Quality of life after hip fracture: a 12-month prospective study

ANTECEDENTES: La fractura de cadera es un problema de salud importante y frecuente en todo el mundo. Hasta la fecha, todavía son limitados los estudios centrados en el análisis de la calidad de vida relacionada con la salud (CVRS) tras una fractura de cadera en la población española, especialmente con un seguimiento a largo plazo. OBJETIVO: Determinar la CVRS a los 12 meses de la fractura de cadera e identificar posibles factores asociados a la CVRS. DISEÑO: Estudio observacional prospectivo. LUGAR: Unidades de traumatología de dos hospitales universitarios de la provincia de Cáceres (España). PARTICIPANTES: Un total de 224 pacientes ingresados en la unidad que requirieron cirugía inmediata por fractura de cadera. MÉTODOS: La CVRS se midió con el cuestionario EuroQol-5D (EQ-5D) y la encuesta de salud SF-12. RESULTADOS: Las puntuaciones de la escala analógica visual EQ-5D disminuyeron significativamente (p < 0,001) de 72,8 al inicio a 48,3 después de 1 mes, a 48,2 después de 6 meses y a 46,1 después de 12 meses. La puntuación del índice EQ-5D mostró una reducción significativa similar (p < 0,001) de 0,6 a 0,1, 0,3 y 0,3, respectivamente. Los valores del resumen del componente físico (PCS-12) disminuyeron significativamente (p < 0,001) de 38,6 al inicio a 31,0, 33,1 y 33,5. El resumen del componente mental (MCS-12) disminuyó de 46,5 a 44,8 después de 6 meses (p = 0,022) y 44,3 después de 12 meses (p = 0,005). Los factores potencialmente asociados con la CVRS a los 12 meses después de la fractura de cadera fueron el estado de depresión después de los 12 meses (B = 0-1,876; IC del 95% [-2,409 a -1,343]; p < 0. 001), la clasificación de la deambulación funcional después de 12 meses (B = -12,133; IC 95% [-17,970 a -6,297]; p < 0,001), la EQ-5D VAS al inicio (B = 0,223; IC 95% [0,115-0,330]; p < 0,001), y la edad (B = -0,323; IC 95% [-0,594 a -0,053; p = 0,015). CONCLUSIONES: Los pacientes experimentan un deterioro significativo de la CVRS H tras una fractura de cadera, especialmente en el autocuidado, el dolor/malestar, las actividades habituales, la movilidad y la ansiedad/depresión. El deterioro de la CVRS es efectivo el primer mes y dura al menos 12 meses después de la intervención quirúrgica.BACKGROUND: Hip fracture is an important and frequent health problem worldwide. To date, there are still limited studies focused on the analysis of health-related quality of life (HRQOL) after a hip fracture in the Spanish population, especially with long-term follow-up. OBJECTIVE: To determine the HRQOL at 12 months after hip fracture and to identify potential factors associated with HRQOL. DESIGN: Prospective observational study. SETTING: Traumatology units of two university hospitals in province Cáceres (Spain). PARTICIPANTS: A total of 224 patients were admitted to the unit and required immediate surgery due to a hip fracture. METHODS: HRQOL was measured with the EuroQol-5D questionnaire (EQ-5D) and the SF-12 Health Survey. RESULTS: Scores from the visual analog scale EQ-5D decreased significantly (p < 0.001) from 72.8 at baseline to 48.3 after 1 month, to 48.2 after 6 months and to 46.1 after 12 months. The EQ-5D index score showed a similar significant reduction (p < 0.001) from 0.6 to 0.1, 0.3 and 0.3, respectively. Values of the physical component summary (PCS-12) significantly decreased (p < 0.001) from 38.6 at baseline to 31.0, 33.1 and 33.5. The mental component summary (MCS-12) decreased from 46.5 to 44.8 after 6 months (p = 0.022) and 44.3 after 12 months (p = 0.005). Factors potentially associated with HRQOL at 12 months after hip fracture were depression status after 12 months (B = 0–1.876; 95% CI [−2.409 to −1.343]; p < 0.001), functional ambulation classification after 12 months (B = −12.133; 95% CI [−17.970 to −6.297]; p < 0.001), EQ-5D VAS at baseline (B = 0.223; 95% CI [0.115–0.330]; p < 0.001), and age (B = −0.323; 95% CI [−0.594 to −0.053; p = 0.015). CONCLUSIONS: Patients experience a significant impairment in HRQOL H after a hip fracture, especially in self-care, pain/discomfort, usual activities, mobility and anxiety/depression. The decline in the HRQOL is effective the first month and lasts at least 12 months after the surgical intervention.peerReviewe

Quality of life in elderly people after a hip fracture: a prospective study

ANTECEDENTES: La fractura de cadera es un importante problema social y médico por su creciente prevalencia, las consecuencias para la salud y el impacto económico en el sistema sanitario, pero no cabe duda de que también repercute en la calidad de vida relacionada con la salud (CVRS). De ahí la importancia de conocer y determinar el impacto de la enfermedad en la vida cotidiana desde la perspectiva del bienestar físico, emocional y social del paciente. PROPÓSITO: Determinar el impacto de la fractura de cadera en la CVRS de las personas mayores de 65 años un mes después de la cirugía, los factores relacionados y los efectos en la capacidad funcional y el estado de ánimo. MÉTODOS: Estudio observacional prospectivo realizado en las unidades de traumatología de dos hospitales universitarios de la provincia de Cáceres con muestreo consecutivo de todos los pacientes mayores de 65 años ingresados por cirugía de fractura de cadera durante el periodo de estudio. Se registraron datos sociodemográficos y clínicos en el momento del ingreso y de forma prospectiva en la visita de seguimiento 1 mes después. Se recogieron variables clínicas, sociales, de calidad de vida (EQ-5D-), de capacidad funcional e instrumental básica (Índice de Barthel (BI) y Escala de Lawton y Brody) y de depresión geriátrica (Yesavage). RESULTADOS: El estudio incluyó 224 pacientes con una edad media de 84,6 años (DE ± 6,1), el 76,3% eran mujeres. La comorbilidad de Charlson fue de 5,3 (DE ± 1,2). El índice EQ-5D disminuyó de 0,62 (DE ± 0,35) a 0,16 al mes de seguimiento (DE ± 0,20) p < 0,001. La puntuación media de la Escala Visual Analógica (EVA) del EQ-5D disminuyó de 72,8 (DE ± 15,8) a 48,3 (DE ± 17,2) p < 0,001. Todas las dimensiones de la EQ-5D mostraron una reducción significativa desde el momento del estado previo a la fractura hasta 1 mes después de la cirugía. Los factores independientes asociados con la CVRS 1 mes después de la cirugía fueron la puntuación del Índice de Barthel antes de la fractura, la escala de Lawton y Brody, la presencia de depresión y el tipo de cirugía. CONCLUSIONES: Después de una fractura de cadera, los pacientes experimentan un deterioro considerable de su CVRS, especialmente en el cuidado personal, las actividades diarias y la movilidad. También se produce una disminución significativa de la capacidad funcional para las actividades básicas e instrumentales de la vida diaria. Un mes después de la cirugía, la CVRS está muy lejos de los niveles previos a la fractura.BACKGROUND: Hip fracture is an important social and medical problem due to its increasing prevalence, the consequences for health and the economic impact on the health care system, but there is no doubt that it also has repercussions on health-related quality of life (HRQoL). Hence the importance of understanding and determining the impact of the condition on everyday life from the perspective of the patient’s physical, emotional and social well-being. PURPOSE: To determine the impact of hip fracture on HRQoL of people over the age of 65 1 month after surgery, related factors and the effects on functional ability and mood. METHODS: Prospective observational study conducted in the traumatology units of two university hospitals in the province of Cáceres with consecutive sampling of all patients over the age of 65 admitted for hip fracture surgery during the study period. Sociodemographic and clinical data were recorded at the time of admission and prospectively at the follow-up visit 1 month later. Clinical, social, quality of life (EQ-5D-), basic functional and instrumental capacity (Barthel Index (BI) and Lawton & Brody Scale), and geriatric depression (Yesavage) variables were collected. RESULTS: The study included 224 patients with a median age of 84.6 years (SD ± 6.1), 76.3% were female. Charlson’s comorbidity was 5.3 (SD ± 1.2). The EQ-5D index decreased from 0.62 (SD ± 0.35) to 0.16 at 1 month follow up (SD ± 0.20) p < 0.001. The mean Visual Analog Scale (VAS) score of EQ-5D decreased from 72.8 (SD ±15.8) to 48.3 (SD ± 17.2) p < 0.001. All dimensions of EQ-5D showed a significant reduction from the time of pre-fracture status to 1 month after surgery. Independent factors associated with HRQoL 1 month after surgery were pre-fracture status Barthel Index score, Lawton and Brody scale, presence of depression, and type of surgery. CONCLUSIONS: After a hip fracture, patients experience considerable deterioration in their HRQoL, especially in selfcare, daily activities, and mobility. There is also a significant decline in functional capacity for both the basic and instrumental activities of daily living. One month after surgery, HRQoL is a long way from pre-fracture levels.peerReviewe

Mediación y sustracción internacional de menores: buenas prácticas

Grado en Derecho. Derecho Internacional Privado Grupo II, 2020-201[ES]La sustracción internacional de menores tiene su origen en el seno de los conflictos familiares que como siempre plantean numerosas complejidades para ser solucionados, y con más intensidad cuando esos conflictos ocurren entre parejas que en el momento de la ruptura tienen descendientes menores de edad. La globalización ha contribuido al incremento de parejas mixtas, en el que cada sujeto en ocasiones tiene un origen diferente, algo que complica la situación de sus hijos cuando se producen separaciones o divorcios matrimoniales. Principalmente por ese elemento sentimental, que no se aprecia en otros sectores del Derecho, es importante una especial fijación y sensibilidad por el legislador para que se vele siempre por el interés y el bienestar del menor que en algunas ocasiones es el que sale más perjudicado de las situaciones descritas

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

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A facility and community-based assessment of scabies in rural Malawi.

Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control