Fiabilidad y validez de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos de Albacete y Murcia (España) / Reliability and validity of the Acquired healthy lifestyle assessment scale (E-VEVSA) in adults from Albacete and Murcia (Spain)

Fundamentos El estilo de vida es un constructo teórico que está formado por los hábitos de vida de un sujeto. El análisis y la cuantificación objetivable del estilo de vida, puede tener un gran impacto sobre la salud de las personas, así como en la evolución del estado de la misma con el transcurso de los años. El objetivo de la presente investigación ha sido la validación de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos españoles. Métodos Sobre una muestra inicial para las pruebas exploratorias de 248 sujetos y final para las pruebas confirmatorias de 780 sujetos, de edades comprendidas entre los 22 y 72 años de edad, se realizaron pruebas psicométricas exploratorias y confirmatorias basadas en el estadístico alfa de Cronbach (fiabilidad) y análisis factorial exploratorio con rotación oblicua (oblimin) y confirmatorio con rotación varimax (validez de constructo), que dieron lugar a un instrumento definitivo formado por 52 ítems y estructurado en siete dimensiones: Responsabilidad individual en el cuidado de la salud (nueve ítems), hábitos de práctica físico-deportiva (seis ítems), hábitos de salud en las relaciones sociales (10 ítems), hábito de consumo de tabaco y alcohol (nueve ítems), hábito de alimentación saludable (siete ítems), hábito de salud psicológica (seis ítems) y hábito de descanso y sueño diario (cinco ítems). Resultados Todos los ítems explicaron una varianza total de 66,87% y un alfa de Cronbach de 0,894, estando por encima de 0,700 el alfa parcial de cada dimensión o factor. Conclusiones Los resultados arrojan pruebas psicométricas que confirman la validez de la escala E-VEVSA como un instrumento útil para medir el estilo de vida saludable adquirido en personas adultas (AU)

Background Lifestyle is a theoretical construct that is formed by the life habits of a subject. The analysis and objective quantification of lifestyle can have a great impact on people's health, as well as on the evolution of its status over the years. The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale (E-VEVSA) in Spanish adults. Method On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects, aged between 22 and 72 years of age. Exploratory and confirmatory psychometric tests were carried out based on the Cronbach's alpha statistic (reliability) and exploratory factorial analysis with oblique rotation (oblimin) and confirmatory with varimax rotation (construct validity), which resulted in an instrument made up of 52 items and structured in 7 dimensions: individual responsibility in health care (9 items), habits of physical-sports practice (6 items), health habits in social relationships (10 items), habit of tobacco and alcohol consumption (9 items), habit of healthy eating (7 items), psychological health habits (6 items) and daily rest and sleep habits (5 items). Results All the items explained a total variance of 66.87% and a Cronbach's alpha of .894, with the partial alpha of each dimension or factor being above .700. Conclusions The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults (AU)

[Reliability and validity of the Acquired healthy lifestyle assessment scale (E-VEVSA) in adults from Albacete and Murcia (Spain)]. / Fiabilidad y validez de la Escala de valoración del estilo de vida saludable adquirido (E-VEVSA) en adultos de Albacete y Murcia (España).

BACKGROUND: Lifestyle is a theoretical construct that is formed by the life habits of a subject. The analysis and objective quantification of lifestyle can have a great impact on people's health, as well as on the evolution of its status over the years. The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale (E-VEVSA) in Spanish adults. METHOD: On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects, aged between 22 and 72 years of age. Exploratory and confirmatory psychometric tests were carried out based on the Cronbach's alpha statistic (reliability) and exploratory factorial analysis with oblique rotation (oblimin) and confirmatory with varimax rotation (construct validity), which resulted in an instrument made up of 52 items and structured in 7 dimensions: individual responsibility in health care (9 items), habits of physical-sports practice (6 items), health habits in social relationships (10 items), habit of tobacco and alcohol consumption (9 items), habit of healthy eating (7 items), psychological health habits (6 items) and daily rest and sleep habits (5 items). RESULTS: All the items explained a total variance of 66.87% and a Cronbach's alpha of .894, with the partial alpha of each dimension or factor being above .700. CONCLUSIONS: The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults.

Physical activity and its association with Mediterranean diet patterns among Spanish university students / Actividad física y su asociación con los patrones de dieta mediterránea en universitarios españoles

Objective: the aim of the present study was to assess the level of physical activity and its association with Mediterranean dietary patterns in university students of health sciences at Universidad de Castilla-La Mancha (Spain). Method: a cross-sectional study was performed through an online survey. The final sample consisted of 555 university students (78.2 % females). Adherence to Mediterranean diet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). To measure physical activity, the Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used. Results: according to physical activity, 2.5 % of the participants were considered active and 35.1 % did both strength and flexibility activities. A greater association was seen between intake of fruits (OR = 1.95; 95 % CI, 1.25-3.04), pulses (OR = 1.51; 95 % CI, 1.00-3.20), and nuts (OR = 1.99; 95 % CI, 1.33-2.99) in those considered sufficiently active. Similarly, we found a significant relationship between the intake of fruits (OR = 2.28; 95 % CI, 1.49-3.47), pulses (OR = 1.41; 95 % CI, 1.00-2.08), nuts (OR = 1.96; 95 % CI, 1.34-2.86), and fish/seafood (OR = 1.67; 95 % CI, 1.15-2.43) in those who engaged in both strength and flexibility activities. Conclusion: this study suggests that consumption of certain Mediterranean foods was associated with higher levels of physical activity in a sample of Spanish university students (AU)

Objetivo: el objetivo del presente estudio fue evaluar el nivel de actividad física y su asociación con la dieta mediterránea en estudiantes universitarios de ciencias de la salud de la Universidad de Castilla-La Mancha (España). Método:: se realizó un estudio transversal a través de una encuesta online. La muestra final estuvo formada por 555 estudiantes universitarios (78,2 % mujeres). La adherencia a la dieta mediterránea se evaluó mediante el evaluador de adherencia a la dieta mediterránea de 14 ítems (MEDAS). Para medir la actividad física se utilizó el cuestionario Rapid Assessment of Physical Activity Scale (RAPA). Resultados: de acuerdo con la actividad física, el 2,5 % de los participantes se consideraron activos y el 35,1 % realizaban actividades tanto de fuerza como de flexibilidad. Se observó una mayor asociación entre la ingesta de frutas (OR = 1,95; IC 95 %, 1,25-3,04), legumbres (OR = 1,51; IC 95 %, 1,00-3,20) y frutos secos (OR = 1,99; IC 95 %, 1,33-2,99) en aquellos considerados suficientemente activos. Asimismo, encontramos una relación significativa entre la ingesta de frutas (OR = 2,28; IC 95 %, 1,49-3,47), legumbres (OR = 1,41; IC 95 %, 1,00-2,08), frutos secos (OR = 1,96; IC 95 %, 1,34-2,86) y pescado/marisco (OR = 1,67; IC 95 %, 1,15-2,43), en aquellos que participaron en actividades de fuerza y flexibilidad. Conclusión: este estudio sugiere que el consumo de determinados alimentos mediterráneos se asocia con mayores niveles de actividad física en la muestra de universitarios españoles analizada (AU)

Update on smoking. Alternatives for the management of patients with cardiovascular risk / Puesta al día del tabaquismo. Alternativas para el manejo del paciente con riesgo cardiovascular

Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA. (AU)

El tabaquismo es la principal causa de morbimortalidad a nivel mundial y tiene una implicación clara como factor de riesgo cardiovascular. El tabaco posee distintos efectos a nivel cardiovascular, como son una disminución del óxido nítrico, aumento de la respuesta inflamatoria, aumento de la adhesión de moléculas proaterogénicas, modificaciones lipídicas, generación de estrés oxidativo y disfunción endotelial que puede verse reflejada en distintos biomarcadores. A pesar de las ayudas que se poseen actualmente para la cesación tabáquica, parte de la población consumidora no quiere o no lo puede conseguir y es por ello que herramientas alternativas como los productos de reducción del daño y el tabaco por calentamiento podrían ser una opción gracias a los mejores resultados que muestran sobre los factores de riesgo cardiovascular comparado con el cigarrillo convencional. Algo que ha llevado a estos dispositivos para ser considerados como producto de tabaco modificador del riesgo, según la FDA. (AU)

Update on smoking. Alternatives for the management of patients with cardiovascular risk.

Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA.

[Influence of a programme of therapeutic exercise on different clinical indicators related to dyslipidaemia in adult subjects aged between 26 to 73 years with a cardiovascular risk factor]. / Influencia de un programa de ejercicio físico terapéutico en diferentes indicadores clínicos relacionados con la dislipidemia en sujetos adultos de 26 a 73 años con algún factor de riesgo cardiovascular.

INTRODUCTION: A sedentary lifestyle is indicated in the international literature as one of the main causes for the onset of some cardiovascular risk factors. OBJECTIVE: To assess the effect of a therapeutic physical exercise programme on different clinical indicators related to dyslipidaemia (total cholesterol, HDL and LDL) in sedentary subjects with a cardiovascular risk factor. METHOD: Intervention study with before-and-after evaluation of a sample of 340 patients (132 males and 208 females) referred from the 2 primary care centres of the municipality of Molina de Segura (Murcia), and who participated in a 30-week programme of physical exercise combining muscle-conditioning work circuits with other cardio-respiratory resistance workouts. Regarding the clinical indicators, the health professionals collected in the medical history the health indicators corresponding to the biological evolution of the process for which the subjects studied had started the physical exercise programme. RESULTS: The statistical analyses showed a significant improvement (p<.005) in the LDL indicator and a non-significant improvement in total and HDL cholesterol indicators after a 3-month exercise programme of 3 weekly sessions. CONCLUSIONS: The prescription of physical exercise in dyslipidaemic subjects from primary care centre should be evaluated as a resource for improving the clinical indicators specific to their pathology.

[Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year]. / Análisis de relevancia clínica aplicado a 3métodos de reducción de peso en pacientes con sobrepeso u obesidad seguidos durante un año.

OBJECTIVE: To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. MATERIAL AND METHODS: The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. RESULTS: All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). CONCLUSIONS: All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.

UPLIFT study - understanding potential long-term impacts on function with tiotropium - and sub-analyses. Bibliographic resume of the obtained results.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a respiratory problem with the highest prevalence and strongest socio-economic impact in the world and whose morbimortality keeps increasing. Treating this disease is a challenge in the field of pneumology since the market now offers a wide range of bronchodilators. Tiotropium bromide, a long-acting anticholinergic bronchodilator, is a drug used to deal with this pathology. AREAS COVERED: The UPLIFT study was a 4-year (2004-2008) clinical multi-center trial in which tiotropium bromide was compared with a placebo. We present a bibliographic resume covering the multiple sub-analyses published since the end of the clinical trial, between 2009-2015. These sub-analyses analyzed the results obtained in UPLIFT in parallel, provided additional data about safety profiles, exacerbations, hospitalization and mortality rates, and lung function, among others. Expert Commentary: Tiotropium bromide is a significant advance for the maintenance treatment of patients with COPD. The favorable results obtained leave the door open to the possibility of improving the natural history of COPD and confirmed tiotropium bromide as the gold standard drug as monotherapy for treatment of COPD.

Calidad de vida en pacientes con disfunción eréctil / Quality of life in patients with erectile dysfunction

Introducción: La disfunción eréctil (DE) es un problema de salud importante que afecta a la calidad de vida de millones de personas, hecho que ha adquirido importancia, tanto en estudios individuales como poblacionales, en la calidad de la atención médica y eficacia de las intervenciones a nivel de salud pública. Objetivos: Valorar la calidad de vida y comorbilidades de pacientes, con y sin DE, en atención primaria. Material y método: Pacientes: los participantes se captaron en los centros de salud incluidos en el estudio. Se reclutó una muestra de 210 varones, de los cuales 31 no pudieron concluir el estudio por diversos motivos (n final = 179). Análisis de variables: la variable principal, de carácter cualitativo, es la ausencia o presencia de DE. Las variables secundarias se distribuyen según 3 campos: demográficas, bioquímicas y comorbilidades con fármacos asociados, además de las variables de grado de DE y calidad de vida, mediante el cuestionario de salud sexual del varón y el cuestionario de satisfacción con la vida, respectivamente. Análisis estadístico: estudio de observación, descriptivo y analítico, de sección transversal. Variables cuantitativas: comparación entre medias con la prueba t de Student para grupos independientes o la U de Mann-Whitney si las condiciones de normalidad (aplicación del test de Kolmogorov-Smirnoff o de Shapiro-Wilks) no se cumplían. Variables cualitativas: prueba de χ2. Resultados: De las 210 personas seleccionadas, completaron correctamente la encuesta 179 (85,2%). La edad media fue de 64,5 ± 11,6 años. Respecto de las variables demográficas, el incremento de los años aumenta la incidencia de DE, llegando al 95% entre 71-86 años. En las variables bioquímicas, se encontró una relación significativa entre la ausencia o existencia de DE con el índice aterogénico y su variable recodificada en riesgo aterogénico alto y bajo (p < 0,04)...(AU)

Introduction: Erectile dysfunction (ED) is an important health problem that affects the quality of life of millions of persons, a fact that has acquired importance both in individual and population studies, quality of medical care and efficacy of the interventions on the public health level. Objectives: To evaluate quality of life and comorbidities of patients with and without ED in Primary Care. Material and methods: Patients: The participants were obtained in the health care centers included in the study. A sample of 210 males were recruited, 31 of whom did not complete the study for different reasons (final no. =179). Analysis of variables: The principal variable, having qualitative character, is the absence or presence of ED. The secondary variables are distributed according to 3 fields: demographic, biochemical and comorbidities with associated drugs as well as the variables grade of ED and quality of life, by questionnaire Sexual Health Inventory for Men and Fugl-Meyer Life Satisfaction Checklist respectively. Statistical analysis: Observation, descriptive and analytic, cross-sectional study. Quantitative variables: comparison between means with Student's T test for independent groups of Mann-Whitney U Test if the normality conditions (application of Kolmogorov-Smirnoff or Shapiro-Wilks test) are not met. Qualitative variables: Chi square test. Results: Of the 210 persons selected, 179 (85.2%) completed the survey correctly. Mean age was 64.5 ± 11.6 years. Regarding the demographic variables, increased age increased the incidence of ED, reaching 95% between 71-86 years. In the biochemical variables, a significant relation was found between absence or existence of ED, with the atherogenic index and its variable recodified in high and low atherogenic risk (p< 0.04). The same occurs with the HDL-cholesterol, transaminase GPT and GGT levels...(AU)

[Subclinical hypothyroidism and cardiovascular risk factors]. / Hipotiroidismo subclínico y factores de riesgo cardiovascular.

OBJECTIVE: To determine the prevalence of subclinical hypothyroidism in the general population of an urban health center and describe the clinical characteristics and cardiovascular risk factors in patients with subclinical hypothyroidism. METHODS: An observational study, retrospective, reviewing the medical histories of patients sampled from June 2005 until July 2007. We analyzed the following variables; facts: age and sex. Family history thyroid disease and other diseases. Personal History: cardiovascular pulmonary autoimmune, alterations gynecology obstetric diabetes, hypertension (HT) dislipemia, obesity, psychiatric alterations and haematological. Laboratory data: novel TSH, free T4, antiperoxidase antibodies, total cholesterol and its fractions. RESULTS: The prevalence of the sample of 100 patients collected over 8 months was 3.8% in the general population over 14 years, of which 79 were women and 21 were men. 13% were type 2 diabetics, 23% had HT and 40% had dyslipidemia. Overweight and obesity were present in 26%. The average level of TSH was 6.92 ± 2.29 µU/ml and the average level of free T4 was 1.16 ± 0.16 ng/ml. CONCLUSIONS: Prevalence subclinical hypothyroidism was 3.8%. especially in women with a mean age of 46. The incidence of cardiovascular risk factors in the subjects studied is higher in DM (13%), similar to general population in terms of dyslipidemia (40%) and obesity (23%) and lowest in hypertension (23%). In our study we observed a common pattern in the management of subclinical hypothyroidism, requiring the implementation and promotion of practice guidelines in primary care.

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department.

OBJECTIVE: To determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain. METHODS: A retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient s final diagnosis. RESULTS: Our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy s sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively. CONCLUSIONS: a) Anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

[Influence of diet and lifestyle in colorectal cancer]. / Influencia de la dieta y los estilos de vida en el cáncer colorrectal.

OBJECTIVE: to assess the relationship between different colorectal cancer risk factors in Albacete province. MATERIAL AND METHOD: the incidence and prevalence of CC (colorectal cancer) in Albacete province during the years from 1992 to 1999 were calculated using data from the Surgery and Anatomical Pathology Departments of hospitals located in the province, both public ("Complejo Hospitalario Universitario de Albacete" and "Hospital Comarcal de Hellín") and private ("Recoletas", "Sanatorios del Rosario" and "Santa Cristina"), and the provincial archives of the National Cancer Registry. Subsequently, the same calculation was made for each of the 33 Health Areas into which the province is organized. The three Health Areas with the highest incidence, and the three with the lowest incidence, of CC were selected for the study. By means of a systematic randomization of persons over 50 years, 445 persons were selected for the study using the census of the 25 villages and towns located in the high and low CC incidence areas. Subsequently we carried out the survey in these two zones: high and low incidence areas. Data were collected in Dbase IV, and the statistical analysis was carried out with the statistical package SPSS 10.1 for Windows. RESULTS: during the period studied 531 new cases of CC were registered, of which 291 (54.99%) were men. Mean rate was 15.9 per 100,000 persons/year. Highest incidence areas included Elche de la Sierra (30.2 per 100,000 persons/year), followed by Alcadozo (28.3), and Ontur (26.9). Lowest incidence areas were Ossa de Montiel (5.9), Munera (5.1), and Balazote (6.5). Out of 450 participants 414 (92%) filled out the questionnaire correctly. Variables including some kind of alcohol use (beer, wine, and coffee with brandy) are significantly associated with CC and multiply by more than one the risk for this disease. Some qualitative variables with statistically significant association increase, while some decrease, the risk of CC. For example, associated pathologies multiplies the risk of CC by 0.6, physical exercise by 0.3, moderate intake of alcohol by 0.5, olive oil intake by 0.7, and water intake by 0.3. Furthermore, a high intake of alcohol multiplies the risk of CC by 1.8, eggs and omelette by 2.95, pasta and rice by 2.15, blue fish by 1.8, meat and cold meats by 1.6, and having a first- or second-degree relative with cancer by 3. CONCLUSIONS: there is a significant relationship between colorectal cancer and familial cancer, physical activity, and the ingestion of alcohol, water, pasta, rice, and eggs.

Constipation in the population over 50 years of age in Albacete province.

OBJECTIVE: To Determine the incidence of constipation in Albacete province and its relation with diet and lifestyle. PATIENTS AND METHODS: Cross-sectional population survey. We studied 414 participants over 50 years of age in Albacete province. 445 persons over 50 years of age were included in the study. All participants were selected by systematic random sampling; 414 participants filled in the questionnaire correctly. MAIN MEASURES: age, weight and height, marital status, level of education and occupation; presence of a disease, number of sleep hours a day, physical exercise, smoking, alcohol intake, drug intake (anti-inflammatories and laxatives); bowel habit, diet, meal frequency and place; food intake frequency per week, daily intake of water, coffee, tea and herbal beverages; vitamin and fiber supplements; presence of cancer in the family. RESULTS: 56.9% of participants were women. Mean age 67.07 years. In Albacete province, 4.4% of the population over 50 years have a bowel habit consistent with constipation. Most participants had three meals a day (breakfast, lunch, and supper), while 50% had another meal in the morning or afternoon. These meals took place, habitually, in the domicile. There was a preponderance in daily intake of the following foods: milk (83.7%), bread (95.1%), vegetables (68.8%), fruit (91.8%), and virgin olive oil (96.6%). Fish was eaten every one to two days, and pulses and meat every three to six days. 44.4% of participants drank one to two liters of water a day. Only 3.9% of participants took some supplement; 35% of participants were on a diet. It was observed that 97.7% of participants with more than three defecations a week had a high intake of virgin olive oil; 65.7% of participants did some physical exercise customarily; 70.2% of participants were non-smokers, 10.2% were smokers, and 18.4% were ex-smokers. With regard to alcohol, the percentage of drinkers was 35.1%. The main class of medications taken by participants was NSAIDs - 14.5%; 79.7% took neither NSAIDs nor laxatives. Only 2.7% of participants took laxatives regularly. CONCLUSIONS: Most participants had relatively healthy eating habits.

[Economic impact of the introduction of a minor surgery program in primary care]. / Impacto económico de la implantación de un programa de cirugía menor en atención primaria.

OBJECTIVE: To value the economic impact of implantation (establishment) of a minor surgery programme within health area of primary care in Albacete (Spain). SETTING: Primary care (PC). DESIGN: Observational, cross-sectional and retrospective study. Interventions and measurements. It has been recorded some patients operated on subsidiary minor surgery pathologies in the three health centers of Albacete area that participated in pilot experience from 1 November 1997 to 30 October 1998. It has been calculated the fixed costs corresponding to sanitary staff and the repayment of chirurgical area daily. As well, it were calculated the costs corresponding to disposable and not disposable equipment. It were analysed costs in function of intervention and the total cost were compared with the cost it would have supposed if it would carried out in specialized private centers according to up to dated fees of 1998 insurance companies. MAIN RESULTS: During the study interval were operated on 185 patients with an average age of 64,5 years (SD +/- 21,4) with a slight predominance of women. All pathologies treated were benign, 39 cases were abscess, 38 were nail pathology, and 35 were foreign bodies removed.Cost were calculated on the basis of time of one year. Total cost of minor surgery programme were 1.234.440 Pts (7715 Euros) whereas if it would have carried out at specialized level it supposed between 2621450 Pts (15755.23 Euros) and 4440000 Pts (26684.94 Euros). CONCLUSION: In our study, the minor surgery programme in primary care diminish the cost in comparison with private specialized level, at the same time as reducing standby list in specialities like surgery or dermatology.

Impacto económico de la implantación de un programa de cirugía menor en atención primaria / Economic impact of the introduction of a minor surgery programme into primary care

Objetivo. Valorar el impacto económico de la implantación de un programa de cirugía menor en un área de salud de atención primaria. Ámbito. Atención primaria. Diseño. Observacional, transversal y retrospectivo. Medidas e intervenciones. Se han registrado todos los pacientes intervenidos de algunas patologías subsidiarias de cirugía menor en los 3 centros de salud del Área de Albacete que participaron en la experiencia piloto desde el 1 de noviembre de 1997 al 30 de octubre de 1998. Se calcularon los gastos fijos correspondientes al personal sanitario y a la amortización del área quirúrgica diaria. También se calcularon los gastos correspondientes al material fungible y no fungible. Se analizaron los gastos en función de la intervención, y el coste total se comparó con el coste que hubiese supuesto su realización en centros especializados privados según tarifas vigentes de 1998 de compañías de seguros. Resultados principales. Durante el período de estudio se intervinieron 185 pacientes con una edad media de 64,5 años (ñ 21,4) con ligero predominio de mujeres. Las patologías tratadas fueron todas benignas, siendo en 39 casos abscesos, 38 casos de patología de la uña y 35 consistieron en extracción de cuerpos extraños. Los costes se calcularon sobre la base de tiempo de un año. El coste total del programa de cirugía menor fue de 1.234.440 pts., mientras que si se hubiese realizado en el nivel especializado hubiese supuesto 2.621.450-4.440.000 pts. Conclusión. En nuestro estudio el programa de cirugía menor en atención primaria reduce los costes en comparación con el nivel especializado privado, a la vez que podría mejorar los recursos utilizados en especialidades como cirugía o dermatología (AU)

[Cost-effectiveness of atorvastatin against simvastatin as hypolipemic treatment in hypercholesterolemic patients in primary care]. / Análisis coste-efectividad de atorvastatina frente a simvastatina como tratamiento hipolipemiante en pacientes hipercolesterolémicos en atención primaria.

OBJECTIVE: To perform an economics evaluation of lipid-lowering therapy with atorvastatin and simvastatin in patients with hypercholesterolemia in primary care setting. DESIGN: Cost-effectiveness analysis (CEA) has been carried out by means of an open, random, prospective, "real world" study, with hypercholesterolemic patients (total cholesterol [TC] > 240 mg/dl and cLDL > 160 mg/dl). PATIENTS: A total of 92 patients were included (44.8% males), with a mean age of 64.9 +/- 9.4 years old (mean +/- standard deviation). 41.4% were diabetics, 62.1% hypertensives and 16.1% smokers. INTERVENTIONS: Patients were allocated to simvastatin 20 mg/day (44) and atorvastatin. 10 mg/day (48) for 6 months. ASSESSMENT AND MAIN RESULTS: Both therapies reduced significantly cLDL, TC and triglycerides at the end of the study. Atorvastatin reduced lipids faster than simvastatin at 3 months (p < 0.05), but significant differences could not be observed at 6 months. Atorvastatin reduced cLDL levels by 21.5 +/- 13.2% and 23.8 +/- 13.9% at 3 and 6 months, respectively, versus 16.4 +/- 14.2% and 22.8 +/- 10.8% with simvastatin. By these reductions, 54.2% of patients treated with atorvastatin and 50.0% of those allocated to simvastatin reached therapeutic goals of cLDL control. Atorvastatin 10 mg was more cost-effective than simvastatin 20 mg; 95,406 versus 101,335 pts per patient reaching therapeutic goals, respectively, which means that simvastatin need an extra cost of 24,833 pts per patient reaching therapeutic goals to be as efficient as atorvastatin. Sensitivity analysis to control for uncertainty confirmed the results of cost-effectiveness analysis. CONCLUSIONS: Both statins were effective as lipid-lowering agents. However, atorvastatin 10 mg was more efficient than simvastatin 20 mg due to a better cost-effectiveness ratio.

Economic evaluation of colorectal cancer screening with fecal occult blood detection.

OBJECTIVE: To analyze the cost/benefit (CBA), cost/effectiveness (CEA) and cost/utility (CUA) of colorectal cancer (CC) screening through the detection of fecal occult blood (FOB). METHODS: A retrospective 10-year study was carried out in primary care hospitals to observe the evolution of CC in the study zone; subsequently, CC screening with FOB detection was done, and the entire population aged 50 to 75 years living in the Casas Ibáñez Health Zone was invited to take part. When the results had been evaluated, the screening program was evaluated in economic terms to determine CBA and to compare screening costs (option A) with the cost of allowing CC to develop without intervention (doing nothing), according to the previous retrospective study. The CEA calculated the cost of each cancer found in an asymptomatic stage, and the CUA calculated the cost of each year adjusted to quality of life (QUALY) for both options. RESULTS: The CBA showed that screening for CC with FOB detection (option A) produced a savings of 2,001,067 Spanish pesetas (USD15,310) in comparison with option B (doing nothing). The CEA showed that each cancer detected by screening at an asymptomatic stage cost 806,025 pesetas (USD6,167). The CUA showed that each QUALY for men in option A cost 1,051,185 pesetas (USD8,043), whereas for option B each QUALY would cost 4,220,315 pesetas (USD32,290). For women, each QUALY cost 564,795 pesetas (USD4,321.31) in option A and 2,413,834 pesetas (USD18,469) in option B. CONCLUSIONS: Our economic evaluation demonstrates that the cost/benefit, cost/effectiveness and cost/utility ratios for CC screening through FOB detection with the Hemoccult test are better than for the alternative of doing nothing.

Evaluación económica de un cribado del cáncer colorrectal mediante detección de sangre oculta en heces / Economic evaluation of colorectal cancer screening with fecal occult blood detection

OBJETIVO: determinar la relación coste/beneficio (AC13), coste/efectividad (ACE) y coste/utilidad de un cribado del cáncer colorrectal (CCR) mediante la detección de sangre oculta en heces (SOH). ÁMBITO: atención primaria-secundaria. METODOLOGÍA: se hizo un estudio retrospectivo previo de 10 años para ver la evolución del CCR en la zona de estudio; posteriormente se inició un cribado del CCR mediante la detección de SOH invitando a participar a toda la población entre 50 y 75 años perteneciente a la Zona de Salud de Casas Ibáñez. Una vez valorados los resultados se ha realizado una evaluación económica del cribado mediante: AC13 en el que se comparan los costes del cribado (opción A) con los costes de dejar evolucionar el CCR sin hacer nada, según el estudio retrospectivo previo. El ACE calcula el coste de cada cáncer encontrado en estadio asintomático y por último el ACU, que consiste en valorar el coste de cada año ajustado por calidad de vida (ACVA) para las dos opciones. RESULTADOS: en el ACI3 resulta que hacer el cribado del CCR por detección de SOH (opción A) tiene un ahorro de 2.001.067 pesetas (15.310 dólares) que la opción B de no hacer nada. En el ACE resulta que cada cáncer detectado en el cribado en estado asintomático tiene un coste de 806.025 pesetas (6.167 dólares). En el ACU cada ACVA de hombre de la opción A tiene un coste de 1.051.185 pesetas (8.043 dólares), mientras que en la opción B costaría 4.220.315 pesetas (32.290 dólares), para mujeres cada ACVA de la opción A ha costado 564.795 pesetas (4.321,31 dólares) y para la opción B costarían 2.413.834 pesetas (18.469 dólares). CONCLUSIONES: la evaluación económica de nuestro estudio demuestra que un cribado del CCR mediante detección de SOH con el test Hernoccult tiene mejor relación coste/beneficio, coste/efectividad y coste/utilidad que la alternativa de no hacerlo (AU)