Effectiveness of Twitter Threads to Improve Medical Student Electrocardiogram (ECG) Reading-Skills. The TwittUVa-ECG Non-Randomized Pre-Post Study.

Introduction: social media is increasingly used in medical education, but its real educational effectiveness is unclear. In this study we assess the effectiveness of Twitter threads (TTS) in improving electrocardiogram (ECG) basic reading skills (ECGBRS). Materials and Methods: Seven TTS describing ECGBRS were published from October 28, 2021, to November 24, 2021. Tests were used to assess medical students ECGBRS pre and post intervention. All third and sixth-year medical students were invited to participate. Sixty-three students were enrolled (33 third year and 30 sixth year). Nine (14.3%) participants dropped out. Results: Sixth year medical students had higher ECGBRS at baseline. The number of correct items increased after the Twitter intervention; median correct pre-test items were 20 out of 56, (interquartile range (IQR) 14-23), and median post-test were 29 out of 56, (IQR 21-36) (p < 0.001). The improvement in sixth year students was greater than for third year students; 10 more correct items (IQR 4-14) vs. 7 (IQR 1-14) items (p = 0.045). The more TTS followed, the greater the improvement in ECGBRS (p = 0.004). The QRS axis calculation was the ECG reading skill with the lowest scores. Most medical students were definitely (35%) or very probably (46%) interested in repeating another on-line learning experience and found the TTS extremely (39%) or very (46%) interesting. Conclusions: The use of specifically designed TTS was associated with improvement in medical students' interpretation of ECGs. The effectiveness of the threads was higher in the final years of medical school when basic skills had already been acquired. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01885-x.

LDL particle size and composition and incident cardiovascular disease in a South-European population: The Hortega-Liposcale Follow-up Study.

BACKGROUND: The association of low-density lipoprotein (LDL) particle composition with cardiovascular risk has not been explored before. The aim was to evaluate the relationship between baseline LDL particle size and composition (proportions of large, medium and small LDL particles over their sum expressed as small-LDL %, medium-LDL % and large-LDL %) and incident cardiovascular disease in a population-based study. METHODS: Direct measurement of LDL particles was performed using a two-dimensional NMR-technique (Liposcale®). LDL cholesterol was assessed using both standard photometrical methods and the Liposcale® technique in a representative sample of 1162 adult men and women from Spain. RESULTS: The geometric mean of total LDL particle concentration in the study sample was 827.2 mg/dL (95% CI 814.7, 839.8). During a mean follow-up of 12.4 ±â€¯3.3 years, a total of 159 events occurred. Medium LDL particles were positively associated with all cardiovascular disease, coronary heart disease (CHD) and stroke after adjustment for traditional risk factors and treatment. Regarding LDL particle composition, the multivariable adjusted hazard ratios for CHD for a 5% increase in medium and small LDL % by a corresponding decrease of large LDL % were 1.93 (1.55, 2.39) and 1.41 (1.14, 1.74), respectively. CONCLUSIONS: Medium LDL particles were associated with incident cardiovascular disease. LDL particles showed the strongest association with cardiovascular events when the particle composition, rather than the total concentration, was investigated. A change in baseline composition of LDL particles from large to medium and small LDL particles was associated with an increased cardiovascular risk, especially for CHD.

Do genes modify the association of selenium and lipid levels?

The interaction of selenium, a component of antioxidant selenoproteins, with genetic variation in lipid-related pathways has not been evaluated earlier as a potential determinant of blood lipid levels. We aimed at evaluating the effects of gene-environment interactions between plasma levels of selenium and polymorphisms in lipid metabolic pathways on plasma lipid levels in a study population from Spain (N=1,315). We observed statistically significant associations between plasma selenium and lipid levels (differences in total, low-density lipoprotein [LDL]-cholesterol, and triglycerides comparing the 80th with the 20th percentiles of plasma selenium levels were, respectively, 12.0 (95% confidence interval 6.3, 17.8), 8.9 (3.7, 14.2), and 9.0 (2.9, 15.2) mg/dl). We also found statistically significant interactions at the Bonferroni-corrected significance level (p=0.0008) between selenium and rs2290201 in FABP4 for total and LDL cholesterol levels and rs1800774 in CETP for elevated LDL cholesterol. Other polymorphisms showed statistically significant differential associations of plasma selenium levels and lipids biomarkers at the nominal p-value of 0.05. Reported statistical interactions with genes involved in lipid transport and transfer provide biological support to the positive associations of selenium with lipids shown in cross-sectional studies and lead to the hypothesis that selenium and lipid levels share common biological pathways that need to be elucidated in mechanistic studies.

Risk factors associated with retinal vein occlusion.

AIMS: Retinal vein occlusion (RVO) is the most frequent retinal vascular disease after diabetic retinopathy in which arterial risk factors are much more relevant than venous factors. The objective was to evaluate the role of risk factors in the development of the first episode of RVO. SUBJECTS AND METHODS: One hundred patients with RVO [mean age 56 years, 42% females and mean body mass index (BMI) 27.5 kg/m(2)] were recruited consecutively from the outpatient clinic of a tertiary hospital in Valencia (Spain). All subjects underwent clinical assessment including anthropometric and blood pressure measurements and laboratory test including homocysteine, antiphospholipid antibodies (aPLAs) and thrombophilia studies. In half of the subjects, a carotid ultrasonography was performed. Three control populations matched by age, sex and BMI from different population-based studies were used to compare the levels and prevalence of arterial risk factors. One cohort of young patients with venous thromboembolic disease was used to compare the venous risk factors. RESULTS: Blood pressure levels and the prevalence of hypertension were significantly higher in the RVO population when compared with those for the general populations. There was also a large proportion of undiagnosed hypertension within the RVO group. Moreover, carotid evaluation revealed that a large proportion of patients with RVO had evidence of subclinical organ damage. In addition, homocysteine levels and prevalence of aPLAs were similar to the results obtained in our cohort of venous thromboembolic disease. CONCLUSIONS: The results indicate that hypertension is the key factor in the development of RVO, and that RVO can be the first manifestation of an undiagnosed hypertension. Furthermore, the majority of these patients had evidence of atherosclerotic disease. Among the venous factors, a thrombophilia study does not seem to be useful and only the prevalence of hyperhomocysteinaemia and aPLAs is higher than in the general population.

Enfermedad pulmonar obstructiva crónica. ¿Los tiempos están cambiando? / Chronic obstructive pulmonary disease. Are the times changing?

La enfermedad pulmonar obstructiva crónica (EPOC) es una de las afecciones más prevalentes, y que provoca mayor morbimortalidad en nuestro país. En la actualidad la EPOC se considera una afección tratable, de origen inflamatorio y frecuentemente asociada a otras enfermedades, cuya prevalencia está claramente aumentada en los pacientes con EPOC, independientemente de otras variables de confusión como el tabaquismo. Los tratamientos actuales han demostrado frenar la pérdida de función pulmonar, disminuir el número de exacerbaciones, mejorar la calidad de vida relacionada con la salud y prolongar la supervivencia. La recuperación de los fenotipos clásicos y de otros nuevos como el de los pacientes con exacerbaciones frecuentes o el de EPOC con comorbilidad asociada, deberían permitirnos individualizar los tratamientos, al mismo tiempo que los avances en investigación genética y de los mecanismos inflamatorios nos permitirán conocer mejor la enfermedad y añadir nuevas terapias a las ya existentes(AU)

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases and a major cause of morbidity and mortality in Spain. Currently, COPD is considered a treatable disease with an inflammatory origin that is frequently associated with other diseases. The prevalence of comorbidity is clearly increased in patients with COPD, irrespective of other confounding variables such as smoking. Current treatments have been proven to slow the loss of lung function, decrease the number of exacerbations and improve health-related quality of life and survival. New advances regarding the classics and more recent phenotypes such as patients with frequent exacerbations or COPD with associated comorbidity should allow for more individualized treatment while advances in genetic research and inflammatory mechanisms of the disease will help us to increase our knowledge of the disease and the development of new treatments(AU)

Chronic obstructive pulmonary disease. Are the times changing?

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases and a major cause of morbidity and mortality in Spain. Currently, COPD is considered a treatable disease with an inflammatory origin that is frequently associated with other diseases. The prevalence of comorbidity is clearly increased in patients with COPD, irrespective of other confounding variables such as smoking. Current treatments have been proven to slow the loss of lung function, decrease the number of exacerbations and improve health-related quality of life and survival. New advances regarding the classics and more recent phenotypes such as patients with frequent exacerbations or COPD with associated comorbidity should allow for more individualized treatment while advances in genetic research and inflammatory mechanisms of the disease will help us to increase our knowledge of the disease and the development of new treatments.

[Complexity in chronic obstructive pulmonary disease. Individualized treatment, new approaches, phenotypes and comorbidities]. / Complejidad de la EPOC. Tratamiento individualizado, nuevas aproximaciones, fenotipos, comorbilidades.

The current definition and severity stages of chronic obstructive pulmonary disease (COPD) focus excessively on spirometric criteria alone. Measurement of chronic airflow obstruction and its degree of reversibility is complex. The etiology of this disease cannot be fully explained in relation to smoking and the heterogeneity of this systemic disease that affects mainly the lung cannot be expressed through forced expiratory volume in 1 second (FEV(1)) alone. This simplification was useful for a period but the loss of clinical subtlety in large studies hampers interpretation of their results and their conclusions lose external validity. Accepting the complexity of COPD requires substituting the analytic focus centered on FEV(1) for a multifaceted approach that integrates other aspects in the analysis of real COPD patients. Identifying and classifying clinically significant subgroups or "COPD phenotypes" may help to guide treatment more efficiently. In patients with COPD, mortality due to cardiovascular diseases or malignancies occurs earlier than that due to respiratory causes; that is, deaths from COPD occur in patients not succumbing to cardiovascular diseases or cancer. To prolong survival in these patients, comorbidity should be evaluated and treated. COPD treatment based on severity measured by lung function can no longer be recommended. The various therapeutic options should be individualized according to the patient's other characteristics.

Conducta a seguir ante la EPOC desde Medicina Interna / Approach to COPD management in Internal Medicine

Un paciente de 60 años, con obesidad y diabetes mellitus tipo 2, consulta por presentar hipertensión arterial, temeroso de padecer una cardiopatía isquémica. También presenta antecedentes de tabaquismo de 20 cigarrillos/día desde hace 30 años, pero eso no le preocupa. En el interrogatorio refiere, sin darle importancia, y desde hace años tos y disnea de medianos esfuerzos. Muy probablemente ningún internista dude sobre si debemos evaluar y tratar su diabetes mellitus tipo 2 o su hipertensión arterial, estimar su riesgo cardiovascular o si padece un síndrome metabólico, intentar reducir su obesidad y que abandone el tabaquismo; pero ¿le etiquetaríamos de bronquitis crónica o de EPOC?, ¿debemos hacerle una espirometría y un test broncodilatador?, ¿tratar su probable EPOC? Todos sus síntomas actuales probablemente se deban solo a la EPOC(AU)

A 60-year old male patient with obesity and type 2 diabetes mellitus consulted due to high blood pressure, fearful of suffering ischemic heart disease. He also had a background of smoking 20 cigarettes/day for the last 30 years, but this did not concern him. In the questioning, he reported, although he did not consider it important, that he had cough and dyspnea on moderate exertions for some years. It is very unlikely that any internal medicine physician would doubt about whether to evaluate and treat his type 2 diabetes mellitus or high blood pressure, calculate his cardiovascular risk or if he has a metabolic syndrome, attempt to reduce his obesity and to make him stop smoking. However, should we label him as having chronic bronchitis or COPD? Should we perform a spirometry and bronchodilater test, treat his probable COPD? All his current symptoms are probably only due to COPD(AU)

[Approach to COPD management in Internal Medicine]. / Conducta a seguir ante la EPOC desde Medicina Interna.

A 60-year old male patient with obesity and type 2 diabetes mellitus consulted due to high blood pressure, fearful of suffering ischemic heart disease. He also had a background of smoking 20 cigarettes/day for the last 30 years, but this did not concern him. In the questioning, he reported, although he did not consider it important, that he had cough and dyspnea on moderate exertions for some years. It is very unlikely that any internal medicine physician would doubt about whether to evaluate and treat his type 2 diabetes mellitus or high blood pressure, calculate his cardiovascular risk or if he has a metabolic syndrome, attempt to reduce his obesity and to make him stop smoking. However, should we label him as having chronic bronchitis or COPD? Should we perform a spirometry and bronchodilator test, treat his probable COPD? All his current symptoms are probably only due to COPD.

[Type 2 diabetes mellitus and health-related quality of life: results from the Hortega Study]. / Diabetes mellitus tipo 2 y calidad de vida relacionada con la salud: resultados del Estudio Hortega.

OBJECTIVE: To evaluate which health-related quality of life (HRQOL) aspects are affected by type 2 diabetes mellitus (DM) and influence of glycemic control and associated cardiovascular risk factors (CVRF). METHOD: A descriptive cross-sectional study was carried out in the health coverage area of our hospital. Following a multiphase sampling a final sample of 495 people, representative of the general population, was analyzed. HRQOL was evaluated with the Short-Form 36 (SF-36). RESULTS: After adjustment for sociodemographic variables (age, sex, education level, marital status, number of persons residing together, labor situation, social class and rural or urban ambience), comorbidity and CVRF (smoking, systolic blood pressure, LDL-cholesterol level and body mass index), the patients with DM presented lower scores on four SF-36 scales: physical function, bodily pain, general health and vitality. Among people with diabetes systolic blood pressure, body mass index and glycosylated hemoglobin, but not lipid levels, were negatively correlated to some SF-36 scores. CONCLUSIONS: In our population patients with DM present a poorer HRQOL, specifically in the physical dimensions, but neither their social function nor their mental health was affected. Hypertension, obesity and poor glycemic control are associated with worst subjective state of health.

Diabetes mellitus tipo 2 y calidad de vida relacionada con la salud: resultados del Estudio Hortega / Type 2 diabetes mellitus and health-related quality of life: results from the Hortega Study

Objetivo: Evaluar qué aspectos de la calidad de vida relacionada con la salud (CVRS) se ven afectados por la diabetes mellitus tipo 2 (DM), y la influencia del control glucémico y de los factores de riesgo cardiovascular (FRCV) asociados. Método: Llevamos a cabo un estudio transversal descriptivo en el área sanitaria de nuestro hospital. Tras un muestreo polietápico analizamos una muestra final de 495 personas, representativa de la población general. La CVRS se valoró con el Short-Form 36 (SF-36). Resultados: Tras ajustar por variables sociodemográficas (edad, sexo, nivel de estudios, estado civil, número de persones residiendo juntas, situación laboral, clase social y medio rural o urbano), comorbilidad y FRCV (tabaquismo, tensión arterial sistólica, LDL-colesterol e índice de masa corporal), los pacientes con DM presentaban menores puntuaciones en cuatro escalas del SF-36: función física, dolor corporal, salud general y vitalidad. Entre los diabéticos tensión arterial sistólica, índice de masa corporal y hemoglobina glicosilada se correlacionaban negativamente con algunas escalas, pero no así los niveles lipídicos. Conclusiones: En nuestra población los pacientes con DM presentan una peor CVRS específicamente en las dimensiones físicas, sin que se vean afectadas ni su función social ni su salud mental. Hipertensión, obesidad y mal control glucémico se asocian en estos enfermos a un peor estado subjetivo de salud

Objective: To evaluate which health-related quality of life (HRQOL) aspects are affected by type 2 diabetes mellitus (DM) and influence of glycemic control and associated cardiovascular risk factors (CVRF). Method: A descriptive cross-sectional study was carried out in the health coverage area of our hospital. Following a multiphase sampling a final sample of 495 people, representative of the general population, was analyzed. HRQOL was evaluated with the Short-Form 36 (SF-36). Results: After adjustment for sociodemographic variables (age, sex, education level, marital status, number of persons residing together, labor situation, social class and rural or urban ambience), comorbidity and CVRF (smoking, systolic blood pressure, LDL-cholesterol level and body mass index), the patients with DM presented lower scores on four SF-36 scales: physical function, bodily pain, general health and vitality. Among people with diabetes systolic blood pressure, body mass index and glycosylated hemoglobin, but not lipid levels, were negatively correlated to some SF-36 scores. Conclusions: In our population patients with DM present a poorer HRQOL, specifically in the physical dimensions, but neither their social function nor their mental health was affected. Hypertension, obesity and poor glycemic control are associated with worst subjective state of health

[Chlamydophila pneumoniae seroprevalence in adults from the general population]. / Seroprevalencia de anticuerpos frente a Chlamydophila pneumoniae en adultos de la población general.

BACKGROUND AND OBJECTIVE: Chlamydophila pneumoniae is an intracelular pathogen involved in the inflammatory pathogenesis of some chronic diseases with high prevalence. Infectivity is supposed to be high because the serologic patterns published are widely spread out all over the world. However, the prevalence in the Spanish adult population is unknown. Our goal was to assess the seroprevalence of specific IgG and IgA against C. pneumoniae in the general adult population performing an indirect immunofluorescence assay. MATERIAL AND METHOD: 462 serum samples were analysed from subjects over 15 years of age in the general population in Valladolid. RESULTS: IgG 1:16 seroprevalence was 74.1% (95% confidence interval [CI], 69.7-78.6) and IgG 1:64 was 32.2% (95% CI, 27.6-36.8), whereas IgA 1:16 was 21.5% (95% CI, 17.7-25.4) and IgA 1:32 was 5.2% (95% CI, 3.3-7.2). Higher titles were found in men and with increasing age, specially for IgA (p < 0.05). Only 3.6% (95% CI, 1.9-5.3) and 0.7% (95% CI, 0.03-1.4) of subjects showed titles IgG 1:256 or 1:512, respectively. Almost one fourth showed a title 1:16 for both immunoglobulins. CONCLUSIONS: Chlamydophila pneumoniae maintains a high seroprevalence of infection in the Spanish adult population.

Seroprevalencia de anticuerpos frente a Chlamydophila pneumoniae en adultos de la población general / Chlamydophila pneumoniae seroprevalence in adults from the general population

Fundamento y objetivo: Chlamydophila pneumoniae es un germen patógeno intracelular implicado en la patogenia inflamatoria de algunas enfermedades crónicas con alta prevalencia. Su capacidad de difusión es elevada porque los patrones serológicos de infección descritos para la población general están ampliamente distribuidos en todo el mundo; sin embargo, se desconoce la seroprevalencia en la población adulta de España. Nuestro objetivo fue determinar la seroprevalencia de inmunoglobulinas (IgG) e IgA específicas frente a C. pneumoniae en la población general adulta mediante su determinación por inmunofluorescencia indirecta. Material y método: Se analizó 462 muestras de suero procedentes de individuos mayores de 15 años de la población general de Valladolid. Resultados: La seroprevalencia de IgG 1:16 fue del 74,1% (intervalo de confianza [IC] del 95%, 69,7-78,6) y para una IgG 1:64 del 32,2% (IC del 95%, 27,6-36,8), mientras que para la IgA fue del 21,5% (IC del 95%, 17,7-25,4) a una dilución 1:16 y del 5,2% (IC del 95%, 3,3-7,2) a un título 1:32. Encontramos títulos más altos en los varones y a medida que aumentaba la edad, especialmente para la IgA (p < 0,05). Sólo el 3,6% (IC del 95%, 1,9-5,3) y el 0,7% (IC del 95%, 0,03-1,4) de los sujetos presentaron títulos de IgG 1:256 o 1:512, respectivamente. Conclusiones: C. pneumoniae mantiene una alta seroprevalencia de infección en la población adulta española

Background and objective: Chlamydophila pneumoniae is an intracelular pathogen involved in the inflammatory pathogenesis of some chronic diseases with high prevalence. Infectivity is supposed to be high because the serologic patterns published are widely spread out all over the world. However, the prevalence in the Spanish adult population is unknown. Our goal was to assess the seroprevalence of specific IgG and IgA against C. pneumoniae in the general adult population performing an indirect immunofluorescence assay. Material and method: 462 serum samples were analysed from subjects over 15 years of age in the general population in Valladolid. Results: IgG 1:16 seroprevalence was 74.1% (95% confidence interval [CI], 69.7-78.6) and IgG 1:64 was 32.2% (95% CI, 27.6-36.8), whereas IgA 1:16 was 21.5% (95% CI, 17.7-25.4) and IgA 1:32 was 5.2% (95% CI, 3.3-7.2). Higher titles were found in men and with increasing age, specially for IgA (p < 0.05). Only 3.6% (95% CI, 1.9-5.3) and 0.7% (95% CI, 0.03-1.4) of subjects showed titles IgG 1:256 or 1:512, respectively. Almost one fourth showed a title 1:16 for both immunoglobulins. Conclusions: Chlamydophila pneumoniae maintains a high seroprevalence of infection in the Spanish adult population

[Prevalence of mild to moderate chronic kidney disease in the general population of Spain. Hortega study]. / Prevalencia de la enfermedad renal crónica leve y moderada en población general. Estudio Hortega.

BACKGROUND: Although the epidemiology of subjects with end-stage renal disease is well-known in Spain, the prevalence of mild to moderate chronic kidney disease (CKD) in the general population is unknown. In order to measure this, it is necessary to carry out studies in the general population including those who are not health service patients. During epidemiology studies, the method of measuring glomerular filtration rate can change significantly the measurements of the prevalence of mild to moderate CKD. METHODS: Between 1997 and 2000, we performed a multi-phase descriptive polistratified epidemiological transversal study. The section of public chosen was between the ages of 15 and 85 living in the health area of western Valladolid (Spain). We calculated creatinine clearance using four methods: serum creatinine concentration, creatinine clearance using 24-hour urine samples adjusting the volume to the expected creatinuria with the Walser formulas, using the Cockcroft-Gault (CG) equation and applying the Modification of Diet in Renal Disease (MDRD) study abbreviated formula. We classified the level of kidney function, according to the National Kidney Foundation-Dialysis Outcomes Initiative (NFK-DOQI) guidelines. RESULTS: The instances of stages 2 and 3 CKD rise with age and are more common in women than men. This tendency is apparent in middle age and persons of 65 and above. Using the CG method, almost half the old women had a stage 3 CKD as opposed to a third of the men. If the measurement is performed using the abbreviated MDRD study, there are very few differences between the sexes. The prevalence of stage 3 CKD is similar (around 8%) but the prevalence of stage 2 CKD rises to 60% as opposed to 36% calculated using the CG equation. After comparing the results obtained with those of the third National Health and Nutrition Examination Survey Study (see table VII), the measurements of stage 3 CKD using the CG formula or by means of expected creatininuria coincide relatively, although the prevalence of stage 2 CKD is higher in persons of 65 and over. If we use the abreviated MDRD study, the prevalences increase by more than 20%. CONCLUSIONS: The prevalence of stages 2 and 3 CKD is clearly influenced by the method of calculation used. The prevalence of stage 2 CKD affects at least a third of the general population while those affected by stage 3 CKD are between 3.3% and 8.5%.

Effects of dietary intake and life style on bone density in patients with diabetes mellitus type 2.

OBJECTIVE: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. DESIGN: Cross-sectional study. SETTING: Tertiary care hospital. PARTICIPANTS: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. RESULTS: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 +/- 6.9 vs. 62.1 +/- 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 +/- 387 vs. 839 +/- 251 mg/day; p < 0.05) and zinc intake (9.23 +/- 3.5 vs. 13.3 +/- 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = -0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. CONCLUSIONS: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.

The SF-36 Questionnaire as a measurement of health-related quality of life: assessing short- and medium-term effects of exposure to tobacco versus the known long-term effects.

BACKGROUND: In order to determine the magnitude of the short- or medium-term effects of tobacco use on the health-related quality of life (HRQOL) of smokers and ex-smokers, and to compare them with the estimated long-term effects reported in other studies, a cross-sectional epidemiological study was designed. METHODS: A representative study of the general population over 14 years of age was conducted in the western health area of Valladolid, Spain. HRQOL was evaluated using the SF-36 Health Questionnaire. Differences in HRQOL among smokers, non-smokers, and former smokers were determined. Standardized scores from the general population and long-term effects of tobacco exposure were compared. RESULTS: Former smokers had a better HRQOL than smokers and non-smokers on the emotional dimensions, especially "vitality" and "role emotional", while differences between the groups on the physical and emotional dimensions did not reach statistical significance. Smokers displayed deterioration in "bodily pain", "general health", "vitality", "social function", and "role emotional", while deterioration in ex-smokers only occurred in "bodily pain" and "general health." The variable package/year was correlated with "general health." CONCLUSIONS: Short- and medium-range effects of tobacco consumption on HRQOL cannot be demonstrated with the SF-36 Health Questionnaire in the general Spanish population, whereas long-term effects can.