ABSTRACT
Objetivo. Explorar las preferencias de los ciudadanos sobre el tratamiento de soporte vital en situaciones sanitarias críticas. Método. Estudio transversal mediante encuesta a 306 participantes, seleccionados aleatoriamente de consultas de enfermería, centros culturales, residencias asistidas y aulas universitarias. Para medir las preferencias en el tratamiento ante situaciones sanitarias críticas se empleó el cuestionario Life Suport Preferences Questionnaire (LSPQ). Se realizó un análisis descriptivo, bivariante y multivariante de los datos. Resultados. La edad media de los participantes fue de 39,28 años y la desviación estándar (DE) de 24,52; el 29,1% de los encuestados eran varones y un 37% no tenía estudios o sólo estudios primarios. La edad se mostró inversamente correlacionada con la preferencia de aceptar tratamientos, de tal manera que los mayores de 55 años optan en menor medida por los tratamientos de soporte vital que los más jóvenes y ocurre lo mismo con los de menor nivel académico respecto a los de nivel superior. Entre varones y mujeres no se han encontrado diferencias. Ante enfermedades graves sin posibilidad de recuperación las preferencias son similares, hay un rechazo del tratamiento en todos los grupos de edad. Cuando hay posibilidad de recuperación o se trata de tratamientos no invasivos, las personas de 21 o más años prefieren recibir tratamiento. Conclusión. Existe una gran variabilidad entre la población a la hora de aceptar o rechazar el tratamiento de soporte vital. Es inadecuado considerar que consiste siempre en la aceptación de tratamientos a toda costa. Convendría divulgar el conocimiento y uso de las instrucciones previas como mejor vía para respetar la voluntad del paciente cuando no tenga la capacidad de expresarla personalmente (AU)
Objective. To explore citizens treatment preferences in critical health situations.Method. We performed a cross-sectional study through a questionnaire administered to 306 participants, randomlyselected from nursing consultations, cultural centers, nursing homes and the university. Treatment preferences in critical health situations were measured through the Life Support Preferences Questionnaire (LSPQ). A descriptive bivariate and multivariate analysis was performed.Results. The mean age of participants was 39.28 years (SD: 24.52), 37% had primary school or no education, and29.1% were male. Age was inversely correlated with accepting treatments; thus acceptance of life support measures was lower among participants older than 55 years than among the youngest participants and was also lower among those with a lower educational level than those with a higher educational level. No differences were found between men and women. In serious diseases with no possibility of recovery, all age groups rejected treatment. When there was the potential for recovery or for non-invasive treatments, participants aged 21 years old or older would prefer to be treated.Conclusion. There is wide variability among the population when accepting or rejecting life support treatment. The view that treatment should be accepted at all costs is inappropriate. Disseminating knowledge of advance directives and the use of these documents is recommended as the most effective way to respect patients wishes when they are unable to express themselves (AU)
Subject(s)
Humans , Resuscitation , Patient Acceptance of Health Care , Emergency Treatment/standards , Resuscitation Orders/ethics , Informed Consent , Age DistributionABSTRACT
OBJECTIVE: To determine the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in the Republic of Uruguay. METHODS: The study was performed in Uruguay (3,241,003 inhabitants) during a 2-year period (2002-2003). To ensure complete case ascertainment, multiple sources of information were used, including all the neurologists, other medical specialties, general physicians, neurophysiology laboratories, hospital medical records and death certificates. ALS diagnosis was based on El Escorial criteria. Although all patients with motor neuron disease were enrolled in the follow-up, only probable and definite cases are included in the study. RESULTS: Between January 1st, 2002, and December 31st, 2003, 89 new patients were diagnosed with probable or definite ALS. The mean annual incidence rate was 1.37 per 100,000 persons. The incidence was higher for men (1.95) than for women (0.84) with a male to female ratio of 2:1. For both, the incidence increased throughout the years showing a peak in the 65-74 age group among men and the 55-64 age group among women. Mean age at onset of ALS disease was 58.7 years. The estimated mean annual incidence for ALS calculated by the capture recapture method was 1.42 (95% CI, 1.13-1.72). On December 31st, 2002, the crude prevalence was 1.9 per 100,000 inhabitants. CONCLUSIONS: ALS incidence is within a narrow range across countries despite the genetic, environmental and socioeconomic differences when similar prospective design, diagnosis criteria and data analyses are applied.
