Revista Espanola De Salud Publica最新文献

Objective: A common secondary effect after SARS-CoV-2 immunization is an increased in size of the axillary lymph nodes ipsilateral to the vaccinated site. Eventually, an increased in size of the axillary lymph nodes may lead to a misinterpretation of the breast screening mammogram, performed in asymptomatic women between the age 50 to 69 years old for early breast cancer diagnosis. The aim of our research was to evaluate the impact of the vaccination for SARS-CoV-2 in the breast screening programmes in terms of recall rates and number of false positive results. As a secondary purpose we would analysed the protocols adopted by different breast screening units around the world after SARS-CoV-2 vaccination.

Methods: Observational and retrospective study analysing breast screening mammograms from a single Breast Cancer Screening Unit in Madrid. The mammograms of previously vaccinated women were analysed, reviewing the axillary lymph nodes and the re-call rate secondary to axillary lymphadenopathies.

Results: Four hundred and twenty three screening mammograms were performed in May 2021 in the University Hospital Ramon y Cajal in Madrid, which is part of the Breast Screening Programme in Madrid, Spain. None of the women previously vaccinated for SARS-CoV-2 were recalled for complementary studies due to an increased in the axillary lymph nodes.

Conclusions: The protocol stablished by the Spanish Society of Breast Image that stands up for a routine breast screening mammogram after SARS-CoV-2 immunization, has no increase in the recall rate or increase in number of false positives.

Objective: Hip fracture (HF) in the elderly carries high mortality and decreases functionality and quality of life after one year. The aim of this paper was to identify risk factors that influenced functionality (Barthel) and quality of life (EQ-5D) of the elderly with osteoporotic HF.

Methods: A prospective observational study was made in people over 65 years of age with HF between October 2017 and November 2018. Clinical information was collected from the digital medical record and the scales were measured by telephone at four times: baseline, one month, six months and twelve months. Statistical analysis was made thanks to SPSS vs 25.0. Multivariate analysis was performed using a generalized linear model for repeated measures to determine the relationship of risk factors with functionality and quality of life.

Results: Functionality showed significant differences (p<0.001) between baseline measurement and one month (90 points vs 50); baseline and at twelve months (90 vs 60 points); and that of the month and at twelve months (50 points vs 60). Quality of life also presented significant differences (p<0.001) between baseline and one month (0.587 vs 0.113); and baseline and twelve months (0.220). The functionality should be in transfused and with high surgical risk (p<0.05) and the quality of life will arrive in high surgical risk (p=0.017). Those older than 85 years were the ones who recovered the least after one year, as well as patients with delirium on admission and those who received transfusions. Patients with iron therapy recovered better at six months compared to those who did not and maintained this improvement at twelve months.

Conclusions: Among the main risk factors are advanced age, male sex, transfused, high surgical risk, delirium on admission and malnutrition.

Objective: The control of cardiovascular (CV) risk factors in high-risk population is still suboptimal. This fact should make us reconsider current preventive strategies. The objective of this study was to transform the secondary cardiovascular prevention program of the University Hospital of Torrejon (Madrid, Spain), to make it more proactive, preventive, productive and efficient.

Methods: Within the quadruple aim perspective, we present a mHealth project where the patient will include, and periodically review, the parameters and values related to the main CV risk factors (smoking, diet, physical activity, weight, blood pressure, LDL cholesterol and glycosylated hemoglobin), allowing to check if therapeutic objectives recommended in the clinical practice guidelines are achieved, facilitating doctor-patient communication, and generating warnings to reinforce indications and/or intensify the therapeutic and pharmacological measures in case of non-complianc.

Results: A detailed evaluation of the achievement of quadruple aim goals will be performed. Improvements in CV risk control, experience in care, health spending and the healthcare professionals' satisfaction will be assessed.

Conclusions: mHealth offers new opportunities to improve the control of CV risk factors in high-risk patients. Better control might reduce the high cardiovascular morbidity and mortality of this population, helping to reduce health spending and improving the patients' experience and adherence to secondary prevention strategies.

Objective: The COVID-19 pandemic has had a negative effect on the mental health on the population. It is unknown if the different types of patient isolation affect them equally. The objective of the study was to determine if the effect on the psychological discomfort caused by the isolation of the population with COVID-19 in a hotel supervised by health professionals was different compared with those who were isolated at home.

Methods: Patients diagnosed with COVID-19 during the first pandemic wave in Barcelona, consecutively selected from the Primary Care lists. A telephone survey was carried out to collect information about mental health in patients who were isolated in a hotel compared to those isolated at their homes. Descriptive statistics were performed and the study variables were analyzed using mean and standard deviation, count (percentage), Chi-square test, and Student's t-test. Logistic regression models were carried out selecting frustration and anger/irritability as response variables.

Results: Of the 89 patients included, 45 (50.6%) were isolated at their homes and 44 (49.4%) at the hotel. Frustration was identified in 48.3% and irritability in 29.2% of the most patients. Most of those who presented frustration were between 45 and 65 years old, while 50% of those who felt irritability were younger. Multivariate models confirmed that patients isolated at home showed a higher risk of frustration (Odds ratio 4,12; 95% Confidence interval 1,60-11,49) and irritability (Odds ratio 3,81; 95% Confidence interval 1,32-12,10), respectively.

Conclusions: Patients isolated at home show a higher risk of presenting feelings of frustration and irritability than isolated patients in supervised hotels.

Since countries and their institutions began to feel overwhelmed by COVID-19, it has not been surprising to hear the complaints, ailments and discomforts of millions of people who have experienced significant emotional and material losses. It has been a cluster of factors that have been crossed by biological, socioeconomic and cultural phenomena, interconnected with each other, and that have become structural. Despite the broad contribution of the scientific field to the study of this phenomenon, the different disciplines in general, and those from the Social Sciences in particular, have had little participation and opportunities for communication and research. A good indicator to assess the priorities regarding the generation of knowledge is to observe the number of relevant publications and total citations, among which biomedical ones stand out . This invites a tremendously necessary debate since, considering the complexity of the phenomenon, we wonder why it has not been proportional to the collaboration of the different disciplines when considering its approach.

Objective: The analysis of efficiency represents an area of growing interest in the field of public management. Hospital efficiency depends mainly on the use that the institution makes of its resources and their cost. The importance of hospital efficiency studies is justified by the fact that health spending is the second most important item of public spending. The objective of the present study focused on the analysis of the degree of efficiency with which the public hospitals of Castilla y León were managed.

Methods: The scope of the research was limited to the 14 hospitals of the Public Health Service of Castilla y León (Sacyl), taking the five-year period 2014-2018 as the study period. For the analysis, the non-parametric technique of Data Envelopment Analysis (DEA) was used. Both constant returns to scale (CRS) and variable returns to scale (VRS) have been used, calculating the global technical efficiency, pure technical efficiency and scale efficiency for each health institution.

Results: The grouped results showed that the global technical efficiency (GTE) had reached an average of 92.02%, the pure technical efficiency (PTE) 94.10% and the scale efficiency (EE) 97.74%.

Conclusions: The DEA is presented as a valid technique for analyzing the efficiency of hospitals, with the efficiency of all groups of hospitals (groups I, III and IV) being very similar in terms of PTE, around 97%, with the exception of group II hospitals that are the least efficient.

Objective: The benefit-risk balance of statins and ezetimibe as primary prevention of cardiovascular disease is controversial in elderly patients due to the doubts about their effectiveness and certainty about adverse effects. The aim of this paper was to analyze health outcomes of a statin and ezetimibe deprescription strategy in patients aged 75 or older treated with these drugs for primary prevention of cardiovascular disease.

Methods: An observational ambispective cohort study was made to evaluate health outcomes after the implementation of a strategy for deprescribing statins and ezetimibe in patients aged 75 or older who take these drugs for primary prevention of cardiovascular disease. To avoid the risk of bias due to non-random assignment of patients to different groups, a propensity score will be calculated for each patient using logistic regression. The outcome of interest will be the deprescription or not of statins or ezetimibe. Time to hospital admission or death from any cause and other variables related to health outcomes will be analysed. Groups with and without statin or ezetimibe deprescription will be compared by survival analysis using Cox regression to estimate the hazard ratio.

Conclusions: It is expected to obtain health outcomes of the strategy of deprescribing statins and ezetimibe in primary prevention in patients aged 75 or older. They will provide information on the advisability of continuing the strategy.

Objective: Drowning is one of major public health problem in childhood. The aim of this paper was to describe the characteristics, locations, interventions and outcomes of child drowning in Galicia over 17 years.

Methods: Retrospective study of 100% of data of drowning amongst children aged 0-14 in the 2004-2020 period who were attended by the 061 emergency services in Galicia (Spain) was made. The characteristics of the incident, the victim's profile, location, type of medical care given and whether the victim survived or died were analysed using the Chi Square test to compare relative frequencies, and Odds Ratio to estimate the risk.

Results: During the period under study, 100 child drownings were recorded. In 55%, the main cause was lack of supervision. Young children (aged 0-4) primarily drowned in pools, and pre-teens and teenagers (aged 10-14) in the sea. In 42% of the incidents, bystanders performed CPR (37% included ventilation). Emergency services took 12 minutes on average to arrive at the scene. 6% died in situ and of the rest, were taken to hospital and admitted in 47% PICU, 26% ward, 8% discharged from Accident and Emergency (43% with pulmonary oedema, 41% with supplemental oxygen, 13% with IMV/NIMV [invasive mechanical ventilation/non-invasive]). Pneumonia was the most common complication and survival to discharge was 77%.

Conclusions: Small children usually drown in pools and water facilities because of lack of supervision, whereas adolescents usually drown in the sea. CPR started by bystanders and the fast response of emergency services contributed to a high rate of survival. A large amount of data was lost during the process: accurate, standardized coding of drowning is necessary.

Objective: Medications errors are a major problem that can cause a harm to inpatients. The main objective of the study was to compared medication errors in pharmacotherapeutic process before and after to carried out an intervention: to implant an automated dispensing cabine with to use Lean Six Sigma methodology. The secondary objective was to assess process performance, sigma level and defects per one million opportunities for medication error.

Methods: Quasi-experimental and randomized study carried out in a Thoracic Surgery Unit of a Spanish Hospital. A pharmaceutic recorded and assesed the medication errors detected during pre-intervention period (july-august 2017) and post-intervention period (march-april 2018). The steps analyzed were dispensing, storage and compounding/administration. The pharmacist observed a third of the medication dispensed, stored and compounded/administered during the study period. The observed medication was randomly selected using AleatorMetod.xls software. To perform the statistical analysis, Student's t test and Mann-Whitney U test were used to compare quantitative variables, and Chi-square test for qualitative variables. A significance level of p<0.05 was considered.

Results: The pharmaceutic recorded 4,538 drugs. After intervention, medication errors were decreased a 49% in total pharmacotherapeutic process (12.06% vs 6.15%; p<0.001). In addition, errors were decreased a 91.6% (4.27% vs 0.36%; p=0.004) in the step of medication storage; and a 75.8% (22.52% vs 5.46%; p<0.001) in the step of drugs compounding/administration. However, medication errors were increased in the step of medication dispensing (4.51% vs 15.29%; p<0.001). The process performance increased a 6% (87.9% vs 93.9%), sigma level increased from 2.67 to 3.04 and defects per one million opportunities for medication error decreased a 49%.

Conclusions: To implant an automated dispensing cabinet with Lean Six Sigma methodology helps create a safer environment for the inpatient, reducing medication errors in the steps of storage and preparation/administration, as well as improving the total process performance and sigma level.