Dolor como factor predictor de depresión en el paciente oncológico: estudio de casos y controles. Estudio D-PRESS / Pain as predictor of depression in cancer patients: case-control study. Studio D-PRESS

Objetivos: Valorar la correlación entre dolor oncológico y depresión, determinar la prevalencia de depresión en los grupos de casos y controles, y conocer qué factores de la historia clínica del paciente podrían estar potencialmente asociados a la depresión. Métodos: Estudio observacional, retrospectivo, y multicéntrico. Se recogió información de la historia clínica de pacientes, de al menos 3 meses anteriores al inicio del estudio, de edad ≥ 18 años, que padecían dolor tras el diagnóstico oncológico (EVA ≥ 3) y que cumplimentaron el inventario de depresión de Beck (IDB). Los pacientes se clasificaron como casos y controles en base a la puntuación IDB (≥ 8 y ≤ 7, respectivamente). Resultados: Se incluyó un total de 248 pacientes con una media de edad de 59,0 ± 12,4 años. La media del IDB para el grupo de casos fue 13,1 ± 4,9, y para el grupo control 3,8 ± 2,1. El tiempo medio de supervivencia de los pacientes fue mayor en el grupo control (20,0 meses) en comparación con el grupo caso (12 meses; p = 0,0032). En líneas generales, la puntuación del IDB se correlacionó significativamente con la intensidad del dolor en las últimas 24 horas (0,215; p = 0,0007) y con el número de horas de dolor durante las últimas 24 horas (0,170; p = 0,0073). Presentar un estadio tumoral más avanzado fue uno de los factores que aumentó el riesgo de padecer depresión (p = 0,0113). El análisis multivariante demostró el carácter predictivo del cáncer digestivo (p = 0,0454) y del estadio tumoral T (T2 vs T4; p = 0,0039, y T3 vs T4; p = 0,0012) como factores de riesgo de padecer depresión. Conclusiones: De acuerdo a otros estudios previos, existe una clara correlación entre la intensidad de dolor y el estado psicológico del paciente. El potencial predictivo de ciertos factores clínicos (estadío tumoral y ciertos tipos tumorales) posibilita la identificación de pacientes oncológicos en riesgo de padecer depresión (AU)

Objectives: To evaluate the relationship between cancer pain and depression, to determine the prevalence of depression in both groups the cases and controls and also to evaluate which factors from the medical records can be potentially associated with depression. Methods: Observational, retrospective and multi-centre study. Patients were ≥18 years old, had medical data ≥ 3 months, experienced pain after cancer diagnosis (VAS ≥ 3) and completed the Beck Depression Inventory (BDI). Patients were classified as cases and controls based on the BDI score (≥ 8 y ≤ 7, respectively). Results: A total of 248 patients were included (mean age 59.0 ± 12.4 years). Mean BDI for the case group was 13.1 ± 4.9, and for the control group, 3.8 ± 2.1. Patients in the control group, had a longer survival time (20.0 months) in comparison with patients in the case group (12 months; p = 0.0032). For the overall population, BDI scoring was correlated with the intensity of pain during the last 24 hours (0.215; p = 0.0007) and the hours of pain during the last 24 hours (0.170; p = 0.0073). A more advanced disease stage was also among the factors that increased the risk of depression (p= 0.0113). The multivariate analysis revealed the predictive nature of digestive cancers (p = 0.0454) and T stage (T2 vs T4; p = 0.0039, and T3 vs T4; p = 0.0012) as risk factors for depression. Conclusions: According with previous studies, there is a clear relationship between pain intensity and patient's psychological status. The predictive potential of medical factors for depression (tumor stage and type of cancer) opens the possibility to target patients at risk (AU)

Comorbilidades en pacientes hospitalizados por enfermedad pulmonar obstructiva crónica. Análisis comparativo de los estudios ECCO y ESMI / Comorbidities in patients hospitalized due to chronic obstructive pulmonary disease. A comparative analysis of the ECCO and ESMI studies

Antecedentes y objetivos. La presencia de enfermedades asociadas es muy frecuente en los pacientes hospitalizados por exacerbación de EPOC. Hemos estudiado las comorbilidades de pacientes ingresados por la enfermedad en los servicios de Medicina Interna españoles y hemos valorado las variaciones con respecto a un estudio previo (estudio ECCO), realizado 2 años antes. Pacientes y métodos. Estudio de cohortes, transversal y multicéntrico. Se incluyeron pacientes hospitalizados por exacerbación de EPOC en los servicios de Medicina Interna españoles. A todos los pacientes se les estudió la presencia de comorbilidades mediante el índice de Charlson y un cuestionario con afecciones relevantes no incluidas en este índice. Además, se recogieron datos espirométricos, sobre la duración de la enfermedad o el tratamiento domiciliario, entre otras variables. Resultados. Se estudiaron 1.004 pacientes (398 en el estudio ECCO y 606 en el ESMI), un 89,4% eran varones, con una edad media de 73 años (DE: 9,5 años). Los pacientes del estudio ESMI obtuvieron mayores puntuaciones en el índice de Charlson (3,04 vs. 2,71; p<0,01), y presentaron una mayor prevalencia de cardiopatía isquémica (17 vs. 22,0%; p<0,05), insuficiencia cardiaca (26,9 vs. 35,5%; p<0,002), enfermedad vascular periférica (12,6 vs. 17,4%; p<0,02), hipertensión arterial (54,8 vs. 65,6%; p<0,001), diabetes mellitus (29,4 vs. 37%; p<0,02) e insuficiencia renal (6,5 vs. 16,8%; p<0,0001). Conclusiones. Este estudio confirma la elevada prevalencia de enfermedades asociadas en los pacientes con EPOC que ingresan en los servicios de Medicina Interna españoles, así como el aumento de comorbilidades(AU)

Backgrounds and objectives. The presence of associated diseases is very frequent in patients hospitalized due to exacerbation of COPD. We have studied the comorbidities of patients admitted due to the disease in the Spanish Internal Medicine Services and we have evaluated the variations in regards to a previous study (ECCO study) performed two years earlier. Patients and methods. A cross-sectional, multicenter and cohort study was performed. Patients hospitalized due to exacerbation of COPD in Spanish Internal Medicine Services were enrolled. All the patients were studied for the presence of comorbidity using the Charlson index and a questionnaire with relevant conditions not included in this index. Furthermore, spirometric data were collected on the duration of the disease or home treatment, among other variables. Results. A total of 1004 patients (398 in the ECCO study and 606 in the ESMI study) were studied. Of these, 89.4% were males, with mean age of 73 years (SD: 9.5 years). The patients of the ESMI study obtain higher scores on the Charlson index (3.04 vs. 2.71; P<0.01), and had a greater prevalence of ischemic heart disease (17 vs. 22.0%; P<0.05), heart failure (26.9 vs. 35.5%; P<.002), peripheral vascular disease (12.6 vs. 17.4%; P<.02), arterial hypertension (54.8 vs. 65.6%; P<.001), diabetes mellitus (29.4 vs. 37%; P<.02) and renal failure (6.5 vs. 16.8%; P<.0001). Conclusions. This study confirms the elevated prevalence of associated diseases in patients with COPD who are admitted to the Spanish Internal Medicine Services and the increase of comorbidities(AU)

[Comorbidities in patients hospitalized due to chronic obstructive pulmonary disease. A comparative analysis of the ECCO and ESMI studies]. / Comorbilidades en pacientes hospitalizados por enfermedad pulmonar obstructiva crónica. Análisis comparativo de los estudios ECCO y ESMI.

BACKGROUNDS AND OBJECTIVES: The presence of associated diseases is very frequent in patients hospitalized due to exacerbation of COPD. We have studied the comorbidities of patients admitted due to the disease in the Spanish Internal Medicine Services and we have evaluated the variations in regards to a previous study (ECCO study) performed two years earlier. PATIENTS AND METHODS: A cross-sectional, multicenter and cohort study was performed. Patients hospitalized due to exacerbation of COPD in Spanish Internal Medicine Services were enrolled. All the patients were studied for the presence of comorbidity using the Charlson index and a questionnaire with relevant conditions not included in this index. Furthermore, spirometric data were collected on the duration of the disease or home treatment, among other variables. RESULTS: A total of 1004 patients (398 in the ECCO study and 606 in the ESMI study) were studied. Of these, 89.4% were males, with mean age of 73 years (SD: 9.5 years). The patients of the ESMI study obtain higher scores on the Charlson index (3.04 vs. 2.71; P<0.01), and had a greater prevalence of ischemic heart disease (17 vs. 22.0%; P<0.05), heart failure (26.9 vs. 35.5%; P<.002), peripheral vascular disease (12.6 vs. 17.4%; P<.02), arterial hypertension (54.8 vs. 65.6%; P<.001), diabetes mellitus (29.4 vs. 37%; P<.02) and renal failure (6.5 vs. 16.8%; P<.0001). CONCLUSIONS: This study confirms the elevated prevalence of associated diseases in patients with COPD who are admitted to the Spanish Internal Medicine Services and the increase of comorbidities.

Pain in clinical oncology: patient satisfaction with management of cancer pain.

BACKGROUND: Despite effective analgesic therapy, inadequate pain control is frequently perceived by patients and caregivers. AIMS: To assess satisfaction with management of pain in cancer patients. METHODS: Between January and May 2007, a cross-sectional multicentre study was conducted in 64 Medical Oncology Departments throughout Spain. A total of 525 outpatients with oncological diseases completed a questionnaire with demographic data, characteristics and intensity of pain, and perceptions and attitudes towards pain management at the time of a routine clinical visit. Physicians also completed a questionnaire with tumour-related and treatment-related data. Cluster analysis was used to classify patients into three groups (satisfied, neither satisfied nor dissatisfied or neutral, dissatisfied) according to pain intensity and satisfaction with treatment. RESULTS: Patients satisfied with their analgesic treatment (33%) had lower pain intensities and, when regularly asked about their pain, considered their physicians to be more involved in their treatment. Neither satisfied nor dissatisfied patients (neutral) (44%) had higher mean pain intensities. Two-thirds of them achieved marked relief of their pain and also thought that physicians were aware of their situation. Dissatisfied patients (23%) had moderate to severe pain intensities, and said that they were asked less frequently about their pain, and thought that their physicians were less involved in their analgesic treatment. CONCLUSION: Physician-patient communication and information provided to patients are essential aspects of patient perceptions and attitudes towards control of cancer-related pain. Pain is seen as a condition that may be controlled but affects the capacity to lead a normal life.

[Study of the comorbidities in hospitalized patients due to decompensated chronic obstructive pulmonary disease attended in the Internal Medicine Services. ECCO Study]. / Estudio de las comorbilidades en pacientes hospitalizados por descompensación de la enfermedad pulmonar obstructiva crónica atendidos en los servicios de Medicina Interna. Estudio ECCO.

OBJECTIVE: Evaluate comorbidity in patients hospitalized due to COPD in the Internal Medicine services. METHODS: An observational, prospective and multicenter study. The Charlson index and a specific questionnaire were used. RESULTS: A total of 398 patients, 353 men (89%), with mean age of 73.7 years (8.9) and mean FEV(1) of 43.2% (12.5), were included. The most frequent comorbidities were: arterial hypertension (55%), arrhythmias (27%) and diabetes mellitus (26%). A total of 27% suffered heart failure, 17% coronary disease and 9% previous myocardial infarction. The number of associated chronic diseases was 3.6 (1,8). Score on Charlson index was 2.72 (2). CONCLUSIONS: The patients hospitalized due to decompensated COPD had an elevated comorbidity.

Estudio de las comorbilidades en pacientes hospitalizados por descompensación de la enfermedad pulmonar obstructiva crónica atendidos en los servicios de Medicina Interna. Estudio ECCO / Study of the comorbidities in hospitalized patients due to decompensated chronic obstructive pulmonary disease attended in the Internal Medicine Services. ECCO Study

ObjetivoValorar la comorbilidad en pacientes hospitalizados por enfermedad pulmonar obstructiva crónica en los servicios de Medicina Interna.MétodosEstudio observacional, prospectivo y multicéntrico. Se utilizó el índice de Charlson y un cuestionario específico.ResultadosSe incluyeron 398 pacientes, 353 varones (89%) con una edad media de 73,7 años (8,9) y volumen expiratorio máximo en el primer segundo medio del 43,2% (12,5). Las comorbilidades más frecuentes fueron hipertensión arterial (55%), arritmias (27%) y diabetes mellitus (26%). Un 27% tuvo insuficiencia cardíaca, un 17% tuvo enfermedad coronaria y un 9% tuvo infarto de miocardio previo. El número de enfermedades crónicas asociadas fue de 3,6 (1,8) y la puntuación del índice de Charlson fue de 2,72 (2).ConclusionesLos pacientes hospitalizados por descompensación de la enfermedad pulmonar obstructiva crónica tienen una comorbilidad elevada(AU)

ObjectiveEvaluate comorbidity in patients hospitalized due to COPD in the Internal Medicine services.MethodsAn observational, prospective and multicenter study. The Charlson index and a specific questionnaire were used.ResultsA total of 398 patients, 353 men (89%), with mean age of 73.7 years (8.9) and mean FEV1 of 43.2% (12.5), were included. The most frequent comorbidities were: arterial hypertension (55%), arrhythmias (27%) and diabetes mellitus (26%). A total of 27% suffered heart failure, 17% coronary disease and 9% previous myocardial infarction. The number of associated chronic diseases was 3.6 (1,8). Score on Charlson index was 2.72 (2).ConclusionsThe patients hospitalized due to decompensated COPD had an elevated comorbidity(AU)

Primary care nursing of coronary patients and reduction of re-infarction risk: a nested case-control study.

OBJECTIVES: To estimate the risk reduction for re-infarction achieved in primary health care centres. STUDY DESIGN: This was a case-control study nested in a cohort of coronary patients. POPULATION: Nine hundred and eighty-five coronary patients, aged less than 76 years who had survived for more than 6 months after their first acute myocardial infarction (AMI), were recruited from two public hospitals in Navarre, Spain. Cases (repeated myocardial infarction, n = 137) and controls (patients with one AMI who had not had a second infarction, [n = 137) who had not been treated with invasive procedures were extracted from this cohort and matched by gender, age, hospital and the secondary prevention time frame. OUTCOMES MEASURED: Re-infarction. RESULTS: In total, 31.4% of cases and 51.8% of controls attended the primary care nurse clinic regularly. This difference accounted for a significant reduction of the risk of re-infarction, even after adjustment for regular visits to the family physician, life styles (smoking, walking habit and dietary changes) and drug treatments (odds ratio: 0.48; 95% confidence interval: 0.26-0.89). A regular schedule of visits to the family physician showed no association with further coronary risk reduction. CONCLUSIONS: Regular attendance of coronary patients at a primary care nurse clinic is associated with a lower risk for re-infarction. Psychological rehabilitation could be the main reason for this benefit, since protection persists after adjustments for other known risk factors.