Joaquín Moncho Vasallo

Quality of life in simultaneous pancreas-kidney transplant recipients.

Abstract:  Background:  Simultaneous pancreas‐kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT).BACKGROUND Simultaneous pancreas-kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT). METHODS Short Form Health Survey 36-Item (SF-36) was administered to 69 SPK transplant recipients and 34 patients with DM1 under RRT. A descriptive analysis, multiple linear regression, ANOVA, and ordinal regression (PLUM) models were constructed. RESULTS QoL was higher in SPK transplant recipients than in patients receiving RRT. The best results were in the recently transplanted patients. Respect to Spanish population the men with SPK transplants scored higher on vitality and lower on general health, role limitations-physical and role limitations-emotional. Women with SPK transplants scored lower on general health. Among patients under RRT, men scored lower on the general health, physical functioning, vitality, and bodily pain while women scored lower on all dimensions. In both groups, greater age was associated with better mental health. CONCLUSION Positive predictive factors of QoL are SPK Tx and age while negative predictive factors are female sex and RRT.

Proceso de adaptación a la diabetes mellitus tipo 1 (DM1). Concordancia con las etapas del proceso de duelo descrito por Kübler-Ross

OBJECTIVE To understand the process of adaptation to type 1 diabetes mellitus (DM1) and analyze its alignment with the grief cycle phases described by Kubler-Ross. SUBJECTS AND METHOD We performed an ethnographic study through in-depth interviews with 20 patients, 10 relatives and 12 health professionals (6 physicians and 6 nurses). For the analysis, the Miles and Huberman qualitative data analysis model was used. RESULTS Patients diagnosed with DM1 and their families face a loss of lifestyle and of the objects, real or imaginary, of their previous life. Patients and relatives experience emotional reactions that in some cases can be similar to the grief cycle phases described by Kubler-Ross for terminal diseases (denial, anger, bargaining, depression and acceptance). However, there are some differences depending on personal and psycho-social factors. Health professionals tend to relate low adherence to denial of the disease, but some patients feel threatened by the demands of treatment and control and their effects on their quality of life, and consciously choose not to follow recommendations. It is more realistic to talk about disease adaptation than acceptance, since the loss processes are ongoing and patients must reconstruct their identity according to their situation. The grief cycle also affects the family and may differ from that of the patient in its duration, intensity and assessment of problems. CONCLUSIONS Adaptation is a complex process in which many variables intervene. There are observable differences among the mechanisms used by each specific individual. Healthcare professionals, and specifically nurses, should consider the multiple psycho-social dimensions of chronic disease.Objetivo Conocer el proceso de adaptacion a la diabetes mellitus tipo 1 (DM1) y analizar su correspondencia con las etapas del proceso de duelo descritas por Kubler-Ross. Sujetos y metodo Estudio etnografico mediante entrevistas en profundidad a 20 pacientes, 10 familiares y 12 profesionales (6 medicos y 6 enfermeras). Para el analisis se siguio el esquema de analisis de datos cualitativos de Miles y Huberman. Resultados El paciente diagnosticado de DM1 y su familia afrontan la perdida del estilo de vida y los objetos reales o imaginarios de su vida pasada. Enfermos y familiares experimentan reacciones emocionales que, en algun caso, pueden asemejarse a las etapas de duelo descritas por Kubler-Ross en una enfermedad terminal (negacion, rebeldia, negociacion, depresion y aceptacion), pero hay diferencias que dependen de factores personales y psicosociales. Los profesionales tienden a relacionar la mala adherencia con la negacion de la enfermedad, pero algunos pacientes se sienten amenazados por las exigencias de tratamiento y control y por sus consecuencias en su calidad de vida, y conscientemente optan por no seguir las recomendaciones. Es mas realista hablar de adaptacion a la enfermedad que de aceptacion, puesto que los procesos de perdida son constantes y el enfermo debe reconstruir nuevas identidades segun su estado. El proceso de duelo afecta tambien a la familia y puede ser diferente que el del enfermo en tiempo, intensidad y valoracion de los problemas. Conclusiones La adaptacion es un proceso complejo en el que intervienen muchas variables. Se observan diferencias en los mecanismos que utiliza cada sujeto en particular. Los profesionales sanitarios y, particularmente la enfermera, deben considerar las multiples dimensiones psicosociales de la enfermedad cronica.

Cumplimiento de las recomendaciones de aportes de vitamina D y calcio en pacientes con osteoporosis

Objetivos: - Conocer los aportes diarios de vitamina D y calcio (suplementos farmacologicos y dieta) en mujeres mayores de 65 anos. - Conocer si existe relacion entre el consumo diario de vitamina D y las variables clinicas y sociodemograficas.