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Biomedical subjects

L Prieto

Publications and source records attributed to L Prieto.

At least 91 records · Page 5Linked to original sources
PubMed1997

Measuring functional status of chronic coronary patients. Reliability, validity and responsiveness to clinical change of the reduced version of the Duke Activity Status Index (DASI).

AIMS: Health-related quality of life assessment may be useful for understanding the variability in functioning of patients with a similar level of clinical impairment. We assessed the reliability, validity and responsiveness to clinical change of a reduced version of the Duke Activity Status Index (DASI) in chronic coronary patients. METHODS AND RESULTS: The reduced version of the DASI, a measure of self-reported functional capacity, was administered twice to two groups of patients: 46 stable coronary heart disease outpatients were tested and re-tested 2 weeks after their initial visit; and 44 patients undergoing elective angioplasty for angina pectoris were evaluated the day before and one month after the procedure. The Canadian Cardiovascular Society (CCS) functional grade was assessed in all patients, and a treadmill exercise test was performed sequentially (before and after the procedure) in angioplasty patients. Cronbach's alpha reliability coefficients for reduced DASI scores were high (between 0.81 and 0.89). Correlations of the reduced DASI scores with CCS grade and exercise test duration were moderately high (r = -0.51 and r = 0.45, respectively). Improvement after angioplasty as assessed by the reduced DASI scores was important (effect size = 0.75, P < 0.001). CONCLUSION: The reduced DASI is reliable, valid and responsive to clinical changes. Health-related quality of life measures may be useful in monitoring coronary patients.

Activities of Daily Living↗
PubMed1997

Clinical skills assessment with standardized patients.

Previous projects (Combell I & II) to assess clinical skills were conducted in medical schools in Catalonia, in order to introduce a model of such an assessment using standardized patients (SP). The aim of this study (Combell III) was to measure selected characteristics of our model. Seventy-three medical students in the final year at the Bellvitge teaching unit of the University of Barcelona participated in a clinical skills assessment (CSA) project that used 10 SP cases. The mean group scores for the four components of clinical skills for each day of testing were studied, and ratings for each student in the 10 sequential encounters were checked. The study also compared the clinical skills scores with their academic grades. The total case mean score (mean score of history-taking, physical examination and patient notes scores) was 51.9%, and the mean score for communication skills was 63.6%. The clinical skills scores over the 8 testing days showed no day-to-day differences. The study did not find differences among the sequential encounters for each student (training effect). There was a lack of correlation between clinical skills scores and academic grades. The project demonstrated the feasibility of the method for assessing clinical skills, confirmed its reliability, and showed that there is no correlation between scores with this method and academic examinations that mainly reflect knowledge.

Clinical Competence↗
PubMed1996

Epidemiological analysis of the association between two congenital anomalies in the same child: a method for adjusting nonspecific clustering.

Most of the methods proposed to analyze patterns of congenital anomaly clusters have been criticized because large observed/expected (O/E) ratios are obtained for many defect combinations, suggesting that the association of congenital defects is a generalized and nonspecific tendency. To avoid this problem, two methods have been proposed: (1) the analysis of the association of two defects in the subgroup of infants with only multiple congenital anomaly (MCA) patterns, and (2) a method for adjusting the O/E ratio for the nonspecific tendency of defects to cluster among themselves. However, neither of these methods analyzes the association of only two particular defects in a child who apparently has no other anomalies apart from the two that are being analyzed. Here we present a method that analyzes the association of two particular defects, when they are the only defects observed in the child. The method is tested on the Spanish Collaborative Study of Congenital Malformations (ECEMC) data base. The proposed method also controls for the tendency of nonspecific defect clustering.

Child↗
PubMed1996

Clinical/epidemiological analysis of congenital anomalies associated with diaphragmatic hernia.

Several studies have been published on congenital diaphragmatic hernia (CDH), either as an isolated defect or as part of a multiple congenital anomaly (MCA) pattern. Here we present an epidemiological study designed to measure the association between CDH and a group of 17 selected congenital anomalies in an attempt to identify groups of specific defect patterns. This analysis was done using the data from the Spanish Collaborative Study of Congenital Malformations (ECEMC).

Congenital Abnormalities↗
PubMed1996

Polymorphism analysis of the VNTR locus D17S5 in central Spain.

The fragment length polymorphism YNZ22 (D17S5) was analysed for a sample of 207 unrelated individuals living in Madrid (Spanish Caucasians) using PCR-methodology and high resolution separation. Hardy-Weinberg expectations (HWE) were calculated after pooling alleles into four groups. No deviations from HWE were detectable using the conventional chi 2-test. The power of discrimination was estimated as 0.96 and the mean paternity exclusion chance as 0.7587. A comparison of the allele frequency distribution with those of other Caucasian groups revealed no major differences.

Alleles↗
PubMed1996

Scaling the Spanish version of the Nottingham Health Profile: evidence of limited value of item weights.

The Nottingham Health Profile (NHP) is a measure of health status developed in Great Britain and adapted into Spanish. the objective of the study was to obtain item weights for the Spanish version and to compare them with those of the original instrument, to further asses the cross-cultural equivalence of the new version. The usefulness of using weights in obtaining scores for the Spanish version was also evaluated. Weights for the Spanish items were obtained using Thurstone's method of paired comparisons in a sample of 1123 individuals. Correlations between Spanish and English weights ranged from 0.72 to 0.93. A comparison between unweighted, weighted, and randomly weighted NHP scores was also performed. Results showed extremely high correlations between these scoring strategies, and a similar consistently satisfied using unweighted scores. Item weights comparison provided evidence of the cross-cultural equivalence of the adapted version. Nevertheless, the unweighted NHP scoring is recommended because weighted NHP items do not improve the psychometric properties of the instrument.

Adult↗
PubMed1996

Validity and reliability of the St George's Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example.

We describe the adaptation into Spanish of the St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire developed by Jones et al. (1991) covering three domains of health in airways disease patients: symptoms, activity and impacts. For the adaptation, the forward and back-translation method by bilinguals was used, together with professional committee and lay panel. Once tested for feasibility and comprehension, 318 male chronic obstructive pulmonary disease (COPD) patients with a wide range of disease severity completed the Spanish version of the SGRQ. The clinical status of the patients was evaluated concurrently with the measurement of health status. Lung function was assessed in the 2 months before or after the questionnaire administration. The Spanish version of the SGRQ was acceptable and easy to understand. Cronbach's alpha reliability coefficient was 0.94 for the overall scale and 0.72 for "Symptoms", 0.89 for "Activity", and 0.89 for "Impacts" subscales. Correlation coefficients between the overall score and dyspnoea and % forced expiratory volume in one second (FEV1) were 0.59 and -0.45, respectively, and these correlations were higher than those observed between the clinical variables and the Nottingham Health Profile, a generic measure of health-related quality of life. Results of the study suggest that the Spanish version of the SGRQ is conceptually equivalent to the original, and similarly reliable and valid. Although further studies should complete the adaptation work, results suggest that the SGRQ may already be used in Spain and in international studies involving Spanish respiratory patients. According to the present approach, it appears to be feasible to adapt a specific questionnaire on health-related quality of life in respiratory disease to another language and culture.

Cross-Cultural Comparison↗
PubMed1995

Chloroethylclonidine increases the incidence of lethal arrhythmias during coronary occlusion in anesthetized dogs.

We studied the role of alpha1-adrenoceptors in the modulation of ventricular tachycardia and fibrillation in chloralose-anesthetized dogs subjected to 30 min left anterior descending coronary artery occlusion. Study groups were control, and those treated with the alpha1-adrenoceptor-subtype blockers WB4101 (0.5 mg/kg i.v.) or chloroethylclonidine (1.9 mg/kg i.v.). For the first set of experiments all animals were in sinus rhythm and heart rate was slower in the chloroethylclonidine-pretreated animals than the WB4101-treated group (P < 0.05). During occlusion, ventricular tachycardia and ventricular fibrillation incidence did not differ among control, WB4101 or chloroethylclonidine (3 dogs with ventricular fibrillation in each group and 0, 2 and 3 dogs respectively with ventricular tachycardia), but ventricular premature depolarizations were significantly reduced by both interventions, and nonsustained ventricular tachycardia was suppressed by WB4101. In a second set of experiments, animals were atrially paced at a cycle length of 300 ms, and divided into control, WB4101-treated or chloroethylclonidine-treated, as above. Here, 9/10 chloroethylclonidine-treated animals developed ventricular tachycardia and fibrillation during occlusion, whereas only 4/10 controls and 4/10 WB4101-treated animals did so (P < 0.05). In conclusion, during sinus rhythm, both types of alpha1-adrenoceptor subtype blockade significantly suppressed ventricular premature depolarizations and neither affected ventricular tachycardia and fibrillation. In contrast, when heart rate was held constant, chloroethylclonidine clearly enhanced the occurrence of ventricular fibrillation during occlusion. These results suggest the alpha1-adrenoceptor subtype blocked by chloroethylclonidine, but not that blocked by WB4101, is capable of increasing the incidence of lethal arrhythmias that occur at rapid atrial rates during ischemia.

Adrenergic alpha-Antagonists↗
PubMed1995

[The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results].

BACKGROUND: The present study, performed within the International Quality of Life Assessment project (including researchers from 15 countries) presents preliminary results of the process of adaptation of the SF-36 to be used in Spain. METHODS: The adaptation was based on the translation/back-translation methodology. Meetings of translators, researchers and patients were organized in order to produce successive versions. A study involving 47 individuals was carried out to assess the relative value (through a visual analogue scale) of each response choice of the questionnaire items. Finally, internal consistency and reproducibility of the Spanish version of the SF-36 was assessed by administering the questionnaire to 46 patients with stable coronary heart disease in two different occasions 2 weeks apart. RESULTS: The average ratings of equivalence of the translated version with the original were high regardless of the difficulty of translation. The rank ordering of mean scores for each responses choice agreed with the ranking assigned in the questionnaire in all cases. Cronbach's Alpha was higher than 0.7 for all dimensions (range: 0.71-0.94) except for Social Functioning scale (alpha = 0.45). Intraclass correlation coefficients between both administrations of the questionnaire ranged from 0.58 to 0.99. CONCLUSIONS: The adaptation process of the SF-36 has concluded with an instrument apparently equivalent to the original and with an acceptable level of reliability. Nevertheless, other basic characteristics of the adapted questionnaire (i.e. validity and sensitivity to changes) should be also assessed.

Adult↗
PubMed1995

Relationship between airway responsiveness and peak expiratory flow variability in subjects with allergic rhinitis.

BACKGROUND: Previous studies have demonstrated an increase in diurnal variation of peak expiratory flow (PEF) in subjects with allergic rhinitis who had decreased methacholine PC20 values. The relationship between PEF variability and some indices of the concentration-response curve to methacholine such as the position and level of the maximal response-plateau has not been studied. OBJECTIVE: The study was carried out to determine differences in PEF variability between subjects with allergic rhinitis who showed plateaus on the concentration-response curves to methacholine at mild degrees of airway narrowing, and patients in whom no plateau was detected. METHODS: Forty-three nonasthmatic patients with allergic rhinitis were included in the study. Subjects underwent methacholine challenge tests with doubling concentrations from 0.39 to 200 mg/mL and measured their PEF three times daily for the next seven days, using mini-Wright peak flow meters. The concentration-response curves to methacholine were characterized by the threshold value (PC20 = provocative concentration required to produce a 20% fall in FEV1) and, if possible, by the position (EC50 = concentration of methacholine that produced 50% of the maximal response) and maximal response-plateau (FEV1 falls < or = 5% after at least three of the highest concentrations). The variability of PEF was expressed as the amplitude percent mean. RESULTS: No correlations were observed between amplitude percent mean and PC20 (r = -.23, NS), EC50 (r = -.07, NS), or level of plateau (r = .02, NS). The amplitude percent mean was higher in subjects who had decreased methacholine threshold values without plateau (geometric mean = 8.3%; range = 3.8% to 14.2%) than in subjects who had decreased threshold values and plateaus (geometric mean = 4.5%; range = 2.4% to 9.9%; P < .01), or subjects who had normal threshold values and plateaus (geometric mean = 4.4%; range = 1.6% to 10.8%; P < .01). Although subjects who had decreased threshold values and plateaus showed higher methacholine responsiveness than subjects with normal threshold values and plateaus (geometric mean PC20 = 6.2 mg/mL versus 107.1 mg/mL, P < .01; geometric mean EC50 = 3.1 mg/mL versus 9.1 mg/mL, P < .01; mean +/- SEM level of plateau = 17.2 +/- 1.8% versus 28.8 +/- 1.1%, P < .001), the difference in amplitude percent mean was not significant. CONCLUSIONS: The loss of plateau on the concentration-response curves to inhaled methacholine at mild degrees of airway narrowing identifies those subjects with allergic rhinitis who show a greater PEF variability. The PEF variability and airway responsiveness are not interchangeable terms.

Adult↗
PubMed1994

Holoprosencephaly associated with caudal dysgenesis: a clinical-epidemiological analysis.

We have studied 9 cases with the combination of some form of holoprosencephaly and any degree of caudal dysgenesis. The cases were identified through the Spanish Collaborative Study of Congenital Malformations (ECEMC). Of the 9 cases, 6 infants had an aneuploidy syndrome, one had Meckel syndrome, and 2 cases were of unknown etiology. We determined that the prevalence figure for the association of both conditions in the same child was 0.08 per 10,000 livebirths, and 18.8 times higher for stillbirths (i.e., 1.50/10,000). This prevalence is significantly higher than what would be expected by chance.

Abnormalities, Multiple↗
PubMed1994

The Spanish version of the Nottingham Health Profile: a review of adaptation and instrument characteristics.

The increased interest in measuring health status implies a need for instruments that are appropriate and valid. Adaptation of existing instruments may be a cost-effective strategy. In this paper we describe the adaptation into Spanish of the Nottingham Health Profile (NHP), a self-administered perceived health questionnaire developed in the UK. The characteristics of the adapted questionnaire (validity, reliability, and sensitivity to change), as well as current and purposed applications, are discussed. Some of the principles that were applied in the described adaptation process may be useful for similar future research: involving the investigators that developed the original instrument; using a panel of lay individuals in the translation process; testing the characteristics of the adapted instrument by replicating previous studies with the original instrument, and organizing an international group for the development and use of the European versions of the NHP. Adaptation of health status measures is an opportunity for gaining comparability when measuring health, and for learning about cross-cultural differences in health-related quality of life.

Adult↗
PubMed1994

[Relations between nonspecific bronchial hyperreactivity, diurnal variation of peak expiratory flow and medication requirements in patients with mild asthma].

To assess the relation between non-specific bronchial hyperreactivity, we recorded diurnal peak expiratory flow variation (PFV) and asthma symptoms in 36 individuals with mild allergic asthma. The patients were challenged with methacholine to induce decreases greater than 40% in FEV1, or until a maximum of 200 mg/ml had been administered. Over the next 14 days, PFV was measured three times per day and symptoms and inhaled salbutamol requirements were recorded. In the 11 patients with complete dose-response curves, the geometric mean of diurnal PFV variation (% mean range) was 5.0%; this parameter was 8.3% (p < 0.01) in the 25 subjects whose curves did not reach a plateau. A correlation (r = -0.56, p < 0.001) was found between PC20 and % mean range. PFV for the sample as a whole. In the 11 patients with complete curves, however, no correlation (r = -0.31, p = NS) between % mean range of PFV and PC20 was found. Nor could the plateau (r = 0.19, p = NS) or EC50 (r = -0.26, p = NS) be found for these patients. The geometric mean for PC20 in the 12 subjects who needed salbutamol throughout the 14-day study period after methacholine challenge was 1.06 mg/ml; this parameter was 1.32 mg/ml (p = NS) for those with no symptoms. A plateau was reached by 2 of the 12 patients who experienced asthma symptoms and in 9 of the 24 who were asymptomatic (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Modification of concentration-response curves to inhaled methacholine after the pollen season in subjects with pollen induced rhinitis.

BACKGROUND: The effect of cessation of exposure to pollen on the concentration-response curves to inhaled methacholine was investigated. METHODS: Methacholine inhalation challenges (up to 200 mg/ml) were performed in 13 non-asthmatic patients with grass and/or Parietaria pollen-induced rhinitis during the pollen season, and one and four months after it. Concentration-response curves were characterised by their PC20, position, and plateau. RESULTS: Geometric mean methacholine PC20 increased from 6.4 mg/ml during the pollen season to 28.2 mg/ml and 54.9 mg/ml one and four months after the end of season, respectively. The mean (SE) level of the plateau decreased from 30.5 (4.3%) in the pollen season to 23.3 (3.7)% and 20.1 (3.3)% one and four months after the end of pollen season, respectively. Although the methacholine concentration that produced 50% of the maximal response increased from 2.9 mg/ml to 4.3 mg/ml and 6.0 mg/ml, the differences were not significant. CONCLUSIONS: In non-asthmatic patients with pollen-induced rhinitis cessation of exposure to pollen is associated with significant modifications in the methacholine threshold value and level of plateau, and with a small shift in the concentration-response curves to the right.

Adult↗