ABSTRACT
The identification and evaluation of specific health care activity indicators of primary care and family medicine of the regional health ministries is proposed, analyzing their experiences. A descriptive observational study of healthcare information on institutional websites and its availability, accessibility, and quality, offered between 2015-2020 has been developed. A sample of 19 websites has been compiled. The information is freely accessible, aggregated at the regional/area level, updated (2018) and in "pdf" format. Only Catalonia and Valencia discern by sex and age. Most used indicators: assigned cards (health coverage), attendance and healthcare pressure. Average indicators per community: 6. The current experiences in indicators and activity data of primary care and family medicine at the level of the Spanish National Health System are shown. Catalonia and Madrid have stood out in offering quality of care and health outcomes. The constructive debate focuses on offering a coordinated proposal of information on quality and health outcomes, accessible, relevant, understandable, and updated, learning from current best practices.
Subject(s)
Government , Primary Health Care , Humans , Observational Studies as Topic , Quality Indicators, Health CareABSTRACT
Informar a los pacientes, de forma previa a la aplicación de procedimientos diagnósticos y terapéuticos, es recomendable para establecer una relación asistencial de confianza. En este artículo se analizan factores determinantes de la percepción del riesgo por parte de los pacientes, así como elementos facilitadores de una buena información por parte de los profesionales de la salud (AU)
Informing the patients before starting diagnostic and therapeutic procedures is advisable in order to establish a trusting and caring relationship. In this article, we analyze factors that determine the risk perception by the patients, as well as elements which facilitate a good information process by health professionals (AU)
Subject(s)
Humans , Male , Female , Decision Making, Organizational , Health Manager , Access to Information/ethics , Access to Information/legislation & jurisprudence , Communication , Primary Health Care/methods , Primary Health Care/organization & administration , Primary Health CareABSTRACT
Informing the patients before starting diagnostic and therapeutic procedures is advisable in order to establish a trusting and caring relationship. In this article, we analyze factors that determine the risk perception by the patients, as well as elements which facilitate a good information process by health professionals.
Subject(s)
Communication , Decision Making , Delivery of Health Care , Health Personnel , Humans , RiskABSTRACT
El reconocimiento recíproco es un concepto, surgido del pensamiento filosófico, imprescindible para comprender las actitudes que fundamentan unas relaciones interpersonales pacíficas. Cuando no se da, se establecen relaciones en las que personas o colectivos humanos luchan por ser reconocidos. Excluir a los pacientes de la toma de decisiones concernientes a su salud es no respetar su autonomía y puede hacer que éstos se sientan tratados como objetos, con la consiguiente pérdida de confianza en el profesional. El paciente informado, es decir, con criterio propio y deseos de participar en lo que le concierne, está generando un colectivo de tendencia creciente. El reconocimiento recíproco aplicado a la relación clínica requiere, por una parte, la confianza del paciente en el profesional al que consulta y, por otra, la iniciativa profesional de compartir decisiones con el paciente. Los autores reflexionan sobre el concepto de reconocimiento recíproco, ejemplificando con situaciones posibles en la consulta(AU)
Reciprocal recognition is a philosophical concept that is essential to understand the attitudes that are basic for peaceful personal relationships. When it is not present, relationships in which people struggle for recognition are established. When the patients are excluded from the decision making regarding their health, their autonomy is not respected. This may make the patients feel like they are being treated as objects, with the consequent loss of trust in the doctor. An informed patient, that it, with their own criteria and desires to participate in what concerns them, is generating a group of growing tendencies. Reciprocal recognition applied to the physician-patient relationship need for one hand, the patient's trust in professional consulting and, secondly, the professional's initiative of sharing decisions with patients. The authors reflect on the concept of reciprocal recognition, with scenarios illustrating the consultation(AU)
Subject(s)
Humans , Male , Female , Decision Making/ethics , Decision Making/physiology , Interpersonal Relations , Referral and Consultation/ethics , Referral and Consultation/trends , Decision Support Techniques , Health Manager , TrustABSTRACT
"Reciprocal recognition" is a philosophical concept that is essential to understand the attitudes that are basic for peaceful personal relationships. When it is not present, relationships in which people struggle for recognition are established. When the patients are excluded from the decision making regarding their health, their autonomy is not respected. This may make the patients feel like they are being treated as objects, with the consequent loss of trust in the doctor. An informed patient, that it, with their own criteria and desires to participate in what concerns them, is generating a group of growing tendencies. Reciprocal recognition applied to the physician-patient relationship need for one hand, the patient's trust in professional consulting and, secondly, the professional's initiative of sharing decisions with patients. The authors reflect on the concept of reciprocal recognition, with scenarios illustrating the consultation.
Subject(s)
Decision Making , Patient Participation , Physician-Patient Relations , Cultural Competency , Humans , Informed Consent , Patient Education as Topic , Personal Autonomy , Social ValuesABSTRACT
Plasma level of the protein VAP-1/SSAO (Vascular Adhesion Protein-1/Semicarbazide-Sensitive Amine Oxidase) is increased in diabetes and/or obesity and may be related to vascular complications associated to these pathologies. The aim of this work was to complete a preceding study where we described the role played by some hormones or metabolites, implicated in diabetes and/or obesity, in the regulation of the release of VAP-1/SSAO by 3T3-L1 adipocytes. Here we focused on the previously observed effect produced by TNFalpha in the release of VAP-1/SSAO and studied the effect of a beta-adrenergic compound, isoproterenol. Both compounds stimulated the release of VAP-1/SSAO to the culture medium but had a different effect on the VAP-1/SSAO membrane form. While TNFalpha produced a decrease on VAP-1/SSAO membrane form content, isoproterenol did not modify it. We thus observed two different ways of regulation of the release of VAP-1/SSAO by 3T3-L1 adipocytes by metabolites implicated in diabetes and adipose tissue physiopathology. Our work permits a better understanding of this increased plasma VAP-1/SSAO levels observed in diabetes.
Subject(s)
Adipocytes/drug effects , Adrenergic beta-Agonists/pharmacology , Amine Oxidase (Copper-Containing)/metabolism , Cell Adhesion Molecules/metabolism , Isoproterenol/pharmacology , Tumor Necrosis Factor-alpha/pharmacology , 3T3-L1 Cells , Adipocytes/enzymology , Adipocytes/metabolism , Amine Oxidase (Copper-Containing)/analysis , Animals , Blotting, Western , Cell Culture Techniques , Cell Fractionation , Dose-Response Relationship, Drug , Electrophoresis, Polyacrylamide Gel , Mice , SolubilityABSTRACT
Plasma level of the protein SSAO/VAP-1 (samicarbazide-sensitive amine oxidase / vascular-adhesion protein-1) is increased in diabetes and/or obesity and may be related to vascular complications associated to these pathologies. The aim of this work was to complete a preceding study where we described the role played by some hormones or metabolites, implicated in diabetes and/or obesity, in the regulation of the release of VAP-1/SSAO by 3T3-L1 adipocytes. Here we focused on the previously observed effect produced by TNFa in the release of VAP-1/SSAO and studied the effect of a beta-adrenergic compound, isoproterenol. Both compounds stimulated the release of VAP-1/SSAO to the culture medium but had a different effect on the SSAO/VAP-1 membrane form. While TNFa produced a decrease on SSAO/VAP-1 membrane form content, isoproterenol did not modify it. We thus observed two different ways of regulation of the release of SSAO/VAP-1 by 3T3-L1 adipocytes by metabolites implicated in diabetes and adipose tissue physiopathology. Our work permits a better understanding of this increased plasma SSAO/VAP-1 levels observed in diabetes
Los niveles plasmáticos de la proteina SSAO/VAP-1 están aumentados en la diabetes y la obesidad, lo que podría estar relacionado con las complicaciones vasculares asociadas a estas patologías. En continuidad con trabajos anteriores acerca del papel de algunas hormonas o metabolitos, implicados en la diabetes y obesidad. Se estudia en este trabajo el efecto producido por el TNFa y del agonista beta-adrenérgico, isoproterenol en la regulación de la liberación de VAP-1/SSAO por adipocitos 3T3-L1. Ambos compuestos estimularon la liberación de VAP-1/SSAO al medio de cultivo, pero tuvieron un efecto diferente sobre la isoforma ligada a la membrana de SSAO/VAP-1. Así, mientras que el TNFa produjo una disminución significativa en la actividad SSAO/VAP-1 ligada a la membrana, no se modificó por el isoproterenol. Además, observamos dos maneras diferentes de regulación de la liberación de SSAO/VAP-1 por adipocitos 3T3-L1 a través de metabolitos implicados en diabetes y fisiopatología del tejido adiposo. Nuestro trabajo permite un mejor entendimiento de estos niveles plasmáticos aumentados de SSAO/VAP-1 observados en diabetes
Subject(s)
Animals , Mice , Adipocytes , Adrenergic beta-Agonists/pharmacokinetics , Amine Oxidase (Copper-Containing) , Cell Adhesion Molecules , Isoproterenol/pharmacology , Blotting, Western , Cell Adhesion Molecules/metabolism , Cell Fractionation , 3T3-L1 Cells , Adipocytes/enzymology , Adipocytes/metabolism , Amine Oxidase (Copper-Containing)/analysis , Amine Oxidase (Copper-Containing)/metabolism , Dose-Response Relationship, Drug , Electrophoresis, Polyacrylamide Gel , SolubilityABSTRACT
AIMS/HYPOTHESIS: Vascular adhesion protein-1 (VAP-1), which is identical to semicarbazide-sensitive amine oxidase (SSAO), is a dual-function membrane protein with adhesion properties and amine oxidase activity. A soluble form of VAP-1 is found in serum, where concentrations are enhanced in diabetes and obesity. In vitro, soluble VAP-1 enhances lymphocyte adhesion to endothelial cells, thus possibly participating in the enhanced lymphocyte adhesion capacity that is implicated in the cardiovascular complications associated with diabetes or obesity. In both, the tissue origin of the soluble VAP-1/SSAO is unknown. We examined whether adipose tissue, which has abundant expression of VAP-1/SSAO, is a source of soluble VAP-1. METHODS: We detected VAP-1/SSAO in plasma of diabetic animals, with or without VAP-1 immunoprecipitation, and in culture medium from 3T3-L1 adipocytes and human adipose tissue explants. VAP-1 protein glycosylation was measured. RESULTS: Diabetic and obese animals have increased plasma SSAO activity associated with VAP-1 protein. We also found that 3T3-L1 adipocytes and human adipose tissue explants release a soluble form of VAP-1/SSAO, which derives from the membrane. The release of soluble VAP-1 was enhanced by exposure of murine and human adipocytes to TNF-alpha and blocked by batimastat, a metalloprotease inhibitor. Partial ablation of adipose tissue reduced plasma SSAO activity in normal and diabetic rats. CONCLUSIONS/INTERPRETATION: Adipose cells are a source of soluble VAP-1/SSAO released by shedding of the membrane form. The release of SSAO is regulated by TNF-alpha and insulin. By releasing VAP-1/SSAO, adipose cells could contribute to the atherogenesis and vascular dysfunction associated with diabetes and obesity.
Subject(s)
Adipocytes/metabolism , Amine Oxidase (Copper-Containing)/metabolism , Cell Adhesion Molecules/metabolism , Metalloproteases/metabolism , 3T3 Cells , Adipocytes/cytology , Adipocytes/enzymology , Animals , Humans , Male , Mice , Neuraminidase/pharmacology , Obesity/physiopathology , Rats , Rats, Wistar , Rats, ZuckerSubject(s)
Arthritis, Rheumatoid/drug therapy , Immunosuppressive Agents/adverse effects , Leishmaniasis, Visceral/etiology , Methotrexate/adverse effects , Opportunistic Infections/etiology , Pregnenediones/adverse effects , Arthritis, Rheumatoid/complications , Bone Marrow/parasitology , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Leishmaniasis, Visceral/diagnosis , Male , Methotrexate/therapeutic use , Middle Aged , Pregnenediones/therapeutic useABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Immunocompromised Host , Methotrexate , Opportunistic Infections , Pregnenediones , Arthritis, Rheumatoid , Leishmaniasis, Visceral , Immunosuppressive Agents , Bone MarrowABSTRACT
In order to determine the renal concentration capacity in neonatal hydronephrosis, 10 micrograms of DDAVP were administered intranasally to 18 infants with hydronephrosis. Fluid intake was restricted to 50% of normal for 3 hours before and 6 hours after the administration of DDAVP. Maximal urine osmolality (mean +/- SD) was 348 +/- 180 mOsm/kg in 7 newborns younger than 21 days and 420 +/- mOsm/kg in 11 neonates between 22-50 days of age. Both osmolarities were inferior to the standard response to DDAVP reported in normal neonates. After 24 hours of clinical observation, we did not notice any secondary effects caused by this test.
Subject(s)
Hydronephrosis/urine , Kidney Concentrating Ability , Deamino Arginine Vasopressin/administration & dosage , Female , Humans , Infant, Newborn , Male , Osmolar Concentration , UrineABSTRACT
OBJECTIVE: To find the existence of early relationships between alterations in the glucidic metabolism and the glomerular and tubular basal function in diabetic insulin-dependent children without clinical evidence of diabetic nephropathy (DN). METHODS: We determined blood pressure, basal plasma concentrations of glucose, glycosilated hemoglobin and total proteins, glomerular filtration rate (GFR), and the glucose, proteins, calcium, phosphorus, uric acid, sodium, potassium and chloride excretions in diurnal, nocturnal and 24-hour urine samples in 43 diabetic children and 13 healthy controls. RESULTS: The microproteinuria mean value in all urine samples (always less than 15 micrograms/min/1.73 m.2), the GFR and blood pressure were similar in both groups. In the diabetic children, we found an inverse correlation between age and 24-hour urine microproteinuria (r-0.33; p less than 0.05) and between age and nocturnal urine microproteinuria (r-0.35; p less than 0.05). There was also a highly significant correlation between microproteinuria and the albumin/creatinine ratio in urine samples (r = 0.94, p less than 0.0001). Diabetic children showed a greater nocturnal excretion of calcium (p less than 0.05) and phosphorus (p less than 0.05). CONCLUSIONS: Our results suggest that microproteinuria, GFR and blood pressure have not served as predictors of DN in pediatric patients.
Subject(s)
Diabetes Mellitus, Type 1/metabolism , Diabetic Nephropathies/metabolism , Age Factors , Blood Glucose/analysis , Blood Pressure , Calcium/urine , Child , Child, Preschool , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/etiology , Female , Forecasting , Glomerular Filtration Rate , Humans , Male , Proteinuria/diagnosisABSTRACT
The influence of chronic renal failure (CRF) on growth hormone (GH) and insulin-like growth factor I (IGF-I) metabolisms is not well understood. Clinical studies on GH secretion in CRF have yielded conflicting results. In vitro, pituitary GH secretion has been shown to be unimpaired in moderate uremia. CRF reduces binding of GH to liver as a result of decreased number of GH receptors. CRF induces elevation of serum GH concentrations and does not modify the circulating values of IGF-I. However, the somatomedin bioactivity of uremic serum is depressed, and unsaturated low-molecular-weight IGF-I-binding proteins have been suggested to act as inhibitory factors of IGF-I action. Circulating GH and IGF-I do not necessarily reflect the state of GH and IGF-I in tissues, and further investigations on the effect of CRF on GH and IGF-I metabolisms at the growth plate level are clearly required.
