Functioning of autobiographical memory specificity and self-defining memories in people with cancer diagnosis.

OBJECTIVES: Cognitive and emotional disturbances have been associated with the diagnosis and treatment of cancer. Autobiographical memory is one of the specific cognitive processes affected during this disease. The current study had two main aims: (1) to compare the functioning of autobiographical memory specificity and its related variables (executive functioning, depression and perceived stress) in a group of persons with cancer and a control group; and (2) to analyze whether the experience of cancer evolved into a self-defining memory in the sample of participants diagnosed with this disease. METHOD: The study sample comprised 62 participants, 31 in the group with a cancer diagnosis and 31 in the control group. Autobiographical memory specificity, executive functions, depression, stress and self-defining memory were evaluated in the current study. RESULTS: Depressive symptomatology and reduced executive functioning, but not perceived stress levels, are related and are predictors of autobiographical memory specificity. In addition, the identified characteristics of the self-defining memories were associated with the cancer experience as a threat to physical integrity and an awareness of the meaning of life. CONCLUSION: This emerging research line is especially important in view of its possible impacts on patients' well-being, due to the importance of psychological processes in cancer disease.

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

Introducción. Estimar la prevalencia del consumo de ansiolíticos e hipnóticos referido por los mayores de 65 años e identificar posibles factores condicionantes del citado uso. Material y métodos. Estudio transversal. La población de estudio fue de 1.161 sujetos de ≥65 años no institucionalizados con suficiente capacidad para llevar a cabo una entrevista personal. Selección mediante muestreo aleatorizado simple del listado de tarjeta sanitaria. Las principales variables evaluadas incluyeron: consumo referido de ansiolíticos/hipnóticos y otros fármacos (según el sistema de clasificación ATC), estado anímico (GDS-VE), estado cognitivo (cuestionario Pfeiffer), valoración física-funcional sobre actividades básicas de la vida diaria (índice de Katz), problemas de salud (clasificación CIAP-2 de la WONCA) y variables sociodemográficas. Resultados. La prevalencia de uso referido de ansiolíticos/hipnóticos fue del 16,6% (IC 95%: 14,5-18,7). El 90,5% fueron benzodiacepinas (BZD), fundamentalmente lorazepam (39,4% de las BZD). Las BZD de vida media prolongada supusieron el 24,7% de todas. Los hipnóticos representaron el 27,5% de los ansiolíticos/hipnóticos. El uso de ansiolíticos/hipnóticos se asoció independientemente con consumir otros fármacos no psicotrópicos (OR: 6,8; IC 95%: 2,1-22,0), presentar depresión establecida (OR: 2,5; IC 95%: 1,0-5,9), presentar 4 o más problemas de salud (OR: 2,0; IC 95%: 1,4-2,9), ser mujer (OR: 2,1; IC 95%: 1,5-3,1) y ser dependiente para las actividades básicas de la vida diaria (OR: 1,8; IC 95%: 1,1-2,9). Conclusiones. La prevalencia de uso de ansiolíticos/hipnóticos es elevada en mayores de Albacete. Diversos factores han sido identificados como potenciales condicionantes de su utilización. Sería importante mejorar el conocimiento sobre el mal uso de estos fármacos con el fin de desarrollar estrategias de prescripción efectivas y seguras (AU)

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 (AU)

[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.

Understanding insomnia in older adults.

OBJECTIVE: The aims of this study were to determine the true frequency of primary insomnia (PI), sleep disorder related to another mental disorder (SDMD) and sleep disorder due to a general medical condition (SDMC) in older adults and to establish their differentiating characteristics. METHODS: This is a cross-sectional study. Participants were randomly selected samples of 951 subjects who are 65 years or older. Main measures were as follows: presence (according to DSM-IV-TR diagnostic criteria) of PI, SDMD, SDMC or other sleep disorders, co-morbidity and psychotropic consumption. RESULTS: Of the subjects, 36.1% reported having sleep problems (95% CI: 33.0-39.2) and 37.0% reported regularly consuming a psychotropic drug. The prevalence of PI was 8.9% (95% CI: 7.1-11.0), and according to the criteria for differential diagnosis, the prevalence of SDMD was 9.3% (95% CI: 7.5-11.4) and that of SDMC was 7.0% (95%CI: 5.4-8.9). A higher percentage of PI subjects had problems in falling asleep on most days (52.5%), had frequent night-time awakenings (66.3%) and early awakenings (51.3%). In subjects with any type of insomnia, the variables that showed a statistically significant association were female gender (OR: 2.21), consumption of psychotropic drugs (OR: 1.83), presence of four or more health problems (OR: 1.88) and being single, widowed or divorced (OR: 1.43). CONCLUSIONS: Our results provide a true picture of the prevalence of insomnia in older adults on the basis of diagnostic criteria and indicate that it is a widespread, significant health problem. The peculiarities of PI, SDMD and SDMC need to be appropriately differentiated in clinical practice, and each needs a different approach to obtain the best outcome.

La Práctica de la Medicina de Familia en el National Health Service / The Practice of Family Medicine within the National Health Service

En los meses de abril, julio y agosto de 2010, los autores de este artículo nos marcamos como objetivo conocer de primera mano la atención primaria en el Nacional Health Service (NHS). Así pues, la experiencia de participación activa de cada uno de nosotros en un modelo referente en atención primaria responde a una fuerte motivación personal, suponiendo un especial atractivo para la configuración de este artículo el poder extrapolar nuestras apreciaciones e impresiones, claramente marcadas por los diferentes momentos de nuestra trayectoria profesional en la valoración de las diferencias estructurales, organizativas, de los lugares de trabajo, del análisis de los equipos, de la formación y de la figura del que hoy por hoy es el principal protagonista de un modelo de salud pionero en Europa (AU)

In the months of April, July and August 2010, the authors of this article set themselves the objective of learning about Primary Care in the National Health Service (NHS) from first hand experience. The active participation of each of us in a reference primary care model stems from a strong personal motivation. Our findings and impressions, clearly influenced by the different periods in our career, were very useful in preparing this article. Through them we could assess the structural and organisational differences of the work places, the team analysis, the training and the figure that today is the main protagonist of a pioneering health model in Europe (AU)

Trastornos del sueño y condiciones ambientales en mayores de 65 años / Sleep disorders and environmental conditions in the elderly

Objetivos: Establecer la prevalencia y las características del insomnio y su relación con otros problemas de salud, consumo de fármacos, situación socio sanitaria y hábitoshigiénicos en mayores de 65 años.Diseño: Estudio de prevalencia y asociación cruzada.Emplazamiento: Albacete (Castilla-La Mancha), 2004–2005.Participantes: Población mayor de 65 años no institucionalizada (n = 424).Método: Entrevista semiestructurada. Variables de estudio: características del sueño, repercusiones sociofamiliares, hábitos higiénicos del sueño, problemas de salud, medicación, utilización de servicios sanitarios y variables sociodemográficas. Insomnio primario (IP) diagnosticado con criterios DSM-IV.Resultados: Declaró problemas para dormir el 34,2%; en el 95,7% la alteración era crónica. La repercusión más frecuente fue sensación de descanso nocturno insuficiente (62,1%) y cansancio o somnolencia diurna(52,2%). El 20,3%(intervalo de confianza [IC] del 95%, 16,5–24,1) cumplía criterios de IP. El insomnio fue mayor en las mujeres, en los quetenían horarios irregulares e insatisfacción con las condiciones ambientales del dormitorio.El 26,9% (IC del 95%, 22,7–31,1) consumía de forma habitual psicofármacos. El número medio de problemas de salud fue superior en sujetos con insomnio (2,471, 6 frente a1,771, 5; p<0,001). Mediante regresión logística, el sexo femenino (odds ratio[OR] = 2,8; IC del 95%, 1,6–4,8) y tener dos o más problemas de salud (OR = 2; IC del 95%, 1,2–3,4) mostraron su asociación con el IP Conclusiones: El IP afecta a una quinta parte de los mayores de 65 años. Es más frecuente en mujeres y se relaciona con otros problemas de salud, consumo de fármacos e inadecuados hábitos de sueño(AU)

Objectives: To establish the prevalence and characteristics of insomnia and itsrelation ship to other health problems, medication, socio-health status and sleep hygiene in the elderly over 65 years of age.Design: Cross sectional study of prevalence.Setting: Albacete (Castilla-La Mancha), 2004–2005.Participants: A non-institutionalized elderly patient population (n = 424).Method: Semi-structured interview. Study variables were: sleep characteristics, socio-familial repercussions, sleep hygiene, health problems, medication, health careutilization and socio-demographic variables. Primary insomnia (PI)was diagnosed according to DSM-IV criteria.Results: Reported sleeping difficulties, 34.2%; in 95.7%the sleep disturbance was chronic. The most frequent repercussions were: sensation of insufficient night-time sleep (62.1%)and daytime tired ness or sleepiness(52.2%). 20.3% (95% CI, 16.5–24.1) met criteria for PI. Insomnia rates were significantly higher in females and in subjects maintaining irregular hours and expressing dissatisfaction with bedroom environmental conditions. Psychophar-maceuticals were regularly consumed by 26.9% of the subjects (95% CI, 22.7–31.1). The average number of health problems was higherin subjects with insomnia (2.471.6 compared with 1.771.5 innoninsomniacs; P<001). By means of logistic regression, female gender (OR = 2.8; 95% CI, 1.6–4.8) and the existence of 2 or more health problems (OR = 2; 95% CI. 1.2–3.4) were associated with PI.Conclusions: PI affects approximately one fifth of people over the age of 65. It is more frequent in females and is related to the existence of other health problems, medication and inadequate sleep hygiene(AU)

Functional status of elderly people with hearing loss.

The objective is to determine the prevalence of hearing loss in people over 65 years of age, to describe the functional status of people with hearing loss and to identify the need for hearing aid use. In a cross-sectional study, a random sample of 1387 people aged 65 years and over was selected. The primary study variables were: hearing level by audiometric assessment, self-perceived hearing loss, screening for hypoacusia using the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and physical, cognitive and emotional functional status. Using the HHIE-S it was determined that 11.3% of the subjects had severe hearing handicap. According to the Ventry/Weinstein criteria 43.6% had hearing handicap. When asked about the use of hearing aids, 4.5% of the study subjects said they used them, although 41.9% had hearing loss of 35 dB or more in their better ear. The variables associated with the need for a hearing aid were age >75 years (odds ratio=OR=3.2), ADL dependence (OR=2.7), cognitive impairment (OR=2.0), multiple health problems (OR=1.8), male sex (OR=1.6) and single/widowed (OR=1.5). In conclusion, there is a high prevalence of hearing loss associated with other functional limitations. Of those people who would benefit from a hearing aid (more than a third of people over 65 years old), 89.3% do not own one. The screening of hearing loss needs to be improved.

Revisión clínica del tratamiento de los Trastornos de Ansiedad / Clinical review of the treatment of Anxiet y Disorders

La ansiedad es patológica cuando se produce ante estímulos inadecuados o inexistentes, o cuando éstos existen o son adecuados, pero la intensidad y/o la duración de la respuesta supera los límites adaptativos. Es el síntoma común de un conjunto de cuadros clasificados como trastornos de ansiedad. Nos ocuparemos en la presente revisión de los más frecuentes y con mayor trascendencia en la calidad de vida de los pacientes. Revisamos las pruebas actualmente disponibles sobre efectividad y seguridad de las opciones terapéuticas utilizadas para el abordaje del trastorno de angustia, el trastorno de ansiedad generalizado, la fobia social y simple o específica y el nivel asistencial más eficiente para su tratamiento. Se trata de una revisión de la bibliografía seleccionada (guías basadas en la evidencia y revisiones sistemáticas y clínicas), considerando básicamente la validez y consistencia de los estudios, importancia de los resultados y su aplicabilidad. Los grados de recomendación se fundamentan en los niveles de evidencia existentes (AU)

Anxiety is pathological when it is produced in the absence of stimuli or with inadequate stimuli, or when stimuli do exist and are appropriate but the intensity and duration of the response exceed adaptive limits. This is the common symptom of a group of disorders classified as anxiety disorders. In this review, we focus on the most frequent of these and those with the greatest repercussions on the patients’ quality of life. We review currently available tests of efficacy and safety of the therapeutic options available to treat panic attacks, generalised anxiety disorder, specific or simple social phobia and the most efficient healthcare levels for their treatment. This paper reviews the literature selected (evidence-based guidelines and systematic and clinical reviews), basically considering the validity and consistency of the studies, the importance of the results and their applicability. The recommendations are based on existing levels of evidence (AU)

Litiasis renal / Nephrolithiasis

La nefrolitiasis se caracteriza por la aparición de cálculos en el aparato urinario superior (parénquima renal, cálices, pelvis o uréter). El cólico nefrítico es la forma de presentación más común y aparece cuando el cálculo se desprende o se rompe, depositándose en el sistema colector del riñón, lo cual aumenta la presión intraluminal y provoca el cuadro doloroso. Cualquiera que ha sufrido un cólico renal aprecia la importancia de un tratamiento precoz y de la aplicación de medidas preventivas, todo lo cual constituye una responsabilidad del médico de atención primaria. Después de un primer episodio de litiasis renal, el 50-60% de los pacientes ha presentado un segundo episodio a los 10 años. El medico de familia es el más apropiado para indicar las recomendaciones para la prevención de las recidivas de litiasis renal y realizar el seguimiento

Nephrolithiasis is characterised by the presence of stones in the upper urinary tract (renal parenchyma, calyces, pelvis or ureter). Nephritic colic is the most common symptom and appears when the stone becomes detached or breaks up and is deposited in the kidney collection system. This increases intraluminal pressure and provokes pain. Anyone who has suffered renal colic will appreciate the importance of early treatment and the taking of preventative measures. This is the responsibility of the primary care doctor. After the fi rst kidney stone attack, 50 – 60% of patients have a second attack within 10 years. The family doctor is the most suitable person to advice the patient on the prevention of recurrence of kidney stones and to follow up the patient

[Design and validation of a questionnaire for the detection of major depression in elderly patients]. / Diseño y validación de un cuestionario para la detección de depresión mayor en pacientes ancianos.

BACKGROUND AND OBJECTIVE: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). METHODS: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). RESULTS: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). CONCLUSIONS: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.

Diseño y validación de un cuestionario para la detección de depresión mayor en pacientes ancianos / Design and validation of a questionnaire for the detection of major depression in elderly patients

Fundamento y objetivo: Elaborar y validar una escala para detectar trastornos depresivos mayores (TDM) en ancianos que utilizan las consultas de atención primaria (Escala para la Detección de Depresión en Ancianos [EDDA]). Métodos: Estudio observacional transversal para validar una escala, administrada mediante entrevista personal, en 259 pacientes de 65 o más años. Tras revisar los instrumentos disponibles y elaborar los ítems, se realizó una primera prueba piloto o pretest. En una segunda prueba piloto se analizó la reproducibilidad del instrumento. El estándar de oro fue el resultado de una entrevista psiquiátrica estandarizada realizada por psiquiatras (criterios DSM-IV y entrevista SCAN). Resultados: Los coeficientes de correlación intraclase (CCI) correspondientes a la fiabilidad intra e interobservador fueron, respectivamente, de 0,858 (intervalo de confianza [IC] del 95%, 0,634-0,946) y 0,908 (IC del 95%, 0,726-0,969). El número de sujetos válidos para el estudio fue de 216 ancianos, en quienes se realizó, de forma ciega, una valoración en consultas de atención primaria y de psiquiatría. En éstas se objetivó la existencia de un TDM en 81 de ellos (37,5%; IC del 95%, 31,1-44,4). La EDDA mostró una elevada coherencia interna (* de Cronbach = 0,79). El análisis factorial determinó que existían 8 factores capaces de explicar el 55,8% de la varianza total. Para una puntuación mayor o igual a 15, la EDDA presenta una sensibilidad del 90,1% (IC del 95%, 80,95-95,33), una especificidad del 74,8% (IC del 95%, 66,48-81,71) y un cociente de probabilidad positivo de 3,58 (IC del 95%, 2,65-4,83). Conclusiones: La EDDA es un instrumento clínicamente útil para la detectar los TDM de los ancianos en la atención primaria

Background and objective: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). Methods: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). Results: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). Conclusions: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care