Assessing gender stereotypes and sexual risk practices in men who have sex with men / Valoración de estereotipos de género y prácticas sexuales de riesgo en hombres que tienen sexo con hombres

Objective: To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM). Methods: Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed. Results: Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants. Conclusion: The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs

Objetivo: Analizar la validez de constructo y la consistencia interna del cuestionario Bem Sex Role Inventory (BSRI-12) y estudiar la asociación entre estereotipos de género y prácticas sexuales de riesgo en hombres que tienen sexo con hombres (HSH). Métodos: Estudio transversal con 601 HSH que de manera anónima y voluntaria respondieron a un cuestionario online sobre prácticas de riesgo y estereotipos de género. Se utilizó el cuestionario BSRI-12 sobre estereotipos de género (masculino, femenino, indiferenciado y andrógino). Se realizó un análisis factorial exploratorio (AFE) del BSRI-12 y regresión logística. Resultados: Se obtuvieron dos factores principales (alfa de Cronbach: 0,95 y 0,81). Utilizando el rol andrógino como categoría de referencia, encontramos menores odds ratios (OR) de realizar penetración anal sin condón (PASC) entre aquellos pertenecientes a roles femeninos (OR: 0,53; intervalo de confianza del 95% [IC95%]: 0,29-0,95). Los roles masculinos con consumo de alcohol (OR: 1,92; IC95%: 1,15-3,20) y los indiferenciados con desconocimiento del estado serológico de la pareja (OR: 1,55; IC95%: 1,02-2,35) se asociaron con mayores OR de PASC en comparación con los roles andróginos. Los indiferenciados realizaron más PASC usando popper (OR: 2,19; IC95%: 1,24-3,87) y PASC insertiva con desconocimiento del estado serológico de la pareja sexual (OR: 1,69; IC95%: 1.04-2.76) en comparación con los andróginos. Conclusión: El BSRI es un instrumento consistente y válido para identificar estereotipos de género en los HSH. Los participantes de las categorías indiferenciado y masculino realizan más prácticas de riesgo bajo la influencia de sustancias y desconociendo el estado serológico de las parejas. La información obtenida es útil para definir programas de intervención y prevención

Assessing gender stereotypes and sexual risk practices in men who have sex with men.

OBJECTIVE: To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM). METHODS: Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed. RESULTS: Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants. CONCLUSION: The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs.

Correlation between diagnosis of depression and symptoms present in primary care patients.

Depression is a chronic disease with a high prevalence that normally is episodic and an average episodic duration of 16 weeks. No analyses that evaluate the correlation between the evolution of the episode and its appearance have been found. The aim of this study is to analyze the correlation between symptomatic progression (appearance, maintenance, remission of different symptoms) and the evolution of the diagnosis of depression (onset, maintenance, and remission) in a cohort of patients diagnosed with and without major depression. A prospective cohort study was performed with a one year follow-up in which a random sample of 741 subjects attending primary care was interviewed. Diagnosis of depression was made according to DSM-IV criteria and symptoms presented were analyzed. These subjects were reevaluated at 6 months and 12 months. Depressed mood state, decreased interest or anhedonia and symptoms related to sleep (insomnia or hypersomnia), agitation, feeling of guilt, fatigue or energy loss, are consistent with the diagnosis. The rest of the symptoms display an evolution independent of the diagnostic trends. In Primary Care, it is important to know which are the key symptoms in the evolution of the diagnosis in order to achieve full remission of depression and avoid maintenance of residual symptoms that can become prodromal.

Correlación entre el diagnóstico de depresión y la sintomatología presentada en pacientes de atención primaria / Correlation between diagnosis of depression and symptoms present in primary care patients

La depresión mayor es una enfermedad crónica con una alta prevalencia que cursa habitualmente de manera episó- dica, con una duración media del episodio de 16 semanas. No se han encontrado análisis que evalúen la concordancia entre la aparición de los mismos y la evolución del episodio. El objetivo de este estudio es analizar la concordancia entre la evolución sintomática (aparición, mantenimiento, remisión de los diversos síntomas) y la evolución del diagnóstico de depresión mayor (aparición, mantenimiento y remisión) en una cohorte de personas con y sin diagnóstico de depresión mayor. Se realizó un estudio de cohortes prospectivo a un año de seguimiento en el que se entrevistó a una muestra aleatoria de 741 sujetos que acudían a consultas de atención primaria, se elaboró el diagnóstico de depresión según criterios del DSM-IV y se analizó la sintomatología que presentaba. Estos sujetos fueron re-evaluados a los 6 meses y 12 meses. El estado de ánimo deprimido, la disminución del interés o anhedonia y los síntomas relacionados con el sueño (insomnio o hipersomnia), la agitación, el sentimiento de culpa y la fatiga o pérdida de energía son concordantes con el diagnóstico. El resto de los síntomas muestran una evolución independiente de la evolución del diagnóstico. En Atención Primaria, es importante conocer qué síntomas son claves en la evolución del diagnóstico con la finalidad de conseguir la remisión total de la depresión y evitar mantenimiento de sintomatología residual que puede dar lugar a pródromos

Depression is a chronic disease with a high prevalence that normally is episodic and an average episodic duration of 16 weeks. No analyses that evaluate the correlation between the evolution of the episode and its appearance have been found. The aim of this study is to analyze the correlation between symptomatic progression (appearance, maintenance, remission of different symptoms) and the evolution of the diagnosis of depression (onset, maintenance, and remission) in a cohort of patients diagnosed with and without major depression. A prospective cohort study was performed with a one year follow-up in which a random sample of 741 subjects attending primary care was interviewed. Diagnosis of depression was made according to DSM-IV criteria and symptoms presented were analyzed. These subjects were reevaluated at 6 months and 12 months. Depressed mood state, decreased interest or anhedonia and symptoms related to sleep (insomnia or hypersomnia), agitation, feeling of guilt, fatigue or energy loss, are consistent with the diagnosis. The rest of the symptoms display an evolution independent of the diagnostic trends. In Primary Care, it is important to know which are the key symptoms in the evolution of the diagnosis in order to achieve full remission of depression and avoid maintenance of residual symptoms that can become prodromal

Pareja, situaciones socioeconómicas y prácticas de riesgo en hombres que tienen sexo con hombres / Type of partner, socio-economic factors and risk practices in men who have sex with men

Objetivo: Los hombres que tienen sexo con hombres (HSH) realizan prácticas de riesgo que desafían las estrategias de prevención. El objetivo del estudio es analizar la asociación entre penetración anal sin condón receptiva o insertiva (PASCR/PASCI) según el tipo de pareja y el barebackcon variables socioeconómicas. Métodos: Estudio descriptivo, mediante encuesta online, difundida en redes sociales y organizaciones no gubernamentales, de junio de 2014 a enero de 2015. Participaron 601 HSH residentes en España. Se aplicaron la prueba de ji al cuadrado de Pearson y regresión logística, valorando laodds ratio (OR) con un intervalo de confianza del 95% (IC95%). Resultados: En las parejas estables, el riesgo de PASCR aumenta en los que tienen ingresos medios (OR: 1,79; IC95%: 1,14-2,80) y conviven en pareja (OR: 2,94; IC95%: 1,74-4,98), y el de PASCI en los que viven en pareja (OR: 5,58; IC95%: 3,24-9,59). Con amigos, el riesgo de PASCR es mayor entre aquellos con estudios secundarios (OR: 2,20; IC95%: 1,44-3,36) y jubilados (OR: 3,6; IC95%: 1,25-10,37), y vivir en pareja es un factor protector (OR: 0,56; IC95%: 0,32-0,98). El riesgo de PASCI con amigos aumenta en aquellos con estudios secundarios (OR: 1,84; IC95%: 1,21-2,81). El riesgo de bareback es mayor en los jóvenes (OR: 2,59; IC95%: 1,27-5,28), en los que tienen estudios secundarios (OR: 1,51; IC95%: 0,99-2,29) y en los que viven en pareja (OR: 3,64; IC95%: 2,12-6,24). Discusión: Es necesario reducir la vulnerabilidad por factores socioeconómicos que determinan las prácticas de riesgo, señalar la importancia del bareback, sobre todo en los jóvenes, e incorporar en la prevención intervenciones en las parejas sexuales y estrategias de reducción de daños (AU)

Objective: Men who have sex with men (MSM) perform risk practices that pose a challenge to prevention strategies. The aim of this study was to analyse the association between receptive and insertive unprotected anal intercourse (RUAI and IUAI) according to the type of partner and the practice of barebacking with socioeconomic factors. Methods: A descriptive study was conducted through a self-administered questionnaire distributed by a software tool in social networks and non-governmental organizations from June-2014 to January-2015. Participants consisted of 601 people living in Spain. Pearson's ÷2 test and logistic regression models were applied with odds ratios (OR) and 95% confidence intervals (95% CI). Results: In stable couples, the risk of RUAI increased in individuals with a medium income (OR: 1.79; 95%CI: 1.14-2.80) and in those who lived together (OR: 2.94; 95%CI: 1.74-4.98) and IUAI increased in individuals living with a partner (OR: 5.58; 95%IC: 3.24-9.59). When the partner was a friend, the risk of RUAI was higher among individuals with secondary education (OR: 2.20; 95%CI: 1.44-3.36) and those who were retired (OR: 3.6; 95%CI: 1.25-10.37), while living with a partner was a protective factor (OR: 0.56; 95%CI: 0.32-0.98). The risk of barebacking was greater in younger men (OR: 2.59; 95%CI: 1.27-5.28), in those with secondary education (OR: 1.51; 95%CI: 0.99-2.29) and in those living with a partner (OR: 3.64; 95%CI: 2.12-6.24). Discussion: There is a need to reduce vulnerability due to socioeconomic factors that influence engagement in risk practices and to highlight the importance of barebacking, mainly in young MSM. Partner-based interventions and harm reduction strategies should be incorporated into preventive strategies (AU)

[Type of partner, socio-economic factors and risk practices in men who have sex with men]. / Pareja, situaciones socioeconómicas y prácticas de riesgo en hombres que tienen sexo con hombres.

OBJECTIVE: Men who have sex with men (MSM) perform risk practices that pose a challenge to prevention strategies. The aim of this study was to analyse the association between receptive and insertive unprotected anal intercourse (RUAI and IUAI) according to the type of partner and the practice of barebacking with socioeconomic factors. METHODS: A descriptive study was conducted through a self-administered questionnaire distributed by a software tool in social networks and non-governmental organizations from June-2014 to January-2015. Participants consisted of 601 people living in Spain. Pearson's χ(2) test and logistic regression models were applied with odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: In stable couples, the risk of RUAI increased in individuals with a medium income (OR: 1.79; 95%CI: 1.14-2.80) and in those who lived together (OR: 2.94; 95%CI: 1.74-4.98) and IUAI increased in individuals living with a partner (OR: 5.58; 95%IC: 3.24-9.59). When the partner was a friend, the risk of RUAI was higher among individuals with secondary education (OR: 2.20; 95%CI: 1.44-3.36) and those who were retired (OR: 3.6; 95%CI: 1.25-10.37), while living with a partner was a protective factor (OR: 0.56; 95%CI: 0.32-0.98). The risk of barebacking was greater in younger men (OR: 2.59; 95%CI: 1.27-5.28), in those with secondary education (OR: 1.51; 95%CI: 0.99-2.29) and in those living with a partner (OR: 3.64; 95%CI: 2.12-6.24). DISCUSSION: There is a need to reduce vulnerability due to socioeconomic factors that influence engagement in risk practices and to highlight the importance of barebacking, mainly in young MSM. Partner-based interventions and harm reduction strategies should be incorporated into preventive strategies.

Cuidados familiares prestados por los ancianos del ámbito rural a distintas generaciones / Family care provided by the elders of a rural area to different generations

Objetivos: Describir el perfil del cuidador mayor del ámbito rural, analizar las diferencias sociodemográficas, de salud, relaciones sociales y necesidades de servicios no cubiertas entre cuidadores familiares y no cuidadores. Metodología: Se encuestaron 787 mayores de 64 años no institucionalizados pertenecientes a una Zona Básica de Salud de Zaragoza. Las variables recogidas mediante el cuestionario OARS-MAFQ (OARS) fueron: sociodemográficas, necesidad de servicios, recursos sociales, económicos y salud física. Otras variables: capacidad funcional para las actividades de la vida diaria, básicas e instrumentales, índice de masa corporal y realización de actividad física. Resultados: Los cuidadores de hijos/nietos fueron independientes para las actividades de la vida diaria, realizaron más actividad física, presentaron buena salud física y así lo percibieron. Los no cuidadores tuvieron mayor dependencia y depresión. Los tres grupos mostraron buenos recursos sociales y económicos, aunque significativamente mejores los cuidadores de hijos/nietos, cuyas necesidades fueron: transporte público y viajar. Los no cuidadores refirieron mayor necesidad de ayuda para bañarse, vestirse, realizar tareas de casa y preparar comidas. Los cuidadores de cónyuges/padres necesitaron más tratamientos por problemas familiares y personales. Todos precisaron cuidados de enfermería. Conclusiones: El perfil, características y necesidades del cuidador y no cuidador fueron diferentes, coincidiendo en la elevada necesidad de cuidados de enfermería

Objectives: To describe the profile of caregivers higher in rural areas, to analyze sociodemographic differences in health and social relations between family caregivers and non-caregivers, and service needs unmet. Methodology: We surveyed 787 people over 64 noninstitutionalized belonging to the Basic Health Area of Zaragoza. Variables were collected through the questionnaire OARS-MAFQ (OARS): sociodemographic, need for services, assessment of social, economic and physical health. Other variables were: functional capacity for activities of daily living, basic and instrumental, body mass index and physical activity undertaken. Results: All caregivers of children/grandchildren were independent for activities of daily living, performed more physically active, had good physical and so perceived. Noncaregivers had the highest proportion of dependence and depression. The three groups had good social and economic resources, although significantly higher in those who care for children/grandchildren in which needs were perceived as more public transport and travel more. Non-caregivers reported more need for help with bathing, dressing, household chores and meal preparation. Caregivers of spouses/parents needed more treatment to personal or family problems. There was a great need for nursing care in the three groups. Conclusions: The profile, characteristics and needs of caregiver and no-caregiver were different, coinciding only in high need for nursing care

Prevalencia, factores predictivos y registro en la historia clínica de la consulta sobre incontinencia urinaria en mujeres gestantes riojanas / Prevalence, predictor factors and clinical record documentation on urinary incontinence in pregnant women of La Rioja

OBJETIVOS: Conocer el porcentaje de gestantes con incontinencia urinaria (IU) que consultan su problema con un profesional sanitario, analizar los factores que se asocian a la consulta y evaluar el porcentaje de registro de la IU en la historia obstétrica. METODOLOGÍA: Se trata de un estudio descriptivo transversal, realizado en la consulta de Obstetricia del Hospital San Pedro de Logroño. Participaron en él gestantes con un control prenatal realizado en el Servicio Riojano de Salud. Para la identificación de la IU se utilizó el Urogenital Distress Inventory. Los datos se obtuvieron mediante una entrevista personal y los datos de registro con la revisión de la historia clínica obstétrica y electrónica. RESULTADOS: En el análisis se incluyeron 274 gestantes con IU. Sólo en 6 casos (2,2%) se registró la IU en la historia obstétrica, y en la historia clínica electrónica en ninguno. Consultaron su problema de IU con un sanitario35 mujeres (12,8%), 31 de ellas (88,6%) por iniciativa propia. El análisis multivariante muestra que la probabilidad de consultar es mayor en mujeres con IU moderada (odds ratio [OR] 4,31; intervalo de confianza [IC] del 95%: 1,37-13,58) y severa (OR 5,93; IC del 95%: 1,25-28,11), con una renta mensual más elevada (OR 2,90; IC del 95%: 1,27- 6,63) y una peor calidad de vida (OR: 1,02; IC del 95%: 1,00-1,40). CONCLUSIONES: Los resultados de este estudio dejaron patente que pocas gestantes consultaron sobre IU. Raramente se documentó el estado de continencia urinaria de las mujeres, por lo que no se consiguió obtener en la consulta resultados sobre posibles factores asociados. Es importante que los profesionales que atienden la salud de la gestante les pregunten sobre la IC y se registre en la historia clínica, para facilitar que la mujer consulte y hacer visible el problema

OBJECTIVES: To know the percentage of pregnant women with urinary incontinence (UI) that consult with health professionals, to analyze the factors that are associated with the consultation and to evaluate the percentage of episodes of female urinary incontinence are registered in the clinical record. METHOD: DESIGN: cross-sectional study. Site: Obstetric consult of Hospital San Pedro in Logroño. PARTICIPANTS: pregnant women with prenatal control in Health Service of La Rioja. To identify the UI is been use the Urogenital Distress Inventory-short form questionnaire. Measures: the data about the consult have been obtained by personal interview and the registration data have been obtained by a review of both obstetrics and electronic clinical record. RESULTS: 274 pregnant women with urinary incontinence were included in the analysis. Only 6 of them (2.2%) were registered in the clinical record and none in the electronic clinical record. A 12.8% of pregnant women consult their problem with a health professional, the 88.6% among them by self-initiative. The multivariate analysis shows that the probability of having consult is higher between women with moderate UI, OR: 4.31 (1.37-13.58) and severe, OR: 5.93 (1.25-28.11) with higher incomes, OR: 2.90 (1.27-6.63)and worse quality of life, OR: 1.02 (1.00-1.40). CONCLUSION: The results of this study made clear that few pregnant women asked about UI. A condition of UI was rarely documented in women, for which reason the study was unable to gather results in terms of possible associated factors. It is important for the professionals attending to pregnant women's health to ask them about UI and record it in their clinical history, to make it easier for women to ask about the problem and make it visible

Factors associated with treatment-seeking behavior for postpartum urinary incontinence.

PURPOSE: To identify the factors associated with treatment-seeking behavior for urinary incontinence (UI) among postpartum women. DESIGN: This is a cross-sectional study. A total of 142 women with postpartum UI responded a telephone interview between August of 2010 and March of 2011. The association between the treatment-seeking and the predicting variables were measured through odds ratio and 95% confidence interval. RESULTS: The treatment-seeking percentage was 37.3% and the treatment percentage was 27.5%. The result of multiple logistic regressions indicated that: counseling about UI in pregnancy, postpartum physical exercise, and Spanish nationality predicted 47.8% of the variance in treatment-seeking behavior CONCLUSIONS: The lack of counseling largely determines the low rates of treatment-seeking among Spanish mothers. CLINICAL RELEVANCE: Nursing counseling during pregnancy can contribute substantially to increasing the number of women treated for postpartum UI.

Incontinencia urinaria a los 6 meses del parto / Urinary incontinence 6 months after childbirth

Fundamento y objetivo: La incontinencia urinaria iniciada antes y justo después del parto y que persiste tras 3 meses de posparto tiende a cronificarse. El objetivo de este estudio fue estimar la persistencia de incontinencia urinaria a los 6 meses del parto y analizar los factores que se asocian con ella. Pacientes y método: Estudio de seguimiento tras 6 meses posparto de mujeres que inician síntomas de incontinencia en gestación o 2 primeros meses de posparto. La variable dependiente fue la persistencia y las independientes se agruparon en obstétricas y no obstétricas. En el análisis bivariante se calcularon las odds ratio (OR) con sus intervalos de confianza del 95% (IC 95%). Con las variables que mostraron riesgo importante de persistencia de incontinencia se realizó un modelo de regresión logística multivariante. Resultados: La persistencia de incontinencia urinaria tras 6 meses posparto fue del 21,4% (IC 95% 16-26,7). El riesgo de persistencia aumentó con maniobra de Kristeller (OR 7,89, IC 95% 3,04-20,49), no recuperación de peso (OR 3,64, IC 95% 1,10-12,02), no realización de ejercicios musculares del suelo pélvico en posparto (OR 9,36, IC 95% 2,71-32,33), aparición de incontinencia tras el parto (OR 6,66, IC 95% 2,37-18,68) y peso del recién nacido > 3,5 kg (OR 6,76, IC 95% 2,54-18,03), que explican el 58% de la variabilidad de la persistencia. Conclusión: Un 21,4% de mujeres con incontinencia urinaria causada por embarazo/parto seguirán padeciéndola pasados 6 meses del alumbramiento. Parte importante de esta persistencia se asocia a factores fácilmente modificables (AU)

Background and objective: Urinary incontinence initiated before and right after delivery and persisting 3 months after delivery tends to become chronic. We intended to estimate the persistence of urinary incontinence 6 months postpartum and to analyse the different factors associated with it. Patients and methods: Follow-up study 6 months after delivery of women presenting urinary incontinence symptoms in gestation or in the first 2 months of postpartum. The dependent variable was the persistence and the independent variables were grouped in obstetric and non-obstetric. Odds ratio (OR) were calculated with their confidence interval at 95% (IC 95%) in the bivariate analysis. The variables that showed an important risk of persistence of incontinence were used to perform a multivariate model of logistic regression. Results: The persistence of incontinence 6 months after delivery was 21.4% (CI 95% 16-26.7). The risk of persistence increased with the Kristeller maneuver (OR 7.89, CI 95% 3.04-20.49), not weight recovery (OR 3.64, CI 95% 1.10-12.02), not practising pelvic floor muscle exercises in postpartum (OR 9.36, CI 95% 2.71-32.33), appearance of incontinence after delivery (OR 6.66, CI 95% 2.37-18.68) and the weight of the newborn > 3.5 kg (OR 6.76, CI 95% 2.54-18.03), all of them explaining 58% of the variability of persistence. Conclusion: 21.4% of women with urinary incontinence caused by pregnancy/delivery will continue to have it 6 months postpartum. An important part of this persistence is associated with some factors easy to modify (AU)

Urinary incontinence and weight changes during pregnancy and post partum: a pending challenge.

OBJECTIVE: to analyse the association between urinary incontinence and maternal weight, and its variations in pregnancy and post partum. DESIGN: observational study of a cohort of women from the start of pregnancy until six months post partum. SETTING: Hospital San Pedro in La Rioja, Spain. PARTICIPANTS: 402 pregnant women without urinary incontinence at the start of pregnancy. MEASUREMENTS AND FINDINGS: the dependent variable was urinary incontinence, assessed using the Urogenital Distress Inventory-Short Form questionnaire. The main independent variables were body mass index (BMI) at the first antenatal visit and six months post partum, weight gain during pregnancy, postpartum weight loss, and weight retained from the start of pregnancy to six months post partum. The association between urinary incontinence and the main independent variables was measured using Student's t-test. Three simple logistic regression models were used to assess the strength of this association, one for each of the independent variables that showed a significant association with urinary incontinence (p<0.05), and three multiple regression models that included the possible variable effect modifiers were also used. At the start of pregnancy, 20.1% of the women were overweight and 8.7% were obese. Six months post partum, 30.3% of the women were overweight and 11.4% were obese. The mean (±standard deviation) retained weight was 2 (±3.1) kg. Postpartum urinary incontinence was associated with BMI at six months post partum, postpartum weight loss and retained weight at six months post partum (p<0.05). The association of urinary incontinence with these variables was significant, and remained stable in both simple and multiple regression analyses with BMI at six months post partum [odds ratio (OR) 1.09 versus 1.08], weight loss from delivery to six months post partum (OR 0.88 versus 0.88), and retained weight from the beginning of pregnancy until six months post partum (OR 1.23 versus 1.19). KEY CONCLUSIONS: high BMI and weight retention at six months post partum increase the risk of urinary incontinence, whereas postpartum weight loss decreases the risk of urinary incontinence, even if other urinary incontinence risk factors co-exist. IMPLICATIONS FOR PRACTICE: primary care midwifes can make a major contribution towards the prevention and rehabilitation of urinary incontinence in women. It is important for the midwife and the woman to keep in contact in the first six months post partum. Individualised advice about eating and exercise habits to avoid weight retention after pregnancy may have a considerable impact on decreasing the risk of urinary incontinence.

[Urinary incontinence 6 months after childbirth]. / Incontinencia urinaria a los 6 meses del parto.

BACKGROUND AND OBJECTIVE: Urinary incontinence initiated before and right after delivery and persisting 3 months after delivery tends to become chronic. We intended to estimate the persistence of urinary incontinence 6 months postpartum and to analyse the different factors associated with it. PATIENTS AND METHODS: Follow-up study 6 months after delivery of women presenting urinary incontinence symptoms in gestation or in the first 2 months of postpartum. The dependent variable was the persistence and the independent variables were grouped in obstetric and non-obstetric. Odds ratio (OR) were calculated with their confidence interval at 95% (IC 95%) in the bivariate analysis. The variables that showed an important risk of persistence of incontinence were used to perform a multivariate model of logistic regression. RESULTS: The persistence of incontinence 6 months after delivery was 21.4% (CI 95% 16-26.7). The risk of persistence increased with the Kristeller maneuver (OR 7.89, CI 95% 3.04-20.49), not weight recovery (OR 3.64, CI 95% 1.10-12.02), not practising pelvic floor muscle exercises in postpartum (OR 9.36, CI 95% 2.71-32.33), appearance of incontinence after delivery (OR 6.66, CI 95% 2.37-18.68) and the weight of the newborn>3.5 kg (OR 6.76, CI 95% 2.54-18.03), all of them explaining 58% of the variability of persistence. CONCLUSION: 21.4% of women with urinary incontinence caused by pregnancy/delivery will continue to have it 6 months postpartum. An important part of this persistence is associated with some factors easy to modify.

Mental health and social relations in older rural population.

OBJECTIVES: To describe and analyze the influence of social relations in the elderly in the rural setting with depression. DESIGN: A cross-sectional study. SAMPLE: Patients (N=787) over 64 years, non-institutionalized who belong to the Basic Health Zone Substations (Zaragoza), a representative rural area of Aragon. The following variables were evaluated: diagnosis of depression, comorbidity, taking antidepressants, sociodemographic variables and use of social resources (OARS questionnaire), instrumental activities of daily living (Lawton-Brody test) and basics daily living activities (Barthel test). RESULTS: According to multivariate analysis, the risk of suffering depression is higher in women (OR=5.6 CI=3.0- 10.5), patients with comorbidity (OR=12.2 CI=5.1-29.2), people who speak by phone with other at least 5 times a week (OR=3.1 CI=1.7-5.5), who have no one to confide in (OR=3.9 CI=1.8-8.5), sometimes feeling alone (OR=2.7 CI=1.0-4.8), they do not see their family as much as they want to (OR=2.1 CI=1.3-4.4) and who are dependent on others for daily living activities (OR= 2.6 CI=1.5-4.6). CONCLUSIONS: These results confirm the findings in other studies and provide clues to guide interventions aimed at improving the quality of life of the elderly.

Salud mental y relaciones sociales en población mayor rural / Mental health and social relations in older rural population

Objetivos. Describir y analizar la influencia de las relaciones sociales en la depresión en personas mayores. Métodos. Diseño: Estudio transversal. Muestra: Mayores de 64 años (N=787), incluidos en la Zona Básica de Salud de Casetas (Zaragoza), un entorno rural representativo de Aragón. Variables evaluadas: Diagnóstico de depresión, consumo de antidepresivos, variables sociodemográficas y de recursos sociales (cuestionario OARS), así como actividades de la vida diaria instrumentales (test de Lawton-Brody) y básicas (test de Barthel). Resultados. En el análisis multivariante el riesgo de padecer depresión es mayor entre las mujeres (OR=5,6 IC=3,0-10,5), los que presentan comorbilidad (OR=12,2 IC=5,1-29,2), hablan por teléfono con otras personas 5 o más veces/semana (OR=3,1 IC=1,7-5,5) no tienen a nadie en quien confiar (OR=3,9 IC=1,8-8,5), alguna vez se encuentran solos(OR=2,7 IC=1,0-4,8) no ve a su familia/amigos tanto como le gustaría (OR=2,1 IC=1,3-4,4) y es dependiente para las actividades de la vida diaria (OR=2,6 IC=1,5-4,6).Conclusiones. Estos resultados confirman los hallazgos obtenidos en otros estudios y proporcionan claves para orientar las intervenciones dirigidas a mejorar la calidad de vida de los mayores (AU)

Objectives. To describe and analyze the influence of social relations in the elderly in the rural setting with depression. Methods. Design: A cross-sectional study. Sample: Patients (N=787) over 64 years, non-institutionalized who belong to the Basic Health Zone Substations (Zaragoza), a representative rural area of Aragon. The following variables were evaluated: diagnosis of depression, comorbidity, taking antidepressants, sociodemographic variables and use of social resources (OARS questionnaire), instrumental activities of daily living (Lawton-Brody test) and basics daily living activities (Barthel test).Results. According to multivariate analysis, the risk of suffering depression is higher in women (OR=5.6 CI=3.0-10.5), patients with comorbidity (OR=12.2 CI=5.1-29.2),people who speak by phone with other at least 5 times aweek (OR=3.1 CI=1.7-5.5), who have no one to confide in(OR=3.9 CI=1.8-8.5), sometimes feeling alone (OR=2.7CI=1.0-4.8), they do not see their family as much as they want to (OR=2.1 CI=1.3-4.4) and who are dependent on others for daily living activities (OR= 2.6 CI=1.5-4.6). Conclusions. These results confirm the findings in other studies and provide clues to guide interventions aimed at improving the quality of life of the elderly (AU)

Actitudes de los españoles frente a los espacios libres de humo de tabaco / Spanish opinions on tobacco smoke-free areas

Objetivo: Conocer las cifras de fumadores pasivos, los lugares donde con más frecuencia se produce la exposición al humo de tabaco (HT), la opinión de fumadores y no fumadores sobre estos espacios y la influencia que pueden ejercer sobre el tabaquismo. Diseño: Estudio observacional descriptivo y transversal de una muestra de conveniencia. Emplazamiento: Multicéntrico, centros de salud (CS) españoles. Participantes: 9.733 mayores de 16 años usuarios y trabajadores de los CS que en abril de 2008 acudieron a dichos centros. Mediciones principales: Condición de fumador, sexo, profesión y opinión que les merece la exposición al HT. Resultados: Se consideran fumadores pasivos en lugares públicos el 42,4% de los encuestados y en lugares cerrados el 96,8%. El 91,8% consideran que el HT es perjudicial para los no fumadores, el 70,3% que los espacios libres de humos de tabaco (ELHT) son buenos para no empezar a fumar y el 71,8% para dejar de fumar. El 81,1% prefieren ELHT. Están más expuestos al HT en el coche (79,8%) y cafeterías (34,7%). Son los no fumadores, tanto hombres como mujeres, los que significativamente comparten estas opiniones (p<0,05). Conclusiones: En conjunto, los encuestados se consideran fumadores pasivos, piensan que los espacios sin humo disminuyen la incidencia de tabaquismo, favorecen que se deje de fumar y además, los prefiere para vivir. Esto hace recapacitar sobre la necesidad de instar a los gobiernos a establecer medidas legislativas que promuevan ELHT, dadas las preferencias de la mayor parte de la población(AU)

Objective: To determine the number of passive smokers, the environments where exposure to second-hand smoke (SHS) is higher, the opinion of smokers and non-smokers with regard to these spaces and their influence on smoking. Design: Descriptive and cross-sectional observational study of a convenience sample. Location: Multi-centre, Spanish Health-care Centres. Participants: A total of 9733 people older than 16 years who were seen or were working in Spanish Health-care Centres in April 2008. Main measurements: Smoker condition, gender, profession and their opinion with regard to second-hand smoke (SHS) exposure. Results: A total of 42.4% of participants considered themselves second-hand (passive) smokers in public places and 96.8% in indoor areas. Almost all of them (91.8%) considered SHS exposure harmful for non-smokers, Smoke-free environments were considered to be good for discouraging people from starting to smoke (70.3%), and for quitting smoking (71.8%). Smoke-free environments were preferred by 81.1%. They felt more exposed SHS inside a car (79.8%) and in cafes (34.7%). Non-smokers, both men and women, shared these opinions significantly (P<.05). Conclusions: Altogether, those surveyed considered themselves as second-hand smokers and think that smoke-free environments reduce the impact of smoking and help in quitting smoking. Besides, they prefer living in those environments. Considering the preferences of most of the population, this stresses the need to urge governments to establish legislative measures promoting smoke-free environments(AU)

[Spanish opinions on tobacco smoke-free areas]. / Actitudes de los españoles frente a los espacios libres de humo de tabaco.

OBJECTIVE: To determine the number of passive smokers, the environments where exposure to second-hand smoke (SHS) is higher, the opinion of smokers and non-smokers with regard to these spaces and their influence on smoking. DESIGN: Descriptive and cross-sectional observational study of a convenience sample. LOCATION: Multi-centre, Spanish Health-care Centres. PARTICIPANTS: A total of 9733 people older than 16 years who were seen or were working in Spanish Health-care Centres in April 2008. MAIN MEASUREMENTS: Smoker condition, gender, profession and their opinion with regard to second-hand smoke (SHS) exposure. RESULTS: A total of 42.4% of participants considered themselves second-hand (passive) smokers in public places and 96.8% in indoor areas. Almost all of them (91.8%) considered SHS exposure harmful for non-smokers, Smoke-free environments were considered to be good for discouraging people from starting to smoke (70.3%), and for quitting smoking (71.8%). Smoke-free environments were preferred by 81.1%. They felt more exposed SHS inside a car (79.8%) and in cafes (34.7%). Non-smokers, both men and women, shared these opinions significantly (P<.05). CONCLUSIONS: Altogether, those surveyed considered themselves as second-hand smokers and think that smoke-free environments reduce the impact of smoking and help in quitting smoking. Besides, they prefer living in those environments. Considering the preferences of most of the population, this stresses the need to urge governments to establish legislative measures promoting smoke-free environments.

Validación de la versión española de las formas cortas del Urogenital Distress Inventory (UDI-6) y del Incontinence Impact Questionnaire (IIQ-7) en mujeres embarazadas / Validation of the Spanish version of the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) in pregnant women

Objetivo Validar dos instrumentos de medida, el UDI-6 y el IIQ-7, para el estudio de la incontinencia urinaria y de su repercusión en la calidad de vida de las mujeres gestantes. Métodos Estudio de validación de un instrumento diagnóstico. Autocumplimentaron los cuestionarios UDI-6 e IIQ-7 181 mujeres embarazadas. Se analizaron la factibilidad, la consistencia interna, la fiabilidad y la validez de constructo y de criterio. Resultados La autocumplimentación del UDI-6 y del IIQ-7 llevo menos de 5 minutos y la tasa máxima de no respuesta por ítem fue del 3,3%. El coeficiente alfa de Cronbach del UDI-6 fue 0,667 y el del IIQ-7 de 0,910. La fiabilidad del UDI-6 para el diagnóstico de incontinencia urinaria presentó valores en el índice Kappa entre 0,856 y 0,966, y la fiabilidad de las puntuaciones del UDI-6 e IIQ-7 mostró valores en el de correlación intraclase de 0,902 y 0,954, respectivamente. Los valores medios del UDI-6 y el IIQ-7 fueron más altos en las mujeres con incontinencia mixta, más bajos en la incontinencia de esfuerzo y aumentaron con las pérdidas diarias (p<0,01). La correlación entre los cuestionarios UDI-6 e ICIQ-SF (coeficiente de correlación intraclase [CCI]=0,497; intervalo de confianza del 95% [IC95%]: 0,326-0,625) y entre los cuestionarios IIQ-7 e ICIQ-SF (CCI=0,472; IC95%: 0,268- 0,619) resultó mediocre. La sensibilidad y la especificidad del UDI-6 para el diagnóstico de incontinencia urinaria fueron del 98,9% y el 86,7%, respectivamente. Conclusiones Las versiones españolas del IIQ-7 y del UDI-6 son instrumentos factibles, fiables, consistentes y válidos para medir los síntomas y la calidad de vida en las mujeres gestantes españolas con incontinencia urinaria (AU)

Objective To validate two measurement instruments, the UDI-6 and the IIQ-7, for the study of urinary incontinence and its impact on the quality of life of pregnant women. Methods We carried out a validation study of a diagnostic tool. A total of 181 pregnant women completed the UDI-6 and IIQ-7 questionnaires. Feasibility, internal consistency, reliability, and construct and criteria validity were analyzed. Results Self-administration of the short forms of the UDI-6 and IIQ-7 questionnaires took less than 5minutes and the maximum rate of no answer per item was 3.3%. Cronbach's alpha was 0.667 for the UDI-6 and was 0.910 for the IIQ-7. The reliability of the UDI-6 in the diagnosis of urinary incontinence showed Kappa statistic values of between 0.856 and 0.966, and the intra-class correlation coefficients of the UDI-6 and IIQ-7 were 0.902 and 0.954, respectively. Average values of the UDI-6 and IIQ-7 were higher in women with mixed incontinence, were lower in women with stress incontinence and increased with daily losses (p<0.01). The correlation between the UDI-6 and the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) (CCI=0.497; 95% CI: 0.326-0.625) and between the IIQ-7 and ICIQ-SF (CCI=0.472; 95% CI: 0.268-0.619) was moderate. The sensitivity and specificity of the UDI-6 for the diagnosis of urinary incontinence was 98.9% and 86.5%, respectively. Conclusions The Spanish versions of the IIQ-7 and UDI-6 are feasible, reliable, consistent and valid in the measurement of symptoms and quality of life in pregnant Spanish women with urinary incontinence(AU)

[Validation of the Spanish version of the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) in pregnant women]. / Validación de la versión española de las formas cortas del Urogenital Distress Inventory (UDI-6) y del Incontinence Impact Questionnaire (IIQ-7) en mujeres embarazadas.

OBJECTIVE: To validate two measurement instruments, the UDI-6 and the IIQ-7, for the study of urinary incontinence and its impact on the quality of life of pregnant women. METHODS: We carried out a validation study of a diagnostic tool. A total of 181 pregnant women completed the UDI-6 and IIQ-7 questionnaires. Feasibility, internal consistency, reliability, and construct and criteria validity were analyzed. RESULTS: Self-administration of the short forms of the UDI-6 and IIQ-7 questionnaires took less than 5minutes and the maximum rate of no answer per item was 3.3%. Cronbach's alpha was 0.667 for the UDI-6 and was 0.910 for the IIQ-7. The reliability of the UDI-6 in the diagnosis of urinary incontinence showed Kappa statistic values of between 0.856 and 0.966, and the intra-class correlation coefficients of the UDI-6 and IIQ-7 were 0.902 and 0.954, respectively. Average values of the UDI-6 and IIQ-7 were higher in women with mixed incontinence, were lower in women with stress incontinence and increased with daily losses (p<0.01). The correlation between the UDI-6 and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) (CCI=0.497; 95% CI: 0.326-0.625) and between the IIQ-7 and ICIQ-SF (CCI=0.472; 95% CI: 0.268-0.619) was moderate. The sensitivity and specificity of the UDI-6 for the diagnosis of urinary incontinence was 98.9% and 86.5%, respectively. CONCLUSIONS: The Spanish versions of the IIQ-7 and UDI-6 are feasible, reliable, consistent and valid in the measurement of symptoms and quality of life in pregnant Spanish women with urinary incontinence.

Enfermedades crónicas y deterioro funcional para las actividades de la vida diaria en población mayor no institucionalizada / Chronic diseases and functional deterioration in activities of daily living in community-dwelling elders

ObjetivoAnalizar la influencia de las enfermedades crónicas en el desempeño funcional de las actividades de la vida diaria, tanto básicas (ABVD) como instrumentales (AIVD), en población mayor socialmente activa.MétodoEstudio transversal de 380 individuos mayores de 64 años que acuden con regularidad a centros de convivencia de Zaragoza capital. Se cumplimentó por entrevista personal el cuestionario OARS, valorándose mediante un modelo multivariante de regresión logística, de forma diferenciada, la capacidad funcional para las ABVD y las AIVD como variables dependientes y las variables sociodemográficas y enfermedades crónicas como predictivas.ResultadosEl riesgo de presentar dependencia para las ABVD aumenta significativamente en presencia de alteraciones mentales leves (odds ratio [OR] = 4,02; intervalo de confianza [IC] del 95%: de 1,81 a 8,95), graves (OR = 10,61; IC del 95%: de 4,68 a 24,05), enfermedad cardíaca (OR = 2,79; IC del 95%: de 1,32 a 5,91), reumatismo/artrosis (OR = 2,75; IC del 95%: de 1,42 a 5,33) y tener 75 o más años (OR = 2,70; IC del 95%: de 1,42 a 5,13). Para las AIVD, alteraciones mentales leves (OR = 2,11; IC del 95%: de 1,10 a 4,04), graves (OR = 4,50; IC del 95%: de 2,27 a 8,90), tener 75 o más años (OR = 3,06; IC del 95%: de 1,78 a 5,25) y enfermedad cardíaca (OR = 2,64; IC del 95%: de 1,35 a 5,16).ConclusiónEl nivel de independencia es mayor para las ABVD que para las AIVD. La patología mental es la que se más relaciona con elevados niveles de dependencia, seguida de la cardíaca y de reumatismo/artrosis. El deterioro para el desempeño de las AIVD debería considerarse para una valoración temprana de la dependencia, al ser el primero en aparecer y condicionar de modo fundamental el manejo independiente de los mayores(AU9

ObjectiveTo analyze the influence of chronic medical conditions on functional performance of activities of daily living, both basic (BADL) and instrumental (IADL), among the socially-active older population.MethodsWe performed a cross-sectional study of 380 individuals aged over 64 years old who regularly attended community centers in the city of Zaragoza. The Older Americans Resources and Services (OARS) questionnaire was completed in a personal interview. A multivariate logistic regression model was used to analyze functional capacities for BADL and IADL as dependent variables, and socio-demographic variables and chronic medical conditions as predictive variables.ResultsThe risk of showing dependence for BADL significantly increased in the presence of mild and severe mental illness (OR=4.02; 95% CI=1.81–8.95; and OR=10.61; 95% CI=4.68–24.05, respectively), heart disease (OR=2.79; 95%CI=1.32–5.91), rheumatism/osteoarthritis (OR=2.75; 95% CI=1.42–5.33) and age 75 years or older (OR=2.70; 95% CI=1.42–5.13). For IADL, these risks increased with mild and severe mental illness (OR=2.11; 95% CI=1.10–4.04; and OR=4.50; 95% CI=2.27–8.90, respectively), age 75 years or older (OR=3.06; 95% CI=1.78–5.25) and heart disease (OR=2.64; 95% CI=1.35–5.16).ConclusionThere was greater level of independence for BADL than for IADL. The factor creating most dependence was mental illness, followed by heart disease and rheumatism/osteoarthritis. A declining ability to perform IADL should prompt early assessment of dependence, as it is the first sign to appear. Prevention is fundamental for independent functioning in older people(AU)

Enfermedades crónicas y deterioro funcional para las actividades de la vida diaria en población mayor no institucionalizada / Chronic diseases and functional deterioration in activities of daily living in community-dwelling elders

ObjetivoAnalizar la influencia de las enfermedades crónicas en el desempeño funcional de las actividades de la vida diaria, tanto básicas (ABVD) como instrumentales (AIVD), en población mayor socialmente activa.MétodoEstudio transversal de 380 individuos mayores de 64 años que acuden con regularidad a centros de convivencia de Zaragoza capital. Se cumplimentó por entrevista personal el cuestionario OARS, valorándose mediante un modelo multivariante de regresión logística, de forma diferenciada, la capacidad funcional para las ABVD y las AIVD como variables dependientes y las variables sociodemográficas y enfermedades crónicas como predictivas.ResultadosEl riesgo de presentar dependencia para las ABVD aumenta significativamente en presencia de alteraciones mentales leves (odds ratio [OR] = 4,02; intervalo de confianza [IC] del 95%: de 1,81 a 8,95), graves (OR = 10,61; IC del 95%: de 4,68 a 24,05), enfermedad cardíaca (OR = 2,79; IC del 95%: de 1,32 a 5,91), reumatismo/artrosis (OR = 2,75; IC del 95%: de 1,42 a 5,33) y tener 75 o más años (OR = 2,70; IC del 95%: de 1,42 a 5,13). Para las AIVD, alteraciones mentales leves (OR = 2,11; IC del 95%: de 1,10 a 4,04), graves (OR = 4,50; IC del 95%: de 2,27 a 8,90), tener 75 o más años (OR = 3,06; IC del 95%: de 1,78 a 5,25) y enfermedad cardíaca (OR = 2,64; IC del 95%: de 1,35 a 5,16).ConclusiónEl nivel de independencia es mayor para las ABVD que para las AIVD. La patología mental es la que se más relaciona con elevados niveles de dependencia, seguida de la cardíaca y de reumatismo/artrosis. El deterioro para el desempeño de las AIVD debería considerarse para una valoración temprana de la dependencia, al ser el primero en aparecer y condicionar de modo fundamental el manejo independiente de los mayores(AU)

ObjectiveTo analyze the influence of chronic medical conditions on functional performance of activities of daily living, both basic (BADL) and instrumental (IADL), among the socially-active older population.MethodsWe performed a cross-sectional study of 380 individuals aged over 64 years old who regularly attended community centers in the city of Zaragoza. The Older Americans Resources and Services (OARS) questionnaire was completed in a personal interview. A multivariate logistic regression model was used to analyze functional capacities for BADL and IADL as dependent variables, and socio-demographic variables and chronic medical conditions as predictive variables.ResultsThe risk of showing dependence for BADL significantly increased in the presence of mild and severe mental illness (OR=4.02; 95% CI=1.81–8.95; and OR=10.61; 95% CI=4.68–24.05, respectively), heart disease (OR=2.79; 95%CI=1.32–5.91), rheumatism/osteoarthritis (OR=2.75; 95% CI=1.42–5.33) and age 75 years or older (OR=2.70; 95% CI=1.42–5.13). For IADL, these risks increased with mild and severe mental illness (OR=2.11; 95% CI=1.10–4.04; and OR=4.50; 95% CI=2.27–8.90, respectively), age 75 years or older (OR=3.06; 95% CI=1.78–5.25) and heart disease (OR=2.64; 95% CI=1.35–5.16).ConclusionThere was greater level of independence for BADL than for IADL. The factor creating most dependence was mental illness, followed by heart disease and rheumatism/osteoarthritis. A declining ability to perform IADL should prompt early assessment of dependence, as it is the first sign to appear. Prevention is fundamental for independent functioning in older people(AU)