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Biomedical subjects

J Alonso

Publications and source records attributed to J Alonso.

At least 19 recordsLinked to original sources
PubMed2006

Risk factors for suicidality in Europe: results from the ESEMED study.

BACKGROUND: Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. METHODS: The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. RESULTS: Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression. LIMITATIONS: Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews. CONCLUSIONS: In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

Adolescent↗
PubMed2006

Evaluation of heavy metal contents in co-composts of poultry manure with barley wastes or chestnut burr/leaf litter.

The presence of heavy metals in composts is a main cause of adverse effects on animal and human health, transmitted through the food chain from the soil, groundwater and plants. In this study, the contents of Zn, Cd, Pb and Cu present in co-composts of poultry manure (liquid or solid) with a co-composting material (barley wastes or chestnut burr/leaf litter) were assessed. A compost of solid manure was used as control because a compost cannot be obtained from the liquid manure. The original solid poultry manure showed a Zn content of 2134+/-75 mg/kg, exceeding the current legal limit in Spain of 1100 mg/kg. In the solid poultry manure co-compost with chestnut burr/leaf litter and barley wastes, Zn content decreased to 813+/-25 mg/kg and 883+/-37 mg/kg, respectively. The contents in heavy metals (Zn, Cd, Pb and Cu) of the co-composts were under the maximum limit permitted under the Spanish legislation, excepting for the Zn level in liquid poultry manure co-composted with chestnut burr/leaf litter.

Animals↗
PubMed2006

Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments.

BACKGROUND: Choosing an adequate measurement instrument depends on the proposed use of the instrument, the concept to be measured, the measurement properties (e.g. internal consistency, reproducibility, content and construct validity, responsiveness, and interpretability), the requirements, the burden for subjects, and costs of the available instruments. As far as measurement properties are concerned, there are no sufficiently specific standards for the evaluation of measurement properties of instruments to measure health status, and also no explicit criteria for what constitutes good measurement properties. In this paper we describe the protocol for the COSMIN study, the objective of which is to develop a checklist that contains COnsensus-based Standards for the selection of health Measurement INstruments, including explicit criteria for satisfying these standards. We will focus on evaluative health related patient-reported outcomes (HR-PROs), i.e. patient-reported health measurement instruments used in a longitudinal design as an outcome measure, excluding health care related PROs, such as satisfaction with care or adherence. The COSMIN standards will be made available in the form of an easily applicable checklist. METHOD: An international Delphi study will be performed to reach consensus on which and how measurement properties should be assessed, and on criteria for good measurement properties. Two sources of input will be used for the Delphi study: (1) a systematic review of properties, standards and criteria of measurement properties found in systematic reviews of measurement instruments, and (2) an additional literature search of methodological articles presenting a comprehensive checklist of standards and criteria. The Delphi study will consist of four (written) Delphi rounds, with approximately 30 expert panel members with different backgrounds in clinical medicine, biostatistics, psychology, and epidemiology. The final checklist will subsequently be field-tested by assessing the inter-rater reproducibility of the checklist. DISCUSSION: Since the study will mainly be anonymous, problems that are commonly encountered in face-to-face group meetings, such as the dominance of certain persons in the communication process, will be avoided. By performing a Delphi study and involving many experts, the likelihood that the checklist will have sufficient credibility to be accepted and implemented will increase.

Clinical Protocols↗
PubMed2006

Is psychometric scoring of the McNew Quality of Life after Myocardial Infarction questionnaire superior to the clinimetric scoring? A comparison of the two approaches.

OBJECTIVE: 'Clinimetric' and 'psychometric' approaches are currently used to develop health related quality of life questionnaires. The Quality of Life after Myocardial Infarction questionnaire (QLMI) was originally developed using 'clinimetric' criteria; it was subsequently modified (McNew QLMI) and a new domain structure was defined using factor analysis. The objective of this study was to compare the measurement properties of the McNew QLMI scores when both approaches for scoring are used. METHODS: The McNew QLMI and SF-36 were administered to patients 2 weeks and 2 months after myocardial infarction. Two sets of scores for the McNew QLMI were computed using the original 'clinimetric' and the subsequent 'psychometrically' derived scoring systems. Reliability statistics for the two sets of domains were compared and construct validity was assessed by establishing a priori hypotheses on the expected correlation between each score and the dimensions of the SF-36. RESULTS: Both sets of scores had similar reliability (Cronbach's alpha between 0.64 and 0.93) and responsiveness (SRMs between 0.17 and 0.87) while validity was better for the 'clinimetric' set of scores (concordance between observed and expected correlations was moderate for the 'clinimetric' scores and fair for the 'psychometric' scores). CONCLUSION: Since overall measurement properties of the 'clinimetrically' scored McNew QLMI are better than the 'psychometrically' scored version, we suggest that either the original 'clinimetric' system is used or that an improved 'psychometric' version is developed.

Adult↗
PubMed2006

A simple technique for shoulder arthrography.

PURPOSE: To present a systematic approach to teaching a technique for arthrography of the shoulder. Using an adhesive marker-plate with radiopaque coordinates, precise sites for puncture can be identified and the need for fluoroscopic guidance obviated. MATERIAL AND METHODS: Forty-six glenohumeral arthrograms were performed in 45 patients; in 1 case involving examination of both shoulders. The stages of the technique are described in detail, as are the fundamental aspects of achieving an effective glenohumeral injection. Pain intensity was measured in all patients using a verbal description scale. RESULTS: Shoulder arthrography was successful in all cases. Average time taken for the procedure was 7 min, with no difference in the respective times required by an experienced radiologist and a resident. The procedure was well tolerated by most patients, with slight discomfort being observed in a very few cases. CONCLUSION: The arthrographic technique used in this study is simple, safe, rapid, and reproducible, and has the advantage of precise localization of the site for puncture without need for fluoroscopic guidance. The procedure described in this study can be of help in teaching residents and can reduce the learning curve for radiologists with no experience in arthrographic methods. It also reduces the time of exposure to fluoroscopy.

Adult↗
PubMed2006

Functional disability of mental disorders and comparison with physical disorders: a study among the general population of six European countries.

OBJECTIVE: To examine the association of mental and physical disorders with multiple domains of functioning and compare the two. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders, a general population study in which adults (n > 21,000) from Belgium, France, Germany, Italy, the Netherlands and Spain were assessed using the Composite International Diagnostic Interview (mental disorders), World Health Organization Disability Assessment Schedule second edition (functional disability) and self-report (physical disorders). Means in different groups were compared using the Mann-Whitney U-test and multiple regression analyses. RESULTS: Mental disorders were related to disability in all domains of functioning: anxiety disorders the most, followed by mood disorders, and finally alcohol disorders. The findings suggest that mental disorders are associated with similar or higher levels of disability in all domains, except getting around, than arthritis and heart disease. CONCLUSION: Mental disorders are associated with a similar or higher negative impact on daily functioning than arthritis and heart disease.

Attitude to Health↗
PubMed2006

Assessment of service use patterns in out-patients with schizophrenia: a Spanish study.

OBJECTIVE: The objective is to describe and characterize patterns of service use by out-patients with schizophrenia in Spain. METHOD: A representative treated prevalence sample of cases with schizophrenia was selected from four Spanish health areas. The evaluation included health service use, clinical severity, functioning and disability. Statistical analysis was based on hierarchical clustering methods. RESULTS: A total of 356 patients were included in the analysis. Five patterns of health service use were defined: heavy out-patient mental health users; mental health and general health service users; heavy hospital service users; nursing service users; low users of mental health services. Patients in each group showed differences in clinical and disability status. Patterns of health service use showed consistency, but also variability, among the geographical areas. CONCLUSION: Development and organization of mental health services should take into account the combinations of services patients most frequently use.

Adult↗
PubMed2006

[Place of death of elderly persons in Catalonia].

STUDY OBJECTIVE: To describe the place of death of the elderly and to analyze the factors associated with death occurring in an acute care hospital. DESIGN: Cross-sectional interview of a randomized sample of individuals aged 65 or over who died during the year 1998. Three to four months after the death of the elderly subject, the main caregiver was interviewed about the socio-demographic characteristics, chronic conditions, functional and cognitive status, and use of health services in the months previous to the death, as well as the place where death occurred and their preferences on this site. SETTING: Six areas of Catalonia, Spain, differing in the level of health and end of life social services. PARTICIPANTS: 584 caregivers (78.6% response rate). MAIN RESULTS: Mean age of the deceased elderly was 81.4 (+/- 8) and half of them were females. 52% (95% CI: 47.5-55.7) had died in acute care hospitals. 35% of the caregivers of those dying at an acute hospital reported that they would have preferred another place for death. After adjustment, variables associated with dying in acute care hospitals were: living in an area with lower availability of social and health services for the end of life (OR: 2.8; 95% CI: 1.4-5.5) and suffering from chronic obstructive pulmonary disease (OR: 1.7; 95% CI: 1.1-2.5). CONCLUSIONS: Acute hospitals are the predominant place of death in Catalonia, Spain. The place of death seems to be more closely influenced by the availability of end-of-life care services. There is a clear preference for dying at an alternative place to acute hospitals.

Aged↗
PubMed2005

Residual aqueous ozone determination by gas diffusion reverse flow injection analysis.

A novel system based on reverse flow injection analysis with a gaseous diffusion step (GD-r-FIA) has been developed for the analysis of ozone. It includes an automatic microburet injection system. The ozone diffuses through a microporous membrane of polyvinylidene difluoride (PVDF) from the donor stream to the acceptor stream containing nitrite ions. The nitrite concentration in the acceptor solution decreases due to the ozone reduction reaction. In this way, a simple indirect measurement of the ozone concentration can be performed using the Griess-Ilosvay reaction for the nitrite ion. This correlates with the decrease in absorbance of the azoic dye formed with the ozone concentration in the donor stream. The system has been optimised by investigating the effect of the nitrite concentration in the acceptor stream on the diffusion flow. The optimum nitrite concentration was set at 0.250 ppm with a flow rate of 1.5 ml/min. The efficiency of the ozone diffusion through the membrane was only 4.4%. This affects the average sensitivity, which is low (0.0092+/-0.0012 AU/ppm), although the detection limit is similar to that obtained with other reported methods (0.03 ppm). The main advantage of the system reported here is that it has a linear range that is an order of magnitude broader than those observed for other GD-FIA systems. This is especially useful for continuous monitoring systems, since the residual ozone concentration is normally between 0.05 and 5.0 ppm. Additionally, using the reverse flow injection analysis (FIA) technique minimises chemical consumption and residue generation. Finally, the stability of the ozone solution and the repeatability and reproducibility of the method have been studied.

Journal Article↗
PubMed2005

Health-related quality of life during the bereavement period of caregivers of a deceased elderly person.

Few studies have addressed the health-related quality of life (HRQL) impact of bereavement. The objective of this study was to evaluate the HRQL of the main caregiver after the death of a close elderly relative. 142 caregivers were invited to participate in a phone interview with the SF-36. General population SF-36 norms, were used to calculate the gender and age standardised physical component summary (PCS) and mental component summary (MCS) scores. A MCS below 43 was used as an indicator of possible depression. Databases of several patient studies were additionally used to facilitate interpretation of results. 130 caregivers (91.5%) participated, the majority being women (80%), middle aged (56 years), and the spouse (22%) or son/daughter (56%) of the deceased person. Caregivers' SF-36 scores were lower than expected for mental health, role emotional and social functioning. Their MCS was below that expected by 0.6 SD units, whereas their PCS was above by 0.2 SD. The proportion of caregivers with possible depression was 33.8%. First-degree family relationship with the deceased (OR = 4.5), and lower age of the deceased (OR = 3.8) were significantly associated (p < 0.02) to a possible depression. The recent death of an elderly person is associated with significant emotional health impact on the caregiver.

Adult↗
PubMed2005

The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients.

BACKGROUND: Evidence about the impact of routine feedback of patient-reported outcomes is contradictory, and there is limited information regarding its use in the routine management of cataract patients. METHODS: The VF-14 Index was used to assess the visual function of 833 consecutive cataract patients, attending 19 ophthalmologists from public and private hospitals and primary care practices in Spain, in 1999-2000. In this before/after trial, the intervention included (1) an educational session, and (2) the provision of the VF-14 scores of all subsequent patients to the ophthalmologist. Mixed effects linear and logistic models were constructed to assess the effect on the process (correlation between patients' and physicians' assessments of visual function, appropriateness of surgery recommendation) and the outcome of care (satisfaction). RESULTS: The adjusted regression coefficient for the VF-14 score significantly increased after the intervention as a predictor of the ophthalmologist's assessment of visual function (beta coefficient: control 0.10 vs. intervention 0.35, p < 0.05). The intervention did not increase the probability of an appropriate medical decision (OR = 0.90; 95% CI: 0.42; 2,69) and it did not change patient satisfaction with care. CONCLUSIONS: Routine provision of education and feedback on the patient's VF-14 Index score significantly increases agreement between patients' and physicians' assessments of functional capacity. The lack of a beneficial effect on management or outcome suggests the need for a more intense intervention to change medical practice.

Aged↗
PubMed2005

Nasal polyposis and its impact on quality of life: comparison between the effects of medical and surgical treatments.

BACKGROUND: Nasal polyposis (NP) is not a life-threatening disorder but may have a great impact on the quality of life (QoL). The objective of this study: (i) to investigate the health burden incurred by NP compared with the Spanish general population using the Short Form-36 Health Survey (SF-36) questionnaire; (ii) to compare the QoL outcome after medical or surgical treatment; and (iii) to assess and compare the effect of medical and surgical treatment on nasal symptoms. METHODS: About 109 patients with nasal polyps were included. Fifty-three patients were randomly allocated to receive oral prednisone for 2 weeks and 56 to undergo endoscopic sinus surgery. All patients administered intranasal budesonide for 12 months. Patients were evaluated for nasal symptoms, polyp size, and QoL. RESULTS: In comparison with the Spanish general population, patients with NP had worse scores on all SF-36 domains except for physical functioning. Nonasthmatic patients with NP had better QoL than asthmatic patients with NP on role physical functioning, body pain, and vitality (P <0.05). At 6 and 12 months, a significant improvement on all of SF-36 domains was observed after both medical and surgical treatment reaching the levels of general population (P <0.05). Nasal symptoms and polyp size improved after both medical and surgical treatment at 6 and 12 months (P <0.05). CONCLUSION: These results suggest that NP has considerable impact on a patient's QoL and that both medical and surgical treatment led to similar effects in improving QoL.

Asthma↗
PubMed2005

Effectiveness of antipsychotic treatment for schizophrenia: 6-month results of the Pan-European Schizophrenia Outpatient Health Outcomes (SOHO) study.

OBJECTIVE: To present the 6-month outcomes associated with antipsychotic treatment of patients participating in the Schizophrenia Outpatient Health Outcomes (SOHO) study. METHOD: SOHO is a 3-year, prospective, observational study of the health outcomes associated with antipsychotic treatment in 10 European countries. The study included over 10,000 out-patients who were initiating or changing their antipsychotic medication. RESULTS: Clinical Global Impression (CGI)-severity and quality of life (QOL) scores improved in all treatment cohorts. There was a higher response in the CGI-overall symptoms and in the CGI-schizophrenia positive, negative, cognitive and depressive symptom scales in the olanzapine (Olz) and clozapine (Cloz) cohorts compared with other treatment cohorts. Changes were associated with an improvement in QOL. CONCLUSION: Patients starting Olz and Cloz tend to have better outcomes at 6 months than patients who start other antipsychotics in actual out-patient clinical practice. The results should be interpreted conservatively because of the non-randomized study design.

Adult↗
PubMed2004

[Cross-cultural adaptation of the Spanish version of the Child Health and Illness Profile, Child Edition (CHIP-CE)].

OBJECTIVES: To obtain a Spanish version of the CHIP-CE semantically and culturally equivalent to the original version. METHOD: The methodology used was based on the forward-backward method. Two translations into Spanish were performed. After the first reconciled version, 44 cognitive interviews were carried out with children aged 6-11 years old, selected from two schools in Barcelona. The interviews were recorded and transcribed. A qualitative content analysis of the textual data was carried out. A panel of experts developed the second reconciled version taking into account the children's comments. A back-translation into English was carried out and was compared with the original version. RESULTS: Of a total of 45 items induced in the first reconciled version, 21 were considered equivalent, 23 required changes and 1 was considered not equivalent. Comprehension of abstract concepts differed according to age. Older children differentiated among concepts and gave different examples of experiences related to these concepts, while younger children (6 to 7-year olds) provided similar examples for different concepts. The children's comments were used in the reformulation of the items. An illustrative figure reinforced understanding. Children aged 7 or more started to use an adequate recall period and used the response options correctly. CONCLUSIONS: The Spanish version of the CHIP-CE seems appropriate for children aged 6-11 in Spain. The present study shows that children from the age of 6 years onwards are able to describe the health concepts included in the CHIP-CE.

Child↗
PubMed2004

Content-based interpretation aids for health-related quality of life measures in clinical practice. An example for the visual function index (VF-14).

BACKGROUND: In spite of a well-established development of instruments, difficulty in interpreting health related quality of life scores may limit its use in clinical practice. OBJECTIVE: To develop generalizable interpretation aids for a measure of perceived functional visual status, the VF-14 index. DESIGN: Item Response Theory (Rasch analysis) was used to analyze the performance of VF-14 items. The 'ruler' aid was derived from the most difficult activity (item) a patient is able to do without difficulty; the 'clinical scenarios' aid, first identified all significantly different clusters of items within the index and then estimated the mean expected difficulty (responses) to perform a benchmark item in each cluster. SETTING: The study was conducted in four hospitals and six ambulatory cataract surgery centers in Barcelona, Spain. PATIENTS: One hundred and ninety-eight patients scheduled for first eye cataracts surgery. MEASUREMENTS: The self-reported VF-14 index and clinical measures were used. RESULTS: All VF-14 items were found unidimensional with three items showing only partial misfit. For a patient with a VF-14 Rasch score of 71, the 'ruler' aid indicated that 'doing fine handwork' would be the most requiring activity he/she would perform without difficulty. The 'clinical scenarios' aid estimated that such a patient would be unable to 'drive at night', would have some difficulty 'reading small print' and no difficulty 'doing fine handwork', 'watching TV' or 'recognizing people'. Concordance between modeled and observed responses was fair to substantial. CONCLUSIONS: Simple content-based interpretation aids for the VF-14 scores were developed that should facilitate its use in clinical practice. These aids should be easily generalizable to other quality of life instruments.

Activities of Daily Living↗
PubMed2004

Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. METHOD: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. RESULTS: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. CONCLUSION: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

Adolescent↗
PubMed2004

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Adolescent↗