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.     

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.     

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.     

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.

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).

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.     

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 evaluación del proceso en relación con la evaluación de la efectividad: Experiencias de programas en el medio escolar

Evaluation of public health interventions usually focusses on the quality of design and research methods, and less on the quality of the intervention or process evaluation. In process evaluation of school-based interventions, key issues are how completely the intervention is carried out and adherence to the protocol. In addition, exploration of intermediate variables, such as those that influence (and often predict) preventable behavior, is highly useful. This article describes the basic concepts in this topic, using examples of the effectiveness of some preventive interventions carried out in schools. The interventions discussed were mainly quasi-experimental studies, based on data from programs promoted by public health teams in the city of Barcelona. Data from process evaluation of preventive programs in secondary schools that underwent formal assessment of their effectiveness is provided. The examples are drawn from preventive programs of HIV infection or unprotected sexual intercourse (PRESSEC program) and drug consumption prevention (the PASE, PASE.bcn and xkpts programs). These examples show why the intervention process influences the impact of the programs and their results. Thorough planning of process evaluation is essential to obtain valid indicators that will identify, in the effectiveness evaluation of the intervention, the most efficacious strategies to obtain positive outcomes.     

Evaluación de la efectividad de los programas de vacunación

Vaccines have contributed enormously to reducing the incidence of many communicable diseases. The protective efficacy of a vaccine refers to the health effects of the vaccine applied in optimal, ideal conditions, whereas the effectiveness of a vaccination program refers to the health effects of vaccination in the vaccinated individuals in clinical practice or within public health programs, which may differ widely from optimal conditions. Vaccine efficacy is estimated by randomized clinical trials. In contrast, effectiveness can be measured by various types of epidemiological studies: randomized community trials, in which the target vaccine is randomly assigned to a group and disease incidence in this group is compared with that of an unvaccinated group; cohort studies, which are observational epidemiological studies in which the vaccination status is known in healthy vaccinated (vaccinated cohort) and unvaccinated (unvaccinated cohort) people and the occurrence of the disease in the two groups is studied; and observational case-control studies, in which two groups are selected; one with the disease under investigation (cases) and the other without (controls), and vaccination histories are investigated in the two groups. Vaccine effectiveness may also be estimated by comparing attack rates in epidemic outbreaks or secondary attack rates in the home, or by screening.