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Santa Monica, CA, United States

Juanola Roura X.,Hospital Universitari Of Bellvitge | Juanola Roura X.,Institute Dinvestigacio Biomedica Of Bellvitge | Collantes Estevez E.,Grupo de Estudio de las Espondiloartritis de la SER | Collantes Estevez E.,Instituto Maimonides Of Investigacion Biomedica Of Cordoba | And 9 more authors.
Reumatologia Clinica

Objective: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. Methods: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. Results: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. Conclusions: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments. © 2014 Elsevier España, S.L.U. Source

Ramos D.L.,Arroyo Center | Armando Alonso Alvarez C.,University of Habana | Penedo H.G.,University of Habana
Revista del Hospital Psiquiatrico de la Habana

Objectives: To characterize the specific positive psychological factors in the alcoholic abstinence on a group of rehabilitated alcoholic individuals; to characterize the personality self regulators mechanisms of the abstinent individuals (motivational system, self assessment and temporal dimension); to identify the difference between abstinent individual and consumers according to the study variable.Methods: a non experimental design, transversal and descriptive- qualitative research was carried out. The questionnaire of Factors, Interview and the psychological tests Register of Activities and Direct and Indirect Methods and Dembo - Rubenstein Self -Assessment Scale were used.Results: there were found differences between both groups according to the categories of study and a prevalence of positive factors in the alcoholic abstinence on the group of alcoholic individual, meanwhile on the group of consumers the risks of the abstinence prevailed. Conclusions: the personality self regulators mechanisms of the abstinent individuals are: optimism before complex situations, positive self assessment towards emotional self control, temporal dimension, useful use of time, awareness of the disease, trust on rehabilitation therapy, they do not believe that they are able to consume alcohol with control, they believe in God or in a Superior Divinity Power, they develop moral principles, they become stable with their couple and also with their worḱs duties, they become liable with other alcoholic individuals, they are able to make plans for the future and to have a good disposition, they also have a regular participation to Anonym Alcoholic Groups or to Psychotherapy Groups among other characteristics. Source

Tola-Arribas M.A.,Hospital Universitario Rio Hortega | Yugueros M.I.,Hospital Universitario Rio Hortega | Garea M.J.,Hospital Universitario Rio Hortega | Ortega-Valin F.,Hospital Universitario Rio Hortega | And 7 more authors.

Objective:To describe the prevalence of dementia and subtypes in a general elderly population in northwestern Spain and to analyze the influence of socio-demographic factors.Methods:Cross-sectional, two-phase, door-to-door, population-based study. A total of 870 individuals from a rural region and 2,119 individuals from an urban region of Valladolid, Spain, were involved. The seven-minute screen neurocognitive battery was used in the screening phase. A control group was included.Results:A total of 2,170 individuals aged 65 to 104 years (57% women) were assessed. There were 184 subjects diagnosed with dementia. The crude prevalence was 8.5% (95% CI: 7.3-9.7). Age- and sex-adjusted prevalence was 5.5 (95% CI: 4.5-6.5). Main subtypes of dementia were: Alzheimer's disease (AD) 77.7%, Lewy Body disease, 7.6% and vascular dementia (VD) 5.9%. Crude prevalences were 6.6% (AD), 0.6% (Lewy Body disease), and 0.5% (VD). Dementia was associated with age (OR 1.14 for 1-year increase in age), female sex (OR 1.79) and the absence of formal education (OR 2.53 compared to subjects with primary education or more).Conclusion:The prevalence of dementia in the study population was lower than the most recent estimates for Western Europe. There was a high proportion of AD among all dementia cases and very low prevalence of VD. Old age, female sex, and low education level were independent risk factors for dementia and AD. © 2013 Tola-Arribas et al. Source

Cano Gonzalez J.M.,Arroyo Center | Martin Lopez A.,Consultorio Becerril de la Sierra
Medicina Paliativa

Objective: To describe the socio-demographic and clinic characteristics and aspects related to information of non-oncological patients (NOP) with advanced disease, which are included in a palliative-home care support unit. To identify the variables that could be associated with the death of NOP at home. Material and method: A retrospective descriptive study was performed by reviewing the clinical histories of NOP attended by a Palliative-home Care Support Unit during the period from November 2009 to March 2013. An analysis was performed on the socio-demographic and clinical data of the patients and their main caregivers, as well as the analysed, diagnostic and prognostic information provided by the family and the patient, preferences about end of life care of both parties, and the place of death. The data analysis was performed with the computer pack SPSS® v. 21. Results: Of the 371 clinical histories reviewed, 249 patients met the inclusion criteria. The NOP represented the 36.19% of the activity, with a mean age of 81.4 years. The most common disease was dementia (22.1%). More than two-thirds (67.5%) of the patients came from Primary Care and residential homes for the elderly. The main reason for referral was to control symptoms in 85.5%, with the most frequent being asthenia, dyspnoea, and pain. A high comorbidity, geriatric symptoms, cognitive impairment was observed in 65%, and an important functional impairment (mean Barthel Index of 21.52, and Palliative Performance Scale score of 38.18). The majority of main caregivers were women, and the patient's daughter, and the burden of caring was identified in 55.4%. In the group without cognitive impairment, the diagnosis was known by 83%, and 30% knew the prognosis. Staying at home to receive end of life care was preferred by 95%, and 78% kept this preference for dying. Two-thirds (66%) of all the patients died at home or in residential homes for the elderly. The statistical analysis of the possible factors associated with dying at home showed a significant odds ratio when the patient lived in rural areas, and preferred home as the place of death. Another factor is when the main caregiver does not suffer care burden and has a subjective perception of good health. Conclusions: The predominance of NOP in end of life situations is characterised by advanced age, high comorbidity, increased symptomatic burden, significant overall functional impairment on admission, and high mortality. More than the half of the caregivers showed excessive burden of caring. In conclusion, they are patients with similar needs to those with advanced oncological disease. The high prevalence of cognitive impairment suggested that only half of the patients were able to participate in the information and in the advanced care planning. © 2015 Sociedad Española de Cuidados Paliativos. Source

Forns-Serrallonga D.,Autonomous University of Barcelona | Duran-Iglesias C.,Arroyo Center
Journal of Asthma

Objective: Describe the association between parents' quality of life and the two components of asthma control in children: impairment and risk. Methods: Cross-sectional study with children between 4 and 14 years of age with active asthma recruited at primary care centers in Spain. Asthma control was assessed according to the Third National Asthma Expert Panel Report, classifying "impairment" in three levels (well-controlled asthma, partially controlled, and poorly controlled), and "risk" as high or low. The parents' quality of life was evaluated using the specific Family Impact of Childhood Bronchial Asthma Questionnaire instrument (IFABI-R). The association between asthma control and the parents' quality of life was analyzed using multivariate regression models adjusted for other social and family variables. Results: Data from 408 children were analyzed. The parents' quality of life was affected in the partially controlled asthma group when compared with well-controlled asthma, as showed by an increase in IFABI-R scores in all dimensions: functional 17.2% (p<0.001), emotional 10.4% (p=0.021), and socio-occupational 6.8% (p=0.056). The differences were higher in poorly controlled asthma compared with well-controlled asthma: functional 24.3% (p=0.001), emotional 18.9% (p=0.008), and socio-occupational 11.5% (p=0.036). The "risk" component was independently associated with the parents' quality of life. Of all the elements used to assess the control, the only one independently associated with the parents' quality of life was recurrent asthma crisis. Conclusions: In asthma control, both "impairment" and "risk" in children are gradually associated with the parents' quality of life. The global assessment of the control surpasses the importance of each individual element used in this assessment. © 2014 Informa Healthcare USA, Inc. All rights reserved. Source

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