Disfunción eréctil, litiasis renal y test de ADAM: estudio observacional mediante encuesta telefónica / Renal lithiasis, erectile dysfunction and ADAM test: observational study using telephone survey

Objetivo. La litiasis renal se asocia con trastornos hormonales y metabólicos, factores comunes a la disfunción eréctil. Algunos trabajos han estudiado la asociación entre la disfunción eréctil y la urolitiasis; sin embargo, los datos son todavía escasos. El objetivo del presente estudio fue estudiar la asociación entre la disfunción eréctil y la litiasis renal, así como las relaciones entre disfunción eréctil y síntomas asociados con el envejecimiento sugestivos de síndrome de déficit de testosterona con factores de riesgo cardiovascular. Material y métodos. Se realizó un estudio observacional transversal mediante encuesta telefónica. Por muestreo polietápico aleatorio, se seleccionó una muestra de 1.193 varones de edades comprendidas de 40 a 65años residentes en España. Se recogieron variables sociodemográficas y clínicas. Se usó el cuestionario del ADAM para evaluar los síntomas sugestivos de síndrome de deficiencia de testosterona. Resultados. La litiasis renal fue más frecuente en los pacientes con disfunción eréctil. La hipertensión arterial, la diabetes y la hipercolesterolemia se asociaron significativamente con la disfunción eréctil. La diabetes, la edad, la clase social media-alta basada en la ocupación laboral (claseii), la hipertensión arterial y la hipercolesterolemia fueron factores predictores independientes de un cuestionario ADAM positivo. Conclusiones. Nuestros datos indican una posible relación entre la disfunción eréctil y la litiasis renal. La relación entre la disfunción eréctil y un cuestionario de ADAM positivo con los factores de riesgo cardiovascular ponen de manifiesto la importancia de evaluar el riesgo cardiovascular de los pacientes que presentan dichas condiciones (AU)

Objective. Renal lithiasis is associated with hormonal and metabolic disorders, common factors to erectile dysfunction. A number of studies have analyzed the association between erectile dysfunction and urolithiasis, however data are still scarce. We aimed to study the association between erectile dysfunction and renal lithiasis, as well as the relations between erectile dysfunction and symptoms associated with aging suggestive of testosterone deficiency syndrome, and cardiovascular risk factors. Material and methods. A cross-sectional observational study of population level by telephone survey was conducted. By sampling random multistage, we selected a sample of 1,193 males aged 40 to 65 living in Spain. Socio-demographic and clinical variables were recorded. Suggestive symptoms of testosterone deficiency syndrome were screened by the ADAM questionnaire. Results. Renal lithiasis was more frequent in patients with erectile dysfunction. High blood pressure, diabetes and hypercholesterolemia were significantly associated with erectile dysfunction. Age, upper middle based on occupation (social classii), high blood pressure, diabetes and hypercholesterolemia were independent predictors of a positive ADAM questionnaire. Conclusions. Our results point out a possible relationship between erectile dysfunction and renal lithiasis. The connection between erectile dysfunction, symptoms associated with aging suggestive of testosterone deficiency syndrome, and cardiovascular risk factors remarks the importance of assessing the cardiovascular risk of patients presenting these conditions (AU)

Is the Scale for Measuring Motivational Interviewing Skills a valid and reliable instrument for measuring the primary care professionals motivational skills?: EVEM study protocol.

BACKGROUND: Lifestyle is one of the main determinants of people's health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors' communication skills, and more specifically the Motivational Interviewing. METHODS/DESIGN: The hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. - SCOPE: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change (Pearson product-moment correlation coefficient). DISCUSSION: The verification of the hypothesis that EVEM is a valid and reliable tool for assessing motivational interviewing would be a major breakthrough in the current theoretical and practical knowledge, as it could be used to assess if the providers put into practice a patient centered communication style and can be used both for training or researching purposes. TRIALS REGISTRATION Dislip-EM study: NCT01282190 (ClinicalTrials.gov).

Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of a multifactorial intervention program to prevent falls among older adults as compared with a brief intervention. DESIGN: Randomized controlled trial. SETTING: Eleven health centers located in Córdoba, Spain. PARTICIPANTS: People over 70 years old (N=404), who are residents in the community. INTERVENTIONS: The centers were randomized to either 1 of the 2 groups: intervention group (IG), of a multifactorial nature (individual advice, information leaflet, physical exercise workshop, and home visits), or control group (CG) (brief individual advice and information leaflet). MAIN OUTCOME MEASURES: Fall rates and time until the fall; estimates of the relative and absolute risk of falls; and survival analysis and Cox regression. RESULTS: Of the patients recruited, 133 were in the IG and 271 were in the CG. Around 33% in the IG and 30.25% in the CG had had a fall in the previous year (P=.56). After 12 months, the fall incidence rate was 17.29% in the IG and 23.61% in the CG (relative risk=0.73; 95% confidence interval [CI], 0.48-1.12; P=.146). Around 60% of the IG patients said they had increased the time spent on physical activity. In the IG, the incidence of falls at home was 27.5% compared with 49.3% in the CG (P=.04). Being a woman (odds ratio [OR]=1.62; 95% CI, 1.03-2.54), having a history of falls (OR=1.15; 95% CI, 1.05-1.26), suffering acute health problems (OR=2.19; 95% CI, 1.09-4.40), and doing moderate exercise (OR=1.91; 95% CI, 1.08-3.38) were found as factors associated with a higher risk of falls. CONCLUSIONS: Although the reduction of falls in the IG was nearly halved, and after the intervention there was a significant reduction in the number of falls at these patients' homes, the multifactorial intervention program is no more effective than the brief intervention to reduce the overall risk of falls.

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol.

BACKGROUND: The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. METHODS/DESIGN: An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. DISCUSSION: Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity. TRIALS REGISTRATION: ClinicalTrials.gov (NCT01282190).