Artículos (Medicina Preventiva y Salud Pública)

URI permanente para esta colecciónhttps://hdl.handle.net/11441/11050

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Desarrollo de un cuestionario para evaluar conocimientos, actitudes y prácticas de automedicación en personas mayores
(Fundación Pharmaceutical Care España, 2026-07-30) Miranda, Aída; Morales, Fátima; Teran, Enrique; Medicina Preventiva y Salud Pública; CTS1162: Investigación Clínica y Experimental en Salud Pública
Introducción: La automedicación es habitual en personas mayores, la cual puede estar influenciada por hábitos propios de cada región, por lo tanto, el objetivo de este trabajo fue desarrollar y validar un cuestionario para evaluar conocimientos, actitudes y prácticas de la automedicación en adultos mayores. Métodos: La metodología incluyó seis etapas: i) generación de ítems y estructuración del cuestionario, ii) validación cualitativa por juicio de personas expertas, iii) evaluación de la comprensión del instrumento por 40 participantes, iv) modificación de ítems, v) segundo análisis de comprensión del instrumento por 13 personas y vi) segunda modificación de ítems. Resultados: Inicialmente, el instrumento conformó 88 preguntas, categorizadas en tres dimensiones: conocimientos, actitudes y prácticas. Todas las modificaciones realizadas por las personas expertas después de indagar en la comprensión de las preguntas se enfocaron en mejorar la claridad, coherencia, así como en eliminar tecnicismos e incrementar la pertinencia del instrumento al objetivo de la investigación. Conclusiones: Finalmente, se obtuvieron 62 ítems: 23 de conocimientos, 16 de actitudes, 10 de prácticas y 13 de las razones por las cuales se automedican. El desarrollo del instrumento pretende ser de utilidad como herramienta para la correcta evaluación de la automedicación en adultos mayores.
Healthcare access in chemsex contexts in Brazil: a scoping review and the vip-chemsex model
(MDPI, 2026-07-06) Silva de Carvalho, Isadora; Angel Cepas, Lariane; Lopes de Sousa, Álvaro Francisco; Morais Fernandes, Talita; Gomes Luz, Talia; Morales, Fátima; Morais Fernandes, Ana Paula; Medicina Preventiva y Salud Pública; CTS1162: Investigación clínica y experimental en salud pública
Background/Objectives: Sexualized drug use (SDU) and chemsex have emerged as a growing public health concern globally, reflecting complex intersections between sexual practices, psychoactive substance use, and structural vulnerabilities. In Brazil, however, evidence on healthcare access among individuals who engage in SDU/chemsex remains limited and fragmented. This scoping review aimed to map and analyze the available literature on healthcare access in this population, identifying barriers, facilitators, and gaps in care. Methods: The review followed the Arksey and O’Malley framework and Joanna Briggs Institute recommendations, with searches conducted in six databases (MEDLINE/PubMed, Embase, Scopus, SciELO, LILACS, and PsycINFO) for studies published between 2014 and 2025. Results: Eleven studies met the inclusion criteria, predominantly quantitative and concentrated in large urban centers. Findings indicate that healthcare access is shaped by persistent structural and symbolic barriers, including stigma, discrimination, fear of disclosure, and limited professional preparedness. Care remains largely centered on human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) services, with insufficient integration of primary care, mental health, and substance use services, contributing to fragmented care. Significant gaps were identified, including the underrepresentation of women, transgender, and non-binary populations, and the absence of studies focusing on healthcare professionals. Conclusions: Substance use patterns reflect both global trends and local specificities, particularly the prominence of alcohol and cocaine in Brazil. This review provides the first synthesis of Brazilian evidence on chemsex from a healthcare access perspective. The findings highlight critical inequities and support the need for integrated, stigma-free, and context-sensitive care within the Brazilian Unified Health System. Based on these findings, the VIP-SDU/Chemsex Model is proposed as a multilevel framework to explain how structural, symbolic, and programmatic factors shape access and health outcomes.
The role of 3D/4D transperineal ultrasound in risk stratification for pelvic organ prolapse recurrence: native tissue versus mesh repair
(MDPI, 2026-06-14) García Mejido, José Antonio; Nuñez-Matas, María José; Salas-Álvarez, Olaya; Crespo-Rodriguez, Alejandro; Fernández Palacín, Ana; Sáinz Bueno, José Antonio; Cirugía; Medicina Preventiva y Salud Pública; CTS312: Análisis de la Demanda Sanitaria
Background/Objectives: Pelvic organ prolapse (POP) management requires precise patient selection for surgical techniques to balance clinical efficacy and safety. The primary aim of this study was to evaluate the role of preoperative 3D/4D transperineal ultrasound in the risk stratification of POP recurrence. We analyzed the impact of levator ani muscle (LAM) injuries, specifically avulsion and ballooning, as identified by ultrasound, on both anatomical and subjective success rates, comparing native tissue repair versus mesh-augmented surgery. Methods: A prospective, multicenter observational study was conducted over a five-year period, January 2021 to December 2024 (recruitment), with follow-up completed in December 2025, ensuring a minimum follow-up of 12 months for all participants. The cohort included 276 women scheduled for primary surgery for symptomatic POP stage ≥ 2. Prior to intervention (116 underwent native tissue repair and 160 received mesh), all patients underwent 3D/4D transperineal ultrasound for standardized volume acquisition. Using this preoperative functional imaging technique, we measured the hiatal area and diagnosed the presence of hiatal ballooning (≥25.0 cm2) or levator muscle avulsion. Results: Ultrasound assessment revealed significant differences in surgical success based on the diagnosed baseline site-specific defects. Hiatal ballooning was the sonographic finding that demonstrated the greatest impact on risk stratification. Among patients with preoperative ballooning, mesh use significantly reduced both subjective recurrence (5.7% vs. 21.4%, p = 0.001) and objective recurrence (21.4% vs. 35.7%, p = 0.040) compared to native tissue repair. Furthermore, in women without ultrasound-documented avulsion, mesh also decreased objective recurrence (17.9% vs. 33.0%, p = 0.024). Multivariate analysis, adjusted for age, BMI, menopausal status, and parity, confirmed that, after stratifying by these preoperative ultrasound findings, a native tissue approach remains the primary independent predictor of surgical failure (OR 1.752 for objective recurrence; p = 0.041). Conclusions: In conclusion, native tissue repair was identified as the primary independent predictor of surgical failure. While 3D/4D transperineal ultrasound helps identify high-risk phenotypes such as hiatal ballooning, these sonographic findings did not maintain independent significance in the multivariate model. Therefore, ultrasound should be considered a complementary tool for surgical planning rather than a definitive predictor of recurrence.
Occupational and lifestyle associations with mental health of healthcare workers
(Lippincott, Williams & Wilkins, 2026) Jiménez-Ortega, Lara Estefanía; Ladisa, María; Delgado-Calderón, Manuel; Camacho Vega, Juan Carlos; Vilches Arenas, Ángel; El Khoury Moreno, Luis; Torrejón Martínez, Julio; Gómez-Salgado, Juan; Medicina Preventiva y Salud Pública; Construcciones Arquitectónicas II; Estomatología
Mental disorders are a leading cause of morbidity worldwide, and healthcare professionals are particularly vulnerable due to occupational stressors, a vulnerability intensified during the coronavirus disease 2019 pandemic. This study assessed the prevalence of mental health disorders among hospital workers and examined changes in their perceived mental health during the pandemic. A descriptive cross-sectional study was conducted with 215 employees attending the Health Surveillance Service of Virgen Macarena University Hospital (Seville) between January 2019 and December 2022. Data were collected from occupational health records and a telephone survey, including the General Health Questionnaire (12 items) questionnaire. The prevalence of diagnosed mental health disorders was 7.0%, with mixed anxiety-depressive disorder being the most frequent. Most affected workers required short-term temporary incapacity due to common contingencies, and 36.7% required job adaptations, mainly involving task modifications. During the pandemic, 68.1% of workers reported a perceived worsening in mental health, which was more common among alcohol users. Among those receiving treatment, 70.8% required medication adjustments, and 31.2% reported increased analgesic use. Although prevalence rates were lower than expected, likely due to underdiagnosis and prioritization of coronavirus disease 2019-sensitive evaluations, the profile of affected workers was consistent with previous literature, predominantly women around 50 years old, often Assistant Nursing Care Technicians. These findings highlight the crucial role of occupational health services in early detection, monitoring, and support of healthcare professionals. Identification of alcohol use, psychiatric medication adjustments, and increased analgesic intake as risk factors emphasize the need for proactive interventions to sustain the healthcare workforce.
The uncorrected defect: a risk stratification model for persistent levator ballooning following pelvic organ prolapse repair
(Springer london LTD; Springer Science and Business Media LLC, 2026-05-04) García Mejido, José Antonio; García-Pombo, Sara; Salas-Álvarez, Olaya; Fernández Palacín, Ana; Bugatto-Gonzalez, Fernando; Sáinz Bueno, José Antonio; Cirugía; Medicina Preventiva y Salud Pública; CTS312: Análisis de la Demanda Sanitaria
Objective To develop and validate a multivariable prediction model capable of identifying patients at high risk of persistent levator hiatus ballooning 3 months following primary POP reconstructive surgery. Method A prospective observational study was conducted on a consecutive cohort of 140 women undergoing primary surgery for symptomatic POP (POP-Q stage ≥ 2). All patients underwent a standardized transperineal ultrasound assessment preoperatively and at 3 months postoperatively. Ballooning was defined as a levator hiatus area (LHA) of ≥ 25 cm2 on straining maneuver. A multivariable binary logistic regression model was developed to predict the presence of postoperative ballooning. The model’s performance was assessed using Harrell’s C-index (AUC) and calibration plots. Results Although surgery resulted in a significant mean reduction of the LHA on straining (from 29.60 ± 8.30 cm2 to 27.17 ± 7.24 cm2; p < 0.001), the ballooning phenotype persisted in 57.1% (80/140) of the cohort. The final multivariable model identified three independent predictors: age (OR 0.959; 95% CI 0.920–0.999), body mass index (OR 1.095; 95% CI 1.004–1.194), and preoperative resting LHA (OR 1.276; 95% CI 1.158–1.405). Notably, resting area proved to be a stronger predictor than straining area. The model demonstrated high discriminative ability with an AUC of 0.84 (95% CI 0.77–0.91) and good calibration. Conclusions Surgical correction of POP reduces hiatal dimensions but fails to correct levator ballooning in the majority of patients. We developed a highly accurate predictive model that identifies this “uncorrected defect” using preoperative resting biometry. Identifying this high-risk phenotype is crucial for patient counseling and managing expectations regarding long-term recurrence.
COVID-19 Infection Risk Among Vulnerable Healthcare Workers: The Protective Role of Pre-Pandemic Recognition
(MDPI, 2026-02-26) Ladisa, María; Cabanilla-Moruno, Juan Luis; Jimenez-Ortega, Lara Estefania; Delgado-Calderon, Manuel; García Cabrera, Emilio; Romero-Barranca, Julia; Vilches Arenas, Ángel; Medicina Preventiva y Salud Pública; CTS312: Análisis de la Demanda Sanitaria
Background: During the first wave of the COVID-19 pandemic, the importance of the recognition of vulnerable workers was well-established, but the specific impact of the timing of their recognition remains less understood. Objective: This study evaluates the impact of early recognition of vulnerable healthcare workers (VHCWs) and identifies factors associated with SARS-CoV-2 infection. Methods: We performed a retrospective cohort study at the Virgen Macarena University Hospital (HUVM) in Seville and included employees classified as VHCWs between January 2020 and December 2021. All data, including demographic, occupational, and clinical data, were collected from occupational health records and the Andalusian digital health system. The incidence of COVID-19 was analyzed using descriptive, bivariate statistics, and Cox regression. Results: A total of 471 VHCWs were included. Most of the VHCWs were women (79.8%) with a median age of 50 years. The most common vulnerability criteria were pregnancy (32.9%) and age > 60 (28.7%). During the study period, 58 VHCWs (12.3%) were diagnosed with COVID-19, compared to 18.35% of the general workforce. Recognition of VHCW status after the pandemic was declared was strongly associated with higher infection risk (HR = 48.84; 95% CI: 26.21–90.99; p < 0.001). Conclusions: The timing of vulnerability recognition emerged as the most critical protective factor in this cohort. Healthcare workers whose vulnerability was not proactively identified before the pandemic onset faced a substantially higher risk of infection (HR = 44.68; 95% CI: 26.21–90.99; p < 0.001) compared to those recognized early. These findings underscore that pre-pandemic identification facilitated the immediate implementation of task adaptations and workplace restrictions, effectively mitigating high-risk exposure during the most critical early stages of the crisis.
Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain)
(MDPI, 2021-07-21) Zapata Moya, Ángel R.; Martín Díaz, María J.; Viciana Fernández, Francisco José; Medicina Preventiva y Salud Pública; Junta de Andalucía; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER)
Area-based policies (ABIs) aim to improve the quality of life and health of residents in socio-economically disadvantaged areas of cities. Although health impact evaluations of ABIs have proliferated in the last decade, several weaknesses have been identified in these evaluations. Inspired by the propositions of the fundamental cause theory (FCT), this paper attempts to address some of these weaknesses by investigating the possible impacts of different combinations of ABIs on premature mortality in vulnerable urban areas of Andalusia (Spain). We conducted a quasi-experimental cohort study, based on the longitudinal statistics on survival and longevity of a population aged 40–70 during the period from 2002 to 2016. Hazard ratios for individuals living in targeted areas relative to control areas were estimated using quasi-Poisson regressions, and the impact was evaluated using a difference-in-difference approach. Most of the ABIs studied do not seem to generate a visible impact on premature mortality. However, the combination of ARB and URBAN interventions is associated with a significant decrease in preventable and all-cause mortality in the targeted versus control areas. The flexible resources proposed by FCT can operate at both the contextual and individual levels, since more comprehensive interventions seem to contribute to achieving health impacts on vulnerable populations. Future evaluations should consider the nature of the intervened areas themselves in relation to the dynamics of the city and the degree of comprehensiveness of the policies, to elucidate what may constitute “fundamental interventions” to reduce health disparities between urban places.
Geographical variations in cancer mortality and social inequalities in southern Spain (Andalusia). 2002-2013
(Public Library of Science, 2022-05-20) Santos Sánchez, Vanessa; Córdoba Doña, Juan Antonio; Viciana Fernández, Francisco José; Escolar Pujolar, Antonio; Pozzi, Lucia; Ramis, Rebeca; Medicina Preventiva y Salud Pública; LONGPOP; European Union (UE)
Introduction: Geographical variations in cancer mortality can be explained, in part, by their association with social inequalities. The objective of our study was to analyse the spatial pattern of mortality in relation to the most common causes of cancer in the Spanish autonomous community of Andalusia and its possible association with social inequalities. Materials and methods: A small area cross-sectional study in Andalusia, with census tracts as units of spatial analysis, for the period 2002–2013. Cases and person-years, sex and age group came from the Longitudinal Population Database of Andalusia. Standardized mortality rates and smoothed risk ratios were calculated using the Besag, York and Mollié model for lung, colorectal, breast, prostate, bladder and stomach cancer. In order to evaluate the association with social inequalities we included the deprivation index of the census tract as a covariate. Results: The results show an East-West mortality pattern with higher risk in the west for lung and bladder cancer among men, and breast cancer among women. For all of Andalusia, the association between deprivation index of the census tract and mortality relative risks is positive and significant for lung, stomach and bladder cancers in men, while in women we observed a negative association for lung cancer and a positive for stomach cancer. Conclusions: Knowledge regarding the spatial distribution of cancer mortality and the socioeconomic inequalities related should contribute to the design of specific health and social policies–aimed at tackling cancer mortality and social inequalities in areas of high mortality and/or levels of deprivation.
Comparative clinical outcomes of acenocoumarol versus direct oral anticoagulants (DOACs) and warfarin in patients with atrial fibrillation: real-world-evidence (SIESTA-A study)
(Frontiers Media, 2025-08-01) Montero Balosa, María del Carmen; Limón Mora, Juan A.; Leal Atienza, Ana; García Robredo, Beatriz; Sánchez Villegas, Pablo; Isabel Gómez, Rebeca; Aguado Romeo, María José; Luque Romero, Luis Gabriel; Molina López, María Teresa; Medicina Preventiva y Salud Pública; Fundación Pública Andaluza para la Investigación en Salud Gestión en Sevilla (FISEVI); Junta de Andalucía; Instituto de Salud Carlos III; Gobierno de España; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER)
Objective: The aim of this study was to evaluate the effectiveness and safety of direct oral anticoagulants (DOACs: dabigatran, rivaroxaban, apixaban and edoxaban) and warfarin versus acenocoumarol in patients with atrial fibrillation under real-world clinical practice conditions. Methods: This was a retrospective, real-world data-based study. The data source was the Andalusian Population Health Database. The study covered the period from January 2012 to December 2020. Effectiveness outcomes were defined as the identification of a first occurrence of ischaemic or bleeding events, or all-cause mortality. The statistical analysis included crude incidence analysis, survival models: Kaplan-Meier curves, propensity score matched pairs analysis, Fine-Gray model, and Cox regression analysis adjusted for possible confounding. Results: A total of 150,949 patients were included. The mean age of the cohort was 74 years (48.2% female). The mean follow-up time was 3.3 years. The combined effectiveness endpoint of ischaemic events (transient ischaemic attack, systemic embolism, pulmonary embolism, or ischaemic stroke) showed the following results compared to acenocoumarol: warfarin (RR:1.06; 95%CI 0.93–1.22); dabigatran (RR:1.17; 95%CI 1.02–1.33); rivaroxaban (RR:1.15; 95%CI 1.05–1.26); apixaban (RR: 0.96; 95%CI 0.87–1.07) and edoxaban (RR: 1.10; 95%CI 0.79–1.51). Compared to acenocoumarol, the risk of all-cause mortality was lower for dabigatran, rivaroxaban and apixaban (RR:0.77; 95%CI 0.72–0.82; RR:0.79; 95%CI 0.76–0.83; RR:0.85; 95%CI 0.81–0.89, respectively) and higher for warfarin (RR:1.12; 95%CI 1.05–1.20). An increased risk of gastrointestinal bleeding was observed with dabigatran (RR:1.36; 95%CI 1.09–1.70) and a lower risk with rivaroxaban (RR:0.84; 95%CI 0.72–0.98). All 4 DOACs showed a lower risk of intracranial bleeding compared to acenocoumarol. Warfarin carried a higher risk of both gastrointestinal bleeding (RR:1.64; 95%CI 1.31–2.06) and intracranial bleeding (RR:1.61; 95%CI 1.22–2.13) compared to acenocoumarol. An unadjusted analysis of matched groups in a multivariate Cox regression analysis yielded similar results for combined effectiveness and safety outcomes compared to acenocoumarol. Conclusion: Although DOACs were clearly associated with a lower risk of intracranial bleeding compared to acenocoumarol, our data did not reveal a significant reduction in thromboembolic events. Warfarin was found to be both less effective and less safe than acenocoumarol.
Efficacy of a Digital Educational Intervention for Patients With Type 2 Diabetes Mellitus: Multicenter, Randomized, Prospective, 6-Month Follow-Up Study
(JMIR Publications, 2025-05-23) Caballero Mateos, Irene; Morales Portillo, Cristóbal; Lainez López, María; Vilches Arenas, Ángel; Medicina Preventiva y Salud Pública; Fundación Pública Andaluza para la Investigación en Salud Gestión en Sevilla (FISEVI); CTS312: Análisis de la Demanda Sanitaria
Background:Adherence to therapies and metabolic control among patients with type 2 diabetes mellitus (T2DM) remain challenging. The use of new technologies, such as telemedicine, digitalized systems, and social networks, could improve self-management and disease control. Objective:We evaluated the efficacy of a digital educational intervention for patients with T2DM, expressed as changes in glycated hemoglobin (HbA1c) and body composition and evaluation of the response using validated questionnaires of satisfaction with health care professionals (Instrument for Evaluation of the Experience of Chronic Patients), Diabetes Knowledge Scale (ECODI), and adherence to treatment over 6 months of follow-up (Morisky, Green, Levine Medication Assessment Questionnaire). Methods:This multicenter, randomized, prospective study included adults with T2DM with poor metabolic control who started treatment with glucagon-like peptide-1 receptor agonists. Patients were randomized to digital intervention or usual care. The intervention group received education through social networks and digital tools in a structured program of healthy lifestyle changes. This was provided by a “Digital Coach” for weekly and on-demand advice and individualized support. Baseline and follow-up demographic, clinical parameter, adherence, and quality of life data were collected. Results:We included 85 patients (control: n=41; intervention: n=44). Both groups were matched regarding demographics, physical examination, insulin, and biochemical parameters. We observed a reduction in body weight (intervention: –8.7, SD 6.1 kg vs control: –4.9, SD 5.0 kg; t83=–3.13; P=.002), BMI (intervention: –3.0, SD 2.1 kg/m2 vs control: –1.8, SD 1.8 kg/m2; t83=–2.82; P=.006), and fast mass in both groups but greater in the intervention group. There were greater reductions in fasting plasma glucose (intervention: 122.6, SD 81.5 mg/dL vs control: 70.5, SD 72.9 mg/dL; t83=3.10; P=.004) and HbA1c (intervention: 3.7%, SD 1.9% vs control: 2.6%, SD 2.1%; t83=2.54; P=.006) in the intervention group. Although there was no significant change in the Spanish version of the Diabetes Quality of Life Questionnaire (EsDQOL) satisfaction score in the control group after 6 months of follow-up (0.7, SD 19.8), there was a marked reduction in EsDQOL satisfaction score in the intervention group (–13.7, SD 23.1; t83=–3.08; P=.02). According to the ECODI scale, knowledge about diabetes increased more in the intervention group (intervention: 0.3, SD 1.8 vs control: 1.5, SD 1.5; t83=–3.33; P=.001). Although the medication adherence score worsened in the control group after 6 months, it significantly improved with the intervention (control: –8% vs intervention: 13.8%; χ21=0.35; P=.01). Patients’ health care experiences improved with the intervention but not with the control. Conclusions:The digital educational intervention was effective at improving glycemic control, body composition, adherence, and patient satisfaction compared with usual care in patients with T2DM. The implementation of digital tools and social media could highly improve the multidisciplinary approach to the management of this population.
Las mujeres inmigrantes en Sevilla
(Centro de Investigaciones Sociológicas, 2024) Río Benito, María J.; García Gil, Carmen; Solano Parés, Ana; Medicina Preventiva y Salud Pública; SEJ066: Mujeres, Bienestar y Ciudadanía
La mayor parte de las mujeres inmigrantes que viven en Sevilla trabajan en el servicio doméstico. Sus quejas en los servicios de urgencias y de atención primaria, según la impresión de los profesionales sanitarios, van más allá de los síndromes y encierran toda su historia. La atención directa a estas mujeres en los servicios sociales y sanitarios, así como la gestión a medio-largo plazo de los servicios para el futuro, necesitan de una mirada integradora que contemple los movimientos migratorios, las nuevas relaciones laborales en la era de la globalización, las relaciones salud-género y la cultura, que lo atraviesa todo. Una mirada del profesional que intente comprender con la finalidad de reducir las desigualdades en salud evitables.
Comparison of two methods to estimate adverse events in the IBEAS Study (Ibero-American study of adverse events): cross-sectional versus retrospective cohort design
(BMJ Publishing Group, 2017) Aranaz Andrés, Jesús María; Limón Ramírez, Ramón; Aibar Remón, Carlos; Gea Velázquez de Castro, María Teresa; Bolúmar, Francisco; Hernández Aguado, Ildefonso; IBEAS Teamwork; Valencia Martín, José Lorenzo; Medicina Preventiva y Salud Pública; World Health Organization
Background: Adverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs. Objectives: The aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design. Setting: Secondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru. Participants: The IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population. Methods: This study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study. Results: The prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk. Conclusion The retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.
Efficacy of CDK4 inhibition against sarcomas depends on their levels of CDK4 and p16ink4 mRNA
(Impact Journals, 2015-10-20) Pérez, Marco; Muñoz Galván, Sandra; Jiménez García, Manuel Pedro; Marín López, Juan José; Carnero Moya, Amancio; Medicina Preventiva y Salud Pública; Junta de Andalucía; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Fundació Josep Botet; Instituto de Salud Carlos III; Gobierno de España
Sarcomas are malignant tumors accounting for a high percentage of cancer morbidity and mortality in children and young adults. Surgery and radiation therapy are the accepted treatments for most sarcomas; however, patients with metastatic disease are treated with systemic chemotherapy. Many tumors display marginal levels of chemoresponsiveness and new treatment approaches are needed. Deregulation of the G1 checkpoint is crucial for various oncogenic transformation processes, suggesting that many cancer cell types depend on CDK4/6 activity. Thus, CDK4/6 activity appears to represent a promising therapeutic target for cancer treatment. In the present work, we explore the efficacy of CDK4 inhibition using palbociclib (PD0332991), a highly selective inhibitor of CDK4/6, in a panel of sarcoma cell lines and sarcoma tumor xenografts (PDXs). Palbociclib induces senescence in these cell lines and the responsiveness of these cell lines correlated with their levels of CDK4 mRNA. Palbociclib is also active in vivo against sarcomas displaying high levels of CDK4 but not against sarcomas displaying low levels of CDK4 and high levels of p16ink4a. The analysis of tumors growing after palbociclib showed a clear decrease in the CDK4 levels, indicating that clonal selection occurred in these treated tumors. In summary, our data support the efficacy of CDK4 inhibitors against sarcomas displaying increased CDK4 levels, particularly fibrosarcomas and MPNST. Our results also suggest that high levels of p16ink4a may indicate poor efficacy of CDK4 inhibitors.
High casein kinase 1 epsilon levels are correlated with better prognosis in subsets of patients with breast cancer
(Impact Journals, 2015-07-13) López Guerra, José Luis; Verdugo Sivianes, Eva María; Otero Albiol, Daniel; Vieites Pérez-Quintela, Begoña; Ortiz Gordillo, María José; León Carrillo, José Manuel de; Praena Fernández, Juan Manuel; Marín López, Juan José; Carnero Moya, Amancio; Medicina Preventiva y Salud Pública; Junta de Andalucía; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Instituto de Salud Carlos III; Gobierno de España
Reliable biological markers that predict breast cancer (BC) outcomes after multidisciplinary therapy have not been fully elucidated. We investigated the association between casein kinase 1 epsilon (CK1ε) and the risk of recurrence in patients with BC. Using 168 available tumor samples from patients with BC treated with surgery +/- chemo(radio)therapy, we scored the CK1ε expression as high (≥1.5) or low (<1.5) using an immunohistochemical method. Kaplan-Meier analysis was performed to assess the risk of relapse, and Cox proportional hazards analyses were utilized to evaluate the effect of CK1ε expression on this risk. The median age at diagnosis was 60 years (range 35-96). A total of 58% of the patients underwent breast conservation surgery, while 42% underwent mastectomy. Adjuvant chemotherapy and radiation therapy were administered in 101 (60%) and 137 cases (82%), respectively. Relapse was observed in 24 patients (14%). Multivariate analysis found high expression of CK1ε to be associated with a statistically significant higher disease-free survival (DFS) in BC patients with wild-type p53 (Hazard ratio [HR] = 0.33; 95% CI, 0.12-0.91; P = 0.018) or poor histological differentiation ([HR] = 0.34; 95% CI, 0.12-0.94; P = 0.039) or in those without adjuvant chemotherapy ([HR] = 0.11; 95% CI, 0.01-0.97; P = 0.006). Our data indicate that CK1ε expression is associated with DFS in BC patients with wild-type p53 or poor histological differentiation or in those without adjuvant chemotherapy and thus may serve as a predictor of recurrence in these subsets of patients.
Casos autodeclarados de síndrome gripal en trabajadores sanitarios españoles durante la pandemia de gripe A (H1N1) 2009
(Elsevier, 2012-03-29) Olalla, Julián; Ory, Fernando de; Casas, Inmaculada; García Alegría, Javier; Rivas Ruiz, Francisco; Grupo de Trabajo para el Estudio MARBEGRIP; Román Casares, Encarnación; Briones Pérez de la Blanca, Eduardo; Medicina Preventiva y Salud Pública; Instituto de Salud Carlos III
Objetivos: Describir la prevalencia de síndrome gripal en el invierno de 2009 y los factores asociados a su ocurrencia. Método: Estudio transversal en 18 hospitales españoles. Los voluntarios respondieron un cuestionario de salud, informando sobre si habían sufrido síndrome gripal y su estado vacunal. Resultados: Participaron 1289 trabajadores sanitarios, y de ellos, 72 (5,6%) refirieron gripe en su familia, 195 (15,1%) se vacunaron frente al virus A/California/7/2009/H1N1 y 75 (5,8%, intervalo de confianza del 95% [IC95%]: 4,5-7,1) sufrieron síndrome gripal. Hubo diferencias entre comunidades autónomas. En el análisis de regresión logística, se asoció a síndrome gripal trabajar en la Comunidad de Madrid (odds ratio [OR] = 8,31, IC95%: 1.05-65.39), tener casos de gripe en la familia (OR = 2,84, IC95%: 1,41-5,73) y no estar vacunado frente a la gripe A (OR = 2,68, IC95%: 1,05-6,82). Conclusiones: La presencia de casos en la familia y la comunidad donde se trabaja determinaron una diferente prevalencia de síndrome gripal. La vacuna se asoció a una menor prevalencia de la enfermedad.
Desarrollo y validación de un modelo predictivo para la identificación de pacientes infectados por el VIH con problemas relacionados con los medicamentos. Estudio predictor
(Sociedad Española de Farmacia Hospitalaria, 2012-08-09) Morillo Verdugo, Ramón Alejandro; Martín Conde, María Teresa; Valverde Merino, M.P.; Illaro Uranga, Aitziber; Ventura Cerdá, J.M.; Serrano López de las Hazas, Joaquín Ignacio; Plata Paniagua, S.; Ibarra Barrueta, Olatz; Moriel Sánchez, C.; Ortega Valín, L.; Fernández Palacín, Ana; Almeida González, Carmen V.; Medicina Preventiva y Salud Pública; Farmacología; CTS312: Análisis de la Demanda Sanitaria
Objetivo: Desarrollar y validar un modelo predictivo para la detección de problemas relacionados con los medicamentos (PRM) en pacientes con tratamiento antirretroviral (TAR), durante su seguimiento periódico en consultas de atención farmacéutica (AF) y previamente a la dispensación. Método: Estudio multicéntrico, abierto, prospectivo. Se incluyeron pacientes infectados por el VIH con y sin PRM. Para el diseño del modelo se incluyeron variables demográficas, clínicas y farmacoterapéuticas (relacionadas o no con el TAR). Para encontrar factores pronósticos de PRM, se realizó un modelo de regresión logística binaria tras un análisis univariante, el cual identificó variables independientes relacionadas con PRM que fueron introducidas en el modelo multivariante para la selección final. La validez del modelo se determinó por el método Shrinkage y la capacidad discriminatoria por el estadístico C-Harrell. Resultados: Se incluyeron 733 pacientes. Las variables «adherencia», «prescripción de fármacos con necesidad de ajuste posológico» y «número de medicamentos totales prescritos (al margen del TAR)» se relacionaban de manera independiente con la aparición de PRM. Las probabilidades predichas por el modelo, personalizando los coeficientes por el método shrinkage uniforme mostraron un valor R2 = 0,962 para la muestra de construcción y R2 = 0,872 para la de validación. La capacidad discriminatoria del modelo fue de 0,816 para la muestra de construcción y 0,779 para la de validación. Conclusiones: El modelo predictivo desarrollado y validado permite la detección de pacientes con tratamiento antirretroviral y con mayor riesgo de sufrir un PRM. Las variables predictoras utilizadas se corresponden con las manejadas habitualmente en la historia farmacoterapéutica del paciente, permitiendo su empleo sistemático en la práctica asistencial.
Editorial: Participación de la enfermería en la evaluación de tecnologías sanitarias: ¿una asignatura pendiente?
(2024-11-04) Lacalle Remigio, Juan Ramón; Benot López Soledad; Medicina Preventiva y Salud Pública
La imagen popular de la enfermera que cuida a sus pacientes incluye la jeringuilla y el termómetro. A estos dos instrumentos se le han unido recientemente otros instrumentos electrónicos y recursos digitales. Para muchas personas, estos son ejemplos de tecnologías sanitarias (TS). Pero en realidad, este término tiene un significado mucho más amplio. Abarca no sólo a los dispositivos médicos, sino que también a los medicamentos, los procedimientos médicos y quirúrgicos, los de prevención, diagnóstico y tratamiento de problemas de salud, así como las fórmulas de organización y gestión sanitaria. (extracto)
Root Cause? Yes of course … but then what? [Carta al director]
(2019) Mira Solves, José Joaquín; Carrillo, Irene; Guilabert, Mercedes; Valencia Martín, José Lorenzo; Aranaz Andrés, Jesús María; Martín, Jimmy; Medicina Preventiva y Salud Pública
Analyzing the causes of unsafe care can reduce the number of ‘near misses’ (incidents that may cause harm to patients) and adverse events (that actually produce harm). This is an important mandate for health care organizations committed to providing a safe environment for patients. Although guaranteeing absolute safety in all interventions is not always possible, hospitals and other health care institutions implement safety practices and surveillance methods to understand how these unsafe incidents occur. In many cases, these incidents were not generated by a single cause; and remote causes are as significant as more proximate ones… (excerpt)
Multicompartmental prolapse: a comparative study between clinical examination and ultrasound
(Elsevier ireland LTD; Wiley, 2026-02-21) García Mejido, José Antonio; Salas‐Álvarez, Olaya; Bugatto‐Gonzalez, Fernando; Fernández Palacín, Ana; Fernández Palacín, Fernando; Sáinz Bueno, José Antonio; Cirugía; Medicina Preventiva y Salud Pública; CTS312: Análisis de la Demanda Sanitaria
Objective The accurate diagnosis of multicompartment pelvic organ prolapse (POP) is fundamental to surgical success. This study aims to compare the diagnostic performance of transperineal ultrasound against clinical examination (pelvic organ prolapse quantification, POP-Q) for the detection of compartmental defects in patients with multicompartment POP, using assessment under spinal anesthesia as the reference standard. Method A prospective randomized diagnostic accuracy study was designed, including 129 patients scheduled for multicompartment POP surgery. Patients were randomly assigned to undergo either a preoperative POP-Q two-dimensional transperineal ultrasound assessment. The reference standard for all patients was the intraoperative POP-Q assessment, conducted under spinal anesthesia immediately before surgery. Sensitivity, specificity, and likelihood ratios (LR) were calculated for each method and compartment. Results Both techniques demonstrated high sensitivity for the diagnosis of cystocele (100% vs 98.3%). However, their performance varied across the other compartments. Ultrasound showed superior specificity for uterine prolapse (73.4% vs 45.4%) and rectocele (86.3% vs 66.0%) and was particularly robust in confirming enterocele (LR+ of 10.5). In turn, clinical examination had a higher sensitivity for detecting rectocele (61.5% vs 21.4%) and was highly reliable for ruling out cystocele and uterine prolapse (LR− of 0). Conclusion Clinical examination and ultrasound are complementary in the diagnosis of prolapse. Their combined use is key to accurate surgical planning.
Biomonitoring of DAPs levels in urine and amniotic fluid of pregnant women in Seville (Spain): evaluation of prenatal exposure
(Elsevier, 2025-12-19) Sánchez Ruiz, Rocío; Hinojosa Hidalgo, María Gracia; Aranda Merino, Noemí; Fernández Torres, Rut; Cerrillos, Lucas; Ostos, Rosa; Fernández Palacín, Ana; Moreno Navarro, Isabel María; Nutrición y Bromatología, Toxicología y Medicina Legal; Química Analítica; Medicina Preventiva y Salud Pública; Ministerio de Ciencia, Innovación y Universidades (MICIU). España; European Union (UE); Junta de Andalucía
Among all population groups, pregnant women are one of the most vulnerable due to increasing concern about prenatal exposure to environmental pollutants, including pesticides such as organophosphates (OPs). In this regard, dialkyl phosphates (DAPs) are nonspecific metabolites excreted in urine and widely used to assess OP exposure. Thus, this study aimed to assess the risk of indirect OP exposure by determining six DAPs (dimethyl phosphate (DMP), O,O-dimethyl thiophosphate (DMTP), O,O-dimethyl dithiophosphate (DMDTP), diethyl phosphate (DEP), O,O-diethyl thiophosphate (DETP), and O,O-diethyl dithiophosphate (DEDTP)) in urine and amniotic fluid (AF) from a 74-pregnant-women cohort in Seville (Southern Spain). Sample preparation was based on electromembrane extraction (EME), a microextraction technique using an electric potential to selectively extract analytes across a supported liquid membrane (SLM). The analysis was performed using ion-pair ultrahigh-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS). Results showed that DAPs can cross the placental barrier, as most AF samples showed between 80 and 99 % positive levels, depending on the compound, however, the studies in this regard are very scarce. Nonetheless, these levels were slight, and both mean and maximum concentrations detected in AF were lower than urine levels in every case. Moreover, the percentage of positive samples in urine was lower (44–92 %). Thus, this research highlights the importance of studying the presence of these metabolites, both in urine and in AF, and the physiological outcomes that their presence may cause both in the mothers and infants.

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