Introducción. Varios aspectos en el adulto mayor deterioran su calidad de vida, como son las relaciones familiares y de amigos, la soledad e, incluso, el mismo centro geriátrico. Objetivo. Explorar las condiciones asociadas con la calidad de vida de los ancianos en hogares geriátricos. Materiales y métodos. Estudio transversal de 276 ancianos de 39 Centros de Bienestar del Anciano de Medellín. Se excluyeron aquellos con grave deterioro cognitivo y los que no residían de forma permanente en la institución. La calidad de vida se evaluó mediante el World Health Organization Quality of Life of Older Adults (WHOQOL-OLD) de la Organización Mundial de la Salud; se utilizaron la escala de depresión de Yesavage, la de ansiedad de Goldberg, la de funcionalidad de Pfeffer, la minivaloración nutricional y, además, se evaluaron aspectos demográficos y sociales. La información se analizó con pruebas U de Mann-Whitney, Kruskal-Wallis, la correlación de Pearson y un modelo de regresión lineal múltiple. Resultados. El 59,4 % eran mujeres, la edad promedio fue de 79,2 ± 8,0 años, 71 % se consideraron independientes para realizar actividades de la vida diaria, 45,7 % presentaba sintomatología depresiva y 33 % mostraron riesgo de ansiedad, 28,3 % deterioro funcional y, 54,3 %, posible malnutrición. Se encontró una asociación negativa con la calidad de vida el ser mujer, presentar diabetes, altos puntajes en las escalas de capacidad funcional, depresión y ansiedad; el ir voluntariamente a la institución mostró una asociación positiva. Conclusión. Se halló deterioro en la calidad de vida cuando las condiciones de funcionalidad y autonomía limitaban la realización de actividades de la vida diaria, agravado por el hecho de ser mujer, tener sintomatología depresiva y de ansiedad, y sentirse maltratado por sus familiares.Palabras clave: calidad de vida, anciano, institucionalización, ansiedad, depresión. Quality of life in institutionalized elderly people of MedellínIntroduction. Many factors contribute to the deteriorating quality of life of elderly people living in care institutions. Some of these problems are a consequence of few contacts with relatives and friends, and being alone with a feeling of isolation. Objective. The conditions of quality of life are explored for elderly people living in care institutions. Materials and methods. In a cross sectional study, 276 subjects were selected from 39 long term institutions located in the city of Medellín, Colombia. The sex ratio was female:male 60:40% with a mean age of 79.2 ± 8.0. Elderly subjects with cognitive problems or not living in the institution were excluded. The World Health Organization Quality of Life of Older Adults (WHOQOL-OLD) questionnaire was applied; in additional, capacity and cognitive functional scales of Pfeffer, the anxiety scale of Goldberg, and the Geriatric Depression Scale of Yesavage were administered. Mininutritional assessment scales and complementary questionnaires about demographics, health perception, social support system were also included. The inform...

The trabecular micro-bypass stent is a highly cost-saving strategy due to more QALYs related to a lower rate of the population with loss of visual acuity in the long-term, and because the costs associated with additional medications and complications are lower with trabecular micro-bypass stents.

BackgroundPneumococcal diseases in children under five years are common and preventable. In Colombia there are two pneumococcal conjugate vaccines (PCV) that have proved clinical efficacy. The aim was to estimate the cost-effectiveness of 13-valent PCV (PCV13) and 10-valent PCV (PCV10) in terms of prevention of Invasive Pneumococcal Diseases (IPD), radiologically-confirmed pneumonia, and their related mortality, as well as, acute otitis media (AOM) in a cohort of newborns in Colombia.MethodsWe developed an analytical decision tree model with national data including the distribution of pneumococcal serotypes in Colombia between 2009 and 2013. A simulation of vaccination of 90% of newborns in Colombia took place with a time horizon of 5 years. The analysis was done from the Colombian health system perspective. Vaccines efficacy parameters were measured as life-years gained (LYG) and avoided morbidity by pneumococcal diseases; they were determined by a systematic review of literature. A health insurance company provided the costs. A probabilistic and a univariate sensitivity analysis for epidemiological, efficacy and cost parameters were done.ResultsAfter 5 years projection, PCV13 would prevent 437 deaths due to pneumococcal infections versus 321 that would be prevented by PCV10, compared to no vaccination. PCV13 would generate 25 396 LYG, and PCV10 would generate 18 708 LYG. Medical costs avoided would be US$ 19 479 395 for PCV13 and US$ 13 703 271 for PCV10. Compared to no vaccination, PCV13 and PCV10 were cost-effective, with an incremental cost-effectiveness ratio (ICER) of US$ 489.26 and US$ 813.41 per additional LYG, respectively; besides, PCV13 was dominant over PCV10 due to lower costs and better outcomes.ConclusionPCV13 is a cost-saving strategy compared with PCV10, as part of a universal coverage vaccination program in Colombian children under one year. PCV13 is expected to lead to a greater decrement in infant mortality from pneumococcal diseases, and a higher cost saving by preventing more pneumococcal diseases compared with PCV10 in a 5 years projection.

BackgroundNowadays, there are two vaccination strategies in Colombia to prevent pneumococcal diseases in people over 50 years. Our aim is to estimate cost-effectiveness of pneumococcal conjugate vaccine 13-valent (PCV13) versus pneumococcal polysaccharide vaccine 23-valent (PPSV23) to prevent pneumococcal diseases and their related mortality in people over 50 years old in Colombia.MethodsA Markov model was developed with national data, including pneumococcal serotypes distribution in Colombia between 2005 and 2010. Vaccination of a cohort was simulated and a five year time horizon was assumed. Analysis was done from a perspective of a third party payer. Direct costs were provided by a national insurance company; sensitive univariate and probabilistic analysis were done for epidemiological and clinical effectiveness parameters and costs.ResultsPCV13 avoids 3 560 deaths by pneumococcal infections versus PPSV23 and 4 255 deaths versus no vaccine. PCV13 prevents 79 633 cases by all-cause pneumonia versus PPSV23 and 81 468 cases versus no vaccine. Total costs (healthcare and vaccines costs) with PCV13 would be U.S. $ 97,587,113 cheaper than PPSV23 and it would save U.S. $ 145,196,578 versus no vaccine.ConclusionPCV13 would be a cost-saving strategy in the context of a mass vaccination program in Colombia to people over 50 years old because it would reduce burden of disease and specific mortality by pneumococcal diseases, besides, it saves money versus PPSV23.

Objetivo. Evaluar la calidad de vida relacionada con la salud en pacientes conpsoriasis, por medio del Dermatology Life Quality Index (DLQI).Metodología. Revisión sistemática de estudios sobre calidad de vida relacionada con la salud en pacientes con psoriasis y en que se haya utilizado el DLQI. La búsqueda incluyó estudios publicados entre el 1994 y el 2012. Se excluyeron los estudios que evaluaran la calidad de vida relacionada con los tratamientos farmacológicos.Resultados. En ocho estudios se cumplieron los criterios de inclusión y exclusión. Hubo una pérdida de la calidad de vida en los pacientes con psoriasis. El DLQI fue reportado en dos estudios con promedios de 6,4 y 10,8; la duración de la enfermedad varió entre 17,6 y 28,9 años.Conclusión. La psoriasis afecta la calidad de vida de los pacientes que padecen la enfermedad, tanto en su forma leve como moderada, y este deterioro es superior al encontrado en enfermedades como el acné o el vitiligo.