Pilar Isla Pera

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.

Living with diabetes: quality of care and quality of life

Background: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients’ opinions of the quality of care received and the results of interventions. Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed. Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system. Conclusion: The bureaucratic circuits of the health care system impair patients’ quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials.

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.

Perceptions of diabetes obtained through drawing in childhood and adolescence

Objective To examine whether drawing is useful in the detection of problems of psychosocial adaptation in children and adolescents with type 1 diabetes (T1D) and in improving communication with health professionals. Methods We performed an exploratory descriptive study in 199 children and adolescents with T1D aged 4–13 years. The participants were asked to render a drawing on a suggested topic. The variables analyzed were related to the drawing and to clinical and sociodemographic data. Results Most participants showed evidence of having a well-balanced personality, but there were also signs of affective or psychosocial difficulties. Conclusion Drawing is a useful technique by which to identify children’s and adolescents’ feelings and possible problems in adapting to T1D, as well as to gain information directly from the children themselves. Future studies should delimit the possibilities of this technique in clinical practice in greater detail.

¿Qué es la salud? Percepción comunitaria

Resumen Introduccion Tras revisar y analizar diferentes definiciones de salud, se disena un estudio descriptivo transversal con el objetivo de conocer el significado de salud en 4 colectivos comunitarios diferentes e identificar los factores socioculturales que determinan la percepcion del concepto de salud Material y metodo Se pide a estudiantes sanitarios, adolescentes, ancianos y amas de casa que definan la salud con palabras clave. Otras variables estudiadas son el sexo y la edad. Se agrupan las palabras por categorias, se calcula el porcentaje de las 10 palabras mas repetidas en cada estamento y se analizan en grupos de discusion Resultados Se obtienen 534 respuestas y 2.947 palabras que ofrecen una dimension multidimensional y rica del concepto de salud. Para el estudiante de medicina, la salud es fundamentalmente ausencia de enfermedad, mientras que para enfermeria, es bienestar. Para los adolescentes, es “estar cachas” y “ligar mucho”. Para el anciano, ausencia de enfermedad pero tambien “tener dinero”, y para las amas de casa, bienestar, “comer bien” y felicidad Discusion Los estudiantes sanitarios tienen un concepto de salud aprendido y distinto ligado a un enfoque educativo y profesional diferenciado, mientras que para el resto de los grupos, la salud es un concepto cultural y mas pragmatico

Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people

Aim We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss. Background Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective. Design A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman. Findings Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as “obese” and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories. Conclusion Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.

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.