Revista espanola de salud publica最新文献

Objective: The aim of this paper was to estimate the prevalence of vitamin D deficiency in our healthcare area to implement strategies aimed at reducing its frequency.

Methods: A descriptive prospective study was conducted, including 701 pregnant women who were managed in the healthcare area of Sagunto. 25-hydroxyvitamin D levels in blood were determined during the first trimester of pregnancy, and women with suboptimal vitamin D levels were treated. Demographic characteristics of participating women were analyzed to identify factors associated with vitamin D deficiency. A descriptive statistical analysis was performed for all the variables.

Results: Mean vitamin D levels in the overall population were 19.6 ng/ml. Of them, 52.5% had levels <20 ng/ml, requiring oral vitamin D supplementation, while 97% of women of African origin had suboptimal levels. Pregnant women with obesity or overweight and those aged <25 years old (62% and 71%, respectively) showed inadequate levels of vitamin D to a greater extent than women without overweight or ≥25 years old. Samples collected in winter and spring had lower levels of vitamin D compared to those from other seasons.

Conclusions: In our study, we observe high rates of vitamin D deficiency in the first trimester of pregnancy, with suboptimal levels in four out of ten women. Additionally, we identify different factors associated with vitamin D levels, which shows risk groups of deficiency.

Objective: The Intercentre Clinical Management Unit (UGCI) of the Regional and Virgen de la Victoria University Hospitals in Malaga, in collaboration with the Biomedical Research Institute of Malaga (IBIMA Bionand) and the University of Malaga (UMA), has developed its own system of records that allows the procedure to be carried out in a simple and intuitive way, by means of a user-friendly interface that includes the basic needs according to Virginia Henderson, and a series of assessment tests (Pfeiffer, Braden, etc.) with drop-down menus and one-click answers, which facilitates the work of nursing assessment and provides data for subsequent monitoring of patients, both in the nursing office and in the emergency room or in the Day Hospital.

Methods: The programming methodology followed has been an iterative development, which focuses on the repetition of phases where in each iteration a functional version of the same is obtained, which allows each version to be improved, using the programming language C#. This process has been carried out with the information provided by the nursing team of the CMU.

Results: An adaptive, user-friendly system compatible with the medical section of Galen® has been developed. From the launch of the programme to the submission of this manuscript, 471 first assessments have been carried out. The most common Nursing Diagnosis was Poor knowledge (00126).

Conclusions: The progressive implementation of this registry system will allow better care for oncology patients, improving waiting times and delays in appointments, as well as the quality of care, by having a computerised database that will allow us both to know our patients better and to plan and implement improvement strategies based on the advanced study of these data.

Objective: In Spain, several studies describe the population with cystic fibrosis (CF) and analyze mortality trends, but few determine factors that influence survival. The objective of this study was to analyze survival in people with CF included in a population-based registry of rare diseases and determine factors that influence it.

Methods: An observational study was carried out in people with a confirmed diagnosis of CF until December 31, 2018 registered in the Rare Diseases Information System of the Region of Murcia (SIERrm). The Kaplan-Meier method and the log-rank test were used to estimate and compare survival curves, and the Cox proportional hazards model was used to calculate survival predictors.

Results: Of 192 patients registered in SIERrm on the date of the study, 39 died, with the median age of survival being 26 years. The high-risk genotype (HR: 5.8 [95%CI: 1.97-16.94]), pancreatic insufficiency (HR: 5.4 [95%CI: 1.24-23.48]), colonization chronic by Pseudomonas aeruginosa (HR: 6.8 [95%CI: 1.21-38.54]), CF-related liver disease (HR: 5.0 (95%CI: 1.61-15.61]), and bone abnormalities (HR: 6.4 [95%CI: 1.91-21.61]) were associated with decreased survival (p<0.05). Adjusting the model for genotype, the association with high-risk genotype, CF-related liver disease, and bone changes remained (p<0.05).

Conclusions: Population registries are useful to identify patients at risk of serious disease due to their genetic and clinical characteristics, who may benefit from specific treatments and health resources that influence factors that reduce survival.

Objective: Therapeutic exercise (TE) is a fundamental component of preventive treatment for chronic primary headaches, as outlined in clinical practice guidelines. Its implementation requires human, structural, and material resources. Currently, headache units and monographic consultations (HUM) are multidisciplinary teams focused on managing chronic headaches, high-frequency episodic headaches, and the most complex cases. The aim of this paper was to assess the status of TE recommendations in HUM, identifying modalities, resources, adherence, barriers, facilitators, and opportunities for improvement in its implementation.

Methods: Qualitative data were collected through semi-structured interviews with twenty-seven healthcare professionals from ten HUM in Catalonia (Spain) between March and November 2024, using chain sampling. Data were analyzed through inductive thematic analysis.

Results: All participants (100%) recommended TE, highlighting moderate-intensity aerobic exercise as the preferred modality, particularly for chronic migraine. Currently, implementation is limited to verbal recommendations and informational leaflets. The main barriers identified were headache frequency, painful comorbidities, and a lack of tailored programs. Facilitators included prior positive exercise experience and professional supervision, highlighting the role of physiotherapist in this field.

Conclusions: TE is considered essential in headache management; however, there are significant shortcomings in resources for its implementation and monitoring. Incorporating physiotherapists and technological support could enhance the application of these recommendations.

Objective: The implementation of the Cervical Cancer Population Screening Programme involves sending an invitation letter and a leaflet to the target population. The objective of this paper was to evaluate the readability, comprehensibility and acceptability of the letter and leaflet of the Cervical Cancer Population Screening Programme in Asturias.

Methods: A mixed methods study was conducted in fifty-four women living in Asturias between 2021-2022. The INFLESZ 1.0 was used to measure readability and the Cloze test combined with multiple-choice questions was used to assess comprehension. Semi-structured interviews and focus groups were used to evaluate acceptability and understanding.

Results: The leaflet presented normal readability. The general comprehension of the materials (letter and leaflet) was good, however, some terms such as screening were deemed confusing. The leaflet was perceived as interesting, very detailed and comprehensive. The main themes were: 1) the process of reporting on the program and its outcomes; 2) women's knowledge of screening programs and human papillomavirus were improvable; 3) the letter and leaflet were understandable; 4) what the format of the letter and leaflet should look like; and 5) factors related to participation in the programme.

Conclusions: The target population's assessment of the letter and the leaflet is positive, and no problems of legibility, comprehension or acceptance were detected. However, it is important to review some terms that can generate confusion. The population perceived that the information received from the screening programs is highly valuable.

In an increasingly aging population, patients increasingly require palliative end-of-life care, given the increase in chronic and advanced organ diseases. Therefore, advance planning of the care they receive is essential, allowing patients, based on their principles and experiences, to freely and autonomously decide their preferences. The advantages of implementing this process include respecting patient autonomy; strengthening the relationship between doctor and patient; alleviating the burden that may fall on the family in decision-making at the end of their lives; improving satisfaction with the care received; avoiding excessive or invasive treatments with dubious benefits, or hospitalizations against the patient's wishes.

A classification model of group and community activities carried out from Primary Care and used in the Community Health Strategy of the Valencian Community is developed. The model is framed within three levels of community orientation, based on the prior conceptualization of what a community activity is according to the axes of temporality, intersectorality, and participation, and it is represented by a staircase. At the first step, individual care with a community orientation is located; the second step is subdivided: sublevel 2- (represents punctual group action); sublevel 2 (where the action has continuity and is considered group health education with an equity approach and social determinants of health); and sublevel 2+ (where intersectorality and engagement community are also incorporated). At the third step is where community action is situated. The model includes recommendations on how to progress from each level.

Objective: Cancer is one of the main causes of death in Spain. However, data on cancer mortality in the young adult population are scarce. The aim of this study was to analyze the development of cancer mortality among adults aged 20-49 between 1999-2022 in Spain, according to sex, age, region and tumor group.

Methods: Cancer deaths (ICD-10: C00-C97) from the mortality registry of the National Institute of Statistics, among population aged 20-49 between 1999-2022 were selected. Crude and age-adjusted rates were calculated. Temporal trends were analyzed using joinpoint models.

Results: The age-adjusted cancer mortality rate (AACMR) decreased significantly in both sexes, with a further descrease in men (from 47 to 17.7 deaths per 100,000) than in women (from 34 to 20.8 per 100,000). The decrease was greater in the group aged 40-49 years-old. Among men, no turning point was observed (annual percentage change [APC]: -4.4%), whereas in women a change in trend was observed in 2003 (APC: -1.1% to -2.4%). Statistically significant differences by region were observed in first five-year period (1999-2003), with higher AACMR in northern Spain, diminishing these differences in last five-year period (2018-2022). The tumors with larger decrease of AACMR were those of oral cavity and pharynx in men (-72.8%) and those of ill-defined sites in women (-56.8%).

Conclusions: Cancer mortality in population aged 20-49 decreased in Spain between 1999-2022 with differences according to sex, age, region and tumor group. The most notable decrease occurred in men and in the group aged 40-49.

The history of poliomyelitis (polio) vaccination is both complex and fascinating. This article focuses on two distinct, but related, aspects of this history: the discovery and development of the original polio vaccines in the U.S. and the development of the first polio vaccination campaigns in Spain. The epidemiological situation in both countries and the development of vaccines carried out in the United States are analyzed: Jonas Salk's IPV vaccine and Albert Sabin's OPV vaccine. The Spanish response to the possibility of implementing vaccination was slower and late. For different reasons, the health authorities were not aware or did not want to be aware of the epidemiological reality: polio reached its period of highest incidence and mortality in Spain between 1950 and 1963. The IPV vaccine was available in Spain since October 1957 and in 1958, the General Directorate of Health (Dirección General de Sanidad) began a vaccination program with IPV vaccine. In 1963, in the absence of a single campaign, due to conflicts of competence, two simultaneous mass immunization campaigns against polio were organized and developed: a campaign led by the Compulsory Health Insurance (Seguro Obligatorio de Enfermedad), which used the Salk injectable vaccine (IPV), and another campaign by the General Directorate of Health, which used the Sabin oral vaccine (OPV). Heading these two campaigns, it is worth highlighting two people, Juan Bosch Marín and Florencio Pérez Gallardo, protagonists of a scientific confrontation regarding the benefits and usefulness of each of the two vaccines available at the time. The fight against polio encompasses decades of commitment by hundreds of thousands of people to immunization, surveillance, financing, and many other activities around the world. Despite the health gains made through efforts to eradicate polio, which have involved the elimination of wild polioviruses from all but one WHO region, and the global eradication of two of the three wild poliovirus serotypes, we cannot and should not underestimate the challenges that still lie ahead. The goal of eradicating polio is now set for 2026.

Objective: Current international institutional promotion of breastfeeding (WHO-UNICEF) incorporates cultural and social elements that shape experiences related to caregiving and parenting practices for infants in their first months of life. The aim of this paper was the analysis of the theoretical framework underpinning current breastfeeding promotion efforts, and given that global breastfeeding rates do not reach 50 percent of infants breastfed up to six months, as well as to identify new theoretical premises from a gender perspective. This analysis will focus on uncovering gender biases and the role assigned to male partners in current institutional advertising aimed at promoting breastfeeding.

Methods: The research was conducted in Granada (Spain) in 2023, using a qualitative analysis approach (Strauss-Corbin Grounded Theory). Seventy promotional materials related to breastfeeding, located in healthcare settings, were analyzed.

Results: Gender biases were confirmed through a gender-focused qualitative analysis of institutional materials intended to promote breastfeeding. These biases were grouped into six conceptual categories.

Conclusions: Current institutional health promotion of breastfeeding contains numerous explicit and implicit gender biases. The fundamental theoretical finding (substantial category) is developed through six key propositions that give rise to novel theoretical categories (such as the co-responsibility of breastfeeding environments), which become determining factors in future promotional theoretical frameworks. As an alternative, a Comprehensive Human Latation Model is proposed.