[Food consumption patterns among adolescents]. / La alimentación en el adolescente.

BACKGROUND: Adolescence is a critical time for the establishment of healthy eating habits. The objective was to analyze food consumption patterns among adolescents and their relationship with family and social factors. METHODS: Multicentre observational cross-sectional descriptive study using a food frequency questionnaire for the last week. It was answered anonymously. The adolescent's age/gender, parents' studies/occupation and school's location/type were included. The population sample was composed of 1,095 adolescents in sixth grade at primary schools from an Andalusian region. They were chosen by polietapic random sampling that distinguished between public/private and capital/provincial schools. RESULTS: 1,005 surveys were analyzed. The mean age is 11.45 (SD: 0.59). Fifty-three percent were male. The intake of dairy products (only two-thirds taken daily), pasta, fruit and vegetables (daily consumption of 30%) is deficient. Sixty-four point five percent consume legumes weekly. Fish consumption is equal to meat, with a preference for poultry. More than half consume red meat daily. Olive oil is preferred. The intake of "empty calories" (fast food, candies, soft drink) is high. Through multivariate analysis the existence of clusters of healthy and unhealthy foods, related to the social status of the parents and the type of school, is proved. CONCLUSIONS: A healthy diet based on the nutritional pyramid is not the consumption pattern in the adolescents surveyed. There is a low consumption of diary products, legumes, fruits and vegetables. There is a relationship between the social class of the family and consumption patterns (healthy and unhealthy). Health strategies are needed to modify such inappropriate consumption.

Resultados del tratamiento quirúrgico en las fracturas de pelvis / Results of the surgical treatment of pelvic fractures

Objetivo. Evaluar los resultados clínicos y radiológicos obtenidos tras el tratamiento quirúrgico de las fracturas del anillo pélvico. Material y método. Se analizan en esta revisión un total de 23 pacientes que han sido tratados quirúrgicamente por presentar una fractura de pelvis y de los que se ha obtenido un seguimiento completo con un mínimo de tres años. Resultados. La edad media de los enfermos en el momento del accidente ha sido de 32 años (13-59) y ha habido un predominio del sexo masculino (19:4). La fractura más frecuente ha sido la de tipo C3 (7 casos). El trayecto de la línea de fractura se ha localizado en 7 ocasiones a través de la región transacroilíaca. Las lesiones acompañantes se han presentado en 21 de los 23 enfermos y ha sido la fractura de algún hueso de la extremidad inferior la que lo ha hecho en más ocasiones (14 veces). El tratamiento más frecuente en urgencias ha sido la inmovilización mediante fijación externa. El tratamiento definitivo se ha realizado de preferencia a través del abordaje a la región posterior. El tiempo medio de seguimiento ha sido de 5,74 años (3,14-10,02). El 48% de los pacientes presentan algún grado de cojera residual y 8 de cada 23 tienen clínica dolorosa. Cuatro enfermos presentan dismetría de miembros inferiores superior a 2 cm. En tres permanece como secuela una oblicuidad pélvica. En los resultados radiológicos se ha conseguido una reducción perfecta en 18 pacientes en la parte anterior del anillo pélvico, y en 13 ocasiones en la parte posterior. En 5 casos se ha diagnosticado un trastorno de la consolidación y en el 86,4% de los pacientes se han evidenciado signos radiológicos compatibles con el diagnóstico de artrosis. Conclusiones. A pesar de una correcta reducción quirúrgica de los fragmentos óseos, la clínica dolorosa, así como la persistencia de dismetría y la cojera son secuelas frecuentes en este tipo de lesiones. A pesar de las cifras porcentuales, probablemente debido a lo limitado de la casuística, no se han podido identificar factores del cuadro inicial, ni características del resultado quirúrgico, relacionados con el resultado final del tratamiento quirúrgico de las fracturas de pelvis

Purpose. To examine the clinical and radiological results obtained after surgical treatment of pelvis ring fractures. Materials and methods. In the course of the present review, a total of 23 patients were assessed, who had been treated surgically for a pelvic fracture and who were followed-up thoroughly for at least three years. Results. Patients' average age at the time of the accident was 32 (13-59) and males outnumbered females(19:4). The mist frequent fracture type was type C3 (7 cases). On 7 occasions, the fracture line ran along the transacroiliac axis. Related lesions were found in 21 out of the 23 patients and most of them involved fractures of some small bone in the lower limb (14 cases). The most usual treatment in the emergency setting was immobilization with an external fixation device. Definitive treatment involved preferably a posterior approach. The mean follow-up period was 5.74 years (3.14-10.02). 48% of patients present with some degree of residual limping and 8 patients have pain. Four patients have lower-limb dysmetria greater than 2 cm. Three have been left with pelvic obliquity. The radiological results reveal that 18 patients achieved a perfect reduction in the anterior part of their pelvis ring and 13 in the posterior part. In 5 cases an integration disorder was detected and in 86.4% of patients radiological signs have been detected that are compatible with the diagnosis of osteoarthritis. Conclusions. Even if a correct surgical reduction of the bone fragments can be achieved, the feeling of pain and the persistence of dysmetria and limping are among the most frequent sequelae of these types of lesions. In spite of the percentages presented, probably because of the small number of cases in the series, it was not possible identify some of the factors of the initial condition or the characteristics of the surgical result related to the final result of the surgical treatment of pelvic fractures

[Validation of the AUDIT test for identifying risk consumption and alcohol use disorders in women]. / Validación del cuestionario AUDIT para la identificación del consumo de riesgo y de los trastornos por el uso de alcohol en mujeres.

OBJECTIVE: To validate the AUDIT test for identifying women with excess alcohol consumption and/or dependency syndrome (DS). DESIGN: Descriptive study to validate a test. SETTING: Two primary care centres and a county drug-dependency centre. PARTICIPANTS: 414 women from 18 to 75 recruited at the clinic. Interventions. Social and personal details were obtained through personal interview, their alcohol consumption was quantified and the AUDIT and MALT questionnaires were filled in. Then the semi-structured SCAN interview was conducted (gold standard; DSM-IV and CIE-10 criteria), and analyses were requested (GGT, GOT, GPT, VCM). 186 patients were given a follow-up appointment three-four weeks later (retest). MAIN MEASUREMENTS: Intra-observer reliability was evaluated with the Kappa index, internal consistency with Cronbach s alpha, and the validity of criteria with indexes of sensitivity and specificity, predictive values and probability quotients. To evaluate the diagnostic performance of the test and the most effective cut-off point, a ROC analysis was run. RESULTS: 11.4% (95% CI, 8.98-13.81) were diagnosed with alcohol abuse (0.5%) or DS (10.9%). The Kappa coefficients of the AUDIT items ranged between 0.685 and 0.795 (P<.001). Internal reliability, with Cronbach s alpha, was 0.932 (95% CI, 0.921-0.941). Test sensitivity was 89.6% (95% CI,76.11-96.02) and specificity was 95.07% (95% CI, 92.18-96.97). The most effective cut-off point was at 6 points. CONCLUSIONS: The AUDIT is a questionnaire with good psycho-measurement properties. It is reliable and valid for the detection of risk consumption and DS in women.

[Effectiveness of medical counseling for alcoholic patients and patients with excessive alcohol consumption seen in primary care]. / Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria.

AIM: To determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers. DESIGN: Quasi-experimental, open, multicenter before-after study.Setting. 14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain). PARTICIPANTS: 306 patients of both sexes, recruited with a case-finding strategy, who consumed >=35 (men) or >=21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O>=11). Interventions. All patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later. MAIN MEASURES: The response variable was self-reported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis. RESULTS: Of the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05). CONCLUSIONS: Counseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS.

[Reliability of blood pressure measurement: the patient versus primary care workers]. / Fiabilidad en la medición de la presión arterial: paciente frente a profesionales de atención primaria.

OBJECTIVE: To evaluate the degree of inter-observer concordance in the blood pressure figures taken by a nurse and a doctor with a mercury sphygmomanometer and by the patient with a semi-automatic device. DESIGN: Observational, crossover study. SETTING: A rural health centre. PATIENTS: 318 people selected by systematic sampling. INTERVENTIONS: Pressure was taken in different ways by 3 different "observers" (0): the patient with a semi-automatic device (01), a nurse (02) and a family doctor (03). Inter-observer concordance was assessed through the Intra-class Correlation Coefficient (ICC) and the kappa index. MEASUREMENTS AND MAIN RESULTS: 42.1%, 41.8% and 44.3% of patients had high blood pressure (> or = 140/90 mmHg) according to 01, 02 and 03, respectively. 33% were known to be hypertense. The ICC for systolic pressure was 0.81 (95% CI, 0.75-0.87) between 01 and 02; 0.84 (CI, 0.78-0.90) between 01 and 03; and 0.87 (CI, 0.82-0.92) between 02 and 03. The ICC for diastolic pressure was 0.67 (CI, 0.59-0.75), 0.72 (CI, 0.64-0.79) and 0.79 (CI, 0.72-0.86) for 01-02, 01-03 and 02-03, respectively. The kappa index was 0.53 (CI, 0.43-0.62) for 01-02; 0.60 (CI, 0.51-0.68) for 01-03; and 0.67 (CI, 0.58-0.75) for 02-03. CONCLUSIONS: Inter-observer concordance was good, with no substantial differences between the measurements made by the different observers. As the figures determined by the semi-automatic device were reliable, this is a good option for the follow-up and monitoring of hypertense patients.

[Alcohol consumption among students in a basic health area in Córdoba]. / Consumo de alcohol entre los escolares de una zona básica de salud de Córdoba.

BACKGROUND: To determine alcohol consumption amongst schoolchildren, and to discover the factors which are associated with the said consumption. METHODS: A cross-sectional study, by means of a health questionnaire administered to 548 schoolchildren in the 6th and 8th years of Primary Education (EGB) in schools within the Basic Health Area of Cordoba, with a median age of 12.4 years old (limits at 10 and 15 years old). Data were gathered on the consumption of alcohol by schoolchildren and in their social environment, as well as other variables in the lives of schoolchildren. RESULTS: 43.7% (interval of confidence at 95% -IC95%: 39.4-47.9) have tried alcohol, 3.8% (IC95% 2.5-5.9) drink regularly, while 26.8% (IC95% 23.2-30.8) drink occasionally. By means of logical regression analysis we found a connection between the consumption of alcohol and increasing age (Odds Ratio -OR: 0.83; IC95% 0.07-0.98), being male (OR: 1.78; IC95% 1.16-2.73), the consumption of alcohol by older brothers or sisters (OR: 2.25; IC95% 1.35-3.75), the consumption of medicines to treat nervousness (OR: 5.33; IC95%: 1.26-22.5), poor educational performance (OR: 1.002; IC95% 1.0-1.005), the consumption of tobacco (OR: 4.55; IC95% 2.4-8.61) and the feeling of loneliness (OR: 1.41; IC95% 1.01-1.97). CONCLUSIONS: Although the number of schoolchildren who try alcohol is low in comparison with other areas, the percentage of current drinkers is very similar. It would seem that older brothers and sisters have an important influence on starting consumption. The profile of a school age child who drinks corresponds to a male, a smoker, and having feelings of loneliness.

[The approach to the etiological diagnosis of hyperlipemias in primary care]. / Aproximación al diagnóstico etiológico de las hiperlipemias en atención primaria.

OBJECTIVE: To perform etiological diagnosis of hyperlipidemia (HL) brought to light in family medical (general practice) consultations. DESIGN: Retrospective descriptive study. SITE. A basic health zone (ZBS). PATIENTS: 231 patients diagnosed as having HL by their doctors. MAIN MEASUREMENTS AND RESULTS: Lipidic levels (average figures): total cholesterol (CT): 280; C-LDL: 201; C-HDL: 49 and triglycerides (TGL): 198. Distribution by phenotypes: IIa: 178 patients, IIb: 42, IV:5, with 6 doubtful cases. Distribution according to etiological diagnosis: 79% primary HL (83% polygenic and 17% family) 15% secondary HL, with 6% having both types in association. CONCLUSIONS: Diagnosis of HL in the visits to the family doctor reveals probability-predictable patterns based, above all, on the the overall assessment made by the doctor of his/her patient. The survey and the family study are very limited in our circles. The predominating type of HL is primary polygenic where prescribing of special diets will be sufficient in most cases.