[Health-related quality of life in patients recovered from COVID-19]. / Calidad de vida relacionada con la salud en pacientes recuperados de COVID-19.

INTRODUCTION: The presence of symptoms after acute SARS-CoV-2 infection is frequent and has an impact on patients' quality of life. The aim of this study is to assess the health-related quality of life of COVID-19 survivors and to ascertain which factors are related to worse results. METHODS: An observational, cross-sectional study has been performed, using, a telephone survey that was administered to all patients with COVID-19 from the first pandemic wave in our healthcare area 10months after the acute infection. Patients with dementia and nursing home residents were excluded. Health-related quality of life was assessed using the EQ-5D instrument and its índices EQ-VAS and EQ-Health Index. RESULTS: 443 answers were collected. Mean age was 54±16 and 38.4% of patients were male. The most affected domain was anxiety/depression (23.9% of patients) and mobility (16.5%). Mean global EQ-VAS score was 75.8±18.7, and mean EQ-Health Index was 0.884±0.174. Both VAS and Health Index scores were lower in females, patients older than 65 years, patients with comorbidities, and those who needed hospital admission during the acute infection. VAS scores in our sample were lower than in the general Spanish population, but similar to the scores in our region prior to the pandemic. Female sex, hospital admission, and a lower educational status were independently associated to lower EQ-Health Index scoring. CONCLUSION: While health self-perception is affected after COVID-19, this might not be directly related to the infection. There exist profiles of patients more prone to a worse quality of life in which interventions may be considered.

Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19 / Tracing of COVID-19 patients by telemedicine with telemonitoring

OBJETIVO: Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. MÉTODOS: Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril de 2020. Se incluyeron dos grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo contactando con todos los pacientes al menos una vez al día. RESULTADOS: Se incluyeron 313 pacientes (52,4% mujeres) con edad media 60,9 (DS 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio se siguieron ambulatoriamente 224 pacientes y 89 tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (SD 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. CONCLUSIONES: Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least once a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DS 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way

Monitoring of COVID-19 patients by telemedicine with telemonitoring. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

[Monitoring of COVID-19 patients by telemedicine with telemonitoring]. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11 a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

[Joint hypermobility syndrome]. / Síndrome de hipermovilidad articular.

Joint hypermobility syndrome is an inherited disorder with autosomal dominant pattern; is characterized by joint hyperlaxity and musculoskeletal pains. Thermal hypermobility refers to the increase in active or passive movements of joints based on their normal ranges. Joint hypermobility syndrome also has gastrointestinal symptoms, sleep disorders, fibromyalgia, psychological disorders, migraine headache, ophthalmic, autonomic, among others. To diagnose hypermobility syndrome, Brighton's criteria are generally accepted and published in 1998. This criteria also known as benign joint hypermobility syndrome. The term benign is used to distinguish it from other more severe conditions such as Ehler-Danlos (classic or vascular type), Marfan syndrome, and imperfect osteogenesis. Treatment with physiotherapy and pharmacological means help improve patients' quality of life.

El síndrome de hipermovilidad articular es un desorden hereditario con patrón autosómico dominante; se caracteriza por hiperlaxitud articular y dolores musculoesqueléticos. El término hipermovilidad se refiere al incremento en los movimientos activos o pasivos de las articulaciones con base en sus rangos normales. El síndrome de hipermovilidad articular presenta además síntomas gastrointestinales, trastornos de sueño, fibromialgia, trastornos sicológicos, cefalea migrañosa, oftálmicos, autonómicos, entre otros. Para diagnosticar el síndrome de hipermovilidad, en general son aceptados los criterios de Brighton, los cuales fueron publicados en 1998. También se le conoce como síndrome de hipermovilidad articular benigno. El término benigno se utiliza para distinguirlo de otras condiciones más severas como Ehler-Danlos (tipo clásico o vascular), síndrome de Marfan y osteogénesis imperfecta. El tratamiento con fisioterapia y medidas farmacológicas ayudan a mejorar la calidad de vida de los pacientes.

Prevención de las náuseas y vómitos postoperatorios con dimenhidrinato en pacientes con riesgo moderado (según escala de Apfel) intervenidos de colecistectomía laparoscópica en régimen ambulatorio / Prevention of postoperative nausea and vomiting with dimenhydrinate in outpatients with moderate risk (as scale Apfel) undergoing laparoscopic cholecystectomy

Introducción: Las náuseas y vómitos postoperatorios (NVPO) constituyen uno de los principales problemas asociados a las intervenciones quirúrgicas. En la actualidad, estos episodios se siguen produciendo en un 20-30 % de los pacientes que son sometidos a una intervención quirúrgica. Además del alto grado de disconfort que este problema puede generar en los pacientes, pueden acarrear otras consecuencias negativas como deshidratación y alteraciones hidroelectrolíticas por vómitos recurrentes, evisceración o dehiscencia de suturas debido a la mecánica del esfuerzo, retraso en la reinstauración de la dieta por vía oral, retraso del alta en las unidades de cirugía ambulatoria, etc. (1-3). Todas estas complicaciones suponen también un aumento del gasto sanitario (2,3). Material y métodos: La evidencia actual muestra que los fármacos más efectivos son droperidol, ondansetrón y dexametasona. Nuestro estudio trata de profundizar en el conocimiento de los fármacos antieméticos menos usados, como el dimenhidrinato, con el fin de proporcionar nuevas alternativas con una buena relación coste/efectividad para la prevención de las NVPO. Para ello se han comparado la combinación dimenhidrinato + dexametasona frente a ondasentrón + dexametasona para la prevención de las NVPO en pacientes de riesgo moderado según la escala de Apfel, intervenidos de colecistectomía laparoscópica en régimen ambulatorio. Resultados: En este estudio no se han observado diferencias significativas en ambos grupos, tanto en la eficacia como en la seguridad. Conclusión: Podemos concluir que el dimenhidrinato es una buena alternativa para la prevención de las NVPO en pacientes de riesgo moderado que precisan una doble terapia (AU)

Introduction: Postoperative nausea and vomiting (PONV) is one of the main problems associated with surgical procedures. Currently these episodes still occur in 20-30 % of patients who undergo an surgery. In addition to the high degree of discomfort that this problem can be generated in patients, they may lead to other negative consequences such as dehydration and electrolyte disturbances by recurrent vomiting, evisceration or wound dehiscence due to mechanical effort, delay in reinstating the oral diet, delayed discharge in outpatient surgery units, etc. (1-3). All of these complications are also an increase in spending health (2,3). Objective and methods: The evidence shows that the most effective drugs are: droperidol, ondansetron and dexamethasone. Our study seeks to deepen the unders-tanding of antiemetic drugs less used as dimenhydrinate, in order to provide new alternatives with a good cost / effectiveness in the case of PONV. This has been compared the dimenhydrinate combination + dexamethasone versus dexamethasone + ondansetron for the prevention of PONV in outpatients undergoing laparoscopic cholecystectomy moderate risk according to the scale of Apfel. Results: In this study we have observed no significant differences in both groups in both efficacy and safety. Conclusion: We can conclude that dimenhydrinate is a good alternative for the prevention of PONV in moderate-risk patients who require dual therapy (AU)

Linking hearing impairment, employment and education.

OBJECTIVE: To analyse the impact that hearing impairment and other relevant variables have on the education and employment situation of those affected by it in the Principality of Asturias, Spain. METHODS: To achieve this objective, two discrete choice models (probit) are presented. The first one associates, among other variables, hearing impairment with the individual's employment status and in the second model, an ordered multinomial probit model is used to analyse, among other variables, how the impairment affects the individual's level of studies. RESULTS: Although the levels of statistical significance are low, the model's estimates appear to indicate that hearing impairment in Spain increases the probability of being unemployed by 18.4% (P = 0.09). Additionally, the people suffering from such a disability are, compared with the rest of the population, 10.2% (P = 0.05) more likely to have only completed elementary studies without pursuing any further education. CONCLUSIONS: If an individual is able to reach a level of secondary or higher education thus enabling a future incorporation to the work place, a benefit is obviously generated for both the individual as well as society (which has additionally incurred an investment in human capital). In this regard, encouraging the education of hearing-impaired students would profit both the individual (who receives an early integration as a child), which may contribute positively to family and social factors, as well as society who have incurred the investment. Therefore, our result could indicate that programmes created to support individuals with this type of disability represent an increase of welfare both individually and socially.

[Impact in Asturias of primary care emergencies on hospital emergencies for the 1994-2001 period. A time series cointegration analysis]. / Impacto en asturias de las urgencias de atención primaria sobre las hospitalarias. Un análisis de cointegración de series temporales.

BACKGROUND: Greater accessibility to the primary care continuing care points (CCP's) could reduce the visits to the Hospital Emergency Services (HES's). This study analyses whether Primary Care can replace and Hospital Services in emergencies. METHODS: All of the emergency visits (n=6.454.034) made to the HES's and Primary Care CCP's in Asturias and of each one of the healthcare districts within the 1994-2001 period were calculated. The time series were constructed with monthly frequencies for Asturias and each one of the districts, a cointegration analysis having been made to assess whether the two series are inter-replaceable. RESULTS: A mean annual increase of the total number of emergencies in Asturias of 6.2% (CCP: 7,8%; HES: 5.1%) was found, with different growth among the healthcare districts. In the time series cointegration analysis, no replaceability was found between the primary care and hospital emergencies for Asturias and for the healthcare districts, except for the healthcare district of Oviedo, where a 10% growth rate in primary would lower hospital emergencies by 2.7%. CONCLUSIONS: The greater accessibility to the Primary Care CCP's increases the use thereof without reducing the visits to the HES's. Therefore, the increase in Primary Cart resources does not seem to be an effective alternative for reducing the visits to the HES's.

Impacto en Asturias de las urgencias de atención primaria sobre las hospitalarias: un análisis de cointegración de series temporales / Impact in Asturias of primary care emergencies on hospital emergencies for the 1994-2001 period. A time series cointegration analysis

Fundamento: La mayor accesibilidad a los puntos de atención continuada (PAC) de la atención primaria podría disminuir las visitas en los Servicios de Urgencias Hospitalarias (SUH). En este estudio se analiza si existe sustituibilidad entre las urgencias de Atención Primaria y Hospitalaria. Métodos: Se analiza la totalidad de las visitas urgentes (n=6.454.034) realizadas en los SUH de los hospitales y PAC de Atención Primaria de Asturias y de cada una de las áreas sanitarias entre 1994 y 2001. Se construyeron las series temporales con frecuencias mensuales para Asturias y cada una de las áreas y se realizó un análisis de cointegración para evaluar si existe sustituibilidad entre ambas series. Resultados: Se observó un incremento medio anual de las urgencias totales en Asturias del 6,2% (PAC: 7,8%; SUH: 5,1%), con diferente crecimiento entre las áreas sanitarias. En el análisis de cointegración de las series temporales no se detectó sustituibilidad entre las urgencias de atención primaria y hospitalaria para Asturias y para las áreas sanitarias, salvo en el área sanitaria de Oviedo, donde una tasa de crecimiento del 10% en primaria reduciría un 2,7% las urgencias hospitalarias. Conclusiones: La mayor accesibilidad a los PAC de Atención Primaria incrementa su utilización sin reducir las visitas en los SUH. En consecuencia, el incremento de recursos en Atención Primaria no parece constituir una alternativa eficaz para disminuir las visitas en los SUH

Background: Greater accessibility to the primary care continuing care points (CCP’s) could reduce the visits to the Hospital Emergency Services (HES’s). This study analyses whether Primary Care can replace and Hospital Services in emergencies. Methods: All of the emergency visits (n=6.454.034) made to the HES’s and Primary Care CCP’s in Asturias and of each one of the healthcare districts within the 1994-2001 period were calculated. The time series were constructed with monthly frequencies for Asturias and each one of the districts, a cointegration analysis having been made to assess whether the two series are inter-replaceable. Results: A mean annual increase of the total number of emergencies in Asturias of 6.2% (CCP: 7,8%; HES: 5.1%) was found, with different growth among the healthcare districts. In the time series cointegration analysis, no replaceability was found between the primary care and hospital emergencies for Asturias and for the healthcare districts, except for the healthcare district of Oviedo, where a 10% growth rate in primary would lower hospital emergencies by 2.7%. Conclusions: The greater accessibility to the Primary Care CCP’s increases the use thereof without reducing the visits to the HES’s. Therefore, the increase in Primary Care resources does not seem to be an effective alternative for reducing the visits to the HES’s

Influence of anionic surfactants on the electric percolation of AOT/isooctane/water microemulsions.

A study was carried out concerning the influence of sodium alkyl sulfonates on the electric percolation of AOT/isooctane/water microemulsions ([AOT] = 0.5 M and W = [H2O]/[AOT] = 22.2). An important effect was observed with regard to the percolation temperature caused by the addition of small quantities of alkyl sulfonates (rho = [alkyl sulfonate]/[AOT] = 0.01). The short chain alkyl sulfonates (C3-C5) cause an increase in the percolation temperature, which in turn is reduced as we increase the chain length of the additive until we obtain a percolation temperature which is lower than that which is observed in the absence of an additive (C6-C8). For hydrocarbon chains of a greater length we can observe a new increase in the percolation temperature (C10-C18). This behavior has been explained as a consequence of (i) the incorporation of the additives at the interphase of the microemulsion and (ii) the geometric parameters of the different surfactants added to the microemulsion.