Necesidad y uso de productos de apoyo y facilitadores arquitectónicos en población dependiente

ObjectiveTo describe the use and perception of the need for assistive devices and identify their relationship with instruments to measure dependence and caregiver burden.DesignCross-sectional study.LocationPrimary Health Care in the southern area of Pontevedra.ParticipantsA total of 112 informal caregivers providing care to 125 dependent persons.Key measurementsThrough a personal interview, data was collected on the use and perception of the need for these devices. In addition, sociodemographic data and information on the time dedicated to daily care, caregiver burden, the Dependency Rating Scale, and the DEP-6D dependency indicator were obtained. A contrast mean was used to identify whether there are significant differences in these indicators, depending on whether or not they use the facilitator devices. A logistic regression was performed to identify those variables most associated with not having a need covered.ResultsMore than half (60%: 95% CI; 50.9-68.7) of dependent persons have unmet needs for these devices. These needs are mainly associated with a low family income, a high degree of dependence, and better health of the caregiver; although in extreme situations of greater dependence and worse health of the caregiver these deficiencies are smoothed out.ConclusionsThere is a strong association between the level of dependence and the use of these devices. However, there is a high percentage of the sample that do not have the products that they need, which are associated with the socioeconomic situation of the household as well as with the characteristics of the dependent person and the caregiver.     

Consumo intensivo de alcohol y cannabis,y prácticas sexuales de riesgo en estudiantes universitarios

ObjectiveTo determine the incidence of unsafe sex among university students and its association with heavy episodic drinking (HED) and cannabis use.MethodA cohort study was carried out from 2005 to 2011 among university students of the Compostela Cohort (n = 517). HED was measured using the third question of the Alcohol Use Disorders Identification Test (AUDIT). Unsafe sex was considered to be sex under the influence of alcohol (SUA) and sex without a condom (SWC). Logistic regression models were created.ResultsThe incidence of SUA was 40.9% for women and 53.0% for men, while the SWC incidence ranged from 13.7% for women to 25.7% for men. HED and cannabis use were associated with SUA in both women (OR = 2.08, 95% CI: 1.03-4.21; OR = 2.78, 95%CI: 1.57-4.92) and men (OR = 4.74 (95%CI: 1.49-15.09; OR = 4.37, 95%CI: 1.17- 16.36). Moreover, cannabis use in women was associated with SWC (OR = 2.96, 95%CI: 1.52-5.75). The population attributable fractions of SUA for HED were 24.7% and 52.9% for women and men, respectively.ConclusionsHED and cannabis use represent a public health problem due to their association with a variety of problems, including engagement in unsafe sex. Our results suggest that a significant proportion of unsafe sex could be avoided by reducing this consumption pattern of alcohol.     

Grado de control metabólico y de factores de riesgo cardiovascular en pacientes con diabetes tipo 2 con y sin enfermedad cardiovascular

AimsTo determine the proportion of patients with type 2 diabetes with and without cardiovascular disease achieving the main cardiovascular goals.MethodsDesign: Cross-sectional study. Setting: A regional health district in a European country, Spain. Year: 2013. Participants: Adult patients diagnosed with type 2 diabetes with and without cardiovascular disease. Measurements: Study using secondary data obtained from electronic records of clinical history. Haemoglobin A1c, blood pressure, LDL cholesterol, smoking and medication were covered. n=49,658ResultsThe proportion of patients with diabetes achieving cardiovascular goals (among those with recent measurement) was: haemoglobin A1c 68.8% (CI95%:68.2%-69.4%), blood pressure 74.3% (CI95%:73.9%-74.7%), LDL cholesterol 59.8% (CI95%:59.0%-60.6%), tobacco 80.2% (CI95%:79.6%-80.8%). Only 40%-67% of patients has recent measurement. Only 48.0% (CI95%: 46.6%-49.4%) of patients who needed statins were receiving them. Higher proportion of patients with cardiovascular disease were achiving goals. Differences were small but significant.ConclusionsCardiovascular goals were measured in around half of patients with diabetes. Proportion of patients achiving cardiovascular goals were similar to published and best in patients with cardiovascular disease but it could improve. This points to prioritising interventions in this group of patients at very high risk, improving the implementation of guidelines and patient adherence.     

Cambios de regulación y de gobierno de la sanidad. Informe SESPAS 2014

The economic and fiscal crisis of 2008 has erupted into the debate on the sustainability of health systems; some countries, such as Spain, have implemented strong policies of fiscal consolidation and austerity. The institutional framework and governance model of the national health system (NHS) after its devolution to regions in 2002 had significant weaknesses, which were not apparent in the rapid growth stage but which have been clearly visible since 2010. In this article, we describe the changes in government regulation from the national and NHS perspective: both general changes (clearly prompted by the economic authorities), and those more specifically addressed to healthcare. The Royal Decree-Law 16/2012 represents the centerpiece of austerity policies in healthcare but also implies a rupture with existing political consensus and a return to social security models. Our characterization of austerity in healthcare explores impacts on savings, services, and on the healthcare model itself, although the available information only allows some indications. The conclusions highlight the need to change the path of linear, rapid and radical budget cuts, providing a time-frame for implementing key reforms in terms of internal sustainability; to do so, it is appropriate to restore political and institutional consensus, to emphasize «clinical management» and divestment of inappropriate services (approach to the medical profession and its role as micro-manager), and to create frameworks of good governance and organizational innovations that support these structural reforms.     

Burnout y malestar psicológico en los residentes de Medicina Familiar y Comunitaria

ObjectiveTo estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions.DesignCross-sectional study.LocationPrimary Care.ParticipantsOn-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%.Main measurementsPrevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use.Outcomes72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7)depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training.In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress.ConclusionsThe prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures.     

WebSurvCa: estimación vía web de las probabilidades de fallecimiento y de supervivencia de una cohorte

Relative survival has been used as a measure of the temporal evolution of the excess risk of death of a cohort of patients diagnosed with cancer, taking into account the mortality of a reference population. Once the excess risk of death has been estimated, three probabilities can be computed at time T: 1) the crude probability of death associated with the cause of initial diagnosis (disease under study), 2) the crude probability of death associated with other causes, and 3) the probability of absolute survival in the cohort at time T. This paper presents the WebSurvCa application (https://shiny.snpstats.net/WebSurvCa/), whereby hospital-based and population-based cancer registries and registries of other diseases can estimate such probabilities in their cohorts by selecting the mortality of the relevant region (reference population).     

Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil

ObjectiveTo compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil.MethodsA cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n = 2163) and two in Brazil (n = 2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country.ResultsThe determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care.ConclusionsIn both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care.     

Problemas de conducta infantil y competencias parentales en madres en contextos de violencia de género

Objective

To assess the behavioural problems of children who have been exposed to intimate partner violence situations, and the moderating effect of mother parenting.

Evaluación del paciente y medida de resultados

Both the initial evaluation and follow-up of patients with osteoarthritis require systematic evaluation of the indicators that provide information on the degree of involvement of the disease and allow its quantification. Reliable measures of disease progression help decision-making by clinicians and provide valid information on treatment response and the effectiveness of the distinct therapeutic interventions.The instruments recommended in research, as outcome measures in osteoarthritis, are pain evaluation, assessment of physical function, and self-reported global evaluation. In studies lasting more than 1 year, structural changes are evaluated through simple X-ray. Self-reported quality of life assessment and physician global assessment are also recommended as options. These indicators should be incorporated into routine clinical practice for adequate evaluation and correct follow-up of patients with osteoarthritis.The recommended pain evaluation method for use in clinical practice is the visual analog scale (VAS).The best instrument to evaluate physical function in patients with hip or knee osteoarthritis is the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index).For patient-reported global assessment in routine practice, the recommended scales are VAS or the SF-12 (12-item short-form health survey).     

Prevalencia de consumo de alcohol y factores de riesgo cardiovascular en un área sanitaria de Extremadura. Estudio Hermex

ObjectivesAlcohol has been associated with a lower risk of developing cardiovascular disease. It has been our objective to determine the prevalence of use of alcohol and its association with the presence of cardiovascular risk factors (CRF).DesignCross-sectional study.SettingDon Benito-Villanueva de la Serena health area (Badajoz).ParticipantsWe selected a random sample of 25 to 79 year olds, representative of the population.MethodsWe collected a survey about the history of cardiovascular risk factors and alcohol consumption in the previous seven days. We measured blood pressure and a fasting blood sample was obtained. The association of alcohol consumption with the different CRF was studied by multivariate analysis, adjusting for different variables.ResultsA total of 2833 subjects participated, with a mean age 51.2 (SD 14.7) years and 46.5% males. We detected 36.1% (95% CI 34.4 to 37.9) of alcohol consumers. The overall prevalence and consumption medium or high risk was 63.2% and 15.2% in men, and 12.6% and 1.5% in women, respectively. In men, consumption of medium-high risk was associated with hypercholesterolemia, hypertension and smoking. In women, low-risk consumption was associated with a lower prevalence of obesity and hypertension and higher smoking.ConclusionsWe found a lower prevalence of alcohol use, especially in women, compared to the Spanish national average. The consumption of medium-high risk mainly affects men and is associated with increased cardiovascular risk. In women at low risk consumption is associated with a lower prevalence of certain CRF and increased smoking.     

Estudio descriptivo y comparativo de factores de riesgo cardiovascular y actividad física en pacientes con síndrome coronario agudo

Aim

To analyse several cardiovascular risk factors by means of the physical activity performed by patients with acute coronary syndrome (ACS).