Interrupción temprana de la lactancia materna. Un estudio cualitativo / Early interruption of breastfeeding. A qualitative study

Objetivo: Conocer la experiencia personal y sentimientos de las mujeres primíparas que se vieron obligadas a abandonar la lactancia materna (LM) antes del tiempo previsto inicialmente por cada mujer, así como las causas del abandono y el papel de los profesionales sanitarios. Método: Estudio cualitativo fenomenológico mediante entrevista semiestructurada. Se realizó un muestreo opinático mediante informadores clave, hasta alcanzar la saturación de la información. Se realizó análisis de contenido cualitativo para generar códigos y asignar categorías. Resultados: Se entrevistaron 15 mujeres de 33,1 (DE 5,4) años. Se constató ambivalencia de sentimientos, considerando que la LM es una experiencia satisfactoria a la par que sacrificada y dolorosa. Las mujeres referían escasez de conocimientos. La inseguridad sobre la alimentación y el dolor físico fueron las causas más importantes para el abandono. Se evidenció además una dualidad de sentimientos entre la tranquilidad que supone la alimentación artificial, al saber que el niño está bien alimentado, y la sensación de culpabilidad por no haber mantenido la LM. Consideraron que los profesionales no realizan adecuadamente su labor de promoción de la LM, refiriendo numerosas ocasiones en las que los propios profesionales sanitarios efectuaron prácticas contrarias a su instauración y mantenimiento. Conclusiones: En el relato de las madres se constatan necesidades formativas y de soporte emocional insuficientemente cubiertas. Las enfermeras implicadas en la atención de estas mujeres deberían explorar sistemáticamente dichas necesidades

Objective: The aim of this study was to discover the personal experience and feelings of primiparous women who had to abandon breastfeeding (BF) before the expected time, as well as the causes of abandonment and the role of health professionals. Method: A qualitative study through semi-structured interview was carried out. A purposive sampling by key informants was conducted, until saturation of the information was reached. Qualitative content analysis was carried out to generate codes and assign categories. Results: We interviewed 15 women aged 33.1 (SD 5.4) years. Ambivalent feelings were found, while BF was considered a satisfying experience, it was also sacrificial and painful. They refer to a lack of knowledge, and insecurity about nourishing their infant and physical pain seem to be the most important reasons for giving up. There is also a duality of feelings between the peace of mind afforded by artificial feeding, knowing that their child is well nourished, and the feeling of guilt for not having maintained BF. They believe that professionals do not adequately perform their work to promote BF, referring to numerous occasions when health professionals themselves have performed practices contrary to its establishment and maintenance. Conclusions: In the mothers' account, emotional training and emotional support needs are insufficiently covered. Nursing professionals involved in the care of these women should systematically explore these needs

Early interruption of breastfeeding. A qualitative study. / Interrupción temprana de la lactancia materna. Un estudio cualitativo.

OBJECTIVE: The aim of this study was to discover the personal experience and feelings of primiparous women who had to abandon breastfeeding (BF) before the expected time, as well as the causes of abandonment and the role of health professionals. METHOD: A qualitative study through semi-structured interview was carried out. A purposive sampling by key informants was conducted, until saturation of the information was reached. Qualitative content analysis was carried out to generate codes and assign categories. RESULTS: We interviewed 15 women aged 33.1 (SD 5.4) years. Ambivalent feelings were found, while BF was considered a satisfying experience, it was also sacrificial and painful. They refer to a lack of knowledge, and insecurity about nourishing their infant and physical pain seem to be the most important reasons for giving up. There is also a duality of feelings between the peace of mind afforded by artificial feeding, knowing that their child is well nourished, and the feeling of guilt for not having maintained BF. They believe that professionals do not adequately perform their work to promote BF, referring to numerous occasions when health professionals themselves have performed practices contrary to its establishment and maintenance. CONCLUSIONS: In the mothers' account, emotional training and emotional support needs are insufficiently covered. Nursing professionals involved in the care of these women should systematically explore these needs.

Relación entre el uso del antígeno prostático específico y tratamiento de bloqueo androgénico. Un estudio ecológico / Relationship between prostate-specific antigen testing and androgen deprivation therapy use. An ecological study

Objetivo: Determinar si un mayor número de determinaciones de antígeno prostático específico (nPSA) se asocia a un mayor número de tratamientos de bloqueo androgénico (nTBA). Diseño del estudio: Estudio transversal de tipo ecológico. Emplazamiento: Atención Primaria de ámbito provincial. Participantes: Facultativos titulares con al menos 1 año de permanencia en su plaza. Mediciones principales: Se determinó, para cada cupo de medicina de familia de la provincia de Ourense, el número de varones mayores de 50 años (V50) y su edad, nPSA y nTBA en 2012. Se calculó un tamaño muestral de 113 médicos. La asociación entre nTBA y nPSA se analizó mediante correlación de Spearman. El nTBA se consideró variable dependiente en un análisis de regresión lineal múltiple, incluyendo como covariables sexo del facultativo, ámbito de ejercicio, V50, edad de los pacientes y nPSA. Se consideró significativo un valor de p<0,05. Resultados: Se estudiaron 265 facultativos, 54,1 % varones. La media de V50 era 272,6 (68,6) y el nTBA era 8,5 (DE 4,0) por cupo, siendo nPSA 90,9 (52,4)/año. Existía relación entre número de V50 y nPSA (Rho de Spearman=0,4; IC95 %: 0,3-0,7; p=0,01), así como entre nTBA y edad de V50 (Rho de Spearman=0,2; IC95 %: 0,04-0,31; p<0,001). Se demostró asociación entre nTBA y nPSA (Rho de Spearman=0,2; IC95 %: 0,04-0,31; p=0,01) y entre número de V50 y nTBA (Rho de Spearman 0,5; IC95 %: 0,75-0,84; p<0,001). La regresión lineal mostró relación entre nTBA y edad de los varones (p<0,001) y número de V50 (p<0,001). Conclusiones: Una mayor frecuencia de PSA no se sigue de un mayor diagnóstico de CP medido por el número de TBA instaurados, estando asociados a la edad y número de varones mayores de 50 años (AU)

Objective: To determine if a larger number of determinations of prostate-specific antigen (PSAn) is associated with an increased number of androgen deprivation therapies (ADTn). Study Design: Transversal ecological study. Setting: Primary care at provincial level. Participants: Permanent general practitioners with at least 1-year tenure. Main measurements: The number of men over 50 (V50) and their age, PSAn and ADTn in 2012 were determined for each family medicine quota in the region of Ourense (Spain). A sample size of 113 physicians was calculated. The association between ADTn and PSAn was analyzed by Spearman correlation. The ADTn was considered as a dependent variable in a multiple linear regression analysis, including as covariates gender of the physician, rural or urban context of work, V50, patient age and PSAn. A p value <0.05 was considered significant. Results: We studied 265 physicians, 54.1% men. V50 average was 272.6 (68.6), ADTn was 8.5 (4.0) per medical quota, and PSAn was 90.9 (52.4)/year. There was a relationship between the number of V50 and PSAn (Spearman´s Rho=0,4; CI95%:0.3-0.7; p=0.01) and between ADTn and age of V50 (Spearman´s Rho=0.2; CI95%:0.04-0.31; p<0.001). Association was found between ADTn and PSAn (Spearman´s Rho=0.2; CI95%:0.04-0.31; p=0.01) and number of V50 and ADTn (Spearman´s Rho=0,5; CI95%: 0,75-0,84; p < 0,001) . Linear regression showed a relationship between ADTn and age of males (p <0.001) and number of V50 (p <0.001). Conclusions: A higher frequency of PSA testing does not follow from an increased diagnosis of PCa measured by the number of ADT, that is associated with the age and number of males over 50 (AU)

Evolución de los factores de riesgo cardiovascular en pacientes sometidos a intervención coronaria percutánea / Evolution of cardiovascular risk factors in patients undergoing percutaneous coronary intervention

OBJETIVO: Controlar los factores de riesgo cardiovascular (FRCV) es importante para el resultado de las prácticas intervencionistas (intervención coronaria percutánea [ICP]) en cardiopatía isquémica. El objetivo de este estudio es comprobar la evolución de los FRCV a 6 meses de su realización y su relación con nuevos episodios. MÉTODO: Se realizó un estudio descriptivo de series de casos retrospectivo. Se determinó edad, sexo y enfermedad renal crónica (ERC), así como colesterol total (CT) y HDL, presión arterial sistólica (PAS) y diastólica (PAD), tabaquismo e IMC antes y 6 meses después de la ICP. La aparición de muerte o nueva ICP se consideró variable dependiente en un análisis de regresión logística. Se consideró significativo un valor de p < 0,05. RESULTADOS: Se incluyeron 222 casos (75,2% varones), con una media de edad de 70,2 (DE 11,9) años. El 57,7% eran hipertensos, el 55,9% tenían hiperlipidemia, el 50,4% eran fumadores o exfumadores y el 28,2%, diabéticos. Tras 6 meses fallecieron el 5%, y el 15,3% necesitaron nueva ICP, mientras que el 33% tenía determinados todos los FRCV. Se constataron disminuciones de PAS (-3,3 mmHg) y PAD (-2,6 mmHg) y CT (-35,2 mg/dl). Un nuevo episodio se asoció con edad (OR: 1,06; p = 0,003) y ERC (OR: 3,7; p = 0,04). CONCLUSIONES: Existe alta prevalencia de FRCV. A los 6 meses constaba un descenso de presión arterial y CT, aunque con control incompleto de FRCV. Una quinta parte de los pacientes sufrieron algún episodio en ese período, observándose asociación con edad y ERC

AIM: Controlling cardiovascular risk factors (CVRF) is important for the outcome of interventional practices (percutaneous coronary intervention [PCI]) in ischemic heart disease. The aim is to determine the evolution of the CVRF 6 months after the intervention and their relationship with new events. Method: A descriptive study was conducted on a case series. The variables recorded were: age, sex and chronic kidney disease (CKD), as well as total (TC) and HDL cholesterol, systolic (SBP) and diastolic blood pressure (DBP), smoking habit, and body mass index (BMI), before PCI and after 6 months. The occurrence of death or new PCI during the follow-up was considered an independent variable in a logistic regression analysis. A P < .05 was assumed significant. RESULTS: A total of 222 cases (75.2% males) were included, with a mean age of 70.2 (SD 11.9) years, of whom 57.7% were hypertensive patients, 55.9% had hyperlipidemia, 50.4% were smokers or ex-smokers, and 28.2% were diabetics. After 6 months, 5% died, and 15.3% needed a new PCI, while 33% of the sample had all the CVRF considered. Decreases were observed in SBP (-3.3 mmHg), DBP (-2.6 mmHg), and TC (-35.2 mg/dl). The emergence of new event was associated with age (OR: 1.06; P = .003) and CKD (OR: 3.7; P = .04). CONCLUSIONS: There is a high prevalence of CVRF. After 6 months, there was a decrease in blood pressure and TC, although incomplete control of CVRF was found. One fifth of the patients had an event in that period, showing association with age and CKD

[Evolution of cardiovascular risk factors in patients undergoing percutaneous coronary intervention]. / Evolución de los factores de riesgo cardiovascular en pacientes sometidos a intervención coronaria percutánea.

AIM: Controlling cardiovascular risk factors (CVRF) is important for the outcome of interventional practices (percutaneous coronary intervention [PCI]) in ischemic heart disease. The aim is to determine the evolution of the CVRF 6 months after the intervention and their relationship with new events. METHOD: A descriptive study was conducted on a case series. The variables recorded were: age, sex and chronic kidney disease (CKD), as well as total (TC) and HDL cholesterol, systolic (SBP) and diastolic blood pressure (DBP), smoking habit, and body mass index (BMI), before PCI and after 6 months. The occurrence of death or new PCI during the follow-up was considered an independent variable in a logistic regression analysis. A P<.05 was assumed significant. RESULTS: A total of 222 cases (75.2% males) were included, with a mean age of 70.2 (SD 11.9) years, of whom 57.7% were hypertensive patients, 55.9% had hyperlipidemia, 50.4% were smokers or ex-smokers, and 28.2% were diabetics. After 6 months, 5% died, and 15.3% needed a new PCI, while 33% of the sample had all the CVRF considered. Decreases were observed in SBP (-3.3 mmHg), DBP (-2.6 mmHg), and TC (-35.2mg/dl). The emergence of new event was associated with age (OR: 1.06; P=.003) and CKD (OR: 3.7; P=.04). CONCLUSIONS: There is a high prevalence of CVRF. After 6 months, there was a decrease in blood pressure and TC, although incomplete control of CVRF was found. One fifth of the patients had an event in that period, showing association with age and CKD.

Adecuación del tratamiento inhalado en pacientes diagnosticados de Enfermedad Pulmonar Obstructiva Crónica / Suitability of inhaled therapy in patients diagnosed with chronic obstructive pulmonary disease (COPD)

Objetivo: Valorar la adecuación a las guías clínicas (GOLD) del tratamiento por vía inhalada de los pacientes diagnosticados de Enfermedad Pulmonar Obstructiva Crónica (EPOC). Diseño del estudio: Estudio observacional transversal de indicación-prescripción. Emplazamiento: Atención Primaria en la provincia de Orense. Participantes: Todos los casos de EPOC incluidos en el registro de pacientes crónicos de 28 cupos de 9 Centros de Salud de la provincia de Orense. Mediciones principales: Se determinó: edad, sexo, datos espirométricos, adecuación diagnóstica según resultados espirométricos y tratamiento farmacológico por vía inhalada (anticolinérgicos de larga duración, corticoides inhalados, beta-2 de larga duración y beta-2 de corta duración). Resultados: Eran varones 297 (77,7%) casos, con una media de edad de 77,0 (DE 11,0) años. El índice VEF1/CVF estaba registrado en 174 (45,5%) pacientes, siendo menor de 0,7 en 138 casos (36,1%), y figurando el VEF1 en 125 casos (90,6%). Fueron clasificados como Graves o Muy graves 71 pacientes (56,8%). El tratamiento era conforme a las recomendaciones en el 26,4% de los casos. En el 19,2% era incorrecto por defecto y en el 54,4% por exceso de medicación, relacionado fundamentalmente con el uso de corticoides inhalados, que estaban correctamente indicados en el 9% de los casos. No existían diferencias en el uso de fármacos en asociación en función de la gravedad de la EPOC. Conclusiones: En la terapia de la EPOC con fármacos inhalados existe una baja adecuación a los criterios recomendados en las principales guías de práctica clínica, sobre todo en el uso de corticoides (AU)

Objective: To assess the compliance of inhaled therapy in patients diagnosed with chronic obstructive lung disease to clinical guidelines (GOLD) Design: Indication/prescription cross-sectional observational study Location: Primary care in the province of Orense Participants: All cases of COPD included in the register for 28 chronic patients in 9 health centres in the province of Orense. Main Surveyed Data. The following were determined: age, sex, spirometric data, adjustment of diagnosis based on spirometric results, and inhaled drug therapy (long-acting anticholinergics, inhaled corticosteroids, long-acting beta-2 and short-acting beta-2) Results: 297 cases (77.7%) were male, with an average age of 77.0 years. The FEV1/ FVC ratio was registered in 174 (45.5%) patients. It was lower than 0.7 in 138 cases (36.1%) and FEV1 appeared in 125 cases (90.6%). 71 patients (56.8%) were classified as severe or very severe. The treatment was in accordance with recommendations in 26,4% of the cases. In 19.2% it was incorrect by default and in 54.4%, through over-medication, related primarily to the use of inhaled corticosteroids, which were correctly indicated in 9% of cases. There were no differences in the use of associated drugs based on the severity of the COPD. Conclusions: In COPD therapy with inhaled drugs, there is a low level of compliance with criteria recommended in the main clinical practice guidelines, especially regarding the use of corticosteroids (AU)

La demora diagnóstica en el cáncer colorrectal en función del medio de procedencia / Delayed diagnosis in colorectal cancer based on background

Objetivo: Determinar la existencia de diferencias en la demora diagnóstica del cáncer colorrectal atribuible al proveedor en función del medio de procedencia (rural/urbano) y valorar la repercusión que esa demora pudiera producir sobre la extensión tumoral medida mediante la estadificación. Diseño del estudio: Estudio observacional transversal. Emplazamiento: Atención sanitaria en la provincia de Orense. Participantes: Todos los pacientes diagnosticados de cáncer colorrectal registrados en el Complejo Hospitalario de Orense en los años 2006 y 2007. Mediciones principales: Se determinó: sexo, edad al diagnóstico, medio de procedencia (rural/urbano), fecha del primer contacto del paciente con el sistema sanitario (médico de familia, urgencias, otros), fecha de estadificación, grado de extensión al diagnóstico y demora diagnóstica (fecha de estadificación menos fecha de primer contacto del paciente). Resultados: Fueron incluidos 549 casos, con una media de edad de 72,6 años (DE 11,2) y 64,5% de procedencia rural. No se constataron diferencias significativas en la estadificación entre ambos medios. La media de la demora diagnóstica era de 87,2 días (DE 119,7), siendo significativamente mayor en el medio rural (95,5 días [DE 135,5]) frente al urbano (71,5 días [DE 79,7]). La regresión lineal mostró que una mayor demora se asociaba a la procedencia rural. Conclusiones: En el cáncer colorrectal, la procedencia rural supone una mayor demora diagnóstica atribuible al proveedor respecto al medio urbano, aunque no se acompaña de una estadificación más avanzada (AU)

Objective: To determine the existence of differences in the delayed diagnosis of colorectal cancer attributable to the provider based on background (rural/urban) and to assess the repercussion that the delay may produce on the extension of the tumour by staging. Design of the study: Cross-sectional observational study Location: Health care service in the province of Orense. Participants: All patients diagnosed with colorectal cancer registered at the Orense Hospital Complex in the years 2006 y 2007. Main measurements. The following were determined: sex and age at time of diagnosis, background (rural/urban), date of the patient's first contact with the health system (family practitioner, emergencies, other), date of staging, degree of extension at time of diagnosis and delay in diagnosis (date of staging minus date of patient's first contact) Results: 549 cases were included, with an average age of 72.6 years (DE 11,2) and 64.5% from a rural background. No significant differences in staging were found between the two areas. The mean delay in diagnosis was 87.2 days (DE 119,7), with a much higher incidence in the rural area (95,5 days [DE 135,5]) than in the urban area (71,5 days [DE 79,7]). The lineal regression showed that a longer delay was associated with the rural area. Conclusions: In colorectal cancer, a rural background implies a greater delay in diagnosis attributable to the provider than in an urban area, although it is not accompanied by (associated with) a more advanced staging (AU)

Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados: estudio transversal multicéntrico / Prevalence of neuropsychiatric symptoms and associated factors in institutionalised dementia patients: a multicentre cross-sectional study

Objetivo. El objetivo fue estimar la prevalencia y la gravedad de los síntomas neuropsiquiátricos en los pacientes con demencia ingresados en centros residenciales, evaluando su asociación con ciertos factores que podrían influir en su aparición. Material y métodos. Se realizó un estudio transversal. Se incluyeron todos los ancianos diagnosticados de demencia degenerativa, vascular o mixta, en estadios 4 a 7 de la Global Deterioration Scale de Reisberg (GDS), y residentes en 6 centros residenciales de la provincia de Ourense (España). Se calculó un tamaño de muestra de 120 individuos. La evaluación de los síntomas se realizó utilizando el Neuropsychiatric Inventory-Nursing Home (NPI-NH). La influencia de los factores considerados se analizó mediante el análisis de regresión lineal y logística. Resultados. Fueron incluidos 212 casos con una media de edad de 85,7 (6,7) años. La prevalencia de síntomas neuropsiquiátricos fue 84,4%. El síntoma más común fue la apatía, seguido por la agitación y el delirio; los menos frecuentes fueron la euforia y las alucinaciones. El síntoma que producía más interrupción ocupacional fue la agitación. El análisis multivariante mostró que una mayor puntuación en el NPI-NH estaba asociada con mayor puntuación en la escala GDS y el uso de neurolépticos, inhibidores de la colinesterasa y memantina. Conclusiones. En los pacientes con demencia institucionalizados los síntomas neuropsiquiátricos que presentan prevalencia elevada se asociaban con la gravedad de la demencia GDS, el uso de neurolépticos, inhibidores de la colinesterasa y memantina(AU)

Objective. The aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence. Material and methods. A cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors. Results. A total of 212 cases were included, with a mean age of 85.7 (SD=6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine. Conclusions. In nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine(AU)

[Prevalence of neuropsychiatric symptoms and associated factors in institutionalised dementia patients: A multicentre cross-sectional study]. / Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados: estudio transversal multicéntrico.

OBJECTIVE: The aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence. MATERIAL AND METHODS: A cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors. RESULTS: A total of 212 cases were included, with a mean age of 85.7 (SD=6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine. CONCLUSIONS: In nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine.

Forma de acceso a los Servicios de Urgencia hospitalarios y pertinencia de la consulta / Means of access to hospital emergency departments and relevance of the consultation

Objetivo. Conocer las diferentes formas de acceso a los Servicios de Urgencia Hospitalarios (SUH), valorar la adecuación de las consultas allí atendidas y analizar la posible asociación entre forma de acceso y adecuación, así como con otros factores relacionados. Diseño. Estudio observacional transversal. Emplazamiento. Servicio de urgencias hospitalario. Participantes. Pacientes que acuden al SUH, espontáneamente o derivados por Servicios de Urgencia Extrahospitalarios (SUE) o médico de atención primaria (MAP). No hubo negativas a contestar. Mediciones principales. Cuestionario elaborado ad hoc con 14 variables: sociodemográficas y otras relacionadas con la forma de remisión y el tipo de consulta en el SUH. La encuesta fue llevada a cabo en el SUH por los investigadores que prestaban la asistencia a la totalidad de los pacientes atendidos por ellos en cada jornada de servicio. Resultados. Fueron analizadas 264 encuestas. El 77,6% (205) de los casos se corresponde con cuadros agudos de inicio y patología de tipo traumatológico. En 74 casos (28,0%) el paciente había consultado previamente a su MAP por este mismo motivo. En los pacientes remitidos por su MAP, en el 68,4% de los casos procedía la consulta en el SUH. En los pacientes que acudían espontáneamente este porcentaje era del 25,7%. No se constataron diferencias en el porcentaje de pacientes en los que no procedía consulta urgente. Los pacientes que acudían espontáneamente al SUH eran más jóvenes (diferencia de medias 9,2 años; IC 95%: 3,4-14,9; p = 0,001) y procedían mayoritariamente del medio urbano (x2 = 9,8; p = 0,002). Conclusiones. La mayoría de los pacientes que demandan atención urgente lo hacen mediante el bypass de los SUE, fenómeno influido por la procedencia urbana, una menor edad y la existencia de ingresos previos. La remisión por SUE o MAP mejora la pertinencia de la consulta en los SUH (AU)

Objective. To determine the different means of access to hospital emergency departments (ED), assess the appropriateness of consultations given there and analyze the possible association between access and appropriateness as well as other related factors. Design. Observational cross-sectional study. Setting. Hospital Emergency Departments. Participants. Patients who go to the ED on their own accord or are referred by Prehospital Emergency Care (PEC) services or a General Practitioner (GP). No-one refused to answer the questionnaire. Measurements. Ad hoc questionnaire with 14 variables: socio-demographic and others related with the means of access and type of consultation in the ED. The survey was conducted in the ED by the researchers who provided care to all patients seen by them on each shift. Results. A total of 264 surveys were analyzed. 77.6% (205) of cases were due to acute episodes of disease onset and trauma related events. At total of 74 (28.0%) patients had previously consulted their GP for the same reason. For 68.4% of the patients referred by their GP and 25% of the patients who came on their own accord the consultation in the ED was appropriate. There were no differences in the percentage of patients whose emergency consultation was not appropriate. Patients who came to ED on their own accord were younger (mean difference 9.2 years, 95% CI: 3.4-14.9, p = 0.001) and mostly came from urban areas (x2 = 9.8, p = 0.002). Conclusions. Most patients requiring emergency care access the ED through the PEC service, this is influenced by the urban origin, younger age and the existence of previous admissions. Referrals by PEC or GP improves the appropriateness of the consultations in the ED (AU)

Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular / Prostate cancer, antiandrogen treatment and cardiovascular risk

Objetivo: Comprobar si las tablas de riesgo cardiovascular (RCV) habitualmente empleadas soncapaces de identificar el incremento de riesgo producido por la terapia de bloqueo androgénico(BA) en los pacientes con cáncer de próstata (CP).Diseño: Estudio de cohortes retrospectivo.Emplazamiento: Centros de salud urbanos y rurales de la provincia de Ourense.Participantes: Pacientes diagnosticados de CP que tenían prescrito tratamiento de BA entre losaños 2007 y 2008.Mediciones principales: Se registró edad, residencia (rural/urbana), estadificación (Gleason),procedimiento diagnóstico y, al comienzo y fin del seguimiento, perfil lipídico, presión arterial,diagnóstico de diabetes mellitus, tabaquismo, uso de fármacos hipotensores e hipolipemiantes,e índices Framingham calibrado y ATP III. Se registraron los eventos cardiovasculares (ECV) alo largo del seguimiento. Cada paciente fue su propio control. Para calcular los índices al finaldel período no se consideró el incremento de edad. Los índices se compararon utilizando la tde Student para muestras apareadas (SPSS 15.0).Resultados: Se incluyeron 209 casos. La media (DE) de edad fue de 73,8 (8,0) años, con un 64,6%de casos urbanos. Los índices al inicio y a los 12 meses de seguimiento fueron: Framingham 9,0(4,6) y 9,2 (4,8) (p = 0,5); ATP III 14,2 (1,7) y 14,2 (1,7) (p = 0,9).Conclusión: Las tablas de RCV no permiten valorar adecuadamente el incremento del riesgoasociado a la terapia de bloqueo androgénico en cáncer de próstata(AU)

Aim: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk causedby androgen deprivation therapy (ADT) in patients with prostate cancer (PCa).Design: Retrospective cohort study.Location: Urban and rural health centres in the province of Ourense.Participants: Patients diagnosed with PCa who had been prescribed treatment for ADT between2007 and 2008.Main measures: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, atthe beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus,smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATPIII indexes, were determined. Cardiovascular events were recorded during the follow-up. Eachpatient was his own control. Increasing age was not used in the calculation of the scores atthe end of the follow up period. The scores were compared using the t-test for paired samples(SPSS 15.0).Results: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6%of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0(4.6) and 9.2 (4.8) (P = 0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P = 0.9).Conclusion: CVR charts do not assess the increased risk associated with androgen deprivationtherapy in prostate cancer(AU)

[Prostate cancer, antiandrogen treatment and cardiovascular risk]. / Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular.

AIM: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk caused by androgen deprivation therapy (ADT) in patients with prostate cancer (PCa). DESIGN: Retrospective cohort study. LOCATION: Urban and rural health centres in the province of Ourense. PARTICIPANTS: Patients diagnosed with PCa who had been prescribed treatment for ADT between 2007 and 2008. MAIN MEASURES: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, at the beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus, smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATP III indexes, were determined. Cardiovascular events were recorded during the follow-up. Each patient was his own control. Increasing age was not used in the calculation of the scores at the end of the follow up period. The scores were compared using the t-test for paired samples (SPSS 15.0). RESULTS: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6% of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0 (4.6) and 9.2 (4.8) (P=0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P=0.9). CONCLUSION: CVR charts do not assess the increased risk associated with androgen deprivation therapy in prostate cancer.

Factores asociados con la aparición de caídas en ancianos institucionalizados: un estudio de cohortes / Risk factors for falls amongst older people living in nursing home. A cohort study

ObjetivoDeterminar los factores asociados con caídas en ancianos institucionalizados.Material y métodosEstudio de cohorte, con una duración de 18 meses. Se incluyeron 203 internos mayores de 65 años con capacidad para la deambulación. Se determinaron edad, sexo, IMC, índices de Barthel, Pfeiffer, Tinetti y FRAT (Falls Risk Assessment Tool), caídas previas, ayudas para deambular, existencia de hipotensión ortostática, delirium en el mes previo, presencia de diferentes enfermedades crónicas (10), número y naturaleza de los fármacos habituales (15). Cada caída fue registrada por la enfermera responsable del paciente. El análisis se realizó mediante regresión logística.ResultadosLa media de edad de los participantes fue de 80,1 años (desviación estándar [DE]=9,1 años), siendo varones el 37,9%. Hubo 35 pérdidas (11,5%/año). Se registró un total de 204 caídas en 99 personas (incidencia acumulada del 48,8% a los 18 meses de seguimiento). Cuarenta y cuatro personas (21,7%) sufrieron caídas repetidas. El análisis de regresión mostró asociación con la presencia de delirium en el mes previo a la inclusión en el estudio (OR: 6,7; intervalo de confianza del 95% [IC95]: 1,6–30,3) y menor IMC (OR: 1,1; IC95: 1,01–1,12), y con la deficiencia visual en el caso de las caídas repetidas (OR: 2,2; IC95: 1,1–4,5).ConclusionesLa incidencia de caídas en ancianos institucionalizados es alta. Se constata asociación con algunas condiciones expresivas de fragilidad como indicadores de riesgo(AU)

ObjectiveTo determine factors associated with falls in institutionalized elderly.Material and methodsA prospective cohort study was carried out, over a 18 months period. We included 203 subjects aged 65 and over who were able to walk. We recorded: age, sex, BMI, Barthel, Pfeiffer, Tinetti and FRAT tests, history of falls during the previous year, walking aids, the existence of orthostatic hypotension, delirium in the previous month, presence of various chronic diseases (10), number and nature of the usual drugs (15). Each fall was recorded by the nurse in charge of the patient. The analysis was carried out using logistic regression.ResultsThe average age of participants was 80.1 (SD=9.1) years, male 37.9%. There were 35 losses (11.5%/year). 204 falls were registered in 99 people (48.8% cumulative incidence at 18 months of follow-up). 44 people (21.7%) suffered repeated falls. Regression analysis showed association with the presence of delirium in the month prior to the inclusion in the study (OR 6.7; CI95% 1.6–30.3) and a smaller BMI (OR 1.1; CI95% 1.01–1.12), and visual impairment in the case of repeated falls (OR 2.2; CI95% 1.1–4.5).ConclusionThe incidence of falls in institutionalized elderly is high. It was found strong association with some conditions of fragility as indicators of risk(AU)

[Risk factors for falls amongst older people living in nursing home. A cohort study]. / Factores asociados con la aparición de caídas en ancianos institucionalizados: un estudio de cohortes.

OBJECTIVE: To determine factors associated with falls in institutionalized elderly. MATERIAL AND METHODS: A prospective cohort study was carried out, over a 18 months period. We included 203 subjects aged 65 and over who were able to walk. We recorded: age, sex, BMI, Barthel, Pfeiffer, Tinetti and FRAT tests, history of falls during the previous year, walking aids, the existence of orthostatic hypotension, delirium in the previous month, presence of various chronic diseases (10), number and nature of the usual drugs (15). Each fall was recorded by the nurse in charge of the patient. The analysis was carried out using logistic regression. RESULTS: The average age of participants was 80.1 (SD=9.1) years, male 37.9%. There were 35 losses (11.5%/year). 204 falls were registered in 99 people (48.8% cumulative incidence at 18 months of follow-up). 44 people (21.7%) suffered repeated falls. Regression analysis showed association with the presence of delirium in the month prior to the inclusion in the study (OR 6.7; CI95% 1.6-30.3) and a smaller BMI (OR 1.1; CI95% 1.01-1.12), and visual impairment in the case of repeated falls (OR 2.2; CI95% 1.1-4.5). CONCLUSION: The incidence of falls in institutionalized elderly is high. It was found strong association with some conditions of fragility as indicators of risk.

Las medidas no farmacológicas en el manejo de la hipertensión arterial / Non-pharmacological measures in the management of hypertension

Objetivo. Conocer la utilización por los médicos de familia de las medidas no farmacológicas (MNF)recomendadas en el tratamiento de la hipertensión arterial. Diseño. Estudio transversal mediante encuesta a pacientes. Emplazamiento. Consultas de Atención Primaria rurales y urbanas. Participantes. Pacientes hipertensos pertenecientes a 30 médicos urbanos y rurales. Mediciones principales. Se registró la prescripción de MNF (reducción de peso y consumo de sal, dieta equilibrada, realización de actividad física, reducción del consumo de alcohol, abandono del tabaco). Si la medida no procedía, se hizo constar así. Los datos fueron analizados con SPSS.15.0.Resultados. Se incluyeron 150 pacientes, 70 (46,7%) varones, con una edad media de 65,5 años(DE 10,2). El 50% residía en medio urbano. De las medidas consideradas se recomendaba el 77,5%,recibiendo algún consejo el 98% de los pacientes. El 42% recibió consejo sobre la totalidad de las medidas que le correspondían. No hubo diferencias estadísticamente significativas entre médicos urbanos y rurales, ni en función del sexo o la edad del facultativo, siendo más frecuente en los pacientes de menor edad (Rho de Spearman 0,28; p < 0,001). Un análisis de regresión, considerando el grado de realización de consejo como variable dependiente, mostró relación significativa con la edad de los pacientes (t = -2,9; p = 0,04).Conclusiones: Es posible incrementar la utilización de medidas no farmacológicas en el tratamiento de la Hipertensión Arterial en nuestro medio. Los pacientes más jóvenes reciben más consejo sobre estas medidas. No hubo diferencias en función del lugar de trabajo, sexo o edad del médico (AU)

Objective. To determine family physicians’ (FP) use of the recommended non-pharmacological treatment(NPT) for hypertension. Design. Cross-sectional survey. Setting. Primary care practices in rural and urban areas. Participants. Patients with hypertension from 30 urban and rural practices. Measurements. We recorded the prescription of NPT (weight loss, alcohol and salt intake reduction, diet, physical activity, and smoking cessation). If the measure was not applicable, it was recorded as such. Data were analyzed with SPSS.15.0.Results. We included 150 patients, 70 (46.7%) males. Mean (SD) age was 65.5 (10.2) years, and50% resided in urban areas. 77.5% of the above measures were recommended, 98% of the patients were receiving some counselling and 42% received counselling on all the indicated measures. There were no significant differences between urban and rural doctors, or according to the sex or age of the physicians. Counselling was more common in younger patients (Spearman _ - 0.28, p <0001). A regression analysis considering the degree of counselling as the dependent variable showed a significant association of counselling with patient age (t = -2.9, p = 0.04).Conclusions. Non-pharmacological treatment for hypertension could be increased in the Primary Care setting. Older people were less likely to be given relevant counselling. There were no differences as regards FP rural/urban practice, sex or age (AU)

[Survival of patients diagnosed with prostate cancer and monitored in primary care]. / Supervivencia de pacientes diagnosticados de cáncer de próstata seguidos en atención primaria.

OBJECTIVE: To study survival of patients with prostate cancer and its relationship with diagnostic delay. DESIGN: Retrospective cohort study. SETTING: Six rural primary care practices. PARTICIPANTS: All patients diagnosed with prostate cancer and monitored in these practices between 1992 and 2005. MAIN MEASUREMENTS: Patient age at definite diagnosis, dates of definite and suspected diagnosis, diagnostic method, treatment strategy, and date of death, if it occurred, were determined. Kaplan-Meier analysis was used to estimate survival probability; and Cox's regression, to examine prognostic factors. RESULTS: A total of 84 patients were identified. Mean (SD) age at diagnosis was 75.8 (8.6) years. Median delay until definite diagnosis was 31 days. The diagnosis was carried out through biopsy in 38 cases (45.2%). Eighteen patients were given possibly curative treatment (21.4%) and 66 patients (78.6%) received palliative treatment. Mean age of the deceased was 82.6 (9.1) years. Of 49 patients who died by the end of the study, 22 (44.9%) died from prostate cancer. Mean survival was 72.1 months (SE, 6.1). The probability of overall survival 10 years after diagnosis was 33.3%, and specific survival was 57.5%. There were no differences in survival due to delay in definite diagnosis. CONCLUSIONS: Survival after diagnosis of prostate cancer can be considered high. There is no relationship between survival and delay in definite diagnosis in patients with prostate cancer.

Supervivencia de pacientes diagnosticados de cáncer de próstata seguidos en atención primaria / Survival of patients diagnosed with prostate cancer and monitored in primary care

Objetivo. Analizar la supervivencia de los pacientes afectados de cáncer de próstata y su relación con la demora diagnóstica. Diseño. Estudio de cohortes retrospectivo. Emplazamiento. Seis consultas rurales de atención primaria. Participantes. La totalidad de pacientes diagnosticados de cáncer de próstata entre 1992 y 2005 atendidos en dichas consultas. Mediciones principales. Se determinaron la edad en el momento del diagnóstico de confirmación, las fechas de diagnóstico de sospecha y confirmación, el método diagnóstico, la estrategia terapéutica y la fecha de fallecimiento cuando procedía. Se utilizó el método de Kaplan-Meier en la determinación de la probabilidad de supervivencia y el análisis de regresión de Cox en la investigación de los factores pronósticos. Resultados. Se estudiaron 84 casos. La edad media ± desviación estándar (DE) en el momento del diagnóstico fue de 75,8 ± 8,6 años. La mediana del retraso en la confirmación diagnóstica fue de 31 días. El diagnóstico se realizó mediante biopsia en 38 casos (45,2%). Se realizó tratamiento potencialmente curativo en 18 casos (21,4%) y recibieron tratamiento paliativo 66 pacientes (78,6%). La edad media de los fallecidos era de 82,6 ± 9,1 años. Entre los 49 fallecidos en el momento del cierre del estudio, 22 (44,9%) murieron por el cáncer de próstata. La mediana de la supervivencia fue de 72,1 ± 6,1 meses. La probabilidad de supervivencia global a los 10 años tras el diagnóstico fue del 33,3%, y la específica, del 57,5%. No se encontraron diferencias en la supervivencia en función del retraso en la confirmación diagnóstica. Conclusiones. La supervivencia tras el diagnóstico de cáncer de próstata se puede considerar alta. No hay relación entre la supervivencia y el retraso en la confirmación del diagnóstico en el conjunto de los pacientes afectados de cáncer de próstata

Objective. To study survival of patients with prostate cancer and its relationship with diagnostic delay. Design. Retrospective cohort study. Setting. Six rural primary care practices. Participants. All patients diagnosed with prostate cancer and monitored in these practices between 1992 and 2005. Main measurements. Patient age at definite diagnosis, dates of definite and suspected diagnosis, diagnostic method, treatment strategy, and date of death, if it occurred, were determined. Kaplan-Meier analysis was used to estimate survival probability; and Cox's regression, to examine prognostic factors. Results. A total of 84 patients were identified. Mean (SD) age at diagnosis was 75.8 (8.6) years. Median delay until definite diagnosis was 31 days. The diagnosis was carried out through biopsy in 38 cases (45.2%). Eighteen patients were given possibly curative treatment (21.4%) and 66 patients (78.6%) received palliative treatment. Mean age of the deceased was 82.6 (9.1) years. Of 49 patients who died by the end of the study, 22 (44.9%) died from prostate cancer. Mean survival was 72.1 months (SE, 6.1). The probability of overall survival 10 years after diagnosis was 33.3%, and specific survival was 57.5%. There were no differences in survival due to delay in definite diagnosis. Conclusions. Survival after diagnosis of prostate cancer can be considered high. There is no relationship between survival and delay in definite diagnosis in patients with prostate cancer

Influencia de la edad y el sexo en la información del paciente en fase terminal / Influence of age and sex on information for terminal-stage patients

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[Compliance with the metabolic goals in diabetes mellitus treatment in the rural area of Ourense, Spain]. / Cumplimiento de los objetivos de control metabólico en diabetes mellitus en el medio rural de ourense.

BACKGROUND: To evaluate the degree to which the metabolic check-up objectives among Type II diabetes patients were met in rural primary care by comparing them to the values recommended by the American Diabetes Association (ADA) and the Diabetes in Primary Care Study Group (GEDAPS). METHODS: Descriptive cross-sectional study. A sample size was calculated based on the glycosolated hemoglobin (HbA1c) test in 119 individuals. A total of 253 patients with Type II diabetes followed up for at least two years at their healthcare facility took part. The patients in question were selected at random from among 17 medical lists at 11 rural healthcare facilities in the province of Ourense (Spain). Demographic variables, cardiovascular risk factors, pharmacological treatment, self-analyses, eye fundus, tactile sensitivity, HbA1c, lipid profile, blood pressure and body mass index data were taken from the patients' clinical records. RESULTS: A total of 44.3% of those in the sample had undergone an HbA1c test within the immediately prior six-month period, showing a value of under seven percent (7%). A total of 21.2% had a blood pressure of under 130/80, and 19.8% a LDL cholesterol level of under 100 mg/dl. A total of 40.7% of those patients with a LDL cholesterol level over 100 were not undergoing any hypolipemiant treatment. A total of 20.4% of the patients showing high blood pressure readings were not undergoing any blood pressure lowering treatment. On the basis of these three factors, a total of 2.5% met the check-up objectives. Thirty-six percent (36%) were antiaggregated with AAS. CONCLUSIONS: A major deficit is revealed both in the frequency of the check-ups conducted by the healthcare professionals as well as the number of interventions performed for achieving the proposed objectives, showing results far below what is recommended in the clinical practice guidelines.