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Introduction: Gastric cancer (GC) is the first cause of cancer-related death in Chile and 6 th in Latin America and the Caribbean (LAC). Helicobacter pylori (H. pylori) is the main gastric carcinogen, and its treatment reduces GC incidence and mortality. Esophageal-gastro-duodenoscopy (EGD) allows for the detection of premalignant conditions and early-stage GC. Mass screening programs for H. pylori infection and screening for premalignant conditions and early-stage GC are not currently implemented in LAC. The aim of this study is to establish recommendations for primary and secondary prevention of GC in asymptomatic standard-risk populations in Chile., Methods: Two on-line synchronous workshops and a seminar were conducted with Chilean experts. A Delphi panel consensus was conducted over 2 rounds to achieve>80% agreement on proposed primary and secondary prevention strategies for the population stratified by age groups., Results: 10, 12, and 12 experts participated in two workshops and a seminar, respectively. In the Delphi panel, 25 out of 37 experts (77.14%) and 28 out of 52 experts (53.85%) responded. For the population aged 16-34, there was no consensus on non-invasive testing and treatment for H. pylori, and the use of EGD was excluded. For the 35-44 age group, non-invasive testing and treatment for H. pylori is recommended, followed by subsequent test-of-cure using non-invasive tests (stool antigen test or urea breath test). In the ≥45 age group, a combined strategy is recommended, involving H. pylori testing and treatment plus non-invasive biomarkers (H. pylori IgG serology and serum pepsinogens I and II); subsequently, a selected group of subjects will undergo EGD with gastric biopsies (Sydney Protocol), which will be used to stratify surveillance according to the classification Operative Link for Gastritis Assessment (OLGA); every 3 years for OLGA III-IV and every 5 years for OLGA I-II., Conclusion: A "test-and-treat" strategy for H. pylori infection based on non-invasive studies (primary prevention) is proposed in the 35-44 age group, and a combined strategy (serology and EGD) is recommended for the ≥45 age group (primary and secondary prevention). These strategies are potentially applicable to other countries in LAC., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Cardiovascular disease secondary to atherosclerosis is the main cause of morbidity and mortality in the world. Cardiovascular risk stratification has proven to be an insufficient approach to detect those subjects who are going to suffer a cardiovascular event, which is why for years other markers have been sought to help stratify each individual with greater precision. Two-dimensional vascular ultrasound is a excellent method for vascular risk assessment., (Copyright © 2024 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: This study aimed to validate the IberScore cardiovascular risk model in a population attended in the primary care setting., Methods: A cohort of patients with no history of cardiovascular disease visited in a primary care center during the years 2008 and/or 2009 and followed up until 2018 was selected. Cardiovascular risk was calculated with the IberScore formula for all the subjects of the cohort and the model was calibrated, graphically represented by risk deciles the proportion of expected events and proportion of observed events at 10-year follow-up, stratified by sex. The area under the ROC curve was calculated to assess the discrimination of the model., Results: A total of 10,085 patients visited during the years 2008 and/or 2009 were included in the study. Men showed a mean 10-year risk of suffering a fatal or non-fatal cardiovascular events according to IberScore of 17.07% (SD 20.13), with a mean estimated vascular age of more than 4 years higher than the biological age; while women had a mean 10-year risk of 7.91% (SD 9.03), with an estimated vascular age of more than 2 years above the biological age. The area under the ROC curve showed a discrimination index of the model of 0.86 (95% CI 0.84-0.88) in men and 0.82 (95% CI 0.79-0.85) in women., Conclusion: IberScore model discriminates well in the population attended in primary care but the model overestimates the risk., (Copyright © 2023 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Gender-based violence is a serious public health problem and a violation of human rights. The vast scale of the problem indicates that it is necessary to advance in its primary prevention. The health sector has an important role to play, especially Primary Health Care, based on its community orientation and with the involvement of all members of the team. The intervention framework defined by the acronym "RESPECT", promoted by the World Health Organization, shows the 7 strategies that are currently promising to lead to reductions in gender-based violence, based on the best scientific evidence available to date. Using a participatory, life-cycle approach, promoting coordination and partnership across sectors, and implementing combined interventions are some of the guiding principles from which to work today., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

Objective: To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years., Design: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care., Setting: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid., Participants: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia., Method: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022)., Statistical Analysis: MC Nemar's test to compare the main variables between the study periods., Results: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05)., Conclusions: Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care., (Copyright © 2023 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Aims: During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events., Patients and Methods: The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended., Results: Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005)., Conclusions: The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications., (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The function to estimate lifetime cardiovascular risk -IBERLIFERISK- in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women., Objective: To recalibrate the current lifetime risk equation after extending the follow-up by 3 years., Methods: Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell's C index., Results: The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell's C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05)., Conclusions: The updated model continues to discriminate satisfactorily, although the model's calibration has not substantially improved with the new update., (Copyright © 2022 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone., Methods: A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list., Results: Two thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €., Conclusions: The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature., (Copyright © 2022 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The family structure and parenting are changing in society, sedentary lifestyle, the use of screens and social networks is increasing. Families and health professionals must learn to educate, adapting their health advice to the new social and digital environment., Materials and Methods: A survey was sent to the representatives of more than 5000 paediatricians to renew the Well Child Visits Programme of the Spanish Association of Primary Care Paediatrics (AEPap). Contributions from preventive programmes from Andalusia, the Balearic Islands and Asturias were incorporated. The different interventions and advice were distributed in nine age groups., Results: Part of the recommendations are based on the work of the PrevInfad group. It uses the methodology of evidence-based medicine and performs the evaluation and synthesis of the evidence in the proposed preventive activities. The AEPap considers that the Well Child Programme should be carried out by the paediatric team: the paediatrician and the nurse, thus enhancing specific skills. The WHO considers it essential to empower individuals, families, and communities to optimize their health by making them caretakers of themselves and others, equipping them with tools that protect their well-being., Conclusion: Hence, it was decided to capture the Well Child Programme in the format of a free APP for mobile devices, as an innovative and affordable method of disseminating child and adolescent health. Information is given on parenting advice for family members, for children and adolescents and describes health check-ups for health workers., (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Clinical studies show that patients with high cardiovascular risk are still far from reaching the therapeutic objectives, especially of the levels of LDL cholesterol. If the management of these patients in specialized units differs from other scenarios is known., Patients and Methods: 61 certified Lipid Units were selected in the Registry of Dyslipemias of the Spanish Arteriosclerosis Society for the collection of study data. The study included 3958 subjects >18 years of age who met the criteria for hypercholesterolemia (LDL cholesterol ≥160 mg/dL or non-HDL cholesterol ≥190 mg/dL) without familial hypercholesterolemia. A total 1,665 subjects were studied with a mean follow-up time of 4.2 years., Results and Conclusions: A total of 42 subjects had a cardiovascular event since their inclusion in the Registry, which represents 0.6%. There were no differences in the treatment used at follow-up, but 50% of the patients did not reach the therapeutic goals at the visit end of follow-up. An increase in the potency of the lipid-lowering treatment was observed, including PCSK9 inhibitors use in 16.7% of subjects with recurrences., (Copyright © 2022 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Cancer is a major cause of morbidity and mortality. Tobacco use, unhealthy diet, and physical inactivity are some of the lifestyle risk factors that have led to an increase in cancer. This article updates the evidence and includes recommendations for prevention strategies for each of the cancers with the highest incidence. These are based on the reduction of risk factors (primary prevention) and early diagnosis of cancer through screening and early detection of signs and symptoms, in medium-risk and high-risk populations. This update of the 2022 PAPPS has taken into account the vision of the National Health System Cancer Strategy, an update approved by the Interterritorial Council of the National Health System on January 2021 and the European Strategy (Europe's Beating Cancer Plan) presented on 4 February 2021., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Skin cancer deaths continue to rise despite the implementation of numerous preventive campaigns and programs. The aim of this systematic review was to evaluate reviews of primary and secondary skin cancer prevention strategies as reported over the past 10 years. We analyzed 63 systematic reviews and meta-analyses: 30 (46.6%) addressing primary interventions and 35 (55.6%) addressing secondary interventions. Two of the reviews covered both. The most widely reported primary prevention approaches were education programs (63.3%), followed by risk modeling to identify individuals at high risk for melanoma (17.6%), and the promotion of sunscreen use (11.8%). The most widely reported secondary prevention measures concerned imaging systems for early skin cancer detection (40%), smartphones and new technologies (22.9%), and visual diagnosis in population-based screening (17.4%). The most effective measures were primary prevention education programs to improve sun protection habits., (Copyright © 2022 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Cow's milk protein allergy (CMPA) is the most frequent food allergy in the first year of life. There is no clear consensus regarding its prevention. A recommendation to avoid CMP in the first week of life as a preventive measure in all infants, regardless of their atopic risk, has recently been published. The purpose of this document is to issue a recommendation on the use of extensively hydrolyzed CMP formulas in the first week of life for the primary prevention of CMPA., Methods: A group of experts was formed with members proposed by the Spanish Association of Pediatrics (AEP), the Spanish Society of Clinical Immunology and Allergology and Pediatric Asthma (SEICAAP), the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Society of Neonatology (SENEO). The group conducted a critical review of the evidence on the subject published in the last 10 years., Results: The search yielded 72 studies, of which 66 were rejected for not meeting the inclusion criteria. The final review included 6 documents: 3 clinical trials and 3 systematic reviews, 2 of them with meta-analysis. There was no evidence of a statistically significant reduction in the incidence of CMPA in the infants who received hypoallergenic formulae or exclusive breastfeeding., Conclusion: Based on the current evidence, it is not possible to draw clear conclusions about the effect of avoiding CMP in the first week of life for prevention of CMPA. Although there are data that suggest a certain beneficial effect of avoiding CMPA in atopic risk infants, these results are not conclusive enough to extend the recommendation to the general population., (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Coronary artery calcium (CAC) score improves the accuracy of risk stratification for atherosclerotic cardiovascular disease (ASCVD) events compared with traditional cardiovascular risk factors. We evaluated the interaction of coronary atherosclerotic burden as determined by the CAC score with the prognostic benefit of lipid-lowering therapies in the primary prevention setting., Methods: We reviewed the MEDLINE, EMBASE, and Cochrane databases for studies including individuals without a previous ASCVD event who underwent CAC score assessment and for whom lipid-lowering therapy status stratified by CAC values was available. The primary outcome was ASCVD. The pooled effect of lipid-lowering therapy on outcomes stratified by CAC groups (0, 1-100,> 100) was evaluated using a random effects model., Results: Five studies (1 randomized, 2 prospective cohort, 2 retrospective) were included encompassing 35 640 individuals (female 38.1%) with a median age of 62.2 [range, 49.6-68.9] years, low-density lipoprotein cholesterol level of 128 (114-146) mg/dL, and follow-up of 4.3 (2.3-11.1) years. ASCVD occurrence increased steadily across growing CAC strata, both in patients with and without lipid-lowering therapy. Comparing patients with (34.9%) and without (65.1%) treatment exposure, lipid-lowering therapy was associated with reduced occurrence of ASCVD in patients with CAC> 100 (OR, 0.70; 95%CI, 0.53-0.92), but not in patients with CAC 1-100 or CAC 0. Results were consistent when only adjusted data were pooled., Conclusions: Among individuals without a previous ASCVD, a CAC score> 100 identifies individuals most likely to benefit from lipid-lowering therapy, while undetectable CAC suggests no treatment benefit., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together., Objective: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR)., Material and Methods: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown., Results: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively., Conclusion: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM., (Copyright © 2022 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Implantable cardioverter-defibrillators (ICD) are a cost-effective alternative for secondary prevention of sudden cardiac death, but their efficiency in primary prevention, especially among patients with nonischemic heart disease, is still uncertain., Methods: We performed a cost-effectiveness analysis of ICD plus conventional medical treatment (CMT) vs CMT for primary prevention of cardiac arrhythmias from the perspective of the national health service. We simulated the course of the disease by using Markov models in patients with ischemic and nonischemic heart disease. The parameters of the model were based on the results obtained from a meta-analysis of clinical trials published between 1996 and 2018 comparing ICD plus CMT vs CMT, the safety results of the DANISH trial, and analysis of real-world clinical practice in a tertiary hospital., Results: We estimated that ICD reduced the likelihood of all-cause death in patients with ischemic heart disease (HR, 0.70; 95%CI, 0.58-0.85) and in those with nonischemic heart disease (HR, 0.79; 95%CI, 0.66-0.96). The incremental cost-effectiveness ratio (ICER) estimated with probabilistic analysis was €19 171/quality adjusted life year (QALY) in patients with ischemic heart disease and €31 084/QALY in those with nonischemic dilated myocardiopathy overall and €23 230/QALY in patients younger than 68 years., Conclusions: The efficiency of single-lead ICD systems has improved in the last decade, and these devices are cost-effective in patients with ischemic and nonischemic left ventricular dysfunction younger than 68 years, assuming willingness to pay as €25 000/QALY. For older nonischemic patients, the ICER was around €30 000/QALY., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Iron deficiency prevalence in infants is high. Therefore, iron supplementation has been recommended and specified as a program. This study aimed to determine the characteristics of the prescription of ferrous sulfate as a preventive therapy for iron deficiency anemia in young infants., Methods: We conducted a descriptive cross-sectional study of clinical records of young infants with eight visits per year. We analyzed a total of 287 records. The prescription characteristics included five criteria prescription indication, age at prescription, dosage, periodicity, and time. These characteristics were scored as follows 1 point when it was considered adequate and 0 when it was considered inadequate; the minimum possible score was 0, and the maximum possible score was 5 points. Statistical analysis included percentages and 95% confidence intervals (CI)., Results: The prescription pattern of ferrous sulfate as preventive therapy in infants under one year of age was indicated in 100% of the records reviewed. All five criteria were met in 18.1% of the reviewed records (95%CI 13.6-22.6). The lowest compliance corresponded to adequate dosage (29.2%; 95%CI 23.9-34.5). Age at prescription was correct in 75.9% (95%CI 70.9-80.9); duration of prescription was correct in 44.2% (95%CI 38.4-50.0), and periodicity was proper in 31.1% (95%CI 25.9-36.7) of the files reviewed., Conclusions: Compliance with the prescription of ferrous sulfate as a preventive measure for anemia in infants was not as expected; interventions are needed to reverse this behavior., (Copyright: © 2022 Permanyer.)

Introduction and Objective: This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention., Methods: This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until December 2017., Results: A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively., Conclusions: The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Objective: To describe pharmacological and non-pharmacological practices for delirium, carried out by psychiatry residents and psychiatrists in Colombia., Methods: An anonymous survey was conducted based on the consensus of experts of the Liaison Psychiatry Committee of the Asociación Colombiana de Psiquiatría [Colombian Psychiatric Association] and on the literature review. It was sent by email to the association members., Results: 101 clinicians participated. Non-pharmacological preventive measures such as psychoeducation, correction of sensory problems or sleep hygiene are performed by 70% or more. Only about 1 in 10 participants are part of an institutional multi-component prevention programme. The preventive prescription of drugs was less than 20%. Regarding non-pharmacological treatment, more than 75% recommend correction of sensory difficulties, control of stimuli and reorientation. None of the participants indicated that the care at their centres is organised to enhance non-pharmacological treatment. 17.8% do not use medication in the treatment of delirium. Those who use it prefer haloperidol or quetiapine, particularly in hyperactive or mixed motor subtypes., Conclusions: The practices of the respondents coincide with those of other experts around the world. In general, non-pharmacological actions are individual initiatives, which demonstrates the need in Colombian health institutions to commit to addressing delirium, in particular when its prevalence and consequences are indicators of quality of care., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

In recent years, the demographic transition has resulted in an aging population, which has increased the number of illnesses such as depression. Often, the family physician is the first contact with these patients, therefore, comprehensive patient management is essential, emphasizing the primary and secondary prevention of depression in the elderly population. From primary health care, all risk and protective factors related to depression should be comprehensively evaluated. Among the former, widowhood, disability, and chronic diseases stand out. Likewise, the diagnostic criteria must be known to provide timely treatment. And, on the other hand, knowing the appropriate treatment will reduce the symptoms of depression, suicidal behavior, relapse, or recurrence of symptoms. Treatment usually consists of psychotherapy, psychosocial interventions, antidepressants, and electroconvulsive therapy. Therefore, the objective of this review is to offer family physicians a guide on the primary prevention, secondary prevention, and treatment of depression in the elderly., (Copyright © 2020 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Cancer is a major cause of morbidity and mortality. Tobacco use, unhealthy diet, and physical inactivity are some of the lifestyle risk factors that have led to an increase in cancer. This article updates the evidence, and includes recommendations for prevention strategies for each of the cancers with the highest incidence. These are based on the reduction of risk factors (primary prevention) and early diagnosis of cancer through screening and early detection of signs and symptoms, in medium-risk and high-risk populations., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine possible differences in the incidence of cardiovascular events between dyslipidaemia patients older than 75 years treated with statins compared to those not treated with them, as primary prevention., Material and Methods: A retrospective cohort study was conducted in patients older than 75 years with dyslipidaemia in a health centre, between 2005 and 2015. The study included 329 patients (182 on treatment with statins and 147 with no lipid-lowering treatment) who met the inclusion criteria (patients older than 75 years, on treatment with statins for at least 3 years, or to have not had any lipid lowering treatment and as primary prevention). The study variables were all those considered as a risk factor in the latest cardiovascular risk guidelines, and the dependent variable was "cardiovascular event". A descriptive and inferential analysis was carried out for quantitative and qualitative variables, as well as a multivariate analysis using binary logistic regression., Results: The incidence of cardiovascular events in patients without treatment with statins was 15.93% (95% CI 11.15-21.80), and 37.42% (95% CI 29.87-45.45) in those that were taking them (P<.001). The RR was 2.35 (95% CI 1.58-3.48)., Conclusions: There are statistically significant differences, with an increase in the incidence of cardiovascular events in patients taking statins, compared to those who do not. It is currently considered whether real importance is being given to cholesterol levels in this patient group, as well as whether the prescription of statins in patients older than 75 years is suitable in primary prevention., (Copyright © 2020 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: The use of low-dose acetylsalicylic acid (LD-ASA) in primary prevention is a matter of controversy, but its magnitude is unknown in Spain. The aim of the study was to estimate the proportion of patients who are prescribed LD-ASA for primary prevention and to identify their characteristics., Methods: In a sample from the primary care database BIFAP we obtained the proportion of persons with prescriptions of LD-ASA over the period 2002-2015, excluding patients with any previous record of occlusive vascular disease, atrial fibrillation or cancer. The proportions were standardized to the Spanish population aged 40-99 years old. We identified the factors associated with the use of LD-ASA through a logistic regression and estimated its prevalence of use according to the presence of such factors., Results: The sample included 102,850 subjects; of which 6,198 were users of LD-ASA. The standardized prevalence of prescription was 2.21% at the start of the period and 3.57% at the end, and increased with age. The factors with the strongest associations were diabetes (OR=3.26; 95%CI: 3.07-3.47), dyslipidaemia (OR=2.08; 1.96-2.21), heart failure (OR=2.02; 1.72-2.37), and hypertension (OR=1.78; 1.67-1.90). Among diabetic patients older than 70 years with hypertension and dyslipidaemia, the prevalence of LD-ASA prescription was 33.7%., Conclusions: The prescription of LD-ASA for primary prevention in Spain over the study period was low in the general population, but high in older diabetic patients with additional risk factors. After years of controversy, it is time to realign the use of this drug in primary prevention according to recent guidelines., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Objective: To describe pharmacological and non-pharmacological practices for delirium, carried out by psychiatry residents and psychiatrists in Colombia., Methods: An anonymous survey was conducted based on the consensus of experts of the Liaison Psychiatry Committee of the Asociación Colombiana de Psiquiatría [Colombian Psychiatric Association] and on the literature review. It was sent by email to the association members., Results: 101 clinicians participated. Non-pharmacological preventive measures such as psychoeducation, correction of sensory problems or sleep hygiene are performed by 70% or more. Only about 1 in 10 participants are part of an institutional multi-component prevention programme. The preventive prescription of drugs was less than 20%. Regarding non-pharmacological treatment, more than 75% recommend correction of sensory difficulties, control of stimuli and reorientation. None of the participants indicated that the care at their centres is organised to enhance non-pharmacological treatment. 17.8% do not use medication in the treatment of delirium. Those who use it prefer haloperidol or quetiapine, particularly in hyperactive or mixed motor subtypes., Conclusions: The practices of the respondents coincide with those of other experts around the world. In general, non-pharmacological actions are individual initiatives, which demonstrates the need in Colombian health institutions to commit to addressing delirium, in particular when its prevalence and consequences are indicators of quality of care., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Lung cancer mortality is increasing in women. In Spain, estimates suggest that lung cancer mortality may soon surpass breast cancer mortality, the main cause of cancer mortality among women. The aim of this study was to estimate the proportion of women at high risk of developing lung cancer in a group of participants in a population-based breast cancer screening program., Methods: Cross-sectional study in a sample of women who participated in a population-based breast cancer screening program in 2016 in Hospitalet de Llobregat (n=1,601). High risk of lung cancer was defined according to the criteria of the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized lung cancer screening trial (NELSON)., Results: Around 20% of smokers according to NLST criteria and 40% of smokers according to NELSON criteria, and around 20% of former smokers according to both criteria, are at high risk of developing lung cancer. A positive and statistically significant trend is observed between the proportion of women at high risk and nicotine dependence measured with the brief Fagerström test., Conclusions: A high proportion of participants in this breast cancer screening program have a high risk of developing lung cancer and would be eligible to participate in a lung cancer screening program. Population-based breast cancer screening programs may be useful to implement lung cancer primary prevention activities., (Copyright © 2019 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

In primary health care only chronic pain surpass depression and anxiety in loss of quality-adjusted life years. More than 70% of people suffering from common mental disorders consulted their GPs for this reason. However, 'the declining halves rule' is a reality: less than 50% of primary care attendees with common mental disorders were correctly diagnosed, of these less than 50% received adequate treatment (pharmacological or psychological) and of these less than 50% patients were adherent. Collaborative models of common mental disorders care in primary health care have demonstrated their effectiveness through clinical trials; however, its implementation in a more general and real context is difficult and its effectiveness remains unclear. Risk algorithms have been developed and validated in primary health care to predict the onset and prognosis of common mental disorders; which are useful for their treatment and prevention. There is evidence that psychological and psychoeducational interventions (and possibly those of physical exercise) are effective for the primary prevention of common mental disorders, even in primary health care; although their effects are small or moderate. These interventions have a high potential to be scalable in schools, workplace and primary health care; in addition, when they are administered through information and communication technologies (e.g. by App), in self-guided or minimally guided programs, they have demonstrated their effectiveness for the treatment and prevention of common mental disorders. They are also very accessible, have low cost and contribute to the massive implementation of these interventions in different settings., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introducción: La utilidad de la aspirina en la prevención primaria es todavía objeto de controversia. Los avances médicos y la variabilidad del riesgo cardiovascular podrían explicar la heterogeneidad de los estudios publicados, y las poblaciones de alto riesgo tendrían mayor beneficio., Objetivo: Analizar los efectos de la aspirina en pacientes sin antecedentes cardiovasculares y evaluar los resultados de acuerdo con el riesgo cardiovascular de las poblaciones., Métodos: Se incluyeron estudios que evaluaron el uso de la aspirina en comparación con placebo en la prevención primaria. Se analizó la combinación de muerte cardiovascular, infarto agudo de miocardio (IAM) y accidente cerebrovascular (ACV) isquémico. El punto final de seguridad fue la combinación de ACV hemorrágico y sangrado mayor. Se clasificaron los estudios en riesgo bajo y moderado/ alto, de acuerdo con el número de episodios en la rama de placebo., Resultados: Se evaluaron 13 estudios (n = 164,225), ocho de riesgo cardiovascular bajo (n = 118,455) y cinco de moderado/alto (n = 45,770). Se observó una reducción del punto final combinado en el grupo de aspirina (OR 0.90; IC 95%, 0.85-0.94), sin diferencias en mortalidad cardiovascular (OR 0.94; IC 95%, 0.86-1.04). No se identificaron diferencias entre los subgrupos de riesgo. Se reconocieron mayores complicaciones hemorrágicas en el grupo de aspirina (OR 1.45; IC 95%, 1.32-1.60), sin diferencias entre los subgrupos de riesgo., Conclusión: La aspirina se relacionó con una leve disminución de IAM y ACV isquémico en términos absolutos, sin diferencias en la mortalidad cardiovascular. Esto, junto con el aumento de las complicaciones hemorrágicas, se traduce en una ausencia de beneficio clínico neto. El riesgo cardiovascular basal de la población no modificó los resultados., Background: The usefulness of aspirin in primary prevention continues to be the subject of debate. Medical advances and the variability of cardiovascular risk could explain the heterogeneity of the published studies. High risk populations would have greater benefit., Objective: Analyzing the effects of aspirin in patients without cardiovascular disease and evaluating the results according to the cardiovascular risk of the populations., Methods: Studies evaluating aspirin versus placebo in primary prevention were included. The primary endpoint was the combined cardiovascular death, acute myocardial infarction (AMI) and ischemic stroke. The final safety point was the combination of hemorrhagic stroke and major bleeding. The studies were classified into low and moderate/high risk, according to the number of events in the placebo arm., Results: Thirteen studies were evaluated (n = 164,225), eight of low cardiovascular risk (n = 118,455) and five of moderate/high risk (n = 45,770). There was a reduction of the combined endpoint in the aspirin group (odds ratio [OR] 0.90; 95% confidence interval [CI], 0.85-0.94), without differences in cardiovascular mortality (OR 0.94; 95% CI, 0.86-1.04). No differences were observed when comparing the risk subgroups. Greater hemorrhagic complications were observed in the aspirin group (OR 1.45; 95% CI, 1.32-1.60), without differences between the risk subgroups., Conclusion: Aspirin was associated with a slight decrease in AMI and ischemic stroke in absolute terms, with no differences in cardiovascular mortality. This accompanied by the increase in hemorrhagic complications, results in an absence of net clinical benefit. The baseline cardiovascular risk of the population did not affect the results., (Copyright: © 2020 Permanyer.)

Aspirin indication in primary prevention has been questioned in the last ten years due to the publication of several trials with neutral outcomes. In the last year, three research studies discussed in this review (ASCEND, ARRIVE, ASPREE) have weighed the benefit (cardiovascular events reduction) against the adverse effects (especially bleeding) in several situations such as general population with moderate cardiovascular risk, diabetics and elderly population. This review performs a detailed analysis of these trials and it also comments on a recent metanalysis that includes these projects along with others undertaken in the last 30 years. In addition, the current position of aspirin in primary prevention is established based on the latest evidence reviewed., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the effectiveness of the interventions to prevent a pregnancy in adolescence., Design: Systematic review., Data Sources: The following databases were consulted: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS, and IME, in order to identify interventions aimed at preventing a pregnancy in adolescence., Study Selection: A total of 24 primary investigations, in which an educational program to prevent a pregnancy in the adolescence was evaluated, were selected. The quality of the selected studies was assessed according to the CASPe scale., Results: Educational programs for the modification of the teenage pregnancy rate show inconclusive results, as there are 2 studies that find a reduction, and 2 that find that there are no significant changes. For secondary outcomes, it was found that educational programs are effective for increasing the knowledge level about sexuality and contraceptive methods and changing attitudes about the risk of a teenage pregnancy or the use of contraceptive methods. There are no statistically significant differences between the studies with a positive and negative outcome (P>.05) for any of the results analysed in this review., Conclusion: There is no a single intervention modality that is the most effective for prevention of a teenage pregnancy. More research is needed with a longitudinal approach that assess not only intermediate results, but also a modification in the pregnancy rate., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To ascertain the degree of lipidic control before the first cardiovascular accident in population attended during 2013 at Primary Care. To analyze the distribution of these events depending on control intervals of cholesterol LDL (LDL-chol), cholesterol HDL (HDL-chol) and triglycerides (TG)., Method: A multicentric cross-sectional, descriptive study on above 18-year-old people attended at the centres of the Primari Care Service (PCS) Baix Llobregat Nord, who had suffered a first cardiac or cerebral ischemic attack from 01/01/2013 to 31/12/2013. Variables collected included age,sex, smoking, high blood preassure,diabetes, dyslipidemia (DLP), obesity, total cholesterol (chol-tot), LDL-chol, HDL-chol, TG, systolic and diastolic blood preassure (SBP,DBP), IMC, HbA1c, atherogenic indices, REGICOR, drugs., Results: 379 affected people, among them 197 (52%) heart attack and 182 (48%) stroke (ictus). Two hundred and twenty-five (54.4%) males, diagnosis median age 68.9 years (DS 13.7), 71.2 (DS 14.4) in CV (p: .001). High blood preassure 214 (56.5%), diabetes 113 (29.8%), DLP 193 (50.9%). Cases in LDL<100-159: 88%, HDL≥40/50: 72.8%, TG<150: 71.3%. chol-tot average: 198.3 mg/dl (DS 40.2), LDL-chol:121 (DS 33.8), LDL-chol<130:170 (58.6%). HDL-chol average: 52.5 mg/dl (DS 15.4) and TG: 130.9 mg/dl (DS 73.2) (CI:139.5 [DS 84.2] vs. CV: 120.9 [DS 55.9] [p: .003]). Optimal chol-tot/HDL-chol 67%, optimal TG/HDL-chol 39.8%. CI:optimal chol-tot/HDL-chol male vs. female: 51.2% vs. 76.9% (p: .002); optimal TG/HDL-chol male vs. female: 28% vs. 53.8% (p: .004)., Conclusions: The quantity of events was similar in both cardiac and cerebral territories, whereas the median age in the diagnosis was a little higher in CV. High blood preassure, DLP and obesity are the most prevalent FRCV, and its control at primary prevention is improvable. Most of the cases were grouped in the LDL lipid ranges <100-159mg/dl, HDL ≥ 40/50mg/dl and TG <150mg/dl., (Copyright © 2019 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain., Methods: Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014., Results: A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index, a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure. The area under the curve receiver operating characteristic was 0.84 (95%CI, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles., Conclusions: The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women., (Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation., (Copyright © 2019 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Dementia is recognised as a public health problem with high incidence and prevalence, as well as an increase in its burden of disease and associated with mortality. The different treatments have not provided clinical results that modify the course of the disease or reduce its impact in terms of mortality or disability. This review indicates that it is feasible to avoid the development of dementia despite the fact that age continues to be an important non-modifiable risk factor. The control of widely recognised modifiable and aetiopathogenically-related factors can decrease the number of cases of dementia. Multimodal interventions focused on the control of these risk factors continue to show inconsistent results; therefore, new trials should be carried out in addition to applying the clinical precision medicine approach that provides evidence to improve public health decision-making in order to address this problem., (Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Fibrates are drugs that reduce triglycerides, elevate high-density lipoproteins, as well as decrease small, dense LDL particles. The results of a study have recently been published by the Cochrane Collaboration on fibrates efficacy and safety in the primary prevention of cardiovascular disease. This study includes a systematic review and a meta-analysis of 6 studies (16,135 patients) that evaluated the clinical benefits of fibrates compared to placebo use or other lipid-lowering drugs. This review showed evidence of a protective effect of the fibrates compared with placebo as regards a reduction 16% of a compound objective of death due to cardiovascular disease, non-fatal myocardial infarction, or non-fatal cerebrovascular accident (NNT: 112), and that reduce coronary morbidity and mortality by 21% (NNT: 125). In addition, fibrates could reduce previously established diabetic retinopathy. However, fibrates do not influence total mortality, or non-cardiovascular mortality. Its joint use with statins does not benefit patients without established cardiovascular disease, compared to the use of statins in monotherapy. Fibrates are safe, although they can elevate serum creatinine levels., (Copyright © 2018 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease., Methods: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers' Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored., Results: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed., Conclusions: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions., (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

To establish the ability of a potential biomarker to discriminate between diseased and healthy subjects, it is essential to know the intrinsic variability of the methods used to measure the biomarker. This aspect is especially important in the ultrasonographic measurement of carotid intima-media thickness, where submillimetric variations due largely to the unrecognized lack of precision in the ultrasonographic technique can have a significant clinical impact on the classification of cardiovascular risk. This article aims to present the evidence about the reproducibility of carotid intima-media thickness measured by ultrasonography to discuss whether the variability inherent in the technique can influence the potential of this parameter as a biomarker., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

A unique primary prevention effort, Strong Communities for Children (Strong Communities), focuses on changing attitudes and expectations regarding communities' collective responsibilities for the safety of children. Findings from a 6-year pilot of the initiative in South Carolina have shown promise in reducing child maltreatment, but efforts to adapt the initiative to different cultural contexts have been lacking. No models exist for adapting an initiative that takes a community-level approach to ensuring children's safety. Thus, this article addresses the gap by providing an overview of the original initiative, how the initiative was adapted to the Israeli context, and lessons learned from the experience. Building on conceptualizations of cultural adaptation by Castro et al. (Prevention Science, 5, 2004, 41) and Resnicow et al. (Ethnicity and Disease, 9, 1999, 11), sources of nonfit (i.e., sociodemographic traits, political conflict, government services, and the presence and role of community organizations) were identified and deep and surface structure modifications were made to the content and delivery. Ultimately, this article describes the adaption and dissemination of a community-based child maltreatment prevention initiative in Tel Aviv, Israel, and addresses researchers' calls for more publications describing the adaptation of interventions and the procedures that need to be implemented to achieve cultural relevance., (© 2015 Family Process Institute.)

Objective: To analyze the effect of an intervention with a Mediterranean diet supplemented with either extra virgin olive oil or nuts, on the fatty liver index (FLI), compared to a low-fat control diet., Methods: Participants of the PREDIMED-Malaga trial, free from cardiovascular disease at baseline, but with a high risk to develop it, were included in this study. Anthropometric measurements were assessed and blood samples were taken to calculate participants' FLI at study baseline and after one, 3, 5 and 6 years. Mixed linear models were used to explore the fixed effects of the 3 intervention groups on the FLI as well as their interaction with time., Results: A total of 276 participants were included in the study. Average participant age was 67 years, with 66% of participants being women. The baseline prevalence of NAFL was 57%. The change in the FLI of the control group increased significantly over time (1.13±0.41; P=.006). In the MedDiet+EVOO group, the time trend of the change in the FLI was similar to that of the control group, although it was seen to be lower (-3.90±1.9; P=.038). In the MedDiet+Nuts group, the trend was significantly lower than that of the control group (-1.63±0.62; P=.009). In the MedDiet+Nuts group, the trend of changes in participants' BMI was 0.100 points lower per year compared to the control group (P=.004). In the control group, the change in waist circumference increased significantly over time (0.61±0.16cm/year; P<.001) in contrast to the MedDiet+EVOO group, in which this variable remained stable (-0.51±0.22; P=.019)., Conclusions: A dietary intervention consisting of a Mediterranean diet could delay or slow down the natural progression of NAFL, thus, being beneficial for its prevention and treatment. However, further studies supporting these conclusions have yet to be carried out., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. Apart from these circumstances, a number of situations could lead to AKI, related to the administration of nephrotoxic drugs, intra-tubular deposits, the administration of iodinated contrast media, liver failure and major surgery (mainly heart surgery). In these cases, in addition to hydration, there are other specific preventive measures adapted to each condition., (Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Background and Objective: Estimating cardiovascular risk with SCORE is not recommended in persons over 65 years. SCORE investigators have recently published specific tables for older people (SCORE Older Persons [SCORE OP]). The aim of this study is to assess the impact of using SCORE OP tables on a Spanish population aged over 64 years, and compare it with the use of SCORE in patients aged 65-69 years., Patients and Method: Cross-sectional study carried out in 2 urban primary health care centres. Individuals between 65 and 85 years old without diabetes or established cardiovascular diseases were included. Cardiovascular risk using SCORE and the new SCORE OP tables for low risk countries was calculated., Results: Cardiovascular risk was estimated in 3,425 patients. Mean values of the original SCORE and SCORE OP were 4.08 and 3.83, respectively in the group of patients aged 65-69 years old (n=974, 22.44%) (P< .001). The percentage of patients at high or very high risk was 25.46% and 22.90% with the original SCORE and the SCORE OP, respectively (P<.001). Using the original SCORE, 16.43% of the total patients should potentially be treated with lipid lowering drugs, while using the SCORE OP, 13.45% of the patients aged 65-69 years should potentially be treated. Using SCORE OP in patients older than 69 years, 61.49% patients should potentially be treated with lipid lowering drugs., Conclusions: SCORE OP identifies fewer patients at high or very high risk than the original SCORE, therefore, its utilization would imply treating fewer patients of this age with lipid lowering drugs., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Several clinical risk scores have been developed to identify patients at high risk of all-cause mortality despite implantation of an implantable cardioverter-defibrillator. We aimed to examine and compare the predictive capacity of 4 simple scoring systems (MADIT-II, FADES, PACE and SHOCKED) for predicting mortality after defibrillator implantation for primary prevention of sudden cardiac death in a Mediterranean country., Methods: A multicenter retrospective study was performed in 15 Spanish hospitals. Consecutive patients referred for defibrillator implantation between January 2010 and December 2011 were included., Results: A total of 916 patients with ischemic and nonischemic heart disease were included (mean age, 62 ± 11 years, 81.4% male). Over 33.4 ± 12.9 months, 113 (12.3%) patients died (cardiovascular origin in 86 [9.4%] patients). At 12, 24, 36, and 48 months, mortality rates were 4.5%, 7.6%, 10.8%, and 12.3% respectively. All the risk scores showed a stepwise increase in the risk of death throughout the scoring system of each of the scores and all 4 scores identified patients at greater risk of mortality. The scores were significantly associated with all-cause mortality throughout the follow-up period. PACE displayed the lowest c-index value regardless of whether the population had heart disease of ischemic (c-statistic = 0.61) or nonischemic origin (c-statistic = 0.61), whereas MADIT-II (c-statistic = 0.67 and 0.65 in ischemic and nonischemic cardiomyopathy, respectively), SHOCKED (c-statistic = 0.68 and 0.66, respectively), and FADES (c-statistic = 0.66 and 0.60) provided similar c-statistic values (P ≥ .09)., Conclusions: In this nontrial-based cohort of Mediterranean patients, the 4 evaluated risk scores showed a significant stepwise increase in the risk of death. Among the currently available risk scores, MADIT-II, FADES, and SHOCKED provide slightly better performance than PACE., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

This article presents an overview of the work done over the past 12 years in a collaboration between the school communities at various primary and secondary schools and the practical experience managers working in the Preventive and Community Podiatry area of the Podiatry degree at the University of Seville (Spain). The article presents several strategies, which were carried out in the fields of Foot Health for All and Preventive and Community Podiatry as part of the Hermes Research Group (CTS-601) aimed at promoting general foot health. Foot examinations were conducted in a total of 4,630 school pupils, with foot problems being confirmed in 677 of them. Some 7,145 members of the school community were also helped, with these people being reached through educational activities around foot care. The aim of the initiative was to prevent foot damage among children, which could have a harmful impact on their quality of life as adults., (Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease (COPD) patients, and the effectiveness of the procedure., Methods: Retrospective population-based cohort study. On 31 December 2011, influenza vaccination history was retrieved from 899 patients with confirmed COPD selected by simple random sampling from all COPD patients in Cantabria (northern Spain). Severe exacerbations (hospitalization due to COPD exacerbation) and overall mortality during 2012 were treated as dependent variables. Odds ratios (OR) were estimated by logistic regression, adjusting for age, sex, smoking status, severity of COPD, and frequency of exacerbations during the previous year. Prevented fraction among the exposed (PFe-adjusted) was determined as a measure of impact., Results: Overall prevalence of influenza vaccination was 62.7%, but this rate fell in patients classified as more severe according to FEV1 (52.0%). Influenza vaccination showed a statistically significant protective effect against severe exacerbations in the following year: Ora: 0.54 (95%CI: 0.35-0.84); FPe-adjusted: 0.46 (95%CI: 0.16-0.65). A non-significant protective effect for overall mortality was observed: Ora: 0.76 (95%CI: 0.41-1.40). When stratified according to COPD severity (FEV1), the protective effect against risk of hospitalization was higher in more severe COPD patients: Ora: 0.23 (95%CI: 0.11-0.48); FPe-adjusted: 0.77 (95%CI: 0.52-0.89)., Conclusions: We found that influenza vaccination has a protective effect and reduces the risk of hospitalization due to exacerbations in the following year. Despite the evidence for protection, prevalence of vaccination was not optimal, especially in more severe COPD patients., (Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: Delirium is the most prevalent neuropsychiatric syndrome in the general hospital. Its presence is a marker of poor prognosis for patients. Its prevention could be the most effective strategy for reducing its frequency and its complications., Objective: To review recent findings and strategies for the prevention of delirium., Methodology: A non-systematic review of scientific articles published in the last ten years in Spanish and English. A search was made in databases such as MEDLINE, Cochrane, EMBASE, Ovid, and ScienceDirect, for articles that included the terms, delirium and prevention., Results: Identification of predisposing and precipitating factors for delirium and a better understanding of the pathophysiological mechanisms underlying the onset of delirium have enabled the implementation of various pharmacological and non-pharmacological strategies in patients at high risk to develop hospital delirium. The studies to prevent delirium have focused on surgical patients. The current evidence supports the daily implementation of non-pharmacological measures to prevent delirium, as they are easy and cost effective. The available evidence is still limited to recommend the daily use of pharmacological strategies in delirium prophylaxis, and there is a consensus against the modest use of antipsychotic drugs in surgical patients and dexmedetomidine in patients in intensive care., Conclusions: New high-quality clinical trials and studies involving non-surgical patients are needed to provide more evidence about this subject., (Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Objectives: India is the most malaria-endemic country in South-East Asia, resulting in a high socio-economic burden. Insecticide-treated or untreated nets are effective interventions to prevent malaria. As part of an Indian first-aid guideline project, we aimed to investigate the magnitude of this effect in India., Methods: We searched MEDLINE, Embase and Central to systematically review Indian studies on the effectiveness of treated or untreated vs. no nets. Parasite prevalence and annual parasite incidence served as malaria outcomes. The overall effect was investigated by performing meta-analyses and calculating the pooled risk ratios (RR) and incidence rate ratios., Results: Of 479 articles, we finally retained 16 Indian studies. Untreated nets decreased the risk of parasite prevalence compared to no nets [RR 0.69 (95% CI; 0.55, 0.87) in high-endemic areas, RR 0.49 (95% CI; 0.28, 0.84) in low-endemic areas], as was the case but more pronounced for treated nets [RR 0.35 (95% CI; 0.26, 0.47) in high-endemic areas, risk ratio 0.16 (95% CI; 0.06, 0.44) in low-endemic areas]. Incidence rate ratios showed a similar observation: a significantly reduced rate of parasites in the blood for untreated nets vs. no nets, which was more pronounced in low-endemic areas and for those who used treated nets. The average effect of treated nets (vs. no nets) on parasite prevalence was higher in Indian studies (RR 0.16-0.35) than in non-Indian studies (data derived from a Cochrane systematic review; RR 0.58-0.87)., Conclusions: Both treated and untreated nets have a clear protective effect against malaria in the Indian context. This effect is more pronounced there than in other countries., (© 2015 John Wiley & Sons Ltd.)

Objective: To develop and validate a questionnaire on the integral assessment of the habits and knowledge in personal hygiene in children between 7 to 12 years old in the educational, social and health environment., Design: Cross-sectional study for the validation of a questionnaire., Location: One primary and secondary school and one children's home in the Region of Murcia, Spain., Participants: A total of 86 children were included (80 from a primary and secondary school; 6 from a children's home), as well as 7 experts., Main Measurements: Content validation by experts; qualitative assessment; identify difficulties related to some questions, item response analysis, and test-retest reliability., Results: After the literature search, 20 tools that included items related to child body hygiene were obtained. The researchers selected 34 items and drafted 48 additional ones. After content validity by the experts, the questionnaire (HICORIN®) was reduced to 63 items, and consisted of 7 dimensions of child personal hygiene (skin, hair, hands, oral, feet, ears, and intimate hygiene). After with the children some terms were adapted to improve their understanding. Only two items had non-response rates that exceeded 10%. The test-retest showed that 84.1% of the items had between very good and moderate reliability., Conclusions: HICORIN® is a reliable and valid instrument that integrally assesses the habits and knowledge in personal hygiene in children between 7-12 years old. It is applicable in educative and social and health environments and in children from different socioeconomic levels., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Objective: To explore views about risky sexual behaviors and perceptions of HIV, and to propose interventions for preventing HIV infections in a group of men who have sex with men., Methods: We performed a qualitative study in a sample of 13 men who have sex with men, who were participating in an HIV-seronegative cohort, and who we contacted via saunas for the gay community in Barcelona (Spain). We performed in-depth semi-structured interviews, followed by content analysis., Results: Risky sexual behaviors were associated with masculinity related to strong sexual needs, certain sexual exchange venues (such as saunas, private parties and clubs), drug use, and a desire to experiment with risk and one's own sexuality. HIV infection was perceived as a normalized disease, although becoming infected was still associated with shame and guilt. Proposed interventions included raising awareness of what it is like to live with HIV, generating greater social alarm, incorporating new technologies in prevention, and intensifying activity at gay venues., Conclusions: The concept of masculinity plays a fundamental role in sexual practices among men who have sex with men. We suggest renewed innovation in preventive programs and incorporating the perception of risk and HIV infection from a gender perspective., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To determine nitrate concentrations in drinking water in a sample of Spanish cities., Material and Methods: We used ion chromatography to analyze the nitrate concentrations of public drinking water in 108 Spanish municipalities with more than 50,000 inhabitants (supplying 21,290,707 potential individuals). The samples were collected between January and April 2012. The total number of samples tested was 324., Results: The median nitrate concentration was 3.47 mg/L (range: 0.38-66.76; interquartile range: 4.51). The water from 94% of the municipalities contained less than 15 mg/L. The concentration was higher than 25mg/L in only 3 municipalities and was greater than 50mg/L in one., Conclusions: Nitrate levels in most public drinking water supplies in municipalities inhabited by almost half of the Spanish population are below 15 mg/L., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Asymptomatic carotid stenosis (ACS) is a common problem in daily clinical practice, and its management is still the subject of controversy. In contrast to symptomatic carotid disease, the main studies on surgical treatment of patients with ACS have shown only a modest benefit in the primary prevention of stroke. In addition, current medical treatment has drastically decreased the risk of stroke in patients with ACS. Selecting patients amenable to endovascular treatment and determining how and when to conduct the ultrasound follow-up of these patients are issues that still need resolving. This article analyzes two new studies underway that provide evidence for better management of ACS in daily clinical practice., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

The training strategies targeted at men so as to reflect on the cultural patterns of patriarchy are an alternative in the promotion of human rights, the prevention of violence towards women and the mainstreaming of gender equality in public policies. With a socio-critical pedagogical approach, we conducted a Training Certification Program in gender equality and gender-sensitive masculinities, for a group of 76 male civil servants and civic leaders in the Colombian city of Medellin, for the purpose of questioning their gender socialization in the patriarchal model, directed towards the development and execution of social, educational or communications projects. The projects proposed by the participants criticize the andro-centric, sexist and discriminatory discourses regarding women that circulate in a manner predominant in their academic, workplace and family ambits, with a gender political commitment and respect for diversity., (Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)