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Fran Calvo Xavier Carbonell Ramón Valero Jordi Costa Oriol Turró Cristina Giralt Marissa Ramírez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(8):477-485
Aim
The aim of this study is to define the risk factors associated with early discharge in out-patients clinics.Design
Cross-sectional and observational study.Setting
Substance abuse clinics in Girona (Catalonia, Spain).Participants
A total of 264 individuals were included in the sample, and 34.8% of them abandoned the process within two months of starting the therapy (n = 92).Procedure
Clinical and socio-demographic variables of the clinical history were compared between participants with/without adherence.Main measurements
The Student t test was used to measure the comparison, and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression model was adjusted, with adherence as the dependent variable.Results
The results indicated that attending the appointments unaccompanied (OR = 3.13), being female (OR = 2.44), having cocaine related issues (OR = 1.14), and being younger (OR = 0.89) are the factors which increase the risk early abandonment. Contrarily, being referred to specialists from a Primary Health Centre reduces the risk (OR = 0.28).Conclusions
It is concluded that special attention must be devoted to the patients’ families, women, and young patients. Moreover, the appropriate coordination between specialist services and basic services increases adherence to treatment among drug users. 相似文献3.
Objectives
To describe the epidemiological, clinical, microbiological, and therapeutic characteristics of Nocardiosis patients treated in a general hospital.Patients and methods
Monocentric retrospective analysis of patients presenting with Nocardia-positive biological sample from January 1, 1998 to May 1, 2017.Results
We identified nine cases of Nocardia infections. Risk factors were oral corticosteroid therapy (n = 3), solid cancer (n = 2), hematological cancer (n = 1), COPD (n = 1). No risk factor was identified in patients with isolated cutaneous presentation (n = 2). Disseminated presentations (n = 3) were observed in patients receiving corticosteroid therapy (n = 2) and presenting with ENT cancer (n = 1). Identified Nocardia species were Nocardia nova (n = 4), Nocardia cyriacigeorgica (n = 2), Nocardia abscessus (n = 1), Nocardia brasiliensis (n = 1), and Nocardia asteroides (n = 1). The median diagnostic time was 17 days. Antibiotic therapy was prolonged and included trimethoprim-sulfamethoxazole in 6/9 cases. The overall one-year case fatality was high (3/8). No recurrence was observed. We identified two cases of respiratory colonization with N. abscessus and N. cyriacigeorgica in COPD patients.Conclusion
Nocardiosis can occur both in immunocompetent and immunocompromised patients. It is a severe infection, with a miscellaneous clinical spectrum and complex treatments. Greater knowledge of nocardiosis is required from physicians for optimal medical care. 相似文献4.
Gloria Aranda Auserón M. Rosario Elcuaz Viscarret Carmen Fuertes Goñi Victoria Güeto Rubio Pablo Pascual Pascual Enrique Sainz de Murieta García de Galdeano 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(3):141-150
Objective
To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals.Design
Randomised, controlled clinical trial.Participants and setting
Training in Mindfulness was offered to 1,281 health professionals in Navarra (Spain) Primary Care, and 48 of them accepted. The participants were randomly assigned to groups: 25 to the intervention group, and the remaining 23 to the control group.Intervention
The Mindfulness and Self-Compassion training program consisted of sessions of 2.5chours/week for 8 weeks. The participants had to attend at least 75% of the sessions and perform a daily practical of 45 minutes.Main measurements
The levels of mindfulness, self-compassion, perceived stress, and burnout were measured using four questionnaires before and after the intervention.Results
After the intervention, the scores of the intervention group improved significantly in mindfulness (P < .001); perceived stress (P < .001); self-compassion: self-kindness P < .001, shared humanity P = .004, mindfulness P = .001; and burnout: emotional fatigue (P = .046). The comparison with the control group showed significant differences in mindfulness (P < .001), perceived stress (P < .001), self-kindness (P < .001) and emotional fatigue (P = .032).Conclusions
This work suggests that it may be beneficial to encourage mindfulness and self-compassion practices in the health environment. 相似文献5.
Daniela Dubois Marques Vicente Mora Llabata Julián Pacheco Arroyo Salvador Gasull Insertis Manuela Vicente Cañizares Ildefonso Roldán Torres 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(6):340-349
Objective
To determine whether antithrombotic treatment (ATT) in patients with non-valvular atrial fibrillation in a health area complies with the recommendations of current clinical guidelines.Design
Prospective observational study.Location
Primary Health Care Centres and Cardiology Department of a Health Department of the Valencian Community, Spain.Participants
A total of 505 patients with nonvalvular atrial fibrillation were included in the study.Main measurements
ATT was deemed to be inappropriate in patients with a CHA2DS2-VASc score ≥ 1 and who were not under oral anticoagulation, in patients treated with antivitamin K drugs, and poor control of oral anticoagulation, or with antiplatelet therapy inappropriately associated with anticoagulation, and in patients on ATT with a CHA2DS2-VASc score = 0.Results
The median age was 77.4 ± 10 years. The ATT was considered inadequate in 58% of cases. Factors independently associated with inadequate ATT were age (OR: 1.02 [1-1.04]; P = .029), hypothyroidism (OR: 1.98 [1.14-3.43]; P = .015), ischaemic heart disease (OR: 1.3 [1.15-2.59]; P = .008) and paroxysmal non-valvular AF (OR: 2.11 [1.41-3.17]; P < .0001).Conclusions
These data underline the high prevalence of inadequate ATT in daily practice, as well its different causes. 相似文献6.
Ramon Mir-Abellán Anna Falcó-Pegueroles María Luisa de la Puente-Martorell 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(2):145-149
Objective
To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables.Methods
The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative.Results
59% (n = 123) of respondents rated safety between 7 and 8. 53% (n = 103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was “teamwork in the unit/service” and the opportunity for improvement was “staffing”. A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff.Conclusions
This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies. 相似文献7.
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Objective
To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE).Methods
We surveyed 195 hospital (n = 113) and PC (n = 82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions.Results
Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p = 0.0001) and external (p = 0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers’ role in case of an AE (10.7% hospitals versus 6.25% PC).Conclusion
A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens’ trust after an AE. 相似文献9.
Andrés Cabrera-Leon Miguel Ángel Cantero-Braojos 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(9):527-538
Objective
To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services.Design
Cross-sectional population study with face-to-face interview.Setting
Andalusian Health Survey (2011 edition).Participants
6,507 people over the age of 16 (p = q = 0.5; confidence level = 95%; sampling error = 1.49, design effect = 1.52).Interventions
Not applicable.Main measurements
Dependent variable: DCP: population limited in their activity by any of the CP specified in the survey. Independent variables: quality of life, absence from work, consumption of medication and utilization of health services.Results
Compared to a population without CP, DCP impact is 6 points less on the mental quality of life and 12 points on the physical one, medication consumption is triple, health services utilization is almost double, and long absence from work is triple. On the other hand, a population with nondisabling chronic pain (nDCP) presents similar results to a population without CP.Conclusions
We have considered DCP as another CP category because of its huge impact, as is shown in our study, on the study variables. On the contrary, the population with nDCP does not obtain significant impact differences when compared to the population without CP. Therefore, we believe that Primary Care and Public Health should lead different prevention strategies for DCP as well as for the identification of the nDCP population to decrease its possible deterioration towards DCP. 相似文献10.
B. Franko P. Fournier T. Jouve P. Malvezzi I. Pelloux J.P. Brion P. Pavese 《Médecine et maladies infectieuses》2017,47(1):18-25
Objective
Lactobacillus bacteremia is a rare event and its epidemiology is poorly known. Whether Lactobacillus bacteremia is a contaminant, a risk factor, or a risk marker of death remains an open question.Patients and methods
We conducted a retrospective study of patients presenting with Lactobacillus bacteremia (LB), between January 2005 and December 2014, at the Grenoble University Hospital.Results
LB was observed in 38 patients (0.34% of all positive blood cultures). Cancer (40%), immunosuppression (37%), and use of central venous devices (29%) were frequently associated with LB. We observed a significant increase with time in the number of Lactobacillus positive blood cultures among all blood cultures performed (P = 0.04). LBs were divided into two clinical-biological presentations: secondary bacteremia with a known portal of entry (n = 30) and isolated bacteremia (n = 8). Case fatality was 31% at D28, 55.2% at 1 year in the secondary bacteremia group, and 12.5% (both at D28 and 1 year) in the isolated bacteremia group. Secondary bacteremia with a known portal of entry was significantly associated with case fatality after adjustment for age, co-infection, cancer, immunosuppression, diabetes, and sex (OR 14.9 [1.04–216] P = 0.047) for fatality at one year, but not for D28 fatality (P = 0.14).Conclusion
Lactobacillus bacteremia may be an important marker of disease severity rather than a pathogen, suggesting comorbidities. It should not be considered a contaminant, but should lead physicians to screen for associated infections and underlying diseases. 相似文献11.
Borami Ahn Shin-Hye Kim Mi-Jung Park 《International journal of hygiene and environmental health》2017,220(1):37-42
Objective
To assess blood cadmium levels in Korean adolescents with respect to demographic and lifestyle factors.Methods
We analyzed data from the Korea National Health and Nutrition Examination Survey from 2010 to 2013, totaling 1472 adolescents aged 10–18 years. Geometric means of blood cadmium were calculated using a complex samples general linear model to compare blood levels in different demographic and lifestyle groups. Multivariate logistic regression analyses were also used to find predictors for high blood cadmium (>90th percentile).Results
The geometric mean of the blood cadmium concentrations was 0.30 μg/L in Korean adolescents. Older age, type of housing (multifamily house and commercial building), smoking and alcohol consumption, and iron deficiency/iron deficiency anemia (IDA) were significantly associated with higher blood cadmium concentrations (P < 0.05). Blood cadmium concentrations were not significantly affected by gender, region, body mass index status, or household income. In multivariate logistic regression analysis, independent predictors for higher blood cadmium levels included current smoker (OR = 7.77), alcohol consumption (OR = 4.31), living in a multifamily house or commercial building (OR = 3.11–3.46), and IDA (OR = 2.64).Conclusions
Possible associations between blood cadmium levels and type of housing or alcohol consumption in adolescents are suggested for the first time in this study. Further studies are needed to elucidate the mechanism of these findings. 相似文献12.
Maria Isabel Vazquez-Arce Elena Marques-Sule 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(10):576-582
Aim
To analyse several cardiovascular risk factors by means of the physical activity performed by patients with acute coronary syndrome (ACS).Design
Cross-sectional study.Location
Cardiovascular prevention service (Health Department, Valencia, Spain).Participants
The study included 401 individuals with acute coronary syndrome and discharged from hospital 2-3 months before the assessment. The inclusion criteria included age between 30 and 80 years-old, no contraindication for physical activity, and no previous participation in cardiac rehabilitation programmes.Main measurements
Metabolic equivalent MET (Kcal/Kg) was calculated, based on the type of activity, frequency, duration and intensity. Participants were divided into two groups: sedentary group (< 10 METs/week) and physically active group (≥ 10 METs/week). Several variables associated with cardiovascular risk factors were assessed: body mass index (BMI), waist circumference, lipid profile, blood glucose, and arterial pressure.Results
The mean consumption was 8.24 ± 12.5 METs/week. Prevalent factors were overweight (77.05%), and dyslipidaemia (64.3%), whilst 64.8% were sedentary. The physically active group showed differences when compared to sedentary group in triglycerides (146.53 ± 72.8 vs. 166.94 ± 104.8 mg/dL; 95% CI; P = .031), and BMI (27.65 ± 3.86 vs. 28.50 ± 4.38 kg/m2; 95% CI; P = .045).Conclusion
Physical activity was performed by a limited number of patients with ACS, with a prevalence of overweight and dyslipidaemia. Being physically active improved triglycerides levels and BMI. Therefore, health promotion from Primary Care and encouraging physical activity amongst patients with ACS is crucial. 相似文献13.
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Mariano de la Figuera Sergio Cinza Nuria Marín Isabel Egocheaga Miguel Angel Prieto 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(6):359-367
Objective
To analyse the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC).Design
Observational, cross-sectional and multicentre study.Location
Autonomous Communities in which the general practitioner can prescribe DOAC (n = 9).Participants
The study included a total of 790 patients on chronic treatment with anticoagulants, and on whom therapy was changed, as well as being currently on treatment with DOAC for at least for 3 months.Main measures
A record was made of the sociodemographic and clinical management date.Results
Mean age was 78.6 ± 8.4 years, and 50.5% of patients were men. Mean CHADS2 score was 2.6 ± 1.2, mean CHA2DS2-VASc score was 4.3 ± 1.6, and the mean HAS-BLED score was 2.3 ± 1.0. Mean duration of treatment with DOAC was 15.8 ± 12.5 months. Rivaroxaban was the DOAC most frequently prescribed (57.8%), followed by dabigatran (23.7%), and apixaban (18.5%). Of the patients receiving rivaroxaban, 70.2% were taking the dose of 20 mg/daily. Of the patients receiving dabigatran, 41.7% were taking the dose of 150 mg twice daily, and in the case of apixaban, 56.2% were taking the dose of 5 mg twice daily. Satisfaction (ACTS Burdens scale 52.0 ± 7.2 and ACTS Benefits scale 12.1 ± 2.2), and therapeutic adherence (97.8% of patients took their medication regularly) with DOAC were high.Conclusions
Patients treated with DOAC in Spain have a high thromboembolic risk. A significant proportion of patients receive a lower dose of DOAC than that recommended according to their clinical profile. Satisfaction and medication adherence are high. 相似文献15.
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Carmelle Mizéhoun-Adissoda Achille Yémoa Charles Sossa Jerome Adama Biobou Koffi Alouki Colette Azandjèmé Jacques Houngbénou Houngla Dismand Houinato André Bigot Jean-Claude Desport 《Nutrition Clinique et Métabolisme》2018,32(2):102-108
Objective
To evaluate the iodine content and microbiological contamination of salts sold at Dantokpa, the Benin's largest market, in order to assess quality throughout the distribution chain.Materials and methods
From October to November 2016, 190 salt samples were collected from 18 wholesalers and 172 salt dealers at the Dantokpa market in the town of Cotonou. Iodine content was qualitatively determined using the MBI-Kit and quantitatively by spectrophotometry. The microbiological quality assessment involved 30 samples randomly selected to count Total Mesophilic Aerobic Flora (TMAF).Results
With the MBI Kit, 47.9 % of samples did not contain iodine. By spectrophotometry, 40 % of the salts had an iodine content equal to 0 ppm, 59.5 % a content < 15 ppm and 0.53 % of the samples an iodine content ≥ 15 ppm. None of the salt samples met the Beninese recommendations of iodized salt for sale (20–60 ppm). For microbiological quality, 100 % of the samples were contaminated with microorganisms, which were staphylococci in 10 %.Conclusion
This study showed that the dietary salts sold at the Dantokpa market are not adequately iodized. In addition, some samples are contaminated with halophilic microorganisms. These disturbing results highlight the need for an immediate strengthening of the salt iodization strategy in Benin while including sellers’ awareness for a better hygiene. 相似文献17.
Itsaso Elizalde-Beiras Francisco Guillén-Grima Inés Aguinaga-Ontoso 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(6):332-339
Objectives
To determine the factors associated with asthma and asthma-related symptoms in children and adolescents in rural areas of Navarre (Spain).Participants and methods
A cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as additional variables, was conducted on 797 children and adolescents. These provided prevalence data on asthma symptoms and associated factors without further diagnostic testing.Location
Primary Care setting, through the basic health areas and in the corresponding education centres.Measurements and results
The prevalence of referred asthma is 11.7% in children, and 13.4% in adolescents. The prevalence in the female population is 13.7% and in males it is 11.3%. As for the related factors according to the values of OR, an OR = 9.5 was found between wheezing and asthma, and an OR = 3.5 between recent rhinitis and asthma. As regards recent wheezing, an OR = 11.5 was found between awakenings due to wheezing and recent wheezing, and an OR = 3.4 between recent rhinitis and wheezing.Conclusions
Referred asthma is a prevalent disease in children and adolescents in rural areas. It is more prevalent in adolescence and in the female population. Rhinitis and other asthma symptoms are related to asthma and wheezing, as well as the use of emergency services, in the case of asthma. 相似文献18.
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Cristina Martínez Carlos Méndez María Sánchez José María Martínez-Sánchez 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(2):132-138
Objective
To assess attitudes towards the extension of outdoor smoke-free areas on university campuses.Methods
Cross-sectional study (n = 384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement.Results
Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR = 12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR = 3.001; 95% CI: 1.439-6.257) were the strongest supporters.Conclusions
The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses. 相似文献20.
Dan Norbäck Jamal Hisham Hashim Zailina Hashim Vinoshini Sooria Syazwan Aizat Ismail Gunilla Wieslander 《International journal of hygiene and environmental health》2017,220(4):697-703