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OBJECTIVE: To assess the self-perceived quality of life of institutionalized adults with cerebral palsy and to identify factors that influence their well-being, including sociodemographic, clinical, and diagnostic characteristics, as well as the degree of institutionalization. METHOD: A descriptive cross-sectional study was conducted using the San Martin Quality of Life Scale among adults with cerebral palsy. Data were collected in 2021 and 2022 in a sample of adults with cerebral palsy in Navarra, Spain. Multivariate regression was used to explore the relationship between quality of life and various influential factors. RESULTS: The self-determination dimension positively influenced quality of life scores, whereas the social inclusion dimension had the opposite effect. Descriptive and regression analyses revealed that factors such as residing outside the city and a high degree of dependency had a negative influence on quality of life, while the degree of institutionalization had a positive impact. CONCLUSIONS: It is important to highlight the positive effects of the degree of institutionalization on rehabilitation and well-being, as it seeks to enhance autonomy and social integration when talking about patient-centered models of institutionalization.
ABSTRACT
INTRODUCTION: Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy. METHODS: Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n=2); parastomal hernia (n=3); and colostomy stenosis (n=1). RESULTS: The mean cumulative cost in 10 years per patient in each alternative was: 10,972.9 symptomatic treatment (62% diapers); 17,351.57 SNS (95.83% interventions; 81.6% devices); 25,858.54 definitive colostomy (70.4% ostomy material and accessories). CONCLUSIONS: Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment.
Subject(s)
Fecal Incontinence , Cohort Studies , Colostomy , Fecal Incontinence/therapy , Financial Stress , HumansABSTRACT
INTRODUCTION: Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy. METHODS: Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n=2); parastomal hernia (n=3), and colostomy stenosis (n=1). RESULTS: The mean cumulative cost in 10 years per patient in each alternative was: 10,972.9 symptomatic treatment (62% diapers); 17,351.57 SNS (95.83% interventions; 81.6% devices); 25,858.54 definitive colostomy (70.4% ostomy material and accessories). CONCLUSIONS: Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment.
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Chronic diseases strongly affect individuals' health status. In aggregate terms, this impact is reflected by the stock of health, which measures the amount of health of a population in a given period of time. The objectives of this study were to measure the relative burden of chronic illnesses by assessing health-related quality of life using the EQ-5D-5L instrument, to rank diseases according to their associations with the stock of health, and to calculate the stock of health of the Spanish population and the amount of health loss attributable to each chronic disease from a social perspective. Data were gathered from the Spanish Health Survey (ENSE 2011-2012, N = 20,587). A population weighted least squares model was used. Chronic diseases represent 19.19% of the stock of health losses in Spain compared with a country free from those diseases. In Spain, the stock of health in 2011 was 31.86 million units on the visual analog scale. The diseases with the strongest impact in terms of loss of stock of health at the individual level were mental illness and embolism, stroke, or cerebral hemorrhage. Collectively, the diseases with the largest impact included osteoarthritis, arthritis, or rheumatism; chronic back pain; and high blood pressure.
Subject(s)
Chronic Disease/psychology , Health Status , Quality of Life/psychology , Surveys and Questionnaires/standards , Adolescent , Adult , Aged , Aged, 80 and over , Educational Status , Female , Humans , Male , Middle Aged , Psychometrics , Spain , Young AdultABSTRACT
A partir de la hipótesis de que la utilización exclusiva de incentivos monetarios puede minar la motivación intrínseca de los profesionales sanitarios y producir el efecto contrario al perseguido, este trabajo analiza los factores que se asocian con la motivación intrínseca de los profesionales responsables de gestión en enfermería. Para ello, se elaboró un cuestionario sobre Motivación en el Trabajo de Gestión en Enfermería basado en el Intrinsic Motivation Inventory (IMI), que se distribuyó en las Jornadas Nacionales de Supervisoras de Enfermería (Bilbao, 2010). Tras el análisis de los resultados, se obtiene un perfil motivacional que puede orientar a los gestores sanitarios en el rediseño de un sistema de incentivos que, alineado con los valores profesionales, influya en el comportamiento eficiente de los agentes sanitarios, y a invertir en un nuevo tipo de capital que denominamos 'capital motivaciona'(AU)
From the hypothesis that the exclusive use of monetary incentives may undermine intrinsic motivation of health professionals, causing the opposite effect to that intended, this paper analyzes the factors that are associated with intrinsic motivation of professionals responsible for nursing management. To this end, we designed a questionnaire on Work Motivation in Nursing Management based on Intrinsic Motivation Inventory (IMI), which was distributed at the National Conference of Supervisors of Nursing (Bilbao, 2010). After analyzing the results, we obtained a motivational profile that can guide health managers in the redesign of a system of incentives that, aligned with professional values, influence the efficient performance of health workers, and to invest in a new type of capital that we call 'motivational capital'(AU)
Subject(s)
Humans , Employee Incentive Plans/organization & administration , Nursing Care/organization & administration , Nurse Administrators , Program for Incentives and Benefits , Nursing, Supervisory/organization & administrationABSTRACT
BACKGROUND: The repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline. METHODS: The decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 µg/dl was obtained in the 1995 study and of 0.9 µg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever. RESULTS: The decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the 626.4m- 865.4m range (2009). CONCLUSIONS: The figures of the economic benefits derived from the decision to ban leaded gasoline are very high.
Subject(s)
Environmental Exposure/prevention & control , Environmental Pollutants , Gasoline , Health Policy/economics , Intelligence , Lead , Child , Cross-Sectional Studies , Efficiency , Employment/economics , Environmental Exposure/economics , Environmental Exposure/legislation & jurisprudence , Environmental Pollutants/blood , Environmental Pollutants/toxicity , Female , Health Impact Assessment , Health Policy/legislation & jurisprudence , Humans , Intelligence Tests , Lead/blood , Lead/toxicity , Male , SpainABSTRACT
Fundamentos: la evaluación económica de las repercusiones sanitarias de las políticas públicas es difícil y escasa. El objetivo del presente estudio fue cuantificar monetariamente los beneficios de la reducción del plomo en la sangre de los niños de 7-8 años en la Comunidad de Madrid (España), derivada de la prohibición del plomo en las gasolinas. Métodos: se calculó la disminución de puntos de cociente intelectual (CI), utilizando dos estudios realizados en niños de 7 a 8 años según los valores de plomo en sangre que presentaban: media geométrica de 3,8 μg/dL en 1995 y 0,9 μg/dL en 2010. La mejoría neta de CI se midió en términos de capacidad de producción ganada a lo largo de la vida laboral, siguiendo los métodos de Schwartz y Salkiver. Resultados: la reducción de los niveles de plomo en sangre de estos niños evitó perder entre 135.391 y 144.153 puntos de CI. La valoración económica actual de estos puntos en términos de capacidad de producción ganada a lo largo de la vida laboral de estos sujetos se estimó en un rango entre 626,4 y 865,4 millones de euros (valor 2009). Conclusiones: las cifras de beneficios económicos encontradas derivadas de la medida de prohibición de uso de plomo en las gasolinas son importantes en términos sociales (AU)
Background: The repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline. Methods: the decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 μg/dl was obtained in the 1995 study and of 0.9 μg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever. Results: the decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the 626.4m-865.4m range (2009). Conclusions: the figures of the economic benefits derived from the decision to ban leaded gasoline are very high (AU)
Subject(s)
Child , Female , Humans , Male , Gasoline/adverse effects , Air Pollutants/adverse effects , Lead/adverse effects , Lead Poisoning/complications , Unleaded Gasoline/economics , Intelligence , Unleaded Gasoline/methods , Unleaded Gasoline/prevention & control , Unleaded Gasoline/policies , Education of Intellectually Disabled/economics , Education of Intellectually Disabled/legislation & jurisprudence , Intellectual Disability/chemically induced , Intellectual Disability/complications , Intellectual Disability/prevention & control , /standards , Environment/methodsABSTRACT
OBJECTIVES: To identify which clinical and social characteristics should be used to prioritize patients on the waiting list for elective surgical procedures. METHODS: A discrete choice experiment (DCE) was conducted using a representative sample of the general population in Navarre (Spain). The sample was selected through simple random sampling by age and sex quotas, stratified by the areas and municipalities of residence of the population aged more than 18 years old. Data were analyzed using Bayesian methods. RESULTS: The relative weights of attributes show that the most important attributes when prioritizing patients were the disease, the cost of the intervention, and waiting time. As expected, severity of illness was the most important attribute and, contrary to prior expectations, improvements in health were considered less important. These findings show that prioritization according to waiting time alone may not take into account other issues considered important by the general public. CONCLUSIONS: Patients should not be prioritized according to waiting time only. An interesting finding that should be analyzed in future is that cost was considered an important prioritization criterion. This study provides a further example of the potential of DCE in health economics. If its limitations are borne in mind, this tool may be useful to develop prioritization scoring systems for patients on waiting lists.
Subject(s)
Patient Selection , Surgical Procedures, Operative , Waiting Lists , Adolescent , Adult , Aged , Bayes Theorem , Female , Humans , Male , Middle Aged , Severity of Illness Index , Spain , Surgical Procedures, Operative/economics , Surveys and Questionnaires , Time FactorsABSTRACT
Objetivos: Analizar cuáles deben ser los criterios clínicos y sociales en función de los cuales deben ser priorizados los pacientes en listas de espera quirúrgicas programadas. Métodos: Se estima un modelo de elección discreta (MED) utilizando una muestra representativa de la población general de Navarra. La muestra fue seleccionada mediante muestreo aleatorio simple por cuotas de edad y sexo, estratificada por áreas y municipios de residencia de la población mayor de 18 años. La información obtenida se analizó por métodos bayesianos. Resultados: Los pesos relativos de los atributos revelan que los problemas de salud del paciente, el coste de la intervención y el tiempo de espera son los 3 más importantes a la hora de priorizar a los pacientes. Conforme a lo esperado, la gravedad de la enfermedad se presenta como el atributo considerado de mayor importancia, y llama la atención la menor importancia de la mejora de la salud causada por la intervención. Estos resultados indican que la priorización de pacientes de acuerdo solamente al tiempo de espera no tendría en cuenta los aspectos considerados importantes por la población. Conclusiones: El tiempo de espera no debería ser la única variable utilizada para la priorización de pacientes en las listas de espera. Un resultado interesante que deberá ser analizado en el futuro es la importancia otorgada al coste de la intervención. Este trabajo es otro ejemplo del potencial de los MED en economía de la salud, que teniendo en cuenta sus posibles limitaciones, puede ser útil para crear mecanismos de priorización de pacientes en las listas de espera (AU)
Objectives: To identify which clinical and social characteristics should be used to prioritize patients on the waiting list for elective surgical procedures. Methods: A discrete choice experiment (DCE) was conducted using a representative sample of the general population in Navarre (Spain). The sample was selected through simple random sampling by age and sex quotas, stratified by the areas and municipalities of residence of the population aged more than 18 years old. Data were analyzed using Bayesian methods. Results: The relative weights of attributes show that the most important attributes when prioritizing patients were the disease, the cost of the intervention, and waiting time. As expected, severity of illness was the most important attribute and, contrary to prior expectations, improvements in health were considered less important. These findings show that prioritization according to waiting time alone may not take into account other issues considered important by the general public. Conclusions: Patients should not be prioritized according to waiting time only. An interesting finding that should be analyzed in future is that cost was considered an important prioritization criterion. This study provides a further example of the potential of DCE in health economics. If its limitations are borne in mind, this tool may be useful to develop prioritization scoring systems for patients on waiting lists (AU)