Rosa Magallón Botaya

Primary prevention of anxiety disorders in primary care: A systematic review

OBJECTIVE Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care. METHODS A literature search was carried out in four databases-PubMed, PsycInfo, Cochrane, and Web of Science-from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire. RESULTS No high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child-adolescent population or on other types of interventions, usually as secondary prevention. CONCLUSION This study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.

Enfermedades cronicas y deterioro funcional para las actividades de la vida diaria en poblacion mayor no institucionalizada

OBJECTIVE To 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. METHODS We 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. RESULTS The 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). CONCLUSION There 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.

Cuidados familiares prestados por los ancianos del ámbito rural a distintas generaciones

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.