Inercia diagnóstica para la hipertensión arterial en pacientes diabéticos con seguimiento en atención primaria / Diagnostic inertia for hypertension in diabetic patients with follow-up in primary care

Objetivos: Se buscó estimar la prevalencia de hipertensión arterial no diagnosticada en pacientes con diabetes mellitus tipo 2 y las variables relacionadas. Métodos: Cohorte histórica mediante auditoría de historias clínicas (años 2012-2015), recogiendo los registros de presión arterial para cuantificar hipertensión arterial no diagnosticada (HTAND) según criterios de la American Diabetes Association (ADA) (presión arterial > 130/80 mm Hg) y criterios de la European Society of Hypertension/European Society of Cardiology (ESC/ESH) (presión arterial > 40/90 mm Hg) (año 2013). Otras variables: edad, sexo, frecuentación sanitaria, control metabólico, antecedentes personales, índice de masa corporal y formación previa a los médicos de familia sobre el tema. Análisis descriptivo, bivariado y multivariado (regresión logística). Aprobado por el Comité de Ética de la Investigación. Resultados: Setecientos treinta y dos pacientes (10% pérdidas) de 10 centros de salud (64 médicos), con una media de edad de 63.1 ± 12.4 años y 62% de mujeres. El 76% consulta a demanda de forma anual, con 72% de visitas programadas y 2.1 ± 2.3 de registros anuales de presión arterial. La duración de la diabetes fue de 6.3 ± 4.5 años, el 67% presentó control óptimo y el 15%, complicaciones vasculares, con el 77% con sobrepeso/obesidad. La incidencia de HTAND con criterios de la ADA fue del 43.2% y se relacionó con la obesidad (OR: 1.06) y las complicaciones vasculares (OR: 6.5). Con los criterios de la ESC/ESH fue del 13.4%, relacionada con polifarmacia (OR: 1.2) y con complicaciones vasculares (OR: 3.0), mientras que el mayor número de registros de presión arterial (OR: 0.9) y la atención programada (OR: 0.8) la evitan. Conclusión: Un elevado porcentaje de diabéticos no son correctamente diagnosticados de HTA, lo cual varía según el criterio diagnóstico empleado. La atención en programas, con especial atención a polifarmacia, complicaciones vasculares y obesidad, puede mejorar la inercia diagnóstica.

We sought to estimate the prevalence of undiagnosed hypertension in patients with type 2 diabetes mellitus and related variables. Methods: Historical cohort by auditing medical records (years 2012-2015), collecting blood pressure records to quantify undiagnosed arterial hypertension (HTAND) according to criteria of the American Diabetes Association (ADA) (blood pressure> 130/80 mm Hg ) and criteria of the European Society of Hypertension / European Society of Cardiology (ESC / ESH) (blood pressure> 40/90 mm Hg) (year 2013). Other variables: age, sex, health care, metabolic control, personal history, body mass index and previous training for family doctors on the subject. Descriptive, bivariate and multivariate analysis using logistic regression. Approved by the Research Ethics Committee. Results: Seven hundred thirty-two patients (10% losses) from 10 health centers (64 physicians), with a mean age of 63.1 ± 12.4 years and 62% women. 76% consult on demand annually, with 72% scheduled visits and 2.1 ± 2.3 annual blood pressure records. The duration of diabetes was 6.3 ± 4.5 years, 67% presented optimal control and 15% vascular complications, and 77% overweight or obesity. The incidence of undiagnosed arterial hypertension according to the ADA criteria was 43.2% and it was related to obesity (OR: 1.06) and vascular complications (OR: 6.5). With the ESC / ESH criteria prevalence it was 13.4%, related to polypharmacy (OR: 1.2) and with vascular complications (OR: 3.0), while the highest number of blood pressure records (OR: 0.9) and scheduled care (OR: 0.8) avoid it. Conclusion: A high percentage of diabetics are not correctly diagnosed with HT, which varies according to the diagnostic criteria used. Specific diabetic care programs, with special attention to polypharmacy, vascular complications, and obesity, can improve diagnostic inertia

Cambios en el consumo alcohólico de riesgo en población adolescente en la última década (2004-2013): una aproximación cuanti-cualitativa / Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design

Objetivo: Conocer los cambios del consumo alcohólico de riesgo en los adolescentes en la última década, así como sus motivaciones y vivencias. Diseño: 1) descriptivo transversal: encuesta autoadministrada; 2) cualitativo explicativo: grupos de discusión videograbados, con análisis de contenido (codificación, triangulación de categorías y verificación de resultados). Emplazamiento y participantes: Alumnos de un instituto urbano de educación secundaria, administrando un cuestionario cada 3 años de 2004 a 2013. En el año 2013 se realizan las entrevistas grupales, con muestreo de conveniencia. Criterio de homogeneidad: nivel educativo; criterios de heterogeneidad: edad, sexo y consumo de drogas. Mediciones principales: Cuestionario: edad, sexo, consumo de drogas y cuestionario CAGE. Entrevistas: semiestructuradas sobre un guión previo, valorando vivencias y expectativas. Resultados: Descriptivo: 1.558 encuestas, edad 14,2 ± 0,3años, 50% mujeres. Disminuye la prevalencia de consumo de alcohol (13%), aumentando el consumo de riesgo (11%; p < 0,001 χ2). Relacionado con ser mujer (p < 0,01 χ2), mayor consumo alcohólico (> 6 unidades de bebida estándar/semana; p < 0,001 ANOVA) en fin de semana (56%; p < 0,01 χ2) y policonsumo (p < 0,01 χ2). Cuestionario CAGE: 37% ≥ 1 respuesta positiva (relacionado con consumo de riesgo, p < 0,05 χ2), 18% ≥ 2 respuestas. Cualitativo: 48 entrevistados; se establecen 4 categorías: determinantes personales (edad, género), influencias sociales (familia, amigos), normalización del consumo (accesibilidad, ocio nocturno) y adicción (riesgo, policonsumo). Conclusión: Es preocupante el aumento del porcentaje del consumo alcohólico de riesgo, pese a disminuir las prevalencias del consumo. Se relaciona con el sexo femenino, el consumo binge-drinking y el policonsumo. El ocio nocturno y la normalización social son las principales motivaciones argumentadas por los adolescentes, sin percepción del riesgo de este tipo de consumo (AU)

Objective: To determine the changes in hazardous drinking in adolescents in the last decade, as well as their motivations and experiences. Design: Firstly, a descriptive design using a self-report questionnaire, and secondly an explanatory qualitative design, with video recordings of discussion groups with content analysis (coding, triangulation of categories and verification of results). Setting and participants: Pupils from an urban High School, administering a questionnaire every 3 years from 2004 to 2013. Purposive sampling was used to elect groups in qualitative design. Homogeneity criteria: education level; heterogeneity criteria: age, gender, and drug use. Main measurements: Questionnaire: age, gender, drug use, and the CAGE test. Interviews: semi-structured on a previous script, evaluating experiences and expectations. Results: Descriptive design: A total of 1,558 questionnaires, age 14.2 ± 0.3 years, 50% female. The prevalence of alcohol drinking decreases (13%), but its hazardous use increases (11%; P < .001, χ2). This is associated with being female (P < .01 χ2), higher alcohol consumption (> 6 standard drink units weekly; P < .001, ANOVA), during the weekend (56%; P<.01, χ2) and multiple drug use (P < .01, χ2). CAGE questionnaire: 37% ≥ 1 positive response (related to hazardous drinking, P < .05 χ2), 18% ≥ 2 answers. Qualitative: A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). Conclusion: Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk (AU)

[Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design]. / Cambios en el consumo alcohólico de riesgo en población adolescente en la última década (2004-2013): una aproximación cuanti-cualitativa.

OBJECTIVE: To determine the changes in hazardous drinking in adolescents in the last decade, as well as their motivations and experiences. DESIGN: Firstly, a descriptive design using a self-report questionnaire, and secondly an explanatory qualitative design, with video recordings of discussion groups with content analysis (coding, triangulation of categories and verification of results). SETTING AND PARTICIPANTS: Pupils from an urban High School, administering a questionnaire every 3 years from 2004 to 2013. Purposive sampling was used to elect groups in qualitative design. Homogeneity criteria: education level; heterogeneity criteria: age, gender, and drug use. MAIN MEASUREMENTS: Questionnaire: age, gender, drug use, and the CAGE test. Interviews: semi-structured on a previous script, evaluating experiences and expectations. RESULTS: Descriptive design: A total of 1,558 questionnaires, age 14.2±0.3years, 50% female. The prevalence of alcohol drinking decreases (13%), but its hazardous use increases (11%; P<.001, χ2). This is associated with being female (P<.01 χ2), higher alcohol consumption (>6 standard drink units weekly; P<.001, ANOVA), during the weekend (56%; P<.01, χ2) and multiple drug use (P<.01, χ2). CAGE questionnaire: 37% ≥1positive response (related to hazardous drinking, P<.05 χ2), 18% ≥2answers. QUALITATIVE: A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). CONCLUSION: Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk.

Cambios en la estructura y la función familiar del adolescente / Changes in the family structure and function in adolescents

Objetivos: Conocer la estructura y la función familiar del adolescente y sus cambios en la última década. Diseño: Estudio descriptivo mediante encuesta. Emplazamiento: Alumnado de educación secundaria obligatoria y bachillerato en un medio urbano (Jaén) y uno rural (Granada, España). Población e intervenciones: Encuestas autoadministradas cada tres años desde 1997 a 2010, recogiendo edad, sexo, estructura y función familiar (prueba de Apgar-familiar). Resultados: Se realizaron 1 493 encuestas (97% del total de alumnos), 50% hombres y 14.5 ± 0.6 años. Función familiar: normal 74%, disfunción leve 18%,disfunción grave 8%. Estructura familiar: nuclear 83%, monoparental 8%, ampliada 7%, reconstituida2%. La estructura y función familiar no varía según el sexo ni el año de estudio; por edad, los adolescentes de 16 años o más presentan una menor percepción de normofunción familiar (p < 0.05 c2). Mientras que en 1997 la familia nuclear presenta un mayor número de adolescentes con función familiar normal (p < 0.05 c2), en los restantes años no existen diferencias significativas entre las distintas estructuras familiares. Conclusiones: La percepción de función familiar en los adolescentes ha cambiado y actualmente no depende del sexo ni de la estructura del hogar. La atención familiar durante la adolescencia debe centrarse en la promoción de una dinámica familiar positiva, independientemente de la estructura familiar.

Cambios en la estructura y la función familiar del adolescente / Changes in the family structure and function in adolescents

Objetivos: Conocer la estructura y la función familiar del adolescente y sus cambios en la última década. Diseño: Estudio descriptivo mediante encuesta. Emplazamiento: Alumnado de educación secundaria obligatoria y bachillerato en un medio urbano (Jaén) y uno rural (Granada, España). Población e intervenciones: Encuestas autoadministradas cada tres años desde 1997 a 2010, recogiendo edad, sexo, estructura y función familiar (prueba de Apgar-familiar). Resultados: Se realizaron 1 493 encuestas (97% del total de alumnos), 50% hombres y 14.5 ± 0.6 años. Función familiar: normal 74%, disfunción leve 18%,disfunción grave 8%. Estructura familiar: nuclear 83%, monoparental 8%, ampliada 7%, reconstituida2%. La estructura y función familiar no varía según el sexo ni el año de estudio; por edad, los adolescentes de 16 años o más presentan una menor percepción de normofunción familiar (p < 0.05 c2). Mientras que en 1997 la familia nuclear presenta un mayor número de adolescentes con función familiar normal (p < 0.05 c2), en los restantes años no existen diferencias significativas entre las distintas estructuras familiares. Conclusiones: La percepción de función familiar en los adolescentes ha cambiado y actualmente no depende del sexo ni de la estructura del hogar. La atención familiar durante la adolescencia debe centrarse en la promoción de una dinámica familiar positiva, independientemente de la estructura familiar.(AU)

Motivaciones para el consumo de tabaco entre los adolescentes de un instituto urbano / Motivations for tobacco consumption among adolescents in an urban high school

Objetivo Conocer las motivaciones (actitudes, creencias y experiencias) de los adolescentes para el consumo de tabaco. Método Diseño cualitativo con videograbación de seis grupos de discusión (6-8 adolescentes, 50 minutos), curso escolar 2008/09. Muestreo intencional de adolescentes (12-18 años) de un instituto urbano de clase media (Jaén-España), usando el nivel educativo como criterio de homogeneidad y el sexo/consumo como criterio de heterogeneidad. Análisis de contenido: codificación, triangulación de categorías y obtención/verificación de resultados. Resultados Cuarenta y cuatro adolescentes, 54% varones. Fumar relaja y mejora la imagen personal: da seguridad (chicos) y mejora las relaciones con el sexo opuesto, además de controlar el peso (chicas). La familia favorece el tabaquismo por imitación de comportamientos, aunque no lo normaliza. Los amigos constituyen un grupo de presión para el inicio/mantenimiento del consumo. El inicio de la educación secundaria marca el principio del consumo experimental. La sociedad suele normalizar el consumo y es fácil para los menores de edad comprar tabaco. Los universitarios son un modelo a seguir, con libertad para el consumo. Piden ejemplo de abstinencia a progenitores y educadores/sanitarios, dicen estar bien informados, pero recuerdan sólo mensajes impactantes. De forma unánime indican que el tabaco provoca adicción, pero de manera proporcional al tiempo de consumo; sólo les preocupan los síntomas inmediatos provocados por el tabaquismo. Los adolescentes fumadores relacionan el policonsumo con los momentos de ocio. Conclusiones El estudio aporta motivos potencialmente útiles para mejorar la intervención antitabaco en los adolescentes. La influencia de los amigos, las actitudes parentales, la accesibilidad al tabaco y los síntomas de dependencia parecen ser los factores más relevantes(AU)

Objective To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. Methods This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaén, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results .Results There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time. Conclusions This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence (AU)

Motivaciones para el consumo de alcohol entre adolescentes de un instituto urbano / Motivations for alcohol use among adolescents in an urban high school

ObjetivosConocer las motivaciones (actitudes, creencias y experiencias) de los adolescentes para el consumo de alcohol.DiseñoMetodología cualitativa con método explicativo. Uso de técnicas conversacionales (grupos de discusión con 6–8 adolescentes/grupo, 50min duración) registradas mediante videograbación durante el curso escolar 2008–09.Participantes y contextoAdolescentes de 12–18 años de un instituto urbano de clase media (Jaén, España). Muestreo intencional estratificado por niveles educativos; criterios de heterogeneidad: sexo y consumo de alcohol.MétodoProceso de análisis cualitativo de contenido: codificación, triangulación de categorías y obtención/verificación de resultados.ResultadosSe realizan seis entrevistas grupales, incluyendo 44 adolescentes (54% varones). El tipo de consumo varía con la edad, existiendo diferencias de género en las motivaciones. El alcohol se relaciona con actos lúdico-sociales desde las primeras experiencias familiares, y con el ocio nocturno al entrar en el instituto y aumentar las relaciones entre iguales. Los modelos sociales preferidos son los jóvenes universitarios, con un consumo excesivo en fin de semana que es entendido como un acto de independencia. Se rechazan las figuras de autoridad (profesores/sanitarios), criticando la información recibida (solo de contenidos, sin elementos motivacionales) y la omisión en la educación sobre este tema. Existen una accesibilidad para la compra de alcohol elevada, una sensación de control del consumo y una tendencia a entender las intoxicaciones agudas como parte del ocio. Salvo pocas discrepancias, se relaciona el consumo de alcohol con el consumo de tabaco y de otras drogas.ConclusionesLa intervención sobre el consumo alcohólico de los adolescentes debe incorporar sus motivaciones para lograr una mayor eficiencia(AU)

ObjectivesTo find out the motivation (attitudes, beliefs and experiences) behind adolescent alcohol consumption.DesignQualitative methodology, explanatory method, using conversational techniques (discussion group with 6–8 adolescents/group, 50min duration) recorded by videotape during the school year 2008/09.Participants and contextAdolescents 12–18 years-old of a middle-class urban school (Jaen-Spain). Purposive sampling stratified by level of education; heterogeneity criteria: sex and alcohol consumption.MethodProcess of content analysis: coding, triangulation of categories and obtain/verify results.ResultsSix group interviews, including 44 teenagers (54% males). The rate of consumption varies with age, and there are gender differences in motivations. Alcohol is related to social and leisure activities from early family experiences, and the nightlife on entering school and as peer relationships increase. The preferred social models are university students, with excessive consumption at the weekend that is understood as an act of independence. Rejection of authority figures (teachers/health), critical attitude to the received information (content only, without motivational elements) and failure in education on this topic. There is high accessibility for the purchase of alcohol, a sense of controlled consumption and a tendency to understand acute poisoning as part of leisure. The adolescents related alcohol consumption, tobacco and drug use (except for minor discrepancies).ConclusionsThe intervention on alcohol consumption of adolescents should incorporate their motivation to achieve greater efficiency(AU)

[Motivations for alcohol use among adolescents in an urban high school]. / Motivaciones para el consumo de alcohol entre adolescentes de un instituto urbano.

OBJECTIVES: To find out the motivation (attitudes, beliefs and experiences) behind adolescent alcohol consumption. DESIGN: Qualitative methodology, explanatory method, using conversational techniques (discussion group with 6-8 adolescents/group, 50min duration) recorded by videotape during the school year 2008/09. PARTICIPANTS AND CONTEXT: Adolescents 12-18 years-old of a middle-class urban school (Jaen-Spain). Purposive sampling stratified by level of education; heterogeneity criteria: sex and alcohol consumption. METHOD: Process of content analysis: coding, triangulation of categories and obtain/verify results. RESULTS: Six group interviews, including 44 teenagers (54% males). The rate of consumption varies with age, and there are gender differences in motivations. Alcohol is related to social and leisure activities from early family experiences, and the nightlife on entering school and as peer relationships increase. The preferred social models are university students, with excessive consumption at the weekend that is understood as an act of independence. Rejection of authority figures (teachers/health), critical attitude to the received information (content only, without motivational elements) and failure in education on this topic. There is high accessibility for the purchase of alcohol, a sense of controlled consumption and a tendency to understand acute poisoning as part of leisure. The adolescents related alcohol consumption, tobacco and drug use (except for minor discrepancies). CONCLUSIONS: The intervention on alcohol consumption of adolescents should incorporate their motivation to achieve greater efficiency.

Cambios en la estructura y en la función familiar del adolescente en la última década (1997–2007) / Changes in structure and function of the family of the adolescent in the last decade (1997–2007)

ObjetivosConocer la estructura y la función familiar del adolescente y sus cambios en la última década.DiseñoEstudio descriptivo mediante encuesta.EmplazamientoAlumnado de Educación Secundaria Obligatoria y Bachillerato en medio rural (Granada) y en medio urbano (Jaén).Población e intervencionesEncuestas autoadministradas de los años 1997, 2001, 2004 y 2007, en las que se recoge edad, sexo, estructura y función familiar (test de Apgar familiar).Medidas y resultados principalesParticipan 1.356 alumnos en total, con 1.271 encuestas válidas (259, 386, 246 y 380, respectivamente). La edad de los alumnos es de 12 a 18 años con igualdad de sexos. La estructura familiar más frecuente es la nuclear (78–84%), seguida por la estructura monoparental (7–11%), la estructura extensa (6–7%) y la estructura reconstituida (2%). La función familiar es mayoritariamente normal (70–76%), con hasta un 30% de disfunciones (leves del 18 al 21% y graves del 5 al 10%). La estructura y la función familiar no varían según el sexo ni el año de estudio; en cambio, la edad sí influye: los adolescentes con 16 años o más presentan mayor porcentaje de disfunción familiar en 1997 a 2001 que en el resto de las edades, disminuye en los años 2004 a 2007 (p<0,05; test de la χ2), y es similar en el resto de las edades. Mientras que en 1997 la familia nuclear presenta un mayor número de adolescentes con función familiar normal (p<0,05; test de la χ2), en los restantes años no hay diferencias significativas entre las distintas estructuras familiares.ConclusionesLa percepción de la función familiar en los adolescentes ha cambiado y actualmente no depende del sexo, la edad ni la estructura del hogar. La atención familiar durante la adolescencia debe centrarse en la promoción de una dinámica familiar positiva, independientemente de la estructura familiar(AU)

ObjectivesTo find out the structure and functioning of the family of the adolescent and its changes in the last decade.DesignCross-sectional descriptive study using questionnaires.Setting and populationPupils in obligatory secondary education and high-school in one rural (Granada) and one urban (Jaén) area.Participants and measurementsSelf-administered questionnaire (years 1997–2001–2004–2007) in which details of age, sex, family structure and family-Apgar test were recorded.Measurements and main resultsA total of 1356 adolescents participated, 1271 questionnaires valid (259, 386, 246 and 380 respectively per year). Ages 12–18 years, equality of sexes. The nuclear family structure was predominant (78-84%), followed by single parent family in (7–11%), extended (6–7%) and reconstituted (2%). The family function was mainly normal (70–76%), with 30% dysfunction (slight dysfunction 18–21% and severe dysfunction 5–10%). The structure and family function does not vary by sex or the year of study, it is influenced by age: adolescents ⩾16 years with a higher percentage of family dysfunction in 1997/2001 than the rest of ages, declining in the years 2004/2007 (P <0.05 χ2), similar to other ages. While the nuclear family in 1997 had a greater number of adolescents with normal family function (P <0.05 χ2), in the remaining years there were no significant differences between different family structures.ConclusionsThe perception of family function in adolescents has changed and now does not depend on sex, age and structure. Family care during adolescence should focus on promoting positive family dynamics, regardless of family structure(AU)

[Changes in structure and function of the family of the adolescent in the last decade (1997-2007)]. / Cambios en la estructura y en la función familiar del adolescente en la última década (1997-2007).

OBJECTIVES: To find out the structure and functioning of the family of the adolescent and its changes in the last decade. DESIGN: Cross-sectional descriptive study using questionnaires. SETTING AND POPULATION: Pupils in obligatory secondary education and high-school in one rural (Granada) and one urban (Jaén) area. PARTICIPANTS AND MEASUREMENTS: Self-administered questionnaire (years 1997-2001-2004-2007) in which details of age, sex, family structure and family-Apgar test were recorded. MEASUREMENTS AND MAIN RESULTS: A total of 1356 adolescents participated, 1271 questionnaires valid (259, 386, 246 and 380 respectively per year). Ages 12-18 years, equality of sexes. The nuclear family structure was predominant (78-84%), followed by single parent family in (7-11%), extended (6-7%) and reconstituted (2%). The family function was mainly normal (70-76%), with 30% dysfunction (slight dysfunction 18-21% and severe dysfunction 5-10%). The structure and family function does not vary by sex or the year of study, it is influenced by age: adolescents 16 years with a higher percentage of family dysfunction in 1997/2001 than the rest of ages, declining in the years 2004/2007 (P <0.05 chi(2)), similar to other ages. While the nuclear family in 1997 had a greater number of adolescents with normal family function (P <0.05 chi(2)), in the remaining years there were no significant differences between different family structures. CONCLUSIONS: The perception of family function in adolescents has changed and now does not depend on sex, age and structure. Family care during adolescence should focus on promoting positive family dynamics, regardless of family structure.

[Evolution of the consumption of toxic substances among the adolescents of an urban area (1997-2004)]. / Evolución del consumo de sustancias tóxicas en los adolescentes de una zona urbana (1997-2004).

OBJECTIVES: To find the evolution of the consumption of alcohol, tobacco and other drugs among adolescents in an urban area. DESIGN: Descriptive, cross-sectional study using a self-administered questionnaire. SETTING: Secondary school (middle-class urban area). PARTICIPANTS AND MEASUREMENTS: Six hundred and seventy-eight students took part in the years 1997, 2001, and 2004. MEASUREMENTS AND MAIN RESULTS: The questionnaire included questions on age, sex and consumption of toxic substances. The following figures are given in order of the year of study. We studied 172, 249, and 257 adolescents, with a mean age of 14 (interval, 12-17) and equality of sexes. The proportion of adolescents with no consumption of toxic substances increased (21%+/-3.1%; 34%+/-3.0% 56%+/-3.1%; P<.001, chi2), basically because alcohol consumption dropped (58%+/-3.6%; 61%+/-3.2%; 41%+/-3.1%; P<.001, chi2), although its weekend consumption increased (84%+/-2.6%; 85%+/-2.2%; 96%+/-1.2%; P<.05, chi2), especially of spirits. Tobacco consumption increased (12%+/-2.4%; 21%+/-2.3%; 29%+/-2.4%; P<.001, chi2) with a pattern of daily smoking (9%+/-0.6%; 34%+/-3.2%; 47%+/-3.1%; P<.01, chi2). The consumption of illegal rugs also increased (9%+/-0.6%; 24%+/-2.8%; 16%+/-2.4%; P<.001, chi2), with an intermittent pattern of consumption (87%+/-1.6%; 71%+/-2.3%; 85%+/-1.8). Cannabis is the most used drug (>90%), cocaine use fell and design drug use increased. Age affected consumption, but sex did not. CONCLUSIONS: In the last 8 years the consumption of toxic substances among adolescents has dropped, mainly because of less alcohol consumption. However, new forms of consumption of alcohol and other illegal drugs, especially at weekends, emerged and daily consumption of tobacco increased.

Evolución del consumo de sustancias tóxicas en los adolescentes de una zona urbana (1997-2004) / Evolution of the consumption of toxic substances among the adolescents of an urban area

Objetivos. Conocer la evolución del consumo de alcohol, tabaco y otras drogas entre adolescentes de una zona urbana. Diseño. Descriptivo, transversal, mediante encuesta autoadministrada. Emplazamiento. Instituto de enseñanza secundaria (zona urbana de clase media). Participantes. Un total de 678 alumnos durante los años 1997, 2001 y 2004. Mediciones y resultados principales. Se recogieron datos de la edad, el sexo y el consumo de sustancias tóxicas. Los resultados se exponen según el año de estudio. Se estudian 172, 249 y 257 adolescentes, respectivamente, con mediana de 14 años (intervalo, 12-17 años) e igualdad de sexos. Se incrementa el número de adolescentes que no han consumido ningún tóxico (21 ± 3,1%, 34 ± 3,0%, 56 ± 3,1%; p 90%), disminuye el uso de cocaína y aumentan las drogas de diseño. La edad influye en el consumo, pero no el sexo. Conclusiones. En los últimos 8 años ha disminuido el consumo de tóxicos entre los adolescentes, sobre todo por una menor ingesta de alcohol. Sin embargo, aparecen nuevas formas de consumo de alcohol y otras drogas, sobre todo durante el fin de semana, y se incrementa el consumo diario de tabaco

Objectives. To find the evolution of the consumption of alcohol, tobacco and other drugs among adolescents in an urban area. Design. Descriptive, cross-sectional study using a self-administered questionnaire. Setting. Secondary school (middle-class urban area). Participants and measurements. Six hundred and seventy-eight students took part in the years 1997, 2001, and 2004. Measurements and main results. The questionnaire included questions on age, sex and consumption of toxic substances. The following figures are given in order of the year of study. We studied 172, 249, and 257 adolescents, with a mean age of 14 (interval, 12-17) and equality of sexes. The proportion of adolescents with no consumption of toxic substances increased (21%±3.1%; 34%±3.0% 56%±3.1%; P90%), cocaine use fell and design drug use increased. Age affected consumption, but sex did not. Conclusions. In the last 8 years the consumption of toxic substances among adolescents has dropped, mainly because of less alcohol consumption. However, new forms of consumption of alcohol and other illegal drugs, especially at weekends, emerged and daily consumption of tobacco increased

[Family structure and function during adolescence: relationship with social support, tobacco, alcohol and drugs consumption, and psychic discomfort]. / Estructura y funcionalidad de la familia durante la adolescencia: relación con el apoyo social, el consumo de tóxicos y el malestar psíquico.

OBJECTIVES: To find out the family structure and functionality of the family of the adolescent and their relationships with social support, consumption of drugs and alcohol, and psychic discomfort. DESIGN: Cross-sectional descriptive study. SETTING AND POPULATION: Pupils in obligatory secondary education in one rural and one urban area. MATERIAL AND METHODS: Self-administered questionnaire in which details of, age, sex, family structure, family Apgar test, Saranson social support questionnaire (SSQ-6), drug and alcohol consumption, and the Goldberg anxiety-depression scale (GADS), were recorded. RESULTS: A total of 386 adolescents participated, and had a mean age of 14.3 years +/-0.3 and with 51+/-2.5. The nuclear family structure was predominant, with 84%+/-1.9%, single parent family in 7%+/-1.3%, extended in 7%+/-1.3%, and binuclear in 2%+/-0.6%, and was not associated with any of the variables studied. The family function was normal in 54.5%+/-2.5%, with slight dysfunction in 38.3%+/-2.5% and severe dysfunction in 7.2%+/-1.3%. The SSQ-6 (satisfaction 4.6+/-0.1; number of supports 3.1+/-0.1) varied according to family function (satisfaction: normal, 4.9+/-0.6; slight dysfunction, 4.4+/-0.5; severe dysfunction, 3.4+/-1.8: P< .01, ANOVA). Severe family dysfunction was associated with a higher consumption of drugs and alcohol: there was 27%+/-6.4% (P< .01, chi2 test) higher alcohol consumption, with a quantitative increase of 4.3+/-0.9 standard drink units/week (P< .001, ANOVA); 32%+/-5.9% (P< .01, chi2 test) more smoking, with an increase in consumption of 4.3+/-1.4 cigarettes/day (P< .001, ANOVA), and the consumption of other illegal drugs increased to 13%+/-4.7% (P< .087, chi2). A high prevalence of psychic discomfort (GADS: anxiety, 92.0%+/-1.4%, depression, 74.1%+/-2.2%); there were more depressive symptoms when the family function was more intense (P< .01, chi2 test). CONCLUSIONS: Structure does not influence family function during adolescence. However, the adolescent perception of the family structure influences social support, the consumption of drugs and alcohol and the presence of depressive symptoms.

Estructura y funcionalidad de la familia durante la adolescencia: relación con el apoyo social, el consumo de tóxicos y el malestar psíquico / Family structure and function during adolescence: relationship with social support, tobacco, alcohol and drugs consumption, and psychic discomfort

Objetivos. Conocer la estructura y la funcionalidad de la familia del adolescente y su relación con el apoyo social, el consumo de tóxicos y el malestar psíquico. Diseño. Estudio descriptivo, transversal. Emplazamiento y población. Alumnos de educación secundaria obligatoria de una zona rural y otra urbana. Material y métodos. Encuesta autoadministrada en la que se recogían la edad, el sexo, la estructura familiar, el test de Apgar familiar, el cuestionario de apoyo social de Saranson (SSQ-6), el consumo de tóxicos y la escala ansiedad-depresión de Goldberg (EADG). Resultados. Participaron 386 adolescentes con una edad media de 14,3 ± 0,3 años y un 51 ± 2,5% varones. La estructura familiar nuclear es predominante, con un 84 ± 1,9%, mononuclear en el 7 ± 1,3%, ampliada en el 7 ± 1,3% y binuclear en el 2 ± 0,6%, y no se relaciona con ninguna variable estudiada. La función familiar es normal en el 54,5 ± 2,5%, con disfunción leve en el 38,3 ± 2,5% y disfunción grave en el 7,2 ± 1,3%. El SSQ-6 (satisfacción 4,6 ± 0,1; número de apoyos 3,1 ± 0,1) varía según la función familiar (satisfacción: normal 4,9 ± 0,6; disfunción leve 4,4 ± 0,5; disfunción grave 3,4 ± 1,8; p < 0,001, ANOVA) (número de apoyos: normal 3,8 ± 0,7, disfunción leve 2,8 ± 1,0; grave 2,4 ± 1,5; p < 0,01, ANOVA). La disfunción familiar grave se relaciona con un mayor consumo de tóxicos: hay un 27 ± 6,4% (p < 0,01, test de la χ2) más consumo de alcohol, con un incremento cuantitativo de 4,3 ± 0,9 unidades de bebida estándar/semana (p < 0,001; ANOVA); un 32 ± 5,9% (p < 0,01 test de la χ2) más tabaquismo, con un aumento del consumo de 4,3 ± 1,4 cigarrillos/día (p < 0,001; ANOVA), y se eleva el consumo de otras drogas no legales un 13 ± 4,7% (p = 0,087, χ2). Observamos una alta prevalencia de malestar psíquico (EADG: ansiedad 92,0 ± 1,4%, depresión 74,1 ± 2,2%); hay más síntomas depresivos cuanto más intensa es la disfunción familiar (p < 0,01, test de la χ2). Conclusiones. La estructura no condiciona la función familiar durante la adolescencia. Sin embargo, la percepción del adolescente de la función familiar influye en el apoyo social, el consumo de tóxicos y la presencia de síntomas depresivos

Objectives. To find out the family structure and functionality of the family of the adolescent and their relationships with social support, consumption of drugs and alcohol, and psychic discomfort. Design. Cross-sectional descriptive study. Setting and population. Pupils in obligatory secondary education in one rural and one urban area. Material and methods. Self-administered questionnaire in which details of, age, sex, family structure, family Apgar test, Saranson social support questionnaire (SSQ-6), drug and alcohol consumption, and the Goldberg anxiety-depression scale (GADS), were recorded. Results. A total of 386 adolescents participated, and had a mean age of 14.3 years ±0.3 and with 51±2.5. The nuclear family structure was predominant, with 84%±1.9%, single parent family in 7%±1.3%, extended in 7%±1.3%, and binuclear in 2%±0.6%, and was not associated with any of the variables studied. The family function was normal in 54.5%±2.5%, with slight dysfunction in 38.3%±2.5% and severe dysfunction in 7.2%±1.3%. The SSQ-6 (satisfaction 4.6±0.1; number of supports 3.1±0.1) varied according to family function (satisfaction: normal, 4.9±0.6; slight dysfunction, 4.4±0.5; severe dysfunction, 3.4±1.8: P<.01, ANOVA). Severe family dysfunction was associated with a higher consumption of drugs and alcohol: there was 27%±6.4% (P<.01, χ2 test) higher alcohol consumption, with a quantitative increase of 4.3±0.9 standard drink units/week (P<.001, ANOVA); 32%±5.9% (P<.01, χ2 test) more smoking, with an increase in consumption of 4.3±1.4 cigarettes/day (P<.001, ANOVA), and the consumption of other illegal drugs increased to 13%±4.7% (P<.087, χ2). A high prevalence of psychic discomfort (GADS: anxiety, 92.0%±1.4%, depression, 74.1%±2.2%); there were more depressive symptoms when the family function was more intense (P<.01, χ2 test). Conclusions. Structure does not influence family function during adolescence. However, the adolescent perception of the family structure influences social support, the consumption of drugs and alcohol and the presence of depressive symptoms