Análisis comparativo de las derivaciones desde atención primaria de salud a salud mental: Atención psicológica y atención psiquiátrica / No disponible

Este trabajo analiza las derivaciones a primeras visitas en el Centro de Salud Mental de Adultos de Badalona 2 durante el año 2015, comparando las características de las mismas según sean destinadas a atención psiquiátrica o psicológica. Método: Estudiamos 898 derivaciones categorizadas en 14 variables. Hacemos tablas de contingencia a partir de la variable especialidad y vemos cómo se comportan las variables. Resultados: Casi todas se muestran como variables dependientes, es decir, se comportan de diferente manera según sea la derivación a psiquiatría o a psicología. Discusión: A Psiquiatría se derivan pacientes con unos diagnósticos, medicados, >41 años; hombres; con menor tiempo de espera, en derivación urgente y preferente. Mientras a Psicología, se derivan pacientes menos medicados, con otros diagnósticos; <40 años; mujeres; con más tiempo de espera; en prioridad ordinaria. Conclusiones: La derivación a Salud Mental es una cuestión compleja; habría que tener en cuenta tanto aspectos del paciente como del contexto, mejorar la coordinación e incrementar los recursos para atender la salud mental de los pacientes

This paper analyzes referrals to first visits in the Adult Mental Health Center of Badalona 2 during 2015, comparing the characteristics of these according to whether they are intended for psychiatric or psychological care. Method: We studied 898 derivations categorized in 14 variables. We make contingency tables from the specialty variable and see how the variables behave. Results: All the variables are shown as dependent variables, that is, they behave differently depending on whether they are referred to psychiatry or psychology, with the exception of assistance. Discussion: Patients are referred to Psychiatry with any diagnoses, medicated, >41 years; mens; with less waiting time; in urgent and preferential priority. While in Psychology, less medicated patients are derived, with other diagnoses; <40 years; women; with more waiting time; in ordinary priority. Conclusions: Referral to Mental Health is a complex issue; it would be necessary to take into account both aspects of the patient and the context, improve coordination and increase resources to assist the mental health of patients

Intestinal Metaplasia is Present in Most if Not All Patients Who Have Undergone Endoscopic Mucosal Resection for Esophageal Adenocarcinoma.

Barrett esophagus is presently defined in the United States by the presence of intestinal metaplasia in columnar-lined esophagus based on the premise that the risk for adenocarcinoma depends on the presence of intestinal metaplasia. Recently, arguments have been made that nonintestinalized cardiac epithelium is also at risk and should be included in the definition of Barrett esophagus, as it is in England and Japan. One of these arguments is that residual intestinal metaplasia is frequently absent around early adenocarcinomas removed by endoscopic mucosal resection (EMR). We reviewed 27 EMRs performed in 21 patients. Residual intestinal metaplasia was absent in 10/27 (37%) EMR specimens. An in-depth study of these 10 cases showed that 3 had intestinal metaplasia in a concurrent second EMR specimen, 4 had intestinal metaplasia in prior biopsy material available in our unit, and 2 had intestinal metaplasia in an esophagectomy that followed the EMR. The single patient in whom no intestinal metaplasia was found, neither in biopsies nor in EMR, and who did not undergo an esophagectomy had been under surveillance for Barrett esophagus for over 20 years. We conclude that the frequent absence of residual intestinal metaplasia around an adenocarcinoma in an EMR specimen is the result of sampling error. When evaluated in depth by looking at history, biopsies preceding the EMR, and esophagectomy following the EMR, all of these patients with adenocarcinoma had intestinal metaplasia in their columnar-lined esophagus. This indicates that intestinal metaplasia is a necessary precursor to adenocarcinoma of the esophagus.

The October 1994 flood of Harris County, Texas

Between October 15 and October 18, 1994, meteorological conditions combined to set up one the most extreme and intense storm systems in recent history over Southeast Texas. During the four days, between 10 and 30 inches of rain fell across the 4,000 square mile San Jacinto River watershed (Fitzgerald, 1994). Approximately 3400 structures in Harris County were inundated along the San Jacinto River and its tributaries. Record flooding was experienced on the San Jacinto river, Spring Creek, Upper Cyprees Creek, and Cedar Bayou (Fitzgerald, 1994). Along the San Jacinto River, in the Banana Bend and Rio Villa areas, the river cut a new path, bypassing the old meanders along which those two subdivisions were built. A number of lessons were learned from this event. First, there exists a need to turn phone calls from residents into informations resources to rely upon for good field data. Second, the many high water marks taken after the flood gave excellent information to pinpoint anomalies in hydraulic characteristics that will in turn help engineers develop better analytical models for design and better understanding of real storm events. And last, though certainly not least, it was realized that although proper flood control planning and floodplain management may not have solved all of the problems experienced during this flood, they will definitely aid in reducing the damage caused by more frequent events in the future