Modelos predictivos de la epidemia de COVID-19 en España con curvas de Gompertz

During the international health crisis caused by the COVID-19 pandemic, it is necessary not only to know the data on infections, deaths and the occupation of hospital beds, but also to make predictions that help health authorities in the management of the crisis. The present work aims to describe the methodology used to develop predictive models of infections and deaths for the COVID-19 epidemic in Spain, based on Gompertz curves. The methodology is applied to the country as a whole and to each of its Autonomous Communities. Based on the official data available on the date of this work, and through the models described, we estimate a total of around 240.000 infected and 25.000 deaths at the end of the epidemic. At a national level, we forecast the end of the epidemic between June and July 2020.     

Prevalencia en la realización de mamografías en España: análisis por comunidades 2006-2014 y factores que influyen

Objective

To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion.

Prevalencia y factores de riesgo asociados a la retinopatía diabética en Santander. Norte de España

ObjetiveTo assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria.Designross-sectional population based study.LocationHealth center of Cantabria.ParticiantsA random sample of 442 patients with type 2 diabetes.Main measurementsNon-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events.ResultsThe prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors.ConclusionsThe prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR.     

Trastornos del sueño y condiciones ambientales en mayores de 65 años

ObjectivesTo establish the prevalence and characteristics of insomnia and its relationship to other health problems, medication, socio-health status and sleep hygiene in the elderly over 65 years of age.DesignCross sectional study of prevalence.SettingAlbacete (Castilla-La Mancha), 2004–2005.ParticipantsA non-institutionalized elderly patient population (n=424).MethodSemi-structured interview. Study variables were: sleep characteristics, socio-familial repercussions, sleep hygiene, health problems, medication, health care utilization and socio-demographic variables. Primary insomnia (PI) was diagnosed according to DSM-IV criteria.ResultsReported sleeping difficulties, 34.2%; in 95.7% the sleep disturbance was chronic. The most frequent repercussions were: sensation of insufficient night-time sleep (62.1%) and daytime tiredness or sleepiness (52.2%). 20.3% (95% CI, 16.5–24.1) met criteria for PI. Insomnia rates were significantly higher in females and in subjects maintaining irregular hours and expressing dissatisfaction with bedroom environmental conditions. Psychopharmaceuticals were regularly consumed by 26.9% of the subjects (95% CI, 22.7–31.1). The average number of health problems was higher in subjects with insomnia (2.4±1.6 compared with 1.7±1.5 in non-insomniacs; P<.001). By means of logistic regression, female gender (OR=2.8; 95% CI, 1.6–4.8) and the existence of 2 or more health problems (OR=2; 95% CI. 1.2–3.4) were associated with PI.ConclusionsPI affects approximately one fifth of people over the age of 65. It is more frequent in females and is related to the existence of other health problems, medication and inadequate sleep hygiene.     

Competencia en Práctica Basada en la Evidencia y factores asociados en las enfermeras de Atención Primaria en España

ObjectiveTo describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors.DesignCross-sectional, national survey design, carried out between January and March 2020.SettingPC in Spain.ParticipantsSeven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience.Main measurements(1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out.ResultsThe mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150 h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization.ConclusionsThese findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.     

Monitorización de la COVID-19 en España: ¿es posible un análisis con perspectiva de género?

ObjectiveTo analyse the sex disaggregation and availability of gender indicators in the reports of the National Epidemiological Surveillance Network (RENAVE) and the National Study of Sero-Epidemiology (ENE-COVID-19).MethodPeer review of indicators available in 72 RENAVE reports and 4 rounds of the ENE-COVID-19 study to calculate the percentage of those disaggregated by sex and their variation over time.ResultsIn March 2021, 52.4% of RENAVE indicators were disaggregated by sex. From July 2020, 54% of disaggregated indicators ceased to be published and 23% lost their disaggregation. In the ENE-COVID-19 study, the 1 st round 88,23% of the indicators are disaggregated and the 4th round 94,74%. The 2nd and 3rd round do not disaggregated by sex.ConclusionsThe RENAVE reports do not allow for a gender-sensitive analysis while the ENE-COVID-19 study provides the most information on social determinants.     

Agenda de género en la formación en ciencias de la salud: experiencias internacionales para reducir tiempos en España

ObjectiveTo analyse experiences and lessons learned in the process of incorporating gender perspective into health sciences degrees in the international arena.MethodNarrative literature review with no date limit. Keywords “curricula”, medical education”, “nursing education”, “health science”, “gender education”, “gender medicine” and “gender health issues”. Other articles were snowballed from those identified in the review.ResultsContent on sex-gender appears in learning outcomes and evaluation. Learning based on discussing innovations and assistive applications on gender issues. Resistance: scepticism as a useful academic exercise; lack of time for teacher training and difficulty in finding concrete solutions, due to the diversity of contents; Curriculum overload; the idea of dealing exclusively with women's issues. Difficulties in implementing change policies in centres arising from the difficulty in identifying and presenting gender biases to academic authorities.ConclusionsThe key to gender mainstreaming in university degrees lies at the level of political, organizational and cultural change, as well as at faculty level. There are facilitating factors and individual and interpersonal barriers; the organizational level is essential with institutional support through norms that enforce the incorporation of this perspective and ensure its sustainability.     

Heterogeneidad en el perfil profesional y las actividades de los registros de mortalidad en España

ObjectiveThe mortality registries (MR) code death causes for the elaboration of the mortality statistics of the Spanish National Institute of Statistics (INE). Documentary research and medical training can improve this activity. Our objective was to analyse the professional profile and activities of the MR.MethodA survey was designed and distributed in February 2021. Professional profile, quality activities, medical training, and regular publications were the major topics. 16/18 MR participated. A cluster analysis was performed.ResultsEleven registries belong to Public Health. Five have an INE agreement, 39% provided training, and 56% made regular publications. Ten improved the causes of death, and 17% reviewed the automatic coding. The cluster analysis started from 5/16 groups of registries.ConclusionsThe MR were heterogeneous in professionals, quality and publications. Homogeneity implies documentary search, a sole INE agreement, and providing systemic medical training.     

Efectos del cambio de apariencia de medicamentos en seguridad y adherencia en pacientes crónicos mayores de 65 años en atención primaria. Estudio CAMBIMED

ObjectiveTo study whether the changes in bioequivalent drugs with different appearances are associated with an increase in lack of adherence and medication use errors, in patients > 65 years old treated with antihypertensive and lipid-lowering medications.DesignObservational longitudinal prospective cohort study with a one-year follow-up period between 1 January 2013 and 31 December 2014.LocationPrimary Healthcare Centres in the Community of Madrid.ParticipantsPatients ≥ 65 years-old with a diagnosis of hypertension and/or dyslipidaemia receiving treatment with Enalapril and/or Amlodipine and/or Simvastatin.Main measurementsVariables collected during a Primary Care consultation by means of a personal interview were: sociodemographic (age, gender, level of education), clinical variables, adherence (Morisky-Green test and direct counting), medication errors (number and type), medication changes and number, analytical (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) and combined variable (error and/or adherence). There were 1 baseline and 4 quarterly visits.ResultsThe study included 274 patients with a mean age 72 (6.6) years, of whom 47.8% were female. Some medication changes were observed in 134 patients (48.9%), with a median of 3 (IQR 1-5) and a maximum of 11 changes. The risk of presenting with a medication use error or decreased adherence was increased in patients exposed to changes in all visits with RR 1.14 (1.16-1.69) at one year of follow-up. The most frequent error was the loss of dose. For each change in medication, the probability of a combined event increases by 41%.ConclusionsThe changes made in bioequivalent drugs with different appearance could increase the number of medication use errors and decrease the adherence. More studies should be carried out to assess how much this affects the control of the disease.The intervention section is not considered because it is an observational study.