Effectiveness of a Physical Therapeutic Exercise Programme for Caregivers of Dependent Patients: A Pragmatic Randomised Controlled Trial from Spanish Primary Care.

Female family caregivers (FFCs) constitute one of the basic supports of socio-health care for dependence in developed countries. The care provided by FFCs may impact their physical and mental health, negatively affecting their quality of life. In order to alleviate the consequences of providing care on FFCs, the Spanish Public Health System has developed the family caregiver care programme (FCCP) to be applied in primary care (PC) centres. The effectiveness of this programme is limited. To date, the addition of a physical therapeutic exercise (PTE) programme to FCCP has not been evaluated. A randomised multicentre clinical trial was carried out in two PC centres of the Spanish Public Health System. In total, 68 FFCs were recruited. The experimental group (EG) performed the usual FCCP (4 sessions, 6 h) added to a PTE programme (36 sessions in 12 weeks) whereas the control group performed the usual FCCP performed in PC. The experimental treatment improved quality of life (d = 1.17 in physical component summary), subjective burden (d = 2.38), anxiety (d = 1.52), depression (d = 1.37) and health-related physical condition (d = 2.44 in endurance). Differences between the groups (p < 0.05) were clinically relevant in favour of the EG. The experimental treatment generates high levels of satisfaction.

[Economic evaluation of pneumococcal vaccination in adults aged over 65 years in Castilla y León (SPAIN)]. / Evaluación económica de la vacunación frente al neumococo en mayores de 65 años de Castilla y León.

INTRODUCTION: The burden of disease due to pneumonia in older adults has a major impact on health systems. The aim of this study is to carry out an economic evaluation of the vaccination strategy against Streptococcus pneumoniae using the 13-valent pneumococcal conjugate vaccine. MATERIAL AND METHODS: A simulated economic model has been developed in the form of a decision tree to evaluate the cost of the vaccination strategy in the population over 65 years of the Valladolid-East Health Area, versus non-vaccination, using a Monte Carlo probabilistic analysis. RESULTS: Streptococcus pneumoniae annually generates 557.24 cases of pneumococcal disease in the Valladolid-East Health Area, and 506.60 episodes have pneumonia symptoms. Vaccination of the cohort over 65 years of age is an efficient measure from the third year, with a cost per quality-adjusted life years (QALY) of 20,496.20 €. The number of QALYs gained in a decade is 86.07 and an amount of 216.252.89 € with this vaccination strategy would be saved. CONCLUSIONS: The evaluation of the different incremental costs (QALY,euros) in the years of follow-up, the pneumococcus vaccination program in people over 65 in Castilla y León is cost-effective.

[Burden of hospitalization for pneumonia in a Spanish tertiary hospital. Period 2009-2014]. / Carga de hospitalización por neumonía en un hospital terciario español. Período 2009-2014.

BACKGROUND: The aim of this paper is to estimate the burden of hospitalization for community-acquired pneumonia and pneumococcal pneumonia at a tertiary level hospital in the Spanish National Health System. METHODS: A retrospective study which compiles data from the Minimum Data Set using clinical codes of the International Code of Diseases, as well as the hospitalization rate index per thousand inhabitants, the hospitalization rate per thousand population, mortality and fatality rate, using as denominator the demographic data of the population of the Health Area. RESULTS: The discharge of 5758 episodes coded with CIE codes 480 to 486 related to pneumonia, indicates an hospitalization rate of 3.54 people hospitalized per 1000 inhabitants, 65.34 % of all hospital admissions occured in Internal Medicine Services and Pneumology. The average hospital stay per year is 16.63 days. The crude death rate is 69.15 per 100 000 inhabitants and the fatality rate is 19.56 % being higher in adults over 65 years. CONCLUSIONS: Despite the current therapeutic and preventive measures, the incidence and mortality of community-acquired pneumonia in adults remains high, which justifies the strengthening and awareness to address new strategies and prevention such as vaccination.

Introducción: el objetivo de este trabajo es estimar la carga de hospitalización por neumonía adquirida en la comunidad y neumonía neumocócica en un hospital de nivel terciario del Sistema Nacional de Salud Español. Métodos: estudio retrospectivo en el que se recogen los datos del Conjunto Mínimo de Datos Básicos que usa códigos clínicos del Código Internacional de Enfermedades, asi como el índice de hospitalización por mil habitantes, la tasa de hospitalización por mil habitantes, el índice de mortalidad y la tasa de letalidad, usando como denominador los datos demográficos de la población del Área de Salud. Resultados: la descarga de 5758 episodios codificados con los códigos CIE 480 a 486 relativos a neumonía, señalan un índice de hospitalización de 3.54 personas hospitalizadas por cada 1000 habitantes, 65.34% del total de ingresos hospitalarios se produce en los Servicios de Medicina Interna y de Neumología. La estancia media hospitalaria por año es de 16.63 días. La tasa bruta de mortalidad es de 69.15 cada 100 000 y la tasa de letalidad de 19.56%, siendo más elevadas en adultos mayores de 65 años. Conclusiones: a pesar de las medidas terapéuticas y preventivas actuales, la incidencia y la mortalidad por neumonía adquirida en la comunidad en adultos se mantienen elevadas, lo que justifica fortalecer y abordar nuevas estrategias de concienciación y prevención.

Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. / Evaluación de la obstrucción nasal mediante rinomanometría y escalas subjetivas y medición del éxito terapéutico médico y quirúrgico.

INTRODUCTION: Prospective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests. METHODS: Patients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed. RESULTS: A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327). CONCLUSIONS: The patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.