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1.
Behav Med ; 47(4): 311-323, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32356678

RESUMO

There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.


Assuntos
Dor Crônica , Fibromialgia , Transtornos de Estresse Pós-Traumáticos , Comorbidade , Feminino , Fibromialgia/complicações , Fibromialgia/epidemiologia , Humanos , Limiar da Dor , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia
2.
Med Intensiva ; 36(7): 481-7, 2012 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-22277345

RESUMO

OBJECTIVE: To validate a safety tool used in high-risk sectors (safety briefing) in intensive care medicine. DESIGN: A prospective, observational and analytical study was carried out. SETTING: Trauma and emergency intensive care unit in a tertiary hospital. PATIENTS: Patients with severe trauma (Injury Severity Score ISS≥16). INTERVENTION: Documentation of incidents related to patient safety (PS). VARIABLES: Patients characteristics, state of the Unit, patient safety incidents, aspects of the tool (SP) and safety culture impact. RESULTS: We included 441 patients (75.15% males, mean age 39.9±17.5 years), with blunt trauma in 89% and a 10.5% mortality rate. The tool was applied in 586 out of 798 possible shifts (73.4%), and documented 942 events (2.20 incidents per patient). The incidents were more frequently associated with medication (20.7%), devices (placement 4.03%, and maintenance 17.8%) and airway and mechanical ventilation (MV) (17.09%). A correlation was established between the occurrence of incidents and the characteristics of the patient (higher Injury Severity Score, presence of MV, and continuous renal replacement therapies) and the status of the Unit (more than 6 patients per shift out of 8 possible, and holiday period). The tool significantly influenced different aspects of the safety culture of the unit (communication frequency, number of events, punitive loss and active work in PS). CONCLUSIONS: Safety briefing is a tool for the documentation of incidents that is simple and easy to use, and is useful for implementing improvements and in influencing safety culture.


Assuntos
Lista de Checagem , Unidades de Terapia Intensiva/normas , Segurança do Paciente , Centros de Traumatologia , Adulto , Comunicação , Feminino , Humanos , Masculino , Estudos Prospectivos
3.
Med Intensiva ; 35(9): 546-51, 2011 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21906847

RESUMO

OBJECTIVES: Our purpose is to validate previously described massive transfusion (MT) scoring in our Transfusion Trauma Registry. DESIGN: A retrospective cohort of adult trauma patients. SETTING: Trauma and Emergency Intensive Care Unit of a tertiary hospital. PATIENTS: Patients with severe trauma (injury severity score>15) admitted from October 2006 to July 2009. INTERVENTIONS: None. VARIABLES: The following MT scoring and cutoff points (CP) were evaluated: Trauma-Associated Severe Hemorrhage (TASH) CP: ≥16 and ≥18; Assessment Blood Consumption (ABC) CP: ≥2 and Emergency Transfusion Score (ETS) CP: ≥3, ≥4, ≥6. MT was defined as the transfusion of 10 units or more of packed red blood cells in the first 24 hours. We studied the sensivity (S), specifity (SP), and positive and negative predictive values (PPV, NPV), the positive and negative likehood ratios (LHR +, LHR-) and area under the receiver operating characteristic curve (ROC). RESULTS: A total of 568 patients were available for analysis; 77.6% were men, with a mean age of 41.16 ± 18 years and an ISS of 30 ± 13. 93.8% with blunt trauma. The overall MT rate was 18.8%. The best S was obtained with ETS ≥3 and best SP was obtained with TASH ≥18. ROC for different scores was: ABC: 0.779, ETS: 0. 784, TASH: 0.889. CONCLUSION: These scales can be useful for characterizing the TM population, for excluding low-risk populations, and for attempting to be objective in hematological damage control and in supporting clinical decisions, based on fe1w and easily obtainable data.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Índices de Gravidade do Trauma , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sistema de Registros , Estudos Retrospectivos , Espanha , Centros de Traumatologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/terapia
4.
Semergen ; 47(3): 161-169, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-33160855

RESUMO

OBJECTIVES: The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain. MATERIAL AND METHODS: A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being). RESULTS: A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent. CONCLUSIONS: This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.


Assuntos
Diabetes Mellitus Tipo 2 , Dieta Mediterrânea , Comportamentos Relacionados com a Saúde , Adulto , Idoso , Estudos Transversais , Feminino , Estilo de Vida Saudável , Humanos , Estilo de Vida , Masculino , Espanha
5.
Semergen ; 46(6): 415-424, 2020 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-32094051

RESUMO

The prevalence of type 2 diabetes (DM2) diagnosed in childhood and adolescence is currently increasing, and is characterised by a rapidly progressive decline in beta-cells and insulin resistance. Physical inactivity and obesity are the main risk factors for its development. Diagnostic criteria are similar to those used in adults, although HbA1c as a diagnostic method is questioned. Diabetes-related complications are more aggressive than in adults. Diabetic nephropathy is the most frequent complication in the young population and macrovascular complications appear early, leading to high mortality rates. Healthy lifestyles are the basis of the treatment, and metformin, insulin and liraglutide (approved by FDA for its use in the United States) are the pharmacological options indicated in this population. It is important to establish models of health care transition from paediatric to adult care to ensure continuity of care and avoid patient disengagements.


Assuntos
Diabetes Mellitus Tipo 2 , Transição para Assistência do Adulto , Adolescente , Diabetes Mellitus Tipo 2/terapia , Humanos , Insulina , Metformina , Atenção Primária à Saúde , Estados Unidos , Adulto Jovem
6.
Vasc Health Risk Manag ; 15: 57-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30936712

RESUMO

BACKGROUND: Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. PATIENTS AND METHODS: A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. RESULTS: A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer-Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. CONCLUSION: Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Técnicas de Apoio para a Decisão , Infarto do Miocárdio/diagnóstico , Fatores Etários , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/sangue , Estenose Coronária/epidemiologia , Estenose Coronária/terapia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Troponina/sangue , Regulação para Cima
7.
Semergen ; 44(8): 579-585, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29174068

RESUMO

OBJECTIVE: The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. MATERIAL AND METHODS: A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. RESULTS: The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). CONCLUSIONS: Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Adesão à Medicação , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Fatores de Risco , Falha de Tratamento
8.
Arch Bronconeumol ; 41(9): 478-83, 2005 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-16194509

RESUMO

OBJECTIVE: To gather information on the disease characteristics and survival rate of patients diagnosed with bronchogenic carcinoma in the respiratory medicine departments of hospitals in Asturias, Spain. PATIENTS AND METHODS: This was a retrospective observational study carried out using a standardized data collection protocol. All cases of lung cancer diagnosed during 2001 were included provided there was cytologic or histologic confirmation or they fulfilled a series of clinical, radiological, and/or endoscopic criteria consistent with such a diagnosis. RESULTS: Standard incidence rates adjusted to the world population were 22.4, 42.6, and 4.6 per 100,000 population for the whole population, men, and women respectively. The mean (SD) age was 67 (10.9) years, and 92% of the patients were men. Overall, 98% of the men and 44% of the women were smokers. Diagnosis was confirmed by cytologic or histologic findings in 92% of patients, and the majority were non-small cell tumors (81.4%). At the time of diagnosis, 65% of the patients had advanced disease, with distant metastasis in 26.6% of the non-small cell cancers and 52.8% of the small cell cancers. Patients received surgical treatment in 21.3% of cases, chemotherapy alone or combined with radiation therapy in 43.1%, and radiation therapy alone in 9.3%. In 26.2% of patients only palliative care was given. Overall, median survival in weeks was 36.4 (95% confidence interval [CI], 29.4-43.4). Median survival by treatment type was as follows: 69.3 (95% CI, 49-9.5) for surgery; 39.6 (95% CI, 31.2-48) for chemotherapy alone or with radiation therapy; 30 (95% CI, 15.4-44.6) for radiation therapy alone; and 13.3 (95% CI, 5.9-20.6) for patients who received palliative care alone (P< .05). CONCLUSIONS: The findings with respect to age, sex, incidence, histology, extent of tumor, and smoking status of patients with bronchogenic carcinoma in our region does not differ significantly from those reported for other areas of Spain. Current smoking is the primary cause of the high prevalence of this disease. Twenty-six percent of patients received only palliative care. The percentage of patients treated with surgery was low.


Assuntos
Carcinoma Broncogênico/epidemiologia , Neoplasias Pulmonares/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fumar/epidemiologia , Espanha/epidemiologia , Análise de Sobrevida
9.
Semergen ; 41(2): 89-98, 2015 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-25533449

RESUMO

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Dislipidemias/terapia , Terapia Combinada , Diabetes Mellitus Tipo 2/fisiopatologia , Dislipidemias/diagnóstico , Dislipidemias/etiologia , Dislipidemias/fisiopatologia , Comportamentos Relacionados com a Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , Atenção Primária à Saúde/métodos , Fatores de Risco
10.
An Med Interna ; 21(8): 378-81, 2004 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-15373720

RESUMO

BACKGROUND: Few information about descriptive studies of autoimmunity in diabetes mellitus type 1 onset patients and family exist. The aim of our study was to analyze clinical and biochemical parameters of onset diabetes mellitus type 1 patients and first degree families. PATIENTS AND METHODS: Forty seven onset diabetes mellitus type 1 patients and 148 first degree families were studied, between January 1999 and December 2002, in the west area of Valladolid. In all cases and families an anthropometric study and biochemical determination with autoimmunity levels were performed. RESULTS: Average age in onset diabetes mellitus type 1 patients was 16.09 (9.36) years, without differences between males (32 cases, 68%) and females (15 cases, 32%), with an incidence of 4.66 cases/100,000 habs./year. Average values of peroxidase antibodies (antiPTO) and glutamic descarboxilase antibodies (antiGAD) were higher in diabetic patients than in families. No differences were detected in insulin antibodies (IAA) and tiroglobuline antibodies (antiTG). No correlation was detected between anti TPO and anti pancreas. Autoantibodies did not influence in glycemic control. Average dose of NPH insulin and regular insulin were 27.58 (13.88) UI/d y 3.05 (4.90) UI/d, respectively. CONCLUSIONS: Average age of onset diabetes mellitus type 1 patients was similar than other studies, with a high frequency of males. Values of antiGAD y antiTPO were higher in diabetic patients than families. No correlation between autoimmunity and glycemic control was detected.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/genética , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Autoanticorpos/análise , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Família , Feminino , Glutamato Descarboxilase/imunologia , Humanos , Lactente , Insulina/imunologia , Iodeto Peroxidase/imunologia , Masculino , Fatores Sexuais , Espanha/epidemiologia
11.
An Med Interna ; 20(12): 617-20, 2003 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-14697081

RESUMO

BACKGROUND: The incidence of sarcoidosis is different among distincts geographic areas, probably due to climate variations. At present, there is in Spain few studies that correlate the observed cases with a concrete population. The aim of this study is to investigate the epidemiology of sarcoidosis in Leon"s sanitary area, in comparison with others spanish geographic areas. Moreover, we present a description of the clinic and radiologic characteristics of the studied cases. METHOD: We analyzed the cases of sarcoidosis attended in the area from 1993 until 2001. The incidence, age, sex, place of residence and clinic-radiologic characteristics are described. The population data of the sanitary area to calculate the incidence were obtain from the Insalud"s data base. The climatology values were collected from the National Institute of Meteorology. RESULTS: The incidence of sarcoidosis in Leon"s sanitary area was 1,37/100.000 habitants/year, and was similar to that founded in Catalonia, Galizia and others provinces of the Castilla and Leon community. We observed a higher incidence of sarcoidosis in female patients, because of predominance of cases among women aged forty years or more. No differences between rural and urban populations were founded. The clinical characteristics were similar those described in other geographics areas of our country. CONCLUSION: Although there are climate differences between the geographics areas of Spain, these aren"t enough to explain his influence in the incidence of sarcoidosis, which is similar in all of them, at least in the middle north of the country.


Assuntos
Sarcoidose/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/diagnóstico , Sarcoidose/terapia , Distribuição por Sexo , Espanha/epidemiologia
12.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(8): 579-585, nov.-dic. 2018. graf, tab
Artigo em Espanhol | IBECS (Espanha) | ID: ibc-181271

RESUMO

Objetivo: El objetivo de este estudio fue analizar el impacto de la baja adherencia terapéutica (AT) y la inercia terapéutica de los profesionales (IT) sobre el mal control glucémico y de los factores de riesgo cardiovasculares en personas con DM2. Material y métodos: Estudio transversal realizado en atención primaria. Se incluyeron 320 personas con DM2. Se valoró si cumplían los objetivos de control (HbA1c≤7%, PA≤130/80mmHg, LDL≤100mg/dl). Se consideró falta de AT la retirada de farmacia <80% de las recetas prescritas e IT la no modificación del tratamiento en personas mal controladas. Resultados: Presentaron buen control de HbA1c, PA y cLDL el 62,5, el 40,9 y el 35,9%, respectivamente. Las personas mal controladas presentaron cifras de AT menores y la IT no se relacionó con la AT. En sujetos mal controlados para HbA1c, presentaban IT el 25,8%, el 24,8% mala AT y el 11,9% estaban afectados por ambos comportamientos. Para cLDL, el 3,6% presentaban mala AT, el 70,4% IT y el 16,0% mala AT e IT (p<0,001). Respecto a la PA, el 3,5% tenían mala AT, el 54,6% IT y el 21,5% presentaban mala AT e IT (p<0,01). Conclusiones: La falta de AT y la IT han estado implicadas en un porcentaje elevado de personas con DM2 mal controladas. La IT ha resultado de gran relevancia en el presente estudio


Objective: The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. Material and methods: A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. Results: The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). Conclusions: Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cardiopatias/etiologia , Hipoglicemiantes/administração & dosagem , Adesão à Medicação , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Atenção Primária à Saúde , Fatores de Risco , Falha de Tratamento
13.
Semergen ; 38(2): 118-21, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-24895710

RESUMO

Lyme disease, caused by Borrelia burgdorferi sensu lato, is a multisystem disease that may occur with rheumatic, dermatological, neurological symptoms and heart diseases. Its most typical lesion is erythema migrans, although not always present. The clinical diagnosis is supported by serology, and treatment is almost always tetracycline in young people and adults. Amoxicillin is most often used in children and pregnant women, and cephalosporins in the presence of neurological signs. The prognosis, with the appropriate treatment, is good. But if not treated promptly, there may be chronic signs, particularly, neurological, which may be disabling. In Spain, where the incidence is low, antimicrobial prophylaxis is indicated the after a tick bite.


Assuntos
Antibacterianos/uso terapêutico , Borrelia burgdorferi/isolamento & purificação , Doença de Lyme/diagnóstico , Idoso , Amoxicilina/uso terapêutico , Cefalosporinas/uso terapêutico , Feminino , Humanos , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Prognóstico , Espanha/epidemiologia , Tetraciclina/uso terapêutico
16.
Rev. Soc. Esp. Dolor ; 24(3): 125-131, mayo-jun. 2017. tab
Artigo em Espanhol | IBECS (Espanha) | ID: ibc-163153

RESUMO

Introducción: La actividad deportiva habitual puede ayudar a mantener una buena calidad de vida, aportando bienestar físico y emocional. No obstante, si dicha práctica no se lleva a cabo de manera adecuada, puede conllevar riesgos para la salud, como la producción de lesiones físicas. Una vez producida, la lesión puede conllevar dolor y alteraciones emocionales. Sin embargo, los factores psicológicos que influyen en su aparición son muy poco conocidos. Objetivo: El presente estudio se centró en analizar el papel predictor del estilo rumiativo y el mindfulness rasgo en el dolor experimentado y en los cambios en el estado de ánimo del deportista tras una lesión deportiva. Material y método: Se realizó un estudio longitudinal en el que se evaluó a 15 deportistas, mayores de edad, que habían sufrido una lesión moderada en los tres días anteriores al inicio del estudio. Todos ellos cumplimentaron una batería de cuestionarios de autoinforme en dos momentos temporales: a los tres días de producirse la lesión y una semana más tarde. Asimismo, durante toda la semana, cumplimentaron un diario de dolor en el que reflejaron la intensidad mínima, máxima y media diaria. Las variables dependientes evaluadas fueron: intensidad de dolor, ansiedad y sintomatología depresiva. Como variables independientes se evaluaron el estilo rumiativo, la rumiación sobre la lesión y el mindfulness rasgo. Resultados: Los análisis de regresión lineal efectuados mostraron un efecto significativo de la rumiación sobre la lesión sobre la intensidad de dolor y la ansiedad sufrida diez días después de la lesión. La depresión fue predicha únicamente por la propia depresión medida en un primer momento, y el mindfulness rasgo quedó fuera de todas las ecuaciones. Conclusiones: Los procesos rumiativos sobre la lesión aumentan las posibilidades de aparición de un estado negativo postlesión, principalmente los síntomas de ansiedad, y predicen la intensidad de dolor experimentada durante los 10 días posteriores. Por tanto, sería recomendable realizar intervenciones que disminuyeran o modificaran tales procesos de manera inmediata a la lesión, con el fin de disminuir la ansiedad y el dolor postlesión (AU)


Introduction: Daily sporting activity helps us to maintain a good quality of life, and physical and emotional well-being. However, if this practice is not carried out properly, can pose risks to health, such as physical injuries. When it occurs, the injury can lead to pain and emotional disturbances. The psychological factors that influence their occurrence are little known. Objective: This study focused on analyzing the predictive role of ruminative style and trait mindfulness in pain intensity and changes in mood after a sport injury. Method and equipment: We selected 15 athletes with a moderate sport injury, produced three days ago. They filled a battery of self-report questionnaires in two temporal moments: three days after the injury and a week later. Also, they completed, for a week, a pain diary in which reflected the average daily, minimum and maximum. As dependent variables were evaluated: pain intensity, anxiety and depressive symptoms. As independent variables: ruminative style, rumination about the injury and trait-mindfulness. Results: The data analysis was performed using linear regression, finding that rumination about the injury was predictor of pain intensity during the week after injury, and of anxiety level suffered ten days after the injury. Conclusions: The ruminative processes about the injury increase the chances of occurrence of a negative state after injury, mainly anxiety symptoms, and predict the intensity of pain experienced after sport injury. It would therefore be advisable to perform interventions that would reduce or modify such processes immediately to the injury in order to reduce anxiety and pain post injury (AU)


Assuntos
Humanos , Traumatismos em Atletas/complicações , Traumatismos em Atletas/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Afeto/fisiologia , Atenção Plena/métodos , Depressão/psicologia , Ansiedade/psicologia , Estudos Longitudinais , Manejo da Dor , 28599 , Medição da Dor/métodos
18.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(6): 415-424, sept. 2020. tab, graf
Artigo em Espanhol | IBECS (Espanha) | ID: ibc-200415

RESUMO

La prevalencia de la diabetes tipo 2 diagnosticada en la infancia/juventud está aumentando y se caracteriza por una disminución acelerada de la función de las células beta pancreáticas y resistencia a la insulina. Los principales factores de riesgo para su desarrollo son obesidad e inactividad física. Los criterios diagnósticos son similares a los utilizados en adultos, aunque la HbA1c como método diagnóstico está cuestionada. Las complicaciones son más agresivas que en la diabetes tipo 2 del adulto, siendo la nefropatía la más frecuente. Las complicaciones macrovasculares aparecen precozmente y su mortalidad es elevada. La alimentación saludable y el ejercicio físico continuado son los pilares básicos del tratamiento, y la metformina, insulina y liraglutide (aprobado por la FDA en Estados Unidos) las opciones farmacológicas con indicación en esta población. Es importante establecer modelos de transición de la atención pediátrica a la atención adulta para garantizar la continuidad asistencial y evitar pérdidas en el seguimiento de estos pacientes


The prevalence of type 2 diabetes (DM2) diagnosed in childhood and adolescence is currently increasing, and is characterised by a rapidly progressive decline in beta-cells and insulin resistance. Physical inactivity and obesity are the main risk factors for its development. Diagnostic criteria are similar to those used in adults, although HbA1c as a diagnostic method is questioned. Diabetes-related complications are more aggressive than in adults. Diabetic nephropathy is the most frequent complication in the young population and macrovascular complications appear early, leading to high mortality rates. Healthy lifestyles are the basis of the treatment, and metformin, insulin and liraglutide (approved by FDA for its use in the United States) are the pharmacological options indicated in this population. It is important to establish models of health care transition from paediatric to adult care to ensure continuity of care and avoid patient disengagements


Assuntos
Humanos , Diabetes Mellitus Tipo 2/terapia , Obesidade/epidemiologia , Comportamento Sedentário , Nefropatias Diabéticas/epidemiologia , Síndrome Metabólica/epidemiologia , Fatores de Risco , Diabetes Mellitus Tipo 2/epidemiologia , Complicações do Diabetes/epidemiologia , Hemoglobinas Glicadas/análise , Atenção Primária à Saúde/tendências , Estilo de Vida Saudável/classificação , Metformina/uso terapêutico , Adolescente , Adulto Jovem/estatística & dados numéricos
19.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. impr.) ; 41(2): 89-98, mar. 2015. tab, ilus
Artigo em Espanhol | IBECS (Espanha) | ID: ibc-133818

RESUMO

Las personas con diabetes mellitus tipo 2 tienen un riesgo de desarrollar enfermedad cardiovascular de 2 a 4 veces superior al observado en la población general de similar edad y sexo. Este riesgo se mantiene después de ajustar para otros factores clásicos de riesgo cardiovascular. La dislipidemia asociada a la diabetes mellitus tipo 2 se encuentra presente en hasta un 60% de las personas con diabetes y contribuye en gran medida al incremento de riesgo cardiovascular y de morbimortalidad que presentan estos pacientes. La dislipidemia diabética es una alteración del metabolismo lipídico que se caracteriza por un exceso de triglicéridos, un déficit del colesterol HDL y una alteración de la composición de las lipoproteínas que consiste sobre todo en un exceso de partículas LDL pequeñas y densas. Múltiples ensayos clínicos han demostrado los beneficios del tratamiento farmacológico de la dislipidemia (principalmente estatinas), para prevenir eventos cardiovasculares y mortalidad en personas con diabetes tanto en prevención primaria como secundaria. El presente documento de consenso elaborado por médicos de familia, integrantes del Grupo de Diabetes de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), pretende servir de ayuda en el manejo de las personas con diabetes y dislipidemia a la vista de las recomendaciones más actualizadas (AU)


People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Ácidos Fíbricos/uso terapêutico , Padrões de Prática Médica , Fatores de Risco , Doenças Cardiovasculares/prevenção & controle , Resistência à Insulina , Triglicerídeos/sangue , Lipoproteínas HDL/sangue
20.
Med Intensiva ; 32 Spec No. 1: 100-6, 2008 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-18405543

RESUMO

The epidural analgesia is one of the most effective techniques for pain relief when it is indicated, but it can present potentially serious complications that must precociously be diagnosed and be treated. In the Critical Care setting, epidural analgesia is used for pain control after surgery or major trauma. The technique is simple, a catheter is placed into a virtual cavity, so the administered drugs are absorbed through the epidural space into nerve roots. The administration of local anesthetics, opioids or the combination of both by epidural route (administered in continuous infusion or bolus), provides better analgesia. Also the clonidine can be used. In order to diagnose and to treat suitably the possible complications (pain, urinary retention, nauseas and vomits, itching, motor block, infection, respiratory depression, hypotension) a series of safety measures must be adopted (respiratory and heart rate, blood pressure, sedation score, sensory and motor level assessment, rate of diuresis, temperature and signs of infection).


Assuntos
Anestesia por Condução/métodos , Dor Pós-Operatória/prevenção & controle , Analgesia Epidural , Humanos , Injeções Espinhais , Entorpecentes/uso terapêutico
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