[Hospital morbidity of elderly population in Andalusia (Spain)]. / Morbilidad hospitalaria aguda de las personas mayores de Andalucía.

INTRODUCTION: In recent years we have seen in Spain a significant increase in the number of old people. The aim of this work was to determine hospital morbidity among the elderly. MATERIALS AND METHODS: We studied the morbidity among patients older than 65 years admitted at the hospitals of our Andalusian public health system that belongs to the Spanish National Health System. We analysed the minimal basic data set at discharge (MBDSD) over a period from January 1998 to December 1999, both inclusive. RESULTS: In the 32 hospitals studied, a total of 25,255 hospital discharges of patients older than 65 years were recorded. This means an annual hospitalization rate in this age group of 15.2% (95 % CI: 15.1-15.3). The most frequent causes of hospitalisation are: diseases of the circulatory system (20.7%), diseases of the respiratory system (14.0%), diseases of the digestive system (11.6%). CONCLUSIONS: The old population of Andalusia (Spain) has a high rate of hospital morbidity, specially for people older than 75 years, and significant variations are seen between the different provinces of the Andalusian Region. Their hospitalization is due mainly to chronic diseases of developed countries.

Morbilidad hospitalaria aguda de las personas mayores de Andalucía / Hospital Morbility of ederly population in Andalucía (Spain)

Introducción: En los últimos años asistimos en España a un incremento importante del número de las personas mayores, siendo el objetivo del presente trabajo estudiar la morbilidad hospitalaria de los ancianos. Material y método: Hemos estudiado la morbilidad en las personas mayores de 65 años ingresadas en los hospitales del sistema sanitario público andaluz perteneciente al Sistema Nacional de Salud de España, analizando el conjunto mínimo básico de datos al alta hospitalaria (CMBDH). En un periodo de tiempo que abarca desde enero de 1998 a diciembre 1999, ambos inclusive. Resultados: En los 32 hospitales estudiados se registraron un total de 25.255 altas hospitalarias de personas mayores de 65 años. Que se se traduce en una índice anual de hospitalización para este grupo de edad del 15,2% (IC95% 15,1-15,3). Los motivos de ingreso más frecuentes son: las enfermedades del aparato circulatorio (20,7%), enfermedades del aparato respiratorio (14,0%), enfermedades del sistema digestivo (11,6%). Conclusiones: Los ancianos de Andalucía (España) poseen unos índices elevados de morbilidad hospitalaria, especialmente a partir de los 75 años, con importantes variaciones entre las distintas provincias que componen la región andaluza. Los ingresos de estas personas están provocados fundamentalmente por las enfermedades crónicas de los países desarrollados

Introduction: In recent years we have seen in Spain a significant increase in the number of old people. The aim of this work was to determine hospital morbidity among the elderly. Materials and methods: We studied the morbidity among patients older than 65 years admitted at the hospitals of our Andalusian public health system that belongs to the Spanish National Health System. We analysed the minimal basic data set at discharge (MBDSD) over a period from January 1998 to December 1999, both inclusive. Results: In the 32 hospitals studied, a total of 25,255 hospital discharges of patients older than 65 years were recorded. This means an annual hospitalization rate in this age group of 15.2% (95 % CI: 15.1- 15.3).The most frequent causes of hospitalisation are: diseases of the circulatory system (20.7%), diseases of the respiratory system (14.0%), diseases of the digestive system (11.6%). Conclusions: The old population of Andalusia (Spain) has a high rate of hospital morbidity, specially for people older than 75 years, and significant variations are seen between the different provinces of the Andalusian Region . Their hospitalization is due mainly to chronic diseases of developed countries

Cambios demográficos y asistencia geriátrica

Los cambios demográficos producidos en España en los últimos años son similares a los del resto de los países desarrollados de nuestro entorno: incremento del porcentaje de personas mayores y descenso del porcentaje de jóvenes. Las proyecciones demográficas indican que estos cambios se van a mantener e incluso se acentuarán en el futuro, lo que ocasionará un preocupante envejecimiento de la población, cuyo origen se encuentra en la caída de la natalidad y, fundamentalmente, en un aumento de la esperanza de vida (AU)

Utilidad de los sistemas de información en psiquiatría: análisis de un hospital general básico / The efectiveness of information systems in Psychiatry: analisis of a Standard General Hospital

En este trabajo se realiza un análisis descriptivo de los 2.175 ingresos producidos en la Unidad de Hospitalización Psiquiátrica del Hospital Punta Europa de Algeciras durante siete años (1995-2001), utilizando como fuente de información el conjunto mínimo básico de datos al alta hospitalaria (CMBDH), obteniéndose y analizando los Grupos Relacionados de Diagnóstico de los pacientes ingresados por el mismo GDR en el periodo de tiempo de estudio. Se evalúa la utilidad de éste sistema de indicadores para la gestión de un Servicio de Psiquiatría. Creemos que los GDR son un indicador útil de la calidad asistencial, pero es preciso continuar investigando en nuestro país (AU)

Consentimiento informado (II). Aspectos prácticos / Informed consent (II): Practical aspects

No disponible

No disponible

Consentimiento informado (I). Fundamento ético y legal / Informed consent (1). Ethical and legal bases

No disponible

No disponible

Mortalidad innecesariamente prematura y sanitariamente evitable en un Hospital General Básico / Unnecessary and avoidable healthcare-wise premature death in a basic general hospital

No disponible

[Medical and psychosocial evaluation of a mentally retarded adult population]. / Evaluación médica y psicosocial de una población adulta con discapacidad intelectual.

BACKGROUND: This study is aimed at describing the psychological, psychopathological, medical and social aspects of a mentally retarded population being provided with care by AFANAS-Jerez affording the possibility of assessing this type of problem from an epidemiological standpoint. METHODS: A descriptive case series study is conducted to characterize a mentally retarded (MR) population. An assessment was made of the psychological, medical and social aspects. The degree of intelligence was analyzed using the Weschler Adult Intelligence Scale. The adaptive behavior, frequency, typology and seriousness of the behavior problems were assessed by means of the Service Planning and Individual Scheduling Inventory. A psychopathological screening examination was conducted. This study is rounded out with a social and medical evaluation by means of structured interviews. The information from the different areas was encoded and was analyzed using the EPIINFO v6.0 and C.I.A. programs. RESULTS: The average age of the mentally retarded population studied was 32.2 (S.D. 9.2 years). Seventy-three percent (73%) males as compared to 27% females. Behavior problems were found to exist among 45.1% of the subjects. We have set up a statistical relationship between the existence/non-existence of said problems and the degree of MR, such that the greater the loss of intellectual capacity, the greater the probability of having behavior problems. One of the psychopathological symptoms worthy of special mention is the anxiety found to exist among 60.2%. The medical examination reveals the large number of problems related to with MR, we thus finding 22.48% of the subjects to have epilepsy, nearly 20% Down's Syndrome, etc. Also worthy of special mention is the low educational level of the parents and the family conflicts resulting from the child's retardation. CONCLUSIONS: Special mention must be made of how MR is a highly complex whole entailing a large number of related medical, psychological, psychiatric and social disorders, this being a situation brought to fore in this study, many of the disorders revealed to exist being related to the degree of MR. We are of the opinion that an epidemiological approach to the study of MR may be of use for a better comprehension of this problem.

[Characterization of major ambulatory surgery in a basic general hospital]. / Caracterización de la cirugia mayor ambulatoria en un hospital general básico.

BACKGROUND: Outpatient surgery initially came into being and further developed as a result of the progressive increase in the demand and in hospital expenses. Although it has afforded the possibility of lowering the cost per procedure and of improving the efficiency of the hospitals by maintaining the degrees of patient satisfaction and safety, it has also made it necessary to question the customary activity indicators. This had led us to assess the outpatient surgery units of the recently-opened Algeciras Hospital based on the customary system of payment in other countries, the Related Diagnostic Groups (RDG's). METHODS: Descriptive study regarding 3,051 surgical procedures performed on a scheduled basis in 1997 (not including the minor surgery using a local anesthetic), using as a source of information the minimum basic set of data for hospital discharge, obtaining and analyzing the RDG's. The hospital stays avoided based on the average stay of those patients admitted for the same RDG within the time period under study have been calculated. RESULTS: Major surgery performed on an outpatient basis afforded the possibility of an overall replacement percentage of 50.4% (33.3% of all of the patients who underwent surgery on a scheduled basis, that is, 4.1% of all of this Hospital's admissions), which meant an savings of 2,112 hospital stays. The most frequent RDG's having the greatest impact on stays avoided were the surgical procedures performed on the crystalline lens and the scraping or conization procedures performed for reasons other than malignant neoplasia. The readmission rate was 1.5%. CONCLUSIONS: The overall replacement rate obtained by this major outpatient surgery unit is considered to be acceptable, although it must increase within the next few years. We found differences in the spread of the processes dealt with as compared to other units in our environment, this being explainable due to the difficulties involved in starting up surgery of these characteristics.

[Readmission rate at a regional hospital]. / Tasa de reingresos de un hospital comarcal.

BACKGROUND: The purpose of this study is that of describing the frequency of re-admissions at the "Punta de Europa" Hospital in Algeciras. METHODS: The source of information employed was that of the Minimal Basic Hospital Admission Data Set (MBHADS) for 1995-1996, a total of 24,613 cases of hospitalization being analyzed. Re-admission has been defined as any admission entailing an identical major diagnosis within the 30 days following release from the hospital. A descriptive analysis has been made of the variables of age, sex, the unit/ward to which admitted and major diagnosis involved employing conventional single-variable techniques. RESULTS: The 30-day re-admissions rate was 5% (IC95% 4.8-5.2), totaling 3.4% (IC95% 3.2-3.6) if only the emergency re-admissions are taken into account. A higher probability of re-admission is related to males, to an older age to certain diagnoses and to the units/wards to which admitted. The units/wards showing the highest percentage of re-admissions were the Psychiatric Ward, Hematology and the Otolaryngology. The Units/Wards showing the lowest percentages of re-admissions were Ophthalmology, Traumatology and Obstetrics. The most frequent re-admissions diagnoses were: impending childbirth, AIDS and complications thereof, neoplasia of the bladder, unstable angina pectoris and paranoid schizophrenia. CONCLUSIONS: Hospital re-admissions are a useful indicator of the quality of health care which must be continued to be researched in our country, particularly after its having been included as an indicator of the public hospital program contracts in Andalusia. It is also deemed necessary to improve the definition of re-admission in said program contracts.

[Specific mortality rates at the Algeciras hospital during 1995-1996]. / Tasas específicas de mortalidad en el hospital de Algeciras durante el período 1995-1996.

BACKGROUND: In-hospital mortality has been proposed as an indicator of health care quality. It is also a fact that should be used for epidemiological monitoring and health planning. The aim of this work is to analyse the mortality in Algeciras Hospital, belonging to the Andalusia Health Authority. METHODS: A descriptive study was carried out of the patients discharged from hospital between January 1995 and December 1996, using discharge data and/or their medical record. The structure of the joint basic minimum data report on hospital discharge was used. The periods of hospitalisation were grouped into the diagnosis-related groups (DRGs). Following an initial analysis of all the periods of hospitalisation, the discharges of patients under 80 years of age were analysed and the risk of death in hospital in line with the reason for admission was set. RESULTS: In Algeciras Hospital between January 1995 and December 1996 a total of 24,194 episodes of hospitalisation and a 4.1% death rate were recorded. A higher death rate was observed for males (5.3%), as opposed to females (3.2%). (P < 0.01). There were 750 in-hospital deaths in patients under 80 years of age, with a continued higher mortality rate for males. The most frequent causes of deaths in this age group are: 66 deaths caused by cerebro-vascular disease (the probability of dying in this age group if the patients were admitted to hospital because of cerebro-vascular disease IC95% 0.12-0.19), 58 deaths due to AIDS (IC95% 0.09-0.15), 51% due to bronchial and lung neoplasias (IC95% 0.18-0.30), 49 deaths from acute myocardial infarction (IC95% 0.12-0.21), 39% as a result of chronic obstructive pulmonary disease (IC95% 0.07-0.14). CONCLUSIONS: The abundant information supplied by hospital mortality statistics is confirmed, especially if the age and illness of the patients involved is taken into account. There is an evident need for health policies to prevent HIV/AIDS, cerebro-vascular disease, lung cancer and ischaemic heart disease to be adopted in the Algeciras catchment area. Thus, there is a need to monitor and draw up new indicators of hospital mortality and to expand the list of unnecessarily premature and avoidable deaths with strictly hospital causes.

[Efficiency evaluation of the diabetic education unit at the hospital in Algeciras]. / Evaluación de la efectividad de la unidad de educación diabetológica del hospital de Algeciras.

BACKGROUND: Diabetic Education is a basic part of treating Diabetes Mellitus and is intended to improve a patient's quality of life. An analysis was made of the effectiveness of a diabetic education program at the Algeciras Regional Hospital. METHODS: Results achieved by the Diabetic Education Unit were measured according to frequency of hospital visits. A parallel study was therefore carried out on the Unit's first 86 patients and an analysis made of the percentage of patients admitted as well as the period of hospitalization, four years before the Diabetic Program was carried out and four years later. RESULTS: The 20.7% rate of patients admitted four years before the program was reduced to 6.1% in the four following years (IC 95% of the difference between 0.055 and 0.170). A significant decrease (p < 0.001) was also observed in the period of hospitalization, before and after the program, which was quantified in 3.54 days/patient in four years (IC 95%: 1.02 to 5.56 days). CONCLUSIONS: The educational program reduced complications of the disease and improved quality of life.