Validación del RUDAS como instrumento de cribado de población con demencia en atención primaria / Validation of RUDAS: A screening tool for dementia in Primary Health Care settings

Objetivo: Validar la escala Rowland Dementia Assessment Scale (RUDAS) como instrumento de cribado de deterioro cognitivo y demencia en atención primaria (AP). Es un test breve, válido para población con bajo nivel educativo formal y fácilmente traducible en entornos multiculturales. Diseño: Se realizó un estudio epidemiológico descriptivo, de corte transversal, con seguimiento a los 5años. Emplazamiento: Centro de salud de atención primaria de O Grove, que atiende a una población de 10.650 habitantes en Pontevedra. Participantes: Ciento cincuenta personas aleatoriamente seleccionadas, con una edad media de 76,35±7,12años, bajo nivel educativo, origen predominantemente rural y semirrural y nivel socioeconómico bajo. Intervención: Se analizó la viabilidad, la aceptabilidad, la validez y la fiabilidad de la escala. Mediciones principales: RUDAS, Mini Mental State Examination, Clinical Dementia Rating, Índice de Katz, Índice de Barthel, Índice de Lawton y Escala de Depresión Geriátrica de Yesavage. Resultados: El test fue bien acogido por los pacientes y rápido de aplicar (7,58±2,10min). El área bajo la curva COR para el diagnóstico de demencia fue 0,983 (IC95%: 0,97-1,00). Para un punto de corte óptimo de 22,5 presentó una sensibilidad del 89,3% y una especificidad del 100%. El área bajo la curva COR para discriminar personas con DCL de personas con demencia fue 0,965 (IC95%: 0,91-1,00). Conclusiones: El RUDAS ha demostrado ser un instrumento viable y eficiente para cribar demencias en AP, libre de influencias educativas y socioculturales. Es especialmente sensible para discriminar población con deterioro cognitivo leve de población con demencia.(AU)

Objective: To validate Rowland Dementia Assessment Scale (RUDAS), as an instrument for the screening of people with dementia and cognitive impairment in Primary Health Care (PHC). RUDAS is a brief cognitive test, appropriate for people with minimum completed level of education and easily adaptable to multicultural contexts. For these reason it could be a good instrument for dementia screening in PHC. Design: Cross-sectional descriptive epidemiological study with a five-year follow up. Location: O Grove PHC centre, Galicia, Spain (covering a population of 10,650 individuals). Outcome measures: RUDAS; Mini Mental State Examination; Clinical Dementia Rating; Katz, Barthel and Lawton Indexes; MMSE and Yesavage Geriatric Depression Scale. Participants: A total of 150 older adults (mean age 76.35±7.12years) randomly selected, from a low sociocultural and economical background and mainly rural and semirural origin. Intervention: RUDAS viability in PHC was checked, and its psychometric properties assessed: reliability, sensitivity, specificity, positive and negative predictive values. Results: RUDAS application was brief (7.58±2.10min) and well accepted. RUDAS area under receiver operating characteristic (ROC) curve for the detection of dementia was 0.983 (95% confidence interval (CI): 0.97-1.00) for an optimal cut-off point of 22.5, with sensitivity of 89.3%, and a specificity of 100%. Area under ROC curve for discriminating dementia from mild cognitive impairment was 0.965 (95%CI: 0.91-1.00). Conclusions: RUDAS test is fit for dementia screening in PHC and it is especially sensitive to discriminate PWD from people with MCI.(AU)

[Validation of RUDAS: A screening tool for dementia in Primary Health Care settings]. / Validación del RUDAS como instrumento de cribado de población con demencia en atención primaria.

OBJECTIVE: To validate Rowland Dementia Assessment Scale (RUDAS), as an instrument for the screening of people with dementia and cognitive impairment in Primary Health Care (PHC). RUDAS is a brief cognitive test, appropriate for people with minimum completed level of education and easily adaptable to multicultural contexts. For these reason it could be a good instrument for dementia screening in PHC. DESIGN: Cross-sectional descriptive epidemiological study with a five-year follow up. LOCATION: O Grove PHC centre, Galicia, Spain (covering a population of 10,650 individuals). OUTCOME MEASURES: RUDAS; Mini Mental State Examination; Clinical Dementia Rating; Katz, Barthel and Lawton Indexes; MMSE and Yesavage Geriatric Depression Scale. PARTICIPANTS: A total of 150 older adults (mean age 76.35±7.12years) randomly selected, from a low sociocultural and economical background and mainly rural and semirural origin. INTERVENTION: RUDAS viability in PHC was checked, and its psychometric properties assessed: reliability, sensitivity, specificity, positive and negative predictive values. RESULTS: RUDAS application was brief (7.58±2.10min) and well accepted. RUDAS area under receiver operating characteristic (ROC) curve for the detection of dementia was 0.983 (95% confidence interval (CI): 0.97-1.00) for an optimal cut-off point of 22.5, with sensitivity of 89.3%, and a specificity of 100%. Area under ROC curve for discriminating dementia from mild cognitive impairment was 0.965 (95%CI: 0.91-1.00). CONCLUSIONS: RUDAS test is fit for dementia screening in PHC and it is especially sensitive to discriminate PWD from people with MCI.

Health care contact prior to suicide attempts in older adults. A field study in Galicia, Spain.

INTRODUCTION: Older people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. Many studies have found greater health contact, especially with general practitioner, prior to suicidal behaviour in this age group. Less information is availbale about prior contact with other health services. OBJECTIVE: The objective of the study is to know the characteristics of contact with all levels of health services, prior to a suicide attempt in people over 65 years of age in a defined population. MATERIAL AND METHODS: Along the period January 2015 to December 2017, all persons over 65 years of age admitted by suicide attempt to emergency room in the health area of Santiago de Compostela were interviewed. The interview included a psychiatric evaluation and the collrection of relevant clinical and sociodemographic variables, in particular, data on prior contact with health services. RESULTS: 80 suicide attempts were recorded, which represents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. 61.3% had visited their general practitioner the month prior to the attempt, 72.5% had visited a health centre. On the other hand, 41.3% were not under the follow up of Mental Health services. CONCLUSIONS: The facts hat two out of three people over 65 years who commit suicide attempt in our area visit their general practitioner the previous month and 90% visit a health service along the previous three months, raise the question of wheter preventive measures of suicide could take place beyond the scope of Primary Care.

Contacto sanitario previo a intentos de suicidio en personas de edad avanzada. Un estudio de campo en Galicia, España / Health care contact prior to suicide attempts in older adults. A field study in Galicia, Spain

INTRODUCCIÓN: Las personas de edad avanzada presentan las tasas más altas de suicidio en todo el mundo. A su vez, tienen las menores tasas de intentos de suicidio. Muchos estudios coinciden en señalar que en este grupo de edad existe un mayor contacto sanitario previo a las conductas suicidas, especialmente con Atención Primaria. El contacto previo con otros niveles asistenciales es menos conocido. OBJETIVO: El objetivo del estudio es conocer las características del contacto con centros sanitarios, de todos los niveles asistenciales, previo a un intento de suicidio, en personas mayores de 65 años, en un área sanitaria bien delimitada. MATERIAL Y MÉTODOS: En el periodo de enero de 2015 a diciembre de 2017, todas las personas mayores de 65 años del área sanitaria de Santiago de Compostela atendidas en el servicio de urgencias por intentos de suicidio fueron entrevistadas. La entrevista incluyó una evaluación psiquiátrica y la recogida de distintas variables clínicas y sociodemográficas, así como datos sobre el contacto previo con centros sanitarios. RESULTADOS: Se registraron 80 intentos de suicidio, lo que supone una incidencia de 35,3/100.000. La edad media de nuestra muestra fue de 74,85 ± 7 años, la proporción entre hombre: mujer fue de 2:3. En las cuatro semanas previas a la tentativa, el 61,3% visitó a su médico de Atención Primaria y el 72,5% visitó algún centro sanitario. El 41,3% no estaba a seguimiento en servicios de Salud Mental. CONCLUSIONES: El hecho quedo de cada tres personas mayores de 65 años que cometen un intento de suicidio en nuestra área visitaron a su médico de Atención Primaria durante el mes previo y el 90% hubieran visitado algún centro sanitario durante los tres meses previos, plantea la posibilidad de que las medidas preventivas del suicidio pudieran llevarse a cabo más allá del ámbito de la Atención Primaria

INTRODUCTION. Older people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. Many studies have found greater health contact, especially with general practitioner, prior to suicidal behaviour in this age group. Less information is availbale about prior contact with other health services. OBJECTIVE: The objective of the study is to know the characteristics of contact with all levels of health services, prior to a suicide attempt in people over 65 years of age in a defined population. MATERIAL AND METHODS: Along the period January 2015 to December 2017, all persons over 65 years of age admitted by suicide attempt to emergency room in the health area of Santiago de Compostela were interviewed. The interview included a psychiatric evaluation and the collrection of relevant clinical and sociodemographic variables, in particular, data on prior contact with health services. RESULTS: 80 suicide attempts were recorded, which rep-resents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. 61.3% had visited their general practitioner the month prior to the attempt, 72.5% had visited a health centre. On the other hand, 41.3% were not under the follow up of Mental Health services

Perfil de los intentos de suicidio en personas mayores de 65 años del area sanitaria de santiago de compostela en el periodo de 2015 a 2017 / Profile of suicide attempts in people over 65 years of the sanitary area of santiago de compostela in the period of 2015 to 2017

Introducción: Las personas de edad avanzada presentan las tasas más altas de suicidio en todo el mundo. A su vez, tienen las menores tasas de intentos de suicidio. Este hecho responde a diversos factores, que hacen que la conducta suicida en el anciano sea de alta letalidad, consumándose el suicidio al primer intento en un gran número de casos. Objetivo: conocer el perfil sociodemográfico y clínico de las personas mayores de 65 años que son atendidas en el servicio de urgencias del Hospital Clínico de Santiago de Compostela por un intento de suicidio. Material y métodos: en el periodo de Enero de 2015 a Diciembre de 2017 todas las personas mayores de 65 años atendidas por intento de suicidio en el servicio de urgencias e Interconsulta de psiquiatría del Hospital Clínico de Santiago de Compostela fueron evaluadas y entrevistadas. Se recogieron distintas variables clínicas y sociodemográficas de interés. Resultados: se registraron 80 tentativas de suicidio, lo que supone una incidencia de 35,3/100.000. La edad media de nuestra muestra fue de 74,85±7 años, la proporción entre hombre:mujer fue de 2:3. La mitad de la muestra estaba casada y la mayoría vivían con familia. El 25% presentaba tentativas previas, siendo la mayoría mujeres (p<0,01). El diagnóstico mayoritario pertenecía al grupo de Trastornos afectivos y el método más utilizado fue el de sobreingesta medicamentosa. El desencadenante o estresante más frecuente estuvo en relación a conflictiva intrafamiliar. Se encontraron diferencias en los subgrupos por la edad del episodio índice superior o inferior a los 65 años en cuanto al sexo, diagnóstico, e ingresos previos. Conclusiones: Las personas de más de 65 años que intentan suicidarse en nuestra área presentan un perfil sociodemográfico similar a otras muestras de nuestro entorno. Las mujeres, con ingresos previos en psiquiatría, tentativas antes de los 65 años, y con algún diagnóstico de Trastorno de la Personalidad son una población de riesgo para presentar nuevas tentativas más allá de los 65 años

Introduction: Elderly people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. This fact responds to several factors, which make suicidal behavior in the elderly a behavior of high lethality, committing suicide at the first attempt in a large number of cases. Objective: to know the sociodemographic and clinical profile of people over 65 years who are treated in the emergency department of the Clinical Hospital of Santiago de Compostela for an attempted suicide. Material and methods: from January 2015 to December 2017 all people over 65 years treated by suicide attempt in the emergency service and Psychiatry Interconsultation of the Clinical Hospital of Santiago de Compostela were evaluated and interviewed. Different clinical and sociodemographic variables of interest were collected. Results: 80 suicide attempts were recorded, which represents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. Half of the sample was married and most lived with family. 25% had previous attempts, the majority being women (p <0.01). The majority diagnosis was the Affective Disorders group and the most used method was drug overdose. The most frequent trigger or stressor was related to intrafamiliar conflict. Differences were found in the subgroups by the age of the index episode above or below 65 years in terms of sex, diagnosis, and previous income. Conclusions: People over 65 who try to commit suicide in our area have a sociodemographic profile similar to other samples from our environment. Women, with previous income in psychiatry, attempts before the age of 65, and with some diagnosis of Personality Disorder are a risk population to present new attempts beyond 65 years

Validity across translations of short survey psychiatric diagnostic instruments: CIDI-SF and CIS-R versus SCID-I/NP in four European countries.

OBJECTIVES: The aims of the study are: first, to compare two short diagnostic instruments, CIDI-SF and CIS-R, with respect to the structured clinical interview for non-patient (SCID-I/NP) for anxiety and depressive disorders; and second, to evaluate the influence of four languages, Italian, Romanian, Spanish and French, on the concordance tests. METHODS: A total of 120 participants from Italy and Romania, 119 from Spain and 141 from France (N = 500) were recruited randomly in a local primary care research centre (GPs or medical centres). The instruments were administered during a unique session: the lay instruments by students in psychology and the SCID by experienced psychiatrists. Kappa, sensitivity/specificity/negative (NPV) and positive predictive values (PPV), ROC curve (AUC) and the Youden Index (Y) were calculated. RESULTS: Results were better for the CIDI-SF than the CIS-R for anxious disorders, depressive disorders and any of them. The results were identical to that obtained by the CIDI 3.0 for the three categories and constant across the languages except for depressive disorders in Romania and France. CONCLUSIONS: CIDI-SF is a cost-effective instrument and could be easily integrated into health surveys; its performance values are better across languages than values proposed by the CIS-R and could be increased by inclusion of few additional information.

Formación específica en psicogeriatría: necesidades y situación actual / Specific training in psychogeriatry: needs and present situation

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