increases the monthly average cost of therapy.

Valoración geriátrica integral en adultos mayores hospitalizados a nivel nacional / Multidisciplinary geriatric assessment in peruvians hospitals

Conocer el perfil de los síndromes y problemas geriátricos, así como la situación funcional, mental y social de los adultos mayores internados en los servicios de medicina de los hospitales en el Perú. Se incluyeron 400 pacientes de 60 años o más internados en los servicios de medicina interna de distintos hospitales a nivel nacional, durante el periodo de Febrero a Octubre del 2003, a quienes se les aplicó el addedum VGI (instrumento para realizar una valoración geriátrica integral). La edad promedio fue de 74.68 años, predominando el sexo femenino con un 50.5 por ciento, el número de síndromes fue de 4.19 (d.s. = +/-2.44). Se encontró una frecuencia de alteraciones de cavidad oral en 98 por ciento; deprivación sensorial, 82.5 por ciento; malnutrición, 68.22 por ciento; incontinencias, 54 por ciento; insomnio, 52.72 por ciento; caídas, 39.75 por ciento; mareos, 39 por ciento; constipación, 37.25 por ciento; prostatismo en un 31.25 por ciento; confusión aguda o delirio, 28.25 por ciento; inmovilización 22 por ciento; úlceras de presión, 15.75 por ciento; síncope 14.25 por ciento y ortostatismo en un 10.25 por ciento. La autonomía funcional fue de 53 por ciento, el deterioro cognitivo en un 22.11 por ciento; la depresión fue de 15.97 por ciento y una situación socio-familiar buena o aceptable sólo se presenta en un 26.63 por ciento. Los adultos mayores hospitalizados presentan una gran cantidad de síndromes y problemas geriátricos que muchas veces son pasados por alto, aumentando la frecuencia de la mayoría de estos con la edad. La situación socio-familiar de estos pacientes es en la mayoría de casos incierta y en muchos casos precaria.

Valoración geriátrica integral en una población de adultos mayores / Appraisal geriatric integral in a population of older adults

Objetivos: Evaluar por medio de la valoración geriátrica integral las características de la población mayor de 60 años del distrito de Barranca a 200 km. al norte de la ciudad de Lima e identificar los principales problemas que la aquejan. Material y métodos: se realizó un estudio transversal, descriptivo y comparativo. La muestra estuvo constituida por 90 adultos mayores que habitan el distrito de Barranca, a los que se les aplicó una encuesta de valoración geriátrica integral. Resultados: la media de la edad fue 68, mas menos 7,3 años. Los adultos mayores que habitan el distrito de Barranca presentan 40 por ciento de dependencia funcional (CI igual 0,29 menos 0,50), 52,2 por ciento de deterioro cognitivo (CI igual 0,37 menos 0,58) y 41,7 por ciento de depresión (CI igual 0,32 menos 0,52). El 95,6 por ciento de habitantes presenta por lo menos un síndrome o problema geriátrico (CI igual 0,91 menos 0,99), los más frecuentes fueron: riesgo y problema social en 86.6 por ciento (CE igual 0,79 menos 0,93), deprivación visual 82,2 por ciento (CI igual 0,74 menos 0,90) y malnutrición en 80 por ciento (CI igual 0,71 menos 0,88) Conclusiones: En los adultos mayores del distrito de Barranca se encontró: 1) alta frecuencia de dependencia funcional, deterioro cognitivo y depresión, 2) un alto porcentaje de adultos mayores presenta por lo menos un problema geriátrico. 3) alta frecuencia de riesgo y problema social.