Adaptación y validación al español del cuestionario Aid to Capacity Evaluation (ACE), para la valoración de la capacidad del paciente en la toma de decisiones médicas / The adaptation and validation to Spanish of the questionnaire Aid to capacity evaluation (ACE), for the assessment of the ability of patients in medical decision-making

OBJETIVO: Adaptar al español y validar la escala Aid to Capacity Evaluation, diseñada para evaluar la capacidad del adulto para la toma de decisiones médicas, tanto en procesos de diagnóstico como de tratamiento para su enfermedad. DISEÑO: Observacional de validación prospectiva. Emplazamiento: Atención primaria y hospitalaria de la Zona Básica de Salud de Jaén. PARTICIPANTES: Ciento veintinueve pacientes. MEDICIONES PRINCIPALES: Cuestionario que incluía variables sociodemográficas, variables relativas a la decisión (ámbito, tipo de decisión, necesidad de consentimiento informado escrito), valoración de la capacidad con la escala Aid to Capacity Evaluation y otras relativas a la comorbilidad (hipoacusia, alcoholismo, nivel cognitivo con el Mini-Examen Cognoscitivo, y depresión mediante el test Goldberg o el Yesavage). RESULTADOS: La herramienta se considera viable. Las conclusiones del panel de expertos fueron favorables. El resultado de la validez de criterio, al comparar los resultados con la valoración de los expertos (forense y psiquiatra) fue muy satisfactorio (p < 0,001). La fiabilidad intraobservador fue baja, con un índice kappa de 0,135. La fiabilidad interobservador fue alta, con un índice kappa de 0,74. La consistencia interna obtuvo un α de Cronbach de 0,645 para el modelo reducido de 6 ítems. CONCLUSIONES: La adaptación al español de la escala Aid to Capacity Evaluation muestra una adecuada validez de constructo y consistencia interna. Su utilización contribuiría a la identificación de pacientes incapaces de tomar una determinada decisión médica y/o de otorgar un consentimiento informado

OBJECTIVE: To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. DESIGN: Observational study of prospective validation. SETTING: Primary and hospital care of the basic health area of Jaen. PARTICIPANTS: One hundred twenty-nine PATIENTS: MAIN MEASUREMENTS: Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). RESULTS: The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P < .001). The intra-observer reliability was low (kappa = 0,135). Interobserver reliability remained high (kappa = 0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. CONCLUSIONS: The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent

[The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making]. / Adaptación y validación al español del cuestionario Aid to Capacity Evaluation (ACE) , para la valoración de la capacidad del paciente en la toma de decisiones médicas.

OBJECTIVE: To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. DESIGN: Observational study of prospective validation. SETTING: Primary and hospital care of the basic health area of Jaen. PARTICIPANTS: One hundred twenty-nine patients. MAIN MEASUREMENTS: Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). RESULTS: The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. CONCLUSIONS: The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent.

Consumo de drogas entre los Especialistas Internos Residentes de Jaén (España) y su relación con el consejo clínico / Drugs consumption among Intern Specialists in Jaén (Spain) and their relationship to clinical counseling

Hay pocos estudios sobre prevalencia de consumo de alcohol, tabaco y drogas ilegales entre los especialistas internos residentes (EIR) o sobre el empleo que hacen del consejo clínico. Se diseña un estudio multicéntrico transversal mediante cuestionario validado y autoadministrado vía correo electrónico, para describir el consumo de los EIR de 17 centros docentes de una provincia andaluza (4 hospitales, 13 centros de salud) y su relación con el consejo. Participan 215 EIR (81% de cuestionarios válidos); edad media 31,2 años (±0,7), 70% mujeres, 13% extranjeros, sólo 6% enfermería. Un 78% consumen alcohol (edad inicio 16,8 años±0,3), 81% de forma ocasional y 17% fin de semana. La ingesta alcohólica semanal es 5,9 UBE (±5,8), fundamentalmente cerveza y combinados; 17% con patrón binge-drinking, mayor en hombres (p= ,001 χ2). Un 19% fuman, de ellos un 71% diariamente con una media de 8,9±1,6 cigarrillos/día; la dependencia es baja (68%) y dos terceras partes han intentado dejar de fumar. Sólo un 3% consumen cannabis. La quinta parte de los EIR no suelen aconsejar contra el consumo de tabaco (21%), la tercera parte no aconseja contra el alcohol (34%) y casi la mitad tampoco aconseja sobre drogas (44%) (p= ,001 χ2). Mediante regresión logística se aprecia un mayor consejo clínico entre los EIR de mayor edad. El consejo contra el alcohol es mayor entre mujeres (OR 2,93) y, posiblemente, en los que no tienen un consumo tipo binge-driking (OR 2,32). El comienzo tardío del tabaquismo implica un menor consejo contra las drogas ilegales (OR 0,76) (AU)

There are few studies on the prevalence of alcohol, tobacco and illegal drugs consumption among Specialist Interns (EIR) and their counseling to the patients. A multicenter cross-sectional study is carried out, consisting in a self-administered validated questionnaire to describe the consumption of the EIR of 17 health centers in Jaén (Andalusia) (4 hospitals, 13 primary care) and their relationship with their counseling. 215 EIR participate with 81% of valid questionnaires: mean age 31,2 years (±0,7), 70% women, 13% foreigners, only 6% nursing. Of them 78% consumed alcohol (onset age 16,8 years ± 0,3), 81% occasionally and 17% weekend. The alcohol average weekly intake was 5,9(±5,8) UBE, especially beer and cocktails; 17% show a binge-drinking pattern (more frequent in men, p= ,001x2). 19% smoke. A total of 71% smoke on a daily bases (mean of 8,9±1,6 cigarettes/day); the nicotine dependence is low (68%) and two thirds have tried to quit. Only 3% use cannabis. A fifth part of EIR does not usually advise against smoking use (21%), a third part does not advise against alcohol (34%) and almost half of them neither advises against drugs (44%) (p= ,001x2). Logistic regression shows greater clinical advice from older EIR. Advice against drinking alcohol provided by EIR women is more frequent (OR 2,93) and, probably, even more in EIR that binge drink (OR 2,32). Late smoking onset is related to less clinical advice against illegal drugs (OR 0,76) (AU)

[Drugs consumption among Intern Specialists in Jaén (Spain) and their relationship to clinical counseling]. / Consumo de drogas entre los Especialistas Internos Residentes de Jaén (España) y su relación con el consejo clínico.

There are few studies on the prevalence of alcohol, tobacco and illegal drugs consumption among Specialist Interns (EIR) and their counseling to the patients. A multicenter cross-sectional study is carried out, consisting in a self-administered validated questionnaire to describe the consumption of the EIR of 17 health centers in Jaen (Andalusia) (4 hospitals, 13 primary care) and their relationship with their counseling. 215 EIR participate with 81% of valid questionnaires: mean age 31.2 years (± 0.7), 70% women, 13% foreigners, only 6% nursing. Of them 78% consumed alcohol (onset age 16.8 years ± 0.3), 81% occasionally and 17% weekend. The alcohol average weekly intake was 5.9 (± 5.8) UBE, especially beer and cocktails; 17% show a binge-drinking pattern (more frequent in men, p = .001 x 2). 19% smoke. A total of 71% smoke on a daily bases (mean of 8.9 ± 1.6 cigarettes/day); the nicotine dependence is low (68%) and two thirds have tried to quit. Only 3% use cannabis. A fifth part of EIR does not usually advise against smoking use (21%), a third part does not advise against alcohol (34%) and almost half of them neither advises against drugs (44%) (p = .001 x 2). Logistic regression shows greater clinical advice from older EIR. Advice against drinking alcohol provided by EIR women is more frequent (OR 2.93) and, probably, even more in EIR that binge drink (OR 2.32). Late smoking onset is related to less clinical advice against illegal drugs (OR 0.76).

[Psychosocial nature of chronic illnesses in the dependent elderly]. / Tipología psicosocial de las enfermedades crónicas en los mayores dependientes.

OBJECTIVE: To find the psychosocial nature of chronic diseases in elderly dependent persons. DESIGN: Transversal, observational study. SETTING: Two urban health districts in Granada and Jaén, Spain. PARTICIPANTS: One hundred five patients included in the Family and Home Care programme for elderly dependent persons. MAIN MEASUREMENTS: The type of chronic illness was analysed through the modified Rolland classification. Types of incapacity, demographic variables and the presence of multi-pathologies were recorded. RESULTS: 47.6% of the 105 participants were between 70 and 79 years old. On their psychosocial nature, 94.2% had some kind of disability, 78% had a gradual start, 61% had a progressive course of disease, and 63.8% had a possibly fatal prognosis. Psychosocial type B -- incapacitating, gradual start, progressive and possibly fatal -- was the most common (44.7%). CONCLUSION: The study of psychosocial type in elderly dependent persons is an important instrument for the analysis of families with chronic illnesses within them. Questions relating to its progressive course and the fatal prognosis may have a more determining prognostic weight.

Tipología psicosocial de las enfermedades crónicas en los mayores dependientes / Psychosocial nature of chronic illnesses in the dependent elderly

Objetivo. Conocer la tipología psicosocial de las enfermedades crónicas en las personas mayores dependientes. Diseño. Estudio observacional, transversal. Emplazamiento. Dos zonas básicas de salud urbanas en Granada y Jaén. Participantes. Participaron 105 pacientes incluidos en el Programa de Atención Domiciliaria y Atención Familiar en Personas Mayores Dependientes. Mediciones principales. Se analiza la tipología de la enfermedad crónica según la clasificación de Rolland modificada. Se registran los tipos de incapacidad, las variables demográficas y la presencia de varias enfermedades. Resultados. De los 105 participantes, el 47,6% tiene entre 70 y 79 años. En cuanto a los rasgos de la tipología psicosocial, el 94,2% tiene algún tipo de incapacidad, el 78% tiene un inicio gradual, el curso es progresivo en el 61% y el 63,8% tiene un pronóstico posiblemente fatal. La tipología psicosocial B ­incapacitante, inicio gradual, progresiva y posiblemente fatales la más frecuente (44,7%). Conclusión. El estudio de la tipología psicosocial en personas mayores dependientes es un instrumento importante para el análisis de las familias con enfermedades crónicas en su seno. Los aspectos relativos al curso progresivo y al pronóstico fatal pueden proporcionar un factor pronóstico más determinante

Objective. To find the psychosocial nature of chronic diseases in elderly dependent persons. Design. Transversal, observational study. Setting. Two urban health districts in Granada and Jaén, Spain. Participants. One hundred five patients included in the Family and Home Care programme for elderly dependent persons. Main measurements. The type of chronic illness was analysed through the modified Rolland classification. Types of incapacity, demographic variables and the presence of multi-pathologies were recorded. Results. 47.6% of the 105 participants were between 70 and 79 years old. On their psychosocial nature, 94.2% had some kind of disability, 78% had a gradual start, 61% had a progressive course of disease, and 63.8% had a possibly fatal prognosis. Psychosocial type B--incapacitating, gradual start, progressive and possibly fatal--was the most common (44.7%). Conclusion. The study of psychosocial type in elderly dependent persons is an important instrument for the analysis of families with chronic illnesses within them. Questions relating to its progressive course and the fatal prognosis may have a more determining prognostic weight