Intervención grupal del síndrome subacromial en atención primaria / A group intervention for shoulder impingement syndrome in primary care

Introducción. El aumento de consultas por dolor de hombro en los servicios de rehabilitación impone buscar alternativas eficientes para mejorar su manejo. Objetivos. Evaluar la efectividad de un programa de rehabilitación grupal para mejorar la funcionalidad y el dolor en pacientes afectos de síndrome subacromial y ver qué variables se asocian a un mejor resultado funcional final. Métodos. Estudio longitudinal prospectivo de intervención antes/después. Muestra: 211 pacientes. La intervención consistió en 10 sesiones de electroterapia analgésica individual, 5 sesiones de cinesiterapia grupal y una sesión informativa: «escuela de hombro». El seguimiento fue de un año. Medimos la funcionalidad con el test de Constant y el dolor con la escala visual analógica. Pruebas estadísticas: chi cuadrado, T-test, ANOVA y regresión lineal múltiple (p < 0,05). Resultados. La funcionalidad mejoró significativamente en los 4 períodos estudiados respecto al valor inicial y se estabilizó a los 6 meses. El perfil de paciente que obtuvo mayor funcionalidad fue: mujer, mayor de 60 años, sin dolor en reposo inicial y laboralmente no activa. La mejora del dolor observada a largo plazo no fue significativa. El consumo de analgésicos se redujo significativamente a los 3 meses. La adherencia al tratamiento domiciliario de ejercicios fue del 81% a los 3 y 6 meses y del 70,6% al año. Conclusiones. La aplicación de un programa de rehabilitación grupal en pacientes afectos de síndrome subacromial se ha mostrado efectivo para mejorar la funcionalidad a largo plazo. Sin embargo, el dolor no ha mostrado mejoría significativa a lo largo del estudio (AU)

Introduction. Due to the increase in consultations for shoulder pain in rehabilitation services, there is a need for efficient alternatives to improve the management of this disorder. Objectives. To evaluate the effectiveness of a supervised group exercise program to improve functionality and pain in patients with shoulder impingement syndrome and to identify the variables that are associated with a better functional outcome. Methods. A prospective longitudinal, pre and post intervention study was carried out in a sample of 211 patients. The treatment consisted of 10 individual sessions of analgesic electrotherapy, 5 sessions of group exercise therapy and an educational session: «shoulder school». One year follow-up was performed. Shoulder function and pain were assessed using Constant's test and the visual analogue scale. The statistical analysis was carried out with the chi-square test, T-test, ANOVA and multiple linear regression (P < .05). Results. Functionality improved significantly in all periods studied compared with baseline and stabilized at 6 months. The profile of patients who achieved greater functionality was female, older than 60 years, with no initial rest pain and occupationally inactive. Long-term pain improvement was not significant. Analgesic use was significantly reduced at 3 months. Adherence to home exercise treatment was 81% at 3 and 6 months and 70.6% at one year. Conclusions. The application of a group rehabilitation program in patients with shoulder impingement syndrome was effective in improving long-term functionality. However, there was no significant pain improvement during the study (AU)

Estudio clínico controlado de la sacarosa como reductor de la duración del llanto en lactantes en el momento de la vacunación / Controlled clinical study of sucrose administration to reduce the duration of crying in infants undergoing vaccination

Objetivo: Valorar el efecto de la solución de sacarosa al 75%, administrada por vía oral, sobre el tiempo de duración del llanto en la vacunación a lactantes. Material: Ensayo clínico controlado, aleatorizado, doble ciego, de solución de sacarosa al 75% o agua potable como control. Pacientes: Un total de 323 controles de salud fueron atendidos a la edad de 1,2, 4 o 6 meses para ser vacunados de hepatitis B o de difteria, tétanos, tos ferina y Haemophilus influenzae tipo B (DTPHib). Método: Se midió el tiempo de duración del llanto desde el momento de administrar la vacuna intramuscular hasta el cese del llanto arropado en el brazo materno. Resultados: La administración de 2 mL de sacarosa al 75% reduce el tiempo de duración del llanto después de la inmunización de hepatitis B o DTPHib, diferencia de medias de 5,05 seg. (IC 95% entre -9,2835 y -0,8110 seg.) (p<0,02). El número necesario de niños (NNN) a los que hay que administrar 2mL de sacarosa previo a la inmunización para obtener un tiempo de duración del llanto inferior o igual a 25 segundos (media de tiempo de duración del llanto del grupo de sacarosa) fue de 11 (IC 95%=5 a infinito). Conclusiones: Durante las inmunizaciones intramusculares, la administración de soluciones de sacarosa en altas concentraciones tiene efectos clínicamente modestos en cuanto a la reducción del tiempo de duración del llanto (AU)

Objective: To evaluate the effect of an oral sucrose solution on infant crying times in immunization clinics. Methodology: Randomised, double blind, placebo-controlled trial involving a 75% sucrose solution or drinking water as a control. Patients: A total of 323 infants receiving 1, 2, 4 or 6-month intramuscular immunization against hepatitis B virus or against diphtheria, tetanus, pertussis and haemophilus influenza type B (DTPHib). Methods: The duration of infant crying was recorded during and immediately after intramuscular vaccine injection until it ceased in the mothers’ arms. Results: The administration of 2 ml 75% surcrose reduced the infant crying time after immunization against hepatitis B virus or DTPHib, with a mean difference of 5.05 seconds (95% CI between – 9.2835 and -0.8110 seconds) (p < 0.02). The number of children to whom it was necessary to administer 2 ml of sucrose prior to immunization to obtain a crying time of less than or equal to 25 seconds (mean duration of crying in the sucrose group) was 11 (95% CI=5 to infinite). Conclusions: During intramuscular immunization, the administration of sucrose solutions at high concentrations has only clinically modest effects in terms of reducing the duration of crying (AU)

[Determinants of the use of pediatric consultations: study of child morbidity and maternal variables]. / Determinantes del uso de las consultas de pediatría: estudio de morbilidad infantil y variables maternas.

OBJECTIVE: To know the relations of the frequency of the pediatrics consultations with the maternal use of the consultations of family medicine, the maternal perception of his son's health, the events happened previously in the family, the infantile morbidity and socioeconomic condition. DESIGN: Prospective and observational study, duration 12 months. EMPLACEMENT: Primary care. PATIENTS: 261 children from 0 to 12 years old selected by systematic randomized pattern. The mother was required to have history in the center. MEASUREMENTS AND RESULTS: The dependent variable was the frequentation to the pediatric clinics, and the independent variables were the mother frequentation to the medical clinics; perception of its son's health, measured by health questionnaire; inventory of previous events according to Holmes and Rahe's questionnaire; sociodemographic variables and children morbidity registered in the medical files. The mean of infantile frequentation proved to be 10.18 visits per year (7.9 DS). 12% of children were high users and they accounted for 42% of all contacts. The variables associated to the frequentation were: age smaller than the boy, infantile morbidity and maternal frequent to the medical services, p < 0.001 for each one the variables. Those variables explained 40.8% of the variance in volume of care. CONCLUSIONS: The maternal use exercises an independent influence in the use of the pediatric services. Educative performances directed to the mother could improve this behaviour. The age is a predisposing factors of frequentation to the infantile services. The conditions of health are a potent predictor of frequentation, those children require more cares to attend their needs. Educational strategies which improve the level of maternal cares to the child in situation of illness could diminish the cares which are offered in pediatrics.