ABSTRACT
RESUMEN Objetivos. Evaluar la asociación entre las enfermedades crónicas (EC) y la necesidad de cuidados paliativos (NCP). Materiales y métodos. Se realizó un estudio transversal analítico en un hospital peruano durante el 2019. Se incluyó a pacientes hospitalizados con EC y se excluyó gestantes y a los hospitalizados en unidades críticas. En la evaluación de la NCP se aplicó el instrumento SPICT-ESTM, adicionalmente se evaluaron características sociodemográficas y clínicas. La fuerza de asociación se calculó con regresiones de Poisson con varianza robusta para estimar razones de prevalencia crudas (RP) y ajustadas (RPa) por confusores. Resultados. Se evaluó 172 pacientes, la media de edad fue 61 años, donde el 54,7% eran varones y 123 pacientes tenían NCP. En el modelo crudo se encontró asociación con tener enfermedad cerebrovascular (RP: 1,23; p=0,028), cualquier tipo de cáncer (RP: 1,38; p<0,001), cardiopatías (RP: 1,29; p=0,007), nefropatía (RP: 1,42, p<0,001) y enfermedad de Alzheimer (RP: 1,42; p<0,001). La asociación se mantuvo en la mayoría de EC evaluadas en el modelo ajustado, excepto para cardiopatía (RPa: 1,11; p=0,320). La fuerza de asociación fue menor en el caso de diabetes mellitus (RP: 0,78; p=0,044). Conclusión. La NCP en pacientes con enfermedades crónicas hospitalizados es alta y más frecuente en pacientes con cáncer, enfermedad cerebrovascular, problemas renales y enfermedad de Alzheimer. Los programas de cuidado de pacientes con diabetes mellitus pueden disminuir la NCP.
ABSTRACT Objectives. To assess the association between chronic disease (CD) and the need for palliative care (NPC). Materials and methods. An analytical cross-sectional study was carried out in a Peruvian hospital during 2019. Patients hospitalized with CD were included, and pregnant women and those hospitalized in critical units were excluded. The SPICT-ESTM instrument was used to assess the NPC; sociodemographic and clinical characteristics were also evaluated. The strength of association was calculated with Poisson regressions with robust variance to estimate crude prevalence ratios (PR) and adjusted prevalence ratios (aPR) by confounders. Results. A total of 172 patients were evaluated, the mean age was 61 years, where 54.7% were male and 123 patients had NPC. In the crude model, we found an association with having cerebrovascular disease (PR: 1.23; p=0.028), any type of cancer (PR: 1.38; p<0.001), heart disease (PR: 1.29; p=0.007), nephropathy (PR: 1.42, p<0.001) and Alzheimer's disease (PR: 1.42; p<0.001). The association was maintained for most of the evaluated CDs in the adjusted model, except for heart disease (aPR: 1.11; p=0.320). The association strength was lower for diabetes mellitus (PR: 0.78; p=0.044). Conclusion. NPC in hospitalized chronically ill patients is high and more frequent in patients with cancer, cerebrovascular disease, renal problems and Alzheimer's disease. Care programs for patients with diabetes mellitus may decrease NPC.
Subject(s)
Humans , Male , Female , Palliative Care , Peru , Chronic Disease , Hospitalization , Cerebrovascular Disorders , Diabetes Mellitus , Alzheimer Disease , Noncommunicable Diseases , Kidney Diseases , NeoplasmsABSTRACT
OBJECTIVES.: To assess the association between chronic disease (CD) and the need for palliative care (NPC). MATERIALS AND METHODS.: An analytical cross-sectional study was carried out in a Peruvian hospital during 2019. Patients hospitalized with CD were included, and pregnant women and those hospitalized in critical units were excluded. The SPICT-ESTM instrument was used to assess the NPC; sociodemographic and clinical characteristics were also evaluated. The strength of association was calculated with Poisson regressions with robust variance to estimate crude prevalence ratios (PR) and adjusted prevalence ratios (aPR) by confounders. RESULTS.: A total of 172 patients were evaluated, the mean age was 61 years, where 54.7% were male and 123 patients had NPC. In the crude model, we found an association with having cerebrovascular disease (PR: 1.23; p=0.028), any type of cancer (PR: 1.38; p<0.001), heart disease (PR: 1.29; p=0.007), nephropathy (PR: 1.42, p<0.001) and Alzheimer's disease (PR: 1.42; p<0.001). The association was maintained for most of the evaluated CDs in the adjusted model, except for heart disease (aPR: 1.11; p=0.320). The association strength was lower for diabetes mellitus (PR: 0.78; p=0.044). CONCLUSION.: NPC in hospitalized chronically ill patients is high and more frequent in patients with cancer, cerebrovascular disease, renal problems and Alzheimer's disease. Care programs for patients with diabetes mellitus may decrease NPC.
OBJETIVOS.: Evaluar la asociación entre las enfermedades crónicas (EC) y la necesidad de cuidados paliativos (NCP). MATERIALES Y MÉTODOS.: Se realizó un estudio transversal analítico en un hospital peruano durante el 2019. Se incluyó a pacientes hospitalizados con EC y se excluyó gestantes y a los hospitalizados en unidades críticas. En la evaluación de la NCP se aplicó el instrumento SPICT-ESTM, adicionalmente se evaluaron características sociodemográficas y clínicas. La fuerza de asociación se calculó con regresiones de Poisson con varianza robusta para estimar razones de prevalencia crudas (RP) y ajustadas (RPa) por confusores. RESULTADOS.: Se evaluó 172 pacientes, la media de edad fue 61 años, donde el 54,7% eran varones y 123 pacientes tenían NCP. En el modelo crudo se encontró asociación con tener enfermedad cerebrovascular (RP: 1,23; p=0,028), cualquier tipo de cáncer (RP: 1,38; p<0,001), cardiopatías (RP: 1,29; p=0,007), nefropatía (RP: 1,42, p<0,001) y enfermedad de Alzheimer (RP: 1,42; p<0,001). La asociación se mantuvo en la mayoría de EC evaluadas en el modelo ajustado, excepto para cardiopatía (RPa: 1,11; p=0,320). La fuerza de asociación fue menor en el caso de diabetes mellitus (RP: 0,78; p=0,044). CONCLUSIÓN.: La NCP en pacientes con enfermedades crónicas hospitalizados es alta y más frecuente en pacientes con cáncer, enfermedad cerebrovascular, problemas renales y enfermedad de Alzheimer. Los programas de cuidado de pacientes con diabetes mellitus pueden disminuir la NCP.
Subject(s)
Alzheimer Disease , Diabetes Mellitus , Heart Diseases , Chronic Disease , Cross-Sectional Studies , Female , Heart Diseases/epidemiology , Heart Diseases/therapy , Hospitals , Humans , Male , Middle Aged , Palliative Care , Peru/epidemiology , Pregnancy , PrevalenceABSTRACT
INTRODUCTION: Only 3 types of coronavirus cause aggressive respiratory disease in humans (MERS-Cov, SARS-Cov-1, and SARS-Cov-2). It has been reported higher infection rates and severe manifestations (ICU admission, need for mechanical ventilation, and death) in patients with comorbidities such as diabetes mellitus (DM). For this reason, this study aimed to determine the prevalence of diabetes comorbidity and its associated unfavorable health outcomes in patients with acute respiratory syndromes for coronavirus disease according to virus types. METHODS: Systematic review of literature in Pubmed/Medline, Scopus, Web of Science, Cochrane, and Scielo until April of 2020. We included cohort and cross-sectional studies with no restriction by language or geographical zone. The selection and extraction were undertaken by 2 reviewers, independently. The study quality was evaluated with Loney's instrument and data were synthesized by random effects model meta-analysis. The heterogeneity was quantified using an I 2 statistic. Funnel plot, Egger, and Begg tests were used to evaluate publication biases, and subgroups and sensitivity analyses were performed. Finally, we used the GRADE approach to assess the evidence certainty (PROSPERO: CRD42020178049). RESULTS: We conducted the pooled analysis of 28 studies (n = 5960). The prevalence analysis according to virus type were 451.9 diabetes cases per 1000 infected patients (95% CI: 356.74-548.78; I 2 = 89.71%) in MERS-Cov; 90.38 per 1000 (95% CI: 67.17-118.38) in SARS-Cov-1; and 100.42 per 1000 (95% CI: 77.85, 125.26 I 2 = 67.94%) in SARS-Cov-2. The mortality rate were 36%, 6%, 10% and for MERS-Cov, SARS-Cov-1, and SARS-Cov-2, respectively. Due to the high risk of bias (75% of studies had very low quality), high heterogeneity (I 2 higher than 60%), and publication bias (for MERS-Cov studies), we down rate the certainty to very low. CONCLUSION: The prevalence of DM in patients with acute respiratory syndrome due to coronaviruses is high, predominantly with MERS-Cov infection. The unfavorable health outcomes are frequent in this subset of patients. Well-powered and population-based studies are needed, including detailed DM clinical profile (such as glycemic control, DM complications, and treatment regimens), comorbidities, and SARS-Cov-2 evolution to reevaluate the worldwide prevalence of this comorbidity and to typify clinical phenotypes with differential risk within the subpopulation of DM patients.
ABSTRACT
AIM: To evaluate the association between elevated body fat percent (BF%) and the prevalence of insulin resistance (IR) in the adult population with body mass index (BMI) in the normal values. METHODS: We carry out an analytical cross-sectional study. The participants attended outpatient from 2012 to 2016 in a private clinic in Lima-Peru between 18 and 60 years with a BMI between 19 and 24.9/Kg/m2. We defined elevated BF% if the values were greater than 25% in men and 30% in women and IR with a cut-off point of HOMA-IR based in the 75th percentile. We performed a generalized linear model from family Poisson (crude and adjusted) with robust standard errors to evaluate the association between BF% and the IR. We reported as association measure the prevalence ratio (PR) with their respective 95% confidence intervals (CI). RESULTS: We included 284 participants, the average age was 33.77⯱â¯10.86 (SD) years and the percentage of women was 88.1%. The prevalence of elevated BF% was 71.13% and the prevalence of IR was 25%. We found an association between the elevated BF% and IR, PRâ¯=â¯3.17; 95% CI: 1.46-6.91. CONCLUSIONS: Body fat percentage seems to be a good indicator of IR in patients with normal BMI and without endocrine comorbidities. Longitudinal prospective studies are recommended to corroborate our findings.
