Biomedical subjects

A Otero Puime

Publications and source records attributed to A Otero Puime.

18 recordsLinked to original sources

PubMed2005

[Evaluation of referrals in primary care].

OBJECTIVE: To study the process of referral from primary care in a health area in Madrid. The second objective was to evaluate the trends in the referral process. DESIGN: Observational, descriptive and cross-sectional study. SETTING: Three urban health centers in the Area 2. PARTICIPANTS: All referrals made by 13 doctors during 3 consecutive weeks. The total number of visits attended were 6012. The study was realized between February 2002 and January 2003. MAIN MEASUREMENTS: Patient, doctor and referral characteristics on every referral. RESULTS: 349 referrals were studied. The rate of referral 5.8% (5.21-6.39). The referred patients, 65.5% women, medium age 50.6+/-21. The specialties that received more referrals are gynecologist, ophthalmology, dermatology, otorhinolaryngology, rehabilitation, orthopedic surgeon and general surgeon. The most common conditions referred, 25.6% of all referrals, are gynecologist check, blindness, other illnesses of subcutaneous cellular tissue, arthrosis, joint pain, diabetes, benign neoplasm of skin, depression and hypoacusis. 92.3% of the referrals were sent to the specialist center. 89.7% were normal (no urgent). The reason for referral was to accede to the patient's request in 18.3% of the referrals. CONCLUSIONS: The process of referral is similar to previous studies. Although people are more participative, have more information and the defensive medicine is increasing, the process of referral have not changed.

Adult↗

PubMed2004

[Impact of cataract surgery upon functional capacity of the elderly].

PURPOSE: To determine the impact of cataract intervention on visual function of the elderly and on autonomy in daily activities, analyzing the influence of clinical and sociodemographic variables. METHODS: Observational and longitudinal study. 185 elderly patients having undergone cataract surgery were compared with 179 elderly patients on a surgical waiting list. The first group was evaluated prior to surgery and at 4 months post-intervention. Control group patients were evaluated at the same times, without having received surgery. For all subjects, the state of visual function was determined by the Activities of Daily Vision Scale (ADVS). Degree of dependence in carrying out basic daily activities, cognitive state and self-perception of vision were also measured. Other variables were visual acuity, other ocular diseases and sociodemographic characteristics. RESULTS: Amongst the elderly patients having undergone surgery, the proportion of subjects able to carry out basic activities 4 months post-intervention (60.7%) was very similar to the initial pre-intervention figure (62.2%). However, in the control group, the proportion (63.1%) diminished significantly at the 4-month mark (48.8%) (p= 0.0001). Of the intervened subjects, 75.7% demonstrated improved self-perception of vision after 4 months as opposed to 15.4% of the non-intervened patients (p= 0.00001). Post-intervention, the mean score on the ADVS rose from 51.0 S.D. 28.4 to 76.0 S.D. 25.4 (p < 0.001). In contrast, the control group's mean score dropped from 54.8 S.D. 24.8 to 46.5 S.D. 27.1 (p < 0.001). CONCLUSIONS: Cataract surgery in the elderly improves visual function and prevents loss of autonomy, delaying dependency in carrying out basic daily activities.

Activities of Daily Living↗

PubMed2004

[Spanish version of the 7 Minute screening neurocognitive battery. Normative data of an elderly population sample over 70].

INTRODUCTION: To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. METHODS: We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were obtained in the subgroup of non-demented subjects. RESULTS: The easiest and most efficient method to obtain the total score of the 7MS was the sum of the z-scores of the four subtests. We present the mean values, -1 and -1.5 standard deviations, range and percentiles of the partial and total scores of the 7MS stratified by age (71-75, 76-80, 81-85 and > or = 86 years) and education (less than primary education and primary education or greater) in the subgroup of non-demented subjects. CONCLUSIONS: The normative data of the 7MS obtained in a representative sample of the general elderly population support its rigorous use in the Spanish clinical setting.

Aged↗

PubMed2003

[Prevalence of urinary incontinence and linked factors in men and women over 65].

OBJECTIVES: To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. DESIGN: Population survey. SETTING: Leganés (Madrid). PARTICIPANTS: Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). MAIN MEASUREMENTS: Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. RESULTS: The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. CONCLUSIONS: Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Aged↗

PubMed2003

[Non-detected dementia and use of the health services: implications for primary care].

OBJECTIVES: To calculate the proportion of cases of dementia detected in people over 70 living in their homes and to describe the use made by people with dementia of the health and social services. MATERIAL AND METHODS: Population survey of the survivors of the cohort "Growing old in Leganés", started in 1993. In the third monitoring (1999-2000), the clinical diagnosis of dementia on the basis of a neurological examination and an extensive neuro-psychological battery was included. Their use of health and social services and prior diagnoses were also asked. RESULTS: In the sample of survivors (n=527), there was 12.1% prevalence of dementia. Only 30% of the demented had previously been diagnosed by the health services. The proportion of undetected dementia was significantly associated with its seriousness (light 95%, moderate 69%, severe 36%). Compared with older persons who were not demented, the demented used more often hospital services, medical and nursing consultations at home and consultations through third parties; and less often, preventive and rehabilitation services. This trend was accentuated in patients with grave dementia. The use of community social services was very low (below 8% in the most serious cases). CONCLUSIONS: The detection of dementia in the elderly is very low and efforts to detect it in primary care need to be stepped up. Specific social-health resources for this population also need to be increased and the attendance guide-lines for primary care teams, and for health professionals in general, need to be changed.

Aged↗

PubMed1997

[Factors associated with chronic drug consumption in the elderly].

BACKGROUND: To determine chronic drug intake in the non-institutionalised elderly population and identify factors associated with polypharmacy. PATIENTS AND METHODS: Cross-sectional study by means of home interview. 1,015 elderly individuals were selected systematically from the 1991 municipal electoral list of Albacete, Spain (level of confidence 95%, precision 3%, response rate 93.8%). The questionnaire included, disability scales (Minimental test, index of Katz and Lawton-Brody, Yesavage scale and DUKE-UNC questionnaire), a self-preceivement of health, demographic data and qualitative and quantitative information about drug intake. We employed the anatomic classification of drugs to obtain a profile of consumption. RESULTS: 75% of those interviewed admitted to taking medication chronically (CI 95%: 72.6-78.6). The mean number of drugs was 3.17 +/- 1.94 SD. Intake was significantly higher in women (p = 0.01), widows (p = 0.04), those of lower social status (p = 0.01), greater age (p < 0.02), and a greater number of illnesses (p < 0.001), more frequent users of health resources (p < 0.001), those physically dependent (p < 0.001) and those suffering from depression or cognitive impairment (p = 0.001). The most commonly taken drugs were: cardioactive drugs (22.1%), diuretics (19.4%) and vasodilators (14.2%). Using logistic regression analysis we found that the factors associated with higher drug intake were: three or more ilnesses (OR = 2.24), poor self-assessed status of health (OR = 1.45), physical dependence (OR = 1.59), age greater than 74 years (OR = 1.63), depression (OR = 1.68), > or = 4 contacts with health providers over a three-month period (OR = 2.73) and previous hospital admissions (OR = 2.67). CONCLUSIONS: The high intake of drugs by the elderly is determined, among other factors, by sociodemographic considerations, the subject's perceived status of health and different forms of disability. These factors should be taken into account by health professionals when planning a rational use of drugs. There is a high consumption of peripheral vasodilators despite their scanty therapeutic value.

Aged↗

PubMed1997

[Depression in older persons. Associated factors].

OBJECTIVE: To determine the proportion of elderly people with depressive disorders and study the possible association with sociodemographic factors, self-perception of health, cognitive function, diseases suffered, drug consumption, sleep disorders and use of services. DESIGN: An observational crossover study using a home interview. SETTING: Community-based. PARTICIPANTS: 787 elderly people aged 65 and over, not institutionalised and living in the city of Albacete. MEASUREMENTS AND MAIN RESULTS: A questionnaire designed for the study was used to gather data on the sociodemographic variables, self-perception of health, diseases suffered, drug consumption, cognitive function, sleep disorders and contacts with the health service. The variables found by logistic regression to be associated independently to the presence of depressive disorders were: being female (OR = 2.75), habitually suffering sleep disorders (OR = 2.75), having self-perception of poor health (OR = 17.61) and cognitive deterioration (OR = 2.45). CONCLUSIONS: It would be advisable to apply a screening test to detect depressive disorders in elderly people with associated factors (being female, having sleep disorders, self-perception of poor health and cognitive deterioration), so that they could benefit from early diagnosis and adequate treatment.

Aged↗

PubMed1994

[The levels of knowledge about nonclinical areas which are characteristic of the new model of primary care].

OBJECTIVE: To evaluate the level of knowledge about the non-clinical areas which characterise the new model of primary care among doctors and nurses who work in primary care teams (PCT); and to identify the most deficient areas of knowledge and the variables associated with these lower levels of knowledge. DESIGN: An observation study of a crossover kind. SETTING: PCTs of Health Area 1 in Madrid. PARTICIPANTS: Doctors and nurses who were working in the 23 PCTs functioning when the study was carried out (321 people). MEASUREMENTS AND MAIN RESULTS: Knowledge was measured by a self-filled, anonymous questionnaire elaborated by a panel of experts. It contained 72 items with correct (C) or false (F) double reply, grouped in 12 basic areas of knowledge relating to the non-clinical aspects which characterise the new model of primary care (PC). A pilot test was done in a PCT in another Area. The data bases were performed on DBASEIII+ and the statistical analysis on SPSS v. 4.0. The required level of knowledge through the questionnaire as a whole was attained by 41.6% of the professionals. An association with the following was noted: Age (p < 0.0001), Profession (p < 0.005), Year that training ended (p < 0.01), Type of contract (p < 0.005), Nature of access to a permanent post (p < 0.0005), postgraduate academic training for doctors (p < 0.001) and Residency in Family and Community Medicine (p < 0.009). The most deficient areas of knowledge were: Evaluation of procedures and programmes (46%), Community Participation (51.6%), the filling-out and standardisation of records (55.2%), and the Evaluation of objectives and quality control mechanisms. CONCLUSIONS: Knowledge of non-clinical areas is low.

Adult↗

PubMed1992

[Main errors in the discharge report and in the registry book of a hospital].

BACKGROUND: The registration book for admission and discharge of patients was the basis of a survey of hospital morbidity and the main source of information concerning the diseases attended in the hospitals in Spain. The aim of this study was to evaluate the quality of this information from the data of a hospital with a computerized patient registration system. METHODS: The sample collected from the registration book in 1985 by the National Institute of Statistics studied three types of errors: the main error being selection of diagnosis, coding and transcription of the principal diagnosis, and comparison of data contained in the patient discharge form. RESULTS: In the 896 releases studied an error oscillating between 1 and 2% was found in transcription. The principal diagnosis had been erroneously selected in 26% of the reports with more than one diagnosis. Important coding errors were found in 11%. Transfer between different hospital wards or death were variables found to increase the probability of error. CONCLUSIONS: Hospital registers should be submitted to quality control processes in which the physicians facilitating the data should participate.

Death Certificates↗

PubMed1992

[Breast feeding in a metropolitan area: (I). Analysis of the current situation].

In order to elaborate a program to promote breast-feeding, it is necessary to know in advance the difficulties encountered by the mothers in the target population. For this purpose, we surveyed a sample of 400 mothers who were representative of those who gave birth in Móstoles in 1989. We found that 56% of the mothers did not exceed two months of breast-feeding. Breast-feeding was shorter in low-income families. Its duration was influenced by the husband's and grandmother's opinions and also by previous failure with elder siblings. Mothers made their choice of feeding method before getting pregnant. We also found that most health professionals acted unsatisfactorily. Other unfavorable factors included excessive insecurity of the mother and misinformation.

Breast Feeding↗

PubMed1992

[Breast feeding in a metropolitan area: (II). Design for a promotion program].

Because of the importance of breast-feeding in the health of both the mother and child, and taking into consideration its poor situation at the present time, it seems fully justified to start a program to promote breast-feeding. This program basically will consist of training health professionals and in the improvement of both the mother's and hospital's practices. It is necessary to motivate health authorities and to curb the excess in formula promotion. Mass-media should be employed for the promotion of breast-feeding and a system should be implemented to obtain a proper record of the duration of breast-feeding.

Breast Feeding↗

PubMed1992

[Importance of maternity routines in the success of maternal breast feeding].

Many of the problems that are associated with breast-feeding appear to be caused by various postnatal care procedures that take place in the majority of our hospitals. In order to identify these obstacles, a survey was carried out on a sample of 400 mothers whose children were born in Móstoles in 1989. The results were as follows: 1) The average duration of breast-feeding was 2.43 months (SD = 2.19 months). 2) The lower the baby's birth weight and the longer that he was kept in the hospital, the shorter the time that he was breast-fed. Two basic procedures in the hospital "norms" appear to contribute to the failure of breast-feeding. First, the provision of glucose water or formula bottles and second, a ridged feeding schedule. If the newborn was fed on demand in the hospital it tended to be continued once at home. In both the hospital and in the home, on demand feeding was strongly associate with successful breast-feeding. Some simple modifications to the Maternity departments are recommended.

Birth Weight↗

PubMed1976