Paternalism vs. autonomy: are they alternative types of formal care?

This study has been supported by MINECO Project: PSI2014-52464-P-ICESE

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain

Background. Pharmacological non-adherence in chronic diseases is 40–65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. Methods. This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky–Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April–December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. Results. Non-adherence was 48.4% (95% confidence interval (CI): 47.2–49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. Conclusions. It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle

Spanish translation, cultural adaptation and validation of the SarQoL®: a specific health-related quality of life questionnaire for sarcopenia.

peer reviewed[en] BACKGROUND: In 2015, a specific health-related quality of life questionnaire for sarcopenia, SarQoL®, was developed and validated in French. Since then, SarQoL® has been adapted and validated in different languages. We prepared a translation, cultural adaptation and validation of the psychometric properties of the SarQoL® into Spanish. METHODS: A cross-sectional study with 86 participants. The translation and adaptation followed international guidelines with two direct translations, a synthesized version of the direct translations, two reverse translations, consensus by an expert committee of a pre-final version, pre-test by end users and final version. The discriminative power (logistic regression analyses), construct validity (Pearson and Spearman´s correlation), internal consistency (Cronbach´s alpha coefficient), test-retest reliability (intraclass correlation coefficient) and ceiling and floor effects were analyzed. RESULTS: The Spanish version showed good construct validity (high correlation with comparable domains of the SF-36), high internal consistency (Cronbach's alpha coefficient: 0.84) and excellent test-retest reliability (ICC: 0.967, 95%, CI 0.917 - 0.989). However, it had no discriminative power between sarcopenic and non-sarcopenic participants defined with the EWGSOP and FNIH diagnostic criteria of sarcopenia. It did show discriminative power between patients with decreased vs normal muscle strength (54.9 vs. 62.6, p 0.009) and low vs. normal physical performance (57.3 vs. 70.2; p 0.005). No ceiling or floor effect was found. CONCLUSIONS: The Spanish version of SarQoL® has similar psychometric properties to those of the original version of the instrument. It did not discriminate between sarcopenic and non-sarcopenic patients diagnosed according to the EWGSOP or FNIH criteria, but it did with those with low muscle strength and low physical performance

Length of stay in patients admitted for acute heart failure

Objective: To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Methods: Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. Results: We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay <= 7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p < 0.001). Conclusions: A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure

Centenario de Elie Metchnikoff (1845-1916)

Celebramos en este año de 2016 el centenario de la muerte de una de las grandes figuras de la medicina, surgidas a finales del siglo xix y a principios del xx, Elias Metchnikoff, Premio Nobel con Paul Ehrlich en 1908. El objetivo de este trabajo es el de rendir un homenaje a su figura con motivo de este aniversario. Metchnikoff fue quien descubrió y describió el fenómeno de la fagocitosis y en función de ello ha sido considerado como el «padre de la inmunidad celular». En paralelo fue quien acuñó la palabra «gerontología», aplicándola al estudio del envejecimiento en toda su extensión y en cualquiera de sus formas, lo que le convirtió en un pionero del trabajo interdisciplinar. Consideraba que las bacterias intestinales generaban una autointoxicación que envenenaba nuestro organismo y que la acidificación del mismo a través de los bacilos ácidos que contienen los yogures podría contribuir a mantener la salud y a prolongar la vida

La enseñanza médica teórica y en la cabecera del paciente

Lo que corresponde básicamente a la educación pregraduada es formar a médicos de cara al futuro, focalizando esta enseñanza en aquellas materias esenciales que debe conocer cualquier profesional, con independencia de lo que vaya a ser su vía posterior de especialización. Enseñar a saber cómo aprender. Hay que instruir pero, sobre todo, hay que educar. Ser capaces de desarrollar las capacidades y habilidades del estudiante de manera que pueda encontrar por sí mismo las respuestas a los problemas planteados. La función del docente es motivar y potenciar este tipo de actitud en el estudiante. Con la presente revisión se pretende analizar, a través de unas reflexiones basadas en 6 preguntas interrelacionadas, las posibilidades que ofrecen hoy la facultades de medicina para conseguir estos objetivos