Relación entre el estado nutricional y el riesgo de presentar úlceras por presión en pacientes incluidos en el programa de atención domiciliaria

ObjectiveThe objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence, underlying diseases and the nutritional status.ScopePatients in home care program in Primary Health Care.Patients100 home care patients.Main variablesage, sex, caregiver, illness, BMI, haemoglobin, haematocrit, lymphocyte count, albumin, cholesterol, Barthel index, Pfeiffer, nutritional assessment (MNA) and Braden scale.ResultsFourteen percent of the ATDOM patients had malnutrition and 46% a high risk of malnutrition. The degree of dependency, and the level of cognitive impairment increased (P < 001) the risk of pressure ulcers. Furthermore, the nutritional status affected the risk of pressure ulcers (P < 001) with OR 3.73 higher in malnourished patients. Values of 3.76 ± 0.05 g/dL albumin and cholesterol of 176.43 ± 6.38 were associated with an increased risk of ulceration. There was a significant relationship between nutritional status (P < 01) and the degree of dependence. In malnourished patients albumin levels decreased to 3.46 ± 0.098, with averages of 11.41 ± 154.95 mg/dL cholesterol. Finally, a lower BMI was significantly related to malnutrition.ConclusionsThe present study demonstrates that 14 % of the ATDOM patients showed malnutrition, and 46 % a high risk of malnutrition. Malnutrition, the degree of physical dependence and severity of cognitive impairment is associated with an increased risk of ulceration, which justify the need for carrying out some personalised measurements on ATDOM patients.     

El registro de los estudios observacionales: es el momento de cumplir el requerimiento de la Declaración de Helsinki

Publication bias is a serious deficiency in the current system of disseminating the results of human research studies. Clinical investigators know that, from an ethical standpoint, they should prospectively register clinical trials in a public registry before starting them. In addition, it is believed that this approach will help to reduce publication bias. However, most studies conducted in humans are observational rather than experimental. It is estimated that less than 2% out of 2 million concluded or ongoing observational studies have been registered. The 2013 revision of the Declaration of Helsinki requires registration of any type of research study involving humans or identifiable samples or data.It is proposed that funding agencies, such as the Fondo de Investigaciones Sanitarias, as well as private companies, require preregistration of observational studies before providing funding. It is also proposed that Research Ethics Committees which, following Spanish regulation, have been using the Declaration as the framework for assessing the ethics of clinical trials with medicines since 1990, should follow the same provisions for the assessment of health-related observational studies: therefore, they should require prospective registration of studies before granting their final approval. This would allow observational study investigators to be educated in complying with an ethical requirement recently introduced in the most important ethical code for research involving humans.     

La prevención universal del consumo de drogas en el entorno escolar: el valor de la monitorización continua

This paper documents the management of two programs for the universal prevention of substance use offered in secondary schools by the public health services of the city of Barcelona, reviewing the period from 1989–1990 to 2016–2017. Both programs had proven effectiveness in evaluations with a comparison group, they are promoted by the public health agency free of cost, and are taught by teachers, using standardized manuals with support materials and training. The coverage achieved over recent years declined from 40% to 25%. Changes observed in the acceptance and implementation of these programs could be related with logistics and follow-up by the public health services, changes in substance availability, and with budget cuts in education. The monitoring of effective programs by public health services is essential to preserve their actual implementation.     

Estratificación de la población en el País Vasco: resultados en el primer año de implantación

Predictive models allow populations to be stratified according to their health requirements for the following year. They offer health care organizations the opportunity to act proactively, designing specific interventions adapted to the level of need of different groups of people. The “Strategy for tackling the challenge of chronic illness in the Basque Country” proposes the use of such models, integrating them with other policies. The prospective categorization of all the population assigned to Osakidetza was performed for the first time in 2010 using the Johns Hopkins Adjusted Clinical Groups predictive model (ACG-PM). For this purpose, already recorded information extracted from electronic health records of primary care and hospital discharge reports was used. This article discusses the advantages of the combined use of various sources of information, and describes the application of the stratification in three programs, targeted at chronic patients who suffer different burdens of comorbidity.     

Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria

Objective

To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals.

Variaciones en el proceso de confirmación diagnóstica entre unidades de cribado poblacional de cáncer de mama

ObjectiveTo analyse variations in the diagnostic confirmation process between screening units, variations in the outcome of each episode and the relationship between the use of the different diagnostic confirmation tests and the lesion detection rate.MethodObservational study of variability of the standardised use of diagnostic and lesion detection tests in 34 breast cancer mass screening units participating in early-detection programmes in three Spanish regions from 2002–2011.ResultsThe diagnostic test variation ratio in percentiles 25–75 ranged from 1.68 (further appointments) to 3.39 (fine-needle aspiration). The variation ratio in detection rates of benign lesions, ductal carcinoma in situ and invasive cancer were 2.79, 1.99 and 1.36, respectively. A positive relationship between rates of testing and detection rates was found with fine-needle aspiration-benign lesions (R²: 0.53), fine-needle aspiration-invasive carcinoma (R²: 0 28), core biopsy-benign lesions (R²: 0.64), core biopsy-ductal carcinoma in situ (R²: 0.61) and core biopsy-invasive carcinoma (R²: 0.48).ConclusionsVariation in the use of invasive tests between the breast cancer screening units participating in early-detection programmes was found to be significantly higher than variations in lesion detection. Units which conducted more fine-needle aspiration tests had higher benign lesion detection rates, while units that conducted more core biopsies detected more benign lesions and cancer.     

Utilidad de los estudios serológicos en los centros de Atención Primaria para el diagnóstico precoz de la enfermedad de Lyme

Objective

The main aim of this study was to determine the usefulness of an early diagnosis of Lyme disease (LD) in Primary Health Care Centres (PHCC) using the ELISA test as serological screening technique.

Intervención no farmacológica como estrategia para favorecer el control de la hipertensión arterial y mejorar el cumplimiento antihipertensivo

ObjetiveTo evaluate the efficacy of an intervention by means of an educational magazine on treatment compliance in uncontrolled arterial hypertension (AHT).DesignControlled, randomised clinical trial.Setting87 primary care centres. Spain.ParticipantsA total of 450 patients with uncontrolled hypertension were included.InterventionTwo groups of 225 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention Group (IG): received a twice monthly educational magazine at home.Main measurementsCompliance was measured using the Medication Event Monitoring System (MEMS-Aardex). Compliance rate (CR) was recorded. Compliers were defined as individuals with a treatment compliance of 80–110%. The percentage of compliers, the mean percentage of doses taken and the percentage of patients taking the medication at the correct times were estimated. The mean blood pressures (BPs) and the percentage of controlled patientswere calculated. The number needed to treat (NNT) was calculated.ResultsA total of 393 individuals were evaluable (Age: 62.4 years), 196 in the IG and 197 in the CG. There were 83.2% (95% CI 78–88.4) and 49.2% (95% CI 42.2–56.2) (P=0.0001) of overall compliers in the IG and CG, respectively and 74% (95% CI: 67.9–80.1) and 42.6% (95% CI=35.7–49.5) (P=0.0001) of correct times compliers. A total of 81.6% (95% CI=76.2–86.5%)) were controlled in the IG and 56.3% (95% CI=49.4–63.2) in the CG. The NNT was 3.3 patients.ConclusionsTherapeutic non-compliance was very high. The educational magazine is an effective strategy to improve the compliance and degree of control of the AHT.     

Estudio de la situación nutricional de pacientes mayores de 65 años incluidos en el programa de atención domiciliaria de una población urbana

Objective

To analyse the nutritional status of patients older than 65 years included in the home care program (PAD).

Cambios en el consumo de tabaco: auge del tabaco de liar e introducción de los cigarrillos electrónicos

Objective

To assess changes in smoking prevalence and study roll-your-own (RYO) tobacco and e-cigarette use in the Galician population between 2007 and 2015.

Determinantes sociales de la salud y discapacidad: actualizando el modelo de determinación

Social determinants of health (SDH) are conditions in which people live. These conditions impact their lives, health status and social inclusion level. In line with the conceptual and comprehensive progression of disability, it is important to update SDH due to their broad implications in implementing health interventions in society. This proposal supports incorporating disability in the model as a structural determinant, as it would lead to the same social inclusion/exclusion of people described in other structural SDH. This proposal encourages giving importance to designing and implementing public policies to improve societal conditions and contribute to social equity. This will be an act of reparation, justice and fulfilment with the Convention on the Rights of Persons with Disabilities.