Revista Espanola De Salud Publica最新文献

Objective: The main justification of this study was to describe our experience in neonatal screening and to define the prevalence of the diseases included in the neonatal screening program in Andalusia, among which are congenital hypothyroidism, expanded screening (aminoacidopathies, mitochondrial beta-oxidation defects and organic acidurias), cystic fibrosis, and screening for sickle cell anemia.

Methods: The study was carried out in the Metabolopathies Unit of the Virgen del Rocío Hospital in Seville with samples of newborns from Western Andalusia (Cádiz, Córdoba, Huelva and Seville) and autonomous city of Ceuta. A total of 435,141 newborns were studied (from the period from April 1st 2009 to December 31st 2019) to rule out congenital hypothyroidism and expanded screening; 378,306 for cystic fibrosis from May 1st 2011 to the same date described above. Finally, sickle cell anemia screening was included, which comprised a total of 55,576 newborns from November 26th, 2018 to the same period as the previous ones. Statistical analysis was performed using IBM SPSS software (version 22, SPSS INC., USA).

Results: The study revealed a prevalence of 1:1565 newborns for congenital hypothyroidism, 1:1532 newborns for extended screening, 1:6.878 newborns for cystic fibrosis, and a 1:11.115 newborns for sickle cell disease.

Conclusions: The neonatal screening program allows a large number of newborns to benefit from the early detection of certain serious congenital diseases. This aim improves the morbidity and mortality of those who suffer from them.

Objective: Tandem mass spectrometry (MS/MS) is being used for newborn screening since this laboratory testing technology increases the number of metabolic disorders that can be detected from dried blood-spot specimens. In the Community of Madrid, it was implemented in March 2011 and it includes 13 aminoacidopathies, fatty acid oxidation disorders and organic acidemias. The aim of this study was to describe our experience and evaluate the screening positive cases in a period of 9 years (2011-2019).

Methods: During the period of the study, a total of 592.822 neonates were screened with this expanded program by MS/MS in the Community of Madrid. Amino acids, acylcarnitines, and succinylacetone were quantified in all samples that met the quality criteria. Means, medians, percentiles and standard deviation of the analytes and ratios of interest were calculated.

Results: 901 patients (0,15 %) with a positive screening test were referred to clinical evaluation. 230 patients were diagnosed of 30 different inborn errors of metabolism (prevalence 1:2577), 11 of which were not included as a target in the Community of Madrid newborn screening program. The global positive predictive value was 25,6 %. During this period of time, two false negative cases were detected. The most prevalent disorders were phenylketonuria/hyperphenylalaninemia and medium chain acyl-CoA dehydrogenase deficiency (1:6444 and 1:13174 respectively). 93 % of the patients were detected in the presymptomatic stage.

Conclusions: During the last 9 years a large number of cases of IEM have been detected with an acceptable global positive predictive value. These results confirm the utility of inborn errors of metabolism newborn screening as a public health program.

Within the framework of the Global health sector strategy on viral hepatitis and the Strategic Plan for tackling hepatitis C in the Spanish National Health System, the Secretariat of the National Plan on HIV and STIs and the Unit for Screening Programs in the Ministry of Health have coordinated the policies around the screening of hepatitis C virus (HCV) in Spain. This paper describes the experience and learnings arisen around it. The key points of the process include interdisciplinary work through a Technical Group made up of experts from the different fields involved; the availability of scientific evidence for decision-making, highlighting the 2nd Seroprevalence Study in the general population; and a public health approach along the entire process. As a result, the recently published Guideline on hepatitis C testing includes the indication for HCV testing for people with risk exposures and situations, as well as the main recommendations to improve screening and linkage to care in the most affected populations. We hope that this Guideline and the continuation of joint work will be a step towards equitable access to the diagnosis and treatment of HCV infection in Spain.

Faced with the prospect of a collapsed health system due to the COVID-19 pandemic, the professionals involved in the Neonatal Screening Programme (NSP) of Catalonia had to adapt to this situation in a flexible, forceful and efficient manner. The most important goals were to prevent the risk of infection in the professionals, in families and their newborns, as well as to ensure the same effectiveness for the early detection of the diseases included in our programme. To this end, the laboratory was reorganised by dividing the staff into groups and the spaces were redistributed. It was also necessary to modify several protocols and circuits, especially for the management of early discharges from maternity centres, and for the collection of the necessary second samples (from newborns with inconclusive results or for low quality samples). In general, a 36% reduction in the time of arrival of these second samples at the laboratory was achieved with respect to the previous circuit. In the specific case of cystic fibrosis detection, the implementation of a new strategy meant a 100% reduction in the request for second samples and a 70% reduction in the age of diagnosis of the newborn. After evaluating these changes, it can be concluded that in the face of the pandemic, the NSP of Catalonia showed determined leadership, aligning all its professionals, ensuring the continuity of the activity in the programme and generating new opportunities. The new processes and circuits implemented have been definitively consolidated, improving the efficiency of the programme.

Objective: In Spain, water pipe is a common device for substance abuse. It is the second most widespread way of cannabis abuse (11.9%) between young people from 14 to 23 years old. This use has become a public health problem, because of an intensive consumption in young people is considered as a predictor of excessive consumption in adulthood, and it causes health problems and increases the health costs. The aim of this study was to analyze the relationship between water pipe use, lifestyle (diet, physical activity and sleep) and psychological distress, also considering unexpected effects, in university students.

Methods: An observational and cross-sectional study was carried out, on a sample of 825 students from the University of Huelva, selected by random sampling stratified by conglomerates. The instruments used were extracted from a larger study called "Health Behavior in University". SPSS 26.0 software was used for statistical analysis and statistical analysis was performed on the data collected.

Results: The use of water pipe was associated with less adherence to the Mediterranean diet (t=1.64; p=0.04; d=0.12), a lower number of hours of sleep during weekends (t=2.12; p =0.03; d=0.14) and with intense physical activity (t=-1.80; p=0.07; d=0.13). On the contrary, it was not associated with psychological distress.

Conclusions: The use of water pipe seems to be inversely related to some aspects of a lifestyle that could be associated with long-term metabolic and respiratory diseases.

Objective: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO).

Methods: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed.

Results: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05).

Conclusions: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.

Objective: One of the adverse drug reactions (ADR) can be the Ototoxicity, either in a cochlear level or in a vestibular one. This may cause an incapacitating symptomatology due to a hearing impairment or deafness, tinnitus, or a vertiginous syndrome. The objective of this work was to analyze the notifications of ototoxic ADRs registered in the FEDRA database of the Spanish Pharmacovigilance System for Medicinal products for Human Use (SEFV-H), manifested as tinnitus, describing epidemiological and prognostic factors, as well as active principles and associated therapeutic groups.

Methods: An observational retrospective study based on the incoming registers in the FEDRA database of the SEFV-H, with tinnitus symptomatology due to ototoxicity between 1984 and 2017 has been carried out. SPSS v.20.0 program has been used for the descriptive and inferential statistics searching elements related to the emergence, seriousness or recuperation of the tinnitus.

Results: A total of 662 patients notifications were obtained with 899 suspected drugs. 64% of the patients were women. The average age was 55.8 years old. An 8.5% of the tinnitus were classified as serious, meaning a significant and persistent disability. Evaluating the causality through the modified Karch-Lasagna algorithm (SEFV-H algorithm), a causal group credible or well defined, was discovered in 48.6%. In the ATC ranking, the most frequent group of cause drugs was the N, nervous system. It was concluded, among others, that the seriousness is more significant in men and that the elder group have a great influence in the tinnitus recovery.

Conclusions: The appearance of tinnitus brought on by medical ototoxicity may determine an important limitation on the patient. A vestibular and cochlear function monitoring must be carried out on patients under treatment with high ototoxicity drugs. The task of the pharmacovigilance seems to be essential, by spreading its results and stimulating the ADR notifications in order to identify pharmacological threats.

Objective: Brucellosis is the most widespread zoonosis in the world. In Spain its incidence has decreased considerably in recent years thanks to the social and health measures carried out. 40 cases of brucellosis have been reported in humans in 2018, representing a rate of 0.09 per 100,000 inhabitants. The objective of the study was to highlight the importance of epidemiological suspicion, as well as the screening of relatives for the diagnosis of the disease.

Methods: A descriptive study of a family outbreak of imported brucellosis was carried out. Five members of the same family were evaluated after the diagnosis of brucellosis in a patient in the Health Area III of Zaragoza, in May 2019. The relatives of the patient and the health center were contacted by telephone to investigate the possibility of involvement of the relatives with whom he had traveled and lived in Morocco.

Results: In a scenario with a low frequency of disease such as our country at the present time, family screening, after an initial diagnosis of imported brucellosis, allowed the detection and treatment of four members of the same family of Maghreb origin. They were infected during a trip to their place of origin in April 2019, a month in which they lived in rural areas in contact with animals (sheep, goats, cows) and consumed dairy and meat products. The appearance of presented symptoms was temporally consistent with the incubation period of the disease.

Conclusions: Emphasize the importance of active surveillance and screening in relatives of patients diagnosed with Brucellosis, since they generally share exposures to a common source.

Objective: Interventions for the health promotion and prevention of HIV infection and other sexually transmitted infections (STIs) are not being effective. I have analyzed the risk behaviors, the effectiveness of the campaigns, and the effectiveness of the channels, to determine the strategic keys of an effective communication. The aim of this work was to identify critical points and opportunities for communication improvement to promote behavioral changes and adoption of healthy lifestyles aimed at preventing HIV infections and other STIs.

Methods: Target audiences, channels, terminology used in the media, campaigns and behavior surveys were analyzed. The analysis was completed using the Focus Group's qualitative research technique aimed at target audiences, made up of young people between 16-18 years old, and men who have sex with other men (MSM).

Results: Young people do not have quality information and do not distinguish reliable sources to make decisions. The terminology used in the media does not respond to the current epidemiological situation. The campaigns go unnoticed, the messages are very general, the channels are not appropriate, and they do not achieve behavioral changes. Focus groups are very useful for analyzing critical points and insights, which cannot be measured with quantitative methods.

Conclusions: A new communication model is necessary for prevention of HIV and STIs, with the participation of the target audience to make the problem visible, transmit quality information, train communicators, adapt messages and channels, and evaluate interventions through Focus Groups of key populations.

Nowadays, care for a breech delivery in the out-of-hospital environment through the vaginal route can be a frequent process caused by the change in the scientific literature favoring the free evolution of the delivery of a breech presentation compared to the previous literature where the Caesarean section scheduled at week 37 of gestation, avoiding its free evolution. Furthermore, among the statistical data consulted at the INE (Instituto Nacional de Estadística), there is an increase in preterm deliveries outside the hospital, which increases the presentation of buttocks more frequently, between 25-32 weeks, around 42%. Therefore, the objective of this manuscript was to instruct the health professionals of the out-of-hospital emergency services in the event of imminent delivery in breech presentation. This type of training would consist of maintaining an expectant attitude during the expulsion period until the lower angle of the newborn's scapula is visible, followed by manual assistance by detaching the shoulders while gently and slowly removing the fetal head.