Revista Espanola De Salud Publica最新文献

Objective: In 2013, the Galician Health Service (SERGAS) adapted the Patient Health Notification and Learning System (SiNASP) to health centres. Due to its novelty, it is necessary to know the state of use of this tool and its determinants. The objective of this work was to describe the knowledge of health professionals in Primary Health Care and reception of the (SiNASP), in the health centres where has been implemented in the district of Ferrol (A Coruña).

Methods: Descriptive cross-sectional study. 76 care professionals were surveyed (<=0.05, d=±3,3%) in 3 primary health care centres in Ferrol. Questio-nnaires were delivered to the health professionals with the information document after obtaining permission from the ethics committee. Collection point as set up for their deposit in a sealed envelope.

Results: Health professionals know this Reporting and Learning System for Patient Safety (78.9%), and a small percentage of professionals claimed to have made any notification in the system (9.2%). Training is low (22.7% do some course); there is a high degree of interest in training courses (72%). More than half of professionals who do not use the Reporting and Learning System for Patient Safety do not know how to handle it (52.2%). In relation to the barriers that could prevent performing notifications, lack of time is the main point (51.5%). Health professionals believe that the system is a useful tool and the reporting of adverse events is important, regardless of the system used for it.

Conclusions: It is needed to expand the culture of safety and training to improve the detection and reporting of incidents, considering that, nowadays, there is underreporting and low perception of adverse events. In addition, the health care loads should be reviewed to determine whether the lack of time could stop the reporting of incidents.

Objective: E-parenting is an opportunity to provide parental support as a universal prevention strategy. This study analysed the extent to which the promotion actions improve universal use of the online course 'Positive parenting: Gaining health and wellbeing from birth to three' (GH&W) (http://aulaparentalidad-msssi.com/) at the primary care centers.

Methods: The profile of participants and the adherence to the course in a national sample of families using the GH&W course were compared with another Canarian sample distributed in three groups: only GH&W (level 1), GH&W + face-to-face group activities (level 2), and users who also received individual support in the medical checking (level 3). It was carried out in 20 health centers on the islands of Tenerife and Gran Canaria randomly assigned to one of the three levels. Participants were 175 national parental figures and 160 parental figures users of the Canary Health Service, both with children from 0 to 3 years. The sociodemographic profile and the completion rate of the GH&W were registered, as well as a template of implementation quality indicators for innovative experiences. To compare the sociodemographic profile differences between groups, a Chi-square contingency analysis with standardized residuals was performed.

Results: Compared to the national sample mainly of high educational level, primiparous mothers and 14% completion, the Canarian sample attracted different educational levels and multiparous mothers, with a higher completion rate at levels 2 and 3 (62.5% and 67.5%) than at level 1 (38.5%).

Conclusions: The universal use of the course and its adherence improve due to the inclusion of face-to-face activities. The implementation process in the selected health centers satisfactorily meets the quality indicators of an innovative initiative.

Objective: Having certain open data means that this data is accessible and available to everyone, without legal or technical restrictions. The public sector produces a wide variety of information (social, economic, health, statistical) that is attractive, complete and reliable, coming directly from official sources. The aim of this study was to show the open data related to COVID-19 published by the regions of Spain and the Ministry of Health, and compare these data.

Methods: Each of the open portals was accessed and an observation of the published data was made, analyzing since when they were published and their periodicity in the update. The Tim Berners-Lee tool was used to classify the degree of reuse of the data. Regarding the statistical treatment, a frequency analysis was carried out, to analyze which data are given in a greater number of times.

Results: 15 regions publish open data related to COVID-19, as well as the Ministry of Health. The contents shown in the open data portals varied from one autonomous community to another, but the regions provided data confirmed by PCR. The data collection start date and the updating of the data varied.

Conclusions: There is an enormous diversity among de regions in terms of the publication of COVID data, in relation to indicators, dates. It shows a great existence of data and in reusable format, but you have to go to many sources to obtain information of the epidemiological situation at a national level.

Objective: To assess the degree of compliance of the Comprehensive Health and Judicial Care Protocol for Victims of Sexual Assaults attended in Emergencies, and to compare the quality indicators of care with those obtained for the 2 years prior to its implementation.

Methods: Retrospective, comparative, cohort study of the 128 victims (124 women and 4 men), aged 4 to 62 years, treated in the Hospital Emergency Department, before and after the publication of the Protocol through the CIE-10 diagnostic code T74.2 Sexual assault and CIE-10 T76.2 Suspected sexual assault, between January 2018 and December 2020. The sample was divided into two groups, before (n=80) and after (n=48) the implementation of the protocol. A sub-analysis of 109 women older than 16 years attended in the Gynecological Emergencies has been performed.

Results: The implementation of the Protocol has led to a significant increase in the compliance with the main indicators, more evident in Gynecological Emergencies: HIV prophylaxis (43.4% vs 83.7%, respectively in the Pre and Post-protocol Groups), pregnancy prophylaxis (54.5% vs 81.4%), police intervention (48.5% vs 74.4%) and SIVIO form compliance (16.7% vs 46.5%). Attention time has not shown significant changes. The referral for psychological support has been increased by a very low percentage (0% vs 12.5%).

Conclusions: The implementation of the Protocol has led to an evident improvement in the quality of care in Emergencies, with a significant increase in key indicators. Care time in Emergencies should be reduced, and the SIVIO form compliance, as well as the referral for psychological support should be increased.

Background: In the debate on the determinants of social class variation in health, it has been suggested that social mobility and associated factors play an important role in this variation. Social mobility describes changes or stability between social class positions. The aim of this paper was to identify studies on the association between social mobility and health.

Methods: The databases consulted were MEDLINE/PubMed, Cochrane, SciELO, CRD. The keywords used (in English), through the MeSH methodology, were: Health (MajorTerm), Class mobility, Vertical mobility, Social position, Socioeconomic factors, Social class, Social conditions, Social environment, Poverty and Social marginalisation (MeSHTerm). The search period was from January 2010 to December 2019. The STROBE statement has been used to develop the checklist. Finally, the evaluation of the studies has been carried out by means of a qualitative systematic review.

Results: The search identified 1,092 potentially relevant studies. After analysis, 376 studies were retained and their full texts were reviewed in depth, resulting in a final set of 42 studies. Of these, 2 studies were identified on Class Mobility and Health; 5 studies were also identified on Poverty and Health, showing evidence of effect on Health by Social Mobility; 9 studies on Social Class and Health, showing effect of Social Mobility on Health and 8 studies showing effect of Social Position on Health.

Conclusions: Social mobility measures convey additional information to that of poverty indices. Using indices of social position and their impact on health inequalities could be empirically useful. More research is needed on this issue.

Objective: National hip fracture registries have been established in several countries and recent publications show that the care process has been audited inspecting the representativeness according to quality standards. The aim of this study was to analyse if the Spanish National Hip Fracture Registry (RNFC) represents the Spanish population aged 75 and older admitted for hip fractures, and to compare its results regarding the care process with the national average, according to the National Inpatient register (Minimum Basic Dataset, CMBD).

Methods: The 2017-2018 National Minimum Basic Dataset (Conjunto Mínimo Básico de Datos, CMBD) was used as reference. For analysis, we included 83,110 cases from the CMBD and 21,130 from the RNFC. Eight common variables of both registries were selected for comparison.

Results: No significant differences were observed in the patient-related common variables (age, sex, type of fracture and fracture side), but statistically significant differences were found in the variables describing the care process (proportion of patients operated, deceased, surgical procedures and postoperative length of stay).

Conclusions: The RNFC, designed as a convenience sample, is also representative of the population of patients aged 75 and older treated for hip fractures in Spain. However, there is a participation bias related to the professionals and the hospitals interested in voluntarily participating in a quality improvement program, which would explain the better results observed in the care process, compared to the national average as collected by the CMBD.

Objective: The Hospital Virgen de la Poveda, (Villa del Prado, Spain), assists patients in need of Continuous medical care, Rehabilitation or Palliative care; these patients have many risk-factors of COVID-19 morbility and mortality. With both healthcare humanization and contagion-prevention purposes, in July 2020 two patient visit protocols were implemented. The objective of this study is to describe these measures qualitatively and quantitatively.

Methods: A context is provided regarding COVID-19 measures in this institution. The content and follow-up indicators of visit protocols (number of visits, of outbreaks, inpatients, etc.) and of their context were provided. The empirical outbreak probabilities were calculated, and hypothesis contrast was performed against no-visits (0%) and no visit-control (7-day cumulative incidence/habitant).

Results: Two protocols were created. Accompanying was applied to Palliative Care cases (no appointments required, no time limits), and a short visits protocol was applied to the other patients (appointments for 1 weekly visit for 1-2 persons were given and visits last up to 45 minutes). In both protocols, visitors with symptoms or fever or particularly susceptible were forbidden entrance. Between July and April 2021, 4,759 short-visit appointments were given and 7,544 total visits took place (short visits, accompanying, exceptions). An outbreak was possibly attributed to short visits (probability=0.021% [CI95%: 0.0005-0.1171%]) and two outbreaks were possibly attributed to visits globally (probability=0.0265% [IC95%: 0.0032-0.0958%]).

Conclusions: Elaborating adapted, applicable and prospectively-evaluated protocols with prevention measures at multiple levels might succeed in minimizing the risk of adverse events (in this case, COVID-19 outbreaks).

Objective: Intravenous (IV) tocilizumab has been used to stop the inflammatory phase of SARS-CoV-2 infection. To preserve the largest number of IV units for this use, the Spanish Agency for Medicines and Health Products (AEMPS) carried out a controlled supply of it and recommended the change to a subcutaneous presentation (SC) of tocilizumab or sarilumab in all those patients in IV tocilizumab treatment for rheumatologic indications. The objective of this study was to evaluate the change from IV tocilizumab to SC presentation due to its controlled supply during the COVID-19 pandemic.

Methods: Retrospective observational study of adult patients (>18 years old) under treatment with IV tocilizumab follow-up by the Rheumatology Service of the Hospital 12 de Octubre. The follow-up period was 3 months (March 2020-June 2020) and 39 patients were included in the study. Variables related to the patients and their treatment were collected. A descriptive analysis of the data was carried out.

Results: In 69.23% (n=27) of the patients, treatment was changed to SC tocilizumab (n=23) or sarilumab (n=4). 44% of patients (n=12) switched back to their original IV tocilizumab treatment. The reasons for stopping treatment with SC tocilizumab were: drug intolerance (n=4), disease worsening (n=4), and patient preference (n=1). Regarding sarilumab, the reasons were drug intolerance (n=2) and patient preference (n=1).

Conclusions: Almost half of the patients had to return to the original treatment. The main reason was intolerance to the new treatment, followed by ineffectiveness and patient preferences.

Objective: Hand Hygiene (HH) is the most important measure to prevent healthcare-associated infections. The aim of this study was to determine the impact of the COVID-19 pandemic on the degree of compliance (DC) of HH in an Emergency Department (ED).

Methods: Cross-sectional study. DC of HH in the ED was calculated from 2005 to 2021. We studied the association between DC of HH and different variables (age, sex, status, ED area, time of WHO, etc.) by calculating the Odds Ratio (OR) and its 95% confidence interval (95%CI). To study the impact of the pandemic, we compared the C of HH before and after the onset of the COVID-19 pandemic, calculated the OR and its 95%CI.

Results: DC of HH increased to 75.9% (95%CI: 68.6%-83.2%) in the period after pandemic onset from the previous baseline period of 48.9% (95%CI: 43.4%-54.5%) (p<0.001). Factors significantly and independently associated with DC of HH were time period (before or after pandemic), attending training sessions, having alcohol solution in pocket format and WHO moments 3,4 and 5.

Conclusions: DC of HH in the ED has reached the highest value in 17 years of monitoring following the COVID-19 pandemic. This increase reflects a very positive change in the behavior of healthcare personnel with respect to HH.