Revista espanola de salud publica最新文献

Objective: Chronic kidney disease (CKD), characterized by progressive renal function loss, often necessitates replacement therapies to prevent mortality, with kidney transplantation being the most effective option. The COVID-19 pandemic profoundly affected healthcare systems, reducing transplant activities and lengthening waiting times. This study assesses differences in kidney transplant activity, waiting list durations, and renal replacement therapy usage during pre-pandemic and pandemic periods.

Methods: This observational study was conducted at Miguel Servet University Hospital in Zaragoza, analyzing 326 kidney transplants performed between 2017 and 2022. Two periods were defined: pre-pandemic (2017-2020) and pandemic (2020-2022). Data were sourced from hospital records, excluding living or combined donor transplants. Statistical analyses included Kaplan-Meier survival curves and Cox regression models.

Results: Median waiting list times increased from 3 months in the pre-pandemic period to 7.5 months during the pandemic (p=0.0014). Transplant density decreased from 5.02 to 4.21 cases per month. The proportion of donors in asystole rose significantly from 15.1% to 34.8%. Men over 61.9 years were the most impacted demographic.

Conclusions: The pandemic significantly extends waiting times and reduces kidney transplant activities, disproportionately affecting older male patients. These findings underscore the necessity of optimizing healthcare resources in future crises.

Objective: Three clinical conditions related to wheat consumption and associated with gluten are recognized: celiac disease; gluten sensitivity; wheat allergy. The World Health Organization defines food safety as a fundamental aspect of public health. Allergen management is an integral part of the food safety management system. The objective of this study was to understand the knowledge, attitudes, and practices of food handlers, administrative, and care staff involved in the production of gluten-free food in hospital settings for patients with disorders related to gluten consumption.

Methods: A qualitative case study was conducted using various ethnographic techniques, including observation, field diaries, document review, and semi-structured interviews. Additionally, a format was used to verify the Hazard Analysis and Critical Control Points (HACCP) plan, facilitating the triangulation of information from sources for analysis.

Results: While there was general awareness of the importance of food safety, limitations persisted in the continuous and specific training of the involved staff. This suggested that, without adequate and updated knowledge, allergen management practices may be insufficient, increasing the risk of cross-contact and compromising patient safety.

Conclusions: In the institutions evaluated, staff demonstrates a positive attitude toward allergen management. Nevertheless, it is essential to provide training in allergen handling and establish standardized protocols to guarantee food safety.

Objective: Smoking is a chronic addictive disease with high morbidity and mortality, and its consumption patterns vary by sex. Among its many associated pathologies, smoking is a leading cause of cardiovascular diseases and chronic obstructive pulmonary disease (COPD). It represents the principal Public Health issue in our country and a global epidemic. Its treatment encompasses the use of pharmacological therapies for nicotine dependence, cognitive-behavioural interventions, and fundamental Public Health measures aimed at promoting health and preventing initiation. Since 2023, cytisinicline has been available as a publicly funded active ingredient for smoking cessation. The objective of the present study is to evaluate the effectiveness of cytisinicline and explore the benefits of pulmonary function tests for the early detection of smoking-related pulmonary diseases.

Methods: A prospective observational study will be conducted with convenience sampling in primary care patients attempting to quit smoking with cytisinicline, involving continuous follow-up and interventions based on an integrated care pathway. Abstinence will be measured at three, six, and twelve months, alongside assessments of pharmacological adherence, the presence of adverse effects, and their relationship with sex and other personal and smoking-related factors.

Conclusions: This study provides an important opportunity to evaluate the effectiveness of cytisinicline for smoking cessation in real-world conditions, while addressing the underdiagnosis of COPD by optimising the use of spirometry in primary care.

Objective: Cognitive biases, such as anchoring bias, significantly influence clinical decisions and contribute to up to 75% of diagnostic errors. Anchoring bias affects both general practitioners and specialists, although its impact may vary depending on the clinician's experience and other factors. Biases are responsible for a substantial proportion of medical errors, highlighting the need to address them through interventions in training and clinical practice. The aim of this paper was to evaluate the impact of anchoring bias on diagnostic decision-making among general practitioners and specialists in the Spanish healthcare system.

Methods: An experimental cross-sectional study using simulated clinical vignettes was carried out. Participants were randomly assigned to one of two experimental groups to examine how initial information influenced the final diagnosis. A total of fifty four active physicians were included, selected through convenience sampling. No dropouts were reported during the study. Participants were exposed to clinical vignettes in which the patient either mentioned or did not mention a possible serious illness. They were asked to formulate a diagnosis and request relevant diagnostic tests. The independent variable was the type of clinical vignette (mention of serious illness vs no specific suggestion). Dependent variables included the diagnosis made and the tests ordered. Covariates included gender, specialization, and medical experience. Logistic regression models were used to analyze the results.

Results: The analysis revealed a significant relationship between the information provided and the final diagnosis (p<0.05), with a pseudo R-squared of 0.0825. Specialization showed a significant interaction with the independent variable (p=0.009), suggesting that specialists were more prone to anchoring bias than general practitioners. No moderating effect of gender or experience was found.

Conclusions: The findings highlight the importance of addressing cognitive biases -particularly anchoring bias- in medical training to improve diagnostic accuracy and reduce clinical errors.

The COVID-19 pandemic has catalyzed an increased focus on strategies to combat racism as a public health issue. However, this trend contrasts sharply with the stagnation in the response to these inequities in Europe, and in particular in Spain. This article offers a comprehensive diagnosis and proposes a roadmap to address racism as a social determinant of health in Spain. The paradigm in which the invisibilization of racism prevails manifests through the marginalization of racial stratification as a legitimate topic of discussion, the delegitimization of race as a valid analytical category, and the attribution of its effects to alternative variables such as social class or immigration status. In addition, it is noted that current initiatives tend to have significant limitations in both their approach and methodology. These initiatives often adopt an individual perspective to the detriment of a structural vision, and exhibit a culturalist bias that minimizes the importance of hierarchies of power. As a result, ethnicity is prioritized over race and interculturality over racial equity. The article concludes with a call to action, proposing a roadmap aimed at institutional actors to promote greater racial equity in the field of health in Spain. Key lines for the effective integration of racism as a critical component in public health analysis and the implementation of more equitable policies, are highlighted.

Currently, substance use and mental health problems are on the rise. Gender-integrated treatments for dual pathology exist, although no specific therapies have been found for major depressive disorder co-occurring with alcoholism in women. Women initiate alcohol consumption later than men but experience a faster escalation of addiction, although they seek help earlier. Among women, depressive disorder, somatomorphic disorder, bipolar disorder, dysthymia, post-traumatic stress disorder, and cluster C personality disorders are more prevalent. Alcohol is the primary substance consumed by women. Although ten gender-integrated models have been identified any models of this kind have been found for the treatment of dual depression. Sociocultural differences in the development of dual diagnosis between genders are influenced by changing gender roles in alcohol consumption and variations in the prevalence of specific disorders.

The use of benzodiazepines (BZD) in the geriatric population represents a significant public health concern due to their high prevalence and associated risks. We present the case of an eighty-five-year-old patient illustrating the consequences of polypharmacy and inappropriate prescribing, including the concurrent use of multiple BZDs. This case highlights the need to limit BZD use in older adults and to prioritize evidence-based deprescribing strategies. Robust evidence confirms that BZD use increases the risk of adverse events, compromising functional independence and quality of life in older adults. Strengthening healthcare professionals' training in rational and appropriate prescribing is essential.

Objective: The justification for the research was the economic approach to breast cancer in order to introduce improvements. The objectives were to know the final cost in each subgroup of women with non-metastatic breast cancer, to know the average cost per patient, to predict the cost and to identify groups with the greatest economic impact for health systems.

Methods: A retrospective descriptive study was carried out in 411 women, after systematic random sampling, diagnosed with non-metastatic breast cancer and undergoing surgery in Abente y Lago Hospital (A Coruña) during 2010-2013. The information was obtained from medical records and databases. For cost evaluation, rates for health services in the Galician Health Service were taken into account. Univariates and multivariates analysis were performed.

Results: The average cost of non-metastatic breast cancer in women was €23,752.16±€16,015.82 and varied according to ten care profiles based on therapeutic management (p<0.001 in six of the profiles in relation to non-adjuvant surgery; in one, p=0.004; in one, p=0.022; not demonstrable in one with p=0.132). In the profiles with immunotherapy (14.6%) the cost was €54,190.54; €55,238; €69,278.45 and €57,364.81.

Conclusions: In non-metastatic breast cancer, ten care profiles according to therapeutic management best approximate the cost. In addition to having the average cost, the cost per patient can be predicted with a mathematical formula that includes age, origin of screening, infiltrated nodes and care profile. The groups with anti-HER2 treatment have a greater economic impact.

Objective: Poliomyelitis and post-polio syndrome (PPS) continue to affect many people in Spain. Despite the eradication of the virus in much of the world, its sequelae persist and cause significant functional and social limitations. The lack of recent studies on the reality of this population makes it difficult to design appropriate interventions. This study aimed to investigate the current situation of individuals with polio and PPS, focusing on their functional, nutritional, psychological, emotional, and social status.

Methods: A descriptive cross-sectional study was conducted with a sample of eighty-seven individuals from various polio associations in Spain. Data were collected using self-administered questionnaires. Descriptive statistical analyses were applied to interpret the data.

Results: The results showed that the majority of participants (85.1%) exhibited some degree of dependence in daily activities and a high concern about the risk of falls, with 78.2% identified at risk of falling and 80.5% expressing high concern. Additionally, a significant risk of malnutrition was observed in 49.3% of the participants, along with a tendency toward overweight and obesity affecting 40.3%. Emotional issues such as anxiety (mean 7.26) and depression (mean 5.10), as well as sleep difficulties (mean insomnia score 25.77), were common among those affected. While social support was adequate for most, 31.7% perceived limited support.

Conclusions: The findings highlights the need for a multidisciplinary approach that integrates physical rehabilitation, psychological support, and nutrition programs to improve the well-being of individuals with polio and PPS in Spain.