Risk of Dependency: A Challenge for Health and Social Care Planning-Observational Stroke Cohort.

BACKGROUND: After a stroke, families require the coordinated assistance of health and social care. Currently there is a lack of comprehensive evaluation and assessment tools to identify discharge needs, and there is separate management of health and social resources, and access to these services is variable between regions. OBJECTIVE: The main objective of this study was to assess the factors associated with risk of dependency after stroke and propose a suitable instrument for identifying patients at higher risk. METHODS: This was a 2-year prospective and community study of a stroke cohort. The primary outcome was recognized dependency. The potential predictors were considered in a multivariate regression and area under curve (AUC) to evaluate its discriminative capacity. RESULTS: Overall, 233 stroke survivors were recruited, 49.8% of whom were women, and the average age was 78.1 ± 11.6 years. The total rate of dependency was 31.5 (95% confidence interval [CI] 26.1-37.7) cases/100 person-years. The independent factors associated with dependency outcome were age >80 years (hazard ratio [HR] 2.03, 95% CI 1.32-3.12, P = .001), Pfeiffer score ≥4 (HR 1.82, 95% CI 1.25-1.2.66, P = .002), Barthel score <60 (HR 1.79, 95% CI 1.21-2.66, P = .003), and Charlson score ≥3 (HR 1.49, 95% CI 1.02-2.16, P = .039). The AUC was 0.84 (95% CI 0.79-0.89; P < .001). CONCLUSIONS: Stroke has serious effects on the dependency outcomes. The patient's age, cognitive or physical impairment, and comorbidities as measured on the Pfeiffer score, Barthel Index, and Charlson score identified people at high risk and may ease the integrated role of social and health services.

¿Siguen patrones de dieta mediterránea los universitarios españoles? / Do the Spanish university students follow Mediterranean dietary patterns?

Objetivo: Determinar el patrón de consumo de alimentos del alumnado de la Universidad de Alicante (UA) mediante el grado de adecuación a la dieta mediterránea. Método: Estudio transversal descriptivo para estimar la ingesta individual a través de un cuestionario de frecuencia de consumo de alimentos (CFCA) en una muestra representativa de 380 universitarios. Variables a estudio: edad, sexo, área geográfica de procedencia, peso y talla autoreferidos. Así como los alimentos y frecuencias de consumo que componen el CFCA. Se determinó el porcentaje de adecuación teniendo en cuenta, consumo real sobre consumo recomendado por la guía dieta mediterránea tradicional: (100 x raciones consumidas/raciones recomendadas). Se establecieron 5 rangos de porcentaje adecuación: consumo óptimo (80%-119%), consumo aceptable (60%-79%), consumo deficiente (40%-59%), consumo muy deficiente (< 39%), consumo excesivo (> 120%). Se realizó contraste de diferencia de proporciones y la prueba t-Student con EPIDAT 3.1, y SPSS 15.0. Resultados: Prevalencia de sobrepeso-obesidad, es mayor en hombres (34,6%) que en mujeres (9,8%), p < 0,001. Mientras que las mujeres presentan mayor prevalencia de bajo peso (7,0%) que hombres (0,7%), p < 0,05. El consumo de cereales y derivados es muy deficiente (mujeres = 90,6; hombres = 94,9), y el consumo de carnes rojas (mujeres = 90,6; hombres = 92,7) y embutidos (mujeres = 95,9%, hombres = 96,3%) es excesivo. Ningún alumno cubre un "consumo óptimo" o un "consumo aceptable" de todos los grupos de alimentos (n = 12). Discusión: El nivel educativo y el acceso a la información no protegen a la población universitaria de factores socioambientales que influencian sus hábitos alimentarios. Deben reforzarse estrategias de salud pública dirigidas a este grupo de población (AU)

Objective: To determine the pattern of food intake among the students of the University of Alicante (UA) by the level of adherence to the Mediterranean diet. Methods: Descriptive trans-sectional study estimating the individual intake by means of a questionnaire of food intake frequency (QFIF) in a representative sample of 380 college students. Study variables: age, gender, geographical area of origin, self-communicated weight and height; types and intake frequencies of the foods included in the QFIF. The percentage of adherence was calculated taking into account the actual intake and the intake recommended in the guideline of traditional Mediterranean diet: 100 x servings consumed/recommended servings. We established 5 ranges of percentage of adherence: optimal intake (80%-119%), acceptable intake (60%-79%), deficient intake (40%-59%), very deficient intake (< 39%), excessive intake (> 120%). We analyzed the differences in proportions distribution and the Student's t test with EPIDAT 3.1 and SPSS 15.0. Results: The prevalence of overweight/obesity is higher in men (34.6%) than in women (9.8%), p < 0.001, whereas women had higher prevalence of low weight (7.0%) than men (0.7%), p < 0.05. The consumption of grains and derivatives was very deficient (women = 90.6; men = 94.9) whereas the intake of red meats (women = 90.6; men = 92.7) and cold meats (women = 95.9%, men = 96.3%) was excessive. No student had an "optimal intake" or an "acceptable intake" of all the dietary groups (n = 12). Discussion: The educational level and access to the information do not protect the university population from socio-environmental factors that have an influence on their dietary habits. The public health strategies focused on this population group should be strengthen (AU)

[Do the Spanish university students follow Mediterranean dietary patterns?]. / ¿Siguen patrones de dieta Mediterránea los universitarios Españoles?

OBJECTIVE: To determine the pattern of food intake among the students of the University of Alicante (UA) by the level of adherence to the Mediterranean diet. METHODS: Descriptive trans-sectional study estimating the individual intake by means of a questionnaire of food intake frequency (QFIF) in a representative sample of 380 college students. STUDY VARIABLES: age, gender, geographical area of origin, self-communicated weight and height; types and intake frequencies of the foods included in the QFIF. The percentage of adherence was calculated taking into account the actual intake and the intake recommended in the guideline of traditional Mediterranean diet: 100 x servings consumed/recommended servings. We established 5 ranges of percentage of adherence: optimal intake (80%-119%), acceptable intake (60%-79%), deficient intake (40%-59%), very deficient intake (< 39%), excessive intake (> 120%). We analyzed the differences in proportions distribution and the Student's t test with EPIDAT 3.1 and SPSS 15.0. RESULTS: The prevalence of overweight/obesity is higher in men (34.6%) than in women (9.8%), p < 0.001, whereas women had higher prevalence of low weight (7.0%) than men (0.7%), p < 0.05. The consumption of grains and derivatives was very deficient (women = 90.6; men = 94.9) whereas the intake of red meats (women = 90.6; men = 92.7) and cold meats (women = 95.9%, men = 96.3%) was excessive. No student had an "optimal intake" or an "acceptable intake" of all the dietary groups (n = 12). DISCUSSION: The educational level and access to the information do not protect the university population from socio-environmental factors that have an influence on their dietary habits. The public health strategies focused on this population group should be strengthen.

Influencia de la cirugía mayor ambulatoria y de corta estancia en las diferencias por sexo de las hernias inguinocrurales / No disponible

Objetivo: El objetivo del presente estudio es valorar en que medida la cirugía mayor ambulatoria (CMA) y de corta estancia mantienen, aumentan o disminuyen las desigualdades por sexo en la asistencia sanitaria de las intervenciones quirúrgicas practicadas por hernia inguinocrural (HIC). Material y métodos: Estudio transversal sobre 3.834 reparaciones(3.076 hombres/758 mujeres) de HIC practicadas en el Hospital General Universitario de Alicante entre 1995 y 2004.Fuente: conjunto mínimo básico de datos (CMBD). Variables: edad, sexo, diagnóstico principal, procedimiento quirúrgico, fechas de intervención y de alta. Cálculo de frecuencias y tasas por sexo, edad y tipo de admisión: contraste de proporciones. Estancia media (EM) mediante Contraste Mann-Whitney. Resultados: El 78% de las HIC fueron operadas en régimen de CMA o corta estancia, el resto con estancia de tres días o mayor. El 50% de todas las reparaciones se practicaron en niños menores de 14 años, siendo la indicación de CMA mayor en las niñas. A los pacientes mayores de 55 años se les tiende a admitir menos en CMA, con mayor proporción de mujeres. RatioH/M de todas las HIC = 4,06. En CMA: 0-14 ratioH/M= 3,25; > 55 años ratio H/M = 6,87 (p < 0,001). En hospitalización convencional: > 55 ratioH/M = 3,65.EM total: > 55 = 3,66H y 4,09M (p < 0,001); EM CMA: > 55= 1,04H y 1,27M (p < 0,001). Conclusiones: La CMA representa la forma idónea de tratamiento quirúrgico para la HIC no complicada tanto en hombres como en mujeres, sobretodo en la infancia, adolescencia, jóvenes y adultos. La atención de las HIC en mayores de 55 años presenta sesgo de género: a las mujeres se las ingresa 3 días o más en mayor proporción que a los hombres, con menor EM, mientras que siendo casi 7 veces menor el número de casos de mujeres que de hombres en CMA, estas presentan mayor EM. Resulta pues una diferente atención médica por sexo para igual proceso patológico y edad. (AU)

Objective: This study is intended to evaluate in what way ambulatory and short stay surgery maintain, increase or reduce sexinequities on inguinal and femoral hernia (I&FH) repair. Method: Transversal study on 3834 I&FH operations (3076men/ 758 women) between 1995 and 2004. Source: hospital’s minimal basic data set. Variables: age, sex, main diagnosis, surgical procedure, operation and discharge dates. Frequency andrates of hernia procedures by sex, age and admission type: proportion contrast. Length of stay (LOS): Mann-Whitney contrast. Results: 78% of I&FH were operated on an ambulatory or short stay basis (AMB) vs. 22% that stayed in hospital 3 or more days (STAY). 50% of all repairs were done on children 0 to 14 years old, the indication for AMB was higher in girls. In the group of patients older than 55, rate of AMB is lower than in younger patients, being higher in women than in men. RatioM/W for allI&FH = 4.06. In AMB: ratio M/W for 0-14 = 3.25; ratioM/W for> 55 = 6.87 (p < 0.001). In STAY: ratioM/W for > 55 = 3.65.LOS in > 55 (AMB and Stay): 3.66 M 4.09W (p < 0,001).LOS for AMB in > 55: 1.04 M 1.27W (p < 0,001).Conclusions: AMB is the most suitable way for repairing uncomplicated I&FH in men as well as in women, and even more so for children, adolescents, young people and adults. Nevertheless, gender bias in patients older than 55 is revealed: a greater proportion of women are admitted for 3 or more days as compared to men. However LOS is shorter in women. On the other hand, the amount of women treated as AMB is seven times smaller than men, being LOS longer for women in this group. That shows a difference in medical attention depending on sex for the same pathological process and age (AU)