Mortalidad de una cohorte de hombres con fractura de cadera por fragilidad en un sector sanitario: factores asociados / Mortality in a cohort of men with fragility hip fracture in a health area: associated factors

FUNDAMENTOS: Una cuarta parte de los pacientes con fractura de cadera por fragilidad (FCF) son hombres, y estos presentan una mortalidad mayor que las mujeres. El objetivo de este trabajo es estudiar la mortalidad consecuencia de la FCF en hombres ≥65años, tanto intrahospitalaria como al año y a los 3años, y los posibles factores asociados. MATERIAL Y MÉTODOS: Estudio observacional analítico de una cohorte histórica de 182 pacientes varones con FCF ≥65años ingresados en un servicio de Cirugía Ortopédica y Traumatología (COT) entre enero de 2009 y diciembre de 2014. RESULTADOS: La mortalidad intrahospitalaria fue del 10,9% (6% en el servicio COT y 8,6% en el centro sociosanitario). Se encontró asociación entre la mortalidad intrahospitalaria y la edad (p = 0,039). Veinte pacientes murieron durante su estancia en ambos hospitales. Cuarenta y dos (25,9%) murieron un año después y 95 (58,6%) murieron 3años después. La demencia/deterioro cognitivo se relacionó con un riesgo relativo de mortalidad a un año de 2,2, y de mortalidad a 3años de 1,6. Encontramos asociación entre la edad y la mortalidad y entre el índice de Barthel al inicio y la mortalidad en ambos períodos. Las causas más frecuentes de muerte fueron cardiovasculares (15,7%) y tumores (13,6%). CONCLUSIONES: Los varones con FCF presentaron una mortalidad elevada tanto intrahospitalaria, como al año y a los 3años. El factor de riesgo más determinante de mortalidad al año es la demencia/deterioro cognitivo, y el de mortalidad a los 3años, la HTA

BACKGROUND: A quarter of the patients with fragility hip fracture (FHF) are men, and they have higher mortality rates than women. The objective of this study is to analyse the mortality, as well as associated factors, due to FHF in men aged ≥65years, while in hospital and at one and three years of follow-up. MATERIAL AND METHODS: An analytical observational study was conducted on a historical cohort of 182 male patients equal or older than 65 years that were admitted to an Orthopaedic Surgery and Traumatology (OST) Department between January 2009 and December 2014. RESULTS: Within-hospital mortality was 10.9% (6% in the OST Department, and 8.6% in a Social-Health centre). A relationship (P=.039) was found between within-hospital mortality and age. A total of 20 patients died during their stay in both units, 42 (25.9%) died one year later, and 95 (58.6%) died three years later. Dementia/cognitive impairment was associated with a relative risk of one-year mortality of 2.2, and 1.6 of three-year mortality. An association was observed between age and mortality and between Barthel Index at baseline and mortality at both periods. The most frequent causes of death were cardiovascular (15.7%) and tumours (13.6%). CONCLUSIONS: Male patients with FHF showed high mortality rates in hospital, and at one-year and three-years follow-up. The most important risk factor of mortality was dementia/cognitive deterioration at one year, and high blood pressure at three years

[Mortality in a cohort of men with fragility hip fracture in a health area: Associated factors]. / Mortalidad de una cohorte de hombres con fractura de cadera por fragilidad en un sector sanitario: factores asociados.

BACKGROUND: A quarter of the patients with fragility hip fracture (FHF) are men, and they have higher mortality rates than women. The objective of this study is to analyse the mortality, as well as associated factors, due to FHF in men aged ≥65years, while in hospital and at one and three years of follow-up. MATERIAL AND METHODS: An analytical observational study was conducted on a historical cohort of 182 male patients equal or older than 65 years that were admitted to an Orthopaedic Surgery and Traumatology (OST) Department between January 2009 and December 2014. RESULTS: Within-hospital mortality was 10.9% (6% in the OST Department, and 8.6% in a Social-Health centre). A relationship (P=.039) was found between within-hospital mortality and age. A total of 20 patients died during their stay in both units, 42 (25.9%) died one year later, and 95 (58.6%) died three years later. Dementia/cognitive impairment was associated with a relative risk of one-year mortality of 2.2, and 1.6 of three-year mortality. An association was observed between age and mortality and between Barthel Index at baseline and mortality at both periods. The most frequent causes of death were cardiovascular (15.7%) and tumours (13.6%). CONCLUSIONS: Male patients with FHF showed high mortality rates in hospital, and at one-year and three-years follow-up. The most important risk factor of mortality was dementia/cognitive deterioration at one year, and high blood pressure at three years.

Infl uencia de la dieta hiposódica en el paciente hipertenso / The infl uence of the hyposodic diet in the hypertensive patient

Introducción: La hipertensión arterial es una enfermedad muy frecuente en las sociedades desarrolladas, cuya prevalencia aumenta con la edad, llegando a afectar al 50% de las personas mayores de 60 años, con graves consecuencias para la salud. Para su tratamiento, además de las medidas farmacológicas, se dispone de las llamadas medidas higiénico-dietéticas, entre las que tiene especial importancia la reducción en la ingesta total de sodio, como puso de relevancia el estudio INTERSALT en 1988. Tal es así, que actualmente está socialmente aceptado que la primera medida que se debe tomar para el control y la disminución de las cifras de presión arterial (PA) es la dieta hiposódica. Objetivo: Comprobar el efecto de la reducción de la ingesta de sodio en las cifras de PA en personas con PA sistólica ³139 mmHg y de PA diastólica ³89 mmHg. Metodología: Se diseñó un estudio de intervención, casi experimental, tipo ensayo cruzado (crossover). Se midió la disminución de la PA conseguida tras 10 días de dieta hiposódica. Para obtener una potencia en el estudio del 90% y un error alfa del5%, necesitamos al menos un tamaño muestral de 50 casos, según una toma previa de datos. Resultados: La reducción de la ingesta de sodio durante el periodo estudiado produce una disminución media de 4,76 mmHg en la PA sistólica y de 2,92 mmHg en la PA diastólica. Los resultados obtenidos son significativos (p <0,00001). Conclusiones: La dieta hiposódica reduce los niveles de PA. Hemos apreciado que un menor seguimiento en la dieta hiposódica previa se corresponde con un mayor descenso dela PA (AU)

Introduction: Arterial hypertension is a very frequent condition in developed societies. Its prevalence increases with age and it may affect 50% of those older than 60 years, with serious consequences for their health. In addition to the pharmacological measures, one may treat this sickness using the so called hygienic-dietetic measures. Among these it is especially important the reduction in the intake of sodium as shown in the INTERSALT (1998) study. Nowadays it is socially accepted that the first measure one should take in controlling and decreasing arterial pressureis a hyposodic diet. Objective: To test the effect of a reduction in the intake of sodium in the arterial pressure in several people with systolic arterial pressure greater than 139 mmHg and diastolic arterial pressure greater than 89 mmHg. Methodology: We designed a quasi-experimental intervention study of crossover type. We measured the decrease in arterial pressure attained after 10 days of a hyposodic diet. To obtain a power in the study of 90% and an alpha error of 5% we need at least a sample of 50 individuals, according to a previous data sample. Results: The reduction in the sodium intake during the period of study produces a decrease of an average of 4.76 mmHg in the systolic arterial pressure and 2.92 mmHg en the diastolic arterial pressure. The results are significant (p <0.00001). Conclusions: A hyposodic diet reduces the level of arterial pressure. We have appreciated that the effect is greater in those who had not previously followed hyposodic diet (AU)

Secondary effluent reclamation: combination of pre-treatment and disinfection technologies.

A study was carried out to evaluate the efficiency of secondary effluent additional treatment, using a combination of pre-treatments (ring filter, physico-chemical and infiltration-percolation) followed by disinfection methods (chlorine dioxide, peracetic acid and ultraviolet light). Three different indicator microorganisms were determined: E. coli, total coliforms and somatic bacteriophages. The results show better efficiency of physico-chemical and infiltration-percolation processes. Bacteriophages were eliminated to a lesser extent than bacterial indicators in all the treatment systems. Chlorine dioxide and peracetic acid seems to be more efficient in disinfection than ultraviolet light when a ring filter is the pre-treatment used. For the same doses and contact times, the efficiency of the disinfection methods is higher when the pre-treatment used is the physico-chemical or the infiltration-percolation system. The final effluent quality from the physico-chemical treatment train and the infiltration-percolation treatment train, followed by the disinfectants, achieves an E. coli content that allows the reuse in most of the uses described in the Spanish legislation for wastewater reuse.

No confundir las estimaciones con la realidad / Not confusing estimates with reality

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Reflection in action in caring for the dying: applying organizational learning theory to improve communications in terminal care.

Currently, single loop learning is the predominant method of problem solving orientation engaged in by healthcare institutions. This mode of learning is not conductive to fostering needed communications between health care providers and terminal patients. Reflection in action, second loop learning, focuses on deep listening and dialogue and can be critical in opening communications paths between the dying patient and his or her caregivers. This article discusses organizational learning theory and applies the theories double loop learning technique of reflection in action to end-of-life care. The article further explores an exemplar of reflection in action in a Palliative Care Program, and end-of-life home care program at Kaiser Permanente. In order to more effectively meet the needs of terminally ill patients, greater efforts are needed to incorporate second loop learning into the practice of those caring for these patients.

Integrating behavior change theory into geriatric case management practice.

Case management practices have continued to grow despite a lack of clear evidence of their efficacy. With the expanding segment of the elderly population, there is a critical need to develop and identify programs that will address the many needs of the aging. Geriatric Case Management has been the avenue selected by many health care providers to address these issues, focusing on maintaining health status and improving linkages with medical and community resources. Studies testing the effectiveness of these models have failed to demonstrate their effectiveness in reducing depression, reducing acute care service use, and improving or maintaining health status. The Geriatric Case Management models presented in these lack an evidence-based, theoretical framework that provides definition and direction for case management practice. This article introduces behavior change theories as a method of structuring and delineating the case management intervention. The Transtheoretical Model and the Theory of Planned Behavior are discussed and methods of integrating these theories into practice are discussed.

Development and use of role model stories in a community level HIV risk reduction intervention.

A theory-based HIV prevention intervention was implemented as part of a five-city AIDS Community Demonstration Project for the development and testing of a community-level intervention to reduce AIDS risk among historically underserved groups. This intervention employed written material containing stories of risk-reducing experiences of members of the priority populations, in this case, injecting drug users, their female sex partners, and female sex workers. These materials were distributed to members of these populations by their peers, volunteers from the population who were trained to deliver social reinforcement for interest in personal risk reduction and the materials. The participation of the priority populations in the development and implementation of the intervention was designed to increase the credibility of the intervention and the acceptance of the message. The techniques involved in developing role-model stories are described in this paper.