Health and wellbeing status of the long-lived individuals of the Spanish LONGECYL cross-sectional study.

BACKGROUND: The increase in life expectancy and long-lived individuals is a challenge for public health and provides an opportunity to understand the determinants of longevity. However, few studies have addressed the factors associated with the health status and quality of life in a long-lived individual population. We described the perceived health, clinical status, quality of life, and dependency for activities of daily living in a representative population in Castile and Leon, Spain. METHODS: A sample of 759 long-lived individuals aged 95 years and older was studied by the Health Sentinel Network of Castile and Leon (Spain) through a health examination and a structured questionnaire covering quality of life (EQ-5D-3), lifestyle habits, diet, working life and family health. A blood sample was taken for the study of biological and genetic markers. Chi Square and logistic regression OR with 95% confidence intervals were used to analyze the determinants of the long-lived individuals' health status. The significant level for the bivariate analysis was established at 0.05. RESULTS: Perceived health was good, very good or excellent in 64.2%, while only 46.0% had a quality-of-life index above 0.5 (ranging from 0 to 1) and 44.1% maintained acceptable independence for activities of daily living. Quality-of-life index was higher in the oldest, (OR 7.98 [2,32-27.41]) above 100 years compared to those under 98, and men had better values for independence than women (OR 2.43 [1.40-4.29]). Cardiovascular diseases were the most prevalent (85.5%), but neurological and mental diseases and vision problems had the highest impact on quality of life and independence. CONCLUSION: The long-lived individuals of Castile and Leon have a relatively well-preserved health status, although the perception of health is higher than that describing their quality of life and dependence. The quality of life was higher in the oldest age group and showed differences according to sex, with a better quality of life in men. Public health policies and programs should take in account the differences by sex and age as well as the prevention and control of the main conditions related with poor quality of life or dependence. Future research must include the interaction among genetic, socioeconomic, environmental, and other clinical factors in the quality of life and disability of long-lived individuals.

Formación y aplicación del instrumento NECPAL en el ámbito de la Atención Primaria / Training on and application of the NECPAL instrument in the Primary Care setting

INTRODUCCIÓN: En el área de salud de Segovia los datos existentes de morbilidad en relación con la enfermedad crónica no permiten conocer las necesidades de atención en cuidados paliativos de los pacientes y su entorno familiar. El proyecto NECPAL CCOMS-ICO© puede constituir el instrumento adecuado para identificar a los pacientes crónicos en situación de enfermedad avanzada con necesidades paliativas en cualquier recurso del sistema de salud. OBJETIVO: Formación de los profesionales en el Instrumento NECPAL y, a través de su aplicación, identificar a las personas que presentan necesidades de atención paliativa, describir sus características demográficas, conocer sus problemas de salud, el grado de dependencia, las demandas de atención sanitaria que generan y el circuito asistencial implicado en la respuesta a sus necesidades. MÉTODO: Estudio observacional, descriptivo, longitudinal y prospectivo de una muestra de la población del área de salud de Segovia, atendida en las consultas de Atención Primaria, desarrollado entre el 1 de diciembre de 2014 y el 16 de mayo de 2015. Los datos descriptivos de las variables cuantitativas se han expresado como media y desviación típica. Los estadísticos descriptivos para variables cualitativas se han expresado en frecuencias y porcentajes. RESULTADOS: Se realizó formación a 35 profesionales. Se obtuvo una muestra total de 316 pacientes NECPAL positivo procedentes del medio rural, con una edad media de 84,8 años y una distribución paritaria de mujeres y hombres. Los pacientes presentaban una elevada comorbilidad, una media de 4,6 enfermedades crónicas, un consumo de 6 fármacos por paciente y una elevada frecuentación de servicios sanitarios. El 86 % de los pacientes habían acudido al Centro de Salud menos de 1 vez a la semana, el 64 % no recibieron ninguna visita a domicilio y el 10 % precisaron 2 visitas semanales. La media de consultas hospitalarias por paciente fue de 1,6 siendo las más frecuentes las de Neurología, Cardiología, Medicina Interna, Geriatría. CONCLUSIONES: La formación de los profesionales para la utilización del instrumento NECPAL facilita la adquisición de conocimientos en el área de los cuidados paliativos. El instrumento NECPAL permite la identificación de pacientes con necesidades de atención paliativa, siendo de utilidad para su aplicación por los Equipos de Atención Primaria, sin que su utilización suponga una sobrecarga. El perfil de los sujetos identificados como NECPAL positivo es el de un paciente estable en su entorno asistencial habitual, de baja demanda asistencial activa, con necesidades episódicas hospitalarias breves (inferiores a 15 días), y con un alto consumo tanto de medicación como de recursos sanitarios

INTRODUCTION: Morbidity data related to chronic disease in the Segovia Health Area do not allow an understanding of the palliative care needs of patients and their families. The NECPAL CCOMSICO © project may represent an appropriate tool for the identification of patients with advanced chronic conditions who require palliative care in any of the health system resources. OBJECTIVE: To train professionals on the NECPAL tool and, via its application, to identify people who require palliative care, to describe their demographic characteristics, to gain insight into their health issues, level of dependence, and health care demands, and to identify the health care circuit involved in satisfying their needs. METHODS: An observational, descriptive, longitudinal, prospective study in a population sample from the Segovia Health Area attending Primary Care clinics from December 1, 2014 to May 16, 2015. Descriptive data for quantitative variables are expressed as mean and standard deviation. Descriptive statistics for qualitative variables are expressed as frequencies and percentages. RESULTS: Thirty-five professionals were trained. A total sample of 316 NECPAL-positive patients from rural areas was obtained, with a mean age of 84.8 years and a balanced distribution of men and women. Patients had high comorbidity levels, with 4.6 chronic conditions on average, use of 6 drugs, and high rates of health services frequentation. Of these patients, 86 % had visited their health center less than once a week, 64 % received no home care visits, and 10 % required 2 visits per week. The mean number of hospital visits per patient was 1.6, most commonly to Neurology, Cardiology, Internal Medicine, and Geriatrics. CONCLUSIONS: Training of professionals in the use of the NECPAL tool facilitates knowledge acquisition in the field of palliative care. The NECPAL tool allows to identify patients with palliative care needs, and is useful for application by Primary Care teams without overloading their work schedule. The profile of subjects identified as NECPAL-positive is that of a stable patient in their usual care setting, with low rates of active care demands, short (less than 15 days) episodic hospital care needs, and high medication use and health care resource utilization rates

Actitudes, dudas y conocimientos de los colectivos implicados en la atención del paciente con Alzheimer: resultados de la encuesta del proyecto kNOW Alzheimer / Attitudes, uncertainties and knowledge among the different parties involved in alzheimer’s patients care: findings from the kNOW Alzheimer project survey study

Introducción: La enfermedad de Alzheimer (EA) involucra a colectivos diversos de profesionales y cuidadores. Las actitudes y necesidades de formación en diagnóstico temprano, tratamiento, síntomas conductuales, recursos sociosanitarios y aspectos legales o éticos son desconocidas. Métodos: Estudio observacional transversal tipo encuesta dentro del proyecto kNOW Alzheimer, iniciativa de la SEN, SEGG, SEMERGEN, SEFAC y CEAFA mediante cuestionarios específicos. Cada sociedad invitó a todos sus miembros a cumplimentarlos a través de www.knowalzheimer.com. Resultados: Participaron 114 neurólogos, 113 geriatras, 275 médicos de atención primaria, 328 farmacéuticos y 858 cuidadores. Los retrasos en el diagnóstico se originan en pacientes y cuidadores, el sistema y en los profesionales, que carecen de medios o malinterpretan síntomas tempranos. Persiste el uso del término 'demencia senil'. Profesionales y cuidadores perciben buena eficacia del tratamiento. Se apuesta por el diagnóstico y tratamiento en fase pre-demencia. Hay déficit de formación en el manejo de la conducta. Los profesionales afirman que informan pero los cuidadores se sienten desinformados. Los cuidadores desean conocer cuanto antes si ellos o un familiar padecen Alzheimer. Los síntomas conductuales y la necesidad de restringir actividades son fuentes de sobrecarga. Los farmacéuticos pueden contribuir a la detección y manejo, pero precisan de formación amplia. Hay necesidad de formación en aspectos legales, bioéticos, recursos y acceso a la investigación. Conclusiones: Este proyecto ha permitido obtener información sobre actitudes y dudas de los colectivos involucrados en la atención a la EA, necesidades de formación y puntos de mejora (AU)

Background: Alzheimer’s disease (AD) involves different groups of professionals and caregivers. Their attitudes and needs of training in early diagnosis, treatment, behavioral symptoms, resources, social and legal or ethical aspects are unknown. Methods: Survey study within the project 'kNOW Alzheimer', a SEN, SEGG, SEMERGEN SEFAC and CEAFA initiative, through specific questionnaires. Each Society invited all its members to complete them through www.knowalzheimer.com. Results: Participants were 114 neurologists, geriatricians 113, 275 primary care physicians, 328 pharmacists and 858 caregivers. Delays in diagnosis arise in patients and caregivers, the system and the professionals, who lack the means or misinterpreted early symptoms. The term 'senile dementia' is still in use. Professionals and caregivers perceived good efficacy of treatment. Professionals advocate for diagnosis and treatment in the pre-dementia stage. There is a need for training in behavior management. Practitioners claim they inform but caregivers feel uninformed. Caregivers want to know as soon as possible if they or a family member suffers from AD. Behavioral symptoms and the need to restrict activities are sources of overload. Pharmacists can contribute to detection and management, but require extensive training. There is a need for training on legal aspects, bioethics, resources and access to research. Conclusions: This project has yielded information on attitudes and doubts of the collectives involved in AD care, their training needs and points of improvement (AU)

Enhanced membrane filtration of wood hydrolysates for hemicelluloses recovery by pretreatment with polymeric adsorbents.

In this study adsorption of foulants from birch and pine/eucalyptus wood hydrolysates on two polymeric adsorbents was studied aiming to reduce the membrane fouling. The effect of the pretreatment of hydrolysate on polyethersulphone membrane performance was studied in dead-end filtration experiments. Adsorption pretreatment improved significantly filtration capacity and decreased membrane fouling. Especially high-molecular weight lignin was efficiently removed. A multistep adsorption pretreatment was found to reduce the amount of adsorbent required. While large adsorbent amount was shown to increase flux in filtration, it was found also to cause significant hemicellulose losses.

UV-photo graft functionalization of polyethersulfone membrane with strong polyelectrolyte hydrogel and its application for nanofiltration.

A strong polyelectrolyte hydrogel was graft copolymerized on a polyethersulfone (PES) ultrafiltration (UF) membrane using vinyl sulfonic acid (VSA) as the functional monomer, and N,N'-methylenbisacrylamide (MBAA) as the cross-linker monomer. This was carried out in one simple step using the UV photoirradiation method. The effect of the polymerization conditions on the degree of grafting (DG) was investigated using the gravimetric method which measures the total hydrogel grafted on the membrane, and with ATR-FTIR spectroscopy which indicates the functional monomer fraction in the hydrogel layer. The VSA could not graft polymerize without the cross-linker as comonomer. An increase in the cross-linker fraction from 0.25 to 2.5 mol % (relative to the functional monomer VSA) resulted in a higher DG. Although the surface morphology changed upon modification, the resulting surface roughness as measured by AFM was very low. From the monitoring of DG with UV time (4.5-30 min) at constant conditions, it was deduced that during the early stages of the polymerization mainly the cross-linker was grafted, thus inducing the graft copolymerization of the functional monomer. Polymerization using a higher monomer concentration (12.5-40% VSA) at constant monomer/cross-linker ratio resulted in a higher VSA fraction in the grafted hydrogel, although the gravimetric DG was similar. Ion exchange capacity and X-ray photoelectron spectroscopy measured after modification under the different conditions supported these findings. The new membranes were tested under nanofiltration (NF) conditions. A NF membrane could be obtained when the MBAA fraction was above 0.25%. The Na2SO4 rejection was 90-99% and the permeability 10-1 L m(-2) h(-1) bar(-1) when the MBAA fraction increased from 0.75 to 2.5%. The order of rejection of single salts solution was Na2SO4 > MgSO4 ≈ NaCl > CaCl2, as expected on the basis of Donnan exclusion for negatively charged NF membranes. An increase in the salts rejection with increasing degree of cross-linking and VSA fraction was attributed to an increase in the membrane charge density and to steric exclusion that also resulted in an increase of rejection for uncharged solutes such as sucrose or glucose. The new membrane presented a high, essentially unchanged Na2SO4 rejection (>97%) in the range of salt concentrations up to 4 g/L, and only slightly reduced rejection (>92%) at a concentration of 8 g/L; this can be related to its high barrier layer charge density measured by ion exchange capacity. In addition, because poly(vinyl sulfonic acid) (PVSA) is a strong polyelectrolyte the membrane separation performance was stable in the range of pH 1.5 to pH 10.

Guía de práctica clínica sobre prevención primaria y secundaria del ictus / Primary and secondary prevention of stroke: A guideline

No disponible

No disponible

Efectividad de las Pruebas Psicométricas en el Diagnóstico y Seguimiento de Deterioro, Depresión y Ansiedad en las Personas Mayores / Effectiveness of Tests for the Diagnosis and Follow up of Deterioration, Anxiety and Depression in Elderly People

El presente estudio indaga acerca de la posible correlación existente entre depresión, ansiedad y deterioro en personas mayores. Se examina el valor predictivo de los cuestionarios utilizados en Atención Primaria puesto que los resultados estadísticos no siempre coinciden con la experiencia clínica. La conclusión final apunta a que existen dos variables que podrían justificar este hecho: La dificultad para evaluar síntomas afectivos frente a síntomas cognitivos en atención primaria. El desconocimiento del entorno en que envejecen las personas, que opera como variable contaminante en los resultados de la evaluación personal. Por último, se sugiere que se tengan en cuanta las diferencias entre Atención Primaria y práctica psiquiátrica a la hora de establecer un modelo para la identificación y tratamiento de la Depresión, utilizándose un instrumento de medida para el diagnóstico diferente del empleado para observar la evolución (AU)

This paper analyzes the correlation between depression, anxiety and deterioration in elderly people. Since statistical results not always match up clinical experience, the predictive value of primary health care was checked. As a conclusion it appears to be two reasons accounting for this fact: the difficulty to assess affective vs cognitive symptoms in primary health care and a lack of knowledge of the environment where people age –a fact that contaminates personal assessment results. Finally, a suggestion is made to consider the differences between primary care and psychiatric care with regard to establishing a model for depression identification and treatment –the tool for diagnosis should be different from the one used to check symptom evolution (AU)