[Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area]. / Evaluación de la adherencia al tratamiento con calcio y vitaminaD en ancianos de una zona básica de salud.

BACKGROUND AND OBJECTIVE: The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. PATIENTS AND METHODS: Intervention study performed on 438 individuals ≥65years from the 'Peñagrande Cohort' with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. RESULTS: A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P=.027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index=69.8%). CONCLUSIONS: Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice.

[Analysis of the results of treatment of obesity in the hospital outpatient department]. / Análisis de los resultados del tratamiento de la obesidad en consultas externas de un hospital.

The results obtained in the treatment of obesity in the out patient department of the Nutrition Unit of "La Paz" hospital during the first 6 years of experience were analyzed. To this end, different aspects of the treatment of obesity were studied in a successive manner. The first approach prospectively compared the results obtained with individual or group health care education (HCE); with no statistically significant differences being found. Before analyzing the results obtained with the different treatments, one notes a high rate of abandonment (65%). One sees that the global weight lost is statistically significant (7%). The amount of weight los differs depending on the degree of obesity (measured by the Body Mass Index): grade I and II obesities lost the same percentage of weight (7%), grade III lost 8% and grade IV is the grade that loses the most, 12%. Keeping in mind the treatment modality used, the results are as follows: both the diet alone and the diet in association with health care education in a group, achieve a weight loss of 7%, modified fasting yields 6%, adding drugs to the diet achieves a loss of 11% and the most effective is bariatric surgery with a loss of 18%.