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1.
Semergen ; 44(5): 335-341, 2018.
Artículo en Español | MEDLINE | ID: mdl-29162472

RESUMEN

OBJECTIVE: The aim of this study is to assess the self-perception of disease by patients with chronic diseases and determine factors related to their perception of disease. MATERIAL AND METHODS: Cross-sectional descriptive study performed between September 2014 and April 2015 in nine (6 urban and 3 rural) Health Centres of Navarra, Spain. The participants were recruited by convenience sampling of 196 patients aged over 65 years with at least one chronic disease. The outcome variable was: Perception of disease evaluated through The Brief Illness Perception Questionnaire (9 items. Assessment of the cognitive and emotional representation of the disease. A higher total score indicates a greater threat of disease to the patient). Explanatory variables: Evaluation of the care received through the Patient Assessment of Chronic Illness Care, Katz index, Gijon's socio-family evaluation scale and quality of life using the EQ5D questionnaire. Other variables studied were: gender, age, education, Charlson index, and number of chronic diseases. The association between the total The Brief Illness Perception Questionnaire value and the rest of the variables was calculated. RESULTS: The self-perception of disease is more negative for a larger number of diseases (rho: 0.242; p=.001), greater patient dependence (rho: -0.193; P=.007), and a poorer self-perceived quality of life (EQ VAS rho: -0.484; P<.001. EQ5D5L Index value rho: -0.507; P<.001). CONCLUSIONS: The perception that chronic patients have about their disease worsens as their diseases and their dependence increase, and also worsens their quality of life.


Asunto(s)
Enfermedad Crónica/psicología , Calidad de Vida/psicología , Autoimagen , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Población Rural , España , Encuestas y Cuestionarios , Población Urbana
2.
Rev Esp Cir Ortop Traumatol ; 61(3): 185-192, 2017.
Artículo en Inglés, Español | MEDLINE | ID: mdl-28363666

RESUMEN

OBJECTIVE: To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. MATERIAL AND METHODS: A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. RESULTS: The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. DISCUSSION AND CONCLUSION: Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan.


Asunto(s)
Fijación de Fractura/mortalidad , Fracturas de Cadera/cirugía , Fracturas Osteoporóticas/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Fracturas de Cadera/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Fracturas Osteoporóticas/mortalidad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo
3.
Rev. clín. esp. (Ed. impr.) ; 215(1): 9-17, ene.-feb. 2015. tab
Artículo en Español | IBECS | ID: ibc-132107

RESUMEN

Antecedentes y objetivos. El paciente multiingresador origina un gran consumo de recursos sanitarios. Hemos estudiado los factores asociados con el ingreso hospitalario múltiple en una cohorte de pacientes asistidos en un Servicio de Medicina Interna. Pacientes y métodos. Se analizaron 613 ingresos hospitalarios consecutivos. Se definió como paciente multiingresador a aquel que al ingresar contabilizaba 3 ingresos o más en los últimos 12 meses. Se analizó la relación de factores demográficos, clínicos y sociales con la característica de ser multiingresador. Además, se analizó el reingreso en los 6 meses siguientes al alta así como el fallecimiento en el ingreso y en los 6 y 12 meses siguientes al alta. Resultados. Los multiingresadores se caracterizaron frente a los no multiingresadores por ser de sexo masculino, ser más jóvenes y presentar mayor comorbilidad, mayor consumo de medicaciones y mayor puntuación en el índice de Katz. La principal causa de ingreso de los multiingresadores fue la «descompensación de una enfermedad crónica» (87,3%). Las enfermedades que se asociaron de forma más destacada con el multiingreso fueron la insuficiencia cardiaca, la diabetes mellitus y la enfermedad pulmonar obstructiva crónica. En los 6 primeros meses tras el alta los multiingresadores presentaron más reingresos. Durante el periodo de estudio, falleció el 40,4% de los pacientes multiingresadores y el 28,8% de los pacientes no multiingresadores. Conclusiones. Los pacientes multiingresadores presentaron mayor complejidad clínica que los no multiingresadores, y el multiingreso se asoció con las enfermedades crónicas, la polifarmacia, el deterioro funcional y tasas elevadas de mortalidad (AU)


Background and objectives. Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. Patients and methods. A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. Results. When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. Conclusions. Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates (AU)


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Readmisión del Paciente/economía , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/tendencias , Enfermedad Crónica/economía , Enfermedad Crónica/epidemiología , Medicina Interna/métodos , Medicina Interna/estadística & datos numéricos , Readmisión del Paciente/normas , Comorbilidad , Enfermedad Crónica/mortalidad , Estudios de Cohortes , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Estudios Prospectivos , Intervalos de Confianza , Enfermedad Pulmonar Obstructiva Crónica/economía , Enfermedad Pulmonar Obstructiva Crónica/epidemiología
4.
Rev Clin Esp (Barc) ; 215(1): 9-17, 2015.
Artículo en Inglés, Español | MEDLINE | ID: mdl-25278435

RESUMEN

BACKGROUND AND OBJECTIVES: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. RESULTS: When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. CONCLUSIONS: Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

5.
An Sist Sanit Navar ; 37(1): 169-76, 2014.
Artículo en Español | MEDLINE | ID: mdl-24871126

RESUMEN

The spleen is the largest lymphopoietic organ, containing 25% of total lymphoid mass. It participates in cellular and humoral immunity and intervenes in the renovation of red cells and the elimination of bacteria. Splenic functions are reduced when the spleen is absent, which entails, amongst other complications, greater susceptibility to suffering from sepsis due to encapsulated organisms. We present 6 clinical cases admitted to the Internal Medicine serve with splenic pathology and we make a review of the approach to be used. The spectrum of splenic lesions in internal medicine is very wide. On occasions, a splenic pathology can be suspected due to clinical history, physical exploration or because of cytopenias in the analyses. Different complementary tests are available for completing study of these lesions. A splenectomy can be carried out in case of diagnostic doubt, with the most frequent diagnoses being hepatic cirrhosis and lymphoma/leukaemia.


Asunto(s)
Enfermedades del Bazo/diagnóstico , Adulto , Anciano , Femenino , Humanos , Medicina Interna , Masculino , Persona de Mediana Edad
10.
Rev Neurol ; 44(2): 68-74, 2007.
Artículo en Español | MEDLINE | ID: mdl-17236144

RESUMEN

INTRODUCTION: Its high rates of prevalence, mortality and disability make acute cerebrovascular disease (ACVD) a priority health problem. It is as the second most common cause of admission to internal medicine services. AIMS: To examine inpatient care for ACVD during 2004 in the Valle de los Pedroches health area in the province of Cordoba, as well as survival at six months, so as to be able to carry out the changes needed to improve the attention offered for this condition. PATIENTS AND METHODS: A longitudinal study of the acute phase of the illness and survival at six months was conducted by means of face-to-face interviews. RESULTS: The prevalence of arterial hypertension (75.5%) stands out as a risk factor. The mean age was higher than in other series. There is no characteristic profile of clinical symptoms. The proportion of ischaemic to haemorrhagic strokes falls within the normal range. All 110 patients were submitted to a cranial computerised axial tomography scan in less than three hours. A compromised level of consciousness, senility, haemorrhagic stroke, poorer scoring on the Canadian Neurological Scale and complications all affected mortality rates. The study showed that 20% died while in hospital and 19.1% at six months. At discharge, 30.9% were undergoing rehabilitation. The spouse was the main caregiver in 55.5% of cases. A total of 79% had sequelae at six months. CONCLUSIONS: Instruments that allow fast effective diagnoses and treatments and guarantee proper clinical practice while reducing brain damage and its dependence should be made generally available. Improving primary and secondary prevention is essential in order to halt the progression of ACVD.


Asunto(s)
Hospitales de Distrito/estadística & datos numéricos , Accidente Cerebrovascular/epidemiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Daño Encefálico Crónico/prevención & control , Isquemia Encefálica/epidemiología , Fármacos Cardiovasculares/uso terapéutico , Áreas de Influencia de Salud , Hemorragia Cerebral/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Manejo de la Enfermedad , Progresión de la Enfermedad , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Necesidades y Demandas de Servicios de Salud , Mortalidad Hospitalaria , Humanos , Hipertensión/epidemiología , Hipoglucemiantes/uso terapéutico , Incidencia , Masculino , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Resultado del Tratamiento
11.
Rev. neurol. (Ed. impr.) ; 44(2): 68-74, 16 ene., 2007. tab
Artículo en Es | IBECS | ID: ibc-053087

RESUMEN

Introducción. La enfermedad cerebrovascular aguda (ECVA) es un problema de salud prioritario por su elevada prevalencia, mortalidad y discapacidad. Constituye la segunda causa de ingreso en el servicio de medicina interna. Objetivo. Conocer la asistencia hospitalaria en la ECVA durante el año 2004 en el área sanitaria del Valle de los Pedroches en la provincia de Córdoba y la supervivencia a los seis meses para emprender los cambios necesarios que mejoren la atención en este proceso. Pacientes y métodos. Estudio observacional de la fase aguda de la enfermedad y de supervivencia a los seis meses mediante una entrevista personal. Resultados. Destaca la prevalencia de hipertensión arterial (75,5%) como factor de riesgo. La edad media es superior a otras series. No hay un perfil de síntomas clínicos característico. La proporción de ictus isquémico y hemorrágico es la habitual. Los 110 pacientes disponían de tomografía axial computarizada craneal en un tiempo inferior a tres horas. La afectación del nivel de conciencia, la senectud, el ictus hemorrágico, la peor puntuación en la escala canadiense y las complicaciones marcaron la mortalidad. El 20% murió durante el ingreso y el 19,1% a los seis meses. El 30,9% realizaba rehabilitación al alta. En el 55,5% el cuidador principal era el cónyuge. El 79% tenía secuelas a los seis meses. Conclusiones. Deberían generalizarse los instrumentos para el diagnóstico y la terapéutica rápidos y eficaces que garanticen una práctica clínica adecuada y disminuyan el daño cerebral y su dependencia. Es imprescindible mejorar la prevención primaria y secundaria para frenar la progresión de la ECVA


Introduction. Its high rates of prevalence, mortality and disability make acute cerebrovascular disease (ACVD) a priority health problem. It is as the second most common cause of admission to internal medicine services. Aims. To examine inpatient care for ACVD during 2004 in the Valle de los Pedroches health area in the province of Cordoba, as well as survival at six months, so as to be able to carry out the changes needed to improve the attention offered for this condition. Patients and methods. A longitudinal study of the acute phase of the illness and survival at six months was conducted by means of face-toface interviews. Results. The prevalence of arterial hypertension (75.5%) stands out as a risk factor. The mean age was higher than in other series. There is no characteristic profile of clinical symptoms. The proportion of ischaemic to haemorrhagic strokes falls within the normal range. All 110 patients were submitted to a cranial computerised axial tomography scan in less than three hours. A compromised level of consciousness, senility, haemorrhagic stroke, poorer scoring on the Canadian Neurological Scale and complications all affected mortality rates. The study showed that 20% died while in hospital and 19.1% at six months. At discharge, 30.9% were undergoing rehabilitation. The spouse was the main caregiver in 55.5% of cases. A total of 79% had sequelae at six months. Conclusions. Instruments that allow fast effective diagnoses and treatments and guarantee proper clinical practice while reducing brain damage and its dependence should be made generally available. Improving primary and secondary prevention is essential in order to halt the progression of ACVD


Asunto(s)
Masculino , Femenino , Anciano , Humanos , Accidente Cerebrovascular/epidemiología , Hospitales de Distrito/estadística & datos numéricos , Enfermedad Aguda , Fármacos Cardiovasculares/uso terapéutico , Hemorragia Cerebral/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/rehabilitación , Accidente Cerebrovascular/terapia , Comorbilidad , Diabetes Mellitus/epidemiología , Manejo de la Enfermedad , Progresión de la Enfermedad , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Estudios de Seguimiento , Mortalidad Hospitalaria , Hipertensión/epidemiología , Hipoglucemiantes/uso terapéutico , Incidencia , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Áreas de Influencia de Salud , Necesidades y Demandas de Servicios de Salud , Lesión Encefálica Crónica/prevención & control , Isquemia Encefálica/epidemiología
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