Utilización del servicio de urgencia de un hospital universitario por los adultos mayores en Santiago de Chile

Introduction

An increase in visits to Emergency Departments by older adults has been reported, but there are no data available on this in countries in the early phases of demographic and epidemiological transition. This paper describes the characteristics of people over 60 years-old (AM) who visited the Emergency Department of the Hospital Clínico Universitario de la Pontificia Universidad Católica, Chile (SU-PUC), compared to those less than 60 years-old (AJ).

Material and methods

Demographic data and reasons for admission and re-admission were collected retrospectively from the SU-PUC monthly statistics report. Obstetrics, paediatrics and «scheduled admissions» were excluded. The frequencies were compared using Chi-squared (significance: P < .05).

Results

A total of 37,660 visits to the SU-PUC were recorded (81% AJ; 19% AM; with 8% being older than 75 years). No statistical differences were found in the visit time (70% daytime), or by season between the groups.A total of 7,414 (19.6%) of those who visited were hospitalised, with differences being detected between groups (AM: 48.9% vs 12.9% AJ; P < .001), particularly in those over 75 years (59%). The primary cause of admission was cardiopulmonary in AM (22%) and gastrointestinal in AJ (31%). Re-admissions were 10% in AM and 6% in AJ (P < .001).

Conclusion

The use of SU by AM and some characteristics of their care process (hospitalisation) are similar to those found in countries in more advanced phases of demographic transition.     

Tafonomía y contexto paleoambiental de los restos de un cetáceo del Mioceno medio de Tarragona (NE España)

A new finding of a marine mammal is documented from the middle Miocene of El Camp basin in Tarragona (NE Spain). The incomplete and disarticulated bone remains belong to the skeleton of a juvenile cetacean. These remains appear deposited above a transgression surface and included within a glauconitic calcisiltite layer. This unit constitutes the beginning of a shallowing-upwards sequence and was deposited under low-energy conditions and low sedimentation rates in a middle-outer platform setting. This context was responsible for the long exposure of the remains and, consequently, an extension of the biostratinomic stage. These conditions favored the natural decomposition and disarticulation of the carcass, allowing the action of different types of scavenging organisms. The interpretation of the paleoenvironmental setting is based in the combination of different datasets: taphonomic data of the bone remains, paleoecologic and taphonomic information provided by the fauna associated to the bones, and ichnologic and sedimentologic interpretation of the sediments where the fossils are included. Combination of such different proxies enables a very good characterization of the paleoenvironmental context of the studied fossils.     

Regulación de la expresión sexual de los mayores ingresados en residencias: la visión de los profesionales

Introduction

The purpose of this study is to determine the opinion of professionals working in residential aged care facilities on the regulation of sexuality in these settings.

Materials and methods

Fifty-three professionals from five residential aged care facilities located in the metropolitan area of Barcelona answered several questions regarding the advisability of establishing measures for the regulation of sexuality in RACFs, the elements that could contribute to this, and the aspects that such regulations should consider.

Results

Around 50% of the participants recognized the advisability of having some type of measures for sexuality regulation in residential aged care facilities. According to their responses this should be developed taking into account professional opinions, but also the points of view of the residents and their relatives. The most frequently mentioned regulations were those that ensured that any kind of sexually charged situation occurred in a private environment. The development of strategies are suggested to distinguish those people with dementia that are competent to consent to sexual acts from those who are not.

Conclusions

The opinion of professionals working in RACFs regarding the advisability of establishing measures for sexuality regulation seems to be considerably divided. Thus, whilst around 50% of them recognize their potential usefulness, the other half consider them unnecessary or even counterproductive for the sexual freedom of residents. Associating regulation with prohibition and sexuality with sexual activity was not uncommon among the responses of the participants.     

Fiabilidad interobservador de los 4 índices de comorbilidad más utilizados en pacientes ancianos

Objective

To report on the interrater reliability of four common comorbidity indexes used in the hospitalised elderly: Charlson Index (CI), Geriatric Cumulative Illness Rating Scale (CIRS-G), Index of Co-existent Disease (CoD) and Kaplan-Feinstein Index (KFI).

Method

Four trained observers, independently reviewed the same 40 medical charts of hospitalised geriatric patients. Scores for the four indexes were calculated, along with the intraclass correlations coefficient (ICC) (quantitative index: CI and CIRS-G) and Kappa coefficient (qualitative index: CoD and KFI). The agreement <0.4 was considered deficient, 0-4-0.75 acceptable and >0.75 excellent.

Results

A total of 40 patients (29 women) of 85.93 (±5.35) years were analysed. Intraclass correlations coefficient: CI: 0.78 (95% CI: 0.67-0.86); CIRS-G (score): 0.66 (95% CI: 0.53-0.78). Kappa coefficient: KFI: 0.51 to 0.76; CoD: 0.44-0.66. The application time was lower for the Charlson index (median of 39 seconds [30-45]) and the KFI (42 seconds [35-52]) and higher for CIRS-G (score) (128 seconds [110-160]) and CoD (102 seconds [80-124]).

Conclusions

Of the four comorbidity indexes used in a hospitalised elderly population, the CI, and CIRS-G (score), are those that have better interrater reliability. The Charlson index and KFI show a lower application time than the CIRS-G (score).     

Las comunidades de los ventisqueros (Salicetea herbaceae) del Pirineo central

Resumen Se hace un estudio de las comunidades de los ventisqueros del Pirineo Central (Salicetea herbaceae) y se las compara con las de los Pirineos Orientales y Alpes Occidentales. El autor publica 36 inventarios originales correspondientes a tres asociaciones: Cardamino-Gnaphalietum supini, Anthelio-Salicetum herbaceae y Carici-Salicetum retusae, de las que hace un estudio florístico, ecológico y corológico. Los fenómenos de zonación de los suelos y de la vegetación del piso alpino, son destacados.

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Summary A study is made on plant communities of stands that remain covered with snow almost all the year (Salicetea herbaceae) in the Central Pyrenes Mountains; they are compared with those of the Oriental Pyrenees and Occidental Alps. The author publishes 36 original relevées of 3 associations: Cardamino-Gnaphalietum supini, Anthelio-Salicetum herbaceae and Carici-Salicetum retusae. A floristical, ecological and chorological study of them is made. The phenomena of soils and vegetation zonation in the alpine range are emphasized.

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Zusammenfassung Untersuchung der Schneetälchengesellschaften der zentralen Pyrenäen (Salicetea herbaceae) und Vergleich mit denen der Ostpyrenäen und der Westalpen. Die Arbeit beinhaltet 36 unveröffentlichte Aufnahmen, die in drei Ass. gegliedert werden: Cardamino-Gnaphalietum supini, Anthelio-Salicetum herbaceae und Carici-Salicetum retusae, die floristisch, ökologisch und chorologisch beschrieben werden. Besondere Aufmerksamkeit wird der Abstufung der Bodentypen und der alpinen Vegetation gewidmet.