Revista espanola de salud publica最新文献

Objective: Acute confusional syndrome (ACS) is one of the complications with the highest morbidity and mortality in hospitalization units, but it is a reversible situation if detected early, representing a clear challenge for nursing. The objectives of this study were to assess the interventions carried out by nurses for the identification and non-pharmacological preventive measures applied in acute confusional syndrome and relate them to the years of professional experience and training received.

Methods: A quasi-experimental, prospective and analytical study was carried out through a self-administered structured questionnaire pre-post intervention (extracted from the JBI PACES program-Practical Application of Clinical Evidence System) on the identification and preventive measures applied in ACS. A total of 520 questionnaires (pre and post assessment) were distributed to nurses from the emergency department and the internal medicine unit of the Miguel Servet University Hospital in Zaragoza (Aragón, Spain) from January 2021 to April 2022. Statistical analysis carried out with the program Jamovi®2.3.13.

Results: 180 correctly completed questionnaires (94 pre and 86 post) were received. For 100%, the ACS supposed an extra workload and significant differences were found between the ability to manage ACS with the years of professional experience (p≤0.028). 97.2% of the nurses applied non-pharmacological interventions.

Conclusions: Despite being perceived as an extra burden in daily work, nurses perform non-pharmacological prevention for the management of ACS. It is necessary to improve training to provide guidance strategies.

Objective: The availability in the literature of data related to perinatal variables in the Spanish population is very scarce. The aim of this study was to know the evolution of perinatal health indicators according to the risk groups of prematurity and birth weight, the proportion of multiple births, caesarean section and stillbirths.

Methods: We conducted a population-based cross-sectional study of births in eleven hospitals in Castilla y León (January 2015 to June 2020). There were 70,024 newborns from 68,769 deliveries. Jointpoint regression analysis was used to identify changes in trend over the years, and binomial logistic regression was used to adjust for the potential interaction of hospital type, sex, type of delivery and multiple births on the frequencies of prematurity and death.

Results: There was a 19.9% decrease in deliveries and a 42% decrease in multiple births, with no change in preterm (7.7%) and stillbirths (0.44%). The percentage of caesarean sections was 21.5% with a slight downward trend over time. Death (stillbirth) was associated with preterm multiple birth; especially with the male-male combination (p<0.05). Late preterm and early term newborns showed higher risk of death compared to term newborns: OR 7.7 (95%CI 5.6-10.7) and 2.4 (95%CI 1.6-3.6), respectively; as well as the low birth weight group (OR 17.6; 95%CI 13.9-22.2) and small for gestational age (OR 3.4; 95%CI 1.9-5.8), compared to those of adequate weight.

Conclusions: Prior to the development of the COVID-19 pandemic there is a decline in births, including multiple births, with no change in stillbirths or prematurity. Late preterm and early term newborns are at increased risk of intrauterine death.

Objective: Diabetic ketoacidosis (DKA) is a serious complication that usually occurs at diagnosis of type 1 diabetes mellitus (T1D). However, the prevalence of DKA at diagnosis of T1D is heterogeneous in different regions of the world. The aim of this study was to determine the prevalence of DKA at diagnosis of T1D in Asturias.

Methods: This study included all patients under nineteen years of age diagnosed with T1D in Asturias between 2011 and 2020. Retrospective review of medical records was performed to analyse DKA and other characteristics at diagnosis. A log binary regression model was constructed to obtain an estimate of the prevalence ratio of DKA to diagnosis in the years studied.

Results: A total of 267 people were diagnosed with a mean age of 9.85±4.46 years. The prevalence of DKA at diagnosis during this period was 38.63%. There was an increasing trend, with a prevalence ratio over the years studied of 1.015 (95%CI: 0.96-1.07; p=0.61). Duration of symptoms before diagnosis was 4.57±7.64 weeks. Weight loss was 7.56±7.26%, being more than 10% of previous weight in almost half of the patients who loosed weight. There was a positive relationship between symptoms duration and prevalence of DKA and between time to diagnosis and weight loss.

Conclusions: Asturias has a high prevalence of DKA at diagnosis of T1D, slightly higher than observed in other studies at national level and higher than in other similar countries, with a tendency to increase. Delayed diagnosis is a key factor in the prevalence of DKA and weight loss. Thus, health actions are needed for the early detection of T1D to avoid DKA at diagnosis.

Objective: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since the onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country.

Methods: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student's t- test were used to compare epidemiological and demographic variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020).

Results: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions).

Conclusions: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution of the disease are not uniform. It starts in the center of Spain and ends on the coast.

Objective: Sentinel surveillance is used to monitor health problems. The COVID detection strategy conducts universal surveillance of SARS-CoV-2 infection, which can be monitored by sentinel systems, through surveillance of mild acute respiratory infection (IRA) or severe respiratory infection (IRAG). The objective of this study was to compare incidence data obtained through sentinel surveillance against versus universal surveillance in acute respiratory infections.

Methods: A descriptive study of the incidences (cases/100,000 inhabitants) of acute respiratory infection (sudden onset of cough, sore throat, dyspnea or runny nose and clinical judgment of infection) was carried out in the entire population of La Rioja recorded in the primary care medical record, and in a sentinel cohort, by age and sex during the period from weeks 40-2021 to 06-2022. For SARI, the total number of hospitalized cases per 100,000 inhabitants with onset of symptoms in the previous ten days was calculated, as well as the incidence in a systematic selection of all SARI hospitalized one day a week. Weekly incidence rates were calculated in each cohort from week forty of 2021 to week six of 2022 by sex and age group. The characteristics of the population were expressed in their distribution by number and percentage.

Results: The data observed for ARI were similar in both systems by sex and age, except for the zero to four-year-old group and the group over seventy-nine years of age, where differences were observed, with the highest ARI figures in the first age group in sentinel surveillance, while in the older group they were superior in universal surveillance. SARIs showed a similar incidence, except in the fifteen/fourty-four age groups, which was higher in universal surveillance than in sentinel surveillance.

Conclusions: There are no significant differences. Sentinel surveillance allows optimization of resources, being the most efficient methods for surveillance of high-incidence diseases.

Objective: There are controversies regarding the effect of the influenza vaccine on the risk of suffering from COVID-19. The aim of this paper was to compare the risk of suffering from COVID-19 between vaccinated and unvaccinated patients against influenza.

Methods: A retrospective case-control study of patients assigned to an urban CAP (coverage: 44,564 inhabitants) was carried out during 2020. Patients with diagnostic confirmation of COVID-19 (ART, PCR or serology) were defined as cases, and those who have not had said infection, selected by simple random sampling, were defined as controls. The case/control ratio was 1:1. The data sources used were the Khalix health data registry databases and the computerized medical record (E-cap). Data were analyzed with a multivariable logistic regression model.

Results: A total of 4,320 patients were included in the study: 2,160 cases (50%) and 2,160 controls. 18% of the cases and 14.3% of the controls were vaccinated against influenza [OR=1.3 (95% CI: 1.2-1.5; p=0.001)]. Multivariate analysis showed that in patients under eighty years of age, there were no differences between vaccinated and unvaccinated patients [OR=1.02 (95% CI: 0.8-1.3; p=0.8)]; while in those over eighty years of age, there was a lower risk of presenting COVID-19 in vaccinated patients [OR=0.4 (95% CI: 0.3-0.7; p<0.001)].

Conclusions: The adjusted model shows that at ages above than 80 years, flu-vaccinated patients have decreased risk of COVID-19 with statistical significance.

Objective: Alzheimer's disease has become the great epidemic of the 21st century, being a challenge for the sustainability of the social and health system. Alzheimer's causes disability and dependency among the elderly, requiring continued care with therapies that improve the health and quality of life of these people. The objective of this paper was to evaluate the effectiveness of non-pharmacological therapies applied to people with Alzheimer's in Primary Care.

Methods: A systematic review of articles published between April 2017 and April 2022 was carried out, applying the PRISMA methodology. The databases consulted were: PubMed, CINAHL, Dialnet, Web of Science and PsycINFO. MeSH and DeSH were used, with the Boolean operators AND and OR. The quality of the articles was evaluated with the STROBE, COCHRANE, AMSTAR-2 and JBI scales.

Results: A total of nineteen articles were selected in which various non-pharmacological therapies and their effectiveness in people with Alzheimer's were evaluated. Therapies based on physical activity and rehabilitation, cognitive stimulation and occupational therapy with music, animals and art, applied and maintained over time, are an alternative which, either combined or applied in isolation, are effective in preventing, stopping and slowing down Alzheimer's disease symptoms, especially in the first phase.

Conclusions: Physical activity and rehabilitation, cognitive stimulation and therapy with music, animals and art, improve the health status and quality of life of patients with Alzheimer's disease in the first phase of the disease.

Objective: Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood, let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different impact on patients with and without diagnosis of COVID-19.

Methods: A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional, mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence (100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX proportional hazards models.

Results: Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%), respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and 2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04).

Conclusions: The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.

Objective: There is increasing evidence of deterioration in the mental health of the population, especially among women and adolescents. We aimed to analyze gender inequalities in the consumption of anxiolytics and hypnosedatives (AHS) among adolescents in Spain in 2021 and its time trend, from an intersectional approach.

Methods: We conducted a cross-sectional study of time trends based on the ESTUDES national survey (n=22,321), comprising students between the ages of fourteen and eighteen. We calculated prevalences, prevalence ratios (PR) and interaction terms for consumption (both ever and in the last year), based on robust variance Poisson models, by sex, age, place of origin and parents' educational level. We also examine trends in consumption between 2010 and 2021.

Results: Female students showed higher consumption in all categories of the studied variables, together with a higher probability of use (PR_vital=1.56 [1.47-1.64] and PR_annual=1.81 [1.69-1.94]). Likewise, consumption increased with age, more pronounced in the case of male students (18 years old: PR_vital=1,93 1,62-2,28]). Place of origin showed no statistically significant differences in AHS consumption. Lower educational level of parents predicts higher consumption among daughters, with mothers´ educational level showing a stronger association. Consumption increased over the 11-year period, and was consistently higher among women.

Conclusions: We observe inequalities by gender and parents' educational level in AHS use among adolescents in Spain. It is critical to apply the model of the social determinants of health, which will lead to effective interventions in public health.

This document summarises the evidence regarding the association between adverse pregnancy outcomes (APOs), such as hypertensive disorders, preterm birth, gestational diabetes, fetal growth defects (small for gestational age and/or fetal growth restriction), placental abruption, fetal loss, and the risk that a pregnant individual in developing vascular risk factors (VR) that may lead to future vascular disease (VD): coronary heart disease, stroke, peripheral vascular disease, and heart failure. Furthermore, this document emphasises the importance of recognising APOs when assessing VR in women. A history of APOs serves as a sufficient indicator for primary prevention of VD. In fact, adopting a healthy diet and increasing physical activity among women with APOs, starting during pregnancy and/or postpartum, and maintaining it throughout life are significant interventions that can reduce VR. On the other hand, breastfeeding can also reduce the future VR of women, including a lower risk of mortality. Future studies evaluating the use of aspirin, statins, and metformin, among others, in women with a history of APOs could strengthen recommendations regarding pharmacotherapy for primary prevention of VD in these patients. Various healthcare system options exist to improve the transition of care for women with APOs between different healthcare professionals and implement long-term VR reduction strategies. One potential process could involve incorporating the fourth-trimester concept into clinical recommendations and healthcare policies.