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INTRODUCTION AND PURPOSE: The purpose was to analyze socioeconomic and clinical factors of psychosocial functioning and self-perception in relation to health-related quality of life (HRQOL) in people with severe mental health illness (SMI) by gender. MATERIALS AND METHOD: A cross-sectional study was conducted on a sample of 133 women and 90 men. Recorded variables: HRQOL, SF-36 Physical Component Scores (PCS) and Mental Component Scores (MCS); sociodemographic and clinical data on psychosocial and self-perception functioning. Correlational studies using raw and adjusted linear regression models to evaluate the factors associated with HRQOL by obtaining coefficients, p-values and respective confidence intervals. RESULTS: The mean PCS for women and men was 44.6 and 49.0 (p = 0.004) and 36.4 and 37.5 (p = 0.575), respectively for MCS. The factors associated with PCS in women were age, -0.2(-0.4:0); in work, 4.2(0.3:8.2); with an income higher than 700 euros/month, 4.4(1:7.7). In men, these factors were education level, 6.1(0.4:11.7); belief that they would not need help in the future, 4.6(0.1:9.2) and a higher need for psychosocial services, -6.6(-11.1:-2). Factors associated with MCS in women were, in work, 6.1(1.5:10.7); and having a high number of friends, 6.6(2.1:11.1). In men, these factors were, living alone, -7.1(-12.7:-1.4); lack of economic benefits, 8.5(3.2:13.8); and a higher need for psychosocial and social services, -3.6(-7.1:-0.2) and -7.7(-13.4:-2). CONCLUSIONS: The dimensions affected and the factors that are associated with HRQOL for people with SMI differ by gender. Therefore, these differences should to be taken into account when designing interventions for improving HRQOL.

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OBJECTIVES: To assess the effect of sound isolation versus music on the comfort of mechanically ventilated patients admitted to the intensive care unit (ICU) as a combined measurement of the hypnotic level, the level of sedation and the alteration of behaviour because of pain. INTRODUCTION: Patients admitted to the ICU who require mechanical ventilation are surrounded by an ambient noise level ranging from 60 to 90 dB, well above the 40 dB recommended by the World Health Organization (WHO). METHODS: This was a randomized crossover clinical trial. Group A: sound isolation (1 h) followed by music (1 h); Group B: music (1 h) followed by sound isolation (1 h). Interventions were administered using noise-cancelling headphones. The hypnotic level, the level of sedation and the alteration of behaviour because of pain was assessed using the bispectral index (BIS), the Ramsay scale and the behavioural pain scale (BPS), respectively. Statistical analysis of correlated data was performed using a generalized estimating equations (GEE) model. RESULTS: Of 130 patients assessed for eligibility, 82 were randomized to Groups A (n = 40) or B (n = 42). Mean age was 69 years (SD = 14), and 77·3% were men. A decrease of 4-5 points out of 100 during sound isolation and music therapy was recorded in BIS in both groups; the differences were not statistically significant compared with baseline scores. Likewise, no differences were observed in the scores obtained in the Ramsay scale and BPS. CONCLUSIONS: Sound isolation and music intervention did not modify the comfort or physiological variables of mechanically ventilated critical patients from their respective baseline values. RELEVANCE TO CLINICAL PRACTICE: Music and sound isolation are potential strategies that could be used in nursing care to provide comfort to critical patients. Further studies should be undertaken to define the role of these new approaches and determine which groups of patients can benefit most from music or sound isolation.

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OBJECTIVES: To determine the relationship between quality of life (QOL) and environmental factors of temperature, noise, and lighting in nursing home residents with severe dementia. DESIGN: Cross-sectional, observational, analytical. SETTING: Eight public, long-term care nursing homes in the province of Girona, Spain. PARTICIPANTS: Random sample of 160 nursing home residents with severe dementia. MEASUREMENTS: Functional and cognitive impairment, pain, neuropsychiatric disturbances, and QOL were determined using standardized instruments. Temperature, noise, and lighting in bedrooms, dining rooms, and living rooms were measured in the morning and afternoon using a multifunction environment meter in a standardized manner. RESULTS: Adjusted multivariate linear regression models demonstrated that environmental measures were independently associated with QOL and related factors. High temperature in the bedroom was associated with lower QOL (standardized ß = 0.184), high noise levels in the living room were associated with low behavioral signs of social interactions (ß = 0.196), and low lighting levels in the bedroom were associated with number of signs of negative affective mood (ß = -0.135). CONCLUSION: The QOL of nursing home residents with severe dementia was related to environmental factors such as temperature, noise, and lighting. The monitoring of these environmental factors may improve these individuals' QOL.

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PURPOSE: The aim of the study was to develop a cross-cultural adaptation and to evaluate the validity and reliability of a Spanish version of the Quality of Life in Late-Stage Dementia (QUALID) scale. METHODS: Observational and cross-sectional validation study. The QUALID was translated according to standardised procedures. Internal consistency was assessed using Cronbach's alpha. The QUALID structure was assessed using a Principal Component Analysis (PCA). Inter-respondent (one rater asking two respondents) and inter-rater (two raters asking one respondent) reliability was assessed using the Intraclass Correlation Coefficient (ICC). The criterion validity (concurrent) was assessed by Spearman's correlation between the QUALID score and the QoL-Visual Analogue Scale (QoL-VAS) score. The construct validity (convergent) was assessed by Spearman's correlations between QUALID score and scores on the Pain-Visual Analogue Scale (Pain-VAS), on the Mini-Mental State Examination (MMSE) and on the Neuropsychiatric Inventory-Nursing Home (NPI-NH). RESULTS: A total of 160 elderly residents and 152 respondents at 8 long-term care centres in the province of Girona (Spain) participated in the study. Results showed satisfactory levels of internal consistency (Cronbach's alpha coefficients 0.74) and evidenced the multidimensionality of the scale. Three factors were identified (behavioural signs of discomfort, behavioural signs of social interaction and signs of negative affective mood). Acceptable inter-respondent reliability (ICC = 0.74) and high inter-rater reliability (ICC = 0.95) were found. The QUALID score was associated with the QoL-VAS score, suggesting a good concurrent criterion validity, and also with the Pain-VAS, the MMSE and the NPI-NH scores, suggesting good construct validity. CONCLUSIONS: Our evaluation of the psychometric properties of the Spanish version of the QUALID indicates that it is a reliable and valid instrument with an adequate capacity to distinguish between different clinical status.

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OBJECTIVES: To assess the prevalence of suspected elder abuse subtypes and to identify related factors. DESIGN: Cross-sectional, population-based, descriptive study. SETTING: Eight rural villages in Girona, Spain. PARTICIPANTS: Six hundred seventy-six inhabitants aged 75 and older. MEASUREMENTS: All participants were interviewed in their homes using the study protocol, which includes an abuse screen used in previous elder abuse studies and questions about demographic, social, physical, psychiatric, cognitive, and social services variables. RESULTS: The mean age of the participants was 81.7 +/- 4.8; 58.2% were female. Prevalence of suspected neglect abuse was 16.0% (95% confidence interval (CI)=13.2-18.9), prevalence of psychosocial abuse was 15.2% (95% CI=12.8-18.2), prevalence of financial abuse was 4.7% (95% CI=3.0-6.4) and prevalence of physical abuse was 0.1% (95% CI=0.004-0.8). Psychosocial abuse was positively associated with depressive symptoms (odds ratio (OR)=1.65, 95% CI=1.01-2.72), social isolation (OR=0.35, 95% CI=0.18-0.69), and frequent bladder incontinence (OR=2.44, 95% CI=1.23-4.86). Neglect abuse was positively associated with social isolation (OR=0.52, 95% CI=0.27-0.99), use of social services (OR=1.83, 95% CI=1.05-3.20), and living arrangements (OR=5.29, 95% CI=2.65-10.56). Financial abuse was associated with marital status (OR=0.15, 95% CI=0.04-0.59), age 85 and older, (OR=3.84, 95% CI=1.70-8.68), and Mini-Mental State Examination score (OR=0.85, 95% CI=0.78-0.94). CONCLUSION: After adjustment for confounding factors, each subtype of suspected elder abuse was associated with different variables. The results of this study suggest that elder abuse cannot be analyzed as a unitary concept and that risk factors must be assessed for each abuse subtype.

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BACKGROUND: High prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain. DESIGN: Comparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain. METHODS: An electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age. RESULTS: A total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol >3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiovascular risk factors. In 1995, 2000 and 2005, low-density lipoprotein cholesterol decreased in both men and women: 4.05-3.91-3.55 mmol/l (156-151-137 mg/dl) and 3.84-3.81-3.40 mmol/l (148-147-131 mg/dl), respectively. Increases were observed in lipid-lowering drug use (5.7-6.3-9.6% in men and 4.0-5.8-8.0% in women), controlled hypertension (14.8-35.4-37.7% in men and 21.3-36.9-45.0% in women); (all P-trends <0.01), and obesity (greatest for men: 17.5-26.0-22.7%, P-trends=0.020). Prevalence of myocardial infarction or possibly abnormal Q waves in electrocardiogram also increased significantly (3.9-4.7-6.4%, P-trends=0.018). CONCLUSIONS: The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs.

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Physiological and pathological processes differ in men and women, depending on factors such as sex and sociological and anthropological characteristics. However, many diseases are still approached from a masculine point of view. In this respect, ischemic heart disease is one of the diseases that most clearly reflects biological differences and social inequalities. In women, the disease presents at a more advanced age, and presentation is frequently atypical with a higher prevalence of comorbidities and greater severity. Consequently, treatment and outcome differ from those in men. Additionally, women differ in their knowledge, and beliefs regarding ischemic heart disease, as well as in their attitudes at symptom onset. Therefore, clinical practice should place significant emphasis on all these aspects in order to avoid inequalities between men and women in the correct diagnosis, treatment, prevention, and rehabilitation of ischemic heart disease.

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Tanto el sexo como los aspectos sociológicos y antropológicos relacionados con el género son factores que contribuyen a particularizar los procesos fisiológicos y patológicos de mujeres y hombres. Sin embargo, el abordaje integral de muchas enfermedades se realiza desde la perspectiva masculina. En este sentido, la cardiopatía isquémica (CI) es una de las enfermedades donde se pueden ejemplificar claramente las diferencias biológicas y las desigualdades sociales. Las mujeres presentan la enfermedad en edades más avanzadas que los hombres, la forma de aparición es más frecuentemente «atípica» y está asociada con una mayor comorbilidad y gravedad. Por tanto, el tratamiento y el pronóstico es diferente. Además, también se han observado diferencias en relación con el conocimiento y las creencias sobre la enfermedad, así como en las actitudes adoptadas cuando aparecen los primeros síntomas. Es preciso tener en cuenta todos estos aspectos biológicos y de género porque frecuentemente ocasionan desigualdades entre los hombres y las mujeres, tanto en relación con el diagnóstico certero de la CI como en el tratamiento, la prevención o la rehabilitación posterior (AU)

Physiological and pathological processes differ in men and women, depending on factors such as sex and sociological and anthropological characteristics. However, many diseases are still approached from a masculine point of view. In this respect, ischemic heart disease is one of the diseases that most clearly reflects biological differences and social inequalities. In women, the disease presents at a more advanced age, and presentation is frequently atypical with a higher prevalence of comorbidities and greater severity. Consequently, treatment and outcome differ from those in men. Additionally, women differ in their knowledge, and beliefs regarding ischemic heart disease, as well as in their attitudes at symptom onset. Therefore, clinical practice should place significant emphasis on all these aspects in order to avoid inequalities between men and women in the correct diagnosis, treatment, prevention, and rehabilitation of ischemic heart disease (AU)

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