52 research outputs found
Cálculo de los tiempos de circularvección en una población con patología vestibular. Influencia del estímulo visual
[corrected] To describe the results obtained for circularvection times (tCV) in a study of the phenomenon of visual-vestibular interaction for a population with vestibular pathology and to analyze differences in its calculation among patients reporting a worsening of their symptoms with visual stimuli.
MATERIAL AND METHODS:
A detailed case history was taken for all patients, followed by a sensory organization test using computerized dynamic posturography and the calculation of their tCV.
RESULTS:
The mean tCV results were: tCV2= 6.32+/-3.17 s; tCV3=6.57+/-3.68 s; tCVr=6.27+/-6.02 s. Significant differences were obtained in tCV2 (P=.046) and tCVr (P=.023).
CONCLUSIONS:
tCV is a diagnostic test using simple tools that can help differentiate patients in whom the visual stimulus is influenced
Methodological and ethical quality checklist assessment in issues of Annals of Family Medicine Clinical Trials (2010-2013)
Abstract
Introduction: At present, the quality of the publication of Control Trials (CTs) in medical journals improved due to
the inclusion of the CONSORT (CONsolidated Standards of Reporting Trials) standards and the Declaration of Helsinki.
The aim is to analyse methodological and ethical quality of published CTs in Annals of Family Medicine journal.
Material and methods: We use a 133-item checklist divided into 11 sections based on CONSORT and the
Declaration of Helsinki. The Confidence Interval of 95% (95% CI) of Clopper-Pearson for κ average is calculated.
Results: We found 35 CTs in a literature review (2010-2013) on March 25, 2014 according to PRISMA (Preferred
Reporting Items for Systematic reviews and Meta-Analysis). CT was mentioned in all heading/subheadings; CT
controlled parallels in 80%; cluster type 45.7%. The most observed method was masked, active-controlled, decentralized
randomization. The most frequently found category was an open CT assessing a medical intervention, with a positive
significant result surveyed. The most common Informed Consent (IC) was in writing, not clearly voluntary, without prior
knowledge and doubtful. It was not withdrawn in 45.7% of cases. A grant/scholarship was found to be the most frequent
incentive for researchers. In 28 CTs there was no conflict of interest. The κ average was 0.93 (95% CI, 0.90-0.96).
Conclusions: CT published “standard” characteristic are indicated. Following the CONSORT standards publication,
it has increased the overall quality of the CTs published. But there are some areas for improvement in the methodological
and ethical quality of the CTs published from 2010 to 2013 in Annals of Family Medicine
Lifestyle factors modify obesity risk linked to PPARG2 and FTO variants in an elderly population: a cross-sectional analysis in the SUN Project.
Genetic factors may interact with lifestyle factors to modify obesity risk. FTO and PPARG2 are relevant obesogenes. Our aim was to explore the effect of Pro12Ala (rs1801282) of PPARG2 and rs9939609 of FTO on obesity risk and to examine their interaction with lifestyle factors in an elderly population. Subjects (n = 978; aged 69 ± 6) were recruited from the SUN (Seguimiento Universidad de Navarra) Project. DNA was obtained from saliva, and lifestyle and dietary data were collected by validated self-reported questionnaires. Genotyping was assessed by RT-PCR plus allele discrimination. Subjects carrying the Ala allele of PPARG2 gene had a significantly increased obesity risk compared to non-carrier (Pro12Pro) subjects (OR, 1.66; 95 % CI, 1.01-2.74; p = 0.045). Greater obesity risk was also found in inactive or high carbohydrate intake subjects with the Ala12 allele of PPARG2 gene. Interestingly, subjects carrying the Ala allele of the PPARG2 gene and with a high CHO (>246 g/day) intake had an increased obesity risk compared to Pro12Pro subjects (OR, 2.67; 95 % CI, 1.3-5.46; p = 0.007; p for [CHO × PPARG2] interaction = 0.046). Moreover, in subjects with a high CHO intake, the co-presence of the Ala allele of PPARG2 gene and one minor A allele (rs9939609) of FTO gene did increase obesity risk (OR, 3.26; 95 % CI, 1.19-8.89; p = 0.021) when compared to non-carrier (Pro12Pro/TT) subjects. In conclusion, it appears that lifestyle factors may act as effect modifiers for obesity risk linked to Ala12 allele of the PPARG2 gene and the minor A allele of FTO gene in an elderly population
Validación del Cuestionario de Orientación a la Vida (OLQ-13) de Antonovsky en una muestra de estudiantes universitarios en Navarra
Fundamento. El sentido de coherencia interna (SOC), concepto
central del modelo salutogénico descrito por Aaron
Antonovsky, se ha empleado como predictor de medidas
de salud percibida y objetiva, se relaciona fuerte y positivamente
con comportamientos saludables, y se desarrolla
principalmente en la juventud y en la época de estudiante.
Los universitarios son un grupo de jóvenes diana para aplicar
medidas promotoras de salud en función de su nivel SOC,
siendo necesario comprobar la calidad de la medición de la
escala. El objetivo es validar y estudiar las propiedades psicométricas
de la escala SOC en los estudiantes de la Universidad
de Navarra, y conocer su evolución temporal.
Sujetos y método. Se analizaron los estudiantes de nuevo
acceso de la Universidad de Navarra. Estudio de cohortes
con seguimiento a los tres años. Los instrumentos utilizados
fueron el cuestionario de orientación a la vida (OLQ-13), la
Escala del Estrés Percibido (EEP) y el Índice de malestar. Se
estudiaron la calidad de los datos y viabilidad, asunciones
escalares, estabilidad temporal, fiabilidad, validez de criterio
concomitante y clínica, y estructura factorial y análisis confirmatorio
de los datos obtenidos. Se utilizaron los paquetes
estadísticos SPSS v. 19 y Amos v.7.
Resultados. La muestra ha sido de 508 estudiantes, 33,5% varones
y el 65,9% mujeres. Fiabilidad alta (Alfa de Cronbach de
0,814). Adecuada validez convergente con la EEP. Inadecuada
validez clínica. Análisis de componentes principales con tres
factores que explican el 50,73% de la varianza.
Conclusiones. Instrumento válido que permite proponerlo
como herramienta para aplicar medidas promotoras de salud
en jóvenes.Background. The sense of coherence (SOC), the central
concept of the salutogenesis model described by Aaron Antonovsky,
has been employed as a predictor of measures of
perceived and objective health. It is strongly and positively
related to healthy behaviour and is mainly developed while
young and studying. University students are a target youth
group for applying measures promoting health according to
their SOC level; it is therefore necessary to check the quality
of the scale’s measurement. The goal is to validate and study
the psychometric properties of the SOC scale in students at
the University of Navarre and determine their temporal evolution.
Methods. Newly enrolled students at the University of Navarre
were analysed. Cohort study with a 3 year follow-up. The
instruments used were the Orientation to Life Questionnaire
(OLQ-13), Perceived Stress Scale (PSS) and the Discomfort
Index. The following were studied: the quality and viability
of the data, scale assumptions, temporal stability, reliability,
concurrent and clinical validity, as well as factorial structure
and confirmatory analysis of the data obtained. SPSS v. 19
and Amos v.7 statistical software were used.
Results. The study sample consisted of 508 students, 33.5%
male and 65.9% female. High reliability (Cronbach Alpha
0.814). Adequate validity converging with the PSS. Inadequate
clinical validity. Analysis of main components with three
factors that explain 50.73% of the variation.
Conclusions. A valid instrument that makes it possible to
propose it as a tool for applying measures promoting health
in young people
Satisfacción laboral y factores de mejora en profesionales de atención primaria
Fundamento. La calidad de los servicios en un sistema sanitario está relacionada con el nivel de satisfacción de sus
profesionales. El objetivo de este trabajo es conocer la satisfacción laboral y jerarquizar aquellos factores capaces de
mejorarla, en profesionales de atención primaria.
Metodología. Estudio descriptivo realizado en 2010 en Navarra. Se remitió por correo un cuestionario validado a la
población de estudio: médicos, pediatras y enfermería de
atención primaria. Se recogen variables de datos sociodemográficos y autocalificación de su satisfacción laboral en
escala de 1 a 10. Se solicita la jerarquización de 10 factores
que puedan mejorar la satisfacción previa señalada.
Se realizó comparación de medias y análisis bivariante
mediante el test de la Chi cuadrado, estudiando la asociación entre variables mediante la Odds Ratio (OR). El análisis
ajustado se realizó mediante regresión logística no condicional.
Resultados. Se recogieron 432 cuestionarios (77,5%). La
satisfacción media fue 6,7 (escala 1 a 10), más alta en enfermería. Las mujeres presentaron una media superior a los
hombres (6,90: 6,34).
Los trabajadores de centros de salud urbanos (OR:1,71;
IC:1,10-2,65) presentaron un mayor riesgo de insatisfacción
respecto a los profesionales de centros rurales.
Las actividades formativas de los profesionales es el
ítem más valorado, seguido de razones económicas y de presión asistencial, no encontrándose diferencias por profesión.
Conclusión. La satisfacción laboral es una dimensión de
la gestión de calidad en atención primaria y su estudio
permite identificar problemas u oportunidades de mejora
con impacto en la calidad de los servicios que se ofertan.Background. The quality of services in a health system is
related to the level of satisfaction of its professionals. The
aim of this article is to determine job satisfaction in primary
care professionals and rank those factors capable of improving it.
Methodology. Descriptive study carried out in Navarre in
2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians
and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1
to 10. Respondents were asked to rank 10 factors that could
improve the previously mentioned satisfaction.
Averages were compared and bivariate analysis was
carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The
adjusted analysis was realized through unconditional logistic regression.
Results. We collected 432 questionnaires (77.5%). Average
satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34).
The workers at urban health centers (OR: 1.71; CI: 1.10-
2.65) showed a higher risk of dissatisfaction with respect to
professionals at rural centers.
The training activities of the professional is the most
highly valued item, followed by economic questions and
questions of care pressure, with no differences found by
profession.
Conclusion. Job satisfaction is a dimension of quality management in primary care and its study enables identification
of problems or opportunities for improvement with an impact on the quality of the services offered
Validación de un cuestionario de mejora de la satisfacción laboral (CMSL) en profesionales de atención primaria
Fundamento. La satisfacción laboral de los profesionales
sanitarios se considera un indicador de calidad en la gestión del sistema, estando relacionado con la eficacia de los
servicios ofrecidos.
El objetivo del estudio es la validación de un cuestionario para evaluar la mejora de la satisfacción laboral
(CMSL) en una población de profesionales sanitarios de
atención primaria en Navarra.
Metodología. Se realizó un estudio descriptivo con cuestionarios autocumplimentados, siendo la población diana
todos los profesionales de atención primaria (médicos,
pediatras y personal de enfemería) de los centros de salud
de Navarra. Se utilizó la escala Lickert para la medición de
los ítems. Se recogieron datos descriptivos de sexo, años
de ejercicio profesional, satisfacción laboral, estamento
profesional, centro de salud y 47 ítems sobre mejora de
satisfacción laboral. Se calculó la fiabilidad mediante el
coeficiente alfa de Cronbach y se halló la validez de constructo mediante un análisis factorial con rotación varimax,
agrupando los ítems en 9 dimensiones.
Resultados. Se recogieron un total de 414 cuestionarios. Se
obtuvo el coeficiente alfa de Cronbach, con un valor global
de 0,933. Entre 5 dimensiones se explica el 41,287% de la
varianza total. La dimensión “relaciones con los pacientes”
presentó la media (4,087) más alta de mejora de la satisfacción laboral y el ítem “Si pudiera eliminar la demanda
injustificada” presentó una media de 4,21.
Conclusiones. El cuestionario diseñado es un instrumento
válido para la evaluación integral de la mejora de la satisfacción laboral de los profesionales de atención primaria.
Los resultados obtenidos pueden orientar sobre qué áreas
de mejora se deben implantar para mejorar la satisfacción
de los profesionales.Background. Job satisfaction of health professionals is
considered to be a quality indicator, as it is related to the
efficacy of the services.
The aim of the study is to validate a questionnaire for
evaluating job satisfaction improvement in a population of
health professionals in primary care in Navarre.
Methodology. Descriptive study with self-completed
questionnaires; the target population was all health care
professionals (family doctors, pediatricians and nurses)
of primary health centers of Navarre. A Lickert scale was
used for measuring the items. Other variables measured
were: sex, years in the profession, job satisfaction, professional status, health center, and 47 items on improving
job satisfaction. Cronbach’s alpha coefficient was used to
evaluate reliability, and to evaluate construct validity factor analysis with varimax rotation, grouping the items in 9
dimensions was used.
Results. A total of 414 questionnaires were collected.
Cronbach’s alpha coefficient was 0.933. Forty-one point
two eight seven percent (41.287%) of total variance was explained by five dimensions. The dimension “relations with
patients” presented the highest average (4.087) of improvement in job satisfaction, and the item “If it were possible to
eliminate unjustified demand” showed an average of 4.21.
Conclusions. The questionnaire designed is a valid instrument for a comprehensive evaluation of the improvement
in the job satisfaction of primary care professionals. The
results obtained can indicate which areas of improvement
should be implemented in order to improve the satisfaction of the professionals
Self-reported drinking and driving amongst educated adults in Spain: The "Seguimiento Universidad de Navarra" (SUN) cohort findings
Background: The role of alcohol as a risk factor for motor vehicle crashes is long known. Yet, reports on the prevalence of drinking and driving suggest values between 20%–30% when the adult driving population is interviewed. We wondered whether these values hold true among European educated citizens and whether there are any significant differences in prevalence by age, gender, type of profession and other lifestyle indicators.
Methods: Cross-sectional analyses of baseline data from a cohort of university graduates in Spain (SUN study). Answered questionnaires contained items on current drinking and driving practices,
together with data on socio-demographic characteristics and lifestyle habits. Chi square, Fisher test, and multivariate logistic regression were used to investigate the impact of several variables on
drinking and driving practices. Analyses were stratified by gender.
Results: Almost 30% of the participants reported "sometimes" drinking and driving. This percent increased to 47% when "almost never" was also included as a positive answer to the drinking and driving practice question. These percentages varied significantly by gender, with up to 64% of men reporting "sometimes" or "almost never" vs. 36% of women doing so. Drinking and driving practices also differed by overall alcohol consumption habits, smoking, use of safety belts, and notably, type of profession.
Conclusion: Our findings are amongst the first on the high prevalence of drinking and driving among Spanish. Particularly worrisome is the fact that health professionals reported this habit even
at higher rates. Multidisciplinary interventions (e.g., legal, educational, economic) are needed to reduce this serious health risk
Valoración de la repercusión del dolor sobre la productividad laboral: validación del cuestionario WPAI:Pain
Fundamento. Los instrumentos de medida de salud son esenciales en la actividad clínica diaria. Sin embargo, es necesario
un proceso de validación para poder certificar la validez y
fiabilidad de los mismos. En la actualidad no existe ninguno
que permita evaluar la repercusión del dolor en la productividad laboral de los pacientes. El objetivo de nuestro estudio
es validar un cuestionario para evaluar las consecuencias del
dolor en dicha productividad.
Método. En base al Work Productivity and Activity Impairment
Questionnaire – General Health hemos creado una versión
modificada denominada WPAI:Pain con el fin obtener un
cuestionario que pudiera medir las consecuencias del dolor
en la productividad laboral. El estudio se realizó siguiendo
las pautas habituales de validación de pruebas, omitiéndose
las fases de redacción y validez de contenido ya que se modificaba un cuestionario existente.
Resultados. Se obtuvieron 577 cuestionarios en dos hospitales
universitarios españoles. Se comprobó la capacidad discriminante del cuestionario mediante prueba de U de Mann-Whitney. Se realizaron los test de fiabilidad obteniéndose un alfa de
Cronbach de 0,896 con un test de dos mitades de Guttman de
0,921. Se comprobó la estabilidad con un test-retest estadísticamente significativo. La validez de constructo se estableció
mediante correlación de Pearson comparando los resultados
del cuestionario con el dolor en escala visual analógica, que
resultó estadísticamente significativa para todos los valores.
Conclusiones. El cuestionario WPAI:Pain es un instrumento de medida válido para determinar las consecuencias del
dolor en la productividad laboral de los pacientes, siendo el
único validado en español. Sin embargo, se requieren estudios de mayor envergadura para poder confirmar una validez
universal.Background. Health measuring instruments are essential in
daily clinical practice. However, a validation process is needed in order to certify the validity and reliability of it. The
aim of our study is to validate a questionnaire to assess the
consequences of pain in work productivity.
Methods. Based on the Work Productivity and Activity Impairment Questionnaire – General Health we have created
a modified version called WPAI:Pain in order to be able to
measure the consequences of pain in work productivity. The
study was conducted following the usual guidelines of test
validation, omitting face validity as WPAI:Pain is a modification of an existing questionnaire. Validity and reliability were
calculated.
Results. A total of 577 questionnaires were obtained in 2
spanish university hospitals. The questionnaire’s discriminating power was verified by Mann-Whitney test. Reliability
tests were realized, Cronbach’s alpha was 0.896 and Guttman
split-half was 0.921. Stability was evaluated with a test-retest
which was significant. Construct validity was established by
Pearson correlation comparing the results of the questionnaire with the pain visual analog scale, which was statistically significant for all values.
Conclusions. The WPAI:Pain questionnaire is a valid instrument for measuring the consequences of pain in work productivity. It is currently the only one validated in Spanish.
Major studies are needed in order to establish its universal
validity
Placebo-controlled trial of nimodipine in the treatment of acute ischemic cerebral infarction
Nimodipine is a 1,4-dihydropyridine derivative that shows a preferential
cerebrovascular activity in experimental animals. Clinical data suggest that
nimodipine has a beneficial effect on the neurologic outcome of patients
suffering an acute ischemic stroke. Our double-blind placebo-controlled
multicenter trial was designed to assess the effects of oral nimodipine on the
mortality rate and neurologic outcome of patients with an acute ischemic stroke.
One hundred sixty-four patients were randomly allocated to receive either
nimodipine tablets (30 mg q.i.d.) or identical placebo tablets for 28 days.
Treatment was always started less than or equal to 48 hours after the acute
event. The Mathew Scale, slightly modified by Gelmers et al, was used for
neurologic assessment. Mortality rate and neurologic outcome after 28 days were
used as evaluation criteria. We considered 123 patients to be valid for the
analysis of efficacy. Mortality rates did not differ significantly between
groups. Neurologic outcome after 28 days of therapy did not differ between
groups. However, when only those patients most likely to benefit from any
intervention (Mathew Scale sum score of less than or equal to 65 at baseline)
were analyzed separately in post hoc-defined subgroups, the nimodipine-treated
subgroups showed a significantly better neurologic outcome. This result suggests
that some patients with acute ischemic stroke will benefit from treatment with
nimodipine tablets
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