Anales del sistema sanitario de Navarra最新文献

Background: The aim of this study was to examine the psychometric properties of the Observational Gait Scale for Individuals with Lower Limb Amputation, including intra- and inter-rater reliability, minimal detectable change, and construct validity.

Methods: An observational study was conducted in individuals with unilateral lower limb amputation. Gait was recorded under standardized conditions and independently assessed by two trained evaluators using the Observational Gait Scale for Individuals with Lower Limb Amputation, which comprised two sections: 1 - assessment of kinematic gait patterns focused on joint mobility, and 2 - assessment of spatiotemporal parameters. Intraclass correlation coefficient, Bland-Altman plots and Pearson's correlation with the Houghton Scale were used.

Results: Thirty-seven participants were included, 56.8% women and mean age 45.6 years (SD=13.8). Intra-rater reliability was excellent for the total score (ICC = 0.996), section 1 (ICC = 0.988), and section 2 (ICC = 0.995) with an MDC95 of 0.12 points. Inter-rater reliability was also excellent (total ICC = 0.987; section 1 = 0.966; section 2 = 0.986), with an MDC95 of 0.36 points. Bland-Altman analysis showed narrow limits of agreement (±1.4 points intra-rater and ±2.28 points inter-rater). Construct validity was strong and statistically significant (r= -0.773; p <0.001).

Conclusions: The Observational Gait Scale for Persons with Lower Limb Amputation is a reliable and valid tool for assessing an objective and structured evaluation of gait patterns in individuals with unilateral lower limb amputation. Its design, excellent reliability and strong construct validity support its use in both clinical practice and research.

Background: The International Agency for Research on Cancer classifies night shift work as Group 2A, a probable human carcinogen. This study updates the evidence on the association between night shift work and the risk of breast and prostate cancer.

Methods: Searches were conducted in PubMed and Web of Science. Case-control and cohort studies were included if they assessed night work as a risk factor for breast or prostate cancer, had =100 participants, provided full text in English or Spanish, scored =6 on the Newcastle-Ottawa Scale, and reported relative risks or odds ratio with 95% confidence interval. Heterogeneity and study quality were evaluated. Data synthesis followed PRISMA guidelines.

Results: Twenty-one studies including 586,890 participants were analysed. For breast cancer, significant association were found only in cohort studies, both overall (RR=0.82; 95%CI: 0.67-0.99; I2=91%) and for <10 years of night work (RR=0.75; 95% CI: 0.68-0.82; I2=0%). Average study quality was acceptable (score 7), although heterogeneity was substantial. For prostate cancer, case-control studies reported an OR of 1.14 (95%CI; 1.02-1.27; I2=25%). For exposures =10 years, both RR (2.20; 95%CI: 1.35-3.59) and OR (1.16; 95%CI: 1.03-1.30) were significant. Overall quality was moderate (score 6) with low heterogeneity (25%).

Conclusions: Weak associations between night shift work and prostate cancer are observed in case-control studies and among individuals with =10 years of exposure, but no consistent association was found for breast cancer. These findings remain inconclusive and highlight the need for further research.

Background: This study aims to evaluate hand hygiene performance among nursing students and to explore their reflections following an innovative educational intervention.

Methodology: A simulation-based study was conducted with undergraduate nursing students using a mixed-methods design: a quantitative cross-sectional component to evaluate the effectiveness of the intervention and a qualitative exploratory component using reflective writing. Hand hygiene was performed with a hydroalcoholic solution containing ionizing agent that fluoresce under ultraviolet light. A portable ultraviolet device was used to visualize clean and missed areas. The time spent and the percentage of clean surface area were recorded. After reviewing the initial results, the handwashing procedure was repeated, and both time and clean surface area were compared. Participants then answered open-ended written questions about their experience.

Results: Thirty students participated in the quantitative component and sixty in the qualitative component. The most difficult areas to clean were the fingertips, palms, and thumbs. The second handwashing attempt was 2.6 seconds longer (p=0.012), increased the median clean surface area by 9% (p=0.006), and raised the proportion of students achieving =70% cleanliness from 36.7% to 66.7%. Students reported notable benefits, including heightened awareness of personal errors, visual learning, and reinforced understanding of proper technique.

Conclusions: This visual and hands-on educational strategy effectively increases student awareness of key aspects of hand hygiene and may contribute to reducing iatrogenic nosocomial infections.

A 57-year-old male smoker underwent endobronchial ultrasound-guided fine-needle aspiration due to increased radiotracer uptake on positron emission tomography. The cytopathologist prepared in situ smears for immediate (Diff-Quick) and definitive (Papanicolaou) evaluation. Solid tissue fragments and blood clots were used to create a cell block processed as a biopsy. Cytological analysis revealed histiocytic cells with clefted nuclei expressing CD68, CD1a, Langerin, and S100, along with a numerous eosinophils, establishing the diagnosis of Langerhans cell histiocytosis. Accurate cytological identification of this entity in mediastinal lymph nodes remains a significant diagnostic challenge. This case underscores the importance of the cytopathologist´s active involvement in sample handling during the procedure to optimize material performance, enabling the use of ancillary techniques required for a comprehensive diagnosis, avoiding more aggressive diagnostic approaches.

Background: Mild Cognitive Impairment (MCI) involves both subjective and objective cognitive decline with relatively preserved daily functioning, whereas Subjective Cognitive Impairment (SCI) refers to perceived decline without measurable deficits. This study aimed to compare the effects of a personalized computerized cognitive stimulation (CS) program (IG1) and a stimulating leisure activities program (IG2) in adults with MCI and SCI.

Methods: A single-blind randomized controlled trial was conducted in primary care with participants aged =50 years with SCI or MCI. Participants were randomized to IG1, IG2), or a control group (CG). IG1 completed personalized computerized CS for 30 minutes/day, 5 days/week, for 8 weeks. IG2 engaged in 2-5 stimulating leisure activities per week for the same period. The primary outcome was global cognition; secondary outcomes included memory, verbal fluency, daily functioning, and mood.

Results: Fifty-nine participants were enrolled in the study, 44 with SCI and 15 with MCI. Compared to CG, IG1 showed greater reductions in anxiety post-intervention (2.07; 95%CI: 0.93-3.22 vs. 4.34; 95%CI: 3.22-5.46) and lower depressive symptoms at 6-month follow-up (3.41; 95%CI: 2.05-4.77 vs. 5.62; 95%CI: 4.26-6.97). IG2 participants demonstrated improved global cognition post-intervention (29.2; 95%CI: 27.625-30.776) and at 6 months (28.78; 95%CI: 27.16-30.42) relative to CG (30.626; 95%CI: 28.99-32.27).

Conclusion: Personalized computerized CS reduces anxiety and depression symptoms, while stimulating leisure activities enhances global cognition in community-dwelling adults with SCI and MCI, suggesting complementary benefits of both interventions.

Vibrio cholerae is a gram-negative rod commonly found in marine environments. Serogroups O1 and O139 are associated with serious enteric disease, whereas non-O1/non-O139 serogroups are responsible for mild gastroenteritis, as well as bacteremia and infections of wounds, the ear, and other sites. We report a rare case of otitis media caused by non-O1/non-O139 Vibrio cholerae in a female patient without any history of travel to endemic areas, who showed favorable progress with topical treatment. This case, occurring without clear aquatic exposition and outside endemic regions, supports the presumption that chronic otitis caused by V. cholerae may be underdiagnosed and increasing in frequency, It highlights the importance of obtaining cultures and guiding treatment based on antibiotic susceptibility in cases of slow-onset otitis.

Background: Nurses play a crucial role in providing family support to families of hospitalized patients, particularly in the context of chronic diseases. To enhance the quality of care validated tools are needed to assess perceived family support. The Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) measures families´ perceptions of support provided by nurses; however, no culturally adapted Spanish version exists. The objectives of the study are: i) to develop a version of the ICE-FPSQ suitable for nurses; and ii) to translate and adapt both instruments conceptually and linguistically to the Spanish context.

Methodology: The study followed four phases: I) adaptation of the ICE-FPSQ for nurses; II) translation, back-translation, and linguistic adaptation of both scales; III) content validation by an expert panel; and IV) a pilot study with cognitive interview techniques to assess the applicability and comprehension.

Results: Translated and adapted versions were obtained: one for family members and another for nurses. In terms of relevance, content validity was excellent for both instruments (S-CVI/AVE = 1). In terms of clarity, the family version achieved a content validity index of 0.77, while the nurses´ version reached 0.88. Pilot study participants highlighted the clarity of the items and the speed of completion.

Conclusions: Two culturally adapted tools for the Spanish context have been developed, demonstrating adequate clarity and relevance for assessing perceived support from both family and nurse perspectives. These findings indicate that both instruments are suitable for their future psychometric validation in Spain.

Cervicobrachialgia is a common reason for consultation among women in the fourth and fifth decades of life. However, the diagnostic approach is often incomplete, leading to delays in both diagnosis and treatment. We report the case of a 44-year-old woman presenting with left craniocervical pain of several years´ duration, radiating to the left arm and the pectoral and dorsal regions, accompanied by paresthesia. Physical examination revealed findings compatible with Eagle's syndrome (tonsillar fossa) and thoracic outlet syndrome (TOS) (positive Adson, Wright, and Roos tests). Assessment using the ankle-brachial index demonstrated vascular involvement, suggesting a potential new diagnostic approach for TOS. Cranial radiographs showed hyperdevelopment of both mastoid processes, while orthopantomography demonstrated elongation (>5 cm) of the left styloid process, which was confirmed by computed tomography that also revealed a duplicated C3 rib with supraclavicular course, confirming the coexistence of Eagle's syndrome and TOS - an uncommon association in clinical practice.

Background: This study aimed to examine sex differences and the influence of social determinants of health on the uptake of colorectal screening in Spain from 2009 to 2023.

Methods: A cross-sectional analysis was conducted using data from the European Health Interview Survey in Spain (2009, 2014, 2020) and the Spanish Health Survey 2023. The frequency of faecal occult blood test use among individuals aged 50 to 69 was analysed by autonomous community and by variables related to social determinants of health using Chi-square tests. Temporal trends were assessed through joinpoint regression.

Results: Overall, faecal occult blood test uptake increased during the study period, with significant variation across autonomous communities (p<0.005). In 2023, some communities with longer-standing screening programs showed a decline in participation. A joinpoint was identified in 2014, with the annual percentage change decreasing from 33.6% to 10.0% (p<0.005). Higher test utilization was associated with the presence of a screening program, male sex, older age, higher education and income levels, cohabitation, healthy lifestyle behaviours, poorer health status, and urban residence.

Conclusions: The COVID-19 pandemic may have substantially affected screening participation. If the observed annual percentage of change is maintained, participation targets may be reached by the end of this decade. Further analyses incorporating an intersectional gender perspective are essential to understand and address the observed differences in participation between women and men.