Aplicabilidad y limitaciones de las pruebas de ejecución funcional en el cribado de fragilidad al alta de un centro de atención intermedia / Applicability and limitations of physical performance tests for frailty screening on discharge from an intermediate care hospital

INTRODUCCIÓN: La fragilidad puede ser detectada con distintas herramientas y en múltiples entornos. Entre los diferentes sistemas de cribado, la velocidad de marcha (VM) y el Timed Up-and- Go (TUG) se postulan como sistemas sencillos y fácilmente aplicables. Existen pocos datos sobre su aplicabilidad en pacientes hospitalizados en centros de atención intermedia. MATERIAL Y MÉTODOS: Estudio descriptivo para determinar la aplicabilidad de la VM y el TUG como herramientas de cribado de fragilidad en un hospital de atención intermedia, así como una estimación de la prevalencia de fragilidad al alta mediante estas pruebas de ejecución funcional. Se consideraron frágiles los pacientes con una VM<1m/s y/o un TUG>12s. Se incluyeron todos pacientes atendidos por la unidad de rehabilitación del centro a lo largo del año 2015. RESULTADOS: Novecientos nueve fueron los pacientes incluidos (edad media de 80,12 años). De estos, solo 205 (22,6%) estaban en condiciones de realizar la VM y TUG en el momento del alta; de estas 205 personas, el 89,8% (VM) y el 92,2% (TUG) presentaban criterios de fragilidad, no habiendo diferencias estadísticamente significativas entre ambas herramientas (p = 0,25). CONCLUSIONES: La utilización de la VM y el TUG para el cribado de fragilidad tiene una aplicabilidad limitada en el entorno de atención intermedia. A pesar de ello, los resultados obtenidos indican una alta prevalencia de fragilidad en este entorno. Serán necesarios más estudios para corroborar estos datos

INTRODUCTION: Frailty screening can be performed with different tools and in multiple settings. Among the different evaluation systems, gait speed (GS) and Timed Up-and-Go (TUG) are postulated as simple and easy to apply systems. There are few data on the prevalence of frailty in intermediate care centre inpatients. MATERIAL AND METHODS: Descriptive study to determine the applicability of GS and TUG as frailty screening tools in an intermediate care hospital, as well as an estimate of frailty prevalence at discharge. Frailty was considered when GS<1m/s and / or TUG>12seconds. The study included all patients attending the rehabilitation unit of the centre throughout 2015. RESULTS: A total of 909 patients were included (mean age of 80.12 years). Only 205 (22.6%) were able to perform GS and TUG at discharge from the rehabilitation unit. Frailty prevalence for this group was between 89.8% (GS) and 92.2% (TUG), with no statistical differences between both tools (P=.25). CONCLUSIONS: The applicability of GS and TUG for frailty screening in intermediate care hospitals is limited. Despite this, the results obtained suggest a high prevalence of frailty. More studies will be necessary to corroborate this data

[Applicability and limitations of physical performance tests for frailty screening on discharge from an intermediate care hospital]. / Aplicabilidad y limitaciones de las pruebas de ejecución funcional en el cribado de fragilidad al alta de un centro de atención intermedia.

INTRODUCTION: Frailty screening can be performed with different tools and in multiple settings. Among the different evaluation systems, gait speed (GS) and Timed Up-and-Go (TUG) are postulated as simple and easy to apply systems. There are few data on the prevalence of frailty in intermediate care centre inpatients. MATERIAL AND METHODS: Descriptive study to determine the applicability of GS and TUG as frailty screening tools in an intermediate care hospital, as well as an estimate of frailty prevalence at discharge. Frailty was considered when GS<1m/s and / or TUG>12seconds. The study included all patients attending the rehabilitation unit of the centre throughout 2015. RESULTS: A total of 909 patients were included (mean age of 80.12 years). Only 205 (22.6%) were able to perform GS and TUG at discharge from the rehabilitation unit. Frailty prevalence for this group was between 89.8% (GS) and 92.2% (TUG), with no statistical differences between both tools (P=.25). CONCLUSIONS: The applicability of GS and TUG for frailty screening in intermediate care hospitals is limited. Despite this, the results obtained suggest a high prevalence of frailty. More studies will be necessary to corroborate this data.

Alta incidencia de diabetes tipo 1 en población magrebí de Osona y Baix Camp / High incidence of type 1 diabetes in the immigrant population of Osona and Baix Camp

INTRODUCCIÓN: Se ha postulado que la migración podría actuar como factor modificador de la incidencia de diabetes tipo 1 (DM1), por lo que el objetivo de este estudio es determinar si existen diferencias en la incidencia de DM1 según el origen. MATERIAL Y MÉTODOS: Estudio retrospectivo de los casos de debut diabético tipo 1 en menores de 19 años en las comarcas de Osona y Baix Camp entre los años 2000 y 2012, utilizando la historia clínica de las unidades de endocrinología y los datos demográficos del Institut d'Estadística de Catalunya. RESULTADOS: La población infantil en Osona y el Baix Camp aumentó un 36,6%, un 18,9% los autóctonos y un 482% los inmigrantes, a expensas mayoritariamente del colectivo magrebí (90%). Han acontecido 118 debuts diabéticos, 66,9% en nativos, 32,2% en magrebíes y 0,9% en niños de otros países, con una tasa de incidencia total de 14,4 casos/100.000 habitantes/año (c/105 h-a). La incidencia es mayor en magrebíes respecto a autóctonos, 37,1 vs. 11,2 c/105 h-a (p < 0,001), y en menores de 5 años respecto a los de 5 a 18 años, 18,9 vs. 12,5 (p < 0,05), sin observar diferencias entre sexos (p > 0,05). El riesgo relativo es 3,1 para magrebíes y 1,5 para menores de 5 años. CONCLUSIONES: La incidencia total de DM1 se mantiene estable, pero es mayor en magrebíes que en nativos y en menores de 5 años respecto a los de 5-18 años. Estos resultados abren un campo de estudio sobre los factores de riesgo que podrían estar incidiendo sobre esta población en los países de destino

INTRODUCTION: It has been postulated that migration could act as a modifying factor in the incidence of Type 1 diabetes mellitus (T1DM), so the aim of this study is to determine if there are differences in the incidence of T1DM by origin. MATERIAL AND METHODS: Retrospective study of cases of T1DM onset in the population younger than 19 years old in Osona and Baix Camp between 2000 and 2012, using the medical histories of endocrinology units of the health centres and demographics from Catalonia Statistical Institute as sources. RESULTS: The child population in Osona and Baix Camp increased by 36.6%, with 18.9% in the local population, and 482% in the immigrant population, and most of this increase (90%) in the Maghreb immigrant group. A total of 118 diabetics onset were found, 66.9% in the local population, 32.2% Maghrebi population, and 0.9% in children from other countries, with a total incidence rate of 14.4 cases per 100,000 population/year (c/105p-y). The incidence is higher in the Maghrebi population compared to the local population, 37.1 vs 11.2 c/105p-y (P<.001), and in children under 5 years compared to the 5-18 years group, 18.9 vs 12.5 c/105p-y (P<.05), with no differences between sexes (P>.05). The relative risk is 3.1 for the Maghrebi population, and 1.5 for children under 5 years. CONCLUSIONS: The total incidence of T1DM remains stable, but is higher in the Maghrebi than in the local population, and in children under 5 years compared to 5-18 years group. These results opens a study field of which risk factors could be affecting this immigrant population in their destination countries

[High incidence of type 1 diabetes in the immigrant population of Osona and Baix Camp]. / Alta incidencia de diabetes tipo 1 en población magrebí de Osona y Baix Camp.

INTRODUCTION: It has been postulated that migration could act as a modifying factor in the incidence of Type 1 diabetes mellitus (T1DM), so the aim of this study is to determine if there are differences in the incidence of T1DM by origin. MATERIAL AND METHODS: Retrospective study of cases of T1DM onset in the population younger than 19 years old in Osona and Baix Camp between 2000 and 2012, using the medical histories of endocrinology units of the health centres and demographics from Catalonia Statistical Institute as sources. RESULTS: The child population in Osona and Baix Camp increased by 36.6%, with 18.9% in the local population, and 482% in the immigrant population, and most of this increase (90%) in the Maghreb immigrant group. A total of 118 diabetics onset were found, 66.9% in the local population, 32.2% Maghrebi population, and 0.9% in children from other countries, with a total incidence rate of 14.4 cases per 100,000 population/year (c/105p-y). The incidence is higher in the Maghrebi population compared to the local population, 37.1 vs 11.2 c/105p-y (P<.001), and in children under 5 years compared to the 5-18 years group, 18.9 vs 12.5 c/105p-y (P<.05), with no differences between sexes (P>.05). The relative risk is 3.1 for the Maghrebi population, and 1.5 for children under 5 years. CONCLUSIONS: The total incidence of T1DM remains stable, but is higher in the Maghrebi than in the local population, and in children under 5 years compared to 5-18 years group. These results opens a study field of which risk factors could be affecting this immigrant population in their destination countries.

Cabeza caída como inicio de la miastenia en la enfermedad de Parkinson: ¿una asociación característica? / Dropped head as the presenting symptom of myasthenia in Parkinson's disease: a characteristic association?

No disponible

[Influence of meteorological and chronological factors in epilepsy]. / Influencia en la epilepsia de factores meteorológicos y cronológicos.

INTRODUCTION: The professionals who deal with medical emergencies observe peaks in the incidence of epileptic seizures. Some epileptic patients attribute their seizures to climatic and seasonal changes. AIMS. To analyse the relationship between meteorological, calendar-related and circadian variables and the appearance of epileptic seizures. PATIENTS AND METHODS: A retrospective study was conducted in a residential home for persons with intellectual disability. RESULTS: The 16 residents who were studied presented 855 epileptic attacks, including 159 in peaks or clusters, over the period 2009-2012. The predominance of seizures observed in autumn and during the fourth quarter of the year is not significant (p > 0.05). There is no statistically significant relation between the presence of epileptic seizures and the phases of the moon or days of the week. Most epileptic seizures (87.2%) occur during the daytime (p < 0.001). Findings showed that 36.3% occur in the morning between 08:00 and 10:59. There is no statistical correlation between the number of epileptic seizures and the atmospheric pressure, rainfall, degree of humidity or mean temperature (p > 0.05). CONCLUSIONS: The appearance of peaks or clustering of epileptic seizures was observed. Their presence shows a marked circadian component. The influence of meteorological factors, the phases of the moon and seasons of the year on epilepsy is not significant.

TITLE: Influencia en la epilepsia de factores meteorologicos y cronologicos.Introduccion. Los profesionales que atienden urgencias medicas observan picos de incidencia de crisis epilepticas. Algunos pacientes epilepticos atribuyen sus crisis a cambios climaticos y estacionales. Objetivo. Analizar la relacion de variables meteorologicas, de calendario y circadianas con la aparicion de crisis epilepticas. Pacientes y metodos. Estudio retrospectivo en un centro residencial de personas con discapacidad intelectual. Resultados. Los 16 residentes estudiados presentan 855 crisis epilepticas, entre ellas 159 en picos o cumulos, a lo largo del periodo 2009-2012. El predominio de crisis encontrado en otoño y durante el cuarto trimestre del año no es significativo (p > 0,05). No hay relacion estadisticamente significativa entre la presencia de crisis epilepticas con las fases lunares y los dias de la semana. La mayoria de crisis epilepticas (87,2%) se presenta en horario diurno (p < 0,001). El 36,3% aparece entre las 8:00 y las 10:59 h. No hay correlacion estadistica entre el numero de crisis epilepticas respecto a la presion atmosferica, la precipitacion, el grado de humedad y la temperatura media (p > 0,05). Conclusiones. Se constata la aparicion de picos o cumulos de crisis epilepticas. La presencia de estas presenta un marcado componente circadiano. La influencia en la epilepsia de los factores meteorologicos estudiados, fases lunares y estaciones del año no es significativa.

Influencia en la epilepsia de factores meteorológicos y cronológicos / Influence of meteorological and chronological factors in epilepsy

Introducción. Los profesionales que atienden urgencias médicas observan picos de incidencia de crisis epilépticas. Algunos pacientes epilépticos atribuyen sus crisis a cambios climáticos y estacionales. Objetivo. Analizar la relación de variables meteorológicas, de calendario y circadianas con la aparición de crisis epilépticas. Pacientes y métodos. Estudio retrospectivo en un centro residencial de personas con discapacidad intelectual. Resultados. Los 16 residentes estudiados presentan 855 crisis epilépticas, entre ellas 159 en picos o cúmulos, a lo largo del período 2009-2012. El predominio de crisis encontrado en otoño y durante el cuarto trimestre del año no es significativo (p > 0,05). No hay relación estadísticamente significativa entre la presencia de crisis epilépticas con las fases lunares y los días de la semana. La mayoría de crisis epilépticas (87,2%) se presenta en horario diurno (p < 0,001). El 36,3% aparece entre las 8:00 y las 10:59 h. No hay correlación estadística entre el número de crisis epilépticas respecto a la presión atmosférica, la precipitación, el grado de humedad y la temperatura media (p > 0,05). Conclusiones. Se constata la aparición de picos o cúmulos de crisis epilépticas. La presencia de estas presenta un marcado componente circadiano. La influencia en la epilepsia de los factores meteorológicos estudiados, fases lunares y estaciones del año no es significativa (AU)

Introduction. The professionals who deal with medical emergencies observe peaks in the incidence of epileptic seizures. Some epileptic patients attribute their seizures to climatic and seasonal changes. Aims. To analyse the relationship between meteorological, calendar-related and circadian variables and the appearance of epileptic seizures. Patients and methods. A retrospective study was conducted in a residential home for persons with intellectual disability. Results. The 16 residents who were studied presented 855 epileptic attacks, including 159 in peaks or clusters, over the period 2009-2012. The predominance of seizures observed in autumn and during the fourth quarter of the year is not significant (p > 0.05). There is no statistically significant relation between the presence of epileptic seizures and the phases of the moon or days of the week. Most epileptic seizures (87.2%) occur during the daytime (p < 0.001). Findings showed that 36.3% occur in the morning between 08:00 and 10:59. There is no statistical correlation between the number of epileptic seizures and the atmospheric pressure, rainfall, degree of humidity or mean temperature (p > 0.05). Conclusions. The appearance of peaks or clustering of epileptic seizures was observed. Their presence shows a marked circadian component. The influence of meteorological factors, the phases of the moon and seasons of the year on epilepsy is not significant. (AU)

Análisis de las defunciones de pacientes con demencia ingresados en una unidad de psicogeriatría / Analysis of dementia patient mortality in a psychogeriatric unit

Objetivo. Determinar las características de los pacientes con demencia fallecidos y describir las condiciones que determinaron la muerte. Material y método. Estudio observacional de los pacientes que murieron en la Unidad de Psicogeriatría del Hospital de la Santa Creu de Vic durante 3 años y medio. Resultados. De 554 ingresos se registró una mortalidad del 14,6% (81 casos). El análisis de los fallecidos mostró que el 67,9% eran mujeres con una edad media de 85,8 años, siendo la demencia más frecuente la tipo Alzheimer (37%) y encontrándose en fase avanzada (CDR3, GDS 6-7) el 72,8% de los casos. Al ingreso se registraron las siguientes características: Mini Mental State Examination (MMSE) 9,5; índice de Barthel (IB) previo de 50,1; IB al ingreso de 17,4, y Neuropsychiatric Inventory (NPI) 31,4. En el momento del ingreso, en un 84% se determinó limitación terapéutica. Del análisis de las condiciones que condujeron a la muerte observamos: en el 74,1% la muerte es consecuencia directa de un episodio gatillo (la infección respiratoria fue el más frecuente); en un 17,3% se produce la muerte por declive progresivo sin claro factor desencadenante y en un 8,6% los pacientes precisaron sedación paliativa por mal control de síntomas. Conclusiones. Los problemas intercurrentes fueron el factor más frecuente asociado a la muerte de los pacientes. La mayoría de los pacientes mueren en fases previas a los criterios establecidos para demencia terminal. En algunos casos los pacientes pueden presentar trastorno de conducta como síntoma refractario(AU)

Aim. To determine the characteristics of patients with dementia who died in a psychogeriatric unit, and to describe the conditions that led to their death. Material and methods. Observational study of patients who died in the Psychogeriatric unit of Hospital de la Santa Creu de Vic during a three and a half year period. Results. Of the 554 patients admitted during the study period, we recorded a mortality of 14.6% (81 patients). The analysis of those who died showed that 67.9% were women, with a mean age of 85.8 years, with the most frequent cause being Alzheimer type dementia (37%) and being in an advanced stage (CDR3, GDS 6-7) in 72.8% of cases. On admission the following characteristics were recorded: Mini Mental State Examination (MMSE) 9.5, Barthel Index (BI) prior to entry 50.1, BI on admission 17.4, and Neuropsychiatric Inventory (NPI) 31.4. A therapeutic limitation treatment was determined for 84% of patients on admission. From the analysis of the conditions that lead to death it was noted that: In 74.1% of the patients the death was a direct result of a triggering event (the most frequent being respiratory infection), in 17.3% the death occurred by a gradual decline, with no clear precipitating factor, and in 8.6% of patients palliative sedation was required due to poorly controlled symptoms. Conclusions. Intercurrent problems were the most common factors related to the death of the patients. Most patients died in the stages prior to the established criteria for terminal dementia. In some cases patients may experience disorder behavior as a refractory symptom(AU)

[Analysis of dementia patient mortality in a psychogeriatric unit]. / Análisis de las defunciones de pacientes con demencia ingresados en una unidad de psicogeriatría.

AIM: To determine the characteristics of patients with dementia who died in a psychogeriatric unit, and to describe the conditions that led to their death. MATERIAL AND METHODS: Observational study of patients who died in the Psychogeriatric unit of Hospital de la Santa Creu de Vic during a three and a half year period. RESULTS: Of the 554 patients admitted during the study period, we recorded a mortality of 14.6% (81 patients). The analysis of those who died showed that 67.9% were women, with a mean age of 85.8 years, with the most frequent cause being Alzheimer type dementia (37%) and being in an advanced stage (CDR3, GDS 6-7) in 72.8% of cases. On admission the following characteristics were recorded: Mini Mental State Examination (MMSE) 9.5, Barthel Index (BI) prior to entry 50.1, BI on admission 17.4, and Neuropsychiatric Inventory (NPI) 31.4. A therapeutic limitation treatment was determined for 84% of patients on admission. From the analysis of the conditions that lead to death it was noted that: In 74.1% of the patients the death was a direct result of a triggering event (the most frequent being respiratory infection), in 17.3% the death occurred by a gradual decline, with no clear precipitating factor, and in 8.6% of patients palliative sedation was required due to poorly controlled symptoms. CONCLUSIONS: Intercurrent problems were the most common factors related to the death of the patients. Most patients died in the stages prior to the established criteria for terminal dementia. In some cases patients may experience disorder behavior as a refractory symptom.

Resultados de los parámetros de evaluación asistenciales de una unidad de atención intermedia para pacientes con demencia / Care assessment parameters in an intermediate care unit for patients with dementia

Objetivo. Evaluar los resultados asistenciales de nuestra unidad de Psicogeriatría. Material y métodos. Estudio prospectivo de 46 pacientes con demencia ingresados en la unidad de Psicogeriatría entre mayo y agosto del 2008. Se analizó: a) mediana del Neuropsychiatric Inventory al ingreso, a la semana y al alta; b) porcentaje de pacientes procedentes de domicilio y procedentes del hospital de agudos; c) porcentaje de pacientes procedentes del hospital con estancia media inferior o igual a 7 días; d) porcentaje de caídas y restricciones físicas, y e) destino al alta. Las comparaciones entre variables se realizaron con el T-test y el chi-cuadrado. Resultados. Se observaron diferencias estadísticamente significativas entre la mediana del Neuropsychiatric Inventory al ingreso (37,7) y a la semana (13,7) (p<0,001). El 50% de los pacientes procedía de domicilio y el 50% del hospital de agudos, de éstos, el 73,9% tuvo una estancia media en el hospital de procedencia inferior o igual a 7 días. El 19,6% de los pacientes presentó caídas. Se utilizaron restricciones físicas en el 43,5% de los pacientes. Al ingreso se observó un bajo grado de prescripción de benzodiacepinas de vida media larga (6,5%) y neurolépticos típicos (2,2%), y un 6,7% de los pacientes no presentó prescripción de psicofármacos. Un 33% de los pacientes fueron dados de alta sin prescripción de psicofármacos. El porcentaje de nueva institucionalización fue del 43,5%. Conclusiones. Las unidades de Psicogeriatría de media estancia permiten el control de los síntomas psicológicos y conductuales y probablemente optimizan el recurso de los hospitales de agudos(AU)

Objective. To evaluate the care outcomes of a psychogeriatric unit. Material and methods. A prospective study of 46 patients with dementia consecutively admitted to Psychogeriatric Unit between May and August 2008. The parameters analysed were: a) median Neuropsychiatric Inventory (NPI) on admission, after one week and at discharge, b) percentage of patients coming from home or discharged from the acute hospital, c) percentage of patients coming from the acute hospital with an average stay equal or less than 7 days, d) percentages of falls and physical restraints, and e) destination at discharge. Comparisons between variables were performed using t-test and chi-squared. Results. There were a statistically significant difference between the median NPI on admittance (37.7) and after a week (13.7) (p<0.001). Half of the patients came from home and the other half from acute hospital, 73.9% of whom had had an average hospital stay equal or less than 7 days. Falls were reported in 19.6% of patients. Physical restraints were used in 43.5% of patients. On admission there was a low level of prescription of long half-life benzodiazepines (6.5%) and typical neuroleptics (2.2%), and 6.7% of patients had no prescription of psychotropic drugs. At discharge psychotropic drugs were not prescribed in 33% of patients. The institutionalisation rate was 43.5%. Conclusions. Intermediate Psychogeriatric wards enable behavioural symptoms to be controlled (BPSD) and they probably optimize the use of acute hospitals(AU)

[Care assessment parameters in an intermediate care unit for patients with dementia]. / Resultados de los parámetros de evaluación asistenciales de una unidad de atención intermedia para pacientes con demencia.

OBJECTIVE: To evaluate the care outcomes of a psychogeriatric unit. MATERIAL AND METHODS: A prospective study of 46 patients with dementia consecutively admitted to Psychogeriatric Unit between May and August 2008. The parameters analysed were: a) median Neuropsychiatric Inventory (NPI) on admission, after one week and at discharge, b) percentage of patients coming from home or discharged from the acute hospital, c) percentage of patients coming from the acute hospital with an average stay equal or less than 7 days, d) percentages of falls and physical restraints, and e) destination at discharge. Comparisons between variables were performed using t-test and chi-squared. RESULTS: There were a statistically significant difference between the median NPI on admittance (37.7) and after a week (13.7) (p<0.001). Half of the patients came from home and the other half from acute hospital, 73.9% of whom had had an average hospital stay equal or less than 7 days. Falls were reported in 19.6% of patients. Physical restraints were used in 43.5% of patients. On admission there was a low level of prescription of long half-life benzodiazepines (6.5%) and typical neuroleptics (2.2%), and 6.7% of patients had no prescription of psychotropic drugs. At discharge psychotropic drugs were not prescribed in 33% of patients. The institutionalisation rate was 43.5%. CONCLUSIONS: Intermediate Psychogeriatric wards enable behavioural symptoms to be controlled (BPSD) and they probably optimize the use of acute hospitals.