Comprehensive geriatric assessment for identifying older people at risk of hip fracture: cross-sectional study with comparative group.

Background: Hip fracture (HF) is by far the most common serious fragility fracture. Its care is a major challenge to all healthcare systems. Aim: To determine whether there are characteristics of older people identified via comprehensive geriatric assessment (CGA) that help identify those with an increased risk of HF. Methods: The demographic, functional, cognitive and nutritional data of a cohort of patients admitted for acute HF were compared with those of a population cohort representing community-dwelling older people in the same urban district without HF. Bivariate analysis was performed on the variables in both the complete samples and in a subsample of age and sex paired subjects, followed by logistic regression analysis. Results: A total of 509 HF patients and 1315 community-dwelling older people were included. The HF patients were older and more frequently women and had more frequent disability and cognitive impairment, lower handgrip strength, lower body mass index (BMI) and a higher frequency of vitamin D deficiency compared with the community controls (P < 0.001). The variables most strongly associated with the presence of HF in the multivariate analysis, aside from age and female sex, were BMI<22 kg/m2 [odds ratio (OR) = 5.11], disability (OR = 4.32), muscle weakness (OR = 3.01), and vitamin D deficiency (OR = 2.13). Conclusions: There are easily obtained CGA determinants that are strongly associated with fragility HF. The detection of low weight, disability, malnutrition, muscle weakness, and vitamin D deficiency can help identify at-risk older people to implement prevention strategies.

Úlceras genitales dolorosas y de larga evolución en paciente con leucemia linfática crónica / Long-standing painful genital ulcers in a patient with chronic lymphocytic leukaemia

No disponible

Necesidades formativas en la atención a pacientes oncológicos en Castilla-La Mancha / Training needs in the care of oncological patients

Objetivo Conocer las necesidades formativas en la atención a pacientes con cáncer. Método Estudio descriptivo transversal, basado en encuesta a médicos de cupo que trabajan en los centros de salud de Castilla-La Mancha. La encuesta fue diseñada ad hoc e incluía variables sobre necesidades formativas en la atención a pacientes con cáncer, en fase terminal y supervivientes (en escala de 0 a 5), seguridad en el manejo de estos pacientes, opinión sobre quién debería asumir el cuidado de estos enfermos, grado de comunicación con el oncólogo y la Unidad de Cuidados Paliativos, e implicación en la atención a los pacientes. Para el análisis se utilizó el test de Chi-cuadrado de Pearson, la t de Student y el coeficiente de correlación rho de Spearman. Resultados Respondieron 172 médicos (14,9% de la población); 51,2% varones; edad media 49,1 años. La media de pacientes terminales atendidos al año es 3,9.Las mayores necesidades formativas sentidas se refieren a la atención a supervivientes (3,44). El aspecto más reclamado es la atención a urgencias terminales (3,77). En general, la mujer tiene mayor percepción de necesidades formativas (3,44 vs. 3,21; p = 0,045). El 69,2% ha realizado algún curso en los últimos 5 años. La seguridad en el manejo de oncológicos es calificada como «media» por el 74,4% y se relaciona inversamente con la necesidad de formación, siendo mayor en (..) (AU)

Objective To determine the training required in the care of cancer patients .Method A cross-sectional study was performed, based on survey of family doctors in Health Centres of Castilla-La Mancha, Spain. The survey was designed ad hoc and included questions about training needs in caring for cancer patients, in terminal phase and survivors (level 0-5), safety management, opinion about who should care for these patients, communication with oncologist and palliative care unit, and involvement in oncological patient care. For statistical analysis we used Pearson Chi-square, Student t test and Spearman's rho coefficient. Results A total of 172 doctors responded (14.9% of the population) with a mean age of 49.1 years and 51.2% were male. The mean number of terminals patients per year was 3.9.The most required training need was related to care for survivors (3.44). Better care for emergency terminal patients (3.77) was one of the most mentioned. In general, women had a greater perception of training needs (3.44 vs. 3.21; P=.045). Over two-thirds (69.2%) has attended a training (..) (AU)

Réplica a Carta al Director / Reply to letter to the editor

No disponible

Necesidades Formativas en la Atención a Pacientes Oncológicos en Castilla-La Mancha / Training needs in cancer patient care in Castilla La Mancha, Spain

Objetivo. Conocer las necesidades formativas en la atención a pacientes con cáncer. Diseño y emplazamiento. Estudio descriptivo transversal, basado en encuesta a médicos de cupo de Castilla-La Mancha. La encuesta fue diseñada ad hoc sobre necesidades formativas (escala 0-5), seguridad en el manejo e implicación en la atención a pacientes oncológicos. Resultados. Respondieron 172 médicos (14,9% de la población, 51,2% varones, edad media 49,1 años). El número medio de pacientes terminales atendidos al año es 3,9. Las mayores necesidades formativas sentidas se refieren a la atención a supervivientes (3,44). El aspecto más reclamado es la atención a urgencias terminales (3,77). En general, la mujer tiene mayor percepción de necesidades formativas (3,44 vs 3,21; p = 0,045). El 69,2% ha realizado algún curso en los últimos 5 años. La seguridad en el manejo de oncológicos es calificada como 'media' por el 74,4% y se relaciona inversamente con la necesidad de formación, siendo mayor en hombres. El 65,1% considera que la mayor responsabilidad del manejo del paciente con cáncer debe ser del oncólogo, recayendo en el Médico de Familia cuando se trata de terminales (según el 43,9%) o supervivientes (70,4%). La comunicación con el oncólogo es "mala/muy mala" según el 53,2%, siendo este porcentaje del 9,3% cuando se refiere a Unidad de Paliativos. Para el 70,3% su grado de implicación con estos enfermos es adecuado. Respecto a una hipotética falta de implicación, la razón considerada más importante es la falta de experiencia (31,6%). Conclusiones. Las necesidades formativas sentidas podemos considerarlas medio/altas, aunque en general se sienten razonablemente preparados para atender a estos pacientes. La falta de experiencia y de formación pueden ser factores que limitan la implicación del médico de familia (AU)

Objective. To determine the training needs in cancer patient care. Method. Cross-sectional study based on a survey of family doctors in Castilla-La Mancha, Spain. An ad hoc questionnaire was designed which included questions on training needs (scale of 0-5), safety management and involvement in cancer patient care. Results. A total of 172 doctors (14.9% of the population) responded; 51.2% male; average age 49.1 years. The average number of terminal patients per year was 3.9. The doctors consider that the main training need is related to care of survivors (3.44). The most important is the care of emergency terminal patients (3.77). In general, women have a greater perception of training needs (3.44 versus 3.21; p = 0, 045), 69.2% has taken a course in the last 5 years. Safety management of cancer patients was rated as 'moderate' by 74.4% and was inversely related to the need for training, and was higher in male doctors. 65.1% believed oncologists should have the most responsibility for the management of cancer patients, but that the Primary Care doctor should be responsible for terminal patients (according to 43.9% of doctors) or survivors (70.4%). According to 53.2% of doctors communication with the oncologists is "poor or very poor" this percentage being 9.3% when referring to the Palliative Care Unit. For 70.3% their degree of involvement with these patients is adequate. The main reason for a hypothetical lack of involvement would be the lack of experience (31.6%). Conclusions. The doctors consider that there is a moderate to high need for training, although in general they feel reasonably prepared to treat these patients. Lack of experience and training could be factors that limit the involvement of the primary care doctor (AU)

Actitud y comportamiento de la mujer frente a la prevención de la enfermedad cardiovascular / Attitudes and behaviour of women towards cardiovascular disease prevention

Objetivo. Conocer la actitud y el comportamiento de las mujeres hacia las actividades preventivas relacionadas con la enfermedad cardiovascular. Método. Estudio descriptivo transversal, mediante encuesta autoadministrada sobre actitudes y comportamientos en prácticas preventivas, realizado en 3 centros de salud de Toledo, en 539 mujeres de 18-65 años. Resultados. Edad 40,4 años. Proceden del medio urbano 361 (66,7%); 354 (65,4%) están casadas; 221 (40,8%) son universitarias; trabajan 382 (70,8%). Creen que la principal causa de muerte en las mujeres es el cáncer 432 (83,2%); 174 (32,4%) dicen realizarse anualmente un chequeo médico preventivo; 411 (76,8%) consideran muy peligroso fumar, pero fuman actualmente 159 (30,0%). El consumo de alcohol es considerado muy peligroso por 232 (43,4%); son consumidoras habituales (casi todas las semanas) 92 (17,2%). Sólo 128 (23,8%) hace ejercicio habitualmente. Hacen algún tipo de dieta 127 (24,0%). Se realizan al menos una vez al año una toma de PA y analítica (colesterol y glucemia) el 68,4, el 64,1 y el 53,9%, respectivamente. Recuerdan haber sido aconsejadas alguna vez sobre el estilo de vida por un profesional sanitario 266 (51,7%). Conclusiones. La repercusión de las enfermedades cardiovasculares en la mujer está infravalorada. Nuestra población parece concienciada del riesgo de determinados hábitos, pero eso no se traduce siempre en un estilo de vida saludable. Parece que nuestros consejos no consiguen modificar la conducta de las mujeres en muchos casos, pero sí «medicalizar» su vida, aumentando la realización de controles analíticos y clínicos. Debemos insistir en la prevención del riesgo cardiovascular en la mujer y mejorar la efectividad de nuestras intervenciones (AU)

Objective. To find out the attitudes and behaviour of women towards preventive activities related to cardiovascular disease. Method. Cross-sectional descriptive study, through a self-completion questionnaire, in three Health Centres in Toledo (Spain). A total of 539 women between 18 and 65 years old answered an ad hoc developed questionnaire that contained items on knowledge, attitudes, and behaviours in preventive practices. Results. The mean age was 40.4 years age; 361 (66.7%) came from urban areas; 354 (65.4%) were married; 221 (40.8%) had university studies; 382 (70.8%) were working; 432 (83.2%) believed that the leading cause of death in women was cancer; 174 (32.4%) said they had annual preventive medical check-ups; 411 (76.8%) considered it very dangerous to smoke, but 159 (30.0%) currently smoked. Alcohol consumption was considered very dangerous by 232 (43.4%); 92 (17.2%) were regular consumers (almost every week). Only 128 (23.8%) did exercise one or more times per week. Only 127 (24.0%) followed some type of diet. At least one annual BP and laboratory tests (cholesterol and blood sugar) were measured in 68.4%, 64.1% and 53.9%, respectively. A total of 266 (51.7%) had been advised once on their lifestyle by a healthcare professional. Conclusions. The impact of cardiovascular disease in women is underestimated. Our population seemed concerned about the risk of certain habits but this was not always translated into a healthy lifestyle. It seems that our advice may not change the behaviour of women in many cases, but it does increase the number of clinical and analytical controls. We must insist on the prevention of cardiovascular risk in women and improve the effectiveness of our interventions (AU)

[Attitudes and behaviour of women towards cardiovascular disease prevention]. / Actitud y comportamiento de la mujer frente a la prevención de la enfermedad cardiovascular.

OBJECTIVE: To find out the attitudes and behaviour of women towards preventive activities related to cardiovascular disease. METHOD: Cross-sectional descriptive study, through a self-completion questionnaire, in three Health Centres in Toledo (Spain). A total of 539 women between 18 and 65 years old answered an ad hoc developed questionnaire that contained items on knowledge, attitudes, and behaviours in preventive practices. RESULTS: The mean age was 40.4 years age; 361 (66.7%) came from urban areas; 354 (65.4%) were married; 221 (40.8%) had university studies; 382 (70.8%) were working; 432 (83.2%) believed that the leading cause of death in women was cancer; 174 (32.4%) said they had annual preventive medical check-ups; 411 (76.8%) considered it very dangerous to smoke, but 159 (30.0%) currently smoked. Alcohol consumption was considered very dangerous by 232 (43.4%); 92 (17.2%) were regular consumers (almost every week). Only 128 (23.8%) did exercise one or more times per week. Only 127 (24.0%) followed some type of diet. At least one annual BP and laboratory tests (cholesterol and blood sugar) were measured in 68.4%, 64.1% and 53.9%, respectively. A total of 266 (51.7%) had been advised once on their lifestyle by a healthcare professional. CONCLUSIONS: The impact of cardiovascular disease in women is underestimated. Our population seemed concerned about the risk of certain habits but this was not always translated into a healthy lifestyle. It seems that our advice may not change the behaviour of women in many cases, but it does increase the number of clinical and analytical controls. We must insist on the prevention of cardiovascular risk in women and improve the effectiveness of our interventions.