Esclerosis múltiple y trastornos asociados al consumo de alcohol: mortalidad atribuible, prolongación de estancias y exceso de costes hospitalarios / Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures

INTRODUCCIÓN: El objetivo de este estudio es el análisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en los pacientes con esclerosis múltiple (EM), en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. MÉTODOS: Estudio observacional retrospectivo de una muestra de pacientes ingresados con EM recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Se calculó la mortalidad, la prolongación de estancias y los sobrecostes atribuibles a los TCA controlando mediante análisis multivariado de la covarianza variables como la edad y el sexo, el tipo de hospital, el tipo de ingreso, otros trastornos adictivos y las comorbilidades. RESULTADOS: Se estudiaron 10.249 ingresos por EM de 18 a 74 años de edad, entre los cuales hubo 215 pacientes con TCA. Los ingresos con EM y TCA fueron predominantemente varones, mayor frecuencia de ingresos urgentes, con mayor prevalencia de trastornos por tabaco y drogas y con índices de comorbilidad de Charlson más elevados. Los pacientes con EM y TCA presentaron importantes excesos de mortalidad (94,1%), prolongación indebida de estancias (2,4 días) y sobrecostes por alta (1.116,9 euros). CONCLUSIONES: De acuerdo a los resultados de este estudio, los TCA en pacientes con EM aumentaron significativamente la mortalidad, la duración de la estancia hospitalaria y sus costes

INTRODUCTION: The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS: We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS: The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS: According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures

Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures. / Esclerosis múltiple y trastornos asociados al consumo de alcohol: mortalidad atribuible, prolongación de estancias y exceso de costes hospitalarios.

INTRODUCTION: The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS: We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS: The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS: According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.

Quality of life in patients with oral and oropharyngeal cancer.

Quality of life (QoL) is an important aspect in the clinical assessment and management of patients with cancer. The aim of the present study was to evaluate QoL at the time of diagnosis in patients with oral and oropharyngeal cancer and to establish the influence of variables such as gender, age, tumor location and tumor staging. The authors studied 149 patients with oral and oropharyngeal cancer for 2 years. QoL was measured using the EORTC QLQ-C30 and its specific modules for head and neck cancer QLQ-H&N 35. Variable deterioration of QoL was observed before therapy. The emotional domain showed the greatest alterations, while pain was the most remarkable symptom variable. QoL seems to be associated with gender (female patients obtained worse scores in most of the functional scales), age (patients < 65 years scored better), tumor location (orpharyngeal tumors showed worse prognosis) and tumor staging (early stages obtained better scores than advances ones). Many patients with oral and oropharyngeal cancer show poor QoL before initiating treatment. The present study of a homogeneous group of patients is the first carried out in Spain following the EORTC QLQ-C30 questionnaire and its results may serve for future reference. These results are similar to those obtained in populations from the north and centre of Europe.

Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study.

Nosocomial bacteremia caused by Acinetobacter baumannii (AB) is of increasing concern in critically ill patients, and the risk factors for this infection are not well established. An inception cohort study in a 40-bed medical and surgical intensive care unit (ICU) at a single institution was conducted during a 2-year period to determine the risk factors for AB nosocomial bacteremia. Risk factors related to the underlying diseases, the clinical picture at admission, and those acquired during the stay in the ICU were recorded upon admission and daily throughout the ICU stay. We defined an "invasive procedures index" as the number of invasive procedures performed every day during the ICU stay before the onset of AB bacteremia divided by the number of days in the ICU before the onset of AB bacteremia. Risk factors that were independently associated with AB bacteremia were immunosuppression, unscheduled admission to the hospital, respiratory failure at ICU admission, previous antimicrobial therapy, previous sepsis in the ICU, and the invasive procedures index.

Carbon fiber implants in osteochondral defects of the rabbit patella.

Carbon fiber implants were used to fill osteochondral defects created on the articular surface of the patella of 36 rabbits, for the purpose of studying the long-term histological changes of the repair process. Six months after surgery the defect was filled by fibrous tissue, where the superficial area was organized parallel to the joint surface. Fibrocartilage developed after 9 months and, after 12 months, the defects were covered by hyaline cartilage tissue.

Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients.

OBJECTIVE: To determine the impact of Acinetobacter baumannii (AB) acquisition in intensive care unit (ICU) patients on mortality and length of stay (LOS). DESIGN: Pairwise matched 1:1 case-control study. SETTING: Medical-surgical ICU in a tertiary health care institution. PATIENTS: During 16 months, all patients admitted to the ICU were eligible. Case patients were defined as every patient with an AB isolation 48 hrs after ICU admission. Control patients were retrospectively selected from ICU patients without any AB isolation, according to seven matching variables. MEASUREMENTS AND MAIN RESULTS: Attributable mortality and excess LOS in the ICU were measured. Eighty-seven patients were included, with 75 pairs successfully matched. Infection was defined in 48 patients (23 respiratory). The attributable mortality rate for AB acquisition was 30% (49% vs.19%) (95% confidence interval [CI] = 23%, 37%): 43% (CI = 34%, 52%) in patients with infection (58% vs.15%) and 53% (CI = 41%, 65%) in patients with respiratory infections (70% vs.17%). The estimated risk rates for death were 2.6 (CI = 1.6, 4.5; p < .001), 4.0 (CI = 1.9, 8.3; p < .001), and 4.0 (CI = 1.6, 10.2; p < .01), respectively. The attributable excess LOS was 13 days for both AB acquisition and infection (23 vs. 10 days; p < .001) and respiratory infections (23 vs. 10 days; p < .01). In noninfected patients, no significant excess of mortality was found (33% vs. 26%), but LOS increased in 15 days. CONCLUSION: AB acquisition involved an excess LOS in ICU patients and increased risk of death, but the latter could be found only in patients with proven infection.

[Hospital admissions related to lung disease in Andalucia: 1993-1994]. / Ingresos de causa neumológica en hospitales de Andalucía: 1993-1994.

To determine the pneumological causes for hospital admission in Andalucia (Spain) and thereby improve knowledge of respiratory morbidity. From the Combined Minimum Data Base on admissions to Andalusian hospitals for 1993 and 1994, adjusted to the CIE-9-MC coding system, we analyzed main diagnoses registered. Cases with respiratory involvement were obtained, excluding patients under 7 years of age. Admissions for pneumological causes accounted for 6.3% of all admissions, with a total of 314 diagnostic categories, although 98.5% of all admissions were related to only 139 diagnoses. The 53 most frequent diagnostic categories accounted for 93% of patients and 55.2% of admissions were related to only 10 causes and led to 54.16% of all stays for pneumological diseases. Categories 486 and 481 (pneumonias), along with 496, 491.2 and 491.21 (diseases involving chronic air flow obstruction) were the most often used. Respiratory problems account for 6.23% of all hospital admissions in Andalucia, with lung infections and conditions falling under the category of chronic obstructive pulmonary disease being by far the most frequent pneumologically related reasons for hospitalization. The precise interpretation of diagnostic categories needs to be better defined in the coding system.

[Detection of alcohol-related problems in primary care]. / Detección de problemas relacionados con el alcohol en atención primaria.

The results of a survey of primary health care physicians in order to know which factors are associated with the efficacy in the detection and treatment of patients with alcohol-related problems are analyzed in this article. The number of diagnosed patients is related with previous formal education on alcohol-related problems of primary health care physicians. Primary health care physicians are very interested in this issue, but they don't feel satisfied nor gratified with their work with this type of patients. Gratifying feelings are directly related to previous formal education, and those who feel gratified diagnose more patients. Needs for formal education must be accompanied by profound organizational changes in the coordination of actions between primary health care, specialized services and social care.

[Ischemic heart disease, neoplasms and risk factors: ecological correlation]. / Cardiopatía isquémica, neoplasias y factores de riesgo: correlación ecológica.

In this paper, correlations between ischaemic heart disease and several cancers associated with cigarette smoking are examined. Also, tobacco consumption data are correlated against ischaemic heart disease mortality incidence rates. Furthermore, correlations between ischaemic heart disease incidences and per capita consumption of fattening foods (meat, milk and eggs) are analyzed. In this work, results referring to Spain, and at an ecologic level, confirm conclusions of observational and experimental studies carried out in other countries, which points out a strong association between ischaemic heart disease, cigarette consumption and fattening diet.