Healthcare use among people with diabetes mellitus in Europe: a population-based cross-sectional study.

OBJECTIVE: This study aimed to determine the association of health determinants, lifestyle and socioeconomic variables on healthcare use in people with diabetes in Europe. DESIGN: A cross-sectional study was conducted using data from the European Health Interview Survey wave 2 (ie, secondary analysis). SETTING: The sample included data from 25 European countries. PARTICIPANTS: The sample included 16 270 patients with diabetes aged 15 years or older (49.1% men and 50.9% women). RESULTS: The survey data showed that 58.2% of respondents had seen their primary care physician in the past month and 22.6% had been admitted to the hospital in the past year. Use of primary care was associated with being retired (prevalence ratio (PR) 1.13, 95% CI 1.07 to 1.19) and having very poor self-perceived health (PR 1.80, 95% CI 1.51 to 2.15), long-standing health problems (PR 1.14, 95% CI 1.04 to 1.24), high blood pressure (PR 1.06, 95% CI 1.03 to 1.10) and chronic back pain (PR 1.07, 95% CI 1.04 to 1.11). Hospital admission was associated with very poor self-perceived health (PR 3.03, 95% CI 2.14 to 4.31), accidents at home (PR 1.54, 95% CI 1.40 to 1.69), chronic obstructive pulmonary disease (COPD) (PR 1.34, 95% CI 1.22 to 1.47), high blood pressure (PR 1.08, 95% CI 1.01 to 1.17), chronic back pain (PR 0.91, 95% CI 0.84 to 0.98), moderate difficulty walking (PR 1.33, 95% CI 1.21 to 1.45) and severe difficulty walking (PR 1.67, 95% CI 1.51 to 1.85). CONCLUSIONS: In the European diabetic population, the high cumulative incidences of primary care visits and hospital admissions are associated with labour status, alcohol consumption, self-perceived health, long-standing health problems, high blood pressure, chronic back pain, accidents at home, COPD and difficulty walking.

Analgesia epidural multimodal en isquemia arterial aguda / Multimodal epidural analgesia in acute arterial ischemia

La isquemia arterial aguda (IAA) es un síndrome causado por la interrupción brusca del aporte sanguíneo a un determinado territorio del orga-nismo, a consecuencia de la obstrucción súbita de la arteria que lo irriga. Puede ir acompañada de un intenso dolor que no responda a la anal-gesia convencional. La analgesia epidural multi-modal es la administración de un anéstesico lo-cal con un opioide en el espacio peridural para mantener al individuo libre de dolor. El uso de una técnica multimodal reduce la incidencia y gravedad de los trastornos fisiológicos que oca-siona el dolor agudo. Presentamos un caso de un paciente ingresado a cargo de la Unidad de hospitalización a Domicilio para control evoluti-vo y manejo del dolor por una IAA en miembro superior izquierdo. Tras intervencionismo, se realizó una analgesia epidural multimodal con fentanilo y bupivacaina con mejoría completa del mismo y sin incidencias clínicas.(AU)

Acute arterial ischemia (AAI) is a syndrome caused by the sudden interruption of the blood supply to a certain territory of the body, as a result of the sudden obstruction of the artery that supplies it. It can be accompanied by se-vere pain that does not respond to conventional analgesia. Multimodal epidural analgesia is the administration of a local anesthetic with an opi-oid into the epidural space to keep the individual pain free. The use of a multimodal technique re-duces the incidence and severity of physiologi-cal disorders caused by acute pain. We present a case of a patient admitted to the Home Hos-pitalization Unit for evolutionary control and pain management due to an AAI in the left upper limb. After intervention, a multimodal epidural analgesia with fentanyl and bupivacaine was performed with complete improvement of the same and without clinical incidences.(AU)

Quality-of-Life Determinants in People with Diabetes Mellitus in Europe.

This study aims to analyze self-perceived health and lifestyles in the European Union Member States Iceland, Norway, and the United Kingdom, examining associations with diabetes prevalence; and to identify the demographic, economic and health variables associated with diabetes in this population. We performed a cross-sectional study of 312,172 people aged 15 years and over (150,656 men and 161,516 women), using data collected from the European Health Interview Survey (EHIS). The EHIS includes questions on the health status and health determinants of the adult population, as well as health care use and accessibility. To estimate the magnitudes of the associations with diabetes prevalence, we fitted multivariate logistic models. The EHIS data revealed a prevalence of diabetes in Europe of 6.5% (n = 17,029). Diabetes was associated with being physically inactive (OR 1.14; 95% CI 1.02-1.28), obese (OR 2.75; 95% CI 2.60-2.90), male (OR 1.46; 95% CI 1.40-1.53) and 65-74 years old (OR 3.47; 95% CI 3.09-3.89); and having long-standing health problems (OR 7.39; 95% CI, 6.85-7.97). These results were consistent in the bivariate and multivariate analyses, with an area under the receiver operating characteristic curve of 0.87 (95% CI 0.87-0.88). In a large European health survey, diabetes was clearly associated with a poorer perceived quality of life, physical inactivity, obesity, and other comorbidities, as well as non-modifiable factors such as older age and male sex.

Abordaje de la hiperpotasemia: desde urgencias a la unidad de hospitalización domicilio / Management of hyperkalemia: from the emergency department to the home hospitalization unit

La hiperpotasemia es una anomalía eléctrica común que puede empeorar arritmias cardía-cas y aumentar significativamente la mortalidad. El envejecimiento progresivo de la población sumado a la mayor incidencia de entidades como la diabetes mellitus (DM), enfermeda-des cardiovasculares (ECV) o enfermedad re-nal crónica (ECV) así como el creciente uso de inhibidores del sistema renina angiotensina aldosterona (RAASi) ha provocado que sea un problema frecuente al que tenga que enfrentar-se el clínico en su día a día. Presentamos un caso de un paciente ingresado a cargo de la Unidad de Hospitalización a Domicilio de San Juan de Alicante que presentaba un cuadro de inicio súbito y clínica inespecífica debido a una hiperpotasemia grave. Tras estabilización pre-via en el servicio de urgencias, se realizó́ una combinación de tratamiento con fármacos RA-ASi, diuréticos de asa y resinas de intercambio catiónico (patiromero) presentando una mejoría de la sintomatología y control de la potasemia.(AU)

Hyperkalemia is a common electrical abnor-mality that can worsen cardiac arrhythmias and significantly increase mortality. The pro-gressive aging of the population added to the higher incidence of entities such as diabetes mellitus (DM), cardiovascular diseases (CVD) or chronic kidney disease (CVD) as well as the increasing use of renin angiotensin aldosterone system inhibitors (RAASi) has caused make it a frequent problem that clinicians have to face in their day-to-day life. We present a case of a pa-tient admitted to the San Juan de Alicante Home Hospitalization Unit who presented a sudden onset and nonspecific clinical picture due to se-vere hyperkalemia. After prior stabilization in the emergency department, a combination of treat-ment with RAASi drugs, loop diuretics and cati-on exchange resins (patiromer) was performed, presenting an improvement in symptoms and control of potassium levels.(AU)

Manejo farmacológico de la obstrucción intestinal maligna / Pharmacological management of malignant bowel obstruction

La obstrucción intestinal maligna (OIM) es uno de los problemas más difíciles de manejar por las unidades de cuidados paliativos debido a la elevada carga de síntomas, a menudo recurrentes y, a veces, refractarios entre los pacientes con cáncer avanzado. La falta de estudios contundentes hace que la OIM se maneje empíricamente, existiendo una elevada variabilidad clínica y falta de consenso. Presentamos el caso clínico de un paciente ingresado a cargo de la Unidad de Hospitalización a Domicilio de San Juan de Alicante que presentaba un cuadro de oclusión de intestino delgado debido a implante mesentérico en cuadrante inferior derecho. Se realizó una combinación de agentes propulsores y antisecretivos que actuaron sinérgicamente reduciendo los síntomas gastrointestinales, y presentando una mejoría tanto en la calidad de vida como en el tiempo medio de supervivencia

Malignant bowel obstruction (MBI) is one of the most difficult problems to manage by palliative care units because of the high burden of often recurrent and sometimes refractory symptoms among patients with advanced cancer. The lack of robust studies means that MBI is managed empirically, with high clinical variability and lack of consensus. We present the clinical case of a patient in charge of the Home Hospitalization Unit who presented a picture of small bowel occlusion due to mesenteric implant in the lower right quadrant. A combination of propellant and antisecretory agents were used, which acted synergistically to reduce gastrointestinal symptoms, and showed an improvement in both quality of life and average survival time