A Measurement Scale to Assess Children's Satisfaction with Hospitalization in the Andalusian Population.

Background: Patient satisfaction is a principal indicator in the evaluation of the stay of pediatric patients in hospitals, since its consequences can emotionally interfere with health treatment. The aim of this study was to obtain a valid scale to assess children's satisfaction with their time spent as a patient in an Andalusian hospital. Method: The Children's Satisfaction with Hospitalization Questionnaire (CSHQ) was applied to 623 pediatric patients hospitalized in Andalusia. An exploratory factor analysis (EFA) showed one dimension underlying the children's satisfaction with their hospitalization. After that, we developed a depuration analysis process to achieve a valid and unidimensional scale to assess children's satisfaction. Results: The eleven-item one-dimension solution showed suitable consistency and goodness-of-fit indices. The final scale addresses hosting aspects as the main dimension of a minor's satisfaction in Andalusian hospitals. Conclusion: A unidimensional scale has been determined for the assessment of children's satisfaction with their stay in Andalusian hospitals based on hosting aspects. Nonetheless, other dimensions underlying the satisfaction of patients should also be considered.

Inter-rater reliability of the digital palpation of pelvic floor muscle by the modified Oxford Grading Scale in continent and incontinent women. / Fiabilidad inter evaluador de la palpación digital de los músculos del suelo pélvico utilizando la escala modificada de Oxford graduada en mujeres continentes e incontinentes.

OBJECTIVE: The first choice treatment in stress urinary incontinence (SUI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the inter-rater reliability of the Modified Oxford Scale (MOS) used as the gold standard for measuring PFM strength. METHODS: Test-retest reliability study. One hundred and twenty-two women with SUI and thirty continent women were recruited. Patients were excluded if they had a history consistent with pelvic organ prolapse, pregnancy, previous urogynaecological surgery, or neurological conditions. Bidigital palpation quantified by the MOS was carried out by three independent examiners. Each subject answered a two-part questionnaire: demographic and clinical characteristics and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The Cohen's Kappa index with quadratic (Kw) weighting was used to assess the inter-rater agreement. RESULTS: 122 incontinent and 30 continent women were included. MOS ranged between 0 and 2 in 72.2% incontinent and 19.5% of continent women. The degree of agreement was substantial in the group of incontinent women (Kw between 0.73 and 0.81) and moderate in the group of continent women (Kw between 0.55 and 0.72). CONCLUSIONS: Our results suggest that the inter-observer reliability of MOS is improbable, especially in continent women.

OBJETIVO: El tratamiento de primera elección en la incontinencia urinaria de esfuerzo es la rehabilitación del suelo pélvico con el fin de mejorar la fuerza muscular. Sin embargo, actualmente no se dispone de instrumentos totalmente fiables para cuantificar la fuerza de la musculatura del suelo pélvico. Nuestro objetivo fue determinar la fiabilidad interobservador de la Escala de Oxford Modificada (MOS) utilizada como el patrón oro para medir la fuerza. MÉTODOS: Estudio de fiabilidad test-retest. Se reclutaron ciento veintidós mujeres con Incontinencia Urinaria de Esfuerzo y treinta mujeres continentes. Las pacientes fueron excluidas si presentaban: prolapso de órganos pélvicos, embarazo, cirugía uroginecológica previa, o enfermedades neurológicas. La palpación bidigital cuantificada con la Escala de Oxford Modificada fue realizada por tres examinadores independientes. Cada sujeto respondió a un cuestionario en dos partes: características demográficas y clínicas y el International Consultation on Incontinence Questionnaire-Forma abreviada (ICIQ-SF). Se utilizó el índice de Kappa de Cohen con ponderación cuadrática (Kw) para evaluar el acuerdo entre evaluadores. RESULTADOS: El MOS osciló entre 0 y 2 en el 72,2% de incontinentes y el 19,5% de las mujeres continentes. El grado de concordancia fue considerable en el grupo de mujeres incontinentes (Kw entre 0,73 y 0,81) y moderado en el grupo de mujeres continentes (Kw entre 0,55 y 0,72).CONCLUSIÓN: Nuestros resultados sugieren que la fiabilidad interobservador de la MOS es mejorable, especialmente en las mujeres continentes.

Spanish Version of the Family Health Behavior Scale: Adaptation and Validation.

Different studies around the world indicate that the percentages of overweight and obesity in childhood and adolescence are high. In this context, it would be useful to have a common, valid, and reliable instrument to assess health behaviors of families that allows comparisons of data from different countries. The objective is the adaptation of a Spanish version of the Family Health Behavior Scale (FHBS). The questionnaire originally developed by Moreno group was translated and adapted following the International Test Commission protocol. Its psychometric properties were evaluated through analysis of internal consistency, factor analysis and other evidences of validity. The Spanish version of the FHBS demonstrated adequate reliability coefficients, and its factor structure sufficiently replicated that obtained by the original measurement. The results suggested that the adapted version of the questionnaire was an adequate and valid measure for the evaluation of family health behaviors related to the prevention of overweight and obesity.

Clinical and pathophysiological evidence supporting the safety of extremely low LDL levels-The zero-LDL hypothesis.

While the impact of very low concentrations of low-density lipoprotein cholesterol (LDL-C) on cardiovascular prevention is very reassuring, it is intriguing to know what effect these extremely low LDL-C concentrations have on lipid homoeostasis. The evidence supporting the safety of extremely low LDL levels comes from genetic studies and clinical drug trials. Individuals with lifelong low LDL levels due to mutations in genes associated with increased LDL-LDL receptor (LDLR) activity reveal no safety issues. Patients achieving extremely low LDL levels in the IMPROVE-IT and FOURIER, and the PROFICIO and ODYSSEY programs seem not to have an increased prevalence of adverse effects. The main concern regarding extremely low LDL-C plasma concentrations is the adequacy of the supply of cholesterol, and other molecules, to peripheral tissues. However, LDL proteomic and kinetic studies reaffirm that LDL is the final product of endogenous lipoprotein metabolism. Four of 5 LDL particles are cleared through the LDL-LDLR pathway in the liver. Given that mammalian cells have no enzymatic systems to degrade cholesterol, the LDL-LDLR pathway is the main mechanism for removal of cholesterol from the body. Our focus, therefore, is to review, from a physiological perspective, why such extremely low LDL-C concentrations do not appear to be detrimental. We suggest that extremely low LDL-C levels due to increased LDLR activity may be a surrogate of adequate LDL-LDLR pathway function.

[Development and pilot study of a questionnaire to assess child and teenager satisfaction with their stay in hospital]. / Desarrollo y estudio piloto de un cuestionario para evaluar la satisfacción con la estancia hospitalaria en población infanto-juvenil.

OBJECTIVE: To develop an instrument to assess the satisfaction of children and teenagers with their stay in hospital. METHODS: A qualitative analysis of hospitalisation satisfaction dimensions based on the feedback of hospitalised children and teenagers; a content validation study by a group of experts of the items generated for the different satisfaction dimensions; and a pilot study to assess the usefulness of the questionnaire with a sample of 84 children and teenagers hospitalised in Andalusia. RESULTS: After successive refinements, a short questionnaire was obtained which took between 5 and 15minutes to complete. All items presented positive item-total correlations (r>0.18). The questionnaire showed an internal consistency index of 0.779 (Cronbach's alpha) and significant rank differences (Mann-Whitney U test; p<0.001) with medium size effects (η2>0.151) in three satisfaction dimensions compared between hospitals. DISCUSSION: A short, easy-to-answer questionnaire was developed that is reliable regarding its internal consistency and sensitive to differences in hospital satisfaction dimensions. Once validated, it will be used to assess the satisfaction of children and teenagers with their hospital stay, in addition to being a potential indicator of quality of care.

The efficacy of a supervised exercise training programme on readmission rates in patients with myocardial ischemia: results from a randomised controlled trial.

BACKGROUND: The results of research into the outcomes of physical rehabilitation and its relationship with post-myocardial ischaemia survival and readmissions are inconclusive. Our primary aim was to evaluate the efficacy of a supervised exercise training programme in terms of decreasing hospital cardiac readmission in patients with myocardial ischaemia. METHODS: We conducted a randomised controlled trial including patients with myocardial ischaemia. Eligible patients were assigned to a control group receiving standard care or to an intervention group that took part in a supervised exercise training programme. The follow-up period was 12 months after hospital discharge. RESULTS: Of 478 patients assessed for eligibility, 86 were randomised to the control group ( n = 44) or the intervention group ( n = 42). Cardiac readmission rates were 14% versus 5% ( p = 0.268) in the control and intervention groups, respectively, and all-cause readmission rates were 23% versus 15% ( p = 0.34). There were no deaths in either group. More control patients were treated in the emergency services (50% vs. 24%; p = 0.015). In terms of health-related quality of life, patients in the intervention group presented with significant increases in functional capacity and mobility. More intervention patients returned to work (77.3% vs. 36.0%; p = 0.005). CONCLUSIONS: The supervised physical exercise programme was effective at reducing the number of emergency room visits and at increasing the percentage of patients who returned to work. It also improved patients' exercise capacity and increased their health-related quality of life. Although the results were promising, the programme was not associated with a significant reduction in cardiac and all-cause readmission rates.

Intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle strength in women with urinary incontinence.

AIMS: The first choice treatment in urinary incontinence (UI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer for measuring PFM strength. METHODS: Test-retest reliability study. One hundred and four women with stress urinary incontinence (SUI) were recruited. Patients were excluded if they had a history consistent with urge urinary incontinence or pelvic organ prolapse, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital palpation quantified by the modified Oxford scale and by two consecutive dynamometry measurements obtained using a new prototype dynamometer. This instrument comprises a speculum in which an inductive displacement sensor (LVDTSM210.10.2.KTmodel, Schreiber) is attached to a spring of known stiffness constant (k). The intraclass correlation coefficient (ICC) was calculated to assess intra-rater reliability. Diagnostic accuracy was assessed using Receiver Operating Characteristics (ROC) curves analysis. RESULTS: Of the 104 subjects included, 59.6% presented scores between 0-2 on the Oxford scale. Intra-rater reliability was 0.98 (95%CI: 0.97-0.99). In the Bland & Altman plot, the distribution of disagreements was similar in the lowest and the highest strength values. The diagnostic accuracy of the dynamometer with regard to digital palpation showed an area under the curve of 0.85 (95%CI: 0.77-0.93). CONCLUSIONS: Our results suggest that this new vaginal dynamometer is a reliable and valid instrument for quantifying PFM strength. Neurourol. Urodynam. 36:333-337, 2017. © 2015 Wiley Periodicals, Inc.

Randomized clinical trial to evaluate the effect of a supervised exercise training program on readmissions in patients with myocardial ischemia: a study protocol.

BACKGROUND: In recent decades, several studies have assessed the value of cardiac rehabilitation as secondary prevention and have reported substantial reductions in readmissions. However, conclusive evidence is scarce. The present study aims to evaluate the efficacy of a supervised exercise training program for improving percentages of hospital readmission for cardiac causes in patients with myocardial ischemia in the first year after a cardiac event. The effect on all-cause readmission, all-cause mortality, functional capacity, quality of life and adherence to regular exercise is also discussed. METHODS/DESIGN: This study will be conducted as a randomized controlled trial. Eligible patients will be randomly assigned to a control group receiving standard care or to an intervention group which, in addition to standard care, will take part in a supervised exercise training program consisting of three hours a week (spread over three alternate days) of supervised exercise training for 10 weeks. Both groups will perform an exercise stress test and a blood test during the first and third month after hospital discharge. The follow-up period will be 12 months after hospital discharge. The primary outcome measures will be the percentage of patients readmitted, total number of readmissions and length of hospitalization for cardiac disease during the first year after hospital discharge, and time to first hospital admission for cardiac disease. DISCUSSION: A representative group of hospitalized patients after myocardial ischemia will be studied in order to provide comprehensive data on the potential impact of a supervised exercise training program on hospital readmission rates. TRIAL REGISTRATION: Current Controlled Trials ISRCTN57634424.

The -1131T>C SNP of the APOA5 gene modulates response to fenofibrate treatment in patients with the metabolic syndrome: a postprandial study.

OBJECTIVE: Apolipoprotein A5 is a key gene controlling VLDL synthesis and hydrolysis and is the target of the main pharmacological agent to lower triglycerides (fibrates). We hypothesised that variability in the promoter of the APOA5 gene may affect the individual response to fibrate therapy, in both the fasting and postprandial states. METHODS: We selected 50 subjects with the metabolic syndrome who also had important increase in fasting triglycerides. A subgroup of 36 patients underwent lipid-lowering treatment with 160 mg/day of fenofibrate (Secalip) for 3 months. The participants underwent a 60 g fat overload with a commercial preparation, after which we assessed the influence of the -1131T>C APOA5 SNP on the postprandial response. RESULTS: Compared with non-carriers, the C allele carriers had significantly higher triglyceride levels at baseline (54.87%), and at 3h (61.08%) and 4h (68.35%). Other lipid parameters were not affected by the APOA5 genotype. Our results indicate that carriers of the -1131C allele had a better response to fenofibrate treatment (reduction in triglyceride levels of 40.33% at baseline, P=0.018; and postprandially, 37.64% at 3h, P=0.028 and 42.58% at 4h after the high-fat meal, P=0.018) than wild-type subjects (30.91% decrease at baseline, P<0.001; and 26.61% at 3h P=0.005 and 22.95% at 4h P=0.033 after the high-fat meal). CONCLUSION: Thus, the treatment for patients with the metabolic syndrome and elevated plasma triglyceride levels may vary according to whether they carry the APOA5 -1131T>C polymorphism.