Prevalence of chronic renal disease in Spain: results of the EPIRCE study.

INTRODUCTION: Chronic kidney disease (CKD) is an independent cardiovascular risk factor. The knowledge of prevalence in general population may help to early detection of CKD and prevent or delay its progression. METHODS: Sociodemographic, baseline characteristics, and CKD prevalence (measured by centralized serum creatinine and MDRD equation) were evaluated in a randomly selected sample of general population aged 20 years or older, collected in all Spanish regions and stratified by habitat, age and sex according to 2001 census (n=2746). Univariate and multivariate logistic regression analyses were used to evaluate associations with CKD risk factors. RESULTS: Mean age was 49.5 years. The overall prevalence of Kidney Disease Outcomes Quality Initiative grades 3-5 CKD was 6.8%, with a 95% confidence interval (CI) of 5.4 to 8.2 (3.3% for age 40-64 years and 21.4% for age > 64 years). The prevalence estimates of CKD stages were: 0.99% for stage 1 (glomerular filtration rate [GFR] >or=90 ml/min per 1.73 m2 with proteinuria); 1.3% for stage 2 (GFR 60-89); 5.4% for stage 3a (GFR 45-59); 1.1% for stage 3b (GFR 30-44); 0.27% for stage 4 (GFR 15-29); and 0.03% for stage 5 (GFR < 15). An important prevalence of classical cardiovascular risk factors was observed: dyslipemia (29.3%), obesity (26.1%), hypertension (24.1%), diabetes (9.2%) and current smoking (25.5%). The independent predictor factors for CKD were age, obesity and previously diagnosed hypertension. CONCLUSION: The prevalence of CKD at any stage in general population from Spain is relatively high, especially in the elderly, and similar to countries of the same geographical area. Independently of age, two modifiable risks factors, hypertension and obesity, are associated with an increased prevalence of CKD.

ACE clock scoring: a comparison with eight standard correction methods in a population of low educational level.

The authors compared the accuracy of Addenbrooke's Cognitive Examination Clock Drawing Test scoring method with 8 standard Clock Drawing Test scoring methods in a Spanish speaking population of low educational level. A clinical group composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia was compared with 72 controls matched for gender, age, and educational level. The clinical group was studied with standard neuropsychological instruments and neuroimaging. Clock Drawing Tests extracted from Addenbrooke's Cognitive Examination were randomly distributed and scored by 2 independent raters. There were statistically significant differences between the different scoring methods. Addenbrooke's Cognitive Examination Clock Drawing Test scoring method obtained and optimal areas under the curve and interrater reliability, showing no statistical differences with previously standardized systems. In our population, Addenbrooke's Cognitive Examination and the methods of Cahn, Mendez, Rouleau, Shulman, and Sunderland were of optimal and equivalent usefulness regarding dementia detection.

Epidemiology of chronic renal disease in the Galician population: results of the pilot Spanish EPIRCE study.

BACKGROUND: Chronic kidney disease (CKD) is a major social health problem because of the aging of the population, the high incidence of diabetes mellitus, and the epidemic of silent CKD resulting from inadequate diagnosis of early chronic renal insufficiency METHODS: The sociodemographic, baseline characteristics and CKD prevalence measured by the Modification of Diet in Renal Disease formula were studied in a randomly selected sample of people aged 20 years or older in the general population. We report the results of the analysis of the EPIRCE (Estudio Epidemiológico de la Insuficiencia Renal en España) pilot study performed in Galicia, Spain, in the last quarter of 2004. RESULTS: Baseline characteristics, sociodemographic characteristics, and results of a clinical examination and blood variables were collected from 237 patients who fulfilled the study's inclusion and exclusion criteria. The mean age of the sample was 49.58 years (95% confidence interval, 47.39-51.76). The prevalence of Kidney Disease Outcomes Quality Initiative grade 3 CKD was 5.1%, but the coexistence of an albumin/creatinine ratio>30 mg/g with grade 1 to 2 CKD raised the final rate to 12.7% in this population. We found a high prevalence of hypertension (31.5%), isolated systolic hypertension (20.1%), diabetes mellitus (8%), obesity (13.1%), smoking habit (22.7%), high atherogenic index (30.8%), and high alcohol intake (24%). Risk factors significantly associated with renal disease were age [P=0.018; odds ratio (OR) 2.7], hypertension (P=0.023; OR 2.13), pulse pressure (P=0.04; OR 0.10), diabetes mellitus (P=0.08; OR 4.48), obesity (P=0.000; OR 7.7), and insulin resistance index (P=0.04; OR 4.95). CONCLUSION: The prevalence of CKD and conventional cardiovascular risk factors is high in this randomly selected sample of the general population. Secondary preventive measures are needed to detect chronic kidney impairment as early as possible and to reduce the incidence and mortality arising from the associated comorbidities.

Validación de un cuestionario de calidad de cuidados de enfermería / Validation of an instrument to measure the quality of nursing care

Fundamento: La satisfacción del paciente es un importante indicador de calidad de la atención recibida durante su estancia hospitalaria. El objetivo del estudio es validar al idioma castellano y gallego el instrumento de valoración de cuidados de enfermería The Newcastle Satisfaction with Nursing Scales (NSNS). Material y método: Estudio transversal. Traducción, adaptación cultural y validación del NSNS. Tiene 3 partes: experiencias con los cuidados de enfermería (26 preguntas, tipo Likert), satisfacción con los cuidados (19 preguntas, tipo Likert) y variables sociodemográficas. Las dos primeras aportan una puntuación global sobre 100. Resultados: Total de entrevistas: 46 (21 gallego/25 castellano), con un 77% de varones cuya edad media era de 47 años (intervalo de confianza [IC] del 95%, 43-51). La estancia media fue de 12 días (IC del 95%, 8-16). No se observaron diferencias entre sexos en la edad, el uso de idioma, el nivel de estudios o la estancia media. En el análisis de fiabilidad realizado en castellano se obtuvieron los siguientes datos: primera parte, alfa de Cronbach = 0,8561, prueba de las dos mitades: alfa1 = 0,8758, alfa2 = 0,6244; segunda parte, alfa de Cronbach = 0,9754, la prueba de las dos mitades alfa1 = 0,9648, alfa2 = 0,9486. En el realizado en gallego los datos fueron: primera parte, alfa de Cronbach = 0,9280, las dos mitades: alfa1 = 0,8696, alfa2 = 0,8556; segunda parte, alfa de Cronbach = 0,9785, dos mitades alfa1 = 0,9702, alfa2 = 0,9558. Conclusiones: Tras el proceso de traducción y adaptación cultural se han obtenido 2 instrumentos conceptualmente equivalentes, tanto en castellano como en gallego. Permiten incorporar la opinión del enfermo hacia los cuidados e implicar de una forma directa al personal en su mejora

Introduction: Patient satisfaction with nursing care is an important indicator of the quality of care received during hospitalization. The objective of this study was to describe the adaptation and validation of the Newcastle Satisfaction with Nursing Scales (NSNS) to Spanish and Galician. Material and method: A cross sectional study of the translation, cultural adaptation and validation of the NSNS was performed. The scale has three subscales: experiences of nursing care (26 Likert-like items), patient satisfaction (19 Likert-like items), and sociodemographic variables. The first two subscales are given an overall score with a potential range of 0-100. Results: Forty-six interviews were carried out (21 Galician/25 Spanish). Seventy-seven percent of the patients were men. The mean age was 47 years (95% CI, 8-16). No differences between sexes were found in age, language, educational level, or mean length of hospital stay. Analysis of the reliability of the Spanish scale: Cronbach's alpha for the first part = 0.8561 and for the two halves: alpha1 = 0.8758, alpha2 = 0.6244; Cronbach's alpha for the second part = 0.9754, and for the two halves: alpha1 = 0.9648, alpha2 = 0.9486. Reliability of the Galician version was: Cronbach's alpha for the first part = 0.9280, and for the two halves: alpha1 = 0.8696, alpha2 = 0.8556; Cronbach's alpha for the second part = 0.9785, and for the two halves: alpha1 = 0.9702, alpha2 = 0.9558. Conclusions: The translation and cultural adaptation to both Spanish and Galician has provided us with a comprehensible and reliable instrument to measure the quality of nursing care. Use of this scale identifies patients' opinions and allows staff to be directly involved in improving nursing care

[Diarrhea associated with Clostridium difficile: experience at a secondary hospital]. / Diarrea asociada a Clostridium difficile: experiencia en un hospital secundario.

BACKGROUND AND OBJECTIVE: Our purpose was to know the incidence, clinical profile, evolution and mortality of Clostridium difficile-associated diarrhea. PATIENTS AND METHOD: Retrospective study. Inpatients were included who had a positive toxin on stools or a diagnostic colonoscopy (pseudomembranous colitis) after ruling out other causes (n=113). RESULTS: We observed a growing annual incidence (1.05, 1.7, and 2.6 per 1000 admissions in 1999, 2000 and 2001, respectively). Hyponatremia (OR=5.16) and vomiting (OR=3.09) were found to be worse-prognosis factors. Hyponatremia (OR=2.72) and chronic renal disease (OR=4.45) increased the mortality risk. CONCLUSIONS: The incidence of C. difficile-associated diarrhea is growing, probably in relation to increased clinical suspicion, wide antibiotics utilization, and old age of inpatients. Hyponatremia could be a predictive factor of both illness and worse-prognosis.

Diarrea asociada a Clostridium difficile:experiencia en un hospital secundario / Clostridium difficile: experience at a secondary hospital

FUNDAMENTO Y OBJETIVO: El objetivo de este estudio fue conocer la incidencia, las características clínicas, la evolución y la mortalidad de la diarrea hospitalaria asociada a Clostridium difficile. PACIENTES Y MÉTODO: Estudio retrospectivo, realizado entre 1999 y 2001, de 113 casos de diarrea por C. difficile, determinados mediante toxina positiva en heces o colonoscopia diagnóstica de colitis seudomembranosa, una vez descartadas otras causas. RESULTADOS: Se ha observado una incidencia anual creciente (1,3-1,7-2,6 por cada 1.000 ingresos en los años 1999, 2000 y 2001, respectivamente). La hiponatremia (OR = 5,16) y los vómitos (OR = 3,09) fueron factores de mal pronóstico. El riesgo de fallecimiento aumentó con la presencia de hiponatremia (OR = 2,72) e insuficiencia renal crónica (OR = 4,45). CONCLUSIONES: La enfermedad asociada a C. difficile está aumentando en incidencia en nuestro centro por un aumento de sospecha, amplio uso de antibióticos, edad avanzada y gravedad de los pacientes hospitalizados. La hiponatremia podría ser un predictor de gravedad y mala evolución (AU)

[Nosocomial diarrhea outbreak due to Clostridium difficile in a vascular surgery department]. / Brote nosocomial de diarrea por Clostridium difficile en un servicio de cirugía vascular.

INTRODUCTION: Clostridium difficile is considered the most common cause of nosocomial-acquired diarrhea. In Spain this condition is rarely reported. METHODS: Over a five-month period, 35 episodes of C. difficile diarrhea were diagnosed by toxin A detection in stool samples. Case-control studies were designed to assess risk factors for the outbreak. Twelve cases from the vascular surgery department were compared with 24 randomized controls, patients admitted to the same ward during this period, but without diarrhea. Statistical comparisons (SPSS software) were performed with the Student's t and X2 tests (OR with 95% CI). RESULTS: Overall incidence was 3.42 episodes: 48 episodes/1000 admissions to vascular surgery. Among the total, 80% had received antibiotics before admission and the mean number of antibiotics administered was 2.91 per patient. Comparative analyses disclosed that the cases had received a larger number of antibiotics during hospitalization (p 5 0.000) and in the two months before admission (p 5 0.031) than the controls. Clindamycin administered alone (p 5 0.001) or associated with aztreonam (p 0.000) were the most frequently used antibiotic treatments. CONCLUSIONS: C. difficile diarrhea is common in our setting. Diagnosis requires a high index of suspicion. We attribute the nosocomial outbreak in our vascular surgery department to broad-spectrum antibiotic use (clindamycin and aztreonam). Surveillance, together with restriction of antibiotic use was effective for control.

Brote nosocomial de diarrea por Clostridium difficileen un servicio de cirugía vascular / Nosocomial diarrhea outbreak due to Clostridium difficile in a vascular surgery department

Introducción: El uso indiscriminado de antibióticos se ha asociado a un aumento de resistencias y constituye el factor de riesgo más importante para el desarrollo de diarrea asociada a Clostridium difficile, que se aísla entre el 10 y el 30 por ciento de los pacientes con diarrea nosocomial1, con grandes problemas para su erradicación y elevados costes en términos de morbimortalidad2,3.Intuitivamente tenemos la impresión de estar ante un problema infradiagnosticado debido a la dificultad para la confirmación de laboratorio que exige la demostración de toxina de C. difficile en un contexto clínico adecuado4. Desde el primer caso publicado por Finney5, se han publicado gran número de brotes epidémicos nosocomiales en hospitales generales y residencias de enfermos crónicos1,2,3,6, de grandes dimensiones, uno declarado en un hospital dublinés que afectó a 139 pacientes con 4 muertes7.En España se le ha dedicado escasa atención publicándose casos aislados y dos brotes epidémicos; de 6 y 5 casos, respectivamente8,9.Se describe un período de 5 meses en el que se detectó un aumento de la incidencia de diarrea por C. difficile y las INTRODUCCIÓN. La infección por Clostridium difficile es una causa de diarrea nosocomial poco descrita en España. MÉTODOS. En un período de 5 meses se detectaron 35 episodios de diarrea por C. difficile diagnosticados por la detección de toxina A en heces líquidas. Se compararon 12 casos de cirugía vascular con 24 controles aleatorizados, sin diarrea. El análisis estadístico (SPSS) utilizó para las comparativas t de Student y chi cuadrado (odds ratio con intervalo de confianza del 95 por ciento).RESULTADOS. La incidencia global fue 3,42 frente 48 casos/1.000 ingresos en cirugía vascular. El 80 por ciento recibieron antibióticos antes del ingreso y la media durante el ingreso fue de 2,91 antibióticos/paciente. El estudio casos-controles se diseñó para estudiar los factores de riesgo del brote de vascular. El análisis reveló que los casos recibieron un mayor número de antibióticos antes (p 0,0031) y durante el ingreso (p 0,000), siendo la clindamicina sola (p 0,001) o asociada a aztreonam (p 0,000) los más utilizados. CONCLUSIONES. La diarrea por C. difficile es frecuente en nuestro medio, su diagnóstico exige un elevado índice de sospecha. Se publica un brote atribuido al uso de clindamicina y/o aztreonam. Las medidas de control y la restricción en el uso de antibióticos fueron efectivos (AU)