[Costs study in Alzheimer's disease]. / Estudio de costes en la enfermedad de Alzheimer.

UNLABELLED: The Alzheimer disease (AD) it constitutes one of the socio-sanitary and economic problems and more important in the systems of health of the developed countries. Also, this problem will be increased in next years with the population's progressive aging and the biggest incidence of this illness. The family will support the biggest load in the care of these patients. The devices like the units by day will give a bigger independence to these families. OBJECTIVES: It is sought to study the direct sanitary and social costs of a group of patients with AD that live in the area of health of Guadalajara. They will be evaluated the global cost and I average according to the degree of deterioration, sex, and age. The aspects will be determined that more they influence in these costs, as the epidemic variables and the associate comorbility. MATERIAL AND METHODS: An observational and descriptive study was designed on 337 patients of EA, selected according to the registries of the section of neurology of the university and General Hospital of Guadalajara, the registrations EAP of the centres of health of the area, and the existent ones in two nursing homes of our environment. For the obtaining of the data the clinical histories were used. The used computer systems were: the EPINFO V.6 & SPSS V, DBASE IV, EXCEL, and the system of hospital costs of the University and General Hospital of Guadalajara. For the analysis of the data an error typo I p < 0.05 was used, this analysis began with the test of Kolmorov-Smirnov to contrast the normality of the curves of distribution of data of each variable. RESULTS: 76% was women and the rest males. The global stocking of age was of 73 0.63 years, with more age in the women. The associate comorbility was bigger in the men. The stocking of the consumption of pharmacotherapy was of 3.1. The costs of the consultations carried out for these patients were of a stocking of 2.064,75 euros patient/year, and that of the complementary explorations of 639 euros for patient/year. The pharmacy cost was of 4.560 euros patient/year, with more expense in women and in the degree sick persons II of the EA. The hospital half stay was of 10.8 days with a cost for each entrance and patient of 2.778 euros. In Primary Attention the cost for patient and year was of 8.615 euros. The cost of these patients in the residences was of 11.900 euros for patient and year, in those of private administration, and of 12.982 euros in those of mixed administration, according to the degree of deterioration, the pharmacy expense was of 2.470 euros for those of degree I, of 141.359 euros for those of degree II and of 31.059,10 euros for those of the degree III. CONCLUSIONS: The half cost of the attendance is three times adult that the pensions received by these sick persons, for that that the patients and/or the families support more than 60% of the direct cost. The families don't have this way more remedy than to increase their expenses because neither the society neither the sanitary system have still given an appropriate answer to the problem of this illness.

Estudio de costes en la enfermedad de Alzheimer / Costs study in Alzheimer's disease

La enfermedad de Alzheimer (EA) constituye uno de los problemas sociosanitarios y económicos más preocupantes en los sistemas de salud de los países desarrollados. Además este problema se agravará en los próximos años con el envejecimiento progresivo de la población y la mayor incidencia de la EA. La familia va a soportar la mayor carga en el cuidado de estos pacientes. Los dispositivos como las unidades de día van a dar una mayor independencia a estas familias. Objetivos. Se pretende estudiar los costes sanitarios y sociales directos de un grupo de pacientes con EA que residen en el área de salud de Guadalajara. Se evaluará el coste global y promedio según el grado de deterioro, sexo y edad. Se determinarán los aspectos que más influyen en estos costes, como las variables epidemiológicas y/o la comorbilidad asociadas. Material y métodos. Se diseñó un estudio observacional y descriptivo sobre 337 pacientes con EA del área de salud de Guadalajara, seleccionados según los registros de la sección de neurología del Hospital General y Universitario de Guadalajara, los registrados por los equipos de Atención Primaria (EAP) de los centros de salud del área y los existentes en dos residencias de nuestro entorno. Para la obtención de los datos se utilizaron las historias clínicas. Los sistemas informáticos utilizados fueron el EPINFO V.6 SPSS V & DBASE IV, EXCEL, y el sistema de costes hospitalarios del Hospital General y Universitario de Guadalajara. Para el análisis de los datos se utilizó un error tipo 1 de p<0,05.Este análisis se inició con la prueba de Kolmorov-Smirnov para contrastar la normalidad de las curvas de distribución de datos de cada variable. Resultados. El 76 por ciento fueron mujeres y el resto varones. La media global de edad fue 73ñ0,63, con mayor edad en el sexo femenino. La comorbilidad asociada fue mayor en varones. La media de la cantidad de consumo de fármacos fue de 3,1. Los costes de las consultas realizadas para estos pacientes fue de una media de 2.064,75 por paciente/año y el de las exploraciones complementarias de 639 por paciente/año. El coste de farmacia fue de 4.560 por paciente/año, con mayor gasto en mujeres y los de grado II de la EA. La estancia media hospitalaria fue de 10,8 días, con un coste por cada ingreso y paciente de 2.778. En Atención Primaria el coste por paciente y año fue de 8.615. El coste de estos pacientes en las residencias fue de 11.900 por paciente y año en las de gestión privada y de 12.982 para las gestionadas de forma concertada. Según el grado de deterioro el gasto de farmacia fue para los del grado I de 2.470 , para los del grado II de 141.359 y para los de grado III de 31.059,10 .Conclusiones. El coste medio de la asistencia es tres veces mayor que las pensiones recibidas por estos enfermos, por lo que los pacientes y/o las familias soportan más del 60 por ciento del coste global directo. Así, las familias no tienen más remedio que aumentar sus gastos debido a que ni la sociedad ni el sistema sanitario han dado aún una respuesta adecuada a la problemática de esta enfermedad (AU)

[Epidemiologic aspects of the burnout syndrome in hospital personnel]. / Aspectos epidemiológicos del síndrome de "burnout" en personal sanitario.

BACKGROUND: Burnout Syndrome is claimed to be the most probable cause of the lack of motivation suffered by professional health workers nowadays. This suggests that the syndrome may be linked to the high levels of absenteeism from work among this professional group. The study aims to provide a number of descriptions of the universal epidemiological variables that would allow us to draw up a risk profile for this profession. METHOD: We studied a random sample of 294 professionals working in the primary specialised health sector to which we applied the Burnout Syndrome measurement instrument (Maslach Burnout Inventory) which was self-administered. Descriptive statistics were gathered with a comparison of average values for socio-demographic variables (P < 0.05) using Epiinfo V.60 and SPSS PC.W. RESULTS: We obtained 87.76% responses compared with 12.23% losses. This sample gave us a 95% reliability level with a 5% error margin. We obtained significant differences in line with sex, age, marital status, length of service in the workplace, number of workers, place of work, number of patients under their responsibility, weekly working hours, patient interaction time. The Burnout average was 47.16 +/- 7.93, with the highest proportions corresponding to emotional fatigue and lack of self-fulfilment. CONCLUSIONS: The epidemiological risk profile obtained would be as follows: a female, over 44 years old, with no stable partner, with more than 19 years service in the profession and more than 11 at that particular workplace, working in a specialised department, with more than 21 patients under her responsibility, devoting more than 70% of the working day to these patients and with a working week of 36-40 hours.

[Plasma concentrations of fibronectin in septic, hypovolemic, and cardiogenic shock. Prognostic usefulness of their variation]. / Concentraciones plasmáticas de fibronectina en el shock séptico, hipovolémico y cardiogénico. Utilidad pronóstica de sus variaciones.

BACKGROUND: Fibronectin is a protein with opsonic capacity. Its plasma level is diminished in septic shock. The aim of the present was to study its behavior in other types of shock. METHODS: A prospective study of 60 patients in shock (septic, hypovolemic and cardiogenic) was carried out. Serial plasma levels of fibronectin were determined in these patients over a period of 72 hours. The values of the cases which evolved favorably were compared with the values of those which did not. RESULTS: In all the cases, the plasma levels of fibronectin were diminished within a minimum of approximately 12 hours with a tendency to recovery of initial values being observed within 72 hours, except in cases in which the evolution of the patient was poor. In these cases fibronectin values remained diminished in such statistical significant. CONCLUSIONS: Plasma levels of fibronectin behave similarly in the three types of shock studied (septic, hypovolemic and cardiogenic). Serial determination of fibronectin provides a good prognostic index in patients with shock.