Estudio de la hipertensión arterial en una población española de personas mayores: comorbilidad y mortalidad a corto y largo plazo

Tesis doctoral leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura:19 de Noviembre de 201

Evolution of physical function, cognition, depressive mood, and quality of life during the Covid-19 pandemic in prefrail elderly people: A longitudinal cohort study (Covid-Mefap)

Confinement due to the COVID-19 pandemic has had a major impact on the living habits and health of the population, notably in the pre-frail elderly. This study aimed to study the effect of the COVID-19 pandemic on the physical function, mental function (cognition and mood), and quality of life of pre-frail elderly individuals over 70 years of age following confinement as well as to analyze the variables associated with the observed changes. Methods: Observational study of a cohort of pre-frail community-dwelling older adults over 70 years of age during the COVID-19 pandemic conducted in primary care. Variables: The main outcome variables were recorded during face-to-face interviews between December 14 of 2020 and August 12 of 2021 using scales for the evaluation of physical function (Short Physical Performance Battery), cognition (Lobo's Mini-Examen Cognoscitivo), depressive mood (Geriatric Depression Scale), and quality of life (EuroQol-5D-3L). Covariates: sociodemographic data and variables related to the pandemic and general health (social support network, COVID-19 infection, exercising, and leisure activities) were also collected. Analysis: The Student's t-test for paired samples and multivariate linear regression models were employed for the statistical analyses. Results: Ninety-two subjects were included in the study. Physical function, cognition, and depressive mood improved during the pandemic, whereas no changes were observed in quality of life. Suffering from COVID-19 was associated with deterioration of the cognitive function (−1.460; CI95%: −2.710 to −0.211). Conclusion: Confinement due to the COVID-19 pandemic was not associated with a decline in physical function, cognition, depressive mood, or quality of life in pre-frail individuals over 70 years of ageThis study has been partially funded by the Instituto de Salud Carlos III (ISCIII) (project ref.: PI17/01887) and co-funded by the European Union. The study also received funds from the Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP) and the Regional Health Ministry of the Community of Madrid through non-refundable grants from the credits awarded to the Community of Madrid by the Spanish Government Fund COVID-19, included in Law HAC/667/2020. The funders had no role in the study design or decision to publish this articl

Lo que nos preocupa a los médicos. Reflexión y enseñanza: Una experiencia educativa en el Grado de Medicina Universidad Autónoma de Madrid

Los valores clínicos en el ejercicio de la medicina son múltiples y muchas veces los médicos no somos conscientes de los mismos cuando trabajamos. No existen técnicas suficientemente contrastadas para la enseñanza efectiva de la reflexión y el profesionalismo. Objetivos: Integrar la enseñanza del humanismo y del profesionalismo en el currículum del estudiante de medicina en etapas tempranas. Utilizar la reflexión personal, como técnica más efectiva para la docencia del profesionalismo. Material y Métodos: Se invitó, a través del envío de un vídeo, a los estudiantes de 2º curso Medicina, en la asignatura Introducción a la Práctica clínica y tras la rotación por consulta en el centro de salud, a participar en un seminario de reflexión "sobre lo que nos preocupa a los médicos", vivencia de la enfermedad y profesionalismo. La sesión de 90 minutos, fue dirigida por los profesores responsables de la asignatura y grabada. Se acompañó de un observador externo, psiquiatra, para la evaluación posterior. Resultados: Las preocupaciones recogidas fueron: Lograr una calidad humana en la atención al individuo y la comunidad, Habilidades en comunicación, Compromiso emocional. Gestionar sus miedos. Tras el feed back expresan ganaron en confianza, al poder dar salida a sus dudas, y reforzada la vocación médica. Conclusiones: La reflexión se identifica como un componente clave del profesionalismo, y se debiera incluir en los planes de estudio formativos de los profesionales de la saludThe clinical values in the practice of medicine are multiple and many times doctors are not aware of them when we work. There are no sufficiently proven techniques for effective teaching of reflection and professionalism. Objectives: Integrate the teaching of humanism and professionalism in the curriculum of the medical student in early stages. Use personal reflection as the most effective technique for teaching professionalism. Material Methods: Through the sending of a video, the students of the 2nd year Medicine were invited in the subject Introduction to Clinical Practice and after the rotation by consultation in the health center, to participate in a reflection seminar "on what we care about doctors ", experience of the disease and professionalism. The 90-minute session was directed by the teachers responsible for the subject and recorded. He was accompanied by an external observer, a psychiatrist, for further evaluation. Results: The concerns collected were: Achieve a human quality in the attention to the individual and the community, Communication skills, Emotional commitment and Manage your fears. After the feedback they expressed confidence, being able to answer their questions, and reinforced the medical vocation. Conclusions: Reflection is identified as a key component of professionalism, and should be included in the training curricula of health professional

Quality of life and physical activity in prefrail individuals over 70 years in primary care

[ES] Fundamentos: La fragilidad es un problema de creciente magnitud entre los mayores que afecta en mayor proporción a mujeres. La actividad física mejora tanto la funcionalidad como la calidad de vida. Dadas las diferencias en la percepción de la calidad de vida y en la práctica de actividad física entre hombres y mujeres, se planteó como objetivo analizar la asociación entre calidad de vida y actividad física en mayores de 70 años prefrágiles y su relación con el sexo. Métodos: Estudio descriptivo en mayores de 70 años prefrágiles realizado entre junio de 2018 y marzo de 2020 en 12 centros de salud de Madrid. Se recogieron mediante entrevista clínica, variables de actividad física (cuestionario de Yale), calidad de vida (Euroqol-5D); variables sociodemográficas y de salud (comorbilidad, depresión y dolor). Se realizó análisis descriptivo y modelos de regresión lineal múltiple con calidad de vida como variable dependiente (total población y por sexo). Resultados: Participaron en el estudio 206 individuos (152 mujeres), con una edad media de 78 años. Las mujeres presentaron menos comorbilidad (32,3% versus 55,6%) y más dolor (60,5% versus 44,4%) que los hombres. La media de actividad física fue de 40 puntos (55,9% de la puntuación corresponde a pasear relajadamente). La calidad de vida fue de 0,74 según utilidades y de 68 en la EVA-EQ5D, sin diferencias según sexo. Pasear más de 5 horas/semana se asoció a mejor calidad de vida según utilidades (0,08, IC95%: 0,03 a 0,14), y según EVA (5,38, IC95%: 0,25 a 10,51). Conclusiones: La actividad física se asoció a una mejor calidad de vida en población prefrágil mayor de 70 años. [EN] Background: Frailty is an increasing problem among the elderly people and it is more frequent in women. Physical activity improves either the function and quality of life. Given the diferences reported by the literature about the quality of life perception and the physical activity practice between men and women, the aim of this study is to analyze the association between health related quality of life (HRQoL) and physical activity in a pre-frail population and to study its relationship with gender. Methods: Descriptive study in pre-frail individuals over 70 years old assigned to twelve primary care health centers carried out between 2018 Jun and 2020 March in Madrid. The studied variables were registered by clinical interview: Physical activity (Yale), HRQoL (EQ-5D-3L), sociodemographic and clinical variables (comorbidity, depression and pain). Descriptive analysis and multiple linear regression for the whole population and stratified by gender, using the quality of life as dependent variable. Results: The study involved 206 pre-frail individuals (152 women) wih an average age of 78 years. Women had less comorbidity (32.3% versus 55.6%) but more pain (60.5% versus 44.4%) than men. The median of physical activity was 40 points (55.9% of that score was attributable to relaxed walk). HRQoL was 0.74 in utility score and 68 in the EQ-VAS. No differences were found by gender. To walk more than 5 hours a week was found associated with better quality of life by EQ-5D utility score (0.08, IC95%: 0.03 to 0.14), and by EQ-VAS score (5.38, IC95%: 0.25 to 10.51). Conclusions: Physical activity was associated to better quality of life in a pre-frail population of individuals older than 70 years old.El presente estudio ha sido financiado por el Fondo de Investigaciones Sanitarias ISCIII (PI17/01887) y el Fondo Europeo de Desarrollo Regional (“Una forma de construir Europa”). Los financiadores no tuvieron ningún papel en el diseño del estudio o en la decisión de publicar el estudioS

Medical students maintain their humanistic and patient‑centred vocation throughout Medicine Degree in Spain: a study based on narratives

Narrative medicine has great educational potential in the degree of medicine. This study explores for the frst time the use of narrative medicine in relation to longitudinal evolution of medical vocation for the same group of students. In the context of the Degree in Medicine at the Universidad Autónoma de Madrid (Spain), students wrote narratives about what it meant to them to be a doctor at the beginning and end of their studies. The narratives of 338 students of the academic years 2012/13– 2017/18 and 2013/14–2018/19 were analysed and compared. Students mostly pursued a degree in medicine on account of humanistic motivations, which are reinforced throughout their degree. In contrast, up to 10% of students reference to have experienced vocational crises and sufered frustration, with up to 25% of the references pertaining to having made signifcant sacrifces. Students maintain and evolve their humanistic, patient-centred vision throughout their degree studies, despite the difculties they appear to encounter. We suggest that eforts must be made to include more humanistic perspectives in the medical degree to keep this trend, which may improve both the educational experience created in universities and the health care given to patient

Prevalencia de depresión en una cohorte de personas de 65 años o más residentes en la comunidad de Peñagrande: relación con factores sociodemográficos, de salud, de ayuda y red social

Depression has great influence on the burden of disease in the elderly population all over the world. So that, the aim of this study is to assess the prevalence of depression in a population based spanish cohort of people aged 65 years and older (N=762) and to study its associated factors. Logistic regression analysis were run, taking depression as the dependent covariate and sociodemographic, health, social networking and social help factors as independent covariates. The prevalence of depression was 29,7%. Being woman, having low incomes and/or low level of education, having at least one grandchild, having poor self rated health and/or disability and has been given external help were associated with depression in an independent and strong way.La depresión se postula como un factor influyente en la carga de enfermedad en la población mayor a nivel mundial. Por ello, el objetivo de este estudio es determinar la prevalencia de depresión en una cohorte española de base poblacional de personas de edad mayor o igual a 65 años (N=762) y analizar sus factores asociados. Se realizaron análisis de regresión logística, utilizando la variable depresión como dependiente y variables sociodemográficas, de estado de salud, de red de apoyo y ayuda social como independientes. La prevalencia de depresión fue del 29,7%. Las variables: ser mujer, tener bajos ingresos económicos, nivel de instrucción bajo, tener al menos un nieto/a, haber recibido ayuda externa, tener mala salud autopercibida y discapacidad, se asociaron de forma independiente y robusta a la depresión

Diabetes in older people: Prevalence, incidence and its association with medium- and long-term mortality from all causes

AbstractObjectiveTo estimate the prevalence and incidence of self-reported diabetes and to study its association with medium- and long-term mortality from all causes in persons ≥65 years.DesignA population-based cohort study begun in 1993.Setting“Envejecer en Leganés” cohort (Madrid).ParticipantsA random sample of persons ≥65 years (n=1277 in the 1993 baseline sample).MethodsParticipants were classified as having diabetes if they so reported and had consulted a physician for this reason within the last year. Diabetes history was categorized in <10 and ≥10 years in 1993. Incidence density was calculated in 2-year periods in non-diabetic individuals (1965 persons/2 years). Vital status was recorded on 31 December 2011. The association between diabetes history ≥10 years and mortality at 6 and 18 years follow-up was studied by the Kaplan–Meier and Cox regression analyses after adjusting for age, sex, heart disease and comorbidity.ResultsThe prevalence of self-reported diabetes rose from 10.3% in 1993 to 16.1% in 1999 (p≤0.001) and was higher in women than men (p≤0.05). Total incidence density was 2.6 cases/100 persons/2 years (95% CI: 2.0–3.3). Medium- and long-term mortality was higher in persons with diabetes history ≥10 years than in non-diabetic individuals (HR: 2.0; 95% CI: 1.2–3.3 and HR: 1.7; 95% CI: 1.1–2.5, respectively). In diabetics with history <10 years the HR was 1.3 (95% CI: 0.9–1.9) and HR: 1.5 (95% CI: 1.2–1.9, respectively).ConclusionsAlthough diabetes is clearly associated with increased risk of mortality, it is significant only for patients with ≥10 years’ history of diabetes

Towards an Open Medical School without Checkerboards during the COVID-19 Pandemic: How to Flexibly Self-Manage General Surgery Practices in Hospitals?

Background: Can we create a technological solution to flexibly self-manage undergraduate General Surgery practices within hospitals? Before the pandemic, the management of clerkships was starting to depend less on checkerboards. This study aims to explore undergraduates’ perceptions of doing rotations in teaching hospitals using different teaching styles and elicit their views regarding the options of managing practices to design a mobile app that substitutes for checkerboards. Methods: In this sequential exploratory mixed methods study, 38 semi-structured interviews at a teaching hospital were conducted. The data was used to survey 124 students doing their rotations in four teaching hospitals during the first wave of COVID-19. Results: 21 themes highlighted concerns related to the practices, the teacher involvement in the students’ education, and the students’ adaptation to clinical culture. The students reported positive perceptions concerning self-managing and organizing practices via a mobile application. However, problems emerged regarding transparency, the lack of feedback, and the need for new tools. Regarding the teaching styles, the facilitator and personal models were perceived as optimal, but the personal style had no effect on using or not using a tool. Conclusions: A mobile-learning application designed like an educational opportunities’ manager tool can probably promote self-directed learning, flexible teaching, and bidirectional assessments. However, teachers who employ a personal teaching style may not need either checkerboards or a tool. This solution supports teaching at hospitals in pandemic times without checkerboards

Mortality among older Spanish people with hip fractures: a population-based matched cohort study

Hospital La Paz Institute for Health Research (PI-1339 Project)Spanish Ministry of Health, Carlos III Institute (FIS: PI 09/2143)RETICEF (Network Research in aging and frailty) (RD 06/0013/1013)4.481 Q2 JCR 20210.911 Q2 SJR 2021No data IDR 2021UE