Análisis de la problemática del pie diabético en la Comunidad Valenciana (2009-2013)

Introducción: Las úlceras son la principal causa de hospitalización en el paciente diabético y motivo de complicaciones, como la amputación de miembro inferior. Objetivos: Conocer y analizar los ingresos de pacientes diabéticos con úlcera en el pie en los hospitales públicos de la Comunidad Valenciana durante el periodo 2009-2013, según bases de datos hospitalarios. Calcular las estancias, tasas y costes de dichos ingresos. Determinar la relación entre ingresos y el registro de podólogos ejercientes colegiados. Conocer la formación, prevención y recursos materiales que existen en los centros de atención primaria de la ciudad de Valencia en relación con la úlcera de pie diabético. Material y método: Estudio observacional, ecológico, retrospectivo y descriptivo con componentes analíticos. Se analizaron los ingresos por úlcera de miembro inferior de pacientes diabéticos, durante el periodo 2009-2013, registrados en el CMBD de hospitales públicos de agudos de la Comunidad Valenciana. Resultados: Se registraron 2.702 altas durante los cinco años de estudio, con una media de 547,6 ingresos por año. Los hombres presentaron el 69% de los episodios y el grupo entre 75-79 años fue el que mayor número de ingresos presentó (373). El Hospital General de Alicante fue el que atendió más casos, con 460 episodios y en cinco centros se acumuló el 50% de la actividad asistencial. Los pacientes fueron atendidos de urgencia (2.314) por los servicios de cirugía vascular, cirugía general y medicina interna, en este orden, siendo el alta, en su mayoría, a domicilio (1.884). El 59% fue amputado, el 21% precisó un desbridamiento quirúrgico y el 6% revascularización. Las patologías asociadas más frecuentes fueron la hipertensión arterial (12,5%), la angiopatía periférica (6%) y la gangrena (5%). La estancia media fue de 11,4 días por ingreso y un coste medio de 7.632 euros. La tasa acumulada durante estos 5 años fue de 5,33 casos/10.000 habitantes en hospitales de agudos. No se encontró relación estadísticamente significativa entre los ingresos y el registro de podólogos ejercientes. La asistencia en atención primaria la ejercen mayoritariamente mujeres (87%), la mitad tiene más de 51 años y 16 años de experiencia. Los recursos materiales son escasos, salvo el martillo de reflejos del que todos disponen, y los protocolos no son cometidos. El 80% mejoraría la prevención y todos incluirían al podólogo en los equipos multidisciplinares de atención de pacientes con pie diabético. Conclusiones: La úlcera de pie diabético va en aumento en el número de ingresos hospitalarios agudos en la Comunidad Valenciana y requiere un elevado coste socioeconómico. Entre 2009-2013 se atendieron 2.702 ingresos Las tasas obtenidas muestran un total de 5,33 casos/ 10.000 habitantes, en los cinco años de estudio. Las estancias totales fueron 30.886 días y su media fue de 11,4 días con un coste de 7.632,99 euros por ingreso. Los hombres presentaron más del doble de ingresos siendo en el grupo entre los 75-79 años el mayor número de casos atendidos. Los ingresos hospitalarios fueron de urgencia y atendidos en el servicio de cirugía vascular. La prevención y la inclusión de podólogos en equipos multidisciplinares son fundamentales para evitar futuras complicaciones como la amputación.ANALYSIS OF THE DIABETIC FOOT PROBLEM IN THE VALENCIAN PROVINCE (2009-2013) INTRODUCTION: Ulcers are the principal cause of hospitalization in diabetic patients and of complications like amputation of lower limbs. OBJECTIVES: Know and analyse, by means of the hospital database, the entry of diabetic patients with foot ulcers into public hospitals in the province of Valencia during the period between 2009 and 2013. Calculate the stay, taxes and cost of the hospitalization. Determine the relationship between hospital entry and the podiatry registry. Understand education, prevention, and material resources that exist in primary health care centers in the city of Valencia with regards to ulcers and the diabetic foot. MATERIALS AND METHOD: A descriptive retrospective observational ecological study with analytical components. An analysis of those diabetic patients hospitalized because of ulcers in the lower limb during 2009 and 2013, registered in MBDS within the public hospitals of the Valencian province. RESULTS: 2.702 patients were registered in hospitals during the five year period of the study, with an average of 547,6 entries per year. Men present 69% of the episodes whilst the age group of 75 to 79 year olds had the most hospital entries (373). The General Hospital of Alicante attended the most cases, a total of 460 episodes in five centers accumulating 50% of the assistance given. Patients were seen in emergency room (2.314), vascular surgery, general surgery and internal medicine units, in that order, mostly being discharged at home (1.884). 59% had amputations, 21% needed surgical debridement and 6% revascularization. The most frequent pathologies associated were arterial hypertension (12.5%), peripheral angioplasty (6%) and gangrene (5%). The average duration of stay was 11,4 days at an average cost of 7.632 euros. The accumulative rate over the five years was 5,33 cases /10.000 habitants in acute care hospitals. No statistical relevance was found between hospital entry and the working registered podiatrists. Primary care assistance is provided mainly by females (87%), over half being over 51 years of age and with 16 years’ work experience. The resources and materials are scarse, except for the reflex hammer which is readily available to everyone although protocols are not followed. 80% would improve prevention and all would include a podiatrist within the multidiscipline team to assist diabetic foot patients. CONCLUSIONS: Diabetic foot ulcers are increasing the numbers of acute hospitalization within the Valencian province which requires an elevated social-economic cost. Between 2009-2013 2.702 income rates obtained show a total of 5,33 cases / 10.000 inhabitants in the five years of study were treated. Total stays were 30.886 days and the average was 11,4 days with a cost of 7.632 euros per admission. Men showed more than twice the revenue being in the group between 75-79 years the largest number of cases handled. Hospital admissions were treated in the emergency and vascular surgery. The prevention and the inclusion of a podiatrist within a multidiscipline group are fundamental to avoid further complications such as amputation. Key words: Diabetic foot. Ulcers. MBD

Comparative study between nail retraining with gauze bandaging and the nail remodeling with acrylics as a conservative treatment for stage I and IIa onychocryptosis

Objective: Onychocryptosis is one of the most prevalent onychopathies, being a frequent reason for consultation in podiatric clinical practice. Conservative treatments are the first therapeutic choice, with nail remodeling using clotrimazole gel emerging as an alternative, although its medium-term effectiveness is unknown. The objective of this study was therefore to compare the efficacy of the technique of nail retraining using gauze bandaging with that of nail remodeling for the conservative treatment of stage I and IIA onychocryptosis. Methods: An analytical, randomized clinical trial study was performed following a longitudinal and prospective design. A sample was selected of 20 subjects presenting stage I and IIA onychocryptosis. Of these, 10 cases formed the group of nail retraining using gauze bandaging, and the other 10 the nail remodeling group. The presence of recurrence in a 3-month period was evaluated. Results: Before the intervention, the patients in the retraining group presented pain of 6.7 ± 1.9 vs. 6.8 ± 1.6 in the remodeling group, with no significant difference between the two (p = 0.900). After the 3-month follow-up period, seven of the retraining group patients presented recurrence of onychocryptosis vs. only one in the remodeling group. Conclusion: The technique of nail remodeling has a lower recurrence rate than that of nail retraining with gauze bandaging, with the pain, inflammation, and infection reported being less, and with greater patient satisfactio

Risk factors and associated factors for calcaneal apophysitis (Sever’s disease) a systematic review

Objectives The aim of this review was to identify the potential intrinsic and extrinsic risk factors (RFs), associated factors (AFs) and consequences of developing calcaneal apophysitis (CA). Design Systematic review. Data sources Cochrane Library, Embase, Medline Ovid, PubMed, Web of Science and Evidence, searched from inception to April 2021. Eligibility criteria We included cohort, case–control and cross-sectional studies that were conducted in patients younger than 18 years who were exposed to RFs or who presented with factors associated with developing CA. Studies in languages other than English or Spanish were excluded. Data extraction and synthesis Two reviewers worked independently to evaluate the risk of bias of included studies. The Newcastle–Ottawa Scale (adapted version) was used. Results A total of 736 studies were identified and 11 observational studies fully met the inclusion criteria, including 1265 participants with a mean age of 10.72 years. Four studies identified extrinsic factors, 10 identified intrinsic factors and three identified both. The extrinsic and intrinsic RFs, AFs and consequences of CA include limitation of ankle dorsiflexion, foot alignment, stiffness and mobility of the midfoot, plantar pressures and ground reaction force, body mass index, age, gender, presence of other osteochondroses and practice of sport. The risk of bias varied, being either moderate or low. Conclusions Regarding the factors and consequences associated with CA (Sever’s disease), ankle dorsiflexion limitation is the most frequent intrinsic factor studied, followed by peak plantar pressures and foot malalignment. However, disagreements between the investigators of the included studies were found; in some cases, there is a lack of unanimity between different studies as to which factors are considered to be RFs, AFs and consequences. PROSPERO registration number CRD42021246366

Hospitalisation cost of patients with diabetic foot ulcers in Valencia (Spain) in the period 2009-2013 : a retrospective descriptive analysis

Ulcers are the main cause of hospitalisation and clinical complications in patients with diabetes. We analyse the length and cost of hospital stay of patients with diabetic foot ulcers, taking into consideration that hospitalisation and, if necessary, amputation represent the greatest area of expense to the healthcare system for such patients. This analysis focuses on the treatment provided to these patients in public hospitals in the region of Valencia (Spain), registered in the Spanish Minimum Basic Data Set, during the period 2009-2013. The number of acute hospital admissions in this respect is increasing and has a high socioeconomic cost. During the study period, there were over 2700 hospital admissions, an average of nearly 550 per year. The total hospital stay for these patients was 30,886 days, with an average of 11.4 days and a cost of 7633 per admission. Preventive policies and the deployment of multidisciplinary teams are essential to reduce these costs and avoid future complications such as amputation

Universidad y sociedad: comunicación e integración en empresas e instituciones públicas y organizaciones no lucrativas. Nuevos avances

Depto. de Teorías y Análisis de la ComunicaciónFac. de Ciencias de la InformaciónFALSEsubmitte

Memoria del segundo simposium sobre historia, sociedad y cultura de México y América Latina

La presente obra reúne 20 ponencias de las 27 que se presentaron en el “Segundo simposium sobre historia, sociedad y cultura de México y América Latina”, realizado el 8 y 9 de noviembre de 2006, en el Centro de Investigación en Ciencias Sociales y Humanidades (CICSyH) de la Universidad Autónoma del Estado de México (UAEM), en Toluca, Estado de México

Derecho a una buena visión en los mayores: evitar la ceguera evitable. Prevención y cuidados para una atención integral

Este documento, que constituye el nº 8 de la colección Promoción de la salud en las personas mayores, pretende abordar buena parte de los problemas de salud de este colectivo aportando criterios y metodología para la intervención a sus cuidadores y responsables de salud