Epidemiology and societal costs of gastroesophageal reflux disease and Barrett's syndrome in Germany, Italy and Spain.

AIM: To estimate the economic consequences for society arising from populations with poorly treated gastroesophageal reflux disease (GERD) and Barrett's esophagus in Germany, Italy and Spain. METHODS: The following epidemiologic data were used: total population figures, the prevalence and incidence of GERD and its complications, and data on patients with poorly treated GERD, as well as data on treatment costs and active workers' presenteeism and absenteeism. These data were used to calculate the economic consequences arising from the population with poorly treated GERD and Barrett's esophagus for the healthcare system and employers in each country. RESULTS: The size of the population with poorly treated GERD with Barrett's esophagus was estimated to be 29,678 in Spain, 19,327 in Germany and 10,079 in Italy. Costs for the healthcare systems in Spain, Germany and Italy for the population with poorly treated GERD with Barrett's esophagus were estimated to be €18, 12 and 7 million, respectively, for each country. Total costs for absenteeism and presenteeism for employers due to poorly treated GERD with Barrett's esophagus were €10 million for Germany, €1 million for Italy and none for Spain. CONCLUSION: Costs due to poorly treated GERD with Barrett's esophagus represent a substantial burden for the healthcare systems of all three studied countries. Costs for employers owing to absenteeism or presenteeism of employees were low or no costs were found.

[Primary care doctors' and nurses' opinion of elder abuse and neglect]. / Visión del maltrato al anciano desde atención primaria.

OBJECTIVE: To identify primary care health professionals' opinion of elder abuse and its management. Qualitative study through focus groups. PARTICIPANTS: Twenty-seven health professionals in primary care. Analyses of the thematic content of data, codification, segmentation and creation of categories of the text corpus. RESULTS: The most frequent types of abuse were psychological and financial. Neglect was associated with current lifestyles. Physical and sexual abuse was considered infrequent, but possibly under-detected. Important risk factors were dysfunctional families, stressed and under-trained caregivers, and elder hostility. The profile of the abuser was associated with mental disorders, drug addiction and prior family violence in physical and financial abuse, but no clear profile was identified in the categories of neglect and abandonment. Social and health resources were insufficient and limited intervention, thus making detection fruitless. Education, monitoring and counseling of health professionals in elder abuse was considered necessary because, given external and well coordinated support, primary care could intervene effectively in situations of elder abuse. CONCLUSIONS: Although the phenomenon of elder abuse is well known, consensus guidelines for its detection and intervention need to be defined. The lack of resources and the difficulties of delimiting responsibilities in the management of elder abuse should be taken into account when planning strategies. The health professionals considered themselves as a resource and did not avoid involvement.

Visión del maltrato al anciano desde atención primaria / Primary care doctors' and nurses' opinion of elder abuse and neglect

Objetivo: Identificar la opinión de los profesionales sanitarios de atención primaria (AP) sobre el maltrato al anciano (MA) y su abordaje, mediante un estudio cualitativo de grupos focales. Sujetos y métodos: Participaron 27 sanitarios de AP. Se llevó a cabo un análisis del contenido temático de los datos, la codificación, la segmentación y la creación de categorías del corpus textual. Resultados: Consideraron más frecuentes los abusos psicológicos y económicos. La negligencia se relacionó con el estilo de vida actual. Los abusos físicos y sexuales se consideraron anecdóticos, aunque posiblemente infradiagnosticados. Entre los factores de riesgo destacan la desestructuración familiar, la sobrecarga, la escasa formación del cuidador y la hostilidad del anciano. El maltratador se asoció con determinadas variables, como enfermedad mental, drogodependencia, violencia familiar previa en abusos físicos y económicos; no había un perfil definido en situaciones de negligencia o abandono. Los recursos sociales y sanitarios son insuficientes y limitan la intervención, haciendo infructuosa la detección. La formación, la supervisión y el asesoramiento de los profesionales respecto al MA se consideraron recursos necesarios puesto que, con apoyos externos y bien coordinados, la AP podría actuar eficazmente en estas situaciones. Conclusiones: Aunque los profesionales demostraron un buen conocimiento del problema, se puso de manifiesto la necesidad de disponer de pautas consensuadas de detección e intervención. Afloraron carencias de recursos y dificultades en la delimitación de responsabilidades en el abordaje del MA, que han de tenerse en cuenta a la hora de planificar estrategias. Los profesionales se consideraron a sí mismos un recurso de actuación sin rehuir su implicación

Objective: To identify primary care health professionals' opinion of elder abuse and its management. Qualitative study through focus groups. Participants: Twenty-seven health professionals in primary care. Analyses of the thematic content of data, codification, segmentation and creation of categories of the text corpus. Results: The most frequent types of abuse were psychological and financial. Neglect was associated with current lifestyles. Physical and sexual abuse was considered infrequent, but possibly under-detected. Important risk factors were dysfunctional families, stressed and under-trained caregivers, and elder hostility. The profile of the abuser was associated with mental disorders, drug addiction and prior family violence in physical and financial abuse, but no clear profile was identified in the categories of neglect and abandonment. Social and health resources were insufficient and limited intervention, thus making detection fruitless. Education, monitoring and counseling of health professionals in elder abuse was considered necessary because, given external and well coordinated support, primary care could intervene effectively in situations of elder abuse. Conclusions: Although the phenomenon of elder abuse is well known, consensus guidelines for its detection and intervention need to be defined. The lack of resources and the difficulties of delimiting responsibilities in the management of elder abuse should be taken into account when planning strategies. The health professionals considered themselves as a resource and did not avoid involvement