Prevalencia de síntomas depresivos y diagnóstico de sospecha de depresión en pacientes con EPOC

Objectiveto determine the prevalence of and predictive factors for depression in patients diagnosed with COPD and referred from primary care to pneumology departments, departments that share care for COPD patients.Designobservational, multicentric, prospective with non-probabilistic sample, transversal study.Settingtwo pneumology visit offices at two hospitals offering different levels of care.Participants293 patients diagnosed with COPD in a stable phase of the disease.InterventionsCarryng out common clinical questionnaires in COPD & HADS.Main measurementsDemographic, clinical, and functional variables of COPD, and HADS depression scale.ResultsIncluded were 229 men (78.16%) and 64 women (21.8%), with an average age of 68.2 ± 10.3 years of whom 93 (31.7%) were active smokers and 200 (68.3%) ex-smokers. 19.45% of patients had a previous diagnosis of clinical depression but the HADS test established a diagnosis of suspicion of depression in 32.6%. Predictive factors included: being female, living alone, and variables related to the severity of the disease (FEV1 postbronchodilator, being a high-risk patient, exacerbating phenotype criteria, and C and D GOLD criteria levels).ConclusionsThe prevalence of depression in patients with COPD is high and is infra-diagnosed. The HADS diagnostic test is useful for establishing a diagnosis of suspicion of depression at primary care and pneumology visit offices. There are personal and clinical factors that may be considered predictive and aid healthcare professionals in determining which patients should take the HADS test and, based on results, referring patients to the mental health department to confirm or reject the diagnosis.     

Síndrome de desgaste profesional en trabajadores de atención a la salud en el área sanitaria de Ceuta

ObjectiveThe aim of this study is to determine the levels of burnout among employees of health care workers in the Health Area of Ceuta (Spain).DesignPrevalence study.SettingCeuta Health Area (Primary and Specialty Care).ParticipantsA sample of 200 workers stratified by sex, job and workplace.MeasurementsThe tool used was the MBI (Maslach Burnout Inventory). We also studied personal (age, sex, marital status) and work variables (centre, job, age) and blood parameters (C-reactive protein and others).ResultsThe burnout syndrome was present in 17.2% of workers (95% CI: 10.4-26.0). There was a significant relationship with job, with differences in emotional exhaustion, depersonalisation, and professional achievement. C-reactive protein was significantly higher in workers with burnout.ConclusionsBurnout prevalence in the health care workers in our sample is similar to other studies. The differences between health and non-health workers could be due to greater motivation for professional achievement, but they scored higher in exhaustion and depersonalisation. The increase in C-reactive protein, a non-specific inflammation marker, seems to confirm the findings of other studies.     

Demora en el diagnóstico y tratamiento de 5 tipos de cáncer en 2 centros de salud urbanos

ObjectivesTo assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors.DesignObservational, retrospective, analytical cohort study.SitePrimary care. Two urban health centres.ParticipantsThree hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017.Main measuresThe medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed.ResultsMedian ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder.ConclusionsID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.     

Evolución del perfil clínico y pronóstico de pacientes con alta hospitalaria por insuficiencia cardíaca en las dos primeras décadas del siglo xxi. El Registro INCA-Ex

AimTo study the evolution of the clinical profile of a population discharged with a main diagnosis of heart failure (HF) in the first two decades of the century and the predictive variables of mortality and readmission in the first year of discharge.DesignObservational, retrospective, longitudinal study.SiteDon Benito Villanueva de la Serena Badajoz health area.ParticipantsAll patients discharged with a main diagnosis of HF between 2000 and 2019 in a general hospital complex were included.Main measurementsSociodemographic and clinical variables were collected, and a one-year follow-up; the result variable was a composite of mortality and/or readmission.ResultsA total of 4107 discharges were included, mean age 77.1 (SD ± 10.5) years, 53.1% women. The number of admissions, age, history of neoplasms, stroke, kidney failure, and anemia increased, as did readmissions (P for trends < .001), while mortality remained constant. Predictive variables for readmission and/or death were HR (95% CI): age (per year) 1.04 (1.03-1.04), diabetes: 1.11 (1.01-1.24), previous HF 1.41 (1.28-1.57), composite variable myocardial infarction, stroke and/or peripheral artery disease 1.24 (1.11-1.38), chronic obstructive pulmonary disease (COPD) 1.29 (1.15-1.44), neoplasia 1.33 (1.16-1.53), anemia 1.63 (1.41-1.86), chronic kidney failure 1.42 (1.26-1.60).ConclusionsIn the last 20 years, admissions for heart failure, patient age, and comorbidity have increased. Predictive variables for mortality and/or readmission were age, diabetes, previous cardiovascular disease, neoplasms, COPD, kidney failure, and anemia; however, mortality at one year remained constant.