L’etapa de consolidació del CEA de Sant Joan de Déu – Serveis de Salut Mental: un relat en primera persona des de la memòria imperfecta

Serveis de salut mental; Assistència psiquiàtrica; BioèticaServicios de salud mental; Asistencia psiquiátrica; BioéticaMental health services; Psychiatric assistance; BioethicsL’autor ens explica en primera persona com la reflexió ètica va ser un pilar fonamental en el procés de transformació d’un hospital psiquiàtric tradicional i en la necessària superació d’una cultura asilar basada en una visió paternalista i en uns valors que contradeien els nous enfocaments cap a una salut mental comunitària

Voluntats anticipades: dificultats per a la posada en pràctica i finestres d’oportunitat: taula de valors

Declaració de voluntats anticipades; Testament vital; Malalties cròniquesLiving Will Declaration; Chronic diseasesDeclaración de voluntades anticipadas; Testamento vital; Enfermedades crónicasEl present article es centra en les polítiques que tendeixen a incrementar el percentatge de ciutadans amb declaració de voluntats anticipades (DVA) en el context de les malalties cròniques complexes

Nutritional Status According to the GLIM Criteria in Patients with Chronic Heart Failure : association with Prognosis

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria were recently proposed to build a global consensus on the diagnostic criteria for malnutrition. This study aimed to evaluate the GLIM criteria for its prognostic significance in outpatients with heart failure (HF), and to compare them to a previous validated method, such as the Mini Nutritional Assessment (MNA). Methods: This was a post hoc observational analysis of a prospectively recruited cohort, which included 151 subjects that attended an outpatient HF clinic. At baseline, all patients completed the nutritional screening MNA short form and the nutritional assessment MNA. In a post hoc analysis, we evaluated the GLIM criteria at baseline. The outcomes were based on data from a five-year follow-up. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular (CV) mortality and recurrent HF-related hospitalizations. We also investigated whether the GLIM criteria had better prognostic power than the MNA. Results: Abnormal nutritional status was identified in 19.8% of the patients with the GLIM criteria and in 25.1% with the MNA. In the multivariate analyses (age, sex, NYHA functional class, diabetes, and Barthel index), nutritional status assessed by the MNA, but not by the GLIM criteria, was an independent predictor of all-cause mortality, CV mortality, and recurrent HF-related hospitalizations during the five-year follow-up. Conclusions: Malnutrition assessed by MNA, but not by the GLIM criteria, was an independent predictor of all-cause mortality, CV mortality, and recurrent HF-related hospitalization in our cohort of outpatients with HF

Propostes d'acció per a un model col·laboratiu entre serveis sanitaris i serveis socials bàsics

Serveis sanitaris; Serveis socials bàsics; Model d'acció i col·laboracióServicios sanitarios; Servicios sociales básicos; Modelo de acción y colaboraciónHealth services; Basic social services; Action and collaboration modelDocument que recull models d'acció i col·laboració entre els serveis sanitaris i els serveis socials amb l'objectiu de promoure estratègies conjuntes de treball entre tots dos sistemes per poder abordar els problemes comuns detectats

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection