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3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(10): 571-576, dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176482

RESUMO

Introducción: El objetivo fue estimar la incidencia de diabetes y explorar la mortalidad de pacientes hospitalizados durante el seguimiento posterior al alta, clasificados durante la misma según el comportamiento glucémico como hiperglucemia de estrés (HE) o normoglucemia (NG). Material y métodos: Cohorte retrospectiva de adultos no diabéticos con HE (>140mg/dl y HbA1c<6,5%) o NG (todos los valores de glucemia <=140mg/dl). Resultados: Se identificaron 3981 pacientes con NG y 884 con HE. Durante el período de observación (mediana de seguimiento de 1,83 años), hubo un total de 255 casos de diabetes y 831 muertes. La incidencia acumulada de diabetes al año fue de 1,59% (IC95%:1,23-2,06) en NG y 7,39% (IC95% 5,70-9,56) en HE. HE se asoció significativamente con la incidencia de diabetes (HR crudo 1,33; IC95% 1,13-1,73; p 0,025), incluso después del ajuste por edad y sexo (HR ajustado 1,38; IC95% 1,06-1,78; p 0,014). La incidencia de mortalidad al año fue 10,07% (IC95%:9,18-11,05) en NG y 13,24% (IC95%:11,17-15,65) en HE. El sub hazard ratio de desarrollar diabetes considerando la muerte como evento competitivo fue 1,41 (IC95% 1,29-1,53; p<0,001). Conclusiones: La HE es un factor de riesgo para desarrollar diabetes. No hubo diferencias de mortalidad en el seguimiento, pero la muerte parece comportarse como un evento competitivo al desarrollo de diabetes en esta población


Introduction: The study objective was to estimate during post-discharge follow-up the incidence of diabetes and to ascertain mortality in hospitalized patients, classified during follow-up as having stress hyperglycemia (SH) or normoglycemia (NG) based on blood glucose levels. Material and methods: A retrospective cohort of non-diabetic adults with SH (> 140mg/dl and HbA1c <6.5%) or NG (all blood glucose values ≤ 140mg/dl) was used. Results: There were 3981 patients with NG and 884 with SH. During the observation period (median follow-up of 1.83 years), there were 255 cases of diabetes and 831 deaths. The cumulative incidence of diabetes per year was 1.59% (95% CI: 1.23-2.06) in patients with NG and 7.39% (95% CI: 5.70-9.56) in those with SH. SH was significantly associated to diabetes (crude HR 1.33, 95% CI: 1.13-1.73, p .025), even after adjusting for age and sex (adjusted HR 1.38, 95% CI 1.06-1.78, p .014). The mortality rate at one year was 10.07% (95% CI: 9.18-11.05) in NG patients and 13.24% (95% CI: 11.17-15.65) in SH patients. The sub-hazard ratio of developing diabetes considering death as a competitive event was 1.41 (95% CI 1.29-1.53, p <.001). Conclusions: SH is a risk factor for diabetes. There were no differences in mortality during follow-up, but death appears to be a competitive event in development of diabetes in this population


Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Hiperglicemia/epidemiologia , Hospitalização , Diabetes Mellitus/etiologia , Estresse Psicológico/patologia , Argentina , Hiperglicemia/fisiopatologia , Hiperglicemia/mortalidade , Incidência , Mortalidade , Estudos de Coortes , Estudos Retrospectivos , Fatores de Risco
6.
Rev Fac Cien Med Univ Nac Cordoba ; 75(2): 82-87, 2018 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-30273531

RESUMO

BACKGROUND: There is limited knowledge of the incidence of venous thromboembolic disease (VTE) during hospitalization, since most of these are community-based data. PURPOSE: To estimate the incidence rate (IR) of VTE developed during hospitalization. METHODS: Prospective cohort of all inpatients admitted in a university tertiary hospital, in Argentina. The inclusion criteria were defined as: adult patients consecutively admitted from July/2006 to August/2013, for any cause. Patients admitted for VTE were excluded; all patients at the time of admission were free of event. Each person was followed contributing time at risk, from admission to event, discharge or death. VTE incident cases were captured from the Institutional Registry of Thromboembolic Disease (ClinicalTrials.gov Identifier NCT01372514). Incidence rate was calculated with 95% confidence intervals. RESULTS: The crude incidence rate of VTE for clinical patients was 0.49 (95%CI 0.45-0.55) per 1,000 cases person-days, and IR adjusted for WHO was 0.23 (95%CI 0.19-0.26). The crude IR of VTE for surgical patients was 0.25 (95%CI 0.23-0.27), and IR adjusted for WHO was 0.13 (95%CI 0.10-0.17). The incidence rate ratio (IRR) for VTE shows that surgical admission reduces the IRR and age categories increases the thrombosis rate risk, after adjustment for age category, sex and surgical admission. CONCLUSIONS: This study suggests that there is a high risk of VTE in hospitalized patients and is still a frequent problem.


Assuntos
Hospitalização/estatística & dados numéricos , Tromboembolia Venosa/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Registros Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/cirurgia , Adulto Jovem
7.
Endocrinol Diabetes Nutr ; 65(10): 571-576, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30293899

RESUMO

INTRODUCTION: The study objective was to estimate during post-discharge follow-up the incidence of diabetes and to ascertain mortality in hospitalized patients, classified during follow-up as having stress hyperglycemia (SH) or normoglycemia (NG) based on blood glucose levels. MATERIAL AND METHODS: A retrospective cohort of non-diabetic adults with SH (> 140mg/dl and HbA1c <6.5%) or NG (all blood glucose values ≤ 140mg/dl) was used. RESULTS: There were 3981 patients with NG and 884 with SH. During the observation period (median follow-up of 1.83 years), there were 255 cases of diabetes and 831 deaths. The cumulative incidence of diabetes per year was 1.59% (95% CI: 1.23-2.06) in patients with NG and 7.39% (95% CI: 5.70-9.56) in those with SH. SH was significantly associated to diabetes (crude HR 1.33, 95% CI: 1.13-1.73, p .025), even after adjusting for age and sex (adjusted HR 1.38, 95% CI 1.06-1.78, p .014). The mortality rate at one year was 10.07% (95% CI: 9.18-11.05) in NG patients and 13.24% (95% CI: 11.17-15.65) in SH patients. The sub-hazard ratio of developing diabetes considering death as a competitive event was 1.41 (95% CI 1.29-1.53, p <.001). CONCLUSIONS: SH is a risk factor for diabetes. There were no differences in mortality during follow-up, but death appears to be a competitive event in development of diabetes in this population.


Assuntos
Diabetes Mellitus/epidemiologia , Mortalidade Hospitalar , Hiperglicemia/epidemiologia , Pacientes Internados , Estresse Fisiológico , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Grupos Diagnósticos Relacionados , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Hospitalização , Hospitais Universitários/estatística & dados numéricos , Humanos , Hiperglicemia/etiologia , Incidência , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos
8.
Rev. Hosp. Ital. B. Aires (2004) ; 38(3): 96-104, sept. 2018. tab.
Artigo em Espanhol | LILACS | ID: biblio-1022741

RESUMO

Introducción: el síndrome de burnout (BO) suele afectar a médicos residentes, debido al estrés laboral crónico. Desde un marco logoterapéutico, la pérdida de un sentido de la vida (SV) es el denominador más común de todas las formas de perturbación emocional, y el BO podría enmarcarse dentro de un proyecto de vida laboral (PVL) con enrolamiento enajenante. El objetivo principal del trabajo es evaluar la relación entre el BO, el SV y el PVL, en los programas de residencia del Hospital Italiano de Buenos Aires. Población y métodos: se evaluaron residentes de 6 programas de residencia del Hospital Italiano de Buenos Aires, a través de un cuestionario. El BO se midió con el "Maslach Burnout Inventory" (MBI). El SV se midió con el "Purpose in Life Test" (PIL Test). El PVL se midió con la Escala de PVL de la Dra. Isabel Pérez Jáuregui. Resultados: participaron 104 residentes. El 28,8% de los evaluados mostraron BO, el 18,3% falta de SV y el 30,8% un PVL inauténtico con sobreadaptación. Tanto la falta de SV como el PVL inauténtico con sobreadaptación se asociaron en forma estadísticamente significativa con BO (p < 0,01), y la presencia de cualquiera de estas alteraciones aumentó en casi 18 veces (odds ratio [OR] crudo) la probabilidad de presentar el síndrome. Los OR ajustados de falta de SV (6,28) y PVL inauténtico (9,57) para la presencia de BO continuaron siendo estadísticamente significativos. Por último, en esta investigación pudimos determinar que las subescalas del MBI agotamiento y despersonalización se correlacionaron negativamente con el PIL Test (r=-0,41 y r=-0,53, respectivamente) y la Escala de PVL (r=-0,45 y r=-0,42, respectivamente), mientras que la subescala de realización se correlacionó positivamente en forma significativa con estas dos últimas (r=0,63 y r=0,61, respectivamente). Conclusiones: se encontró una relación estadísticamente significativa entre BO, falta de SV y PVL inauténtico, en la residencia. (AU)


Introduction: The Burnout Syndrome (BO) usually affects medical residents because they are exposed to chronic labour stress. From a logotherapeutic view, the loss of meaning and purpose in life (ML) is the common denominator of all types of emotional distress, and the BO could belong to an altered labour life project (LLP) with overadaptation. The objective of this study was to evaluate the relationship between the BO, the ML, and the LLP, in residency programs at a university hospital. Population and methods: residents from six programs at Hospital Italiano de Buenos Aires were evaluated. The BO was measured with the Maslach Burnout Inventory (MBI). The ML was measured with the Purpose in Life Test (Pil Test). The LLP was measured with the LLP Scale created by Doctor Isabel Pérez Jáuregui. Results: one hundred and four residents participated. Out of the evaluated residentes, 28.8% showed BO. The loss of ML was observed in 18.3%, and an altered LLP with overadaptation affected the 30.8% of the sample. Loss of ML and altered LLP with overadaptation were associated in a statistically significant way with BO (p<0.01), and the presence of any of this alterations increased the odds ratio almost 18 times to suffer BO. The adjusted odds ratio of loss of ML (6.28) and altered LLP (9.57) to suffer BO, were also statistically significant. Finally, a negative correlation was observed between exhaustion and despersonalization (MBI) and the Pil Test (r=-0.41 and r=-0.53, respectively) and the LLP Scale (r=-0.45 and r=-0.42, respectively), while a positive significant correlation was observed between the personal accomplishment (MBI) and the Pil Test and LLP Scale (r=0.63 and r=0.61, respectively). Conclusions: in the residency, we found a statistically significant relationship between BO, loss of ML and altered LLP. (AU)


Assuntos
Humanos , Masculino , Feminino , Qualidade de Vida/psicologia , Esgotamento Profissional/terapia , Estresse Ocupacional/terapia , Internato e Residência , Grupos de Autoajuda/tendências , Fonoterapia/psicologia , Fonoterapia/tendências , Esgotamento Profissional/classificação , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Esgotamento Profissional/epidemiologia , Razão de Chances , Estudos Transversais , Inquéritos e Questionários/estatística & dados numéricos , Despersonalização/prevenção & controle , Despersonalização/terapia , Educação Médica/estatística & dados numéricos , Equilíbrio Trabalho-Vida/tendências , Estresse Ocupacional/prevenção & controle
10.
Rev Med Chil ; 145(5): 557-563, 2017 May.
Artigo em Espanhol | MEDLINE | ID: mdl-28898330

RESUMO

BACKGROUND: Crowding in Emergency Departments (ED), results from the imbalance between the simultaneous demand for health care and the ability of the system to respond. The NEDOCS scale (National Emergency Department Crowding Scale) measures the degree of crowding in an ED. AIM: To describe ED Crowding characteristics, using the NEDOCS scale, in an Argentinean hospital. MATERIAL AND METHODS: A retrospective cohort study was conducted with all adult patient consultations between July 2013 and July 2014 at the ED of Hospital Italiano de Buenos Aires. We included all hours in the analysis period (365 days x 24 h = 8,760). The NEDOCS value was calculated for each hour using an automatic algorithm and was quantified in a six points score. Levels 4 (overcrowded), 5 (severely overcrowded) and 6 (dangerously overcrowded) were defined as overcrowding. Contour plots analysis was applied to identify patterns. RESULTS: During the study period, 124,758 visits to the ED were registered. Overcrowding was present in 57.7% (5,055) of the analyzed hours. A predominance of scores between four and five was observed between 10:00 and 24:00 hours. The months with predominance of overcrowding were June, July and August (southern winter). CONCLUSIONS: The calculation of the NEDOCS score and the analysis of its temporal distribution are highly relevant to identify opportunities for improvement and to develop mechanisms to prevent the highest categories of overcrowding.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Argentina , Estudos de Coortes , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estações do Ano , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo
12.
Rev. méd. Chile ; 145(5): 557-563, mayo 2017. ilus, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-902512

RESUMO

Background: Crowding in Emergency Departments (ED), results from the imbalance between the simultaneous demand for health care and the ability of the system to respond. The NEDOCS scale (National Emergency Department Crowding Scale) measures the degree of crowding in an ED. Aim: To describe ED Crowding characteristics, using the NEDOCS scale, in an Argentinean hospital. Material and Methods: A retrospective cohort study was conducted with all adult patient consultations between July 2013 and July 2014 at the ED of Hospital Italiano de Buenos Aires. We included all hours in the analysis period (365 days x 24 h = 8,760). The NEDOCS value was calculated for each hour using an automatic algorithm and was quantified in a six points score. Levels 4 (overcrowded), 5 (severely overcrowded) and 6 (dangerously overcrowded) were defined as overcrowding. Contour plots analysis was applied to identify patterns. Results: During the study period, 124,758 visits to the ED were registered. Overcrowding was present in 57.7% (5,055) of the analyzed hours. A predominance of scores between four and five was observed between 10:00 and 24:00 hours. The months with predominance of overcrowding were June, July and August (southern winter). Conclusions: The calculation of the NEDOCS score and the analysis of its temporal distribution are highly relevant to identify opportunities for improvement and to develop mechanisms to prevent the highest categories of overcrowding.

13.
Arch. cardiol. Méx ; 86(2): 140-147, abr.-jun. 2016. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-838363

RESUMO

Resumen Objetivo Evaluar la asociación entre las diferencias de mediciones de 2 ECG separados en el tiempo, con el desarrollo de fibrilación auricular (FA). Método Cohorte retrospectiva de 9,975 pacientes adultos, afiliados a la prepaga del Hospital Italiano de Buenos Aires, Argentina, con realización de al menos 2 ECG sinusales digitales entre 2006-2011. Se siguieron clínicamente para la detección de FA. Todas las mediciones electrocardiográficas y los deltas (diferencias entre los 2 ECG) fueron estandarizadas. Se estimaron los hazard ratio para desarrollo de FA, para cada delta de los distintos componentes electrocardiográficos utilizando un modelo de regresión de Cox. Resultados Durante una mediana de seguimiento de 3,5 años se detectaron 189 episodios de FA. El delta FC, delta intervalo ST y delta amplitud onda P se asociaron significativamente a FA. Ajustado por características clínicas y mediciones de ECG basal, el hazard ratio ajustado para FA fue 0.86 (IC95%: 0.75-0.98, p = 0.024) para delta FC; 1.12 (IC95%0.98-1.27, p = 0.082) para delta intervalo ST; y 1.21 (IC95%: 1.05-1.38, p = 0.006) para delta amplitud onda P. Conclusiones Las diferencias FC y amplitud onda P, entre mediciones de ECG, predicen FA en forma independiente de características clínicas y mediciones de ECG basal.


Abstract Objetive To evaluate the association between delta variations in the parameters of 2 sinusal ECG with atrial fibrillation (AF) onset. Method Retrospective cohort of 9,975 adult patients and members of the prepaid system at Hospital Italiano de Buenos Aires from Argentina, who had at least 2 sinusal ECG between 2006 and 2011. Population was followed up for detection of AF. All measurements and electrocardiographic deltas (differences between the 2 ECG) were standardized. Hazard ratio (HR) was estimated for the development of AF for each delta of the different ECG parameters using a Cox regression model. Results During a median follow up of 3.5 years, 189 patients (1.89%) developed AF. Heart rate delta, ST interval delta and P wave amplitude were predictors of AF. Hazard ratio Adjusted for clinical characteristics and ECGbasal values was 0,86 (CI95%: 0.75-0.98, p = 0.024) for heart rate delta, 1.12 (CI95%: 0.98-1.27, p = 0.082) for ST interval delta and 1.21 (CI95%: 1.05-1.38, p = 0.006) for P wave amplitude delta. Conclusion Differences of heart rate and P wave amplitude between ECG's measurements may predict AF, independently of clinical features and ECGbasal values.

14.
Arch Cardiol Mex ; 86(2): 140-7, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-26905510

RESUMO

OBJETIVE: To evaluate the association between delta variations in the parameters of 2 sinusal ECG with atrial fibrillation (AF) onset. METHOD: Retrospective cohort of 9,975 adult patients and members of the prepaid system at Hospital Italiano de Buenos Aires from Argentina, who had at least 2 sinusal ECG between 2006 and 2011. Population was followed up for detection of AF. All measurements and electrocardiographic deltas (differences between the 2 ECG) were standardized. Hazard ratio (HR) was estimated for the development of AF for each delta of the different ECG parameters using a Cox regression model. RESULTS: During a median follow up of 3.5 years, 189 patients (1.89%) developed AF. Heart rate delta, ST interval delta and P wave amplitude were predictors of AF. Hazard ratio Adjusted for clinical characteristics and ECGbasal values was 0,86 (CI95%: 0.75-0.98, p=0.024) for heart rate delta, 1.12 (CI95%: 0.98-1.27, p=0.082) for ST interval delta and 1.21 (CI95%: 1.05-1.38, p=0.006) for P wave amplitude delta. CONCLUSION: Differences of heart rate and P wave amplitude between ECG's measurements may predict AF, independently of clinical features and ECGbasal values.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos
15.
J Thromb Thrombolysis ; 40(2): 225-30, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25995104

RESUMO

Venous thromboembolism (VTE) is the most common cause of preventable mortality in hospitalized patients, and pulmonary embolism is responsible for 5-10 % of all hospital deaths. To estimate the hospital mortality in hospitalized patients who developed VTE during hospitalization. Prospective cohort of all adult inpatients >17 years admitted to the hospital between August 2006 and August 2013, and follow-up until discharge to measure death. VTE incident cases were captured prospectively from the Institutional Registry of Thromboembolic disease in a tertiary hospital care in Buenos Aires. In hospital global mortality and fatality rate of inpatients with VTE was calculated. The cumulative incidence of VTE was 1.8 % (95 % CI 1.77-1.93 %), representing 1.32 % (95 % CI 1.23-1.41 %) in the subgroup of surgical patients and 2.1 % (95 % CI 1.9-2.2 %) in clinical inpatients. The overall hospital mortality was 2.4 % (95 % CI 2.35-2.53); being 3.95 % (95 % CI 3.78-4.12) in clinical inpatients and 1.15 % (95 % CI 1.06-1.23) in surgical patients. The death in patients who had developed VTE, represented between 4 and 7 % of hospital deaths, and it increases with age in both clinical and surgical patients. In Argentina there are few data of hospital mortality in patients with VTE. This information is useful when assessing the need for resources for prevention, diagnosis and treatment in inpatients.


Assuntos
Mortalidade Hospitalar , Tromboembolia Venosa/mortalidade , Adulto , Fatores Etários , Argentina/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Tromboembolia Venosa/etiologia
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