Evaluation of antimicrobial persistent activity of alcohol-based hand antiseptics against bacterial contamination.

The purpose of this study was to evaluate persistent activity of three alcohol-based antiseptics widely used in the clinical routine containing chlorhexidine, triclosan or mecetronium after hand disinfection. Four tests were used to evaluate the antimicrobial activity of antiseptics on: (i) resident microbiota; (ii) nutrient agar plates (NAP) subsequently inoculated with a test organism; and transient microbiota acquired by contact with dry hands (iii), or (iv) a wet inert surface that had been artificially contaminated. Four reference strains (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis) and an Acinetobacter baumannii strain responsible for a hospital outbreak were used as transient microbiota. Antimicrobial activity was calculated according to the CFUs reduction by reference to non-disinfected control hands. The antiseptics were applied according to European Standard EN1500. Solutions containing chlorhexidine or triclosan showed some persistent effects on transient microbiota on inert humid surfaces and NAP, but not on contaminated dry hands. Solutions containing mecetronium showed no persistent effect on transient flora in any of the trials. All alcohol-based antiseptics tested were more effective against resident flora than soap. No persistent activity was observed for A. baumannii in any of the trials. Chlorhexidine and triclosan are preferred when an antiseptic with persistent activity is desired, but a moist environment appears to be necessary for that antibacterial activity. Accordingly, relevant conclusions regarding the persistent activity of antiseptics for clinical practice and protection against bacterial contamination cannot be derived from this study for the alcoholic solutions tested.

An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease. / Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. PATIENTS AND METHODS: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. RESULTS: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. CONCLUSIONS: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services.

Health-related quality of life in caregivers of patients with Alzheimer's disease. / Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Informal caregivers of patients with Alzheimer's disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. METHODS: Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients' clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. RESULTS: At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for 'physical function' and 'social function'. Baseline scores in our sample were lower than those of the general population. 'Vitality' is the dimension that presented the lowest scores. CONCLUSION: HRQOL in caregivers of patients with Alzheimer's disease deteriorates over time and is poorer than that of the age- and sex-matched general population.

Dietary total antioxidant capacity and mortality in the PREDIMED study.

PURPOSE: The aim of the present study was to assess the association between the dietary total antioxidant capacity, the dietary intake of different antioxidants and mortality in a Mediterranean population at high cardiovascular disease risk. METHODS: A total of 7,447 subjects from the PREDIMED study (multicenter, parallel group, randomized controlled clinical trial), were analyzed treating data as an observational cohort. Different antioxidant vitamin intake and total dietary antioxidant capacity were calculated from a validated 137-item food frequency questionnaire at baseline and updated yearly. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were fitted to assess the relationship between dietary total antioxidant capacity and mortality. Dietary total antioxidant capacity was estimated using ferric-reducing antioxidant power assays. RESULTS: A total of 319 deaths were recorded after a median follow-up of 4.3 years. Subjects belonging to the upper quintile of antioxidant capacity were younger, ex-smokers, with high educational level, and more active and had higher alcohol intake. Multivariable-adjusted models revealed no statistically significant difference between total dietary antioxidant capacity and mortality (Q5 vs. Q1 ref HR 0.85; 95% CI 0.60-1.20) neither for the intake of all the vitamins studied. CONCLUSIONS: No statistically significant association was found between antioxidant capacity and total mortality in elderly subjects at high cardiovascular risk.

Does the Mediterranean diet counteract the adverse effects of abdominal adiposity?

BACKGROUND AND AIM: We tested the hypothesis that an intervention with a Mediterranean diet (MeDiet) could mitigate the well-known harmful effects of abdominal obesity on cardiovascular health. METHODS AND RESULTS: We assessed the relationship between baseline waist-to-height ratio (WHtR) and major cardiovascular events during a median follow-up of 4.8 years in the Prevention with Mediterranean Diet (PREDIMED) randomized primary prevention trial, which tested a MeDiet against a control diet (advice on a low-fat diet). We also examined whether the MeDiet intervention was able to counteract the detrimental cardiovascular effects of an increased WHtR. The trial included 7447 participants (55-80 years old, 57% women) at high cardiovascular risk but free of cardiovascular disease (CVD) at enrollment. An increased risk of CVD events (myocardial infarction, stroke, or cardiovascular death) was apparent for the highest versus the lowest quartile of WHtR (multivariable-adjusted hazard ratio: 1.98) (95% confidence interval: 1.10-3.57; linear trend: p = 0.019) only in the control-diet group, but not in the two groups allocated to intervention with MeDiet (p for interaction = 0.034). This apparent interaction suggesting that the intervention counterbalanced the detrimental cardiovascular effects of adiposity was also significant for body mass index (BMI) (p = 0.01) and waist circumference (p = 0.043). CONCLUSIONS: The MeDiet may counteract the harmful effects of increased adiposity on the risk of CVD.

Excess mortality in 22 European countries in 2020 and 2021: relationship with socioeconomic indicators.

AIMS: For better understanding of the impact of COVID-19 pandemic on mortality in different countries, we studied the excess mortality from any cause during 2020 and 2021 in 22 European countries, and its relationship with three socioeconomic variables: life expectancy at birth in 2019, per capita income, and low education level. METHODS: Using an ecological design, we analyzed excess mortality data between January 2020 and December 2021 in 22 European countries, obtained from the EuroMOMO surveillance system. Using weekly Z-score data for each country, we estimated the annual average deviation in mortality during 2020 and 2021 for each country. We analyzed possible relationships between the excess mortality and three independent variables: gross domestic product per capita (GDPpc) in 2020, life expectancy at birth in 2019, and proportion of the population over age 18 years with a lower than secondary education level in 2018. RESULTS: In the 22 European countries analyzed, the total number of excess deaths in 2020 and 2021 was 800,011 (11%) more than expected, with deaths among those aged 65 years and over accounting for 87.66% of these. Excess mortality was higher in 2020, especially in Spain, UK, Italy, and France. In 2021, excess mortality was highest in Hungary, the Netherlands, France, and Germany. Excess mortality during 2021 was inversely correlated with life expectancy (r =-.489, p = .021) and income level (r =-.550, p = .008). CONCLUSION: Reducing socioeconomic inequalities among countries not only improves conditions of most disadvantages but also will help to reduce excess of mortality from future pandemics.

Sudden unexpected death in epilepsy: Incidence at a Spanish epilepsy unit. / Muerte súbita en epilepsia: casuística de una unidad médica de epilepsia española.

INTRODUCTION: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with epilepsy. Most studies concerning this issue have been conducted in central and northern European countries and the United States. We conducted an epidemiologic study of SUDEP at our hospital's epilepsy unit. METHODS: This retrospective cohort study included all epileptic patients aged ≥14 years, regardless of epilepsy severity, who were treated at the outpatient epilepsy unit of our hospital between 2000 and 2013. The study included 2,309 patients. Deceased patients were identified using civil records. The cause of death was obtained from death certificates, autopsy reports, hospital reports, general practitioner records, and witnesses of the event. We calculated the incidence and proportional mortality of SUDEP based on our data. RESULTS: We identified 7 cases of definite SUDEP (2 patients with SUDEP plus), one case of probable SUDEP, and one case of possible SUDEP. Considering only cases of definite SUDEP, incidence was estimated at 0.44 cases per 1,000 patient-years and proportional mortality at 4.6%. Mean age of patients with definite SUDEP was 38.14 years; 4 were men and 3 were women. Most deaths occurred while patients were in bed and were therefore unwitnessed. Epilepsy in these patients was either remote symptomatic or cryptogenic. All patients but 2 had generalised seizures. None of the patients was in remission. CONCLUSIONS: SUDEP incidence and proportional mortality rates in our study are similar to those reported by population studies. This may be due to the fact that we did not select patients by severity. Risk factors for SUDEP in our sample are therefore consistent with those reported in the literature.

Longitudinal changes in Mediterranean diet and transition between different obesity phenotypes.

BACKGROUND & AIMS: Little is known about the impact of specific dietary patterns on the development of obesity phenotypes. We aimed to determine the association of longitudinal changes in adherence to the traditional Mediterranean diet (MedDiet) with the transition between different obesity phenotypes. METHODS: Data of 5801 older men and women at high cardiovascular risk from PREDIMED trial were used. Adherence to MedDiet was measured with the validated 14p-Mediterranean Diet Adherence Screener (MEDAS). Using the simultaneous combination of metabolic health- and body size-related parameters participants were categorized into one of four phenotypes: metabolically healthy and abnormal obese (MHO and MAO), metabolically healthy and abnormal non-obese (MHNO and MANO). Cox regression models with yearly repeated measures during 5-year of follow-up were built with use of Markov chain assumption. RESULTS: Each 2-point increase in MEDAS was associated with the following transitions: in MAO participants, with a 16% (95% CI 3-31%) greater likelihood of becoming MHO; in MHO participants with a 14% (3-23%) lower risk of becoming MAO; in MHNO participants with a 18% (5-30%) lower risk of becoming MHO. In MANO women, but not in men, MEDAS was associated with 20% (5-38%) greater likely of becoming MHNO (p for interaction by gender 0.014). No other significant associations were observed. CONCLUSIONS: Better adherence to the traditional MedDiet is associated with transitions to healthier phenotypes, promoting metabolic health improvement in MAO, MANO (only in women), and MHO, as well as protecting against obesity incidence in MHNO subjects.

[NUTRISOL: a computer programme for communitary and hospital nutritional evaluation of free access]. / NUTRISOL: un programa informático para la evaluación nutricional comunitaria y hospitalaria de acceso libre.

We have developed the computer programme NUTRISOL, a nutritional programme destined to analysis of dietary intake by means of the food transformation to nutrient. It has been performed under Windows operative system, using Visual Basic 6.0. It is presented in a CD-Rom. We have used the Spanish CSIC Food Composition Table and domestic food measures commonly used in Spain which could be modified and updated. Diverse kind of diets and reference anthropometric data are also presented. The results may be treated using various statistical programmes. The programme contains three modules: 1) Nutritional epidemiology, which allows to create or open a data base, sample management, analyse food intake, consultation of nutrient content and exportation of data to statistical programmes. 2) Analyses of diets and recipes, creation or modification of new ones. 3) To ask different diets for prevalent pathologies. Independent tools for modifying the original tables, calculate energetic needs, recommend nutrient intake and anthropometric indexes are also offered. In conclusion, NUTRISOL Programme is an application which runs in PC computers with minimal equipment in a friendly interface, of easy use, freeware, which may be adapted to each country, and has demonstrated its usefulness and reliability in different epidemiologic studies. Furthermore, it may become an efficient instrument for clinical nutrition and health promotion.

[INFORNUT process: validation of the filter phase-FILNUT--and comparison with other methods for the detection of early hospital hyponutrition]. / Proceso INFORNUT: validación dela fase de filtro-FILNUT--y comparación con otros métodos de detección precoz de desnutrición hospitalaria.

INTRODUCTION: According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. OBJECTIVES: To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. MATERIAL AND METHODS: In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull's method, CONUT and INFORNUT were done. The settings of the INFORNUT filter were: albumin < 3.5 g/dL, and/or total proteins <5 g/dL, and/or prealbumin <18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol <180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. RESULTS: In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66.9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. CONCLUSIONS: Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.

Muerte súbita en epilepsia: casuística de una unidad médica de epilepsia española / Sudden unexpected death in epilepsy: Incidence at a Spanish epilepsy unit

INTRODUCCIÓN: La muerte súbita en epilepsia (SUDEP) es la causa más frecuente de muerte atribuible a la propia enfermedad. Casi toda la información sobre esta entidad procede de estudios realizados en el centro/norte de Europa y Estados Unidos. Presentamos la casuística de SUDEP de la Unidad Médica de Epilepsia de nuestro hospital. MÉTODOS: Estudiamos una cohorte histórica hospitalaria española, sin selección de pacientes por su gravedad, con 2.309 pacientes, de edad ≥ 14 años, entre enero de 2000 y junio de 2013. La identificación de los fallecidos se realizó a través de los Registros Civiles. Las causas de muerte se establecieron mediante certificados de defunción, autopsias forenses, informes de mortalidad hospitalarios, de médicos de familia y de testigos de los fallecimientos. Calculamos la incidencia y la mortalidad proporcional. RESULTADOS: Identificamos 7 casos de SUDEP definitivas (2 SUDEP-plus), uno probable y uno posible. Considerando solo los casos con autopsia, la incidencia es de 0,44/1.000 persona-año; la mortalidad proporcional es del 4,6%. Son 4 varones y 3 mujeres. La edad media es de 38,14 años. Casi todos los fallecimientos ocurrieron sin testigos, en la cama. La etiología de la epilepsia es sintomática remota o criptogénica. Menos 2 pacientes, todos tenían crisis generalizadas. Ninguno estaba en remisión. CONCLUSIONES: Pensamos que la incidencia y la mortalidad proporcional de SUDEP de nuestro estudio se asemejan a las encontradas en estudios poblacionales por el carácter escasamente seleccionado de nuestra cohorte. Los factores de riesgo para SUDEP encontrados en nuestros pacientes son concordantes con los reconocidos en la bibliografía

INTRODUCTION: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with epilepsy. Most studies concerning this issue have been conducted in central and northern European countries and the United States. We conducted an epidemiologic study of SUDEP at our hospital's epilepsy unit. METHODS: This retrospective cohort study included all epileptic patients aged ≥14 years, regardless of epilepsy severity, who were treated at the outpatient epilepsy unit of our hospital between 2000 and 2013. The study included 2,309 patients. Deceased patients were identified using civil records. The cause of death was obtained from death certificates, autopsy reports, hospital reports, general practitioner records, and witnesses of the event. We calculated the incidence and proportional mortality of SUDEP based on our data. RESULTS: We identified 7 cases of definite SUDEP (2 patients with SUDEP plus), one case of probable SUDEP, and one case of possible SUDEP. Considering only cases of definite SUDEP, incidence was estimated at 0.44 cases per 1,000 patient-years and proportional mortality at 4.6%. Mean age of patients with definite SUDEP was 38.14 years; 4 were men and 3 were women. Most deaths occurred while patients were in bed and were therefore unwitnessed. Epilepsy in these patients was either remote symptomatic or cryptogenic. All patients but 2 had generalised seizures. None of the patients was in remission. CONCLUSIONS: SUDEP incidence and proportional mortality rates in our study are similar to those reported by population studies. This may be due to the fact that we did not select patients by severity. Risk factors for SUDEP in our sample are therefore consistent with those reported in the literature

[Quality of life in patients treated for early laryngeal cancer, in healthy people and in those with other associated pathologies]. / Calidad de vida en pacientes tratados por un cáncer de laringe inicial y en personas sanas y con otras patologías.

Nowadays there are different non aggressive treatment options for early laryngeal cancer. However, they are not free of undesirable effects. We have studied this patients' quality of life, by comparing it with that obtained from healthy population and other illness groups (post-AMI patients, Chronic Kidney patients). We have studied 62 T1-T2NoMo laryngeal carcinoma diagnosed at the "Virgen de la Victoria" clinical hospital from Malaga, Spain, between 1990 and 1998. We used the Quality of Life in Málaga (QLM), general QL questionnaire which was developed and validated at the Department of Preventive Medicine of the University of Málaga, Spain. The results were compared with those obtained from ramdom samples in healthy population from Málaga and from various pathology groups. The global QOL of our patients treated for an early glottic cancer (Index Quality of life 29.4%) was better than almost all the other ones.

[Quality of life in patients treated for head and neck cancer]. / Calidad de vida en pacientes tratados por un cáncer de cabeza y cuello.

In this paper we have studied the quality of life of patients that underwent treatment for an early laryngeal carcinoma in comparison to others with an advanced head and neck cancer. We have studied 62 patients (T1N0M0, T2N0M0) with laryngeal carcinoma diagnosed between 1990 and 1998. We have applied the European EORTC QOL C-30 questionnaire, and more specifically its head and neck module (H&N 35). The results were compared with a heterogeneous group of 48 patients with different degrees of head and neck cancers. The quality of life of our patients who were treated for an early glottic cancer was better in many functional scales of the EORTC and in many specific symptom scales of the H&N 35, but not in global cancer symptoms.

Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer / Health-related quality of life in caregivers of patients with Alzheimer's disease

Introducción: Los cuidadores de pacientes con enfermedad de Alzheimer (EA) tienen un deterioro de su calidad de vida relacionada con la salud (CVRS). La CVRS es una medida de resultado centrada en el usuario cada vez más usada. Evaluamos de forma longitudinal la CVRS en cuidadores de pacientes con EA, antes y después, durante un periodo de 12 meses. Métodos: Se incluyó en el estudio a 97 pacientes diagnosticados de EA según criterios NINCDS-ADRDA (Instituto Nacional de Trastornos Neurológicos y de la Comunicación y Accidente Cerebrovascular y Asociación de Enfermedad de Alzheimer y Trastornos relacionados) y sus respectivos 97 cuidadores principales. Se analizaron datos sociodemográficas de ambos, clínicos de los pacientes, y datos en relación con el cuidado en la visita basal. La CVRS se midió con el cuestionario SF-36 en la visita basal y a los 12 meses. Resultados: Las 8 dimensiones de la escala SF-36 en los cuidadores principales empeoraron de forma significativa a los 12 meses, salvo las dimensiones «Función física» y «Función social», que lo hicieron de forma no significativa. Las puntuaciones en la visita basal fueron menores que las correspondientes a la población general. La dimensión que presentó peor puntuación fue «Vitalidad». Conclusiones: La CVRS en cuidadores de pacientes con EA empeora a lo largo de la evolución de esta y es peor que la de la población general, para su edad y género (AU)

Introduction: Informal caregivers of patients with Alzheimer's disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. Methods: Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients’ clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. Results: At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for ‘physical function’ and ‘social function’. Baseline scores in our sample were lower than those of the general population. ‘Vitality’ is the dimension that presented the lowest scores. Conclusion: HRQOL in caregivers of patients with Alzheimer's disease deteriorates over time and is poorer than that of the age- and sex-matched general population (AU)

Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer / An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease

Introducción: La asistencia telefónica a demanda (ATAD) es una práctica habitual en las consultas de Neurología; no obstante, los estudios que valoran dicha modalidad de asistencia sanitaria son escasos. Hemos evaluado la ATAD en cuidadores de pacientes con enfermedad de Alzheimer (EA) desde el punto de vista económico y de la satisfacción percibida por el cuidador principal. Pacientes y métodos: Se seleccionó a 97 pacientes con diagnóstico de EA según criterios NINCDS-ADRDA y sus respectivos 97 cuidadores principales. Estudiamos los gastos diferenciales entre las modalidades asistenciales presencial y a demanda a lo largo de 12 meses. A los 12 meses se valoró la satisfacción de los cuidadores principales mediante un cuestionario autoadministrado. Resultados: El ahorro que supuso la ATAD frente la asistencia presencial fue de 80,05 ± 27,07 euros por usuario. Al 73,6% de los cuidadores que usaron la ATAD les parece mejor o mucho mejor esta que la asistencia presencial, mientras que al 2,6% de los cuidadores les parece peor o mucho peor. Conclusiones: La ATAD supone un servicio de salud eficiente en el seguimiento de los usuarios con EA en las consultas de Neurología y la satisfacción de los usuarios fue alta, por lo que consideramos que debería incluirse en la cartera de servicios del sistema sanitario (AU)

Introduction: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. Patients and methods: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. Results: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. Conclusions: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services (AU)

NUTRISOL: un programa informático para la evaluación nutricional comunitaria y hospitalaria de acceso libre / Nutrisol: A computer programme for communitary and hospital nutritional evaluation of free access

Hemos desarrollado el programa NUTRISOL, un programa informático destinado al análisis de la ingesta alimentaria mediante la transformación de alimentos a nutrientes. Ha sido elaborado bajo el sistema operativo Windows®, usando el entorno Visual Basic® 6.0. En su elaboración se han usado las tablas de composición de alimentos del CSIC y medidas domésticas de alimentos de uso común en España, siendo posible modificarlas y actualizarlas. También se presentan diversas dietas y datos antropométricos de referencia. Los resultados que aporta pueden procesarse con la mayoría de los programas estadísticos. El programa ofrece tres módulos: 1) Epidemiología nutricional, en el que se pueden crear o abrir bases de datos, gestionar muestras, gestionar la ingesta, consultar contenido de nutrientes y exportar datos para tratarlos con programas estadísticos. 2) Análisis de dietas y recetas, en el que además se pueden crear o modificar las existentes y exportarlas. 3) Solicitud de distintas dietas para patologías prevalentes. También se ofrece un apartado de herramientas independientes en el que se pueden modificar las tablas originales, calcular las necesidades energéticas, las ingestas recomendadas e índices antropométricos. En conclusión, el programa NUTRISOL es una aplicación que funciona en ordenadores tipo PC-compatibles con mínimo equipamiento, con una interfaz "amigable", de uso sencillo, que se puede adaptar a cualquier región, de acceso gratuito y que ha demostrado su utilidad y fiabilidad en distintos estudios epidemiológicos. Además, puede ser un instrumento eficiente para la educación nutricional, la nutrición hospitalaria y la promoción de la salud (AU)

We have developed the computer programme NUTRISOL, a nutritional programme destined to analysis of dietary intake by means of the food transformation to nutrient. It has been performed under Windows® operative system, using Visual Basic® 6.0. It is presented in a CD-Rom. We have used the Spanish CSIC Food Composition Table and domestic food measures commonly used in Spain which could be modified and updated. Diverse kind of diets and reference anthropometric data are also presented. The results may be treated using various statistical programmes. The programme contains three modules: 1) Nutritional epidemiology, which allows to create or open a data base, sample management, analyse food intake, consultation of nutrient content and exportation of data to statistical programmes. 2) Analyses of diets and recipes, creation or modification of new ones. 3) To ask different diets for prevalent pathologies. Independent tools for modifying the original tables, calculate energetic needs, recommend nutrient intake and anthropometric indexes are also offered. In conclusion, NUTRISOL Programme is an application which runs in PC computers with minimal equipment in a friendly interface, of easy use, freeware, which may be adapted to each country, and has demonstrated its usefulness and reliability in different epidemiologic studies. Furthermore, it may become an efficient instrument for clinical nutrition and health promotion (AU)

Proceso INFORNUT®: validación de la fase de filtro —FILNUT— y comparación con otros métodos de detección precoz de desnutrición hospitalaria / Infornut process: validation of the filter phase -Filnut- and comparison with other methods for the detection of early hospital hyponutrition

Introducción: El problema de la desnutrición hospitalaria afecta según las series entre un 30-50% de los pacientes ingresados. Esta alta prevalencia justifica la necesidad de su detección precoz al ingreso. Existen múltiples herramientas clásicas de cribaje que muestran limitaciones importantes en su aplicación sistemática en la práctica clínica habitual. Objetivos: Ver la relación entre desnutrición, detectada por nuestro método de cribaje, y mortalidad, estancia o reingresos. Asimismo analizar la relación entre desnutrición y prescripción de soporte nutricional. Comparar distintos métodos de cribaje nutricional al ingreso sobre una muestra aleatoria de pacientes hospitalizados. Validación del método INFORNUT para cribaje nutricional. Material y Métodos: En una fase previa al diseño del estudio se realizo un análisis retrospectivo con datos del año 2003 con el fin de conocer la situación de la desnutrición en el Hospital Virgen de la Victoria de Málaga, recogiendo datos del CMBD (Conjunto Mínimo Básico de Datos), analíticas de riesgo nutricional (filtro FILNUT) y prescripción de soporte nutricional. En la fase experimental se realizo un estudio de cohorte transversal con una muestra aleatoria de 255 pacientes en Mayo del 2004. Se realiza estudio antropométrico, Valoración Subjetiva Global (VSG), Mini-Nutritional Assessment (MNA) y Nutrtional Risk Screening (NRS), método de Gassull, CONUT® e INFORNUT. Las condiciones de filtro aplicadas por INFORNUT son: albúmina < 3.5 g/dL y/o proteinas totales < 5 g/dL y/o prealbúmina< 18 mg/dL con o sin linfocitos totales < 1.600 cel/ml y/o colesterol total <180 mg/dL. Para la comparación entre métodos se construye un Gold Standard basado en las recomendaciones de SENPE sobre datos antropométricos y analíticos. El análisis estadístico de asociación se realizó mediante Test Chi-cuadrado (α:0.05) y concordancia a través del índice κ. Resultados: En el estudio realizado en la fase previa se observa que la prevalencia de desnutrición hospitalaria es del 53,9%. Recibieron soporte nutricional especializado 1.644 pacientes; de ellos el 66,9% padecían desnutrición. También se observa que la desnutrición es uno de los factores que favorecen el incremento de la mortalidad (desnutridos: 15,19% vs no desnutridos: 2,58), la estancia (desnutridos: 20,95 días vs. no desnutridos: 8,75 días), e reingresos (desnutridos: 14,30% vs. no desnutridos: 6%). Los resultados del estudio experimental son los siguientes: La prevalencia de desnutrición obtenida por Gold Standard (61%), INFORNUT (60%). Los grados de concordancia entre los métodos INFORNUT, CONUT y GASSULL son buenos o excelentes comparados entre sí (k : 0,67 INFORNUT con CONUT y k : 0,94 INFORNUT con GASSULL) y con Gold Standard (k : 0,83 INFORNUT; k : 0,64 CONUT; k :0,89 GASSULL). Sin embargo los test estructurados (VSG, MNA, NRS), presentan bajos índices de concordancia con el Gold Standard y los test analíticos o mixtos (Gassull); aunque si muestran un grado de concordancia ligero a moderado cuando se comparan entre si (k : 0.489 NRS con VSG). INFORNUT presenta una sensibilidad del 92,3%, un valor predictivo positivo del 94,1% y una especificidad del 91,2%. Tras la fase filtro se envía un informe preliminar, sobre el que cumplimentados datos antropométricos y de ingesta, se elabora un Informe de Riesgo Nutricional. Conclusiones: La prevalencia de desnutrición en nuestro estudio (60%) es similar a la hallada por otros autores. La desnutrición lleva consigo un aumento de mortalidad, estancia y reingreso. No existen herramientas que se hayan demostrado capaces detectar desnutrición precoz el medio hospitalario que no tengan grandes limitaciones de aplicabilidad. FILNUT como 1ª fase de filtro del proceso INFORNUT constituye una herramienta valida: sensible y específica para el cribado nutricional al ingreso. Las ventajas principales del proceso serían la capacidad de identificar precozmente pacientes con riesgo de desnutrición, ejercer una función docente y sensibilizadora en facultativos y personal de enfermería implicándolos en la valoración nutricional de sus pacientes y elaborar un informe del diagnóstico al alta de desnutrición y soporte nutricional para el Servicio de Documentación Clínica. Por tanto INFORNUT constituiría un método de cribado universal con una buena relación coste-efectividad (AU)

Introduction: According to several series, hospital hyponutrition involves 30-50% of hospitalized patients.The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. Objectives: To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. Material and methods: In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull"s method,CONUT® and INFORNUT® were done. The settings of the INFORNUT filter were: albumin< 3.5 g/dL, and/or total proteins < 5 g/dL, and/or prealbumin < 18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol < 180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. Results: In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66,9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. Conclusions: Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. Thereare no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio (AU)

Calidad de vida en pacientes tratados por un cáncer de cabeza y cuello / Quality of life in patients treated of a head and neck cancer

En este trabajo pretendemos comparar la calidad de vida global de pacientes que recibieron tratamiento por un carcinoma laríngeo inicial con la de otros pacientes tratados de un cáncer de cabeza y cuello avanzado. Hemos estudiado a 62 pacientes que constituyen la totalidad de los casos diagnosticados de un carcinoma laríngeo inicial T1, T2-N0M0 en el Hospital Clínico Virgen de la Victoria de Málaga entre 1990 y 1998. Hemos aplicado el Cuestionario EORTC QLQ C-30 y su módulo de cabeza y cuello H&N 35. Comparamos los resultados con los de un grupo heterogéneo de 48 pacientes con cánceres avanzados de cabeza y cuello. La calidad de vida de nuestros pacientes fue mejor en muchas escalas funcionales del EORTC y en varios síntomas específicos del H&N 35, pero no en los síntomas generales del cáncer (AU)

In this paper we have studied the quality of life of patients that underwent treatment for an early laryngeal carcinoma in comparison to others with an advanced head and neck cancer. We have studied 62 patients (T1N0M0, T2N0M0) with laryngeal carcinoma diagnosed between 1990 and 1998. We have applied the European EORTC QOL C-30 questionnaire, and more specifically its head and neck module (H&N 35). The results were compared with a heterogeneous group of 48 patients with different degrees of head and neck cancers. The quality of life of our patients who were treated for an early glottic cancer was better in many functional scales of the EORTC and in many specific symptom scales of the H&N 35, but not in global cancer symptoms (AU)

Calidad de vida en pacientes tratados por un cáncer de laringe inicial y en personas sanas y con otras patologías / Quality of life in patients treated for early laryngeal cancer and healthy people and in those with other associated diseases

Hoy dia existen múltiples tratamientos, poco agresivos, para un cáncer de laringe inicial, pero ninguno está exento de efectoos secundarios. Pretendemos comparar la calidad de vida global de estos pacientes con la población sana y otros grupos de enfermedad (IAM y nefrópatas crónicos). hemos estudiado a 62 pacientes que constituyen la totalidad de los casos diagnosticados de un carcinoma laringeo inicial T1-T2NoMo en el Hospital Clinico Virgen de la Victoriade Málaga entre 1990 y 1998. Hemos aplicado el Cuestinario general de Calidad de Vida en Málaga (QLM) desarrollado por el departamento de Medicina Preventiva de la Universidad de Málaga, de propiedades psicometricas demostradas. Comparamos los resultados de nuestros pacientes con los obtenidso con muestras aleatorias de población de málaga sanas y con diversas patologias. Nuestros pacientes con un indice de Pérdida de la calidad de vida del 29,4% superaban a casi todos los grupos de comparación (AU)

Nowadays there are different non aggressive treatment options for early laryngeal cancer. However, they are not free of undesirable effects. We have studied this patients' quality of life, by comparing it with that obtained from healthy population and other illness groups (post-AMI patients, Chronic Kidney patients). We have studied 62 T1-T2NoMo laryngeal carcinoma diagnosed at the "Virgen de la Victoria" clinical hospital from Malaga, Spain, between 1990 and 1998. We used the Quality of Life in Málaga (QLM), general QL questionnaire which was developed and validated at the Department of Preventive Medicine of the University of Málaga, Spain. The results were compared with those obtained from ramdom samples in healthy population from Málaga and from various pathology groups. The global QOL of our patients treated for an early glottic cancer (Index Quality of life 29.4%) was better than almost all the other ones (AU)