Los problemas relacionados con el alcohol en la práctica médica general.

El presente trabajo se incluye en el contexto de un proyecto de investigación-acción sobre «Respuesta comunitaria a los problemas relacionados con el alcohol». Se investiga en él mediante cuestionarios enviados por correo a una muestra representativa de los médicos de familia y de urgencia de Cantabria (n =85; 30,8 %), aspectos relevantes para el manejo de los problemas relacionados con consumo de alcohol. Se encuentra, entre otras cosas, que los médicos de familia, aun a pesar de su escasa formación en este área y del bajo nivel de recursos de que dispone tiende a responsabilizarse de un alto porcentaje de dichos problemas, tendiendo, por lo general, a medicalizarlos y psiquiatrizarlos. Su función preventiva, divulgadora o investigadora en este área es, sin embargo, escasa. Se constata así la necesidad (vivida por el propio médico) de mejorar el nivel de formación del médico de familia en este área y de desarrollar servicios para la atención de este tipo de problema

Los problemas relacionados con el alcohol en la práctica médica general.

El presente trabajo se incluye en el contexto de un proyecto de investigación-acción sobre «Respuesta comunitaria a los problemas relacionados con el alcohol». Se investiga en él mediante cuestionarios enviados por correo a una muestra representativa de los médicos de familia y de urgencia de Cantabria (n =85; 30,8 %), aspectos relevantes para el manejo de los problemas relacionados con consumo de alcohol. Se encuentra, entre otras cosas, que los médicos de familia, aun a pesar de su escasa formación en este área y del bajo nivel de recursos de que dispone tiende a responsabilizarse de un alto porcentaje de dichos problemas, tendiendo, por lo general, a medicalizarlos y psiquiatrizarlos. Su función preventiva, divulgadora o investigadora en este área es, sin embargo, escasa. Se constata así la necesidad (vivida por el propio médico) de mejorar el nivel de formación del médico de familia en este área y de desarrollar servicios para la atención de este tipo de problema

Global and regional cortical thinning in first-episode psychosis patients: relationships with clinical and cognitive features

BackgroundThe thickness of the cortical mantle is a sensitive measure for identifying alterations in cortical structure. We aimed to explore whether first episode schizophrenia patients already show a significant cortical thinning and whether cortical thickness anomalies may significantly influence clinical and cognitive features.MethodWe investigated regional changes in cortical thickness in a large and heterogeneous sample of schizophrenia spectrum patients (n=142) at their first break of the illness and healthy controls (n=83). Magnetic resonance imaging brain scans (1.5 T) were obtained and images were analyzed by using BRAINS2. The contribution of sociodemographic, cognitive and clinical characterictics was investigated.ResultsPatients showed a significant total cortical thinning (F=17.55, d=−0.62, p0.53). No significant group × gender interactions were observed (all p’s>0.15). There were no significant associations between the clinical and pre-morbid variables and cortical thickness measurements (all r’s<0.12). A weak significant negative correlation between attention and total (r=−0.24, p=0.021) and parietal cortical thickness (r=−0.27, p=0.009) was found in patients (thicker cortex was associated with lower attention). Our data revealed a similar pattern of cortical thickness changes related to age in patients and controls.ConclusionsCortical thinning is independent of gender, age, age of onset and duration of the illness and does not seem to significantly influence clinical and functional symptomatology. These findings support a primary neuro-development disorder affecting the normal cerebral cortex development in schizophrenia

Origen y razones del consumo de psicofármacos y analgésicos en la población general.

Se investiga en este trabajo el origen y razones del consumo de psicofármacos y analgésicos en una comunidad de Cantabria. El 2,6± 1% de los varones y el 10,7 ±2% de las mujeres consumen psicofármacos, siendo para ambos sexos los porcentajes de consumo de analgésicos significativamente más altos (varones = 6,5 ± 2 %; mujeres = 16,4 ± 3 %). Distintos factores como el sexo femenino o la presencia de enfermedad física o psíquica incrementan de forma significativa el consumo de dichos fármacos. Se observó, sin embargo, que la presencia de enfermedad psíquica (medida mediante el sistema PSECA TEGO-ID) se asociaba a tratamiento psicofarmacológico sólo en un reducido número de casos. Es más, en aquellos cuadros depresivos o psicóticos que recibían tratamiento farmacológico, éste solía pertenecer al grupo de las benzodiacepinas. Se evidenció además en nuestro estudio una clara interacción entre factores psicosociales y los modos o formas de consumo definidos como "auto-consumo" o "consumo bajo control médico ". Dicha interacción demuestra la existencia de perfiles sociodemográficos específicos para cada uno de dichos modos de consumo

Origen y razones del consumo de psicofármacos y analgésicos en la población general.

Se investiga en este trabajo el origen y razones del consumo de psicofármacos y analgésicos en una comunidad de Cantabria. El 2,6± 1% de los varones y el 10,7 ±2% de las mujeres consumen psicofármacos, siendo para ambos sexos los porcentajes de consumo de analgésicos significativamente más altos (varones = 6,5 ± 2 %; mujeres = 16,4 ± 3 %). Distintos factores como el sexo femenino o la presencia de enfermedad física o psíquica incrementan de forma significativa el consumo de dichos fármacos. Se observó, sin embargo, que la presencia de enfermedad psíquica (medida mediante el sistema PSECA TEGO-ID) se asociaba a tratamiento psicofarmacológico sólo en un reducido número de casos. Es más, en aquellos cuadros depresivos o psicóticos que recibían tratamiento farmacológico, éste solía pertenecer al grupo de las benzodiacepinas. Se evidenció además en nuestro estudio una clara interacción entre factores psicosociales y los modos o formas de consumo definidos como "auto-consumo" o "consumo bajo control médico ". Dicha interacción demuestra la existencia de perfiles sociodemográficos específicos para cada uno de dichos modos de consumo

Prevalence of disability in a composite ≥75 year-old population in Spain: A screening survey based on the International Classification of Functioning

<p>Abstract</p> <p>Background</p> <p>The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.</p> <p>Methods</p> <p>Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2^ndedition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100).</p> <p>Results</p> <p>The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32).</p> <p>Conclusions</p> <p>Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.</p

Disability, support and long-term social care of an elderly Spanish population, 2008-2009: an epidemiologic analysis

BACKGROUND: Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity. METHODS: We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008–2009, which provided data on disability, morbidity, and service use among 1216 residents aged ≥50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit. RESULTS: Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86–38.16), declared non-professional care 10.99 (1.28–94.53), and publicly-funded, non-professional care 26.30 (3.36–205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer. CONCLUSIONS: Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons

The 12-item World Health Organization Disability Assessment Schedule II (WHO-DAS II): a nonparametric item response analysis

<p>Abstract</p> <p>Background</p> <p>Previous studies have analyzed the psychometric properties of the World Health Organization Disability Assessment Schedule II (WHO-DAS II) using classical omnibus measures of scale quality. These analyses are sample dependent and do not model item responses as a function of the underlying trait level. The main objective of this study was to examine the effectiveness of the WHO-DAS II items and their options in discriminating between changes in the underlying disability level by means of item response analyses. We also explored differential item functioning (DIF) in men and women.</p> <p>Methods</p> <p>The participants were 3615 adult general practice patients from 17 regions of Spain, with a first diagnosed major depressive episode. The 12-item WHO-DAS II was administered by the general practitioners during the consultation. We used a non-parametric item response method (Kernel-Smoothing) implemented with the TestGraf software to examine the effectiveness of each item (item characteristic curves) and their options (option characteristic curves) in discriminating between changes in the underliying disability level. We examined composite DIF to know whether women had a higher probability than men of endorsing each item.</p> <p>Results</p> <p>Item response analyses indicated that the twelve items forming the WHO-DAS II perform very well. All items were determined to provide good discrimination across varying standardized levels of the trait. The items also had option characteristic curves that showed good discrimination, given that each increasing option became more likely than the previous as a function of increasing trait level. No gender-related DIF was found on any of the items.</p> <p>Conclusions</p> <p>All WHO-DAS II items were very good at assessing overall disability. Our results supported the appropriateness of the weights assigned to response option categories and showed an absence of gender differences in item functioning.</p