Design of a Nutritional Survey to Detect High Dietary Salt Intakes and Its Usefulness in Primary Care Compared to 24-Hour Urine Sodium Determination.

Many population studies report salt intakes that exceed the WHO recommendation (2 g/day of Na+ or 5 g/day of salt). We do not have tools for detecting high salt intakes that are easy to apply in primary health care (PHC). We propose the development of a survey to screen for high salt intake in PHC patients. A cross-sectional study of 176 patients determines the responsible foods, and a study of 61 patients studies the optimal cut-off point and discriminant ability (ROC curve). We assessed the salt intake using a food frequency questionnaire and a 24 h dietary recall and used a factor analysis to identify the foods with the highest contribution to be included in a high intake screening questionnaire. We used 24 h urinary sodium as a gold standard. We identified 38 foods and 14 factors representing a high intake, explaining a significant proportion of the total variance (50.3%). Significant correlations (r > 0.4) were obtained between nutritional survey scores and urinary sodium excretion, allowing us to detect patients who exceed salt intake recommendations. For sodium excretion ≥ 2.4 g/day, the survey has a sensitivity of 91.4%, a specificity of 96.2% and an area under the curve of 0.94. For a prevalence of high consumption of 57.4%, the positive predictive value (PPV) was 96.9% and the negative predictive value (NPV) was 89.2%. We developed a screening survey for subjects with a high probability of high salt intake in primary health care, which could contribute to the reduction in diseases associated with this consumption.

Translation and validation of the “personal evaluation of transitions in treatment (PETIT)” scale for people with schizophrenia.

To adapt the ‘Personal Evaluation of Transitions in Treatment (PETIT)’ scale into Spanish and analyse its psychometric properties on schizophrenic population.

Traducción y validación de la escala personal evaluation of transitions in treatment (PETIT)” para población conesquizofrenia / Translation and validation of the “personal evaluation of transitions in treatment (petit)” scale for schizophrenic population

Objetivo. Adaptar al español la escala Personal Evaluation of Transitions in Treatment (PETIT) y analizar sus propiedades psicométricas en población con esquizofrenia. Metodología. Participaron 223 pacientes en tratamiento ambulatorio con diagnóstico de esquizofrenia según criterios DSM-5. Se utilizaron como gold estándar la variable cumplimiento terapéutico, DAI10 y SMAQ y se analizaron las propiedades psicométricas de la escala en tres momentos (basal, al mes y 6 meses). Resultados. La validez de apariencia (lógica) de la escala es muy elevada. En el análisis factorial exploratorio identificamos que sería necesario eliminar el ítem-7. La fiabilidad de la escala es alta con un alfa-Cronbach de 0,91 demostrando buena consistencia interna. El análisis factorial confirmatorio tras eliminar el ítem-7 obtiene 5 componentes que explican el 57,76% de la varianza. El contenido de la escala es válido para discriminar pacientes con diferente adherencia, respuesta al tratamiento y calidad de vida. El punto de corte de la escala PETIT en español se establece en 24 puntos para ambos sexos; presentando una buena sensibilidad al cambio, y una fuerza de concordancia muy buena para los tres momentos evaluados. Conclusiones. La escala PETIT tras eliminar el ítem7 y utilizando 24 como punto de corte permite detectar cambios en la adherencia al tratamiento, su respuesta y las modificaciones resultantes en la calidad de vida de los pacientes. Su uso como único instrumento que mide todo lo anterior lo hace recomendable en la práctica clínica ya que esta precisa de métodos de evaluación sencillos que no consuman grandes esfuerzos o tiempo.(AU)

Aims. To adapt the ‘Personal Evaluation of Transitions in Treatment (PETIT)’ scale into Spanish and analyse its psychometric properties on schizophrenic population. Method. 223 patients in outpatient treatment diagnosed with schizophrenia according to DSM-5 criteria participated in the study. A defined variable ‘therapeutic compliance’, DAI10 and SMAQ were used as a gold standard and the psychometric properties of the scale were analysed at three time points (baseline, 1 month and 6 months). Results. The scale has very high face (or logical) validity. Exploratory factor analysis showed it would be necessary to eliminate item 7. The reliability of the scale is high (Cronbach’s alpha = 0.91), demonstrating good internal consistency. After eliminating item 7, confirmatory factor analysis obtained 5 components that explained 57,76% of the variance. The content of the scale is valid for discriminating between patients of different treatment adherence, response and quality of life. The cut-off point of the ‘PETIT’ scale in Spanish is set at 24 points for both sexes, with good sensibility to change and very good concordance force over the three time points evaluated. Conclusions. After eliminating item 7 and using ‘24’ as cut-off point, the ‘PETIT’ scale was able to detect changes in both adherence and response to treatment as well as the resulting modifications to the quality of life of patients. Its use as a single instrument to measure all of the above makes it advisable for use in clinical practice, as the evaluationmethods it requires are relatively simple and quick to perform.(AU)

Role of Leptin as a Link between Asthma and Obesity: A Systematic Review and Meta-Analysis.

Asthma and obesity are considered as highly prevalent diseases with a great impact on public health. Obesity has been demonstrated to be an aggravating factor in the pathogenesis of asthma. Adipose tissue secretes proinflammatory cytokines and mediators, including leptin, which may promote the development and severity of asthma in obese patients. This study is a systematic review and a meta-analysis based on the relationship between leptin and asthma during obesity. MEDLINE, Cochrane, EMBASE and CINAHL databases were used. Data heterogeneity was analyzed using Cochran's Q and treatment effect with the DerSimonian and Laird method. Random effect analyses were carried out to test data sensitivity. Asymmetry was estimated using Begg's and Egger's tests. All studies showed significant differences in leptin levels. The effect of the measures (p < 0.001), data sensitivity (p < 0.05) and data asymmetry were statistically significant, as well as tBegg's test (p = 0.010) and Egge's test (p < 0.001). Despite the existing limiting factors, the results of this study support the relevant role of leptin in the pathophysiology of asthma in obese subjects. Nevertheless, further studies are needed to obtain better insight in the relationship between leptin and asthma in obesity.

Nutritional Status of Non-Institutionalized Adults Aged over 65. Study of Weight and Health in Older Adults (PYSMA).

BACKGROUND: A significant increase in the prevalence of malnourishment, obesity, and sarcopenic obesity has been observed in developed countries over the last few decades. In Spain, this especially happens in populations over 65 who are not institutionalized. Differences in lifestyle, medication, and economic capacity partially explain this increase. OBJECTIVE: To study the nutritional status of a population of 65 year-olds and subjects who are not institutionalized, in the Cádiz region (Spain). METHODS: Observational, transversal study carried out on 2621 subjects who are 65 years old and over, with a direct weight and height measurement, in 150 pharmacy offices from 44 locations. A mobile application was designed for homogeneous data collection in all the pharmacy offices. The data required from all subjects was gender, age, postal code, social security contribution regime, if the patient lives alone, type of food consumed as the main meals, level of physical activity, polypharmacy, weight, and height. RESULTS: The prevalence of overweight and obesity amounts to 82.2% of the population (43.2% overweight and 39% obese). We found an inverse relationship between the prevalence of overweight and obesity with carrying out physical activity and having full dinners. CONCLUSION: We identify the need to reinforce the messages to the elderly aimed at maintaining adequate physical activity and assessing the quality and quantity of dinners, as well as reducing, as much as possible, the treatments that may lead to weight gain.

Psychopathological profile and prevalence of dual pathology on patients with alcoholic dependence undergoing outpatient treatment.

AIMS: Assess the prevalence of dual pathology in patients with alcohol dependence and describe the psychopathological profile of mental disorders, impulsiveness, ADHD presence and craving. METHOD: It is a cross-sectional study about dual pathology, carried out on 102 patients undergoing outpatient treatment. The presence of dual pathology is established by means of the MINI-5 interview and the MCMI-III test; DSM-IV being used as the alcohol abuse criteria. Impulsiveness, ADHD presence, craving and quality of life were measured through SIS, ASRSv1, MACS and SF-36. RESULTS: The prevalence of dual pathology ranges from 45.1% to 80.4% according to MCMI-III and MINI-5, respectively. The most frequent pathologies are current major depressive episodes, followed by current generalized anxiety disorders, suicide risk and current dysthymia disorders; 73.2% of dual patients present a moderate and intense global score according to MACS, 56.1% got a meaningful score in impulsiveness according to SIS and 41.5% has highly consistent symptoms with ADHD. As regards quality of life, 53.7% of the sample had bad mental health. In the case of dual patients consuming other substances, 30% had a history of bipolar disorders and 10% had a high suicide risk. CONCLUSIONS: The prevalence of psychiatric comorbidity in patients with alcohol dependence undergoing outpatient treatment varies depending on the detection method, MINI being the one identifying a greater number of cases. More than half of dual patients present impulsive behavior, a bad mental health state and high craving levels. Special attention should be paid to dual patients consuming other substances.

Perfil psicopatológico y prevalencia de patología dual de los pacientes con dependencia alcohólica en tratamiento ambulatorio / Psychopathological profile and prevalence of dual pathology on patients with alcoholic dependence undergoing outpatient treatment

Objetivo. Estimar la prevalencia de patología dual (PD) en pacientes con dependencia alcohólica y describir el perfil psicopatológico de los trastornos mentales, su impulsividad, hiperactividad y craving. Metodología. Estudio transversal sobre PD de 102 pacientes en tratamiento ambulatorio. Se determina la presencia de PD mediante la entrevista MINI-5 y el test MCMI-III, utilizando como criterio de abuso o dependencia de alcohol el DSM-IV. Se emplearon además la EIE (impulsividad), ASRSv1 (hiperactividad), EMCA (craving) y SF-36 (calidad de vida). Resultados. La prevalencia de PD varía del 45,1% (MCMI-III) al 80,4% (MINI-5) dependiendo del instrumento utilizado. Predominan el episodio depresivo mayor actual y recidivante, seguido por el trastorno de ansiedad generalizada actual, el riesgo de suicidio y el trastorno distímico actual; el 73,2% de los pacientes duales presenta una puntuación global moderada-intensa en EMCA, un 56,1% tiene conducta impulsiva y un 41,5% síntomas altamente consistentes con el TDAH. Respecto a la calidad de vida, el 53,7% tenía un mal estado de salud mental. Un 30% de los pacientes con PD y consumo añadido de drogas tenía antecedentes de trastorno bipolar y un 10% riesgo de suicidio alto. Conclusiones. La prevalencia de comorbilidad psiquiátrica en pacientes con dependencia alcohólica en tratamiento ambulatorio varía dependiendo del método de detección, siendo la MINI la que identifica un mayor número de casos. Más de la mitad de los pacientes con PD tiene conducta impulsiva, mala calidad de salud mental y altos niveles de craving. Requieren especial atención los PD con consumo de otras sustancias

Aims. Assess the prevalence of dual pathology in patients with alcohol dependence and describe the psychopathological profile of mental disorders, impulsiveness, ADHD presence and craving. Method. It is a cross-sectional study about dual pathology, carried out on 102 patients undergoing outpatient treatment. The presence of dual pathology is established by means of the MINI-5 interview and the MCMI-III test; DSM-IV being used as the alcohol abuse criteria. Impulsiveness, ADHD presence, craving and quality of life were measured through SIS, ASRSv1, MACS and SF-36. Results. The prevalence of dual pathology ranges from 45.1% to 80.4% according to MCMI-III and MINI-5, respectively. The most frequent pathologies are current major depressive episodes, followed by current generalized anxiety disorders, suicide risk and current dysthymia disorders; 73.2% of dual patients present a moderate and intense global score according to MACS, 56.1% got a meaningful score in impulsiveness according to SIS and 41.5% has highly consistent symptoms with ADHD. As regards quality of life, 53.7% of the sample had bad mental health. In the case of dual patients consuming other substances, 30% had a history of bipolar disorders and 10% had a high suicide risk. Conclusions. The prevalence of psychiatric comorbidity in patients with alcohol dependence undergoing outpatient treatment varies depending on the detection method, MINI being the one identifying a greater number of cases. More than half of dual patients present impulsive behavior, a bad mental health state and high craving levels. Special attention should be paid to dual patients consuming other substances

Analgesic Effect and Functional Improvement Caused by Radiofrequency Treatment of Genicular Nerves in Patients With Advanced Osteoarthritis of the Knee Until 1 Year Following Treatment.

BACKGROUND AND OBJECTIVES: Radiofrequency ablation of genicular nerves has proved to be successful in relieving pain and incapacity caused by osteoarthritis of the knee. However, long-term efficacy of such a treatment remains to be assessed. The current study aimed to reproduce radiofrequency neurotomy of genicular nerves to manage gonarthrosis pain and disability and establish therapeutic response until 1 year after intervention. METHODS: This single-center, prospective, observational, noncontrolled, longitudinal study included patients with grade 3 to 4 gonarthrosis suffering from intractable knee pain, scoring 5 or more on the visual analog scale (VAS) during >6 months. Therapy was based on ultrasound guided radiofrequency neurotomy of the superior medial, superior lateral and inferior medial genicular nerves. Visual analog scale and Western Ontario and McMaster Universities Osteoarthritis scores were assessed before therapy and at 1, 6, and 12 months following treatment. RESULTS: Radiofrequency neurotomy of genicular nerves significantly reduced perceived pain (VAS) and disability (Western Ontario and McMaster Universities Osteoarthritis) in the majority of participants, without untoward events. The proportion of participants with improvement of 50% or greater in pretreatment VAS scores at 1, 6, and 12 months following intervention were 22/25 (88%), 16/25 (64%) and 8/25 (32%), respectively. CONCLUSIONS: Ultrasound-guided radiofrequency neurotomy of genicular nerves alleviates intractable pain and disability in the majority of patients with advanced osteoarthritis of the knee. Such a treatment is safe and minimally invasive and can be performed in an outpatient setting. The beneficial effect of treatment started to decline after 6 months, but even 1 year after the intervention, 32% of patients reported 50% improvement or greater in pretreatment VAS scores.

[Parents´perception of childhood overweight and obesity and eating behaviors, physical activity and sedentary lifestyle of their children. Spain]. / La percepción del sobrepeso y la obesidad infantil por parte de los progenitores.

BACKGROUND: Parents often do not perceive their children's excess weight, and therefore not modified their lifestyles. We study how often this actually occurs and whether this perception is associated with differences in dietary habits, physical activity and sedentary in children. METHODS: Cross-sectional study of 1620 children aged 3-16 years selected by multi-stage sampling (2008-2010) of which 454 children had excess weight. We studied family anthropometric characteristics, dietary habits, physical activity (adapted questionnaires Cindi/Marathon), and sedentary lifestyle. We analyze the differences in children with normal weight, unperceived and perceived excess weight (chi² test and ANOVA). RESULTS: Parents receive 34.7% of overweight cases and 72.3% obesity cases of their sons, and a 10.8% and 53,8% respectively in daughters. Obese parents recognize a 54.5% and 57,7% of cases of excess weight in sons, compared to 23.8% and 27,8% in daughters. Perception of excess weight was associated with the professional qualifications of the father (47%) and be a housewife (40%). Excess weight parents' perception coincided with more compliance with physical activity recommendations in younger's sons (67.5% vs. 77.3%) and daughters (47.5% vs. 55.6%), and a lower frequency of sedentary in 3-9 years girls (42.6% vs. 38.9%). According to parents' excess weight perception we found slight differences in dietary by gender and age group of children. CONCLUSIONS: A significant percentage of children´s excess weight is not perceived by the parents, being due to study the causes and why parent's perception does not determine differences in dietary habits, physical activity and sedentary habits in their children.

La percepción del sobre peso y la obesidad infantil por parte de los progenitores / Parents' perception of childhood overweight and obesity of their children. Spain

Fundamento: Con frecuencia los padres no perciben la sobrecarga ponderal de sus hijos. El objetivo de este trabajo es estudiar con que frecuencia se produce este hecho y si esta percepción se asocia a diferencias en hábitos alimentarios, actividad física y sedentarismo de sus hijos. Métodos: Estudio transversal de 1.620 niños de 3 a 16 años seleccionados en un muestreo por conglomerados (2008-2010). 454 presentaron sobrecarga ponderal. Se estudiaron sus características antropométricas, hábitos alimentarios, actividad física (adaptación cuestionarios Cindi/Maraton) y sedentarismo. Analizamos las diferencias con niños con normopeso, sobrecarga ponderal percibida y no percibida (chi2 y Anova). Resultados: Los padres percibieron el 34,7% del sobrepeso y un 72,3% de obesidad en sus hijos varones, y un 10,8% y 53,8% respectivamente en las hijas. Los padres y madres obesos identifican un 54,5% y el 57,7% de los casos de sobrecarga ponderal de varones, frente al 23,8% y 27,8% en niñas. La percepción del exceso de peso se asocio a la cualificación profesional del padre (47%) y a la de ser ama de casa en las mujeers (40%). La percepción coincidió con mayor cumplimiento de recomendaciones de actividad física en los hijos (67,5 vs. 77,3%) e hijas (47,5% vs 55,6%) más jóvenes, menor sedentarismo en éstas (42,6% vs. 38,9%), y discretas diferencias por sexo y edad en los hábitos alimentarios. Conclusiones: Un porcentaje significativo de casos con sobrecarga ponderal infantil no es percibida por sus padres debiéndose estudiar sus causas y por qué esta percepción parental no determina diferencias en alimentación, actividad física y sedentarismo de sus hijos(AU)

Background: Parents often do not perceive their children's excess weight, and therefore not modified their lifestyles. We study how often this actually occurs and whether this perception is associated with differences in dietary habits, physical activity and sedentary in children. Methods: Cross-sectional study of 1620 children aged 3-16 years selected bymulti-stage sampling (2008-2010) ofwhich 454 children had excessweight.We studied family anthropometric characteristics, dietary habits, physical activity (adapted questionnaires Cindi/Marathon), and sedentary lifestyle. We analyze the differences in children with normal weight, unperceived and perceived excess weight (chi2 test and ANOVA). Results: Parents receive 34.7%of overweight cases and 72.3%obesity cases of their sons, and a 10.8% and 53,8% respectively in daughters. Obese parents recognize a 54.5% and 57,7% of cases of excess weight in sons, compared to 23.8% and 27,8% in daughters. Perception of excess weight was associated with the professional qualifications of the father (47%) and be a housewife (40%). Excess weight parents’ perception coincided with more compliance with physical activity recommendations in younger’s sons (67.5% vs. 77.3%) and daughters (47.5% vs. 55.6%), and a lower frequency of sedentary in 3-9 years girls (42.6% vs. 38.9%). According to parents’ excess weight perception we found slight differences in dietary by gender and age group of children. Conclusions: A significant percentage of children's excess weight is not perceived by the parents, being due to study the causes and why parent’s perception does not determine differences in dietary habits, physical activity and sedentary habits in their children(AU)

[Prolonged hypogonadism after cessation of androgen deprivation therapy for prostate cancer]. / Hipogonadismo prolongado tras la suspensión de tratamiento hormonal en pacientes con cáncer de próstata.

OBJECTIVES: To study the levels of LH, testosterone and PSA after suspending prolonged treatment with LH-RH analogs. MATERIALS AND METHOD: Hormonal evolution was studied in 29 patients from whom treatment had been withdrawn. The patients had previously been receiving treatment with LH-RH analog for more than one year, and with LH< 2 mUI/mL and testosterone < 2.8 ng/mL. LH, testosterone and PSA were determined monthly, together with clinical assessment. The treatment was re-initiated and the period of monitoring ended before the presence of clinical progression and/or PSA > or = 10 ng/mL. The cohort was described and survival was calculated using Kaplan-Meier and Cox regression. RESULTS: The mean period of time without treatment for the series was 35 months (CI 95%, 15.7-54.2 months). Prolonged hypogonadism (> 24 months) was presented by 17% of the patients. The recovery of the LH-T-PSA axis, when it occurred, followed the expected sequence. The variables that influenced the period of recovery of the PSA were the PSA pretreatment and the association of an antiandrogen. CONCLUSIONS: After withdrawing the prolonged treatment with LH-RH analogs, most of the patients recovered the levels of LH-T-PSA, although a subgroup remained hypogonadic for more than 24 months.

Hipogonadismo prolongado tras la suspensión de tratamiento hormonal en pacientes con cáncer de próstata / Prolonged hypogonadism after cessation of androgen deprivation therapy for prostate cancer

Objetivos: Estudiar los niveles de LH, testosterona y PSA tras suspender el tratamiento prolongado con análogos LH-RH. Material y Método: Se estudió la evolución hormonal de 29 pacientes a los que se les retiró el tratamiento. Los pacientes previamente habían seguido tratamiento con análogo LH-RH por más de un año y con LH<2 mUI/mL y testosterona <2,8ng/mL. Se determinó mensualmente la LH, testosterona y PSA junto con valoración clínica. Se reinicia el tratamiento y el tiempo de seguimiento finaliza ante la presencia de progresión clínica y/o PSA ≥ 10 ng/mL. Se realizó descripción de la cohorte, el cálculo de supervivencia mediante Kaplan-Meier y regresión de Cox. Resultados: El tiempo medio sin tratamiento de la serie fue de 35 meses (IC 95% 15,7-54,2 meses). El 17% de los pacientes presentaron hipogonadismo prolongado (>24 meses). La recuperación del eje LH-T-PSA, cuando se produjo, siguió la secuencia esperada. Las variables que influyeron en el tiempo de recuperación del PSA fueron el PSA pretratamiento y la asociación de antiandrógeno. Conclusiones: Tras retirar el tratamiento prolongado con análogos LH-RH la mayoría de los pacientes recuperan los niveles de LH-T-PSA si bien un subgrupo se mantienen hipogonádicos más de 24 meses (AU)

Objectives: To study the levels of LH, testosterone and PSA after suspending prolonged treatment with LH-RH analogs. Materials and Method: Hormonal evolution was studied in 29 patients from whom treatment had been withdrawn. The patients had previously been receiving treatment with LH-RH analog for more than one year, and with LH< 2 mUI/mL and testosterone <2.8 ng/mL. LH, testosterone and PSA were determined monthly, together with clinical assessment. The treatment was re-initiated and the period of monitoring ended before the presence of clinical progression and/or PSA ≥ 10ng/mL. The cohort was described and survival was calculated using Kaplan-Meier and Cox regression. Results: The mean period of time without treatment for the series was 35 months (CI 95%, 15.7-54.2 months). Prolonged hypogonadism (> 24 months) was presented by 17% of the patients. The recovery of the LH-T-PSA axis, when it occurred, followed the expected sequence. The variables that influenced the period of recovery of the PSA were the PSA pretreatment and the association of an antiandrogen. Conclusions: After withdrawing the prolonged treatment with LH-RH analogs, most of the patients recovered the levels of LH-T-PSA, although a subgroup remained hypogonadic for more than 24 months (AU)