Valoración de la respuesta a la quimioterapia de inducción seguida de quimioradioterapia concomitante en carcinoma de laringe localmente avanzado y análisis de los factores que pueden influir en la misma.

El tratamiento de los tumores localmente avanzados de laringe es un tema a debate actualmente por la diversidad de estrategias terapéuticas disponibles. Nuestro objetivo es evaluar la respuesta a la quimioterapia de inducción seguida de quimioradioterapia concomitante en carcinoma de laringe localmente avanzado y analizar determinados factores que puedan influir en ella. Para ello, se han estudiado 41 pacientes afectos de carcinoma de laringe en estadio localmente avanzado (III-IV) que se incluyeron en el Protocolo de Conservación de Órgano en el Comité de Tumores de nuestro hospital en los tres últimos años (2014 a 2016). Los pacientes recibieron el tratamiento en dos tiempos: en primer lugar se administró quimioterapia de inducción, y en segundo lugar, en los pacientes en los que se obtuvo respuesta (n=32), se continuó el tratamiento con quimioradioterapia posterior o radioterapia exclusiva. La valoración de la respuesta al tratamiento se ha llevado a cabo mediante exploración clínica otorrinolaringológica y estudio radiológico con TC tras la quimioterapia de inducción y después tras el tratamiento final con quimiorradioterapia o radioterapia sola. Se han analizado también la respuesta al tratamiento en relación a diversos factores epidemiológicos, estadificación tumoral, calidad de vida (ECOG), variables anatomopatológicas, variables bioquímiconutricionales y tratamiento recibido. La respuesta obtenida a la quimioterapia de inducción mediante exploración clínica otorrinolaringológica ha sido del 85.37% y mediante TC del 75.61%. Un 21.95% de los pacientes precisaron cirugía tras el tratamiento inicial con quimioterapia de inducción sin poder preservar la laringe ni continuar con el Protocolo de Conservación de Órgano. Al finalizar el tratamiento completo y con la exploración clínica otorrinolaringológica el 53.66% de los pacientes presentaron respuesta completa mientras el 41.46% presentaron respuesta completa radiológica. Los pacientes con respuesta completa a la quimioterapia de inducción presentan cifras de hemoglobina significativamente más altas (14.58 g/dL, p=0.019) respecto a los pacientes sin respuesta (13.38 g/dL)

Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

<p>Abstract</p> <p>Background</p> <p>There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden.</p> <p>Methods</p> <p>This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System^®).</p> <p>Results</p> <p>The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix.</p> <p>Conclusions</p> <p>Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.</p

Does the pharmacy expenditure of patients always correspond with their morbidity burden? Exploring new approaches in the interpretation of pharmacy expenditure

<p>Abstract</p> <p>Background</p> <p>The computerisation of primary health care (PHC) records offers the opportunity to focus on pharmacy expenditure from the perspective of the morbidity of individuals. The objective of the present study was to analyse the behaviour of pharmacy expenditure within different morbidity groups. We paid special attention to the identification of individuals who had higher values of pharmacy expenditure than their morbidity would otherwise suggest (i.e. outliers).</p> <p>Methods</p> <p>Observational study consisting of 75,574 patients seen at PHC centres in Zaragoza, Spain, at least once in 2005. Demographic and disease variables were analysed (ACG^®8.1), together with a response variable that we termed 'total pharmacy expenditure per patient'. Outlier patients were identified based on boxplot methods, adjusted boxplot for asymmetric distributions, and by analysing standardised residuals of tobit regression models.</p> <p>Results</p> <p>The pharmacy expenditure of up to 7% of attendees in the studied PHC centres during one year exceeded expectations given their morbidity burden. This group of patients was responsible for up to 24% of the total annual pharmacy expenditure. There was a significantly higher number of outlier patients within the low-morbidity band which matched up with the higher variation coefficient observed in this group (3.2 vs. 2.0 and 1.3 in the moderate- and high-morbidity bands, respectively).</p> <p>Conclusions</p> <p>With appropriate validation, the methodologies of the present study could be incorporated in the routine monitoring of the prescribing profile of general practitioners. This could not only enable evaluation of their performance, but also target groups of outlier patients and foster analyses of the causes of unusually high pharmacy expenditures among them. This interpretation of pharmacy expenditure gives new clues for the efficiency in utilisation of healthcare resources, and could be complementary to management interventions focused on individuals with a high morbidity burden.</p

Predictive value of intracrystalline interphase point measured by optical low-coherence reflectometry for the estimation of the anatomical position of an intraocular lens after cataract surgery

Purpose: To investigate the predictive value of the intracrystalline interphase point (ICIP) measured with optical low-coherence reflectometry (OCLR) to estimate the final lens position (FLP) of an intraocular lens (IOL) after cataract surgery. Setting: Alcañiz Hospital, Teruel, Spain. Design: Single-center retrospective descriptive study. Methods: Patients undergoing cataract surgery were enrolled. They were grouped according to the IOL implanted as follows: Group 1, Acrysof IQ aspheric SN60WF IOL (77 eyes); Group 2, enVista MX60 IOL (71 eyes); Group 3, CT Asphina 409 IOL (44 eyes). An OCLR-based biometer (Lenstar LS 900 system) was used for biometric measurements preoperatively and at 4 to 5 weeks postoperatively. Results: The study comprised 192 eyes of 174 patients (mean age: 76.4 years). One hundred seventy eyes (88.5%) eyes showed an absolute refractive prediction error (ARPE) less than 0.50 diopters (D). The mean ARPE was 0.25 D ± 0.21 (SD). Significantly higher FLP values were found in Group 2 compared with the other two groups (P < .001). Significantly lower ICIP values were found in the eyes with an ARPE of 0.50 D or more compared with eyes that had an ARPE less than 0.50 D in Group 1 (P = .042) and Group 2 (P = .023). The correlation of the FLP with the ICIP was good in all three groups (r ≥ 0.74, P <.001). Three linear expressions were obtained to predict the FLP from the ICIP and other preoperative data (R2: 0.85, 0.69, and 0.49 in Groups 1, 2, and 3, respectively). Conclusions: The position of the ICIP measured with OCLR correlated with the FLP after cataract surgery, and it can be used to optimize IOL power calculations.The study was supported by an unrestricted research grant from Alcon Cusi SA. The author David P. Piñero was supported by a grant from the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal (RYC-2016-20471)

Análisis del impacto psicoemocional de la pandemia del COVID-19 entre los profesionales de enfermería

Introduction: The 2019 new coronavirus disease was diagnosed in December 2019 in Wuhan (China), declaring a global pandemic in March. Epidemics generate fear, anxiety and anguish amongst the general population, and amongst health personnel (especially in nursing), the COVID-19 pandemic has been no exception. The objective of the study was to analyze the psycho-emotional impact of COVID-19 among nurses in the province of Huesca.Methods: Descriptive cross-sectional study, approved by the Ethics Committee. With prior informed consent, anonymously and voluntarily, the participants filled out a questionnaire on psychological symptoms, using the DASS-21© scale, the ISI©, the MBI© and the FCV 19S© scales, also collecting sociodemographic, professional and COVID-19 associated variables.Results: The sample consisted of 196 nurses. 16,8% presented depression, 46,4% anxiety, 22,4% stress and 77,6% insomnia, with higher levels amongst the eldest, permanently employed, more experienced nurses, risk comorbidities, less leisure and more hours of work. Psychological Exhaustion (Burnout Syndrome) was detected in 50,5% and fear of coronavirus-19 in 46,9%, variables such as having a position in a COVID-19 unit, more experienced, being a Specialized Care Nurse and not living with family members, triggered greater symptomatology. Regression analyzes showed that the COVID-19 infection was a common risk factor.Conclusions: The SARS CoV-2 health crisis has generated a relevant psychological impact among nursing staff. Therefore, they should be offered psychological support to reduce it and thus ensure their mental health and the valuable care they provide.Introducción: La enfermedad por el nuevo coronavirus 2019 se diagnosticó en diciembre de 2019 en Wuhan (China), declarándose en marzo pandemia mundial. Las epidemias generan miedo, ansiedad y angustia en la población general, y entre el personal sanitario (especialmente en enfermería), la pandemia del COVID-19 no ha sido una excepción. Objetivo: El objetivo del estudio fue analizar el impacto psicoemocional del COVID-19 entre los enfermeros de la provincia de Huesca.Métodos: Estudio descriptivo transversal, aprobado por el Comité Ético. Previo consentimiento informado, anónima y voluntariamente, los participantes diligenciaron un cuestionario sobre síntomas psicológicos, sirviéndose de la escala DASS-21©, del ISI©, del MBI© y de la FCV 19S©, recopilando además variables sociodemográficas, profesionales y asociadas al COVID-19.Resultados: La muestra se conformó por 196 enfermeros. El 16,8% presentaron depresión, el 46,4% ansiedad, el 22,4% estrés y el 77,6% insomnio, con mayores niveles entre los enfermeros de más edad, fijos, con mayor experiencia, comorbilidades de riesgo, menos ocio y más horas de trabajo. Se detectó burnout en el 50,5% y miedo al coronavirus-19 en el 46,9%, variables como tener el puesto en una unidad COVID-19, más experiencia, ser Enfermero de Atención Especializada y no convivir con familiares, desencadenaron mayor sintomatología. Los análisis de regresión mostraron que la infección por COVID-19 constituyó un factor de riesgo común.Conclusiones: La crisis sanitaria del SARS CoV-2 ha generado un relevante impacto psicológico entre enfermería. Por ello, se les debería ofrecer apoyo psicológico para reducirlo y así asegurar su salud mental y los valiosos cuidados que otorgan

Health perception among older adults according to lifestyle and functional capacity

Objetivos: Conocer la salud autopercibida, estilo de vida, capacidad funcional y relación existente entre ellas, en un grupo de adultos mayores de un centro de atención primaria rural. Métodos: Estudio observacional transversal. Los participantes diligenciaron un cuestionario compuesto por datos sociodemográficos, clínicos, de apoyo sociofamiliar, ligados al COVID-19 y 5 escalas: MEDAS-1, RAPA, Barthel, SARC-F y SF-36. Las variables se analizaron mediante contrastes de hipótesis y coeficiente de Pearson, considerando la significación estadística con un p<0.05. Resultados: La muestra se conformó por 142 adultos mayores, con una edad media de 75.85 años. La mayoría estaban casados, tenían estudios primarios, no eran cuidadores, no tenían hábitos tóxicos, estaban polimedicados, tomaban psicofármacos y no padecían temor ante el COVID-19. La muestra presentó globalmente normopeso, el 48.6% demostró una adherencia alta a la Dieta Mediterránea (DM), el 35.9% eran moderadamente activos, el 54.9% indicaron tener independencia para las ABVD y el 75.4% mostraron bajo riesgo de sarcopenia. La percepción de la salud de la muestra fue inferior en la mayoría de las subescalas analizadas del SF-36 que la de la población de referencia, siendo inferior en mujeres y conforme avanza de la edad. Los adultos mayores con baja adhesión a la DM, sedentarios, dependientes y con sarcopenia mostraron inferior percepción de salud. Los participantes con baja adhesión a la DM eran más sedentarios y los más dependientes tenían más riesgo de sarcopenia. Conclusiones: Un estilo de vida inadecuado y la limitación funcional reducen significativamente la autopercepción de la salud, debiendo intervenir para corregirlas.Objectives: To know the self-perceived health, lifestyle, functional capacity and relationship between them, in a group of older adults from a rural primary healthcare center. Methods: Cross-sectional observational study. The participants filled out a questionnaire made up of sociodemographic, clinical, socio-family support data, linked to COVID-19 and 5 scales: MEDAS-1, RAPA, Barthel, SARC-F and SF-36. The variables were analyzed through hypothesis contrasts and Pearson's coefficient, considering statistical significance with p<0.05. Results: The sample consisted of 142 older adults, with an average age of 75.85 years. Most of them were married, had primary education, were not caregivers, did not have toxic habits, were polymedicated, took psychotropic drugs, and were not afraid of COVID-19. The sample had a normal weight overall, 48.6% demonstrated high adherence to the Mediterranean Diet (MD), 35.9% were moderately active, 54.9% indicated independence for basic activities of daily living (BADL), and 75.4% showed low risk of sarcopenia. The sample's perception of health was lower in most of the SF-36 subscales analyzed than that of the reference population, being lower in women and with increasing age. Older adults with low adherence to MD, sedentary, dependent, and with sarcopenia showed a lower perception of health. Participants with low adherence to the MD were more sedentary and those who were more dependent had a higher risk of sarcopenia. Conclusions: an inadequate lifestyle and functional limitation significantly reduce the self-perception of health, requiring intervention to correct them

Analysis of the psycho-emotional impact of the COVID-19 pandemic among nursing professionals

Introducción: La enfermedad por el nuevo coronavirus 2019 se diagnosticó en diciembre de 2019 en Wuhan (China), declarándose en marzo pandemia mundial. Las epidemias generan miedo, ansiedad y angustia en la población general, y entre el personal sanitario (especialmente en enfermería), la pandemia del COVID-19 no ha sido una excepción. Objetivo: El objetivo del estudio fue analizar el impacto psicoemocional del COVID-19 entre los enfermeros de la provincia de Huesca. Métodos: Estudio descriptivo transversal, aprobado por el Comité Ético. Previo consentimiento informado, anónima y voluntariamente, los participantes diligenciaron un cuestionario sobre síntomas psicológicos, sirviéndose de la escala DASS-21©, del ISI©, del MBI© y de la FCV 19S©, recopilando además variables sociodemográficas, profesionales y asociadas al COVID-19. Resultados: La muestra se conformó por 196 enfermeros. El 16,8% presentaron depresión, el 46,4% ansiedad, el 22,4% estrés y el 77,6% insomnio, con mayores niveles entre los enfermeros de más edad, fijos, con mayor experiencia, comorbilidades de riesgo, menos ocio y más horas de trabajo. Se detectó burnout en el 50,5% y miedo al coronavirus-19 en el 46,9%, variables como tener el puesto en una unidad COVID-19, más experiencia, ser Enfermero de Atención Especializada y no convivir con familiares, desencadenaron mayor sintomatología. Los análisis de regresión mostraron que la infección por COVID-19 constituyó un factor de riesgo común.Conclusiones: La crisis sanitaria del SARS CoV-2 ha generado un relevante impacto psicológico entre enfermería. Por ello, se les debería ofrecer apoyo psicológico para reducirlo y así asegurar su salud mental y los valiosos cuidados que otorganIntroduction: The 2019 new coronavirus disease was diagnosed in December 2019 in Wuhan (China), declaring a global pandemic in March. Epidemics generate fear, anxiety and anguish amongst the general population, and amongst health personnel (especially in nursing), the COVID-19 pandemic has been no exception. The objective of the study was to analyze the psycho-emotional impact of COVID-19 among nurses in the province of Huesca. Methods: Descriptive cross-sectional study, approved by the Ethics Committee. With prior informed consent, anonymously and voluntarily, the participants filled out a questionnaire on psychological symptoms, using the DASS-21© scale, the ISI©, the MBI© and the FCV 19S© scales, also collecting sociodemographic, professional and COVID-19 associated variables. Results: The sample consisted of 196 nurses. 16,8% presented depression, 46,4% anxiety, 22,4% stress and 77,6% insomnia, with higher levels amongst the eldest, permanently employed, more experienced nurses, risk comorbidities, less leisure and more hours of work. Psychological Exhaustion (Burnout Syndrome) was detected in 50,5% and fear of coronavirus-19 in 46,9%, variables such as having a position in a COVID-19 unit, more experienced, being a Specialized Care Nurse and not living with family members, triggered greater symptomatology. Regression analyzes showed that the COVID-19 infection was a common risk factor. Conclusions: The SARS CoV-2 health crisis has generated a relevant psychological impact among nursing staff. Therefore, they should be offered psychological support to reduce it and thus ensure their mental health and the valuable care they provide

Enfermedad renal crónica en España: prevalencia y factores relacionados en personas con diabetes mellitus mayores de 64 años

Resumen: Introducción: La diabetes mellitus tipo 2 y la enfermedad renal crónica (ERC) son afecciones de elevada prevalencia en personas ≥ 65 años y constituyen un importante problema de salud pública. Objetivos: Conocer la prevalencia de la ERC, sus categorías y su relación con diversos factores demográficos y clínicos, en pacientes ancianos con diabetes mellitus tipo 2 en España. Métodos: Estudio epidemiológico, observacional, transversal, multicéntrico, ámbito nacional. Se incluyeron pacientes con diabetes mellitus tipo 2 conocida, edad ≥ 65 años atendidos en Atención Primaria. Se recogieron variables demográficas, antropométricas y analíticas de los últimos 12 meses, incluyendo el cociente albúmina-creatinina y el filtrado glomerular estimado para evaluar la función renal. Resultados: La prevalencia de ERC fue del 37,2% (IC95%, 34,1-40,3%), de insuficiencia renal del 29,7% (IC95%, 26,8-32,6%) y de elevación de la albuminuria del 20,6% (IC95%, 17,3-23,9%), moderadamente elevada 17,8% (IC95%, 14,7-20,9%), severamente elevada 2,8% (IC95%, 1,4-4,2%). La prevalencia de las categorías de ERC fueron: G1 1,3% (IC95%, 0,6-2%), G2 6,2% (IC95%, 4,6-7,8%), G3a 17,2% (IC95%, 14,8-19,6%), G3b 9,8% (IC95%, 7,9-11,7%), G4 2% (IC95%, 1,1-2,9%) y G5 0,7% (IC95%, 0,2-1,2%).En el análisis multivariante, después de ajustar por el resto de variables, la ERC se asoció a mayor edad OR 5,13, (IC95%, 3,15-8,35), alta comorbilidad OR 3,36 (IC95%, 2,2-5,12) y la presencia de tratamiento antihipertensivo OR 2,43 (IC95%, 1,48-4,02). Conclusiones: La ERC es frecuente en la población diabética ≥ 65 años y se asocia con mayor edad, alta comorbilidad e hipertensión tratada. No se ha encontrado asociación con el género y años de evolución de la diabetes. Abstract: Introduction: Type 2 diabetes mellitus and chronic kidney disease (CKD) are conditions which have a high prevalence in individuals ≥ 65 years of age and represent a major public health problem. Objectives: To determine the prevalence of CKD, its categories and its relationship with various demographic and clinical factors in elderly patients with type 2 diabetes mellitus in Spain. Methods: Observational, cross-sectional, multicenter, Spanish epidemiological study. Patients with known type 2 diabetes mellitus, age ≥ 65 years of age treated in Primary Care were included. We collected demographic, anthropometric and analytical variables from the previous 12 months, including the albumin-to-creatinine ratio and estimated glomerular filtration rate to evaluate renal function. Results: The prevalence of CKD was 37.2% (95% CI, 34.1–40.3%), renal failure was 29.7% (95% CI, 26.8–32.6%) and increased albuminuria was 20.6% (95% CI, 17.3–23.9%), moderately increased albuminuria was 17.8% (95% CI, 14.7–20.9%) and severely increased albuminuria was 2.8% (95% CI, 1.4–4.2%). In turn, the prevalence of CKD categories were: G1 1.3% (95% CI, 0.6–2%), G2 6.2% (95% CI, 4.6–7.8%), G3a 17.2% (95% CI, 14.8–19.6%), G3b 9.8% (95% CI, 7.9–11.7%), G4 2% (95% CI, 1.1–2.9%) and G5 0.7% (95% CI, 0.2–1.2%).In the multivariate analysis, after adjusting for the remaining variables, CKD was associated with elderly age (OR 5.13, 95% CI, 3.15–8.35), high comorbidity (OR 3.36. 95% CI, 2.2–5.12) and presence of antihypertensive treatment (OR 2.43. 95% CI, 1.48–4.02). Conclusions: CKD is frequent in the diabetic population ≥ 65 years of age and is associated with elderly age, high comorbidity and with treated hypertension. No relationship has been found with gender and time in years since onset of diabetes. Palabras clave: Enfermedad renal crónica, Categorías, ancianos, Dependencia, Comorbilidad, Diabetes mellitus tipo 2, Keywords: Chronic kidney disease, Categories, elderly, Dependence, Comorbidity, Type 2 diabetes mellitu