Analysis of antiretroviral therapy interruption in people living with HIV during the 2010-2021 Period. / [Artículo traducido] Análisis de la interrupción de la terapia antirretroviral en personas que viven con VIH/sida durante el periodo 2010­2021.

OBJECTIVE: In the context of the advancement of antiretroviral therapy and, as the characteristics of people living with HIV progress toward an aging population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated. METHODS: We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term 'interruption' will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilized Kaplan-Meier methods and Cox proportional models. RESULTS: We included 789 people living with HIV, predominantly male (81,5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analyzed to the therapeutic optimization (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV ≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes. CONCLUSIONS: Over the 12 years there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimization being the main reason. Integrase inhibitors-based regimens and singletablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV ≥50 years with comorbidities.

Analysis of antiretroviral therapy interruption in people living with HIV during the 2010-2021 period.

INTRODUCTION: In the context of the advancement of antiretroviral therapy and as the characteristics of people living with HIV progress toward an ageing population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated. METHODS: We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term "discontinuation" is employed synonymously with "interruption". The term "discontinuation" will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilised Kaplan-Meier methods and Cox proportional models. RESULTS: We included 789 people living with HIV, predominantly male (81.5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analysed to the therapeutic optimisation (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes. CONCLUSION: Over the 12 years, there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimisation being the main reason. Integrase inhibitors-based regimens and single-tablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV≥50 years with comorbidities.

Dermatology Care in Spanish Public Hospitals: A Mapping Study of Health Care Resources and Medical and Surgical Activity in Dermatology Departments in 2019. / Mapa asistencial dermatológico: descripción de los recursos estructurales y de la actividad médico-quirúrgica de los servicios de dermatología de los hospitales públicos españoles en 2019.

BACKGROUND AND OBJECTIVE: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. MATERIAL AND METHODS: Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. RESULTS: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. CONCLUSIONS: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement.

Mapa asistencial dermatológico: descripción de los recursos estructurales y de la actividad médico-quirúrgica de los servicios de dermatología de los hospitales públicos españoles en 2019 / Dermatology Care in Spanish Public Hospitals: A Mapping Study of Health Care Resources and Medical and Surgical Activity in Dermatology Departments in 2019

Antecedentes y objetivo: No existen datos actualizados sobre los recursos asistenciales ni la actividad médico-quirúrgica de los servicios de dermatología españoles. El objetivo de esta investigación es conocer la situación y actividad de dichos servicios durante el año 2019. Material y métodos: Estudio transversal mediante cuestionario online distribuido a los jefes de servicio de dermatología de hospitales públicos españoles. Resultados: De los 162 jefes de servicio encuestados, se obtuvo una participación del 36,4% (59/162). Se observó un déficit de personal generalizado, especialmente de dermatólogos en hospitales de complejidad media-baja. La principal causa del déficit de dermatólogos fue la ausencia de profesionales interesados. Las infraestructuras y equipamiento disponibles fueron superiores en los grandes complejos hospitalarios. La atención mixta presencial-telemática estuvo presente en más de la mitad de los centros. En el ámbito de las consultas monográficas, la de psoriasis fue la más implementada. Aproximadamente el 75% de los centros contaron con quirófanos con anestesista. Procedimientos quirúrgicos de mayor complejidad como la biopsia selectiva de ganglio centinela o la cirugía de Mohs se realizaban con mayor frecuencia en los grandes complejos hospitalarios. La hospitalización de pacientes y la presencia de dermatólogos residentes de guardia fueron igualmente más habituales en estos hospitales. La actividad docente e investigadora también se relacionó con la complejidad del hospital. Conclusiones: Nuestros resultados describen la situación de los servicios de dermatología españoles justo antes de la pandemia por COVID-19, y pueden ser útiles para la gestión clínica y para definir líneas de trabajo y áreas de mejora (AU)

Background and objective: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. Material and methods:Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. Results: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. Conclusions: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement (AU)

[Translated article] Dermatology Care in Spanish Public Hospitals: A Mapping Study of Health Care Resources and Medical and Surgical Activity in Dermatology Departments in 2019 / Mapa asistencial dermatológico: descripción de los recursos estructurales y de la actividad médico-quirúrgica de los servicios de dermatología de los hospitales públicos españoles en 2019

Background and objective: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. Material and methods:Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. Results: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. Conclusions: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement (AU)

Antecedentes y objetivo: No existen datos actualizados sobre los recursos asistenciales ni la actividad médico-quirúrgica de los servicios de dermatología españoles. El objetivo de esta investigación es conocer la situación y actividad de dichos servicios durante el año 2019. Material y métodos: Estudio transversal mediante cuestionario online distribuido a los jefes de servicio de dermatología de hospitales públicos españoles. Resultados: De los 162 jefes de servicio encuestados, se obtuvo una participación del 36,4% (59/162). Se observó un déficit de personal generalizado, especialmente de dermatólogos en hospitales de complejidad media-baja. La principal causa del déficit de dermatólogos fue la ausencia de profesionales interesados. Las infraestructuras y equipamiento disponibles fueron superiores en los grandes complejos hospitalarios. La atención mixta presencial-telemática estuvo presente en más de la mitad de los centros. En el ámbito de las consultas monográficas, la de psoriasis fue la más implementada. Aproximadamente el 75% de los centros contaron con quirófanos con anestesista. Procedimientos quirúrgicos de mayor complejidad como la biopsia selectiva de ganglio centinela o la cirugía de Mohs se realizaban con mayor frecuencia en los grandes complejos hospitalarios. La hospitalización de pacientes y la presencia de dermatólogos residentes de guardia fueron igualmente más habituales en estos hospitales. La actividad docente e investigadora también se relacionó con la complejidad del hospital. Conclusiones: Nuestros resultados describen la situación de los servicios de dermatología españoles justo antes de la pandemia por COVID-19, y pueden ser útiles para la gestión clínica y para definir líneas de trabajo y áreas de mejora (AU)

Evaluación del dolor en consultas de reumatología españolas: Estudio EVADOR / Pain assessment in Spanish rheumatology outpatient clinics: EVADOR Study

Introducción: Las enfermedades reumáticas son la causa más frecuente de dolor crónico no maligno. En los últimos años el dolor y su manejo han cobrado mayor relevancia en reumatología. Objetivos: Establecer la prevalencia y las características del dolor asociado a enfermedad reumática atendido en consultas de reumatología de nuestro país, así como de su tratamiento y la respuesta a este. Métodos: Estudio multicéntrico observacional con 2 fases, una transversal y otra prospectiva. Se recogieron variables del médico, paciente, dolor y su manejo, comorbilidades, respuesta terapéutica y aspectos psicosociales relacionados. Se analizaron las diferencias entre pacientes nuevos y en revisión (PR). Resultados: Se incluyeron 34 centros y 1.084 pacientes, 32% pacientes nuevos y 68% PR. En general, el dolor estaba presente en el 86% de los pacientes, era crónico en el 81% y neuropático en un 12%. El 50% de los pacientes consideraría el dolor aceptable cuando la intensidad en la escala visual numérica fuese≤2. Entre los PR existía mayor percepción de dolor controlado (65,5% vs. 49,4%) y satisfacción con el tratamiento (53,3% vs. 35,6%). El 23,5% estaba en tratamiento con opioides en el mes previo. Conclusiones: En la última década la prevalencia de dolor en el ámbito reumatológico en nuestro país persiste elevada, aunque ha disminuido. El empleo de opioides, por otra parte, ha aumentado.(AU)

Introduction: rheumatic diseases are the most frequent cause of non-malignant chronic pain. In recent years, pain and its management have become more important in rheumatology. Objectives: to estimate the prevalence and characteristics of pain associated with rheumatic pathology treated in rheumatology clinics in Spain, as well as their treatment and response to it. Methods: Multicentre observational study with two phases (cross-sectional and prospective). Variables were collected from the doctor, patient, pain and its management, comorbidities, therapeutic response and related psychosocial aspects. The differences between de novo (NP) vs follow-up (FP) patients were analyzed. Results: 34 centres and 1084 patients were included, 32% NP and 68% FP. Pain was present in 86%, was chronic in 81% and neuropathic in 12% of the surveyed population. Fifty percent of the patients would regard their pain as tolerable if its intensity according to the visual numeric scale (VNS) was≤2. Among the FP it was more frequent to have the perception of controlled pain (65.5% vs 49.4%) and to be satisfied with the treatment (53.3% vs. 35.6%). Of these patients, 23.5% had been treated with opioids in the previous month. Conclusions: In the last decade, the prevalence of pain in rheumatology in Spain remains high, although it has diminished. The use of opioids, on the other hand, has increased.(AU)

Pain assessment in Spanish rheumatology outpatient clinics: EVADOR Study. / Evaluación del dolor en consultas de reumatología españolas: Estudio EVADOR.

INTRODUCTION: rheumatic diseases are the most frequent cause of non-malignant chronic pain. In recent years, pain and its management have become more important in rheumatology. OBJECTIVES: to estimate the prevalence and characteristics of pain associated with rheumatic pathology treated in rheumatology clinics in Spain, as well as their treatment and response to it. METHODS: Multicentre observational study with two phases (cross-sectional and prospective). Variables were collected from the doctor, patient, pain and its management, comorbidities, therapeutic response and related psychosocial aspects. The differences between de novo (NP) vs follow-up (FP) patients were analyzed. RESULTS: 34 centres and 1084 patients were included, 32% NP and 68% FP. Pain was present in 86%, was chronic in 81% and neuropathic in 12% of the surveyed population. Fifty percent of the patients would regard their pain as tolerable if its intensity according to the visual numeric scale (VNS) was≤2. Among the FP it was more frequent to have the perception of controlled pain (65.5% vs 49.4%) and to be satisfied with the treatment (53.3% vs. 35.6%). Of these patients, 23.5% had been treated with opioids in the previous month. CONCLUSIONS: In the last decade, the prevalence of pain in rheumatology in Spain remains high, although it has diminished. The use of opioids, on the other hand, has increased.

Development of an index of complexity for outpatient endocrinology and nutrition clinics. / Desarrollo de un índice de complejidad en consultas externas de Endocrinología y Nutrición.

INTRODUCTION: The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen. MATERIAL AND METHODS: Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism. RESULTS: The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed. CONCLUSIONS: This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation.

Analysis of patients shared in consultations of internal medicine and other medical specialties. / Análisis de pacientes compartidos en consultas de medicina interna y otras especialidades médicas.

BACKGROUND AND OBJECTIVE: The aging population is resulting in an increasing number of patients with multiple diseases that require treatment by various specialties. We examined the evolution of consultations and of the percentage of patients treated by several medical specialties. METHODS: We analysed internal medicine (IM) consultations and those of other medical specialties in a hospital during 1997, 2007 and 2017 for the general population and for those older than 65 years. RESULTS: Over the course of 20 years, the rate of first IM consultations per 1000 inhabitants increased 44%, and that of other medical specialties increased 137%. The percentage of patients seen by more than one specialty went from 13.8% in 1997 to 32.6% in 2017 and reached 45.5% for those older than 65 years. CONCLUSIONS: The care for populations with growing comorbidity has a major impact on health systems and requires organisational changes for their care.

[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]. / Absentismo, y factores asociados, en las citas programadas de una consulta externa de Medicina Preventiva.

BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

High-resolution circuit for the diagnosis of faecal incontinence. Patient satisfaction. / Circuito de alta resolución en el diagnóstico de la incontinencia fecal. Satisfacción de los pacientes.

INTRODUCTION: Despite its high prevalence, faecal incontinence (FI) is still underrated and underdiagnosed. Moreover, diagnosis and subsequent treatment can be a challenge for the colorectal surgeon because of its associated social taboo and embarrassment, and the wide range of symptoms. The aim of the present study is to describe a new high-resolution circuit (HRC) for FI diagnosis, that was implemented at our center and to evaluate patient satisfaction. METHODS: The structure and organization of the HRC are described. Demographic and clinical data of the patients included in the HRC between February 2014 and June 2016 were collected. Moreover, patients' satisfaction was measured through a structured survey. RESULTS: A total of 321 patients were evaluated in our pelvic floor outpatients clinic during the study period: 65% (210) of them had FI (81% women, median age 66 years). The mean time since FI onset was 24 (range 4-540) months. A total of 79% (165) of the patients were included in the HRC. 62% of them responded to the survey. Of these, only 32% (33) had consulted for FI before coming to our centre. The majority, 88% (90) considered that performing the 2diagnostic tests the same day of the visit was a very good option. And 94% (96) were satisfied with the information received on their FI, with a median satisfaction value of 10 (5-10). CONCLUSION: With the HRC, the patient spends about 2h in the outpatient clinic of the hospital, but leaves with the complete diagnostic process performed. The satisfaction survey confirms that most patients prefer this system.

e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics. / La discusión de casos por videoconferencia mejora la eficiencia de la consulta externa de cirugía torácica.

OBJECTIVE: The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD: Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS: The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS: The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

Quality standards for rheumatology outpatient clinic. The EXTRELLA project. / Estándares de calidad asistencial para las consultas externas de reumatología. El proyecto EXTRELLA.

INTRODUCTION: In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented. OBJECTIVE: To develop specific quality criteria and standards for an outpatient rheumatology clinic. METHOD: The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants. RESULTS: 148 standards were developed, grouped into the following 9 dimensions: a) structure (22), b) clinical activity and relationship with the patients (34), c) planning (7), d) levels of priority (5), e) relations with primary care physicians, with Emergency Department and with other clinical departments, f) process (26), g) nursing (13), h) teaching and research (13) and i) activity measures (8). CONCLUSION: This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organising this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators.

Treatment for weight loss of grade iii obese patients in the hospital environment: comparative study between hospitalization and ambulatory programs / Tratamiento para la pérdida de peso en pacientes con obesidad grado iii en ambiente hospitalario: estudio comparativo entre programas de internación y ambulatorio

Introduction: Obesity is a disease characterized by excessive accumulation of body fat with health damaging effects. Objective: To assess the impact of two programs for the treatment of grade III obesity, hospitalization and ambulatory care, on weight loss and body composition. Methods: This was a retrospective study based on the analysis of the medical records ofpatients submitted to the above programs between 1990 and2005, with evaluation of weight evolution, body circumferences (abdominal, hip and arm), fat mass (FM, kg) and fat-free mass (FFM, kg). Results: A total of 50 medical records were evaluated, 54% of them concerning patients of the hospitalization program (HP). Both programs were efficient in promoting weight loss, however, it was greater for HP. HP led to reduction of all body circumferences and of FM but its cost was 80 times higher than the ambulatory program. Conclusion: On the basis of the data evaluated, despite its much higher cost, the HP yielded more effective results in terms of weight loss and change of body composition.

Introducción: La obesidad es una enfermedad caracterizada por la acumulación excesiva de grasa corporal, con efectos nocivos para la salud. Objetivo: Evaluar el impacto de dos programas para el tratamiento de la obesidad grado III: hospitalización y ambulatorio, en la pérdida de peso y composición corporal. Método: Se realizó un estudio retrospectivo basado en el análisis de las historias clínicas de los pacientes sometidos a los dos programas, entre 1990 y 2005, con la evaluación de la evolución del peso, circunferencias corporales (cadera, abdominal, y del brazo), la masa grasa (MG, kg) y masa libre de grasa (MLG, kg). Resultados: Un total de 50 historias clínicas fueron evaluadas, siendo la mayoría (54%), de los pacientes del programa de hospitalización (PH). Los dos programas fueron eficaces en la promoción de la pérdida de peso, pero esta pérdida fue mayor para el PH; que llevó a una reducción de todas las medidas de las circunferencias corporales y de la MG. Sin embargo, su costo fue 80 veces mayor que el del programa de ambulatorio. Conclusión: Sobre la base de los datos evaluados, a pesar de su costo mucho más alto, el HP dió resultados más eficaces en términos de pérdida de peso y en el cambio de la composición corporal.