Incidental finding of rare hemoglobin: hemoglobin Bari in northeast Spain.

Objectives: Cation exchange high-performance liquid chromatography (HPLC) is one of the techniques available for determining glycated hemoglobin (HbA1c) and also the method of choice for structural hemoglobinopathies screening. The objective of this case is to show how in a routine HbA1c test it is possible to incidentally find a hemoglobinopathy. Case presentation: In a routine blood analysis, an abnormal value for the hemoglobin A2 (HbA2) was obtained during the study of HbA1c with HPLC on the ADAMS™ A1c HA-8180T. After suspecting it could be due to the presence of a hemoglobinopathy, the study of possible variants was expanded using electrophoresis and HPLC on the Hydrasys and Variant II analysers, respectively. Since it could not be identified by these conventional methods, a genetic study was also carried out using Sanger sequencing. The patient presented a low HbA2 (1.3 %) and a 24.9 % variant with a retention time of 1.95 min, compatible with alpha-globin chain variant. In the genetic study, the pathogenic variant c.138C>G was detected in the HbA2 gene in heterozygosis, which resulted in the expression of the structural hemoglobinopathy known as hemoglobin Bari. Conclusions: The initial screening for structural hemoglobinopathies allows its identification or suspicion especially when it was performed with HbA1c analysis, requiring subsequent confirmation and diagnosis by other techniques.

Pharmacokinetics and oral bioavailability of cannabidiol in horses after intravenous and oral administration with oil and micellar formulations.

BACKGROUND: Intravenous pharmacokinetics and oral bioavailability of cannabidiol (CBD) with different formulations have not been investigated in horses and may represent a starting point for clinical studies. OBJECTIVES: To describe pharmacokinetics after intravenous and oral administrations with oil and micellar formulations and simulate different treatments. STUDY DESIGN: Single intravenous experiment and two-way randomised oral experiments, Latin-square design. METHODS: Eight healthy horses received intravenous CBD at 1.00 mg/kg dose, oral CBD in sesame oil and in micellar formulation, both at 10.00 mg/kg. Concentrations were measured using LC-MS/MS and fitted by nonlinear mixed effect modelling. Parameters obtained were used to simulate single and multiple treatments at steady state. RESULTS: Intravenous and oral concentrations were simultaneously fitted using a three-compartment model. Final estimates indicate that CBD has a volume of distribution of 36 L/kg associated with a systemic clearance of 1.46 L/h/kg and half-lives ranged between 24 and 34 h. Oral bioavailability was close to 14% for both oral administrations. Simulated dose regimen of CBD every 12 and 24 h predicted similar percentages to reach effective plasma concentration with both oral formulation at 10.00 mg/kg. MAIN LIMITATIONS: A small horse population was used (8 horses per trial). CONCLUSIONS AND CLINICAL IMPORTANCE: Oral bioavailability was low at the doses studied but fell within the range described for horse and other species. CBD had a high steady-state volume of distribution, a high clearance and long half-lives. No adverse reactions were detected at any dose or route. The micellar formulation showed a faster absorption and higher concentration peak, while the oil formulation presented lower levels, but more maintained over time. Simulations predicted that both could be useful in multiple oral dose treatments. These results indicated that CBD could be of interest, but further studies are needed to evaluate its clinical use in horses.

Previous Exercise on a Water Treadmill at Different Depths Affects the Accelerometric Pattern Recorded on a Track in Horses.

During a water treadmill (WT) exercise, horses change their accelerometric patterns. We aimed to analyze if these changes persist during terrestrial locomotion. Six horses were randomly subjected to 40 min duration WT exercises, without water (WW), at the depth of fetlock (FET), carpus (CAR) and stifle (STF), with a day off between them. Before and after 30 min after WT, horses were evaluated at walk and at trot on a track with a triaxial accelerometer fixed on the pectoral (PECT) and sacrum (SML) regions. The percent of change from baseline (before WT and after each exercise session) were calculated. Total, dorsoventral, longitudinal and mediolateral accelerometric activities and dorsoventral displacement increased with the accelerometer in PECT but decreased after WT at STF. Velocity increased with the accelerometer in PECT but decreased with the accelerometer in SML, particularly after WT at STF. A reduction in stride frequency was found with the accelerometer in PECT. SL increased with the accelerometer in SML but decreased with WT at STF. Some accelerometric changes that happened on WT remained shortly in terrestrial locomotion. The reduction in some parameters after WT at STF depth seems to indicate fatigue. This should be considered in training or rehabilitation programs for unfit animals.

Accelerometric Changes before and after Capacitive Resistive Electric Transfer Therapy in Horses with Thoracolumbar Pain Compared to a SHAM Procedure.

Capacitive resistive electric transfer (CRET), a radiofrequency at 448 kHz, increases flexibility in quadricep muscles of human athletes. To assess whether CRET would result in clinical and biomechanical improvements in horses with thoracolumbar pain, 18 sport horses were divided into two groups: CRET (n = 9), subjected to four CRET sessions, during two consecutive weeks, and SHAM (n = 9), subjected to the same procedure with the device off. Clinical examination and accelerometry were performed before and after the four sessions. During the study, horses were in training and in active competition, and did not receive any other treatment. Mann-Whitney and a Wilcoxon matched pair tests were used to compare between the SHAM and CRET groups and before and after the intervention, respectively. CRET horses showed increased dorsoventral (p < 0.002), mediolateral and total power (p < 0.01) after the intervention, suggesting increased back flexibility. SHAM horses did not show any of these modifications after the intervention. No changes were found in the dorsoventral displacement of the gravity center in either group. Thoracolumbar pain decreased one degree after CRET (p = 0.002), and it did not change after SHAM. Epaxial muscle pain decreased two degrees after CRET (p = 0.03) and one degree after SHAM (p = 0.01). These results reflected that CRET therapy would increase back flexibility and decrease thoracolumbar and epaxial pain.

Combined Effects of Water Depth and Velocity on the Accelerometric Parameters Measured in Horses Exercised on a Water Treadmill.

Horse trainers often claim that exercise on a water treadmill (WT) leads to a greater muscle power and development compared to terrestrial locomotion, because of the greater viscosity of water compared to air. This research assesses locomotor changes measured with accelerometers fixed in the pectoral region and in the sacrum midline in six horses subjected to exercise sessions of 40 min duration on a WT without water (DT), and with water at the depth of fetlock (FET) and carpus (CAR) with velocities of 6 km/h and at the depth of stifle (STF) at 5 km/h. Another five horses performed the same exercise sessions but always with a velocity of 5 km/h. Total power increased from DT to FET and CAR, without significant differences between CAR and STF depths when the velocity was the same. However, a significant decrease was found when the velocity was reduced. The greater total power with water was distributed mainly to the dorsoventral axis, with significant increases in dorsoventral displacement and dorsoventral power. Both parameters were significantly affected by velocity and water depth. In conclusion, total and dorsoventral powers increased with velocity and water depth, leading to reduction in longitudinal and mediolateral power, during exercise on a WT.

Capacitive resistive electric transfer modifies gait pattern in horses exercised on a treadmill.

BACKGROUND: Capacitive resistive electric transfer (CRET), a radiofrequency at 448 kHz, resulted in increased superficial and deep temperature and hemoglobin saturation, faster elimination of metabolic and inflammatory products and enhanced sport performance in humans. This research aims to investigate whether the application of CRET affects the locomotor pattern in horses and to assess whether an accumulative effect appears when two CRET sessions are applied two consecutive days. METHODS: Nine horses were subjected to two CRET sessions applied in both right and left sides of neck, shoulder, back and croup. The horses were exercised on a treadmill, at walk and at trot, before CRET application and at 2, 6 and 12 h after. A second CRET session was applied next day, and the animals were evaluated again at the same times (i.e. at 26, 30 and 36 h after the first session). Between 5 and 7 days later, the same horses were subjected to a sham procedure and they were evaluated in the same times as in the CRET experiment. During treadmill exercise, locomotor parameters were measured with a triaxial accelerometer fixed in the pectoral region and in the sacrum midline. RESULTS: The sham procedure did not affect any of the accelerometric variables studied. CRET applications resulted in greater total powers, which resulted in absolute increased dorsoventral, mediolateral and longitudinal powers. However, a reduction in dorsoventral power expressed as a percentage of total power was found. Stride regularity increased. The greater total power resulted in longer stride length and because the velocity was kept fixed on the treadmill, stride frequency decreased. An accumulative effect of CRET application was only found in stride length and frequency. CONCLUSIONS: It appears that CRET is a useful technique to enhance power and to elongate the stride at defined walk and trot velocities. The effect of these changes on performance should be studied for horses competing in different sport disciplines.

The Use of the Water Treadmill for the Rehabilitation of Musculoskeletal Injuries in the Sport Horse.

In recent years, exercise on a water treadmill has come to have great relevance in rehabilitation and training centres for sport horses. Its use exploits certain physical properties of water, related to the fundamental principles of hydrodynamics, such as buoyancy, viscosity, hydrostatic pressure, and water temperature. These properties together with deliberate specification of the depth of the water and the velocity of the treadmill provide a combination of parameters that can be varied according to the purpose of the rehabilitation or training programme, the disease to rehabilitate, or the healing phase. In the current article, kinematic adaptations to exercise on a water treadmill and the direct application of such exercise to the rehabilitation of superficial and deep digital flexor tendon and accessory ligament injuries and back and joint diseases are described.

Clinical efficacy of clodronic acid in horses diagnosed with navicular syndrome: A field study using objective and subjective lameness evaluation.

Navicular syndrome, a common cause of equine forelimb lameness, is associated with pathological changes in the navicular bone. Consequently, administration of bisphosphonates (BPs) has been advocated in order to modify the rate of bone turnover. The present study aimed to assess the clinical efficacy of intramuscularly administered clodronic acid for the treatment of 11 horses with clinical and radiographic findings compatible with navicular syndrome. Magnetic resonance imaging was performed in 5 of the 11 horses. The animals were treated with an intramuscular dose of clodronic acid of 765 mg/horse, administered over three separate injection sites. Before and at 7, 30 and 90 days after treatment, horses were subjected to lameness and accelerometric evaluations. A clinical improvement was observed in 6 of the 11 horses. These 6 horses showed a mean reduction of two degrees in lameness score. Accelerometry in these horses revealed increased velocity, stride length, stride regularity and dorsoventral displacement of the gravity of centre together with a reduction in stride frequency, suggesting a gait improvement. This study demonstrates that intramuscular clodronic acid can be useful for lameness reduction in some horses with navicular syndrome.

Natural outdoor environments and mental and physical health: relationships and mechanisms.

BACKGROUND: Evidence is growing for the beneficial impacts of natural outdoor environments on health. However, most of the evidence has focused on green spaces and little evidence is available on health benefits of blue spaces and about possible mediators and modifiers of such impacts. We investigated the association between natural outdoor environments (separately for green and blue spaces) and health (general and mental) and its possible mediators and modifiers. METHODS: Cross-sectional data from adults interviewed in Catalonia (Spain) between 2010 and 2012 as part of the Catalonia Health Survey were used. The collected data included sociodemographic characteristics, self-perceived general health, mental health, physical activity and social support. Indicators of surrounding greenness and access to natural outdoor environments within 300 m of the residence and degree of urbanization were derived for residential addresses. Associations were estimated using logistic regression and negative binominal models. RESULTS: Green spaces were associated with better self-perceived general health and better mental health, independent of degree of urbanization. The associations were more consistent for surrounding greenness than for access to green spaces. The results were consistent for different buffers, and when stratifying for socioeconomic status. Slightly stronger associations were found for women and residents of non-densely populated areas. No association was found between green spaces and social contacts and physical activity. The results for blue spaces were not conclusive. CONCLUSION: Green spaces are associated with better general and mental health across strata of urbanization, socioeconomic status, and genders. Mechanisms other than physical activity or social support may explain these associations.

The Spanish version of the Warwick-Edinburgh mental well-being scale (WEMWBS) is valid for use in the general population.

PURPOSE: Mental well-being has aroused interest in Europe as an indicator of population health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed in the United Kingdom showing good face validity and has been previously adapted into Spanish. The aim of this study is to assess the validity and reliability of the Spanish version of WEMWBS in the general population. METHODS: Cross-sectional home face-to-face interview survey with computer-assisted personal interviewing was administered with the 2011 Catalan Health Interview Survey Wave 3, which is representative of the non-institutionalized general population of Catalonia, Spain. A total of 1,900 participants 15+ years of age were interviewed. The Spanish version of WEMWBS was administered together with socioeconomic and health-related variables, with a hypothesized level of association. RESULTS: Similar to the original, confirmatory factor analysis fits a one-factor model adequately (CFI = 0.974; TLI = 0.970; RMSEA = 0.059; χ (2) = 584.82; df = 77; p < .001) and has a high internal consistency (Cronbach's alpha = 0.930; Guttman's lambda 2 = 0.932). The WEMWBS discriminated between population groups in all health-related and socioeconomic variables, except in gender (p = 0.119), with a magnitude similar to that hypothesized. Overall, mental well-being was higher for the general population of Catalonia (average and whole distribution) than that for Scotland general population. CONCLUSIONS: The Spanish version of WEMWBS showed good psychometric properties similar to the UK original scale. Whether better mental well-being in Catalonia is due to methodological or substantive cultural, social, or environmental factors should be further researched.

Evaluación de la inmunofijación sérica frente al cociente de cadenas ligeras libres Kappa/Lambda en la confirmación de componentes monoclonales de baja concentración / Evaluation of serum immunofixation compared to the free Kappa/Lambda light chains ratio for confirming low monoclonal component concentrations

Introducción. La electroforesis de proteínas séricas (EFs) constituye, por norma general, el primer paso en la búsqueda de componentes monoclonales (CM). Una baja concentración de CM dará lugar a pequeños picos en la EFs que pueden hacer sospechar la existencia de una gammapatía monoclonal de significado incierto (GMSI). Para confirmar estas GMSI se ha utilizado la inmunofijación sérica (IFs) y un cociente de cadenas ligeras libres séricas (CLLs) Kappa (K)/Lambda (λ) alterado. Materiales y métodos. De 3.683 EFs realizadas en nuestro laboratorio durante los meses de febrero a noviembre de 2011, se observaron 165 con pequeños picos en las fracciones β1, β2 o gamma. La confirmación del CM se realizó mediante la IFs y la existencia de un cociente de CLLs K/ λ alterado. Resultados. De las 165 EFs seleccionadas para el estudio, la IFs fue positiva en 82, mientras que un cociente de CLLs K/λ alterado solo se observó en 11 de los 82. El cociente de CLLs K/λ de las 71 EFs restantes con IFs positivas, estuvo dentro del intervalo de normalidad para sujetos sanos (0.25-1.65). Conclusiones. La EFs constituye el primer paso en la búsqueda del CM, aunque esta interpretación está ligada a un cierto grado de subjetividad cuando estos CM están a baja concentración. Al valorar la utilidad de la IFs frente al cociente de CLLs K/λ en la confirmación de estos CM, se observó que la confirmación debe realizarse por IFs ya que la cuantificación del cociente de CLLs K/λno resultó útil (AU)

Introduction. Serum protein electrophoresis (SPE) is the first step in the search for a monoclonal component (MC). A low concentration of MC will give small spikes in the SPE, which may lead to the suspicion of a monoclonal gammopathy of undetermined significance (MGUS). To confirm these MGUS, serum immunofixation (sIFE) and abnormal serum free light chains (sFLC) Kappa/Lambda ratio have been used. Material and methods. Of 3683 SPE carried out in our laboratory during the months from February to November of 2011, we observed 165 small spikes in the SPE in β1, β2 or gamma region. The confirmation of these MGUS was made using sIFE and abnormal sFLC Kappa (K)/Lambda (λ) ratio. Results. Of 165 SPE selected for the study, sIFE was positive in 82, while an abnormal sFLC K/λ ratio alone was observed in 11 of the 82. The sFLC K/λ ratio of the 71 SPE remaining with positive sIFE was inside the interval of normality for healthy people (0.25-1.65). Conclusion. SPE is the first step in the search for a MC. When there is a low concentration of MC, this interpretation has a certain grade of subjectivity. When we evaluated the utility of sIFE versus sFLC K/λ ratio in the confirmation of these MC, it was observed that the confirmation should be carried out by means of sIFE since the quantification of the sFLC K/λ ratio was not useful (AU)

Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña / Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population

Fundamento y objetivo: El cuestionario de salud SF-12 es una versión reducida del SF-36. La estrategia principal de interpretación de estos cuestionarios de calidad de vida relacionada con la salud (CVRS) es la utilización de normas poblacionales. Este estudio pretende obtener las normas de referencia para la versión española del SF-12 versión 2 (SF-12v2), evaluar su validez de constructo y comparar los métodos de puntuación estándar y específico. Sujetos y método: Se analizó una submuestra de la Encuesta de Salud de Cataluña (n=4.261), representativa de la población general no institucionalizada. Se calculó la media y percentiles para las 8 dimensiones y los componentes sumarios, estratificando por sexo y edad. La validez de constructo se evaluó mediante la comparación de grupos conocidos aplicando la prueba de ANOVA. Resultados: Los resultados apoyaron las hipótesis establecidas a priori para los grupos conocidos (p<0,001): peor salud física en las personas con problemas de movilidad (EQ-5D) (37,8 frente a 52), con mayor restricción en actividades (41,8 frente a 51,2) y con mayor número de trastornos crónicos (43,2 frente a 53,9); y peor salud mental en las personas con problemas de ansiedad/depresión (EQ-5D) (42,2 frente a 51,9). Las puntuaciones obtenidas con ambos métodos de puntuación fueron similares, excepto en Salud General y Vitalidad. Conclusiones: El SF-12v2 es un instrumento válido para medir CVRS en nuestro entorno. Las normas obtenidas facilitan la interpretación de sus puntuaciones en la práctica clínica, la investigación y la gestión sanitaria. Se recomienda el método específico para comparaciones de CVRS a nivel nacional y el estándar para las internacionales (AU)

Background and objective: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. Subjects and methods: We analyzed a subsample of the Catalan Health Interview Survey (n = 4,261),representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. Results: The results for the known groups analysis supported the hypothesis established a priori(P < .001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9);and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scoresobtained by the 2 different methods of calculation were similar, except for General Health and Vitality. Conclusions: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison (AU)

[Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population]. / Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña.

BACKGROUND AND OBJECTIVE: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS: We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS: The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey.

PURPOSE: To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey. METHODS: Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions. RESULTS: All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D. CONCLUSIONS: The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.

[Injuries from falls and associated factors among elderly people in Cataluña, Spain]. / Lesiones por caídas y factores asociados en personas mayores de Cataluña, España.

OBJECTIVES: To assess, based on a population health survey, what proportion of individuals in a sample of non-institutionalized older persons suffered injuries from unintentional falls, and to evaluate the associated demographic and health-related factors. METHODS: A total of 3,247 individuals over 65 years of age, selected by multistage random sampling, participated in the Health Survey of Cataluña (ESCA-2006), answering an interviewer-administered questionnaire that included questions about injuries from falls, and any relevant associated factors, during the 12 months preceding the survey. RESULTS: Of the respondents, 14.9% reported having been injured by falling. Multivariate analysis indicated that sex, age, living alone, taking five or more medications, and suffering from mobility problems, diabetes, or musculoskeletal disorders were associated with an increased risk of injury from falls. However, no statistically significant effect was observed from sensory or communication impairment, cardiovascular disease, cataracts, or alcohol consumption. CONCLUSIONS: Health care services, which are often in contact with the elderly, can identify those who are at increased risk of falling and put into place a variety of proven, preventive interventions. Though somewhat limited, population health surveys provide useful information regarding the burden of fall-related injuries on elderly health and complement data provided by other sources.

Lesiones por caídas y factores asociados en personas mayores de Cataluña, España / Injuries from falls and associated factors among elderly people in Cataluña, Spain

OBJETIVOS: Evaluar, a partir de una encuesta de salud poblacional, la proporción de personas que han sufrido lesiones por caídas no intencionadas en una muestra de personas de edad no institucionalizadas, y valorar los factores demográficos y condicionantes médicos asociados. MÉTODOS: Un total de 3 247 personas de 65 y más años de edad seleccionadas mediante un muestreo aleatorio polietápico participaron en la Encuesta de Salud de Cataluña (ESCA-2006), respondiendo un cuestionario administrado por un entrevistador que incluía preguntas sobre lesiones por caídas en los 12 meses previos a la encuesta y otros factores relevantes asociados. RESULTADOS: El 14,9 por ciento de los encuestados manifestaron haber sufrido lesiones por caídas. En el análisis multivariado, el sexo, la edad, vivir solo, estar tomando cinco o más medicamentos y padecer problemas de movilidad, diabetes o trastornos músculo-esqueléticos se asociaron a un mayor riesgo de lesiones por caídas. No se observó, en cambio, un efecto estadísticamente significativo de las discapacidades sensoriales y de la comunicación, las enfermedades cardiovasculares, las cataratas o el consumo de alcohol. CONCLUSIONES: Los servicios de salud, que suelen estar en contacto con las personas de edad, pueden identificar a quienes están expuestos a un mayor riesgo de sufrir caídas, desarrollando diferentes intervenciones preventivas de efectividad demostrada. Aun con ciertas limitaciones, las encuestas de salud poblacionales proporcionan información útil sobre la carga que representan las lesiones por caídas para la salud de las personas de edad, complementando datos que proporcionan otras fuentes.

OBJECTIVES: To assess, based on a population health survey, what proportion of individuals in a sample of non-institutionalized older persons suffered injuries from unintentional falls, and to evaluate the associated demographic and health-related factors. METHODS: A total of 3 247 individuals over 65 years of age, selected by multistage random sampling, participated in the Health Survey of Cataluña (ESCA-2006), answering an interviewer-administered questionnaire that included questions about injuries from falls, and any relevant associated factors, during the 12 months preceding the survey. RESULTS: Of the respondents, 14.9 percent reported having been injured by falling. Multivariate analysis indicated that sex, age, living alone, taking five or more medications, and suffering from mobility problems, diabetes, or musculoskeletal disorders were associated with an increased risk of injury from falls. However, no statistically significant effect was observed from sensory or communication impairment, cardiovascular disease, cataracts, or alcohol consumption. CONCLUSIONS: Health care services, which are often in contact with the elderly, can identify those who are at increased risk of falling and put into place a variety of proven, preventive interventions. Though somewhat limited, population health surveys provide useful information regarding the burden of fall-related injuries on elderly health and complement data provided by other sources.

[Public healthcare coverage versus double healthcare coverage: what are the differences?]. / Población con cobertura pública o doble cobertura de aseguramiento sanitario. Cuál es la diferencia?

OBJECTIVE: To identify differences in socioeconomic characteristics, health status, health services' utilization, and satisfaction with health services between the population with public healthcare coverage only and the population with double healthcare coverage through additional affiliation to mutual or private health insurance companies. METHODS: Data from the 2002 Catalan Health Interview Survey with interviews to 8,400 individuals were used. Individuals with public healthcare insurance were differentiated from those who also had private health insurance. Multivariate logistic regression analysis was used. RESULTS: A total of 99.2% of the population reported public healthcare coverage and 24.7% also had voluntary mutual or private insurance. Individuals with double coverage were younger, had a high level of education, belonged to advantaged classes, and reported better self-perceived health and fewer chronic diseases and disabilities. No significant differences in the percentage of individuals who reported visiting a health professional in the previous 15 days were observed. Significant differences in the type of professional visited were observed: 65% of individuals with public healthcare coverage only visited primary care settings but 51.1% of those with double coverage visited specialists. The proportion of persons reporting that they were satisfied or very satisfied with professional attitudes, waiting times and administrative procedures was higher in the double coverage group. CONCLUSIONS: Distinct sociodemographic and health profiles were found between persons with public coverage only and those with double coverage. Health services' utilization also differed between the two groups.

Población con cobertura pública o doble cobertura de aseguramiento sanitario. ¿Cuál es la diferencia? / Public healthcare coverage versus double healthcare coverage: what are the differences?

Objetivo: Conocer las diferencias en las características socioeconómicas, el estado de salud, la utilización de servicios y la satisfacción con éstos entre la población catalana que dispone únicamente de aseguramiento sanitario público y la que tiene doble cobertura de aseguramiento. Métodos: Datos de la Encuesta de Salud de Cataluña 2002 con entrevista a 8.400 personas. Entre los individuos que tenían cobertura pública de servicios sanitarios, se han diferenciado los que también tenían cobertura por entidades de aseguramiento libre. Se aplica un modelo de análisis multivariable de regresión logística. Resultados: El 99,2% de la población manifiesta disponer de cobertura sanitaria pública y un 24,7% estar además afiliada a una mutua voluntaria o aseguradora privada. La población con doble cobertura se caracteriza por ser más joven, tener mayor nivel de estudios, pertenecer a clases sociales más favorecidas, declarar mejor estado de salud percibido, menos enfermedades crónicas y discapacidades. El porcentaje de personas que han acudido a algún profesional sanitario los últimos 15 días no muestra diferencias estadísticamente significativas, pero sí se observan según el tipo de profesional; en la población sin doble cobertura, la última visita corresponde, en el 65,0% de los casos, a atención primaria, mientras que en el grupo con doble cobertura, el 51,1% corresponde a atención especializada. El porcentaje de personas satisfechas o muy satisfechas con la última visita es superior en el grupo con doble cobertura en relación con el trato profesional, el tiempo de espera y los trámites burocráticos. Conclusiones: Se constatan perfiles sociodemográficos y de salud diferentes entre las poblaciones con cobertura pública únicamente y con doble cobertura. Se observa un patrón distinto de utilización de servicios

Objective: To identify differences in socioeconomic characteristics, health status, health services’ utilization, and satisfaction with health services between the population with public health care coverage only and the population with double healthcare coverage through additional affiliation to mutual or private health insurance companies. Methods: Data from the 2002 Catalan Health Interview Survey with interviews to 8,400 individuals were used. Individuals with public healthcare insurance were differentiated from those who also had private health insurance. Multivariate logistic regression analysis was used. Results: A total of 99.2% of the population reported public health care coverage and 24.7% also had voluntary mutual or private insurance. Individuals with double coverage were younger, had a high level of education, belonged to advantage classes, and reported better self-perceived health and fewer chronic diseases and disabilities. No significant differences in the percentage of individuals who reported visiting a health professional in the previous 15 days were observed. Significant differences in the type of professional visited were observed:65% of individuals with public healthcare coverage only visited primary care settings but 51.1% of those with double coverage visited specialists. The proportion of persons reporting that they were satisfied or very satisfied with professional attitudes, waiting times and administrative procedures was higher in the double coverage group. Conclusions: Distinct sociodemographic and health profiles were found between persons with public coverage only and those with double coverage. Health services’ utilization also differed between the two groups