Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality.

OBJECTIVE: To analyse the relationship between the presence of malnutrition (MN), as measured by the NRS-2002 nutritional evaluation, and the rate of morbidity and mortality. DESIGN: Cross-sectional study. SETTING: Patients admitted to Mateu Orfila Hospital, the regional hospital for the island of Menorca, Spain. SUBJECTS: 1,075 patients who were admitted to Mateu Orfila Hospital (Menorca) who had laboratory studies and a nutritional risk (NR) evaluation available were studied. Those who had a clinical suspicion of MN or those at risk were studied. INTERVENTION: Demographic (age, gender) and clinical (current weight, normal weight, body mass index, weight loss, oral intake, presence of intestinal failure, fistula, renal failure, respiratory infection, urinary infection, hyperglycaemia, admission to the ICU, hospital stay, days of parenteral nutrition treatment and reason for admission) were collected during hospitalisation, as well as hospital mortality and mortality at 6 months following discharge. All underwent the NRS-2002 test. RESULTS: The mean patient age was 67.9 years and 58.3% were men. 62% of patients met the criteria for manutrition according to the NRS-2002 test. A statistically significant association was seen between malnutrition according to the NRS-2002 and intestinal failure, fistula, renal failure, respiratory infection, hyperglycemia, hospital mortality and mortality at 6 months. CONCLUSION: Malnutrition affects more than half of the patients who are admitted to a medium-long admission hospital and it is associated with increased morbidity and mortality. The results underscore the need to establish an update plan and preventative and therapeutic nutritional follow-up. These measures reduce the rate of avoidable complications and save the costs associated with them.

Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality / Evaluación de la asociación entre el grado de riesgo nutricional según el test NRS-2002 y la morbimortalidad hospitalaria

Objective: To analyse the relationship between the presence of malnutrition (MN), as measured by the NRS-2002 nutritional evaluation, and the rate of morbidity and mortality. Design: Cross-sectional study. Setting: Patients admitted to Mateu Orfila Hospital, the regional hospital for the island of Menorca, Spain. Subjects: 1,075 patients who were admitted to Mateu Orfila Hospital (Menorca) who had laboratory studies and a nutritional risk (NR) evaluation available were studied. Those who had a clinical suspicion of MN or those at risk were studied. Intervention: Demographic (age, gender) and clinical (current weight, normal weight, body mass index, weight loss, oral intake, presence of intestinal failure, fistula, renal failure, respiratory infection, urinary infection, hyperglycaemia, admission to the ICU, hospital stay, days of parenteral nutrition treatment and reason for admission) were collected during hospitalisation, as well as hospital mortality and mortality at 6 months following discharge. All underwent the NRS-2002 test. Results: The mean patient age was 67.9 years and 58.3% were men. 62% of patients met the criteria for manutrition according to the NRS-2002 test. A statistically significant association was seen between malnutrition according to the NRS-2002 and intestinal failure, fistula, renal failure, respiratory infection, hyperglycemia, hospital mortality and mortality at 6 months. Conclusion: Malnutrition affects more than half of the patients who are admitted to a medium-long admission hospital and it is associated with increased morbidity and mortality. The results underscore the need to establish an update plan and preventative and therapeutic nutritional follow-up. These measures reduce the rate of avoidable complications and save the costs associated with them (AU)

Objetivo: Determinar la relación entre el grado de Desnutrición (DN), detectada según el test de valoración nutricional NRS-2002, y la tasa de morbimortalidad. Métodos: Estudio transversal de 1075 pacientes que ingresaron en el Hospital Mateu Orfila (Menorca) de los que se disponía una analítica de ingreso y valoración del riesgo nutricional (RN) mediante el test NRS-2002. Se recogieron datos demográficos (edad, sexo) y clínicos (peso actual, peso habitual, Índice Masa Corporal, pérdida peso, ingesta oral, presencia de fracaso intestinal, fístula, fracaso renal, infección respiratoria, infección urinaria, hiperglucemia, estancia en la UCI, estancia hospitalaria, días de tratamiento de nutrición parenteral y enfermedad motivo de ingreso) durante su hospitalización así como la mortalidad hospitalaria y a los 6 meses posteriores al alta. Resultados: La edad media de los pacientes fue de 67,9 años y el 58,3% eran hombres. El 62%de los pacientes presentaron criterios de DN según el test NRS-2002. Se halló asociación estadísticamente significativa entre DN según el test NRS-2002 y fracaso intestinal, fístula, fracaso renal, infección respiratoria, hiperglucemia, mortalidad hospitalaria, mortalidad 6 meses y estancia hospitalaria. Conclusiones: La DN afecta a más de la mitad de los pacientes que ingresan en un hospital de media-larga estancia y se asocia con mayor morbi-mortalidad. Los resultados nos permiten establecer un plan de actuación y seguimiento nutricional de prevención y tratamiento (AU)

[Influence of organizational climate on job satisfaction among health professionals]. / Influencia del clima laboral en la satisfacción de los profesionales sanitarios.

OBJECTIVE: To describe the quality of professional life (QPL) as perceived by primary care workers and to measure the organizational climate (OC). To identify the influence of OC on QPL and the variables that explain this relationship. DESIGN: Cross-sectional study. SETTING: Primary care centres in the Menorca Health Area (Balearic Islands, Spain). PATIENTS: One hundred and sixty six primary care, including health-workers and others. MAIN MEASUREMENTS: Two anonymous, self-administered, PC-validated questionnaires were filled in: QPL-35 (dimensions: perception of demands, support from managers, and motivation) and OC (dimensions: team-work, cohesion, and commitment). Age, seniority, professional group, job relationship, and the health centre were analysed. RESULTS: Positive answers: 67.4%. Average QPL was 5.78, lower for older workers and higher among those perceiving more cohesion. Average score for perceived demands was 5.53, higher among physicians and less if there is high commitment. Support from managers was 4.9, positively associated with cohesion and team-work and negatively associated with permanent workers and clerical staff. Intrinsic motivation was 7.43, greater if commitment was higher. Regardless of age, professional category and seniority, there was a significant association between OC and QPL (strongest in the motivation [r2=0.26] and managerial support [r2=0.476] dimensions). CONCLUSIONS: OC influences QPL, especially in motivation and managerial support. Commitment enhances motivation and perception of demands. Where there is better cohesion and team-work, the manager s support is also rated more highly.

Influencia del clima laboral en la satisfacción de los profesionales sanitarios / Influence of organizational climate on job satisfaction among health professionals

Objetivo. Describir la calidad de vida profesional (CVP) percibida por los trabajadores de atención primaria (AP) y el clima de la organización (CO) de sus centros, y conocer la influencia del CO sobre la CVP y las variables que explican esta relación. Diseño. Transversal, analítico. Emplazamiento. Centros de atención primaria del Área de Salud de Menorca. Participantes. Un total de 166 profesionales sanitarios y no sanitarios. Mediciones principales. Dos cuestionarios anónimos autoadministrados y validados en AP: CVP-35 (dimensiones: demandas, apoyo directivo y motivación) y CO (dimensiones: trabajo en equipo, cohesión y compromiso). Se analizan la edad, la antigüedad, el grupo profesional, la relación laboral y el centro sanitario. Resultados. La tasa de respuestas fue del 67,4%. La CVP global es 5,78, peor a mayor edad y mejor cuanta más cohesión. La percepción de demandas es 5,53, más en médicos y menos si hay un elevado compromiso. El apoyo directivo se valora en 4,9, mejor cuanta más cohesión y trabajo en equipo y peor en trabajadores fijos y administrativos. La motivación intrínseca es 7,43 y aumenta con el incremento del compromiso. Hay asociación entre CO y QVP (mayor en las dimensiones motivación [r2 = 0,26] y apoyo directivo [r2 = 0,476]), independientemente de la edad, el grupo profesional y la antigüedad laboral. Conclusiones. El clima influye en la calidad de vida profesional, especialmente en la motivación y el apoyo directivo. El compromiso mejora la motivación intrínseca y la percepción de demandas. La valoración del apoyo directivo mejora si lo hacen la cohesión y el trabajo en equipo

Objective. To describe the quality of professional life (QPL) as perceived by primary care workers and to measure the organizational climate (OC). To identify the influence of OC on QPL and the variables that explain this relationship. Design. Cross-sectional study. Setting. Primary care centres in the Menorca Health Area (Balearic Islands, Spain). Patients. One hundred and sixty six primary care, including health-workers and others. Main measurements. Two anonymous, self-administered, PC-validated questionnaires were filled in: QPL-35 (dimensions: perception of demands, support from managers, and motivation) and OC (dimensions: team-work, cohesion, and commitment). Age, seniority, professional group, job relationship, and the health centre were analysed. Results. Positive answers: 67.4%. Average QPL was 5.78, lower for older workers and higher among those perceiving more cohesion. Average score for perceived demands was 5.53, higher among physicians and less if there is high commitment. Support from managers was 4.9, positively associated with cohesion and team-work and negatively associated with permanent workers and clerical staff. Intrinsic motivation was 7.43, greater if commitment was higher. Regardless of age, professional category and seniority, there was a significant association between OC and QPL (strongest in the motivation [r2=0.26] and managerial support [r2=0.476] dimensions). Conclusions. OC influences QPL, especially in motivation and managerial support. Commitment enhances motivation and perception of demands. Where there is better cohesion and team-work, the manager´s support is also rated more highly

[Division of time in the consultation with the primary care doctor]. / Tiempos durante la visita médica en atención primaria.

OBJECTIVE: To determine the mean time per meeting--visit--and per problem attended to in the doctor's office and their distribution according to the care procedure during the visit. DESIGN: Prospective study of the direct encounter in the doctor's office with a third person as timer. SETTING. Three doctors at 2 family medicine clinics (each with a list of about 2500 health cards). PARTICIPANTS: 316 health problems attended to in 289 direct encounters in the doctor's office. Main measurements. Total time according to type of direct encounter in the doctor's office and problem addressed. Determination of the time spent on each stage of the encounter. RESULTS: Mean time per direct encounter in the doctor's office of 9.1 minutes, and mean time per problem attended of 7.4 minutes, with a range from 76 seconds to 25 minutes. 84% were spontaneous visits, 13.5% were scheduled and 2.5% could not be put off/were urgent. Problems were mainly bureaucratic in 17% of cases, organic in 77.4 and psycho-social-family in 5.6%. Mean time devoted to advice and treatment was 2.4 minutes; that devoted to explanation of the problem, 18.3 seconds. The times varied according to the kind of problem, the doctor and the sex and age of the patient. CONCLUSIONS: Distribution of time during the medical visit depends on the kind of problem involved. The doctor and the age and sex of the patient also affect the question. The short time spent on the explanation of the problem suggests that the period for active listening should be extended.

Tiempos durante la visita médica en atención primaria / Division of time in the consultation with the primary doctor

Objetivo. Determinar el tiempo medio por encuentro -visita- y por problema atendido en el despacho médico, y su distribución según el proceso de atención en dicho encuentro. Diseño. Estudio prospectivo del encuentro directo en el despacho médico con un tercero como cronometrador. Emplazamiento. Tres médicos en 2 consultas de medicina de familia (aproximadamente, 2.500 tarjetas individuales cada una).Participantes. Un total de 316 problemas de salud atendidos en 289 encuentros directos en el despacho médico. Mediciones principales. Tiempo total según el tipo de encuentro directo en el despacho médico y según el problema atendido. Determinación del tiempo invertido en las distintas fases del encuentro. Resultados. El tiempo medio por encuentro directo en el despacho médico es de 9,1 min, y el tiempo medio por problema atendido es de 7,4, con un recorrido entre los 76 s y los 25 min. El 84 por ciento de los encuentros fue espontáneo, el 13,5 por ciento concertado y un 2,5 por ciento no demorable o urgente. Los problemas fueron predominantemente burocráticos en el 17 por ciento de los casos, orgánicos en el 77,4 por ciento y psicosociofamiliares en el 5,6 por ciento. El tiempo medio dedicado a consejo y tratamiento fue de 2,4 min, y el dedicado a la exposición del problema, de 18,3 s. Los tiempos variaron según el tipo de problema, el médico, y el sexo y la edad del paciente. Conclusiones. La distribución del tiempo durante el encuentro médico depende del tipo de problema atendido. También influyen el médico, así como el sexo y la edad del paciente. El breve tiempo consumido en la exposición del problema sugiere la necesidad de ampliar el tiempo de escucha activa (AU)

[Prescriptions of low therapeutic value imposed on primary care]. / Prescripciones de utilidad terapéutica baja inducidas en atención primaria.

OBJECTIVES: 1. To quantify the percentage of prescriptions of low therapeutic value, and the associated pharmaceutical expenditure, which the specialist incurs for the general practitioner. 2. To determine which are the therapeutic groups of low therapeutic value most often delegated in this way, and so determine the profile of the specialists who recommend most medication with insufficient benefits. DESIGN: A descriptive, crossover, prospective study based on all the prescriptions of the month of March (21 days) to 4156 patients from the town of Es Castell (5720 inhabitants), Menorca. MATERIAL AND METHODS: The variables to be evaluated were defined and classified in scales. They included prescription, packages, working age/pensioner, origin (General Practitioner, Specialist, Private, Emergency), cost of the prescription, specialties broken down into anatomical-therapeutic groups, whether it was chronic or acute medication, and whether it was of high or low therapeutic value. RESULTS: Of the 3599 packages prescribed, 1993 were generated from outside the PC practice (55.3%). Of the 6069411 pesetas of expenditure in the period studied, 38.5% was due to general practitioners, 59.1% specialists, and 2.3% emergency services. 12.7% (456) of the packages prescribed were of low therapeutic value, of which 52.6% corresponded to the general practitioners' prescriptions, 45.6% to the specialists' and 4.5% to private practice. However, of the 523224 pesetas of expenditure, 62% was for specialists' prescriptions and only 36% for the general practitioners'. On comparing the profiles of prescriptions of low therapeutic value coming from specialists and direct from Primary Care, differences were found. The "cardiovascular" group accounted for 40.9% of specialist prescriptions and only 11.3% of G.P. ones; "central nervous system" (psychiatry, neurology) accounted for 24.5% and 12.1%, respectively. "Respiratory", however, was the opposite: 3.8% specialist and 25% G.P. Similarly the "others" category and 18.8% for specialists against 37.1% for G.P.s. CONCLUSIONS: It can be inferred that there is shared responsibility in the public health system between specialists and G.P.s for prescribing products of low therapeutic value. However, since the medication that specialists prescribe is dearer, they cause more expenditure than the packages of low therapeutic value, which they delegate to G.P.s.

[Campaign for the detection of minor beta-thalassemia and prevention of major beta-thalassemia in the isle of Menorca. 10-year experience]. / Campaña para la detección de la betatalasemia minor y prevención de la major en la isla de Menorca. Experiencia de 10 años.

BACKGROUND: The high prevalence of betathalassemia minor and the presence of several cases of thalassemia major in Menorca (Spain) led us, ten years ago, to set up a population based prevention campaign, following the basic schedule of those already taking place in other areas, specially in Italy. PATIENTS AND METHODS: The target population was the children in the last year of mandatory school, when they are 13 to 14 years old. The campaign started in the school year 1986-1987 and in the 1995-1996 course we reached the tenth yearly campaign. The campaign was structured in three stages: the first one included all information and educational aspects; the second step corresponded to blood sampling and detection of carriers; finally, results were reported to the individuals and genetic counseling was given. For evaluation purposes, we have monitored participation rates, the proportion of detected carriers which present to haematology visit and the trend in the proportion of carriers which previously knew their status. RESULTS: A total of 8,591 children were screened, accounting for a 83.8% participation rate. The observed prevalence was 26.7/1000 (95% CI, 23.5-29.9/1000). We also detected 9 cases of alfathalassemia and 4 cases of deltabetathalassemia. CONCLUSIONS: Our results show that participation rates may be reached through school screening campaigns for thalassemia. After ten years of campaign, the number of not previously known cases has become small, indicating that the campaign screening to relatives of detected carriers and a higher consciousness level in the general population have given the expected effect. In the last 14 years, not a single homozigote case has been born, although we cannot conclude that this has been only due to the campaign.

[Prevalence of glucose-6-phosphate dehydrogenase deficiency in a student population on the island of Menorca]. / Prevalencia del déficit de glucosa-6-fosfato deshidrogenasa (G6PD) en la población escolar de la isla de Menorca.

BACKGROUND: The G6PD deficiency is a red cell enzymopathy very frequent in certain Mediterranean countries. In Menorca (Balearic Islands), a relatively high incidence of favism carried us to study the prevalence of this alteration, taking advantage of the "Campaign for detection of heterozygous beta-thalassaemia to prevent the homozygous beta-thalassaemia" that we make annually. METHODS: We studied a total of 1139 school boys between 13-14 years old for three consecutive school years. We used the methylene blue as screening test and the deficiency of G6PD was confirmed with enzymatic quantification in the haemolysate. We also analysed the clinical manifestations and studied the relatives. RESULTS: We have confirmed 11 cases of G6PD deficiency (prevalence of 9.7/1000), all of them native of the island. The clinical manifestations were: in 6 cases (54.5%) no clinical manifestations were found, 5 cases (45.4%) had presented neonatal jaundice and 2 cases (18.2%) had suffered a favism crisis. The study of relatives permitted us to analyse 26 additional samples (17 women and 9 men), detecting in 8 of them (4 women and 4 men) the enzymopathy . CONCLUSIONS: The prevalence of G6PD deficiency in Menorca is one of the highest in Spain. Most of the carriers are asymptomatic, the most important clinical manifestations being the neonatal jaundice and favism. The screening test used is efficient for unmistakable hemizygotes detection.

[Lung cancer in the Island of Menorca (1990-1993)]. / Cáncer de pulmón en la isla de Menorca (1990-93).

OBJECTIVE: To assess the incidence, mortality, and survival of lung cancer in Menorca (Balearic Islands, Spain). METHODS: All cases detected between 1990 and 1993, were collected retrospectively, using the cancer registry methodology. RESULTS: The incidence rate observed was 47.7 cases per 100,000 inhabitants per year, while the mortality rate was 44.2. Mean age of patient was 67.5 years 90% of whom were male. The most frequently observed histological type was the epidermoid carcinoma (43% of cases), followed by the small-cell carcinoma (20%) and the adenocarcinoma (19%). Mean survival, over a total of 141 cases studied, was about 9 months (281 days). CONCLUSION: Incidence rates adjusted by world population show that Menorca lung cancer incidence rates are in the upper range among Spanish regions.

Oil-stop method as an alternative to filtration for transport studies on plasma membrane vesicles. A preliminary report.

The oil-stop procedure applied in transport studies on whole cells was adapted for isolated plasma membrane vesicles. The advantages of the proposed technique with respect to the commonly used filtration method are the reduction of the period of the termination step, the increase in the allowed membrane content of the samples and the absence of the leakage of substrates from the intravesicular space.