Anales Del Sistema Sanitario De Navarra最新文献

Background: The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain).

Methods: Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre.

Results: A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March.

Conclusions: The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Background: Cardiovascular diseases (CVD) are a major cause of death worldwide and Hypercholesterolemia (HC) is an important cardiovascular risk factor. In Spain, approximately 25% of middle-aged adults suffer from HC. Our objective was to analyse current health strategies and plans in Spain related to CVD and HC in order to define possible future courses of action to bring about better control from a health management and policy perspective.

Methods: The study was observational and descriptive. In the first step, a literature review was carried out, followed by six semi structured interviews. In the second step, a group of 12 experts in the field identified existing barriers to HC control and suggested ways to reduce premature mortality due to CVD.

Results: A total of 51 documents were identified, of which 43% referred to HC. There was a high variability at the regional level in the implementation of measures and initiatives for the control of HC. Barriers that were identified were : trivialization of HC, lack of active participation by key stakeholders, lack of understanding of the impact of HC, existing care models and pathways, and short-term health policies that limit the provision of resources for HC care and control.

Conclusion: Despite the considerable medical and socioeconomic burden of CVD and HC in Spain, the importance of HC is not reflected in health policies. There is a lack of HC control measures, even when they are shown to be highly feasible and beneficial. This article proposes specific measures to improve control of this issue.

Refeeding syndrome is a serious and life-threatening complication associated with oral, enteral and parenteral nutritional therapy. It appears in severely malnourished patients or in those at risk of malnutrition, such as persons with cerebral palsy. We present the case of an 8-year-old girl with cerebral palsy who was admitted with severe hypoglycemia. After starting enteral nutrition by nasogastric tube, she developed refeeding syndrome. In children with cerebral palsy, it is essential to assess the presence of risk factors for refeeding syndrome before starting any nutritional support, and then start feeding progressively and monitor serum electrolytes.

Background: Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients.

Methods: An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchiolitis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data.

Results: Overall, 3.5% (IQR: 3.4-3.5%) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p<0.001) and increased by 65.7% from 1997 to 2018. A 41.2% of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p<0,001). In 89.1% of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8%, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7%; p

Conclusions: LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute towards the prevention and treatment of LRTIs need to be adopted.

Background: Cognitive stimulation programs in older adults seek cognitive and emotional improvements. The literature makes no reference to programs adapted according to cognitive and occupational levels in older adults with no cognitive impairment. The objective of this study was to analyze the effectiveness of level-adapted cognitive stimulation intervention in older adults in terms of cognition and mood.

Methods: Randomized clinical trial (CONSORT) at a health center, which included 201 participants =?65 years (101 intervention and 100 control) evaluated immediately after the intervention, then at six months and finally at one year. The assessment instruments were the cognitive mini-exam (CME), the abbreviated Goldberg anxiety scale and the Yesavage geriatric depression scale (GDS-15). The intervention was carried out through a cognitive stimulation program with two cognitive levels according to CME (high: 32-35; low: 28-31) with ten sessions of 45 minutes. Statistical analysis was performed by Student's t-test.

Results: The difference observed in the averages between control and intervention groups was statistically significant in the three assessments; these differences were observed regardless of gender, age, cognitive level, and mood. One year after the intervention, CME score reached an increase of 1.48 points in the in the high level group and 2.03 points in the low level. However, no significant differences in CME score were observed in any of the assessments for anxiety or depression.

Conclusion: A cognitive stimulation program, cognitive level-adapted, has shown cognitive benefits in older adults without cognitive impairment living in the community, regardless of sex, age and educational level.

The SARS-CoV-2 infection has become as a worldwide public health emergency. It exhibits a variety of clinical presentations, ranging from benign to acute respiratory distress syndrome, systemic involvement, and multiorganic failure. The severity of the clinical picture depends on host and virus biological features and the presence of comorbidities such as chronic kidney disease. In addition, the interaction between the virus, angiotensin-converting enzyme 2, and the exacerbated immune response could lead to the development of acute kidney injury. However, the implications of SARS-CoV-2 infection on renal cells, the prognosis of patients with chronic kidney disease, and the long-term behavior of renal function are not entirely understood. This review aims to explore the role of SARS-CoV-2 in acute and chronic kidney disease and the possible pathogenic mechanisms of renal involvement.