Asociación entre tamización de cáncer de próstata, vinculación al sistema de salud y factores asociados en adultos mayores: análisis secundario de la encuesta SABE Bogotá, Colombia

Introduction Prostate cancer is a high prevalence disease in our male population. Early diagnosis is important in order to improve its prognosis. The aim of this article is to describe the factors associated with prostate cancer screening of older adults in Bogotá, Colombia. Materials and methods The study used data from the Bogotá 2012 Health, WellBeing, and Ageing (Salud, Bienestar y Envejecimiento [SABE]) survey, which included 736 men aged 60 years or older. The dependent variable used was self-reported prostate screening in the last 2 years. An analysis was performed to determine the between this variable and socio-demographic variables and comorbidities using multivariate analysis. Results There was a prevalence of prostate cancer of 3.15%, with 57.8% of the population having had at least one prostate examination. Those affiliated to a health insurance scheme were more likely to be screened than the uninsured with an OR: 8.81, 95% CI: 2.92-26.63, P less than .001, as those affiliated to subsidized social security health scheme OR: 3.70, 95% CI: 1.20-11.41, P =.023, respectively). Conclusion There is inequity in the opportunity of screening for prostate cancer according to the type of health insurance scheme. Early detection strategies must be strengthened in order to include the entire population. Further studies are needed to provide more information on this issue. © 2018, Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda., Rio de Janeiro, Brazil

Elder abuse : a narrative review

El maltrato a las personas mayores es un tema de interés creciente, tanto así que se considera un problema de salud pública. Hay particularidades que hacen del entorno colombiano un ambiente propicio para generar situaciones de maltrato: la exposición a la “violencia a gran escala”, la diferencia de género y el cambio de la pirámide poblacional. Según el estudio SABE Colombia, el 12,9% de las personas mayores informó haber sufrido maltrato, del cual el más común es el psicológico, seguido por el físico, el financiero y el sexual. A pesar de que el Estado reconoce al adulto mayor como “sujeto de especial protección”, aún hay desconocimiento por parte de los profesionales de la salud a la hora de enfrentar estos casos. Este debería ser un tema de obligatoriedad moral, por lo que se debe abordar a profundidad para así identificarlo oportunamente y proponer estrategias de prevención de una manera contextualizada. Esta revisión de la literatura tiene por objetivos sintetizar la información epidemiológica disponible, los factores de riesgo y las estrategias de evaluación y plantear las rutas de atención idóneas asentadas en los aspectos legales alrededor del maltrato hacia los ancianos en Colombia.Artículo de revisión1-16Elder abuse is a topic of growing interest and it is considered as a public health problem. The Colombian context has built an ideal climate generating situations of abuse: the exposure to “violence on a large scale”, the gender gap and the change of the population pyramid. According to the SABE Colombia, 12.9% of the elderly reported having suffered abuse, the most common is psychological abuse, followed by the physical, financial and sexual. Although the Colombian State recognizes the elderly as a special subject of protection, perhaps there is still ignorance of the health professionals. This should be a moral obligation for the medical community, so it must be addressed in depth in order to identify cases in time and propose prevention. This review of the literature aims to synthesize the available epidemiological information, clinical evidence and legal aspects of elder abuse in the Colombian context and finally propose routes of attention with the legal aspects surrounding the abuse

Family centered decision making in advanced chronic kidney disease. From individual autonomy to family or community autonomy

El aumento de la tasa de incidencia y prevalencia de la enfermedad renal crónica plantea desafíos y dilemas éticos que tanto pacientes como familiares y profesionales de salud deben enfrentar diariamente. El objetivo de este artículo es presentar una reflexión sobre la manera como, para la toma decisiones, los pacientes recurren a terceros como partícipes, lo que requeriría un abordaje desde la autonomía solidaria. Se presenta el análisis de doce entrevistas semiestructuradas, realizadas a pacientes de 60 años o más, de distintos programas de la Unidad de Nefrología del Hospital Universitario San Ignacio, Colombia, entre 20172018. En este artículo se propone la necesidad de toma de decisiones centradas en la familia de los pacientes con enfermedades crónicas, antes de que su estado sea avanzado y los estados de inconsciencia impidan su autodeterminación, considerando la determinación social de la autonomía.Q4Q4The increase in the incidence and prevalence rate of Chronic Kidney Disease poses challenges and ethical dilemmas that patients, family members and health professionals must face daily. The objective of this article is to present a reflection on the way in which patients make recourse to third parties as participants in their decision-making, which would require an approach based on solidarity autonomy. The analysis of twelve semi-structured interviews conducted with patients 60 years of age and older, from different programs of the Nephrology Unit of the Hospital Universitario San Ignacio in the period 2017-2018 Colombia, is presented. This article proposes the need for family-centered decision making of patients with chronic diseases, before their state is advanced and states of unconsciousness prevent their self-determination, considering the social determination of autonomy.Revista Internacional - Indexad

Social representations of old patients with advanced chronic kidney disease about the right to die with dignity and the advance decisions

INTRODUCCIÓN: Gran parte de los pacientes con enfermedad renal crónica en estadio avanzado tienen una alta carga de comorbilidad, discapacidad y en su mayoría son ancianos, lo que lo hace complejo el proceso de toma de decisiones, pues no todos los pacientes son candidatos a las terapias de sustitución renal, y se debe plantear la suspensión de estas en el momento en que se consideren fútiles. Las representaciones sociales respecto a las voluntades anticipadas y el derecho a morir dignamente en personas mayores con enfermedad renal crónica no han sido investigadas. Este estudio abordó las representaciones sociales alrededor del derecho a morir dignamente, en busca de mayor humanización de la medicina, y de mejorar la comprensión del proceso que lleva a la muerte. DISEÑO Y MÉTODO : Estudio cualitativo apoyado en la teoría de las representaciones sociales; basado en entrevistas semiestructuradas realizadas a 12 pacientes mayores de 60 años en los programas de pre diálisis, diálisis y trasplante renal del Hospital Universitario San Ignacio y aprobado por el comité de investigaciones y ética. El análisis se realizó entre el 2018 a 2019. Para el análisis se utilizó el programa NVivo12codificando como categorías iniciales: derechos de los pacientes, derecho morir dignamente, muerte digna y voluntades anticipadas. Analizando las dimensiones de las representaciones sociales: la información, la actitud y el campo de representación. RESULTADOS Y DISCUSIÓN: Los pacientes entrevistados con enfermedad renal crónica no cuentan con una estructura de campo de representación de los derechos de los pacientes, el derecho a la muerte digna y las voluntades anticipadas, ya que se expresan a través de elementos dispersos y desorganizados por lo que se observa que la representación no está aún estructurada, sin embargo en la categoría de las voluntades anticipadas se reconoce el conocimiento de estas por la dimensión actitudinal , la suscripción de las voluntades y la asignación de un subrogado. La temática relacionada con la muerte y las decisiones al final de la vida no son discutidos con la familia, así como tampoco con el personal médico. Cuando se aborda la relación persona asistencial- paciente aparece tras una experiencia negativa la Intersubjetividad estructurada. Existe un rechazo al derecho a morir dignamente, al asociarlo a la eutanasia y aspectos de la religión profesada. CONCLUSIONES :Se debe trabajar en construir una cultura de muerte para médicos y pacientes que conduzcan a mejores decisiones al final de la vida, involucrando a la familia, con estrategias de comunicación integrales, que involucren mitos, aspectos religiosos y mejora de la difusión de la información.INTRODUCTION: The most patients with advanced chronic kidney disease are older, have a high burden of comorbidity and disability, which makes the decision-making a complex process, patients are not all candidates for renal replacement therapies, and maybe have to be suspended when these therapies are futile. Social representations about living wills and the right to die with dignity in older people with chronic kidney disease have not been investigated. This study addressed social representations about the right to die with dignity, in search of greater humanization of medicine, and to improve understanding of the process that leads to death. DESIGN AND METHOD: qualitative study supported by the theory of social representations; based on semi-structured interviews with 12 patients over 60 in the pre-dialysis, dialysis and kidney transplant programs of the San Ignacio Hospital and approved by the research and ethics committee. The analysis was carried out between 2018 and 2019. For the analysis, the NVivo12 program was used, which codes as initial categories: patient rights, right to die with dignity, dignified death and anticipated wills. Analyzing the dimensions of social representations: information, attitude and representation field. RESULTS AND DISCUSSION: Patients interviewed do not have a structure of representation field, the rights of patients, the right to death and living will, since they are expressed through dispersed and disorganized elements, however, in the category of living wills, their knowledge is recognized by the attitudinal dimension, the subscription of the wills and the assignment of a subrogation. The issue related to death and decisions at the end of life are not discussed with the family or medical staff. When it comes to the care-patient relationship, structured intersubjectivity appears after a negative experience. There is a rejection of the right to die with dignity, when associated with euthanasia and aspects of professed religion. CONCLUSIONS: We must work to build a culture of death for health staff and patients that leads to better decisions at the end of life, involving the family, with comprehensive communication strategies, involving myths, religious aspects and improving the information dissemination.Especialista en GeriatríaEspecializació

Valoración geriátrica integral : ¿tienen acceso a ella los adultos mayores institucionalizados en Colombia? reflexión desde lo encontrado en un hogar geriátrico

El presente artículo de reflexión parte de un estudio transversal realizado en un hogar geriátrico de la ciudad de Tunja, Colombia. Se tomaron datos de 64 adultos mayores. Se preguntó sobre el acceso a la valoración geriátrica integral y se evaluaron otras esferas como la nutrición, la cognición, comorbilidades y funcionalidad. Encontramos que ningún adulto mayor de dicho hogar había tenido una valoración geriátrica integral previamente y una gran proporción tenían alteraciones nutricionales, depresión y polifarmacia. Al ser una muestra a conveniencia no se pueden extrapolar los resultados a la población en general. Sin embargo, se generan muchos interrogantes y esto nos lleva a reflexionar sobre la necesidad de estudios que describan más a fondo esta problemática en todo el país y la necesidad de personal capacitado para afrontar esta situación. Creando la hipótesis desde la experiencia según la cual la falta de implementación de la valoración geriátrica integral (herramienta mundialmente probada como la estrategia estándar para la prevención, el diagnóstico y el tratamiento de síndromes y enfermedades en los adultos mayores) se produce por el gran desconocimiento por parte del sistema de salud y de los prestadores de esos servicios.Adultos mayoresThe present investigation is a cross-sectional, descriptive study, which was carried out in a nursing home in the city of Tunja, Colombia. Data was collected from 64 older adults who were inquired regarding previous access to comprehensive geriatric assessment; other areas such as nutrition, cognition, comorbidities and functionality were explored as well. Our findings revealed that none of the older adults evaluated had had access to an integral geriatric assessment previously. In many of them, findings suggestive of malnutrition were demonstrated, along with depression and poly-pharmacy. Data was collected through convenience sampling; therefore it cannot be extrapolated to the entire population. However, our findings raise many questions and lead us to deeply reflect on the need for studies describing similar issues at a national and regional level. Additionally, we propose the following hypothesis: The lack of implementation of comprehensive geriatric assessment (widely proved as the best tool for prevention, diagnosis and treatment of syndromes and diseases in older adults) might be due to lack of knowledge and training, which turns into the urge for trained personnel to adequately approach the elderly.Revista Internacional - Indexad

Asociación entre tamización de cáncer de próstata, vinculación al sistema de salud y factores asociados en adultos mayores: análisis secundario de la encuesta SABE Bogotá, Colombia

Introduction Prostate cancer is a high prevalence disease in our male population. Early diagnosis is important in order to improve its prognosis. The aim of this article is to describe the factors associated with prostate cancer screening of older adults in Bogotá, Colombia. Materials and methods The study used data from the Bogotá 2012 Health, WellBeing, and Ageing (Salud, Bienestar y Envejecimiento [SABE]) survey, which included 736 men aged 60 years or older. The dependent variable used was self-reported prostate screening in the last 2 years. An analysis was performed to determine the between this variable and socio-demographic variables and comorbidities using multivariate analysis. Results There was a prevalence of prostate cancer of 3.15%, with 57.8% of the population having had at least one prostate examination. Those affiliated to a health insurance scheme were more likely to be screened than the uninsured with an OR: 8.81, 95% CI: 2.92-26.63, P less than .001, as those affiliated to subsidized social security health scheme OR: 3.70, 95% CI: 1.20-11.41, P =.023, respectively). Conclusion There is inequity in the opportunity of screening for prostate cancer according to the type of health insurance scheme. Early detection strategies must be strengthened in order to include the entire population. Further studies are needed to provide more information on this issue. © 2018, Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda., Rio de Janeiro, Brazil

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit