Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members.

Search and rescue teams and Antarctic research groups use protective cold-water anti-exposure suits (AES) when cruising on Zodiacs. Extremity tourniquet (ET) self-application (SA) donned with AESs has not been previously studied. Our study therefore assessed the SA of 5 commercial ETs (CAT, OMNA, RATS, RMT, and SWAT-T) among 15 volunteers who donned these suits. Tourniquet's SA ability, ease of SA, tolerance, and tourniquet preference were measured. All ETs tested were self-applied to the upper extremity except for the SWAT, which was self-applied with the rest to the lower extremity. Ease- of- SA mean values were compared using the Friedman and Durbin-Conover post hoc tests (P < 0.001). Regarding the upper extremity, OMNA achieved the highest score of 8.5 out of 10, while RMT, and SWAT received lower scores than other options (P < 0.001). For lower extremities, SWAT was found to be inferior to other options (P < 0.01). Overall, OMNA was the best performer. The RATS showed significantly lower tolerance than the other groups in repeated- measures ANOVA with a Tukey post hoc test (P < 0.01). Additionally, out of the 5 ETs tested, 60% of subjects preferred OMNA. The study concluded that SA commercial ETs are feasible over cold-water anti-exposure suits in the Antarctic climate.

Tourniquet self-application assessment in cold weather conditions.

BACKGROUND: Our study aimed to assess the ability of nonmedical civilians to self-apply extremity tourniquets in cold weather conditions while wearing insulating technical clothing after receiving basic training. METHODS: A field study was conducted among 37 voluntary participants of an expedition party to the Spanish Antarctic base. The researchers assessed the participant's ability to self-apply five commercial extremity tourniquets (CAT, OMNA, RMT, SWAT-T, and RATS) over cold-weather clothing and their achieved effectiveness for vascular occlusion. Upper extremity self-application was performed with a single-handed technique (OHT), and lower extremity applying a two-handed technique (THT). Perceptions of self-application ease mean values ± standard deviation (SD) were compared by applying a 5% statistical significance threshold. Frequency count determined tourniquet preference. RESULTS: All the tested ETs, except the SWAT-T, were properly self-applied with an OHT, resulting in effective vascular occlusion in the upper extremity. The five devices tested were self-applied correctly in the lower extremities using THT. The ratcheting marine-designed OMNA ranked the highest for application easiness on both the upper and lower extremities, and the windlass CAT model was the preferred device by most participants. CONCLUSIONS: Civilian extremity tourniquet self-application on both upper and lower extremities can be accomplished in cold weather conditions despite using cold-weather gloves and technical clothing after receiving brief training. The ratcheting marine-designed OMNA ranked the highest for application ease, and the windlass CAT model was the preferred device.

Extremity Tourniquet Training at High Seas.

BACKGROUND: Future navy officers require unique training for emergency medical response in the isolated maritime environment. The authors issued a workshop on extremity bleeding control, using four different commercial extremity tourniquets onboard a training sail ship. The purposes were to assess participants' perceptions of this educational experience and evaluate self-application simplicity while navigating on high seas. METHODS: A descriptive observational study was conducted as part of a workshop issued to volunteer training officers. A post-workshop survey collected their perceptions about the workshops' content usefulness and adequacy, tourniquet safety, self-application simplicity, and device preference. Tourniquet preference was measured by frequency count while the rest of the studied variables on a one-to-ten Likert scale. Frequencies and percentages were calculated for the studied variables, and application simplicity means compared using the ANOVA test (p < 0.05). RESULTS: Fifty-one Spanish training naval officers, aged 20 or 21, perceived high sea workshop content's usefulness, adequacy, and safety level at 8.6/10, 8.7/10, and 7.5/10, respectively. As for application simplicity, CAT and SAM-XT were rated equally with a mean of 8.5, followed by SWAT (7.9) and RATS (6.9), this one statistically different from the rest (p < 0.01). Windlass types were preferred by 94%. CONCLUSIONS: The training sail ship's extremity bleeding control workshop was perceived as useful and its content adequate by the participating midshipmen. Windlass types were regarded as easier to apply than elastic counterparts. They were also preferred by nine out of every ten participants.

Efectividad del tratamiento ambulatorio con hierro intravenoso en pacientes seleccionados de atención primaria / Effectiveness of outpatient treatment with intravenous iron in selected primary Care patients

No disponible

Influencia del sexo, la edad y la altitud de residencia en los niveles de hemoglobina y la prevalencia de anemia / Influence of gender, age and residence altitude on haemoglobin levels and the prevalence of anaemia

Introducción: Existen lagunas respecto a los niveles normativos de hemoglobina y la prevalencia de anemia en nuestro entorno y en determinados subgrupos de población. Objetivos: Examinar los valores medios de hemoglobina en una región española de orografía montañosa, según sexo, rango de edad y altitud de residencia, y la predicción de anemia según umbrales de la OMS y otras propuestas. Material y métodos: Estudio descriptivo transversal de todos los pacientes > 14 años del Sector Huesca con ≥ 1 analítica en los 5 años de inclusión; análisis multivariado para determinar la influencia de los factores demográficos en los valores de hemoglobina. Resultados: Se incluyeron 583.856 informes analíticos de 90.800 pacientes (cobertura 89,1%) residentes entre 281 y 1.305 metros de altitud: 54,6% mujeres; edad media 52,6 años. Hemoglobina media: 14,1 g/dl (hombres:15,0/mujeres:13,4). Prevalencia de anemia: 8,99% (hombres: 7,8%/mujeres: 10,0%). Resultó más frecuente en mujeres (1,6 veces), y aumentaba llamativamente con la edad: > 65 años: 16,5%; ≥ 75 años: 21,7%; ≥ 80 años: 25,7%; > 90 años: 35%. Aumentaba 1,02 veces por cada año, y 0,99 veces por cada metro de altitud. En residentes a ≥ 1.000 m, descendía a la mitad. Conclusiones: Se obtuvieron datos de subpoblaciones previamente poco descritas; la anemia en población mayor requiere consideración. La influencia de la altitud no parece suficientemente abordada con la corrección de la OMS. Se deben plantear estudios amplios para definir criterios apropiados para edades avanzadas y residentes en altura en España, pues ambos grupos constituyen una proporción importante, para evitar incurrir potencialmente en infradiagnóstico de anemia y supradiagnóstico de otras patologías

Introduction: There are gaps in our knowledge of the normative levels of haemoglobin and the prevalence of anaemia in our geographical area, and in certain population subgroups. Objectives: To study the mean values of haemoglobin in a mountainous Spanish region, according to sex, age range and residence altitude, and the prediction of anaemia according to the WHO thresholds and other proposals. Material and methods: Cross-sectional descriptive study of all patients aged >14 residents in the Huesca healthcare Sector with ≥1 laboratory report in the 5 years of inclusion; multivariate analysis to determine the influence of demographic factors on haemoglobin values. Results: 583,856 laboratory reports of 90,800 patients (coverage 89.1%) residing between 281 and 1305 meters: 54.6% female; mean age 52.6 years. Hb mean: 14.1 g/dl (males:15.0/females:13.4). Prevalence of anaemia: 8.99% (males: 7.8%/females:10.0%). It was more frequent in women (1.6 times) and increased markedly with age: >65 years:16.5%; ≥75 years: 21.7%; ≥80 years: 25.7%; >90 years 35%. It increased 1.02 times per year, and 0.99 times per meter of altitude. In residents ≥1000 m, anaemia prevalence fell by half. Conclusions: We obtained data from sub-populations that were previously not well described; anaemia in the elderly requires consideration. The influence of altitude does not seem to be fully considered within the correction framework proposed by WHO. Broader studies should be planned in order to obtain adequate parameters for the elderly and residents at high altitudes in Spain, as both groups represent an important proportion of the population, to avoid potential underdiagnosis of anaemia and overdiagnosis of other pathologies

Anciano y anemia: revisión crítica de su definición y prevalencia / Anaemia and the elderly: critical review of its definition and prevalence

Antecedentes y objetivos: La prevalencia de anemia es un importante indicador sanitario, a pesar de lo cual en nuestro país hay poca información rigurosa recopilada al respecto en población anciana, especialmente en mayores de 80 años. De forma habitual se utiliza el mismo criterio para definir anemia en población anciana que en población general, aunque los datos epidemiológicos recogidos por la OMS en 1968, sobre la base de los cuales se generalizó dicho criterio, no incluían a mayores de 65 años. Nos planteamos dos objetivos. Por un lado, realizar una revisión crítica sobre si la validez del criterio usado para definir anemia en población adulta es extrapolable al adulto anciano. Por otro, revisar las publicaciones sobre prevalencia de anemia en ancianos mayores de 80 años. Material y métodos: Búsqueda bibliográfica sistemática sobre los objetivos planteados. Resultados: Aunque se utiliza de forma generalizada los criterios basados en datos de la OMS de 1968, diferentes autores han propuesto otros valores diagnósticos para población anciana. Hemos encontrado 20 estudios, realizados en Norteamérica y Europa, con solo 70.000 pacientes, y criterios de edad dispares. La prevalencia de la anemia oscila en estos estudios entre el 3 y el 63%, dependiendo del criterio diagnóstico utilizado, los rangos de edad estudiados y si eran institucionalizados o no. Conclusiones: La anemia es un enfermedad muy prevalente en pacientes de edad avanzada. Es necesaria la recogida de bases de datos amplias de población anciana para determinar unos criterios diagnósticos más adecuados

Background and objectives: The prevalence of anaemia is an important health indicator, although there is little rigorous information gathered on the elderly population, particularly in those over 80 years old. The same criteria that are used in the general population are often used to define anaemia in the elderly. The epidemiological data collected by the WHO in 1968 (that have been used to generalise this criteria), did not include the population over 65 years-old. Two objectives are established, which includes a critical review of the available evidence on whether the criteria used to define anaemia in the adult population can be extrapolated to the elderly, and a review of publications on the prevalence of anaemia in the elderly over 80 years-old. Material and methods: A systematic bibliographic search was performed on the established objectives. Results: Although the WHO criteria, based on data from 1968, are widely used, other possible cut-off points have been proposed for elderly people. A total of 20 studies were found that were conducted in North America and Europe, with only 70,000 patients, and different age criteria. The prevalence of anaemia ranges between 3% and 63%, depending on the diagnostic criteria, age, and whether they were institutionalised or not. Conclusions: Anaemia is a very prevalent disease in elderly patients. The collection of large databases is necessary to determine more adequate diagnostic criteria

[Anaemia and the elderly: Critical review of its definition and prevalence]. / Anciano y anemia: revisión crítica de su definición y prevalencia.

BACKGROUND AND OBJECTIVES: The prevalence of anaemia is an important health indicator, although there is little rigorous information gathered on the elderly population, particularly in those over 80 years old. The same criteria that are used in the general population are often used to define anaemia in the elderly. The epidemiological data collected by the WHO in 1968 (that have been used to generalise this criteria), did not include the population over 65 years-old. Two objectives are established, which includes a critical review of the available evidence on whether the criteria used to define anaemia in the adult population can be extrapolated to the elderly, and a review of publications on the prevalence of anaemia in the elderly over 80 years-old. MATERIAL AND METHODS: A systematic bibliographic search was performed on the established objectives. RESULTS: Although the WHO criteria, based on data from 1968, are widely used, other possible cut-off points have been proposed for elderly people. A total of 20 studies were found that were conducted in North America and Europe, with only 70,000 patients, and different age criteria. The prevalence of anaemia ranges between 3% and 63%, depending on the diagnostic criteria, age, and whether they were institutionalised or not. CONCLUSIONS: Anaemia is a very prevalent disease in elderly patients. The collection of large databases is necessary to determine more adequate diagnostic criteria.

Influence of gender, age and residence altitude on haemoglobin levels and the prevalence of anaemia. / Influencia del sexo, la edad y la altitud de residencia en los niveles de hemoglobina y la prevalencia de anemia.

INTRODUCTION: There are gaps in our knowledge of the normative levels of haemoglobin and the prevalence of anaemia in our geographical area, and in certain population subgroups. OBJECTIVES: To study the mean values of haemoglobin in a mountainous Spanish region, according to sex, age range and residence altitude, and the prediction of anaemia according to the WHO thresholds and other proposals. MATERIAL AND METHODS: Cross-sectional descriptive study of all patients aged >14 residents in the Huesca healthcare Sector with ≥1 laboratory report in the 5 years of inclusion; multivariate analysis to determine the influence of demographic factors on haemoglobin values. RESULTS: 583,856 laboratory reports of 90,800 patients (coverage 89.1%) residing between 281 and 1305 meters: 54.6% female; mean age 52.6 years. Hb mean: 14.1 g/dl (males:15.0/females:13.4). Prevalence of anaemia: 8.99% (males: 7.8%/females:10.0%). It was more frequent in women (1.6 times) and increased markedly with age: >65 years:16.5%; ≥75 years: 21.7%; ≥80 years: 25.7%; >90 years 35%. It increased 1.02 times per year, and 0.99 times per meter of altitude. In residents ≥1000 m, anaemia prevalence fell by half. CONCLUSIONS: We obtained data from sub-populations that were previously not well described; anaemia in the elderly requires consideration. The influence of altitude does not seem to be fully considered within the correction framework proposed by WHO. Broader studies should be planned in order to obtain adequate parameters for the elderly and residents at high altitudes in Spain, as both groups represent an important proportion of the population, to avoid potential underdiagnosis of anaemia and overdiagnosis of other pathologies.

Problemática psicosocial en la atención sanitaria urgente / Psychosocial problems in emergency health care

No disponible

Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores / Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly

Objetivo: El principal objetivo del estudio es determinar los factores relacionados con la fragilidad y el desequilibrio de la estabilidad psicosocial en los mayores que residen en la comunidad. Métodos: Estudio prospectivo multicéntrico sobre una muestra representativa de las personas mayores de 75 años que residen en la comunidad en la provincia de Huesca. Seguimiento a 5 años con evaluaciones periódicas semestrales. Entrevista individual estandarizada realizada por médicos de atención primaria entrenados para evaluar depresión, ansiedad, deterioro cognoscitivo, síntomas psicóticos, sarcopenia, red de apoyo social, dependencia para las actividades básicas e instrumentales de la vida diaria, gravedad física, riesgo de dependencia y calidad de vida. Evaluación a los 2 y 5 años después para cuantificar acontecimientos adversos: institucionalización, dependencia funcional o mortalidad. Se valorarán posibles factores de riesgo: sexo, edad, situación social, situación funcional, situación psíquica y gravedad física. Se diseñarán modelos predictivos y de cuantificación del riesgo individual para definir finalmente las personas mayores con alta fragilidad psicosocial y riesgo de desestabilización. Conclusiones: Conociendo los posibles factores de riesgo, sería posible definir al anciano con gran riesgo o mayor fragilidad psicosocial, y aplicarlo a actividades preventivas dirigidas a reducir la fragilidad y los acontecimientos adversos asociados (institucionalización, mortalidad, etc.) (AU)

Objective: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. Methods: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. Conclusions: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.) (AU)

[Estimation of arterial oxygen saturation in relation to altitude]. / Estimación de la saturación arterial de oxígeno en función de la altitud.

BACKGROUND AND OBJECTIVES: Arterial Oxygen Saturation (AOS) predicts altitude sickness. OBJECTIVES: To estimate the AOS values with relation to altitude. Furthermore, make a graph to use during activity which assesses the AOS for each altitude and the normal range. PATIENTS AND METHOD: Values of AOS were assessed during eight high mountain activities in the Alps, Himalaya, Caucasus and Andes; 53 mountaineers participated, 17 of them in more than one activity; 761 measurements of AOS were registered. RESULTS: A Logistic Regression Model was made to estimate the AOS values dependent on altitude, adjusted to possible related factors. A strong lineal relationship exists between altitude and AOS (R2=.83, P<.001); .7 points more in women. The AOS in a particular altitude is not related to age, weight, height, smoking, heart rate, or even with previous experiences in mountains. The calculation of the AOS responds to the follow equation: Blood Oxygen Saturation=103.3-(altitude × .0047)+(Z), being Z=.7 in men and 1.4 in women. A scatter plot was made to relate the estimated altitude with the AOS, with their normal limits values: percentiles 2.5 and 97.5. CONCLUSIONS: The simple calculation of the AOS estimated for a particular altitude with the proposed graphic can help in the early decision-making onsite.

[Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly]. / Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores.

OBJECTIVE: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. METHODS: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. CONCLUSIONS: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.).

Estimación de la saturación arterial de oxígeno en función de la altitud / Estimation of arterial oxygen saturation in relation to altitude

Fundamento y objetivos. La saturación arterial de oxígeno (SAO) es capaz de predecir el desarrollo de mal de altura. Objetivos: estimar los valores de SAO en función de la altitud y, adicionalmente, diseñar un gráfico para usar sobre el terreno que muestre la saturación esperada para cada altitud y sus límites de normalidad. Pacientes y método. Se registraron valores de SAO a los participantes de 8 actividades de alta montaña en los Alpes, el Himalaya, el Cáucaso y los Andes. Participaron 53 montañeros; 17 de ellos repitieron en más de una actividad. Se registraron 761 mediciones de SAO. Resultados. Se diseñó un modelo de regresión lineal múltiple para estimar los valores de SAO en función de la altitud, ajustados por distintos posibles factores relacionados. Existe una fuerte relación lineal entre altitud y SAO (R2=0,83, p<0,001), dando valores 0,7 puntos mayores en mujeres. La SAO a una determinada altitud no se relaciona con la edad, el peso, la talla, el tabaquismo, la frecuencia cardíaca ni con la experiencia previa en montaña. El cálculo de la estimación de la SAO responde a la siguiente ecuación: SAO=103,3-(altitud×0,0047)+(Z), siendo Z=0,7 en hombres y 1,4 en mujeres. Se ha diseñado una gráfica de coordenadas que relaciona la altitud con los valores estimados de SAO con sus límites de normalidad: percentiles 2,5 y 97,5. Conclusiones. La sencillez en el cálculo de la SAO estimada para una determinada altitud mediante la gráfica propuesta ayudará en la toma de decisiones precoces sobre el terreno (AU)

Background and objectives. Arterial Oxygen Saturation (AOS) predicts altitude sickness. Objectives: To estimate the AOS values with relation to altitude. Furthermore, make a graph to use during activity which assesses the AOS for each altitude and the normal range. Patients and method. Values of AOS were assessed during eight high mountain activities in the Alps, Himalaya, Caucasus and Andes; 53 mountaineers participated, 17 of them in more than one activity; 761 measurements of AOS were registered. Results. A Logistic Regression Model was made to estimate the AOS values dependent on altitude, adjusted to possible related factors. A strong lineal relationship exists between altitude and AOS (R2=.83, P<.001); .7 points more in women. The AOS in a particular altitude is not related to age, weight, height, smoking, heart rate, or even with previous experiences in mountains. The calculation of the AOS responds to the follow equation: Blood Oxygen Saturation=103.3-(altitude × .0047)+(Z), being Z=.7 in men and 1.4 in women. A scatter plot was made to relate the estimated altitude with the AOS, with their normal limits values: percentiles 2.5 and 97.5. Conclusions. The simple calculation of the AOS estimated for a particular altitude with the proposed graphic can help in the early decision-making onsite (AU)

Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado / Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests

Objetivo: Estimar la prevalencia de deterioro cognitivo (DC) en ancianos de la comunidad. Evaluar el rendimiento diagnóstico de los principales test de cribado cognitivo usados en atención primaria: miniexamen cognoscitivo (MEC), test del reloj (TR), test de fluencia verbal (TFV) y test del informador (TIN). Calcular la concordancia entre ellos y su validez como pruebas de cribado. Diseño: Estudio descriptivo transversal. Participantes: Doscientos noventa y tres personas de ambos sexos, mayores de 64 años, residentes en la provincia de Huesca, seleccionados mediante muestreo aleatorizado sistemático. Marco muestral: base de datos de Tarjeta Sanitaria Individual. Ámbito provincial. Mediciones: Variables sociodemográficas básicas, y exploración del DC con MEC, TR, TFV y TIN. Resultados: En función del MEC y los diagnósticos previos, la prevalencia de DC es del 18,1% (IC del 95%: del 15,3 al 24,4%). Resultados: La concordancia del MEC con el resto de los test de cribado es moderada: con el TR kappa (κ)=0,40, con el de TFV: 0,33, con el TIN: 0,36. Resultados: La concordancia global del conjunto de los test cognitivos es moderada-baja: κ (Jackknife)=0,35 (IC del 95%: 0,269 a 0,444). Resultados: Considerando patrón de oro al MEC junto con el diagnóstico previo de DC, el TR presenta una sensibilidad del 78,3% y una especificidad del 76,9%; el TFV presenta el 80 y el 70%, respectivamente, y el TIN presenta el 76,7 y el 71,4%, respectivamente. El área bajo la curva ROC (receiver operating characteristics) del TFV es significativamente superior al resto. Conclusión: La concordancia entre los distintos test de cribado cognitivo es moderada. El TFV es el que mejor rendimiento diagnóstico presenta (AU)

Objective: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. Design: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. Participants: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. Participants: Main measurementsWe analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. Results: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3–24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. Conclusions: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy (AU)

[Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests]. / Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado.

OBJECTIVE: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. DESIGN: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. PARTICIPANTS: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. MAIN MEASUREMENTS: We analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. RESULTS: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3-24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. CONCLUSIONS: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy.

[Predictive value of the quality of life questionnaire in the elderly]. / Validez predictiva de mortalidad del cuestionario de calidad de vida en ancianos.

OBJECTIVE: To evaluate the predictive value of the quality of life (QOL) questionnaire at 8 years and analyse which of its 5 dimensions better predict adverse results in health. DESIGN: Descriptive, longitudinal, and retrospective study. SETTING: Three basic health areas in Cuenca province, Spain. PARTICIPANTS: We randomly selected 519 subjects over 64 years, taking addresses in which more than 1 person over 64 years resided as a sample marker. MAIN MEASUREMENTS: The QOL questionnaire was used to evaluate the quality of life of the subjects in 1994 and in 2002. Main results. Between 1994 and 2002, 25% of the participants died, 2.6% were institutionalised and there 3.6% losses. The QOL questionnaire has a mortality predictive capacity at 8 years, the cut off point of its global index being situated around 13 points. The sensitivity of the model is poor (41.5%), with a high specificity (93.5%) and a good classification percentage of 80.3%. The positive and negative probability ratios were 6.36 and 0.62, respectively. Using a Cox regression model, it is seen that of the 5 dimensions of the QOL test, activities of daily living show a relationship with mortality (risk ratio or OR=1.3; 95% confiance interval [CI], 1.049-1.611), mental health (OR=1.048; 95% CI, 1.054-1.620), and economic resources (OR=0.806; 95% CI, 0.648-1.003). CONCLUSIONS: The QOL questionnaire has a mortality predictive capacity at 8 years.

Validez predictiva de mortalidad del cuestionario de calidad de vida en ancianos / Predictive value of the quality of life questionnaire in the elderly

Objetivo. Evaluar la validez predictiva del cuestionario calidad de vida en ancianos (CVA) a 8 años y analizar cuál o cuáles de sus 5 dimensiones predicen mejor los resultados adversos en salud. Diseño. Estudio descriptivo, longitudinal y retrospectivo. Emplazamiento. Tres zonas básicas de salud de la provincia de Cuenca. Participantes. Se incluyeron 519 individuos mayores de 64 años seleccionados aleatoriamente tomando como marco muestral los domicilios en los que residía al menos una persona mayor de 64 años. Mediciones principales. Se utilizó el cuestionario CVA para evaluar la calidad de vida de los individuos en 1994 y en 2002. Resultados principales. Entre 1994 y 2002, falleció el 25% de los participantes, fue ingresado en instituciones un 2,6% y se produjo un 3,6% de pérdidas. El cuestionario CVA tiene capacidad predictiva de mortalidad a 8 años, y el punto de corte de su índice global se sitúa en torno a los 13 puntos. La sensibilidad del modelo es pobre (41,5%), con una especificidad alta (93,5%) y un porcentaje de buenas clasificaciones del 80,3%. Las razones de probabilidad positiva y negativa fueron 6,36 y 0,62, respectivamente. Mediante un modelo de regresión de Cox se aprecia que de las 5 dimensiones del test CVA tienen relación con la mortalidad las actividades de la vida diaria (razón de riesgos o HR = 1,3; intervalo de confianza [IC] del 95%, 1,049-1,611), la salud mental (HR = 1,048; IC del 95%, 1,054-1,620) y los recursos económicos (HR = 0,806; IC del 95%, 0,648-1,003). Conclusiones. El cuestionario CVA posee capacidad para predecir la mortalidad a 8 años

Objective. To evaluate the predictive value of the quality of life (QOL) questionnaire at 8 years and analyse which of its 5 dimensions better predict adverse results in health. Design. Descriptive, longitudinal, and retrospective study. Setting. Three basic health areas in Cuenca province, Spain. Participants. We randomly selected 519 subjects over 64 years, taking addresses in which more than 1 person over 64 years resided as a sample marker. Main measurements. The QOL questionnaire was used to evaluate the quality of life of the subjects in 1994 and in 2002. Main results. Between 1994 and 2002, 25% of the participants died, 2.6% were institutionalised and there 3.6% losses. The QOL questionnaire has a mortality predictive capacity at 8 years, the cut off point of its global index being situated around 13 points. The sensitivity of the model is poor (41.5%), with a high specificity (93.5%) and a good classification percentage of 80.3%. The positive and negative probability ratios were 6.36 and 0.62, respectively. Using a Cox regression model, it is seen that of the 5 dimensions of the QOL test, activities of daily living show a relationship with mortality (risk ratio or OR=1.3; 95% confiance interval [CI], 1.049-1.611), mental health (OR=1.048; 95% CI, 1.054-1.620), and economic resources (OR=0.806; 95% CI, 0.648-1.003). Conclusions. The QOL questionnaire has a mortality predictive capacity at 8 years

[Social inequality and changes in quality of life among the elderly in rural areas of the Province of Cuenca (Spain) between 1994 and 2002]. / Desigualdades sociales y cambios en la calidad de vida de los ancianos en el medio rural de Cuenca entre 1994 y 2002.

OBJECTIVE: To evaluate changes in quality of life (QoL) in a sample of elderly community-dwelling individuals. Overall QoL was evaluated, in addition to the dimensions of physical health (PH), mental health (MH), activities of daily living (ADL), economic resources (ER) and social resources (SR). MATERIALS AND METHODS: Of a sample of 918 persons aged more than 64 years old in the Province of Cuenca (Spain), QoL was measured in 519 in 1994 by means of the Quality of Life for the Elderly (QLE) questionnaire, developed from the OARS-MFAQ Older Americans Resources and Services Multidimensional Functional Assesment Questionaire. In 2002, with a 3.6% loss, the QLE was administered again in all participants that were still alive and non-institutionalized. The results were compared for the two periods and the factors associated with variation in QoL were estimated by means of multiple regression analysis. RESULTS: Of the 519 participants at baseline, 130 died (25%) and 14 (12.7%) were institutionalised. Elderly individuals who were still alive in 2002 showed a general worsening in their overall QoL, specifically in the variables of ADL, PH and MH. However, after adjusting for age, we found that overall QoL was better in 2002 than in 1994. Logistic regression revealed that the factors associated with a lesser decrease in QoL were education, being male, lower age, and being widowed. CONCLUSIONS: QoL in community-dwelling elderly individuals in the Province of Cuenca improved between 1994 and 2002.