Carga del cuidador principal informal del paciente crónico complejo y paciente crónico avanzado en dos centros de urgencia de atención primaria de la provincia de Barcelona / Burden of the informal primary caregiver of the chronic complex patient and chronic advanced patient in two emergency primary care centres in the province of Barcelona

OBJETIVO: Determinar el grado de carga del cuidador principal informal (CPI) de pacientes identificados como paciente crónico complejo (PCC) y paciente crónico avanzado (PCA), asistidos en dos centros de urgencias de atención primaria (CUAP) de la provincia de Barcelona. METODOLOGÍA: Estudio descriptivo, observacional, prospectivo, transversal, de tipo exploratorio, de diciembre de 2015 a noviembre de 2016. Muestra formada por 271 CPI del CUAP de Cerdanyola /Ripollet y del CUAP de Sant Fèlix de Sabadell (Barcelona). Para medir la carga del CPI se obtuvieron datos del Test de Zarit y datos descriptivos sobre el CPI y sobre la persona cuidada. RESULTADOS: Parentesco del CPI: 36,5 % (n=99) pareja, 57,6 % (n=156) hijos, 3 % (n=8) hermanos, 1,1 % (n=3) nietos, otros cuidadores (amigos, vecinos,... ) 1,8 % (n=5). Sexo del CPI: 53 % (n=144) mujeres y un 47 % (n=127) hombres. Edad media del CPI: <70 años 19 % (n=52), 71-85 años 61,4 % (n=166), >85 años 19,6 % (n=53). Edad media del PCC/PCA fue de 81 años. Los resultados del Test de Zarit fueron: Media 54 [40-65], presentando una carga intensa del 43 % en el CPI (valores > 56 puntos). Los resultados del Índice Barthel fueron: Media 69 en PCC y Media 54 en PCA, presentando una dependencia severa (24,2 %) en los PCC/PCA (valores entre 21-60). CONCLUSIONES: El estudio ha evaluado la carga del CPI con el Test de Zarit en los PCC/PCA con el objetivo de incorporar un programa de educación que repercuta positivamente sobre su cuidado, mejorar la asistencia recibida, reducir la utilización de servicios sanitarios y conseguir disminuir el grado de carga y la percepción de falta de apoyo social sobre el CPI

OBJECTIVE: To determine the degree of burden of informal primary caregiver (IPC) of patients identified as chronic complex patient (CCP) and chronic advanced patient (CAP), assisted in two emergency primary care centres (EPCC) in the province of Barcelona. METHODOLOGY: Cross-sectional, prospective, observational, descriptive exploratory type from November 2015 to December 2016 study. Sample consisting of 271 IPC in EPCC Cerdanyola /Ripollet and the EPCC St. Fèlix de Sabadell (Barcelona). To measure the burden of IPC, data were obtained by Zarit Burden Inventory and descriptive information about the IPC and careful person. RESULTS: Kinship of the IPC: 36.5% (n = 99) couple, 57.6% (n = 156) children, 3% (n = 8) brothers, 1.1% (n = 3) grandchildren, other caregivers (friends, neighbours,...) 1.8% (n=5). Sex of the IPC: 53% (n = 144) women and 47% (n = 127) men. Average age of the IPC: <70 years 19% (n= 52), 71-85 years 61,4% (n=166), >85 years 19.6% (n = 53). The CCP/CAP average age was 81 years old. The Zarit Burden Inventory results were: average 54 [40-65], presenting an intense load 43% in the IPC (values > 56 points). The Barthel Index results were: average 69 in CCP and average 54 in CAP, presenting a severe dependence (24.2%) in the CCP/CAP (values between 21-60). CONCLUSIONS: The study has evaluated the IPC charge with Zarit Burden Inventory on the CCP/CAP in order to incorporate an educational program that positively impact on their care, improve the assistance received, and reduce the use of health services and get decrease the degree of load and the perceived lack of social support of the IPC

Estudio descriptivo de los trabajadores de servicios sanitarios de una dirección de atención primaria confinados por Covid-19 / Descriptive study of the health service workers of a Primary Care Department confined by Covid-19

OBJETIVO: La pandemia de la Covid-19 está poniendo a prueba la resistencia de los sistemas sanitarios. La preservación de los profesionales sanitarios es prioritaria siempre y especialmente ante situaciones de este tipo. La exposición de los profesionales frente a contactos sospechosos obliga en muchas ocasiones a su confinamiento. El objetivo fue conocer las características epidemiológicas de los profesionales de atención primaria que han precisado confinamiento. MÉTODOS: La investigación se llevó a cabo en el área de atención primaria Metropolitana Nord de Barcelona, desde el 17 de febrero al 3 de mayo de 2020. Participaron 1.418 profesionales que requirieron confinamiento debido a la epidemia por la Covid-19. Se registraron los motivos de confinamiento, sintomatología, tiempo de confinamiento y resultados de las pruebas PCR. Se realizó análisis descriptivo univariante. RESULTADOS: El 78,8% de los profesionales eran mujeres y la edad media de fue 45,2 años. El 67,8% fueron facultativos y enfermeras, en el 32,2% restante había diferentes profesionales asistenciales y no asistenciales. El 64,1% de la muestra presentó sintomatología compatible con Covid-19. Los participantes describieron múltiples síntomas durante el confinamiento. Se realizaron 1.050 pruebas diagnósticas RT-PCR resultando positivas en 323 casos, de los que 33 fueron en personas asintomáticas. CONCLUSIONES: El impacto de la epidemia por Covid-19 se adelanta en el personal sanitario respecto a la población general. La distribución de síntomas en profesionales sanitarios es similar a la de otros estudios en población general. Del total de profesionales que precisan confinamiento en el 22,7% se confirma el diagnóstico

OBJECTIVE: The Covid-19 pandemic is testing the resistance of health systems, the preservation of health professionals is a priority in processes of this type. The professionals' exposure to suspicious contacts often requires their confinement. The objective was to know the epidemiological characteristics of the primary care professionals who required confinement. METHODS: The research was carried out in the North Metropolitan Primary Care Area of Barcelona, from February 17 to May 3, 2020. 1,418 professionals who required confinement due to the epidemic by Covid-19 participated. The reasons for confinement, symptomatology, the confinement time and the results of PCR tests results were recorded. Univariate descriptive analysis was performed. RESULTS: 78.8% of the professionals were women and the mean age was 45.2 years. 67.8% were doctors and nurses, in the remaining 32.2% there were different healthcare and non-care professionals. 64.1% of the sample presented symptoms compatible with Covid-19. Participants described multiple symptoms during confinement. 1,050 diagnostic RT- PCR tests were performed, being positive in 323 cases, of which 33 were in asymptomatic people. CONCLUSIONS: The impact of the epidemic by Covid-19 is anticipated in health personnel compared to the general population. The distribution of symptoms in healthcare professionals is similar to that of other studies in the general population. Of the total number of professionals requiring isolation, 22.7% confirmed the diagnosis

Medición del incumplimiento terapéutico en el paciente crónico complejo / Measurement of the therapeutic breach in the chronic patient complex and model of attention advanced cronicity in two primary care emergency centers of the province of Barcelona

Objetivo. Determinar la adherencia al tratamiento farmacológico en los pacientes identificados como PCC/MACA en dos centros de urgencias de atención primaria de la provincia de Barcelona durante el año 2016. Metodología. Estudio descriptivo observacional de tipo exploratorio y transversal. Se incluyeron un total de 379 sujetos. Resultados. Edad media 81,8 años; el 52,8% eran mujeres y el resto, hombres. Fueron identificados como PCC el 89,4% y el 10,6%, MACA. Los factores de riesgo predominantes fueron la hipertensión arterial, la obesidad, diabetes y dislipemia. El 98,4% de los pacientes presenta pluripatología. Se obtuvieron unas me-dianas de Índice de Barthel de 85, del Test de Zarit 54, de la probabilidad de ingresos anuales 18,2% y de consumo diario de 11 fármacos. El cumplimiento terapéutico se observó en 274 (72,3%) pacientes, presentando un porcentaje mayor en los MACA respecto de los PCC (p=0,058). El cumplimiento resultó mayor cuando el cuidador era un familiar y menor cuando era institucional o no tenía cuidador (p = 0,008). En cuanto al incumplimiento, se olvidaban más frecuentemente los diabéticos (p = 0,010 ) y los obesos (p=0,013) que el resto de pacientes. La correcta toma de toda la medicación se asocia con un mayor nivel de estudios (p = 0,028). Conclusión. El incumplimiento por olvido es menor en pacientes que tienen el apoyo de los hijos, por lo tanto los pro-gramas deben potenciar la implicación siempre que sea posible de los hijos en los cuidados. En la población de diabéticos es mayor el incumplimiento que en el resto, siendo necesario realizar un seguimiento más exhaustivo de estos pacientes. Las mujeres son más incumplidoras que los hombres y no es por falta de responsabilidad, sino por falta de apoyo

Objective. To determine the adherence to pharmacological treatment in patients identified as PCC / MACA in two primary care emergency centers in the province of Barcelona during 2016.MethOdOlOgy. Observational descriptive study of exploratory and transversal type. A total of 379 subjects were included. Results. Average age 81.8 years of which 52.8% were women and the rest were men. They were identified as PCC 89.4% and 10.6% as MACA. The predominan risk factors were hypertension, followed by obesity, diabetes and dyslipidemia. 98.4% of patients have multiple pathologies. We obtained a median of Barthel Index of 85, of the Zarit Test 54, of the probability of annual income 18.2% and of daily consumption of 11 drugs. Therapeutic compliance was observed in 274 (72.3%) patients, presenting a higher percentage in MACA versus PCC (p = 0.058). Compliance was higher when the caregiver was a family member, and lower when the caregiver was institutionalized or had not caregiver (p = 0.008). In terms of non-compliance, diabetics (p = 0.010) and obese patients (p = 0.013) were more frequently forgotten than the rest of patients. The correct intake of all medication is associated with a higher level of study (p = 0.028). Conclusion. Non-compliance due to forgetfulness is less in patients who have the direct support of children, therefore the programs should enhance the involvement whenever possible of the children in the care of their elders. In the population of diabetics, non-compliance is higher than in the rest of the population, and a more exhaustive follow-up of these patients is necessary. On the other hand, women are more deviant than men and it is not due to lack of responsibility, but rather lack of support

Control de calidad de la translucencia nucal. Experiencia en 6 centros del ámbito de primaria / Quality control in nuchal translucency measurement. Experience in six primary care centers

Objetivo. Aplicar el control de calidad de la medición de la translucencia nucal en las ecografías realizadas en primaria en las regiones Vallès y Centre de Catalunya. Sujetos y métodos. Se han evaluado 7.386 ecografías de primer trimestre realizadas durante el año 2009 en el ámbito de primaria en las regiones Vallès y Centre del Institut Català de la Salud (ICS). Se han aplicado 2 métodos de control de calidad de la translucencia nucal: el propuesto por la Fetal Medicine Foundation (FMF) y el propuesto por el grupo de Women and Infant's Hospital Rhode Island (WIHRI). Resultados. El método de la FMI muestra una tendencia global a la infraestimación. Los resultados individuales muestran una infraestimación del 68, el 89 y el 32%, según los porcentajes de mediciones de TN situados en los percentiles p50, p95 y p5, respectivamente. Aplicando el método de WIHRI en la serie general, todos los parámetros están dentro de la normalidad. Al analizar los resultados individuales de la mediana de los MoM se observa que un 43% de los ecografistas presenta una infraestimación. Conclusiones. El control de calidad es poco útil cuando se aplica a toda la serie. En cambio, su aplicación a nivel del ecografista individual permite la detección de los ecografistas que se desvían de forma importante de los valores correctos, y proponer su corrección (AU)

Objective. To apply quality control to nuchal translucency (NT) measurements in the scans performed in two primary care health regions (Vallès and Centre de Catalunya) in Catalonia, Spain. Subjects and methods. We evaluated 7,386 TN measured in 2009 in the prenatal care centers of two health areas (Vallès and Centre de Catalunya) of the Catalan health service. We applied two methods of quality control: the method proposed by the Fetal Medicine Foundation (FMF) and that proposed by the Women and Infants’ Hospital, Rhode Island (WIHRI) group. Results. The FMF method showed that 68% of sonographists underestimated NT when the 50th percentile was assessed. For the 95th and 5th percentiles, the underestimation rates were 89% and 32%, respectively. When the WIHRI method was applied to the overall series, all parameters were within the normal range. Results by individual sonographists showed that 43% underestimated the median value of the multiple of the median (MoM) measurements. Conclusions. NT quality control was not useful when applied to the entire series. Instead, its application in individual sonographists allows those that significantly deviate from the expected values to be identified and corrections to be proposed (AU)

Hand and wrist arthralgia in systemic lupus erythematosus is associated to ultrasonographic abnormalities.

OBJECTIVE: Systemic lupus erythematosus (SLE) is an autoimmune disease which may has joint impairment. Often, SLE patients complain of hand and wrist arthralgia (HA). Usually, these patients do not show any swelling in the physical exam. Our aim was to demonstrate Power Doppler Ultrasound (PDUS) abnormalities in SLE patients with HA. METHODS: We recruited 58 consecutive SLE patients and divided them into two groups: case group (n = 28) were patients with HA, and control group (n = 30) were patients without HA. We also collected socio-demographic and disease activity data, biological markers and SLEDAI index. We evaluated disability and quality of life by mHAQ and SF-12, respectively. We performed a bilateral hand and wrist PDUS on all patients. PDUS findings were based in OMERACT-7 group criteria. RESULTS: We found PDUS abnormalities in most of SLE patients who suffered HA, when compared to SLE controls (P < 0.001). The main findings in Case Group were: tenosynovitis (39.2%), synovial effusion or hypertrophy (25%) and active synovitis (14.2%). SLEDAI score and dsDNA antibodies were related to the presence of PDUS abnormalities (P < 0.05 and P < 0.001, respectively). We also found worse physical SF-12 (P < 0.05) and mHAQ (NS) scores in case group. CONCLUSIONS: SLE patients who present HA have more PDUS abnormalities. These findings are associated with a higher SLEDAI score and dsDNA antibodies. This articular affection may contribute to a worsened functional ability and a lower quality of life. PDUS seems to be a reliable tool in the assessment of SLE patients with HA.

Entrainment from the para-Hisian region for differentiating atrioventricular node reentrant tachycardia from orthodromic atrioventricular reentrant tachycardia.

AIMS: The difference between the stimulus-atrial and ventriculo-atrial intervals (SA-VA) and between the post-pacing interval and the tachycardia cycle length (PPI-TCL) during entrainment from the right ventricular apex distinguishes atrioventricular node reentrant (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT). We hypothesized that these features still apply when entrainment is performed from the para-Hisian region. METHODS AND RESULTS: Forty-seven supraventricular tachycardias (34 AVNRT/13 AVRT) were included. The SA-VA and PPI-TCL were obtained in all patients by using two right-sided diagnostic catheters. In 24 of them, these measurements were also performed upon His-bundle capture during entrainment. A paced QRS widening of >or=40 ms during entrainment, when compared with the tachycardia QRS width, identified absence of His-bundle capture, P < 0.001. A SA-VA >75 ms distinguished AVNRT from AVRT, P < 0.001 (sensitivity/specificity 97%/100%). A PPI-TCL >100 ms was diagnostic of AVNRT, P < 0.001 (sensitivity/specificity 97%/92%). Upon His-bundle capture, the SA-VA and PPI-TCL shortened in AVNRT (121 +/- 23 to 66 +/- 24 ms; 139 +/- 30 to 85 +/- 31 ms, respectively, P < 0.001) and no longer differentiated AVNRT from AVRT. CONCLUSION: Para-Hisian entrainment without His-bundle capture distinguishes AVNRT from AVRT with the advantage of using only two diagnostic catheters.

Atención a la salud sexual y reproductiva de trabajadoras de sexo comercial / Sexual and reproductive health care of female commercial sex workers

No disponible