A telephone support program for patients with home enteral nutrition contributes to nutrition status and quality of life maintenance and reduces health resource use.

BACKGROUND: Appropriate patient/caregiver training and continuity of care after hospital discharge are key factors for the success of home enteral nutrition (HEN). This study aims to assess the effects of a specific patient support program (PSP) on the nutrition status, health-related quality of life (HRQoL), and healthcare resource utilization and associated costs of patients with HEN. METHODS: Observational study of adult patients with HEN enrolled in a PSP. Sociodemographic variables (baseline), HRQoL (NutriQoL) and nutrition status (Mini Nutritional Assessment [MNA]) (baseline, 6 months after PSP enrollment), and use of unplanned HEN-related healthcare resources (6 months prior to or after PSP enrollment) were recorded. HEN-related resource cost was estimated from total resources used (all patients) and each resource cost. Data were analyzed with Stata program (v. 14), considering P < 0.05 as significant. RESULTS: Forty-three patients were included in the study (mean age, 72 years [SD = 21]; 54% women; mean HEN duration, 4 years [SD = 5]). A total of 401 calls were recorded in the PSP, 7% made proactively by the patient. HRQoL and nutrition status remained stable during the study period (NutriQoL baseline, 64; 6-months, 66; P = 0.3737; MNA baseline, 10; 6-months, 10; P = 0.0675). Unplanned resources amounted to €6229 (US $5563) and €4711 (US $4207) before and after PSP enrollment, respectively. Cost savings, representing €1518 (US $1356), were related to fewer emergency visits. CONCLUSIONS: Health advice provided through a PSP and close patient monitoring in the hospital can help to maintain patients' nutrition status and HRQoL and to reduce the use of certain unplanned HEN-related resources, leading to cost savings.

Neurocirugía en el paciente mayor: neurocirugía geriátrica / Neurosurgery in the elderly patient: Geriatric neurosurgery

Objetivo: Entre los años 2000 y 2050 la población mundial mayor de 60 años se duplicará y la mayor de 80 se cuadruplicará. El entrenamiento del profesional sanitario no incluye normalmente una formación específica al respecto. Por ello, la Organización Mundial de la Salud recalca la necesidad de una formación sobre los problemas del envejecimiento dirigida a todos los sanitarios. Nos proponemos analizar el efecto de la edad sobre la neurocirugía en nuestro entorno. Material y método: Se realizó un estudio retrospectivo de cohortes históricas. Se recogieron, analizaron y compararon las personas con 70 o más años ingresadas en Neurocirugía o en la unidad de cuidados intensivos de nuestro hospital con patología neuroquirúrgica entre 2 periodos: 1999-2000 y 2010-2011. Se estudiaron variables como: edad, patología, estancia, comorbilidad, estado funcional, reingresos o mortalidad. Resultados: Ingresaron aproximadamente el mismo número de pacientes en los 2 periodos: 409 y 413. Sin embargo, los pacientes mayores de 70 años aumentaron un 77,5%: 80 frente a 142. Se observaron diferencias estadísticas en el índice de comorbilidad de Charlson, el Glasgow al ingreso, la estancia hospitalaria y los reingresos. Específicamente, la comorbilidad y el Glasgow fueron peores en el segundo periodo. Sin embargo, la estancia fue menor en este periodo, aunque con mayores reingresos. Tras un análisis multivariante se observó que los reingresos eran dependientes de la mayor comorbilidad y no del alta precoz. No encontramos diferencias en el estado funcional o en la mortalidad. Conclusiones: Actualmente observamos un aumento considerable de los pacientes mayores de 70 años. No se observa, sin embargo, un empeoramiento del estado funcional o de la mortalidad gracias, probablemente, a un manejo multidisciplinario de estos pacientes. Los resultados de este estudio apoyan el desarrollo de un grupo de trabajo dedicado a la neurocirugía geriátrica

Objective: Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. Material and method: A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. Results: Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. Conclusions: A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery

[Neurosurgery in the elderly patient: Geriatric neurosurgery]. / Neurocirugía en el paciente mayor: neurocirugía geriátrica.

OBJECTIVE: Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. MATERIAL AND METHOD: A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. RESULTS: Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. CONCLUSIONS: A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery.

La valoración de la capacidad funcional, el bienestar psicológico y la salud mental en la atención primaria de salud / Assessment of functional capacity, psychological well-being and mental health in primary care

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[Reference population values of the Spanish version of the COOP/WONCA charts of quality of life in an urban adult population]. / Valores poblacionales de referencia de la versión española de las viñetas COOP/WONCA de calidad de vida en población adulta urbana.

BACKGROUND AND OBJECTIVE: We intended to obtain reference population values of the COOP/WONCA charts of health-related quality of life (HRQOL) among a Spanish urban adult population. MATERIAL AND METHOD: Cross sectional study based on data from the Survey of Health of the City of Madrid 2005. 7341 adults were selected by biphasic cluster sampling. The variable HRQOL was measured through COOP/WONCA charts of quality of life (9 dimensions), culturally validated for Spanish people. Other variables included age, sex, marital status, and social class, zone of origin and level of education. Statistical treatment included descriptive statistics for the dimensions and summation of HRQOL, significance tests (Kruskal-Wallis, Mann-Whitney, ANOVA), analysis of internal consistency and correlation. RESULTS: Highest mean values were found in the dimensions Changes in the State of Health, Health Status, Physical Form and Social Support. The average value of the dimensions and the summation of HRQOL increased significantly with age, and in parallel to a lowering of the social class and depending on the country of origin (higher in native people). They were also higher in women. The alpha of Cronbach for the questionnaire was 0.77. CONCLUSIONS: Reference population values were obtained for a Spanish urban adult population according to sex, age, social class and status of native or immigrant people. All ratings increased with age and were highest in women. The availability of benchmarks values contribute to the score' interpretation, which would ease the systematic use of tools of self-assessed health in clinical practice.

Valores poblacionales de referencia de la versión española de las viñetas COOP/WONCA de calidad de vida en población adulta urbana / Reference population values of the Spanish version of the COOP/WONCA charts of quality of life in an urban adult population

Fundamento y objetivo: el objetivo del estudio ha sido obtener valores poblacionales de referencia de las viñetas COOP/WONCA de calidad de vida relacionada con la salud (CVRS) para población adulta española de medio urbano. Material y método: se ha realizado un estudio descriptivo y transversal basado en los datos de la Encuesta de Salud de la Ciudad de Madrid de 2005. Se eligió a 7.341 adultos mediante muestreo por conglomerados bietápico. La variable CVRS se midió a través de las viñetas COOP/WONCA de calidad de vida (9 dimensiones), validadas culturalmente para población española. Otras variables estudiadas fueron: edad, sexo, estado civil, clase social, lugar de origen y nivel de estudios. El análisis estadístico se realizó mediante índices de estadística descriptiva para las dimensiones y el sumatorio de CVRS, pruebas de contraste de hipótesis (Kruskal-Wallis, Mann-Whitney, ANOVA) y análisis de consistencia interna y de correlación. Resultados: los valores medios más altos se encontraron en las dimensiones Cambios en el Estado de Salud, Estado de Salud, Forma Física y Apoyo Social. Aumentó significativamente el valor medio de las dimensiones y del sumatorio de CVRS con la edad, a medida que se desciende en la clase social y según el país de origen (mayor en autóctonos); los valores fueron también más altos en mujeres. El coeficiente alfa de Cronbach para el cuestionario fue de 0,77.Conclusionesse han obtenido valores poblacionales de referencia para población adulta española de medio urbano según sexo, grupos de edad, clase social y condición de autóctono o inmigrante económico. Contar con valores de referencia contribuye a la interpretación de las puntuaciones obtenidas, lo que ayudaría a emplear de forma sistemática instrumentos de salud percibida en la práctica clínica (AU)

Reference population values of the Spanish version of the COOP/WONCA charts of quality of life in an urban adult population Background and objective: We intended to obtain reference population values of the COOP/WONCA charts of health-related quality of life (HRQOL) among a Spanish urban adult population. Material and method: Cross sectional study based on data from the Survey of Health of the City of Madrid 2005. 7341 adults were selected by biphasic cluster sampling. The variable HRQOL was measured through COOP/WONCA charts of quality of life (9 dimensions), culturally validated for Spanish people. Other variables included age, sex, marital status, and social class, zone of origin and level of education. Statistical treatment included descriptive statistics for the dimensions and summation of HRQOL, significance tests (Kruskal-Wallis, Mann-Whitney, ANOVA), analysis of internal consistency and correlation. Results: Highest mean values were found in the dimensions Changes in the State of Health, Health Status, Physical Form and Social Support. The average value of the dimensions and the summation of HRQOL increased significantly with age, and in parallel to a lowering of the social class and depending on the country of origin (higher in native people). They were also higher in women. The alpha of Cronbach for the questionnaire was 0.77. Conclusions: Reference population values were obtained for a Spanish urban adult population according to sex, age, social class and status of native or immigrant people. All ratings increased with age and were highest in women. The availability of benchmarks values contribute to the score’ interpretation, which would ease the systematic use of tools of self-assessed health in clinical practice (AU)

Necesidad de utilizar instrumentos adaptados y validados a nuestra lengua y cultura para evaluar la calidad de vida relacionada con la salud en nuestro país. Réplica / Need for instruments adapted to and validated for our language and culture to evaluate health-related quality of life in our country. Reply

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[How does intensive therapy of cardiovascular risk factors affect health-related quality of life in diabetic patients?]. / Cómo influye el tratamiento intensivo de los factores de riesgo cardiovascular en la calidad de vida relacionada con la salud de los pacientes diabéticos?

OBJECTIVE: To assess the health-related quality of life (HRQoL) in diabetic patients who have followed a protocol of intensive treatment of cardiovascular risks (CVR). DESIGN: Clinical trial randomised by cluster. A convenience sample of 65 primary care practitioners, randomly assigned to a control or intervention group. Patients were selected by systematic sampling from diabetic lists. The follow-up for the control group was by normal practice and the intervention group by using the intensive control of cardiovascular risk factors (CVRF) protocol. SETTING: Seventeen health-centres in the Valencia Community, Spain. PARTICIPANTS: One hundred and eighty-four patients, 93 in the control group and 91 in the intervention group. INCLUSION CRITERIA: patients diagnosed with diabetes mellitus (DM) type 2, aged between 45-75 years, DM for more than 2 years and less than 20 years and a cardiovascular risk (CVR) >20% after 10 years (Framingham equation). The exclusion criteria were: history of ischaemic heart disease, terminal illness, hepatic cirrhosis, renal failure, grade III-IV cardiac failure, and mental disorders. The patients self-completed the Spanish versions of the COOP/WONCA charts and a diabetes-specific tool (ADDQol questionnaire) at the start, and after 6 months and 12 months. MAIN MEASUREMENTS: Means of COOP/WONCA charts and ADDQol. Comparison between groups using Mann-Whitney U test, and the group follow ups using the Wilcoxon test. RESULTS: No significant differences were found in the COOP/WONCA charts. At 12 months the only significant difference was in the feelings chart (P=.024; control group 1.86+/-1.03: intervention group 2.23+/-1.11). A negative impact of diabetes was seen in all the dimensions of ADDQoL. The most negative impact of diabetes was related to diet. There were no significant differences between groups in the ADDQoL throughout the study. CONCLUSIONS: The HRQoL in diabetic patients is not affected by intensive therapy of cardiovascular risk factors. Diabetes has a negative impact on HRQoL in the patients studied.

¿Cómo influye el tratamiento intensivo de los factores de riesgo cardiovascular en la calidad de vida relacionada con la salud de los pacientes diabéticos? / How does the intensive therapy to control cardiovascular risk factors affect health-related quality of life in diabetic patients?

Objetivos. Valorar la calidad de vida relacionada con la salud (CVRS) de los diabéticos tras la aplicación de un protocolo de tratamiento intensivo para control de los factores de riesgo cardiovascular (FRCV). Diseño. Ensayo clínico aleatorizado por agrupaciones. Muestreo de conveniencia de 65 médicos de atención primaria (AP), asignación aleatoria al grupo control e intervención. Muestreo aleatorio sistemático de los diabéticos de cada médico. El seguimiento de los pacientes del grupo control se realizó mediante la práctica habitual y del grupo intervención a través del protocolo de tratamiento intensivo para el control de los FRCV. Emplazamiento. El estudio se realizó en 17 centros de salud de la Comunidad Valenciana. Participantes. Se incluyó a 184 pacientes, 93 en el grupo control y 91 en el grupo de intervención. Los criterios de inclusión fueron: diabéticos tipo 2 entre 45 y 70 años, diabetes de 2 a 20 años de evolución y riesgo cardiovascular mayor del 20% a los 10 años (ecuación de Framingham). Los criterios de exclusión fueron: antecedentes de cardiopatía isquémica, enfermedad terminal, cirrosis hepática, insuficiencia renal, insuficiencia cardíaca de grados III-IV y alteraciones mentales. Los pacientes autocumplimentaron los cuestionarios de calidad de vida relacionada con la salud: COOP/WONCA y ADDQoL al inicio y a los 6 y 12 meses. Mediciones principales. Valores medios de viñetas COOP/WONCA y ADDQoL. Comparación entre grupos mediante el test de la U de Mann-Whitney. El seguimiento de cada grupo se realizó con la prueba de Wilcoxon. Resultados. No encontramos diferencias significativas en las viñetas COOP/WONCA. A los 12 meses sólo encontramos diferencias significativas en la viñeta sentimientos (p = 0,024; grupo control 1,86 ± 1,03; grupo intervención 2,23 ± 1,11). Se observa un impacto negativo de la diabetes en todas las dimensiones del ADDQoL. No se han encontrado diferencias en el ADDQoL entre los grupos ni a lo largo del estudio. El impacto más negativo se obtiene en las dimensiones relacionadas con la dieta. Conclusiones. La CVRS en pacientes con diabetes tipo 2 no resulta afectada por el tratamiento intensivo de los FRCV. La diabetes tiene un impacto negativo en la CVRS de los individuos del estudio

Objective. To assess the health-related quality of life (HRQoL) in diabetic patients who have followed a protocol of intensive treatment of cardiovascular risks (CVR). Design. Clinical trial randomised by cluster. A convenience sample of 65 primary care practitioners, randomly assigned to a control or intervention group. Patients were selected by systematic sampling from diabetic lists. The follow-up for the control group was by normal practice and the intervention group by using the intensive control of cardiovascular risk factors (CVRF) protocol. Setting. Seventeen health-centres in the Valencia Community, Spain. Participants. One hundred and eighty-four patients, 93 in the control group and 91 in the intervention group. Inclusion criteria: patients diagnosed with diabetes mellitus (DM) type 2, aged between 45-75 years, DM for more than 2 years and less than 20 years and a cardiovascular risk (CVR) >20% after 10 years (Framingham equation). The exclusion criteria were: history of ischaemic heart disease, terminal illness, hepatic cirrhosis, renal failure, grade III-IV cardiac failure, and mental disorders. The patients self-completed the Spanish versions of the COOP/WONCA charts and a diabetes-specific tool (ADDQol questionnaire) at the start, and after 6 months and 12 months. Main measurements. Means of COOP/WONCA charts and ADDQol. Comparison between groups using Mann-Whitney U test, and the group follow ups using the Wilcoxon test. Results. No significant differences were found in the COOP/WONCA charts. At 12 months the only significant difference was in the feelings chart (P=.024; control group 1.86±1.03: intervention group 2.23±1.11). A negative impact of diabetes was seen in all the dimensions of ADDQoL. The most negative impact of diabetes was related to diet. There were no significant differences between groups in the ADDQoL throughout the study. Conclusions. The HRQoL in diabetic patients is not affected by intensive therapy of cardiovascular risk factors. Diabetes has a negative impact on HRQoL in the patients studied

[Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA Study]. / Tratamiento inicial de los pacientes con quejas subjetivas de memoria y/o deterioro cognitivo en atención primaria: estudio ISSEA.

OBJECTIVE: To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. DESIGN: Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. SETTING: A total of 105 primary care centres. PARTICIPANTS: The study included 921 patients who attended a clinic. MAIN MEASUREMENTS: In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. RESULTS: The majority of subjects were female (66.9%) and the mean age was 74.3+/-6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. CONCLUSIONS: The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.

Tratamiento inicial de los pacientes con quejas subjetivas de memoria y/o deterioro cognitivo en atención primaria: estudio ISSEA / Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA study

Objetivo. Describir el tratamiento inicial de pacientes > 60 años con quejas subjetivas de memoria y/o deterioro cognitivo de al menos 6 meses de evolución. Diseño. Estudio observacional, longitudinal, multicéntrico y naturalístico, con un período de seguimiento de 12 meses. Emplazamiento. Un total de 105 centros de atención primaria. Participantes. Participaron 921 pacientes que acudieron a consulta. Mediciones principales. En la visita basal se recogieron las características sociodemográficas, el diagnóstico, el tratamiento y las derivaciones asistenciales, y en las 2 siguientes (6 y 12 meses), el cambio de diagnóstico, el tratamiento y las derivaciones. Resultados. El 66,9% de los sujetos eran mujeres y la edad media fue de 74,3 ± 6,8 años. En la visita inicial, el 50,5% (intervalo de confianza [IC] del 95%, 47,3-53,7) de los diagnósticos fue de tipo sindrómico y el 33,3% (IC del 95%, 30,3-36,3), etiológico. El médico de atención primaria modificó el diagnóstico de sospecha inicial en el 22% (IC del 95%, 19,3-24,7) de los pacientes durante el año de seguimiento del estudio. El 63,8% (IC del 95%, 60,7-66,9) de los pacientes fue diagnosticado a través de la anamnesis, la exploración física, el test de cribado y los datos de laboratorio. En la visita inicial, el 52,6% (IC del 95%, 49,4-55,8) de los pacientes recibían tratamiento, principalmente nootropos y neuroprotectores, y más tarde aumentó el porcentaje de pacientes con inhibidores de la colinesterasa. Durante los 12 meses de estudio, el médico de atención primaria remitió a un 54,9% (IC del 95%, 51,7-58,1) de los pacientes. Conclusiones. El médico de atención primaria diagnostica a la mayoría de los pacientes con los medios disponibles, basándose fundamentalmente en la anamnesis, la exploración, el test de cribado y los datos de laboratorio. Se prescriben fármacos que carecen de eficacia en esta enfermedad y pocos de los que han demostrado eficacia

Objective. To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. Design. Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. Setting. A total of 105 primary care centres. Participants. The study included 921 patients who attended a clinic. Main measurements. In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. Results. The majority of subjects were female (66.9%) and the mean age was 74.3±6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. Conclusions. The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective

[Impact of psoriasis on health-related quality of life]. / Impacto de la psoriasis en la calidad de vida relacionada con la salud.

BACKGROUND AND OBJECTIVE: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). PATIENTS AND METHOD: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. RESULTS: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. CONCLUSIONS: Psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to their state of health, and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment.

Impacto de la psoriasis en la calidad de vida relacionada con la salud / Impact of psoriasis in health-related quality of life

Fundamento y objetivo: Diversos estudios han informado de las desventajas físicas, sociales y psicológicas que presentan los pacientes con psoriasis. El objetivo del presente estudio es conocer la repercusión de la psoriasis moderada-grave en la calidad de vida relacionada con la salud, evaluada por medio del Índice de Discapacidad de la Psoriasis (Psoriasis Disability Index, PDI). Pacientes y método: Se ha realizado un estudio observacional, transversal e internacional en consultas de dermatología de España y Portugal. Participaron 332 investigadores, cada uno de los cuales incluyó a 10 pacientes consecutivos diagnosticados de psoriasis moderada-grave. Se recogieron, entre otras, las siguientes variables: calidad de vida relacionada con la salud, medida por el PDI, variables objetivas de gravedad como la superficie corporal afectada (body surface area, BSA) y el índice de gravedad y de área de la psoriasis ­PASI (Psoriasis Area and Severity Index)­, prurito, costes y disposición a pagar. Resultados: Se incluyó a un total de 3.320 pacientes. La mayoría eran varones (57%) y la edad media era de 47 años. El PDI presentó un valor medio de 8,93 (intervalo de confianza del 95%, 7,83-9,21), lo que representa un porcentaje de discapacidad global inferior al 20%. El efecto suelo osciló entre el 8,3 y el 61,2% y el efecto techo, entre el 0 y el 3%. Las correlaciones entre el PDI y las variables objetivas de gravedad (PASI y superficie corporal afectada) fueron débiles, aunque estadísticamente significativas (p < 0,001). Todas indican que cuanto mayor es la afección o la gravedad de la psoriasis, mayor es el impacto negativo en la calidad de vida relacionada con la salud. Conclusiones: La psoriasis tiene un impacto negativo en la calidad de vida relacionada con la salud, aunque las magnitudes halladas son débiles e indican algunos problemas con el cuestionario. Posiblemente el PDI refleje más la discapacidad que la forma en que los individuos perciben y reaccionan ante su estado de salud, y algunos ítems parecen tener una escasa aplicabilidad a la población española y portuguesa. El PDI no parece el instrumento idóneo para este tipo de pacientes en nuestro entorno sociocultural

Background and objective: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). Patients and method: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. Results: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. Conclusions: The psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to its health's state and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment