Atención Integral del Paciente Diabético en el Centro de Salud Nº 150. Departamento Godoy Cruz, Mendoza. Nuestra experiencia.

El siguiente Proyecto de Extensión Mauricio López 2010“Cuidado Integral de Personas con Diabetes desde la Atención Comunitaria” se desarrolló en un Centro de Salud, Bº la Gloria durante el año 2011. Con él pudimos responder a una necesidad que trascendió la atención del consultorio, llegando a una atención integral del paciente, teniendo en cuenta su entorno personal. Nuestro objetivo fue motivar, informar y educar a los pacientes para fomentar y estimular el “autocuidado” frente a una enfermedad crónica, como es la Diabetes, con la finalidad de prevenir o reducir al mínimo las complicaciones crónicas y discapacidades. La población sometida a estudio, se conformó por 168 adultos mayores que asisten espontáneamente al centro de salud. Para fomentar el intercambio se organizaron los talleres de educación terapéutica. El grupo extensionista se conformó por: una médica especialista en Diabetes, dos podólogas, una licenciada en enfermería, una psicóloga, una nutricionista y seis estudiantes de las carreras de medicina, enfermería y de artes plásticas. Para el avance del proyecto, se armó en el Centro de Salud un consultorio de podología. La atención asistencial médica y psicológica fue provista por el consultorio médico-psicológico del Centro de Salud N°150. Durante un período de 12 meses se realizaron 14 talleres de educación terapéutica que abarcaron temas de alimentación, automonitoreo, infecciones, cuidados de la boca, cuidado de los pies, prevención y manera de actuar ante una hipoglucemia o hiperglucemia . Al consultorio de podología asistieron76 pacientes, siendo 61%mujeres y el 38% hombres. La afectación más común fue la hiperqueratosis, en el 47% de las mujeres contra un 14 % de los hombres; la onicomicosis en 52% de los hombres y 47 % de las mujeres. Además la complicación más frecuente fue la neuropatía, presentando una frecuencia similar entre hombres y mujeres (53% y 47%). La vasculopatía diabética fue mayor en mujeres (72%) y (27%) hombres. El trabajo realizado intentó lograr una mayor coherencia y eficiencia del sistema de atención de salud. Además nuestros objetivos fueron alcanzados. El consultorio de podología fue innovador y único en el centro de salud. En su conjunto la atención fue individual y contenedora representando una mejoría en la atención y seguimiento del paciente Diabético

Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models

This is the final version. Available on open access from Nature Research via the DOI in this recordThis study aimed to analyse the trajectories and mortality of multimorbidity patterns in patients aged 65 to 99 years in Catalonia (Spain). Five year (2012–2016) data of 916,619 participants from a primary care, population-based electronic health record database (Information System for Research in Primary Care, SIDIAP) were included in this retrospective cohort study. Individual longitudinal trajectories were modelled with a Hidden Markov Model across multimorbidity patterns. We computed the mortality hazard using Cox regression models to estimate survival in multimorbidity patterns. Ten multimorbidity patterns were originally identified and two more states (death and drop-outs) were subsequently added. At baseline, the most frequent cluster was the Non-Specific Pattern (42%), and the least frequent the Multisystem Pattern (1.6%). Most participants stayed in the same cluster over the 5 year follow-up period, from 92.1% in the Nervous, Musculoskeletal pattern to 59.2% in the Cardio-Circulatory and Renal pattern. The highest mortality rates were observed for patterns that included cardio-circulatory diseases: Cardio-Circulatory and Renal (37.1%); Nervous, Digestive and Circulatory (31.8%); and Cardio-Circulatory, Mental, Respiratory and Genitourinary (28.8%). This study demonstrates the feasibility of characterizing multimorbidity patterns along time. Multimorbidity trajectories were generally stable, although changes in specific multimorbidity patterns were observed. The Hidden Markov Model is useful for modelling transitions across multimorbidity patterns and mortality risk. Our findings suggest that health interventions targeting specific multimorbidity patterns may reduce mortality in patients with multimorbidity.Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain)European Regional Development FundDepartment of Health of the Catalan GovernmentCatalan Governmen

Relationship between the Sensory-Determined Astringency and the Flavanolic Composition of Red Wines

[EN] The relationship between the proanthocyanidin profile and the perceived astringency was assessed in 13 commercial Tempranillo red wines. The concentration and compositional information were obtained by liquid chromatography with diode array detection coupled to electrospray ionization mass spectrometry after acid-catalyzed depolymerization of wine proanthocyanidins in the presence of excess phloroglucinol. Statistical analysis of the results showed significant correlations between sensory and chemical determinations. Astringency was more affected by the subunit composition than by the total concentration or the average degree of polymerization of wine proanthocyanidins. Higher proportions of epicatechin (EC) subunits in extension positions and gallocatechin (GC) subunits in terminal positions were shown to increase astringency. On the contrary, the amount of epigallocatechin (EGC) in both extension and terminal positions was negatively correlated with the perceived astringency

Social, Clinical and Microbiological Differential Characteristics of Tuberculosis among Immigrants in Spain

BACKGROUND: To identify the differential tuberculosis (TB) characteristics within the immigrant population with respect to natives in Spain. METHODOLOGY/PRINCIPAL FINDINGS: A prospective cohort study design was implemented to examine the TB cases diagnosed and starting standard antituberculous treatment in Spain, between January 1st 2006 and March 31st 2007. A logistic regression analysis was performed to determine differential characteristics. 1,490 patients were included in the study population, 1,048 natives and 442 (29.7%) immigrants. According to the multivariate analysis, the following variables were significantly associated with immigrant TB cases: younger age (OR = 3.79; CI:2.16-6.62), living in group situation (OR = 7.61; CI:3.38-12.12), lower frequency of disabled (OR:0.08; CI:0.02-0.26) and retired (OR:0.21; CI:0.09-0.48) employment status, lower frequency of pulmonary disease presentation (OR = 0.47; CI:0.24-0.92), primary or emergency care admission (OR = 1.80; CI:1.05-3.06 and OR = 2.16; CI:1.36-3.45), drug resistance (OR = 1.86; CI:1.01-3.46), treatment default (OR:2.12; CI:1.18-3.81), lower frequency of alcohol and cigarette consumption (OR = 2.10; CI:1.42-3.11 and OR = 2.85; CI:2.10-3.87 respectively), more directly observed treatment (OR = 1.68; CI:1.04-2.69), and poor understanding of TB disease and its treatment (OR = 3.11; CI:1.86-5.20). The low percentage of primary MDR-TB in the native population (0.1% vs. 2.2% of immigrants) should be noted. CONCLUSIONS/SIGNIFICANCE: The differences show the need to introduce specific strategies in the management of TB within the immigrant population, including the improvement of social and work conditions

Personalized Respiratory Medicine: Exploring the Horizon, Addressing the Issues. Summary of a BRN-AJRCCM Workshop Held in Barcelona on June 12, 2014.

This Pulmonary Perspective summarizes the content and main conclusions of an international workshop on personalized respiratory medicine coorganized by the Barcelona Respiratory Network (www.brn.cat)and the AJRCCM in June 2014. It discusses (1) its definition and historical, social, legal, and ethical aspects; (2) the view from different disciplines, including basic science, epidemiology, bioinformatics,and network/systems medicine; (3) the bottlenecks and opportunities identified by some currently ongoing projects; and (4) the implications for the individual, the healthcare system and the pharmaceutical industry. The authors hope that, although it is not a systematic review on the subject,this document can be a useful reference for researchers, clinicians, healthcare managers, policy-makers,and industry parties interested in personalized respiratory medicine