Complexity of needs in amyotrophic lateral sclerosis (ALS) patients using the ENP-E scale in the north-eastern region of Spain.

OBJECTIVES: This study aimed to explore the clinical characteristics of amyotrophic lateral sclerosis (ALS) patients in Spain's north-eastern region, their inclusion in chronic care programmes, and their psychosocial and spiritual needs (PSNs). METHODS: A longitudinal descriptive study in adult patients with ALS. We analyzed clinical variables and participation in chronicity and PSNs assessment using the tool Psychosocial and Spiritual Needs Evaluation scale in end-of-life patients (ENP-E scale). RESULTS: 81 patients (average age 65.6 ± 11.7) were studied. At the study's outset, 29.7% employed non-invasive ventilation (NIV), increasing to 51.9% by its conclusion. Initial percutaneous endoscopic gastrostomy (PEG) utilization was 14.8%, rising to 35.85%. Chronic care programme participation was as follows: home care (24.7% initially, 50.6% end), palliative care (16% initially, 40.7% end), case management (13.6% initially, 50.6% end), and advance care planning registration (6.2% initially, 35.8% end). At study start, 47.8% of patients (n = 46) showed moderate-to-severe complexity in PSNs assessment using the ENP-E scale, without showing differences in age, sex, and time of evolution; whereas, on the evolutionary analysis, it was 75% (n = 24). A higher evolutionary complexity was observed in males <60 and >70 years, with no PEG and evolution of ALS of <2 and ≥5 years, and not included in chronicity programmes. When assessing concerns, physical pain and family aspects stand out in all measurements. Forty-eight percent of patients at study start and 71% at end of study showed external signs of emotional distress. SIGNIFICANCE OF RESULTS: Most ALS patients showed a high degree of complexity and were not integrated in chronicity programmes. A "care path" is proposed to integrate ALS patients in these programmes and systematically assess their needs.

Predictive capacity of FRAX in a spanish region with a hip fracture rate close to the national mean.

BACKGROUND: It is known that standardized incidence rates of hip fracture vary among older people in Spain. So far, the results published on the validation of the FRAX® tool in Spain have suggested that the major osteoporotic fractures (MOFs) risk in our country is underestimated. These studies have practically been based on Spanish cohorts evaluated in Catalonia, a higher hip fracture rate area. The purpose of this study is to analyse the ability of the FRAX® in a Spanish mid-fracture rate population. METHODS: Study design: Retrospective cohort study. MEASURES: MOFs: hip, humerus, wrist, spine fractures. Risk of fracture assessed by calculating odds ratios (ORs). Predictive capacity of FRAX® according to the osteoporotic fractures observed between 2009 and 2018 (ObsFr) to predicted by FRAX® without densitometry in 2009 (PredFr) ratio. RESULTS: 285 participants (156 women, 54.7%) with a mean ± SD of 61.5 ± 14 years. Twenty-four people sustained 27 fractures (15 MOFs). Significant ORs were observed for an age ≥ 65 (2.92; 95% CI, 1.07-7.96), female sex (3.18; 95% CI, 1.24-8.16), rheumatoid arthritis (0.62; 95% CI, 2.03-55.55), proton pump (2.71; 95% CI, 1.20-6.09) and serotonin reuptake (2.51; 95% CI, 1.02-6.16) inhibitors. The ObsFr/PredFr ratio in women were 1.12 (95% CI, 0.95-1.29) for MOFs and 0.47 (95% CI, 0-0.94) for hip fractures. Men had a ratio of 0.57 (95% CI, 0.01-1.14) for MOF, no hip fractures were observed. The ratios for the overall group were 1.29 (95% CI, 1.12-1.48) for MOFs and 0.70 (95% CI, 0.22-1.17) for hip fractures. CONCLUSIONS: FRAX® accurately predicted MOFs in women population with a hip fracture incidence rate close to the national mean compared to previous studies conducted in higher incidence regions in Spain.

Health literacy of patients on oral anticoagulation treatment- individual and social determinants and effect on health and treatment outcomes.

BACKGROUND: Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of complications associated with oral anticoagulation therapy. AIM: To evaluate the relationship between health literacy and health and treatment outcomes (concordance with oral anticoagulants, Normalized Ratio control and occurrence of complications) in patients with cardiovascular pathology. METHODS: Observational, analytic and cross-sectional study carried out on 252 patients with cardiovascular pathology (atrial fibrillation, flutter or valve prosthesis), aged 50-85 years, accessing primary care services in Valencia (Spain) in 2018-2019. Variables referring to anticoagulant treatment with vitamin K antagonists (years of treatment, adequate control, polypharmacy and occurrence of complications, among others) and health literacy (Health Literacy Questionnaire) were analysed. RESULTS: All dimensions of health literacy were significantly related to the level of education (p < 0.02), social class (p < 0.02), an adequate control of acenocoumarol (p < 0.001), frequentation of health services (p < 0.001), information by patients to health professionals about anticoagulant treatment (p < 0.03), emergency care visits (p < 0.001) and unscheduled hospital admissions (p < 0.001). CONCLUSION: Health literacy has a relevant influence on the adequate self-management of anticoagulation treatment and the frequency of complications. The different dimensions that comprise health literacy play an important role, but the "social health support" dimension seems to be essential for such optimal self-management. TRIAL REGISTRATION: ACC-ACE-2016-01. Registration date: December 2015.

Multicentre Study of Chronic Wounds Point Prevalence in Primary Health Care in the Southern Metropolitan Area of Barcelona.

BACKGROUND: Chronic wounds give rise to major costs and resource consumption in health care systems, due to their protracted healing time. Incidence and prevalence data are scarce or nonexistent in community settings. OBJECTIVE: The aim of the present epidemiological study was to analyse and determine the prevalence of chronic wounds in the community in the south of the province of Barcelona (Spain). DESIGN: A cross-sectional, multicentre secondary data analysis study was conducted in the community (excluding nursing homes) in Barcelona between 16 April and 13 June 2013. It included 52 primary care centres that serve a total population of 1,217,564 inhabitants. RESULTS: The observed prevalence was 0.11%. Venous ulcers presented the highest prevalence, at 0.04%, followed by pressure injuries, at 0.03%. The >74 age group presented the highest frequency of chronic wounds, accounting for 69.4% of cases. CONCLUSION: The results obtained are consistent with those reported in previous similar studies conducted in Spain and elsewhere. As with most studies that adjusted their variables for age and sex, we found that the prevalence of ulcers increased with age and was higher in women, except in the case of diabetic foot ulcers and ischaemic ulcers, which were more frequent in men.

Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care.

Background: A short TOP10 scale based on the Practice Environment Scale-Nursing Work Index questionnaire measures the characteristics of nursing work environments. Positive environments result in better quality care and health outcomes. Objective: To identify a small number of core elements that would facilitate more effective interventions by nurse managers, and compare them with the essential elements proposed by the TOP10. Method: Qualitative research by a nominal group of eight experts. The content analysis was combined with descriptive data. Results: Ten most important items were selected and analyzed by the expert group. A high level of consensus in four items (2, 15, 20, 31) and an acceptable consensus in five items was reached (6, 11, 14, 18, 26). The tenth item in the top ten was selected from content analysis (19). The expert group agreed 90% with the elements selected as essential to the TOP10. Conclusion: The expert group achieved a high level of consensus that supports 90% of the essential elements of primary care settings proposed by the TOP10 questionnaire. Organizational changes implemented by managers to improve working environments must be prioritized following our results, so care delivery and health outcomes can be further improved.

Relationship between Determinants of Health, Equity, and Dimensions of Health Literacy in Patients with Cardiovascular Disease.

Background: Health literacy (HL) has been linked to empowerment, use of health services, and equity. Evaluating HL in people with cardiovascular health problems would facilitate the development of suitable health strategies care and reduce inequity. Aim: To investigate the relationship between different dimensions that make up HL and social determinants in patients with cardiovascular disease. Methods: Observational, descriptive, cross-sectional study in patients with cardiovascular disease, aged 50-85 years, accessing primary care services in Valencia (Spain) in 2018-2019. The Health Literacy Questionnaire was used. Results: 252 patients. Age was significantly related with the ability to participate with healthcare providers (p = 0.043), ability to find information (p = 0.022), and understanding information correctly to know what to do (p = 0.046). Level of education was significant for all HL dimensions. Patients without studies scored lower in all dimensions. The low- versus middle-class social relationship showed significant results in all dimensions. Conclusions: In patients with cardiovascular disease, level of education and social class were social determinants associated with HL scores. Whilst interventions at individual level might address some HL deficits, inequities in access to cardiovascular care and health outcomes would remain unjustly balanced unless structural determinants of HL are taken into account.

Recomendaciones de la Guía de Práctica Clínica de la exploración de la vía aérea superior para pacientes adultos con sospecha de síndrome de apnea-hipoapnea obstructiva del sueño (versión reducida) / Clinical Practice Guideline recommendations on examination of the upper airway for adults with suspected obstructive sleep apnoea-hypopnoea syndrome

En noviembre 2014 la Sociedad Española de Otorrinolaringología, la Sociedad Española de Sueño y la Sociedad Española de Cirugía Maxilofacial propusieron y avalaron la elaboración de una Guía de Práctica Clínica sobre la exploración física de la vía aérea superior en pacientes con apnea obstructiva del sueño. La Guía ha seguido de forma estricta en toda su elaboración las recomendaciones del manual de elaboración de guías de práctica clínica del Sistema Nacional de Salud 2007 y 2009 y el manual de la Scottish Intercollegiate Guidelines Network (SIGN) 2015. El documento final puede ser altamente útil para los fines que se propuso inicialmente: ser un referente para unificar las regiones que deben ser exploradas en los pacientes con síndrome de apnea-hipoapnea obstructiva del sueño, mediante qué tipo de exploración y cómo gradarla, y expresada para todos los ámbitos asistenciales a los que estos pacientes pueden acudir. Las conclusiones y recomendaciones están basadas en una revisión exhaustiva y actualizada de la bibliografía con alto nivel de evidencia, además de la experiencia y conocimientos demostrados de todos los integrantes del grupo de elaboración. Dicho grupo se constituyó pensando siempre en la transversalidad del proyecto, y, por tanto, han participado especialistas de todos los ámbitos implicados (cirugía maxilofacial, medicina de familia, neumología, neurofisiología clínica, odontología y otorrinolaringología). Con la misma idea se seleccionaron los revisores externos del texto final

In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea. The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015. The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access. The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group. This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines

Las publicaciones científicas en enfermería comunitaria: análisis de situación / Scientific publications in community nursing: situation analysis

INTRODUCCIÓN: A pesar de que la producción científica en enfermería comunitaria ha aumentado en los últimos años, no es sencillo publicar en revistas específicas de alto impacto. Pretendemos identificar revistas científicas en las que publicar estudios enfermeros comunitarios, así como discutir ciertas características científico-técnicas de dichas revistas. MÉTODO: Artículo de enfoque constructivista, con diseño cualitativo. Parte de una revisión documental no sistemática en Scopus, Journal Citation Reports -JCR- y el catálogo Index, complementada con un informe de evaluación crítica tras análisis e interpretación de contenido a partir de opiniones de expertos/as (12 editores/as de revistas científicas en España, en las que sea posible publicar estudios de enfermería comunitaria). Se utilizó un cuestionario de preguntas abiertas remitido mediante Google forms(R). RESULTADOS: No existen revistas en español específicas de enfermería comunitaria en JCR, siendo 6 específicas en inglés y 9 generalistas. En Scopus encontramos 4 específicas y 4 inespecíficas en idioma inglés, siendo numerosas las revistas generalistas. En Index se localizaron 12 revistas, 4 con línea específica comunitaria. Transparencia y ética son claves para la mejora de las revistas científicas. Editores y revisores deben tener experiencia, no solo como autores sino también como revisores. Mejorar la visibilidad de las revistas, la calidad editorial y su impacto es importante, y ello puede provocar el pago por publicación. CONCLUSIONES: La publicación de estudios científicos de alto impacto debe hacerse necesariamente en revistas en inglés, no existiendo revistas específicas en español. Transparencia, calidad y procesos editoriales deben mejorarse en las revistas científicas

INTRODUCTION: Although scientific production in community nursing has increased in recent years, it is not easy to publish in specific journals of high impact. We intend to identify scientific journals in which to publish community nursing studies, as well as to discuss scientific-technical characteristics of these journals. METHOD: Constructivist approach article, with qualitative design. Part of a non-systematic documentary review in Scopus, Journal Citation Reports JCR and Index, complemented with a critical evaluation report after analysis and interpretation of content based on expert opinions (12 editors of scientific journals in Spain, in which it is possible to publish community nursing studies). An open-ended questionnaire sent by Google forms(R) was used. RESULTS: There are no Spanish-language journals specific to community nursing in JCR, with 6 specific in English-language and 9 generalists. In Scopus, we find 4 specific and 4 non-specific in English-language, being numerous generalist Journals. In Index, 12 journals were located, 4 with a specific community line. Transparency and ethics are key to the improvement of scientific journals. Editors and reviewers must have the experience, not only as authors but also as reviewers. Improving the visibility of journals, editorial quality, and its impact is important, and this can lead to paying per publication. CONCLUSIONS: The publication of high impact scientific studies must necessarily be done in journals in English, there is no specific journals in Spanish. Transparency, quality, and editorial processes should be improved in scientific journals

Development of a short questionnaire based on the Practice Environment Scale-Nursing Work Index in primary health care.

BACKGROUND: Professional nursing environments determine the quality of care and patient outcomes. Assessing the quality of environments is essential to improve and obtain better health outcomes. Simplifying and shortening the way to evaluate environments reliably is also important to help nurses better understand the strengths and weaknesses of their environments. In that sense, identifying essential elements of nursing environments would allow the construction of short assessment tools to improve such environments. OBJECTIVE: To construct a short tool to assess primary health care (PHC) nursing environments based on the Practice Environment Scale-Nursing Work Index (PES-NWI) questionnaire. METHODS: Observational, cross-sectional, analytical study (data collection February-April 2015). Tool: PES-NWI (31 items). Population: PHC nurses (three health districts in Valencia, Spain) with more than 3 months in the organization. The nurses were asked to select the 10 elements of the questionnaire (items) that they considered key to facilitate and improve professional care, establishing as a final selection criterion that they obtain a global election >40%. Variables: sociodemographic and 31 questionnaire items. Analysis: descriptive statistics, reliability, multidimensional scaling (ALSCAL), factor analysis, multiple linear regression. Finally, we have analyzed the concordance between both measurements (TOP10 score on the full scale score) using the Bland-Altman method. RESULTS: Study sample = 269 (Response rate = 80.29%). A total of 10 elements were identified based on selection frequency of the questionnaire PES-NWI. A factorial analysis explained 62.1% of variance, internal structure of three dimensions: (1) Participation in leadership and management, (2) Nursing foundations for quality of care, (3) Adequacy of resources, with Accumulate Variance explained: Component (1): 24%; Component (2): 43.1%; Component (3): 62.1%. Reliability (Cronbach's Alpha) was 0.816 for short questionnaire, and >0.8 for all measurements. Stress = 0.184 and RSQ = 0.793. Bland-Altman method: the scaling tends to be 1.92 points higher (equivalent to a maximum deviation of 1.54%) than the full-scale PES-NWI score (max score on PES-NWI = 124 points). CONCLUSIONS: It is possible to identify essential elements of environments to construct a short tool that simplifies the study of PHC environments. Conducting rapid studies of environments will provide managers with information about specific elements that require prioritization to enhance quality of care and safety.

Motivations, Beliefs, and Expectations of Spanish Nurses Planning Migration for Economic Reasons: A Cross-Sectional, Web-Based Survey.

PURPOSE: Migration of nurses is not a new or recent event. During the past few decades, nursing migration flows have been a constant trend worldwide. The main objective of this study was to explore the motivations, beliefs, and expectations that Spanish nurses had when considering migration to another country in the near future. DESIGN: Cross-sectional, Internet survey of Spanish nurses planning migration for professional reasons. METHODS: Ad hoc, web-based questionnaire following the Nurses Early Exit Study guidelines. FINDINGS: One hundred seventy-two nurses responded. Fifty percent of the participants intended to emigrate in the following 6 months and had chosen the United Kingdom as their destination. The most important drivers of migration were unemployment or precarious employment, and professional development. Fifty-eight percent of the participants were very afraid of experiencing discrimination or rejection. CONCLUSIONS: This first study conducted in Spain directly exploring determinants of nurse migration highlighted globalization-driven factors and specific acculturation fears. CLINICAL RELEVANCE: Employment uncertainty and professional development remain key push drivers for migration of Spanish nurses. Discrimination and rejection due to migrancy were concerns for 60% of the participants.

Clinical Practice Guideline recommendations on examination of the upper airway for adults with suspected obstructive sleep apnoea-hypopnoea syndrome. / Recomendaciones de la Guía de Práctica Clínica de la exploración de la vía aérea superior para pacientes adultos con sospecha de síndrome de apnea-hipoapnea obstructiva del sueño (versión reducida).

In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea. The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015. The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access. The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group. This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines.

Entorno de práctica profesional en enfermería

Un entorno de práctica profesional en enfermería (EPPE) es el que promueve, facilita u obstaculiza al personal de enfermería para prestar cuidados de calidad, además de incrementar la seguridad y bienestar de los pacientes y de sus profesionales. Construir entornos positivos fomenta la excelencia de la organización, optimiza los resultados y mejora la percepción y satisfacción del usuario. En numerosos países se ha podido constatar que determinados ámbitos asistenciales de enfermería considerados excelentes influyen de forma objetiva en los resultados en salud, con disminución de la morbimortalidad, aumento de la calidad y mejora del cuidado (1), además de la contención de costes (2) y otros múltiples beneficios para la sociedad, el ciudadano, el usuario y el profesional.

Elementos esenciales de los entornos profesionales enfermeros en Atención Primaria y su influencia en la calidad del cuidado / Essential elements of professional nursing environments in Primary Care and their influence on the quality of care

Objetivos: Conocida su influencia sobre la calidad del cuidado, pretendemos con nuestro estudio valorar las características de los entornos profesionales enfermeros en Atención Primaria de Salud de la Comunidad Canaria, y determinar cuáles son los elementos clave de dichos entornos para mejorar la calidad del cuidado. Método: Estudio observacional, transversal, analítico, en Atención Primaria de Salud de Canarias, con el cuestionario Practice Environment Scale - Nursing Work Index. Se midieron variables sociodemográficas, puntuaciones en el test, y se seleccionaron los ítems fundamentales que las enfermeras consideran que facilitan prestar cuidados de calidad. Se valoró la normalidad de la muestra, y se calcularon estadísticos no paramétricos y paramétricos para analizar la relación entre variables (IC=95% error=5%). Resultados: Participaron 144 enfermeras. Puntuación media total = 81,6. Las 5 dimensiones oscilaron entre puntuaciones medias de 2,25-2,92 (rango 1 a 4). Se seleccionaron 12 elementos clave para mejorar los cuidados: 6 fueron positivos en Canarias, 2 mixtos, y 4 negativos. Siete de los 12 elementos pertenecen a la dimensión 2 (fundamentos enfermeros). Ser coordinadora mostró significación (p<0,000) con mayores puntuaciones. Años de experiencia mostró significación (p<0,021) con la puntuación obtenida en los 12 elementos clave, más alta a menor experiencia. Conclusiones: Los entornos en Atención Primaria de Salud de Canarias son similares a los antecedentes en España. Como áreas de mejora: recursos humanos y participación de las enfermeras en la gestión. Los gestores enfermeros deben conocer sus entornos, implantando cambios prioritariamente sobre los elementos esenciales (AU)

Objectives: Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. Method: We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). Results: One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Conclusions: Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions (AU)

Essential elements of professional nursing environments in Primary Care and their influence on the quality of care. / Elementos esenciales de los entornos profesionales enfermeros en Atención Primaria y su influencia en la calidad del cuidado.

OBJECTIVES: Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. METHOD: We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). RESULTS: One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). CONCLUSIONS: Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions.

Enfermería de Atención Primaria en España / No disponible

No disponible

Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women.

BACKGROUND: The FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007. The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities. METHODS: The discriminatory ability of the FRAX was assessed using the 'area under curve' of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period. RESULTS: One thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630-0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661-0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652-0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827-0.938), 0.857 (95 % CI 0.773-0.941), and 0.814 (95 % CI 0.712-0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively. CONCLUSIONS: The FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool's predictive capability.

Incidencia de la fractura de fémur en España (1997-2010) / Incidence of hip fracture in Spain (1997-2010)

Fundamento y objetivo: Analizar las diferencias en la incidencia de fractura de fémur en mayores de 65 años en las 17 comunidades autónomas (CC. AA.) del estado español en el período de 1997-2010. Material y métodos: Estudio ecológico, observacional y retrospectivo que incluye a las personas ≥ 65 años que han presentado una fractura del tercio proximal de fémur en España durante 14 años. Estos registros provienen del conjunto mínimo básico de datos de los pacientes atendidos en el conjunto de hospitales de España. Resultados: Se analizan 534.043 fracturas de fémur en personas ≥ 65 años (414.518 en mujeres y 119.525 en varones). En ≥ 75 años ocurrieron el 85,4% (86,7% en mujeres; 80,7% en varones). La tasa ajustada/100.000/año fue de 722,6 en mujeres y 284,8 en varones. Por encima de la media en mujeres hay 7 CC. AA., y destacan: Cataluña, Comunidad Valenciana y Castilla-La Mancha. Por debajo de la media hay 6 CC. AA., y destacan: Canarias y Galicia. La diferencia entre CC. AA. con mayor y menor tasa de fractura ajustada por población es un 44% menor en mujeres (Canarias frente a Castilla-La Mancha) y un 50% menor en varones (Galicia frente a Cataluña). Conclusiones: La incidencia de fractura de fémur en España en ≥ 65 años muestra una importante variabilidad entre CC. AA. y, por tanto, entre zonas geográficas. Excepto en Canarias, esta variabilidad es difícil de explicar solo por factores como la edad de la población, la exposición solar o el gradiente norte-sur. Son necesarios estudios que analicen las causas de estas importantes diferencias entre CC. AA. Españolas (AU)

Background and objective: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. Material and methods: Ecological, observational and retrospective study that includes people ≥ 65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. Results: The analysis include 534,043 hip fractures in ≥ 65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people ≥ 75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). Conclusions: The analysis of the incidence of hip fracture in Spain in people ≥ 65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC (AU)

[Incidence of hip fracture in Spain (1997-2010)]. / Incidencia de la fractura de fémur en España (1997-2010).

BACKGROUND AND OBJECTIVE: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. MATERIAL AND METHODS: Ecological, observational and retrospective study that includes people≥65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. RESULTS: The analysis include 534,043 hip fractures in≥65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people≥75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). CONCLUSIONS: The analysis of the incidence of hip fracture in Spain in people≥65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC.