RESUMO
La colonoscopia (CS) es una técnica invasiva, fundamental para el estudio del colon. Es un procedimiento seguro y bien tolerado. Sin embargo, en personas de edad avanzada o con fragilidad (PEA/F) aumenta el riesgo de acontecimientos adversos, preparación insuficiente o exploraciones incompletas. El objetivo de este documento de posicionamiento fue consensuar recomendaciones sobre valoración del riesgo, indicaciones y cuidados especiales necesarios para la CS en PEA/F. El documento fue redactado por un grupo de expertos designados por la SCD, la SCGiG y la CAMFiC entre 2020 y 2022. Se consensuaron 8 afirmaciones y recomendaciones, entre ellas: no realizar CS a los pacientes con fragilidad avanzada, indicar CS solo si los beneficios son claramente superiores a los riesgos en fragilidad moderada, no repetir CS en PEA/F que tienen una CS completa previa sin lesiones y no indicar CS de cribado en pacientes con fragilidad moderada o avanzada (AU)
Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty (AU)
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Idoso Fragilizado , Sociedades Médicas , Fatores de Risco , EspanhaRESUMO
Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty.
Assuntos
Fragilidade , Humanos , Idoso , Fragilidade/diagnóstico , Idoso Fragilizado , Colonoscopia/métodos , Medição de RiscoRESUMO
BACKGROUND: The Covid-19 pandemic has increased stress levels in GPs, who have resorted to different coping strategies to deal with this crisis. Gender differences in coping styles may be contributing factors in the development of psychological distress. OBJECTIVES: To identify differences by gender and by stress level in coping strategies of GPs during the Covid-19 pandemic. METHODS: A cross-sectional, web-based survey conducted with GPs in Catalonia (Spain), in June-July 2021. via the institution's email distribution list, all GPs members of the Catalan Society of Family and Community Medicine were invited to complete a survey assessing sociodemographic, health and work-related characteristics, experienced stress (Stress scale of the Depression, Anxiety and Stress Scales-DASS 21) and the frequency of use of a range of coping strategies (Brief-COPE) classified as problem-focused, emotion-focused and avoidant strategies, some of which are adaptive and others maladaptive. We compared the scores of each strategy by gender and stress level using Student's t-test. RESULTS: Of 4739 members, 522 GPs participated in the study (response rate 11%; 79.1% women; mean age = 46.9 years, SD = 10.5). Of these, 41.9% reported moderate-severe stress levels. The most common coping strategies were acceptance, active coping, planning, positive reframing and venting. More frequently than men, women resorted to emotional and instrumental support, venting, distraction and self-blame, whereas men used acceptance and humour more commonly than women. Moderate-severe stress levels were associated with non-adaptive coping, with increased use of avoidance strategies, self-blame, religion and venting, and decreased use of positive reframing and acceptance. CONCLUSION: The most common coping strategies were adaptive and differed by gender. However, highly stressful situations caused maladaptive strategies to emerge.
Assuntos
COVID-19 , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Espanha/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Pandemias , Fatores Sexuais , Adaptação PsicológicaRESUMO
INTRODUCCIÓN: El objetivo principal fue determinar la efectividad de la vacunación antigripal para evitar la hospitalización por agudización de la enfermedad pulmonar obstructiva crónica (EPOC). Como objetivos secundarios se estimó la prevalencia de vacunación y sus factores asociados. Métodos Se realizó un estudio de cohortes retrospectivas que incluyó a los 1.323 pacientes diagnosticados de EPOC del Área Básica de Salud del Pla d'Urgell (Lleida) y se clasificaron en 2 cohortes: cohorte 1, pacientes vacunados contra la gripe estacional (campaña 2011/2012), y cohorte 2, no vacunados. Se cuantificaron los pacientes que requirieron ingreso hospitalario por exacerbación de la enfermedad entre el 1 de diciembre de 2011 y el 15 de marzo de 2012. Para cada paciente se registró información sobre las variables de interés. Se efectuó un análisis univariado y multivariado. La efectividad de la vacunación se calculó con la fórmula: E = (1 - OR) × 100. La OR y su intervalo de confianza del 95% (IC 95%) se determinaron a través de modelos de regresión logística multivariante. Resultados El 55,3% habían sido vacunados. Los pacientes vacunados eran de mayor edad y presentaban mayor comorbilidad asociada. A la vez, estos ingresaron menos (3,0% versus 8,9%, p < 0,001). Las efectividades cruda y ajustada de la vacunación antigripal fueron del 68,4% (IC 95%: 47,5-81,0) y del 90,8 (IC 95%: 96,8-88,2), respectivamente. Conclusión La vacunación antigripal es efectiva para evitar el ingreso por agudización. Sin embargo, la cobertura vacunal no es la deseada. Los programas para incrementar la tasa de vacunación en esta población reducirían el número de ingresos por agudización
INTRODUCTION: The main objective was to determine the effectiveness of influenza vaccination in preventing hospitalization due to exacerbation of chronic obstructive pulmonary disease (COPD). One secondary objective was to estimate the prevalence of vaccination, and to describe the factors that were associated with being vaccinated. METHODS: A retrospective cohort study was conducted that included 1,323 patients diagnosed with COPD in the Health Centre of the Pla d'Urgell (Lleida, Spain). They were classified into two cohorts: cohort1, patients vaccinated against seasonal influenza (campaign 2011/12), and cohort2, non-vaccinated. The number of patients in both cohorts requiring hospital admission for exacerbation of the disease between the 12/01/2011 and the 03/15/2012 was quantified. Information about the variables of interest was recorded for each patient. A univariate and multivariate analysis was performed. The effectiveness of vaccination was calculated with the formula: E=(1-OR) ×100. The ORs and their 95% confidence interval (95%CI) were determined by multivariate logistic regression models. RESULTS: Just over half (55.3%) of the patients had been vaccinated. Vaccinated patients were older and had more associated comorbidity. At the same time, they were less hospitalized (3.0% versus 8.9%; P=.001). The crude and adjusted effectiveness of influenza vaccination in this population subgroup was 68.4% (95%CI: 47.5-81.0) and 90.8 (95%CI: 96.8-88.2), respectively. CONCLUSIÓN: Influenza vaccination is effective in preventing hospitalization due to acute exacerbations in COPD patients. However, immunization coverage is not as high as desired. Designing programs to increase the rate of vaccination in this population would reduce the number of hospital admissions for COPD exacerbation
Assuntos
Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Hospitalização/estatística & dados numéricos , Prevenção Primária/organização & administração , Avaliação de Resultado de Ações Preventivas , Fatores de RiscoRESUMO
INTRODUCTION: The main objective was to determine the effectiveness of influenza vaccination in preventing hospitalization due to exacerbation of chronic obstructive pulmonary disease (COPD). One secondary objective was to estimate the prevalence of vaccination, and to describe the factors that were associated with being vaccinated. METHODS: A retrospective cohort study was conducted that included 1,323 patients diagnosed with COPD in the Health Centre of the Pla d'Urgell (Lleida, Spain). They were classified into two cohorts: cohort1, patients vaccinated against seasonal influenza (campaign 2011/12), and cohort2, non-vaccinated. The number of patients in both cohorts requiring hospital admission for exacerbation of the disease between the 12/01/2011 and the 03/15/2012 was quantified. Information about the variables of interest was recorded for each patient. A univariate and multivariate analysis was performed. The effectiveness of vaccination was calculated with the formula: E=(1-OR)×100. The ORs and their 95% confidence interval (95%CI) were determined by multivariate logistic regression models. RESULTS: Just over half (55.3%) of the patients had been vaccinated. Vaccinated patients were older and had more associated comorbidity. At the same time, they were less hospitalized (3.0% versus 8.9%; P=.001). The crude and adjusted effectiveness of influenza vaccination in this population subgroup was 68.4% (95%CI: 47.5-81.0) and 90.8 (95%CI: 96.8-88.2), respectively. CONCLUSION: Influenza vaccination is effective in preventing hospitalization due to acute exacerbations in COPD patients. However, immunization coverage is not as high as desired. Designing programs to increase the rate of vaccination in this population would reduce the number of hospital admissions for COPD exacerbation.
