Factores de riesgo asociados a Pérdida de Sensibilidad Protectora en pacientes con Diabetes en la Unidad Multidisciplinaria de Pie Diabético / Risk factors associated with Loss of Protective Sensitivity in Diabetes patients in the Multidisciplinary Unit of Diabetic Foot

Introducción: Identificar factores de riesgo para pérdida de la sensibilidad protectora es fundamental para prevenir el Pie Diabético. Objetivos: Analizar los factores de riesgo asociados a la pérdida de la sensibilidad protectora en pacientes con diabetes mellitus y sus complicaciones. Materiales y métodos: diseño observacional, de casos y controles. Se incluyó pacientes de ambos sexos, con diabetes mellitus; ≥ 18 años, a quienes se realizó el Test de monofilamento en la Unidad Multidisciplinaria Hospital de Clínicas, de enero 2014 a julio 2019. Factores de riesgo considerados: edad, años de diabetes mellitus, Hba1c, HTA, dislipidemia; se tuvo en cuenta las complicaciones: retinopatía, enfermedad arterial periférica = ITB <0,9 derecho e izquierdo, enfermedad renal= ClCr <60 ml/min/m2 (MDRD), amputaciones (mayores y menores). Resultados: De 100 pacientes; 33% con pérdida de la sensibilidad protectora; edad 59±9,7 años; 55% masculino. Factores de riesgo: edad: 57,7±1,0 años sin pérdida de la sensibilidad protectora y 61,2±9 años con pérdida de la sensibilidad protectora, p=0.08; años de diabetes mellitus 9,4±8,4 vs 11,5± 8,7 p=0,20; HbA1C 8,8± 2,7% vs 9,1±2% p=0,50; HTA 63,5% vs 75,6% p=0,20; dislipidemias 75,9% vs 57,69%, p=0,09; complicaciones con pérdida de la sensibilidad protectora: retinopatía 88% vs 57,5% OR=1,67, p=0,02. ClCr 84±40,3 ml/min vs 90,9±30,4, p=0,40. Enfermedad arterial periférica derecha 27,78% vs 11,1% OR=0,1, p=0,10; enfermedad arterial periférica izquierda 20% vs 7 15,5% OR=1 p=0,60; amputación 17,5% vs 7,9% OR=2,01, p=0,06. Conclusión: con pérdida de la sensibilidad protectora: la edad, años de diabetes mellitus fueron mayores. HTA fue más frecuente y Hba1c más elevada; nefropatía, enfermedad arterial periférica y amputación con mayor frecuencia, todas no significativas. La retinopatía fue más frecuente en forma significativa.

Introduction: Identifying risk factors for loss of protective sensitivity is essential to prevent Diabetic Foot. Objectives: To analyze the risk factors associated with the loss of protective sensitivity in patients with diabetes mellitus and its complications. Materials and methods: observational, case-control design. Patients of both sexes were included, with diabetes mellitus; ≥ 18 years, who underwent the Monofilament Test in the Multidisciplinary Unit Hospital de Clínicas, from January 2014 to July 2019. Risk factors considered: age, years of diabetes mellitus, Hba1c, HT, dyslipidemia; Complications were taken into account: retinopathy, peripheral arterial disease = ABI <0.9 right and left, kidney disease = CrCl <60 ml / min / m2 (MDRD), amputations (major and minor). Results: Of 100 patients; 33% with loss of protective sensitivity; age 59 ± 9.7 years; 55% male. Risk factors: age: 57.7 ± 1.0 years without loss of protective sensitivity and 61.2 ± 9 years with loss of protective sensitivity, p = 0.08; years of diabetes mellitus 9.4 ± 8.4 vs 11.5 ± 8.7 p = 0.20; HbA1C 8.8 ± 2.7% vs 9.1 ± 2% p = 0.50; HTN 63.5% vs 75.6% p = 0.20; dyslipidemias 75.9% vs 57.69%, p = 0.09; complications with loss of protective sensitivity: retinopathy 88% vs 57.5% OR = 1.67, p = 0.02. CrCl 84 ± 40.3 ml / min vs 90.9 ± 30.4, p = 0.40. Right peripheral arterial disease 27.78% vs 11.1% OR = 0.1, p = 0.10; left peripheral arterial disease 20% vs 7 15.5% OR = 1 p = 0.60; 17.5% amputation vs 7.9% OR = 2.01, p = 0.06. Conclusion: with loss of protective sensitivity: age, years of diabetes mellitus were older. HBP was more frequent and Hba1c higher; nephropathy, peripheral arterial disease and amputation with greater frequency, all not significant. Retinopathy was significantly more frequent.

Estudio descriptivo de la consulta en un Punto de Atención Continuada rural de Castilla-La Mancha / Descriptive study of reasons for consultation at the locations of continuous medical attention rural

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Behavior of Parents Seeking Care From Emergency Services Due to Fever in Children.

PURPOSE: To explore the behavior of parents, with and without health training, seeking care from emergency services due to their child's fever. DESIGN AND SETTING: A qualitative study based on Grounded Theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children 0 to 12 years old who received care for fever in the emergency primary care services of two Spanish municipalities. METHODS: Data saturation was achieved after eight focus groups segmented by gender, place of residence, and education (57 participants). Data analysis followed the constant comparative method and coding process. FINDINGS: The parents attended the emergency department when fever was high or persistent and to determine the cause. The reasons for avoiding the emergency department differed; whereas the health professional parents avoided consulting other colleagues as they felt questioned, for parents who were not healthcare professionals, there was a fear of acquiring an infection. CONCLUSIONS: Parents' search for healthcare differs according to their background and education. CLINICAL RELEVANCE: These results provide key information for the design of care plans to improve health care and patient satisfaction.

Parents' and primary caregivers' conceptualizations of fever in children: A systematic review of qualitative studies.

This study was a systematic review and thematic synthesis of qualitative studies. The aim was to explore parents' and primary caregivers' knowledge and conceptualizations of fever in children aged between 0 and 12 years. A systematic literature search of the Medline, CINAHL, SCOPUS, Web of Science, Cochrane Library, BIREME, CUIDEN, ProQuest, and PsycINFO databases was undertaken for qualitative studies published in English or Spanish up to December 2018. Ten studies were included in the thematic synthesis. Parents' perceptions of their children's fever were classified according to three criteria: fever as a pathology, care for the febrile child, and the search for understandable and reliable information on this topic. Fever was perceived as being harmful to children's health and as a pathology that requires health care. Further studies are necessary to gather key information for improving health action plans and satisfaction with the care received. This information might help us to understand the management of fever and the related fears experienced by caregivers. These perceptions can be influenced by parents' knowledge, attitudes, and beliefs on fever and their previous experiences.

Parental Approach to the Management of Childhood Fever: Differences between Health Professional and Non-Health Professional Parents.

Fever is responsible for 30% of pediatric consultations at primary care services. The aim of this study was to explore the parental approach to fever in children aged between 0 and 12 years old by both health professional and non-health professional parents. A qualitative study based on grounded theory was performed. Focus groups were conducted, segmented by sex, place of residence, and healthcare training, using a triangulated sample (theoretical and snowball sampling) of parents of children aged between 0 and 12 years who were treated for fever at primary care emergency services. The constant comparative method and a process of coding was used for the analysis. The study findings reveal that the health training of parents, their former experience, family pressures, the age of the child, and the parents' work outside the home, all influenced how they approached fever management. These findings could be incorporated into clinical practice to improve care and compliance with fever treatment.

A Qualitative Study of Parents' Conceptualizations on Fever in Children Aged 0 to 12 Years.

Many parents experience "fever phobia", based on misconceptions regarding the repercussions of fever in their children. The aim of this paper was to explore the conceptualizations of parents who are health professionals and parents without health qualifications on childhood fever. This qualitative study was based on grounded theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children aged 0 to 12 years old who received care for fever in the Emergency Primary Care Services two in Spanish municipalities. Data collection was based on focus groups segmented by gender, place of residence and education. Data analysis followed the constant comparative method and involved a coding process. Results show that independently of the parents' place of residence or education, their perceptions of fever were somewhat ambivalent, beneficial at times, but also harmful. Parents acknowledged feelings of concern, fear, being overwhelmed, freezing up and relief once the fever was controlled. Health professional parents considered they had an extra responsibility for caring. Finally, parents without health education demanded more information from professionals. These results provide key information for the design of interventions directed at the management of fever in children.

Aplicación de un sistema de información geográfica a la gestión informativa de la tuberculosis pulmonar / Application of a geographical information system for information management on pulmonary tuberculosis

Fundamento: el programa de la tuberculosis está priorizado dentro del Sistema Nacional de Salud en Cuba. Las dificultades identificadas en el enfrentamiento a la enfermedad están asociadas, directa o indirectamente, a una restringida gestión del conocimiento en el sistema de salud. Objetivo: aplicar un sistema de información geográfica a la gestión de la información para la tuberculosis pulmonar. Métodos:estudio retrospectivo descriptivo-correlacional realizado entre el 1 de enero de 1996 y el 31 de diciembre del 2007 que incluyó a los 155 casos nuevos de tuberculosis pulmonar ocurridos en la población de 15 años o más en la provincia de Cienfuegos. Se utilizó el software MapInfo 8.5 para el diseño del sistema de información geográfica. Se combinaron métodos teóricos, empíricos y estadísticos. Resultados: la exclusión del factor geográfico como elemento de dificultad para la realización de las acciones de prevención establecidas en el programa y la estratificación de la tuberculosis pulmonar según incidencia en los barrios y repartos de laciudad. Conclusiones: el sistema de información geográfica diseñado constituye una herramienta tecnológica auxiliar que mejora la gestión de la información para la tuberculosis pulmonar en Cienfuegos como base para disímiles análisis y la generación de nuevos conocimientos(AU)

Background: tuberculosis program is a priority for the National Health System in Cuba. The difficulties encountered in dealing with the disease are associated, directly or indirectly, to a restricted knowledge management by the health system. Objective: to implement a geographical information system to manage information on pulmonary tuberculosis. Methods: retrospective, descriptive and correlational study conducted between January 1, 1996 and December 31, 2007. It included the 155 new cases of pulmonary tuberculosis in 15 years old patients and on in the province of Cienfuegos. MapInfo 8.5 software was used to design the geographical information system. Theoretical, empirical and statistical methods were combined. Results: the elimination of the geographical aspect as an obstacle for carrying out preventive actions established in the program and for the stratification of pulmonary tuberculosis according to its incidence in districts and neighbourhoods of the city. Conclusions: the designed geographical information system is an auxiliary technological tool that improves information management on pulmonary tuberculosis in Cienfuegos as the basis for a variety of analysis and the generation of new knowledge(AU)

¿Quiénes, de qué y dónde fallecen en Cienfuegos?

Fundamento:El análisis de la mortalidad constituye un elemento importante para los estudios sobre la situación de salud de cualquier grupo poblacional y para su vigilancia epidemiológica. Objetivo: Describir el comportamiento de las siete primeras causas de muerte en los municipios de la provincia de Cienfuegos por grupos de edad seleccionados y sexo. Métodos: Estudio descriptivo sobre el comportamiento de la mortalidad de las siete primeras causas en los municipios de la provincia de Cienfuegos en el período de 1990 al 2002 por grupos de edad seleccionados y sexo. Se trabajó con las siguientes variables: total de fallecidos por grupos de edad y sexo por municipios en cada causa de muerte, calculándose las tasas específicas por 1000 habitantes. Resultados: Las causas de muerte analizadas representan el 77,52 porciento de la mortalidad general de la provincia. Para todas las causas seleccionadas el grupo de 65 años y más, tiene las mayores tasas de mortalidad y particularizando, para las enfermedades del corazón, la tasa más elevada corresponde a los masculinos del municipio de Cienfuegos; en los tumores malignos corresponde a los masculinos de los municipios de Cumanayagua y Cienfuegos; para la mortalidad por accidente vascular encefálico y accidentes, las tasas más elevadas corresponden a las femeninas del municipio de Cienfuegos; en la mortalidad por influenza y neumonía las tasas más elevadas corresponden a los masculinos de Aguada; en la diabetes a las femeninas de Aguada y en el suicidio a los masculinos de Aguada, Cruces y Cienfuegos respectivamente(AU)