[Effectiveness of a therapeutic practice on overweight in primary care]. / Eficacia de una intervención terapéutica sobre el exceso de peso en atención primaria.

OBJECTIVES: To evaluate the effectiveness of an intervention program on overweight to achieve a minimum decrease of 5% or a optimum of 10% of initial weight a year, and to identify the factors associated with slimming. DESIGN: Randomized controlled trial. SETTING: Urban health centre. PARTICIPANTS: Overweight subjects over 18 years old (n=169), wanting treatment or referred by their doctor. They were randomly assigned to the intervention (n=95) or control (n=70) group. INTERVENTIONS: Intervention group: yearly program with consultations every 15-21 days, using a low calorie diet, prescribing physical exercise, changing of habits and health education. CONTROL GROUP: low calorie diet, seen 3 times/year. RESULTS: The minimum weight loss was achieved in 6 months by 37.9% of the intervention group and by 21.4% of the control group. At one year, 45.3% of the intervention subjects and 24.3% of the control group reached this objective. The optimum loss of 10% was higher in the intervention group, but was not statistically significant. The minimum objective was associated with the intervention group (OR=4.5 [1.36-14.49]). It was also associated to the number of visits during therapy (OR=1.85 [1.50-2.29]) and diabetes (OR=10 [1.13-90.9]). CONCLUSIONS: The intervention group had a loss of 5% of initial weight in the first 6 months, 16.5% more than the control group, and 21% more in one year. Achieving the minimum objective was associated with the intervention group, the number of visits and the diagnosis of diabetes.

Eficacia de una intervención terapéutica sobre el exceso de peso en atención primaria / Effectiveness of a therapeutic practice on overweight in primary vare

Objetivos. Evaluar la eficacia de un programa de intervención sobre el exceso de peso para conseguir una disminución mínima del 5% u óptima del 10% del peso inicial al año, e identificar los factores relacionados con el adelgazamiento. Diseño. Ensayo clínico aleatorizado. Emplazamiento. Centro de salud urbano. Participantes. Se incluyeron en el estudio 169 sujetos mayores de 18 años con exceso de peso, que habían demandado tratamiento o que habían sido remitidos por su médico. Fueron asignados aleatoriamente al grupo de intervención (n = 95) o al grupo control (n = 70). Intervenciones. En el grupo de intervención, se realizó un programa anual con consultas cada 15-21 días, mediante dieta hipocalórica, prescripción de ejercicio físico, modificación de hábitos y educación sanitaria. En el grupo control, se realizó dieta hipocalórica con cita 3 veces al año. Resultados. La mínima pérdida de peso fue alcanzada por el 37,9% de los participantes intervenidos y por el 21,4% del grupo control en 6 meses. Al cabo de un año, el 45,3% de los sujetos intervenidos y el 24,3% del grupo control consiguieron este objetivo. La pérdida óptima del 10% fue mayor en el grupo de intervención, sin significación estadística. El objetivo mínimo se relacionó con el grupo de intervención (odds ratio [OR] = 4,5 [1,36-14,49]). También se relacionó el número de visitas durante la terapia (OR = 1,85 [1,50-2,29]) y la diabetes (OR = 10 [1,13-90,9]). Conclusiones. El grupo de intervención experimentó una pérdida del 5% del peso inicial un 16,5% superior que el grupo control los primeros 6 meses y un 21% más en un año. La consecución del objetivo mínimo se relaciona con el grupo del ensayo, el número de consultas y el diagnóstico de diabetes

Objectives. To evaluate the effectiveness of an intervention program on overweight to achieve a minimum decrease of 5% or a optimum of 10% of initial weight a year, and to identify the factors associated with slimming. Design. Randomized controlled trial. Setting. Urban health centre. Participants. Overweight subjects over 18 years old (n=169), wanting treatment or referred by their doctor. They were randomly assigned to the intervention (n=95) or control (n=70) group. Interventions. Intervention group: yearly program with consultations every 15-21 days, using a low calorie diet, prescribing physical exercise, changing of habits and health education. Control group: low calorie diet, seen 3 times/year. Results. The minimum weight loss was achieved in 6 months by 37.9% of the intervention group and by 21.4% of the control group. At one year, 45.3% of the intervention subjects and 24.3% of the control group reached this objective. The optimum loss of 10% was higher in the intervention group, but was not statistically significant. The minimum objective was associated with the intervention group (OR=4.5 [1.36-14.49]). It was also associated to the number of visits during therapy (OR=1.85 [1.50-2.29]) and diabetes (OR=10 [1.13-90.9]). Conclusions. The intervention group had a loss of 5% of initial weight in the first 6 months, 16.5% more than the control group, and 21% more in one year. Achieving the minimum objective was associated with the intervention group, the number of visits and the diagnosis of diabetes

El anciano dependiente y el desgaste físico y psíquico de su cuidador / Dependence in the elderly and mental and physical strain among caregivers

Introducción: se describen las características clínicas, funcionales y socioeconómicas de un grupo de pacientes que precisan atención para cuidados domiciliarios. Se evalúa la repercusión en el cuidador principal del hecho de cuidar. Material y método: estudio descriptivo transversal. Marco comunitario (Centro de Salud San Agustín de Burgos). Se recogen datos de la historia clínica del paciente y se aplica un cuestionario específico a un grupo de cuidadores. Análisis estadístico: SPSS versión 10.0. Resultados: Pacientes: 88 casos (63,6% mujeres), 93,2% mayores de 65 años. Más del 50% con dependencia grave o total. La mayoría vive en domicilio propio. El 21,6% de las viviendas no dispone de ascensor. Cuidadores: edad media ± desviación estándar de 62,0 ± 14,9 años; el 84% eran mujeres (hija en el 56% de los casos, cónyuge en el 36%). Dos terceras partes están casados. Principales quejas del cuidador: falta de tiempo libre (60%), restricción en su vida anterior (84%), cambio de proyectos personales (66%). Tienen lumbalgias (64%) y algias musculares (40%), ansiedad (36%), depresión (44%) y síndrome de estrés del cuidador (36%). Más estrés en enfermos terminales, enfermedad mental y déficit visuales y auditivos. Menor necesidad de consultas médicas a mayor tiempo de inclusión en el programa. Conclusiones: el paciente inmovilizado tipo en nuestro medio es una mujer anciana, viuda, que vive en su domicilio, cuidada por una hija/o, con escaso apoyo social, importante comorbilidad y polimedicada. La mayoría de los cuidadores son mujeres casadas de mediana edad, con gran prevalencia de ansiedad/depresión, y pueden estar infratratados (AU)

Introduction: the aim of this study was to describe the clinical, functional and socioeconomic characteristics in a group of patients requiring home care and to identify the effects of this activity on their main caregivers. Material and method: a descriptive, cross-sectional study was performed in the San Agustin Health Centre in Burgos (Spain). Data from patients’ medical records were collected and a specific questionnaire was administered to a group of caregivers. The statistical analysis was performed using the SPSS statistical package, version 10.0. Results: Patients: there were 88 patients (63.6% women), of which 93.2% were aged more than 65 years. More than 50% showed severe or complete dependence. Most of the patients lived in their own homes. A total of 21.6% homes had no lift. Caregivers: the mean ± SD age was 62.0 ± 14.9 years, and 84% were women. Fifty-six percent of caregivers were daughters and 36% were spouses. Two-thirds were married. Caregivers complained mainly of lack of free time (60%), restriction of their former lives (84%), and changes in personal plans (66%). Low back pain was present in 64% and muscular aches in 40%. Anxiety was present in 36% and depression in 44%. Caregiver stress syndrome was found in 36%. Stress was greater among the caregivers of persons with terminal disease, mental illness, and visual and auditory impairment. The longer the period of inclusion in the program, the lower the need for medical consultations. Conclusions: the profile of immobile patients in our environment corresponds to an elderly widow, living in her own home, cared for by a son or daughter, with little social support, substantial comorbidity, and receiving polymedication. Most of the caregivers are married, middle-aged women, with a high prevalence of anxiety/ depression, and who may be under-treated (AU)

Pleural aspergillosis with bronchopleurocutaneous fistula and costal bone destruction: a case report.

A 65-year-old man who, when young, had had tuberculosis treated by therapeutic pneumothorax, consulted his family physician for a constitutional syndrome and dyspnea. At this time radiologic studies showed left pleural effusion with bilateral calcified plaques, an infiltrate in the upper left lobe, and a picture compatible with aspergilloma, all suggesting semi-invasive aspergillosis. The patient failed to show up for his followup visit, so no therapy could be started or further diagnostic tests ordered. One month later he was admitted to this hospital for a bronchopleural fistula (empyema necessitatis) with subsequent spontaneous hydropneumothorax and costal bone involvement. The patient underwent surgery because of his rapid worsening condition. Biopsy examination revealed a large pleural aspergilloma. Despite immediate antifungal therapy, the patient died. We believe this to be the first report of pleural Aspergillus with a bronchopleurocutaneous fistula and costal bone destruction.