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1.
Artigo em Inglês | MEDLINE | ID: mdl-34071171

RESUMO

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.


Assuntos
Diabetes Mellitus , Qualidade de Vida , Exercício Físico , Hábitos , Humanos , Atenção Primária à Saúde , Fumar , Espanha/epidemiologia
2.
Med. paliat ; 27(4): 287-293, oct.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-202709

RESUMO

OBJETIVO: Describir dónde fallecen las personas tributarias de recibir atención por servicios específicos de cuidados paliativos en la Comunidad Autónoma de les Illes Balears (CAIB) en los años 2015 y 2016. MÉTODO: Estudio descriptivo. Sujetos: personas fallecidas en la CAIB por causas susceptibles de requerir atención paliativa prestada por los servicios específi cos de CP. VARIABLES: lugar de fallecimiento, sector sanitario, causa, sexo y edad. Fuentes: registro de mortalidad de la CAIB y memorias de actividad de los Equipos de Soporte de Atención Domiciliaria y de la Unidad de Cuidados Paliativos Pediátricos del Hospital Son Espases. RESULTADOS: En 2015 fallecieron en el domicilio 852 personas, mientras que en el año 2016 fueron 837. Representan el 31,2 y el 28,9 %, respectivamente, del total de fallecidos tributarios de recibir cuidados paliativos específicos. El número de personas que fallecen en el domicilio es distinto entre los sectores sanitarios de las islas con porcentajes que oscilan entre el 20,6 y el 48 %. También se han hallado diferencias en función del sexo de las personas fallecidas en domicilio, siendo menor en los hombres que en las mujeres. CONCLUSIONES: Los porcentajes de fallecidos en domicilio en CAIB se encuentran alejados de las preferencias manifestadas en los estudios revisados. Existe variabilidad entre los sectores sanitarios de la Comunidad. Se han reducido los porcentajes de muerte en domicilio entre los años 2015 y 2016. Se identifi can diferencias en función del sexo y de las patologías analizadas. Necesitamos avanzar en la disponibilidad de estándares


OBJECTIVE: To describe where people candidate to receive specific palliative care (PC) services died in the autonomous community of the Balearic Islands (CAIB) from 2015 through 2016. METHOD: This was a descriptive study. Subjects: people who died in the CAIB from causes susceptible to requiring palliative care by specific PC services. VARIABLES: place of death, health care sector, cause, sex, and age. Sources: CAIB death registry and activity reports by home care suport teams (ESAD) and the pediatric palliative care unit (PPCUN) at Hospital Son Espases. RESULTS: In 2015 a total of 852 patients died in their homes, whereas in 2016 the number of home deaths was 837. These represent 31.2 % and 28.9 % of all deaths in patients candidate to receive specific palliative care, respectively. The number of patients who die in their homes varies among health care sectors in the Islands, with percentages oscillating between 20.6 % and 48 %. Differences were also found according to the gender of those who died in their homes, with numbers being lower for men as compared to women. CONCLUSIONS: The percentages of home deaths in the CAIB are far removed from the preferences reported in the studies reviewed. There is variability among health care sectors in our autonomous community. Home death percentages decreased from 2015 to 2016. Differences may be identified according to gender and health condition. We need to move forward to having some standards available


Assuntos
Humanos , Mortalidade Hospitalar/tendências , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Assistência Domiciliar/estatística & dados numéricos , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Evolução Fatal , Diretivas Antecipadas/estatística & dados numéricos , Causas de Morte , Habitação/estatística & dados numéricos
3.
Aten. prim. (Barc., Ed. impr.) ; 52(9): 600-607, nov. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-198436

RESUMO

OBJETIVO: Determinar la cantidad de envases de broncodilatadores de corta duración (SABA) dispensados en farmacia en un año que se asocia con mayor riesgo de hospitalización por asma en el mismo periodo en pacientes con asma activa. Diseño descriptivo transversal multicéntrico. EMPLAZAMIENTO: Atención primaria, cohorte MAJORICA. Incluye datos codificados durante la práctica asistencial, sociodemográficos, clínicos y del sistema de prescripción electrónica de 68.578 pacientes con EPOC y asma de Baleares. PARTICIPANTES: Se incluyeron 7.648 pacientes mayores de 18 años con asma activa, que retiraron envases de SABA durante el periodo 2014-2015. Se excluyeron pacientes con EPOC. Mediciones principales: Hospitalización por asma, utilización de fármacos respiratorios, tabaquismo, comorbilidades, edad y sexo. RESULTADOS: Edad promedio 47 años, 38% mujeres, 23,2% fumadores activos. Setenta y siete pacientes (1%) ingresaron por exacerbación de asma en el periodo de estudio. Los pacientes que recibieron más de 8 envases de SABA por año aumentaron el riesgo de hospitalización (OR 2,81; IC95% 1,27-6,24). El escalón terapéutico de gravedad, la cantidad de corticoides inhalados, así como la insuficiencia cardíaca y la apnea del sueño se asociaron también significativamente con la hospitalización. CONCLUSIONES: Un mayor escalón terapéutico de gravedad, la presencia de algunas comorbilidades, el consumo de mayor cantidad de corticoides inhalados y de un mayor número de envases de SABA identifica a asmáticos con mayor riesgo de hospitalización. Existe una asociación significativa entre el riesgo de hospitalización y la retirada de un mayor número de envases de SABA de la farmacia. El número de envases/año que mejor define un mayor riesgo de hospitalización es ≥ 8 y se podría utilizar para identificar asmáticos de riesgo


OBJECTIVE: To determine the number of short-acting beta-agonists (SABA) canisters dispensed in a pharmacy during one year that is associated with higher asthma hospitalization risk in the same period in patients with active asthma. Multi-centre cross-sectional descriptive design. LOCATION: Primary care, MAJORICA cohort including sociodemographic, clinical and electronic prescription system data coded during clinical practice from 68,578 patients with COPD and asthma in the Balearic Islands. PARTICIPANTS: A total of 7,648 patients older than 18 years with active asthma, who got any SABA canister from the pharmacy during the 2014-2015 period were included. COPD patients were excluded. Main measurements: Asthma hospitalization, respiratory medication, tobacco, comorbidities, age and gender. RESULTS: Mean age 47 years, 38% women, 23.2% active smokers. Seventy-seven patients (1%) were admitted for asthma exacerbation in the study period. Patients who received more than 8 SABA containers per year increased the risk of hospitalization (OR 2.81; 95% CI 1.27-6.24). Severity by therapeutic step and amount of inhaled corticosteroids, as well as heart failure and sleep apnea were also significantly associated with hospitalization. CONCLUSIONS: There is a significant association between the risk of hospitalization and the higher number of SABA canisters dispensed from the pharmacy. The number of canisters/year that best defines a higher risk of hospitalization is ≥ 8 and could be used to identify asthma at risk


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Broncodilatadores/provisão & distribuição , Embalagem de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Asma/epidemiologia , Estudos Transversais , Fatores de Risco , Modelos Logísticos , Fatores Sexuais , Fatores Etários , Atenção Primária à Saúde/estatística & dados numéricos , Espanha/epidemiologia , Azidas , Serotonina/análogos & derivados
4.
Aten Primaria ; 52(9): 600-607, 2020 11.
Artigo em Espanhol | MEDLINE | ID: mdl-32571597

RESUMO

OBJECTIVE: To determine the number of short-acting beta-agonists (SABA) canisters dispensed in a pharmacy during one year that is associated with higher asthma hospitalization risk in the same period in patients with active asthma. Multi-centre cross-sectional descriptive design. LOCATION: Primary care, MAJORICA cohort including sociodemographic, clinical and electronic prescription system data coded during clinical practice from 68,578 patients with COPD and asthma in the Balearic Islands. PARTICIPANTS: A total of 7,648 patients older than 18 years with active asthma, who got any SABA canister from the pharmacy during the 2014-2015 period were included. COPD patients were excluded. MAIN MEASUREMENTS: Asthma hospitalization, respiratory medication, tobacco, co-morbidities, age and gender. RESULTS: Mean age 47 years, 38% women, 23.2% active smokers. Seventy-seven patients (1%) were admitted for asthma exacerbation in the study period. Patients who received more than 8 SABA containers per year increased the risk of hospitalization (OR 2.81; 95% CI 1.27-6.24). Severity by therapeutic step and amount of inhaled corticosteroids, as well as heart failure and sleep apnea were also significantly associated with hospitalization. CONCLUSIONS: There is a significant association between the risk of hospitalization and the higher number of SABA canisters dispensed from the pharmacy. The number of canisters/year that best defines a higher risk of hospitalization is≥8 and could be used to identify asthma at risk.


Assuntos
Asma , Broncodilatadores , Asma/tratamento farmacológico , Asma/epidemiologia , Broncodilatadores/uso terapêutico , Estudos de Coortes , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade
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