Percepciones de pacientes y profesionales sanitarios sobre la calidad de la atención a personas diabéticas / Patient and health professional perceptions on the quality of care provided to diabetic patients

Objetivo. Describir la percepción y el conocimiento de pacientes y profesionales sanitarios (PS) sobre los factores que influyen en la calidad y continuidad asistencial de los cuidados prestados en atención primaria a personas diabéticas. Material y métodos. Estudio cualitativo de trayectoria fenomenológica. Participantes: profesionales médicos y de enfermería que trabajan en diferentes centros de atención primaria de Zaragoza y pacientes con diabetes atendidos en esos centros. Entre febrero y marzo de 2010 se realizaron 2 entrevistas grupales (grupos de discusión) y 6 individuales. Se siguió un guión preestablecido con las variables a explorar. Resultados. Los pacientes y profesionales entrevistados identificaron dificultades para asumir la diabetes como una enfermedad crónica. Se observaron como factores relacionados con problemas en el cambio de hábitos y estilos de vida el sexo (las mujeres mostraron mayores dificultades para el cambio), el tipo de trabajo y la situación de actividad laboral. Por parte de los profesionales entrevistados, se identificaron como factores favorecedores la existencia de guías y protocolos y la motivación personal, y como factores que dificultan la asistencia, la falta de tiempo y los sistemas de información existentes. Hay discrepancias entre los profesionales respecto al papel de grupos de pacientes y asociaciones. Conclusiones. En el diseño de intervenciones para la modificación de estilos de vida de los pacientes diabéticos se deben tener en cuenta las dificultades para el cambio ligadas al sexo y la situación laboral de los pacientes(AU)

Objective. To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. Material and methods. A qualitative study using a phenomenological perspective. Participants. Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. Results. The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. Conclusions. It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients(AU)

[Patient and health professional perceptions on the quality of care provided to diabetic patients]. / Percepciones de pacientes y profesionales sanitarios sobre la calidad de la atención a personas diabéticas.

OBJECTIVE: To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. MATERIAL AND METHODS: A qualitative study using a phenomenological perspective. PARTICIPANTS: Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. RESULTS: The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. CONCLUSIONS: It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients.

Presence and chromosomal subtyping of Legionella species in potable water systems in 20 hospitals of Catalonia, Spain.

OBJECTIVE: To investigate the presence and clonal distribution of Legionella species in the water supply of 20 hospitals in Catalonia, Spain. SETTING: 20 hospitals in Catalonia, an area of 32,000 km2, located in northeast Spain. METHODS: Environmental cultures of 186 points of potable water supply and 10 cooling towers were performed for the presence of Legionella species. Following filtration and acid treatment, the samples were seeded in selective MWY (modified Wadowsky Yee)-buffered charcoal yeast extract-alpha agar. All isolates obtained were characterized microbiologically and genotyped by SfiI pulsed-field gel electrophoresis (PFGE). RESULTS: 73 of 196 water samples, representing 17 of the 20 hospitals included in the study, were positive for Legionella pneumophila (serogroups 1, 2-14, or both). The degree of contamination ranged from 200 to 74,250 colony-forming units/L. Twenty-five chromosomal DNA subtypes were detected by PFGE. A single DNA subtype was identified in 10 hospitals, 2 DNA subtypes were observed in 6 hospitals, and 1 hospital exhibited 3 different DNA subtypes. Each hospital had its own Legionella DNA subtype, which was not shared with any other hospitals. CONCLUSIONS: Legionella was present in the water of most of the hospitals studied; each such hospital had a unique, dominant chromosomal DNA subtype. The verification of several genomic DNA restriction profiles in such a small geographic area demonstrates the great genetic diversity of Legionella in the aquatic environment.

[Intravesical hemangiopericytoma]. / Hemangiopericitoma intravesical.

OBJECTIVE: To report on a case of hemangiopericytoma of the urinary bladder mimicking a urothelial tumor. METHODS: A case of hemangiopericytoma arising from the urinary bladder in a 78-year-old man is described. The initial symptoms included gross hematuria, and it was confused with a urothelial tumor. The difficulty in making the diagnosis in regard to the site of origin and histological findings are discussed. The literature is briefly reviewed. RESULTS/CONCLUSIONS: Ultrasound and urographic evaluation showed an intravesical mass which was suspected to be a urothelial tumor. The patient was submitted to transurethral surgery. Histological analysis and immunohistochemical techniques demonstrated a hemangiopericytoma.

[Bladder malacoplakia: apropos of 2 cases]. / Malacoplaquia vesical: a propósito de dos casos.

OBJECTIVES: To describe two cases of malakoplakia of the bladder with an unusual form of presentation and review the cases previously reported in the literature. METHODS/RESULTS: Two patients, a 61-year-old female and a 71-year-old male, are described. Both patients had a history of recurrent infection caused by coliform pathogens. Treatment consisted of trimethoprim sulfamethoxazole, ascorbic acid and bethanecol chloride, together with extended TUR of the bladder lesion. CONCLUSIONS: Although malacoplakia of the bladder is considered to be a benign disease, close follow-up is warranted due to frequent recurrence of symptoms and the difficulty in achieving long-lasting effects since it is frequently associated with immunosuppression.

Role of immunosuppression in the evolution of Legionnaires' disease.

The clinical course of legionella pneumonia in immunosuppressed patients is uncertain. This study was undertaken to determine the clinical evolution of legionellosis on the basis of the immune state and to establish the variables associated with death directly related to legionellosis. The study included 78 patients: 28 with chronic disease who had received immunosuppressive treatment (group 1), 24 with chronic disease without immunosuppressive treatment (group 2), and 26 controls. Inclusion criteria were the occurrence of nosocomially acquired pneumonia, Legionella pneumophila infection, and erythromycin therapy that was initiated within 72 hours following diagnosis. Respiratory and extrarespiratory complications were observed more frequently in groups 1 and 2. Bilateral radiological involvement was most frequent in group 1, and recurrence of legionella pneumonia was observed exclusively in group 1. None of these variables achieved statistical significance. The global mortality of the series was 11.5% (17.9%, 12.5%, and 3.8% in groups 1, 2, and 3, respectively). Variables statistically related to mortality were acute renal failure, shock, and need for mechanical ventilation. Although many of the variables analyzed lacked statistical significance, a trend was seen between complications and basal immunosuppression, as previously suggested.

[Urethral condylomata acuminata: management and review of the literature]. / Condiloma acuminado uretral: manejo y revisión de la literatura.

A case of condyloma acuminata occupying almost the entire penile urethra is reported herein. The literature is reviewed highlighting its etiopathogenesis, histologic features, and treatment according to the stage of the disease. The different treatment modalities that have been utilized and those currently used are described, with a special emphasis on the increasing importance of laser therapy. Some considerations are presented relative to diagnosis, and a therapeutic protocol according to the stage of the disease is described. Due to the high incidence of recurrence, close follow-up of these patients is advocated.

[Perineo-scrotal gangrene (Fournier's gangrene)]. / Gangrena perineoescrotal (gangrena de Fournier).

Four cases of perineoscrotal gangrene are reported herein. All were immune-suppressed and three were diabetics. Its primary focus was in the GU tract or intestine. Culture was positive for Gram-negative aerobes and anaerobes. Early aggressive surgery and adjuvant antibiotic therapy achieved an excellent survival rate.

[Hormonal contraceptives and high blood pressure (author's transl)]. / Anticonceptivos hormonales e hipertensión.

The aim of this report is to offer an explanation for the high incidence of arterial hypertension in women taken hormone contraceptives. The real incidence of this association has been considered in women initially having a normal blood pressure and in others who had high blood pressure before using these contraceptives. The estrogen and progestogen components in hormone contraceptives were analyzed individually in various studies. The most recent investigations seem to indicate that progestogen is the main cause of high blood pressure. Different mechanism that could link hormone contraceptives to high blood pressure were investigated. The renin-angiotensin-aldosterone axis involving the action of estrogens and progestogens on the renin substrate, plasma renin, angiotensin II and aldosterone were analyzed. Another possible mechanism could involve glucocorticoids, altering the metabolism of glucose, pyruvate, cholesterol, and triglycerides, Kidney disease involving renal function, microangiopathic anemia, and renal thromboembolism; hyperactivity of the sympathetic nervous system (noraepinephrine and dopamine-beta-hidroxylase blood levels); prostaglandins; genetic mechanism; and individual mechanism were all taken into consideration. Lastly the priorities of the different systems linking high blood pressure to hormone contraceptives and the relationships between them are analyzed.