Pacientes que reciben atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio. Estudio APASO, mediante Redes Centinelas Sanitarias / Patients receiving palliative and supportive care from primary health care teams at home. APASO study through Health Sentinel Networks

OBJETIVO: Describir las características clínicas y los problemas de salud que afectan a la población que recibe cuidados paliativos y de soporte en su domicilio prestados por los equipos de atención primaria. MÉTODO: Estudio observacional prospectivo realizado por profesionales pertenecientes a 5 Redes Centinelas Sanitarias (Asturias, Castilla y León, Extremadura, La Rioja, Comunitat Valenciana) mediante un cuestionario por cada paciente que recibió atención paliativa con participación del equipo de atención primaria, durante un periodo de 3 meses, utilizando una definición y unos criterios comunes basados en el tipo de atención recibida y no en el diagnóstico clínico. Se recogieron problemas de salud causantes de la situación, los síntomas y el estado funcional del paciente además de otras variables relacionadas con su proceso clínico y entorno de apoyo. RESULTADOS: Se recogieron 1.192 casos, de los que 1.043 respondían a la definición de incapacidad funcional y 149 eran enfermos terminales. La mayor proporción correspondía a mujeres en situación de incapacidad. Ambos tipos de pacientes presentaban como media 3 o más problemas de salud que justificaban la atención paliativa o de soporte, aunque existen diferencias entre los problemas que tenían un tipo y otro de pacientes. La mitad recibía cuidados por 4 o menos síntomas, pero un 10% tenían 8 o más síntomas, con diferencias significativas en los síntomas más prevalentes entre los 2 tipos de pacientes. CONCLUSIONES: Los cuidados paliativos en atención primaria se prestan a pacientes con problemas de salud que provocan incapacidad. Las Redes Centinelas son una herramienta útil en la investigación en cuidados paliativos

OBJECTIVE: The aim of this paper is to describe the clinical characteristics and health problems affecting the population receiving palliative care and support at home by primary care teams. METHOD: A prospective observational study was conducted by professionals from 5 Sentinel Health Networks (Asturias, Castile and Leon, Extremadura, La Rioja, and the Community of Valencia) who completed a questionnaire for each patient receiving palliative care involving a primary care team during a period of 3 months, and using a common definition and criteria for the type of care, rather than the clinical diagnosis. This questionnaire addressed the health problems that caused the situation, the symptoms, the patient's functional status, and other variables related to the clinical process and supportive environment. RESULTS: Data were collected on a total of 1,192 cases, of which 149 were terminally patients, and 1,043 meet the definition of functional disability. The large majority were women with functional disability. Both types of patients had a mean of 3 or more health problems that justified palliative or supportive care, although there were differences between the problems presented by each type of patient. Half of them received care for 4 or fewer symptoms, but 10% had 8 or more symptoms. There were significant differences in the most prevalent symptoms between the 2 types of PATIENTS: CONCLUSIONS: Palliative care in primary care is provided to patients with health problems that cause disability. The Sentinel Networks are a useful tool for research in palliative care

[Palliative and support care at home in primary care]. / Atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio.

OBJECTIVES: To estimate the proportion of people requiring palliative and support care at home in primary care and to describe their characteristics. METHODS: A descriptive study was carried out by five Spanish sentinel networks between October 2007 and March 2008 in 282,216 people attended by 218 general practitioners and nurses. Patients receiving comprehensive, active and continued care at home were included if the aim was not to prolong life but to achieve the best quality of life for the patient, the family and the carers. A standard form was used to collect data on age, sex, type of patient, underlying diseases and other variables related to the process. Crude and age-adjusted rates were estimated. RESULTS: Of the 400 men and 792 women registered, 12% were strictly terminal. The mean age was 82.4 years and was higher in patients with functional disability (82.9 years) than in terminally-ill patients (78.9 years) (p<0.01). The estimated prevalence was 422.3 per 100,000 inhabitants aged 14 years or more (95% CI: 398.7-447.0) and was much higher in women than in men (553.9 versus 287.3, p<0.01). The estimate for the entire Spanish population was 309.0 per 100,000 inhabitants (95% CI: 286.0-332.0). CONCLUSIONS: The prevalence of palliative and support care in Spain is around three cases per 1,000 inhabitants and is higher in elderly populations. More than 85% of patients needing palliative or support care have a life expectancy of over 6 months and thus represent the majority of persons using this type of medical and social support. The most susceptible groups are women and the oldest-old.

[Immunity to diphtheria among adults older than 65 years]. / Inmunidad a la difteria en una población anciana.

BACKGROUND AND OBJECTIVE: To know the immune state against diphtheria through a survey, a consultation of the vaccination documents and a seroepidemiologic study of an old population. PATIENTS AND METHOD: The immunization status and the prevalence of antidiphtheria antibodies were determined in a representative sample (n = 231) of this population group (> 65 years). Concentrations of toxin antibodies were measured using a commercial ELISA kit. Samples with titres > 0.1 UI/ml were considered protective. RESULTS: In the vaccination documents we only found 19 old individuals vaccinated against tetanus-diphtheria. 47.1% had no protective titres. Geometric mean titres were 0.12 UI/ml. There was no statistically significant difference between the variables age and sex and the prevalence of antibodies. 84.4% of the 122 seropositives did not report having received diphtheria vaccine and neither had documents about the vaccination. CONCLUSION: There were almost no documents about diphtheria vaccination. Therefore, the serologic study is the only reliable way to know the immunity status against diphtheria in elderly people. Approximately 50% of this population need primary immunization. The rest of this group need to have completed antidiphtheria vaccination or a dose booster within a period of 2 years in order to guarantee protective antibody levels against diphtheria.

Inmunidad a la difteria en una población anciana / Immunity to diphtheria among adults older than 65 years

Fundamento y objetivo: Conocer el estado inmunitario frente a la difteria de una población anciana a través de una entrevista al paciente, los registros sanitarios y el análisis serológico. Pacientes y método: Se han determinado el estado vacunal y la prevalencia de anticuerpos antidifteria en una muestra representativa (n = 231) de este grupo poblacional (> 65 años). Los antecedentes de vacunación se analizaron a través de una encuesta y de una consulta de los registros sanitarios. Los títulos de anticuerpos se determinaron por enzimoinmunoanálisis. Los valores superiores a 0,1 U/ml se consideraron protectores. Resultados: En la encuesta ningún anciano conocía sus antecedentes de inmunización. Diecinueve pacientes tenían registrada su vacunación. Un 47,1% fueron seronegativos. La media del título de anticuerpos fue de 0,12 U/ml. No hubo diferencias significativas entre los títulos de anticuerpos y la edad y sexo del paciente. En el 84,4% de los 122 ancianos que fueron seropositivos no había constancia de la inmunización contra la difteria en la encuesta ni en los registros sanitarios. Conclusión: El infrarregistro de la vacunación contra la difteria en los ancianos hace que el estudio serológico sea el único método fiable para conocer el estado inmunitario frente a la difteria en esta población. Casi la mitad de los ancianos precisan la pauta de vacunación básica, mientras que en la población restante es necesaria una dosis de recuerdo o completar el calendario vacunal en un plazo menor de 2 años para mantener un grado de protección adecuado contra la difteria

Background and objective: To know the immune state against diphtheria through a survey, a consultation of the vaccination documents and a seroepidemiologic study of an old population. Patients and method: The immunization status and the prevalence of antidiphtheria antibodies were determined in a representative sample (n = 231) of this population group (> 65 years). Concentrations of toxin antibodies were measured using a commercial ELISA kit. Samples with titres > 0.1 UI/ml were considered protective. Results: In the vaccination documents we only found 19 old individuals vaccinated against tetanus-diphtheria. 47.1% had no protective titres. Geometric mean titres were 0.12 UI/ml. There was no statistically significant difference between the variables age and sex and the prevalence of antibodies. 84.4% of the 122 seropositives did not report having received diphtheria vaccine and neither had documents about the vaccination. Conclusion: There were almost no documents about diphtheria vaccination. Therefore, the serologic study is the only reliable way to know the immunity status against diphtheria in elderly people. Approximately 50% of this population need primary immunization. The rest of this group need to have completed antidiphtheria vaccination or a dose booster within a period of 2 years in order to guarantee protective antibody levels against diphtheria