ABSTRACT
Objetivo: Describir la situación de accesibilidad y adherencia a tratamientos con drogas biológicas en pacientes de un servicio público de reumatología. Métodos: Estudio de corte transversal, observacional y retrospectivo que incluyó pacientes con gestión de DB. Variables: sociodemográficas, clínicas, tratamientos, tiempo desde el diagnóstico al acceso, adherencia (porcentaje de toma mensual y adecuada de la droga ≥75%); tiempo desde prescripción a administración; trámite administrativo realizado por entidad pública u obra social; certificado único de discapacidad (CUD). Resultados: Se incluyeron 57 pacientes, 86% mujeres, edad media 47,79 años (IC 95%: 44,46-51,12); educación media 8,42 años (IC 95%: 7,68-9,16); 82,5% nivel socioeconómico medio-bajo; 63,2% etnia mestiza; 19,3% cobertura privada. Patología más frecuente: artritis reumatoidea. Tiempo medio desde el diagnóstico a la DB: 104,25 meses (IC 95%: 82,61-125,89). Tiempo medio desde la prescripción a la aplicación: 6,4 meses (IC 95%: 5,62-7,18). Adherencia del 86,0%. 50% de los pacientes contaban con CUD. No hubo diferencias en el tiempo de espera desde prescripción a administración de DB, en relación a cobertura de salud (p=0,065) y nivel socioeconómico. Conclusión: Existe un largo tiempo de evolución de la enfermedad en relación a la accesibilidad a DB y tanto el acceso como la adherencia reflejan la vulnerabilidad de estos pacientes.
Objective: To describe the situation of accessibility and adhesion treatment of patients with biological drugs (BD) from a public rheumatology service. Methods: Cross-sectional, observational and retrospective study, which includes patients who have been treated with BD. Variables: sociodemographic; clinical and treatments; time from diagnosis to BD access, adherence (monthly intake percentage of the drug ≥75%); time from the prescription to the administration of the BD; paperwork by a public or private entity; disability certificate (DC). Results: A total of 57 patients were included, 86% women, mean age being 47.79 (95% CI: 44.46-51.12) and education years being 8.42 (95% CI: 7.68- 9.16). 82.5% belonged to a medium-low socioeconomic status and 63.2% were mestizos. 19.3% had private coverage. Rheumatoid Arthritis was the most frequent disease. The mean time from diagnosis to BD: 104.25 months (95% CI: 82.61-125.89). The mean time from prescription to application: 6.4 months (95% CI: 5.62-7.18). The adherence was 86.0% and 50.0 % of patients had DC. There were no differences in the waiting time from the prescription to BD administration, taking into account the health coverage (p = 0.065) and socioeconomic status. Conclusion: There is a long time of disease evolution in regarding the accessibility to BD. In addition, accessibility and adherence reflect the vulnerability of our patients.
Subject(s)
Biological Factors , Rheumatic DiseasesABSTRACT
Species interactions are integral drivers of community structure and can change from competitive to facilitative with increasing environmental stress. In subtidal marine ecosystems, however, interactions along physical stress gradients have seldom been tested. We observed seaweed canopy interactions across depth and latitudinal gradients to test whether light and temperature stress structured interaction patterns. We also quantified interspecific and intraspecific interactions among nine subtidal canopy seaweed species across three continents to examine the general nature of interactions in subtidal systems under low consumer pressure. We reveal that positive and neutral interactions are widespread throughout global seaweed communities and the nature of interactions can change from competitive to facilitative with increasing light stress in shallow marine systems. These findings provide support for the stress gradient hypothesis within subtidal seaweed communities and highlight the importance of canopy interactions for the maintenance of subtidal marine habitats experiencing environmental stress.
Subject(s)
Acclimatization , Ecosystem , Kelp/physiology , Stress, Physiological , Australia , Kelp/classification , Light , TemperatureABSTRACT
The purpose of the study was to evaluate the feasibility of nutritional therapy in a university hospital. Over a four-year period, 542 adult patients from 16 different departments were included in the study due to malnutrition and/or severe disease. Energy requirement including a surplus for weight gain was calculated by the factorial method and feeding was undertaken by means of food, liquid supplements, tube feeding or parenteral nutrition for an average period of 4.8 weeks. In patients with benign disease only, the average weight gain was as expected from energy balance but in patients with a benign stress-catabolic disease weight gain was only 40% of that expected. In malnourished patients with malignant disease, radiation- or chemotherapy could be carried out without further loss of body weight. During bone-marrow transplantation only a minor weight loss occurred. In conclusion, nutritional therapy is feasible in a clinical setting and the methods employed can identify groups of patients that require only nutritional support and other groups of patients that in addition require treatment of a stress-catabolic state.
