Enfermos crónicos domiciliarios: valoración integral físico-cognitiva y caídas durante 3 años de seguimiento

ObjectiveTo assess the physical and cognitive capacity of chronically ill homebound patients, and the falls they suffered during three years of monitoring.DesignDescriptive, longitudinal study.Setting«Raval Nord» Health District, Barcelona.Patients and other participantsAll the 243 homebound chronic patients registered in the home care programme in May 1996 (67% women, average age 84).Measurements and main resultsAfter three years 16% had gone into an old people's home, 9% had moved house and 38% had died. The probability of not continuing in the programme after three years monitoring was related to less autonomy, presence of comorbidity, and worse cognitive capacity (p < 0.05). Of the 90 patients (37%) who remained active in May 1999, 41% showed disorders on the Short Portable Mental Status Questionnaire (SPMSQ), with a significant relationship to greater age, less autonomy and the presence of comorbidity. Numerous alterations in analysis (21.6%) and linked illnesses (18.9%) were found in the patients with cognitive deterioration. 42% of the patients active in May'99 had fallen during the monitoring period. 10% of the falls involved fractures. The number of falls was higher when there was visual-auditory loss, consumption of psychiatric drugs or absence of use of orthopaedic aids. There was also a greater probability of falls in patients who only had a part-time carer (p < 0.05).ConclusionsIt is important to assess the autonomy, cognitive capacity and comorbidity of homebound chronic patients when monitoring them. Likewise, cognitive disorders and falls must be properly weighed, as they are common in this class of patient

Enfermos crónicos domiciliarios y consumo de psicofármacos

ObjetivoValorar el consumo de psicofármacos en los pacientes crónicos domiciliarios.DiseñoEstudio longitudinal, descriptivo.EmplazamientoÁrea Básica de Salud Raval Nord de Barcelona.Pacientes u otros participantesTodos los 243 enfermos crónicos domiciliarios registrados en el programa de atención domiciliaria en mayo de 1996. A los 3 años un 16% ha ingresado en una residencia, un 9% se ha trasladado de domicilio, un 38% ha fallecido y un 37% permanecía activo.Mediciones y resultados principalesDe los 90 pacientes que seguían activos, un 40% había consumido algún psicofármaco en mayo de 1999. El 8% de los pacientes que refirió consumir psicofármacos lo hacía por automedicación. El grupo farmacológico más consumido entre los psicofármacos era las benzodiazepinas, en un 64%. El consumo de psicofármacos fue superior en el sexo femenino (45%) y en las personas que vivían solas o en estado de viudedad (50%). El porcentaje de pacientes con consumo de psicofármacos fue superior cuando había peor grado de autonomía según el índice de Katz (67%), déficit cognitivo en el Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer (62%) y ante la presencia de comorbilidad (56%) (p < 0,01).ConclusionesExiste un elevado consumo de psicofármacos en los pacientes crónicos domiciliarios, especialmente cuando hay deterioro físico-cognitivo y presencia de comorbilidad.ObjectiveTo assess the consumption of psychiatric drugs by chronic homebound patients.DesignDescriptive, longitudinal study.SettingRaval Nord Health District, Barcelona.Patients and other participantsAll 243 chronically ill homebound patients registered on the home care programme in May 1996. After three years 16% had gone into a home, 9% had moved residence, 38% had died, and 37% remained active.Measurements and main resultsOf the 90 patients still active, 40% took some psychiatric drug in May 1999. 8% of the patients who said they had taken psychiatric drugs did so by self-medication. The most commonly consumed pharmocological group of the psychiatric drugs were benzodiazepines at 64%. Women took more psychiatric drugs (45%), as did persons living alone or who had been bereaved (50%). The proportion of patients taking psychiatric drugs was greater when there was worse autonomy according to the Katz index (67%), a cognitive deficit on the Short Portable Mental Status Questionnaire (SPMSQ) of Pfeiffer (62%), and in the presence of comorbidity (56%) (p < 0.01).ConclusionsThere is high consumption of psychiatric drugs by chronic homebound patients, especially when there is physical-cognitive deterioration and presence of comorbidity

Estudio de prevalencia sobre los hábitos alimentarios y el estado nutricional en población adulta atendida en atención primaria Prevalence of food habits and nutritional status in adult population served in primary care

Introducción: Identificar los hábitos alimentarios y el estado nutricional de la población entre 18-44 años atendida en un centro de salud (CS) y estudiar los factores asociados. Métodos: Estudio transversal realizado en un CS urbano en el que se seleccionó una muestra aleatoria de 201 personas. Se analizaron datos socio-demográficos, medidas antropométricas, recordatorio ingesta últimas 24 horas, cuestionario de frecuencia alimentaria semanal. Resultados: La edad media de los participantes fue de 32,81 años (Desviación Estándar 6,72). El 63,68%(128) eran mujeres y 62,69%(126) inmigrantes. El 45,27%(91) manifestaba no realizar ejercicio. Alrededor del 60% de los participantes refería un consumo deficitario de lácteos, frutas, cárnicos y farináceos y el 80% de verduras; el 58% lo refería excesivo de lípidos. El 44,4%(56) de inmigrantes era obeso respecto al 20,3%(15) de autóctonos (P= 0,001). La proporción de personas con "cintura de riesgo" era superior entre los inmigrantes respecto a los autóctonos (19,0% vs 6,8%; P= 0,017) y entre los que no hacían ejercicio respecto a los que sí (17,6% vs 8,1%; P= 0,049). Los inmigrantes referían realizar menos ejercicio físico que los autóctonos (42,1% vs 62,7%; P= 0,013). Ser inmigrante era la variable más explicativa de la distribución aceptable de macronutrientes en la ingesta diaria (Odds Ratio 4,7; Intervalo de Confianza del 95% 2,02-11,03). Discusión: Los participantes referían un consumo excesivo de lípidos y deficitario del resto de grupos alimentarios. La obesidad y la "cintura de riesgo" eran más frecuentes entre los inmigrantes y los participantes más sedentarios. Los inmigrantes referían una mejor distribución de macronutrientes en su alimentación diaria.Objective: To identify dietary patterns and nutritional status of the population between 18-44 years visited at a health center (HC) and explore the associated factors. Methods: Cross-sectional study conducted in an urban HC in a random sample of 201 people. Were analyzed socio-demographic data, anthropometric measurements, 24 hours latest reminder intake, weekly food frequency questionnaire. Results: The mean age of participants was 32.81 years (standard deviation 6.72). 63.68% (128) were women and 62.69% (126) immigrants. 45.27% (91) expressed no exercise. About 60% of participants related a deficit in consumption milk, fruits, meat and farinaceous and 80% vegetables, 58% related excessive fat. 44.4% (56) of immigrants was 20.3% with respect to obese (15) of native (P = 0.001). The proportion of people with "waist-risk" was higher among immigrants as compared to the native (19.0% vs 6.8%, P = 0.017) and among those who did not exercise with respect to each other (17.6% vs 8.1%, P = 0.049). Immigrants perform less physical activity related to the native (42.1% vs 62.7%, P = 0.013). Being an immigrant was the variable explaining of distribution acceptable daily macronutrient intake (Odds Ratio 4.7, Confidence Interval 95% 2.02-11.03). Discussion: The participants related excessive consumption of fats and deficient in the rest of food groups. Obesity and the "risk waist" were more common among immigrants and sedentary population. Immigrants talked of a better distribution of nutrients in your daily diet