Comparación entre biodanza en medio acuático y stretching en la mejora de la calidad de vida y dolor en los pacientes con fibromialgia

ObjectiveTo determine the level of improvement, as regards pain, impact on fibromyalgia and depression, achieved by patients with fibromyalgia by comparing aquatic biodanza and stretching exercises.DesignRandomised controlled trial with two intervention groups.LocationFive health centres (Almeria).PatientsA total of 82 fibromyalgia patients between 18 and 65 years old, diagnosed by American College of Rheumatology criteria, were included, with 12 patients declining to take part in the study. The 70 remaining patients were randomly assigned to two groups of 35 patients each: aquatic biodanza and stretching exercises. Those who did not attend in at least 14 sessions or changed their treatment during the studio were excluded. The final sample consisted of 19 patients in aquatic biodanza group and 20 in stretching group. The limitations of the study included, the open evaluation design and a sample size reduced by defaults.Main measuresThe outcome measures were sociodemographic data, quality of life (Fibromyalgia Impact Questionnaire), pain (McGill-Melzack questionnaire; and Visual Analogue Scale), pressure algometry (Wagner FPI10 algometer) and depression (Beck Inventory). These were carried out before and after a 12-week therapy.ResultsThe mean age of the sample was 55.41 years. The mean period from diagnosis was 13.44 years. The sample consisted mainly of housewives. There were significant differences (P<.05) between groups, in pain (P<.01), fibromyalgia impact (P<.01), and depression (P<.04) after the treatment.ConclusionsThe biodanza aquatic exercises improve pain and quality of life in fibromyalgia patients.     

Efectividad de las intervenciones educativas para la prevención del embarazo en la adolescencia

ObjectiveTo assess the effectiveness of the interventions to prevent a pregnancy in adolescence.DesignSystematic review.Data sourcesThe 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 selectionA 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.ResultsEducational 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.ConclusionThere 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.     

Efectividad de un programa educativo de rehabilitación respiratoria en atención primaria para mejorar la calidad de vida,la sintomatología y el riesgo clínico de los pacientes con enfermedad pulmonar obstructiva crónica

Aim

To determine the impact of an educational program to improve the management of chronic obstructive pulmonary disease (COPD) that contributes to an increase of the quality of life, exercise capacity, level of dyspnoea, and clinical risk.

Efectividad de las intervenciones basadas en telemedicina sobre resultados en salud en pacientes con multimorbilidad en atención primaria: revisión sistemática

ObjectiveTo evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care.DesignA systematic review.Data sourcesINAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018.Study selectionInclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located.Data extractionDuplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis.ResultsFive articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included.ConclusionsThe relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care.     

Síntomas psicosomáticos como expresión del deterioro de la calidad de vida relacionada con la salud en adolescentes

Aim

To analyze, in a population of adolescents in school, the relationship between psychosomatic symptoms and the perception of health-related quality of life (HRQoL), differentiating by gender and age group.

El impacto de las primeras olas pandémicas de la COVID-19 en las personas mayores con demencia

Patients with dementia are in themselves more vulnerable, and have been especially affected by the effect of the COVID-19 pandemic, both directly due to the disease itself, and indirectly due to the deprivation of cognitive stimulation due to isolation social due to confinement.SARS-CoV-2 virus infection has given rise to a wide variety of symptoms, including neurological symptoms and especially delirium in the elderly with dementia. The virus has affected the central nervous system, both directly due to the neurotropism of the virus, and indirectly due to inflammation and tissue hypoxia of vascular origin.The different causes that have been able to lead, in the different waves prior to the omicron variant, to the significant increase in morbidity and mortality in patients with dementia, especially the elderly, are analyzed.     

Herramienta multidimensional para la medición de la calidad de la participación en salud

Health strategies, programs and activities have historically been the result of institutional practices with a limited participatory component. Traditionally, institutional action is mainly determined by the criteria of the political actors and, in the best of cases, by the criteria of healthcare professionals. New forms of governance for health equity advocate for the inclusion of the community in the design of strategies, programmes and activities in health. For this reason, a growing concern in the field of participation in health is the measurement of the participatory quality of new designs of institutional practices. This article aims to develop an operational proposal to design, measure or describe the scope in participatory terms of the health planning processes. The proposal elaborates six dimensions for the measurement and assessment of participatory process: inclusivity, information flow, deliberative quality, decision making, institutional commitment and community empowerment.     

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.     

Caída de la esperanza de vida en distritos de Madrid en 2020: relación con determinantes sociales

ObjectiveEstimating the decrease in life expectancy (LE) of the population of Madrid and its districts and its relationship with socioeconomic variables in the first year of the COVID-19 pandemic.MethodDeath records were obtained from the Municipal Register of inhabitants (Municipal Statistics Service). Based on Chiang II method, life expectancy at birth and at 65 years of age (LEB and LE65) were calculated, as well as their 95% confidence intervals both for men and women and their gross, net and minimum falls for each district in 2020 over 2019, their correlation with some socioeconomic variables distribution and the existence of multiple linear regression explicative models.ResultsIn 2020, deaths in Madrid increased by 46.1% compared with the previous year, the LEB was 79.31 years in men and 85.25 years in women, meaning a decrease of 3.67 and 2.56 years respectively (4.42% and 2.91%). All districts registered decreases in LE, with the largest decrease in men in Tetuan (4.72 years) and in women in Chamartín (3.91 years). The most affected were the southern districts, especially in men. Immigrant and people over 80 years old rates explained 24% of the drop in LE in men, using linear regression model.ConclusionsThe decrease in LE recorded in Madrid and its districts in 2020 is bigger than in Spain (1.6 years), takes us back to values of 2002 (LE65) and 2008 (LEB), has a sharper fall in the south and is territorially unequally distributed, according to socioeconomic variables and being associated with some of them.     

Comorbilidad de la depresión mayor con otros trastornos mentales comunes en pacientes de atención primaria

IntroductionPsychiatric comorbidity affects the impact, the prognosis and the management of depression.AimsTo determine the prevalence of other common mental disorders in patients with major depression and to analyse their associated comorbidities.DesignTwo-stage cross-sectional study: a) screening (Zung's Self-Rating Depression Scale); b) a standardised psychiatric interview.SettingsTen health centres in the province of Tarragona.PatientsA total of 906 consecutive patients were screened. In the second stage, the 209 patients who gave a positive result and 97 patients who gave a negative result (1/7 at random) were evaluated.AnalysisThe statistical analysis used weights that took into account the two-stage sampling. The frequency with which dysthymia, generalised anxiety disorder, panic disorder and somatisation disorder presented concomitantly with major depression was determined. The characteristics of the depressed patients were compared for different degrees of comorbidity.ResultsIn 45.7% (95% CI, 32.8–59.2) of patients with major depression there was one other coexisting mental disorder, in 19.9% (95% CI, 13.7–27.9) two more mental disorders and in 8.3% (95% CI, 4.5–14.8) three more mental disorders. Generalised anxiety disorder was present in 55.2% of depressed patients (95% CI, 41.6–68), panic disorder in 33.8% (95% CI, 21.1–47.1), dysthymia in 15.7% (95% CI, 10.3–23.4) and somatisation disorder in 6.6% (95% CI, 3.3-12.8). In the groups of patients with comorbidity, the depression was more severe and had a greater functional impact. There were no differences in the clinical management variables.ConclusionsPsychiatric comorbidity of depression is common in primary care. Most depressed patients suffer from other disorders, often anxiety.     

Aplicación del benchmarking en la gestión de la cadena de aprovisionamiento sanitaria: efectos sobre el coste y la calidad de las compras

ObjectiveHealthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement.MethodsData were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products.ResultsThe use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%.ConclusionsThe use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality.     

¿Es útil la implantación de programas de gestión clínica de los pacientes con enfermedad pulmonar obstructiva crónica? Comparación de la efectividad de dos intervenciones sobre la evolución clínica y la atención recibida

Objective

To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD).

Metodología de conciliación del tratamiento farmacológico en pacientes pluripatológicos

ObjectiveTo carry out a bibliographic review in order to identify the different methodologies used along the reconciliation process of drug therapy applicable to polypathological patients.DesignWe performed a literature review.Data sources The bibliographic review (February 2012) included the following databases: Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME). The different methodologies, identified on those databases, to measure the conciliation process in polypathological patients, or otherwise elderly patients or polypharmacy, were studied.Study selection Two hundred and seventy three articles were retrieved, of which 25 were selected.Data extraction Specifically: the level of care, the sources of information, the use of registration forms, the established time, the medical professional in charge and the registered variables such as errors of reconciliation.ResultsMost of studies selected when the patient was admitted into the hospital and after the hospital discharge of the patient. The main sources of information to be highlighted are: the interview and the medical history of the patient. An established time is not explicitly stated on most of them, nor the registration form is used. The main professional in charge is the clinical pharmacologist. Apart from the home medication, the habits of self-medication and phytotherapy are also identified. The common errors of reconciliation vary from the omission of drugs to different forms of interaction with other medicinal products (drugs interactions).ConclusionsThere is a large heterogeneity of methodologies used for reconciliation. There is not any work done on the specific figure of the polypathological patient, which precisely requires a standardized methodology due to its complexity and its susceptibility to errors of reconciliation.