Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors / Impacto de la pandemia de COVID-19 en el carcinoma de células escamosas cutáneo: un estudio unicéntrico de los factores epidemiológicos, clínicos e histopatológicos

Background: The COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. Objective To compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. Material & methods: We conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. Results: 248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. Conclusions: Although there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future. (AU)

Antecedentes: La pandemia de COVID-19 ha podido afectar negativamente el diagnóstico precoz del cáncer de piel. Objetivo Comparar las características epidemiológicas, clínicas e histopatológicas en los pacientes intervenidos de carcinoma de células escamosas (CCE) cutáneo antes de la pandemia y después del inicio de la pandemia. Material y métodos: Se diseñó un estudio transversal que incluía 2 series de pacientes: 1) pacientes intervenidos de CCE el año posterior a la declaración del confinamiento general en España (15 de marzo de 2020), y 2) pacientes intervenidos de CCE el año previo. Se recogieron variables epidemiológicas, clínicas e histopatológicas, así como el estadio tumoral y el grado de riesgo. Resultados: Se incluyeron 248 pacientes (127 intervenidos antes de la pandemia y 121 intervenidos después de la pandemia). Tras el inicio de la pandemia, el porcentaje de CCE de alto riesgo aumentó significativamente de 32,3 a 45,5% (p=0,011). No obstante, no se encontraron diferencias significativas en el grosor tumoral, la invasión perineural o la presencia de metástasis. Conclusiones: Aunque no se produjo una reducción significativa en el número de CCE intervenidos después de la pandemia, ha habido un incremento significativo en los CCE de alto riesgo. Todo ello puede conllevar un incremento en la mortalidad por cáncer de piel en el futuro. (AU)

[Artículo traducido] Impacto de la pandemia COVID-19 en el carcinoma de células escamosas cutáneo: un estudio unicéntrico de los factores epidemiológicos, clínicos e histopatológicos / Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors

Antecedentes: La pandemia de COVID-19ha podido afectar negativamente el diagnóstico precoz del cáncer de piel. Objetivo Comparar las características epidemiológicas, clínicas e histopatológicas en los pacientes intervenidos de carcinoma de células escamosas (CCE) cutáneo antes de la pandemia y después del inicio de la pandemia. Material y métodos: Se diseñó un estudio transversal que incluía 2 series de pacientes: 1) pacientes intervenidos de CCE el año posterior a la declaración del confinamiento general en España (15 de marzo de 2020), y 2) pacientes intervenidos de CCE el año previo. Se recogieron variables epidemiológicas, clínicas e histopatológicas, así como el estadio tumoral y el grado de riesgo. Resultados: Se incluyeron 248 pacientes (127 intervenidos antes de la pandemia y 121 intervenidos después de la pandemia). Tras el inicio de la pandemia, el porcentaje de CCE de alto riesgo aumentó significativamente de 32,3 a 45,5% (p=0,011). No obstante, no se encontraron diferencias significativas en el grosor tumoral, la invasión perineural o la presencia de metástasis. Conclusiones: Aunque no se produjo una reducción significativa en el número de CCE intervenidos después de la pandemia, ha habido un incremento significativo en los CCE de alto riesgo. Todo ello puede conllevar un incremento en la mortalidad por cáncer de piel en el futuro. (AU)

Background: The COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. Objective To compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. Material & methods: We conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. Results: 248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. Conclusions: Although there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future. (AU)

Comparacion de las escalas Heart, Grace Score y los parámetros clínicos como predictores de eventos cardiovasculares en pacientes con dolor torácico en Urgencias / Comparison of Heart, Grace Scores and clinical parameters as predictors of cardiovascular events in patients with chest pain in the Emergency Department

Fundamentos: La valoración del riesgo de los pacientes con dolor torácico se basa en los parámetros clínicos. Sin embargo, sin un sistema de puntuación, como las escalas de estratificación del riesgo, las estimaciones son menos precisas y exactas. El objetivo de este estudio fue comparar las escalas HEART, GRACE Score y los parámetros clínicos en la predicción de eventos mayores cardiovasculares (mortalidad cardiovascular o infarto agudo de miocardio) durante la hospitalización, en pacientes con dolor torácico atendidos en Urgencias. Métodos: Se realizó un estudio observacional descriptivo de pacientes que, durante un año, acudieron a Urgencias del Hospital Universitario Miguel Servet (Zaragoza) por dolor torácico de tipo isquémico. Las puntuacionesHEART y GRACE se calcularon retrospectivamente a partir de las historias clínicas. Las variables cuantitativas se expresaron como media (±desviación estándar), y las cualitativas como frecuencias y porcentajes. Se llevó a cabo un análisis bivariante mediante la prueba chi cuadrado. El rendimiento de las escalas y parámetros clínicos se comparó mediante el cálculo del área bajo la curva. El resultado primario fue la ocurrencia de un evento mayor cardiovascular (mortalidad cardiovascular o infarto agudo de miocardio) durante el ingreso hospitalario. Resultados: Se registraron 306 pacientes (66,3% eran hombres, n=203), con edad media de 71,45±12,85 años y un 48,7% de antecedentes de cardiopatía isquémica. El área bajo la curva, para el evento primario, de las escalasHEART, GRACE y parámetros clínicos fue 0,80 (IC al 95%: 0,73-0,86), 0,79 (IC al 95%: 0,72- 0,85) y 0,74 (IC del 95%: 0,68-0,80), respectivamente. Durante la hospitalización, la incidencia del evento primario fue del 13,4% y ningún paciente de bajo riesgo, en ambas escalas, presentó un evento mayor cardiovascular. Conclusiones: En pacientes con dolor torácico de tipo isquémico atendidos en Urgencias, tanto la escala...(AU)

Background: Risk assessment of patients with chest pain is based on clinical parameters; however, without a scoring system, such as risk stratification scales, estimates are less precise and accurate. The aim of this paper was to compare the HEART, GRACE score and clinical parameters in the prediction of major cardiovascular events (cardiovascular mortality or acute myocardial infarction) during hospitalization, in patients with chest pain attended in the emergency department.Methods: A descriptive observational study of patients with ischemic chest pain, who attended to the Miguel Servet University Hospital emergency department (Zaragoza, Spain) during one year was carried out.HEART and GRACE scores were calculated retrospectively from clinical history. Quantitative variables were expressed as mean (±standard deviation), and qualitative variables as frequencies and percentages. A bivariate analysis was carried out using the chi-square test. The performance of the scales and clinical parameters was compared by calculating the area under the curve. The primary outcome was the occurrence of a major cardiovascular event (cardiovascular mortality or acute myocardial infarction) during hospital admission. Results: 306 patients were registered (66.3% men, n=203), with a mean age of 71.45±12.85 years and a 48.7% history of ischemic heart disease. The areas under the curve for HEART scales, GRACE and clinical parameters were 0.80 (95% CI: 0.73-0.86), 0.79 (95% CI: 0.72-0.85) and 0.74 (95% CI: 0.68-0.80), respectively. During hospitalization, the incidence of the primary event was 13.4% and no low-risk patient, in both scales, presented a major cardiovascular event. Conclusions: In patients with ischemic chest pain attended in the emergency department, the GRACE and HEART scale have a greater area under curve than clinical parameters.(AU)

Future expectations of adolescents from different social backgrounds / Expectativas de futuro de adolescentes procedentes de distintos contextos sociales

Este trabajo analiza las expectativas futuras durante la adolescencia y su relación con variables personales (edad, sexo, autoestima y satisfacción vital) y contextuales (apoyo social percibido y nivel de riesgo). La muestra está formada por 748 adolescentes, con edades comprendidas entre los 9 y 16 años (M = 11.93, SD = 1.42) procedentes de contextos con distinto nivel de riesgo social. Los resultados muestran que las expectativas futuras disminuyen a medida que aumenta la edad, con pocas diferencias encontradas en función del sexo. Autopercepciones y sentimientos de apoyo social más positivos se asocian a mejores expectativas futuras. En relación al nivel de riesgo, contextos más vulnerables tienen un efecto negativo en las expectativas futuras. Los análisis de regresión muestran la capacidad predictiva de las variables estudiadas. Finalmente, el modelo de ecuaciones estructurales confirma el efecto causal positivo del ajuste psicológico y del apoyo social percibido, así como la influencia negativa de los contextos con mayores desventajas sociales, sobre las expectativas de futuro. Los resultados encontrados proponen la necesidad de instaurar programas preventivos orientados a fomentar los recursos personales de los niños, especialmente en aquellos que pertenecen a contextos vulnerables.(AU)

This paper analyzes adolescents’ future expectations (FE) and their relationship with personal variables (age, sex, self-esteem, and life sat-isfaction) and contextual variables (perceived social support and level of risk). The sample includes 748 adolescents, aged 9-16 (M= 11.93, SD= 1.42), coming from contexts with different levels of social risk. The results show that FE decrease as age increases, with few differences found based on sex. More positive self-perceptions and perceived social support are as-sociated with better FE. Concerning the level of risk, more vulnerable con-texts have a higher negative effect on FE. The regression analysis reveals the predictive capacity of the studied variables. The structural equation model confirms the positive causal effect of psychological adjustment and perceived social support, as well as the negative influence of contexts with greater social disadvantages on adolescent FE. The results suggest the need to establish preventive programs aimed at promoting personal resources of children, especially those who come from vulnerable contexts.(AU)

Impacto de la percepción de riesgo de padecer cáncer en Consejo Genético Oncológico / Impact of cancer risk perception on Oncology Genetic Counseling

El Consejo Genético Oncológico (CGO) es una herramienta útil para la detección de familias con alto riesgo cáncer de mama/ ovario hereditario, con la detección de mutaciones patogénicas en los genes BRCA1 y 2. Objetivo: valorar la percepción de riesgo de cáncer en mujeres con historia personal y/o familiar de cáncer de mama/ ovario hereditario, valorar la percepción de riesgo en función de la detección de la presencia/ ausencia de una mutación patogénica en el estudio genético, y de la medida preventiva elegida tras la realización del estudio genético (seguimiento periódico o cirugía reductora de riesgo). Método: se realizó una valoración de variables sociodemográficas, clínicas y percepción de riesgo de cáncer retrospectivamente en un grupo de mujeres portadoras de mutación sometidas a estudio genético desde 1998, y prospectivamente en un grupo de mujeres sometidas a estudio genético a partir de 2015. La muestra global estaba compuesta por 262 mujeres (173 mujeres recién estudiadas y 89 mujeres portadoras de mutación estudiadas previamente). Resultados: se encontraron diferencias significativas en las mujeres que decidieron optar por una cirugía reductora de riesgo, que presentaban una percepción de riesgo mayor que las que eligieron seguimiento y se observó una disminución significativa de esa percepción tras llevar a cabo la cirugía. Conclusiones: se resalta la necesidad de evaluar la percepción de riesgo de las participantes en CGO. (AU)

The cancer genetic counseling oncology helps for detecting families at high risk for hereditary breast/ovarian cancer, due to BRCA1/2 pathogenic mutations. Objective: To assess the perception of cancer risk in women with a personal and/or family history of hereditary breast/ovarian cancer, assess the perception of risk based on the detection of the presence/absence of a pathogenic mutation, and the preventive measure chosen after completion of the study genetic (periodic follow-up or risk-reducing surgery). Method: an assessment of sociodemographic and clinical variables and perception of cancer risk was carried out retrospectively in a group of women carriers of the mutation who underwent genetic testing since 1998, and prospectively in a group of women who underwent genetic testing since 2015. The global sample was made up of 262 women (173 newly studied women and 89 previously studied mutation carrier women). Result: Significant differences were found in women who decided to opt for risk-reducing surgery, who presented a higher risk perception than those who chose follow-up, and a significant decrease in this perception was observed after carrying out the surgery. Conclusions: It is necessary to evaluate the perception of risk of the participants in CGO. (AU)

Leisure-Time Physical Activity and All-Cause Mortality: A Systematic Review

Many scientific studies have been shown the positive effect of physical activity (PA) on reducing morbidity and mortality, whereas physical inactivity is globally one of the leading factors in mortality. Therefore, the purpose was to investigate the relationship between leisure-time physical activity (LTPA) and all-cause mortality among adult population. The data search was performed of 3 electronic databases for the years 2000-2021 February as follows: Google Scholar, PubMed, and ResearchGate. This search was made by using the following terms and operators AND/OR, individually/combination: "physical activity", "physical fitness", "leisure-time physical activity", "all-cause mortality", "risk of death", "mortality". 1220 studies were initially identified, 22 studies were met the inclusion criteria (5 male studies, 2 female studies, 15 both sexes). The results of this systematic review, with total 2568097 participants (aged 20-98 years), showed that any level of PA had health benefits compared to inactivity and sedentary lifestyle. The highest levels of PA had the lowest risk of all-cause mortality. In conclusion, there is an inverse relationship between LTPA and the risk of all-cause mortality, and the harmful effects of physical inactivity may be largely eliminated among those who are most active. So, promoting regular LTPA is strongly associated with well-being, quality of life and reduced the risk of all-cause mortality both in general adult population and elderly population with chronic diseases.(AU)

Comparación de dos sistemas de medición de glucosa en sangre en pacientes adultos internados en una unidad de cuidados intensivos / Comparison of two blood glucose measurement systems in adult patients hospitalised in an intensive care unit

Resumen El desempeño analítico de la determinación de glucosa es crucial para el manejo del paciente crítico. El objetivo del presente estudio fue establecer si los valores de glucosa determinados por un sistema point of care (POC) eran comparables con el sistema de uso habitual del laboratorio. Se analizaron 60 muestras de pacientes críticamente enfermos. La medición de la glucosa en suero y sangre entera se realizó en el analizador modular Cobas c 501 y, en el POC, Cobas b 221, respectivamente. Se estudió la correlación y concordancia entre los métodos, se compararon los resultados con requerimientos de calidad internacionales y se realizó el análisis de exactitud clínica en planillas de vigilancia de errores (Surveillance Error Grid). La glucemia media en el equipo Cobas b 221 fue 149,96 mg/dL, mientras que la glucemia media en suero en el equipo Cobas c 501 fue 148,37 mg/dL. El coeficiente de correlación obtenido fue 0,95. Mediante el análisis de concordancia se observó que un 5% de los valores superaban las 2 desviaciones estándar. En base a las especificaciones de los requerimientos internacionales, los resultados obtenidos no alcanzaron el desempeño óptimo. El análisis mediante planillas de vigilancia de errores determinó que el 90% de las mediciones se encontraron en la clasificación de grado de riesgo A, y el resto en grado de riesgo B. El analizador Cobas b 221 presenta las características metrológicas adecuadas para suplir al sistema de referencia en situaciones de urgencia o avería.

Abstract The analytical performance of glucose determination is crucial for the management of critical patients. The objective of this research was to establish whether the glucose values determined by a point of care (POC) system were comparable with the laboratory's usual use system. Sixty samples from critically ill patients were analysed. The measurement of serum glucose and whole blood was performed on the Cobas c 501 modular analyser and, at the POC, Cobas b 221, respectively. The correlation and agreement between the different methods was studied and the results compared with the international quality requirements. The analysis of clinical accuracy was performed in ways to monitor errors (Surveillance Error Grid). The average blood glucose in the Cobas b 221 was 149.96 mg/dL, while the average blood glucose in the Cobas c 501 was 148.37 mg/dL. The correlation coefficient obtained was 0.95. The concordance analysis showed that 5% of the values exceeded the two standard deviations. Based on the specifications of the international requirements, the results obtained did not reach the optimum performance. The analysis using error monitoring forms determined that 90% of the measurements were in the classification of risk grade A, while the rest were in risk grade B. The Cobas b 221 analyser presents the appropriate clinical characteristics to be used to replace in case of emergency in relation to the Cobas c 501 measurement system.

Resumo O desempenho analítico da determinação da glicose é crucial para o manejo do paciente crítico. O objetivo da presente pesquisa foi estabelecer se os valores de glicose determinados por um sistema point of care (POC) eram comparáveis com o sistema de uso habitual do laboratório. Foram analisadas 60 amostras de pacientes criticamente doentes. A medição da glicose em soro e sangue total foi realizada no analisador modular Cobas c 501 e no POC Cobas b 221, respectivamente. A correlação e concordância entre os diferentes métodos foram estudadas, os resultados foram comparados com os requisitos de qualidade internacionais. A análise de precisão clínica foi realizada em formulários de monitoramento de erros (Surveillance Error Grid). A glicemia média no equipamento Cobas b 221 foi de 149,96 mg/dL, enquanto que a glicemia sérica média no equipamento Cobas c 501 foi de 148,37 mg/dL. O coeficiente de correlação obtido foi de 0,95. A análise de concordância mostrou que 5% dos valores superavam os dois desvios-padrão. Com base nas especificações dos requisitos internacionais, os resultados obtidos não atingiram o desempenho ideal. A análise por meio de formulários de monitoramento de erros determinou que 90% das medições foram encontradas na classificação do grau de risco A, enquanto que o restante estava no grau de risco B. O analisador Cobas b 221 apresenta as características metrológicas apropriadas para suprir o sistema de referência em situações de emergência ou avaria.

Concordância interavaliadores do Protocolo de Acolhimento e Classificação de Risco em Obstetrícia do Ministério da Saúde / Inter-rater agreement of the Reception Protocol and Risk Classification in Obstetrics of the Ministry of Health

Introdução: A classificação de risco é definida como uma ferramenta utilizada nos serviços de urgência e emergência que auxilia na identificação de pacientes que necessitam atendimento prioritário. Em obstetrícia o surgimento de um protocolo específico por intermédio do Ministério da Saúde que conta com 12 fluxogramas tem sido uma medida adotada para organização e humanização dos serviços que atendem obstetrícia, no intuito de minimizar danos relacionados à saúde dessas usuárias que aguardam atendimento . O objetivo do estudo foi: determinar o grau de concordância interavaliador na aplicação do protocolo de acolhimento e classificação de risco em obstetrícia do Ministério da Saúde em uma unidade de pronto atendimento obstétrico. Métodos: Trata-se de um estudo transversal, com abordagem metodológica, que analisou a reprodutibilidade do protocolo em obstetrícia do Ministério da saúde. Para a coleta dos dados: foram avaliados prontuários com o registro de atendimentos ocorridos entre novembro 2019 e maio de 2020. Foram entrevistados enfermeiros que possuem treinamento em classificação de risco e também enfermeiros que não possuem treinamento em classificação de risco. Para análise estatística dos dados foram calculados através do coeficiente de Kappa, sensibilidade e especificidade. Resultados: Os resultados do estudo demonstraram que o grau de confiabilidade interavaliadores foi considerado de moderado a forte representado pelo coeficiente Kappa que variou entre (0,47 e 0,77), foi observado também uma tendência na subestimação do grupo prioritário vermelho e amarelo, e uma tendência de superestimação nas prioridades clínicas amarelo e verde. Apesar de ter acontecido casos de subestimação e superestimação não ocorreram diferenças significativas nos grupos de enfermeiros treinados versus não treinados para utilização do protocolo de A&CR-O. Assim, os resultados desta dissertação corroboram com a hipótese que o protocolo de A&CR ­ O é confiável para o que se propõe. Conclusão: Esse estudo possibilitou verificar que o protocolo é confiável para sua utilização no campo da obstetrícia, uma vez que demonstrou concordância moderada a forte entre os grupos de avaliadores, além disso contribuiu para a análise da reprodutibilidade do protocolo de classificação de risco em obstetrícia que vem sendo implantado desde se sua publicação podendo ser utilizado com maior segurança por Enfermeiros. Palavras-chave: Protocolos. Protocolos clínicos. Confiabilidade. Obstetrícia. Classificação de risco. Serviços de emergência obstétrica. Reprodutibilidade. Enfermagem. Enfermagem Obstétrica. Estudos de avaliação.

Introduction: Risk classification is defined as a tool used in urgent and emergency services that helps to identify patients who need priority care. In obstetrics, the emergence of a specific protocol through the Ministry of Health, which has 12 flowcharts, has been a measure adopted to organize and humanize the services that attend obstetrics, in order to minimize the health-related damage of these users who are awaiting care. The objective of the study was: to determine the degree of inter-rater agreement in the application of the welcoming protocol and risk classification in obstetrics of the Ministry of Health in an obstetric emergency care unit. Methods: This is a cross-sectional study, with a methodological approach, which analyzed the reproducibility of the protocol in obstetrics of the Ministry of Health. For data collection: medical records were evaluated with the record of visits that took place between November 2019 and May 2020. Nurses who have training in risk classification and nurses who do not have training in risk classification were interviewed. For statistical analysis of the data, they were calculated using the Kappa coefficient, sensitivity and specificity. Results: The results of the study showed that the degree of inter-rater reliability was considered moderate to strong, represented by the Kappa coefficient that varied between (0.47 and 0.77), a tendency was also observed in the underestimation of the red and yellow priority group, and a tendency to overestimate the yellow and green clinical priorities. Despite cases of underestimation and overestimation, there were no significant differences in the groups of trained versus untrained nurses to use the A & CR-O protocol. Thus, the results of this dissertation corroborate the hypothesis that the A&CR - O protocol is reliable for what it is proposed. Conclusion: This study made it possible to verify that the protocol is reliable for its use in the field of obstetrics, since it demonstrated mode rate to strong agreement between the groups of evaluators, in addition it contributed to the analysis of the reproducibility of the risk classification protocol in obstetrics that it has been implemented since its publication and can be used more safely by nurses.

Tratamiento del aspergiloma pulmonar en paciente de alto riesgo quirúrgico: cavernostomía / Cavernostomy in the Treatment of Pulmonary Aspergilloma in a High Surgical Risk Patient

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Avaliação fisioterapêutica dos pés e do grau de risco de desenvolvimento de ulcerações em indivíduos diabéticos fisicamente ativos / Physiotherapeutic assessment of feet and risk degree of ulceration in physically active diabetic individuals

Evidências epidemiológicas mostram um aumento do número de indivíduos diabéticos, sendo o Diabetes Mellitus tipo 2 (DM2) correspondente a 90% dos casos. O pé diabético está entre as complicações mais graves e onerosas e pode ser prevenido com estratégias de avaliação e cuidados básicos de saúde. Objetivo: Avaliar, detectar alterações morfofuncionais, classificar o Grau de Risco (GR) em desenvolver ulcerações dos pés de indivíduos diabéticos fisicamente ativos e orientar quanto aos autocuidados com os pés. Métodos: Doze indivíduos com DM2 foram avaliados quanto ao tipo de calçados utilizados; perguntas sobre a presença de ulcerações, dor, fraqueza muscular e outros incômodos nos pés e membros inferiores, condição motora e da sensibilidade dos pés. Resultados: Com relação ao GR de ulceração e amputação, verificou-se que 8% dos indivíduos estão inseridos no GR 0; 8% no GR 1; 25% no GR 2; 25% no GR 3; e 34% já apresentavam ulceração. Conclusão: Apesar da realização de atividade física regular, a grande maioria apresentou ausência de sensibilidade protetora plantar com quatro indivíduos já apresentando ulcerações. Sugerem-se que mais estratégias sejam desenvolvidas no sistema público de saúde para atendimento básico, multidisciplinar e multiprofissional ao diabético. (AU)

Epidemiological evidence shows an increased number of diabetic individuals and type 2 diabetes mellitus (DM2) accounts for 90% of cases. Diabetic foot is among the most serious and costly complications which can be prevented by an assessment strategy and basic health care. Objective: To evaluate and detect morphofunctional changes, to classify the Risk Degree (RD) in developing foot ulcers of physically active diabetic individuals and to guide feet self-care. Methods: Twelve DM2 individuals were assessed based on observations regarding the type of shoes wearing, questions about the presence of ulcerations, pain, muscle weakness and other feet and lower limbs discomforts, plantar feet sensibility and, motor condition. Results: About the RD of ulceration and amputation, we verified that 8% of the individuals were included in the RD 0; 8% in the RD 1; 25% in the RD 2; 25% in the RD 3; and 34% already had ulceration. Conclusion: Despite regular physical activity, most individuals presented loss of protective plantar sensibility with four of them already showing foot ulceration. It is suggested that more strategies should be developed in the public health system for multidisciplinary and multiprofessional basic care for diabetics. (AU)

Atención médica según el nivel de riesgo y su adecuación a las recomendaciones de la guía española de la enfermedad pulmonar obstructiva crónica (EPOC) (GesEPOC): Estudio EPOCONSUL / Medical Care According to Risk Level and Adaptation to Spanish COPD Guidelines (Gesepoc): The Epoconsul Study

Introducción: EPOCONSUL es la primera auditoría nacional que analiza la atención sanitaria de la EPOC en consultas de neumología en España. El objetivo principal fue determinar, en un análisis retrospectivo, la distribución de los niveles de riesgo de la EPOC según GesEPOC 2017 y evaluar las actuaciones clínicas según las nuevas recomendaciones. Material y métodos: Es una auditoría clínica de diseño trasversal, con reclutamiento de casos consecutivos de EPOC durante un año. Se evaluó el nivel de riesgo y el fenotipo clínico según GesEPOC 2017 y su relación con las intervenciones clínicas realizadas. Resultados: El nivel de alto riesgo fue más frecuente (79,8 versus 20,2%; p < 0,001) y se caracterizó por un mayor nivel de gravedad medido por los índices BODE y BODEx, además de por mayor comorbilidad. El fenotipo clínico más frecuente fue el no agudizador. La opción más utilizada en el bajo riesgo fue la monoterapia broncodilatadora (en un 34,8%) y la triple terapia en el alto riesgo (en un 53,7%). En el alto riesgo fue más frecuente la caracterización por fenotipos (57,6 versus 52%; p = 0,014) y la realización de pruebas de función respiratoria: volúmenes pulmonares (47,7 versus 35,8%; p < 0,001), test de difusión (51,4 versus 42,1%; p < 0,001) y test de marcha (37,8 versus 15,8%; p < 0,001). Conclusiones: La mayoría de los pacientes atendidos en las consultas de neumología fueron de alto riesgo y con fenotipo clínico no agudizador. La práctica clínica realizada fue diferente según el nivel de riesgo y mayoritariamente acorde con las recomendaciones de GesEPOC, aunque con importantes áreas de mejora

Introduction: EPOCONSUL is the first national audit to analyze medical care for COPD in pulmonology departments in Spain. The main objective was to perform a retrospective analysis to determine the distribution of GesEPOC 2017 COPD risk levels and to evaluate clinical activity according to the new recommendations. Material and methods: This is a cross-sectional clinical audit in which consecutive COPD cases were recruited over one year. The study evaluated risk and clinical phenotype according to GesEPOC 2017, and their correlation with the clinical interventions employed. Results: The most common risk category was high risk (79.8% versus 20.2%; p < 0.001), characterized by a higher level of severity on BODE and BODEx indexes, and a higher comorbidity burden. The most common phenotype was non-exacerbator. The most commonly used treatment in low-risk patients was bronchodilator monotherapy (34.8%) and triple therapy in high-risk patients (53.7%). High risk was most frequently characterized by phenotype (57.6% versus 52%; p = 0.014) and pulmonary function test results: lung volume (47.7% versus 35.8%; p < 0.001), lung diffusion (51.4% versus 42.1%; p < 0.001) and walk test (37.8% versus 15.8%; p < 0.001). Conclusions: Most patients treated in pulmonology departments were high-risk and non-exacerbator phenotype. Clinical interventions differed according to risk level and mainly followed GesEPOC recommendations, although there is significant room for improvement

Avaliação do Risco Cardiovascular segundo os Critérios de Framingham em Adultos / Evaluation of Cardiovascular Risk According to the Framingham Criteria in Adults

Estimar o risco de ocorrência de eventocardiovascular nos próximos 10 anos, bem como identificar osfatores associados em indivíduos adultos de Tubarão, SantaCatarina. Material e Métodos: Foi realizado estudo transversal,de base populacional, aplicando-se o escore de Framingham,em amostra randomizada de 358 adultos de Tubarão, SantaCatarina, para avaliação do grau de risco e sua associaçãocom variáveis que podem influenciar esse risco cardiovascular,como alcoolismo, sedentarismo, nível de escolaridade, alémdas já previstas no escore, como sexo, idade e tabagismo. Ostestes de significância usados foram o teste chi-quadrado dePearson, e o teste exato de Fisher. Razão de prevalência foiutilizada como medida de associação. Resultados: Dos 358indivíduos analisados, 64,8% eram de mulheres, da cor branca(87%), com escolaridade superior a oito anos de estudo (51%),com companheiro fixo (68,7%), sedentários (60,6%), nãotabagistas (69,3%) e não alcoolistas (91,8%). A prevalência deobesidade foi de 26,5%. O risco percentual médio foi 2,6% ±3,7%, sendo 94,9% situando-se na categoria de baixo risco.Sexo masculino (RP=1,13 [1,07-1,20] p<0,001), idadeavançada (RP=1,01 [1,00-1,01] p=0,012) foram fatoresassociados ao médio e ao alto risco cardiovascular de formaindependente ao desfecho, enquanto a maior escolaridade secomportou como fator de proteção (RP=0,99 [0,98-1,00]p=0,039). Conclusão: A população estudada apresentou baixorisco para eventos cardiovasculares. Porém, a associação defatores de risco potencialmente modificáveis com moderado ealto risco sugere que a modificação do estilo de vida de maneiraprecoce deve acontecer nessa população, para redução dorisco cardiovascular...

To estimate the risk of a major cardiovascular eventwithin a 10-year period, as well as identify associated risk factorsin adults from Tubarão, Santa Catarina, Brazil. Material andMethods: This was a cross-sectional, population-based studyapplying the Framingham score in 358 adults from Tubarão,Santa Catarina. We aimed to assess the degree of risk and itscorrelation with variables that may influence cardiovascularrisk, such as alcoholism, sedentariness, lifestyle, educationallevel, in addition to sex, age and smoking habits. The datawere analyzed using Pearson’s Chi-square test (÷2) and Fisher’sexact test. The prevalence ratio was used as a measure ofassociation. Results: Among the 358 people surveyed, mostwere women, Caucasian (87%), with schooling higher thaneight years of study (51%), with a steady partner (68.7%),sedentary (60.6%), non-smokers (69.3%), and non-users ofalcohol (91.8%). The prevalence of obesity was 26.5%. Themean risk percentage was 2.6% ± 3.7%, with most subjectsreaching the low-risk category (94.9%). Male gender (PR =1.13 [1.07 to 1.20] p <0.001), advanced age (PR = 1.01 [1.00to 1.01] p = 0.012) and educational level (PR = 0, 99 [0.98 to1.00] p = 0.039) were factors associated with medium and highrisk for cardiovascular events regardless of the outcome.Conclusion: The studied population had a low risk forcardiovascular events. However, the association betweenpotentially modifiable moderate and high risk factors suggeststhat modification of lifestyle should happen early in thispopulation in order to reduce cardiovascular risks...

El pie de riesgo de acuerdo con su estratificación en pacientes con diabetes mellitus / The high risk foot: stratification in patients with diabetes mellitus

Introducción: el pie diabético y su impacto sobre los sistemas de salud han sido puestos de manifiesto en diferentes estudios en todos los continentes. Se introduce el concepto de pie de riesgo como una entidad a tener en cuenta en la prevención del pie diabético.Objetivo: determinar la frecuencia y principales características del pie de riesgo, de acuerdo con su estratificación en grados, en el paciente diabético.Métodos: se realizó un estudio clínico transversal y descriptivo con 212 personas con diabetes que acudieron al Centro de Atención al Diabético de La Habana, en el período de enero 2012-2013. El análisis de los resultados incluyó las estadísticas descriptivas de todas las variables, análisis bivariados mediante comparación de medias.Resultados: el pie de riesgo es frecuente entre la población diabética estudiada (56,0 por ciento), así como la neuropatía periférica (63,7 por ciento) y la angiopatía ligera (23,1 por ciento).Conclusiones: el examen físico vascular y neurológico de los miembros inferiores es importante en la identificación y estratificación del riesgo, el cual existe en una elevada prevalencia entre la población diabética. Juegan su rol el tiempo de evolución de la diabetes, la neuropatía periférica de miembros inferiores, la enfermedad vascular periférica ligera, los dedos en martillo y la hiperqueratosis plantar; en cambio, el descontrol glucémico, el índice de masa corporal y el hábito de fumar no influyen, a corto plazo, en la estratificación del pie de riesgo(AU)

Introduction: the diabetic foot and its impact on health systems have been dealt with in various studies conducted in all continents. The concept of high risk foot is presented as an entity to bear in mind in the prevention of the diabetic foot.Objective: determine the frequency and main characteristics of high risk foot in diabetic patients based on its stratification into grades.Methods: a descriptive cross-sectional study was conducted of 212 diabetic patients cared for at Havana Diabetes Care Center from January 2012 to 2013. Analysis of results included descriptive statistics for all variables and bivariate analysis based on comparison of means.Results: the diabetic population studied showed a high prevalence of high risk foot (56.0 percent), peripheral neuropathy (63.7 percent) and mild angiopathy (23.1 percent).Conclusions: physical vascular and neurological examination of lower limbs is important to identify and stratify risk, which is highly prevalent among the diabetic population. In the stratification of high risk foot, a significant role is played by the time of evolution of diabetes and the presence of lower limb peripheral neuropathy, mild peripheral vascular disease, hammer toe and plantar hyperkeratosis. However, lack of glycemic control, body mass index and smoking do not have a short-term effect on such stratification(AU)

El pie de riesgo de acuerdo con su estratificación en pacientes con diabetes mellitus / The high risk foot: stratification in patients with diabetes mellitus

Introducción: El pie diabético y su impacto sobre los sistemas de salud han sido puestos de manifiesto en diferentes estudios en todos los continentes. Se introduce el concepto de pie de riesgo como una entidad a tener en cuenta en la prevención del pie diabético.Objetivo: determinar la frecuencia y principales características del pie de riesgo, de acuerdo con su estratificación en grados, en el paciente diabético.Métodos: se realizó un estudio clínico transversal y descriptivo con 212 personas con diabetes que acudieron al Centro de Atención al Diabético de La Habana, en el período de enero 2012-2013. El análisis de los resultados incluyó las estadísticas descriptivas de todas las variables, análisis bivariados mediante comparación de medias.Resultados: el pie de riesgo es frecuente entre la población diabética estudiada (56,0 por ciento), así como la neuropatía periférica (63,7 por ciento) y la angiopatía ligera (23,1 por ciento).Conclusiones: el examen físico vascular y neurológico de los miembros inferiores es importante en la identificación y estratificación del riesgo, el cual existe en una elevada prevalencia entre la población diabética. Juegan su rol el tiempo de evolución de la diabetes, la neuropatía periférica de miembros inferiores, la enfermedad vascular periférica ligera, los dedos en martillo y la hiperqueratosis plantar; en cambio, el descontrol glucémico, el índice de masa corporal y el hábito de fumar no influyen, a corto plazo, en la estratificación del pie de riesgo(AU)

Introduction: The diabetic foot and its impact on health systems have been dealt with in various studies conducted in all continents. The concept of high risk foot is presented as an entity to bear in mind in the prevention of the diabetic foot.Objective: determine the frequency and main characteristics of high risk foot in diabetic patients based on its stratification into grades.Methods: a descriptive cross-sectional study was conducted of 212 diabetic patients cared for at Havana Diabetes Care Center from January 2012 to 2013. Analysis of results included descriptive statistics for all variables and bivariate analysis based on comparison of means.Results: the diabetic population studied showed a high prevalence of high risk foot (56.0 percent), peripheral neuropathy (63.7 percent) and mild angiopathy (23.1 percent).Conclusions: physical vascular and neurological examination of lower limbs is important to identify and stratify risk, which is highly prevalent among the diabetic population. In the stratification of high risk foot, a significant role is played by the time of evolution of diabetes and the presence of lower limb peripheral neuropathy, mild peripheral vascular disease, hammer toe and plantar hyperkeratosis. However, lack of glycemic control, body mass index and smoking do not have a short-term effect on such stratification(AU)

Classificação do grau de risco de famílias na estratégia saúde da familia / Classification of risk levels of families in the family health strategy

Este trabalho visa apresentar os resultados da implementação da classificação familiar por grau de risco, em uma micro área adstrita a uma unidade da Estratégia Saúde da Família, em Alfenas, Minas Gerais, Brasil. Essa tecnologia é realizada por meio da ficha de cadastro familiar, na qual se identificam os dados socioeconômicos (renda familiar per capita, alfabetização do chefe da família e abastecimento de água) e dados clínicos (número de pessoas da família com uma ou mais patologias ou condições crônicas). Esses dados recebem uma pontuação e, a partir da consolidação desses, as famílias recebem uma classificação. Na microárea em estudo, 129 famílias eram cadastradas, sendo analisadas 53 fichas (41,08%) com o seguinte resultado: Sem risco = 5 famílias (9,43%); Risco baixo = 6 famílias (11,32%); Risco médio = 30 famílias (56,61%); Risco Alto = 12 famílias (22,64%); revelando que 90,57% das famílias abordadas possuíam algum grau de risco.

This work aims to present the results of implementing a process for family classification by degree of risk in a micro-area covered by a Family Health Strategy unit in Alfenas, Minas Gerais, Brazil. The process is carried out using the family registration form, in which socioeconomic data (household income per capita, literacy of the head of household, and water supply) and clinical data (number of family members with one or more diseases or chronic conditions) are specified. These data are given a score, and from their consolidation, families receive a rating. In the micro area in question, 129 families were enrolled and 53 medical files were analyzed (41.08%), with the following result: No risk = 5 families (9.43%); Low risk = 6 families (11.32%); Average risk = 30 families (56.61%); High risk = 12 families (22.64%); revealing that 90.57% of the families surveyed had some degree of risk.

Grados de riesgo para la adherencia terapéutica en personas con hipertensión arterial / Degrees of risk for therapeutical adherence in persons with arterial hypertension

Objetivo: Determinar los grados de riesgo para la adherencia terapéutica en los tratamientos farmacológicos y no farmacológicos en personas con hipertensión arterial. Metodología: Estudio de abordaje cuantitativo, descriptivo y transversal, realizado con 282 personas hipertensas hospitalizadas en el Hospital Universitario de Santander (HUS). Se utilizó un instrumento validado, con alto índice de confiabilidad y trayectoria para la medición del fenómeno de adherencia, elaborado por Bonilla y De Reales (2006); para este estudio se utilizó la última versión propuesta por Consuelo Ortiz Suárez (2008). Resultados: El 18.4% de la población hipertensa estudiada se encuentra en un nivel de riesgo alto, el 47.2% en un nivel de riesgo medio y el 34.4% de las personas hipertensas en un nivel de riesgo bajo. El 50% de la población estimada se clasifica como adulta mayor (≥ 60 años) y la proporción de hombres (63.1%) fue mayor que la de mujeres (36.9%) participantes en el estudio. Discusión y Conclusiones: Más del 50% de la población hipertensa evaluada se encuentra en un grado de adherencia global en riesgo medio y alto, lo que se simboliza un preocupante pronóstico del comportamiento de la adherencia en este grupo poblacional. De igual forma, se demostró el impacto negativo en la adherencia cuando el nivel educativo de las personas es bajo y cuando existen limitaciones económicas para subsanar las necesidades básicas, lo que generó un grado de riesgo medio limítrofe que pone en peligro el alcanzar o mantener comportamientos compatibles con la adherencia en este grupo poblacional.

Objective: To determine the degree of risk for adherence in pharmacological and no pharmacological treatments in people with hypertension. Methodology: Quantitative approach, descriptive and cross-sectional study with 282 hypertensive patients was hospitalized at the Hospital Universitario de Santander. We used a validated instrument, with high reliability and path for measuring the phenomenon of adhesion, drafted by Bonilla and De Reales (2006), with the latest version proposed by Consuelo Ortiz Suárez (2008). Results: 18.4% of the hypertensive population studied is in a high risk level, 47.2% of the sample population in a medium risk and 34.4% of hypertensive patients in a low risk. 50% estimated population classified as elderly (≥ 60 years) and the proportion of men (63.1%) was higher than females (36.9%) participants in the study. Discussion and conclusions: More than 50% of the hypertensive population is evaluated on a global level of adhesion medium and high risk which is symbolized a disturbing forecast of adherence behavior in this population. Similarly, the negative impact on adherence is demonstrated when the educational level of people is low and when there are economic constraints to address basic needs, which generated an average risk grade boundary, which threatens to reach and/or maintaining behaviors consistent with adherence in this population.

Objetivo: Determinar os graus de risco para a aderência terapêutica nos tratamentos farmacológicos e não farmacológicos em pessoas com hipertensão arterial. Metodologia: Estudo de abordagem quantitativo, descritivo e transversal, realizado com 282 pessoas hipertensas hospitalizadas no Hospital Universitário de Santander (HUS). Utilizou-se um instrumento validado, com alto índice de confiabilidade e trajetória para a medição do fenômeno de aderência, elaborado por Bonilla e De Reales (2006). Para este estudo utilizou-se a última versão, proposta por Consuelo Ortiz Suárez (2008). Resultados: 18,4% da população hipertensa estudada encontra-se em um nível de risco alto, 47,2% em um nível de risco médio e 34,4% das pessoas hipertensas em um baixo nível de risco. 50% da população estimada se classifica como idosa (≥ 60 anos) e a proporção de homens (63,1%) foi maior do que a de mulheres (36,9%) participantes no estúdio. Discussão e Conclusões: Mais de 50% da população hipertensa estudada se encontra em um grau de aderência global em risco meio e alto, o que simboliza um preocupante prognóstico do comportamento da aderência neste grupo populacional. Da mesma forma, se demostrou o impacto negativo na aderência quando as pessoas apresentam um nível educativo baixo e quando existem limitações econômicas para suprir as necessidades básicas, o que gerou um grau de risco médio limítrofe que dificulta atingir ou manter comportamentos compatíveis com a aderência neste grupo populacional.

Relación entre estados de salud y riesgos de no adherencia al tratamiento en pacientes en rehabilitación cardiaca / Relationship between health states and risks of non-adherence to treatment in patients undergoing cardiac rehabilitation

Objetivo: Este trabajo describe la relación del el estado de salud y el grado de riesgo de no adherencia a los tratamientos farmacológicos y no farmacológicos en pacientes con enfermedad coronaria que asisten a un programa de rehabilitación cardiaca. Método: Estudio de tipo descriptivo, se analizaron 260 sujetos asistentes al programa de Rehabilitación Cardiaca de la Fundación Cardioinfantil ­ Instituto de Cardiología clasificados en una lista de chequeo en tres grupos de estados de salud (óptimo, aceptable e insuficiente), según las metas internacionales de prevención secundaria. Posteriormente se les aplicó el instrumento que evalúa los factores que influyen en la adherencia a tratamientos midiendo el grado de riesgo de no adherencia y se realizó la comparación entre los grupos y relación entre las variables. Hallazgos: El comportamiento en el grado de riesgo de no adherencia entre los grupos de estados de salud no presentó ninguna diferencia. En general los tres grupos reportaron alto grado de adherencia. Conclusión: El grado de riesgo de no adherencia que se mide a través del instrumento "factores que influyen en la adherencia a tratamientos farmacológicos y no farmacológicos en personas con factores de riesgo cardiovascular" no muestra diferencia con respecto al estado de salud de personas con enfermedad coronaria que asisten a un programa de rehabilitación cardiaca de una institución especializada de Bogotá, no existe relación.

Aim: This paper describes the relationship between Health Status and the degree of risk of non ­ adherence to pharmacological and non ­ pharmacological treatments in patients with coronary artery disease who attend a cardiac rehabilitation program. Method: Descriptive study, 260 attended the Cardiac Rehabilitation program of the subjects were analyzed Cardioinfantil Foundation - Institute of Cardiology ranked a checklist into three groups of health states (optimal, acceptable and unsatisfactory), according to international targets for prevention secondary. Then we applied the instrument that assesses the factors that influence adherence to treatment by measuring the degree of risk of nonadherence and comparison between groups was performed and the relationship between the variables. Findings: The behavior in the degree of risk of non-adherence among health status groups did not show any difference. Generally all three groups reported high degree of adherence. Conclusion: The degree of risk of nonadherence measured through the instrument "factors influencing adherence to pharmacological and nonpharmacological treatments in people with cardiovascular risk factors" shows no difference to the health of people with coronary heart disease attend a cardiac rehabilitation program in a specialized institution Bogotá, there is no relationship