Francisco Guillén Grima

Prevalencia de actividad física y su relación con variables sociodemográficas y estilos de vida en la población de 18 a 65 años de Pamplona

Fundamento: Los conocimientos actuales permiten considerar que existe una asociacion de tipo causal entre el nivel de actividad fisica y la aparicion de diversas enfermedades. A pesar de ello, la actividad fisica es una practica poco arraigada en la poblacion, que cada vez se esta haciendo mas sedentaria. El objetivo de este estudio es describir la prevalencia de sedentarismo en la poblacion de Pamplona, asi como conocer cuales son los factores que mas influyen en el. Metodos: Se llevo a cabo un estudio transversal mediante encuesta postal en una muestra significativa de la poblacion de Pamplona de 18 a 65 anos. La encuesta utilizada incluia una evaluacion de la actividad fisica realizada, basada en el cuestionario de actividad fisica de Paffenbarger. Se realizo un analisis bivariado y multivariado con aplicacion de regresion logistica. Resultados: Un 76,6% de las mujeres tienen un estilo de vida sedentario, mientras que en los varones este porcentaje se reduce hasta un 56,7%. El sedentarismo se incrementa con la edad, existiendo hasta un 80,3% de varones sedentarios en el grupo de mayor edad, y un 86,3% entre las mujeres, respectivamente. Conclusiones: Los factores sociodemograficos como sexo, edad, estudios, profesion y estado civil parecen ser determinantes del estilo de vida sedentario, mientras el consumo de tabaco y la existencia de sobrepeso y obesidad no lo son. Entre las personas jovenes, las mujeres sin estudios universitarios y los varones casados y fumadores parecen ser poblaciones diana para la promocion de la actividad fisica.

Desarrollo y validación de una escala de insatisfacción corporal para adolescentes

Fundamento y objetivo En Espana se dispone de pocos instrumentos especificos para la evaluacionde alteraciones de la imagen corporal. El objetivo de este trabajo es el diseno y la validacionde un instrumento especifico de evaluacion de insatisfaccion corporal para adolescentes. Sujetos y metodo El estudio se realizo en 6 fases utilizando 2 muestras de 91 y 569 sujetosadolescentes escolares de 12 a 19 anos de ambos sexos. En las fases 1, 2 y 3 se diseno uncuestionario con items recogidos de la bibliografia y se analizo la potencia discriminante de loselementos. En las fases 4, 5 y 6 se calcularon diversos indices de fiabilidad y validez y se tipificaronlas puntuaciones obtenidas. Resultados El cuestionario final tras los trabajos de depuracion de los items quedo constituidopor 32 items distribuidos en 6 categorias de respuesta. Los valores de fiabilidad obtenidos parala escala fueron: alfa de Cronbach de toda la muestra, 0,91 (0,66 en el grupo de varones de17-19 anos y 0,93 en el grupo de mujeres de 14-16 anos), el indice de fiabilidad por la tecnicade dos mitades fue para toda la muestra de 0,84, y la fiabilidad test-retest de 0,90. La validezconcurrente proporciono indices de entre 0,67 y 0,89 con otros instrumentos, y el analisisfactorial hallo 4 factores capaces de explicar el 50,3% de la varianza. Conclusiones El trabajo realizado ha proporcionado un nuevo instrumento de evaluacion de insatisfaccioncorporal, especificamente disenado para adolescentes, y que obtiene valores defiabilidad y validez adecuados en relacion con otros instrumentos disponibles en la actualidad.

Deformaciones raquíticas de miembros inferiores en los niños congoleños

Background. To analyse risk factors in rachitic Congolese children with serious deformities in their lower members and to describe the lesions. Methods. The authors analysed the parameters obtained in a survey of two groups of children: a group of 194 rachitic children with severe deformities of their members and another control group of 107 healthy children of similar ages. The types of deformity and the degrees of rachitism were described. Results. The most frequent deformity was genu varum (58.2%), followed by windsept (23.7%) and genu valgum (13.9%). Genu varum predominated in girls of between 2-4 years (p=0.0025). We found florid rickets in 19.1% of the cases, moderate in 15.5%, minimal in 14.2% and osseous deformities alone without active rachitism in 41.2%. Of the parameters analysed, the most important risk factor was being a twin (OR=25.43 ; 95% CI=3.76-1098.27), followed by lack of sunlight (OR=18.39, 95% CI=6.69-61.55) and having a rachitic sibling. Maternal feeding was a protective factor (OR=0.94, 95% CI=0.90-0.98). Premature birth and low weight at birth had no influence. Walking age was 15.4 months in the rachitic cases and 12.4 months in the control group (p<0,01). Conclusion. Severe deformities of lower members as a sequel to rickets are frequent; they are associated with being a twin, lack of sunlight and precocious weaning.

Does medical treatment of mild intraocular hypertension prevent glaucoma

Glaucoma is a serious disease that may cause a decrease in peripheral vision as well as blindness. Although the treatment of extreme levels of high intraocular pressure (p > 35 mm) reduces the risk of glaucoma it is not known if the treatment of mild and moderate intraocular pressure prevents the onset of glaucoma. A bibliographic search in Medline CD-ROM was performed from 1967 to 1995, as well as in SIGLE CD-ROM. The keywords used were ‘glaucoma prevention’ and ‘glaucoma suspects’. After the search 18 papers which treated moderate and mild intraocular pressure were selected. Of all these papers, those that used the same methodology; randomization and timolol as treatment, were chosen. The possibility of publication bias was controlled by plotting effect size vs. number of papers, as well as effect size vs. year of publication. A meta-analysis using two methods, weighted zetas and adding zetas, was performed. The combined effect size was —6.25%, and the weighted effect size was — 6.45%. We computed the pooled z by two methods: adding Zs and adding weighted Zs. The Z obtained by adding Zs has a value of 2.31120 p = 0.0177, one tail). Using the method of adding weighted Zs we obtained a value of 2.4201 (p = 0.0082, one tail). Our results show that the treatment with timolol of patients with mild and moderate intraocular pressure may help to prevent the onset of glaucoma.

Estudio de prevalencia y asociación entre síntomas de asma y obesidad en la población pediátrica de Pamplona

OBJECTIVES The objective of this study is to determine the prevalence of asthma symptoms and overweight-obese in children aged 6-7 years and adolescents aged 13-14 years within the metropolitan area of Pamplona, and analyse the risk of asthma within the age groups and the influences if sex on this relationship. METHODS The study is based on data of asthma symptoms and body mass index of 4,413 children and adolescents obtained from the International Study of Asthma and Allergies phase III questionnaire. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for overweight-obesity and asthma symptoms in both groups, taking as reference the group of normal weight. Afterwards, it was stratified by sex. RESULTS The prevalence of overweight-obesity in the group aged 6-7 years was 23.9% and in the group of teenagers was 11.5%. The prevalence of asthma symptoms in both age groups was lower than the Spanish average. The obese children aged 6-7 years had a higher risk of asthma symptoms. When it was stratified by sex, an increased risk in all asthma symptoms was observed only in obese girls. No relationship between obesity and asthma was observed n the adolescents group. CONCLUSIONS Obesity in children is related to asthma symptoms. Obese girls have an increased risk and more severe asthma symptoms than boys.

Análisis de la calidad de la información proporcionada a los pacientes por parte de unidades clínicas especializadas ambulatorias mediante análisis por modelos multinivel

Background. The influence of the information received by patients on their satisfaction is of great importance since, amongst other aspects, it can improve patients’ adherence to treatment and contribute to improving their state of health. The study aimed to determine, on the basis of satisfaction questionnaires, the percentage of variability in patients’ perception of the information received concerning way of life and medicines, attributed to the following levels: patient, clinical unit and specialisation. It also aimed to identify the variables that influence the results. Methods. Telephone interviews were conducted with 6,922 patients treated in outpatient units in the Navarre Health Service in the year 2005 (rate of reply, 92.4%). An evaluation was made of whether the patients had received medical prescription and information on way of life and, where affirmative, their evaluation of the quality of this information. Ninety-four outpatient clinics and 34 medical specialisations were analysed. A hierarchical statistical analysis at three levels was made. Results. In the items studied, the variability explained by clinical unit and medical specialisation oscillated between 0 and 12.6%, and explained by the patient between 87.4 and 99.3%. Conclusions. Variability was detected in the behaviour of the different clinical units in relation to medical prescription and information provided on way of life. However, the greater part of the variability was localised at the “patient” level.

Radiología innecesaria en Atención Primaria

Background. The request for diagnostic tests proceeding from primary care shows a progressive increase over time and a great interpersonal variety in the requests, which suggests that ineffective services are being applied. The aim is to determine the characteristics of the those making requests for radiological tests (general radiology and echography) and to quantify the unnecessary tests in primary care. Methods. Cross-sectional study of a cluster sample of 23 health centres of Navarre in the month of March 2004. A specific questionnaire was designed to be completed by the doctor requesting the diagnostic test. Logistic regression to study the association between unnecessary tests and the other variables of the study was used. Results. Tests were asked for on 9 per thousand of the population studied. The inter-professional variability in the request for tests oscillated between 0 and 33.3 per 1,000 health cards of children’s age. The radiological studies requested with greatest frequency were osseous (48.9%, IC: 42.4-55.5). In 63.2% of the requests no modifications were made to the treatment prior to the request for a test and 57% (IC: 52.4-61.7) of the tests carried out were requested to rule out pathologies. Twenty-four point seven percent (IC: 17.1-29.2) were unnecessary tests and in 15.2% (IC: 10.7-18.2) there was pressure from the patient in the request. In the multivariant analysis significant differences were observed for thorax Rx, changes in the treatment and pressure from the patient. After adjustment for the other variables, the request for an unnecessary test is 12.55 times greater if the doctor feels under pressure from the patient. Conclusions. The correct indication for radiology must be analysed, especially in osseous radiology, and the role of the radiologist in the final decision on carrying out the test must be strengthened.

Docetaxel en combinación con cisplatino para el tratamiento en primera línea del cáncer de pulmón no microcítico metastásico o localmente avanzado: metaanálisis de ensayos clínicos aleatorizados y controlados

Fundamento y objetivo: La reciente aprobacion de la combinacion docetaxel/cisplatino (DP) para el tratamiento del cancer de pulmon no microcitico (CPNM) hace necesaria una evaluacion de su eficacia y toxicidad. La existencia de otras combinaciones de cisplatino para esta misma indicacion hace cuestionable su ventaja terapeutica real. El objetivo de este trabajo es evaluar, mediante metaanalisis, el regimen DP frente a otras combinaciones de cisplatino para el tratamiento en primera linea del CPNM metastasico o localmente avanzado. Material y metodo: Se realizo una busqueda de ensayos clinicos aleatorizados, controlados y en fase III que compararan DP frente a otras combinaciones de cisplatino. Los pacientes debian estar diagnosticados de CPNM avanzado y no debian haber recibido quimioterapia. Los estudios seleccionados se sometieron a metaanalisis mediante el metodo de Mantel-Haenzel. Se evaluaron tanto la actividad antitumoral como las reacciones adversas. Ademas, se determinaron la heterogeneidad y el indice NNT (numero necesario a tratar) para la respuesta y la supervivencia. Resultados: Cumplieron nuestros criterios de preseleccion 3 ensayos clinicos. Los resultados indicaron una mejora significativa en la supervivencia a los 2 anos favorable a DP (11-47% superior al resto) pero mayor incidencia de diarreas (odds ratio = 2,525; intervalo de confianza del 95%, 1,697-3,756). Se encontro heterogeneidad en la respuesta y en la presencia de anemia y trombocitopenia. El NNT fue de 17 para la supervivencia. Conclusiones: La combinacion DP es una buena opcion para el tratamiento en primera linea del cancer de pulmon no microcitico avanzado. La supervivencia a 2 anos es significativamente mayor y su toxicidad similar al resto, excepto para los episodios diarreicos.

Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en Pamplona, (1991-95)

BACKGROUND: To assess the short-term impact of air pollution on the daily death rate in the city of Pamplona. METHOD: Ecological study with a population of 212,000 inhabitants. A time series data analysis is conducted by means of multiple linear regression and Poisson regression, with the daily death rate data, air pollution levels for Particles and SO2, weather parameters of average relative humidity and temperature daily and number of cases weekly of flu for the 1991-1995 period. RESULTS: The average number of deaths daily for non-external causes is that of 4.15 deaths, with a range from zero to 13 deaths. The city of Pamplona has a mean annual temperature of 12.7oC (-2.3C to 31.6oC) and a relative humidity of 68.5%. In the model, the temperature (with a one-day time lag and a six-day time lag temperature squared) and the humidity (with a one-day time lag) is related to the death rate for all causes. But the death rate for non-external causes is only related in the model with the temperature (one-day time lag, P:0.035) and five-day time lag with temperature squared (p: 0.028). The timely estimates of the relative particle-related risk show that the highest risk of dying stems from respiratory causes with a relative risk of 1.13. However, none of these relationships is statistically significant. In the case of Sulfur Dioxide, the estimates closely near the zero figure, and none of them is significant. CONCLUSIONS: The Temperature has an impact of the death rate for all causes, both external and non-external, and the relative humidity solely has an impact on the death rate for non-external causes. It has not been possible to prove any influence of the daily environmental pollution levels on the daily death rate.

Validación del Cuestionario de Orientación a la Vida (OLQ-13) de Antonovsky en una muestra de estudiantes universitarios en Navarra

Fundamento . El sentido de coherencia interna (SOC), concepto central del modelo salutogenico descrito por Aaron Antonovsky, se ha empleado como predictor de medidas de salud percibida y objetiva, se relaciona fuerte y positivamente con comportamientos saludables, y se desarrolla principalmente en la juventud y en la epoca de estudiante. Los universitarios son un grupo de jovenes diana para aplicar medidas promotoras de salud en funcion de su nivel SOC, siendo necesario comprobar la calidad de la medicion de la escala. El objetivo es validar y estudiar las propiedades psicometricas de la escala SOC en los estudiantes de la Universidad de Navarra, y conocer su evolucion temporal. Sujetos y metodo. Se analizaron los estudiantes de nuevo acceso de la Universidad de Navarra. Estudio de cohortes con seguimiento a los tres anos. Los instrumentos utilizados fueron el cuestionario de orientacion a la vida (OLQ-13), la Escala del Estres Percibido (EEP) y el Indice de malestar. Se estudiaron la calidad de los datos y viabilidad, asunciones escalares, estabilidad temporal, fiabilidad, validez de criterio concomitante y clinica, y estructura factorial y analisis confirmatorio de los datos obtenidos. Se utilizaron los paquetes estadisticos SPSS v. 19 y Amos v.7. Resultados. La muestra estudiada ha sido de 508 estudiantes, 33,5% varones y el 65,9% mujeres. Fiabilidad alta (Alfa de Cronbach de 0,814). Adecuada validez convergente con la EEP. Inadecuada validez clinica. Analisis de componentes principales con tres factores que explican el 50,73% de la varianza. Conclusiones. Instrumento valido que permite proponerlo como herramienta para aplicar medidas promotoras de salud en jovenes.