Características clínicas y sociosanitarias en mayores de 65 años asistidos en atención primaria. Estudio PYCAF / Clinical and socio-sanitary characteristics in adults older than 65 years attended in the Primary Care setting. The PYCAF study

OBJETIVO: Describir las características clínicas y sociosanitarias de los pacientes mayores de 65 años atendidos en consultas de atención primaria. MATERIAL Y MÉTODOS: El estudio PYCAF (Prevalencia Y Características del Anciano Frágil) es un estudio descriptivo, transversal y multicéntrico. Se incluyeron de manera consecutiva sujetos mayores de 65 años, atendidos en las consultas de atención primaria de toda España en condiciones de práctica clínica habitual. RESULTADOS: Se analizaron un total de 2.461 pacientes (edad media de 76,0+/-6,9 años; 57,9% mujeres). La coexistencia de factores de riesgo cardiovascular y comorbilidades fue frecuente, siendo las más prevalentes: hipertensión arterial (73,7%), dislipidemia (58,3%), artrosis (56,4%), obesidad (34,0%) y diabetes (28,9%). El 13,4% de los pacientes tenían algún grado de deterioro cognitivo. Las mujeres mostraron un mayor grado de fragilidad (61,0% vs.51,8%; p < 0,001). El 47,4% de los pacientes tomaban más de 6 fármacos, siendo mayor el consumo en las mujeres (44,2% vs.49,8%; p = 0,047). El 49,5% de los pacientes realizaron más de 10 visitas a atención primaria, el 25,9% 4 o más visitas a atención especializada y un 22,3% estuvieron ingresados en el último año. CONCLUSIONES: El estudio PYCAF nos muestra que los pacientes ancianos tienen mayor prevalencia de enfermedades crónicas cardiovasculares y no cardiovasculares, lo que conduce a una elevada polimedicación. Esta última tiene consecuencias tanto en la seguridad del paciente como en los costes directos e indirectos sobre el Sistema Nacional de Salud que emanan de la asistencia al paciente mayor de 65 años. La prevalencia de fragilidad alcanza a la mitad de la muestra

OBJECTIVE: To describe the clinical and socio-sanitary characteristics of adults older than 65 years attended in a Primary Care setting. MATERIAL AND METHODS: The PYCAF study (Prevalence and Characteristics of the Fragile Elderly) is a descriptive, cross-sectional and multicentre study, in which patients older than 65 years attended in clinical practice in Primary Care in Spain were consecutively included. RESULTS: A total of 2,461 patients (mean age 76.0+/-6.9 years, 57.9% women) were included in the study. The coexistence of cardiovascular risk factors and comorbidities was frequent, with arterial hypertension (73.7%) being the most prevalent, followed by dyslipidaemia (58.3%), arthrosis (56.4%), obesity (34.0%), and diabetes (28.9%). Some degree of cognitive impairment was observed in 13.4% of patients. Women had higher rates of frailty (61.0% vs.51.8%; P<.001). Just under half (47.4%) of subjects were taking more than 6 drugs, with the prescription being higher in women (44.2% vs.49.8%; P=.047). Just under half (49.5%) of patients made more than 10 visits to Primary Care, 25.9% of patients 4 or more visits to the specialist, and 22.3% of patients were admitted to hospital in the last year. CONCLUSIONS: The PYCAF study shows that elderly patients have a higher prevalence of chronic cardiovascular and non-cardiovascular diseases, which leads to high polypharmacy. The latter has consequences both on patient safety and on the direct and indirect costs of the National Health System that emanate from the care of patients over 65 years of age. Half the sample has fragility

[Clinical and socio-sanitary characteristics in adults older than 65 years attended in the Primary Care setting. The PYCAF study]. / Características clínicas y sociosanitarias en mayores de 65 años asistidos en atención primaria. Estudio PYCAF.

OBJECTIVE: To describe the clinical and socio-sanitary characteristics of adults older than 65 years attended in a Primary Care setting. MATERIAL AND METHODS: The PYCAF study (Prevalence and Characteristics of the Fragile Elderly) is a descriptive, cross-sectional and multicentre study, in which patients older than 65 years attended in clinical practice in Primary Care in Spain were consecutively included. RESULTS: A total of 2,461 patients (mean age 76.0±6.9 years, 57.9% women) were included in the study. The coexistence of cardiovascular risk factors and comorbidities was frequent, with arterial hypertension (73.7%) being the most prevalent, followed by dyslipidaemia (58.3%), arthrosis (56.4%), obesity (34.0%), and diabetes (28.9%). Some degree of cognitive impairment was observed in 13.4% of patients. Women had higher rates of frailty (61.0% vs. 51.8%; P<.001). Just under half (47.4%) of subjects were taking more than 6 drugs, with the prescription being higher in women (44.2% vs. 49.8%; P=.047). Just under half (49.5%) of patients made more than 10 visits to Primary Care, 25.9% of patients 4 or more visits to the specialist, and 22.3% of patients were admitted to hospital in the last year. CONCLUSIONS: The PYCAF study shows that elderly patients have a higher prevalence of chronic cardiovascular and non-cardiovascular diseases, which leads to high polypharmacy. The latter has consequences both on patient safety and on the direct and indirect costs of the National Health System that emanate from the care of patients over 65 years of age. Half the sample has fragility.

Satisfacción de las personas con diabetes mellitus tipo 2 tras iniciar tratamiento con insulina / Satisfaction of patients with type 2 diabetes mellitus after starting treatment with insulin

Objetivos. El 'miedo al pinchazo' de muchos pacientes con diabetes tipo 2 (DM2) puede retrasar el inicio del tratamiento con insulina. Nuestro objetivo es valorar si superar dicha barrera e iniciar el tratamiento con insulina mejora el control clínico y produce mayor satisfacción del paciente con su tratamiento. Material y métodos. Estudio observacional, multicéntrico, de pacientes con DM2 —realizado en atención primaria— con un mal control glucémico (A1c≥8%), en tratamiento con antidiabéticos orales y a los que se aplicó una intervención motivacional para vencer el miedo al pinchazo y se inició el tratamiento con insulina. Se valoró el grado de satisfacción con el tratamiento mediante el Diabetes Treatment Satisfaction Questionnaire (DTSQ). Resultados. Quinientos setenta y tres pacientes, 64±10 años. Puntuación global media del cuestionario DTSQs de 18,3±6,3. El cambio de tratamiento produjo una mejoría de la satisfacción del paciente con respecto al tratamiento anterior (puntuación media DTSQc 8,8±5,9). La A1c descendió desde 8,7% (desviación típica 0,8) hasta 7,5% (desviación típica 0,7) (p<0,001). La frecuencia de hiperglucemia percibida fue significativamente menor después de superar el miedo al pinchazo (35,6% frente a 11,5%; p<0,001), sin encontrar diferencias estadísticamente significativas en la frecuencia de hipoglucemias (32% frente a 35%; p=0,059). Conclusión. En pacientes con DM2 mal controlados con antidiabéticos orales, vencer el miedo al pinchazo e iniciar el tratamiento con insulina se asoció a una mejoría global de la satisfacción con el tratamiento, y disminuyó la percepción de episodios de hiperglucemia. El control glucémico y el perfil metabólico de los pacientes también mejoraron de forma estadísticamente significativa (AU)

Objectives. The objective of this study is to evaluate if overcoming the barrier of starting treatment with insulin can lead to better clinical control and a higher level of patient satisfaction with their treatment. Material and methods. This is an observational, multicentre study of patients diagnosed with DM2 who attended primary care centres with poor glycaemic control (A1c≥8%) under treatment with oral antidiabetic drugs (OADs), and who were given motivational treatment to overcome their fear of injections, and started treatment with insulin. The level of satisfaction with the treatment was evaluated using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The questionnaire was used before initiating the treatment with insulin and in the follow-up visit (3-4 months from the beginning of treatment with basal insulin). Results. A total of 573 patients with a mean age of 64±10 years were recruited. The overall mean score from the DTSQs satisfaction questionnaire was 18.3±6.3, and the change of treatment led to an improvement in patient satisfaction compared to the previous treatment (DTSQc mean score 8.8±5.9). A1c dropped from an initial value of 8.7% (SD 0.8) to 7.5% (SD 0.7) (P<.001). The frequency of hyperglycaemic episodes perceived by the patients was significantly lower after they overcame their fear of injections (35.6% compared to 11.5%; P<.001), but no statistically significant differences were found in the frequency of hypoglycaemic episodes (32% compared to 35%; P=.059). Conclusion. In patients with DM2 poorly controlled with OADs, overcoming a fear of injections and starting treatment with insulin was associated with an overall improvement in satisfaction with the new treatment, and decreased the perception of hyperglycaemic episodes. Glycaemic control and the metabolic profile of the patients also improved to a statistically significant degree with the change of treatment (AU)

[Satisfaction of patients with type 2 diabetes mellitus after starting treatment with insulin]. / Satisfacción de las personas con diabetes mellitus tipo 2 tras iniciar tratamiento con insulina.

OBJECTIVES: The objective of this study is to evaluate if overcoming the barrier of starting treatment with insulin can lead to better clinical control and a higher level of patient satisfaction with their treatment. MATERIAL AND METHODS: This is an observational, multicentre study of patients diagnosed with DM2 who attended primary care centres with poor glycaemic control (A1c≥8%) under treatment with oral antidiabetic drugs (OADs), and who were given motivational treatment to overcome their fear of injections, and started treatment with insulin. The level of satisfaction with the treatment was evaluated using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The questionnaire was used before initiating the treatment with insulin and in the follow-up visit (3-4 months from the beginning of treatment with basal insulin). RESULTS: A total of 573 patients with a mean age of 64±10 years were recruited. The overall mean score from the DTSQs satisfaction questionnaire was 18.3±6.3, and the change of treatment led to an improvement in patient satisfaction compared to the previous treatment (DTSQc mean score 8.8±5.9). A1c dropped from an initial value of 8.7% (SD 0.8) to 7.5% (SD 0.7) (P<.001). The frequency of hyperglycaemic episodes perceived by the patients was significantly lower after they overcame their fear of injections (35.6% compared to 11.5%; P<.001), but no statistically significant differences were found in the frequency of hypoglycaemic episodes (32% compared to 35%; P=.059). CONCLUSION: In patients with DM2 poorly controlled with OADs, overcoming a fear of injections and starting treatment with insulin was associated with an overall improvement in satisfaction with the new treatment, and decreased the perception of hyperglycaemic episodes. Glycaemic control and the metabolic profile of the patients also improved to a statistically significant degree with the change of treatment.

[Use of glucose-lowering drugs in a primary care setting in Malaga during the years 2008-2012]. / Utilización de fármacos hipoglucemiantes en el ámbito de la atención primaria de Málaga durante los años 2008-2012.

INTRODUCTION: The aim of the study is to describe the pattern of use of hypoglycemic agents in a primary health care district of Málaga between the years 2008-2012. MATERIAL AND METHOD: Cross-sectional descriptive study. Málaga health district. Population of 609,781 inhabitants; 42,060 people in the diabetes process. Therapeutic sub-group A10 (drugs used in diabetes). Data is presented as defined daily dose (DDD). Years 2008-2012. Measures of frequency. RESULTS: The population grew by 0.4% and the people included in the diabetes process, by 19%. The hypoglycemic agents have increased from 12,453,443 to 14,144,817 DDD (13.5%). Oral antidiabetics increased by 13.8% and insulin by 9.7%. Metformin is the most used oral antidiabetic (6,655,923 DDD) and the iDDP4 was the one that had increased more (from 63,882 DDD to 1,482,574). The growth in insulin use was mainly due to the long-acting (38%) and the shorter-acting one (40%). The most used insulin doses are the long-acting ones, followed by the pre-mixed. The proportion of insulin use as regards the use of ADOs has remained stable (31%)., Long-acting (36%) insulin has become the most used, followed by pre-mixed (34%), shorter-acting (16%), and the intermediate-acting (12%). CONCLUSIONS: There is an increase in the use of hypoglycemic agents., Metformin and iDPP4 are the antidiabetics oral with the greatest growth., There is an increase in shorter-acting and long-acting insulins with a decrease in intermediate-acting and pre-mixed., The proportion of oral antidiabetics/insulins has remained stable.

Intervenciones que mejoran el pronóstico en la neurofibromatosis tipo 2: a propósito de un caso / Interventions that improve the prognosis in neurofibromatosis type 2: a case report

La neurofibromatosis tipo 2 (NF2) es una enfermedad autosómica dominante (AD) que predispone a múltiples lesiones neoplásicas; el neurinoma del acústico bilateral es patognomónico. Es frecuente la presencia en el mismo paciente de varios tipos de tumores con estirpe patológica y localización diferentes, lo que hace más difícil las decisiones terapéuticas, especialmente en niños y adolescentes. El trastorno se localiza en el cromosoma 22q12. Las distintas modalidades de cirugía y radioterapia son armas fundamentales en el tratamiento de la NF2. El tratamiento rehabilitador individualizado influye en el pronóstico funcional final. El seguimiento clínico y de neuroimagen debe tener como objetivo el control evolutivo de los tumores y la decisión terapéutica(AU)

Neurofibromatosis type 2 (NF2) is an autosomal dominant (AD) disease that predisposes to multiple neoplasms; the bilateral acoustic neuroma is pathognomonic. The presence of several types of tumors having different pathological lineage and localization is frequent in the same patient. This hinds treatment decisions, especially in children and adolescents. The disorder is located on chromosome 22q12. The different types of surgery and radiotherapy are essential tools for the treatment of NF2. Therefore, individualized rehabilitation treatment influences the final functional prognosis. The purpose of the clinical and neuroimaging follow-up should be that of controlling the progression of tumors and therapeutic decision(AU)